The most powerful part of travelling to Zomba was getting a true grasp for the importance of Rice 360.  Walking into the PAM workshop, the shelves full of broken medical equipment were initially pretty overwhelming.  Fine dirt covered every concentrator, similar to the dirt on the ground outside that blows onto everything and covers my shoes when I walk.  I didn’t know how long it would take to assess all of the concentrators, open them for measurements, and close them again.  Our task was made more difficult by the variety in concentrator models.  Mr. Khonje said the hospital buys DeVilbiss 525KS concentrators, but the others were donated and commonly failed more quickly- specifically the Invacare Platinum XL, which tends to fail within a year of donation in comparison to the 5-10 years of the DeVilbiss.

Shelves plus Kate

           Inside the shop was an incubator that immediately caught my eye because it was the first piece of thermoregulatory equipment I had seen at Zomba.  I asked if it was broken too, to which Mr. Khonje simply responded, “No.”  Confused, I then asked why it wasn’t in use.  He said that nurses rarely use incubators at Zomba Central Hospital because they require too much concentration and monitoring (are difficult to use).  He said they don’t trust themselves because of the fear of “cooking the baby”.

An incubator sitting untouched in the nursery ward

          Walking to the back door of the workshop, I looked outside and saw what was essentially a junkyard full of medical equipment- large, expensive, and broken.  As I began talking to the technicians and nurses, I realized there were so many things about these contraptions that just weren’t practical in this setting.   It didn’t matter how much equipment was donated, how new it was, or how much it cost.  It is ignorant to hand what works well in one part of the world to someone else in an entirely different environment and assume it will benefit them similarly.  There is a need for personalization of equipment through root-cause analysis of specific challenges and sustainable redesign.  Rice 360 truly takes into account the needs of the end user, and I am glad to be a part of this program.

Part of the junkyard