20 Ugandans, 21 including you

At the conference I was at in Cape Town, I was chatting with the lab coordinator from one of the USAID implementing partners I have worked with a bunch this past year.  I said "there are so many people from Uganda at this conference" and he responded "yes, so far I have counted 20 Ugandans, now 21 including you."  It made me smile in a moment when I was feeling homesick for my "real" home.  8 days until Christmas trip!

I had to head to the embassy in Kampala recently to get a second set of extra pages added to my passport after trips (since August) to Kenya (2x), Ethiopia (2x), Mozambique (2x), South Africa (2x), Swaziland, Tanzania, Rwanda and Zimbabwe.  Reading that list makes me feel tired, but the travel itself was actually generally great and pretty energizing.  Coping methods for excessive travel: 1) write in beautiful journal given to me as going-away present by my Credit Suisse co-workers during airplane take-off and landing when I'm not allowed to read my Kindle or work on my laptop 2) carry Kindle everywhere, download New Yorker Kindle edition every Monday and lots of good books 3) take advantage of quality time with friends when I get it 4) meditate! I started meditating and try to do it 5 times a week - so far so good.  5) practice gratitude for this wealth of experiences and the opportunity to do work I care deeply about.

A very few photos from various adventures (there would be more except that I stupidly took my blackberry on a 3.5 hour hike with my friend Leah in a banana farm/forest by Lake Kivu in Rwanda during which we got caught in three torrential downpours... attempts at recovery of said device and photos contained within are ongoing):

From a trip to a teeny island in the middle of the Nile with my roommates Lorne and Lindsay (below) and a couple friends

 Nile

 In Beira, Mozambique (where I hung out with Abel)

Crazy urban decay in Beira - it's a fascinating post-colonial town with wide avenues, beautiful beaches, and tons of once gorgeous buildings.  I'm told it has experienced a bit of revival of late with Chinese investment in the port for exporting goods mined inland.

 Soccer game in Beira

The pretty marvelous coffee shop that opened down the street from my house in Kampala.  The manager there once described it as me and my roommates' "home" which I'm just going to take as a good thing

A bit worse for the wear after the infamous hike in Rwanda (Leah's camera).  Leah is working for an organization called the One Acre Fund that provides fertilizer and training to farmers on a loan plan - if you have read Poor Economics, you will know why I think it's a super cool organization

Re-uniting with Global Health Corps friends Morris, Emma, Ashley and Leah in Kigali, Rwanda

 With dear Abel.  Before I left Beira, he asked me about 6 times for a copy of this photo.

Habituation

I've been in Cape Town for a week and a half now, and I've already started to take some things for granted (cheese! grapes! shrimp! craft beer! have all been reduced from 2 exclamation point items to 1 exclamation point items), but it's still too beautiful to fully take for granted.  It has been described as "the least African city in Africa" and in my limited experience, that is definitely accurate.
I've been at the first annual summit of the African Society for Laboratory Medicine which has been really fascinating because it brought together a lot of the people I've been working with in Uganda, Ethiopia, and Mozambique over the past year and allowed me to learn a lot more about labs than the beginnings I've gotten from learning on the job.  I'm generally anti-conference -- I think they can be a major waste of time and take people away from real work -- but I've had more productive meetings this week than I would have in a typical month, so that's been great.  We were at the conference center from 8am to 9pm most days this week, but I also got to see penguins AND a Lady Gaga concert in the past week, so I am feeling pretty lucky and grateful to be here both for work and for fun reasons.
More photos - and hopefully will take more this weekend before I head to Zambia on Sunday.
With my manager and the scientist on my team before the Lady Gaga concert - we have all looked better...

 Great hike overlooking the city

 Beach on the peninsula

Penguins and other nice things in Cape Town

Cape Town is just so beautiful that even my disastrous blogging habits cannot stop me from posting photos of it... more to come

Swaziland

I was working in Swaziland this past week, and now I'm in Mozambique again (and unfortunately still do not speak Portuguese).  I got to take a beautiful hike this morning - if you've ever wondered what Swaziland looks like.... 

