Where has the time gone?

I really can’t believe almost 6 months have gone by since I arrived back in South Africa and first began working at m2m. It especially does not seem like the Holiday season here, as the incredibly warm weather and lack of Christmas commercialism (at least in comparison to the States) can make a person nearly forget what time of the year it is.

These past 2 weeks have been very busy in the office. Last week, Nzwaki was visiting from East London (she’s based at the Innovation Center in East London and we’ve spent quite a bit of time with working with each other over the past months) to work with Monica and me on wrapping up the Baby HIV Test Study. To remind you, the Baby Study is the first study to take place at the Innovation Center, which is a group of 10 sites where m2m can pilot and evaluate new initiatives before rolling out new protocols to all 600 sites. This particular study aims to see whether Active Client Follow Up activities (phone calls and home visits) help increase testing for babies (a major drop-off point in the PMTCT care continuum). The study is also trying to elucidate what the major barriers to testing are, and to evaluate the cost of ACFU activities in relation to beneficial outcomes. I’m really happy I’ve been able to become more involved in the study and am glad I’m getting the opportunity to learn about different kinds of research other than just what goes on in the lab. I’ve been sifting through our final database and working on all the analyses (and learning a ton about Excel in the process, haha!), and when we come back in January I’ll get to jump into the writing stage of things. It’s been really fun to work with Nzwaki and Monica on this project and I’m excited to see how it turns out. And it was really nice to have Nzwaki in the office last week – too bad she’s based in East London!

Last Friday everyone in the office had the afternoon off for the annual office Holiday party. This year it was hosted at the castle across the street from the office. (Yes, there is a castle in Cape Town. For your history lesson, it was built from 1666-1679 by the Dutch East India Company and is the oldest surviving building in South Africa.). After an inspirational office-wide meeting where Gene presented all of the year’s progress (expansions, number of women reached, famous people who visited, etc.), we all walked over to the castle and enjoyed a lovely sit-down lunch together. It always takes a while to adjust to a new environment and workplace, so it’s nice to realize that I finally feel like I really fit in the m2m community. I’m just glad my upcoming trip home isn’t the end of things and that I get to come back after Christmas – the longer stay, the more excited I get about our projects and the more I value my time here, so I feel very fortunate in that respect.

Yes, it’s that time of year when it’s impossible not to sit back and reflect on how fortunate I am to have access to the opportunities I’ve had. Living here, where millions of people are faced with a very different reality, really puts things even more in perspective. And here’s a shameless plug – if you want to make a holiday donation this year, consider donating to m2m! :)

Anyway, I’m really looking forward to seeing everyone at home in just a few short days! More to come in January once I return…

View of the castle courtyard where we had our holiday lunch


A good crowd!


Nzwaki and me

Concerts galore and related epic disasters

This last weekend was actually rather tiring, seeing 3 concerts in 3 days (though obviously not something I can complain about, haha). After Friday’s World Cup Draw party, on Saturday, Julia, Wenli, and I spent the entire afternoon sitting outside listening to various bands play at an outdoor restaurant in Hout Bay. Even though we had seen Freshly Ground the night before, it’s always a pleasure to see them and this time there were just a handful of people between us and the band, as opposed to thousands, haha. (For anyone who doesn’t know Freshly Ground, you should check them out – they’re great fun!) It was a perfect way to spend a sunny summer afternoon – outside, on the beach, listening to music. Despite applying layers and layers of high SPF sunscreen, I still got a little burned, but that’s ok – maybe this means I won’t be the pastiest person in the room come Christmas time, for once :)

Hout Bay, where Saturday's festivities took place


Just before Freshly Ground went on, there were some really great dancers imitating the MTN robot

And finally, Freshly Ground!



To round out the weekend, on Sunday, Byron, Julia, Wenli, and I went to see The Killers play at a vineyard in Paarl (a wineland area about an hour outside of Cape Town). Huge international bands don’t come to Africa that often, as you can imagine, so everyone around here was rather excited. The show itself was pretty fun, and of course it was quite unique to see them play at a vineyard, as opposed to a concert hall or regular indoor venue…but I don’t think I would ever, ever do something like that again. Confused? Well, let me take a minute to explain...

Julia picked Byron, Wenli, and I up at 3pm and we jovially embarked on what we thought would be approximately an hour-long drive to Paarl. We anticipated some parking issues, so we figured if we arrived at 4pm we were allowing ourselves plenty of time to deal with crowd issues before the 6pm start time. If only we had foreseen what was coming.

Shortly after 3:30, traffic came to a grinding halt on the freeway, and we inched (quite literally) along for, oh, a mere 3.5 hours or so. Being stuck inside a hot car and really having to pee isn’t the most fun thing in the world, as I’m sure you all can imagine. However, once we exited the freeway and reached the road the vineyard was on, our good spirits returned with the excitement and anticipation of the concert inspiring us. Noticing tons of cars were just parking along the side of the road at this point, and having read online at the vineyard website that the venue was 3km from the freeway exit, we opted to park as well, looking forward to stretching our legs a bit, still seeing nothing but a slow-moving, endless line of cars ahead of us, and assuming we would then be able to beat the traffic on the way back if our car wasn’t jammed up in a vineyard parking lot.

Thus, at 7pm we abandoned the car and joined forces with the hundreds of other concert-goers walking to the concert. Hearing music far off in the distance, we were sure we were missing the concert and walked as fast as we possibly could to make it to the venue. We walked along the main road for quite sometime and finally saw a sign for the vineyard up ahead, turning onto a smaller paved road. Then we once again walked for quite sometime before seeing another sign for the vineyard, this time turning onto a small dirt road. Do you see a theme here? Once again, we walked for quite sometime before we finally saw signs of concert life. Oh, did I mention that Byron and I have lately been having knee problems? Yeah, Byron tore his meniscus about 2 weeks ago and I’ve encountered some knee pain that has forced me to stop running for the time-being. Yes, considering that half the people in the car were icing their knees during the drive to the show, it wasn’t exactly an ideal situation to be walking for hours on end. (Thankfully, my knee caused me no problems whatsoever yesterday and is doing fine today, but I have to say, I don’t know how Byron made it, limping along and visibly in pain for the whole time. You amaze me, Byron!) Suffice it to say the vineyard was most definitely NOT less than 3km from the car.

So, let’s see…at this point it was about 8:30pm, we were hot, sweaty, hungry, and tired, etc. and there was no band onstage. Though we missed the opening act, luckily The Killers had not yet come on and by the time we arrived, we only had to wait about 15 minutes for them to start playing. It was a huge venue, and I think I would have actually appreciated the surroundings had I not just spent over 5 hours trying to get there. Yeah, that kind of put a damper on things. In the end, I did enjoy the show, but I think that’s beside the point as far as this nightmare is concerned.

At 10pm when the band finished, dreading the walk ahead of us, we somehow managed to find the energy to trek for however-many odd kms back to the car, in the dark. It only took us 2 hours though! (That was sarcasm, in case you didn’t catch the tone.) Haha, it sort of felt like we were participating in some sort of “Night of the Living Dead” ordeal, walking in pitch black darkness across fields and along roads in the middle of nowhere surrounded by hundreds of half-dead (from exhaustion) concert-goers. Well, by the time we reached the car, most of the traffic had cleared and it only took us 45 minutes to get back to Cape Town. I guess that’s one thing to be appreciative of? (We talked to a woman from work this morning who said she was stuck in her car for 3 hours trying to exit the venue.)

So, to sum up, 4 hours waiting in traffic to get there (or sort of near there) + 3.25 hours walking back and forth + 0.75 hours driving home = 2 hours watching the band? Unfortunately, I think it’s quite obvious that one side of that equation far outweighs the other, especially when you consider that I actually forked over $50 to participate in the madness…

Can I just say, if you have a vineyard, perhaps the kind that only has one entrance, and if that entrance consists of a one-lane dirt road, it might not be the best place to hold a concert with thousands of people attending? Yeah, it definitely does not take much thought to see that one coming. I had gotten my hopes up with the relatively smooth operation of the World Cup Draw, but this is case in point why I’m a bit concerned about how South Africa is going to handle hosting a World Cup. I hate to be this scathingly critical of event planning in a developing country, but the thing is, this situation would not have been that hard to avoid if someone had just sat down and thought about it for approximately 2 seconds. Anyway, I sincerely hope the “park and ride” trend catches on in Africa before June.

Well, I think about the only thing we have to be thankful for was the band coming on hours late – given the trials and tribulations we went through to get there and back, I hate to think how we would have dealt with things had we missed the show. Haha, at one point the band even apologized for being late, explaining it was due to the fact that “yeah, we were on the same one-lane road you were.” In conclusion, as refreshing as the open air was, having now experienced what a never-ending walking tour of Paarl is like, I think we’re all in agreement that next time we’ll be doing all vineyard sight-seeing by car.

Ok, even though it was a hike to get to the vineyard, I admit the view was quite nice

It's hard to get good pictures in the dark, but it was fun to see the band. I guess.


And now for this upcoming week, I’m looking forward to resting (at least socially speaking)! Should be a very busy week at work, as Nzwaki is visiting Cape Town to work with Monica and me on writing up the report for the big study that recently wrapped up at the Innovation Center in East London. More to report on that later!

World Cup Draw

As an avid soccer/football fan, needless to say, I’m quite excited that my time in South Africa coincides with this country’s hosting of the 2010 FIFA World Cup. Yesterday the World Cup Draw was held in Cape Town, as I’m sure many of you know. Feeling as though this was a once in a lifetime opportunity that simply I could not miss, I donned my South Africa jersey and decided to brave the crowds and chaos and head out to Long Street to take part in the festivities (and thanks to Wenli and Julia for sticking it out with me!), despite not having the greatest confidence in the South African police force and its ability to manage crowds.

So, anyway, after work we headed directly out to Long Street…along with about 30,000 of our best friends. Though a bit crazy at times, it was really fun to get caught up in all of the excitement. To use South African slang, it was quite “vibey.” Long Street is known as the party street of Cape Town, lined with numerous bars, restaurants, and shops. Oh yeah, and it’s long. Though many of the bars have second story open decks, we had no chance of making it inside anywhere by the time we arrived on the scene, so instead we just kept fighting our way towards the top of the street where they had set up a big stage and huge TV screen. We actually managed to get relatively close, at least close enough to have a decent view and hear everything. Yes, despite the annoying Afrikaner woman wearing a giant orange pumpkin hat with a stem coming out the back that kept poking me in the face, it was a relatively pleasant experience considering the number of people present. Before the draw began, bands were playing and everyone was just dancing in the street. I was really happy to see K’naan (a Somali-born musician that I like), and it turns out one of his songs is the official song of WC 2010. Watching the draw was fun too, except for the fact that South Africa received such a disappointing outcome. The U.S. certainly did alright, but it was way more fun to spend the evening showing my support for South Africa than the U.S., as you can imagine! Following the draw, Freshly Ground (my favorite South African band) played as well. After 5 hours on our feet, we finally decided to call it a night. Everything went very smoothly, raising my faith in South African police security just a little bit and making me even more excited for next summer. All in all it was a fantastic evening and I’m so glad I had the opportunity to participate in the revelry! Ayoba!

Starting at the back end of Long Street, we have our work cut out for us to make it closer to the stage



Well, at least the pumpkin hat wasn't this big (yes, that's a hat)

Looking back at everyone behind us - finally, some progress!

Watching ourselves (well, the crowd) on screen

K'naan singing the official song of WC 2010, "Wavin' Flag" - hence all the waving flags

The crowd went absolutely wild when Madiba came on screen

Charlize Theron wasn't actually that exciting as an MC, but the I guess new ball looks cool

Julia and Wenli with Pearl, a coworker we ran into. Oddly enough, amidst that huge crowd, we still saw 4 separate people we knew. Once again, Cape Town can be a very small town.

Freshly Ground on stage

At one point some people on the street started singing the South African national anthem with a bunch of people on the decks above. This picture obviously doesn't convey much, but it was really fun to see everyone get so excited about the upcoming World Cup. Only 6 more months!

