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Battling cholera in the communities

I’m just back from Burundi, a small, beautiful country in Africa, sandwiched between Rwanda, Democratic Republic of Congo and Tanzania. It’s capital, Bujumbura, sits on the shore of the deep, gorgeous Lake Tanganyika, where on a clear day you can see the mountains of DRC on the other side.

I went to Burundi with the Norwegian Red Cross to support trainings on a really cool strategy to fight cholera.

Cholera, as you probably know, is a diarrheal disease that still kills people in the 21st century (between 21,000 and 140,000 per year, according to WHO). It causes vomiting and what we call Acute Watery Diarrhea or AWD.

Acute, because it starts very suddenly and lasts only a few days. Watery, because the diarrhea very quickly becomes mostly water. It’s even called “rice water diarrhea”, as it looks like the whitish water left behind after you’ve washed rice. (I hope you are not having lunch while reading this!). The reason for all this water is because the bacteria that causes cholera, Vibrio cholera, has a toxin that pumps water out of the cells in the intestines.

Cholera can quickly (in a matter of hours) lead to dehydration that can result in death, even in healthy adults. Basically, it’s the dehydration that kills the person, so the treatment for cholera focuses on keeping the person well hydrated while the body fights off the infection.

In severe cases, if the person has lost consciousness or can't drink enough, this has to be done by giving the person fluids intravenously at a hospital or clinic. But in the majority of cases, giving fluids orally is enough.

When I talk about fluids I’m not talking about water, though. Water is fine for rehydration purposes in regular life, but in cases of AWD, oral rehydration solutions (ORS) with the right concentration of salts and sugar allow a much faster rehydration and a better balance of electrolytes, and thus have a much better track record of saving lives.

In any given cholera epidemic, most people won’t develop symptoms, although they will still shed the bacteria in their faeces and thus transmit the infection. Among those who do develop symptoms, only around 20% will be severe cases requiring intravenous fluids and hospitalization.

But what usually happens is that most people with symptoms end up at hospitals or cholera treatment centers anyway. In a bad epidemic, this can overwhelm the healthcare system. Plus it usually means that people are coming to the hospital late in the disease, and more dehydrated.

So, how can we provide access to rehydration closer to home to all those cases that don’t require hospitalization? Well, if you come from a middle or high income country, you might be thinking, “Duh… just go to the pharmacy and buy one of those electrolyte drinks”.

Unfortunately, that doesn’t work in poor communities in developing countries, or in camps for displaced people, which is where cholera epidemics usually happen. Here there’s usually no pharmacies, no electrolyte drinks, and most importantly, no clean and safe drinking water.

Enter the ORPs, short for Oral Rehydration Points. A place in the community where community health workers can provide water purification tablets and sachets to prepare ORS.

The Red Cross has now taken the ORP concept one step further by developing ORP kits. These compact kits can be quickly set up in the communities during an epidemic. They contain two key ingredients for treating cholera: a water filter that produces clean and safe drinking water, and sachets of ORS (plus other goodies like soap, water treatment tablets, glasses, jugs, etc).

One of the key resources of the Red Cross is its volunteers, who exist in communities in almost all countries in the world. During an epidemic, community health workers and other health staff can get very busy and be in short supply. Trained volunteers from the Red Cross can provide support by staffing these ORPs.

Volunteers can provide the communities with quick access to rehydration by giving sick people ORS straight away (with cholera, time is key) at the ORP. They also teach families how to prepare the ORS sachets at home (just mix them in a liter of safe drinking water) and how to make water potable by boiling it or treating it. They distribute chlorine tablets for water purification and soap for hand-washing.

Volunteers are trained to detect severe dehydration and quickly refer these cases to the hospital or cholera treatment center. They also provide communities with information on how to prevent cholera, such as washing hands with soap, protecting food from flies, using latrines and avoiding open-air defecation.

My trip to Burundi was about supporting the Burundi Red Cross in training its volunteers to install and use the ORP kits. Burundi has experienced intermittent cholera outbreaks, especially among the areas close to the Tanganyika lake. They now plan to preposition the ORP kits in case they are needed, to be able to respond quickly and give people in affected communities early access to rehydration.

