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...