First Person Perspectives – Kupona Foundation

December 5, 2018

Women are the Heartbeat of Africa

A guest post by Betsy Zink, Kupona Board of Directors.

Betsy (right) learns screen printing at The Mabinti Centre

“They say you can’t understand someone’s life until you have walked a mile in their shoes.”

This past October, I was privileged to do just that. As a new member of Kupona Foundation’s Board of Directors, I made my first trip to visit Kupona’s partner in Tanzania, CCBRT. In addition to visiting the CCBRT campus in Dar es Salaam, I visited CCBRT’s clinic in Moshi to learn more about the community based rehabilitation work happening in that region.

On my first day at CCBRT’s Disability Hospital in Dar, I was struck by the devotion of the medical staff and hospital administration. It was inspiring to hear how they articulated their sense of purpose as healthcare providers. It was also clear to me that Kupona and CCBRT support a critical piece of the Tanzanian healthcare system.

On each of the wards, patients receiving treatment for obstetric fistula, orthopedic conditions, and congenital and visual impairments conveyed the same thing: they had no other means of receiving high quality disability or rehabilitative healthcare, and they rely on the services we provide. A similar sentiment was expressed when I visited CCBRT’s maternal healthcare capacity building sites and met doctors and nurses who are being trained and mentored to provide high quality, life saving maternal healthcare. They are so grateful for the support they are receiving from CCBRT (and Kupona) and know that it is improving the entire Tanzanian healthcare system when they can better serve the people who are most in need.

And it was the people most in need that I was now seeking.
I’d seen patients and caregivers within the clean, organized CCBRT clinics but wondered, “where are our patients coming from”? Answering that question directed the rest of my personal travel time in Tanzania as I tried to walk in the footsteps – if just for a short while – of those we serve. I plunked myself in a simple lodge outside of Arusha and vowed to “live locally” for the week.

Each day I set off on foot, with minimal shillings and a small backpack, and headed away from the nearest road to a local village. I spoke with shop owners, and women working in the fields. I visited schools, made friends, was invited into homes, tasted local dishes, learned about crops and asked folks about medical care, birth experiences, their families and challenges in their lives. My experiences and photos revealed something I knew all along: women are the heartbeat of Africa. They are the workers in the home, fields and small businesses. Every time I stopped to take in my surroundings, I saw women hauling water, carrying firewood, harvesting, planting, selling, milking, cooking, washing and child rearing.

When the need to seek medical care means a woman must travel from her home, the ripple effect is destabilizing. Whether she is a woman with obstetric fistula who must seek surgical care, she is a mother experiencing complications in childbirth who requires medical intervention for a safe delivery, or a mother accompanying her child for orthopedic care or eye surgery her absence is keenly felt by those at home and in her community.

Kupona, through CCBRT, supports affordable, comprehensive care for women and children. From transportation costs, to providing room and board, and throughout treatment, there is a focus on easing the family’s burden. For those needing outpatient care, trained therapists travel to homes to deliver training and patient monitoring, allowing mothers to stay at work and avoid costly travel. Whenever possible, we use mobile phones and mobile technology – to assist with appointment reminders, follow-up to ensure patients are having good outcomes, and as a means to help patients travel to the hospital – for fistula and cleft lip/palate patients, the cost of transportation can be a barrier to accessing care – even if the services are free.

On my last day of travel, I enlisted the help of a local fellow and his pikipiki (motorized scooter) to help get me to the bus stop. As we were driving, a woman suddenly stepped out and waved us down. She asked if I was the Fistula Lady. She had overheard conversations in the village that someone working with CCBRT and Kupona was in town and could help women with fistula, so she came looking for me.

She told me her sister-in-law had experienced terrible symptoms after a difficult labor and had delivered a stillborn child. Her husband, believing her to be ill or cursed, and embarrassed by her physical state, sent their two older children away to his parents, refusing to allow them to see their mother. My new friend was determined to help her desperate sister-in-law and asked for our help. She added that there were many more women in surrounding communities that were living with fistula, and they needed our help too. I thought about that forlorn mother who had been separated from her children after surviving such horrific and preventable trauma. I thought about her heartsick children and misguided husband and the grief that all of them must be feeling. And it was then that I vowed to continue the work Kupona and CCBRT are engaged in.

