Swiss Water has long been a supporter of Grounds for Health, an organization dedicated to women's health in coffee-growing regions. We believe in their efforts so strongly, both the company and our employees contribute. In 2018, our corporate and individual contributions totaled more than $48,000 CAD. The tenth annual Grounds for Health Auction will take place this week, June 12–13, 2019, and Swiss Water has donated three bags of coffee in support. We had the pleasure of sitting down virtually with Lisa Espenshade, Director of Donor Relations, to share more of the GFH story.

Please tell us a little bit about the origin of your organization—how did you choose the coffee lens through which to view the global crisis of women's reproductive health?

In 1996, Grounds for Health was founded by a coffee executive, Dan Cox of Coffee Enterprises, and his 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. Over the years, funding from the coffee industry—which has such a strong sense of social responsibility—has given us the resources to grow from a small program in Mexico to a leader in cervical cancer prevention in Latin America and East Africa.

Women receiving services from Grounds for Health are a largely underserved population who live predominantly in coffee-growing regions. These communities are in some of the most remote regions of the world, where 85% percent of all cervical cancer deaths occur simply because women do not have access to effective prevention and treatment services. We are working to change that. Cervical cancer is one of the few preventable cancers and yet in the next 15 years it is expected to kill 6 million women, most of whom live in developing countries. This 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.

What have been the biggest barriers to cervical cancer prevention for women in the coffeelands?

We have been doing it long enough (2 decades!) 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. 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—and that takes time.

Because coffee is generally grown in remote regions of the world, we have many 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.

Transportation 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. In Tanzania, we once had a woman walk 12 hours in her flip-flops to attend her screening. Anything we can do to either bring services closer to women or find them transport is critical—we have had coffee co-ops use their trucks to bring their women workers to our screenings.

A fundamental part of our work revolves around the Community Health Promoters 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 an organization based in the United States but with two-thirds of our staff in-country, it is a constant challenge to communicate effectively through language barriers, cultural differences and poor connectivity.

What kind of relationships have you built with coffee roasters and companies like Swiss Water to help support your mission?

We have a history of strong support from all facets of the coffee industry from growers, importers, roasters, all the way to retail shop owners.

In 2015, Royal Coffee Inc. of California and Dean’s Beans Organic Coffee Company of Massachusetts created the East vs. West Roasters Challenge for Cervical Cancer Prevention. This friendly competition pitted coffee roasters east and west of the Mississippi against each other to see which side could raise the most to help Grounds for Health start its program in Ethiopia. Industry leaders like Swiss Water participated to help us reach our goal of $200,000.

We were then able to double those gifts with 1:1 matching funds from the President’s Emergency Plan for AIDS Relief (PEPFAR) in its support for Pink Ribbon Red Ribbon, a public-private partnership focused on reducing deaths from cervical and breast cancer in Latin America and Africa.

Since 2009, the annual Grounds for Health Auction has also rallied the coffee industry behind our mission. Importers and producers donate small lots of green coffee, which are then auctioned off to roasters and retailers around the country. All proceeds benefit our programs.

More recently, Grounds for Health has created a circle of Anchor Donors comprising major corporate donors who have committed to gifts of $25,000 annually for 3 years. The size and duration of this type of support allows us to plan more effectively for the future, expand our programs, and introduce innovative approaches to screening and treatment. Our Anchor Donors are vital to our ability to look to the future with the assurance that we’ll have the resources to deliver cervical cancer prevention services to women at origin who need it most.

Our work in Latin America and now East Africa has been supported in large part by the coffee industry. Our relationship with coffee demonstrates how much social change can be achieved when an industry fundamentally cares about its people at every step of the supply chain.

Tell us about your new initiatives—where do we go from here?

Thanks to the financial help from our Gedeo Challenge fundraiser, we were able to complete our first campaign at Yirgacheffe Health Center in Gedeo Zone in the SNNPR Region of Ethiopia and are thrilled to report that it was a rousing success!

As we got things going in 2019, we were excited and motivated by the initial community response. We screened 298 women and 40 (13.4%) screened positive. We treated 39 of the women with cryotherapy and referred one woman to Dilla Hospital for more advanced treatment. Our clinical team was able to provide counseling for the woman and her husband as well.

We plan to work in three facilities in Gedeo and, over the course of 2019, expand into Guji Zone. This is how we grew our service in Sidama Zone and across Ethiopia, leading to 30,000 women seen in just 4 years. We’re pleased to be receiving both financial and logistical support from METAD, a family-owned coffee business with farms in both zones, and a strong belief in strengthening their local communities.

Throughout Ethiopia, we will be assessing equipment needs and supplying the participating health centers with cryotherapy or thermocoagulation devices and supplies. We’ll conduct trainings of local healthcare providers and conduct outreach campaigns to reach additional women.

In addition to our geographical expansion, we are starting to plan for implementation of new technologies that are on the horizon for both screening and treatment.

For screening, we are looking forward to a huge technological leap with development of a new device that uses a visual analysis of cervical images with a learning algorithm called “automated visual evaluation” (AVE) to screen for cervical precancer or cancer. This exciting use of artificial intelligence is in the late development and research validation stage. Because this new device promises to standardize cervical cancer screening practices, Grounds for Health is pleased to participate in ongoing discussions among the community of professionals involved in this project, with the goal of providing greater objectivity and accuracy to the screening process.

As for treatment of precancer, we use cryotherapy to freeze cells, which although effective, requires large canisters of CO2 and takes around 15 minutes. A new technology that uses thermocoagulation (heat) takes only a few minutes, and is powered by a long-life battery, eliminating the need for refilling and transporting ungainly and hard-to-find canisters. This new method provides a better experience for the woman, is easy to use, and has no ongoing costs. We’ve piloted a program in Kenya over the past year and are planning to equip our staff in Ethiopia with the new devices so that we’ll be ready to implement once the expected approval comes from Ethiopian Ministry of Health.

So, 2019 promises to be an interesting year for new initiatives that have the promise of improving our program’s efficiency and reach, and most importantly, bringing this basic preventive healthcare to women in coffee.

Photos courtesy Grounds for Health.

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