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Photo: Dr. Martina C. Fuchs, RMF Founder/CEO, making new friends at the Lwala, Kenya Community Hospital, October 1, 2011

We are so grateful to all our friends, supporters and teams around the world and wish everyone a fantastic 2012!

Having wrapped up another successful  we want to pause and say a huge THANK YOU to all of you who supported our work in 2011.  You have helped us achieve so much, and we give our deep thanks to everyone for your generosity and support!

In 2011 we..

  • In Japan, post-earthquake and tsunami, RMF reached over 33,000 people in Ishinomaki City with supplies, debris/sludge cleanup, and community center support.
  • In India, in RMF’s Malnutrition Eradication Program, our field staff of 75 Community Nutrition Educators diagnosed and treated 85,016 cases of Acute Malnutrition in more than 600 villages since our program started in 2010.
  • In Uganda, we provided healthcare, education and vocational training support to 55,000 refugees at the Kiryandongo Refugee Settlement.
  • In South Sudan, 40 Nurses and Midwives at the RMF sponsored first-ever accredited Nursing and Midwifery College in Juba, are beginning their 2nd year of training.
  • In Pakistan, RMF treated more than 25,000 flood victims at our free medical camps, 32,000 patients at our clinic in Gulbella and provided healthcare in Talhatta for more than 150,000.
  • In Haiti, our free clinic at Hôpital Lambert Santé provided public access to 24-hour emergency and general healthcare to a community that is home to more than 100,000 displaced persons.
  • In Kenya, we upgraded the only hospital for 1,000,000 people in Lodwar, Turkana, starting with the pediatric ward and also continued to provide medical support, food and water to thousands through mobile and stationary clinics in the poorest and most drought ravaged regions in Kenya.
  • Closer to home, in South Los Angeles, RMF provided 70 children with new backpacks filled with school supplies and personal products, and just threw a Holiday Party for these children on December 17th.

From all of us at RMF: Have a Happy, Healthy and Prosperous 2012!

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October 21st 2011, I had the privilege of going undercover as a waitress at the highly publicized and anticipated Dionicess IX, a culinary extravaganza which has been appearing on the LA scene for the past 3 years, with all proceeds benefitting charity.

Gev Kazanchyan,a member of the Real Medicine Advisory Board and creator of these events was introduced to Real Medicine 3 years ago through our Armenian Project Director, Nairy Ghazourian.  This introduction would lead to a series of pairings over the next 3 years benefitting our project in Shinuhayr, Armenia. From Dionicess II (which paired Coffee & Chocolate) to Dionicess VI (which paired Beer, Sausage & Fries) all have had rave reviews and have brought much needed awareness and support to our Armenian Projects.

This year’s event  teamed up Gev with Dave Waltrous (Beachwood BBQ & Brewing) , Randy Clemens and Matt Biancaniello featuring “Beer & Booze” with an assortment of vegetarian dishes to compliment each.

The event was held at the Steingarten LA, which gives you a feeling of times past. Dark woods, a beautiful patio area and an atmosphere of sophistication, were the perfect setting for what we were about to experience. Their extensive menu was hard to pass up, and I enjoyed an absolutely exquisite Wild Boar & Berry Sausage with owner Abraham Berookhim  between seatings.
Matt Biancaniello (voted  LA’s top bartender 2010) was hard at work preparing the garnishes for the cocktails. There was fresh verbena that had been hand picked at 2am, pumpkin infusions, and a rare Belgian elderberry liqueur thathad never seen American soil. International shipping had caused quite a predicament as the precious nectar-of-the-gods had only arrived 2 days prior to the event!

Author and Chef Randy Clemen’s tantalizing vegetarian dishes included items such as the “Taquit-Ohhh Yeah”, a fabulous “Risotto Pop” and myfavorite, “the Hop and the Hound” which had a had a kick stronger than a mule!  Randy’s “Sriracha Cookbook” is
available through Amazon.com and his recipes do deliver a punch! If you like it spicy, this is definitely the crème de la crème of cookbooks!

