A Summer in Review

Eight weeks ago, we started off as two organisations working on four projects and over the course of thirty-five working days, we end as a team – one team united in the shared commitment to deliver an equitable, prosperous, and sustainable future for all. There certainly have been challenges – it has at times been difficult, demanding, and draining. And while it might not have always seemed or felt this way, as we finish and reflect, it has without a doubt been an immensely rewarding summer.

Over our thirty-five project days:

  • Our Entrepreneurship Project ran nine seminars and one network event which had nearly fifty participants
  • Our Health Project ran three workshops in two schools on four different topics which all aimed to increase awareness of sexual and reproductive health amongst school girls
  • Our Education Project ran eight KompyutHer sessions which helped fourteen young women enhance their businesses and
  • Our WaSH Project connected twenty-one latrines to our simplified sewerage networks to provide access to safe sanitation for more than two hundred people in the informal settlement of Vingunguti.

And this is only part of what we’ve been able to accomplish this summer.

On behalf of CDI’s Executive Committee, I thank you all for doing a part – your part. Thank you to our volunteers, our Trustees, our partners, our donors, and our supporters – thank you for believing in us and in our work as we endeavour to re-imagine the world. I am proud of how far we have come and all that we have been able to do. But this doesn’t mean that we are done and that there isn’t more left to do. Your commitment begins again here and now. This is our charge to you all: (Continue to) Do your part as the hope of tomorrow and as the promise of today.

By Peter Lee FRAI, FRGS, FCPS Deputy Director 2018/19

Peter is an MPhil candidate in Social Anthropology at Corpus Christi College.

What the internet can’t teach you – realities of working on the ground, and the importance of learning from Tanzanian counterparts

In purely numerical terms, I reckon I’m a prime contender for qualifying as CDI’s Most Keen Volunteer 2019. As we come back to start work on the CDI and KITE projects after our mid-trip break, I’ve already been in Tanzania for over a month, and in East Africa for a good six weeks. Owing to the logistics of timing a backpacking holiday in neighbouring Kenya (as well as a touch of incompetence on my part about dates!), I arrived the day before the CDI committee, with around ten days to spare before the other volunteers landed. As the Director, Deputy Director Project Directors and Treasurer busied themselves with the necessary meetings and logistical arrangements before everything got properly underway, I found myself with quite a bit of time on my hands. This was despite my best efforts – even after pootling around the local markets, killing some time on one of the most beautiful beaches I’ve ever seen, and getting to grips with some rudimentary Swahili grammar, I was still at something of a loose end! So I decided to get stuck in to a bit of preparatory reading. The focus of the Health Project this year is on raising awareness of sexual and reproductive health among youth in Dar es Salaam, which, as the resources I found on the internet quickly made clear, is an area in which there is significant scope for awareness to be raised, myths dispelled, and services made more readily available. I learnt about how sexual and reproductive health fits into a positive, holistic understanding of health, as a universal human right, and about the specific barriers to the realisation of this right in the Tanzanian context.

And so it was that, at the first meeting of the Health Team, I came armed with a mental list of what I took to be our most urgent priorities, the most efficacious ways of tackling the issues at hand. But of course, it didn’t take long to realise that this theoretical, rights-based approach to interventions couldn’t simply be copy-and-pasted onto the context we were dealing with. From day one, my Tanzanian counterparts helped me to realise that we had to work within the realities of the Tanzanian situation, and that meant adapting some of the goals and tactics I had identified. When I suggested partnering with companies and stakeholders who would be willing to supply us with contraceptives to hand out to students, my colleagues responded with a definite no. ‘We can’t just hand out condoms in schools!’ they told me. ‘The parents would be horrified, and we’d never be invited back!’ Certainly, this has sometimes proved frustrating: how can we make the most necessary, impactful changes if we’re barred from delivering practical advice and resources in certain areas? Isn’t it precisely these taboos, this reticence towards discussion, that is what we’re trying to change? But as time goes on, the more I realise the importance of working within the framework in which we find ourselves, of taking small steps to tackle issues that are within our reach, without jumping the gun, jeopardising our work by provoking negative responses from the community. To do otherwise, to focus on the bigger picture and try to completely redraft the society we’re working in, would be utterly counterproductive. And let’s not forget, when we’re talking about sexual health, we’re dealing with areas that are pricklier than most, more likely to provoke strong feelings and sensibilities, and to challenge deep-seated beliefs. We, as volunteers from Cambridge and hence outsiders, are all relying on our Tanzanian colleagues to help us to negotiate these views with sensitivity, to navigate the realities of the cultural and social situation and deliver an impact that is both meaningful and acceptable.

