Thyolo and Mulanje District Hospitals

What an incredible first week in Blantyre it has been!!

On Tuesday, I had the chance to travel with Shannon and Caroline to Thyolo and Mulanje District Hospitals and learn a bit more about how they carry out their CPAP data collection. Thyolo was the first clinic that we visited in the morning, and never before have I seen such a beautiful hospital! The walls are a stunning shade of clay-red that stands in awesome contrast to the green, green, green of its surroundings. I didn’t feel comfortable whipping out a camera and taking pictures, so I don’t have one for you here, but you can just google some images of it online if you want to see it. Here’s a pretty good link: http://www.sydellewillowsmith.com/photography/msf-in-malawi/sws_thyolodistricthospital_msf_malawi20131010_0014.jpg/

Since it was really only my second day on the job, I spent the majority of my time observing Shannon and Caroline doing all the heavy lifting. We went through a number of the pink data collection forms that are currently being used to record the heath outcomes out neonates who are eligible to be put on CPAP. We wanted to ensure that the baseline information that was being collected at Thyolo was thorough and accurate, and we spent some time talking to a few nurses in the various wards to try to track down any missing data. Thyolo District Hospital is one of the clinics has not yet started using any of the CPAP machines, as collecting this baseline data has proven really difficult so far. The problem with trying to get all this information can’t really be attributed to just one specific thing, but rather is impacted by many little different things that build on one another. Most notably, the lack of functional oxygen concentrators in many of the wards forces patients to be transferred from department to department in search of the sole functioning device in the hospital. This jumping around from Labor and Delivery ward, to Maternity, and then Peds and then back again, is problematic due to difficulties in coordinating and communicating between the various wards of the clinic. So, tracking down these CPAP-eligible patients and properly documenting their progress from enrollment to discharge is far from perfect. Training staff to properly collect this data on the specified CPAP study forms is already difficult even just within one ward due to the enormous amount of staff rotation that occurs in Malawi. Working between different wards multiplies this challenge ten-fold.

To start addressing the problems with data collection at this clinic, we suggested that the first step would be to get a new functional oxygen concentrator within the nursery/pediatric ward, or at least to work with PAM to bring the failing ones into service once again. Then, it would be useful to re-train any nurses or coordinators within the department to properly record the relevant neonate information. Getting all these pieces into place will obviously take some time, resources, and patience, but after seeing how much the nurses, doctors, coordinators, and everyone at the hospital care about their patients, I am hopeful. We plan on re-visiting Thyolo in about a month.

At the Mulanje clinic, I was happy to see two CPAP machines being put to use, with a functioning oxygen concentrator right next to them. While I was there, I showed the CPAP repair video to two PAM personnel and answered their questions about the CPAP machine. This week, Caleb and I plan on starting to develop a CPAP and oxygen concentrator step-by-step repair manual with all of the major/most common breaks, which can hopefully serve as another useful resource to future PAM members at the CPAP clinics.

CPAP machines at Mulanje

As for the rest of the week, Carissa, Caleb, and I have spent a good amount of time fixing the broken CPAP machines that are sitting in the BTB office. And at the Poly, we have even been assigned a design project! Rodwell, one of our supervisors, asked us to design a stand for the phototherapy lights he has developed. The phototherapy lights are great, and Rodwell took us through his designs and everything and even let us take the lights apart to get a better look inside. An ENG 120 team last year developed some kind of stand for some phototherapy lights last year, which is actually being used at Queens currently. However, there are issues with transporting this 3-fold steel stand design from bedside to bedside. Also, since the lights Rodweel designed are about double the weight of the current ones, we came up with a new IV-pole-esque design entirely, which we plan on prototyping in the next few weeks.

Rodwell’s Phototherapy Lights Carissa fixing CPAPs!

On a more fun note, we have been eating lots of yummy things (including full loafs of bread at a time, and fried dough balls- which costs 40 cents and 4 cents respectively), and keeping active! Our team has decided to do “Insanity” workouts together to stay in shape, and on Saturday we climbed a mountain with two of our friends Alex and Jonathan. This summer is off to a great start and I can’t wait for all the amazing work and fun times ahead.