Executive Summary

There is a high incidence of urinary tract infections (UTIs) among pregnant women in Sierra Leone which often lead to severe kidney damage and spontaneous abortions. Pregnant women are also at risk for a hypertensive condition called preeclampsia. Ukweli Test Strips, with the help of community health workers, enable women in rural communities to be screened for UTIs  and Preeclampsia in the comfort and privacy of their own homes and connect with the healthcare system for treatment. Ukweli test strips are specific, affordable, and accessible. In contrast to nine parameter test strips that cost upwards of 15,000 leones, Ukweli test strips cost 500 leones and are easier to use by community health workers with a primary school education. Ukweli test strips exhibit a clear, instantaneous color change when dipped into an infected urine sample. Over the last three years, UTI (and diabetes) test strips have been field-tested across three provinces of Sierra Leone. With funding from Grand Challenges Canada, Ukweli has studied fourteen different distribution strategies in urban and rural communities based on the season and local livelihoods. Ukweli has demonstrated that (1) people are willing to pay to get tested, (2) with appropriate training, CHWs are able to screen and refer patients, and (3) the healthcare system can integrate this simple but potent innovation to improve maternal health. In addition, with the funding, Ukweli has bona fide on-the-ground operations selling strips to CHWs and is collecting data about distribution and the results of the tests. The goal is to expand into the rest of the country and be designated as a National Essential Medicine. Once adopted as an essential medicine, the venture will be integrated into the government. Leveraging the data and support from the venture in Sierra Leone the adoption of Ukweli test strips will be negotiated in Liberia.

Problem: Maternal Mortality and Healthcare Access

Sierra Leone has the highest incidence of maternal mortality in the world with 1,360 deaths per 100,000 live births. In combination with the high total fertility rate, low use of contraceptives, and exceptionally low physician density (0.02 physicians per 1,000 population) in Sierra Leone, diseases are often untreated and become lethal. A urinary tract infection (UTI) is one such infection that, while easy to diagnose, is often left untreated. In fact, if untreated for an extended period of time, UTIs can lead to a myriad of complications in both daily life and childbirth including maternal mortality, preeclampsia, proteinuria, mother-to-child transmission of syphilis, low birth weights and spontaneous abortion. Access to care is further limited when people need to travel long distances for medical care. Most clinics and major hospitals are located in, and near, urban areas. It is difficult for people in rural areas to reach the primary care facilities, often walking for miles. How can we empower these people with a screening technology and help them make an informed decision to seek out the care they need?

Ukweli Product Line

Ukweli Test Strips for UTIs and preeclampsia screen for three biomarkers in urine: nitrites, leukocyte esterase, and proteinuria. Using a urine dipstick technology, Ukweli delivers a readable and vibrant color change. The choice to reduce nine parameters to three has been integral in keeping costs down without sacrificing accuracy. Ukweli delivers a 92% confidence level for UTI tests as opposed to 98% by the nine-parameter test strips that cost 30 times more, which is acceptable for screening purposes. These strips are manufactured by a partner in China with ISO 9001 and ISO 13485 quality certifications since 2017. Ukweli has successfully imported these test strips into Sierra Leone with local IRB and regulatory approvals.

Distribution Strategy

The test strips arrive in Freetown and are transported to Makeni under the direction of Allieu Bangura, Director of Health Projects for World Hope International, who also handles quality control and regulatory compliance issues. Once in the World Hope Office in Makeni, the distribution employee disseminates the boxes of strips to the peripheral health units (PHUs). These boxes are distributed monthly when all CHWS in their respective divisions attend their monthly meetings at Community Health Centers (CHCs). These boxes contain 50 strips and are sold to CHWs at a price point of 25,000 Sierra Leonean Leones (SLLs) per box so that they can be sold at ~50,000 SLL to turn a small profit for CHWs. The CHWs use their discretion on how much to actually charge community members – their cost price of 500 Leones, for 2,000 leones and earn a small profit, or to give them for free to women who just can’t afford them. The price cannot exceed 3,000 Leones under any circumstances. Depending upon the location, season, income level,  and proximity to the nearest clinic, CHWs use specific last-mile awareness and distribution approaches developed by the Ukweli team. These approaches include going door-to-door, engaging with mother support groups, educating community stakeholders and religious leaders, and marketing via posters at health facilities and community centers. The peer supervisors as well as nurses-in-charge oversee all CHW operations. They provide guidance to the CHWs and support their flexible and autonomous operations while providing oversight.

Human Capacity Building Model

Ukweli educates and empowers CHWs, nurses, and other stakeholders through validated training regimens that were developed in collaboration with community partners. These training materials include not just the appropriate use of the test strips but also topics related to informed consent and ethics to ensure that they offer tests without any coercion or conflicts of interest. These training sessions are led by Ukweli staff in collaboration with local governmental health authorities.

Ukweli Business Model

Ukweli makes a profit of 30,000 Leones for every box of 100 test strips. While the Cost of Goods Sold (COGS) and local distribution expenses can be covered through operations, Ukweli cannot recover operating overheads without making the test strips prohibitively expensive. Training CHWs and other stakeholders, measurement and evaluation expenses, and quality control and regulatory compliance are expensive functions that need donor support. While Ukweli will need donor funds for the first three years of operation, it provides a compelling and proven method to improve maternal health by screening women in their own homes and communities.

Project Progress

Since Ukweli received approval from the Pharmacy Board of Sierra Leone in December 2019, the venture has been operational and selling test strips and collecting data it is possible to quantify the project’s progress. To date, 49 health units have been onboarded with 66 health workers certified and 70 boxes of test strips have been sold. Of 1,227 tests administered to pregnant females approximately 90% have tested positive for leukocytes indicating a high prevalence of UTIs and approximately 38% tested positive for proteins indicating a high prevalence of preeclampsia as well. This information indicates that: 1) there is a high proportion of females who are tested which have UTIs and/or preeclampsia 2) Ukweli test strips distributed to CHWs is an effective system in identifying and testing at-risk individuals. In addition to normal on-the-ground operations, a WhatsApp group to connect CHWs at different PHU locations to each other as well as to the distribution manager, and the Lehigh team has been established. This group provides the team with a better sense of the effectiveness of the venture, and allows the CHWs to share information and insights with one another.

 

Next Steps

By July 2021, Ukweli’s goal is to make the test strips available in clinics, hospitals, and PHUs in five of the most populous districts in Sierra Leone, with a catchment population of 3 million people. Upon successful implementation in the Sierra Leonean Healthcare System, Ukweli plans to expand operations into Liberia. The Family Health Division of the Liberian Ministry of Health and United Nations Population Fund (UNFPA) have expressed interest in supporting a pilot program introducing Ukweli Test Strips Liberia. 

Resources

So far, Ukweli has received $25K from VentureWell to develop the test strip and run quality control tests, $100K from Grand Challenges Canada to conduct a 9-month fieldwork study to determine the best Last Mile Distribution strategy, and $12K through fundraising, with World Hope International matching those funds, that were used to start operations in two Sierra Leone districts.  On-the-ground operations take up a major portion of funds which consists of paying the monthly salary for the distribution manager, monthly transportation and printing costs for training sessions, and the manufacturing/shipping costs for getting the test strips to Sierra Leone. 

 

Ukweli needs 75,000 USD to establish operations across three provinces. 50,000 USD of the funding will be allocated for ground operations in collaboration with World Hope International offices in Makeni and Freetown. 25,000 USD are needed for research purposes to study how the test strips are working and further develop and deploy data collection mechanisms across all the community health facilities. These insights will help us refine operations and iterate towards a training, distribution, and tracking strategy that enables the test strips fulfill their destiny and drastically reduce maternal morbidity and mortality rates in Sierra Leone. Lehigh students in the Inquiry to Impact ecosystem will continue to serve as the intellectual base for this project while World Hope International will serve as the operation base in Sierra Leone.

