Annual Report 2018
Annual Report 2018
Our partner, CCBRT (Comprehensive Community Based Rehabilitation in Tanzania), is a leading healthcare provider specializing in disability, rehabilitation and maternal and newborn healthcare. A linchpin in the Tanzanian healthcare system, CCBRT has over two decades of service to the Tanzanian community and partnership with the Government of Tanzania.
The power of your impact
The power of your impact
As we prepare to celebrate our 10th Anniversary in 2019, we pause to reflect on the things you, our community, have accomplished. We are filled with gratitude. Over the past decade, your partnership, passion, and support have unlocked accessible, high quality healthcare for some of the most vulnerable groups in Tanzania. Asanteni sana (thank you very much).
Some of our biggest victories this year include:
Over 30,700 Disability Adjusted Life Years (years lost due to disability) averted through high quality surgical and rehabilitative interventions
Over 10,000 life changing surgeries performed
The soft launch of the CCBRT Private Clinic and the CCBRT Academy
More than 900 maternal and newborn healthcare workers trained by CCBRT’s expert teams
These victories would not have been possible without the Kupona community. You mobilized over $1.1 million in financial and in-kind resources. Beyond financial support, you contributed your time, expertise, and resources as diligent and enthusiastic partners. We don’t take one bit of it for granted.
This year saw many changes for both Kupona and CCBRT. In December, we said farewell to Erwin Telemans after nearly 13 years of dedicated service as CCBRT’s CEO, and welcomed Brenda Msangi into that critical role (you can ‘Meet Brenda’ below!) My colleagues Alexandra Cairns and Samantha Bossalini concluded their official tenure with Kupona - Alex to return to graduate school, and Sami to launch her own business. Kupona Directors Dr. John Brothers and James Mann stepped down from the Board after an incredibly committed 4 years and 9 years of service, respectively. I would be remiss not to thank each of them for their dedication to CCBRT and Kupona. They have left an indelible mark on our organizations, and it has been an honor to work with them. Many of you may be part of our community because of one of these amazing individuals. I encourage you to stay; the powerful work they supported continues, and we need your support. In the first half of 2018, we were thrilled to have Bob Schwed step into the Board President role, and to welcome Betsy Zink to our Board of Directors. You can read more about Bob and Betsy’s October trip to Tanzania below.
The victories we celebrate in the pages of this report are part of your story too. This narrative will only continue as CCBRT sinks their roots deeper into the community they serve, implementing new programs to make this life changing work sustainable for generations to come. In 2018, CCBRT embarked on a new 5-year strategy, and we were thrilled to work with our colleagues at CCBRT to deliver innovation, progress, and improvements across our transformative programs. We cannot stress enough how critical CCBRT’s programs are to the people they serve, and it is with that in mind that we set our intentions for the future. There is still much work to be done, and we are committed to doing it together.
We are abundantly grateful for all you have contributed to our past and present.
Executive Director, Kupona Foundation
Brenda has been a vital member of the team at CCBRT since 2009, most recently serving as Chief Operating Officer, and previously as the Director of the Disability Hospital. She was appointed CEO in December. This transition was part of the long-term vision for CCBRT’s leadership succession. Brenda is a great colleague and friend to Kupona, and we look forward to continuing to work productively with her in support of Kupona and CCBRT’s missions.
Thank you to every member of our community who supported our work this year. In 2018, you made donations of time, dollars, and even photos through Johnson & Johnson’s Donate A Photo app. You joined us for cocktail receptions, meetings, and golf outings. You brought a piece of Tanzania home with you while supporting the holistic recovery of women who have lived with obstetric fistula through your purchases of handmade items from The Mabinti Centre. And you shared our story by raising awareness on your social media platforms and among the members of your own community.
By sharing your passion and support for our work, you became an integral part of Kupona’s story. You significantly changed the lives of thousands of women, children and people living with disabilities.
