Good Intentions Gone Efficient

Sitting in the front seat of a white government issued SUV, I felt sick to my stomach. Two of my teammates sat behind me joking with Dr. H, a well connected health official, as we rumbled between two South Indian villages. It felt like something out of a movie – foreigners wearing sunglasses arriving to a host of curious looks. I tried hard to put aside the misgivings I had for the time being. At each stop we were graciously accommodated - bodies whirling around us preparing tea as doctors dropped everything to answer our questions. Yet, it felt far from traditional Indian hospitality.

Maybe it was the looks in their eyes, or the urgency with which they moved, but it quickly became clear that the staff was afraid of something. Behind us our host barked orders, apparently using our visit as an opportunity for an inspection of the facility. I bit my tongue as the janitor hung his head- presumably being told in Kannada that the floor was not clean enough. Eventually we received news that a baby had been delivered earlier that morning and Dr. H shepherded us into a makeshift recovery room.

The new mother laid with her child as her family watched us from neighboring beds. Dr. H paced around asking questions and noting the quality of the room. Our eyes drifted to the squirming hours old baby. My heart sank when our curiosity was noted and we were prompted to touch the newborn. Here we were on what should be one of the new family’s proudest and happiest days – strangers barging in and being asked to treat their child like a hands-on experiment. My discomfort was visible, but our host insisted. I eventually touched the poor thing’s head and hustled out of the room. Dr. H teased me and we moved on with our day.

I couldn’t put the experience behind me. Images of the day kept flashing through my head- the vacant looks on the faces of patients in the crowded waiting room as the doctor left his post to meet us, the embarrassment of another clinic’s staff when Dr. H pointed out a error in their tabulation of the month’s deliveries, and my silence throughout the whole ordeal. I had come to India to help people, but had I really spent the day doing the opposite?

That feeling stuck with me for longer than I expected. While the three of us had spent the day with Dr. H, one of our team members stayed back in Hubli to troubleshoot our technology and do other some other work. Over the past week our team had researched something called Samastha, a HIV/AIDS program funded by USAID and an organization called KHPT that our NGO was responsible for implementing in Dharwad District. Eager to gain a perspective on the finer details and goals of the program we decided to email two contacts listed on a PDF document we had found online. The responsibility of writing the email fell to Jon as we toured the clinics.

The email read:

Hi Ms. Shankar and Mr. Gurnani,

My name is Jonathan Goldford and I am part of a team from the University of Southern California. As a group of four we are working with the Desphande Foundation to improve the efficiency and effectiveness of the Samastha project at BCT in Dharwad. To do this, we are implementing a simple SMS-based healthcare communications network using software called FrontlineSMS.

Once we have completed the project we hope to be able to scale it to each of the other NGO's in the Samastha project. It would be great if we could set up a phone call with you to discuss our project and the potential to work with the other NGOs in the future. Thank you and I look forward to hearing from you both.

As we later found out, the message was a textbook error for several reasons. First, we had unintentionally reached out to two very high up officials. Despite the relative ease of obtaining their contact information we were later told, “People don’t just email them.” The best description of communication in India I have heard since is that in this country things are “well stratified, well channelized”. The status of the two individuals made the informal tone and greeting of “Hi” unacceptable. Worst of all, we had used the terms “efficiency and effectiveness” – two words thrown around American business communication that had been misunderstood in this instance to mean we were calling their program inefficient and ineffective.

The message would later prove to be a bold, but brash gesture. The introduction we were trying to make for ourselves was independently made by a Deshpande Foundation program officer the very next day. When he received a call later that afternoon he assumed it was in response to his request for a meeting, but instead it was to admonish him for our communication. It quickly became clear that we had made a mistake that jeopardized not only our project, but our relationships with the Foundation and our partner NGO as well.

The next day the possible consequences were presented as such by our mentor, Rahul Brown:

• You will be spending the remainder of your vacation in America
• You will be reassigned to another project
• You may be able to salvage your project with another NGO, but you will need to work 12 hours a day, 7 days a week.

