She Loves Me

OR AT LEAST she reads my blog.

MQVB is back, across from the Peloustore. As you can see, they do cost 200 Cf. The question is for how much. I still don't really know. What I did was fork over 400 Cf (about 70 cents) for six of those yellow beauties. My sense is that she and I were both pretty happy with the terms of that transaction. Take a look at my prizes, all nestled up and cozy, luxuriating atop my hotel TV. You can calibrate their size against the Pop Tarts box.

Postscript: Now there are five.

The Medical Detectives

THIS IS THE BOOK I'm now reading. It's an anthology of "Annals of Medicine" articles that Berton Roueche wrote for The New Yorker from the 1940s through the 1980s. (More here on Roueche if you have full-text access to the New England Journal of Medicine.) Roueche was a great writer, to be sure, and many of his pieces are classics. The best known is probably "Eleven Blue Men" (sodium nitrite poisoning in the Bowery; sound familiar?). Another example is "The Liberace Room" (histoplasmosis outbreak among schoolchildren in Arkansas).

So, yeah, great writing and interesting topics.

The rub is that much of the sleuthing that cracks the conundrums reported by Rouehe relies on epidemiologic methods that seem a bit, well, quaint. (Props here to Prof. Art Reingold, who used Roueche's "The Santa Claus Culture," published in 1971, to illustrate the limitations of old-school epidemiologic methods in his outstanding "Outbreak Investigations" course that I took last year at the University of California at Berkeley's School of Public Health.)

Roueche's articles generally feature smart, observant, committed epidemiologists, statisticians, public-health practitioners, and clinicians -- not to mention very astute patients. But the epidemiologic methods that Roueche recounts his subjects using were limited (at best) and do not include many now-standard ones. What about developing a questionnaire? How about a case-control study? A cohort study? That's what you want to ask these folks. (Actually, I have been doing just that. Not audibly, of course. Just very loudly inside my head. But for an introvert like me I figure that is pretty much the same thing.)

Anyway, the bottom line is that some of the vignettes are more reminiscent of Encyclopedia Brown than MMWR. Consider "A Game of Wild Indians," about an epidemic of typhoid fever in Manhattan. Ultimately, the critical clue emerges from a chance encounter between the investigating epidemiologist and the superintendent of the implicated apartment building. "I walked right into it," the epidemiologist tells Roueche. "It was mostly pure luck."

But read it anyway. The Encyclopedia Brown books are, in the end, pretty cool too.

Le 30 Juin

HAPPY DRC INDEPENDENCE DAY. The Democratic Republic of Congo (DRC) gained independence from Belgium on June 30, 1960. That's the DRC flag and a map of the country. (I'm in Kinshasa.) Get more info on DRC from the BBC.

Bananas and Apricots

I REALLY DON'T want to perseverate about FRI (fruit-related issues). So I'm going to try to keep it to this single post. But I've been sans bananas for a couple days now, which is rare for me. I like bananas, as you know from the earlier post.

So you're probably wondering why I didn't just pick some up at Peloustore. Well, they don't have them there. I looked. Twice. (Yes, I know; Peloustore does have plaintains; that's wonderful, truly; hooray for Peloustore and hooray for plaintains; but plantains are merely bananalike and don't really count as bananas per se.)

What they do have at Peloustore is lots of other fruit, including apricots. Apricots were selling today for 12,000 Cf (Congolese francs) per kg. At an exchange rate of 550 Cf per dollar, that's $21.81 per kg, or $9.92 per pound.

So right now I'm basically just happy that I like bananas a lot more than apricots. I mean, I can do without apricots. But not really without bananas. Which is why I'm really hoping the banana-seller-woman returns soon. Ou etes-vous, madame qui vend bananes (MQVB, in case she likes abbreviations as much as I do)? Oh, and bananas, as far as I could tell, were going for 220 Cf/kg at her stand across from Peloustore. I'll keep the blog updated in case she returns and you want to catch her while she's still there.

Another thing about Peloustore, while I'm at it. While produce prices are marked on the bins where each item is stored, that's not the case for most nonperishables. Those are marked with a number between 1 and 100. You then have to look on a xeroxed sheet that tells you the price in Cf that corresponds to each number. Likely that's because inflation is running at an annualized rate of 64 percent, according to a report from the U.S. Embassy in Kinshasa, which would mean they'd have to change the price tags on individual items often. So I understand that. But it would be nice if all items actually had number tags attached to them. Many don't, leaving one to wonder, when apricots are so pricey, how much items will actually cost at check-out.

(Quick note: That Embassy report lists bananas as "1000." Either I'm wrong about the listed price or I've found a frargain [i.e., a fruit bargain] chez MQVB. I'll let you know after I've bought myself a decent supply, so that her stand is not overrun before I get there.)

Prices of other items: A loaf of bread set me back about $1.50. A 1.5 L bottle of water (swissta brand) was just under a buck.

Alright, this was a long post. I can't guarantee I won't revisit this or other FRIs, however. You'll have to check back to see.

Le Boulevard

LE BOULEVARD DE 30 JUIN (that's June 30, Independence Day, tomorrow) is just around the corner from Residence Les Voyageurs. It's one of the main drags in town. Peloustore is a supermarket just a few minutes away. A good selection, but pricey. Philadelphia cream cheese is about 9 bucks, Head and Shoulders about 10 bucks. They take Congolese francs or U.S. dollars (as long as the latter are in pristine condition -- seriously).

I was looking forward to buying some bananas from a woman who was selling bananas (imagine that) yesterday. But she was not there today. I hope she comes back tomorrow. I do like bananas. Please come back tomorrow, banana-seller-woman, if you are reading this blog. Merci.