Spencer Moros

Living an Impact-Focused Life

What’s your Why?

I believe I was put on this earth to:

• Live my life in a way that I have no regrets
• Help others without hurting myself
• Specialize and be the best at what I decide to do

 

 

My purpose is to:

• Leave those I come across better than before I met them

 

 

I believe (my core values):

• You shouldn’t have regrets
• There are no wrong paths in life
• Happiness and helping is paramount

 

 

The one thing I must do before I die is:

• Earn my Medical Doctorate
• Be fulfilled with the life I have lived

 

 

My advocates and supporters all believe I:

• Have a passion for people and will find happiness for myself and those around me

 

 

The evil I want to eradicate in this world is:

• Egocentricity

 

 

I want to work in order to:

• Help others in a way that helps myself

 

Walk the Talk – Your How

If you are truly committed to your Why, you show it in your everyday behavior. It is all air until you do it. Working from your Why, How do you prove that you are true to your Why in all you do?

 

I always:

• Try to find the benefit in everything and try to learn and grow

 

I never:

• Compromise my values or beliefs

 

My work style is:

• 1000% for a select amount of time with breaks in between
• If I hit a wall to work on something else and return to it

 

I try to treat people:

• Like they are having the worst day of their life

 

I approach problems by:

MY

• Freaking out, procrastinate
• Talking to others
• Writing out an explicit approach
• Break down the approach even more into more manageable pieces, then break it down again so that my goals
• Adjust my approach as I am doing it and continue to refine

 

OTHERS

• Put myself in their shoes
• View from outside perspective
• Compare the two views and see what is logical (and what may be due to emotions of the individual)
• Plan out something to say that will not offend them
• Verbalize what I believe
• Listen to their response
• Refine my idea of a potential solution until we come to something we agree on

 

Victories are time to:

• Reload for the next challenge

 

If another attacks my point of view I:

• Try to not take personal offense and reflect on my viewpoint and why it is such

 

If I fundamentally do not agree with what an organization or person is doing, I will:

• Try even harder to understand where they are coming from and speak with them

 

 

 

 

Your Credibility – Your Whats – Who will fight with you aside from yourself?

You have just spent some considerable time at Lehigh, and specifically in the Global Social Impact Fellowship, on many whats. Your whats include lab research, formal presentations, writing research papers, engaging with people in other cultural contexts, building prototypes, designing and building systems, raising funds, hiring employees, etc. The whats you have collected along the way are critical to your credibility when you are entering the workforce or applying to the best graduate and professional schools. They signify a credible currency to which organizations can assign value. Create a list of your Whats that are truly reflective of your Why & How.  You did these things because you believe (Why) and you acquired them in the following (How) manner. These are examples you can use in interviews.

What Have I Done	List of Experiences, Accomplishments, and Lessons Learned
Degrees, Minors, Certificates, Fellowships	Emergency Medical Technician Basic Bachelor of Science – Bioengineering – Pharmaceuticals Global Social Impact Fellow
Research Experiences	Lehigh University – Brown Lab – Antibiotic Resistance Lehigh Valley Hospital Research Scholar St. Luke’s Hospital Research Intern GSIF
Inventions and Innovations	Google Sheets-based database
(Social) Entrepreneurial Ventures	Ukweli Test Strips
Publications (Formal and Informal)	Case Study of Data-Centric Approach   Process Simulation of Monoclonal Antibody Production in Bacteria   Outer Membrane Vesical
Formal Presentations (at Lehigh and Beyond)	IEEE Global Humanitarian Technology Conference
Awards and External Recognition

 

Articulating and learning from GSIF-related Experiences. For each of these prompts, we want you to identify one and only one specific and compelling event/incident/experience/moment and identify exactly how you grew personally and professionally through that moment.

Teamwork Experience (and Lessons Learned)	Interviewing CHWs for WhatsApp Communication study: Countless CHWs need to be interviewed, sometimes with little notice, but when something needs to be done someone always stepped up, watching others do this encouraged me to do so (in other involvements outside of GSIF as well).
Conflict Resolution Experience (and Lessons Learned)	Communication was poor: It is easier to ask how someone is doing rather than why they haven’t done something, they usually admit to themselves and the team where they have been slacking on their own.
Leadership Experience (and Lessons Learned)	Data model: Took database into my own hands and applied my knowledge without consulting with anyone, having a consult with someone may have destroyed my system, was more important to finish system to give others a full picture of what I was trying to accomplish.
Dealing with Chaos, Ambiguity, and Uncertainty (and Lessons Learned)	Interview at 8am without any briefing (woke up at 6:30am): It is important to review ahead of time when people are available instead of waiting for the last second, however if you are in a situation where others are not available it is important to take a breath and create a plan to utilize all your resources to be the best prepared you can be.
Personally Challenging Experience (and Lessons Learned)	Researching funding opportunities for the venture: Seemed like an impossible task and many times opportunities only led to a brick wall Instead of defining success as finding an opportunity to apply for at the moment, redefined success as updating the proposal and communicating with foundations and others who have expertise in the area, applying for funding may come later, however this work directly prepares for that.
Cross-cultural Experience (and Lessons Learned)	WhatsApp Study Interview: Pre-interviews were conducted to better understand the phone usage habits of CHWs and their involvement with maternal mortality and Ukweli A lesson learned about other cultures is the great differences in communication. In my interviews in particular I found that questions were most effective when they were direct and to the point and that one question should be asked at a time. This took some trial and error in order to improve.
An experience that helped you connect your GSIF work to your discipline / major.	Data model development: This task connects to engineering in that I was given desired functions, got an idea, created a concept, planned, designed, created, and polished.
A moment that boosted your sense of agency and self-efficacy – you felt like you can speak for yourself, get stuff done, take on the world and make it better.	Finishing data model: When I finished entering the equations and setting up the forums and had a fully functional system. For me this was important because I identified an important task, identified potential solutions, and through trial and error constructed a system which fulfilled the desired specifications and exceeded them as well by allowing for additions in the future. In most of my previous projects at one or more of these
A moment where you felt like you truly have a strong sense of purpose and belonging in this dynamic, globalized interdependent world.	Reviewing testing data: This moment came to me recently while reviewing the data of tests that have been done and the results of those tests. The number of women tested was surprisingly high, and the proportion of women who tested positive for UTIs and/or preeclampsia. Although they were numbers on a screen, each one represented a baby, and a mother who as a direct result of Ukweli have been diagnosed and received treatment, who otherwise could have died.

 

Spencer Moros, Noah Weaver, Skyler Martinez, Anneke Roy

Blog #8 

1. If you are the Chief of Police for Afghanistan, what solution would you develop to pay the cops that are actually working, reduce corruption, and boost their morale.

