Nicholas Davis- Running for Esperanza
This race and blog has 2 goals. Goal #1- To inform my followers of the health disparities that are a barrier for people to obtain health care in Chicago, and Kisimu. Goal #2- Raise money for Esperanza Health Centers to continue tearing these barriers down and helping all those who need care.
July 20, 2017; Kwaheri, Anza Mapema
Swahili of the day:
Mpaka Baadaye- Until Later
Anza Mapema- Start Early
The last day at work with Anza Mapema. We had a feast! Amanda and I pitched in and bought food for the office. Everyone joined together and cooked an amazing meal. We had goat, chicken, fish, ugali, rice, chapati, sakumo wiki, and salad. I was basically forced to load up my plate with a mountain of food. I will say, I did not put up a fight when I was told that I had to eat it all. As you can see, it was quite a large amount of food. Of course everything was delicious.
The fish, however, was phenomenal! After lunch, we were surprised to see that everyone had pitched in and bought us a cake and a couple of bottles of champagne. The cake was covered with a passion fruit frosting and halved passion fruits. It was delicious, until Violet decided to take a glob and spread it across my face haha! After that, it was an all-out frosting war. Even Dr. Bailey (UIC professor and advisor) was wearing some frosting on his face. It was quite the last day of work. Many of our coworkers had some very nice words to say. We thanked everybody for their hospitality and the amazing experience that we gained from them. In the group picture, you can see that we are quite the amazing group of people! Thank you, again, for everything. My time here is almost finished, but my work with everybody at Anza Mapema is just beginning. I will be working closely with everybody as I begin writing my thesis proposal for my MS epidemiology program.
July 19, 2017; Sexually Transmitted Infections
Let's jump into the adult stuff. These infections are more common than people would like to admit. Many individuals feel shame or major embarrassment when presented with the topic. Sexually Transmitted Infections (STI) include, but are not limited to, chlamydia, gonorrhea, syphilis, HSV2(genital-herpes), HPV (Human Papillomavirus), genital ulcer disease, and trichomoniasis. At Anza Mapema, I have been extracting data on sexually transmitted infections among the men in the study. I will be running a number of analyses on the data dealing with diagnosis, lab testing, and treatment. On the other side of the clinic, we have the staff who are very hands-on in the prevention of STI transmission. In the picture, you can see the boxes upon boxes of condoms that we have in stock. We routinely give participants and peer educators condoms for use and distribution among the MSM (men who have sex with men) community.
Prevention and timely treatment is key. I was fortunate to get my data gathered and to run a preliminary analysis. I made a 30-minute presentation to the clinic on the topic of diagnosis/treatment of STIs in Anza Mapema. I used the epidemiology skills that I have learned at UIC to integrate biostatistics with communication. I am hoping that the results I presented will be beneficial to the staff here in moving forward and improving the treatment of STI positive men.
July 18, 2017; Kiboko Bay (Hippo Bay)
Let's talk a little about where I have been living for the past 2 months. We live in a small bay on Lake Victoria that is called 'Kiboko Bay'. The name is very fitting, because Kiboko means hippo in Swahili. This is a very popular hangout for the hippos to spend their days. In the picture we can see 2 adults and a baby. The reason why these hippos are so special is because they feed in our yard on a nightly basis. After dark we can hear the splashing and grunting as the hippos enter our yard. We peak through the windows to see the group grazing on the delicious grass. They are our neighbors, and we treat them as such. Nobody chases them away, and nobody gets annoyed by them. They are welcome at the house. I take that back... the dogs are not fans of the hippos. Occasionally, the hippos wander too close to the house and the dogs go crazy. They begin protecting their territory and barking. It is quite funny because the hippos tend to ignore the 4 dogs. There has only been one occasion when I woke up at 2am to a fight between the dogs and a large hippo. I peeked out of my window as I heard growling and hippo grunts. I saw 2 of the dogs in front of the hippo while the other 2 nipped at its legs from behind. The hippo eventually moved farther away from the house and the dogs seemed content. Regardless of the situation, the giant hippo did not seem threatened at all. It seemed annoyed that these pesky dogs were bothering its meal time. All in all, the kiboko are quite nice neighbors.
