diary of an emerging social enterprise

Click here to see a short video slideshow from our recent trip to Rwanda.

Safety first. Every decision on this trip has started with ensuring that we have a safe and secure environment. This is actually a big challenge considering that fistula is prominent in the most desperate places and that getting to such places usually means piling into overcrowded rust boxes that zip around corners and over potholes at breathtaking rates.

After hearing Lyn Lusi describe HEAL Africa’s innovative approach last April in Accra, I really wanted follow up my enlightening encounter with a visit to the Democratic Republic of the Congo. But because Shannon spent last semester researching this region, specifically atrocities committed against women there, I had reservations about crossing into this wild and war-torn region. To mitigate what I considered our greatest exposure, I set two security conditions: (i) someone walks us through the border and (ii) we stay within the HEAL Africa compound. We didn’t immediately hear back from the HEAL Africa team and as we waited, both Shannon and I started to question whether or not we should follow through with the visit. But a chance meeting with a Belgian midwife who had just returned from a remote part of North Kivu combined with the affirmative response we heard from HEAL team finally pushed us over the edge.

I wasn’t actually sure how any of us were going to fit into the battered, red matatu (read minivan), but the three men sitting in the back row of this crowded Nissan seemed to manufacture a place for me to sit. Despite sardine seating, the ride to Congo was magnificent. The growing height and scale of the hills was only countered by the severe depth and drop of the valleys. The road seemed to float around sharp turns, but the turning forced a collective sway of the four grown men pressed shoulder to shoulder in the back row. On every hairpin twist, a view down the steep slopes or across the valley revealed endless swarms of banana trees attacking the hills like angry, green-winged dragon flies. Gasping from the ride, my breathing was further challenged by the shear beauty of Lake Kivu, which abruptly presented itself just before the border.

After a short walk through a no-mans-land that doubled as a vegetable garden and the near-theft of our yellow fever cards by an alleged official, we were bouncing through the volcanic ruins of Goma en route to HEAL Africa. Goma was destroyed in 2002 by a volcanic eruption and the shattered state of the Congo meant that very little was rebuilt. This left a dusty ramshackle of lean-tos partially rebuilt on the flowery curves of hardened lava. The molten rock destroyed many roads as well, but over time, the unceasing flow of traffic pulverized the jagged black remnants into a fine dust that, when mixed with car exhaust, formed a sinister cloud that ominously hung everywhere cars dared to venture. The chaotic jumble of movement seemed to expand and contract at will, encompassing every type of transport as well as people carrying everything you could imagine. The direction of this mass movement had no order whatsoever and the only factor potentially limiting the blob was the mass of buildings at its margin.

When we pulled into the grounds of Maji Matulivu (HEAL’s resident compound), I was amazed at the stunning contrast to the streets outside the gates. Lyn and her husband Dr. Jo Lusi built an oasis on Lake Kivu and the place was teeming with young people working on a wide variety of projects or doing nursing rotations on a semester break. With a clear energy in the air and dusk approaching, we sat down at the lakeside for a group dinner. Eager to discuss the fine points of how HEAL Africa had been so successful creating service structures in the complete absence of stability, I launched into a series of questions. As he humored my queries, Jo (who is an orthopedic surgeon) told me about his passion: club foot. I had never heard of this highly correctable congenital birth defect that makes feet grow in unnatural directions, but Jo showed me some incredible pictures of what his intervention had produced and I could not believe my eyes. Jo went on to describe the process of correction and some of the challenges he faced helping children with this devastating disorder. Our passionate discussion gained so much momentum that time evaporated and we were eventually the only people at the table. Given the late hour and our 6am start, we agreed to continue the dialog the following day

But trying to sleep was no use to me. Like a kid at Christmas, I anxiously waited for slumber to pull me into its grasps, but the promise of an electric week full of inspiring surprises filled me with anticipation and kept me just beyond the nocturnal world for what seemed like an eternity.

I spent my 24th birthday at a hospital in Butare, Rwanda, meeting sad yet hopeful women awaiting fistula surgery in one of only three places in the entire country where this is possible. After months of reading patient histories, personal tragic stories, UNFPA reports, maternal morbidity statistics and health delivery system studies—anything tangentially related to O.F—I was actually standing in the maternity ward looking into the promising and serene eyes of a woman who had been leaking urine for more than two years. She sat timidly on the edge of a worn mattress, holding a beautiful baby boy, born in the bush despite her fistula. It was only as I touched his tiny head that she smiled radiantly; a smile that conveyed her dignity as both a woman and a mother.

