Author: Jasper Yan

Second Microenterprise Training Sessions

Posted on by Jasper Yan

The glaring problem that we identified when visiting our target student population of HIV support groups and Village AIDS committee was the lack of long-term planning. It seemed like these people focused on meeting their own daily needs for basic necessities in the present, and that planning for the future was an impossibly difficult task. To address this problem, the hospital decided to encourage planning for the future by requiring an action plan from each of the HIV Support Groups and VACs. However, when we requested action plans from some of the groups that we had visited, we received plans that ranged from being comprehensive to being rather cursory. Therefore, we decided to integrate lessons on 1) developing an action plan, 2) developing a budget, and 3) keeping an accounting ledger, all to encourage planning for the future. Moreover, these lessons would instruct our students how to implement what they had previously learned in our previous session with the six lessons from Barefoot MBA.

This time, the conference room of the new Family Care Center Unit (FCCU) of St. Gabriel's Hospital was available for us to use. It was certainly an upgrade from the make-shift conference room in the cafeteria from our first training session!

Action Plan Lesson
During the Action Plan lesson, I noticed an absence of class participation, which was quite odd since I had structured questions concerning the importance of vision in developing an action plan. Vision is important because it represents a long-term goal or dream that provides motivation and direction. A vision can guide actions and unify a group of people to work in a united effort, which is especially important for these HIV Support Groups that have a hard time motivating their members to contribute to the group. At first, I thought that Angela (HIV Support Group Liaison who was the one lecturing) was skipping over the Vision section of the lecture. However, I found out that Angela did in fact go over the Vision section of the lecture. The responses to “What is your vision?” were just inadequate: most of the students simply said that their vision was to “start a business.”

The problem with the vision of “starting a business” is that it’s short-term and hardly provides the guidance for future actions. Yes, starting a business is a goal, but what’s the true purpose of starting the business? Is it to ensure financial and food stability during the infamous “hungry season” that lasts from September to January? Is it for personal gain? Is it to send children to secondary school? Is it to start an HIV orphanage? My point is that the vision “starting a business” isn’t a great vision because it’s a means to an end that hasn’t been specified. The vision should be the end. It should be the dream that not only guides and provides a clear path for actions, but continually motivates everyone. “Starting a business” is an action that one can take, but it is by no means the dream or long-term goal that people are shooting for. What happens when one “starts a business?” If one says their vision is to “start a business,” then I guess one has already accomplished their dream, and must come up with another vision to replace their previous, short-term vision. Perhaps the reason why our students gave the answer as “starting a business” is simply because our entire trainings were focused on business skills, and they thought that this was a satisfactory answer.

It took me a while to explain this to Angela, and she either understood it quite well or was in polite agreement, which is customary for Malawians. It was just impossible to understand what exactly was going on during class and judge whether or not our students really understood our lessons. During the first class two weeks ago, Angela started to translate students responses for us, but we told her to stop since that would make the class too inefficient and bore the students (who didn’t know English). Perhaps the best solution is to ensure that 1) the teacher fully understands the entire lesson (maybe make the teacher rehearse the lesson in English to ensure the teacher’s comprehension) or 2) learn the native language.

Microfinance Loan Survey
After the budgeting lesson, we passed out a paper survey to assess students’ knowledge of microfinance loans. During our first training, we had given a lesson on debt, and the students had asked why we were not offering them money. We were shocked, and we became very interested in finding out whether our students knew of how to obtain a loan from the biggest microfinance organization in Malawi, Opportunity International Bank of Malawi (OIBM). Tiffany designed a 8-question survey that assessed the students’ knowledge and experience with microfinance. Administering the survey was frustrating: questions were left blank or answered in the incorrect form, even after Angela had provided additional instruction. We had to look at each survey one-by-one before collection to ensure that all the questions were answered completely and correctly, to ensure the validity of the survey. Nevertheless, the initial results were interesting: most of them knew of OIBM, some of them had tried to get a loan, but very few of them knew how to get the loan, and almost none of them had actually gotten the loan.

Filling out a survey. These were hard to administer, but we appreciated our students' cooperation!

