Resolutions...

One of my New Year's Resolutions is to do better with the blog. I want to use this space to reflect on pubic health, particularly MCH and HRH. Additionally I want to post updates from my life that inspire me, mostly odds and ends about my family and friends. I resolve to be a better blogger in 2011!

Here are a few quick updates from the past 6 weeks!

MCH and the Holidays!

The girls and I were able to celebrate the holidays in style during the month of December.

From potlucks to pajama parties, we really took a break from thestresses of work and scho

ol and enjoyed each other (as well as several Love Actually viewings). Enjoy the pictures!

KiSwahili and UNC Basketball!

I have been really excited to get to know a few of my beloved UNCbasketball players in my Swahili class this semester. Not only are they star athletes, they are genuinely nice kids. And they speak a word or two of Swahili!

Research Methods, M&E, Reproductive Health Policy, Swahili, Oh My!

These were my courses this semester and I ended my studies with a bang. I have to admit this was my favorite semester so far of grad school as far as course work goes. The classes were top notch and my professors were inspiring and thought-provoking. Reflecting back on what I learned here are some highlights:
- Stata (um yes, I can do that)- Research Paper on Gender Distribution Trends (Pre-Service Education Institutions and Service Delivery Points) of 6 key cadres in Kenya
- 15 page research paper on HTSP (I dare you to look up that acronym)- nearly 40 page Monitoring and Evaluation plan about CareGiver, a microinsurance program just launched by MicroFund for Women in Jordan (completed with the best group to date in grad school)
- 2 individual presentations and one group presentation (PowerPoints included some pretty cool animations!)- A LOT of KiSwahili words! Nilisoma sana!

First Trip to Denver
Despite a cold, I had a great time at APHA in Denver. Here is a link to the blog I wrote for CapacityPlus. There will be many more updates on HRH and Workforce Development in the coming future. I'll be in DC next week and I anticipate a beautiful whirlwind of opportunities and experiences!
http://www.capacityplus.org/social-justice-global-health-workforce

Friends and Family!

Here are some pictures of Baby Annabel (born November 11 to my friends David and Fairley) and my family and I during the Thanksgiving and Christmas Holidays!

So dear readers, I will do better. Happy New Year and see you a lot more in 2011!

Long time no post!

Where have I been? School, work, school, work - it is certainly that time of the semester when things have overnight turned into constant deadlines, presentations, papers and exams (oh my). In just over a month I'll be done with the semester and starting my Masters Paper. Oh the joys of almost being done with graduate school!

Several VERY exciting things have happened over the past few weeks. Today, my dear friend Fairley Mahlum delivered a healthy baby girl named Annabel Grey. I can't wait to meet her and I'm so proud of Fairley!

I just returned last night from Denver where I attended my first American Public Health Association conference. The event was massive and thru all the presentations and posters I found inspiration in the intersection of public health and social justice. I'll have a blog coming out soon thru CapacityPlus and will be sure to put the link up on this blog.

I want to take a moment on this public space of "the internet" to thank my friends and family. I have never known life to be so busy and days to be so full of challenges but you all are supportive in every facet of my life. I have to remind myself a lot these days of why I am working so hard and of the many blessings in my life - including you all! Asante sana!

The health workforce is more than doctors and nurses...under recognized cadres need a voice too!

Visit the CapacityPlus blog site to read my recent post about HRH and supply chain management.

http://www.capacityplus.org/human-resources-constraints-public-health-supply-chains

Henry

I am two days from Fall Break - and I need a break or I'm going to fall down. The pace of grad school has really picked up the last few weeks and that balance of work, school and life is getting harder to achieve. For the most part, I've been able to stay positive and certainly motivated.

Last week I traveled to Washington, DC to meet with some of our partners at the World Bank and my CapacityPlus colleagues. I also attended a USAID DELIVER critical issues series on human resources for health and supply chain management. If this seems like a foreign language, stay tuned. My project blog on the meeting will be going live any day now!

As my schedule has ramped up, the temperatures have cooled down and Chapel Hill is slowly starting to turn from green to electric yellow, orange and red. Fall is by far my favorite season - I always savor those pumpkin lattes at Starbucks, pulling out my tall boots and that night you first need to get out the extra blanket. I am promising myself to slow down, take deep breaths and take it all in. Life is really that precious.

And speaking of life, I have the best news to share. My best friend Ben and his wife Ginny welcomed their adorable son Henry Arthur Marks yesterday. I am savoring every detail of the pictures and can't wait to meet this little man. Ben is my oldest and dearest friend - who is now a daddy! Congratulations to the proud, new parents! Vintage photos below! Henry photos to come!

Don't forget the mommas!

Check out this blog on maternal mortality that I co-wrote with my colleague Kate.




Saving Mothers’ Lives
October 2010 by Amanda Puckett and Kate Tulenko

Much literature has celebrated the recent World Health Organization report that maternal mortality declined by a third in the past decade. Though this downward trend is remarkable, the global public health community is concerned that the declaration will shift attention away from sustaining and increasing efforts to address maternal deaths throughout the world. Also important is decreasing maternal morbidity, which creates huge costs in terms of human suffering, health care expenditures, and lost productivity.

Health systems strengthening reduces maternal mortality
The headline The Top Three Things We’re Not Doing to Save Mother’s Lives recently caught our attention. CapacityPlus’s result areas—global leadership, policy and planning, education and training, workforce effectiveness, and evaluation and knowledge-sharing—are key pieces of the health systems strengthening puzzle needed to improve health outcomes for men, women, and children. Addressing the global health worker shortage, which is most critical in countries with higher maternal mortality rates, will strengthen health systems and improve more than just maternal outcomes.

The article claims that health systems strengthening isn’t “sexy”, which explains why it doesn’t get as much donor funding as other initiatives that target specific diseases. We beg to differ. There is no more attractive way to invest time and resources than ensuring a system functions at all levels so that health services are delivered at a high quality and effectively to populations. Strong systems enable the rest of those “sexy” services like antiretrovirals and immunizations to function at capacity.

Access to contraception and postabortion care
Birth spacing and unmet need for family planning are major concerns for women in many parts of the developing world, but barriers too often prevent women from obtaining access to contraception. These obstacles include logistics, money, access to a provider, and gender norms. Today, more than 200 million women around the world have an unmet desire to control their fertility, and this should not be ignored.