Abel and adventures in faux-Portuguese

For the project I describe in the previous post, I was basically on my own in 2 health centers in Mozambique with only a 20-year-old data entry clerk helping me out.  He found the files, I entered them.  Thankfully, he was an ample source of entertainment, very patient, and diligent.  In my bad faux-Portuguese (mostly Spanish with a few newly-learned words peppered in) and his worse English, we managed to communicate well if hilariously.
Highlights of our conversations:

(In English)
Abel: I think you are not a discrimination
Me: Excuse me?
Abel: Uh.. you are not a racism.  You white, I black.  Uh.. I think you are a very person.  Good person.
Me: Not being racist seems like a low bar for being a good person, but thanks Abel.

(In faux-Portuguese)
Me: (As I turn on Vampire Weekend music at the end of the day) This is American music Abel, do you like it?
Abel: Uh I don't think that's American.  I know American music, like L'il Wayne, R. Kelly, Celine Dion.  Well no, actually, she's Canadian.  Do you have any Celine Dion music? 
The next day I heard a sound coming from the corner and quickly realized it was Abel singing along to Celine Dion playing on his phone. Thankfully, he also came around to some of my music taste.

(In faux Portuguese)
Me: So Abel, do you have a girlfriend? 
Abel: No.  I had a girlfriend.  Then I found her with another guy.  (Switches very emphatically to English) LOVE IS OVER. 

(In English, on Friday)
Abel: Ann Marie, have good fine of week.
Me: Abel, you say "Have a nice weekend."  Fine do semana (sp?) is weekend in English
(In English, on Monday)
Abel: You have a nice fine of week?
Me: Try that again 
Abel: You have nice week? 
Me: Abel, I know you can do it! 

Abel asked me if I could help him find a job in Uganda (that's a first...) - I told him I would love to, but that I think he needs to work on his English first.  I also hope to work on my Portuguese before coming back to Mozambique -- I can only imagine how funny my attempts at his language sounded to him.  

Mozambique

I'm about to wrap up a week and a half in Mozambique, and I have to say, I have never been more excited to go back to Kampala.  It's been a good adventure and definitely a good learning experience, but figuring out a new place (two new places, I was in Maputo and Beira, a port town in the middle of the country) by one's self in an unfamiliar language is a little tricky!  On the upside, Mozambique has an amazing coastline and spectacular seafood, so my senses have been kept happy.  Internet here is spectacularly bad, but I'll post photos as soon as I can.

I am in Mozambique to work on a research project.  In 2010, CHAI co-published an article in the Lancet about the impact that point-of-care testing could have on reducing patient loss.  The findings showed that allowing patients to get a CD4 test (which determines whether they can begin antiretroviral therapy basically by measuring the strength of their immune system) the same day as they test positive resulted in fewer patients getting lost before beginning ART.  

Now, we're trying to figure out if that impact is sustained by following the same two groups for 2 years from their enrollment in care.  To do that, I go through patient files and track whether the patients are attending, whether they initiate ART, and when they are getting CD4 tests.  The work can be a bit tedious (thankfully I don't have to do much of this type of work), but it was really interesting to see how health centers in Mozambique are different and similar to those in Uganda, and patient files themselves can be fascinating. 

Flipping through files, certain ones stand out and make you want to cry-- the 12 year old who can't seem to shake tuberculosis, the mother of 5 who died at 32 after being in care for 2 years, the 6 year old who died just two months after enrolling into care.  Some are unexpectedly entertaining - the woman who managed to put on 50 pounds going from 90 kilos to 110 kilos in the 2 years after she was diagnosed (it usually goes in the opposite direction!), or the man who shows up every 6 months or so just to get a CD4 test and make sure that he is actually miraculously staying as healthy as he feels.    