Accounting Lesson
Despite being the shortest in duration, the accounting lesson was definitely the most interactive and fun. When we visited the HIV support groups, we noticed that those that did keep records kept stray pieces of written paper in plastic bags. It looked like records could have easily been lost or damaged among the jumble of papers. Therefore, we wanted to get accounting books for our students to encourage organization and maintenance of financial transactions related to their support groups. We ended up going to Lilongwe to purchase accounting books from ShopRite, which is a major South African supermarket chain all over southern Africa. We stapled printed review material in Chicewa to the covers of each accounting book as reference. We also purchased blue pens and plastic sleeves to protect the books from the prevalent red dust here. We bundled the three and gave an accounting package to each of the HIV support groups and Village AIDS committees.

Accounting package with an accounting book, blue pen, and protective plastic cover
We also stapled a study guide review in Chichewa covering materials from both training sessions.

Their excitement and gratitude were apparent, especially as the treasurer of each group came up to the front of the room to receive his/her accounting kit. It was also apparent that other members who were not in possession of a kit were jealous.

Angela (HIV support group liaison) explaining how to fill out the accounting books.
Here, students are labeling the columns for their accounting ledgers.
Tiffany and Angela explaining how to fill out the accounting books using an example.

At the end of the training sessions, some of the students rose for a couple minutes to speak. Since it was in Chichewa, we only found out later that our students were expressing the gratitude for the trainings we had put on for them, especially since it had been about a year since they had received trainings at the hospital. Of course, Tiffany and I were grateful that they had expressed their appreciation, and it was only at the end of the fourth and last training did we have the opportunity to say our “parting words” with the students.

High Tech Medical Records System at St. Gabriel’s ART Clinic

Posted on by Jasper Yan

The Baobab tree is famous here in southern Africa. It’s a majestic tree with an enormously thick trunk that also lives and grows for hundreds of years. One organization here in Malawi has adopted the iconic Baobab name to demonstrate their commitment to improve the health of the people of Malawi. Baobab Health, based in Lilongwe, offers innovative and high-tech medical records solutions for hospitals here in Malawi, and we got a glimpse of the recent Baobab medical records system installation in the new ART (AntiRetroviral Therapy) clinic, which provides free medication for HIV suppression to hundreds, if not thousands, of HIV patients within St. Gabriel’s catchment area.

Funding for this new medical records system specifically for St. Gabriel’s ART clinic was generously provided by the fellowship of Issac Holeman, co-founder of FrontlineSMS:Medic, who was stationed at St. Gabriel’s for the majority of this year. It’s an amazing, innovative, high-tech, and robust system that is quite unlike any of the traditional book and paper systems observed in the rest of the hospital.

Here are some highlights:

  • Four touch-screen terminals with barcode scanners and label printers are individually stationed in the nurse’s room, two ART clinician rooms, and the ART dispensary.

  • Terminals are networked to a main server, and the entire system is powered by either the hospital’s electric grid or a backup battery system that can last for several days.
  • ART patients are first received in the nurse’s room. For patients already in the Baobab system, the nurse scans the patient barcode, which pulls up the patient file.
  • The system asks if the patient is present, and if the guardian is present.
  • If the patient is present, the system asks for weight, and presents a numerical BMI number (to detect malnutrition) and a historical graph of BMI. BMIs that are unacceptably low are highlighted in red, and the nurse will then counsel the patient.

  • The system then asks for patient’s health complaints, and the nurse can select from a list of symptoms that are related to HIV.
  • The system then asks for numbers of ART pills remaining, and automatically calculates adherence on the spot. The nurse counts the few pills remaining in the bottle (rather quickly by eye). If the patient has missed any pills, then the nurse questions the patient.

  • Based on an existing algorithm taking into account BMI, symptoms, and past history, the Baobab system will decide whether or not to refer the patient to the ART clinician in the next room, who has his own Baobab terminal.
  • Patients are then automatically scheduled to come back based on the number of pills they will receive.
  • Scheduling is optimized to equally distribute patients that come in on each of the 3 HIV clinic days to even out the workload for the ART staff.

The ART clinician brings up the patient record via barcode, and makes the appropriate updates to the patient file.

