Conceptual Framework – Project

Sickle Stick (name still TBD) focuses on the idea that all individuals with sickle cell disease should be able to live a fulfilling life. The opening slide depicts how sickle cell disease reduces life expectancy (the blood cells shown at the top of the graphic are sickle-shaped and stick together, causing blood clots); however our dream is that sickle cell patients are able to live fulfilling, long lives similar to individuals with normal blood (normal blood cells shown on the bottom of the graphic).

The low education on prevalence, causes, symptoms, and management, the absence of screening programs, and diagnostic capabilities, and the limited access to treatments (financially, availability) are the underlying systemic problems preventing people in result in Sierra Leone with sickle cell disease from living long fulfilling lives. In Sierra Leone, 50-90% of individuals with sickle cell disease will die before the age of 5, and most of these children are never even diagnosed. Children who do live long enough to present with symptoms often still remain undiagnosed. If sickle cell disease is suspected patients receive little to no guidance on how to handle symptoms and usually don’t have access to proven, cheap treatments because of the low education, lack of diagnostic capabilities, and limited access to treatments. These three undressed problems results in a large loss of life as well as low qualities of life (increased risk for infection, frequent pain crisis and stigma) for the patients who are left untreated.

 

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.

Systems Thinking Post

Part I

  • Interdependence: The relationship, dependence, and connectedness of different systems on each other
    • Ukweli relies on Hassan to accomplish his mission of distributing test strips and collecting data to ultimately reduce maternal mortality in Sierra Leone, and Hassan relies on Ukweli to get paid.
    • The Malnutrition team relied on Bettah bakery for baking space, while Bettah bakery relied on us for business knowledge and help to grow.
  • Holism: Individual parts are dependent on each other and produce more value together than they would on their own
    • The Malnutrition team has many bioengineers that have taken similar classes, but when put together, they know more than what they know themselves
    • The Sickle Cell (SC) Screening team needs to pair their final test strip with a treatment program. Without the treatment program, the knowledge from the test strip (positive for SC or negative for SC) is useless because medication/treatment is necessary. 
  • Multi-finality: Achieving different outcomes from the same original process, “win-win for everyone” 
    • The network we have formed in GSIF has our own goals for our own projects, but overall, GSIF wants to find sustainable solutions to health and development problems in Sierra Leone
    • Mushrooms team creates income for Jawara and rice farmers and addresses issues of nutrition in poor communities.
  • Equifinality: There are many approaches that can be taken to reach the same goal
    • There are several different recipes that the Malnutrition team can use to lower child malnutrition rates in Sierra Leone
    • There are many different aspects (travel to clinics, light in birthing rooms, ANC days)  of maternal healthcare that can be focused on by the Safe Motherhood Documentary in order to reduce material death/improve maternal healthcare. 
  • Differentiation: Within a given system, specific and unique parts are performing specific functions distinct from one another.
    • In the Ukweli operation, Wancheng is responsible for shipping the test trips to Freetown, Allieu is responsible for getting them to Makeni and Hassan is in charge of getting the strips to the clinics and CHWs. Each needs the other in the larger operation to function, but each is also its own subsystem.
    • For all teams we must be able to balance and divide our personal and professional relationships. We have to be able to disagree, agree, and build off of each others ideas in order to make progress as a group. 
  • Regulation: Making sure that intentions and actions match up with each other.
    • The Malnutrition team will be having clinical trials to make sure that we are actually reducing child malnutrition the way we say we are
    • The Sickle Cell group will be running many confirmatory tests, including a clinical trial (with a verification test, the gold standard), in order to insure the test strip is able to diagnose Sickle Cell Disease with a certain level of accuracy.
  • Abstraction: viewing a system from a birds eye view approach, thinking through complex scenarios with a level of higher context and in broader terms
    • Thinking of the Ukweli operation through a context of the larger Ministry of Health perspective and what they need and deal with at a nationwide perspective
    • Expanding projects to multiple countries eg. whatever Khanjan is doing in Liberia and Madagascar
  • Leverage Points: A small area within a given system where a small change can be made in order to produce big change.
    • CHWs are an easily accessible and effective part of the healthcare system
    • By charging a fee (~$5) to mothers giving birth at home, mothers will go to the clinic saving many lives.
    • A small change in the Malnutrition team’s product can make a huge change in the effectivity of our product.

Part 2: Emergence 

Explanation: Emergence is the process of an entity coming into view. When the parts together have different properties/behaviors than they do alone the entity is able to emerge.

Example: An emergent system that creates sustainable and scalable social value are social movements. The social movement “Black Lives Matter” is sustained by the people that support it however the movement is not owned by the people. These are the two parts (idea and people) that come together to emerge.

Part 3: The solution to water hyacinth

Processing Side 

  1. Employ community to gather hyacinth and pay for the supply by the kilo

Marketing Side (BEST SOLUTION – explained below)

  1. Partner with the fishermen to sell the briquettes with the fish (need the briquette to cook the fish), they can make money and will help the entrepreneur collect the hyacinth. Only fisherman that want to be involved will be hired/become a partner. The other fisherman who aren’t involved originally will feel like they are missing out once they see the success of the original fisherman and will then want to join the venture. 

Other

  1. Sell briquettes to community
  2. Partner with a certain group of fishermen, in a certain area and provide discounted or free briquettes.

Explanation:

The marking side solution, to partner with the fishermen and have them trade hyacinth for briquettes to sell with their fish is a solution that exhibits tenets of multi-finality, holism and regulation. With the fishermen and the briquette venture working together both entities are improving. The fishermen are able to increase their income by minimally increasing/or not at all, their workload by providing hyacinth (collecting – which they may already do in order to travel in their boats) in exchange for briquettes that can be sold along with their fish, increasing the purchase value. The briquette venture is able to obtain a consistent source of hyacinth by only providing a fraction of the product back to the suppliers. The main fraction of the product is revenue for the briquette venture. These two entities (fisherman and briquette venture) are working together in order to benefit themselves in very different ways (multi-finality). Without each other the two entities would most likely be successful but not to the extent they will be together (holism). If one of the entities are not happy with their benefits/outcomes they are free to disengage from the partnership. The briquette venture will provide the appropriate number of briquettes for the amount of hyacinth brought in therefore, the fisherman determine how many briquettes they receive (regulation).

