A quick post to highlight an important event: World Malaria Day! We celebrate WMD every year, on April 25th. To say the least, it holds some weight to me with my work, and proud to say this year’s festivities were Namibia’s greatest. With the country’s steady decline in malaria cases, marked with their shift from a control to elimination stage, Dr. Margaret Chan, the Director General of the World Health Organization, made a first-time visit to Namibia:
Much credit goes to Namibia’s Minister of Health, Dr. Richard Kamwi, for his persistent requests to Dr. Chan, never giving up the chance to proudly display his country’s progress in the fight against malaria.
Preparations:
The special events began on Monday when Dr. Chan arrived. Early in the morning she met with the Prime Minister and then followed with a speech to the Namibian Parliament. Not only was this a special parliamentary moment to mark Namibia’s heath improvements and the important link with the WHO, but Margaret Chan became the first women to ever speak to the parliament and state house officials. Her eloquent and strong speech concluded with a standing ovation.
The activities continued on Tuesday evening when WHO used this visit to launch their new malaria surveillance guidelines and their “T3” initiative. Here is Dr. Chan and the Honorable Minister Kamwi getting ready for the launch:
With this event, they have become good friends, and she commended his dedication and efforts numerous times during the World Malaria Day activities.
The ‘T3’ stands for “Test, treat, and track”. Ensuring every suspected case of malaria is first tested before receiving treatment, combined with vigilant surveillance is exactly the malaria mantra that we have been chanting during my first year working in Namibia, and we were quite pleased to see the WHO encouraging and pushing these messages with their new initiative. Part of Dr. Chan’s entourage included Dr. Robert Newman, the Director of WHO’s Global Malaria Program, who presented T3. During his speech I was excited when he highlighted the need for cross border work, and mentioned our Tans-Kunene Malaria Imitative, the malaria cross border project we launched last year with Angola and Namibia! It was fun hearing those words out of the WHO malaria leader’s mouth:
A critical issue that Dr. Newman brought up was the need for increased domestic investment in malaria, along with donor support, to help Namibia cross the barrier into malaria elimination. It is something we have been stressing with private companies within the country, especially with the global financial crises threatening the gains made over the past 5 years. In fact this year’s global malaria day slogan was: “Sustain gains, save lives, invest in malaria”. With Dr. Newman echoing our concerns, we hope that it had some resonance with the stakeholders present.
Malaria is still a killer, in Southern African particularly, where a child still dies every minute. I try to remind our donors, especially form the US, that the figure equals a “9/11” worth of children every day. Astonishing. We are lucky that this is not the case in Namibia, but have to be reminded of what can happen if our efforts slip.
After the document launch, the festivities continued with a pleasant reception and long dinner that of course included more speeches. Some came from the EU Ambassador, the US Ambassador, the Permanent Secretary, the Minister of Health, and of course Dr. Chan herself.
Minister Kamwi:
Margaret Chan:
She did not have a formal speech prepared, but took notes during the presentations and addressed topics she felt was relevant. I was impressed with her presence, engagement with the room, intelligence, and warmth. Not to mention, I was quite pleased she read the malaria briefing given to her prior to the event and was on point with the state of malaria within Namibia and highlighted key issues.
To lighten the evening, the dinner also included performances by some of Namibia’s young artists. One in a friend of mine, Shishani, and I was so happy that she could make the event. The head of one of the international malaria organizations, ALMA, even bough a copy of her album and Dr. Chan quoted one of her lyrics! “Stay true to yourself”. Way to go, Shishani:
The night came alive when the artist ‘Tequila’ performed, bringing the Minister of Health to his feet, followed by Margaret Chan! Once they were up, everyone followed and it was hilarious seeing her rock out and smile to the music. We knew the rest of the events would be a breeze!
The following day was the main event, where World Malaria Day was commemorated in the north of the country in the second largest city, Oshakati. Our northern malaria office is located there and has the country’s biggest district hospital, where the DG was welcomed:
Health staff gave her a warm reception, and the delegation met in the hospital assembly hall where Dr. Chan addressed the room:
She commended Namibia on the progress made in controlling malaria and gave credit to all the right staff, from the health workers, to the spray men and women. It was a special moment for the Namibians in the north and I was proud to be witness to that historic day.
The crowd filling up Oshakati Stadium, with Margaret in the foreground:
Ovambo cultural dance:
Here is Permanent Secretary Kahuure, WHO country rep, Dr. Robalo, Minister Kamwi, and Margaret Chan in a presentation of WHO donating bednets to Namibia:
Then Dr. Chan helped launch our own ministry malaria documents!
The festivities concluded with Dr. Chan visiting a health facility where local nurses demonstrated proper use of our malaria rapid diagnostic tests and indoor spraying techniques. Here Dr. Chan looks over the RDT procedure, with the new diagnostic posters we just developed, proudly hanging in the background:
Now we will see if this visit will boost private sector and donor commitment to malaria elimination in Namibia. The next steps will be to continue outreach while we still have the momentum, but for now, I need a break! Off to visit some waterfalls in the north and camp under the stars as I recharge the batteries. A special shout out to my friend, Michelle Thulkanam, the WHO communications officer for Namibia, and the one responsible for making WMD 2012 a complete success. Thank you, Michelle! The preparations were hectic to say the least, but we worked with smiles, so thrilled for the chance to showcase Namibia in their fantastic malaria accomplishments. Happy World Malaria Day!
“I am proud to be here in Namibia. This is a perfect place to celebrate World Malaria Day and consolidate our optimism about the prospects of freeing this world from an old and tenacious killer.”
- Dr. Margaret Chan, WMD 2012
I am breaking my own rules. The obvious relationship of blog title and entries means I write about Namibia. Not this time. As much as I am completely overloaded with material and pictures from Namibia, a large potion of my time has been spent outside the country. I would not be able to share my complete experience without covering those trips, and the justification to this post is that they would have never occurred if it was not for my Namibia work. It has opened doors to explore Africa, and these adventures have shaped me just as much. An important one, for both the student and explorer in me, was my trip to Zanzibar.
MEG
The malaria ‘elimination’ global community is not that large. In fact, it is a small family, and this allows the opportunity for all of them to meet. As I have mentioned in previous posts, I am part of the Southern Africa Malaria Elimination Support Team (SAMEST), a long name I know, but as a true public health partnership, of course we needed an acronym. Silly.
As part of SAMEST, I am linked with the Global Health Group (GHG) in San Francisco, who is responsible for establishing the Malaria Elimination Group (MEG). Yes, I live in an acronym soup.
MEG is a group of 50 international experts “brought together to elaborate the scientific, technical, operational, financial, and programmatic issues that countries need to consider when pursuing or embarking on malaria elimination”. Basically, MEG is a bunch of malaria elimination celebrities. Half of these professionals I know through journals and stories, with most having a big part of the history in the fight against malaria. It was a privilege meeting them, to say the least.
