On Bangkok

Greetings from Bangkok! I mentioned in my last post that I’d been outside of sub-Saharan Africa; more precisely, I’ve been in Thailand. After a somewhat troubled journey (my Kenyan Airways flight from Nairobi to Bangkok was spontaneously canceled twenty minutes prior to departure) that necessitated my spending a night in Nairobi—the airline did pay for my visa, accommodation, and transport to and from the airport—I landed (DVT free) in Asia last Monday evening.

I traveled to Bangkok for a Clinton Foundation global conference for laboratory staff. Approximately forty-five people were invited to attend, representing the majority of the countries in which CHAI operates . To list some (though I’m surely missing others), there were staff from Botswana, Ethiopia, Kenya, Mozambique, Zambia, Lesotho, South Africa, Tanzania, Jamaica, Ukraine, Indonesia, Thailand, Cambodia, Vietnam, China, Malawi, Uganda (me!), etc. Staff included both analysts (such as myself) and those with technical laboratory training. Ages in the room likely ranged from 25 to 65ish.

The agenda was jammed packed. It covered logistical topics (market access, pricing of laboratory equipment, supply chain management, service delivery and design, forecasting and budgeting), technical topics (CD4, viral load, rapid diagnostic tests, TB, Malaria), surveillance and quality control issues (regulatory frameworks, post market surveillance, MOH structures and policies) and large policy issues (early infant diagnosis, point of care technologies, user fees). Hearing the debates and experiences of both scientists and analysts who’ve been working in this field for a while was extraordinarily helpful. Not only did it expose me to concerns and nuances that I’ve not yet encountered in Uganda, but it gave me a framework through which to view my work and a number of new ideas to run by the MOH.

Though our schedule was quite full, we did have an afternoon free and I extended my stay by one extra day so as to have slightly more time in the city. Because it would be excruciatingly boring to post pictures of our conference room (where I spent the vast majority of my time), I’ve included a couple of shots from sites around Bangkok. More can certainly be found in the new photo album I’ve created! I leave Bangkok in about an hour to return to Uganda, so my next post, though it may recount a story or two from Thailand, will greet you from Kampala.

(Pictures embedded in this blog include the Grand Palace, the Golden Budda, chapels that surround the Reclining Budda (and their reflections).

On Great Friends and Good Fun

On Monday, June 8^th a wonderful thing happened to me. One of my closest friends from Swarthmore, Garth, showed up at the Clinton Foundation office in Kampala. My first friend to travel all the way to Uganda solely to visit me, Garth reminded me all over again what fantastic friends I have, and how exceedingly lucky I am.

The following day, the two of us took the bus to Jinja to raft the source of the Nile. Now, if any of you missed the Times article a few weeks ago describing this experience, here it is: http://travel.nytimes.com/2009/05/24/travel/24uganda.html?8dpc. Needless to say, rafting was great fun, and the day wrapped up splendidly with a spread of beef skewers—my pescatarianism has become significantly more lax since moving to Uganda (I can hear many male friends rejoicing from here)— and Nile Special beer. Wednesday I worked a full day, followed by a Khana feast (see the below blog entry), which Garth absolutely loved, deeming it the best Indian food he’s had outside of Asia.

Thursday morning the two of us left early for three full days of safari. We drove north to Murchinson National Falls/Park, where we went chimpanzee tracking, game driving, and Nile boating. We saw incredible wildlife—elephants, giraffes, hippos, buffalo, crocs, a lion, baboons, warthogs, a plethora of different deer type species, etc.—and gorgeous scenery. Highlights of the trip included the boat ride down the Nile and the Red Chili Rest Camp, a very comfortable budget accommodation facility that we shared with a group of close to 30 missionaries from the States. The nature of our company of course led to some interesting conversations between Garth and me, and between the two of us and a subsection of the young, college-age group. On the return to Kampala, the two of us dined at the Masindi Hotel, the oldest hotel in Uganda, where Humphrey Bogart and Katharine Hepburn spent significant time while filming The African Queen and Ernest Hemingway also resided for a while. It was very posh indeed.

After a few more good meals (Khana take II), a Ugandan music and dance concert, and a day spent relaxing at the Kabira pool while I worked, Garth departed this past Tuesday.

I realize that this blog entry is not as descriptive as some of my earlier posts, and that's largely because these are creatures and sites that one needs to see for themselves. Describing them is relatively futile. Since transporting everyone over isn't realistic, I've done the next best thing: finally uploaded pictures! Colby, I am sincerely sorry that it's taken me so long. There is a very simple reason for the delay: internet in Uganda is not fast enough to quickly upload large files (i.e. photographs). So, I needed to wait until I was somewhere outside of Uganda (and sub-Saharan east African in general) in order to upload. More on that in my next blog, but in the meantime, enjoy the photos from the safari, and from my earliest days in Uganda!

http://www.flickr.com/photos/39613627@N04/sets/

On Problems

Due to the below-mentioned medical situation, I’ve needed to reduce my normal level of exercise. In an attempt to move a little, while not putting unnecessary strain on my leg, I’ve taken to going on long walks around Naguru, the area where I live. Now, the decision regarding whether to walk with or without music is a crucial one. Strolling with music blasting from my headphones makes it difficult for me to hear approaching cars; thus, as there are no sidewalks, I’ve more than once genuinely thought I was going to be hit by a moving vehicle. (As an aside, there are likely people reading this with whom I’ve been on the phone during these encounters, and I sincerely apologize for any stress or concern I've caused.) On the flip side, walking without the ability to zone out to the tunes on my iPod leaves me vulnerable to the type of encounter I describe below.