When we met Dr. Kakoma, the head of obstetrics and gynecology, we were immediately impressed by his passion and knowledge. The Congolese surgeon actually shocked us when he said that only one urologist serves the entire population of Rwanda (almost 9 million people). But as Seth described our organizational plan to change the fistula world, Dr. Kakoma’s face lit up with excitement and he began talking rapidly about all the possibilities a few more resources would enable here in Butare. The National Teaching Hospital currently maxes out at around 50 surgeries per year, a drastically low number considering that 10 rural districts refer into this relative center of excellence. We believe our operational expertise and some investment could improve this amount up to five fold. Such dramatic change could be accomplished through training staff and adding infrastructure necessities such as more instrument kits, an expanded ward and potentially a fistula operating theatre. Dr. Kakoma connected us with a couple young surgeons who gave us a thorough tour of the facilities.

Despite their commitment and skill to conduct operations, surgeons in Butare are challenged daily by limited hospital facilities as the maternity ward is grossly under-funded. The uneven floors, broken beds and cracked walls are jarring to the senses but at the same time the miracles that are being achieved with such little material resource are incredible. The scrubbed up surgeons expressed the challenges of working with only one instrument kit, insufficient catheters, too few beds and an inadequate supply of medicine. Despite the tough conditions, these dedicated few have committed their lives to serving the mothers of this country and only made modest requests for instruments and training that would assist them in doing their job better. Their hearts were clearly with the women, but in a country trying to rebuild after such recent devastation by a horrific genocide, resources and government healthcare assistance are not exactly in abundance. As we left Butare, it was clear to us that this was one place that could surely benefit from some assistance.

We boarded the overnight train in Mombasa knowing about the possibility of massive delay (and derailment), but hopeful that the law of averages was on our side. After a fitful night of interrupted sleep, I woke confident of our on-time arrival. The train is a great way to travel for a view of the country and certainly beats simply popping in an out of airports. Though great, the views can last a bit long at times, as the African train slows and sometimes stops briefly in smallish towns where the locals, especially the children, take an interest in the passengers. On more than one occasion we noticed the local kids racing the massive locomotive as it began to build speed on its way out of town. These barefoot children maintained pretty impressive speeds on the rail yard gravel.

As excited as we were to get into the field and start reviewing potential pilot sites, we still had a pretty reasonable backlog of information gathering and analytical modelling to complete in Nairobi. A friend of mine got us into the “members only” Nairobi Club, a delightful colonial leftover that provided us with a warm workplace much more like the fraternity house of my academic years than the office cubicles that had stolen the summers between them. Despite the workload and a super office, our time in Nairobi had to be very brief. Our solidifying agenda revealed Uganda as the country we would spend the most time visiting, and we still planned to visit a Ugandan surgeon in Rwanda and possibly an innovative Congolese doctor in Goma. We looked at flying to Kigali, but interregional African flights are terribly expensive and not particularly air worthy. The cheapest alternative is to spend the night on a bus, but bad roads and limited visibility had us nix that idea for safety reasons. This meant finding a network of connecting day buses that let us inch our way around Lake Victoria and into Rwanda.

While Shannon was busy coordinating our continental bus transit, I met with Dr. Tom Raassen, a native of Holland who has spent the last 30 years helping the women of East Africa. Besides treating thousands of fistula sufferers himself, Tom has also trained a sizable population of surgeons throughout the region. When I met Tom in Accra in April, he agreed to meet with me in Kenya and, despite a very busy schedule, he kept to his promise and sat down with me at the Nairobi Club. This meeting turned out to be one of the most productive of the trip as Tom shared his expertise in capacity building and helped me better understand fistula center infrastructure requirements and how to rapidly facilitate human resource development (especially in terms of surgeon training).

Shannon managed to get us the last two seats on a 14 hour bus from Nairobi to Kampala that left the next morning. With an afternoon to spare, we went to visit my friend Becky Chinchen, an American who runs a social business called Amani ya Juu. Amani was borne from Becky’s experience in Liberia. Having fled the country during the devastating civil war, Becky set up a very small operation in Kenya that sought to create peace and reconciliation through textiles. With a huge heart, a sharp mind, and a keen eye for quality, Becky built her little venture into an export driven women’s empowerment movement operating in several countries and continents. The grounds of Amani are the most inviting I have experienced in Africa and Becky says she “just wanted a peaceful place for the ladies to work.” Amani hires refugee women to produce high quality fashion and accessories that are not only saleable in western markets, but are actually on the high end of the quality spectrum. Amani pays these women 3 times the minimum wage and even encourages them to start their own businesses employing other women to produce products for sale to Amani. Not only was everyone we saw glowing with happiness, but they also leapt up from their sewing machines when we entered the production room and proceeded to surround us with a joyful welcome song.

