Day 7: In Which the Lack of Sleep Catches Up

Saturday 14 Aug

Though we really put the pedal to the imaging metal Friday, we still had a literal pile of mosquitos to deal with. Also, I had stayed up very late Friday night. We’ve been working some long days – from 6:30 AM until 10 or 11 at night. On top of that, I’ve been doing some other work (mostly writing) into the wee hours of the morning. Waking up on this morning was especially hard for me – I woke up to knocking and a request through my door for the microscopes I had stashed away for the night, but I’ve been enjoying living the free life here in Uganda, so I've been sleeping in the nude! I know, TMI, I’m sorry. Anyway, I woke up in that state and had another ridiculous moment of becoming partially entangled in my mosquito net in my attempt to get out of bed and then struggling bleary-eyed to find something to put on so I could hand over the microscopes. While booting up my brain the hurdle of my TSA suitcase lock seemed insurmountable, and I only had dirty clothes lying around, which I somehow thought were not a good plan. With half-conscious rashness I decided my best option was to try to hand off the tangle of USB microscopes without clothes. I hid behind the door and reached my arm through the crack, dangling the scopes from their cords. I was expecting someone to take the goods immediately, but no one did. I shook them a little so that they would clank together, thinking maybe the person was on their phone or something (that was literally what I thought) and hadn’t noticed this mystery arm silently delivering a black octopus of cords. After a few seconds of continuing to hold my arm out, I tried to speak to whoever it was who had woken me up. Finally, I realized that they in the time it had taken me to untangle myself from the net and decide that a naked handoff was the right thing to do, they must have left thinking I was not there. I get plenty of opportunities to laugh at myself.

I put on some clothes and headed up to the “conference room” (seems much more like a dance hall to me…) and immediately started imaging, trying to push through the fatigue by supplementing with some tunes. After I got into the zone, I was starting to feel pretty good about myself and thought I had overcome my tiredness. Then Dr. Acharya came and sat next to me to discuss our plans for the day, and one of the first things he said to me was “Are you alright? You look…different than you usually do.” I guess I wasn’t as good at hiding it as I thought, bless me.

When you have lots of mosquitos together, their legs get tangled up and they form a little bug ball. They’re a real pain to pull apart! You have to try to grab the legs of only one mosquito when you pick up the ball, and then you have to shake and shake and hope that when the mass of mosquitos eventually does break loose from the winner in your forceps it lands where you want it to. I got pretty good at that in the morning while working on the imaging. Tired as my body apparently looked, I was deep in the work zone, digging into to the albums I used to swirl my test tubes to in my intro chem course lab. I was grooving. The rest of the team was, too. It was clear that the lack of fresh mosquitos in our database was largely resolved now, and it was time to move back to our original work: studying how our technology might fit into the workflow of the people with boots on the ground.

We went to a Village Health Center to formally meet/interview with some VHTs. Don’t know whether I’ve mentioned this, but I am the luckiest person I know. Sounds too good to be true, right? But it really is true, I have luck like you wouldn’t believe and this adventure has been full of it (yes, luck is a vulgar term, but I don’t have a better way of describing it in this setting). One example is Dr. Acharya and I ending up in the only district (Soroti) in Uganda that participated in a pilot study for a new vector surveillance workflow. Some of the VHTs here received special training in mosquito identification using a magnifying glass, an almost perfect analog for our system. The pilot was discontinued in 2019 for political reasons, but having VHTs with vector surveillance experience made their feedback on our technology 10x more valuable than it would have been otherwise.

Oh my goodness, I haven’t explained anything about this. The point of the technology we’re developing isn’t just to make VCOs faster at their jobs. The way the Ugandan system and most systems are structured, vector surveillance is performed by well-trained experts. This is great for accuracy, but it really hurts the spatial resolution of the sampling. For example, in Uganda, a single VCO is in charge of an entire district (like a state). They will visit only ~3 sentinel sites within their entire district. While they choose these sentinel sites carefully to try to best represent surrounding areas, the reality is that the data backing up the intervention decisions made by head honchos is really insufficient. There are very few VCOs, such that even if they had an overflowing budget they could never properly cover their district. And so, our technology. We are shifting the task of vector surveillance to less skilled but better-distributed VHTs, at a very low cost and with an increase in speed. The data that can be collected using our system will provide a thorough and comprehensive picture of the mosquito goings-on in the country. All of this will drive better decision making at the head honcho level, which will ultimately save lives and reduce suffering. This shift has global vector-driven disease implications!

We gave a little intro talk and a demo, and then we engaged directly with them in a dialogue about where our design succeeded, where it failed, and most importantly how we might improve it to make it more useful for them. It was a pleasure to hear their thoughts in the highly intelligent yet understated Ugandan style. As we got deeper into their perspectives, we began to co-create new designs which were better than anything we could have come up with in 5 years in the Design Studio in Baltimore. This really highlighted for me the importance of getting right in with end users in the design process – there really is no other way to do it right.

Another highlight of this talk was hearing the VCOs, some of whom had accompanied us, come in at the end with motivational speeches for these guys about the importance of the VHT role in the community. The VCOs are also great leaders.

On the way back to our lodging I started to doze off – I was tired! The lack of sleep had finally caught up to me. I was able to pull myself out of it, but when we arrived I went to my room for a quick rest before returning to imaging. A few minutes later I heard another knock on my door, this time it was Dr. Acharya. I told him I was looking at my phone, to which he politely told me he would come back later. After feeling my strength return a bit, I headed back up and began imaging. He met me in the dance hall and told me that he had noticed me dozing off in the van and had prepared for me a plate of good things to help restore my energy. He brought me downstairs and sat with me on the porch in the courtyard while I ate from his private supply of figs, dates, sprouts, and nuts on a carefully arranged plate. We also took tea together, a practice I am becoming quite fond of. This was a perfect kindness that touched my heart. I like Dr. Acharya.

We then interviewed the VCOs in a formal way, similar to our time earlier in the day with the VHCs. They gave us very insightful advice on both our design and its implementation at a system level. These guys are awesome!

Dinner – thus far I haven’t really written about the food here. It’s good! I came in with the expectation that between my parosmia Covid sequelae and the likely school-of-hard-knocks education for my ignorant immune system, food would not be very good for me here. Quite the opposite! I have found that everything I have tried, which is everything I have had the opportunity to try other than raw fruits and vegetables, has been wonderful. In fact, I think that the spices are helping me to overcome the parosmia! Both the peas and the gram lentils with roti are particularly good!