Archives for April 2017

How to balance numbers with people: losing sight of the cause

Living in Mwanza, Tanzania as an expat is like being in freshman year of college again except with slightly different questions. Instead of “what dorm do you live in?” and “what is your hometown?”, people continuously ask “how long have you been here?”, “which country are you from?” (although my very obvious American accent answers that question by itself), and “what are you doing here?”. The first two questions are pretty straightforward but the third question normally confuses people because of my vague job title: program analyst for Touch Foundation. That title translates to my sitting at a desk working on excel to organize data and create models, work central to our monitoring and evaluation (M&E) effort of various health system strengthening programs. The science major in me loves this. I lose track of time when I’m immersed in a project. I get excited when there is a challenging concept to grasp or formula to learn, and find instant gratification from figuring out how the numbers fit together. However, there is a large part missing from my daily routine and work: the population I am working with/for to improve healthcare in Tanzania. I go most of my days not thinking about the reality of the dire situation of healthcare in Tanzania. This is problematic considering our office is surrounded by coffin shops that are constantly producing coffins for the avoidable deaths that happen on a daily basis at the regional referral hospital five minutes up the road.

This lack of context and desensitization became even more apparent when I started working on M&E for our Mobilizing Maternal Health program. We are measuring how many women’s lives were saved with the implementation of an emergency transport and referral system in a neighboring district. To gather raw data on maternal deaths at the hospital I traveled to the hospital, a fun hour long ferry ride followed by a bumpy 30 km dirt road. Being at the hospital definitely put the deaths into context. The bustling health care workers going from ward to ward, mothers carrying two babies at a time, and pregnant women roaming the hospital waiting to give birth. However, as soon as I arrived back at the office these women became just numbers.  To start the analysis I stripped down the complex life of deceased women into a raw number for an excel model. This raw data was used to inform conversations about our impact and the status of the maternal mortality ratio in the district.

In the midst of calculating a maternal mortality ratio and drafting a graphic for a power point slide the actual women we are impacting were lost. However, we were able to reach a conclusion about the cost-effectiveness of our program and justify the continuation of our program. This information will also be used in the future to inform our program design but also programs in similar settings throughout lower-income countries to improve maternal health. Therefore, there is value in M&E to continue to foster evidence-driven programs that are effective. However, I am torn between balancing objective analysis with the subjective nature of human life.

Objective analyses are crucial to be able to make forward movements in improving healthcare in Tanzania (something Touch Foundation values and prioritizes), but what is the tradeoff? Is it possible to remain connected and empathize with the mamas while conducting objective outcome driven analyses?

I do not have the answer, but working at Touch Foundation has started me on the journey of discovering this balance by showing me how difficult it is. I hope that as my career continues I will learn to strike a balance between these two contradictory but crucial aspects of global health and international development. I believe that with this balance the value of the dollars that are donated by the millions to international development will come closer to reaching their full impact in a helpful, effective way.

Dirty Jobs: Land Conservation and Environmental Management

My time at Catawba Lands Conservancy and Carolina Thread Trail has been split in many different directions, doing many different types of work, and working with all types of people. You can really learn a lot about the society we live in behind stands of pines and hardwoods, in the riparian lands along our creeks and rivers. Last week I went on a site visit to a Catawba Lands Conservancy (CLC) property (I won’t specify the exact location so all landowners may remain anonymous). This conserved land is separated by just a few parcels, and as many landowners from our most popular natural surface trail in the Carolina Thread Trail (CTT) network. To make this connection, would add about two miles onto our existing trail, and is a very tangible goal depending on landowner cooperation. That being said, I and two others went to the site to walk the corridor and assess trail possibilities. What we were met with was both exciting and discouraging.

Our walk started off through a managed forest of loblolly pines, which make for a great trail because of the relatively clean understory and forest floor, and then shifted down to the creek bank where the walking got a bit more laborious, but still had great potential for a trail. The creek wandered through the forest, large native pines and hardwoods on the east bank, and an intimidating wall of invasive privet on the west. Eventually the forest gave way to a wide, beautiful wetland area fed by a creek (name undisclosed) and the flood waters of the lake (name undisclosed). This area was quite pleasant this time of year, but would be a breeding ground for mosquitoes in warmer weather. The wetland area would require a series of bridges or boardwalks to implement a sustainable trail (although bridges and boardwalks would be a nice amenity for users, it can be a very expensive obstacle for us). Back into the woods we went for a short distance until we reached an untouched pool of the lake. This water body encompassed about ten acres, but was only about two feet deep and littered with trees, fallen branches, and exposed islands of grasses—a heaven on earth for wood ducks and other waterfowl. As we approached, sure enough, we bumped up a pair of wood ducks, a blue heron, and three Canadian geese. This was a beautiful sight, and rare to see on a commercialized lake such as this one. Our admiration, unfortunately, soon turned to dismay as we made our way around the water and saw the disgusting scene on the other side.

As we circumvented the pond, we came upon a litter pile of glass and plastic bottles, plastic toys, beer cans, tires, Styrofoam, and old household appliances. This was the largest and most dense litter pile I have ever seen in an undeveloped area. It was amazing amount of trash, and we soon came to realize that to make a trail a reality in this area we would need to have multiple volunteer workdays with many hands working diligently for hours, filling several dump truck loads of trash for removal. Trash pickup is not the most glamorous work in land management, but one that is necessary in many cases. This is one of the “dirty jobs” in land conservation work, and frankly, a job that can be over-looked or brushed under the rug because of the limited resources in small land trusts and other environmental organizations like ourselves.

As a conservationist, this is extremely frustrating to see. Trash is a serious problem in our society and a major concern for the environment through its impacts on wildlife, water quality, etc. Action needs to be taken on this front, and I’m not exactly sure what that will look like. Is it local, state, or federal policy changes? Or is it an effort made through corporate responsibility initiatives from companies producing these products, maybe an effort at the grassroots level? I’m not sure, but if something isn’t done about this soon, the increasing global population combined with the societal obsession with on-the-go products, fast food, and plastic products will be the demise of our natural environment as we know it today.

Seeing is believing. It is hard to wrap the human brain around something of this magnitude from anecdotes and photos, so it is important for organizations like us to get people outside and facilitate this conversation. But remember, non-profit environmental organizations love volunteers and would fall apart without them. So please look into spending some time researching and finding places to get involved in the conservation efforts wherever that may be.

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