"This is why we practice"

This has been Glen’s constant refrain the past few days. Recall that we’re in Ghana as an advance trip for a group that’s going to be brought over early next year to meet with Ghanian and Liberian NGOs. We’re checking out candidate NGOs, checking out the facilities and logistics, and making sure that we can put together a program that is both coherent and tractable.

For the Ghana portion, this has meant 23 different meetings in three and a half days, and – for some of us – upwards of 4 hours of driving each day. Amid all these meetings and driving, stuff goes wrong. Hotels don’t have the facilities advertised. Instead of being a 2.5 hour drive to Akim Kukubi, it’s four hours – we found that out the hard way, after 8 hours on the road. Or the NGO that looked so promising on paper turns out to be ready to fold.

This morning, it turned out that the location of the AWDF office wasn’t actually discernible from its address – the driver who took Glen there yesterday found it in 15 minutes, but the swap-in we had this morning took three phone calls and nearly an hour to get us there. Lost and late,  Glen pulled his favorite line from the Michael Jackson movie: “Guys, this is why we practice.”  We’re trying to figure out where things go wrong now, so that they go right when we’ve got two dozen TPW students and alums in tow next year.

We did finally make it to the AWDF office, picked up program officer Abigail, and raced over dusty red dirt roads to the Ark Foundation, our first actual site visit of the day.

Note: “AWDF” stands for “African Womens’ Development Fund”, but we were so tired it kept coming out like “American Womens’ Defense Fund” or something equally inappropriate when we tried to say it. They humored us as best they could. The Ark Foundation is one of their grantees. They’re a network that provides advocacy, protection, support and education to battered women. They’ve done some serious lifesaving, and their media campaign to convince both men and women that domestic violence isn’t acceptable seems to be gaining some traction.

At Ark, we sat in the sweltering shade of their main meeting room, talking over the rumble of the generator that powered their projector.  Two standalone fans provided our only relief from the heat while Angela, their dynamic, Whoopi Goldberg-evoking executive director, described their mission.

Glen, Darian and I went through our due diligence checklist – did they have a strategic plan? How were they measuring impact? They had their act together, but When we got to the funding questions, we had a showstopper. Yes, they were getting by, but – by the way – the Dutch grant that provided 70% of their institutional funding was expiring next month, and wasn’t going to be renewed.

There was a moment of awkward silence: “Um, do you have any plans for what you’re going to do then?”

Angela laughed and sounded disturbingly unconcerned. “Oh, we’re working on a few ideas. Starting some businesses that can help us support ourselves. Selling some things. That sort of stuff.”

More awkward silence. Losing 25% of your funding is frequently fatal, even to healthy organizations. Losing 70%? Next month? And they’re just “working on a few ideas”? How do we break this to them? They’re dead, dead, dead, and so is all of the wonderful work they’ve been doing.

Glen turned the conversation to a deep dive on their finances, and we discovered that it wasn’t quite so bad. While the grant was 70% of their institutional funding, it accounted for just an occasionally-not-quite-lethal 30% drop in their total revenues.

Not wanting to probe any further into this awkward topic, we drifted into chit-chat and set out for the obligatory tour of the facility. It was spartan by American standards, but remarkably full-featured for a Ghanaian operation, and impeccably organized.

Getting lost first thing in the morning had gotten us a late start, so we began our goodbyes and prepared to bolt for the car. We were still hoping we could make up lost time and get to our next site visit on time, but Joseph caught us as we headed out the door: “Do you want to see the well?”

Now, they’d mentioned something about a well when we pressed them on the “working on a few ideas” thing. We didn’t quite get it, but sure, we could take a moment to see the well. Through a side room into the back of the building, we found ourselves confronted with an array of huge tanks and pipes. At one end, the pipes led out to a cistern, pump and borehole well. At the other end, they led to an elaborate high-tech filtration system feeding a fantastical Chinese machine that formed those little hermetically-sealed bags of drinking water you see being sold all over west Africa.

