Patience...

This week, I've been helping one of the PhD student's with their thesis. I discovered a mistake in his sample size calculation, which means he is grossly underpowered. He wanted to change his objectives to compensate. I explained that he shouldn't change his objectives just because of the error, but he should only change them if he wasn't happy from a clinical perspective. I explained that ethically, it wasn't a viable thing to do, now that the study had started. I said we could change the sample size section to base it on feasibility and logistical considerations, and look at the precision estimates around the point estimate, rather than power. I'm not sure if he bought into this idea, but I'm working on it :) As Margaret Thatcher once said:

“I am extraordinarily patient, provided I get my own way in the end.”

I had a call from Tom* this morning (from Sally Test centre), saying he had some documents for me to review? Turns out, his friend has been sent some documentation from Shell Oil company saying that he won an award of £94,000, on condition that he transfers 28,000 KS (approx £180) into a given bank account. Tom* wanted to know if it was a scam.  His friend was going to sell his cows in order to get this money. After looking at the documentation, it was an obvious scam. For example, the letter was signed from the Reverend Peters, and he'd signed it “With every blessing”.  It made me sad that his friend would've sold his herd, and bought into this scam. It shows the desperation of people here.

There was a meeting scheduled from 4pm until late tonight. I was told about it only 5minutes before the meeting was scheduled to start, and I'd already organised to meet Mira for Taibo class....ergh! I felt bad for missing the meeting, but I was only told at such short notice. Meeting's don't seem to be organised in advance here, or if they are, it's by word of mouth and no email communication to confirm. I think I need to do some investigation, so this doesn't keep happening. Myself and Mira were in hysterics during the step class! We just couldn't grasp the routine, and were about 5 steps behind everyone else. It didn't help that the teacher taught in Swahili! The boxing class after was good, and I managed to get some of those frustrations out with my punches!

Monday's isn't a good day for cash

Worked really hard to wrap up the time to event analysis, and sample size problem. I’d spoken to a friend over the weekend, who does research at the University back home, and feeling so much better about things. She explained that sometimes, as a consultant you do feel out of your depths, but she had some really good suggestions, like making a check list of questions to ask when your client asks for advice. I liked this idea, because often after students left, and I began working on their problem, I'd think of questions I should've asked them. Also, she said you won’t be able to answer the problem straight away, it was normal to have some exchanges back and forth to understand the problem, and the objectives of the study. Often, the client would have a vague idea of what they wanted to achieve from the study, but it takes some interrogation to get what specifically they want. I guess I need to learn to be patient, and realise that I can't always resolve these problems instantaneously. I mean, i've been working on some of these problems for weeks now.

At lunchtime went up to withdraw cash from Barclay's. The cashpoint didn’t dispense. When I called my bank, they said the money had been debited so then I wondered whether it had been dispensed, and I'd walked away too quickly (especially since my colleagues said the cashpoint can print faults on the screen, but still dispense the money!). My colleagues said I should go back to the bank, and enquire. The cashier explained that when the cash point dispenses, it debits your account first, then dispenses, but then if it has a fault, or is out of cash, the money has already been recorded as debited, and is not corrected straight away. In which case, the merchant would not go back to your bank to confirm the transaction. I was later to learn, this would happen again, and that Mondays isn't a good day to withdraw cash...ERGH! Seems that the cashpoint was just out of cash...perhaps Monday's is top-up day?! 

One of the data manager's, was fitting a cable in the office, so I can get connected to the university network, without using a modem, however, I've heard the university internet can be unreliable, so have been advised to have a modem too. Mira texted asking if I could buy some candles, as we were having a power cut from 6.30pm – 9.30pm. I didn’t have enough money to buy them, so we’d have to sit in darkness tonight! Luckily, the paper was wrong, and we didn't have a power-cut. Mira put on pasta for all of us.

