Onwards and upwards (well, technically downwards) to Accra!

Tim Yuan - Ghana

Well folks, that's all she wrote for Kumasi! I had a great six weeks in the Central/Ashanti region getting ingrained with Ghanaian (and specifically Ashanti) culture and lifestyle.

During these six weeks I was also able to make significant headway on my internship. My biggest accomplishment was successfully completing over 50 interviews of potential customers (especially since most of these people only spoke Twi and not English). The interviewees included tro-tro drivers and mates (basically the public bus system composed of privately-operated shared vans; see video below), tricycle delivery personnel, taxi drivers, market vendors, and shop owners. While some instantly saw the value-add of the solar-powered electric vehicle, others were more dismissive. However, what struck me most was the willingness and excitement of most people to talk to me about their day-to-day and share information, even if they had no direct use for the product we are developing.

Tricycle taxi

Tricycle loaded with goods

By conducting these interviews of potential customers, three clear use cases arose and, with them, various design requirements. Furthermore, I have built a number of in-country connections within the solar space, including the former head of the Ghana Energy Commission. These points of contact help provide a picture of the current state of solar power within Ghana and can be leveraged when looking for in-country manufacturing partners.

Kumasi sent me off with a double rainbow

Oxford Street in the Osu neighborhood

Now, I'm wrapping up my first week in the bright city lights of Accra, Kumasi's big brother. In terms of infrastructure and development, Accra is much further along than Kumasi with numerous multi-story buildings, an international airport and bus network, and a number of westernized shopping centers. In addition, there's a large expat community and even a slow-pitch softball league! That's not to say you can't find the raw Ghana in Accra; turn off the main roads and you're on a street that could be anywhere in the country. You'll hear a variety of dialects spoken but, unlike Kumasi where almost everyone is Ashanti and speaks Twi, most people in Accra speak English as well due to the amount of ethnic diversity.

Being on the coast means BEACHES

(would not recommend swimming though)

In addition, most of the solar players in the country are based in Accra (or nearby Tema). Being Ghana's capital, this means that most of the relevant government ministries and international organizations are located here as well. This greatly facilitates my ability to get in touch with appropriate contacts given their proximity. Therefore, while I plan to repeat the customer interview exercise, I am also hoping to lay the groundwork for manufacturing and regulatory approval of the electric vehicle.

So here's to six great weeks in Accra!

My First Month In Ruli at The Ihangane Project

 

 


Occasionally I get to explore other communities outside Ruli

Nana Asare

Time does fly by indeed. Next week marks the conclusion of the first of my 3 months working with The Ihangane Project (TIP) in Ruli, Rwanda. The Ihangane Project’s mission is to empower local communities to develop sustainable, effective, and patient-centered health care delivery systems that holistically respond to the needs of vulnerable populations. They envision a world in which quality health care leads to healthy, inclusive, and empowered communities. Since its inception in 2012, TIP has been working with the Ruli District Hospital and its seven associated health centers to determine key strategies for improving health outcomes within their community.

Before I go any further, some introductions are surely due. My name is Nana Asare, I just completed the first half of my MPP degree at the Gerald R. Ford School for Public Policy. My interests in the intersection of policies, global health and international development is what motivated me to seek out this summer opportunity as a WDI fellow. My primary objective this summer is to support Ruli District Hospital (RDH) and The Ihangane Project through a strategic planning process by building upon work performed by the 2017 Ross Healthcare Delivery in Emerging Markets BA 685 team.

Ruli District Hospital

My experience didn’t start that well.  First, I wasn’t given the 90-day visa I applied for, which was a bit frustrating because Ruli is about 3 hours outside of Kigali and I had commute back and forth to solve this issue- it’s all sorted now. Second, I seem to have arrived at a time when the internet at the TIP office decided to stop working, thus I couldn’t access materials I needed to start brainstorming for my primary objectives- the internet is somewhat working now but everyone at the office claims it used to be better. Anyway, I expected the downside of this experience as this is my second time working in Rwanda and I’m glad to say everything is going smoothly now, I just needed a bit of Ihangane (patience).

