Renata: Well, we’ve just finished off our Friday work, meaning that Nkechi and I have spent exactly a week working at St. Gabriel’s.

 

You: Well golly gee, a week sure is a long time.

 

(this role may also be played by your 1950s children’s show counterpart in the unlikely event that you do not regularly use the phrase “golly gee”)

 

You: Surely you’re well on your way to saving St. Gabe’s, Namitando, Malawi, and all of Africa.

 

Renata: …

 

Okay, so I might have exaggerated your parts in this script just a little. At least I hope you know I’m hyperbolizing, because that would be the overstatement of the CENTURY! It’s just that, exaggerations aside, we’re taking dialogue from the wrong part of the script. What’s happening now is more like Act 1 of my work.

 

Don’t get me wrong; I’m very proud of the steps that we’ve taken towards achieving our objectives this week. Just this afternoon, I experienced the tremendous joy of fixing one of the functions in Morphine Tracker, a database that allows the hospital’s palliative and home-based care program to have an up-to-date record of how many patients are on this Schedule II controlled substance (1) (2) (check out interns Joao (3) and Jesal (4) ‘s blogs from last summer, which do a great job of explaining the importance of morphine records for palliative care in sub-Saharan Africa). My fix was a minor one, but to anyone who knows how truly awful I am at coding, it was just shy of a miracle. (This is the point where the BTB staff is probably cringing at the realization of my technological incompetence)

 

I’m also really happy with how our tech surveys have gone so far. Earlier this week, we brought a respiratory rate timer and binary thermometer to the paediatric ward, where they were put the under intense scrutiny of the nursing staff and the patients’ mothers.

 

The respiratory rate timer is an electronic device that assists clinicians in diagnosing pneumonia, a major cause of morbidity and mortality among children under 5. Once diagnosed, the young patients can be continually monitored, receive antibiotics to treat the infection in the lungs, and can receive supplemental oxygen from one of St. Gabriel’s many O2 concentrators (more on this to come). What’s handy is that there’s a reliable predictor of pneumonia. If a child exhibits tachypnea (abnormally rapid breathing)(5), it indicates pneumonia with 50-85% sensitivity and 70-90% specificity (6). In other words, those are pretty good odds that the child is indeed sick with pneumonia.

 

But there’s a catch.

Making the diagnosis requires careful scrutiny and an accurate calculation of their breathing rate, which is much harder than walking and chewing gum at the same time (7). Think more along the lines of paying careful attention to minute risings and fallings of an infant’s rib cage, doing mental math, and keeping an eye on the clock.

That’s where the respiratory rate timer comes in, keeping track of breaths and making rate calculations for the heath care workers. Seeing the timer develop over this past semester in GLHT 360 (shout out to Nkechi’s team) was pretty cool, but seeing the nurses lay hands on it was something else entirely! Their competence, their enthusiasm, and their honesty were an overwhelming combination (in the best of ways). Similarly, getting to talk to mothers who would potentially use BTB’s binary thermometers really put the device in perspective.

 

It’s definitely a small start, but I’m glad to be fully entrenched in Act 1. Because at the moment, perhaps even more important than my official tasks are the relationships I’m forming- the incredible people I’m meeting, the scene that’s set before me in the form of St. Gabe’s. I think of it as the exposition, the fleshing out of these characters. We’re starting to get glimpses of the motives and relationships that are really going to advance our plotline. This is the time when I start to understand how the hospital works, and with any luck, how BTB can partner to improve quality of life for patients at St. Gabe’s. This is still just the beginning, and I invite you to grab some popcorn (8) and watch to see how the rest unfolds.

Tionana! (see you later!

P.S. As you may be wondering, I intended to post this on Friday, but had to wait until we got Internet from Lilongwe to post. That being said, I’m looking forward to staying up to date with the Blackhawk’s likely Stanley Cup victory tomorrow (GO HAWKS!!!), and you should be on the lookout for another blog post on what I see as a really fun topic in the next few days.

 

(1). From http://www.deadiversion.usdoj.gov/schedules/

(2). Only tangentially related, but given the technology focus of this internship, II had to share an interesting development for pharmacological tech: http://www.bbc.com/news/health-32780624

(3) . http://malawi.blogs.rice.edu/2014/07/28/morphine-tracker/

(4). http://malawi.blogs.rice.edu/2014/07/10/palliative-care-morphine-dosing-system/

(5). From http://www.nlm.nih.gov/medlineplus/ency/article/007233.htm

(6).From Samin S. Shah’s Blueprints in Pediatric Infectious Diseases, pgs 64-66, ISBN 1-4051-0402-3. It’s a fantastic read. Seriously.

(7). Terrible example, I know, but hopefully you understand.

(8). Sorry for the corny line. Wait, no I’m not.