 

 

Possible Partners

Partners

  1. Dr. Cheedy Jaja
    • Learned about Dr. Jaja’s work 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. 
  1. Sia Evelyn Nyandeno (SCCAN)
    • Traveled to Kono to meet Dr. Jaja at the Jericho Road 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 Clinic 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. 
  2. Sickle Cell Society
    1. Mrs. (Sister) Amelia Gabba (Sickle Cell Society) 
    2. 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. 
  3. 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. 
  4. 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. 
  5. 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. 
  6. 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. 
  7. 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. 
  8. 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. 
  9. 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: 
  • 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 
  • 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.
  • 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 
  • 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 

 

Playing By Strengths

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.

Roles: 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. 

Procedures: Decisions on experiments and next steps forward (grants, publications, protocols) 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 power points; 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. 

Relationships:

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. 

Case Study 4: OOPs and Chetan

Case 1: Ethical Decision Making 

1: Facts of situation:

  • The 14 million trees in India have been used extensively over the past 2,000 years for medicinal purposes, food production, toiletries, fuel, and pesticides
  • Azadirachta indica (Neem) a tree indigenous to India
  • Neem is sacred
  • Neem is used for medical purposes, food production, toiletries, fuel, and pesticides
  • India employes about 100k people and used in pesticide industry
  • Pesticides are used widely across India
  • Chetan lives in Agra, India and operates a small business of neem tree products
  • including pesticides, skin creams, contraceptives, lamp oil and many other products
  • Family owned biz Chetan has HS education
  • Chetan employs 60 people
  • Does quality control reference 
  • Chetan does not know the exact name of the neem seed extract, Azadirachtin
  • Has cultural knowledge but not a lot of knowledge in the science end
  • Tom Johnson is developing neem seed pesticides (affiliated with OOPS)
  • Johnson’s co invested 5mil to conduct safety and performance tests over last decade
  • Tom’s company has certification (patent) through the EPA to sell pesticides (worldwide patent)
  • Tom has made profit of 12.5 million during his first year
  • OOPS wants to set up biz in India
  • Economy of scale at play bc OOPS selling all over world and will likely put Chetan out of business
  • OOPS is demanding a royalty from Chetan’s business and other small industries that make neem-based insecticides

Problem

What rights does Chetan have and is it ethical for the US company to uphold their patent rights? 

Stakeholders and Motivations

  • Chetan
    • Professional: Chetan wants to maintain his business without the royalties charged by OOPS ruining his venture
    • Wants to see his families generation long venture continue
    • Personal: Can be assumed that Chetan would struggle supporting his family members if his co. collapses bc royalties
  • OOPS
    • Prof: They want the business to work in India. 
    • Personal: they want to provide effective organic solutions to pesticides so people do not get sick and that they can protect the patent 
  • Tom Johnson
    • Prof: Tom wants money and he wants his business to be successful. He wants to tap into the market in India 
    • Personal: He might want to give back.. I.e. help Indians
  • Chetan’s Family
    • Prof: not really
    • Personal: Wants to see the business grow. Distrust for westerners. They know the market very well. They hold the plant sacred and might be sus of the westerners. 
  • Chetan’s employees (60+)
    • Personal: Want to keep their jobs to provide for their families. Same distrust of western influence as Chetan’s family. 
    • Professional: Want a stable job that gives them income. 
  • OOPS investors
    • Personal: n/a
    • Professional: Want the company to be as successful and profitable as possible. Also want the company to act ethically so that there are no scandals. 
  • Other small Indian ventures that will have to pay royalties
    • These ventures will be charged royalty by OOPS on products that are tied to their patent. This would negatively impact their ventured greatly and may put them out of business
  • Indian People
    • Personal: want the product to stay the same price or go down 

Alternate Solutions 

  1. Legal way (Patent binding)
    1. Tom obtained the patent so Chetan has no option but to pay the royalty
      1. Pros: Tom makes a lot of money and he is successful 
      2. Cons: Tom puts people out of business and he is disliked by many causing his business to fail. Chetan is run out of business. 
  2. Something in between: Tom Johnson and OOPS understand that entering the Indian market and collecting royalties from Chetan’s business will put Chetan out of business. To compromise, OOPS hires Chetan and his employees for a standard working wage. OR OOPS buys Chetan’s company
    1. Pros: Chetan and his employees already know how to make neem based products, Chetan also already has a following (loyal customers) Chetan and his employees retain a job. 
    2. Cons: Wages under OOPS might not be the same as the wages Chetan and his employees were making independently. The change in oversight might be hard to adjust to and Chetan’s past employees may take their frustrations out on him. 
  1. “Moral Way”
    1. Tom does not make Chetan or any other neem company pay a royalty to use neem in their products
      1. Pros: Smaller neem companies are able to stay in business, Tom will be in good standing with the other neem company and will be in a position where he can possibly partner/ask favors from them. 
      2. Cons: Tom will not be earning the money from his hard earned patent, OOPS could be run out of business by the local businesses.  

