Sticks and Stones

Sorry I haven’t updated my blog in a very long time. Mostly, it’s because these past couple months have been really frustrating! I finally got my kits to do HIV assays at work. For those of you who are more scientific minded, I’m running ELISAs on HIV samples in order to establish the HIV prevalence of various communities where ZAMBART has implemented interventions. I’ve got about 6000 samples to test, which is a lot. A lot of the same test over and over, which should take me about 2 months. And since I’ve been here for about 3 months, theoretically, I should be done by now. Alas, things never work out that nicely. It took the first month to get the kits and to order the fridge to store them in. It took the second month to figure out why the tests weren’t working. ELISAs are not complicated so having it go wrong millions of times over was a bit of a downer. Anyway, after two weeks, we decided it must be the water which we get from across the street at University Teaching Hospital (UTH). (It’s quite strange to have to leave the building and drive across the street in order to transport distilled water back to the lab.) After we started getting our water from CIDRZ instead, the test worked! For a day. It took another two weeks to finally sort it and start getting valid results, but now we’re finding that some of the results aren’t reproducible. Perhaps now you understand my reticence. Being in a constant state of frustration is not very conducive to writing. Hopefully I’ll have some social science work soon, considering that’s what I came here to do. It was a bit disappointing when I mentioned to the social science team that I wanted to work with them. They thought I was joking since I’m considered a lab person.

Moving on, I managed to solve the root of a few of my other frustrations, the main one being transportation, or the lack thereof. I’ve wanted to write about this, but I needed to break the news to my parents first. It went something like this:

“Shruthi, how are you getting to work?”

Pause.

“Shruthi?”

“Well, you see……I have a car.”

“YOU BOUGHT A CAR?”

“No, no. Someone gave it to me.”

“SOMEONE GAVE YOU A CAR?”

“Yeah, and it’s a manual, so I had to learn to drive stick….”

Here’s where you can really tell my parents apart. Mom’s reaction:

“You learned to drive stick?! So you can drive us around when we visit?”

Dad’s reaction:

“Do you have insurance?”

So yeah, I drive here. And I can drive stick, which I’ve always wanted to learn. Perhaps learning to drive stick while adapting to driving on the left hand side of the road in Lusaka traffic all at the same time was biting off too much, but I did it! Helen, who runs ZAMBART and wrote a letter of support for me for the Fulbright is the rightful owner of the two-door periwinkle Suzuki. It was sitting sadly in her garage and she agreed to let Ramona and me drive it for as long as we need! It can’t do long distances and it leaks a bit when it rains, but we’re quite delighted with it. Ramona is a Dutch intern who will be here until May. We were living together in the guest house at Petra’s. I say “were” because I’ve recently shifted, as they say here. There are quite a lot of other British English phrases I’ve picked up since I’ve been here. Fries are now officially chips. The hood is the bonnet and the trunk the boot. Flashlights are torches (very helpful during power outages). When I leave work, I’m knocking off. And instead of signal lights, we have robots, though I’m not actually sure if that last one is British or just Zambian…Anyway, I now live across from Manda Hill, one of the shopping areas. I’m much closer to work, and I live with Barbara, a woman who works at CIDRZ (she’s also the one who got kicked by the zebra). This makes sharing a car with Ramona a bit tricky and we’re still working it out.

Learning to drive was quite interesting, both liberating and frustrating (sorry, there’s just not a sufficient synonym I’d like to use…aggravating perhaps or vexing or chagrining…so maybe there are others I could use…). It’s much easier to get around now. Being dependent on others all the time for transportation was like being in junior high again. The only problem with driving stick is how easy it is to stall, and it usually happens at the most inopportune moments, like at intersections or in heavy traffic. And people here don’t hesitate to honk to let you know how annoyed they are. Also, you have to find this balance between the accelerator and clutch when you start moving, but I couldn’t get it for the longest time and kept jerking back and forth. It didn’t help that Ramona, who drives stick in the Netherlands, got it right away and proclaimed how easy it was to drive the car.

