29 July 2012

Hey all!

Kathleen has been sick since Thursday, and now Rahul is feeling ill as well! I’m sure this is not how they imagined their last week and first week of work would be. So without a doubt we will be staying here in Blantyre instead of going to Mt. Mulanji.

I hadn’t realized it, but for a few days there has been a water strike going on in Malawi; I thought it strange that the water wasn’t working in the women’s restroom at the hospital, but had not realized it was something affecting the rest of the hospital let alone the whole community. I think some things may be getting resolved because we had water in the hospital today.

This Friday I did CPAP checks as usual (Rahul ended up going home early because he wasn’t feeling well), then I went on a hunt for the Head of Obs & Gynae but to no avail; this week is just probably a bad week to try to get any meetings arranged because it’s exam period for all of the medical students…I’ll try again next Monday.

After lunch the day got pretty eventful…I don’t think I should go into the specifics on my blog page so I shall leave it at that; but family and friends feel free to ask me about it when I get home!

On Saturday Rahul woke up feeling much better, however, not the same luck with Kathleen’s fever. So we went to Blantyre Adventist Hospital up the road from Kabula…completely different from QECH! The doctor wasn’t able to pin-point what exactly she had, but said whatever it was is flu-like; he gave her some meds so hopefully they’ll kick in soon.

Sunday

With love,

Bridget

“We’re kind of like boys…we talk about sports, [we] have big feet…”
–Kathleen amidst her delirious, feverish state

What I’m glad I brought:
Shoe laces and bungee cord – Used to hold my 2 heavy check bags together when wheeling around the airport and served as a clothesline when I got to my living area
A bottle with milliliter markers on it
Laundry detergent
Nail kit – with tweezers, nail clippers, nail filer, nail scissors
Shower caddy – I hate putting my personal items on the floor
Shower shoes (flip flops)
Long socks – bedbugs can’t bite thru them
Small container of safety pins – I used them to hem torn bags, hang wet clothes, other misc. things
2 ½ weeks worth of underwear and socks
Flash light
Laptop

What I’m glad Kathleen and Rahul brought:
Debit card – I brought my credit card instead…definitely bring a debit for withdrawals
Big bottle of hand sanitizer
Sandwich Ziploc bags
Dish soap

For my parents—I promise I’m eating:
For breakfast: PB&J with banana sandwich / banana in oatmeal
For lunch: leftovers from previous dinners / chicken and cheese sandwich and strawberry and cream ice cream (Kips)
For dinner: leftovers from previous dinners / stir-fried rice and soup

26 July 2012

Hey all!

IT’S MY BIRTH-WEEK!!! I was determined to make every day this week be awesome…just because my birth-week normally is.

On Monday we showed Rahul the ropes; we took him through the morning CPAP checks, introduced him to key doctors and nurses, and set out a running schedule for the week. We ended up tackling everything on the day’s list so we made a Shoprite stop in preparation for the Christmas in July party on Tuesday. While I was at Shoprite I bought a hinge lock and padlock for the cupboard in Chatinkha; apparently some of the nose prongs for the CPAP have grown legs and walked off.

That evening we had dinner at Prof. Molyneux’s house; her husband, sister, brother-in-law, and one other doctor from QECH were all there. It was the best entertainment I’ve ever had amongst people I didn’t know; I never knew how found of British wit I was until this evening…I am very glad she invited us for dinner on my birthday!

Tuesday was Christmas in July Day! It was all I could think about…good, good food. We went to work as usual; it was another day of training for Rahul, however the WIFI was down at the hospital so showing him the CPAP documents on Dropbox took much longer than necessary.

When we got home the challenge was on: Kathleen and I had to roast 2 chickens, make vegetarian stuffing, sweet potato casserole, frosting for the Christmas cookies, corn and green beans—all of this from scratch (minus the can of corn and green beans)…and work around the scheduled 6pm blackout…for 14 people! If all else failed we would all be eating plain Christmas cookies, rolls, and a three bean casserole that Alice, the Kabula Lodge owner, made me for my birthday; she’s such a sweet woman!

Christmas in July was an EPIC SUCCESS! The food was ready by 8:30 (and everything was so yummy!),

We got to decorate Christmas cookies, and some friends even helped us do the dishes after we finished cooking…the only thing that could have made this evening better is some Christmas music or a Christmas movie classic.

