Flood Destroys Elegu – A Health Center that wasn’t to be

Phase 1 – Great hope
In March, we rode a trusty-rusty pickup with enthusiastic nurse Walter to the frontier town of Elegu on the South Sudanese border. High population, no health center, traders with a bit of money. What location could be better? The place even came with our Bishop’s recommendation.


Optimism, Hope and an Amazing nurse Walter

Phase 2 – Bewilderingly slow
Things started surprisingly slowly. Only 60 patients came the first month. 97 the second. Walter was bored. The patients who came appreciated the service greatly, but we were bewildered by how few there were. After an amateur advertising campaign where we shouted through a megaphone, smeared A4 notices around town, and gained the trust of the local Maadi tribe, things started to pick up.

Phase 3 – Maybe yes?
In July, the clinic broke even for the first time, with a bunch of sick patients coming for IV treatment, in addition to more minor conditions. 175 patients for the month. Walter called excitedly with the statistics, sharing that the word had spread, that people were appreciating him, the health center, and the care- the only high quality care available in the area.

Flooding Elegu

Some parts of Elegu flooded even worse than our healht center

FLOODED OUT  – We’ll never know

On Tuesday 22nd August, at around 4:00pm the banks of the Unyama River burst. The flooding was swift and violent. The scale is huge – as of now at least 3 people have been found dead, and over 2000 are displaced. Our nurse Walter Ran 50 meters to the clinic from his hut in an attempt save the drugs, but only managed to gather half before the water reached waist deep. By the time he filled a bag with drugs, his own home was flooded. He lost all his rice and beans, but him and his wife made it safely up to the safety of the raised main road. I thought he exaggerated when he said the water level reached over a meter, until I saw the water line on our drug cupboard today. Around 1.2 meters high. Today, a week later the water is still ankle deep, and Fiona from our Health office went to Elegu to retrieve the Cupboard, desks and other equipment that were covered in mud. Amazingly the clinic hadn’t been looted. We spent this afternoon washing them up, so we can use them in another health center soon. It hurts to lose Elegu clinic. something that could have done so much good. Time to mourn and move on.

Water line from flooding

So much malaria medication

Ruined Drugs

Cleaning up

The crew cleans up back at the office

There’s a great song, “Flood Waters” by Josh Garrells (do listen) which discusses a deep love which can’t be washed away. A love which can’t fail no matter what. Our love for this place, and Walther’s love for the people he treats won’t be washed away by this flood. We’ll all find new ways to put it into action.

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Teaching Kids – A Photoessay

Tuesday evening are special. Every week we’ve been in Gulu for the last 4 years, we’ve run an evening class for kids in the neighbourhood. They live within 200 meters of our house, and we’re really close with them. We focus on catching up kids who have missed large chunks of school because their parents couldn’t afford the fees. We also have a library of story books which kids can borrow from – if they can prove they’ve read their current book! In the last year we’ve exchanged over 200 books with the kids. While yesterday Tessa arranged the whole library, lazy me just made the kids laugh for the photo.


We have 3 classes based on ability. Tessa takes the lower two, and I take the older kids. This is the middle class. Why so serious?


Our visitors have been a great help with the class, and many have run their own programmes during the week to help give the kids an extra boost. Some of the results have been remarkable. Phoebe helped one girl to improve her reading and math by over 2 year levels in just 3 months. Six of the kids are sponsored to school through generous friends and churches, and will now finish primary school without missing another day. Thank you!

Phoebe kids.jpg


Lydia was always ready to drop whatever she was doing to read with the kids.  Lydia designed a star system where kids get a sticker for every book they read. Three kids have read over 10 books already! Sharon (below) is keen and focused, but over 5 years behind due to missing school and poor teaching.


Ira re-invigorated math for the older kids, and helped pitch the work more at the individual levels of the kids. (Nearly) all of these kids are from our class.

DSC05266 (1)

Mum is the biggest contributor to the  library, which now includes classics like The Very Hungry Caterpillar, Where the Wild things are and Dr. Seuss. While she was here she did class every day for a week, which was extremely popular. She may or may not have given out a few more stickers than we usually do ;).

mum and kids

And a huge thanks to our resident education expert Jody for making this all possible by showing us how to teach her wonderful phonics program.



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Theft, opportunity, deception and scandal

The truth about the Chicken. Our awesome friends sort out a simmering issue in the community 😀

Dan and Jodes... in Gulu, Uganda

Today I begin a short series (four posts) on community life living in Uganda. There are four short stories I want to share with you. I will begin with one today, then the rest should follow in coming days…

False accusations

Ned_2 Dan with Ned.