Participating in "A walk to Remember"

On the positive side of things, Ruli is really beautiful. The town is in the hills so the skies are vivid blue every day and there are lots of stars at night. I live about a 5-minute walk from the TIP office which is on the premises of the RDH and I share a house with two Global Health Corps (GHC) fellows who work on different projects with TIP.  In general, I’ve been well received here and I am always reminded of the great work of previous WDI Fellows from the  University of Michigan so I definitely have a reputation to uphold. The Ruli community is very close knit so I am friends with pretty much everyone within proximity of the hospital. I had the opportunity to attend "A Walk to Remember" which is a day set aside throughout Rwanda to remember the 1994 Genocide. It was definitely heartwarming to be among the community members as they joined together to remember, unite and renew relationships and dedication towards one another.

View of the nursing school and administration blocks

I work with a very dedicated team that focuses on four aspects of healthcare delivery and management such as clinical care, community health, social enterprise and health systems management. The latter is where my I am mainly focused because the strategic planning process is to ensure that the RDH has a system that allows for the provision of quality health services while reducing costs, generating new revenue, as well as being financially stable and sustainable. It is definitely a lot of challenging work and I am learning a lot on a daily basis because I get to apply my previous experiences but through a different methodology that is specific to TIP. My next post will be more focused on the work I am doing and the additional objectives I’ve been assigned. Anyway I recently fine-tuned and completed the agenda created by the BA 685 team for the 2017 TIP retreat, which is next week. Wish me luck!

Planning for an Impact Evaluation in Ethiopia

An ADHENO tree nursery 

Julia Entwistle - School for Environment and Sustainability



ADHENO is an Ethiopian non-profit organization implementing environmental restoration and economic empowerment programs in the North Shoa region. Their work includes various trainings for smallholder farmers on environmentally sustainable management practices such as terracing, use of improved seeds, water run off mitigation, and intercropping. Much of ADHENO’s environmental restoration work is aimed at reducing the rate of erosion. Loss of soil matter and nutrients due to heavy rains and steep slopes in the region is a major concern for farmers. Another key program that ADHENO operates is called tree gudifecha, which is an afforestation program where farmers are paid to adopt and care for trees. Additionally, ADHENO is also involved in the construction of improved drinking water sources, supporting children’s education through payment of school fees, and training farmers on beekeeping.

Many farmers utilize terracing as a way of
reducing soil erosion on the steep slopes

As part of a team of four graduate students from the School of Natural Resources and Environment at the University of Michigan, I am spending the summer in Ethiopia to perform an impact evaluation of ADHENO’s programs. To accomplish this, my team is evaluating the impacts on farmer’s livelihoods as well as the ecological outcomes of ADHENO’s work. My role is mainly in measuring the former and to do so we are creating a household survey aimed at assessing farming management practices, crop yield, and other indicators of wellbeing, such as income and health. Our goal is to administer the survey with both households who have participated in ADHENO’s programs as well as those who have not as a means of comparison. To do this we are enlisting the help of several translators to act as our local guides as well as conduct the in person surveys with the farmers. Our translators are more than capable of this job, however getting an idea across different cultures and languages can sometimes be a challenging task.

In the rural area where we are staying, few people know more than some basic English. One of my first days here, I crossed paths with a man who spoke a small amount of English. As a group of monkeys ran across the path in front of us, he pointed and exclaimed, “monkey!” He then began pointing to things and asking me the English word for them, rock… cow… tree…

When I said tree, he looked at me with a puzzled expression, then pointed to a patch of grass, “tree?” he asked. I shook my head, “grass”. “Why not tree?” he asked. For lack of a better explanation, I said “trees are tall”. He accepted this description and we moved on. This conversation would come to shed some light on a translation challenge we were about to encounter.

A farmer looks over an area to become part of
ADHENO's tree gudifecha program

While in the process of translating our survey into the local language, one of the translators paused when he came to the first question asking about tree adoption. “There is no word for this in Amharic,” he told us, referencing the word tree. We were baffled, there were trees all around us, surely there was a word for this. He went on to explain that they called each tree by its species name, and there was no generic term that referred to all trees. I thought back to my conversation with the man on the path. We would need to come up with a more accurate definition for the household survey than “trees are tall”.

