QUINNTELLIGENCE

A Healthy Development

2009-05-15T13:40:00.003-04:00

A step in the right direction, thanks to Swine Flu?

Politics (read: China) has kept Taiwan out of the WHO for decades, but now the island is going to send an observer delegation to the WHO Congress. This is important on a purely practical level -- swine flu didn't amount to much this time around, but what happens if the next bird flu/SARS outbreak comes in East Asia? Getting everybody on the same page is crucial and now Taiwan's public health authorities will have a seat (ok, an observer seat) at the table.

Taiwan to join WHO congress in "huge breakthrough"
* Taiwan set to join World Health Organisation assembly

* Self-ruled island had been barred by China since 1971

* Pandemic flu fears support calls for observer status
TAIPEI/GENEVA, May 15 (Reuters) - Taiwan is set to take part in next week's World Health Organisation annual congress for the first time in 38 years, in what is regarded as a rare diplomatic opportunity for the self-ruled island.

Under an agreement reached with Beijing, 15 people will represent Taiwan at the World Health Assembly under the name of Chinese Taipei.

China has claimed sovereignty over Taiwan since 1949, when Mao Zedong's Communists won the Chinese civil war and Chiang Kai-shek's Nationalists fled to the island. Beijing has vowed to bring Taiwan under its rule, by force if necessary.

"Our delegation will define this trip as a journey of professional studying and sharing," the Taiwanese health department said in a statement on its website on Friday.

"Because our country has not joined any U.N. agencies for 38 years, it's important to study the internal process of the WHO and interact with officials from other countries," it said.

Taiwan is not a U.N. member but is represented at the World Trade Organisation under the name of Chinese Taipei. China, backed by about 170 diplomatic allies including the world's most powerful nations compared to Taiwan's 23, normally stops the island from joining international organisations that require statehood as a prerequisite.

But relations between Taipei and Beijing have improved since the island's President Ma Ying-jeou took office in May 2008, with top negotiators on both sides holding meetings and signing a series of deals to boost trade ties.

Raymond Wu, a political analyst in Taipei, said Taiwan's representation in Geneva may help Taiwanese authorities improve their links with major economies that are allied with China, such as the United States and European Union.

"Symbolically, it's a huge breakthrough for Taiwan," Wu said of the agreement with China announced by Taipei on April 29.

Fears about the newly discovered H1N1 virus added impetus to Taiwan's argument that it should be allowed to observe the WHO policy-setting assembly, where 193 member states will discuss the global response to the flu strain with antiviral drugs and vaccines.

Taipei has long argued its exclusion from the WHO and its meetings has made it tough to handle major health issues such as the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS). WHO laboratories have confirmed four H1N1 flu infections in the Chinese mainland and Hong Kong to date, with none in Taiwan.

ZOMBIES!

2009-05-06T16:35:00.003-04:00

here's a link to a sort of feeble minded story I did today on social media and pandemic planning, and how the mechanics of public health communication are changing in the new environment.

We've been busy at Reuters with the swine flu tale..and I've been busy otherwise with politics, the Hill and all the other aspects of my non-global health life. I'm going to try to get going on this blog again more seriously now -- but it will be a lot more random. I'll also be twittering now and and again (when I remember to) at http://twitter.com/andrewquinn

Anyway, take a look at Reuters' main H1N1 news page and see what you think....

More Success!

2008-12-09T08:26:00.004-05:00

There was more promising news about the Glaxo malaria RTS,S vaccine yesterday, with researchers publishing results showing the malaria vaccine protects up to 65 percent of infants from infection -- setting up the Phase III trial that I reported on over the summer.

This is not a surprise, but it is good news for all the people who have put such hard work to get this trial off the ground and for the families who have been part of the trials so far, including those I met in Kenya and Tanzania.

Of course 65 percent protection is not 100 percent protection, and it will be interesting to see how the public health puzzle pieces fit together as this project moves forward. Will other, potentially more promising vaccines still receive development funding? Will the investment into the African clinical trail centers have more effect on improving basic healthcare in the region?

As one doctor in Kenya told me: "we don't want to save them from malaria as children so they can grow up to die of AIDS as adults".

Success!

2008-11-28T09:44:00.006-05:00

Well, it took a while but I've finally managed to put out a couple of stories from the trip. Here is the main malaria vaccine story, and here is a sidebar about the babies who are participating in it.

It feels good to have finally produced something, although as usual it is frustrating to see how much reporting gets whittled away in the editing process -- particularly for a wire service feature. Now I'll have to try a similar repackage job on the material from the AIDS vaccine trial sites!

