Kenya: faces of FACES

Check out a slideshow of the fabulous staff at FACES, taken for a photobook i am putting together:

faces of FACES

Kenya: FACES Clinic & expansion of HIV care

[FACES Kid's Club - older kids posin on the staircase]

It is astounding how much HIV clinical care has expanded in Kenya since I was here in January 2004. At that time, I was in Eldoret, a smaller and more mountainous city about 3 hours by matatu from Kisumu. We were just beginning to roll out antiretrovirals (ARVs), and most patients who were on them had to pay out of pocket for their ARVs. Cipla was producing Triomune 30 and 40, the generic fixed-dose combination pill which includes d4T (stavudine), 3TC (lamivudine), and NVP (nevirapine), and ARV treatment suddenly became more affordable. Part of my project in Eldoret back then was to help link patients diagnosed with HIV in the hospital to be properly referred to the subsidized HIV treatment available at the new AMPATH HIV clinic, which was in the process of being built. That program in Eldoret was also starting to branch out to a few rural and more remote clinical sites.

You can read an article about the AMPATH program in Eldoret here: http://alumni.indiana.edu/magazine/kenya.shtml

Imagine providing HIV management and treatment in a place without roads, electricity or clean water. It is still like that in many places. But now these places are remarkably better staffed, better resourced and are seeing 10 to 20 times the number of patients. The Kenyan government has trained young medical officers in ARV management, and now Kenyan 20-somethings are running HIV clinics with 10-20 staff and managing huge public health programs. I’ve never witnessed such rapid development and growth in healthcare. And I am fortunate enough to be a part of it.

Back in early 2004, the AMPATH program in Eldoret had only a couple thousand patients involved, and only a small fraction of those on ARVs. We were just beginning to roll out Triomune for free or heavily subsidized rates. Of all the people who needed to be on ARVs due to advanced HIV disease, less than 1% of those people were getting it. Now AMPATH is serving 33,000 patients, runs several children’s programs and innovative farm-based nutritional and micro-enterprise programs. In Kenya, roughly 20% of the people with HIV who need ARVs are now getting ARVs. That means 80% still go without, but this is way, way better than more than 99% of people going without treatment. This is a result of a massive influx of attention and resource allocation by the Kenyan government, NGOs and global public health institutions. They’ve built clinics, they’ve provided lab equipment, we’ve trained thousands of clinical staff in HIV care. We’re in the middle of a 20-fold jump in treatment, and there’s still a lot more to do to get it to 100%.

I will visit Eldoret and the AMPATH program at a more rural site called Turbo at the end of this week. It’ll be really interesting to see how much it has changed.

FACES (Family AIDS Care and Education Services) is the clinic where I am now working in Kisumu. First, I should note how great it is to work at a place where people are incredibly welcoming and happy that you’re there. It creates a much happier, positive work environment. The staff at FACES seems to naturally create a constructive work community. Similar to AMPATH, FACES started with a partnership between a Kenyan medical site in Kisumu, and a US-based institution. In this case, it was the CDC and UCSF Ob-Gyn program. They had started with PMTCT (prevention of mother to child transmission of HIV) and microbicide projects, and then expanded their clinical care to include one of the biggest glaring health needs: HIV clinical care for adults. This is where the UCSF ASPIRE and internal medicine residents (like me) step in. We can actually be helpful in training folks here to manage complicated adult HIV cases.

Their family-based model is great in involving whole families and encouraging everyone in the family to be tested and treated as needed. It is much more holistic than dividing families up into internal medicine, pediatrics, and ob-gyn. It also includes home-based, hospital-based visits by staff, nutritional supplementation and counseling, as well as programs such as “Kids Club” and “Family Empowerment” workshops. [I attended the most recent Kids Club yesterday and got some really great photos and video of the kids. It’s not hard to get great pictures of kids- they love the camera. I’ll post some up.] FACES also has an integrated lab and pharmacy, so patients can get all these services on site, rather than having to trek around town to get blood drawn and their medications. The approach is so much more comprehensive than most of our out-patient clinics in the US. And they do it with a lot of people-power but not much in material resources.