It is estimated that globally 20 million unsafe abortions occur each year, and account for 13% of maternal deaths as well as long-term morbidity for many women who suffer from such consequences as chronic pain, pelvic inflammatory disease, tubal occlusion, and secondary infertility. Improving access to both preventive contraception and emergency contraception has the double benefit of dramatically decreasing the number of abortions performed each year. In addition it is important to continue to expand and scale up primary-level postabortion care services that include family planning counseling and methods.

Back to the health system
What is striking about the elements needed to save mothers’ lives is that they require a strong health system. Access to contraception and postabortion care in countries where abortions are currently illegal demands a properly functioning health system. How can access to contraception be improved without a qualified health workforce and fully stocked and operational facilities?

Let’s focus this list even further. We suggest that the one thing we need to doing more of to save mothers’ lives is health systems strengthening.




http://www.capacityplus.org/saving-mothers-lives

GOAL

I looked up the word "goal" in the dictionary and many of the "definitions" were about sports or an end point of a race. I was looking for that perfect arrangement of words to describe the goal my project just reached - the GlobalGiving goal. The best "definition" was "the end to which an effort is directed" but this really doesn't touch the surface of what it means to have met the GlobalGiving goal for the Open Challenge. It is not the end but just the beginning of an exciting journey for someone in Malawi.

If you are an avid and faithful reader of my blog, you will recall my push for donations on GlobalGiving.org for IntraHealth's project in Malawi. We were raising money to fund tuition for health workers in Malwai - a country with many health-related challenges including a severe shortage of heath workers. As part of the challenge, we had to raise $4000 from 50 different donors to earn a permanent spot on the GlobalGiving site.

We did it. We raised $4585 from 71 different donors. We have earned a permanent spot on the GlobalGiving site to continue raising funds and grow the company's presence thru networks like those on GlobalGiving. But we have done something so much bigger that it makes me want to jump up and dance every time I think about it: WE HAVE ADDED A NEW HEALTH WORKER TO MALAWI'S HEALTH WORKFORCE.

Just think, someone's dream of going to school can now be realized. After graduation, this health worker will be posted to a clinic in Malawi and will help probably thousands of men, women and children during their career. This health worker will help save lives.

This might be one of the most tangible things I've done in my career and I'm so proud to have reached this GOAL with so many supportive colleagues, friend and family members. It means so much to me that people have listened to my countless pleas for this cause. I did not do this alone but I put my heart into promoting this project and I firmly believe in its success. Next up: follow our health worker on his/her journey and continue supporting them as they take on this great next step in entering Malawi's health worker education system and work force.

I love this quote and it has really rang true for me this week:

"People want to know that you care before they care what you know."

Jina langu ni Amanda...mimi ni mwanafunzi

Fall is finally arriving and it's been a busy few last weeks of summer. Many of my oldest friends are expecting - here are some pictures from some recent baby showers. I can't wait to meet Fairley's little girl and Benjamin's little boy. They are set to arrive next month!

Can it really be fall? It feels like school started just yesterday but already my cohort and I are busy with literature reviews, conceptual models, logic models, Stata data analysis frustrations, papers, research....the list goes on. My second year of graduate school is starkly different than the first year. Classes are much more intense and I can see how we are building off our foundation courses from last year. Dare I say I really am becoming an advanced public health professional? It sure feels like I am on the right road!

Here are some fun shots of my public health friends and then some....

Today at lunch, my friends were talking about what they are thinking of doing next year. Some want to continue school - aiming for nursing degrees, other graduate programs and even PHD programs. I know I want to continue my education but I feel that I want more working knowledge under my belt before taking a beat to go back to school yet again. But what will I do after May? Stay at my wonderful company in North Carolina or move on to the unknown? Continue working for an NGO or embark employment under a donor or multilateral agency? I didn't have this question mark looming over my head after graduating from undergrad - I knew I was going to move to London and just figure it out there. It worked out fine but I can't just escape across the big pond for a "once in a lifetime" adventure at the age of 31. In all honesty, I don't want to go out and look for a new adventure - I want to settle into these comfortable shoes of my career that is global public health. I love it and it feels so good to know I love what I do (except maybe Stata).

This week some of my IntraHealth colleagues are in Kenya presenting the PNA results to the stakeholder groups. I am so envious. Not only do I want to be back in Kenya, I miss that team and I really like following thru on my work such as this awesome assessment. Soon I'll connect with my colleagues and hear about the next steps for the assessment!

Speaking of Kenya, let me introduce myself in Kiswahili.

Ninaitwa Amanda. Ninatoka Oxford, NC. Kwa sasa nina ka Chapel Hill, NC. Mimi mwanafunzi wa UNC-CH. Mama ni Linda. Sina kaka wala dada. Mbwa langu ni London. Ninasema Kiingereza, Kifaransa na Kiswahili (kidogo). Sisemi Kirusi! Ninakula chakula cha nafaka kwa chakula cha asubuhi na ninanywa kahawa. Kweli!

If you speak Kiswahili you'll probably laugh but if you don't, you'll think I'm one smart blogger! :)

Until next time....

Italian canals and root canals

This week my dentist is in Italy. I know this because I have experienced the most intense toothache or any type of ache ever in my life. While my dentist has surely been enjoying gelato while gazing at architecture from Venetian canals, I have been in agony. But thank goodness another dentist in the office was available to see me not once, but twice this week! Though not as lovely as a gondola ride, I got my own "root" canal (a bit cheesy but I couldn't resist). Today I am sore, but very grateful to be on the road to tooth recovery!

This experience reminds me of how fortunate I am to live in a community with access to quality healthcare - which includes quality dental care. So many of my fellow global citizens are not so lucky. It is important for us to remember that our teeth are an important aspect of our health. From early childhood caries to advanced gum disease, if we do not take care of our teeth and gums and our children's teeth, our quality of life can be greatly affected. I learned this lesson first hand this week.

A Quote

"The most common language is neither English nor Spanish nor Hindi. The most common language is silence - the language of the world's poor and marganilized women." (Indira Gandhi)

Did this strike a chord with you as it did with me? I have been focusing a lot more on gender and human rights in my public health studies lately. I have also been taking on some gender activities at work. It isn't an impossibility that I will will include gender as an aspect in my Masters paper next year. From compulsory steralizations to workplace violence to forced prostitution, women have stigmatized and denied a say in their reproductive health and their basic human rights for centuries. I know this subject is pretty dour but there are so many stories of hope and persaverence. Women around the world are truely amazing. If you live in the Triangle, check out Nicolas Kristoff at UNC on September 14th and at Meredith College on September 20th. Kristoff co-wrote "Half the Sky", which I have blogged about already. It is a wonderful book all about women, who "hold up half the sky".