Residence Les Voyageurs

HERE'S WHERE I'M STAYING in Kinshasa. It's a hotel with a pool, gym, tennis courts, and a bar. There are photos of the nondescript entrance, the courtyard, the doorway to my room, and those amenities.

Last night there was music playing outside the hotel bar and a lot of young Congolese hanging around. I was hoping to see some dancing; the Congolese are famous for that. But there was no dancing, just the sort of milling about you'd expect at, say, a Bar Mitzvah. Before the booze kicks in. I haven't run that analogy by any of the Congolese. Yet.

Anyway, the tennis courts seem to be clay courts, which I could confirm if I'd ever played on clay before. Yesterday I played with an instructor - le 'prof,' qui s'appelle Paul. His rate is 10 bucks an hour. He might be a good instructor; you should ask someone who can take instruction in French. The real bargain is the ballboy, who works at 2 bucks an hour.

Map of Africa

I ARRIVED IN KINSHASA, capital of the Democratic Republic of Congo (DRC), on Friday, June 27, 2008. The black arrow on the map points to Kinshasa, the red arrow to Nairobi.

KEMRI

KEMRI IS THE Kenya Medical Research Institute. Note the photos related to HIV testing on the road near KEMRI.

Nairobi street scene

A STREET MARKET near Kenyatta National Hospital.

Personal protective equipment (PPE)

Personal protective equipment (PPE) is important to use when dealing with dangerous cases of flu in people or animals. There is a tear on the backside of the PPE belonging to one trainee who, while remaining nameless, is considering Atkins. Again.

Training site

HERE'S WHERE OUR TRAINING was held. There's a tent nearby where Kenyan food, including rice, chapatis, ugali, lentils, chicken, and stew, is sold at lunchtime.

Influenza sentinel surveillance training

I WENT TO NAIROBI with 4 colleagues from the USA and a few others to be trained on sentinel surveillance systems for influenza. Influenza (flu) is a viral disease that typically causes respiratory symptoms as well as other (you guessed it) flu-like symptoms. In kids in particular, flu can also cause gastrointestinal symptoms. Influenza causes significant morbidity and mortality each year in the USA and worldwide, particularly among kids and the elderly.

One big concern is that a new subtype of flu will emerge and spread among humans, causing a pandemic. Flu is subtyped by H's and N's according to which hemagglutinin and neuraminidase proteins, respectively, it expresses. Right now the major subtypes affecting humans are H1N1 and H3N2. Birds are affected with a subtype called H5N1 that's more pathogenic. According to the World Health Organization, as of June 19, 2008, 385 humans are known to have contracted H5N1, and 243 of those have died. But there hasn't yet been sustained human-to-human transmission of H5N1. Yet. That's the concern, though, about avian (or bird) flu. A pandemic could be a major public health problem. To say the least.

Having a surveillance system -- that is, a system that monitors the number and characteristics (including subtype) of flu cases -- will allow us to better understand who gets flu, what subtypes of flu are around (to determine the strains that next year's vaccine should target and to identify whether new subtypes -- like H5N1 -- have emerged in humans), and how much morbidity and mortality flu causes. So flu surveillance is conducted in the USA and in an increasing number of countries abroad, including African countries. My task in the Democratic Republic of Congo is to help get a flu surveillance system off the ground here.

The week-long training in Nairobi aimed to teach us how to get a surveillance system up and running -- a challenge in general, but particularly in countries (including some in Africa) with less developed infrastructures for health care and in general.

In Naioribi and other places in Kenya there are already flu surveillance sites. One of them is at Kenyatta National Hospital (KNH), one of the largest hospitals in the country, located in Nairobi. We toured KNH and the National Influenza Center (NIC) laboratory near KNH to get a better sense of how the system works there.

There's a shot of me in front of the Kenyan Centre for Public Health Research, where the NIC
is located. There's also a photo of me and my brother and me and other trainees and a surveillance staff member, both in front of KNH. A really nice, motivated, and smart group from Kenya, the USA, and other countries...

Mathare slum

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ON MY FIRST FULL DAY in Nairobi (Sunday, 6/22/08), I went with my cousin David Rochkind, who's a widely published photojournalist. He's been doing some projects in Mathare slum, the second largest slum in Nairobi. Housing there is mostly corrugated tin shacks with dirt or cement floors. There are a few apartment buildings. Sewage runs in open troughs in the middle of the dirt paths that run through the slum. It was laundry day, so clothes were hanging on clotheslines between houses throughout the slum. We met some Mathare residents whom David knows. They took us to a Protestant church, where 20 people (including David, me, and two women David knows) fit into an approximately 8 foot x 8 foot room for a rousing church service, complete with Bible readings and songs accompanied by percussion. Most was in Swahili (or Luo?), so I was pretty lost.

Others in the slum were at church, working (selling various things, washing clothes, making moonshine), or playing (including Ludo, a backgammon-like game [I bought a board; a photo of one is below, but the handmade ones are much cooler]).

In light of the poverty and issues with hygiene (at least by developed-world standards), you might think it would be a grim place. Quite the opposite, however, is the case. People were incredibly friendly and hospitable. Lots of smiles and laughing. That might be because they knew David. Or because that's the normal response to seeing a devilishly handsome bald dermatologist. Hard to tell.

Anyway, that's David with the kids of a couple of the women he met, in one of their apartments. (We went into a few apartments; again, incredibly hospitable there.) The other photos are of me in front a small shop that sells, among other things, Kensalt.

Nairobi

I ARRIVED AFTER 30 HOURS (San Fran to DC to Zurich to Nairobi). My older brother Mark, who works in Nairobi on influenza, met me with his SUV at the Nairobi airport. I stayed at his apartment (not at all shabby, let's leave it at that). Here's Mark with his SUV.