I spent last weekend up at Harvard talking to this year's Nieman Global Health Fellows. It was fun to see old friends and interesting to hear how this year's crew are handling the challenges/opportunities of this amazing program (go Nauru!).

My Reuters work life has been very busy -- its an exciting time to be in Washington. I still hope I can somehow engineer myself back into a reporting role which will have at least some focus on global health, but for the moment U.S. politics is plenty to handle! If you are interested in some of less 'straight-up' news we are producing here at Reuters, the bureau runs a Washington political blog that has some interesting tidbits.

Gone Pollin'

2008-10-16T14:41:00.004-04:00

I'm on hiatus for a few more weeks as I come to grips with my new job at Reuters, where I'm filling in as U.S. political editor for a bit.

I did manage to squeeze out a quick curtainraiser on the Cape Town AIDS vaccine conference and I'm still working on longer pieces on both AIDS and malaria vaccines, based on reporting done on the trip.

I'll post again after the Nov. 4 presidential election

Back in DC -- Polar Bear Terror

2008-09-16T12:39:00.003-04:00

I've been back in DC for a couple of weeks now, going thru my notebooks and trying to figure out how I am going to squeeze all my Africa info into a package of stories (I hope for Reuters)

Meanwhile, as an aside, strange days in the Nation's Capital. I went up to the subway this morning and found the whole area cordoned off with police, bomb disposal squads, Special Ops vans..the whole security clampdown whoopla. Somone jogging by breathlessly said it appeared there was a dangerous "abandoned teddy bear" in the area...

The folks at the good local blogsite Dcist had a contact who emailed them a picture -- not quite a teddy bear and a little creepy, really.

They later opined that it might be the work of this guy -- an installation/conceputal artist. Have a look at his other stuff -- I love it.

Ok enough sidetracking. Back to the notes.

What a Wonderful Trip!

2008-08-30T09:36:00.002-04:00

I wrapped up my reporting today with the Phambili Soweto AIDS vaccine volunteers at a Sports Day jamboree in a dusty field just down the road from Chris Hani Baragwanath Hospital -- a great end to a great trip!

I showed up at the Phambili clinic at Baragwanath at the appointed time of 10 a.m., and found the counselors and other Phambili staff busy in the kitchen with huge vats of baked beans, the chopped tomato salad known as "chakalaka" and mounds of fluffy "Pap"..a sort of cornmeal porridge. Lucky I was there as we needed all hands to transport the food down to the athletic field. The organizers had hoped that more than 300 of the Phambili volunteers would show up, but in the end it was the hard core "Soccer Boys" (some pictured above as Team Phambili) who turned out, ready to have fun.

It was a fantastic day. The guys, most of whom clearly didn't have much, had somehow rustled up full soccer uniforms complete with golden boots and they ended up playing a ferocious game against some of the male staff at the Perinatal HIV Research Unit. Women were underepresented (especially since more than half of the Phambili volunteers were women) but those that showed were also kitted out and eventually took to the field, amid great gusty blasts of wind and dust that seemed to deter no-one. Dr. Mkhize, the medical officer for the trials, was stationed at the braai (barbecue) and the DJ pumped out booming tracks of Kwaito (local hip hop) music. In the distance, the signature cooling towers of the Soweto power plant loomed through the haze.

I can't believe the trip is over. It has been amazing -- I've been met at every turn with hospitality, cooperation and patience. I have no history as a science reporter, and often I felt very at sea with the technical details of what these volunteers and the scientists and researchers behind them are trying to achieve. But as I watched the game today -- young South Africans who stepped up to try to contribute to ending the AIDS pandemic -- I was both moved and humbled.

I head back to Washington tomorrow. I'll write more over the next couple of weeks as I begin to synthesize the experience and get down to the work of writing it up. But today was not a day for "issues" or journalistic head-scratching. It was just a great day in an unexpected place with people I admired. I'm full of thanks to them, and to the many, many people who have helped me along the way in South Africa, Kenya and Tanzania. And, of course, most thanks go to the Nieman Foundation and especially the foundation's global health supremo Stefanie Friedhoff for taking a chance on me with this wonderful opportunity.

Bagamoyo Bye Bye

2008-08-23T12:19:00.003-04:00

I’ve wrapped up my visit to Bagamoyo (pictured above, the district hospital and its signature baobab trees!).

My final interview was with the “malaria focus person” on the hospital medical staff. She apologized because she was new on the job for only two weeks. Her predecessor in the post had recently died – of cerebral malaria.

