Kakamega Forest

I spent my last weekend in Kenya at Kakamega forest. Apparently, just 400 years ago the forest stretched all the way across Equatorial Africa. After years of heavy cultivation and deforestation, it is now 2400 square km, a tiny island to the west of the barren Rift Valley.

Kakamega is famous for its biological diversity, especially the bird population. Lucky for me, Lucy is an expert bird-watcher (although she downplays this, in her modest fashion). But even Lucy paled next to our guide Wilberfource, who knows the habitats, flight patterns, facial wattles, and calls of each of the 430 avian species in Kakamega. We saw 43 bird species, including the famous Great Blue Turaco, which looks like a prehistoric beast. Lucy’s favorite is the Black-and white-casqued Hornbill. The Hornbill makes a racket--the Helm Field Guide describes its call as a “spectacular and musical bugled waah or waaah, which develops into a cacophonous din.” We also saw 2-meter Forest Cobra, which crossed our path approximately 5 meters ahead. The pictures above show Lucy standing on a hill with the forest canopy in the distance, and Wilberfource resting on a bench, East African bird Field Guide in hand.

Kids At Work and Play

The kids in our neighborhood make their own toys out of recycled wire and other bits of garbage. These two boys in Busia made some cool cars-on-sticks. The other picture is of kids in Kakamega forest who are hauling out large bundles of firewood on their head.

Re-repatriation

I am leaving Busia in just one week to return to the USA via Barcelona. The work I was doing in November and December has been on hold since the election in December.

Prior to the election, I had been working on an Operational Research project in our clinic. The study is about resistance to antiretrovirals, a subject about which there is relatively little known in Africa. This is an interesting topic, and I was learning a lot about how to organize a clinical study. Unfortunately, the Barcelona MSF headquarters decided to put the project on hold until the post-election violence subsides. Perhaps I will come back to Kenya to work on the study if and when it starts up again. Or else I will come up with another life plan. Suggestions welcome.

Meanwhile, I will go back to New York and California to see friends and family and readapt to life in the big city.

After the sunset...

There have been demonstrations throughout Kenya for the last three days. The ODM political party (opposition party) organized them to protest the Kibaki administration. The demonstrations in Busia have been mostly peaceful, but apparently Nairobi and Kisumu have seen violence. I took these pics yesterday through the peephole in the gate of our house.

Sunset Over Busia

Lucy says the clouds in the upper right corner look like they are giving us a kiss...

Primary Care for Internally Displaced People

I did medical consultations in one of the nearby refugee camps today. The work was different than my usual daily activities as technical reference/supervisor for the HIV/AIDS clinic. The work today had more in common with my old job in NYC:

Most common chief complaint in Kenyan refugee camp: back pain.
Most common chief complaint in Upper Manhattan primary care practice: back pain.

Biggest challenge in Kenyan refugee camp: skin rash in the under-five crowd.
Biggest challenge in Upper Manhattan primary care practice: multiorgan failure in the over-80 crowd.

Medicine most commonly dispensed in Kenyan refugee camp: Acetaminophen.
Medicine most commonly dispensed in my upper Manhattan primary care practice: Acetaminophen.

Average documentation per consult in Kenyan refugee camp: one line (hand-written).
Average documentation per consult in Upper Manhattan primary care practice: two pages (typed, 10-point font).

Average number of medicines dispensed per patient in Kenyan refugee camp: one.
Average number of prescriptions per patient in Upper Manhattan primary care clinic: seven (likely a gross underestimate in my clinic, aka Polypharmacy Central).

Functional Genomic Screen of HIV

The New York Times Science Times reported on a new study of HIV proteins published in Science this week. I have not read the study, but it sounds interesting. [Science charges an arm and a leg for on-line access- this makes me so mad!]. The authors call this type of study a "functional genomic screen."

From what I can tell, the research team used bits of RNA that they call Short-Interfering RNAs (SiRNAs) to interrupt immune cell function. They added different SiRNAs to healthy immune cells, in thousands of small plastic laboratory wells. Next, they added HIV to the mixture. If the HIV could not replicate within the SiRNA-modified cells, they concluded that the SiRNA interrupted the function of a vital protein that HIV needs in order to function. They called these proteins HDFs, or "High Dependency Factors." The NYT cartoon helps explain the study.

Hopefully, further work will help determine how the HDFs help HIV live in human cells. Once they understand this better, pharmaceutical companies can develop better drugs. Luckily, I have a dad who knows proteins like I know Tusker beers. Dad will explain all of this in detail. More to follow after I hear from him

Tribalism In Kenya

The BBC website has an article today on ethnic divisions in Kenya. It is essential to understand the tribal divisions in order to understand politics. The sentence in the story that really says it all: "tribal differences in Kenya, normally accepted peacefully, are exploited by politicians hungry for power who can manipulate poverty-stricken population." The BBC map of ethnic group distribution in Kenya is copied above.

Cursed Looters

The BBC reports that people throughout Kenya are returning stolen goods to stores after hearing of a curse on looters. The story says that Kenyan looters have been struck by fecal and urinary retention. Apparently news of the curse has traveled quickly throughout the countryside; fecal and urinary retention are no fun.

Repatriation

We are back in Busia Kenya. It has been calm here for over a week. Apparently there is still violence in Nairobi and Kisumu, especially last night, when Kibaki announced his cabinet.

Busia seems to be almost entirely back to normal. We have not seen any of the food shortages that have been reported in other parts of the Western Province and Rift Valley. Fuel and mobile phone scratch cards ("airtime") are in short supply. I depend on the airtime for my external dial-up modem, so I have to strictly ration my internet connection time. Thanks again to Aoibheann and Inez for that short wave radio. Long live the BBC world service.

Our clinic is open. Apparently patients came everyday during the week were were closed--even while bullets were flying! Many of them walked or biked more than 20 km from their villages to the clinic and back so that they could get medication refills. We've scared them senseless with our lectures on antiretroviral adherence.

Election, Evacuation

The last two weeks have been tense in Kenya. Presidential elections were held on December 27th. Our wise MSF boss anticipated the peri-election violence. She arranged for us to cross over to Uganda on December 26th.

As votes were counted in Kenya on December 27th and December 28th, doubts were raised about the voting process and the validity of the results. All hell broke loose on December 29th. When the disputed election results were formally announced, shots were fired and houses were burned. At least seven people were killed in Busia town. For more background on the election, post-election violence, and the deterioration into chaos, see today's NYT story or the BBC coverage.

After the violence erupted on December 29th, our team set up a base in Busia Uganda. We are holed up in a hotel that is just about 4km from our home, just over the border. Of course we are happy to be safe, but I want to go back to Kenya soon. Groups of displaced Kikuyus are congregated in schools at police stations on both sides of the border. MSF can help set up clean water points and latrines. Malaria and diarrheal diseases will likely become a concern. I also want to reopen our clinic. Our patients need antiretrovirals and medical attention.