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December 22, 2017

A moment to reflect, and say Thank You

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  • Under : News and Updates

As we wrap up another year at Kupona Foundation, we want to say ‘thank you’.

Thank you for standing with us as we provide life changing surgeries and rehabilitative care to thousands of people living in poverty in Tanzania. Thank you for unlocking the potential of children living with correctable conditions like clubfoot or pediatric cataract. Thank you for restoring hope and health to women and girls like Tausi who have lived with obstetric fistula, and others who are rebuilding their lives through entrepreneurship. Thank you for empowering people working on the frontlines of care with the tools and skills they need to save lives, people like Midwife Dorcas.

We support solutions developed in country by local experts because they are the most effective way to realize opportunities and ensure long term impact. Our community based partner, CCBRT, is a leading healthcare provider with over two decades of service to the community and partnership with the Government of Tanzania.

The end of a year always gives us the opportunity to look back on our accomplishments, and to consider how far we still have to go. This year is a particularly timely moment for reflection, as CCBRT comes to the end of a five-year strategic plan, driving towards a Tanzania where people have access to quality disability services as well as safe maternal and newborn healthcare.

As CCBRT evaluates its impact over the last five years, we are able to take stock of the role that you – our Kupona Foundation community – have played. Since 2012, we have built a strong network of over 2,000 donors, advisors and advocates, mobilizing financial and in-kind resources exceeding $4.8 million, all in support of CCBRT’s life changing programs.

CCBRT’s triumphs are your triumphs, and we’re so proud of our collective progress. Your support, and the support of our partners have resulted in:

  • More than 50,000 disability-adjusted life years averted through high quality surgical and rehabilitative interventions
  • More than 5,000 maternal & newborn health workers trained by CCBRT’s expert teams
  • A more than 20% increase in the number of people with visual impairments served at CCBRT Disability Hospital

Of course, there is more work to be done, but today we celebrate the progress made, with an eye towards the future. Stay tuned in January to hear more about what is in store for 2018.

Thank you for your commitment to this life changing work. We would not have been able to achieve these milestones without you.

Help to change a life today! Set up a recurring donation through GlobalGiving, and your first month’s donation will be matched 100%!


December 5, 2017

Life Saving Priorities: Capacity Building

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  • Under : CCBRT Publications, News and Updates

Originally posted on the CCBRT blog

Tanzania is home to seven health professionals per 10,000 population. The World Health Organization recommends 45 per the same number of people. This workforce shortage overwhelms health professionals, leading to poor working conditions, poor quality of care and poor health outcomes. Facing these challenges, how does Kupona’s partner in Tanzania, CCBRT, save lives? By prioritizing capacity building.

Capacity building can take many shapes and forms. It can focus on the needs of CCBRT, like sponsored trainings for doctors to specialize in anesthesiology. It can focus on the needs of partner facilities, like newborn health equipment donated to Temeke Hospital. Or it can focus on the needs of the greater Tanzanian health workforce, like planning for the CCBRT Centre for Excellence in Clinical Education.

Perhaps the greatest example of CCBRT’s efforts in the past five years lies in their Maternal & Newborn Health Capacity Building (MHCB) Program, currently working in 23 sites across Dar es Salaam. MHCB aims to strengthen the skills of health professionals to improve health outcomes for mothers and babies. From 2013 to 2017, this included training, coaching and mentoring of more than 5,000 healthcare workers.

The results for health services? An increase in the use of life saving interventions, like vacuum delivery (used when labor has not progressed adequately), Cesarean section (used when vaginal delivery would risk the life of mother or baby) and Kangaroo Mother Care (used when a baby is born premature).

The results for quality of care? A 720% increase – from 10% to 82% – in quality of care, according to standards-based performance assessments. These measure adherence to standards related to labor, delivery and newborn care, infrastructure, human resources, education, communication and support systems.

And the results for patients? As of 2016, a 40% reduction in maternal deaths and a 14% reduction in stillbirths across facilities – with further reductions expected in 2017.

As one nurse reported, “If I can now save children, it is only because of what I have learned from CCBRT. Before I was not fully aware of what to do, for example, with premature kids, but now it is a pleasure for me to see them grow through Kangaroo Mother Care!”

