Week 4

Hello World!

Eastern Pennsylvania seems to really not want GSIF class to happen; as seen by the snow on Tuesdays exclusively. Global Social Impact, however, does not stop for the weather! This week we reviewed several resources on topics including biomimicry and cradle to cradle manufacturing, design. Through this week’s blog post, I hope to answer and respond to several ideas that would have been talked about in class.

The first idea that I want to talk about is the idea of nature. Nature inspires and motivates me in life and urges me to design better. Moreover, nature can serve as a model and mentor in every aspect of life. Take Entropy for example. Entropy is the constant movement towards disorder or chaos. From the ocean constantly churning solutes throughout its vast body to organizing every thread that goes into the concept of operations for Ukweli, entropy is constant. As a mentor, nature teaches me the concept of Strong as One. In short, this means that the whole is greater than the sum of its parts. Take carbon for example. By itself, it is subjected to both ionic and covalent attractions; however, a carbon lattice is the hardest and one of the strongest substances on planet earth. Diamonds baby! Another way nature influences my life is as symbols of unity and integration of divergent ecosystems. You may think this is a stretch but – I am a Salmon! Much like salmons thrive in estuaries, I live on the intellectual line between Arts & Sciences and Engineering.


Later, through the readings we received and in the ideas embedded within Life’s Principles, I am curious how one specific principle relates to both my life and project. The principle of Being Locally Attuned and Responsive encompasses the idea of fostering cooperative relationships between people and the Earth in order to embrace constant improvement:

Be Locally Attuned and Responsive
Ukweli My Life
Leverage Cyclic Processes – Our venture aims to seamlessly integrate into the already working community health worker network. The same rules apply to UTI screening as does Malaria. There are limitations to the CHW capabilities. We are keeping it consistent. -Not sure, I’ll do some soul searching.
Use Readily Available Materials and Energy – Utilization of Common Tests that could be replicated

-This is a potential area of improvement I am curious what type of plastic should be used.

-I am not sure how I can integrate this into my life other than recycling.
Use Feedback Loops This is yet another area that I want to explore with the Ukweli team. How can we utilize feedback loops in our venture?

– Perhaps there is a feedback loop in the cycle of Sensitization ~> Screening ~> Diagnosis ~> Treatment ~> Sensitization.

-I readily use Feedback loops as I am constantly trying to become a better professional and overall quality human.

-Another aspect of this is how I choose to look at problems and how I choose to react. If I learn to better understand how I react to certain situations, I can better handle them making a “Negative Feedback Loop”.

Cultivate Cooperative Relationships – Foundation in working with several key stakeholders in order to run the venture. -Working as a team is not something that has come naturally to me. I have had to practice this, and now I can say that my best work comes from working with my peers!

This idea using readily available materials and energy is related to the concept of cradle to cradle design. This concept is based on the fact that all products have life cycles. For Ukweli, my vision for a cradle to cradle design would include a biodegradable test strip that contains three parameters with common assays that contain harmless chemicals that decompose easily. In addition, this product should have a small half-life of decomposition to deter negative effects on the environment

This week, I learned that impact starts with personal reflection. Who are you? What do you want to do? Why? I realize that the pathway to effective design solutions may not always be the sexiest or innovative; however, they are deeply rooted in the way we approach problems. We often overlook the most practical models for design in the quest for the most appealing technology when the solution might be right in front of us. On a more light-hearted note, I was asked to blog about some interesting things my friends taught me that was completely unknown to me. The first is camping. As funny as it sounds, I have never camped before coming to Lehigh. My friend Teddy took me on a camping trip my freshman year and I learned to make fire! Alek, one of my good friends since the start of Lehigh, taught me about the concept of cloud seeding. He is an environmental engineer and he spoke about how people can actually cause rain by the process of cloud seeding. Finally, a more recent example is during fieldwork in Sierra Leone this past summer. Rachel, a civil engineer and friend, was tasked with constructing a dark greenhouse to grow mushrooms. I definitely did not expect to be learning how to grow shrooms or build a grow house!