Keeping women whole, healthy and at the center of Tanzanian life is a worthy goal, and through Kupona’s support of CCBRT and its programs we are doing our part to achieve this goal. I invite you to join us. Email us with questions, visit our impact page to learn more or read our Annual Report. Every woman, every child and every family deserves to have access to high quality healthcare that is affordable. And when a family or community loses its heartbeat, the ripple effect of that loss touches so many.

Asante sana,

Betsy
Birth Doula, Postpartum Doula, Breastfeeding Counselor, Childbirth Educator
Kupona Foundation Board of Directors

November 26, 2018

Dr. Brenda D’mello ‘A Sweet Victory’

As we wind down the last weeks of 2018, my team and I are reflecting on a year that has been difficult, yet so rewarding. Our CCBRT Maternal Health Capacity Building team feels we sometimes learn more than we teach. While working together with our partners and healthcare providers, we find new solutions to old challenges.

Recently, we conducted a refresher on-the-job training for healthcare workers that focused on postpartum hemorrhage (PPH). PPH is the leading cause of maternal mortality in Tanzania, accounting for more than 30% of all maternal deaths. The tragedy is that death due to PPH is preventable. The challenge is it requires an entire team to respond. Unfortunately, a full team of medical professionals is not always available. Staff shortages, gaps in training, and overwhelmed, overcrowded delivery wards in Tanzania are all factors that can contribute to a mother’s life being lost in just minutes.

At one of the facilities where my team trains and mentors healthcare workers, the supervising medical officer identified that staffing was an issue and that sometimes emergency cases did not have the support they needed. She wisely requested that we train non-maternal healthcare staff in PPH management. So, we conducted the training, even training outpatient nurses and staff from wards serving men only.

One week after the training, this medical officer called me with so much excitement. The night before, a patient had delivered her baby, and began to hemorrhage after delivery. The attending nurse shouted for help, but the doctor and only other nurse on duty in the ward were handling an emergency caesarean section in the operating theater. The nurse’s cries reached the neighboring wards, and ‘help’ came running from the outpatient and men’s wards. Thanks to the training they had received the week before, everyone knew exactly what to do. The team saved the mother’s life.

The medical officer told me that before her staff received the PPH training, they would have been afraid to respond to an emergency like this, but not anymore. Her staff were excited and motivated. She said, ‘For them, it truly was a sweet victory.”

My team and I are always grateful for these moments. Equipment and innovation in low-resource settings are critical for progress, but at the heart of our success lies one indispensable resource: people. It is the people we train, their collaboration, their courage in the face of emergencies, and their dedication to their patients that will change the face of maternal healthcare in Tanzania. And it is your support that empowers us to keep going.

We are more powerful together.

Tomorrow is Giving Tuesday in the United States. Here in Tanzania, we are also answering the call to give. I invite you to join us. Your gift of $100 provides training for two healthcare workers to save lives at birth, to prevent birth injuries like obstetric fistula, and to identify congenital disabilities like clubfoot for immediate referral and treatment. Just as one nurse cannot do the work of a full team, our success requires us all to work together for the mothers we are serving.

Thank you for supporting my team, and for helping us save the lives of women and newborns in Tanzania.

Be well,

Dr. Brenda D’mello
Technical Advisor & Project Manager
Maternal Health Capacity Building Program, CCBRT

September 25, 2018

An Update from Tim’s Corner on Contraception Day

By Chloe Manchester, Kupona Foundation Advisory Board Member.

It was a warm Friday morning in May 2018, and the first rain showers of the day had cleared. There was a quiet buzz around the CCBRT Disability Hospital campus in Dar es Salaam, Tanzania. Patients flowed through the gates, some sitting on benches in the reception area, some mothers holding their children on their laps, or nursing their newborns. For a hospital that serves between 400-600 patients daily, the work was just getting started. That day, I was visiting CCBRT’s Family Planning clinic, Tim’s Corner and meeting with Nurse Bola, Technical Advisor in Nursing.