A new mother of twins echoed this statement: “I was scared, as I had never experienced premature babies. But doctors and nurses advised on taking care of them. I am grateful for their help because, without it, I would have lost them.”

Providers and patients agree: the MHCB model works. The achievements of this program from 2013 to 2017 pave the way for additional activities in the upcoming strategy period, from 2018 to 2022. Following the success of supporting frontline health workers, the next phase of capacity building will support leaders in the regional health system.


November 28, 2017

Supporting Families in Tanzania to Thrive

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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


November 1, 2017

10 Years of the Mabinti Centre

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Originally posted on the CCBRT blog

The Mabinti Centre turns 10 today! To recognize this milestone anniversary, we sat down with Mabinti founder Katia to reflect on the past decade.

The Mabinti Centre grew out of Katia Geurts’ dream: to start an organization to empower women who have suffered from obstetric fistula. With a background in sewing, textile design, and teaching, Katia worked for years in the Sudan, Rwanda, and Kenya teaching crafting and embroidery skills to people living with disabilities, their mothers, and other women. When she and her family moved to Dar es Salaam in 2006 and learned of CCBRT’s fistula program, she approached CCBRT’s management with an idea for a partnership.

On 1 November 2007, the Mabinti Centre opened its doors to its first class of trainees. In the 10 years since then, 100 women recovering from fistula surgery have benefited from the Mabinti Centre’s intensive 12-month course, training in sewing, screen-printing, beading, design, English, and business skills. In addition to training, the women continue their holistic recovery from fistula through group support, life skills, health education (including HIV/AIDS, family planning and nutrition) and wellbeing promotion activities like yoga. By the end of the course, Mabinti graduates have gained the knowledge and skills to enable them to earn their own incomes and build healthier, brighter futures for themselves and their families.

 

“The difference [at the end of the year] is so big compared to when the women start,” Katia says. “The confidence they build is thanks to the Mabinti Centre. It’s not just having [technical] skills – it’s having life skills lessons, like welcoming visitors and meeting new people, that builds this confidence and helps empower them.”

Whether they settle in Dar or return to their homes elsewhere, Mabinti’s graduates spread awareness about what fistula is and how to seek treatment for it. Through their entrepreneurship, they demonstrate that women can have full lives after suffering from fistula. Each week, one of Mabinti’s graduates leads a crochet lesson with women being treated for fistula at CCBRT as part of their holistic care program, providing a positive example to them that there is life after fistula.

Mabinti’s impact also goes beyond its walls in other ways: as a social business, it runs a successful production unit, providing income generating opportunities for graduates to work on an extensive range of accessories and home furnishings. The products’ popularity at fairs, retail locations in Tanzania and for international wholesale orders have led Mabinti to near-double its revenue in the last three years alone – revenue which is reinvested into free, high-quality care for women living with fistula at CCBRT’s Disability Hospital.

Reflecting on this success, Katia says, “[it’s] much bigger than I would have imagined at the beginning. But it has grown by itself. We can continue to get better at a lot of things, but I’m proud of the 10 years that we have been helping women with fistula rebuild their lives.”

Please join us in celebrating 10 years of Mabinti by sending a birthday gift of $10 through our GlobalGiving page.

Want to learn more about the Mabinti Centre’s work or to visit Mabinti in person? Find out more on our fact sheet and Facebook page.


October 23, 2017

Kupona Foundation & Lavelle Fund for the Blind Launch Partnership for Sustainable Vision Care in Tanzania

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  • Under : News and Updates, Partners

We are delighted to announce our latest collaboration with Lavelle Fund for the Blind. Over the next 2.5-years the Lavelle Fund will support critical financial and technical investments, enabling the CCBRT team to scale the provision of low cost, high quality services to people living with blindness or visual impairment in Tanzania, and to sustain these critical services for future generations.

