diary of an emerging social enterprise

How does a twenty three old woman who has never been to Africa decide to spend her entire summer internship with a charity in startup mode? Well yes, it might be that I am partly crazy (although I prefer the word adventurous); Or you could call it passion and youthful idealism. It might even be a naïve quest to “save the world”. Honestly, there are probably components of all of it.

My catalyst for working in the developing world really began when I started to see how the rest of the world lives. I had the good fortune to travel throughout Latin America and Asia where I had to reconcile my romantic illusions of these ancient and beautiful cultures with the crushing social problems created by poverty. While I was definitely privileged to have such opportunity, my biggest stroke of luck came in the form of getting hit by a car in Heredia, Costa Rica. Though traumatic this transformative experience showed me the vast disparity of treatment in the social healthcare system. It did not go unnoticed that as an American citizen, I took priority over the poorer natives and Nicaraguans waiting for hours in the hall.

In order to sharpen my skill set to be more affective in the field of social change, I decided to get my Master’s degree in Public Affairs from the LBJ School at the University of Texas. I know I am learning valuable tools but between 400 pages of reading a week, and 30 page papers, not to mention trying to stay above the poverty line, school can be a frustrating experience. Social life is a hodgepodge of other like minded liberal kids at coffee shops discussing international theory, debating foreign policy and regurgitating the morning’s New York Times. After spending our days educating ourselves about atrocities that happen in the world, we ask: what can we do for the starving and oppressed people in Zimbabwe?, how can we support protesting Tibetan monks? We discuss some great ideas, but like me, many of my peers also feel the frustration of talk over action. Acquiring the skills to make substantive change is important, but every year in the books, is a year lost to the actual change we want to see.

Sometimes just a simple article on the BBC can lead you on a journey into the heart of Africa to help desperate and forgotten women. In November of 2007, I read three stories of women in Nigeria who suffered from obstetric fistulas. They were young, alone, completely marginalized by their communities and abandoned by their husbands. They were poor, uneducated and attributed the fistula to a curse. Any woman can imagine the pain of losing a child and any person can envisage the shame and embarrassment of walking down the street or riding the bus unable to control basic bodily functions.

I immediately knew I wanted to do something for these women. But what? With no money and little time, how does one, at this stage in life, get up and do something big? I think the answer is easier than most of us like to think: if you want something to happen, you make it happen.

For me, that first meant learning everything that I could about the condition, where it is prominent, what agencies focus on it, how a surgery is conducted, the profiles of the women, the hospitals and the countries. And then I talked. I had never heard of this condition in America, and if I had not, I assumed a lot of people were equally in the dark. One of the friends I talked to was Seth, who I met through his Summit for Smiles campaign. Seth and I had discussed his imminent career transition into social enterprise but I never suspected that he would leave his private sector career to devote his life to helping millions of ostracized women in the developing world.

But that is exactly what happened. Seth began to think about a new business model for treating OF and my knowledge was at the center of this developing idea. As the concept for OperationOF began to materialize, Seth talked about leaving his job to focus full time and OperationOF began to seep into every aspect of my life - it became my second job (after school). We wrote to surgeons, the UNFPA and nonprofits working in the space and as things progressed, a summer project began to solidify. After the concept phase, Seth envisioned a pilot phase and needed to travel around Africa vetting different potential pilot sites. My ever-growing knowledge of fistula coupled with the need for research and analytical skills made this a fantastic opportunity to gain real hands on experience and active social change with the population I intended to serve.

I lobbied the graduate coordinator to let me make OperationOF my internship and applied for outside funding to help support this unpaid (and underfunded) summer internship. After receiving a grant from the Strauss Center at the LBJ School, our summer project to Africa became a reality for me. So here I am, packing my bags for Nairobi, and getting ready spend two months working tirelessly to help make this charity a reality that can help these women.

Why am I doing this? Why did I choose to leave a promising private sector career path and devote a significant portion of my savings to a venture totally focused on an obscure women’s health issue? Those of you who have witnessed and even supported my transition into social enterprise understand what is driving me generally. But most people could not (and maybe still don’t) comprehend my specific motivations for founding OperationOF.

The fistula problem moved me immediately. I don’t think you have to be a woman to appreciate the absolute devastation caused by constant incontinence, but when I say “the fistula problem,” I don’t actually mean the affliction that condemns these women to a life of ostracism. To me, “the fistula problem” describes a major system failure and the most blatant and compelling symptom of this failure is OF.

As someone who has spent his career optimizing process to improve efficiency, I was first captured by the challenge of more effectively treating women living with OF. The numbers themselves are a call to action:

• at least 2 million women living with a devastating, but correctable condition
• at least 100,000 new cases every year
• existing worldwide capacity can only treat 10,000 women per annum.

