Effective Verbal Communication in Healthcare

What I find the most challenging in the clinical setting as a new nurse practitioner, is effective verbal communication. Being able to succinctly deliver information to colleagues and patients alike, is a component ever so vital as successful practitioner, and something I still struggle with. I felt that this method of communication was not stressed enough in my education. We are constantly taking tests, reading books, and writing papers, however in the "real world" the majority of the communication in healthcare is verbal, not written. I have had plenty of experience with public speaking, and am not a poor public speaker. The difference with public speaking, however is that you have plenty of time to rehearse your presentation. When presenting a patient to a specialist or supervising physician, you don't have time to rehearse what you will say. I am adding this link to a blog post I found helpful from Little Bit of Lacquer, that discusses techniques to help with thinking on your feet.
 In nursing school and working as a RN, I did get experience with daily verbal communication during shift and nurse-to-nurse hand-offs, however in the provider role the reports given to other providers are more complex. As a nurse we learn the SBAR report format, which stands for situation, background, assessment and recommendation. Nurse-to-nurse reports are usually include the situation, (is the patient AAOx3), background (what has already been done in your care of the patient and recently), assessment (what is the diagnoses) and what is your recommendation (i.e. patient is nauseated need a PRN order).  The provider report is similar, however follows the SOAP (subjective, objective, assessment and plan) format, and requires you to come up with the plan, rather than just a recommendation. In my graduate education, I wrote plenty of SOAP notes in nearly all my graduate classes. I never had any problems with the written SOAP note. Presenting a patient verbally in this same fashion was difficult for me, and still is. In general I am shy around new people, and I tend to keep quiet around people I don't know too well. I think I enjoy blogging so much because I am a better written communicator, and it gives me time to process what I want to say and how I want to say it. In the medical field, your verbal communications skills must be strong or else you will not have the confidence and trust from your patients or your colleagues.  Here are some tips from my experience on how to effectively communicate verbally with your colleagues in the health care field.

1) Have a Plan
All so often I would have a situation in the ER I didn't know how to handle, a skyrocket high lab value, and I would run to ask the physician or another colleague  without organizing my thoughts. Big mistake. Rambling on and unorganized presentation are not tolerated well by busy providers. Put together what you have in an organized fashion (SOAP format) and if you are not sure what the plan is and research what you think is the best option and present that. If the supervising physician or other advising colleague disagrees with your plan they will tell you and modify it. Bottom line, always have a plan in mind before speaking.

2) Avoid slang and filler words
I was the queen of using slang and other informal vernacular, as well as my fair share of "ummmms and likes". It sounds so unprofessional and is incredibly distracting. My overuse of filler words was pointed out to me during clinicals by my preceptor, an internal medicine doctor. Ever since then I have made a concerted effort to eliminate these distractors in my speech. I attempt to slow down my speech, and pause instead of inserting these fillers. As a young, female provider, without MD behind my name, some patients and other colleagues already have a bias that I am incompetent before even speaking to me. Not speaking assertively and adding distractors will only decrease their confidence in your ability as a provider.

3) Use medical vocab and be as descriptive as possible
This seems obvious, but without practice it's easy to slip up and using layman's terms when presenting a patient. This was also was a habit I had to break. Instead of "a boil to abdomen" use descriptive language such as, a "3 cmx 1 cm erythematous nodule with surrounding induration to right upper abdomen."  Description is especially important when you are unsure of a diagnosis and are presenting a case to a consulting specialist. My former preceptor would put me on the spot in the room of a patient and have me describe a rash as if I was presenting to a dermatologist. I would stumble at first, but with time I improved.

4) Eliminate any distracting information
As in contrast from written documentation, when communicating information to a colleague eliminate all the unnecessary facts. In the subjective simply state the patient's complaints and duration of symptoms. Only state the past medical history and review of systems if it directly related to the patient's reason for the visit. For example, it is necessary to state a patient has history of uncontrolled diabetes with a patient presenting with cellulitis, however it's not necessary to mention the patient had an appendectomy two years ago. When discussing the physical exam, only report the abnormals pertinent to the complaint at this visit, and if there are none state "normal exam".