Below, is our group shot. I think it was the first time the hotel staff person held a camera, but think he did quite well:
Every year MEG has a meeting to go over specific issues and concerns facing global malaria elimination. The 2011 location was Zanzibar. How inconvenient:
As much as I believe this location was truly chosen for its paradise environment, Zanzibar is approaching malaria elimination itself, and the meeting was elected to celebrate its successes. Since we are directly involved with elimination efforts in Southern Africa, we were invited to attend (not without a tiny push from our manager. Thanks Deepika!).
In celebrating Zanzibar’s accomplishments, we would be able to visit the Zanzibar malaria control program (the ZMCP, an equivalent unit to the one I support in Namibia) as well as hospitals, village clinics, and the communities themselves.
What an opportunity for a true glimpse of the area, and a welcomed balance to us sitting around a hotel conference room all week.
Going from the west side of Africa to the east, is no easy task. However, even with no-show airplanes and 4am layovers in shutdown airports, I was still giddy putting my feet in the east coast soil. After 3 flights and two days, I finally arrived:
Before we got down to business, my CHAI team and I took advantage of our time on the island and arrived the weekend before the MEG conference. It not only allowed us a chance to explore Zanzibar on our own, but gave us some much-needed team time. My colleagues from South Africa and Swaziland respectively, Allison and Joe, were there, as well as our manager Deepika. Allison and Joe are not only my CHAI family, but are great friends from my public health days at BU.
Here I am with Allison and Joe. Is this really what an elimination team looks like?
I still pinch myself knowing that I have my good friends on my work team, it is a fun and fortunate combination. Joe took care us and did all the bookings for the first weekend in Stone Town, and some ocean adventures at the tail end of our trip. We wanted to close our week gliding through the waters on one of the typical Zanzibar Dhow ships. I love those sails:
Those of you not familiar with Zanzibar, it is a magical mixing pot, blending in bits of Africa, the Middle East, India, and Europe. With the boundaries of surrounding water, these influences have aged and matured on this island to create a vibrant culture and identity.
It has a rich and complex history with exploration dating back to the Greco-roman and Persian empires, to the Portuguese and British, and private holdings by an Omani sultan.
Zanzibar is actually a semi-autonomous island archipelago, off the coast of Tanzania. One of its main industries is spice production (cloves, nutmeg, cinnamon, and pepper) which lends itself the knick name the Spice Islands. Random fact: At one point, Zanzibar was the world’s largest clove producer after the Omani sultans brought the spice with them from Indonesia in the 19th century. I hope you can use that on jeopardy one night?
Here is one of the many spice fields:
Stone Town
Our first weekend concentrated on the old center of the capital, called Stone Town. Mji Mkongwe, Swahili for “old town”. This area is a World Heritage site, and has tremendous historic and artistic importance for East Africa.
For centuries in was an intense and crucial sea-trade link between Asia and Africa, and the fabric of history envelops the entire city.
The architecture found here still holds the Arabic, Persian, Indian, and European design from its early explorers. The Arabic design dominates however, with the country primarily being 98% Islamic, which is clearly depicted in the conservative dress, beautiful doorways, and call to prayer:
With its traditionalist and conventional way of life, Zanzibar still gives off a sense of welcoming and warmth to foreigners, primarily due to the dependency on tourism.
Due to its preserved heritage, Stone Town is a popular tourist attraction for the islands, with tourism remaining one of Zanzibar’s primary forms of income.
The people in this old city center are extremely kind and hospitable, but some can become even smothering to the visitors as they try to sustain themselves off tourism. Despite this constant bombardment, the old town provides a warm and stimulating atmosphere of tight, winding streets, colorful shops, and taste of time travel.
The town is a maze network of picturesque narrow alleys filled with bazaars, tall apartments, mosques, and cafes.
Joe and I were the first arrivals, and our main goal on day 1 was to get lost in those alleyways. We easily succeeded:
I didn’t think it was possible with the seemingly small size of the town, but after a few twists and turns we were deep into the heart of Stone Town. I loved every minute of it, and this dense, colorful, old city was a stark contrast to the open, quiet solitude found in Namibia.
Here is a montage of Stone Town entryways, alleyways, window-ways, and every-ways…because of course I went photo-crazy:
Our cute guest house was right in the middle of Stone Town and was an easy starting point to stroll around the neighborhood. Even when we were caught in the rain, it was a pleasant walk and we knew the powerful sun would dry us in minutes.
The threat of more rain didnt stop these guys from catching some premiere league soccer action:
Joe and I had the second goal of the day getting in the ocean. The Stone Town coastline is probably the worst on the whole island, since it is primarily a port town filled with industry and boat traffic. Not the open paradise beaches found on the East Coast of the main island, but for us, the warm water, hot sun, and busy boat atmosphere hit the spot:
I think we were the only white people to jump in this water, and were surrounded by a sea of local children laughing at us two silly guys. We were as happy in that port as they were.
Here are a few of our explorer friends. I still dont know what they were looking for:
Finally we were joined by our counterparts, Allison and Deepika, and more lazy Stone Town explorations took place.
Deepika and Joe leading the way, as Allison and I lag behind with our cameras out:
I never would be sick of walking those streets.
It was great having the full team together, we don’t get that much time to hang out, so we take the opportunities we can.
With the Indian ocean, spices, and roots, Zanzibar provides a nice change of cuisine as well. I tried to have some kind of sea food every day, and each one was better than the next, with one amazing curry or sauce after another:
MEG Conference
The weekend sailed by and then it was business time. The MEG conference took place at the nicest resort I think I have stayed.
It was located in a secluded area of the island, with an amazing pier and private beach:
It was such a contrast to the small villages we passed through to get there, it felt alittle out of place. However, we were not going to pass up a chance for brief resort living, especially when our brain will be on overdrive for a week.
It was quite amusing being at this hotel; definitely a romantic spot.
So it was basically honeymoon couples and a bunch of malaria scientists. Interesting. If we were stuck in this resort the whole week, it would have given such a skewed and artificial perspective on Zanzibar, we were so lucky that the week included trips to the national malaria program and community clinics.
Our program tour started with a look at the malaria control office. They had an impressive team and facility. Their labs were top notch and a big difference to the rural clinic labs we would see later in the day:
Here is the insectary where mosquitoes are tested and studied, a key component of any malaria program and one that we are struggling to support in Namibia:
Here is the MEG gang at our first rural clinic. Like the rest of our tour, we were warmly greeted by the local staff:
Here the staff describes their use of cell phones for malaria case reporting:
MEG and the locals discuss some of the challenges and issues with the cellphone-based reporting system:
Our next visit was with a community group responsible for educating the public about malaria prevention. Again, they were open to share their experiences and barriers.
Here is MEG and the community group:
One issue discussed with the community group was advocacy around bed net use, an important preventative method. With the malaria threat decreasing, some villagers began using the nets for other purposes. Here, this one farmer used a bed net to protect his crops. Smart guy:
This is a challenge facing many malaria eliminating countries, including Namibia. In the north, villagers are using the nets to capture fish during the flood season. We have to think of practical solutions like teaming up with the Ministry of Fisheries to provide fishing nets along with our malaria nets. With this, we will still need to increase education on the proper use of each.
The final stop was at a regional hospital to examine their malaria diagnostic and treatment capabilities.
d
Some of the facilities were definitely in some rough shape, but they still successfully support all blood analysis at the hospital. Impressive work, considering the limited availability of lab products and tools:
As a biology boy, have to give a shout out to the trusty microscope. Instructions on the wall for preparing and reading malaria parasite blood slides:
I felt like I was able to experience a part of Zanzibar that is rarely seen by the tourist and I think the whole MEG group had that sense of appreciation of the value that was added to our malaria conference.
This produced a very pleasant vibe for the whole week and I think it made everyone more comfortable with each other and gave us the chance to have some stimulating and candid discussions. Every night I crashed from information overload. My brain had to be set to ‘turbo’ to keep up with some of the brilliant company we had. For example, we met a gentleman from the London School of Hygiene and Tropical Medicine who was the first to discover one of the 4 malaria parasites, P. vivex. We had representatives from the Gates Foundation, who have been supporting our CHAI work directly, and it was a great opportunity to have some one-on-ones with the folks that fund our work. The lectures included regional elimination updates from the Americas, Asia/Pacific regions, and Southern Africa, group breakout sessions on active surveillance, malaria importation and migration, global financing on elimination, and finally some feedback for our Zanzibar colleagues on ways forward in their program. The scientist/public health side of me was in scholarly heaven and was absolutely burned out from my attempts to absorb all the discussion details.
One way to recharge the brain batteries, and an overall highlight for our week, was waking up early every day for a morning swim in the Indian Ocean.
The water was almost too warm, and the morning provided the best time to refresh and clear your mind for the next full day of meetings.
The subject matter, company, and Zanzibari backdrop made the MEG conference one of the most worthwhile meetings I have attended and will keep those memories close as I push through the office work these next few months.
Ocean Adventures
After the amazing yet intense week, we spent the rest of our time in Zanzibar in the ocean. Instead of spending an extra night at the resort, Joe and I went on a mini-adventure to explore the northern tip and eastern side of the island.
If I thought the bay side was beautiful, The east destroyed it. Here it was all open sea, with a color that was more green than blue. Pure, perfect, ocean, the aquamarine tone almost glowing.
I have seen some wonderful oceans in my life, but nothing was like this. I was mesmerized. Something special about the Zanzibar horizon that Joe and I realized immediately was the cloud cover. It gave such a beautiful frame to that sea, to have those deep colors surrounded by these enormous fluffs in the sky, made it dreamlike. How do places like this exist? Call it nature, call it God, whatever it is, it makes life worth it. If everything collapses in the global health world and the economy in Europe or the US finally hits bottom, I will move back to Zanzibar to paint and fish. That is a promise.
Joe and I set our homebase in Nungwi, the small party town at the furthest point North. The highlight was the fact that the main route from the guest houses and bungalows to the cafes, restaurants, bars, etc, was the beach. The coastline was the main sidewalk for Nungwi. Amazing.
Joe and I of course filled ourselves with more fish and curry, and sampled the East African beer. Fun to try beers called “ Kilimanjaro” and “Serengeti”, but it made me appreciate our Namibian micro-brew, Camel thorn. Still my #1 African beer.
We met some nice kids from the UK, and hung out with them the rest of the night. We were also joined by a monkey, who used our UK friends as a restroom.
The next day was all swimming. We smartly sun-screened up, but the Zanzibar sun still won the battle and Joe and I were fried. Never was I so burned. I thought I was invincible with my Mediterranean blood, but I was proved wrong. Ouch. Despite the ridiculous burns, the day out in the Indian Ocean was another highlight of my time in Africa.
Zanzibar concluded in style with a dhow trip complete with some snorkeling, “exotic fruit tasting”, and mangrove lagoon exploration with our GHG colleagues.
It was sensory overload and the life underwater was just as vibrate as the life above. To all by scuba friends, get out to Zanzibar.
The sail going…
Up.
Here is Sir Richard Feachem, the Director of GHG, with his Coke commercial:
Allison and our colleague, Jenny, who will be doing a research project in Namibia with me later this year:
We spent the day, drifting from reef to reef, and soaking in the ocean lifestyle before being sent back to the African interior.
As mentioned above, the dhow trip included a stop at a mangrove lagoon, which had some incredible, petrified reef walls, that were etched away through time:
We stopped at one tiny island for lunch.
Here is the SAMEST/GHG gang enjoying our last Zanzibar meal together:
To have a link between paradise and work is incredible, and I appreciate it even more this last month as I spend day and night cramped over the laptop writing ‘PPP’ reports: policies, protocols, and proposals.
This office work is my punishment for my island adventures, but I will take it, because Zanzibar gave me so much in terms of unique and beautiful memories as well as insight on the work I do. It has enriched my life with a new country experience and a new frame of mind on Namibia. I hope I will get to experience Zanzibar again (and see it malaria free when I do), but until that time, as I sit in a dark cave of work, I will keep those images of colorful streets and fairytale oceans close to my heart.
“…you have to leave the island in order to see the island…”
- José Saramago
Wow. I am absurdly behind on posts, but I will never surrender! Things have kicked into high gear these last few months, as we dove into malaria season in Namibia. Malaria season also coincides with the end of the year, which means major scrambling by the Ministry of Health to tidy up all their leftover projects and to complete all of their malaria prevention activities. This translates to more work for me. I cannot complain because with this intense work came some amazing opportunities to travel to more parts of Namibia and to a few of her neighboring countries (ill report all of this probably 3 months from now, at the rate of these blog entries). I have been living out of suitcases, with six countries in six weeks. Now I am on the road in Namibia for a month to perform some supervisory support visits and training for the health facilities around the country. I have had some fantastic experiences in this last stretch of the year, but needless to say, I am welcoming the holiday break. Almost home!