This morning Dan went to unlock the gate and was greeted by three women, one particularly agitated. It was the second time this woman had appeared at our gate. Three weeks ago she waved a dead chicken around in the air accusing our pup Izzy of killing it. She appeared the day after Izzy had got out for the first time and had a little run around, it was also after a severe storm. We tried to inspect this chicken, no bite marks, we were skeptical. We asked a lot of questions, we didn’t really get many answers, so the lady threw the dead chicken at…

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New Health Clinics – The Numbers

We’re 5 months into the trial of the 4 new clinics, with a total of 12 operational months between the health centers – the halfway point in the trial. Cetkana has been running for 5 months, and our most recent Obanga pe Wany. only 1 month. We’re aiming for ‘operationally sustainability’, which means the patient fees cover running costs. The new clinics have already treated 2293 patients combined which is impressive. YAY STATS here goes…

The patients

Here’s the graph of the number of patients seen by each clinic every month. Note Obanga Pe wany only has 1 dot – the clinic has only been running for a month. I’m not currently collating the data for conditions seen (its available at the health cetners), but over 60% of these patients had malaria.

Monthly Patient Number

Two Thirds of our patients are kids under 12, which is great from a saving lives perspective, but not so good for our sustainability as they pay less money.

Age of patients

The money

Patients pay a flat fee which covers Consultation + Test + drugs. This means someone knows before they walk 2 hours to the health center exactly how much money they need. Patients 0-4 years old pay USD 0.70. 5-12 pay US 1$, 13+ pay $1.50. Even in Uganda where people have very little, this is a relatively small amount of money, and always less than transport to the nearest other health facility. You won’t find cheaper healthcare in Northern Uganda outside the hopeless government system.

Over 90% of our running cost are drugs + the nurse’s salary + rent, and from our current experience it takes around 235 patients a month to raise the money required to pay for this. Here’s the graph showing how much money our health centers are losing/gaining each month. The line in the middle is the “sustainability line”, which the health center has to stay above on average to be viable. Keep in mind a couple of really good months can offset 4-6 not so good ones (see Ocim) If you’re wondering why its US rather than NZ dollars, its because the New Zealand Dollar is a backwater currency and we want to be taken seriously. A beautiful backwater though…

Profit Loss

As a side note We also give some stuff out for free, like condoms, family planning and mama kits for pregnant mothers. Nurse Naume at Ocim gave out 300 free condoms one month. Awesome.

Take away points

  • Around 235 patients a month is what’s needed for sustainability
  • Even after only 4 months, Ocim is doing well enough for us to say they can continue indefinitely. Sustainability win and compounded good!
  • Obanga Pe wany had a fantastic first month, if this continues it should also become sustainable.
  • Cetkana is doing a great job, but Is unlikely to become sustainable,.
  • Elegu has started very slowly and is losing a lot of money, but its early days.
  • Stats alone don’t show the good these places are doing. Stay tuned for the non evidence based stories to pull the heartstrings and give the majority of people who didn’t read this blog a warped view of how awesome these health centers are :p.
  • 2/3 of our patients are kids, which is great for their health and their future

PS: Since starting writing this we’ve decided to extend Cetkana’s trial another 3 months to 9 months, Despite their currently unsustainably low number of patients, they’ve actually lost very little money. Unfortunately I doubt they will reach the magical 235 number to be able to continue, but we wanted to give them every chance. Their deficit is only USD 40 a month. You might say, why don’t we just fund that shortfall? That’s so little money to help provide healthcare for 150-200 really poor people a month. People have already offered. Maybe in future we will run centers with small subsidies. For now though lets shoot for the moon and go for 100% local sustainability. It may hurt to shut places down, but we can always go back and through this approach we’ll find the areas which desperately need quality health care, rather than just a lot.

If you got to the end my respect for you is immense. More exciting and inspiring stories coming soon :D.



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Going Big at St. Philip

Today was EPIC at St. Philip Health Center. Our Visionary In-Charge Moses typified his Go Big attitude by advertising on the radio and churches on the same day…

  1. Free HIV testing  (tested 90 people for HIV)
  2. Free drop-in Cervical Cancer screening (screened 40 women)
  3. The opening of our Inpatient service

And all that in addition to seeing 70 patients as part of regular outpatients. Crazy town.

You heard it right, we’ve opened our Inpatient, 24 hour service. St. Philip is now a mini hospital – sort of. Complete with beds, night staff and everything. We had our first 4 admissions today, 3 with severe malaria and one with bad epilepsy 4 seizures in one day. Great work moses and the team!




