Ngumbo Guest House

Even though four people from IHME stayed in this guest house before we showed up, I realized I had no idea what to expect as we arrived.  I knew that the beds had nets, and Megan had described the shower sans curtain and wall mount, but otherwise it was all a surprise.  So here's a glimpse into the world in which Laura and I will be spending the next five weeks.

There are three bedrooms.  Laura and I have the two that use the bathroom in the hallway, and the third is the master suite, with a walk-in closet and its own bathroom (complete with a shower stall!).  We've been told that Gil, the third roommate when Megan and Spencer were here, will be coming back soon to stay with us, but in the meantime we're expecting two new roommates to show up today or tomorrow to stay for a few days.

The outside of the house:

Here's the room that I'm using:

There's not much by way of drawers, but we didn't bring all that much stuff, so it works out rather nicely.  The bed is pretty comfortable, once you get used to the permanent buttocks indentation.  There are separate rooms for the toilet and the shower:

The shower setup makes it a little logistically difficult, but I'm incredibly happy that we have reliable hot water.  The kitchen is huge, and rather well equipped.  We've found both the can opener and knives to be completely ineffective, so we're left with a dilemma of how to cut our (two-headed!) pineapple and open the myriad canned goods that we bought on our first grocery outing.  A few kitchen-stocking purchases may be in order sometime soon.

And the living room is lovely, though the comfort of the couches and chairs is lacking.  We've taken to bringing out pillows and leaning against those, so that we have at least some sort of padding.

Overall, I think we're really lucky that we're able to stay in such a nice setup.  The only downside is that it's a long, dangerous walk to UNZA, so we have to take a taxi to and from work every day.  But IHME is paying for that, so it's not half bad!

Settling In

Things have been relatively quiet here while we've been settling into our new routine.  On Monday, Laura and I were supposed to meet with our collaborators at the University of Zambia (UNZA) to lay out a game plan for our stay.  We never quite managed to get in touch with them, so instead we decided to walk around a bit and explore.  About 10 miles (17 kilometers?) and two sunburns later, we ended up back home with the following observations:

• Everything is covered in dust.  Unless we wear sunglasses while walking, this includes our eyeballs.
• Drivers are crazy, and there's not really anything resembling speed limits, traffic control, crosswalks, or sidewalks.  Initially we couldn't decide whether we felt safer as passengers or pedestrians, but this walk made it very clear that we'd rather be inside the vehicles.  Walking along the side of the road works relatively well in most cases, but drivers don't pay much attention to pedestrians, and crossing the road is incredibly difficult because there are traffic circles rather than traffic lights or stop signs, so the flow of incoming traffic literally never lets up.

We finally started work on Tuesday, and our first lesson was that nothing ever starts on time.  So far, no matter the time that we've been told to be available (8, 8.30, 9...), things have started at 10.30.  It'll be a great source of amusement to see how long this phenomenon can continue.

Everyone at UNZA has been incredibly nice and wonderful to work with.  We're getting ready to pilot a costing study that aims to "provide quality evidence for improving the equity and cost-effectiveness of health systems."  I'm really excited to be able to see the survey development and implementation side of things rather than just the data analysis side.  So far, this has consisted of our spending two days looking through the 172-page survey questionnaire and compiling a list of clarifications and changes that should be made.  172 pages!  This is going to be one hell of a survey to take (we're currently estimating that it will take most health facilities multiple days to complete), but it should capture a lot of incredibly useful and relevant information that hasn't been collected before.

Time for bed, but first: more random observations!

• It's much colder than we expected.  Most days this week, the maximum temperature was around 72 degrees (22 C?).  This would be perfectly pleasant if we were outside in the sun, but we've been spending most days indoors at UNZA, where the windows are open and the breeze makes it quite chilly with a long sleeve shirt and a fleece.  At night the temperature tends to drop into the mid-40s, and there's not much in the way of insulation in our guest house (not to mention the fact that most windows don't close very effectively).  Needless to say, I've been wearing lots of layers to bed, and Laura and I immediately curl up in blankets when we get home in the evenings.
• The shower is ... interesting.  It's essentially just a tub with a shower head attachment.  No shower curtain, no hook on which to hang the shower head.  It's taking some getting used to, especially since I'm usually freezing by the time I get around to taking a shower at night.
• I have yet to see a mosquito.  Laura claims to have seen one in her room the first night, but I have a sneaking suspicion that all the mosquitoes in the house are being eaten by the giant spiders that like to hang out on the walls and ceilings.  I'm trying not to think about it. In the meantime I'm continuing to take my antimalarials and sleep under a bednet.
• Speaking of bednets, I feel like I'm camping every night when I crawl into bed.  We don't have bedside lamps, and even if we did it would require climbing out of the net to turn it off, so I've taken to wearing a headlamp to bed so I can read for awhile before sleeping.  I'm sure I look absolutely ridiculous with my sweatshirt hood pulled up and a flashlight on my forehead.  We'll see how long it takes for the batteries to run out...