Baby times three and all about me!

Labor day weekend has come and gone, all too quickly! I spent some quality time with friends, family and myself. It was nice to have some time to reflect on the past few days in which I attended a three day workshop for my MCH Leadership Consortium training. The workshop was all about me - each attendee focused on themselves and their unique, natural qualities that make them a good leader. The trainees used the standby MBTI as well as some other personality and style indicator type tests. I am a proud ENFJ (not a shocker) and scored pretty high on the FIRO-B. In short, I am a people person who is intuitive, likes to make plans and is outgoing, enthusiastic and friendly. There are about 20 pages of reports that go into more detail but all of this "me" stuff will help me learn how I work best as a leader. Pretty cool stuff.

I have to say that I am so inspired by the wonderful people involved in the MCH Leadership Consortium. This experience is kicking off to be one of my best grad school experiences so far and I feel so privileged to have been accepted to participate in this training and learn from my instructors and my distinguished cohort. We come from all different backgrounds at UNC and beyond but I feel like already, we have a supportive foundation in each other. Pretty cool stuff!

Let me end this blog by telling you about the wonderful journey I made Sunday with my mother to meet three very special little boys - Austin, Currin and Lee McLamb (see photos at top). They were born July 14 - two months early. These little guys are identical triplets and are too precious! Austin and Currin are getting adjusted to life at home with big sister Lilly and Lee is still in the NICU fighting away intestinal bad guys. He is doing well though and like his brothers, has captivated my heart. Elizabeth, their mother, is one of the bravest and most extraordinary women I've ever met. She has the best attitude and is a strong and loving mother to her four children. "Lizzie" and I went to high school and college together and she is just so amazing, I want to get the girl on Oprah! You can read all about them at Elizabeth's excellent and well written blog - http://multiplemclambs.blogspot.com

YOU can help Malawi!

If you are still with me on this blog, you care about public health and perhaps my thoughts on public health. Please visit my blog on IntraHealth's site to see what I'm currently working on - a partnership with GlobalGiving to raise funds for tuition for health workers in Malawi. I know when you hear fundraising you think big bucks but in this case, small donations or microdonations are gleefully accepted. Even better, all of your donations are matched! So you if you give $50 - it's like giving $100! It's an easy, innovative solution to helping train a critical cadre of health workers in a country with a serious shortage of healthcare professionals.

Check this out immediately!

http://www.intrahealth.org/page/small-sums-incredible-impacts-microdonation-challenge-to-support-health-worker-education-in-malawi-

So why Malawi? Here are some facts:

- For every 1,000 live births, 120 children under the age of five will die. In the United States, the probability is that only 8 out of 1,000 children will die before the age of five.

- It is estimated that between 700,000 and 1.1 million people in Malawi are living with HIV, or 11 to 18% of the population. This is among the highest HIV prevalence rates in the world. Only 34% of women and 41% of men in the country have knowledge of HIV prevention methods.

- Malaria is a huge problem for Malawi's population. An estimated 3 million people are treated each year. Malaria is the main of morbidity and mortality, especially among young children and pregnant women. Malaria has long been eradicated in the United States.

- Only 54% of births are attended by skilled birth attendants.

- Life expectancy is 53 years compared with the global average of 68 years

By increasing qualified human resources in Malawi's health sector, skilled resources will be on hand to help treat malaria, HIV and TB. Children under five stand a better chance of receiving care if they suffer from pneumonia or diarrhea. Pregnant women and families will have greater access to antenatal care and family planning counseling. Clearly, training more healthcare workers in Malawi will lead to a healthier population.

If I've already persuaded you to donate, here is the direct link:

http://goto.gg/6215

The beginning of the end...

I can't believe how time flies. A year ago, I nervously went through the motions of my UNC-CH Masters program orientation. I met professors and classmates who would soon become mentors and best friends. I timidly weaved my way around the public health buildings and health sciences library. Just one year later, I am on the other side, helping first year students with their orientation. It is a surreal feeling to be back in school and preparing for my final year at the Gillings School of Global Public Health. It feels like I wrestled with the thought of graduate school for years and then spent time studying for the GRE and perfecting my application. Now, here I am, the beginning of the end of it all. I'm excited and eager for that type of learning and stimulation that you get from a room full of classmates with so much knowledge and experience. I can't wait to reconnect with my friends who have been all over the world this summer doing internships but have now returned to Chapel Hill to finish up this adventure with me. I've never felt so motivated, which I think is partly due to how much I love my work at IntraHealth on CapacityPlus. I'm ready and set to go - 264 days until graduation!

Gender and Public Health

This week has flown by! I am finally caught up on all the CapacityPlus emails that came thru while I was in Kenya and Canada. I was nervous that after nearly 3 months of leave from the project that it would be hard to get back up to speed. However, it wasn't as bad as I thought it would be and I feel nearly up to date on all of my work with the project's PSE, ISE and CPD work. We have so many exciting and innovative plans for year two of the project - stay tuned!

Today I attended a Gender 101 training at FHI. The intent was to train us to be able to go in the field and train our programmatic colleagues on how to think about gender, how to integrate it into programs and how to write a gender analysis plan. In our field we call this training at "TOT" or training of trainers. One of the facilitators actually conducted this gender training in my Family Planning/Reproductive Health class this past spring so I was familiar with a lot of the material. It was interesting to learn how to deliver that same training I had received only a few months earlier.

After the day-long workshop, I was reflecting on gender in public health. It is not a new concept but it seems that these days, the light is shining brighter on ensuring gender equity and gender equality in public health programs. When Obama's Global Health Initiative (GHI) debuted this year, guiding principles for a Women Centered Approach called for "support for a right to health for all women, men, children and youth" and "meaningful participation of women in planning, decision-making, monitoring and evaluation", among other things. Recently, the GHI changed this from the "Women Centered Approach" to "Women, Girls and Gender Equality Principle". I really like this because gender is about much more than women.

Also, USAID's ADR now calls for gender analysis plans to be part of all programs. In the past, gender analysis plans were a nice supplement to proposals and workplans but now with federal regulations requiring them, a stronger emphasis is being placed on planning and integrating gender into our work.

