The Impact of HIV Drugs

A pretty incredible video demonstrating the impact of HIV drugs.  People talk about the "Lazerus Lazarus Effect" of ARVs, which you can see pretty clearly from this video.

What do you want to know?

I guess this is a little bit shameless, but I'm sure that I'm not doing as well writing this thing as I could be, and that's in part because I am terrible at coming up with ideas for things to write about.

So a request: what do you want to know about?  If you propose an idea, I'll write about it, at least in some way. The more ideas, the more posts, maybe?

-G

What I Do, Vol. II

This story from today's New York Times talks about how hard it is to identify patients in need of HIV/AIDS treatment, and how much harder it is to keep them on treatment once they've started: http://www.nytimes.com/2010/10/26/health/26cases.html 

It's a good opportunity to talk a bit about what I do in the context of what the article lays out.  We face all the same problems here in Swaziland, though admittedly it's easier to get from one end of the country to the other than it is in Kenya.

What I do -- what a large number of people at the Ministry of Health and other NGO partners do -- is try to make it easier in different ways for patients to begin and remain on treatment.  For me specifically that means helping more patients get onto medicine regimens that are as close to one-pill, once-per-day as possible instead of that (mostly antiquated) handful of pills you see in the picture from the Times at left.  This means helping doctors and nurses understand and order the new medicines for all their facilities, quantifying the number of patients expected on each regimen so that medicines are available centrally, making sure the government is aware of future changes, etc.  The hope is that changes like these will ultimately make it cheaper and easier for all patients to be on treatment.  

Other things we're trying, (both at my office and in other parts of the Swaziland health community) to add more color to the Times article :

• Decentralization: Move treatment closer to patients to reduce travel time and cost and make seeking help more convenient.  Of course, with a limited number of doctors in the country this means empowering nurses to initiation HIV treatment (the drugs are toxic if used incorrectly, remember), ensuring monitoring and evaluation, etc.  No easy feat but one that the country is pursuing with some vigor.
• Patient Tracking: Collecting better information about patients at treatment facilities to allow for better follow up if they miss an appointment.  Details include the usual, cell phone number, cell phone of family or friend, address (including nearest bend in the river/other landmark since postal addresses don't exist for homesteads) and better counseling 
• Advertising and media and other outreach to minimize the stigma of HIV and HIV treatment, and teach people that if one regmien isn't working for them another might be better.
• Develop community support structures to identify patients that have missed appointments to encourage them to return.
• etc., etc.  

If you have an idea, this country would try it.  Facing a "lost-to-follow-up" rate approaching 20% per year, clearly what we have isn't working well yet.

-G

Silverback

Hiked in the north of Rwanda yesterday to see the Mountain Gorillas.  More to come soon:

The "king" Silverback Gorilla from the Sibyinyo Group

A King Sighting

I got my first glimpse of King Mswati III over the weekend at the annual Umhlanga ceremony.  He's the one in the middle with the red something-or-other on his shoulder.  Check out the fancy watch.

The Umhlanga (reed dance) ceremony is one where thousands of Swazi "maidens" celebrate the Queen Mother in a week-long event that culminates in two days of  traditional dancing.  The King has been known to pick a new wife at or near the event, but doesn't seem to have done so this time.

A Quick (probably boring) Travel Story

I think travel stories are mostly annoying, but I'll use this to vent, even if no one else finds it interesting:


Buying flights to anywhere from here is the most frustrating thing about living in Southern Africa. A somewhat short story.

For my last trip to Botswana, I booked my flight over the phone because the internet is so difficult to use and the South African Airways web site is designed for people with fast internet.  The woman tells me that for my return trip, I can either leave at 10:25 a.m. to Johannesburg and get a 3:15 flight to Swaziland, OR I can leave at 11:00 a.m. and get a 5:15 flight to swaziland.  I ask if I can get the 11:00 flight AND the 3:15 flight, and she says no.  I give up, and book the first option.

I paid a $20 US change fee for this since I was changing a flight from a few weeks ago that I didn't take.

I look on the internet, and find out there's also a 12:40 flight to Swaziland, that I would likely be able to make if things are on time.

I land in Johannesburg for the return trip, and things are on time.  I landed at at 11, and was still booked on the 3:15 flight back to Swaziland.  I figure there might be seats on the 12:40 and maybe I can get home early.  I go to the ticket counter in the international transfers terminal and ask if they can switch me.  


First I get sent from the South African Airways counter to the "Airlink" counter for some reason, even though
I booked my flight with SAA and they are the same company basically. My fault, I should have guessed that.

Then I get back in line, wait my turn again and ask to change my flight.  The woman looks at me a little confused, like this doesn't happen often, and tells me that it will cost me something, but she doesn't know how much.  Either another 20 bucks (US) change fee or 60 bucks for an "upgrade".  Then she says that she can't find out how much, because the ticket has to be processed, and they only have 10 minutes to complete it because the flight booking closes 1 hour before takeoff.  She goes to find out from someone in the back if they can do it, but that someone is not there.  Don't know when he or she will be back.  Meanwhile, the clock is ticking and it's getting harder for me to get on the flight.  She says I can leave her the $20 and by the
time I get to the gate it will be done and "you can get a receipt in Swaziland" or I'm out of luck.   I demurred, and went to the gate to try my luck there.