The comfort of our afternoon with Amani contrasted greatly with the next morning’s transit to Uganda. Stuffed into the last seats of a roller coaster bus that bounced hundreds of pothole-ridden miles, we arrived in Kampala with a rainbow of bruises more varied than the stamps in our passports. After a day of waiting for our next bus, we boarded the luxury liner to Kigali, which was much better than our trip to Uganda, except for the “American Boy.” Instead of the quiet roar of a diesel bus, which drowns itself out, we were treated to a Nigerian film about that blared loud sound from a cracked speaker for over 3 hours. The rest of the passengers loved the film but the “Welcome to Rwanda” sign, was a long awaited visual cue that this comedy/drama classic would soon end. When we finally arrived in Kigali, we needed to set up camp and get to business.

As a social entrepreneur on the go in East Africa, I would say the first step upon arrival into any new town is to establish an “office.” Step 1 is getting a local SIM card to slide into your phone. Africa is a “pay as you go” market for everything from shampoo to liquor, meaning you only have to purchase the amount you intend to use. (I discovered this last year in Tanzania when a women I wanted to photograph talked me into giving her some money for the picture and then proceeded to buy one Coke and one serving of gin in a small plastic bag which she quickly opened and poured into the Coke.) With phones, this means you can buy a phone number via the SIM for about $1 and then charge it up as you need it. Step 2 is finding a place to work. Electricity is a must, internet is a nice-to-have and a comfortable environment is a supreme luxury. We found office utopia in Kigali’s Bourbon Café at the Union Trade Center. I typically avoid such Americanized places when travelling abroad, but at this point wireless internet and overstuffed chairs seemed a reasonable balance to our bus rodeo.

We headed down to Butare meet a Dr. Ignatius Kakande, a Ugandan surgeon who produced a brilliant presentation on surgical challenges in Africa. I had only communicated with Dr. Kakande over email and he invited us to visit him at the University of Rwanda. Our intent in the 2 hour trip was purely to meet Dr. Kakande, but upon arrival, we were quickly sent to see Dr. Jean-Baptiste Kakoma, a Congolese doctor and Head of the Obstetrics and Gynocology at the university. It didn’t take long before our collective enthusiasm for helping women with fistula exploded into an impassioned hand-waving discussion of how we might work together to change the face of fistula in Rwanda. Our tour of the facilities revealed two young surgeons with some fistula training and experience who were both interested in learning more as well as a physical infrastructure facility in need of support. We met a few fistula survivors in the small and crowded post-operative recovery ward. This hospital in Butare handles a consistent, albeit small, flow of fistula patients and the entire staff seems to believe that significant expansion of activities is possible with a little outside support.

We excitedly took notes and reviewed the site thoroughly, noting infrastructure gaps and potential opportunities. Unfortunately, the Hospital Administrator was not in the office, which limited a full scale site analysis. But we did find out that EngenderHealth had visited Butare in May and having gathered all the info we could, we rushed back to our regional office (Borubon Café) to follow up with our friends at Engender.

After twenty four hours of departure delays, missed flights and mindless people-watching in airports, I finally arrived in Berlin, disoriented and in great need of a toothbrush. Seth in his usual high-energy, unrelenting O.F. focus immediately wanted to get to work. Although obviously exhausted, my adrenaline took over as we walked all over Berlin for last minute items and packed and repacked our gear a million times. That night, over a plate of cow (Seth is a huge carnivore and I am practically Hindu) and spinach artichoke tapas we defined our organizational objectives and flushed out our ever-evolving strategy for the summer.

We left the next day for Nairobi via Doha, the capital of Qatar in the Middle East. Our 12 hour overnight layover exposed us to an antiquated world of Arabic and African cultures that have been mixing for centuries through commerce. The airport was a diverse stage of hundreds of languages, with poor South Asian migrant workers, wealthy oil tycoons, western businessmen, and fully clad Muslims of African and Arab descent. The smells of body order and Indian spices that permeated the air and strange and beautiful faces provoked a sense of curiosity and intrigue to the unknown world we were embarking upon.

Despite months of planning, traveling to Africa on this type of quest is a nebulous affair. We had reached out to surgeons and health professionals all over the region but a solid schedule seemed to elude us. As soon as we hit African soil we were welcomed Dr. Westin Khisa, a fistula surgeon in Nairobi. Dr. Khisa is a short, smiling man with a hundred jokes in his pocket and a warm hospitable heart on his sleeve. Working with AMREF, he has helped build O.F. treatment capacity throughout Kenya. Seth met Dr. Khisa while in Geneva at the World Health Organization and our primary purpose in reconnecting with him was to pick his brain on how he and his team built this capacity. After a short tour of his office, Dr. Khisa invited us to an evening of masala tea (a black pepper and ginger spiced African tea) and fish sticks as we discussed maternal health in Africa and American politics with he and his colleagues (these Kenyans sure love Obama!)