David Beckham visits m2m!

This was a particularly big week for m2m. On top of World AIDS Day publicity, UNICEF Goodwill Ambassador David Beckham went on a visit to Site B Clinic in Khayelitsha last week (see link). As my dad commented, those are some of the most intelligent quotes to ever come out of Beckham’s mouth, haha! But even if it’s just due to really good PR on the UNICEF side, it’s so nice to have his support, and it’s such an important message he’s sending. The only downside is I’m still dying of jealousy over the fact that only a few very senior m2m people got to accompany him on the visit. Sigh. But there are obviously tons more important things in life, as I am reminded every day I live here.

Apparently he was very humble and really great with the kids, so further kudos to him.

Here’s a link to more pictures, if you’re interested.

World AIDS Day

Tuesday, December 1st was World AIDS Day. If you had asked me a year ago when World AIDS Day was or what I did to commemorate that day, sadly, I really wouldn’t have been able to respond. This year was certainly different, and I don’t think I’ll ever forget.

I think it’s important for all of us, no matter where we live, to be reminded of the realities of HIV across the globe. 33 million people worldwide are infected with HIV, 2 million of which are children and 22 million of which live in Sub-Saharan Africa. 2 million people died last year, and 2.7 million more became infected. 1.4 million HIV+ women gave birth last year, and over 400,000 children were infected with HIV, primarily through vertical (mother to child) transmission. In South Africa alone, 5.7 million people are living with HIV – roughly 20% of the population. In some places in South Africa, 40% of pregnant women are HIV+.

Those numbers are just unreal. Sometimes the scale of the epidemic can make it hard to wrap your head around it, especially when living in a region like the U.S. where being faced with the effects of HIV is not a daily reality for most people. For me, living in South Africa and working for a public health NGO, these numbers are no longer abstract. Being here, working for and with HIV+ people, has really put a face to the name of the epidemic, to speak in cliché terms.

There are more people living with HIV in South Africa than in any other country. Mbeki (South Africa’s former president, for those of you who don’t know) has a lot to be ashamed of. Once an instrumental freedom fighter with the ANC who helped end the apartheid era, he sadly turned into a mad man, denouncing that AIDS is caused by a virus. As a result of his ignorance, the epidemic has had an even more damaging effect on this country, and there’s a lot of catching up to do in terms of removing the stigma, making sure people are tested and knowledgeable of transmission, and providing ARVs to those in need. Despite holding very worrisome stances on HIV in the past (he once admitted to knowingly havnig sex with an HIV+ woman but said it was ok because he took a shower afterwards), Zuma (the current president) unveiled a very broad-reaching and positive policy on HIV/AIDS this week. He pledged to provide ARVs to many more South Africans and is also launching a big campaign for everyone to get tested. Though there are a lot of logistics to be worked out with this policy shift and its effectiveness obviously remains to be seen, it was still very inspiring to hear Zuma. Just having leadership in this country that TALKS about the epidemic is an incredibly important first step.

At the m2m office, all staff convened to commemorate World AIDS Day together. A few people from senior management spoke, and a few HIV+ women shared stories. One woman broke down crying as she was reading us a poem about being strong, which was very painful to witness. Although I cannot understand first hand what it means to live with HIV, over the past few months, I have gained so much insight into this epidemic, and I will never forget who I’ve met, what I’ve seen and learned, and how I feel. Though our office commemoration was sad, the ultimate message was that of hope – of what good people and good organizations can do. (And on that note, an m2m promotional plug: Without any intervention, mother to child transmission is roughly 30%; with the proper antiretrovirals and knowledge about breastfeeding, MTCT can be reduced to under 2%. mothers2mothers, started at one site in Cape Town in 2001, now reaches 300,000 HIV+ women per year by employing over 1500 HIV+ women to act as mentors across nearly 600 sites operating in 7 countries in Sub-Saharan Africa.)

Of course it’s hard not to get emotional and dejected when you hear story after heartbreaking story about the effects of HIV/AIDS, but it really is so important not to assume a defeatist mindset. I will never forget the incredible women I’ve had a chance to meet and work with and I truly thank them for their inspiration. I hope the rest of the world doesn’t forget about them either.

Thanksgiving, Cape Town style

Happy belated Thanksgiving to you all! It just doesn’t feel like fall harvest season here, as Thanksgiving is a non-holiday and the weather keeps getting warmer and warmer. Byron, Julia, Wenli, and I decided that if we couldn’t stuff ourselves with turkey on Thanksgiving, we might as well stuff ourselves with African food. We headed out to a very touristy restaurant where they serve you 15+ African dishes for everyone to share, with a fixed price/menu and freedom to order seconds of any dish. Needless to say, we ate a LOT. Though a bit touristy, it seemed like an appropriate way to spend Thanksgiving in Africa.

On Saturday, an American friend from work cooked a real Thanksgiving meal to celebrate the fact that her family was visiting (yes, we ate special-order turkey and even had pumpkin pie, thanks to the fact that her sisters smuggled some canned pumpkin in their suitcases). Cynthia and her family had rented a GORGEOUS house in Camp’s Bay (the most beautiful, exclusive neighborhood of Cape Town), and it was a perfect afternoon spent staring at the mountains and ocean and hanging out on the sunny deck. Of course it doesn’t feel like November when you have to wear sunscreen, but I think I could get used to that idea :)

Here's Camp's Bay, as seen from Lion's Head. Not bad, eh?

Here's the house...

...which had great views of the ocean...


...not to mention great views of the mountains!

And if the view from the ocean side isn't quite right, the pool in the back isn't so bad either

If only a Princeton in Africa stipend could pay for accommodations like these!!