Belgian beer in Kenya and other delights

I've started my new job within CHAI on the global lab systems team, and my travel schedule has been as follows:
August 22 - Arrive back from the US at 7am, leave for Addis Ababa, Ethiopia at 5pm for meetings with Ethiopia team
August 23 - Return to Kampala
August 28 - Fly to Nairobi for meetings
August 29 - Return to Kampala
September 2 - Back to Nairobi, more meetings
September 5 - Return to Kampala
September 9 - Fly to Dar es Salaam, Tanzania for a conference
and to come
September 15- Fly to Mozambique to do operational research in health centers on point-of-care testing for CD4 in HIV patients
Return to Kampala sometime between September 21 and October 2....

So far I've made a lot of progress in filling up my passport and sampling East Africa's finest Asian food, and I have also been able to meet the CHAI teams around the region.  We're in the process of launching a 4 year project on the lab systems team, so there is a lot of "workplanning" to be done -- I'm working on a CHAI team that is administering a $95mn grant in 7 countries (Uganda, Tanzania, Kenya, Mozambique, Malawi, Zimbabwe, and Ethiopia) that is procuring point-of-care laboratory diagnostics for HIV with the aim of creating a healthy, competitive market in these diagnostics.

The work is building a lot on the work I did in rolling out point-of-care CD4 testing in Uganda last year with the Ministry of Health, but it's expanding on that work both geographically and in scope, as the project is looking at CD4 (test of immunological status needed to determine when patients can initiate anti-retroviral therapy), viral load (test primarily used to determine whether patients on treatment have become resistant to the drugs they are on) and Early Infant Diagnosis (test to determine whether infants are infected - the standard antibody tests don't work for babies because they carry their mothers' antibodies, so they have to be tested through a complicated DNA PCR test), and also dabbling in tuberculosis diagnostics.  The tests are important because they help patients access the right treatment faster.

I'm excited about the project, and the travel is fun and interesting for now at least!  Leaving Kampala means I get to eat better seafood (I'm staying in a hotel overlooking the Indian ocean), more variety of food, and both frozen yogurt and Belgian beer in Nairobi.... both of which made me way more excited than is reasonable.  

Said beer (which is not actually that amazing, but has about 10 times more flavor than anything normally sold in East Africa):

 Wonderful hotel in Nairobi:

Hopefully all this travel will give me some better photo-taking opportunities than I've had so far in hotels and meeting rooms! And hopefully I'll get to spend time in health centers in these places to get a sense of what the universals are and what the unique challenges of each country are.  One of the reasons I was excited to move to this team was to be able to get a broader perspective of global health challenges beyond just one country. 

Back in Uganda

I got back on Wednesday from an absolutely delightful trip to the US for Ramya's wedding and time with family and friends in San Francisco, Chicago and New York.  While I was there, I got a number of complaints about my abysmal blogging of late - I'm sorry!  I will go backwards with a small catch-up of photos... unfortunately my photo-taking has also been pretty bad lately.
1.  Ethiopia.  10 hours after I landed in Uganda, I took off for two days of work in Addis Ababa, Ethiopia.  It was really interesting to be there, and we had some great food, but I won't lie - I hope I don't have to spend a lot of time there.  It is very grey and rainy for about half the year, and didn't feel very welcoming culturally, though that could be a mistaken impression after a very short visit.
Photographic evidence that I was there and it was grey and there are a lot of very old cars there, though no good photos:

A friend from freshman year at Harvard, Troy, just got hired to join the team I just joined.  He was in Ethiopia with me, and it was great to re-connect

2) US of A!!
It was so great to be home, to get to go to my dear friend Ramya's (who I met the week before we started freshman year during a pre-orientation camping trip) wedding to wonderful Samir, and to just spend time with beloved people.  I really did not do well at photo taking, especially during the time with Brian and Lois, but here are a few pictures from a most excellent trip.
Giving a speech/poem with Emma and Camden at Ramya's wedding

 She was/is so beautiful!

