A few common refrains in the world of development-focused, service-minded people include “making a mark” and “creating change in the community” and “impacting individuals”. These alliterative idioms may sound attractive, but they encompass a dangerous mindset. Beginning a two month internship with the goal of changing things would have prevented me from being able to learn from, adapt to, and understand the cultural, social, economic, and health contexts that I was about to be immersed in. Reflecting back on this experience, though, I have to admit that marks have been made, so this post is a catalog of the scars, bumps, bruises, and more that I’ll leave Malawi with.

Stubbed toes and hole-ridden shoes

I am by no means the most graceful person, as any of the other interns can attest. The uneven ground around Blantyre often had me tripping around the city as I took in the sights. I had less of an excuse for my clumsiness at Queens. My interest in peering into wards and out through windows often led me into walls and doors, causing me to stub several toes in the process. There were too many colors, smells, sounds, and sights for me to watch where I was going (or at least that’s what I say to save face). By the end of the internship, I was much better at walking the familiar routes in the hospital. I’m going to miss the long walk between the CPAP Office and Chatinkha Nursery, which we sometimes took several times a day. It was probably this trek more than anything that created and widened the ever-growing hole in my shoes.

Papercuts from folder-making

Making folders for the maternity ward was one of the smallest but most rewarding things we did. We noticed early on that the ward needed chart holders, which led to several hours of hand-lamination that left me with some pretty painful papercuts. The best part was being able to follow up on how the chart holders were doing. The nurses and doctors in the ward often recognized us as the “yellow-folder girls” and always welcomed us back with huge smiles and excited chatter about how they were using the chart holders. It was great to see the effect such a small project had on the ward. Don’t get me wrong. We didn’t change lives or make an impact in the traditional sense, but we did make the jobs of clinicians in the ward just a little bit easier. Earning their smiles, interest, and excitement was a great reward.

A semi-permanent dust tan

My personal project during this internship was to learn more about the supply chain of medical devices as it related to the Ministry of Health, Physical Assets Management, the Department of Procurement, and QECH. The best part of the project was being able to talk to a wide variety of people for my research. From contacts in the MoH in Lilongwe to officials at QECH, I talked to a diverse range of people who were extremely welcoming and willing to answer my litany of questions with the utmost honesty. Last Friday, I got to run around Blantyre between QECH, the College of Medicine, PAM, and copyshops as I asked some of my final questions. It left me exhausted, excited, and covered in a fine layer of dust from traipsing across the city.

Scars from playing soccer at Lake Malawi

Visiting Lake Malawi was probably the pinnacle of our cultural immersion in Malawi. We travelled up with the Malawian interns and did everything typically Malawian: eating Kampango (or butterfish), learning to play Bawo (our new favorite game), speaking Chichewa with the villagers. On the rocky shores of the lake, there were roving bands of children (and I do literally mean bands), who played us ridiculous and infectious versions of “Who Let the Dogs Out” and other classics. At one point, we invited the children to an impromptu soccer game (barefoot, of course) which left me with scars all along my feet.

In the end, Malawi probably made more marks on me than vice versa. I’ve learned and experienced more in these two months than I could have ever hoped. I come away with more knowledge about Malawi, a renewed respect for the healthcare professionals who work tirelessly in low-resource settings, and an appreciation for the complexities and challenges of the healthcare system itself. Nearly every intern blog from previous years has ended with a “Tionana” (“see you later” in Chichewa), and I definitely understand that sentiment. I don’t want this internship to be a one-off experience. I want to come back to Malawi, to low-resource health settings, to other countries so I can learn more and do more. I’m not out to make my mark on the world, but rather I want to be marked by my travels, experiences, and knowledge so I can be an advocate for and an agent of sustainable change.

Jaundice is something that affects a lot of the babies born in Queens. Especially in preterm babies, the levels of bilirubin (the pigment that causes the trademark yellow tint of jaundice), are usually a little elevated. Generally, these babies do not need treatment since they will naturally adjust back to normal levels. However, in babies with severe jaundice, the threat of brain damage necessitates treatment with phototherapy lights, which break down bilirubin.