Improving access to quality, specialist surgery & rehabilitation
Improving access to quality, specialist surgery & rehabilitation
Tanzania has one of the highest population growth rates globally. As a result, the number of people affected by disability in Tanzania will continue to increase. People living with disabilities experience disproportionate levels of poverty and exclusion from social and economic activities, and children with disabilities are particularly vulnerable. More than half of children with disabilities do not attend school due to the stigma and challenges surrounding their condition. Illiteracy among Tanzanians with a disability is 48%. Compounding this struggle is a shortage of high quality surgical and rehabilitative care providers. As a result, even if a person knew that their condition could be treated and sought out treatment, the availability of specialist healthcare is limited.
In Tanzania, only an estimated 3.1% of adults with a disability are gainfully employed.
Estimates suggest that only 51% of boys and 42% of girls with disabilities in Tanzania will complete primary school education.
Many families affected by disability in Tanzania spend 15% of their household budget on healthcare, one third more than the average.
The exclusion of people with disabilities from the workplace, either through discrimination or inaccessible work environments, costs Tanzania $480 million every year.
Tanzania has only 5.2 clinical health workers per 10,000 people, (one fifth of the optimal ratio recommended by the World Health Organization) and only 177 specialist surgeons to serve the current population of over 55 million people, (the Lancet Commission recommends at least 10,694 surgeons to serve this size of population).
You invested in comprehensive treatment and rehabilitation for adults and children with disabilities. Your support trained healthcare providers in specialist fields, and made improvements to the existing healthcare infrastructure, enhancing the quality and sustainability of healthcare in Tanzania.
CCBRT is the largest provider of disability and rehabilitation services in Tanzania, providing comprehensive, specialist care that is accessible for every patient regardless of their ability to pay. As a specialist in disability and rehabilitation, CCBRT is committed to sharing its expertise and strengthening the network of quality care available to people with disabilities in Tanzania. Their capacity building efforts target every level of the healthcare system, starting in the home and community and ending with regional hospitals.
Our partner CCBRT saw great change and expansion beginning with the soft launch of their new Private Clinic in July. The Private Clinic offers the same high quality rehabilitation services as the Disability Hospital, but also offers ear, nose and throat (ENT) and gynecological services, and some extra conveniences for patients who are able to pay more for their treatment. Revenue from The Private Clinic helps subsidize the cost of care provided to patients who cannot afford crucial health services. In 2018, Private Clinic revenue funded treatment for 20% of patients who could not afford to pay themselves.
With the support of the Kupona community, Johnson & Johnson, and the UCLA Anderson School of Management, our colleagues at CCBRT are now sharing their expertise and strengthening the health workforce in Tanzania and beyond through their dedicated training facility: The CCBRT Academy.
In April 2018, the Academy hosted its first class: a Training of Trainers session with our friends at Miraclefeet on clubfoot casting techniques. Trainees came from nine countries across Africa and ranged from experienced clubfoot care providers looking to further develop their skills as trainers, to health professionals with limited experience of using the Ponseti method for clubfoot care. The CCBRT Academy will be a Center of Excellence in Clinical Education, based at CCBRT’s hospital in Dar es Salaam. This training is the first step toward CCBRT’s goal of helping address the significant human resources for health shortage in Tanzania and East Africa by delivering education and training for working clinical, nursing and healthcare staff in a learning environment of the highest quality.
CCBRT also took steps to improve internal communication, and to become a ‘greener’ institution in 2018, by furthering the transition to electronically stored medical records.
They also finalized improvements for patient follow-up and treatment monitoring via SMS messages that remind patients of their recovery protocol and when they need to come in for an appointment.
CCBRT is the largest obstetric fistula treatment provider in the country. Nine years ago, CCBRT saw a sharp increase in the number of fistula patients they received due to their utilization of MPESA, a mobile money transfer system that CCBRT uses to send patient transport stipends. In 2018, CCBRT piloted an additional mHealth initiative – a free, interactive voice response (IVR) information platform hosted by a telecommunications provider to raise awareness about fistula, its causes and treatment options. The IVR platform uses 16 Swahili-language messages about obstetric fistula to increase community health education, reduce stigma and misconceptions, and, ultimately, encourage all women to seek treatment earlier.