No luck there, "the flight is full" which it wasn't, and I had to wait in the airport for 3 more hours.



Pretty standard stuff.  I'm back to Botswana next week, so we'll see what fun that brings.

I'm alive

I guess it's been a few weeks since I last posted, judging by the reminders I've been getting in my e-mail (again, thanks!) so I thought I'd put something quick together in the interest of saying hello.*

The last few weeks have been a whirlwind here, as I hit the 3-month mark in Africa I finished the first part of the ongoing forecasting project at work which has consumed a lot of my time.  By all accounts the result was a big improvement  -- maybe purely because we implemented a process where there wasn't much of one before --  but there's still lots of room for improvement.  I'm not out of a job yet, at least.

In personal news, continuing what someone called my "club med" experience in southern Africa, I've spent the last two weekends in Maputo, the capital of Mozambique.  Mozambique could not be more different from Swaziland.  As soon as you cross the border you can feel a difference, though that may just be relief after making it past the guys with huge semi-automatic rifles that guard the entrance (and patrol the streets in the city). It's a great city, full of people, energy, nightlife, the beach, tropical weather, etc., nearly all of which don't exist in any real way in Swaziland.

We were there for an Ultimate Frisbee tournament on the Costa del Sol beach the first weekend.  I can barely throw a Frisbee but for some reason I decided to play.  (See below for one example of me failing to at the game -- don't ask about the headband, wasn't my decision.)   The second weekend we went back for a night with a guy who was leaving town and hadn't been yet.  

I am terrible at Ultimate Frisbee.  But I enjoyed sitting on -- being
relegated to -- the beach (riding sand?)

This was my real contribution to the weekend,
organizing an American-style Flip Cup Game

The highlight of both trips was the other-worldly fish market, where one half contains a few dozen vendors selling very fresh seafood, and the other half comprises a bunch of restaurant/shacks where they'll grill the fish for you and serve you Mozambican beer over the course of a 3-hour lunch.  Worth a trip just by itself.  Maputo also has an actual coffee shop that sells freshly-roasted coffee and decent bagels where you can sit overlooking the ocean.  You can't get bagels or decent coffee in Swaziland that I can tell, so that shop also is worth a trip by itself.

Next weekend is the Swaziland Umhlanga (pronounced Um-schlanga), which is a Swazi tradition not to be missed, apparently. I'll let Wikipedia describe it for you:

Umhlanga, or Reed Dance ceremony, is an annual Swazi and Zulu tradition held in August or September. Tens of thousands of unmarried and childless Swazi/Zulu girls and women travel from their villages to participate in the eight-day event.

It's a signal that the cold winter is finally ending, so as you all head into the Labor Day end of summer, we'll finally be starting to warm up here.  In other words, time to come visit.

Anyway, I keep writing more than I intend to when I start these things, so I'll leave it at that.  Hope everyone is doing well, I love hearing from everyone even though I'm a terrible correspondent.  I will write back eventually, I swear.

-Garrett

*I'm in a downward spiral it seems, 8 posts in May, 6 in June, 4 in July and now it's the middle of August and this is the first of the month.  I will improve.  I hope.  Keep bugging me, please.

Say My Name

People here have an impossible time with my name.  The majority think my name is Gareth, maybe because they have more historical exposure to British names, and if I don't correct them (usually more than once) that's typically what I go by.  But there are some other fun ones.

The car mechanic, a hilarious Portuguese guy (maybe Mozambican?) with whom I've spent a lot of time lately while trying to buy a cars, calls me one of two things.  His favorite when he's most animated is MisterGreg, which sounds more like Mista Grrreg with a rolled r.  Sometimes he calls me Mister Geret, which is almost Garrett but shorter.  He does know how to spell my name, because he gets it right on the bills I've paid.

The taxi driver our office uses a lot uses a variant of that, calling me Jerret, or Gerrat (with a soft G). It sounds something like jer-rot, again with a rolled r in between.

I've learned to respond to anything that sounds like it starts with a G.

Phone Companies Are All the Same

Phone companies are the same the world over.  We have an ADSL internet connection (don't know what the A stands for, or for that matter what DSL stands for) at our house.  Two weeks ago, Swaziland Post and Telecommunications Company cut us off because the last tenants hadn't paid the bill within the appropriate time period.  They turned our phone back on last Monday after a quick phone call.  So far so good.

But the Internet didn't work.  So I called back Monday, talked to someone after a few tries, who promised to call me back. They didn't.  Tuesday, same thing.  Wednesday, Thursday, Friday, same thing.   Finally Today, a Tuesday and a full 8 days after I started, I convinced a technician to come to our house, who hit a few buttons and we were back up and running.  Stuff I could have done over the phone.  Awesome.  My US telcom training came in handy.

Maybe SPTC has an internet presence like Comcast, and now that I've complained about it on the Internet they'll try to make me a happy customer.  What are the chances they refund the lost week?

Unintentionally Long Update -- Finally (almost) Settled

I'm long overdue for a real update on what's been going on, and many thanks to those of you who keep prompting me to write.  


In the usual style -- one day I'm going to write impossibly good prose for this thing -- here's another relatively unrelated list of things that have been happening in my life.