Read a sad article in the Standard tonight. Basically, a British woman came to Kenya, and whilst out on the beach was approached by a Masai Warrior in Mombasa. They got chatting and she fell in love. She sold everything back home in the UK, and moved out to Kenya to live with him. After some time, his relatives moved in (not just his relatives, but his Kenyan wife, and cousin!) The Masai Warrior had kids who she believed were the relatives. When they called him ‘dad’ he just said it was part of the community spirit. When she returned to the UK for a break, he spoke to some dishonest lawyers to change the legal documents so everything was in his possession, and he left her. Seems that this isn't a unique case!

Calling on help from back home, Tuesday meetings, and the retro, 70's, stuntman, red, indie, sunglasses!

The week has got quite a bit better. I think on Wednesday I'd just hit a real low. I read through my Sheffield university sample size course notes as a refresher. The key message is to keep sample size calculations simple. Even if the main analysis is a complex logistic regression, or survival analysis. This helped me focus with the “Time to event” problem. It turned out, using 80% power, and a 5% type I error rate, that the sample size was too big to recruit in such a short timeframe, so in the end I asked the student what would be a logistically feasible sample size (she was looking at measuring the adherence to scheduled Well Child Care (i.e. success is measured as the proportion of mothers and babies that are compliant on a monthly basis) as a primary objectives, and a secondary objective of factors motivating mothers to turn up for scheduled clinic visits. As an exploratory objective, does the mother receive the correct services at each visit? If the mother does not receive the correct services, does this influence whether she drops out or not?). We resolved the problem, and with 400 patients, we estimated the precision that we were likely to see around the point estimate.

I came to realise that the regular Tuesday meetings just aren’t working (or I am getting missed off the communication channels.)? I was the only one to turn up at 7am this week. Is this the normal way of working here? The focus of the Tuesday meetings is to start writing the research papers. I should probably say something, otherwise we won’t get anything achieved.

One of the children at the Sally Test Paediatric Centre

This morning (Saturday), I went to the Sally Test Paediatric centre. There weren’t many children there. I played the memory game (involved turning all the cards face down, and trying to find pairs) with the 4 children there. Tom*, one of the teaching assistants came over with Charlotte*, whose just over a year old. She was very unbalanced on her feet. I later learned that she has cerebral palsy, and can’t talk. She fell asleep in Tom’s* arms. I spoke to Tom* for quite some time. He told me about the politics, and the “stolen elections” in 2008. The rioting sounded horrific here. He asked me about politics back home, and also the schooling system, which, sounds a little different to the Kenyan system. Here, the students study at primary school for 8 years, then secondary for 4years, where they do their Kenyan Secondary Certificate of Education. There is no A-Level equivalent before University (which is for 4 years). My colleague is actually planning to put her daughter through the British schooling system here because she says it’s more student focused, whereas the Kenyan system is more curriculum based.

One of the children at the Sally Test Paediatric Centre

Went up to the swimming pool to give the pool attendants daughter a French lesson. The pool attendant said she’d missed me, and wondered where I’d been – I didn’t realise this had turned into a business agreement! Met up with Mira and Mike in town for lunch…but sizzler’s was closed. Was gutted as wanted to try their milkshakes. We tried the Better Health, a vegetarian cafe that my colleague had recommended,  in Zion Mall but it was also closed :( I was surprised, being the weekend, I thought this was when they would make most of their business? Perhaps the owners are from the Kikuyu tribe whose religious day is a Saturday? So we ended up in Klique. We sat by the window and people watched. There was a man cycling with about 20 live chickens attached to his bike! Poor birds would be in for a bumpy ride!  It was ages before our food arrived, but we had an order of masala chips, which made it worth the wait. Mike headed home, whilst me and Mira went up to the Nakamatt's, the supermarket. Mira tried on some big retro 70s stuntman red indie sunglasses. I couldn't stop laughing, as I thought it was a joke, but she was actually serious about buying them – I wish I had a picture to show you. Perhaps I'm just out of touch with fashion..!? Mira – if you're reading this, you know i'm just kidding! The rain came on, pretty bad so got soaked, and Mira was almost talked into buying a 350KS Umbrella with the US flag on from a street seller.

