Greetings from rain-soaked Munsieville! Over the last two weeks, several storms have doused the Gauteng province, but the rain is necessary to turn the landscape green again and help usher in spring. While the intensity of the thunderstorms is unlike anything I have previously experienced, I am not letting the rain put a damper on my work in Munsieville.

Last week Courtney and I led part two of our surveying and research methods class, and we taught the class how to format and administer a survey. We included lessons on the layout and visual design of the survey, how to format questions and avoid bias, and the different methods used to administer questionnaires and interviews. There were eleven people in attendance, and everyone seemed engaged in the lessons. The best part of the class was teaching about interviewing techniques and conducting mock interviews to demonstrate the process. Courtney and I exemplified both a good and bad way to interview someone and then asked the class to name some positive and negative aspects of our demonstration. Next, Courtney and I paired up everyone in the class, gave them a mock interview scenario, and had them act out a good and bad interview based on what they had just learned. Everyone demonstrated understanding of what Courtney and I were teaching. All the groups really expressed their creativity, and I was pleased that the class was so engaged in the activity.

Courtney and I also got to conduct two Garden Soxx® training classes in Mshenguville. Because Safira had some trouble contacting some of the families, the training had to be rescheduled several times. It was exciting to finally have not one, but two Garden Soxx® classes in the community. After so much interest was shown in the project at the first class, Safira, Courtney, and I decided that a second class would be beneficial so that more people could learn about the Garden Soxx® project. Because Courtney and I had already created our own Garden Soxx® sock and knew how to assemble it, we went to the first class and demonstrated how to create the sock. Once we did the demonstration, we let the ladies there work together to assemble a new sock. At the second class, Courtney and I let the ladies from the first class teach the new members who were at the second class, and the ladies created three new socks together. We felt this was a good way to encourage the women of Mshenguville to take ownership of the project because they are now the ones instructing others on sock assembly. I am excited about the future of this project, and I think that it will be sustainable in the community of Mshenguville.

I am also happy to report that some of the ladies at the Children’s Embassy are starting to use the vegetables from the keyhole garden to made salads for the community! Our preceptor said she enjoyed a tasty salad of vegetables grown from our garden and commended Courtney and me on our work with both the keyhole garden and the Garden Soxx®. It is exciting to get to see the bountiful results of a small initiative that was started at the beginning of my internship.

To conclude this post, I want to mention that one of the highlights of this reporting period was getting to spend an afternoon with Mama Gloria, the sister of Archbishop Desmond Tutu. Desmond Tutu is the patron of The Thoughtful Path and a respected social rights activist who has earned several awards and recognitions for his work. His sister lives in Munsieville, just down the street from the Children’s Embassy.  It was a pleasure to spend the afternoon with Mama Gloria and hear her talk about her daily life and the people in Munsieville. She is truly an inspiring lady, and I am fortunate to have had the chance to meet her! 

Originally published in The Tennessean, May 3, 2014

When we married in December 2007, we knew we wanted to enjoy the adventure of marriage together for a while before having children. So, we concocted a whimsical battle cry: “Baby Free Until 2013!”

In summer 2013, after thoughtful conversations, we decided to go off birth control. And lo and behold, we quickly became pregnant. The battle cry worked.

As we watch Jena’s belly grow, we realize how fortunate we were, especially as some of our closest friends and family have not had nearly as much ease. We also recognize that for many, contraceptive access and the ability to time pregnancy are not universal.

You see, we work for two organizations that provide health care to HIV-infected and affected people in Africa, and we have been given a unique window into the lives of many girls, women and men in countries like Kenya, Uganda, Zambia, Ethiopia, Rwanda and Central African Republic. For our friends in that part of the world, the nuanced discussion of family planning is very different than the one we hear in the U.S.

In Lwala, Kenya, 16-20 percent of the adult population is HIV-positive. The Lwala Community Hospital is providing more than 1,000 HIV patients with life-saving medical care. Many of these patients come to us for contraceptive options.

Try to imagine that you are our friend Maurice. You are facing some frightful questions because you are HIV-positive, but your wife, Betty, is not. A nurse explains to you that the hospital is out of condoms, so you must abstain from sex or risk infecting Betty. The nurse says the condom shortage is nationwide and there is nothing she can do.