  • The system is capable of performing HIV staging based on the symptoms that he enters into the system and World Health Organization (WHO) HIV staging standards.
  • If the clinician observes any respiratory distress (TB) or infection, then the patient is admitted to the hospital.

The patient then proceeds to the dispensary.

  • The amount of pills (often extra pills) is automatically calculated by the computer to allow for future calculation of adherence.
  • Pill packaging is labeled by barcode and automatically scanned and associated with a patient record.

The Baobab system currently being implemented in the St. Gabriel’s ART clinic is truly a remarkable and revolutionary system. The ART staff that used to almost be overwhelmed by the amount of patients and tasks associated with HIV treatment is now delivering great treatment with remarkable efficiency. It is truly an example of the efficiency that is greatly needed in developing healthcare settings all over the world. However, I am not sure what were the costs of such a system, and whether it is practically affordable for the health organizations here that truly need it.

First Microenterprise Training Sessions

Posted on by Jasper Yan

We had our first microenterprise lessons to the leaders of HIV Support Groups and Village AIDS Committees (Community Healthcare Volunteers that facilitate the formation of these groups) under the auspices of St. Gabriel’s Hospitals here in Namitete, Malawi.

Of the 144 students we were anticipating, about 100 arrived from all over the Namitete region, mostly by bike.  Our students were a diverse group of men and women of all ages.  We had informed them of the trainings using Frontline SMS, an innovative and affordable technology that uses existing SMS and cell-phone networks as a means of communication among large groups of people such as our students.

Most of our students arrived on bike.
Most of our students arrived on bike.

We had divvied them up into four groups of 36 to facilitate group discussion. We covered 6 topics that Angela (the HIV Support Group Liaison here at St. Gabriel’s Hospital) had handpicked from our Malawian-adapted Barefoot MBA lessons, and she worked hard to translate all 6 topics into Chichewa

These topics included:

  1. Planning and Records
  2. Savings
  3. Production
  4. Debt
  5. Investing
  6. Incentives

The general structure of the Barefoot MBA lessons included (in the following order):

  • Overall concept
  • Background story
  • Specific, story A demonstrating a bad example of the concept
  • Specific, story B demonstrating a good example of the concept
  • Questions asking about the stories, ranging from simple recall questions to full-on application to their own experiences.
  • Summary of the stories and concept

We decided that it would be best to reinforce the concepts and stories using PowerPoint. It was useful to have the stories displayed on the wall, as the students often repeated and read over the stories after Angela presented the stories, which is typical of the Malawian learning style.   Also, we thought that it would be best to have stories remain on the PowerPoint for reference while Angela asked them questions.

We had a PowerPoint set up to reinforce main concepts and stories.
We had a PowerPoint set up to reinforce main concepts and stories. Screen reads "Planning and Records" in Chichewa. Trainings took place in the hospital's cafeteria.

Halfway through the training, we had a 15-minute break with refreshments. This worked wonders in terms of livening up discussion. It’s amazing what sugar can do to a class!

It is customary to provide refreshments at any trainings at the hospital, especially because transportation to and from the hospital is such a burden. Coconut cookies ($0.67) and Soda ($0.40)
It is customary to provide refreshments at any trainings at the hospital, especially because transportation to and from the hospital is such a burden. Coconut cookies ($0.67) and Soda ($0.40)

Because the entire lesson was taught in Chichewa, it was hard for us to understand what was really going on.  We did get quite excited, though, when we observed energetic discussion going on about the stories and topics.

Angela (St. Gabriel's HIV Support Group Liaison) teaching our lessons in Chichewa (local language here)
Angela (St. Gabriel's HIV Support Group Liaison) teaching our lessons in Chichewa (local language here)

We were reminded of the HIV Support Group and VAC’s dependence on St. Gabriel’s Hospital during our lesson on Debt; the students had asked why St. Gabriel’s was not giving them money at this training.  This dependence on the hospital is a source of frustration for not only us, but the leaders of the hospital.  Financial and agricultural resources recently given to these groups as a means of setting up income-generating projects have not been used wisely, since the groups tend to simply distribute these resources among themselves.  For example, instead of ensuring that donated pigs reproduce enough piglets for a steady and consistent supply of pigs, the groups tend to simply distribute these pigs amongst themselves instead of breeding them, and after the pigs are slaughtered, they ask the hospital once more for another donation of pigs.