Having not waitressed since college (we won’t say how long ago that was!), I was a bit nervous-but with the assistance of  Dr. Susan Jarakian & Armenian Country Director Nairy Ghazourian we were well prepared for the days journey. The 1st seating’s attendees consisted of a host of press from a variety of culinary publications, some local and some from as far as Wisconsin.  The 2nd seating was primarily comprised of Gev’s cult following, this being his 9th highly anticipated event which each year sells out within days of its announcement.

This year’s event raised over $1,400 for our project in Shinuhayr ,Armenia which supports 8,000 people from surrounding villages and is the only access to medical care in the region. Last year, we were able to provide food and clothing to sustain families through the brutal winter months as well as providing the region with an ambulance equipped with emergency supplies.

A huge Real Medicine thank you to all that helped to put on this year’s event! To read more about Dionicess IX please go to:

DionicessIX: Combining Craft Beer & Cocktails for Charity and to be added to the
main invite list for future events please send a simple email request to: dionicessgigs@gmail.com.
For information about our Armenian Project and how you can help support the families through this year’s winter please go to:

RealMedicine Armenia or directly to our donor page here.

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Sonu’s Story Continued

By Michael Matheke-Fischer, Director of Programs, RMF India

Sunday, November 20, 2011 was the first time I met Sonu. To me, he was a picture on a PowerPoint presentation, a picture that continues to shock me today. Sonu came into our program 15 months ago while I was in Delhi working on streamlining our administrative procedures and, more importantly, trying to raise more funds to help children like him. Fundraising and administrative work, while just as vital as the field work we engage in, is an ever present necessity shared by our small, but dedicated team.

Caitlin McQuilling told me about a case that had shocked even her. While sitting in Delhi, it was hard to hear the emotion in her voice. Days were spent monitoring his progress, coordinating with doctors, and attempting to diagnose exactly what was causing his dramatic wasting. All of this was terribly frustrating while sitting in meetings and pouring over budgets.

The team watched Sonu finally begin to improve, his weight gaining dramatically over three months until he was a healthy, even hefty, child.

Stories of Sonu floated around our house in Jhabua, and his example served as an inspiration to all of us to work harder, reach more children, and find out what we are capable of.

On Sunday, I met a child who could not possibly be the picture I had seen and shown so many times. There was no way, simply none, that such a child could have ever been as wasted and close to death as the picture I was so familiar with. Now back in the field, Sonu has turned in my mind from a stark example of the ravages of malnutrition to a child with a future, a face with expressions, and an energy that I will feed off of for the months to come. His sisters have taken to calling him “motapet” which in Hindi roughly means fat belly.

Even though budgets, PowerPoint’s, reports, and fundraising are still a large part of my job, at least now I have yet another example of why I do it!

For more information about RMF’s Malnutrition Eradication Program in India, click here

We can use any financial help you are able to provide on this project to continue our Education,Treatment and Outreach and help toward our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org

 

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by Jonathan White and RMF Partner Fumiko Tanaka at Japanese Emergency NGO

Geographic Locations

Ishinomaki City, Miyagi Prefecture

Taking Care of Local Students during Summer Vacation

Beneficiaries

Approximately 1,690 individuals, employees of 7 local companies, 11 households and the residents of 11 communities of Ishinomaki were reached by JEN’s activities during this period.

Activities

1) Volunteer Dispatch

  • Supported by 2,890 volunteers, JEN has completed removing rubble and sludge from a total of 196 buildings in Ishinomaki City. JEN dispatched volunteers to clean places such as houses, an office and a factory.

 

  • JEN was requested to send volunteers to help hold a sports event at Oshika Junior High-School. The tasks involved weed removal, setup for the event, food tray service and participation in the event.

 

  • Starting of an Aqua-Farming project in the Sameura area of the Oshika Peninsula, 108 additional JEN volunteers were dispatched to help fishermen on the port.

 

2) Psychosocial Care through Community Space

JEN has been providing community spaces where evacuees can gather for activities and share their experiences as psycho-social care. There are currently 3 places where activities have begun as pilot projects in the existing communities, and 8 at transitional shelter compounds.

<Nakayashiki Space>

 

  • Homework support for children by university students from Tokyo has been ongoing throughout the reporting period. In addition to homework support, classes for Japanese calligraphy and balloon art were held for the children. This space held between 10 and 20 students every day during the summer vacation.

