Friday, October 28, 2011
Monday, October 24, 2011
Rhinos!
I went to a rhino sanctuary this weekend for a short getaway with a big group from Kampala. We drove up Saturday morning, had a wonderful lunch prepared by a few members of our group of 14, and then went for a rhino trek. The sanctuary has 10 very well-guarded rhinos -- they need to be tracked and guarded because rhino horns sell for $50-100,000! It was neat to see the rhinos on this huge sanctuary - two of them had actually been born at Animal Kingdom in Disney World, but were brought to Uganda to breed and re-introduce rhinos into the country after poaching killed them off by the 80s. One of the rhinos is named Obama because his mom was born at Animal Kingdom in the US and his dad was born in Kenya.
We had a lovely barbecue and campfire (plus spectacular stargazing) Saturday night, and then we went for a really cool bird watching canoe trip and hike through a swamp early Sunday morning. I have to get photos of the hike from someone else because I forgot to charge my camera, but here are some rhino pictures and the beautiful Sunday sunrise.
Friday, October 21, 2011
Life here.
A fake interview with me (questions inspired by real questions I've been asked):
Q: WOW what's it like driving on the wrong side of the road?
A: Easy! The hard part is dealing with some crazy drivers and loads of motorcycles. Thankfully cars move very slowly (I don't think I've driven >40mph here and usually slower), so you have more time to react.
Q: You're near the equator, so is it like 100 degrees all the time?
A: No! The weather is awesome! It's roughly 65-85 degrees year round, with rain being the only variable. We are in the rainy season now, but the rain is usually only for an hour a day or less. We have almost all of our internal meetings outdoors, eat outside all the time, and every time I walk outside at night, I feel like I'm on vacation. It is definitely weird not feeling a change in seasons - it's hard to get the sense of time passing (and I miss fall colors and Michigan apples), but it's pretty great to be able to be outdoors year round and never have to bundle up.
Q: Any weird surprises?
A: Hm - I guess that my Chinese has come in way more handy than expected. There are several good Chinese restaurants, and it's always best to order in Chinese, and casinos here tend to be filled with Chinese businessmen. I don't like to gamble, so when I've been to the casino with friends, my entertainment is finding a Chinese person to make friends with. I usually get some funny stares, but I've gotten to learn a bit about Chinese companies operating in Uganda and life here for people who don't speak English. I may never use it for work again, but I guess Chinese is a fun language to be able to speak.
Q: Do you lose power a lot?
A: Yes. Computing by candlelight as we speak. It's frustrating and tough to get work done sometimes, but with a combination of generators, candles, and long battery life computers, we cope pretty well, though it's clearly a really bad thing for the country and has gotten way worse even since I moved here. On the plus side, I never fully appreciated how awesome candles were until now.
Q: WOW what's it like driving on the wrong side of the road?
A: Easy! The hard part is dealing with some crazy drivers and loads of motorcycles. Thankfully cars move very slowly (I don't think I've driven >40mph here and usually slower), so you have more time to react.
Q: You're near the equator, so is it like 100 degrees all the time?
A: No! The weather is awesome! It's roughly 65-85 degrees year round, with rain being the only variable. We are in the rainy season now, but the rain is usually only for an hour a day or less. We have almost all of our internal meetings outdoors, eat outside all the time, and every time I walk outside at night, I feel like I'm on vacation. It is definitely weird not feeling a change in seasons - it's hard to get the sense of time passing (and I miss fall colors and Michigan apples), but it's pretty great to be able to be outdoors year round and never have to bundle up.
Q: Any weird surprises?
 |
| Hotpot night at a Chinese restaurant |
Q: Do you lose power a lot?
A: Yes. Computing by candlelight as we speak. It's frustrating and tough to get work done sometimes, but with a combination of generators, candles, and long battery life computers, we cope pretty well, though it's clearly a really bad thing for the country and has gotten way worse even since I moved here. On the plus side, I never fully appreciated how awesome candles were until now.
Work work work
Work has been a bit hectic lately (part of the reason for my terrible blogging), but it is hectic in a really good way. One of the big projects I have been working on is really getting off the ground and another one is finally wrapping up. I wrote a while back about our research on HIV care before patients begin antiretroviral therapy and how big an issue (54% of patients are lost!) patient retention is. Along with Isaac and Evan, I've been working on developing an intervention to pilot to try to improve retention and quality of care. We've been visiting health centers, meeting with people in all areas of HIV care, digging for research, and communicating with other CHAI offices to figure out what makes the most sense.
