Malnutrition in Sierra Leone

After the mishaps of yesterday, the malnutrition team is proud to say that today ran much more smoothly. The day began by boiling the sweet potatoes in the mushroom team’s pressure cooker and preparing the recipes for the day. The muffin team decided that they should add salt for their next iteration of the recipe. This was one of the biggest suggestions from the mothers who tried our product the previous days. The pudding team decided to go back through their three iterations of the recipe to try and collect double the data points per recipe. Today they went with their third iteration – more sugar! 

Then Karli, Neena, Kayla, Seanna, and Rachel went to the Kalongba clinic with our four translators to try and collect as much data as we could.

Unfortunately the word did not spread to the mothers too well and most of the families there were children under 6 months waiting to get their immunizations. However, we stayed and collected as much surveys as we could – in total we got 10 for the pudding and 2 for the muffins. 

After the disappointing outing, we regrouped at World Hope to determine our game plan for the rest of the day. Since we still needed at least 50 more surveys in total for both teams, we took a trip to one of the local villages, Masongba, to go taste testing house to house. 

It is absolutely insane that this is the second to last day in Makeni! During the drive, Rachel kept saying, “this is the last time you’re going to see this” and it was really sad. We have enjoyed our time here so much and absolutely loved working with and getting to know everyone who has helped us complete our research. 

Today was a super successful day. The day started with Zach Day from the Ukweli Team showing us his design for our team name “NewTrition”. WOW! This is something that will be super important if our products are going to be successful in the markets and shops. We were looking for a logo that would catch people’s eyes and that’s what exactly what he made for us. Thanks Zach!

We started our day similar to the last few days by preparing our recipes. We had coordinated a visit with the CHO at Kamambai Health Clinic last week. Unfortunately, we ran into a problem with the bakery this morning as it was their first day in business, and were not able to cook the muffins in time to go to the clinic. Nevertheless, Rachel, Seanna, and I [Matt] took our pudding recipe to the clinic to get feedback from mothers of children under 24 months. With the help of our three fantastic translators (Ibrahim, Abubacar, and Futia) we were able to get 33 surveys filled out to bring our grand total to about 150! We have made tremendous progress in the last week and plan to continue gathering data through Wednesday. Here are a few pictures from our time at the clinic:

(This girl loved playing and dancing around with Rachel!)

(Rachel, Seanna, and myself with our translators)

(A happy baby after trying our pudding recipe!)

(This young boy loved our pudding and kept coming back for more!)

While the pudding team was at the clinic, the rest of the team worked with the bakery to cook their muffins and were able to travel to Ropolon village once the translators returned from the clinic. Neena, Kayla, Karli, and Chris were able to complete 38 surveys in the afternoon! This brings the muffin surveys to a total of 147. Here are some photos from their day in Ropolon:

(Two children enjoying our muffins)

With this being my last blog post in Sierra Leone, I think I can speak for our entire team when I say that we are super proud of the work we’ve accomplished over the past three weeks. As a team, I think we have created a new team dynamic that has become crucial to our success. Together, we are projected to gather over 300 completed surveys and formed lasting relationships that will be invaluable to the future of this project.

Today was another very successful day of data collecting!  But unfortunately, we were only able to test the pudding.  In the morning, Chris woke up bright and early to get to the bakery and begin roasting sweet potatoes in prep for our recipes.  Sadly, the workers who were supposed to be there and open the bakery for us did not show up!  So, we were unable to roast potatoes for the muffins, and we no longer had access to an oven to bake them.  This meant we had to focus on just the pudding, and maximize what we still could get out of the day.

We luckily were able to use Belle and Marc’s pressure cooker to boil our sweet potatoes, and Matt proceeded to make our base pudding recipe.  Since we have successfully gathered at least 30 data points for all three recipes, we are going to start from the base recipe again and get another 30 data points for each, to total 180 data points on the pudding.

Once the pudding was prepared, and we lathered sunscreen on, the team went to another village to begin taste testing and conducting more interviews.

We were able to reach our goal and get over another 30 data points!  With clinic visits planned for the next two days, this makes our goal of 180 total points seem very attainable.

The mothers are really liking the pudding, and the kids are always so excited to meet us (except for some really little ones, who have cried upon site numerous times because they are scared of us).  We have been noticing that many mothers breastfeed their children through well over a year old, so some of the babies turn their heads or don’t eat the food because they are not used to eating other things yet.  It could be useful when we return to school to look into nutritious products we can make specifically directed toward breastfeeding mothers that could then potentially pass on nutrients to the children that way.  We also think since so many of the other 2-5 year old kids that have gotten to taste our product loved it, the product could sell to an even bigger age range if we wanted to market it to include them.  There’s definitely a lot to think about the more and more we explore, and we haven’t even drawn conclusions from our interviews yet!