The FACES clinic in Kisumu started out in September 2004 with just a few hundred patients and now sees over 4,000 patients, most of who are on ARVs, including children. It is truly inspiring to see how far HIV care in Kenya has come since 2004. They have a lot more to work with than what I had 3 years ago: a full formulary of medications, CD4 counts, HIV qualitative PCR (measuring the presence of the HIV virus), and they used to provide viral loads too. And it’s free for patients. The clinic has a very deliberate patient flow model which allows them to see about 200-250 patients every day. For the number of clinical staff, it is incredibly productive.

I’ve seen patients for three clinical days during my first week at FACES, and already I’ve initiated (alongside a clinical officer) several people on ARVs, diagnosed ten or more smear-positive malaria cases, managed people with extrapulmonary TB on ARVs. I’ve seen with Liz and Everia (a Kenyan FACES clinical officer) a young man stumble into clinic with left-sided pain and weakness and treated him for presumptive toxoplasmosis, a parasite that can create masses in the brain causing focal neurological deficits. I see about 20 patients a day… and I’m relatively slow! It’s a very very busy clinic. And amazingly, despite my newness to this clinical site, I feel helpful: seeing patients and helping clinical officers think about the differential diagnosis and treatment options, assisting with paperwork and getting the patients the treatment or investigations (labs and studies) they need.

You can read more about FACES at their website:

http://www.faces-kenya.org/index.php

I also have a number of projects that I created for myself and have been assigned to do by the rotation. Because the clinic is so busy, it feels a little crazy to add so many things on top of the clinical work. However, it is the diversity of my work that keeps me engaged. I think I would go crazier if I saw patients from 8 am to 6 pm every day without other work projects going on. This is not news, but I am once again confirming that I need a wide variety of creative, clinical and program/systems-level projects to keep me happily and actively engaged with work. Here’s my current list of projects, in rough order of what I personally think is most important. Pole, sorry, it's like showing you my to-do list, but at least you get an idea of what I'm doing here. You’ll hear more about them as they develop:

1. video documentary on capacity building and training at FACES (my own gigantic project)

2. the faces of FACES staff photo book (my own project)

3. CME (continuing medical education) session on HIV and pulmonary (lung) diseases

4. mentoring clinical officers and nurses

5. organizing the rotation for future UCSF residents with proper orientation materials and resources so that they are useful and get the most out of being here

6. less formal educational workshops for clinical officers; i will do one on a subject they choose

7. journal club (not my favorite thing to do because it is highly entrenched in academia, but it has become part of the rotation)

8. developing sections in the clinical officer handbook; i will likely tackle sections on HIV and pulmonary disease, diarrheal disease (my personal fave!)

Somewhere lodged into this list is the clinical work of seeing patients. I can’t decide how to prioritize that because it always becomes a priority once I commit to seeing patients on certain days. I’ve decided to see patients for at least 3 days a week and spend one full day and some half-days on my other projects.

Yikes! It’s a lot to get done in the next 3 ½ weeks. Time here always goes so quickly.

Kenya: wiki moja, first week explorations

[photo: me, baby Shawn, and mom Triza, who is also the pediatrics medical officer at the Nyanza Provincial Hospital]

*adjusting to life in Kisumu

I intended to have a restful first weekend in Kisumu. I was finally able to chill out after my long journey and busy tourism in London. I pictured myself lounging by the pool, reading and finishing my crochet amigurumi mushroom dude. No such luck!

But it was poa (cool) because I was able to meet up with my friend Kibachio, who happened to be in town for a Kenyan Medical Association meeting. He now is a Medical Officer in the provincial hospital of Embu, and apparently in charge of both the maternity ward as well as expected to help manage the HIV clinic. They were discussing the Millenium Goals in healthcare, since most countries have not yet met these goals. It was great to be able to meet up with him because 1) he is a all-around fabulous person with good energy and 2) he has really grounded, constructive insight to the politics and health care systems in Kenya. Despite his packed schedule at the medical meeting, he came out early to meet with me and catch for an hour or so. He also gave me 15 minutes to interview him on the topic of capacity building in Kenyan healthcare. I accompanied him on his errands in preparation to leave and met his friends Triza and Katana, who work for the district hospital and CDC-Kisumu, respectively. It’s helpful and normalizing to be able to hang out with friends here and meet more folks who are roughly in my peer group. Triza and Katana are young Kenyan doctors, about my age, and have a new baby. They are coming over to the cottage with their baby, Shawn, for afternoon tea today.