That a malaria doctor can die of malaria in Tanzania, now, is shocking. There were extenuating circumstances – he had been diagnosed with hypertension, and the initial diagnosis was stroke, which meant that malaria “slipped through” undetected until it was too late. But even so it surprised me.

Doctors and nurses here work on the slimmest of margins. The hospital, serving an area of some 200,000 people, has only one full MD on staff, plus several assistants and “clinical officers” who perforce do much of the work. Referrals go to Dar es Salaam which is about 75 km away and overstretched as it is.

I’m not sure I learned a lot about malaria vaccines here, but I did learn more about how hard it is to be a health worker in what they call “resource poor” settings. It’s hard, and often depressing work. In Bagamoyo, the presence of the Ifakara institute – with its well connected funders pushing along projects including the malaria vaccine trials – has been a bonus. But it is still at least partially representative of the difficulties in getting health care to the people who need it in developing countries. When even the doctors are dying, of preventable diseases, something is going wrong somewhere.

Anyway I’m off to go snorkeling (yes you heard me right). And back to Joburg midweek where I am going to try AGAIN to get somebody from the health ministry to talk to me. And then I’ve got an “athletics day” date with some AIDS vaccine volunteers, and then I’m headed home. Hard to believe.

I'm getting cranky

2008-08-21T13:19:00.004-04:00

I can feel it. I'm fighting it..but my temper is short these days....

Bagamoyo has been interesting so far, but frustrating. Perhaps its my mood. I feel like I got off on the wrong foot with them and it hasn't right-footed itself yet. We've been in "the field" for a couple of days, talking to mothers who enrolled their kids in the malaria vaccine trial. Again - wish I spoke the language. As it is I feel like I'm not getting much, at least in the way of real insight into these people's lives. Peasant farmers are not particularly forthcoming to strangers -- particularly in translation.

The town features some German graves, a few old Zanzibar-style doors, and one Rastaman...Rasta Zion. He gave me a tour yesterday before I could say no. I ended up kind of liking him...he would give me the spiel on whatever it was we were looking at and then stop. Then after a pause of about five seconds he'd remember he was a Rasta and add a "yeah Mon".....must be tough being the only one of the tribe around! He wasn't happy with the $2 I offered so I upped it to $5. He was whistling as he headed to the beer store.

The hotel is a sort of African conference hotel. At the moment it is occupied by a Tanzanian women's NGO conference. These ladies are a sight to behold..beautiful, each wrapped up like a brightly colored confection in her own traditional garb. Think sari, but with no skin exposed. Add wigs for some, turbans for others and you've got a fashion hit parade. These women can EAT! They are not small to begin with, and the way they load their plates at the breakfast buffet would put any American to shame. Then
they sail around in slow, stately gangs..checking each other out and trading notes.

I thought I scored a jackpot today when I bought "24" -- the entire 3rd season on one disc -- for $5. Get home and load it up and damn thing is in French and French only...Jacques Bauer. Je m'en fou

Tanzania's Top Twenty

2008-08-20T10:43:00.003-04:00

I’ve gotten used to seeing notices like those posted above in the African hospitals I’ve visited – an easy aide memoire for clinicians on the most usual diseases they’re likely to encounter.

The picture on the left is the Top 10 Disease List for the pediatric ward at the Bagamoyo District Hospital, while the one on the right is the Top 10 for the adult male ward.

Couple of interesting things: for pediatrics, the rank of malnutrition here is much lower than I’ve seen elsewhere, which is strange because it is a poorer region, on the whole, than the others. Doctors say food isn’t a problem in the region – and I guess this proves it. But I can’t really see why this would be so different from Kilifi in Kenya, which is only a couple of hundred kilometers up the coast. I’ll keep asking.

The other odd thing is the relatively low ranking of HIV. There’s an estimated adult HIV prevalence of about 8 percent in the region, meaning HIV should probably be higher on the pediatric list. But doctors say that this reflects more the population sample than anything else: these are babies born, for the most part, in town – where mothers have access to regular antenatal care. In rural areas most mothers give birth at home under the care of traditional birth attendants – and HIV tests as well as drugs to prevent mother-to-child transmission are not as widely available.

HIV jumps to the top of the list for the adult males. Malaria as number two is a sign, doctors say, of overall decline in malaria prevalence – people are getting exposed later, and often no longer have the childhood immunity that most people used to develop as a matter of course. It’s a good thing in a way, although not for the guys admitted to this bare bones facility.

Wow Woops

2008-08-16T13:01:00.001-04:00

How did I end up here…..

It’s a long day’s story. I left Joburg in the early morning, paying up and getting out of my nice service apartment there. It felt like packing up a house a bit..but was easy enough to do.

