Accra presentation

Here is the presentation I just gave on demographic and epidemiologic transitions. It was nice to get some feedback, and now I can just participate in the meetings without thinking about the presentation.


Matthews INDEPTH Transitions Pres 20100623

Notes from Accra

I haven't really left the hotel since I arrived Saturday evening, so I don't have a lot of observations to write here. I will say the dogs, pig and rooster outside my window do a good job of waking me up. The Jaria Hotel is not far from the airport, which is surprisingly small for serving such a large city. My friend said, and I agreed, that from the outside the buildings in this neighborhood look like drug dealer mansions: tall, white, and fenced in.

The hotel is pretty nice, I think. It's funny how old most of the furniture and curtains are. I think having relatively nice accommodations in a developing country just requires a little adjustment in expectations. Get used to turning on the water heater some number of hours before you want a shower. Get used to rinsing your toothbrush with bottled water. Watch out for raw vegetables (risky for us because of the fertilizers used... I'll leave it at that). But otherwise, things aren't too different. Breakfast is kind of a bummer, but lunch and dinner in the hotel restaurant are surprisingly good.

Tonight the whole group is going out to dinner somewhere in Accra, so I can provide more observations and maybe some photos.

Accra, Ghana

Perhaps it is time to dust off the old blog. I'm traveling to Accra today for meetings with INDEPTH Network site staff about the project I'm working on. I'll probably post some pictures here.

Accra is 4 hours ahead of EST and 7 hours ahead of PST.

Noises

I swear I just heard a lion attack an elephant.

It's hard to imagine a lion being so brave. But first I heard the angriest lion roar I've ever heard. Then a loud elephant trumpet. I had never heard that before.

Maybe they were teaming up against a poacher.

I could never get used to these noises.

Antici..........pation

As anxious as I am about wrapping up the study successfully in the next 6 work days, I'm even more anxious to get home to Seattle. Of course the biggest factor is that I've now been separated from my wife for 3.5 months. Other factors that make me miss home are friends, food, my dog, and being tired of the extra work it takes to navigate the culture in a foreign country. But I'm also realizing how much I really like the city where we live.

This September makes three years since we hauled our junk across the country to start anew on the west coast. I don't think Jess or I immediately fell in love with the city. The weather turned bad quickly--that November there was rain something like 28 of 31 days--and it takes time to make friends and find things to do. We've slowly grown more fond of the Emerald City as we've integrated ourselves.

Now, reading Seattle blogs, looking at pictures, perusing concert schedules, and just hearing what my friends are up to makes me realize what a great place it is to live. The restaurants, bars, museums, parks and different communities offer a lot to Seattle residents. From a different continent, many Pacific Northwest quirks that have at times grated my nerves seem more like adorable cliches performed mostly by genuine people. The mustachioed hipster cyclists who peg their skinny jeans; eco-obsessive young parents; queer scenesters; the connoisseur class. From my perspective now these people blend together in a cute, happy bubble of good will, enlightenment and acceptance. That's a place where I want to live.

I think I love you, Seattle. Be home soon.

Food in South Africa: Meaty Edition

I haven't had many requests for specific blog posts from my brilliant and beautiful audience, but I did get one early in my trip and have since neglected it. Erin wants to know more about the food here. Well, here is a little digest of some of the things I've digested. Since I don't take my camera everywhere I've had to rely on Wikipedia for illustrations. Today's post is meat-centric and I hope you will find it meat-tastic.

The braii
One of the first things to learn about food is that people here have braiis, not barbecues. However, if you come to the braii with the same attitude you bring to a barbecue you should be fine. Wood is burned to create hot embers, which can then be shoveled into a small pit or even just in a pile on the ground. The grilling rack is placed on top. Hot embers can be added as needed. I think every braii I've attended has included at least a couple kinds of meat (beef, chicken, venison or boerewors), pap, and "soup" or chakalaka, a spicy sauce of tomatoes, onions, peppers, chili, and other veggies. I'm not sure any particular food is as essential as the fire, alcohol, and talking. The braii I attended last night even included family squabbling, which I really consider an indispensable feature of American BBQs.
MMM...doesn't that look appetizing?

Potjiekos (sounds similar to `POY-key')
This is an Afrikaner dish. Place your huge cast-iron pot on the fire, heat some oil, and cook your meat. Add...well, everything. I ate this once and I think we had rabbit, chicken, pumpkin, corn... I don't remember the rest. This is one of those everything-in-the-pot meals that just tastes heavenly and helps soak up all the beer you were drinking while standing around the fire for 4 hours.
Good things are happening inside this pot. I mean potjie.

