Cactus Mama Telemental Project

We will establish a mobile health (m-health) application(app); availing evidenced-based mental health support to women in remote Kenya. This telemental service will bridge Kenyan women dealing with depression during and after pregnancy to quality, timely, affordable and culturally safe care. We will increase support and mental health care resources through local peer support networks, collaboration between medical and mental health providers, subsidized treatments and empowering community health workers to deliver mental health first aid. 

By raising women who are mentally well, we increase their ability to nurture their children with confidence. Postpartum depression (PPD) occurs three weeks post-birth and up-to one year;- this includes the six months when infants need exclusive breastfeeding. PPD can make mothers experience challenges with breastfeeding leading to early feeding which increases risk of choking or malnutrition. Our solution can be scaled globally as it empowers communities to actively engage in mental health promotion and wellness.

Most women suffer silently from postpartum depression(PPD) due to limited focus given to their psychological wellbeing ante-partum and postpartum. Global statistics show that at least 10-20% women experience PPD and in Africa, this rises to 32%! In Kenya, Tuitoek, Doris & Jeptalam (2019) estimated 11-13% of women in Kenya suffer from PPD. Often,  diagnosis is missed at Kenyan hospitals yet PPD, which is a non-psychotic mood disorder may progress to postpartum psychosis that has long-term impact to both the mother and her child. There is necessity to create evidence-based maternal mental health care especially to women in remote Kenya where there is limited access to trained mental health professionals. 

According to NTV Kenya, in 2004, there were 53 psychiatrists serving 31 million Kenyans while in 2017, 777 psychiatrists, 418 psychiatry nurses and 4000 psychologists served over 43 million Kenyans. Despite this improvement, there is still an overarching need for quality mental health care in rural areas. It is time to build capacity of rural medical providers in addressing maternal mental health through granting them mental health screening tools and a pathway to collaborate with mental health professionals who are often in peri-urban or urban areas.

Our solution is a two-pronged app with an interface that links women to mental health professionals and another that creates a pathway for collaboration between medical providers at local health centres in remote Kenya with mental health professionals at primary care settings.

Women in remote Kenya, often visit their local health centres that lack medical providers with training in maternal mental health care. For women dealing with depression during or after pregnancy we will connect them to mental health resources, increase their confidence in seeking care and self-efficacy in coping with depression. The m-health telemental app will include mental resources for stress management and increase support through connecting them to local peer networks, free soothing music with our partnering musicians and links to exercise videos including yoga and mental health blogs on the Cactus Mama website.

In remote areas, we will increase mental health screening capacity and mental health first aid skills through integrating the WHO mental health treatment gap(mhGap-IG) intervention guidelines and Edinburgh Postpartum Depression Scale(EPDS) in the m-health app. These tools and skills will guide community health workers, nurses and clinical officers at remote clinics in Kenya to offer women best quality mental health care.

Women in Eldoret are the direct beneficiaries of our project at this phase. We have included 30 women in our need assessment who aside from acting as our advisory team, they benefit from peer mentorship training and mental health support. 

With success of our phase 2, women in Eldoret will benefit from expanded mental health resources via the peer support network, the Cactus Mama m-health app and subsidized mental health treatment. The women will benefit from mental resources that will help them manage their stress management and increase support through connecting them to local peer networks, free soothing music with our partnering musicians and links to exercise videos including yoga and mental health blogs on the Cactus Mama website. 

Through all our stages of developing the m-health app, we will continue to involve the women in Eldoret community and the medical providers to ensure the app addresses the needs of women experiencing PPD appropriately. The involvement of women who underwent PPD is crucial as it gives our m-health app a lived-experience perspective that will ensure women in Eldoret benefit from person-centred mental health care.

With the success of our project in Eldoret community, we aim to scale to three other districts in phase 3. We hope our success will inspire more use in Africa and in global areas that struggle with inaccessibility to mental health care due remote geography.

In the long term, with success at Eldoret community, we plan to scale to three other districts to campaign for better mental health in Kenya. Through our service, women in remote Kenya will access a person-centred mental health care that will be accessible, affordable and acceptable. Through expanding mental health resources, we hope these women will benefit from improved mental wellness that will encourage them to build secure bond with their children.

In addition, the indirect beneficiaries will be significant others of our target population who will have increased awareness of perinatal mood disorders since the blog and social media will be educative platforms. There attitudes will shift from blaming and criticizing to inspiring these women dealing with PPD to seek mental health care.

COVID-19 pandemic complicated hospital and wellness clinical visits especially for women experiencing PPD. With onset of this pandemic, medical providers shifted their attention to patients experiencing respiratory issues to rule out COVID-19 leading to further alienation of women suffering from PPD from receiving urgent mental health care. Research shows that women with PPD are less likely to experience complications related to mental security if they have a friend/family member accompanying them during clinic appointments yet with this pandemic, social distancing was essential that unfortunately lead to increased social isolation and less clinical visits that led to decreased diagnosis of PPD.

