||Reduction in maternal mortality
||The number of maternal deaths compared to those in previous years
||1360 maternal deaths for 100000 live births
||A number that is lower than 1360
||Use medical data from PHUs and hospitals
||Every year would be a good frequency
||World hope international would be an important help in this process
||The statistics would have to be reported the Ministry of Health and world hope international if they are not the ones taking down the numbers
||The number of women screened positive for UTIs and Preeclampsia increasing
||The number of referral tickets used by the CHWs would show how many women are screened positive and that subtracted from the total numbers of screens
||This information is not available
||For as many at risk people to be screened as possible
||Ukweli data tracking
||CHWs and other medical workers in the rural areas
||This would be reported to world hope international, the Ukweli team and the ministry of health
||Changing the stigma of UTIs and getting more women to get screened while also educating people about the symptoms and signs
||Track screens and referrals and whether or not the referrals did anything
||Increase in women seeing doctors about UTIs and Pree
||Using the records that the Ukweli team has previously made
||This is monitored as frequently as the meetings the CHWs have with the people of Sierra Leone
||The CHWs who are distributing the strips, referring people and educating those around them
||Reported to the WHI, the ministry of health and the Ukweli team
- The strategy of distributing the information about the UTI test strips are able to reach the audiences that need it most.
- The accuracy of the test strips, which will soon be tested for this summer for quality control
World Hope International and Wancheng
Team at lehigh
|Distributing test strips
Training health workers
|Number of women screened and those that get treatment because of referrals
||Maternal mortality rate lowers
Happier life for mothers and babies
|If these factors work the goals will align
Social Return on Investment
With $1, 50 strips are able to be purchased by a community health worker. When a woman buys it would most likely be for about $0.23. This allows the CHW to make a profit of $0.18. This would allow for the CHW to have a much more stable income which is not the situation at the moment. Payments are few and far between since the system of payment is quarterly and often the payment dates are missed. This would mean that if a CHW sold all his strips, he would make $9. All of those strips sold would mean the 50 women are being screened for UTIs and preeclampsia. There is no monetary value for the knowledge of medical safety, but there is still some monetary gain from this. The normal strips sold cost about $2.00. This means that a woman buying the strips for $0.23 would save $1.77. When using the money to calculate the social return on investment, every test strip bring back about $1.95. This does not include the medical safety of the women gaining knowledge about UTIs or the CHWs mental peace from having a steadier income. This means that for every $1.00 spent, $97.50 is generated.
A source of funding that we as a group have been looking into is crowdfunding. We are using sites that allow people to donate money to ventures like ours in order to better the world. There are multiple platforms to do this like Gofundme and Kickstarter. We have been looking into sources like Indigogo that have much more reputable people donating. At this point we are looking to find money anywhere since the grants that we usually dip into have already given money over the years. We are also making a video to encompass the goal of our project that would be put on these crowdfunding sites. The website that one of our members has been working on will also, in part, help our venture. If people are able to read and understand more of what we are doing then our venture can really take off. This is a double edged sword of funding though. If a project does not develop any following and does not rise in popularity on the site, less people will donate, but if it does then the people donating will exponentially grow. It is not the first choice to base the success of our venture off popularity, but when funding is needed this is what has to be done.
Another place that could be applied to is Global Social Venture Competition. This is a program that awards money to those who are developing technologies for social ventures across the world. This would be an extremely good source of funding. Not only does this program award large sums of money, up to $80,000, the exposure from the contest would encourage more to give. This combined with the crowdfunding platform would allow for an enormous amount of funding. This group also has a wide spreading reach of connections world wide. They have done work in Africa, Asia, Europe, the US, Latin America, and Australia. Although this might be getting ahead of the what we are doing, but having those international connections early in the process would give us a leg up when we are expanding to more places than just Sierra Leone. The values that the group possess also firmly line up with the values of the GSIF program. They are firmly set on making useful and creative impact all around the world in order to better the lives of those who have it less fortunate than us. This is exactly what the GSIF program sets out to do with our ventures, which means this partnership could be fruitful for both sides.
This picture is the financial model of the Ukweli Test Strip team’s future ventures. It shows what has been done in the past along with what we aim to do in the future. As you can see in the picture, the growth of Ukweli is not large until we really get some traction with the people of Sierra Leone. It should also be noted that we do not break even with our own overhead, but with the funding received we do. We are not aiming to make a profit but we are trying to put all the money we receive towards our important venture.