I spent the next few days incredibly jetlagged, probably the worst I’ve ever been coming to Africa or Asia. I blame my prolonged stopover in London for this. I had adjusted to Sophy-Standard-Time (SST) in London, which is the equivalent of going to bed at 2 am in London, which is 4 am in Kisumu. The problem with this is that I have to get up a 6 am on workdays so I can make the 45 minute walk to work, and arrive for 7:30 meetings or 8 am clinic. A few days of 2-4 hours of sleep was still not making me tired enough to sleep at a normal time in Kenya; this was bad jetlag. Part of the problem was the nasty crunchy foam mattress I was sleeping on, the suffocating feeling of a mosquito net over a small bed, and the insane amount of howling animal and insect noises at night. I was trying to spare my melatonin for my trip home (I sadly didn’t bring much and had used up most of it in London), but gave up and took some for the next 3 days to get some shut-eye.

*Kisumu is big and diverse

Kisumu is a big city. Way bigger than I remember Eldoret being. The largest market in western Kenya is in Kisumu. Apparently people come over from Uganda to buy stuff here. The market is so big that it has metastasized and spilled way out of the marketplace area into the public park, main road, and has established sub-markets in different areas of the city. This makes the city incredibly lively (which I like) as well as crazy and congested (which I don’t like).

If Liz wasn’t here for my first week in Kisumu, I would have gotten totally lost going to and coming from work every day. There is so much construction and craziness downtown that it makes it all the more difficult for a directionless person such as myself to get her bearings.

We walk 3.7 km each way to the FACES clinic. I know because I took a taxi home one day and watched the odometer. Amazingly, the whole way is paved with nice asphalt. I really feel like I’m in a big city because of this. The walk would not be so bad, and in fact is mostly pleasant and allows us great exercise, except for the fact that you have to cross (unprotected) an undivided highway to Nairobi and walk on rocky dirt patches in order to avoid being hit by a swerving boda boda (see below) or a speeding matatu (privately-operated “public” transport vans). The roads are quite busy here. You have to share it with a wild medley of transport forms: people, carts carrying huge loads of petrol, carts carrying huge loads of chickens or furniture, boda bodas, bikes, matatus, tuk tuks (three-wheeled gas-powered covered vehicles for hire as a cheaper alternative to taxis), taxis, large buses, construction tractors, trucks crammed full of people in the back, trucks crammed full of various other goods, and oh yeah- cars. And of course there are no real traffic signals.

I’ve seen few mzungus here, relatively speaking. I see them mostly at the fancier stores and at the CDC. It’s nice not to be in a heavily tourist city. I even met a crew of four young men from Southern-Central China here. Of course, I bumped into them at a store in the rice and noodle aisle. They said that they had been in Kisumu for two years, operating a vehicle repair shop. They said that life here is OK, they miss home, but they couldn’t make enough money at home with their skills, so they came here instead and are financially doing better for it. Go figure!

There is a huge South Asian population here, and the cottage I am staying at is in the upper-class neighborhood of Kisumu, called Milimani. Most of the families here seem to be very wealthy black Kenyans as well as wealthy South Asians (South Asians here tend to be merchants and owning class). Despite the obvious class schism, it is nice to have different cultures represented strongly here. Plus, it allows me to go out and get lots of yummy South Asian food ingredients, and buy delicious samosas, dal and dhosas for lunch.

As Kisumu is quite cosmopolitan, it also has a bigger diversity of tribes represented here. Despite the large Luo majority, the businesses and NGOs here have attracted folks from tribes all over Kenya. FACES ends up being diverse for that reason. In fact, some of the clinical officers have to get interpreters who speak Luo in order to interview patients. I’m not the only one…

*boda boda phenomenon

There is a new mode of “public transportation” in Kenya now: boda boda taxis, or bicycle taxis. Generally, they are young-ish men with big, old school Chinese-style bikes outfitted with a big cushion, extra handlebars and foot rests in the back. They weren’t around when I was in Eldoret 3 years ago. Liz told me that someone had recently institutionalized the boda bodas in order to address the extremely high unemployment rate among able-bodied young Kenyan men. Very smart. Though now there is a surplus of boda boda drivers. And people are saying that Kenyans are now going to get fat riding on the backs of boda bodas rather than walking on their own. Ah, the price of development.