Best Course of Action

The best course of action would be something in between, number 2. It is not in Toms best interest to follow through with solution 1 or 2. If Toms goes with solution 1 or 2 there is a good chance OOPs will be run out of business. For option 1, Tom would have to go through a legal battle to ensure neem businesses are paying their royalty, Tom and OOPs will be receiving a lot of bad PR which can turn the loyal neem customer base against OOPs. While Tom is trying to make more by having businesses pay the royalty he will still end up going out of business because no one will want to buy OOPs products. For option 2, Tom is “giving up too many of his cards”. Tom has the upper hand by having a patent and the ability/infrastructure to make companies pay the royalties by caving and asking for nothing he is taking a big risk. The royalties might be the only thing that holds OOPs together; Tom can not insure the loyal neem customers will leave their regular providers to buy from OOPs. In order to take the less risk and predict the best outcome it is safest for Tom to make a deal with Chetan; to pitch to him (Chetan) that he should sell or come work for OOPS and that all of his long lasting employees also have a new home with OOPs. Tom will make the argument that if he enforces Chetan to pay the royalties he will be run out of business so in order to carry on his legacy and ensure his employees have jobs Chetan and OOPs should partner up. This is the best course of action for Tom however this might not be the best option for Chetan. The change in oversight and not having control over the process would be a hard adjustment for Chetan. Not running the business might also be a big issue and could be a loss in the family’s eyes and might even be worse than just selling the company. However, the argument for Chetan can also be turned the other way, it might be a better idea to have any type of legacy carry on than none. Finally, I do not believe this is an ethical decision making case study. I think it is a decision that is completely based around the possible business implementations. 

Implications

A number of the implications are talked about in the solutions, and are used as reasons not to/to follow that solution. The main implication that both OPPs and Chetan are trying to avoid is being run out of business. Worst case scenario, Chetan partners/joins/sells to OPPs in order to save his business and employees however, OOPS still runs out of business because customers do not like the idea of buying from a foreign company, they want to buy from a locally run neem company.   

Case 2: Grassroots Diplomacy

The Facts 

  • OOPS launched 6 months ago, crushing market
  • 20 different products
  • neem based soap – most successful 
  • OOPS wrapper features a photo of Tom Johnson
  • Chetans wrapper features a photo of the founders great grandfather
  • Chetan has tried to convince Tom to leave the market or collab
  • Tom will not leave market 
  • Tom is open to collaboration if it will make him money
  • Chetans business if suffering will have to lay of half his staff
  • Employees and families have worked with him for centuries
  • Chetan will not suffer as much from declining business because of his investments
  • Chetan s employees know he met with Tom 
  • Believe Chetan has cut a deal with Tom/OOPS
  • Employees feel cheated and abandon 
  • Some employees have resigned to their fate
  • Some are confident Chetan will find a way out 
  • Some want to physically want to beat Chetan up 

Problem:

OPPS is dominating the neem product industry and small business owners like Chetan and his employees are in danger of going bankrupt and want OPPS to leave the market or collaborate. 

Stakeholders and Motivations: 

  1. OOPS
    1. Personal/professional: Want to keep business growing and keep control over the market 
  2. Tom
    1. Personal: Wants to be the top dog, wants Chetan to pay the royalty 
    2. Professional: Want OOPS to grow bigger and make more money. Provide neem products for indians. 
  3. Chetan
    1. Personal: Family legacy is on the stake. Employees are friends (assumption because they are long term employees) and he doesn’t want to seem like a bad friend by betraying them. 
    2. Professional: Don’t want to go out of business and don’t want to lay off their long term loyal employees.
  4. Chetan’s family
    1. Personal: Don’t want to lose the family legacy. They’d feel sad if they have to fire employees who are also their friends. Don’t want to feel financially unstable when invested money later decreases too low. 
  5. Chetan’s employees
    1. Personal: They’re long term employees and so are their relatives so it’s a personal business to them. 
    2. Professional: They need the money to make a living so they can’t be fired. 
  6. Employees’ family
    1. Personal/professional: They need their breadwinners to make money to provide at home otherwise they could starve and die. 
  7. Neem customers
    1. Personal: Desire to get neem products at the cheapest price. Want the neem products they trust/have loyalty too. 
  8. Other small neem product businesses
    1. Personal: Keep their employees’ jobs.
    2. Professional: Continue making money/grow profits
  9. Neem growers/gardeners 
    1. Personal/professional: Want to make money selling neem.

Alternate Solutions

  • Solution 1: Chetan leaves his business and negotiates with Tom to find jobs for his employees at OOPS
  • • How does it solve the problem?
    • o Pros: Chetan’s employees have jobs, OOPs no longer has Chetan as a competitor, OOPs could possibly gain Chetan’s customers if they hire his employees
    • o Cons: Chetans family business dies, Chetan/his future family may have to find work somewhere else in the future (even though he is well off now) 
  • • How does it save face of those involved?
    • Chetan will be able to say that he went out with the upper hand because he got his employees jobs. 
  • • Implications on relationships
    • o Short-term: Chetans employees feel resentment toward Chetan because he bailed on the company but they are grateful because he found them new jobs. 
    • o Long-term: Cheten and his family could lose their connections and respect within the community because they no longer have the long lasting family business (something to define them) 
  • • Implications on the venture (OOPs)
    • o Short-term: Might be a learning curve, gaining and training all the new employees. Transition of the new employees might cause some tension. 
    • o Long-term: OOPs makes more money ,is more successfully, moves on to phasing out other neem businesses
  • Solution 2: Cut a deal with Tom to use Chetans’ business’ image and brand name to further penetrate the Indian market, Chetan receives compensation from this deal (for using his brand) and his employees receive jobs.
  • • How does it solve the problem?
    • o Pros: Chetan gets to continue employing his workers, and his family’s legacy will continue on. 
    • o Cons: Will likely have to surrender business capital and/or oversight. Chetan won’t have much of a say in how the business is run. 
  • • How does it save face of those involved?
    • Chetan will be able to continue employing the same families and continue to generate a profit. Tom will grow his business and profit margin.
  • • Implications on relationships
    • o Short-term: Chetan will maintain his relationship with his employees and generate a relationship with Tom and OOPS
    • o Long-term: Chetan’s relationship with his employees may remain strong, but as his business and Tom’s continue to dominate the market, there could be increased tensions with other Indian Neem businesses and their employees.
  • • Implications on the venture
    • o Short-term: No layoffs will occur, management will likely change
    • o Long-term: The employees’ jobs will be safe, the overall business structure will be permanently altered, they will edge out other small Neem businesses
  • Solution 3: Chetan and Tom do nothing. Chetan will help his employees find jobs elsewhere (letters of rec). 
  • • How does it solve the problem? 
    • o Pros: It eliminates the tension between Tom and Chetan. Chetan’s employees can find new jobs and provide for their families. At least some of employees will remain employed 
    • o Cons: Chetan’s legacy dies. There is no guarantee that his past employees will find new jobs in a timely manner. Customers may feel betrayed and may have a bad lasting impression of Chetan. 
  • • How does it save face of those involved?
    • Chetan can confidently say that he never gave in to the forign company. 
  • • Implications on relationships
    • o Short-term: Chetans employees feel resentment toward Chetan because he bailed on the company but they are grateful because he is helping them find new jobs/writing letters of rec. 
    • o Long-term: Cheten and his family could lose their connections and respect within the community because they no longer have the long lasting family business (something to define them) 
  • • Implications on the venture
    • o Short-term: Chetan’s business ends, Chetan’s customers feel like they have been betrayed because they can no longer buy from their favorite neem business 
    • o Long-term: Chetan and his family will not have enough money to carry on with what they had left over from the business. Chetan’s customers will eventually transition over to OPPs, OPPs will gain more customers and will become more successful 

