As much as I hate to say it, my time in South Africa has now come and gone. Calandra Miller and I safely arrived back on American soil at 7:30 AM on August 6, 2009. At the time, I could not say the same for our luggage, which remained (safely) in Johannesburg, South Africa.

The last couple of weeks spent in South Africa were bittersweet, to say the least. I was looking forward to coming home and seeing my family and friends once again, but at the same time I was having to say goodbye to many good friends and, what I consider to be, family back in South Africa. The volunteer girls, Betty, Eva, and Engelinah treated us to some milkshakes as a going away present. This was a distinct honor to me, because what we might take for granted in the United States, they had to budget for weeks in advance. We also spent some time celebrating with Stefan and his family, the Wiids (the family who hosted me in their cottage during my stay in SA), and Pastor Dave Garton and his wife Gail (who run the rehab program that Project HOPE is partnering with). In the midst of our imminent departure, I took some time to reflect on what I was doing and had done since arriving in South Africa.

My purpose for being in South Africa was to assist in the fledgling steps of a promising program targeted towards orphans and other vulnerable children. Calandra and I had the distinct privilege to contribute our work to laying the foundation on which this program could get started. Much of this consisted of doing what many would consider mundane: data collection. Day in and day out we went door to door asking the same questions for our rapid needs assessment. After all was said and done, we had a grand total of 185 caregiver surveys and 266 parenting maps for children. This data has since been used by Project HOPE for grant proposal writing and other fund raising endeavors. All of our labors brings to mind a famous quote from Dr. Irving J. Selikoff, "Statistics are human beings with the tears wiped away." I can now whole-heartedly attest first hand to this, and with nearly every interview was reminded of why I was there.

My translator and I entered into a dimly lit home constructed entirely of sheet metal where we found a frail middle-aged woman crouched down washing the red clay dust off some furniture in her small room. She was obviously ill, and barely had the strength to stand and greet us with the customary handshake. Yet, when asked to take part in our survey she eagerly agreed and carefully sat down on the edge of her bed. Throughout the entire interview the woman provided responses through restrained whimpers and sobs. The questions I asked were simple, non-intrusive, and were not targeted toward specific health conditions. I could only assume it was due to her being overwhelmed with her health and living conditions. At the conclusion of our interview, she pleaded for any help we could give her, but all I could do was offer her a hug and a promise of my prayers, which she gratefully accepted. For many, the only hope they have is their faith in God to deliver them from their squalid conditions.

While walking through the dusty, debris ridden streets of the Zenzele settlement with Betty as my translator, I saw three men sitting on buckets in front of their home singing a song. I didn't think much of it, and continued on to the next person's home to conduct another survey. About 20-30 minutes later, we emerged to these same three men singing the same song. I asked Betty what they were singing out of curiosity. "God have mercy on us," she said.

Unfortunately, many of these people will not find much refuge from the currently overwhelmed healthcare system in South Africa. Residents of these settlements have told us that healthcare providers will often mistreat or even completely overlook them when it is discovered that they are not native South Africans. This is only exacerbated by the physician strikes taking place all around the country due to poor salaries and working conditions.

This is not by any means encouraging for a woman who volunteered for a field test of the Munsieville Survey Calandra and I had designed for Project HOPE. She was 23 years old, and spoke English well enough for me to conduct most of the survey without Betty's help. Within this survey were much more detail oriented and intrusive questions, including those that asked about sexual behavior. After completing the field test, Betty and I struck up a conversation with this woman to discuss the strengths and weaknesses of the survey. When I least expected it, she volunteered to us some extremely sensitive information that she would only entrust to her closest friends and family. She had AIDS. On top of this, she also told us that she had recently been diagnosed with breast cancer in her left breast (which she reported only having pain medications for). Her live-in boyfriend and sole bread winner for the family (making about R800 per month, or around $100 U.S.) also had AIDS. While he was at work, she was responsible for raising their young 2 year old child in the small shack they called home. I was deeply honored by her telling this to us. It was as though she trusted us, as representatives of East Tennessee State University, Project HOPE, and Hope Through Healing Hands, like we were family. She understood that we were there to help and wanted to change the conditions that they lived in for the better.

