Wednesday, October 8, 2008

delayed but prudent...since I was dreaming of it!

ok, so Ethiopian Airlines is not in fact my favorite airline any longer. I wasn't going to mention it...but just woke up after vividly remembering the flight home...

so without graphic detail...how exactly do bugs, lots of bugs, ok...cockroaches (lots of them) get on a plane? (I know, luggage, but seriously?!) And how do I always (and yes I'm comfortable using the very overgeneralized always) end up next to the guy with raging TB? (just kidding Mom. It wasn't TB, and no I'm not coughing and my screen was negative...and the bugs weren't that bad. Actually Mom, forget everything you just read and remember I love what I do.) but really, bad cough...seemed really hot...thin...hello?!

So did I mention I was glad to be home, well at a minimum not on a plane on my way home?

Wednesday, September 17, 2008

Late breaker...

So Dr. Bola just sent me these pics of when he and Dr. Dotun (aka Dusty) came to visit me at my posters in Mexico. As soon as I get my new laptop I can return the favor and send them the pics of the two of them in front of their poster, yeah! So here are Bola and Dotun....and me in Mexico.

This is me and Bola



And this is Dotun and me (yes, he's tall).



So this is me with my suave Nigerian doctor buds. And no I didn't wear the same shirt all week Mom, this is all the same day when everyone had a chance to come by and visit.

Ok, back to Rwanda time and jet lag :).

Welcome to the US...

Dear Luci and M,

So I actually made it all the way inside the Embassy today. Last time I was here we made it to the security gate and ended up going into town for our meeting. I was supposed to give a presentation so I brought my lap top and the necessary USB to be told we couldn't bring any of it in. This time, I knew enough to send things in advance, but apparently the USB rule has been laxed a bit so I didn't have to send everything in advance after all. They have consolidated the US Government agencies into the new Embassy building here, USAID, CDC, State...

All that to say, we made it fully inside the walls today. There is a first set of walls, then you enter another building and go through security again. As we cleared the second level and walked through the courtyard one of the guys we were meeting said "welcome to the US". It was shockingly accurate. It feels entirely separate from the place we are actually in. A piece of US soil in the middle of Kigali. It was all constructed by US contractors. I wouldn't be surprised if the materials were sourced from the US too. It's an impressive structure, and there is a nice atrium area and coffee shop and official looking Marines around. I would not have been the least surprised has I encountered a McDonald's or a Starbucks.

For obvious reasons, there are no pictures. But just wanted you to know I was stateside for about an hour and half today and I didn't even have to change planes!

Cheers,

Kik

A hot shower beats a bucket any day!

Dear Luci and M,

While I have remained in a perpetual state of jet lag for the past several years a few fundamental truths are beginning to emerge:

1) No matter what your watch says it is in fact morning when the sun comes up, get used to it.

2) Sleeping on the plane doesn't really help.

3) Coffee is good.

4) A hot shower beats a bucket any day!!!!!

xo,

kik

Tuesday, September 16, 2008

For once my bag got here before I did!

Dear Luci and M,

Hello from Rwanda...again. Made it safe and sound. Ethiopian Airlines may be my new favorite carrier. The plane was old and I skipped the meals because they looked pretty, ummmmm, not pretty (but it's airplane food which is a lot like hospital food without the added bonus of a hospital stay). The upside? The plane was only about half full so I got an entire row to myself which means I got some sleep! And even though I had to transfer in Addis Ababa and in Entebbe (which made little sense since there is a direct flight from Addis to Kigali but I'm not complaining as all flights took off and most importantly landed!) my bag arrived. Ahead of me in fact. Apparently my bag was smarter than my itinerary and hopped the direct flight instead of the detour through Uganda. I might want to think about that next time.

Off to a running start, the work is going well and so far no goat on a stick! No pictures yet but will try and get some shots of the blooming jacaranda trees since it is coming into springtime here.

Hope all is well in B'more and NYC! Miss you both.

Kik

Wednesday, August 6, 2008

Cultural research is part of being here too!

Dear Luci and M,



Went to a great market this morning and took in the sights including this adorable little girl!



And of course no trip would be complete without...



...potentially dangerous food from a roadside stand.

Don't worry it wasn't all fun and games, there was work too!



And my favorite quote of the day...

Enough Said!

No, seriously this is work!

But where else can you get your picture taken with life size rainbow condoms that randomly get up and walk around...really. Can you think of another place?



There are these great displays all over the place, including a recreated shanty shack with pictures and stories.







ok, so back to work. This is a very serious shot of me making a really profound and important point.