 

  • JEN provided soup kitchen and massage services for the local people including residents of temporary housing. On September 13th, nearly 50 meals were provided and relaxation services were offered to 10 people.

 

  • Some new services including health checkup and a handicraft class began during the reporting period. The handicraft classes have been popular especially among housewives.

 

  • JEN proceeded with the preparation for the first workshop on September 17th.

 

  • JEN contributed an article to a monthly social educational magazine on its community support project in Nakayashiki that will be published on September 15th.

All photos JEN Copyright

 

<Kazuma Space>

  • The Kazuma festival was held on August 20th and attracted a large number of local residents. 4 food stalls were opened and all their food was sold out. In addition, a famous singer gave a performance to encourage the residents.

 

  • The meetings regarding the construction of a community café in Kazuma Space were continuously arranged with donors and local self-governing bodies. A “jichin-sai”, a Shinto ceremony to purify the building site and offer prayers, was also held.

 

<Koganehama Space>

  • The first workshop at the Koganehama Space and neighboring areas was held on September 4th. The workshop focused on the things to do right now and the long-term reconstruction plans.

 

  • JEN provided massage service for the local residents. Acupuncture practitioners were invited this time and their service was quite popular among the residents. Moreover, new programs such as cooking or handcraft class are being considered.

 

<Transitional Shelters>

As part of the community space projects, the following events were held in the temporary housing areas: tea party, massage service and legal counseling. Some tea parties called ‘Ochakkonomi’ in local dialect were held inviting local elderly mothers to chat over the tea for socializing purposes.

Economic Recovery Assistance

Rubble Clearance through Assisting Local Waste Management Contractors

JEN lent 4-ton garbage cars to Katsumata Transport, the Watanabe Cleaning Service Company and the Suzukyu Recycle Shop. A 4-ton damp car will be handed over to the Ishinomaki Waste Disposal Center.

Assistance of Small to Mid-size Local Businesses

JEN has decided to conduct assistance for building temporary shopping streets in Ayukawahama. The meeting on the contents of the project and how the project will develop in the future was held between JEN and the commerce and industry association in the area on August 23rd. To acquire cooperation from the public administration, the meeting with Mr. Okada, a head of the Oshika Branch of the Ishinomaki City Council, was also arranged. JEN confirmed the project site and gained the agreement on the implementation of the project from Mr. Okada. The next steps for the project will be: acquirement of permission in writing on the use of the town-owned land, selection of contractors, cost estimates on prefabricated houses, order for construction work and arrangement of contract documents and minutes.

Material Distribution

JEN distributed vegetables to 80 households (260 people) in the Higashihama area of Oshika Peninsula. 280 loaves of bread were also distributed to the area from a bread factory in Ayukawahama.

For more information about our Japan Relief Efforts click here

If you are interesting in donating to the earthquake/tsunami relief efforts with our partner JEN in Japan, click on Donate below.

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By Nyamat Bindra, Director, Education, Real Medicine Foundation, India

How to make the children not get bored in the summer? How can I make them enjoy staying at school? What can I make them do that is new, exciting, cost effective and something that the children would learn new skills from? What could it be …. Then it struck me! The one thing that Indians love…. Cricket!

I decided to organize a camp for the boys at school and art class for the girls!

Our school boys would play cricket the minute they got a chance, so I got in touch with a cricket coach I met earlier and asked if he could help me.  Mr Ajij Sheikh said that they were conducting a month long camp at the nearby college ground, free of charge, everyday 8am to 10am and 4pm to 6pm for interested cricket enthusiasts! He asked me if we would like to send some of our students. I told him that I could get 10 boys. When I made the announcement to the boys at school, 20, class 6th to 9th graders enrolled! I knew I had struck the right chord with them!

Every day, for the following month, the boys would go for a run in the morning and train in the afternoon, under a team of 5 coaches. They would get free breakfast, which consisted of an egg and a glass of milk in the morning and a banana in the afternoon. All 20, braced themselves for a new challenge!

Caitlin asked them on day 2, so `will you be able to keep up and be ready to be on the ground at 8 am? Jointly, they replied `Yes!’ `We don’t want to be punished by Mr. Shiekh and take extra rounds of the field’.

