Don’t Put THAT in THERE!!!

On this wild and crazy day in Kenya, I am celebrating a few pieces of excitement in Rachel-world:

1. I officially got promotion and tenure at the university. (My great team in Kenya got me a surprise “Congrats, Prof. Vreeman” cake!)


2. My absolutely wonderful part-time research associate started full-time as my pediatric global research program manager. (This is probably the most life-changing.)


3. Don’t Put THAT in THERE! And 69 Other Myths Sex Myths Debunked was published today!!!!

Dont Put That in There

That’s right. Aaron Carroll and I are back with our third book debunking all those crazy things you still believe about your body. This time, focused on how all those things you think you know about sex that just might be completely wrong.

We go through the science exploring some common ideas like these:

Penis size matters.

Blonds have more fun.

You shouldn’t have sex before the big game.

Watching porn is a guy thing.

Only men have wet dreams.

Big feet, big hands, big…?

You’re going to break that boner.

Women don’t really want sex.

That hole does nothing for me.

There’s a 10 year difference in sexual peaks.

Women are wired for monogamy.

Don’t take your socks off!

Don’t swallow your cum!

We have already had some fun write-ups in places like the New York Post and Slate. And… The July issue of Cosmo should feature a bunch of our sex myths as well!

You should be able to buy a copy from any major bookseller (find all the links here) — and if you send me a photo of you and the book, I’ll bring you a special gift from Kenya!

You know you want to be a sexpert too…



All I need to conclude this lovely day is a US victory over Belgium tonight!

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Soccer Stories: Tony

soccer_river valley

Tony is 12, and soccer (football) is his favorite thing in the world.  He has been infected with HIV his entire life, and has been taking medicines for HIV over the last 4 years. The soccer sometimes causes problems with taking his medicines:

I was so bad with my meds.  I just didn’t remember.  It’s hard to remember when you are playing football like I am.  I love football.  I would miss meds because of not remembering when I was playing for hours every day.  I wasn’t trying to skip.  Sometimes my older sisters would try to remind me, but the way they tell me is not good.  I don’t want to do what they say.”

Because he missed too many of his medicines, HIV started to weaken Tony’s body. He developed a terrible pneumonia and had to be admitted to the hospital a few months ago.


We really thought Tony might do better with his medicines — and stay stronger — if he knew why he was taking them. Our team in the clinic worked with his one living parent to tell Tony that he was infected with HIV.  This was a slow process for Tony. At first, he did not want to believe that he had HIV.

When I got back from the hospital, I just wanted to say, “That never happened. I don’t have the disease.”  I was feeling better and thought it was some mistake. I think I was in some big shock. I wasn’t listening. I started to get sick again. I wasn’t playing football much and the kids were saying I was too weak for it.  They started talking about me. I didn’t like the meds but I started hating being sick. I wanted to forget I had HIV, but some of the kids were guessing and calling me names. They said I couldn’t play on their football team anymore. They make it hard for me to forget about this disease.”

As part of my research study figuring out how to disclose HIV status to children, we offer counseling for families and for children like Tony. We have a curriculum and special materials to guide families through this process of talking with children about HIV and helping children accept their diagnosis. We also offer support groups for adolescents once they know their status so that they have a place for ongoing support and discussion.

Tomorow, we are having a special discussion group with adolescents who have taken part in these groups so that my team can learn from the kids what types of resources and group activities would make the groups even better. We were supposed to meet in the clinic, but our compound is going to be on lockdown because of a planned protest in town that could become messy. But our kids were so eager to share that we didn’t want to cancel the group. Instead, they are going to come to our house and share their stories in the living room! Excited to host them — and hoping, of course, for peace and safety in town.

Our young football player, Tony, has benefited a lot from one of these groups. We want to make the groups available for more and more kids like Tony:

My counselor was saying there were other kids coming to the clinic like me.  There are times when they talk together at the clinic.  I go [to the group] and listen.  It helps me to remember that I am not the only one and we learn how to accept this disease.  It is still a bit hard, but I don’t skip meds.  I don’t want to get sick again.”

Most of all, I hope we will make it possible for kids like Tony to get back to doing what they love best – playing, being with friends, going to school, and growing into confident adults who can take care of themselves.

