I like my women like I like my hospitals. The largest in the Southern Hemisphere.
On Thursday I visited Chris Hani Baragwanath Hospital. Bara is the main hospital serving Soweto, a black area that abuts the southwest of JoBurg. It was a separate municipality until 2002 but now Soweto is considered part of JoBurg. There are clinics in Soweto, but if you need a hospital for something serious, or you can't pay very much (or at all) you go to Bara. The hospital gets 150 000 inpatients and 500 000 outpatients per year and 160 gunshot wounds a month (1).
Aside from being really really big, Bara is unlike any hospital I have ever seen. I have only seen hospitals in America, where they are usually squareish buildings with a lot of concrete. Bara has lots and lots of one-story buildings as well as two larger buildings and a variety of sizes in between. The largest building is about 11 stories. The wards are mostly 1 story and they are scattered around the middle area of the grounds. There are brick buildings, concrete, tin roofs, and a variety of colors. There are small buildings scattered around between the wards. Some of them are restrooms, some have doctor’s office, some sell halal food.
I was at Bara to learn about the GERMS-SA surveillance and burden of disease. The Group for Enteric, Respiratory and Meningeal Disease Surveillance-South Africa (GERMS-SA) does surveillance for a variety of disease that are associated with HIV positive individuals. HIV is one of the risk factors for invasive pneumocococcal disease generally, as well as for serotype 19A specifically, which I am working on. Bara has about six surveillance officers for adults and 1 for pediatrics, all women. In SA, nurses are called nursing sisters. Sadly, male nurses are not nursing brothers. When diseases under surveillance by GERMS-SA are identified in the hospital laboratory the surveillance officers go to the patient to ask for consent to have that person be a part of the surveillance.
The sisters told us that finding patients and consenting them can be tricky. Older patients may be illiterate. Sometimes it is hard to locate patients in such a large hospital. Patients with cryptococcus are often experiencing cognitive difficulties. People may abscond. We couldn’t locate a patient and the sisters thought he might have absconded. People may be transferred to the step-down hospital before the sisters have time to see them. People may be unclear about what they are consenting to because they want to be treated and so want to approve everything. This happens with HIV testing as well. GERMS-SA wants to identify HIV positive individuals. Sometimes patients “consent” to HIV testing. Then when asked if they want to receive the results, they don’t.
The first patient we saw was a child. The mother was there and so the surveillance officers were collecting information from the chart and from talking to the mother. They want to know things like vaccination record, temperature on the day the CSF isolate was collected, does the child live with siblings under 18, has the child been hospitalized recently, etc. If the patient is a child, surveillance officers will check when family members visit so they can talk to someone.
While walking to the next patient we had a fascinating discussion about HIV treatment. People will often see a traditional healer, either instead of seeking treatment or in conjunction. This occurs especially in HIV positive individuals with Cryptococcus as the mental effects may seem to be a curse from someone else or spirits and also may affect judgement. The doctors try to incorporate the traditional healers into the health plan and people will come with their healer to the doctor. Also, we learned that people sell anti retroviral drugs to drug dealers. ARVs can cause hallucination even if taken correctly so people will grind them up and smoke them for fun (2). About this time we passed a condom lying in the gutter. Oh JoBurg.
Then we looked for a patient in one of the adult wards. He wasn’t where they expected so they did a bit of investigating. They knew where he had been admitted and so they could check the night counts and what the computer system said about transfers. They weren’t sure if he was transferred to a different ward and it wasn’t noted or if he absconded. The wards are segregated by gender. This seemed strange to me because I don’t think of US hospitals as segregating by gender but I guess they do. We do it by room but their wards are one giant hall so it’s the same idea. It just felt different because it isn’t stated in the US, only one gender but room, but I guess that’s the policy. I asked a sister about it and she said privacy is important and “you wouldn’t put a lion in a room with a lamb.”
The next patient we saw was an HIV positive individual with Cryptococcus. The patient (TP) was experiencing cognitive effects so TP had been admitted to the hospital. TP had ARV medication but hadn’t been compliant with the treatment. Both interviews by the surveillance officers were in languages I don’t speak so they would have to explain what was happening. TP wasn’t clear on the importance of taking medication and possibly TP’s counseling when TP was diagnosed with HIV was not adequate. TP wanted to know about buying ARVs but that would be very expensive and they would be free at the hospital. Sometimes people that are HIV postive are in denial or don’t want to talk about their status because of the stigma so the sisters will talk to them about treatment without talking about their status. It was sad to see TP because TP was very nice and the sisters were trying to impress upon TP to take TP’s medicine and TP didn’t seem to be getting it. One of the doctors told us if TP wasn’t complying with his treatment he would be sent to the step-down hospital and then discharged because they need the bed available. One of the people with me on the site visit was an MD from London and she said TP would probably relapse and die from crypto if TP didn’t take the medicine for that.
Then we went to the morgue where the sisters sometimes go to check about paperwork. There was music playing a bit loudly in the morgue. The sisters told us that is to keep the spirits cheerful.
There is a building at Bara for prisoners that require medical treatment. Also you see people with orange jumpsuits and wrist and ankle chains being escorted around the grounds. We went to an HIV clinic next and it was pretty crowded. The waiting room had about 30 people in it including a prisoner. It is an obstacle to testing and treatment that the HIV care is pretty centralized in Soweto. It can be hard for people to get the Bara.
The sisters were very friendly and worked hard. It was great to see where my dataset has come from and what data they have trouble collecting. I asked one how long she has worked at Bara and she had been there 4 years. She said she enjoyed her job and it is interesting but it is hard because so many people have HIV. She said ARV treatment wasn’t helping very much because people get sick before they are started on ARV. I think the CD4 count has to get below a certain number before ARV is started. In the 80’s mortality at Bara was similar to a hospital in the US but now it is much higher. It can make treating patients seem futile. I was a little concerned with some aspects of the data quality after seeing the sisters. For example, they mentioned that they round age up. If I have a date of birth, I use that. If not, I go with the indicated age.
