Katie Hsih, who is from Los Altos, California, spent her last undergraduate summer in Sierra Leone working for the GAF/NOW organization based in the eastern diamond mining district of Kono. Fatu Conteh, of Houston, Texas, is a native of Sierra Leone, whose family was forced to flee the country in a fishing boat in 1999 to escape its civil war. They decided to pool their talents and resources for their ReachOut international project with what is now called the Wellbody Alliance in Sierra Leone.
Katie (with aid from Fatu) has been helping run and manage the current programs of GAF/NOW, founded and managed by Dr. Dan Kelly '03 and Dr. Bailor Barrie of Sierra Leone, one of the few physicians in Sierra Leone who has made the decision to stay and help the country recover from the war. The two most important projects are: the Kono Amputee Clinic, a primary healthcare clinic that offers free services to amputees and others who are war-wounded and inexpensive healthcare to the local community; and the HIV-TB Home-based Care Program, a recent initiative that trains
community health workers in partnership with the Sierra Leonean government. Katie and Fatu say: “GAF/NOW is a pillar of inspiration for the country's progress into the future and uses the lens of healthcare to facilitate its transition from post-war to development. It has a striking need for help. Our management role will help prevent the organization from collapsing while propelling it forward in new and promising directions to create social change and improve healthcare in Sierra Leone."
Fatu (with help from Katie) has created a peer education program for teenage pregnancy by setting up a youth center, a safe space that fosters intimate
relationships with the youths, particularly young girls. At this center, they have support group meetings, conference gatherings, social events, and education workshops to explore and address the issue of teenage pregnancy that is rampant in the local community and across the entire country. Fatu and Katie told us that "teenage pregnancy is one of the root causes of the astronomical maternal mortality rate in Sierra Leone, and it is an issue that is perpetuated by social norms. The activities we plan to implement will encourage the youths to make wise sexual decisions and contribute positively to the health and wellbeing of their community."
Katie (with help from Fatu) proposed to conduct an ethnographic research and analysis project to explore female genital mutilation (FGM), which is a wide-spread
practice in Sierra Leone and other West and Central African countries. It is closely
linked to marriageability, chastity, and family honor, and young girls who are not
"circumcised" often experience social ostracism or inability to marry, which is very
detrimental to the quality of life in a patriarchal society. The surgery often takes place in unsterile conditions, can lead to severe health complications, and is closely tied to maternal mortality. It is, however, a sensitive topic that must first be approached with immersion in the local environment and education about the complexities of the issue.
Fatu and Katie say: "Women have no power in Sierra Leone. They face discrimination under the law, in traditional practice, and in culturally acceptable social behavior. We will not only be a pivotal force in maintaining the GAF/NOW organization and sustaining its current projects, which alleviate healthcare disparity in the country, but we will also initiate the organization's first programs in a new direction to address women's rights."
Fatu Conteh &
Class of 2010
Fatu did well at Princeton, serving as vice-president of her class, and in addition to engaging in various public service activities, was the founder and president of the Princeton Africa Development Institute. One summer she worked in an Ethiopian village helping residents install hand-dug wells. She was highly recommended by one of her professors who also oversaw a conference that Fatu organized: "Her creativity, energy and maturity make her a pleasure to have as a student, and more importantly, as a colleague. She is highly selfmotivated, dedicated, driven and passionate…." Her supervisor at the Pace Center said that Fatu "is the kind of graduating senior that the ReachOut 56-81 Fellowship Committee might have had in mind," and went on to note that she "has demonstrated her commitment for hard work and leadership and she has executed both of these qualities with excellence and a great sense of responsibility."
Katie Hsih is a top student with a large roster of public service activities while at school. One of her teachers (for whom Katie later served as a research assistant) said that Katie "does a beautiful job integrating her operations research expertise and her clear interest in and deep commitment to global health issues. It was a joy to watch the gears turning in her impressive brain…"; and she concluded that "Katie is simply a spectacular young woman and will make any program that supports her proud." Another instructor who is also helping advise her thesis said that "Katie has the strongest inner drive of any undergraduate I have encountered as a teacher."
Dr. Barrie, with whom Katie spent last summer in Sierra Leone, said of her: "With Katie…as the programs manager, I will have time to focus on treating patients at the clinic. I have no hesitation that Katie will perform this role perfectly. We really need her out here…" This was echoed by Dr. Kelly ("we need her"), who praised her maturity, hard work, sensitivity, leadership and creativity.