Did I mention there were a lot of people here?



That's pretty much how it feels in the middle of these rows of posters. No, they were not all there looking at mine, but some did glance as they went by! Seriously it was really good. I feel lucky to have been able to participate.

I'll try and photo more tomorrow to post before heading back to the US.

See you soon!

Love,

Kik

Tuesday, August 5, 2008

Really, I am working

Dear Luci and M,

The opening plenary session was great. There was a 22 year old young woman who spoke in front of this crowd passionately and articulately about HIV and youth. The courage and poise she showed was amazing. Imagine these chairs full...it's a lot of people!!!





So two posters Monday and two today. Kimberly is here from Zambia and has been a great help with getting the posters up, minding one or two while I run back and forth. She even got pictures of people actually asking me questions about them!!! (here you go Mom, see I really am working :)



And here I am with Kimberly in front of today's posters.



More later, off to dinner with some colleagues.

Love,

Kik

Greetings from someplace other than Africa...or Haiti

Dear Luci and M,

Hola from Mexico. The word of the week is overwhelming. Flying in was just the beginning. For about a full half hour we were over Mexico City (just a small part of it). Shimmering copper and sliver lights spread out forever looking like a carpet of jewels on the ground only broken by dark patches. Little mountains with these lights wrapped around them in all directions. With visibility of about 5 miles, you can still see the glow going on past the horizon. I have never seen anything so vast that was man made from the air. Such a different feeling than flying over the Sahara. It's quite beautiful from the air. The city itself is actually quite lovely, the parts I have seen. There are little parks and gardens dappling the downtown, which you have plenty of time to see on the way to the conference venue and back due to the wonderfully congested traffic. One of the conference goers traveling with us actually got off the bus last evening, did a little shopping and got back on with plenty of time to spare before we started moving again. It was great.

It is easy to see how this is the largest city in the world. 20 million people is really hard to fathom in one area actually. There are about 1 million in Kabera slums in Kenya and I was awestruck by the expanse of tin roofs woven together there for days as well.

There are an additional 22,000 people here just for the International AIDS Conference. Part two of overwhelming. Really just an ice cube melting in an ocean, but in the venue itself, holy cow. There are people from everywhere doing amazing things. It's humbling to say the least, and encouraging to see so many people dedicated to this effort. It's really part scientific conference part Mardi Gras! There have been a number of "spontaneous" demonstrations for lots of things, housing for people living with AIDS, changes in guidelines, and simply celebrations of life.



There is great coverage on the web from lots of organizations, pod casts of great talks, pictures. Check it out from the main conference page http://www.aids2008.org/

Wish you could see this. The global village is full of activist organizations from all over the world. Some of the bravest people I've seen around. The talks have been great and I've gotten to see some folks I hadn't seen in quite some time.

Really a motivational week!

All for now. Love, Kik

Tuesday, July 1, 2008

Juxtaposition or an oxymoron by any other name...

Dear Luci and M,

So one of the things I love the most about Africa is the dichotomy. Let's talk a moment about the most spectacular efficient inefficiency. Africa is the place where they sell postcards but no stamps, have traffic lights that no one follows (apparently red really does mean go until a much larger vehicle is braver than you are), and where there are "oui madam" moments every five minutes.

What is a "oui madam" moment? Funny you should ask. A "oui madam" moment is when you spend an exorbitant amount of time speaking very slowly (not in a condescending way, but in a thoughtful way) explaining exactly what you are ordering from a menu...something actually on the menu and well spelled out on the menu, and you get something completely different. Say you order a grilled cheese sandwich, and explain you want two pieces of bread with a piece of cheese in between that melts once the bread is "toasted" in a pan over heat. What you get is goat on a stick with a roll next to it and small squares of very yellow cheese. This is a "oui madam" moment, and proof that you should never ever order a sandwich of any kind in Africa.

Marik has an even better "oui madam" moment and I will try and convey it as best I can here. So here is Marik on her way back to Kigali from Kemembe, and she's at the "airport" (local building with a strip of paved area nearby where the 60 seater lands) and she realizes she does not have her phone charger. She calls the guy that watches her house. He is almost at the market and not there. She asks him to get a moto (motorcycle taxi) and tells him she is paying for it. She says "stop at my house, in the top drawer of the dresser in my bedroom is phone charger. Get that and bring it to the airport for me. (by the way she speaks fluent french so this is all in french). He says "oui madam, oui madam". About 45 minutes go by and she calls him, asks where he is and he says " I'm just getting to the market". She explains again, grab a moto, go to the house, go inside, go into my bedroom, open the top drawer of the dresser and get my phone charger. Hop back on the moto that you have asked to wait and bring it to me at the airport. "oui madam, oui madam". Another 45 minutes go by, the plane that was luckily delayed is getting ready to finish boarding. In the distance comes a moto speeding up the road. It peels into the parking lot, tires screeching, pouring rain...the guy hops off, nothing in his hands, runs up to Marik and says..."oui madam?". No charger, no nothing. That is the ultimate "oui madam" moment in history.