During our next lessons on the 26th and 27th of July, we plan on teaching our students how to implement the business skills that they learned during this week’s training.  We will also emphasize achieving financial independence from the hospital by taking a loan from Opportunity International Bank of Malawi (OIBM), which would make them much more accountable spending loaned resources wisely.  A major difficulty with obtaining a loan from OIBM is that one must go to the Malawian capital Lilongwe (about 45 minutes transportation by minibus) to obtain this loan.  Also we have heard that there are stringent requirements such as business plans and training classes.  This is perfectly understandable from OIBM’s perspective; business operations must be sustainable, and these stringent requirements ensure that the majority of loans are repaid.  Hopefully, our training will be adequate preparation for these students to take this next step in obtaining capital for their small business.

Don’t Reinvent the Wheel: Barefoot MBA Lessons for Implementation in Malawi

Posted on by Jasper Yan

“Don’t reinvent the wheel.”

During this internship, we were placed with the task of reinforcing small-business skills in both community healthcare workers and HIV support groups. Just a couple days ago, I was tearing my hair out trying to reorganize and revamp our lessons on basic business concepts. For some reason, the organization and structure of the lessons just didn’t make sense to me, and it was so incredibly frustrating.

In hopes of getting inspiration for our lessons, I turned towards the incredible set of lesson plans by Barefoot MBA, an open-source project started by two students from the Stanford Graduate School of Business. As I read the Authors’ Notes from the curriculum they had developed for rural India, I became so excited to see that they shared the same teaching goals, constraints, and expectations that we also face here with our target population in Malawi:

“Our sources consistently emphasized the need for just-in-time learning: teaching only skills and concepts so fundamental to the fabric of our subjects’ immediate needs that they perceive no choice but to learn them. Understanding what those immediate needs are has been a daunting task. Though we have listed lessons in an order that makes sense for many, we intentionally have kept them short, allowing the local adapters to select and prioritize relevant lessons and to determine the timing of lesson delivery as circumstances dictate. For example, a village might teach a set of three lessons over one three-hour session on a weekend or over three one-hour sessions on weekday evenings.” – Barefoot MBA

We showed these Barefoot MBA lessons to Casey Nesbit, who definitely has a much better understanding of education techniques and Malawian learning styles than we do. She remarked that the Barefoot MBA lessons were perfect for our audience; these lessons provided simple stories to illustrate the core concepts of each lesson, and follow-up questions ranging from simple comprehension to full-on discussion and application. To put it simply: the Barefoot MBA lessons were written by people that had done a tremendous amount of research in developing appropriate educational material to teach entrepreneurship in low-resource settings like ours. It is comprehensive as it covers 15 topics, which may be chosen and reordered based on what the target audience already knows.

The constraints that we are facing make implementation and adaptation of Barefoot MBA ideal:

  1. Despite the fact that we had conducted field research visiting the various HIV support groups, we still do not fully understand how much our students do and do not know. The flexibility and comprehensiveness of Barefoot MBA allows our HIV support group liaison (Angela) and community healthcare volunteer liaison (Alexander) to select the appropriate lessons based on their experiences with both groups.
  2. Although we know that our students will have a primary-education background, we’re not exactly sure what that entails. The follow-up questions that Barefoot MBA has after each story demonstrating a concept gradually increase in difficulty, and this ensures that we can cater to the learning ability of all of our students.
  3. It is a burden for HIV support group members and community healthcare volunteers to travel long distances to attend trainings at the hospital. Therefore, we are limited to 2 sessions that are 3 hours each. The flexibility and simplicity of each Barefoot MBA lesson allows it to easily stand on its own or in combinations. For example, if community healthcare volunteers need to come for a medical-related training at the hospital, a Barefoot MBA lesson could also be easily and quickly implemented at the end of the training.