Photo credit: Sala Lewis

Blindness and visual impairment in Tanzania

  • In Tanzania, an estimated 1.1 million people are visually impaired and 33,000 are blind.
  • With an average household size of five, at least 4.7 million people are directly affected by blindness and visual impairment in Tanzania.
  • Up to 70% of cases of blindness or visual impairment can be treated or cured with surgery, medical intervention or assistive devices, but access to quality services is limited.
  • CCBRT’s immediate catchment area, Dar es Salaam, is one of the fastest growing urban centers in Africa, and Tanzania’s largest city. Dar es Salaam is on track to become a megacity, with a population of 10 million by 2025.
  • Though poverty rates have declined in recent years, about 12 million Tanzanians still live in extreme poverty, earning less than $0.60 per day.

Without intervention, individuals with preventable or treatable blindness and visual impairment struggle to access vital healthcare services, education or employment opportunities and are often excluded from community life. CCBRT provides high quality, affordable, comprehensive outpatient and surgical care to thousands of people every year to either restore their vision or provide long term support to people with permanent vision loss, enabling them to fully participate in their community. CCBRT is the largest provider of ophthalmology services in Tanzania, and its Disability Hospital in Dar es Salaam is one of only three facilities equipped to provide pediatric ophthalmology services nationwide. More than 60,000 people a year currently rely on CCBRT’s services, and Dar es Salaam’s growth means demand continues to increase.

Photo credit: Sala Lewis

Working together with global experts
Leveraging the advice and expertise of esteemed advisors from the world of social enterprise and sustainable eye care, the goal is to use investments in equipment, staff training, community outreach and facility refurbishment to increase both volume-driven patient revenue and efficiency-driven cost-savings. This will facilitate a 70% increase in the volume of cataract surgeries currently performed at the hospital and double the number of patients that receive care at no charge, while also reducing CCBRT’s dependence on volatile external aid.

The partnership will convene a technical advisory group comprised of three visionary leaders in the field of sustainable eye care. Mr. David Green, a MacArthur Fellow and Ashoka Fellow, helped develop the Aravind Eye Hospital in Madurai, India, the largest eye care system in the world and a blueprint for sustainable eye care in the Global South. Dr. Levi Kandeke is a pediatric ophthalmologist and pioneer of sustainable eye care in Burundi, East Africa. Ms. Penny Lyons is Executive Director of Seva Canada Society, an international eye care organization that provides funding and expertise to eye care partners and institutions worldwide.

“CCBRT is not only Tanzania’s largest provider of many core eye care services, it is also one with an exemplary record of service quality,” said Daniel Callahan, Board President at Lavelle Fund for the Blind. “The Lavelle Fund is proud to be supporting CCBRT and its partner Kupona Foundation in their current initiative to drive increased eye care volume, efficiency, affordability, and sustainability at CCBRT Disability Hospital. We’re also delighted to see the contributions of experts like David Green and the team at Seva Canada, as we facilitate knowledge exchange from a range of successful sustainable eye care initiatives across the world.”

This partnership, combining financial resources and ongoing technical support from world-renowned experts, will ensure that CCBRT can reach more people in need of affordable, high quality, specialized services to restore their sight, while investing in organizational sustainability. This partnership is about ensuring that critical, high quality healthcare services are not only available today and tomorrow, but in ten years’ time.

The official press release for this announcement is available here.


October 20, 2017

A Night (and Round) for Health & Hope raises over $50,000

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Celebrating the success of our second annual event in Saratoga Springs, NY.

Last week, we were thrilled to host our second local fundraising event in Kupona’s hometown of Saratoga Springs, at Saratoga National Golf Club.

Photo credit: Niki Rossi Photography

Through the support of our sponsors, friends, family and volunteers, A Night (and Round) for Health & Hope was a resounding success, raising over $50,000 to support life changing care for children living with disabilities in Tanzania.

Photo credit: Abbey Kocan

We couldn’t have asked for a more beautiful day as golfers played a round on Saratoga National’s pristine golf course, followed by an evening cocktail reception. Local musicians Leah Woods and Just Nate shared their talent as guests enjoyed Saratoga National’s delicious cocktails and appetizers, and bid on a stunning range of silent auction items.

Photo credit: Niki Rossi Photography

We were excited to bring back (by popular demand) handmade items crafted by women recovering from obstetric fistula at The Mabinti Centre. We were practically sold out within an hour!

