Thursday, May 27, 2010

More changes

Rachel Snow, our professor from U-M SPH, her son, Julian, and Kofi, a U-M OB/GYN, all arrived yesterday evening. They’re going to be living here for the next 2 weeks and Rachel will be overseeing our work. We caught up for a little bit, let them go to town and get some supplies, and then walked out to Lord’s for the yummy goat meat and plantain meal with Nile Specials – still my favorite thing about being here, next to the scenery. As we ate, I couldn’t take my eyes off the sky. It’s incredible how much light pollution we’re used to in the US; here, you see a completely different picture at night. There was a full moon, giving us the most spectacular view of wispy, rippled clouds and stars that glowed brighter than any I’ve ever seen...

I guess I should finally explain more of what my research project is about (I will keep it brief!). The study focuses on fertility aspirations and HIV, exploring various social and structural determinants of contraceptive use and pregnancy terminations among HIV+ women – and also interviewing HIV- women as a control. This includes the use of ARV treatment, family burdens, marriage, social stigma, etc. So, we basically ask a lot of questions about a woman’s past and present contraceptive use, their HIV status and questions concerning it, their opinions on abortion and contraception use, and their household structure and who they provide support to. While I’ve done a lot of work with HIV, I’ve never really been interested in maternal health until I took a reproductive health class my first year at U-M. I still don’t see myself working in the field but it made me aware of huge disparities and how important this research is.

As expected, a lot is changing now that Rachel is here. She’s proposed that we take the existing data to do an initial analysis and then start over sometime next week with the finalized version of everything. Thankfully, we have a large, willing study population, so it shouldn’t be a problem with the numbers. Sparring all the mundane details, we’re finalizing the questionnaire (again!), making a new database (AHHHH!) that should be more functional (she’s also paying Nickolas now to assist us with problems – which is a godsend), and starting over with interviews for the final analysis. This will be a lot of work upfront, but I’m really excited that we’re finally going to have everything correctly in place and end a lot of the unfocused, frustrating, and ever-changing tasks. Maybe I shouldn’t speak too soon, but I think the project will be much clearer now. Snow really knows how to organize once she comes through. I wish I could explain her better for those who don’t know her. I’m sure I’ll have much more fun stuff to write about later :-D

We actually get a little mini-vacation before all of this hard work begins. We’re leaving tomorrow for a 2-day adventure at Queen Elizabeth National Park – Uganda’s largest. Hoping to see lots of animals and beautiful sights.

Monday, May 24, 2010

Adventures on bodas

Saturday evening, after a long day of not eating, Lindsey and I decided to find a restaurant that was listed in my 2010 Bradt Uganda travel guide – Big Five, a Dutch-owned pizzeria that promised excellent food and beer. The only obstacle was its location – about 5km out of town, definitely too far too walk. The guide said you could take a “special hire” – cars and vans used for transport – from the city center for about 3,000 Ush to get there. We decided to be adventurous and go for it…

As we began to walk, we started discussing more of the logistics of getting there. We really didn’t know much about special hires – how to find them and how they really worked – so our thoughts turned to boda-bodas (or just bodas for short). Bodas are one of the main ways people get around here. These small motorbikes are a ubiquitous sight on the streets and roads all over the country; you’ll also see riders sitting around in various spots waiting to pick up potential customers. Because of their erratic driving (compared to US standards) and how dangerous it seems at first, we always joke that “oh, we’ll have to ride on a boda before we leave.” However, we soon discovered that walking everywhere gets tiring and that they might be a pretty good, cheap option to take advantage of.

There are always boda riders on the way to town, so we approached two of them parked under a tree. They barely spoke English and had no idea what Big Five was, but said they could get us downtown to High Street; we knew the restaurant was on that road eventually, so we figured we could tell them to just keep driving. That didn’t work. We got downtown and they stopped and our communication ceased to function. They called a man over, who looked like some sort of public worker, who spoke better English but also didn’t know of the restaurant. We gave up, paid the boda riders 1,000 Ush that we agreed to and started walking.

Once you pass the larger downtown buildings, the land gets more flat, open and dusty. Tons of buses, boda riders, and other vehicles line the roads here. At least 4 people asked us if we needed to go to Kampala because the road we were on leads there. We might have been able to jump on a ride and then jump off down the road at the restaurant, but we were hesitant to do so - and we also didn’t want to ultimately get stuck there. We found 2 boda riders who at first didn’t know of Big Five, but then asked around and reapproached us saying they could take us there. We hoped on and were off on our 2nd boda ride.