Imagine that you are our friend Sarah. You are just 13 and a new mother to a premature baby boy named Moses. You have had to drop out of school to care for your new child. You did not plan on getting pregnant, but an older relative forced himself on you while he was drunk. Your parents know about the rape but have decided not to confront the relative and instead blame you. Your circumstance makes you one of the 300 pregnant teens who delivered their babies at Lwala Community Hospital last year.

When you bring Moses in for immunizations, you ask the nurse for birth control pills, but she tells you they are not available to you without parental permission. “How do I avoid getting pregnant again?” you ask.

For us as Americans, these seem like unimaginable predicaments related to contraception — catch-22s with life-altering consequences. But, sadly, these stories are not unique in Africa.

We are Christians, propelled by our faith in a loving and merciful God to do the work we do. Most of the year, we make our home in Tennessee. We are not abortion-rights activists or “lefty liberals.” We understand why some people of faith are hesitant to support increased access to contraceptive choices. But our view has been broadened through our experiences and the many conversations we’ve had with families in Africa.

The nuanced circumstances of couples like Maurice and Betty, or young teenagers like Sarah, cannot be addressed with one-dimensional responses. We must take seriously the complexity and urgency of the dilemma for many around the world. International policies, politics and financing must do more to account for the real predicaments people face.

We believe that families have the right to time their child-rearing; protect themselves against HIV; and pursue healthy, productive and prosperous lives. We believe that teenage girls should be able to avoid unintended pregnancies and the difficult decisions and desperate measures that sometimes follow. And we believe that access to contraception is critical to reducing poverty and promoting health.

As we welcome our newborn baby, we invite you to join us in respectfully broadening the conversation around contraception to include the perspective and urgency of our friends in Africa.

James and Jena Lee Nardella live in Nashville. James is executive director of Lwala Community Alliance, and Jena is co-founder of the nonprofit Blood:Water Mission.

Class, Camp, and Compost.  What do these three things have in common?  They all relate to the work Courtney and I completed last week.  We have been working hard on three different projects, and I am very excited about what we were able to accomplish.  

Our first big project of the week was to teach part one of a surveying and research methods class.  In September, Paul Brooks, the director of Project Hope, visited Munsieville with some Project Hope board members in order to check up on The Thoughtful Path’s operations.  He discussed the importance of community mapping and surveying in order to better understand the Munsieville community.  He stressed the need to get quantifiable survey results so that statistics could be interpreted and the needs of the people addressed. After hearing this Courtney and I talked to our preceptor and suggested putting together a three-part research methods class that would help teach volunteers and workers from The Thoughtful Path how to design their own surveys and interpret the results. In this way they would be better equipped to assess the needs of the community.  We presented the first class on Tuesday of last week.  There were nine people in attendance, including our preceptor, and I am happy to report that it was a great success!

In this first class Courtney and I discussed how to design a survey and covered the different types of surveys, types of survey questions, and emphasized clarity, simplicity, and neutrality in wording of questions.  We also had everyone participate in a group activity in which they had to choose a survey topic, design survey questions that would address that topic, and then explain how they would conduct a survey on that topic.  One lady in the class was so inspiring as she got up to present her group’s work.  She demonstrated understanding of all the topics that Courtney and I had covered in the class and gave an excellent presentation! It was encouraging to see that the first class went well.  Courtney and I have already scheduled the next class for the middle of October and we will be teaching ways to format a survey.

The next big event was participating in a youth camp where Courtney and I taught lessons on exercising and nutrition.  This was an unexpected project, but it turned out to be a pleasant surprise and a lot of fun.  The youth camp was a weeklong event for youth in Munsieville that range in age from approximately 15 to 18 years.  There were 18 participants at the camp and they were learning different life lessons so that they could then teach these lessons to other younger kids in the Munsieville community.  This really is an amazing group of youth and it was so fun to get to spend time with them.  Surprisingly, most of them do not receive any formal health classes in their schools, so they were really listening to the exercise and nutrition lessons that Courtney and I were teaching.

For the exercise class, Courtney and I spoke about the importance of exercise on a daily basis and what happens to the body when it does not get enough regular physical activity. We demonstrated some basic exercises that the youth could do at home without any formal workout equipment.  After doing the various exercises with them, we played a game called The Last Man Standing where Courtney and I called out the different exercises we just taught, and the youth had to continually do them until there was just one person left doing the exercises—the last man (or woman) standing.  This was a lot of fun and it was interesting to see how competitive everyone got with each other.

