Tuesday, December 9, 2008

More Success!

There was more promising news about the Glaxo malaria RTS,S vaccine yesterday, with researchers publishing results showing the malaria vaccine protects up to 65 percent of infants from infection -- setting up the Phase III trial that I reported on over the summer.

This is not a surprise, but it is good news for all the people who have put such hard work to get this trial off the ground and for the families who have been part of the trials so far, including those I met in Kenya and Tanzania.

Of course 65 percent protection is not 100 percent protection, and it will be interesting to see how the public health puzzle pieces fit together as this project moves forward. Will other, potentially more promising vaccines still receive development funding? Will the investment into the African clinical trail centers have more effect on improving basic healthcare in the region?

As one doctor in Kenya told me: "we don't want to save them from malaria as children so they can grow up to die of AIDS as adults".

Friday, November 28, 2008

Success!



Well, it took a while but I've finally managed to put out a couple of stories from the trip. Here is the main malaria vaccine story, and here is a sidebar about the babies who are participating in it.

It feels good to have finally produced something, although as usual it is frustrating to see how much reporting gets whittled away in the editing process -- particularly for a wire service feature. Now I'll have to try a similar repackage job on the material from the AIDS vaccine trial sites!

I spent last weekend up at Harvard talking to this year's Nieman Global Health Fellows. It was fun to see old friends and interesting to hear how this year's crew are handling the challenges/opportunities of this amazing program (go Nauru!).

My Reuters work life has been very busy -- its an exciting time to be in Washington. I still hope I can somehow engineer myself back into a reporting role which will have at least some focus on global health, but for the moment U.S. politics is plenty to handle! If you are interested in some of less 'straight-up' news we are producing here at Reuters, the bureau runs a Washington political blog that has some interesting tidbits.

Thursday, October 16, 2008

Gone Pollin'




I'm on hiatus for a few more weeks as I come to grips with my new job at Reuters, where I'm filling in as U.S. political editor for a bit.

I did manage to squeeze out a quick curtainraiser on the Cape Town AIDS vaccine conference and I'm still working on longer pieces on both AIDS and malaria vaccines, based on reporting done on the trip.

I'll post again after the Nov. 4 presidential election

Tuesday, September 16, 2008

Back in DC -- Polar Bear Terror

I've been back in DC for a couple of weeks now, going thru my notebooks and trying to figure out how I am going to squeeze all my Africa info into a package of stories (I hope for Reuters)

Meanwhile, as an aside, strange days in the Nation's Capital. I went up to the subway this morning and found the whole area cordoned off with police, bomb disposal squads, Special Ops vans..the whole security clampdown whoopla. Somone jogging by breathlessly said it appeared there was a dangerous "abandoned teddy bear" in the area...

The folks at the good local blogsite Dcist had a contact who emailed them a picture -- not quite a teddy bear and a little creepy, really.

They later opined that it might be the work of this guy -- an installation/conceputal artist. Have a look at his other stuff -- I love it.

Ok enough sidetracking. Back to the notes.

Saturday, August 30, 2008

What a Wonderful Trip!



I wrapped up my reporting today with the Phambili Soweto AIDS vaccine volunteers at a Sports Day jamboree in a dusty field just down the road from Chris Hani Baragwanath Hospital -- a great end to a great trip!

I showed up at the Phambili clinic at Baragwanath at the appointed time of 10 a.m., and found the counselors and other Phambili staff busy in the kitchen with huge vats of baked beans, the chopped tomato salad known as "chakalaka" and mounds of fluffy "Pap"..a sort of cornmeal porridge. Lucky I was there as we needed all hands to transport the food down to the athletic field. The organizers had hoped that more than 300 of the Phambili volunteers would show up, but in the end it was the hard core "Soccer Boys" (some pictured above as Team Phambili) who turned out, ready to have fun.

It was a fantastic day. The guys, most of whom clearly didn't have much, had somehow rustled up full soccer uniforms complete with golden boots and they ended up playing a ferocious game against some of the male staff at the Perinatal HIV Research Unit. Women were underepresented (especially since more than half of the Phambili volunteers were women) but those that showed were also kitted out and eventually took to the field, amid great gusty blasts of wind and dust that seemed to deter no-one. Dr. Mkhize, the medical officer for the trials, was stationed at the braai (barbecue) and the DJ pumped out booming tracks of Kwaito (local hip hop) music. In the distance, the signature cooling towers of the Soweto power plant loomed through the haze.

I can't believe the trip is over. It has been amazing -- I've been met at every turn with hospitality, cooperation and patience. I have no history as a science reporter, and often I felt very at sea with the technical details of what these volunteers and the scientists and researchers behind them are trying to achieve. But as I watched the game today -- young South Africans who stepped up to try to contribute to ending the AIDS pandemic -- I was both moved and humbled.

I head back to Washington tomorrow. I'll write more over the next couple of weeks as I begin to synthesize the experience and get down to the work of writing it up. But today was not a day for "issues" or journalistic head-scratching. It was just a great day in an unexpected place with people I admired. I'm full of thanks to them, and to the many, many people who have helped me along the way in South Africa, Kenya and Tanzania. And, of course, most thanks go to the Nieman Foundation and especially the foundation's global health supremo Stefanie Friedhoff for taking a chance on me with this wonderful opportunity.

Saturday, August 23, 2008

Bagamoyo Bye Bye





I’ve wrapped up my visit to Bagamoyo (pictured above, the district hospital and its signature baobab trees!).

My final interview was with the “malaria focus person” on the hospital medical staff. She apologized because she was new on the job for only two weeks. Her predecessor in the post had recently died – of cerebral malaria.

That a malaria doctor can die of malaria in Tanzania, now, is shocking. There were extenuating circumstances – he had been diagnosed with hypertension, and the initial diagnosis was stroke, which meant that malaria “slipped through” undetected until it was too late. But even so it surprised me.

Doctors and nurses here work on the slimmest of margins. The hospital, serving an area of some 200,000 people, has only one full MD on staff, plus several assistants and “clinical officers” who perforce do much of the work. Referrals go to Dar es Salaam which is about 75 km away and overstretched as it is.

I’m not sure I learned a lot about malaria vaccines here, but I did learn more about how hard it is to be a health worker in what they call “resource poor” settings. It’s hard, and often depressing work. In Bagamoyo, the presence of the Ifakara institute – with its well connected funders pushing along projects including the malaria vaccine trials – has been a bonus. But it is still at least partially representative of the difficulties in getting health care to the people who need it in developing countries. When even the doctors are dying, of preventable diseases, something is going wrong somewhere.

Anyway I’m off to go snorkeling (yes you heard me right). And back to Joburg midweek where I am going to try AGAIN to get somebody from the health ministry to talk to me. And then I’ve got an “athletics day” date with some AIDS vaccine volunteers, and then I’m headed home. Hard to believe.

Thursday, August 21, 2008

I'm getting cranky

I can feel it. I'm fighting it..but my temper is short these days....

Bagamoyo has been interesting so far, but frustrating. Perhaps its my mood. I feel like I got off on the wrong foot with them and it hasn't right-footed itself yet. We've been in "the field" for a couple of days, talking to mothers who enrolled their kids in the malaria vaccine trial. Again - wish I spoke the language. As it is I feel like I'm not getting much, at least in the way of real insight into these people's lives. Peasant farmers are not particularly forthcoming to strangers -- particularly in translation.

The town features some German graves, a few old Zanzibar-style doors, and one Rastaman...Rasta Zion. He gave me a tour yesterday before I could say no. I ended up kind of liking him...he would give me the spiel on whatever it was we were looking at and then stop. Then after a pause of about five seconds he'd remember he was a Rasta and add a "yeah Mon".....must be tough being the only one of the tribe around! He wasn't happy with the $2 I offered so I upped it to $5. He was whistling as he headed to the beer store.

The hotel is a sort of African conference hotel. At the moment it is occupied by a Tanzanian women's NGO conference. These ladies are a sight to behold..beautiful, each wrapped up like a brightly colored confection in her own traditional garb. Think sari, but with no skin exposed. Add wigs for some, turbans for others and you've got a fashion hit parade. These women can EAT! They are not small to begin with, and the way they load their plates at the breakfast buffet would put any American to shame. Then
they sail around in slow, stately gangs..checking each other out and trading notes.