There are some assumptions that go along with this model. We are assuming that by the end of this summer at the latest, the marketing license will be accepted by the Sierra Leone government and ministry of health. This is important because without the actual approval of these governing bodies, we will not be able to sell our product to those who need it. This will not drastically change the flow of the financial model though, it would only push it back to the time that we have achieved the license. The other assumption is that the radio program and work of mouth marketing strategy take. Both of these are intended to inform people about the symptoms of a urinary tract infection. With this educational material being spread, hopefully people will be able to recognize the signs and go to their local CHW or buy the strip themselves. Another assumption that we are making involves quality control. By the time our strips are widely used, we assume that there will be a system in place in order to alert those using the strips if something has gone wrong. This would be whether or not the strips have been tampered with or exposed to harsh elements. This is important because we want those using our strips to be able to trust the result of the screening device.
There were many important takeaways from Guy Kawasaki’s video. One of them was that you should always hire better than yourself. I thought this was a very important idea about management since I had always thought that one should hire at the same level as themselves, but Kawasaki made a lot of good points. Another takeaway was that when starting a venture the most important thing is to try to make change with the product not just to make money. He stated that he has seen much more come from a project when it is centered on making a difference for people. Another interesting point that Kawasaki made was that you cannot please everyone with a product. If there is a demographic of people who like the product, work with them to improve the product since they are the ones that are going to buy the product. You might not be able to hit every single person with your product but you can find the niche that your product fits into. Another idea that Kawasaki presented was the 10/20/30 rule. This outlines how a presentation should be given. The 10 represents 10 slides because you want to keep the presentation short and concise, otherwise the people listening might lose interest. The 20 represents 20 minutes. The presentation should not be larger than 20 minutes. This also falls along the lines of keeping the interest of those you are presenting for. The 30 represents the font size of the words in the presentation. Keeping the font size above 30 serves a couple purposes. For example, most people will not be able to read with a lot of ease most font sizes smaller than that. The second reason is that you do not want to just read off the presentation while giving it. Using a large font forces you to learn the information instead of just putting it on a slide because there is no entertaining way to present information that people can get if they read the slide behind you. I thought a very interesting point that he made was about the mission statement. A lot of companies have a long winded mission statement that does not say anything unique about their company. Kawasaki said that the best thing to do was have a mantra instead. Three or four words that outline the short simple goal that your company wants to achieve. I thought this was interesting and valid since you do not want to confuse you investors by hitting them with a paragraph of large words you found in a thesaurus, you want the message to be clear and concise. Another takeaway that I thought was interesting was the idea that ideas that were abandoned by others can be extremely useful. His point was that you should not listen to the “bozos” of the industry and follow what you believe could be the next revolution. His examples were about the cellphone and his work in Apple. In both cases a good idea was dismissed earlier by someone and then later on the advancement went on to change the industry in a revolutionary way.
Our main business plan for this venture is to make a product that can be sold for a very low price. We plan to sell our strips to the community health workers of Sierra Leone so that they can sell them to people. This is important because we want to empower the community health workers to help out the community and make sure that everyone is living a safe and healthy life. We are also putting money into hiring people that can teach the new community health workers while we are out of country. There is also a person is also in charge of delivering the UTI test strips out to the community health clinics. He is paid less than the first one but, that is because the first person has a much more important job of selling and teaching the community health workers. A large portion of this money must come from grant money from different charitable operations like world hope and the Gates foundation. All of these organizations have given us money for this venture because in order to sell the test strip for such a small amount of money and make no profit we need to be able to front the overhead costs. Obviously some of the money goes to the manufacturers who make the test strip so that we can sell it to the community health workers. We try our best to keep everything as clean cut as possible.
There are many assumptions that our research group has to make when designing our final product. We have to assume that people will trust our product when it enters the market. Some people might look at the results from the test strip and dismiss them because they believe the strip is wrong. We also assume that people will want to learn about UTI’s once we start up the educational programs in country. We have to assume that people will want to buy more boxes or encourage their Community Health Clinic to buy some after the classes. We also have to assume that the Community Health Workers will continue to use the skills we taught them after we leave the country. It is extremely hard to have someone check when the clinics are spread out so much, but we have one employee who will be training all the CHW’s so he has some checks on them. Another assumption that we have is that the marketing license will be acquired. That is an integral part of our project especially for when we are in country. Without that we would not be able to do the advertising that is necessary for this project. We also have to assume that people will want to buy our product when we put it into circulation. There is a stigma against people with UTI’s and that might be so engrained with some people that we cannot change that. We also have to assume that our marketing strategy will work. We have put a lot of effort into planning it but we will only know for sure when we get in country. We also have to assume that customs will not have any problems with our packages of boxes. There are often mixups and confiscations when shipping to a not as well organized system. We also assume that our target consumers have a way to get to the test strips we are providing. We might be missing more people that are too far away from any CHC’s. We also have to assume that the quality control system that will be in place will survive the shipping to farther out CHW’s. This is something that we have to make sure of that when we are in Sierra Leone.