So where did I leave off with these posts? Oh yes, still trying to cover many of my spring activities. I will make this a double entry and will overload on pictures to make up for my absence:
As the winter closed in Namibia, my friends and I had the itch to get out of Windhoek and enjoy some weekend trips. As I have mentioned in previous posts, weekend trips in Namibia = hiking. Nothing is better than exploring this beautiful country by foot (of course we have to sit through very long car rides first before any walking). There are so many different landscapes, landforms, and landdreams to choose from, that anytime we can, we aim to cover a new territory. This post will cover two favorite hiking/camping trips I took a few months back.
Brandberg
Brandberg is the tallest mountain in Namibia at about 8500 ft. The mountain is not a beast, but since it elevates from the flat surrounding plains, it looks extreme. It is just not just a peak either; it is a wide disk of jagged rock, almost looks like a giant outmeal cookie resting on the countryside. It makes a dramatic sight, and on a clear day, it can be seen from miles in all directions. It can even be spotted from space. It is like Namibia’s birth mark. Here is one of my favorite satellite views of Brandberg:
http://en.wikipedia.org/wiki/File:Brand_hires_trimmed.jpg
I expected to catch site of the big cookie early on the journey, but no such luck. August and September are the dry, dusty months and we had a layer of haze blocking our views. (This time of year is annoying with the dust, but it is the end of winter and gives us reasonable temps during the day for some comfortable hiking. We had to deal with cold nighttime temps, but it was worth the sacrifice.) So, through the haze I kept mistaking every hill for Brandberg. When we finally made it, I had no doubt….
An impressive sight after stretches of flat road. Even more impressive when we drove closer and only saw rock on our horizon:
Brandberg is located in the Northwest part of the country, in an area called Damaraland. I want to minimize my use of “Damaraland” since it is the name given by the apartheid government in the 1970s. It was the forced territory for the relocated Damara people (in a similar story to many of the Native Americans in the United States), and was a hostile environment for the farming community. This stark landscape is quite striking though, and is probably one of my favorite areas of Namibia so far:
The space is so vast and untamed, and even in these modern times, the feelings of seclusion are palpable. It is hard to imagine the isolation felt here by the Damaras in years past:
Amazingly, the Damaras have no known cultural relationship with any other tribe in Africa, and very little is known of their origin. They now represent just 8% of Namibia’s population. The Damara story adds to the mystery of the Brandberg region and gives the beautiful environment a touch of sadness:
The name Brandberg is Afrikaans/Dutch/German for ‘Fire mountain’, which comes from its glowing color which is sometimes seen in the setting sun. Similarly, the Damara name for the mountain is Dâures, which means ‘Burning mountain’. If we tried this camping trip in the summer, we would face temps over 100 degrees. Burning mountain indeed:
África is our hiking leader, and has done many trips in her 2+ years in Namibia:
Yes, her name is Africa. Great having her expertise around, not to mention she is one of my dearest friends here (even if she yells at me for leaving my cell phone and wallet in the wrapped up tent….)
We arrived about midday, and even at the close of winter, it was too hot to attempt any hikes. So we drank some Windhoek Lagers at the camp and built ourselves up for the exploration ahead. That first evening we decided to go on our own quest to find a decent sunset spot and view of Brandberg:
We were a group of four, which was a perfect sized camping team. It included my French friend, Sandrine, and two of my Spaniards, África and Olga (Usually a European flavor to my trips). Sandrine is now back in Paris, and I was real happy I was able to have a trip with her before she departed:
She was a great adventure friend (and laughed at my stupid jokes). We miss her, but breaking news is that she will join us as a neighbor in Botswana! We will rejoice… then probably meet for a hike.
We had our wine for warmth that evening, but it turns out some layers would have helped as well. As soon as the sun dipped below the horizon, the temps fell dramatically. I think it was a change of about 30 degrees in 30 minutes. With wine in belly, we took in the sunset and rushed back to set up the fire for dinner.
Digression: That night I was wound up because I heard that the rare desert elephant has been spotted walking through the camp grounds in the past few mouths. A few minutes after settling in my sleeping bag, I heard some noise outside, and my heart sped up. Could it be some elephants strolling through our site!? Nope. Just a bunch of donkeys. I grumpily wrote them off, but one of them captured my attention. He found out how to open our water faucet with his mouth! Ingenious little bastard. I was impressed. SO, to not waste the water all night, I had to MacGyver rig our kettle over the faucet to protect it from our new donkey friends. How exciting.
We woke up at sunrise and were ready for our big day. Here is another friend that visited us during breakfast:
The next day we had the goal of reaching the White Lady hidden within Brandberg. No this is not some crazy witch, the White Lady is a rock painting. It has been an archaeological dilemma and several different hypotheses have been put forth on its origins, authorship and dating. With recent technology, it was discovered that the White Lady is much older than first thought, and was found to be a bushmen painting dating back at least 2000 years ago:
The White Lady is actually not a lady at all, but a medicine man, in a ritualistic dance, adorned with decorative attachments to his legs and arms. The White Lady-man has some neighbors too. The rock face that it is painted on includes many other bushmen art, even older than the white lady, depicting some animals as well, like the oryx:
The painting has undergone severe damage since it was first “discovered” in the early 20th century. For a few decades, brilliant tourists used to pour water on the painting to make the colors more clearly visible in their pictures, thus causing the painting to fade quickly. Morons. The rock face is now a protected heritage site of Namibia, and visiting is only permitted with official Damara guides. I don’t mind this at all, because these Damara guides are quite knowledgeable about their area and was a good move by Namibia to bring some income to their peoples. No independent tour groups are allowed to setup shop here. You still have to wonder how much of the profits the Damaras get and how much goes straight to the Namibian government…
The area is quite rich in bushmen art, and over 45,000 rock paintings can be seen within Brandberg. I love getting the chance to catch a glimpse of the past, and relished the opportunity to sit and get lost in the paintings. It still blows my mind at the years these paintings have been resting here, a testament to time and the history of man.
Some of the older paintings were quite simple but still held some raw, primeval beauty. Ancient dancers, hundreds of years before the White Lady:
As much as I enjoyed the rock art, the hike in itself was pleasant:
The Brandberg is a spiritual site of great significance to the San (Bushman) tribes of the past and you can see why as you follow the guides to the White Lady. The landforms and flora are quite unique, and give some mystique while surrounded by the high Brandberg walls:
One of the many distinctive flowers living in Brandberg:
Black, magnetic rocks magically strewn all around Brandberg:
Who doesn’t love stepping stones?
