Caroline and I were on the road visiting the northern district hospitals for a little over a week. We visited 12 hospitals all over Malawi, and saw so many incredible/heartbreaking/thought-provoking things. I decided to share a small taste of our trip through my favorite signs, whether from the hospitals or on the road.

 

Salima District Hospital (as well as many others) claimed to be “The Baby Friendly Hospital” right smack dab over the front of the entrance. The other panel opposite the painting of the mom and baby was 10 reasons why breast-feeding is beneficial. Just right in the parking lot.

 

Seen at Machinga District Hospital promoting Kangaroo Mother Care.

 

 

Seen at Mua Mission Hospital outside the labor ward.

 

 

Seen inside the Kangaroo Mother Care ward at Mua Mission Hospital. Goals to combat neonatal mortality. You go, Mua Mission.

 

 

Seen at Ntcheu District Hospital. Not sure the correlation, but without context, it’s pretty funny.

 

 

Seen right next to the visa desk at the Zambian border passport office.

 

 

Seen at the edge of a bridge over looking a gorgeous river in Rumphi. Food for thought.

 

 

Seen in Salima. Not at all true, but I love the Ice Cream Den’s confidence.

One of my individual projects is a qualitative analysis of the CPAP mentorship program at district hospitals. Basically, very well-trained CPAP nurses from Queen’s go to struggling district hospitals to mentor nurses and staff on CPAP. From this visit, the mentor’s write a report on each mentee’s performance and improvement, as well as a general report about the neonatal ward in the hospital. So what I do is, go through all these reports and code various trends that I find pervasive across the hospitals to help to give more information on the condition of the nurseries, adherence to CPAP procedures, and if the mentorship program is effective, which informs the CPAP team about how to improve the mentorship program. I draw information from these reports, as well as personal interviews with the mentors here at Queen’s.

Okay, all the technical stuff is out of the way.

Let’s talk about how all this data collection and analyzing gave me goosebumps. Surprising, no?

Yesterday, I interviewed a veteran CPAP nurse from Queen’s named Chrissie. I told her about my project, and we worked out that 2pm is the best time to conduct the interview. Being in Malawi, things often seem to run on their own clock, so I knew 2pm could mean anywhere between 2pm to… well, anytime this week. Chrissie comes into the office at 1:50pm with a stack of reports from all her mentorships compiled and ready to go. One can say I was caught a little off-guard. So, I ask my questions, she gives me thoughtful, insightful answers. I can tell when she talks about her work that she is completely committed and believes in what she is doing. I see this commonly among nurses here, but still every time I come across it, I’m inspired by their dedication. As the interview was coming to a close, we were getting up and putting our things together to go our separate ways. I asked her what she had going on the rest of the day, and she told me she was on her way to teach a CPAP refresher for the nurses in the pediatric nursery and she was so excited. I asked her, “You really love CPAP, don’t you?” to which she responded with, “CPAP is why I do what I do.” From there she told me all about what CPAP means to her and this hospital.

Chrissie told me that she goes into work each day and mothers waiting in the hallways recognize her as the CPAP nurse. “Mothers come up to me and say [cradling her arms as if she was holding a baby] ‘Do you remember me? You are the nurse that saved my son’s life.’ ‘You’re that CPAP nurse! Look at my girl, she’s healthy and alive! Thank you, sister!'”

Then she told me about a time that MBC, the major news broadcasting company in Malawi, was interviewing patients at Queen’s. One of the interviews was with a mother that had recently given birth to a preterm baby that had to be put on CPAP. “In the news cast, this lady said, ‘My son is alive and breathing because of the endless care of the amazing nurse, Chrissie Mbendera.’ My name! On the news!”

After I was fully in awe of everything about Chrissie, she told me a story about when she was shopping for potatoes at the market. She told me that it was some random weekend, and she was buying potatoes from a vendor at the market. “I told the woman, ‘I would like one bunch of those over there.’ Then, I felt a person come up behind me and put my hand on my shoulder. This person said, ‘No, she wants two bunches and I am buying them for her. This woman saved my baby boy’s life.'”

Was I wrong about the goosebumps?

The new Chatinkha nursery in QECH.

http://www.rice360.rice.edu/#!day-one-project/udbk5

While abroad, it is really easy to get wrapped in your own bubble of experience. I have noticed this about myself this summer and have been actively fighting this instinct. I know that I am constantly trying to push my boundaries while being here–whether it be jumping into an icy waterfall, trying to eat food with only my hands and nsima (blob of maize flour and water), or convincing myself to enter wards knowing I’ll see patients in a lot of pain.

Ironically, when I was opening my mind to new things and experiences, I seemed to have closed it the goings on of the rest of the world. I was focused on Malawi, and not much could shake that. With limited internet, in this day and age, it can be very difficult to stay informed about current events. Now that I realized how wrapped up I was in time here, I have made efforts to stay informed and not use poor Wi-Fi as an excuse to be ignorant.

