Jocelyn Cheng Summer
by Jocelyn Cheng  on Wed 13 Jul - 0 Comments
Categories: Internship, Summer 2011

This is a guest post by Jocelyn Cheng. Jocelyn is a joint-degree student at Harvard Business School and Harvard Kennedy School.  Prior to school, she worked in investment banking and private equity in the US and Latin America.  She graduated from the Huntsman Program in International Studies and Business at the University of Pennsylvania.  She is a proud Canadian and a co-chair of the 2012 Social Enterprise Conference.


Introduction

May 30, 2011

Hello world,

I haven’t had a blog since my mid-teenage years. I’m excited about the summer ahead, and also for the opportunity to share it with all of you. Special thanks to theCultural Bridge Fellowship for not only generously supporting my internship, but also providing an impetus to document and share my summer experiences.

I’ll be based this summer in Zanzibar, a semi-autonomous region of Tanzania, where I’m interning with the Clinton Health Access Initiative (CHAI). CHAI is launching the Affordable Medicines Facility – malaria (AMFm) initiative to increase malaria treatment around the world. I’ll be working with CHAI to launch the AMFm program in Zanzibar, in partnership with the Zanzibar Ministry of Health, NGOs and private businesses. Enough acronyms for you? I’ll also be spending part of my time working on CHAI global initiatives, including the evaluation of AMFm initiatives in other pilot countries.

As some of you know, I debated over the summer internship decision fairly endlessly.  These are the key reasons why I’m excited about the CHAI project:

  • Working with CHAI. I’ve heard great things about the organization first-hand, and about how they’re not afraid to ‘rock the boat’ a little to accomplish their development goals.  I’m a big believer in people as an indicator of organizational quality, and CHAI people are some of my favourite people (Shaloo, Linda, Anil, Deb, Laura, I’m looking at you).
  • International development / global health experience. International development is the reason why I came to the Kennedy School, and I’m superexcited to work in a full-time capacity (if only for a summer) in the field. I’m also passionate about global health issues, especially after taking an Economics of Global Health class this semester. I’ve also never been to Africa, and have been dreaming about an opportunity like this for years.
  • The role itself. This is probably what sold me in the end on this internship. I’m excited (and nervous) about working fairly independently in launching a new program. As my college roommate Julia put it, I’ll learn skills that will be helpful in case I want to launch my own business down the road. Implementing the AMFm pilot will require working in marketing, pricing, distribution and operational research, amongst other fields. In addition, I’ll be working fairly closely with the Zanzibar Ministry of Health, which fulfills a personal goal of gaining government experience. I’m also excited for the global aspect of my internship, which will involve evaluation of AMFm programs across different countries. Hopefully the global CHAI work will let me understand and compare different public policy and health environments across countries, and figure out what works best in each context.
     
I could go on (of course, I have a spreadsheet outlining the pros and cons).  As excited as I am, I’m fairly sure that for all my careful researching and planning, this summer will be full of unforeseen surprises.  I look forward to sharing them with all of you!

Women in Saudi Arabia

June 11, 2011

I recently returned from a trip to Saudi Arabia, where we were guests of the Ministry of Higher Education and visited universities in Riyadh and Jeddah.  In addition to learning about how human capital development fit into their economic competitiveness strategy, we also had the chance to observe and meet many local and expat women.

Women in Saudi Arabia have a very different set of rights and practices than I’m accustomed to.  The most obvious difference is the dress code (we wore full-length black abayas and hijab headcoverings in 42 C heat!) However, the differences go much further and strike at essential rights and freedoms.  Women cannot be seen in public with a male they’re not related to – we were told a story of a female investment banker that had to move her business meeting to a Starbucks after a power outage. While the rest of the group was on their way down, the woman was briefly alone with her business colleague in the Starbucks.  Unfortunately, the mutawa (religious police) raided the Starbucks at that moment and arrested the woman, who remained in jail for several days. The concept of gender segregation is absolute and pervasive, and heavily biased against females.  The women’s section of the library we visited had 20,000 items out of a total collection of 1.5 million.  At another center, there were no female bathrooms, and the guard had to clear out the male bathroom in order for us girls to use it.

Unfortunately, these discriminations extend beyond just gender segregation, but to fundamental rights like driving (women can’t), voting (ditto) and divorce (women can’t grant divorce). So if a Saudi woman is in an abusive relationship, she cannot legally divorce if her husband refuses. Even if he agrees, custody of children automatically go to the man.  The driving ban is also essential in restricting women’s independence and autonomy, and is especially regressive as the poor cannot afford drivers and women aren’t allowed on the scant public transportation.  On a side note, this is also a country with INCREDIBLE amounts of urban sprawl, given gas is 10 cents a liter…even though they run their power plans on hyper-expensive oil!

Employment is a key restriction, as unemployment amongst women is sky-high (it makes sense that many companies don’t want to hire women, as they’d have to build out a completely segregated section for them). The majority of Saudi women who work go into education, which of course means teaching at female-only schools, thereby not unlocking any real economic gains. While the education system is making some steps forward (e.g. the preparatory curriculum is now taught in English, and we visited a mixed gender medical school), segregation poses a fundamental barrier to breaking this dead-end cycle. For example, it’s difficult for companies to hire a female intern as she needs to be completely segregated from males, and teaching quality is restricted as female students can only have female professors (or male professors over closed circuit TV).

What’s sobering is how quickly you get used to this environment. After a couple of days, all the girls on the trip were admonishing each other when a little bit of hair showed under our hijab, and friends I’ve known all year were shocked to see my hair exposed again.  If you live in a place with extremely restricted liberties, you quickly learn to accept that as normal. Saudi women have protested, but change is gradual (possibly glacial). In a classic case of one step forward, two steps back, a woman who started a Right to Drive campaign was put in jail for many days, and men have threatened to whip women who drive with their headdresses.

We were told the situation has actually improved in the past couple of years, especially with technology that allows men and women to communicate without being face-to-face (it’s amazing the impact Facebook has had worldwide, especially in the Middle East!) There’s definitely a cultural basis in these rules, and some side benefits (I didn’t have to worry about how my hair was under the hijab, and being chauffeured around wasn’t too bad).  With that being said, there’s still a long way to go for women’s rights in Saudi Arabia.

 

The Great Zanzibar Apartment Hunt

June 18, 2011

Mambo from Stone Town, Zanzibar!  I arrived in Dar es Salaam last week, where I found out that a CHAI colleague in Dar also went to my high school (and was even in the same house – go Vikings!)  It’s amazing how small the world is and how UTS manages to pop up in random corners of the world.

After a couple of days of onboarding in Dar, I moved to Stone Town, Zanzibar, on Sunday.  Without even unloading my luggage from the car, I immediately set off on the great Zanzibar apartment hunt.

Apartment hunt day 1: Apartment number one: directly in the market, had to weave by vendors selling sweets made from dates and swatting the constant buzz of flies.  Apartment number two: had multiple chickens running around the yard, and similar to a Soviet-style apartment block, but strangely spacious and designed for a family of 6.  After these two apartments, I started to think I might just want a guesthouse for my 2.5 month stay here…but most guesthouses were vastly out of my price range (despite being down dark crooked dirt alleys, not having toilet seats, signs on the door that say “don’t turn left here past 10pm”, etc.).

The great Zanzibar apartment hunt continued with a real estate broker named Mvicta.  Mvicta knows almost all apartments in town, but on short notice he could only show us the following: one directly across from a carpentry workshop (I’m told it makes the best furniture in Stone Town, but the noise would have kept me up forever), one with flies all over the bathroom, another that stunk of smoke and had no oven in the kitchen (but did have a broken refridgerator!), and one that had a Zanzibar bed, but no bednets or mattress.  When I inquired about the mattress, the landlord said he’d think about getting one.  All these apartments seemed designed for families of at least 4, and all proceeded to make me very depressed about my housing prospects.

What a Zanzibar bed is supposed to look like:

 

Social Enterprise Club

What this Zanzibar bed looked like:

Social Enterprise Club

 

Apartment hunt day 2: Another day, another apartment search. Monday turned out to be infinitely better than Sunday (possibly the only time I will ever utter that phrase).  On Monday I saw a flat which the owner admitted ‘is not a very nice place’.  However, the location was great – central and right across from a well-lit hotel, so it felt very safe.  The place itself was sort of like a bohemian treehouse – it was all open-air, had an outdoor kitchen and was up a couple of sets of precarious metal stairs.  It’s hard to describe, but definitely felt very student-y.  After the previous day’s apartments, though, I was just glad to find an apartment in a central location.  I met the two Swedish girls currently living there, who liked the place because of its open-air nature (despite the millions of mosquitoes) and its safe location.  However, Mvicta had promised to show me another apartment, which turned out to be gorgeous – it was a compact but comfortable renovated one-bedroom with a small balcony and an amazing roof terrace.  It was a bit further in the maze of Stone Town streets, however, which made me slightly apprehensive as a single female in a town where it gets dark (with minimal street lighting) at 6.

Apartment search day 3: I heard the yoga teacher in town was renting a room in her flat.  I googled her and managed to see her place on Wednesday.  The apartment was gorgeous – typical Zanzibari stained glass windows, big and expansive, with a washing machine (!) and an amazing roof terrace right next to the Cathedral tower.  She mentioned the Cathedral bells woke her up at 6am every day, however, and that a laptop was stolen through her open windows and she had also recently been mugged right outside.  Now I know Stone Town is a very safe place, and muggings can happen anywhere, but I still wanted a day to think through it.

Apartment hunt day 4: the Swedish girls from the bohemian treehouse had told me the hotel across the street was run by a Canadian who rented out rooms in his flat.  I decided to stop by and ask – after all, I feel an instant kinship with all 33 million Canadians out there!  Salim, the Canadian, was somewhat surprised to see me, as it turns out he’s never rented out a room in his apartment.  He showed me his place, which is inhabited by a 5th-generation Swahili family on the ground floor, but also offered me a long-term room at the hotel for a rock bottom price.  The advantages: a safe, well-lit and well-guarded location, and the amenities of a hotel (namely breakfast, A/C, hot water and cleaning).  The disadvantages: less space, harder to have guests, and no washing machine or roof terrace.  I decided to prioritize safety, even if it was incremental, and I moved into the Pearl of Zanzibar this morning!

Lessons from the great Zanzibar apartment search (yes, I always need down arrows for every experience):

  • The more time you can devote to a search and have an idea of what’s important to you, the better
  • Think about different alternatives (e.g. the great Zanzibar apartment hunt wound up not in an apartment, but in a guesthouse).
  • Ask around – people can be very helpful.  For a couple of days, I asked literally every person I talked to (in the US and here) if they had any apartment leads.  For example, I learned about the yoga teacher via Amanda, who I was put in contact with via email through a friend of a friend of a friend in the US.

*Apologies for the lack of pictures – in my moving/packing frenzy I forgot to pack the USB cord for my camera, so I have no way of getting pictures off of it.  I’m impressed if you managed to make it all the way through the dense blocks of text!


AMFm Launch – Day 1

June 22, 2011

We kicked off the AMFm program today!  We had a press conference with the Minister of Health as the Guest of Honor, and a Retail Meeting to introduce the branded subsidized ACTs to the retail distributors.  Feedback was generally positive, although we did hear some confusion around diagnosis (the test told me I don’t have malaria, but I took an antimalarial and my fever went away) and regulatory status (what the policy is around the existing stock of banned artemisinin monotherapies and how tracking/enforcement of the private sector will occur).

Tomorrow is the official launch event for the community.  There’s going to be local entertainment and again a guest of honor speech – I’m so excited to hear Jupiter (a local Zanzibari boy band) perform their original malaria song, written specifically about AMFm!


AMFm Launch – Day 2

June 24, 2011

AMFm in Zanzibar – officially launched!

We had our community launch yesterday in a field just outside Stone Town.  There were around 500 participants, including medical students and schoolchildren, community members and 50 VIPS (regional commissioners, key stakeholders, antimalarial manufacturers, etc).  There was a variety of entertainment, including Zanzibari boy-band Jupiter with their original malaria song, a sung poem by two local girls, a hip-hop performance by Baby J (the ‘Tanzanian Rihanna’), and community theatre.  The Guest of Honor (the Principal Secretary of the Ministry of Health) gave a short speech (I wish I could tell you what was said, but it was all in Kiswahili).

Our key message was emphasized and repeated in many different mediums – ACTms (artemisinin combinational therapies) are the best, most effective treatment against malaria, and they are widely available at a cheap price.  We had different types of branded merchandise that was distributed as well.  Hopefully people will continue to wear their ACTm t-shirts and see the ACTm stickers, so they recognize AMFm products with the green leaf throughout Zanzibar.

Pictures to be uploaded the next time I can borrow a USB cord… in the meantime, here’s the sports flex banner that was used at all the launch events:

Social Enterprise Club

AMFm Basics

July 3, 2011

Jambo – hello! (vs mambo from my previous post, which means ‘what’s up’)

With all the acronyms flying around, I’m not sure if I’ve ever explained what AMFm is. The Affordable Medicines Facility – malaria is a new financing mechanism for Artemisinin-based Combination Therapies (ACTs), funded by the Global Fund to Fund AIDS, Tuberculosis and Malaria.

  • What is its purpose? The idea behind AMFm is to utilize the private sector to increase malaria access to ACTs. Not only will this help prevent deaths from malaria (especially for pregnant women and children under 5), but it will also promote the use of ACTs instead of less-effective treatments. Since malaria parasites adapt rapidly to anti-malarials, the use of artemisinin in combination (rather than as a monotherapy) will help delay resistance to the drug.
  • How does it work? The Global Fund provides a co-payment to qualified ACT manufacturers, who then provide co-paid ACTs at a lower cost to retail first-line buyers (1LBs) in-country. In Zanzibar, a treatment pack of ACTs are not supposed to cost more than 1,000 Tanzanian shillings (roughly 67 cents). There are also a host of supporting interventions, including marketing, provider training, regulatory strengthening and increasing effective diagnosis.
  • Where does it work? There are 9 AMFm pilot programs, of which 8 have received co-paid ACTs to date – Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania, Uganda and Zanzibar.
  • What is its timeline? AMFm opened its doors to registered 1LBs in June 2010, and Phase 1 is scheduled to run through the end of 2010. The Zanzibar 1LB (Izmir Pharmacy) received its first shipment of co-paid ACTs in May of this year.
  • How does CHAI fit in? CHAI provides technical support to countries implementing the AMFm pilot. For me on a day-to-day basis, this means working with the Zanzibar Malaria Control Program (ZMCP) to implement AMFm and its supporting interventions. I am also working with the AMFm coordinator to look at evaluation and best practices of AMFm programs across the 8 countries.

     

ZFDB photos

July 3, 2011


Ok, my photo-posting ability is limited until I can find a USB cord. Until then, here’s a photo of the Zanzibar Food and Drug Board (ZFDB) office, the regulatory body overseeing anti-malarials in Zanzibar (think the equivalent of the FDA in the US).

 

Social Enterprise Club

 

And a rooster right in front of the ZFDB:

 

Social Enterprise Club

 

Data – A ‘Binding Constraint’ on Development?

July 10, 2011

Data – consistent, updated, easy access. Is this a big background enabler of development?  Put another way, is the lack of clean and reliable data a ‘binding constraint’ on development?

Two examples from frustrations I’ve encountered recently:

External perspective: Understandably, outside funders want to understand the true picture of what is going on in a country before they commit grant funds.  After these funds are committed, monitoring and evaluation require reliable data.  My experience thus far with shifting data sources / numbers has been frustrating to say to least.  Zanzibar does not have a central statistician, and individual pieces of data are kept with individuals.  As I tried to track down a key historical indicator requested by the key AMFm funding source, I ran into multiple roadblocks, including a) not having a centralized place to request the data from (instead, the person who had the data was out, thereby causing long delays), b) having conflicting data sources, and c) having the same data source conflict itself.  Building up capacity at the central statistics bureau, having a consolidated open-access system and appointing someone to track and clean data would go a long way toward resolving this problem, and ultimately being able to attract and disburse funds easier.

Internal perspective: I’ve informally heard that many Zanzibaris do not believe in the official malaria rate.  They suspect the government has been covering up malaria cases (either by underreporting them or by falsifying diagnostic tests results) in order to prove its malaria ‘success story’.  Again, building up the capacity of an internal statistics bureau would be helpful in alleviating these suspicions.  If the citizens trusted the low malaria prevalence rate, they would be open to believing that malaria symptoms (e.g. fever) can be caused by ailments  other than malaria.  Currently, even if they test positive for malaria, my hypothesis is that many patients self-medicate with anti-malarials anyway.  This increases resistance to effective malaria drugs in the long run, and not to mention is a huge waste of the AMFm anti-malarial subsidy.  The same applies for patients who don’t even bother doing a diagnostics test and just go straight to buy anti-malarials.  If the capacity of the statistics bureau were to be improved, my hope is that the suspicion Zanzibaris hold of the malaria prevalence rate would dissipate.  This would lead people to a) get malaria tested and b) increase trust in these results.


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