Luckily, since I already had a driver’s license from the States, I didn’t have to pass a test to get my driver’s license here. I did, however, have to go through an interview to make sure I knew the rules before I could even get the form you’re supposed to fill out to obtain a license. I went down to the RTSA (Road Traffic and Safety Administration) with one of the ZAMBART drivers, which is probably half the reason everything went smoothly. For my interview, the man asked me if I knew the ten basic highway road rules. I said I didn’t, but how different could it be from driving in the States? He didn’t really like that answer. Then he pointed to a poster with a bunch of different road signs on them and asked me to tell him what some of them meant. I got the cattle crossing and railroad signs right, but there was one of a locomotive and one of a picket fence about which I had no idea. I took a stab at the latter and said it stood for a residential area. He kind of chuckled, told me it stood for a barrier, and gave me my form anyway. So it only took about an hour and half for me to get my license, which I’m told is really fast. Of course, it’s just a sheet of paper for now because they’ve run out of the cards, so I have to go back in a couple months to see if they’ve come in.

There are some strange road signs in Zambia. Besides the cattle crossing and “deep potholes ahead” signs, I’ve seen one for an elephant crossing and one that said “careful of flying stones”. It’s no wonder belief in spirits is so prominent if the stones are flying! Another funny thing about driving here is what you can buy along the roads. When cars stop at the robots, people come into the streets and try to sell anything from talk time, newspapers and umbrellas to potatoes, floaties for the pool and ab workout contraptions.

One event that took place before the holidays was World AIDS Day on December 1. Any AIDS-related organization had the opportunity to participate in a march through Lusaka. It started off around 9:30 in the morning and we walked for about an hour. It was shorter than previous years. There were a lot of groups there though and, as we marched, the ZAMBART people sang songs about HIV and TB that the drama groups had made up for their community interventions. Here are some pics:

The Zambezi! Whoohoo!

Thursday, October 30, were the Zambian elections. President Mwanawasa, elected in 2006 for a five-year term, died in August and the constitution dictates that elections must then be held within ninety days.  There were two main candidates: Rupiah Banda of the MMD (Movement for Multiparty Democracy) which was Mwanawasa’s party and Micheal Sata of PF (Patriotic Front).  Lusaka is a Sata stronghold and during the week preceding the elections, cars and trucks drove through town with his banners on the side, blasting music.  Some of them were trailing motor boats with people inside carrying oars.  I think it was supposed to be some reference to Noah’s Ark, but it didn’t quite work. Many of the expats were concerned that there would be rioting following elections if the results weren’t announced quickly and if Sata didn’t win (Many people chose not to go to work on Friday).  It was announced on Sunday that Rupiah Banda won the election by around 30,000 votes I think, and everything was peaceful as we had been assured by the Zambians it would be.  This president will fill the remainder of the term so there will still be elections in 2011.

On Tuesday, Election Day in the States, I left for Choma and Livingstone with Monde, one of the supervisors at ZAMBART, and Phalesh, who leads the household interventions. This trip was super helpful because I was able to learn a lot more about the project and specifically Zamstar (Zambia and South Africa TB and AIDS Reduction), the study on which I’ll be working.  So before I get ahead of myself, I’ll explain Zamstar in more detail.  The purpose is to reduce TB transmission and infection. The prevalence is currently estimated around 1% in Zambia but is as high as 50-70% in people with HIV.  So a big part of the study is urging people to get tested for HIV. If they are found HIV positive but don’t have TB, then they’re put on isoniazid preventive therapy so they won’t get TB. The study compares interventions in 24 communities – 16 in Zambia and 8 in South Africa.  They’re broken into 4 groups of 6 communities.  Since we use pre-existing Ministry of Health clinics at the various sites, all the communities receive support for their current government TB and HIV activities.  One group serves as the control, another receives household interventions (where counselors visit homes with a TB patient and speak to all the family members about HIV and TB, urging them to join the study and get tested), a third groups receives community interventions (dramas in schools and marketplaces, lessons to schoolchildren, and easily accessible sputum deposit sites) and the last group gets both household and community interventions. I got to visit some households with the counselors, some of which were very far away.  Luckily, we had a car, but the patients may have to walk great distances in some areas to get to the clinic and same with the counselors if a car is not available. I also got to see a drama in the marketplace which was really interesting.  The band of actors came out and started playing drums to get everyone’s attention and then started talking about TB, its symptoms and where to get tested. Once they started talking, lots of people surrounded them in the market.  Sadly, I didn’t understand exactly what they were saying because they were speaking in a local language, Nyanja, but it was still fun to watch. 

