Summer in Shirati

Grace Goldstein grew up outside of Washington, DC and didn’t stray far from home for college where she graduated with a B.S. in Architecture from the University of Virginia. While at UVA she studied abroad in Falmouth, Jamaica and Copenhagen, Denmark. After graduating Grace moved back to DC and worked for a national construction company for two years. She decided to go back to school and is currently in her last year at Washington University in St. Louis in the dual MBA and Master of Architecture program. She is focusing on social entrepreneurship and related architectural design. She took advantage of the travel opportunities in graduate school and has studied in Barcelona, Japan and just returned from her first experience with Maji Safi in Shirati, Tanzania with her experience described below. 

Why Tanzania?

When I introduce myself as a dual MBA, Master of Architecture candidate most people are surprised and question the combination as unusual, unique and occasionally contradictory.  It should come as no surprise then that my summer internship fell under the category “unconventional”. Washington University (WUSTL) touts itself as an interdisciplinary, cross collaborative university, and while that feels hard to believe on the 3rd day straight in studio working towards final deadline or locked in study rooms during ICE week, my internship epitomized that ideal. I took a joint architecture – social work class my first year at WUSTL and was introduced not only to the world of social work but also to my partner for the semester, a graduating student in social work focusing in international development. Emily and I ended up with a great project, a look into each other’s worlds and a connection to another part of the university. We didn’t talk until almost a year later as I was finishing up the first year of my MBA. Emily was now working for Maji Safi Group, a non-profit organization operating in Shirati, Tanzania. Maji Safi needed a designer and Emily recalled her semester long encounter with an architecture student. It’s hard to pass up any opportunity as an architect to design your own building (ever) especially before graduating from school. I jumped at the chance offering both my design services and applicable skills, like budgeting, from the MBA. Not unselfishly, this “internship” fulfilled every box I wished I could have checked on Weston Career Center but couldn’t – design focus, MBA focus, non-profit/social good, and travel.

Tanzania?

I knew very little about Tanzania before I left. The sum total of my knowledge included friends and friends of friends exclaiming, “I know someone who went to Tanzania,” an introduction to the Maji Safi and the information about Shirati Tanzania posted on their website, and a suggested dress code that included skirts below the knee and shirts with sleeves (a very different wardrobe than the one you would find in my closet).

Tanzania is an east African country bound by the Indian Ocean on the east, Lake Victoria to the northwest and surrounded by Kenya, Mozambique, Malawi and Zambia. Tanzania is home to the Serengeti, Mt. Kilimanjaro, and Zanzibar Island and as a result is as much a tourist destination as an intensely local population.

An Internship in Tanzania?

Fast-forward five weeks, a safari, countless hours in planes and airports, a week with the Swiss Family Robinson exploring Mwanza and acclimating to Tanzania, and the grown up version of sleep away camp in Musoma spending days working and evenings throwing the Frisbee, gathering for family dinners and projecting movies and time to move to Shirati. It’s unfair to boil my first five weeks down to a run-on sentence. It does the experience an injustice; I would need a book or at the least a pamphlet to describe the collage of culture that I was exposed to, woven threads of conversations, people, Swahili bumbles, mundane activities turned epic in their variety, and encounters with animals, food and stories.

 

I will start the summary story with our 2 hour drive from Musoma to Shirati. Shirati is a village on Lake Victoria in the Mara region, home to 150,000 people. Shirati is also the home base for Maji Safi Group and very dear in the hearts of Max, Bruce and Emily.  So, anticipation and excitement to get to Shirati was high and had been anxiously building for weeks. I heard stories about the Mamas and the Community Health Workers, the KMT Hospital and the puppies that were awaiting their parent’s return to the Shirati House. Mama Deborah, who runs the house in Shirati and kept us all fully fed at all hours of the day and Judith, the Mama of the Community Health Workers had been built up to god status in my head before getting to Shirati (the description was more than accurate). If I had a scale for “venturing into the unknown” the meter would have been topping the scale as we drove into Shirati.