The next day at Queen’s I showed Rahul how to do the CPAP test. After lunch we began a second round of searching for missing CPAP patient files in the Pediatrics’ Medical Records room; which is the most boring thing I’ve ever had to do while being here, but it still must be done. Through our search of thousands of patient files we managed to find two! This is counted as success in my book.

When we got back to Kabula Kathleen baked peanut butter cookies and strawberry oatmeal bars for our last night of Bible study on Thursday.

I knew today was going to be action-packed when Toni (one of the British doctors in pediatrics) summoned us as we were walking out of the morning meeting to tell us that there was an oxygen concentrator that needed tending to because its audible alarm was triggered. Normally what the nurses and doctors do to combat this irritant is switch the concentrator off and on again.

When I got to Peds Special Care Ward the alarm was still sounding, but when a nurse toggled the power button the alarm ceased. Then arose another issue; one of the CPAP machines had gone missing *sound effect: DUN DUN DUN!*…which in this hospital could either mean it was rolled away to another ward or some curious wanderer decided to relieve their mischief with this device—fortunately it was the former. Laura (the American doctor in pediatrics) told us that an oxygen concentrator stopped working in Peds Nursery so they took the nearest one, which so happened to be one of the CPAP study oxygen concentrators.

I brought down the oxygen concentrator that I fixed the previous week from the library to place it in Peds Nursery…finally, this oxygen concentrator has found a home! I then moved our oxygen concentrator back to its rightful place.

After lunch I decided to make a trip to PAM (Physical Assets Maintenance) to see if they were able to take a look at the oxygen concentrator that had stopped functioning in Peds Nursery; I thought it would be the perfect opportunity to watch how they assessed the issues and fixed the devices that got sent to them. By the time I got there, the concentrator was already fixed! I was not very happy…yes I know, that’s very selfish of me; however, I was glad the concentrator was able to be fixed. I signed a form and wheeled the concentrator back to its home in Peds Nursery.

To top off this perfect Thursday, I decided today was the day that I demonstrate the Babalung apnea monitor to the nurses in Peds Special Care Ward. The nurses pointed out an apneic child about 4 to 6 months old (much bigger than the children I’ve tried the monitor on before); unlike the previous times I’ve placed the Babalung apnea monitor on an infant, this time the breath LED turned on when the infant inhaled and turned off when the baby exhaled…SUCCESS!!! The monitor finally detected breaths on a baby!

Out of all the birthdays I’ve had, this one was truly the most rewarding. It has been my dream to do the things that I’m doing here in Queen Elizabeth Central Hospital, with my dream senior design project, and with results that I could have never imagined!

With love,

Bridget

Things that were new to me:
Making cornbread with corn flour
Malawi red sweet potatoes (which are purple if you ask me)

Things I wish I had:
Food containers
A sleeping bag for our Mt. Mulanji trip this weekend
Christmas music and movies
Christmas tree

For my parents—I promise I’m eating:
For breakfast: PB&J with banana sandwich / banana in oatmeal
For lunch: PB&J with banana sandwich / leftovers from previous dinners / chicken, rice, and stew ( I forgot the name of the restaurant) and once at Hotel Victoria
For dinner: Soup, steak, rice, beans, and fruit pie (at Prof’s house) / Vegetarian stuffing, sweet potato casserole, green beans, corn, apple sauce, roasted chicken three bean casserole, Christmas cookies, and rolls

22 July 2012

Hey all!

The internet subscription for the dongle that Kathleen and I were using has ended, so that means it’s back to busting out blogs with my 5 minute free trial at Kabula and at the hospital whenever the WIFI is not being finicky.

Friday, I met with the Electrical Technician at queens about getting a new switch for the space heater in Chatinkha. I showed him the melted/corroded switch that needed replacing and he told me to check back with him next Friday to see if he gets some in his anticipated shipment of parts.

I also fixed the 2

nd scale!!! This one was a bit more complicated than the first; I put in a new battery and it didn’t work. This one also didn’t appear to have any external defects—which meant that I had to open it up and probe around. After two days of work it turns out that the switch was faulty, so I rewired the power leads to the pounds to kilograms toggle switch…works like a charm now!