A group of clients was waiting under the shade of acacia trees on a patio next to the clinic. As I walked up, I found it hard to believe that the brightly painted clinic was once a commercial shipping container. Now, the carefully remodeled container was a safe and comfortable space for clients, CCBRT staff and patients to receive the confidential, high quality family planning care and information they need. In Tanzania, access to high quality sexual and reproductive healthcare is not only a convenience; it can be life saving and can break the cycle of poverty. A young girl is more likely to remain in school and pursue higher education or employment opportunities if she can avoid an unplanned pregnancy. A mother is more likely to safely space her pregnancies if she can access contraceptive methods. And a woman who is recovering from surgery to correct an obstetric fistula can give her body the time it needs to heal.

I felt a great sense of pride to be part of my father’s legacy and I knew he would have been so pleased to see the progress at the clinic that bears his name. This was certainly not my first time at Tim’s Corner, but it has been a few years since my last visit. I could see and feel that there had been many improvements as soon as I walked in. The shelves were stocked with contraception options trusted throughout Tanzania, and all the necessary supplies, medical equipment and educational materials.

Many of the health centers and dispensaries I have visited in Tanzania have struggled to keep basic commodities and supplies in stock. I consistently have heard complaints of staff shortages, lack of space and long wait times for clients. However, Tim’s Corner, located in a busy neighborhood in Tanzania’s largest city, is well stocked and outfitted to serve adolescents, people living with disabilities, and the most marginalized members of the community. My discussion with Bola and the Tim’s Corner nurse-midwife gave me even greater assurance that the clinic was delivering a high standard of care to their clients.

During our visit Bola received a phone call from a young woman. In Tanzania, many nurses and midwives serving in family planning health centers give out their personal cell phone numbers in case their clients have questions about symptoms or need further guidance when using a certain method of contraceptive. After finishing her call, Bola explained that the woman wanted to come in to discuss her contraceptive options on a Saturday. Unfortunately, the clinic is closed on the weekends. The young woman wanted to come at a time when she would not have to worry about being spotted by a neighbor or family member who might happen to be at the hospital. There is still a great deal of social disapproval for unmarried women using contraception, especially adolescents. It is for this reason that we are exploring the possibility of keeping Tim’s Corner open on Saturdays for just a few hours so the adolescent community of Dar es Salaam can comfortably access the care they need.

Staffing can also be a challenge, because if a provider falls ill or goes on leave, services can be interrupted. At the moment, staffing the clinic is the greatest operating expense, but we are committed to ensuring this care remains available to the populations we serve. The impact of high quality sexual and reproductive healthcare cannot be ignored. In addition to the positive impact on an individual’s life, there are farther reaching benefits for the community and Tanzania as a whole. The Post-2015 Copenhagen Consensus¹ estimates that for every $1 spent on family planning, $120 is saved. At Tim’s Corner, our services cost an average of $35 per client or family. That means, our program generates over $4,200 in benefits for each client.

Today, on World Contraception Day, I want to invite you to help us reach 500 more women and girls with the care they need. It costs just $35 to deliver counseling to one young man or woman. We can absolutely impact 499 more. To lend your support today, visit the CrowdRise page established in honor of my father and his belief that it is every person’s basic right to reproductive health services.

Asanteni sana. Thank you all so much.

Chloe

¹ http://www.copenhagenconsensus.com/post-2015-consensus/health-women-children

November 28, 2017

Supporting Families in Tanzania to Thrive

A guest post by Chloe and Katherine Manchester

The holidays are an extra reminder that family matters most.

And it may seem obvious, but ‘family’ is what’s truly at the heart of ‘family planning’. Not politics or fraught debates. Just family.

Being able to plan if, and when, to have children is a crucial starting block for being able to care for your family in the best way you can. It means, in a life full of uncertainties, that parents have a greater ability to invest in their children’s education and nutrition; that mothers can plan enough time between births so that mother and baby are as healthy as possible; and so that a baby on the way is cause for celebration, not concern, and never burden.

Our father Tim would have done (and did) anything for his family, and he dedicated his career to helping other families around the world build healthier futures. We chose to work together with Kupona Foundation and CCBRT because we knew that doing so would continue his legacy, and give parents in Tanzania the same opportunity to provide for their families.

