My study

You've been privy to the thoughts inside my little oval head.  You've let me talk about sleeping next to hippos and drowsing in kayaks.  But what do I actually do?  Why did I leave a job, city, boyfriend, and move to Uganda? 

Because this is the coolest shit in the whole world.  Malaria, HIV, Ebola:  Infectious diseases make me hot and feverish.  I love having a forseeable impact.  The strongest core value that I bear is that health is not a privilege but a right.  But also, I find the science incredibly sexy.

I moved to Kampala to work on Malaria.  I am doing a randomized control trial with 150 facilities in 17 districts spread all over Uganda.  The trial is 3-tiered mentorship project with the ultimate goal to increase testing for malaria and decrease non-adherence to test results.

In other words, when a patient comes in with a fever, test that patient for malaria before just prescribing anti-malarials.  If the test comes back negative for malaria, believe the test and do not continue to prescribe the patient anti-malarials.  Overtreatment of anti-malarials has 3 main negative effects: 1) The actual cause of sickness is not addressed and you are sending a patient home who is still stick, 2) You are wasting money and precious antimalarial drugs, 3) abuse of anti-malarials can lead to drug resistance, and guess what people, we don’t have another drug on the backburner.  Scary stuff.

 I helped train the 9 master trainers recommended from the ministry to train the 70 clinical mentors from the 17 districts to mentor the 300 mentees (clinicians) in their district facilities.  My first part of the job was heavily field based.  Traveling to clinics, teaching people how to collect the data and training the mentors.  The project officially rolled-out last month.  Now my main job is to watch the data roll in and analyze it so we can troubleshoot.  I've become a wiz at excel.  Pivot tables are my slaves.

The study will continue for a year at which point we’ll write up the paper and recommend a national scale up of the mentorship project to the Ugandan Ministry of Health. 

SO NIFTY, RIGHT?

How to make Cat Litter

A few entries ago I explained my trial taking my cat on the 48 hour trip from Washington, DC to Uganda.  It was rough.  And I still think she a little bit hates me.  She left a decapitated mouse on my rug yesterday.  It was very The Godfather.

We have our problems but we're working through them.  But I can't find her cat litter.  Cats are all outdoor cats.  So I had to learn how to make my own.  Let me share my knowledge.

Step 1)  

Shred a bunch of newspaper

2) Fill the bucket with warm water and dish soap.  Squish it all around.

3) Dump out the warm water, fill it back up with more warm water and baking soda. Squish it all around.  

4) See video for Step 4. 

When I bring a cat to Uganda

A few years ago a boy broke up with me.  And it sucked.  So I adopted a cat and named her after my favorite singer, and morbid pearl of Baltimore (my current city), Billie Holiday.  I met Billie at the shelter and when I stopped petting her for a second, she reached her little paw through the bars imploring me to continue.  I admired her forceful neediness.

Billie and I licked our wounds (her more literally from her spaying surgery) in my tiny studio apartment in Baltimore.  I was waitressing and looking for jobs.  I'd bring her home bits of chicken from the restaurant and my two  girlfriends,  Jen and Val, and I would hang out on my bed, growing up, and realizing how awesome it was to be young, single and living alone.  (Something I recommend every woman do in her life.)

Billie moved with me to DC and learned to love her new window perch overlooking the projects on 13th street more than she loved me.  When I moved to Uganda, I knew I would return home in a few months to grab a few things and to grab Billie.

Billie sitting on the love of her life

I was dreading taking my cat on the 26 hour journey back to Kampala because hell isn't other people, it's being responsible for the annoying thing on the plane.  When I have kids I plan to check them with my luggage.

Just as I was finalizing her paperwork, I called the USDA to double check the requirements.
"You cannot take your cat, she doesn't meet regulations."
I was heartbroken.  I'd have to say goodbye to my shedding friend forever.
Until Sarah, my goddess friend, agreed to take her and we could try again when I next return.  Which was amazing.  But, because I'm from NY, I thought I'd call the USDA again.
"Oh yeah, you can totally bring her.  Just get us her health paperwork by tomorrow."

...

So I grabbed Billie, shoved her into a cab to get her rabies shot updated.  But shit!  I need a fecal sample!  (See what I did there?)  So I rush Billie home and spend the next hour willing her with my eyes and syrupy voice to poop.  But the vet is closing in 15 minutes!  So I take a crusty old poop, stick it in the tube, and re-hydrate it with a splash of water so it looks fresh and bring it to the vet.

I wake up early and schlep to the vet to grab her paperwork (water poop worked) and rush to Alexandria, Virginia to the USDA office.  When the guards look confused I realized I was in the wrong branch office, and actually needed to be in Richmond which is 4 hours away.  I run to a rental car place.  Still no coffee.  No cars available.  Then, my second goddess friend, Jen, says "I'll drive from Baltimore and PICK YOU UP and take you to Richmond."

