Today we left the hotel at 8:30 bright and early, ready for whatever the day throws at us!

Once we got to World Hope, Rohan and Jordan immediately left to visit three clinics—Mabunbuka, Mateboi and Gbendembu. The team sent Jordan to ask CHOs and nurses about preeclampsia and the monthly CHW meeting times each clinic has. We sent Rohan, Ukweli’s quality control guy, to look at how each clinic is storing their test strips. Since we’ve been in Makeni, he’s been running experiments on how the combined humidity and temperature of the region effects each assay of the test strip. From his testing so far, our test strips have had no problems! The original assay color has remained the same after about an hour of exposure.

 

The other four remaining Ukweli team members stayed behind at World Hope to work on training with Hassan. Hassan has done an incredible job so far comprehending and learning the UTI and preeclampsia information. We are all starting to feel very confident in his abilities to train other CHWs, and he is super eager to start training at clinics. He’s been telling us every day now that he is meant to be in the field and not in a conference room. We hope to soon grant his wishes and put him into the field, however we are still waiting on the approval of our marketing license :(. Praying it gets approved by August 20^th!

Teaching Hassan in the World Hope Conference room.

 

Later in the day, Zach, Naakesh, Sage and I went to the market to get supplies for the training sessions Hassan will hold. We got 300 blue pens which will be given to each CHW who purchases a box of test strips. This will hopefully incentivize CHWs to record the number of people who screened positive or negative for a UTI and/or preeclampsia on our data chart print out. We then bought 5 large ledgers to give to PHUs so they can also record information about the people they are screening. We also purchased 15 cups that Hassan can utilize in the role play part of his training session. We plan on having CHWs practice on each other with these urinary cups before they get certified to screen people in their community.

 

Zach is a big fan of the quotes they put on the cars and buses. “Son of man” is just one of his favs.

The busy market roads

This bumper sticker describes how it feels to be in the conference room all day.

 

When we got back from the market we continued training with Hassan. He absolutely nailed it and we had a really good discussion about how he would present it differently in front of a PHU vs. a CHW. He even did part of the training without the reference guide. Tomorrow we will continue on with more of the training and hopefully get more updates on the status of our marketing license!

Today’s events featured malaria, a meeting with one of World Hope’s top administrators and lots of training….. along with a near-death experience. I’m sitting here writing this blog post STILL trying to catch my breath from a whirlwind day, so away we go!

When Hassan came into the World Hope office today, he explained to us that he was just recovering from contracting malaria the previous day. He told us he had been bed-ridden, but after taking some medicine and staying in bed, he was ready for whatever we were prepared to throw at him. Naakesh, Zach and Rohan spent a good chunk of the day running through a mock training session with Hassan, in which members of the Ukweli team ran through an example training session before Hassan practiced running one back to the team himself. Hassan even surprised us by coming in with several pages of notes which documented research he had conducted regarding preeclampsia and the symptoms and complications that can arise from the condition.

Picture 1. Scenes from the rainy season in Sierra Leone. 

Meanwhile, Sage, Cassidy and I took a trip to the market downtown to scout out some of the supplies we need to purchase for Hassan to get him started when we launch Ukweli. We created a shopping list of sorts, which included ledger notebooks, pens, and clean cups for urine, among other items. We had pretty good luck finding the items on our list and getting a gauge on the cost of these supplies. Besides a minor detour in which we had to hide under the roof in an alley due to a storm that turned walkways into rivers, all was going well…. until IT happened. We were buying some food in the market area when one car began honking behind us for the crowds to disperse to let it through. ‘ok,’ I thought. ‘I don’t know why cars are allowed through this narrow, pedestrian-heavy road, but whatevs, I’ll move.’ But then, much to my horror, a SECOND car started driving down the opposite side of the road, trying to get through, get past the crowds and get past the oncoming car. CHAOS. The drivers began honking at both each other and the crowds swarming either side of the market, and I dared to look down to find one of the car’s wheels mere inches away from my feet. Trapped with nowhere to go, me, Cassidy and Sage eyed each other, wondering if we would make it out of that mess by some miracle. Somehow, someway, the drivers screeched past each other, and here I am able to write this blog post. Why is that entire area not pedestrian-only? These are the answers I will never know. Truly an experience, but I won’t tell lies: I was scared.

Picture 2. A NEMS ambulance from a clinic last week. You can see this size of car should not fit in a one-lane road.

We arrived back from our adventure at the market to discover Saidu, the country director of World Hope in Sierra Leone, was in the Makeni office and ready to meet with the Ukweli team. We had a productive conversation about the logistics of our venture, including contract details for Hassan and discussing how transportation and phone costs could work if resources are shared between the Lehigh team and World Hope.

Picture 3. Loki, the sweet World Hope puppy.