Tim’s Corner is a small kiosk next to CCBRT Disability Hospital in Dar es Salaam, where patients, their families, and other visitors can speak with a trained nurse about family planning, and access the best contraceptive options to suit their reproductive intentions, in a safe and welcoming space. The average Tanzanian earns less than $3 a day, so making these services accessible to everyone is part of our shared vision of making family planning services more equitable.

The next step is integrating these services into other programs at CCBRT, including the new Maternity and Newborn Hospital, as well as for women recovering from obstetric fistula repair surgery. We also need to make the services as accessible as possible for adolescent men and women. Reaching high risk groups with contraceptive services can be life-saving.

There are many worthy causes deserving of your support this holiday season; we sincerely hope that you will consider giving to Kupona in honor of happy families in a part of the world where poverty poses a daily struggle. Tanzania was our adopted home for more than eight years, and holds a special place in our hearts. We are so thankful for the amazing staff at CCBRT and Kupona who work so hard to champion this cause.

Happy holidays, and thank you for all that you do.

Chloe and Katherine Manchester

March 31, 2017

“There is no substitute for seeing the work first hand”

Seeing is Believing.

There is no better way to grasp the challenges and opportunities in our work than seeing our programs in action. This March, members of our Board were able to do just that. Bob, Mira and Jameel accompanied our Executive Director, Abbey, on her latest trip to Dar es Salaam to see the impact of high quality, accessible healthcare on the lives of the people and communities we serve, and to gain a deeper understanding of the most pressing needs on the ground.

L-R: Jameel, Abbey, Mira, and Bob from Kupona Foundation, with Radha from the CCBRT External Affairs Team, enjoying the sunset at Dar Yacht Club

Abbey and Bob arrived first, and spent some time deep diving into sustainability at CCBRT – touring CCBRT’s new Private Clinic, learning about the transformation of CCBRT’s Eye Outpatient Department as part of CCBRT’s lean journey, and meeting with CCBRT’s new Technical Advisor for Training and Capacity Building, who will drive forward plans to establish CCBRT’s new training centre. Over the weekend, the team took a fantastic tour of the city with Afriroots. Visiting homes, markets and cafes in local neighborhoods gave Bob, Mira and Jameel an opportunity to see the ‘real’ Dar es Salaam, away from tourist destinations, and get a sense for the challenges that CCBRT’s dedicated staff and clients face every day.

Left: Mira meets a child recovering from cleft lip surgery. Right: Abbey and Bob taking a tour of the CCBRT Private Clinic construction site with Pierre, Director of the Private Clinic, and Erwin, CEO of CCBRT

Tours of the CCBRT Disability Hospital, as well as one of the Health Centers where CCBRT is improving the quality of maternal and newborn healthcare, demonstrated the scale and comprehensive nature of our work in Tanzania. Meetings with clients currently recovering from treatment for obstetric fistula and cleft lip, and receiving artificial limbs from the physical rehabilitation department, showed the impact high quality healthcare has on the lives of the people we serve.

There is no substitute for seeing the work first hand. There is so much you can’t digest until you’ve seen it. I was impressed by how efficient and modern the hospital was compared to others I’ve seen in developing countries. CCBRT is also very resourceful, grabbing every opportunity to eliminate waste where they can. I left with a huge sense of optimism. There are clearly significant challenges to providing safe, affordable, quality care to such a high volume of patients. Now we need to find a way to mobilize as much support as possible to help address these challenges. – Jameel Farruk, Member of the Advisory Board since 2012

Tours of the CCBRT Maternity and Newborn Hospital and the CCBRT Private Clinic construction sites showed the progress of CCBRT’s initiatives to bring quality care closer to the people of Tanzania, and also the scale of CCBRT’s goals for the future.

The people we met at CCBRT are impressive, dedicated and hard working. The level of services exceeded my expectations. I was clearly aware of the efforts in maternal care, fistula and eye care, but the range of services offered and the size of the CCBRT campus were very impressive. There is a lot going on at CCBRT and the needs are clearly apparent; it’s important that Kupona’s support is targeted in the most effective and efficient way to have the greatest impact. It’s going to be a challenge, but one I’m looking forward to tackling. – Bob Schwed, Member of the Board of Directors since 2015

Abbey with members of the CCBRT Maternal and Newborn Healthcare Capacity Building Program

The visit concluded with a trip to The Mabinti Centre, CCBRT’s socioeconomic empowerment project for women recovering from obstetric fistula treatment. Ladies at the Mabinti Centre have all been treated for obstetric fistula at CCBRT, and are currently undergoing vocational training as they continue their recovery. During the visit, Mabinti trainees showcased their latest designs, and passed on the secrets to screen-printing!