This issue is a web of interrelationships. However, one long standing causal factor which if fixed would create a snowball effect is the establishment of strong leadership. As Police Chief it is important to set an acceptable standard for the rest of the police force. This also would mean personally investigating corruption from the top down. An example of such would be that if a Lieutenant is participating in illicit activities such as corruption that he would be fired, and severely punished. Doing this and publicizing it to the public and the rest of the police force serves two functions: to help reestablish public trust in law enforcement and set an example to other police officers what may become of them if they continue to participate in corruption. Replacing these high-ranking officials with individuals who legitimately perform their duties will be transferred down the hierarchy creating a positive-feedback system of regulation. This also will help improve morale because the police officers will not endure the abuse and be taken advantage of for their commander’s personal gain and they will be reassured that they will receive the resources required to conduct their job. After establishing a legitimate leadership (or at the same time) a better system of financial accounting at the level of each local station (chance of corruption is reduced due to strong leadership). By doing so, this creates another barrier to corruption and also will help to eliminate “ghost” policemen. By adjusting the salaries so that everyone who is supposed to receive some receives the correct amount it is expected that additional money is likely to be left over. Using this surplus, awards could be given to officers who report corruption. Lastly, the issue of defection to the Taliban is the most difficult issue to solve. The Taliban have represented the norm for pseudo-government power for decades and are more prevalent throughout the country. In order to create effective change regarding this dynamic a potential solution is to concentrate police resources in a smaller region and create a strong relationship with the locals, while cooperating with the Taliban (who are not committing terrorist acts and are religiously extremist, the Taliban in many regions only serve as a regulatory power for the locals). By leveraging this existing power and creating an interdependence between the existing local customs (Taliban) and organized police the goal of providing security and governance can be achieved (equifinality). 

2. If you are the entrepreneur, what multi-final solution will you develop so that you succeed, your venture succeeds (takes water hyacinth off the lake), and the people living along the lakeshore also walk away happy. Please be specific on how your solution might function and precisely whom you would work with. For example, refrain from including vague stakeholders like entire communities.

As the entrepreneur, one must shift their focus from making money to how you can leverage your solution to create even more opportunities for the surrounding community.  The people living along the lakeshore have an invested interest in removing the water hyacinth due to it’s obstructive and invasive nature so they would be motivated employees.  Instead of hiring employees to collect, I would create a system where people in the local community can harvest the water hyacinth themselves and bring it to my workshop where it can be exchanged for a set price based on weight.  By leveraging relationships with prominent fishermen and community leaders, I can begin to gauge the potential interest in this partnership and even have them encourage participation among community members as it benefits them by both creating a profit and getting rid of the water hyacinth. This plays on the Multifinality and interdependence tenets of systems thinking because it leverages the differing goals of the stakeholders to reach a larger goal while creating a mutually beneficial system for all involved.  This plan also relies heavily on regulation specifically when it comes to the pricing of the hyacinth.  If there is no regulation, community members may try to raise the prices for the hyacinth and the system will be broken. 

Blog #7

Noah Weaver, Spencer Moros, Anneke Roy, Skyler Martinez

5 Partnerships: Individual, Team, Lehigh/GSIF

 

1. World Hope International
   1. What constituted the partnership? 
      1. Khanjan provided the relationship developed through a history of other projects
   2. How did the partner help you? 
      1. Provide in-country resources: offices, motorcycles, employees, provide strong basis of support which WHI has created over decades of involvement, legal coverage
   3. How did you help them? 
      1. Provide bandwidth and intellectual resources with the goal of improving the living conditions of people of Sierra Leone, provide access to other funding opportunities not usually open to non-profit organizations
   4. Was this a symbiotic relationship? Why or why not?
      1. Yes this is a symbiotic relationship because as we become more successful we have more to offer and the more WHI is 
   5. What would help strengthen the partnership and make it more equitable?
      1. Create a contract of the partnership
      2. Create a profit sharing scheme for the future if the venture is profitable
2. Ukweli Distribution Manager
   1. What constituted the partnership?
      1. WHI hired Hassan to work full time on the Ukweli venture. Hassan is well known in his community and has served in public health capacities for several years.
   2. How did the partner help you?
      1. Hassan has allowed Ukweli to distribute its test strips directly to CHWs, expand the venture’s reach by training CHWs to become UHWs, as well as collect relevant data needed for us to show the depth and breadth of Ukweli operations. Perhaps most significantly, Hassan has provided extensive social capital to Ukweli.
   3. How did you help them?
      1. We are able to help Hassan have a regular salary that allows him to not worry as much about financial obstacles in his life. He also is able to make a positive impact in his community, and being able to combine self-preservation with the advancement of the needs of others is, in my opinion, the ideal professional situation.
   4. Was this a symbiotic relationship? Why or why not?
      1. Yes; both the Lehigh team and Hassan are able to mutually benefit in a manner that would not be achievable by either party independently. If Hassan did not have Ukweli/Lehigh, he would likely struggle with finding consistent work/pay needed to survive. On the flip side, the Lehigh Team would be greatly hindered in its ability to access hard-to-reach communities within Sierra Leone without the social capital provided by Hassan.
   5. What would help strengthen the partnership and make it more equitable?
      1. It would be more equitable if we could find a way to give Hassan more bandwidth by hiring another employee. The workload that Hassan is responsible for is considerably greater than when the venture first started, and I am concerned about how equitable it is for Hassan to continue being responsible for the setup of new PHUs/CHWs in addition to the increasing number of previously-onboarded PHUs and CHWs.
3. Ministry of Health and Sanitation of Sierra Leone
   1. What constituted the partnership?
      1. A Temporary Service Level Agreement that allows us to sell and distribute the test strips across Sierra Leone.
   2. How did the partner help you? 
      1. They give us the legal ability to sell our test strips.
   3. How did you help them?
      1. We are actively working to help increase screening for UTIs and Preeclampsia in pregnant women in an attempt to lower the Maternal Mortality rate.  This helps them because maternal death is a huge health issue in Sierra Leone. 
   4. Was this a symbiotic relationship? Why or why not?
      1. This is a symbiotic relationship because through our work that they approved, we are aiming to solve or at the very least help a major health crisis in Sierra Leone. In return, we are able to take this model and show its usefulness in the existing healthcare system of Sierra Leone.
   5. What would help strengthen the partnership and make it more equitable?
      1. More consistent data reporting (as outlined per our agreement) would allow the Ministry of Health and Sanitation of Sierra Leone to regularly see what progress Ukweli makes towards combatting the maternal mortality rate.
4. PHUs/CHWs
   1. What constituted the partnership?
      1. Distribution manager initiates and upholds relationships with PHUs, which further allows us access to connections to that unit’s CHWs.
   2. How did the partner help you? 
      1. PHUs give us access to trained healthcare professionals within that local region; they are the direct connections to screening and referring the patients.
   3. How did you help them?
      1. We incentivize the CHWs buy selling them boxes of test strips and allowing them to sell the strips at an increased price for profit. 
   4. Was this a symbiotic relationship? Why or why not?
      1. Yes, this is a symbiotic relationship. The skeleton of our venture is based on the efforts and data collected by the CHWs we partner with, and they are able to make an earning through the selling of test strips.
   5. What would help strengthen the partnership and make it more equitable?
      1. With our WhatsApp communication system, we are hoping to strengthen our partnerships with the individual CHWS and PHUs by creating a line of communication between the Lehigh team and them.  Through this, we can have open communication between our partners and make it more equitable. 
5. Michelle Spada
   1. What constituted the partnership? 
      1. Introduced through Khanjan Mehta during the Mountaintop Experience 
   2. How did the partner help you? 
      1. Provided support when establishing messaging and interview questions for the Ukweli WhatsApp communication system.  Assisted in editing and looking over papers as well.
   3. How did you help them? 
      1. Was introduced to us as a support system so we did not provide help to her.
   4. Was this a symbiotic relationship? Why or why not? 
      1. Commensalistic relationship→ we benefited and she didn’t benefit or experience harm
   5. What would help strengthen the partnership and make it more equitable?
      1. We could potentially offer student support and work for any projects she is working on. More consistent communication between her and the team.