July 13, 2017; Data Data Data
From what you have read, up until this point, I have been experiencing the world around me. I have been exploring the sights and sounds of Kenya. I have been training my body for the upcoming marathons that I will be running. I have been making friends and eating delicious food. Let me tell you, briefly, about the other side of Epidemiology. Since I have arrived, I have combed through 3 years’ worth of medical records for just shy of 1,000 individuals. I have been looking at dates, test results, treatments, the whole shebang. Every day, I open up drawers of files and drudge through the monotonous task. I have created enormous datasets looking at sexually transmitted infections and diseases. As I spend hours a day with my face crammed into a computer, I can only hope that the data extracted will be of some use.
July 12, 2017; Fauna of Running
Let's go back to my Marathon training for a quick blog post. The past 2 weeks, I have run nearly 75 miles. I put in a 36-mile week and then about 39-miles the following week. This included a 13.1 mile run on Sunday. During my training, I have experienced a plethora of animals, with goats and cows being the most common. As we can see in the picture, the cows are very docile. They do not react to much. They often lay in the middle of the dirt road while cars/trucks/motorcycles zoom past. They run the show, and people treat them like royalty (since the cows are such a huge source of income). The goats often stare me down with their little eyes as they chew on some freshly picked garbage or grass. Once, while running sprints at the steepest hill I could find, I began to hear a deep, hearty roar. It was a lion! My heart nearly leapt from my chest before I realized the local 'zoo' called Impala Park was situated directly behind me. Fortunately, the lion is in a cage, and has never been known to escape... yet. I guess that in itself is motivation to run faster. I have 2 more weeks in Kisumu, and my running continues.
July 11, 2017; How Do You Measure, Measure a Year?
Sorry for the absence from my blogging. We have had intermittent electricity and I have been very busy in the data side of my work. I will talk about this lifestyle in a separate blog. This blog, however, is to talk about Movie Monday. This week, we decided to show one of my favorite films. We screened the movie 'Rent', and held a short discussion afterwards. For those of you who don't know, 'Rent' is a musical about drug addiction, living with HIV/AIDS, LGBTQ rights, and homelessness. It follows a young group of friends in New York City. I must admit, the film did not go over as well as I had hoped. They loved the story and found many of the social issues very relatable, but they found the idea of a musical to be quite dull. They were not very engaged with the music. It was a lot of fun to discuss the film, however. Many points were brought up, such as the lack of confidence among the LGBTQ community to dress how they feel. The group found it very exciting that an individual would feel comfortable enough to wear a dress, as a man. We explained many phrases and words that were new to them as well. 'Drag Queen', 'Twinkie', and 'Hicksville' being three of the memorable words.
June 28, 2017; Art Adherence Group Therapy
ART - antiretroviral therapy used in treating HIV
Adherence - Consistently and regularly taking ART medication
Viral Load - The number of HIV viral copies in the bloodstream per milliliter.
CD4+ - A specialized Thelper cell of the immune system that is brought to the front lines of tissue damage
Discordant Couple - When in a relationship, one person is HIV positive and the other is HIV negative
Washikaji - A peer with very high adherence that is trained to help other patients strictly adhere to their medication
Let's move into a very public healthy blog post. I am going to tell you about the first ART Adherence Group Therapy session that I participated in. First of all, the above words are commonly thrown around in the public health world of HIV/AIDS. When an individual is diagnosed with HIV, they are put on ART in order to prevent the virus from taking over their CD4+ cells, and compromising their immune system. When the immune system is compromised, and the level of CD4+ cells drops below a critical level, the patient is often diagnosed as having AIDS. When a patient has HIV, the amount of viral copies in the blood stream grows from 10 to hundreds, to thousands, to hundreds of thousands per milliliter of blood. Being on, and adhering to ART will reduce the viral load of an individual to a point that we consider undetectable, or less than 20 copies. When an individual has an undetectable viral load, they are essentially not able to transmit the virus. It is not impossible, but the chances are extremely low. Therefore, if we keep patients 100% adherent to ART, then the chances of the virus being transmitted are extremely small.