The women at Mabinti welcomed me with warm smiles and open arms. They are confident women who take pride in their work. I was amazed at the transformative effects of holistic treatment for fistula. What a remarkable contrast compared to the women I met in the fistula ward of the CCBRT hospital! I saw first hand how the post-operative care provided by CCBRT and the Mabinti Centre radically improves lives.” – Mira Dewji, Member of the Board of Directors since March 2017

Rhoda, a former fistula patient and Mabinti graduate, teaching Mira to screen print

We are so grateful for our dedicated Board and Advisory Board members, and for the support of our friends and partners who empower CCBRT’s life changing work. If you are interested in visiting our programs in Tanzania, please get in touch.

March 8, 2017

How Sewing Lessons are Empowering Women and Girls

Be Bold for Change this International Women’s Day.

“We all recovered from fistula surgery [at CCBRT], and now, thanks to The Mabinti Centre, we have new skills and the confidence to use them. Working with other women who had the same experience helps me remember that I am not alone.” – Asha, Mabinti graduate and employee

Photo by Sala Lewis

Today, on International Women’s Day, we celebrate the courage of the women and girls recovering from obstetric fistula at The Mabinti Centre. In spite of a devastating childbirth injury, these women are boldly rebuilding their lives one stitch at a time.

Tackling a Silent Tragedy

Estimates suggest that up to 3,000 women like Asha develop obstetric fistula every year in Tanzania. Obstetric fistula is caused by prolonged, obstructed labor without access to timely, high quality medical care. The injury causes chronic incontinence. Leaking urine, feces, or both, women who develop fistula live at risk for infection and further health complications.

In 90% of cases the baby does not survive the traumatic delivery. The mother is then left to process the physical trauma of fistula, and her grief over the loss of a child. She is often left to endure this pain alone. Obstetric fistula carries severe stigma within communities, and is considered a punishment for witchcraft or adultery. Women living with fistula are often abandoned by their families, excluded from their communities and are unable to work, making them some of the poorest and most marginalized people in the world.

Obstetric fistula is treatable

Kupona’s sister organization is one of the largest providers of comprehensive fistula treatment in the world. In 2016, CCBRT supported the treatment of over 1,000 women with fistula, restoring their dignity and helping them to rebuild their lives.

Committed to a comprehensive, holistic approach, CCBRT provides surgery, accommodation, food, physical rehabilitation and counseling to all patients free of charge during an average three week stay at the hospital. Recognizing that surgery is just the first step on the complex road to recovery, CCBRT’s holistic approach addresses the psychosocial as well as physical impact of fistula. CCBRT also offers numeracy and literacy lessons to women who do not know how to read and write.

Photo by Sala Lewis

The Mabinti Centre

The Mabinti Centre was established by CCBRT as part of their fistula treatment program. Mabinti serves as a socio-economic empowerment program for women recovering from obstetric fistula repair surgery. Since 2006, 100 women have completed a training course in sewing, screen-printing, beading, design, English and business skills. Graduates from the course leave with the skills and confidence to start their own businesses, or secure employment. Committed to the long term well-being of every trainee, Mabinti follows up with graduates after they complete their training, conducting home visits and refresher classes to help guide these new entrepreneurs. Some graduates are also employed by Mabinti to produce items for wholesale or for sale at artisan fairs.

Women at the Mabinti Centre are empowered to begin a new chapter in their story of recovery, equipping themselves with the skills to build bright futures.

We still have a long way to go.

The backlog of women awaiting treatment is in the thousands, so while we work to stop new cases of fistula from developing, we will continue to provide fistula surgery and holistic care to help women recover and thrive after treatment.

Inspired by this story? Make a donation to our GlobalGiving project before March 15^th and help us win a place on the GlobalGiving Girl Fund, which will grant us exclusive access to more funding for women and girls recovering from fistula in Tanzania, and training at the Mabinti Centre.