*I’ve changed the names in this posting

Struggling a little today...

Today has been the hardest day since I’ve arrived, in terms of, dare I mention the 8 letter word beginning with h and ending in k.  I keep trying not to admit it, or let it grab hold of me, but I’m really missing home today. The internet has been down all day, which has been frustrating and I’m feeling so distant from everyone back home. It seems like so much is going on in their lives, that I’m not able to take part in or share. I keep telling myself I need to embrace my experience here, let it take hold of me, and loose myself in the culture and activities, but as much as I’m trying, today I can’t stop thinking about home.

My phone reception isn’t that great either, and haven’t heard from my boyfriend in days….it turned out retrospectively his messages weren’t getting through, so I think before I explode about something, I should make sure my facts are right :) Anyways, when I got to chat, it all became clear, and felt better about everything. I really must stop being a moody cow!

When I went out on my lunch break, one of the patients collapsed on the hospital stairs. The ladies behind me said “It’s no wonder these ladies collapse. Having just given birth, and having to climb up all these stairs.” It's a frequent occurrence to see blood on the stairs, or at the entrance to the Mother and Baby hospital. You just hope that these ladies are ok, as you never find out what happens. A boy grabbed my arm in the street, wanting to sell me something., and shouted something in Swahili, which I couldn’t understand. The woman behind me laughed, and that almost sent me off into tears feeling the communication barrier…it’s just a bad bad day!

Work’s so hard too, I’m struggling to see what the overall objective of a certain paper is, which is making it difficult to work on the sample size calculation, or even think about a data analysis section. Another student is trying to achieve so much in her study, and has about 10 objectives, so much so, that I’m finding it hard to focus….HELP! I texted Mira asking if she was about for a chat tonight! I warned her it might be more of a moan! She texted back saying the kettle was on already..wow, she’s a life saver. Not sure what I would’ve done without her to chat to!?  

Sosiani Power Plant and Umbrella Falls

Went to Sosiani to see the power plant, and the big waterfalls there (Umbrella Falls). We did some hiking, but unfortunately, weren't able to go under the waterfalls, as it was too wet and slippery.

Hiking up to the Falls

Saw a black snake (a black mamba) in the water. It was difficult to see the length of it, as we just caught a glimpse.

The Black Mamba

Umbrella Falls

Our guide went back to kill it. We saw the guides' bean batch too...wow! I've never seen such a huge selection of different types of beans. Was pretty cool! I wish I could tell you all of them, but he only knew the names in Swahili. 

Bean Pod

When we got back to Eldoret, we saw the cheese factory on Kenyatta Street (Doinyo Lessos Creameries Cheese Factory) which was interesting. From reading the Lonely Planet Guide, I was expecting a huge factory, and a guided tour. However, when we showed up, the factory was at the end of a dirt track. We couldn't see inside the factory, all we got to experience was a lady sitting behind bars, selling different cheeses. It was still worth it, the cheese was yum! The rain came on whilst we were out, so nipped into café delicious for ndazi's and tea!

I've inserted a map, so you can see where Eldoret is in relation to Kisumu and Nairobi.

After my second week at work, I'm still feeling a little out of my depth - I've been calling on help from back home, emailing colleagues for advice, and using my old university notes for help with sample size calculations! I've even got a survival analysis to look at. I haven't looked at survival analysis since we had the graduate workshops back in 2005...eek!

I am told it is no bother and that it is perfectly normal to call for advice or just to share ideas. It’s something I must come to learn. To get things right, or as right as they can be, is important and sharing ideas is the best way to do so, so I’m told.

The greatest good you can do for another is not just to share your riches but to reveal to him his own. ~ Benny Disraeli

I'm also a little concerned that I'm not meeting my primary goal of the PULSE assignment, which is to create a sustainable change that can be carried on indefinitely once I am gone. I have been helping students with their sample sizes and analysis sections of their papers, and assisting with the transfer of word documents into excel format, and with the analysis for a paper on community mobilisation, but how can I make a sustainable difference?If I were to come back in 6months time, how would I notice the difference?

