Pulled in many ways all at once

So a couple of exciting things happened today- the surveillance group decided to go to Kanungu, which is a region of Uganda in the southwest, in a higher mountainous elevation, near Kibale National Park- apparently it's the most (or one of the most) beautiful places in Uganda. Somewhere in the area there is suppsed to be a lake that lies in the remains of some volcanic remains (safe to swim in apparently) and an island in the middle of the lake, with a resort too... Kanungu, however, is pretty far away from Kampala (8-10 hours).

So I was all set to go with Yeka, Hasifa, and Shereen at 6:30 the next day, when we realized that some other people from the Infectious Disease Institute (Gisela and a co-worker of hers) wanted to go see the Apac site, and someone had to show them around... and after a lot of calls and discussion, we finally got Gisela's group to come to Kanungu as well. The only problem with that was that they could only come on Sat-Mon... meaning that my trip to Kanungu would be from tomorrow (thurs) to monday.

Which would have been fine, except for Art Reingold, my main advisor at UC Berkeley, is arriving tonight around midnight, and will be here till next tuesday. That put me in a pretty tight spot- Kanungu is a brand new surveillance site, and it would be great to be there personally to help start it all up, and in addition to that, there's a President's Malaria Initiative funded group headed by Linda Quick who just did some Indoor Residual Spraying (you spray the inner walls of houses before rainy seasons and in key times of year, and the mosquitoes that land on sprayed surfaces die- mosquito nets are similar in action, only they hang over your bed instead of being glued to the walls). They really really wanted surveillance data from the Kibale region, where they sprayed, and since Kibale is close by and IRS's impact on malaria burden could be really interesting to look at with surveillance data, we wanted to set up 2 sites at once with this trip. However, Art's trip here is also really important, but in reality, it's unknown why he's coming here. He could be just coming to visit me and check up, or have meetings scheduled, or any number of things- vacation, sightseeing (all unlikely given how busy he is). He just never told anyone anything about the purpose of the trip.

In the end, I decided to not go with the group heading out tomorrow morning, but that I would go later this weekend (leave Sat, get there Sat night, then work Sun and come back Mon). Grant figures that if Art wants to go as well, he'd come and drive the entire group there, and if that happens, Aliza and Sam may also want to go- it'd be a big fun caravan.

After a day of chasing down printing parts and testing the feasibility of taking digital photographs of surveillance log books (as opposed to waiting for the periodic power to come on so we could photocopy the books at the site), we finally got things to work well enough that we'll continue to try to photograph (the images need to be focused better, but the printing out here at Kampala seems to be able to work well enough to read- additional advantages are less paper records to save, and less dependance on power, among other advantages).

Here are the photos I promised, and a few more:


Kasugi Tombs:




The ceiling of the Tombs:




The Malaria Symposium:




Shereen and Aliza, from left to right:




Some Doxycycline and Artesunate that I picked up for self-treatment, in case I break into mass fever and get malaria... (Artesunates are the big hot anti-malarial nowadays, newly arrived in some parts of Africa, very rapid clearance of parasites, great drug as far as we can tell- fantastic actually). Didn't get Coartem because of Heidi's recommendation, but Grant and Phil both said that they'd go for the Coartem. Maybe I'll pick one up for fun. Total cost: 14,000 USH- 1k for doxy, and 13k for artesunate, made in Belgium. Not sure if the plants are grown there, but the pills I suppose are made there:

Weekend events

This past weekend was pretty interesting- on Saturday we went to see the Kasugi Tombs, which is this big palace made of concrete and spear grass- I'll post a picture of it later. But for now, imagine a straw hut, only x10. It’s a very large and dramatic structure, and apparently after the rainy season, they change the spear grass roof- all of it. Must be a huge task.

Some of the more interesting facts about the place:

One of the kings had something like 90 odd wives, and had 112 odd offspring from these wives- talk about prolific. Only 5 wives could be “official” wives at any one point, but the rest of the wives lived behind a fence… all 85 or so of them. The kings also had multiple palaces (3) that were located around Kampala, and when a king was alive, a big bonfire would be lit outside the palace grounds. When the kings died, they were to be buried in their own palace, and the fire would move inside the grounds, and the wives of the king would have to maintain the palace. The firstborn son of the king had to take care of the wives and the family (poor guy!) while the second borne and onwards had a chance of being king. There is still a current king, and he lives in a little house on Jinja road, apparently.

After that, I went for a run with Aliza, which was pretty decent- only thing is I don’t really run to exercise, whereas Aliza does (at least she goes to the gym regularly, and what else I don’t know) so in the end I was sore, and she wasn’t.

Sunday was great- I slept in till 11, which probably added up to a 13 hour night or something along those lines, which is somewhat strange in that I don’t stay up here in Uganda that often, but the work must have just got me tired. After wasting half the day, I went for another run with Aliza, and we decided to run a bit further than normal… and got promptly lost and ended up running around in circles for about 40 minutes, till we met a nice guy named James who walked us to the main road, and we finally got back home after a full hour. Needless to say, I was sore again after the run. At least I finish the run…

Today was the first day of the Malaria Symposium, which was pretty awesome in terms of getting a crash course in all the important issues going on with malaria and specifically malaria in Uganda- I got all the background information and the research history that I wouldn’t have gotten without sitting down explicitly and asking every single question myself (which I probably wouldn’t have done, for fear of seeming ridiculous). Shereen and Aliza seemed to be especially entertained by my “schmoozing” which basically consisted of me walking around and “looking important” and striking up random conversations with people… though I do have to admit that I did get to know a fricking lot of people, and even had some people I didn’t know at all come up and say hi to me… All in all, it was really good to get a lot of issues addressed and questions answered (especially the questions that I wouldn’t have been smart enough to come up with on my own) and I’m glad the symposium happened. There were a few low points to the symposium, mainly presentations that didn’t really present new information and were just brochures read aloud, but the quality overall was quite high. We’ll see how tomorrow goes.

Back from the Road Trip

Just got back from a neat loop trip around the eastern/central part of the country. We woke up at 5 to head to Tororo at 6, we being me, Shereen (new U of O med student who got here the night before) Grant, Phil, Heidi, and Sarah (the last four are all senior researchers working together/individually on research projects here in uganda).

Tororo is a region right next to the Kenyan border, on the east side of Uganda, and the CDC runs a huge study over there, where they have a bunch of people enrolled in a HIV study, and they drive massive distances every week on a fleet of motorcycles to each individual's house, and interview them/give them medication. It's a huge project, and very cool. We got a tour of their impressively high-tech facilities (their lab is on par with the lab we have here in Kampala pretty much, and their data center is much larger and has a ton of staff, making data entry easy for them to do, even with double-entering the data, a quality control check we don't have the manpower to do yet). We even went on a home visit (we drove our separate cars of course, but it would have been neat to have gone on one of the motorcycle fleet- haven't ridden one myself in a while).

Motorcycle Fleet:




Home Visit:



The CDC motorcycle guys are highly motivated and do a good job of getting all the data that they can, and it's a very neat setup, albeit really really expensive to do.

After seeing Tororo, we went to a clinic that was the equivalent of the one in Apac, that we were thinking of potentially setting up another efficacy/surveillance project at. It was at this place that we met this chicken:



For the vets that read this blog, maybe you can tell me what the chicken is suffering from... seems pretty interesting. One of our group commented that chickens suffering from bird flu tend to shed their feathers... needless to say, we didn't go petting the chicken.

Sarah split up with us after that and headed to Jinja, while the rest of us started driving to Apac. After spending the night in one of the towns halfway between Tororo and Apac (we ran into a World Bank meeting there, complete with lots of armed guards- they had their conference at the hotel we planned to stay at), we continued on in the morning to Apac and got there around 11. Here is a picture of the registration desk, which is insanely full at 6 am, and is still quite busy even at 11.




Dr. Yeka from the drug efficacy study had just arrived before us, and we heard from his group and Nuhu that the Nile ferry had run out of fuel, and would not be running that day! This made it important that we leave earlier and go back to Kampala by a different route, thus making our departure time 2 pm.

Shereen and I spent the time walking around the facility and taking photographs of the log books- it's a new idea, and we hope it will cut down on any data entry errors (photocopies cut the log books into several pages that were hard to put back together accurately). After this, we had a meeting with most/all of the staff at Apac, and Grant gave a good talk to them about the importance of the surveillance project. His key points were that 1) the surveillance project is a bridge of sorts between the clinic in Apac and the Ministry of Health in Kampala 2) that collecting good accurate data on malaria is important, because the Ministry of Health needs to distribute resources all over the country- if they see that Apac has the most malaria, then it makes sense that the Ministry should give more aid and supplies to Apac 3) The surveillance program itself can't give extra funds/pay for the extra work done- the extra work is part of the job, and should be done, but there are perks that can be had, including all-expense paid training programs for the clinical officers and lab techicians, feedback reports on how the clinic is doing with its surveillance, continued visits and attention from the UCSF group and by extension the Ministry of Health, and certain supplies that get provided in the course of various studies (ie chairs and tables and other infrastructure stuff). After giving the "carrot" Grant followed it with the "stick" by stating that if the surveillance data had lots of holes, and that there was missing data for more than 20% of the observations consistently, then the project was going to be a waste of time and resources, and that we would have to leave and do the surveillance project elsewhere- our data from the previous months had been good (one month had close to 95% complete records) but in the past few weeks, the record keeping had slipped a ton, and looked more like 60-70% at best, and some pages were almost completely blank. The workers there all seemed to understand the situation well and want to do well, so we hope that the results will be good.