I was able to diagnose the problem with one of the suction machines in the Library; turns out that an important piece to the internal pump has broken…and I’m not able to mend it with neither Epoxy nor tape…the chances of getting a replacement part is inexistent. Sad times indeed. I’m planning on asking Professor Molyneux if I can alter some connections on one of her (unused) suction machines so that I can use the battery of the broken one for the new one that just needs a 220VAC to 12VDC converter.

And just as I was packing up for the day to leave the Library, I shocked myself with the suction machine power board that I left plugged in and exposed. That hurt just as bad as when I accidentally resting my hand on the soldering iron some weeks ago! Welp, lesson learned…don’t leave your circuit boards out while they’re being powered, and definitely don’t pick up a piece of paper that’s lying on top of it while it’s being powered.

That evening we went to Chez Maky for Sarah’s farewell dinner…I have really grown to despise eating at this restaurant; we only seem to go when someone is departing from Blantyre.

Saturday was another French toast day out on the veranda at Kabula; I was a bit of a fatty the previous night and ate the last banana, so I suffered the next morning by not having the banana with my French toast and caramelized-apples like I usually do. After we finished brunch we were off to Chileka Airport to pick up the other Rice student that would be completing our trio in Blantyre, Rahul. To think, only 7 weeks ago that was Kathleen and me arriving and Jocelyn awaiting us!

We had predetermined that Rahul was going to receive the same first day experience we’d received when we arrived in Blantyre…so after he got settled into his room we took him straight to market and all around town. We got back home before sunset, had the routine blackout, then began cooking Sarah’s surprise farewell dinner. We made her one of her favorites; Sheppard’s pie. She said it tasted exactly how she makes it at home!

After dinner I washed my last big bundle of laundry I will do here! I’ll be giving my clothes away piece by piece until the day Kathleen and I get on the plane to go back home.

This morning Kathleen and I woke up early to have breakfast with Sarah before she left; no tears this time! …At least not in front of her. After she left we went to Blantyre Community Church; one of the Bible study leaders picked us up. It was very much a Western style church, which I was not expecting; it was nice getting to see some of the friends from Bible study. Going to church today reminded me that I’m going to have to look for a new church home when I move to Indiana to start work.

When we got back went to Veg-Delight and wandering about Blantyre with Rahul. This evening we went to Gelato Carnival, which is apparently a chain of a variety of restaurants in one building, one of which sells Gelato! We were all amazed at the variety that was offered and Kathleen and I both agree that Chez Maky will not do for our farewell dinner when it comes time; we shall eat at Gelato Carnival once more! I finished my last load of laundry when we got back and what happens while I’m letting my jeans soak in the sink? –A puddle on the kitchen floor led me to discover that the water leaks from the pipes whenever you put the stopper in the drain.

I’m expecting nothing but happiness and great accomplishments on the day of my 23

rd year of life!

With love,

Bridget

Things that were new to me:
Gelato Ice Cream…um um umm!
Getting shocked

Things I wish I had:
A mop to clean up this puddle

For my parents—I promise I’m eating:
For breakfast: Toast, jam, eggs / banana in oatmeal / French toast, caramelized apples, banana, and egg
For lunch: PB&J with banana sandwich / Rahul’s pickings from Veg-Delight
For dinner: Mongolian chicken (Chez Maky) / Chilli-Cheese Fries (Gelato Carnival)

 

19 July 2012

Hey all!

Big Monday—Kathleen and I found out WE GOT FUNDING TO CONTINUE THE CPAP STUDY!!!! WOO HOO!!! I thought we were excited, when we told the CPAP nurses they were ecstatic; Florence (one of the nurses in Chatinkha) asked in confirmation “So we will get to keep our jobs?” Once I told her yes, for at least 3 years she even did a little praise dance!

After the morning checks, Sister Patrige (one of the CPAP nurses) showed me a space heater in Kangaroo Care that was broken; the switch to turn it on was burnt…when I dismounted the switch from the wall the inside looked even worse than the out. Hopefully the only problem with the heater is it needing a new switch…that would be an easy fix.

I got permission to use some of Jocelyn’s spare CPAP machine tubing to replace the disintegrated tubing inside of an oxygen concentrator I’ve been working on in the Library (a storage room that also contains a few books). Guess what folks…I FIXED THE OXYGEN CONCENTRATOR!!! This has been another one of my greatest moments working here; having the chance to reverse-engineer the inside of the concentrator…and succeeding, was a bit challenging but so much fun!