In 2018, CCBRT provided interventions to more than 62,800 individual patients, including over 12,700 patients who received services completely free of charge and more than 49,900 who received services at subsidized rates.
8,900 surgeries were provided at CCBRT Hospital, including over 6,800 surgeries for people with visual impairments, 931 orthopedic and reconstructive surgeries, and 207 surgeries for children with cleft lip/palate.
Over 700 women and girls with obstetric fistula received comprehensive treatment.
96% of women surveyed were dry six months after fistula surgery, a surgical success rate that far exceeds the established FIGO standard of 75%.
More than 340 children were newly enrolled in CCBRT’s clubfoot treatment program.
Families of over 2,000 children with disabilities were supported through over 5,600 home visits.
Over 1,300 assistive devices including prosthetics, orthotics, orthopedic devices and wheelchairs were provided to children and adults with physical impairments.
Almost 450 community health workers received training, enabling them to identify and refer women and girls with fistula for treatment at CCBRT and its partner facilities.
275 people received disability inclusion trainings.
After giving birth to her first son, Hilda could not control her bowels. This is one of the most common and devastating symptoms of obstetric fistula. Hilda’s uncle worked in a military hospital, so she sought treatment there. Less than a year after the surgery, Hilda suffered a trauma. She was physically attacked, and as a result, all of her healing and progress was undone. "I was torn apart," she said. Living with her condition, Hilda moved in with relatives and tried to start afresh.
Thirteen years later, Hilda delivered another healthy baby. During labor, Hilda’s nurse recognized the improperly healed fistula and referred her to CCBRT. A few weeks later, Hilda met with Dr. Eric at CCBRT. She underwent a successful fistula repair operation, provided free of charge, and she recovered at the hospital.
"I was so happy to spend time with the other women here. Before this, I thought and felt I was alone."
Soon after being discharged, Hilda received a phone call from Mama Millinga, CCBRT's Holistic Care Coordinator, inviting her to join The Mabinti Centre's arts and entrepreneurship training program. Her first thought was how to afford this apprenticeship, but she was assured that her training, transportation and meals would be subsidized. She completed the program and graduated in 2015.
"I learned how to use the sewing and screen-printing machines. Now I can make handbags, purses, bags, pillowcases, toys and my favorite: backpacks."
Hilda returned to CCBRT in 2018 as a fistula ambassador. She is one of thousands of individuals across Tanzania trained by CCBRT to identify and refer women with fistula for treatment. During her visit, she shared her experience with the ladies waiting or recovering from treatment. She talked about her training at Mabinti and her time as an ambassador and encouraged the women to make use of the resources available to them for “life after fistula.” Hilda and her son joined the patients for Mama Millinga’s therapy session and lessons of the day. Hilda continues to fight fistula stigma in her community and empower women with fistula to seek treatment.
Making Motherhood Safer in Tanzania
Making Motherhood Safer in Tanzania
Improvements to maternal and newborn healthcare save lives and are also the most effective way to prevent disability. For every woman that dies in childbirth in Tanzania, 20 more will develop an injury, infection or debilitating impairment. Each year, thousands of children in Tanzania are born with birth defects like cleft lip/palate and clubfoot. When these impairments aren't properly diagnosed and referred for treatment at birth, they can develop into long-term disabilities, compounding the complexity of treatment and adversely affecting a child's development.
Tanzania's largest urban center, Dar es Salaam, is one of the fastest growing cities in the world. Dar es Salaam is on track to become a megacity (with a population greater than 10 million) by 2025, yet the city's healthcare infrastructure was built to serve only 750,000 people. Healthcare facilities are stretched beyond their capacity as more people move into the region. Despite the best efforts of frontline heath workers, shortages of skilled staff, critical gaps in equipment and supplies, and broken referral systems put the lives and welfare of women and newborns at serious risk.
Investments supported training and capacity building in Dar es Salaam's public healthcare facilities, the training of frontline maternal healthcare workers, and the implementation of systems that will improve the standard of care for women in Tanzania. Your support resulted in the delivery of integrated services to help address the unmet need for family planning as well as preparations to open a new referral hospital for emergency and high-risk deliveries.