Spencer Moros, Noah Weaver, Anneke Roy, Skyler Martinez

Blog #6

1. Ten specific ways teaming has changed:
   1. Opened myself up to learning about the other tasks of my team members.
   2. Summarize my work and contributing in a way that someone who was not doing the same task could understand it.
   3. Learned how to better accept criticism and pushing from my team members without feeling personally attacked.
   4. Learned to ask for help from others when I do not know what to do or when I will not be able to complete it myself.
   5. Take a more passive role in meetings where I know I am not a subject expert, however I do my best to learn about the subject.
   6. Learned an effective way to check in on people without seeming like a micromanager, by asking how they’re doing and let them bring up the task they are assigned to instead of bringing it up myself.
   7. Learned to be more accepting that people are not always able to complete what is asked of them due to life events.
   8. Developed a threshold to differentiate between laziness and inability to complete tasks.
   9. Learned to foster a more light-hearted atmosphere between group mates, establish us as friends and not just team members.
   10. Develop my own tasks which exceed what was asked of me to motivate myself to push further in addition to what was assigned to me. Also, if a task requires more work than expected I do this work automatically instead of pushing it off or telling the group that I was not assigned to do it originally
2. Collaboration Plan

 

Team Name: Ukweli Test Strips                                          Date: October 2, 2020
Goals	Project GOAL (Big G): Create a self-sustaining system that changes the way maternal conditions are identified and followed up with appropriate care, improving maternal health and reducing maternal mortality from UTIs and preeclampsia to zero Scaling: Our project goal is not scaled to our resources  Metrics for Success: Number of Women screened Number of women who test positive for one or more parameters and receive follow-up care Number of women dying from preeclampsia or UTIs Personal GOAL (Small G):  Spencer: Ensure the continued success of the venture through identifying and submitting applications to multiple funding sources Noah: Finish writing a robust data analysis for screening metrics Skyler: Conducting and managing the WhatsApp Communication study  Anneke: Provide support to the team for WhatsApp Communication Study and personal support to individual team members
Roles	Spencer: Shaper, Resource Investigator Collecting list of sources for funding Creating proposals  Applying for funding Skyler: Shaper Conducting WhatsApp Interviews Mapping locations/finding system for that Applying for funding  Noah: Coordinator Discussion and Analysis of WhatsApp content (later in semester most likely) Wrap up of data analysis paper Coordinate team responsibilities in conjunction with Zach Regular communication with the Distribution Manager in Sierra Leone Anneke: Team Worker  Conducting WhatsApp Interviews Funding
Procedures	·  Decision Making – What process shall we use: deference to expert→ refer back to Khanjan before making any decisions to get his input. ·  Meeting roles: Zach Day = Scribe Communication – Meetings Once a week with Khanjan over Zoom, daily communication over GroupMe, additional meetings added throughout the week if needed (Blog Post Meetings, larger group meetings)
Relationships	Team Diversity Disciplines: Bioengineering, Health Medicine & Society, Sociology, Marketing, Molecular Biology Work Experience: Healthcare, Customer Service, Retail, Food Service Backgrounds: Christian Ministry, Community College Listening – Give each group member a turn to speak. Listen thoughtfully and wait to come to a conclusion until everyone has gone. Team Name– Ukweli Test Strips

 

Spencer Moros, Noah Weaver, Anneke Roy, Skyler Martinez

Blog #5

20 FAQs Ukweli Test Strips

Questions:

1. What makes your product better than any competitors in the region?
   1. The product itself isn’t any better: it’s the system created around the product that makes Ukweli better. By integrating the strip into the pre-existing community health worker system, a method of distribution and trust with individual participants is established. The bare bones approach of the 3 parameter strip (instead of the standard 9-parameter) ensures that the strip is more affordable and accessible to underserved communities.
2. How does the 3-parameter test compare to the standard 9-parameter test in terms of specificity and sensitivity? 
   1. Utilize same mechanism as FDA approved test strips in US; same specificity and sensitivity – unable to get testing for our own produced strips due to expense
      1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408713/
   2. Repeated testing throughout pregnancy helps to reduce low specificity of the test
3. How do you establish trust with the communities you deserve? Do they have a distrust of Westerners?
   1. The CHWs (which are certified UHWs) are nominated by their communities to serve in such a capacity, and using Lehigh’s relationship with the non-profit WHI within Sierra Leone, we are able to establish as much trust as possible while maintaining accessibility to the strip.
4. How do you plan to establish relationships with other government agencies beyond Sierra Leone?
   1. We are utilizing our network as well as the network which our partner World Hope International currently has in other countries. We hope to leverage the support from the government of Sierra Leone and success on the ground to support the adoption of our venture elsewhere.
5. What are the preliminary results from the WhatsApp Communication Study Interviews?
   1. Currently, we are still working on transcribing and coding the interviews but as a group we have noticed some trends already. For example, cultural and language barriers have been a very common issue that’s come up when talking about educating women.  This can help us understand how we can shape our WhatsApp messages to be specific for the UHWs and the problems they’re facing. 
6. How do you choose participants for the WhatsApp Communication Study?
   1. Our distribution manager goes to the PHUs and recruits specific healthcare workers.
7. What metrics are you planning to measure during the WhatsApp Communication Study?
   1. The metrics themselves are partially shaped by the participants themselves. The overall goal of the study is to identify emerging themes through messages sent between the UHWs and the interviews of each participant. Such examples of what we might identify would be encouragement, clinical questioning, and advice, and then those would fall under the larger category of teamwork, and we can do those for multiple themes.
8. What issues have you identified during the WhatsApp Communication Study?
   1. Within the study, issues we have identified primarily revolve around internet connectivity concerns and reliable access to the internet for our UHWs. From the UHW perspective, we have come to reinforce our understanding of the challenges women of Sierra Leone face when seeking medical treatment (traveling distance, lack of time, lack of money).
9. How do you stay within the scope of your project without the “white savior” complex? 
   1. We seek to ensure that any aspect of operations incorporates the collaborative nature and overall focus on the women, other locals, and government/medical operatives of Sierra Leone. For example, are pre and post-WhatsApp survey questions are designed to encourage honest and genuine answers from the UHWs who are involved to give us direct feedback. This would be opposed to pressuring them to falsely believe their feedback may influence or hinder they ties to Ukweli, this way we create a comfortable environment for all parties. 
10. Where are the test strips produced? 
    1. Our test strips are produced by an OEM in China. 
11. Does your OEM engage in unethical treatment of minority populations? How do you address this from your perspective of a social venture?
    1. Beyond the fact that our OEM has all necessary regulatory approvals and meets all legal requirements set forth by China to operate, we don’t know. Besides that, it is not clear what demographic works for our OEM. As a social venture, we are only able to tackle so much at a given time, and our efforts need to remain concentrated on the exceedingly high maternal mortality rate in Sierra Leone and beyond.
12. How has COVID-19 impacted your venture? What adjustments have you had to make?
    1. I would say the biggest impact was on the new team because they were unable to travel to Sierra Leone this year.  It made it hard to really communicate and gain the trust of our distribution manager.  On the distribution of the test strips, the impact was pretty minimal besides a temporary price reduction in March from $50,000 to $30,000 due to economic hardships that CHWs and frankly everyone was experiencing.
13. How do you validate your data?
    1. In order to validate our data after paper copies are collected by our distribution manager from each PHU, our distribution manager enters these values into a google forum. This data automatically is populated into our data backbone. Additionally, the paper forms are scanned and emailed providing a redundant system to check the data through regular auditing by the Lehigh Team.
14. How do you know which specific Ukweli operations enhance screening participation
    1. We have performed an analysis of our data using a method known as multiple linear regression analysis. This type of analysis allows us to find which metric(s) are the most influential on increased screenings. We looked at the data on a monthly basis between PHUs with a minimum number of x screenings, and found (insert here).
    2. *We still have to finish the write-up of the paper doing this analysis, but we will be able to answer this question fully by the time our presentations are due for submission.
15. Have you considered looking at other metrics? If so, why/why not did you decide to evaluate them further?
    1. We have considered metrics such as the rate of follow-up care received by women who screened positive for any of the parameter within our test strip, but we have chosen to forego some valuable metrics because of the inconsistencies and lack of reliability associated with gathering them. In an LMIC setting, it is already difficult enough to gather reliable data on the strip itself where it’s a “once-and-done” situation (i.e. was the screening positive? If so, what?). However, following up with those same participants is an entirely different challenge by itself.
16. You mentioned in previous presentations that you were having some difficulties coordinating with your employee in Sierra Leone. How have you progressed since
    1. Yes, we have. We have increased the frequency of our communications with our onsite employee and in the process have allowed a stronger bond and trust between the Lehigh team and him. Even through technical difficulties, he understands the importance of completing his duties given specific circumstances, as we develop a better understanding on ways we need to accommodate to his circumstances.
17. How do you incentivize UHWs to participate in the Ukweli screening program?
    1. The UHWs are able to buy the test strip boxes (50 strips in each) for roughly 25,000 SLLs, and they each can be sold at around 50,000 SLLs for them to turn a profit.
18. How do you know the venture has actually had an impact on maternal mortality?
    1. Determining Ukweli’s actual impact on the maternal mortality rate in Sierra Leone is nearly impossible due to the lack of regularly collected census data as well as the numerous ventures in the area that have the same goal as us.  However, we can look at our own personal metrics of success, like number of boxes sold and number of women screened and treated, in order to determine how successful the venture has been.   
19. What was the regulatory approval process to sell test strips in Sierra Leone? 
    1. We were required to complete a Service Level Agreement (SLA) between Ukweli and Ministry of Health and Sanitation which allows the venture to operate in Sierra Leone’s healthcare industry. Also, we obtained a Marketing License from the Pharmacy Control Board of Sierra Leone by providing information about the test strips and allowing us to sell the strips commercially.
20. Where do you plan to get more funding from?
    1. We are looking to a variety of charities which support initiatives and research for preeclampsia and maternal health.

