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.

Quis custodiet ipsos excelum

I’m trying to navigate through the bureaucracy of obtaining a work permit with an immigration officer, and my progress is interrupted by the officer’s ringtone. It reminds me of the ringtone I had on the phone I was given during my semester in Uganda almost a year ago. Moments later, someone else’s cell phone brings up the same memory, then again. Welcome to East Africa, pronounces the immigration officer as he stamps approval in my passport. Where all ringtones are identical.

If everyone’s ringtones are identical, how can people distinguish whether it’s their phone ringing in a 20-person dala dala (read: a most common form of public transportation here; a little, chubby, falling apart Toyota van with anywhere between 20 and infinite number of passengers)? Would they even care to check whether they should pick it up on the off chance that it is theirs ringing? What if it’s an urgent call, say, a medical emergency? So it is I begin my work with the Touch Foundation thinking about the management inefficiencies of the Tanzanian healthcare system as suggested by people’s ringtones.

Hypothetical exaggerations aside, the provincial East African environment here in Mwanza does make you appreciate the impact that minute details may have on quite important aspects of life or, for that matter, lack thereof. During my first couple of weeks here, I have learned, for example, that, much like a bug big enough to drive you mad by flying and buzzing into your eardrum is the single most prominent vector of death south of the Sahara, a couple of minor, easy-to-overlook errors in an excel spreadsheet may result in dramatically inadequate staffing of healthcare facilities throughout a country north of 50 million people.

It’s not bad to have an opportunity to affect 50 million people after 4 years of liberal arts intellectualism, especially while being merely one more health-related NGO worker in the developing world. Like a mosquito. Only, hopefully, with a positive impact. A nice mosquito. (?)

Until my next post, I will be assuming the duties of keen vigilante of mosquito-sized details. An excel guardian.

Matching Idealism with Pragmatism: Working towards a Healthier Tanzania

Over 7,000 miles away from Tanzania’s Lake Zone is a different sort of jungle—New York City. While Touch’s in-country team executes and manages our projects in East Africa, I support the development, implementation, and evaluation of the organization’s communication plan from Touch’s New York office. Established in 2004, the Touch Foundation works to improve Tanzania’s quality and quantity of healthcare workers, optimize their deployment and retention, and enhance the healthcare delivery mechanisms in which they work.

I worked with a lot of nonprofits during my four years at Davidson. What drew me to Touch was its commitment to sustainable impact and emphasis on local collaboration and ownership. Our projects are designed from careful needs-based analyses and executed with the expectation that Touch will eventually transition them to Tanzanian management, empowering our Tanzanian partners and ensuring the vitality of Touch’s work. Touch embodies a sense of idealism matched with a pragmatism that channeled the many Exit 30 discussions had on effective service and international development. This isn’t entirely coincidental as a fellow Wildcat, Lowell L. Bryan ‘68, founded and leads Touch as its president. This now a warrants a shout-out to Dr. Steve Justus ‘78, Touch’s Chief Medical Officer and Senior Vice President and Hannah English ’12, Touch’s Development Manager. Adjusting to post-grad/city life wasn’t too bad as you can now see.

Working from New York has also enabled me to obtain a greater grasp at nonprofit development, i.e., the fundraising elements of nonprofits. It certainly spans far beyond throwing annual galas and generating appeals. Development is a giant undertaking an an integral component of a nonprofit organization. It encompasses donor management to ensuring funds are raised, responsibly spent, tracked, and reported. What repeatedly overwhelms me most about the process is learning how many organizations there are working on healthcare in Africa. What makes Touch worthy of donor contributions among the tens of dozens of organizations doing great work?

But then I step back. I think about our approach. It’s a single country focus and while not as “sexy” as rolling out a map with project dots emblazoned across four continents, it’s what makes Touch effective. International development takes time. There are relationships to build and success is contingent upon a community’s specific dynamics and institutions in place. We’re here for the long-term and when we leave it’s because Tanzania is ready for us to leave. Such realizations make me even more proud to be part of such a dedicated and reflective team.