Sally Test Paediatric Centre

This morning, I went to Sally Test Pediatric centre to help out. It's a care centre for abandoned and sick children, with various conditions, such as severe burns, head injuries, or HIV/AIDS. The children come here to learn, play games, and interact with other children of similar ages. Through their achievements, they gain confidence, self-esteem and build their own inner strength. It helps children forget their illness and learn to have fun.

It's helping with my Swahili, as I read Jack and the Bean Stalk to the kids, and Michael the teacher translated! I felt a bit of a communication barrier with the children, as my Swahili isn't up to scratch. I'm hoping after a few more weeks, I'll find communication easier with them! I wonder what they make of this far off land I come from where there are giants and idiots selling cows for beans?

Met Mira and Mike in town (at Wills Pub). I was excited, because it advertised a beer garden on the outside. Mira was skeptical, and her skepticism proved right. They had created an indoor beer garden, with a concrete wall, and imitation lighting to create a “fake” beer garden. Tried masala chips for the first time...I'm an addict now! I'm glad Mira and Mike are here, as it's keeping me distracted, and keeping my thoughts away from what's happening back at home!

Myself and Mira decided we'd go on a trip to Umbrella Falls tomorrow. Mike's off to Kisumu.

Are we talking African minutes or UK minutes?

Crikes...I completely forgot, but I was supposed to be at a meeting at 7am this morning. Legged it into the office for 8am, but no one had turned up!!! Is somebody having a laugh at my expense? People started arriving at 8.30am..so hakuna matata (=no worries) everyone...no panic!  The atmosphere is a lot more relaxed here. As my professor says, are we talking 5minutes African time, or 5 minutes UK time?

Helping Betsy and Peter with their community mobilisation paper...hmmm, I'm not sure how I'm supposed to be helping though, the objectives are vague at the moment, and there is a wealth of data here! It clicks, maybe that is my role to help them define such things in advance and set up the research targeted clearly at the objectives.

There is nothing like looking, if you want to find something. You certainly usually find something if you look, but it is not always quite the something you were after. (JRR Tolkien).

Time to learn Swahili and sample the East African food!

I've been going to the swimming pool in town. The pool attendant started teaching me a few Swahili words. So I said to her I didn't know how to thank her. She explained that actually there was a way I could help. Her daughter wants to learn French, and wondered whether I’d be able to teach her? I'm not an expert, and explained this to her, but I could teach her some basic vocabulary and phrases.  This sounded like a good deal, I'd teach her French, and she could teach me Swahili. (In the back of my mind, I'm hoping that it doesn't turn into another Chepkemoi situation!)

My day was spent discussing sample size calculations for 2 students, both studying malaria; the first looking at HIV and its impact on diagnosis of malaria (since some medics can make “presumptive diagnosis” that a fever implies malaria, however, HIV also causes fever, so she was looking at the proportion of misdiagnosed cases). The second student was also looking at those malaria cases in children which had been misdiagnosed. He would look at the treatment given, and compare it to the results of the blood slides. He wanted to compare the proportion of subjects with a positive blood slides who had been diagnosed correctly, and treated with anti-malarials versus those with a negative blood slide who had been misdiagnosed, and treated with anti-malarials.  It is clear that the majority of the endeavour here is aimed at identifying drastic beneficial changes in the control of massive problems. I have yet to observe the real situation on the ground but from anecdotal information the struggle is immense. 

Myself, Mira and Mike were invited to dinner at our landlady's.  I'm loving the East African food . For an appetizer, we had ndazi's (fried dough). Incredibly unhealthy, but amazingly delicious! For starters, we had pumpkin soup. Main was millet, ugali (the staple food here – cornmeal porridge), vegetables from their vegetable patch, mince, chicken and chapatis. There was a power cut (I would learn this to be a regular occurrence), so we sat in candle light. There were a couple of other guests over from Oklahoma University. One of these, Randy had been over doing mission work and had lived previously in Kenya for around 10 years. He'd set up his own NGO (Non-Governmental Organisation), and was fluent in Swahili. It was interesting to hear about his experiences and the challenges he faced setting up the NGO. 

 

I'm learning a bit about the culture here for example, my landlady, a career driven woman, had house helpers and cooks, and rather than preparing the dishes herself, she would instruct the home helps on what to do. People are surprised that I'm not married with my own family at my age. In certain tribes, you must marry, otherwise it brings shame on your family. It is common in Kenya to marry young, and to have many children, particularly in the villages, the parents encourage their daughters to marry, so they can obtain a dowry to pay for their sons' education. Even one of my colleagues said that I should have children to help me with the cleaning and the washing!! It seems I have little chance of being a Kenyan wife here though, since I cannot cook – my boyfriend stands a better chance than me!

 

The end of my first week...

This is my walk to work

When it's been raining, you can get pretty muddy!

The drive leading up to my work

This is the Riley Mother and Baby Hospital, where I work

Over a week since arriving and I've done my first week at the Moi University, attended a peer review for the MSc medical students discussing thesis proposals. Helped a student with defining their null and alternative hypothesis, and the use of 1 or 2-sided tests in his proposal looking at electrolytes in babies with gastroenteritis. Met with my Global Network colleagues to discuss possible research proposals and papers. This is one of the main objectives of my trip; to improve the data management skills of the researchers of the Global Network that will aid them in publishing research papers. If I can play a role in that whilst improving my consultancy skills then it will be all worthwhile. If I can hone my skills in various other ways to give up the day job then all the better ;)

Random trainers next door

 

How am I feeling...I guess a bit nervous, and a bit worried that I might be out of my depth here. I've been asked to convert some word questionnaires (pre and post training) into SAS datasets, and I don't know where to start. There's too many of them to data entry myself...I gotta call on alternative resources..i.e. My big bro with his IT expertise! I guess this is the secret to surviving it in an unfamiliar setting, knowing where ones limitations lie and using (and knowing when to call on) those with additional knowledge. 
 

Mira, my house mate's back from her Masai Mara trip. We all go out to Sheikh Union for a yummy Indian meal. Mira's trip sounds amazing. This is somewhere I'd like to visit if I get the chance. Sadly she didn't see any duma (cheetah's) though. I laughed so much tonight I ended up in tears...I really like these guys, they're a good laugh! Sadly, they're research will come to an end mid-August, and they'll be leaving soon. Already, I don't want them to go, I'm getting on with them so well.

Mike and Mira in our back garden

I'm finding communication with family and friends back home a struggle. It doesn't help that I'm not the best on the phone! Sometimes the internet connection is a bit ropey, and keeps booting me out of Skype, and when I try and call I can't talk for longer than 3mins without being cut off because I've drained all my credit. I'm learning to be patient, and got to remind myself I'm in Africa! Mustn’t worry so much, maybe that’s a lesson I will profit from during my stay. 

London Heathrow to Eldoret Kenya

 Time to leave. Full of emotions - nerves, fear, excitement. Boarding flight KQ0101...Nairobi here I come..what adventures await me?!

The last few weeks have been full of trepidation, analyzing everything that is important to me and worrying that I might lose something special. Thinking about all the things that could and might go wrong, thinking about the things and people I will miss in my life. Of course it’s difficult to lose something that special in such a short time but still I had many sleepless nights with consideration of unlikely events.

I know this is a great opportunity, something that I’ll be able to talk about at parties and tell others about, but right now adventure seems secondary in my life, to what I know and love. Just trying to calm myself with reassuring words from friends and colleagues; ”You’ve done it before, you’ve been to India”; “Remember, it’s only for 6 months, in the grand scheme of things it’s not really that long”. I’m still feeling scared of the unknown. I rushed through my goodbyes, because I hate this part, and always end up in tears, and set off to Kenya.

The following day (Saturday 2nd July) I arrived on time in Nairobi for the transfer, unfortunately bags don’t seem to have been so timely. Late arrival of luggage at Nairobi airport, and a flight to Eldoret leaving in erm....30mins! Let’s hope  luggage is late and not lost, or sat on tarmac at Heathrow.

What to do?! Do I take this flight to Eldoret, and risk leaving my baggage behind in Nairobi, or just miss this flight, and hang around Nairobi for around 12hrs until the next flight to Eldoret? How do I know that my baggage hasn't gone direct to Eldoret...crikes. They did say at Heathrow they'd put an Eldoret label on my luggage, but Nairobi airport officials assured me I'd have to collect my bags here. Spoke to the lost luggage office, and started filling in a form, when one of the airport attendants shouts out “Here's your rucksack”. I turned to find my rucksack sitting in the middle of the bagging area...phew. Where's my case though?! An attendant disappears with my luggage label...20mins until take off. Panic setting in now. He reappears, with the alleged case..hoorah! No time for tipping I'm afraid, I raced off at top speed to the domestic airport. With 10mins before the flight was due to leave.

There was a lot of tutting at the check-in desk (especially since my 2 bags were over the weight limit...oops!) No time to charge me though, an attendant came to carry my bags onto the plane. Someone else there kept insisting that I tip him...alright, point taken. Not having done any research about the exchange rates before coming out, I had no idea what the value of the money was, and no idea how much is the norm for tips. I gave him a 100 KS note (which is worth about 70p). Onto the plane...sweating, panting...not a pretty sight, only to find that my seat number of 14E didn't exist. There was a spare seat anyhow, which I fell into, and slept practically the whole 45minute journey there. Charles (the taxi driver) met me at Eldoret airport. I was telling him about my experiences, and he found it hilarious and told me my tip was worthless to the airport attendant. I then felt guilty, and tipped him 400 KS. Again, not realising that you don't need to tip taxi drivers here...ergh...I'm learning. This won't be the first time a Mzungu (white person) gets ripped off.

I’m here finally, 15 hours since I left home, wonder what lies ahead, what lies are ahead and where my head will lie?

The following morning, Sunday 3rd July, Chepkemoi, one of the ladies working at the Grand Prix hotel, was very friendly, showed me the local grocery store and the swimming pool. I later found out why. She sent me a text message saying “God has answered my prayers. I hope you will make my dream come true to settle in the UK. God bless you”. I didn’t need God’s blessing so soon, I just needed my shopping and a swim. 

Later on in the day, I met her husband. During this time, the landlord perhaps conveniently called him, saying he was evicting him from their house unless he paid their rent from the previous 6months (30,000 KS = approx £200). They have 2 small children. The whole time, I'm feeling uncomfortable, not knowing quite what to do, or say. Particularly so when Chepkemoi asks if there's any way I can give them the money. In retrospect I shouldn’t have felt so bad but immediately I did, but there was just no way, I can’t save the world after all.

She then asked if there was anyone back home who I could ask...so I explained politely, that even for a Mzungu, 30,000 KS was a lot of money – I couldn't think of anyone that I could ask and reprimanded myself later for even thinking that I might! I asked (perhaps naively) whether the government could help them. They laughed at me, and said there was no way. I’d forgotten for a moment where I was, and that things such as social care and benefits aren’t the same as back home

After only my second day of being here, was this going to become a regular occurrence? I’d have to be a little more careful and seek advice of how to deal with the inevitable repetitions of these events. These are the potential everyday struggles and hardships that some people are facing here, and no doubt many face much worse.  How much is real and how much is opportunistic claimed hardship/tragedy is impossible to determine but it’s a question one must always bear in mind if one is to go shopping or have the odd swim.

I don't know how the story ends as that was my last night at that hotel.  I’d like to think all was OK and my 200 quid would only have improved life rather than save it.  One thing perhaps I need to think about is the value of money and how I use it.