Biltong
Really, it's just jerky. But it's possible it's made from an animal you have never seen, nevermind eaten. I've had kudu biltong but you can also get ostrich, chicken, fish, and apparently even shark. Another difference is you will come across biltong in South Africa in places you'll never see American jerky. The biltong, feta and butternut squash pizza at Upper Deck in Kampesrus is actually delicious!
Here's a common biltong display in airports, tourism centres, and other shops.


Mopane Worms
This one I haven't tried yet. My housemate, Susan, generously purchased a plastic bag full of these guys so she could prepare them for me to try. We haven't gotten around to it yet, and somehow I've forgotten to mention it. Wikipedia says they are considered a delicacy in some places and they have a meaty taste. All I know is they look spiky and crunchy and not at all pleasant to chew. But what do I know?


Bonus: Absolutely stupid video about a braii. I think the fact they're using charcoal is lame. You'll recognize the satire on male behavior around the grill but you'll also get to hear some SA accents and jargon.

Caster Semenya, continued

The New York Times puts it better than I did.

Lions on the loose

As I've mentioned, my house sits on a farm within Wits Rural Facility, a large gated area where many scientists, doctors and students stay while working at the hospital, Wits, or Kruger Park. We are surrounded by private game reserves that have some noisy lions that have kept me awake at night.

Two nights ago I woke up to actual roaring (rather than the sort of lion humming noises I'm used to) that sounded extremely close to my bedroom. Then Friday morning I received an SMS:

2 lions seen at Caravilla this am so don't walk around and if you have staff give them lifts.

Caravilla is the other side of WRF, maybe 1km away from my house. Susan and I nervously laughed about whether the lions knew the shortcut to our house from Caravilla, then we went on our way to work. As we rolled down the hill toward the gate we were shocked to see three lions, two white and a third tawny. These specific lions are mentioned here.

After a bit of stuttering---"Oh my god, oh my god, oh my god" from me, "Li-li-lions!" from Susan---I was able to reach for my camera and indiscriminately click away. They kept walking down the road, and after a moment of hesitation I decided we should follow. As we got closer all three walked into the bush to the side of the road. Two were further ahead and disappeared quickly, but one wasn't scared and eyed us as we pulled up next to her.

I was only able to get two photos where you can see her. The second one shows the side mirror so you can see how close we were.




And the close-up...


Once this lioness blended into the bush we sped down the road to alert the guards.

I saw a male lion in Kruger Park a couple months ago, but he was very distant and didn't move. Looking at these three walking down the road was awesome in the original sense of the word. They have such obvious power. I wish I had video of them walking. It was the most thrilling and scary moment of my time in South Africa.

The people sent to capture the lions found a waterbuck the lions had killed and dragged it to the road to bait them. The plan worked and all three are back in captivity. Hopefully the holes in the fence have been patched...

Sex vs. gender in the news

Really interesting controversy about an 18-year old South African track star whose gender is being questioned. Why biological sex is different from gender is something you learn in anthropology and sociology courses but is generally not discussed in ordinary conversations. Human variation is too broad for the distinct categories we use in everyday life, like man or woman, straight or gay, black or white.

Is this person a woman? Yes, I think so, because she identifies as a woman, regardless of what sort of plumbing she has. Is she categorically, biologically female? I don't know. But it's important to recognize that everyone she competes against has different levels of estrogen and testosterone, different secondary sex characteristics, and maybe even different primary sex characteristics. Maybe this woman is at the masculine end of the spectrum of female variation. But where is the line drawn? When a case like this comes up, it complicates our common sense understanding of sex and gender.

UPDATE: From the BBC, a blog post about the athlete and the reaction here and the ANC's response here.

Where the antelope play

I see impala just about every day. Yesterday I finally captured some for you in this terribly grainy video:

They are known as "McDonalds" because of the not-so-golden arches on their rears that look just like the M.

There's also a huge male waterbuck that seems to have taken residence behind my house. I couldn't get a picture of him before he ran off, but he looks a lot like this:

Seminar

Today I'm giving a seminar about the project. Let's see if this nifty document uploader thingy will work...

