Makerere University Scientific Symposium

A busy week, but one of the best so far!

I spent most of the week at the 6th annual Makerere University College of Health Sciences Scientific Symposium. There were lots of great presentations from researchers, students, and NGO workers from around Uganda, as well as a few pretty dismal reviews of topics such as the scientific basis of reflexology (NONE) and whether 'speaking in tongues' is associated with hysteria (seriously??). My favorite presentations (besides UVP's of course) were during the session on medical education at the end of the conference.

Uganda Village Project staff members gave presentations on our surgical referral networks, village health teams, sanitation campaigns, and recommendations for international volunteer programs. I was hoping that the conference would be an opportunity for UVP staff to share some of their experience with others, raise UVP's profile in the country, and network with faculty and students from Makerere (for our internship program). We succeeded at the first two objectives, but because there were fewer students at the conference this year compared to past years, I wasn't as happy with our ability to network. I hope that next year the conference has enough money to better subsidize students, who should be one of the main audiences for the conference.

On Friday afternoon, I gave a presentation about health and human rights education in the US. My goal was to share some of the PHR student program's experiences in this area, and to start a conversation with students and faculty about incorporating health and human rights education into the health professional school curricula in Uganda. Given the situation with student attendance I describe above, I was pretty nervous by lunchtime Friday that I'd be speaking to a room full of chairs.

However, much to my delight, the presentation was pretty well attended (thanks to being just before the closing keynote), and lots of Makerere faculty members, health workers, and even the WHO Special Representative to Uganda came up to me afterward to trade contact information and share their perspective on health and human rights education.

One of the most inspiring conversations I had was with a health promoter from Pallisa district who shared stories of patients dying because doctors and nurses wouldn't treat them without getting paid first. She noted indignantly, "This is a human rights issue! These people do not need to die!". Bingo.

Several of the health workers from various parts of the country invited me out to their districts to see what's going on where they work. I really hope I get a chance to take them up on these generous offers.

Random Notes:
- Went to an amazing Thai restaurant in Kampala which can actually make green curry, pad thai, and tom kha. Ate there twice this week.
- Bought a helmet for my boda-boda rides. Very, very happy about this, partly because I'll be safer and partly because I won't show up to work with a thick layer of red dust on my face anymore.

Nesting

I'm still nesting. Brandon and I moved into an apartment a few weeks ago, but it's taken some time for me to fully unpack, get organized, and make the place feel more like a home. Since this apartment is probably the nicest place I've ever lived besides my parents' house, I'm not complaining too much. I bought a couple of paintings late last week, which gave the place a bit of color and personality.

My room

My room

Kitchen

Living room

Dining room

Also, in terms of settling in, I got an office at the JCRC Mengo campus today. Though I enjoy having the flexibility to work from home, internet cafes, or various places at Mulago, I'm looking forward to having a particular place to sit and do work every day. I'm also hoping that it pushes me to work a bit more, rather than getting caught up in watching more 'Mad Men' episodes. Now, I just need to be able to find a few boda drivers that don't get lost on the way to the JCRC from Kamwokya.

In terms of my research work on HIV in older adults, I have lots of ideas, but actually putting together a dataset that makes some sense is proving to be a quite a challenge, as I should have anticipated. Nothing insurmountable, I think, and in a sense, figuring out how to overcome that challenge is the whole point of this year anyways. My PI from the US comes into town later this week, and I'm looking forward to getting his perspective on some of the ideas I've been working on.


One of the highlights of last week was an advocacy training for HIV/AIDS activists on how to use the upcoming elections to secure commitments from potential lawmakers. There were lots of similarities with the birddogging/advocacy training sessions that Health GAP  and AMSA activists hold in the US, so it was really cool to see what resonated with activists here, what needed to be adapted, the differences in barriers to effective birddogging, etc. It was also really nice to spend a day with advocacy-oriented people. With all my research work, I miss having friends and colleagues around who have that particular streak of vibrancy, set of priorities, and grounded perspective.

Another big part of last week was trying to figure out how to digitize documents in the Makerere University College of Health Sciences (MUCHS) Library. I'm interested in the project in order to make the knowledge generated by scholars here available to students, faculty, and researchers in Uganda and around the world. Makerere is one of the preeminent centers of medical education in Africa, so this is a pretty serious amount of knowledge that's lying unused and largely inaccessible. The project is currently facing a major hurdle: all of the theses are bound, and they only have access to one flat-bed scanner. Almost a dozen people back home have been helping me get in touch with people who have experience in this field, and all of those contacts have been very helpful so far. I'm getting a better idea of what we'll need to do/build to speed up the scanning process. Now I've got to convince people/organizations to help me find the equipment or money to buy equipment (probably around $500-$800).