On Thursday of last week, Courtney and I taught the nutrition class.  This was highly relevant, as most of the youth had never heard about the food pyramid, portion sizes, or the importance of a balanced diet.  Everyone seemed very engaged in the lesson and quite a few questions were asked about diabetes and low-sugar and low-sodium diets.

The final project of last week involved creating our own Garden Soxx® so that Courtney and I could better understand how to create the “sock” once we train the families.  Courtney and I cut the black mesh material, filled it with compost, and tied off the ends of the material to create the “sock.”  We then planted nine starter vegetable plants inside the sock.  This involved cutting holes in the sock and digging away a small hole with our fingers in order for the starter to have a place to grow.  Now that we better understand how to create a proper Garden Soxx® garden, Courtney and I can teach the families how to grow these gardens in their homes in Mshenguville.  The small keyhole garden that Courtney and I planted at the Children’s Embassy at the beginning of our time here is thriving.  It is exciting to see a garden full of leafy green vegetables that once started out as small starter plants.  All the mamas at the Embassy are excited about getting to eat these vegetables in a few more weeks.  I believe that the Garden Soxx® project will be just as successful, if not more so, as people learn to grow their own gardens for themselves.

I remain positive that the actual process of teaching the families and talking to them about the gardening initiative will happen soon.  The training process was supposed to happen last week, but it is now rescheduled for this coming week.  Mama Safira, who walked through Mshenguville with Courtney and me to help us find the houses a couple weeks ago, has had trouble contacting the five families and getting them together to meet.  This actually made me aware of how often I take for granted the ease of communication that is available in the US.  Not everyone in the township has a cell phone, and it is not like Mama Safira can simply e-mail a Google calendar or send an event reminder on Facebook.  She has to go door-to-door and speak with everyone and make the families aware of what we are planning.  Hopefully we can get all the families together soon so that they can start growing their own gardens.

Last week was a busy week of work, but it is exciting to know that Courtney and I are getting things accomplished and making a difference in the Munsieville community.  I look forward to my next report and giving details of further work. 

CSIS Ethiopia blog

In January, we traveled as part of a CSIS delegation to Ethiopia to see the work happening there in their Health Extension Workers program. Because of their leadership focus on advancing maternal health and the healthy timing and specing of pregnancy, contraception use has risen from 15% in 2005 to 29% in 2011. This is a tremendous gain, although there is still a long way to go before every women who wants access to contraception has it.

Watch this video to learn more about the program.

Sarakay

This starts week number four of my internship here in Munsieville, and I cannot believe time is going by this fast!  Last week Courtney and I began work on a big project that I hope will have a lasting positive impact on the people of Munsieville.

As I mentioned in my last post, Courtney and I planted a small vegetable garden.  This served as a pilot to see how the vegetables that were planted would thrive in the climate and sun exposure.  Now that we understand what types of vegetables are appropriate to grow at this time of year and in this climate, we can take our project to the next level with the help of a product called Garden Soxx®.  We are encouraging the women of the community to grow their own vegetable gardens using this product.  Garden Soxx® was developed by a company called Filtrexx International and consists of a black mesh material filled with weed-free compost.  The mesh material can be cut to any desired size, and it creates perfect growing conditions for a garden without requiring a large piece of land or nutrient rich soil.  The compost-filled mesh can be placed anywhere and, with appropriate watering and care, will grow a small garden.  What Courtney and I would ultimately like to see is a community full of these homegrown gardens, with one at every home in Munsieville.

Sarakay Johnson Muncieville

We are piloting this project with five houses in Mshenguville that we think would most benefit from this initiative.  Mshenguville is an informal settlement within Munsieville, and the houses there were selected based on household income and the number of children livingin each home.  On Tuesday and Wednesday of last week, Courtney and I walked through Mshenguville with Safira, one of the ladies working with The Thoughtful Path, so we could find the houses and talk to the families to get them interested in the idea of growing their own gardens.  We are thinking of making the garden growing into a competition so that the families will be encouraged to take care of and look after their gardens.  Ultimately, though, this project is about sustainability and teaching the women to garden for themselves and then going out and teaching their neighbors to do the same.  We had successful home visits in Mshenguville, and this week we will begin gathering the materials for the gardens and teaching the women how to start using their Garden Soxx®. Imagine how great it would be for every family in Munsieville to be growing their own vegetables!