Even though she was just one year younger than myself, I couldn't help but think about her as a child no more than 10 years ago. There was no one around to teach her safe sexual practices, or to help her get a proper South African identification card. There were no concerted efforts to give her the proper education she needed to become an empowered woman and begin the climb out of poverty's grasp. Then it struck me. This is why Calandra and I are here. This is the spirit of public health, to prevent terrible outcomes like this regardless of where they come from or what gender they are. Though her story was transformed into categorical and continuous variables in a database, her story, in conjunction with many others, will be used in research by Project HOPE and its partnering organizations to help prevent suffering like this for future generations.

I feel honored to have taken part in Project HOPE's endeavors in South Africa. Without Hope Through Healing Hands and the Frist Global Health Leaders Program, it would not have been possible for me to contribute to this great cause. Through this experience, I have gained tremendous into what it is like to operate a health campaign in a foreign country, something that I plan to pursue professionally when I am finished with my formal education. I am forever grateful for having this opportunity, and will carry what I have learned from this experience for the rest of my life.

August 24, 2009


Today, after meeting all day with health reformers in China, it is clear that partnerships with U.S. academic institutions are important to build capacity and institutional support here. 


At Peking University, Dr. Ke Yang, Executive Vice President of Peking University (PKU), enthusiastically described the great results of a Duke-Peking University two-week global health diploma program with the School of Public Health.


By email, my friend and global leader at Duke University’s Global Health Institute, Mike Merson, M.D. also told me of Duke's training program in cardiovascular disease at Peking University Health Sciences Center and their partnership in a new Center of Excellence in Cardiovascular Disease Research led by Yengfeng Wu, M.D., Ph.D. that is based at The Georges Institute in Sydney, Australia.


And at Vanderbilt University’s Institute for Global Health, global health leader Sten Vermund, M.D., Ph.D. tells me Vanderbilt has a twelve year partnership with two sides of the Ministry of Health for training, the Foreign Loan Office and National Center for AIDS.  They have strong research ties in Guangxi, Xinjiang, and Yunnan Provinces (one large ongoing study in the former two provinces). Also, they have a special partnership on rural health management training that Governor Bredesen and Commissioner Matt Kisber have co-initiated and sponsored.  In fact, there are other VU links to China (history, business, education, etc) including the partnerships between Fudan University and VU as "peer partner institutions."


Frist Visits Ditan Hospital, Peking University, and Tennessee-China Development Center

August 23, 2009

Frist visited the Beijing Ditan Hospital which was the center for dealing with the SARS virus in 2003. Today, it has been refurbished to hold 500 beds. It is now designated as the H1N1 Hospital for China.

Frist visits with nurses inside Beijing Ditan Hospital. They are demonstrating how their PDA is monitoring H1N1 patients. The Senator notes that it is one of the most electronically integrated hospitals he's ever visited.

Frist meets with Vice President of Peking University. Peking University has eight hospitals and health science schools. There, he discussed health care reforms underway and how American health care companies can assist in improving health care in China today.

Senator Frist, Tommy Frist, and Chuck Elcan visit Tennessee China Development Center.









Sunday, August 23, 2009

9 pm, Beijing

In 2003, representing the U.S. Senate I met with President Hu Jintao, CMC Chairman Jiang Zemin, Premier Wen Jiabao, and the Foreign Minister and Health Minister. One evening there was a majestic dinner in our delegation's honor, similar to our State dinners, hosted by the NPC Chairman Wu Bangguo (who I understand is coming to DC in a couple of weeks). It was the height of the SARS crisis and China had been shut down. I remember so vividly the discussion we had in the Ambassador's residence in Japan (the country visited just prior to our planed trip to China) when I gathered all the Senators around to make a final decision of whether to enter China at a time of some risk. We decided to go ... to demonstrate our support of the Chinese government in those difficult times as it did its best to fight the new, frightening and deadly SARS virus.

I am reminded of all this as I enter China today and read the China Daily headlines in the airport, "H1N1 will endanger more lives," with a subtitle "Up to 2 Billion may be infected; China will see rise in cases this winter." The article goes on in the first few paragraphs to say that the number of H1N1 cases will double every three or four days until they reach the peak transmission period.