Blog #4 Spencer Moros, Jenn Nester, Beigie Lam, Ugochi Amadi

Questions:

What is our role in the cooperative? Are we on the ground (making, selling, educating)?

• We’re developing the whole cooperative
• Malnutrition team is a good example of people who are doing what we want to do

Are there any crops that aren’t using pesticides? 

• No, practically all use pesticides.

 

Step 1: Determine the facts in the situation – obtain all of the unbiased facts possible. Clearly state the ethical issue. 

• Livelihoods of rural households
  • 500 women want to join the co-op
  • They are skeptical of the porridge because it is new
• HIV/AIDS and breastfeeding
  • HIV+ should wean early
  • Not everyone knows if they are HIV+
  • Access to supplements that prevent spread of HIV through breast milk more prevalent
  • Nutritious alternative really a good supplement
• Pesticides on produce
  • Cash crops
  • Subsistence crops
• Childhood nutrition is a problem b/c local gruel is not providing all key nutrients
  • 35% of children have stunted growth
• Breastfeeding can spread HIV from mothers to infants 
• Want to reduce risk of spread of HIV by using new porridge formula for children instead of breastfeeding
• Porridge formula is using locally grown crops in a different way (as opposed to traditional gruel)
• Mothers usually give gruel from ~2 months to 24 months
  • Skeptical of using new formula because it’s not something they’re used to, the traditional gruel is cornmeal
  • Not something they’ve done before
• The WHO recommends breastfeeding until ~6 months but the longer time of breastfeeding with HIV means greater risk
• Reduce risk of HIV/AIDS by having children eat the porridge → Formula for new nutritious porridge is made from locally grown crops → locally grown crops have high levels of potentially harmful chemicals from pesticides / porridge can be sold to improve women’s livelihoods
• Don’t know who has HIV or not, there is now aggressive plan for testing of HIV and most people who have it know that they have it

Ethical Issue: Is it better to wean infants off of breastfeeding with porridge which provides sufficient nutrients, but exposes the infants to the risky chemicals from pesticides on the crops or spread HIV through prolonged breastfeeding and wean them with a traditional gruel lacking nutrients?

 

Step 2: Define the Stakeholders – those with a vested interest in the outcome / Step 3: Assess the motivations of the Stakeholders 

• Mothers
  • Give their child the best food
  • Have their child grow safely & healthily
  • May have mixed opinions about the effectiveness of the porridge formula
  • Want to improve their livelihoods
  • Not risk giving HIV/AIDS to their children
  • Make some money – growing/selling the cash crops
• Children 
  • Stay healthy (not get HIV/AIDS)
  • Get good nutrition / be fed
• Cooperative Participants
  • More participants, lessen burden on individuals
  • Make some money – growing/selling the cash crops, getting some form of return from their investment be it labor or something else
  • Bring more success
• Cooperative Organizers/researchers
  • Respect local traditions and culture
  • Attract women to join
  • Build reputation and credibility to gain more funds and resources for future
  • Reduce malnutrition, improve nutritional status of children
  • Increase livelihood of households
  • Reduce transmission of HIV/AIDS
  • Make venture financially successful/sustainable
• Donors of money for the projects (secondary)
  • Improve nutritional status of children and livelihoods of rural households

 

Step 4: Formulate (at least three) alternative solutions – based on information available, using basic ethical core values as guide 

 

Approaches [1/2/3: repeat for every action] 

• Potential solution: Have women give children the traditional gruel from 2-6 months, then market the porridge as “stage 2”, 6-12 months wean children off breastfeeding entirely. Educate women as to why this is best for their children 
• Ethical Principle or code: Consequence based thinking & ethics of care
• Pros:  respect local traditions while supplementing nutrition, while child is eating gruel they have supplemental nutrients from breast milk; would be less financially costly for the venture
• Cons: Children are more at risk for acquiring HIV/AIDS (breastfeeding to 12 months instead of 6 months suggested), children are exposed to pesticides, 

 

• Potential solution: Have mothers switch to the porridge formula or some diet of both the formula and traditional gruel after ~2 months of breastfeeding and Educate women as to why this is best for their children  
• Ethical Principle or code: consequence based thinking
• Pros: Reduces risk of passing HIV to child in timely manner by cutting short the breastfeeding period, new formula compensates for key nutrients in infants’ diet, improve livelihoods with increased sales or production of porridge
• Cons: May not convince a lot of mothers who don’t believe that the new formula will provide enough nutrients for their child, would expose children to more pesticides from the produce, would be more financially costly for the venture

 

• Potential solution: Refer all of the mothers to a place where they can be tested for HIV/AIDS in order to identify the most at risk children
• Ethical Principle or code: Consequence based thinking & duty based thinking
• Pros:  Many at-risk children are identified as early as possible, targets problem at root by identifying mothers who should switch to porridge from breastfeeding, allows mothers to learn if they have the virus and what measures they should take for their own health, 
• Cons: Invasion of the privacy of the women, not many women get tested so there may not be many testing sites/facilities/resources, adds more stress on the venture as a whole, morally obligated to educate about HIV/AIDS if test positive, identifying at risk children puts a target on some mother’s backs

 

Other possible solutions: 