Oh, and I went to The Royal Ascot Goat Races, and sat in the VIP section, thanks to some friends (and friends of friends).

Non-work related things: Football, Entebbe, Sipi

Work stuff is still slowly picking up steam. Drafted some proposals, thinking about some other ones, reaching out to friends and mentors here and elsewhere for thoughts/critiques on said proposals (thanks everyone!). I'm hoping something makes sense to other scientists and that we're able to get some good work done this year.

But, I haven't only been doing work here. Last weekend I went to the Uganda vs. Angola football (soccer) match at Nelson Mandela Stadium. The Ugandan fans were out in force, and President Museveni even made an appearance. We won 3-0, and will go on to face Kenya in the next match for the African Cup of Nationals qualifiers.

Uganda vs. Angola

Fellow football enthusiasts at the match

Last Sunday, I went to Entebbe to check out the botanical gardens, zoo, and Lake Victoria.

Entebbe Botanical Garden

Entebbe Zoo

Then, this weekend, I took advantage of the Eid holiday to spend a few days near Sipi Falls in Eastern Uganda. It was good to get out of the city for a bit to clear my mind. When I went to Sipi in 2005, I hiked to the last of the three waterfalls; this time I went to all three, which was a much better experience. You can abseil alongside the third, 100 meter-high drop, but after one of my hiking companions discussed the finer points of not slamming into the wall while abseiling, I decided to try it next time.

The top waterfall at Sipi Falls

Third waterfall at Sipi Falls

On Saturday afternoon, a gin and tonic kept me company while I read the day's paper. I leafed through page after page of articles about the latest election intrigue and violence. On page 6, there was a small line reminding me that it was September 11, and that nine years ago, many things for many people changed for the worse. I looked out at Sipi Falls, the acres of farms surrounding it, and the rain clouds over me, and was struck by how much had changed here and elsewhere in the last nine years. And how much things had stayed the same. No conclusions, no epiphanies. Just a deep feeling of melancholy about what might have been. 

The clouds broke over the ridge and the blue sky reminded me that our best moments often come on the September 12ths of our lives.

Sipi Falls at sunset

Buckling Down

Now that I’ve gotten settled into a (temporary) living situation, there are fewer random life-associated things to report. Early this week I had another meeting with Prof. Mayanja, Aggrey, and Ekwaro, and we decided to move forward with exploring possible work to be done on the topic of HIV in older adults (>50). 

Much has been written about how the HIV/AIDS epidemic affects older adults in Africa, mostly discussing how they have to take care of adult children and orphans, and the impact of providing that care on their own health. However, there’s only been one publication (that I have found) about older adults with HIV/AIDS in Africa. There have been a couple dozen publications from Western Europe and the US about virologic/immunologic/clinical outcomes in older adults with HIV, comorbidities, different antiretroviral treatment regimens, etc., and I spent most of the rest of the week reading those. I still have maybe 20-25 articles left to read, but it’s a cool feeling to know that at the end of that I will have read most of what has been written about this topic.

I’m excited about exploring this area. I’ve started jotting down notes about information we might be able to generate here that would 1) improve the care of older Ugandan adults with HIV (and perhaps older Ugandan adults in general), 2) inform fellow health workers in order to improve the care of older African adults with HIV, and 3) inform the international community about the unique situation that older adults with HIV face in this setting (due to different risk behaviors, social/economic/cultural factors, medications available, comorbidities, and so on), compared to patients in the West.

Of course, the actual work is going to be designing and implementing a study that will allow us to generate this information, but my plan is to dive into the literature, try to get a nuanced understanding of what is known, how it was discovered, and what needs to be done, and then to start to think through a protocol. I’m going to have to rely on Aggrey and Ekwaro (and many other people here) to help me discern what is relevant and feasible.

I also got in touch with colleagues at the Action Group for Health Human Rights and AIDS (thanks Sarah!), which is a sister organization of Physicians for Human Rights. I’m hoping to visit them in the next two weeks, and will write more about the organization for the PHR Student Blog after that. I’ll probably also write about Peter Mugyenyi’s book “Genocide by Denial: How Profiteering from HIV/AIDS Killed Millions”. Mugyenyi is the official Ugandan mentor for my Fogarty program, so it was fascinating to learn about his work at JCRC over the past 20 years, as well as his perspectives on access to essential medicines, TRIPS, patient care, etc.