Best Course of Action

Chetans best course of action would be, solution 2, to cut a deal with OPPs that benefits the employees and Chetan. Solution 1 and 3 are not viable because Chetan does leave the market with anything to show from it. These two solutions are also unfavorable for the employees because for solution 3 they are not guaranteed a job and solution 1 they are going to work for OPPs without their long time boss, Chetan. Solution 2 is optimal because Chetan is still carrying out his legacy, by letting OPPs use his branding (his great-grandfather’s face) and bonus he will be receiving a steady compensation for it. Chetans employees receive jobs and still feel like they are working for the family business because it is their (Chetans) branded product they are still providing with OPPs. And finally OPPs will also benefit from this deal for they are receiving the rights to the branding that is holding them back from taking over the entire market. OPPs will be gaining a large number of customers with this deal and ultimately money. They are also avoiding bad PR by partnering with Chetan instead of just running him out of the market.

Steps to Implement Best Course of Action

  1. Chetan and Tom/OPPs will meet in private and will discuss Chetan’s plan (to give up his branding, receive compensation, employees plan). 
  2. Once Tom/OPPs has agreed to the plan, specifies will be worked out/discussed, type of branding OPPs can use, how much Chetan will be receiving as compensation, wages and positions for employees. 
  3. An announcement will be made that Chetan and Tom/OPPs are partnering and the plan for employee integration. 
  4. Chetan employees will be phased in to work at OPPs after Chetan’s business officially closes. 
  5. Chetan will start receiving compensation for the branding, Chetan’s employees will be receiving consistent work, OPPs will be more successful on the market. 

Case Study 2: Grassroots Diplomacy

The Facts

  1. Jack is American on a social venture
  2. Jack is at a youth center in Kenya
  3. Int. donor Org. sent gifts for the children at the center
  4. Children are younger than 14, 4 of them did not receive gifts ceremoniously
  5. Jack was in charge of handing out gifts
  6. Jack was thanked for the gifts by the children
  7. Children were convinced the gifts were from jack
  8. Jack is going to be there for 5 months (lots of contact w/ the children)
  9. Children that didn’t get gifts blamed jack
  10. Staff did not care about the children not getting gifts
  11. Staff calls Jack a “children’s rights activist” because they were annoyed that Jack brought up the 4 children not receiving gifts and how he felt awkward

Stakeholders and Motivations

Both: Personal and Professional Motivations

  1. Jack
    1. Both: Wants to be liked by the children/wants them to be happy (save face)
    2. Both: Wants the venture to be successful and to be praised for his work, gain (even more) approval from the university/people backing him
    3. Professional: Wants to keep a good relationship with the center staff
    4. Personal: Wants to be approachable and be able to candidly speak/hang out with the children and center staff during his 5 months there 
  2. Children that got gifts
    1. Personal: Like Jack for giving them gifts, that situation gave him a good first impression
    2. Personal: Think the foreigner (Jack) got them the gifts and will get them more (bringer of gifts)  
  3. Children that did not get gifts
    1. Personal: Want to have the same dignity as the children that received the gifts ceremoniously, don’t want to be seen as “ unworthy” of receiving gifts  
    2. Personal: May think that Jack doesn’t care about them 
  4. Youth center staff
    1. Professional: Don’t want their work to be seen as unfair
    2. Professional: Do not care about the issues of the children, they care about the bigger picture and not about one kid, that didn’t get one gift, one time 
    3. Professional: Want Jack to help the youth center (make a difference) and do the work he is there to do, want his work to benefit the center/community as a whole (not just one child) 
    4. Personal: Want to be seen as people who are doing well and care about the children
  5. Int. donor Org. (Gift funders)
    1. Both: Want to look good, need to uphold a reputation that they are doing good, therefore they sent gifts to the children at this center
    2. Professional: Want to successfully present a nice gesture
  6. University (Jack)
    1. Personal: Want this venture to bring good publicity to the school
    2. Professional: Want the social venture to prosper and their funding to go to good use
  7. Parents of the children
    1. Personal: Want to send their children to good youth center that cares about their children
  8. Locals (Will hear about situation from parents of children)
    1. Personal: Could be expecting parents and may not want to send their children to the youth center

 

Possible Solutions

 

  • Jack finds/makes/orders gifts to ceremoniously give to the other children in front of the group

 

      1. Pros: The children who did not originally receive gifts would be happy because they were validated and got their gifts and ceremony. This act would mend Jack’s reputation/relationship with the original children who were originally affected/received a bad impression of Jack from the first ceremony. This will also make him look better in the parents and communities eyes because the event proves he truly cares.    
      2. Cons: This could cause an issue between Jack and the children who originally received a gift because some children have 2 gifts (black hat and gift) and some have 1 (gift). This will cost Jack money and time both of which could have been used for the venture. In order to pull off this ceremony Jack will need help from the center staff; the center staff already thinks Jack has overreacted and will resent him/dislike him/have a worse impression of him for making them do extra work. This event will also emphasize to the staff that Jack is a child rights advocate and could turn them off to working with him which could potentially greatly affect his venture. This event will emphasize to the children and the children’s parents/community members that Jack was originally responsible for not having enough gifts for all the children.