Very random notes

Ok, after trying to prove to you that my year in Cape Town is not just about Namibian safaris, I really have to laugh at the fact that Wenli recently found this photo of Byron and I on the Stellenbosch wine route webpage (towards the bottom of the page, in the "Social" section). Nothing like trying to hide the fun and games when there is clear evidence to the contrary available for the world to see ...though in our defense this was taken a very long time ago! :)

Some other fun facts: Mitch (the m2m founder) is bringing Annie Lennox as his date to an upcoming m2m fundraiser in London! She is a huge supporter of m2m and visited us in Cape Town a few months ago. Apparently on her site visit she surprised everyone by initiating a group song in Xhosa, which no one expected her to know at all (you can see video here). So yeah, Annie Lennox is pretty cool...and thus for those 80s fans out there this means you can rock out to “Sweet Dreams” guilt free, haha. Elton John is also pretty cool by the way; he just gave our M&E department about $1.2 million dollars to improve our M&E work (considering there are only 4 of in the M&E department right now, that’s not bad!). Oh, and I met the Prince of Liechtenstein the other day! I followed some very tall men wearing suits into the office and was wondering who they were when Heather pulled me aside and said “you just followed the Prince of Liechtenstein into the office!” I was able to meet him briefly when he came by to talk to Monica, and he was very casual and just held out his hand and said “hi, I’m Max.” Ilan didn’t even bother getting up from his desk to say hello, but was later a bit embarrassed when he realized who it was…luckily I had the head’s up from Heather!

It’s also been fun getting to know people from work a little better these days. The other weekend we went over to Monica’s new house (which is GORGEOUS) for a braai and had a great time enjoying the outdoors and the good company. Their house is perfect for braais – tons of outdoor deck and patio space, a pool, a large braai, all on a lakefront with a dock and boats for the adventurous to go exploring. Byron, Wenli, and I happened to be the first to arrive, so Monica sent us out in the row boat to try and catch some fish. About a minute after we left the dock, we realized this was going to be a failed expedition. Byron was in control of the rowing, but we soon found out the oarlocks were not actually attached to the boat, and the oars barely fit in the oarlocks, so whenever you tried to row, the oarlocks came out and you had no traction to gain momentum. Wenli and I were also really struggling keeping our fishing rods from getting tangled in the swampy water. Before we knew it, we had been blown across the lake and were stuck on the far edge, with my rod completely caught in the swamp grass and what seemed like no hope of us ever getting back to the other side. After finally disentangling our rods and reeling them in, giving up on the fishing part of things in hopes of making better progress on the rowing, I grabbed an oar and Byron and I worked our hearts out to get us back to Monica’s dock. Of course by that time a lot more people had arrived and were able to have a good laugh watching us struggle to get back. (The next day at work Monica told us she had tried to go out in the boat but had quickly given up after realizing they needed to fix the oarlocks before it would be useable…at least it’s comforting to know it wasn’t our incompetency that got us stuck, though we might have been wise to turn around before being blown to the other side.) Aside from that, the braai was great and it was fun to hang out with a really diverse group of people (from the U.S., U.K., Cote d’Ivoire, Australia, Italy, Angola...) so at any given moment there was English, French, and Portuguese flying around the table. Hopefully there will be more braais to come, though unfortunately the weather hasn't been that great until just recently.

To celebrate the first rain-free Saturday in a while, we took a walk on Devil's Peak behind Julia's new apartment (see pictures below). I really appreciate living somewhere you can enjoy both the outdoors and city life.


View of Table Mountain

And that's Lion's Head

And finally Devil's Peak



The new Green Point Stadium is off in the distance (as is Robben Island)


I think the burnt proteas (yes, Cape Town has forest fires too) actually look really cool

Another trip to East London and other m2m news

You might be thinking all I do is experience the beautiful scenery that Southern Africa has to offer, but that’s not entirely true, I promise! Work has actually been quite time consuming of late – but it’s rewarding and exciting to feel like I’m finally making a meaningful contribution to the M&E department, as opposed to just being the new fellow.

One overarching theme we are focusing on is developing new ways to routinely collect outcome data from sites in an attempt to have a better understanding of the impact our efforts have, and also to monitor data quality at the site level. (FYI, outcome data is different from the routine output data we collect on a monthly basis, and it’s much harder to produce. Outputs are essentially just numbers produced (e.g. number of new clients, number of m2m one-on-one interactions, number of support groups, etc.) whereas outcomes show our achievements and the effect our program has on people (e.g. % of clients on ARVs, % of clients who have disclosed, etc.) With better data collection, we hope to provide feedback not only to site staff about their services and impact, but also to provide programmatic feedback to m2m senior management staff so we can address problem areas and improve upon m2m practices. Basically, we’re trying to do what would sound quite logical and obvious – USE DATA to inform decision making, prove to outsiders we do good work, and motivate staff – but in practice it’s a bit more difficult than that. We already have a ton of data out there in the logbooks kept at each site, but accessing it is a whole other story when dealing with limited resources, the absence of electronic databases, and often less-than-ideal English literacy and numeracy rates at the site level.

Related to accessing logbook data, I’ve been helping develop and pilot a new tool (FYI in m2m lingo “tool” = Excel spreadsheet) aiming to track program quality at the site level. The basic idea is someone could go to a site with their laptop, spend a few hours getting some data out of the logbook, and then use spreadsheet calculations to project site statistics on outcome data. The logbook abstraction process I was previously involved in for the J&J report involved collecting data on individuals and then analyzing trends; this program quality assessment tool is meant to be a much faster way of collecting population level data (as opposed to individual client data). This tool has also been developed such that we can get a feel not only for program quality and impact, but also for level of potential client follow up needs at each site. Active Client Follow Up (ACFU) is a big term on the m2m radar right now, as we explore ways to contact clients beyond when they come to see us at clinics, in order to improve service delivery and increase the % of women who take up a certain behaviour (e.g. take ARVs starting at 28 weeks, have their baby tested at 6 weeks post birth, etc.). Ok, sorry for all the explanations, it just seemed like some context was necessary...

The other week I spent the whole afternoon by myself at a site in Cape Town piloting this Program Quality tool, trying to work out the kinks and see how long it took, how difficult it was, etc. I really must say, I LOVE working at the site level, and once again, I am so grateful my M&E position allows me to do so relatively frequently. It is always so refreshing to hang out with the Mentor Mothers and Site Coordinator and be reminded of how your efforts contribute to something so meaningful in the end. I really can’t say it enough – I am so happy to be taking part in the work that m2m does!