Oh, and we were told that it was more than likely that our partner NGO would lose its funding from the organization we had contacted. Our emotions at the time were many – disbelief that a harmless email could cause such damage, frustration that we ourselves were unable to do anything to rectify our actions (we were put on “communications lockdown” and referred to as “grounded”), and fear that the friendly staff we had grown to know would be out of the job.

Yet, today our project continues. We enjoy a healthy relationship with administrators at KHPT (the organization we emailed). In fact, we met with one administrator today to make an introduction to EXPAND our project in the future and another requested a PowerPoint of ours yesterday to take to a meeting in Bangalore. So how did we get from the dire straits described above to where we are now? The short answer is, I don’t know. The apologies we showered on the affected parties were laughed off, administrators whose relationships we had supposedly strained behaved like old friends, and after a long lay-off our project emerged stronger with important people supporting it. The full story involving exactly who reacted and in what way, and other critical details have not been shared with us and likely never will.

I still think about the incident amidst our now demanding project's activities. New information emerges every day and with it new theories – for instance, that our affiliation with a US university combined with the American government’s funding had led some to believe we were contracted to evaluate their program without their knowledge or consent. Most read the text of the email and can’t believe our stories – a high-up staff member at Deshpande even told me recently that he thought it was a good email. Most often I think about the ubiquitous Samastha program banners. In small print beneath the USAID logo it says, “From the American People.” Wasn’t that our intention as well? Where had I gone wrong? Where had we all gone wrong?

In the end, I've given up explanations in favor of something Gandhi says in his autobiography:

“Numerous examples have convinced me that God ultimately saves him whose motive is pure.”

- Dan

Power Law, Sex Workers, and HIV/AIDS

After 12 agonizing days our project is back on track! Unfortunately, I'm going to delay telling the back story of our lay-off yet again. Hopefully the suspense is building - I hope we don't disappoint when the time comes!

In the meantime, our project has developed a clear direction - employing a FrontlineSMS system
around the Bhoruka Charitable Trust’s HIV prevention programs. BCT is part of a larger network of organizations working in a comprehensive HIV program. They implement the preventative side of the equation- including outreach, education, referrals for testing. BCT focuses almost entirely on high risk populations- mainly sex workers. But why sex workers? What about everyone else?

I spent one of my off days powering through Malcolm Gladwell's Outliers - a very interesting study that attempts to explain extraordinary people. Gladwell is a great writer for a number of reasons- including his gift for turning complex streams of information into a narrative. His writings also get the user to question closely held assumptions and do something we often don't stop to do - think. Since Gladwell got me thinking, I'd like to attempt to do the same for you - explaining the pilot use of our project (including the question of “Why sex workers”) in the context of one of his writings - a New Yorker article from 2006 called "Million Dollar Murray" (accessible here)

I’d recommend reading the article, but I’ll try to summarize as best I can. Gladwell believes that we have a tendency view problems ranging from homelessness to HIV as “normally” distributed. He explains what he means by this using the LAPD’s issues with racism and violence following the Rodney King riots:

In the language of statisticians, it was thought that L.A.P.D.'s troubles had a "normal" distribution— that if you graphed them the result would look like a bell curve, with a small number of officers at one end of the curve, a small number at the other end, and the bulk of the problem situated in the middle. The bell-curve assumption has become so much a part of our mental architecture that we tend to use it to organize experience automatically.

In fact, the opposite is often true. Problems like violence at LAPD can be said to follow something called the “Power Law”. The problem is not in the middle, but rather at the extreme. Gladwell claims that a small population accounts for the majority of the costs associated with homelessness (the namesake of the article is an individual from Reno named Murray who racked up over a million dollars in hospital expenses over 10 years!). The optimal solution changes the minute you begin to envision problems as following a power law distribution. In the case of homelessness it became rounding up the chronically homeless population (read: the long tail) and offering them a free apartment and intense case management.

Now try to envision HIV/AIDS as following a power law distribution. What if you focused on the population that accounted for a large proportion of the infection’s spread? Turns out that some visionaries in Thailand did just that (read more here). While other countries were spending vast resources on Anti-Retroviral Drugs (ARV’s), Thailand invested its funding in prevention programs- including interventions with the country’s sex worker population. Describing the “100% Condom Program”:

This program aimed to enforce consistent condom use in all commercial sex establishments. Condoms were distributed free to brothels and massage parlours, and sex workers and their clients were required to use them. Brothels that failed to comply could be closed. Without this program, it is estimated that Thailand’s national HIV prevalence would be ten times higher than it currently is.