This one was fabulous; everywhere around me was beautiful countryside and gorgeous views of large hills. I actually felt safe and balanced on the boda and started snapping away with my camera. My rider and I exchanged names and conversation, as he told me about the sights we were riding by. We passed a Coca-Cola plant and a large soldier housing area before finally arriving to our destination. There it was: Big Five, in all its glory – dark and completely empty. There was a huge, uncovered entrance and as we wandered in, a man who was sleeping on a couch near the back jumped up. Our boda riders came down at this point and after speaking with the man, we realized that it definitely wasn’t operational (they tried to explain to us exactly why but we never really figured it out). So, it was back on the boda ride, right back to near we began at Hotel Agip - one of the few restaurants we know has reliable food and service. The boda ride out was 2,000 Ush – and we didn’t get a courtesy ride back because of our bad luck.

Looking back, I wonder if the riders knew all along that Big Five was defunct. It probably was an easy way to make 2 bucks off of ignorant foreigners. Several lessons learned (possibly) about bodas and travel guides. Still, I got a magnificent, new desktop picture from it.

Thursday, May 20, 2010

Obstacles and overcoming them

Our first day of pilot interviews gave a lot of insight into what we needed to change; there were numerous issues with question wording, skips, consistencies, etc. Eventually, we’re supposed to complete 10 interviews per day. I sat through 4 and all of them were in Lugandan… meaning a Ugandan had to conduct the interview by reading it from an English version, translating it to Lugandan and then after getting the answer, telling it to me in English so I could input the data – I felt a bit useless. There are supposed to be some done in English but I think it’s going to be very few. We were also supposed to have translated it into the local language to avoid translation discrepancies between different interviewers and other cultural variations… but as of now, it’s not happening. I’m a little nervous about the quality of our data.

On Wednesday and Thursday, Lindsey and I stayed home from interviews to solely work on the database. We had 2 meetings with Nickolas who turned out to be an Access wiz. We finally learned some really useful Access skills and we’re in the process of finishing things up into the weekend. It actually looks really good and it’s giving us a greater role in the project. Interviews were put on hold starting Thursday and the questionnaire is being revised; we should be meeting as a team to clarify some issues and hopefully we’ll set more uniform standards for collecting data.

I also moved out of the house I was in to the other one with Lindsey and Tegan. We have a couple other roommates – Johanna from Germany who is a resident and Sarah from the UK who is doing research in microeconomics. I’m really happy with my new room, too – more sunlight, a wardrobe and a desk. Downside: I’ve seen way more bugs over here. I doused my curtains in Permithrin.

We finally found a good restaurant right when you enter the city – City Top. They have good Indian food and a bar in a separate room before you enter the restaurant. You’re supposed to visit them separately, but we convinced our waiter to let us eat in the bar after he asked his boss for permission. We desperately needed beer.

Today, we traveled further down High Street (just like Morgantown!) and saw some newer sights. It’s interesting. Some parts of town are more segmented – as in, there’s an area of town that’s predominantly furniture making, one that’s tailor and fabric shops, and a couple others. But then, there’s like 100+ different little hole in the walls that sell basically everything, existing everywhere between the only other types, which are grocery, pharmacy, kitchen supplies, and mobile phone shops. And I feel like no one is ever shopping at them except us. There are some great products over here – and by great, I mean hilarious. My favorite today was a maxi-pad called Secrets: no one has to know. I also found some whiskey in mini-juice boxes.

Mzumba! I probably spelled that wrong (CORRECTION: Muzungu!) but that’s the phrase for “white person” that people say to us – while a few add a “how are yooooou?” in a high-pitched, mocking voice. I just wave at everyone and smile and probably make a fool out of myself as they make fun of me :)

I washed my clothes by hand for the first time. It’s really not that bad. You just fill up a wash bucket with Omo and water and get to scrubbin’! Then you wring it out, stick it in the rinse bucket, and ring it out again. The worst parts are trying to get all of the soap out and the fabric getting stiff after lying out in the sun. Once you wear them they pretty much go back to normal, but I’m happy I didn’t bring anything irreplaceable.

I’ve had a rollercoaster of emotions since arriving here. I got really distraught on Tuesday when the project seemed out of control. It also didn’t help constantly feeling sweaty, thirsty, and dirty. Since then, I’ve been better. I’m learning tricks to make myself more comfortable and how to make it out here. Being away has made me realize how much I love home and miss water that tastes normal, clean floors, good showers, the absence of insects, AC, refrigerators that are cold, and coolants in general. There’s still a ton more new experiences ahead though – not to mention, more fun.