I will write another post on my tips on communicating with patients in the future. Please share your comments below.

My Favorite Accessories Under $40.00


FYI this is not a sponsored post, but have recently received complements on several accessories, which were  bargains and wanted to share. I do tend to wear more basic neutral colors, but for accessories I like adding some bright colors.

1.This iphone 6 plus case,  has also received many complements. I upgraded my phone to the iphone 6 plus last year, and my husband bought me a sturdy case to prevent cracking the screen. The 6 plus is already large as it is, and the case was too much. I got this glitter case for $8.00 on Several people have asked if I had it customized because it looks like a skin. It does not give your phone a great deal of protection, but I'm avoiding letting my son play with the phone anyways.

2.I have received numerous complements on these puma Carson runners. On my days off I am out and about walking, and these shoes are incredibly comfortable and fashionable. Originally $65.00 I bought them for $29.00 on myhabit.

3.This Sam & Libby Crossbody bag I have also received many complements on. Yesterday someone ask me if it was Kate Spade and someone else asked if it was real leather... Oh no it's from Target. I am really hard on my purses and I tend to collect receipts, tissues and other clutter in larger bags, so I wanted to downgrade to a smaller bag. I needed one that I could carry over the shoulder, however, and I wanted a metal strap so it wouldn't fray with overuse. This purse is perfect, and at the price of $34.99 it doesn't matter if milk is spilled on it.
4.I bought these Oshkosh Austin slip on shoes for my son as a Christmas present. When he started walking we were buying him nikes, which can be as expensive as adult nikes, which is just ridiculous for the rate at which he is growing. I got these on sale from myhabit for $12.00. I like putting him in bright shoes so they stand out from other kids shoes at daycare, and as a kid you can get away with wearing fun bright shoes.

5. Lasty, the fitbit bands. I originally received my fitbit as a gift from my husband who loves gadgets. I wasn't that into the fitbit at first, however now I am obsessive about tracking my steps (My goal is 12k, although my days a work I average 7k) calories, and sleep. The bands are interchangeable, and a pack of three different colors is $30.00. I got mine at Macys. The pink one in the above photo does not really go with my attire, but I was in a rush this morning. The blouse and necklace are from stitchfix and the cardigan from myhabit.

Hope during Holy Week

I realized when I was contemplating writing this post that it may come off "preachy" or like a sermon. This is not my intention whatsoever. I do identify as a Christian, and attend a Christian church, however I do not take it upon myself to influence others in their beliefs.  During this Easter Season and Holy Week, a time of renewal or rebirth, I find myself reflecting on suffering. Although spring is traditionally seen as the time of hope and rebrith, in real life this is not always the case. The anticipation that spring will bring about positive change is often attributed to the increase incidence of depression and higher suicide rates during this season. I remember when working in the ER one Easter Sunday, having a conversation with a patient about the events that led to her checking herself in that day on a voluntary psychiatric hold. This season is not always hopeful.  Especially with the recent violence in Brussels, the refugee crisis in Europe, the political climate in the U.S. and  recent life-altering events with several of my close friends, I find a hard time feeling hopeful. However, in my faith I know Easter is also about suffering and pain. The story of Easter is also one of loss, betrayal, suffering, and through all of this came hope. I am praying this week for all those suffering that they may find some source of hope.
On the plus side, my grapefruit tree has flowered. I am hopeful to have fresh grapefruit to make greyhounds at some point this year!

I love going to San Diego for a quick getaway from L.A. The atmosphere is much more kick-back, and it's an easy two hour drive from L.A. Now that I have family living in the area, I make more frequent trips to SD sometimes for a turn around 24 hour trip. Here are my recommendations of places to stay, eat and sight see while visiting in San Diego.

