GSIF Conceptual Framework

Above is the conceptual framework my group created to demonstrate what is unique about GSIF. This conceptual framework highlights two key components:
1. Team-oriented: Knowledge and resources from Lehigh and on the ground-partnerships are channeled through multidisciplinary, student and faculty teams which continue to cycle throughout the long-term duration of the project. These teams turn these inputs into real-world outcomes and impact.
2. The cyclical nature of the project: The impact and knowledge obtained from success and failures of the ventures allows for the teams (new members, continuing members, and members from other teams) to get feedback and push all of the projects forward over the years.

Sickle Cell Conceptual Framework

The goal for the sickle cell team focuses on the idea that all individuals with sickle cell disease should be able to live a fulfilling life. This cover slide demonstrates how sickle cell (a genetic condition where blood cells become sticky and sickle-shaped, causing blood clots), results in reduced life expectancy (among other symptoms); however, our dream is that these individuals should be able to live fulfilling lives, similar to those of individuals with normal blood (symbolized by the difference between the top and bottom graphics).

The conceptual framework highlighting the problem points out three underlying, systemic problems preventing individuals in Sierra Leone with sickle cell from living fulfilling lives. These underlying, healthcare system challenges are
1. Low education on prevalence, causes, symptoms, and management.
2. Limited access to treatments (including financially).
3. No screening programs, and diagnostic capabilities limited to small, isolated programs.

These underlying problems together result in unfulfilling lives for individuals with sickle cell. Specifically, in Sierra Leone, 50-90% of individuals with sickle cell will die before the age of 5, and most of these children are never even diagnosed. In the rare event that a child lives long enough to be present with clinical symptoms, low education, a lack of diagnostic capabilities, and limited access to treatments means that the individual often remains undiagnosed, and even if sickle cell is suspected, they receive no to little guidance on how to handle symptoms or have access to proven, cheap treatments. The only exception to this, is in Freetown and Kono, where individuals at the hospitals who present with clinical symptoms can be referred to programs for official diagnosis, and can receive subsidized treatments and education. Despite this, these programs are limited to a few hundred individuals in these two cities, and do not address the huge proportion of children who die before they present with clinical symptoms, or those who are never referred due to a lack of education. Because of this, the majority of children experience an increased risk for infection, frequent pain crisis, and stigma.

Our solution focuses on a systemic change. By implementing a newborn screening program, individuals with sickle cell can be identified before they present with symptoms, and can start treatments early when they are most effective. Our solution will also incorporate a life-long treatment and education program which will allow the individuals to manage their symptoms, and live fulfilling lives. By collaborating with other sickle cell ventures in Sierra Leone, this solution can be implemented at a national level.

Eight Tenets & Hyacinth Problem

– Relationships that are symbiotic in that when one person makes a decision it directly affects another or the larger system
– An example from malnutrition is while we were in country we were partnering with the bettah bakery. We worked with them to improve their business model but when they decided to not show up or there was huge miscommunication, it directly impacted our efficiency and work for the muffins

– The individual parts by themselves cannot operate a complex function– this requires all the parts to work together to form a system to perform that function.
– When it comes to distributing our documentary we are going to be unable to do it without the help of other components of the system. For example, we want to distribute our doc through Marie Stopes and they want to help spread the word about maternal health and mortality throughout their system. We each cannot easily do this by ourselves, we each need the other component to reach our desired outcomes and joint outcome of eliminating maternal mortality.

– The same or similar inputs lead to different outputs. Or a win-win situation for all
– Sickle cell diagnostic devices can be used to provide different outputs depending on the context. For example, in Nigeria, sickle cell diagnostics were successful because of their use in family planning, whereas in Sierra Leone programs are more focused on newborn screening efforts.

– The idea that any given output can be reached by a variety of potential means or combination of inputs.
– An example for malnutrition is how we originally created a lot of products that essentially all did the same things but through different “means”. We had different products but ultimately the outcome would have been the same – healthier children

– Each part in the system plays a crucial role and the system would not be whole without each individual part
– An example from the Safe Motherhood team would be when we compiled a list of our stakeholders we wanted to interview, we wanted to include as many people as possible. We needed to get the perspectives of the local community members, the PHU, and the hospitals. Each doctor, nurse, midwife-to-be and mother were essential to understanding the problem of maternal mortality in Sierra Leone to help prevent us from jumping to conclusions.

– A process using checks and feedback to make sure goals are being accomplished & taking corrective action
– In the future, the sickle cell team will rely heavily on regulation concepts. For example, during clinical trials, we will need to confirm our test results by comparing our results to the gold standard (either collecting dried blood spot samples or using in-country IEF), and will adjust accordingly.

– “Zooming out” to look at a problem from multiple angles or “zooming in” to see underlying concepts
– For the Safe Motherhood team, we had a point in our fieldwork when we were coming up with all these theories of how Sierra Leoneans are trying to hide the problem of maternal mortality and how we needed to focus our documentary on exposing the truth. But we had to zoom out to look at the problem from different angles to realize that there could be multiple reasons why people were telling us that maternal mortality wasn’t a problem in their clinic. They could be telling the truth that maternal death didn’t happen in their clinic because any deaths occurred after they had referred them to the hospital and therefore they did not count as patients of the clinic.

Leverage Points
– Places within a complex system where a small shift in one thing can produce big changes in anything
– For example, while in Sierra Leone, the malnutrition team had trouble forming connections with the local bakery. Once Khanjan spoke to the owner, they had no further problems. In this case, Khanjan (and his network/power in the community) was the leverage point.

– The concept that the value of a system as a whole is greater than the value of the individual parts
– For example, the sickle cell project will represent an emergent system in the future. A sickle cell screening device has very little value without a program (individuals are diagnosed, but nothing is done to address their diagnosis). Similarly, a sickle cell program has very little value without a low-cost screening device (you can’t treat individuals if you don’t know their diagnosis). However, when both parts come together, our project can be very valuable: individuals with sickle cell anemia are diagnosed and then access low-cost treatments to make their lives better and healthier.

Hyacinth Problem:
– In order to solve the problem of allowing the entrepreneur to have access to the hyacinth in the lake, while making the community happy because she is not the only one being paid, our team came up with a solution utilizing the Multifinality principle.
– Solution: The entrepreneur can pay the local community members (or fisherman who are hurt by the high hyacinth levels) to collect hyacinth from the lake. The entrepreneur can then process and sell the hyacinth products for a profit without the community saying she is the only one who is benefitting financially.
– Multifinality: This solution encompasses the Multifinality principles because it is a “win-win,” where one input has multiple beneficial outputs. Specifically, by allowing any community member to collect and sell their hyacinth to the entrepreneur, the entrepreneur “wins” because they have access to the hyacinth without getting push back from the community, and the community “wins” because they can make money by selling the hyacinth.