 

  • Jack wears a black hat every day (frequently) to make the other children feel special

 

      1. Solution pros: The children that were originally left out from the ceremony may feel more included, respected, or dignified since the foreigner/adult is also wearing their hat. The issue with the staff is mended with time, tensions from the ceremony will eventually fade as long as Jack leads the movement/makes an effort to move past that one moment. This solution allows Jack to save face quietly, and without confrontation, solving the issue with the children/community and the staff, and avoiding conversation that could potentially come across the wrong way, making things worse. By solving everyone’s adverse feelings towards Jack this solution benefits the venture by allowing it to continue without a bad reputation behind it. 
      2. Solution cons: The children that did not receive the original gifts could still be upset because the hat was not given to the ceremoniously. The children that did not receive the hats could feel left out and think that Jack does not like them/think they are cool because they don’t have a hat. Could result in a divide between the children and the community. The center staff could still hold a grudge against Jack which would hinder collaboration and productivity affecting the venture. 

 

  • Jack approaches the staff to try and save his own face by suggesting they change their perspectives on working with the children

 

    1. Solution pros: This straightforward solution will allow both Jack and the center staff to be on the same page when it comes to working with the children and would solve the awkwardness/tension formed from the ceremony rapidly. Would hopefully ease the tension from the ceremony and restart Jack and the center staff on the right foot. Could possibly change the centers staffs mentality to help improve Jack’s experience for the rest of the time he will work there. Could lead to increased levels of collaboration and productivity that would otherwise not be achievable. Could result in a better relationship between the children and the staff, bettering the youth center overall. 
    2. Solution cons: This solution only addresses Jacks issue with the center staff not the children. The children who did not receive gifts could possibly spread rumors about Jack and influence the other children not to like him. this would greatly impact his relationships with the children who he is supposed to be working closely with for the next 5 months, ultimately, greatly affecting the venture. Jacks suggestions could come off as inconsiderate because even though he might be right (it is wrong that only some kids get gifts and others don’t) he truly do not know the constraints the staff is working in and that there are probably way bigger issues than a few children not being presented a gift. This situation of Jack confronting the staff forms sort of a power complex; the staff could feel obligated to do what Jack wants them too because he is a foreigner and it could be frowned upon making foreigners upset. This solution could backfire and completely ruin Jacks chance to save face; he could lose dignity in the eyes of the staff and ultimately lose social influence. All in all, this solution will lead to less productivity and collaboration between Jack and the staff and Jack and the community/children.

Additional Assistance 

  1. Kenyan gift culture: Kenyan Gift Culture
    1. Guests invited to someone’s home may bring a small gift of appreciation.
    2. Common gifts to give are flowers and tea leaves.
    3. In rural areas of Kenya, coffee, sugar, flour, and maize are usually given. These gifts are presented in a woven bag (‘kiondo’ in Kikuyu). The host will return the bag at the end of the visit after placing gifts for their visitor inside.
    4. It is impolite to return a kiondo empty.
  2. American Gift Culture:  American Culture
    1. If you are invited to a wedding, baby showers, bar mitzvah, or other celebration, it is expected that you will bring a gift. Unless you know the host very well, the gift should be modest in value, about $20.
    2. For a wedding, the bride will have “registered” at one or two local department stores, indicating the items and styling she prefers. You can buy the couple a gift that isn’t listed, but most people buy something listed on the registry. If you buy an item listed on the registry, be sure to tell the store that you are doing this, so that the couple doesn’t receive duplicate gifts. For a baby shower, bring a gift appropriate for a newborn baby. For a bar mitzvah, bring a gift appropriate for a 13-year-old boy. Bar Mitzvah gifts tend to be more formal in nature. For example, a gold-plated Cross pen is quite common. Personalizing the pen by engraving the recipient’s full name will be appreciated.
    3. If you wish to give a gift when you leave to return to your home country, the best gift is something that is unique to your country. It does not need to be especially valuable or rare, just reminiscent of your home. Possibilities include a book about your country, an inexpensive handicraft or piece of art, or something else that reflects your culture. If the children collect coins and stamps, they would be very pleased with a set of your country’s coins or a selection of mint stamps from your country. Items that are common in your country but difficult to find in the USA are also good.
    4. If you owe a debt of deep gratitude to an American host family, a common way of repaying it is to take the family to a form of entertainment, such as a baseball, basketball, or hockey game, the ballet, or to a good restaurant.
    5. When giving gifts to a business acquaintance, do not give anything of a personal nature, especially to a woman. Do not give cosmetics. A scarf is ok, but other types of clothing are not. Something appropriate for the office is the best. But gift-giving is not as important in America as it is in other countries, so there is nothing wrong with not giving a gift.
    6. If you need help selecting a gift, talk to a salesperson at a department store. Tell them about the person who will be receiving the gift and the reason for the gift, and they will help you find something appropriate and within your budget.

The best course of action

In order to effectively mend Jack’s relationship with the children who did not receive the gifts and the center staff, Jack should wear the black hat that was also given to the children. Even though the children were not given the hats ceremoniously by wearing the hat Jack will hopefully make them feel included and respected. If the children appreciate this gesture this solution will mend his relationship with those specific children but also the other children and the community members who could have been influenced by these children’s adverse feelings toward Jack. The community members, children and staff will also be able to visually (with the hats) see that Jack truly cares about these children and that he wants to make things right. Jack will insure that the situation does not being clique by only wearing the hat every so often in order to insure the other children do not feel left out. 