I thought I scored a jackpot today when I bought "24" -- the entire 3rd season on one disc -- for $5. Get home and load it up and damn thing is in French and French only...Jacques Bauer. Je m'en fou

Wednesday, August 20, 2008

Tanzania's Top Twenty




I’ve gotten used to seeing notices like those posted above in the African hospitals I’ve visited – an easy aide memoire for clinicians on the most usual diseases they’re likely to encounter.

The picture on the left is the Top 10 Disease List for the pediatric ward at the Bagamoyo District Hospital, while the one on the right is the Top 10 for the adult male ward.

Couple of interesting things: for pediatrics, the rank of malnutrition here is much lower than I’ve seen elsewhere, which is strange because it is a poorer region, on the whole, than the others. Doctors say food isn’t a problem in the region – and I guess this proves it. But I can’t really see why this would be so different from Kilifi in Kenya, which is only a couple of hundred kilometers up the coast. I’ll keep asking.

The other odd thing is the relatively low ranking of HIV. There’s an estimated adult HIV prevalence of about 8 percent in the region, meaning HIV should probably be higher on the pediatric list. But doctors say that this reflects more the population sample than anything else: these are babies born, for the most part, in town – where mothers have access to regular antenatal care. In rural areas most mothers give birth at home under the care of traditional birth attendants – and HIV tests as well as drugs to prevent mother-to-child transmission are not as widely available.

HIV jumps to the top of the list for the adult males. Malaria as number two is a sign, doctors say, of overall decline in malaria prevalence – people are getting exposed later, and often no longer have the childhood immunity that most people used to develop as a matter of course. It’s a good thing in a way, although not for the guys admitted to this bare bones facility.

Saturday, August 16, 2008

Wow Woops

How did I end up here…..

It’s a long day’s story. I left Joburg in the early morning, paying up and getting out of my nice service apartment there. It felt like packing up a house a bit..but was easy enough to do.

I had forgotten, however, that most of South African Airways’ Africa flights depart at 9 a.m…so the airport was a complete mess. Because baggage theft is so rampant, people now prefer to have their bags shrink-wrapped before loading them on to the planes…endless queues and discussions while bag after bag (not mine) was engulfed in plastic.

Ok fine, then on the plane. Then we sit. I look out the window and see one bag – MINE – sitting on the tarmac, unescorted. Why? Who knows. But there it was, and in it were all my notebooks (foolish move I know…not to be repeated). After a while the airplane began its countdown, and there was my bag. Outside. I had my face glued to the window and was just about to make a scene when some bag guy saunters by and throws it into the hold. Ok.

Arrival in Dar es Salaam is always a little hectic. They require visas from almost everybody, and the promise that you can obtain one at the airport means you queue and queue and then someone takes your passport, forms, and $100 and disappears. I’ve done it before so I was pretty sure the passport would come back but it’s always stressful…especially when an Air India flight had just landed and LOTS of people were freaking.

Made it. Next was the taxi queue. Some driver grabbed my bag and we headed to the parking lot..only to see him accosted by about 10 other angry drivers. He’d jumped HIS queue. My bag went from shoulder to shoulder as the argument progressed..and eventually, as these things seem to do, a victor was declared in the person of the angriest and most voluble driver. He took my bag and off we went to the parking lot.

The airport road into Dar is much nicer than the one in Nairobi…but heavily patrolled by police. At one stop light, a police lady (wearing the odd Catholic School outfit that policewomen seem to have here) stopped us for some kind of infraction. We were pulled over, the driver sweating and swearing, and she plunked herself in the back seat (I was sitting in the front). Fifteen minutes of sweating and swearing later, the driver finally handed over the equivalent of $2 and she got out. Totally brazen on all sides.

Then I end up at Q-bar. It is one of those things that seemed reasonable enough when was planning the trip in Cambridge in April, but in reality? Woops. Basically I’m staying in a sports bar. It’s a four storey, concrete building built around an atrium of huge television sets. One for soccer, one for rugby, and the other two flashing a mind-boggling array of “sport” ranging from yachting to motocross to whatever. All at high volume. Inside, on arrival, the place was packed with bloated beer drinkers of every description. It’s a dream come true for a certain kind of person (straight, alcoholic, temporarily unattached, sport fan) – but I fail on (most?) of those counts.

I called an old reporter friend in Dar and was greeted with gales of laughter when I told her where I was …”The prostitutes totally take over at 9..take cover”….was her advice. And judging from the pretty raunchy outfits that were already on show in bar, I think she was about three hours too late.

Strangely, the room is fine. My fight or flight instinct led me to an Internet cafĂ© where I checked out other options..but at my self-imposed $50 night limit there’s not much in Dar, which is pretty expensive. I’ll see how it goes. My door is bolted.

Friday, August 15, 2008

Saturday to Tanzania



I'm packing again...feels like Groundhog Day. No matter how much I scrunch, and how much I throw away, the stuff expands to fill the bag -- and just a little bit more. This despite having mailed most of my books home...

Anyway I head up to Tanzania tomorrow. After a couple of days in Dar es Salaam sorting out my media accreditation (the first time that has been required on this trip, thank goodness) I'll be spending most of the following week or so with the people at Ifakara back on the malaria beat. I'm looking forward to it -- somehow the malaria vaccine story, with its promise of the big clinical trial next year, is more fun to do that sorting over the ruined AIDS vaccine hopes here in South Africa.

Also it will bring me back to the seaside...the research institute is located in Bagamoyo which sounds like a pretty interesting place on its own. We'll see how the Internet connectivity goes but I was pleasantly surprised in Kenya so perhaps they're all online in Bagamoyo too!

Monday, August 11, 2008

Death to Popcorn

Ok I know I'm getting to be a crank but my cold heart was warmed by this kernel of news out of the UK.

I hate popcorn. I hate the way it smells, I hate the way it gets lodged in your teeth, and I especially hate the way it SOUNDS when people chomp their way thru buckets of it at the movies.

I'd definitely pay extra (maybe the amount of an average popcorn serving, $7) to attend popcorn-free movies.

Am I sick or just intolerant?

Invisible Theater


Gugulethu may lie within shouting distance of Cape Town's famous Table Mountain, but it is a different world. While in Cape Town, all the world is a stage for the convertible-driving, sunglasses-wearing hipsters that seem to rule the roost, in Gugulethu the theater is invisible -- and in taxis.

Cape Town must be one of the most beautiful urban settings in the world, the endless wash of the rough South Atlantic pounding in on shiny white apartment blocks ringed by beautiful roads that stretch up into the mountains. But behind the mountain, Gugulethu and its township neighbors are one of the most dismal -- stretches of homemade shacks, cobbled together out of plywood shards and bits and pieces of corrugated iron, and all cheek-by-jowl with busy freeways and featureless industrial parks. It's right by the airport so you can't miss it -- which should be an interesting welcome for the World Cup 2010 tourists when they arrive in the "new South Africa".

I spent the last couple of days at the Emavudleni AIDS vaccine clinic in Gugulethu (in Crossroads, to be exact). It is the vaccine trial site run by the Desmond Tutu HIV Foundation. Like Baragwanath in Johannesburg, this was one of the main sites developed to run new trials of HIV vaccines -- an enterprise that has all but stopped with the failure of the most hopeful candidate last year (see earlier entries on Phambili/Merck).

It's a familiar sight now after two months on this project -- a fully equipped, fully staffed operation searching for a new mission. The scientists and counselors and Emavudleni are working on side studies, but the raison d'etre for the clinic has been ripped away. There simply are no major HIV vaccine products in the pipeline.

It's a depressing reality -- for them and for me. But the work continues -- at at Emavudleni part of that involves invisible theater.

Community educator Pozna Gomomo talked me thru how this works.

Three AIDS vaccine workers will get on a minibus taxi -- the often ramshackle minibus that serves as the main mode of transportation in the townships. One vaccine worker will sit right in the front, another right in the back, and a third, surreptitiously, will take a seat in the middle.

The one in the front will call back to the one in the back: "Hey, didn't I see you at the AIDS vaccine clinic?"....the reply will come "Yes, they've told me how it works and I think I'll sign up."