February 17, 2017

Meet Hanaa

The bridge between disability and maternal health.

“For six months she remained indoors so her neighbors wouldn’t know that she was leaking.”

Hanaa’s story is a case study in the linkage between disability and maternal healthcare. Access to high quality maternal healthcare is the key to disability prevention. With skilled attendance at birth, impairments like obstetric fistula can be avoided, and congenital impairments like cleft lip/palate or clubfoot can be identified and treated in a timely manner.

With interventions focused on improving the quality of care available to expectant mothers and their newborns, we can spare patients like Hanaa from the grief of losing a baby and from unimaginable suffering.

Photo by Maddie Johnson

Hanaa was 19-years-old when she developed obstetric fistula. As soon as her labor pains began, she traveled to the nearest healthcare facility to deliver her baby. From there, she was referred to a second hospital, and then a third. Two days after her contractions began, she finally had a C-section. Her baby did not survive. Two weeks later, Hanaa discovered she was leaking urine.

Hanaa needed to heal from her C-section before she could be referred to CCBRT for a surgery to repair her fistula. Her doctors sent her home to heal, and for six months she remained indoors so her neighbors wouldn’t know that she was leaking.

She shared, “I found it difficult to wait the required six months to heal. I was crying a lot. I said to my mother ‘I cannot stay with this condition. I heard that this can be cured. Why won’t you send me to the hospital?’ The father of my child abandoned me, and I was living with a lot of grief.”

When Hanaa was finally ready for surgery, a CCBRT ambassador paid for and arranged her transportation to Dar es Salaam. Following her free surgery and comprehensive treatment, this young woman is dry and has hope for her future.

Ten years ago, CCBRT entered into a Public Private Partnership with the Government of Tanzania, joining the fight to improve the quality of maternal and newborn healthcare in the country. Today, CCBRT’s Maternal & Newborn Healthcare Capacity Building Program works in 23 public healthcare facilities in Dar es Salaam, reaching women like Hanaa with the respectful, quality care they need and deserve. Dar es Salaam is Tanzania’s most populous region, and one of the fastest growing cities in the world. Healthcare facilities are overwhelmed and underequipped to meet demand that shows no sign of abating.

By training healthcare workers in key clinical skills and filling critical resource gaps in these facilities, CCBRT is equipping medical teams with the tools they need to identify and prevent impairments like fistula, and also refer newborns like Lita for treatment for conditions like cleft lip/palate, pediatric cataract or clubfoot. CCBRT works with facilities at every level, decongesting regional hospitals that should be focused on emergency and complex cases, and ensuring patients are evenly dispersed and served across the entire regional healthcare system.

In 2018, CCBRT will also open the doors to the largest dedicated maternity and newborn hospital in the country. This 200-bed referral hospital will provide high quality care for emergency and high risk cases, as well as dedicated care to sick newborns. The facility will oversee 12,000 deliveries a year.

If Hanaa had been able to access a safe C-section without delay, things could have been very different. With high quality, timely emergency obstetric care, conditions like fistula can be prevented, and babies’ lives can be saved. Since 2009, the Kupona community has raised over $3million for CCBRT’s comprehensive programs to identify, treat and prevent disability in Tanzania. Together, we are making motherhood safer for women in Tanzania, and giving newborns a healthy start in life.

March 31, 2016

People Making It Happen: Meet Rehema

We’re celebrating World Health Worker Week!

Healthcare workers are the beating heart of any healthcare facility; without trained, motivated staff, services will grind to a halt, and patients will not receive the level of care they need and deserve. This week, we’re celebrating the healthcare workers at CCBRT, who serve their patients and clients with pride.

Meet Rehema. One of the only Prosthetic Eye Technicians in Tanzania, Rehema provides a life changing service to patients who would otherwise face a lifetime of stigma. When Rehema first joined the CCBRT team, she didn’t expect to end up working at the cutting edge of rehabilitative care.

Photo credit: Sala Lewis

Meet Rehema
“In 2005, I joined CCBRT’s team as a cleaner in the hospital. After 2 years, my managers realized I had a positive attitude and a desire to learn. They promoted me to Nurse’s Assistant. I was very excited about this chance; I had always wanted to know more about what the nurses around the hospital did. Then, CCBRT supported my training as an Ophthalmic Assistant, and also supported me through 2 years of nursing school.