There are a couple things that we need to test when we get in country. We need to test whether or not the system of quality control for the bottles work in country and that it is easy to read. We are also designing a radio program to broadcast information about UTI’s and we have to make sure that the people who are listening are the ones who need that information the most. The second assumption that goes along with this point is that we need people to respond to the program and feel knowledgable enough to recognize the symptoms of a UTI. We designed the radio program to do this but we will only know for sure once we test it. We also need to test that our system of employees is working out for the better of the project. If there needs to be some changes, we can make those when we are in Sierra Leone. With that we also need to make sure that we have enough employees. The system might work, but without enough people on staff it could still fail. We have to also test the viability of our shipping methods while we are in country and make sure that it can handle the load of test strips. We have one person on a bike which we have had work in the past but we have to be absolutely certain. We also have to test the effectiveness of the training procedure that we are making for the CHW’s. It might have all the proper information, but we have to present it in a way that is understandable. We have to also test the record keeping system we have in place, since we are revamping it a little bit. We need to test the effectiveness of our payment plans as well to make sure the employees respond the way we hope. Finally, we need to test the effectiveness of our strips and how accessible they are to people.
I feel as though I present a different perspective than most while I am with my research group. I was fortunate enough to travel a good amount before college when I would visit family in India or earn trips to Europe by playing with different ensembles. I feel as though I have a much more diverse point of view than most and I try to bring those ideas into the work we do. The way I have begun to view myself has changed over the course of this project. I used to believe that my strength was in leading, but once you realize that there are other people who are more knowledgeable about a subject you have to learn to take a step back.
I believe that overall, the presentation that my group gave to the judges had a lot of strong qualities, but as always there is room for improvement. One of the comments that most of the students and judges had for my group involved the fact that the people who answered questions were the same for every question. They thought that our group should have spread out who answered the questions to show the validity of the groups’s work. This is a valid comment on our group and we will work to improve this but it was also a conscious decision by the group to have these specific people answer the questions. The group members who answered the questions were long time members and had a lot more experience than the newer members both in the lab and in Sierra Leone. We decided it would be better for them to answer the questions because they have a much larger scope of the issues. Personally, I could improve my presentation skills a lot. I did not make as much eye contact with the crowd as I should have. I looked down a little too much and that took away from the message we were presenting. I also stuttered a little bit during my part of the presentation. This could have been solved by a simple flashcard or just putting in more time on practicing the exact words I would be saying. Another problem we had with our presentation was the lack of cultural information about the people of Sierra Leone. This is a much harder issue to tackle because it is such an enormous topic, it would take a lot of time to fully explain. My responses personally were not very strong. I did not answer any questions in the question portion of the presentation. I will personally have to work on this in order to increase my confidence in my knowledge of the information to answer questions. I also could have talked about the quality control portion of the presentation since that is the part of the project I am working on. I think we also could have improved our responses by having more specific numbers memorized. We also could have used the backup slides in our presentation more. There were some questions that would have been explained but we just answered the question instead. Another comment that some of the students had was that I did move around enough and that I stood still. This is just another problem that can be solved with confidence in the information. The problem I saw in our presentation that not many people commented on was the transitions for the slides. We had a clicker but no one really used it, and I think that is a simple problem to fix, but still is a noticeable problem.
The work that we will be performing in Sierra Leone will require IRB approval since we are working with human subjects. Although the work we are doing is noninvasive and has minimal risk for those involved we still need to gain approval for our work since we are trying to create a widely used screening device. Most of our approval has already been laid out since the project my team has been working on has been going on for a long time. The problems that might arise are something that needs to be lookinOne of the tougher things that we will have to deal with when it comes to IRB approval is the identifiable information. One of the harder things will be to track the progress of individuals since the identification process will be much harder without out formal identification. Private information will also pose a problem because there is a lack of privacy in a lot of the health care centers in Sierra Leone. There were stories told by the veterans of the project that some of the health care workers would often talk about a patients symptoms and problems out in open in the middle of the community health centers. Informed consent might also be a problem without a translator since there might be a large language barrier between us and the people who live in the more rural areas where english is spoken much less often.