The "sleeper" vaccine worker, seated in the middle of the bus, will then pipe up:

"Don't they infect you with HIV at those places? Why are you going there?.." and thus a discussion will start.

"You know that those 18 people in that taxi will be going home and talking about what they heard," Gomomo said. "It is a way for us to start discussion, and to get the message across."

A quick google of "Invisible Theater" shows that it was developed in Latin America as an activist/theatrical way of making political points. It's also known as "Theater of the Oppressed"...which seems apt.

Gomomo says Invisible Theater and other forms of community outreach are part of showing that they are still "engaged" with the community, and keeping the AIDS vaccine issue in people's minds despite the lack of immediate hopes. I wonder how long people will keep listening.

I'm back in Joburg now and have to admit I'm dragging a bit. I feel like I keep asking the same questions and keep getting the same answers. I have to be more creative.

Tuesday, August 5, 2008

On The Move (Again)



I'm headed for Cape Town tomorrow. While there I've got some interviews set up at the South African AIDS Vaccine Initiative as well as the Cape Town site for the Phambili vaccine trial. I'm also going to see my old Nieman pal Melanie Gosling plus (I think) some other friends....so it should be fun.

I've been fretting about "narrative arcs" and "stories behind stories" with this trip...do I have one? Is it all going to pan out? The bottom line, of course, is that I am learning a great deal. But is it going to translate into copy? Sheeeeez.

Anyway, more soon from "The Mother City".

Sunday, August 3, 2008

"The future belongs to pharmaceuticals"

Helen Epstein, who wrote the good AIDS in Africa book I mentioned below, has an interesting piece in the LATimes today marking start of World Aids Conference

The bit about the promotional video suggesting that in the future, happy African teens will be accessing ARVs from school vending machines is a chiller!

Here's another one I just ran across by the Council on Foreign Relations' Laurie Garrett, one of the most respected global health writers around.

I think they both show the frustration that is developing over the idea that drugs, and only drugs, are the way forward against HIV.

Saturday, August 2, 2008

web address

finally managed to change all the various settings so this appears under www.quinntelligence.com (I know, not the hardest thing in the world to do but it took me ages to figure out!)

anyway I hope this makes the blog easier to find

Friday, August 1, 2008

yes, I am "working"

it's not all for naught! here's something that ran on the Reuters wire.

Wednesday, July 30, 2008

Back in Jozi



I'm back in Johannesburg. Strange that a city so foreign can feel so much like home. I'm psyched to be back! Kenya was great but it's always nice to feel at home. The picture is the Ponte Tower...an apartheid-era redoubt for the yuppies of the day, now a mad African city in a towerblock. The scuttlebutt (used to be -- see Josh's comment) that the garbage in the former central grand atrium, discarded by various squatters, campers, and n'er do wells, now reaches to the 11th floor.....

I don't know if that's true (Ponte is a particularly scary place to visit..but maybe I'll find out this trip) but I like the imagery.

A Note on Backpacks

I’ve always had a thing against them – associating them with filthy feet in run-down sandals, Let’s Go travel books and raucous laughter in overcrowded train compartments.

My bias has cost me over the years. In the late 1970s, when a high school friend and I went to Europe, we decided we weren’t going to join the backpack crowd – and went instead equipped with two huge duffel bags, which over the ensuing months cut huge gashes into our shoulders with their single straps.

Roller bags, which I later moved to, are fine for airports but not so good when you are running through markets trying to catch a bus or walking miles to try to find the weirdly isolated B&B you booked.

In both cases, the contents end up a jumbled mess and mornings were devoted to frantic grab-bag searches to look for clean underwear, my passport, or whatever else I needed.

You’d think I’d learn. But vanity persists and I reverted to a duffel bag for this trip – one of the most intense packing/unpacking sequences of my life. But I’m saved! Before leaving the U.S. I bought a set of “Eagle Creek Travel Gear” packing envelopes – Velcro and cloth sleeves that zip up into neat little packages. Into one go socks and underwear, into another shirts and t shirts, and into the largest go pants, sweaters, my raincoat and whatever else I stupidly overpacked on the trip. Then, one by one, they slide into the duffel, making it a convenient traveling dresser.

I’m usually sceptical of “organizational breakthroughs” – doubtless the sign of a terminally disorganized mind. But these damn things have made a real difference. Thank You, Eagle Creek (I’m not a paid spokesman but I would be in a second – Eagle Creek, call me).

Now, back to packing.

Tuesday, July 29, 2008

Books for an African Trip

African taxi drivers are usually pretty nice and often offer to help put your bag in the car – but when they take mine they grimace.

My trusty red duffel bag weighs a ton, and most of it is reading matter. Along with my notebooks and an ever-expanding file folder of copied articles, I’ve been lugging around a little mini-traveler’s library to keep me occupied on the many nights when the TV reception is bad or the language incomprehensible.

Here’s what I’ve read so far:

“The Invisible Cure: Africa, the West and the Fight Against AIDS” by Helen Epstein. This is depressing in more ways than one. Epstein does a masterful job chronicling many of the missteps and bad judgments that have marked the world community’s response to Africa’s AIDS crisis. She’s got a bee in her bonnet about U.N. agencies and Western aid groups and she marshals the facts to show that in many cases the “AIDS establishment” has done more harm than good. For a reporter, it is both thrilling and daunting so see someone else tackle the subject so well.

“The Scramble For Africa” by Robert Pakenham. Clocking in at around 750 pages, this is a blow-by-blow account of Europe’s various colonial enterprises in Africa during the latter half of the 19th Century. He delves with equal passion into better known sagas (Stanley and Livingstone, the Boer War, Cecil Rhodes) as well as tales perhaps less familiar to English-speaking readers including the formation of French Equatorial Africa, the revolts against the Germans in East and Southern Africa, and Italy’s war with Ethiopia. It is, perforce, more about diplomatic dealings in European capitals than about the impact these had on African states and peoples, but it’s an amazingly comprehensive and often thrilling account of what happened.

“After the Party” by Andrew Feinstein. Feinstein is a former MP for South Africa’s ruling ANC who grew increasingly frustrated and disillusioned with Thabo Mbeki’s government. Here he sets out what he thinks went wrong (paranoid leadership style, blind eye toward corruption) and calls for a “new politics” to revive South Africa’s great experiment. Probably too much inside baseball for most readers, but a heartfelt analysis of where one semi-insider thinks things went wrong in the post-Mandela era.

“Dinner with Mugabe” by Heidi Holland. Holland, a South African journalist, is a friend of mine and had amazing timing with this book, a sort of psycho-biography of Zimbabwe’s Robert Mugabe. She was the last foreign journalist to get an exclusive interview with him before this year’s disputed election. She concludes that Mugabe is a spurned Anglophile with mother issues – an interesting take if perhaps of little comfort to Zimbabwe’s suffering people.

“In the Footsteps of Mr. Kurtz” by Michela Wrong. A former Reuters journalist who went to work for the Financial Times, Wrong’s book takes us through the rise and fall of Zaire’s Mobutu. No mother issues here, just a lot of excessive greed, bad taste, and thirst for power. As they say in the trades, “rollicking”.

“The Wizard and the Crow” by Ngugi wa Thiong'o. This is a great fictional counterpoint to the two books cited above, and all the more interesting because it is by one of Africa’s most prolific and interesting writers. Wa Thiong'o paints a lengthy, magical realist fable of a mythical African country where “The Ruler” sets his people to building a new Tower of Babel. His chief advisor, meanwhile, grows enormous eyes to better see the Ruler’s enemies while the number two in the cabinet sets about growing enormous ears the better to hear of plots against him. Weird, wonderful (and long).

I’m going to be sticking all these books in the mail when I get back to South Africa and sending them home – so I hope my bag will be a bit lighter.

Not mentioned above was the three day British “chick lit” binge (“Confessions of a Mad Housewife”, “Lessons for an New Divorcee” etc) that occurred in Lamu thanks to the leavings of previous guests. I don’t remember anything about any of them except a vague feeling of queasiness

Autoclave and Destroy




There’s a freezer full of dashed hopes at the AIDS vaccine clinic in Kangemi, one of Nairobi’s crowded slums.

