That was the response I got from one of my Ugandan colleagues when I told her I was heading to the states (and more specifically California) today.
For those of you who have been concerned about my safety in Kampala, hopefully that gives you some perspective :) It’s been a busy past few days! Between doing some Christmas shopping, making quite possible the best PowerPoint deck of my life, figuring out my housing situation for when I come back in January, trying to get myself to go to the gym, and spending time in the field last week, I haven’t had time to post! I’m flying back to the states tomorrow night and once I’m reunited with high speed internet, I'll share some pictures from the field. But for now, a really cool update from another CHAI Uganda team. Last week, our Lab and eHealth teams presented this brand new Viral Load Dashboard to PEPFAR / CDC. What is viral load? According to aids.gov... “...the term “viral load” refers to the amount of HIV in a sample of your blood. When your viral load is high, you have more HIV in your body, and that means your immune system is not fighting HIV as well. A viral load test is a lab test that measures the number of HIV virus particles in a milliliter of your blood. These particles are called "copies." A viral load test helps provide information on your health status and how well antiretroviral therapy (ART – treatment with HIV medicines) is controlling the virus. ART involves taking a combination of HIV medicines (called an HIV regimen) every day. ART can’t cure HIV, but it can help you live a longer, healthier life and reduce your risk of HIV transmission. The goal of ART is to move your viral load down, ideally to undetectable levels. In general, your viral load will be declared "undetectable" if it is under 40 to 75 copies in a sample of your blood. The exact number depends on the lab that analyzes your test. Having an “undetectable” viral load doesn’t mean that the virus is completely gone from your body, just that it is below what a lab test can find. You still have HIV and need to stay on ART to remain healthy.” This dashboard is big step towards increasing data transparency and access. While I think the hope is that districts will start using this to monitor their own performance more carefully, I’m not sure that there are incentives for them to do so yet. I’d be interested to understand if facilities are held accountable for performance or adherence to national policies and processes. For now, donors, IPs (implementing partners), and CPHL will be some of the main users as they measure progress against key indicators. Potential use cases of the dashboard:
Collecting, reporting, and understanding healthcare data seems to be a challenge for healthcare providers and systems of all sizes. This data can be really powerful for stakeholders to identify underserved populations, quality of care issues, opportunities for time / cost savings, and more. From a few of my experiences working with health systems in the United States, there was an issue of analysis paralysis – there was so much data that was being collected (albeit not always done correctly or consistently), that the teams in charge of going through the data weren’t sure what would be helpful to know more about. Some of that may have been because the analytics teams didn’t have an understanding of what would allow for actionable change and two-way communication about challenges, potential hypotheses about opportunity areas, etc. wasn’t occurring. Presenting and analyzing data in a clear (and agreed upon) manner can be really powerful and I’m excited about what impact this, and other dashboards that teams here at CHAI Uganda are working on, will have. If anyone wants to leverage the front-end code, you can check out the team’s GitHub page here. Maybe I should learn to code…especially if I’m not confident that Tableau will be around forever…
The lab computer allows the lab technicians (is that their title?) to create "worksheets" of samples with bar codes. They look for the correct DBS tests, and start setting up their trays. No idea how the science works behind all this...but the lab tech puts all the samples in order, then puts one of the little blood samples (still on the paper) into a little test tube with a reagent. That reagent pulls the blood off the paper and into the fluid, so that it can be tested for the antibodies. I think they sit for awhile on that machine (where they're in the square configuration) before they are ready to get put into the large machine scanners. The bar codes allow the machines to assign results from the trays (based on location in the tray) directly to the profile in the computer system. From what I've been hearing, consolidating all the testing in this central lab (they also run sickle cell tests, TB, malaria, and probably others) was a big success. I think there was a CHAI team working on that (maybe why our logo is on the plaque) to increase quality control, data collection and reporting, and process standardization. The CPHL website says that funding comes from the Government of Uganda and PEPFAR (United States President's Emergency Plan for AIDS Relief) through the MoH (MInistry of Health)-CDC Cooperative Agreement. PEPFAR is a huge source of funding and I believe one of the few that will support the purchase of commodities (e.g. test kits) which is important because there's a predicted stock shortage coming soon. I don't know much about the MoH-CDC relationship, maybe some of my Deloitte federal friends know a thing or two about this :) I'm excited to continue geeking out over all this over the next few months. It was really cool to see things in action today and next week I'll be "in the field" helping with a lot of data collection at health facilities. We're gathering a lot of data that create a baseline for many different indicators (# of HIV+ children started on ART, % of tests given to children in the TB ward, etc.) that we'll measure against over time. Also, last night I had amazing bibimbap that, I have to say, was better than Del Seoul. I had leftovers but the power was out all day today which means no refrigeration...think it's still good? There's been a lot of buzz about Priscilla Chan and Mark Zuckerberg's letter to their newborn daughter where they commit to donating 99% of their Facebook shares. The comments from Melinda Gates, Gavin Newsom, Richard Barth, and many more seem to echo the sentiment that I had when reading the letter. More or less that...this is awesome, it may encourage similar people to do the same, and will really make a positive impact for our global community. My curiosity led to looking up some of the organizations that the Chan Zuckerberg Initiative has supported (well...not officially on behalf of CZI until now I suppose). They are largely focused around education and healthcare (not surprising given Priscilla Chan's background and work), which, given my interests and experience made learning about these organizations really interesting. Then I came across this Guardian article that challenged me to think more critically about the impact of not only western philanthropy but also the work that I, and many of the folks I'm meeting here in Kampala are doing and the system we are supporting.