Agincourt Seminar 2009-08-13

Cool! It worked, although I couldn't edit the HTML to default to slide mode, so you can choose that from the menu: More -> View Mode -> Slide Mode. Use the full screen toggle button at the top right of the window if it is too small.

This presentation is for Wits' Health Systems Development Unit (HSDU) in Acornhoek. I created this presentation using LaTeX class Beamer with my current favorite theme, Copenhagen. I attached the questionnaire at the end in case any audience members ask to see it after my talk. During the slide with the photo I will talk about the field operations including field workers, villages and households.

Diplomacy in action

So maybe there wasn't public dancing upon my arrival in South Africa. But no one made me move heavy stones, either.

Visit msnbc.com for Breaking News, World News, and News about the Economy

Race and Sport in South Africa

This profile of Matthew Booth, a center-half for the SA national team and its only white player, has some interesting aspects. Booth describes black schools playing soccer on "dirt and scrubland," I saw exactly that last Friday. The guys I was talking to asked if American school teams play in stadiums. Not exactly, but compared to the dirt field they were using, many of our school facilities do seem like stadiums.

For news about Africa in general I recommend the BBC page: http://news.bbc.co.uk/2/hi/africa/default.stm.

Work

I haven't written about the project in a long time so for the sake of bloggy posterity, here's the deal.

At the end of June I projected a large shortfall in the number of interviews that could be completed by the end of August, so I made two suggestions to the PI. First we should offer to pay the field teams for leave not taken. This would prevent a situation where two entire days each month are lost to time off. Of course individuals can still take a day if they want but the idea was maximize time in the field. Second, I finagled four new fieldworkers to add to the original 12. New fieldworkers means more transportation was needed, so we added a rental car in addition to the two large vans we already had. All this was quite an investment but done within budget and the new folks started mid-June. That's going fine.

With 16 fieldworkers we started pulling in a lot more interviews per day and it looks like we can make the deadline. But not so fast... did my projections count the number of days correctly? Turns out, not quite, because of the way payment works here. Allow me to explain.

People get paid once per month in these parts. People in very rural areas (like my field teams) don't have banks in their villages. That means that come pay day, everyone goes to Hazyview or Thulamahashe or Bushbuckridge or another local city to withdraw some money. Month-end pay day is traditionally the day you take off work so you can go to the city. It's just the way it is here. Everyone expects that they won't have to work the last Friday of the month.

Now, I tried to communicate with the teams that they will be paid for every day through August 31, and if they have leave leftover at the end they will be paid for it. But this concept was very hard to make clear, in part because their contracts stipulate that the two days off are (1) a floating day to be taken when needed and (2) you guessed it- month-end. So there was quite a bit of confusion coming into last Friday. Turned out that everyone wanted the day off. No one wanted to earn an entire day's pay as a bonus to put off their trip to the city until Saturday.

I guess it's easier to empathize with this decision when you imagine that you are only paid once a month, you earn very little money, and you probably have a lot of family asking for a piece of your paycheck. Add to that the fact that after weeks without money you really just need to blow off a little steam and I think it's not hard to understand why the teams didn't want to work.

The down side of course is that I am left 250 interviews short for last week and the deficit is not closing as fast as it should be. We have now completed about 7,000 out of 12,776 9 weeks into a 13-week project. So we're adding an extra four days to the field operations to give us a fifth week. We should average 1200 per week, except there's a holiday on August 9 and of course people will probably want to leave on the last Friday in August, so... we'll see.

And there's a little peek at some of the work I do.

Observation of the moment

Rain is really loud when you have a metal roof.

Circumcision as cultural practice

Procrastination, it turns out, pushes its way into your fun activities like blogging just as much it does reading for class or writing a thank you note.

Today I saw the end of an Initiation School in Acornhoek. According to Shangaan tradition, boys around the age of ten must go out in the bush for 3 months. During that time they can be visited by their fathers but not their mothers. I saw a group coming out of the bush a few weeks ago, rough blankets over their shoulders, looking exhausted. I imagine they sleep and eat outdoors. During this process they become men, ritualized through circumcision near the end of the journey. This practice is somewhat controversial. I heard on the radio the other day that 50 boys have died in the Eastern Cape due to botched circumcisions this year. Some of the traditional leaders don't keep up with the medical journals, I take it. So the boys get circumcised -- no anasthesia -- and then they are official men. They come home in a parade along the road waving long sticks and beating drums. Their mothers welcome them and there is, of course, food, drink and dancing long into the night. What i witnessed today was the beginning of that celebration.

