I’ve spent many hours in nurseries and maternity wards across Malawi these past two weeks, traveling to nearly ten different hospitals with Shannon, Carol, German, and Carissa to collect data on the hospitals’ use of CPAP. At the risk of sounding trite, I return to Blantyre humbled and in awe: the nurses and doctors I met have seen and learned to deal with countless problems, treating babies diagnosed with everything from sepsis to birth asphyxia to severe arrhythmia, often without the proper tools. It felt wrong, almost inconsiderate, to see how they could do better.

But at many of the hospitals we visited, few babies were being put on CPAP, despite having symptoms that provided a clear mandate to do so. Walking into the nursery at one hospital, I could see the CPAP machines tucked into a corner, untouched. The nurses knew about the machine, however, and even about its benefits. They pointed us to the extra supplies and helped us find the patient records that gave us information about its use. And, as I mentioned earlier, the nurses and doctors were clearly not lazy. Everything, from the hours they put in to the conditions they endure demonstrate how much they care. So why in the world weren’t the CPAPs being used?

We hear a lot about how technology can solve all of our problems. Nearly every start-up company, whether they have developed a low-cost diagnostics tool for HIV or have built an app that erases photos five seconds after being seen, proclaims that they are in the business of “changing-the-world.” But often, and especially in the developing world, just having the technology does not guarantee better results: the CPAP is only one example. Even educating the nurses and doctors about its use does not guarantee success, as I’ve seen these past couple weeks. Unfortunately, real solutions to these problems do not go viral.

So what can we do? One thing is to stop making general statements for the hospitals. While some hospitals were struggling, others were doing extraordinarily well. And even at the hospitals that struggled, many have different problems. One had frequent power outages that interrupted continuity and created more pressing problems. Another had just gone through a staff rotation. We need to look at each hospital individually and not expect a one-size-fits-all solution.

Another thing is to build better relationships with more of the nurses. During our monthly visits to each hospital, we meet with one doctor or nurse, appointed the “CPAP coordinator” for that hospital. We come in, check the equipment, count the supplies, record the data, and then leave. If our coordinator isn’t there, few others know who we are. We are strangers.

We hope that by building better relationships with more of the nurses, we will give them more ownership over the CPAP project by making them more involved. Right now we collect data and give some criticism to a few people. We’re the faceless administrators from the outside that come and give directions. The more people we involve, the more, we hope, they will understand our mission and feel a part of it themselves.

We also hope to bring the CPAP coordinators from all the hospitals together for a day to discuss best practices, hopefully motivating each coordinator to have his/her hospital perform as well as all the others.

These solutions will take time. There is no quick fix. There is no “app for that.” But despite seeming otherwise, these laborious, individualized solutions are the only way for the CPAP project to be scalable in the long-run.