Monday, May 17, 2010

Meeting the team

This morning, we had our meetings with the doctors, nurses, and other staff members at MUST. It started out with a large group of people, which Godfrey introduced us to and gave details about the study. Immediately afterward, we sat down around the conference table to go through the questionnaire and make any needed changes. We got to meet the Ugandans with who we would be paired with for the interviews. I’m working with Joy, a nursing student; she’s really humorous, intelligent, speaks great English and seems to know everything about the hospital and how the HIV clinic operates. I’m really glad we’re together.

Afterward, we went on a full tour of the hospital. Every day, I see something new that amazes me yet again. Today, it was the hundreds of people scattered around the hospital in different areas, waiting to be seen by a doctor, to get their meds, for immunizations, and so on… they sat in chairs in tightly packed rooms, on benches in narrow hallways, on the floor, outside, everywhere. Their faces were completely solemn as their stared at us walking by - another indescribable feeling…

Our group is kind of in a predicament. We’re supposed to start working on interviews TOMORROW, which really shocked us because nothing is completely finalized. We revised the questionnaire and have to edit these changes in Word and Access, but there are some functions we don’t know how to do and we haven’t had the Internet access to search how. Thankfully, we met Henry at the library who referred us to Tash, who is in charge of IT… now, we’re up and running on TashNet. Haha. This gives us slow, yet functional, Internet access on the main campus – which is right across the street from us. We’ve only tested it for several minutes, so here’s hoping that it continues to work.

Everything is also disorganized. This isn’t surprising, but it would help if things were a bit more finalized before we plow ahead with research. There’s a ton of issues with the database, available times of Ugandan team members, getting a high number of questionnaires completed every day, and so on. We’ll be working on what we can tonight… thankfully, we have instant coffee and electricity to boil water.

Also – I’ll eventually describe what the research is exactly about. I’m just burnt out at the moment.

Sunday, May 16, 2010

Hello, white people!

In Mbarara, white people a very rare occurrence (obviously)... as we roam through the streets, people constantly stare us at. It still feels uncomfortable. Now I know what it’s like to be a totally visible minority. For the most part, people mind their own business here. Each trip, maybe one or two people will shout “hello!” or “how are you?!” enthusiastically. I had my first encounter with a boy begging for money who followed us relentlessly, grasping my arm and shouting in Lugandan or Ruyankole. Massy had to tell him to leave us alone. It felt horrible. I wanted to give him something, but it’s going to happen again and again - and I also don’t know if I’m really helping. Basically, it just sucks and is out of my control.

We bought a few more needed supplies and groceries today. I’m always amazed at how you can turn down an alley on one of the main streets to find a whole new maze of shops and people, crammed into the smallest, dilapidated structures.

Five days in, I’m starting to realize mistakes I made while packing…

Should have packed:
A lot more hand sanitizer
Easily washable sandals (bought some today)
Reusable grocery bags
Sticky hooks
Larger towel
Some kind of medication to knock me out
Nonperishable salty foods

Over packed:
Bug repellant
Jackets
Money belt (not really necessary)

Lifesavers:
iPod
Laptop
Keychain flashlight
Card games
The hand sanitizer I did bring
A pair of shorts (but I can’t wear them out; no one does)

We worked on the Access database; Lindsey taught me how to create forms and finished up the last of the questionnaire. Tomorrow we have our meeting with some of the faculty to present our study. I don’t really know what to expect, but I’m hoping it’s nothing too formal.

Saturday, May 15, 2010

Kampala and the road to Mbarara

Even though we stayed in Kampala the first night, we actually didn’t see the city. Makerere University is on the northern side of town and slightly hidden from the hustle and bustle. Tegan and I woke up around 9, ate breakfast, and met Massy to go to downtown Kampala. One of the main ways of getting around the city (and country) is shared taxis. These vans are constantly visible and usually are jam-packed with riders. There is a rider whose job is to regulate the passengers and take their money; they also stick their heads through the window and shout at people to get in.

Kampala overwhelmed me yet again. I have never seen so much activity in my life before. Everyone and everything seems to be constantly moving. I wish I had a video because it’s so intense and hard to describe… constant traffic, noise, people everywhere, endless shops and goods, red dirt, heat, broken sidewalks, old buildings, tropical plants, beautiful cranes and birds, dust, smoke, and more people…

It seems like everyone is selling something – and in different ways. There are, of course, more traditional stores along the street you can enter. Then, you have your smaller, one-room shops – many of which are selling a wide variety of trinkets and goods, though some specialize in a service like foreign currency exchange, phone cards, apparel, and so on. People also stand along the street, holding handfuls of belts or shoes. There are also people sitting along the sidewalks with blankets spread out under umbrellas, selling books, newspapers, and other various items that look secondhand.