Sounds pretty familiar right? Thailand has been able to reduce its number of new HIV infections from 143,000 in 1991 to 19,000 in 2003. The same cannot be said of countries in Sub-Saharan Africa that did not pursue this approach.

For some this may still feel wrong. Power law solutions often don’t. One doctor here expressed his frustration with the response of NGO’s here. He believed that everyone should be tested for HIV, not just high-risk populations. There is also a moral hazard here - why not just shut down the brothels all-together? why should we spend tens of thousands of dollars housing a few select homeless people?As Gladwell puts it: “Power-law problems leave us with an unpleasant choice. We can be true to our principles or we can fix the problem. We cannot do both.“ It’s worth noting that Thailand combined their targeted interventions with a massive public information campaign and other initiatives.

After meeting with sex workers here and listening to their diligence surrounding condom use and HIV/AIDS it’s hard to deny that important progress is being made. Our hope is that a FrontlineSMS system can build on the success of this and other programs. Who knows what lessons we may learn.

- Dan

FrontlineSMS for Healthcare, Genesis

Several times since we have arrived in Hubli, people have inquired about how our project began, so now I would like to take the time to recount the tale.

Two of the people I lived with this past school year, Alex John and DJ Strouse, were amongst the participants of the University of Southern California Steven Institute for Innovation’s first Global lmpact Program (GIP) (see their project’s blog here, last year's group posts are the earliest entries). Last summer DJ, always challenging me intellectually, recounted the lessons he learned while working in Hubli and I followed his team’s blog sporadically. Fast forward to November 2008. DJ Forwarded me an email regarding a brainstorming session for the upcoming summer’s second GIP. During the session I remember feeling confident and hopeful- here was a program that sought to bring students together to spearhead projects that would have a sustainable social impact.

After that initial meeting with my future Global Impact teammates I knew I was interested in the program- an all-expenses paid (minus the cheap cost of food and leisurely travel) trip to India would allow me to truly explore my socially innovative potential. I thank DJ for being what I now fondly refer to as “my catalyst”. He encouraged me to apply for the GIP and as soon as I began to show an interest in diving into the world of social development he met me head on, always offering me a challenge and his extensive knowledge of that world, which he had been pursuing as a potential life path before he discovered his love of physics.

Because it was not initially clear whether GIP member selection would be based on initial project proposals with self-made groups or selection through individual applications, and because I studied Biological Sciences at USC, DJ got me in touch with someone he knows who is interested in public health, Daniel Bachhuber.

Daniel and his friend Isaac Holeman had collaborated on trying to merge FrontlineSMS, (a software program that allows for bulk text messages, automated responses, grouping of cell phone numbers and many other features,) with OpenMRS, (the organization Partner In Health’s electronic medical records system). At 2008’s Netsquared conference, the two were finalists with this merger proposal. MobilizeMRS was its name, but it would soon become a larger organization called FrontlineSMS: Medic, thanks to further partnering with some Stanford University students.

Because I was trying to find an idea that could be implemented in Hubli, Karnataka, India, where I knew there was little in the way of electronic medical records infrastructure, Daniel and Isaac suggested I aim for a simpler technology than their MobilizeMRS. They got me in touch with Josh Nesbit, a Stanford undergraduate who had successfully implemented a pilot project called Mobiles in Malawi. He first used FrontlineSMS without the more complex link to an electronic medical records system, which can be overly complicated technology for rural populations who have little-to-no knowledge of computers and or mobile phones.
I was eager to bring this project to the table and very early on got great feedback about its potential- both for impact and adaptation to India. After applying for the Global Impact Program as individuals in January 2009, there began a long process of project development, multiple proposal drafting sessions and eventually selection and rejection of projects. This was done by members of the Deshpande Foundation, which is the source of funding for the Global Impact projects.