Then I went on pediatric rounds. I have been on rounds once before, at the ICU at SF General. That tine, there were a few people dying, a lot of people with trache tubes that couldn’t talk and seemed pretty miserable, etc. Although yesterday we were seeing sick kids, it was still kind of cheerful, compared to SF. In one room, there was a dad laughing as his kid held a Gatorade bottle for his dad like a bottle. The rooms were painted brightly with lots of images on the walls. There were usually parents with the kids and sometimes there were siblings too. The kids all had infections of some kind and antibiotic resistance is often a problem.
In one of the wards I vaguely noticed something on the ground but it didn’t register because hospitals often have miscellaneous equipment scattered around. The doc mentioned how it is hard to do infection control and pointed. I realized it was a sink on the ground that was ripped out of the wall. Everything was a bit grubby and the doctors talked at times about having trouble getting certain (expensive) medicines, but they seemed very competent and able to treat the kids.
Jeff
1. http://www.chrishanibaragwanathhospital.co.za/bara/article.jsp?id=161
2. http://www.aidshealth.org/news/in-the-media/no-turning-back-teens.html
p.s. I retracted my earlier post about hearing gunfire (in the comments), but I should say it on the front page too. It was just a loud noise. Although a friend of a friend was shot in an attempted carjacking near to where I live. She survived.
Friday, July 3, 2009
Tuesday, June 30, 2009
Happy 4th of July!
We have upon us what is arguably the best holiday ever -- the 4th of July!
So, what's everyone doing to celebrate this weekend?? Are you celebrating with other Americans, hosting a BBQ, or bringing yard games and fireworks to the locals? Whatever it is, take plenty of pictures and we'll have a story and picture posting blitz on the 5th! Pictures with American flags get extra props!
Happy 4th!
So, what's everyone doing to celebrate this weekend?? Are you celebrating with other Americans, hosting a BBQ, or bringing yard games and fireworks to the locals? Whatever it is, take plenty of pictures and we'll have a story and picture posting blitz on the 5th! Pictures with American flags get extra props!
Happy 4th!
Monday, June 29, 2009
Grananda
First of all, Granada = heaven. It is my favorite place so far in Nicaragua, and I feel slightly guilty saying so because it is very touristy (aka lots of gringos, different foods, streets are clean) but it was really beautiful. It is the oldest Spanish colonial city in Central America and there were great churches and cathedrals. This is us at a lookout over a lagoon that connects to Lake Nicaragua. (Still not sure how a lagoon is different than a lake but enough to look it up). Don't let this picture fool you, we were hotter than ever, it was over 100 and I was sweating sunscreen!
Fabulous market where Allison secured her hammock.
Happy Hour! Two mojitos for $1.25. You know what that means.
Cathedral. For the Jesus lover in all of us.
Time is running out and I am sad! Only a month left. I was going to travel up Central America but those damn Hondurans are having a coup so I think I will instead go down Costa Rica and Panamá. Maybe dabble in Columbia. Mwhahaha.
Tourist in Hanoi (Ron)
I thought I would add some pictures and comments from the tourist sites that I've visited in Hanoi. Most of these I saw a few weeks ago but some were just this past weekend.
This Hoan Kiem Lake, one of the multiple lakes in Hanoi but the most popular being right in the center of downtown.
A refurbished section of Hoa Lo prison. Originally constructed as a prison to hold Vietnamese political prisoners fighting against French occupation it is commonly known as the famous prison where US Soldiers were held during the "American War" as it's known here.
The Temple of Literature is the first "university" of Vietnam established in 1076. It has stone tablets with the names of its doctoral graduates.
I enjoy the Night market better in Hanoi than in other places. It's more of a gathering place for a nice walk than the Ben Thanh market in Ho Chi Minh City (Saigon) where you are treated as a walking wallet.
Speaking of "Uncle Ho" here is his final resting place and Ba Dinh square. The sheer size of this open area is hard to describe. In one of the most crowded cities I have seen, this large open area is just stunning.
My project is coming along fine. Two months just isn't a lot of time to get even basic research done in my mind, but I think what I'll collect will be helpful to ACS and hopefully to the organizations here.
This upcoming weekend I'm going to travel to Sapa which is a nothern mountainous region where many ethnic minorities live. Hiking along the rice paddies from village to village sounds like a great way to spend my weekend in attempt to get away from city life.
This Hoan Kiem Lake, one of the multiple lakes in Hanoi but the most popular being right in the center of downtown.
A refurbished section of Hoa Lo prison. Originally constructed as a prison to hold Vietnamese political prisoners fighting against French occupation it is commonly known as the famous prison where US Soldiers were held during the "American War" as it's known here.
The Temple of Literature is the first "university" of Vietnam established in 1076. It has stone tablets with the names of its doctoral graduates.
I enjoy the Night market better in Hanoi than in other places. It's more of a gathering place for a nice walk than the Ben Thanh market in Ho Chi Minh City (Saigon) where you are treated as a walking wallet.
Speaking of "Uncle Ho" here is his final resting place and Ba Dinh square. The sheer size of this open area is hard to describe. In one of the most crowded cities I have seen, this large open area is just stunning.My project is coming along fine. Two months just isn't a lot of time to get even basic research done in my mind, but I think what I'll collect will be helpful to ACS and hopefully to the organizations here.
This upcoming weekend I'm going to travel to Sapa which is a nothern mountainous region where many ethnic minorities live. Hiking along the rice paddies from village to village sounds like a great way to spend my weekend in attempt to get away from city life.
Sunday, June 21, 2009
Pacific (Kaleigh)
Hi!
I may have mentioned that Pohnpei is kind of a boring place… well, the massive Pacific Ocean that surrounds it most certainly is NOT boring. We almost died today and I am not exaggerating. Lois’ husband, Konrad, took us to Ant Atoll (an outer island about 25 miles from Pohnpei) on his small fishing boat. On our way to Ant Atoll, we did some snorkeling first. It was the most impressive coral reef. I cannot even describe it. This is one of the best places in the world for seeing such sights and now I know why. It was just tons and tons of coral reef (a wall) that spans an entire island. Kim took some underwater pictures, so hopefully I will steal some from her eventually. Alyssa saw a couple of reef sharks (Konrad said we probably would), but I didn’t see them... they were far below us.
