Lifelens Project

What if you could use a mobile phone as a microscope to detect malaria? Lifelens introduces a new type of user friendly, tech-based rapid test to diagnose malaria. Decreasing false diagnosis will reduce risk of drug resistance, and proper detection will ultimately increase child survival.

Mobile Alliance for Maternal Action

MAMA delivers vital health information to new and expectant mothers through mobile phones. Messages can be given audibly for illiterate individuals & multiple family members can receive messages – impacting the influencing group. Check out what’s going on in Kenya.

Medic Mobile

Medic Mobile has developed several tools that help health workers and even health facilities collect and send information via mobile phone. Read their High Impact Use Cases to understand what their technology can do. Here are the Tools.

Medical Aid Films

MAF aims to save the lives of vulnerable women and children in developing countries by providing innovative training and education through film. Film Categories include: Safe Delivery and Healthy Newborns, Obstetric and Neonatal Emergencies, Food for Life, Breastfeeding, and more. Many films are in Swahili.

 Incentives for Immunization

What explains low take-up when vaccines are usually provided for free? In India, small incentives for parents, plus reliable services at convenient mobile clinics, increased full immunization rates sixfold. This approach was twice as cost effective as only improving service reliability.

Melinda French Gates: What Nonprofits can Learn from Coca-Cola

The Gates Foundation funds global programs to enhance Healthcare and reduce extreme poverty. Melinda talks about the great success of Coca-Cola and how it is desired and accessible in the most remote areas. She shares 3 key learnings from CocaCola that can help the Health community successfully spread life saving interventions.

Sanitation Marketing Toolkit

This online toolkit offers audio and Powerpoint presentations of topics teaching how to implement Sanitation Marketing in diverse geographic, cultural, and political settings. Learn about Sanitation Marketing, Formative Research, Product, Place, Price, Promotion, Communication Campaign, and Implementation. Watch this toolkit Overview.

Sprinkles: Easier Than Taking Vitamins

This article discusses the slow uptake of Sprinkles, an innovative treatment to address anemia and micronutrient deficiencies in children. Sprinkles proved popular in Kuria West, but due to a hold up in supply chain Nuru lost access. More information here.

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Susan Mosenya, a Nuru Healthcare Field Officer from Kehancha Division is among the early risers. Wearing a Nuru branded backpack, a couple of mosquito nets in one hand and a clean water storage bucket on the other, Susan sets out for the day. While Nuru farmers work on their shambas, she will be working on their health. A short time spent with her is enough to make you realize how resourceful and committed the Healthcare Field Officers are.

Sunrise has a different meaning for Mama Matinde Momase, a Nuru Farmer from Kwirambo village. As she works on her household chores, her 2 year old daughter, Mary is running up down gathering her toys in readiness for a full day of “work”.  As Mama Matinde pauses to look at her bright, energetic daughter, she smiles and says a prayer of thanks.

Baby Mary was never able to walk. At 18 months old, she was not even able to stand on her own. Because of this, Baby Mary was permanently on her mum’s lap or back, never able to explore the wonderful world of babies. As for Mama Matinde, her activities were cut down to the essentials only since she had to care for little Mary around the clock.

Susan Mosenya, the Healthcare Field Officer, was quick to note the unusual condition of Baby Mary on her first visit to the household. Mary was extremely small for her age, thin, pale and had diarrhea. Though the parents knew that there was something wrong, they held back from seeking help due to the stigma of having a disabled child. Susan used the behavior change communication skills that she had learned from Nuru to tell Mary’s parents about the treatments available that could help their daughter and break down the barrier that was preventing them from getting treatment. At the end of Susan’s visit, it was agreed that Baby Mary would be taken to the nearest health facility the following day. Susan wrote a referral letter which Mama Matinde took with her to Tisinye Health Centre where the baby was treated and put on Ready to Use Therapeutic Food (RUTF).

It’s now 4 months since that day. A beautiful girl who was headed for a stunted growth is now playful and active thanks to the intervention of the Nuru Healthcare Program. Better still, Baby Mary will not be the “baby” of the family for much longer because her mother is expecting another child in a few months! Unlike her previous pregnancy, Mama Matinde is up to date with her Antenatal Care clinic visits, has necessary vaccines, and all the plans are in place for her to deliver at the clinic.

As a result of Nuru Healthcare program interventions, the days ahead are looking healthier and brighter for baby Mary, her mother and so many other people.