We continued the conversation the following morning for a 7am breakfast. The doctors shared their deep sense of African society at the community, district, and national level. Kenyatta National Hospital (where they all work) is one of the largest hospitals in Africa and they are responsible for even the most remote patients in Kenya. Despite efforts to set up a formal network of referral hospitals, reliance on traditional medicine sometimes keeps populations of people out of the national health scheme. Nairobi doctors are seen by some local people as alien and these people prefer treatment by community health workers who they know and trust, but who sometimes have absolutely no medical training. To build bridges as outsiders, working in this area is a tricky task even for Africans. This discussion over breakfast helped us to understand the intricacies of working within tribal populations in African society and bridging the gap between rural and urban (read modern) medicine.

That night we took the overnight train to Mombasa, an ancient Afro-Arab trade port on the Indian coast. The rhythmic but loud thumping of trains usually keeps me from sleeping but this train was magic. I woke up at 7am, refreshed, ready to go and expecting to arrive in an hour with a full day. But for some reason we were stopped. Five minutes into breakfast, we learned that we had actually been stopped the entire night due to a carriage derailment about a mile up- comforting to know as we traveled in a carriage on the same archaic tracks. To kill time, we walked around Kibwezi, the small village that our waiting train had invaded. But as curious as we were about the villagers, they seemed even more interested in watching us. We made friends with unspoken words and nail polish and were finally on our way again.

Twelve hours later, we were greeted at Mombasa Railway Station by Dr. Jennifer Merry Othigo, a fistula advocate and surgeon from Coast General Hospital. Seth met Dr. Othigo for a few minutes in New York and had mentioned our upcoming trip to Kenya. Without hesitation, Dr. Othigo offered to host us and we were as excited for this experience as we were to discuss her success in treating fistula in the coastal region. Dr. Othigo has a deep understanding of treatment costs and she helped us develop a detailed patient costing analysis so that we could capture and categorize the components of a single vesico-vaginal fistula (VVF) surgery. While we had planned on at most two days of meetings, our delayed arrival and Dr. Othigo’s phenomenal African hospitality extend our stay through the weekend.

With extra time, we had a chance see the real Mombasa and to get to know Dr. Othigo and her friends and family. As Mombasa is a rich blend of Arab Muslim and African Christian societies, Dr. Orthigo transcends religious and cultural divides by working in partnership with the Council of Imams, an organization of Muslim societal leaders. This deep cross culturalism is pronounced in her personal life and we were invited by her close friends Zeitun and Said to a traditional Arab-Swahili meal in their warm and simple home. The magnificent food and Arab generosity highlighted the unceasing African kindness we had experienced since we landed on the continent. Though we were really beginning to grow comfortable in this coastal port, it came time to board the train once more for an overnight (hopefully) return trip to Nairobi.

Sun drenched cafés, open air cinemas, and the burst of applause roaring from a pack of rabid football (soccer) fans – even I can’t believe I am leaving Berlin at peak season. But duty calls.

After months of deep thought, broad conversation, and thorough strategic consideration, we at OperationOF are ready to take our little venture to the next level. For us, this means condensing the idealistic clouds of our Concept Phase into a tangible base of test cases that will define our Pilot Phase. In this pilot phase we will put some of our concepts into action, testing specific techniques in different environments to see what really works and what needs improvement. A successful pilot will not only teach us volumes, but it will also allow us to develop and refine a set of programs applicable to a broad set of situations. The design and implementation of the pilot is really the key to developing a highly scalable approach to treating fistula. (The first pilot program is focused exclusively on treatment, but subsequent iterations include and will eventually focus exclusively on prevention.)

Our concept is to build highly efficient and sustainable capacity to treat women with obstetric fistula. This means getting local African doctors the training and equipment they need to address the enormous and pent-up fistula demand. It also means working closely with hospital administrators to ensure that their organizational resource base and processes are sufficient to serve our cause without abandoning all the other good working being done by the hospital. In an environment of mind-boggling lack of medical capacity and infrastructure, it is important to design structures that keep hospitals balanced while also serving our cause.

With all that in mind, we decided to launch our first pilot in East Africa and will spend summer gathering information and evaluating potential pilot sites. Besides meeting with proven capacity builders in Kenya, Uganda, and the Democratic Republic of the Congo, we will be reviewing various hospitals in Uganda and Rwanda. Throughout the trip, we will also engage with various women’s empowerment organizations.