I had forgotten, however, that most of South African Airways’ Africa flights depart at 9 a.m…so the airport was a complete mess. Because baggage theft is so rampant, people now prefer to have their bags shrink-wrapped before loading them on to the planes…endless queues and discussions while bag after bag (not mine) was engulfed in plastic.

Ok fine, then on the plane. Then we sit. I look out the window and see one bag – MINE – sitting on the tarmac, unescorted. Why? Who knows. But there it was, and in it were all my notebooks (foolish move I know…not to be repeated). After a while the airplane began its countdown, and there was my bag. Outside. I had my face glued to the window and was just about to make a scene when some bag guy saunters by and throws it into the hold. Ok.

Arrival in Dar es Salaam is always a little hectic. They require visas from almost everybody, and the promise that you can obtain one at the airport means you queue and queue and then someone takes your passport, forms, and $100 and disappears. I’ve done it before so I was pretty sure the passport would come back but it’s always stressful…especially when an Air India flight had just landed and LOTS of people were freaking.

Made it. Next was the taxi queue. Some driver grabbed my bag and we headed to the parking lot..only to see him accosted by about 10 other angry drivers. He’d jumped HIS queue. My bag went from shoulder to shoulder as the argument progressed..and eventually, as these things seem to do, a victor was declared in the person of the angriest and most voluble driver. He took my bag and off we went to the parking lot.

The airport road into Dar is much nicer than the one in Nairobi…but heavily patrolled by police. At one stop light, a police lady (wearing the odd Catholic School outfit that policewomen seem to have here) stopped us for some kind of infraction. We were pulled over, the driver sweating and swearing, and she plunked herself in the back seat (I was sitting in the front). Fifteen minutes of sweating and swearing later, the driver finally handed over the equivalent of $2 and she got out. Totally brazen on all sides.

Then I end up at Q-bar. It is one of those things that seemed reasonable enough when was planning the trip in Cambridge in April, but in reality? Woops. Basically I’m staying in a sports bar. It’s a four storey, concrete building built around an atrium of huge television sets. One for soccer, one for rugby, and the other two flashing a mind-boggling array of “sport” ranging from yachting to motocross to whatever. All at high volume. Inside, on arrival, the place was packed with bloated beer drinkers of every description. It’s a dream come true for a certain kind of person (straight, alcoholic, temporarily unattached, sport fan) – but I fail on (most?) of those counts.

I called an old reporter friend in Dar and was greeted with gales of laughter when I told her where I was …”The prostitutes totally take over at 9..take cover”….was her advice. And judging from the pretty raunchy outfits that were already on show in bar, I think she was about three hours too late.

Strangely, the room is fine. My fight or flight instinct led me to an Internet café where I checked out other options..but at my self-imposed $50 night limit there’s not much in Dar, which is pretty expensive. I’ll see how it goes. My door is bolted.

Saturday to Tanzania

2008-08-15T08:16:00.006-04:00

I'm packing again...feels like Groundhog Day. No matter how much I scrunch, and how much I throw away, the stuff expands to fill the bag -- and just a little bit more. This despite having mailed most of my books home...

Anyway I head up to Tanzania tomorrow. After a couple of days in Dar es Salaam sorting out my media accreditation (the first time that has been required on this trip, thank goodness) I'll be spending most of the following week or so with the people at Ifakara back on the malaria beat. I'm looking forward to it -- somehow the malaria vaccine story, with its promise of the big clinical trial next year, is more fun to do that sorting over the ruined AIDS vaccine hopes here in South Africa.

Also it will bring me back to the seaside...the research institute is located in Bagamoyo which sounds like a pretty interesting place on its own. We'll see how the Internet connectivity goes but I was pleasantly surprised in Kenya so perhaps they're all online in Bagamoyo too!

Death to Popcorn

2008-08-11T07:33:00.002-04:00

Ok I know I'm getting to be a crank but my cold heart was warmed by this kernel of news out of the UK.

I hate popcorn. I hate the way it smells, I hate the way it gets lodged in your teeth, and I especially hate the way it SOUNDS when people chomp their way thru buckets of it at the movies.

I'd definitely pay extra (maybe the amount of an average popcorn serving, $7) to attend popcorn-free movies.

Am I sick or just intolerant?

Invisible Theater

2008-08-11T06:50:00.002-04:00

Gugulethu may lie within shouting distance of Cape Town's famous Table Mountain, but it is a different world. While in Cape Town, all the world is a stage for the convertible-driving, sunglasses-wearing hipsters that seem to rule the roost, in Gugulethu the theater is invisible -- and in taxis.