The freezer, kept under multiple lock and key, contains vials of the vaccine prototype that many researchers hoped would mark the next big step forward toward preventing new HIV infections.

But like other trial sites across the globe, Kangemi is now under orders to destroy the vaccine following a decision by U.S. sponsors not to proceed.

“It will be autoclaved and incinerated,” said pharmacist Jennifer Kigera. “We are still hoping for a new product one day.”

They will have to wait a while.

The cancelled PAVE trial has left few immediate prospects for large-scale human testing of HIV vaccine prototypes, with the U.S. National Insitute of Allergies and Infectious Diseases now saying it will focus on small, focused trials and basic lab science to better understand HIV.

The cancellation of PAVE followed the mid-way halt of a similar trial using a vaccine developed by Merck (see my entries on Phambili), a double blow.

Kangemi, which like many other sites had been set up expressly to prepare for big Phase II and Phase III trials, now has to repurpose itself – looking at basic epidemiological studies on HIV incidence in the region as well as tracking the early progress of infection among volunteers who recently rested HIV positive.

Gaudensi Mutua, pictured above, is the research physican at the site – which is made out of converted shipping containers stacked outside Kangemi’s municipal clinic.

“We all felt crushed and a little bewildered,” Mutua said of the PAVE decision. “It was the hype. Everyone had such high expectations.”

Kangemi hopes its work on HIV infection will feed into studies of two select groups of people – the “Long Term Non-Progessors” and the “Elite Controllers”. The first represent people who have been infected with HIV but take a very long time to develop any symptoms of AIDS. The second, a much smaller group, never develop symptoms at all.

By studying how their immune systems work – and particularly the role of “cell mediated immunity” which keeps long-term infections under control (think chickenpox), scientists hope that they will come across a key to disabling or even eliminating the HIV virus.

“It is these two groups that keep alive the hope that a vaccine is possible,” said Prof. Olu Anzala, the head of the Kenya AIDS Vaccine Initiative.

Friday, July 25, 2008

Lucky (?) Pluckers



Ok, it looks like a Teletubby encampment but this weird little village of round red cement houses is actually corporate housing for James Finley Teas, one of Kenya’s biggest tea exporters.

In many ways it appears idyllic – groups of these houses are set in rolling tea fields which, from a distance, look like the frozen emerald froth of some great sea. The workers (“pluckers”, locally) are actually in pretty good shape by working class African standards. They are given free health care, their kids go to company schools, and the little round houses come with the job.

Still, tea plucking is backbreaking work and at 7 shillings a kilo, a good day’s take home would be only about $5. That’s better than the $1-per-day benchmark that the U.N. has set for the poorest of the world’s poor, but it’s not exactly easy money.

The tea plantations have worked with the U.S. military’s HIV program and many of these workers have been among the volunteers for HIV vaccine studies. From a researcher’s point of view, it’s a great “cohort” – a large group of people with relatively similar living patterns in a controlled environment.

Ironically, the pluckers are almost too good. They are generally seen as at a low risk for HIV, so discovering whether or not a potential vaccine would work is that much harder – is it the vaccine working, or is it simply that these workers are too bushed to get up to much risky behaviour?

For that reason, the Walter Reed program (like the IAVI group in Mtwapa I mentioned before) is gearing up to bring a high risk group under study – commercial sex workers who make their living in the trucker bars and hostels along the main highway. This group will be harder to find, harder to enlist, and harder to track – but may, in any future vaccine study, be the ones with the answers.

I’m leaving Kericho and the Walter Reed program today. On Monday, I’m hoping to do another IAVI site in one of Nairobi’s many slums.

Wednesday, July 23, 2008

Lab Work



The Walter Reed lab in Kericho began as a makeshift workspace in a rented living room.

"I came out here and took one look at the place and thought I would take off..Kericho is pretty small," said lab director Rukiya Kibaya, remembering her first foray into the new world of scientific support for the AIDS effort in rural Kenya in 2003.

"But the enthusiasm of everybody at the site caught up with me."

The Walter Reed lab is now one of the best in Kenya, the only one in the country to win the prestigious College of American Pathologists (CAP) certification and one of only a handful in Africa with that designation -- which means its procedures and results are on par with the best labs in the world.

This minor miracle -- brought about with a lot of investment from the U.S. military and a lot of hard work by dedicated Kenyan scientists like Kibiya -- now operates from a suite of rooms in the Clinical Research Center at Walter Reed's headquarters in downtown Kericho. Reaching it is like moving through a series of airlocks leading from the developing world to the front lines of science.

Just off Kericho's main drag, where minibus taxis jostle and hawkers congregate selling everything from bananas to cellphone minutes, you walk down a quiet alleyway to a large metal gate. Behind it, the CRC is a freshly-built, stone building surrounded by manicured lawn and "keep off the grass" signs. A reception hall leads to a landscaped inner courtyard that wouldn't look out of place in Silicon Valley. And around it are arrayed quiet, airconditioned offices ranging from IT to pharmacy, and well-equipped laboratories where the exacting work of testing, measuring and reporting the biomedical ravages of HIV in the region are carried out.

Lab workers in blue coats work quietly and quickly, surrounded by the metallic gleam of state-of-the-art machinery enabling them to do everything from basic urinalysis to complicated tests to assess patient HIV viral load -- an increasingly important signpost for AIDS-related illness.

In the cold storage room, a row of locked refrigerators gives way to massive scientific freezers - set at -74 degrees Celsius -- which preserve samples and are backed-up and failsafe-d to keep the both the samples and the data reliable.

While the CRC lab was originally set up in line with Walter Reed's "primary mission" in Kericho -- the thus far fruitless hunt for an AIDS vaccine -- the lab is clearly realigning itself with the new realities and new priorities of PEPFAR, the U.S. AIDS treatment aid program. Much of the work now is devoted to new studies aimed at assessing how and when to intervene with anti-retroviral treatment, and in training lab personnel from other nearby facilities on how to handle the scientific backup required for a program that is enrolling tens of thousands of local Kenyans on AIDS drug treatment.

"We're spreading our risk," Kibaya said.

Monday, July 21, 2008

Cute is not a word



that springs to my mind when I imagine a U.S. military installation -- but here I am in one of the cuter ones. This is the guest house at the U.S. Military HIV Research Program in Kericho. It is set amid lush tea plantations in Kenya's cool, wet highlands that mark the southern edge of the Rift Valley. It takes about an hour and half to get here from Kisumu, juddering at 120 km/hr across some hilariously pot-holed roads navigated by frighteningly self-confident drivers.

The cute ends here, though, and real work gets done not too far away. The USMHRP office in downtown Kericho sits atop a stubby block of converted flats, backing up onto an intensely busy gas station which seems to be a major transit crossroads for minibuses and everybody else.

Despite its military affiliation, there's no camouflage fatigue around. The USMHRP site in Kericho appears entirely civilian run, and in fact there is only one American -- the director Dr. Doug Shaffer -- working here, while the rest of the staff, from senior scientists to data entry monitors, is Kenyan. Administratively, it's a joint effort of the U.S. military and Kenya's KEMRI medical research institute.

The USMHRP has been involved in HIV vaccine work here for several years, and was due to have been a site for the next round of large scale tests before they were scrapped last week out of lingering safety concerns. They are still "cohort building" looking for the next possible trial, while research into other areas of HIV goes on.

One fascinating study they've got underway involves looking at the actual cost benefit of putting tea plantation workers on ARV treatment. While its not news that people get better after starting on the drugs, the genius of this study is that there is a very basic -- and very measurable -- way to measure the economic difference made by the treatment: how much tea the workers are able to pick. Apparently its the first study of its kind to attempt to put a $ figure on productivity gains associated with the widening ARV roll out.

The PEPFAR program for AIDS drugs seems to be playing a big role here -- in essence, the availability of free public treatment is opening ethical doors to study proposals which would have been impossible before when treatment itself, offered through a clinical trial, might have been seen as an inducement.

Sunday, July 20, 2008

On Lake Victoria


I'm on the other side of Kenya now...in Kisumu, the country's third largest city and chief outlet on Lake Victoria.

I just arrived so have nothing wise to say except Kisumu on a Sunday afternoon is QUIET. But the hotel has surprise wireless Internet....a first for me in Kenya so far.