Stops Along the Way

I usually drive down the I-5 from L.A. which has many scenic spots including state beaches and vista points. My favorite pit-stops are San Clemente Beach and Carlsbad.

Carlsbad has a beautiful state beach as well, and a quirky Friday's with a windmill that is fun to grab a quick bite.

Best Places to Stay
If you want the gaslamp district, which is full of nightlife and posh restaurants, I highly recommend staying at The Keating. It's a modern hotel in walking distance of everything in the gaslamp district.  We stayed at The Keating and the room was soo soothing, with a white noise machine, black out shades, and the most comfortable bed and sheets. I didn't want to leave the room.

If you are interested in staying in the Mission Bay or are planning on visiting Sea World, I highly recommend staying at the Dana on Mission Bay. This hotel is more family friendly, and has a wonderful pool and sandpit. The hotel overlooks the Mission Bay with stunning views.

If North Park is more your scene, a neighborhood full of hipster bars, vegan restaurants, and record shops, The Lafayette Hotel is a good option. This hotel has large suites with bunkbeds. A large pristine pool is at the center of these bungalows. This hotel is not always family-friendly as there are often events and loud parties around the pool, but otherwise is a fun place for kids and adults alike.
 While in North Park eat at city tacos. You an enjoy carnitas, portabello and camerones tacos for $3.00 each. Another favorite spot in North Park is Swarmi's, which has really amazing brunch.

Outdoors and Beaches
Coronado Island has a beautiful beach for swimming in addition to a great shopping district. I want to stay at the Hotel Del Coranado at my next visit, so I will report back on that.

Mission Trails Regional Park
In the Mission Valley the Mission Valley Regional Park has over 7,000 acres with multiple trails for which guided hikes are offered several days during the week.
La Jolla Cove is another favorite of mine. It's nice to take a stroll along the cove and watch the sea lions. Downtown La Jolla also has a lot of shopping and restaurants.

Museums and Culture

The San Diego Zoo is a must while in San Diego, and is fun for kids and adults. You could fill an entire weekend just at the Zoo. Take the tram and have a bird's eye view of the exhibits and animals.

While at Balboa Park check out one of the many museums. The San Diego Natural History Museum is a great one to check out.

This is the oldest Mission in California, founded in 1769. Although the inside has been redone, the history is fascinating, and the grounds are very peaceful.

Post your comments or suggestions on visiting San Diego below.