After the meeting, we left to head back to Kampala by way of Lira then a bridge over the Nile. This is where the scariest part of the trip happened. The area is beautiful, and big baboons are all over the road there, and the Nile is a series of awesome rapids that would make a kayaker very very happy. Heidi took this route often on matatus, and since we were actually driving it, we decided to take the opportunity to stop and look at the Nile, the trees, the rapids, and take a few pictures... which ended being a bad idea. While I was taking photos, a soldier came out of the bushes under the bridge, and started yelling at me to stop taking pictures, asked where did I get my permission from, asking for documents, then said "you are under arrest" which needless to say, freaked me out- I was just stunned and couldn't say anything for a while, and the rest of my group came up and we started talking with the soldier. Heidi tried to speak to him in one of the native tongues, but he only spoke English and Swahili, and another armed guard came up (both of them had automatic rifles...). I ended up deleting all the photos of the Nile, and it seems that they were really agitated that we took photos of the bridge at all, I guess because bridges are military structures and they don't want pictures taken of the bridges the same way that the US doesn't like people takinig pictures of the Stealth bombers and fighters and their engine structures... We had to pull rank by saying we were associated with the Ministry of Health, and that the photos on the camera were for the Ministry, and that we couldn't give him the camera, and finally we got away, but it was definitely pretty scary for a while. I suppose I've been arrested and released technically- wonder if it will go on a rap sheet somewhere.

My only picture of the Nile:




Another baboon:



We joked that I could blame it on my look alike- apparently at Cirrote, the town we stayed at the night before, there was a guy who "looked like me" who ate dinner and didn't pay for it at the hotel- which surprised all of us because the chances of a Chinese guy being at the hotel who looked like me (we were really far from anything well developed) we thought was close to zero percent... I suppose stranger things have happened.

Some definite good things came up on the trip- I had a good long talk with Phil about research and what I want to do. We broke it down into two big categories- academic research and public health, with one being grants and funding and publishing and research studies while the other encompassed outbreak investigation and salaried position and more applied health. I don't think that the competitive world of grants and publishing is really for me, and I feel a much stronger pull towards public health departments and working for places like the CDC, but the problem is that you can't really write a thesis on applied public health that easily. The one thing that does make a lot of sense, with my molecular bio background, is doing some molecular epi on malaria- and molecular epi does have good use in outbreaks and public health application (albeit slower than you'd like, what with PCR and culturing and lab work and all). I think I've come to the conclusion that a molecular epi thesis will be good for my PhD, then following it up with some EIS work for the CDC and then applied public health would be a good move- we'll see what Art thinks when he comes. Apparently we have a malaria symposium that's happening Monday and Tuesday of this coming week, but Art is coming a bit too late for the symposium, so it seems like he'll just be here to hang out and visit people and see how I'm doing- I'll hopefully have some good long talks with him about this stuff, and about funding for the coming years...

New People

Another new person showed up today, besides the people that I was expecting. A guy named Troy, UCSF med guy, doing some clinical studies over here.

The day has been busy, mainly with logistic stuff actually. For those of you interested, one part of my job this summer is to make sure that the malaria surveillance data that we collect from seven sites in Uganda is good data- not missing any fields, and most definitely not huge misentry mistakes. There are 2 really obvious places where this data in the end can get majorly screwed up- the first is the person who writes it all down- if they mess up or make mistakes, it's bad, but not something that we can control or change about the system very easily (for a variety of reasons, one of which is the whole "if you make me do work, I should get more pay" issue). The second place where big errors can come along is the person who actually enters the handwritten stuff into the computer.

This has a potential to be a big problem, on rare occasions, because the personal information for each person is entered across 2 normal 8.5 x 11 sheets of paper. When we photocopy this stuff in the field we get 2 8.5 x 11 sheets of paper, which are hard to align properly since the binder paper lines are often too faded to use as guidelines. Most of the time, no problem- but if there ever was a misalignment problem, there's a big chance that 60-70 entries on that page might get mixed up pretty badly. To prevent this from happening, we've thought of a few solutions 1) bring a photocopier that can do long sheet photocopies 2) bring a scanner and laptop that can do the same 3) take a digital camera photo, then print it out on long paper. Because someone else has done it, and it seems possible, we decided to go with option 3- but before we actually put it into practice, we've taken a few practice photos, and want to hook up a laptop to the Canon photocopier we have here in the hospital, and use the photocopier to print out long sheets of data.

Decent idea, but no printer cable- so among other things (buying power converters and power strips, bedsheets for the house, exchanging cash) I have to run a lot of errands today, and go to a few meetings. It's nice actually to be busy, and not have to be coding in front of the computer all day without getting anything really physically done.

We leave tomorrow morning early to go to Tororo. Will bring back pictures and be back Thurs night, hopefully (early departure Wed morning, spend a few hours in Tororo, then late departure and overnight in Lira, which is near Apac, then a full day at Apac on Thurs, then late departure for Kampala, or so I think the plan is).

Back to Normal

Feeling a lot better in general, think I'm over the bug, once again. Let's see, the past few days I've been working on coding Stata to automate a lot of outputs, so nothing's really changed on that front. I'm just playing around with graphs now, and how to get nice outputs, which is slow and tedious, and involves a lot of looking at examples, and seeing how vastly complicated they are, and then stealing techniques like a spy.

The other exciting news is that though I thought that I would be going to Kunungu, which is this high mountainous pretty region in the south-western corner of Uganda, there's a big group going out to Tororo, which is EAST, near the Kenyan border, then from there, the caravan is going to Apac again, then back home. It looks like a trip out east on Wed, then on Thurs in Apac, then back either Thurs night late or on Fri, so hopefully it'll be fun and interesting. Apparently Tororo and Apac are the most malaria plagued parts of the country. It looks like the goal in Tororo is to recruit a "cohort," which apparently is not a cohort study like I've learned in epi- it's more like just a bunch of kids that get recruited, regardless of anything besides the fact that they're young, then following them up for a long time, and visiting them at the end of every month period. Seems pretty unfocused, but since malaria, the outcome of interest, happens so frequently, by getting some periodic data, I suppose they can figure out what exposures might be causing kids to have more or less malaria. We'll have to see what I can find out on the trip.

A new person has arrived today, and 2 more are coming tomorrow. Phil Rosenthal, another big malaria/hiv guy from the Bay Area (think he's UCSF and UCB affiliated, maybe more UCB side) has come, and will be here for 2 weeks. Tomorrow 2 females will be coming in- one for the surveillance project I'm on, and another one who I think is affiliated with Edwin's work. As a result, Grant and I have moved from the second floor 2 bedroom room to the third floor, to share the big 3 bed room with Sam, who came yesterday. Everyone's pouring in it seems- and on top of that, Art is coming in the next 2 weeks or so, making this house officially overbooked, and someone will be on a couch for a few days. We'll see how it all works.

Back to Square One

About a week ago, I took a full regimen of Cipro (2x a day, for 3 days) to get over some traveler's diarrhea that I got a few days after arriving. No big deal, expected when you switch to a new diet and a different environment, kinda like new teachers entering a room full of young students who are constantly sick- you expect to come down with something.

After the Cipro, everything was back to normal, and I was pretty pleased- in China, I didn't even need any meds, it was fine after like a day, and in South America, there wasn't any trouble at all (but then again, we did pretty much eat like kings, or at least feudal lords).

But as of last night, I'm back to square one, another regimen of Cipro. I thought that I had a craving for cheese or good dairy yesterday, so I ordered lasagne from the Blue Mango, expecting that this "western" dish would be perfectly fine. Boy was I wrong- it was too oily, and that just doomed me somehow.

I'm doing much better now, but I think I understand why Grant and Edwin lose 10-15 pounds every time they come to Africa- and at the rate I'm going, it'll be more like 20-25 pounds. But since I don't have that much fat to lose, I'll probably just lose a lot of my wushu muscles, especially in my legs (not kicking and jumping and running and holding stances nearly as much as I used to).

Work is picking up now, Grant and I did a good bit of analysis of data today, and coding automated scripts in Stata to do a lot of it for us- which will be really convenient in the long run, since there's going to be tons of new data, but all falling under the same names and headings, so if we program a script now, we won't have to retype the same commands in later. We'll see how long this keeps me busy- I'll have to code some analysis scripts too, but I don't think it'll take me the rest of my time here in Uganda. The other projects I have are to turn a room into a new office for me and a few others, which is sounding pretty easy since another department is going to pay for a lot of the work to be done by outside groups. My other project is to experiment with digital camera photos of the data sheets that we want to record, to see if we can get good images that we can print out well enough to read. It's going to involve hooking up printers to photocopy machines to print long sheets of paper, but hopefully it works well.

Last night, Derek's laptop seemed to have a fatal hard drive crash, wouldn't boot, and needless to say, he was very upset. It turns out that Edwin was able to help him fix it today- apparently when you put your laptop on standby, and your battery drains, there's a decent chance that your comp can get all its files corrupted! So don't put your comp on standby, especially if it's on battery power and you're leaving town for 4 days...

World Cup soccer matches again tonight, Grant's a big fan, and we'll probably all head over. I need to put calories in my body- for the most part, I'm just drinking fruit juices, which are rather good (Del Monte and Ceres, this fancy brand that you can get in the States for expensive, but since the mystical Ceres valley is in South Africa, it's cheaper here). I think I will try a bacon sandwich tonight, something tame.

