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.