Knowledge of the local context has also repeatedly been invaluable in other ways. When it comes to logistical matters, for instance, to the day-to-day practicalities of operating the project, some understanding about how things function in the country is indispensable. I personally, when faced with the conundrum of how actually to set up a workshop in schools, would have drawn a blank, scratched my head and perhaps fired off a few tentative emails, which would almost certainly have been ignored. But fortunately, the KITE volunteers in my team were much more clued up; they wasted little time in making sure we had the documents we needed, then jumping on a bus and heading off to ask the appropriate schools in person. The headteachers were more than happy to speak to us, and mostly proved very co-operative, readily inviting us to work with their students. This knowledge of how to open the necessary doors has served us well on many occasions: for example, I was amazed when I learned that our team’s publicity manager had somehow secured a spot to talk about the project live on morning television, and had connected more than hundred local youths in a WhatsApp group to start discussing the issues we’re focusing on. It’s a kind of know-how that would take me years to acquire, but that is vital in moving forward the pace of our project’s activities.

All in all, my weeks volunteering with CDI thus far have been a fascinating, and at times intense, learning process. Much of this has been about learning to view the theoretical principles and guidelines in new ways, through eyes more attuned to the intricacies and sensitivities of cultural context. As I move on to a postgraduate course in Development Studies, I hope to deepen my theoretical, academic knowledge of key issues in the field – but this more practical, pragmatic understanding of how development work unfolds is one that I will not leave behind. I now realise the value of reconciling both approaches, combining cognizance of certain contextual realities with a broader, more long-term view of the universal goals towards which we are working. And for that I will remain indebted to these experiences working in Tanzania, and to all the colleagues and friends with whom I have shared them.

By Kitty Chevallier, Health Project Volunteer 2018/19
Kitty is a fourth-year student studying Asian and Middle Eastern Studies (AMES) at Emmanuel College.

A Day in the Life of a Health M&E Volunteer

Welcome to the Day in the Life series, where you can get to know the volunteers and what they do every day in a more informal way!

 

My name is Katherine Wong, the Monitoring and Evaluation Officer of Health Team. I decided to volunteer with CDI because I wanted to gain some fieldwork and real-life experience on how to conduct research. As a psychology student, it is very difficult for us to apply what we learn in university to real life, and I think CDI provides me with a unique opportunity to do so. I also enjoy the process of working on a project from scratch, follow it through and evaluate the impact of our work at the end of the summer. I think this will be a challenging yet rewarding journey, I am looking forward to the things we could achieve as a team!

 

8:30 – Wakeup / Breakfast – I usually skip breakfast or have a few Digestives before heading out for work. (Totally not because I wake up super late every morning because I value sleep over everything.) When I do have breakfast at the canteen, this is what it looks like, plus some Nutella which my friends kindly share with me.

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9:00 – Work time!

When I’m at the classroom, I usually have a cup of tea or a cup of coffee to kick-start my day. The plan of my day really depends on the amount of work I have, but for today, it looks something like this:

  • Complete M&E a day in the life blog post (Top priority!!!)
  • Emotional well-being student baseline survey data analysis
  • Coding for emotional well-being teacher interviews #1 – #6
  • Plan and design sampling method for NCDs workshop, Then speak to the central M&E officer, Adi.   

 

10.00 – Emotional well-being student baseline survey data analysis

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There are currently two ongoing initiatives within the health team: emotional well-being and non-communicable diseases. For the emotional well-being project, we are collaborating with the Education team. I have been working closely with their M&E Officer for the past couple of weeks. Last week, we conducted our baseline survey with students from two different secondary school. We collected responses from a total of 114 students, and the survey consists of 18 questions, which means there are A LOT things to go through.

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You can probably tell from that pile of surveys, we are dealing with a relatively large set of data right here. Emotional well-being is a topic I am personally very passionate about, so this is very exciting for me!

11:00 – Emotional well-being data analysis with Simina

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It would be pretty tough if I had to go through all the surveys alone, so here is Simina – the M&E officer from the Education team, and together we have successfully finished analysing all the surveys! Yay!

Big shout-out to Simina for all her hard work despite the immense workload she is facing and thank you everyone on both the Health and Education team (Priyanka, Fatmah, Oliva, Florida, Nasma, Irene, Mahamudi) for going onsite to conduct these surveys and interviews. Also, a token of gratitude for all the Kite volunteers and our counterparts for translating the question and responses from Swahili to English, also for communicating with the schools – without you guys, none of this would have been possible.

 

13:00 – LUNCH TIME (WHOOP WHOOP!!!)