I would highly recommend when visiting a village in Tanzania to visit one where the organization you work for and the people you are working with are highly respected in the eyes of the villagers and their employees. I have never met (descriptors are accurate not exaggerated) a more welcoming and excited group of people, much less employees. I’d consider myself a pretty friendly person but I couldn’t keep up with the enthusiasm of each of the CHWs. Saying “hello” to someone is a conversation in and of itself in Kiswahli. It is one of the first things I tried to tackle in Tanzania and the last thing I managed to become passable at. There are so many different ways to say hello and each version requires different responses; it felt like an art form and certainly a window into the lost art of conversation, which in the US has been reduced to empty letters sent anonymously over text message. Maji Safi has 16 employees each of whom has been trained in community health practices and has passed tests to qualify them to go out into the village and educate their community about WASH practices. They wear their uniforms with pride, each shirt proclaiming “Niulize kuhusu Maji Safi!” ask me about clean water. Over the course of three weeks in Shirati, this phrase would come to epitomize the spirit and dedication of Maji Safi Group and all the Community Health Workers.

The original premise for spending the summer in Tanzania was to design the Community Resource Center (CRC).  One of the first agenda items in Shirati was to hold a design workshop with the CHWs. The workshop was designed to introduce the premise of the CRC to the health workers and to engage them from the beginning in the discussions and design of the center. After a day of designing we had 4 unique, beautiful designs for the center. However, the true power of the exercise was in the explanation each team gave for their design: the juxtaposition of different spaces, the need for designated rooms and the potential they saw for the growth of the organization in dedicated built forms.

The second work driven goal of the trip was to create a budget for Maji Safi. Two weeks later and countless hours spent pacing the porch, drinking glass bottle sodas and calling CHWs to answer reference questions, we had a budget. But like the design workshop and most of our activities in Tanzania the process was arguably as important as the budget itself. I was in a unique position to participate in conversations that were refining and redefining the mission of the organization, the core values and the direction of the individual Maji Safi programs. It’s an unusual experience to sit with a dedicated and driven leadership team and debate the power of a single word in setting the course for an organization’s impact evaluation, growth trajectory and program structure.

 

I still find it amazing a month later, how powerful those three weeks in Shirati were. We spent all of our time together, sleeping, eating, working and playing and the result was that three weeks in Shirati felt more like three months and made leaving a lot harder. I had become much more invested in the future of Maji Safi than I had expected and didn’t want the summer to end and with it my involvement in the organization. The result: I agreed to be the Maji Safi Group Treasurer for the next year and have received approval (officially) to design the Community Resource Center as my Masters Thesis Project. I now have the benefit of designing the CRC with the support and guidance of Maji Safi Group, my thesis advisor, my peers and the resources the Sam Fox School make available. With any luck I’ll be back in Shirati soon, meanwhile the adventure will continue from afar in St. Louis.

HEALTH SCREENINGS

A great public service and a metric to measure disease prevalence amongst current and potential program participants.

Health-Screenings-Maji-Safi

During the years 2015-2019, MSG conducted an annual Health Screening Campaign as a public service and a way to monitor the impact of MSG’s WASH education. Approximately 25,000 participants were tested for amoebas, intestinal worms, schistosomiasis (bilharzia), and malaria – all common water-related diseases. In cooperation with the Rorya District Medical Office and practicum students from the US, MSG screened participants and provided them with appropriate medications and educational flyers. The health screenings helped patients keep track of their well-being and provided an incentive for community members to get involved in MSG’s programs. In addition, the health screening results enabled MSG to compare the disease rates of our program participants to those of community members who had not received our education.

Ree Pads

Ree Pads is a supplier of reusable pads to support MSG's Menstrual Hygiene Health programs.

afya plus pad logo

Afya Plus

Afya Plus is a supplier of reusable pads to support MSG's Menstrual Hygiene Health programs.

ReliefPad

ReliefPad supplies reusable pads to support MSG's Menstrual Hygiene Health programs.

Saalt

Saalt is a global company that provides reusable solutions for menstruation. Their products are donated to MSG to support our Menstrual Hygiene Health programs.

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AnuFlo

AnuFlo is a Tanzania-based social enterprise that manufactures reusable menstrual products. MSG utilizes AnuFlo products in our Menstrual Hygiene Health programs.

Women's Choice Tanzania

Women’s Choice is a social enterprise that manufactures and distributes low cost, affordable menstrual hygiene products – especially, reusable Salama pads.

Street Business School

Street Business School (SBS) empowers women to become thriving entreprenuers, lifting themselves and their families to a more vibrant future by teaching them tools they need to successfully start and grow microbusinesses. Several of MSG's employees are certifies SBS trainers who work with cohorts of women in the Mara region.