Kisumu's chief claim to fame is that it was almost strangled by a voracious explosion of water hyacinth in the 1990s. The alien invader hobbled shipping and nearly killed the local fishing industry, laying Kisumu low. Apparently they've beaten it back (how and with what I don't know..will have to investigate) but like all kinds of third-tier places, it now seems to have its hopes set on bigger and better.

I'm here for one night on my way to Kericho, Kenya's tea capital and home to the Kenya division of the U.S. Military HIV Research Program. They've been involved in vaccine studies, and were getting ready to participate in the PAVE program that the NIH just formally stopped.

We'll see what they say!

Thursday, July 17, 2008

Ok I admit it




I’m not exactly “roughing it”. But wait (I swear) there’s a reason!

I’m now in Shella, a village on Kenya’s Lamu Island. It is hardly undiscovered – the construction/reconstruction around here is amazing. That is all thanks to Lamu’s reputation as a get-away-from-it-all destination for various jet set stragglers (bonjour, Princess Caroline).

This is, of course, Kenyan winter and therefore off season, so no ramshackle Royalty to be seen. But the weather is great and Lamu is a spectacular place, enough to have been named as one of the U.N. World Heritage Sites – if you give that any credence given the politics involved there.

Lamu’s claim to fame is that it is the best-preserved Swahili town left standing, better and more authentic (so the experts tell us) than Zanzibar’s Stone Town. It’s a medieval agglomeration of squat buildings built out of stone and coral, all facing an estuary that gives out to the sea. The waterfront has a few Victorian-era monoliths – the District Commissioner’s Office, the Museum – but behind that the streets quickly shrink into a dark, confusing rabbit warren of alleyways and bypasses. None is wider than 8 feet, so cars are out – the only mode of transport on Lamu is the donkey, which are here in abundance. Local mahouts jockey them around, sweet-eyed beasts that let out the most heart-rending bleats at all hours (I know…they woke me up last night).

The Muslim heritage is strong here – many of the women are veiled, and alcohol is verboten except for a few, touristy places. But on the whole it is extremely relaxed and friendly. Everyone, and I mean everyone, pipes up with a friendly “Jambo!” (hello!) on the walkways, which can be exhausting.

My excuse for being here is twofold. The KEMRI malaria people in Kilifi could only see me last week, and the U.S. Military HIV programme in Kericho was only free next week.

Voila, a few days to spare.

It also dovetails with an ongoing interest of mine, which is the triangular relationship between the Sultans of Zanzibar (the source of Swahili culture), Kaiser Wilhelm’s Germany and late Victorian England in the latter 1800s. It’s colonialism with a capital “K” – the Zanzibari rulers were Arabs from Oman and the African population suffered from all hands. Still, it’s a fascinating glimpse of one of the early encounters between Africa, the “Muslim World” and modern Europe.

More about that, if I ever get my act together, later.

Meanwhile, back on Lamu, everything is pretty good. Shella has one world-class hotel – the Peponi, frequented by the above mentioned royals, clapped out rock stars and site of the only decent Internet connection, from which I will post this– but also a lot of very nicely set-up B&Bs. I’m staying in one (thanks Andy Meldrum!) called Banana House, run by a Dutch woman named Monika and her Lamu husband, who goes by the name of Banana.

Monika is a yoga master, and I hear her doing athletic yoga breathing just as the sun rises. She’s also a specialist in the “Art of Living” (apparently a recognized qualification?) so we’ve got a Wellness Center attached to the hotel. I slept through the yoga class this afternoon – too much sun and heavy thinking – but will be bending my heart out tomorrow, I promise.

There’s a lot of construction around, so days are not quiet. But it is a beautiful place – and, for the moment, empty so I am the sultan of my surrounds, sitting on an open terrace with the fullish moon now mottling through the flowering vines overhead (I can’t spell bougainvilla but that’s what it is). In the garden, where the guys are digging by hand what promises to be a pretty cool swimming pool, there are frangipani, which give off the sweetest honey scent as the sun goes down.

So that’s where I am right now. But I’m still focused on global health, don’t get me wrong. More about that soon.

Sunday, July 13, 2008

Exploring

I'll be off exploring for a few days next week and probably won't be able to post for a while.

I'll recap when I get back.

Friday, July 11, 2008

Procedure

It was, I imagine, like trying to interview Madonna.

Crouched on a rickety wooden folding chair, I had my notebook out. Dzame Kitti, whose guest I was, was sitting cross legged in the doorway of her small, mud-walled house. The sun was shining bright, and chickens pecked at the ground near a round rattan mat where corn kernels lay out to dry.

I began to ask a question, and was immediately stopped. Procedure. My companions – Dzame’s handlers – swung into action. Dr. Ally Olotu, who had overseen the early malaria vaccine trial which Dzame’s daughter Jazmilla participated in, brought out a sheaf of papers and began to speak to her in Kiswahili.

The papers were the consent form we had worked out for the interview.

Informed Consent is a key element of clinical trials. Participants are asked to sign forms that indicate they have been told all of the details of the trial, including risks and benefits, and have agreed to take part voluntarily.

The informed consent process extends to interviews. I had come with a Kiswahili translation of a consent form that had been worked out by malaria workers in Tanzania. It was modeled on a form drawn up for an earlier visit by a TV crew, and apparently had some jarring language – “universal distribution rights”, “all media” etc.

This had raised red flags in the KEMRI social research group, which felt that perhaps that Kenyan participants would be signing away too much. So Ally helpfully drew up a new, simpler form, stating that the interview was for Reuters news and was voluntary. This had been cleared by the KEMRI social research team, one of whom was with us and watching with the eagle eye of a Hollywood publicist.

We were good to go.

Dzame – wearing a t-shirt supporting Louisiana State University -- listened carefully as Ally read through the form, and bashfully nodded her assent. I began to ask my first question, and was immediately stopped by the social research worker.

She hadn’t signed yet.

Dzame – rail thin, with two-year-old Jazmilla clinging to her legs – didn’t know how to write. Discussion ensued. We had forgotten to bring the ink pad for a thumb print. Would an “X” suffice? No. More discussion. Eventually Dzame allowed the social research worker to use a ballpoint pen to coat her thumb with ink. Pressed against the consent form, it yielded an acceptable “signature.”

We began. Dzame didn’t have much to say about the malaria vaccine trial, it turns out. Inexpert translation flattened her comments and left me with the feeling that it had all gone well – but no sense of her personality, or the real considerations that went in to her enrolling Jazmilla in the vaccine study.

This obviously is due to my inability to speak Kiswahili, and my ignorance of the local customs and attitudes. A better informed local reporter would have a sense of what was really going on.

But I’m equipped as I am, and this is my project, so we continued.

Toward the end, I asked if I could take a photograph. The social research worker frowned. Photographs had not been mentioned in the consent form. If I wanted to take a snapshot, the entire process would have to be revisited. Dzame has not released visual rights. Would this be for publication? If so we might have to refer to the ethics committee in Nairobi.

I put the camera away.

At the end of the interview, Dzame gathered Jazmilla up in the billowing folds of her colorful wrap, strapping her tightly against the maternal back to get ready for the day’s work. Jazmilla looked at me with a fathomless stare as Dzame offered me some fresh corn from her fields.

Sitting on the stoop of a peasant farmhouse in rural Kenya, the elaborate protocol to get to a simple interview seemed absurd. But I understand why it is there – the KEMRI researchers have, as their paramount responsibility, the welfare of their trial participants. And their main objective is to obtain data on the vaccine – not to publicize the project, or to trot out helpful “spokespeople” for the vaccine enterprise.

Dzame waved as we set off back toward the KEMRI landrover through thickets of corn. Jazmilla had already scrunched the consent form into a ball. But we had followed procedure.

Thursday, July 10, 2008

You Gotta Have Faith


Faith Okuma, 25, sits behind the reception desk at the International AIDS Vaccine Initiative (IAVI) trial site in Mtwapa, Kenya.

On her desk is a huge bowl, overflowing with condoms. In her pencil jar is a large wooden penis.

With her wildly tousled hair, brilliant smile, nose stud and hot pink high heeled sandals – pink spaghetti straps snake up her long legs – Faith is a great advertisement for the 24-hour party people of Mtwapa, locally known as the Sin City of Kenya’s coast.