By consulting carefully with the ever-so-helpful FrontlineSMS: Medic team (Isaac, Josh, Lucky and Nadim- see their web site), I spearheaded the project proposal of team SMS. After it became one of the approved projects I soon welcomed Jonathan Goldford and Dan Greenberg to the team- two amazing additions, both Business majors who could bring a fresh and different perspective from my own (particularly in the area of organization). I had been working with Jon all semester in my first and only college business class, Global Strategy, and knew him to be a natural-born leader with monk-like patience, a seemingly inexhaustible work ethic and a soothing willingness to lend a hand to teammates in need of help. After beginning to get to know Dan I was initially blown away by how much he had already pursued social development- co-founding a chapter of Net Impact at USC. I always left our conversations and on-campus speaker events where we ran into each other, mind abuzz with exciting thoughts and new possibilities.

After some re-working of the Global Impact team rosters for the three projects, the SMS team was lucky enough to welcome Tapasya Desai. In the initial stages of the project, even before it was definite that she would be a member of the team, she was always the most attentive and quick to respond to my project proposal logistical emails and her knowledge of Hindi (which she will self-deprecatingly claim to be minimal) seemed, and now has undeniably PROVEN, to be a powerful asset. The language and her cultural understanding of Indian people has allowed us to approach many a person with warmth and a bond that can only be had through understanding of another person’s language and thoughts. I knew Tapasya and I would be able to chat about both saving the world (given the nature of the program) and the lighter side of life (evidenced by her extremely helpful recommendations for my spring break trip to Miami in March)!

With our team fully formed, we had only to search more actively for a partner NGO. This would be a complicated process for various reasons. As Dan pointed out in his last post, there were many things that would change once we finally landed in Hubli. Our team will write a fully detailed account of our project’s full process once we have made more progress. Please stay tuned.

~Lena

When my journey began

To provide a more personal context for my upcoming post about our project’s nuts and bolts genesis, let me share my experience with the development world up to this point in time:


I forayed into international development two summers ago; I spent three weeks in Ghana volunteering with the Non-Governmental Organization (NGO) Global Volunteers. However, that summer trip was a short service project, for which I had to pay far too much money to have far too little of an impact. I remember thinking about that while I was in New Akrade, Ghana, when I would pass the abandoned, half-finished project from a previous group’s trip- the basic foundations of what was supposed to be a new health clinic.

However, at the time my plan was still to hold off on my dreams of changing the world until I was “qualified” and had finished medical school and residency. Thus many of my observations about non-governmental, non-profit work would be put on the backburner until I would revisit them, once fully committed to pursuing social impact with the Global Impact crew. Now, to be sure, I learned a great deal during my summer in Ghana, but the work was clearly tilted towards the observational and self-, not the social-development, side of having an impact on the world…

~Lena

Opportunities from the In-Between

The basement of USC’s Leavey Library – we sat in an enclosed study room amidst the sea of computers and eclectic crowd of students that seemed to radiate stress. For months we found the hidden hours to meticulously plan, research, and speculate about our project. Yet, three weeks into our journey in India those meetings seem distant in every way imaginable. Our naivety at the time makes me smile- we were silly to think that business-speak, whiteboard diagrams, and PowerPoints could adequately prepare us for the challenge of working in India.

As I write this post our FrontlineSMS project is at a standstill. However, I’m not ready to comment on the questions of exactly “why” or “how”. To be frank, I’m not sure I adequately understand the answers to those questions myself and so that book remains open. The resulting downtime, while unsolicited, has afforded us the opportunity to pause, to reflect, and to begin to observe our surroundings – with a view and mindset not available in the university library’s basement.

I’ve found that India’s sporadic power and internet connections have not hampered my research and exploration of a place that continues to baffle me. As I’ve ridden buses and strolled the crowded streets a number of ideas have popped into my head. The sight of a child playing feet away from a hog rooting through garbage prompts the question – “Where are the playgrounds” while collective cravings have led to a half joking proposal for a restaurant that would serve omelettes, black coffee, and other comfort items (all veg of course).

Our most promising idea can best be exhibited by the picture included above. Photography is an interesting tool- allowing us to precisely capture a moment and in our case, the memories of this trip. Yet between the millions of Facebook albums and the obligatory graduation shots, photos have grown routine- more of a duty than a luxury. That is not the case here in India. People here not only want to have their picture taken, they want to see the picture and inevitably own a copy themselves.