• People might be reluctant to use the new formula
• Have information sessions to inform the locals about the harms of pesticides and HIV and educate them about what the porridge’s benefits vs consequences are so they can make decisions for themselves
  • Who will pay for that?
  • Who will organize and make these sessions happen?
  • Way to make money with this cooperative is to scale up with this product so it gains traction and spreads 
• Partner with other entities to aid with product development
  • Put information labels or tags on the back or packaging of the porridge
  • Community health workers (need incentives)
  • Do partners have something to gain from working with you?
• Focus on tackling HIV problem by providing infrastructure to fight HIV epidemic
  • Better sex education by focusing on impact to children
  • Very expensive because they have deep ingrained beliefs
• Partner with Health Ministry and WHO to leverage introducing the porridge product as a second stage diet product for infants
• Focus on scope issues which is this cooperative that sells porridge for infants after 6 months of breastfeeding
• Profit by making this product shelf stable and with low production cost that can sell for higher prices
• Source input locally when practical but go to the open market if it is more efficient

Step 5: Seek additional assistance, as appropriate – engineering codes of ethics, previous cases, peers, reliance on personal experience, inner reflection 

• Malnutrition Team
• What accountability structure do you make in order to incentivize people but also have people join for the right reasons (might be second part)
• Look at long-term effects of either side of the problem to decide which problem is more impactful (e.g., pesticides may not be as bad as HIV)
• How do you start as close to the solution as possible?
• Addressing skepticism isn’t the biggest issue (in terms of an ethical issue)
• https://www.azurihealth.co.ke/ 

 

Step 6: Select the best course of action – that which satisfies the highest core ethical values. Explain reasoning and justify. Discuss your stance vis-a-vis other approaches discussed in the class. 

The best solution is to respect traditions of the locals by allowing them to give gruel to the children, and encourage mothers to not wean as quickly until 6 months and market the porridge as a next step. Also, as part of the program the mothers will be instructed to breastfeed until 12 months. This solution is not ideal for a few reasons: the children are receiving nutrient-lacking gruel from 2 months – 6 months and the infants are breastfeeding past the recommended time, 6 months, instead they are breastfeeding to 12 months. Although the children are malnourished when they are receiving gruel this respects the traditions of the community, thereby gaining respect from the locals, and reducing the reliance on the gruel by discouraging weaning from 2-6 months ensures that the infants receive the nutrients that require from breast milk. Also, this solution works to respect the longer breast feeding which is typically until 24 months by incorporating breast feeding until 12 months. This approach also helps to reduce the risk of HIV transmission via breast milk by cutting the time of breast feeding in half (24->12).  Lastly, the children are receiving good nutrition from the porridge from 6-12 months. One issue that still remains is the exposure to pesticides, however this is somewhat combatted by more reliance on breast feeding, and most detrimental effects of pesticides are from exposure on a time scale of years rather than months and these children would be exposed regardless.

 

Step 7: (If applicable) What are the implications of your solution on the venture. Explain the impact of your proposed solution on the venture’s technology, economic, social and environmental aspects.

This solution affects the social aspects of the venture a great deal. By incoporating the traditional practices the project as a whole is more likely to be adopted. Additionally, by beginning on the right foot the venture is able to build upon the strong foundation and move to even more favorable solutions. Such as, eliminating the gruel completely and replacing it with the porridge and weaning off breast feeding completely by 6 months. This plan also improves the economic health of the venture by acquiring a sizable workforce as part of the cooperative which also can grow from there.

Part 2

Issue: women work and the men take the money and spend it on things other than food for the family.

 

Step 2: Define the Stakeholders – those with a vested interest in the outcome 

• Mothers
  • Want to improve their livelihoods
  • Make some money – growing/selling the cash crops
  • Don’t want the money they earned to be wasted
  • Want the money to go to their children’s benefits
  • Use the money to feed their children
• Cooperative Participants
  • Make some money – growing/selling the cash crops, getting some form of return from their investment be it labor or something else
  • Improve livelihoods of rural women

 

• Cooperative Organizers/researchers
  • Respect local traditions and culture
  • Build reputation and credibility to gain more funds and resources for future
  • Reduce malnutrition, improve nutritional status of children
  • Increase livelihood of women in rural households
  • Ensure the added wealth is going towards feeding the children
  • Make venture financially successful/sustainable
• Donors of money for the projects (secondary)
  • Improve nutritional status of children and livelihoods of rural households

 

Step 4: Formulate (at least three) alternative solutions – based on information available, to have a win-win situation for your relationship and your venture. 

Approaches [1/2/3: repeat for every action]

 

• Potential Solution #1: Offer “store credit” rather than cash so the women can use their money to feed their families.
• How does it solve the problem? 
  • Pros: Money goes where the earner wants it to go, there is no risk of it being taken away by the husbands or being sold off, more value if they use it as credit instead of cashing it out
  • Cons: Might cause domestic issues; go against traditional hierarchy
• How does it save face of those involved?
• Implications on relationships
  • Short-term: Women can get more food for their children, might create mistrust between the men and the cooperative organizers/researchers
  • Long-term:  
• Implications on the venture 
  • Short-term: mitigate the issue of mismanagement of funds
  • Long-term: make women more independent; close the gender gap 

 

• Potential Solution #2: Give the women the option to get paid in essential items as opposed to cash, make them accept part of the wage to the product that they are making and the rest will be cash or credit, buy in bulk things like goats that cooperative members can get for cheaper than market price so they can take it directly home
• How does it solve the problem? 
  • Pros: builds livelihood of families because the members can save money and keep producing with things like goat milk and cheese, can bring the men in because it makes them money in the long run, production of things will build towards feeding the children
  • Cons: only about 20 women will actually be working in packaging the porridge so it’s unrealistic to create an entirely separate system of distribution of goods
  • How does it save face of those involved?
• Implications on relationships
  • Short-term
  • Long-term 
• Implications on the venture 
  • Short-term
  • Long-term 

 

• Potential Solution #3: Act as a bank for the workers, hold the workers’ wages and let them grow and only let them cash out when they reach a certain amount or emergency
• How does it solve the problem? 
  • Pros: allows people to save and build capital, free as opposed to banks that need you to pay to make an account, allows women to save and improve their livelihoods because it prevents the money from being taken away by the men
  • Cons: Social implication that the men may get angry that the women are working without making anything, may still take the money after it gets cashed out
• How does it save face of those involved?
• Implications on relationships
  • Short-term
  • Long-term 
• Implications on the venture 
  • Short-term
  • Long-term 

 

Step 5: Seek additional assistance, as appropriate – previous cases, peers, reliance on personal experience, inner reflection 

• Maybe only 20 women will be working with the cooperative to grow/sell crops
• Cooperatives emerged as a way for people to save money and collect capital
• Research indicates that men are less likely to take all of the money that’s saved compared to a weekly wage
• Women aren’t upset men are taking the money, they’re upset about their misuse
• Don’t cut off the entire money source (maybe leave like 5% or something)
• How to establish a banking system
• Sporadic bigger rewards (e.g., every three months can buy a goat)
• Bring together a group of people who have clout in the community

• Get people with clout including men and religious leaders so that they can deal with this issue and consider taking ⅓ of the wages in cash while the ⅔ is going back to the cooperative as an investment so they can grow it
• Have the council agree on what products they think the cooperative should make available to use the credit for such as goats, etc..
• Address nutrition issue by having women who work in the cooperative walking away with a small amount of the porridge everyday that can feed two people
• Elderly people are a big customer section for the porridge
• Validate the solution by telling it to the other 6 leaders on the committee, also go out to men and other leaders (maybe 25 people one on one) and get them on board with the way to tackle the issue → bring people together to talk about the problem and let the people discuss and come up with their “own” solution → create a contract or system of more equitable bylaws that everyone involved will agree with and enforce in the community → go towards developing this in the community so they adopt it 

Step 6: Select the best course of action – that solves the problem, saves face and has the best short term and long-term implications for your relationship and venture. Explain reasoning and discuss your solution vis-a-vis other approaches discussed in class. 