Swiss Midwife Project

MSG has been hosting midwifery students from the Bern University of Applied Sciences in Switzerland since 2021. The nurses come to learn and help at the Shirati KMT District Hospital’s maternity ward, while also supporting MSG’s Menstrual Hygiene Health program.

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Touro University, Program of Public Health

Touro University California is a non-profit institution of higher learning and professional education with programs in Public Health. In partnership with MSG, Touro is conducting research and mapping in the Rorya District to determine the prevalence of and need for increased services in non-communicable disease treatment and education.

Shirati College of Health Sciences

The Shirati College of Health Science partners with MSG to provide field work and practicum experience to local nurses. Nurses work alongside MSG's Community Health Educators to provide community health education.

Shirati KMT District Hospital

MSG was founded as a pilot program under the Shirati KMT District Hospital in 2012. Since then, the KMT has been a seminal partner with whom MSG continues to grow and share support. Today, the two organizations especially partner on running Disease Prevention Centers and providing nutrition education as well as schistosomiasis prevention and treatment.

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Project C.U.R.E.

Project C.U.R.E. is a US- based nonprofit dedicated to addressing the shortage of medical resources around the world. MSG and Project C.U.R.E. partner to provide critical medical supplies for clinics and hospitals in the Rorya District.

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AllPeopleBeHappy

AllPeopleBeHappy is a US-based foundation which supports projects that address the root causes of poverty and increase prospects for happiness and better livelihoods. MSG partnered with AllPeopleBeHappy to extend female hygiene health education to the Butiama District in 2022.

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mWater

mWater is a women-owned small business provider of data-driven project management. The MSG team uses the mWater platform to track project data collection, monitoring, and evaluation.

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The Center for Affordable Water and Science Technology (CAWST)

The Center for Affordable Water and Science Technology (CAWST) is a Canadian charity and professional engineering consultancy dedicated to teaching people how to bring safe drinking water, sanitation, and hygiene to their homes, schools, and clinics via simple, affordable technologies. CAWST supports MSG with capacity building in a training-of-trainers model. Together, we are increasing the capacity of MSG’s staff to provide critical WASH education and training across East Africa, including in Tanzania, Kenya, Uganda, and Ethiopia.

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The Roddenberry Foundation

Roddenberry is a global foundation that supports bold ideas. MSG is a proud recipient of the Roddenberry Catalyst grant.

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Rotary Club of Southeast Denver & Rotary Club of Northwest Spirit

Rotary International is a member-driven organization and network made up of over 1.4 million neighbors, friends, leaders, and problem solvers who see a world where people unite and take action to create lasting change. MSG is fortunate to partner with two Rotary chapters: the Rotary Club of Denver Southeast (US-based) and the Rotary Club of Northwest Spirit (Canada-based). These two chapters have supported MSG's focus in Menstrual Hygiene Health and WASH in Health Care Facilities with multiple grants.

Grow and Know

In 2009, Grow and Know launched the very successful Vipindi vya Maisha, a book about female puberty. The book received positive responses from girls, women, mothers, teachers – even fathers and male peers. MSG’s Community Health Educators use this book as a resource in our Female Hygiene Program.

University of Colorado at Boulder

The University of Colorado is the alma mater of co-founder Bruce Pelz and home to the Mortenson Center in Engineering for Developing Communities. MSG has participated in the Center’s annual WASH Symposium since 2015 and has hosted several CU students in Tanzania. In 2016, MSG hosted professor Beth Osnes; together, we conducted research on the vocal empowerment of women.

Washington University in St. Louis

Since 2013, MSG has partnered with the Brown School of Social Work at Washington University in St. Louis by providing practicum opportunities for graduate students studying Social Work and/or Public Health. In 2017, MSG hosted Professor Carolyn Lesorogol and twelve graduate students focusing on participatory development tools.

Heatherwood Elementary School

MSG started collaborating with Heatherwood Elementary on read-a-thons in 2018. Participants spread awareness and raise contributions for MSG by recruiting sponsors for each book they read. This win-win grassroots partnership with Heatherwood promotes reading and teaches social responsibility and helping others through personal effort. The money raised has benefitted our Tanzanian youth projects and most recently the construction of a school latrine.

