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Each year as part of their training in New York, the new class of Acumen Fund fellows is sent out into the city armed only with a $6 metro card, a $5 bill, and their IDs. Their mission is to experience the challenges of obtaining basic services with these meager, minimal resources; in the course of the day, they stand in soup kitchens, visit shelters, and attempt access to medical care. Over the next week, we will be sharing their experiences on our blog. The last entry in this series comes from Meghan Simkins.

After training, Meghan will work with LifeSpring, a growing network of affordable maternal and child healthcare hospitals in India. She has a background in public health and business administration. Meghan holds a Masters in Public Health from Columbia University.

“He’s just so heavy, isn’t he?” the young mother says to me as she looks solemnly at the wailing child in the stroller in front of her. His fists are clenched and his two front teeth, the only in his mouth, do little to modulate his scream, directed right at us. I look carefully at her and wonder if her question is a rhetorical or literal one – or if it is both at once.

The emergency room we are waiting in is full and the lines seem only to be metastasizing, threatening to burst, not unlike like the feral will of the wailing child between us.

“Did you try the pediatric ER, it might be quicker” I ask?

She soberly nods her head, replying, with no small amount of resignation, “yeah, they sent me here because his fever is so high. Now I’ll have to wait here for the nurse. And then move to the next line. Then finally a real appointment. I’ll be waiting all day.” She sighs, aggrieved in a mild way, though with little expressed shock. Clearly she’s been in this position before.

My first instinct is to feel bad for her plight, to pity her. Yes, my first instinct is to pity this young woman, and to pity her suffering, shrieking, toothless son. I feel like I should pity the circumstances that have led her to this burdensome position, in an ER with a child ‘so heavy,’ and a wait so taxing.

I feel pity because this is exactly what I have been taught to think. My response to her is by this point almost conditioned, reflexive. Whether or not I had ever encountered a situation such hers in person, her story was utterly familiar. Whether I had read about young single mothers without health insurance in school, heard tales about women such as her as a kind of grave warning growing up, or somewhere else entirely, I am sure that I have heard her story before. And I realize waiting here with this real young mother, no longer just a story, case, or class, but flesh and blood and screaming child, that I had been taught to react with some form of condemnation.

“Well, you should have known better before you got yourself into this situation,” I faintly hear myself saying, suddenly aware of my own judgmental inner voice. I have heard her story and I have been taught to react with a stream of stinging “you should have known betters.” Of course, the ultimate judgment is about me: I knew better than you and now I’m not in your situation.

The boy continues to thrash about screaming, increasingly impatient, uncomfortable, and ill.

“May I touch him too see how hot he is?” I ask.

“Yea, sure,” the young mother replies.

I bend over and gently touch his head with the palm of my hand. The boy is hot, very hot. As if spurred on by my touch, the young mother picks the child up into her arms and caringly nestles him against her shoulder. Soothed almost instantly, he quickly quiets.

With the child pacified, the young mother seems to relax. A kind of ease comes over her – an ease bearing the mark of both routine and talent. She’s done this before and she does it well. In the place of the resignation that earlier pervaded, I begin to notice a certain resilience, determination, even pride in her and in her child. She smiles at me and offers a slight nod; she seems encouraged, bolstered by the skill with which she had provided succor to her sick child. With her nod she also encourages me. She has encouraged me to step outside my conditioned, judgmental assumptions, and my pity. I start to see her differently, as skilled, talented, and dignified. Perhaps it is the new, relaxed silence between us or perhaps it is the way my palm still feels the heat from her son’s forehead.

I start to notice her manicured nails, each with a miniature and vibrant design – a personal statement so foreign to me, but so alluring. I notice her immaculate cleanliness and the precise care she clearly takes in her self-presentation. Her hair, I notice, is skillfully swept away from forehead and more sophisticated by far than the ponytail I have sloppily swept mine into. Her jewelry, though minimal, is well thought out and tasteful. Here also, I start to really realize, is her own dignity. As she stands in line surrounded by impatient, ill people she does not know, with a sick, crying, ‘so heavy’ child, this young mother sends an unmistakable statement both to herself and to me: I have dignity. Hers is a conscious choice; there is nothing incidental about it.