Partnerships & Coalition


1. Dr. Cheedy Jaja
– Heard of him from the SickleScan website, got in contact b/c one of Prof. Cheng’s contacts and one of Khanjan’s contacts from Sicklescan
– We received feedback on the usability of our device and how cost, over everything, is the most important and the biggest distinguisher for a medical device.
– Our device is another option to use in the future for sickle cell screening. If we join the effort to try and have the medical system adopt a sickle cell protocol we could help write/develop the protocol and be the man power behind the effort.
– We need to bring back a working device ready for clinical testing that can be compared to the devices Dr. Jaja is testing now in order to receive more feedback.
2. Sia Evelyn Nyandeno (SCCAN)
– Traveled to Kono to meet Dr. Jaja at the Jarbario Clinic. Sia is the founder of SCCAN (Sickle Cell Carers Awareness Network), an awareness program that helps care for children and adults who suffer from sickle cell disease in Kono. Sia met Dr. Jaja on Facebook and asked him to come support the SCCAN program at the Jericho Road clinic.
– SCCAN runs a program at the Jericho road clinics which diagnoses and treats patients. Although they are currently using the SickleSCAN device, they are very open to trying another device which is cheaper and more effective.
– This partnership has the potential to be symbiotic, and can be better, once we have a functioning device. Specifically, they will help us with the on-the ground expertise, and we will help them diagnose more patients for a cheaper price.
3. Sickle Cell Society (Specifically: Mrs. (Sister) Amelia Gabba (Sickle Cell Society) and Dr. Gibrilla Fadlu-Deen (Sickle Cell Society/Congought Hospital))
– Found the Sickle Cell Society website and mission online, on their website. Made contact with the Sickle Cell Society through a publication involving a study run by heads of the Sickle Cell Society in Sierra Leone.
– Met with Ms. Gabba and Dr. Fadlu-Deen to learn more about there program for people with Sickle Cell Disease, said they would possibly be open to running a clinical trial with us
– If they chose to adapt our device in the future after a clinical trial and manufacturing they will be saving a lot of money because they are currently paying $25 for each diagnosis making our partnership symbiotic in the long run.
4. Prof. Martin Grobusch (Masanga Hospital)
– Prof Martin Grobusch is the director of the medical research unit at a hospital in Masanga. Masanga is the only hospital in Sierra Leone that has its own electrophoresis machine (the gold standard for diagnosing sickle cell).
– Since the Masanga hospital is research-driven, and already has an electrophoresis machine, this partnership has the potential to be very symbiotic once we have a functioning device. Specifically, they could serve as a location for clinical trials, since they have sickle cell expertise and a mechanism for comparing our device, while we would be providing them with additional research, publication, and prestige opportunities.
5. Dr. Sandra L Lako (Aberdeen Women’s Hospital)
– Dr. Sandra Lako is a pediatrician at a major hospital in Freetown. She is also doing her MPH dissertation on sickle cell. We met with her in order to learn more about sickle cell at her hospital in Freetown. Although at the time this partnership was very one sided (we were learning about sickle cell conditions in Freetown), there is a lot of potential for the partnership to become symbiotic in the future.
– Since Dr. Lako is focused on helping her patients, and has an academic interest in sickle cell, once we have a functioning, proven device, we can form a strong partnership. Specifically, we can provide her with a device which will help her patients, and she can provide us with feedback and information on the local healthcare system.
6. Dr. Abu Bakarr Bah (Children’s Hospital)
– Dr. Abu Bakarr Bah is a pediatrician in Freetown with an interest in sickle cell, who was recommended to us by Dr. Lako. Like with Dr. Lako, this relationship has so far been very one sided (we were learning about sickle cell conditions in Freetown).
– During our meeting, Dr. Bakarr Bah expressed his enthusiastic interest in working with us in the future. Specifically, he hopes to use our device to improve the wellbeing of his patients, and believes that by having more people in Sierra Leone pushing for a national screening program, the problem can eventually be addressed. Similarly, Dr. Bakarr Bah would be helping us by using our device, and working towards our mutual goal of reducing the childhood mortality associated with sickle cell.
7. Hasan & World Hope International
– Our main partner in Sierra Leone, connected through GSIF organizer Khanjan. World Hope has helped us get our foot in the door to a lot of these other possible partnerships. Hasan is currently working for Ukweli and was a recourse to all teams, providing insight on locations in Sierra Leone and meaning fully questions that need to be asked
– Our team specifically does not have a symbiotic relationship with World Hope, however Lehigh does. The relationship with Lehigh is symbiotic because they provide us with resources on the ground and we are bringing them more manpower and ideas.
8. Dr. James Bunn (WHO Child Health Specialist)
– Dr. James Bunn is a Child Health Specialist at the WHO, who has experience working with sickle cell. We were put into contact with him by Anna Vines and the Sickle Cell Society. During our meeting, Dr. Bunn was very helpful to us in talking about next steps, and ethics.
– In the future, this relationship has the potential to become mutually beneficial, as our device has the potential to make a national screening program cost-effective. Therefore, we could help him advance his goals of improving child health in Sierra Leone, while he provides us with policy help.
9. Faye Simmonds (E-health)
– Was introduced to E-Health and Faye Simmonds by Dr. Mary Hodges who was unfortunately not in Sierra Leone during the time we were there. Was able to talk to Ms. Simmonds and her colleagues in Nigeria about their SCD programs.
– Learned a lot about how all the partnerships above are connected and was added to the SCD google group. Learned more about their monthly meetings and their push to start a SCD screening program and treatment program. Heard about their program in Nigeria and the deice they are currently using there and how their treatment program runs.
– This relationship is not directly symbiotic however we were added to the google group through Ms. Simmonds, and in the future we could possibly have something to share that would benefit the group as a whole.
10. VentureWell
– Applied the the E-Team Stage 1 grant and were one of the teams to win, just sent in our E-Tram Stage 2 grant, and are waiting to hear back. This partnership is mainly a funding partnership. They are not only providing us with funding but also advice and training at their workshops. This is not a totally symbiotic relationship, we learn and gain a lot from them and they gain the ability to say they have funded our team which could possibly benefit them in the future but right now they are not receiving a lot out of this partnership.

Coalition: Stop Sickle Sick aka. Triple S, S cubed, SSSSSSSSSS (sound it out)
– Mission: To lower sickle cell mortality, specifically during childhood, by implementing a low-cost screening device partnered with a treatment program for all sickle cell patients.
– Key Partners: When we were in Sierra Leone, we found out that there was a google group for all individuals in the country who were interested in sickle cell. Because it was such a small community, we were able to meet everyone who is working to improve the lives of individuals with sickle cell in Sierra Leone, and would want all of these people to be our partners in the coalition. These partners are:
1. SCCAN (opinion leaders, resource partners, signaling partners) – including Dr. Jaja and Sia; a sickle cell clinic in Kono district; have sickle cell expertise and program in place for those diagnosed
2. WHO (opinion leaders, policy makers)- in particular Dr. James Bunn, a child health specialist with an interest in sickle cell; as a powerful, policy setting organization, having a partner from the WHO will be essential.
3. Sickle Cell Society (opinion leaders, resource partners, signaling partners) – including Dr. Gibrilla Fadlu-Deen, the medical director; a sickle cell program in Freetown; have sickle cell expertise and program in place for those diagnosed
4. E-Health (resource partners) – has experience setting up sickle cell programs in other LMIC countries, and is trying to do the same in Sierra Leone; also have experience with clinical trials and low cost technology

Team Goals


Personal goals:
Jannah: I hope to push the project forward and make a contribution towards improving the lives of individuals with sickle cell anemia in Sierra Leone. Additionally, I hope to work on my team work, leadership, and presentation skills.
Maria: My personal goal is to learn valuable lab, entrepreneurship, presentation, leadership and teamwork skills all while working on a project that I truly care about and has the possibility to truly make a difference/impact (isn’t just a simulation).