The Road to becoming a Family Nurse Practitioner

I decided early on in college I wanted to be in the medical field, however it took me some time to choose the path towards Family Nurse Practitioner. I started undergraduate with little direction, although in high school I gravitated towards the arts and humanities and I assumed I would end up picking a major in that field. I had no one in my family in the medical field, or really had much experience with ill family members, so a career in the medicine was not something that crossed my mind. I did take an anatomy class in high school, which I ended up loving, but I didn't see it as anything I wanted to do. My first semester in college I took an introductory biology course as a requirement. When I found myself neglecting my other subjects and rigorously taking notes from my biology textbook and acing every exam, I thought maybe I should go into the sciences. I did just that the following semester. A lot of my classmates and others majoring in the sciences were on the pre-med track, and I thought I may look into this option. I shadowed several primary care doctors, volunteered in the Emergency Room, and realized I did indeed want to go into medicine. As I approached the end of my four years in college, I was ambivalent about which path I wanted to take. Was medical school right for me? Physician's Assistant, Pharmacy, Nursing, Biomedical engineering, and medical technician, were all among other options I considered. After college I spent more time volunteering in clinics, working in labs, and shadowing doctors. After a lot of research and time, I decided to pursue the Family Nurse Practitioner route via the entry-level master's programs. For those unfamiliar, these programs are for individuals with a bachelor's degree in a field outside of nursing. The Master's entry programs usually consist of an accelerated "pre-licensure" BSN program, in which case my program the pre-licensure portion was an accelerated 20 months. After this you are eligible to take the NCLEX RN certification board exam. During  the post-licensure portion of the program, you may specialize in the master's area you wish. My school, Azusa Pacific University, offered Family Nurse Practitioner (FNP), Adult Nurse Practitioner (ANP) Pediatric Nurse Practitioner (PNP), Psychiatric Nurse Practitioner, and Clinical Nurse Specialist (CNS).  Unless you already know for sure you want to work in a particular field, such as pediatrics, I would recommend doing the FNP track. The reason is that the family nurse practitioner can work with all age groups and in most settings, and thus is most marketable. The "pre-licensure" portion of the program is full-time, and working during this time is discouraged. I had a part-time job as a CNA during most of the program, which was great experience, however balancing both was tough. After the "pre-licensure" portion you are required to obtain hours as a registered nurse to be eligible to apply for the nurse practitioner license. This requires getting a job as a RN. What was not made clear to me when starting this program, was that getting a part-time or per diem job as a newly graduated RN is nearly impossible. The other difficulty in this portion of the program is that it is nearly impossible to get a day-shift position as a newly-graduated RN. This means you will likely be working full-time nights as a new RN while starting the graduate-level courses for the post-licensure part of the program, including clinical hours which is as time-consuming as a full-time job. For this reason, less than half of the cohort starting my program did not continue on and obtain the masters. The advantage to my program was there was no minimum credit requirement to stay enrolled, so I was able to adjust my course load based on what I could manage. When I started the graduate-level courses I was also in a new-grad program at the hospital where I was hired, so I only started taking one class that semester. I also took off school during the summer when I was married. The master's portion took me 3 and a half years, because I attended school part-time and was working full-time. Some of my coworkers who were experienced nurses, completed a MSN program in 2 years while working full-time, however neither one of them were married nor had kids. Some of my classmates completed the masters in less than two years, however they were working part-time jobs or per-diem jobs. However, if you are planning on going through the Master's-Entry level nursing, I would highly recommend getting experience in a hospital as a RN. In the FNP program, all my clinical rotations were in outpatient clinics. Although my goal was to work in an outpatient setting, the experience in the ER was so formative in my career and personal life, I wouldn't trade it for anything. If you are interested in going into the FNP program, or really any field, I think working in the ER is extremely beneficial. You will encounter every type of patient from neonates, psychiatric, obstetrics, gynecology and gerontology. My nursing skills were fully developed by working in the ER, as you do IV starts, foley catheters, NG tubes and assist with intubations multiple times a day. Furthermore, my assessment skills became strong after working in the ER. You never know what a patient's diagnosis is walking through the door, and after some time in the ER, anticipating orders and being able to identify "sick" from "stable" became second nature. Without having worked in situations where you see the "worst-case" scenarios in all areas of medicine, you may not fully understand the complications of disease states in otherwise healthy patients when working in an outpatient setting.

On a personal level working in the ER made me a stronger individual. The tone of the ER in most cases is high-stress and fast-paced. I remember when I was a new nurse being appalled at the way I was spoke to by patients and coworkers alike. After some time my skin became much more thick, and I was able to keep my cool when a patient was swearing at me at the same time  an irate doctor was yelling at me over the phone because he was talking to fast for me to catch his orders.
The ability to deal with grief and unexpected death is another reason my time in ER was valuable. Unlike other units of the hospital, where death is sometimes predictable or anticipated, the ER is often where families are completely blindsided by the death of a loved-one, and in these cases the grief is often raw and difficult to experience. I remember during the first week in the ER a patient had passed away in several hours after being fully alert and had walked into the ER. The family was inconsolable, and I wasn't even able to make eye contact with them because it was so upsetting and uncomfortable to me. Being able to deal with grieving individuals is essential to any area practice, because the effects of this type of grief are life-long. After witnessing patients die, young and old,  I became better able to talk openly with patients about loss.
The ER is also becoming a place where people receive their primary care, despite the increase access to primary care. Working in the ER I was exposed to almost every condition encountered in primary care. There are plenty of opportunities now for FNPs in ER, and the pay is usually higher than other specialties. The hours are not regular, but if you enjoy procedures and fast-paced work, consider this area of practice.
If you are considering an advance practice nursing degree, there will be considerable amount of sacrifice in terms of time and money, but I believe it's well worth it. Share your comments or stories below.