*Kenya is good for my health (except for the diarrhea, see below)

My pimples are gone, my color has returned, I walk 4 miles a day at 1130 meters, swim 20 laps every day, take most of my weekends off, work almost normal hours at clinic, and cook almost every meal. It’s amazing what a more relaxed culture and work environment will do for you.

*diarrhea

Alas, my GI tract has become immunologically oversensitive and wimpy from being in San Francisco too long. After I had been in Kenya for four days, Liz kindly reminded me that heating up the tap water in the hot pot was not exactly boiling the water for decontamination. Oh. Duh! I had basically been drinking Kenyan tap water (and lots of it) for four days. Somehow I had forgotten that the little hot pot that heats up water to a near-boil doesn’t really kill the organisms living in it. It might fry them a bit, but not enough.

Needless to say, on Kenya Day Six, I started having bad intestinal cramps and gas. Lovely, especially during clinic. The loose stool started on Thursday, Day Seven. I am proud at least to state that my GI system is at least strong enough that I didn’t develop the full traveler’s diarrhea of awful cramps and 10 stools a day. However, I was hoping to stave off the antibiotics and condition my GI tract more (don’t want to contribute to fluoroquinolone resistance!) but after three days of cramps, gas and gnarly loose stool, I decided that it was time to break out the cipro. Sure enough, twelve hours after taking the first dose, I am gas, cramp and loose stool-free. Yay!

Kenya: Karibu Kisumu!

(photo above: sunset over Lake Victoria as seen from the Pabari cottage in Kisumu)

I had a very typical foreigner-in-Kenya entrance to Kenya: By the time I had stepped out from customs onto the arrivals platform, I was assaulted by a huge swarm of touts trying to get me to take their unauthorized taxis and to go on under-the-table safaris. No peace for the travel-weary. I couldn’t even get to the ATM machine without a horde of people following me and talking at me incessantly. Luckily, I had been in Kenya once before and knew about the authorized taxis waiting out in a designated area. It just took me a while to break through the barrier of unauthorized drivers trying to get me to pay for an illegal ride.

My taxi driver, Francis, was a very interesting young man. In addition to driving his (licensed) taxi, he works for a Kenyan pharmaceutical company which was apparently doing trials on an HIV immune modulator. He spoke about wanting to go back to school in order to go to medical school and eventually become a doctor.

I then embarked on another very Kenyan experience (though middle-class Kenyan, as it was quite safe): a hot, dirty, bumpy nine-hour Easy Coach ride from Nairobi to Kisumu on very broken roads. It felt a little crazy doing this after an eight-hour overnight flight from London. The bus was packed to the brim, but luckily not overpacked and luckily I sat next to only one very lovely person (as opposed to a mother carrying two children, etc.). Caren was returning home to a rural town next to Kisumu after visiting her daughters and new grandson in Nairobi. Caren is a primary school teacher and has a fascinating family. In particular, her sister Eugenia was recruited by the Chinese acrobat school when she was 11 years old, back in the 1970s. She then lived, trained and performed Chinese acrobatics for six years afterwards. According to Caren, she was no longer very athletic after having several children. Eugenia now works for Kenya Air’s Chinese department; i.e. she books and arranges flights in Africa for Chinese folks. Caren was so excited to learn that I speak Mandarin that she used her last cell phone minutes to call her sister up and have us conversate. Eugenia’s Mandarin was impeccable. She spoke with all the right intonations, even after all these years. She had Chinese vocabulary that I could only guess at. I imagined a plump, dark-skinned Kenyan woman speaking in perfect Mandarin on the cell phone with me.

I arrived in Kenyan time at the Kisumu Easy Coach terminal: two hours late. I had scared Vero, our wonderful Kisumu-based UCSF/UBC liaison, earlier when I didn’t call her till I reached Nakuru. She was afraid that something would happen to the lone foreign female traveling by bus from Nairobi. I tried to call her earlier, but there was simply no phone to be safely found in Nairobi before we departed. Plus I was still carrying that insane load of luggage by myself. She was quite worried about me, so she and Liz waited at the Easy Coach station starting at 5 pm, when I was supposed to arrive, till nearly 7 pm, when I actually arrived.