I know this will increasingly be the case when I experience and contribute to our on-the-ground work firsthand–and it looks like this will happen sooner than later. Vaccination appointments set and flights are booked! Just in time to escape New York’s painfully cold weather too.

A three-fold cord is not quickly broken…

Lately, its been a little quiet in New York…with Tuesday being a big exception as ‘Polar Vortex 2’ hit the city again. It’s really, really cold. A fun, warm ‘inside’ activity for me is to browse through old pictures. Some memories must always be lived again and again J

A three-fold cord is not quickly broken...

Sekou Toure Team

.  While wrapped in more blankets than I care to admit, I came across a picture of one of my first weeks in Tanzania.  I had just started to work on a new program and the pic was of one of the teams with which I had begun to collaborate. One of the people in the picture was John.  He was the person who introduced me to a phrase I grew to love—“We are in this together, dada.”

Dada means “sister” in Swahili, and to my muzungu ears, the use of the word was endearing. This simple phrase was always delivered to me by Tanzanian co-workers and friends when things were particularly crazy. Whether I was trying to procure wifi from nowhere, running around for keys in the rain, or trying to conjure tents out of thin air, this sentence would be offered in an off-handed but sincere manner.

I can’t really tell you what made me love this phrase. It could be the feeling of camaraderie it provoked— being a new-comer (while always exciting) is sometimes intimidating and being accepted so quickly made my Tanzania-experience so memorable.  It might also be the reassuring feeling that someone was always looking out for me. I was completely new to the language and culture and had already made some really unfortunate mistakes. The phrase, when delivered, reminded me that I was working alongside wonderful individuals who would get me through even the most awkward of foreign muzungu moments. It could also be that the phrase was a gentle reminder about what my work really entailed: collaboration between all the stakeholders in order to strengthen the local healthcare system. Initially, I often thought about my work as MY projects. While the framework was definitely my responsibility, it was far from MY project. It was A project, or THE Project, but it was most certainly not mine.  I relied on everyone around me to see those project through. I relied on my Tanzanian co-workers who would happily translate when I needed it, on the wise-ones who understood way more technology than I ever will, and the generous people who always gave me helpful feedback to strengthen each project. All of us were in it, together, in order to accomplish a common goal. It is only because of this joint effort that these projects are succeeding, despite the rough spots.

I can’t wait until I get to go back—1.5 months and counting!

Like a fish out of water… a general update

Karibu Sana! You are very welcome!

I have been greeted by these words repeatedly for the past 2.5 weeks when people find out that I’ve only just arrived to Tanzania. And I really do feel welcomed–the Touch Staff has been great in making me feel part of the team, Rose (the wonderful woman who does it all at the Touch House) has cooked some awesome Mwanza dishes for me to try, Francis (the 50+ year old man who helps keep the Touch House and gardens running but speaks almost no English) continues to laugh at my Swahili attempts but tries speaking to me regardless. And I’ve slowly started making a couple more friends beyond the Touch House. Life is good 🙂

As a few of you may know, this is my first post (and I think it may be a long one). I’ve held off writing partly because of the bustle and jumble that has been in my life the past couple months and also because I wasn’t really sure how to say what I wanted to say. Moving from Davidson to Ecuador to NY (where I moved twice) to Mwanza, Tanzania was a fun whirlwind but not exactly ideal for letting feelings and thoughts settle into words. Now, I finally feel a little grounded so here goes:

I was a biology major at Davidson, all my summer jobs beginning freshman year were in labs. While I did have to do some “desk work” it was mostly hands-on work. I was fortunate to always end up in labs that were welcoming and did lots of group activities.  Regardless of where I was, I was always moving, doing, and meeting lots of people who I later considered good friends. And then I accepted a job with Touch Foundation. I truly respected this non-profit organization- their projects are based on understanding what the local population needed and they believe that local stakeholders need to buy into these projects and therefore engage them in their programing. They support the Tanzanian health care system by improving a local hospital’s education, and in that way improving the quality (and quantity) of health care workers in the country. They produce tangible, sustainable results. For this and for many other reasons, I accepted the position of analyst with the Touch team.

