Ukweli has officially moved from the Humanitarian Engineering and Social Entrepreneurship (HESE) program at Penn State to Lehigh University Creative Inquiry.
Lehigh’s first Ukweli Team:
Advisor: Khanjan Mehta
Cassidy Drost
Natalee Castillo
Christian Pardo
Morgan Gillies
Our team grew!
Spring 2018 team:
Cassidy Drost
Natalee Castillo
Christian Pardo
Sage Herrick
Daniella Fodera
Meghan Nolte
Naakesh Gomanie
May 27, 2016 | Summer 2016
Our first study in Sierra Leone involved identifying the current pathways individuals take to screen for, diagnose and treat diabetes in Sierra Leone.
This study answered the following question: What is the current system (or baseline) used to screen for, diagnose and treat individuals with diabetes in Sierra Leone?
Interviews were conducted with community health workers (CHWs), community members, pharmacists, doctors and nurses at hospitals and PHUs. The interview questions focused on isolating and tracking the step-by-step process that is used to 1) diagnose individuals with diabetes and 2) treat individuals with diabetes.
Semi-structured interviews were conducted during the first ten days of field work with CHWs, community members, doctors and nurses at local clinics, diabetes support groups, pharmacists, and other entities in the health network. To identify interview participants, we partnered with the District Medical Officer and World Hope International and were connected to doctors, nurses, and pharmacists in the health network.
Through these interviews, we gathered insights not only on the screening pathways for diabetes, but also on the passion of community members, doctors, nurses, and CHOs to enact widespread screening and treatment of diabetes. We talked to a community member who started a Diabetes Association, which is a forum where patients with diabetes talk about their challenges, learn ways to improve their health, and donate money for those who are unable to pay for medication or families of those who have died from diabetes. We got tremendous insight from CHOs as they explained the fatalities that occurred as a result of diabetes and the barriers individuals face to receive health care. We spoke with doctors and nurses who are working hard to provide treatment options, even if it means travelling to Freetown to get medication or donating their time to give free screening. It was evident that individuals of the health care system and community members have deep care and concern about diabetes and are ready to take action against it. They are excited about the research we are doing in order to look at possible ways to implement available screening.
Our second study focused on determining the system response to off-the-shelf diabetes screening strips and assessing the changes in health-seeking behavior of individuals who are screened for diabetes. This study has been initiated by the whole team members and will be fully carried out by Eric through early August. So far we have had initial meetings at all 8 PHUs, gotten all training and screening materials together, and planned further actions for the rest of the summer. Eric will be initiating meetings with the pharmacies in Makeni. The full study is outlined below:
The results from Study 1 were applied to Study 2, where we looked for community responses to the integration of diabetes screening strips through different locations of the health care system and at different costs. There was a free and paid (Le 2000) option for each scenario. To study the rural community, we met with the CHO and the staff in charge at each PHU and explained the scenario that was to take place at their PHU. Next, we went through a training where the PHU staff was trained to use the diabetes screening strips, blood glucose strips, and through the desired process for each screening. Based on the results of this study, we hope to determine the viability of a social enterprise that works to establish nationwide diabetes screening, diagnosis, and treatment plans in Sierra Leone via the sale of urinalysis test strips.
The screening process includes getting a urine sample, dipping the urinalysis strip in the sample, and interpreting the color change on the strip. If the testing is positive, as indicated by a user’s guide that is provided to them, the individual will have the opportunity to take a blood glucose test. The PHU worker will document the results of the tests as well as other provided questions in a notebook that will be collected at the end of the screening period.
Scenario 1: Poster The first of these scenarios was a passive approach, in which only a poster was put up at the chosen PHU. In this scenario it was made clear that there should not be any communication through CHW and town criers to the community. The intention of this scenarios was to see a poster’s ability to communicate a message to the community.
Scenario 2: PHU Outreach The next scenario was PHU outreach, in which the PHU goes for its regular outreach but also holds diabetes screening on site. For this scenario it was communicated that there should not be any spread of word of the diabetes screening by the CHWs or town criers. For this scenario, PHUs with no or a limited number of CHWs were chosen.
Scenario 3: CHW Outreach In another option, the diabetes screening occurred at the PHU and was communication through CHWs. CHWs will be told to tell the members of their community that diabetes screening would be held at the PHU. Individuals who were interested in getting screened at the PHU would travel there to be screened.
Scenario 4: PHU and CHW Outreach The final scenario combines PHU outreach with CHWs communicating the information with the individuals of the community. CHWs will make their normal announcement that there will be a PHU outreach and say that there is diabetes screening available at this outreach. Individuals can be screened on the day of the outreach.
Scenario 5: Pharmacy There were two urban scenarios, in which pharmacies supplied the diabetes screening strips and completed the screening at their pharmacy. If there is a positive screening, the individual would be referred to the local hospital. At one of the pharmacies there is a set price of 2000 Leones and the other pharmacy has the freedom to set their own price for the screening based on their knowledge of the market. They will go through the same screening process, except they will refer individual to the local hospital to have the blood test to verify the strips results. Through these results we hope to be able to develop a sustainable model so that this screening can be available to every community member.
