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.

Pictionary in Tanzania: Bridging Cultural Gaps at the Touch Foundation

I am a Program Analyst at Touch Foundation in Mwanza, Tanzania. Over my time at Touch the program team has consisted of 2 Australians, 1 Bulgarian, 2 South Africans, 1 American, 1 French person, 4 Tanzanians and 2 Italians. Not only is there a variety of nationalities but religious backgrounds, professional backgrounds, and socio-economic statuses vary greatly throughout the team. Needless to say there are a lot of cultures working under the same roof towards the same goal: strengthening the health care system in the Lake Zone of Tanzania and more broadly the country. This diversity manifests itself in a variety of different ways throughout our open-plan office. On the main whiteboard there is a section for Dutch words, Southern phrases and Kiswahili numbers.  There are three languages spoken at any one time in the office, and it is commonplace to hear intelligent conversation about world events showcasing opposing perspectives. At first I was overwhelmed by this culture driven by diversity because I could only understand one of three languages. However, after spending 7 months immersed in this unique environment I am able to understand Kiswahili and I have become accustomed to our team dynamic. Especially now, given the current global political climate, and after my initial time here at Touch I am energized by the vast perspectives and challenged by how to positively influence the team dynamic.

A true test of adapting and facilitating team dynamics in a diverse group appeared when I was charged with planning the office holiday party. Naturally, I wanted to have a game for all of us to participate in to facilitate conversations and team cohesiveness (the Davidson Outdoors group facilitation skills course (GFSC) taught me well). The situation was made all the more complex because it wasn’t just my colleagues (that are already a diverse group) but their families as well. The game needed to be equally accessible and entertaining to people who cannot speak English, people who do not work for Touch, people who are very skeptical of games, people who cannot read, people from various religious backgrounds, and people aged 4-60. After a brief time on the internet I only found appropriate behavior for an office holiday party (pretty entertaining but irrelevant) and games that were specific to the white American Christian holiday experience. While some of the games were appealing and familiar to me (as a white American woman raised in a Christian household) there were no games that met all of the criteria. To involve everyone I needed to step outside of my familiar cultural context and be intentional about inclusivity and tap strongly into my sense of creativity.

After laboring over it, I finally developed a unique activity. The result was a Pictionary type game which required everyone draw a depiction of what they spend most of their time doing: personal or professional. Then, we passed the pictures around and individually had to guess who drew each picture.  While the game was not flawless (communication barriers still existed between English and Kiswahili) it was successfully completed and everyone seemed to enjoy it. For all of the Touch employees, it allowed us to communicate about the work we do in a different form other than spread sheets and power points (a sometimes cold and inaccessible form of communication) to our colleagues and families.

I could have easily picked a game like “name your favorite Christmas memory”, but the majority of the party guests would have felt isolated making for an uncomfortable evening. Instead, the team and our families connected across all of the cultural lines, allowing everyone to contribute and feel included. While this was just for a holiday office party I have seen this situation manifest itself in different ways while working here. I have come to know that being a part of a diverse team is challenging and it is easy to fall back on familiar culture norms. However, when the diversity is embraced and everyone’s perspectives are equally valued, the team works more efficiently and thinks more deeply.

I am lucky to be in an environment that pushes me to think beyond the white, Christian context I was raised in. It is not always easy and comfortable but exposing oneself to “foreign” perspectives and experiences is necessary in today’s world. Working in this diverse environment with atheists, Muslims, Christians, men, women, etc., I am able to empathize with people who are continuously discriminated against and targeted. This empathy is missing in our world today and is something that should be prioritized throughout the United States and the world.