Last Tuesday morning I woke early to embark on one of these lengthy walks. After sipping a cup of coffee while I wrote a few emails, I threw on the oversized red Cornell t-shirt my brother kindly brought me from his alma-mater and my black mesh shorts with paint stains all over the behind, a remnant from a service expedition in New Orleans this past spring. Popping on my now red-tinted sneakers (Kampala is largely composed of a maroon colored dirt that gets very dusty when it doesn’t rain), I headed for the door, sans music. Note that I’ve said nothing about combing my hair (or doing anything with it for that matter), washing my face, brushing my teeth, or any other form of basic grooming/maintenance. When I go for my morning walks, I put zero thought into looking attractive.

After walking for about forty-five minutes and working up a decent sweat (Naguru is very hilly and it gets hot quickly), I turned down the last, fifteen minute stretch towards my house. On the opposite side of the street, a man was walking along in my same direction, unaccompanied. About fifteen seconds after noticing me, this young fellow said, “Hello! How are you?” Not wanting to be rude, I turned and said “I’m good, thank you. How are you?” The response: “I am good. What about you?” Instantly identifying the cyclical nature of this scintillating conversation, I decided to see how long it would last. “I’m doing well,” I said, “and how are you?” The response: “My problem,” admitted the man candidly, “is that I love you.”

Well, that brought our circular chat to a screeching halt, as I was surely not going to respond in kind. Amused by the absurdity of his comment, I smiled. Bad move. At this slightest of encouragements, my new found friend promptly crossed the street and walked along beside me. “Ah,” I said to him once he arrived by my side, “that certainly is a problem.” “Do you love me too?” this man asked, hopefully.

“Well, you see, I’m married,” I started, then glanced down and to the left at my obviously naked ring finger. Note to self: become faster at relocating ring usually situated on left middle finger. “I have a very serious boyfriend,” I offered, consolingly, “and I care about him very much.” After a couple of questions aimed at determining the veracity of this statement, including the location of my boyfriend, and if I loved said boyfriend more than him, my new friend fell silent for all of about three seconds before inquiring optimistically, “do you have any sister?”

Though I did question fleetingly how this man’s love could have moved so quickly from me to my potential, unmet sister, I quickly realized the absurdity of this entire line of reasoning. Instead, my thoughts went directly to my sister, Katherine, to whom I happened to be writing a lengthy email and who had been on my mind through much of my walk. “Yes, I do have a sister,” the first truthful thing I’d told this man so far, “but she is not here; she is in the United States.” Taking it one step further, more for my amusement than anything else, “you would have to have a long-distance relationship.” This of course, was JUST what Katherine needed (on top of the other stresses in her life right now): a long-distance Ugandan boyfriend whom she’s never met. I smiled at the entire concept. For the record, I don’t think my friend found the concept too appealing either; I’m doubtful that a long-distance emotional, non-physical relationship with a young woman he’s never met was really what he sought.

After contemplating this idea for a minute or two, his step slowed and he started to lag behind me. “It was nice talking to you!” I said, and smiled. He smiled back and said “good day”.

On Heparin

Considering that two of my closest friends from Swarthmore are pursuing MDs—Ben and Jayne (to brag on her behalf, Jayne is actually pursuing a MD/PhD)—and that I have personally begun a career consulting in health-related fields, one would think that I would have a profound respect and appreciation for medical doctors. Though I’d like to claim to be a compliant patient (both jobs I’ve held LOVE compliant patients), I seem to have inherited my family’s general disregard for medical expertise and preference for denial. This proclivity to ignore medical advice, coupled with a genetic propensity for blood clots and a fourteen hour flight (twelve of which I spent asleep), caused what was diagnosed at Kampala Hospital as an early stage blood clot.

Before I go any further, I’m FINE. No need to worry at all. I’m describing the back-story only to describe what came next: a prescription for two weeks worth of daily heparin injections! Now, for many, this would be a non-issue. But, for someone who as a child needed to be restrained by multiple nurses for any procedure that involved skin puncture, still gets visibly pale while blood is being drawn, and genuinely appreciates her coworker’s offer to hold her hand during dreaded annual corporate flu shot day (and takes him up on it two years running), this was not the scrip for which I was hoping. Unfortunately, the only orally administered anticoagulant alternative was Coumadin (warfarin), which is extremely difficult to dose, as it requires constant monitoring of the international normalized ratio (INR). In an attempt to avoid weekly blood tests and ingesting a drug too little of which is useless and too much of which is used as rat poison (literally) and can be fatal to humans as well, I opted for the heparin.

My colleagues could not have been nicer or more helpful throughout the entire ordeal. They waited with me at the hospital, sought appropriate medical advice, helped me weigh treatment options, and, two of my four coworkers have now administered my heparin shots. Considering that administering daily subcutaneous injections was unlikely part of either's job description, both Matt and Ian have really gone above and beyond. Additionally, both are better at giving these shots than the nurses at International Hospital of Kampala, which bodes excellently for Ian’s future as a physician!

On the plus side, I’ve learned a valuable lesson: listen to doctors and be a compliant patient, even if the condition is asymptomatic! Additionally, I’m hopeful that this experience will put me one step closer to overcoming my fear of needles, though that certainly still remains to be seen.