We arrived at Ant Atoll, an uninhabited island, and it is exactly what people picture when you think of deserted tropical island… turquoise waters, sandy beach, palm trees. It was incredible and untouched. The only animals on the island are things like birds, salamanders, and lots and lots of hermit crabs. We ate lunch there (pasta salad with mangrove crab, basil spaghetti, boiled eggs, and pineapple) and then napped under some trees. We also did a little bit of snorkeling, but there wasn’t a whole lot to see except crystal clear water and sand. However, we did see a little coral reef with an eel in it. Supposedly there are a lot of stingrays where we were, but we didn’t see any.
Then it was time to head back to Pohnpei. We were in unprotected waters and the wind was extremely strong and we encountered choppy 6 foot waves. The boat got airtime more times than makes on comfortable and it started pouring. At first we thought it was fun, and then it started getting scary. It just got worse and worse. Eventually I had to get a bucket to take water out of the boat. It was very, very scary. Luckily Konrad is a good boat driver. :)
Well, that is about all we did today. It is 8:15 and we are in bed. (It was a big day. )
By the way, I am back to my ORIGINAL research project, which is probably best because I had put a lot of work into it and was prepared to do it. We will see how it goes.
Take care,
Kaleigh
I may have mentioned that Pohnpei is kind of a boring place… well, the massive Pacific Ocean that surrounds it most certainly is NOT boring. We almost died today and I am not exaggerating. Lois’ husband, Konrad, took us to Ant Atoll (an outer island about 25 miles from Pohnpei) on his small fishing boat. On our way to Ant Atoll, we did some snorkeling first. It was the most impressive coral reef. I cannot even describe it. This is one of the best places in the world for seeing such sights and now I know why. It was just tons and tons of coral reef (a wall) that spans an entire island. Kim took some underwater pictures, so hopefully I will steal some from her eventually. Alyssa saw a couple of reef sharks (Konrad said we probably would), but I didn’t see them... they were far below us.
We arrived at Ant Atoll, an uninhabited island, and it is exactly what people picture when you think of deserted tropical island… turquoise waters, sandy beach, palm trees. It was incredible and untouched. The only animals on the island are things like birds, salamanders, and lots and lots of hermit crabs. We ate lunch there (pasta salad with mangrove crab, basil spaghetti, boiled eggs, and pineapple) and then napped under some trees. We also did a little bit of snorkeling, but there wasn’t a whole lot to see except crystal clear water and sand. However, we did see a little coral reef with an eel in it. Supposedly there are a lot of stingrays where we were, but we didn’t see any.
Then it was time to head back to Pohnpei. We were in unprotected waters and the wind was extremely strong and we encountered choppy 6 foot waves. The boat got airtime more times than makes on comfortable and it started pouring. At first we thought it was fun, and then it started getting scary. It just got worse and worse. Eventually I had to get a bucket to take water out of the boat. It was very, very scary. Luckily Konrad is a good boat driver. :)
Well, that is about all we did today. It is 8:15 and we are in bed. (It was a big day. )
By the way, I am back to my ORIGINAL research project, which is probably best because I had put a lot of work into it and was prepared to do it. We will see how it goes.
Take care,
Kaleigh
Saturday, June 20, 2009
Settled in Southern Israel (Heidi)
I've become quite comfortable here in Beersheva and have settled into a nice working routine. During the week I'm at the Medical Center writing about comparisons between the Incident Command Systems (ICS) in Israel and Atlanta. It didn't take long to learn that comparing these two was like comparing apples and pumpkins... So I've made a few changes in the topics I'm looking at and will hopefully be able to generate something a little more practical. This week I'll also be switching my focus a little and looking at the role and development of resilience within the communities here. I'm really looking forward to this and hopefully will be able to use some aspect of this for my thesis.
I've taken the train back up to Tel Aviv and Netanya (up by Haifa), to attend two separate hospital preparedness events. Both were excellent supplements to the military drill I saw my first week here and provide a good background for learning more about mass trauma hospital response. Photo descriptions: The hospitals keep protective suits for their staff for use when patients come in from explosions that occur during wartime or a suspect blast. The decontamination showers are outside the hospitals here, much different from the US where decon takes place at the sight.
I can't say enough about the people I'm working with. They have done so much to make sure I'm taken care of and are really looking after me. Before I arrived my supervisor here put me in contact with one of her graduate students, Adi, which has made it really easy to find things to do and meet people. It seems every night I am invited with her friends to play volleyball, ultimate frisbee, swimming, or repelling. I have found this an excellent chance to get to know "true" Israeli life, especially that of young people here. Plus, they have group meals it seems every night, and they're making sure I'm getting to try all the traditional Jewish food. I could post dozens of pictures of the amazing food here! The Friday feasts are really spectacular and this past Friday we had one that was really traditional with the prayers and separation of meats and milk. Very cool. Photo descriptions: Getting ready for a night of competative foosball... playing volleyball (I've never played when it's this hot)... one of the many delicious meals, this night there were 13 people that brought dishes! 
Last Tuesday was Student Day, and so they had a big 24 hour music festival. Most of the artists sang in Hebrew, but it's pretty amazing how you don't need to understand the words to sing along with the chorus! The whole thing was really fun and it was great to get out and enjoy a little Goldstar-the main beer in Israel. Here's a picture from the festival.
Unfortunately I haven't done much sightseeing -- I've been in Israel for 3 weeks and haven't even visited Jerusalem! How sad is that! Part of this is due to the fact that public transportation doesn't run on Friday afternoons or Saturdays... so it's a bit of a planning dilemma when I'm working all week (the work week here is from Sunday to Thursday), so I'm definitely glad I gave myself a couple weeks at the end to travel. But it's great knowing locals because they have cars and know all the secrets: next Saturday Adi and some friends are planning a morning climb up Masada so I can see the Dead Sea at sunrise, and there's also a 3 day hiking/camping trip at the Sea of Galilee in the works, where I'll get to stay at my first kibbutz! Photo descritptions: I realized I haven't posted any pictures of the area -- just preparedness stuff! So, here's Tel Aviv from the Jaffa side... the Jaffa port is one of the oldest ports in the world, apparently it's referenced in the Bible and was constructed around the time of Alexandria... OK, so India had feral dogs, here cats are absolutely everywhere. Everytime you walk by a dumpster they scatter like crazy. I'm tempted to pet them but I'm sure I'd get infected with a few hundred diseases...