Written by:  Robert Kihara, Healthcare Training Manager, and Becky Okinda, Healthcare District Manager, Nuru Kenya

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The New Year has also brought some new challenges. The nationwide nurses strike has caused significant interruption to healthcare services, particularly in rural areas. Some of the nurses in charge have been treating the seriously ill but the service is patchy and unreliable. The importance of simple, preventative healthy behaviors are more important than ever. The Healthcare Field Officers (FOs) have been doing a great job connecting people in need of treatment to clinics and health facilities that are open. One great story that emerged was that one FO, Magaigwa Wagesa, came across a pregnant woman in labor. The FO was able to contact the nurse in charge at the local clinic who arranged for a government-funded motorcycle to transport the pregnant woman to the clinic. The mother delivered a healthy baby without any complications. Hongera sana! (Congratulations in Kiswahili!)

The Social Marketing team immediately turned their attention to the issue of Maize Lethal Necrosis Disease (MLND) that has the potential to threaten maize crops and livelihoods in Kuria West. One of the strengths of the integrated Nuru program model is that it allows for skills sharing to support other programs areas. The social marketing strategy in particular has the potential to inform much of Nuru’s work beyond the Healthcare program and this campaign will be run in close collaboration with the Agriculture program. The Agriculture team is busy issuing seeds and fertilizer to farmers, while the Social Marketing team conducts focus group discussions with key informant farmer groups in the community. Our aim is to analyze the barriers and benefits that will help the farmers adopt the behaviours necessary to stop and prevent the spread of MLND. The team is already putting some of what they learned during the November Barrier Analysis training into action and we will soon be out campaigning across the communities in which Nuru works.

2013 is going to be an exciting year for Nuru Healthcare. We will continue to scale, to improve our home visits and marketing campaigns, sell more products that will help prevent health problems, and influence more people to adopt healthy behaviours. Check back regularly to hear more about the life saving work that is happening in Nuru’s Healthcare Program.

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Don’t underestimate her petite frame and understated demeanor, Claire emanates a strong presence as she works with the team to strategically manage Nuru’s Healthcare program.  She’s no stranger to rigorous work, nor her current neck of the woods. Interspersed throughout her academics, studying law and politics at the University of Queens in Belfast, followed by earning a M.Sc at University College Dublin, Claire spent significant time working in Eastern and Southern Africa.

Though she claims her accent has lessened since living with 8 Americans, her team can see her roots shine through in idioms from her homeland and are often treated to traditional Northern Irish desserts.

Getting to know Claire personally and professionally during my visit was an absolute pleasure. Since I could not resist sharing my discoveries with the rest of the Nuru World, I persuaded her to undergo yet another one of my grueling interviews. Though slightly more intrusive, this one was under the informal pretense of sharing lessons learned and astute observations to paint a clearer picture of this multifaceted woman—the driving force of the Healthcare program.

On balancing life and work in rural Africa, here’s what Claire has to say:

Claire Rumpsa (CR): Growing up in Northern Ireland in the years that followed the Troubles meant that in some ways, I was on the receiving end of assistance and support from outside organizations, which was an interesting experience. I learned that the best organizations were those that worked alongside the local people, supporting and developing grassroots initiatives. I also love to travel and I want to use my time and talents to support and empower others.

LC: How did you learn about Nuru?

CR: I first came into contact with Nuru at a CAWST workshop on Community Health Promotion in Kenya.  Nicole Scott, (Nuru’s former Water/Sanitation program manager) was there with her team. Over course of the week I got to know them well and I asked lots of questions about Nuru!

LC: What excited you about the Healthcare Program Manager position with Nuru?

CR: I was working for an organization that focused on water, sanitation and hygiene, but I knew that to make a long term difference in community health, a comprehensive approach is necessary.  The 10 Healthy Behaviors that Nuru Healthcare promotes seemed to fit the bill!  I was also excited to work with an organization that believed in an integrated development model and would be able to help people improve their ability to save for their future and improve their crop yield.

LC: When you arrived in Isibania, what was the first thing that went through your mind?

CR: While still working with Aqua Clara, I came to Isibania for a training on affordable sanitation hosted by Nuru. While searching for the training venue, we nearly drove into Tanzania. It was a surprise to realize how close Isibania is to the border!

The training was great and I was amazed to see how far [Nuru’s] team had come in course of year in terms of their confidence and ability to influence change in the community.

