Mhealth, Mtechnologies, Mexplainations… MT1?

I love Dr. Bennett’s blog, whitty, quick reads on new mtechnology/mhealth minutia.

Although not specifically aimed at one health problem, his main focus is on obesity research via mobile or computer technologies. Although knowing virtually nothing about mhealth technologies, his blog has offered up a wealth of information allowing me to dive head first into the pool. He mainly offers insight into the challenges that many mobile health technology apps face, and how to avoid them. But, he also gives other insights that are helpful for academics, such as tips on writing a R01 grant. Finally, he gives good background and insight on popular press items relating to technology, such as the FB algorithm “Year in Review” that has received some, well, negative reviews?

The rise of mtechnologies has also expanded T1 care options… I have vivid memories of astonishment as one of my beloved T1 camp counselors, talking about what it was to have T1 in the 1960s; boiling glass syringes for shots, and using “pee sticks” as affordable glucose meters were yet to be invented. [A cool entire history lesson of T1/T2 can be found here. ] Yet, as of 2014, it is possible to send data from your test meter to your iphone, and the new tslim pump design includes a touch screen. Additionally, the possibility of a bionic pancreas controlled via iphone commands has been postulated as a future direction of T1 care. The advancement of technology for treatment options and rise of information has completely transformed the experience of having T1 in a matter of years… and for those who are young and technologically literate, it works to our benefit. But what about individuals who are not as technologically advanced? Are the new technologies user-friendly enough to be accessible for older generations? And with the shortening of patient-provider time during medical checkups, is there the opportunity for those who are not in the tech know-how to catch up? And does the advancement in technology in the U.S. and other Western countries increase the gap in care opportunity and availability in middle or low income countries?

A resolution, despite being anti-NYE resolution

Based on my academic and travel schedule, the winter holiday has become a time of rest, relax and reflection – probably similar to many other people.

This year has been a busy but exciting one for me. I finished two projects in Kenya, traveled to several countries, came back to the US and spent some time in my beautiful hometown of Jackson, Wyoming, and then headed off for my first semester of graduate school at Duke University, in North Carolina.

But some areas of my life have stagnated, and this blog has been one of them… I struggle to find the write words to post. Who am I writing to? Who am I writing for? Does it even matter? Am I expressing my ideas well? Yes, angsty, but truthful, thoughts that often cross my mind when I think of this blog. So in line with the end of the year, it is time I challenge myself to simply write. The blank page with pulsing courser will no longer be my enemy, but will hopefully turn into a motivating symbol, pushing me onwards even if my mind feels completely blank. And with that, let 2015 come in!

Rules of Matrimony and the Place of Gender

Gender is a very interesting construct in Kenya. In my opinion, women here are generally stronger than the men, upholding children and family lives with or without a present father/husband figure. They find ways of providing food, shelter, and school fees, while not having the same vocational opportunities as their male counterparts. This isn’t to say that all Kenyan men are weak, but the emphasis of their time and roles is very different from women’s roles. Several days ago I was meeting with two businessmen who have become friends, one in his early thirties, the other in his late thirties. The older man, Steve, is married with children, but was in the process of seeking out an mpango wa kando (girlfriend). Polygamous tradition seems to have led to this “modern” mpango wa kando cultural norm, of married men taking girlfriends, wooing them through the exchange of money and gifts. In fact, newspaper reports lead me to believe that many university female students will look for an older successful business man to help them with school fees (while girls in the village look for boyfriends/will exchange sex to boys for the local snack
mandazis or some texting credit).