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After a morning of hard work, finally it’s FOOD TIME!!! I usually have wali (rice) and makange (beef), alongside with some oranges and banana. Sometime if we’re lucky, we get spinach and even some maharage (beans) on the side! It is always nice to sit and chill out with my team and friends from other projects, especially hearing about what others are working on at the moment. Occasionally, we will have weird, philosophical discussion such as the nature of chicken as a continuous verse a discrete concept. Other times, we would have a heated debate about whether the beans they serve are peanuts or not.

 

14:00 – Back to work! Coding teacher interviews

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After lunch, I’ll be working on coding the teacher interviews from the schools we surveyed. I learned about qualitative analysis at university, but this is my first time actually doing it myself. In the emotional well-being initiative, all the qualitative data will be analysed using a bottom-up/data-driven approach. As there are no prior studies on student mental health in Tanzania, this makes it difficult for us to form theories prior to research.

 

17:30 – End of work!

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We usually have our daily briefing at 16:30, where we come together as a team and update each other on the things that we have been working on during the day, plus our progress so far. Here is a group photo of the health team!

 

19:30 – DINNER TIME

I usually have street food at night, and whenever I have mishkaki (meat skewers), I often have to protect my food from the hungry cats in the canteen…

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23:00 – Bedtime!!

Today has been a very productive day – lot of work was completed, but I am exhausted. I will be working on more data analysis and drafting more surveys / interview question tomorrow. My days are generally quite different, as they really depends on the progress of the project. Some tasks might take days to finish, while others can be done within the hour. Although many may say that data analysis and drafting surveys seems to be quite dull, personally I find this quite exciting. It is exactly what I was hoping to do when I decided to volunteer with CDI. Through working on sensitive topics such as mental health and NCDs,  CDI also made me become more mindful of cultural differences between different countries.

Going through some of the responses we have collected from the surveys and interviews, there is often a sense of helplessness within me, but also an intense feeling of wanting to do more for the locals. Stepping back for a second, two months is a very short period and there are only a limited number of things which can be achieved. Yet in the face of this realisation, I still want to make the most of this summer, and hopefully, create some positive changes for various communities.

Let’s end this blog post on a lighter note, here is a cute kitten outside my room, AWWW!!

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Empowerment and Education: Advancing Women’s Health

This summer, the Health Project have been focussing their work on several different lines of research. Charlie Calver (second right), one of the Health Project Volunteers, here details how their examination into the state of women’s health in Tanzania has been translated into a series of workshops, with the aim of educating and empowering the local community.

Women shoulder a disproportionately large share of disease within Tanzania, with gender inequity, neglected maternal health, and sexual-based violence all acting as major obstacles to good health. As of 2014, Tanzania had failed to achieve the 5th MDG (Millennium Development Goals): to reduce the maternal mortality ratio by 75% between 1990 and 2015.[1] Moreover, although Tanzania was on track to achieve MDG 3 (gender equality in primary education) in 2014, it lags behind in the Gender Inequality Index, ranking 125 out of 155 countries.[2]

Whilst some progress has been made towards improving women’s health, maternal mortality remains high: there were 398 deaths per 100,000 births in 2015, with only 49% of births attended to by a skilled personnel.[3] UTIs, sexually transmitted diseases, access to contraception, and various forms of cancer also continue to be pressing issues for many Tanzanian women, and, as such, women’s healthcare stands out as a clear matter that requires evaluation, improvement, and investment.

In response, CDI’s Health Project decided to facilitate a series of Women’s Health Workshops within the informal settlement of Vingunguti in Dar es Salaam. Initially, we conducted focus groups with Community Health Workers, to ensure that our proposed workshops would effectively meet the needs of the community. The main issues identified primarily revolved around UTIs, contraception, breast and cervical cancer, and maternal health. The interviews which were later conducted at the Buguruni Health Centre confirmed these findings, therefore providing a clear curriculum around which to structure the workshops.

Working in collaboration with Childbirth Survival International (CSI), CDI successfully delivered the first of these workshops last Saturday (26th August), with two more to follow over the next couple of weeks. Over 30 women attended and reported positive feedback, particularly stating how pleased they were that international organisations were taking an active interest in their health, wellbeing and empowerment. Although the enthusiastic and engaging responses of the participants were a positive indication of the workshop’s success, they also indicate the lack of healthcare provision in settlements like Vingunguti, and the need for an established educational programme.

Good health is both a cause and a consequence of socioeconomic development. Although only part of a wider set of amelioration initiatives that need to be taken, CDI are focussing upon empowerment and education as methods with which to advance the quality of women’s health in Dar es Salaam. Women can be major agents for change, but are routinely denied access to the most basic tenets of information regarding their own health. Until such deficiencies are accounted for, women will continue to bear the brunt of weak health systems and inadequate infrastructures. As a WHO report into Tanzanian women’s health concluded, ‘the preferences and experiences of women should […] inform health system design.’[4] Through the Health Project’s workshops, CDI hopes to make a positive change that will liberate women, enabling them to take an active stance in their bodily choices and decisions.

