Our last few weeks have been filled with adventure. We travelled from Namitete, to Lilongwe, to Zomba, to Blantyre, back to Lilongwe, and finally to Namitete. We were fortunate enough to have the opportunity to join Dr. Richards-Kortum and Dr. Oden on one of their “investigations”, and met with many of Malawi’s most important health care providers. Here are some of the things we did along the way:
1) Our professors arrived in Namitete on Sunday night, “fired up and ready to go”. We took a quick walk to the dam, where we were greeted by playful kids and a smiling sunset. We spent the evening together, as an assembly line, putting bilirubin lights together to bring to Blantyre. Dr. Richards-Kortum and I agreed that our childhood experiences Lite-Bright gave us a strong advantage when it came to inserting the LEDs. After a wonderful traditional Malawian dinner together, we settled down for the night and prepared for the next adventure.
2) The next morning, we met with Matron Kamera, Dr. Heim, and Dr. Mbeya. Dr. Rickards-Kortum and Dr. Oden gave a flawless presentation of the technologies they brought along, and gave us an opportunity to present the lab-in-a-backpack, CHW screening kit, and bili lights. Some of the other technologies that they brought along included an oxygen concentration sensor, that tests the flow rate and oxygen output of an oxygen concentrator, and can be built for <$100, and a pediatric pulse oximeter, with a hinge adjusted to allow for a baby’s entire hand to be placed in the sensor. St. Gabriel’s Hospital was enthusiastic about testing both of these technologies. Since our meeting, Dr. Heim has come up for a different thing to be put “-in-a-backpack” every day. We are undoubtedly thankful for his support and enthusiasm.
3) After a quick visit to the Furniture Factory, and a few tests with the incubator, we began our journey to Lilongwe. There were seven of us in the car, including all of our bags plus seven bili lights, a CHW backpack, and a lab-in-a-backpack. We were quite a Malawian sight, so say the least. In Lilongwe, we met with a PEPFAR representative, and a CDC representative. We discovered that Malawi was not previously a focus country for PEPFAR1, but will be receiving more money now. Here, we discussed the same desperate need for affordable, accessible, and simple point of care diagnostics. The usual issues were discussed – the need for a mobile, cheep CD4 test, early infant diagnosis, viral load, TB and malaria microscopy – along with several other suggestions, including a point of care lactate test, a test for D4T toxicity, and a CD4 machine that uses micro fluidics.
We discovered that Malawi has just started using liquid baby Triomune, and is transitioning to nevirapine throughout all of breastfeeding. Perhaps, with this shift to liquid ARVs, the adherence monitoring system developed by a design team at Rice could be useful. Finally, we discussed some possible focuses for the CHW backpack, now presented as the “Community Outreach Backpack”. The PEPFAR representative suggested that the backpack focus on those who test positive staying linked to care. He suggested an integration of HIV/AIDS care and family planning, and encouraged the integrations of Health Surveillance Assistants (HSA) in the use of the kit.
4) After a wonderful Indian dinner with one of our professors’ friends, we prepared for an early start the next day. Luckily, we left for Zomba before the sun came up. If we hadn’t, we would have missed the sun rising over the majestic Malawian mountains. We arrived at the Baylor Children’s Center in Zomba by mid-day, and sat down with one of the Baylor Clinic’s PAC Doctors, Dr. Kevin Clarke.
Dr. Clarke has been using the lab-in-a-backpack for the past year, and provided us with wonderful feedback about both the backpack, and our current projects. The items that Dr. Clarke are using most often are the glucometer, the urinalysis strips, the pulse oximeter, the sharps container, the basic supplies, and the syringes. Ideally, he would like to include an IV set and a scale in the backpack. Currently, they are using adult scales to weigh infants and children, and have no pediatrician on site. “When you’re dosing an infant that has a 2 kg window, this is sub-optimal.” He expressed his concerns with both the microscope and the centrifuge. While he often doesn’t have time to use these tools, he still likes the idea of the centrifuge. He is only occasionally able to fins urinalysis strips, and hasn’t used the solar panel to charge the backpack yet. Finally, he would prefer a larger bottle for “methylated spirits” as opposed to alcohol swabs.
Dr. Clarke gave us some wonderful ideas about our new “HIV/AIDS and Family Planning Backpack” idea. He suggested that the backpack include space for tests and reagents, a visual aid for what positive and negative test results mean, a chart of family planning methods, space for medicine, syringes, pregnancy tests, visual aids for the disclosure of a child’s status, lancets, gloves, a sharps container, and a DBS collection method (including a method for tight storage of the required humidity cards). He advised us not to develop a rapid drying method, but instead to develop a way to transport the cards to allow for the required six hours of drying time.
Dr. Clarke, like several other doctors in Swaziland and Malawi, discussed the hospital’s need for a drip monitor, “This will reduce deaths, clearly.” Several Rice engineering teams have worked on drip monitor over the past few years. I think this will become a focus for BTB over the next few semesters.
5) Next, we traveled with Dr. Clarke to the government hospital in Zomba. There, we discovered a plethora of technology needs. A few of the ideas that were discovered include: a water bag for handwashing, a DBS kit, a portable x-ray light box, a pill-breaking method, recitation equipment, a nebulizer, a traditional birth attendant backpack, a method for controlling the amount of milk that goes in a nasal gastric tube, a vitals monitor, a device to measure bilirubin load, and a thermometer that can be applied to the skin. One of the German pediatricians working at the hospital made a wonderful suggestion, “A little pill that goes through the entire body, and tells me everything – oh, and doesn’t cost anything.” We’ll be sure to get right on that.
6) Our final stop was the government hospital in Blantyre. We were thrilled to see two babies under the Rice-designed bililights, along with 20+ incubators. After dropping off six second-generation bililights, and presenting several of our current projects, one of the pediatricians sighed and asked (half-seriously, half-jokingly), “Well then… What else’ve you got in a backpack?!”
As the mountains of Blantyre slowly began to disappear, we made our way back to Lilongwe. During the seven hour drive home, I couldn’t help but think – often times, we set out on a path to help people make their way, and they end up helping us along our way. Maybe that’s what it’s all about. Helping each other along the way.