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In 2006, Shira Rohde, twin sister of UCSF Associate Adjunct Professor Dana Rohde, volunteered for a six-month Pfizer Global Health Fellowship in Zambia. The focus of the Fellowship was HIV/AIDS prevention, care, and treatment.

However, Shira’s interests were quickly drawn to the plight of the many children orphaned as their parents succumbed to the disease. She was stunned by the sheer number of barefoot children on the streets. In neighborhoods strewn with discarded tin cans and broken glass, children would run and play. Shira knew that they risked both trauma from sharp objects, and constant exposure to parasites that access the body through bare skin. Aware that these dangers could be remedied with a simple pair of shoes, she began to buy flip-flops and give them randomly to children in need. At the close of her Fellowship, Shira left Zambia determined to do more. Upon her return to New York, she established a not-for-profit organization with the mission of providing shoes and other basic necessities to disadvantaged Zambian children. Out of her efforts, the Flip Flop Foundation was born.

Through contacts formed during her Fellowship, Shira built a team of Zambians dedicated to the cause of helping children. Together, Shira and the team identified both suppliers of goods and recipients of donations. Critically, the team found local enterprises to provide flip-flops, and other basic items such as food, clothing and school supplies. Buying from local businesses helps the region’s economy and saves on transport costs, thus considerably lowering expenses. Equally strategic was the decision to partner with local institutions, such as orphanages, schools and community-based programs that care for Zambian orphans and vulnerable children. Distributing supplies through these organizations allows for detailed documentation and careful monitoring and evaluation of the work of the Flip Flop Foundation.

The Zambian team works throughout the year to maintain and expand the supply and distribution relationships, and Shira returns every few months to oversee progress and to organize large disbursements. To date, the Flip Flop Foundation has executed more than forty distributions to sixteen organizations serving children in need. These allocations have included 1755 pairs of flip-flops, 190 blankets and 65 sets of bed sheets, 952 notebooks, 41 educational posters, hundreds of pens and pencils, 252 tubes of toothpaste, 132 bars of soap, food supplies and thousands of items of clothing.

While most of the distributions have occurred in the capital city of Lusaka and its eponymous province, there have also been several allocations in the Copperbelt Province, as well as the more rural Eastern, Western, and Luapula Provinces. Ultimately, the organization hopes to reach children throughout all nine Zambian provinces. Detailed documentation and more than 100 photos of these distributions can be found at the website: www.flipflopfoundation.org.

Zambia is a landlocked country in southern Africa, with a population of 11.5 million people. One of the world’s poorest nations, more than 70 percent of the residents live in poverty. With 17 percent of the population infected with HIV/AIDS, and malaria prevalent throughout the country, life expectancy is less than 40 years of age. It is estimated that there are 1.2 million orphans in Zambia.

Although it is difficult to precisely measure the effect of the Flip Flop Foundation’s work, the communities on the ground in Zambia see tangible benefits. Preston Nkhoma, an active community volunteer in Lusaka, and part of the Flip Flop Foundation’s local team, writes from Tiyanjane Theatre Organization, a recipient institution: “On 24th November 2007 we remained distributing more clothes for the kids which warmed them during this cold season. The parents in our community are so happy with what Flip Flop Foundation is doing. We never thought that one day we will meet such an organization that has so much interest for the health of vulnerable children. Hence the joining as partners.”

Appropriate footwear can protect children from diseases caused by parasites that penetrate bare skin. These include the following, all found in Africa. Tungiasis (tunga penetrans) is a disease caused by a parasitic flea. This disease affects the feet because this sand flea is a poor jumper and therefore burrows into the skin of the host on the bare foot or toes. Painful swelling and the development of a fibrous cyst follow. It may progress to bacteremia, gangrene, tetanus and death. The major risk factor for developing tungiasis is failure to wear shoes when walking in flea-infested areas.

Hookworm is an intestinal parasite that can be caused by direct contact with soil contaminated with larvae. Hookworm causes anemia, abdominal pain, diarrhea, weight loss and sometimes stunts growth. Schistosomiasis (bilharziasis) is a condition caused by parasitic worms, and can be acquired by walking through contaminated water. The body reacts with fever, chills, cough and muscle aches. Repeated infections can damage the liver, intestines, lung and bladder.

Establishing a non-profit requires initiative, perseverance, and above all, passion. While maintaining her role in the Regulatory Affairs Department at Pfizer, Shira began the journey by incorporating the Flip Flop Foundation as a not-for-profit organization in New York State in the fall of 2006. She sought an active Board of Directors, tapping people with varied expertise and a commitment to global health. Among these is her sister Dana, who teaches anatomy and physiology in the UCSF Medical and Pharmacy Schools, and who has traveled extensively in Africa (see profile, page 11). The Board also contains an analyst at the United Nations, a medical doctor who has taught and worked in Africa, and other Pfizer staff including two former Global Health Fellows who were stationed in Rwanda and Kenya, and have expertise in finance and epidemiology, respectively. (Full disclosure: this correspondent, a staff scientist at the UCSF Mass Spectrometry Facility, is also a Board member.) In June 2007, the Flip Flop Foundation filed with the IRS to obtain tax-exempt 501(c)(3) status. Once this status is granted, all donations to the Flip Flop Foundation will be retroactively tax-deductible.

To learn more about the Flip Flop Foundation, or to make a donation, visit www.flipflopfoundation.org.

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