The hike was done in the morning and gave us the afternoon to rest in the shade and prepare for another sunset hike. Our camping lodge provides a sweet truck with seats on the roof to cross the high grass and reach one of the surrounding plateaus to climb for a beer and a panoramic view of the surroundings: Smart to not try any hikes through the tall grass, we don’t need any snake bites. In my time in Namibia, I have already encountered 2 cobras on a hike (pictures to come), and we don’t want that tally to increase. Not only did the truck protect us from the potential snakes, but gave us a fun perspective of our path to the plateau:
Once there, we took in the setting sun and had a perfect close to Brandberg:
Nelson Mandela Rock:
Bye bye Brandberg:
Spitzkoppe
This is another favorite mountain range in Namibia. German, for “pointed dome”, Spitzkoppe is a grouping made up of one giant spike of bald granite with its surrounding smaller teeth. Dramatic like Brandberg, rising from the desert surroundings, it still has definite contrasts with the size, shape, and composition of rock. It provides many different hiking options and perspectives, complete with rock bridges, and more ancient paintings. I know Spitzkoppe must be visited again:
This time around, we joined some of our running friends who were doing a 10k relay. We of course missed their race (it was early Saturday morning and some of us couldn’t take that Friday off, shame on work reality for getting in the way), but made it to the festivities for the rest of the weekend. The race atmosphere looked exciting though (despite the heat) and think ill give it a go next year.
Some other race fans:
Our friends did great, all made some solid times, with one group (starting late due to bus issues), still came in second place!
Here is team Suzuki Escudo, Felipe and Samuel, with their prize:
Sam has an amazing ability to always come in second place in his runs, and as my partner in our marathon relay the following month, we continued that tradition with another 2nd place finish! (The Namibia Defense force beat us by 50 minutes, so no chance for us to beat Sam’s tradition!).
So after some celebrating, we went back to the camp to get things set up:
Here is my tent location. I’ll take it:
Here is Klaas, on dinner prep duty:
We setup our “living room” in a sweet spot between some big boulders and had our midday beverage in the shade:
Cheers to the shade!
Here is another shot of favorites; Johanna, Felipe, and Samuel. A perfect blend of Columbia and Spain:
After becoming properly saturated, we went off for (once again) a sunset hike:
Group procession:
Had to stop half way of course for a group shot:
As the usual sunset goal, we climbed up a random outcropping so we could gain some perspective, here to see the colors hit our side of Spitzkoppe:
And then we wait and enjoy:
Closed the day with the great hike and a perfect dinner which included an absurd amount of meat as usual. We had lamb, beef, and kudu I believe:
This weekend was at the start of September, and the temps were already intense. Again, no midday hikes, but different from Brandberg, you could sleep without any sleeping bags or layers at all. Fantastic to stay out and watch the stars, always so bright in Namibia. I will need to attempt some tripod night shots in the future.
The next morning, I woke up early to go on a hike with two favorites, África and Fanny:
We started at sunrise to beat the midday sun. As soon as the sun peaked over the mountain top, the heat was intense. It was good the majority of our hike was early in the morning.
Here is Fanny, will the sun starting to peak in the background. To get an idea of our climb progress, look to the left side of her head and you can see our camping spot:
The hike up was pretty easy and quite enjoyable with some fun rocks to climb, great views, and fun trees. Here are a few of Namibia’s adored quiver trees, hanging off the side of the mountain:
However when we were getting to the summit, some of our climbs seemed demanding and we questioned, how will we will pull this off on the way down? A favorite climbing quote: “Getting to the top is optional. Getting down is mandatory.”
We forgot about our hardships we would face on the return once we reached the top and took in the sights. It was well worth it (Needless to say, our climb down took over twice as long. We were wiped out):
On the summit of this peak, you could see the highest point of Spitzkoppe. That can be reached, but would need some climbing gear. Future challenge?
I really enjoyed both Brandberg and Spitzkoppe for different reasons, each providing their own unique landscapes and feel. Similarly though, (even though both mountains receive many travelers every year) both conjured illusions of exploring ancient, uncharted territories; that each step we took was a step never taken by anyone else:
It was as if this country was designed without humans in mind. I feel as if I am a constant trespasser in a world written in fairytales or nightmares. It is filled with hauntingly beautiful landscapes, and I am constantly humbled by the magnitude of this planet.
Even with my friends present, we have all felt the stark emptiness and depth of our surroundings. It is as if we were magically lifted off Earth and placed into another realm. The landscapes we have witnessed have elements that could be found in a Heaven or Hell, and it still amazes us how these stark contrasts can merge together to form these enormous, neverending, alien landscapes.
Nothing can beat that feeling of conquering a new mountain, charting your own trail, and sleeping under the stars after your successful summit. The weekend tradition of hikes will continue, tt would be a sin if I let this time pass in Namibia without taking these trips. For the past few years, I did not take full advantage of beautiful New England and the outdoor options that she offered. I only managed a few hikes, and I am trying to make up for lost time. I now pledge I must keep a steady contact with Mother Nature, no matter where I end up living, and need the balance of city and countryside to keep myself functioning at 100%. Besides the fun and sense of adventure they offer, they provide a necessary recharge of my batteries after some of the intense work.
This country is built for outdoor activities; I think it has a magnetism pulling you to its furthest outskirts. The landscapes, the stars, the temperatures, all built for perfect hiking/camping experiences. Now we just have to watch out for leopards and we’ll do just fine….
Back to the present day. I am writing this post from the deck of my lodge along the Okavango River. The sun is setting, and I keep getting up to take some pictures. One scene is more beautiful than the last, and I get lost in a trance watching the sun’s colors play off the reflective water. As I write, the crickets are starting their night song, the hippos are having their last chats, and even a lion makes his presence known somewhere in Angola. Now it is past dusk, just at that point where you can make out the last distinction of cloud shapes in the dark sky. Over on the horizon are some scattered flashes. A lightening storm, miles into the Angolan wilderness, is beginning. The only other light now is coming from one small fire I see across the border, some lone souls, possibly looking at the small light from my lodge, wondering about this lone soul. I stop writing and lose track of time as I try to guess where the next flash will come from. You can hear the faint thunder now, as the storm approaches. I turn off all my lights and put this computer away, to adjust my sight to the storm and get lost in the abyss…
I have had one adventure after the next here in Namibia, meeting so many amazing people and having so many stimulating interactions, it is hard to keep track. With so much interaction and stimulation this year, sitting here watching the storm reminds me that the silent and solitary moments will hold in mind just as strong as the exciting times. Like I experienced on my hiking trips, this scene of flashing light on the gaping horizon reminds me how vast this land is and how small I feel sitting in the middle of it. It is just as exhilarating as the moments of action. Next year I will try to do my best to describe these solitary moments that one can experience in Namibia, not just the action adventures. As I continuously mention these strange landscapes, I will try to do my best to describe the feelings one experiences here; the solitude, the excitement, and of course, the awe. The name of this blog started as a joke, but it is becoming more and more fitting. The year was awesome. Namibia is awesome.