Pinning Ceremony 2011

MSN graduation with original cohort classmates 2014
RN residency cohort 2011

Green Smoothie

In the spirit of St. Patrick's Day, I am sharing a simple green smoothie recipe. The "green smoothies" have been popular for some time (at least in Southern California (: ) and are a great way to incorporate greens into the diet, especially with a picky child. Admittedly, the sight of the smoothie may be off-putting (I've heard it compared to the contents of the sputum canister in the hospitals) however don't let that scare you. The taste is actually quite good. Here is the simple recipe and you can add fruit or other greens to your preference:

*1/2 cup ice
*1/2 cup vanilla almond milk
*1/2 cup kale
*one chopped banana
Place all the ingredients in the blender and you're done. I also like to add pineapple at times. Since I have been growing kale, I have a regular supply. Kale is an excellent source of vitamin C, B6, K, A as well as antioxidants and fiber. The vanilla almond milk has only 70 calories per cup and 8 gms of sugar, in comparison to 140 calories and 13g of sugar in one cup 2% cow's milk.  Almond milk also has a much longer shelf life than cow's milk. Enjoy, and share your green smoothie recipes in the comments.

Revisiting our wedding venue


This past weekend my family and I decided to take an outing to the L.A. arboretum, which we have not revisited since we were married almost four years ago. If you live in or are visiting the L.A. area I would highly recommend going, and is a great place to bring kids. There are an abundance of open spaces and wildlife. Our son had the time of his life running at full force in the open spaces.
I fell in love with the arboretum when I initially visited, and we without looking anywhere else decided that's where we would be married. We had a simple wedding, with less than 60 guests. The wedding in my eyes was perfect. It was a burning hot SoCal August day, but the company and the ambiance was exactly as I wanted. Being back at the arboretum of course took me back to the days I was planning the wedding, and how our lives seem worlds different from that time. We have only been married a short four years, but the events during this time make it seem as if it's been a lifetime. We've both been in school, changed jobs, moved four times, had family losses, reconfigurations, and additions.  I felt as though we never really had a "honey-moon" period so to speak, and instead immediately after our marriage were catapulted into adult realities. Both of us have had to grow up and grow together during the this time. Although I love looking at our wedding photos and reminiscing, I feel it's not the commitment we made that  wedding day holding us together.  I feel as though each day we have to make a new commitment to each other and consciously decide to work together with each hurdle we face. As the old adage goes, love is a verb. It's amazing to just reflect on how far we've come to arrive where we are, and what the next years will bring.

Our Wedding Day Los Angeles Arboretum 2012

The challenges and rewards of the toddler stage


My son has hit the year and a half mark and is growing and developing in leaps and bounds. I find this stage sooo much more rewarding and fun than the infant stage. Honestly I felt I was just going through the motions the first year  trying to just fulfill our basic needs. Now that he's older it's a lot more fun. I am off two days a week with him by myself, which is fun because we get bonding time. Sometimes we'll read a book, do sidewalk chalk, walk the dogs, go to the park, or just hang out and play in the living room. He's starting to pick up words and phrases you say. He is able to indicate most of his needs, saying "more" "all done" "up" "down" "elmo" (he wants to watch Sesame Street). We are still working on getting him to indicate when he needs go to the bathroom, and are at the very remedial stages of toilet training. At his preschool/daycare they have taught him some basic sign language, so now he signs "more" and "all done", which is probably the most adorable thing I have ever seen in my life. He is learning numbers and knows routines. He knows to take his shoes off when he gets in the house and put them on the shoe rack.