Photo credit; Niki Rossi Photography

A huge thank you goes to our generous sponsors, including Ally Sponsors Beebe Financial Services, D.A. Collins, Lancaster Development, Tom & Laurie Longe, Bob & Denise Schwed and Steve & Debby Seaboyer, our Event Sponsors Pet Partners, Saratoga Hospital and Tim & Liz Ostrander, our Partner Sponsors Carpet One and Iron Roost and all of our Friend of Kupona Sponsors. We are also grateful for the amazing staff at Saratoga National Golf Club, our golf committee, Tom Longe and Steve Seaboyer, and our event committee chair Kelly Trendell, for making the event such a success. Thanks also to Niki Rossi Photography for capturing the event, and to Leah and Nate for contributing their time and talent.

During the evening, Kupona’s External Affairs Manager Alexandra Cairns recounted meeting a young boy named Frederick in rural Tanzania. Frederick lives with cerebral palsy, and due to a lack of resources, he used to spend his hours lying in the dark on the dirt floor of his home, almost completely isolated from the world. Then one day, our sister organization in Tanzania provided him with a wheelchair and regular physiotherapy, and Frederick’s life was completely changed. You can see the smile on Frederick’s face and read more of Frederick’s powerful story, here.

Alexandra shares Frederick’s story.
Photo credit: Niki Rossi Photography

Meet Frederick. Photo credit: Benjamin Eagle

The $50,000 raised on Thursday night will help change the lives of 387 children just like Frederick.

Photo credit: Benjamin Eagle

The generosity of our supporters has unlocked access to the healthcare services children like Frederick need to improve their mobility, giving them the opportunity to play with friends in their community and go to school.

We invite you to stay involved with this work. Why? Because it’s your support that is breaking the cycle of poverty for thousands of families in Tanzania. Here’s how you can help:

Help us reach 77 more children with a gift today
We want to change the lives of  77 more children like Frederick. We invite you to join us in reaching this goal and making dreams come true with a gift. It’s your support that can break the cycle of poverty for thousands of families in Tanzania. Help us reach our goal of raising another $10,000.

  • Donate today! A gift of $130 will support a child living with a disability, improve their mobility and give them the chance to learn and play. Reach out to someone who might want to learn more: a friend, colleague, teacher, minister, or neighbor.
  • Check out the photos from the event.
  • Follow us on social media. We’re on Facebook, Instagram, and Twitter

L-R: Abbey Kocan, Alex Cairns, Sami Bossalini, and Kupona Board member Robert Schwed.
Photo credit: Niki Rossi

We’re so proud to call Saratoga Springs home and so grateful for the incredible generosity and support of this community.  Thank you.


September 25, 2017

Conquering Kilimanjaro, Conquering Fistula

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Celebrating the creativity and dedication of our supporters.

Whether they are hosting cocktail receptions in a New York City apartment or a fundraising pasta dinner in a middle school gym; whether they are golfing for good, running half marathons, or purchasing handmade items from The Mabinti Centre, our supporters astound us.

This month, we are so excited to watch our new friend, Sara Safari, climb Mount Kilimanjaro to raise funds and awareness for women living with and recovering from obstetric fistula in Tanzania. Her goal is to raise $19,000, $1 for each foot of Kilimanjaro’s elevation.

An inspirational journey
Sara is an author, engineer, professor, mountaineer, TedEx speaker, recipient of the 2015 Global Citizen Award from the United Nations, and advocate for the empowerment of women and girls.

In 2015, Sara was climbing Mt. Everest to raise funds to empower Nepali girls who were trafficked or forced into marriage. On day 25 of Sara’s climb, Nepal was struck by a 7.8 magnitude earthquake. Sara survived the quake and the devastating avalanche that followed while clinging to the edge of the treacherous Khumbu Icefall by her harness and anchor.

Today, Sara continues working, and climbing, to empower women and girls. She aims to climb the highest mountains on every continent (The Seven Summits) to raise funds for seven charities working for women’s empowerment. When she completes her climbs in July 2018, she will be the first Iranian in history to conquer The Seven Summits.

Conquering Mt. Kilimanjaro
Kupona Foundation is honored to be Sara’s charity of choice on the African continent as she summits Africa’s highest mountain, Kilimanjaro, this week.

