Angola

Since I'm only content in the US for a month or so at a time, when I was asked to take a last-minute trip to Angola to do a rapid needs assessment to supplement a major proposal my organization was working on I said yes right away.  I believe what they may have said to me was, "Can you go to Angola tomorrow?"   Unfortunately, the embassy of Angola had other plans and helpfully gave me a whole extra week and half to get ready while they processed my visa.  When it finally came, I was on a flight the next night.  The only reason I didn't leave that night was there wasn't enough time to get to the airport.  Seriously.  They tried. 

Here are the important things about flying to Angola you should know:  the flight is full of oil company employees and when you land in the capital, Luanda, you can see all the oil rigs lit up off the coast. 

Also, don't fly SN Brussels.  When Sabena went under, it was only partially reincarnated as SN Brussels.  All I have to say is:  my blanket had a cigarette burn in it.

Anyway, I spent a phenomenally boring Friday in the office of another organization we are going to partner with and then a phenomenally boring Saturday morning at the hotel in the suburbs.  After a midday meeting, I suggested something along the lines of that I was going to die of boredom if I had to spend any more time in the hotel please please please take me somewhere.  Wish granted.

We went to eat dinner on the Ilha de Luanda, a long narrow strip of beach curving out around Luanda's harbor. 

I don't know what I ate, but it came out of the ocean and it was delicious.

I left early the next morning for the 12-hour drive to the town of Huambo.  I couldn't fly because the "runway is broken" at the airport (no further details forthcoming despite many questions).   An interesting thing about Angola:  it has some of the worst road safety statistics in the world.  I have never, anywhere, seen a road with so many flipped over, crumpled vehicles, left to rot away.  Unsurprisingly, fatality rates are high--high speeds, narrow roads, long distances to hospitals, old cars, low safety belt use, giant trucks coming to/from the port laden with goods and without any kind of lights (yes, all the time).  Add in the rusting remains of tanks and other war detritus, and it's just another charming drive through the countryside.  Fortunately, we only saw one just-happened accident.

Then I fell asleep and I honestly couldn't tell you anything about anything between Luanda and Huambo except that the suburbs were ugly and went on a long way and there was a truck accident and then I was in Huambo.  Except that I needed to pee really, really bad about 8 hours in and I could not make my exclusively Portuguese-speaking driver understand that for another 2 hours or so after that.  As Anthony pointed out, I really should have invested in that English-Portuguese phrase book.  Next time....

Huambo is a pleasant enough town, the capital of Huambo Province, largely rebuilt after the bloody civil war that ended in 2002 but still with its share of scars.

Huambo is where we would be based if we were awarded the proposal, working with the Provincial and District Ministries of Health and the health facilities across the province.  I spent most of my time in three facilities, a maternal and child health clinic and an HIV/AIDS clinic in Huambo town and a district hospital further out. 

 I asked a lot of questions and got some information, although not nearly as much as the number of questions I asked might suggest I would get.  But I always like going into clinics and talking to people and hearing their experiences and want they would like to see happen and watch how things happen.

36 hours after arriving in Huambo, I headed back to Luanda.  This time I managed to stay awake, and it was quite beautiful.

I arrived in Luanda to discover that while I was gone, the two other members of my group, a VP and a consultant who were doing information gathering at the national Ministry of Health and other organizations in Luanda, had gotten fed-up with the hotel in the suburbs and moved us to a hotel downtown where they could get to their meetings in less than 2-3 traffic-jammed hours.  Did I mention how bad traffic is? 

Luanda is prettier from above the traffic, kinda.

Luanda is out of control expensive, thanks to all of the oil money flowing in, begging the question, how exactly do local people manage to get by in a land of $8 Diet Cokes (yes, it was delicious, no, I didn't know it was $8 until it was too late, yes, I had a small heart attack).  I have no idea.  But my next day's trip to a health facility in Luanda with a child malnutrition referral facility suggested that maybe there's a fair number who aren't. 

This particular health facility also had one of the nicest maternity wards I've seen in a really long time in a public hospital in Africa as well as a pretty nice lab (the lab tech is looking for malaria in these blood smear slides--the facility was out of the rapid tests that are now standard many places).

And that's it.  I left that night, exactly 7 days after arriving.  What can I say?  I put the rapid in rapid needs assessment.  Besides, I had a reunion to get to...

Kenya!