So where is gender in our work? Answer: it really is everywhere and not just in developing countries. In public health, the goal is to promote gender equality for men and women by changing behaviors, attitudes and practices that are harmful to their health. By addressing gender norms and breaking down barriers that prevent women and men fair and equal access to healthcare, public health programs can achieve gender awareness and transformation. In the PNA I did this summer in Kenya, gender was one of the main research questions. In our assessment tools, we looked for qualitative and quantitative data on how gender played a role in health worker training both from the perspective of student and instructor. If young women do not feel they are able to receive the same education as young men because they are women, then there is clear gender bias to address in health worker education. (Note: this is a hypothetical statement, not a finding of the Kenya PNA)

The best part of a training, like the one I attended today, is learning about what other people are doing. Whether you are in public health or not, you have experience in gender. Why not share with me what you have learned, what you found challenging, or what you want to know more about? Post a comment and let's discuss gender in public health! I'm curious to see if this can be interactive!

Canada Brings Good News!

Vacation does a soul good! My trip to Canada did my soul and spirit very good! Here are some highlights...

Our first stop was Ottawa, Canada's capital. Canals, gorgeous architecture and markets along cobblestone streets made Ottawa a charming, quaint city. My favorite part was the parliament light show. Below is a picture of the parliament building - imagine a light show projected on this entire building. It was stunning! I've also added a picture of sunset in Ottawa - one side of the river is Quebec and the other side is Ontario.

Next up was Montreal. The old part of Montreal was so beautiful and Chris and I loved strolling these streets, stopping in shops or for coffee. But the best part of our visit to Montreal was the fine dining! We had an out-of-this world dinner at Europea (www.europea.ca). My taste buds went on a roller coaster ride with the sensational tastes of lobster cream cappuccino with truffle oil, parsnip puree, confit tomatoes with fresh thyme and honey, braised veal cheeks, and an array of deserts including apricot marshmallows, rasberry cream cookies and cotton candy! And would you believe the day after this amazing dinner, we had a delicious brunch in a beautiful "jardin" in Old Montreal? I am eager to return to Montreal to just eat!

After Montreal, we took an 18 hour train ride to New Brunswick. During our tour of the maritimes, we kayaked in the Bay of Fundy in New Brunswick and toured the lighthouses and Anne of Green Gables' stomping ground in Prince Edward Island. We also went whale watching - one of the coolest experiences of my life. We saw birds, porpoises, seals and lots of whales! You feel so small when you see a large fin whale surface near your boat. They weigh a mere 60 tons.

New Brunswick and Prince Edward Island were gorgeous. I love being near the water and driving along lush fields that back up to lighthouses along the coast was amazing. Enjoy these pictures of a lighthouse on PEI, where we were kayaking at the Bay of Fundy's flowerpot rocks and cute seals from whale watching!

Toward the end of my trip I received some very good news - I was awarded a FLAS (Foreign Language Area Studies) scholarship! I am extremely excited and honored to have received this from the African Studies Center at UNC. The scholarship will cover my tuition and fees my final year of school as well as a provide a healthy stipend. This combined with a place on the MCH Leadership Consortium is a huge boost for my grad school morale. I'm so ready to get started!

Tomorrow I will return to work and I am actually very excited! Most people dread going back after vacation but I feel so invigorated by my studies and my job. Vacation was just the respite I needed to motivate me kick ass in global public health!

Check!

I’ve completed my summer internship! Can you believe it? I still have a few reports to submit to UNC but my work with the PNA has sadly come to a close. The team still has a lot of data analysis and report writing ahead of them but I do feel that I made a solid contribution during my practicum this summer. I know that I learned a lot and I am certain that my experiences from supporting the Kenya PNA will benefit my work on CapacityPlus and beyond.

I’ve been taking it easy the past few days. I finished painting six beautiful oak dining room chairs for my condo – with primer and two coats of paint each, it is like I painted 18 chairs! It was more work than I bargained for but I’m so proud of the finished product. I have the bug to decorate and I’m eager to get back into my home in Chapel Hill.

Tomorrow I’m heading to Canada for a much needed vacation. Word cannot describe how excited I am for this trip! My friend Chris and I are going to Ottawa, Montreal, New Brunswick and Prince Edward Island. I’m ready to explore in relax in all of these places unseen. So far, my Canadian travels have been limited to Toronto and Vancouver. I’m keyed up about Tim Hortons, exploring the streets of Montreal, whale watching at the coast and kayaking! It sounds like a dream vacation and Chris has done an excellent job planning out adventure. I can’t wait for that cooler air too!

Before you know it I’ll be writing about starting up my work on CapacityPlus – some new exciting things are coming our way so stay tuned! I am going to be supporting some new and very cool work surrounding nursing education! In the mean time, soon you can check out IntraHealth’s website for a guest blog by yours truly. (www.intrahealth.org)

School too will be back in session next month. In fact I plan to take a course at the Odum Institute before classes even start so I’m getting a jumpstart (inspired by my data analysis on the PNA). Stay tuned friends – I have so much more to write about, ay!

Making Dustin proud!

The data is coming in! I love this part of the study when data sets are coming in and after they are cleaned, we can look for trends and feedback to help us address our research questions. The PNA is so big, it will take a while to digest all of the information and how we want to report on it but for now, I’m taking some of the pieces and analyzing away. In a nerdy way, I am seriously enjoying this! Yesterday I downloaded a free trial version of SPSS and I’m getting a preview of what I’ll be learning in my Research Methods class this fall. SPSS seems much more user friendly than SAS and I’ve already been able to teach myself how to run some of the descriptive statistics.

Can you tell I am enthusiastic about our data analysis? Last night, I stayed up later working analyzing some qualitative data and went to bed thinking about how we can link pieces of that data to other parts of the PNA. This morning when I was typing out notes I had an epiphany – I literally slept with my data! My MCH girls will laugh because our biostatistics professor Dustin told us from day one that biostatisticians often sleep with their data to help process it. I’m by no means anything close to a biostatistician but last night, I slept with my data (no p-values yet Dustin, sorry).

In my last post I encouraged you to read Half the Sky. Well if you don’t have time to read a book but would like to read something uplifting and “public healthish”, I encourage you to pick up a copy of this month’s Glamour (Vanessa Hudgens is on the cover) and turn to page 125. There is a great story about a female US solider that saved a 13-year old girl’s life by delivering her still born baby in very resource constrained Afghanistan. It’s gripping and a reminder that we still have a long way to go to ensuring equal and high quality maternal health care for women across the globe.