I've taken the train back up to Tel Aviv and Netanya (up by Haifa), to attend two separate hospital preparedness events. Both were excellent supplements to the military drill I saw my first week here and provide a good background for learning more about mass trauma hospital response. Photo descriptions: The hospitals keep protective suits for their staff for use when patients come in from explosions that occur during wartime or a suspect blast. The decontamination showers are outside the hospitals here, much different from the US where decon takes place at the sight.
I can't say enough about the people I'm working with. They have done so much to make sure I'm taken care of and are really looking after me. Before I arrived my supervisor here put me in contact with one of her graduate students, Adi, which has made it really easy to find things to do and meet people. It seems every night I am invited with her friends to play volleyball, ultimate frisbee, swimming, or repelling. I have found this an excellent chance to get to know "true" Israeli life, especially that of young people here. Plus, they have group meals it seems every night, and they're making sure I'm getting to try all the traditional Jewish food. I could post dozens of pictures of the amazing food here! The Friday feasts are really spectacular and this past Friday we had one that was really traditional with the prayers and separation of meats and milk. Very cool. Photo descriptions: Getting ready for a night of competative foosball... playing volleyball (I've never played when it's this hot)... one of the many delicious meals, this night there were 13 people that brought dishes! 
Last Tuesday was Student Day, and so they had a big 24 hour music festival. Most of the artists sang in Hebrew, but it's pretty amazing how you don't need to understand the words to sing along with the chorus! The whole thing was really fun and it was great to get out and enjoy a little Goldstar-the main beer in Israel. Here's a picture from the festival.
Unfortunately I haven't done much sightseeing -- I've been in Israel for 3 weeks and haven't even visited Jerusalem! How sad is that! Part of this is due to the fact that public transportation doesn't run on Friday afternoons or Saturdays... so it's a bit of a planning dilemma when I'm working all week (the work week here is from Sunday to Thursday), so I'm definitely glad I gave myself a couple weeks at the end to travel. But it's great knowing locals because they have cars and know all the secrets: next Saturday Adi and some friends are planning a morning climb up Masada so I can see the Dead Sea at sunrise, and there's also a 3 day hiking/camping trip at the Sea of Galilee in the works, where I'll get to stay at my first kibbutz! Photo descritptions: I realized I haven't posted any pictures of the area -- just preparedness stuff! So, here's Tel Aviv from the Jaffa side... the Jaffa port is one of the oldest ports in the world, apparently it's referenced in the Bible and was constructed around the time of Alexandria... OK, so India had feral dogs, here cats are absolutely everywhere. Everytime you walk by a dumpster they scatter like crazy. I'm tempted to pet them but I'm sure I'd get infected with a few hundred diseases...
Friday, June 19, 2009
The Good and The Bad (Ron)
I haven't posted in a while partly my own doing and partly because I felt too sick to leave my bed.
So the beginning........
A few weeks ago I was notified by my work that they would be holding a journalist training seminar on how to write effective tobacco control stories. The 2 day conference was to be held in Ha Long which is about a 3.5 hour drive from Ha Noi. So I thought to myself, what a wonderful opportunity to visit Ha Long Bay the weekend before and begin the conference the following Monday. So I booked overnight passage on the SS White Dolphin. Here's a picture of it's little cousin - my boat was another floor bigger.
Ha Long Bay was absolutely beautiful. It was simply amazing to see the limestone rock formations sharply extend from the water which is turned a very pretty green due to the dissolved rock. Everything is so calm with the exception of all the other boats touring the bay but when you have some free time it's truly a relaxing place to be.
The trip itinerary was a little touristy for my liking but we did explore "Surprise Cave" (ask me why it's a surprise and I'll show you the picture), hike one of the islands and kayak a smaller enclosure.
Pretty much the entire time was a relaxing boat cruise on the bay. I ate great seafood and met some really nice people as well.
The conference was likewise a really enjoyable time. Even though I did not understand a word of what was being said without the translator it was successful in that I gained some insight for my work here on Vietnamese media. I met and talked with some newspaper reporters, and TV correspondents - all of these contacts will help in the future when I need some insight into their tobacco control efforts.
Through a work friend I was invited into the home of a local family (the toddler son did not like me), drank beer and ate squid by the bay, and enjoyed pleasant conversation into the evening.
Even the 3.5 hour return bus ride to Ha Noi was enjoyable.
But if the universe is a zero-sum game, I certainly paid for it in the following days.
I made it in to work Wednesday morning noticing that it was hotter than most days (it really was) but that when I made it inside the office I was continuing to sweat. To make matters worse, we had run out of bottled water and a new shipment wasn't due for a few hours. I toughed it out but was feeling pretty bad with some lower back muscle pain. I thought it was due to dehydration, but after 3-4 bottles of water and lunch I decided that I wasn't feeling well enough to work throughout the day. I told the office that I was going home but would likely return tomorrow.
I made it home but by this time I was really burning up. Sure enough the thermometer was beeping with a temperature of 100.5. I monitored it throughout the day and it steadily climbed to 102 before plateauing. Then on came the headaches and diarrhea. Sadly this continued for another 3 days. I literally left my room a total of 3 times in five days all of which to go buy small amounts of food and large amounts of water.
This was the most sick I have felt in a long time.
When I finally recovered, I made it back to work just in time to be the butt of jokes pertaining to H1N1 and the American.
So the beginning........
A few weeks ago I was notified by my work that they would be holding a journalist training seminar on how to write effective tobacco control stories. The 2 day conference was to be held in Ha Long which is about a 3.5 hour drive from Ha Noi. So I thought to myself, what a wonderful opportunity to visit Ha Long Bay the weekend before and begin the conference the following Monday. So I booked overnight passage on the SS White Dolphin. Here's a picture of it's little cousin - my boat was another floor bigger.
Ha Long Bay was absolutely beautiful. It was simply amazing to see the limestone rock formations sharply extend from the water which is turned a very pretty green due to the dissolved rock. Everything is so calm with the exception of all the other boats touring the bay but when you have some free time it's truly a relaxing place to be.
The trip itinerary was a little touristy for my liking but we did explore "Surprise Cave" (ask me why it's a surprise and I'll show you the picture), hike one of the islands and kayak a smaller enclosure.