Work

So for the past 3 days, I've been working on reading papers on drug resistant malaria, as well as doing work with the data set that's coming out of the surveillance project. The main program we're using to analyze and set up the data is Stata, and I took a bit of time to do a few tutorials and get up to speed on labeling variables and just cleaning up data. It's pretty interesting to be able to do all this data management, especially since there are over 4000 patient visits that I have data for, and hundreds more coming every week. Coding a program is something I didn't think I'd have to do ever, but I find that I spend a lot of time writing little programs to tell myself if there's missing data, to rename stuff and recategorize things, etc. Programs are pretty neat- they really save a lot of time and make life much easier.

Back at UC Berkeley, it was much easier to have a data set already compiled, and to just run commands happily and see how different variables interacted, if something was a risk factor for cancer, etc. Now it's enlightening to work with a data set, know how it was generated, from the first person to write down the data to the person who enters it into a computer, and finally to me- and I have the chance to pick up on problems with missing data and weird values and go back and fix them.

While I've mentioned that the variables themselves, the ones that I'm looking at, are pretty basic, it'll be much more interesting when we have tons and tons of data over a long period of time. The 3 variables that are the most interesting are how many people get diagnosed with malaria, their lab results, and what treatment they get. It'd be nice if we could know how the people do after their treatment (whether or not they get better) or to track individuals with like the equivalent of a social security number, but nothing like that is being tackled quite yet.

In terms of being a hands-on experience with getting to know Uganda and how the health setting responds to malaria, it's been really worthwhile. Fortunately, Grant (my project advisor) just arrived this morning, and gave me a lot more work to do, so it's nice to have a bit more focus rather than just getting an "experience." The goal seems to be getting good data from 1-2 more places like Apac before I leave- the same variables and same data. As you look at the data over long periods of time, and over different regions, the data set has the potential to become more and more interesting. It feels like I'm setting the groundwork for the future- that if I do some good work and build solid foundations now, later I can relax a bit more and let the data stream in after I leave the country.

Sorry if the post is a bit boring- I'm feeling a little sick- headache, tiredness, and complete lack of appetite. I don't know if it's all the starch that they eat here (it's literally a plate full of it, with a small bit of meat and veggies) but my stomach has gotten progressively less and less pleased with the food here. I sometimes get a craving for... ice cream, or pizza, and have a constant desire for fresh clean fruit. While there's a bit of paranoia that comes with being in a country where everything is unfamiliar, having paranoia about the cleanliness of the food and getting strange diseases does kinda push things over the top.

Last night and the night before I watched a World Cup game or two- the US game and the French/Swiss game (and like 10 minutes of the Brazil game, before I felt too tired and my headache persuaded me to go to sleep). The US team got pretty trounced, and the French/Swiss game was a draw, so all and all, it hasn't been too satisfying an experience watching the World Cup. I remember when I was younger and there seemed to be way more action and scoring going on, but I'm sure if I just wait till the quarterfinals or the finals, it'll get more and more interesting (that and I was just unlucky in my choice of games- apparently australia and south korea had amazing games, but I just wasn't around).

Oh, I almost forgot- here's a little tidbit about Ugandan culture/attitudes towards thievery. It happens here (Derek got his iPod stolen out of his backpack while in a commute), but what's interesting is what happens when someone gets CAUGHT stealing. Apparently up north, in the Apac area, the punishment is death (not sure if it's always true though). I was sitting around with Dr. James from the Malaria Consortium and Dr. Yecka, and the local administrator guy, and when the question came up about theft (and why people seemed so relaxed and kept things unlocked) the administrator mentioned that sometimes thieves just get killed outright. He said last week there was a thief who has a gun who got into a shootout with the police. Apparently, the thief only had one gun vs. 10 policemen, but he did have a LOT of bullets, and just continuously sprayed bullets in the general direction of the police. The administrator got shot at in his car as well by the thief, and after stopping his car and talking to the police, he asked what was happening. The police told him the shooter was a thief, and that they weren't planning to bring him back in alive- that they were just going to kill him in out in the brush and not bother bringing him in.

In Kampala, Edwin was the witness to a thievery incident right at the hospital- some baby was playing with its mother's cell phone, and a guy just walked up, said hello, then grabbed the cell phone and ran. The mother immediately started chasing and yelling, and within moments, masses poured out of every door and path, and chased down the thief, whom the mob caught and promptly began to beat with sticks and other weapons.

Derek's mentioned to me that apparently, if you hit a pedestrian on the streets, you're supposed to keep driving as fast as possible, otherwise mobs will drag you out of your car, and also beat you (not sure if it's to death or not, but I wouldn't trust a mob to hold back).

I've joked with Derek that if we ever get confronted by an angry stranger, we'll just give them our wallet, then cry "thief thief" and enlist the protective powers of passerbys.

More Pictures

Since Blogger can't seem to put a ton of pics in one post, here are more pictures I wanted to share.

One of the nicer looking open areas of Kampala, where people can play soccer and stuff.



The infamous car park. Think of a train terminal, where all the trains meet, and depart for different destinations, only turn it into a mob of mini-vans. There are little signs that say what general area the taxi-vans are going to, and you just kinda ask around and hope for the best.



Another picture of the Nile- only this time at Jinja, where I'm standing at the "Mouth of the Nile." It's not really the mouth, since there are a lot of tributaries that contribute to the Nile, but it's one of the big ones. Where I'm standing there used to be a waterfall, but the Owen Dam flooded it well, and all that's left are just those pylons that I'm standing on.
















Here's me protected against the hordes of mosquitoes that go bump in the night- This picture was taken upcountry, in Lira, where mosquitoes abound, but not as badly as in Apac. No bites that night, thankfully- good fan system, and pretty good hotel, though the room was rather cramped.

















I'll probably try to do some work in the labs from here on out, and supplement it with some data entry on the surveillance side of the project. I'm still struggling with learning Stata commands, but if they don't have a specific task they want me to do tomorrow, I'm going to read drug-resistance papers and spend a good chunk of time doing the online tutorials that UCLA put up for Stata- should be helpful for commands and getting what I want out of the program.

Finished off the night by going across the street to the Blue Mango to get dinner (got a whole tilapia, wrapped in thyme or some herb and with wedges of garlic, served with potato wedges- pretty good) and to watch the World Cup games, namely the US game. The US got pretty handily crushed, and we were commenting that the Czech guy who scored all the goals must be getting a big bonus for every goal he scores (I think that's the way most countries motivate their players in general, with bonuses for good performance of the team and players, but I might be wrong- I just heard something about it on the radio today too. The Ugandan sportscaster was saying that if Uganda had a soccer team, and the Ugandan government had to pay those bonuses for good performance, all the cabinet members and president would be praying for the team to always lose).

Photos

Today was a light day- the data has been entered and caught up as much as possible, and I spent most of the day looking up drug resistance articles, and uploading a few pictures for everyone to see:

This is the barge that I mentioned earlier- the one that crosses the Nile with cars, trucks, and a hundred people... supposedly.




The picture below is of Jinja, which you can compare to one of the less pleasant areas of Kampala, and see why I thought Jinja was such a relaxing place to be.



One of the more slummy areas of Kampala.



There are also some very nice areas in Kampala, and a few nice open areas too. This is Garden City Mall, kinda upscale, they're building apartments right next to it, a la Santana Row. Not what I'd call home, but it's posh and lots of foreigners come here, so it feels pretty safe.



Here are those longhorn cows that I mentioned before- like most animals in Uganda (vegetarian dogs...), they're foragers, and eat everything... including trash. Also taken in Kampala

New arrival

I've finally met our third housemate, Edwin, who is both a technical/computer guy and a epi guy who does work with HIV stuff. A handy guy to have around- he's fixed the second internet connection, and pulled a melted power prong out of a wall socket (while the power was out, and we were on battery). We went shopping at Garden City again today, and I bought mango juice, 5 liters of water, and more stuff for curries and drinking in general. And a 1 dollar fake swiss army pocketknife, which I feel much happier having around- I used to always have some sort of cutting tool in my backpack, which always was useful (cutting carrots for horses, or tags off of shirts, or tape, etc.). It has already happily cut off the top to the mango juice cardboard carton, as well as opened my 5 liter jug of water for me (the plastic cap was fused to the plastic ring that keeps the cap from coming off, so I just cut through the little plastic bits that keep the two fused together). All in all, a relaxing day, since we just came back and watched spiderman the movie on my laptop, and otherwise did nothing.

Edwin knows a lot about the area, and has a good bit of experience with the place- he was here during the elections this past year, and he said that the entire capital shut down- there were just armed guards camping all over, and the entire city turned off, nobody went on the streets, everyone hid at home, while he walked to the hospital surrounded by military personnel. Interesting story- will relate new ones as they come up.

Jinja

So Derek is leaving soon, and last night he decided that he wanted to make a day trip out of today, and either go to the Entebbe area (near the airport and Lake Victoria) or go to Jinja (mouth of the Nile, and also near Lake Victoria- the lake is huge, and those places are probably at least an hour to two hours apart).

Since traveling alone is a bad idea, and I figured that I would be holed up forever unless I had people to go out with, I was happy to come along with Derek, and let him make the choice, and since the "mouth of the Nile" and the Nile river and its rapids are so famous and well known, visiting Jinja became the final choice.