Random Notes:
- Scoured Nakumatt (one of the 3 main supermarkets) for a Pinot Noir, without luck. Found lots of Pinotage, which Wikipedia informs me is South Africa’s signature wine and is related to Pinot Noir. Sipping on it now (out of a tea cup) and it tastes great!
- Submitted 3 abstracts to the annual Makerere College of Health Sciences Scientific Symposium, two of which were with friends at Uganda Village Project and one about work with PHR's Student Program. Fingers crossed!
 - I want to start taking language classes soon. Luganda costs $105 and Kiswahili is $150 for 30 hours of tutoring. Not bad at all. I think I’m going to start with Luganda since I know a bit, and then branch out to Kiswahili later.
- There was hail during a rainstorm here today. The “nuts of the water of heaven” as Achebe calls it his classic, ‘Things Fall Apart’. Reminded me of Spring in Texas.

Temporary housing at Golf Course Apartments. Not too shabby...

View of the golf course, out of our (temporary) living room window. $100/person/18 holes.

Getting Going

End of my first full week!

The last few days have felt pretty helter-skelter with meetings and brainstorming research projects. Things move at a different pace here, and because the professors are quite busy, our meetings often get rescheduled (i.e. moved back a few hours). However, when we do sit down and talk, everyone has been very supportive and has given us all the time we need. This combination makes days feel quite busy despite the fact that we may only have a few appointments.

I'm still figuring out what I'm going to work on this year, and at each meeting I've been explaining that "My interests are pretty broad, and my experience is varied, but I want to work on a project that is locally relevant and has the support of faculty and institutions here, so that when I leave the work is useful and can continue if necessary." Of course, I don't want to work on something that I'm not passionate about, nor do I want to jump off the deep end into something that will take a lot of time for me to become proficient (i.e. lab work). On the other hand, the whole point of this year is to stretch myself, gain skills I don't have, learn about topics with which I'm unfamiliar, and ultimately with the help of others, explore research questions that no one knows much about. Being too careful is as big a risk as being too cavalier.

Several faculty members gave me some ideas about projects, but I got the sense that they probably wouldn't have a lot of time to continue working with me. I've saved those suggestions to think about more later this year. One topic that seems to generate a lot of interest is HIV/AIDS in the older adult population in Africa. I was initially exposed to this idea by one of my mentors at Michigan (Hi Dr. Malani!), but was unsure about whether to push forward on it without some support from others around here. Yesterday, I had a great set of discussions with Aggrey and professor Mayanja-Kizza at Makerere, which got me excited about moving forward in that vein. I'm going to try to do some reading this weekend to get caught up on what is known and what isn't so I can start to think through research projects that we can do at JCRC and IDI.

In other work-related news, on Tuesday I sat in on the JCRC equivalent of grand rounds and went on ward rounds with one of the staff physicians. I love seeing patients and thinking through clinical dilemmas, and I forgot how much I missed it until I was back in the thick of things. I have a lot to learn about taking care of people living with HIV/AIDS, TB patients, etc. The docs are really welcoming and have a lot of experience, so I think this is going to be an awesome opportunity to learn from experts in the field.

In terms of personal life, I'm still living at the Case Western house, but will be moving out in the next couple of days. I'm either going to move into Brandon's living room at his hotel, or to a hotel near Makerere. The IDI has a really nice apartment near Mulago, but it's a bit more expensive than I was expecting to pay (but still well within reason and my budget). I might look at a couple of places this weekend with some brokers, but my gut tells me I'm probably going to end up at the IDI apartment. A nice roommate, washing machine, good security, and garden aren't easy to turn down.

Sorry about the few photos. I've been around most of these places before and will be here all year, so I rarely have an urge to pull out my camera.

Random Notes:

- Brandon found metered taxis in Kampala, which sounds awesome.
- Ate at Hanndi twice this week. Beautiful.
- There was a special about cross-cultural relations in Dearborn, MI on Al Jazeera earlier this week.

View of City Center (Nakasero) from Kololo

Familiar Surroundings, New Faces

After taking advantage of two long plane flights to start to catch up on my sleep debt from last year, I arrived safely in Kampala on Tuesday night.

Henry, one of the TB Research Unit drivers, picked me up and took me to the Case Western Reserve Guest House in Kololo (which Ekwaro calls the Beverly Hills of Uganda). The house is very nice, but I'm hoping to move to a place that is easier to access and less expensive as soon as possible. Because I might be working in several different places in the city, figuring out where exactly to live is a bit tricky. Right now I'm thinking somewhere in the Mengo area so that I can get to Mulago Hospital (the national referral hospital) and JCRC's offices in Mengo quickly.