Thanks to Faith and other volunteers like her, the IAVI center in Mtwapa is reaching out to some of the most marginalized – and most at risk – populations in Africa: female sex workers (FSWs in global health speak), and men who have sex with men (MSMs).

“I’m MSM friendly – it means I have a lot of friends,” Faith said with a low laugh.

Acceptance and understanding are hard for both of these groups in Kenya, where prostitution and homosexuality are illegal on the books and widely stigmatized by political and religious leaders.

And both groups are seen particularly at risk for the next wave of HIV, in large part because existing public education programs and interventions ignore their existence.

Not so at the IAVI center.

Mtwapa, despite its rock’n roll reputation, is a pretty gritty little town. About 60 km north of Mombasa, it has an aura of fun because its bars are open 24 hours a day, there are beaches and hence tourists, and the taxi system works thru the night. But the reality of Mtwapa is a collection of ramshackle dives, blaring music, set up next to day traders peddling everything from car parts to DVDs and salted with a lot of dubious hotels promising “excellent service” and “superior meals”….

The IAVI center lies down one of Mtwapa’s rutted, muddy roads. Go through its gates and you enter the world of international AIDS enterprise – clean, new furniture, decent computers, and in the labs up to date equipment. The IAVI center was one of many in Africa that was gearing up to test the next wave of AIDS vaccine candidates – until hopes came crashing down with the disappointing results last year of South Africa’s Phambili trial, which cast doubt over the current basic premises of AIDS vaccine design.

The work goes on, however.

In Mtwapa, they are doing what is called “cohort building” – trying to attract and retain people seen at particularly high risk for contracting HIV, such as MSMs and FSWs. While the point initially was to enroll participants in vaccine trials, the outreach now is about education. And research: the more we understand about how HIV is transmitted, by whom and to whom, and under what circumstances, gives us more weapons to halt its spread.

Faith says the people who are brave enough to walk through the IAVI Center doorway are often not brave enough to stay.

“Sometimes they come in and I call a counselor, and by the time I get back they are gone,” she said. “We are trying to get them to stay.”

You Gotta Have Faith

Tuesday, July 8, 2008

The Therapeutic Misconception




I’ve spent the last few days at the KEMRI-Wellcome center at Kilifi District Hospital (picture from kid's ward above...am still negotiating to actually take pictures of the kids!). It is a joint project of Kenya’s Medical Research Institute – the country’s equivalent of the U.S. Centres for Disease Control – and Britain’s Wellcome Trust.

The “Unit”, as it is known, is a major research center on Kenya’s coast and the home base for a number of clinical trials including the coming Phase III large scale trial of the RTS,S malaria vaccine candidate.

Dorcas Kamuya is the community liason manager, who is in essence charged with sorting out the unit’s relationship with the local people who must consent to being part of a medical research project. In the case of most malaria research, this involves parents giving consent for their children – the infants who are the most likely to contract and possibly die from severe malaria.

Dorcas has a broad smile and a businesslike manner, and readily discusses the complications in the relationship between researchers – who are equipped with state of the art equipment and aspire to produce world class data -- and the researched, often subsistence farmers in one of the poorest and most unequal regions of Kenya.

Unit scientists have run into a series of problems, including widespread rumours that their requests for blood samples were somehow related to “Miyani”, a local version of the vampire legend. And the unit had to replace the familiar snake-and-staff logo of the medical fraternity on its vehicles after the serpents drew suspicions that somehow they were involved in devil worship.

But a more persistent problem for medical researchers is what they call the “therapeutic misconception” – the idea that parents get that somehow participating in the research will result in a better treatment for their own children, and that declining to participate may mean the children aren’t treated.

In any randomized clinical trial, there is at best only a 50/50 chance that a given child will receive the test treatment. And even then, there is no guarantee that it will produce any protective or curative effect – all the trial is aimed at doing is delivering data on whether or not the treatment might be effective in a broad sense.

In kiSwahili, there is no direct equivalent for the English term “research”, at least in a medical context. Various words including “utafiti” (study), “unchunguzi” (investigation) and “mradi” (project) may be used, but Dorcas said that none really conveys the idea of scientific research with its hard repetitive queries and often elusive conclusions. How do people really give “informed consent” for a process that is at least initially alien to them?

It is just one example of the weird collision of science and hope that occurs around here every day.

The KEMRI group says they are pretty sure that they are overcoming the culture gap – and point to rising numbers of people declining to enroll in trials as evidence that “they are learning that it is ok to say no”…..an ironic symbol of success, but one just the same.

Sunday, July 6, 2008

comments please

I'm new at this game so please bear with me...but I think I've finally got the comments enabled now. If anybody feels like venting, please do!

It's hard not to like



a town where the two main traveler's hotels are the Titanic and the Watergate.

Despite the catastrophic references, Kilifi is pretty swell. Built at the mouth of a deep water creek, the town faces the Indian Ocean on bluffs -- the pelucid waters of the creek slowly giving way to the surge and chop of the ocean.

It is quiet, and the Southern Hemisphere starscape burns bright.

I'm not staying at the Titanic or the Watergate, despite the attraction of the names. But don't cry for me -- my place has a huge pool overlooking the ocean!

Saturday, July 5, 2008

Dork on a Dhow

I should have known better!

Arrived in Mombasa yesterday. After Nairobi's smog and grit, this is a very agreeable city. The "Swahili Coast" elements are all there -- New Orleans style covered porches, elaborately carved wooden doors, and an Indian Ocean mashup of people all going about their business.

Some colleagues of mine at Reuters in Nairobi told me that THE thing to do in Mombasa is a dinner cruise on a "dhow" -- one of the old wooden sailing ships (refitted of course) which still sail up and down the East African coast and on to the Arabian Peninsula.

Dinner can be a problem when you are traveling alone. I can take the rest of it -- in fact I sort of prefer being a free agent during the day -- but at night you pay the price.

After a quick look at my hotel restaurant, I thought what the hell, at least it will give me something to do/look at during dinner, and it is THE thing to do in Mombasa.

So, even though the ticket cost almost twice as much as my hotel room, I splurged -- envisioning a sort of jolly putt-putt swing around the bay, a big sloppy buffet with crowds of noisy tourists, and a quick tourguide version of Mombasa history.

When I arrived at the jetty, I began having second thoughts.

There sat a splendid dhow, hung with lanterns. On its decks, however, were only about seven tables -- each kitted out in full "luxury dining" mode with a panoply of plates, glasses, silverware etc. While most were ready for groups of four or six, or romantic Honeymoon outings of two, one table was set majestically for one -- me.

A helpful waiter informed me that the cruise would take 4-1/2 hours.

So, under a fingernail moon, off we steamed. The point of this cruise was clearly the dinner and not the sightseeing. There was no guide, and within about 20 minutes night had fallen and it was hard to make out what was on the shore aside from a few twinkling lights.

I kept looking anyway, if only to avoid eye contact with my fellow passengers. Sometimes a single traveler can feel dangerous in groups of others -- a warning beacon.

Of course the other diners probably didn't give me a second thought. But the fact that my table was under the same spotlight as the band and the lady chanteuse decided to direct some of her more warbly numbers ("Midnight at the Oasis" -- oh yes) directly at me left me feeling kind of exposed!

On the upside, the food WAS delicious -- barbecued king prawns. And the 4-1/2 hours did pass. And I've now done THE thing to do in Mombasa.

Today I'm headed up the coast to Kilifi, where the malaria vaccine researchers are working, so I hope we'll get back to health-related stuff soon.

Right now, I'm going to go out and see if I can find Mombasa's most famous landmark -- giant metal tusks erected in arches over the main drag to commemorate a 1950's visit by Princess Margaret.

P.S. One of Nairobi's most popular (or at least most advertised) funeral parlors is gloriously dubbed "Montezuma and Monalisa Funerals". Aztec Renaissance?

Wednesday, July 2, 2008

Smog Birds

I don't think that's Kenya's national bird but it certainly should be Nairobi's.

You arrive at Kenyatta Airport, which is situated about 15 miles out of town. Then, in a rattletrap taxi with a grim-faced driver, its off along the "Uhuru Highway" into the city.