Week 3

This week in the Global Social Impact seminars, we talked about the cultural context presented in Sierra Leone. In Sub-Saharan Africa, healthcare resources may be extremely strained especially with regards to emergency care. Often times, people wait to seek medical treatment until the burden of their particular disease becomes too great. With the introduction of screening, we plan to address this problem on two fronts. The first is screen early, and the second is sensitization to risk factors/symptoms during the screening process. Another interesting example of how cultural issues may affect Ukweli is the concept of community leaders. Yet another key stakeholder for this venture, community leaders can either make or break Ukweli. In Sierra Leone, community leaders come in many forms such as Chiefdom Heads, Religious Leaders, or the Matriarchal Head of House. Our idea is to leverage these community leaders to support our venture by encouraging pregnant mothers to get screened for UTIs. This will ensure that the overall health of their community progresses. My last example of cultural issues that affect Ukweli is the use of Alternative Medicine Practitioners. AMPs are most common in the rural parts of Sierra Leone and are extremely difficult to compete with in terms of healthcare. The biggest issue that we are facing is changing the mindset of people who have relied on AMPs for generations. We plan to address this particular issue by the use of extensive marketing strategies such as i.e. radio programming and engagement with community leaders.

Sierra Leone Cultural Challenges
Challenges: How we plan to address these issues:
Waiting to Seek Medical Treatment  1. Screen Early

2. Conduct Sensitization while screening

Community Leader Support 1. Meet with them personally

2. Explain to them that doing this improves the overall health of their community

Alternative Medicine Practitioners 1. Marketing Strategies: (Radio Drama, Clinic Engagement, stakeholder profile)

2. Endorsement by the Sierra Leonean Ministry of Health and World Hope International

3. Obtain Community Leader Support, especially religious leaders

 

Another way to analyze these issues is to see if I have any personal connection. Here is one story, I have not shared since high school. For context, I typically overwork myself and neglect the basic responsibilities of eating and sleeping for the sake of getting things done (I know this is unhealthy… I’m working on it). So once upon a time in Whitehall High School, I was in a play. Naturally, I was also taking 4 AP classes, a Dual Enrollment class, and the President of literally everything I was a member of so sometimes sleeping and eating did not happen. Fast forward to the spring of that year, it was the opening night to the play and I had a huge abscess on my neck!

I will spare you the gruesome details.

Moral of the story, I should have gone to the doctor two weeks earlier. Instead, I waited until it was hard for me to breathe then I stayed in the hospital for 9 whole days. Yikes right?

This connection is far less gross. In Guyanese culture, there is a dichotomy between the religious leader of the house which is typically male and the “real” head of the house – Mom. Needless to say, nothing gets done unless the matriarchal head of house gives her approval. This is extremely progressive in my opinion and has led my family, at least, to be more socially aware, strong-minded, and overall tough people. It is kind of funny, whenever anyone has an important decision to make in my house, we always turn to my mother for advice and guidance. The parallels in Sierra Leone are truly remarkable.

My final example is weak but still valid. Again, my family comes from Guyana South America where life is extremely different (compared to western tradition) especially in religious practicings. My parents have told me stories about how my ancestors used to engage in “Alternative Medicine” of course there were a plethora of names we knew it by, but the general concept remains the same. The whole Temple of Doom and Witchdoctor thing is very present in Guyana, even today. So what is the point of this? AMPs prescribe herbal remedies and pray for divine intervention rather than utilize vaccines, screening technologies, and antibiotics. I recognize that people are creatures of habit and gravitate to who or what is most familiar, however, if what is most familiar could potentially hurt them in the long term I simply cannot do not understand why they keep going back.

To finish up this week’s post, I wanted to talk about specific cultural practices and how they could be leveraged to address community and market problems.

  • The Art of Storytelling:

In Sierra Leone, the ancient tradition of storytelling is extremely popular and can be leveraged to be used as a marketing strategy. How might we utilize this tradition to our advantage? How can we get the people most need sensitized to UTIs and aware of Ukweli? Our current answer is in creating a drama. In class, we discussed a venture in India that used the storytelling tradition to express how a drip irrigation changed the life of an individual and her family. We want to use the same idea: create a drama that can relate to populaces affected by UTIs and introduce the Ukweli as a possible solution.

  • Visual Communication Strategies:

Since the Ebola epidemic, there has been a clear strategy for marketing in Sierra Leone. In all posters, there is a huge emphasis on the use of visual aids. There is a difference between western understanding and the African context. The posters are all extremely graphic, clear, and concise. We hope to utilize this on all levels of our venture. See below for an example:

  • Payment Schedule:

Community health workers are faced with many challenges, and it is often difficult to get a large number of them in the same place at the same time. However, the current healthcare system has some interesting features that could be leveraged for the dissemination of test strip boxes. CHWs all meet at a central clinic on a specific day for refresher training, reports, resources, and most importantly payment. Why is the payment the most important? CHWs are not in the business of making money, often they expend their own capital for the needs of their community so this payment acts as a cost recovery system. We hope to utilize these payment schedule days to initiate training and certify CHWs as Ukweli CHWs. We can reduce our own overhead by conducting these training sessions when there are large numbers of CHWs in the same place.