After multiple iterations, the intervention we are going to pilot (in 7 sites - site visits next week!) is one that combines improving data management with introducing reminders and follow-ups. We, along with a team from one of the PEPFAR implementing partners, are going to be working with sites to re-organize patient files and improve systems to make sure that files are not lost and that they are complete -- this is a big issue in treating HIV as a chronic disease because doctors need to know a patient's medical history in order to know how to treat them, and we frequently see patient records piled haphazardly in facilities. The hope is that doing this will cut down the time staff spend digging for records, ensure that test results reach patients, and reduce the huge information loss that happens when patient files go missing. The second piece is introducing text message reminders to remind patients when to come back to the clinic and implementing a system of phone call follow-ups for when patients miss their appointments. Mobile phones are amazingly widespread (74% of patients had them in a recent CHAI study), and from the existing published research and work CHAI has done elsewhere, it seems like this is a way we can really improve attendance and retention. In a recent CHAI pilot, patients were more than 50% more likely to come back when followed up by phone than otherwise.
There's a bit more to it than that, but those are the basics, and I'm really excited about it! The pilot should give us some very interesting information, and the Ministry of Health is interesting in rolling this system out more broadly in the country if the pilot goes well. It's a very cool feeling to be working on something that I was a big part of developing and really believe can be effective. Funding issues, getting sites to actually implement changes, and politics will all be uphill battles, but I think/hope that this can help bring patients back to get the care they so desperately need.
(and let me know if you know of any relevant studies/research - have found a lot of great evidence on the usefulness of each of these elements, but always looking for more).
After multiple iterations, the intervention we are going to pilot (in 7 sites - site visits next week!) is one that combines improving data management with introducing reminders and follow-ups. We, along with a team from one of the PEPFAR implementing partners, are going to be working with sites to re-organize patient files and improve systems to make sure that files are not lost and that they are complete -- this is a big issue in treating HIV as a chronic disease because doctors need to know a patient's medical history in order to know how to treat them, and we frequently see patient records piled haphazardly in facilities. The hope is that doing this will cut down the time staff spend digging for records, ensure that test results reach patients, and reduce the huge information loss that happens when patient files go missing. The second piece is introducing text message reminders to remind patients when to come back to the clinic and implementing a system of phone call follow-ups for when patients miss their appointments. Mobile phones are amazingly widespread (74% of patients had them in a recent CHAI study), and from the existing published research and work CHAI has done elsewhere, it seems like this is a way we can really improve attendance and retention. In a recent CHAI pilot, patients were more than 50% more likely to come back when followed up by phone than otherwise.
There's a bit more to it than that, but those are the basics, and I'm really excited about it! The pilot should give us some very interesting information, and the Ministry of Health is interesting in rolling this system out more broadly in the country if the pilot goes well. It's a very cool feeling to be working on something that I was a big part of developing and really believe can be effective. Funding issues, getting sites to actually implement changes, and politics will all be uphill battles, but I think/hope that this can help bring patients back to get the care they so desperately need.
(and let me know if you know of any relevant studies/research - have found a lot of great evidence on the usefulness of each of these elements, but always looking for more).
Thursday, October 20, 2011
Ssese Islands
Last weekend, we went on a fellowship retreat on the Ssese Islands (in Lake Victoria) for all the Global Health Corps fellows based in Uganda. It was a lot of fun and nice to have time to discuss what we have done so far and what our goals are for the rest of the year. The islands are quiet, but really, really beautiful. We had a bonfire, ate good food, went swimming at night, and just enjoyed each other's company.
The only bad part of the weekend was when I woke up on Saturday morning to discover that I had slept next to the below pile of mouse (we think) poop - SO GROSS! It seems to have been hidden under the blanket and the bed hadn't been made for a long time. Pretty horrifying. The next night, my friend volunteered to sleep in the affected bed (the sheets had been changed), and I was very, very grateful.
Monkey friend!
Isaac and crew running out of the rain
View from where we were staying up on a hill
The Uganda crew
Monday, October 3, 2011
Good (and by good I mean horrifying) article on Uganda's health sector
It's pretty astonishing seeing the state of affairs quantified as it is in this article. We see every day how inefficient it is to have different NGOs and aid organizations working on different priorities and also doing overlapping work, but one can't really say the solution is to do everything through the Ministry of Health as there are so many issues there as well.
Sunday, October 2, 2011
Prevention of Mother to Child Transmission
I've been doing a lot of work lately on prevention of mother-to-child transmission of HIV/AIDS. About 20,000 children are infected each year in Uganda during pregnancy, childbirth, or breastfeeding - about 10% of the children of HIV+ mothers. If the right drugs are taken at each stage (anti-retrovirals are used in prevention here) and protocols are followed (exclusive breastfeeding for the first 6 months is recommended in Uganda because very few women can access formula and clean water and not be stigmatized when using infant formula), this percentage can go down to 1-5%.