Project goal: To improve the lives of individuals with sickle cell anemia in Sierra Leone (and other LMICs) through the design and implementation of a low-cost screening device and program.

Scaled project goal & metrics for success: Because of constraints, this goal will take at least 5-10 years to be achievable, and will take many outside resources and connections. Within the next few years, our current team will work towards several scaled goals.

First, we hope to design a low-cost, sensitive and specific lateral flow device to diagnose sickle cell anemia. Success of this goal will be evaluated based on an estimated scaled-up production cost below $1 per test strip, and a proven sensitivity and specificity above 98% (meaning there are very few false positive and negative test results).

Second, we hope to establish connections who can help the team scale-up and implement in the future. Success of this goal will include networking with doctors in the US and Sierra Leone who can help with clinical trials, programs and healthcare professionals in Sierra Leone who can help with program design and implementation, and NGOs who can possibly help fund the advancement of the project.


Currently our device is divided up into three teams (team is 10 people total):
Production Scale Up (3)
Assay Development (4)
Assay Optimization (3)

The production scale up team is focusing on rapid, simple and consistent ways to build our device. Their number one goal right now is to design and build a test line printing machine that will allow us to have more consistent read outs of positive and negative results. In order to truly start optimizing our device we need this machine to be up and running as soon as possible.

The assay development team is mainly focusing on the test lines. They are continuing the development of the sickle cell test line and working to find sensitive and specific antibodies. They are also working on determining the dynamic range of the test strip which is incredibly important data that is a main selling point for our device.

The assay optimization team works very closely with the assay development team. Their goal is to determine the optimal amount and volume of each material we should be using in order to minimize cost. Materials that are optimized first go through the assay development team and are compared to other materials based on their sensitivity and specificity. The assay development team and the assay optimization team works together on some experiments in order to work more efficiently. Communication between the teams mainly travels through the three main leaders of the two teams.

There is at least one leader on each team who has been on the project for at least a semester. We have a meeting as a whole research team once a week where we go over/share the progress each team made. At the meeting any experiments that need to be run by multiple teams in conjunction that week are planned. Goals for the week are laid out at the meeting therefore it is very clear what each group needs to get completed by the next meeting.


Decisions on experiments and next steps forward (grants, publications, prodacols) are mainly proposed by the 3 team leaders that have the most experience with the project. The decision proposals are then brought to the group at the team meeting and any feedback is discussed. At this team our PI also provides feedback and new insights. The final decision and how it is going to be carried out is made at the meeting.

Our meetings are guided using powerpoints; each team makes their own slides covering what was accomplished the past week, outcomes, and plans for the next week. The power points are used to keep us on track and insure that everyone is prepared. We like to have a different person from each group each week present what has been accomplished in order to insure everyone is engaged and understands what is going on with the project.

Are meetings are on Monday nights which is very convenient because we are able to plan additional meeting times if necessary then. All other communication is mainly done through email or text messaging.


Currently, there is very little diversity on our team. All of our members have engineering backgrounds, and are focused on the design of the physical test strip. Despite this, we have significant team diversity in terms of strengths. For example, Maria has very strong networking skills while Jannah has a lot of experience working in a lab. Additionally, our team hopes to recruit new members who have business experience, who can help with the scale up process.

Our team has spent a lot of time thinking of a team name and has yet to decide on one. Some ideas have included: SScreen, SSave, and SickleStick.


Part I

Step 1:
– Azadirachta indica (Neem) is a tree indigenous to India
– Neem is sacred
– Neem has been used for over 2,000 years for medical purposes, food production, toiletries, fuel, and pesticides
– Over 100,000 people in India are employed in the Neem industry
– Chetan lives in Agra, India and operates a small business making and selling Neem products
– Chetan’s business employs 60 people
– Chetan does not know the exact name of the neem seed extract, Azadirachtin
– Tom Johnson is developing neem seed pesticides as part of his company OOPS
– Johnson’s company invested $5 million to conduct safety and performance tests over last decade
– Tom’s company has a worldwide patent for the pesticide use produced from neem seeds
– Tom has made profit of $12.5 million during his first year
– OOPS wants to sell their neem products in India
– Because of their patent, OOPS is demanding a royalty from Chetan’s business and other small industries that make neem-based pesticides
– Ethical dilemma: Is it ethical for OOPS to charge Cheetan and other Indian business for their use of neem, even though they have been making the products for centuries? What rights does Cheetan have? Is it ethical for a US company to enforce patent rights in this situation?

Steps 2 & 3: Define the stakeholders and assess their motivations
1. Cheetan
– Wants a successful business
– Wants to be loyal to his employees and customers
– Doesn’t want to pay royalties on a product his family has been selling for decades
– Wants to support his family
– Wants to maintain the dignity of his family legacy (the company) and his culture (neem is sacred)
2. Cheetan’s employees
– Want to provide for their families and maintain jobs
3. Tom Johnson (OOPS)
– Make money
– Expand into Indian market
– Have his patent and investment in safety testing respected
– Make royalties off of patent
– Consumers of Neem products in India
– Want the purchase neem products for the lowest cost

Step 4: Formulate alternative solutions

1. Cheetan pays the patent royalties to OOPS
– Pros: Tom and his company get the patent royalties which they are legally owed, and which they spent a lot of time and money investing in. Tom’s product is a cheaper option for customers.
– Cons: Cheetan loses a lot of money on paying the patents, and may have to lay off employees who he can no longer afford to employ.

2. Cheetan does not pay the patent royalties
– Pros: Cheetan can continue selling his products, although he may still have increased competition from Tom. Although this would be illegal, ethically it would be okay. Ethically, neem is sacred, a natural product, and has been used for years, therefore, it wouldn’t be unethical to keep selling the product. This option gives the best chance for Cheetan to keep his employees, and maintain those relationships.
– Cons: Tom would lose money on royalties, but could still make money selling the product. The customers may not be able to access the product for as cheaply as option 1.

3. Cheetan works with other Neem-based companies to get the patent revoked in India.
– Pros: Cheetan could continue selling his product without paying royalties, legally.
– Cons: This may be a very expensive, timely process for all stakeholders. Therefore Cheetan may have to layoff employees.

Step 5: Seek additional assistance
During class discussion, Prof. Cheng mentioned that it was illegal to patent a natural resource.

Step 6: Select the best course of action
Cheetan does not pay the patent royalties. Although this is technically illegal, it is ethically okay. It is unethical for OOPS to charge Cheetan and other Indian business for their use of neem, since it is a natural, sacred product, and they have been making the products for centuries.