 

The best course of action is to have the cooperative can act as a bank where the women can keep their wages as credit and build capital until they reach a certain amount to cash out or want to cash out. Keep a portion of their wages as immovable credit and maybe cash out about 5-10% directly so that the women can have something to spend, although the men may take the cash and spend it themselves. The could act cooperative as a distribution center or “store” for alcohol and cigarettes at lower than market price so that the men are incentivized to spend at the cooperative instead of outside markets and the cooperative can help to control the rampant spending of the men and give back control to the women to spend the money on food and other necessities.  Additionally, the cooperative can act as a source of goods that the members can get goods from for a better price based on the women’s needs and the men will feel motivated to save as well if they realize that saving for a couple months will actually build more value for them. 

 

Step 7: List the sequence of actions you will take to implement your solution.

 

1. Survey women about a banking system
2. If general consensus is yes, the banking system would be established, implement any changes they would like
3. Work with women to decide how much of their wages go between store credit and cash (make 3 options: %70-30, %80-20, %90-10)
4. Find out the most pressing needs of the women (specific foods, clothing, household items, etc) with which to stock the “co-op” store.
5. Find out where to get those resources in bulk to keep prices low enough to incentivize purchasing in the co-op. Ideally these products would come from co-op members.
6. Get those resources and stock the store.

 

Other possible solutions: 

• ⅓ of the wage is the porridge 
• Instead of money or full amount of money, they can get something that creates value

 

Banking system: 

portion of wage=store credit (stored in every week)

-portion of store credit=saved in the bank

portion of wage=cash (given out every week)

 

Blog #3 Spencer Moros

Grassroots Diplomacy Case Study: Youth Center Gifts

Step 1: Facts

• Children living in youth center in Kenya
• Children of all ages 3-14 yo
• Youth center received gifts from donor
• Gifts already allocated for specific children, Jack is meant to distribute gifts
  • Four children did not receive gifts
  • Staff unconcerned about these children that didn’t get a gift
• Have black hats which are available to distribute as an alternative
  • These children are unhappy with Jack and feel excluded
• Assumed cultural difference between Jack (who is American) and the Staff (who are Kenyan)
  • It may be a cultural normal that when gifts come to the center, not every child gets a gift every time
• Black hat assumed to have some sort of negative stigma for being viewed as less valuable than other gifts

Step 2: Problem & Stakeholders

Problem: Four children at the youth center didn’t receive a gift from the donor because they were short. They were given hats to supplement, but now it looks bad that Jack didn’t get them a similar gift. 

• Children Without Gifts
• Children With Gifts
• Jack 
• Youth Center Staff 
• Donor of Gifts

Step 3: Personal vs Professional Motivations

• Children Without Gifts
  • Personal: might want to take the other children’s gifts because they feel left out 
  • Professional: N/A
• Children With Gifts
  • Personal: might make the children without the gifts feel bad, want to keep their better gift
  • Professional: N/A
• Jack 
  • Personal: doesn’t want the kids at the youth center to hate him, wants to be “the good guy”
  • Professional: doesn’t want to upset the staff by blaming the mix up on them or overstepping with his solution; concerned about well-being of children
• Youth Center Staff
  • Personal: be trusted and liked by the children, wants to be “the good guy”
  • Professional: want to be respected by the children and not to be taken advantage of, wants the operation to keep running smoothly
• Donor of Gifts
  • Personal: make kids happy
  • Professional: reach as many youth centers as they can

Step 4: Solutions

1. The children can share the gifts so that no child goes without a gift. This solves the problem by combining all gifts for use by any child at the youth center. Assign gifts on a number system each week (to mitigate the effect of cons).

• • Pros: no child will feel excluded, and each child can have access to a variety of gifts rather than one gift. It will instill a positive lesson in the children, as sharing is important for the kids to learn. Jack will save face providing a quick solution to the imminent issue involving the shortage of gifts. 
  • Cons: children may fight over the gifts, some gifts may be neglected because the children choose others. In this situation, it is likely that the children will want something that they can call their own. Asking the children to share the gifts they were given as individuals may take away some of the feelings of pride of ownership. Not all gifts may be appropriate for all children due to the range of ages.
  • Saves Face: No child will feel completely left out anymore and everyone will be able to play at some point
  • Implications on Relationships: In the short term, some of the children might be upset they have to give up their personal gift for everyone to share, but in the long term all the children should be happy because they now have more gifts overall to play with.
  • Implications on Venture: The youth center will have to monitor when each child can play with each toy to allow everyone to play equally, so it is a little more work in the short term. But long term, hopefully everyone is happier.

2. Jack can tell them their gifts were lost, delayed, give them the hats for now. Get the children gifts at a later date.

• Pros: eventually all children will have a gift, everyone is leaving with something at the time (although some just have hats).
• Cons: children will be disappointed until they receive their actual gifts, may not be as interested in the gift at the later time, have to go out and acquire additional gifts.
• Saves Face: Jack doesn’t blame any specific person for the children not receiving their gifts, and promises them that they will get the same gift eventually so hopefully saving his relationship with them.
• Implications on Relationships: Children will be unhappy until they receive their gifts, putting more responsibility on Jack to make up for shortcoming. Once they receive their gift they will be happy with Jack after that.
• Implications on Venture: Short term the youth center (or Jack) will have to spend money out of pocket to get the children their gifts. The children will potentially be upset until they get the gifts. But long term everyone will receive a gift of the same caliber.

3. Jack can take the children who received the black hats aside and make up a fun story to tell them about why the hats are special and how they can use them to play a game of some sort. Make modifications to hats to make them more appealing, add a fun experience to the gift.

• Pros: This will make the children feel better about not receiving one of the other, more exciting, gifts. It will allow Jack to preserve his relationship with the children. It will avoid setting a precedent or creating a conflict with the staff at the center. This also preserves Jack’s status with the children, which will prevent them from walking all over him because he acts too sympathetically.
• Cons: The children may see right through the act, making them still feel left out. The staff may be wary that you have chosen to act when they did not perceive a problem. Making decorations on hats requires additional resources- sets precedent. Kids without hats feel excluded.
• Saves Face: Children will feel better about not getting the other gifts and they will still like Jack. Jack will make them and their gifts seem special.
• Implications on Relationships: This is a “goldilocks” approach that will not completely satisfy the children because they are still without a conventional gift, but it does not cause conflict with the staff. By acting in this way, Jack is able to preserve relationships with the children and the staff for the long term.
• Implications on the Venture: By preserving relationships with all parties, the motivation of the venture is saved. If partnerships were strained by the decision made by Jack, they may be less likely to continue working together / work effectively. 

Step 5: Additional Info

• From personal experience, children like when they are singled out in a good way, so the solution that makes an interesting story about the hats may be even happier than the other kids because they now feel special.

Step 6: Best Action

• Give the children the hats initially and do an activity / customization of them. Then, go get them their gifts. Combination of #2 + #3.
  • Avoids having any child leaving with nothing at the time
  • Customizing hats gives a fun experience for them to associate them with, so although it is perceived as “less” than other gifts originally it helps to make up for that fact
  • Does put additional responsibility on Jack, however this is essential to keep the venture and relationships running smoothly (saving face of Jack, donors, and staff)
    • Must make clear to staff and donors that this is the only time he will provide this type of charity – to avoid being taken advantage of
• Please see above in #2/#3 for Saving Face and Implications on Relationships / Venture

Step 7: Sequence of Action

1. Distribute available gifts along with hats to those without gifts.
2. Take the children aside with hats.
3. Speak to the children to establish special quality of hats / decorate the hats.
4. Acquire additional gifts. (Inform donors that this personal donation is a one-off, and tell staff and children that gifts came from the same donor to avoid conflict about personal contribution)
5. Distribute gifts to those with only hats.