Cape Town must be one of the most beautiful urban settings in the world, the endless wash of the rough South Atlantic pounding in on shiny white apartment blocks ringed by beautiful roads that stretch up into the mountains. But behind the mountain, Gugulethu and its township neighbors are one of the most dismal -- stretches of homemade shacks, cobbled together out of plywood shards and bits and pieces of corrugated iron, and all cheek-by-jowl with busy freeways and featureless industrial parks. It's right by the airport so you can't miss it -- which should be an interesting welcome for the World Cup 2010 tourists when they arrive in the "new South Africa".

I spent the last couple of days at the Emavudleni AIDS vaccine clinic in Gugulethu (in Crossroads, to be exact). It is the vaccine trial site run by the Desmond Tutu HIV Foundation. Like Baragwanath in Johannesburg, this was one of the main sites developed to run new trials of HIV vaccines -- an enterprise that has all but stopped with the failure of the most hopeful candidate last year (see earlier entries on Phambili/Merck).

It's a familiar sight now after two months on this project -- a fully equipped, fully staffed operation searching for a new mission. The scientists and counselors and Emavudleni are working on side studies, but the raison d'etre for the clinic has been ripped away. There simply are no major HIV vaccine products in the pipeline.

It's a depressing reality -- for them and for me. But the work continues -- at at Emavudleni part of that involves invisible theater.

Community educator Pozna Gomomo talked me thru how this works.

Three AIDS vaccine workers will get on a minibus taxi -- the often ramshackle minibus that serves as the main mode of transportation in the townships. One vaccine worker will sit right in the front, another right in the back, and a third, surreptitiously, will take a seat in the middle.

The one in the front will call back to the one in the back: "Hey, didn't I see you at the AIDS vaccine clinic?"....the reply will come "Yes, they've told me how it works and I think I'll sign up."

The "sleeper" vaccine worker, seated in the middle of the bus, will then pipe up:

"Don't they infect you with HIV at those places? Why are you going there?.." and thus a discussion will start.

"You know that those 18 people in that taxi will be going home and talking about what they heard," Gomomo said. "It is a way for us to start discussion, and to get the message across."

A quick google of "Invisible Theater" shows that it was developed in Latin America as an activist/theatrical way of making political points. It's also known as "Theater of the Oppressed"...which seems apt.

Gomomo says Invisible Theater and other forms of community outreach are part of showing that they are still "engaged" with the community, and keeping the AIDS vaccine issue in people's minds despite the lack of immediate hopes. I wonder how long people will keep listening.

I'm back in Joburg now and have to admit I'm dragging a bit. I feel like I keep asking the same questions and keep getting the same answers. I have to be more creative.

On The Move (Again)

2008-08-05T13:39:00.002-04:00

I'm headed for Cape Town tomorrow. While there I've got some interviews set up at the South African AIDS Vaccine Initiative as well as the Cape Town site for the Phambili vaccine trial. I'm also going to see my old Nieman pal Melanie Gosling plus (I think) some other friends....so it should be fun.

I've been fretting about "narrative arcs" and "stories behind stories" with this trip...do I have one? Is it all going to pan out? The bottom line, of course, is that I am learning a great deal. But is it going to translate into copy? Sheeeeez.

Anyway, more soon from "The Mother City".

"The future belongs to pharmaceuticals"

2008-08-03T05:19:00.003-04:00

Helen Epstein, who wrote the good AIDS in Africa book I mentioned below, has an interesting piece in the LATimes today marking start of World Aids Conference

The bit about the promotional video suggesting that in the future, happy African teens will be accessing ARVs from school vending machines is a chiller!

Here's another one I just ran across by the Council on Foreign Relations' Laurie Garrett, one of the most respected global health writers around.

I think they both show the frustration that is developing over the idea that drugs, and only drugs, are the way forward against HIV.

web address

2008-08-02T03:59:00.003-04:00

finally managed to change all the various settings so this appears under www.quinntelligence.com (I know, not the hardest thing in the world to do but it took me ages to figure out!)

anyway I hope this makes the blog easier to find

yes, I am "working"

2008-08-01T15:29:00.001-04:00

it's not all for naught! here's something that ran on the Reuters wire.

Back in Jozi

2008-07-30T14:59:00.005-04:00

I'm back in Johannesburg. Strange that a city so foreign can feel so much like home. I'm psyched to be back! Kenya was great but it's always nice to feel at home. The picture is the Ponte Tower...an apartheid-era redoubt for the yuppies of the day, now a mad African city in a towerblock. The scuttlebutt (used to be -- see Josh's comment) that the garbage in the former central grand atrium, discarded by various squatters, campers, and n'er do wells, now reaches to the 11th floor.....