We stayed two nights in Choma in a semi-dodgy lodge.  It was clean though and had three satellite channels, one being CNN, so I was able to keep up with the elections. I was ecstatic!  I even called the States and texted everyone I knew in Lusaka (a very short list).  And I’m so happy Indiana went blue!  Everyone here kept asking me if I voted, and after I told them that I did, they asked if I voted for Obama.  Frankly, I think I would be scared to say otherwise!  But everyone here is very happy about the news as well. 

After Choma, we made our way to Livingstone, home of Victoria Falls. It’s about 200 km from Choma, which shouldn’t take more than two hours, in theory, but the road is one of the worst I have ever seen.  Potholes galore! We basically had to drive 20-30 km/hr the whole way, unless the stretch of dirt road on the shoulder was long enough and wide enough so we could get up to 40 or 50 km/hr. There were some strange sights on the road as well. For a while, we were driving behind a maintenance truck.  I, for one, would like to know what they were maintaining!  On this road, rules did not matter. We drove where the road was least bumpy, and if that was on the right side of the road, then we switched over, as did everyone else.  At one point, a truck almost swerved into us trying to avoid a giant pothole. Ironically, it had “Steering Toward Perfection” stamped on its front bumper. After about an hour of these ridiculous potholes, we saw some workers tearing up the tarmac, so I think the plan is to redo the entire road. This was also the point at which they finally decided to warn us about the road’s condition with signs stating “Slow Down. Deep Potholes Ahead.” (though I must admit that I was concerned about this late warning and expected craters).   

On Friday, Monde and Phalesh left Livingstone early since it’s a seven-hour drive back to Lusaka.  I decided to hang around since I hadn’t seen the falls yet.  Well, I still haven’t seen the falls. It’s the dry season, so there’s just a trickle.  It looks there’s a leak in the face of this enormous cliff. I could see down a bit to the Zimbabwe side where there appeared to be mist from the falls, but the Zambia side was quite dry.  During the rainy season, around March and April, you can see the mist from the falls more than 30 or 40 km away.  If you go into the park, you’re immediately wet from the spray.  In the local language, the Falls are called Mosi-Oa-Tunya, which means the smoke that thunders.

The nice thing about being in the park during the dry season is that it’s not super crowded.  I took the trail down to the Boiling Pot which is where the water from the falls enters the Zambezi River.  There was a lot of climbing over rocks and wading through water.  I can’t imagine how hard it would be to make it during the rainy season! I had a guide who led me down there and pointed out where you would normally see the waterfall and how high the water can get during the rainy season.  Then I walked along the lip of the falls, where there would generally be water, but is now completely dry.  I wanted to see how close I could get to Zimbabwe.  Unfortunately, once you get near an area called Livingstone Island (not so much an island this time of year), where you’re supposed to pay to enter, the area is restricted, so I didn’t get close enough to feel the mist.  Anyway, at that point, it became very windy and I could smell rain in the air. I started booking it back to the main trail, but the area is very rocky so it was incredibly slippery. I finally made it though, completely soaked, and wandered into the Zambezi Sun (a nice hotel next to the Falls) for lunch. I was slightly embarrassed being completely drenched, which everyone I passed along the way felt the need to point out. After lunch, I walked down to the Royal Livingstone, a super posh five-star hotel and had some tea to warm up. One thing I forgot to mention is that there are these crazy monkeys running around the park and at these hotels.  There are men stationed at the hotels who look like guards, but I think their real job is monkey-chaser. Anyway, I was sitting on the terrace enjoying the view of the river with my nice cup of tea and this monkey makes a dash toward me, jumps on my table and steals my sugar packets!  Two seconds later the guard shooed it away, but it definitely caught me by surprise.  Then, I took a shuttle back to main entrance to the falls and along the way, there were giraffes and zebras!! I got out of the van to take a picture and the driver said we could go closer to the zebras, so I was standing just a few feet from one!  Then another one started to walk toward us at which point I was ready to hop back into the van, remembering how Barbara (one of the women who works at CIDRZ) had been kicked by a zebra when she was at the Zambezi Sun. Luckily, I avoided a kick and headed back to my hotel for the day. 

