My trip to Uganda to set up the test of sanitary pads alternatives had its comic moments, as well as some frustrations, but, with support from friends and partners on the ground (as well as email efforts of the team in the UK and US), everything is now in place.
Our partners in the ESRC-DfID test going on elsewhere in Uganda, Plan International, arranged for research assistants to come in to the Kampala Sheraton for more training on the iPads. The training went smoothly and we all continued to be impressed with
how much easier it is to do complex surveys through Survey Deck/Survey Gizmo technology. Maryalice Wu, who trained the group in Kamuli recently, was available by Skype to answer questions.
In fact, most of the arrangements went smoothly–all the difficulty was around delivery of the pads we had planned to test. While both Makapads and Afripads staff delivered those products without a hitch, the products that had to come from Kenya were more difficult to get. The Project Mwezi pads did finally arrive at the bus station in Mbale, after a lot of work by Florence Otieno Gundo and Charles Orongo to put them on Kampala Coach in Kisumu, as well as by Sam Mugisha and Rose Manana to retrieve them in Mbale. We are also indebted to Rita Nabuzale, Lillian Iraguha, and, again, Sam Mugisha for eventually obtaining the KMET pads, which went astray in Kampala.
In the end, however, it seemed that there had been misunderstanding about the number and costs for the KMET pad. Once shipping and foreign exchange costs were included, the pads cost about US$10 for a box of six. This price makes them impractical for girls in impoverished circumstances–and too expensive for our study. We ended up with 200 pads, rather than 200 boxes of six, as we thought we would have, and could not afford to buy more, once the real price was understood. So, we have decided to provide each girl in that segment of the test with two pads, for a total of 100 girls who will try that option. The pad looks and acts a great deal like home-made patterns that have been introduced by NGOs in the area. Girls are often advised to make two or even provided the material to make two. So this testing strategy will at least give us feedback for a solution that may be suggested by community workers–but we do feel that the option will likely not be adopted by the girls because the drying time will mean two pads must be supplemented by other means. The Project Mwezi and Afripads will still be provided in full kits.
While I was there, I enjoyed the chance to meet with Sophia Klumpp and Paul Grinvalds, the founders of Afripads, for coffee in Kampala. They are an open and enthusiastic pair, very friendly and optimistic. But the thing that impressed me most about them was the time they had taken to study the problem, listen to the girls, and design a pad that reflected both the demands of the situation and the materials available locally. They have done an admirable job of putting a product in place that responds to input from the intended users.
Paul and Sophia’s patient and painstaking work stands in stark contrast to companies who are now marketing menstrual cups in east Africa and elsewhere. I have been dismayed lately to learn of efforts to distribute such products in Kenya, under the guise of “business fighting poverty.” Menstrual products violate local taboos about insertion, much as tampons once did in America. The more urgent concern is that limited availability of soap and water, as well as the propensity to share even intimate objects, are likely to make menstrual cups unsafe for poor populations. I am discouraged by the ongoing propensity of Westerners to decide “what’s best” for developing world populations from the perspective of their own mores and material conditions.
The community members supporting the students in our test area offer both a local sensibility and a humane attitude. I am not at liberty to divulge the name and location of
the school because ethics considerations make it important to protect the identities of the girls in the study. I do want to mention, however, that the school’s headmaster and staff have been particularly cooperative. They are providing both time and space private enough that the girls can be surveyed and trained without embarrassment.
Maintaining privacy was a key benefit of the incinerator we selected for the disposal method to be used for both the MakaPads and other non-reusable pads the girls may have. As the photograph here shows, a girl can change her pad, putting the used one down the shoot without ever leaving the latrine room. Other incineration equipment forces the girl to walk, sometimes into an easily observed area, to put the used pad into a receptacle. Many of these incinerators are open, sometimes just surrounded by mesh, leaving the used pad in full view of any passersby. It is no wonder that girls choose instead to put the pads down the latrine, causing them to back up.
Moses Musaazi, professor at Makerere University and inventor of MakaPads, arranged installation of the incinerator, which he designed. He came out to demonstrate use of the device for school officials and community members, as well as for the research team, while also explaining how the design works to burn materials at medical waste temperatures even without fuel.
We wait with keen interest to see how the girls respond to each of these methods: the Makapads and incineration, the Afripads, the Mwezi towels, and the KMET pads. The test will run until July.