The logic model of our project is very simple. We develop test strips that are easy to read, accessible to all, and cheap to buy. Afterwards, we have to develop quality control to make sure that each bottle stays viable. Then we have to solve the last mile distribution problem. The final indicator of whether or not our test strip has entered the market and is there to stay is a lowering of maternal death rate. This is a statistic that has to be measured over ten years in order to make sure the study is viable. The short term goal is to raise the number of diagnosis and treatments.
I have played music ever since I was young. I started playing the piano when I was 5 and the trombone when I was 12. I believe this creative outlet gave me the ability to think in more creative ways than the average engineer. Intertwining creativity and engineering solutions to problems would be a large part of my design process. I have also found that depriving yourself of resources when trying to solve a problem makes you more creative and can help find ingenious solutions. After you have found that solution, it is usually only a simple task of improving it with the resources. I learned this technique when I taught myself how to play chess. The way to get good with a certain piece is to play someone by only using that piece. Eventually you learn the strategies and begin to think about the smaller picture while never loosing focus on the grand scheme. I know it sounds like a process that does not work because why would anyone work with less resources than are available, but I have seen it do amazing things to some people.
The overarching point of the Ukweli project is to reduce the maternal mortality rate in Sierra Leone by making it easy for people to screen for urinary tract infections. UTI’s are also one of the largest contributors to spontaneous abortions and complications during birth. In the long term, the validation for our product will come from a reduced maternal mortality rate, but such a task is hard to measure in such a short period of time. In the short term, our project will be validated if there is an increase in screenings and referrals to the hospital. Although this does not directly correlate to our goal, it is a good indicator that our test strip is being used and that people are trusting it enough to go to a hospital if the results show positive. In order to validate our technology, we need to develop a system of quality control to show which strips have been affected too much by conditions like humidity, temperature and light. This is the part of the project I am focused on. I have found stickers that change color as these conditions change. I am beginning talks with the supplier in order to begin testing in order to determine if these are viable. Although I have only begun to research this thread, I believe this could be the cheapest option since many pharmaceutical companies in the US use a similar product when they ship vaccines. The usability of the device will be validated when are able to teach the community health workers (CHW’s) how to use the test strip. We designed the strip so that it could be used by people without an enormous amount of medical knowledge. If the CHW’s are able to properly screen and refer people who come to them with symptoms, then we will have succeeded in our goal. Our operational model is something that we have worked on for a while now. The next step in our operational model is to solve the last mile distribution problem. A goal of this project was to make the strips accessible to the more rural areas of Sierra Leone since those areas are much farther away from any hospital or practicing doctor. When we solve this last mile distribution problem we will validate our operational model.
Many people believe that when they volunteer they are educating those around them in the developing nation and I think this is wrong. I think when it come to engaging with communities, partners, and markets in Sierra Leone, they are the ones teaching us. In order to help them solve a problem we have to learn why that problem began and only they can teach us. The underlying cultural significance of something is not an easy thing to pick up. You have to listen to the people of the region and understand their point of view of the world in order to really help them. For example, when working with the communities, you do not want to change their ways just to mirror the US. They have their own culture and that should be respected. By listening to what the community has to say, you can learn a lot about the real problem and then use that to help them. Furthering this thought, I believe that open and honest communication is also extremely important and should be valued just as highly as respect.
Nature is an amazing mentor for some of the more complicated problems. Watching the video about biomimicry made me think about the correlations between my project and nature. One thing that immediately stood out is the stark difference in the number of complicated materials we as humans use compared to those used in nature. In the natural world there are only 5 polymers used to make everything, but in the human world we use 350 polymers, and most of it is turned into trash at the top of a landfill. The lesson behind this point is that the answer is not always a complicated one, it is often a simple one. This is not always the case but trying to simplify problems is definitely something that we could try. Another example of how nature can be used as a model is the shark’s way of keeping bacteria off its skin. The formation of its skin makes it impossible for bacteria to easily bind and cause infection. Instead of using a chemical solution to what is usually known as a chemical problem, the shark has a physical answer for a chemical problem. This just shows that sometimes you have to change the way that you go about solving a problem in order to solve it the most efficiently. It probably will not work too well in relation to my specific project but it is still a good idea to keep in mind moving forward. Finally, nature could also be used to test for humidity. As seen in the video about biomimicry, there is a bug that is able to retrieve water from fog by use of specially coated bumps on its back. This is an amazing evolutionary ability, but it could possibly have applications to my project. The test strips my group is working on cannot be exposed to a lot of humidity or it will show false results. We are looking for a cheap simple way to make sure that each bottle has a way of telling if it has been exposed to too much humidity. If we were able to design a sticker or a button that could trap water from the air at a specific humidity and change color then we could have quality control on every bottle of UTI test strips.