Here are Katie’s own words to describe her far-reaching project:
“My role within the organization has spanned across many areas of operation within a startup global health NGO such as this one. I have been referred to as managing director, communications director, administrative coordinator... this is because the organization is small, transparent, and fellows are given many opportunities for responsibility and contribution.
“I did take over a number of management roles on the ground in Sierra Leone, and was involved in projects that include: HIV/AIDS home-based care program, HIV survey validation study, HIV stigma scale survey, amputee chronic pain program, palm kernel farm and oil processing plant (micro-agriculture social entrepreneurship), --ANC child health community health worker program. Fatu and I spent a large portion of our time in the fall implementing a pilot for the school-based reproductive health peer education program.
“I also spent a significant amount of time learning more about the executive side of the organization and what it takes to run a global health NGO in a developing environment such as Sierra Leone. I attended meetings with government ministries, funding agencies, existing and potential partners, and learned about the complexities and challenges associated with navigating in a developing environment. It is eye-opening to see all of the non-health factors that significantly affect healthcare delivery, such as corruption, politics, personal relationships, economic infrastructure, knowledge and education... the list goes on. The opportunity to learn and contribute along the entire pathway of healthcare delivery is invaluable and shapes my understanding of health policy, healthcare delivery, and global health as I continue my education in these fields.
“I intended to conduct ethnographic research on female genital mutilation during this year. While I was able to make headway on this project, it was not in the spotlight, as much of my fieldwork time was dedicated to the peer education program and supervising other projects on the ground. I did not want to tackle too many projects at once for fear of being unable to complete any of them with adequacy. Instead. I decided to focus my priorities on a few projects and researching others (such as female genital mutilation) when I was given the opportunity. I was still able to learn a great deal more on the subject (since the previous summer) and attend many events that led to interesting interviews. In addition, part of our peer education training involved focus groups and discussion groups that treaded into this realm of research.
“While a large part of my fellowship is spent on the field, another half is spent on the executive side of the organization. The infrastructure and systems of communication within Wellbody Alliance are overwhelmed by the rate at which the organization is expanding. Thus, I took on a role as communications director, relieving leaders of the organization (that are trying to manage, direct, and conduct research all at once) of those responsibilities. In addition, I reached out to those experienced in communications for larger service organizations and am trying to implement a new model of communication catered to the operations of Wellbody Alliance. It is a work in progress, but also an incredible experience in understanding how to manage a startup NGO.
“I have also gained experience in grant-writing, project reports, and am helping put together the annual report for the organization. Working with Wellbody Alliance during my post-bac year has truly been comprehensive and revolutionary in a personal sense – every experience I have moving forward will be informed by what I have experienced during this fellowship.
“We trained a group of students at the local high school to be peer educators and peer advisers in their school and community. The training included topics such as puberty, sexually transmitted infections, HIV/AIDS, contraception, family planning, reproduction, pregnancy, healthy relationships, solidarity, education and advocacy, and peer counseling. The program led to a one-week campaign which took place during school-wide assembly before class for five days. The program for the campaign was a collaborative effort between myself, Fatu, our sponser organization, and the peer educators in our program. The campaign itself featured education through theatre (a continuous four-part skit that included main concepts from the training in an engaging way), guest speakers (a teenage mother within the community), and interactive discussion with the audience. This pilot was implemented alongside research, as we designed and administered surveys to assess knowledge, attitudes, and behaviors towards these topics.
The surveys were conducted on a random sample of students within the school community prior to the campaign, immediately after the campaign, and will be conducted 3 months later to evaluate behavioral change. The program will be replicated in a handful of other schools over the following months.
“It is impossible not to worry about sustainability when operating in a developing country. NGO after NGO implements programs that last for no longer than a few months or years. When designing the program, Fatu and I have kept in mind how to structure it in ways that will encourage continuation after our departure, but it’s a constant concern that it will fall through the cracks. ReachOut has been unbelievably supportive throughout this process and in fact created a new continuation fellowship to bring a new post-bac fellow to Kono and continue and expand our work. I cannot express how appreciative I am of the support and encouragement from the entire committee during the fellowship.
“I have been moved by ReachOut’s support during this fellowship. The committee members give fellows freedom and independence, but also provide abundant support beyond the financial. I have been connected to other organizations in my field of
work, received an inspiring book written by others traveling in the developing world, and met kindness when my camera was stolen abroad during the fellowship. During the winter, I came home to a holiday greeting package that made me feel truly welcome and
part of the ReachOut community. This fellowship is not simply a means to pursue a project during the year after graduation; it is a comforting and generous community of support and guidance in the arena of humanitarian service work, and I will appreciate this beyond the conclusion of this year.