Friends and the Dewey Decimal System

This past weekend was such a nice break for fun! Friday night I was invited to the Michael Buble concert with friends – it was a great show and even better was laughing and spending time with such a great family. Saturday I had breakfast with some of my oldest friends from growing up and that night had dinner in Raleigh at Sitti (yum Lebanese). Sunday I met grad school friends out in Carrboro to watch the World Cup final – great time but I just wish the Netherlands had won! So all and all, a great weekend spent with so many brilliant friends that I am thankful to have in my life. I am very appreciative of all of the support and happiness they bring to my life so for all of my friends out there who read my blog (and those that don’t), thank you for being so wonderful!

I have two weeks left supporting the Kenya project before taking a much needed vacation and returning to my work with CapacityPlus. All of the sudden time is flying by! While we are waiting for the data to be entered in Nairobi, I’ve been doing a literature review to see what else is “out there” about health worker training and the linkages between all of the parts of the system. Thank goodness for the internet and my experience in doing so much research and paper writing in grad school last year! I just don’t know how people managed without access to so many journals and articles from all over the world. I remember learning the Dewey Decimal System when I was in elementary school and I imagine kids these days are learning how to Google. What will my kids and grandkids be using? We are so fortunate to have so many tools at our fingertips to help further our work. We have to ensure we are expanding technologies to developing countries and using them to strengthen and improve the health workforce. I love reading about innovative ways of doing this and learning about programs that have successfully integrated new approaches using technology. We had a great presentation at work last week about using mobile phones (m-learning) for data collection and health education. This isn’t new but it is expanding in our field. Imagine a world where everyone has a cell phone and everyone has cell phone access. I think that might be in my lifetime!

One last note – I wanted to share with you a wonderful book I am reading called Half the Sky by Nicholas Kristof and Sheryl WuDunn. This should be required reading for anyone in public health but there is much to gain for anyone who reads this book. It is a compellation of stories about empowering women and girls, focusing on gender-based violence, sex trafficking and prostitution and maternal mortality. Though these are dire subjects, this well-written book relays true stories with a twinge of hope and optimism for the future. See the link and please read this book!

http://www.halftheskymovement.org/

Adjusting...

The past week-plus has been busy! On the work front, I have been supporting the Kenya team from Chapel Hill. Data entry started in Nairobi this week and most data collection has completed. I am eager to see the data and start data analysis for my sections of the draft report. I’ll be looking specifically at the data from the client exit interviews, which assessed how clients rated the students who treated them or their children. There are other pieces of the data that I’ll be helping to analyze and I look forward to applying my skills in this next step of the PNA.

Outside of work, I have been adjusting to my unexpected return to the US. This has been much harder than I would have thought. While I am appreciative to be in a safe environment and surrounded by my friends and family, I have felt such emptiness. It is hard to explain and I don’t think it will go away for a while. I wish I were still in Kenya. I catch myself thinking of my Swahili words to make sure I have not forgotten them and I often dream of being back in Africa. This will pass but I am certainly learning to handle one of life’s familiar lessons – disappointment. I’ll go back to Africa and specifically Kenya sooner rather than later and I think it will mean so much more to me than it ever has before. I am determined to work hard at IntraHealth and at school to ensure I get back to East Africa soon to continue supporting teams like my colleagues in Kenya. Despite the lovely safaris and the exotic food, the ultimate goal is to improve health outcomes for families.

This past weekend was July 4^th. I had a low-key holiday celebration, spending some of it antiquing with my mom and friend Chris in Virginia and some of it at Christina and Greg’s party. This week there will be rest of the weary! I am staying with my friend Laura and I know it will be like a fun summer camp in the evenings! During the week, I already have a few early morning Skype calls on my calendar so the Chapel Hill team can liaise with the Kenya team on the PNA data! Have I mentioned I am excited to see what has been coming in from the field?!

18 hours in the air

I am feeling so many emotions this week – disappointment probably being the most predominant. On June 22, I had to leave Kenya. The departure was unanticipated and it feels like in the blink of an eye I’ve transported back to North Carolina. The good news is that I arrived safely home and will complete the work on the PNA from IntraHealth’s Chapel Hill office. I will soon reunite with Cathy and Leigh to begin data analysis and report writing. I am excited about the writing – especially the gender components of the assessment. So, despite not physically being in Kenya in July as planned, I will carry-forward on this important piece of work for IntraHealth.

I am not happy about leaving the team in Nairobi. I feel like I am abandoning them and I am disheartened to physically disconnect myself from the work on the PNA in the field. But this is the nature of my work – spontaneity, flexibility, working with teams via Skype and email. Though it is easier to be in the field, sometimes safety trumps physical location and we have to make alternative plans. I am more determined than ever to support this team and look forward to going to the Chapel Hill office on Monday to reconnect with both the Chapel Hill and Nairobi teams!

Since returning to the US I will admit to being enthralled with reuniting with my family and friends. I’m enjoying sweet tea but really missing my Kenyan coffee (good thing I bought some Dormans to bring home)! I also miss the cooler Nairobi climate – I was greeted with 100+ temperatures in North Carolina! The actual flying time to get from Nairobi to RDU is about 18 hours but the journey is much longer if you factor in layovers and travel time to and from the airport. I had to layover in Amsterdam on my way back and while the stay in the Netherlands was very short, it was nice to walk around by the canals. It is around the time of the summer solstice so in northern Europe, it stays light out very late. At 11 pm, the sun was still up!

This is not the end of the blog! I guarantee you I have much more to say about public health and human resources for health. I also assure you that I am not deterred in the least from traveling to Kenya or other places where we do our work. I have been so motivated by the commitment and hard work by my colleagues and local collaborators in Kenya. I cannot put into words how inspired I am by the sacrifices that some people make in our field of work. There are two sides to every coin – the good and the evil – and I choose wholeheartedly in the good. I choose to undertake my role as a leader in global public health and do my best to support programs that improve the lives of families around the world. I choose to encourage and believe in the good of my fellow global citizens. And after these last three weeks in Kenya, I choose to believe in myself. I have personally come thru a lot and feel confident in not only my ability to do my work but in my ability to do it well. Though this experience has not turned out as I planned, I have learned oh so much to carry with me for the rest of my life!

Nyama Choma

Yesterday, I had my first Nyama Choma to celebrate Father’s Day with Scott and Pam. This traditional Kenyan meal is basically roasted meat. We got ribs (goat meat) that was roasted for about 45 minutes. We also ate traditional Kenyan veggies. I normally don’t like eating goat meat or any meat off the bone but Nyama Choma was fantastic! By the end, my belly was full and my hands were a little dirty but I have to say, this was delicious! It is exciting to experience these traditions. I am just happy I didn’t have to participate in slaughtering the goat.

