We have entered the implementation phase of the CPAP Clinical Trial! Previously, we have been collecting data at 8 hospitals around Malawi for baseline data to see what kind of respiratory problems are affecting neonates and their survival rates with treatment on oxygen. Starting this week MK and Jocelyn along with the rest of the CPAP team will be training nurses, clinical officers, and doctors when and how to use the bCPAP and be bringing the bCPAPs to each of the hospitals that have received training. Training/implementation will continue over the next few months until all 8 hospitals have staff trained and equipment at their site. With the bCPAP, we are also bringing a lot of other equipment including a suction machine, an oxygen concentrators, nasal prongs, suction catheters, OG feeding tubes, and a cart to organize all the machines and supplies.

Monday + Tuesday = Training

This week we trained three nurses and clinical officers from Zomba, Machinga and Mwanza. Monday morning, we arrived extra early to set-up for training, and then we sat there anxiously hoping that trainees would actually arrive. This was the first week so we were all a bit nervous. Training ended up going very well and by the end of the second day, I think the trainees had really understood what they had learned and were ready to teach others back at their respective hospitals.

  

  

Wednesday + Thursday = Implementation at Zomba

On Wednesday, Jocelyn, MK, two CPAP nurses, Sam and I hauled two carloads of equipment, including 4 bCPAPs, 2 wooden carts, 2 suction machines, and an oxygen concentrator through bumpy dirt roads to Zomba Central Hospital. When we first arrived one of the trainees came out to meet with us. About 15 minutes later, a dozen other people showed up all very excited to see new equipment. They were so excited that they demanded a photo in the parking lot before we even got a chance to move the equipment in.

  

We put these carts into the ward and all the nurses started crowding around to see this new machine. As we were setting up one of the carts, a nurse had asked me about what we were doing. I explained to her about the CPAP project and she asked if the CPAP was going to be brought to the rest of Africa. I told her just Malawi. She smiled with gratitude and said “We are very lucky then.”

Throughout the morning I was walking around the hospital to get things set up. And I one point I returned to the nursery and found that a giant crowd of nurses were all crammed into the already crowded nursery to watch of a demonstration of how the bCPAP works from our nurse Florence. It was great to see the enthusiasm and interest that everyone had. And then when we were heading out, I peaked around the corner and saw that at the nursing station, they had set up an assembly line to make the stockinette hats! I’m really excited for Zomba to have these bCPAPs and I can’t wait until they start using them.

Reflections from the Week

Working day to day here, I feel like I don’t really think about the big picture impact that the CPAP project truly has. But this week through training and implementation I have such an appreciation for everyone who is making this happen. I don’t even know everyone who is involved but just to show how many people and different institutions this takes, I am going to try and list the key players.

• Queen Elizabeth Central Hospital: First hospital to use bCPAP, and where the clinical trial last year was done to show the effectiveness of bCPAP. Also, many doctors and nurses from QECH are involved in training people from the other hospitals.
• Malawi College of Medicine: Where the CPAP project idea was first conceived.
• Texas Children’s Hospital
• Malawi Ministry of Health: Norman and Alfred who are helping us collect data through their ARI (Acute Respiratory Infections?) Program
• District and Central Hospitals around Malawi: They have been collecting baseline data and are now starting to send trainees on how to use bCPAP
• Rice University: Dr. Richards-Kortum and Dr. Oden are spearheading the project from Texas. MK and Jocelyn have been amazing at coordinating the entire study here on the ground and making this actually happen.

From what the nurse at Zomba said, I truly think Malawi is a very lucky place to be able to receive these CPAPs. Oxygen has been the most that majority of Sub-Saharan Africa could offer to babies with respiratory problems. Now with the bCPAP in Malawi, babies with respiratory distress will have a better chance of surviving. From helping out these last few weeks, I have experienced first-hand the complexity and level of difficulty that this project truly is. But we are all very lucky to have so many people who are so passionate and dedicated to making this CPAP project happen. Congrats to everyone on the first successful week of implementation and training!