 During the part of the ceremony involving fire....

 McDonald family by the lake in Chicago!

 Ugandan aprons with Ellen

 Reuniting with friends in New York

3.  End-of-Year Global Health Corps retreat in Jinja, Uganda
My Global Health Corps fellowship year has come to an end.  I feel really lucky to have been and to still be part of such a great community of young people working on social justice issues.  I've learned a lot from collaborating with people in so many different global health organizations - Partners in Health, Elizabeth Glaeser Pediatric AIDS Foundation, the U.S. State Department, community-based organizations, and so on.  The retreat was a fun, interesting, and reviving week with a great group.  I am really going to miss the fellows who are heading back to the US.

4) I turned 25!
I think it's going to be a good year.  My friend Julie, roommate Lorne, and I had a joint birthday party at the best Mexican restaurant in Kampala - I can say the best because there are two.

5) Isaac!

My Global Health Corps Ugandan co-fellow, Isaac, finally had me over to meet his family -- it was really fun to meet them after spending a year working together. I wish he was staying with CHAI

6) Rwanda - went to Lake Burera on the border of Uganda and Rwanda with friends - so beautiful

Catch-up

Here is a photo catch-up to attempt to make up for some very bad blogging over the past few months.

1) Trip to Tanzania.  I led a training of trainers in Arusha, Tanzania on Pima Point-of-Care systems.  In February. Yes, that is a long time ago.
They are using a slightly modified version of the systems training package that we developed in Uganda, and it was fun to see how the model would work in a different context.  I didn't get to climb Mt. Kilimanjaro or Mt. Meru, but I did get to see them!  Maybe one of these days.

2. GHC 3rd quarter retreat.  The fellowship year is winding down!  We had our 3rd quarter retreat at Lake Nabugabo outside of Masaka.  Our end-of-year retreat is at the end of July -- I can't wait to see all the fellows from Rwanda, Burundi, Malawi, and most especially the US (all the Africa fellows got to see each other in January).  I'm also excited to welcome the new CHAI Uganda GHC fellows - I think they are going to be great.

3. Kampala history tour -- Julie, one of my good friends here, organized a Kampala history tour for about 15 of us in April.  It was a lot of fun to be tourists in the city we live in and do the things we never otherwise get around to.  We visited the Gaddafi Mosque, Idi Amin's torture chambers, and the tombs of the kings of the Buganda kingdom.  We had a hilarious conversation with our guide about how they are destroying all the tombs (to be fair, most of them have already been destroyed and rebuilt) and rebuilding them with more authentic materials so that the UNESCO board will approve them as a heritage site.

4. Pima rollout -- the rollout of 250 machines is well underway.  There have been major and minor hiccups, but the fact that things are actually moving is really exciting.  I've been helping out with some trainings and with organizing the trainers, and it has been awesome to see facilities ready to put our systems in place and really doing a good job integrating the machine.  It is also tough to see facilities with far too few staff to implement the systems or with major issues (like no power within an hour radius) that will prevent them from using the machine well.  We have an intern coming on Sunday to work with me on reviewing the rollout, and I'm excited to get some preliminary data on what is going well and poorly in the rollout.

My co-trainer Stephen was an excellent model (and an excellent trainer), though he was kind of confused by my request to take a picture of him.

 Frank (second from right) is one of the best trainers I have worked with.  I love it when I get to work with trainers who really care about their work and really understand the key messages of the training package - their experience as lab technicians and health workers helps me better understand what the key issues really are.

5. The future.  It is looking like I will almost certainly be staying in Africa with CHAI beyond August in some form or another.  Some details need working out, but I'm excited to keep doing work I enjoy and care about, and to keep living in such an interesting place.  At the moment, I'm even more excited to come back to the US for a little while in August and see many beloved people.

This photo is meant to symbolize me looking towards the future....