Saturday, August 21, 2010


I have not been able to write as much during this trip as I would have liked, partly due to time constraints, and party due to delayed processing speed (both brain and computer). This trip has been an emotional journey through peaceful being and a still mind, extreme self doubt, intense inquiry, and contemplation of the thoughts that churn through all of the above. It's hard to parcel out each of those moments and dig up their roots, but I have been able to glean a little off the top.

Last week I traveled to Kisumu alone, and it was the first time in my life I have gone entire days without seeing another white face. There was nothing threatening or fearsome in my environment, yet I felt an intense urge to return to my hotel room after even a few hours out, because I grew weary of being so obvious, so foreign. I can't quite think of the words to describe the experience, but it reminded me of my recurring dream that I've gotten on the school bus wearing no clothes. the obvious thread is exposure, and fear of it. At the end of the day I wanted something familiar, a need that was somehow fulfilled by the environs of the New Victoria Hotel. The New Vic is fairly basic and inexpensive--its rooms are furnished with wooden beds with nets circling overhead, a small table, a black and white TV, a plywood dresser, and ceiling fan. The bonus features are the en suite bathrooms, hot water, window screens, and balconies with a view of Lake Victoria. Downstairs there is a restaurant, managed by two Yemeni brothers who are very kind. This was my third stay at the hotel in the past three months, so I am beginning to have the status of a regular; this means freebies from the brothers--water, juice, and cakes. There is one server there, Wilfred, who is very kind and has a nice smile. He always brightens when he sees me, and we have a clear affinity for each other in spite of linguistic and cultural barriers. Each day he taught me a bit of Kiswahili, and I greeted him exuberantly. And somehow he became an anchor of familiarity when I felt otherwise adrift.

I spent time with colleagues in Kisumu, which also provided much food for thought. It's always humbling to realize that one's achievements and overall development are largely a function of geography, which is largely a function of luck. I have met so many intelligent, enthusiastic, and hard working people and can't help but think of the opportunities I've had that they haven't had, which also makes me think carefully about whether I'm living up to my full potential. I spent an evening talking with my colleague Benard, getting his thoughts about globalization, public health, and their intersection. We talked about the "brain drain" and U.S. agencies and NGOs plucking Africa's scientists and health professionals, leaving their communities bereft of the talent and dedication of their best and brightest young people. While this practice is vilified in the liberal enclaves of the U.S. (ahem, Seattle), Benard sits on the flip side of the argument. Who are we to say he shouldn't leave for the comfort and security of American professional life? Who are we to say where he should or should not work? He talked about his sister in law, who is a Kenyan doctor and works for a Western NGO, and pointed out that she is helping Kenyans, she earns more money than she would at the Ministry of Health, and that earned income goes back into the Kenyan economy. He feels that Western organizations and researchers have influenced national policy for the better, and doesn't see a problem with Africa's scientists abandoning government agencies for Western organizations, or even Western countries. It was an interesting conversation, and quite a different story than the one that is often told in Seattle.

I also had my first teaching experience while here, and it was terrifying! I let my nerves and fear get the best of me, and I wasn't able to be the kind of teacher I would like to be. I was tentative and scripted, unable to think through my fear to provide good examples and stimulate conversation. I am usually my harshest critic, but this time I just didn't excel. It reminded me of the first time I went to swimming lessons. I can't recall all the details, but I do remember the fear. I was terrified when my instructor put me in the proper diving position and pushed me in. I thought back to that, and realized that the first time I swam, I didn't do it well. I just survived it, basically. It reminded me that sometimes I need to know what it means to struggle to do something well, and taking that first plunge can tell help me learn what it takes to get to the end goal. I think the biggest lesson in this experience was trying to be kind to myself, and let go of my perfectionism (as much as possible!).

Today we are going back to the field to disseminate research results to the community members who participated. This is the part of the trip that I always really enjoy, even though I can't understand much of what is said. Our project has been very well received, and I will write more about that soon.

with love, gratefulness, and careful thought,

Wednesday, August 11, 2010

What will be your legacy?