Part of my site visit work involved asking the site staff about whether they would be interested in doing ACFU work, and whether there would even be a need or interest in their opinion. (ACFU work is not entirely simple when dealing with an HIV+ population – you can’t just assume that everyone will want to receive phone calls or home visits, since they may not have disclosed and don’t want to be associated with m2m outside the privacy of the clinic.) It’s always so interesting to get to talk to these women. They were very enthusiastic about sharing their experiences with me and kept saying how nice it was for me to be there using their data, because it made them feel like it was actually important. This is yet more evidence that better data use is a must for m2m, in terms of motivating staff and giving them a better understanding of the number of people they help and the impact they have. There’s a big disconnect between telling someone to record the numbers and getting them interested in WHY they’re recording the numbers, and closing that gap will obviously help improve upon data quality too. When I asked the site staff about whether they would be interested in ACFU (such as being given airtime to call their clients and remind them to come in and have their babies tested), much to my surprise they told me they already keep in touch with their clients on their own. As they described going well beyond the work that they were hired to do, giving their numbers out and making themselves available to their clients 24hrs/day and calling clients on their own, they expressed how much they really cared about their jobs. Very inspiring!

A few days later, the DSITS M&E team (consisting of Monica, Alisha, Ilan (a Pfizer Fellow here until March) and me) hopped on a plane to East London. Monica also brought Angela, her 5 month old baby, who served as an entertaining team mascot. She was very cute and an incredibly well-behaved baby, I must say! We had 3 days blocked out to meet with Nzawki (the woman I did all the J&J data abstraction with), get updated on the Early Infant Diagnosis study that is wrapping up at the East London Innovation Center, talk through the study and decide how we want to analyze and present the data, pilot the Program Quality Assessment Tool, pilot more Data Quality Assessment Tools, go through all the results from the Johnson&Johnson report and share the results with the East London Provincial Managers (PMs are local program managers in charge of about 10 sites each, making sure the site staff have adequate support, maintain good records, don’t run into problems with facility staff, etc.) and get their opinions on the results, discuss how to use the lessons learned from the J&J data abstraction process to integrate data use into m2m programs, and finally to meet with an IT specialist about helping to revamp our routine monitoring database (the one that collects the monthly output data from each site and compiles it into monthly country level reports)…needless to say, 3 days was not nearly enough time to accomplish all of this, despite the fact that we worked nearly every waking hour of the trip!

Of course it was great to see Nzwaki again, and I’m really excited about the fact that we’ll be working together more, as Monica, Nzwaki, and I are going to be the 3 primary people wrapping up the Early Infant Diagnosis Study. I’ve written about this before, but just a quick reminder: the Innovation Center is a new concept that consists of 10 sites in East London where we can pilot new program tactics and evaluate their impact before doing a large-scale roll-out at all 579 m2m sites; the EID study is the first IC study, involving ACFU work. A lot of women drop out of the PMTCT continuum after they give birth, but it’s incredibly important for them to follow-up and get their babies tested because if the baby is HIV+ then early ARV treatment makes a huge difference in the baby’s outcome. Also, all babies should be initiated on cotrimoxizole prophylaxis at 6wks of age while breast feeding. (CTX is an important antibiotic because it’s effective in preventing a certain type of opportunistic pneumonia infection that is the leading cause of death in babies that contract HIV; WHO guidelines say all HIV-exposed babies should be on cotrimoxazole until HIV transmission has been ruled out and the baby is no longer breastfeeding.) The EID study was designed to determine whether improves testing uptake. This involved providing mothers with an actual test date (babies should be tested for HIV at age 6wks; the date given to mothers was predicted based on their expected delivery data; it was reasoned that providing mothers with an actual date might help them better remember/focus on testing), and having mentor mothers make calls and in some cases home visits to follow-up with clients and remind them about testing. We also want to analyze whether such services are sustainable for m2m (a lot of extra cost and manpower are required to organize airtime distribution and client tracking, etc.).

The trip was incredibly interesting. One morning I went out to another site by myself with a PM to again pilot the Program Quality Assessment Tool after I had made some revisions to it based on my experience the week before. Once again, it was so great to get to chat with the site staff, and so inspiring to really hear first hand how much they care about their work. I had actually been to that particular site before with Nzwaki when we were doing the data collection for the J&J report in August, so I shared with the site staff how successful the report had been. (J&J was very impressed with m2m’s work and signed on to not only continue funding 15 sites across the Eastern and Western Cape but also to fund new sites in South Africa, Swaziland, and beyond.) When I thanked them for working hard to keep good records, since it really does make a difference allowing us to prove our impact to donors and subsequently sustain funding to help even more people have the opportunity to access m2m services, they were truly so thrilled, cheering enthusiastically.

We sometimes walk a delicate line when we visit sites to do M&E work, because site staff often get nervous and feel like they’re being critiqued, when really we often just want to learn from them what they find difficult about the record-keeping tools, etc. so we can improve our services. It’s hard not to feel a little out of place as a young, white, American in an African clinic, and I’m sure my appearance and accent do not make it any easier for site staff to feel at ease, but I’m try to just be comfortable and friendly, and at the end of each visit I always feel so grateful for how kind all the women are. It sounds so cliché, and I know I’ve already said a million times, but every time I go to a site I am reminded of what amazing work m2m really does. Once again, the women at this site I visited in East London told me they already follow up with clients on their own. They actually seemed surprised at the fact that I was surprised they already did this (if that makes any sense), as they kept stressing “but it’s so important, and we want to help people, we have to!” When I asked if they minded using their own airtime out of pocket to do this, they said of course they didn’t mind because it was their duty to help other women. Being around these type of women, I feel nothing but admiration. That’s par t of what I love about m2m – it’s not solely about PMTCT; it’s also about women’s empowerment – taking young women who, generally speaking, do not have significant skills and are not good candidates for employment, and making them feel valued and providing them with the chance to do meaningful work in the community.