The next day, Saturday, was probably one of the best days I’ve ever had!  I went white-water rafting on the Zambezi!  Whoohoo!  That’s what the guide, Boyd, was always shouting “The Zambezi!  Whoohoo!” I was picked up from my lodge at around 7:30 in the morning and didn’t get back until 6 in the evening.  I was in a boat with a middle-aged German couple, an American boy, Sam, from Vermont but currently working in Botswana, a Dutch boy, Janno, working in Lusaka at WFP, and an Australian boy, also Sam, who was just traveling around Africa doing crazy things I think. Anyway, these boys were masochists and insisted we flip at some point. In the morning, we left off from the Boiling Pot, so I had to make that same hike down as the day before. We all managed to stay in the boat over the first class 5 rapid, and at times when the water was still and we had time to kill, we jumped in the river and swam.  Actually, some of us were pushed into the water.  Even the guys on kayaks who were supposed to pull us out of the water if we got in trouble would float by and dunk our heads while we were swimming. The first time I fell out of the boat was on the 8^th rapid, another class 5.  I think they were trying to flip the boat but it didn’t go over all the way. The water washed over my side of the boat and when we straightened out, everyone on my side had fallen out!  It was a bit disorienting.  We had to walk around the ninth rapid since it was a class 6 which essentially equals death.  Then we had lunch on some rocks.  The rest of the day was pretty easy.  We swam a lot more and floated down the river. But since we still hadn’t flipped, we chose the 18^th rapid to do it.  At least we were prepared.  Boyd was the first one to jump off the boat.  A couple of us got stuck under it when it flipped, but there was enough room to breathe so I could get my bearings and come out the other side. It wasn’t as bad as I thought it’d be! Apparently now is the time to raft the Zambezi since the water is low.  It’s more exciting and you get to do all the rapids (they don’t do the first ten during high water).  For the second to last rapid (the 24^th), we were even allowed to float on our backs down the river since it was just a class 1!   

I took the bus back to Lusaka on Sunday.  Even though it was seven hours, it wasn’t too bad.  It was just a bit nerve-racking because of all the potholes and because the woman sitting next to me was rather large (let’s just say it was cozy).  The driver, I thought, did a good job. He didn’t drive crazy fast and was good about slowing down in areas where more people were walking along the streets.  The road cuts through grazing land, I think, because we always had to watch out for suicidal cattle that would cross the road without warning. The driver was watching out for them though.  He seemed to care less however for the welfare of grazing goats.  There was a group of them in the middle of the road and he honked at them so they’d move, but the poor things didn’t know which way to run. Then, I heard a very unpleasant thud and I’m pretty certain we ran over a baby goat!

On that sad note, I think this is the end to my crazy adventures for now.  At least, I don’t have any planned.  I’ll keep you posted on my work though, which will be taking off shortly and is sure to be a different kind of adventure.

My first two weeks

As most of you may know, I’ve been in Lusaka, Zambia for two weeks now though it feels like much longer. The journey was tiring. I flew from Indy to Chicago to London to Lusaka with two overnight flights. I arrived very early in the morning on October 16. From the sky, it's evident how few paved roads there are, and much of the land appears undeveloped. Although you arrive at an ungodly hour (well, 6:30am used to seem ungodly) if you take the British Airways flight from London, it’s the perfect time to arrive. The sun has just risen and the side of the airfield looks straight out of NatGeo. I half expected to see an antelope dart past (sadly, I didn't see one). I took a deep breath stepping off the plane, my first steps onto the continent, but arriving in the middle of October, it’s the dry season and my nostrils were immediately filled with dust. I felt coated in it as I walked the short distance from the airplane to the airport. I spent most of my first day trying not to fall asleep, and for the most part, I succeeded.