Later that day we made some more progress with finding missing study files; Dr. Laura confirmed that she had at least 2 in her possession. It was such a good Monday.

Monday evening Kathleen and I made Mexican food! It is amazing what you can do with the foods from the Blantyre Market and a mini-kitchen. We ate Spanish rice, tortillas, shredded chicken, guacamole, and brownies while we watched an episode of Modern Family. And right before I went to sleep I changed the code for the apnea monitor, so now the sensor belt is more sensitive to stretching!!! I can’t wait to show Dr. Sandi and Dr. Queen!

Tuesday Morning I got some 3V coin batteries to fix two scales in the Library. One of the scales wouldn’t measure weight because it was missing a foot, so I took some of the scrap tubing that I used to fix the oxygen concentrator the other day to make a replacement foot for the scale. Fixed 1 scale, tomorrow I shall fix the other!

I just realized that I’m finally running out of American snacks!!! I brought an entire carry on suitcase full of goodies and managed to shove one extra outfit and 2 pairs of underwear in as well just in case my check bags got lost during my travels to Blantyre…I’ve gotta make my little bit last for 12 more days.

On Wednesday I talked to the Head of the Electrical Building about the heater switch in Chatinkha; I’m beginning to notice the funny looks I get when I tell the men that work in the Electrical Building, Carpenter’s Building, and PAM (Physical Assets Maintenance) that I need parts, I’ve already diagnosed the problem with the machine, and that I can fix it myself if they don’t have time.

For the first time since I’ve been here the power went out for about 10 minutes in the hospital; I went to check in Pediatrics Special Care Ward if the babies had the nose prongs from the CPAP machine removed so they would not suffocate with no oxygen being pumped through them. Chrissy had that already taken care of; these nurses are so on top of things!

Prof. (Professor Molyneux…who is also a doctor) invited us to a Monday night dinner at her house, I’m so excited…though that means my Christmas in July birthday celebration will have to be postponed until Tuesday.

And I’m nearly done with reading Pride and Prejudice; you’re probably thinking I should be done with this book already…I really am a slow reader, but I definitely don’t read every evening.

Today we had the CPAP training for the Malaria Research Ward nurses. Kondwani led the training and Florence and Chrissy did a full-out, step-by-step demonstration. It was PHENOMENAL! These women were very engaging and naturally commanded attention as they presented; especially Florence. She did an excellent job at giving a thorough explanation of how you assemble the machine and parts, how you hook it up to the baby, and what not to do in order to avoid harming the baby. If Jocelyn was here she would be impressed.

This weekend we lose a Sarah but gain a Rahul! I’m excited and sad at the same time…but more so the former than the latter.

With love,

Bridget

Things that were new to me:
Being called Professor is a higher honor than being called Doctor; my British friend explained to me why Prof. Molyneux was called Prof. and not Dr.
Watching Definitely, Maybe

Things I wish I had:
Some sour cream and salsa

For my parents—I promise I’m eating:
For breakfast: PB&J with banana sandwich / Toast, jam, eggs / banana in oatmeal
For lunch: PB&J with banana sandwich / chicken rice and stew (Hotel Victoria) / leftovers from dinner
For dinner: Chicken noodle soup…without chicken / Stir-fried rice for dinner / Spanish rice, tortillas, shredded chicken, guacamole, and brownies

 

Last week, I had the opportunity to meet with the Tiyanjine Palliative Care clinic at Queens, building on earlier weeks’ progress in field-testing devices that aim to reduce liquid morphine dosing errors–a significant health challenge posed to such low-resource settings. In introducing the devices to the medical team, the nurses, students, and physicians were doubtlessly taken by the simple, yet substantive manner in which they profoundly changed palliative drug delivery. But this enthusiasm did not come without apprehension. No sooner had I demonstrated the technology than concerns of cost arose, even for something so simple. A similar experience was had in going over the SAPHE pads with physicians in the Ob/Gyn department.

In many ways, this back-and-forth–a delicate dance between health innovations and the resource constraints that bind them–has come to define my time at Queens. Indeed, how much is too much; to what extent is even the most medically useful technology simply out of financial reach for the hospital staff? The answer to this question is surprisingly tough to scrounge up. Because device procurement is done here in a top down fashion, by the governing board of the hospital, and over a period of many years, there appears to be little understanding of how a clinican’s need is translated into obtaining a relevant technololgy to address it. And so, too, is there great obscurity in terms of what innovations are out on the market for immediate impact. At the WHO, one of the projects I worked on was developing a “Compendium of Innovative Technologies”–a one stop, agency-reviewed guide for the latest innovations in medical care, such as the Odon Device I mentioned previously. But at least at Queens, such aids seem to be hardly realized by physicians, much less accessed.