Our 20 players of TEAM BHIL, needed track pants, shoes, caps, and cricket gear. Caitlin’s father and our volunteer Carolina graciously donated money for that.

The boys learnt and practiced how to be fit, how to increase their stamina through regular runs, stretches and eat the right diet.

In the cricket camp the boys learnt the techniques behind batting, bowling and fielding and other nuances behind playing the game the right way such as pitching a leather ball! 3 of our boys were even selected for a tournament in Dahod and represented team Jhabua.

They learnt a new skill, met new people, made friends with other students from different schools and learnt true sportsmanship spirit.

My goal was achieved!

To keep the girls from class 6th to 9th, I organized stitching, needlework, working with beads and art class, which they enjoyed thoroughly under the guidance of our wardens Nirmala and Pushpa.

For more information about RMF’s Malnutrition Eradication Program in India, click here

We can use any financial help you are able to provide on this project to continue our Education,Treatment and Outreach and help toward our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org

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by Marshall Singh

Virgil wrote that fortune favors the bold, but I’m pretty sure this isn’t what he had in mind.

I’ve been in India for a grand total of 36 hours, most of it in transit, and it’s this last leg that is the most terrifying. Flashes of colour and sound as we hurdle down a road with what might generously be called lane markers, drivers in opposite directions flashing their headlights and honking frantically.  There are seat belts in the car, but somewhat incongruously, the ones that actually have clips don’t seem to have anything in to which they buckle. Our driver (who, appropriately enough, has been dubbed ‘Michael Schumakr’ by the local staff) seems to revel in swerving away from oncoming trucks at the last possible second, dancing to and fro between lanes like a hippopotamus on roller skates, its sheer bulk and momentum defying the manoevres it seems to barely pull off.

 My companion turns to face me, and grins. “Welcome to India.”

It’s not until we park and move into the RMF house in Jhabua that I pause to contemplate everything I’ve seen so far. Images and soundscapes paint themselves over the canvas of my recollections over the past few days. The gloriously chaotic mess of stores, streets, stalls, banners and people that is Mumbai. The verdant green countryside outside the bustling, churning sprawl of the city, nourished by the monsoon rains, that seems to stretch on and on, ending somewhere beyond the horizon. The somewhat dusty rural charms of Jhabua, tin roofs and half finished houses nestling between green leaves and cows hanging out in the middle of the road, ruminating placidly in the face of people, cars, and more cows.

It is in Jhabua that I find myself resting my head after traveling halfway around the world, mind racing and reeling from the new surroundings. America may be a melting pot, but India is a stew: simmering with heat, varied in texture and flavour, with alternately sweet and spicy components floating and churning in the mix.

Time to start digging in.

As the days go on, I begin taking in the various aspects of the more rural areas where RMF is active. In Bhopal, we meet in the sterile, air conditioned office of a highly placed Indian official who will be supporting us in the district wide mission planning that will be rolled out soon. The day after, in a somewhat stuffy wood paneled boardroom (replete with microphones at each seat), we sit and listen to the machinations and turf squabbles of various governmental departments and NGOs (who will go unnamed here, for reasons that I hope are obvious) over the particulars of how this new district planning process will work, and what exactly it will cover.

When the protocols and procedures of administration and planning are done with (for now), we make our way through the various districts to Barwani, where I encounter the local women who have been employed to work as community nutrition educators (CNEs), with regard to proper diet and malnutrition information. They’re a well versed, capable bunch, who don’t look like they’ll put up with much tomfoolery from anyone, and with one glance around the room, it seems that I’m the newbie – and there’s not much disagreement here.

After becoming inordinately excited on hearing the words ‘party block’ (and having subsequent images of a neighbourhood wide festival of some sort, perhaps of a religious nature, coinciding with one of the many, many faith-oriented holidays that happen here), I look around and see rolling, verdant green hills surrounding houses made from tree branches, mud and tin roofs. This is ‘Pati Block’ (pronounced, as I discovered, in a somewhat misleading way), a historically underserved region, and we are making a field visit.

There are no favors or silly hats here – we’re visiting the rural home of a family with a child who was born with a congenital malformation requiring surgery. We trek out half a mile into the fields, through mud and the pouring rain, taking shelter in the family’s humble dirt floored house. Later, we make arrangements to bring her to Indore, a nearby district, for further examination and surgery.