Step 7: What are the implications of your solution on the venture
– Technological: no impact, both Tom and Cheetan can continue making their product
– Economic: This is the cheapest option for all parties involved, except that Tom will not make money off of the royalties
– Social: Cheetan may face backlash from the government for ignoring the patent laws. Socially, this is the best option for – – Cheetan and his employees, since Cheetan will lose the least amount of money and can keep his employees.
– Environmental: no impact, neem has already been proven environmentally friendly.

Part II

Step 1: Determine the facts of the situation:
– See Part I
– OOPS launched 6 months ago and has expanded throughout the Indian market
– Neem-based soap is their most success product
OOPS wrapper features a photo of Tom Johnson
– Cheetan’s wrapper features a photo of the founder’s great grandfather
– Chetan has tried to convince Tom to leave the market, but Tom will not. He is open to collaboration, however, if it will make him money
– Cheetan’s business if suffering because of the reduced market share
– Because of the lost revenue, Cheetan will have to lay off half his staff if nothing is done
– Cheetan is very loyal to his employees, since the employees and families have worked with him for centuries
– Chetan will not suffer as much from declining business because of his investments
– Cheetan’s employees know he met with Tom and believe he has cut a deal with Tom/OOPS

Step 2: Define the problem and stakeholders:
Problem: Tom’s company is dominating the market, and Cheetan’s business is suffering. Unless something is done, Cheetan will have to layoff half of his employees, with whom he has very deep-rooted loyalties.

Step 3: Determine and distinguish between the personal and professional motivations of the major stakeholders
1. Cheetan
– Personal: wants to maintain family legacy, and help his employees as much as possible
– Professional: Wants to keep is business afloat
2. Cheetan’s employees
– Personal: want to provide for their families
– Professional: want to feel respected by their employer, Cheetan
3. Tom Johnson (OOPS)
– Personal: Wants to run successful business
– Professional: wants to keep business going, keep control of market, and keep making money

Step 4: Formulate alternative solutions
1. Cheetan closes his business but negotiates with Tom to find jobs for his employees at OOPS
– How does it solve problem:
– Pros: Cheetan’s employees have jobs, Tom keeps making money, Cheetan feels good maintaining loyalty to employees
– Cons: Cheetan’s family legacy dies
– Implication on relationships: Cheetan maintains relationship with employee since they stay employed.
– Implications on venture: Cheetan’s business closes, but Tom’s business thrives.

2. Cheetan leverages his brand to make a mutually beneficial deal with Tom, keeping his business afloat with all employees, while Tom makes money. (Specifically, let Tom use his brand for the soap, while focusing on dominating other parts of the market).
– How does it solve problem:
– Pros: Cheetan’s business stays open and he doesn’t have to lose any employees, Tom makes more money using Cheetan’s brand power, Cheetan maintains relationship with employees, Cheetan keep this family legacy alive.
– Cons: This solution may not be accepted by Tom or may still result in Cheetan needing to lay off employees in the future.
– Implication on relationships:
– Short term: best option for Cheetan’s relationship with employees since they keep job and stay employed by Cheetan. Tom and Cheetan start working together instead of against each other.
– Long term: If the deal is not as beneficial as expected, could hurt Tom’s and Cheetan’s relationship in the future.
– Implications on venture:
– Short term: Cheetan and Tom’s business stay afloat.
– Long term: If the deal is not successful, Cheetan’s business could still be forced to close.

3. Cheetan lays off employees as needed, but helps them find new jobs.
– How does it solve problem:
– Pros: All of Cheetah’s employees are able to continue providing for their families, Tom takes control of market and makes more money, Cheetan maintains relationships with employees.
– Cons: Cheetan loses business and the respect of some of his employees, Cheetan still has negative relationship with Tom
– Implication on relationships:
– Short term: Some of Cheetan’s may be mad about the transition
– Long term: When Cheetan helps his employees find new jobs, he will hopefully be able to rebuild their trust
– Implications on venture:
– Short term: Cheetan’s business gets smaller and Tom’s business thrives.
– Long term: Cheetan’s business may continue to suffer as Tom’s continue’s to grow.

Step 6: Select the best course of action
Option 2: Cheetan leverages his brand to make a mutually beneficial deal with Tom, keeping his business afloat with all employees, while Tom makes money. Although this is the riskiest option, it will grant potential for Cheetan to continue his business and keep all of his employees. Additionally, it is the only option which will help to build a positive relationship between Cheetan and Tom, which could be beneficial in the future to Cheetan, his employees, and his business.

Step 7: Sequence of actions to implement solution
1. Meet with Tom to negotiate
2. Explain and prove how using his brand for the soap will allow Tom to make more money
3. Negotiate with Tom to allow Cheetan to dominate other parts of the neem market
4. Cheetan keeps employees as his other neem products sell well
5. Tom makes more money off his Chetan-endorsed soap

Women’s Cooperative

Part I

Step 1: Determine the facts of the situation:
– In the region of East Africa, approximately 35% of children are stunted due to nutritional deficits, and there is a high HIV rate.
– Currently, mothers integrate gruel with breastfeeding from age of 2 months to 24 months. This gruel is not very nutritious (however the mothers believe it is), and could also contain pesticide residues.
– The WHO recommends exclusive breastfeeding until six months; however, in mothers with HIV, breastfeeding is not recommended as it increases the chance of HIV transmission
– We are assuming this case study is taking place in the past, and so there are neither HIV testing nor ART treatments available
– I am an entrepreneur starting a cooperative for women in this region
– The cooperative has a dual goal: (1) improve the nutritional status of the children by making a more nutritious porridge (in stead of the traditional gruel), using local produce (possibly contains pesticides), and (2) improve the livelihoods of the women in the cooperative by providing them an income
– This cooperative is funded by a grant
– The main ethical concerns which has to be addressed is how to implement this venture considering the high HIV rate and pesticide use. Is it more important to focus on avoiding HIV transmission (eating porridge with pesticides) or focus on nutrition (exclusive breastfeeding is the gold standard for infants)?

Step 2: Define the stakeholders:
– Mothers
– Children
– Donor
– Me (the entrepreneur)
– Women in the cooperative
– Local farmers

Step 3: Assess the motivations of the stakeholders
– Mothers: The mothers primary motivation is that they want their children to be healthy. This includes reducing the risk of HIV infection, not letting their children be negatively impacted by pesticides, and for them to be properly nourished
– Children: The children are directly affected by the breastfeeding and gruel. Their health is impacted by HIV transmission, pesticides, and the nutrients they obtain
– Donor: The donor’s primary motivation is for a successful cooperative which increases their reputation, and accomplishes the dual goals they intended to support.
– Me (the entrepreneur): My primary motivation is to make as much impact as possible and to accomplish my dual goals of providing a nutrias porridge for the children in the community, and ensure the cooperative is built sustainably so that the women in the cooperative can improve the livelihoods of their families.
– Women in the cooperative: The primary motivations of the women in the cooperative is to bring a stable income to support their families, and to use that money to improve the livelihoods of their children.
– Local farmers: Local farmers want to make money selling their crops, and therefore would want to sell their products to the cooperative since it would ensure.a stable income.

Step 4: Formulate alternative solutions

Since we are assuming that this community does not have access to ARTs (and HIV is therefore a death sentence), we decided that ethically, the priority of this venture should be on providing a healthy porridge option which can be implemented at a very young age in newborns, in order to minimize the risk for HIV transmission. Because of this, our solutions focused on the best ways to prepare porridge in the cooperative (in order to minimize the harm of pesticides).

