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

Jambo!

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: http://www.statnet.org/movies

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...

Sunday, February 8, 2009

The Joshua Generation











Well folks, it's been awhile. I decided that if I have time for Facebook, I have time for blogger, and it's likely a better use of time and energy anyway.

Today I'd like to tell you a little about our whirlwind three-day trip to Washington, DC for President Obama's Inauguration. As many of you know, I was a reluctant participant in that event because it involved repeating the cross country travel extravaganza that turned so disastrous over Christmas. (But I got a $200 travel voucher from Southwest Airlines after I wrote them a Dear John letter which the customer relations personnel found "entertaining to say the least." More on that later) Rachel and I booked our travel on November 6th, before everyone else had the same idea. We also booked a return flight on Tuesday at 6 pm and then in the proceeding months we realized just how difficult it would be to move from the Mall to BWI by 4 pm. After many phone calls to United and Expedia, we learned that if we canceled or changed our flight it would cost us about $400 so we just decided to go and hope for the best.

We arrived, without incident, into Arlington at 11 pm on Saturday night. Eileen and John kindly picked us up from the airport and then we drove around the monuments and the Mall to check out the pre-Inaugural scene. I remembered just how beautiful DC is, especially on a clear winter night (from a car or other warm space). The creamy monuments contrast against a black sky to create an austere city, which on that night was electrified with parties and planning. We drove by the Canadian Embassy, whose columns had three large banners flapping in the wind: "Congratulations. Barack. Obama." I'm pretty sure I did not see any such salute for Bush's first or second Inauguration. There were flags everywhere, and toilets. People, I have never seen so many port-a-pottys in all my life. There was no need for fences or barricades--there was a small army of green, plastic, 8-foot structures preventing access to critical points of the Mall.



As soon as we got in the car I was so glad we made the trip. After a most wonderful meal (which, true to form at E and J's lasted until 3 a.m.) we went to bed, where we were serenaded by the celebratory cheers of the Adams Morgan revelers. The next morning we went to All Souls Unitarian Church on 16th Street for a celebration of the legacy of Dr. Martin Luther King, JR. The previous week I'd seen President Obama on George Stephanopoulos's show, and he mentioned wanting to find a new church community. I immediately thought of All Souls, though I'm sure the President would be ridiculed for attending a Unitarian church. All Souls is one of very few churches I've known that is not part of the "most segregated hour in America;" its members represent every hue, every fashion persuasion, every generation, and its pastors match that diversity. The best thing about the church, other that its commitment to social justice and creating a safe spiritual haven for all people, is its fabulous choir. I never left that church without feeling moved to tears by the choir, which often sings old gospel songs like "Wade in the Water" and "Motherless Child," so I knew I was in for a stirring hour and a half in the pew.

The church was filled to capacity, and a few people sat on the floor or stood in the aisles. The choir opened with a South African freedom song, "Siyahamba" as they danced their way to the front. The pastors were dancing, as were the congregants, and the energy and enthusiasm were palpable. On the eve of Martin Luther King day, we were also celebrating the achievement of Barack Obama, in a room full of people who never thought they'd live to see it. The pastor welcomed the congregation, and at first mention of the historic day awaiting us on Tuesday, the congregation erupted in cheers and stood. Words fail to describe the joy and the importance of the occasion. I spent most of it in tears, watching the the tiny octogenarian in front of me nod and clap and sing in her purple suit and matching church hat.

The pastor chose a celebratory but cautionary story from the Old Testament, in which God takes Moses to the mountaintop to show him the Promised Land he will never enter. The pastor, like so many of the congregants, felt doomed to linger on that last page of Deuteronomy, in which the Promised Land has been spotted but not yet entered. This year, the pastor felt like turning the page. In the first chapter of Joshua, the people enter the Promised Land, but they do not kick up their heels and relax, having arrived. Instead they continue on in their labors, and this is what was asked of us--that we not see President Obama's election as cause for rest but instead find a way to keep working toward a better life for all people. The hard work lies ahead, the work that requires standing shoulder to shoulder, taking up a cause that is not necessarily one's own except by virtue of membership in the human race. The pastor likened us to the Joshua Generation; we've crossed over, but the work is not finished and history will wait to see what we do after the crossing. The service included several beautiful songs, including "MLK" (by U2) and "Lift Every Voice and Sing" and many moments pregnant with joy and celebration in addition to a few that were devoted to remembering the people who worked toward, but did not live to see, the election of an African American President.