LC: What was your first impression of Jake?

CR: The first time I met him was at that same Sanitation training. I didn’t realize that he was the CEO because he was so unassuming. He was really interested in what we were all learning at the training and how we were going to put it into action (Claire let’s out a quick laugh when reconsidering the situation). I was a little embarrassed that he came in during a role-play activity. I was playing the role of the latrine, crouched on the ground and holding my arms out in a circle…I recall thinking this must be a really odd first impression to make!

LC: While you’re in the field, what is the one thing, other than friends and family, you miss the most?

CR: Cheese!

LC: What has been the biggest surprise you’ve encountered since beginning your role?

CR: Even though I knew it before, it never ceases to amaze me how small behavior changes can make big improvements in health, especially for the most vulnerable.

LC: What single most satisfying aspect of your job?

CR: Working directly with the team. I can see their confidence and ability increasing as we work together. I enjoy helping to draw out their many talents and help build upon them in a way that enables them to really help the community. Building local capacity makes a big difference in the long run.

LC: What has been the biggest professional challenge you’ve faced since being in the field with Nuru?

CR: The original scaling plan for Healthcare was too aggressive. We needed to build a stronger foundation and to solidify the model before scaling. It’s been a good professional challenge and a great opportunity for more co creation with the Kenyan Healthcare team.

LC: Personal challenge?

CR: Learning to cook for 15 people at a time. Strangely, it will now be harder to cook for 2!

LC: In 2013, what goal are you most looking forward to achieving?  

CR: I am looking forward to handing over more of the day-to-day activities to Becky, our District Manager as part of the transition from expat to local management. This is a key milestone for the model and for our program. Also, it’s going to be great to be in my second year in job and know the program inside out!  The transition in responsibilities will allow me the time to explore innovative ideas or technologies that will help take the program to the next level. (Especially referencing our push to incorporate SMS broadcasting.)

LC: What is the funniest moment you’ve had with Nuru so far?

CR: The playboy curtains! We had just moved offices and needed a new curtain for the window.  The curtain that the team bought when I was on leave was patterned with purple playboy bunny rabbits on a pale pink background!  I first noticed the new décor during a meeting and couldn’t help laughing out loud. It’s pretty appropriate that the curtain is hanging in our social marketing office as we have been focusing recently on brand awareness and messaging. Clearly the team hadn’t made a connection to playboy as we know it and honestly, it makes me smile every time I go into the office.

LC: During a typical week, what is the thing you look the most forward to?

CR: I really enjoy the Monday morning staff meeting when the whole team is together sharing successes and challenges and problem solving. It sends people out on a high for the week.

I also look forward to nights around the fire pit at the weekend, relaxing with a glass of wine or taking long walks around where we live.  Kuria is beautiful and it’s a pleasure to wander and get to know the area better.

LC: What is the one thing you will never travel without?

CR: My own pillow– I traveled without it this time and will never do it again. And, my headlamp, of course!

LC: What is your favorite get-a-way in East Africa?

CR: Rondo retreat in Kakamega rainforest.  It’s one of the last areas of virgin rainforest in EA.  The monkeys, tropical birds and butterflies are incredible.

LC: What is your favorite meal at Migosi’s? [The small restaurant at our Regional Training Center]

CR: Chapati, beans and sukumawiki.  Some days Migosi has avocados that are a great addition. I also bring my secret supply of hot sauce.

LC: One piece of fashion advice for being in the field?

CR: Don’t where a pencil skirt if you are going to ride on a long boda ride (motorbike), or when you’re on market duty and have to deal with 4 unwieldy baskets of food.

LC: What is one improvement the HC program needs to make?

CR: We need to increase our ability to incorporate mobile technology into our program monitoring. There is big potential to get more immediate feedback from the field, and it can help provide better services to our community, like providing real time health updates.

As we continue to scale in Kenya mobile tech will become more important for maintaining contact with kikundi (our Field Officer units) that are far away. It will help to keep them up to date on what they need to know and do their jobs more effectively.

LC: What advice do you have for an incoming fellow?

CR: Make sure you really get into the field to see the project in action. Don’t get caught up with the day-to-day stuff at the Regional Training Center.

Take showers when you can! Don’t wait as inevitably the pump will break, the electricity will go out, or something else bizarre will happen.  Also, make your room nice! Create a space that feels like home so you can get away and recharge.

LC: Any advice for married couples in the field together?