“Yes, this is one of the businesses we’re starting. We’ve finished the testing runs and expect to be ready for production in a couple of weeks. Should replace our lost revenue starting next month and be turning a net profit by summer.”

Our jaws dropped. That dead-dead-dead stuff? Not nearly. No wonder Angela wasn’t concerned.  But how the hell can a shoestring service organization afford all this equipment?

“Ah, yes – good question. The granting NGO let us pre-load the three-years of grant money. We invested in some securities and picked up enough in capital gains to purchase everything before we spent down the grant.”

Picked jaws up from floor, released, and let drop again. We could learn a lot from these folks, as could the TPW cohort coming through next year. Glen,  Darian and I exchanged glances: we’ve got a winner.

Okay – we were still going to be late for the next visit, another AWDF grantee. We bounced our way through the tribal villages that had been swallowed whole as Accra expanded, and found ourselves at the Nana Yaa clinic, in perhaps the strangest setting we’d seen so far. The clinic is run out of what appears to be an old railway car or shipping container set smack dab in the middle of a large empty lot ringed by a low concrete wall.

Gladys Okwaning – sorry, Lieutenant Colonel (Ret.) Gladys Okwaning is an elderly matron who retired from her position as an army nurse to open this clinic. Along with compatriot Felicia Darkwah and a skeleton staff, she provides pre-natal and womens’ health services to the neighborhood girls. She’s enlisted the local schoolteachers to help make Nana Yaa a place where the girls feel comfortable hanging out, getting counseling, getting tests and getting treatment when needed.

Their goal is to do something about Ghana’s abysmal maternal mortality rate. In spite of the country’s many advances it has the highest maternal mortality rate in the entire continent, perhaps the world. Nana Yaa is named after Darkwah’s daughter, who died of easily preventable causes during childbirth, so these women are on a mission.

Gladys showed us the rooms that the building had been divided into: the examination room, the records room (filled with overstuffed boxes of plastic folders) and the counseling room. We settled into plastic chairs on the shaded porch area – a familiar habit by now – and listened to the plans and challenges they faced.

As Gladys talked and Felicia added color commentary, a trio of teenage schoolgirls in matching uniforms hopped the low concrete wall and found themselves a place on more plastic chairs arranged at the far end of the shaded porch area. They eyed us secretively, and chatted the way only teenage schoolgirls can.

We sat there, enchanted by the simplicity of Nana Yaa’s innovations. They’d identified nine primary causes of maternal death, and created a set of practices that tracked risk factors. The data were recorded in a small paper booklet which were stored in Nana Yaa’s “records room”.* The girls (and women) could take the booklets with them if they married and moved away, giving the eventual midwife or doctor critical context (more anecdotes from Felicia). The booklets also contained blank partographs, tables in which they, the midwife or doctor were to track the hourly progress of labor during delivery: pulse, blood pressure, dilation, fetal pulse, etc.  If the data on the chart crossed the first line, they were to alert a medical professional. If it crossed a second line, they were to get to a hospital.

What drew me was their M&E (measuring and evaluation) plan – a component almost universally missing from the efforts of NGOs. In six months, Nana Yaa will be throwing all the numbers from those boxes of booklets into a spreadsheet and tracking how often risks arose, how often – and how – they were acted on, and what the outcomes were. Good stuff – they’ll be able to actually measure how they’re doing, and we had another winner. Two for two.

Also two for two was the fact that we’d now spent most of the morning sitting out in 95-degree temperatures, and for the second time that day, we were drenched, dehydrated and hot enough to boil away into a puddle of green goo. We said our goodbyes, made promises to be back, and retreated to the sheltered air conditioning of our waiting car.

On the way back, we tallied our morning: a couple of good logistical lessons learned, some new ideas on how to organize the womens empowerment track, and two good NGOs to illustrate it. It had been a good morning’s practice.

[Yes, Nana Yaa should be maintaining all their records electronically, but they don’t even have electricity for much of the day – one step at a time, one step at a time.]

[On my way back via London as I write – will try to post this from Heathrow. Damn, so much I haven’t written about. Still haven’t told you about surfing in Liberia.]

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