Pretty much the entire time was a relaxing boat cruise on the bay. I ate great seafood and met some really nice people as well.The conference was likewise a really enjoyable time. Even though I did not understand a word of what was being said without the translator it was successful in that I gained some insight for my work here on Vietnamese media. I met and talked with some newspaper reporters, and TV correspondents - all of these contacts will help in the future when I need some insight into their tobacco control efforts.
Through a work friend I was invited into the home of a local family (the toddler son did not like me), drank beer and ate squid by the bay, and enjoyed pleasant conversation into the evening.
Even the 3.5 hour return bus ride to Ha Noi was enjoyable.
But if the universe is a zero-sum game, I certainly paid for it in the following days.
I made it in to work Wednesday morning noticing that it was hotter than most days (it really was) but that when I made it inside the office I was continuing to sweat. To make matters worse, we had run out of bottled water and a new shipment wasn't due for a few hours. I toughed it out but was feeling pretty bad with some lower back muscle pain. I thought it was due to dehydration, but after 3-4 bottles of water and lunch I decided that I wasn't feeling well enough to work throughout the day. I told the office that I was going home but would likely return tomorrow.
I made it home but by this time I was really burning up. Sure enough the thermometer was beeping with a temperature of 100.5. I monitored it throughout the day and it steadily climbed to 102 before plateauing. Then on came the headaches and diarrhea. Sadly this continued for another 3 days. I literally left my room a total of 3 times in five days all of which to go buy small amounts of food and large amounts of water.
This was the most sick I have felt in a long time.
When I finally recovered, I made it back to work just in time to be the butt of jokes pertaining to H1N1 and the American.
Wednesday, June 17, 2009
Melville
I haven't been writing very much about work because it is not very exciting. Using a computer, meetings, learning lab techniques. So, travel writing.
Over the weekend I went to visit Waverly in Melville, which is a neighborhood in JoBurg (hi Waverly!). Firstly, I called a cab to pick me up at the compound. Lots of people who live in JoBurg don’t know where Sandringham is. It’s also called “Jewish” because it’s an area where Jewish people live. Cabbies mostly know where Sandringham is, but then they don’t know where the NICD is. There aren’t really address numbers in the area I live, so you can’t locate 1 Modderfontein Rd by trial and error. You have to know where NICD is. So, of course, the cabbie can’t find me and I have to explain things I’m near, like Sandringham HS and the Elfin Lodge (old people home).
Finally, he finds me, and great, we are off to Melville, which is near Witz University (the main university in JoBurg). He must not be very good at being a cabbie because we get comically, comically lost. Literally, driving in circles and stopping over and over to ask people where Melville is. This seems crazy to me, it’s one of the neighborhoods in a city you are a cabbie in. And other people didn’t know either! We passed through the worst area I’ve seen in JoBurg yet, which was fun to see while uneasy in a cab. It may have been Hillbrough, one of the two places you are definitely not supposed to go, ever. Razor wire even more everywhere than normal, people passed out/sleeping in a park, and it just felt dangerous. A ride that should have taken 30 minutes took an hour and a half instead. The cabbie was nice and he really was lost and not doing the scam-the-foreigner routine. He didn’t charge me much more than it should have cost without the impromptu tour of JoBurg (200 rand, rand is 8 to 1 with dollars).
I arrived eventually and met up with Waverly and we went exploring in Melville. We heard so much about how dangerous JoBurg was before leaving that it felt weird for me just to be walking around on the street. Also, I had spent about three weeks in the compound without leaving except to go to the mall a few times, so being outside around people and stores was making me a bit giddy. We wandered around the residential area in Melville while getting slightly lost in search of a café with internet. There was a reverse vampire effect, where we had to be home before the sun went down because I had my laptop with me.
Finally, he finds me, and great, we are off to Melville, which is near Witz University (the main university in JoBurg). He must not be very good at being a cabbie because we get comically, comically lost. Literally, driving in circles and stopping over and over to ask people where Melville is. This seems crazy to me, it’s one of the neighborhoods in a city you are a cabbie in. And other people didn’t know either! We passed through the worst area I’ve seen in JoBurg yet, which was fun to see while uneasy in a cab. It may have been Hillbrough, one of the two places you are definitely not supposed to go, ever. Razor wire even more everywhere than normal, people passed out/sleeping in a park, and it just felt dangerous. A ride that should have taken 30 minutes took an hour and a half instead. The cabbie was nice and he really was lost and not doing the scam-the-foreigner routine. He didn’t charge me much more than it should have cost without the impromptu tour of JoBurg (200 rand, rand is 8 to 1 with dollars).
I arrived eventually and met up with Waverly and we went exploring in Melville. We heard so much about how dangerous JoBurg was before leaving that it felt weird for me just to be walking around on the street. Also, I had spent about three weeks in the compound without leaving except to go to the mall a few times, so being outside around people and stores was making me a bit giddy. We wandered around the residential area in Melville while getting slightly lost in search of a café with internet. There was a reverse vampire effect, where we had to be home before the sun went down because I had my laptop with me.
After dropping off valuables at home we went out to dinner. There are about 7 blocks between the main street Waverly lives near (Main Street) and the night-life street with bars and restaurants we were going to (7th). This is not something I would think twice about in the States, but Waverly and I have to get into an involved discussion about walking 10 minutes at night. How late we should stay out. And what to do if we see people walking towards us or hanging out on the street. And whether we should go on the slightly shorter street or the busier street that is a bit longer. And, etc. (Safety meeting that emphasized how scary foreign countries are, and JoBurg especially, mission accomplished). I got my wallet ready to hand over to a mugger by removing half of the money and my ID.
For dinner we went to a Chinese/sushi place. Things are cheaper in JoBurg so we had a fantastic meal with sushi, multiple courses of Chinese food, beer, desert and tea for about $10 each. We had Windhoek, which I like more than Castle, the main beer in SA. Windhoek is less bitter and a bit sweeter. They are both lagers. Draft beers are about $1.50.
For dinner we went to a Chinese/sushi place. Things are cheaper in JoBurg so we had a fantastic meal with sushi, multiple courses of Chinese food, beer, desert and tea for about $10 each. We had Windhoek, which I like more than Castle, the main beer in SA. Windhoek is less bitter and a bit sweeter. They are both lagers. Draft beers are about $1.50.