The things I have pondered extensively on this trip are much like that. There is as I mentioned a fundamental inefficiency to this place. There are four waiters standing together talking, I signal to order a drink. One comes over and I order a coke no ice. He goes back to the group and a different guy heads over to the bar. About a half hour later a third guy comes to my table and starts to pour a fanta orange into a glass briming with ice. I decide to just get a glass without ice and drink the damn fanta. Or the postcards no stamps thing. What the heck is that about? 2 hours for dinner on average, just to come, not to eat. 4 hours to get a towel in your room, and that's in a really good resort hotel. But these are the minor things. The things that annoy based on an American mind steeped in rapid response and instant gratification. Not the things of importance.

For the things of importance there is an astounding practical efficiency that American's will never understand. Here is a brief illustration....

I am checking out from the hotel. I have been told to report to the front desk for my ride at 7:30pm to be able to get to the airport by 9 pm (yes traffic over the 40 miles from the hotel to the International Airport is that bad). So I go down at 6:45 to settle my bill. The gentleman at the desk starts to print my bill at about 6:50. I get it at 7:15. There are about 20 $0.10 charges on the bill indicating food purchases. The guy cannot explain to me what they are and suggests that maybe they are water. But a bottle of water is $0.97. It takes another 10 minutes to go through that. During that time I ask him to confirm my transport to the hotel and he says "but we wanted to suggest that you join the group leaving at 6:30 pm since you are the only one going at 7:30 pm but we didn't see you". And I say, "I was in my room and no one rang me there". "oh, you were in your room?". "yes". "Oh, we did not call you there". "no you didn't, so will I still get a taxi to the airport?"... "Oui madam" (just kidding, I got a ride and that is what I'm trying to get to).

This is the time for fundamental efficiency. Every time I get in a taxi in Africa, we stop for petrol before we go wherever I have asked to go. Sometimes the petrol station is in the opposite direction, as it was tonight. But as the young man explained to me, this place had the cheapest gas.

So it was about 1680 Tanzanian Shilling per litre (the other places we passed were between 1700 and 1800; it's about 1100 TShilling to the US dollar these days). First fundamental efficiency, go kilometers out of your way for cheaper petrol. 2nd fundamental efficiency, we all know it takes more gas to start a car than to keep it running....it is the "rule" in the US to turn off your car when fueling. Not so in Africa, they keep their engine running while they fill up. Not entirely sure if this is the safest thing in the world but maybe the "no smoking" signs and "no cell phone" signs are as over rated at the "turn off engine" signs at gas stations in the US.

3rd fundamental efficiency. The airport is 1 1/2 hours from the hotel if there is traffic; which, as I mentioned, there always is. The guy goes in the other direction for cheap petrol, leaves the car running and puts 1 gallon of petrol in his car. The car is on empty. Total E, light on and all (it's a toyota camry of some year). One gallon. Our cars only get about 27 miles to the gallon. There was maybe a 1/2 gallon in the car if the gauge is correct. And we set off to the airport.

This is the fundamental 3rd efficiency, there is never a full tank of gas in Africa. Because why would you put more gas in the car than you need to use at the time. It makes no sense to invest in a reservoir of a resource that you do not know you are going to imminently consume. This is a full cash economy, 1 gallon of gas at a time, buy only the food you need for the day, no debt, no loan society. You get what you can use in the very nearest future and that's it. No hoarding, no what if, no extra. I know the guy has some money in his pocket in case he can't pick up a fare to cover his way back to downtown Dar es Salaam, but first he will try to find another fare. And if he doesn't, his efficiency is that he will spend for another gallon to get him home until he starts again tomorrow where he will get money for his next gallon.

It's an amazing juxtaposition of efficiency with minor inefficiencies built in (wrong direction to get much cheaper petrol, loss of business to someone else because you only sell postcards and no stamps, canceled orders because they take so long and we mzungu's are so impatient).

But I love it. The vast difference from all things here make me love this place and home equally. I am getting to know my place in both.