Posner Center For International Development

MSG is a member at the Posner Center in Denver, Colorado. The Posner Center convenes, connects and catalyzes the international development community to collaborate for greater impact. In 2018, MSG and the African School Assistance Project (ASAP) received an International Collaboration Grant from the Posner Center.

The Generous View Studio

The Generous View Studio is a privately owned meeting space in Boulder, Colorado, dedicated to spreading awareness of global issues in general and MSG’s work in Tanzania in particular. Through professionally taught art classes and informal gatherings, the studio supports the creative community in Boulder and generates revenue for non-profits.

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Paul Horton Visuals

Paul Horton Visuals is a creative company focused on providing digital and print media solutions. They support MSG with video and media content.

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REACH Shirati

REACH Shirati runs Tina’s Education Center (TEC) for primary school students in Shirati. When MSG started, REACH Shirati was our parent organization. Together, we have made TEC a stronghold for students to learn and grow through our programs. Today, MSG and REACH Shirati collaborate on the Binti na Shule (Girls in School) program, a mentorship program to improve girls’ performance in schools.

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Friends of Tanzania

Friends of Tanzania (FOT) is a non-profit charitable organization that has provided funding to grassroots organizations in Tanzania since 1991. FOT was started by former Peace Corps workers in Tanzania (or Tanganyika at the time). FOT has supported MSG since 2018 and has provided funds for multiple projects, including an Arborloo Toilet pilot project, SAFI toilet construction, and Menstrual Hygiene Health Labs.

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Beyond Our Borders

Beyond Our Borders is a group-advised fund under The Women's Foundation of Colorado. Its mission is to strengthen families and communities, while advancing and amplifying opportunities for women to reach economic self-sufficiency. BOB has supported MSG’s Female Hygiene Program.

LUSH Charity Pot

The LUSH Charity Pot offers grants to grassroots organizations that are in an optimal position to make a difference with limited resources. LUSH has been a committed partner of MSG since 2018, supporting a diversity of programs, including cholera prevention, home health visits, and WASH in health care facilities.

Tanzania Menstrual Hygiene Health Coalition

The Tanzanian Menstrual Hygiene Health Coalition is a network of Tanzanian governmental, non-governmental, and civil society organizations working to improve MHH in Tanzania. MSG was a seminal organizer of the original coalition in 2018. The mission is to increase knowledge sharing between MHH stakeholders and combine efforts to increase policies and services at the national level. Current collaborations include organizing the annual National Menstrual Hygiene Day celebration and increasing awareness of MHH issues.

Tanzania Water and Sanitation Network

TAWASANET is a network of Tanzanian civil society organizations in the water and sanitation sector. MSG has been a member of TAWASANET since 2014 and is the Zonal Coordinator for the Lake Zone. MSG participates in annual general meetings and provides advocacy and leadership in the network.

Tanzania Government Logo

School Health Clubs

MSG started its School Health Club programming in 2013 with the mission to improve community health outcomes through hygiene and health education at the student level. To date, MSG partners with 39 schools in the Rorya, Butiama, and Bunda Districts.

Tanzania Government Logo

WASH Health Care Facilities

MSG started its WASH in Health Care Facilities focus area in 2021 with the mission to improve community health outcomes through partnership with local health institutions (hospitals, clinics, and dispensaries). To date, MSG partners with 14 HCFs in the Rorya District.

RUWASA

MSG’s partnership with the Tanzania Rural Water and Sanitation Agency (RUWASA) is critical for implementing and growing rural water supply and access across the Rorya District. In 2024, MSG specifically launched a partnership with RUWASA, whereby the MSG WASH Hub supplies water to surrounding communities managed and operated by RUWASA.

Tanzania Government Logo

Local Government Authorities (LGAs)

MSG works closely with LGAs to provide services at the village and community level. LGAs are paramount to gaining community access, understanding community priorities, and providing valuable services. All programs are implemented hand-in-hand with community leadership and authorities.

Tanzania Government Logo

WASH Pillar

MSG participates in nationwide update meetings with the Ministry of Health and other WASH stakeholders on a regular basis. These meetings focus on providing updates on progress related to various disease outbreaks and allow stakeholders to share their initiatives.

HEALTH SCREENINGS

A great public service and a metric to measure disease prevalence amongst current and potential program participants.