With this solution, Jack will be able to mend his relationship with the center staff quickly and quietly. He will also be able to avoid confrontation which could possibly backfire creating more of a misunderstanding/divide between himself and the center staff/community. The staff will realize that Jack cares about the children (from his act of wearing the hat) but also that he respects how the staff felt about the whole situation. If Jack had confronted the staff about the issue or had told them that they needed to hold another ceremony, the staff would resent Jack even more and truly believe that he is a child’s rights advocate. The staff’s attitude toward Jack would radiate onto the communities view of Jack which would ultimately greatly hinder the progress for the venture, leaving him unable/challenged to have candid and professional conversations, but also effect Jacks ability to live and enjoy his 5 month stay in this community. 

In conclusion, this solution allows Jack to save face in a way that minimizes the risks of a misunderstanding that could cause even more distrust, aversion toward Jack and the community (children, parents, center staff). This solution will allow everyone to move on from the event (the gift giving ceremony) and come out of it feeling understood. This will allow the venture to move forward without a reputation/stigma behind it, which could negatively impact Jack in the eyes of his funding source (the university), that could have been formed if Jack did not address the gift giving ceremony incident. 

 Implement the solution 

  1. Jack should leave the ceremony behind him and come into work the next day approaching it as a new slate. (should not be holding a grudge against the staff/try to be petty)
  2. Jack should put on the hat in the middle of the day, nonchalantly. Hopefully, the staff have appreciated and followed suit to Jacks new look on a new day and have left the past behind him. 
  3. Jack should candidly get to know the kids and the center while wearing the hat. Hopefully, the kids who did not receive their gift ceremoniously recognize the hat. 
  4. Jack should continue to work on the venture, with the staff and play with the kids as if no feelings were affected at the ceremony. If anyone mentions anything, Jack should apologize if he negatively affected them in any way and move on. 
  5. Jack should wear the hat for his first few days at the youth center and then wear it periodically to insure the other kids do not feel left out. 

 

Case Study 1: Water Pathogen in Lesotho

The Facts: of the case, provided by the case study

  • There are 11 researchers, including yourself, traveling to Lestho in South Africa for 10 days 
  • Their goal during there time there is to test the water from different locations for disease causing pathogens
    • They will also be learning about how the locals store their water and how they retrieve it 
  • There are no specific benefits to the community within the scope of the research planned by the team of 11
    • We were told this observation was wrong however, if you read the case study carefully it says “the ultimate goal of the project is to understand the lifecycle and characteristics of a specific pathogen” they do not mention any research or plans to find ways to combat this pathogen’s effects on humans 
    • In my opinion it is wrong to say this research will benefit anyone in the community of Lestho, if a pathogen is found to cause disease in humans, this research team has not explicitly stated they are going to do anything about it, other than publishing their findings
  • The community will be aiding the researchers by leading them to the water sources in the area

Stakeholders and Motivations

Stakeholder: Research team (including yourself) 

Motivations: To benefit professionally from the publications coming out of the research, the chance to say you have worked across different cultures and locations to potential employers  

Stakeholder: Community members

Motivations: To help foreigners find what they need because they will be able to help and bring a solution in the future for the contaminated water (possible thoughts of a community member).

Stakeholder: Community members that help you 

Motivations: They could potentially be receiving compensation for their time and work, or even just a tip. Working with the foreigners could give them a positive reputation/sigma and open up better jobs for them. 

Stakeholder: Organization behind the researchers

Motivations: The organization that backs the researchers and gives them credibility will gain even more respect and publicity if the researchers are able to publish meaningful work. The organization has a lot of money at stake however, these publications can lead to grants that will ultimately be awarded to the organization not the researchers. All in all, the organization will gain more respect and publicity from the researchers work they support. 

Stakeholder: Government of Lesotho

Motivations: To help the foreigners achieve what they set out to achieve in order to create a stigma that Lesotho is an easy, helpful place to work in for foreigners; ultimately increasing tourism which will benefit the economy. The communities of Lesotho also have the possibility of gaining clean water which the government can say they played a part in providing to them; gaining political clout. 

Stakeholder: Anyone who reads the report 

Motivations: To use the information published to find a solution to inhibit the pathogens effect on humans and to sell the solution to Lesotho and other places being affected by water pathogens. 

Ethical Questions

Is it ethical to conduct this study from a human standpoint?

Is it ethical to conduct this study at all? 

Should people (people of Lesotho) be compensated for their time and resources?