So much more to discuss, but all in good time, friends. It has been a year of a lifetime for me, and now feels like only a few days have past. Namibia is defying the laws of physics and ‘time’ has a different translation here. I will hold on to these thoughts, moments and experiences. The only thing missing this year was the chance to share these events with you first hand, and hope this blog opened a piece of it to you. However, I look forward to speaking with many of you in person during the holidays, rather than through this blog. Especially so I can use my hands when I talk….
See you soon!
Ok, time for more work updates. I have to even out my adventuring blog posts with some war-on-malaria blog posts. Some of you must think I don’t have a job, with the bias of my entries, but I assure you that my first six months have been dominated by malaria work. Most of my adventures have been weekend escapes, and as wonderful as they were, not to mention essential for life balance, take up just a fraction of my time. Rightfully so, since I am here to help Namibia eliminate malaria, which might take a bit of effort! Bring it on, parasites… here we go.
As hectic as its been (and at times quite frustrating), I really have been enjoying my CHAI malaria work. As I have mentioned in previous entries, my job is not all locked into office paperwork and politics, but has a healthy fieldwork component thrown in. This is obviously my favorite part, but also adds tremendous clarity to my projects and goals. The fieldwork is instrumental in building necessary knowledge, but more importantly, it provides the true context and perspective that is critical for our potential success. The added bonus is that it also allows me the opportunity to interact with a tremendous variety of people and to explore all parts of Namibia, especially the regions not on the tourist routes:
One of the most valuable field trips I have taken in my initial few months was my northern trek for our Diagnostic Algorithm Study. I have briefly mentioned this study in one of my early posts but here is some background information on the project, as well as a refresher on the Namibia malaria situation:
The country is on track to reaching malaria elimination by 2020. Excellent. One key factor in achieving this target is establishing an effective diagnosis system. If the health workers diagnosis malaria properly, then they can treat properly. Also the more accurate the diagnosis, the more able we are to prevent onward transmission of malaria. Diagnosis is a critical component of an elimination program not only to ensure good malaria management, but will also aid in the patient care overall (as malaria cases go down, fevers are attributable to other causes, and that ‘differential diagnosis’ becomes just as important).
Diagnosis is also the cornerstone for malaria surveillance. So, as Namibia pursues malaria elimination, the NVDCP (the office where I work, the National Vector-borne Diseases Control Programme) must implement the most efficient diagnostic algorithm (methodology) that will capture the maximum number of malaria cases. A more accurate, efficient, and fast response to identifying true malaria cases (in what we call, the passive surveillance system) will trigger active surveillance, where surveillance (or environmental health) officers trace the origin of the malaria case(s). With this, we aim to interrupt local transmission, limiting cases to importation from neighboring countries (with this, comes our cross-border work, but we’ll save that for another entry perhaps). With this improved diagnosis and surveillance, we can actually map malaria risk and identify where the trouble spots are for malaria transmission. The Diagnosis Algorithm Study will also be used to inform and direct the new national diagnosis and treatment guidelines that we are developing.
All clinics in Namibia have stock of rapid diagnostic tests for malaria (RDTs) that can give an accurate test result in about 15 minutes. They are simple devices that just need a drop of blood and some buffer solution:
If used properly, these RDTs are the best diagnostic tools, especially in these rural clinics where microscopy is unavailable. For any result that is unclear, district hospitals do have microscopes for parasitological confirmation of cases.
Health care workers in Namibia have been dealing with malaria for decades, and are quite familiar with the signs and symptoms. When the malaria season is at its peak, and the clinics become over-burdened, some health care workers will treat for malaria just based on the clinic signs rather than using the RDTs to confirm if the person is truly positive. This is a big no-no and happens often in the high endemic regions, Kavango and Caprivi, where a lot of our work takes place.
Although all clinics have RDTs and all district hospitals have access to laboratory diagnostic services, an estimated 50% of suspected malaria cases are treated based on clinical suspicion, even despite negative test results. The over diagnosing prevents accurate reporting and determination of disease trends. This is also quite dangerous, as the true cause of illness goes undiagnosed and has been shown to increase the chance of death.
The aim of this study is to assess the ability and feasibility for the health care workers to test ALL fever cases for malaria.
We also have these secondary objectives:
- To determine the true prevalence of malaria in these 4 sample health facilities
- To establish a list of common risk factors for having malaria
- To design a testing algorithm in order to catch all cases with minimum cost
- To understand the current diagnostic practices, outlooks, and challenges of the health facility personnel
We chose the four health facilities from three high endemic regions in northern Namibia; Kavango, Caprivi, and Omusati. These facilities were selected because of their representativeness of other government health facilities in the malaria-endemic areas and because of their high reported malaria caseloads. These clinics also seemed to be overburdened and their reporting has not been consistent, so it gave us an opportunity to visit, work with, and re-train the clinic staff. We could see where their problems persist, evaluate what they need to improve, and see what we can do to help.
On the trip, I would have ‘Meme’ (title of respect, ‘Tate’ for men) Haidula with me, the national case management coordinator for the NVDCP. She is based in our northern office in the second biggest city (town) of Oshakati. Haidula has been a nurse in the malaria program for over 20 years and is the veteran of the department. Her institutional knowledge is unbelievable, plus, Haidula has such a nice rapport with the clinic nurses. She definitely made my trip easier.
Since this project is under the Ministry of Health, we had to travel in the official 4x4. Sweet. I could have flown up north to meet Haidula there, but figured the ride up would allow us to get to know each other better and to have the chance to review the study protocol. I forgot to mention that the first leg of the trip was a 12 hour drive. Yikes. It would just be Haidula, myself, and the ministry driver Kiwasha. 12 hours. 6am to 6pm. Plenty of time to find out how we would get along on the rest of the study trip, which would last about two weeks. That initial drive turned out to be a great decision though, and by the time we made it to the first clinic, we were the best of buddies, which the health workers could immediately sense. The nurses had automatic trust and comfort with me, when they saw I had a good working relationship with Haidula. It was a tremendous advantage and allowed for candid dialogue with the nurses, and more accurate information for the study. I felt so lucky to have that connection established with them, and lots of credit to Haidula. A huge first step.
During those long trips, I had the chance to befriend our driver, Kiwasha, as well. We shared snacks, stories, and music. We would listen to his Herero mixes and then would switch over to my tunes. I tried to limit my music, because I thought he wouldn’t want to listen it, but he actually kept asking for more! (He had Peter, Bjorn & John and Fleet Foxes on repeat. Too funny watching this old African man bob his head to those guys). A highlight to the drives without a doubt. Another road trip memory that sticks out in my mind is when Haidula offered me a “snack” she prepared. I said yes please, and then I see her take out a whole fish. Didn’t see that coming. I of course didn’t want to offend her right at the start of our time together, so there I was in the front seat of the ministry 4x4, eating a foot-long fish with my hands. Next, I washed it down with a lemon from her garden. Sure, why not.
