Improving Communication in the Congo

The cell phone revolution in sub-Saharan Africa is often taken for granted, yet in reality many areas still lack telecommunications infrastructure. The DRC has one of the lowest mobile phone penetration rates in the world, negatively impacting multiple sectors. We have been tackling this problem since 2012, when we began installing High Frequency (HF) radios in health centers in rural Moba Territory. To date, the LTFHC has installed 11 HF radio with Electronic Medical Record (EMR) systems and 29 stand-alone HF radios, impacting over 325,000 people.

HF radios continue to be a robust stand-alone solution to fragmented communications infrastructure in the Lake Tanganyika Basin, and we repeatedly see evidence of an improved reporting and feedback loop between the Ministry of Health (MOH) and rural health centers as a result of our radios. In South Kivu, DRC, for example, some of the most rural health centers have the highest reporting rates because calling in reports using the HF radio is so simple and effective. Health centers are also better able to communicate with each other: Lusenda Health Center, responsible for the Burundian refugee population in Lusenda camp (now overflowing beyond capacity at 20,000 people), uses their LTFHC-supplied radio to speak regularly with the Nundu Reference Hospital. This allows for much smoother management of the center, ensures the reference hospital is adequately prepared for incoming refugee patients, and provides up to date information to other partners managing the refugee crisis.

Given the increasingly troubling security situation in the eastern DRC, a robust radio communications system will also be important for basic safety and community resilience. Though mobile networks continue to grow in the region, it is a slow process, the service is unreliable, and the data component is either unavailable or prohibitively expensive.

We are now preparing to pilot a tablet-based EMR application in ten health centers in Tanganyika Province, DRC early next year. At the request of the Tanganyika MOH, this exciting next iteration of the program focuses on prenatal data collection. We are, however, designing the software to accommodate other activities and indicators at the health center level in the future, such as delivery services, childhood illnesses, and malaria diagnostics and treatment. While there are many “m-health” applications in the global healthcare space, few are designed and built in partnership with exactly the people the technology is intended to serve. Our tablet app is thus a powerful example of what differentiates us in our approach.

We are eager to share further updates on this cornerstone program in 2017.

Donate today to support the LTFHC’s continued healthcare infrastructure building in the Lake Tanganyika Basin.

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Reproductive Health Access in the Lake Tanganyika Basin

In the Lake Tanganyika Basin, accessing reproductive health care is a challenge. Impassable roads, poor communications infrastructure, broken supply chains to rural health centers, and extreme poverty all contribute to high birthrates, early childbearing, and exceptionally high maternal-fetal morbidity and mortality.

Path to Buma Health Center-- imagine walking here while in labor!

Path to Buma Health Center, DRC– imagine walking here while in labor!

The LTFHC is committed to making contraception accessible to empower local women, save lives, and prevent disease. In 2015 and 2016, we partnered with Hivos International and local Ministry of Health (MOH) officials to provide family planning services for patients, training for health care workers and community education in Nkasi and Uvinza Districts, Tanzania.

In summary, this project achieved:

  • Public information – Over 100,000 people were reached with medically accurate family planning information through a local radio program and two national newspaper articles.
  • Contraceptive implants – Over 1,000 women, previously without access to contraception, received implantable long-lasting reversible contraceptives.
  • Condom distribution – 10,000 condoms were distributed to a high degree of demand in all communities.
  • Counseling services – Over 4,000 women received one-on-one family planning counseling.

    mariettaeducatingpatientsinkatete-smaller

    Counseling patients in Katete, Tanzania

  • Education – Nearly 2,000 community members from Nkasi and Uvinza Districts were engaged on issues regarding women’s health, and sensitized to family planning with information through educational festivals.
  •  Health care worker training – 22 rural health care workers from 18 villages received comprehensive family planning training, covering topics from correct pelvic exam techniques, to lessons in counseling reproductive health patients and inserting implantable contraceptives.
  • Supply chain improvement  the LTFHC assisted in the coordination and normalization of ordering processes of essential health center supplies with the MOH and Medical Stores Department (MSD).

The combined activities of this two-year program impacted over 260,000 people.

Community festival at Ilagala

Community festival at Ilagala

The communities involved expressed great satisfaction with the work, and the health care workers we trained voiced their happiness with the curriculum, and their excitement about putting their new knowledge to work in their home villages. Throughout the program, we had full support from the Ministry of Health and local authorities.

Demand for similar services in the DRC is high. It is our hope that we can expand this successful initiative to rural communities in the DRC in the future.

P.S. In case you missed it, check out our video overview of Phase 1 of this program last year

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How We’re Addressing Malaria in the Lake Tanganyika Basin

Fishing boats filled with bed nets line Lake Tanganyika

Fishing boats filled with bed nets line Lake Tanganyika

Malaria is the number one cause of death in the Lake Tanganyika Basin, and the need for appropriate solutions to combat this disease couldn’t be more pressing. Over the past two years, we have begun to shed light on the complexities of malaria prevention in this region, and the clear need for alternative and innovative solutions. “Business as usual” malaria eradication is failing this part of the world, all the more staggering considering 40% of all worldwide malaria deaths (78% of which are of children under 5) occur in Nigeria and the DRC alone.