1. Have the cooperative grow their own produce (pesticide-free), and employ more local women to do so. This solution is based on the duty-based ethical principle, which focuses on “do only that which you would want everyone to do.” In other words, we would not want out children and communities eating crops stayed with pesticides.
– There are many pros to this approach. First, it creates additional jobs for the women. Additionally, it is the only way we can ensure the crops are pesticide free, since we would be in full control of the crops.
– There are also several cons to this approach. First, it is probably the most expensive option, since we would have to obtain all of the infrastructure for farming, and would have to train all of the additional workers. Second, this could potentially harm the community, since we could be putting other farmers our of business.

2. As part of the porridge-making procedure at the cooperative, include a wash step. This is based on the virtue-based ethical principle, where ethics often times relies on judgement, and what is “honest” depends on the culture. Specifically, the gruel which children are using currently probably contains pesticides. Although this approach does not guarantee the removal of pesticides, it is a better alternative to the current gruel (more nutritious and less pesticides), and still helps to reduce HIV transmission.
– There are many pros to this approach. First, washing theoretically should remove pesticides from the food, eliminating any health challenges which may result from having pesticides in the porridge. Additionally, we accomplish our goals of creating a healthy, nutritious porridge, without needing costly investments like mentioned in solution 1.
– There are also several cons to this approach. Although washing technically should make remove pesticides, it is hard to measure if the wash step is effective, or if the procedure is being followed correctly. Additionally, the water we use to wash the food may not be clean, so we would still have to invest in a filtration system or risk causing more harm than good.

3. Develop a vitamin supplement powder which can be added to gruel so that the children can continue eating gruel but be more nourished. This solution is based on consequence-based thinking, focused on the benefits outweighing the costs. Although the children would still be eating pesticide-contaminated gruel, they would at least be getting the nutrients they need.
– There are many pros to this approach. First, this approach is probably the easiest to implement, since the women are already used to giving gruel to their kids. Additionally, because we are using the basic recipe, it is probably the cheapest option. Finally, this approach solves the malnourishment problem, and prevents the need for breastfeeding (therefore preventing HIV transmission).
– There are also several cons to this approach. First, the gruel the supplements would be added to may still contain pesticides. Second, the supplements may not be as nutritious as incorporating healthy foods. And finally, this approach probably requires hiring the least amount of women for the cooperative, since the supplements would be imported. Since the dual goal of this venture is to provide employment opportunities for the women to help them improve their livelihoods, this is a significant negative.

Step 5: Seek additional assistance
My primary resource for helping to determine the best course of action for this particular dilemma was to speak with individuals from the malnutrition team, who are working on a very similar project. They explained that they have learned incorporating whole, nutrias foods into children’s diets is important, but that supplements can be effective too if they are needed.

Step 6: Select the best course of action
In my opinion, the best course of action is approach two: washing the produce with filtered water to remove the pesticides. Like all three options, this solution will help prevent HIV transmission by allowing a healthy alternative to breastfeeding, while also creating employment opportunities. However, this solution was chosen as it best upholds the interests of all of the stakeholders, and is the cheapest, healthiest option. Specifically, this solution accomplishes the dual goals of providing a healthy, pesticide free, nutritious gruel alternative, while also maximizing employment opportunities for women (unlike the supplement solution) without taking away from local farmers (like solution one). Additionally, it is better than solution 1 because it is cheaper, and better than solution 3 because using nutrias whole foods is better than using supplements.

Step 7: What are the implications of your solution on the venture
Socially, this solution will have positive impacts on the venture, since it will maximize employment opportunities for women in the cooperative, without taking away from local farmers. Economically, this solution is a good option for the venture, since it avoids expensive investments (using local produce instead of starting a new farm). Additionally, by using local produce from farmers who are already established is a very economically sustainable option, since there will be very little maintenance or unexpected costs in the future for the cooperative. Environmentally, this solution is neutral. Unfortunately, our solution does not prevent pesticide use, which is bad for the environment. However, since pesticides are already being used, our solution does not specifically have an impact on the environment. Finally, this solution does not really have any technological impacts, since there is no new technology being developed.

Part II

Step 1: Determine the facts of the situation:
– See Part I, Step 1
– Six months after the launch, the cooperative is thriving
– Women work 9 hours a day, maybe KES 300, and have the opportunity to sell the produce grown on their farms to the cooperative
– Strong sense of community and identity at the cooperative
– Only problem is that when the women bring their earnings home, the women must turn the money over to the men in the family, who often waste it on frivolous things instead of helping the livelihoods of they families.
– I as the entrepreneur am on the leadership committee for the next six months
– The other six members on the committee are locals who understand the problem and want things to change
– The women in the cooperative are convinced nothing can be done because thats just the way it is in their community.

Step 2: Define the problem and stakeholders:
– The main problem is that the women are not able to use their earnings to support their families like they want to, but the community culture means that they have to give the money to the men in their families. Although we are not sure on the specific culture, asking the women to defy the culture could be dangerous for them, since the men could get angry. How can we continue to push for the dual goals fo the cooperative without putting the women in a bad position?
– There are several stakeholders in this problem: Me (the entrepreneur), the women in the cooperative, the children, and the men who are taking the money

Step 3: Determine and distinguish between the personal and professional motivations of the stakeholders
– Me, the entrepreneur: As an entrepreneur focused on social impacts, my personal and professional motivations are probably the same. Specifically, I want the cooperative to be successful and to achieve the twin social outcomes of financially empowering the women and providing nutritious foods for the infants in the region.
– The women in the cooperative: Personally, the women in the cooperative want to make money to support heir families, and for their children to be healthy. They probably also want to make sure their husbands (and other men in their families) are happy, and that they maintain a good relationship. Professionally, the women probably want the cooperative to be successful, to make money from the cooperative and their farms, and to work in a positive, community-focused cooperative.
– The children of the women in the cooperative: The children are personally motivated by their mother’s ability to provide for them and take care of them.
– The men of the women in the cooperative: The primary personal motivations of the men is that they want to be in charge of the money (as is the cultural norm), and want to be respected by their wives. In addition to taking care of their families, they probably also want to be able to enjoy themselves (and spend money on frivolous things).

Step 4: Formulate alternative solutions
1. Compensate the women in goods (for example, food, personal care products, etc) instead of money
– The primary pro for this approach is that the women are able to use their time at the cooperative to support their families, instead of having the money wasted on frivolous things by their husbands.
– The primary con for this approach is that the husbands may be upset that the women are not bringing any money back, and the women may be less willing to work long hours without monetary compensation. Additionally, it may be hard logistically to determine what the women want and need.
– This approach saves face for the women because they do not have to directly face their husbands about wasting the money, but are still getting what they want in terms of providing for their families. Additionally, this solutions saves face for the cooperative, because it would now be achieving its twin goals.
– In the short term, this approach may negatively impact the relationships within the families, since the men may be angry at the women for note bringing money home any more. In the long term, however, the family will hopefully be better off.
– In the short term, this approach will have positive implications on the venture since the women and children will be receiving things that they need (improving the livelihoods of the women, one of the goals). In the long term, the children may have more resources are be better nourished, but the cooperative may have trouble finding new women to join since there is no monetary reward.