Leaving was also intense. We walked down a narrow, steep set of stairs, containing vendor stalls on each side. At the bottom, the land became flat and graveled, giving way for us to view an endless sea of taxi vans, with signs on the top designating their location. We got there just in time to catch ours back to the university. As we sat in the van while it loaded, various people walked by holding assortments of goods, trying to sell us newspapers, belts, water, pinwheels… absolutely everything and anything! The taxis somehow managed to squeeze through the people, motorcycles, and other vans to the main road. We got back and still suffering from the time zone adjustment, took a much-needed nap. When we woke up around 9:30PM, Lindsey had arrived and we hung out for a while before bed.

The next morning, we woke up around 7:30 AM, had breakfast, loaded up our stuff in the jeep (we had a driver from Mbarara), and left for our final destination! The journey is about a 4 ½ hour drive and we were stuck in heavy traffic as we tried to leave Kampala. Once we got on the road, we moved pretty smoothly. The two-lane road had some nice sections with pavement and some not-so-nice holes, bumps, and dusty stretches. We got to stop at where the equator passes; there is a touristy monument there and we got pictures of course. We also stopped on the outskirts of Lake Mburo National Park when we saw a couple zebras grazing.

The rural scenery here is absolutely amazing. Uganda is fairly mountainous and the hills were among the most beautiful, rolling and green that I’ve ever seen. Sometimes, the land reminded me of the West Virginia along the interstate – only more open, expanded and tropical. We also were exposed to a lot of poverty and typical images of destitute Africa. Rows of shops and scattered homes – most of which were old and dilapidated – lined the road. Many people were performing various tasks outdoors, carrying goods, moving items on bikes, working on construction, and so on. There were small and smaller children running around barefoot in mud – some of which had to have learned to walk only weeks earlier. Again, no pictures of this, but you can imagine.

We arrived in Mbarara late afternoon and put our belongings in the guesthouses. At the moment, the team is split up because other students are also using the houses - we’ve met people from Germany, Sweden, the Netherlands, the UK and US. Next week some people are leaving and we’ll get our official house, so it will be nice to have our belongings in a more permanent setting. The houses are better than expected (I tried to imagine having absolutely nothing). We have running water (which is warm if you turn on the heater at least 30 minutes earlier), electricity (half of the time - usually out in the day), flushing toilets, and a small fridge. We also have sinks to wash our clothes in. I’ve only seen some scattered insects, but I have a few lizard friends that will hopefully eat them.

We’re close enough to the city that we can walk down in about 15 minutes to get anything we need. We ventured in to buy groceries and more phone time; the rate is horrible, by the way, so it’s mostly going to be the Internet - which is also horrible, so actually, don't expect anything from me very often! All my blog posts are delayed by days. I also tried to add pictures but the connection can't handle it. I'll have to find something better hopefully...

Shopping for food is going to be a challenge. I can easily get fruits and veggies at the outdoor markets – and will have to build up the confidence to do this on my own – but the grocery stores didn’t seem to have what I’m looking for. So much of the food is sugary, sweet and processed – tons of biscuits, cookies, and cakes shipped in from the Middle East and Kenya. I think I will end up eating a ton of soybeans, plantain chips, and other local foods. The Mbarara region is also the country’s dairy capital, meaning we’re gong to be able to get some fabulous milk once we figure out where to go.

Later in the evening, Godfrey and his wife invited us to dinner and graciously paid for all of us. Godfrey is a doctor who works in the obstetrics and gynecology department at Mbarara University of Science and Technology (MUST) and is a co-investigator on the study alongside Rachel Snow, our professor at Michigan. We had an AMAZING outdoor meal at Lord’s Inn of grilled goat meat, plantains (which were not banana-tasting at all), and a pico de gallo type sauce. Everything is eaten with your hands; a server comes around the table with a jar of warm water and bucket for patrons to wash their hands before and after the meal. He apparently said I seemed the most appreciative! Haha. I even got to have my first Ugandan beer – Nile’s Greatest – unexpected and very delicious! Afterward, we hit up Heat, a large, outdoor club (hey, it was Friday night).