Briefing Relais Communautaires before data collection in Kasenga Etat

Briefing Relais Communautaires before data collection in a Health Area in Uvira

For the past several weeks, our teams have been collecting extensive household-level data in South Kivu, DRC, covering indicators on health, socio-economics, fisheries, security, and malaria control, in particular the use and effectiveness of bed nets. This is a challenging and essential exercise that encapsulates the LTFHC’s unique approach of data-driven, boots on the ground interventions.

Over a year ago, we established a cross-sectoral study group of experts from The Chicago Booth School of Business, Tufts University, Harvard Kennedy School of Government, and impl project, combining expertise on behavioral economics, environmental economics, parasitology, field data collection and analysis, and public health. Working with this team, we designed a set of comprehensive surveys.

CLAs head out for data collection

CLAs head out for data collection

We invested deeply in our field staff by conducting intensive training pre-deployment, covering everything from understanding the goals and challenges of academically rigorous data collection, to empathic community engagement, and the ethical treatment of personal information.

Road conditions in the Eastern DRC are a significant hindrance to our operations

Road conditions in the Eastern DRC are a significant hindrance to all who operate on the ground in this region

Data collection has been a priority for the LTFHC for years. Although operationally intense, rigorously gathered information helps us and the world to understand both the specific problems and practices surrounding malaria control, as well as the complex landscape in which they arise. Without this information we cannot begin to design and implement appropriate interventions, and will continue to see unintended (and potentially negative) consequences of old and contextually ineffective methods.

The CLAs are dusty after a long day's work!

The CLAs are dusty after a long day’s work!

We are proud of our team and their commitment to this arduous work, and bolstered by our strong relationships with the local community. Even in the face of complex challenges including malaria, lack of WASH, food insecurity, growing physical insecurity and local violent dynamics, we are nonetheless confident that there is a path forward to fewer malaria deaths.

Despite what we are learning and sharing about the magnitude of this problem, the international community has yet to dedicate the necessary resources to truly understand and reduce malaria incidence and death in highly endemic areas. Together with partners in academia, public health, malaria innovation and the private sector, we can all hopefully come together to start deploying a wider toolkit for this problem. Only by channeling our energy into this preliminary process can we hope to develop new and better interventions that are truly innovative and community-appropriate.

Amy and Anderson speak to fishermen on Lake Tanganyika about local fishing practices

Amy and Anderson speak to fishermen on Lake Tanganyika about local fishing practices

We hope you will consider investing in our capacity to continue this exercise– we could not do this work without all of you. We look forward to keeping you involved in this fascinating and impactful journey as it progresses.

In case you missed it, read more about malaria bed net misuse from the New York Times (our initial data from Lake Tanganyika is highlighted).

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Big Plans for 2016

 

After an incredibly busy 2015, the LTFHC/WAVE is poised to launch into an impactful 2016 with a series of exciting programs, from direct service provision to critical infrastructure improvements affecting communities in the Lake Tanganyika Basin, and beyond:

 

Innovation in Malaria Control: In January, we will begin the first phase of our extensive research into bed net misuse and alternative vector control methods in water-based communities– a scoping exercise to gather extensive cross-sectoral baseline data that includes public health, socio-economic, fisheries, and environmental indicators in at least 65 villages along the Congolese coast of Lake Tanganyika.

Access Lake Tanganyika: Facilitated by the LTFHC/WAVE and supported by British Telecom and other telecom partners, this exciting public-private partnership to bring a comprehensive mobile network to the Lake Tanganyika Basin plans to conduct its first partners’ planning meeting in conjunction with the GSMA Mobile World Conference in February in Barcelona.

Continued Radio Network Expansion: We will expand our HF radio network to 18 additional remote health centers in the DRC, impacting an estimated 150,000 people where needs are most acute. We also have plans to develop and pilot a user-friendly medical informatics tablet application in cooperation with our tech partners.

Extending Family Planning to Kigoma Region: Year Two of our comprehensive contraception program, funded by Hivos International, will support family planning education, health care worker training, and long- and short-term contraception distribution in rural Kigoma, Tanzania.

Water Purification: Supported by P&G, we will begin a substantial distribution of water purification materials to remote areas in the DRC. These efforts will coincide with other LTFHC water, sanitation, and hygiene programming.

Water-based Health Care: Have We Missed the Boat? We will release our next white paper in 2016. This paper will provide an overview of issues facing the hundreds of millions of people who live near water and highlight innovative approaches to make the case for a new model of health care for littoral and coastal communities.

If you have not yet given in 2015, please consider a U.S. or U.K tax-deductible donation today to help us carry out these activities.

Thank you again for your support. Cheers to 2016!

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A review of our accomplishments in 2015

The Lake Tanganyika Floating Health Clinic (LTFHC)/WAVE has had an incredibly important year, both in terms of our program implementation and in elevating awareness of what is at stake in the Lake Tanganyika Basin.