I think one of the most important of Life’s Principles is “Be Resource Efficient (Material and Energy)”. I think this is one of the most important lessons to humanity as a whole. We as people have become wasteful and inefficient with our material. We output dump trucks and dump trucks of trash everyday and we all act like it is just commonplace. We have become inefficient in using materials in every part of our daily lives and it is driving society to the edge of destruction. Because our inefficient use of materials, in about 30 years, the earth’s atmosphere will be past the point of no return unless we drastically change the way we live on this planet. I think this principle also applies to the project I am working on. We are not aiming to make a profit in our venture, we just want to make the people of Sierra Leone happier and healthier. In doing this, we are not able to mass manufacture these strips on our own and we have to look for outside funding. Being efficient with these funds and the materials we get with them is imperative to the success of this project.
I think integrating cradle to cradle would be a lot tougher in a project that involves a screening device since contamination is something that always has to be accounted for and we would have to find a way to use this kind of technique in Sierra Leone where resources are much more limited but I believe it could be done. I don’t know if we would be able to come full circle like the man in the video did with the yarn to carpet idea, but I think we could find a way to make our test strips better. If we could find a biodegradable material to make the strips from, people could use them after getting the results for fertilizing their gardens or something like that.
My friends have taught me many things over the years. The biggest thing they taught me was to enjoy myself and not just do what my parents tell me to do. I used to play the viola and absolutely hated it until one day I saw the trombone and wanted to pick it up. My parents did not want me to but after talking to my friends I realized that I should enjoy what I do and ever since then I have played the trombone. My friends also taught me about the real injustice given to those in the LGBTQ community, not just the publicized stuff. Many of my friends in high school came out and they would often tell me about the insults they received. The final thing my friends taught me about was unhealthy food. My mother is a pediatrician and would often not let me and my brother eat unhealthy food so eating unhealthy food at a friends house was a novel concept when it first happened.
There are many stakeholders for our project of making UTI test strips for people in Sierra Leone. The most important stakeholder is the women of Sierra Leone and whoever else this strip helps. By increasing awareness and screening for UTI’s people are able to live happier and safer lives. Sierra Leone has one of the highest maternal mortality rates and these test strips aim to help lower that. If we can succeed in our efforts, then the women of Sierra Leone will live much healthier lives. Another stakeholder in our project are the Community Health Workers in Sierra Leone. These people work extremely hard to provide the best care they can with limited resources and training. Most Community Health Workers have not had education past a middle school level, and it is tough to provide good care without proper education. Our goal for them is to make an easy to use and easy to read diagnostic test strip so that they can provide better care for the people of their village. If we can make their job any easier, then we will have made a difference. Another stakeholder in our project is World Hope International. They are a national charity that does amazing work and they have people on the ground in Sierra Leone who work tirelessly in order to help the people around them. They have given their time, resources and money in order to further our cause. They give us a place to work while in Sierra Leone, help us visit different communities during our research, and provide us with a translator so we can further our work with the community. Their motivation to have stake in our venture is the same as ours, to help people lead better lives. Another stakeholder for our venture is Lehigh University. They have created a number of programs that do amazing work to improve the lives of others just like ours. They have invested money and resources by funding a lot of altruistic projects like our own in order to see results around the globe and bring recognition to the university. The final stakeholder in our project is the Ministry of Health in Sierra Leone. The Ministry of Health is the overarching governmental body that regulates the medical practices in Sierra Leone. It has tried in different ways to lower the maternal and infant mortality rate but it has proven to be a difficult task. Sierra Leone is not one of the wealthier countries in the world, and therefore does not have a lot of medical resources to allocate to more rural areas. With our test strips, more people who live farther away from the city can still have a chance of getting a semblance of a medical opinion from their Community Health Workers and other people employed in the medical field in rural areas.