2 .Instead of paying the women KES 300 per day, pay them KES 150 and provide KES 150 in equivalent coupons for them to exchange for food and personal products.
– The primary pro for this approach is that it is easier to integrate into families, since they are receiving both cash (which the husbands expect) and the products they need (improving the livelihoods of their families).
– The primary con for this approach, however, is that the men can still waste a lot of the money. Additionally, it may be challenging to determine which products should be offered in exchange for the coupons.
– This approach saves face for the women by allowing them to still bring money for their husbands, while they are still able to purchase (indirectly) the products they need for their families. Additionally, it saves face for the cooperative since it allows for the dual goals to be accomplished.
– In the short term, this approach may still have negative implications in the relationships within the family, since the men may still be upset at having less control over the income. – In the long term, families will hopefully get used to this way of compensation and the relationships will restrengthen.
– In the short and long term, this will hopefully have positive implications on the venture, since it will allow for the accomplishment of the twin goals (by allowing for the improved livelihoods of the families).

3. Give the women the option to receive shares in the cooperative instead of receiving cash. These shares will increase in value, and can be liquidated for a large lump sum of money.
– The primary pro for this approach is that the women will still be receiving money (therefore making the men happy), but because they would receive it in larger quantities, the men are less likely to spend it on frivolous things, and more likely to spend it on an investment, like purchasing animals for a farm.
– The primary con to this approach is that it does not immediately enable the women to help their children, and the men would still be in control of how the money is spent.
– This approach saves face for the women by allowing them to still bring money for their husbands, but in a different more, long-term focused way. Additionally, it saves face for the cooperative since it allows for the dual goals to be accomplished.
– In the short and long term, this approach probably will not impact the familial relationships too much, since the men are still receiving money and are ultimately entirely in control of how it is spent.
– In the short term, this option will not positively impact the venture, since the women won’t be able to use the money immediately to help their families. In the long term, however, it could significantly aid the women in improving the livelihoods of their families, by allowing them to invest in things which they need for the family.

Step 5: Seek additional assistance
In oder to make sure that the approaches were appropriate, I made sure to consider points made during class discussions, and to read about cooperatives (this allowed me to see how option 3 is feasible).

Step 6: Select the best course of action
In my opinion, the best course of action is approach two, because it allows for a win-win with all stakeholders, and allows for the twin goals of the cooperative to be best accomplished. Specifically, this solution is a win-win because the women get coupons which they can exchange for products and nutritious food which they need for their family, while the men get the money they expect based on the culture. Additionally, unlike option 3, this solution allows for the livelihoods of the women and their families to improve immediately, and unlike option 1, doesn’t jeopardize the future of the cooperative (men might not allow the women to keep working if they’re not bringing back any income. The primary challenge for this method is that it may be difficult to choose which products are available for the women to use their coupons on. This can easily be fixed however by making sure the women have an active say in how the strategy is operationalized.

Step 7: Sequence of actions to implement solution
– Survey the women in the cooperative about their opinions on implementing solution 2, on what products they would want available to them, and on any concerns they may have about how the men may handle the transition
– Obtain products in bulk to minimize costs, and set up prices / coupon system.
– If the women expressed any concerns about their husbands in the initial survey, make sure to address those concerns during the transition (for example, by sending a notification to the men about the change in payment structure, so that the women are not responsible for telling their husbands, therefore helping them to save face).
– Change the women’s income to cash plus coupons.

Grassroots Diplomacy & Saving Face in Kenya

Step 1: Determine the facts of the situation:
– Jack is an American student working on a social venture in Kenya, where he interacts with children and collaborates with local staff at a youth center
– One Saturday, kids under the age of 14 were given presents
– The presents were donated by international donor, and were staff members from the youth center picked up, organized, allocated, and labelled the gifts for the presents
– There was a gift-giving ceremony, where Jack was told to and out the gifts
– Four children did not receive presents. These four children received black hats from the staff (not Jack) after the ceremony (not in in a ceremonious way like the other children, instead they were simply shooed away)
– The children were under the assumption that Jack got them gifts (Jack did nothing to correct this false assumption)
– The kids who did not receive a gift handed out by Jack during the ceremony (and received a hat from the staff instead) blamed Jack
– Jack knows a good relationship with the kids will help him with his work at the youth center
– Jack met with the staff and discussed how the kids who did not receive a present felt left out
– The staff did not acknowledge the problem, were upset that Jack made it out to be their fault, and told him to fix it himself. The staff also called Jack a “children’s rights activist.” (The staff’s reaction could imply that the Jack does not fully understand the cultural norms at the youth center, or that he could have unintentionally criticized the staff on how they run the center).

Step 2: Define the problem and stakeholders:
– The main problem that Jack faces is whether or not he should do something more to address the children who did not receive presents, and if so what should he do. This problem is important to address because the way he responds could affect his relationship with the children and staff that he will be working with at the youth center, and could therefore affect the kind of impact he can make during his time doing social work there.
– There are three major stakeholders: Jack, the kids at the youth center, and the staff at the youth center. (Additionally, the international donor organization is a stakeholder, however, they are not as relevant as it pertains to the main problem described above).

Step 3: Determine and distinguish between the personal and professional motivations of the stakeholders
– Jack: Spending five months working on a social venture at the youth center, Jack’s personal motivation is probably to maintain a good relationship with both the kids and staff so that he can have an enjoyable experience. Additionally, he probably wants the kids to be happy. Professionally, however, his priority is probably to maintain relationships with the center staff, since they will be assisting him on his social venture.
– Kids: Personally, the kids are probably most concerned with being being treated fairly, and not feeling singled out. They all want to feel like Jack cares about them. (The children probably do not have any professional motivations).
– Staff: Professionally, the staff wants to maintain a well-run youth center and to feel respected and appreciated by visitors (Jack). Additionally, the staff wants to focus on important issues, and not have to worry about “trivial” or “unnecessary problems” which will take away from their work with the children. Personally, the staff is probably also motivated by the helping the kids and by being seen as people who care for kids at the youth center.

Step 4: Formulate alternative solutions
1. Jack approaches the staff again to explain his side (and apologize for making them feel like he was blaming them), and apologizes to the kids who did not receive gifts.
– This approach solves the problem and saves face of those involved by addressing the feelings of both the staff (they felt blamed when Jack approached them earlier, and were worried he was going to cause trouble in the future) and the children, (some of them felt that Jack forgot about them), while allowing Jack to maintain good relationships with both of them (by apologizing and explaining his side).
– The primary pro for this approach is that it allows all stakeholders to feel respected and appreciated. Additionally, it will make Jack feel better, since he is currently worried that the kids blame him. In the short and long term, this could positively impact the relationship between Jack and the staff/kids at the center, and therefore allow him to better complete his social work.
– There are several cons for this approach, however. First, if Jack does not articulate his apologies correctly, he may make things worse with the staff and/or children. Second, the staff already thinks that he is blowing the problem out proportion, and so by bringing it up again, they may get even more worried that he is going to create unnecessary problems for them at the center in the future, thereby worsening the relationship and the experience for Jack as well. Finally, although the children may appreciate the apology, it probably will not make up for the embarrassment they felt at being left out. Therefore, in the short term, this solution has the potential to make things worse for Jack’s relationships with the staff and kids, which could have long term implications on his venture since he will be less able to work effectively at the center.