What changed between that time and now was Orlando. Hearing about the biggest mass shooting in history shocked me, to say the very least. I wanted to be in the US; I wanted to mourn with my country; I wanted to talk about it endlessly and try to make sense of something that had no answer. I angrily googled things and read the latest reports about the shooter and his victims, stories from the families of the affected, speculations about the shooter’s background and motivations, and reactions from our country’s leaders and presidential candidates. This tragedy, among other things, made me realize how important it is to be a well informed global citizen. It is important to learn the incredible things I’m learning here, but vital to stay connected to the world outside my environment of Blantyre.

Since the tragedy in Orlando, there has been police shootings in Dallas and Baton Rouge, attacks in Istanbul and Nice, a political uprising in Turkey, and so many more horrible events where so many have died. Just as I am writing this now, my phone buzzed with a news alert with a headline that 2 people were killed and 17 were shot outside a club in Fort Myers, Florida. Out of all of the ways these tragedies have affected the world, me becoming more cognizant of life outside my bubble is insignificant by an impressive magnitude, but it has affected how I view the world and myself more than I know or can process.

A few weeks ago, the vote concerning whether the UK will stay or leave the European Union came out. It was a very close race with about 52% of the vote in favor of leaving the EU.

The place I’m staying for these 9 weeks, Kabula Lodge, is host to many international travelers, mostly working at Queen’s–and many being from the UK. I woke up on the morning that the result was to be announced to an Associated Press alert on my phone saying that the votes were still being counted and no decision has been reached. I knew all my friends from Kabula had been on edge the past couple weeks about whether the UK with remain or leave the EU — calling home to make sure their absentee ballot was being cast, relentlessly checking the latest poll data, and just verbally processing their thoughts with those surrounding them.  I had heard about the referendum and had done some preliminary reading about how the outcome would effect the UK before coming to Malawi, but to hear opinions from the people it would actually affect was fascinating to me. Breakfast on the morning of the vote was just a flurry of questions about how they feel about the vote, how they think their country will lean, what brought about the call for the referendum, and their opinions on party leaders and their Prime Minister, David Cameron. I learned more about British politics waiting for our bus to work than I could have possibly from the news. By the time the bus came to get us, everyone’s news alert on their phone had buzzed and delivered the result: the UK had voted to leave to EU.

That entire week, while my friends were processing what leaving the EU means to themselves and their country, I took this opportunity to pump them for as much information as possible. I wanted raw emotion mixed with political perspective to really get a feel for what this referendum meant to them. I had a friend that goes to veterinary school in the UK and had just applied to a global health masters program in Holland. Now she was left wondering whether she would have to pay international fees or could still pay fees as though she was in the EU. I had a friend’s sister, who after a long and painful process of endless interviews had just gotten job at a bank in London, be laid off that next day due to Brexit.

These would be things I might hear in anecdotes in articles or interviews on the news, it was a completely unique experience to be able to hear and empathize with people we have been getting to know this summer. I would have never have gotten the chance to hear these stories or be a sounding board for British people’s thoughts on the result at home. But, I am eager to experience this in my home country come November when the US elects a new president.

faceofmalawi.com

Last Friday I had the wonderful opportunity to visit Mulanje Mission Hospital again. We were able to bring the filter material that we had tested and the educational poster that we created. It was great going back to the hospital and showing them what we were able to accomplish in just a couple weeks. The doctor we were in contact with was really appreciative of the materials and was encouraged by the use of local resources to make filter materials. I am so glad that we were able to give them resources that can actually be used at the hospital. We were able to send the doctor a copy of the pdf and raw files of our documents so that they can create more posters to use around the wards.

To further benefit the hospitals, Harvey and I went to Queens on Monday to give out the educational posters and filters. It was wonderful walking to three different wards and putting up the posters. I truly hope that the educational posters we created get the nurses to think more about the oxygen concentrators and the maintenance that they require. We were even able to replace one of the dirty filters on the concentrator with a filter that we had created.

 

 

I am glad that we took the time to focus on educational material and filters. While they both may not have been the most technical projects to do, they were definitely needed in the hospitals. It is sad that smaller projects sometimes get overlooked or not noticed for the benefits that they can produce. Sometimes the simplest answer is the best. Even if the filters do not get used much and the posters are not always looked at, they are still a talking point for the nurses. The head nurse in the pediatric ward at Queens now understands more the importance of filters and taking care of the machines.

 

Brighton and I are nearly ready to present our designs to nurses and physicians at Queen’s, and I am interested to see what they think! One simply has 3 LEDs for cold, normal, and hot. This is the simplest model. It would be the easiest and cheapest to build, but it also gives the least amount of information. The second model has a seven-segment display that gives the temperature readout, but does not tell the user if the temperature is too low or too high for a neonate. This is in the middle in terms of material cost, but it is the most difficult to build. However, the actual temperature display is the clearest of the three options. The third model has an LCD which displays both the temperature and the word “COLD”, “Normal”, or “HOT”, depending on the temperature of the neonate. It also has a buzzer, which beeps when the temperature is too low or too high. This design has the highest cost for parts, but it also gives the most information of the three. However, the LCD is harder to read from far away than the 7-segement display.