I learned so much from Monica as we went over the nuances of the Baby Study to date, and I am grateful for the opportunity to participate in this kind of research. It’s so different from lab work, but I think it’s incredibly valuable for me to have an appreciation for these types of studies and to realize the logistical challenges behind making them happen. I’m really looking forward to working with Monica on this further. As an M.D. herself with years of experience practicing in war zones and doing epidemiology work accross Africa, she’s a particularly fitting mentor for me to have. Anyway, I won’t get into to all of the roadblocks we’re encountering with the seemingly simple Baby Study, as I’m sure I’ll more to say about that later as we really delve into the analysis and reporting later this month, but suffice it to say it’s not as easy as it sounds to conduct a meaningful study with this population in this setting.

Ok, enough rambling about m2m stuff for now. All in all it was a great trip to East London! I've really enjoyed work these past few weeks and am looking forward to more to come...

Constantia half marathon

Things have actually stayed been quite busy since Mikael left, making it increasingly difficult to find time to blog. I’ll do my best to keep you updated though!

Katherine, a former clinical midwife specializing in women with HIV and current volunteer consultant at m2m, convinced me to participate in her running club’s half-marathon race a few weeks ago. I was a little afraid what running 13 miles was going to be like after not having done much exercising in Namibia, Stellenbosch, etc. (as you can imagine), but luckily it worked out ok in the end.

The race was held in Constantia, the wineland suburb of Cape Town. That’s right – drive a mere 15 minutes beyond our apartment and you become surrounded by beautiful rolling vineyards situated along the foothills of the mountains. Not bad! Runners were allowed special access to the vineyards (Groot Constantia, Klein Constantia, and Buitenverwagting) for the race, and it was honestly the most beautiful run I have ever been on. (Random fact: Groot Constantia is the oldest wine farm in South Africa, founded in 1685.) Of course the rolling vineyards and views of the valley come at a price – I have also never done so much uphill before, in a race nonetheless. The first 7k were pretty much straight uphill, in fact. Another complicating factor was that the race started at 6:30am, and Wenli and I arrived about an hour early to help out. In the end I couldn’t complain too much, however, as the morning light made the scenery all the more beautiful. Despite everything (the hills, the earliness, the lack of training) it went pretty well and I met my goal of not having to stop at all. I finished in just under 1:50 which I was pretty happy about because the course was so tough. Anyway, if I counted through the race results correctly, I came in #219 of 1500, or #31 of roughly 635 women. Never before have I felt so accomplished by 8:30am on a Sunday morning, haha!

After needing to wait a few days for feeling to return to my thigh muscles (seriously, they were so sore I thought they might have just disintegrated – perhaps an indication that hill training would a be useful addition to my workouts) and trying to deal with an annoying foot pain, I now have one new pair of running shoes to my name and am getting excited about the prospect of more races to come. Turns out Cape Town is full of runners and running clubs and there are races somewhere almost every weekend, so hopefully I can start doing more.

FYI, I stole these pictures from the race website (http://www.vob.co.za/_race_graperun.asp). It’s way too hard to think about taking photos/carrying a camera while running 21k but I wanted to give you an idea of how beautiful it was!

Mikael’s visit part II: Namibia

Hmm, this is a bit backwards in order, but oh well…Mikael and I left for Namibia very early on a Tuesday morning. We took a direct flight from Cape Town to Windhoek, which was only about 2 hours. The flight itself was really nice, as we flew over lots of interesting desert scenery. For those of you who don’t know, Namibia is extremely empty. I think I remember it being about twice the size of Germany, with only 2 million people. Despite knowing how empty it was, it was still a little weird to land at the Windhoek International Airport only to look around and see…nothing. In fact, Mikael and I were sort of left wondering where Windhoek was. Most places when you land you can see the city as you come in, but no such settlement was visible in any direction. We were picked up by a shuttle from our rental car company, and as we left the airport the road sign said “Windhoek 42 km.” I inquired as to why the airport was so far from the city, when there seemed to be plenty of empty land for them to build wherever they wanted to, at which point our driver said something like “well, typically you need flat space to land a plane.” Who knew. Haha, needless to say, I felt pretty dumb, but at least the mystery was solved, and 30 minutes later the emptiness turned into housing and we determined that Windhoek did, in fact, exist.

After sorting out our car rental (a 4x4 extended cab Nissan truck), we were off on our way up north to Etosha National Park. I’ve never driven a truck before, but it felt fitting to have one for a safari vacation. Plus, the 4 wheel drive is kind of a must in Namibia (more on that later). It only took us about 5 hours to reach Etosha, on paved roads. We were staying at a lodge about 10km outside of the park entrance, as the park camps were all filled when I was making the reservations. The lodge was really beautiful though – it had a big main lodge situated on top of a hill with great views of the surrounding bushland, with a bar and indoor and outoor dining areas, and then each guest had their own private chalet-type room. The lady who checked us in said it was a 20 minute walk from our room to the main lodge, so after getting situated, we drove up in order to make it in time to watch the sunset…only to discover we were epitomizing the image of lazy American (and lazy Swedish?) tourists, as it would have taken about 3.5 minutes for us to walk to the main lodge, haha. Anyway, we at least had time to enjoy our sundowners (=cocktail had while watching the sunset) before having dinner. It was incredibly warm and felt great to enjoy the dinner outside on the deck. I think we hit Namibia at a great time, as there were very few mosquitos to deal with. Yup, it was just us…and tons of German tourists. I knew that Namibia was a former German colony, but as they hadn’t been controlled by the Germans since after WWI ended, I thought there wouldn’t be that big of a German influence there. I thought wrong. Apparently when Germans go to Africa, they go to Namibia. Literally everyone besides us was German. It was nice to be in the minority for once, and I must admit I took comfort in realizing that Germans can be fat, ignorant, annoying tourists just as well as Americans can! :)

Wednesday morning we got up extremely early in order to catch breakfast at 6am and hop on a safari truck at 6:30 am. Though morning is not Mikael’s forte, I guess the realization that animal viewing is much better during the cooler hours of the day was enough motivation to get him going, haha. We were very fortunate in that, since we had signed up late for a lodge-led safari, they had to organize an extra vehicle for us. This time the early birds didn’t get the worms, since we had our own vehicle and guide for just the two of us, while everyone else was packed into buses or trucks carrying more like 10 people. The vehicles are made so the driver is in the truck cab, and then the passengers ride in open bench seating in the back, with a cover on top to provide shade. I’m so glad we signed up for a guide-led safari, as we would have had no idea where to go otherwise. Rodney (our guide) had a radio and was not only able to keep up to date on where the day’s best sightings were, but he of course knew where the large pride of lions slept, what time the elephants bathed in which water hole, etc.