During our first training session, we will implement Barefoot MBA lessons to teach and reinforce basic business principles. These Barefoot MBA lessons will be translated into Chichewa and are completely adapted to Malawi. Therefore, these adapted Barefoot MBA lessons could potentially be taught by anyone here in Malawi, and they don’t even need to know English! I know that a great majority of the Peace Corp volunteers here in Malawi are also working on teaching entrepreneurship skills, and hopefully this will be helpful to them, as well. During our second training session, we will be focusing on implementation of basic business principles, mainly by teaching them how to develop action plans, budgets, and accounting/cash-flow ledgers.

I am so excited that our microenterprise program is finally coming together, and that what we develop now can hopefully be of use to other volunteers here in Malawi. Once we are done with the translations, our first round of teaching these lessons, and final revisions, we hope to make our microenterprise program for Malawian settings available to everyone. After all, what’s the use in “reinventing the wheel,” when we’ve already put this much time into it already!

Imagine trying to teach business skills to 3rd graders…Sound tough?

Posted on by Jasper Yan

144 students
2 trainings
4 sessions for each training
36 students for each session
3 hrs for each session
6 hours total instruction time per student
48 hours of total instruction time for teachers

Our microenterprise training program to teach necessary business skills as a means of tackling poverty is starting to materialize. We’ve already hashed out the overall logistics for our program that will train 144 people who are leaders of their HIV support groups and Village Aids Committee (VAC). In order to spread out our material, we will be requiring them to come here to St Gabriel’s Hospital twice. They will come once next week (the week of July 12th), and once more the week after next (the week of July 26th) for 3-hr training sessions each time. Since they will be doing a considerable amount of traveling to get to the hospital, we will be providing them with soda and biscuits, and we are strategically avoiding having to feeding them lunch (considerably more expensive) by positioning the sessions right before and after lunch.

Since we have limited amount of time, and 6 hours of total instruction time, we are going to have to select the most crucial content that we developed last semester. Because almost all of our students have only primary school education, we will have to make things simple, REAL simple. We will have to take out extraneous concepts that are too abstract, and make sure to provide lots and LOTS of real-life examples to back up every concept that we do decide to teach. We will have to provide simple definitions that are easy to remember, as well. These are all things that Casey Nesbit emphasized from her experience in teaching during her 5 years here in Malawi. (Casey is the mom of Elizabeth Nesbit, who is a current Global Health Senior at Rice, and we are SO glad to have her experience and feedback)

We will present our revamped lesson plans tomorrow to Alexander (community healthcare worker liaison and palliative care nurse) and Angela (HIV support group liaison), and they will provide feedback. They will then translate the lessons into the local language (Chichewa), and we will update the lessons plans with the translations and make PowerPoint slides in Chichewa.

I never knew teaching could be this challenging. It seems like I’m constantly trying to stretch my brains out in different ways to try to understand how our students (with primary school education) will be thinking, and to determine the best way to get a point across. I guess nothing really could have truly prepared me for this challenge besides being in the environment itself. Imagine trying to teach business skills to a 3rd grader. How hard could it be! (sarcasm)

Okay, back to lesson planning!

Independence Day Picnic in Lilongwe: Meeting Social Heroes in Malawi

Posted on by Jasper Yan

Burgers, hot dogs, beer, fireworks, and good company. These are all quintessential elements of the celebrations that mark the day that the 13 colonies declared independence from British rule. Despite being almost halfway around the world, I managed to happily integrate all of the above into my celebration of the 234th anniversary of US independence, thanks to the current US Ambassador to Malawi, Peter Bodde, who had invited Americans all over Malawi to the US Ambassador’s residence in Lilongwe.

After listening to a speech given by the Ambassador and written by President Obama (by the way, Malawians here are CRAZY about Obama: Obama gum, Obama jeans, Obama T-shirts, etc), I had a great time meeting the many American expats living here in Malawi. There were probably about a hundred that attended, and the majority of them were young, probably no older than 35, which is not surprising as there were two busloads of Peace Corps volunteers that attended.