In the past few weeks, Karen and I have gotten a chance to work a lot more closely with the nurses and babies in Chatinkha Nursery on a project involving jaundice. The Poly Interns recently helped fix a broken bilirubinometer (a diagnostic machine that shows the bilirubin levels in the blood). Our first project was to test it’s accuracy against the working Chatinkha bilimeter. The second part of our project involved the diagnosis of jaundice through visual assessment. Chatinkha has a working bilimeter that gives nurses an accurate readout of how severely jaundiced a baby is. In the district hospitals, however, bilimeters are often unavailable. This is why some doctors at Queens are trying to teach nurses about Kramer Scores. The Kramer Score is an old technique to estimate the severity of jaundice by looking at how far down the body the line of jaundice has progressed:

By palpating the skin on the forehead, nose, arms, legs, and chest, the nurse will be able to tell which areas of the baby are affected. Using the chart above, they can then estimate bilirubin levels. We worked with nurses these past few weeks in order to get them to estimate the bilirubin levels of babies without any Kramer Score training. What we found was that nurses were fairly good at telling which babies had jaundice. However, when it came to assessing the severity of the jaundice, they had problems. It is very possible that Kramer Score training will help nurses make better diagnoses when they do not have access to a bilimeter.

Bilirubinometer Readout
Though there is definitely a need for cheaper and better technologies (ex. bilimeter, phototherapy lights), this example also proves that training and education can be an important first step to bridging gaps in healthcare provision. Though neither technology nor education is a magic bullet that will work overnight, in combination they can be very effective. Teaching nurses about how to identify jaundice without technology creates a sustainable way for them to be able to assess patients even if they lack access to technology. Meanwhile, building low-cost technlologies addresses longer-term issues of improving healthcare capabilities and infrastructure even in low-resource settings.

Malawi is an incredibly beautiful country and we were lucky enough to be able to sample some of its natural beauty through weekend trips. Its stunning mountains, rolling greenery, and diverse wildlife can be seen nearly everywhere. A thirty minute drive from Blantyre led us to Mount Mulanje, a massive collection of 21 peaks (one of which we then attempted to climb–something Sarah and I are still recovering from). A little farther away was Satemwa, a tea plantation that sported low hills covered in lime green tea plants.

The View from Mulanje

Dusk at Satemwa

One of our favorite trips took us to Liwonde on a boat safari where we watched hippos and elephants frolic under a melting sunset sky. It was a peaceful  Finally, there was the trip to Lake Malawi, the countries biggest tourist attraction, with the Malawian interns at the Poly.

Elephants at Sunset

Sunrise at the Lake

Natural beauty, though, is not always appreciated and maintained. Our weekend trips often took us to places removed from heavy human contact. There were definitely people living in villages and towns near Mulanje, Satemwa, Liwonde, and Lake Malawi, but their lifestyles were simple enough that the nature around them remained pristine. The situation is completely different in Blantyre, a city where people are crammed together in small spaces and have to use products that are packaged and processed rather than relying on their subsistence farms. Here, trash often litters the streets and the sight of plastic bags and cartons thrown in nearby creeks or gutters is not uncommon. It’s quite the public health problem, especially when families use creeks as water sources to wash dishes, do laundry, or even cook food.

Trash in the Market Creek

The Malawian government, like several others in Africa (1) (2) (3), has started to take measures to combat the pollution. In the two months we have been here, the government has passed legislation that prevents plastic bags from being less than 35 microns thick. Grocery stores now charge 20 to 40 kwacha for a plastic bag, a small price to pay, but ultimately something that could begin to make Malawians more conscious of their choices. In the short run, this will hopefully make places like the Market Creek safer and cleaner. In the long run, this is a progressive step by the government towards fixing environmental factors and practices that can endanger public health.

So let’s say you’re reading this blog. Let’s say that you’re maybe even enjoying it. OK, maybe not MY blog specifically- this one person’s opinion based on a singular experience working on technologies for global health. But perhaps more realistically, let’s say that the topic of one of my posts tickles your fancy. You want to learn more about development and healthcare and Malawi. Now what?