Solutions

  1. After their research is concluded, provide conclusions and results to the community members and relevant government departments for free and insure they understand the findings. 
    1. Pros: This solution will ensure that everyone involved/that could be affected by the possible pathogen is aware of its existence, ensures respect of the local stakeholders. With this solutions everyone is getting something out of the conclusions, the researchers are able to publish and the community has their water tested for free. 
    2. Cons: Leaves the country/community with potentially bad news and no way of immediately fixing the problem. People will be left to drink contaminated drinking water and the country does not have the means to find a solution. Could leave a bad impression on the country that foreigners are only there to benefit themselves. Community members/locals could possibly lose faith/trust in the government because they (possibly) can not help solve the problem.  
  2. Only provide conclusions and results from the research to the relevant government departments. 
    1. Pros: With this solution the government and leading bodies are informed and have gained something (knowledge) from the research groups presence. The relationship between the research group and the government could be solidified from sharing this information. By only providing the information to the government you are avoiding the situation were the citizens of Lesotho could possibly lose trust in government if they (the government) are not able to fix the water issue (if there is one). You are also avoiding possible panic from the people if they find out there is harmful bacteria in the water but no way to fix it/get clean water.  
    2. Cons: You are not telling the people who are directly affected by this research. This could be considered an ethical violation because withholding this information from them could possibly result in harm. If the citizens of Lesotho find out about the water situation but are not told by the government this could result in a political uprising. This situation would not be directly your fault, it would be the government’s fault because they withheld information, but this situation still needs to be taken into account. 
  3. To receive approval from the water ministry of Lesotho (or the equivalent) to conduct this test. 
    1. Pros: This solution will ensure that the researchers can get their testing done. If they are stopped or questioned by anyone in the community they can show them that they have approval from the government. Will allow the researchers to form a good relationship with the government. 
    2. Cons: Does not ensure the information is portrayed to the community members, the ones immediately affected by the pathogen. The community members/locals could view this situation as a bunch of foreigners barging into their community and doing whatever they want because the government told them they could. This situation could create a bad stigma for foreigners and potentially cause community member/locals to lose faith/trust in their government. 
  4. Pay the community members that help them achieve their goals (show them to various water sources). 
    1. Pros: Involves the least amount of planning/work before the trip. Can potentially save a lot of money on government approval submissions. Provides a few community members with a consistent, fair pay for a few days that will help them support their families. 
    2. Cons: Can not guarantee people will be willing to help them, especially if they have not received government approval. Once you pay someone for a job you can never take that back (decided to not pay them/someone). The other community members/rest of the people in the community do not benefit in any way from the foreigners research. It is possible that with this solution that Lesotho will never learn about the researchers findings and how it affects the country, even though the research will be publicly published. Poses the ethical question: is it okay to conduct an experiment and not explicitly state the results to everyone possibly affected by the results? 
  5. Do not pay the community members that show them to various water sources for testing. 
    1. Pros: If the community members are willing to help the researchers out without being paid that is one more expense that is eliminated (doing research overseas is very costly). Eliminates the situation where if you pay someone once for a task they never do anything for free again. Instead of having to walk to the water source that day the community members are being driven which saves them a bunch of time and is a form of payment that is not money.
    2. Cons: The community members could possibly think they are being compensated in a different way other than money (food, supplies). This miscommunication could cause tension and make it hard to work with the community members again. Another situation that could arise from not paying the community members is that the venture/researchers could be called out for taking advantage of the community members. This is a generalization: many citizens in developing countries go out of their way to help foreigners because it is believed the foreigners have a lot of money and they are there to help The researchers could be accused of taking advantage of this situation instead of paying the community members what is fair (especially since the researchers would most likely have to pay the community members back in their home country to help them do this same job). 

Previous cases and personal experience 

From what I know about clinical trials and the clinical trials they are running in Sierra Leone on sickle cell anemia. Researchers/doctors running clinical trials are not obligated to provide treatment or any follow up care after the trial is run. They must provide the patient with the outcome but they do not have to educate them on what the outcome means or the next steps they should be taking (unless they ask obviously). This can be applied to this case study. The researchers have no obligation to explain or provide any follow up assistance if the water is found to have a disease causing pathogen in it. The researcher do have to provide their finds, how they provide these findings is a slippery slope. Is publishing online publicly enough? Or should they have to provide the paper directly to the government? Should they have to provide the paper directly to the people? Should they send someone back to Lesotho to explain in person exactly what they found to ensure understanding? All these questions will be answered in my  best course of action plan. 

Best Course of Action 

The researchers best course of action would be to first receive permission from the government to conduct this research on their water. As for the community members, permission should be sought from the community leader and then volunteers from the community should be paid a fair wage for their time and knowledge (the people who will be taking them to the water sources). The community members must be paid for their time, there are too many cons that would greatly affect the relationship between the community members and the researchers and the researchers themselves (presented above) associated with not paying them. Once the research has concluded the researchers need to send a written concise/easy to understand letter of their findings on the water and possible pathogens to the government and local community leaders. These entities are then responsible for passing the message along to the rest of community or doing what they think is best with that information. This solution ensures that everyone involved has the opportunity to benefit from the researchers findings. By receiving permission and providing their findings to the government and local community leaders the foreigners are forming good relationships with every entity. If the research was only shared with the government trust could be lost between many relationships; between the people and the researchers/foreigners, between the government and their people. As for the local people themselves, the researchers have no way of ensuring they are conveyed the findings of the study, however, the people trust their local leaders and government and the researchers trust the community heads will provide information they deem as necessary to their people. By conducting their research in this manor all stakeholders are happy, the research is conducted (researchers, organization), a paper will be published (researchers, organizations), and what is learned is shared (researchers, organization, government, community members helping/not helping, people who read the paper). 

 

Implications of the best course of action 

A possible implication is that if the government and community members do not convey the findings to the people they will continue to get sick (possibly) and have the possibility of finding out the water is contaminated from someone else. If this happens they will lose trust in their leaders and foreigners which can cause major political unrest and make the country a hard place to work and visit, ultimately affecting the economy, for foreigners. 

Also if it is not explicitly stated/understood, the government/community may believe that the foreigners are going to find a solution to the water pathogen. The researchers do not have a plan to solve the pathogen contamination issue (per my interpretation of the case) therefore this could cause tension between the foreigner and local government relationship. This issue also has the potential to make the organization backing these researchers look bad and give them a back reputation. This miscommunication will not only have an impact on this venture but any other venture that tries to do work in Lesotho, all trust in foreigners could be lost. The interrelationship between the citizens, government and foreigners would crumble. All trust would be lost and the path to solving this miscommunication (not making it clear that the water situation would be solved) would be a he said she said situation. The citizens would be in the middle and have the most to lose; not only were they betrayed (possibly what they could be feeling from the situation) by the foreigners but they would be destroyed by their own government.

Fall 2019 – Entry 1

Hello everyone, I’m back. It’s a new semester which means new blog posts; but are you surprised?

Here is the link to the Sierra Leone blog: https://wordpress.lehigh.edu/sicklecellscreening/

Go check it out!

And now, a brief reflection on Sierra Leone.