It’s been such a short span of time since I landed at Mumbai, and the scope of the work that RMF does is starting to take shape before me. There’s still a lot to see and take in, from the coordination with governmental forces and application of resources in various directions, to the monitoring and field work that needs to happen on the ground. I’ve still so much to learn.

Until next time,

-M

For more information about RMF’s Malnutrition Eradication Program in India, click here

We can use any financial help you are able to provide on this project to continue our Education, Treatment and Outreach and help towards our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org.

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by Roma Patel

Real Medicine Foundation Guest Entry

I heard about the Real Medicine Foundation and that they would be needing help in Ahmedabad, Gujarat through a friend of a friend. Always looking for any unique volunteer opportunity, I jumped to the occasion. They needed me to assist patients and their families that came to the Civil Hospital, a local government hospital, for advanced medical care. Even though I had vast experience at hospitals in the United States, I had never before been to a hospital at India. I was only vaguely familiar with how healthcare worked in India. But, nonetheless, when I got a call saying they have a patient admitted and would I go to help out, I was elated at the prospect of being able to help.

It was not until I got to the hospital and realized how monstrous it was that I felt totally apprehensive and overwhelmed about the situation. But I carried on and went inside to find the first patient, Rahul. As soon as I saw the look of relief on Rahul’s parent’s faces when I introduced myself, all of my fears vanished. I visited the hospital daily during Rahul’s admission. I learned to communicate with the doctors and translate the information they told me (or that I got out of them) in my broken Hindi. I quickly realized that the parents were simply scared and overwhelmed. They just needed someone at their side to advocate for their child and help them navigate. My regular connection with them kept them rooted at the hospital and prevented them from eloping. Knowing that my connection with them kept his parents in the hospital and allowed Rahul to get the treatment he needed made my time and efforts worthwhile.

The families that I worked with during my few months with the Real Medicine Foundation were illiterate but very competent. They just needed someone by their sides to give them courage and support and to help them get through the difficult time in their lives. My time with the Real Medicine Foundation gave me the opportunity to connect with people, help patients, learn about the healthcare system in India, and grow as a person. I am grateful for this opportunity and hope that the Real Medicine Foundation continues to get the support they need in order to keep touching lives everywhere they go.

For a more detailed account of my time in India, please visit my blog at www.romasindiatrip.blogspot.com.

With love in service,

Roma

“From Mud Huts to the Cutting Edge of Technology”

by Michael Matheke

In March 2010, Caitlin and I were driving around Khandwa district on a motorcycle desperately searching for staff to begin operations of our ambitious “Eradicate Malnutrition” program. In our heads, we had a checklist of criteria for potential new staff, mostly focusing on education levels and any experience in the health, nutrition, or NGO sector. As we drove from hamlet to hamlet, over dried streambeds and through fallow, dusty farmland, the checklist was whittled down to one item: literate.

In July of 2011, 5 of our amazing CNEs from Khandwa are now on the cutting edge of technology, helping Microsoft design their Digital Slate technology for data collection in the field. At the same time, the rest of our Khandwa team is collecting information with an application on their phones specifically designed from RMF called Commcare. After a 3 month study, Microsoft Research will publish a paper based on the inputs of our team comparing these solutions to data collection problems. It seems that my initial pessimism, as it so often is, may have been a bit misguided.

On a motorcycle in 100 degree heat, it was hard for me to imagine solutions to the multitudes of challenges our program would face. How would we train our staff? Would they understand the material and the importance of our task? Would they be able to accurately report what they were seeing and doing, and, if so, how would our small team process this information? We knew that none of our team was lacking in passion or enthusiasm, but how well would we adapt to new challenges? I couldn’t imagine, in my own head, solutions to all of the problems I could invent. I should have had more faith in the Korku women of Khandwa.

After our initial consultations, the team from Microsoft decided that a two day training session would be the best to cover all the topics and ensure that our CNEs know how to use the device, since it is a prototype of new technology. It took our team an hour. The rest of the weekend was spent by our CNEs training every member of the hotel staff where the training was held. After that, they also held an impromptu malnutrition awareness raising session, educating everyone and anyone who would listen about our program and the needs of the surrounding community.