 

Well, when curiosity strikes, my recommendation is almost always to go read a book, and this is certainly no exception! I tend to devour books on development and healthcare in low resource settings, and public health. Before I left, I got a little… inspired. Okay, so I went a bit crazy on the books. But that’s to your benefit now, because I am armed to the teeth with suggestions. The following are all titles that I’ve read during my evenings and plane rides here in Malawi. So look no further! Here’s my suggestion list for anyone who wants to learn more about Africa (especially Malawi), global health, and/or epidemiology:

 

Poor Economics by Abhijit Banerjee and Ester Duflo

Poor Economics is probably my favorite book that I’ve gotten the chance to read here in Malawi. It causes us to radically rethink several of the most common development tropes, such as microfinance and free provision of public health infrastructure like malaria nets. It also allows us to consider decisions that the poor make from their own perspective- actually taking the time to ask people why they are or are not willing to make changes to their lives, even if in the long haul, those changes will be beneficial. The section on nutrition I found particularly interesting- it turns out that once people move out of abject poverty, they don’t actually use it to buy more foods that are healthier or the most calorically dense (the most bang for their buck, as it were). Instead, people move towards more expensive, better tasting calories: things that make them happier! Although this very much a research book, it has a sharp personal slant. Banerjee and Duflo remind us that this nameless group we call ‘the poor’ are individuals with goals and thoughts and personalities. They remind us that although people’s decisions may appear backward from the outside, they have a logical grounding in helping people achieve their dreams.

 

The Boy Who Harnessed the Wind by William Kamkwamba

William Kamkwamba gained fame as the self-taught Malawian inventor who built a windmill to power his family farm. He has a great TED talk that you can watch here:

http://www.ted.com/talks/william_kamkwamba_how_i_harnessed_the_wind?language=en. But if that wasn’t enough to blow you away, his book is enthralling. Threaded with his trademark humility, Kamkwamba also gives insight into everyday Malawian life. This is where I learned that “bo” and “sharp” are casual greetings for friends or children. This is where I first heard about the terrifying native dancers who harass people on the streets and are rumored to steal children- and then a painted troop of them was in Namitando last weekend. It also gives perspective on the power of agriculture in dictating people’s futures: in Kamkwamba’s telling, a famine had power to not only push their family near starvation, but prevent William from attending school and tear apart the village’s society at the seams. This is a quick read, an uplifting story, and a great perspective into life in rural Malawi.

 

The Bright Continent by Dayo Olopade

This book is for the optimists. The basic premise is that we hear so much about outsiders coming in to ‘fix’ Africa; however, Africans aren’t just sitting around waiting to be rescued by foreigners. Olopade examines innovations that are occurring both through formal programs and the informal economy within Africa. It celebrates the leaders within education, healthcare, technology, and youth development. It also celebrates “kanju”, a sort of defiant libertarian spirit of innovation that can be found among average people anywhere on the African continent. I’d say that you should pick up The Bright Continent if you want to change the record- if you’re tired of the same old same dog and pony show, and you want a new perspective on true forward momentum in Africa.

 

HIV/AIDS in Africa: Beyond Epidemiology ed. by Ezkiel Kalipeni, Susan Craddock, Joseph R. Oppong, and Jayati Gosch

So this is an anthology that examines pretty much exactly what the title would lead you to believe. Each chapter explores a different facet of the complex relationships between culture and the HIV virus. Even if you’re not into the idea of reading the entire book, you can easily glean some valuable takeaways from a chapter or two. First, many of the chapters are regionally specific, which serves as a great reminder of Africa’s cultural and historical heterogeneity. What’s especially great is that they have an entire chapter on how various definitions of ‘traditional values’ in Malawi have influenced the virus’ progression. This is also a book that isn’t afraid to speak about historical and political shortcomings, from colonialism to government denial of the AIDs crisis in the 1980s. Woven throughout are stories of local customs, traditional health practices, and tribal affiliations that cross the continent in defiance of national borders. This book is for you if you’re interested in discovering how truly complex healthcare in African nations can be.

 

The Hot Zone by Richard Preston

One of the things that surprised me the most about flying into Malawi was the presence of thermal imaging technology and Ebola warning posters, both in South Africa and in Lilongwe. Why would they have such stringent security towards the end of an epidemic in a region where cases hadn’t been reported?!?