K.  She does that.  GPS says we'll get there at 4:30.  USDA says they close without exception at 3.  "But my sister's getting married!" ( Again:  http://chelseatosea.blogspot.com/2011/12/red-bangkok.html) No sympathy from the Ihatemyjob woman on he phone.  "Speed", I tell Jen.  Then, the Ugandan Embasssy called me.
"Your visa is delayed."
So I call my boss and I call the airline and move my ticket back two days.  I can now Fed Ex Billie's paper work.  We can turn around.
I buy Jen a beer.

Meanwhile, my hand has swollen to the size of a watermelon.  But I have random swelling all the time so this doesn't bother me.  But I decide, since I am in the US, I might as well see a hand doctor.  The doctor runs a bunch of tests and, as it turns out, I have Lyme disease and have probably had it for years.  Probably what this craziness was:  http://chelseatosea.blogspot.com/2011/08/bedrest-in-bangladesh.html.  So that's not good.

Billie's paperwork comes through fine and Wednesday morning I calmly try to put Billie into her travel bag.  She deeply wounds me.  I call my roommate, who has a sprained ankle, to help me and we hobble around, me with my flesh wound and watermelon hands, her with her limp foot, trying to grab Billie.  We finally corner her, and I throw a towel over her head and shove her into the bag growling like a devil child.  I decided not to sedate the cat because that's bad for her on the plane.  So there's that.

Billie meows all throughout the airport and I get a lot of looks, but I'm used to that re: white lady in Uganda.  Our first flight is 2 hours to Atlanta.  The plane is grounded for 5 hours. Billie is a wreck.  When we finally land in Atlanta, I miss all my connecting flights until the next night and Billie is bald from stress shedding.
"I'm sorry, we can't comp your rooms because the delay is due to weather."
"But my sister is getting married!"  Yet again: (http://chelseatosea.blogspot.com/2012/01/french-nuns.html)
'Cause a hustler's gotta hustle.

So me and Billie get into our free hotel and she chills out under the bed like some childhood nightmare and I grab some ribs and beer because I'm in Georgia.  I get back and I find the cat in the carrier I had to force her into earlier.  I think my cat has Stolkholm Syndrome.

Billie acting concerningly weird

The next day we board another 2 hour flight to Detroit, lay over 1 hour, 8 hour flight to Amsterdam, 2 hour lay over, 8 hour flight to Rwanda, 1 hour layover, and then a 1 hour flight to Uganda.

Me and Billie step off, smelling like fresh peaches, and all 3 of my bags are missing.  I go to lost baggage and I'm back in Uganda when the person takes a tea break in the middle of my inquiry.
Finally, "I'm sorry, your bags are not trackable."
"Is there anything we can do?"
"No."
"K."
p.s. it's 4 days later and I still don't have my bags...

We took the hour car ride home, I released Billie into her new house, she shot me a dirty look, and I didn't see her again for 48 hours.

Next challenge: Making homemade cat litter out of newspaper, dish soap and baking soda.

And of course the Lyme disease.

Ugandan Coworker: "Why are you bringing your cat when we have cats here?"
Me: "I don't know, I'm a crazy person."
Ugandan Coworker: "Yeah."

Marilyn Monroe

I live in fear of pit latrines.  You know the kind.  Out in the back of the clinic.  You pass the man peeing on the wall and balance over the hole with one hand gripping the wooden door closed.  As you pee, the flies in the hole circle up like a backwards tornado and your skirt has a smelly Marilyn Monroe moment.

But it takes some imagination to complain.  Living in Kampala (with money), is breezy.  We work hard, late into the night most nights because people are dying and that sits on our back.  But I have a masseuse that can get rid of most of these knots and a cleaning woman who makes my bed so tight I wriggle a little with happiness when I go to sleep.  And when I'm sick of the city life, I'm usually about to go into the field.

I love being out in rural Uganda working.  It often takes me over an hour to get from clinic to clinic in the same district.  So I take my van with my favorite driver, Leston, and we bounce up the mountains.  I like watching the proud teenage boys building their first grass huts away from their family's--a sign of first independence.  And the women with their bright yellow bananas on their heads and their naked babies on their backs.

For lunch, Leston and I stop to east some rice, beans and goat in a red broth.  Or our other favorite thing to do is slow down near a bus stop and have men run to our cars with just roasted chicken on a stick and charred corn.  My hotels are simple but I have my favorites.  Generally ones that have good hot water and know me well enough to stop a few Coke Zeros in their fridge.

My work has officially kicked off and I trained my 90 doctors for the last time on Friday.  This week I go into the field to supervise them.  Along the way I'm stopping to go to my friend's traditional Ugandan wedding!

I leave to go back to the US next week for 10 days to pack up my house, say hello and goodbye to family and friends and officially move to Uganda.  I don't miss much about being back home and I'm so excited to move here for a few years a least.  But I am looking forward to seeing family and friends, eating good pizza, drinking good red wine, and reveling in the sanctity of a clean toilet.

Kayaking the Nile

When I was younger, I was obsessed with Egypt.  I wanted to be an archaeologist and spend my days in the hot sun working near the banks of the Nile, finding mummified cats and perfume bottles.  The discovery of King Tut’s tomb was the single most exciting thing to happen to me at age 12. 

