DRC, Day 1: More Travels

I didn’t write anything yesterday, because as far as I’m concerned, yesterday and today are the same day. I guess that’s what happens when you travel through the night and only sleep in airplane seats.

                

I went on a long run yesterday morning (well, longish—only six miles, which is a short run back home, but with the altitude and hills, I’ll call it a long run in Lesotho) and then bummed around the hotel until the shuttle came to pick me up for the airport at 2. After that, it was a quick check-in process and short flight to Johannesburg, where I then had a seven and a half hour layover.

Three African airports... Yeah, let's go with the African luggage security system of plastic wrap

                

The Johannesburg international transfer system is interesting. In Maseru, they only gave me my ticket for that flight, and said I had to get the remaining tickets in Johannesburg. Well, I get to international transfers, and I see a line of desks and agents, none of which were for Kenya Airlines. So I go through security, thinking I’ll get my boarding passes at a Kenya Airlines desk at a gate. Wrong. The gates aren’t airline specific, and they don’t have agents sitting there. So then I went back to the unsecured area, finally found an automatic check-in terminal, and checked in, changed my seats, and got my boarding passes.

                

By this time, I had about six and a half hours left of my layover.

Zebra pelt, anyone?

                

I went and got a massage (because, why not?), exchanged my remaining South African Rands for U.S. Dollars, and then headed to the lounge. Since I was flying Kenya Airlines, which is a Sky Team partner, I couldn’t use my Gold Star Alliance card to get in that lounge. So I paid $30 to go in another lounge, which had food, drinks, outlets, and wifi, so I was okay paying. Unfortunately, they closed at 10, which left me with two hours to kill before boarding.

                

Once I finally got in the air, I was out for the entire flight, waking up once to realize that I had missed a dinner service (who serves dinner at 1 am?) and that was about it, and then arrived in Nairobi around 5:30 am local time. The flight to Kinshasa didn’t leave until 8:30, so I wandered around, bought some hot chocolate (have to take malaria pills with milk, after all), and met up with MAJ Lang, the environmental science officer for U.S. Army Africa (USARAF) and my companion for this trip, and we chatted until it was time to board. And again, I was out for most of the three hour flight to Kinshasa (I did wake up for the food this time).

                

It was the usual scene at customs at the Kinshasa airport, a process I’m now unfortunately familiar with, and then we got our bags and headed out. Unfortunately, we’re not staying at the Fleuve Congo Hotel this time, which has me really disappointed. It was pretty much the only decent thing about going to DRC, and I was really looking forward to it. The hotel we’re in isn’t bad, but it isn’t even in the same class as the Fleuve. I’m going to see if we can get moved to the Fleuve when we come back to Kinshasa after our week in Muanda.

The pool at the O'Costelo

                

After some overpriced lunch, I took a nap, and then I navigated the hotel looking for a decent place to connect to the internet (turns out, the only place that works is the bar…) before an overpriced dinner. Neither MAJ Lang nor I was ambitious enough to try to call motorpool to get a pickup to take us to a real restaurant, so instead I paid $15 for a croquet monsieur (grilled ham and cheese sandwich). Gotta love it.

                

I think all we’re doing tomorrow is going to the embassy for the Regional Security Office (RSO) brief, which is about all the security and safety threats in the area and the rules to follow to not get hurt. It only takes about half an hour, so I have no idea what we’ll be doing for the rest of the time. Oh, well. I guess time will tell.

6-13-13: Last Day in DRC

I realized earlier today that I never wrote a blog entry for yesterday. Oops. Well, nothing exciting happened. We flew from Muanda to Kinshasa and arrived in one piece, and that was just about it.

The plane that took us back to Kinshasa

Today we got back to work, with an early morning meeting at the Embassy. We had an outbrief with the ambassador, and I presented the medical piece, as the “medical mission lead”. I presented an overview of Kitona Health Zone, using the surveillance data that we heard in academics during the mission, and then touched on the kinds of patients we saw and the health assessments we did. It went pretty smoothly, but what I neglected to say was that while I noticed that the MoD had solid programs and policies in place, they were obviously having problems with implementation, based on what we saw. Oh, well.

