My next training session

Had a good training session this morning. One of my colleague's asked me to clarify that if working with continuous data, did you still need to check for normality, if going on to analyse with an ANOVA model? She explained that she’d never done this before in her career, and was grateful that I’d made her aware of it. I’m glad they will take something away from my sessions.

When explaining variability, signal to noise ratios and decision making, the original example in the training was the journey from home (Manova) to work. The two methods of transport were a train or car. I changed the example to be applicable here; by taxi or matatu, from Lion School (on the Nandi road) to the Moi University. When I asked which method they would recommend and why they would make this recommendation. The things the group came up with made me smile. Some of the examples included things like the taxi not arriving on time, the matau breaking down, the matatu driver falling sick, the taxi driver getting a puncture/stuck in mud etc

This evening I went out running along the Uganda road. Almost got intoxicated with car fumes there was so much traffic. It’s probably not the best route to take. I chatted to friends back home on Skype. It was so nice to hear from them. Made me realize how much I’m missing everyone back home! I spoke to my brother as well. Seems like I chat to him more now I’m out in Africa compared to when I’m at home :)

Trip to Lake Kamnarok and Kerio Valley

Michael was visiting from Kisumu, and we took a trip with Taxi Max to Lake Kamnarok and Kerio Valley. My haggling skills are improving. Originally he was going to charge 12,000 KSH for the trip as we needed a 4WD due to the weather and road conditions. I tried to haggle him down to 6,000KSH, and in the end settled on 8000 KSH (£55). Taxi Max begins by telling us we are going to Paradise (eek – is his driving that bad?!). He says Kerio Valley is so beautiful, he compares it to Paradise.

So, we learn that there used to be elephants in Lake Kamnarok, but they were pushed out because of the humans building. There is a lot of soil erosion, caused by the rains. We also saw how the rivers have eroded the lands. The soil is red because of the high iron content. Michael thought the children were malnourished because they had red hair, but Max explained it was dust from the soil. The termite homes are amazing! 

We didn’t spend a lot of time at Lake Kamnarok, since Michael needed to get back to Kisumu, but we saw a stork, and had a small walk around the Lake.

On the way home, I learnt why Kenyans aren’t as susceptible to malaria as whites. If you are a carrier of sickle cell anaemia (which white people are not) i.e. an abnormal hemoglobin cell from your father, but a normal hemoglobin cell from mother, then you don’t display the characteristics of sickle cell anemia, but it means that the parasite doesn’t like the “taste” of the hemoglobin cell. Interestingly, given evolution, in more predominantly malaria areas, the number of sickle cell carriers is greater (For ex. In the highlands, where malaria is not common, carriers are around 3% compared to the lowlands where it is around 20%).

Can you spot the stork?

View of the lake

Also, within 6months of birth, you have the antibodies from the mother, so if you get bitten, you might display mild malaria symptoms, but not fully blown. So if the baby gets malaria several times when young, they develop their own resistance, I guess like the chicken pox parties we have back home. All very interesting!

When I arrived home, worked on slides for tomorrow's teaching session, and sent out a reminder text to the group about training. There was nothing “express” about Michael’s “express” shuttle back to Kisumu, as he didn’t get him home until 10pm.

Team trip to Malaba

The team were travelling through to Malaba (which is close to the borders with Uganda) for a meeting with the cluster coordinators for the EmONC (Emergency Obstetric and Neonatal Care ) project. On the way, we saw an overturned truck. I later found out that the accident had happened yesterday, a matatu driver had been driving behind a truck and seen it start to topple. The matatu driver jumped out trying to save himself, and the matatu continued travelling with no driver. Sadly, the driver got killed as the truck toppled on him. I can't believe how many road traffic accidents occur, it’s so sad. People drive at crazy speeds, and overtake at every opportunity.

The cluster coordinators were filling in questionnaires in preparation for the closing of the project, we discussed any difficulties they were experiencing, and also how each cluster was doing in terms of meeting their 80% target.

Here I am with Prof, and Dr Gisore

Working with Colleta on the cluster questionnaires

The Global Network Team with the Cluster Coordinators

The journey back was long, and there was a lot of traffic coming back into Eldoret.

Ergh – had a power cut right in the middle of my clothes wash tonight. This is something I'm going to have to get used to!

My trip to Bumula and closure of the EmONC program

On the journey over to Bumula (about 2.5hr drive from Eldoret) this morning, we discussed Kenyan politics and the International Criminal Court (ICC) hearing. It seems that Eldoret had been affected badly by the post election violence in 2007/8. People were displaced from their homes, and homes burnt down. Even one of my colleagues returned home to hear that they planned to set his apartment alight. He gathered all his important belongings, and slept in the hospital that night. Sounds like a pretty treacherous time. As we got nearer to Bumula, we saw an overturned oil tanker. Apparently, people had run over to collect the fuel in the hope they could sell it. The lorry caught fire, setting these people alight. It's so sad to see the desperation of people here, and what they are driven to do in light of the poverty. The situation was similar to the gas leak in Nairobi and people trying to steal fuel to then sell it.

