capacity building

Sankofa mHealth Innovation Brings PTSD Support to War-Impacted Communities

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Monrovia. 3 May 2017 – Second Chance Africa and Code Innovation announce our partnership on the Sankofa project to create a mobile application of an innovative clinical curriculum that helps people recover from trauma in war-impacted communities.

The mHealth curriculum pioneered by Second Chance Africa will be used by the organization’s cohort of mental health facilitators, half of whom are graduates of the program. Since 2008, they have reached more than 7,000 war-impacted Africans on a shoestring, crowdfunded budget. Participants in one of their clinical outreach projects report a 65% reduction in the debilitating symptoms of trauma like intrusive memories, hyper-arousal, and avoidant behavior, a difference that allows them to return to a more stable life in their families and communities.

Post-traumatic stress disorder (PTSD), complex trauma and extreme stress are common outcomes of war and debilitate a person’s ability to function in society. In West Africa, the recent Ebola outbreak worsened existing war-related PTSD, compounding long-lasting community mental health issues that remain unattended. In post-conflict areas, trauma often becomes a silent epidemic and while some people get better with time, many do not.

In some areas, rates of PTSD diagnosis are close to 100% based on the nature and severity of events, and trauma symptoms have been documented in refugee groups decades after traumatic exposure. PTSD may heighten the risk for poverty, aggravating the consequences of war and conflict.

“Approximately 17.6 million people are currently impacted by war and conflict across East, West and Central Africa,” says Second Chance Africa founder and Executive Director Jana V. Pinto. “Yet despite the clear need, trauma relief is not yet a humanitarian priority, as current efforts are expensive and there is no evidence base available to guide treatment choice. We urgently need more scientific research to develop best practices around trauma relief interventions in war-impacted communities.”

“While it may seem secondary to investments in maternal health or child survival, research has shown that communities with a high prevalence of trauma struggle to progress economically,” says Elie Calhoun, Director of Code Innovation. “Trauma becomes a piece of the poverty trap and needs to be addressed before war-impacted communities can make lasting social and economic progress.”

“The Sankofa mHealth app is designed as a tool for civilians and community health workers to lead local trauma relief groups independently and without prior training or experience,” says Calhoun “The 10-hour protocol directly addresses major PTSD symptoms without one-on-one psychotherapy or drug interventions. Digitizing this model on a free mobile app makes the approach accessible to health systems and organizations all over the world. It is a truly game-changing model.”

“Although feature phone handsets still significantly outnumber smart phones in Africa, we expect to see a gradual shift to smartphones as they become increasingly available and affordable. Because the Sankofa mobile app is designed to be used by one facilitator working with many groups over time, the program model leverages what is still a relatively rare technology to harness its impact.”

Field testing of the digital tool will begin in June in Northern Uganda with South Sudanese refugees fleeing current conflict, and in Monrovia, Liberia with a core team of Second Chance Africa facilitators who have been with the organization since its inception in the Buduburam Refugee Camp in Ghana in 2008. As early recipients of the intervention, the facilitators are a testament to the transformative potential of the Second Chance Africa model and have dedicated themselves to ensuring that others in their country receive the same life-changing services.

The Sankofa digital tool will help them and other heroes in the battle against trauma to reach more people and help more people impacted by war regain their lives.

###

Sankofa is crowdfunding to cover its program costs: https://www.razoo.com/story/Sankofa2017

For more information about the Sankofa project, visit http://secondchanceafrica.org/sankofa

Second Chance Africa After six years delivering hands-on clinical services, Second Chance Africa’s team of scientists and health workers now focus on rigorous research and development of innovative, scalable and culturally-adapted intervention tools to advance trauma relief for African communities impacted by war. For more information, visit http://www.secondchanceafrica.org.

Code Innovation’s team of ICT4D experts specialize in helping high-impact development solutions go to scale. Our projects have been supported by UNICEF, the UK Department for International Development and major philanthropic foundations. For more information, visit http://www.codeinnovation.com.