Health-Screenings-Maji-Safi

During the years 2015-2019, MSG conducted an annual Health Screening Campaign as a public service and a way to monitor the impact of MSG’s WASH education. Approximately 25,000 participants were tested for amoebas, intestinal worms, schistosomiasis (bilharzia), and malaria – all common water-related diseases. In cooperation with the Rorya District Medical Office and practicum students from the US, MSG screened participants and provided them with appropriate medications and educational flyers. The health screenings helped patients keep track of their well-being and provided an incentive for community members to get involved in MSG’s programs. In addition, the health screening results enabled MSG to compare the disease rates of our program participants to those of community members who had not received our education.

SINGING AND DANCE GROUPS

Using cultural customs to teach WASH and empower rural youths
to be change makers in their communities.

Singing-and-Dancing

Over the years, MSG has used these dances, songs, and skits extensively to teach students and spectators how to:

  • avoid water-related diseases,
  • practice proper handwashing,
  • prevent fecal-oral disease transmission, and
  • practice proper menstrual hygiene management.

MSG no longer runs a specific Singing and Dance Program, but this effective way of disseminating knowledge about WASH, behavioral change, Menstrual Hygiene Health, etc. is still widely used in our programming.

RoryasGotTalent

Song and dance are of great cultural importance in Tanzania. They are perhaps the most effective medium for communicating disease prevention to a community. In MSG’s Singing and Dance Group, students learned life-saving lessons in a fun and memorable manner, developed their talents, and became community leaders. Following WASH lessons, students worked together to create songs, dances, and skits to perform for their families, friends, and community members at MSG events.

Sing and Dance

Rorya’s Got Talent

For many years, the Singing and Dance Group held annual auditions for the Roya’s Got Talent competition.

Participants wrote songs and skits and performed choreographed dances to communicate their WASH knowledge to peers and members of the community.

Once the best 10 participants had been chosen, MSG hosted a semifinal event and then a final event, each attracting over 1,500 community members.

AFTER SCHOOL PROGRAM

After School Program

CHEs taught WASH and disease prevention lessons in a fun, nurturing environment. Art, games, puzzles, and other activities encouraged students to develop their creative and cognitive skills. This way, the things they needed to learn became things they wanted to learn! In addition, their knowledge trickled down to their families. Over the academic year, students learned about:

  • sanitation,
  • personal hygiene practices,
  • waterborne and water-related diseases,
  • water treatment,
  • the fecal-oral disease cycle,
  • bilharzia, and
  • the benefits of preventing diseases.

To enable proper WASH techniques, MSG provided schools with demonstration ceramic drinking water filters and handwashing stations. At the end of the program, our staff artist painted a large WASH-related mural to serve as a reminder of lessons learned and as an inspiration to future students.

The After School Program was one of MSG’s very first programs, started in 2013. Its purpose was to teach students about water-related disease prevention and proper WASH behaviors, so they could stay healthy and succeed in school. In 2015, the District Education Office approved MSG to teach in all 125 primary schools in the Rorya District.

Over time 6,000+ students attended this program.

After School Program 2
After School Program 3

MAJI SAFI CUPS

Maji Safi Cup 1

Combining disease prevention education and team sports to promote a healthy and cohesive community.

Football (soccer) is a popular pastime in Tanzania. Organized tournaments are a common occurrence, and each game attracts hundreds of spectators. This community tradition affords a unique educational opportunity.

For several years, our CHEs would organize a month-long Maji Safi Cup on a biannual basis. These tournaments also included netball matches for women and girls. Before each football or netball game, teams must attend a one-hour lesson about WASH and disease prevention. Combining athletics and education promotes overall wellness and makes lessons more memorable and thus more effective.

The winners of a Maji Safi Cup were awarded school supplies and WASH products. Although only one team was crowned as champions, all tournament participants benefited from team-building and pre-game lessons!

LEARNING TOOLS

MSG is proud of its creative and original curricula, songs, art, games, outdoor murals, and train-the-trainer programs.

Learning Tools_Mural 3

Maji Safi Group’s unique learning tools have become the catalyst for healthy WASH lifestyles and disease prevention. From education on common water-related diseases and treatments to menstruation and proper handwashing, our learning tools are fun, engaging and specifically designed to accommodate the varying literacy levels among our participants. 

MALE HYGIENE PROGRAM

Teaching young men and boys about male and female anatomy, puberty, adolescent body changes, and personal hygiene.