Out-briefing the ambassador

After the out-brief with the ambassador was the press conference, and LTC McCullough asked COL Lesho to be the medical representative on the panel, as the highest ranked military officer. He did his piece well, although I would have answered some of the questions a little bit differently than he did. But that’s what LTC McCullough wanted, and it was his show.

The group before the press conference

After a quick lunch (of pizza) we headed to Camp Kokolo, which is the main military base in Kinshasa, to visit the hospital. This was the site of MEDFLAG 10, a joint-service medical mission in 2010, and also a site that LTC McCullough neglected to take us to during the pre-deployment site survey back in March. The hospital is bigger and has a larger patient volume than Kitona, as well as better equipment (as a result of MEDFLAG 10), and today LTC McCullough’s rationale for not taking us there was that they get a lot of attention from NGO’s, etc, and we would have been lost in the shuffle, whereas nobody really goes out to Kitona. While this is undoubtedly true, it would have been nice to see Kokolo in March, when we were trying to find a site, instead of being herded to Kitona. It would have completely changed the dynamics of the mission, with how many days we would have been able to work (not having to take days out for travel), where we would have been staying, and even who we would have brought on the mission. It’s kinda frustrating to get actual confirmation of being used to further someone else’s agenda.

The cardiac ward at Kokolo

Anyway, after that we swung by the Thief’s Market, where I bought some more touristy things, and then we had a bit of downtime before the reception at the deputy ambassador’s house. It’s a very nice house, and he invited quite a few medical people that we got to mingle with. I talked to the head of the PEPFAR (Presidential Emergency Program For AIDS Relief, a program started under George W. Bush) program in DRC, the USAID chief in DRC, the CDC chief in DRC, and several other equally important people. It was quite an evening, and I’m sad that I didn’t remember to bring my business cards.

               

 Tomorrow we have a long(ish) day of doing not much, and then we hop on the plane in the evening to begin the epic journey back home. I can’t wait (sarcasm). 

Stranded in Brussels

Well, the inevitable has finally happened. After years of traveling to remote and exotic locations, I finally had a missed connection on a flight that happens once a day, stranding me in a foreign city.

Fortunately, it was a foreign city I've never been to, so once I calmed myself down, it was actually a win.

Yesterday started pretty much the same as any traveling Saturday. I had done most of my packing Friday night (translation: I grumbled about packing and procrastinated until I finally got around to putting some clothes in a duffle bag hours after I should have), so after my run in the morning, all I had left was my carry-on stuff and then I was good to go to the airport.

I was flying United from Savannah to Chicago, and again from Chicago to Brussels, but then I switching to Brussels Airlines. It's still a Star Alliance partner (yay for frequent flier miles... I'm going for gold), but I wasn't able to print off my boarding pass in Savannah due to the airline change. I didn't think much of it, figuring I would have plenty of time when I got to Brussels.

Wrong.

The weather in Chicago was pretty terrible, which delayed us about two hours. We made up some of the time in flight, but in all, my comfortable two hour lay-over was reduced to 25 minutes, which is never comfortable, especially when 1) flying internationally; 2) connecting in an airport I'm not familiar with; 3) in a country where I don't speak the language; and 4) I don't have a boarding pass yet. So nope. Didn't make the connection.

And there's one flight a day down to Kinshasa.

Fortunately, United/Brussels Air/Star Alliance/some unknown benefactor put me up in the Sheraton (on airport grounds) and gave me meal vouchers for lunch, dinner, and breakfast tomorrow. After having to forcibly calm myself down (because honestly, what good does getting angry/frustrated get? They're not going to create more flights out of thin air), I got a shower and free lunch and decided that there's no point in spending my free day in Belgium cooped up in the hotel. So I got on the train and headed down into the city and walked around a bit, taking some pictures.