Besides gathering information and gauging fit, we will model capacity building/expansion and process improvement techniques for centers currently treating fistula as well as those with little or no presence in the space. We break the potential sites into two groups, which we describe as follows:

• Greenfield (less than 75 surgeries per year); and
• Expansion (more than 75 per year).

Throughout the trip, we will work to update the blog and send reports from the road, so check back often, or subscribe to stay updated!

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!

Anyone who has spent any time in a hospital knows that the food there is usually pretty terrible, but what if there were no overcooked carrots or flavorless Jello? Can you imagine traveling a great distance for medical procedure that required hospitalization and having to bring along a cook for your entire hospital stay just so you could eat?

Holy Family Hospital, like the vast majority of comparable hospitals in the region, does not have a cafeteria or regular food service for patients. This means that a community of informal caregivers formed behind every ward with clusters of people sitting together preparing the meals their loved ones would later consume. People laughed and kids played and it seemed a world separated from whatever affliction had brought all these strangers together. I happened to walk up on a lively group of women pounding out some fufu, a local favorite made by beating cassava roots with the end of a six foot stick. One of the women had the most beautiful native fabric wrapped around her and when I non-verbally asked permission to photograph her, she jumped up and ran away. A few minutes later, the young lady returned having replaced the vibrantly patterned local fabric-wrap that had inspired my interest in taking a picture with a pink tank top imported from somewhere in the West. I paused to consider the wardrobe change and was brought back to attention by the young lady now yelling at me to take the picture as her hand danced around the pounding staff that formed the fufu.

Like the families who had come to support their loved ones, John Kelly had a relentless dedication to both Glenda and Isabella. I followed him around as he frequently checked on both ladies. Isabella’s procedure was relatively simple and she started a full recovery almost immediately. Glenda’s post operative status was much less stable. Her surgery had been major and despite having consumed liters of fluid, Glenda’s catheter bag remained empty. Every couple of hours, John would look in on Glenda, and every time her face seemed to get more and more bloated. John picked up the frequency and intensity of his intervention, giving instructions to the nurses and even Glenda’s husband, who didn’t speak English, but seemed to absorb the exact meaning of John’s every word.

Mr. Devotion, the name I gave Glenda’s husband, was far and away her best nurse. He always seemed to be there comforting Glenda at her sickest and he never left her side. In fact, he even chose to spend his nights sleeping on the floor underneath her bed. Unlike many fistula patients, Glenda was never forced to endure her fistula alone because Mr. Devotion stayed with Glenda through her 16 years of leaking urine and feces. After about 30 hours of worry, we found Mr. Devotion giving John the thumbs up sign as he sat next to a full catheter bag.

As Glenda’s condition stabilized, I started looking at and thinking about all the processes that had brought these women to Holy Family Hospital and had finally resulted in their fistulas being repaired. I met with the hospital administrator, Father Ofusu, and reviewed the hospitals cost and operating structure. With all these components, I began hypothesizing ways to cut significant cost out of the process and how we might scale up a treatment and training program to other parts of Ghana. In my research, I realized that Glenda’s Ghanaian insurance covered the cost of her procedure, but that Isabella would have to pay for her procedure out of pocket because she was from the Ivory Coast. I estimated that even with John’s donated surgery Isabella would still need to pay almost $200 – a fortune in her world. I decided to intervene.

I went to the women’s ward and first spoke with Glenda and Mr. Devotion. After discussing how happy we all were about the surgery’s success, I handed Mr. Devotion 10 ceedees (just over $10). This covered all their cooking cost for the entire hospital stay and left them a bit extra. They were both very happy to receive the cash support and thanked me profusely. I snapped a pic, wished them luck and headed across the ward to Isabella and her sister.

With Isabella, I had to speak through two interpreters, so things took a bit longer, but the 10 ceedees had a similar effect. When I told Isabella that OperationOF would be picking up the tab on the surgery, she first didn’t understand. After I confirmed that, like Glenda, Isabella would not have to pay for her procedure, Isabella finally broke her gaze from the floor and hit me with an enormous and radiating smile. After seeing what a brilliant and contagious smile Isabella had, I told her that the surgery was actually not free. Her puzzled look returned. I went on to explain that Isabella had to fulfil two conditions for her side of the deal. The first was to find more women who need the surgery and refer them to us and the second was that she had to smile as often as possible because her smile made the world a happier place. After 30 seconds of translation, Isabella looked me in the eyes and nodded affirmatively with a smile of absolute and pure joy that continues to move me.