On Monday we opened the Advanced Research Methods 2010 course at the University of Nairobi. More than 150 Kenyan professors, researchers, and graduate students applied, and about a third were accepted. I am co-teaching a course next week, and attended the first day to support my colleagues and greet the students. Before we began instruction, Professor Ngugi, Director of U of N's Centre for HIV Prevention and Research, gave a welcome speech to the students. First I should say Professor Ngugi is a tiny but formidable woman, and when she shakes her finger and gives a directive, I'm inclined to take heed! She congratulated the students for being accepted to the course, and provided a warm welcome. Then after emphasizing the importance of creating real and palpable change with newly acquired knowledge, with a slight pace and a finger pointed toward her audience she pointedly asked them to consider the following question: "What will be your legacy?"

When I have a spare moment to think, I'm going to marinate on that question and get back to you. Would love to hear what you hope your legacy will be.

much love.

Monday, August 9, 2010

Leaving Diani

I left Diani Beach kicking and screaming. (Not really, but I did pull out that protruding lower lip, leftover from childhood.) We had three glorious days of reading, swimming, snorkeling, stargazing, and listening to the rhythmic Indian Ocean lapping the shore. After a fierce doggy paddle competition (I won!...but I had an unfair advantage thanks to Steve's improperly healed clavicular fracture), Steve noted that we have minds to mold! Discoveries to foment!

As we left Diani Beach at a breakneck speed, I was mesmerized by the blurry images of women in matching chador and kanga sets in tangerine and electric blue, royal purple and bright gold, lime green and fuchsia. Most had a baby strapped to their back, or dangling from a hip while they walked the maze of corrugated tin stalls from which people hawked clothes, fabrics, shoes, books, belts, and produce. We queued up for the ferry to Mombasa, and watched as throngs of people streamed back over to Diani. There were very few walk on passengers headed toward Mombasa, so Steve and I got out of the car to get some fresh air. We caught the attention of several small children who whispered and elbowed each other.

I've noticed there are three distinct reactions I receive from children. The most common is a sequence that goes like this: astonishment, bashful excitement, fear (evidenced by the quick and firm grasp to mom or dad's leg) and then a game of peek-a-boo. The next most common is wide mouthed curiosity followed closely by disinterest. The third is exuberance+reckless abandon, evidenced by a speedy run up to shake my hand. One child on the boat was in the middle of the first response sequence, and her father noticed and prodded her to come and greet us. She greeted us quietly, with the oft repeated phrase "How are you," with a shy smile and a formal handshake in the style reserved for people with high status. This show of respect from a small child was bittersweet. It was sweet because it was an opportunity her father noticed and seized to teach his daughter to demonstrate confidence and good manners. It was bitter because my white skin is the only thing that grants me the high status signaled by her greeting. I am adjusting to the outward displays of respect that remind me of my unearned privilege and of my whiteness, but it is still a bit unnerving. I wanted to tell her that my skin color does not make me respectable or important, but in her world it does.

Saturday, August 7, 2010

Kenya, Take Three

Well folks I'm so relaxed I may not be able to assemble an eloquent missive, so please accept my apologies upfront. After 30 hours of travel, I arrived in Diani Beach where two of my professors and I are staying at the Bahari Dhow Villas. As soon as I am able, I will upload some photos for you, because I cannot find the words to provide you with the tools to create an accurate mental image. But picture a large white villa with a Spanish tiled roof, white tiled floors, big windows, large airy bedrooms overlooking the ocean and young coconut trees. Our villa is steps from the Indian Ocean, whose colors change from midnight blue, pastel turquoise, seafoam green, and sandstone. Our complex is flanked on either side by clothes lines with brightly colored kangas flapping in the breeze. The complex has three palm tree lined swimming pools, and the villas are occupied by people from many different nations. It was a pleasant surprise to find that a minority of the guests are white tourists. There are many families with young children in addition to couples and groups of friends.