After church I took the Metro to Union Station to meet Maurice for lunch. I have never seen Union Station so crowded, and I've never seen so many ways to sell one man's image. In about ten minutes, I saw Barack Obama's name or face on the following items: charcoal drawings, quilted purses, afghans, flip flops, magnets, key chains, lanyards, shot glasses, beer glasses, sweatshirts, t-shirts, jean jackets, posters, photographs, plastic dolls, fans, postcards, pins, pens, books, and flags. It was bizarre. And people couldn't get enough of it. There were crowds around every kiosk selling this stuff. Additionally, Pepsi had decked the halls with signs that said "Oh Boy!" and "hope, hope, hope" on which the letter "o" was replaced with its logo. I tried to navigate my way through the station without hitting any bewildered tourists, and without disrupting the Latino Inaugural Ball, for which there was a 20-person band playing.

On Sunday night we had some friends over for dinner, and then watched a little bit of the concert on the Mall (which we did not attend because we figured standing still in the frigid air with hundreds of thousands of strangers is something that really only needs to happen once). When Obama spoke we all ran into the living room and sat in perfect silence listening. I snapped a photo which failed to capture the moment, but it was one I won't forget because it reminded me of old movies that take place during war times, and you see the whole family gathered around those old radios (and usually the mom is knitting or mending socks)...On Monday we tooled around the city some more, and happened upon a large balloon George Bush at which we were invited to throw one of the hundreds of shoes that were scattered in front of him. A band was playing, and people were thrilled to give George his well-earned goodbye party. We went to Buffalo Billiards, where we enjoyed some overpriced adult beverages, and socialized with (read: took photos of) the original "Rednecks for Obama" who gave us some free bumper stickers.

On Tuesday we awoke at 6 a.m. and scurried to assemble our supplies for the day which included: toilet paper and hand sanitizer, fruit, water, energy bars, Julia's Empanadas, instant hand and toe warmers, and foot-sized cardboard pieces to stand on. We each had on at least four layers of clothing, and each carried a supply pack and a camera. We actually left the house by 7 which was nothing short of a miracle, and we headed down Columbia Road toward Connecticut. While we walked in Adams Morgan, we saw a few others walking with a purposeful stride, but as we approached Dupont Circle, we saw more and more people headed toward the Mall. By the time we reached Farragut Square, we were absorbed into a mass of people all walking the same direction, taking over one of the largest streets in DC, and surrounded by police. Eventually we were barricaded into the route to the Mall by string of Metro buses that blocked every intersection and corralled us all into a crowd that seemed to have its own irreversible momentum.

We walked toward the Capitol until we could not move any further, which placed us fairly close to the Smithsonian Castle. It was about 8 am. It occurred to us that we were going to be very bored for the next three and a half hours. Luckily the Inaugural Committee had the brilliant idea to replay the free concert on the jumbotrons, so at least we had something to look at besides the shoulders of the person in front of us. After about two hours in the 17-degree weather, I felt completely frozen. I could no longer feel my feet, and no cardboard or instant toe warmers could reverse the process. After the concert we watched the procession of who's who (and who's that?) and Marcus provided us with many laughs by loudly shouting "Hey, there's that guy!" whenever someone unfamiliar appeared on the monitor. As time passed, my personal space decreased, and this discomfort failed to at least provide me with additional warmth. However, it did provide an exemplar of a crowd on its best behavior, and that was nice to see. I expected people to fight and get territorial, but I saw none of this.

The crowd was increasingly vocal as the bigger political celebrities were paraded out to the stands. Jimmy and Rosalyn Carter got big cheers, as did the Clintons. Former President Bush was neither booed nor welcomed. But oh, when President Bush was sighted, the crowd began singing "Nah Nah Nah Nah, Hey Hey Hey, Goodbye!" and I'll admit, I felt kind of bad for the man. This was of course, followed by the Michelle, Sasha, and Malia sightings, over which the crowd went wild! But when we first glimpsed P-E Obama, the crowd erupted in screams and a flurry of cell phone photographs. The woman behind me said she thought she might faint and I got ready to absorb her impact. She pulled through, but cried softly and kept repeating "I never thought I'd see this day."

I'll never forget the screams of the crowd and the sheer enthusiasm expressed by people willing to stand still in frigid temperatures to watch something they could have seen better at home on television. I felt so fortunate to be able to participate in such a momentous national occasion, and it's a moment that will sustain me when my faith in our country is shaken again, which will undoubtedly happen. Barack Obama is just a man, and he is a politician. He is not a miracle worker, or a god, or a saint. But he managed to make people believe in their government and in the power of democracy. He stirred something in our collective unconscious that motivated us to vote, to campaign, to watch debates, to stand in the freezing cold to wave signs and register voters, and to witness a moment in our nation's history, together. His election makes me hopeful that the next time I venture beyond our borders I won't find myself apologizing for being American.

I hope we will work shoulder to shoulder from this moment forward. I hope we can capitalize on our momentum and do great things. I hope.

Saturday, February 9, 2008

Caucusing in the other Washington

well, thought I'd tell ya'll a little about caucusing, since many of you won't have the chance to participate in one any time soon.

