Chongwe, Luangwa, Nyimba, Petauke and Katete

Note to self . . . never leave Lusaka with anything less than a full tank of fuel.

Filling up in Luangwa!

I’m always up for a bit of excitement, but our trip to Eastern Province this week proved a little more exciting than is comfortable – on various fronts. If you’d like to share some of the sights, the map below summarises what we saw where (you’ll need to be online to view it):

I was keen to get on the road as soon as possible on Wednesday (11/1/12) morning as the trip to Petauke was going to be a long one. I’d drawn out cash the night before, and we set off early, thinking we’d buy fuel on the way. Mistake. A couple of hours into the journey, we realised this wasn’t the M4. It wasn’t even the Great North Road (which we are used to) or the Kafue Road going south (which had lulled us into a false sense of development). This was the Wild East. There is not a lot between Chongwe and Nyimba and certainly no filling stations. By 11 am, it became blindingly obvious that we were going to run out of fuel.  As the fuel gauge wobbled between ‘Reserve’ and a quarter full we started doing some sums and some planning. When we ran out of fuel would Jane stay in the car while I hitched a lift or would she come with me? How many litres were were going to need to get to the next filling station? The answer was about 30 litres.. so, this wasn’t a small jerry can situation!

At this point some people flagged us down for a lift. One of them was the guy in the NY hat above. “Where are you going?” we said. “Luangwa.” We explained our predicament. “I sell fuel”, he said, “I have fuel in Luangwa”. We were not going to the Luangwa we knew (on the border with Mozambique). And we didn’t have enough fuel to reach there. But the cross-roads town at the river is also called Luangwa. “How far?” we said. “12 Kilometres.” Actually it was 20 or so. “How much?” “10 pin a litre.” 10 pin is ten thousand Kwacha – it’s 8 or 9 a litre in Lusaka. So, this was a bargain…(it must have fallen out of a lorry). Anyway, there is no filling station, as such, in Luangwa. But the picture tells the story and we were on our way.

One good turn deserves another so we stopped to give  lift to another group after Luangwa. We had absolutely no language whatsoever in common and one of the passengers was obviously very sick. We dropped them at Nyimba and they headed straight to the hospital.

The aim for this trip was to sound out wholesalers from our very short shortlist of districts which fit our criteria for the trial. We’d been given a contact in Petauke and we were off to visit him. When we got there we tried to track him down. In the process, we quickly realised that Petauke was not going to work as an intervention district. Among other problems, the Coca-Cola was sold from a shipping container – these get too hot in the summer to store medicines, even the simple medicines we will be distributing. We never did find our contact. The nearest we got to him was his nephew who told us he was travelling outside the country. That would explain my failed attempts to confirm with him before we travelled.

It was now nearly 4pm and we were feeling pretty down in the dumps. It looked like we were going to have to go back to the drawing board, and it’s a long way to go, to find out that what looks good on paper isn’t going to work in real life. But having come all this way, we decided to travel to the next district town, Katete, to ‘have a look’. It was ‘only’ another 100km up the road towards the Malawi border and we’d already driven 400km from Lusaka.

We arrived by 5, and asked where the Coca-Cola wholesaler was. We were directed around the corner. It was easy to find, as there was a huge lorry outside unloading crates of Coca-Cola! We explained in broad terms what we were up to and were guided around the back to meet the owner who greeted us very warmly and invited us in. Anyway, to cut a long story short, after an hour’s discussion we felt we’d found our second ‘willing wholesaler’ in a district that matched our criteria – even though it was a bit further from Lusaka than we’d intended to go. All of sudden, a wasted day was fast turning into a very worthwhile trip. But it was now 6.30 pm and a beautiful sunset quickly took over the horizon. The sun drops fast here; within minutes it would be dark. Zambian roads after dark are full of unlit obstacles, animate and inanimate – and all too often the animate are inanimate by morning. So, we asked about places to stay and in ten minutes pulled up at the recommended lodge. Fully booked.