Again, the most memorable part of this experience was definitely meeting all the amazing, passionate people who were also doing service here in Malawi. I met:

  • a nurse working at the US Embassy clinic for American diplomats in Malawi. She had been working there for 10 years, and when she found out I was Taiwanese, told us that the recent transfer of diplomatic relations from Taiwan to China had caused the departure of many Taiwanese volunteers who were doing good work in Malawi. Now, there are many Chinese companies here in Malawi employing Malawians in factories.
  • Peace Corps volunteer from Pepperdine in charge of developing pit latrines for her community. This is important as lack of proper human waste disposal are a huge public health risk for any population. In her (approximate) words, it is definitely “positively affecting people at their most sensitive moments.”
  • Peace Corp volunteers selling goods from the support groups they are serving and mentoring. It seems like the majority of the Peace Corp volunteers here are involved with microenterprise/income-generating projects. Some of the projects include selling music CDs, cloth sackey balls, and bags made of local cloths here which are so popular with tourists/volunteers here.
  • Kelly, a Peace Corps volunteer from UCSD who was one of the other few Asian Americans at the event. She was responsible for setting up HIV support groups and managing community healthcare workers.
  • Missionaries from Florida who were in charge of facilitating projects with a microfinance group called Tricord. They had so many inspiring stories about their experiences here in Malawi: they had adopted an HIV+ (now HIV-) orphan who was absolutely adorable and so lucky to have such loving parents, they had worked on projects specifically focused on women/girl empowerment such as working with mother/child prison populations who were living in absolutely squalid conditions and their children were now suffering because of the measles epidemic. We shared our frustrations with how education was so lacking here, and how that was the root of many social problems here in Malawi.
  • James & Robyn Nottingham. Robyn has recently written a book in Chitumbuka (another Malawian language) to teach small business/savings skills to the community she serves up in Northern Malawi.
  • Sam from UC Santa Cruz and his friend, both Peace Corps volunteers, who were speaking fluent Mandarin to each other. Sam had spent 2 years teaching English in Beijing and now was just starting his Peace Corps assignment here in Malawi. Sam and his friend’s Mandarin was absolutely amazing, and these are the type of people that my mom would show me and tell me that I should be ashamed at myself! He told me about that it has been a trend for Malawians to describe things “Chinese” as shoddy and low-quality. I’m not particularly offended by it, but find it quite interesting.

The one thing that I regret is not meeting more people and getting to know them better. The one thing that unifies the majority of the Americans here is their commitment to service and truly making a positive impact on their communities wherever they are, which is a common goal we all share. However, most of them will be here for the long haul (at least 2 years) to ensure the success of their projects. It’s definitely something that I would not be able to commit to, and I really applaud them for their commitment.

Red, Dirt Roads: More Field Research for Microenterprise Training

Posted on by Jasper Yan

Red, dirt road. The communities under the auspices of St. Gabriel’s Hospital here in Namitete, Malawi, are connected by red, dirt roads, which are probably more like paths with tough bumps that necessitate the use of the hospital’s Toyota Land Cruiser, the 4X4 that is renowned for its versatility and durability on tough terrain all over the world. Having grown up in the urban sprawl of Los Angeles with Land Cruisers that have probably never been driven off-road, driving on unpredictable grounds has always been appealing to me, the same way that attacking dirt trails in the mountains on a mountain bike appeals to me. It seems exciting but challenging at the same time. You don’t go quite fast, but it’s exhilarating having to anticipate the unpredictabilities of the road.

Tiffany (my internship partner) and I spent all of Tuesday on these red, dirt roads traveling to three different HIV support groups to conduct field research for our microenterprise program. Last week, we had visited three other groups, and we felt that it would be useful to visit three more groups. We really wanted to try to fully understand the challenges that these HIV support groups face in their everyday lives, as this is also the target audience of our microenterprise program, which we designed last semester to teach sustainable, financial skills as a means of uplifting these groups from poverty.

Here’s a quick summary of the three groups we visited. I don’t remember the names of these groups, so I will be giving them my own names.