Around 12:45 pm we left our house, and could see dozens of our neighbors walking to caucus sites around the neighborhood. There was a pretty palpable energy among all the caucus goers. We lined up outside of the democratic location, a local elementary school, and noted that there was no line outside of the republican site! In the line there were lots of families and couples, young and old, though mostly white middle class (that's the demographic of my neighborhood). It was neat to see everyone with their kids, and taking photos of the children at their first caucus. Once we got inside it was pure chaos. We were shuffled into the cafeteria, and there was a much larger than expected crowd so we barely fit. Several precincts chose to meet outside or in an adjacent gym as it was difficult to hear anything.

Upon finding our precinct group (finally) we signed in on a registration sheet and wrote down our names, address, phone number, email, race (optional), disability (optional) and sexual orientation (optional)--the last three are to determine how well minorities are represented by the caucusing process, b/c there is much concern that minorities and disabled folks are not well represented. Then we wrote down which candidate we came to support.

At 1:30, we recited the pledge of allegiance and then a script was read to explain how everything would work. Then our precinct had to elect a captain, secretary, and vote tallyer. I was the secretary because I was sitting next to the guy appointed captain, who was appointed only because he was somewhat willing and had been to a caucus before unlike the other 65 people in our precinct. So the ad-hoc leadership team moved to the front of our precinct crowd of 66, and tried to figure out what to do. We read through all the instructions in our envelope, and figured things out as we went along. Our first count of the votes showed 53 for Obama, 10 for Clinton and 3 undecided. We announced those, and then I figured out that Clinton needed 7 more voters to win a second delegate. We announced that.

Then we split into 3 groups, according to designated candidate and elected one person to give a one minute speech about the candidate. After those speeches, we chose to spend 10 minutes respectfully talking with neighbors about the candidates. Everyone swarmed the three undecided voters, and I stood guard over the sign in sheets because I didn't want them to go missing in all this chaos. I should say that in the same room, at least 5 other precincts were going through this same process, which made things pretty kinetic. After 10 minutes, we had to practically remove the Clinton supporters from the undecided voters. Then we opened up the sheets for revision, and one undecided person switched to Obama; also two late comers were allowed to vote in the final count, so we ended with 56 Obama, 10 Clinton, and 2 undecided. Then we elected delegates to represent each candidate (5 for Obama, 1 for Clinton) at the district level convention in April.

We left around 2:45 and I have to say it was a very unique and engaging voting experience. I do think it marginalizes some folks, particularly people who do not speak English proficiently, people who are low income and/or working on weekends, parents of young children, elderly folks, and people with disabilities. So, I can't say that I think it is a very fair way of doing things. For example, Bryn had to work today, and I doubt that her employer (Whole Foods) allowed her to leave to participate in this two hour process. I don't know that yet, but you can imagine that most people working minimum wage or hourly jobs with no benefits are not going to be able to participate in this process--I don't think that is fair. So, while I had a great time participating, meeting neighbors, and feeling the energy of the crowd, I couldn't help but think about those that the process excludes.

I did put my vote down for Obama. Why (you didn't ask...)? It's not that I think he is perfect, but I do think he has an incredible way of inspiring people to get involved and interested, not only in politics, but also in the country and the local community. I think he has a way of getting people to be passionate about change and passionate about actively doing something to make this country a better place to live, work, and raise a family. I can't say that I really vote based on what a candidate says about his or her policy ideas, because I think those rarely line up with what takes place after a candidate is actually elected. And I don't think the lack of follow through can always be blamed on the candidate; we do live in a democracy and the President / elected official cannot always do what he or she promises to do, because we have a system of checks on executive power. Anyway, so I think for me the biggest draw to Barack Obama is his relatively clean slate (again, he's not perfect; but none of them and none of us are, either) coupled with his ability to truly inspire people, especially young people. And those young people did come out today to vote for him, so it goes beyond just being a celebrity to actually moving people to action. I think that young people need to feel inspired by their leaders, we need to feel hopeful that what we do and think matters to someone. We, as the future of this country, are facing many obstacles: graduating and entering the workforce during an economic crisis, a shrinking middle class (and it really is shrinking; I've done that research), a world that is full of conflict (some of which are perpetuated by our national policies), the dim prospect of social security for our generation, a huge national deficit, overseas competition for jobs we are qualified to perform, a tarnished image in the international political arena, the destruction of our environment, and the rising cost and declining value of a college degree. I don't mean to sound doom and gloom, but I do think that those of us who are in the generation that must push for these issues to be addressed--if we want a comfortable middle/old age and a comfortable life for our children and grandchildren--need to feel like someone can help us find the solutions to these issues. And I think that Barack Obama is that person. Amen.