We woke up early, and headed out around 9 ish to get a matatu down to the center of Kampala city, on Kampala road. We got cash exchanged at one of the main banks, which was actually rather freaky. They have little pods that you have to enter the bank in- you push a button, then a semi-circular glass door opens up, you step into this little capsule that barely fits you, the door seals behind you, and after a bit, the semi-circular glass door opens in front of you. The freaky part is that when you step in, it bounces a bit like an elevator... as if they could banish you to interrogation chambers in the basement if they were somehow displeased with your looks or what you had on your person. We got our money without much trouble, then we headed down to the "taxi park," which is this football field full of these crazy matatu drivers, and tons of people who make food and carry around trinkets and water and every little impulse buy item they can think of. You find a sign (or ask some people) that has a matatu going the direction you want, then you wait for it to fill up, then you go. The ride to Jinja costs 3000 USH, and before I left, I spent 2k on 2 water bottles (good investment, finished it all in the period of the day) and a bag of "chups" which Derek said was a decent tasting fried meat thingie, and since I had no breakfast, and needed to eat something with my mefloquine (saturday is my date with mefloquine tablets) I decided to try the chups. It turns out that chups is actually "chips" and chips is exactly what the English meaning of the word is- fried potato wedges. But Uganda is rarely that straight forward, so they also threw in... 1) orangey-red sauce, identical in consistency to sweet and sour sauce that they put on random fast food chinese stuff. Did not try it. 2) chunks of beef. Those were decent, as long as you ate the chips before they got soggy with the moisture from the beef. 3) noodles. That was by far the strangest addition, at the bottom of the plastic bag, that was wrapped with a brown bag. I had to eat all this with my fingers, since there was no utensil provided, and after some purell, I dug in, then ate my mefloquine with half a bottle of water. I feel my malaria protection is renewed once again.

The matatu ride to Jinja is rather fast, like 1-1.5 hrs, considering that once the matatu is full, they don't slow down or stop to take new passengers, and just speed as fast as they can to the destination so they can get paid and get more passengers. After arriving, I used a travel guide that Howie gave me (thanks man, it's a really good book, lifesaver) that had a MAP of the city, and recommendations on what to see and where to eat. As a result, we saw a few good souvenier shops (kampala kinda sucks for tourists, it's kinda a mess and too urbanized to have much in the way of crafts, and the rural areas are busy trying to survive, and don't see enough tourists to warrant making any crafts). Jinja is a pretty nice town, quieter, posher, and prettier than Kampala (the flow of tourists that come in may help contribute to the prosperity of the area). There are class 5 rapids and some awesome play holes for kayakers in the area (Amanda, you'd love it I think- they have a place like 40 clicks away with "one of the world's best play-holes for kayakers" which I think you've heard about before, and mentioned to me) and lots of tourists come to go white water rafting on the Nile, which sounds pretty neat when you think about it.

Derek and I went to this place that was recommended in Howie's book, Gately on the Nile, for lunch- and we both agreed that it was the best food that we had eaten in the entire country of Kampala, for the durations that we had been there. I had this gnawing craving for veggies- veggies tend to be pretty bad looking here, and not too safe to eat, but when I saw this tender beef fillet and wok fried vegetable dish, I had to get it. It was great- the beef was really tender and tasty, and there were zucchini, and mushrooms, and green beans, and cauliflower, and butternut squash like the way Paula makes it, and potatoes... just great. The price was 11k USH, which is like 6 dollars... and for a plate of food that I would have paid 10-15 bucks to have in the states, it was a great deal. And the place was fabulous too, like a resort almost, without being huge and resort like- the entrance is much like a little house/inn with a hedge that blocks view to and from the main street. It's right on the Nile, and on the dining patio, there is this great view of the Nile, and a fountain and immaculate garden and lawn- it's a rather beautiful place, with good weather, and nice breezes, and comfortable places to read, and no mosquitoes at the time (but then again, it was midday, and mosquitoes come out in force at dawn and dusk if they're going to come out at all).

After lunch, Derek and I walked over to the "Mouth of the Nile" monument/gardens, which actually are on both sides of the Nile- apparently the site used to be a waterfall, but with the construction of the Owen Dam, the area is now flooded, and there only remains the monuments. Jinja is so safe feeling and nicer in atmosphere than Kampala is- Derek mentioned it was like being in the Southern part of the US- lots of large, well worn houses, plantation like fields and open spaces, and a river kinda like the Mississippi. We actually felt safe enough that both of us walked around with our digital cameras... in our hands! as opposed to hiding them in our backpacks and feeling paranoid. My camera isn't much, but Derek's is a very nice and rather expensive digital SLR, which is about as pricey as my brand new laptop.

We walked a decent long ways to the gardens, mainly because we took an indirect path, but the Mouth of the Nile was actually not that impressive- it was as impressive as the rest of the Nile was, which is pretty impressive in its width, and reputation, but this segment wasn't much special, except for the fact that you knew that part of Lake Victoria was draining into it.

After seeing this, it was getting close to 3 pm, and we wanted to be out of Jinja by 4, so we could be back to Kampala before the sun set and the muggers came out with the mosquitoes (we're just a bit paranoid). We had seen a few handicraft souvenier stores on the way in, and told them that we'd shop on our way out, since the stuff was going to be heavy, and we didn't want to carry stuff- we probably spent about 50 US total on all the kind of traditionally stereotypical African souveniers- wooden masks, animals, and the like. I do have to say that some of them are rather well carved, and even if it is an obvious souvenier that would never have been used in some village in Uganda for a village ceremony, they're still pretty neat, and the wood and stone is just nice to the touch.

We made it back without issue, and I bought mangoes when we got back. Craving for fruit and veggies persists, but more so fruit now, that I had that great lunch at Gately's.

Loose Ends

Just to cover a few loose ends- I mentioned earlier how Hasifa would give her right hand to not stay in Apac, and how she said there was no food to eat. In reaction to that, I brought 2 cans of this bug repellant stuff from REI (when I was choosing it out, there were like 5 brands- they all had deet in various concentrations, like 18%, 23%, 12% etc... until REI's brand, which had a whopping like 98% deet- not sure if it's a typo, but they mean business if that's true) and I also brought like a backpack of snack foods to supplement whatever little amount of food I expected to get.

It turned out that staying there would have been a nightmare, but we drove over to Lira, a city/town about an hour away (the US Embassy forbids US government employees to be in Lira, or the environs, because of the danger level...). It seemed fine, about as hectic as Kampala was. I stayed in this one room, tiny little place with just enough room for the bed, a tiny tablestand, and a chair, but that was about it. Thankfully, there was a bednet, and a high powered fan, because though the bednets keep mosquitoes out, they also do a great job of keeping the heat in and roasting you alive, so the fan really helped keep me alive that night.

The food actually was really decent- I got some good eggplant, cooked like the way I cook zucchini, to the point where I couldn't even tell the difference, and free range chicken. The chicken was good- it tasted like chicken, and the only difference was that the chicken was extremely buff, the way you expect chickens that have grown up in the bush, living off of what they can find, and fighting off attackers. I got a drumstick, and when I tried to put my fork into it, it was like the entire thing was made of bone- I couldn't even dent the drumstick. Eventually, I applied a good deal of pressure in one promising groove and I got through, and ate very tough, but good chicken.

Will do a separate post for the city of Jinja, which I went to see with Derek today.

Back from the bush

So I'm finally back after 2 days and a night in central Uganda, and I have to say, that it is really very pretty. I actually much prefer driving in the countryside to being in Kampala, surrounded by the hectic city life, and the multitude of staring eyes... I think I'm still not used to it, and it adds to the uncomfortable feeling I get with being a foreigner.

The roads were both surprisingly good and surprisingly bad. Surprisingly good in that they were well paved (better than many of the streets in Kampala proper) from Kampala most of the way up north, but once we got onto the dirt roads, the going was pretty rough. It made me laugh thinking about people in the US with their SUV's, or "off-roading" vehicles that will probably never see the roughness of the roads that we drove on. They weren't really that bad- there were parts where the drivers were going at least 40-50 miles an hour, and just dodging pot holes, but there were definitely times, especially on the way back, when we actually used the 4 wheel drive function on the land rover, and were bouncing up and down pretty violently, even at 10-20 mph.

One very neat thing that we did with one of the 5 hours we spent traveling was fording the Nile. I didn't expect it- I heard something about a ferry/barge crossing, but I didn't realize it was the Nile that we were fording. I was also surprised by the craft we were crossing on. Advertised at being able to carry like 2 fully loaded cargo trucks and 3 cars and 100 people, I expected something much bigger and more... stable looking than what I found. The barge was basically two ramps on either end of a platform, which was two car parking spaces wide, and 3 car parking spaces long. On either side of the platform was a large turbine engine, one side with a broken motor, and the other side with an identical, but working propeller motor. The platform itself was made of two pieces of metal, with a crack between them, where joints held the halves together. On top of the metal, planks of wood (some of them broken, and some areas not having any at all) covered the metal. It was quite a sight. The crossing was fantastic though- the Nile, where we crossed it, was really wide and beautiful. Apparently the Egyptians sent people down to Uganda to keep the Nile clean and clear of debris (otherwise Egypt's delta would dry up and go kaput). The Nile is said to have its mouth in Uganda, near a city named Jinja. I might go on a rafting trip there sometime- they have class 5 rapids and lots of whitewater trips there, but that all depends on the clearance of my resident vet, Paula (and whether or not I decide to do it myself).

