Day 3: Monday, July 23: Let’s Get to Work: A Case of the Mondays
Unlike our past 2 days in Nairobi, this morning welcomed us with sunshine. We enjoyed our usual breakfast (2 eggs, beef sausage, toast, mandazi and pineapple- which Zac is resisting as he is allergic but loves those sweet, yellow slices of heaven…mmm) on the YMCA outdoor patio, and for once, Fatima was not shivering in Nairobi’s biting breezeJ This hostel is convenient in its location and amenities (namely internet, printer and copy machine) but we all feel an urge to leave this environment and get a better feel for Nairobi outside of the ‘Y’.
The day was spent in meetings. Sam and Karl went to the Ministry of Health to seek formal approval for our research, while Fatima and Zac went to Kenyatta National Hospital (the country’s largest government run hospital) and the KEPI (Kenya’s Expanded Programme in Immunizations) office. Dr. Tatu Kamau, head of KEPI, was undoubtedly the highlight of the meetings as she made a formative impression and also helped set us up with a larger group body meeting to be held Wednesday afternoon. We feel deeply pleased by her guidance and support for our research project.
Meanwhile across town Tweedle Dee and Tweedle Dumber spent 45 minutes in the office of Dr. S.K. Sharif, the Director of the Department of Preventative and Promotive Health at the Ministry of Health, waiting for the Director’s return, doing cross word puzzles on a newspaper given to them by the receptionist and playing “Guess Who”- not knowing if Dr. Sharif was a male or female doctor. Upon His arrival he promptly walked right past them and barked orders at his secretary. As he began closing the door to his office, his perplexed look provided the inopportune moment for Karl and Sam to introduce themselves. He stopped Karl midsentence and proclaimed that their inquiry was better directed to Dr. Tatu Kamau at KEPI. However, recalling an email from WHO’s EPI Representative, Dr. Duale, stating that all official business would require approval from the Director, Karl decided to push his luck in the face of adversity. He humbly suggested setting up an appointment for a future meeting and attempted to explain the importance of an approval letter. As the door was closing on our heros, the Director sighed and hastily proclaimed, arms waving wilding, “I approve everything!” While Karl contends that he approved of them getting the hell out of his office, Sam is confident that he really just approved of Sam’s father’s corduroy blazer, complete with elbow pads. As they evacuated the office, proud of their accomplishments, they were kindly requested to return the newspaper containing their completed crossword puzzle. Karl still has second thoughts about “20 Down”.
Unlike our past 2 days in Nairobi, this morning welcomed us with sunshine. We enjoyed our usual breakfast (2 eggs, beef sausage, toast, mandazi and pineapple- which Zac is resisting as he is allergic but loves those sweet, yellow slices of heaven…mmm) on the YMCA outdoor patio, and for once, Fatima was not shivering in Nairobi’s biting breezeJ This hostel is convenient in its location and amenities (namely internet, printer and copy machine) but we all feel an urge to leave this environment and get a better feel for Nairobi outside of the ‘Y’.
The day was spent in meetings. Sam and Karl went to the Ministry of Health to seek formal approval for our research, while Fatima and Zac went to Kenyatta National Hospital (the country’s largest government run hospital) and the KEPI (Kenya’s Expanded Programme in Immunizations) office. Dr. Tatu Kamau, head of KEPI, was undoubtedly the highlight of the meetings as she made a formative impression and also helped set us up with a larger group body meeting to be held Wednesday afternoon. We feel deeply pleased by her guidance and support for our research project.
Meanwhile across town Tweedle Dee and Tweedle Dumber spent 45 minutes in the office of Dr. S.K. Sharif, the Director of the Department of Preventative and Promotive Health at the Ministry of Health, waiting for the Director’s return, doing cross word puzzles on a newspaper given to them by the receptionist and playing “Guess Who”- not knowing if Dr. Sharif was a male or female doctor. Upon His arrival he promptly walked right past them and barked orders at his secretary. As he began closing the door to his office, his perplexed look provided the inopportune moment for Karl and Sam to introduce themselves. He stopped Karl midsentence and proclaimed that their inquiry was better directed to Dr. Tatu Kamau at KEPI. However, recalling an email from WHO’s EPI Representative, Dr. Duale, stating that all official business would require approval from the Director, Karl decided to push his luck in the face of adversity. He humbly suggested setting up an appointment for a future meeting and attempted to explain the importance of an approval letter. As the door was closing on our heros, the Director sighed and hastily proclaimed, arms waving wilding, “I approve everything!” While Karl contends that he approved of them getting the hell out of his office, Sam is confident that he really just approved of Sam’s father’s corduroy blazer, complete with elbow pads. As they evacuated the office, proud of their accomplishments, they were kindly requested to return the newspaper containing their completed crossword puzzle. Karl still has second thoughts about “20 Down”.