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Soccer Stories: Philip

Since I am immersed in World Cup excitement — along with most of the rest of the world — I thought I would share a few a few soccer stories from Kenya. For those of you who are not (shockingly) football fans, I figured this might help mitigate my endless enthusiasm about the Dutch (Oranje!!!!) and American teams and their great successes of late.

Philip can tell you a piece of his own story.

As part of a special project where children living on the streets here were given cameras to document parts of their daily life and then describe what the pictures meant to them, Philip took this photo of a street boy and his soccer ball from the garbage piles.


Here’s how Philip described what his photo meant to him:


Sasa. (Hi) My name is Philip Khalale and I am 15 years old. I have been on the streets for 7 months. My favourite activity is swimming. There are 6 in my family, and only I am on the street.

This is how we play football in the dirt and we can get hurt when playing. He found this ball in the garbage pit. Normally, we do not have a good ball to play with so you just put together polythene bags [plastic bags] to make a ball stable for playing. We use the garbage pit as the pitch.

I have a hard time thinking of a group that is more marginalized than children who live on the street. Forgotten. Neglected. Feared.

When you see a dirty boy clutching a bottle of glue and lying in the gutter in a city in the world’s poorest places, it is hard to know what to do. Often, you just want to walk quickly past. Knowing that 100 million children are living on the streets right now is impossible and sad beyond belief.

100 million boys and girls like Philip and his friends. Children — who love to play soccer even when they have to do so in the garbage pit.

Sometimes, the best thing that can happen in the face of great, big problems is to shine as bright a light as you can on them. The world’s orphaned and neglected children, the forgotten, the poorest of the poor – they really need that light.

One of the teams of researchers in our Kenya partnership studies issues involving street children, especially the risks they face from things like substance abuse. Our team published an analysis in the journal Addictions looking at substance use among street children around the world. The review makes it clear that substance use is incredibly common among these children, and they face all the risks that go along with using drugs while their bodies and brains are still developing.

In poor places, children often turn to things like glue to numb their hunger, cold, and the pain in their hearts. If you look at that photo that Philip took, the boy has one hand on the precious soccer ball they found in the trash and a bottle of glue in the other hand.

Substance use among street children is a complicated problem to try to solve, but shining a bright light on their needs — opening your eyes and not turning away and really remembering — this is a good place to start.

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Happy birthday, dear one

Today is the birthday of my dear double cousin.  When I think of her, I think of grace and strength and laughter. She is a wonder.


Thanks to having fathers who are brothers and mothers who are sisters (2 brothers married 2 sisters), we share enough genes to be sisters, and indeed she feels like my sister. My cousin was one of my very best friends through my growing up years, and she is still the person to whom I feel I can tell anything.  When my life has fallen apart, she is the one to whom I run.

Becky_Rachel_March 2014 Minn

As an added bonus, she has known me for my entire life. She was the person who advised me through every childhood crush. The person who would happily read silently with me — or talk until the wee hours of the night. The person with whom I most often laugh until the muscles in our stomach ache. She was also the person in the passenger seat when I accidentally drove our station wagon seriously off-road, ending in donuts that ruined a pristine golf course. When the irate golfers began to chase us, she was the one yelling “Faster, faster, drive into the woods!”


I’m the little one in the middle. My birthday cousin is on the right. Her older sister is like my sister too. LOVE.

Because we share all of the same extended family members – and because our parents were close – we share many of the same memories of childhood. The smell of dried banana chips reminds both of us of car sickness since they were the snack of many a long car trip. We know that our grandmother’s soup should be avoided at all costs. The mention of a not-to-be-described-bed-breaking incident makes both of us laugh uncontrollably.


She’s in curls on the left. Her older sister & my youngest brother in the middle. And me with my long braids (and a Vreeman family reunion shirt).

And when we think of Washington DC, we think of facing one of our greatest fears.

Our earliest memories of Washington DC are that of family vacation disaster.  This is what I remember: Sweltering heat in the middle of July and becoming exhausted and sick with heatstroke while waiting in line to go up in the Washington Monument. Staying all the while at a campground in the aforementioned sweltering heat with our large combined families. And then the water stopped working. Days without showers.  And my younger brother got terribly sick, with sores covering the inside of his mouth and throat. I recall very stressed out adults, and, in retrospect, I can imagine that the no-water, very-hot campground days with 7 children was not an idyllic family get-away.