Playing with the panoramic feature on my iPhone while standing in the middle of Grand Place

It's a chocolate museum. Because, well, it's Belgium and they do that here

I saw the chocolate museum, which was actually pretty interesting. It went into the history of chocolate and how it's made, and then there was a demonstration (and treats). The demonstrator gave one line in French and then repeated the line in English. After a couple of trips to Africa, I've forgotten how well people in Europe speak English.

Belgian waffle with chocolate and banana

 And, of course, when in Belgium, you have to have a Belgian waffle. At least, that's what I told myself. It was very tasty... Much better than Belgian waffles I've had in the States.

So that was my day in Brussels. It's now 6 pm local time and I'm fading fast, so I'll probably be getting dinner soon and then going to bed, keeping my fingers crossed that the plane leaving for Kinshasa tomorrow is on-time (even though, realistically, I'll settle for it landing at any time, as long as it lands).

Democratic Republic of Congo, Day 4

This was our last morning in Muanda, which was a good thing. I was getting a bit tired of that place (which is probably going to make it hard to go back in June…). I did finally get to go running, though; the Defense Intelligence Agency (DIA) major went running yesterday morning, so I asked him if I could go running with him today. We did about 3 miles in 30 minutes, which wasn’t bad, considering the heat, humidity, and poor conditions of the road. I’m excited about getting to go running along the Congo River in Kinshasa tomorrow morning (even though it’ll be early).

The main road in Muanda and where we went running

The flight from Muanda to Kinshasa is the same plane that does the reverse trip (makes sense), which means it doesn’t leave until the afternoon, after the plane gets into Muanda and the crew gets a couple of hours to rest. So we spent the time in the morning hanging out the lobby of the hotel, with its spotty air conditioning, planning the details of the MEDRETE in June. It’s going to be four physicians—me, two adult infectious disease physicians, and one pediatrics infectious disease physician—as well as a laboratory tech who knows blood safety, and three support/security personnel from USARAF. In addition, we’ll also have five Congalese translators, because the doctors at Kitona don’t speak much (if any) English, and the American doctors probably (in my case, definitely) don’t speak much French. The Embassy has already identified two of those translators; I hope they find another three by June and that they know medical speak well enough to translate it.

In all, the mission will be 11 days, but with travel time to and from Muanda, there will only be eight days on the ground, seven of which are working days (they only have one doctor on call on Sundays and don’t see any new patients). On those days, we’ll have physicians paired up (one Congalese, one American) seeing patients as the Congalese normally do in the mornings. Then, in the afternoons, we’ll be having “summit meetings”, which will be discussions about programs that the DRC Ministry of Defense and Ministry of Health has for HIV, malaria, and TB, as well as the American doctors explaining our programs for these (well, for the ones we have programs for) and going over WHO guidelines for diagnosis and treatment. I think the lab tech will just be doing similar things with the lab personnel, in terms of teaching and learning (learning how to read malaria slides, teaching about blood safety, etc).

Finally, noon rolled around and we piled in the rental cars and headed for the Muande airport, where we again loaded a tiny little plane that stopped at the same places as on the way there before depositing us in Kinshasa. The embassy cars met us there and loaded us up to the Fleuve hotel, where we got reliable air conditioning, hot showers, and good food we didn’t have to wait three hours for. It was nice.

The Congo, from the air

Back at Ndolo airport, after spending two hours on the hottest plane in existance

The view from my 17th floor room at the Fleuve

Democratic Republic of Congo, Day 2

Today started way, way too early, with my alarm going off at 4:30 so I could get ready and check out of the room a little after 5, because at 6, an embassy car came to pick us up to take us to Ndojo airport, the domestic airport in Kinshasa. We were going to Muanda to evaluate the hospital at Kitona Base.

Our chariot awaits

Not unexpectedly (as I have spent some time in the developing world), the plane that was headed toward Muanda took off late. We thought we were leaving at 9; it was closer to 10. It was a situation pretty similar to what I experienced in Papua New Guinea: one small plane (maybe 18 seats?) that made a few stops before it got to where I wanted to get off. DRC was pretty, from the air. Because there’s so little development, everything is all green and full of rainforests, without even roads to interfere with the landscape once you got away from the cities.