“Women living with obstetric fistula are often denied the opportunity to live to their fullest potential. Many are cast aside by family members and neighbors, and confined to their homes to avoid the stigma and shame associated with this debilitating childbirth injury. They cannot work, attend community functions, and are often susceptible to infections and disease.  I climb on behalf of all women who don’t have the opportunity to live fully self-expressed lives around the world.” Sara Safari

Thanks to Sara’s incredible commitment, and the contributions of her supporters, we will be able to reach more women living with fistula, supporting their comprehensive treatment and rehabilitation, and their reintegration to their community as they rebuild their lives. The road to recovery is not an easy one, but like Sara’s climb to the summit of Kilimanjaro, their destination is within reach.

We’re excited to conquer fistula together, returning hope, health and empowerment for women in Tanzania.

Are you inspired by Sara’s incredible efforts on behalf of the women we serve? You can support Sara’s CrowdRise project today. You can also follow her journey on Facebook and Instagram.


June 21, 2017

Reflections from Families+Social Good 2017

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Last week, we joined UN Foundation, Johnson & Johnson, and partners for the first ever Families +Social Good in London. Celebrities, journalists, nonprofits, NGOs and grassroots activists came together to explore our wishes for every family, everywhere. Here are a few of our highlights from the day.

(L-R): Chrysula Winegar, Alexandra Cairns, and Daphne Metland

‘Health in Your Hands’ panel

We were honored to be a part of the ‘Health in Your Hands’ panel. Our External Affairs Manager, Alexandra Cairns, joined Chrysula Winegar from UN Foundation and Daphne Metland from Baby Center to explore the game changing impact mobile technology is having on the lives of women and girls.

Alex introduced the audience to obstetric fistula, its impact on the lives of women and girls around the world, and shared how mobile money transfer technology has revolutionized access to healthcare for thousands of women since 2009. Women like Ruth have been given the chance for a brighter future thanks to mHealth innovation. Check out a recording of the full panel session here to learn more, and hear Alex share Kupona’s mission and work from minutes 9:32 – 18:06.

Daphne and Alexandra discussing the power of technology to impact women’s health.

Beating the drum for safe surgery

We were so proud of our colleague and friend Dr. Ruben Ayala, Chief Medical Officer of Operation Smile and fellow member of the G4 Alliance, for his passionate plea for compassion and commitment in the fight to increase access to safe surgery across the world. Billions of people do not have access to the quality surgical care they need globally, and every year a lack of access to safe surgery kills more people than malaria, HIV/AIDS and TB combined. Dr. Ruben shared, “We believe that access to safe surgery is an essential component of healthcare and a basic human right.” We couldn’t agree more!

Invest in girls and women, and you can change the world

While the event focused on the entire family unit, it was clear that investments in the health, education, and empowerment of women and girls are the key to strengthening family units and enabling them to thrive. The return on investment in women and girls is huge. As Jamie Drummond, co-founder of the ONE campaign put it, “Not only is it the just thing to do, but it’s the most efficient thing to do.” The power of investing in girls could not have been clearer than in the ‘Propelling Girls Forward’ interview. Sarra Alayan, a Girl Up Teen Advisor, was confident and eloquent on stage as she asked Anne-Birgitte Albrectsen, CEO of Plan International, why empowering young girls is so important. As Albrectsen said, we don’t need to look any further than Sarra herself to see what can happen when girls are given opportunities to realize their potential.

Thank you to UN Foundation and Johnson & Johnson for inviting us to participate in this inspiring event, and for giving us the opportunity to share more of our stories with the world!

Eager to hear more from these amazing discussions? Check out all of the online recordings from the day at familiesplussocialgood.org

 


May 23, 2017

Fistula in Her Words

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As storytellers mobilizing support through narratives, we are acutely aware of our responsibility to do so without jeopardizing the privacy or dignity of the people we serve.

Today marks International Day to End Obstetric Fistula, and we’ve been reflecting on an important question: How do we, as fundraisers, clinicians and global health advocates, talk about fistula without imposing our own narrative and excluding women from their own stories?

Photo credit: Sala Lewis

How do we talk about fistula?