Anza Mapema has nearly 100 men who are HIV positive. Many of these men have been very adherent to ART, and thus have undetectable viral loads. Many, however, do not take their medication. When they come back for testing, viral loads are regularly seen about 100,000 copies per mL of blood. Our counselor leads an amazing group of adherent and non-adherent men. These men work together and discuss their lives. They tell their histories, how they got HIV, how they work on taking their medication, and even what challenge they face. Many men feel stigma through their families and friends. The community is not always kind to HIV positive men. They are shunned for being infected, and are thus afraid to take their medication when others are around. Many do not like the side effects, or feel that they are perfectly healthy without ART. One individual stated that he used to run from his own shadow. He had been in denial about being HIV positive, and therefore neglected taking his medication. I have witnessed individuals too weak to walk, arrive at Anza Mapema and seek help. This group is extremely important. It is a safe zone where they can discuss and learn. They are not ridiculed or reprimanded for poor adherence. They are encouraged by the peers to use their medication. They help each other, and those who are extremely adherent are considered 'Washikaji'. I remember one question that sparked my curiosity. Our counselor asked how many of the men were sexually active and in a discordant relationship. About 80% responded yes, and of them about 75% said they have disclosed their HIV status to their partners. This was sad, and also happy. It was so sad to see that ~25% of those men felt too stigmatized to disclose their status. I worry for the health of everyone involved. The happy side, however, is that 75% said they have disclosed their status and are still in a relationship! This is amazing. This shows some character of their partners. These men and women show true love. I hope that all of these men can focus on their medication adherence as a protection for themselves and their partners. I leave you with this, and hope that some public health has sunk in.
Thank you for following! Keep checking for more public health, running, and adventures!
June 28, 2017; Social Stigma and HIV in Kisumu
Yesterday was a great reminder just how clueless we are in our bubble of a country. This is not meant to be a stab at our lives or the style in which we conduct ourselves. This is meant to be a moment of learning. We are not as progressive and forward thinking as we believe. We like to think that individuals from our country go to Africa as a way to teach people who need to learn some social or scientific construct. This is not the case. I am learning more here in Kisumu, Kenya than I am teaching. I was fortunate enough to attend a school assembly with hundreds of high schoolers. The entirety of the gathering was focused around the education about HIV/gender/sex/equality/social stigma. To me, one thing that social life in Kenya is great at doing, is stepping outside of the comfort zone. This is a country where individuals speak at least 3 languages. They are open and encourage foreigners to learn about their cultures, politics, strengths, and shortcomings. We, however, hold a large population who push against learning or utilizing any language besides English, value our own comfort over the lives of struggling individuals, and often forget about humanity. We forget that other, better countries exist in the world. We would never even imagine a developing nation that may be pushing the social progressive attitude farther than we could imagine.
The students discussed social stigma of gay, bisexual, transexual, HIV positive, and other individuals. They discussed the use of condoms, PrEP, PEP, birth control, and the role of media in stigmatizing populations who utilize these. This, to me, was amazing. I can't even imagine the red tape that would exist to discuss some of these topics in a school of teenagers without enraging parents/leaders and "compromising the virgin minds of our youth". Im not saying that we are bad. What I am saying is that we can use this as a learning experience. I am saying that if hundreds of high school students can listen to an hour and a half discussion about gender/sexual differences and the acceptance of individuals, then maybe we can normalize some of these as well.
Thanks for following! Keep checking back for more stories.
June 23, 2017; Coffee Wednesday #4
Anza Mapema is a clinic for gay/bisexual men in Kisumu, Kenya. They are HIV positive and HIV negative. They have quarterly visits with the doctors, and regularly get tested for sexually transmitted infections (STIs). Counseling is offered, and many group therapies are provided for the men. Why do we offer coffee Wednesday? First off, addiction is a disease. Whether it be drugs, alcohol, food, sex, etc. addiction is classified as a disease. Anza Mapema is a health clinic, and to offer its best services, the clinic must treat the disease of addiction. Every Wednesday, a group of approximately 20 men get together and discuss their addictions. Some talk, and some listen. The counselor, Godfrey, goes over the 12 steps of Alcoholics Anonymous. He gives an amazing description of each step. The men have taken it upon themselves to open up each session with the serenity prayer. They chose this, because it does not mention any particular religion or spirituality. It is a prayer for help. Everybody can relate to it. They are extremely open men. Addiction is a huge problem for them as well, not only because of the poor health outcomes. Many are on HIV medications, TB medications, or have sexual relations with people that put them at high risk. Their addiction, often leads to missed doses of medication, increased risky behavior, or forgetting to use condoms. This puts them at a very high risk of contracting a life changing disease. Anza Mapema helps them fight their problem, and to live the healthiest life possible. Each week takes these men a step closer to complete health. This is public health, and the work that we do. So cheers, to Coffee Wednesday!