Your support allows us to continue to advocate for an extremely remote yet geopolitically crucial part of the world where no one else is comprehensively working, and whose success—or failure—has lasting consequences for over 12 million people, the entire region, and the world as a whole.

We hope you will consider a year-end gift to enable us to continue this important work.

Here’s a quick snapshot of what we’ve been up to in 2015:

Innovation in Malaria Control

Women use bed nets to fish fry on the shores of Lake Tanganyika. We need further study to understand the full impact of this practiceBuilding upon our previous research (featured in the New York Times in January), this year we assembled a diverse study group and began preparations to further investigate bed net misuse in the Lake Tanganyika Basin. Our team has been busy preparing for the first phase of this research, a scoping exercise to gather extensive cross-sectoral baseline data that includes public health, socio-economic, fisheries, and environmental indicators in at least 65 villages along the Congolese coast of Lake Tanganyika.

Communications Network and Electronic Medical Record Expansion and R&D

The LTFHC has expanded our radio installation program to reach 200,000 people, and we are still seeing dramatic benefits. For example, on-time weekly reporting from Nyemba Health Zone to the DRC Ministry of Health increased from 26% in 2014 to 79% in the first six months of 2015 for the facilities where we installed HF radios. Watch a short film detailing this initiative>>

Comprehensive family planning outreach in Tanzania

Health care worker training in Kirando, Tanzania

Health care worker training

In May, the LTFHC completed phase 1 of a family planning program in Rukwa, Tanzania. The combined activities of this outreach, including training rural health care workers in family planning topics and insertion of implants and IUDs, impacted over 90,000 people. Watch a video featuring our activities>>

Data collection on the remote Ubwari Peninsula

In early 2015, our team traveled to the Ubwari peninsula in the DRC – home to 100,000 people with no road, phone, or access to services—to perform technical and epidemiological surveys and have discussions with health center staff and community members to help inform appropriate program design. See photos from this outreach>>

WAVE’s leadership during the Burundi refugee crisis

A smapshot from Kagunga regugee campAs one of the few organizations with a consistent presence in the Lake Tanganyika Basin, we have delivered on the ground feedback for governmental and multi-lateral stakeholders during this tumultuous time. Through our local office in Kigoma, Tanzania, we have also provided housing and transport for other organizations actively working with Burundian refugees. We continue to work closely with authorities monitoring the situation in Burundi— please contact us if you would like to receive more information.

White Paper on Water-based Health Care

This year we released the executive summary of our next white paper: “Water-based Health Care- Have We Missed the Boat?” Our purpose in publishing this paper is to introduce the concept of “water-based communities” and the unique systems design thinking that they require. Read the executive summary>>

Access Lake Tanganyika

The LTFHC/WAVE is facilitating a public-private partnership between the Lake Tanganyika Authority, British Telecom, and other telecom partners to bring a comprehensive mobile network to the Lake Tanganyika Basin. This fundamental infrastructure will dramatically improve service delivery across sector to the over 12 million people living in the Lake Tanganyika Basin.

Our small, efficient team continues to punch far above our weight, providing on-the-ground tangible improvements to local health care capacity in the Lake Tanganyika Basin, while simultaneously beginning to catalyze other stakeholders towards more effective and durable interventions in this region.

Thank you again. Without you, this work would simply not be possible.

 

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Video Blog from the Field: Family Planning Outreach

We have recently completed phase one of a comprehensive family planning project in Rukwa, Tanzania, funded by Hivos International. Watch our short video clip to learn more about these activities, which impacted over 90,000 people:

The LTFHC/WAVE is committed to addressing high birthrate in the Lake Tanganyika Basin through accessible contraception, not only as a means of empowering local women, but also to save lives and prevent disease. To read more about the activities and outcomes of this project, please visit our website. We are proud of the tremendous impact we have been able to achieve using limited resources and look forward to expanding this program to other regions in Tanzania next year.

Special thanks to DKT Tanzania and Femina HIP for their support and participation in this project.

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HuffPo Canada interviews Dr. Amy Lehman

Photo credit Gene Driskell

Amy at Ideacity. Photo credit: Gene Driskell

LTFHC Founder and CEO Dr. Amy Lehman was interviewed by the Huffington Post while at Ideacity in Toronto last month. Read more on her thoughts about “magic bullet” solutions and her general approach to international aid at HuffPo Canada.

 

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Our Response to the Burundi Crisis Featured on Wilson Center Blog

Responding to insecurity and crises is built into our organizational DNA. Read more about the ‪Burundi‬ crisis and how we’re responding on the Wilson Center Environmental Change and Security Program’s Blog

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A Traveler’s Take on Lake Tanganyika (featuring LTFHC’s contraceptive outreach)

Writer Henry Eliot spent some time with our programmatic team during the Hivos Contraceptive Outreach in May. Read his account of the experience featured in Newsweek Europe >>

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Amy Lehman Speaks at Ideacity 2015

LTFHC Founder & CEO Dr. Amy Lehman was a featured speaker at this year’s Ideacity Conference, “Canada’s Premier Meeting of the Minds”. Watch her speak on why aid and development work is so hard, bed net misuse and unintended consequences, and other hard questions. Don’t miss this great talk!

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