I’m currently staying in Petra’s guest house. She’s the lab coordinator at ZAMBART (Zambia AIDS Related TB) where I’ll be working. She has 3 kids (Bob, Ilsa, and Wouter), 3 cats (Mimi, Tiger, and Rakker), and 2 dogs (Moto and Kalu). There’s also Frida the nanny, Gift the gardener, his brother Rafael, Kift’s wife Maureen, and their 3 kids (Catherine, Irene, and Chris). It’s a very full house. All the kids are always playing together so sometimes it’s hard to tell exactly how many kids Petra has. The dogs are a bit bipolar, superexcited one minute and too lazy to move the next. They’re very fond of jumping on people, so it’s nearly impossible to stay clean around here.

The house is just outside Lusaka, which makes driving a must. The only forms of public transportation are taxis and mini buses (large blue and white vans with about 3 rows). If you’re walking down the street, someone in a minibus will inevitably honk at you and scream at you to get in. I haven’t ridden in one yet (baby steps), but they don’t go as far as I live anyway (and Petra says it’s a vehicle for TB transmission). One funny thing about driving in Lusaka is that when you’re stopped at a light, people run into the streets to sell you anything you could possibly want, from fruits and veggies to talk time (for your cell phone) to floaties for your pool! I’ve been relying on friends (well, mostly Barry who also works at ZAMBART) for rides and also Petra’s driver, Richard. Richard drives one of Petra’s cars when he has to take us places. If he has to pick me up in the morning, he walks to the house, which takes him from 45 minutes to an hour.

My second night in Lusaka, we went to an Oliver Mtukudzi concert at the International School of Lusaka (ISL). He’s a very popular Zimbabwean artist and the father of Tuku music. He uses a lot of traditional African instruments. I’m not sure how to describe the music. It was very soothing and upbeat. It’s definitely worth a listen on iTunes or YouTube. The Zambians love him! If you were standing within the first few rows of the stage, you had to dance or you would eventually get pushed aside. I was still jet lagged, so my dancing was a bit half-hearted but good enough that I wasn’t too jostled.

I’m starting to get a feel for the city. There are a couple popular shopping centers – Manda Hill and Arcades - where there are supermarkets, bookstores, cafes and such. Zambia is actually quite expensive (most things are imported from South Africa), so only the rich can afford these places. If you drive through the compounds (kind of like neighborhoods), you can see the vegetable stands and hair salons frequented by the people who live there. There doesn't seem to be a lot of homelessness; most people live in these compounds, but the standard of living is extremely low. The only ones I’ve been through are Chawama and Kalingalinga. Barry started the Kalingalinga Foundation to provide peanut butter sandwiches and milk to patients at the HIV clinic (the extra fat and protein is important during ART). There’s also a project to provide school supplies like desks and books to kids. Here’s the website: http://www.active.com/donate/kalingalinga. Right now, he’s basically paying for everything out of pocket, but he’s found some good deals in Lusaka. There’s a wildlife conservation group called It’s Wild that supports rural markets from whom he’s started to get peanut butter in 20kg drums (imagine all that peanut butter!).

I haven’t really started working yet. So far, I’ve been visiting the lab, observing and helping out when I can. The lab is actually a very small part of ZAMBART, so I’ll be spending the next couple weeks visiting sites where TB/HIV interventions are in place. My only exposure with the health care system so far is at Care For Business (CFB), a private clinic. I had to get a chest X-ray for a study permit (even though I have a negative TST). I went in on a Monday and the receptionist said that I could get the X-ray, but that there were no doctors available on Mondays to read it. And everytime I said I needed the X-ray for a study permit, people would ask me where I'm going, and I had to explain several times that I wanted to stay in Zambia! It's possible that they thought I was Zambian since there's a large Indian population here, but I definitely don't have the accent. CFB is actually quite nice. I don’t know what the other hospitals and clinics are like. Part of the ZAMBART lab is in UTH (University Teaching Hospital). To get to the parking lot for the lab, you have to drive by the trauma center and the BID (brought in dead) section where mourning families are given no privacy. I have yet to see the rest of the hospital.

