Sunday, October 08, 2006

Arrival and getting started in Niamey

Jodi and I arrived in Niamey at night on August 29th and managed to get ourselves to our hotel, the Gaweye Hotel. Gaweye is in the middle of this picture, right behind the bridge over the Niger River, seen from the balcony of the Grand Hotel, which is a terrific place to have brochettes and Coke and watch the sunset over the river.
The first morning, we headed down to the market to get SIM cards for our phones. We had the guy put them in, and the phones didn't work. So, he took us to his boss, and he fiddled around for awhile and decided it was beyond him. Then he took us to the Celtel office, who did the same, and then decided we needed Kada. So, we were then walked to the Grand Hotel, where a technician named Kada is employed. Kada is a Nigerien, and is one of these brilliant "fixers". He turned Jodi's triband phone into a quadband phone for $10 in 5 minutes in his office, but mine needed unlocking. That evening, our original salesman came with us in a taxi to the other side of Niamey to Kada's home/office, a small room full electronics and motherboards in various states of undress. My phone worked perfectly from then on. Several days later, when Jodi's external hard drive froze with all her necessary programs on it, we took it to him. Had he ever worked with an external hard drive? His eyes lit up - he had heard of them, but not gotten to work on one. Since it was broken anyway, he agreed to give it a try. The next morning, it was running perfectly! There are people in every country who are "fixers" - problem solvers and solution finders, and I love finding them! In the US, those repairs would have been impossible or cost more than the original machine, but interesting how in a country like Niger, anything becomes fixable in the right hands.

Here is Jodi with one of the two trunks full of PDAs we lugged with us!
The project we went to Niger to do was a PDA based, GPS assisted survey. Earlier this year, Niger, with the help of the International Federation of the Red Cross, distributed long-lasting insecticide impregnated mosquito nets in conjunction with a polio vaccination campaign. An initial survey was done, then during the dry season, to evaluate the coverage of the campaign, which was fairly good, and the net usage, which was dismal. This second nationwide survey evaluated the retention and use of nets during the middle of rainy season, the peak of malaria transmission. There are 7 regions in Niger, plus the capital. In each, two departments were randomly selected, and in each department, 10 villages were randomly selected, with probabilities based on census data. The survey questionnaire was to be programmed into PDAs equipped with GPS units. This allowed our teams to map each selected village using the GPS units, and then to select at random 16 households in each village to survey. Jodi and I spent most of the first week getting the PDAs ready for the survey. Jodi was the expert in this department, and I had no idea how much work it took! I quickly learned the basics of programming the questionnaires into the PDAs using Visual CE software, but so many of the steps were a black box to me! The above picture is me attempting to program in Visual CE. They sell wonderful fresh roasted peanuts in whiskey bottles, so there is a whiskey bottle of peanuts sitting next to me for sustenance!

The World Bank has recently decided that Niger is the poorest country in the world, with an average per capita income of $200 per year. That draws the presence of essentially every NGO known to man. In Niamey, which is the quietest, most laid back, and safest African capital I have been in, NGO offices outnumber government offices, and the street is full of NGO vehicles - white land cruisers and pick ups. There are a large number of expats living in Niamey. This in turn fuels the development of an alternate economy targeted at expats. So....Niamey is quite a foodie town! During the three weeks I was in Niamey, I ate wonderful un-Americanized Chinese, delicious thin crust oven baked pizza, Italian, Lebanese, French, Senegalese.....For lunch, we would eat local "street" food - grilled meat, fried cakes, rice and beans, sauce over couscous, rice, etc, but would usually go out at night. As the International Federation of the Red Cross (IFRC) was one of our partners, we went out with them several times, as in the above picture at a Lebanese restaurant. They were a terrific, very international bunch, and opened my eyes to the various opportunities other than academia and CDC. :)
So yes, this is sort of artificial... The Fulani (Fulbe/Fulfulde/Peul - depending on how you know them), stage spectacular celerations of male beauty called Geerewol in which they paint their faces, dress in eleborate costumes, and dance for the appreciation of their female audience. This was a performance put on for a conference at the hotel, but Jodi and I got our pictures taken with one of the dancers.
Sunset over the Niger River. I took far too many landscape pictures in Niger and will spare you most of them, but couldn't help myself to show you a few of them. Niger may be poor, but it's also a country of stark but spectacular beauty and very hospitable, kind people who were mostly an absolute delight to work with.

August

August (and the last of July) - with the EIS summer course ending on July 28th, and classmates dispersing to their states and departments, there was a much needed lull in the social life.

My roommate from Nashville, Aruna, came to Atlanta for the weekend to help me celebrate my 31st birthday. We spent the day shopping, eating out, getting our nails done, and exploring Atlanta together. It was wonderful to spend that time together!
August was about settling in to work - mostly paperwork! I started getting my stuff settled in to my office (me, an office? oh my gosh!), learning the ropes of working in a government agency, trying to organize my time and meet the rest of the malaria branch, get thinking about potential projects, and get some of the required online courses out of the way. I also had one week of classes sponsored by the division, for me and the EIS officer in the other parasites part of the branch. It was so much fun to re-learn about all of the parasites, from the folks who have been working on them all of their lives! I spent several hours most evenings studying for medicine boards.

I took Internal Medicine Boards on August 21st, and was very glad to have 1 of 2 boards over with. To celebrate, I went out to dinner at an Indian restaurant with a few friends!

August 22-24, I had to take a course for US personnel traveling abroad for longer than 30 days. Some of it was very useful and interesting, such as a fascinating segment on cross cultural communication, focusing on body language variance across cultures. (ie, look someone from the Middle East straight in the eye, do not do so in Korea) Other was useful, if not interesting (how to access healthcare abroad). Most was neither - how many times do I really need to hear about bioterrorism, WMDs, and how to survive a hijacking and hostage situation?

After a few frantic days trying to pack and get ready, and praying for clearance to come from the US embassy in Niger, I was off to Niamey, Niger with a statistician (and PDA survey specialist) from our branch on August 28th.

Thursday, August 03, 2006

EIS Week 4 (and my birthday)

Classes drew to a close this week - we had a lot more emphasis on preparing and giving presentations, dealing with the media, and legal issues. It was kind of sad to see our month of "summer camp" come to a close and everyone get scattered to their positions. About 2/3 of us are based in Atlanta, rather than the states, but working out of about 5 CDC campuses sprinkled around Atlanta. I have really grown to love my classmates!
On Wednesday night, my roommate hosted a birthday party at a very cool restaurant called PieBar for me - and we turned it in to a July birthday party. About half of our class, and Ludacris (a rapper), turned out for the party. (That's OK - I had no clue who he was either.) The birthday girls - me, Cindy, and Melissa (there were two boys, but they're not in this picture) - Cindy is an epidemiology PhD (working in birth defects) and Melissa is a veterinarian (working in bacterial zoonoses)
The best two dollar beer in Atlanta (locally brewed) - in the picture, I'm laughing because I have just had a bunch splashed (accidentally I'm told) on my face and down my front - perpetrator pictured on my left. :)
Nick is so helpful - I didn't even have to lift a finger to eat my own birthday cake. And I didn't end up with any on my face!
On Thursday, I hosted a West African food fiesta along with an informatics fellow from Senegal named Salam Gueye - this is Salam sampling the food. He made a Senegalese dish, and I made a Senegalese dish and three Cameroonian dishes.
Again, we had a turn out of a little over 30 classmates - it was a lot of fun to share my favorite West African foods with them!

Friday, July 21, 2006

EIS Week 3

My friends Sonal and Raj (from medical school) were in Atlanta with their gorgeous little girl Kiran visiting Raj's family, so I got to meet them for lunch.

On Tuesday, July 18, Sapna and Vidhya joined forces to cook a huge Indian feast for our class - it was absolutely amazing - I think our classmates will talk about it for years!

We had quite a turn out - at least 30 classmates - I love how everyone just grabs a spot on the carpet, and all the mingling and chatting with everyone never seems to get old - this dinner party lasted from 7:30 - 11!
Sapna and I in our kitchen during the Indian food extravaganza
On July 19, a group of us went to see Paul Simon at the Chastain Park Amphitheatre, which was just amazing - you can just barely see the rest of the amphitheatre behind us, before the concert started.

July 15-16

July 15 was the 40th reunion of the EIS class of 1966 - that put together the first big small pox eradication campaign in West Africa, demonstrating against huge barriers that it was possible. Our class was invited to the morning of talks - all the "old greats" were there - people have made absolutely enormous contributions to public health, and positively impacted the health of millions, like Rafe Henderson, who led the EPI (Expanded Program on Immunizations) from 20% of world children immunized in 1978 to 80% in 1990. It was amazing and humbling. Here is one slide from the small pox eradication talk.
That evening I had dinner with my "ashram" and we watched a movie called Earth, about the partition of India and Pakistan in 1947, that was deeply compelling, and it was fascinating to watch with them - 4 people from very different parts of India, and how they responded. Sapna's grandfather came back to Lahore (now in Pakistan) after being a prisoner of war of the Germans in WWII to face the events of the partition, so it was especially poignant.


On July 16, more than half of us went white water rafting on the Ocoee, back up in Tennessee. This is Doug Hamilton, director of the EIS, aka, "Oh Captain, My Captain", and he who is responsible for putting me in my dream job.

I had just bought a waterproof camera, and this was its maiden voyage - I think it performed very well!

A raft of classmates heading toward us
In the water - I have no idea what Shua is trying to do!
A couple of dragonflies on the edge of the raft - not only is my new camera waterproof, but it takes fabulous close ups!




The group of EIS officers after the rafting trip - I'm in the upper left corner.

EIS Week 2

July 10-14: EIS week 2 of classes. We got into epi and outbreak investigation for real, with classes all morning and case studies in the afternoons. All day in class turned out to be tough for us 30 somethings, so breaks between classes were a huge relief! (Derek, Samir, Patricia, Nandini)

Out for Korean BBQ with a group of EIS classmates - We end up doing something social pretty much every night - trying all kinds of fun ethnic cuisine .... Bangladeshi, Korean, Thai, Ethiopian... It has been so much fun to get to know people - I am continually astounded by what incredible backgrounds people have. It has been a lot of fun to get to know and appreciate the skill mix of my classmates - epidemiology PhDs, veterinarians, MDs. We have so much to learn from each other, and it has been fun to work on teams together.

Several times a week, different folks invite everyone over. This is at Danielle's party - Cindy, Italia, me, Vidhya, and Heather.

Adam, Ingrid, me, and Christine






Melissa, her sister, and Danielle (serving jello shots)

Sunday, July 09, 2006

House warming party

The Saturday night after classes started, Sapna and I hosted a house warming party - Caribbean theme. We had a wonderful turn out of EIS classmates, and our apartment actually does work great for entertaining - especially our kitchen! It's so nice to be all settled in!

Phil, Nick, Sapna, Kate, Danielle, and Michael


Christine (from Belgium - we had a great time speaking French), April, Italia, Cindy, and Adam in the kitchen


Nick, me, and Jim

me sitting on the "make out couch" with Vidhya


overhead party shot into the kitchen

Settling in Atlanta

My new apartment in Atlanta is very spacious and has a very open lay out with a great kitchen - here is Rocky exploring the kitchen.


Samir and his wife Vidhya, Nandini (and when he arrives from India, her husband), Sapna, and I all decided to live in the same complex. We have been jokingly calling it our ashram. The first few days, we used Samir's GPS to explore dinner and dessert options. This was after particularly yummy ice cream (Samir, me, and Sapna). Samir is in diarrheal diseases and just finished a med-peds residency, and Sapna is in refugee health and just finished an infectious disease fellowship. Nandini (not pictured here) has an epidemiology PhD and is in STDs.


One of our classmates got in and settled early, so had a party the Saturday night before classes started. He's got a gorgeous place! Below are my roommate Sapna, Italia, me, and Samir.


The first week of EIS has been pretty much all administrative stuff - basically, working for the government 101. The director of the CDC spoke to us on Thursday, which was interesting. Friday, we did a team building day, which was an incredible opportunity to get to know each other (and ourselves) better.One aspect was the climbing wall - I have always assumed I couldn't climb, but this wall had some ropes and some of the holds had a slight lip - I got all the way to the top, which absolutely astounded me, so I did it two more times! In the picture above, I'm the one in red.

Out to dinner with several EIS classmates - these are Phil and Nick.

Leaving Nashville

My move was a government move - ie, paid for by tax dollars - and my movers were absolutely terrific. They had my place packed up in less than 4 hours!

All my stuff on the moving van, and on its way to Atlanta - I had a total of 116 items - yikes, I have accumulated in the past four years!


The last thing I did on my way out of Nashville was go to the zoo - I had to see the new Masai giraffes.
I fed the lorikeets one more time

And the three new Masai giraffes

Goodbyes


Sherstin, Beth, and I went out to eat for our "un-goodbye" - hot wings and cold beer. These two women have been the hugest blessing, and have kept me sane, encouraged, challenged, and loved these four years. So grateful for your friendship! I am truly blessed!















Hung Do: physical therapist extraordinaire, work out king, and connaisseur of fine food....


Ms. Frith - the first patient I saw in my clinic, and almost the last - have gotten to see her every other month, and have just fallen for her - she is the spunkiest, most delightful almost nonagenarian (is that a word?) I have ever met and I'll miss her!


Me with Sandi Moutsios, my clinic attending, med/peds program director, and personal idol. I stayed at Vanderbilt in part because I wanted to be like Sandi, and have concluded that that would be impossible as she is super-human. It has been such a treat to learn from her!



Robert in his "thinking" chair - has done a terrific job being a big brother to all the estrogen that has congregated in his house, and manged to sleep through a lot of it!