Our test strips team took a snap with the wonderful PHU workers after our first training.
May 26, 2016 | Summer 2016
This morning we set out early to meet with the CHO of Rokota village to finalize this as our last location for Scenarios. We travelled with the mBody team so that they could also pass their app by the clinic workers and find out the opinions of the health care workers on the app. All training materials were finalized for our first scenario training. This included printing out training materials, making notebook columns, and going through a mock training with Sarah as our patient. Slight changes on our procedure were made. GHTC papers were written sporadically throughout the day and are going through revisions from both Khanjan and Sarah.
May 24, 2016 | Summer 2016
Today, we visited the Chief Health Officers (CHOs) of Binkolo, Kapathe, and Kamabai Public Health Units (PHUs) in order to discuss our plans for Study 2. For each visit, we explained the scenario that applied to the specific PHU and provided a general walk-through of how the training would work. Each CHO shared meaningful insights and provided great feedback with respect to the considerations we need to make in our study. We are now preparing for our next visit with each PHU in order to train the CHO and other personnel on how to use and interpret the urine test strips and blood glucose tests. Currently, our study is being conducted across eight PHUs in Bombali District. Each PHU has been assigned a unique scenario, or mode of diabetes screening. Our goal for the study is to identify the optimal route to mass-screen individuals for a particular disease and see how the health care system responds to the introduction of diabetes screening test strips.
Aside from our PHU visits, we spent the day working on our GHTC papers. Additionally, we calculated the allocations that will be made for urine test strips, blood glucose tests, and cups for each PHU.
May 24, 2016 | Summer 2016
This morning we made many preparations for our first scenario meetings so that we have all the paperwork and posters ready to go. We printed out example posters, in black and white, to show the CHOs and CHAs at the PHUs. We met with the CHO of Kunsho and Makeri and the CHA of Kunsho to further explain their scenario, get their feedback and support. They were interested in doing the scenarios and we are planning to meet with them again.
When we showed the CHO and CHA the black and white version of the poster they told us it would be really hard for community members to interpret. They told us to look at the Ebola posters because they were very straight forward. When we showed them the color version, they thought that it was much better and would work well for its purpose.
We also introduced them to the screening questions they will record answers to for each patient and they also thought those were appropriate for any CHA or CHO doing the screening. More meetings were set up for the following few days and integrating the training into the next meetings is being considered.
This morning, we continued to work on our GHTC paper and completed to rearrange our posters to fit different scenarios. We made our posters to be printed in color to get them ready for Monday, which we will start to set up our scenarios. We met with M-Zed to finalize our scenario locations and transportation logistics for the second portion of our study. M-Zed took us to the CHO training session to meet with all the CHO for our study 2 scenarios. This meeting proved to be very helpful in the consideration of CHO schedules as well as other issues such as the number of participants and the spread of the information in ways we don’t want to disseminate.
Tomorrow the GHTC papers will be almost complete and we will finalize all other plans for Study 2. Be on the look out for pictures from the top of a mountain (if we make it).
We spent our day in the WHI office working on the GHTC papers.
May 19, 2016 | Summer 2016
Early in the day, half of our team members visited the Holy Spirit Hospital again to talk to the nurse who manages all the glucose testing on Diabetes Day (every Wednesday). She told us that in the beginning of Diabetes Day, patients had to pay for their registration fee and could not afford it. The nurse later suggested the founder to provide free screening in order to raise awareness and encourage people to know their own status in order to safe lives. It was also interesting that she mentioned some traditional healers told the community to eat honey to cure diabetes, which led more severe cases of diabetes. The nurse explained that more and more patients are coming to get screened for diabetes and that they need more space for the patient’s comfort. In the future, they hope to work with the Chairman of the Diabetes Association to expand their diabetes clinic and visit schools to raise awareness and encourage everyone to get screened. We are delighted to know our team and Holy Spirit Hospital are working together to help patients with diabetes in Sierra Leone.
Over the last few days, we have been interviewing several individuals to map the healthcare network in Sierra Leone and identify the pathway(s) that rural and urban communities take to get screened and treated for diabetes. We are now in the process of moving into the second portion of our study, in which we determine how the healthcare system responds to the introduction of diabetes screening strips. Today we worked on writing and designing referral forms, questionnaires, and surveys to determine how various entities (e.g., pharmacists, hospitals, Pubic Health Units (PHUs), Community Health Workers (CHWs), and people) influence the system response to diabetes screening strips.
May 19, 2016 | Summer 2016
Our first goal of the day was to talk to two Chief Medical Officers (CHOs) about their work at their PHUs as it relates to diabetes as well as the general practices of PHUs. We met them early in the day before their training began and got the opportunity to interview one more CHO than anticipated, all from different rural areas. A few of the CHOs had the means to screen for diabetes at their own PHU but still sent their patients with diabetes symptoms and positive tests to the local hospital. Some even travel to the urban area, Makeni, to stock Metformin at their PHU.