I don't know if that's true (Ponte is a particularly scary place to visit..but maybe I'll find out this trip) but I like the imagery.

A Note on Backpacks

2008-07-30T04:00:00.001-04:00

I’ve always had a thing against them – associating them with filthy feet in run-down sandals, Let’s Go travel books and raucous laughter in overcrowded train compartments.

My bias has cost me over the years. In the late 1970s, when a high school friend and I went to Europe, we decided we weren’t going to join the backpack crowd – and went instead equipped with two huge duffel bags, which over the ensuing months cut huge gashes into our shoulders with their single straps.

Roller bags, which I later moved to, are fine for airports but not so good when you are running through markets trying to catch a bus or walking miles to try to find the weirdly isolated B&B you booked.

In both cases, the contents end up a jumbled mess and mornings were devoted to frantic grab-bag searches to look for clean underwear, my passport, or whatever else I needed.

You’d think I’d learn. But vanity persists and I reverted to a duffel bag for this trip – one of the most intense packing/unpacking sequences of my life. But I’m saved! Before leaving the U.S. I bought a set of “Eagle Creek Travel Gear” packing envelopes – Velcro and cloth sleeves that zip up into neat little packages. Into one go socks and underwear, into another shirts and t shirts, and into the largest go pants, sweaters, my raincoat and whatever else I stupidly overpacked on the trip. Then, one by one, they slide into the duffel, making it a convenient traveling dresser.

I’m usually sceptical of “organizational breakthroughs” – doubtless the sign of a terminally disorganized mind. But these damn things have made a real difference. Thank You, Eagle Creek (I’m not a paid spokesman but I would be in a second – Eagle Creek, call me).

Now, back to packing.

Books for an African Trip

2008-07-29T11:22:00.001-04:00

African taxi drivers are usually pretty nice and often offer to help put your bag in the car – but when they take mine they grimace.

My trusty red duffel bag weighs a ton, and most of it is reading matter. Along with my notebooks and an ever-expanding file folder of copied articles, I’ve been lugging around a little mini-traveler’s library to keep me occupied on the many nights when the TV reception is bad or the language incomprehensible.

Here’s what I’ve read so far:

“The Invisible Cure: Africa, the West and the Fight Against AIDS” by Helen Epstein. This is depressing in more ways than one. Epstein does a masterful job chronicling many of the missteps and bad judgments that have marked the world community’s response to Africa’s AIDS crisis. She’s got a bee in her bonnet about U.N. agencies and Western aid groups and she marshals the facts to show that in many cases the “AIDS establishment” has done more harm than good. For a reporter, it is both thrilling and daunting so see someone else tackle the subject so well.

“The Scramble For Africa” by Robert Pakenham. Clocking in at around 750 pages, this is a blow-by-blow account of Europe’s various colonial enterprises in Africa during the latter half of the 19th Century. He delves with equal passion into better known sagas (Stanley and Livingstone, the Boer War, Cecil Rhodes) as well as tales perhaps less familiar to English-speaking readers including the formation of French Equatorial Africa, the revolts against the Germans in East and Southern Africa, and Italy’s war with Ethiopia. It is, perforce, more about diplomatic dealings in European capitals than about the impact these had on African states and peoples, but it’s an amazingly comprehensive and often thrilling account of what happened.

“After the Party” by Andrew Feinstein. Feinstein is a former MP for South Africa’s ruling ANC who grew increasingly frustrated and disillusioned with Thabo Mbeki’s government. Here he sets out what he thinks went wrong (paranoid leadership style, blind eye toward corruption) and calls for a “new politics” to revive South Africa’s great experiment. Probably too much inside baseball for most readers, but a heartfelt analysis of where one semi-insider thinks things went wrong in the post-Mandela era.

“Dinner with Mugabe” by Heidi Holland. Holland, a South African journalist, is a friend of mine and had amazing timing with this book, a sort of psycho-biography of Zimbabwe’s Robert Mugabe. She was the last foreign journalist to get an exclusive interview with him before this year’s disputed election. She concludes that Mugabe is a spurned Anglophile with mother issues – an interesting take if perhaps of little comfort to Zimbabwe’s suffering people.

“In the Footsteps of Mr. Kurtz” by Michela Wrong. A former Reuters journalist who went to work for the Financial Times, Wrong’s book takes us through the rise and fall of Zaire’s Mobutu. No mother issues here, just a lot of excessive greed, bad taste, and thirst for power. As they say in the trades, “rollicking”.