As a matter of fact, most of the meals we ate were on the road, which gave me the chance to try some of the local fair. Here is Haidula, at a road side vendor loading us up. She knows how to find the quality items:
Here we bought some meat, spinach, and mahango. Mahango, or pap, is the traditional starch source for most northern Namibians, and is like a porridge. Like most starches it is as good as the sauce you smother it in. Kiwasha was our taste tester, and below, he is picking out some more fish.
First the perusal:
Then the sampling:
Then a satisfied purchase:
For our travel route, we would go to the furthest clinic first, in the extreme Northeast of the country, in the small strip of the Caprivi region. This takes us basically to the heart of southern Africa. Like we do, hold out your left hand, palm flat and open, fingers pointing down and thumb sticking out to the right. That is basically the shape of Namibia, and the thumb is Caprivi.
I was really excited to get out to Caprivi because it is a real unique area of Namibia. The strip has its own distinctive history before and through Namibia’s battle for independence. More on Caprivi when I have a more extensive trip there. This time around I was limited in time because of the tight clinic visit schedule.
Due to its northeastern location, wedged between the Zambezi and Kwando Rivers, Caprivi is more densely vegetated compared to its neighboring regions, which adds to its charm:
It was also exciting to see the village homes nestled between the trees:
The northeast of Namibia is filled with traditional homesteads having these characteristic thatched roofs. They were representative of the area, and I was impressed with their strong construction!
We left early in the morning, so we could try to reach Katima Mulilo, the Caprivi capital by sundown. You do not want to be stuck on the road at night in Namibia, it is definitely frowned upon because of the danger in hitting an animal. (Hitting a warthog at 80 mph is like crashing into a brick wall, and has totaled many vehicles here). This danger was intensified in Caprivi because of the dense vegetation and risk of larger animals crossing the road…
As we entered the strip, we kept seeing warning signs for elephants. Midday you would probably not see any, since they will most likely be eating or drinking at a water source. But since sundown was approaching, there was a chance we could see some elephants crossing the street to go back to their home after their drinking and dining sessions for the day.
One of my favorite road signs, all along the strip:
I was on high alert and excited, but Kiwasha was not. He knows the true danger associated with the wild elephants, and if you crossed the wrong one, they have the strength to just toss the vehicle on its side. My eyes were burning, but on we drove and no sight of our giant friends. However as soon as we were ready to leave the thin strip to the district around Katima, we caught my favorite animals!
My first look at wild elephants:
It was a whole family, complete with some “toddlers”. Kiwasha, was not going to hang around. We were already gambling with sundown, so had to keep moving. Still had the opportunity to snap some shots:
It was a special moment, and I think I will never get tired of seeing elephants in the wild. I think they are such amazing and dignified animals, I could watch them for days. Here is my last glimpse, at my first look at elephants in Namibia:
Another added bonus of visiting Caprivi, is that my good friend, Lande, is stationed in Katima for the Spanish Red Cross. I had the chance to crash at his place while up there, and to grab a beer on the edge of the Zembezi River (no hippo or croc sightings, but next time around!…). If we cant squeeze in a trip this month, next year Lande and I will venture over to Zambia and Zimbabwe to catch a glimpse of (and get drenched by) Victoria Falls. Can’t wait, it is a must.
So, back to business. Our first health facility was Bukalo. This was located deep in Caprivi and was a big and busy clinic, servicing a large population.
On the map below, Bukalo is represented by the red pin furthest to the right. On this map, they actually label the areas at risk of flooding in blue, and you can get an idea of how much of the Caprivi tip can get submerged:
“Big” clinic meant 3 observation rooms, a waiting room inside, and 3 nurses on staff. I liked the nurses instantly. They were so kind, inviting, and respectful. I was also quite surprised to see that two of the three nurses were males. Good for Namibia. There was actually a decent representation of male nurses I saw on my trip, and was happy to see this adopted and accepted in the country. How progressive. (Human resources is an extreme issue in Namibia, being the second least dense population in the world, and the health facilities need all the help they can get. One of the biggest deterrents to quality of care is simply the lack of health care workers.)
So first thing, after all our greetings, was to go over the reasoning for the study, why their clinic was chosen, and to review the protocol and methodology. We wanted them to feel proud that their health facility was chosen, that it will represent the whole region, and the information they would provide would not only help their individual clinic but all clinics in Namibia. They were definitely excited, and again, made my work that much easier.
We arrived at Bukalo on a Monday though, and that is definitely the busiest clinic day. To not disturb the flow of patients, we decided to come back early the next morning to do the practice rounds. These were a ton of fun, and the nurses were so attentive to the study protocol, I couldn’t have been happier with their involvement. At Bukalo, with our extra time in the morning, we trained every nurse on the study and all switched being a practice malaria patient. Here is the head nurse, Meme Masurle, and nurse Jason going through a practice round:
We went through the mock visits, but also re-trained the nurses on using the RDTs. Here is Meme and Jason having fun with the training:
I would play the malaria patient most of the time, and can’t tell you how many times my fingers were pricked those few weeks. They did a great job though, and at least I know for certain I don’t have malaria!
Here is a breakdown on the study methodology:
Clinic attendees will be explained the study while in the waiting room. When the patients with fever or history of fever within the past 2 days come to see the clinic clinician they will be asked if they would like to take part in the study. If they agree they will sign or thumb print the attached consent form. All patients will have their axillary (armpit) temperature recorded. During the normal screening, the clinician will also complete a brief questionnaire including demographic data, malaria risk and history of the current illness. Following the questionnaire all patients will be tested with a RDT. The results of the tests will be noted in the case report form and the patient treated according to results. These RDTs were kept for us, in plastic bags with some silica gel beads to preserve the blood samples. Here is my colleague Stark laughing at our ridiculous task of pre-loading 500 bags with silica gel. This took us a whole afternoon, the week before I left for the trip:
We will have our colleagues at the University of Namibia investigate the RDTs, using some lab techniques to examine the parasite genome and to see which malaria parasite species we were dealing with, and also to serve as a quality assurance check on the RDTs, to determine if the patient was in fact positive or negative. Since we were using the patients’ blood for further studies, we wanted to ensure the health workers began using consent forms, mostly as I way to explain to the patients what exactly the study was about and how their blood will be used. This is a common practice in the States, but definitely was an extra step for these clinics. We didn’t receive any objection to this though, and the nurses had fun doing the practice rounds of the consent process. It was fun for me too, as the public health nerd!