There were some very surreal moments when I could not believe I was actually being invited to sit in someone’s house in Mshenguville.  While it is easy to refer to the structures there as shacks, it became very real to me that they are homes.  They are places where people cook meals, spend time with their family, and find rest.  There is a noticeable sense of pride from the residents, especially women, about where they live.  One lady even apologized to us for the messiness because she had not had a chance to clean that morning.  Another lady was doing her laundry and, when she saw us approaching, was quick to go inside and grab crates for us to sit on because that was all she had and she wanted us to be comfortable.  I was very touched by how welcoming these people were.  Even though they don’t have much, they offer what they do have in order for guests to feel more comfortable . . . in their homes.

By Jenny Eaton Dyer, PhD

Having just concluded teaching my annual course at Vanderbilt, Global Health Policy and Politics, I am inspired to write a blog series based on a session I teach regarding the “psychology of global health.” In that session, I have students read a chapter from Peter Singer’s The Life You Can Save. In this chapter, he outlines six reasons  for “Why We Don’t Give More” in terms of philanthropy.

In this blog series, I will write on both why you may OR may not care about global health, along these lines of Singer’s arguments, and I will offer reasons for both. I think this helps explicate our thinking and behavior when it comes to helping people in our global village. It may explain why you are drawn to a specific nonprofit to donate or why you could care less about advocacy, for example.

The first reason it is difficult for us, as humans, to care about global health issues is that it is overwhelming! We are MUCH more apt to give or participate if we focus on ONE single person. Studies show that if we can focus on ONE name, ONE face, and ONE story – we will donate or act far more than if we had the opportunity do the same amount of good for 1000 people. Or even just two. This is called focusing on the “identifiable victim.” We have the capacity to hone in on the one, but not the many. Not even more than one. 

Because a group of people can easily succumb to anonymity in our minds, we lose the emotional stamina and persistence it takes to altruistically donate or take action to save lives. “The many” overwhelms our emotional response system.

We need an image of just ONE person to sustain our interest long enough to feel a human connection, perhaps a transference, with their personal story. This is why child sponsorships are so successful, for instance.

Perhaps put more clearly, we have two systems of thinking. Our first system is emotional, intuitive, and reactive. This system allows us to give generously during an earthquake as we mourn the victims or come to aid quickly during a flood. This system responds immediately with an outpouring of altruism.

Our second system is analytical, logical, and deliberative. As we consider more deeply our actions, we tend to act less quickly and allow for strategy and pragmatism to prevail. 

Most non-profit organizations will attempt to elicit your emotional—system one--response  to a crisis. They want you to move quickly without much analysis.

When it comes to advocating for maternal and child health and the healthy timing and spacing of pregnancies, we instead are asking you to deliberate. To think along the lines of action at a global scale. We would like to ask you to engage system two for a thoughtful, long term stragey of prevention.

220 million women around the world don’t have access to family planning but want to avoid pregnancy, and 287,000 women lost their lives in childbirth last year. Moreover, 6.9 million children will die from preventable, treatable disease this year.

We challenge you to think strategically about these problems for a moment and to partner with us as we draw on years of research, on-the-ground experience, and cultural expertise.

Over the next several weeks we’ll discuss why you may or may not care about global health. We will review Singer’s work highlighting how futility, parochialism, the diffusion of responsibility, fairness, and money affect the good we could do for global health.

We will look at the flip side of that as well. We will discuss why global health is of utmost importance in terms of national security, foreign policy, economics/investments, public health, and humanitarian reasons.

In this age of increasing globalization—we are the generation that can feasibly achieve global health goals for millions. Far beyond our expectations.

We hope you will join us.

 

My name is Courtney Stanley and I am a senior at East Tennessee State University College of Public Health. I am currently earning my B.S. degree in Public Health with a concentration in Community and Behavioral Health. I was fortunate to have the opportunity to travel to Munsieville, South Africa, and complete my internship with The Thoughtful Path, along with my colleague and fellow student Sarakay Johnson.     