MaleHygieneProgram
Male-Hygiene_-3

Male Hygiene Groups

The Male Hygiene Program began in 2016. It empowers boys and young men to respect themselves, girls, and women and lead a culture of change. The program also helps young men be part of the movement to break the stigma and silence around menstruation, help girls stay in school, and close the gender inequality gap.

Male-Hygiene_-4

FEMALE HYGIENE PROGRAM

Menstrual Hygiene Management in Tanzania

Though all residents face WASH issues, it is necessary to look at the situation through the lens of gender in particular. In Tanzania, female hygiene has traditionally been a taboo subject, and most schools lack adequate facilities for young women. Without access to proper sanitary materials and fearing ridicule for bloodstains on their skirts, many girls miss school during menstruation. Lower attendance rates severely limit academic potential and contribute to a cycle of disempowerment. Maji Safi Group, through our work to promote public health, seeks to establish a more comprehensive approach to menstrual hygiene management in Tanzania. We lift the stigma around female hygiene to empower girls and help them reach their full academic potential and become strong leaders.

Menstrual Hygiene Health

Together Women Rise

Influencing Menstrual Hygiene Management in Tanzania (MHM)

Female Hygiene Groups

Young women, ages 11-18, meet with CHEs in after-school groups to learn about female hygiene, health, and puberty. All groups, as well as girls from surrounding communities, are also invited to attend Saturday meetings at MSG’s office. The girls:

  • learn about female health,
  • share stories,
  • seek advice, and
  • engage in peer-to-peer education.

Participants also receive reusable sanitary products to promote proper hygiene and prevent absences from school. MSG strives to offer several different options, such as reusable pads, period panties, and menstrual cups.

Together-Women-Rise

The Decent Girl Competition

Female-Hygiene-Menstrual-Hygiene-Management-in-Tanzania-Maji-Safi--1

COMMUNITY OUTREACH

Interacting with the community and spreading WASH awareness to every age group.

Participating in one’s community is crucial to bringing about positive change. To be heard, one must first be seen.

CHEs organize and host activity days to establish a presence and promote change in their community.

Local-Market-Days

Youth Field Days

Community Outreach_Salon

Food Safety

Schistomiasis Education

Government Collaboration

Community Outreach

Local Market Days

People of the Mara Region gather on market days to trade goods. CHEs take advantage of the large crowds by setting up Disease Prevention Awareness booths and selling crucial WASH materials, such as WaterGuard chlorine tablets for water treatment.

Youth-Field-Days

Shops and Salons

Community Outreach_Food Safety

Schistosomiasis Campaigns

Government Collaboration
Tanzania Government Logo

Tanzanian Government

MSG works closely with the Tanzanian government at all levels: district, regional, and national. Relevant offices include Community Development Offices (district and regional), Medical Office (district and regional), Education Office (district and regional), Health Office (district and regional), Ministry of Health (national), Ministry of Education (national), and Ministry of Community Development Gender, Women, and Special Groups (national).

HOME VISITS

Homevisit-Program-Page

Community Health Educators

For these reasons, CHEs meet with primarily female heads of households to assess their family’s WASH situation. Lessons are tailored to the specific needs of each family, but general topics include: 

  • the economic benefits of preventing diseases,

  • water treatment and storage,

  • toilet use,

  • handwashing,

  • fecal-oral disease cycle,

  • food preparation and storage,

  • personal hygiene,

  • bilharzia, and

  • other neglected tropical diseases.

Delivering WASH knowledge to doorsteps.

In Tanzania, women are typically in charge of WASH-related activities such as, water fetching, cooking, cleaning, and bathing. This makes them the most crucial stakeholders in disease prevention. Educating women empowers them to become change makers in their homes and leaders in their communities. Our CHEs visit individual families to inspire action and transform communities—one home at a time.

Visits to a home are prioritized based on:

  • interest,
  • family size,
  • number of young children,
  • neighborhood disease rates, and
  • local government input.

Family Meetings

Based on initial assessments and rates of progress, CHEs meet with families three to five times over six to 10 weeks. Within the following year, CHEs will revisit families to ensure that good habits are sustained. Home Visits provide each household with equal attention and access to life-saving information. They also foster personal relationships between CHEs and participants. If residents have any questions following the visits, they know there is a friendly face or hotline ready to help. Building trust, confidence, and community is the way to stop disease from continuing.