TOP THREE THINGS I LEARNED IN SALONE

  1. I learned how to communicate an idea/plan clearly and concisely. Along with that, I learned how to present myself as an entrepreneur/scientist instead of just a college student.
  2. I learned to adapt, and improvise plans. By the end of the trip, not only did I how to accept them but I knew to embrace them because they resulted in some of the best experiences.
  3. The trip also taught me how important it is to build a community with the people you are working with. Knowing and caring about the people you work/live with not only makes work more interesting and enjoyable but it also greatly befits you. People are more willing to help you out and get things done for you when they know you would do the same for them.

PROFESSIONAL DEVELOPMENT 

  1. Working with a partner but also everyone (the group) taught me patience and how to collaborate instead of immediately imposing my own thoughts.
  2. During the trip we networked (set up in person meetings with everyone available who was in country) with almost everyone involved with sickle cell in Sierra Leone. We now have connections with people involved in all of the different aspects of solving a disease.
    1. medical field
      1. medical professionals (all levels)
      2. medical supervisors
    2. NGO aspect
    3. Larger health entity (WHO)
    4. Organizations
      1. SCCAN
      2. Sickle Cell Society
  3. Finally I learned how to “just go for it”. This might not make any sense but I learned how to appropriately ask people for their help/knowledge even though they had no idea we were coming to visit (clinic visits). 

PERSONAL DEVELOPMENT 

  1. I learned how invested I am in this project and how much I want a clinical trial and program for treatment (and follow up study) to be set up for next summer. 
  2. I learned how to advocate for myself and my ideas. Along with that I become a leader within my project and realized passion plays a huge role with leadership, age and seniority does not and should not play a role within leadership.
  3. Finally, I learned how to reach out for help/ideas when stuck in a rut and learned to used all of my resources (Hassan and the health clinics, Mark and the boiled eggs/avocados, etcetera).

Entry 11

M&E (Monitoring & Evaluation) Plan and the Social Return on Investment for Our Project

Our inputs include a variety of people and materials. Specifically, we as the GSIF team are working with our advisor, Prof. Cheng, and a TE capstone group to contribute bioengineering expertise towards the development of a low-cost, point-of-care, sickle cell anemia screening device. For this development, we are utilizing Lehigh University lab resources and funding (which will hopefully be expanded by health-related grants). Additionally, we will be getting local and healthcare system expertise from community members in Sierra Leone established through our partnership with World Hope International. In the future, we also hope to include business students, in order to get expertise on distributing the final product.

In addition to these inputs, our team focuses on several activities. Currently, our activities involve designing the device, and learning about the local context so that we can best implement our device. In the future, our activities will focus on distributing the test strip, training healthcare workers on using the device, and working with other NGOs to make sure our device is implemented alongside a treatment regime.

With these inputs and activities, we will create several outputs. Our primary output will be a physical test strip product. Additionally, we will develop jobs for locals in Sierra Leone who will be charged with distributing the device. Finally, our outputs will also include the participants we reach, specifically the healthcare providers who are conducting the testing, and community members who are getting tested. These outputs are directly measurable. We will determine the number of test strips that need to be developed and shipped/distributed to the healthcare providers and ultimately the community members by the amount of funding we receive and projected number of people who will be seeking the test. Once one shipment has been sent out, more concrete numbers for the amount of test strips that need to be delivered at one and how frequently to specific locations will be determined after statistics on the number of people tested and where they got tested have been collected. These statistics will be provided by the medical professionals stationed in different locations throughout the country who will be offering and administering the test.

Finally, our project will also have several short-term, intermediate, and long-term outcomes or impacts. Within a few years, we will hopefully have created a new and usable product which can be used to diagnose people in Sierra Leone with sickle cell anemia. After that, we hope to make a direct impact on community members by allowing individuals to get screened for sickle cell anemia at an early age, and access those potentially life saving preventative treatments. In the intermediate, we also hope that this product can also be expanded in to other low-resource settings, particularly throughout sub-Saharan Africa, where sickle cell anemia is prevalent. These intermediate impacts then have the long-term potential to reduce child mortality due to sickle cell anemia. Once we are able to implement screening for sickle cell anemia with our device at birth or at a young age (before 5) we will be able to take/track statistics around child mortality and determine if child mortality due to sickle cell anemia is going down. If the child mortality, due to sickle cell anemia, rate does not decrease this could be due to the lack of people getting screened or the lack of treatment after being diagnosed. We do not foresee the lack of treatment being a problem for there are cheap penicillin based treatments available. If the child mortality rate does not go down we will need to rethink where and how we have implemented the device and try/decide if it’s possible to make sickle cell screening mandatory at birth.

Additionally, we hope that by working with other NGOs, this product can be used to help bring about policy and social action changes. For example, although hydroxyurea is proven to reduce the symptoms of sickle cell anemia, and has been used successfully for patients in the US for years, it is not currently available in sub-Saharan Africa (original due to concerns that this treatment could increase the risk for malaria, which has recently been disproven). With the effective implementation of a low-cost, point-of-care sickle cell anemia diagnostic tool, we can hopefully initiate a push for health NGOs to make policy changes, getting this treatment to individuals in Sierra Leone. The data stating the number of people being screened and the information around how people are being treated for sickle cell anemia after being diagnosed can and should be presented to NGOs funding medical treatments. Once presented the data these NGOs will hopefully push for policy changes to allow for more options for treatment, like hydroxyurea, that will hopefully reach and affect more people positively.

In order to estimate the social return on investment of our project requires several assumptions. The value of every person who is screened will be equated to the average cost of sickle cell screening in the United States ($50 will be used as a very rough estimate of this price). We would also have to know what the value of each strip would be. To estimate this we would have to assume that one strip accounts for all labor, transportation, materials and other costs associated with eventually delivering the test. For the purpose of this estimation let us say that the total cost per test strip is $0.50. If we make these assumptions, then we can say that for every dollar that is given to the project we generate $100 dollars of social value. One dollar would equate to two test strips which would be used to screen patients. These two screenings in turn would equate to the value of being screened in the United States.

Making the assumption that the $50 test value is the only social value created by our project is false. In reality, the ability to understand and get treatment for sickle cell is very valuable but is not able to be monetized.