Through our needs assessment, we concluded there is an urgency in integrating technology with mental health care to increase accessibility to quality mental health care. COVID-19 further alienated women from accessing mental health care. For most women, it became dangerous to visit doctors at the hospital since there was fear one would “catch” the virus at the hospital or they will be neglected as doctors attended to respiratory issues to rule out COVID-19. It became harder to diagnose women with depression especially in the routine follow-up appointments post birth. 

Now, with the Wazi team, consulting on the Cactus Mama m-health app that will be revolutionary in addressing maternal mental health in Kenya. Our plan is to use the app to bridge women in remote Kenya and community medical providers to mental health professionals at primary health care settings in peri-urban/urban areas. 

We integrate the voice of women who underwent postpartum depression(PPD) in all stages of our telemental service development. These women advise how our m-health solution can weave with the sense community and equity to deliver a telemental health service that is acceptable, affordable and accessible. By involving women who underwent PPD, we give our telemental service a lived-experience perspective that ensures our prospective users get a person-centred mental health approach. We also involve medical providers and utilize Up-to-date website to ensure the telemental service utilizes current evidence-based mental health care.

Our telemental service leverages technology to create a pathway of collaboration between medical providers in remote Kenya with mental health providers in peri-urban/urban areas. This collaboration will expand quality mental health care to women in rural areas as they can get access to treatment without travelling far. This will be done through video conferencing between rural medical providers and the patient in remote Kenya with medical professionals in peri urban/urban areas. For women in crisis, they will get mental health first aid within their communities in remote Kenya before getting referred to specialized hospitals for their admission and specialized care. 

With the advent of COVID-19, our solution is timely! COVID-19 has led to social isolation due to limited human interactions to curb spread of this deadly virus. Our solution will increase social interaction through peer support networks which will reduce social isolation imposed by COVID-19 and any other future pandemics future necessitate social-distancing to curb spread of disease.

The solution currently serves 150 women. This includes 30 women who have underwent postpartum depression who are advising the development of the m-health service as they benefit from peer-mentorship training and mental health support. The other 100 women are those that receive reproductive and mental health education from both Cactus Mama and Washindi Africa. In the next five years, our project aims to penetrate at least 3 districts in remote Kenya where we aim to reach 1000 women in each of the districts. 

In 1.5 years, we aim to sensitize 150 nurses, 50 clinical officers and 50 doctors in the Eldoret community were we will pilot our project. Then in the following 3 yrs, we will train 750 other medical providers in 3 other communities where we plan to scale.

Short-term outcome 1: Women in remote Kenya will have increased access to existing mental health resources and support within year 1 of the program implementation. Performance indicator: qualitative survey reports indicating satisfaction of women with more mental health resources known and available to them.

Short-term outcome 2: Medical providers in remote Kenya will report increased adoption of Cactus Mama m-health solution within year 2 of the program implementation. Performance indicator: qualitative survey reports will show reports of health care providers downloading and using the Cactus Mama m-health solution.

Short-term outcome3: Medical providers in remote Kenya will report increased screening of women with postpartum depression(PPD) within year 3 of the program implementation. Performance indicator: number of women screened with PPD will increase.

Long-term outcome 1: Women in remote Kenya will report increased access to quality mental health care within year 4 of the program implementation. Performance indicator: qualitative survey of women using the Cactus Mama m-health solution will show more satisfaction with the quality of the mental health service.

Long-term outcome 2: Women in remote Kenya will report increased self-efficacy in coping with postpartum depression within year 5 of the program implementation. Performance indicator: qualitative survey of women using the Cactus Mama m-health solution will report their increase self-efficacy  in coping with PPD

Impact goal: Women in remote Kenya will attain mental wellness and satisfaction as mothers. Performance indicator: decreased cases of depression affecting mothers in remote Kenya. 

Our team involves 10 full time contributors: 1 founder, 1 co-founder, 2 psychologists, 2 content/research/grant developers, 2 psychiatrists, 1 health educator and 1 web/app designer. 

Our part-time contributors are 6. They include 4 research enumerators , 1 intern and 1 events organizer/video editor .

We are a vibrant team of passionate changemakers with diverse skills sets. The founder and co-founder of our organization come from medical background. Their vast experience in caring for women antepartum and postpartum was a key influence in the founding of our project. They identified the mental health care inequity to women in remote Kenya. This health accessibility injustice compelled them to find ways to create mental health service that was accessible to all women in Kenya regardless of socioeconomic status or geographical location. They started formulating ideas to create change and recruited the rest of the team to form Cactus Mama Telemental Project.

Our content and grant developing team entails members who have rich experience in finance, community work, entrepreneurship and women empowerment. Their experience working in various non-governmental organizations has expanded our understanding of trauma-sensitive care to create solutions that are inclusive. 

