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Photo: Grounds for Health via Evan Gilman, @evan.gilman



NCA Origin Charity of the Year Award Winner





Ellen Starr, Grounds for Health, speaking at the NCA 2018 Convention in New Orleans

What does Grounds for Health do, and why?

Grounds for Health works to prevent cervical cancer in low resource settings, primarily in the coffee lands. Cervical cancer is one of the few preventable cancers and its high incidence in low- and middle-income countries is one of the great inequities in health care.

Our work makes a huge difference in the lives of women, their families, and their communities. Since we began our work over 20 years ago, we have screened over 92,000 women, treated over 6,700, trained 520 doctors and nurses, as well as over 1,000 Community Health Promotors. Most importantly, we have helped build local capacity to ensure that the work continues after we are gone.

What makes Grounds for Health unique?

Grounds for Health has been using simple and inexpensive screening and treatment techniques since long before the World Health Organization included them in their guidelines. We’ve also championed the same day screen and treat approach which ensures that all women who screen positive will actually get treated that day.

We’re small and nimble, and that enables us to stay on the vanguard of new technologies.

What has been your biggest source of inspiration at Grounds for Health?

Watching the women literally pour into the health centers where our in-country staff conducts cervical cancer screening campaigns. They are compelled to never turn anyone away, knowing how difficult it is to for a woman take a day away from her work or her family. That means that they may see upwards of 150 women a day while training the local providers in the process. It is beyond inspiring.


What are the biggest challenges you face as an organization working at origin?

Every country is different. When we enter a new country, we have to learn about the culture, their customs, and their capabilities. Because our mission is to train local health providers, we must develop strong partnerships with the Ministries of Health, the coffee cooperatives, and the appropriate leaders in the community.

As an organization based in the U.S., but with two-thirds of our staff in-country, we have to get skilled at effective communication with the challenges of language, cultural differences, and poor connectivity.

Transportation and is always a big challenge when working at origin both for our staff and for the women wanting services. These remote regions are challenging and expensive to get to.

What have you learned from your work at origin? Has anything surprised you?

We have been doing it long enough that we generally don’t have big surprises, but we know all too well not to expect to have the same experience in every community and to adapt accordingly.

Because coffee is generally grown in the most remote regions of the world, we have learned about the potential barriers to success. The largest of these are probably transportation and education, or what we call community sensitization. Coffee cooperatives are often able to help us with both.

A fundamental part of our work revolves around the Community Health Promoters, who we train and then send out to educate, correct misinformation and recruit women. They are respected members of their communities and often members of the local coffee cooperative. Without them, our work would be even more challenging.

As for transport, in Tanzania we once had a woman walk 12 hours in her flip-flops to have her screening. Anything we can do to either bring services closer to women or find them transport is critical. For example, we have had coffee coops use their trucks to bring their women workers to screening campaigns .

How do you define success?

Providing high quality screening and treatment to as many women as we can in the communities where we work.

This requires providing treatment for pre-cancerous lesions on the same day the screening is offered and ensuring that both are done with skilled local providers.

What are your goals going forward?

To scale up our programs to reach as many women as we can while maintaining our quality assurance standards. We would like start programs in more coffee growing countries. We also have a history of being at the vanguard of new approaches to service provision. We want to always introduce new and effective innovations into our work.

Why focus on coffee communities?

Grounds for Health was founded by a coffee executive, Dan Cox, and a physician friend, Dr. Francis Fote. They were inspired by their realization that women in coffee communities were dying from cervical cancer and had little access to preventive care.

The coffee community was on board from the beginning and provided a good measure of the support we received. Funding from the coffee industry, which has such a strong sense of social responsibility, has allowed us to bring our programs to the coffee lands in countries in both Latin America and East Africa.

Were there any moments or stories from origin that stand out, or help illustrate the impact of your work in women’s lives?

The little video snippet [below] shows a large group of women piling out of a coffee coop truck.

There are certainly many stories. It is hard to identify a single one.




What advice would you give to anyone looking to help serve the coffee communities at origin?

Take your time to develop strong partnerships with the coffee cooperative leaders and the leaders in the community such as the village elders, priests etc.

Learn the local language if at all possible. Absolutely learn the local customs and politics.

Find a local champion of your work.

Hire local staff who understand all of this and can develop and nurture key relationships

If you can get people to take away one idea from your work, it would be:

If you care about something, get involved. What started as a small volunteer organization is today the winner of the NCA Origin Charity of the Year Award!

 How can people get involved and support Grounds for Health?

Read about our work, talk about our work, advocate for cervical cancer prevention at origin, and of course, become a donor!


Compiled & edited by Kyra Auffermann, NCA


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