CCBRT’s approach to improving maternal and newborn healthcare is a two-pronged. The most immediate need exists in the healthcare facilities that are stretched beyond capacity to serve the booming population. Through the CCBRT Maternal and Newborn Health Capacity Building Program, frontline healthcare workers in 22 partner facilities receive the training and resources they need to save lives at birth. One of those facilities recently requested a training in post-partum hemorrhage (PPH) management. PPH is one of the leading causes of maternal mortality in Tanzania, as clean blood supplies are limited, and there may not be enough staff members to take action in an emergency. CCBRT answered this request for training, and one week later received a call that the training had saved the life of a young mother whose life had been in jeopardy.
The second prong of CCBRT’s approach is to establish a referral hospital for the region’s most at-risk cases. Construction of the CCBRT Maternal and Newborn Hospital is scheduled to conclude in late 2020. When the hospital is fully operational, it will oversee more than 12,000 high risk deliveries each year, alleviating pressure on other facilities. The hospital will host one of the region’s few dedicated blood banks.
CCBRT also recognizes that there is an unmet need for high quality family planning services in Tanzania. Women and adolescent girls may be looking to prevent or space their pregnancies, but may not know what contraception options are best for them, or what is even available. Through the Tim’s Corner Family Planning Clinic at the CCBRT Disability Hospital, patients, staff, and members of the local community can receive the information and tools they need from a highly trained nurse, equipping them to take their reproductive health into their own hands. In the last half of 2018 alone, Tim’s Corner served over 400 patients. Family planning counseling is also provided in discreet one-on-one meetings for all women recovering from fistula surgery at CCBRT, so they have the necessary tools to allow for full recovery following their treatment.
Over 83,400 deliveries supported in 22 partner health facilities, including 12,832 Caesarean sections.
Over 900 frontline health workers were trained in the provision of high quality maternal and newborn healthcare.
Over 700 clients, including 107 fistula patients received respectful, appropriate family planning services.
Dr. Timothy Mushi has worked on CCBRT’s Maternal and Newborn Healthcare Capacity Building team since 2013. As a clinical trainer, he supports health workers in 22 capacity building sites so they can deliver higher quality care to mothers and newborns. His training program in 2018 focused specifically on vacuum-assisted deliveries.
“Mothers in labor need to deliver within a certain time frame,” Dr. Timothy explains. “Prolonged labor isn’t healthy for the mother. It leaves her exhausted and can cause fistula or death. And it certainly isn’t good for the newborn, because it can cause birth asphyxia (when a newborn stops breathing).”
If a woman is eligible, trained nurses and doctors can use a vacuum device to ensure that her baby is delivered during the appropriate window of time. Put simply, “when vacuum rates go up, fistula goes down.”
The procedure only takes 10 to 15 minutes and requires a much shorter preparation and recovery time than a Caesarean section. “The vacuum can have negative side effects if done poorly,” warns Dr Timothy, “so that’s why we focus on training.” In his 2018 training, Dr. Timothy worked with 97 providers in seven of the busiest Dar es Salaam health facilities. His sessions consisted of a brief classroom training to identify existing skills, followed by on-the-job training to fill knowledge gaps and give health workers a chance to perform the procedure with his assistance. From March to April of 2018, 42 vacuum-assisted deliveries were done under his supervision. Average skill scores of participants increased from 53% to 85% at the conclusion of the training.
Stories from the field demonstrate just how important this work is. Dr. Timothy recalls entering a busy labor ward one morning, where the doctor on-call was finishing his eighth Caesarean section in 24 hours. Exhausted, he asked Dr. Timothy to attend to the final woman waiting for surgery.
“I reviewed the client and discovered that the baby was low enough for a vacuum extraction,” says Dr. Timothy. He performed a successful vacuum-assisted delivery, avoiding the need for surgery altogether. “The doctor observed my procedure and insisted that he would not leave until he learned how to do one, too. And the mother had not wanted an operation - she was so thankful for our help.”