While the rest of the team was at the village, Kayla took initiative to continue working on grant research for the team.  She worked on the E-Team grant proposal, and explored potential new sources such as MAV Foundation and Nestle Foundation, which both provide research grants to projects addressing malnutrition.

Despite a minor hiccup in the morning, we were able to keep the ball rolling and do plenty with the day to be proud of!

Today was another awesome day. We had an early start and baked our third variation of the muffin. We added 2 grams of sugar to see if people prefer the muffin just a little bit sweeter, rather than the 4 grams of sugar we added yesterday. We also made pudding with less banana, and pudding with added sugar, to finish out those variations from yesterday.

Neena, Karli, Rachel, Matt, and Kayla went to the Rogbalan, an area about 10 minutes from World Hope. The translators: Abubakar, Ibraham, our intern: Futia, and a teacher: Ngadi came with us to help us with our interviews. We learned about this village because Ibraham, one of our translators, lives here. We divided and conquered to get 55 total interviews done! We were so happy that today was another successful data gathering day.

(A mom trying our pudding)

(Matt giving a survey)

(A girl trying our muffin)

(Kayla and Ibraham’s family)

While most of the group was at the village, Chris and Seanna worked on other things. Seanna worked on a proposal for the ETeam grant from VentureWell to help us fund our project. Chris went to the market and spoke to a bunch of women selling different types of ready-to-eat food to figure out how we should distribute our muffin and pudding. Most women bought their products from somebody and then sold them in the market. We believe that this is how we will sell our products.

It was a very productive, but relaxing Saturday! We are looking forward to collecting more data tomorrow!

Today was an amazing day. This morn we awoke to the delightful sound of harmonic birds chirping as if nature had set us an alarm. With that sound, we rose from our sleeping chambers and embraced in the warmth of the morning sunlight, like a hug from G*d himself. As our chests’ filled with the morning air, the fresh scent of warm bread filled our nasal cavities and quickly our neurons released dopamine into our brains signaling the happiness we all felt deep in our beating hearts. We filled our empty stomachs with bread, eggs, and tea to soon fall victim to our stomach acid, to be converted to ATP to power our minds, bodies, and souls throughout our day. We then congregated at our modes of transportation, entered them gratefully, and sped off towards our destiny. The cool morning breeze flowed through our luxurious hair, acting as nature’s hairdryer. We arrived at our destination and quickly got to work, like all of those also rising for their own days’ trials and tribulations.

We began the day’s task by dutifully beginning to make our recipes. This began with the slow and steady roast of plump and nutritious sweet potatoes. The fire burned hot, like the passion in all of us. The potatoes became soft and warm and mixed with other ingredients in our recipes. The muffins then baked in the oven and became crisp on the outside, but warm soft in the center, a perfect snack. The muffins were magical, marvelous, mysterious, mystical, mushy, and made with love. The pudding was potent, powerful, pleasuring, pleasing, and packed with nutrients.

Our team of talkative translators, along with Matt, Rachel, and Kayla traveled to a local village to have the residents indulge in the delicious recipes, and gathered crucial data for our research. The team was able to conduct 55 bodacious interviews with our impactful foods. This meant we were able to complete yet another tranche of data and will attempt a new recipe on Saturday for each the flavorful foods.

After this, the team went back to the Wesleyan church to attempt another round of questionnaires. This was much more successful than the previous day. We were able to recruit a few volunteers from the church to help us control the immense crowds that swarmed the church when the news of our presence had spread like a wildfire. We were able to keep most people out of the general area which helped us to be much more productive. We were able to collect an additional 25 data points at the church which will help to bolster our muffin data and started the third tranche for the pudding. The success of the day has only put more desire in all of us to continue our work for our few remaining days here in Sierra Leone, and we are excited to see this project through to continue the good work and to continue the impact.

(Neena and Karli conducting interviews with mothers and their children with the help of our translators.)

Today proved to be a very productive and rewarding day for the team overall. We were able to take a big step in our data gathering process. Today the malnutrition team started of the day like every other: baking our products in the Betteh Bakery. After a disappointing turnout yesterday, we were excited to hopefully gather as much data as possible today in the Graceland (Barracks) village and test our products there.

