By Noah Weaver

Ethical issue: is it ethical for researchers to conduct a study in communities that are not necessarily guaranteed to benefit as a result?

Facts:

• the study will require significant assistance from the community members
• researcher does not intend to pay community members for their help
• although the researchers benefit, the community members may or may not benefit in the long-term
• pathogen under study is found only in this specific region of Lesotho

Stakeholders/motivations

• Scientists/researchers– scientists will be motivated to earn recognition from their work and advance knowledge of science. They may also be motivated to help the locals through their work.
• University– the institution(s) that provides resources/support for the researchers will be motivated by increased notoriety and interest from future students in their institution. Like any university, their goal is to attract the “best and brightest”- a university that is known for breakthrough research will attract more talented students, facuity, etc.
• Investors– will primarily be motivated by financial incentive- perhaps to sell the profile of the pathogen to major universities or pharmaceutical companies (although the pharmaceutical route is much less likely if the pathogen does not spread outside of Lesotho). Investors may also be motivated by seeing real-world impact with their investment
• Community members in region– may be motivated by helping prestigious researchers (people of LMICs may be a bit “star-struck” by academics). They might also be motivated by the hope of creating interest among the academic community in Lesotho/understanding the pathogen to treat or cure the disease it causes.
• Lesotho government– like the community members, the government will be motivated by the hope that a treatment or cure can eventually come from the research. The government may also be motivated by increased notoriety for their country

Solutions

Solution A: Survey community health workers (CHWs) working out of PHUs in the region. This solution is much less time-intensive for both the researchers and the community members. This method is ethical because CHWs are more likely than individual community members to understand the importance of understanding what is causing the disease they see first-hand.

Pros of Solution A:

• CHWs are nominated by their peers to serve their community; thus they can act as excellent representatives of the community as a whole
• less time-intensive method

Cons of Solution A:

• depending on how large the sample size is, the data could be skewed/incomplete
• the lack of incentive may make it even more difficult to find willing participants

Solution B: survey individual community members randomly while providing a small incentive such as a soda or snack. This is ethical because it provides a small token of gratitude in return for the time/effort it will take for community members to tell (or show) the researchers the sources of their water supply and storage methods.

Pros of Solution B:

• random sampling makes it much less likely for data to be skewed/incomplete
• Providing a small snack shows a good-faith effort on the part of the researcher: it shows that they are not necessarily there for personal gain only and provides a small benefit to those who give the researchers their time.

Cons of Solution B:

• Much more time-intensive
• snack/soda is still not too much of an incentive
• labor-intensive: sampling as many random individuals as possible will take quite a bit of manpower on part of the researchers

Solution C: work directly with the local government through a partnership and identify community leaders. This will allow both the researchers to clearly relay their intentions and ensure appropriate measures are taken to satisfy the government, researchers, and community members. This option is likely the most ethical route since it considers all levels of the community/country before conducting research in the country. Seeking input from all impacted stakeholders is a crucial part of any ethical decision-making process. For example, I tend to seek input from multiple viewpoints that are also diverse. This is important because it allows one to consider all possible aspects of their decisions before putting them into action.

Pros of Solution C:

• clear working relationship through official channels
• provide a platform for the researchers to receive feedback or answer questions/concerns the community may have before their research actually begins

Cons of Solution C:

• governments can potentially be unethical (even when the researcher is trying to help them).
  • e.g. government officials in some LMICs will expect something of personal gain for allowing the research to take place
• likely a slow and onerous route. Working with governments of any kind is usually a very slow process.

Solution Chosen: Solution C.

This solution is the most ethical of the three listed because it considers all stakeholders within Lesotho, from the individuals to community leaders to the highest levels of their government. This ensures that all participating parties are fully-informed and have a say in the conduct of the research. It also makes it more likely that efficiency during the study period is maintained without the sacrifice of study quality. Although this method will require extensive planning/meeting time before arriving in Lesotho, it will require much less effort on the researchers’ part once they arrive in the specific region of Lesotho.

Solution A might not be the most ethical of the three because it does not consider all potential stakeholders within the community. Solution B, however, is equitable but very time-intensive during in-country fieldwork. Furthermore, providing a snack may be seen as a selfish act. One of my classmates brought up the point that doing this might be a slightly sinister method for establishing a trust/relationship with the locals as the researchers’ primary motivation for providing a snack is to earn something in return for themselves.