After dinner we took a pre-mugging photo so we could have before and after photos if we got mugged. Then we walked around 7th avenue and looked at the bars.
(pre mugging photo)
I liked how Rat’z looked so we went there. It had a great atmosphere; dark lighting, eclectic art on the wall, and good music (US 90’s music ).
It was a bar I would be happy to find in the US. Because I like to be as authentic as possible (and getting drunk in strange and dangerous countries is wise) I had the Melville Rat. Blue curacao, pinapple juice, Malibu, Archers.
Walking back to Waverly’s was a bit tense because it was later (11 pm) and if we were going to be mugged this is when it would happen. We crossed the street at one point because there were two guys ahead, but otherwise it was uneventful. We smelled pot a few times in Melville while walking on that street.
The next day we went to bookstores and ate Indian food for lunch. The Indian food was a disappointment after the Chinese the night before because it didn’t come with a bunch of courses and it wasn’t as delicious. Walking back after lunch I had a moment of disconnect with reality. This was a perfectly normal day to have (book shopping, Indian food) but I am in Africa, and in Johannesburg specifically, which is a completely bizarre place for me to be living. And it still feels completely routine after just a day in Melville. There are kids that hang around the mall begging, but otherwise I could forget I was in a foreign country.
Jeff
p.s. I know some of you don't know Waverly. She is BSHE and doing community research about religion and sex.
Tuesday, June 16, 2009
That's that... (Liz)
The last several days of limbo have finally come to a close.
After initial warnings emerged around Nigeria, the Carter Center reported nothing out of the ordinary in Owerri. Carter Center and CDC are still sending personnel to the area. This is in contrast to information from Professor Dan Smith at Brown.
With these conflicting viewpoints, it's been difficult for me to make an educated choice. So I wrote the following in a letter to the director of my host organization in Nigeria:
"I'm really curious to know your take on everything. My primary interest is to be mainly an asset over a burden to you and your organization. Have these circumstances turned me into more of a liability than a help for CYDI?
In the event that I do not come to Nigeria, I have an alternative option available. Your comfort level with the situation will determine whether I come to Owerri or go to the other location."
This morning, I received a reply:
"First, I am really sorry that you have to be in such a difficult position right now. I realize that a lot of time, money and effort were put into making this trip possible. My colleagues and I are also devastated because this is the first time CYDI would be getting a student from Emory. It means a lot to us, and we have been looking forward to this trip.
Unfortunately, the situation in Owerri is not safe for you to come. This is my candid opinion.
You will recall that these kidnappings started, a few years ago, as a result of the protest in the Niger Delta area (River, Bayelsa and Delta), and the targets were expatriate staff of oil companies. We never had problem in Imo State. Infact, CYDI had students fro, Brown University in 2007 and 2008, which was at the peak of the crisis.
However, since the trouble spilled over to Imo State it has become an all-comers game.
These kidnappings have no political agenda, it just a way of making money. Their targets are random. They have kidnapped people across all ages (babies, children, teenagers, parents and grand parents), and across all sectors (civil servants, businessmen, teachers, lecturers, etc). Sadly, lives have been lost while people are being kidnapped or rescued. Infact things got worse when Imo State Government passed a bill making kidnapping an offence punishable by death.
While I agree that you will, definitely, be an asset to CYDI, I am worried that we shall be looking over our shoulders until you leave in August. I do not scare easily, but this kidnapping stuff is way above my head. I have lived all my life in Owerri, which has always been a peaceful town and I have my ear to the ground. The vibes are not good. People are hungry and angry. The new government has knocked down shops, relocated street businesses, and banned the use of motorcycle for transportation (in bid to make Owerri the cleanest city in Nigeria). Many people have lost their means of livelihood in the process. Most of the younger ones now resort to kidnapping, since it yields a higher return than armed robbery (this is based on the confession of a kidnaper that was caught a few weeks ago). Infact, last week, four students of Imo State University were arrested in Anambra State where they kidnapped a 4-year old boy. Yes, it is that bad.
Carter Center may not have experienced these problems, and I am not aware of the level of protection they offer to their expatriates. But, I am aware that other expatriates (construction workers, oil, hoteliers, etc) all move with Military or Police escorts. CYDI can not afford that level of protection, and even if we did, it will only draw attention to us that we have a valuable asset. Honestly, this is a catch 22 situation.
Right now I will not advise you to come. Dan Smith took the right decision. Infact my friends in the Mass Media and the Police Force tell me that these kidnappings are going on daily, and ransom is being paid quietly. However, only few, high profile, cases make it the press. I cannot afford to let anything happen to you."
This confirms that I will not be getting on a flight to Nigeria on Thursday.
I've been on the phone with different individuals all morning to explore the alternative option of Zimbabwe. Yesterday, with Nigeria still up in the air, I received a promising message from my Zim contact in the States:
"Sounds like a great opportunity to me if you are not able to go to Nigeria. I would think it would be the best of the two options anyway, since you have the relationship and entry points already there. If you try to go do something new in Nigeria in just a few months, you wouldn't get to know the culture/build relationships with the people as well as you already do in Zim. I think we could send a letter through the Fairfield email since they pick it up regularly and ask them to take it up to the VCT explaining what you want to do. Then they could reply on their own or through Linda
....
Let me know what you decide and what I can do to help you get back to Zim if that ends up being the avenue you take.
After initial warnings emerged around Nigeria, the Carter Center reported nothing out of the ordinary in Owerri. Carter Center and CDC are still sending personnel to the area. This is in contrast to information from Professor Dan Smith at Brown.
With these conflicting viewpoints, it's been difficult for me to make an educated choice. So I wrote the following in a letter to the director of my host organization in Nigeria:
"I'm really curious to know your take on everything. My primary interest is to be mainly an asset over a burden to you and your organization. Have these circumstances turned me into more of a liability than a help for CYDI?
In the event that I do not come to Nigeria, I have an alternative option available. Your comfort level with the situation will determine whether I come to Owerri or go to the other location."