Happily Vero and Liz helped me with my luggage into the clinic van, and drove me straight to the cottage that I am staying at for the next five weeks. It’s gorgeous. It’s tropical. It’s perfect. The woman who runs the cottage compound, Mrs. Pabari is a Turkish landscape designer. You can tell. She has an immaculately maintained tropical garden with plentiful flower and vegetable patches, koi ponds, frog ponds and a naturally heated lap pool. Not only am I in this lush natural setting, I also have a home with hot water, plumbing that works, electricity, and –get this- speedy internet access with an ethernet connection.

The only thing tough about this place is 1) the bugs, including mosquitoes and 2) the immense racket that the nighttime animals make. The random outbreaks of hornbills, bullfrogs, dog barks and howling contests keep this jet-lagged insomniac wide awake at night.

What’s gross? Ants one-inch long invading your home.

What’s grosser than gross? Killing a large ant and finding a swarm of smaller ants eating and liquefying its body within 5 minutes.

London - photo slideshow

Check out the other pix from my London wanderings:

London 07 - pokeylotta adventures

London – Lawns, Luggage and Markets

(photo: Hyde Park's Diana Princess of Wales Memorial Walk)

Last night I met my new roommates: two graduate students from Brasil, one in a film program in Paris, and another studying in Germany. I came back yesterday to find neatly placed luggage and crisp, folded men’s polo shirts in the lockers. I was a bit baffled by the neatness of everything, thought there was only one other roommate, and maybe that this man was not from Canada, Australia or the US, just neat because he was from a culture where men kept things thoughtful and tidy. Or maybe my roommate was a woman who liked to wear men’s polo shirts. Or maybe he was gay. Look at all those stereotypes fly! At the risk of supporting my stereotypes, it turned out that one guy is gay (the other didn’t discuss this with me at one in the morning). And both are very friendly. So despite only have met them for 30 minutes before going to bed in the wee hours, one still gave me a friendly and platonic hug and kiss before he left in the morning. It was so lovely to be around genuinely friendly, affectionate, open people. I miss this a ton in the US and especially at work. People are just not friendly or open in this way and it feels stifling.

I spent the day not rushing to get into subway trains. I made it to the Camden Market, the Inverness Market and the Camden Lock Market, which are all in the same neighborhood. It was huge. And it was hugely repetitive, sort of like the markets in China, only ten times more expensive and with only the chichi-est of merchandise. With mostly South Asian, some Southeast Asian, some East Asian, a handful of black folk, and probably 50% white sellers. And, importantly, no one seemed to be bargaining. I thought I was going to get away with walking through the whole market and managing not to buy a single thing. I was reveling in this accomplishment, when I spotted the kind of hip pack that I’ve been trying to make for the last three years. It was hanging up at a store with goods from India- lots of cotton, hand-dyed, but made of hippie-bobos in developing countries. The hip pack was sleek, simple in neutral cotton canvas colors, and just the right size to stash some cash, my Housestaff Handbook, my Clie, my stethoscope on his holster, and my cell phone. I wouldn’t look exactly badass, but much more comfortable and cooler than wearing 1) a white coat or 2) a shoulder bag. Blah blah blah. I have no excuse; I broke down and bought it. And I didn’t even try to bargain for it. I paid the whole 12 pounds with a 3.5% credit card fee since I had run very low on cash in pounds. I forgive myself for this transgression. After all, aside from the necessary food, room, transportation, internet access and a single (unnecessary) hilarious postcard, I did not buy anything in London.

I went to Harrod’s next. I felt like it was necessary to visit the world’s largest department store. This was a dubious honor, but I was curious, and had not been inside of any of London’s big stores yet. It was like a very clean, very expensive wealthy person’s amusement park. The food court had oysters on the half shell and cavier and 20-dollar pieces of chocolate from France. The women’s department had 200-dollar versions of shirts I saw with similar fabric being sold at the Camden Lock Market for 30 dollars. It was so amazingly absurd that it didn’t even cross my mind that I would purchase anything. Instead, I used their “women’s luxury washroom” (yes, it is really labeled that on all the store signs), got a free sample of Aveda hand relief lotion for my cracked dry hands, and sat down for half an hour in “Denim World” on a leather couch, reading a book on the history of blue jeans. Did you know that it wasn’t really Levi Strauss that made the first blue jean but a man in Reno, Nevada named Jacob Davis? Sometimes it’s nice to be invisible. Or maybe that’s just how they are at Harrod’s. No one bothered me for the whole time I sat there with my shoes off, propped up in a fancy leather chair and reading right next to the Denim World cash register, where people were purchasing 400-dollar jeans.