The remaining few hours of daylight were spent perusing bits of Nairobi that we hadn’t seen before. Zac and Fatima took a Matatu (local bus) to town center and shopped for Kenyan crafts. Karl and Sam enjoyed balls of ice cream back at the Y and later met up with their teammates on the grounds at University of Nairobi.
When the sun lightens toward the end of the evening, the bustle at the University of Nairobi seems to migrate from the lecture halls to the sports grounds. Teams playing badminton, basketball, volleyball, and of course soccer, awe passersby (like us). An atmosphere of energy and youthfulness drew the four of us in. Fatima watched the men’s volleyball teams (think Val Kilmer, Tom Cruise and Anthony Edwards circa 1985 but taller and more African) in amazement and the guys went to play a little 3-on-3 (tatu-na-tatu) with their newfound Kenyan friends.
This city continues to charm us. We are so lucky to be here on this investigation, lucky that these people have received us warmly and lucky to be part of this novel collaboration.
–(Mon 7/23/07 9:22pm)
Day 4: Tuesday, July 24: Success at WHO
Weekdays are key. We had scheduled a few meetings before our arrival including a very important one today at 9am with the World Health Organization’s country representative Dr. David O’Kello. To ensure that we would be completely prepared for our pitch we spent Monday evening in Central Command (Fatima’s room-more floor space) preparing with key presentation bullet points and questions to ask. We read ourselves to sleep over WHO-UNICEF published material on Measles Vaccines and created a plan for the morning starting at 7am involving breakfast, showers, dressing sharply, quick internet references, photocopies of handouts and a discussion of our respective readings…
At 8:15am Zac, Karl and Sam awoke to thumping on their door. Apparently the light buzz of Zac’s alarm clock watch (and Zac’s declaration that he doesn’t sleep in) was not enough to keep the boys on schedule. Luckily Fatima was a little more prepared and got them moving and took off with the photocopy material. Within 7 minutes and 27 seconds the boys were dressed in blazers and slacks and had managed to take their malaria pills, eat a banana and a roll, and cover up any signs of major bed-head.
We took a 500 Shilling cab ride (remember matatu is 20 Shillings each) to the Garden House Building, through heavy street security as we were next door to the Israeli Embassy.
We even made it to the Lobby with 8 minutes to spare. Dr. O’Kello turned out to be unavailable but instead sent Dr. Mohamed Duale, WHO’s EPI team leader, to meet with us. Dr. Duale is probably 6’6” and comes from the Eastern Region in Kenya near the Somali border. We had actually been in contact by email and he was the one who suggested that we get approval from the Director at the Ministry. He welcomed us warmly and invited us into their conference room where we met with Dr. Joyce Osongo and another official who arrived late (and did not give his card). It turned out to be an amazingly productive meeting where we were able to describe the project and build up their interest in their roll as experts who could aid us in developing design requirements for a future device. They were quite intrigued with the engineering model microneedle samples that we brought and quickly began guiding us by helping us plan our visits next week to the Western Province and Nyanza Province near Lake Victoria and the Ugandan border. The Nyanza province they claim has the lowest rate of coverage for the vaccines that are administered for free by the government. It was so helpful to listen to them describe the process of vaccine administration for the entire country. They answered so many questions. We easily learned more about the roles and relationships of the government organizations as well as the NGOs and Faith Based Groups in 15 minutes with them, than we had so far in 9 months of reading about this stuff. Their enthusiasm for the project continued when we told them about our meeting with Dr. Kamau and her KEPI team scheduled for Wednesday afternoon. Dr. Duale said that he would like to join us and recommended that we request a tour of the vaccine storage facility on the KEPI campus that is used to store the annual supply of vaccines for the 1.3 million children born each year in Kenya. It was amazing to see how interconnected all of the contacts are that we have been pursuing over the past year. To top off our elation that we finally had a solid supporter and advocate in the government sector, we were also served hot tea during the meeting. Dr. Duale requested that we prepare a PowerPoint presentation for the Wednesday meeting to address all of the questions that he and the other doctors had brought up during our meeting. He also wanted a draft of our itinerary and planned visit locations over the next three weeks so that the KEPI team could start contacting the Provincial Medical Officers and request their support for our visit.