Sunset at Katete
Katete at dusk

It was decision time. Should we waste another half an hour trawling around the tiny town of Katete in the dark? We’d seen 3 or 4 big lodges in Petauke, it “wasn’t far” (according to our newly calibrated sense of distance) so we decided to drive back. It didn’t take us long, however, to find out that the old merc had 2 more quirks, along with the temperamental electric windows, funny hand-brake and wobbly petrol gauge: the headlights.  They worked, but only when it suited them. So, very slowly, very carefully, both of us peered head into the black, shouting at the slightest movement: “Pedestrians!”, “Bicycle!”, “Goats!”, as we tried to make out the sand drifts across the road, pot holes, broken down lorries, parked pick-ups, and unlit motorbikes coming the wrong way…. We tail-gated other vehicles with better headlights, until nearly two hours (and a dry radiator) later we saw the lights of Petauke ahead – exhausted but so relieved, that we didn’t even mind the mosquitoes that insisted on sharing our net… in fact, we hardly noticed them. What’s a mosquito, when you’ve managed not to hit a cow?

The trip back to Lusaka the next day was long (5hrs) but totally straight forward. Today (Friday the 13th – but auspicious for us) we got the nod for Katete as a suitable intervention district from UNICEF and Rohit. So, we are very pleased. This has enabled us to complete the Terms of Reference for the research aspects of the trial and early next week UNICEF will issue a call for Expressions of Interest for the subcontractor to carry out this (significant) part of the project.

 

Moving towards District selection

Crunch time is approaching in terms of which Districts we select for the ColaLife trial. The ‘tension’ between the desire to go for what academics call a ‘randomised cluster trial’ – the gold standard in trial design - and the practicality you encounter on the ground; the way free markets work and the impact of the personality and approach of different distributors and wholesalers, is being brought into sharp focus. This is nothing new we’ve been discussing this for weeks and have just had another 2-hour Skype call about it tonight.

Visiting places and talking to wholesalers really helps. Jane and I went to Choma and Kalomo yesterday (Sunday) which really brought things alive in terms of how the trial might work. Kalomo is a classic market town serving a huge rural hinterland. You can see from the geotagged photos on the above map that every other ‘shop’ is some sort of wholesaler, there to serve retailers coming in to buy supplies.

Today we met another wholesaler in Lusaka who operates in Eastern Province and we’re planning a trip to Petauke on Wednesday to talk to the person who runs a Coca-Cola wholesaler there.

We need to decide on Districts by the end of play on Wednesday so that we can get sign-off of the Terms of Reference for the Monitoring and Evaluation work and go to tender for the supplier of these services to the project.

But before the trip on Wednesday we have our first implementation partners meeting tomorrow (= exciting). A key part of this meeting will be the training partners in the use of our Huddle system which will be the key tool for collaboration, communication and information sharing for the project.


A retailer on a trip for supplies near Mazabuka

The Funding Network pledges £10,000 to ColaLife

The Funding Network LogoWe were honoured to be nominated by a member of The Funding Network and then very pleased to be selected as one of five social causes to face the ‘friendly dragons den’ that is The Funding Network. This all happened last Thursday evening. Our Chairman, Andy Chapman, made the pitch and he was supported by ColaLife supporter, Damian Radcliffe, who helped work the crowd!

On Friday we heard that Funding Network members had pledged a massive £10,260 to our core costs. No one likes funding core costs, everyone wants ‘projects’, so this funding is particularly welcome. So far, we have provided extremely high returns for those people who have given us unrestricted funding. The first significant blocks of funding we received: £6,000 from the Boulogne to Biarritz bike ride and the money raised through the Buzzbnk (£3,000), paid for the trip to Zambia to work with local organisations to co-design and develop the plan for the trial. With this plan we have raised £840,000 for the ColaLife Trial which starts for real in January, and £101,500 for development work in other African countries which will start in September next year. That’s a return of 10,400%.

As is usual, ColaLife got an overwhelmingly positive ‘why didn’t anyone else think of that’ response, with a sprinkling of one or two people suspicious of Coke’s involvement and others wondering why Coca-Cola wasn’t funding the trial themselves.

On the first point, despite the word ‘cola’ in our name, ColaLife is completely independent of The Coca-Cola Company. There are more than 200 ‘Colas’ in the world and Coca-Cola only owns one of them. And ‘Cola’ or ‘Kola’ is also a nut with big cultural (and relevant) significance in many African countries.