Here is nurse Michael, and Haidula going through a mock consent process:
Along with reviewing the protocol and practicing the study procedures, I would do a brief structured interview with the head nurse about diagnostic practices. The information gathered from the interviews will be examined to help identify barriers to diagnosis adherence and to estimate the additional capacity required to operationalize the “test all fevers” algorithm in this zone. I asked the nurses about their view on malaria diagnosis practices, their experience with malaria over the years, opinions of RDTs and their effectiveness, what they should do if the fever is not due to malaria, the structure of the work day, how many patients they see on average per day, if they feel over or under worked, if they receive pressure from patients to treat fever for malaria, etc. I would also do a quick rundown on what they look for during their examinations (signs and symptoms that would make them the most concerned for the patient), and would check the clinic for their supply of diagnostic tools. The interview process was one of my favorite parts of the study and I really enjoyed hearing the nurses’ perspectives.
I can’t be making comments on the results of this study yet, since we are still compiling the data, but what I can say is that I was quite impressed with the nurses’ malaria diagnosis knowledge, and overall skill. I think all the clinics main limitations came in differential diagnosis, i.e. handling fever cases that are NOT malaria. Sometimes this was simply due to not having the proper tools or support. A few clinics just needed basic items like stethoscopes to diagnose their patients properly when they are confirmed negative for malaria.
After our quick Caprivi trip, off we went to the neighboring Kavango region. This was another interesting part of Namibia, as its Northern border is aligned with the Kavango River, separating that side of Namibia from Angola. The capital is Rundu, which is right on the river.
For some reason, seeing this long body of water made it hit home that I was in Africa. You could see people on the shore washing their children, the vegetation was different, and the sounds were fuller with the calls of birds and animals.
I loved that right across the river was Angola. It was so close, I could hear the Portuguese being spoken by the women cleaning their clothes:
It was certainly a contrast to the arid countryside found in ¾ of Namibia. Not to mention, my lodge there had some amazing sunsets. My pictures cannot give this sun justice. It was such a giant red orb sinking over Angola, I would sit and watch its decent every evening:
I have guaranteed eye damage from staring too long. My pictures cant capture this experience, but hopefully you can get an appreciation of the colors and tone of the evenings I had in Rundu:
In Kavango we had our smallest clinic, and largest health center. These were hours outside of Rundu, in the middle of the Nyangana and Ndonga districts, at the top of Namibia.
Here are a few shots from the villages in the area:
For the Portuguese family: Como a ilha Terceira, há mais vacas do que pessoas!
The heath center, Rupara, even had in-patient capabilities, an ambulance, and 6 nurses on staff at one time. This is the largest health facility for hundreds of miles. This setup is a massive machine. In complete contrast was our little Ndonga clinic. This was run by one nurse, our sweet old Kaulura. She has been working as a nurse for over 40 years, and was such a cute little lady. All smiles. This protocol was a bit overwhelming for her, so we gave her an additional visit to have some more practice. I regret not taking a picture, since she was one of my favorites, but it didn’t feel appropriate in the moment. Maybe during my follow up visit this month, we’ll see… One precious thing I’ll never forget, was how she reacted to our stipend we provided. When we said that her clinic was chosen and that we were going to pay her extra (each head nurse received a small payment from CHAI for their service and extra work that comes along with the study), she became emotional. She was so honored to be chosen, and was so thankful for the extra funds, that she began to cry. She thanked God of course, claimed He brought me to her. She wouldn’t let go of my hand for the rest of the visit, which was tough for me, since all my friends know how much I talk with my hands. Won’t ever forget it. She wants to do such a good job on the study, doesn’t want to let us down, but I am already so proud of her work, just hope we can get Kaulura the extra support she needs. She sees, on average, 50 patients per day, in her little, one room clinic. This clinic just had space for her desk and the patient bed, and that is it. All the patients wait outside in a line, tolerantly. What a sight. She is completely overworked, yet did not complain, just stated it as a matter of fact. We are trying to see if we can get a rotation from the district to help her, at least on the busy days early in the week. Just by choosing her clinic for this study, Kaulura is getting noticed more at the district level, especially after we debriefed the local health department staff. No matter the results of the study, I feel good knowing she will receive a bit more attention and appreciation.
We closed on the Dx Algorithm Study with our trip to the Onesi health center in the Omusati region. This area I am familiar with, since it is close to the districts where I do my cross-border work with Angola, as well as a region I visited during the flooding assessment.
Onesi was another busy health facility with a great staff. Here it is, under a Namibian baobab tree:
There was a nice young nurse from Kenya stationed there who had worked with CHAI on an HIV project in East Africa. He was happy to be a part of another CHAI study, and hopes to go to school for epidemiology! He was full of questions, and I really enjoyed his enthusiasm. It reminded me of my first spark in public health and felt good to encourage him.
The head nurse, Mary, was such a lovely lady and she worked outside the box. She even had her own mini project, where she would teach mothers how to grow and cook the local foods. I was so impressed, and she felt proud. She deserves credit for showing initiative.
Here is a picture of Meme Mary with her teaching sample jars:
Onesi so far has had the most fevers in the last few months, at 82, but only 3 positive for malaria! So far so good. We expected low numbers during the last few months, because it was the winter low season. Now as the temp rises, we will see more cases. This study trip was in July (told you I am behind on these posts) which was in the middle of the Namibia winter. As I just mentioned, this is the low malaria season but we decided to begin the study at this time so that we can give the nurses proper training when their days are less hampered with cases. By the time the height of the season would arrive, they would have a good understanding and comfort with the study protocol. Another benefit of starting this study in the winter, was to show the clinic nurses how many fevers will come in that are NOT malaria.
This trip was long with all the driving (I think we drove about 2000 miles, over 3000 Km, in one week) in between each region, visits to the district offices for preliminary meetings and debriefings, not to mention the actual time to reach the clinics. At the minimum, we spent one full day at each health facility to observe the patient care, perform our interviews, do the practice rounds for the study, and to assess their diagnostic tools and capabilities. It was an exhausting trip, but completely worth it.
I only had a chance to see 4 clinics during the Dx Algorithm Study, so very hard to generalize to all clinics in Namibia. Some could be doing better, some could be doing worse, but it least it gave me another opportunity to experience Namibia’s health care system first-hand. The knowledge I gained from that trip has already been so valuable and will continue to influence my next steps here. This month and next I will be conducting another similar diagnosis study in some new clinics, and as this gained knowledge helps guide my personal public health growth, it will more importantly help steer the national malaria program in the right direction and to help us chose the right projects and interventions that will lead to the greatest impact in malaria elimination. I hope this post gives an idea of the kind of work I am dong here. We will have many more similar field trips, but this will hold the greatest weight for me. It was my first exposure to the Northeast endemic zones and the first time I was really directing a study. A special moment for work, and life, and I look forward to the next battles against malaria.
“Much good work is lost for the lack of a little more.”
- Harriman