CR: Take time for just the two of you, whether it be going out for walks or having meals together. Another rule of thumb, no work-talk under the mosquito net.

LC: What’s the first thing that comes to mind when I say communal living?

CR: Getting together at the end of the day and sharing experiences or funny things that happened. A lot of those things are difficult to explain to people back home, so it’s really nice to have built in communal support. Plus, it’s nice only having to cook once a week.

LC: Heading home for the holidays what is the first thing you will do in Michigan and then in Ireland?

CR: In Holland, MI we will go out for breakfast at our favorite place, The Biscuit and then hang out with our new niece. Last we saw her, she was only a few weeks old.

Back home in Ireland the first thing we’ll do is take a long walk on the beach beside my family home.  I’m biased, but it really is the most beautiful pace in the world.

Happy New Year from the Healthcare Program!

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These Field Officers are tasked with both observing and probing for information to understand their households’ current situations, and then using their findings to influence behavior and help troubleshoot maternal and child health problems. Despite their recent release from apprenticeship, both intuition and faculty kicked into high gear as several Field Officers working in the Nyametaburo Sub-location detected and reported a elevated incidence of what they identified as measles. News of these cases traveled swiftly from the field to the local Ministry of Health and the Kenya Medical Research Institute (KEMRI), which took quick action to collect blood samples and confirm the outbreak.

Our District Manager, Becky, and Training Manager, Robert, recognized an immediate need for informative resources and an emergency CUBIT (Continuous Capacity Building Training) about measles. What’s more is the fluidity of the communication and action taken in the absence of our in-country Program Manager, Claire Rumpsa. Claire has clearly made strides in preparing the team for full ownership of the program.

Becky requested Janine and my assistance in creating these materials. The timing could not have been better. Becky’s email landed in my inbox as I was participating in a TOPS Curriculum Development Summit. The module, Knowledge Sharing: Developing and localizing materials to empower Community Health Workers, had just reviewed Hesperian Health Guides’s new HealthWiki component.

Hesperian Health Guides is a nonprofit health information and health education source that supports individuals and communities in their struggles to realize the right to health. They develop easy to read materials that are produced in many languages. Now offering their content in a searchable wiki-based format, implementers can pull directly from their resources to create relevant tools for a particular program. The wiki is well suited for slow or intermittent networks and easy to adapt for local use. All open source, they also provide access to images to compliment the written component.

In about 10 minutes we had a thorough fact sheet ready to equip our Field Officers. Soon after, the team set out on a mission to halt this outbreak and prevent future occurrences by further promotion of one of our 10 Healthy Behaviors:  Fully immunize children under 1 year old.

More than 95% of measles deaths occur in low-income countries with weak health infrastructures.[1] Measles is especially dangerous as complications include blindness, deafness, diarrhea and pneumonia, the leading cause of death of children worldwide. Vaccines are available at local health facilities, and increasing immunization coverage is a high priority for our Field Officers as according to our baseline data, full immunization for children under 1 year old is at a dismal 5.8%.

Figure 1: WHO, Measles Surveillance Data, 2012

Thanks to open-source materials like Hesperian’s we are able to be agile and prepared in times of need, and always have reliable resources to include in our base trainings. We look forward to bringing our field staff up to speed on how to take advantage of these user-friendly, comprehensive resources so materials can be created directly in the field.

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Alice also alerted her Field Manager, Nelly Andega about the measles outbreak. The Nuru Healthcare team then initiated an emergency response to the situation. A simple and informative fact sheet was created, and the Training Manager, Robert Ndiritu immediately developed a refresher training for the Healthcare Field Officers across Isibania and Kehancha Divisions. The measles message is also being passed through the other Nuru impact programs to ensure that it reaches the community quickly. The Field Officers have continued to make referrals of suspected cases of measles and the outbreak has given them more impetus for encouraging Nuru families to immunize their children (one of our 10 Healthy Behaviors).

Robert added an innovative section to the training that focused on the rights of the child to adequate healthcare, which is enshrined in the new Kenyan Constitution. This is a great example of Nuru’s ability to empower people who are living in extreme poverty.

The Ministry of Health confirmed the outbreak and began a countrywide campaign to raise awareness of the infection. Unfortunately the necessary medications are in short supply in the rural clinics, but the Nuru Healthcare team is making targeted referrals to the facilities that are able to acquire the medications.