On the funding front, our strategy has been that we should not approach Coca-Cola for funding, at least in the early years. Instead, we wanted to develop our relationship with Coca-Cola as a ‘trusted third party’. We wanted to be seen as an organisation that could bring unlikely alliances together to do extraordinary things. In addition, we needed a relationship with the business side of the The Coca-Cola Company not the philanthropic side. And finally, we wanted to maintain our independence – always important for a non-affiliated charity organisation, but especially so when you need to show objectively whether an idea works or not. We are very vulnerable to being overwhelmed by organisations such as Coca-Cola and that would not be good, in our judgement, if the ColaLife concept is to flourish.

All of this doesn’t preclude Coca-Cola funding in the future but let that be a business decision they make based on the outputs of the trial.

So once again, many thanks to The Funding Network - your support is very valuable to us.

Honda continue to help us reach new audiences

On Sunday (yesterday, 16/10/11) ColaLife featured in The Sunday Observer Magazine under the headline An idea with fizz (it’s on page 38 apparently). I was the third of the Cultural Engineers to be featured. Seven more to go. Six of these are in place and there are five candidates for the tenth slot. You can vote for your favourite here (there are Amazon vouchers on offer for voters).

My understanding is that there will be one featured per week over the next couple of months. You can read all about Honda’s Dream Factory partnership with the Guardian here. Below is the photo and caption that accompanied the ColaLife article. This was taken about 30 minutes before I realised I’d lost my iPhone! But that’s another story.


Simon Berry is poised to realise a 30-year-old dream when he arrives in
Zambia this autumn to oversee the delivery of basic medicines using
Coca-Cola’s distribution network. Photograph: Jean Goldsmith

Announcing the AidPod Mark VIb

We had a bit of a fright when we went to the local Supermarket to buy a crate of Coca-Cola for a presentation we are giving this week to find that the predictable had happened and Zambia Breweries (SABMiller), the Coca-Cola bottler, had capitalised on the new lighter and stumpier bottles we reported on earlier and have produced a more compact crate to match.

Unfortunately the Mark V AidPod does not fit the new crates. The AidPod is too deep and hits the dividers in the crate which means it sits too proud of the bottles. Time for a re-design. So I’ve spent the last couple of days with a new crate working out the new profile of the Mark VI AidPod. Mark VIa, the first attempt at a new design, still had the shoulders as a feature. However, this has always been a bone of contention as it would complicate the production process and make the AidPods more expensive to produce. So the Mark VIb has no shoulders and its cross-section now looks like this (see picture). It is still half-length (116mm approx), just like its predecessor and so 10 ADKs will fit into one crate.

The big question is, is the new design big enough to take all the proposed components of the Anti-Diarrhoea Kit (ADK)?

We have samples of the soap that will be part of the kit and we also have samples of the PedZinc zinc supplements but we have yet to finalise the ORS we will use. So on Saturday (15/10/11) we went into Lusaka to combine a bit of research, into what was available on the market, with the purchase of some ORS samples. When we got home we were able to see if the components would all fit into the new AidPod. Watch the video to find out!

Here is a set of 9 pictures which show the new AidPods in the new crate (you’ll need to be reading this on the blog to see this slideshow I think):

Tying up the loose ends from Week 1 in Zambia

There’s never a dull moment with ColaLife. Group Skyping with our fellow trustees from Zambia; is Ka-Pakati the new name for the AidPod in Zambia?; Coca-Cola change their crates and our response -> the AidPod Mark VI; meeting up with our friends at Keepers Zambia Foundation; and news that our trial advisor will be joining us shortly . . . it’s all in the Podcast below:


Podcast 27: Summing up week 1 in Zambia (mp3)

At last! A peek at the ColaLife Trial Plan

ColaLife Trial Plan EXEC and Key Diagrams CoverMany of our regular readers will be itching to see the culmination of our work over the last 3 years: our plan for the first field trial of the ColaLife concept – the snappily named ColaLife Operational Trial Zambia (or COTZ, when you are trying to fit it into a funder’s 600 character project description!).

We always said that ‘the devil is in the detail’ and it has taken 3 years: . . . from our first convening on Facebook in 2008, our link-up with BBC Radio, engaging with The Coca-Cola Company, our UnLtd award which has kept food on the table and came just in time as Jane and I decided we had to commit ourselves full-time, the sponsored cycle ride across France, our three trips to Zambia (Oct 2010, Jan 2011, May 2011) . . . All this has culminated in just 14 pages! Plus some very useful charts and diagrams, and for those who are not faint hearted: 39 footnotes and 17 pages of Appendices.