This morning we took a glass-bottom boat out to the Ali Baba Reef, where we went snorkeling. We had a guide who showed us sea urchin, lobster, puffer fish, eel, and coral. The most amazing creatures were the star fish, which varied in appearance from gangly and deep purple, stout and pink with electric red spines, and a purplish grey with electric red grooves and spines. On the way back from the reef we sat on the flat roof of the boat, basking in the sun and intermittently exclaiming "This is amazing!" "This can't be real!" And it doesn't feel real. We hadn't originally planned to take a holiday, but schedule changes due to Wednesday's nationwide voting and other unexpected events left us with three free days at the beginning of this trip. I am so happy we visited the coast. It's beautiful and peaceful, and it has made me think about how Africa is presented to us via the media. We usually hear alternating stories of war, disease, poverty, and corruption with the occasional romanticized exoticism sprinkled in. My time on the coast has reminded me of Kenya's natural beauty and its strengths--a view that is often underrepresented by what we read or see in the news.

Speaking of strengths, you may have read that the Referendum passed, and the voting was peaceful. I am greatly relieved, and have enjoyed reading the newspaper coverage of the election and its significance. Since we are in a holiday location, we have not heard much talk of the new constitution, but I think when we greet our colleagues will we hear more about what meaning it holds for them and for their futures.

That's all for now. We head back to Nairobi tomorrow, and our two-week research methods course begins on Monday. We'll be teaching about 50 faculty and postdocs at the University of Nairobi. On the weekends Martina and I will travel to Kisumu to wrap up our project there. More to come.

Wednesday, June 30, 2010

I spy

Birds circling over corrugated tin roofs, orbiting satellite disks and stopping to rest in hollowed windows
A lady in a red-checkered skirt walking slowly downhill with one arm swinging
Tuk tuks and cyclists ferrying passengers to work
The calm waters of Lake Victoria waiting for the fishermen to pluck their wares from her waters
A pile of garbage next to the Odila Engineers company
Technicolor ads for Popco vegetable oil, Zain internet, Crown weather gaurd, Jessa glass and hardware
A truck driver wearing a beautiful hand knit prayer cap, beating the hood of his truck with a rag to clear it of dust
A man pushing a bicycle uphill while balancing 8 crates of white bread on its back rim
A woman walking while her chador flaps in the breeze
A boda boda driver looking for a fare
A sudden and rare internet connection!

Thursday, June 17, 2010

Wouldn't take nothin for my journey now

I just finished watching "For the Bible Tells Me So," which is a documentary about how the Bible is used to justify prejudice against gay and lesbian Americans. I expected a mildly interesting, dry, same old story and got a penetrating emotional experience instead. I may someday regret not having paused to think, digest, marinate--instead using the tools of the digital age to communicate to any eyes that may linger on my little slice of the public domain--but this film has helped me see that I am constantly self-editing and "sleeping on it" would ultimately be yet another variation on the same theme.

The movie traces the history of several families with gay children, and how the Church influenced the parental response. These family's narratives are threaded between hundreds of video clips of televangelists denouncing homosexuality, protesters holding signs that say things like "God hates fags" and "Die Faggit" [sic], as well as interviews with Biblical scholars, professors, clergy, and the lovable Bishop Desmond Tutu. Together, the movie is arresting, provocative, and devastating. I can't recall the last time I was so shaken by a film--artistry at its best.

I cried throughout the movie. I cried for the parents who tried desperately to understand their children, and to reinterpret the text that they held for decades as the one truth of their lives, only to find that ultimately a literal interpretation created an effect that was incongruous with the content. I cried for the mother whose daughter's suicide finally compelled this reinterpretation. I cried for Gene Richardson, the first openly gay bishop of the Episcopal Church, who had to wear a bullet proof vest under his vestments on the day of his ordination, and who received a letter with a photo of him and his partner and this message: "I have two bullets one for each of your heads when you least expect it." I cried for the family who was arrested while trying to deliver a letter to Dr. James Dobson, whose message encouraging rejection of gay children has divided so many families. And I cried because I have such loving family and friends, some of whom were accepting from the beginning, and some who've made tremendous and commendable efforts to reconsider strongly held religious and cultural beliefs to love me as I am.