The view from above

It was around noon when we landed, and then we had to go through some rigamarole with the passports (why they were checking passports on a domestic flight is beyond me) and luggage, but finally we were able to step out of the grass hut that makes up the airport and into the air conditioned rental cars (complete with drivers) to take us to the hotel. Because the entire city of Muanda is lacking any real-sized hotels, our group is split up between two hotels. I think I’m in the nicer one, but that’s not saying much.

By the time we sat down for lunch (at the hotel’s restaurant), we had already missed our scheduled meeting with the commander of Kitona Base, which was pretty much all we had scheduled for the day. So instead of doing anything meaningful, we did “familiarization activities”, which consisted of scoping out restaurant where we could eat, seeing the beach (since Muanda is on the tiny stretch of Atlantic coastline that DRC has), and traveling the road from Muanda to Kitona Base. It’s a very, very bad road (“unimproved” was how I was told to describe it), and the mission planner is definitely not excited about the idea of a MEDRETE team driving that twice a day for two weeks. More if they don’t have food available on base. It was bad enough that the car I was in got a flat, which always makes for some entertaining pictures.

Fixing the flat

So that was today. Not much meaningful happened, unfortunately. Tomorrow we’re supposed to meet with the deputy base commander (word is the base commander is in the east of the country somewhere) and then visit the hospital to see if there is anything worthwhile there. Pretty much, unless they have really cool diseases and a staff that is really interested in learning about public healthy, we’re probably going to recommend that the MEDRETE not happen. Because it’s really not worth $150,000+ of the taxpayers’ dollars to go on a mission where nobody learned anything and the local Ministry of Defense couldn’t care less.

Goodbye, Kenya

 I've been back from Kenya for a few days now, procrastinating about posting my last few pictures onto the blog. The last couple of days in Malindi were pretty low-key. On Thursday, we took the German medical students out to lunch at the Hilton. The one on the right, Maria (who is actually Norwegian, but goes to school in Germany), ran the 5K as part of the marathon on Saturday (day after I left) and placed third for women. Apparently, there was a girl about 10 years old who showed up for that run in ballet slippers. Dr. Childs told Maria she had to beat the girl, and she did--just barely. Even Kenyan children are good runners.

The girls were quite a hit with the children at the Hilton.

Here's a random picture of the waiting area of the outpatient clinics at the hospital:

Friday I packed up my belongings (which reminds me... I still need to fumigate my duffle bag, my laundry smelled that bad) and attempted to check out of the hotel, but they told me that their credit card machine was down (whether it was or not, I don't know), so they told me to go to the ATM. Well, my government credit card only lets me pull $600/month out in cash, which wouldn't cover the 95000 KSH hotel bill (about $1000), and the ATM that took my personal debit card wasn't working, so I had to take my personal credit card to the bank with my passport to pull the cash out. Long and frustrating story short, two hours later I had the cash to check out of the hotel, and then it was time to head to the airport.

This was the plane that carried me from Malindi to Nairobi, the first of four flights until I landed at Reagan. I had a very long layover in Nairobi (almost eight hours), so I spent some of that time in one of COL Coldren's favorite bars, The Pub (it's at the airport). He discovered that bar when he was in Kenya as a preventive medicine resident and had a long lay-over in Nairobi, so I kept alive the tradition of preventive medicine residents working on data at The Pub while waiting for the next flight.

After Nairobi was Amsterdam, then Detroit (where I again confirmed that the entire state of Michigan is worthless... no USO, no free wifi, and bad cell phone reception in the airport), and then it was back to DCA. I had from Saturday afternoon until Monday morning to recover, and then it was into WRAIR at 7:30 to officially begin my third year of residency. I have a week of in-processing and administrative stuff, and then begin at the Armed Forces Health Surveillance Center (AFHSC) next Monday.