The world is a small place. SARS tore out of China and invaded Canada. The affected economies grounded to a halt. Similarly HINI will be a worldwide pandemic. There are no borders to these cagey and fatal viruses. We are all in this together and our response must be mutually dependent. We are one. There is no separation of global health from domestic health when it comes to these emerging diseases.

August 22, 2009

Frist Update and Expectations: Written on the plane to Shanghai

Just getting used to the new Prius. I am taking a lot of heat from my family who see me more the Tahoe or Suburban type. It was tough trading my 1992 Suburban (my only car) because of the family memories that centered on that car. I had saved some money back in ‘92 by getting a two wheel drive (though I regretted it later when in DC I kept getting stuck in the snow - sometimes doesn't pay to be too cheap); it was the car the boys learned to drive in the narrow streets of Georgetown (side mirrors a little scratched). I resisted this clunker deal initially because I thought it wrong that the taxpayer was buying my new car for me, but after a few days I broke down on the moral argument of mileage, pollution, etc (and the gift of the average taxpayer!!). I always buy my cars from Lee Beaman; his dad and mine were best friends. Christi, who works with me, picked out a great Yukon for me. But I opted for the Prius - why? Because it gets 4 times the gas mileage and I want to reduce gas consumption since so much of the proceeds goes to those who feed terrorism. And it is cheap - we actually ended buying two Pri(i) - one for me and one for my brother Tommy - for the price equal to one Yukon. Still hate to see the Suburban go - and it sounds like they poison it to kill it. Ugh.

Last week Karyn and I were in Nantucket and we hosted an annual clambake for family and friends. Brother Tommy and Trisha come up each year and on Friday night he said that he was going to China in two weeks. "Bill, why don't you and Karyn join us? You know many of the Chinese leaders from your previous Senate trips there; if you were there we could explain what we are doing and what we could potentially do to the central government." You see Tommy and his son-in-law are constructing a hospital that is public-private (government is 70%) in a community about 2 hours south of Shanghai.

Karyn and I had a trip planed to Italy that was to begin on September 1; we hade never vacationed in Italy and it was time for me to take her there since most of our friends at our age that we see day to day have been there multiple times. Our summer vacations have been working and doing surgery in Bangladesh, Mozambique, Uganda, southern Sudan, Darfur, and the Congo. Doing surgery in the bush is a far cry from Florence and Venice and the Amalfi Coast (as I was reminded by Karyn); Italy is the destination this year (and no surgery). No skimping here, I called the famed travel agent Andrew Harper and said just put together the rip for us. Karyn deserves it.

So now 2 weeks before departing to Italy how was I going to get a visa for us to China and then organize a trip there? With a lot of help we did it, and this morning at 3:15am we got up to board Delta to Atlanta and then Atlanta to Shanghai to Beijing. At this point, we have no idea what the plan will be until we see the Minister of Health on Wednesday (today is Saturday in the US).

I am not a China expert, but I am fascinated by the country and when I am advising young people today I tell them to focus on China and figure out some way to go there and live for awhile. The demographics and economic direction are just too clear as we look forward over the next 30 years.

In terms of health, the central government has made a major commitment in funding health services throughout China. And though the "down-side" of central command we all know in America is lack of democratic decision making and transparency, the "up-side" is that once a decision is made there is not a fiddling around to fund and accomplish the result. So with that much boldness directed at solving health inequities and improving health services, coupled with huge investment, I knew I wanted to be in China and get the lay of the land.

We will build the next 8 days around health and healing, be open to opportunities to share our expertise, learn from their culture and approach, and then just see what happens in the future. We're in the information gathering stages ... we are not up to the "conceive it, believe it, do it" phases frequently quoted by my mentor the pioneering heart surgeon Dr. Norman Shumway.

Everyone has a bucket list and we tend to pay more attention to them the older we get. Tommy says Tibet is on his, so the group said let's go. Then we heard that the altitude is 14,000 with no acclimation; I get altitude sickness and he had a minor heart procedure two weeks ago so the doctors said wait 6 months. A relief to me because I know I would be sick. Karyn does well at high altitude (like when we hiked the Virunga Mountains on the order of Rwanda and Uganda looking for the mountain gorillas - at 12,500 feet we eventually found them but I was so hypoxic I don't remember anything we did. Karyn thrived. I should just keep my medical work with the gorillas focused on the National Zoo over in Washington, DC instead of trekking in Rwanda, which was last year's trip - I know ... that is why we are doing Tuscany and Florence!).