I am left with several thoughts, the first of which borrows a line from my friend Sarah Kelley: I can do better. I never attend Pride and rarely join in marches or even campaigns for my own rights. Occasionally when my temper is inflamed I find time to write letters to the editor of various papers that publish hate filled propaganda masquerading as news. I marched against Prop 8 and joined the Students for a Hate Free Daily, but really, these are pretty minimal efforts. I know some of my reluctance to participate fully in supporting gay communities is due to exhaustion. It can be really tiring to fight and when you feel like the battle can't be won (soon), and sometimes bowing out is the only way to preserve your sanity. But I'm done with self-preservation. (Take that Darwin!) I really need to do more to combat prejudice and support people who are marginalized.

The film also left me thinking about how my lack of participation in activism or other shows of support for gays and lesbians serves another darker purpose; it keeps me from being identified too strongly with them. Let me demonstrate: This is an loosing battle = I don't have time to be a good gay = I'm not really that gay = I'm not one of THOSE people = I'm not that different from you and so you don't need to get your feathers all ruffled = Now that everybody is happy, and I can live in peace. But that is not true, I can't live in peace while also living in fear of rejection.

This is getting long, so I'll try to land the plane here. My last reflection is on needless suffering. Tonight I was flooded with memories of all the counselors, therapists, pastors and priests I sought out in my young adulthood, and the multiple baptisms I underwent trying so desperately to change. I thought of the rejection, hate, and needless suffering I experienced. On a global scale my suffering is minor, but in the local scale of my life it isn't; it led me to feel physically ill, mentally defective, alienated, and worthless. I can't be convinced that this is God's intention. So, if you attend church or synagogue I highly recommend you watch the film, preferably at your place of worship. Afterward, give time to thinking about how people are marginalized by the thing that gives you so much meaning, and ask yourself how these people perceive your God through your actions?

I struggle even now to set foot in a church because my wounds are still healing, but I'm trying to see beyond prejudice to the fear that lurks beneath. This perspective makes me more patient and tolerant. And while the Church and the country debate the legitimacy of my love for Rachel, it only grows stronger.

Friday, May 14, 2010

Room with a View

Yesterday we flew from Nairobi to Kisumu, and as I write I am sitting on my porch at the New Victoria Hotel, watching the Kisumu townspeople as they head to work. On the corner below me a group of eight men is pouring over the day’s newspapers while nearby people are sweeping the streets and lining up their wares. A boda boda zips past and is followed by a cyclist with bundles of grain tied to the back of his bike. I can see Lake Victoria, and the surrounding hills. Kisumu town is colorful and vibrant, and very different from Nairobi. This morning I awoke to the 5 am call to prayer from the nearby mosque—it was long and beautiful, even at 5 am.

Yesterday I met the research team, and my enthusiasm has increased exponentially, which I didn’t think was possible. Jacob, Rena, Violet, and John are just amazing, and I am thrilled to have the opportunity to work with them on this project. We spent time organizing our plan of action, and today we’ll visit the village where our trial run will take place in a few weeks. Jacob and Rena work at IMPACT Research and Development Organization, which was founded by Dr. Kawango Agot. Martina says Kawango jokes that IMPACT began as an NGI—a non-governmental individual—and now it’s a large NGO with big presence in western Kenya. I am really inspired by the story of this woman who has become an inexorable force for her people and I look forward to meeting her on my return visit.

Today we traveled to the village, where we looked for a suitable site for our intervention trial run. We spent a couple of hours walking around, and were introduced to several key community leaders. We gained the approval of these leaders, and one of them designated a young man to walk us through the village and serve as our “security guard.” I didn’t get the sense we really needed security, but it did make it easier for a group of outsiders to move around and meet community leaders and village residents. We were asked to meet the principal of the primary school, and guess what that means??? Small friends! Yes indeed, I was quickly surrounded by a mob of tiny faces eager to appear in my digital photos!
I’m including some photos from the village. It was a very productive day of meeting the people we’ll be working with, and explaining our purpose and intentions.

Wednesday, May 12, 2010

A few more photos!

