Day 4: Field work near Soroti

Wednesday, August 11, 2021

Surprise! It’s day 3 (I think?) and I’m not sick yet. I definitely thought I would be worshipping at the porcelain throne by now. I haven’t taken major food risks, but I haven’t been too careful either. And is jet lag even a real thing? I feel very fortunate to feel so good right now.

Today we met up with the VCO team and hurried over to the local District Health Office to check in with their leadership and get some input on our technology. Oh, our technology? It’s a computer vision algorithm that uses a cell phone camera combined with a special lens and lighting setup to distinguish field-caught mosquito species from one another. It’s the result of 3 consecutive CBID teams’ efforts and is the first of its kind. It can distinguish between 66 important species, and that number will only continue to grow. It can also tell you if it’s never seen anything like this before, which is no small feat in the machine learning world. This innovation allows the difficult task of mosquito identification that normally requires years of training and expensive microscopes to be performed by anyone who can operate a smart phone. It empowers health workers in the most remote village of Africa to reduce their community’s exposure to mosquito-borne disease. It’s really cool!

Anyway, we had a brief meeting with the DHO. Guess what? They’re excited about this too! It seems that everyone we interact with is very excited about the potential of such a system. It’s up to our Makerere/Hopkins team now to make that a reality!

We then had an in-depth meeting with the VCOs. They talked us through their process, from catch through identification. We asked many, many questions in an attempt to understand how we can better design the technology to fit their needs. We discovered some important issues with the current design and discussed how they might be mitigated. Of all of our meetings thus far, this was probably the most informative to our engineering efforts. I have pages of notes from our trips down various mosquito rabbit holes (if that’s a thing).

Also, as another aside, I really enjoy Ugandans. These VCOs are people that have no reason to be good to us other than the goodness of their hearts, and yet they treat us with such kindness. I like the way they speak slowly and thoughtfully. Dr. Acharya and I were discussing how they are always good listeners and when they do speak, what they share has been carefully considered. This communication style makes me strain to listen whenever something is said, because I know it’s well thought out. They are gentle by nature, which is especially clear in the apparent tumult of the road where they regularly yield to each other. It’s a different feeling than home, in the best of ways. Oh, and they are hilarious. The jokes that I do catch are whip-smart and so quick that I have to do a mental double take before I decide whether it’s ok for me to laugh of not. And that’s all I have to say about that.

After a nice lunch of many Ugandan foods that I can neither pronounce nor spell, we met with Winnie and Joselyn. We discussed logistical things, but we also discussed the position of the VCOs in relation the advent of our technology. In effect, our app replaces much of their day-to-day efforts. We considered whether we would be taking their livelihood from them by teaching a computer to do mosquito identification. How do we make this innovation something that leverages their training and experience? We came to the conclusion that their knowledge is actually even more valuable at a systems level. If the local Village Health Teams can ID the mosquitos, the VCOs can run the show for their entire district. In fact, shifting the tasks associated with capture and ID of these vectors and leaving the more cerebral challenge of data analysis and intervention management to the VCOs directly increases the value they can contribute to their community. It’s a win all around.

Finally, we left for the field to set our traps! We drove ~30 minutes from our lodging to a small Ugandan village called Madera.

This was an experience that I really can’t convey here. It built me and broke me in too many ways to tell, especially to the whole wide world. I will say a few things though.

It’s real. I made my way out of our van (I sit in the very back with the cool kids) and started following the team down a dirt single track. The sun was bright, which made all of the green things glow. We closed in on a stand of trees and I saw the huts. They are mud huts, the kind you see on Discovery Channel and about which you think “Discovery Channel always likes to make the world seem more exotic than it is. They shoot this rare stuff to tickle brains, not to represent how things really are.” Well, In Uganda, that’s how things really are. The Guy at the Ministry of Health told us that more than half the country lives in rural settings like this one. The huts really are made of earth bricks stacked about 5 feet high in a circle with thatch cones for roofs. They really are grouped in fours or fives around a central space. The furniture inside really does consist of only a bed on a woven mat on the dirt floor. This really is a way that many people live.

I loved it. The horizon was palms and sweet potato mounds and fruit trees. The temperature was just hot enough to make us sweat, but an intermittent breeze kissed our faces cool. When the children weren’t staring at the strange giant they were scampering and laughing and playing together. The goats made their funny goat sounds. In those moments I was very aware of the things this place was not missing – beauty, food from the earth, the joys of family and friendship, the satisfactions of creating and solving problems and helping things grow. I was also at least partially aware of some things that were missing – sofas, clocks, stairs, fancy college degrees (whoops, am I allowed to say that here?). I told Dr. Acharya then that being there was forcing me to rethink everything I had ever thought. What have I been doing this whole time? And why? Clearly there are difficulties here, but could that price be worth the simple goodness that these people enjoy on a daily basis?

We started setting up CDC light traps (look them up, if you’re into that) and Dr. Acharya taught me about the millennia-old evaporative cooling technology of their water containers. We looked at the art on the side of one of the huts together. A few minutes later, I was squatting down to observe a trap being placed inside one hut. A little boy, maybe just turning two, came to me and reached out his hand to pet my flaxen arm fur. Then he looked at me like he hadn’t believed that when he had reached out to touch me that his hand would actually make contact with something real. He put his palm against mine and, after looking at that, his eyes came back to mine and we had a moment of pure human connection. I won’t forget that.

Uganda addresses the health needs of its villages through Village Health Teams. These are residents who volunteer to help in their community with literally everything remotely health-related, including mosquito surveillance. Colloquially, these individuals are referred to as VHTs. The VHTs we interacted with in Madera were amazing. As I observed them working with us and interacting with their neighbors, I had the thought that I could tell they were the leaders in their community just by looking at them. Their faces beamed real love.

I could write a small book about what I saw in this village. I could write a larger one about the thoughts it seeded. I know I’ve been getting weird here - I’ll spare the blogosphere for now. We installed the remaining traps and returned to Soroti where I enjoyed a late dinner and another exciting shower before turning in. What is life?!