This stage has not come without challenges. He is in the stage where he wants to do everything on his own without help. He wants to walk outside without holding my hand, in which he often will run away from me. When I catch him he screams and attempts to hurl himself out of my arms. If something is taken away from him, or he isn't able to have an item he wants, for example the remote, my cell phone, a cookie, a dirty blanket, he will also have a tantrum. After this behavior has become more and more frequent we have implemented time out, making him sit against the wall. My husband is a lot more firm with him in terms of discipline. I tend to start laughing or become amused at some of our son's antics, which is a horrible habit. Because of my behavior when he misbehaves, he tries to push limits with me a lot more than my husband. I know it's bad. My husband however, is a lot more lenient when it comes to giving in to our son's food demands. I am more strict on how much sugar he eats, whereas my husband will bribe him chocolate milk and cookies, which is also creating bad habits.

I was discussing tantrums with a coworker who has five boys. She told me the story of when one of her younger boys was a toddler he would run into a wall head first at full force when he didn't get his way. She would become distraught and cave in after he would pull this stunt. After this went on for some time she discussed with her pediatrician and the pediatrician advised her the next time he did this to deliberately step over him and walk away. She followed this advice, and the tantrums stopped. I try to remember this advice and not cave into his attempts to get his way.

I am loving this stage regardless of the pitfalls. It's such a touching experience to watch him go through all his firsts and watch him at awe of all the little things we take for granted.

From Scrubs to Business Casual

I've previously written on the choice to move from the ER setting to the office setting (a blog on this transition is in the works). Working in the hospital setting for the past eight years, my daily uniform consisted of scrubs. This is the first job I've had where I can "dress-up" to work so to speak. As I've been more involved in the blogging world I've come across many bloggers in the medical field who incorporate style and fashion into their sites. Some of those I enjoy reading for the style aspect, among the other inspirational posts, include mavensinmedicine, a little bit of lacquer and a healer's heart. I tend to err on the more conservative end of the fashion spectrum, and am a minimalist when it comes to most things style-related. I have found having a good set of basic items allows for a versatile work wardrobe without breaking the bank. Here are the items I consider the "staples" of my work attire.
*Navy cotton pencil skirt
*black trousers
* gray trousers
* black pullover sweater
* Dansko maryjane clogs
*wedged sandals
From these pieces I am able to incorporate prints, patterns, or accessories without having to buy so many new clothes. The danskos I recently had to have repaired, but I have had these maryjanes since I was pregnant working in the ER and needed the extra support. I have to wear these intermittently during the week, as the flats and wedges are not ideal for long periods of standing. Here are some of the outfits from the basic pieces.

I most frequently shop at target, Nordstrom or Stitchfix. Target is because I am shopping there often for household items and I will end up browsing the clothing department. I really like their styles, however I mostly skim the clearance rack because I think their prices are a bit high for the quality. I got this striped cardigan for less than $12.00 and the flats for less than $30.00.
Stitchfix is an online company that is somewhat like a Netflix for fashion. You create a free style profile and a personal stylist selects 5 items and mails it to you at your request. There is no monthly fee or monthly requirement to purchase any item, just a $20.00 styling fee with each "fix." The fee is applied to the purchase of any item in the "fix". If you purchase all five items you receive a 25% discount, which works out to the price of one of the items in most cases. I have used this service for several years based on convenience and the quality of the clothing. You also can customize your price ranges for your items so it will be congruent with your budget. The printed navy blouse and printed cropped pants were from stitchfix.
Nordstrom is a favorite, although my budget is not always Nordstrom-friendly. The prices are really a reflection of their customer service however, including the literal forever return policy and free personal styling appointments. I bought this peplum top a few seasons past, which was a splurge, but worth it. A few expensive items offsets having most of the wardrobe being less expensive.