The Executive Summary and the key pictures, charts and diagrams can be downloaded here (PDF, 537 KB).

Because the plan still under consideration by funders, and partners have yet to sign the memoranda of understanding, we can’t yet put the full plan in the open – despite our commitment to Open Innovation. However, if you’d like more than the Executive Summary, you can also request a fuller version of the plan here.

We’ve built the plan using a co-design process, from a well understood need, but from the bottom up. The plan is not a rushed response to a funding opportunity. It is a detailed, and fully-costed, description of how we propose to rigorously test the ColaLife concept in Zambia through a local cross-sector partnership. The formulation of the plan has only been possible because so many big players have been willing to work together in an ‘unlikely alliance’ involving some of the biggest names on the planet. Here are just some of them:

Implementation partners:

  1. Ministry of Health, Republic of Zambia
  2. UNICEF, Zambia
  3. Zambian Breweries plc (Zambian subsidiary of SABMiller plc)
  4. Keepers Zambia Foundation, Zambia
  5. Medical Stores Limited, Zambia
  6. ColaLife

Partnering sub-contractors:

  1. PI Global (ADK Packaging)
  2. Mobile Transactions Zambia Limited

Operational research contractor (still to be selected by UNICEF, through competitive tender)

The planning process would not have been possible without the support at global level of The Coca-Cola Company, SABMiller and Johnson & Johnson and Janssen Pharmaceutica. We are also grateful to Rohit Ramchandani, currently studying for his Doctorate in Public Health at Johns Hopkins University, for his input on the trial design and many others too numerous to mention here, but many of whom are listed in the acknowledgements contained in the plan.

The plan has triggered confirmation of support from the Johnson & Johnson Corporate Citizenship Trust. Jane and I worked with a small team at Johnson & Johnson/Janssen Pharmaceutica in their ‘Innovation Bootcamp’ from October 2010 to January 2011 and this helped to challenge and refine the ColaLife concept.

The plan is now with potential funders, and we’ve been able to approach them with 25% of the total of USD1.354m we need already confirmed in cash and in-kind from partners.

Having the commitment of the Johnson & Johnson Corporate Citizenship Trust is a huge boost and will give some reassurance to others. However, we appreciate that other funders will still have to work hard to support us as we are not always responding to a specific ‘call for proposals’ from them.

We hope that the funders will now be able to show the same creativity and flexibility that we have seen from all the partners and supporters of the plan so far.

This is a really significant milestone in ColaLife’s short life. Thanks to everyone who has helped us get this far.

Onwards and upwards!

Without a Coca-Cola life is unthinkable – Henry Miller

Can Coca Cola Save Children's Lives?
A Shop in Soweto Township. Image credit: Nick Gripton

This is a much-used quote attributed to the late Henry Miller from his book The Air-Conditioned Nightmare.

I don’t know exactly why it’s quoted so often. I’ll need to read the book. But just imagine for a moment a world without Coca-Cola. Or, if that’s too much of a stretch for you, imagine Africa without Coca-Cola. Now hold that image for a moment and imagine someone coming up with the idea that every village in Africa should have Coca-Cola. Most people would think that this was a crazy idea. The majority would dismiss the notion as silly while a minority would challenge the idea with comments like:

  • Do you know how much a glass bottle of Coca-Cola weighs? Who is going to carry it there?
  • Do you know how much it costs to make a Coca-Cola bottle? The bottle would have to be returnable. How on earth are you going to get the bottle back?
  • Coca-Cola is a beverage. People will drink it. How are you going to guarantee quality and ensure they don’t get sick?
  • Who would want to buy a brown fizzy drink?
  • And so on. Add your own challenges.
This is the thought process I go through when, very occasionally, I wake up in the middle of the night in a cold sweat wondering if we can make the ColaLife concept work. I reassure myself that if it can be done with Coca-Cola it can be done with an anti-diarrhoea kit especially if those involved in Coca-Cola distribution are helping us.

