Last Day at CARE

But doesn't mean last day of WORK! CARE Lao is virtually on holiday for the rest of the year, and so...so am I! Today was my last official day sitting at CARE, but it was rather anticlimactic since I've been caught under the weight of an insomniatic cough and confusing sampling statistics. Last night's cold medicine didn't wear off till 4pm today, so today was a bit of a blur.

We did eat a special lunch to celebrate the holiday as well as my farewell. And the AI team got me a beautiful handwoven scarf (presented by Mel above). I even got a wedding invitation from one of the Lao staff, but I probably won't be able to go. Sad. And I myself presented CARE with a number of "presents," not to be read "castaways." The AI team was happy to accept my motorbike helmet, and by the end of the day, it had been adopted into the inventory family (note black sticker!).

Up from the Valley

I am just recovering from a valley. Woo, the last three days have been the most extreme dip (rapid down and up) I've encountered during my time working in Laos.

I have just three days of work remaining to wrap up my project into a tidy package to hand over to CARE Lao and the University of Health Sciences. But our last technical meeting on Wednesday only offered up more questions than answers. Questions that made me anxious: reconsidering the objectives of the assessment, the purpose of it all...with huge ramifications for study design, etc. Pushback from different partners to do more than our power or resources would allow.

But I encouraged UHS to take a position today and luckily, they did. I do have to redraft some portions of the protocol and questionnaire, but all in all, I can leave the project in a good place. Phew!!

Here are photos of CARE Lao's end-of-the-year party yesterday. Plenty of food and drink, birthday cake for the October-December birthdays, frantic wrapping of presents for the gift exchange, and Lam Vong dance around the table!

Official Business 2.0

CDC/CARE Vietnam invited me to go talk about my work in Laos as they prepare for their own health seeking behavior assessment. It was a great meeting and definitely a two-way exchange. Not only did they get a solid start to their assessment, but I also went away with a few ideas to improve our own project in Laos.

I went a few days early to look around the city, and here are about 70 photos of my sightseeing in Hanoi. David was meeting his roommate Jessica coming over for a visit, so it was perfect timing for all of us. Photos include sights of Ho Chi Minh's Mausoleum, the Temple of Literature, the Water Puppet Theater, Hoan Kiem Lake, and lots of food!!

A number of people warned that I might not like Hanoi or Vietnam, but on the contrary, I found it quite refreshing. In comparison with Laos, Vietnam is a lot rougher around the edges, but the bustle of the city is fresh, and the Old Quarter is a throwback to the old days.

Official Business 1.0

Tomorrow I am traveling to Hanoi, Vietnam for my second official trip. I will provide consultation to CDC/CARE Vietnam as they plan to do a similar health seeking behavior assessment.

Below are photos from my first official trip out to our field site in Sayabouli Province, northern Laos, to gather village information for the protocol and questionnaire. Sorry no captions yet. It’s taking multitudes longer than my trip out there to upload these photos online.

Day 1: My flight from Vientiane Capital to Sayabouli Town, the site of our CARE project office and just getting situated before our travel into the mountain villages. We had to bring all of our own food into the villages since they suffer food shortages for six months out of the year.

Day 2: Travel to the field site office in Doikao Village, a 3-hour 60km drive out from Saya Town. These are just the 63 best photos. ;o) Note the poor road conditions. Thank you, donors, for funding those 4-wheel-drive trucks. Money well spent! We got into Doikao before sunset so were able to get a tour of the village from the office guard.

Day 3: The one hour trek to get to Housaylot Village. My translator and I were accompanying the mobile health clinic (team 2) staffed by district public health nurses. Here is preparation of the pharmacy and vaccines for the haul and some lovely images of the hike over the mountain.

Additional photos forthcoming of the mobile health clinic, Day 4 with team 1, and our feast.

CARE AI Meeting

Last Wednesday was CARE Lao's all-day avian influenza program meeting to share lessons learnt and discussing the way forward with donor representatives, government authorities (national, province, and district levels), and international partners, including the WHO and other NGOs.

CARE Lao's AI program works with all of these partners to pilot activities in Laos to build capacity in dealing with issues surrounding AI. This includes community-based surveillance, outbreak response, AI awareness, wet markets, model households, and the 166 free hotline to report bird deaths. I also presented on the health seeking behavior assessment and got questions from both local authorities (re: content) and partners (re: technical aspects). The two guys below were our simultaneous translators; very impressive!

Group photo!

After a day well done, the CARE AI team rounded out with Beer Lao at the Mekong Deck.

Overdue, but alas, keep waiting

Hey hey! Sooo much has been happening the last 1.5 weeks that it'll take quite a while to recount it all here. I'll do my best in fitting photographic glory! Meanwhile, here's a quick summary in reverse chronological order:

1. This week - Big deadline to complete protocol/questionnaires for technical review
2. Last weekend - Detour through Luang Prabang
3. Last week - Work visit to mountainous project site in northwest Laos to observe mobile health clinic in ethnic minority villages and collect info for protocol
4. Last Monday - Le sigh, motorbike accident...but I'm fine!!!

Here are a few photos from my site visit to keep your eyes happy. :-)

Mountain road and foot access to the villages

Modest homes in Prai ethnic villages

Villagers waiting outside the mobile health clinic set up at the school

Sneaking a peek at the AI awareness video with the children

Who me? An epidemiologist??