The highway quickly clogs with minibus taxis, private cars, huge four-wheel drives with diplomatic plates, and the weirdest odd-lot of trucks, tanker trucks, pick-up trucks, and what-have-you -- most of them spewing noxious clouds of greasy grey smog.

Strangely, as you come into Nairobi proper, the highway is quicky overarched with trees, their branches studded with the most amazing -- and huge -- birds. They look a bit like storks, certainly that size and with the same sword-like beak and long, spindly legs. They hang around nonchalantly in the branches above this seething cauldron of traffic and exhaust. Sometimes one will lazily take flight, with breathtaking wingspan, and come coasting in to rest on another branch, which bends dangerously down close to the traffic under its weight....

Anyway that's Nairobi so far. I've got a couple of appointments tomorrow and then head down to the coast and Mombasa.

Monday, June 30, 2008

Next Stop: Nairobi



I'm packing now for Kenya. The next phase of the trip will take me to places a lot less familiar.

In East Africa, malaria is the bug to beat. The following is from the WHO site info on malaria:

About 40% of the world’s population, mostly those living in the poorest countries, are at risk of malaria. Of these 2.5 billion people at risk, more than 500 million become severely ill with malaria every year and more than 1 million die from the effects of the disease.

Malaria is especially a serious problem in Africa, where one in every five (20%) childhood deaths is due to the effects of the disease. An African child has on average between 1.6 and 5.4 episodes of malaria fever each year. And every 30 seconds a child dies from malaria.

The ravages of this disease --- heralded by little more than the buzz of a mosquito -- have become one of the new foci of global health. U.S. President George W. Bush's malaria initiative pledges to increase U.S. malaria funding by more than $1.2 billion over five years to reduce deaths due to malaria by 50 percent in 15 African countries, making malaria one of the "hot" diseases for global health workers and funders.

I'm going to be looking at efforts to prepare the ground in coastal Kenya for clinical trials of the RTS,S vaccine protoype, developed by GlaxoSmithKline.

There's a, perhaps Western, science-based, hope that vaccines are the answer to problems like HIV and malaria. The work going on in Africa will tell us if that is the truth.

I'm expecting to have less reliable Internet connectivity over the next few weeks but will post as I can. Don't forget about me!

Farwell to Baragwanath



I finished the first stage of the project today, wrapping up a couple of last interviews with AIDS vaccine trial participants at Baragwanath Hospital.

Noluvuyo Mncini was my final interview. A 20-year-old from the vast Orange Farm shantytown outside of Johannesburg, Noluvuyo was not letting the world get her down: she showed up in high heels, a smartly cut jacket and long beautiful braids.

Like so many of the participants I talked to at Bara, she seemed both very young and very determined. She lives with eight siblings and her parents in a small house in Orange Farm. Her father was recently laid off, and the whole family is making do with his minimal unemployment insurance -- and, presumably, the periodic payments Noluvyo gets for coming in to the Phambili clinic.

Places like Orange Farm are where South Africa's AIDS epidemic is hitting hardest. People are afraid to get tested, medical services are minimal, and the heavy stigma that surrounds HIV can make people reluctant to access free antiretroviral drug treatment.

Noluvuyo said she sees it all around her: last Saturday she spent at the funeral of a friend, dead at the age of 23.

"I am afraid of HIV. I don't want to die of HIV," she said.

Of course, the money she gets for participating may be important too. Each participant is paid 150 rand (about $20) to come in for their clinic check-ups. The money is reimbursement for transport, but in extremely impoverished households like Noluvoyo's it can make a difference, if only for a couple of days.

She said she thought most of the Phambili participants were in it for the money. Few others that I talked to agreed with her. But teasing out the motivations of people who are part of the AIDS vaccine enterprise is tricky: most sincerely seem to want to be part of the solution, however far off. But most are also very young and very poor -- an ethical conundrum for researchers.

The picture above is not mine, but shows one of the murals painted on the walls of the hospital complex. I've come away with lots of notes and lots of questions. I'm planning to be come back in August to do some follow-up, and also (I hope) to set up a TV version of the story with colleagues at Reuters Television.

Friday, June 27, 2008

Africa Time


I'm remembering why -- for the impatient or the uninitiated -- "Africa time" can be so frustrating! The way that appointments slip and slide, people commit and uncommit..for a reporter it can be daunting trying to figure out what is really going to happen when (or if it will happen at all!)



In my case, today, it didn't. Spent several hours waiting at Bara Hospital for two of the Phambili trial participants who said they would take me visit an AIDS hospice in Soweto. I had hoped that this would give a good view of how the disease is hitting the community, as well as a window into the motivation of the (by and large very young) South Africans who opted to take part in HIV vaccine research trials.

But the wait was fruitless -- despite several phone calls and updates, they never came. I guess I'm not surprised: it is asking a lot of someone to guide around a nosy foreign reporter. And it is Friday afternoon! Still it's too bad. The hard part about this project will be breaking out of the confines of clinics and offices to see how people really live. I'm not there yet.

On the upside, I had a great, 1-1/2 hour interview with Glenda Gray, the principal investigator on the Phambili trial. "Prof. Glenda", as she is almost universally known by the Phambili crew, is certainly an effective advocate for the AIDS vaccine enterprise, and despite the disappointing results so far she seems ready to carry on. One interesting element that was underlined during the interview was the tension between researchers and government health officials. Most top-ranking HIV clincians and researchers in South Africa are white, so inevitably the argument over who decides where to go with clinical trials (done mostly on black citizens) takes on a racial tinge.

But that's the way it is with almost everything in the "Rainbow Nation" -- a country publicly and sometimes angrily wrestling with the race questions that bedevil so much of the world.

Wednesday, June 25, 2008

Journalist, Don't Distort Me



Yesterday I had a long talk with Gloria Malindi, a 60-something Soweto grandmother and retired nurse who also serves as chairperson for the Community Advisory Board at the hospital's vaccine trial site.

Gloria has the cuddly look of a South African "go-go" (granny), but she's no slouch when it comes to self expression or the right to protect herself from misinterpretation.

"Journalist, don't distort me!" she warned, before giving me her two cellphone numbers.

The Community Advisory Board (CAB) is an important part of a vaccine clinical trial, serving as the main conduit between the scientific researchers and the community upon whom the research is being conducted. The Soweto CAB includes nurses, teachers, religious leaders and a hefty helping of HIV/AIDS NGO workers, who are then tasked with "going back to the community" with information about the trial.

Gloria's more at home than I am in discussing the specifics of the Phambili vaccine, and obviously has logged plenty of time in the dismal world of international health meetings, where words like "paradigm shift" and "relevant stakeholder" are tossed around like confetti.

Like most of the people I've talked to, she's got nothing but good things to say about Phambili and how it was conducted (the caveat being, of course, that like most of the people I've talked to, she was INVOLVED in how Phambili was conducted!). Nevertheless it seems like the system worked: participants felt adequately informed, rights were protected.

As a person this is gratifying -- even if, as a reporter, I'd like a little more controversy! Perhaps that will come as I get deeper into the story -- but perhaps not.

A WORD ABOUT SECURITY

It has been funny getting reacquainted with South Africa's security obsession. Everything is triple locked, gates slam shut, guards issue passes...moving through parts of this country can be like moving through a medium security prison. Today when I went for an interview in downtown Johannesburg, I had to have my car registered at the garage, then sign OUT of the garage as a pedestrian, walk down a short street under the view of security cameras, then sign IN to the building where I was going, get a security pass, and go through turnstiles. It's all done with good humor though and I guess in a country with crime rates as high as South Africa's it is to be expected, but it can make even the bravest person a little phobic!

Monday, June 23, 2008

Trapped in an Elevator!

So today it came to pass that I was trapped in an elevator in Soweto's Chris Hani Baragwanath Hospital with one of the principal investigators of South Africa's Phambili AIDS vaccine trial...

Sadly, we were released after only a few minutes so I was denied every reporter's dream of the in-depth, five hour interview with a subject who cannot escape. And, despite the lost interview opportunity with Dr. Glenda Gray, I was just as glad we didn't end up like this. Glenda says she'll give me an interview later in the week.