Dignity is elusive. We often find ourselves speaking of it, but seeing it in real life, in unexpected places like a street or a crowded ER is a different experience altogether. Dignity is about retaining one’s essential humanity by making choices that at times might seem less than essential but on which one’s sense of self rests. It is about boldly maintaining one’s identity precisely in the spaces where identity is often lost, even stolen through a series institutional indignities. This young woman forced me to remember her, to share her story here. Not because she represented a human being behind another sad statistic and not because she had a screaming baby. I remember her and share her story because of the care with which she painted her nails and styled hair. I remember her for the proud way in which she looked at me while holding her child. And I remember her for the skilled, seemingly effortless way she brought her sick child comfort while waiting on an interminable line. I remember her because she did all of this while retaining a strong, unmistakable sense of self. Her dignity made her memorable.

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  • Interview with LifeSpring’s CEO: You can hear Anant Kumar, the visionary head of LifeSpring, in a podcast in the Social Innovations Conversations series.
  • Kashf on Oprah: Nicholas D. Kristof and Sheryl WuDunn’s new book, Half the Sky, includes the story of a Kashf Foundation client, which they recently shared on the Oprah Winfrey show.

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Patient capital around the world: The need for patient capital is increasingly being written about, as in this article from DAWN, Pakistan’s leading English-language publication, or this post on the Harvard Business Review blog.

Friends in the news: Our friend Liz Ellers was cited in Main Line Media News for her creation of and work with the collaborative funding partnership globalislocal, which has supported some Acumen Fund investments.

“The Boss”: The Sunday New York Times included a feature on Acumen Fund CEO Jacqueline Novogratz.

Summer spotlighted in the FT: Abhay Nihalani, one of our summer associates in Kenya, has been writing about his work there for the Financial Times’ MBA blog, as well as in an article in the FT’s print publication.

India investees in the news: Two of our investees were featured recently in Outlook India: D.Light and LifeSpring.

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Along with auto-rickshaws, the customer feedback form has become another ubiquitous feature of Hyderabad. This weekend alone, I was asked to complete three customer feedback forms. You know the type: on a scale of 1 to 5, how satisfied are you with the service, decor, range of products, etc.

While I appreciate the strategic customer focus that these forms imply, I can’t help but wonder: (1) are they actually collecting any meaningful insights from this data? and (2) can these forms do more harm than good for customer satisfaction? We all know that these forms are usually no fun to fill out and often come at the most inopportune times.

And here’s the “so what?” to all of this:

A huge part of my project is helping LifeSpring better understand their customers — the low-income women who give birth in their hospitals. What do they see as quality? How do they view the hospital?

LifeSpring already has quite a few initiatives in place: a feedback form for customers, a customer comment and complaint log at the hospital…For women who do not complete feedback forms, someone from LifeSpring calls to follow-up. LifeSpring takes its commitment to customer satisfaction seriously; last week, I sat in a Customer Relationship Management (CRM) meeting, while each customer complaint or comment was read, analyzed to find its root cause, and discussed to find a resolution.

Yet we are looking for ways to do this better. Feedback forms are intrinsically limited — not only for the reasons cited above, but also because many of LifeSpring’s customers are illiterate. Focus groups provide another option — but these are timely and difficult to scale up as LifeSpring grows.

So I’m throwing the question out to you all, because “your feedback matters to us”. Seriously though. What ideas do you have for us to collect meaningful and action-oriented feedback from our customers?

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The woman looks at the bag, a bit unsure of its contents. Slowly and almost hesitantly, she opens it up, and a huge smile sweeps over her face. Inside is a pink baby gown and a soft baby cloth to wrap her newborn in – a gift from the hospital.

I am at LifeSpring (www.lifespring.in), where I will be working for the next nine months (a time period not lost on someone now working at a maternity hospital!) I’ve spent the last few days completely immersed in its operations: sitting with the doctor as she consults with each woman…sitting in the ultrasound room, watching images of unborn babies on the tiny square screen…sitting with pediatricians as they vaccinate dozens of children…sitting with customers in the waiting room…and easily the best part: watching the customers leave the hospital, healthy new addition in tow!

In the last blog post, Catherine brought up Harvard’s Commencement speech. I am reminded of this year’s other speaker. Bill Clinton commented that: “Human beings, with their three billion genomes, are 99.9 percent identical genetically…Don’t you think it’s interesting that [we]…spend 90 percent of our lives thinking about that one-tenth of one percent?”

Sure, the cultural practices around childbirth may differ around the world. I watch fascinated, as family members circle the new mother’s head with a coconut…then the baby’s head…then break the coconut on the ground before leaving hospital grounds.

But there’s nothing like holding a LifeSpring baby to remind me how similar and connected we all are. Indeed, I am reminded of something Jacqueline Novogratz said before the fellows left: “We all want the same thing – a life full of meaning, a life full of purpose, a life full of dignity.”

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