The first week of my internship with The Thoughtful Path has been tremendous, to say in the least. I have been able to experience and accomplish more in my first week here than I ever expected. The plane landed Thursday, September 6th at 3:00 pm, and by Friday morning Sarakay Johnson and I were walking through the informal settlements in Munsieville along with Betty Nkoana, the on-site director, and Abi Brooks. The informal settlements, or townships, are where the lower income families and the individuals who have not received any government housing live. The individuals residing in these settlements are at a great mental, physical and social risk. To be able to visit and actually go into these houses and talk to the families living there was amazing. It was overwhelming at first to experience such extreme poverty firsthand. Despite all the education and training I have received as a future public health professional, there was a moment of questioning what I would ever be able to do. Soon after this, however, the ideas started to flow. 

I especially began referring to concepts learned in the ESSENTIAL’S class I took over the summer. There are so many basic improvements that can be made that would have an immense effect. First off, is the issue of cooking with a paraffin stove. The possibility exists of creating a brick oven to be used for cooking, or using the bricks to create a stable surface for the paraffin stoves to be placed. There is a brick making site that has finished being constructed, so there is potential create a coalition between the individuals making the bricks and those that are working on home safety. Another issue that I feel needs to be addressed is access to a proper hand washing station. There are only a few pumps between the two different formal settlements that provide access to clean water. I believe the tippy-taps I learned how to make in the ESSENTIAL’S class would serve very well as an affordable and achievable solution.  

After we finished with the walkthrough, Sarakay, Betty and I had a meeting to discuss the projects that we would be working on over the course of our internship. They range from projects such as training adolescents and younger adults on how to educate young children in basic healthcare practices, to creating health education material to be available to everyone in Munsieville, and to creating home based, cost-efficient, nutritional gardens that we can train children to manage. There are several others that I will go into detail at a later time.

This first week Sarakay and I have also been assisting Yi He, a doctorial candidate also from ETSU, with the data capturing project started during his time here.  There was a slight confusion with how the surveys were being recorded. After working with Yi and the surveying team however, we were able to get everything corrected. 

Another rather large and slightly unexpected project that I have worked on this week was a health fair conducted in Mshenguville. Mshenguville is one of the more disadvantaged informal settlements in Munsieville. So, The Thoughtful Path decided to go to Mshenguville and conduct a health fair for the population residing there. Betty requested that Sarakay and I create suitable health information and conduct a health class at the fair.  After meeting with the Health Promotion Unit, we decided to focus on hand washing and oral hygiene for younger children. We created interesting and informational posters that would attract the children’s’ attention. To make it fun and interactive we purchased the supplies for hand washing and had the children create their handprint a piece of paper, then showed them how to properly wash their hands afterwards. We also held small tooth brushing classes intermittently throughout the day. After the children completed the class we awarded them with a gold star. That way when the other children saw the stars they would also want to participate in the class. Another volunteer translated a rhyme while Sarakay and I demonstrated the proper technique, then we had the children repeat it with us. After the children completed the class we awarded them with a gold star. That way when the other children saw the stars they would also want to participate in the class.

The rest of the time, we have been assisting in preparing for the visiting board members of Project Hope UK, Project Hope U.S., and other various partners of The Thoughtful Path.  This was an absolutely amazing experience. We had the opportunity to meet with many influential people within these organizations. I was able to have a discussion concerning the concentration paper and various projects I will be completing with Bradley Wilson, the chairman of Project Hope UK.  It was wonderful to be able to hear the opinion of someone who has so much experience with Project Hope. Also, I attended a leadership lecture conducted by Dame Amelia Fawcett, a board member of Project Hope UK. 

Needless to say, my first week of my internship with The Thoughtful Path has been teeming in extraordinary experiences.  I know that this trend will only continue for the next ten weeks and I cannot wait to continue to develop and demonstrate my public health knowledge with such a wonderful organization.      

Sometimes the most difficult parts of a job produce the situations you learn the most from. Often doctors will remember their most challenging patients for the rest of their lives and rarely forget what they’ve learned through those interactions. Working at Georgetown public hospital has afforded me a wealth of opportunities such as these in my short time here. 