Although none of these solutions directly ensure that the pathogen will have treatments/cures developed in the future, it will at least provide a basis for other researchers that may be interested in doing so in the future. Furthermore, this study may draw the interest of an unknown researcher at some point, as publishing this initial research will generate more interest and awareness of the issue. It is entirely possible that little attention is given to the pathogen prior to the start of this study; thus, it is more ethical to conduct the study than it is to do nothing at all.

By Noah Weaver

1. Facts:

• single-use feature is incredibly important to preventing further spread of disease
• auto-disable feature significantly adds costs to producing the syringe
• without the auto-disable feature, it is a near-certainty that the problem will be made worse compared to doing nothing at all
• if the auto-disable feature is made without any other caveats, the target market the syringe was meant to help will never reach them

2. Stakeholders:

• Investors
• Company
• Designer (myself)
• Hospitals, clinics, PHUs
• Healthcare workers (e.g. doctors, nurses, CHWs)
• patients

3. Motivations of stakeholders:

• Investors have two relevant motivations: the first is that they get a return on investment (financially). They want to know that they are contributing to a venture that they can also succeed from. The second motivation is a reasonable return of investment from a social/health perspective. Considering that they are investing in a technology for an LMIC, it is highly likely that they also care about the impact of the syringe itself on the health crisis. They also would like to broaden their impact by making such an investment, and would hope to continue making world-changing investments going forward.
• The company producing the syringes also have it in their best interest to produce high-quality syringes at an affordable price. They are motivated to do this most likely because they would like to stay in business, keep their employees employed, and potentially expand operations so they can sustain themselves. If the product is not successful, they will all be out of jobs (this is an especially powerful motivator).
• As the product designer, my primary motivation is to solve a complex issue to the extent possible because of the immense responsibility associated with my design. My product design will literally influence whether millions of people live or die. Knowing just how many people’s lives depend on my decision-making/design, I must do the best job possible within the context of an LMIC (that is, if I want to sleep at night considering that I have a conscience).
• The hospital, clinics, and PHUs and healthcare workers want to have a successful syringe because they are the ones who directly treat patients in their communities. They each have a powerful incentive to use an affordable, high-quality syringe because of the need to maintain their reputations, provide a welcoming environment for their patients to receive treatment, and, perhaps most importantly, because they must live with the consequences of the disease. If the disease becomes to rampant, then they will suffer with their patients, become overwhelmed, and risk exposure to the disease to themselves and their loved ones in the process.
• The patients have their health to motivate them to receive treatment. The syringe must be low-cost enough for the common person to afford its use, but quality enough for them to maintain their health.

4. Solution A: Allow the syringe to go to market without the auto-disable feature. This solution makes the syringe affordable for LMICs, and it puts accessibility at the forefront of the decision-making process. Accessibility to healthcare is especially important, because I believe that healthcare should be a basic human right, not a privilege. For example, I see many patients at the hospital I work at that bring up their primary concern for treatment as “how am I going to afford this ER visit?” This is a valid concern because people are often left choosing between food, medicine, and shelter. However, the decision to let the syringe go to market without the auto-disable feature is potentially more dangerous than not allowing the distribution of the syringe to begin with. It is well-documented in the literature that syringes are reused in LMICs. As a result, the disease may spread more rapidly. This option is incredibly unethical because it breaks the basic principle that all medical practitioners need to adhere to: do no harm.

Pros of Solution A:

• accessible
• low-cost

Cons of Solution A:

• very dangerous/near certainty for the spread of the disease
• unethical

Solution B: Allow the syringe to go to market with the auto-disable feature. This puts patient safety as the highest priority, which should (generally) always be the primary concern in a healthcare setting. However, the problem with this option is that the communities the syringe is aimed at helping will never see the syringe, to begin with. As a result, it is pointless to make the syringe. If the syringe cannot be used by the target market, is there really much of a need to produce the product? The answer is no. Although this option aligns with the statement of “do no harm”, it is also not helpful for the problem we are attempting to solve.