As has always been the case over the past year and a half, I am constantly amazed by the abilities of our staff to process new information and technology. Besides the children we help in our program, the empowerment of tribal women is one of the most satisfying aspects of our program. With just a small push, and the framework of opportunity, all of our CNEs continue to inspire us on a daily basis. Their ability to master new technology far exceeds that of even myself; on the long trip back from our initial visit in Khandwa in 2010, I managed to neatly deposit Caitlin from the back of the motorcycle into a rather large pile of mud in front of about 50 people.

Real Medicine Foundation Mobile Data Collection

Currently The Real Medicine Foundation India is running the largest community based malnutrition program in Madhya Pradesh, covering a total of 600 villages across 5 districts with over 65 field staff. RMF’s “Eradicate Malnutrition” program covers over 65,000 children, diagnosing cases of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) and providing linkages to government of MP treatment services, such as referrals to Anganwadi Centres (AWCs) and Nutritional Rehabilitation Centres (NRCs) for inpatient treatment. RMF’s Community Nutrition Educators (CNEs) also provide counseling services to communities and families at risk or affected by malnutrition.

One of the largest problems facing RMF’s management team is a timely compilation and analysis of data collected by our CNEs. Currently, each CNE uses multiple paper reporting formats covering interactions with the communities and families. These diaries are then collated at weekly meetings and the aggregate data entered into computers by data entry officers. The lag time from data collection to analysis under optimum conditions is 1 month, hampering RMF’s abilities to quickly adapt and respond to unique situations and efficiently supervise field staff.

Streamlining Data Collection with Dimagi’s CommCare Application and Microsoft’s Digital Slate

RMF is currently in the test phase of two new forms of data collection tools utilizing low end mobile phones: Commcare by Dimagi and a prototype of Microsoft’s Digital Slate.

Digital Slate by Microsoft

Microsoft’s Digital Slate is a new form of technology that allows paper records to be copied and the information sent to a central database instantaneously. The Digital Slate is a device that converts written text into digital data. As our CNEs conduct their routine work and record their information, every entry is converted into a digital file by the slate. We have developed a special diary specifically for this application that records:

  • Child’s name
  • Village
  • Mid-Upper Arm Circumference (MUAC)
  • Complications such as fever, cough, or rash.

There is also an open field for notes that converts written comments into images that are stored in each case file.

All of the information is sent instantly to our supervisors via sms. Once the information is recorded, we have the ability to instantly process data, giving RMF’s management team a clearer picture of which CNE is handling which case and how many children we currently have enrolled in our program.

Commcare by Dimagi

Using forms developed specifically for RMF’s program and installed on each mobile phone, the CNEs collect information by answering questions in each form that is sent via SMS to a central database in realtime. Commcare provides each CNE with:

  • Entry points for child registration such as child name and village, important indicators such as Mid-Upper Arm Circumference (MUAC) and complication history, and verbal prompts from the phone that instruct the CNE to refer the child based on these inputs;
  • Easily accessed case histories for repeat visits with children that track previous treatments and counseling given and improvement or deterioration of the child’s nutritional status;
  • Referral tools to track recommended treatment for SAM and MAM children and required follow up by dates.
  • Counseling and referral tools that follow Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM) guidelines.

RMF supervisors can access this information from any location anytime via an internet based dashboard. The dashboard provides realtime displays of each form submitted by each CNE, a list of cases currently registered by name, village and CNE, and a downloadable excel file of raw data for instant analysis by RMF’s M&E officer. Pockets of malnutrition and complications by village are flagged so that RMF may investigate further. In addition, RMF can monitor staff activities remotely as all entries are visible by CNE and stamped with a date and time, minimizing the need for spot checks.

For more information about RMF’s Malnutrition Eradication Program in India, click here

We can use any financial help you are able to provide on this project to continue our Education,Treatment and Outreach and help toward our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org


 

 

 

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by Caitlin McQuilling

“Don’t automate a broken system”

Monitoring and evaluation is often the most difficult part of any development program.  It’s often an afterthought for implementers, too busy worrying about rolling out the immediate and the tangible to worry about how they’ll evaluate their work at some later stage.