I had such a great time in Etosha. It was so different from Kruger (South Africa’s large game park and the only other place I’ve ever been on a safari). While Kruger consists of mostly “bush,” and does possess large rivers (or at least the parts I saw) and other water sources, Etosha is quite desertous and has a lot of empty, flat land with little tree vegetation and no major water source (at least not this time of year, towards the end of the dry season). In fact, “Etosha” means “great white place,” referring to the extensive salt pan that covers much of the park. There are also some bush areas, but a lot of the land looks more like savannah, with only grass. The nice thing about the dryness is that it means the animals are forced to congregate at waterholes, providing for some nice all-in-one game viewing. Some people might find it boring, but I found the vast emptiness to be quite beautiful, and I thought it provided a great backdrop for viewing African wildlife.

So yeah, back to the wildlife. Rodney was able to show us quite a bit on Wednesday, as we stayed out with him for 12 hours straight. In the early morning we found a large pride of lions to watch, which was really great because I had never seen lions before. They were all lazing about, so we just sat and watched until they got hot and got up and left (at which point they are very inactive for the rest of the day and mostly just sleep). We saw 3 males and 3 females and 3 cubs, all quite cute. It was really amazing to watch them. One of them was sleeping on its back with its bloody paws in the air, just like Zoё (my dog at home, for those of you who don’t know), minus the bloody paw part. When the males woke up they would stretch, yawn, roar, etc. Seeing them in their natural habitat is so much better than zoos. They are quite beautiful, with those piercing light brown eyes and incredible muscles, and it’s interesting to watch them disappear into the savannah grassland – haha, makes me realize I would never want to go wandering aimlessly about lion country!

After the lion viewing, we saw tons of gemsbok, springbok, zebra, wildebeest, kudu, giraffe, ostrich, etc. at various water holes. Of course you’re not allowed out of your car except within the rest camps which are surrounded by electric fences, but one of the rest camps has stadium seating set up for viewing a waterhole right outside the camp edge, and I must say, it’s kind of a weird feeling to just be hanging out and eating lunch and watching all these animals like you’re at a sporting event. They really are quite entertaining, though. After lunch we headed to another waterhole where there was a large group of elephants hanging out and bathing. Some of the water holes are fed by water that runs off the salt pan (or something like that; I didn’t quite catch all the details), so the elephants who bathe in those waterholes turn white. I know that sounds strange, but I’m serious! It was the craziest thing. They looked totally unreal, like statues. It was really fun to watch them messing around in the water. With our afternoon drive, we also managed to find an endangered black rhino, which was nice to see. It was really, really hot in the afternoon (mid 90s) and the animals clearly all just wanted to hang out in the shade. It was quite common to see a group of 20 sprinbok all crowded under the shade of the one lone tree in the area. We saw a male ostrich with 7 little babies standing in his shadow, and it was really cute to watch them scurry to stay in his shade with every step he took. On the way out of the park, we noticed a jackal eating a springbok by the side of the road, surrounded by a pack of about 20 vultures who did not look happy about having to wait their turn. Rodney said it must have been a cheetah kill, since they are the only animals who don’t finish all their meal (lions mostly eat it all, leopards drag the rest into a tree, cheetah apparently only eat fresh meat and can only eat a relatively small portion and then have to leave the rest – or sometimes get chased off their own kill, which hardly seems fair, especially since we heard it often takes them 15-20 minutes simply to catch their breath after the kill before they can start eating). Too bad we missed the cheetah by about 15 minutes, according to Rodney. Oh well…next time! Rodney was a great guide and I’m very thankful we had him. According to him, Americans and Swedes make up approximately 0.2% of who he takes out on safaris (with over 99% being German), so hopefully we provided him some novel entertainment. He at least liked talking about the Swedish soccer team!

After a very full day of safari-ing, we once again indulged in sundowners and a nice outdoor dinner. Thursday morning we got up really early again, but this time we drove ourselves around the park, since we now had a much better idea of which water holes to visit. (Rodney said unfortunately a lot of tourists drive around all day without seeing anything, because if you just look at the water holes on the map, you don’t know which ones are seasonal, or long since dry, or simply never attract many animals.) Oddly enough (and this would probably only happen with my luck), in the middle of the dry season and amidst the Namibian desert, it was cloudy and even rained a bit on Thursday. I was initially disappointed, but in the end I think it made the game viewing better since the animals were more active without the strong sun out. We went back to the area where we had seen the lions and this time were able to view a male who decided to get up and cross the road right by all the cars. It was really amazing to see. Sadly, however, it was pretty hard to get pictures, as there was a mad rush of cars trying to turn this way and that on a narrow little road to get better views, but that’s ok. After the lion viewing, we headed towards another water hole and on the way Mikael spotted a hyena crossing the road. It was really cool to see the hyena up close, especially since they are usually harder to see and we were the first ones to see it. We then stumbled across a set of female lions crossing the road…though once again the car congestion made picture taking a bit hard. One last stop at the main camp water hole to see more elephants (this time they were the regular grey color, since this group didn’t bathe in the white-mud water), and we had to pry ourselves away from the park in order to get on the road and to our next destination.