In addition to designs for temperature display, we will be bringing designs for ways that the temperature sensor interacts with the neonate. These designs will include a backpack (similar to the KMC monitor), a belt, a hat, a sticker, and a color-change dot (similar to the ThermoSpot* ). They are made of different materials (plastic, cloth, and paper), each of which have benefits and pitfalls. We hope that by presenting a variety of options, we will be able to gain a better understanding of what the doctors and nurses want out of a device that enters their wards.

Preparing these prototypes has been a very interesting experience. Going into it, I had never coded in Arduino, designed circuits, or soldered. In order to finish in time, Brighton and I had to divide work. Because he is studying electrical engineering, he worked on circuit design while I primarily worked on code for the 7-segment display and LCD. It started slow, but after much help from Matt, Tahir, and Google, I eventually developed codes that correctly controlled both displays. Next, Brighton and I transitioned from breadboards to protoboards, which require soldering. Brighton taught me how to solder and I successfully completed the simplest of the three boards (the LED circuit). I enjoyed working with and learning from Brighton, and I look forward to receiving feedback!

 

*An interesting letter to the editor of the Lancet written by a doctor who used the ThermoSpot in the northern region of Malawi can be found here. 

Brighton and I have decided the methods of information display we want to bring to Queen’s: LEDs (blue for hypothermia, green for normal temperature, and red for hyperthermia), an LCD that displays temperature and the words “HOT”, “Normal”, or “COLD”, and a three-digit 7-segment display. The LED display had already been built, because we were considering using it with the KMC Monitoring system. However, we had to build circuits and write code for both the LCD and 7-segment displays.

Brighton is studying electrical engineering, so he focused on the circuits while I sat down to learn how to code literally anything for Arduino. With the help of Tahir, Matt, and Google, I eventually figured out some basic functions. Controlling a 7-segment display takes quite a bit of information, since you need to tell which LEDs to be on when. Controlling 3, the number we need to display temperature, is more difficult. At the Poly, we only have individual 7-segment displays, so in order to use them we must wire together segments and control segments and digits using a tool called a shift register. This is quite complicated, and using a 4-digit 7-segment display would be much simpler.

For this reason, Brighton and I went to Limbe (the part of town that has many shops for electronic components, cloth, tools, and pretty much everything) in search of a 4-digit 7-segment display. We went to 6 shops that morning. At the first 4, they said they did not have them. At the 5^th, they initially asked if it was something you attached to a cellphone. When we explained what it was, they told us that they did not have it. The owner of the 6^th shop was the first to know what it was. Unfortunately, however, he did not have the display either. He said that he used to carry them, but no one ever asked for them, so he never restocked when he ran out. He then added that the same had happened for breadboards.

This surprised and saddened me. The 4-digit 7-segment display is not a very complicated component, and the idea that it was not available anywhere in the city shocked me. How can people create new technology if the instruments for doing so are not available? I was struck by how lucky we are at Rice: if we need a component, we go down to the Electronics lab or ask a professor and they probably have it. On the off chance that it is not available, we order it on Amazon and get it in 3 days, free shipping. Here, if a component is not available, you need to figure out a work-around.

In the end, Brighton and I found a relatively simple way to multiplex 3 7-segment displays to generate the display we needed. However, it was still much more complicated than it would have been had we had the desired component. Because we needed to use significantly more wires, loose connections were a bigger problem and it was generally less elegant than it could have been.

These last few weeks have been spent doing a lot of work on oxygen concentrator filters and sieve beds. We finally got the time to focus on making educational posters to place in the hospitals near the concentrators.

One thing I have learned since being here and getting feedback on different Rice designs and oxygen concentrator tools is that education really is key. A device can be the easiest to use and most needed technology there is, but if the users do not understand why it is needed, then the device will never get used. Making sure the need is present and known is crucial to creating a valuable design that has the potential for use in any setting. I have seen this problem a lot with maintaining oxygen concentrators. A main reason we focused on making locally available filters for the outside of the concentrator is because a large number of concentrators in Malawi do not have filters on them. This is a huge problem that many people do not know about. Without the filter, the oxygen concentrators lifespan is significantly reduced due to the  dirt and other contaminates that are allowed to enter the system and cause contamination to various parts of the device. Concentrators still get used without the filter simply because people do not realize it is a problem. Thus, one of our projects here has been an educational poster to show nurses and doctors the maintenance that must be done to concentrators to keep them in working order.

Whenever any new device is being developed a huge thing that needs to be talked about is education behind the problem it is solving. Unfortunately, this does not always seem to be addressed until the end when the product is being sold. Oxygen concentrators have been used in Malawi for a long time and yet the education still is not present to show how to properly clean the device and use it only with filters.

As we have been developing the educational poster, it has been great being able to go to Queens to get feedback on the material to make sure it is clear. Harvey and Vincent went to Queens and received a lot of positive feedback! A lot of nurses did not realize what maintenance needed to occur on the device and welcomed having more information.