 

Week 2

Hello world, it is me again, here to update you on some GSIF developments. To recap, I am on the Ukweli Test Strips team working to combat one major problem: Maternal Mortality. This is a huge problem and can be addressed in many ways. Ukweli aims to address one specific aspect of health that can lead to premature deaths among women: Urinary Tract Infections. The core of this project resides in the concept of last mile distribution. Basically, how do we get the women in the furthest village in the most geographically remote area access to our test strips? You may be thinking what do test strips and UTIs have anything to do to with maternal mortality? – the short answer is this: UTIs can lead to a myriad of birth complications and we hope to empower women to make informed decisions about their healthcare and the well being of their newborns.

Moreover, let us talk about the last two weeks. We got some snow last week which means class was canceled. However this week we were jam-packed with GSIF events including a Retreat on Saturday, Sierra Leone Healthcare System presentation on Monday, and class on Tuesday. Needless to say, there are a lot of insights and takeaways that I gathered from these events.

From a top-down analysis, my team has been posed with two interesting questions: 1) How does the African context present different challenges than the American context? 2) How does the African context present different resources than the American context?

With regards to the first question, I have identified three challenges in particular: working with protected populations, sensitization, and supply chain management. In Sierra Leone, protected populations do not pay for healthcare treatment. These populations include women who are pregnant, lactating mothers, and children under 5. How will this venture succeed if at first glance there is no profit available? We addressed this challenge through the technology, and intent of the technology. Our test strip is a screening device and is not treatment which allows for our revenue model to work. In addition, our venture is heavily dependent on donor dollars to cover overhead and large capital investments that will allow Ukweli to grow with time. Next, in the United States, sensitization to UTIs and other illnesses affecting the urinary tract are generally not needed because they are pretty well known. In Sierra Leone, people typically go to get conditions checked by physicians only if there it is a life-threatening problem. So how might we explain the importance of screening early and the dangers of waiting? This semester, the Ukweli team is exploring different modes of communication i.e. radio, mother support groups, and the involvement of high ranking community stakeholders. Lastly, in the west, people value time more than most material goods, and this can drastically affect how the supply chain processes will work in Sierra Leone. With consistent unreliability in terms of time and the general uncertainty of how to organize the flow of test strips from its arrival in Freetown, we have much work to do on this front. I anticipate our biggest asset to addressing these challenges will be the cooperation of World Hope International, our partners on the ground.

Challenges Presented via the Sierra Leonean Context and Proposed Solutions
Challenges:  Protected Population & Profit Sensitization Supply Chain Management
Ukweli Solutions: Donor Dollars & Cost Recovery Model Communication & Leveraging Key Community Groups/Leaders Collaboration with World Hope International

While the African context may provide several challenges, it also provides us with several resources that are pivotal to the success of Ukweli. The first is in the Community Health Worker network. This group is a nexus of young, capable, and driven individuals that give up possible income opportunities to serve the needs of their respective communities. CHWs can be leveraged because our venture employs a cost recovery system in which the CHWs benefit by selling/administering the test strips. In addition, CHWs are generally young which means they would be more open to the cost recovery system idea and be easier to teach. Another resource that working in Sierra Leone has is its partnerships with the Chinese government. Our test strips are currently being manufactured by an Original Equipment Manufacturer (OEM) in China, and with these partnerships, the trade will be much easier than if this venture were to be based in the United States. The final resource that my team has identified is both a challenge and an untapped opportunity. As discussed previously sensitization can be a huge challenge, but in Sierra Leone, it can be overcome by the utilization of key community stakeholders. I am particularly interested in what effect mother support groups and involvement of the matriarchal head-of house will do in getting people to be screened.

To get a better understanding of Ukweli, a bottom up analysis (rather than a top down analysis) can be used to get a deeper understanding of how this venture affects various stakeholders. It is important that I explain what exactly a stakeholder is in this context.

Stakeholder : An independent party (individual or organization) that has a vested interest in the success of a venture. These key players at all levels have value propositions that one can leverage for the success of a venture. 