For more information, contact:

Jana V. Pinto, Executive Director, Second Chance Africa, jana@secondchanceafrica.org

Elie Calhoun, Director of Operations, Code Innovation, elie@codeinnovation.com

Attention: We Want to Mentor Teachers

African teachers need mentoring and support to transform and disrupt old paradigms of education (www.codeinnovation.omc)While it is praise-worthy to provide young people with mentoring experiences, the quantity of young people in need is staggering. Bringing professional mentoring to teachers offers a way to impact hundreds of young people with each mentoring relationship. Practitioners of education innovations have repeatedly found that targeting teachers with innovations is a higher impact strategy than engaging with young learners directly. When CODE first decided to explore ways of bringing mentoring opportunities to teachers, we started by exploring the availability and willingness of qualified mentors. We reached out to associations of Advanced Placement (AP) and International Baccalaureate (IB) teachers—especially those already experienced in educating in different countries and cultures. In short order we were able to drum up scores of volunteers willing to commit at least an academic year’s worth of digital mentoring.

The idea is to pair these experienced educators with younger and less experienced teachers (within their same fields) and then to structure an interchange between the senior and the junior teachers over an academic year with a focus on teaching methodologies more than content. Mentors would be trained to share their experience and resources relevant to teamwork, games, community engagement, immersive learning and activities designed to bolster critical thinking. Mentees (or protégées) could be in routine feedback with the pilot facilitator’s to help improve content and focus.

We spent a few months engaging with education sections at various large development organizations, receiving plenty of encouragement and interest; but little actionable commitment. To build a reasonably secure and open source environment to support these interactions would be a relatively easy process. With the mentors and the environment taken care, Mentor Teach requires a partner with field access to a body of educators (or to a teacher training college/facility) and the leverage necessary to extract meaningful commitment to a pilot project of this variety.

If anyone is interested in moving forward with a project of this variety, please let us know. We’re happy to share the documents that we’ve put together in explanation of this approach and we’re happy to support any team that is willing to put in the work to realize this vision.

Notes from TechCamp Dakar

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Last week I had the good fortune to attend TechCamp Dakar, the first of U.S. Secretary of State Hillary Clinton's "Civil Society 2.0" initiatives to be held on the continent. The two-day gathering focused on mobile technologies in agriculture. Given the recurring food crises in the Sahel, examining how Senegalese NGOs can leverage technology for better programming, advocacy and coordination was a good one and over 50 organizations working in agriculture were in attendance, supported by local technology leaders, including us. Check out some of the photos here.

Here's a look at the technologies presented and a few of the applications the NGOs found for those technologies in their agricultural programming:

  • Social media: Marieme Jamme of SpotOne Global Solutions and Apps4Africa presented on the importance of using social media to gain visibility, credibility and funding. She compared social media to the traditional African "arbre a palabre," or palaver tree, to remind participants that the concept of sharing and debating about issues is a familiar one. Some participants later created a Facebook group "L'arbre à palabre des acteurs agricole du Sénégal" to better reach local agriculturalists and include them in online discussion.
  • Community mapping: Open Street Map was in attendance, showing participants the usefulness of visualizing data when planning a program or community outreach. I later participated in a small group session that sought to apply Open Street Maps to community water management of drylands areas.
  • Group networking sites: MeetUp was in attendance, although their paid service model received less enthusiastic support from Senegalese who weren't likely to have a credit card set up to create a group online. At Code Innovation, we like free and open source group networking sites like Crabgrass, as they provide the fewest barriers to entry.
  • Low-cost video: FHI 360 presented a strong case for the ease of use and scalability of low-cost video as a training and communication technology alongside the more traditional agricultural extension agents, field days and demonstration plots. FHI 360 brought along several relatively low-cost cameras and a USB-chargeable mini pico projector for video screenings. Many NGOs saw the potential for low-cost video to aid their agricultural trainings, especially in communicating about new methods and creating the motivation to try them.
  • Mobile money: A private sector organization, E-Amarante, presented Mobile Cash, a local interpretation of the East African service MPesa that's still in development. Although the system is interoperable across mobile networks, participants baulked at the 3-5% fees levied on mobile transfers and transactions. All the same, mobile money has a bright future on the continent, and the leading mobile network operators here in Senegal already have their own programs and versions--with a similar fee structure.
  • SMS: FrontlineSMS was in attendance with a simple demo of how SMS could be used for data collection and crowdsourcing, and showed briefly how to link the system with Ushahidi for data visualization on a map. In my small group, participants saw the relevance for communicating within agricultural cooperatives and about market prices, but would likely need some technical support to set up the system.
  • Google Apps: Presented by People Input, the Google Suite of programs were well presented and enthusiastically received. File-sharing and keeping easily accessible versions of current documents seemed to be major coordination challenges for the NGOs present, and most of the larger group work focused on integrating Google Apps tools into communications protocols to make partnering and information sharing more effective.
  • Mobile phone market information: Africa Market Price, another project by E-Amarante, seeks to communicate local market prices to rural farmers by SMS, as similar projects across the continent have done.
  • Webcasting: CarRapide TV presented its YouTube channel of citizen reporting and spoke about the benefits of web broadcasting to reach large audiences of agricultural producers.

After they'd had a chance to learn about specific technologies more in-depth, participants worked together in small groups to brainstorm major problems they encounter in their day-to-day work, and then examined how a selected technology could help them meet those challenges. There was intense work in small groups around issues including managing water, communicating market prices, and inter-organizational collaboration. As a final exercise, small groups were tasked with creating next steps on how to work together to put these technological tools into practice. The results will be shared internally on the TechCamp Dakar Facebook group and on the public TechCamp Dakar wiki.

One of the best parts of TechCamp, for me, was seeing how focused the NGOs were on solving their challenges through technology together. For many of them, technology was a tool that enabled wider partnership and clearer, more precise communication around their program objectives. They were keenly focused on problem-solving and highly motivated to work together. It will be interesting to see how collaboration continues now that the intensity of TechCamp has passed.

It was also great to meet fellow technology people working in Senegal, including Karim Sy of JokkoLabs in Dakar and the team from Bantalabs up in St. Louis, who have programming expertise and can help to put teams together.

Here at Code Innovation, we're interested in what happens after TechCamp Dakar, particularly if and how NGOs will incorporate these new mobile technologies into their programming, where and why they succeed, and where and why they run into hurdles. We'll be spending time on the Facebook group checking in on their progress and seeing where we can lend a hand.

Teach Yourself mHealth, Part 3

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This post is the third part of a three-part series, 'Teach Yourself mHealth.' In Part 1, we focused on what mHealth is and what mHealth projects look like. In Part 2, we mapped out exactly how mHealth can strengthen communities and information systems, step-by-step. In this post, we'll explore some common design challenges in mHealth projects and review the best online resources for bringing your mHealth knowledge up to speed.

Now that you're familiar with some mHealth basics, it's worth looking closer at what we've learned about how to implement solid, scalable and sustainable mHealth systems. One benefit of the myriad mHealth pilots that are out there is a wealth of lessons learned on everything from project design to better monitoring and evaluation. Many of these challenges exist for other, less technology-focused aid projects as well, of course, but they're nonetheless a good reminder of where to pay special attention.

Design Hurdles in mHealth Projects

The following summary of design hurdles that mHealth projects commonly face is assembled from lessons learned from my own research and interviews. This is by no means a comprehensive list, merely some interesting things to think about if you're considering adding an mHealth component to your international health work.