While I was working in the CCBRT Eye Department, the Doctor In Charge saw that I had artistic talent, and he nominated me to take part in a training course to become a Prosthetic Eye Technician. I felt very lucky to be picked to participate in a program like this and to have the chance to develop my skills.

My journey to become a Prosthetic Eye Technician was challenging.

My friends told me that I shouldn’t take part in the training because I didn’t know how to make artificial eyes and the smell of the materials I would use would be strange. Then my entire class dropped out of the course, leaving me as the only student. Thankfully, I had a good teacher. Mr. Colin Haylock convinced me that I could help many people in this role, and could provide a service that was desperately needed. It gave me confidence to successfully complete the program. Every year, Mr. Haylock returns to CCBRT to update me on the newest techniques in the field.

Since 2009, I’ve worked with my own mentees, to ensure that CCBRT and other health facilities are able to serve the high number of patients seeking artificial eyes across the country.

I feel my biggest accomplishment is providing an artificial eye service that receives so many patients. Hospitals are always calling to say ‘Rehema, can we send this patient?’ and I can say, ‘yes, please send them.’ Because patients come from all over Tanzania to my workshop, I always strive to be efficient in my work to ensure that my patients can leave with an artificial eye just hours after meeting with me.”

I am happy to change lives. My favorite part of working at CCBRT is helping people who have a disability; Patients come with a sad face and one eye and they leave with two eyes and a smile.

Thanks to your support, we can identify people with the potential to change lives, and unlock opportunities for them to learn, grow, and realize their ambitions. The impact ripples out as people like Rehema, motivated by their work and empowered by their mentors, are able to share their passion and skills with others. Together, we can build a strong workforce with the drive and the knowledge to change lives throughout Tanzania.

Thank you for being a part of this journey. Happy Health Worker Week from all of us at Kupona Foundation!

February 18, 2016

Amana Hospital 4 Years Later

A New Reality for Mothers in Dar es Salaam

In February 2012, Kupona Board member Dr. Yoni Barnhard visited Amana Hospital in Dar es Salaam, and shared his experiences in a series of blog posts.

An American OBGYN, Dr. Barnhard found himself in an overcrowded, under-staffed, under-equipped delivery ward, and reported that, despite the desire to save their patients, the staff at Amana didn’t have the resources they needed to do so. The consequences were often tragic.

“Amana. Second largest district hospital in Dar es Salaam. 29,000 deliveries each year. Do the math. Teeming with births. Just 6 birthing beds. Not actually birthing beds. Metal tables with a hole at one end. Fresh blood dripping through. A bucket underneath. No full-time OBGYN. No full-time anesthesiologist. No air conditioning. 92 degrees outside. Hotter inside. This is where we start.”

Four years later, we’ve come a long way from where we started. Thanks to the tireless efforts of CCBRT’s Maternal and Newborn Healthcare team, in close partnership with the Government of Tanzania, Amana is unrecognizable. Kupona donors joined a committed network of supporters and partners including Vodafone Foundation, Global Affairs Canada (GAC – formerly DFATD), and CBM Australia. Today, we see expectant mothers are entering a very different hospital.

“The challenge is not practicing good obstetrics. The challenge is practicing better obstetrics with limited resources.”

Relieving the Pressure
Dar es Salaam’s healthcare system was designed to support a city of 750,000 people; hospitals and clinics now serve a population of over 4.4 million. Severe overcrowding hampers healthcare workers’ ability to give every patient the attention and quality of care they deserve. When Dr. Barnhard visited Amana 4 years ago, the hospital conducted 2,000 deliveries a month. He counted three nurses helping 41 women in labor.

Capacity building and training at smaller pre-referral healthcare facilities across the region means that families now place their trust in a greater number of facilities, decongesting wards at district and regional hospitals and relieving the pressure on healthcare teams. Today, Amana Hospital conducts 1,000 deliveries a month, giving staff more time to focus on each patient and respond efficiently to emergencies. In 2012, the labor wards were so crowded women were delivering five to a bed, or on the floor. Today, more women deliver one to a bed, though there are still space constraints in some of the wards.

