This post is about a week late- it’s taken a while to process all of our site visit information. Also, the Rice University provost, Dr. Richards-Kortum, Dr. Oden, Dr. Leautaud, and some medical doctors interested in the program have come to Malawi for a few days so we’ve spent some time talking to them about our projects and getting great feedback and advice.
The road to Zomba was long. It took about an hour to get there every morning, and I often found myself drifting into sleep to the sound of BBC radio. It was strange to hear about the Orlando shooting occurring at home through British broadcasting in a car in Malawi. A Polytechnic lecturer named Joseph traveled with us every day and was very helpful. The first morning he described an experience he had in Zomba a few years back when he played football (soccer) for school. He said the Zomba team had placed a witch doctor behind their goal because they believed it would help them win, jokingly commenting that it must’ve worked because his team lost.
When we reached the hospital, we went straight to the PAM workshop where we met Mr. Khonje, a PAM technician. At first the sheer number of broken concentrators was overwhelming, but Kate and I just began systematically taking them off shelves and going through our log for each one. We soon discovered that we needed to reevaluate the questions we planned on asking. While Mr. Khonje was able to give us details about a concentrator that had broken two weeks prior, the others had been broken at least six months (most about a year) before. In the absence of newly ordered parts, the technicians had stripped several parts from the broken concentrators in the hopes of using them to repair other broken concentrators. Without flow meters, oxygen sensors or pressure gauges to pinpoint the issue with a concentrator, the repair protocol used by PAM is to switch out parts until the concentrator operates properly. However, proper operation can only be gauged by the absence of low output alarm lights, and the presence of flow that can be felt by hand. For these reasons, we were unable to get details about the other concentrators from the technician, only our own measurements and observations.
Looking at a concentrator in the PAM workshop
We also looked at concentrators in wards and methods of thermoregulation in the nursery, labor, and KMC wards. We were able to interview several nurses, three mothers, and a nursing student. We noticed that the walls were covered in information including the importance of thermoregulation, ideal temperatures of babies, ideal room temperatures, KMC tips and danger signs to look out for during KMC. The nurses were very knowledgeable about hypothermia, most problems seemed to arise from lack of equipment like thermometers or working resuscitators which were used to heat babies. According to a nursery ward nurse, babies weren’t wearing hats due to difficulty affording them (they cost about 1500 kwacha each).
Typical beds in the nursery
Danger signs of KMC posted in the KMC ward
Overall, it was a great learning experience to be able to assess needs based on my own observations. I emphasized my role as an engineering student looking for project ideas, not evaluating or “grading” the nurses and other staff in any way. This was the first time the program included site visits, and I am hopeful that our trips have helped build up the relationship between the Polytechnic (and Rice) and the hospitals we visited.