1. Human-centered design: Designing with people in mind puts the service back into development work. mHealth systems improve communications and information systems when they meet a need better than traditional systems. To meet this need, a thorough understanding of the problem you're trying to solve and the multidimensional context it exists within is essential. Testing and improving ideas and designs with the stakeholders you're trying to serve ensures that their needs are more adequately met by your project, and that means a better and more sustainable system

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2. Interoperability: Customizing and deploying an mHealth platform that interoperates with the Ministry of Health's electronic information system is key to avoiding parallel information systems that can duplicate work and deplete motivation. For example, current iterations of RapidSMS can be customized to interoperate with DHIS2, the open source health information system used by many government ministries throughout Africa.

Creating standalone platforms is often unnecessary and can get especially confusing in a Ministry running multiple mHealth projects. Ensuring interoperability from the start means your SMS platform can be more easily scaled and will likely have an easier time getting Ministry and staff buy-in. After all, your system needs to be useful to the stakeholders that the project is for, otherwise, what's the point? If you're using SMS for health behavior change communications, interoperability may be less important.

3. M&E: Many mHealth projects have been

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criticized for not developing a solid monitoring and evaluation framework to collect baseline and project data and accurately report on project effectiveness. Don't let this happen to you.

4. Map the tech4dev and telecommunications landscape: Any good project idea starts with a solid understanding of the current landscape and technology projects are no different. Before you start sketching out your mHealth idea, it's a good idea to map the landscape of your country and region for other mHealth projects, which could be using software platforms that you can piggyback on. Who else is working in your region? What have they found challenging? Reaching out to colleagues creates an atmosphere of shared collaboration and healthy competition, plus the benefit of shared lessons learned.

The same goes for understanding the mobile phone and telecommunications infrastructure in your country. What does cell phone ownership look like in your country? Is there anywhere where the signal is unreliable? Who are the main mobile network operators? Have they previously partnered on any mHealth projects? Understanding the landscape lets you know what your options and constraints are, so you can proceed with clarity.

5. Sustainability: mHealth systems can

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be extremely cost effective, but implementation costs for SMS air time, server maintenance, and other needs can add up in the long term, especially as the program reaches a national scale. Taking these costs into consideration

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early on will encourage you to design a system that is self-sustaining. The importance of including Ministry of Health and other Ministries' staff from the very start was discussed in my previous post, but suffice to say that their level of ownership over the project is directly related to the system's likelihood of long-term success.

Developing mHealth Expertise

If you'd like to

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programs and projects, check out the links to documents and mHealth communities of practice below. mHealth, like all technology for development innovations, is a field that's changing rapidly. For those of us who want to further develop mHealth expertise, subscribing to regular email updates with the latest research findings and new projects is very useful. So are posting questions and design challenges you're facing on mHealth forums online, where an experienced community of practice is often very willing to offer guidance by sharing their own experiences.

For those eager to incorporate mHealth into their international health work, I recommend two online documents that summarize best practices to date and lessons learned. Both can be read in about an hour and offer pragmatic, no-nonsense guidance on the ins and outs of mHealth programming and implementation.

The first is "How to RapidSMS", written by a friend and former UNICEF colleague, Evan Wheeler. RapidSMS is a customizable mHealth platform that requires technical programming skills to install, but this how-to document is a great primer on the basics of a good mHealth project. The review of different SMS shortcode options offered by mobile network providers is especially helpful for thinking about how to best set up a scalable and financially sustainable system.

The second resource is a white paper written by Jeannine Lemaire for Advanced Development for Africa, "Scaling Up Mobile Health: Elements Necessary for the Successful Scale Up of mHealth in Developing Countries." Lemaire interviewed leading mHealth experts to mine their knowledge and experiences for a concise and thoroughly-researched list of best practices and programmatic, operational, policy and strategic recommendations. This might take you a bit longer than an hour, but is well worth the read.

As with learning any new thing, you're bound to have questions, especially technical ones. In that case, it can be helpful to reach out to a community of mHealth practitioners on one of the many mHealth forums online. I've found that RapidSMS and FrontlineSMS have particularly active communities.

Of course, the best way to teach yourself mHealth is to do it. Design, set up and implement a simple SMS-based project to apply what you've learned, and see what happens.