“The Wizard and the Crow” by Ngugi wa Thiong'o. This is a great fictional counterpoint to the two books cited above, and all the more interesting because it is by one of Africa’s most prolific and interesting writers. Wa Thiong'o paints a lengthy, magical realist fable of a mythical African country where “The Ruler” sets his people to building a new Tower of Babel. His chief advisor, meanwhile, grows enormous eyes to better see the Ruler’s enemies while the number two in the cabinet sets about growing enormous ears the better to hear of plots against him. Weird, wonderful (and long).

I’m going to be sticking all these books in the mail when I get back to South Africa and sending them home – so I hope my bag will be a bit lighter.

Not mentioned above was the three day British “chick lit” binge (“Confessions of a Mad Housewife”, “Lessons for an New Divorcee” etc) that occurred in Lamu thanks to the leavings of previous guests. I don’t remember anything about any of them except a vague feeling of queasiness

Autoclave and Destroy

2008-07-29T04:18:00.001-04:00

There’s a freezer full of dashed hopes at the AIDS vaccine clinic in Kangemi, one of Nairobi’s crowded slums.

The freezer, kept under multiple lock and key, contains vials of the vaccine prototype that many researchers hoped would mark the next big step forward toward preventing new HIV infections.

But like other trial sites across the globe, Kangemi is now under orders to destroy the vaccine following a decision by U.S. sponsors not to proceed.

“It will be autoclaved and incinerated,” said pharmacist Jennifer Kigera. “We are still hoping for a new product one day.”

They will have to wait a while.

The cancelled PAVE trial has left few immediate prospects for large-scale human testing of HIV vaccine prototypes, with the U.S. National Insitute of Allergies and Infectious Diseases now saying it will focus on small, focused trials and basic lab science to better understand HIV.

The cancellation of PAVE followed the mid-way halt of a similar trial using a vaccine developed by Merck (see my entries on Phambili), a double blow.

Kangemi, which like many other sites had been set up expressly to prepare for big Phase II and Phase III trials, now has to repurpose itself – looking at basic epidemiological studies on HIV incidence in the region as well as tracking the early progress of infection among volunteers who recently rested HIV positive.

Gaudensi Mutua, pictured above, is the research physican at the site – which is made out of converted shipping containers stacked outside Kangemi’s municipal clinic.

“We all felt crushed and a little bewildered,” Mutua said of the PAVE decision. “It was the hype. Everyone had such high expectations.”

Kangemi hopes its work on HIV infection will feed into studies of two select groups of people – the “Long Term Non-Progessors” and the “Elite Controllers”. The first represent people who have been infected with HIV but take a very long time to develop any symptoms of AIDS. The second, a much smaller group, never develop symptoms at all.

By studying how their immune systems work – and particularly the role of “cell mediated immunity” which keeps long-term infections under control (think chickenpox), scientists hope that they will come across a key to disabling or even eliminating the HIV virus.

“It is these two groups that keep alive the hope that a vaccine is possible,” said Prof. Olu Anzala, the head of the Kenya AIDS Vaccine Initiative.

Lucky (?) Pluckers

2008-07-25T11:07:00.003-04:00

Ok, it looks like a Teletubby encampment but this weird little village of round red cement houses is actually corporate housing for James Finley Teas, one of Kenya’s biggest tea exporters.

In many ways it appears idyllic – groups of these houses are set in rolling tea fields which, from a distance, look like the frozen emerald froth of some great sea. The workers (“pluckers”, locally) are actually in pretty good shape by working class African standards. They are given free health care, their kids go to company schools, and the little round houses come with the job.

Still, tea plucking is backbreaking work and at 7 shillings a kilo, a good day’s take home would be only about $5. That’s better than the $1-per-day benchmark that the U.N. has set for the poorest of the world’s poor, but it’s not exactly easy money.

The tea plantations have worked with the U.S. military’s HIV program and many of these workers have been among the volunteers for HIV vaccine studies. From a researcher’s point of view, it’s a great “cohort” – a large group of people with relatively similar living patterns in a controlled environment.

Ironically, the pluckers are almost too good. They are generally seen as at a low risk for HIV, so discovering whether or not a potential vaccine would work is that much harder – is it the vaccine working, or is it simply that these workers are too bushed to get up to much risky behaviour?

For that reason, the Walter Reed program (like the IAVI group in Mtwapa I mentioned before) is gearing up to bring a high risk group under study – commercial sex workers who make their living in the trucker bars and hostels along the main highway. This group will be harder to find, harder to enlist, and harder to track – but may, in any future vaccine study, be the ones with the answers.

