Yes yes...I'm still actually working over here in Uganda...thought it might be time to give you all a work-related update :)
CHAI is supporting the Ministry of Health pilot a 9 month rapid antibody test as part of the EID (early infant diagnosis) testing algorithm. The goal is to identify HIV+ infants as soon as possible so they can start on treatment immediately. Currently, the guidelines say that healthcare workers should do a 1st DNA PCR (polymerase chain reaction)at 6 weeks and then a 2nd DNA PCR 6 weeks after the mother stops breastfeeding (usually just over a year). While the infants are young, they carry maternal antibodies, so the tests look at an infant's DNA directly. At or after 18 months, infants will be given a rapid antibody test which is the same test an adult would receive. Rapid tests are cheaper and easier to perform compared to DNA PCR tests which require removal of hemoglobin from the blood in order to obtain leukocytes from which purified genomic DNA is isolated. While facilities can perform their own rapid tests, DNA PCR test samples are collected at the facilities, delivered by hub riders to the local post office and run in the central lab in Kampala. The turn around time (TAT) for results is approximately 2 weeks. While the TAT has decreased over the past few years thanks to some hard work from our labs team, any TAT at all increases the risk of mothers and caregivers not coming back to pick up their results. Introducing a 9 month test between the 1st and 2nd DNA PCR would help identify exposed infants who seroconvert (basically means they weren't showing signs of the virus but now are) after a negative 1st DNA PCR. Additionally, there have been some studies showing that maternal antibodies usually clear by 9-12 months (though they can remain until 18 months and in mothers who continue to breast feed). Lastly, the uptake of the measles vaccine, which is administered at 9 months, is around 95% in Uganda, so the hope is to capitalize on the fact that mothers are bringing their children to the facilities already. The pilot will help us gain insights into the operational challenges we will encounter (and yes, there will be many) so that we can apply lessons learned to the scale-up process. We trained healthcare workers in February and are doing some data collection right now so hopefully we'll see strong uptake of the 9 month test! Here are the current (left) and proposed (right) testing algorithms in case you're interested. One thing I didn't expect to gain from my experience in Uganda is a newfound appreciation and love for outdoor activities. I'm going to work to prioritize time outdoors when I'm home, especially once I'm back in California this fall. A friend from work mentioned his kayaking hobby the first week I was here. After I saw some of the photos on the Kayak the Nile website I knew I had to try it. Kayak the Nile is owned by a British couple, Sam and Emily Ward. Sam is Great Britain's Freestyle Team Coach, so I felt incredibly lucky that he coached my lesson this past Sunday. They've done a great job building well-paced but challenging lessons where you can really feel your own progression day by day. Compared to other rivers, you don't have to worry as much about rocks or shallow water. Also, most rapids will end in a deep, calm pool so if you flip or swim (fall out of your kayak), you can float down and just wait at the bottom. Just like the rafting, there's always a crew of safety kayakers who will help you out right away, so I've always felt really safe. After just four lessons, I'm able to roll and am starting to feel much more comfortable on the rapids. While I still have a lot to learn in terms of reading the water, I'm eager to find a way to get on some white water when I'm back stateside. Also...right outside the entrance to Kayak the Nile, you can get the best rolexes in the country. My recommendation is to get one with avocado, chips (freshly fried potatoes), and green peppers. You can't go wrong. Plus, I'm told it helps your rolling technique :)
Here in Uganda, when asked about my religious practices, I usually just say, "my dad was raised Christian." For the most part, that deflects an otherwise longer conversation that I don't have the energy to have.
Day 6 - Lake BunyonyiReady for some R&R, Liz and I decided to skip out on Genocide Museum and hit the road for Uganda. We'll have to come back another time, I've heard the museum is incredibly powerful and well-designed. Lake Bunyonyi was exactly what we needed. Byoona Amagara was the cherry on top. Don't question it. Just book a geodome, order the rumballs for dessert, and enjoy yourself! Thank you Liz for doing all the work when "we" rowed for an hour to get to Byoona Amagara (you can also pay 25k UGX to take the motorboat which we did on the way back. Day 7 - Kazinga Channel, Queen Elizabeth National ParkAlthough we wished we had more time at Byoona Amagara, we met Isma, our driver for the rest of the trip, and set off for Queen Elizabeth National Park. Isma does a lot of driving for CHAI and my parents graciously subsidized the cost of hiring him for the second half of our trip. Since Liz and I don't know anything about cars really, we didn't feel like it was the best idea driving ourselves around a part of the country we had never been with the risk of car troubles. Plus, Isma has the greatest mix CD of anyone I've ever road tripped with and makes friends with everyone (except matoke merchants trying to rip him off). My biggest regret of the trip was not driving through the Ishasha sector of the park. This is where the famous tree-climbing lions are. I did talk to a friend who was there around the same time and she went on a game drive in Ishasha and said that they didn't see any lions because it's been so hot so they've been hard to find...that made me feel a little better. Anyways, we made it just in time for the 3pm Kazinga Channel Boat Tour. It's an official UWA (Uganda Wildlife Authority) tour and it was well worth the $30 (plus park entry fee of $40). The park ranger was really informative, spoke great English (yay back in an English-speaking country!!), and humored our many questions. The boat has two levels which means you have shade!! You're guaranteed to see lots of interesting birds, hundreds of hippos, and some buffalo. If you're lucky, you'll find herds of elephants drinking and spot a croc or two. We stayed at Pumba Safari Lodge which was okay. Not sure it was worth the $120 we paid, especially when you compare it to our $30 geodome, but the food (included in cost) was delicious and there was plenty of hot water for our showers. Day 8 - Southern to Northern Hemisphere
Days 9, 10, & 11 - Rwenzori National ParkHow many people does it take to bring two muzungus hiking? More than we'd like to admit... While it's a national park, the trails are maintained by RTS and you can't hike in this area without a guide. If you're ambitious and fit, you can do the 8-day trek to Margherita Peak, the third highest in Africa after Kili and Mt. Kenya. It's a glacier up at the summit so you'll be making your way with crampons and an ice pick if you head up...good luck! Our 3-day trek allowed us to explore the lower region of the mountains. We passed through small farming areas, a bamboo forest, and a heather forest. Our guides, Hannington and Remegio (yes, their real names), did a great job explaining all the biodiversity - from the sausage fruit to the various types of lobelia plants. While you don't go about 3,500m on this shorter trek, I did start to feel the altitude. It didn't help that we also had to wear rainboots most of the second day because of how muddy it could get in some areas. Each campsite has a cabin with bunk beds and mattresses, so you just need to bring a sleeping bag. Don't forget a water pump, steri pen, or water purification tablets as there's no potable water during the trek. The water the runs in the rivers on the mountain is super clean and the locals have no problems drinking it directly. Rwenzori bottled water is after all, the most reputable brand of bottled water in Uganda. Day 12 - Fort PortalFort Portal is known for its crater lakes and views of the Rwenzoris. It's a popular weekend getaway for those living in Kampala. We stayed at Yes Hostel which is super cheap - proceeds from your stay go to support an orphanage for HIV+ children in the community. The hallway is super creepy, but the staff is friendly, there's hot water, wifi and cheap food. Fort Portal also boasts some crazy, high-end lodges. We had dinner the night before at Kyaninga Lodge. They have a beautiful pool that overlooks a crater lake you can walk around. While we definitely couldn't afford to stay there (their helicopter landing pad may give you a sense of their clientele), we did decide to treat ourselves to a 70k UGX three-course meal. There was no one staying or eating when we showed up, so we had the place to ourselves which made for a weird, but tasty, dining experience. They must be doing pretty well though because they look to be undergoing an expansion project to build new rooms. So, in an effort to continue to treat ourselves and not do too much physical activity, we drove to Ndali Lodge for lunch. In addition to having their own crater lake, they also produce vanilla and coffee on their land. They export all their coffee to Waitrose in the UK, but you can buy beans at the lodge. Dad, hope you're looking forward to some delicious coffee! Accompanied by one of the lodge's several rhodesian ridgebacks, we went for a nice walk around the lake before lunch. I believe rates at Ndali are $300+ a night. Isma, busy chatting it up with the staff, says that the owner is really proud and instead of decreasing prices, would just rather break even by filling the lodge for ~2 months a year. The lodge owner's wife is Ugandan so I think they already had the property which would cut down on costs. Isma said that Putin also stayed there once...not sure if I believe that but who knows... We had dinner at The Dutchess since we read some great things about their pizza. They also sell these cute boda / bicycle figurines which make for an awesome Ugandan souvenir. Day 13 - Mbale Tea Factory
They contract third-party drivers to go pick up leaves from farmers. Drivers are paid for how many kg of leaves they bring in. Farmers then come directly to the factory to pick up their payment themselves as well. Prices are regulated, but our tour guide says sometimes different factories will offer tiny increases to drivers / farmers to try to get more leaves. While Mbale Tea Factory does package some of its tea leaves for direct-to-consumer sales, they're more focused on selling leaves in bulk and letting other companies package and brand the tea however they'd like. Our guide wasn't exactly sure who their big buyers are, but once it's out of their hands, companies can do whatever they want - like mix the finer grade leaves with courser leaves before putting it in individual bags, adding flavor, etc. Day 14 - Whitewater Rafting in JinjaI'll let these photos speak for themselves...
Day 15 - Bye Liz :(Liz's flight out was around 9pm, but we left Kampala around 3pm to beat the usual Kampala-Entebbe jam that was likely only to get worse given the proximity to the long Easter weekend. We had afternoon drinks and an early dinner at Protea Hotel, which is 5 minutes away from the airport. It has a bar right on Lake Victoria. If you eat, ask them to make the curry but with fish. You won't regret it.
I'm so happy that Liz was able to make the trip out here. Not only was the trip incredibly unique and probably one I won't need to repeat again...ever...it was awesome to have someone from home see Uganda and East Africa. Now, I feel like when I go back (in a month, ahhh), it won't feel like this experience happened in a vacuum. There's someone else that will know what I'm talking about when I try to explain how bad the roads are, how red dust seems to get everywhere all the time, and of course, how beautiful it is here. I've been back for a full week now, but my body seems to still be recovering from an extreme and unique trip. Here's part one of the trip repot! Day 1 - Kigali, RwandaLiz and I met at Kigali International Airport in Rwanda. It's clean, modern, and efficient. Plastic bags are banned in Rwanda and Liz had to carry the cheese she bought in Amsterdam in her hands as she walks out of customs! People follow traffic rules and the roads were nicely paved with lane markers. The contrast with the constant chaos in Kampala was immediately evident. I felt relaxed already. We had dinner at Repub Lounge which was walking distance from Katharine's apartment in Kimihurura. Rwanda is the safest country in East Africa and we felt really comfortable walking in the dark. Katharine described the food to be nicer local food. We had some amazing kebabs, ginger rice, and curried vegetables. The food was full of flavor which is really different from Ugandan cuisine. *Note: there is no wifi in the airport, but if you exit to your left, there's a nice coffee shop that has free wifi and lots of outlets. They take credit card. There are ATMs in the parking lot if you want to get some local currency before hopping in a cab. We didn't prearrange a ride and felt safe taking a cab from the airport. A cab to Kimihurura cost us $10 without any bargaining. Day 2 - Kigali to GomaAfter a sleepless night for Liz (welcome to hot nights on foam mattresses), we headed to breakfast at Shokola (not to be confused with Shokola Lite which has the wall of kitenge that you may have seen photos of). Katharine works remotely from this cafe a lot and I can see why! It's like a library, cafe, and treehouse all in one. The wifi is good and the smoothies / juices are even better. At 11, we met up with Tresor from Kasitu Eco Tours and set off for the Gisenyi - Goma border. It was a beautiful 3ish hour drive to Gisenyi. There's one pit stop where you can use the bathroom and buy snacks. The border crossing was pretty seamless. They took our temperature on the DRC side and checked for our yellow fever cards. Tresor had our visas already and interfaced with the immigration officers on our behalf. It took like 20 minutes for them to process everything and I've heard that sometimes they'll give you a hard time if you don't speak French. We said farewell to the paved roads and neatly manicured gardens of Gisenyi and embraced the roads of Goma filled with motorcycles, chukudus, and white UN Land Cruisers. We spent the rest of our day reading and enjoying a relaxing dinner at Lac Kivu Lodge. The bed there had a spring mattress and I got the most comfortable night's sleep since coming to East Africa.
More photos and details about our time in the DRC are on that webpage - click the button to the right! I can't say enough good things about the gorilla trekking experience. It's not cheap but we all walked away feeling like the experience was well worth it. On top of getting to be up close and personal with these mountain gorillas, the park seems really well run and part of your fees to go support the local schools and communities that live within the park. A bit about Goma...a lot of the kitenge (traditional printed fabrics) in the region is exported from the DRC, so we made a stop on the way back to buy some fabric. 6 square meters goes for about $10. My Ugandan colleague asked me to buy her some from there because they usually have a bigger and higher quality selection that when we can get in Kampala. There is also a small crafts market where you can get cool wooden masks like the one Liz is holding above. The vendors were pretty aggressive and started with prices 3-4x what Liz and Katharine ended up paying, so get ready to bargain! If you don't speak French (and maybe even if you do), don't both trying to ask what the meaning / story behind each mask is. All we could understand is that pregnant women can receive a "message" from the bird on Liz's mask... Day 4 - Nyiragongo Volcano, Virunga National Park, DRCAfter volcano boarding in Nicaragua last fall, I think I've had my fair share of spending time on / around active volcanoes for awhile. Nyiragongo has been really active and we were waiting for the park rangers or tour company to tell us they've shut down the trek. They didn't...so up we went! Day 5 - Nyiragongo to KigaliI couldn't walk normally for two days after this trek. Hanging out above the clouds comes with a price. The descent was easier physically, but still taxing on your ankles since you're walking on unstable rock for most of the way. We hit the round around noon and were back in Kigali in time to make it to Monday night trivia (better known as quiz here in East Africa) at Sol e Luna.
We were surprised to see Howard Buffett's name around the DRC. We first saw his foundation on a billboard at the border and then again further into the park. It turns out, he produced (along side our friend Leo DiCaprio and others) the Oscar-nominated documentary Virunga (it's on Netflix) which spotlights the park rangers' fight to protect the park from poachers, M23 rebels, and large corporations looking to tap into the natural resources. While it looks like he is a well-intentioned environmentalist, we were interested in figuring out why he was building infrastructure at the border. Katharine did some quick googling and we found our answer. Hydropower. I don't know enough about it to understand what the long-term implications are or what local sentiment is like towards him, but at least in the short-term, it sounds like he's creating jobs and pumping money into an area that most others don't want to go near. |
AuthorI'm eager to learn about the world around me and find that travel (and food) is one of my favorite ways in which to do so. Archives
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