I’m slightly fascinated with sexuality and the implementation of sex as a commodity in this area, so of course, I proceeded to grill Steve about his desire for a girlfriend, his motivations, and his rationality on why it was acceptable. Steve has a “girlfriend” he is currently wooing–he has told her he has a wife, and explained his desire to keep things casual. The girl, who works for Emirates airline, spends some time in Kenya, some time in Dubai, and therefore also has limited time. I asked Steve if his wife knew, and he said of course he could not tell her–in fact, he had to go home and be “sweet” to her (have sex) as he was to go the next day to see the girlfriend for several days, and didn’t want suspicion. Based on numerous conversations during cooking,
washing, etc. with other Kenyan married women, I told him that the wives were often conscious of the affair, but as long as the husband kept providing for them, it was okay. He agreed, but insisted his wife didn’t know. I asked him why he was taking another woman, and he said that for several confidential reasons, his wife was no longer making him happy. However, as they have children, he does not want to upset his children’s lives, so he won’t divorce his wife. Being a person who pushes for equality, I asked Steve what would happen if the wife found out, and decided to take a boyfriend… this made Steve a bit upset, but he explained that if the wife was to take a boyfriend, she must go with the boyfriend. He then referred to the newly minted Kenyan law, legalizing polygamous marriage (to those who are not Christian, Hindu or entering into a religiously mandated monogamous marriage), asking
me if I had ever heard of a polyandrous clause. I hadn’t. That’s because one doesn’t exist. Therefore, while Steve can have  girlfriend, that on the off chance might lead to a second marriage, his wife can’t have a boyfriend, because polyandry is illegal.

While totally foreign to me (which he acknowledged), the rational is based on a history and culture of polygamy, and of gender inequality. Women are not equal to men in relationships, and this is demonstrated throughout other sectors. This is why women here (especially in the village) are generally okay if a husband wants a second wife, as long as he is still able to provide some financial assistance to the first wife and her children.  I’ve met many young men in this area who swear to only take one wife, as they came from families with absentee fathers, and watched their mothers suffer greatly to provide food and school fees for their children. In contrast, Steve came from a family with three wives, who his successful father cared for. The world has a long history of polygamy, especially when war eliminates a large percentage of a male population. And yet, looking at the modern world powers, very few “first world” countries exhibit large amounts of polygamous marriage. Perhaps when it comes to development of a
country, the equalizing of gender is an important step. If Kenya was to follow this rational, and work to equalize gender, men and women would be equal, resulting in a law allowing polyandry (highly unlikely) or the end of polygamy (much more likely). This makes me wonder… does the promotion of equality lead to the decline of “culture” and “tradition”? Can it be argued that “new” culture and tradition form (although, based on the definition of culture and tradition – with the basis being history and long term practice), is it even possible to form “modern culture”? Or does equality lead to a population that works to not have differences, where culture and tradition become obsolete?

Defeat via Gender?

I just finished reading an amazing book, The Places in Between, about an adventure taken by a young man through Afghanistan in 2002, right after the Taliban fell. He decides to follow the famous Emperor Babur’s footsteps, walking across Afghani terrain to Kabul. Weaving the tale with threads of personal anecdote, history and observations of another culture, Rory Stewart’s adventure held my attention captive. He tells of evenings sitting with men discussing local politics and religion; moments of possible danger, trying to understand the motives of individuals, what the best answer to a question would be given the region and religion; he tells of moments of loneliness, uncertainty, and ultimately triumph when he accomplishes his goal. I looked forward to sitting down to read a chapter during a quiet period, holding a cup of tea close, taking in each scene he portrayed, the emotions he felt, the physical difficulties he endured.


What made him successful? Firstly, Rory’s knowledge of the language, culture and religion was of great importance in his journey, enabling him to get out of several very dangerous situations. Secondly, he is generally in good health, although experiencing some sickness on the trip. Finally, he is a man. In an Islamic society, I highly doubt a single woman, no matter her nationality, would be able to take such a journey alone. At one village, Rory describes that the women had never left that village, not to even visit a neighboring one. A woman traveler therefore might be at constant danger from local men who believe it is wrong for a woman to walk alone. As Rory often slept in mosques or village leader’s houses, there might not be a place for her to sleep, as she might not be welcomed.


While reading his memoir, I felt a certain sadness, due to the fact that I don’t think it would be possible for me to complete a similar trip. I’ve had almost a year of travel and living in new cultures, but my travels have stayed within certain limits. I was never in a place where I couldn’t get food or water, or where my safety was continuously threatened, or where my gender put me at a larger disadvantage.

But there are two strikes against me completing a similar journey to Rory’s: the first, having T1 diabetes. This is a huge logistical challenge, requiring a lot of attention and dedication, but can be overcome. But the second challenge, that of being female, is much more difficult to more beyond. As a woman, I am unsure I would be able to walk alone for hundreds of miles across an Asian, Middle Eastern or African state without putting myself in extreme danger, simply due to my gender.


