Mombasa

Greetings Friends and Family!

I’m home from Mombasa and enjoying our wet fall weather. I wanted to give an update on my trip since I had little time to write once I got there. The weather was beautiful, in the upper 80’s-mid 90’s with a few rain showers but never any thunder or lightning (which is one of my favorite things about Africa so I was disappointed we didn’t have any). I was conducting a training for the first 3 days for an ancillary study we are starting at 3 of my Uganda sites looking more closely at adherence to PrEP. The remaining 3 days we had our annual PrEP workshop with our site staff. Every year we have this workshop and each of our 9 clinical sites gets to invite 9 of their staff (usually the lead counselors, clinicians, pharmacist, data, recruitment, etc) to attend the workshop. This year we had almost 150 people in attendance. The days are packed with talks and mini workshops and fly by quickly. I usually leave my room at 7:15 in the morning and don’t return until 11:00 at night.

For a quick review of what I do- I am working with a group, called the International Clinical Research Center (ICRC) which is part of the Department of Global Health at UW. We conduct large scale clinical trials in East and South Africa on HIV Prevention. We are currently doing a study called PrEP which stands for Pre-exposure Prophylaxis. The idea is similar to taking birth control or malaria prophylaxis—taking a pill each day to prevent something from occurring or taking root in your body, in this case HIV infection. We work with couples, where one person is HIV positive and the other is HIV negative. The HIV negative person takes a pill a day in the hopes that they will stay negative, this of course is in the context of all the other best prevention practices such as condoms and counseling. We currently have over 2700 couples enrolled in Kenya and Uganda, that is over 5000 people! There are other groups conducting PrEP trials, but we are conducting the largest and the only group looking at heterosexual couples. If you are interested, you can check out www.prepwatch.org which is a website managed by AVAC which is an advocacy group for HIV prevention, or our website www.uwicrc.org. I am proud to say that our study has more HIV negative females enrolled than any other PrEP study. Why is this important you ask? Women will benefit the most if PrEP works. PrEP would allow them to protect themselves when their HIV infected husbands or partners refuse to use condoms (which is very often the case). The workshop was a great success and it was great to see the staff from my 5 sites in Uganda. For most of the staff coming from Uganda, this was their first trip on an airplane, their first time out of their country, their first time staying at a fancy resort and their first time seeing an ocean.

Some tidbits from the trip-

· I almost walked into a spider web in the dark that had a spider in it that was bigger than a baseball…that was exciting!

· After the site staff left, the Seattle based staff (the Coordinating Center) had a little team building time which included camel racing on the beach. Camels are very tall, I hadn’t really realized that until I was on top of one of them. My camel came in second place.

· Most people left on Saturday for the airport but those of us that were still around went into old town Mombasa for dinner. We ate at this great local Swahili place and had the best local food I’ve had on any of my Africa trips (this was trip #9). There were cockroaches running around that we flicked off of our table but the food was still superb. My medical director announced after the meal that he couldn’t guarantee that we wouldn’t all get really sick from this meal but luckily that didn’t happen. There’s nothing worse than being sick when you are sitting on an airplane for 25 hours.

· The Indian ocean was very warm (with pockets of hot water) and was a joy to wade in and swim.

· Beach boys are a pain- they are men that comb the beach trying to make money. They are trying to sell you’re their goods or services (yes, they make quite a living selling sexual favors to tourists). As soon as you step foot on the beach, you are approached by at least 5-10 of them.

· The nights are warm and very pleasant in Mombasa. There is a constant breeze from the ocean. Many nights after the sessions and dinner was done a few of us would head to a spot near the orange cat (see the pictures) and listen to the waves and watch the beach boys and ladies of the night walk back and forth down the beach. The stars were amazing and the sand crabs would having boxing matches over sea weed.

· I’ve posted pictures (follow the link below) of my trip.

Overall it was a good trip. My next trip will be in either December or January and I will be heading to Uganda.

Beautiful Mombasa

Jambo Friends and Family,

I arrived in Mombasa, Kenya late last night after traveling for about 25 hours or 35 if you count the time change. Mombasa is located on the coast of Kenya, on the Indian Ocean. It’s been in the news recently whenever the Somali pirates (Rrrrr!) are talked about since the pirates are intercepting goods that are traveling to Mombasa.

Last night I was only able to sleep for about 3 hours but persisted through my jetlag today and have fought the urge to nap! Today I went on a tour of Mombasa town, stopping at a craft shop where you get to watch all the craftsmen make their goods. Their carvings are then sold on a consignment basis and were very high quality. I really wanted this carved giraffe that was about 6.5 feet tall but feared Northwest could not let me carry it on. We also went to Fort Jesus. Fort Jesus was built in the 1500’s by the Portuguese (well, they made 4000 locals build it and they oversaw it). It’s a pretty amazing place because it was actually carved out of coral and then some layers of stuff went on top. The walls are about 3 feet thick and you can see the coral in the walls. It’s pretty crazy. It’s about 2.5 acres big and was built in just 3 years. We also toured Old Mombasa, which is like stepping back in time. Mombasa is mainly Muslim and old town has the most beautiful carved Arabic doors I have ever seen. These doors (some were also in Fort Jesus), date back to the 15 and 1600’s.

The weather here is fantastic, very hot (about 90 degrees with very high humidity) but there is a wonderful constant breeze that comes from the ocean so it feels very pleasant. I was able to lay by the pool today for a few hours, I think it is the only time this week I’ll be able to do that. Tomorrow our training starts. This is the training that I went to Uganda for last month but had to come home early because of the riots. Then on Wednesday our annual PrEP Workshop starts and we are hosting 140 of our local staff members for 3.5 days of conference style meetings and breakout sessions. I’ll be leading a few of those.