Tomorrow, I am hoping the team can purchase the supplies for Hassan, continue with Hassan’s training and for the universe to balance our bad karma in the market with a happy surprise, like the approval of Ukweli’s marketing license. But worst comes to worst, I know I will be in for some quality insights from Naakesh based on his reading of the business paper. Just when you think you’re bored here in Sierra Leone, that’s EXACTLY when adventure strikes 🙂

Picture 4. off a dirt road next to a clinic in Rokulan.

With Hassan at home celebrating the holiday and most of the market closed for the day, the team took the opportunity to debrief at the World Hope office and work through some logistical details related to the venture. Most importantly, of course, we had some team laughs while playing a new card game that our teammate and Housing Czar Sage taught us: it’s a combo of Crazy Eights and Uno, and it involves giving each other dares whenever a Joker card is played. For example, Cassidy had to stand up every time her name was said, and Naakesh has to read and comment on a 23-page business paper that Sage wrote months ago! Ha!

OK, but down to business. The team accomplished several vital tasks today, the first of which included figuring out the details of Hassan’s employee contract and analyzing our team budget for the next 12 months or so. We ran through these numbers with Khanjan, and after some helpful suggestions, we are on the right track! The meeting was a huge win for the team AND the environment, as Khanjan even agreed to provide Ukweli Health Workers with boxes to collect the used test strips! Who would’ve thought!? But in all seriousness, we preliminarily approved Hassan’s commission-based salary and the various items needed to conduct proper trainings for UHWs, which was one of our big goals heading into Sierra Leone so that we can leave the country with all the financial-based details in place.

Zach and Naakesh worked on the accountability files (whatever that means) for the venture, while Cassidy and I laid out the spreadsheets Hassan will need for his two bound ledger notebooks. One of these notebooks will be for Hassan’s job tracking information, including the amount of fuel used each month and the phone credit he used each month. The other notebook, however, will be for Hassan to track information including the number of test strip boxes sold and the number of positive and negative screenings found at PHUs and other health facilities. The team plans on buying supplies like these notebooks and clean cups for the urine on Tuesday when the market reopens after the holiday.

On an unrelated note in terms of Ukweli, but a very related point in terms of cultural immersion and personal development, the team had a very exciting day interacting with some local Makeni children. Much to our surprise (and pleasure!) several local children came into our conference room and hung out with us for the day. They thoroughly enjoyed my hair and Rohan’s card magic tricks. Cassidy and I also had a fun time playing frisbee with two of the children, and we all found out we were actually better at forehand throws than we had anticipated!

Stay tuned tomorrow for more wins and progress as Ukweli lurches forward!

Today the Ukweli team spent their time indoors for the majority of the day. The team spent the day running through messaging strategies with our great buddy Hassan. He did a fantastic job learning from Naakesh, Jordan and Zach. While that was going on, Cassidy, Sage and Rohan worked on the hiring contract that Ukweli would need for its employees while also starting preliminary quality control tests. When exposing the strip to a detrimental amount of light and humidity at the same time, it was found that the test strip was still able to hold viability up until an hour of exposure. Testing has started for temperature and humidity exposure and soon, light, temperature, and humidity. The testing had to be performed in the mushroom dark grow house in order to keep temperature and humidity stable, but it is through a field that has many fleas and Rohan wore shorts that day. Thankfully no diseases were contracted from the fleas so all is good on that front.

After this, the team all came together to take about the employee contracts. During a break in this process, Sage taught the team how to play an annoyingly complicated version of crazy 8s. Rohan lost every time they played. During this process many questions were raised that Khanjan had to answer. Questions such as how will we incentives CHWs to track negative readings on the test strips, how will Hassan transfer the money earned to us so that we can buy more test strips from the manufacturer, how can we market this to men who need to be screened for UTIs, and what is for dinner? During this meeting, Hassan brought some special green oils that he would rub in his nose and around his face. He let Rohan try a little bit and it burned like the sun itself. He had never felt such pain, but it did clear his sinuses. Hassan then gave a bottle to the very handsome Rohan telling him that he should rub it on his face that night.

After this meeting, the Ukweli team ran over the bakery to catch the malnutrition team making their first batch of bread. It was amazing. The dough was pillowy enough to take a nap in and tasted so delicious that it made Sage say “Gee willikers”. Over the day was a success but it gave the team a lot to think about and a lot to work on in the future. The puppies at World Hope also were so adorable today, especially when they took their naps.

This is the bakery where the malnutrition team made that amazing bread.

Another day of traveling for Ukweli Test Strips! Today the team, along with the Sickle Cell Diagnostic Team and Safe Motherhood Documentary Team made trips to two different clinics within the Bomboli District: Rokulan and Kalangba. These trips were made in order to talk to more health system employees to better understand the current situation regarding Community Health Workers (CHWs) and how we could implement our test strip into these clinics systems.