My final London tourist adventure (besides getting to Heathrow in rush hour with my weight in luggage) was at Hyde Park. The British really know how to garden. Lemme tell you. My mother would be enraptured to wander through their lawns and talk to the gardener about how s/he did everything. I walked along the Lady Diana Memorial Walkway, which was planted with a great array of tulips and pansies and loads of flowers I don’t know the names for. I didn’t even mind the blindingly white (and suburnt) Brits sitting right in the middle of these flower gardens, sun bathing. The flowers in London, although artificially introduced and tightly controlled, are both fragrant and beautiful. Hyde Park and the house gardens I’ve seen completely destroy my previous image of London being totally foggy, cold, gray and dull. Hurray for flowers!

Today my luggage went through a multitude of transformations, from the moment I got up and dragged it all down the 3 flights to the Ace Hotel lobby and devised a way to use my laptop cable to lock my documentary studio (i.e. my laptops and video camera and equipment) to the soda vending machine. I returned from the above described last-day journeys and found… whew… everything still there, untouched. Although I must say that traveling with my most expensive possessions (my laptop) has made me think about how I would feel about losing everything. Mad at myself, but fine otherwise. Being mad at myself is definitely the worst. I had been dreading dragging everything to the Underground Station again at Barons Court, but I made it just fine. Even carried everything myself down several flights of stairs without anyone’s help. No one offered to help anyway. In fact, the worst part was that it was rush hour, and the Heathrow train was paaaacked. And despite the fact that I was clearly carrying the most luggage on my back, no one budged to give me space to put anything down. They certainly could have. But they didn’t. Instead, they rolled their eyes and made stuffy British noises about when I bumped into them while still carrying my heavy pack. They only person who remotely helped me was towards the end of the trip, when a black dude lifted my backpack for me momentarily when I finally got a spot to put down my large pack. I suppose I shouldn’t be that surprised that in a big city that people are unfriendly, but it definitely makes the trip less pleasant. In any case, I made it. And was told at the British Air counter, after meticulously repacking my bags while waiting in line so that I could check in my large backpack, that I couldn’t bring both my small backpack and shoulder bag on the plane with me. “Only one bag, miss,” the South Asian lady at the counter adamantly told me. Another South Asian staff woman spotted me and told me the same thing in a very motherly tone. Sigh. Both of these packs were completely full. And I had thought out very carefully what I was going to bring in them. Enough stuff to allow me to survive and work in Kenya even if all my other luggage was lost. So I repacked yet another time, and did this ridiculous thing of carrying my laptop, charger, and video camera in hand so I could pretend I only had one bag and get through security without getting harassed. The worst part of it all was that despite the rigid scolding I got at the British Air counter, no one at security cared, AND they encouraged people to buy all sorts of large crap after in the airport terminal at their duty-free shops. Yuck. Stupid rules that are variably enforced and mainly for the benefit of making money. Free market capitalism at its finest.

Now I am flying over the Sahara Desert, having just finished watching The Pursuit of Happyness, the Will Smith movie version of Chris Gardner’s life. There were so many references and scenes in San Francisco that it managed to make me feel homesick. It also reminded me of the ridiculous, dehumanizing things people have to do in order to make life work. I cried, I miss home, I miss Young Whan. But I am still whole, and in fact doubled in size, after lugging my weight in luggage during rush hour across London. Another adventure survived. Another one en route.

London – Museum Madness

(photo: Omygod! They're REAL mummies! - British Museum)

I was attacked by an Underground train today. I got off the verrrry loooong escalator at Leicester Square and saw my train at the stop, doors wide open. I sprinted in for the kill, only the train was faster than me. The doors slammed shut on my body, smashing my legs and hands before I could pull them out. Luckily I managed to pry free. The doors didn’t open again to set me free, so I would have been dragged along by the beastly train. I have battle scars left: a black line straight down the side of my pant leg where the door smashed into it, a bunch of scrapes on my hands. Somehow no one else seemed to notice, so I dusted myself off and pretended like nothing happened, just like everyone else. When in Rome…

But that was nothing compared to my next scare: loose stool!! Aiiieeee! And at the Design Museum toilet! There is very little worse than having the runs while traveling to a third world country with no plumbing (is that an oxymoron? Is it safe to assume that by definition a third world country is a country that does not have adequate plumbing?). Imagine the 8 hour flight to Nairobi with diarrhea every 1-2 hours. Horrid. Especially for my neighbor. I started to review my recent ingestions and find a culprit. The nasty airplane yogurt? No, the package was fine. The sushi at SFO? No, everything should have been cooked, no raw meat. The foul-smelling tap water at the Ace Hotel that I’ve been guzzling? Maybe we have a winner. With great relief, I did not have another episode since then (yet. It’s been 7 hours). Whew.