Working so hard to pursue the dreams that motivate me, I have been able to overcome the challenges of Type 1 Diabetes in moving to Kenya, traveling solo in different countries and cultures, and learning about my body and limits. So how can something as basic as gender be the Achilles heel of adventures?



Return to Kakamega, Kenya

With new adventures come new updates! I’m writing to you from Kakamega, Kenya (yes, the place that I left only a mere 3 months ago). Amidst a flurry of washing, and packing, a friend and local business owner asked me if I would consider coming back to help with a social project the company had been struggling to get going. Eco2librium is in the business of reducing carbon emissions through reforestation and low emission stove installation around Kakamega Forest. A couple years ago, an American visited Eco2librium and was inspired by the company’s idea—an ecological change supported through involving the social sector. The stoves that are installed are produced by women’s groups made up of individuals with very low income, education, and options. Almost all of these women have children, but many have lost their husbands due to HIV or other illness, or have absentee husbands who spend a lot of time being drunk on local brew and sleeping with other women. The welfare, nutrition, and education of the children therefore falls to the mothers, who generally don’t have many ways of making money—hence why they join local women’s groups what are aimed at income generating projects.


One incoming generating project is producing low-emission, clay stoves. The women’s groups produce the stoves from local materials, fire them, and then sell the stoves to Eco2librium and other companies doing similar work. Eco2librium sells the stoves (at a very subsidized cost) to local families around the Kakamega Forest area. Before buying these stoves, most families use a 3-stone cooking model—literally 3 large stones placed closely together, with a pot balanced on top. This means that when the families burn wood to cook their food, a lot of heat is lost in the gaps between the stones. The low-emission stoves direct the heat upwards, making cooking faster, and cutting the amount of firewood needed by almost 70%. This allows families to spend less time cooking, and less money or time gathering firewood, and can use that time for other things, like tending the farm, or looking after children.


When Eco2librium first started this project, they bought these liners from one women’s group, called the Volanji Group. As time passed and word spread about this business venture, other women’s groups have come forward wanting to become involved. One big challenge: to have the funds to buy stove molds and build a kiln to fire the stoves. This is what the American who visited found when she visited in 2011, the need for funds. Going back to the US, she managed to raise $10,000 USD to start an initiative of supplying loans to women’s groups so that they can invest in income generating activities. The concept behind the loans is that the women’s groups can borrow the first loan (of ksh100,000- to cover molds and the kiln construction) with no interest, and upon paying back this loan, can borrow again, at a higher amount. The first two loans given are intended to be interest free, with any following loans having some interest attached. The first loan is to be used for stove construction purposes, with future loans having more flexibility in use.


My job is to get this project (which has been dragging along for a year and a half) up and running- to conceptualize, finish drafting and finalize procedure and application forms, work with several groups to get them through the process, and leave a clear procedure behind for Eco2librium staff to follow for groups that are interested in the future. Yes, a big project, but one that is engaging and interesting, and that will hopefully be highly rewarding.


For those of you wondering about the children’s home… no, I haven’t forgotten about the girls! It is currently a school holiday, and I have been able to visit several of them visiting aunties or uncles, and will head to the home tomorrow to see the rest! Since coming back I’ve heard that the John Deere Project I worked on last time I was here (bringing several officials and other staff from South Africa to the children’s home farm to do a project) has actualized, and as of next week, the JD group will be here building two large green houses, where the children’s home staff can grow vegetables, such as tomatoes, for eating and selling! A huge success for Vumilia!

La Dolce Vita… a Roma.