I’m still getting used to everything. People often discuss how difficult it can be to get something done here, which I am slowly discovering. Zambia is not a place for the impatient. At one restaurant, I had to wait three hours for my food. I think the best example though is when I went to a mailing center to post a letter and they didn’t have stamps.

My most exciting adventure so far and perhaps of my entire trip was last weekend at McBride’s. It’s a bush camp in Kafue National Park. Chris and Charlotte are the owners and they run the place with a staff of eight. Chris has a degree on lions which he’s been tracking since the 70s and Charlotte practically grew up in the bush so they’re the perfect pair to have on such an adventure. Chris is quite eccentric and much of his humor is probably not appropriate for this page. I went with four other people: Ranjit and Shilpa (who I know from Purdue), Barry (who used to work with Ranjit at CIDRZ - Center for Infectious Disease Research Zambia), and Annika (who currently works at CIDRZ and used to live with Petra). I’m coming to learn that the HIV community is quite small in Lusaka and everyone knows each other, but that may also be in part because all the expats find each other. It was about a six hour drive and half the time the roads were just dirt, smooth in some areas, a bit marshy in others. The closer we got to the camp, the bumpier it got. At some point after entering the park, hundreds of flies and butterflies started to hitch a ride on the car so we had to keep the windows up. We soon discovered that the flies were tsetse flies and we got bitten a few times once we got out. Tsetse bites are nasty and painful for the first minute or so, but then you hardly notice it. Don’t worry – these didn’t carry the trypanosome for human African sleeping sickness. These only affect cattle, which is why most of the land is uninhabited by humans. As soon as we arrived at the camp, we saw hippos in the river and elephants on the opposite bank. And if you like birds, this is the place to be! As some of you know, I have a slight bird phobia but I managed quite well. The birds in the wild don’t care for humans, so it was quite easy to avoid them (except for the one that Chris was trying to condition with bacon to come when he called). We saw so many animals in such a short amount of time (we arrived on Friday afternoon and left Monday afternoon). We saw puku, impala and oribi (all types of antelope), hippos, elephants, crocodiles, lots and lots of birds, leopards and lions!

By the second day, Sunday, we were a bit down that we hadn’t seen a lion yet, but then we had three sightings! The first one was after our morning walk and we heard there was a lioness on the bank, so we took the boat out to observe her. We had a pretty good view, but unfortunately, a family of warthogs did not and walked straight into her line of vision. Within seconds, she snatched up a baby warthog! The others squealed loudly and ran in various directions. Later that afternoon, Ranjit, Shilpa and I were sitting outside the main chalet and the lioness walked within 20 feet of us! Shilpa freaked out a little which made me freak out a little. Chris and Charlotte weren’t there and we had no way of defending ourselves if she decided to attack, but I think she was as wary of us as we were of her. Later that day, we saw her with her three cubs. They’re eight months old and almost her size, so they were big cubs, but we still couldn’t tell the sex. We thought they were going to attack some pukus, but they decided not to pursue after the puku ran away. That night, on our evening game drive, we also saw a beautiful civet cat. Our last morning at the camp, we woke to see the lion cubs resting at the bank of the river as the hippos waded in. The cubs were playful at times and we watched them for about an hour before heading out on the boat. From the boat we saw some leopards near an area that’s known as NHB (nasty hippo bend). We disembarked and followed as quietly as we could (we had 16 feet altogether, so not that quietly) as Charlotte and the guides tracked them. We didn’t have much luck, but as we headed back to the boat, they ran past very quickly (I heard them, but didn’t see them). Also, during that last night at the camp, I woke up around 11:30 at night to the sounds of heavy breathing, growling, and breaking branches. I was sure that whatever was outside would break down the little chalet! In the morning, we saw the damage that the elephant had caused during the night – some trees on end and lots of fallen branches. The growling turned out to have been its stomach! It’s a lot harder adjusting to the city after the bush than the other way around. On the way back, every sound I heard was an animal!

As you can see, my first two weeks were quite packed. Next week will also be busy as I go to Livingstone (home of Victoria Falls) to visit some of the Zamstar (a ZAMBART study) intervention sites. Please write and let me know how things are going on your end!