Aside from those happenings, today was primarily a Squeeze-as-many-interesting-museums-u-can-see-in Day. I took full advantage of my all-day Underground pass and went to the:

-British Museum and saw the dead Egyptians on display. I mean mummies. It was weird. And weirdly fascinating. Dead humans displayed alongside decorative arts. The British do have a knack for objectifying most things, including people of color. Speaking of scientific objectification, I would have loved to see some better quality CT scans of the mummies. A much more socially relevant piece was Romuald Hazomé’s La Bouche du Roi piece using plastic petrol containers used by the poor folks in Benin who have to overuse the containers to bike as much petrol as they can to make money. He cut them up to be mask-like and set them up in a slave ship formation, to show how much slavery and colonial economics still has huge impact on the people of West Africa. He says, “In many ways, slavery has never ended – many people live in the same kind of conditions, bound to work their whole lives for rich bosses, who use them without regard for their humanity, and who then throw them away, like refuse.”

-Design Museum: wealthy, talented and immensely creative white boys design stuff for other wealthy white boys. I like the use of good design for functional items, but sometimes the aestheticism gets boring and played out.

-Tate Modern: the best part of this museum was getting dismantled in the massive Hogarth room: a gigantic steel spiral tube slide for adults made by an artist whose name I can’t remember. I almost made it through the museum, when they closed off what turns out to be the best part of the museum: Guerilla Grrrls and a few people of color artists (!!). I was so museumed-out at that point that I did not have the patience to meditate on the colour fields of yet another Rothko painting.

I have managed to eat only ethnic minority foods here. My bowels are grateful for sparing them the repetitive fish-n-chips experience. Yesterday night, ramen. Today’s lunch: bi bim bop (that’s right! There was a bi bim bop and kim bop shop next to The British Museum!). Today’s dinner: Maoz Vegetarian falafel sandwich on whole wheat pita and fresh veg toppings. And British chips. It came with the meal. I was only able to finish half of those butt plugs.

I had wandered into Picadilly and Oxford Circus to check out the shopping scene. Not very interesting, considering that the only store I wanted to see: A Bathing Ape (Bape), closed 20 minutes before I showed up. Instead of shopping, I stared at the black and Asian dudes closing up the shop. They stared back with blank faces. They’re really cool. I guess Londoners are not late night shoppers like New Yorkers or East Asians. Shopping all seems to close down by about 7-8 pm.

That was OK. It turns out I was pretty pooped. I fell asleep on the Underground ride back to the Ace Hotel, much to the amusement of the British dude in an office suit staring at me from across the way. Ew.

London Landing

(photo: V&A's Uncomfortable Truths exhibit)

I’ve been in London for 8 hours and already my boogers are black. Despite the deceptively sunny day (and yes, it was surprisingly gorgeous outside today), London gets an unhealthy rating for air pollution. After an Underground trip to Baron’s Court which felt much longer than it should have, mainly because I had the luck of riding with a crew of 100 Canadian students carrying the biggest suitcases you’ve ever seen on a school trip (I’m not kidding! 100!), I carried my large backpack on my back, my daypack on my front, and dragged the insanely heavy Samsonite luggage full of the stuff I brought for the FACES Kisumu clinic. It was quite a sight. I’ll bet I just looked like walking luggage. I think it weighed more than me. I felt like an ant, dragging six times its weight up the 3 flights of stairs to the bunk room at the sterile, no-nonsense Ace Hotel in South Kensington. The reviews of the Ace Hotel on travel websites complained that it was too residential, too quiet, too clean, too small, too strict. Perfect! I was psyched to have a safe place to store my why-don’t-you-just-rob-me-now traveling electronics stash.