I had actually forgotten it was Father’s Day. Ever since losing my father 10 years ago, I try and block out that holiday but this year, I couldn’t escape it. I went to church and so much of the service was about fathers. This one woman wanted to read a letter she had written to her father at the end of the service. It was beautiful. She wanted to publically thank him for all that he sacrificed for her chance of a good education. She was so eloquent, proud and by the end of her letter, not only was she crying but everyone in the church was teary-eyed. I was so happy her father was there to hear her read him that letter. I felt a twinge of sadness that I never got a chance to say anything like that to my own father because he died so suddenly. However, like this woman’s father, my dad sacrificed so much for me. I am so grateful to have had him in my life, although it was too short of a time. I like to think my dad is proud of me now – half-way to a Masters degree, traveling the world and learning new things. A santé sana Daddy!

Huduma Bora Ni Haki Yako

We are off! Data collection started this week and already, our data is rolling in thru Epi Surveyor. I love this feeling – finally deploying and using the tools we have worked so hard to perfect. If I feel this euphoric about just starting data collection, I can’t imagine how excited I’ll feel when we begin to analyze the data and make recommendations to the government of Kenya. Even more so, I can’t wait to see how this assessment will pave the way for improvements in strengthening Kenya’s health worker training and improving health outcomes for this wonderful population. You may think I am getting ahead of myself but if we don’t have our eye on the goals of our work, it is easy to get lost in the details. I am such a detail-oriented person; one thing I wanted to experience from this summer work in Kenya was to do technical work, focusing on that bigger picture. I’m experiencing it!

I have achieved a few notable things this week including learning how to set up views in Epi Info. This is a computer program that helps to analyze data. Before you can analyze it, you have to set up the files toread the data you enter into the system. This is done by coding your data sets, which is the skill I learned this week. The codes can be a little complex but I love seeing how all of the questions are linking and weaving together. We hope to have our tools completely set up in Epi Info by early next week so that data entrants can start inputting responses from our tools. I can’t believe how fast this process is moving along!

Apart from learning this nifty computer program, I got out into the field this week to support one of our teams with data collection. I visited KMTC Muranga and Muranga Hospital in Central Kenya. KMTC stands for Kenya Medical Training College. The sites were an hour-and-a-half outside of Nairobi. The drive to Muranga was beautiful and I was awed by the rolling hills of the Kenyan countryside. Once we (Cathy and I) arrived at the institution, we met up with the data collection team. They were still navigating thru the various district health officers for the go ahead to get started collecting the data. You cannot simply show up at a school and hand out questionnaires and conduct interviews. It is so important that the national and local government support your efforts and usher you thru the institutions. This also enforces the importance of collecting the data. In addition to the local government officials, we also met with the principal of the school and various directors of the hospital. Everyone was very nice and it was eye opening to go thru this “official” process of beginning data collection at Muranga.

Apart from these formalities, we had to plan for our interviews with community health workers and various community members. Many times in rural areas, community health workers deliver basic health care services to the community. Though they have limited training, they are trusted members of the community and an important aspect of healthcare delivery in developing countries. I support this cadre as they most often service populations who are unable to travel to formal healthcare facilities. And as you know by now, rural healthcare facilities are the ones facing the most severe health workforce shortages.

KMTC Muranga was buzzing students studying for finals. It was like Kenya Harry Potter – the students were dressed in uniforms but it was cold and many had scarves to keep them warm. I visited some of the classrooms and most were packed full of eager learners. This facility was obviously beyond capacity because one “classroom” was a tent. There were a dozen or so desks and some benches situated on top of a dirt floor. A flip chart stood in for the instructor board. Glancing thru some of the early responses, I was not surprised that students felt that the facilities were not up to par at this site.

I want to share with you my favorite thing about Muranga. “Huduma Bora Ni Haki Yako”, which means “You have the right to be served”. This was posted all over the site and I loved being reminded that access to healthcare and treatment are a basic human right. So many people are sticking their necks out to ensure this right is respected in Kenya, including our team of data collectors for the PNA (enjoy the picture those of you who are asking I post more photos). I applaud these colleagues who are doing such a great job supporting IntraHealth’s work in Kenya with the PNA. A santé sana!

Now, if only the refs at the World Cup would not have jipped the US team of their third goal!

Buzz! World Cup and Abortion

Have you been watching the World Cup? If not, get on board folks, this is the ultimate global even! I heard more countries are registered with FIFA than with the UN. I goggled this and in fact, FIFA as 208 member countries whereas the UN has 192. I am not a football buff but after a few days of hearing sporadic cheering on the Nairobi streets and passing by television screens literally buzzing with excitement, I had to get in on the action. While I don’t care for the constant buzzing of the horns, I appreciate the lively and often dramatic commentary here on Kenyan television. It is pretty neat to be on the continent for this event!

Tomorrow we go to the field for data collection. These last few days of training our data collectors has been filled with last minute logistics, organizing the teams and ensuring our ducks are in a row before departing for the event tomorrow. We have 7 teams dispersing all over Kenya from Mombasa to Eldoret to Kisumu. We’ve heard from our data collectors how excited they are to participate in this assessment and receive “international” training for the PNA. This enthusiasm and commitment are so important because I am certain each team will face many challenges for the next 2+ weeks of data collection. We’ve done our best to prepare them and I can’t wait to see how it all plays out. The big debrief will be July 3, when all the teams come together to discuss how it went. I hope to learn what pieces of this process worked well and what didn’t so that I can take these lessons learned with me as I am involved in future assessments – though I think I’ll never participate in one quite like this one!

I am learning new things before we set out on this adventure. This includes Epi Info so I can help with the data analysis phase. It is really interesting to see how so much data, both qualitative and quantitative, are entered into a system and analyzed. This will certainly help me with my fall classes that delve into M&E and Research Methods!

Apart from work, there is a lot going on in Kenya. As I understand it, the country is revising their Constitution and the process is very interesting. The big vote is in August and most everyone I have talked to have been interested in participating in the vote. I’ve even seen copies of the draft Constitution in the back of taxi cabs. Several pieces on the table for revision are very controversial and there was even a rally Sunday night, in which 2 explosions occurred, killing five and injuring many others. I’m still learning about the revisions, some that concern land and the court system, but the most interesting to me is the proposed change in the law regarding abortion. Currently, abortion in Kenya is illegal unless a doctor confirms a woman’s life is in danger. Here lies a problem in that there are not enough doctors, especially in rural health centers. Recognizing that the health workforce shortage is contributing to maternal mortality in this manner, the new draft Constitution states that other cadres of health workers such as nurses could also sign off approving an abortion if a woman’s life is in danger. This draft Constitution in Kenya certainly offers an alternative in how the delicate issue of abortion and the challenge of human resources for health can merge to reduce maternal mortality. Ideally, abortion would not be illegal but this is a step. No matter where you stand on abortion, this change in the draft Constitution is a hotly debated issue in Kenya, especially among many of the conservative religious groups in the country. There have been rumors swirling that abortion will be legalized due to misinterpretations of the draft document. It will be interesting to see what happens in August and I pray that the vote goes smoothly.