Wow. All we could do was shake hands and get moving back towards Cent-Com at the YMCA to start preparing for Wednesday with the KEPI crew, who seemed to be the key organization that oversees all vaccine administration in the country.
Our inflated sense of importance was quickly deflated when we left the building and Zac decided that it would be an interesting picture to take a snap shot of the security blockade outside the Israeli Embassy consisting of spiked road blocks and large cement road blocks that cars must weave in and out of, limiting their speed as the pass to about 2 miles an hour. Zac convinced Karl to take the picture and as he did, a Kenyan Security officer, machine gun in hand, immediately told him to stop. As he waved Karl over, and told the others to stay away and asked for a passport, Karl could only wonder if racial profiling had some merit in Kenya as well. Luckily he found the photocopy of his passport and managed to keep the situation to a simple warning. We’re just glad that we didn’t need to call our Uncle Vasanth to straighten things out for us again.
[picture of Road Blockade outside of the WHO would have gone here]
We feel it is important to address security as we’re sure it is always a major concern for our loved ones back home in the US. It is true that Nairobi is a dangerous place and suffers greatly from the ills of poverty and we are certain to watch out for ourselves, traveling by foot only during the day and staying in doors when the sun goes down. And while we have had a few strange incidents, including the bizarre mystery of the missing cameras and an uncomfortable encounter at the city market involving a locked gate and a group of over enthused jewelry vendors, we have more often found the city to be filled with truly warm and welcoming people rather than the stereotype of a lawless town filled with thieves. One individual who stands out to us is a young man by the name of Kenneth who works as a gardener on the grounds of the YMCA. Kenneth struck up a conversation with Zac near the garden one morning wanting to know where we were from and what business we had in Kenya. He immediately was interested in our knowledge of any programs that help young Africans like himself to pursue a college education. He said he was particularly interested in studying hotel management. What at first seemed like a request for a donation turned out to be an honest and hopeful inquiry into any possible means that he could get help attending a university. Kenneth is 23 and explained to us that he lives in the Kibera slum with two younger teenage siblings. They are orphans and he supports all three. Rent in Kibera is 2,000 Shillings/month ($30) which includes a small one room dwelling with running water. He earns 4,000 Shillings/month working 12 hours a day as a gardener and waiter at the YMCA and rides the Matatu to and from work. He didn’t finish high school when he was younger because he had to work, but has recently finished the equivalency tests, studying on his own outside of work. In his words, “For me, education is the power I need to do better. I am always looking for ways [including the internet] that I can find this.”
Does anybody know of any scholarship programs for Kenneth? He wants to give us his email address before we leave. We could only listen to him in awe.
So for us, the interaction with the people of Nairobi is becoming more and more of an educational exchange with the locals rather than the guarded encounter that we started with. There is so much to learn from these people about their lives and their culture, and much of it very inspiring.
So we want you all to know that while we are always careful to be aware of our surroundings in a potentially dangerous city, we are convinced as a team that the only accidents that we may actually come across in Nairobi are: Zac developing a worse runny nose than he already has, Sam breaking his arm trying to kill mosquitoes on the concrete walls, Fatima hopping on an unarmored convoy to Somalia cause “it seems so interesting”, or Karl getting hit by a car as he walks across the street looking left-right-left instead of right-left-right, or sticking his hand out to stop cars much like a traffic cop.
The afternoon was very productive at the YMCA. Lunch was delicious and about $3. With the resources available including two mobile phones, two laptops and an entire internet café, documents were produced, emails were sent, phone calls were made, a Power Point presentation was created and naps were well deserved. Here is a picture of Karl calculating the cost of another couple days at the YMCA before we leave for the Western Provinces. Notice the absence of Sam’s Calculator Watch.