1. I have moved into a permanent house!  My colleague Joe and I are renting a 3 bedroom house in a neighborhood called "Dalriach East" which is just above the main part of town on a hill.  It's a 70s era place with a great view of Pine Valley and a huge yard great for 4th of July parties.  The rent is cheap, but it was completely unfurnished so we have to purchase literally everything, from beds and couches to a fridge, microwave, etc.  We've got much of it now, but our living room is still conspicuously empty.  Couches and a kitchen/dining room table are next on the list, which will just about complete the collection.


Our address is either: 58 Panorama Drive or 188 Panorama Drive or 58/188 Mbandezi Street, depending on who you believe.  They're all the same place, I think, or maybe our house is something else entirely.  It's very unclear.  Street names/numbers seem to change all the time.  When the water company called to turn on our service they just asked me to describe the house relative to other things.  If you're interested in visiting, head up Pine Valley road from town and go straight instead of turning off into the valley.  Go over two speed bumps, you'll see a set of three big white flats on the left, and our driveway is straight ahead.  


This calls for pictures, but I don't have them with me so I'll update later.


On a related note, I finally bought a car.  It's a 2000-something VW Golf (again, these things are never clear), and though it's not formally in my possession yet, I should have it later this week once the international wire transfer is taken care of.  I haven't completed a wire transfer yet, and nothing seems to be as easy as it should be, especially when dealing with banks/credit card companies by phone, but I'll give it a shot.


The car is an import from Japan, so the radio runs from 60-something to 90.1 or so, rendering it almost completely useless here in Swaziland.  This is common here with imported cars.  Before completing the purchase I'll take it to a mechanic, but it seems to be a total crapshoot as to whether you purchase a reliable car or not.  I went to one of the more reputable dealers, so hopefully it will turn out okay.   


2. I am no longer completely inept at my job.  So that's good.  Over the past couple of months I have been working with the National AIDS program to quantify the amount of HIV drugs that the country will require over the next 5 years as part of a big grant application.  It's a fascinating exercise, using more assumptions than we would like, but it's near impossible to project what the global market for HIV/AIDS drugs will look like in 5 years.  This involves trying to estimate what the patient populations will be (difficult), what the prevalence of TB/HIV co-infection will be since it has an impact on what drug regimens patients can take (difficult, and a moving target), what drugs will be available and at what cost (somewhat less difficult), and probably hundreds of other similar estimations.  I've been learning all the stuff by doing, and while I'm not an expert by any means, I'm starting to at least understand all the different components and how they fit together.


I've had a chance to visit a couple of government hospitals in the last few weeks, to see how the pharmacy system works in practice, and it's eye opening, though not necessarily in the ways I expected.  The HIV pharmacy is typically separated from the main hospital pharmacy.  This is partly because the health system here (and in many places) is siloed horizontally, where HIV/AIDS is one program, TB another, Maternal Care another, etc.  Another explanation revolves around issues of HIV patient stigma.  One pharmacist explained that HIV patients do not like to queue in the same line as other patients, since they will be recognized as positive when they receive their medicines.  On the other hand, all it takes is one look at the ART (anti-retroviral treatment) line to see who is there, so I'm not 100% sure that explanation flies.  I suspect it may be an after-the-fact explanation, but I don't really have enough insight to know.


Another surprise has been how healthy The HIV patients that queue appear to be.  Compared to the regular pharmacy line where you can tell people are really sick, most of the people who come to the ART window look just like you or me.  It is impossible to tell from walking around that 25% of the people in this country are infected.  I think I was imagining a lot of people looking like Tom Hanks from the end of Philadelphia or something, but it turns out that the lesions he had are called Kaposi Sarcoma and can equally be treated by medicines.  


The two hospitals I've seen are fine, if not western by many standards.  They appear to have many of the functions of a basic western hospital, but the standards for sanitation and cleanliness are not close and the buildings are a concrete shells that feel more like a prison than a hospital.  That said, the doctors seem to be knowledgeable and focused on providing good treatment, as well as dedicated to improvement.


3.  I have met a lot of great people here, though do not spend much social time with Swazi people.  It's hard to say whether the expats make that true or whether it's Swazi culture, though I suspect it's more on the expat culture.  The social circle I arrived into is nearly all expats, and it has been an easy group to fit into.  It's fairly  diverse group of Americans, Canadians and Europeans.  Our office (6 of us) is almost all American, with the exception of our Swazi administrative assistant, but the UN and some of the other organizations here are much more international.


4. I'll leave you with one more SiSwati language lesson, as I am slowly struggling to learn.  The longer I have been here the more I am thinking that I should formally learn the language, so I might start taking classes one of these days if I get my act together.  Here's the standard greeting, which for the most part isn't so hard, except for the end:

Person 1: Sawubona (Hello) -- easy

Person 2: Yebo (Yes/greeting acknowledgment) -- easy

Person 1: Unjani (how are you?) -- pretty easy

Person 2: Ngiyaphila, Unjani (I am well, how are you? pronounced nee-ah-pee-la, but the "nee" starts with the sound that "ing" ends with) --hard

Person 1: Ngiyaphila

The Ngiya which forms the beginning of "I am well" is the first-person singular pronoun (I think).  It's much easier to travel with more than one person, because then you can say "siyaphila" which doesn't have any linguistic tricks to it.