I’ll leave you with just a few other observations on what I miss from home and what I can live without:

- I do not miss television.

- I do miss sleep.

- I don’t miss any foods from home – Kenyan food is yummy!

- I do miss free time! I’ll never have time to read all the books I brought with me (although I did finish Girl with the Dragon Tattoo).

- I do miss Global Health Council this week but I’m sending my colleagues who are presenting good vibes from Kenya.

- I don’t miss the hot weather NC right now. Nairobi is nice, even cool this time of year!

- I really miss my family and my dog!

Birthday Safari!

Everyone should be so lucky to have a birthday safari and I will never forget my 31st birthday celebration in Kenya. My trip to the Masai Mara this weekend has been so magical – let me share with you the details!

We left out of Nairobi’s Wilson airport Saturday for a 45-minute flight to the Serena land strip in the Masia Mara. This was my first time every being in a plane that landed on dirt strip. The “airport” looked more like a bus stop. A vehicle picked us up and we were off to our lodge, which is set up on a hill overlooking the mara. The view was breathtaking and you could see giraffe and gazelles grazing over the savannah.

The Masai are the tribes people that live in this part of the world (more on them and why they should be in the NBA later) and mara is the name given to the land because there are a lot of bushes speckled about. This differs from the nearby Serengeti in Tanzania has more of a savannah landscape.

We relaxed by the pool and read our books for a while, a much welcome change from the insane work schedule. Around 4:30 we took our first game drive with Sampson, our faithful guide. We saw loads of gazelle and other grazers. We saw giraffe, elephants, wildebeests, zebras, warthogs, baboons and beautiful birds. Pictures can’t capture the magnificence of seeing these animals cohabiting in their natural habitat. The mara is hilly and you could just round a curve and see hundreds of animals eating, playing and running. I am always stunned at the peacefulness and intrigue I feel when “in the wild” in Africa.

One very neat part of this game drive was our trip across the border into Tanzania. I’ve never left a country without my passport and though I was only in Tanzania a few minutes, it was really neat to step foot across the border without going thru customs. I even got a picture of my literally straddling the border.

After dinner, the Masai warriors gave a dance presentation. They are known for their colorful red wraps, beautiful jewelry and inhuman jumping abilities. The warriors sing and chant, encouraging each other to jump with excitement. It honestly looked like some of these guys were on a trampoline. I’ve never seen anyone jump so high.

Post dinner entertainment, we joined the other safari goers to watch the England vs. USA World Cup match. Most fans here were pulling from England but Cathy, Leigh and I were representing the US proudly. Since the World Cup is such a global event and taking place in South Africa, it is easy and exciting to get swept into the spirit of football. Last night’s match, as you know, ended up tied 1-1.

Before crawling into bed I heard a horrible snoring. I was thinking how loud our neighbors must be but after some investigating I learned this was no human snoring. Warthog maybe? It was too dark to tell.

Sunday morning, my birthday, we woke early for a 6:30 am game drive. The difference from the game drive the day before was this was the ideal time to see the cats. We were not disappointed. A pack of lions walked right beside our car - literally. Sampson said they must not have made a kill the night before because they were up moving around and looking for food. These were of course female lions because they do the hunting for the males. After the females kill their prey, the males get to eat it first – typical. Around the lions we also saw hyenas. I can’t help but think of Disney’s the Lion King. Here I was seeing Nala in real life, just a few feet from me.

After driving around a bit, Sampson asked if we’d like to take a walk along the river with a Masai warrior. Sure, why not. Our warrior, Dixon, led us by the river where we saw crocs and loads of hippos (in the water). Next, we came upon tables with waiters and damn if we didn’t have breakfast by the river with the hippos. We also had champagne. It felt unreal and amazing. The hippos were snorting and bobbing up and down in the water while we dined on omelets and fresh mango. Happy birthday indeed.

Leigh treated me to a pedicure in the lodge spa and what girl doesn’t love to be pampered! After lunch, I heard singing and drumming – the whole staff came out to sing happy birthday to me. They even made me a beautiful cake. The whole restaurant was clapping and strangers became my safari friends as they greeted me with happy birthday salutations.

We heard that the great migration had started but we left before seeing any of the herds make their way into the Mara. There is a lot of work to do this week and I feel extremely confident in my ability to help our team meet our goals. After all, I’m another year wiser now.

Machokos

This has been such a busy week training the data collectors. I generally work 10-12 hour days and get home in time for a nice dinner with my “Kenyan family”. We’ve eaten such fascinating things such as roast chicken and mash potatoes. Very exotic I know! Actually we have had traditional Kenyan food (eaten with your hand) in our home and soon I will post some pictures of our meal Wednesday night. Since my birthday is Sunday, Cathy and Leigh joined us for an early celebration. Dinner was excellent and I even got a pink cake with sprinkles!

Yesterday, we took our data collectors and PNA tools to two training sites/hospitals to test them. We were looking for kinks in skip logic, questions the interviewees didn’t understand and other parts of the instruments and process that just didn’t work. Also, we tried to get a general feel for how this process will flow as well as how long it will take to administer each of the tools. The day was a huge success! My site was Machokos, about 70 kilometers out of Nairobi or an hour’s drive. The teams divided up and tackled testing the tools. I was so proud of them – they were so on top of it! This is either a reflection of our stellar training or the fact that these data collectors are super bright and dedicated to improving healthcare in Kenya. I think definitely the latter.