Pros of Solution B:

• safety is at the forefront of the design
• makes it impossible to reuse syringes, thus avoiding further spread of the disease (inadvertently)

Cons of Solution B:

• too expensive to reach LMIC target market
• syringe is useless before it is even sold: if the target population can’t afford to use it, then it won’t be used at all
  • this is as if nothing was done to control the virus to begin with

Solution C: Find a middle ground by producing the syringe with the auto-disable feature and providing financial incentive for the return of used syringes to the manufacturer. This option would likely accomplish our goal while meeting the needs of all stakeholders: we can produce a syringe that does not sacrifice quality, that is safe for patients (and guarantees this), and is affordable/accessible by LMICs and those in the target market. By choosing this option, we acknowledge that no solution is perfect, but this is likely the best way forward within the constraints of the setting we are working in. The primary con associated with this option is that the syringe is still more expensive than it would have been without the auto-disable feature, but producing the syringe without such a feature is highly unethical and unsafe.

Pros of Solution C:

• sustainable/cradle-to-cradle design
• safe
• low-cost
• accessible

Cons of Solution C:

• more labor/logistically-intensive to incorporate a syringe return program
• will likely still be more financially expensive than the syringe without an auto-disable feature at all
• although it will likely be much more accessible than distributing the syringe with only the auto-disable feature, it could still be too expensive for some PHUs to afford

5. As mentioned above, the literature provides an abundance of evidence showing that syringes without an auto-disable feature are reused inappropriately in LMICs. In order to make the best decision, it is imperative that we put patient safety at the top of our priority list while simultaneously considering what is practical in the context of an LMIC. Again, healthcare should be a basic human right, not a privilege. Making the syringe affordable is essential to making the product accessible by all and leaving the greatest impact.

6. The best option is Solution C. This satisfies the highest set of ethical values because we do not sacrifice accessibility, patient safety, affordability, or product quality. Another option my group discussed was distributing the syringe without the auto-disable feature AND investing in education for both healthcare providers and patients. However, we felt that this option was not appropriate because it cannot guarantee that the syringes will not be reused. As mentioned above, Solution C is far from perfect/ideal, but it is likely the most realistic option that will satisfy the needs of all stakeholders and our ethical principles. This minimizes the financial burden on the target market without it being at the expense of patient safety. Please see Solution C above for the detailed pros/cons showing the maximization of benefits and minimization of risks.

For further evidence, please see this article at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3567947/

-the article at the link above discusses the (mixed) but generally positive impact of needle/syringe return programs in LMICs.

7. The solution chosen will provide an affordable syringe that does not harshly burden the economic needs of its target market. It will allow for the containment of the disease with a high-quality technology that is both safe and effective. From an environmental standpoint, this is also ideal because it significantly heightens the ability of the manufacture to recycle used syringes and dispose of any materials that cannot be reused in an appropriate manner. Otherwise, there is a very real chance that the syringes will end up in landfills and other areas that are harmful to the environment. Above all else, this is a socially valid way to contain the disease because it is the right thing to do. This solution does not allow for harm to patients and allows people to maintain their health simultaneously.

1. Refine the detailed income statement for your venture for two years (at six month intervals) or a more appropriate time scale. Explicitly state the assumptions that underlie your financial model.

1. Refine the Business Model for your venture based on your revenue model. You may use the Osterwalder BMC to refine your business model but prepare one or more visuals that explain how your venture will work and accomplish your BHAG.

Our Business Model helps us reach our BHAG because, by working directly with Community Health Workers or CHWs, we are able to bring the test strips directly to pregnant women in more rural communities.  The innovative aspect of our project is not the test strip itself but the way we distribute and bring healthcare to the people in the communities we are trying to serve. 

1. Develop an M&E plan for your venture.
   1. Clearly list all assumptions.

Assumptions: Data is collected in a timely manner, there is no long-term significant impact on our sales due to COVID-19, and we do not lose contact for significant time periods with our partners on the ground.

1. 1. Identify short-term and long-term success metrics.

Short-term metrics: data collection is occurring each month, the sample size is sufficiently large, data is broken down by month in reporting.

 

Long-term metrics: analysis of data is able to occur using PLS-SEM as long as the data is collected in the manner described in the short-term metrics section. A causality model is able to be developed from this and will hopefully show a causal relationship between the Ukweli venture and the maternal mortality rate by using multivariate analysis to show that it is more likely than not that Ukweli is having an impact in the region. This will lead to further scalability of the operation and allow Ukweli to reach more lives.

1. 1. Identify specific methods to measure the metrics.

The monthly reporting required of our DM will allow us to ensure that data is collected in a timely manner (this is attached to his payment). By attaching financial incentive to proper reporting, our data will regularly be completed through Google Forms and scanned PDFs of the same forms will be used to audit this system for inaccuracies.