Pool side

Well, I was going to boast about sitting by the pool drinking a cappuccino, but now it's beginning to storm and I'll probably be forced to relocate to dry ground. Today and yesterday I attended the PSI meetings and it's really been amazing. I've met so many smart, creative, passionate people and it's been so wonderful to see how scientific research has been translated into so many different behavior change programs. I've spent the last three days in a room full of people who are all working toward the same goal, and who have brought examples of their work, tales of lessons learned and challenges overcome, and it has been both energizing and astonishing. The most remarkable thing has been to see how Martina and her colleagues' work has taken on a life of its own, in dozens of languages and culturally nuanced forms. We have seen movies, posters, bumper stickers, T-shirts, billboards, TV ads, television series, magazines, comic books, radio ads, press kits, and research reports about concurrent partnerships and HIV. It's really an amazing opportunity to be a part of this scientific and public health movement, and to think about how to move forward, and how the scientific community can support our public health counterparts.

I have not seen much of Nairobi other than the flat, the hotel, and the interior of a number of cabs. This morning our driver was really entertaining. He apparently spent some time working for a Houston-based company, and developed a love of cowboy hats, boots, and country music. He finds today's music worthless, and bemoans the fact that the youngest generation of Americans doesn't know of Jimmy Reeves. Apparently he loves the Nairobi country western bar, where one must wear the full Texan regalia to gain entree.

In other news, I've become rather fond of two stray cats, instant coffee, and the Kenyan national dish which is a combination of mashed potatoes, chickpeas, and maybe corn and/or peas. It's all sort of mushed together so I'm not clear on the precise ingredients, but it beats pinto beans and posho any day! I have seen only about 5 children thus far, just in case you were wondering why there are no small friends dominating my narrative and photos. Don't worry, I'll come through with the baby stalker photos as soon as possible. :)

Tuesday, May 11, 2010

A few pics!

A pic of Nairobi traffic from the bus, my room, some of the concurrency materials PSI folks have created, and Martina teaching on the bus.

Monday, May 10, 2010


Sorry for the delay in posting; I’ve been without consistent internet access and without much spare time since arriving in Nairobi. We landed around 8 pm on Saturday, after a somewhat harrowing flight to Amsterdam that included a 30 minute delay after a passenger “had to remove himself” from the plane just prior to take off. It was a little unsettling because the security officers only searched the six overhead compartments nearest his assigned seat for any luggage he may have left behind and some of us were sort of hoping for a more thorough search, but what can you do? I mean, it’s not exactly kosher to say “Excuse me officer, if I were planning to leave behind a dangerous item in some luggage, I wouldn’t put it in the compartment near my seat…”

After we found our driver at the airport (no small feat) we stopped at a supermarket that was amazing. You can buy pretty much anything in this one store—I saw a king sized bed with mattress, pharmaceuticals, hair products, all kinds of produce, baked goods, beer, wine, liquor, dishes, etc. I guess it’s like Wal-mart, only it didn’t smell like commercial cleaners and I don’t recall any soft jazz playing. We arrived to the apartment around 10 pm and worked until 4 am. At 8 am we headed to the Holiday Inn where we taught a seminar until 6:30 pm; please note I use “we” very loosely. Martina taught and I tried to remain coherent. I was 2 parts zombie to 1 part human, but Martina was 100% functional, which was more or less amazing. It was a really great workshop, and I think people learned quite a bit. The attendees were still asking questions today, so I think that was a good sign.

At lunch I had a great discussion with three of the conference attendees from Zimbabwe, Benin, and Zambia. We talked about Western-African partnerships, and the meaning of authentic partnerships. I was happy to see that their view of a good partnership was congruent with the one I’m experiencing now with our research team. I always have some trepidation about being a white Westerner conducting research in African or African American communities. The legacies of colonialism, slavery, and human rights abuses (like Tuskegee) and the power differential between privileged and underprivileged group make me very conscious of my role as a researcher, and how I present myself. When I’ve had the opportunity, I’ve asked various people—friends, professional contacts, acquaintances—for their thoughts about this dynamic and how to navigate it well, and so I enjoyed talking about it over lunch.