A few others:  

Ncesi (Nesi, but with the same tsk-tsk click after/on top of the N) means "I'm Sorry, or Excuse Me"

Ngiyabonga means "I thank you" while Siyabonga means "we thank you"

Ngiya Xholisa also means I'm sorry, in a more apologetic way rather than excuse me.  This one uses the X click that is a "cluck" sound that you make with your tongue on the bottom of your mouth, but instead of starting with your tongue on the top of your mouth, start with it on the side of your mouth.  If you know how to pronounce "Xhosa" which is a main language/tribe in southern Africa.  I can't think of when you might use the clucking sound in English, but this is a softer version of what can be a very loud click.

That's all for now, apologies to everyone whose e-mails I haven't returned.  

Reflections on My First Month (long overdue)

**Note: I wrote this a month ago, and some of it's already out of date, but I figured better late than never now that I have internet at home.  I know I'm wayyyy overdue for a new post, and I'll try to get to it this week, but for now, here's an update from a month ago. Imagine it is dated June 7, and it will make things more clear.  Update from month 2 will include new thoughts and updates, I swear.

I’ve been in Africa for a month already. What follows is a bit of a disorganized stream of consciousness, but it will have to do:

Apart from being extremely small, Swaziland is an extremely comfortable place to live. “Africa Light” is probably a good description, given the country’s large network of paved roads, well-stocked grocery stores, restaurants, yoga classes, drinkable tap water, etc. We met some Peace Corps volunteers living in Mozambique last weekend who said it felt like they were back in America because (among other things) people stood in lines and signs actually tell you where to go.

Speaking of meeting people, I’ve been consistently reminded (or perhaps taught) that it’s an extremely small world. Since being here I’ve met several people who know my family and friends, including one girl who went to college with Val and knows Lani, and another who knows both Nick and Val.

Having spoken highly of the physical infrastructure, the telecom infrastructure here is horrible. For being virtually surrounded by South Africa, it’s astonishing how poor the Internet and phone is. I had to make a collect call to my credit card company last week (“How many times do I have to tell you that I am living in Africa now, so transactions that happen in Africa are not automatically suspicious and shouldn’t be blocked!?”) which completely baffled the operator here in Swaziland and was “resolved” over an absolutely horrible connection. Between 2 (14:00) and 5 (17:00) p.m. every day, the Internet basically grinds to a halt. This may turn out to be the best time to have meetings.

It is legitimately cold here. It’s not New England in winter cold, but the homes and offices aren’t insulated in any meaningful way, so it’s not like you walk into someone’s house and escape the cold. In many ways it’s worse inside than out. Hearing about the summer weather (long daylight hours!) in the US causes jealousy.

The healthcare system here is a mess, but there are a lot of dedicated people working to improve it. Sometimes it seems like the various groups and government agencies are working at cross-purposes, but on the whole there appears to be a serious commitment to improvement. Material resource constraints don’t seem to be the biggest challenge, but I haven’t seen enough yet to offer a well-formed opinion.

Women are extremely skilled at carrying things on their heads. I want to learn how to do that before I leave, but have been told it’s not something a man should ever learn. I will not give up.

The poverty of this country is largely hidden from view (see the infrastructure comments above) but is apparent outside the main cities. Perhaps the most consistently visible signs of this are the well-worn walking paths through and across the fields and mountains everywhere. Getting somewhere for most Swazis entails walking to a main road and then hoping a small bus (Kombi, see below) comes by going your direction to get you where you’re going. 

The attached picture is from in front of the house where I’m staying, to give you a sense of what these Kombis look like. The good news, I guess, is that the Kombis are ubiquitous in southern Africa, especially on the main roads, so it is a somewhat effective, if unpredictable, means of transportation.

Woman boarding a Kombi on the road in front of my house

People LOVE KFC here. It’s literally everywhere. The soft-serve ice cream cone for 3 Rand (~50 cents) is great.

I think I doubled my total 2009 frequent flyer miles in May alone. My trips, including several on very small planes with propellers:

- Boston to London

- London to Johannesburg

- Johannesburg to Manzini

- Johannesburg to Nairobi

- Nairobi to Johannesburg

- Johannesburg to Manzini

- Johannesburg to Gaborone

- Gaborone to Johannesburg

- Johannesburg to Manzini

I’m not doing well with taking pictures. I would love some ideas about how to improve, for those of you with amateur or professional experience. The second trick is finding a way to get myself into some of the pictures that are taken with my camera. Another work in progress.

Sadly, I still haven’t seen a Zebra (though I’ve been told I’ll only see a zeh-bra, not a zee-bra) or much else in the way of African game, so I’ll have to make that a priority for the next month.

On a personal note, I’ve moved in to a spare room in a friend’s house for the rest of this month, and plan to permanently move into a house that’s being vacated later this month. The place I’m in now is beautiful, but extremely remote. The view from the front porch is an awesome panorama with a river down below, and extremely quite except for the occasional bus passenger blowing his vuvuzela out the window. That typically happens at 6 a.m.

View from my new (temporary) front porch

The people here are great, and I’ve enjoyed meeting a really diverse group of people from all over the world. Mostly western European and American/Canadian, but people who have lived all over the world and tend to have much more experience with the developing world than I.

More to come. This next month brings the World Cup, trips to Nairobi (hopefully with more time for sightseeing) and Gaborone, and possibly a trip to the beach in Mozambique depending on how the weekends shape up.