Our events organizer/video editor, intern and web/app designer have rock-solid expertise in computer science and informatics that ensure we create telehealth content that is up-to-date with the current digital technology. They ensure the content is easy to read and understand.

Our research team includes members with rich community development experience, fieldwork expertise and the Kenyan medical system understanding that makes our team gather resourceful data that helps us create a platform that is powered by a sense of community, equity, empathy and lived experience for a person-centred approach

Our goal is to create safe, diverse and inclusive organization. Nepotism and tribalism, is the cancer, killing Kenya! Cactus Mama leaders believe it is not about recruiting "someone from my tribe, church, political party..." We recruit team members regardless of their sex orientation, age, technological expertise or religious and political affiliations. We believe it is what value that members bring to our organization that really counts.

Our leaders believe in a collaborative and interactive leadership structure where every team member contributes to the set goals for Cactus Mama. This leadership structure is often challenging to implement; but by outlining and delegating responsibilities, we set clear expectations for all members

As the leadership team, we acknowledge every team member and treat each other with respect, empathy and offer support when needed. We organize monthly check-ins to see how team members are doing. When we have urgent organization needs like applying to the MIT Solve challenge, our check-ins are daily to ensure team members are coping well and receiving the support that they need. We do this through our WhatsApp group. 

We are strong believers of collaborative partnerships. This started from the very beginning of this project. In 2016, Faith, our founder was a student nurse in Canada. She contacted Natalie, our co-founder, to find ways they could make a difference in women's health, in Kenya. It was until late in 2018 that they officially met after various strategic talks that lead to winning the Resolution grant in 2018, in Kigali!

It will be an honour to be part of a community of change-makers. It will help us keep pursuing our goals and dream of transforming maternal mental health services in Kenya. Sometimes, it feels overwhelming and frustrating to be uncertain of next steps. By talking to other individuals who have had experience with start-ups, we will continue to find a path within all the chaos. This community will offer us a home were we will feel safe to ask all possible questions as we learn from each another. 

As a developing project, we will gain from your expertise in advising us on the best business strategy that will lead to sustainability. We propose fee for service and low-client model but wish to learn if their is other strategies that have proven success in healthcare sector. We would welcome training on how to pitch to investors to help us find financial help to built our project.

We also would appreciate your technological expertise especially with data analysis. For overall impact, our team does not have expertise on monitoring and evaluation at the moment. Our founder is currently pursuing post-graduate studies on part-time basis that will include project management skills. In the future, she plans to educate the team on the same.

Safaricom Kenya: They are a successful phone company in Kenya and they pioneered M-Pesa, mobile banking technology that leapfrogged need for internet for accessing mobile banking services via integration of USSD code. This service is for all who can have any kind of mobile phone. We believe their partnership with us will be vital especially for paying for mental health services. M-Tiba, is one of their healthcare related technologies that helps individuals pay for services or take loans. We plan to advocate for subsidized care for our vulnerable population. 

Ministry of Health Kenya: Our partnership with ministry of health will be essential in the buy-in of our m-health solution especially by the medical providers who will collaborate with us to make a difference. They can also help us as we scale to other remote Kenya when we prove that our solution is scalable.

Kamili Mental Health Organization: With our goal of task shifting and increasing mental health training, they are the best at training nurses without a background in mental health care. They offer nursing scholarships and we hope to partner to increase number of trained personnel especially those in remote Kenya.

Still a Mum: They specialize in offering support to women post loss of a baby. They will be a key support resource to women who experience this unfortunate life changing event

Usikimye organization: They specialize in supporting survivors of sexual and gender-based violence. They will help give specialized support to these survivors.

The Innovation for Women Prize will be essential in advancing our Cactus Mama mobile health(m-health) app from prototype to pilot stage. Our approach is innovative and will help cut the cost of travel for women in remote Kenya who often have to travel far to seek mental health care. We will connect women remote Kenya who are experiencing postpartum depression to mental health specialists virtually or physically if their is need for hospitalization.  

Our m-health app will also create a pathway through which medical providers in remote Kenya can collaborate with mental health professionals to enhance effective and timely diagnosis via task sharing and telecounselling. The video interface will allow medical providers to consult with mental health professionals to offer women in remote Kenya telecounselling or any other tailored care according to diagnosis. 

Our project advances the mental health needs of women in remote Kenya who currently face health inequity due to their location and socioeconomic status. We campaign for their mental health needs since every woman in Kenya deserves mental wellness. Postpartum depression is brutal and it affects women at a period when they are nurturing their infants. By empowering these women to find mental wellness, we give them the tools to raise strong, healthy and happy children. It is time we address gather all resources necessary to equip these women so they can lead happy and productive lives.

The AI for Humanity Prize will be critical in helping us build a m-health app that uses machine learning , predictive analytics and cybersecurity to create algorithms that keep our platform secure. It will be essential to have a platform that can maintain patient confidentiality by securing data well.  Our platform aims to connect remote women in Kenya to mental health services.