Since being here, I've met lots of interesting people and have started to have some great conversations around this topic. I've been going back to some of the reading I did in college around international development (like Escobar's thoughts around the "Problematization of Poverty") now that I'm interacting with this space more personally.
I'm not sure I have any coherent opinions to share yet (would love to hear yours!), but general observations include:
It's been over a week now since I arrived in Kampala and I'm starting to feel settled in - of course, a lot of that has to do with how much great food there is here. While a Ugandan colleague described the food as "bland," I would say that at least there is a lot of variety and we have hot sauce stocked in the office kitchen. Maybe I'll start to get bored in a few months, but for now, I'm more than happy spending my time outdoors rather than in the kitchen :) What I've eaten so far "YOU HAVE TO TRY ROLEX!" was probably the most consistent reaction when I spoke with people who had spent time in Uganda. So last night, when my boda driver offered to take me to get some rolex on the way to my apartment, I happily obliged. Key ingredients: egg and chapati. What you see in the picture to the right is essentially an omelette cooking on a rounded metal hotplate over a charcoal cook stove. Before the eggs cooked too thoroughly, he threw a chapati on top. Chapati is like a mix between a tortilla, Indian roti, and Malaysia roti prata. I have to imagine its prevalence in Ugandan cuisine is a result of the large Indian population in Uganda. It’s not as dry as roti, but not as flakey or thick as roti prata. Anyway, once the chapati is added, he presses it to the eggs to get them to stick together. Then, he flips it over and adds a few final ingredients before rolling everything up. This particular stand had fresh tomatoes and cabbage. It seems like there may be more variety and it just depends where you go. Once it’s rolled, it gets put into a plastic bag (think newspaper bag) which then gets put into a paper bag to help with the heat as well as the excessive amount of grease haha. Why is it called rolex? Apparently the name came about from Ugandans saying "rolled eggs" or "roll of eggs" in an Lugandan accent. It seems like the farther you are from the center of town, the better the rolexes are...I'll be sure to taste test my way around and report back soon!
**Okay, I couldn't stay confused about all the data...what I was doing wrong was not looking at the plantains data like Wikipedia (obvi the most reliable) did. Uganda comes in at the top for plantain production which gives them a significant boost up the list. If you want to geek out on agricultural data, I highly recommend checking out the FAOSTAT "browse data" tab...it's super interactive and user friendly which is usually not the case for publicly available large data sets in my little experience. I love popcorn which is great because it seems like Ugandans do too! Not only do they have carnival poppers (not sure what they're called) at a lot of corner stores and events, you can also buy pre-popped popcorn at the grocery store. It's almost like SkinnyPop? And of course, Uganda has amazing fresh fruits! Passion fruit, mango, avocado, pineapple, and more! What's awesome is that I can continue to be super lazy and not even cut my own fruit. There is a woman who provides fresh fruit to the office each day...I'm going to get spoiled! I just go to the fridge and look for my tupperware with my name on it. Fruit and my lunch delivered for $2.50 a day will be my not so guilty splurge. On Mondays and Wednesdays (or apparently just whenever there's availability) we also get fresh loaves of bread in the mornings. Check out that hearty multigrain with chunky peanut butter. YUM. If it weren't so unpredictable, I'd never eat breakfast at home anymore. And don't worry, I'm not using hot sauce on my fruit or toast (yet) - just wanted to showcase that...it's local...I think, and pretty good! Had a slight hint of BBQ flavor which at first I wasn't a fan of but it's hardly noticeable anymore. International Cuisine With the recently released Hello Food, food delivery app (think Grubhub / Seamless without an integrated payment system), I can access a huge variety of cuisines without even leaving my office / apartment. Within a delivery radius of my office, I can order Thai, Chinese, Italian, American (burgers, salads, wraps, etc.)...you get the idea. That said, it's apparently and understandably not all that great. At dinner last week, a German colleague said that the two types of food that are better in Uganda compared to home are Ethiopian and Indian. From the little of both I've tried, so far, I'd agree.
Left: mysore dosa from Chaat House, which was amazing. @Mia Divecha, I think you'd approve :) Center: tiffin delivery we ordered to the office last week. Just found out that the non-veg option which I chose was goat liver (and potentially chicken hearts?)...we're specifying a chicken meat preference next time we order haha Right: this "American Garden" brand has been in most of the grocery stores I've been to. I checked the labels and all the products are actually made in the states, it's not just a branding thing. Regardless, besides the peanut butter, their stuff leaves a lot to be desired. |
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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