The meeting was really interesting. It was great to hear what a positive impact the EmONC 

(Emergency Obstetric and Neonatal Care ) project had on the villages. Many of the clusters explained how villages were looking to provide their own incomes by growing and selling groundnuts and maize etc. They opened their own bank accounts and were doing really well for themselves in terms of sustainability. No more tying the umbilical cord with grass, and the emphasis on using sterile equipment in the delivery process. They discussed the challenges and difficulties too. For example the facilitators were likely to drop out since they were volunteers and getting competition from other paying NGOs. All clusters appeared disappointed that the EmONC project was drawing to a close. One of the ladies had written a song and dance which she performed to the group, and everyone joined in. It was fantastic to see everyone doing the traditional African dancing. At the end of the session, we travelled into Busia, and crossed over the borders into Uganda. Luckily I didn't need to pay for a visa (I had to hand in my passport to the immigration officer. He also asked me to buy him some airtime :)) Otherwise, I think you normally have to pay $70 US to cross the borders. It was madness, with so many lorries crossing. The markets were crowded. I took a picture of a boy selling BBQ meat from an oil canister, which kept them sizzling and hot – quite an ingenious idea I thought. In the background of the picture was a Muslim shop owner. He was deeply offended, so I had to delete the picture straight away. Also, the boy seemed upset, and ran off. I'll need to be careful in the future with my photo taking. Dr Mabaya wanted to buy 2 guinea foul, as his dogs had eaten the last. A lady started following us around. Later I asked Evelyn who she was. Apparently she helps people carry goods across the boarder. If you are buying several items, you pay her to carry things across, so immigration officers don't get suspicious. Evelyn had told her that we weren't planning on taking many items over, but she didn't seem to get the message and continued to follow us.

After dinner at the hotel, we stayed up chatting about the traditions and the culture. We talked about certain tribes, where the ladies put rings around their necks. Apparently, the number of rings equates to their status within the village. Kevin was also explaining that the Luhya tribes have a pre-marriage ceremony (I guess like an engagement party). Here the dowry is discussed, and the rings exchanged. The couple are essentially married after this. Kevin mentioned that in the Kikuyu tribe there aren't really such formalities. 

*I have pictures of the African dancing, which I'll add later when I have a better internet connection :) 

Team spirit

There are so many data issues with the questionnaires that i'm working on, and it's frustrating because the sites are either taking a long time to reply, or don't reply at all. Now I can sympathise with the data-managers back home. I'm sorry for all the times that I've chased them for data, I take it all back now! 

 

Feeling a little frustrated too, as I analysed the data using absolute differences, later to be told that the results were different from the national results. When we looked further into it, it turned out the populations were different pre- and post- training, and so I should have been looking at percentages. Ergh!

My colleague had a call from the college administration office to say that her brother had been arrested with no reason why. She was upset he'd been arrested, but so relieved that he was alive. She was to travel over to the borders to help get him out of jail. Families really pull together here, there's such a sense of team spirit when family members are in need of help, the other members don't even hesitate to help out. My other colleague was back in the office, feeling much better. Her blood-slide had come back negative for malaria, so that's good news. She thought perhaps she was suffering with exhaustion. The reasons for time off work here are a little different to our reasons back home.

More on the African culture...

I thought the training went really well this morning. There were some really good questions asked; Can you write a paper with descriptive statistics only or do you need inferential statistics also. Also, if my sample size should be 342, but 1000 patients were screened and participated, should I only use 342 in the analysis? So the class had a really good discussion around these two points.

Here I am teaching

I finally spoke to the Prof today about the Run for Good in Eldoret. He's not keen on raising money for Vitamin Angels, and wants to have the discussion with the Global Network team about who we raise money for. He felt we should focus on the community needs; for example, buying bicycles, or an ambulance.

One of my colleagues went home with suspected malaria. Another colleague's brother has gone missing. He had gone to take an exam in Uganda at the weekend, and was due back on Sunday evening, however, there was no sign of him. My colleague spent most of her day trying to find out what had happened. She called the university, but couldn't get through.

One of the Professors had come into our office and was talking about Politics as Ruto heads to the Hague to attend the confirmation of charges hearing at the International Criminal Court. He is defending himself, along with 6 others implicated as key perpetrators of the 2007/2008 post-election violence in Kenya. I was finding it hard to follow the discussions as they kept switching between Swahili and English. The conversation changed direction, and they started discussing family planning in Kenya, and I was able to pick up on some of the discussion; which went something like this:.