Without even thinking about it, I apparently chose the perfect vacation destination for Mikael, the off-roading enthusiast. A few main highways in Namibia are paved, but most other roads are not. And you really have to plan where you’re going to get gas, since the country is so empty. After leaving Etosha, our drive towards the Skeleton Coast was mostly on gravel roads. You can drive for almost an hour without running into another car or seeing a town…though there are plenty of goats, baboons, termite mounds, and warthogs along the road to keep you occupied. I’ve said it before (based on a trip 3 years ago through southern Namibia) and I’ll say it again: Namibia makes eastern Montana look like a sprawling metropolis, haha. The endless stream of blown tires left on the roadside made me really glad our rental truck came equipped with two real spares, despite me initially questioning the necessity of the rental car guy taking 20 minutes to explain how to get to each tire and how to change them. For some weird reason, Namibians seem to like to make little shrines for their destroyed tires, perhaps to commemorate the noble life of a tire that was ever so brave as to give it a go on the desolate, rocky roads of Namibia. Yes, it was very strange, but nearly every dead tire we passed was not just abandoned on the side of the road, but propped up with little rock patterns surrounding it, sometimes with empty coke or beer bottles placed on top. The scenery was really beautiful as we drove through savannah and bush, then through a more mountainous region, and then met up with the Namib Desert as we eventually hit the coast. The Skeleton Coast is the very remote and desertous region that makes up Namibia’s northwestern Atlantic coastline. Its name comes from the fact that so many ships have wrecked along the coast over the past centuries. (I read that it’s a ship graveyard due to the combination of a rocky coastline, strong winds, and daily morning fog.) We stayed at a lodge called Cape Cross, which is about an hour north of the last town along the coast. The lodge is right on the beach and of course offered great sunset views, once again.

Friday we spent the day just exploring the Skeleton coast on our own. We set off driving North, towards the Skeleton Coast National Park entrance. Along the way we did some off roading in the sand along the beach in order to visit old remains of shipwrecks. Yeah, you’ll be driving along and then a road sign will pop up and say “Shipwreck” with an arrow pointing towards the ocean, at which point you veer off the main road and try to follow tracks in the sand until you get to the beach and can then search for the wreck. Needless to say, this type of tourism wouldn’t really fly in the U.S., but we had a good time. We were also extremely grateful for our 4 wheel drive. Eventually we reached the park entrance, where we had to fill out paperwork about exactly how far we were going and when we would be back before the guard opened the gates for us. Realizing they were that serious about making sure they could find you if you didn’t come back out, in combination with the gates having skulls and crossbones on them, it was a bit intimidating to enter the park. Seriously, NOTHING is out there. I loved it though. It felt like we had the whole park to ourselves (we didn’t see anyone else while we were there). We didn’t even drive that far into the park (our trip length was dictated by our gas tank) and were only there for a little over an hour, but the emptiness was mind blowing and quite beautiful. We stopped to view one shipwreck and noticed lots of dog-like tracks along the beach, which we later found out belonged to the brown hyena. Talk about being in a place where there would be no one to hear you scream, haha! (Don’t worry mom, we were quite close to the car, and believe me when I say we would have seen something coming from miles away; plus brown hyena are smaller, and hyenas mostly just eat things that are already dead). After leaving the park, we stopped to visit the seal colony at Cape Cross (very close to our lodge). There must be some incredible fishing out there because Cape Cross is host to a seal colony of ~250,000. And no, that’s not a typo. We didn’t catch the colony at the peak time of year though, so there were probably “only” like 70,000 seals. It was cute to see them, especially the babies, but I must admit they smelled really bad.

Another spectacular sunset later, and it was Saturday morning and time for us to drive back to Windhoek. Along the way we stopped in Swakopmund, a very touristy port town. It was weird to be back in the tourist world after getting to experience the other side of Namibia and it made me really glad we had spent our vacation doing more untraditional exploring. All in all it was a really great trip!

View of the bushland surrounding our lodge just outside of Etosha National Park

Sunset #1, at the lodge in Etosha

Such a rare experience for me to catch sunrise, haha!

Trees really stand out in certain areas of Etosha (the black is because some of the grasslands had recently burned)

Animals gather at a waterhole in the distance as the Etosha salt pan stretches on behind them

Lion wandering about (unfortunately he looks very small in this format!)

The empty savannah

The zebra don't have the best camouflage...but apparently their stripes are not to make them blend into their surroundings but instead to make them blend in with one another, thus confusing predators on the chase

Waterhole gathering (unfortunately it's hard to see, but there are gemsbok, springbok, zebra, and kudu all drinking and being merry together)

Ostrich father provides shade for his kids

Springbok have to get their shade elsewhere

The "white" elephants - don't they look fake?





Whoops I forget what those things behind the zebra are called - too many antelope-type-things to keep track of!

Gemsbok/oryx (also pretty tasty)

I love the kudu antlers...and incidentally kudu taste pretty good too :)

Black rhino

Springbok kill - it's hard to tell but there's a jackal in the center who apparently has authority over the vultures to eat first

Sunset Day 2 (can you see a theme here?)

Haha, another tiny lion dot! Luckily we had binoculars, so it felt like we were face to face with them. They have indescribably beautiful, piercing brown eyes.


A lone giraffe in the distance...their height makes it sort of hard for them to blend into the grasslands!

More zebra

And a baby!

On the edge of the vast Etosha pan


Hyena on the prowl

Showing her teeth

Bath time!

Wildebeest

The tree that giraffe is eating is actually covered in 2 inch long thorns - they must have tough mouths!

Driving through Namibia to get to the coast

A very weird cactus

Finally, we reach the Skeleton Coast

Sunset #3, as seen from our room


Haha, that dot in the center is our car. Talk about being in the middle of nowhere!

Shipwreck remains


The colored sand made for interesting patterns along the beach

I really can't convey how empty the Skeleton Coast is, but I find the desert scenery to be quite beautiful


Not a very inviting park entrance!

This park road isn't exactly like the paved highways of the national parks in the U.S.

The Skeleton Coast is so desolate and univiting...especially when the only sign of human life is shipwreck remains!


Cape Cross seal colony

Baby seal feeding

Sunset #4


A more recent wreck (from far away it looks like a normal boat but once you get closer you realize it's old and rusty and falling apart - it's just weird that no one ever took it out of the water)