Teach Yourself mHealth, Part 2

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This post is the second of a three-part series, 'Teach Yourself mHealth.' In the first post, we focused on what mHealth is and what mHealth projects look like. In this post, we'll map how mHealth can strengthen information systems to build better health services, step-by-step. In Part 3, we'll explore some common design challenges in mHealth projects and review the best online resources for bringing your mHealth knowledge up

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to speed.

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We'll focus particularly on how an mHealth information system works on a detailed and practical level. Of course, SMS can improve other health services and plays an active role in communications for behavior change. My interest lies in systems strengthening, particularly in resource-poor settings, so that is the mHealth example I'll choose to focus on here.

 

mHealth Data: How It Works

Information for decision-making can be divided into two main categories: quantitative, to do with numbers, and qualitative, to do with language. Quantitative data, in public health and most social sciences, involves getting the results of random clinical trials or demographic surveys,

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or perhaps the routine information systems that Ministries of Health use to assess their population's disease burden. Qualitative data involves someone telling a story. For example, what does your new community health worker think about her level of supervision by the District Health Team?

By SMS, mHealth coordinators can gather both types of data, quantitative and

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qualitative. For the purposes of national level public health decision-making, numbers are a much easier information source to scale. In the example of outbreak early warning systems, a simple text message can specify the number of deaths, location and suspected diagnosis of a priority disease under surveillance, alerting District Health teams and central level Ministry staff to the need to respond.

Such a system's mHealth information system could look like this:

Of course, whenever gathering and analyzing data is involved, things can get complicated. As with any health information system, we need to identify exactly what we want to know, and trim off extraneous steps to simplify data reporting protocols as much as possible. Smart phones running mHealth apps can lead health facility staff through step-by-step reporting in greater detail than basic mobile phones (though they may be more vulnerable to theft and rough treatment).

 

Isolating Variables

During one of my consultancies, I had the opportunity to interview Dr. Theo Lippeveld, President of the Routine Health Information Network, who quite literally wrote the textbook on the Design and Implementation of Health Information Systems. I was a bit star-struck during the interview, but I remember his emphasis on "data for decision-making".

mHealth projects interface

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directly with health information systems to strengthen the flow of accurate information for improved decision-making. To present information effectively, they must be as simple as possible for the health facility, for the team sending the information, and for the Ministry of Health decision-makers to analyze and take action on.

Breaking down a system to look in detail at the part each reporter and each variable plays helps us identify where systems can be simplified and where the most important information can be prioritized. For example, if I want to use an mHealth SMS platform to gather real-time information about coverage for routine immunization, I will want to identify who will be sending and analyzing what kind of data, when they will

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send it and how it will be received--and ideally, I want to know why:

 

Sending data by SMS is important to keep simple and to the point. At the level of Ministry decision-makers, however, there is a bit more room for visual interpretation.

 

Visualizing Data

When displaying quantitative information and communicating about numbers at scale, design becomes important. In the international development world, many tools use crowd-sourced information and mapping to create real-time displays that shape emergency response (as in the case of Ushahidi in Haiti). In public health, we are used to seeing demographic data on maps and graphs.

The SMS platform (the one that ideally interfaces with

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the Ministry's electronic information system, complementing rather than duplicating the flow of data) selected for an mHealth project will often interpret that data graphically for easier analysis, enabling decision-makers to manipulate and customize the system to tell them exactly what they need to know. I'm currently reading 'The Visual Display of Quantitative Information' by Edward Tufte, who shows a lot of interesting historical examples of how large data sets can be creatively and meaningfully portrayed.

 

mHealth Applications for Developing Country Health Systems

As we see with each new post about an mHealth project in the developing world, using mobile systems to improve information flow can play a large role in systems strengthening. Routine reporting can be distilled into a text message that communicates priority data to government decision-makers. Qualitative information gathering through polls and SMS or radio outreach provides health campaigns with data to develop better communications for behavior change.

