We did not have the opportunity to meet with Matron Kamera this week. In fact many friends whom I was excited to see again were gone. Alex, the nurse in charge of the community health worker outreach program, is at Blantyre attending a two-week study on palliative care. Sister Honesta, a nun in charge of the OPD pharmacy is also at a week-long training session. For a hospital constrained by resources in every way, St.Gabriel’s tries to fully utilize and mobilize its labor force. Because nurses are overloaded (for the Pediatrics Ward, I saw only one nurse managing more than 60 beds at a time), the janitors are trained to perform basic tasks, as counselors and administrators for HIV testing, as nurse-assistors, etc. It is notunusual to see janitors removing cannulas, taking vital signs or giving medicine. In fact, the hospital sends many to central government hospitals to become specially trained in an area. For example, a pair of lady cleaners, trained in the kangaroo method, are in charge of the neonatal ward where the hot cot and the phototherapy lights are situated.

We felt it was inappropriate for us to introduce the technologies we brought to the different wards without first talking to the Matron and receiving her permission. However, we used the time to check up on the technologies we left with the hospital last summer. Mentioned above, the phototherapy lights and the hot cot are in the neonatal ward where two specialized trained assistants are in charge. We learned from them that the hot cot is used for babies with extreme hypothermia. Otherwise, in most cases, the kangaroo method—where the mother straps the baby skin-to-skin in front of her chest—is one they recommend because they want mothers to bond with their children. Moreover, the kangaroo method is a easily sustainable way for mothers to maintain care for the babies after discharge. One other reason they are reluctant to use the hot cot may be that there is only one for the ward. Having one baby in the cot while there are multiple patients may cause discord. However, I was glad, and pleasantly surprised, that they do record the times they use the cot on the sheets that we provided them last time. Even though both ladies were not the audience I showed the cot to last summer, they eagerly demonstrated to Elizabeth and I how they used the cot and referred to the directions Z and I left them. There were, however, two areas of confusion. One was the placement of the board that the baby rests on. I guess when they wanted to check if the bulbs were all lit, the board was moved to the opposite edge opposed to the light bulbs; however, the correct placement is directly on top of the bulbs, which is designed so that the hot air can sweep across the baby before exiting the cot. Another problem was related to a part of directions that was not labeled clearly.  They were confusing the temperature the cot should be based on the baby weight and age (gotten from the Academy of Pediatrics) with the temperature the baby is at. As a result, they always used four light bulbs; however, they assured us that they always check the temperature within the cot when in use. Overall, I am glad to see that the transfer of knowledge from the doctors and head nurses I introduced the device to has successfully passed on to the ladies in charge of the ward.

The jaundice phototherapy lights (fondly called bili-lights) are also kept in great condition. The two units I left with the hospital are both working well. The two nurse-assistants know how to use the device with the cot and what the irradiance meter is used for. The device has not been used frequently because the doctors do not diagnose cases of jaundice often. However, the two units are currently the only working therapy lights as the donated unit from the US is broken.

We also checked on the oxygen sensor used to measure the oxygen level delivered by oxygen concentrators, which ensures that the machines are working properly. The main component of the sensor is the only replaceable part of the device aside from the batteries. The sensors are expensive and impossible to find in Malawi, so we brought a few to keep them in stock for the hospitals. We were just in time for the hospital’s monthly check-up of the oxygen concentrators and had a wonderful opportunity to observe how the technicians use the device. Everything was working fine and the sensor did not seem to need replacement as it was measuring the oxygen of the ambient air within the expected range. We taught the technicians how to replace the sensor if they ever notice the device measuring the ambient air oxygen level to be below 18.

Before arriving at the hospital, one of my greatest fears was that the technologies would not be used. I have learned before that it is emotionally hard to have high expectations in unpredictable situations, so I tried not to hope too much before coming. I am extremely thankful to St.Gabriel’s Hospital for their trust in our projects and their courage and enthusiasm to include new technologies in their healthcare system.