Financial Model Assumptions:

Total overhead costs and returns are relatively stable compared to the past. However, this is difficult to accurately project due to the fluid nature of the current pandemic that is adversely impacting the global financial market. Given this high level of uncertainty, it is nearly impossible to estimate the conditions several months in advance at this point.

 

Design Phase Funding: We are no longer in the design phase of development.

 

Implementation Phase Funding:

 

1. Crowdfunding campaign during Summer 2019. This is a good fit for the venture because it shows the commitment and validity of the venture as a whole and allows us to achieve one of the main goals of the operation: a self-sustaining method of funding. Although this crowdfunding campaign is not directly self-sustaining, it contributed to the implementation of Ukweli Test Strips in Sierra Leone through the community health worker backbone that will create a self-sustaining system of revenue.
2. World Hope Internationalàmatched the crowdfunding campaign contribution. This is a good fit because of the aforementioned reasons above, but it also shows the commitment of WHI and formalizes that meaning of the word “partnership” to a greater extent than what was previously established.

 

Partnerships Forged/Needed:

1. World Hope International – provide logistical support to the Ukweli operation as they are a well-known nonprofit organization with a presence already established in Sub-Saharan Africa.
2. Community Health Workers – these form the backbone of the Ukweli system by a CHWs inherent level of trust and credibility within their communities. By leveraging this partnership, Ukweli is able to gain credibility with the people it aims to serve.
3. Sierra Leone Pharmacy Control Board – approval from the organization allows Ukweli to legally distribute the test strips within Sierra Leone
4. Sierra Leone Ministry of Health and Sanitation – Formal partnership still needed in order for the Sierra Leonean government to eventually take over the Ukweli system and manage its operation
5. Liberian government- preliminary proposal in the works to expand into Liberia, the support of the Liberian government will be needed in order to make this partnership permanent and allow Ukweli to reach millions more people.

Refine your Business Model Canvas:

1. 1. Include a Visual Canvas
   2. Extremely specific notes for each block
   3. Explain how exactly you will deliver an end-to-end solution.
2. Ten practical lessons from the business (revenue) models of ventures we reviewed today (or others you research) as they relate to your venture.
   1. Envirofit uses large distributors but also smaller, local businesses in order to distribute their product to more rural areas.  We can look at this and see how we might scale up in the future in order to make the test strip widely available
   2. Envirofit heavily focuses on the impact they’re making on the people, not necessarily the product→ when reaching out for funding proposals or competitions, we can use Envirofit as an example of how we should market our product. 
   3. Envirofit does impact reporting where they call their customers to evaluate their products and collect information on cooking habits and what it’s being used for. We could translate this into our project through the testing of the WhatsApp communication system.
   4. Envirofit’s Impact of 1 Million Stoves highlights the company’s real-time data that they are collecting on their website.  Being able to include something like this on our website in the future could be incredibly useful for displaying our impact. 
   5. Reel Gardening really focused on simplifying the gardening process and making it easy for users to participate.  Our test strip is designed to make it easier and cheaper for medical staff and patients to use. 
   6. Reel Gardening provided a simple step-by-step tutorial for their users to even further simplify the process.  Our group could look at doing informational videos or messaging for CHWs and the women in the communities on the symptoms and risks of UTI/Preeclampsia going undetected.  Offer a more visual option.
   7. Reel Gardening offers an “Our Blog” section on their website.  It provides customers with information pertaining to gardening.  From different recipes to how to collect rainwater, Reel Gardening provides its customers with all information that’s relevant to the product.  Through our WhatsApp communication system, we can look at different ways to engage UHWs with the test strips and ultimately encourage increased testing.
   8. Greystone Baker has an open-hiring policy and not only pays its employees but also goes above in beyond in providing benefits for them.  Ukweli may not be able to fund benefits/opportunities like Greystone, but we can look at providing some sort of reward or benefits for becoming a UHW.  Making certification to be a UHW something that is exciting and exclusive, while maintaining our accessibility, could encourage word-of-mouth marketing between CHWs.
   9. Barefoot College really looked at spreading their knowledge through already established social networks.  For example, they trained grandmothers in order to educate and spread the use of solar power.  Similarly, we are using already established social connections through CHWs to distribute the product.  We could also potentially look into using and encouraging certified UHWs to spread the word about Ukweli and the test strips to increase interest and testing. 
   10. Barefoot College works to empower women directly by giving them the tools to establish solar power in their rural communities.  We could potentially look at a way to work directly with women so we know they’re seeing an impact and feel empowered to seek medical care. 