I love simple, practical solutions like this one. I’m looking forward to seeing results from studies analyzing the impact of ORPs during cholera epidemics.


Did you like this post? I’m planning on writing more posts like these on interesting solutions to health topics around the world. Are there any particular subjects you would like to know more about? Please let me know in the comments!

2018-03-09 08:45:19

Need inspiration for your 2018 reading? - My list of favorite books this past year

One of my 2017 goals was to read at least 30 books. I'm happy to say that I surpassed that goal. Most of what I read was non-fiction, although I also managed to fit in some fiction books during the holidays :)

Here's a short list of my non-fiction favorites - those that were most useful for my personal and professional growth in 2017 - hoping that you find some inspiration for your 2018 reading list!

And if you have some good recommendations of non-fiction books, please tell me in the comments, I always appreciate a good book recommendation!

Happy reading!



I know how she does it. How successful women make the most of their time. By Laura Vanderkam.

I have been following Vanderkam's blog for some years and I finally decided to read one of her books. I'm very happy I did! This book busts the myth that women can't "have it all", using evidence from detailed time logs representing 1,001 days in the lives of women who make at least $100,000. Vanderkam presents a great analysis, with many stories and examples, of how busy women successfully and happily juggle life and career, by focusing on 168-hour (one-week periods) instead of on a single day. I thought I was a good time-manager already, but I gained many useful strategies from this book.

Rejection Proof. How I beat fear and became invincible through 100 days of rejection. By Jia Jang.

This quirky book made my days in 2017. Jang decided to overcome his fear of rejection by willingly putting himself on rejection's path for 100 straight days, while recording the whole thing and extracting lessons learned. Each day he planned a new scheme to get rejected, everything from knocking on a stranger's door and asking to plant a flower in their garden, to requesting the building's doorman to lend him 100 dollars. The results are funny, moving and eye-opening. Whether you struggle with fear of rejection or not, this is a great book to help us become more comfortable in asking for what we need (and laughing a bit on the way too!)

Decisive. How to make better choices in life and work. By Dan and Chip Heath.

I'm a big fan of the Heath brothers. Their books are always perfectly polished to ensure a seamless, ordered, and useful reading experience. Decisive is no exception. It combines stories and research to present a 4-step strategy to facilitate decision making, help us to stop agonizing over decisions and avoid biases. Decisive is compelling and funny and I love that they always include neat little summaries and tools to make it easier to remember what you learned from the book.

Option B. Facing adversity, building resilience and finding joy. By Sheryl Sandberg and Adam Grant.

Sandberg (the COO of Facebook and author of Lean In), and Grant (author of Originals and Give and Take), are both favorite authors of mine. But this book is very different from their previous ones. Option B talks about grief. The type of grief we experience from the death of a loved one. Option B has been a beacon for me, as in 2017 we lost a beloved family member. The book has helped us understand and cope better with the pain, confusion and anger that grief brings. It has taught me how to better help others who are dealing with grief, as well. If you or someone you know is dealing with grief, Option B is a great guide and comfort.

2018-01-17 19:13:05

Those sneaky little filler words

They crawl up on our speeches, push themselves comfortably into our well practised presentations, sneak up on us - despite our best efforts - when we are answering questions at a conference or an office meeting.

And… uh

Um… er


So, yeah...

... you know?


They are called “filler words”, “interjections” or “pause fillers”. Whatever your preferred term, what amazes me is that these little critters exist in so many languages. In French we have “n’est ce pas?” (isn’t it), “donc” (so) and “tu vois?” (you see?). In Spanish we battle “este…” (this) and “entonces…” (then). In Norwegian, from what I’ve seen so far, we have “ikke sant” (right), a guttural non-committal sound that goes something like “mmm-mmm”, and “også” (and).

In Spanish we call them “muletillas”, which translates as “little crutches”, a very appropriate term if you ask me.

What are filler words?