Uganda is surprisingly flat, and for most of the drive, it was hard to get a good overview of the country, since foliage blocked the view on either side pretty frequently. It's very green this time of year, with lots of trees and grasses. There wasn't any big fauna to be seen, presumably they've been hunted and eaten, except in national parks. I did see a few monkeys that looked like howler monkeys on the side of the road on the way up, and there were huge ant hills that I only noticed and identified as ant hills on the way back. Pictures will get posted eventually, but I have to get to a faster internet connection.

The staple crops that were being farmed on the roadsides were corn and sunflowers, surprisingly enough. I saw my first field of sunflowers on the drive up, and it was rather impressive how tall the stalks were and how large the flowers were. There were quite a few herds of cows, and I could see only a few goats and chickens. Apparently meat is pretty rare up there, to the point where even the dogs are supposedly vegetarian! I'll have to confirm with paula whether or not canines are omnivores, but I was under the impression that they were hunters, and hence carnivores. But one of the doctors I was driving with said that in one of the villages he was working at, the people there had virtually no meat, but they had dogs. He asked what the dogs ate, and they said corn and beans! And I did see one bony dog chewing on a corn husk in the middle of the road, so it seems that they are at least part vegetarian, if not completely. Surprising!

After the 5 hour drive, I finally got to the clincs, which were actually surprisingly good. A good bit of this is due to the fact that UCSF was recruiting for a study there, and there were UCSF hired people in addition to the normal staff that work at the hospital, but the facilites were much better than what I had envisioned. The clinic had separate buildings for each department- the first building was the building with the head clerk and the doctor who diagnosed and prescribed treatments, there was a building for inpatients, a maternity building, and a lab building. The power there is intermittent, and similar in that sense to Kampala.

Apac, the name of that region, is striking for a number of reasons. One, apparently 90% of people in the region are positive for malaria, in that they have active parasitemia (but due to their high resistance and immune status, not all of them show symptoms). That in itself is crazy, but then I realized that all the grassy fields that surrounded the clinic and that region in general, was swamp, not grassy field. And apparently at night, there are swarms of mosquitoes that will follow every human being, and suck blood like crazy. It's like a nightmare, something from a horror movie.

I was there to try to help out with the surveillance data, and try to fill in the gaps, or at least figure out why there was missing data, and try to fix the problems. It turns out that one of the biggest problems was the fact that the UCSF research group was recruiting for a randomized clinical trial, where a new frontline malaria drug was being evaluated. Apparently, everyone in the area wanted to get into the study, and showed up- however, if they weren't accepted into the study, they just left, leaving their records only half filled out.

The way records are filled out at this clinc is:

1) the sick talk to the main clerk, who takes down their basic data (name, age, etc.)
2) they go to the doctor, who diagnoses them, and sends them to the lab if they want tests done (they do a few tests, but the main one of interest is the blood smear test, where they can identify if you have malaria infection- and 90% of them do)
3) they go from the lab back to the doctor, who after seeing your results, prescribes you some meds
4) they go back to the main clerk, who writes down next to the basic info the diagnosis and treatment given
5) they then go to the pharmacy to get their drugs.

Apparently, a lot of people did steps 1 and 2, but after the lab results didn't indicate that they were eligible for the study, they skipped the following steps, thus leaving a lot of blank data in the clerk's data book.

While I was entering data over in Kampala, I was pretty frustrated when I couldn't read the handwriting of the head clerk, especially when it was just scrawled to the point of illegibility. But after sitting next to him, I realized how busy the guy is- there's a constant flow of people coming in, and the clerk has to see everyone twice in order for his job to be done well- once when they first arrive, and once after doctor's diagnosis and treatment prescription. It's a very busy chokepoint, and keeping his handwriting neat I could see was a losing proposition. It would be ideal if he could have a computer in front of him, where we'd never have to worry about his handwriting or even entering the data ourselves, but the intermittent power and the lack of resources really makes this surveillance project hard to improve on.

I'm also thinking about getting involved with some of the lab work and looking at the collected blood samples and slides, even though I told myself that I was going into epi to get out of the lab. It just seems that most of the interesting questions that I can address are in the lab.

Today is the start of the World Cup, and Ugandans in general are pretty crazy about soccer. No TV in the house, so I might stay ignorant, or brave the muggers and go across the street in search of a TV at the Blue Mango.

Into the bush

Note: this is a retroactive post, that I didn't get to finishing- the power died. This should have been a post from Wednesday night (the 7th).

So tomorrow I'm headed upcountry to Apac, where apparently even a native like Hasifa finds the food to be extremely basic and hard to survive off of, and the sleeping arrangements are to the point where she would "give her right hand" to not sleep in the village, and rather go to the nearest town. I'm going with Yecka, her colleague who is in charge of the field work, and he's more of the tough guy who doesn't like wasting time- thus he's booked a room in Apac for me and him I think... haha. Some other people apparently are coming up as well, and they're apparently bringing a whole caravan of 3-4 cars, which Hasifa and Yecka think is a bit much for the few number of people that are coming. They may go to the nearest town to stay, in which case, if it's ridiculous, I may wuss out and go with them.

I'm heading out at 7 am tomorrow, and the ride is projected to take 5 hours, so I'll be there around 12 pm if all goes well. My job is to photocopy the log books they have there and get the most recent data, and to just see in general how the process works.

Since the internet at the house is dial up, and at the hospital it's a bit faster, I took a quick second to put two pics up (they still take forever to upload, even at the hospital). The first picture is of part of the hospital complex.


This photo is on the way back from the hospital, to the house- notice the dark clouds, but the relatively bright day- the constantly threatening rain. The guy on the little moped is a boda boda driver. The minivan in the bottom left is about the same size and make as most of the standard matatu taxi-vans. Notice the sharp cracks in the pavement where people walk- this road has a sidewalk, but those eroded areas can be pretty sheer and up to a foot in height, so watch your step!


Will make a more normal post later today.

Lots of little errands done

The weather in Kampala is always warm, but threatening imminent rain. Darkish clouds like to hover around, suggesting that you might get rained on, but fortunately for me, it's never happened. I bought an umbrella just in case, though Derek seems to be the rain magnet, and hence all the downpours. I just get the puddle aftermath.

Walking on the way to work, I got hailed by a matatu (taxi van) that pulled up next to me and offered to take me to the hospital for 700 USH. I know that sometimes, 300 USH can get me to the hospital, and that 500 should get me to most places in the city... so 700 seemed kinda expensive. Of course, keep in mind that 700 USH isn't even 50 cents, and the walk to the hospital takes an hour (probably 2-3 miles). I said no thanks, and kept walking. But what was funny about the situation was that there happened to be a traffic jam at the time, and at the speed they were moving, I was moving at least their speed, and at times a bit faster. By the time they caught up with me again, the guy at the sliding door said, "... 500 and you can sit instead of walk..." and seemed pretty wise to the fact that there wasn't much difference in speed at the time. I hopped in, and took the ride down.

Once I got in to work, I had barely settled down when I was told that Nuhu was free to take me around to get my errands done finally (read: I wanted a sim card for my cell phone, so I could finally be in contact with all these people). We ended up driving down to Garden City mall, which I had been to on Sunday. It was rather nice recognizing where we were driving, and also knowing where the shops were in the mall that I had to go to. I got my MTN sim card, and put credits on it. Uganda is interesting in that they went from no telecommunications, to wireless telecommuncations, and completely skipped the hard lines. Apparently, everyone uses cell phones, and even the phones that look like hardline phones are actually cell phones dressed up and in disguise. Another interesting thing about cell phones in Uganda is that they're pretty much portable phone cards. You use up phone credit when you make calls, but when you receive calls, it's free. So technically, your phone can be completely without minutes, but getting calls is still possible. If any of you want to call me and hear my voice instead of read my words, my mobile number is 0774116435. Don't ask me how you get through to that number from a US phone, but if you figure it out, let me know. Actually, this is the first country that text messaging is actually economically feasible. In the States, texting costs 10 cents each outgoing message, or something like that, but if it's after 9 or on the weekend, you're on free minutes, and might as well just call and save the cost of texting. However, since calls and texts cost money in Uganda, and texts only cost 200 USH, it's pretty cheap to text here. Now what I REALLY want to know is how to text US phones, because that'd be a pretty darn inexpensive way to keep in touch.

Thankfully, the phone I bought in the US worked over here. It's a NEC unlocked quadband phone that I picked up from a lady who was from Turkey (I suppose she was getting a free upgrade). For those of you who haven't tried using cell phones abroad, a note: your US phone won't work outside the Americas, not even with roaming, unless your phone is tri or quad band (and even then, you might have troubles getting a carrier that will recognize your Cingular or AT&T or Verizon etc. services). The US phones operate on the 850/1900 bands. Don't ask me what this means, I just have a hunch that it's like AM/FM, where one has a far range and one has a short range, and between the two cell phone bands, your reception is optimized somehow. The rest of the world outside the Americas seems to run on 900/1800 bands. So unless you have a phone that can access at least 900, 1800 or both, your phone won't be working in Europe or where I'm at currently. Another thing you might want to make sure of is that your phone is "unlocked" meaning that you can take out that little chip/SIM card in your phone (that has the name of your cell phone provider on it, like Cingular or T-Mobile, etc.) and put in another company's chip/SIM card, and still have your phone work. Most providers, especially if they gave you a free phone or free phone upgrade, won't like to unlock their phones (otherwise you might quit their service, but keep their phone and use it with a different service). But if you're travelling internationally, it's pretty much a must, since you have to get a SIM card for a provider that services the country that you're in.