Following my five weeks in South Sudan, I headed to Nairobi for the East Africa Regional Conference.  I don’t have much to report on the conference (really important professionally, but really not terribly interesting otherwise), other than that it gave me a chance to stay at my friend Dina’s lovely cottage in Nairobi, with it’s lovely garden…

And it’s adorable kitten, Crumble, my new BFF.  I don’t even like cats, but Crumble is awesome.  Let’s just say, a special request for a sparkly kitten collar will be granted upon my return to the US (strangely, sparkly kitten collars are not something that appears to be available in Nairobi.)

Following the conference, two of my colleagues and I headed to the east cost of Kenya to do some site visits.  Conveniently, the conference ended on a Friday and no site visits could be done until Monday.  What to do with a weekend, what to do with a weekend.  How about the White Sands Resort just north of Mombasa?  Yes, please!  

It was lovely, and after weeks of working basically non-stop, a nice break.  

I rode a camel.

The world looks different from the back of a camel.

I hung out with a sand sculptor on the beach.

 Listened to some of the most awesome karyoke (um, not) I’ve ever heard.  I was laughing so hard I cried at one point.  I also met two people NAMED Karyoke while I was in Kenya.

I went to see Owen, a pygmy hippopotamus who was orphaned in the tsunami in 2004 (though less remembered and less substantial, it did damage on Africa’s east cost).  He was taken to the Haller Animal Reserve, but no one knew if he would be able to connect with the hippos already living there and survive.  Fortunately, 100+ year old notoriously grumpy giant tortoise named Mzee took Owen under his wing and taught him the skills he needed to survive.  It’s a great story.

We also saw a lot of monkeys…

And a giant tortoise (maybe Mzee, maybe not).

Oh, and the crocodiles.  Having dinner.  Crocodiles scare me, FYI.

The crocodiles ended up being good practice for one of the field visits later in the week to the Tana River District.  The Tana River has a reputation as absolutely swarming with crocodiles, which my casual viewing from the bridge as we drove over it (me silently praying, please don’t let us fall through, please don’t let us drive off, please don’t let us fall through, and so on), where I got a visual on at least 5 crocodiles, doubtless hungry.  Probably for human.

 Got up early the last morning in Mombasa to see the sunrise.  The monkeys ended up taking center stage, though.

Anyway, in Mombasa, we visited one of Kenya’s largest and highest-security prisons.  Interestingly, this is the prison where the most notorious of the Somali pirates are being held.  We run a tuberculosis outreach program in prisons all through the coastal region, as prisons are notorious for high rates of TB.  The prison was very crowded and basic, but better than I had been expecting.  The prisoners have chances to go to school, sing in choirs or work in one of several workshops and community gardens.  I don’t have any pictures of inside because we weren’t allowed to take anything valuable in, since we were going into the cells to speak with prisoners, but this is the outside.

After the prison, we headed to a health facility that serves the prison and the community, especially through a community health worker outreach program we support.  We gave a group of newly-trained TB-focused CHWs messenger bags to carry their stuff around it, which they were pretty excited to receive.

...and then out to a rural outpost to meet one of the community sputum collectors who help refer potential TB patients to us for treatment.

Then we headed north to Malindi for the night, where we stayed at the gorgeous Eden Roc Hotel.  I’m just going to say that floating in a warm pool surrounded by lights on a string, staring up at the moon and the stars spread across the giant African sky must be one of the greatest pleasures in life.  Even if it is a bit difficult to wrap your head around, given that you spent the better part of your day in a prison.

We were up early the next morning to head further north and inland to the Tana River (aka Crocodile) District.  This is a remote and extremely dry region, dramatically different than the lush coastal region.  Many of its residents are nomadic herders, who are extremely susceptible to drought conditions since they have to go further and further to find less and less water, which sparks tribal conflicts and takes animal protein and milk away from the women and children (who traditionally stay put while the men herd the animals to water), leading to severe malnutrition.  We run a number of nutrition programs in the district, intended to identify malnutrition early on and treat it before a child or a pregnant or lactating woman becomes extremely ill.   Looking out across the landscape, it’s not hard to see how easily malnutrition can occur, what even slight imbalances in the rains can have.

The following morning, we turned around and hightailed it back to Mombasa, as much as you can hightail it on narrow, bumpy dirt roads that don’t let you go more than 10 or 20 kilometers an hour on.  We also got stuck in a terrible traffic…er, cow…jam for half an hour.

We made it back to Mombasa in time to have dinner at a beautiful restaurant across an inlet from downtown Mombasa.  Again, a luxury a bit difficult to wrap your head around when you know that just a few hours north of you there is tremendous food insecurity.  The views were gorgeous.

 Then back to Nairobi for the night and then onward back to the good ole’ USA, just in time for me to take the NCLEX…