Watching this process first hand has personally snapped me out of my entitlement and presented an opportunity. Realizing how a simple photograph can be a tremendous source of pride – Jon and I have embarked on a mission to deliver that service to Hubli and donate the proceeds to acts of kindness. We’ve marched around to print shops, brainstormed logistics, and even tested the market with our neighbors next door at the middle school. While I anxiously anticipate the continuation of our FrontlineSMS implementation, I can’t help but contrast the way in which this entertaining side project has developed in a radically different way.

- Dan

Twitter

Wanted to let everyone know that you can follow the USC Frontline SMS project on Twitter as well: http://twitter.com/USCFrontlineSMS

-Dan

Compassionate Engagement

Rahul Brown, the mentor USC sent with us to Hubli, emphasized the importance of compassionate engagement in our projects to be able to succeed. Despite having the best well researched and planned business models, a project of social impact that we are here to achieve will fail if we do not practice compassion. To aid us with our interactions with the community, he gave us a small comb and nail clippers to use in the field. When children come to ask for alms, it can break your heart to refuse as most of the time they gather and give to a higher child exploitation organization. Instead of ignoring them, try showing some care and compassion by combing their hair or clipping their nails to teach them about hygiene and the importance of keeping hands and nails clean.

Last night, I was fortunate to have my first experience using my hair comb. A young girl, about 7 years old and her older sister were asking us for money as we stepped out of CCD (Cafe Coffee Day). I opened my purse but instead of taking out money as I'm sure they expected, I took my hair comb out of the plastic bag I keep it in. I showed it to the younger girl and motioned with it across her hair to show her what I intended to do. She grabbed the comb, stuck it in her hair, and ran away giggling. After getting over the initial amusement and shock, I ran after her and explained that I wanted to comb her hair and make her look pretty. The sisters were confused that I was offering to provide a service instead of giving something physical to them. I started combing the front of the younger sister's hair and she could hardly contain her excitement as she quickly took out her hair tie to unravel her ponytail. It took me about 3 minutes but I was able to detangle most of her oily unkept hair and smoothed it out for her and showed her and her sister how lovely she looked. As we were leaving, the older girl kept asking for money but the younger girl seemed to have understood and valued the act and smiled, waved and yelled "Bye Tapasya."

As I sanitized my hands, cleaned the hair out of the comb, and put it away in its bag, ready to use for the next child, I couldn't get past how grateful the girl was and how quickly she stopped begging when I interacted with her. I hope this is the first of many successful acts of engagement we get to practice not only over the next few months while we are in Hubli, but throughout our lives.

~ Tapasya

Cows and Dogs and Naan - Oh My!

A sea of flat roofed buildings, cows wandering through the streets, and boys playing cricket in empty fields- India overwhelmed me before I left my window seat on King Fisher Airlines (a conglomerate brand that also manufactures popular beer and bottled water- imagine Bud Light airlines). As we’ve completed our first week it’s worth revisiting some of the biggest shocks to our system since landing in Hubli.

The Food

I wouldn’t count myself among Indian foods biggest fans before my arrival here. In fact, I’ve probably only willing ate Indian food a dozen times before (twice at Global Impact meetings). That being said – the food has been great! As a country with a vast vegetarian population- you have to go out of your way to eat meat. Our entire team has been veg thus far- and the meat eaters among our group have carefully considered a number of arguments why we should never eat meat again. I impress myself every day the streak continues, but I’m really starting to crave some chicken. It has also been interesting to adjust to the preferred eating utensil- the right hand!

Electricity/Water

As Jon’s pocket India guide says- no city in India has a full day’s supply of water. Most buildings here collect water in big tanks on the roof when the government turns the water on in the morning. When it goes off, gravity becomes important (the lower you are the better). The electricity has also been pretty inconsistent- so far we’ve had three extended blackouts, often well over an hour. Our India colleague Golden has just informed me that we are lucky that the electricity has been this good, so let’s hope it holds up.

