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 it should be fun.

I've been fretting about "narrative arcs" and "stories behind stories" with this 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 (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.