But what we remember the most clearly was this: We were driving around the Mall in downtown DC, and, for extra fun, the engine in my uncle and aunt’s van caught fire. This was a old-school conversion van with the engine stuck between the driver’s and passenger’s seat. As the flames and smoke billowed from the front of the van, all of us kids had to quickly evacuate.

Our parents attempted to extinguish the fire with trusty thermoses of coffee (Dutch parents carry those in abundance) and the wailing fire engine sirens could be heard as the engines attempted to make their way through traffic.

But as my cousin and I stood on the sidewalk in the midst of this emergency scene, we had only panic for only one thing — our library books that we had been forced to abandon inside of the van.  WHAT IF THE LIBRARY BOOKS BURNED???

Two book-loving nerds, fearing the loss of books read and unread that did not belong to us. After all, what Midwestern librarian would believe that your library books were incinerated in a conversion van inferno in Washington DC? The revoking of our library cards would have been much, much worse than hot days without running water. It is a nightmare scenario that haunts us still.


And so, on this birthday in 2014, I wish you a day with many books, much laughter, and knowledge of all of the love that so many have for you! Happy birthday, dear one.

As a side note, I dedicated our forth-coming sex book to her…


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Rose sits down on the chair next to my clinic desk with her arms full of toddlers. Her 18-month-old twins, a boy and a girl, are determined to head in different directions in the clinic, and the mama struggles to rein them in.

To help Rose – and to make friends with my patient – I pick up the little girl, Elizabeth. Her short hair has been carefully twisted into tiny, 1-inch braids all over her head. She has enormous eyes that immediately make you think she will grow into a great beauty. She is adorable.

I pull out some stickers from my pocket to woo her with bright smiley faces, and she quickly puts them all over her hands and mine. Of course, I am enchanted by her.

Her twin brother, Kyle, sits more calmly in his mother’s arms, watching me with matching big, brown eyes. I hand over some stickers to him as well, and he smiles at my little gift.

Then, I get to give their mother a much better gift.

Rose is infected with HIV, but during the entire time that she was pregnant and through a year of breast-feeding the twins, she took 3 HIV medicines to keep the virus at a very low level in her body. Every day, she took the medicines — while her babies grew and ate and slept and became these feisty little people. Rose also made sure that her twin babies had preventative HIV medicines for the first months of their lives. She brought them to clinic at AMPATH every month, and we watched them grow and tried to keep them extra-safe with medicines to prevent infections. We try to protect babies from HIV all the way through pregnancy, child birth, and breast-feeding.

Today, I get to tell Rose that it worked. Officially. On their third and final test — the test that we can only do once babies hit 18 months of age — I get to announce to her that these precious babies are HIV negative.  All of Rose’s work meant that the HIV virus in her blood does not infect her babies.

When I told her, Rose’s eyes crinkled and filled with happy tears. So did mine. Such great news.

We are actually really good at preventing babies from being infected with HIV. If a woman starts HIV medicines while she is pregnant or even during the time of delivery, we can reduce the chance that her baby will be infected to less than 2%. There is no reason that we cannot give every HIV-infected mother the gift of good news that Rose received today:

Your baby does not have this virus.


In 2012 alone, programs like ours that are funded by the U.S. government’s PEPFAR program averted at least 230,000 babies from being infected with HIV. Worldwide, we have prevented at least 1 million babies from being infected. No baby should be born with this virus. If we can get women tested and linked into care and if we can get them to take these medicines like Rose did, we can make sure that no baby will be born with the virus. It’s a big “if”, but it is possible. An AIDS-free generation.

The gift of two HIV-negative twins was a gift to me too. As the only pediatrician in an HIV clinic, I usually end up seeing lots of really sick kids, the complicated cases. The clinical officers see most of the regular patients who are doing well. As their consultant and supervisor, I get to see their difficult cases. I spend most of my time in clinic trying to figure out what on earth to do for the children who are having all kinds of problems.

This makes it a special joy when I get to play with healthy, happy, growing toddlers like Elizabeth and Kyle. And the very best part of the day — a gift to me and an even bigger gift for Rose and her children — is to celebrate over the verdict that these little lovies are HIV-free.


I long for the gift of good news for all of the mothers and grandmothers who wait with their babies in the HIV clinic.



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