The Ukweli team through research and travel has identified several key stakeholders that are vital to the success of the venture and a corresponding value proposition for each:

Summary of Stakeholder Identification and Value Proposition
Stakeholder Value Proposition
Community Health Workers CHWs can benefit from Ukweli through empowerment. CHWs can improve their efficacy and effectiveness through this objective way to see if someone might have a UTI, and thus make a better informed decision on referrals while bolstering their livelihood through an income generation opportunity.
Community Health Officers CHOs can benefit from Ukweli by increased efficiency and patients, which will provide the needed data to receive more aid money from the government. The clinics can prove that people are using their service and that they need to expand.
Nurses In Charge NICs can benefit from Ukweli by increased accountability of the CHWs and by getting the right referrals. NICs do not want women coming to them too late when a UTI has progressed to something worse.
Peripheral Health Units Peripheral Health Units can benefit from Ukweli allowing the power of screening to be leveraged by under-served areas, building a national identity and supplying technologies that give an objective, actionable results.
Hospitals Hospitals can benefit from Ukweli by improving systemic health. Through an increase in regular visits from people who usually never make the trip to hospitals, their facilities will become more trusted if they can provide quality care.

I feel this might be an information overload, but this venture takes a lot of dedication and time if we want it to succeed. Perhaps a simpler way of looking at the Ukweli might be through identifying ways we validate and gain credibility during this semester so work on-the-ground goes smoothly.

  1. Obtaining a marketing license through the SL Pharmacy Control Board
  2. Creating a training and communications protocol for Community Health Workers
  3. Identification and development of a distribution pathway
  4. Review of core assumptions that affect the financial model

In summary, the context of working in Africa presents several challenges and resources. How we choose to approach them will determine the fate of our venture. The biggest challenge to the success of Ukweli right now is sensitization and supply chain management while the greatest resources we have are Community Health Workers and the collaboration with key players such as World Hope, chiefdom leaders, and mother support groups. Through deeper look into Ukweli one can identify the various stakeholders and a value proposition for each of them. This exercise has led to the realization and conceptualization of our progress in the venture creation process, and we were successfully able to identify threads that need to be explored this semester to conduct meaningful on-the-ground operations.

Catch you next time!

Week 1

Creative Inquiry 396: Inquiry to Impact Workshop Series

Throughout my journey at Lehigh University, I have gone through the motions of class, homework, test.

Rinse and Repeat.

This seemingly endless cycle has given me a great opportunity to learn theory and how to ace tests, but is there more? I am a Global Social Impact Fellow because I value real-world change that is sustainable, impact-driven, and culturally appropriate. I hope to make a career out of Humanitarian Engineering and Social Entrepreneurship and what better way than to take a “class” in exactly that!

As mentioned in my intro, I am a student in Healthcare Systems Engineering and Public Health. More broadly, I am an IDEAS Major. Through this course, I hope to gain a better understanding of how my two concentrations can be applied to the international development field. I am particularly interested in understanding the stress that focusing on one sustainable development goal (SDG) has on the other SDGs. In addition, Humanitarian Engineering is so much more than engineering, this area is multidisciplinary at heart, and I am excited to learn about the other threads that encompass this space.

Furthermore, this course can help me to strengthen my foundation in the international development field, and teach me how to apply my knowledge to the real world. For example, here is an open-ended case study that we will be discussing:

“The World Health Organization estimates that over one billion people who need eyeglasses do not have access to them. The vast majority of these people live in developing countries like Kenya where there is barely one optometrist per one million people. Given the high poverty levels, access to eyeglasses is almost non-existent. Lack of proper eyeglasses severely impacts people and their livelihoods by decreasing their productivity at work, limiting or eliminating new opportunities, affecting their quality of life, deteriorating their general health and possibly leading to (preventable) blindness. What solution do you propose to address this problem?”

This is a very complex and multifaceted issue. One possible solution is creating a social enterprise. I would utilize the community health worker system and instruct them to conduct the standard eye test. (Snellen Eye Chart) This test addresses two major eye problems: nearsightedness and farsightedness. The idea is to simply screen people who may have eye problems at the community level. Everyone who scores out of the normal range gets referred to a clinic.

This is where the problem becomes a supply chain nightmare. At a clinic, the patient would be tested by trained nurses or health officials and written a specific prescription for glasses. In the best case scenario, this clinic would have interchangeable lenses that can fit into a generic frame. The patient would then pay for his or her glasses and be on their way.

This solution requires three key technologies: The first is a generic frame that can fit all lenses. Secondly, the lenses must meet the most common prescriptions for treating nearsightedness and farsightedness. In addition, they must all be the same size and fit into the generic frame (I’m thinking snap on or clasps) The final technology to successfully run this enterprise is a standardized eye screening test, like the Snellen Eye Chart.

Reading through this solution I can already see several problems or questions that might arise:

  • How do the lenses & glasses get to the clinics
  • Can this technology be cost-effective without jeopardizing its functionality
  • How will the training work on the Community Health Worker level and at the clinic level?
  • How do people know that they should be tested?

I could go on and on about the possible problems with this solution. However, through this class, I am extremely excited to learn more about how to effectively address problems such as this.

 

Till next time!