Obstetric fistula is one of the hardest global health topics to discuss. Women living with fistula are some of the most vulnerable in the world. Each has survived a prolonged, obstructed labor, which could have killed them, only to survive with lifelong morbidities.

Women who survive obstructed labor often lose their baby. The babies that survive can suffer lifelong neurological disease caused by reduced oxygen levels during labor. These babies may suffer paralysis and developmental deficits. In addition to the chronic incontinence that comes when a fistula develops, the women who survive this dangerous labor often experience foot drop, infertility, internal scarring that prevents normal sexual relations, and post-traumatic stress disorder.

When a woman returns home with a fistula she is constantly leaking urine, feces, or both. As a result, she will often face stigma and rejection from her own family and community. Every day, we see the devastating effects harsh words from misinformed family and community members have had on the women who receive free, comprehensive treatment from our sister organization in Tanzania, CCBRT.

“Some of [my neighbors] said having children caused this, others told me I was being cursed by witchcraft”. ~ Fadhila
“My step father influenced my young siblings by telling them that my condition was contagious and that they should keep away from me. They were always laughing at me.”    ~ Mercy

In addition to surgical and physical rehabilitation, CCBRT provides counselling and therapy to address the emotional and psychological scars left by fistula, and conducts national awareness raising campaigns to battle the misconceptions surrounding the condition.

Fistula in her words

We asked twenty women and girls undergoing treatment at CCBRT how they identify themselves and prefer to be identified – they chose words like ‘mama’, ‘businesswoman’, ‘entrepreneur’. Not one person wanted to be thought of as a ‘patient’ or a ‘victim’. The women and girls we serve do not want fistula to define them or their place in their community.  It is imperative that we tell these women and girls’ stories on their terms.

Photo credit: Sala Lewis

The power of an international platform

Kupona and our partners are in a privileged position, able to raise the voices of women and girls who often struggle to make themselves heard even before they are faced with severe trauma. We are inspired by the strength and resilience of those we meet, and strive to communicate that when we amplify their stories.

“In meeting women and learning the stories of what they do to support their families, and how much they have overcome, I am amazed by their strength. I have met women like Christine. A woman of great self-worth, she built her life with little support, and today she stands tall because she found the care she needed with a skilled surgeon. I will always remember her – not as a victim, but as a strong, empowered woman who is a role model, and my hero.” ~ Kim Keller, Johnson & Johnson

We also try to hear our words as they would sound to women who have lived with fistula. Our goal is never to be sensational or graphic; it is always to elevate the voices of these women and girls, allowing them to share their stories in their own words.

“Women with fistula have suffered so much, so deeply.  Many have been voiceless for too long, hiding their injury in shame. The very least we can do is choose our words carefully when it comes to discussing their condition or sharing their story, to be as respectful as we possibly can.” ~ Kate Grant, CEO, Fistula Foundation

As global storytellers, we are custodians of other people’s stories. We still have so much to learn, not just from these women, but from their families as well.

“While many women with fistula are abandoned by their husbands, in every fistula center you will find many husbands who support their wives, bringing food, clothes and news from home, talking to the nurses and doctors and celebrating the day that their wives are able to make the trip home. These men, whose stories are invisible and whose needs are not understood, are certain to have much to teach us. Imagine the value yet to be tapped if we were to expand our storytelling to include these husbands, from whose resilience and creativity we have much to learn.”
~ Dr. Lauri Romanzi, EngenderHealth

Want to learn more about respectful storytelling and how it impacts our discussion of fistula? Check out our Storify with highlights from the #HerWords Twitter Chat, held on International Day to End Obstetric Fistula, featuring thoughts from partners, clinicians, storytellers, and organizations fighting to #EndFistula.


April 13, 2017

Increasing access to sustainable healthcare services

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Quality is Key: How lean management is transforming services at CCBRT

At Kupona Foundation, our priority is improving access to quality healthcare for people living in poverty in Tanzania. Globally, it is estimated that 5 billion people do not have access to safe surgical and anesthesia care. Our sister organization, CCBRT, is one of the leading providers of quality surgical care for people with disabilities in Tanzania.

A triage nurse and patient at CCBRT. Photo by Sala Lewis.