Meanwhile, the first Social Marketing campaign is in full swing. The first product that the team is marketing is a high quality, low cost concrete latrine slab. The brand name for this product is the NuChoo – “Nu” to make the connection with Nuru, and “choo” being the Swahili word for latrine.

In just over three weeks, the team has spread the NuChoo message to over 1,500 people through a variety of channels that were identified during the systematic formative research process. To date they have attended over 30 events and the number of interested customers has significantly increased. We’re following the rule of seven– that people need to hear a message at least seven times before they take action – and are focusing our efforts on Isiabania Division in order to have the greatest chance of people hearing the message multiple times through multiple channels. One of the innovative messaging concepts that was created by Red Balloon Ideas was a simple coloring sheet. The Nuru Education Team distributed to school children at the end of their outreach sessions, and the children brought them home to their parents. Since this distribution we have noted an increase in NuChoo inquires, confirming that children can be important influencers in behavior change.

Nuru Healthcare Program Isibania Division Field Officers

The Social Marketing team also set up a NuChoo stand at the busiest market day in Isibania town and drew a crowd of over 200 people with their attractive banner, dance competitions and catchy messages. A political rally was also taking place increasing the number of people in our target audience (male decision makers) who heard the NuChoo message of affordability, durability and savings. Alice is featured in this blog for the second time as one of her children returned from the market event and told her about the NuChoo. Brand recognition is definitely on the increase as people have been shouting friendly greetings of “NuChoo” to Becky Okinda, the Healthcare Program District Manager, as she goes to buy vegetables!

Epuka gharama jenga NuChoo – Rescue Money, Buy NuChoo!

The crowd at the market event in Isibania where the NuChoo was being introduced by the Nuru Healthcare Social Marketing team.

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During graduation, Scott Rumpsa (Team Leader), was the guest of honor and spoke about the importance of the FOs’ work in the community and encouraged them to do their job to the best of their ability. The FOs received their new uniforms, ID cards and backpacks, and the atmosphere was jubilant. The FOs had been involved in the design process and immediately put on their new uniforms with pride. The team broke into song when we took the group photographs – surprisingly the song of choice was “We Wish You a Merry Christmas!” The FOs are now settling into their normal work rhythm of home visits in their communities and regular meetings with their Field Managers.

Meanwhile, the social marketing latrine campaign is on the brink of launching. Nuru’s Social Marketing Strategy within the healthcare program is relatively new and is designed to reach the wider community with complementary messages that support the Home Visit Strategy. Our first campaign will focus on marketing high quality concrete latrine slabs and strong latrine pit lining which have been designed by the Research and Development Program.

Why latrines? One of the Healthcare Program’s 10 Healthy Behaviors focuses on using a latrine for defecation as latrines have long been shown to be highly effective in reducing the transmission of disease. Diarrhea kills 2.2 million people globally each year, mostly children in developing countries (WHO, 2012).

Diarrhea kills more children than malaria, measles, and AIDS combined. Proportional distribution of cause-specific deaths among children under five years of age, 2004 (excluding neonatal deaths)1

With the guidance of Fay Johnson, of Red Balloon Ideas the team identified our target audience as the heads of households, who are generally men as they make the majority of financial decisions about physical improvements to their homesteads. Formative research analyzed behavioral determinants of people who own a latrine and those who do not helped the Social Marketing Team to identify the key messages.  These messages will help us to reach our audience in a tailored, targeted way, helping community members to overcome barriers to purchasing. The marketing materials designed by Red Balloon Ideas and Advocate Creative highlight affordability, durability, safety and the ease of the purchasing process. The logo, posters, fliers and are really eye catching and informative, and we are eager to start distributing them. The team has also identified key channels to reach the majority the decision making target audience, including campaigning at chiefs’ barazas (community meetings), livestock markets, Nuru Agriculture and Community Economic Development meetings, market days and many other events over the next couple of months. Stay tuned for more stories of latrines and better health in the community!

Nuru Healthcare Social Marketing Team’s poster used to advertise high quality latrines made by Nuru Kenya.

1. UNICEF and World Health Organization. Diarrhoea: Why children are still dying and what can be done, 2009  [PDF - 68 pages] via CDC

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Training Manager Robert Ndiritu and District Manager Becky Okinda show the Field Officers in training a video on fast breathing as a diagnosis of pneumonia.