CWRU House in Kololo

Until recently, all of JCRC's facilities were in Mengo, which is near the city center. However, they now have a gorgeous campus in Lubowa, which is south of Kampala on the way to Entebbe airport. The outpatient services have been moved to Lubowa, but the inpatient wards and labs are still in Mengo. There's a shuttle that runs between JCRC Mengo and JCRC Lubowa, and I need to find out if I can just take that to get to Lubowa, rather than taking several matatus (shared taxis).

On Friday, Ekwaro and I visited the JCRC offices in Lubowa for the first time in order to meet the director, Peter Mugyenyi, the deputy-directory, Cissy Kityo, and the Fogarty coordinator, Nelson Kakande. They were extremely warm and welcoming, which helped soothe some of the restlessness I had been feeling after being in country for a few days without meeting anyone from work. We also met with several other staff members, and will be having more in-depth meetings with JCRC staff over the next few weeks to learn more about JCRC's work and potential projects for this year.

The same day, we also met up with Aggrey and Brandon, the Fogarty Scholars at the Infectious Disease Institute. One of their main projects is the development of a rural cohort of HIV+ patients who will undergo cardiovascular tests (ankle-brachial index, EKG, etc.) in order to assess the cardiovascular burden of HIV and ARV treatment. It's a fantastic project developed by Fogarty Scholars last year and will be continued by scholars in the future.

Other random notes:
- After having a Blackberry for two years, typing with T9 feels really complicated.
- I have 3G mobile internet that is surprisingly fast. 4G coming soon, I'm told!
- I finally had matooke again, which I love and miss whenever I'm not in Uganda. I need to learn how to cook it this year so I can make it in the US.
- Bubbles O'Leary Irish Pub is still one of the best people-watching places I've ever been to. Some things never change. (Also, they have trivia every other Thursday!)
- Security in Kampala is much, much more stringent than before; almost every business has a metal detector now.

Here goes nothin'

As most of you probably know, I'm moving to Uganda on Monday, until June or July 2011. Rather than inundating friends, family, and acquaintances with random emails, I'm taking the advice of several friends and starting a blog. I had a blog briefly in college, but on the whole this is going to be a new experience for me. I hope you'll bear with me as I figure out what I should post, what I should leave out, and how many pictures I should include of Ugandan children running after me yelling "mzungu bye!" That phrase roughly translates into "foreigner/white person bye!" and is a favorite of young children in rural parts of East Africa.

A bit more about what I'll be doing: The Fogarty International Clinical Research Scholars and Fellows Program is sponsoring me to work with the Joint Clinical Research Centre and Case Western Reserve University.  (I'll try to write more about JCRC in the future - it's a phenomenal organization.) I may also be working with researchers and clinicians at Mulago Hospital or the Tuberculosis Research Unit, but more on that if it materializes.

In addition to sponsoring a US-based graduate student, Fogarty sponsors a Ugandan for a year, in an effort to build local capacity for health research (one of the reasons I picked this program). My counterpart/twin - Ekwaro - is a physician who is particularly interested in tuberculosis and has been working with various institutions over the past several years. We had a chance to meet and hang out during our orientation process at Case and at the NIH and got along smashingly well.

Francis Collins (Director of the NIH), me, and Ekwaro (yellow shirt) along with several other Fogarty Scholars

While at Case, we met with several faculty members to discuss potential projects, and we'll be doing the same with Ugandan researchers once I arrive in Kampala. My US-based mentor, Dr. Bob Salata, has recommended that I have a plan for the year in place by the end of August, so hopefully I'll be able to provide more of an update by then about my research plans.

I'm glad to be going back to Uganda, where I've worked twice before. In 2005, I led a team of 7 volunteers for Uganda Village Project, a health and development NGO in Iganga district (eastern Uganda). In 2008, I worked in Kayunga, Uganda with researchers at the University of Michigan and Michigan State University as a field coordinator for a pilot study that assessed whether computer-based cognitive rehabilitation exercises could treat ARV-refractory cognitive deficits experienced by HIV+ children. Both of those were wonderful experiences for me, and are a big part of why I wanted to come back to Uganda.

Once I get settled in and my start fulfilling my research responsibilities with JCRC, I'm hoping to explore doing some work on my own time with UVP, the UM/MSU researchers, or with several other groups I'm in touch with that are doing research or policy work on health and human rights, access to essential medicines, open educational resources, palliative care, etc. I'm also going to try to pick up more Luganda and maybe learn some Kiswahili through language courses. I get excited about a lot of different topics and am lucky to have many colleagues in the region, so staying focused is going to be important this year!

(I should note that everything on this blog is my own opinion and in no way reflects the views or positions of any organizations or persons I work with, including JCRC, Case Western, the Fogarty International Center, the NIH, etc.)