  1. Traditional medicine group. We arrived at 9:30 AM, yet we didn’t leave until almost 2 hours later, which really reminded me of African time. This group runs an orphanage for children affected by HIV/AIDS. They also make little, wearable HIV-ribbon bead crafts for their fellow peers in their HIV community, as well as the variety of traditional Malawian medicinal herbs for a variety of ailments. I wonder if anyone has scientifically studied these plants for any potential medicinal compounds that would also prove useful in Western medicine? At the end, the group wanted to show us a play, but since we didn’t have much time, they ended up just singing us a 10-minute song which was quite nice.
  2. Pig failure group. This group’s entire collection of pigs died from disease, and compared to the previous group, this group was in very low spirits. Angela told us that the porcine disease was probably spread through poor maintenance of the pigsty. Also, this group has been suffering from low participation among support group members as a result of perceived inequality with the distribution of these pigs. I think that this group is in dire need of renewed leadership.
  3. Middle-of-nowhere, field irrigation group. We traveled to a field that was seriously in the middle-of-nowhere, and also unreachable by red, dirt road. It seemed like we were on a path that was probably only used twice, and I seriously would have LOVED to have driven on this road. Well, fine, maybe I would have been a bit nervous, and I wouldn’t have been able to drive manual anyways (yeah, embarrassing right?). This group was in the process of adding an irrigation system (I think subsidized by the government) that was powered by a gasoline engine. I’m frankly a bit worried about the long-term financial sustainability of depending on this gasoline power source. They recently suffered a bad harvest due to poor selection of maize seedlings. They also have a honey business too.

After leaving St. Gabriel’s at 9 AM, we got back around 4:30 PM, and I was exhausted. Nevertheless, I think we really got a better understanding of the challenges facing these support groups to better allow us to improve and plan such microenterprise training programs for these groups:

  • The HIV-support group members are seriously living their financial lives day to day. It seems like the profit that is made from any harvest goes immediately towards necessities such as food and clothing for families often consisting of 5 children (on average). There is often not enough money, so many of these individuals also do work on other people’s crop fields.
  • Savings towards emergency funds is non-existant. This is especially detrimental to these groups, as a single bad harvest could possibly lead to food instability for these groups.
  • Leadership of some of these groups could berevitalized, especially with the pig-failure group.
  • These HIV-support groups have become dependent on outside financial help (specifically from St. Gabriel’s Hospital), almost at an emotional level.

Building Social Business (in Malawi)

Posted on by Jasper Yan

What is a Social Business?

Nobel Peace Prize laureate Muhammad Yunus (also the Commencement speaker for Rice University’s Class of 2010) proposes a new concept for business, called a “social business” in his recent book, “Building a Social Business.” He argues that social businesses are especially relevant in our world dominated by capitalism, as they integrate the productivity and efficiency of profit-making business towards truly making a positive, social impact. I have been reading his book, and I have absolutely fallen in love with this concept of social business, and its implications for helping humanity.

These are the Seven Principles of social business according to Yunus:
“1) The business objective is to overcome poverty, or one or more problems (such as education, health, technology access, and environment) that threaten people and society- not to maximize profit.
2) The company will attain financial and economic sustainability.
3) Investors get back only their investment amount. No dividend is given beyond the return of the original investment.
4) When the investment amount is paid back, profit stays with the company for expansion and improvement.
5) The company will be environmentally conscious.
6) The workforce gets market wage with better-than-standard working conditions.
7) Do it with joy!!!” =)

The problem: the dependance of Malawian people on expensive fertilizer.

Malawi has a primarily agricultural economy. Thus, the main source of income and food for the majority of Malawians come from cultivating crops such as corn (for their starch staple of nsima), soya, ground nuts, tomatoes, and other vegetables. Unfortunately, the soil here in the Namitete region is not very fertile; hence, fertilizer is necessary for any growth of crops. Because the fertilizer is mostly imported from outside of the region, it is expensive and often out-of-reach for many Malawians, especially those suffering from sickness and stigma from HIV. Local political corruption has prevented the implementation of government subsidies of fertilizer in the form of coupons from reaching many Malawians.

When Tiffany and I visited many HIV support groups in the region, their main challenges included malnutrition, lack of secondary education (which is not free in Malawi) for children, and lack of stable income. Many of these HIV support groups were attempting to pursue an agricultural form of living, and St. Gabriel’s Hospital has been trying to help them by supplementing piglets, seedlings, and other relevant materials. However, again and again, we found that support groups were struggling to cultivate crops due to the prohibitively expensive cost of fertilizer.

Therefore, I suddenly thought, “why not create a local, social business developing affordable fertilizer for the area as a means of bringing the region out of poverty and boosting local productivity and economy?”