Nairobi Airport, Diplomatic Incidents, and the Round of 16

Trying to find a TV to watch the game in the Nairobi airport (one of the worst big airports I've seen) was a harrowing experience.  We arrived just as the USA-Algeria game was kicking off, and found that the 3 TVs in the international terminal were all tuned to the England game, as though people might care about that.  Luckily, we discovered the "first class lounge" and negotiated a discount rate of $20 each to get in the door.  Despite promises that the USA game was on the TV, it wasn't.  I worked to get the game put on one of the two TVs (bringing the total in the terminal to 5) and nearly started a diplomatic incident with a Malawian guy who was slumped in a chair watching the game.  Thankfully, we resolved it peacefully and were able to finally watch most of the second half.  


What a win!  


I'm offering a free place to stay for any friends flying in for Saturday's round of 16 game.  If you hope on a plane tomorrow, you can be here in plenty of time!


Garrett

USA-Slovenia

Hi all,

One more quick picture dump.  We spent the day Friday watching USA beat tie Slovenia.  The stadium in Johannesburg was awesome, and the American fans were out in force.  It wasn't even too cold.

This was our group from Swaziland before the game.  It's not quite the whole group, but it's close.  Johannesburg is about a 4-hour trip from Mbabane, more or less depending on the border crossing.  We left at 8 a.m. and made it to the "park and walk" by 1 or so, after a few stops for essentials.

American fans outnumbered the Slovenia fans by a large margin.  The Johannesburg residents were out as well watching the crowd go by.  This kid just wanted to play.

We talked to an Al Jazeera reporter on the way in.  I hope it didn't air, because I'm certain it was embarrassing.  Everybody still loved Cooper's suit (to my right, hidden by the microphone a bit).  To my left is my colleague Jara, who's been in Swaziland for about 8 months.

The view from our seats.  Unfortunately, all the goals were scored in the other end.  All 5 of them.

Finally, A Zebra!

It may have taken 6 weeks, but I've finally seen a Zebra!  And it wasn't the most interesting thing we saw today.

I extended a trip to Nairobi by a day to get a chance to explore the city, and took off early this morning (6 a.m.) to go on a "game drive" through Nairobi National Park.  The park is an amazing place, right in the middle of the city, with widely varying terrain and a huge variety of animals.

Some highlights:

This Black Rhino is (according to our guide) very rare to see.  It even had a bird on its back like you'd see in National Geographic.  You can tell from this picture how close the city of Nairobi is, just across the savanna from where we were stopped.

A Masai Giraffe, framed by the tall buildings of downtown Nairobi.  Apparently the Masai Giraffe is distinguishable by its lack of "socks" as compared to the Somali Giraffe.

The Impala were a dime a dozen in the park, but their horns are awesome.  Of all the horns in the park, these were my favorite.

We saw three of the so-called "big 5" game today, Hippopotamus, Cape Buffalo, and Black Rhino, but didn't see a leopard or lion.  A herd of cape buffalo wandered by our truck -- totally harmless as long as they're not alone, apparently -- and stopped to check us out by sniffing the air, watching us, and generally showing interest.  This guy has a nice little part in his hair.

And finally...Zebra!  I don't understand why they have stripes.  Aside from the enormous ostrich everywhere that look like big black bushes on the horizon, even from miles away, the Zebra were the easiest to pick out by far.  It is awesome to look at.

So who's ready to come visit?

Garrett

P.S. on the Kenya Airways flight from Johannesburg to Nairobi they played the K'Naan song (waving flag), Shakira song (Waka Waka) and the Ricky Martin song from 1998 (copa de la vida) on loop.  I heard each one at least 5 times.  Thank goodness they're so awesome.

USA-England Pictures Part II

I am not so good at choosing interesting pictures for this blog.  Here are a few more, since the internet seems to be working today!

A British fan is not happy with having to drink Budweiser. Not that it stopped him.

A good-looking American fan.

The English Flags far outnumbered the US flags along the top of the stadium. They are clearly more practiced at this. That said, there were a lot of "American" flags that weren't the stars and stripes. in this picture you can see a "don't tread on me" flag and a Wisconsin flag, among others, so it's not quite as bad as it looks at first glance.

This kid was awesome. 2010 is his year.

USA-England Game, A Few Pictures

I managed to snag a last-minute ticket to the USA-England game, so we made the trip to Rustenburg on Saturday from Mbabane. I have many great pictures and a handful of stories that I'll try to tell soon, but here's a few pictures before a longer post tonight or tomorrow.

In short, the game was a blast, the crowd was awesome, and the trip was well worth the 6-hour drive each way. That USA managed a draw is amazing (I've been told, in truth it was sort of difficult to see the game), and hopefully means that next Friday's trip to Johannesburg to see the USA-Slovenia game will give us cause to celebrate again.

A few pictures (Picasa/Blogger limits me to four, but maybe there's a way to change that?)

Cooper, another American Swazi expat, ordered the bolt of fabric you see here and had it made into a business suit. It's not hard to see why he was a fan favorite, for English and American fans alike. The USA Vuvuzela was a big hit, as well.