Working for Touch Foundation is unlike anything I have ever experienced. And to be honest, I struggled with it for the first couple months. Initially, it was pretty much an 8 hour office job. I have a computer that I look at for 98.5% of the time, and reading and reporting to do. I am also now creating consulting power points. Everything you learn about power points as a bio major is 98% inapplicable to consulting power points. A little painful and a lot confusing.  I felt like a fish out of water. Or like Santa Claus on Mother’s day (whichever paints the best picture for you)… very, very much out of my element. Not only was I creating documents and producing information that I had no idea about, but I was sitting still for hours at a time: 8 to be exact. I don’t remember the last time I sat that long. I felt terrible. I would get up and walk to the bathroom or the kitchen every 2 hours or so just to stretch. Although this doesn’t seem like a huge deal to most people, I would like to let you know that Touch’s office share space with a consulting company and I’m sure some of those analysts didn’t move more than once or twice throughout the day (there was a point at which I questioned if they were real people). My restlessness was noticeable. And my lack of an 8-hr concentration span made me uncertain of how well I would be able to meet Touch’s standards. On top of that, I also happened to start at Touch near the close of the fiscal year. Everyone has a deadline to meet and the jargon and the names of each of the programs become a blur, I kind of envied the water-less fish at times, and I’m sure Santa was much less confused than I was.

But now, in retrospect, I remember the craziness with happiness. Yes, my new job (and of course New York) was a bit of shock at first, but I slowly grew to love the city. It’s actually an introvert’s paradise, and a place where kindness goes a long way. It was also a great time to remember and celebrate true friendships. From dear ones who called and skyped with me throughout the first months (or visited!!!) to the awesome Touch team who, regardless of how busy they were, would also take a quick second to answer any questions or recommend a yummy lunch place. It was a little disconcerting at first, but it was good practice for the switch to the Mwanza. Here, while English is generally spoken, Swahili is often the best way to communicate with the locals and picking it up is (for me) a slow going process. In fact, I may or may not have played charades with a wonderfully patient older woman who laughed when she finally understood that I was lost on my way to the grocery store. I also happened to go from the city that never sleeps to the town that isn’t too safe after dark—I need to be home by 7 PM if I’m walking and take taxis wherever I need to go afterwards. Also, in case anyone is wondering, Mwanza lacks good chocolate.  Regardless, I am in love with this place, and have posted a small portion of Lake Victoria’s shores to help you fall in love with it, too.

In regards to my work, this last week my 8- hour days were a little easier, and I was more productive during those hours than before. Bodies and minds really do adapt to their new settings, if you give them a chance. I also really like the Tanzanian Touch staff where, while work gets done, there is teasing, and people are really helpful and kind. And that constant worry about whether or not I’m doing things well was finally soothed yesterday. I’ve been recently working on an project that required that I organize a workshop. Although I usually run things by my “manager” before and after projects (I’m still learning), we didn’t actually get to talk before the workshop. Later in that day, he turned to me and told he had completely forgotten about the workshop. He said he was sorry about forgetting and then said. “I guess that I know that you get things done, so when I knew you were doing the workshop, I stopped worrying about it.” Ahhhh words of confirmation! People, don’t ever underestimate words of confirmation.

Summary of post:

1)    Feeling like of fish out of water is not necessarily a bad thing. Yes it’s uncomfortable at times, but uncomfortable keeps you moving and learning and fully appreciating the times when you do get some air.

2)    Mwanza is beautiful and Touch Foundation work is challenging, but fun.

3)    Words of confirmation. They’re wonderful and best when sincere and unexpected

Enough rambling for the time. This was a quick update and I’ll be posting more structured blog entries soon. Asante sana!