As prepared myself for bed, I felt happy and realized for the first time I was going to be OK. I’ve had a lot of doubt in myself and my ability to “make it” over the past few days. I guess that’s normal when you’re out of your comfort zone, but it’s not a good feeling to have when you know you’re going to be committed to a location for 12 weeks (and when you’re impatient like me). Like most things in life, getting used to change takes time; additionally, the greater the change, the harder and longer the adjustment period – and Uganda is probably near the top of that greater change list for me. I’m beginning to feel I can handle this now… and patience, listening, observing, and lots of good people will aid me on my journey…

Thursday, May 13, 2010

First Night in Uganda

As I write this, I sit on the small twin bed in my 51,000 UGsh (about $25/night) hotel room, shared with my research partner, Tegan. I have made it: I am in Uganda. However, let me start from the beginning of my trek, about 18 hours ago…

First, let me say that travelling internationally is nice. Maybe I’m naïve (this is actually my first time venturing outside North America!), but I couldn’t believe the amenities when compared to domestic flights. Free beer and wine, what seems like never-ending food, and lots of great on-demand movies. I even met an extremely generous Turkish guy on my flight to Amsterdam who pitied my cologne-ness future and gave me a small bottle of Gucci :o

Detroit to Amsterdam actually went by in a blur, thanks to The Hurt Locker, Whip It, and The Blind Side. Our flight arrived late but we actually had a 3-hour layover so everything was fine. I started to get a little more restless – and began to feel the annoyances of jetlag – on the Amsterdam to Entebbe flight, which was also about 7 ½ hours. Surprisingly, the flight was only about ¼ full, meaning everybody sprawled across multiple seats. I originally had a window seat, so I kept it and got to see some nice views of the Italian coast and African topography. Darkness settled in throughout the last hour of our flight (quite early – we landed at 7:30 PM) and I began to notice the stark absence of light below, a shocking contrast to home. But walking off the ramp and into the airport really let me know I was in Africa…

The first thing that hit me was the air… the damp, warm (though not overpoweringly hot) sticky smell of it travelled through my nostrils immediately. I looked up at the indoor lights and saw more mosquitoes swarming around each set of them than ever in my life. I was struck by how different the airport was from what I was used to. Sure, I didn’t expect another Detroit Metro - but this was something completely different. Very small, less lighting, amenities, staff, and very simple… some signs were even posted with tape and looked like Microsoft Word documents. We actually breezed through customs thanks to our pre-arranged visas and found the ATM to get Ugandan shillings (FYI: $1 = roughly 2,000 Ush). Thankfully, Bank of America has an affiliation with Barclay’s, which is extremely prevalent in Uganda, so only the minimal international fees will apply. Afterwards, we found our driver from our hotel holding a sign with what resembled our names and headed with him outside. We loaded up in his van and were off to Kampala, our overnight destination.

From the airport in Entebbe, it’s about a 25-minute car ride to Kampala – and for me, it was my first scenery of “real” African life. The sunroof was open and I couldn’t believe the sights, the smells, the constant sound of insects - my senses were overloaded. The road from Entebbe to Kampala is lined with various gas stations, shops, and shacks. During the entire ride, there was a constant stream of people outside – many walking alongside the road in pairs of 2 and 3. It almost resembled the feeling of driving through a party school’s campus… of course, with obvious differences. The constant stream of people went on for miles and miles and one room shops with the dimmest of lighting seemed to never end. Cars, taxi-vans, and boda-bodas (motorbikes) all drove quickly and carelessly (and the middle of the 2-lane road is apparently game for whoever decides to utilize it). Some of the potholes almost took up the entire width of the road. The smells would change from tropical to moist to dirty and back. Everything felt unreal...

We are staying at the student lodge at Makerere University in the capital city of Kampala. With 1.2 million residents, Kampala is by far the largest city in the country (no other cities even surpass 200,000). We'll actually be staying here an additional night due to our 3rd partner, Lindsey, not making the connecting flight until today. My final destination is the city of Mbarara (population of about 90,000), an up-and-coming city located in the southwestern corner of Uganda and about a 4-hr car ride from Kampala. Mbarara is the home of Mbarara University of Science & Technology, the school that has partnered with U-M to conduct the research we will be doing this summer – much more to come on all of that…

So, now, under a mosquito net, starting to sweat even though I just took a shower (which was HOT because I couldn’t figure out the cold knob), I can't help but wonder to myself if I made the right decision. Am I really cut out for this for 3 MONTHS? Time will tell - but in the end, exposing myself to something new and what I feel to be necessary can’t be wrong...

I can't wait to post pictures and share more of Uganda with you all. Take care everyone. You are all constantly in my thoughts.