After reading the Hot Zone, I understood why. In detailing the events of an outbreak of Marburg (a close cousin of the Ebola virus wreaking havoc in western Africa), Preston gets fairly graphic. By the middle of the book, you have a decent understanding of how the virus spread, an idea of governmental efforts to contain it, and a strong sense that you should never ever mess around with this virus.

The great thing about the Hot Zone is that although the events are true- and provide keen perspective on intersections between epidemiology and government policy- it reads like a novel. The scenario is like a train wreck, and you can’t hope to look away until you find out how the outbreak is suppressed. If you’re interested in epidemiology, but just want to get your toes wet, this is your book. If you don’t know that much about the current Ebola crisis, this may be a good way to get started. And if you would like to learn how health in developing nations could influence the world at home, you will probably enjoy the Hot Zone.

 

Development as Freedom by Amartya Sen

Amartya Sen‘s work is quite cerebral (he DID win the Nobel Prize in Economics), but worth a look if you are willing to dive in. He takes what often seems like the sterile aloofness of economic policy and turns it on its head, defining international development in terms of the humanizing and logical idea of enhancing people’s freedoms. His main thesis is that improving individual freedoms is both the end goal and a major tool of development. On one hand, it encourages critical thought about development- a topic that all too often has its flaws glossed over in the name of ‘doing good’. On the other hand, it’s quite empowering, especially for people who have seen or heard of the many ways in which development efforts can fail. Sen tells us that improving the lives of the world’s disadvantaged individuals can be accomplished, as long as we are setting our sights on the correct goals.

 

Pediatric Infectious Diseases by Samir S. Shah

This is the kind of book that made me feel woefully inadequate while reading it, but it seems to have potential as a primer for the basics of infectious disease management in children. It’s arranged by system, giving a good opportunity to move through potential causes of illness systematically. It gives an overview of epidemiology, symptoms, treatment, and common co-morbidities and complications. Many diseases share symptoms, making it challenging to recognize the correct ailment. However, as the warnings peppered throughout the chapters indicate, failure can have devastating consequences, as children prove most vulnerable to illnesses that might hardly faze an adult. Just thumbing through it can be enough to give an idea of how challenging the treatment of infectious diseases can be in children. It also encourages our pursuit of pediatric medical technologies focused on diagnosis (such as the respiratory rate timer) and treatment (such as the bCPAP heater), as making a positive impact for these most vulnerable patients could prove to have tremendous payouts in terms of reducing mortality.

 

Honorable Mention: Twelve Diseases That Changed Our World by Irwin W. Sherman

This one has been relegated to a separate category because I didn’t read it in Malawi, and it seemed like adding it to the list would be cheating. However, this is an incredible work that makes epidemiology accessible to the masses. Exploring everything from hemophilia to cholera, the book takes you through how various epidemics have influenced history and modern events. Although the entire book is a great read, the chapters on cholera, malaria, TB, and HIV/AIDs are particularly important to modern Sub-Saharan Africa. Malaria and HIV especially a large number of patients at St. Gabriel’s each day, and coming to understand these maladies better can only contribute to an increased ability to combat them. I think this is a good option for people who are interested in the social and political context for global health; it definitely keeps the big picture in mind, while also giving a decent overview of the science behind the illnesses.

 

Honorable Mention: Being Mortal by Atul Gawande

Again, this book has only been demoted because I didn’t read it in Malawi. If you’ve never read Atul Gawande, I kindly suggest that you start. Immediately.
Being Mortal is particularly relevant to the work that we’ve been doing with the palliative care ward at the hospital. Although Gawande’s work doesn’t focus on global health settings, it provides perspective that transcends location. He explores the big questions of how we approach death with dignity in a way that is tremendously personal and deeply moving. You don’t have to be a medical professional for this book to move and inspire you to understand the importance of the ‘unsexy’ practice of palliative care.

 

Hopefully I’ve given you enough information so that if any topic on my blog has peaked your interest, you have a bit of an idea how to learn more. I promise that I’m not quite boring enough to have spent my ENTIRE summer reading books on medicine and development. That being said, if you want confirmation that there are some of Stephen King’s books that won’t give you nightmares, need to hear a rant on the ending of House of Mirth, or want to meet the last person on Earth to finally read Tina Fey’s autobiography, I’m your gal.