But even the most transformative treatment mechanisms only bear fruit when you slow the flow of new cases. So the old adage still holds true: an ounce of prevention is worth a pound of cure. It was this truth that led me to the broader failure of emergency obstetric care in the developing world.

It turns out that pregnancy means something different in the developing world than it does in the West. We have support mechanisms and layers of care up to, during, and after childbirth that ensure the vast majority of women can safely deliver their babies. But in parts of the developing world, limited resources and lacking infrastructure mean that pregnancy is a very solitary and dangerous venture, especially for women in remote rural villages.

We kept all this in mind when developing the Vision, Mission and Core Values for OperationOF. We consider this strategic framework fundamental to our success as an organization. How will we know success if we don’t define the objective? How will we achieve this aim and which principles will guide us? We wanted to describe inspiring and meaningful answers to these important questions, not to produce some drab statement full of buzzwords and corporate speak.

With the Vision, we describe what the world will look like when we ultimately fulfill our purpose. We hoped to paint a picture of the future that was both sensory and concrete. We felt a simple and clear statement, followed by a brief commentary provided an ambitious and inspiring picture of how we want to change the world.

Vision

A world where pregnancy never means death or disability.

Over 500,000 women die every year during childbirth and 20 times as many experience debilitating morbidities. That means that over 10 million women a year face life-altering or -ending adversity while attempting to become mothers. While we are focused on the very specific morbidity of obstetric fistula, we measure ultimate success by how much safer we can make motherhood for every woman, everywhere.

Our original vision focused only on eradicating OF, a formidable objective on its own. But research and conversations showed us that that the only way to end OF specifically was to make motherhood safer more generally. With our Mission, we explain not only how we plan to realize our vision, but also why we felt it critical to pursue such an aim.

Mission

Expanding global capacity to prevent and treat obstetric fistula.

The loss of dignity caused by obstetric fistula is a human rights calamity that affects us all. Our mission is to use operational services and investment-based fundraising methodologies to help further the impact and effectiveness of organizations focused on

• Prevention – making motherhood safer by providing access to emergency obstetric care;
• Treatment – providing interventions that help women recover their dignity through
  • Surgical Repair - performing outreach services, providing surgical correction of obstetric fistula as well as pre- and post- operative care; and
  • Psychosocial Reintegration – ensuring social, psychological, psychosocial and economic reintegration services to fistula survivors.

Besides helping to recovering lost dignity, our treatment intervention provides an opportunity to empower women. We believe that pursuing this objective is in line with our mission and will eventually lead to prevention of obstetric fistula and safer motherhood.

Finally, our Core Values define how we conduct ourselves as an organization. These are the essential and enduring tenants that will help our organization set boundaries and drive action throughout our existence. And we shouldn’t exist indefinitely – achieving our vision should eliminate the need for OperationOF altogether.

Core Values

Dignity. Dignity is the source of all human rights. All human beings possess intrinsic worthiness and deserve unconditional respect. Any discrete indignity, regardless how small, is a direct threat to the collective dignity we all enjoy. Responsibility to recover lost dignity does not fall only on the affected individual, but also on each of us as member of the human family.

Empowerment. Capability is distributed equally across the human family. The accident of geography should never prevent or prohibit an individual from realizing their full potential. Removing barriers that prevent able people from helping themselves and others is the most efficient intervention.

Collaboration. Profound human achievement is always a collective effort. The cooperation of many diverse actors has and will continue to enable the greatest human progress. There is no personal, cultural, ideological, or philosophical difference that a deeply held common purpose will fail to transcend. Together everyone achieves more.

Sustainability. Lasting change results from resource magnification, not consumption. Profit takes many forms and every investment yields returns across this ever-broadening spectrum. Intelligent deployment of capital combined with a tireless effort to identify and capture all resultant value ensures ongoing impact.

I’m on cloud nine. I just transferred 388 ceedees ($390 or 248€) to Dr. Lucia Visser of Holy Family Hospital in Berekum, Ghana, and OperationOF has now officially funded our first surgery! Besides ensuring that Isabella never saw a bill, Dr. Visser also sent me a very detailed and itemized account of all related expenses. Adding this detail to other cost estimates we have collected is helping create an economic model to simulate different approaches to treating OF. We are already simulating some process improvement concepts that we believe will cut significant expense from this intervention. So while the OperationOF team is thrilled to pay just under $400 for a 45 minute surgery that gave Isabella her life back, we are even more excited by the possibility of delivering like transformation to many more women for even lower costs!

Speaking of the OperationOF team, I want to introduce Shannon Dugan. As a key member of our budding organization, Shannon has contributed greatly to helping get OperationOF off the ground. In fact, Shannon is the person who actually first brought OF to my attention. She will be spending her summer internship in East Africa helping us get the pilot phase of our treatment effort started. Shannon is a great writer and will be posting to the blog throughout the summer.

On a final administrative note, we now have pictures up from the trip to Berekum, Ghana. Have a look!