It’s important that data is not something that’s just written down in a grid each month and never seen again.  The strongest programs are the ones in which ground level staff find their reporting useful in their daily work.  By making data helpful to ground level staff it makes their reporting in turn more accurate.

Even though RMF put a focus on our M&E from the beginning of our program, it has continued to be one of the biggest struggles in implementing our program on the ground.  As our program grows we are not only constantly assessing, analyzing and evaluating our data but also try to give the same level of analysis to the processes by which we collect data.

In this age where there seems to be a tech solution for everything, many development programs make the mistake of thinking that technology will be a “silver bullet” which will fix all of their challenges in the field.  The best advice we received from one of the technology experts we were consulting with when deciding which direction we should take our program was “don’t automate a broken system,” meaning that before introducing any new technology, an organization should make sure their fundamentals are solid.  As we moved forward with the planning of two innovative technology pilot programs for data collection integrating technology such as mobile phones or digital slates, we also needed to ensure that the fundamentals of our program are strong and that we understand and were honest about our strengths and weaknesses in data collection.

The following is a description of our current M&E system and the steps we went through to refine our processes and fix the problems we encountered.


M&E Process

Quantitative

  • Daily Diaries:  A simple book in which the CNEs freely record their daily activities and notes in the field
  • MUAC Diary:  CNEs each record in this daily register the names of SAM/MAM children they see and their Mid-Upper Arm Circumference.
  • Triplicate form: a triplicate carbon paper form which the CNEs use to refer children to the NRC and track the referral through the system.  One copy goes to the CNE, one to the family, and one is deposited at the NRC which we collect at the end of the month.
  • Weekly Reporting format:  Using the daily diaries, triplicate forms, MUAC registers the CNEs fill in the weekly reporting format and give that to their supervisors.
  • Monthly Reporting format:  The Supervisors collect all the CNEs’ weekly reporting formats and consolidate these into the monthly format.

Qualitative

  • CNE feedback form:  Filled out once a month by the CNEs to provide RMF management information about case studies, challenges, and success stories in the field.
  • CNE Needs form:  Filled out monthly by putting a simple tally in the boxes where they’ve had to give counseling.  Supposed to be a very easy way to assess the counseling needs in the field.

Process of verifying our data

We held our own internal audit of the first year of our reporting (May 2010 – March 2011).  Since our program is reporting big numbers and getting a lot of attention from government and NGOs, we wanted to be sure internally that our data was airtight and accurate.

Thanks to having a multi-layered MIS, we were able to go to the source of our reporting to get the accurate data.  By back-tracking of the data we were not only able to verify our data down to the individual child but also identify at which steps our MIS wasn’t working well.

Each CNE maintains a daily diary where she notes down information on the village she visited each day.  Then she copies all the information on children under 5 into a MUAC register, where she records the MUACs of children on each visit to the village over the months.  In this we have a full year record (or whenever the child was first identified) for each individual child.  This register is used by the CNE on a daily basis so that she can remember the history of each child she visits and so that she can see whether the child is improving or worsening on each visit to the village and can direct her counseling accordingly.  We believe that we have accurate MUAC registers for all CNEs, except for a few CNEs who we let go for poor performance.  For those villages we had the new CNEs we hired do fresh surveys and collect fresh data and compared that with the questionable data.

The CNEs use this register to fill out their weekly reporting format, which is submitted to their supervisor each week.  This format is where the problems with calculating and addition started.

The Coordinators then collect all the CNEs weekly formats and use those to create the district monthly aggregate report.  This is also where some errors occurred.

The weekly reporting formats and monthly reporting formats were filled out in hard copy by CNEs and District Coordinators, who did math by hand or using their cell phone calculators.  This many times led to human error which was not picked up until later when the data was entered into excel sheets by our data entry operator.  It was also a cumbersome process for the coordinators to consolidate all this data on a monthly basis and often took longer than RMF management would have liked.

Dr. Athar Qureshi, RMF’s Director of Programs, worked with the coordinators to create a new format, by village, where we reworked the totals for each village by month.  This gave us a more accurate number.  The Coordinators spent a weekend filling in all the data and checking the math.