This morning, I received a reply:
"First, I am really sorry that you have to be in such a difficult position right now. I realize that a lot of time, money and effort were put into making this trip possible. My colleagues and I are also devastated because this is the first time CYDI would be getting a student from Emory. It means a lot to us, and we have been looking forward to this trip.
Unfortunately, the situation in Owerri is not safe for you to come. This is my candid opinion.
You will recall that these kidnappings started, a few years ago, as a result of the protest in the Niger Delta area (River, Bayelsa and Delta), and the targets were expatriate staff of oil companies. We never had problem in Imo State. Infact, CYDI had students fro, Brown University in 2007 and 2008, which was at the peak of the crisis.
However, since the trouble spilled over to Imo State it has become an all-comers game.
These kidnappings have no political agenda, it just a way of making money. Their targets are random. They have kidnapped people across all ages (babies, children, teenagers, parents and grand parents), and across all sectors (civil servants, businessmen, teachers, lecturers, etc). Sadly, lives have been lost while people are being kidnapped or rescued. Infact things got worse when Imo State Government passed a bill making kidnapping an offence punishable by death.
While I agree that you will, definitely, be an asset to CYDI, I am worried that we shall be looking over our shoulders until you leave in August. I do not scare easily, but this kidnapping stuff is way above my head. I have lived all my life in Owerri, which has always been a peaceful town and I have my ear to the ground. The vibes are not good. People are hungry and angry. The new government has knocked down shops, relocated street businesses, and banned the use of motorcycle for transportation (in bid to make Owerri the cleanest city in Nigeria). Many people have lost their means of livelihood in the process. Most of the younger ones now resort to kidnapping, since it yields a higher return than armed robbery (this is based on the confession of a kidnaper that was caught a few weeks ago). Infact, last week, four students of Imo State University were arrested in Anambra State where they kidnapped a 4-year old boy. Yes, it is that bad.
Carter Center may not have experienced these problems, and I am not aware of the level of protection they offer to their expatriates. But, I am aware that other expatriates (construction workers, oil, hoteliers, etc) all move with Military or Police escorts. CYDI can not afford that level of protection, and even if we did, it will only draw attention to us that we have a valuable asset. Honestly, this is a catch 22 situation.
Right now I will not advise you to come. Dan Smith took the right decision. Infact my friends in the Mass Media and the Police Force tell me that these kidnappings are going on daily, and ransom is being paid quietly. However, only few, high profile, cases make it the press. I cannot afford to let anything happen to you."
This confirms that I will not be getting on a flight to Nigeria on Thursday.
I've been on the phone with different individuals all morning to explore the alternative option of Zimbabwe. Yesterday, with Nigeria still up in the air, I received a promising message from my Zim contact in the States:
"Sounds like a great opportunity to me if you are not able to go to Nigeria. I would think it would be the best of the two options anyway, since you have the relationship and entry points already there. If you try to go do something new in Nigeria in just a few months, you wouldn't get to know the culture/build relationships with the people as well as you already do in Zim. I think we could send a letter through the Fairfield email since they pick it up regularly and ask them to take it up to the VCT explaining what you want to do. Then they could reply on their own or through Linda
....
Let me know what you decide and what I can do to help you get back to Zim if that ends up being the avenue you take.
I am sure the kids and everyone at VCT would be so happy to see you (and we don't want you to be kidnapped)"
With this optimistic reply, I called Suzanne Mason at the Global Health Institute. She responded positively that GHI would probably support a change in project site. IRB seems equally flexible. I will have to take a few steps to confirm the switch. But overall, Emory appears to be on board.
Now for the bad news...
I got on the phone with Delta to cancel my itinerary. The Delta representative provided different information from the original person I talked to last week. Apparently I can change the dates on my ticket, but not the locations. I called back to confirm this with another representative.
With one useless ticket and visa to Lagos, I have about $1300 left from the original $3000 GHI grant. So I have a couple of options. Either I can start all over and book a flight from Atlanta to Harare. This will cost me upwards of $2300, meaning I would be out $1000. Or I can try to book through the Lagos airport. Flights from Lagos to Harare are still pretty steep at around $1200 - $1300. It would also mean a day or two of hellish travel through multiple ports. But, if I'm strategic enough, I might just be able to get all the way to Harare on GHI money.
So that's where we are now. Still better than being kidnapped. :)
With this optimistic reply, I called Suzanne Mason at the Global Health Institute. She responded positively that GHI would probably support a change in project site. IRB seems equally flexible. I will have to take a few steps to confirm the switch. But overall, Emory appears to be on board.
Now for the bad news...
I got on the phone with Delta to cancel my itinerary. The Delta representative provided different information from the original person I talked to last week. Apparently I can change the dates on my ticket, but not the locations. I called back to confirm this with another representative.
With one useless ticket and visa to Lagos, I have about $1300 left from the original $3000 GHI grant. So I have a couple of options. Either I can start all over and book a flight from Atlanta to Harare. This will cost me upwards of $2300, meaning I would be out $1000. Or I can try to book through the Lagos airport. Flights from Lagos to Harare are still pretty steep at around $1200 - $1300. It would also mean a day or two of hellish travel through multiple ports. But, if I'm strategic enough, I might just be able to get all the way to Harare on GHI money.
So that's where we are now. Still better than being kidnapped. :)
Micronesia - Kaleigh (super long)
Hi!
Warning – this is very long – I probably won’t write often, as it is a lot of effort and expensive to use the internet. –
I am writing this from the Island Food Community of Pohnpei building, where I am working. I will email it when I go to the Telecom building later (it is the only place where we can get on the internet). The Telecom building is air conditioned, so we love it. (It is very, very, miserably hot here.) The Telecom building also has couches and a flat screen TV with usually CNN or ESPN on, so it is an enjoyable place to be. It kind of resembles a bank (with tellers who deal with phone services and internet rather than currency).
Kim and I are living together in a hotel (for 2 months) called Nara Gardens. It isn’t as nice as it sounds. It is quite old and run down. There is no airflow and it smells of mold, is dirty, etc. We were hoping for a home to house-sit, but it doesn’t look as though it will work out with dates and all. I’m really happy that Kim is here.
There are two other public health students (female) working with IFCP this summer. Sueko is from Japan but attends Johns Hopkins. She is one of the sweetest people I’ve ever met. We met in Honolulu and stayed in a hotel together and began our journey to Pohnpei at 3:30 am together. Alyssa is from the University of Arizona. She did Peace Corps in Zambia.