Sooo, have I failed to mention why I'm actually here in Laos? If so, it's probably because it's taken me this long to get a handle on what I'm supposed to be doing. Basically, CDC is a donor agency for CARE Lao, and I'm here to support a project to build local research capacity and increase the knowledge base surrounding influenza and health behavior of the Lao people. I function as a consultant to CARE Lao and the local school of public health.

Work has picked up dramatically since I started writing up the research protocol two weeks ago, and now that I've just gotten off a technical consult call with CDC, I've realized that the next two weeks will be even crazier as I hurtle towards the December deadline of having the protocol complete and translated so we can submit for IRB approval on both the U.S. and Lao sides. Wahoo!

So, target populations, sampling strategy, census data, sample size calculations, cluster analysis...here I come!! UMSPH should be proud. ;-p

P.S. Next week, I'm going into the field to one of our study sites in Sayabouli Province up north. I will observe nutritional assessment and mobile health clinic activities in the mountainous region (read: cold) bordering Thailand. The villages are all of the Prai ethnic minority group. Should have an interesting report for you when I return!

Heeeere, chicken chicken...!

Voting has begun!!! There aren't many Americans among the expats over here in Laos, so 2:1 expats (mainly Aussies & Kiwis) I've spoken with just don't get how I can be so excited -- personally effusive -- about these elections (ok, ok, n=3). BUT I'm proud to see through Facebook how vested my friends at home are in this election. And the world is galvanized from parties in Africa to dedicated cakes in the town of Obama, Japan.

THE WORLD IS WATCHING!!

While we wait for the results (and I OD on CNN International and Katjes gummy fruits), let's talk about chickens. Real chickens. And ducks and turkeys. Today I tagged along on a visit to an in-city backyard poultry slaughterhouse. Sounds icky, but it was really interesting!

Caution: the following images may not be for the faint of heart (not much blood though).

I'm cold...wink wink

My days during the work week fluctuate fairly regularly; starts high, dips, and then climbs back up, thank goodness. I haven't really developed much of a work rhythm, but at least my project is picking up pace. Got some headway into writing up the protocol today, and that feels good.

Left the office plenty early to get to the 16:45 WHO Open House event, since I'd never gone out to the WHO office before on my own, particularly through rush hour traffic. Unfortunately, I thought 16:45 meant 5:45, which...for those of you as slow as me...it doesn't. So I was not at all early.

It was the housewarming, of sorts, for the new WHO office building, and the Lao Minister of Health and UN representative to Lao were there for the obligatory speeches (although not as painful as Japanese ones). The formalities ended with "tree plantation," which turned out not to be like the similar sounding CARE development activities of tea plantation or goat bank (that's gotta be my fav). Here are some photos of the event, including staff from WHO wearing their beautiful sinh.



Afterwards, Monica, Dave, and I hung out at Francette's place nearby (after she'd put Jacques to bed) and then later met up with Seng and friends for drinks at KopJaiDeu. Seng is a Lao national studying in Thailand for his MPH and doing his thesis on AI stuff.

I was getting kinda tired and folded my arms for support, when Seng said, "Are you cold?" Then, he informed me that in Thai, if a man says he's cold, that means he's cold. But if a woman says she's cold (now), then she's lookin' fer some action! What, what?? Then how do I say I'm cold?? Seng had to think hard about it, but said I could use the word that describes ice (nieng). Now that doesn't seem so fair, does it?

My Frankenbike is a Winner!

And now, introducing my fiery steed, the winner that has made my daily commute possible.

I've been peddling this little rental baby (~$1.75/day) since Day 2 of work, braving the Vientiane roads with its tuk-tuks, sawngthaews, imported cars, and motorbikes -- many sputtering lung-burning black exhaust. My smoker's cough scares everyone at the office and in restaurants, but I guess it's good to know that people here recognize that a hacking cough is not good to be around...pulling straws to link my influenza health seeking behavior study here!

The route is pretty treacherous, particularly around Patuxai (below), Vientiane's own Arc de Triomphe. The arch's plaza forms an island around which a huge rotary spins, and vehicles just don't know how to merge or change lanes properly! My winner and I've been cut off by more motorbikes and trucks than we'd like.

But no, not for much longer! I had my first motorbike lesson from Monica today. Cruised up and down the dirt path in front of the CARE office today in 1st gear. Tomorrow I'm graduating to 2nd gear, and by week's end, I'm upgrading from Frankenbike to motorbike, baby!

First Days in the Office

I've been waking up consistently between 5:00am and 6:30am since arriving in Laos. I'm not complaining though since I'm usually a late riser, and this lengthens my days considerably.

This week I've been getting oriented with the projects born of the partnership between US-CDC and CARE Lao. On Monday I received a CARE security brief and overviews of CARE Lao's work and specifically, the avian influenza portfolio. And on Tuesday I went over to the U.S. Embassy to meet folks and learn about the services available to me.

All of the CARE Lao provincial coordinators and staff are in Vientiane for program meetings this week, so it's the perfect opportunity to meet the field staff and learn about CARE Lao's projects and strategic programming. Andy has in effect instructed CARE to "use and abuse" me, so I may be getting into other data collection projects for which they need more manpower. I hope they take Andy's note to the superlative (figuratively, of course)!