“The opportunity to apply for a ReachOut fellowship that allows students to pursue service in the international community is invaluable. Understanding social, economic, and political issues in other countries shapes a mature understanding of global perspective and increases one’s capacity to contribute to their own country. While Sierra Leone is different from the United States in almost every way, understanding their culture and the issues that exist in their healthcare delivery system allows me to see our own healthcare delivery system in a different light, and approach issues from a different angle. International service experience certainly promotes the ability to “think outside the box.” In addition, it really motivates personal growth and reflection in an individual, which feeds into one’s work, regardless of what country or problem is being considered.
“As the world becomes increasingly globalized, it is imperative that Princeton students understand their fields from a global perspective in order to confront modern issues and propose innovative and effective ideas and problem-solving methods. “I’m sure I speak on behalf of many members of the Princeton community in thanking the ReachOut committee for supporting international as well as domestic service opportunities.”
Here is what Fatu told us: “I embarked on my ReachOut fellowship with Wellbody Alliance (formerly the Global Action Foundation) in Kono, Sierra Leone to start a peer education program against teenage pregnancy. I had heard that a lot of young girls are getting pregnant and dropping out of school in Sierra Leone. As a Sierra Leonean woman, I wanted to help. However, I had left Sierra Leone when I was only thirteen; the civil war in Sierra Leone had forced me and my family to emigrate to the U.S, where I have been living for these past ten years. Therefore, coming, I had little idea of what to expect. All I was certain of was that I was about to embark on an experience that will transform me both professionally and personally.
“Through this project, I have not only gained the knowledge and leadership skills required to start and carry out a public health research, I have also gotten a clear perspective of public health in Sierra Leone, one that I am confident will inform many project decisions in my future career as a physician (and maybe a politician).
“Under my leadership, we were able to implement a project with two main components: assessing and keeping track of the scope of teenage pregnancy in Kono District through the Government Hospital’s antenatal records and personal surveys, and establishing school and community peer education programs, Peer Education Program TOK (PEPTOK) and Early Bele Awareness Group (EBAG) respectively, to improve the sexual health knowledge and attitudes of teenagers in the district.
“After eight months of hard work, I am happy to report that we have began to see the scope of the problem at hand and have established very promising interventions. Last year 2010, the Antenatal Clinic at the Koidu Government Hospital recorded over 600 pregnant teenage girls, and from the personal surveys we have been administering to various pregnant teens, we are finding out that most of these girls are getting pregnant between the seventh and ninth grades.
“In addition, I have finished training forty peer educators (ten students in each school), that will work throughout the school year under the guidance of a head teacher to teach their classmates on topics and skills ranging from puberty, condoms and contraceptives, HIV/STIs, to communication in relationships with peers, partners, and parents. In the community, EBAG, which consists of three women and three men who have gotten pregnant/ impregnate, is conducting monthly radio discussions on teenage pregnancy and visiting various communities in Koidu (the capital city of Kono District) to tell their story and talk to parents, young men and women. “Moreover, the opportunity I had to work and interact with Sierra Leoneans across the socioeconomic spectrum has enabled me to reconnect with my people and begin my reintegration into a country I love so dearly.
“From meeting with school administrators and various political leaders, to leading a team of men (in a country where women are still fighting for equal rights), to successfully choosing, training, and graduating the peer educators, I have come to realize just how much a woman with my current (and future) level of education means to a country like Sierra Leone. I will not forget how the Kono people welcomed me as their own “pikin” (child) and the young women as their own sister; nor will I forget the words of my PEPTOK students as they presented me with a going-away gift of traditional Sierra Leone cloth: “…this cloth is to remind you to never forget us and your country Mama Salone.”
“Most people that know of passion to help Sierra Leone usually asks me: Where do you plan to live in the future, Fatu, the United States, or Sierra Leone? For a girl that has literally spend half of her life in Sierra Leone and the other half in the United States, this is a very tough question to answer because I am a citizen of both countries and feel a part of both.
“After graduating from Princeton, I had two choices: to continue on to medical school, and afterwards, go on to establish a medical career and a life in the U.S. with no plans to return back to Sierra Leone, or to go back to contribute something and search for a reason to return to Sierra Leone after my medical training. Thanks to my ReachOut 56-81 Fellowship, I have found very important reasons for coming back and staying connected with Sierra Leone.
“I am very grateful to the Princeton ReachOut 55-81 Fellowship committee for believing in me and being such a strong support throughout this experience. I truly feel a part of the ReachOut family.”