My research project will take place in two rural villages. It was originally going to be qualitative but it has changed and is now going to be quantitative (a questionnaire about how often certain foods are eaten). I think this is better, although I may no longer do my thesis on this. Instead I might just write a report or something for IFCP. I want my thesis to be on high-quality data collection and I don’t know how well this will work out – I would also like my thesis to be qualitative.
We spend all day right now (before research starts) at the IFCP with our supervisor, Lois. We have met state and federal health officials the past two days (today we drove to the federal capital – Palikir – we live in Kolonia – the biggest city). We also get to go to numerous events that the IFCP is invited to, which might be fun. The first is this afternoon.
As far as first impressions of Kolonia, Pohnpei… the town reminds me of a miniature Fort Cochin in Kerala, India. It is kind of like a fishing town. It is along the water and the landscape is beautiful. It is kind of boring though, I’ve not seen anything unexpected yet. It is not crowded. The people here are very nice, which is enjoyable. I feel pretty safe. Even though we are on an island, it doesn’t sound as though there are many (if any) safe places to swim (water quality, currents, etc). We have pretty much already walked around the whole town… multiple times. Kim and I went for a walk last night along the causeway and next thing we knew, we were at the airport.
The food here is…. Interesting I guess. They eat a lot of tuna sashimi (the raw fish), which I love. But I am trying not to eat it every day… we have already been advised to get de-worming medications upon our arrival home. (Fabulous.) Apparently it is likely that we will get worms while we are here. Other foods are breadfruit – which is eaten like a potato. The food environment is basically a combination of local, Japanese, and American food (sometimes all at the same place). There are many varieties of banana… ranging from some which are used like a potato to those that are eaten with ice cream (I, of course, like the ones eaten with chocolate chip ice cream – a dessert Lois’ husband made for us).
I had a good time this afternoon and evening. We went out to a ‘marine park’ for a Peace Corps event that IFCP was participating in. It is a camp for girls who just graduated from 8th grade and it teaches them how to care for themselves, the environment, etc. Very neat. They stay overnight in traditional huts next to the ocean. It is beautiful there. We went swimming in the ocean. Afterwards, we had a dinner of local foods in a large community hut and the food came on a woven basket/plate, you eat sitting cross-legged and with your hands. The fish were fully intact (on one side). It was a good time.
I think I’ve written enough for a book now, so I will close.
Hope everyone is doing well. Look forward to seeing you back in Atlanta. Kaselehlie (hello, good bye, and other greetings in Pohnpeian).
Warning – this is very long – I probably won’t write often, as it is a lot of effort and expensive to use the internet. –
I am writing this from the Island Food Community of Pohnpei building, where I am working. I will email it when I go to the Telecom building later (it is the only place where we can get on the internet). The Telecom building is air conditioned, so we love it. (It is very, very, miserably hot here.) The Telecom building also has couches and a flat screen TV with usually CNN or ESPN on, so it is an enjoyable place to be. It kind of resembles a bank (with tellers who deal with phone services and internet rather than currency).
Kim and I are living together in a hotel (for 2 months) called Nara Gardens. It isn’t as nice as it sounds. It is quite old and run down. There is no airflow and it smells of mold, is dirty, etc. We were hoping for a home to house-sit, but it doesn’t look as though it will work out with dates and all. I’m really happy that Kim is here.
There are two other public health students (female) working with IFCP this summer. Sueko is from Japan but attends Johns Hopkins. She is one of the sweetest people I’ve ever met. We met in Honolulu and stayed in a hotel together and began our journey to Pohnpei at 3:30 am together. Alyssa is from the University of Arizona. She did Peace Corps in Zambia.
My research project will take place in two rural villages. It was originally going to be qualitative but it has changed and is now going to be quantitative (a questionnaire about how often certain foods are eaten). I think this is better, although I may no longer do my thesis on this. Instead I might just write a report or something for IFCP. I want my thesis to be on high-quality data collection and I don’t know how well this will work out – I would also like my thesis to be qualitative.
We spend all day right now (before research starts) at the IFCP with our supervisor, Lois. We have met state and federal health officials the past two days (today we drove to the federal capital – Palikir – we live in Kolonia – the biggest city). We also get to go to numerous events that the IFCP is invited to, which might be fun. The first is this afternoon.
As far as first impressions of Kolonia, Pohnpei… the town reminds me of a miniature Fort Cochin in Kerala, India. It is kind of like a fishing town. It is along the water and the landscape is beautiful. It is kind of boring though, I’ve not seen anything unexpected yet. It is not crowded. The people here are very nice, which is enjoyable. I feel pretty safe. Even though we are on an island, it doesn’t sound as though there are many (if any) safe places to swim (water quality, currents, etc). We have pretty much already walked around the whole town… multiple times. Kim and I went for a walk last night along the causeway and next thing we knew, we were at the airport.
The food here is…. Interesting I guess. They eat a lot of tuna sashimi (the raw fish), which I love. But I am trying not to eat it every day… we have already been advised to get de-worming medications upon our arrival home. (Fabulous.) Apparently it is likely that we will get worms while we are here. Other foods are breadfruit – which is eaten like a potato. The food environment is basically a combination of local, Japanese, and American food (sometimes all at the same place). There are many varieties of banana… ranging from some which are used like a potato to those that are eaten with ice cream (I, of course, like the ones eaten with chocolate chip ice cream – a dessert Lois’ husband made for us).
I had a good time this afternoon and evening. We went out to a ‘marine park’ for a Peace Corps event that IFCP was participating in. It is a camp for girls who just graduated from 8th grade and it teaches them how to care for themselves, the environment, etc. Very neat. They stay overnight in traditional huts next to the ocean. It is beautiful there. We went swimming in the ocean. Afterwards, we had a dinner of local foods in a large community hut and the food came on a woven basket/plate, you eat sitting cross-legged and with your hands. The fish were fully intact (on one side). It was a good time.
I think I’ve written enough for a book now, so I will close.
Hope everyone is doing well. Look forward to seeing you back in Atlanta. Kaselehlie (hello, good bye, and other greetings in Pohnpeian).
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