Animals

I expected to see a lot of cows on the streets and that has certainly been the case. They are pretty docile and tend to do their own thing- occasionally blocking traffic or issuing a loud “moo” to let everyone know they’re here. I’ve been surprised to see a pretty sizable population of stray dogs roaming the streets. They’re joined by goats and the occasional pig/hog. When we told one of the sex workers (referenced on the previous post) that this was not the case in America she was pretty surprised. Thankfully there is plenty of litter and food in the open lots here for these critters to munch on.

The Head Bob

In the US head gesturing works as follows: up and down = yes and side to side= no. Indians are known for what many call “the head bob”. It could best be described as the accelerated tilt of your head from left to right (sort of a cross between the US’ two gestures). The head bob is both confusing, as it can mean everything from yes to maybe to absolutely not, and also addictive (I’ve noticed a number of us unconsciously imitating it.)

Driving

In addition to driving on the left side of the road (I’ve accidently waited on the right side of cars here twice- the passenger’s seat in the US, but driver’s seat here) the motorists here also operate using echolocation. By that I mean they forgo mirrors and sight for the constant use of the horn. It’s pretty smart between all the animals, motorcycles, and people walking on the streets – but makes for quite the cacophony.

As I struggled to adapt I’ve learned a great lesson from an unlikely passenger on our flight from Bangalore to Hubli – Jaishree Deshpande (the billionaire co-founder of the foundation funding our project). She told us two stories about her move from India to Toronto that made me feel better about my own adjustment, describing how she had initially thought pepperoni was a pepper and how she had first distrusted the hot cocoa vending machine because she didn’t see a cup. As foreign as this place was initially, it’s starting to feel like home.

- Dan

It's been one week

It's been exactly one week since the global impact team reunited in Hubli, stepping off the small Kingfisher airplane and into the monsoon. Although I have been in India for weeks already and have no excuse of being jet-lagged, I feel just as exhausted as the rest of my team mates. Our days have been long, the heat has been intense, and I have walked more than I have in months. I can't believe it's only been one week since arrived in this town. Already, I have developed my daily routine of yoga at 6:30 am, cold showers, granola bar for breakfast, and off to work. We have become regulars diners at Hotel Ambesh and know the staff by name. We have learned to barter with rikshaw drivers that try to over-charge us. We have learned how to cross the street dodging buses and cars and risk drinking fresh juice from stands. We're used to our 8:30 pm curfew and don't flinch by power outages. We have even made friends with a few of the girls of BVB Engineering College at the girls' hostel we are staying at and gone to the mess hall to eat 20Rs meal with them and taken the bus to Kopikar Road for bargain shopping and delicious ice cream. They now come to our room every night to come talk, laugh, and share life stories. It feels like we're in the dorms all over again.

It has only been one week and I feel like I have already been living here for a month. I feel like I have seen and interacted more with India in the last week than I have in the two weeks I was in Bangalore. I have met people from all walks of life - from the wealthy but ever so modest co-founder of this foundation, Mrs. Jaishree Deshpande herself to Indian fellows from Karnataka who have dreams of opening their own NGOs to a 16 year old village girl who was thrilled to be able to show me her two bedroom mud hut and wanted me to stay to dinner. We have come here to make a change but judging by the amount I have seen and experienced in the last week, it is I who is going to learn and grow. I hope I can make the most of this amazing opportunity and take lessons learned to heart - let's see what the next month and a half has in store!

~ Tapasya

Unexpected Employment

I'll give you some basic details about one of the people we met yesterday:

- She works two jobs to make sure her kids eat everyday.
- She tells her daughter not to talk to boys.
- She speaks five languages including Hindi, Kannada, and some English.
- She offered our team tea because we were guests.

If I were to ask you to tell me the profession of this person you would either mention any random job or say you just don't know. I don't know a lot of people in the United States who speak five languages and still have to work two jobs. In fact, I don't think I know anyone in the United States who speaks five languages at all.

This person was and is a sex worker. She provides intercourse to clients for a payment. According to the sex workers, they charge anywhere from 50 rupees to 500 rupees. That is roughly $1 to $10. They fear harassment from police and violent clients, and they often have to get illegal abortions if they get pregnant. One abortion alone costs from 1000 to 2000 rupees. Usually the client pays for the abortion, but sometimes they run away and leave the cost to the sex worker. This is not an easy life, especially for two sex workers whose husbands passed away and forced the women to make enough money to provide for their kids.