1. Develop a Business Model for your venture using the Osterwalder Business Model Canvas. 

Value Propositions

For mothers in Sierra Leone, our Ukweli Test Strip is a simple, affordable testing strip for UTIs and preeclampsia that could save their lives and increase their quality of life by identifying potential health issues.

Customer Relationships

Co-Creation

User Communities

 

Channels

Community Health Workers

 

Customer Segments

Women in Sierra Leone 

Community Health Workers 

 

Revenue Streams

Funding from Organizations

Selling of the actual test strips to CHWs

 

Key Resources 

Test Strips (OEM)

CHWs

Intellectual→ Connections on the ground Hassan and his connections, data collection, 

Human→ Hassan, Allieu, Bockarie

Financial→ Funding from world hope and other organizations

Cost Structure 

Sell strips to UHWs/NICs to distribute to the catchment population–>bottle of strips cost 50,000 SL

 

Key Activities

*big idea 

For the Lehigh team, we need to continuously be 

• Communicating and directing on-site UHWs (Ukweli-certified Health Workers) 
• Collecting, storing, managing, and communicating data from fieldwork to necessary stakeholders
• WhatsApp communication with CHWs in order to maintain relationships

 

Key Partners

World Hope

CHWs

Hassan, Allieu, Bockarie

 

2. List ten lessons from the Business and Operations model of the Aravind Eye Hospital.

a. It only takes one person to start something much, much bigger than themselves: just one person’s creativity and willingness to risk his own life savings was enough to bring vision to millions of people in India.

b. Inspiration can come from many places (some of them more “off-the-wall” than others). This was showcased by the inspiration of their model of efficiency from McDonald’s.

c. Resource scarcity forces any venture hoping to truly transform the world take approaches that are much different from the typical start-up in modern society. Proper training and delegation of resources to the right people, in the correct amount, is vital for their sustainability.

d. Several elements go into any operational model (i.e. support services). In order to support the underserved population, things that might not normally be thought of as part of the product delivery itself (eye care) are essential to maintain accessibility.

e. Changing a simple/affordable camera into a type of retinal camera may not be ideal, but this expands access to the eye care services even further.

f. Bringing the technology directly to people who don’t need to travel to the base hospital through the van is key delivering accessible eye care. A qualified person is able to read a patient’s relevant images remotely without the barrier of transporting someone all the way to the hospital.

g. Although the implications of charging only people who can afford to pay may be far-reaching (especially in a capitalistic society), this is a great way to ensure access to those who normally cannot afford it. I believe that it is entirely justifiable to charge those who can afford it because healthcare, in general, should be a right. Regardless of one’s ability to pay, they should not worry about having a lower quality of life and/or death as a result of their economic status.

h. The presentation was incredibly crisp: this is also key to expanding operations. In order for the masses to have confidence in their services, they must have the confidence the speaker showed in himself (knowledgeable and genuine). This might not be a formal aspect of their “model” but it is perhaps one of the most important elements of any operation,

i. Just because you’re low-resourced does not necessarily mean you cannot succeed. The statistical data shown proves this. This builds their credibility, and furthers the meaning of their value proposition.

k. Their target population was specific: like any aspect of their operation, it must be specific in order to be tangibly addressed. The underserved population was the great majority of their target population, and roughly 20% of Indians are potential candidates for their services. Based on this specificity, they show that they spent a great deal of time thinking about their individual customer population and they convey a real sense of empathy by doing so. This is key to selling their product and furthering the venture because remembering the individual one is serving is necessary to provide the best treatment possible.

1. List five compelling take-aways from the Art of the Start.                                                                    The 10/20/30 rule is perhaps one of the most important aspects of a good presentation. A good presentation shouldn’t be overly-distracting visually. The attention should be on the presenter, not the screen itself (i.e. the screen needs to be an aid, not a central feature). To capture the attention of your audience, you need to find ways to be engaging. Humor, when used in the appropriate context, is an excellent attention-getter. However, depending on your audience, this can change what is the most appropriate attention-getting method. Building on the previous point, knowing one’s audience is incredibly important, too. This is because knowing your audience will allow you to tailor your presentation. For example, a presentation/pitch to an investor will likely be very different from a presentation to an audience for purely educational purposes in an academic setting. Investing in worthwhile efforts is always a good way to remain focused. For example, Mr. Kawasaki spent a great deal of time discussing the pointlessness/generic aspects of a “mission statement”. In the grand scheme of things, a mission statement needs to be a “mantra” and effectively/precisely communicate your venture’s goals and reason for existence in a unique/memorable way. Be unique. Do not use generic statements such as “our team is proven/effective”. This is a very generic statement that does not actually show why your venture is worthwhile
2. Articulate your value propositions for your diverse customer segments.