Here is a nice little photo of the wonderful scenes I had this week (minus the kayaking incident, no pictures of the capsizing or resulting carnage).

Love you both and see you soon!







Thursday, June 12, 2008

April in Zambia...and....Paris!!!!! May back in Rwanda, again. And Stateside in June.

April was Lusaka, Zambia for my team retreat. And then Paris for a meeting with WHO and CDC.

Paris was wonderful even though it was busy with meetings and work.

May was back to Rwanda to kick off our mentoring the MOH-TRAC-Plus team.

And June found me home again to meet my new niece! Apparently all my sister needs to go into labor is my getting on a plane. Both Jake and Anna were born while I was flying somewhere in the world.

So welcome Anna Grace!!!!!



All up to date now. I'm home for another week and then on to Tanzania. See you for crabs and birthday fun for M, Morag, and Lynne on Friday.

Love,

k.

Stuck in Entebbe

On my way back from Rwanda, Brussels Airlines had a bit of engine trouble so I got stuck in Entebbe, Uganda...for 3 days. Now I love Uganda, and I'm not going to complain about 3 days on the shore at Lake Victoria. But when you are ready to go home you are ready to go home.

This is the theme music I have now chosen to play on a loop every time I get stuck . This one's for, well...my nephew, my niece, you guys...some others







It was still quite pretty...

But swim at your own risk. As you can see, there are lifeguards available, but...





They had wood stacked for bonfires all over the beach, which would have been lovely had it not been 110 degrees right on the equator!



But cool shells and such kept me occupied while I got my annual March sunburn.

February must mean Rwanda...again.

Hey Luci and M,

So as you know, February and March found me back in Rwanda. This time out in the west. We are supporting the sites in Nyamasheke District right on Lake Kivu bordering Eastern Congo.

There was an earthquake, a big one; 6.0 or so, right before I got there and the aftershocks were indeed interesting. Not being there for the real thing, I found the tremors the weeks I was there plenty to get the idea.

Unfortunately, there was a lot of damage. Western Rwanda gets fairly chilly at night up in the hills, even in their summer time. People, and the hospital, were living and operating out of tents.







The IHV house, aka "Chez Marik" since she has been our only full time team member living in Rwanda is nicely situated overlooking the lake. It was a great place to unwind after full days in the clinics and hospitals. That's Bucavu, Congo off to the left. My visit there is another story...no pictures from that one but walking across the border and making my way through town to meet up with Marik where she was reviewing a hospital was....interesting.



And this is the town of Kemembe were we are based out there.





And that was pretty much it till March. When I came home for a week before heading back to Zambia.

Home for Christmas

So then it was home in time for my first tree in my new house. Dakota was an excellent help with decorating....





And down to VA for Christmas with the nephew, and family of course!




Back in time for Jake's 2nd Birthday!!



And then on the road again...

On to the next clinic...still December

Rwanda is very small, but it takes hours to get from place to place because you have to drive switch back after switch back to get over and around the mountains...land of 1000 hills is very accurate. So a little bit of tarmac...



And then back to those great dirt roads...and kids going to fetch water.



Got lucky with a windless day. This is the new reservoir a Chinese group built to irrigate rice fields.






Back through the banana fields...



and home...



Just kidding, we were in a guest house...buckets outside by 6 am for the hot water to bathe. At least I wasn't sharing the room with 20 racing spiders this time! :)

World AIDS Day 2007

I had the honor of being at Bungwe for World AIDS Day on December 1st. This was my first AIDS Day outside of the US, and it was amazing. No candle light vigil, no sad stories. I think every patient from the clinic and their family, and most of the village came to celebrate life. There was dancing, and singing, and educational skits. I don't have the words for how moving the whole experience was and how humbled I felt to be working with these people hopefully supporting their lives in some small way.

This is the children's support group. They all had new school uniforms made just for the celebration.





There were so many people it was amazing.



This is the support group that is making traditional baskets from world food program sacks for sale in fair trade. If anyone wants one let me know! All the money goes back to the support group for income generation projects.



Just spectacular to have been a part of this special day.

November and December

So it was back to Rwanda in November and December. Out in the field collecting data for the patient level outcomes process.




Typical road shot, lots of people walking. We passed a big market day on the way to one of the clinics and stopped to get some fruit for our final destination.



Rwanda is one of my favorite places for pure scenery value. Being so densely populated, very little land goes unused. So here is a quick shot of hill after hill of terrace farms.



Did I mention we work in really rural sites? I took this walking through the village that surrounds Bungwe clinic just after the rain. The is the mist the gorillas love so much.



And then down into the village.