Erin (a doctor working for Baylor University's clinic(s) in Swaziland) and I in our seats about an hour before kickoff. Our relatively more subdued outfits, compared to Cooper at least, included a flag and a USA scarf for me and a wearable flag, regular flag, and USA Vuvuzela for Erin. The Budweiser--exclusive beer of the World Cup, which the Brits weren't too happy about--in my hand was the most expensive beer I've purchased in Africa at 30 Rand, or ~$4. Usually beers top out at about 10 Rand. We made up for it later at a local township bar on our way back to the car -- where we got 12 beers for 110 Rand for the group.

The view from our seats. You'll notice a dark square in the middle on the opposite side. Our best guess is that that was supposed to be a scoreboard, possibly with the time, maybe the score of the game, and potentially some other information. In reality it was just blank, except for a brief stint at the start of the second half where they showed the score. It's not like it's the world cup, or the game that sold out the fastest of all. They did announce how much injury time was left at the end of each half, so that was nice. The stadium was pretty packed, but is relatively small capacity of 44,000 compared to Johannesburg and others which hold 70,000-90,000 people.


The road from the Johannesburg airport toward downtown was lined with flags for several miles.  We stayed in Johannesburg for the night, which was about 2 hours from the game.

More to come, I have a few posts that are written already but that I haven't found time to put up, along with some more pictures.

Garrett

World Cup Update

Tickets are in hand!  Going to the USA vs. Slovenia game on Friday the 18th in Johannesburg.  Still trying to figure out what other games I'll be able to see in person, but even if I only go to one it will be great.

USA-England is sold out, but to give you a sense of how into it people are here, this is from an English member of the Swaziland ex-pat community:

Now that the tickets are in hand, it's time to find some over-the-top USA gear.

Small Linguistic Victories

Very exciting accomplishment today.  I successfully pronounced the name of the Swazi woman who works with us.

Her name is spelled Gcinaphi, and it's pronounced gi-na-pee with a hard "g", with a Swazi twist.  The "gc" at the very beginning is accompanied by short click with your tongue against your front teeth.  I'm not sure how to articulate the sound in writing, but it's sort of a kissing-type sound or a tsk-tsk sound.  (Potter and Rouss, you'll know the sound I mean).  So try pronouncing a hard G sound while at the same time clicking your tongue against the front of your teeth.  It's as hard to do as it is to explain.

Bonus Wikipedia explanation:

The easiest clicks for English speakers are the dental clicks written with a single pipe, ǀ. They are all sharp (high-pitched) squeaky sounds made by sucking on the front teeth. A simple dental click is used in English to express pity or to shame someone, and sometimes to call an animal, and is written tsk! in American English, or tut-tut! in British English.

Next will be learning how to say it well enough that I can use it in a sentence without completely losing my train of thought trying to concentrate on the pronunciation.

De-bugging the Airplane

South African Law says that all flights inbound from certain countries must spray the cabin for bugs before takeoff to (I suppose) prevent the transmission of insect-borne diseases across borders.  In practice this means that a flight attendant walks down the aisle after everyone is seated with an aerosol can (or 3, as was the case in Nairobi) spouting some kind of bug killing spray that smells like Febreze.  On today's flight there was no air circulating through the small plane at the time, so it hung in the air for about 5 minutes.  Pretty disgusting.  It is nice that they do you the favor of first saying "We are about to spray the cabin, it will not hurt you but you may cover your nose and mouth if you wish" or something to that effect.  

I guess it's in keeping with South Africa's policy on things like Yellow Fever, as well, where you hear nightmare stories of travelers from East West Africa unable to prove their vaccination history and being quarantined for upwards of 10 days.  I haven't been asked for it, but I keep my yellow proof-of-vaccination card in my passport just in case.

Travel update: I've almost made it back from Gaborone, but have a quick stop in Johannesburg tonight since it's not possible to fly direct from Gaborone to Manzini (the Swazi airport).  Additionally, you can't get off of one flight and get on another without waiting several hours or overnight since flights to/from Gaborone and Manzini leave Johannesburg at the same time.  Apparently it's not a popular route.

I'll post some first thoughts on Gaborone shortly, it's a big city compared to all of Swaziland but I didn't get much time to explore (keeping with a trend).  

World Cup Fever

Killing a few hours in the Johannesburg airport this morning, where World Cup 2010 excitement has reached near-fever pitch.  Some examples:
- The one radio station we could listen to on the way from Mbabane (radio in the car receives frequencies from 60.something to 89.0, and the frequencies in SA are the same as in the US) played the K'naan world cup song 5 times in the 4-hour drive.
- Several South African Airways planes are painted with soccer balls and the World Cup Logo.
- Dozens of people are walking around the airport with Vuvuzelas painted with South African colors -- side note, if you haven't heard a vuvuzela, check out here why FIFA almost tried to ban them from this year's event.
-Oversized soccer balls hanging from the ceiling in dozens of places.
-Billboards, signs, ads, etc. from Visa, telling us "Go Fans" whatever that means.  They have purchased ad space on the entire terminal, I think.  The most prominent flag next to the South African flag is the American flag.  


Still have to get some tickets, though the current plan is to watch the US play Slovenia and then catch another game or two in Nelspruit, which is only about 2 hours from Mbabane.  New Zealand plays Italy there, which seems like it would be fun. The Nelspruit stadium is painted like a Zebra, since it's the closest stadium to Kruger National Park.  Funny stuff.


