Notes from the classroom: A student team reflects on what they learned from working with a hospice in Kipkaren, Kenya

by Anjali Sastry on April 30, 2011

Dateline: April 22, 2011
Location: Cambridge, MA

Via ghdLAB, a team of four MIT graduate students (all MBA candidates; one also a Masters of Science in Engineering candidate) worked with a faith-based organization, Living Room International, in rural western Kenya this Spring. As our class comes to a close, each team put together a thank-you note to their hosts. The letter below is directly from the students to our partners in this project. Read it to get a real sense of what the students experienced, learned, and hope for, in their own words.

Dear Juli and Allison,

First we would like to reiterate our heartfelt gratitude for all that you did to welcome us into your community.  Asante sana sana for giving us a glimpse into your lives and your work and inspiring us to also have such a positive impact on the world.

MIT students Dannielle Sita and Barbara Kong with Nurse Betty in Kipkaren, March 2011

Before arriving in visit Kipkaren, we were prepared for emotional challenges (we knew a mortuary visit was in order… ) but looking back, we really had no idea what to expect.  We certainly did not anticipate becoming so connected with the hospice patients such that when we received your email about Isabella’s death, we were stunned with sadness.  It just did not make sense to us—when we met Isabella, we viewed her as a young mother of four who only needed some rest, wholesome food, and her first round of ARVs before she could be strong enough to return home.  Beatrice, on the other hand, seemed depressed and weak but we were consoled knowing that she would be able to pass in peace at the hospice.  Yet on our last day at Living Room, Beatrice was singing and dancing with us and confiding that she wanted to join the staff of caregivers.  Meanwhile, Isabella could barely sit up in her bed and was unable to join the festivities.

The stark contrast between the progression of the two roommates’ health reminded us of the story you told us of the hospice’s original guests, Felix and Flovia.  Living Room is a beautiful place because you open your arms to patients in need without knowing whether the ultimate value you provide will be to strengthen someone physically, emotionally, and spiritually enough to return home and continue to live many more years, or whether you will provide quality of life until they pass in dignity at the hospice.

One experience in particular revealed the extent of the impact you are having on the community.  After a half-day work session with Juli on how to measure quality of care, we had managed to define several quantitative and qualitative survey questions directed towards former hospice patients with the goal of measuring the level of care Living Room provides and tracking changes over time.

The next day, we accompanied Betty and Mishak on a home visit.  As we bounced over potholes in the back of the Land Cruiser, we coached Kirui, our teammate and trusty translator, on how to ask the scripted questions.  Tina reminded him, “You should reinforce that a rating of ten is really amazing, like impossible.  No one should be giving us a ten.”

Our first stop was to visit Ibrahaim, a man with HIV and TB who had experienced a miraculous improvement after a brief stay at Living Room.  The seven of us crowded around the table in the center of Ibrahaim’s tiny home and listened as Betty, Mishak, Kirui, Ibrahaim, and his wife conversed in Kalenjin.  The couple’s two-year-old daughter patiently looked on.  We observed that Ibrahaim’s wife was quite ill and in pain, and anxiously wondered if it was right to be intruding on their home to ask them a round of self-serving questions.

Nevertheless, after some small-talk, Kirui began with the script.  “On a scale of one to ten, one being low and ten being high, how would you rate the physical care you received at Living Room?”

Without pause, Ibrahaim replied, “Ten” and offered a thorough explanation of how the caregivers helped ease his pain and bring him back to life.

Kirui translated this into English, we scribbled notes into our notebooks, and Kurui continued. “On a scale of one to ten, how would you rate the emotional care you received at Living Room?”

“Ten. Beyond ten.” Ibrahaim elaborated on his answer, with Kirui translating bits and pieces.

Again, Kirui proceeded: “And how would you rate the spiritual care you received?”

“Ten. Beyond ten.”

Although several questions on the script remained, we were confident we could predict how Ibrahaim would respond.  We signaled to Kirui to stop the interview.  On the drive back, we discussed why our plan had gone so awry.  We had devised the concept of patient interviews on the ground in the ELI training center, while brainstorming with Juli.  Yet when we actually went out into the field, we realized that we were still out of touch with patients’ lives and the context in which Living Room delivers care.  If Ibrahaim had not been brought to Living Room, his most likely alternatives were to die at home in pain or to try his luck at an overcrowded hospital.  In this light, it would make sense that the kind, loving care Ibrahaim received at Living Room was always going to be “beyond ten.”

Community caregivers Betty and Victoria, Cook Jen, and members of the MIT student team

So while our survey pilot indeed failed, we learned several insights from the experience.  First, it reinforced the extent of the impact that Living Room is having on the community.  The organization is filling a dire need that is not being met elsewhere.  This truly validates the vision that Juli first had when laying the groundwork for Living Room’s mission.  The downside is that because Living Room is operating in such a unique space in this region, it lacks relevant and meaningful benchmarks (one our favorite business school words). Second, it reminded us how important it is to try out new ideas and be willing to iterate on them and change course in real time.  Instead of developing a robust patient feedback survey and process from the start, we wrote our survey one day, tested it the next day, and immediately afterwards acknowledged what had gone wrong and scratched our initial plan.  By being nimble and staying open minded about the outcome, we reached a conclusion more quickly.  As you review our recommendations for you, we hope you consider a similar approach by testing out new processes and being prepared for stops and starts.

After observing first hand the incredible impact Living Room has had on the community, we are even more excited about the opening of the new Kimbilio hospice in a few weeks.  We are confident that this will enable you to grow your impact even more.  Although we only had two weeks to spend with you in Kipkaren, we were able to dig into our project immediately as a result of your willingness collaborate with us over the course of our visit.  Because you were so generous with your time, our recommendations required only minimal revisions.  We hope that everything in our final report looks familiar and appears to be feasible to implement.   Moreover, we hope that our recommendations around organizational design and structure, operational checklists and processes, and guidelines for maintaining a high quality of care help Living Room to continue to strive towards excellence.  For example, we hope that you implement a performance feedback system that incorporates goals and expected results for each management team member.  Please let us know if there are any follow-up questions from our report and recommendations.  We would be happy to offer suggestions around implementation.

Finally, thank you for sharing two additional bits of wisdom.  First, for teaching us the wonderful proverb—“If you want to walk fast, walk alone. If you want to walk far, walk together.” – there is so much truth in that statement in Kenya and beyond. And second, thanks for the incredibly useful advice to avoid calling all men in Kenya BWANA!

We were so inspired by your accomplishments and all the lives you continue to touch.  Perhaps the verse Juli suggested that Kerrie read to the children during Devotions is even more relevant to you: And let us not grow weary of doing good, for in due season we will reap, if we do not give up (Galatians 6:9).

We will never forget the village, Living Room, and the wonderful people who live and work in your community.  Best of luck to you both!


Barbara, Dannielle, Kerrie, Tina

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