June 22, 2017; Boda Boda (Piki Piki)
Let me tell you about my friend, Kevin... The awesome guy next to me. Everyday at 7:00am, Kevin takes myself and Amanda to work. It is about a 25 minute ride from where we live. Our house is in an area called Dunga, and Anza Mapema is in a neighborhood called Tom Mboya. During the trip, we pass through dirt roads that are hazed by red clouds of dust. I began to enjoy Kevin's friendship, so I decided to give him a gift. The pair of sunglasses that he is wearing. The gift was 2 part. #1 I really like him and wanted to gift him something #2 I could see him squinting through the dust as he drove us to work. I figured this gift would be practical, and literally may save my skin. Now, Kevin is a 26 year old that drives his boda boda about 10 hours a day, 7 days a week. He is a working man. Orphaned at the age of 10, Kevin jumped through a couple of local orphanages. He described them as a shelter with occasional food that let him get through life until he was old enough to begin working. He never finished school, but his English is wonderful. Everyday, I am expected to speak a new phrase in Swahili with him. If I don't, he offers a 10 word sentence as my "word of the day"... I guess the word 'word' gets lost in translation... The other day, Kevin invited me to play some soccer with the other boda boda drivers. It was a blast. We spent about an hour just playing small sided soccer on the little dirt patch outside of the local school. This was much different and relaxed than the training with Palos FC. I was actually in better shape than every single one of the boda boda drivers. They are a fun group of guys, but I guess you would have to be in order to drive a motorcycle 10 hours a day. Word of the day- Boda Boda. A motorcycle such as seen in the picture.
2nd word of the day- Piki Piki. A taxi motorcycle which literally comes from the English word 'to pick'
June 20, 2017; Friend From Bujagali Falls
This past weekend, I went for a weekend trip to Bujagali Falls in Uganda on the Nile River. Let me tell you... it was gorgeous. We left Kisumu at about 1:30am, took a motorcycle taxi to the bus stop, and hopped on the bus for Uganda. Around 4am, we reached the border and left the bus to proceed through immigrations. I was traveling with my friend, Amanda, and always forget that this is her first time on the continent. I sometimes forget to warn her of things that may seem completely unusual. In this example, Amanda got off the bus and was aggressively approached by a man speaking very quickly in Swahili. He was holding out a huge stack of cash. I could see Amanda's confused look as she began reaching for the stack of money. I quickly shouted, "He is trying to exchange Kenyan Shillings for Ugandan Shillings." She began to realize the situation, and we pushed on past.
We stayed at a river camp in dorm-style rooms. From the camp, we could see the Nile River in all of it's glory. Down the hill was a rope swing attached to a tree branch. The very first day, we walked down and met a 17 year old boy named Alex. He was a potter from farther up the river. He had never completed school, and was now in the area teaching pottery to younger children. We had a blast over the next hour or so with Alex. We took turns swinging from the rope into the River. In the picture, you can see Alex and myself enjoying the rope swing. The following day, Alex showed up again. This time he opened up his backpack and handed Amanda and I gifts. He had given us items that he had made. I received a beautiful cup, as you can see in the first picture. He gave Amanda a necklace and a pair of earrings. I was floored. It was a genuine kindness that a person almost never sees in their lives. I quickly ran up to the room and grabbed a new deck of playing cards from Auburn that I had. Giving Alex money ran through my mind, but he clearly wanted them to be gifts. I ran back down and offered them to Alex. I told him about their significance, and he seemed thrilled. I only wish that I could have offered him more. This act made my entire trip worth it. The rest was icing on top of a well crafted cake.
June 13, 2017; Futbol Training in Kisumu
I was invited to train tomorrow morning with Palos FC, apparently one of the top soccer clubs in Kisumu, Kenya... I had absolutely no idea how good these guys would be. I was assuming that they were going to wipe the floor with me. Either way, I was excited to get some touches on the field with some top notch athletes.