So now that Tibet is out, we will do a non-health side trip to Xi'an, China, the ancient walled city, once the capital of China, and often overlooked. It is now known for the unearthed Terracotta Army of Warriors and horses of Emperor Qin Shi Huang. Apparently at night the city becomes the City of Lights and an atmosphere that leans on fantasy. One article describes an 18 course dumpling banquet (at De Fa Chang). That is the extent of what I know about the area now, more to come once Karyn and I figure out to get there.

So what is the kernel behind this trip in the first place? It starts with my oldest brother
Tom Frist who founded and ran Hospital Corporation of America, the largest hospital company in the world, and his son-in-law Chuck Elcan who two years ago set out on building a hospital in partnership with the government in China. The location for the hospital (approvals and funding have been obtained) is the city of Cixi (1.8 million people in immediate area) which is in the Zhejiang Providence. Cixi is directly east of Hangzhou and is a little over 2 hours south of Shanghai (directly across the bay).

So that hospital will be built and staffed and locally run (manages using the systems that have been fine tuned by years of western hospital management expertise). If that works and works well, what would the next step be? Our trip and our meetings with the government will help answer that, so it will be fun sharing my observations with you as we go through all this over the next 8 days. What we do know is that the Chinese government is making an unprecedented and monumental commitment to its health sector; they could use, I would think, some western expertise. This is not a venture of HCA. Luckily the third partner Henry Zhou lives in China and will be our host once we hit the ground.


August 22, 2009


This morning, we awoke early to catch a 5:00am flight out of Nashville, through Atlanta to Shanghai, China. Karyn, youngest son Bryan (21), brother Tommy, his wife Trish, and his son-in-law Chuck Elcan and I are all traveling to China to explore the Chinese delivery of health care. During my time in the Senate, at the height of the SARS crisis, I led a Senate delegation to China. They were honored we would come during this period, exhibiting the United States’ trust in the Chinese government to handle this unknown crisis.

      Today, we have a 14 hour flight to Beijing. Once there, we look forward to meeting the new Ambassador to China, Jon Huntsman, Jr. as well as the Minister of Health. We will be in Beijing, Shanghai, and Hong Kong over the next week. And, I’ll be blogging daily with updates on events and health care in China today. Stay tuned…


Big & Rich Find Way Back Together

Kenny Alphin cites work with HTHH

Aug 21 2009

Big & Rich find way back together

Offstage, duo ‘like night and day,’ but their partnership remains strong

For the AJC

9:03 p.m. Thursday, August 20, 2009


Throughout the history of country music, duet acts have proved to be a mainstay in the ever-widening scope of the genre.

In family acts such as the Louvin Brothers and the Judds, intergender pairings including Sugarland, and George Jones and Tammy Wynette, or partnerships like Flatt and Scruggs or Montgomery Gentry, the symbiosis often produces something bigger than the sum of the parts.

In 2004, a pair of Nashville singer-songwriters joined forces in a manner that retained the traditional "duet" mentality, yet pushed the boundaries of country music. Big Kenny Alphin and John Rich, calling themselves Big & Rich, took the music world by storm with their eclectic conglomeration of rock, country, hip-hop and humor.

Alphin, an eighth-generation farm boy from Virginia, is as country as the day is long, but with a very obvious "hippie mentality" that shines through in his conversation. He speaks as enthusiastically about supply delivery trips to refugees in Darfur as he does the 50 new songs he has recorded in his home studio.

In a recent telephone interview, Alphin reflected on the history of Big & Rich, his solo music and the big issues that matter the most to him.

"The MuzikMafia grew out of a 70-week run where a bunch of friends who were all struggling in the music business here in Nashville would get together one night a week to share our songs and just do what we wanted to. Rappers, dancers, horns, whatever. It was 'music without prejudice,' and people just started showing up."