[1] http://www.aho.afro.who.int/profiles_information/images/c/c8/Tanzania-Statistical_Factsheet.pdf
[2] http://www.tz.undp.org/content/tanzania/en/home/countryinfo/
[3] http://www.aho.afro.who.int/profiles_information/images/c/c8/Tanzania-Statistical_Factsheet.pdf
[4] http://www.who.int/bulletin/volumes/92/4/13-126417/en/

Health Project – A Brief Intro to Community Engagement

Our fifth video this summer looks at the Health Project’s focus upon community engagement.

In addition to the research they have been conducting, the team have been running surveys and workshops in the informal settlement of Vingunguti, in order to raise awareness about the most common diseases in this community, and the methods of prevention against them, particularly in the area of women’s health.

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Health Project – A Brief Intro to Malaria Diagnostics

Our next video looks at one area of research being conducted by the Health Project.

In collaboration with WaterScope (a Cambridge based organisation) and STICLab (a maker-space in Dar es Salaam), CDI are conducting field research upon a new 3D-printed microscope in order to bring cheaper, easier and more accurate malaria diagnosis to local communities in Tanzania.

If you are interested in working with CDI, then please see http://www.cambridgedevelopment.org/get-involved – committee applications are NOW OPEN!

Dual Communication: Bringing Together Community Life and the Healthcare System

As part of the Innovation Team on CDI’s Health Project, Lisa Schomerus (left) is one of the volunteers researching the current healthcare system in Dar es Salaam, and engaging with members of the community to ascertain how CDI can best meet the demands of a growing population. Here, she highlights the importance of how, in seeking to improve the accessibility and affordability of healthcare products, the Health Project must carefully consider the balance between the current healthcare system and the habits and needs of the community.

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Vingunguti is an informal settlement in Dar es Salaam, home to more than 100,000 inhabitants. Walking around the streets, the population demographic is dominated by young children, and the main streets are busy with street vendors and people running errands.

Conversing with local residents and healthcare providers the need to facilitate change for the healthcare provision in Vingunguti becomes clearer. Government publications are somewhat limited in providing a full picture of the problems faced by the community on a day-to-day basis. Our role for the past two weeks, therefore, has been to bridge this gap between what the healthcare delivery system should look like in practice, and what, in reality, we have found to be the current national standards.

So far, the main problems we have identified revolve around the poor availability of health-promoting products and services that are affordable. For instance, locals often bypass the healthcare system when they are ill due to the expense of diagnosis, and instead obtain medication from street vendors, without the need of a prescription. These street vendors are usually unqualified members of the public and sell items such as electronic accessories and peanut snacks along with these drugs.

Added to this, many patients tend to visit health centres only at the latter stages of a disease when other treatments – including traditional practices or consultations with witch doctors – have failed. Moreover, these health centres and other healthcare providers are overflowing with capacity; even if the typical habits of the community were to change, the provision would struggle to accommodate them.

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Yet, as a team, it is the community spirit and cohesion of Vingunguti that has struck us most. It is this which will lend itself as indispensable if we are, in cooperation with the locals, to make a sustainable impact on the healthcare system.

Last year, the Health Project saw the implementation of Afya Yetu, a business model which looks to sell affordable healthcare products via under-utilized healthcare workers (whose role it is to educate and advise residents on health matters). Whilst there are a lot of strengths to this model, we are looking to expand a product-range that better meets the demands of the community.

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Over the last two weeks, therefore, we have carried out two major pieces of primary research. Firstly, we approached the hospitals, dispensaries, pharmacies and health centres around Vingunguti to understand better the systems in place and the demographic of the population who use their services. Secondly, we have been conducting surveys in collaboration with the WaSH Project to assess the health-related habits and knowledge of the Vingunguti residents. As we now begin the process of evaluating our findings, we hope to establish the impact of the CDI-implemented latrine networks, which serve approximately 450 people, and to what extent this has improved the standards of sanitation in the community.

Adjusting the Afya Yetu model to better improve health outcomes in Vingunguti – and for communities like Vingunguti, in the future – will not be straightforward. For one thing, each community is unique and uniquely challenging. In addition, the role of Afya Yetu in developing better health outcomes is nuanced, and can only be informed by research and experience. Continuing to engage with both the pre-existing healthcare systems in Dar es Salaam as well as community members themselves is one way of achieving this. It is through maintaining this dual communication that we hope to bridge the current gap between the established structures of healthcare and the reality of daily life in the informal settlements of Dar es Salaam.