In the next post, we'll explore some common challenges that mHealth projects face and review the best online resources for keeping your new mHealth knowledge up to speed.

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Growing the innovations community in West Africa

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I have roots in Kenya, and have watched with pride and admiration the growth of the East African tech community from this side of the continent. I’m obsessed with mPesa, love that Ushahidi has long gone global, and am stalking UNICEF Uganda’s tech4dev projects—to name just a few.

CODE has been working in West Africa since 2007, recruiting locally for our teams as much as possible. Often, local tech talent has been hard to find. Thanks to iLab Liberia and others who are growing it from the ground up, in a few years we hope to have a talented pool of developers in every country we work in.

Jon Gosier’s recent post on AppAfrica, The Lucrative Skills African Talent Should Acquire in 2012 got me thinking about how best to cultivate and support a growing community of professionals in the countries where we work.

To help us get there, I want to share what we look for in our team members—and how, if you’re looking to break into innovations work, you could go

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about getting there. Improving these skills won’t guarantee you a job on cool tech

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projects, but it’s a good start. Jon makes a distinction between tech and non-tech skills in his post, and I draw on the later here. Building on his list, here are the skills we’ve found that serve us well in the innovations space in West Africa:

Writing: This one has to top the list—you can’t get anywhere without

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good writing. Decent writing is passable, but good writing opens doors and lets your ideas travel. Practice makes perfect, but so does lots of reading. Every opportunity can be used to improve the craft—emails, project updates, love letters…

Critical thinking/problem solving: Applying deductive reasoning to see different angles and approaches allows for creative, open-ended solutions that work in the real world. Critical thinking demands an open mind and it demands that we see things from other, often multiple and conflicting, points of view--as F. Scott Fitzgerald quipped, "the

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ability to hold two opposing ideas in mind at the same time and still retain the ability to function." It takes practice, but with good problem solving skills you will identify a problem and its solution before it even manifests. Doesn’t that sound nice?

Project management: Manage projects, lead people. The implementation of successful projects demands

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adaptability and agility to adjust to changing situations. I believe that good management is impossible without good leadership, so see more about that below.

Videography and design: Knowing how to communicate using video and the web is now essential to share ideas in a way that spreads. Having the skills to put together a budget video or design a minimal website or presentation puts you ahead of the crowd and makes you an extra useful member of any team.

To Jon’s list, I’d like to add:

Professionalism: The professional world has its own norms for behavior, and while they may not always include wearing a suit and tie to meetings (especially in the tech world), there are still social graces and etiquette to be observed. A lot of this you likely learned in kindergarden—play nice, play fair, and share.

Leadership: Emotional intelligence is a professional currency that is measured and valued more and more by team leaders. Gone are the days of the stoic, authoritarian manager who sat behind a closed office door and only saw you by appointment—and thank goodness for that. Managers are out, leaders are in, and the better you can relate to, listen to and understand your team, the better you will be able to unite them around a common vision. That’s where the magic happens.

Collaboration: Collaboration is to the 21st century what competition was to the last one. Every opportunity offers a chance to bring people together to collectively innovate, vision and create. Get to know the competition, find ways to collaborate that benefit you both, and watch what happens. We work better and smarter together than any of us do apart. Learning this and making it work for you, is key to long-term satisfaction from your work.

Strategic thinking: Seeing and planning for the long-term future is a rare skill in this quickly-changing world, all the more valued because the landscape changes so quickly. Instead of forging concrete plans for the future, strategic thinking is able to adapt to what it sees and to anticipate the direction of change. It's hard; but it can be learned.

So, you may be thinking, how does one go about getting these skills? Find places to put them to work, giving generously of your time, effort and best ideas. Embed yourself within the community you want to work in. Find and take opportunities to contribute to projects and collaborate on teams to build your experience. In time, the community will know your value and job offers will find you.

CODE is always looking to connect with local

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innovators, so if you’re reading this and you have an idea we can collaborate on, we want to hear from you.