2. Jack says and does nothing else about this particular gift ceremony, but makes sure to double check the fairness of anything else that he is involved in in the future.
– This approach solves the problem and saves face of those involved by following the staff’s implicit advice that it is a trivial matter that does not need to be addressed.
– There are several pros to this approach. First, in the short term, the relationship between Jack and the staff will be maintained since Jack will be following their implicit advice and not “creating any more unnecessary problems”. In the long term, this will positively impact the venture since good relationships with the staff will help Jack accomplish his social work. Additionally, in the long tun, Jack will hopefully also be able to rebuild the relationship with the kids who felt left out, by personally making sure something like that doesn’t happen again.
– The main con to this approach is that in the short term, Jack is doing nothing to address his relationship with the kids who felt left out. Despite this being a con, it does not have a negative short or long term impact on the venture, since the damage has already been done (the kids already feel left out, and nothing can really make up for that other than time to move on and forget).

3. Get gifts himself and hold a ceremony for the children who did not receive presents at the first ceremony (without necessarily getting approval from the staff, since they obviously don’t think it is a big enough problem to need fixing).
– This approach solves the problem and saves face of those involved by allowing the kids who didn’t get gifts to feel respected and appreciated in the same way that the other kids felt.
– The main pro to this approach is that it has the potential to improve the short and long term relationship between Jack and the kids who felt left out, which could positively impact his social venture (both now and in the future).
– However, there are many cons to this approach. First, holding a separate ceremony could potentially make the kids feel even more left out, due to the fact that they are being singled out again. Additionally, the kids who got a gift originally, but not at this ceremony, may now feel left out (both therefore negatively impacting the relationship between Jack and the kids, and potentially his venture). Most importantly, this approach will definitely negatively impact Jack’s relationship with the staff. They already think he is creating an unnecessary problem, and further undermining their authority could severely damage their relationship and any help they could provide to the venture in the short and long term. Although in most of the other solutions the long term impact is less concrete, this particular could severely damage Jacks relationship with the staff in the long-term, since what he is doing completely disrespects their authority what they said earlier.

Step 5: Seek additional assistance
– In oder to make sure that the approaches were appropriate for the Kenyan culture, we researched the Kenyan gift culture. Compared to the American gift culture, the Kenyan practices are much less concrete, and tend to be appreciated rather than expected, and of smaller value. Additionally, I researched a little more on mailing relationships in Kenya, and I learned that “maintaining honor and dignity are paramount” ( Because of this, in choosing my best course of action, I focused on not undermining any stakeholder.

Step 6: Select the best course of action
– In my opinion, the best course of action is approach two: Jack says and does nothing else about this particular gift ceremony. Based on the culture and the priority of saving face, this option is definitely the best solution (as described in detail above). For Jack, this solution is best option for maintaining good relationships, and therefore allowing him to work effectively for the remainder of his venture. For the staff, this is the best solution because it maintains their dignity (Jack follows their implicit advice) and prevents them from getting more worried that Jack will cause problems in the future. Finally, although this problem does nothing to undo the embarrassment that the kids who did not receive presents felt, it also does not make the situation worse. Ultimately, the children were already hurt by the being left out, and the only thing which can make them feel better is giving them time to move on and making sure that it doesn’t happen in the future (the other solutions had potential to help the kids, but also could have made things worse).

Step 7: Sequence of actions to implement solution
– Jack listens to the staff, and realizes that the problem is “trivial” and that he should not create unnecessary problems
– Jack does nothing else regarding this gift giving ceremony
– Relationships between Jack and the staff and kids are not impacted negatively, and they can grow moving forward, therefore positively impacting the venture
– In the future, Jack will make sure to check the fairness of any gift giving beforehand, and will respect the dignity of the staff and children in trying to solve any problems which he may notice (for example, if the same thing were to arise, he may point out the shortage of presents in advance, and kindly suggest presenting the black hats in the same ceremonious fashion)

Lesotho Case Study

Step 1: Determine the facts of the situation:
– Myself and a team of 10 other research will be spending 2 weeks in Lesotho studying a specific disease-causing pathogen
– This disease-causing pathogen is specific to the area, and the community members know it is there
– This research requires community members to show us the location / methods of collecting and storing water. Paying the community members who help us accomplish this is optional.
– My team’s goal is to publish as a result of this research (specifically, focusing on the lifecycle and characteristics of the pathogen)
– In the long run, the results of this research could help the community by aiding in the development of water purification chemicals
– There are two ethical concerns which have to be addressed. First, is it ethical to conduct this study. Second, is it ethical to conduct this study without compensating the community members for their time. In regards to the first question, we already know that it is ethical to conduct this study, as it is not explicitly a human subjects study (just collecting data on pathogen). The answer to the second question is a little more complicated, however, and is discussed in detail depending on the different potential solutions. Since the study can be conducted without the community members needing to take time out of their day (we could just “tag-along” as they go to collect water), it is ethical to run this study without compensation. Additionally, because the research has potential to benefit the community in the future, it is not necessarily exploiting the community for personal gains. However, in this case, the quality of our research might suffer. Since getting good quality research is essential for us to accomplish our goals (and help the community long-term), we have to consider how much extra participation from the community is needed, and we can accomplish this ethically.

Step 2: Define the major stakeholders:

– Myself and my research team
– The community members in the region where the research is being conducted / who use the water where the pathogen is found
– The organization who is funding the research

Step 3: Assess the motivations of the stakeholders

– Myself and my research team: As researchers, our primary motivations are to collect good-quality data, and to use that data to publish. In addition to this, we are probably motivated by the fact that by doing so, our research has the potential to actually help this community in the future.
– The community members in the region where the research is being conducted / who use the water where the pathogen is found: Members of the community probably have different motivations and interests as it pertains to this research project. Although the majority of the community members probably are motivated by the potential to have cleaner water in their community, many of them are probably more focused on their current situation; for example, on providing for their families and maintaining a strong community.
– The organization who is funding the research: The organization who is funding the research (for example a grant, university, or program sponsor) is probably most motivated by getting the best results for the least amount of money. For them, it is important to get high quality data, as prestigious publications will create a better name for themselves, attract more research teams, and contribute to their mission as an organization (for example, to improve global health, etc).

Step 4: Formulate alternative solutions

1. Partner with an established NGO on the ground in Lesotho, and compensate them for helping us conduct the research
– There are many pros to this approach. First, by working with an established organization, we know that we will be working with professional members of the community, who are dedicated to working towards long-term goals. Additionally, as an NGO, they probably have connections and resources (such as vehicles), which will help our research run smoothly. Finally, the bureaucratic nature of most NGOs will mean that the guidelines for compensation will probably already be established, and we will not have to worry about determining who or how much to pay.
– There are also several cons to this approach. First, the need to compensate an NGO for their time is probably the most expensive option. Additionally, the bureaucratic nature of NGOs may result in challenges (for example, getting the correct approvals and working with the right people).