For mothers in Sierra Leone, our Ukweli Test Strip is a simple, affordable testing strip for UTIs and preeclampsia that could save their lives and increase their quality of life by identifying potential health issues.

3. Discuss your total available market and total addressable market. List all assumptions/hypotheses.

The total available market includes any mother within a low- and middle-income within Africa. However, our total addressable market is currently ~250,000 and we will reach about 3 million people by next summer. The addressable market is within Sierra Leone, but we will also cover a greater addressable market in a realistic/sustainable manner by expanding our operations into Liberia, too. 

 

Our targeted market overwhelmingly consists of women who would not normally have access to affordable healthcare services. Although these services are supposed to be free, they are often unable to fully realize these benefits due to limited resources/capabilities at peripheral health units located outside of the main hospital within Makeni. Although the average person in Sierra Leone lives on just $2 per day, in the rural areas where our venture is targeting consumers, this number is usually lower. Because of this extreme poverty, our target population is spread thin.

SKS Exercise Results

Start: communicating more honestly with each other for the good of our work and hold each other accountable in a healthy way that does not sacrifice the mental well-being of each team member. We will do this by performing active-listening exercises as a team/individuals.

Keep: the checking-in on each other to see how we are each doing both personally and professionally, and continue motivating each other through encouragement/positive reinforcement.

Stop: being frustrated and taking it out on other team members, and stop completing work for someone without asking when another person is assigned to that task.

Collaboration Plan

Small Goal: Help the mothers of Sierra Leone, obtain SLA approval, develop a communication system for UHWs through WhatsApp, complete mapping of PHUs to the extent possible

Big Goal: Create a self-sustaining system that changes the way maternal conditions are identified and followed up with appropriate care

Roles:

Skyler: communication

Spencer: Data Collection

Anneke: Financial Processes/oversight

Noah: Support

Procedures/Relationships: Thus far, whenever we are unsure of which direction to go in as a group, we defer our thoughts to Khanjan and he will usually talk us through any challenges and reason with us why we should or should not do something. Generally speaking, we are able to come to a consensus without issue. I believe that we each respect each other enough to listen to what each individual is thinking and how we can get to our desired end result for whatever task is at hand.

Does your work require IRB approvals? If Yes, articulate your detailed IRB strategy. If No, explain why you don’t need IRB approval and identify situations when you might need IRB approval.

 

Our work in Sierra Leone will require IRB approval because we are working with pregnant women, who are considered to be a vulnerable population. 

We may have to submit to Sierra Leone IRB (depending on some alternative avenues that may or may not work out), and we will have to resubmit for continuing review to the Lehigh IRB as this project was approved in the past. However, as we expand operations, we will have to outline further details for the IRB at Lehigh and the stakeholders in Sierra Leone (CMO and other officials). Within those details, we will have to outline specific methods/controls we will have in place during our data collection process and procedures to ensure the safety and well-being of our vulnerable participants.

 

Develop an outline for your mid-semester presentations. What supporting evidence will you provide for each point? How will you boost your credibility every step of the way?

 

 

• Explain the problem/opportunity being addressed from a macro perspective – a bird’s eye view can be the world at large, country, region (and/or relevant combinations). Use your judgment.

 

• • • Highest Maternal Mortality rate in the world 
    • Little-to-no access to easy to healthcare and preventive measures

 

• Explain the problem/opportunity from a micro perspective – how does the problem affect the individual, the family, or relevant entity? What secondary problems does it cause?

 

• • Expectant women face travel challenges when looking to access healthcare
  • The high maternal mortality rate is often a result of easily-preventable conditions that are worsened due to lack of early identification of the issue
    • UTIs and preeclampsia can be identified early but lead to devastating health consequences if left unchecked
    • Any cost of healthcare will take away from the opportunity for the individual to earn money and work in a given time period
  • Cultural issues may also interfere with a woman’s comfort-level when seeking guidance on a sensitive/personal issue regarding their pregnancy
  • Difficulties and limitations with reliable shipping methods/oversight

 

 

• Explain your approach and exactly how your proposed solution is supposed to work.