These guys were really good. I am proud to say, however, that I held my own for the entire 2 hour training. The sun was very hot, and I had to play in regular gym shoes, but I had a blast. I was on the lower end of the spectrum, but mostly because of my fitness. My ball skills were among the top. When we played small sided, I kept up nicely. I fell behind when we switched to full field. They play a bit differently. They do not take their time. The style of play was attack, attack, attack. This was exhausting. I could not see them lasting through an entire tournament with that play, but then again they are young and in tip-top shape. Great experience.
There were 3 players that I really liked: Leone, Josh, and Solomon. These 3 had great personalities, and were very friendly. Leone was actually the one who invited me to join for the training. We played small sided keep away games with touch limits from 3 touch down to 1 touch. I had no problem showing off my skills. I was relieved to see that they would not be absolutely crushing me. My ball ability was well in the top range for their team. Large field play, however, was a different story. They made me feel 80 years old. Even though they are only 19-early 20's, they were in much better shape than I. Marathon training has helped me to run long distances, but I can feel that my agility has slowly disappeared.
Take home of the day... marathon training does not equal soccer training!
June 7, 2017; Coffee Wednesdays
To the right we see a well shaded patch with space to sit a group of people. This is exactly what Anza Mapema uses this space for. Every Wednesday a group of 12-20 men gather in this space to battle their addictions to drugs and alcohol. I have had the chance to sit in and join for the past 2 weeks. Each individual brings a different aspect to the group. Some are quiet while some are loud. Many relate to each other, and some seem out of the loop. The group, however, runs smoothly and everybody gets the help that they need. Last week, the counselor discussed the idea of goal setting, and reaching the goals that one sets. We discussed the idea of a SMART goal. One that is Specific, Measurable, Attainable, Realistic, and Time-bound. Each individual was to write down 3 short term goals that would lead to a long term goal. Our counselor, Gottfried, has an amazing personality and is full of patience. He has the promise of helping each individual fight to achieve their goals. As I continue my 2 months here, I will be attending every coffee Wednesday, because I can see how badly these men want to move forward in their lives.
June 5, 2017; First Days of Work
For now I will share a bit about the organization where I am working. The clinic is called Anza Mapema which is part of the Nyanza Reproductive Health Society. Anza Mapema is a clinic for gay/bisexual Men who have Sex with Men (MSM). Among the MSM community, HIV and other STIs are at high prevalences. The community is also marginalized by stigmatization and fear of living in the surrounding communities as a gay/bisexual male. These men that attend the clinic are provided superb care by a well trained staff. They are offered the opportunity to enroll in studies that ultimately can provide them with antiretroviral therapy (ARTs), STI treatment, and general health care. The staff is what makes Anza Mapema a success. They are hard workers with great communication skills. They are constantly walking around the clinic and asking each other questions. They are interacting with the patients as if they were their own brothers. You can see the compassion in each individual. As I continue my time at this clinic, I will share some more stories and photos. I have only been here a week, but I can tell that Anza Mapema will be a difficult place to leave at the end of July.
June 1, 2017; Public Health Work Begins
Work has begun. It is quite nice to be in a familiar environment again. Despite being in Kenya, the work day reminds me a lot of Mozambique. The low stress environment with a lot of laughing and smiles makes the day a pleasant one. I am working with an amazing group of individuals, and the goal of the clinic is to provide timely and reliable healthcare to the MSM (men who have sex with men) community. Many are HIV positive and many are HIV negative. Some abuse drugs, some abuse alcohol, and some do not use any substances. They are just ordinary men trying to get healthcare in social situations that do not allow them to live normal lives. Each individual has a story, and after the first 2 days I can see that the staff really care about who these people are. It is not just a job. It is an opportunity to work with a marginalized population in the community to promote growth and social stimulation. It is a chance to model their lives after the way they portray healthcare, an opportunity for everyone to be mentally and physically sound. It’s a chance to practice the foundations of public health with new colleagues in a new setting. I am not exactly sure what sort of details I can be sharing at the moment, so I will end the work blog. I will, however leave my followers with a rooftop view of Kisumu. It is a small, bustling city on the Northeastern side of Lake Victoria.