A regular attendee was the daughter of Warner Bros. Records' Paul Worley, and she convinced her father to give them a listen.

"John and I thought we were just going to pitch songs, so we played a few things for Paul," Alphin recalled. "He stopped us and said, 'OK, I want this.' He signed us on the spot as a duet act, and that's what got Big & Rich started."

The loosely organized MuzikMafia and its members, including Big & Rich, "Redneck Woman" Gretchen Wilson and "hick-hop" rapper Cowboy Troy, rapidly climbed into the country radio playlists and charts.

The duet's breakthrough single was met with mixed response from radio listeners.

"When we got some feedback on 'Save a Horse, Ride a Cowboy,' the radio people said it had a lot of 'polarity,' " Alphin said.

"Fifty percent liked it, and 50 percent hated it, and they said that is a good thing," he said. "It is not really a rap song, it is spoken word. We were trying to do something along the lines of the old country songs where the singer would talk instead of sing. The rap part is the added rhythm, which adds flavor to the rhyme. Rap is here, and this was our way to embrace it. We were having fun."

The success of the single propelled Big & Rich to concert headline status fairly quickly, and with Wilson, Cowboy Troy and their close friend Two Foot Fred along for fun, the duo seemed unstoppable.

The ride took a slow nosedive as the "fad" aspect wore off, and professional and personal issues became more prominent. Following an initial surge, sales eventually slowed, some hangers-on were dropped from the labels, and unfortunate offstage events began to get more press than the music.

Big & Rich recently took a one-year break during which both artists recorded solo albums. They are regrouping and touring. The question is, has the damaging negative publicity and absence from the public eye killed the spark?

The contemporary country music business is fickle, and it seemed that Big & Rich may have been a flash in the pan.

"That doesn't concern me at all," Alphin said. "The Big & Rich brand is established, and I feel stronger and more confident than ever. In Nashville, there are so many parts that make up the process, including publicists, promotion, and the artist pays for it all. It's very stressful, and the artist is ultimately responsible for their own career. I'm destined to make music, and I like to do multiple things."

While Alphin recovered from neck surgery, he channeled his energy into solo projects and numerous charity and social causes. The fruits of his labor are on the way, with a new single already out, and a full country album with more to follow.

His charity work includes Hope Through Healing Hands, which helps get doctors into underserved areas.

He organizes the successful "Nashville4Africa" fund-raising concert, supports disabled veterans' groups such as Building Lives and arranges for cargo planes to take supplies to Darfur.

"When I found out how bad it was there, it was more than I could handle," he said. "So far, we have delivered survival kits to refugees, helped build a school for girls called My Sister's Keeper, a clinic and an airstrip."

Rich has often found himself on the receiving end of bad publicity.

An active participant in the Nashville music industry since his days as a member of Lonestar, Rich is a talented songwriter with a strong producer's ear for what works in a song, resulting in numerous hits for other artists. He has hosted and participated in several CMT reality shows.

Outside of music, he is very open and public with regard to his conservative political beliefs and support of Republican candidates. His song "Raisin' McCain" was heard during John McCain's failed 2008 presidential bid.

Politics aside, Rich has a tendency to get into conflicts that often end up in the gossip columns. He was involved in a neighborhood dispute when he bought some prime Nashville real estate and started construction on a giant house that irked the neighbors.

A recent feud with former "Nashville Star" contestant Jared Ashley lingers. (Rich was not available for an interview for this article.)

While distancing himself from his musical partner's recent tribulations, Alphin acknowledges the differences and the connection to Rich.

"He's out there doing crazy stuff, but I still love him," Alphin said. "We are like night and day. He's political, and I just like to get things done. Right now, we meet onstage, that's it. Once he gets his other stuff straight, we will sit down and write some songs."


Concert preview

Kicks 101.5 FM Country Jam 2 with Big & Rich, Craig Morgan, Love & Theft? and Bombshel

7 p.m. Sunday. $19-$49. Verizon Wireless Amphitheatre at Encore Park, 2200 Encore Parkway, Alpharetta. 404-733-5010;,?