2. Hire specific community members (for example, a community leader) to help us conduct the study, and compensate them an average working wage for their time
– The primary pro for this approach is that the quality of our research will be very high, due to the fact that we will be working with chosen community members. Additionally, the community members who we will work with will receive compensation which will help them provide for their families.
– There are also several cons for this approach. First, the need to compensate these individuals will result in higher research costs. Additionally, it may be challenging to choose the correct people to work with, and may create tension in the community if we do not hire fairly. Finally, by paying individual community members for their help, it creates future expectations that may negatively impact future research efforts.

3. Educate community members on the importance of the research, and work with individuals who are willing to volunteer their time in order to help
– The main motivation to choose this approach is to save money. Additionally, since the research can be conducted by simply asking to tag along with community members collecting water samples, it is ethical to not pay them.
– The main con to this approach is that the research quality may suffer. Because we are asking community members to volunteer their help, they may not be as forthcoming with taking the time to explain things or connect us to additional community members who may be helpful. Additionally, although the community members will know that the research may benefit them in the future, it is not helping their livelihood in the present.

Step 5: Seek additional assistance

My primary resource for helping to determine the best course of action for this particular dilemma was my own fieldwork experience in Sierra Leone. Having seen how beneficial being partnered with a local NGO was, I was able to choose the best course of action.

Step 6: Select the best course of action

In my opinion, the best course of action is approach one: to partner with an established NGO. Knowing that my primary goal is to collect high quality data while still conducting ethical research, I believe this is the best option. Having seen first hand how important it is to have local connections in order to navigate the cultural norms and navigation/logistical challenges, I believe this approach gives the best solution while minimizing cons for other stakeholders. For example, although community members will probably not be directly compensated (like in option 2), the NGO will be able to give us guidance on what is culturally appropriate/expected in terms of compensation for any individuals we may work with. Additionally, although the organization who is funding the research may prefer the minimal expenses of option 3, I believe that their interest in getting good quality data in order to extend their mission is a higher priority, and therefore would satisfy their interests.

Step 7: What are the implications of your solution on the venture

Economically, this solution will negatively impact the venture since we will have to compensate the NGO we are working with. However, as a result, the potential social impact of the venture will be positive overall. Although in the short term, the social impact will be neither positive nor negative (by choosing to work with an established NGO, we are avoiding any potential social complications of choosing which community members to pay), in the long-run, the social impact should be positive due to to the increased quality of the research resulting from an on-the-ground partner (which will ultimately lead to better health outcomes in the community). Similarly, there is a potential for this project to have positive technological outcomes, due to the high quality-research pushing advancements in water purifications (however, this is a long-term, indirect outcome). Environmentally, this solution should not have much of an impact, since we are working with on the ground partners and there should be no additional environmental impact by our project (for example, by using the vehicles which they are already using).

GSIF Fieldwork Lessons Learned

Three things I learned during my GSIF trip this summer:

1. Spending three weeks focused on learning about sickle cell in Sierra Leone, I had one main take away: our device has to be implemented as part of a bigger program. Although up until now our research has all focused on designing the physical screening device, the fieldwork made me realize that the biggest challenge in combating the high childhood mortality associated with sickle cell is with what to do next. Specifically, although most healthcare workers in Sierra Leone know about sickle cell and agree that it is a problem, there are only two centers in the whole country which provide treatments for diagnosed individuals. In other areas, even when a patient is suspected to have sickle cell (there aren’t diagnostic services available to confirm), nothing is really done. This is because there aren’t any national protocols in place on how to treat sickle cell. Additionally, although most healthcare workers know that prescribing folic acid helps, the majority that we spoke with did not even bother prescribing it to their patients, because they knew they would stop taking them because they weren’t free. In this way, in order to actually ensure that our device helps, it would have to be implemented alongside public education on the symptoms and treatments of sickle cell, a government policy change on national protocols for treatment, and a sustainable funding source for providing life-long treatments.

2. In addition to learning a lot about the future direction of our project, my fieldwork experience also allowed me to learn a lot about the global health arena. In Sierra Leone, everywhere you look you see signs stating which government or NGO funded that building or program. Despite the global support, most healthcare workers we spoke with expressed a need for more help. Many of them told us that people and projects come and go trying to help, but most of them end leaving an even bigger gap. Hearing some of these comments, I learned just how important sustainability is in making an impact.

3. Finally, during my time in Sierra Leone, I learned a lot about ethics and privilege. Coming in to Sierra Leone as white Westerners, we were automatically given a lot of access. For example, whenever we arrived at clinics (often unannounced), the healthcare workers would stop everything to speak with us, leaving their patients to wait for services. Although part of this was probably due to the welcoming culture in Sierra Leone, I think a lot of it was also due to the perception that we were “coming to help.” Having seen this over and over, I learned how important it is to be aware of your privilege, as well as making sure to present yourself ethically (for example, later in our fieldwork we found out that many of the individuals we were interviewing thought we were medical students or healthcare workers; knowing this, I believe that we should have been more upfront with who we were, and what exactly our projects were looking to accomplish).

Three ways the GSIF trip facilitated my professional development:

1. One of the most important professional skills I developed during the field work was how to network. Speaking with doctors, NGO representatives, researchers, and someone from the WHO, I gained invaluable practice in building relationships and speaking professionally. As one of the most important skills for building a career, this experience will be particularly beneficially in the future.

2. Additionally, I developed skills working as a team, both with peers and advisors. For example, although some of my team’s early interviews were confusing and jumbled, by learning off each others strengths and accepting constructive feedback, we were quickly able to figure out how to work together to get everything we needed from an interview efficiently and smoothly.

3. Finally, during the GSIF fieldwork, I developed significant cross-cultural communication skills. Two of the most valuable lessons I learned about communicating cross-culturally with and without translators is to be very precise and avoiding leading questions. For example, when asking villagers about sickle cell, we noticed that our translator would sometimes include additional descriptions which weren’t necessarily accurate, and we would therefore get answers which didn’t always make sense. Additionally, we noticed that we could get very different answers depending on how we asked questions.

Three ways the GSIF trip helped me grow personally:

1. One of the biggest ways the GSIF trip helped me grow personally was by reaffirming my career goals. I have always wanted to be a doctor, and recently that aspiration has grown specifically to working in developing countries with organizations such as MSF. Not only did this trip help confirm that I love working in that environment, but seeing all of the health challenges and knowing my own skills and interests, I realized that that future really is the best fit for me, and will also allow me to make the most impact.

2. Additionally, this trip was especially beneficial at pushing me to be more comfortable in uncomfortable situations, and in being more confident. Working in unfamiliar environments, as well as with highly accomplished professionals, I quickly grew in my ability to navigate these new situations.

3. Finally, this trip made me realize how much I enjoy working on a project which has true potential. Speaking with doctors in Sierra Leone, we realized that there truly is a need for a low-cost sickle cell screening device, and that many people want to work with us. Getting this feedback was incredibly motivating, and inspired me to continue focusing on projects which I am truly passionate about.