 

Note: As always, I welcome your additions to this list. If you’ve read an interesting and relevant book, feel free to shoot me an email; I’d love to hear more about it!

On Wednesday we took a road trip!

What made this road trip so newsworthy, you ask?

Well, for starters, it was a work-related road trip.

Curious yet?

What if I told you that this road trip changed the way we look at Morphine Tracker?

Okay, maybe I lost you on that last one.

 

Fine, I’ll tell you already!

So this past week we went to NdiMoyo Palliative Care Clinic in Salima. It’s one of the first places in Malawi to focus entirely on pain management in terminal patients.

The story of how this came to be is pretty involved, but I’ll try to stick to highlights. NdiMoyo has a previous relationship with Rice BTB interns; people came 3 years ago to share the Data Pall Electronic Medical Records System with the clinic. Last year, Morphine Tracker made a similar debut. Unfortunately, we weren’t aware of this connection until last week, when one of the St. Gabe’s clinicians, Suave, mentioned NdiMoyo. With a seed of curiosity but fairly low hopes, we shot off an email to the address on the clinic website.

 

In only a few hours, we had gotten a response (remarkable by American standards, not to mention Malawian timing!). Over the next few days, we got pulled into an in-depth email thread that taught us more and more about NdiMoyo. We met Lucy, the Malawian lady who has given her life to promoting the fledgling practice of palliative care in her country. Then we talked with Tony, Lucy’s husband and a whirlwind of force for the planning and promotion of the clinic. Finally, we talked with Linly, the clinic manager, about many of the details of our project.

 

We were simply blown away by NdiMoyo’s responses. Turns out, they have been using BOTH Data Pall and Morphine Tracker! Although they faced similar challenges to St. Gabe’s with staff leaving before other people could be trained, Linly took it upon herself to learn the program. They were super excited to get our updates and training resources. It seemed like before we could blink, we had been invited to visit the clinic and train more of the staff!

 

So less than a week later, we found ourselves on the road to Salima. It was a wild ride (not literally- the driver was quite safe). Over the course of about 10 hours, we got a crash course in goings on at NdiMoyo, a face-to-face meeting with all the incredible people we’ve been corresponding with, and a chance to train two more nurses in Data Pall and Morphine Tracker. It was especially motivating that we left with a veritable laundry list of changes to make to Data Pall and Morphine Tracker. One of the key takeaways from our visit is that NdiMoyo and St. Gabriel’s have very different needs with respect to record keeping. Although they both are doing an incredible job of promoting pain-free dignity for individuals facing chronic illness, they’re doing it in some drastically different ways. All of these differences mean that the two organizations are in a position to have separate needs and goals, especially in terms of record keeping.

Here are a few of the key differences that I took in at NdiMoyo:

 

Patient diagnoses: Tony told us that close to 90% of patients at NdiMoyo are being treated for some form of cancer. Although the most typical is Karposi’s sarcoma (1), cervical cancer comprises a large percentage among women, with esophageal cancer not far behind. As a result, many patients at NdiMoyo are in advanced stages of illness. They will likely die within a relatively short time of beginning the palliative care program. St. Gabe’s sees a lot of cancer patients, true, but also commonly treat heart failure, stokes, and sickle cell anemia. These tend to be conditions that are treated for the long haul; although the conditions may be largely untreatable, patient’s pain and limitations may be controlled with medications like morphine and treatments like physiotherapy.

 

Patient volume: NdiMoyo’s clinic volume has stabilized around 300 patients per year. While I don’t have exact numbers for St. Gabe’s palliative care, the inpatient ward typically holds between 2 and 8 patients in a day. The outpatient clinics, where patients typically go once a month to receive medications and check in with Alex, can see 35-80 patients in a day. Two clinics a week would mean between 320 and 400 patients in a month. Add maybe 30 inpatient treatments and another 50 home based care visits (I’m completely guessing on these numbers), and we’re seeing probably upwards of 450 or 500 unique patients in a year. What I think the difference in caseload primarily contributes to are different needs in terms of record keeping. Because NdiMoyo is a smaller clinic that is exclusively focused on palliative care, comprehensive patient record keeping can prove tremendously important for training staff to meet specific needs and reporting to donors. For organizations like NdiMoyo that may have more of the luxury of time, systems like BTB’s Electronic Medical Records System (EMRS) Data Pall can be an incredible tool. For places like St. Gabe’s, where the sheer patient volume makes it difficult to keep detailed records, systems like Morphine Tracker are down and dirty ways to keep track of what’s most important: the pain management drugs available to the patients who need them most.