We are excited for our interviews with the EPI health workers. There is a lot of work ahead of us but it will be very interesting and we seem to be having a lot of fun. What a crew…
–(Tues 7/24/07 11:46pm)
Day 5: Wednesday, July 25: Big Meeting with the KEPI team (hopefully the last day wearing a jacket and tie)
The day began as usual, with the crew getting up at 7:30. With a planned meeting for 11am at UNICEF and the big meeting in the afternoon with the Ministry of Health’s KEPI team, there were a variety of loose ends that needed tying up in the morning. While Zac and Fatima prepared for the meetings, Sam and Karl decided to pay the Nairobi Hospital another visit to drop off a letter detailing our purpose in Kenya, as well as the official IRB approval document (complete with UC letterhead). During the walk, Sam decided to play chicken with an approaching car by attempting to cross the street at an inopportune moment. Needless to say, playing chicken is a game best left for American soil, and only by the split second warning of his spider-sense did he avoid disaster. His hasty retreat back to the pavement (it isn’t actually pavement but rather a path of bumpy red dirt) was quite amusing to a pair of Kenyans standing nearby who couldn’t help but chuckle. Later on their journey, Karl and Sam (sometimes incorrectly referred to as Tweedle Dee and Tweedle Dummer) found a sports car complete with racing stickers on sale for 1.6 million Kenyan Shillings ($26,000 dollars according to Sam’s calculator watch). Sam is confident that it is within our budget, and may bid on the vehicle tomorrow. They finally made it to the Nairobi hospital, and dropped off the documents at the office of the hospital CEO. On the way back, they decided that they hadn’t had enough of the Israeli Embassy, and so chose to walk by it again. Of course, they were both promptly stopped and asked to show their passports. During the course of the interrogation, the officer was forced to listen, machine gun in hand, while Sam instructed him on Chinese American history. Although the officer was vigilant, he made an effort to be friendly, and even suggested that should we run into any trouble, he would be willing to come to our aid.
With 11am rapidly approaching, the group piled into a taxi headed for the UNICEF meeting. However, at that moment Sam’s contact at the Program for Appropriate Technology and Health (PATH) organization called and said that they could meet us right away. As a result, the group decided to split up with Karl and Zac heading to UNICEF, while Sam and Fatima went to the PATH meeting. Zac and Karl’s cab ride to UNICEF was extremely interesting. The young cab driver detailed the Kenyan Tribal system (consisting of no less than 42 different tribes) and spoke passionately about Kenyan history. His knowledge and enthusiasm for his country’s history not only provided Karl and Zac with a great deal of information, but also showed the pride that the Kenyan people have for their native land.
The UNICEF headquarters is located in Gigiri, a district in northwestern Nairobi. Incidentally, it is located directly across from the US Embassy, which was relocated from central Nairobi after the 1998 embassy bombing. The US Embassy is quite impressive, located in a massive compound with plenty of security. Because of the last minute change in schedule for the group, and because of traffic, Zac and Karl arrived 15 minutes late to the UNICEF headquarters. Entrance into the compound involved passing their bags through security, leaving a form of identification at the front office, and checking in their laptop at the security office. All this led to Zac and Karl being 30 minutes late to their meeting.
At the UNICEF meeting, Karl and Zac were introduced to Ms. Josephine Odongo, and Mrs. Marylin Mcdonaugh. Ms. Odongo was extremely stoic at first (possibly because we were 30 minutes late), but soon warmed up as the meeting went on, and we explained the details of our project. UNICEF is an important player in the immunization program within Kenya. Based on the decisions of the Ministry of Health within the Kenyan Government, UNICEF is responsible for actually procuring the vaccines and related supplies used for immunizations. During the meeting we also spoke with other administrators within the supplies division who listened to Zac ask basic questions about vaccine administration costs, with the hopes of obtaining cost information that is not readily accessible within the public domain. They bluntly responded that Zac should consult the UNICEF website for such information, not realizing that they had been lured into Zac’s crafty trap. He sprung into action, opening his binder to the documents printed from the UNICEF website, and asked if these were the documents they were speaking of. Karl heard Zac say “How do you like them apples” under his breath, but Zac can neither confirm nor deny that claim, and has chosen to plead the 5th even though it is not applicable within the Kenyan legal system. Realizing the folly of their suggestion, since the information on the website was quite outdated they began listing contacts at the UNICEF headquarters in Copenhagen, Denmark who would be able to provide us with cost information for current vaccine materials, storage, and administration. Ms. Dorcas Noertoft, a procurement officer, was extremely helpful, listing names and phone numbers from memory of people she had worked with in Copenhagen who we should contact to obtain this top secret data. Zac, always a master of cultural relations, joked that she must have a rolodex in her head, which made her chuckle (perhaps out of pity).