I’m writing this month’s healthcare blog while observing the initial Home Visit Strategy Field Officer training for Kehancha and Isibania Divisions. Our classroom at the Nuru Regional Training Center is at capacity and the bare walls are quickly being covered with flip chart paper displaying lessons about behavior change, health information, communication strategies, and much more. This is truly an exciting time for the Healthcare Program.

The Healthcare managers are doing an incredible job leading this training. Last week, I was sick and out of the office during an especially trying time for the team. There was potential for activities to wane in effectiveness and efficiency, but the team stepped up and managed all aspects of the training professionally and admirably.

Our Training Manager, Robert Ndiritu, is a wonderful facilitator and it is great to see how the trainees participate, respond and learn as a result of his interactive and informative training style. Some of the other Nuru program staff who are in the process of hiring their own training managers have been spying on our training to get some tips! Robert is also actively mentoring the local Field Managers, who are greatly benefiting from his experience and example. For instance our Mabera Field Manager, Juma Marwa, independently met with Robert at 6 a.m. to discuss and review the training content for the day ahead.

The Field Officers in training are visibly motivated and enthusiastic to learn. Even during inevitable post-lunch energy lull, the Field Officers remain active, and debate new topics energetically. Of course, there have been some challenges, particularly in relation to dispelling common myths about diseases such as pneumonia and malaria. However, trainers have remained patient, encouraging and firm as they work to train on the facts that will save lives.

Feedback from the participants has been positive and constructive. The team attributes this openness to the Nuru Leadership training, which the Field Officers have already attended. This is a great testament to the value of working within an integrated program framework. I am confident that we are going to have some incredible Field Officers coming out of this training, which in turn will benefit the wider Nuru community.

Nine of the participants are boarding at the Regional Training Center for the 2.5 week training. As we are the first Nuru program to utilize the boarding facilities, their patience has been appreciated while facing a few hospitality issues. Becky Okinda, our District Manager, has been managing and troubleshooting these issues independently and going above and beyond to ensure a comfortable stay. This is another great example of local leadership and ownership of the program. I am truly humbled by the dedication, professionalism and attention to detail that I have observed from the healthcare team. As an aside, the boarding facilities have been a great investment by Nuru as they enable participants to stay on site instead of traveling long distances, while also helping the programs to cut transport costs.

While the Home Visit Strategy Team has been partaking in training, the Social Marketing Team is busy collaborating with the Research and Development team for the latrine sales campaign. This campaign will focus on marketing a permanent latrine that is safe, durable and affordable.

It is no exaggeration to say that the Field Officers who will be visiting households after this training will have the ability to save lives through simple training and tailored interventions. I look forward to sharing more stories about these home visits in future blog posts. Next up, the training continues on the topic of newborn health and immunization!

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Last week, we finalized the hiring decisions for the new Social Marketing team.  Three Field Officers who previously worked as part of the WatSan program are now Field Officers for Social Marketing – they are all from the local community and we are grateful to have their knowledge and experience as part of our new team.  The Field Manager is an external hire and brings with her knowledge of behavior change as well as experience in managing a team of community health workers for another organization.

This week, we welcome Fay Johnston from Red Balloon Ideas to Isibania to conduct a training workshop on social marketing.  The first social marketing campaign will focus on latrines which ties directly to one of our 10 Healthy Behaviors.  The Social Marketing team will work closely with the R&D and M&E teams throughout this process to conduct formative research in the area, identify a target market, and develop and implement a tailored and targeted campaign to increase latrine usage in the area.  I’m sure there will also be ample opportunities for a bit of toilet related humor along the way too!

Another big event in the Healthcare Program will be the training of the Home Visit Strategy Field Officers for Isibania and Kehancha Divisions at the beginning of August.  Our Training Manager is busy revising and updating the curriculum to create an interactive and informative training.  Meanwhile, the recruitment for Field Officers from Mabera Division is getting underway.  Busy and exciting times!

This is my first blog for Nuru and I am looking forward to sending frequent updates and reflections over the next two years during my time in Kenya.  It’s hard to believe that it was only this time last year that I visited Isibania for the first time to attend a training that was hosted by Nuru, and now this is my home.  Having worked elsewhere in Kenya running a water, sanitation and hygiene program, I know first hand how difficult it is to create lasting change in a sustainable and scalable way.  What really struck me when I met the Nuru staff was their increasing confidence and ability to solve their own problems and help their community – I was inspired to work alongside them. The Nuru model is truly innovative and I am glad to be a part of helping to end extreme poverty here in Kuria.

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