 

Use of herbal medications: Lucy’s pride and joy is her garden. Beautiful, sprawling across most of the clinic grounds, most every plant also has medicinal functions. Clinic staff will prescribe these medicines in combination with pharmaceuticals in order to increase benefits to the patient. Different plants can soothe the stomach, act as a salve for skin rashes, and even contained some active ingredients for antimalarials and chemotherapy drugs! Probably my favorite is the popo tree (papaya)- it seemed like everything could be used, from the seeds relieve constipation to the skin of the fruit, which can be used to clean debris from an infected wound. And of course, the fruit provides essential vitamins and minerals!

According to Lucy and Linly, patients are usually very accepting of these treatments, eager to use things that they know as a part of a more traditional form of healing.

 

Inward vs. outward focus: St. Gabe’s has a HUGE catchment area, with patients coming from as far as past Lilongwe and across the borders into Zambia and Mozambique. Ndi Moyo, on the other hand, just serves the district of Salima. There’s a reason for this difference, and it largely comes down to the goals of the organization. St. Gabriel’s understands that there is currently a HUGE gap in palliative care provision throughout Sub-Saharan Africa. As such, they’re using the hospital’s resources to allow as many people as possible to face chronic illnesses with dignity. NdiMoyo’s focus for the future is largely on being a role model for aspiring palliative care providers; they specifically have chosen to not expand in favor of instead forming mentorships with hospitals and clinics in other districts. NdiMoyo’s founders, Lucy and Tony, speak of holding brief clinical trainings to allow practitioners from all over the region to get hands-on experience with palliative care. While this scale-up process is still in the early stages, I admire NdiMoyo’s ability to acknowledge the limitations of their clinic.

 

Methods for provision of services: St. Gabriel’s takes care of their patients in three main ways: through inpatient services in the FCCU, through biweekly outpatient clinics, and during home based care appointments with staff and community volunteers. NdiMoyo philosophy doesn’t focus on inpatient services; they believe in seeing patients wherever allows them to live the happiest and most comfortable life. This usually means at the clinic, at outreach clinics, and in the patients’ homes, but it can often expand to include Salima District Hospital or even the side of a road! Both of these systems have merits: some people are sick enough to require the reound-the-clock care of inpatient treatment, while others appreciate the flexibility of mobile visits. The way I see it, they’re two sides of the same coin, trying to provide palliative care with quality and compassion to their patients.

 

I think that perhaps the most telling thing about our trip to NdiMoyo is NdiMoyo means something along the lines of “the place giving life” in Chichewa. From what I’ve seen, that’s an accurate representation of their service. They take people who have lost hope in the face of devastating diagnoses and give them an opportunity to truly live in their last days. NdiMoyo is providing people with a chance to live a fulfilling life- to feel supported, to live pain-free, and to be at peace. I’m very optimistic about the role that Rice BTB software can play in encouraging this goal, and I hope that we have the opportunity to build further on our relationship with NdiMoyo in the coming months and years!

 

(1) A cancer that often arises as a result of being immunocomprimised, as is characteristic of HIV+ patients.

 

I’ve been a little behind in keeping up with posting photos in my blogs. I thought I would make a post that has some photos I’ve been meaning to upload, so that you can have a visual as to who and what I’m talking about in my posts. My apologies for the resolution of some of the photos, and for not making this kind of post sooner.

 

A large focus of BTB’s design projects is that they can be created from parts locally sourced in the setting they are being delivered to. Having locally available materials ensures potential for production of the device without Rice’s participation or intervention. As BTB’s first design-centered interns in Blantyre, Catherine, Sarah and I have an opportunity to observe firsthand what is and isn’t available here and to shape our design on local materials. Doing this makes it easier for BTB to deliver our technology to QECH with assembly instructions, so that PAM or some other qualified personell could build more without our help.