 

Blog #2 Spencer Moros

Lesotho is a small developing country contained within South Africa. You and your team of academic researchers (10 in all) are spending the next two weeks traveling to different communities throughout Lesotho to test water sources for disease-causing pathogens. The testing you need to do is simple but requires significant assistance from the community – showing your team all the different locations where individuals get their water from, and places/methods for storing the water. You do not see the need to pay the community members, considering if someone asked you about your water source, you would not mind driving them up to the lake! The ultimate goal of the project is to understand the lifecycle and characteristics of a specific pathogen, which is found only in this region of Lesotho. Several publications are expected from this research study. A comprehensive profile of this pathogen can help in many ways including development of chemical additives to make the water safe to drink. Is it ethical to conduct this research study? What will you do next?

Waterborne diseases attribute for a wide range of detrimental conditions. It is advantageous to know exactly what pathogen is responsible because it informs decisions about treatment of the conditions caused (eg. effective antibiotics for gram negative bacteria Pseudomonas aeruginosa which causes infections) and what can be done to mitigate the pathogen’s presence in the water. Testing takes time and money. Water testing must be conducted at a variety of locations and timepoints: retrieval from source, storage, and consumption. This requires direct participation from the community to show/explain to provide accurate results. The researchers are seeking to produce reproducible, accurate data to better understand the microbiota of the water source for publication. The location of the research is Lesotho where evidence of water pathogens is present.

The stakeholders of such a situation are:

• Community + Individuals: drink, bathe, use irrigate with water source, testing what pathogens are present informs them what precautions they should take to reduce the detrimental impact of water consumption or what treatments are appropriate for conditions caused by drinking the water
  • Individuals directly working with: may be compensated in some way (food, transportation, etc.)
• Researchers: testing provides data for publishing in academic papers
• Government: provide funding for water infrastructure and subsidize healthcare costs
• Funding Source: paying for expenses of research may be due to different returns: more funding for future outreach, hoping to sell product (water treatment / filtration), build better relationship with Lesotho, etc.
• Healthcare Providers: tertiary party not directly impacted however improving water supply may lead to less stress on infrastructure, devote resources elsewhere
• Academic Journal: tertiary party research is groundbreaking and will lead to more revenue and respect form academic community

Solutions:

• Provide transportation and some accommodations to people who assist researchers
  • Pros: motivation for those who help
  • Cons: may lead to individuals who want to go “above and beyond” and actually provide misleading information, difficulty choosing who should help: needs most assistance, has most knowledge (lead to people unwilling to assist if they do not receive same as others)
• Find water samples on own
  • Pros: does not involve the issues presented with involving locals
  • Cons: takes much more money, effort, and time by researchers, may not find correct locations, would need to conduct much more testing instead of isolating where water is taken from and stored, may give locals impression that researchers are invading to get data and get out, reduces the positive impact of the research, no betterment of relationship
• Do not compensate the locals: make contact as they are doing what they normally would (specifically getting water)
  • Pros: no one feels like they are being treated unfairly compared to other locals,
  • Cons: no motivation to assist except the possibility of research improving water source, make locals feel as they are being taken advantage of

This case is very complex in that the action of conducting the research does not generate an immediate positive impact on the locals as a distributed experimental device. It is a more conceptual benefit in that in the future it may lead to further investment and a solution being put into place. There is no real best answer as to what is the best course of action, however one solution I believe rises above the rest based on my personal moral compass

I believe the best thing to do is to compensate the villagers. By doing such, the villagers would be motivated to help. A way to combat the cons of this strategy is to use multiple people to verify the information provided and standardize what is given. In order to solve the issue of choosing the individuals to help one should go to respected individuals in the village and ask who they believe is best fit and most knowledgable to help with the assessment of the water. Respected individuals will have personal biases, however they hopefully will have the community’s best interest in mind. By providing accommodations to those who help it will better the researcher-community relationship allowing for even better interactions in the future and make the people feel as though they are not being exploited.

By implementing this venture the society’s technological level will be raised and the health of the community will be increased because everyone drinks water. Also, the environment may also be increased once the pathogens are cleared from the water.

Blog #1 Spencer Moros

While trying to develop a low-cost syringe for the developing world context, you (the designer) hit a cross-roads. Constructing the syringe to auto-disable after a single use, an important safety feature, significantly adds to the cost of the design – making it potentially unaffordable for some hospitals and clinics. However, if you don’t add the safety feature, you are enabling the potential for the spread of disease. How do you as a designer proceed?

A syringe with a the auto-retraction safety feature protects those who are uninfected which slows the spread of the disease, however this is a costly feature.

The stakeholders of such a situation are the hospital + healthcare providers who are conducting tests and are directly at risk by providing testing, and community + individuals who are receiving the tests to inform them what precautions they should take or what treatments are appropriate. By implementing a retractable needle the healthcare providers benefit in that they do not contract the disease and the hospital benefits because the personnel can continue to provide care instead of becoming a patient and further taxing the hospital infrastructure. The communities benefit because they may be able to administer the tests themselves better preparing them to take precautions or get treatments, and there would be less stigma around being tested for fear of spreading the disease to others who are conducting the tests. A third party is the government because investing in the auto-retracting technology can reduce the spread of disease which thereby allows for the reallocation of funds to other essential areas.

Solutions:

1. Subsidize costs to lower income hospitals by increasing costs to well-funded hospitals.
2. Base the distribution of auto-retracting needles off of the training of the healthcare professionals.
3. Provide trainings to lower-income using collaborative program with higher-equipped facilities.

Pros/Cons

1. Pros: Reduce costs for lower-funded hospitals, Less concerns about wider distribution of needles Cons: Well-funded hospital personnel are at higher risk – not everyone may have the same training at the more well-funded hospital (possible less funded facilities have personnel with better training), unable to purchase same quantity as what could be purchased at lower price point (more funded hospitals most likely serve a greater number of individuals in more urban environment), distributing to less-funded facilities may only improve geographical coverage area – more efficient to increase coverage of people
2. Pros: Giving personnel the proper equipment based on training helps to prevent accidental sticks Cons: “Better” trained individuals at higher risk and training may not have went over proper use and disposal of needles, losing a more highly trained provider is a much greater loss to the healthcare system
3. Pros: Well equipped facilities have more outreach, Increase training of healthcare personnel in less-equipped environments, Lower risk of accidental sticks Cons: Need to compensate trainers to go out to other facilities, although training will decrease probability of sticks equipment such as sharps containers and gloves may not be accessible thereby decreasing the impact of such training

As an Emergency Medical Technician I have seen first hand the difficulty of a similar situation. Epi-Pens have a proprietary auto-retracting needle, which leads to an exorbitantly high cost. However, this cost has proven to be worth it in life-threatening allergic reactions. Laypeople are unable to properly draw up epinephrine and administer it, using an Epi-Pen this issue is solved. It has enabled many to provide emergency care before paramedics are able to arrive and saved countless lives.

 

My personal experience has given me reason to believe the best solution is to raise costs to more well-funded hospitals in order to subsidize the costs to the less-trained and funded facilities. By doing so, those are not trained can still provide care in a manner which eliminates or at least minimizes their risk of being exposed to a blood borne disease. Getting proper equipment in the hands of the greatest number of people will result in the greatest impact, while also mitigating the risks.

 

By implementing this venture the society’s technological level will be raised and hopefully the social stigma around seeking or providing treatment due to the fear of spreading the disease will be solved.