Uganda recently switched to a more effective method of PMTCT and trained over 600 health facilities in this new method. However, a large number (>1/3) of those sites are not ordering the drugs they need for PMTCT, so they still are not able to promote effective prevention. I've been working on figuring out which sites are not ordering, which sites are ordering wrong, and how many mothers the sites treat in order to do a one time drug "push" to ensure that all sites are stocked with these drugs and begin ordering drugs themselves.
It's been interesting (if frustrating) and honestly a bit scary -- if I make a mistake in sending drugs to facilities, there could be infants infected with HIV who would not otherwise have been infected because they could have accessed the right drugs. If we don't do it at all, most likely a large number more infants would be infected, and 50% of infected infants die before age 2. Prevention obviously has many parts of which I am one very very tiny one, but it's strange and exciting to do work about whose outcome I care so much.
The maternity ward at a health facility an hour and a half from Kampala
Uganda recently switched to a more effective method of PMTCT and trained over 600 health facilities in this new method. However, a large number (>1/3) of those sites are not ordering the drugs they need for PMTCT, so they still are not able to promote effective prevention. I've been working on figuring out which sites are not ordering, which sites are ordering wrong, and how many mothers the sites treat in order to do a one time drug "push" to ensure that all sites are stocked with these drugs and begin ordering drugs themselves.
It's been interesting (if frustrating) and honestly a bit scary -- if I make a mistake in sending drugs to facilities, there could be infants infected with HIV who would not otherwise have been infected because they could have accessed the right drugs. If we don't do it at all, most likely a large number more infants would be infected, and 50% of infected infants die before age 2. Prevention obviously has many parts of which I am one very very tiny one, but it's strange and exciting to do work about whose outcome I care so much.
The maternity ward at a health facility an hour and a half from Kampala
New car, new house, fresh eggs
It has been a couple of crazy weeks in Kampala with a move last weekend, a new (well, to me that is) car purchase, and lots of interesting work. I no longer live off Semawata Road (reasons for the move - better price, better location, nicer house), but Lower Kololo Terrace isn't a nice blog name, so I think I'll stick with this one. Some highlights from the past couple weeks:
I hosted a dinner party for about 20 people in the new place last night which was quite an adventure. At 6:30pm everything was running very smoothly and the food was on track to be ready at 7:30/8.... then the power went out.... then 5 minutes later, the stove ran out of gas. After considering serving people bread and raw vegetables and sending my roommate around town looking for a gas refill (apparently there is a shortage and there won't be any gas until next week), the power came on at 7:40 and a friend brought over their gas tank. By 9:15, we had a meal on the table, and thankfully friends had brought plenty of side dishes to tide people over. Despite the chaos, it was a lot of fun and something I was never quite able to do in my tiny New York apartment.
One of my co-workers introduced me to the "Muzungu Market" (muzungu is the word for white people/Europeans that originally meant wanderers) - basically a farmers market with wonderful food of types that are generally difficult to find in Kampala. Top finds: great bread, amazing eggs with yellow yolks (most yolks here are white and the eggs are flavorless), doughnuts, sun dried tomatoes, basil, goat cheese feta, and much more. They have a little cafe that serves the best breakfast in Kampala, pictured below.
Finally, a few pictures of the new place (bedroom pre-bed net) - it's a neat older house (well, large apartment as it's part of a 6-apartment compound) with a lot more character than my last place and a beautiful big yard.
I hosted a dinner party for about 20 people in the new place last night which was quite an adventure. At 6:30pm everything was running very smoothly and the food was on track to be ready at 7:30/8.... then the power went out.... then 5 minutes later, the stove ran out of gas. After considering serving people bread and raw vegetables and sending my roommate around town looking for a gas refill (apparently there is a shortage and there won't be any gas until next week), the power came on at 7:40 and a friend brought over their gas tank. By 9:15, we had a meal on the table, and thankfully friends had brought plenty of side dishes to tide people over. Despite the chaos, it was a lot of fun and something I was never quite able to do in my tiny New York apartment.
After a couple months of getting frustrated trying to get around Kampala without riding boda bodas (motorcycle taxis that are very cheap and convenient but very dangerous) or driving, I decided it made sense to get a car as used cars maintain re-sale value quite well here and CHAI will cover a good portion of gas money. The expat car of choice seems to be the Rav4 because they are small and fairly cheap, but still have high clearance for Kampala's monster speed bumps and potholes. With the of CHAI's wonderful driver Paul, I found a blue one that even in just the past 4 days has been great to have.
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