I shadowed a data collector who interviewed a clinical preceptor in the pediatric ward of Mochokos Hospital. I have such a soft spot for babies and children. It was heartbreaking to see that ward full. There were twin beds set up and about four children per bed. Most children were there for pneumonia, malaria or other diseases. The mothers all sat with their children and I was told they do not leave the whole time the child is in the hospital – even to sleep. There are no cots at the hospital for them to use to rest either. Since there is a healthcare worker shortage, the mothers need to stay with their children to ensure they are ok and to alert the medical staff if there is a problem. This was a good hospital by many standards in the developing world. However, you can be as equipped and organized as you like but if you do not have a sufficient health workforce, there is a gap that cannot be filled in providing quality healthcare services. As I was looking at these beautiful children I was reminded that this is why I’m here! I have such empathy and compassion for the struggles these mothers and children are facing, which motivate me to study and work as hard and efficiently as possible. I am reminded how fortunate I am to be in a career that I love and most importantly, that helps vulnerable populations in so many parts of the world. As I was leaving Mochokos a beautiful two or three year old little girl was sitting in her mother’s lap and waved to me. I waved back and she cracked a small smile. It is so easy to have stressful times at work and school – I will have to draw on experiences like this one at Mochokos to give me strength to carry-on.

Inside and outside of training institutions and health clinics, Africa and the world are buzzing with the start of the World Cup. The games start Friday and I have a feeling it will be exciting to be in this part of the world for this event. Go Team USA! I’ll be cheering from the Masai Mara this weekend. Cathy, Leigh and I are flying out for safari on Saturday morning. I’ll wake up on the morning of my 31st birthday and experience a game drive with lions, zebras, cheetahs, elephants, giraffes and more. Sounds like Kenya.

A week and the Vice President follows me to Kenya!

This week, VP Biden and his family are in Kenya – their pit stop before going to the World Cup in South Africa. On his agenda is meeting with the president and other top government officials. Also on the agenda is holding up traffic. I have heard horror stories about the Nairobi “jams” and I’m hoping this week they are worse because of Biden’s visit. If this is normal than I am in for a long summer of sitting in the car smelling exhaust fumes and not thinking about how bad I have to go to the bathroom.

Work is going very well. We are training about 40 data collectors who will be going out into the field to use our PNA tools. I thought I’d share with you some estimated numbers about our data collection. Our protocol calls for 480 client exit interviews; 48 school director interviews; 48 facility audits; 24 student focus groups; 384 training coordinator assessments; 384 faculty member assessments; 720 student assessments; 48 clinical preceptor interviews; 7 regulatory body/association interviews and 2 interviews with Ministry Officials. That is just one Phase. No wonder I am working 12-hour days! After we collect the data we’ll launch into data analysis. Holy cow!

I am starting to think about what data I will use for my Masters Paper next spring. I want to write about family planning so I can easily pull out the data just focusing on family planning training. I will also be working with team to launch Kitui Training Center as a center of excellence for family planning and reproductive health in Kenya. Right now I’m focused on the PNA – it is massive!

I am so impressed with the participants in the training. They are a bright group and many are Masters students like myself. I am also enjoying trying on my shoes as a trainer. I don’t mind getting up in front of people talking as long as I know what I am presenting. Going thru this experience is highlighting the skills in which I am good. I’m extremely organized and pay attention to little details. I have the ability to pull back and look at the big picture and not get lost in those little details. I think it is important to recognize where we excel as individual workers and where we need to improve. My goodness I’m far from perfect and have so much to learn. I appreciate the guidance I am receiving from my colleagues about this huge process of going thru an assessment of this nature. I learn all day – at the training and at the dinner table!

Speaking of learning, I wonder if I’ll ever get this Swahili down! It is so hard to learn another language that is completely different from your own. In Swahili, the words for “who” and “you” are so similar, you almost miss it! A few words I’ve mastered are “amani” which means peace; “nanazi” which means pineapple; and “maji” which means water.

Now another one – la la salama, which means rest well. Goodnight friends!

Beads and a Giraffe Kiss!

Today has been one of the most fun days – I’m not sure I’ll be able to top it. So here is a run down of my adventures with Cathy and Leigh…

We started the morning at a market that was set up at a local hotel. I didn’t buy anything but the coolest thing there was jewelry made by a local Kenyan. It was all made from spoons, forks and knives and let me tell you how interesting this stuff turned out – very creative! I also learned the word for market in Swahili is Soko. As proof of entrance to the market we all got Soko Soko stamps on our arms. I’m branded now for Kenya shopping!

Our next stop was the Kazuri bead factory in the Nairobi suburb of Karen. I have coveted Kazuri beads for years and going to the market was like seeing little pieces of heaven come to life. Kazuri means “small and beautiful” in Swahili and these beads are gorgeous. They are actually hand-painted pottery. More inspiring than the colorful jewelry is the fact that the factory employees mostly single mothers and provides them with employment and healthcare (including family planning – yay). I was introduced to one woman who has nearly worked there since the factory opened in 1975! In public health we learn a lot about programs that give women jobs to increase their livelihood and quality of women. I was so happy to see these women making the Kenyan beads I love so much.

Cathy, Leigh and I spent an hour in the shop trying on and contemplating which small and beautiful beads we’d bring home. I’ve attached a picture of me with my purchases. My friends and family should love me – as should the Kenyan economy.

On our way out of Karen we stopped at the Giraffe Centre. I absolutely love animals and feeding and kissing the giraffes was the experience of a lifetime. They are beautiful animals and words can’t describe how cool it was to be interacting with them so closely. (Picture attached) Last time I was in Kenya I was up close and personal with a cheetah and this time a giraffe – what is next?!

The afternoon ended with yummy lunch at a vegetarian Indian lunch. I love Indian food and Africa has some of the best. With a full belly and empty wallet, I headed home.

Tonight Pam will be coming home and I just can’t wait. This is really just a wonderful day.

So what else has been going on other than all of this funness? You do remember I am here working? I had my first day in the office on Friday and boy did we jump right in to work. The training for the assessment is next week and we worked tirelessly discussing the tools (remember those) and how best to go about training the 40 some odd data collectors. It will be busy next week for sure but I was enthralled with how well the Kenya team and the three of us from Chapel Hill meshed. This is a HUGE project and we seemingly jumped right into effortless teamwork.
Here are a few other Kenya observations…

· I love the yogurt – best so far has been Guava yogurt!
· The slang for Shillings is “bob”. It’s fun! “Have you got 100 bob?” (that is just over a dollar)
· Nairobi traffic is rough. I-40 at 5:00pm is much better.
· Kenyans are so fun! I had my dinner table up dancing last night and we laughed and carried on!
· My friend Chinelo is here and we got to talk – can’t wait to see her and I’m even happier to hear she’ll be returning to Chapel Hill in the fall for one more semester!

Sorry this is a long post – there is just so much LIFE here and I wanted to share it with you! I wish I could bottle it all up and bring it home in July!

PS I've been trying to post pics for half an hour - will try again later!