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NGO part 4 – Give your money well

“Many attempts to do good fail, but the best are exceptional”
(William MacCaskill, Effective Altruism)

My first 3 Blogs focused on NGOs in the developing world, but this one explores simple question that’s relevant to all of us. Where should we donate money?

Donated money can do a lot of good. William MacAskill calculated that each dollar you give away if used well can be 100x more beneficial to a poor person, than it will be to you. That dollar which could pay for one days food for a girl in a refugee camp might increase her wellbeing 100x more than that sugar rush you get from a $1 coke (which I’m drinking right now). Makes sense right? This is really encouraging and should make us want to give more of our money away. But we have to send that money the right direction, otherwise its could be wasted.

What matters the most is the difference the money makes in the poorer country. Not how much is spent on overheads, or the reputation of the organisation you are giving too, but the bang for your buck. If you invest in a business, you want the best return for your investment. It helps to think the same way about your donation.

Who NOT to give to
Avoid giving money to high profile, big NGOs. (World Vision, OXFAM, TEAR fund, UNICEF etc.) You simply don’t get bang for your buck. I’ll break down what happens to the money you give them, and you’ll see why.

a) About 15-25% of money donated (varies between NGOs) is used for fundraising and administration in Western Countries. This on its own is not a problem.

b) Probably a higher proportion than 20% (its never published) is wasted on meaningless meetings, administration and high salaries for management in the poor country itself. This is an enormous problem.

c) The 60% (or similar) of your money remaining which is used to actually help the poor people, may not achieve what you expect. World Vision’s child sponsorship programme statesYour generous donations will help the whole community have access to vital resources like clean water, nutritious food, healthcare, education, economic opportunities, and more.” This sounds nice, but the holistic community approach is not as good as it sounds. The interventions may be only marginally useful, or worse foster dependence in the community. As far as I could see, they don’t even confirm whether or not they pay the child’s school fees. There’s nothing wrong with keeping it simple and just paying the school fees. Simple may not be sexy, but it could be better.

When NGOs do a wide range of interventions, they are usually not implemented by appropriately trained people. One staff with a bachelor degree in development will one month be doing an agriculture project, then the next month health education, then the next month starting a village savings group. Would you let your Teacher pull out your teeth?  I was recently outside an NGO office when I noticed a bunch of vegetable seedlings in pots. When I asked what they were for, the project officers said that they so they were about to start a big farming project, but the staff “didn’t have much” farming experience so they wanted to check what would grow! NGOs regularly send ‘quality improvement teams to our health centers who drive hundreds of kilometers in big vehicles, offer mostly useless advice and aggressively try and make us change the way we do things for the worse, often in a paperwork heavy direction. An NGO recently came to our Health Center and tried to get our nurses to implement a 16 column cash book, when we are currently struggling to sort out our 2 columns. Nice one.

Large NGO interventions are also unlikely to be based on what evidence shows works. They like activities which sound nice and inspirational to the Western Public but may be useless. There are plenty of examples like ‘playpumps’ (supported by UNICEF and World Vision) where millions of dollars are poured into useless causes, but this happens on a smaller scale all the time. Why didn’t they do it on a small scale, and study the effect before wasting money on that scale? Despite increasing pressure, NGOs still keen to base their interventions on evidence. Heiffer international (who give out cows) even refused an offer to have the effectiveness their method tested against other NGOs. I’m not saying that all development efforts must succeed, but the more we base our interventions on evidence, the better chance we have.

If you give to NGOs, some of your money is wasted, and the rest may used ineffectively. There’s also the issue of NGO corruption, which you may have already read about. So where do you donate if not to the big NGOs? I’ve outlined three possible approaches below, which are better ways of getting bang for your buck.

The Solution

Approach 1)
Foster personal connections with friends, acquaintances or small NGOS doing work in developing countries, and give money to them. If you have a friend working in aid or development I’d advocate taking the time and money to  see the work they do, or at least talk to them over skype. When you are personally connected to your giving, you see exactly what happens with your money. The photo and the story of the actual kid you sponsored through school. The well built in the village you visited, the Health Center started. Big NGOs can’t usually manage this personal connection as there too many donors to keep personally connected with. Another bonus is that often close to 100% of your donation goes to the intended target. Cut the middle management! If you give money to build a hospital, 100% goes to building the hospital. If you give money for school fees, 100% is used to pay the fees.

Giving through individuals or to small organisations may not be the absolute most brutally effective use of your money, but we are connected, emotional human beings. The more connected we are to where our money is going, the better we feel and the more likely we are to both being socially conscious in our own lives, and continue to giving money to good causes in the future. “Now that I have seen, I am responsible” (Brooke Fraser)

Approach 2) Focus your donation on the most effective and efficient interventions. What aid will give the best bang for your buck? What organisations can best turn your 1 dollar of happiness into 100 dollars worth for your neighbour across the world? Most of us don’t have the time or brains to crunch the numbers, but luckily super-smart people at organisations like Givewell have done the work for us.