To improve access to CCBRT’s services, Kupona supports comprehensive efforts to address the barriers patients face to getting the treatment they need. Patients receive subsidized care so they can seek treatment regardless of their financial circumstance. CCBRT’s innovative application of mobile technology removes the burden of the cost of travel to the hospital for particularly vulnerable patients. Nationwide awareness campaigns educate communities to dispel the myths and misconceptions around disability and promote the medical services available to those in need of care.

When these barriers are removed and patients present for treatment at CCBRT’s hospital in Dar es Salaam, the first priority is to ensure that treatment is of the highest possible quality. But as demand for services continues to grow, meeting this demand with limited resources without compromising quality is one of the team’s greatest challenges. In 2012, CCBRT embarked on a journey of continuous improvement, adapting principles of lean management to help improve efficiency and eliminate waste.

The Challenge: Increasing demand for quality healthcare
Dar es Salaam is Tanzania’s largest city, and one of the fastest growing cities in the world. The city’s population is expected to increase by 85% to 6.2million by 2025. With healthcare infrastructure built to serve ~750,000 people, rapid growth puts the sustained provision of high quality healthcare in the city at risk. At CCBRT Disability Hospital, high demand for services and long wait times resulted in 80+ clients being turned away daily. Patients at CCBRT come from all over the country to seek specialist care, some travelling for days. In communities where ~65% of people live on less than $1.25 a day, and their ability to earn enough money to feed themselves and their family is directly tied to their health, accessible, affordable and timely medical attention is the key to helping communities thrive. Turning people away simply isn’t an option.

Triaging eye patients in CCBRT’s Eye Outpatient Department

The Solution: Lean management
When trying to meet increasing demand without compromising quality, healthcare facilities can learn valuable lessons from the manufacturing industry. Pioneered on the car production lines of Toyota Motor Company, lean management helps organizations to produce the highest quality ‘product’, at the lowest cost, with the shortest lead time, ultimately resulting in greater value for clients. When these principles are adapted and applied in the healthcare setting, their value takes on a new dimension: ensuring patients get the highest quality treatment, for the lowest cost, in the shortest amount of time: particularly critical in low resource settings like Tanzania.

CCBRT’s first major quality improvement initiative focused on the Eye Outpatient Department. After weeks of very specific planning, and with the support of a three-year, £430,000 grant from the Human Development Innovation Fund and advice from lean experts in the United States, CCBRT closed down their Eye OPD for an entire week, implementing a total overhaul of patient flow and processes including: changes to the physical layout of the department, introduction of an electronic ticketing system, and adjustments to processes to reduce bottlenecks and waste.

The changes increased the team’s capacity to serve patients. They saw a 72.5% improvement in the number of patients returned without service, and increased the number of patients served by more than 21%.

CCBRT is still in the relatively early stages of a long term transformation. The focus is now on expanding to the next phase of improvements. With a budget of $150,000 per year, we aim to roll out the principles across other clinical departments, starting with operating rooms, and to establish a central improvement office to institutionalize the changes that are underway.

Working toward ‘True North’
The ultimate goal of any lean transformation is to achieve what we call ‘True North’, the compass point that guides an organization from where they are now, to where they want to be. CCBRT’s True North is focused on outcomes defined around quality and safety, client satisfaction, staff engagement, and financial responsibility. Progress toward that True North will be measured by indicators including mortality and morbidity rates, the infection rate, patient wait times, and number of patient complaints, the rate of absenteeism among staff, ‘profit’ margins and the health of financial reserves.

Every improvement initiative will drive toward True North, designed to ensure that every patient, regardless of their ability to pay, receives the high quality treatment they need from trained specialists. With further investment, we can continue to not only improve the quality and accessibility of CCBRT’s services, but also contribute to a growing evidence base that will allow other frontline healthcare providers to learn from our experiences, and ultimately make high quality surgical care more readily available to the 5 billion people across the world who need it most.

Interested in learning more? Contact us. Attending the Unite for Sight Global Health and Innovation Conference in New Haven, CT in April? We will be giving a Social Impact Lab presentation on the power of lean management in healthcare. Stay tuned for more information.


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