 

PedZinc samples arrive from Tanzania

PedZinc in AidPod PedZinc embossed livery

Regular readers will remember a mini-panic that we had back last month when we visited the Medical Stores Limited (MSL) warehouse to find the type of Zinc supplements we wanted but packed in boxes of 100 tablets (10 blister packs of 10 tablets each) – see the picture below.
ZinCfant 20mg

This is a real problem for us for several reasons:

  1. A course of Zinc supplementation is 10-14 tablets for a child 6 months or older and half that for children between 2 and 6 months. This packet contains 10 courses for older children – more than we need and more than the mothers and care-givers we are targeting could afford, or be willing, to buy in a single purchase.
  2. For good reasons, the pharmaceutical regulations apply to the medicine AND the way the medicine is packaged with its labelling, instructions and so on. This means that we would not be able to break these packets down and include just one or two blister packs in the proposed ADKs (Anti-Diarrhoea Kits).
  3. And finally, the boxes are too big to fit in an AidPod!

It was time for a re-think. The Zinc tablets we were expecting to find at MSL were PedZinc produced by Shelys Pharmaceuticals in Tanzania. These are already approved for general sale in Zambia but we still had no idea of the package size. Would these be supplied to boxes of 100 tablets too?

I contacted Shelys Pharmaceuticals and yesterday the PedZinc samples arrived from Tanzania and they are:

  1. Packaged as single blister packs of 10 tablets. The packets have all the required information on the back: tablet description; storage instructions; manufacturer; batch information including date of manufacture and expiry date.
  2. The package also contains a detailed data and instruction sheet.
  3. The packaging is very attractive with embossed printing on the front
  4. Two packets fit very neatly into an AidPod

The attractiveness of the package might seem an odd thing to highlight but the 2009 WHO/UNICEF ReportDiarrhoea : Why children are still dying and what can be done, recommended that products to treat diarrhoea need to be ‘attractive’ to mothers and care-givers and part of this will be the way the product looks. Other research has indicated that ORS is often not seen as ‘medicine’ and this is a drawback. Mothers don’t like to feel that are being ‘palmed off’ with non-medicine – a feeling that applies to mothers the world over I would suspect. PedZinc carries the look and feel of a high quality medicine.

A nice twist to all of this is that Shelys Pharmaceuticals is part of the Sumaria group which also owns the Nyanza Bottling Company Limited and Nyanza Bottling, which is based in Mwanza, is the Coca-Cola bottler for the Lake Region in Tanzania. I’m not the only one to have made this link . . .

Zambia Diary | Day 8, Visit 3 | From lowlight to highlight

On Tuesday night (17/5/11) I was worried when a potential problem was revealed to me that I hadn’t even thought about. Fortunately, we don’t get a lot of unpleasant surprises in ColaLife because we have been kicking the concept around our thousands of supporters for three years and this has meant that a lot of the issues we are likely to face have been raised and we’ve had time to think and consult on how we might deal with them.

So what was the potential problem?

Every country has some sort of Pharmaceutical Regulatory Authority (PRA). This authority registers medicines and medicines need to the registered before they can be sold. In Zambia medicines are classified as: GS (General Sales); P (Sales under the supervision of a Pharmacist), POM (Prescription Only Medicines) and Narcotic (I’m not sure what this means but it sounds pretty serious).

The components of the ADK (Anti-Diarrhoea Kit) we are proposing all fall under the GS category with things like Aspirin. This means they can be sold in any retail outlet – just like Coca-Cola. So far so good.

What I hadn’t thought about was package size. The potential problem arose when we went to MSL on Tuesday. There we saw precisely the product we wanted: Zinc?? but it was packaged in small boxes of 10 blister packs, each containing one course of treatment (ie 10 tablets). So each box contained 10 treatments. The boxes were labelled and contained the necessary instruction leaflet but the individual blister packs were white and had no markings on them at all.

I’m no expert but I would bet my house on the fact that the Zambia PRA (or any other PRA for that matter) would NOT allow us to break up a box of ten blister packs and put individual, unmarked blister packs into and ADK even if we did write our own instructions!

This whole experience is a real eye opener for me. What it means is that a medicine can be available in a country but can be inaccessible to the end user because of the way it is packaged. Obviously, it is much more cost-effective to put 10 blister packs in one box with a single set of instructions but this makes the medicine less accessible to an individual mother with a child with diarrhoea. She wants, and can only afford, one treatment not 10.

At this point I am in minor panic mode but trying not to let it show.

Time to ignite the ColaLife supporters network to see if we can find a solution.