What are filler words exactly? They are words that we insert into our spoken language, but almost never written one. They’re often irrelevant words that won’t change the meaning of your sentence, and are used as a transition, to indicate that you haven’t finished speaking while you’re gathering your thoughts, or to soften the end of your sentence.

Filler words can make you look unprepared or hesitant when speaking. Yet, I also think they have a role to play in social integration. If you’ve ever learned a new language among native speakers, you’ve probably noticed that, until you’ve mastered the local filler words, you don’t feel you speak the language fluently. They seem to play a role in facilitating or marking social belonging.

So, do we need to get rid of them or not?

For normal conversation, filler words may not be that problematic. Unless you have more filler words than regular words in your sentence (and some people do!). For speeches and presentations, however, I would recommend to get rid of them. One or two will go unnoticed, but frequent use of them can weaken your presentation.

Easier said than done though.. How do we weed them out when we are not even conscious of using them?

Weeding out your filler words

Here are some of the exercises we use in my public speaking courses to diminish or eliminate filler words.

Use embarrassment to your advantage

If you are preparing a speech or presentation, the most effective, albeit hardest way to get rid of filler words, is to film yourself and then watch the recording. This is painful, I know. Participants in my courses cringe when I make them watch their videos . But at the end of the course they systematically say this is the part that helped them the most. You’re your harshest critic. The discomfort you feel when watching yourself on video is your most powerful tool to improve your speech.

Divide and conquer

Grab a pencil and paper and count your filler words as you watch the recording. Make sure you count each filler word separately, for example, ten “um-ah”, twenty-five “like”, three “er…” and so on. Not all filler words are created equal. Determine which are your most problematic ones, and when do you use them.

Now decide how you are going to tackle them. This is where counting them separately comes in handy.

Substitute by a pause. “Um-ah” and “er” are mostly used when you are trying to gather your thoughts. Instead of eliminating them, try substituting them by a PAUSE. Repeat the phrase and in the place of “er…” say to yourself: “Pause. Breath.” . Take one long breath and then continue. For many of my course participants, imagining the pause as a word that they say only in their minds is much more effective than trying to eliminate the filler word.

We tend to dislike pauses because it seems to us like we are staying silent for too long and the audience will think we’ve forgotten what we wanted to say. The truth is, when you are on the podium, what seems like a one-minute pause to you is usually never more than a couple of seconds to your audience.

Pauses, when used purposefully, can be very powerful tools to create expectation in your audience, to signal a change of subject, or to let what you just said sink in. Don’t be afraid to use them to your advantage.

Substitute by a transition phrase. “So”, “like” and similar filler words are used in transitions. In these cases we can substitute them for “first, second, lastly” , or what I like to call “link sentences”. For example:

  • “I want to move on now to talk about…”
  • “This leads us to my second point.”
  • “Let me explain how this relates to what I was saying in the beginning.”
  • “I want to make a parenthesis now to talk about…”
  • “What this means is ...”

Buzz your filler words.

After you’ve decided how to tackle your filler words, rehearse your presentation again. This time ask a friend or coworker to listen to you and hold out a red card every time they hear you use a filler word. When this happens, correct yourself immediately and repeat the last phrase or two, this time without the filler word.

You’ve worked so hard on your presentation or speech, don’t let some nasty filler words dilute its power. But remember not be overly perfectionist, if a couple of filler words remain, they will mostly go unnoticed.

Let me know in the comments, what are your most problematic filler words and how have you got rid of them?

If you want to know more about my public speaking courses, go to

2017-06-21 13:38:21

Are you still using a spreadsheet to collect your data?

I have worked with several NGOs, as well as in hospital, clinics and academia. In many of these places people are collecting AMAZING data from their programmes and projects. Data that I would love to get my hands on to analyse. Unfortunately, in most of these places, they are also collecting these amazing data either on paper or on a spreadsheet (e.g. Excel).

This is frustrating for me for a number of reasons. First, in many cases there is a lot of wasted time and effort, as much of this data is never analyzed. Second, people often don’t realize how precious this data is, and the risks entailed by collecting them on a spreadsheet or on paper. Third, I am one of those people on the other side of the equation, receiving that data for analysis and usually having to deal with the data collection shortfalls.