Over the semester I plan to validate my project and increase my credibility. One way I can do this is by developing a leukocyte test that can withstand variations in humidity, temperature and sunlight. A current problem we have with the test strip is that it is sensitive to all three of these factors. In fact, if it is exposed too long to any of these conditions, the test begins to show false negatives. This is a troublesome problem since Sierra Leone has a rise in all of these factors compared to America. It also leads to problems because electricity is not an easy commodity to find as you go farther into the rural areas of Sierra Leone. This makes it tough to regulate the conditions the strips are being kept in and makes it harder to transport them. If we could develop a sturdier strip, then we would be able to distribute the strips much more easily. Another way of validation is to help educate the people of Sierra Leone about the problems with UTI’s. There is a large stigma about having UTI’s, but they are a common thing for everyone. One of the goals of our group is to create a radio program that will teach people about the dangers of UTI’s. If we could educate people about UTI’s and help diminish the stigma even slightly, then our project will have been validated. A way to increase my credibility would be to participate in writing one of the papers our group is trying to produce. There are many smart individuals on my team and if they help, I could educate myself enough in order to actually give ideas and thoughts towards a paper.
Cultural issues are some of the hardest to understand when starting an international venture. The project of creating low cost UTI test strips for people in Sierra Leone has run into a couple of these problems. First of all, there is a large stigma against people with urinary tract infections in country. This makes it tough to educate people about them. It also means that it is hard to market the test strips when people are stigmatized for buying them. Another cultural problem is the reliance on traditional or alternative medicine. Many people will go to these kinds of doctors and not receive the proper treatment. The reliance on these types of alternative health practitioners is driving some people away from the real health clinics. The third cultural problem in Sierra Leone is the privacy that comes in the health clinics set up in the rural areas. In America, there are HIPAA laws that prevent any medical information being shared without your permission, but in Sierra Leone there are not these kinds of laws. This problem further affects the stigmatization of people with UTIs because even if people are brave enough to go to a clinic and get checked out, they do not always have the privacy they want.
I have not experienced most of these problems in America but while staying in India with family I observed some similar cultural issues. In India there is a large stigma against people with UTIs and I have seen people shamed for going to see the doctor for something like this. In some villages there is also a large reliance on alternative methods for curing diseases. I remember seeing just a hut that the town “doctor” worked in and the treatments that he gave out were a little questionable. One of the largest cultural issues in India is the caste system. Although it was outlawed, it is still very prevalent in society today, and it can affect the treatment you are given. If you are at the top then you can receive the best, but at the bottom, no one will treat you.
A cultural factor that could be used to market the UTI test strip is that most people using them do not have a high level education so we made the strip simple to use and read. Most of the people administering the tests are Community Health Workers (CHWs). Most of the time CHWs have not received more than a middle school education, so by making test strips simpler we can market to them more effectively than other strips. There is also a cultural practice in Sierra Leone that when you miss work to attend a class or something similar food or retribution will be provided. We could use this by partnering with a project also here at Lehigh that is working on making a low cost nutritional meal for malnourished children. Since most people who are going to attending these classes will be woman, and since culturally the women cook and feed the children, we could give out food and the nutritional meals to the mothers. By combining the cultural practice of giving food and women cooking we could get more people to come to our classes and learn about UTIs.
In Sierra Leone, the structure of the health care system is much different than here in America. Usually we have medical practices filled with doctors and nurses, but in Sierra Leone there are about 136 doctors for 6 million people. This has caused a rise in what is known has Community Health Officers (CHOs) and Community Health Workers (CHWs). These are less trained people who can screen and refer people but cannot diagnose diseases. It will also be different because nurses have variable training depending on how close they are to the urban areas. The farther out you go, the less training they usually have. This is much different from America where most nurses have the same amount of training in an area. The largest problem the African context presents is the language barrier. Thankfully we will have a translator when we are in country, but there are certain things that just can not be exactly translated.
There is also a large disparity between the resources available in America compared to the resources available in Sierra Leone. In America, electricity is easily accessible almost everywhere, but in Sierra Leone it is much harder to find in the more rural areas. Some people in Sierra Leone make money by charging others to charge their phone. Transportation is also a lot different in Sierra Leone. Less people have cars and there is not as much public transportation. This makes it much harder for people to make it to health clinics and information sessions. The clinics in more rural areas also do not have the same resources that a clinic in America would. Usually they only have the basic necessities.