The results may surprise you. It turns out buying kid’s school uniforms is more effective than buying them books. You might have heard that small loans, or microfinance is a massive success in the developing world. One of the founders Muhammad Yunus even won the Nobel Prize for it. Unfortunately, the research seems to show that the billions spend on microfinance may have achieved exactly nothing. Perhaps those women in south-east Asia would have started successful businesses without the loans, the economy in those countries was growing so well anyway.

Givewell mostly selects large Public health programmes as the best value for money.  Malaria Nets, Iodising Salt, Deworming programmes. 6 out of 7 of Givewell’s highest rated charities are healthcare related. The seventh, ‘givedirectly’ simply gives money to the poorest people, no strings attached. Although I instinctively hate the idea, the evidence points to it working well. Unfortunately though, studies can only done on big organisations, so smaller endeavours and innovative efforts by individuals which may be at least as effective get missed.

Approach 3) Give to big NGOs that do one thing well and have clear goals. Although they may be a bit inefficient, and their work may not always be evidence based, at least they have experts trying to tackle specific problems. Amnesty International (human rights advocacy), or Doctors without Borders (Healthcare in warzones and famines) are good examples of this.


Give freely, Give well.





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The 8 best Changemaker movies

Here are our 8 favourite movies that both help us learn about injustices in the world, and inspire us to change them. These movies are great to watch as a group, so you can discuss the issue both during and after the movie.

These films had to meet 3 criteria
1. There’s a clear issue, or injustice brought to light in the movie
2. One or more people in the movie are fighting the injustice.
3. Movie not documentary.

In no particular order…

1. Pride – Worker’s right/discrimination
Feel good all the way home. A true, unlikely, heartwarming story where the LGBT community bands together to help miners during their strike.
Con: A bit light and fluffy

lesbians and gays support the miners

2. Lincoln – Slavery
Daniel Day Lewis’ Oscar winning performance as the force behind abolition of slavery in America. Shines light on the mechanics of changemaking. Collaboration vs. Fight. Pragmatism vs Idealism. How low are you willing to go to get the job done?
Con: Dialogue heavy and a little slow. Similar to ‘Ghandi’. Epics are sometimes like that.

3. Made in Dagenham – Women’s rights
True story about a factory worker who took on big business and government to fight for equal pay with men for women throughout England. Lots of fun moments, also believable and hard-hitting.
Con: Perhaps a little bit predictable, but then it is a true story

4. Blood Diamond – Diamond trade

Leonardo cranks out a ‘quality’ Zimbabwe accent in this super Hollywood flick. He’s not the hero though that’s for sure. You’ll never look at your diamond ring the same way again.
Con: The script could have been better. Cheesy and unbelievable at times.


5. Spotlight – Sexual abuse in the Catholic Church
An intelligent depiction of a true story about journalists who made a difference. Made me want to be a journalist. For about 5 minutes. Won Oscar for best film 2 years ago.
Con: A little bit dry. Zero action, comedy and romance. Nothing explodes. Tessa says those are pros.

6. Lord of War – Small Arms trade
Action packed Hollywood blockbuster with yours truly Nicholas Cage. Tells the story of the disastrous small arms trade, where rich countries profit from poor country’s wars. You’ll be hooked after the fantastic first scene. This movie is underrated, and I love it a little too much.
Con: Isn’t really that good a movie. Still its my favourite.

7. Ghandi – Colonial Oppression
Quality 8 Oscar winning epic about the man who organized people like no other, to drive the British out of India.
Con: You’ll need to forgive that a white guy plays Ghandi. They weren’t even thinking about that back in 1982! Make a lot of popcorn, Its over 3 hours long.

8. The Help – Racial injustice
You can’t lose with this one. A product of their love and care, ‘Emma Stone’ bands together with African American house workers to expose their mistreatment by white housewives to the world. Lots of laughs, lots of tears.
Con: Some criticise its “white saviour” narrative. I’ve seen worse

The help

Bonus 9th: Selma – Racial Equality (Thanks Caleb)
Martin Luther King’s story needs no introduction. The Selma March is one of the most incredible events of our time, and if you’re not from America, you may find it hard to believe that it could even happen.
Con: Its not the best quality movie ever. More people should make movies about this story!

Feel free to add your own suggestions. We’d love to watch some changemaking movies we’ve never heard of.

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