Rome for me is kind of like Santa Clause- a shiny, exciting, creature, that isn’t fully real, but that is so adhered to, a culture surrounds it. Rome is a great city to be in for seeing beauty—the Trevi Fountain, the Vatician, the Coliseum. Due to the luxury, there isn’t much evidence that a harsher life exists within and around the city. Taking the train from the airport to Termini Station, there are multiple areas where I saw mattresses rolled up in cardboard, extra clothing in bags, some cooking pots, and sometimes even small shacks made from plastic sheeting. In 2005, the United Nations Commission on Human Rights estimated 7,000 of the 17,000 homeless in Italy to reside in Rome (what was said to be an inadequate number, due to difficulty obtaining realistic estimates). About half live in the historic area of the city, pan handling, while the other half live in areas around the city, one of which, Ostiense, you can see from the train ride. I found myself questioning a bit why I was taking this travel trip while in Rome, why I was spending the money to see the luxury, when I am so aware of poverty after living for 5 months in rural Kenya. Many people say re-integration is difficult—but it’s an odd idea in itself, that you have to have experience emotional, mental and social movement, when all along you were living with other human beings, who exhibit similar needs of food, water, shelter and care, regardless of where in the world you are. So here I sit, questioning being in the café I am in, which has beautiful tiled floors, shiny glass cases, extraneous overpriced candies at the register. In a way, it is more comfortable to be in the shiny, pretty, Rome… and in a way, it causes me to feel uncomfortable, knowing another version of life lives synonymously alongside the Trevi Fountain, a life that is much harder, colder, and less comfortable.

Weighing T1

Backpacking around Europe, Asia, New Zealand, Latin America, Australia, or the US is an amazing adventure, rocked with incredible experiences, questionable moments, and of course, the excitement of seeing new things, meeting new and different people, and the ability to grow and learn from these experiences. I have read a lot of blogs that talk about what and how to pack into your pack, in order to have enough stuff (i.e. underwear), the right items (like the REI fast dry towel), and not too many items weighing you down (do you really need to pack a second pair of tennis shoes?)! These girls (and a few boys) have the perfect-pack down; their bag is beautifully packed, perfectly minimizing clothing, shoes, toiletries, cameras, journals, and a yoga pad into a 40-liter backpack.


I would love to tell you that I too carry a 40-liter pack only weighing 15kg… but I don’t. I carry a 60-liter pack, weighing closer to 22kg. Why? Because months worth of pump and testing supplies takes up a lot of room, and weight. When having to carry them on your back for miles through airports, train stations, and twisting streets in search of a hostel, I’ve learned that things like test strips are surprisingly heavy! But, of course, a little extra struggling is worth the opportunity, and even gives me a bit of extra cardio exercise each day (there is always a silver lining). But here is how I pack my T1 supplies, in order to minimize the space it takes up, so I too can pack minimize my clothing, shoes, toiletries, cameras, journals, and my diabetes supplies into my 60-liter pack.


1. Take all pump sets, reservoirs, test strips out of boxes, and tightly repackage into 1-liter Ziploc bags. I get about 16 sets per bag, and can get up to 50 reservoirs into a bag. (The edges of pump site packages can rip through thin plastic, so try to find thicker plastic re-sealable bags).

2. When initially flying out of the US to Kenya in fall 2013, I left the insulin vials in the prepackaged box, with a sticker of the prescription on each box. Once I had arrived, I unpacked the insulin vials into my Frio-packs to keep them cool (as I have not had a fridge to store the insulin in). I have since traveled with all my insulin/diabetes supplies, and have not had a problem with the vials in the frio-pack. I simply carry a letter from my doctor in case any TSA official stops me and asks me about this.

3. In my big pack, at the very top, I stick the same letter from my doctor, saying I’m allowed to be traveling with needles, insulin, test strips etc. I put it in face up, so the very first thing a TSA official searching the pack will see is this letter, explaining why I am carrying 200 needles and other drug paraphernalia.

4. I prefer to carry all insulin and test strips in my carry on while traveling… in case my pack gets lost in transit, I can usually find a way to get needles in the country I am in, either in a pharmacy, or a hospital. Insulin and test strips are different, as some countries only have some brands, and usually, they are very expensive to buy in the places I’ve been and asked (Kenya, Italy, France). I feel more comfortable knowing I have the insulin and strips on me, as I have more ability to keep track of a carry on.

5. If you are nervous about supplies getting stolen while staying in a hostel, book hostels that specifically have lockers, and carry your own padlock. This way, you can lock up your supplies, and feel comfortable while you are traveling around a city, enjoying the traveling more. And bringing your own padlock means you don’t have to rent one, saving yourself 2 euro!