“When it comes to saving a life, one can do far more with a single unit of blood than an ultrasound machine.”

The Tools to Save Lives
In 2012, Anna¹, a 29-year-old pregnant woman, and mother of 6, arrived at Amana displaying severe preeclampsia symptoms. Her attending healthcare worker ran from room to room borrowing the medication needed to save her life. It wasn’t enough, and she died a few hours later. Anna’s death could have been prevented. Today, eclampsia and emergency kits are readily available, stocked with the medication and supplies needed to avoid preventable tragedies. Today, her 6 other children would still have a mother.

The leading cause of maternal death in Tanzania is post-partum hemorrhaging, and this is unlikely to change without addressing the severe shortages of safe blood supplies. In 2012, little was being done to overcome these challenges. In 2015, CCBRT’s Capacity Building Program began working with the Regional Health Management Team in Dar es Salaam to establish four satellite blood banks, increasing the availability of clean blood in the region. In addition, there are now two full-time OBGYNs at Amana, and training is available for surgical and medical management, giving staff the knowledge to confidently and competently save lives.

Lasting Change You Empowered
Improvements² across the board at Amana mean that staff are equipped, trained, and available to tackle emergency cases, prevent birth injuries like obstetric fistula, and identify and refer newborns with impairments like cleft lip or clubfoot. A healthy child born to a healthy mother is less likely to be caught in the cycle of poverty, and more likely to pursue education and employment later in life.

In 2012, Amana Hospital’s delivery ward was a sea of women in all stages of labor, with an overwhelmed staff fighting an uphill battle to treat and save the patients in their charge. Today, with your support, we are seeing a new reality for the women of Tanzania, and in turn, for their children. There is still room for improvement and growth, particularly in early labor wards which are still crowded. There is also an emerging need for a space where mothers can nurse their sick newborns. However, CCBRT is ready to meet these challenge, spurred on by the success you’ve supported. Four years later, the future for Tanzanian families looks much brighter.

Name changed to protect patient’s identity
Following a recent assessment, Amana achieved 78% of quality standards for Basic Emergency Obstetric Care, compared to a baseline score of 9% in 2010.

February 6, 2016

Join us in welcoming Bob Schwed to Kupona’s Board of Directors.

A long-standing supporter of Kupona Foundation.

Welcome, Bob Schwed

Bob was first introduced to Kupona through our Board Treasurer, Adrian Stewart. Adrian invited Bob to participate in Kupona’s Annual Golf Outing, an event that Bob has attended and supported for the last 4 years, along with his team at WilmerHale, LLP.

“The golf event is really interesting. Adrian created interest in a charity that most people aren’t familiar with, and he was able to accomplish a lot with a group of people who were very serious and very dedicated.”

A graduate of Harvard Law School, Bob practiced law for 40 years, specializing in serving private equity firms and guiding clients through corporate finance transactions and acquisitions. He is an adjunct professor at George Washington University School of Law, and a recently retired partner at WilmerHale, LLP. Bob’s interest in philanthropy, and particularly healthcare in Africa, was inspired by his family. Both his son and daughter-in-law are doctors who have worked in Africa. Bob also worked with Kupona’s Board Chair, Dr. John Brothers, before they both joined the Kupona team, to build a nonprofit serving underprivileged youth and families in his local community in Brooklyn, NY.

“[Kupona] is dedicated to doing the right things for the right reasons.”

Following his retirement, Bob was eager to apply his professional experience to a good cause, and to be more than just a donor. His prior relationships with our Board members, and his history with Kupona make him an excellent addition to our dedicated team.

“I didn’t solely join Kupona’s Board to write checks. I’m looking forward to the challenge of helping however I can, and really getting involved.” – Bob Schwed

“We’re delighted to welcome Bob to the Kupona team. His experience serving on the board for a publicly owned company and advising start-up companies and new ventures across sectors make him a strong addition to Kupona’s Board of Directors. We are energized by his enthusiasm to understand our mission, and his eagerness to get involved wherever he can. He is looking forward to visiting our sister organization, CCBRT, in the near future, to support the work we are doing on the ground in Tanzania. We look forward to working closely with him to build a brighter future for the people of Tanzania.” – Abbey Kocan, Executive Director, Kupona Foundation

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