Potential solution: a social business for locally and sustainably produced fertilizer employing St Gabriel Hospital’s HIV support groups and community health volunteers

The idea is to produce fertilizer in an affordable and sustainable way to help bring the region out of poverty. Inability to purchase fertilizer due to its expensive cost coupled with lack of savings for the September and October “starvation period” are important contributors to malnutrition. We plan on encouraging sustainable business practices at an individual and HIV support group level through the implementation of microenterprise seminars. However, even with adequate saving skills, the expensive cost of fertilizer still represents a formidable barrier.

Thus, what if a social business were created to not only employ these HIV support groups and community healthcare volunteers, but to create fertilizer in a sustainable and affordable fashion? Would it be possible to produce an alternative substantially more affordable than the current fertilizer that is just as effective? Can we make this a sustainable business that will distinguish the Namitete region and bring in business and income from the rest of the agricultural industry in Malawi?

Tiffany and I have spoken to Alex and Angela of St Gabriel’s Hospital, who are both constantly in the field interacting with both HIV support groups and community healthcare workers. They both really like this idea, and think that it has much promise. We got some contact information for some schools of agriculture in Lilongwe (the capital city), so we hope to seek out advice to see if this idea is even viable.

I recognize that this is a huge undertaking that might not even work out. But the least we can do is do some initial research and perhaps deliver a business plan proposal to the leadership at St Gabriel’s to make them aware of such an option.

Commencement of our Projects!: Microenterprise and Sally Microcentrifuge

Posted on by Jasper Yan

Yesterday (Wednesday, June 16), we met with the Matron of the hospital to show and demonstrate all of our technologies. It looks like we will be shifting the attention of our microenterprise project towards HIV support groups instead of the community health workers, especially given the hospital’s current efforts to boost the financial stability of HIV patients by providing seedings for crops and livestock, which is especially applicable given the region’s focus on agriculture. Tomorrow, we will identify promising support groups that will be able to especially benefit from the microenterprise project and impart knowledge gained from our program to other support groups.

It also looks like “Malawi Sally,” our hand-held centrifuge developed for hematocrit detection without power is going to be a BIG hit here. I can’t emphasize enough the need for accurate anemia detection, especially given local health problems such as malnutrition, HIV, and malaria. These conditions all can cause anemia, which can lead to dizziness, heart palpitations, overall fatigue, and possibly even serious cardiovascular complications. For pediatric patients with severe anemia secondary to malaria, it is crucial to monitor recovery in these patients by assessing either hemoglobin or hematocrit. Rapid blood loss during childbirth may be fatal for anemic mothers, especially if anemia is not properly assessed beforehand.

Portable hemoglobin/hematocrit assessment technologies currently exist, but they are extremely expensive for application in low-resource areas. St. Gabriel’s has received a HemoCue device designed to assess hemoglobin levels. However, because the single-use, plastic cuvettes are so incredibly expensive ($0.70 each for 10,000 patients is at least $1000 in recurring costs), the hospital does not dare to use it except for extremely dire situations. Instead, the hospital rely on less accurate, clinical signs such as checking the inner membrane of the eyelid (conjunctivae) and paleness and sometimes a Full Blood Count (FBC) machine, which is very overused and often breaks down.

“Malawi Sally,” our hand-held centrifuge for hematocrit detection, is a solution to this problem with anemia diagnosis, as it is affordable (<$30 in cost), accurate (within 10% of results from regular laboratory centrifuges), and fast (as many as 30 samples in 10 minutes). Today, we tested 40 patients in the antenatal clinic, and the majority of mothers were mildly anemic, which the matron said was normal with these pregnant women. Moderately anemic patients that were assessed by “Sally” were submitted for further and more conclusive hemoglobin/hematocrit testing in the lab. I’m glad that these patients will be monitored more closely to possibly prevent any further complications due to anemia in the future. The nurse we were working with was delighted by the “Sally” centrifuge, especially with the ease-of-use and affordability of the device. Tomorrow, we will continue testing of “Malawi Sally” in the pediatric ward, and I already have a feeling that “Sally” will be very popular with the pediatric nurses, as well!