A Return to the Glittering Gem of the Indian Ocean

Danielle Wilkins  - School for Environment and Sustainability



All roads may lead to Rome, but for me, all air routes lead to Sri Lanka. Over the past few years, first thanks to a number of work assignments and later thanks to some great friends, Sri Lanka has become something of a home away from home.  After approximately 24 hours that included a number of tiny seats, movies, questionable airline food, a croissant in Paris, a samosa in Mumbai and a stroll through the refrigerators and washers for sale in the duty-free section of Sri Lanka’s Bandaranaike International airport, I finally walked out of the airport and into the humid Negombo morning.  A few minutes later and my drivers and I took off down the road heading northeast. Driving in Sri Lanka is always an adventure that can be loosely described as a well-coordinated game of chicken. Honking and overtaking are a way of life. Honking in and of itself is the island’s fourth unofficial language. There is the “overtake honk”, short, urgent, to the point. The “blind turn honk”, performed before making a turn on one of Sri Lanka’s millions of blind turns, this honk has prevented countless collisions. The “hi honk”, occurs when passing a friend’s tuk tuk or roadside shop. Admittedly all the honking can become grinding over time, but today it was a familiar welcome. Finally, after several stops along the road to accept food and drinks from school children celebrating Poya (monthly Buddhist new moon festival), five hours after leaving airport in Negombo, and 31 hours after leaving the U.S., I arrived at Grace Care Center. My home for the next three months.

Grace girls welcoming me on my arrival

Grace Care Center is a girls home and elder care center located in Trincomalee, Sri Lanka. Trincomalee has seen its fair share of upheaval over the years. As one of the world’s deepest natural harbors it is a strategic military installation that was prized by both the British and Japanese during WWII. More recently the city has seen the decades of ethnic strife as post-independence Sri Lanka struggled through a 30-year conflict between the dominant Buddhist Singhalese in the south and the minority Hindu Tamils in the north. At the outset of the conflict Trincomalee was a predominantly Tamil city built around a Sinhalese-controlled naval facility. The violence in the city was not as intense as cities further north, but residents still tell stories of fleeing in the middle of the night to avoid the fires set to their shops and nearly every Tamil family knows someone who was arrested by the government. The conflict was finally brought to a close in 2009, but not before Trincomalee was further devastated by the tsunami of 2004. Today the city, located near within close proximity to some of the world’s best whale and dolphin watching, is a slowly growing tourist destination. While the population today is heavily Muslim, the beautiful Hindu temples sitting alongside of Buddhist pagodas and Islamic mosques provide the backdrop for a diverse country that is learning to live together once again.

The Grace Care Center was established in 2002 as a haven for the young and old most affected by the war, and later, by the tsunami. The facility currently cares for 24 girls and 21 elders. Education is the predominant focus of Grace Care Center with all girls receiving after-school tutoring in addition to their normal class schedule. The goal of the Center is to mold independent young women who are able to make their own decisions in life. To this end the Center seeks to identify suitable vocational training opportunities for its residents. A series of studies conducted by students at the University of Michigan identified an opportunity to provide employment for young people who are not able to qualify for the very limited number of spots in public universities, or pay for education from a private university. This opportunity comes in the form of assisting in the care of diabetic patients.

Diabetes is one of the world’s most prevalent chronic diseases and left untreated, or improperly treated, is deadly. To date nearly 8% of the Sri Lankan population, 1.6 million people, are diagnosed diabetes patients. This number is only expected to grow as Sri Lanka’s economy evolves away from manual agriculture to less physically demanding employment and disposable income allows more people to adopt Western styles of eating.  While Sri Lanka does provide health care free of charge in the country’s public hospitals, the lack of trained medical staff means that for poor patients who have diabetes, their disease is managed through a 2 minute monthly interaction with the doctor to renew their prescriptions, and the occasional blood test. The Grace Care Center thinks there is a better way. 

Dr. Naresh Gunaratnam, the Director of Grace’s Board of Directors in the United States, has partnered with University of Michigan medical faculty and students to design a conceptual model that combines the roles of a Medical Assistant and Diabetes Educator. This new role is supplemented by the development of a web application that uses a patient’s basic vital information to assess the individual’s risk for diabetes-related complications. Now that this concept has been developed, my role is to figure out how to implement it. I will be working with young women from Grace who have begun training for this position, as well as the medical faculty at the Trincomalee General Hospital and medical faculty at the University of Michigan to develop a comprehensive training curriculum and path forward to improving diabetic care in Sri Lanka.