UPDATE: I forgot to mention that I witnessed this parade while waiting to get my car washed (R30 for interior and exterior, or less than $4) and talking to a local guy sitting next to me. We were talking about cultural rituals like circumcision and he asked how it was done in the U.S. I informed him that not everyone was circumcised (he disagreed with that idea) but that those that were had it done when they were babies, usually one week old. This horrified the guy. "How do they even hold the flesh?" he asked. "I don't know," I replied truthfully. The guy had quite a visceral reaction to the idea of circumcising a baby.

Bringing the science (with lots of links)

My dissertation advisor, Sam Clark, is the person who got me involved in this project and got me to Africa. He has a long relationship to this institution where my study is being conducted. Last week he visited for a few weeks for meetings and he and I got to talk about my dissertation.

Sam and I had spoken briefly about this idea before I left and I found it exciting. The idea is sort of at an intersection of demography, sociology, and health. When Sam arrived here we talked more about it and how it could work. Below are my notes from the meeting, summarizing three papers I would write and put together as a dissertation.

*************************************
Background: Agincourt in the observed period provides a complex setting for evaluating transition theories. Longitudinal data allow causal analysis. We expect that the complex changes in economy/development, health care provision, epidemiology, social inequality and government policies will make it a difficult test case for transitions theories and could contribute to revisions of classical theoretical frameworks.

1. Describe demographic transition in Agincourt 1993-2008. Compare causes, timing, and effects of Agincourt transitions to classic DTT. Are trends in age-specific fertility and mortality rates statistically identifiable?
   
   
2. Describe changing epidemiology of Agincourt 1993-2008. Evaluate usefulness of epi. transition theory in this setting where it appears noncommunicable diseases are gaining traction at same time there is are epidemics of communicable diseases like HIV and TB. Relate all-cause mortality levels and trends to cause-specific profiles of mortality.
   
   
3. Create a migration typology using model-based clustering as the method for identifying which HHs will migrate in which ways. Show clusters by SES rank. SES index can be improved, probably through principal components analysis, to more closely identify livelihood strategies common to SES categories. Do identified clusters predict HH composition? Migration history? SES? Geographic location?
   

Yesterday a friend and I drove to the grocery store only to find it closed at 3:00 on Sunday, so on the journey back we travelled out of our way to go to a pizza place. The pizza place was closed too, but across the street was this friendly neighborhood rhinoceros. He was in a fenced enclosure chewing on grass like just any other domesticated animal. We joked that his owner would come out with a leash when it was time to go in.

I'm sure the rhino isn't that domesticated, but I'm not sure how to explain what he was doing there. I also can't imagine he gets enough calories from the little dried grass on the ground this winter. Here's the evidence...




Plus a picture showing the mountains in the background.




Also on this trip I saw many waterbuck, antelope, warthogs, hornbills and baboons. Finding those animals has become routine so I don't write about it much.

Some thoughts

These are some of the things I find myself pondering while I stay in South Africa.

• Is it possible to get sick from breathing too much dust and dirt? What about long-term exposure? You can't walk near a road for more than a couple minutes without inhaling at least one dusty cloud. My hair changed from clean and smooth to chunky and sticky from standing outside for 5 minutes.
  
• Why does it seem like every older lady walks with the same hobbling limp? Is it related to the way they sweep the ground or retrieve water--bent at the hips at a perfect 90 degree angle?
• When did the local language start using English words? Numbers, months, and certain words are spoken in English. Today I overheard a conversation about someone's education that was 95% Shangaan with "graduate" and "registration" thrown in.
• How long will it take to eliminate racism (or get close to eliminating racism) in this country compared to the U.S.? We desegregated schools and workplaces, made voting a positive right, and other measures beginning in the 1950s and 1960s. This was followed by decades of institutional racism (housing market, school funding, etc.), affirmative action, race riots and many other events and processes that leave us wherever it is we are today. South Africa only ended apartheid in 1994. The majority of the population here lived as de jure second class citizens for most of their lives. It seems that amazing progress has been made, but when will South Africa become more equal?
• How long will it take to fully develop this country (already the most developed in sub-Saharan Africa)? In some ways it seems so close but in other ways it seems that it will never come.
  
• When will Nando's bring peri peri chicken to Seattle? Or do I have to visit DC to get it?
  

More pictures from the shuttle