Near the end of a shift one day I saw a patient with chest pain—a thin, uncomfortable-appearing woman in her 50s. When asked where her pain was she did the classic motion of waving her hand over her entire chest and abdomen, attempting to help me pinpoint where she was hurting. I started with x rays, an ecg, and blood tests but unfortunately these would take quite a long time during this busy day. Hoping for faster results, I looked for the ultrasound machine to assist in my work up. After a long search and a battle to keep the battery on, we had it at the bedside. Looking at her heart, lungs, kidneys, liver, and great vessels with the ultrasound machine gave me a wealth of information. I could see she had fluid around her heart and one of her lungs. That provided me a clear start that ended up guiding much of my treatment for her. Although getting the ultrasound, using the machine, interpreting the US (no Radiology to help interpret the scans) were all much more difficult than doing the same would have been in the United States, I can honestly say I learned even more from the process than I would have in my home institution. The difficulty in getting the machine caused me to use it as a precious resource, getting every possible use out of it that I could for that patient. Not having Radiology back up or easily obtainable diagnostic tests caused me to fully scrutinize every image, think outside the box, focus on physical exam clues, and test my confidence in my own ability to obtain and interpret ultrasound findings. On top of all that, I got to teach a group of residents and nurses aspects and uses of ultrasound that they had never seen before. The experience highlighted learning opportunities I take for granted working in the United States and helped me develop my own diagnostic abilities.     

Technology and Poverty

Contraception in Ethopia

Apr 09 2014

Roman Tesfaye quote

Today, I am speaking at the Information and Communications Technology for Development and Faith (ICT4DF) Network Conference preceding the Infopoverty World Conference hosted at the United Nations this week. This conference focuses on the interface of technology and the alleviation of poverty in the developing world. In particular, my session hosts a number global health experts speaking to this issue from a faith-based perspective. Questions include: (1) How do ICT4DF tools maximize results in empowering global missions outreach and sustainable development; and (2) how can we transform traditional organizational paradigms from charity-based missions to maximum impact for developing communities. 

I speak at the Church Center for the United Nations on the new technologies of family planning or Health Spacing and Timing of Pregnancies (HTSP). I will discuss the issues and facts around maternal, newborn, and child health as well as HTSP.  In doing so, I will highlight Ethiopia as a strong example of increased contraception prevalence. Moreover, I will share the newer implant, Jadelle, as a contraceptive option available for Ethiopian women who wish to avoid pregnancies for up to five years. These kinds of technological advances in reversible contraception will save lives, keep girls in school, and increase economic stability—for families and for the nation.

Roman Tesfaye quote

 

We are taught during medical training to be very cautious and to only proceed with decisions and procedures when we are well prepared. Putting in a breathing tube, for example, when a patient is having difficulty breathing or has lost consciousness, is a procedure that can be done with just a few simple pieces of equipment. But in an attempt to ensure success, we bring in advanced tools for back up, cameras to get a better look down the throat, smaller tubes in case the size we have chosen doesn’t fit. Once we are prepared for anything, we are ready. But in many places around the world, including Georgetown Public Hospital in Guyana, those backups are simply not available.

In so many ways the Guyanese healthcare providers have used their limited resources not as an excuse to give up but as an education in how to efficiently and effectively work with what you have. Although the Accident and Emergency Department has less than 20 beds and staffs only a handful of nurses and doctors, they are able to see over 70,000 patients a year, what would be a sizable number for any large tertiary care hospital in the United States. Hallways are lined with chairs for patients who are healthy enough to sit up and often patients walk themselves to the lab to have blood work done or X-ray for their imaging. While working in the A&E one day I saw a 21-day-old baby with a large infected abscess on his arm. The mother brought the child to my chair where I was doing initial evaluations, after seeing the infection we set the baby on a nearby stretcher, cleaned the area and sprayed it with an anesthetic, used a scalpel blade to drain the infection and wrapped the arm back up. We gave the infant some antibiotics and had them go back out into the waiting room until there was a bed available in the Nursery. Neither the staff working with me nor the mother was bothered by our inability to get blood cultures, the lack of a crib or incision and drainage kit, or the fact that they had to wait outside the A&E for a bed. Everyone was just glad this was a child we could clearly help, as opposed to the unfortunately numerous cases where the patients are too sick to turn around.

At times I would find myself frustrated by the lack of certain simple but effective drugs, easily available CT scanners or even ventilators. But then a coworker would teach me about how they have found older, cheaper drugs that works, they use X-rays instead of CTs, and they ventilate the patients by hand. It’s not ideal, but for the most part it works. It’s refreshing to watch the innovative ways resources are used and how nothing is wasted. Even in the sometimes harsh environment of Guyana, the people have remained quickly adaptable to their changing world, generous, and extremely thankful. It is a fantastic privilege to work with them.  

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