This suggests to me that the challenge in improving healthcare technology in developing countries is as much one of diffusion as it is development. To what extent each obstacle proliferates, however, is murky. Yet the barriers each present are anything but unclear.

It is hard to believe that I have already been back in the United States for nearly a week! I am tremendously grateful for a productive and highly informative summer in Malawi. I thank my mentors—both those from Rice and the individuals with whom I worked in Malawi—for their patience, support, advice, and kindness. As I look forward to spending the coming academic year in Colombia, I want to write about a few of the wide-ranging lessons that I will take from my experiences in a low-resource setting this summer.

 

First, the tremendous constraints posed by limited staffing must be a primary consideration when pursuing projects in settings like Malawi. The WHO reports that there are only 2 doctors and 38 nurses per 100,000 Malawians. (At this rate, the city of Houston would have just 42 doctors!) This extreme shortage of medical professionals results from cost constraints, a limited national capacity to train a large volume of new staff, and of the large-scale migration of trained doctors to better-paying markets. The medical professionals that I worked with demonstrated a consistent commitment to patient care despite their overstretched schedules. Nevertheless, it was critical to understand the value—and scarcity—of our mentors’ time and ascertain whether our contributions effectively reduced the severity these challenges. In the future, the limited amount of staff time must continue to be a central consideration of Global Health Technologies design projects.

 

Second, the courtesy and respect afforded to Kamal, Teresa, and I inspired me daily. We embarked upon creating an electronic medical records system for St. Gabriel’s palliative care program within the first week of our internship in June. As we refined and adapted DataPall for St. Gabriel’s, we learned of much more widespread need for this type of patient monitoring, data management, and reporting. In July, we traveled to Queen Elizabeth Central Hospital in Blantyre to implement DataPall at Tiyanjane Clinic. The support and attention the staff in both hospitals gave us was humbling. The staff at Tiyanjane connected us with the Ministry of Health in Lilongwe who eagerly agreed to meet with us to discuss the project near the end of our stay in Malawi. The openness of all of these individuals to meet with a team of undergraduates with no obvious medical qualifications impressed me and inspired us to continue to improve and refine our product. I hope to emulate their tremendous openness and respect in my further educational and professional pursuits.

 

Finally, I would be remiss in not acknowledging the warmth of all of the Malawians that I met. Malawi certainly earns its reputation as the “warm heart of Africa.” The driver that drove us to Salima explained that Malawians know well that “a smile costs nothing.” In the face of severe daily challenges, the kindness of Malawian colleagues, friends, and strangers is astounding. I can only aspire to this level of friendliness in my everyday encounters.

 

Thank you to all that made this journey possible. I will be forever grateful for the generosity of the Beyond Traditional Borders program for a wonderful summer.

It’s been just over two weeks now that I’ve been here in Blantyre, and after overcoming a brief bout of illness, I’m eager to get as much done as possible in my remaining time. With Bridget and Kathleen returned home safe and sound, the task has been left to me to continue the work they began.

Of course, in carrying out these tasks–which ranges from managing the bCPAP clinical trial, repairing medical technologies, and everything in between–not a day has gone by here that I haven’t learned something new, or at the very least confronted a concept or custom that challenges long-held assumptions. I’m amazed, for one, at how quickly one settles into a routine–how entirely novel experiences become normal in short order, even in such a distinctly unfamiliar environment. Fraying, paper-based medical records bound by strips of yarn now present a (reluctantly) accepted standard. Similarly, that vast families quite literally live on the hospital lawns is something I now notice unperturbed.

However, perhaps what I’ve been awed by most is the ability of the staff at Queen Elizabeth Hospital to make so much out of so little–to be frugal innovators. In some cases, to be sure, this results in less-than-ideal care. But it also allows the physicians here to maximize the use of what they do have, such as with the lawn-seat-turned-wheelchair shown below.  Thousands of Malawians’ lives depend on this makeshift ingenuity–and so, too, might the broader goal of making health technologies accessible in such low-resource settings.