Well, after I got my sim card and put a lot of minutes on it (hope I don't get my cell phone lost/stolen) I went shopping for food at the local supermarket. Now in Uganda, it seems to be that everything is pretty extreme... either the market is extremely small (like a one room shack/hut) or it was like the one I went to. It was like a Wal-Mart, only fused with a Safeway as well. They sold electronics, sporting goods, bedding, toys, rice in bulk, produce, fresh bread, canned foods, juice, milk, everything really. I spent a good 80,000 USH (bout 40 bucks USD) on groceries, which seemed like a lot at the time. For 40 USD in a 3rd world country, I felt like I must have gotten food to feed an army, but it didn't seem like I actually got that much. I've come away from Berkeley Bowl with 30 odd dollars worth of groceries, and felt like I had food to last a month at least. I think the big difference was that I had to buy a lot of starch in bulk, and a lot of canned produce so it wouldn't go bad, which tends to be a bit expensive (still cheaper than the US, but fresh produce is dirt cheap at Berkeley Bowl compared to canned stuff just about anywhere). In the end, I got a lot of "long life milk" which you can apparently store at room temperature and it stays good for like 5 months (I wouldn't have trusted it if I didn't see a guy buy a flat of it on Sunday), a lot of rice, pasta, bread, canned beans/corn/carrots, juice (which is incredibly concentrated- to just swallow it, I had to dilute it 2:1), salt, cumin, and cayenne pepper (I expect to be making a lot of curry rice, with either beans or corn making the star appearance). Nuhu was kind enough to drive me back home to drop it all off, then take me back to work.

Once I got back, I had a whole new set of issues. The data being entered is being entered into Microsoft Access. That's no problem, because even though the new laptop I got from the department is an apple, it can dual boot into Windows, and I have access installed there. The major problem was that after I configured my comp to be able to link up with the other computers in the data center, I had to log in as if I was logging into one of the other computers- and their default login screen requires you to press CTRL + ALT + DEL to bring up the the login screen. Normally, this would be no problem on a PC- but apples don't have a delete key. They have a fake key that's labeled "delete" but really is "backspace" and does everything a backspace key does and nothing that a delete key does, at least in Windows. I figured out that I had to "remap" a key, or just redefine one of my keyboard buttons to be a delete key (and forget what it previously was supposed to be- I ended up making the ~ key into my delete key), but the problem was that you have to be IN Windows to change those settings, and I couldn't even log on! I ended up stealing a keyboard, and plugging it into my laptop... finally everything worked in the end... but what a hassle! One other issue that I had was that I couldn't right click (apple computers in general have mice that only have one mouse button, which makes the right click function non-existant), but I fixed that rather easily (had to grab a program that runs in the background and makes it so I can hold down CTRL and then click, and it registers in Windows as a right click).

After fixing those problems, I chugged along and entered a good bit of data. I'm almost up to the point that we're shooting to be at in 10 days, so I'm pretty happy about having gotten so much entered. We might even get a third person to help with data entry (which would be good, since the goal of this summer is to get SUSTAINABLE results, and if I leave or stop entering data, and the data starts to fall behind again, the project faces major slowdowns). It looks like I'll be going to Apac (the place where the data is being generated) on Thursday, so hopefully I'll be able to fix some things up there (probably no update posts till I get back- I might be back the next day or on Saturday, depending on how long it takes to get a feel for the place). It's not that optimistic, since Hasifa, my boss, has said that she sits down and talks with the clerks, who all nod and seem to agree and indicate that they'll try to change- but then when the next month's records come in, nothing's changed at all. Kinda hard to motivate permanent, sustainable change, when you don't have something that's physically different. I think maybe if there were a completely new form or new way of doing things, the changes would be better done, as opposed to asking someone to write more neatly, since that's something that will improve only when someone's breathing down your neck, like my cursive teacher from second grade.

Lunch at the data center, and in many of the offices at the hospital, is actually very easy and cheap. People actually come in and serve you food and drink, without you having to get out of your seat at all... if you can believe that. They bring you a dish of food, and take it away to be cleaned somewhere out of sight and out of mind... and the food is really good for the price (1,000 USH, like 50 cents). You can get chicken or beef with sauce over some sort of starch- rice, potatos, sweet potatos (which are actually rather stringy and not so sweet, last time I had them). Otherwise, it's a great deal- where else can you get a 50 cent meal? Even fast food joints couldn't fill you up for 50 cents, not like this meal did. I'm still new to the whole ordering business- I only got rice and chicken today, but there's a whole set of "insider" side dishes you can get too... I'll learn slowly, by spying on other diners probably.

I decided to walk home after work (I left after most people left, but earlier than I did the day before). I headed out around 5 and started the walk back. The roads are made of this very red earth, that seems to erode pretty badly, given the conditions of the roads, and the sudden "cliffs" that form right next to either side of the road. Livestock free range, and there are a lot of cows that sometimes wander into the roads and block traffic. These aren't your run of the mill angus or jersey or whatever cows- these are what Nuhu calls "North-eastern or western cows." North-eastern cows come from the self named part of the country (or maybe continent). They're crazy looking- think like antelope antlers (long pointed unbranched horns) then thicken them and make em think and mean looking, and put them on a cow with udders, and you get a picture of this type of cow. Not all of them have those crazy horns, but some of them do. Western cows apparently have short horns, compared to North-eastern ones.

I took a few pictures, which I'll try to figure out how to upload, but after I got back, I was pretty darn sweaty- carrying a backpack really cuts down on the airflow to your back, which makes sweating a big deal. Usually there's a decent breeze, but if it's not there, and you've got extremely smoggy cars blowing into your face constantly, you tend to walk a bit faster to make your own breeze and to get out of the smog.

So ends another day. I'm looking forward to when my advisors (Grant and Art) will be coming, since we can all pow-wow and get some good ideas and make some hard decisions and get this show going- once Apac is finally to our standards (or even before it is) we're planning to move to another site and start it up. The goal is to get 7 sites up and running, but if I'm lucky, I'll see 3 by the time I leave.

First Day at Work

I woke up, remembering a small bit of a dream from last night. Apparently someone spilled spaghetti sauce all over my camera, and the case that covers it. Then they put the camera case in the refrigerator, and left the camera on a table... In my dream I then started brushing off the dried spaghetti sauce off of my camera case. The end. Not very vivid... I'm kinda thinking that mefloquine doesn't really have a big impact on me.

I actually woke up at 5 am at first (I went to sleep at 10 pm the night before, because our electricity is on the fritz. Our house, and apparently much of Kampala, is on a rotating 24 hours of power from the grid, 24 hours of no power at all. We have a battery in the house that charges on the "power-on" day, but keeps us from doing a lot of computer related stuff/electricity intensive stuff on the off days). I kinda tossed and turned, listening to the roosters crowing back and forth, then dozed off till I woke up at 8 am. I got dressed, packed my stuff, and Nuhu showed up to take me to work at the hospital. I brought with me one of the heavy suitcases I packed (filled with filter paper for collecting blood samples on), my backpack, and a laptop bag filled with epi books for a newly-developing medical library, and a new laptop for Hasifa, the person who I'm working with/for. First we drove to the laboratories on the hospital grounds, where I met Sam, the lab director. I gave him the filter papers, and when he heard that I was going to be helping with the surveillance in Apac (a central region in Uganda- Kampala, where I'm at, is about 5-6 hours south of it), he laughed and said that he had never been there himself! Wow, in just a week, I'll have traveled more of Uganda than some natives have ever seen!

After meeting Sam, we drove down the street a bit to the Anatomy building, where I met Catherine (who runs the house that I'm staying at and does other work, of which I'm not completely sure of) and Hasifa (who I'm working with). Ugandans here are very different than the african-americans that I see in the States. The most striking thing is that many of them have skin that is a much richer, dark chocolate color, compared to African-americans in the States (who seem almost pale by comparison). Derek also mentioned something interesting as well- apparently the skin of many of the Ugandans he stitches is extremely tough, compared to US citizens. At first he thought that his needles were dull, but apparently all the medical students who come from the States to work here have noticed it too... just two interesting observations, which are most definitely not true for all Ugandans- just a few.

Another interesting thing about Ugandans is that most of them are not immediately friendly- pretty much without exception, they stare (or at least give a long look) to most foreigners, and maybe without intending to, they have a suspicious look on their faces. It isn't until you wave at them or smile or both that they seem to open up and be friendly back. Most of them are friendly and will respond to your waves and smiles with greetings and smiles too, but a few of them just continue to stare at you suspiciously. It can be a bit intimidating, when I walk down a street, or into a ward, or around the hospital, and 10-20 people are looking at me, and Ican't wave and smile at all of them (since they're all surrounding me, and I also would feel kind of foolish spinning around and waving). I imagine that I'll get used to it after a while- it's pretty natural to be curious and look at people who are dressed and look very different from the norm.