Reform the right should embrace

For the U.S. to save more lives, build self-sufficiency abroad

By Mark Green | Thursday, August 20, 2009

Remarkably, a reform effort is under way in Washington that has yet to devolve into a partisan shouting match. The reform involves our foreign-aid apparatus, which is in dire need of an overhaul. It matters because amid this tough economy, every taxpayer dollar is especially precious and because of the great good foreign aid can do.

The legislation that authorizes our overseas development programs is more than 45 years old, without updates or improvements in more than 20 years. At a time when our national-security and foreign-policy priorities have become increasingly dependent on effective development, our political leaders must act swiftly and put partisan politics aside in order to enact reforms that will make our foreign-aid programs more efficient, more effective and therefore more capable of supporting and advancing our national interests around the globe.

Despite some initial positive steps by the Obama administration and Congress, a critical constituency is missing from the discussion: congressional conservatives. As a proud fiscal hawk and a true believer in the power of U.S. foreign assistance to lift lives and enhance alliances, I urge conservatives to get more engaged and embrace the opportunity this debate presents.

I served in Congress from 1999 to 2007, when an unprecedented bipartisan coalition came together and increased U.S. foreign assistance aimed at easing the suffering of people in developing countries. Without the participation and leadership of conservatives in Congress and the George W. Bush administration, none of this would have been possible.

The vital role played by conservatives was perhaps best exemplified by the transformation of the late Sen. Jesse Helms, North Carolina Republican, who went from being Congress' most strident anti-foreign-aid voice to a co-sponsor of a bill providing $200 million to help fight HIV/AIDS in Africa.

Mr. Helms and other conservatives, including President Bush and former Senate Majority Leader Bill Frist, Tennessee Republican, were key players in passing landmark programs such as African debt relief, the President's Emergency Plan for AIDS Relief (PEPFAR), the President's Malaria Initiative and the Millennium Challenge Act (which created the Millennium Challenge Corp.).

Without these initiatives, millions of lives would have been lost, the conditions of despair that terrorists and dictators all too effectively exploit would have deepened, and fewer developing countries would be on paths toward self-sufficiency.

Despite this important progress, U.S. foreign assistance is not as effective and supportive of our diplomacy and security efforts as it should be. Right now, foreign-assistance programs are overseen by more than 60 government offices that frequently are competitive and uncoordinated. Foreign-aid budgeting has become a mess of earmarks because the Cold War-era Foreign Assistance Act of 1961 (FAA) is decades out of date.

I saw firsthand how inefficient this system can be at times when I was U.S. ambassador to Tanzania in 2007-08. Early on, I would attend ribbon-cuttings for U.S.-funded health clinics and other programs only to see banners with countless logos and acronyms from organizations -- including different U.S. government agencies -- all taking credit for the American people's generosity. The maze of obscure names not only was unsightly, but it also confused our Tanzanian audience and diminished the diplomatic value of our work.

After sitting through a few of these events, I issued a directive creating a unified logo -- an American flag with the phrase "From the American People" in Kiswahilii -- and requiring that it be on every press statement and event banner.

Thankfully, we see some progress. The Foreign Relations committees in both the House and Senate have introduced reform bills that have gained some Republican support, but there is still a long way to go. The same leadership from conservatives that helped deliver millions of people in the developing world from poverty and disease over the last decade is needed to keep the foreign-aid reform effort focused on increasing accountability, eliminating waste and maximizing results.

I call upon my conservative former colleagues in Congress to rise to this challenge and join the debate. I urge the Democratic majority to run the reform process in an open and bipartisan way and keep it from becoming a debate over money and divisive social issues.

Given that foreign-assistance reform is fundamentally about making the United States better at saving lives, helping more countries like Tanzania get on the road to true self-sufficiency and highlighting our leadership and compassion abroad, we have to get it right -- and we have to do it quickly.

Mark Green is a former Republican member of the U.S. House of Representatives from Wisconsin and ambassador to Tanzania. He is the director of the Malaria No More Policy Center.

Overcoming Obstacles to Keep Girls in School: Sustainable, Environmental, and Economic Practices

by Anita Henderlight

August 18, 2009

Shortly after NESEI opened our first girls' boarding secondary school in South Sudan, we observed that many of the girls skipped classes routinely each month. Why? Because they did not have necessary supplies for comfort or cleanliness during menstruation. Most were using leaves or old rags to absorb their flow.