Next, our team went to the diabetes day in the Holy Spirit Hospital to finalize our understanding of health care with a specific aim on diabetes. We talked with many individuals with diabetes about their experiences with the disease. In particular, although testing is free at the hospital every Wednesday, many people were complaining about how expensive treatments tend to be and how having to buy specific vegetables and drugs can strain individuals financially. We learned about the clinic and its process and, in addition, we were introduced to a separate entity called the Diabetes Association: a group that meets to share experiences, diets, and exercises between members and collect funds for financial support of those in need and the families of those that pass away. With all these information, our diabetes pathway map was completed.
Our final goal was to establish a plan to implement for Study 2. We met with Bernadette about each of our specific scenarios and created a protocol for the final phase. Our current plan is three different groups, one with a paid and unpaid scenario each. We are in the process of creating a list of all possible options and then eliminating options that don’t fit into our results from Study 1.
The bracelet on one of the diabetic patient we interviewed at the Holy Spirit Hospital.
Our team with the patient we interviewed at the Diabetes Day in Holy Spirit Hospital.
Our interview with the CHOs before their training begins.
May 17, 2016 | Summer 2016
This morning, we met with the Chief Health Officer (CHO) of Kagbere Community Health Center (CHC) at the Bombali District Medical Office. The CHO was very informed about diabetes and acknowledged that it is important for community members to be screened for the disease. In our interview, we interviewed the CHO on various topics such as the frequency of diabetes cases at Kagbere CHC, their relationship with CHWs, their day-to-day casework, and available resources for treatment. Much of the information gathered from Kagbere CHO largely agrees with the information we previously received from the Binkolo CHO and Kamabai health workers. The individuals we interviewed from Kagbere, Binkolo, and Kamabai each explained that diabetes cases in rural communities are rare, but that most people are unaware of their status. In other words, the prevalence of diabetes in rural communities is likely much higher than statistics suggest. In fact, when we asked the Kagbere, Binkolo, and Kamabai CHCs, each said that there would be tremendous interest in getting screened for diabetes if the strips can be distributed for free or sold at minimal cost.
Our wonderful conversation with Kagbere CHO concluded with getting in touch with two other CHOs, who are currently at a training session in Makeni. We have arranged to interview both CHOs early tomorrow morning. We also revisited Holy Spirit Hospital, where there is a diabetes support group for already diagnosed patients. In addition to the CHO interviews tomorrow, we plan to speak with a few individuals diagnosed with diabetes in order to accurately map the diagnosis and treatment pathways for diabetes in Sierra Leone.
Later in the day, we spoke with two Community Health Workers (CHWs) who report to the Kapethe Public Health Unit (PHU). The goal of our interviews was to understand 1) what CHWs know about diabetes and 2) how the health care system operates in rural settings. We interviewed both CHWs separately in their respective communities alongside a translator. The information we gathered suggests that CHWs are not familiar with diabetes or its symptoms. However, CHWs are relatively well trained to recognize the symptoms of malaria, pneumonia, and diarrhea, with diarrhea being the most common disease in both the rural communities we visited. Both CHWs visit community members (ranging from 200 to 800 people) every day, and pay special attention to children under 5 years of age, pregnant women, and breastfeeding women. In addition to monitoring the physical health of their communities, CHWs are also responsible for maintaining a healthy and sanitary environment. Although the CHWs we interviewed were not familiar with diabetes, they provided very useful information on what they do and what they know with regards to safeguarding the health of each community member.
Aside from our outings, we spent some time compiling our findings into a mapped pathway showing how individuals in both urban and rural settings get screened, diagnosed, and treated for diabetes. We are incredibly thankful to both the Kagbere CHO and Kapethe CHWs, who were extremely welcoming and patient in answering each of our questions. Moving forward, we plan to conduct interviews with a couple more CHWs and speak with a few diagnosed individuals.
May 17, 2016 | Summer 2016
This morning, the Ukweli test strip team visited Amara, the District Pharmacist. Today we visited two of five PHUs, Kamabai and Binkolo, classified as CHCs.
At Kamabai, we met the Chief Health Office (CHO) who we were able to interview. It became obvious that the CHC did not see many cases of diabetes. There was still no stigma sensed with diabetes. If they were to see a case, they would refer the individual to a regional hospital, where they would be tested and treated. At the clinic, they had one medication for the treatment of diabetes, but rarely use the drug.
Later, at Binkolo, we interviewed four clinic employees as a group and found a scenario similar to that of Kamabai. The employees we interviewed had never seen a case of diabetes in their clinic; they also don’t typically carry diabetes medication or a regular supply of screening devices. Having the opportunity to talk to multiple employees at once was a great chance to learn about the clinic from several perspectives at once and provided a comprehensive look at how the clinic functions.
To round out the day, we met with Khanjan, Bernadette, and two World Hope employees to schedule interviews with PHUs and CHWs for the next few days. Through these interviews, we’ll be creating a composite view of diabetes in Sierra Leone, in relation to the local health system. This diabetes map that we’ll be making is the product of our first study of our trip; using the map, we’ll structure our second, final study.
Our team member interviewing CHO at the Kamabai CHC.
The map and plan for the national measles marklate campaign at Binkolo CHC.