Let’s be clear here. I’m not waging a war against Excel or any other spreadsheet for that matter. They are highly useful. I use them for a number of things, but they are just not meant to be used for data entry.

So let’s talk about why collecting your data on paper or on a spreadsheet is a bad idea and what better tools you could be using instead.

Wasted time and effort

Data captured and not analysed is a waste of time and effort. Data captured on paper, if it is to be analyzed at all, and thus become useful, will need to be computed manually or be typed into a computer. Both options are inefficient, time-consuming and repetitive, so you want to minimize the time your team spends doing this. I’ve talked with many people in charge of data capturing and they are rarely if ever captivated by they work (shocking!), they just see it as tedious and meaningless.

Variability when collecting data

If you are using paper questionnaires or a spreadsheet with open text cells (that is, cells that allow any type of answer), people collecting the data can fill out their responses any way they want. And trust me, they will do it differently every day, and differently than their colleague. Some will write the date of birth as mm/dd/yyyy while others will use the format dd/mm/yyyy. Distinguishing between the two afterwards can become tricky.

In other cells or paper forms, if you don’t restrict the possible answers (which you CAN do in Excel), some will write “New York”, others “NY”, others “new york” and yet others “ny”. In a clinic, you may have three different names for the same diagnosis. Some will leave key questions blank.

Whenever variability is allowed, it will flourish. The problem with this is that some data may become unusable (if you can’t distinguish the correct date for instance), or will take a longer time to clean up. Result: precious time and effort wasted (and maybe some grumbling from your data analyst).

Errors when passing data to computer for analysis

When data is captured by hand, someone has to pass it to a computer. This is a very common source of errors. When I analyse databases it can sometimes be easy to spot these types of errors: Entries duplicated or mixed up, impossible dates of birth (e.g first of january 2035), etc. A good aim in data collection is always to try to minimize your sources of error.

A spreadsheet is NOT a data-entry system.

To understand the difference, let’s first talk about how a data-entry system works.

In programmes designed for data-entry, you capture the data in a “questionnaire” screen, where you only see the questions for the particular person or household for which you are entering data. The questions have a restricted set of answers to choose from (e.g. “New York” but not “NY” for instance). The data you capture in this way is saved in a “table”, that will look similar to Excel, but which not everyone can access.

In contrast, in Excel or similar spreadsheet solutions, you get to see the whole table of data, and you input the data directly into the cell you want. In many cases, you can write the answer in any way you like inside the cell. Thus, using a database instead of Excel results in “cleaner” data (e.g. just one name and not three for the same diagnosis), and it protects your data from mistakes, as access to the table data is restricted.

One of the worst things that I regularly see happening with spreadsheets, unfortunately cannot be fixed. Excel allows you to move/reorder columns or rows independently, which means that you could accidentally reorder the “date of birth” column, while forgetting to do so for the “name” column, resulting in names and dates of birth that don’t match.The problem is that many of these errors cannot be undone, as there is no way to trace them, so the integrity of the data can come into question when errors are evident at the time of analysis.

In most databases created by a data-entry system, the information in a single row, which normally pertains to the same individual (e.g. name, age, sex, etc), is linked together, so that this type of error is not possible.

Smarter solutions

By now, I hope you are wondering what you can use instead.

There are various user-friendly options out there for data-entry software these days. And many are free. Data collected in them can later be analyzed with your favorite statistical package (or even with Excel if that's your thing!)

If your organization has Office packages, you might want to try Microsoft Access.Two other options that I particularly like, and are widely used in health projects are EpiInfo and EpiData, which are freely available online and not very hard to set up.

For non-routine, small-scale data collection exercises you may want to try out Google forms or Surveymonkey. I’d be hard-pressed to find a more user-friendly option than these two. They are also free for small-scale questionnaires and you can send them out by email. A disadvantage though is that they are online-based, so you need an internet connection.

So what solution are YOU using? And are you happy with it? Let me know in the comments.

Contact me:

2017-01-31 14:30:32