This weekend I went to the source of the Nile in Jinja, Uganda.  From the famous waters of Lake Victoria, the Nile starts its path in Uganda and flows all the way down Africa.  The Nile river can be as spiritual as the Ganges but can also be brutal, crashing down waterfalls and forming grade 5 rapids.  At the Ganges, I said a prayer, closed my eyes, and let my oil scented rose petals join the slow flow.  At the Nile, I said a prayer and got into a kayak to join some of the rapids. 

The Mouth of the Nile

My kayak was a two person kayak and I sat with Sean—a friend visiting from Malawi.  There were 8 of us, including Kiira, my dear friend from graduate school who is now working in Cambodia.  Kiira and I always meet in the strangest places, last time we met we traveled around Shanghai together.  (http://chelseatosea.blogspot.com/2012/01/first-day-in-shanghai.html).

When we started to see the waterfalls and rapids ahead of us we expressed our terror to our guide: Colin, our instructor from Ireland.  He basically just told us to shut up and get on the water.   Sean and I made a good team.  We were swift and sure of ourselves and approached the first rapid laughing.  We were told to not stop paddling even when the rapid was all around us.  Physics and stuff.  The waves rose taller than my head and I was no longer in the Nile but in the Pacific Ocean navigating a storm.

I saw a wave grow over us and I knew.  It crashed down and threw me into the water.  Sean went with our kayak across the river and I flew with my paddle the other way.  My life jacket popped me up but every time I sucked in for a breath a wave crashed over me and filled my mouth.  Choking and gasping, I scrambled for air.  Trying all the while to hold onto my paddle, because even in my terror I was concerned to lose it and to have to pay for damages. 

But then I hit a wall of water.  My paddle went in the other direction.  And I was sucked down spinning violently.  I got stuck in a whirlpool.  Sucking me down lower and deeper even the life vest had no effect. 

I had not taken a breath so there was no air in my lungs.  Just water.  I was under water for 9 seconds.  No profound thoughts went through my head.  No thoughts of regret, no flashes of a storyboard life.  Just “I don’t like this, I don’t like this, I don’t like this, I don’t like this.” 

Good to know.

Then the whirlpool popped me up choking and gasping and still very much not liking this.  Colin (my future husband) was above me reaching out his hand.  “Hold on, grab the back of my kayak!” My eyes were bloodshot, snot was pouring out of my nose, and my stomach was bloated with water.  But I batted my eyelashes and held on tight.

I got myself safely back into my kayak and made it down the reset of the rapids without incident. 

Kayaking the Nile was the single most fun event of my life.

And I’m a little more fearless now. A little more appreciative.  A little more baller.

A moment

I grinned at the boy who grinned back.  He turned to face me and I saw a large, white mass growing, and oozing out of the side of his head.
I looked away.

A mother grabbed my skirt and gave me her daughter.  The back of the little girl's head was necrotic and looked like it had been eaten away.  There were flies in it.
All I could say was, "I'm sorry.  I'm not a doctor."

Holiness to me are moments that blind me to the past and future, granting me complete presence.
Mountains do this to me.
Love does this to me.
And so do moments like these.

I am not thinking, only seeing.  A feeling rising up from the bottom of my stomach and settling in my throat. I smell of sick bodies 5 people thick all around me.

I go in to see the doctor and explain this new tool I developed to help better track malaria testing.

But the boy is still outside.

But the girl is still waiting.

Update, 2 months in, Uganda

I've been here now for almost two months.  It feels like a week.

I spend a lot of time in the field.  Trying to call data collectors to find out why they are two hours late.  Trying to print things in the precious moments between power outages.  Trying not to let my New York sensibilities scare the nice Ugandan people.

I pick up a lot of babies because that is what I like to do.  I gave a piece of my banana to a little girl who waited, alone, in the dirt, for her mother to leave the clinic.  She started choking and then threw it up all over herself.  I should probably not feed the babies.

My team is amazing and we make the numbingly bumpy car rides fun.  Vicky talks about her boyfriend and "why won't he propose already?" I talk about how, at the end of the day, all I really want is someone to share coffee with.  Nescafe doesn't count.

I've made so many friends.  They're all very sexy.  Liz is an american journalist who travels around Africa writing stories about genocide.  Fluff pieces really.  Emily works on the South Sudan humanitarian crisis.  Jenny is dating (and the mother of his son) a Ugandan superstar.  Leanne goes deep into the field providing family planning to those who need it most but are most scared.  Morgan is leaving us.  She is moving to Papua New Guinea to work on domestic violence an epidemic affecting almost 100% of women.  And I've got my mosquitoes.  Which is super sexy.

I've joined the mountain climbing club of Uganda and every week I climb some rocks and drink some adrenaline and get stronger and fight my fear.  Also it helps that the other rock climbers are gorgeous.

I don't know where my long term base will be or when I'm going to come home for a visit, but I'll keep you all posted.

I'm planning to go to Ugandan mass in continuation of my education to learn and understand what sustains people beyond the medicine.  What gives people dignity and strength.  Maybe I'll even get my hair braided.

Maybe not.