All the people who I have to work with are friendly, which is a good thing. They seemed a bit unsure as to what type of person I would be (overseer-type, or secret spy, or normal student- even I was kind of unsure what exactly I should be doing) but they all seemed to warm up to me when they realized that I wasn't there with a secret agenda, and was just there to help out. For the rest of the day, I worked with Alan, the woman (I thought Alan was a guy's name, but maybe it's spelled differently) who does the majority of the data entry for the surveillance project. She's a nice lady, kind of quiet and shy around new people (like me), and has a ton of data to process, and understandably, has more to do than she can do alone. Of course, this kinda meant that I was sucked in to doing data entry, and will probably be doing data entry for a few days. I'm hoping that I won't have to do this for long- I did a ton of data entry when I was back in my undergraduate years, for the Stanford Hospital, and doing it here in Uganda took me back to the old days, where data entry was kind of boring, or at least, not the most stimulating of mental pursuits to be doing. It is a necessity for epi, since in order to look at any big trends/population level effects, you need a lot of data to analyze (and hence the tons of data to be entered), but since I entered PhD training, I was hoping that I was past the menial labor and into the realm of answering deeper questions and tacking bigger problems.

Not that the data entry doesn't have a lot of problems to be tackled. There's always issues with what you can do to minimize the amount of error in your data, and there seems to be a lot of missing data. Most of the problem seems to be lying with the clerks who record the data firsthand at the clinic in Apac. Apparently this surveillance project has created a lot of extra work for them, and they feel that they should be paid more for it. But the flip side of the arguement is that their job description has changed, and to earn their salary, they should be doing their job, even if it's harder than it was before. The bottom line ends up being that the clerks are unmotivated to do the extra work, and so the surveillance data tends to be messy and a bit sloppy, especially as the day goes on. Apparently it's common knowledge that a good bit of work gets done in the morning in Uganda, but after lunch, productivity almost comes to a standstill. At rural clinics, apparently, it's not unheard of for clerics to just leave their posts after mid-day, or the sole laboratory technician to just leave early to get her manicure- which leaves a lot of half collected data, and missing lab results for a lot of people. This is just a sample of the problems that have to be dealt with... how? I don't know yet. I'll be heading out to Apac sometime in the next week, so I'll hopefully be able to update with new thoughts later.

I went out to lunch at a fancy restaurant where native Ugandan food is the focus. It pretty much consists of a starch base, with some sort of sauce that goes on top. The starch base can be steamed bananas a la plantain style, potatoes, rice, sweet potatoes, or anything really. The sauces range from meat sauces to spicy sauces to ground nut sauces. The starches tend to be rather dry and kind of hard to eat without the sauces, and apparently one common staple is the plantains with ground nut sauce. I went with Heidi (an assistant professor who runs a rapid diagnostic malaria test study, a mosquito capture project, and a few other interesting projects) and her friend Susan who came from UCSF to visit her. After lunch (which was really filling- I now have resolved to survive off one meal a day and store food like a bear does, as long as they keep serving me buffet style) (oh and the passion fruit juice is really good here) we went to a building next door filled with art. It was rather nice actually- there were pictures made out of wood chips melded together, large sculptures of wood and metal fused together, and textured paintings where layers of paint had been cut away and pushed around to make a 3D surface.

Actually, I almost forgot to mention the roadblocks that we encountered on our way to lunch. Apparently, the place we went to eat at is right in the vicinity of the Ugandan President's house. The President just amended the constitution to allow himself a third term in office, and apparently he's not the most popular of people with people outside of the southern part of Uganda. He's been accused of using force and throwing around money to get people to vote for him, and this unpopularity apparently led to the deployment of roadblocks with armed guards around his house. It's a bit disturbing going from Cali where guns are only really seen on TV and in movies to Uganda, where troops carrying big rifles and AK-47's are walking around on the normal streets. Our driver apparently got harrassed by the guards (Heidi translated "Who are you? Where do you live? Do you even live in Kampala?") who finally told our driver how to get around the roadblocks to the restaurant we were trying to find... crazy eh?

After lunch and the art, I took my first boda-boda ride back to the Hospital. Boda-boda's are essentially moped-motorcycles that taxi 1-2 people around Kampala, for a price around 2k USH for a chinese guy like me and more like 1-1.5k for people like Heidi, who can speak the local language. They're fast, and daring, on a different level than the taxi drivers. Taxi drivers drive fast and daring, but boda-boda drivers take fast and daring, and mix it with no armored protection and more weaving between large vehicles with the potential to crush bodas with no problem. It's kinda nerve-wracking at first, but the breeze is nice, and it's much faster than cars and taxis when the traffic sucks.

After getting back to the hospital, I entered a bit more data, and finally got Skype to work, and talked with Paula for a bit. However, it was getting late (6 pm) and I had been warned to not be out alone in Kampala after dusk. Uganda's supposed to be safe, as long as you don't do the 2 following things- be alone after dark, or be in the northern regions of Uganda where the Lord's Resistance Army is. I packed up, and went outside, and a boda offered to take me where I wanted to go. I told him the "blue mango" (which is right across the street from where I'm staying) and he promptly started driving in the opposite direction. Fortunately, Derek and I had walked all around on Sunday, or I probably wouldn't have caught it... I kept asking him if he knew where he was going, and he kept saying yes, the "mango." After about 1 minute of going farther and farther in the wrong direction, I just stopped him, and told him to go back, and he acquiesed and just drove where I told him to go. Fortunately, I was able to remember the way back... man, the day I have to give directions to a ugandan is a scary day indeed. I don't know where I would have ended up if I just let him go to his version of the mango...

More to follow later.

Exploration

This morning, Derek and I decided to go see the hospital that I'll be based in for most of my stay here in Uganda. We walked out to the main street, and we hired a taxi-minivan (they seem to be run by 2 man teams- one driver, and one man who sits by the sliding door, opening and waving to people to jump in). The general charge is 500 Ugandan Shillings (USH) to get to most places in town, and we got in and took a ride to the hospital (500 USH is roughly 25 cents). The hospital is a very nice looking facility, and there were many people all around the hospital. Apparently there are very few nurses, and the majority of patients are attended to by their relatives/family. Beds in the hospital are free, as are medications (paid for by the government) but food and dressing changes and all other needs have to be taken care of by the family- which Derek pointed out can be pretty taxing on the family, since they have to literally live in the hospital, on the landings, and do their laundry and other chores in open areas around the hospital. Also, on Sunday, most to all businesses close down, and the hospital isn't much of an exception. There were definitely a few medical staff on hand, but Derek indicated that it was more of a skeleton crew, and that there were also far fewer patients, whereas during the week, the place was extremely busy. The emergency room is often so packed that patients with less severe injuries wait outside and even sleep there till the next day, waiting for treatment.

After visiting the hospital, we walked down to garden city mall, which supposedly was built just like a western mall- and it pretty much was. Large parking structures (under construction), movie theater, cell phone companies, banks, clothes, the equivalent of Wal-Mart, all of it was there. They had playgrounds and those inflatable houses- astrojumps I think they're called. A lot of foreigners were there, many of them in fancy cars- once again, the discrepancy in wealth. I took the opportunity to get draw some money out of my bank account, and apparently, back at home, my parents got called by the fraud division re: my debit card, so I'll have to let them know that it's not a stolen card (yet).

After buying some juice from the Wal-Mart equivalent, we walked back along a different path back to our house. Along the way, there were country clubs and embassies all over- it was actually a really rather posh looking place, if you ignored the dirt roads. Everything was really green, and the buildings were all well kept and quite nice looking. It was, however, really hot to walk uphill carrying supplies in the hot sun. The sun is rather warm, but apparently, there are often flash rain events- it will pour for half and hour to an hour on some days, according to Derek. I thought that it was the "dry" season in Uganda for the next 2 months, but apparently dry still can get very very wet- so I bought an umbrella for 4.8k USH, which translates to roughly $2.50 US.

We finally got back, and bought 1 liter bottles of coke for about a dollar each- apparently, they're cheaper if you bring back the empty bottles of coke for new bottles of coke. I imagine that they must submit them to a recycle area (I hope they don't just refill the bottles themselves... just seems a bit unsterile). We took a break, and then went across the street to a place called the Blue Mango (if you happen to be visiting soon, apparently you can tell most taxi drivers in Kampala to take you to the Blue Mango and they'll know what you're talking about). The Blue Mango is a restaurant/hostel, and after walking into the restaurant area, I saw Ben Bellows sitting in the corner of the restaurant! Ben is one of my classmates from Berkeley- he TA'ed one of my first epi classes, and we took another class together in a different semester. I had planned on meeting up with him at some point in the trip, but since I wasn't able to get my cell phone activated, I didn't think I'd see him till about a few weeks into my trip at least. We were both really surprised, and sat down and talked for a good while over dinner. He's travelling back and forth between Uganda and Kenya, and after hearing all the stuff he has planned, I'm looking forward to work tomorrow, and getting some work done myself.

Finally Arrived

After a 2 days of flying, I'm finally here in Kampala, Uganda. Besides one minor scare at SFO, the flights were pretty uneventful, and rather relaxing. I got to SFO at 4:30 am, thanks to Paula's excellent driving. I remember that for international flights, getting to the airport 3 hours ahead of time is a good thing (my flight was at 8-ish), but then I realized that my first flight was domestic (into Houston, then from Houston to Amsterdam). Fortunately, they had an earlier flight going into Houston, so they decided to put me on that flight... but then a minor issue came up. They couldn't find my name in the computer, at all. I was starting to worry that I'd never get to Uganda, so I had to break out my computer in the airport and try to figure out my confirmation codes and reservation numbers... so $10 dollars later (you ripped me off T-mobile) and with my itinerary in front of me in digital form, I went back to the desk, to find that those confirmation numbers weren't Northwest's normal confirmation numbers (I had gotten my trip booked through the department's travel agent, so I had travel agent confirmation numbers).