Along with being sex workers, some of the women work at BCT as peer educators. Through the NGO BCT they visit villages and educate them on the potential harms of sex work. Working alone in the community they explain the prevelance of HIV and the effectiveness of condoms. Along with education, they recruit community sex workers to visit the organization's Drop In Center for a discussion with a counselor and a checkup from a doctor. If necessary, the sex workers are referred to the Primary Health Center for an HIV blood test.

For the work they do, the peer educators get paid another 1500 rupees per month. This is roughly $30. With a wage in the US of $8 per hour, it would take roughly four hours to earn that much. For peer educators, an entire month of work.

So, how did they act? Were they frustrated? Angry? Mean? Well, as far as we saw, none of the above. They smiled and laughed more than I ever do. They joked with us about our terrible language skills. They talked about taking care of their children and how their job provides security for their family. They even read us some stories and went out to lunch with us. All this is pretty impressive for people who risk HIV, pregnancy, and other STIs for $1 to $10 so they can feed their family. Did I mention one of them spoke five languages? Yeah, she really did.

Jon

Can USC Global Impact Learn from GrameenPhone?

I came across a great TED talk a little while back that is very relevant to our project:

Iqbal Quadir says mobiles fight poverty

Quadir's talk is great for a number of reasons

Bottom Up Development:
I love when he says, "Economic development is of the people, by the people, and for the people." I think that is the real strength of all of the Global Impact projects. We're attempting to connect with people directly and empower them. I think for that reason it's incredibly important to be in Rahul Brown's words "radically open". What works best for the local community will always be our primary guidance.

Mobile Phones/Technology:
The premise behind GrameenPhone was initially very counterintuitive, but that is what makes it powerful. The cellphone was assumed to be a tool exclusively for the developed world, and its introduction was blocked by a number of excuses: The poor can't afford them, etc. Quadir and others have proven that technology can not only be introduced in developing countries to improve quality of life, but can also be done so profitably.

Our Project:
GrameenPhone and others have laid the foundation for individuals and communities across the developing world to communicate with one another. The challenge now is to continue to find ways in which cell-phones can be leveraged to improve lives. Our project attempts to do just that. We will likely face a number of the challenges that Quadir faced, including proving that a Frontline SMS system is a "production tool" and will thus pay for itself, and can certainly learn from his experience.

- Dan

(Video courtesy of TED - for more information visit www.TED.com)

Goals from the Beginning...

Since Lena did an excellent job describing the details of our project, I'll post some of my personal goals for the Frontline SMS Project. Here it goes.

1) Make a Sustainable Impact in Hubli - Unlike any other project I have worked on at USC, this project gives me the opportunity to have a sustainable impact. Our team doesn't want to give out cell phones, install software, and improve healthcare for just two months. We want the hospitals or clinics we work with to improve their medical care far after we leave. To do this we have to create a system to measure our program's impact and also find the champions necessary to continue the program when we leave.

2) Learn About Development Elsewhere - It would be ignorant to say development all over the world happens just like it does in the United States. In India I can really learn what it takes to have an impact outside of the US. Considering I haven't left the country besides heading south to Latin America or the Caribbean, this should be an awesome learning experience for me.

3) Test My Beliefs, Values, and Everyday Life - I'm hoping India forces me to test my beliefs. There are a lot of norms in the US that I follow just because that's all I know. Some aren't really that harmless like waiting in line, while others like our culture's competitiveness or our fast paced society may not be ideal. Since so many things are culturally different in India, I hope being there allows me to look critically at how I live everyday.

I know these goals are tough, but two months is definitely enough time.

Jon

"Social entrepreneurs believe and then they see"

My title is a great introduction to the passionate work my teammates and I will be doing this June and July in Hubli-Dharwad, in the "Sandbox Region" within the state of Karnataka, India. Moreover, it is perfectly in line with the spirit of entrepreneurship that fuels the University of Southern California's Stevens Institute for Innovation. The Stevens Institute introduced me to the field of social entrepreneurship. Since that seredipitous introduction I have independently begun to educate myself about the field, (for example, by watching videos like the one that provides my title quote), and have begun to passionately pursue actualizing my own potential as a social entrepreneur.