After the meeting, Karl and Zac managed to sneak a picture in front of the UNICEF sign, without running into any trouble. After leaving the compound, they decided to roll the dice again, and see if they could take a picture in front of the US Embassy. Remembering their incident from the previous day, they decided not to pull out the camera until they had asked the security guard if they could take a picture. Being proud flag waving Americans, they approached the guard, and stated that as American Citizens they hoped to take a picture in front of the Embassy. Apparently, there are no Amendments stating all Americans shall have the right to take a picture in front of Embassies. Needless to say they were denied.
[picture of US Embassy complex would have gone here]
As they walked away, Zac remarked that there were no signs posted prohibiting flash photography. Karl quickly reminded him that a solider carrying an assault rifle is the universal sign for no flash photography, which Zac reluctantly conceded. However, he was comforted by the fact that he had managed to come so close to his home soil.
Meanwhile Sam and Fatima had a very productive meeting at PATH, which included setting up a possible visit to Kibera. On the lighter side of things, back at the YMCA Sam also showed Fatima how to burp after drinking a bitter lemon soda. While Fatima let out a dainty nodule of puffed air, Sam produced the burp heard round the world. Some would say (mainly Sam himself) that it was perfect in sound, body movement, build up and delivery. While Fatima is thoroughly disgusted, Karl and Zac are still in awe of such a feat.
With the next and possibly most important meeting of the trip planned for the afternoon, the two pairs made their way to the office of Dr. Kamau, who had graciously setup a focus group meeting involving a variety of important members of the Kenyan immunization program. Karl and Zac took a Matatu back to the city center in order to save time and energy. The name “Matatu” arises from the Swahili word tatu which means 3, reflecting the cost of a ride in the early days. The system of Matatus can best be described as capitalism at its finest. Each Matatu consists of a pair working together to obtain as many riders as possible on their route (most matatus can easily handle up to 14 passengers at a time). While one person drives, the other hangs out the side of the vehicle calling out the destination in hopes of attracting others to hop on board. Meanwhile they must compete with and edge out other Matatus, in order to be successful. If your intention is to head in the direction of the city center from any location in Nairobi you should never need to wait for more than 30 seconds to hop on a ride for 20 shillings- $0.30. Zac is convinced that the Matatus should be introduced to the San Francisco Bay Area to replace the common 30 minute waits for Muni and AC transit lines.
After reaching the city center, Karl and Zac made their way to the KEPI office by foot. Karl would like to make it known that during this walk, Zac wanted to take a taxi or Matatu, while Karl was adamant about pressing on under the power of their own legs, regardless of their tardy trackrecord.
The focus group meeting at KEPI provided a forum for us to present the technology of the device, our project goals while in Kenya, and our plans for visiting various sites within the country. The people we met with provided a great deal of advice, and raised various issues such as social acceptance of a new device, whether feeling pain is actually good for vaccine delivery, and whether all childhood scheduled vaccines could be delivered at once using the microneedle. The forum allowed everyone to bounce ideas off of each other, and interact with our group in a critical but positive way. It was a thrill to have the undivided attention of the top 12 immunization officials in all of Kenya together in a room helping us move forward on our project. The meeting ended with hearty handshakes and tentative plans to meet again as a group at the end of our trip.
After the meeting, we returned to the YMCA- proud of the day’s accomplishments.
While Zac and Karl stayed at home to recover from a long day’s work, Sam and Fatima ventured out into the Nairobi night to meet Fatima’s friend’s friend’s friend living in the city. They were shown a great deal of hospitality and the highlight of the night was the tasting of the highly prized and surprisingly not disgusting avocado milkshake. Lastly, though it has been determined that Zac does not in fact have malaria, he is sick. Karl thinks we should try to deliver his antibiotics using a microneedle. In the meantime cough drops, rest, lots of tissue & TP, bottled water and Cipro tablets will have to do.
–(Wed 7/25/07 11:37pm)