For the Poly interns, this internship offers a different opportunity. The students at Poly are normally limited in their designs and prototypes to resources that can be found in Blantrye. If electrical parts are hard to come by or very expensive here, students have to design around those components. Therefore, for Charles, Christina, Andrew and Francis, having American friends who can bring materials with them serves as a unique opportunity. They have a chance to exercise their circuit design expertise using parts they may not have access to at other times. Parts from the US are tools for practical experience that makes them better engineers in the long run, and the ten weeks we are in Malawi is a window of time during which they can use those tools.

In practice, our designs have partially been locally sourced and also included some hard-to-find parts that we had sent from the US with other Rice visitors. We kept the circuit for our dosing meter on a prototyping breadboard as opposed to soldering the components so that future Poly design teams could use the components. We sourced everything but wire for our chitenje warmer device from Blantyre, but we had to order the wire online in the US and have it shipped. Our suction pump has a pretty complicated circuit, so a lot of our parts had to be brought from the US, although or initial prototypes used infrared sensors and diodes taken from VCRs and remote controls found in the local market.

Trying to find a balance between local sourcing and bringing supplies comes back to the question of the most important goals of our internship, and how we are trying to accomplish them. We are expected to design prototypes that can be continued into real interventions in a hospital, so that our work makes a tangible impact on the community. That impact is a goal of BTB’s and it is part of the beauty of the program; as undergraduate students we still get a chance to design and build devices that will actually go to patients, as opposed to theoretical problems being solved simply for the sake of our education. When we use locally available materials we are ensuring that our designs have a greater potential to reach the point of patient use.

However, this internship is also a learning opportunity. We are expected to get something out of this summer that will make us better engineers and further our education. Our group of seven is gaining a lot of knowledge on design and iteration, on scoping problems, on working on a team, and on working independently without continual due dates or deadlines to keep us in check. Working with a variety of parts- even those we can’t find in Blantyre- is part of that education. In the long run, the lessons we learn from this internship should help us to become more capable at doing the same kind of work later in our career. It has been interesting to notice the way these two goals intersect and sometimes conflict, as in the example of finding parts. I believe that our team has done a pretty good job of balancing our interests, and I hope that finding our balance will result at the end of the summer with a few strong designs to show for our work.

Miyezi angati?- How many months ?

 

On the must do on every Saint Gabriel’s volunteer’s bucket list is a visit to one of their outreach clinics. This week, Renata and I finally went. Around 9 am, we helped as the outreach workers loaded the caravan with mosquito nets, scales, blood pressure machines, HIV rapid test, and other medical tools. Today’s clinic was traveling to Malagande training center, which is about 8km from the hospital. The hospital workers perform prenatal check-ups and under 5 check ups.

When we arrived, there was already a line forming prenatal check ups! In one room, we took the weight, blood pressure, and demographic information for the patients. There had to be easily more than 50 pregnant women there. Each of these women were carrying a health passport, a symbol of the Malawian health care system.

 

While I was recording weight and blood pressure, I couldn’t help myself but to look at the year of birth for each of the patients. The majority of the women were born in 1994-1997, making them around 16 to 21 years. In fact, it was uncommon to see a woman that was older. This is a complaint I hear the clinical officers make all the time: women are just having children too young. In some districts, like Mangochi, it isn’t uncommon to find a pregnant 11 or 12 year old. 38% of Malawian women are mothers by 18 years. ¹

 

 

After we were finished taking vitals, we watched as the nurse checked on all 50 women. We were in an abandoned building owned by the hospital that had very little natural light, and definitely no electricity. Instead of using an ultrasound, the nurse used her hands to tell where the baby’s head was, and used a ruler to measure from the head to the pelvis. And instead of a fetal heart monitor, a pinard (kinda like a stethoscope) is used. The visit ends with the nurse prescribe malarial prophylaxis, iron pills, and giving a date for the next visit. It took us about four hours to complete all the visits, and pack up to go back to Saint Gabe’s.

 

But of course, as is customary, we had to stop for nsima for lunch!

 

1) http://www.unicef.org/pon95/fami0009.html