My personal journey to this point has been quite a wild ride; in future posts I will do my story justice. However, for now I would like to introduce the FrontlineSMS Healthcare team's project, as we are now on the eve of its realization in India. We are mere weeks away from the start of the trip that we Global Impacters have been eargerly anticipating since we applied for the program in January 2009.

In a collaboration true to USC's interdisciplinary nature, the business world and the health care world will be crossing celestial paths thanks to our unique team roster which combines equal parts business student (Dan and Jon) and science student (myself and Tapasya). I will leave my lovely teammates' inspiring stories to their posts!

Our team is introducing a mobile phone-based SMS (short message service) health care communications network to the city of Hubli-Dharwad. SMS is a widespread and inexpensive technology that is causing revolutionary changes in the developing world by connecting people though mobile phone text messages. We will create a health care communications network using cell phones in rural areas. The collaboration should include smaller clinics, larger hospitals, and community health workers (CHWs, called "link workers" in Hubli-Dharwad), to more effectively deliver healthcare services to Hubli-Dharwad. The idea is to create a triage system which better connects patients with the physicians who can treat them, allows for patient outreach, and increases the speed of providing health care. We will accomplish this by linking cell phones to FrontlineSMS, a free open source software program which allows users to connect a SIM modem to a PC to create an SMS (text message software) hub. Text messages with patient data will automatically be entered into a central computer, through Frontline SMS. Cell phone-equipped "link workers" (CHWs) will be able to engage in two-way communications with hospitals and clinics. SMS-based technology can solve problems with existing infrastructure and is easier to implement than costlier telemedicine solutions that require the internet. This innovative application of a new technology is unprecedented in the Northwestern Karnataka healthcare system.

By working closely with health care providers at various levels, and a local partner NGO in Hubli-Dharwad, we will determine which of the following potential uses will best serve the needs of people in the Sandbox (the region encompasing Hubli-Dharwad, in which our grant provider, the Deshpande Foundation, operates).
• Patient Regulation: patient tracking, patient updates, patient medication adherence
• More efficient healthcare and information delivery: requests for remote/emergency patient care, coordinating Home-Based Care visits, answer people’s questions regarding: common symptoms and problems with water filters, provide drug dosage/usage information, reduce healthcare workers’ travel costs
• Link worker coordination and response: connect health workers in far out areas and those disconnected by infrastructure from hospitals, clinics and the city’s main resources, Link worker-to-Link worker communication and group mobilization, Link worker status (solidify the link workers’ role as legitimate healthcare representatives in their villages), link worker accountability and transparency (the number of text messages sent and the price of them can be tracked using the FrontlineSMS technology, ensuring proper use of the cell phones we distribute for healthcare concerns).
• Connect patients: facilitate easier access to outreach/support groups: connect people who may be suffering from similar problems, integrating connectivity into HIV counseling

We believe a FrontlineSMS-based system will work because similar solutions have been successfully implemented in other developing countries and the technology is highly flexible and adaptable to local and infrastructure and needs. Overall, the technology will result in a net reduction in organization costs to rural clinics that heavily utilize link workers. Considering the fact that this project only requires a central computer hub/server (with a GSM modem and SIM card that provides the number to which field workers send SMS text messages) and cell phones, the project is highly mobile. The technology is simple and user friendly which makes it very easy to implement. It can be easily adapted to the Sandbox, depending on identified needs and health care infrastructure. It requires only finding local partners to help implement it and become the foundations for its sustainable continuation once the Global Impact Volunteers leave India.


Here is an article from USC's student newspaper, The Daily Trojan, which overviews the project briefly, along with the two other projects that are being spearheaded by additional Global Impact groups.

Thank you for reading.

And please, always remember:
"The moment one definitely commits oneself, then providence moves too. Whatever you can do or dream you can do, begin it. Boldness has genius, power and magic in it. Begin it now."-
Johann Wolfgang Goethe

~Lena

First member abroad...

First blog from abroad! I'm at Singapore airport being diligent and taking care of Global Impact business at 3 am! =) See everyone soon in Hubli!