A Chat with Amelia Sagoff

Last summer, Amelia Sagoff, 24, trained women in Dodoma, Tanzania, to use software on mobile phones to educate expectant and new mothers in their villages. Sagoff hopes the initiative will help lower the neonatal death rate in Tanzania, which is one of the highest in the world.

The Charlestown-based health and technology company that Sagoff works for, Dimagi, created the software that drives this and other community health projects in countries worldwide. Sagoff has spent the last few weeks in India training others to use it, but will return to Dodoma in July to reunite with the women she worked with and expand the services there. 

But she said the project will run out of money in August, and has started an account on the online fundraising website First Giving to try to continue the project. Contributions pay for monthly health care visits, transportation to hospitals and care packages for new mothers.

Q: What sorts of health issues did you and your female community health volunteers encounter frequently while you were in Dodoma last summer? 

A: HIV was prevalent, though the stigma was so great that it was hardly talked about. The CHV reported that lots of mothers were asking what to do about their newborns if they were HIV positive. But by the time a baby is born, it's too late to do anything to prevent transmission. I saw a lot of infected wounds, too, that people couldn’t afford to go to the hospital to get treated. One thing I didn't anticipate was cataracts -- the sun is so strong there that even 30-year-old women found it hard to see clearly.  This was one of the challenges in using a mobile phone.

What I grew most familiar with was the causes of infant death, since that's what I was working on. Infection, pneumonia, hypothermia, and malaria are huge causes.

Q: How did information about hygiene spread in the villages and homes you visited with the volunteers?

A: I, of course, went with them on several house visits, to observe how the application was actually being used. The great thing I learned from this was that during the house visits, you're not just educating the new mother; you're educating all the women of the household (and their friends!). Village life is pretty boring, especially for women, so when someone comes to visit with a cool-looking application and some gifts for the new baby, everyone comes around to check it out.

Some initial data from our field studies indicated that, in areas where a CHV had been using the newborn application, the general knowledge level of women in the community about newborn health was much higher than the knowledge level of women from other communities -- even if none of the women had had an official session with the CHV! Knowledge spreads very quickly among people hungering for education.

Q: Do you pay the women for providing your company with information about their health? 

A: We pay women a small amount to participate in these studies (2,000 Tanzanian shillings, or $1.33). You can watch the women who have completed the study head directly to the market to buy food. One of these women approached the local volunteer who had organized the event, and said, "Thank you for this. I wasn't going to have food to feed my family lunch today, but now I'm going to the market to buy vegetables." The studies often felt like excuses to educate women and give them a bit of money.

Q: How did the volunteers take to the work?

A: They were amazing. These were women who had literally nothing before this program, and were slowly empowering themselves. They all got into it for the money, but it was clear they had started to really care and to push for more. They had started their own association, and were contributing a good chunk of their weekly salary to the association bank account. On World AIDS day, they used their own money to have a health event at the hospital. I was there at a transformative moment for them, which was incredible to witness.

Q: What else did you learn about these women's lives? 

A: One of these CHVs, Dorisi, was probably HIV positive (though the stigma is so great no one ever talks about it). Her husband had died, and she was raising three small children. Before she started working with us, she would hang around the church looking for odd jobs to make enough money to feed her children. When she was chosen to participate in the neonatal pilot, she said "God must have led you to choose me. Now I can not only feed my children but send them to school. We were on our knees all night, praying and thanking God."