We began to supply the students with "comfort kits" - disposable sanitary products imported from more industrialized countries. They met our primary goal - keeping our girls in school.

We soon realized that we would eventually spend more on comfort kits than tuition fees and that we were creating a disposal and environmental problem in a community that had no functioning way to deal with garbage. We needed a financially and culturally appropriate solution - one that would keep girls self-assured and in class.

Thus, the NESEI sanitary pad sewing project was born. A generous group of people from York, South Carolina, invested $250 in a treadle sewing machine and donated patterns, fabric, thread, and needles. Our students begin making their own sanitary pads.

The locally-made pads are absorbent, soft and inexpensive to make. And because they are reusable, they are environmentally and community friendly.

In the first two months of the sewing project, the students made 500 pads. School attendance and personal hygiene have improved. And now the girls are coming up with a plan for a small business packaging and selling surplus pads to girls and women in the surrounding villages.

NESEI hopes to build capacity so we can help the girls market pads to other NGOs working in South Sudan. The girls will use the extra income to purchase additional scholastic materials and other needed items.

The sanitary pad program is another NESEI example of empowerment at work - a small investment is giving our girls the opportunity to find practical solutions to real problems.

In September, NESEI will launch a new, updated website ( with information about the sanitary pad project and other programs which are contributing to the improved health and welfare of our young Sudanese friends.

**NESEI is a proud partner of the HTHH Global Health Coalition.



Loni and I have continued our work on the Munsieville Survey and rapid needs assessment data collection. We can now officially say that our Munsieville Survey is fine-tuned and ready for implementation. Each survey takes about 45 minutes to an hour. I mentioned in an earlier update that Project HOPE had planned to get 1000 surveys. Well, thanks to some mathematical wizardry on my and Loni's part, we discovered that we would only need about 400 surveys to get the same statistical power (something that SIGNIFICANTLY cut on costs for this project). So, with 10 hired surveyors it would take a little less than 2 weeks to complete data collection.

Unfortunately, due to government holidays and political unrest, we will not be able to implement the survey before leaving South Africa. However, we have drawn up a strategy for implementation to help things go more smoothly for our boss, Stefan, when he finds the time and resources to carry it out in the next month or so.

As Loni mentioned in an earlier update, we have been continuing Project HOPE's ongoing quest to find a suitable location for its Munsieville Model by conducting rapid needs assessments in the informal settlements of the Randfontein area. Most recently, we have been shack counting and surveying in Big Elandsvlei (this is in addition to Master, Jabulane, Elandsvlei Klein or "small", and Zenzele). They call it "Big" Elandsvlei because it has more land than the other Elandsvlei settlement, though this in itself is misleading. We counted a total of 210 homes there, whereas at Elandsvlei Klein there were 350 densely packed onto a smaller plot of land. Elandsvlei was a bit different from the other settlements in that it had no formal system of sanitation, not even latrines. Nearly everyone used a bush toilet (i.e., dug a hole in the woods). One of the women we surveyed informed us that rape is a big problem when using the bush toilet in that settlement, something I'd never even considered before.

Due to the aforementioned political issues, there have been many strikes occurring throughout the entire country of South Africa, including both municipality workers and even physicians. The municipality worker strike has had a grave impact on the people living in informal settlements who have to rely on the water tanks to survive. Already residents in Big Elandsvlei were reporting to us that they'd been without a water tank refill for the past three days. Besides a dwindling supply of drinking water, this has had other impacts on the residents, specifically the children. They have not been going to school because there was not enough water to bathe or wash clothes. The parents are consequently refusing to send their children to school because of it.

In spite of the municipality strikes and the resultant disruption in services, we haven't had any issues with our rapid needs assessments. Big Elandsvlei is the last settlement Loni and I were tasked with surveying. Naturally, being interns, we were given the sacred responsibility of doing data entry for all of the surveys we have collected. We are nearly finished with inputting data for the 185 caregivers and 266 children in the above 5 mentioned settlements. Once finished, we'll hopefully have a preliminary analysis completed for Project HOPE before leaving for the States.


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