Mobilizing support & building partnerships
Mobilizing support & building partnerships
By participating in conferences and events throughout the year we have opportunities to build partnerships with organizations and individuals who share our passion for global health. We also use storytelling to mobilize our growing community of Kupona supporters. From digital activations and speaking engagements, to golf tournaments and cocktail receptions, our activities in the United States and abroad take on many forms. However, we have one underlying goal: to shine a spotlight on the causes we champion, and to show individuals and institutions how they can empower people and communities living in poverty to realize their full potential.
Members of Kupona’s network of supporters and the local Saratoga Springs community came together to golf for good. In the evening’s remarks, our Executive Director Abbey Kocan shared how disability can be a life sentence to poverty in Tanzania, and how for children like Lita, accessing free treatment for a condition like clubfoot is life-changing. Because of the generosity of our community, Lita received the treatment she needed and is now able to walk, play and go to school. Abbey also provided an update on the importance of sustainability and the measures we are taking to ensure that high quality care remains available for generations to come. The generous support of Kupona’s sponsors and the Saratoga Springs community raised over $47,000 to provide life saving and life changing healthcare services to mothers, newborns and children living with disabilities in Tanzania. You can read more about the event on our blog.
In early September, Abbey joined an esteemed group of speakers and panelists at the Diaspora Council of Tanzanians in America (DICOTA) 2018 Convention in Bellevue, Washington. Abbey was delighted to address DICOTA for the first time. In her remarks, she highlighted Kupona’s commitment to providing high quality healthcare to those who need it most. She shared CCBRT’s comprehensive approach to healthcare, and important recent and upcoming milestones, including the opening of the CCBRT Private Clinic - a critical achievement in CCBRT’s journey toward social enterprise - and the anticipated completion of the new Maternity & Newborn Hospital in mid-2020.
In September, Abbey spoke on CCBRT’s behalf at the 2018 Concordia Annual Summit in New York City. She shared our joint vision for the future of a new, life-changing project being executed by CCBRT as part of the Creating Hope in Conflict Humanitarian Grand Challenge. Speaking to an audience that included U.S. Agency for International Development Administrator (USAID) Mark Green and Secretary of State for the UK Department for International Development Penny Mordaunt, M.P., Abbey explained how CCBRT will use 3D printing technology to make high quality lower limb prostheses for people with disabilities living in refugee camps in western Tanzania. Ultimately, the project aims to strengthen rehabilitation services in the region and demonstrate the potential to scale this innovative approach in similarly remote and marginalized regions.
In October 2018, two members of our Board of Directors – Bob Schwed and Betsy Zink – traveled to CCBRT to meet with our Tanzanian colleagues in person, share their own expertise and gain a deeper understanding of the priorities in the communities we serve. In addition to taking tours of the new Private Clinic and Maternity Hospital facilities and practicing their screen printing skills at The Mabinti Center, Betsy brainstormed potential areas for future programming with the CCBRT Maternal Health Capacity Building team, calling on her own experience as a doula.
Read more in Betsy’s beautifully written blog post in which she captured her reflections from the trip, including an explanation of how she became known as ‘the Fistula Lady.”
Likewise, Kupona has experienced the support and generosity of local community in our hometown - Saratoga Springs, NY - as we raise funds and awareness for CCBRT’s life changing work.
In November, our team was proud to announce a new partnership with Fingerpaint Marketing and Saratoga Hospital that will help reach more mothers and newborns with high quality care over the next three years. After pledging their support for quality maternal and newborn care on both a local and global level in 2019, Fingerpaint made a generous three-year commitment to support our maternal health efforts in Tanzania. You can read more about our partnership in The Saratogian.
Seizing more opportunities in 2019
Seizing more opportunities in 2019
With investments in scale and sustainability and the opening of the new maternity and newborn hospital, the number of people directly served at CCBRT will increase and thousands more will benefit from our efforts to strengthen the wider healthcare system. At optimal health, individuals and their families thrive, breaking the cycle of poverty.
In 2019, Kupona Foundation will celebrate our 10th anniversary. Stay tuned for more information on how you can celebrate with us.