Section of the road on the way to the CHCs in Rokulan and Kalangba.

 

After an hour and a half ride along semi-paved roads, we arrived at Rokulan, an understaffed and undersupplied Community Health Clinic (CHC). At this clinic, we were able to talk to Mister Francis, a Community Health Officer (CHO) for 26 years who is the head CHO of the chiefdom and leader of the chiefdom. During our time with him, we learned that the CHWs working under the Rakulan clinic were still waiting on the quarterly stipends that should have arrived, and often are not supplied the proper devices to effectively do their job. When we asked Francis about preeclamspia in his clinic, he said the location has not dealt with cases, but since the clinic refers any expecting mother with symptoms of preeclampsia to other hospitals, preeclamptic women could have been to the CHC. Despite the zero confirmed preeclampsia cases, Francis seemed very receptive to our UTI and Preeclampsia test strip, and was happy to work with us to train other CHWs at his location. We are planning to come back to the clinic to train the CHWs on how to use our test strip later on in our trip.

Rokulan’s CHC sign with part of the village in the background.

The CHC located in Rokulan.

 

Our next stop was at Kalangba, a Community Health Clinic that was along the highway back to our hotel from Rokulan. During this visit, we mainly talked to the Community Health Officer and Midwife, but other members of the CHO were present. Similar to the health workers in Rokulan, the workers at Kalangba were very open to us returning to their clinic and training their CHWs, a great sign in the project’s push to expand throughout the Bambali district. The Midwife at the clinic also confirmed that pregnant women have come to the clinic with preeclampsia and many more have shown signs of it, making them even more excited about our test strip being introduced to their clinic.

Images from the Community Health Clinic is Kalangba.

 

After Rokulan, Ukweli returned back to World Hope International, where we met with Burnadette Udo, a World Hope Worker that has recently moved from the Makeni office to the Freetown office. After sharing more about our project, Mrs. Udo seemed very optimistic about our test strips entering the market, and thinks that our product can eventually successfully make its way into Freetown. After our meeting with Mrs. Udo, we continued our work finalizing our training protocols with Hassan Suri, a World Hope International employee assisting us with our project. Hopefully the training and messaging protocols will be done tomorrow so the team can begin mock training sessions!

Today we got up bright and early to visit three clinics. We were joined by the sickle cell team and maternal mortality documentary team. They wanted to come with us to observe how we conduct interviews as well as see what the clinics in Makeni are like.

Yesterday we found out that World Hope is no longer funding Community Health Workers (CHWs) stipends. After hearing this news, we decided that we needed to visit a few clinics to see how the program is functioning despite no stipends being paid to the health workers. We also wanted to see how much of an understanding nurses and Community Health Officers (CHOs) had of preeclampsia.

 

The first clinic we went to was called Kageaneh. We spoke to the female CHO about the CHW program and about the number of cases of preeclampsia she sees. She currently has 11 CHWs working at her clinic and all of them are being paid a stipend for their work. She believes that they are being paid by the government. We asked her about supplies and she told us that they have not received a shipment of supplies since February, which is one of their biggest challenges for providing quality care. When we informed her our strips now screen for preeclampsia, she seemed excited about it but she said that she has not had any cases of preeclampsia at her clinic. She was extremely familiar with the condition and knew the difference between eclampsia and preeclampsia. She also had a blood pressure cuff to test for hypertension.

The second clinic we went to was Kamabai. We met with a male CHO who didn’t seem to be as informed about his clinic as the Kageaneh clinic CHO. He wasn’t sure if his CHWs were being paid a stipend and he wasn’t sure who was paying their stipends if they were receiving one. I was surprised at his lack of information because the Kamabai clinic is one of the newest, biggest and nicest clinics in Makeni. He later told us that he hasn’t had any cases of preeclampsia. He said if a woman has preeclampsia they are immediately referred to a district hospital and so most cases of the condition are dealt with at the hospital.

Kamabai Clinic

This is a catchment map of the communities and villages that the Kamabai clinic serves.

 

The third clinic we visited was in Binkolo. The CHO we met said that he currently manages the care of 15 surrounding communities. He told us that the CHWs he manages are receiving a stipend that the government pays for. He informed us that they currently screening pregnant women for preeclampsia with a protein assay, blood pressure cuff and physical examination. When we informed him that our strip can screen for both UTIs and preeclampsia he was happy and said that combined screening tests are efficient and would help his work.

Some of the Ukweli, Sickle Cell and Documentary team members.

 

Later in the day we met with our translator, Hasson, to talk about an employee contract with Ukweli. We wanted to make sure he understands that his contract focuses on the milestones and accomplishes he makes during the months we employ him. It was interesting to watch how Khanjan negotiates and comes to an understanding with Hassan about his job duties and making money to keep the venture self-sustaining.

Overall, we had a really good accomplished day!