I also need to get accustomed to UK’s use of 240 volt electricity. It’s shocking, really. I plugged in my computer power adapter and had sparks flying accompanied by a strange tingle in my arms.

After my 11 hour, cramped up uncomfortable flight sitting next to the squirmiest big British man I’ve ever met, it was nice to roam free. I thought I’d have the risk of crashing out, but I guess residency has trained me how to walk around like a zombie and pretend that I’m functional when I’m really not. So in the ten hours after I got to London, I’ve managed to pull off some mini adventures in a short period of time:

-Victoria & Albert Museum (now renamed to the hipper acronym of “V&A”): i wanted to check out the Uncomfortable Truths exhibit by artists of the African diaspora to acknowledge the bicentennial of the British abolition of slavery (in the traditional sense, though one can argue that slavery is not really gone, just reconfigured into other forms of racism and economic oppression). Their pieces were cleverly interspersed throughout the colonial and imperial artwork to remind everyone of how slaves have had a huge part in making the lives of the owning class work… and allowed them to own huge treasure troves of stolen artwork. This allowed me to run through a majority of the museum. One of the more direct series was by Lubaina Himid (Naming the Money UK 2004), where she made life-sized painted figures of slaves or servants from history and placed them in the frou frou chi chi bedroom, foyer, dining room, ballroom, etc. setups around the museum. On the back of each figure is how much the person should have been paid for the services s/he rendered. Smart.

-On a whim, I stayed on the Piccadilly Line towards Cockfosters (yes, Cockfosters. The Brits evidently don’t find this funny but you can always spot English-speaking tourists because they giggle every time Cockfosters is announced overhead). I vaguely remembered reading about getting half-priced tickets to see British theatre. Unfortunately, I didn’t remember the details about how to avoid getting scammed, so there I was, in the Leicester Square Underground Terminal, getting scammed. Sigh. I sooo hate getting scammed. Only, this one was pretty convincing- it was an official looking store, with a computer system, lots of seals on the wall proclaiming the outfit to be part of all sorts of accredited theater programs, blah blah. And the guy was pretty convincing. I wanted to see Billy Elliot The Musical (though I wasn’t so keen on the musical part) but he said that the theatre had not released any tickets for that evening. So I asked his opinion, thinking that he was a reputable dude. He told me to see The 39 Steps, an adaptation of Hitchcock’s movie, for 20 quid (that’s US $42, guys. A lot). It wasn’t until 20 minutes later that I spotted the REAL official TKTS office down in the REAL Leicester Square. It was closed, so I didn’t feel so bad at that moment. However, I started to feel bad when I showed up to the Criterion Theatre and was issued a real discounted ticket for 15 quid. That means homeboy and his outfit took home 5 quid, or about US$11 for that ticket. So now I know. And now you know. Go to the damn TIKTS office outside in Leicester Square, not the scammier places in the subway (like this place, West End Theatre Bookings, or right out of the subway). Or, it turns out, if you are a senior, have a student ID, and show up at the theatre for the show you want to see an hour before the show, you can get even cheaper tickets straight from the source.

-The 39 Steps: For all the crap I have written about my overpriced theatre ticket, it was good show. It was a bloody good show. Not a standing O show, cuz Brits don’t do that sort of thing. I imagine that the original movie was captivating with all sorts of smart plots twists, etc. But this adaptation was fkin hilarious. Basically, there were three actors and one actress playing 139 parts. Actually, one dude played the same character throughout, so technically, there were 3 people playing 138 parts. They threw in so much of that slapstick and deadpan British humor that even I, in my post-flight haze, was guffawing in public. There were some slapstick remakes of train chase scenes and little-man-actor-as-elderly-lady cross-dressing scenes that were brilliant.

-London’s Chinatown: is much cleaner and glitzier than any Chinatown I’ve ever seen before. Lots of herbal and acupuncture and massage shops. Some medium to high end Chinese and Japanese restaurants. It’s possible that these are considered low end in super-expensive London, but when I have to pay more than US$10 for a basic Asian meal, I consider it high end. So for 6 quid, I got myself a bowl of veggie ramen. And now I’m starving again. Good thing I brought half a suitcase full of energy bars, chocolate, brownies and oatmeal. Too bad I’m starving because I used those calories carrying all that food around.

It’s midnight in London! Time to get my booty into the bunk bed. G’night y’all.