I’m leaving Kericho and the Walter Reed program today. On Monday, I’m hoping to do another IAVI site in one of Nairobi’s many slums.

Lab Work

2008-07-23T11:40:00.002-04:00

The Walter Reed lab in Kericho began as a makeshift workspace in a rented living room.

"I came out here and took one look at the place and thought I would take off..Kericho is pretty small," said lab director Rukiya Kibaya, remembering her first foray into the new world of scientific support for the AIDS effort in rural Kenya in 2003.

"But the enthusiasm of everybody at the site caught up with me."

The Walter Reed lab is now one of the best in Kenya, the only one in the country to win the prestigious College of American Pathologists (CAP) certification and one of only a handful in Africa with that designation -- which means its procedures and results are on par with the best labs in the world.

This minor miracle -- brought about with a lot of investment from the U.S. military and a lot of hard work by dedicated Kenyan scientists like Kibiya -- now operates from a suite of rooms in the Clinical Research Center at Walter Reed's headquarters in downtown Kericho. Reaching it is like moving through a series of airlocks leading from the developing world to the front lines of science.

Just off Kericho's main drag, where minibus taxis jostle and hawkers congregate selling everything from bananas to cellphone minutes, you walk down a quiet alleyway to a large metal gate. Behind it, the CRC is a freshly-built, stone building surrounded by manicured lawn and "keep off the grass" signs. A reception hall leads to a landscaped inner courtyard that wouldn't look out of place in Silicon Valley. And around it are arrayed quiet, airconditioned offices ranging from IT to pharmacy, and well-equipped laboratories where the exacting work of testing, measuring and reporting the biomedical ravages of HIV in the region are carried out.

Lab workers in blue coats work quietly and quickly, surrounded by the metallic gleam of state-of-the-art machinery enabling them to do everything from basic urinalysis to complicated tests to assess patient HIV viral load -- an increasingly important signpost for AIDS-related illness.

In the cold storage room, a row of locked refrigerators gives way to massive scientific freezers - set at -74 degrees Celsius -- which preserve samples and are backed-up and failsafe-d to keep the both the samples and the data reliable.

While the CRC lab was originally set up in line with Walter Reed's "primary mission" in Kericho -- the thus far fruitless hunt for an AIDS vaccine -- the lab is clearly realigning itself with the new realities and new priorities of PEPFAR, the U.S. AIDS treatment aid program. Much of the work now is devoted to new studies aimed at assessing how and when to intervene with anti-retroviral treatment, and in training lab personnel from other nearby facilities on how to handle the scientific backup required for a program that is enrolling tens of thousands of local Kenyans on AIDS drug treatment.

"We're spreading our risk," Kibaya said.

Cute is not a word

2008-07-21T11:41:00.004-04:00

that springs to my mind when I imagine a U.S. military installation -- but here I am in one of the cuter ones. This is the guest house at the U.S. Military HIV Research Program in Kericho. It is set amid lush tea plantations in Kenya's cool, wet highlands that mark the southern edge of the Rift Valley. It takes about an hour and half to get here from Kisumu, juddering at 120 km/hr across some hilariously pot-holed roads navigated by frighteningly self-confident drivers.

The cute ends here, though, and real work gets done not too far away. The USMHRP office in downtown Kericho sits atop a stubby block of converted flats, backing up onto an intensely busy gas station which seems to be a major transit crossroads for minibuses and everybody else.

Despite its military affiliation, there's no camouflage fatigue around. The USMHRP site in Kericho appears entirely civilian run, and in fact there is only one American -- the director Dr. Doug Shaffer -- working here, while the rest of the staff, from senior scientists to data entry monitors, is Kenyan. Administratively, it's a joint effort of the U.S. military and Kenya's KEMRI medical research institute.

The USMHRP has been involved in HIV vaccine work here for several years, and was due to have been a site for the next round of large scale tests before they were scrapped last week out of lingering safety concerns. They are still "cohort building" looking for the next possible trial, while research into other areas of HIV goes on.

One fascinating study they've got underway involves looking at the actual cost benefit of putting tea plantation workers on ARV treatment. While its not news that people get better after starting on the drugs, the genius of this study is that there is a very basic -- and very measurable -- way to measure the economic difference made by the treatment: how much tea the workers are able to pick. Apparently its the first study of its kind to attempt to put a $ figure on productivity gains associated with the widening ARV roll out.

The PEPFAR program for AIDS drugs seems to be playing a big role here -- in essence, the availability of free public treatment is opening ethical doors to study proposals which would have been impossible before when treatment itself, offered through a clinical trial, might have been seen as an inducement.