The Professor explained that “..people were told you use contraceptives because you didn’t want children. In Africa, everyone wants children – it’s the culture here. If a woman doesn’t want children, she is considered a witch.” Families tend to be large, because it’s a sign of the families prosperity and also, the parents know they will loose some of the children due to disease. I’m wondering if these opinions will ever change in terms of the size of the family reflecting prosperity? I’ve discovered that if a community/tribe have a particular belief, then it is difficult to change this. For example, FGM (Female Genital Mutilation) still goes on in many of the villages in Kenya. Despite efforts from International and local human rights groups, the women in the tribal communities protest against these groups, because they believe that the men won’t want them unless they are circumcised. I have to admit, this shocked me, but then I can understand that if it's been part of the culture and is a long, old tradition here, then it’s hard to change a mindset. Although, it might be an old tradition, but if it leaves the women with chronic infections, infertility, the spread of HIV and severe bleeding being just some of the side effects, I struggle to see the arguments for it. In the Masai community, female and male circumcision occurs when they reach adulthood. It is a sign of the change in their status’. It seems this is changing however, as the communities learn the risks and the side effects of such practices on women.

Things are so different to back home, it made me realise how we are two worlds apart in terms of culture and beliefs.

I'm getting messages from back home, as people are worried about me. They've heard on the news about the British man murdered and his wife kidnapped on 11^th September. It's sad and devastating news.

Four new friends and Kakamega Forest

Arrived at the matatu station this morning. I asked the men there how to get to Khayega, which was a mistake, because of course everyone wants the business. The man I asked said I could take his friends' matatu and change at Kapsabet for another matatu going to Chaveli, and then Khayega, which is where I'd arranged to meet Michael (the other PULSE volunteer from Kisumu working for the OGRA foundation.) He was driving, and the plan was to meet in Khayega, and travel to the forest from there. Anyway, the man at the matatu station gave me his number and said to call if I had any problems. I call Michael from inside the matatu, and we agree to meet in Chaveli instead. The matatu takes some time to fill up, but once full, we’re off. Peter (the missionary sat next to me) overhears my conversation and starts chatting to me. I'm skeptical at first, and weary of how much I tell him, but he seems quite genuine, and i'm enjoying the chat. He's going to preach at a boys school on excellence this morning. Just before getting off, he says if I need help at anytime, here's his number. 

We pass the 5km sign for Kapsabet, and the matatu stops. The locals are talking anxiously in Swahili, and i'm not understanding a word. Suddenly everyone starts putting on their seat belts, so I do the same. We continue a bit further down the road, and the conductor dismounts. He runs up the road, and then back, and says something in Swahili, and everyone gets off the matatu. It seems that the traffic police are there, and the matatu doesn't have the appropriate license for which they could go to jail. The conductor tells me to follow everyone else. So I do as i'm told. It's here that I meet my new friend Robert. He's from the Kalenjin tribe, and an athlete, studying car mechanics at the University in Kapsebet, wanting to get a scholarship for his running to study in France. Robert showed me the way to Kapsebet. He explained he was an orphan. I was expecting that I'd have to give him some money for showing me the way, but at no point on the journey did he ask for or expect me to give him money. I wish I wasn’t always so skeptical, I just can't help it. Instead, Robert gave me his number, and said to call him anytime, and gave me God's blessing. What a nice guy. I called Michael en-route to explain what had happened, and he said he'd drive to Kapsabet instead.

I found a hotel called Elten. Apparently, this is the tallest building in Kapsabet, so Michael should find me easily! Here, I met Dan, who seemed anxious to talk to me. I thought he was a worker at the hotel, as he was lingering in the hotel entrance, but later turns out he is friends with the owner. Michael turns up about 15minutes later in a four-wheel drive.

It was great comparing stories and experiences, it sounds like he’s having a completely different experience to me! I guess one of the reasons being he is one of 6 PULSE volunteers in Kisumu, and I am on my own.

We got a guide at the forest for 500KS (~3.50 GBP) each, and then 600KS (~4.00 GBP) for entry into the forest. We went via the Southern part (the Isecheno area). Kakamega forest is amazingly beautiful. 

Saw lots of butterflies, monkey's, and safari ants! There were also medicinal plants there for various ailments, including healing colds. We ended in the butterfly house. On the way home, we saw baboons on the road, which was pretty cool. I wound up the window to stop them stealing our food!

Can you spot the black & white tailed monkey?

 I caught a matatu from Kapsabet. It took some time for it to fill up though. Street sellers were trying to sell me nuts, fruits, maps, posters and various other paraphernalia. Grace made a fruit salad with the avocados that Evelyn had given me on Friday, which we shared. The fruits are so juicy and tasty here compared to back home. I worked on statistics lesson for tomorrow, then skyped home. Was nice to see and chat to everyone. I feel so distant from them all.