For those of you who haven't seen/heard the K'Naan video, it's pretty catchy:

Rural Swaziland

I had a chance this weekend to see a more rural part of the country. We drove up to "the Gap" -- a spot in the Nkomati river where the water disappears underneath about 50 feet of rock and reappears quite a distance away -- and it didn't take long to leave the paved roads behind.  The roads alone were a bit treacherous, and we had to stop several times for cows and goats to get out of the way.

I still haven't seen a Zebra. Soon, I hope.

Me, near "the Gap"

More Pictures and a Lead on Housing

In keeping with my goal of posting less content, more often, I thought I'd add a few more pictures to the mix and answer a few common questions.

I might have mentioned once or twice that this place is rural. It really is. There are a few main streets that constitute the "city" and I'll post some pictures soon (once I take them), but these next two pictures more accurately capture the overall Swazi scene. It's not always this gray -- today it was 70 degrees and completely clear -- but you get the idea. The winter here is the dry season, so rainy gray days should become much less common. It is definitely starting to feel like fall and get cold at night--after dinner tonight we could see our breath frozen in the air. The swazis are already wearing their thick jackets, even during the day, which is pretty funny.

A view from "Pine Valley," a scenic, if a bit remote, part of Mbabane.

This house is cooler looking than the picture makes it out to be but it provides a sense of how isolated the places in Pine Valley are. Once you get out a few kilometers* past town the houses become very far apart and most/all have great views. I don't expect to live out this far from town, even though it's only a 15-minute drive to work and a few of my colleagues do live in these parts.

Speaking of living, a common question: Do I have a permanent place to live yet? Answer: No, not yet. I'm still living at the cushy hotel with a pool and a tennis court, and will be here for another week at least. The current plan is to find a place with a colleague who is also brand new to the country, in a two- or three-bedroom house depending on what we find. We have a lead on a great place that will be open in late June, which we may take if we can find something temporary (and less expensive) than the hotel we're in now. I don't expect it will be a problem, there's a lot of transient people here, especially in the expat community.

I mentioned that I hiked a mountain when I first arrived. This is the mountain/rock, called Sibebe (si-bay-bay) and is one of the largest single deposits of granite in the world, apparently. We climbed up the face about a third of the way from the right side of this photo, and it was a bit of work at times to keep from tumbling backward due to the steepness. The top has at least one cave that was fortified by original Swazi tribes, which was really cool to see. Apparently there are many thousand-year-old cave drawings in the country which will be interesting to explore.

Finally, this is a relatively unrelated picture from my hotel room in Nairobi, notable for the new-to-me mosquito net that hangs over the bed. I'd never seen anything like it before, but this is a very effective malaria prevention tool. Also it's a very effective fishing net, which is what a sizeable percentage of the netting that is donated to rural parts of the country becomes. In Nairobi and western Swaziland there really isn't much/any malaria to speak of, but the nets make western tourists feel better, I suppose. Right now in Mbabane it's mostly too cold for mosquitos to survive the night, so malaria at this time of year is almost unheard of.

Sala khale (goodbye),

Garrett

*I'm trying desperately to comprehend the metric system and learn 24-hour time--too bad I didn't pay attention to Scott's Anglophile expressions more closely... Thank god no one here uses the term "fortnight"

First Pictures

One of my major misconceptions before arriving in Africa was that the continent would be so different from the rest of my experience that I'd barely recognize it as being on the same planet.  I think expected to step off the plane in Johannesburg or Matsapha and realize "Aha!  I am absolutely in Africa and I can tell because the grass here is blue."  Maybe not quite that extreme, but I think I was expecting something closer to Mars than Colorado.

I was wrong -- the terrain is different in some ways, the trees and bugs and so on are are different, but I can still recognize trees as trees and bugs as bugs.   Swaziland itself reminds me of a hybrid of Ireland--many hills, fairly green but brown in the winter--and New Zealand -- rocks everywhere, cows on the side of the road not fenced in, etc.

Without further ado, here's some pictures to illustrate that the grass is not, in fact, blue.  

If it's possible, this picture doesn't do justice to the airport.  I landed at night this week and could only get a poor picture of the sign in the time I had.  It still makes me laugh, for some reason.

The view from the door of my room at the Brakenhill Lodge where I'm staying in for my first couple of weeks.


At the top of some hill, looking down on Mbabane.

Note: My new colleague Joe and I did a driving tour of Mbabane today.  He's been here a week longer than I have, so we spent some time driving around the hills, getting a little bit lost and taking some pictures.  I don't know where we took this, exactly, so "some hill" will have to suffice.  It was only about 10 minutes drive from town.

Still on "some hill" Same spot, this is to prove to my mother that I'm alive.

More to come!

Two Days on the Job

I've officially started my job.  As an added bonus, I've begun to figure out a bit more about what I'll actually be doing, though after two days of 8 a.m. to 7 p.m. meetings I'm not sure I have the mental capacity to write about it coherently.*

The basics: I'm working for the Clinton Health Access Initiative (henceforth referred to as "CHAI"), which is under the umbrella of the Clinton Foundation.  In particular, I'm working as part of the team in Swaziland dedicated to improving health outcomes in the country.  Specifically, I'll be focused on helping the Ministry of Health and related organizations improve their ability to forecast for drugs and other necessities for combatting HIV/AIDS.  Swaziland has been devastated by the disease, and has the highest per-capita infection rate of any country in the world.  Part of my job will also be in Gaborone, Botswana, where I'll have a similar role in helping in the procurement process.