While the rest of the team headed out with our three translators, Chris worked to bake different trials of the muffins to identify possible variations to use for taste testing. Chris tested a wide variety of additions and removals of sugar (+/- 1-4 grams), corn meal (+/-1-3 grams), and banana (+/- 1-4 grams). He was also able to learn the correct process of preparing palm oil which is frying the red palm oil for five to ten minutes until the oil returns to its original color

.

(Neena, Chris, and Kayla preparing muffins for the day)

Upon arrival, we had to gain approval of the elder “chief” of the village to be able to interact with his people. As a village recently ravaged by the horrors of Ebola, they were hesitant to allow us to conduct taste tests. However, after explaining to him the contents of our products and our overall mission of reducing childhood malnutrition, the chief allowed us to conduct taste tests there for the remainder of the day. We immediately had tons of mothers and children that we were able to get some great feedback from. Walking through the village each house we came upon was home to at least one child under five and a willing mother, easy to agree to the taste tests. After a few hours, we were able to complete forty-six successful questionnaires.

(A baby enjoying our pudding product)

(An infant from the village eating our muffins)

(Kayla exploring the Graceland Village)

As we returned to the World Hope headquarters, we worked to enter the questionnaire information into our digital form and compile it into a well organized excel sheet. Because of our success today, Kayla and Neena worked with our translators to find a few more villages similar to Graceland where we could go over the weekend and into next week. They were able to travel to the Rogbalan Area as well as the SLMB Area of Makeni with the goal of convincing the chiefs of these areas to allow us to conduct questionnaires there as well. These conversations went really well, and we were able to plan taste testing in Rogbalan on Saturday and taste testing in the SLMB Area on Sunday afternoon. We really look forward to exploring these new areas, and gaining as much data as possible.

(Gorgeous views in the Rogbalan area)

This morning, we baked our muffins and pudding at the Betteh Bakery. Alex and Thuimu roasted/boiled our sweet potatoes and cooked our muffins in the oven.

As Kayla mentioned yesterday, we learned a lot from our data collection and were able to implement what we learned in our interviews today. We continued running taste tests with our initial recipe. Starting tomorrow, we will be changing our recipe slightly to see if their is any difference in how mothers and children like it.

We edited our questionnaire to ask more concise and relevant questions based on the feedback we got yesterday. We could not use our initial data from yesterday morning because of overcrowding. Mothers that were being interviewed would listen to the opinions of other mothers around them, instead of giving us their own ideas. This was a flaw in our data collection that we have since fixed. Now, mothers and children being interviewed will be separated from those that are waiting in line (Pictures to come when we get a stronger internet connection!). We also refocused our research to consider funding proposal and future paper outlines in each of the interviews that we do.

Before we conducted interviews this morning, Jawara helped us get two new translators- Abubakarr and Ibrahim. Yesterday, a lot of the mothers that tried our food said the foods were “fine,” but didn’t give us enough information on the taste, texture, or what they would change. We sat with Abubakarr and Ibrahim to communicate how important it is that the mothers convey all their thoughts with us. If we want our product to be successful in Makeni in the future, mothers and children need to enjoy it and be willing to purchase it for their child. Both of them were very understanding of this and really took interest in our products. Each member of our team noticed a difference in the interviews today thanks to Abubakarr and Ibrahim. We were able to get lots of information from mothers. Our interviews were held at the World Hope compound, in a similar manner to yesterday, but we had a much smaller turnout. Momoh helped us invite mothers back to the compound, but he informed us that many of them did not have the time or money to travel to World Hope even if they realized how important our research is. At this point, we have 30 total data points, so we have to continue to get as many successful interviews done as possible.

(Mothers feeding the pudding to their children)

A few days ago, we assigned team roles so everyone is responsible for a different aspect of the project, and I think it has really helped our team come together. Each person has really grown into their role, and each of us and Khanjan has noticed that our team has become more productive and adaptive to changing plans. Even when we were hit with another setback today, we regrouped and devised a plan for each day until Sunday to make up for the small turnout at World Hope. Even still, it was very frustrating that yet again we couldn’t get the data we needed. Matt said it best when sharing his insight tonight; we have learned that it’s always important to have a plan A, B, and C in order to get the data we need. Our team has a goal of reaching 150 successful surveys for each of our two foods before the end of the trip. Over the past 24 hours, we have only been able to get around 14 and 16 surveys for the pudding and muffin, respectively. Over the next few days, we will need to work extremely hard and take advantage of all the time we have left. Luckily, our contacts at the Wesleyan Church, our translators, interns, and employees at World Hope continue to be great resources.