6. Buy local, cheaper, snacks for lows. I keep a small baggie of glucose tabs in my day pack in case I ever get into a jam (which is also my carry on), but I save these for emergencies, such as having a low while trying to go through a very long airport security line, and not having any juice or ability to buy anything without getting out of line and starting the 2 hour wait all over again.



Happy T1 Travels!

Taking fluids in Kenya

Dehydration is a major threat during hot periods for people with T1, and can result in prolonged high blood sugar and possible DKA!

It’s gotten very hot here in Kenya- January through March is the dry seasons, and the hot sun makes the temperatures sore! If not taking enough fluids, the intense heat can cause dehydration.

A couple weeks ago, I fell into this pit- my blood sugars were high for several days, my insulin didn’t seem like it was working, I was feeling sick. Luckily, in Kenya, you can go to a pharmacy and buy bags of saline, tubes and IV insertion sets. My clinical-officer friend gave me the IV, hooked me up with a liter of intravenous fluid, and within the hour my blood sugars started to come down!

Lesson of the week: water is essential (it makes up the majority of our cells), and we have to remember to respect the fluid balance!

“It is better to have HIV, than to have cancer”.

This statement was made by Akinyi, the mother who lives with her 7-year-old son on the compound with me and looks after the area. We were sitting in the kitchen, her in front of the wood-burning cooking stove stirring milk tea, me sitting on the floor that had been smeared with cow dung and clay a few days prior. We sit most days and talk, becoming more frank as our comfort with each other increases. This statement, however, took me by surprise. She explained her reasoning for saying this: in Kenya, ARVs are relatively easy to get, as NGOs and rich Western countries have flooded clinics and hospitals with either free, or very inexpensive forms. But as HIV becomes less of a death threat, and more of a chronic illness, other diseases are starting to be identified as life-threatening… cancer is among them. I saw an article a few weeks back in one of the Kenyan national newspapers about breast cancer’s large impact in Kenya. But I didn’t think much of it, as cancer is a problem most everywhere. But as Akinyi continued to tell me, there isn’t much equipment or drug supply to treat cancer, making it inaccessible to the vast majority of Kenyans, rich or poor. In Kenya, if you have cancer, you go back to your house and lay and rest until you pass… cancer literally means death. I think back over the weeks I’ve been here, and realize I’ve been seeing it, assuming people were getting treatment… most recently, a man with a hugely distended, perfectly spherical stomach, coming out of the general hospital. The longer I live here, and the more I see, I believe more strongly that health care isn’t simply a universal human right, it is a privilege, and one that many don’t have. Universally, human bodies falter, fail and are in need of repair to continue life… and this care isn’t available. How do we lower the cost of health care universally? I read an article recently in the New England Journal of Medicine discussing the cost versus need of HPV vaccination in developing countries… in the US, this cost is around $360, far above what most families in rural Kenya earn in 3 months. And yet, cervical cancer is the second most deadly cancer for women, regardless of country or region.

There are far more health issues in Kenya than cancer and HIV, and it seems that despite the effort put in so far, there is so much still that is totally wrong… structurally, we are flawed. And I feel incredible guilt in having the ability of having access to such a higher level of health care in a mere 26 hours of flying time. It is very different growing up hearing that life isn’t fair, and actually seeing how unfair it is… perhaps this is naivety why should one life have that much more opportunity than another?

Knowing that You’re Plugged In…

Last night, beneath my blanket, under a mosquito net, I tried to sleep… and although it was like every other night since I got my pump in 2002, I was particularly aware that I was connected to it last night… every turn and shift made me alert to the fact that next to me lay a small mechanical box keeping me alive!!


Sitting at the table this morning drinking milk tea (a Kenyan staple), I wonder what caused my hypersensitivity… my pump site wasn’t causing any discomfort, and while I got tangled a little bit, that’s kind of normal when turning over in sleep… and yet, the entire 7 hours of semi-sleep, I consciously knew I was attached. Hmmm, metaphorically, maybe this means I’m having an issue with always having to be attached via cord to a lifeline… and maybe these musings are better for later in the day, once I’ve gotten more caffeine… anyone with a psychoanalysis of this predicament, I am open to your interpretation.