The food is great, the hotel serves a good selection of “coast food” which is mainly Swahili food. I had coconut beans for breakfast this morning. Coconut beans are black beans that are cooked in a coconut sauce and curry, they are super tasty! I also had fresh chipati with lunch. Chipati is like nan bread or a like tortilla. You use it to scoop up your food.

Information on the Riots

Hi everyone,

Below are some links to information on the riots-

http://www.newvision.co.ug/D/8/12/694334

Also includes a photo gallery

http://www.nytimes.com/2009/09/12/world/africa/12uganda.html?_r=1&hpw

http://www.nation.co.ke/News/-/1056/656720/-/item/0/-/rn8bu4/-/index.html

Love and hugs-

Meighan

Riots Schmiots

Hello friends and family-

I am currently in Amsterdam, having fled Uganda when the riots escalated and it became clear the situation was not going to resolve quickly. I will send more information about what is going on over there later, I arrive home at 12:00 on Saturday.

Thanks to everyone for their prayers, they were felt.

Back in Uganda

Greetings from Uganda!

I arrived late last night in Kampala to conduct a training for our new Adherence ancillary study. I’m the only one from Seattle at the training, the rest of the group are all from Harvard. The weather here is beautiful, warm with just enough gentle breeze to keep it from being too hot.

There is a riot currently happening in downtown Kampala, I’m not sure if it will make international news or not. At least one person is dead so far. The riot has to do with some guy who wants to be king of a sub district and those that are standing in his way. When word came in that the riot was happening, many of our site staff at the training had to leave to pick up their children as the schools closed because of the riot. Needless to say I won’t be venturing into downtown tonight.

I’m in Kampala until Sunday, then I fly to Kabwohe (our small site on the south-western border of Uganda) to train them as well. After that training I’m going to head to Queen Elizabeth National Park for two days to go on safari.

Constantly moving

Hello everyone!

Yesterday we traveled around Manila in our big bus looking for the

streets that everyone grew up on. There were big thrills and lots of

disappointments as so much has changed over the years and the city has

been rebuilt after the war. We found Penafracia which is the street

that Grandma grew up on but when she lived there it was a dead end

street filled with beautiful homes. Now it is a narrow one-way street

filled with shops and shacks. Grandma knew that her home was no

longer there, as it had been torched by the Japanese when they

realized they were losing the war and grandma got a pass after her

liberation to go and find her home and she saw her entire neighborhood

flattened.

Today we traveled 60 km to Los Banos, as we traveled out of the city

and the smog a beautiful landscape of lush green hills, banana trees

and rice fields opened up. Today is the 64th anniversary of the

rescue of Los Banos and we arrived to the University campus (the camp

was situated at the agricultural college) to find a banner welcoming

those internees who were rescued so long ago. There were some

filipinos waiting for us when we arrived that had amazing stories to

tell of the war. After the camp was rescued, the Japanese returned a

few days later and in retaliation to the filipino guerillas who helped

organize the rescue, the Japanese murdered over 1500 people, most of

them women and children. One woman who was there today said that her

mother sent her into the field and told her to wait. When the

Japanese came they killed her entire family and eventually found her

in the field where they held her head under water 3 times trying to

get her to name all the guerillas. She didn't but they somehow

decided to let her go.

I sat in awe today of the human spirit and the power resilance as I

watched my grandma and the others who were rescued from the camp talk

about where the paratroopers had landed in the fields and what it was

like that day when angels fell from heaven to rescue them. I learned

that after the fighting had begun and bullets were whizzing through

the air, my great grandma Evalyn got up from the floor of their

barracks and used her pliers to cut a hole in the fence so more

paratroopers and guerillas could squeeze through to join the attack.

Tomorrow we leave Manila and head to Bagio for the next few days. I

hope to send another email there if I can. We return to Manila on

Friday and depart for home on Saturday.

I hope all is well at home.

Jail? That just doesn't work for me!

Hi everyone,

I have a crazy story for you about a situation that happened tonight. I had walked across the Nile river with 2 work colleagues and we had stopped on the bridge to take pictures of the river and to enjoy the view. We were stopped for about 2 minutes, if that. A soldier came up to me (with a rifle of course) and demanded my camera and said we had to follow him. He did not speak English very well. We ended up on the other side of the bridge down a trail. He brought us to a guy who spoke better English who said that we were not allowed to take pictures on the bridge or to stop on the bridge and we were being arrested and going to the barracks (jail) and then tomorrow we would have to meet with a judge to get out.

I told him that didn’t work for me. I had a training to do tomorrow and then I was leaving for the US tomorrow night. Jail was not in my plans. I could tell that both of these guys were serious and we were not going to get out of the situation without paying some money. There was no way I was going to jail. Luckily a high school student named Paul walked by and decided that he was going to help us. He spoke English very well and also Luganda (the local language). He explained to them that we were visitors and I pointed out that there are no signs on the bridge saying that you are not allowed to stop on the bridge or take pictures. After much discussion it was agreed that we would walk back to our hotel and get some money and then walk back across the bridge and pay the guy who would give me my camera back and let us go. He wanted our passports but I was not about to give that up. I paid him 20,000 shillings ($10) for our “get out of jail free card” and gave the student another 10,000 ($5) for helping us out.

We got out okay and laughed about it afterward, but there is always a crazy story or experience every time I come here.