Once the data was in an excel spreadsheet the team analyzed it and compared it to the original data submitted, the baseline data, and the NRC survey.  The NRC survey and baseline data are results we’re sure about because we can link those to the individual children, so those are good points to verify the data from.  We found that most of our data was reported accurately, with minor errors here and there, but that the process in which we collected our data was extremely time consuming and even more time consuming to go back and check.  This also made it difficult for the District Coordinators to apply the program data in the field and to do cross checking of reports which CNEs submitted.

During this review we also realized that there were many activities CNEs were conducting on a daily basis which were not reflected in our reporting formats.  CNEs recorded activities that were not reflected in the reporting formats as notes in their daily diaries, but each CNE recorded these activities in their own method.  During the data cross-checking these daily diaries proved to be very useful for checking numbers, names, and dates whenever there was a question in the reporting formats.  RMF realized the utility of having uniform reporting and a structure to these daily diaries while still allowing the CNEs some free area to write their personal notes.

We also faced some difficulties in the formatting of data from month to month as the overall compilation of the data was done by different people at different time intervals.  Before January of 2011, RMF did not have a data entry operator and instead all program data was entered by DCs or program managers.  Depending on how busy various individuals’ schedules were, one individual would enter the data for a few months and then another person would take over.

Lessons Learned

While this review of program data was tedious and painful at times, it was a tremendous learning experience for all staff members involved.  For the CNEs it was a process of reflection on the quantum of work they had done and also a time to formally point out questions they had and challenges they faced.  By spending so much time sorting through the program numbers, DCs gained an increased familiarity with what the numbers were actually capturing and became much more comfortable with data.  RMF’s program management also got to see where the gaps in reporting were and where we could support program staff better.

 

The following were some of the key lessons we learned and changes we’ve made to our reporting system:

  • The Daily Diaries and MUAC diaries are key, but structure is important
  • Someone needs to “own” the data
    • In November 2010 RMF realized this problem and requested our donors to provide us additional funding for a data entry operator and monitoring and evaluation officer who would “own” the data and make sure entry was uniform across all 5 districts.
  • Each piece of data should be clearly defined

Next steps

Following this review, the team created new, more intuitive daily reporting formats and a revamped MUAC diary to help address many of the problems we identified.  When introducing these new formats Dr. Athar and our Monitoring and Evaluation Manager, Julia Tewaag, held a two-day training for each district (10 CNEs and one DC) to introduce the formats, ensure everyone was clear on definitions and to walk CNEs and DCs through exercises which would help them better apply their data in the field.

 

With our M&E house in order, RMF is now ready to automate!  We have just launched an exciting pilot together with Dimagi and Microsoft Research India (MRI) to help us decide what is the best technology for our program to use.  With the help of Google and the Open Data Kit project, we’re also testing how Androids can be of use in our program.  More on those pilots in the next series of blog entries.

For more information about RMF’s Malnutrition Eradication Program in India, click here

We can use any financial help you are able to provide on this project to continue our Education,Treatment and Outreach and help toward our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org


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In recognition of our organization’s Malnutrition Eradication Project in India, we have been nominated as a “Charity of the Year” for the CLASSY Awards , sponsored by StayClassy  organization.  We need your help to vote for our organization so that we can progress from the list of 25 finalists to the final 10!

To vote for us, please visit this webpage: http://classyawards.stayclassy.org/classy-awards/voting , click on “Charity of the Year” and scroll down until you see Real Medicine Foundation and click on the “Vote” button.  It also allows you to vote for charities in other categories as part of your ballot if you would like.

The CLASSY Awards is the largest philanthropic awards ceremony in the country, recognizing the most outstanding philanthropic achievements by charities, businesses and individuals nationwide. StayClassy has published each nomination as it’s own article on the CLASSY Awards Achievement Blog to put a national spotlight on these amazing stories of achievement. Starting July 25th, America will vote for one winner in each of the 12 categories. The winners will be announced live during a Hollywood-esque award ceremony in San Diego, CA, similar in style to the Academy Awards, but philanthropy-inspired. 

For more information about our Malnutrition Eradication Project and the video that we submitted as part of our award nomination, watch on YouTube here .

Voting lasts until August 25th, so please help us spread the word!

The Team at Real Medicine

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