We are continuing to enjoy our time in Makeni and have really grown to appreciate each of the people we work with. Everyone at World Hope has been extremely willing to drop everything and help us advance our project. We have also loved the chance to get to hear about the success of the other GSIF teams and their projects. We are eager to see what the next week will bring!

Today was an insanely busy but productive day for the malnutrition team! The day began with World Hope providing us with an intern from the University of Freetown to help us out with our research. Her name is Futia and she’s studying social work.

(Futia making homemade peanut butter)

From there, we had to confirm the plans that we had set in place for the day and prepare all of our samples that we needed for our taste testing at both World Hope and Wesleyan Church. Seanna talked with Mo-Mo and guaranteed that women and children were arriving at the WHI at 11:00 AM and Kayla was able to confirm with Reverend David that the he had been spreading the word of our taste testing throughout the villages for the last few days. Simultaneously, Chris was working on making another batch of Magic Muffins.

(Chris mixing the batter for the muffins)

(Kayla, Chris, Matt, Rachel, and Futia preparing the samples)

These batches came out perfectly and were ready to serve just in time!

(The muffins when they were just out of the oven)

When the muffins and the pudding were ready to serve, we had our very first taste test!! Whoo-hoo! It was a huge success in the sense that we were able to collect data and gain experience completing the surveys and working with our translators.

(Neena administering surveys with some of the mothers and children)

(Kayla talking with one of the 6-24 months)

However, during a meeting that we had with Khanjan after the tasting ended, we established that this was going to be a pilot run and we would not be able to use any of the data that we collected. Talking through our survey and interviewing process with Khanjan, we decided that we needed to create a more systematic method as well as set in place goals for our team to accomplish in the next few weeks.

Our team needs to

1. Find and apply for funding to continue our research in the future
2. Write the outline and methodology for a future paper
3. Establish the different variables that are in play throughout our research study
4. Create a matrix of the different recipes we want to compare and analyze for both teams
5. Update the IRB protocol

It felt like things were really shifted into gear for the malnutrition team. We knew what we had to do and we were determined on getting everything done. At 4 PM Kayla, Karli, Yakuba, and Matt headed over to the Wesleyan Church to meet with Reverend David and set up the location in which we would be administering the taste tests and surveys. Since we knew that this tasting would be a larger group of people, we had four interviewers, four interpreters, and a three floaters. Kayla, Neena, Seanna, and Rachel were interviewing with Yakuba, Emanuel, Futia, and Alexander as interpreters. The testing at the church was absolutely chaotic – there were roughly 200 mothers and children who showed up.

(Taste testing at Wesleyan Church)

As a result of the chaos, we weren’t able to get a ton of data points, but the ones we did manage to collect were really helpful. Moving forward we are going to work through avoiding mass crowds swarming the interviews and trying to keep the taste testings in more of an orderly fashioned manner. We are so excited to finally be collecting tangible data and be working through the hiccups we faced and continue being successful.

(Malnutrition team enjoying the beautiful sunset in the back of a truck)

We began our day today by meeting with Khanjan to discuss the best way to move forward after having such a tough day yesterday. Clear communication among all seven members of the team has proved to be fairly difficult. So with Khanjan’s help, we were able to deliberate jobs for each member of the team.

(Our last ride to WHI with our friends Steph and Matt Veto… we’ll miss them!)

When we arrived at World Hope, Chris and the 2-5 year old team went to the bakery to cook their muffins and they came out great! We will be using these muffins tomorrow to get some of our surveys filled out and get our first tangible data. Seanna and Chris sat in on the bakery committee meeting and gave them some insight on their marketing and business strategies. Meanwhile the rest of the team began laid out their plans for the rest of the week through a shared schedule. Most of Makeni is pretty much shut down due to the same religious holiday as yesterday, so we decided to take today to work out some logistics and be a little more proactive in our planning. Hopefully, this will eliminate any confusion further in the week.

(Neena, Rachel, and Matt working out some logistics for the following week)

Although only a few workers were available today, we were able make some negotiations to make our processes smoother later in the week. Chris confirmed that the bakery will be opened everyday for our use, and Kayla confirmed that we can serve and fill out surveys at the Wesleyan Church down the street. Seanna spoke to a WHI employee to get the word out that we will be giving out free food tomorrow.

(The successful sweet potato cakes)

Following the first success, the muffin recipe was doubled and taken to the bakery to be cooked. This batch came out very oily, and not edible. So, we determined that if we are going to double the recipe we need to minimize the amount of additional palm oil used.

Tomorrow we plan to get a significant amount of surveys filled out at the Wesleyan church and on World Hope’s grounds. So, most of our time will be used preparing food and getting ready to get data!