 

• • Work with World Hope International (WHI) to train and sell Ukweli UTI test strips to certified UHWs in order to increase accessibility and affordability to Sierra Leoneans to preventive healthcare measures relevant to the maternal mortality rate
  • Test our population for markers indicative of UTIs and preeclampsia to provide them with information necessary to determine whether or not they are at risk for common contributors of the maternal mortality rate
    • These test strips cost 2 cents per strip
  • Collect data relevant to the number of people tested for UTIs and preeclampsia and follow each participant’s health outcomes to the extent possible (e.g. if testing positive, did they follow up with a provider?)

 

 

• What larger context/system does your project exist in? Illustrate how the various constituent sub-systems work together, and how the system interacts with external systems?

 

• • Sierra Leone Healthcare System 
    • Peripheral Health Units (PHUs) vary in their capability across the country
      • Consist of a nurse in charge (NIC) with multiple community health workers (CHWs) whom report to the NIC
      • NIC reports to the District Medical Officer (DMO) whom then reports to the Chief Medical Officer of Sierra Leone (CMO)
      • Very hierarchical system that requires us to go through a rather bureaucratic process when gaining required approvals for any aspects of our project
        • This can make things a bit inefficient, but it is also necessary for us to maintain a good working relationship with the government of Sierra Leone
    • We mostly work with the Community Health Workers within the Sierra Leone Healthcare system.

 

 

• Summarize what has been done before. What did you inherit this semester?

 

• • Test Strip tested and finalized→ 2 cents for a 3 parameter test strip with a 92% accuracy rate under ideal conditions/Registration as medical device
  •  Bombali District Staff and Connections/Contracts established/Distribution process
  • Training manuals setup

 

 

• Discuss the results of literature reviews, prototyping, experimentation, interviews, simulation, or modeling. Essentially, any work you have done this semester and plan to do.

• Work Done

 

• • • • (Not done yet but should be finished before presentation) Data Collection Forms/Database
        • As well as setting up a dashboard: Forms 1A, 1C, 1B and weekly/monthly spending

 

• Planned Work

 

• • • Establishing WhatsApp UHW communication groups/ drafting messaging 
    • radio programming?
    • Draft out UHW Bylaws
    • By summer/July 2021, Ukweli should have a catchment population of about 3 million→ Expand into the Bombali District, Tonkolili District, Karene District, Western Area Urban District, Western Area Rural District. 
      • In order to do this, we need to hire new distribution employees
    • Eventually, Expand into Liberia

 

• • Identify research/design challenges and detailed plans to address them 
    • Communication between Hassan is limited so making sure he is not only uploading data one time but correctly is key.  Having him upload the paper forms as well will give us the ability to double-check his data entry points 
    • 1C: CHW Data Collection Form→ no way to verify that the CHWs are accurately filling out the forms instead of just creating data in order to buy new boxes. One way we can address this is looking over the data entries and looking for any obviously fake data (e.g. pregnant male)

 

Ten things that make me feel human include:

1. the ability to empathize with others
2. my personal emotional feelings
3. my inner moral compass
4. working with a purpose
5. laughing
6. making mistakes
7. learning from mistakes
8. self-reflection
9. grinding through life
10. listening

I should engage the world in an ethical manner because I am a firm believer that the only purpose of anyone’s life should be to move themselves and humanity forward in the right direction. Engagement with a purpose is central to living a fulfilling life, and, as an Ukweli team member, this means engaging with my teammates, my surrounding community, the residents of Sierra Leone and their CHWs and UHWs, etc.

The challenges I should care about are those with practical applications, such as challenges that have a place for us to change/impact. For example, we should not spend too much time worrying about changing the infrastructure of Sierra Leone’s healthcare system itself, as that is beyond our control. If we spend too much time distracted with this, we will lose valuable time we could use to make progress in ways that involve working with what we are given. This means expanding our reach across more parts of Siera Leone outside of Bombali and working with the strict standards set by the government of Sierra Leone to ensure that we also protect our University. The approach I should care about is doing all of this in an ethical manner. Our goal is not to exploit the vulnerable populations of Sierra Leone, but rather to help them without expecting anything from them in return other than asking them to live their lives as healthily as possible.

When I die, I would like my epitaph to read that Noah cared deeply about serving others in need, and that he was able to hone his personal struggles and challenges in order to create a plethora of positives out of them for not just himself, but the rest of the world, too.