Spolight on International Women's Day


Today is International Women's Day a day to recognize social, economic, political and cultural achievements of women. I thought I would take the time to spotlight work my mother has done abroad. Judy Shepherd has a MSW and  PhD  in social work and currently teaches adjunct at San Diego State University. Judy spent the past three years living and teaching in Uganda. As a daughter, I have had many qualms about having her far away, however the work she has done is truly inspiring. She has set up a foundation and school for widows and orphans promoting health, education and financial independence. Read more below!
1. How did you get involved? 
I was teaching social work at a university in Uganda as a Fulbright Scholar, and a student leader in my class asked me if I'd like to visit his home community in west central Uganda to meet his family and friends and see the work he was trying to do with landless widows (women who have been widowed and are in risk of losing their homes because the father's family inherits property) and with critically vulnerable orphans.  This region has a very high HIV/AIDS prevalence rate, currently listed at around 13% of the district, so subsequently has a high rate of orphans and widows.  It was almost a 4 hour drive to his home community to the rural district of Lwengo. My student, Peter Kitayimbwa, set up a day tour for me where I visited the homes of widows he was helping, the home of his family, a Compassion International Project with 250 kids and 3 workers, and the local water supply (a pond shared with cattle). We had break tea and then lunch and I talked with Peter and his friends about issues and needs in the area.  I realized not only was the need significant, but that Peter, and his friends Isaac and Betty, were amazing community leaders, who would be wonderful to work with on a project to help support orphans in school and to help the widows generate income through micro-lending or micro-enterprise projects.

2. What services are provided? 
The four of us became the founders of an organization called the Widows and Orphans Support Organization Uganda (WOSO) with the purpose of assisting critically vulnerable widows and orphans (in Uganda a child is classified as an orphan if they've lost one or both parents).  WOSO is starting its 4th year of operation this year.  Currently we offer a primary school sponsorship program for orphans who are recommended by community leaders.  In this program we pay all of the children's school fees, provide them with school uniforms and writing materials, feed them breakfast and lunch at school, make sure every child is wormed and tested for HIV/AIDS, and do home visits and meetings with their guardians (the cost to sponsor a child is $250 annually.  We also now have 7 micro-lending groups with 6 women each in a group.  These groups meet and support each other in starting income generating projects (like selling pancakes at the market or selling second hand clothes).  Each member of the group can receive a loan of up to $100 for 6 months, and if they can pay back the loan with 2% interest, they can then apply for two more 6 month loan cycles. And, we started a secondary school for the community in January 2015, since there was no secondary school in this sub-county.  We now have 175 children enrolled in senior 1, 2 and 3 classes (junior high) and will add a class each year so that the children will have a full secondary school curriculum.  We also have 53 girls boarding at the school, since it is too far and often not safe for them to walk to school.  The WOSO website describing these projects here.

3.What advice for starting an international non-profit? 
Make sure you work with people in the community who you trust and whose mission you completely believe in.  Listen to what community leaders say and support the initiatives they suggest, since they know their community's needs and solutions better than any outside NGO worker.  Spend time doing lots of the organizational building activities while you are providing a service, such as setting up a bank account, getting registered in country as a community based organization, getting a website set up, speaking to groups in country and in the US about the work you do, taking lots of pictures and getting short video clips made so that people understand the work, exploring funding possibilities, and getting a registered non-profit organization set up in the US that can accept donations that will be tax deductible.

4. How can someone get involved? 
 There are many ways to help, and assistance is so needed.  Any individual can sponsor a child in school for $250 a year.  We ask that anyone interested in sponsorship commit to supporting the child through primary school, since we want to ensure that every child starting school can complete at least primary education.  Also, individuals or groups can fundraise for needed items such as mattresses for the school boarding section or school desks.  Individuals or groups can also support a micro-lending group so that women can generate income to feed their families and help with their children's school fees.  GoFundMe drives for items for the school or children are so appreciated.  Anyone interested in sponsoring a child in school or donating to the secondary school or micro lending fund could contact me here.  It's a wonderful project that I love being involved with, mainly because of the commitment and hard work of community members who so much want their children to be able to access education. I lived in Uganda for 3 years and will be traveling back again this spring, so I know the project workers and many of the children and widows, and love to see the growth and development of the project.

Thanks for sharing!