May 30, 2017; Training With a View
Today was my first run while in Kenya. It reminded me of my marathon training in Moçambique. The hilly, dusty roads were quite a way to make me feel... well... not quite at home. I ran 2.5 miles out through some neighborhood roads, then ended up near the local fish market. The view of the picture is what I looked at while I was halfway through my run. You can see the boats to the right and market on the left. Lake Victoria is 2nd to only Lake Superior. This means that I have lived on 3 of the worlds largest lakes. Lake Michigan, Lake Malawi, and Lake Victoria. The run was very peaceful, except for dodging the herds of cattle that wander the dusty streets of Dunga. The children were all walking to school, and I must have said "good-morning" and "Hello" at least 100 times. It was very nice to see how supportive people were of my jogging. Many would say that jogging is good for the health, and that they may join me one day soon. There apparently is a jogging group that I will be searching for while I am here. It would be nice to train with some others. I will keep everyone updated on my running.
May 29, 2017; Hippos
Our first night in the house, we were talking to Betty and heard loud grunting. As we all looked out the window, Betty calmly said that we have hippo visitors that come into the yard a few times each week. We looked and looked but could not see a thing. We continued to hear the grunting. Betty informed us that the hippos are very docile unless they have a baby with them. We typically leave them alone, unless they get into Betty's garden. This is when Betty pulls out the good ole, trusty flashlight. She said that a few good shines at the hippos and they go running back through the reeds and into the lake. In the picture you can see that the garden's fence has been crushed under the weight of a hippo. They apparently love papayas, but so does Betty. The roof on the other side of the garden is our guest house. There are a plethora of birds, baboons, and other animals. Check back later, as I will blog about animals as well. Once I get some good pictures, I will expand my writing.
May 29, 2017; Kisumu/Dunga Bay
Karibu, which means welcome in Swahili. Finally in Kisumu, but more specifically Dunga. It is a small fishing town on the outskirts of Kisumu's bustling streets. Two other UIC students and myself are living with a wonderful woman named Betty. She is originally from Nairobi, but moved to Kisumu about 22 years back. In the picture you will see Betty's house. It has a wonderful kitchen and living room. Behind it is a guest house where the 3 of us are staying with another Kenyan college student as well. We each have our own bedroom and between the 4 of us there are 2 bathrooms. It is more than an RPCV (Returned Peace Corp Volunteer) could ask for. It is quite amazing to stumble into a different lifestyle of East Africa from the Peace Corps life. All of us share the kitchen and living room. There is also a garden to the right of the house where Betty grows Papaya trees, amaranth, kale, and beans. The giant mango tree to the left is producing phenomenal red mangos at the moment. We also have a guava tree, passion fruit tree, and ata tree. I haven't had ata in years, since Moçambque. If you are curious what ata looks like, google sugar apple of east Africa. In terms of food, we eat breakfast and dinner together in the main dining room. To the right of the picture, behind the tall reeds is Lake Victoria. I will keep this post short and sweet. Tomorrow we start work at the health center. Thanks for following, and keep up with the posts to come.
May 26, 2017; Nairobi
Today we explored the Nairobi area with our host, Chief, and his wife, Vickie. They took us to an orphaned elephant sanctuary where they are raised and reintroduced into the wild after 2-3 years. The first picture shows some of the orphans playing in the water/mud to stay cool. We saw a total of 18 elephants, and one enjoyed himself by throwing water on anyone that he could. Afterwards, we went to a giraffe sanctuary where we were up close and personal with some of the residents. As you can see in the picture, it was very up close and personal for Ed and I. Ed was the oldest and largest giraffe, and he apparently loved kisses.
Afterwards, we went to a mall with Chief where we got sim cards for our phones and had a nice lunch outside. After lunch we all went up to see a gorgeous viewpoint of Nairobi. This city is very large, and has some really neat buildings. I have really enjoyed the past day, but am excited for the 6 hour drive to Kisumu tomorrow. I will spend the next 2 months in Kisumu with a family and working at an HIV clinic. That is all for now, but keep following. We will begin work at the clinic on Monday. I will try and post 2-3 times each week with pictures in every post.
Thanks for following, and keep up. I will begin posting more frequently.