In the midst of our focus on innovation, we pause to take a moment to recognize and reflect the stark realities faced by midwives in low-resource settings. Some areas have access to basic equipment needs, and are innovating in the technology realm: designing lower cost, solar-powered lights, power and blood banks. But in many places the challenge is making do with an indescribable shortage. Our advisor, Dorcas Kamanda, reminded us that in Sierra Leone she teaches women to take a piece of a plant to tie the umbilical cord because string is simply not available.

In the context of U.S. poverty, a recent NPR show interviewed a woman struggling to make ends meet, saying that she and her family have learned to break a penny in half. The expression reminded us of a conversation with a Massachusetts woman supporting a clinic in Uganda (Angels of HOPE). She described the routine practice breaking razors in half to naturally double the critical supplies on hand. She also described a procedure of snapping off the cuff of latex gloves to use to tie the umbilical cord. Documenting the ways that health staff 'stretch a dollar' or 'break a penny in half' is important to reflect reality but also to illuminate the settings where innovations will end up. The difference between a new technology that is a $1 and one that is $5 is immense.