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.