The rickety elevator leading up 12 floors to the offices of the Perinatal HIV Research Unit (PHRU) is emblematic of the weird world of "Bara", the main public hospital serving Soweto's more than one million residents. A sprawling medical city, Bara resembles a sort of broken down military encampment. Patients, some in pyjamas and others on crutches, hobble to and fro among the low slung brick buildings, many looking as lost as I felt. I saw one security guard go whizzing past on a bright canary yellow quad bike, looking as though he was headed for the beach.

The PHRU, which is probably South Africa's most famous HIV/AIDS research institute, is housed in Bara's only 'skyscraper' -- a 60's building that is still used mainly as housing for trainee nurses, hence the nickname "Nurses' Home". The top floor administrative offices have the hush carpeted feel of a downtown law firm, but at the action level on the ground floor there is the low-level chaos that seems to mark much of Bara. Mothers, many with their babies tied African-style across their backs with warm winter blankets, queued for transport chits while the main infirmary was jammed with people waiting appointments to discuss ARV medication with clinic staff.

Dr. Guy de Bruyn, a young South African MD who did his training in Houston and Seattle, kindly gave me the tour, ranging from the PHRU's first outpost as a site dedicated to fighting mother-to-child transmission of HIV, to its more recent additions including a shiny lab and research offices working on everything from couples' counseling to outreach into South Africa's gay and bisexual community along with investigations of new medicines and other interventions.

The impact of the U.S. Pepfar program on AIDS funding is clear in the PHRU, but one wonders how much of the largesse trickles into other parts of the huge hospital complex (clearly it doesn't go for elevator maintenance: de Bruyn told me all the elevators were out for four months (!) last year meaning that people had to hoof it up 12 floors to do everything from hold a meeting to deliver toilet paper).

I have made a base with the kind people at the office running the Soweto site for Phambili, which continues to collect information on study participants despite being forced to stop new injections of the AIDS vaccine candidate last year. I'll have more on them, and interviews with the formidable women who serve as clinical trial recruiters, as the week continues.

Friday, June 20, 2008

Dateline:Klerksdorp (?)


I was scratching my head too, but Klerksdorp is where I found myself on Wednesday as I began two days of interviews at the Aurum Institute's AIDS vaccine trial site.

While the STEP AIDS vaccine trial and its South African counterpart Phambili were both stopped last year, work is still going in places like Klerksdorp to try to make sense of what happened and where the vaccine enterprise is going from here.

One of the old South African towns built on the gold that made the country rich, Klerksdorp is still surrounded by mine complexes run by major miners such as AngoGold Ashanti, which established Aurum in 1998. The institute is now a public non-profit, however, and is one of the major HIV research groups in South Africa.

It was an interesting couple of days -- I met my first few AIDS vaccine trial volunteers, and sat in on a meeting of the trial's Community Advisory Board which included in its number both a Christian minister and a traditional healer or sangoma ( "He's a witchdoctor!" one of the other board members whispered to me with a smile.)

People were very open about their hopes and disappointment over Phambili, and where they see the vaccine project going. Most said they believe work has to continue. "Many people are dying. My people are dying" one of the trial volunteers said to me.

For the rest of it, Klerksdorp looks alot like Riverside County, California -- a small old downtown surrounded by a vast wasteland of car dealerships and strip malls, eventually flattening into bushveld and mine dumps. The city's small museum is mostly under renovation but did feature a weird exhibit of different cells once used to house blacks and whites, complete with black and white plaster figures.

I'm still going over what I got from Klerksdorp and experimenting with my new digital recorder. Its great to download interview files to the laptop, but listening to them has really made me aware of how cold and clinical my interview style is -- I'm no Oprah, but I guess that's no surprise. I have to work on it though.

I've had patchy Internet connectivity this week but I hope it smoothes out now. I'm still just fooling with this blog but let me know what you think.

Friday, June 13, 2008

"Dr. No" under fire after ruling....


South Africa's health minister Manto Tshabalala-Msimang -- known as 'Dr. No' for her long opposition to anti-retroviral drugs -- gets whacked again after the Cape Town court ruling...

This woman has the heart of a misguided lioness -- she will never give up. If only she'd been fighting for the right side

S.Africa Court: Down with the Quacks!

This is great!

Matthias Rath et al have been poisoning the S.African AIDS discussion for years, giving false credence to the denialists and generally muddying the already muddy waters. In a country where there is already so much fear and misunderstanding, these guys tried to increase both. The court said no and I say VIVA!

Thursday, June 12, 2008

useful: weird world sockets



With all of my electrical adaptors strewn around the room, I just re-ran across one of my old favorite companies: Adaptelec.
They can tell you exactly what kind of elecrical outlet to expect when plugging in your hairdryer in Kiribati or your laptop in Lithuania....

Wednesday, June 11, 2008

Countdown for Africa Reporting Project


I'm due to leave on Sunday to begin my three month Africa reporting project. I'm looking forward to it, but also a little nervous -- I hope I can do justice to all the time and effort people have put into this!

Here's a summary of the project:

FOOTSOLDIERS IN THE GLOBAL AIDS BATTLE

Nieman Global Health Fellowship 2008 Fieldwork Proposal
Andrew Quinn

GOAL: To illustrate the search for an AIDS vaccine by telling the stories of African volunteers who put their bodies on the line in clinical trials – a process which for participants involves both some of the greatest promises and sharpest risks of scientific globalization.

SUMMARY

Developing an AIDS vaccine has long been a major objective for the global health community, spawning an industry of advocates, researchers, bureaucrats and program directors all pushing toward the goal of immunizing people against HIV.

But while the media often depicts the vaccine hunt as taking place chiefly in high-tech research labs, it is in reality an increasingly global project and relies heavily on volunteers in both in developed and developing countries to test potential vaccine candidates.

The research has thus far produced little but disappointment, including the failure of a promising candidate vaccine last year which has slammed the brakes on most active trials around the world. But the hunt goes on, both in laboratories and in follow-up among participants in trials already under way.

My reporting project aims to examine this process, focusing on clinical trial projects in Africa.

The project will center on volunteers, and particularly on how they were recruited for the vaccine drive and what motivated them to participate. It will also look at what impact the string of vaccine failures has had on morale – a potentially significant factor for researchers contemplating future trials.

The role the Gates Foundation, the U.S. government and Western pharmaceutical firms will also come in for scrutiny, as will Community Advisory Boards and local governments which have facilitated interaction between local communities and the global AIDS establishment.

I envision a package of health features for the Reuters newswire, which could provide an effective worldwide showcase for the story. I also propose writing a longer, in-depth piece to explore more fully the promises and pitfalls of globalization in the AIDS vaccine campaign.

Since the original proposal I've also added a segment looking at malaria vaccine research -- particularly the RTS,S vaccine candidate being promoted by the Path Malaria Organization. They are gearing up for what will be the largest clinical trial ever undertaken in Africa, and should be an interesting counterpoint to the gloom surrounding the HIV vaccine campaign.

I'll be blogging here and there during the trip, which is going to last about three months and take me to South Africa, Kenya and Tanzania.

Peter Piot leaving UNAIDS

The U.N. system is losing a good one: Peter Piot says he leaving UNAIDS.

Piot has been a tireless and savvy fighter on the AIDS front for years, putting the squeeze on both Western governments to come up with the $$$ to fight the disease as well as developing country leaders to get serious about confronting the challenge at home.

I've seen Piot in action in Africa, China and the United States and he never failed to impress with his good humor despite some pretty dreary circumstances. UNAIDS is always going to be political, and always going to be controversial, but Piot was a model leader for such a crucial organization.

No word on a successor, but here's a suggestion: South Africa's Nozizwe Madlala-Routledge

Monday, June 9, 2008

WHO backtracks on hetero AIDS threat



The UK's INDEPENDENT newspaper has following story, quoting senior WHO official as saying world now unlikely to see heterosexual AIDS pandemic. Seems pretty obvious if you look at the numbers, but will still be interesting to see how this plays at the AIDS Conference in Mexico City this summer.....

A 25-year health campaign was misplaced outside the continent of Africa. But the disease still kills more than all wars and conflicts

Monday, May 26, 2008


Back from New Orleans...really good trip. Saw lots, ate lots. Now tired. Test post.