I've spent the last two days at a conference hosted by CHAI's global pediatrics team.  That team has focused for the last several years on pediatric HIV prevention and treatment generally, but specifically on managing a donation of "commodities" -- anti-retroviral drugs, testing equipment, etc. -- from UNITAID (pronounced unit-aid).  Depending on the country, CHAI plays a greater or lesser role in the procurement and delivery process, nearly always forecasting and ordering.  I'm here because I'll have a role in helping manage that process in Swaziland and Botswana.


In the sessions I've had a chance to meet a bunch of people that work in or with countries all over the continent.  I'm  struck by how much these people care about what they do.  Each person takes every new case of pediatric HIV/AIDS personally.  They (we?) feel completely responsible for failures at a country level and hold themselves to an extremely high standard.  It was really interesting to sit in a room full of people so clearly dedicated to their jobs, or at least dedicated to the mission.

Unfortunately I haven't had much of a chance to see Nairobi, we're staying at a hotel about halfway between the airport and the city and have been here in meetings most of the time.  We did drive into the city for dinner last night, which gave me my first taste of non-Western driving.  I am fairly certain it was a three-lane highway/main road, but cars were packed about 5-wide and barely crawling along.  It took us an hour and 45 minutes to drive to dinner, and about 15 minutes to drive back.  Switching lanes entailed cutting hard right or left into someone and hoping they'd give way, and our bus driver's strategy was to switch lanes as much as possible.  It was awesome.  It might have been unsafe had we not been driving <3 mph (~5 kph--I'm trying to convert so I can understand things around here) the whole time.
The epic drive did allow for the good-ish food trend to continue.   The Thai food we had for dinner last night was almost all good, one dish better than good, and one dish worse.  I'm staying tomorrow to work with my new boss all day tomorrow, but hope to find some time to explore the city and find our way to some Indian food, for which the city is famous.


I'll stop there, having long overshot the 20-minute time limit I'd set for myself, but will finish with a question to people more knowledgeable (and with better access to Google) than me:  Why does Tusker Lager (the beer of choice here in Nairobi) have sugar as an added ingredient?  It doesn't taste particularly sweet, and it's definitely not Belgian-style, so I'll pose that to someone who knows more about these things than I do and hopefully find an answer.


Kwaherini,
Garrett


*As part of my blogging/communicating plan, I'm trying to hold myself to writing more often at a lower quality standard than I'm usually comfortable with.  Please tell me if I'm boring, but hopefully you can overlook the bad writing.

On The Ground

35 hours after leaving Boston, I made it to Swaziland!  I have a lot of early thoughts, not much time to write right now en route to Nairobi, but I've captured a few below.  Pictures to come, I haven't had a chance to break out the camera yet.  I do have some of my farewell tour, including the bonus 12-hour London stop, which I'll try to post shortly as well (for practice if nothing else).  


Some thoughts, conclusions subject to revision once I get a chance to spend more than 12 hours in the country:
- American Airlines had the worst food I've tasted in a long time.  It was indistinguishable mush, but apparently it was beef.  South African airways apparently had good wine, but I was asleep before takeoff and didn't get a chance to try it.  Thankfully, I was able to sleep for most of the 11-hour flight from London to Johannesburg.  
- I have never seen a smaller airport in my life than the one in Manzini, Swaziland.  Ever.  And it says "Welcome to the Kingdom of Swaziland" on the front, which I found funny for some reason.  I'll get a picture if I fly back in there later this week.  It had one room, maybe two or three others that I didn't see.  They didn't blink when I told them I was staying for 1 day (true-ish, since I'm going to Nairobi today) but was carrying three suitcases, a backpack and a laptop bag with me.

- Mbabane (pronounced alternately "ba-ban-ee" or um-ba-bahn" depending on who is speaking) is absolutely tiny. I'm talking don't blink while driving through or you'll miss it, tiny.  Everyone lives on a hill overlooking some scenic view or other, no one lives in the city center that I can tell.  It feels even smaller than Concord, NH, even though I don't think it actually is.

- The food is respectable, possibly even good.  I had two meals in Swaziland yesterday, and both were good.  One was a panini and one was a pasta dish with chorizo.  Both were tasty.  And pretty cheap, ~10USD for dinner, and 5 USD for breakfast.

- The currency is the Emalangeni, and it trades at about 7 to the dollar.  7 is a terribly difficult number to use in division, but I expect I'll get better at it.

- I will probably be able to go to the World Cup pretty easily, if not cheaply.  Will investigate later this week.

- I went on a hike yesterday just after I arrived.  A "rock" called Sibebe.  Described as a "little walk" it turned out to be a three hour hike up a rock face and down through a valley.  It looked like it would have been fun to rock climb/boulder in some parts.  There seem to be some pictures here: http://www.sibebe.co.sz/gallery.html

Now I'm off to Nairobi for four days to meet with the global pediatric HIV/AIDS team and learn a little about what I'll actually be doing for work.  I expect it will be a firehose of information, but I'll try to retain some of it, at least.


More to come.   I'm excited to be here, the place seems interesting with a lot to explore and I expect to have some interesting stories to tell.

Garrett