Finally, things got figured out, and we weighed my bags. I was actually carrying a ton of stuff- a backpack with my laptop in it, and a ton of paperback books, a second laptop bag with a laptop to be used by some other researchers here associated with the project in Uganda, a suitcase full of filter paper for the labs here in Uganda (and paper is heaaavy- like carrying textbooks almost, since it's so densely packed), and a suitcase of my own private stuff. Max weight in check in luggage = 50 lbs, if any of you plan to go to Uganda. My weight = 55 lbs and 48.5 lbs, so after taking out a few books and redistributing weight, and carrying a few extra pounds in my own backpack, I was on my way.

Flying into Houston was pretty uneventful, but the actual taxi-ing after landing was pretty interesting. The plane actually drove on an overpass... over normal traffic. It was the strangest thing- it seemed like planes should not be driving on wheels over normal streets, but apparently, in Texas, it's fine. I always thought airport security was all about keeping cars and trucks and stuff very very far away from planes and the runway, but it's not the case in this airport. Eventually I found my way to my next flight, and flew into Amsterdam.

Amsterdam's airport is a pretty nice classy place, much like SFO in many regards. Museum exhibits with oil paintings, and... a casino. Besides flying into Las Vegas, this is only the second time I've ever seen gambling in an airport... but this was even on a bigger scale than Las Vegas, if you can believe it. Las Vegas airports have simple slot machines, stuff that you can leave alone, without needing real people to deal you cards or hand you chips and cash. Amsterdam had full on roulette tables and the works... including the indoor smoking that I've forgotten exists since I live in California, where laws prohibit smoking indoors.

The most interesting thing I noticed about the Amsterdam airport was a kiosk that offered whirlwind tours of the city, while you waited for your connection flight! It was kinda funny, since most of the people who were stopping were asian business men, but it wasn't a bad idea. I had 4 hours of down time, and I was kinda tempted, since I'd probably never be in Amsterdam again, or at least, not in the planned/forseeable future.

At all the airports I flew into (with the exception of Entebbe, Uganda, which I didn't check) there was wireless internet, which was nice, but it was all for a fee, something like either 10 dollars US or 10 euros (which is like... 20 dollars US nowadays?). The thing that really sucks is that at each airport, a different company has a monopoly on internet service there... meaning that even if you buy their 10 dollar/euro plan (24 hours of internet access at that airport) you really don't use more than an hour of it... and the next airport you fly into has a different provider, and they want you to pay for 24 hours of access on THEIR plan... it would have been much nicer if all the airports had the same provider, so I could actually take advantage of all the internet time I paid for...

Well, after a long day/2 days of flying (~3 hours from SFO to Houston, 8 hours to Amsterdam, and 9 hours to Entebbe) I finally arrived in Uganda. Entebbe is a very small airport, at least compared to the plane I flew in on. KLM (Royal Dutch airlines) flew us in on a two story/doubledecker jumbo jet, and we all unloaded right onto the runway, and walked into a small building with immigration (really easy to pass through, just have 30 USD ready to buy your visa to get into the country), extremely fast baggage claim (waited maybe 5 minutes for my luggage- and the plane did have quite a few people on it, so it's fast by american standards for sure), and an easy customs (just walked through the nothing to declare door, no hassles). Surprisingly, there were a lot of Caucasians entering the country- and even more surprisingly, around 50% of the "native Ugandan" immigration line was Caucasian as well- a lot of expatriates I imagine.

At the airport, Nuhu (a dedicated driver hired by the UCSF project) was waiting for me, with a 4 seater truck (like an extended cab). We piled in the luggage, and started driving. Driving in Uganda is like fusing the UK with China. Which side of the road you drive on and car construction are English style, with steering wheel on the right side of the car, and you drive on the left side of the road. But with regards to the rule of the road, it's all Chinese. Roads are just like in China, narrow 2 lane roads, that are driven very fast (if there's no traffic, it's as fast as you dare to drive, and Ugandans are daring people). Passing slow cars happens in the oncoming traffic lane, just like in China, and it makes for a pretty interesting ride.

I chose to drive a stick shift, mainly because it would be fun, and so I would stay awake while I drove (I was really feeling tired for some reason, every time I sat behind an automatic car). If I was in Uganda, there'd never be any reason to be asleep at the wheel- traffic is rather crazy, with taxi-vans (14 people fit in one minivan... clown car style) half pulling over randomly wherever they want on the road, and our car swerving around them, forcing oncoming traffic to go to the edge of the road so there wouldn't be any accidents. (I'm currently in the house with my sole other housemate, Derek, a med student at UCSF, who worked in the ER's for a while in the past week. He says there are a lot of people who come in, hit by cars... and I can believe it). Pedestrians just run across the street, and with the speed that cars drive here, it's like crossing the freeway. Lots of foot traffic on the side of the road also makes night time driving pretty crazy. In the main cities, driving is all about asserting yourself, pushing your car's nose into gaps and forcing people to let you in. It's pretty fun, and after my past summer in China, it was surprisingly stress free. However, the pollution was actually worse than I expected. I didn't expect there to be as much industry, and so I thought that pollution would be pretty minimal- but most cars here run on diesel, and a lot of them are really really smoggy. Some of them put out so much smoke you'd think they're on fire or something... clouds of black smoke coming out of the backs of many cars, and it's rather hard to breathe when you get stuck behind those cars. I was pretty glad actually that Nuhu a daring driver.

The roads are decent, but pretty bumpy. They're paved, but dips/almost potholes are pretty common. Between cities, there are a lot of hut/shack one room buildings next to each other, selling goods, and there are no sidewalks, just dirt on the side of the road. It was night time when I was driving into Kampala, so I could only barely see Lake Victoria by the reflection of lights off the lake, and the trees here looked very different than what I'm used to in Cali. It's rather stunning, to come from a Caucasian dominated country into Uganda- I didn't see a single Caucasian on the streets, and there were lots of Ugandans hanging out (I guess a Friday night is the same wherever you are in the world). It's a bit intimidating, realizing that you're surrounded by people who look very different than you, and who stare at you as you drive by. It's also a bit unnerving realizing that if they took everything that belonged to you, and sold it, they'd probably make more money in one night than they would make working for 10 years... It's a thought that really makes me think hard on how lucky I am to have been born where I was born, and to the parents I was born to.

After turning off the main roads in Kampala onto a dirt road, full of potholes and cracks, we got into the walled "complex" where the UCSF house is. It's a really nice setup actually, a very nice house. At night, there's an armed guard with what looks like an automatic rifle who opened the metal gate for us, and let us in. The house is 3 stories, with a three bedroom room on the third floor, a 2 bed room and a single master bedroom on the second floor, and a nice living room, dining room, and kitchen on the first floor. Wood furniture, and everything is really posh. It reminds me of my experience in China- I thought I'd be staying in a much worse place than I actually got there too- it was pretty posh as well. Goes to show that you shouldn't underestimate countries, just because they aren't first world superpowers. Of course, there is a lot of poverty in Uganda, but like in many places, there is definitely a big division between the rich and poor.

After waking up and taking a very cold shower (the hot water didn't come on) I met my housemate, Derek. He's a Stanford alumni, class of 1997, so he's a bit older than I am. He's currently a Med student at UCSF, and he does a lot of research in the labs on bone development and formation. He's here in Uganda doing some surgery stuff, and has been here for a week- he'll be here another week or 2, so it's good that he's here to show me around. Power here is somewhat intermittent- we get power for one day, then the next day we run on battery power, then the battery charges the next day, and so on, so forth.

Oh, I forgot to mention the Mefloquine. So the anti-malarial pills that I'm taking are called Mefloquine, and they're famous for their hallucenogenic/vivid dreaming side effects. The alternative is a different, newer drug (Malarone) that has fewer side effects, but the advantage of Mefloquine is that it's cheaper, and you take it once a week, unlike the new drug which is daily. Apparently, to minimize the side effects, you want to take Mefloquine early in the day, and with lots of food and water. I've only had one vivid dream though, out of the 8 days that I've been on this medication. It was a "scary" dream.... or it was supposed to be frightening. I remember while I was dreaming that the atmosphere was scary, but as the dream progressed, I kinda lucidly decided that there really wasn't anything to be afraid of... and there wasn't. The dream was about some creature/man that had organic tubes that emerged from his calves. It would have been scary if he ate people with that... but he ate pennies and nickles only. And not just pennies and nickles, only the Zinc that was inside of the pennies and nickles.... so what started as a scary dream, became a rather weird one really quickly. It was a half-lucid dream in that I couldn't control what was happening, but I could think about the dream, and was able to tell myself that it was really just a weird dream, and not scary, so when I woke up, I felt fine.

Apparently, the drug has more of an effect on people AROUND me than on me personally.... people who fall asleep in the same room as me seem to have crazier dreams than I do. Paula said that she had vivid dreams twice, and Jose, whose house I crashed at before I left, dreamt that me and a few of my friends into the Risk boardgame setting- we were physically represented by the army colors red, gray, etc. and he just said the rest of the dream was kinda crazy... weird eh?

Well, that ends this rather lengthy post for now. It's Sunday here, and everything is closed, except for restaurants. It's a bright sunny day, and I haven't been bitten by mosquitoes.... yet.