The conference is hosted by Population Services International (PSI), and includes partners from UNAIDS, Soul City, Johns Hopkins, and UW. There are people from 17 countries in southern, eastern, and western Africa, and everyone attending has some role in concurrency program implementation or evaluation. We are here to present the theoretical foundation and provide expertise in data collection and analysis methods, and to learn from the perspective of the program implementers and PSI researchers. The first day was really great, and gave me the chance to meet many of the people with whom I’ve been corresponding, or whose work I’ve read about over the past months.

I’d like you to know this trip has been a real upgrade in terms of my accommodations. I am staying in Martina’s flat (in a very safe neighborhood, for you worrywarts!) where we have the standard amenities and a varied diet. I’ve also been traveling via car rather than boda boda or matatu, which means fewer brushes with death. That’s all for now…hope you are well!

Friday, May 7, 2010

The Answer to Your Most Burning Question

Hello strangers! It's pretty refreshing to use a venue other than Facebook to keep you abreast of the activities of your favorite whirling dervish. Today's post shall answer your most burning question. Charles Widmore has returned to the island because...okay, bad joke. Lots of folks have asked what I'm actually doing in Kenya, and with my studies in general. So the answer to that query is the theme of today's post.

As you know, I'm studying for a PhD in Nursing Science. I settled on Nursing vs. Public Health or some other field because our country is experiencing a nursing shortage that will be exacerbated in the years ahead as the nursing workforce ages into retirement. I used to think that men and women in my generation simply had no interest in becoming a nurse because it's not the most glamorous career. In fact, many youngsters want to be nurses, but there are not enough faculty members to teach them so I chose nursing so I'd be in a position to teach aspiring nurses.

A little about how I landed here, for those of you who don't know. After I worked as a nurse for about six years, I realized that while treating individuals was personally rewarding, there was a larger process that affected my patients' health. I wanted to examine that larger process and interact with it, so that my patients would not need me in the first place. This idea led me to graduate school to study public health, where I became very interested in infectious disease prevention, and HIV in particular. I think HIV is one of the greatest public health crises of our time. The HIV epidemic has contributed to a marked reversal in the trend toward longer life expectancy in some parts of sub-Saharan Africa. In some countries of southern Africa, 1 in 4 people are infected with the virus. Stop and think about that for a minute.

Currently, for every 2 people who begin HIV therapy, 5 people are newly infected, and this is what fuels my proverbial fire. My research emphasis is HIV prevention in sub-Saharan Africa. There are many wonderful scientists working in HIV prevention, and there have been many successes as you may know. But we still have not identified the most effective combination of imperfect prevention strategies for heterosexual populations in sub-Saharan Africa. I am lucky to be working with a fantastic mentor who has been studying HIV transmission for 15 years.

So here is a brief explanation of what I'm working on, and the theory behind the work: HIV and other sexually transmitted diseases travel along the paths of social networks much like information or other social goods. You could think about a sexual network as a system of roads--the more connected the roads, the more efficient the travel. In highly connected networks, HIV and other sexually transmitted diseases have a really well connected highway to travel as opposed to disconnected back roads. And the way that people form sexual partnerships affects the connectivity of the network. If people only have one sexual partner at a time (i.e. are serially monogamous), the network is not very well connected. But when people have more than one partner at a time, like a spouse and another long term partner on the side, the network becomes more connected and the path for disease travel more efficient. These effects have been demonstrated in fairly complicated mathematical models, and you can see a short (and interesting!) movie about it here:

What we are trying to do is move this science to the field, and we are working with a team of Kenyan researchers on an intervention that helps communities understand the effect of concurrent partnerships on HIV transmission. We think that reducing concurrent partnerships will decrease the rate of HIV infection in a community. But changing behavior is difficult, particularly when it is deeply rooted in cultural norms. For this reason, our research team is working with traditional village leaders and community members to pilot test and then refine our intervention. We want to see if it makes sense, if it's acceptable, and if it can even be done.

On this trip, I'll be in Nairobi working with my mentor to teach some seminars about data collection and analysis, and then we'll go to a more rural area in Western Kenya to meet up with the rest of the research team and train them to collect data and prepare for the pilot test. That, in a nutshell, is what I am doing!

Much love to you...