A couple weeks ago, the interns and I spent a great weekend in Liwande, where just outside of our sleeping area was this MASSIVE and very beautiful Baobab tree. In Africa, many people consider baobabs the “tree of life” given how useful their fruits, bark, and general existence is to many humans, animals, and insects alike. They are among some of the largest trees in the world and can only be found in Madagascar and a few African countries, with a few species that exist in Australia. You might even recognize baobabs as the tree from the Lion King, in which wise baboon Rafiki lives! Basically, it’s a pretty neat kind of tree.

 Baobab in the Lion King!

The first time I had ever heard about the baobab tree was when I read the Little Prince by Antoine Saint Exupéry as kid. The significance of the chapter didn’t really resonate with me until a few years later after having to reread the book. But, on a very superficial level, I can still distinctly remember staring for HOURS at the funny little baobab book illustration, thinking about how much I’d like to see such a unique, monstrous tree in real life. So, when I finally had the chance to sit at the base of one of these incredible baobab trunks, I could barely contain my happiness and excitement.

 The Baobab tree in Liwande     Baobab drawing from Le Petit Prince

Now, bear with me for a second, I promise I’m not just writing about some kind of strange fascination with a particular genus of tree! I’ve been thinking a lot about these baobabs and the Little Prince chapter lately, not because we see baobab trees and baobab products everywhere, but mostly because of what the trees represented in that one extremely short chapter. Their symbolism in the Little Prince, I think, ties nicely to my internship experience with BTB over the past few weeks.

To summarize, in the book, the little prince — who lives in a tiny, tiny little planet — views baobabs trees as these terrible, destructive forces of nature that have the potential to wreck havoc on his planet if left to grow to their full size. In order to address this possibly, and quite literally, enormous problem, the prince is very careful to uproot the little baobabs bushes the minute he recognizes them for what they are. He has a conversation with the author about how before the baobabs reach their huge size, that they naturally have to start off really small — almost invisibly– as seeds. He knows that by staying disciplined and constantly addressing this problem even before it has begun, he will be able to protect his beautiful home (and precious rose) from being overwrought by the trees’ massive roots.

You can read the entire chapter that talks about the baobabs here: http://www.angelfire.com/hi/littleprince/framechapter5.html

The baobab chapter’s “life takeaways”, to me, seem to tie into the type of work that we’ve been doing here in Malawi, mainly when it comes to the importance of 1) preventive maintenance in up keeping the hospital’s medical equipment 2) routine and consistency in enacting long term change, and 3) an underlying sense of urgency to drive even the most monotonous and seemingly insignificant tasks forward,.

Preventive Maintenance

 Whether it’s after you’ve bought you first car, or if you’re talking about about dental hygiene or healthcare or whatever, you’ve probably heard about the importance of preventive maintenance. Countless studies can demonstrate the cost benefit of preventive measures to avoid problems with your car engine or a disease like diabetes, and it comes as no surprise that if you can avoid a problem from occurring in the first place, you’re in a much better situation than if you were to have to treat the issue once it’s occurred.

So, basically, like the nearly invisible baobab seeds, preventive maintenance is something that is extremely easy to overlook, especially here in Malawi, when I can see that there are so many extremely pressing matters that need to be tended to around the hospital every single day.

Particularly when working with PAM and in the CPAP office when equipment gets brought in from not just Queens but from some of the district hospitals, it is especially frustrating to seeing broken pieces of equipment that could have easily lasted a few more years if only there had been someone to effectively maintain the device within the clinics.

Just look at the picture below where we had no choice but to replace the grey filter on the left for a new, white one, just because it had gotten so dirty that I was no longer salvageable. (Also, the picture of the filter here is not even CLOSE to how dirty it used to be! Caleb had literally scooped off physical clumps of dirt and grime that had been stuck to the outside). Essentially, a tiny, literally 30-second job of cleaning the gross particle or inlet particle filters about once or twice a month, could literally have prevented the oxygen concentrators from experiencing a significant number of the larger issues due to debris and dust collection within the sieve beds and compressor.

 Dirty Filter

There is a lot of value in taking measures to avoid problems from occurring in the first place. Essentially, by taking a leaf out of the prince’s book by ensuring that we stop these baobabs brushes from growing into the massive problems that they are, we can tackle a lot of challenges even before they’ve turned into actual trees.

 Fixing the dirty oxygen concentrator

Sustainability

The baobab chapter also makes me think about many of issues with sustainability with the CPAP project, most of which Carissa and Aakash already touched on in their blogs not too long ago. Through their travel experiences, they talked about the challenges with getting CPAP to really “stick” within the hospitals that they visited. The CPAP is currently not the “go-to” therapy for preemies with respiratory problems, and there are a lot of barriers to ensuring that this new technology be accepted and smoothly incorporated into the regular hospital pediatric protocol.

Namely, I believe that the CPAP or any new technology, medicine, or protocol has to become a natural as part of a hospital’s “morning toilet” as our dear little prince would call it. It is ultimately routine, an understanding of the need for the technology, and a familiarity with the equipment that is going to drive life-saving changes around the hospital.

And through the many tech surveys that Emily and I have had the chance to do together over the past few weeks, if there’s one thing I’ve learned, it is basically that the nurses run the show at Queens! Therefore, if a technology isn’t well received by them, if the nurses aren’t trained to use it properly, or if they don’t understand the need for a particular device or protocol, the change just isn’t going to happen! Nurses are the soldiers that are in clinic day in and day out and are undoubtedly the people who will be using these new technologies once they’ve been introduced. So if the training, education, and positive “attitude” towards the technology isn’t there, the nurses will never be willing or able to develop a sense of routine and familiarity with the device, and the technology will flop.

It is the prince’s habit of checking for the baobab brushes (initiated and sustained by his knowledge of the importance of catching baobabs early and ability to use a shovel) that ensures the safety and health of his home from the baobabs, in the same way that the nurses habits at Queens have the potential to do the same.

Sense of urgency and necessity

The last “life takeaway” about the importance of a sense of urgency in driving change seems kind of like a stretch, so I thought I’d include a snippet of the chapter for you to read before I go any further.

Perhaps you will ask me, “Why are there no other drawing in this book as magnificent and impressive as this drawing of the baobabs?”

The reply is simple. I have tried. But with the others I have not been successful. When I made the drawing of the baobabs I was carried beyond myself by the inspiring force of urgent necessity.

I included the illustration of the baobabs within Le Petit Prince earlier in the post, and it is undoubtedly one of the best drawings in the entire book. Naturally, the author takes the time to mention how his best work was propelled forward through a sense of responsibility, obligation, urgency to get it out there, and I believe that those are really important things in driving sustainable change forward.

With regards to the CPAP, I think that an underlying sense of urgency and understanding of the potential for device to save the lives of premature infants has to be there for the project to be a success. I believe that this sense of importance can certainly be instilled through doing a good job with presenting the evidence and the numbers that show that “hey this technology really needed and it WORKS!”. But perhaps more importantly, I think this sense of urgency should be translated to a sense of responsibility and determination among the people putting the device to work, to help them push through the massive frustrations, roadblocks, and even heartache, that come with working in this field and setting.

In short, baobabs or global health projects, even as massive as they are in their full form, have to start small, almost invisibly, and the changes that ultimately help them die or thrive, are equally as tiny and long term.

And to wrap up this blog post, just in case you didn’t catch on how incrreeddiiibbbllleee I find these trees, I’ve added a lovely picture that Carissa took with the African sunset in the background. Unreal.