Day 1: Zambian Trade Fair

It feels like it's been an incredibly long day, but that's probably just because I developed a cold on the flight over here and it's starting to get to that point where I feel like my head might topple over any minute now.  I managed to get around 10 hours of sleep last night, interrupted only around 3 AM when I heard a stranger walking through the house and doing confusing things like turning on the shower in the unoccupied room down the hall.  After a minute or so of confusion, I eventually figured out that it was just Laura going to the bathroom, in the normal place, not in Gil's room, and the sounds in the new house just aren't familiar to me yet.

Late this morning, Peter, one of our collaborators, brought the cell phones that Megan and Spencer (and Nancy and Matt before them) had been using during their stay.  The phones already have useful numbers programmed into them, including contacts for multiple taxi drivers who have become a staple in IHME visits, so we now have the ability to move around freely without getting too stranded for too long.  Peter kindly gave us a ride to the Zambian Trade Fair that is happening this weekend and is apparently the cause of a national holiday on Monday.  We didn't really know what to expect, but it sounded like too good an opportunity to pass up.  After Peter parked the car along the side of the road, I was greeted by an incredibly enthusiastic man trying to convince me that I wanted him to paint my face.  He tried talking into the window while I was still in the car, then actually reached out and painted a blob of green paint on my face as I was trying to get out even though I had made it very clear to him that no, I didn't want a face painting.  There were crowds of people jostling in every direction, many with either paint or some other goods that they were trying to sell -- I was incredibly overwhelmed by it all.  Peter led us through the crowds and to the shortest entry line that he could find, then bid us farewell and good luck.

Inside the fair things were a little bit calmer.  There were still huge crowds, but they weren't all trying to sell us things, so we were able to look around in peace.  We eventually found our way to the main stadium, where we watched a simulation of an emergency rescue by the Zambian Red Cross.  They wheeled out a car full of "dead" people and emergency vehicles showed up to "rescue" them and put out the "fire" in the car.  They even had a helicopter show up to medivac the survivors away.

After the emergency simulation, they wheeled out three large guns and had some sort of contest between squads to see who could disassemble and assemble it more quickly; Laura and I didn't really understand why this was necessary, so we moved on... We wandered for a bit, talked to a woman promoting BioGas, a type of sanitation that I hadn't heard of before, and found the coolest kids' entertainment ever: floating hamster balls with children inside!  I think Laura and I both wished we were able to try it out.

After seeing a few more shows at the main stadium, we made our way across the street to one of the big shopping malls.  This involved passing some other incredibly aggressive paint people (one got Laura on the back of her neck this time), but we eventually made it to the mall safely.  I had to wait a ridiculously long time at the Hungry Lion (ha) to receive my two pieces of fried chicken, fries, and a coke, but it was a delicious meal once we actually got to eat.  Finally, we walked to a nearby grocery store, picked out groceries for the week, and caught a ride home with Steve, one of the taxi drivers who comes highly recommended by our predecessors.  Eight hours after waking up, I was ready to go right back to bed.

It was a pretty hectic and overwhelming introduction to life in Zambia, but I'm really glad we got to experience the fair; it only happens once a year, and I think it gave us a glimpse of what public gatherings and celebrations are like here.  Tomorrow, we call our collaborators at the University of Zambia and map out a plan for the coming weeks.

Seattle to Lusaka

Laura did a lovely job documenting our trip from Seattle to Lusaka, so I'm going to let her description speak for itself: http://whatisworthremembering.blogspot.com/

I'm generally skeptical that I'll actually manage to post here on a regular basis, so if you're wondering what I'm up to, Laura's blog will probably be an excellent way to find out.  I'm also always happy to keep in touch via email.

Walking back from our first grocery store visit: