I apologize for the delay in posting to the blog. It isn’t due to lack of activity, but rather an overwhelming volume of activity as we rapidly approach the launch of Life Force Kiosks in Kibera. I’ll write another post in the next couple of days on the launch, but first I wanted to share the results of the Kenya Medical Research Institute (KEMRI) testing.
KEMRI Water testing in Kibera
As we have 12 vendors starting in our pilot, we decided to do a full census of water points and pulled water samples from all 12 taps. We also pulled samples from several other taps in Kibera as well as directly from households. As a reminder, we split each sample into four sub-samples and treated them with 0, 1, 2, or 3 ml of chlorine. When untreated, we saw dramatically high rates of fecal contamination. In our pilot area, about 42% of taps showed unsafe levels of coliforms in the water. In other areas and with household samples that number was even higher.
While that was somewhat expected, the really exciting news was that KEMRI found that only 1 ml of chlorine was enough to reduce the coliform count to safe levels. This means that Life Force Kiosks can achieve the desired health impact without dramatically impact the taste and smell of the water. KEMRI also tested for contamination of water containers before and after Life Force Kiosks washed them. We tested 10 containers, and in all cases the container showed some level of contamination prior to cleaning but no unsafe contamination after the thorough cleaning with soap and chlorinated water.
KEMRI Water testing in Kibera
I was asked the other day why the major promoters of liquid chlorine suggest a 3 ml dosage. It’s a great question, and I believe they have two very good reasons for doing that. First, they are promoting packaged chlorine across a huge geographic region and can’t adjust their dosing directions for each specific community. If packaged chlorine like WaterGuard is being used in areas with untreated water (from wells, streams, etc.), a higher 3 ml dosage may be required. Life Force Kiosks is fortunate to be able to conduct ongoing testing in our specific operating areas and adjust the dosage accordingly. Second, I believe they encourage a higher dosage to ensure there is residual chlorine in the water that will prevent re-contamination. This is not a bad idea. However, Life Force Kiosks is in the position to offer storage container cleaning services alongside the water purification service. This dramatically reduces the risk of recontamination so we can offer a lower dose of chlorine, thus protecting the taste and smell without dramatically increasing the likelihood of re-contamination. We will conduct this testing on a regular basis to ensure that our model continues to be effective.
KEMRI has reviewed the results and has given us their green light to start operations in Kibera. We are very excited to now have full confidence that our model will reduce waterborne disease, and I want to personally thank Professor Karama of KEMRI, Professor Ichinose Yoshio of Nagasaki University who works with KEMRI, and the entire KEMRI lab team.
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After a productive meeting with the Kenya Medical Research Institute (KEMRI) this morning, it was agreed that water testing will begin as early as this Thursday. For those of you who enjoyed your science classes, I thought I’d share the details and objectives of the testing process. This initial round of testing has two parts.
The first test is to determine the optimal amount of chlorine that should be added to the water. Drinking water is treated at the original water source before it is piped into Kibera and other slums. We know from testing performed by the CDC last year that there is some residual chlorine in the water when it reaches the taps, but the chlorine levels are inconsistent and in some cases low enough that unsafe levels of bacteria were found. One of the core Life Force Kiosks (LFK) services will be to “top up” chlorine levels by adding a few drops of chlorine into our customers’ water containers right after they fill them with water. The question is how much to add. Obviously adding more chlorine increases the safety of the drinking water (to a point). Unfortunately, the more chlorine you add, the more the water will start to taste and smell like a swimming pool. Not surprisingly, this is a huge barrier to adoption of liquid chlorine products in the market that give dosage instructions (3 ml chlorine per 20 liters of water) based on the assumption that there’s no chlorine already in the water.
KEMRI will draw 200 water samples from the community and pour each sample into four smaller containers. One container will remain untreated and the other three will be treated with 1, 2, and 3 ml of chlorine. Then they will measure the E. coli counts for each sub-sample. That will allow us to determine the minimum amount of chlorine needed to reduce E. coli counts down to safe levels (as determined by the World Health Organization). Essentially we’re determining the shape and slope of the red line in the graph on the left. Please note that the graph is purely an example and is not populated with real data.
The second test that KEMRI is conducting is on the efficacy of our water storage cleaning methodology. The second core service that LFK offers is to clean water storage containers with soap and chlorinated water. We want to be sure that our cleaning methodology really reduces bacteria levels like we think it will. To be sure, we will take 100 water storage containers directly from residents’ homes. We’ll empty the containers and refill them with sterilized water that starts with no bacterial contamination. After shaking the container lightly, we’ll measure the E. coli count in the water. We’ll then clean the storage containers and repeat the process. If our methodology is effective, we should see significant levels of E. coli in the samples taken from untreated containers, but safe levels after treatment.
The whole process will take roughly 3-4 weeks to complete, barring unexpected delays. I look forward to sharing the results, especially to the first set of tests. If we are correct that a smaller amount of chlorine is needed in these slum environments, it could have a huge impact on chlorine adoption in slums around the world.
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Household Water Treatment and Safe Storage Fair
We’re working hard to complete the few remaining critical tasks so we can launch our pilot in Kibera, but in the meantime I thought I’d share a fun story. A couple of weeks ago the Ministry of Public Health and Sanitation, in conjunction with UNICEF, KWAHO, and several other sponsors including PATH, hosted a public fair on household water treatment and safe storage.
Ministry of Public Health and other NGO officials
I attended with one of my colleagues from PATH to run our booth and discuss the work we’re doing around social marketing for water treatment products. To kick off the fair and generate awareness, a procession complete with marching band and school children holding big banners was held through the streets of downtown Nairobi. Right before it started, I was called over by the Chief Public Health Officer and was asked to join him along with the Deputy Minister of Public Health and Sanitation, the UNICEF Country Representative, the Kenyan Director of Water Services, and a few other high-ranking officials who were leading the parade.
PATH's booth at the HWTSS Fair
Unfortunately I didn’t get to carry the giant Kenyan flag or conduct the band, but all in all, getting to help lead a parade through Nairobi was still a pretty interesting experience!
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I’m extremely excited to share news of two key strategic partners who will be working with Life Force Kiosks… the Center for Disease Control and Prevention (CDC) and Kenya Medical Research Institute (KEMRI). The CDC and KEMRI will both be working with Life Force Kiosks to conduct baseline and ongoing water quality testing as well as several other important tests to ensure the effectiveness of our model. I could not be more pleased to be working with organizations that bring such a high level of expertise and credibility in the area of health impact effectiveness evaluation.
Along with baseline and periodic testing of water in Kibera to determine E. coli levels in water at the source and in homes, they’re helping with a few other very important tests. First and foremost, they’re helping us determine the optimal level of chlorine dosing. One of our core services is to add chlorine to the water people buy at the tap to help ensure it’s safe for drinking. There are already household chlorine products available in Kenya that people can use to purify their water. The instructions call for a dosage of 3 ml of chlorine per 20 liters of water. The biggest barrier keeping these products from achieving higher consumer adoption is that they make the water taste and smell kind of like… well… chlorine. However, testing performed by the CDC last year showed that the tap water already had some chlorine in it from when it’s treated at the initial water source before its piped into the slums. As such, it may be possible to add a smaller dose like 1 ml per 20 liters and still obtain a meaningful reduction in E. coli levels without noticeably impacting the taste and smell. That would be a huge breakthrough, as I’m not aware of any single product in Kenya that’s affordable to the poorest of the poor, convenient, effective, and doesn’t impact water taste. Of course we need to wait for the test results, but I’m excited about the possibility of introducing a truly new and improved product into the market.
The CDC and KEMRI will also conduct some testing to ensure the method we’re proposing for cleaning water storage containers is effective. The CDC also conducts detailed and ongoing disease monitoring and tracks cases of cholera, typhoid, and other waterborne disease. While it’s impossible to isolate the impact from our organization, in theory we should hopefully see some reduction in these diseases over time in the areas where we’re operating.
I’m very grateful to these two fantastic organizations for their help, and I look forward to working with them both.
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So I don’t fail to recognize the irony that the last blog post I wrote titled “Momentum” was followed by three months of silence. While the blog might not have had much activity, I can assure you that plenty was going on here in Kenya. Some good, some not so much.
If you remember, back in December I thought we were nearly through the Kenyan registration process to become an official Community Based Organization (CBO). Unfortunately, despite what we had heard from our contacts in the government, we didn’t qualify as a CBO because we’re run by a management team and not directly by community members. Instead, we were told to register as an NGO (Non-governmental organization) and that turned out to be quite the lengthy process. In fact, a couple of months after submitting all the paperwork, we just received approval on our bylaws yesterday. I’m waiting to hear back on if there are any additional requirements, but fingers crossed, we may be closing in on finally becoming an officially recognized NGO in Kenya.
There’s been a tremendous amount of less sexy work going on over the last few months as well such as identifying suppliers, crafting training materials for the vendors, meeting with water vendor groups, creating marketing materials, and more.
I also have some exciting news to share about a few strategic partnerships that are in the works, but I’ll explain more about them in my next post. Things are starting to really heat up and it’s possible that we could be up and running within the next few weeks if a couple of things break our way (though it is Africa, so you never know). Either way, I promise you won’t have to wait another 3 months for the next update. Stay tuned…
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Kibera Community Meeting
We’ve had a few exciting developments over the last couple of weeks. First, we had a very interesting community meeting last week. The meeting was attended by water vendors, village elders, and religious leaders. It was kicked off by the Chief. Overall I’d say the meeting went fairly well. Most of the water vendors and community leaders were very supportive and excited about our coming to Kibera. We did have a couple of people who considered themselves “water experts” and made some pretty crazy claims about the effectiveness of chlorine. This is not surprising, as we’ve heard some pretty outrageous misconceptions as we conducted our research over the last few months. Now we just know where these rumors come from. I was also pleased with the strength of our management team, Steve and Freddy, who organized and ran the majority of the event.
Steve presenting at the Kibera community meeting
On the registration front, we’ve submitted the paperwork to become an official Kenyan organization and are just a day or two away from registering with the IRS to become an official US Non-Profit. Once our IRS paperwork is submitted, we’ll be able to accept tax-deductable donations.
Kibera community meeting
We’ve also made some great progress on the last milestone of funding. We have three different organizations that have expressed interest in funding part or all of our pilot. I don’t want to go into details until we’ve received a firm commitment, but needless to say I’m very excited about the progress in this area.
I look forward to providing hopefully positive updates in the near future, and I’m optimistic that we can still hit our goal of launching the pilot by the end of January. Kenya pretty much shuts down for the holidays for about 3 weeks starting next week, but hopefully we can keep our momentum and start off strong in the new year.
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District Public Health Officer
So my 9:00 am meeting kicked off right on time at 11:15 this morning. Fortunately, it was worth the wait and we had a very productive meeting with the District Public Health Officer overseeing Kibera. It’s becoming very clear that the District Officer who we’ve met with a few times is a strong supporter of our organization when listening to his introduction. He can articulate the need for our presence and the value of our model about as clearly as I can. After the conversation with the District Public Health Officer, I believe he’s now just as big an ally. Both officials clearly recognize that poor water quality at the time of consumption is a likely contributor to the outbreaks of cholera they’re currently experiencing and waterborne disease in general within Kibera. They also seem to have a lot of confidence in our operating model and strategy, which is quite encouraging.
Next week we will present our concept to a large group of 15-20 community leaders and water vendors. I anticipate a lot more questions and a bit more skepticism in this group, but it will be a challenge that I’m very much looking forward to. Fortunately I’ll now have the District Officer and District Public Health Officer at my side to lend credibility and political cover. My hope is that after next week’s meeting, we’ll receive the approval to register as an official organization with the Kenyan government and the go-ahead to begin operations when we’re ready. I’ll certainly post an update next week after the meeting with hopefully good news. Things are starting to get exciting!
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Kibera Water Vendor
Yesterday morning my general manager, assistant manager, vice chairman and I met with the District Officer (DO) who oversees Kibera. I had met with the DO back in May and he was supportive of the idea, but the model has since changed dramatically. Fortunately, he was equally if not more excited to hear our current plans. He told us that one area within Kibera is currently suffering from an outbreak of Cholera fueled by poor water quality and sanitation, and that our plan could really help the government’s efforts in getting it under control. Over the next couple of weeks the DO will be setting up additional meetings with government and community leaders so we can present our idea and get their input and buy-in. Once that is accomplished, we will be able to register the non-profit with the Kenyan government and have the official authorization to launch the pilot. Then we just have the minor detail of securing funding and we’ll be off and running.
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I’m excited to introduce another fantastic board member, Richard Wardell.
Richard has twenty years of business experience in international banking and strategy consulting, together with several years of non-profit work. As Vice President of Global Programs for Unitus over the past 3 years, he advised microfinance institutions in 9 developing countries, and made many working visits to Kenya. He’s also a board director and officer of Navos, an innovative non-profit mental health organization.
Before joining Unitus, Richard held senior positions at Lloyds Bank in Europe and at Washington Mutual in the USA. He also spent 3 years with the Boston Consulting Group, providing strategic advice to diverse companies in financial services, manufacturing, and other industries. He is now working with Russell Investments, a global investment management company.
Richard has a BS in Physics and Electronics from the University of St. Andrews in Scotland, and an MBA from the University of Chicago.
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The second board member I’d like to introduce is Andrew Otieno. Andrew is the Nairobi West Regional Manager for Jamii Bora Trust, a major Kenyan micro-finance institution. Andrew works to empower the residents of Kibera every day by providing access to capital for business expenses and other critical needs.
Andrew is deeply involved in the community, serving as the Chairman of the Makina Community Development Project, the Makina Health Clinic, and the Macodep Orphanage. He has also consulted for Microfinance Without Borders to develop and deliver business training in Kibera.
I was fortunate to meet Andrew towards the end of my last trip to Kenya and he was an immediate help. Andrew was able to arrange a meeting with the District Commissioner and the District Officer that oversee the Kibera area. He has also been very helpful in arranging focus groups with several Kibera community groups. I am excited to tap into Andrew’s deep understanding of the Kibera community, and I’m very pleased to welcome him onto our board.
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