After spending a two weeks researching current methods for monitoring temperature in neonates and beginning the design process for an improved temperature monitoring system, we had a bit of a change in direction. Initially, we wanted to start from scratch, designing a new method that is inexpensive and accurate. However, we soon learned that even at Rice alone, quite a bit of work is already being put into solving this problem. (At least we found a good need!)

Next, we decided to focus on modifying the Kangaroo Mother Care Monitoring device to be used for temperature sensing in neonates who are not receiving KMC. We thought this was a good plan, since we would be building off existing technology, but modifying it according to what the client wants. We expected to do many visits to Queen’s in order to adapt the KMC device to its new purpose.

This did not work out either. At this point, we were asked to focus solely on the Chitenje Warmer. This is a device that interns began to implement last year, but was not currently being used. To be honest, we were not completely enthusiastic about this and did not think that there would be enough for 4 people to do full-time. For this reason, Tahir, Kate, Brighton and I decided to split into two groups. Tahir and Kate would focus on the Chitenje Warmer, validating data obtained by previous students and educating staff on how to use it. Brighton and I would continue work on temperature monitoring. However, instead of working on any device in particular, we would focus on user-interaction, building a few different prototypes that display information in different ways. We will then bring these to Queen’s. Our hope is to get a good idea of what type of user-interface is favorable to clinicians and nurses. We will then pass along our findings to future teams, both at the Poly and at Rice, so they know the best way to display information for their designs.

Although this is not the type of work I initially expected to be doing while here, I think the information we gather could be very helpful to many teams in the future. I am nervous, because I have very little experience with circuit design and exactly zero experience with Arduino, but I am excited to learn!

I cannot believe there is only a week and a half left in Malawi. While I will be happy to see my family again, I will be very sad to leave this place I have called home for the last two months.

Last week was super busy! Tahir and I finally were able to make a lot of progress on our PneumaShoe (an intermittent pneumatic compression device we started working on last semester with three other teammates). We were able to move our prototype along with the help of Matt and create an automatic, functioning design. I love working in the design studio and finally have experience using the laser cutter and other tools available.

The best part about working on the PneumaShoe is being able to get feedback immediately from actual surgeons and doctors that would be using the device. After making lots of changes to the PneumaShoe, we were able to walk from the Poly to Queens in order to see what the surgeons had to say about our design. It was awesome to show the surgeons how the design was able to change just within a day. Another amazing feature was being able to say that this prototype was created in Malawi using local parts along with a few parts we brought from Rice.

Tahir and I were also able to present at the morning meeting last Thursday and get feedback from medical students and surgeons. While our device is nowhere near ready to be used by patients, I am optimistic at the feedback we have received. It is one thing trying to build a device at Rice and make contacts with your client through email. It is a whole other experience being able to get responses in person and see people’s reaction when they can actually see the device working.

Getting feedback on the PneumaShoe has really motivated me to work harder and make more iterations of the design. I cannot wait to continue working on the device and see how far we can get with it.

Whenever I’m in a new place, I consider it a sign of a certain level of belonging when I am able to give someone directions. It means both that I know where something is as well as that my face no longer looks timidly confused as I make my way to a destination. Well three people have asked me for directions in the last week and I was able to successfully help them all- winning!

But as much as I feel like after 7 weeks I can get myself from point A to point B, eat nsima without making a total mess, and know a decent price for chitenjis at the market, I know there will always be an element of not belonging completely— even if I were to stay for decades. I have been reflecting on those things that would still hold me outside of complete assimilation.

I’ve thought a lot about this idea of never fully being a part of a place in regards to culture- perhaps an idea for another blog post. In this one I want to discuss what happens at the end of the day. Every night I come home from the hospital, drink my boiled/bottled water, take my malaria prophylaxis, and tuck myself into a cocoon of a mosquito net— I have become increasingly aware of the safety net I live in.

Granted, the car I am riding in could crash or someone could decide my purse was in need of a violent change of ownership. This is not to say that life is perfectly safe here (or anywhere). However, there are many small precautions that my education, and frankly my money allow me to take. Beyond these precautions, there is a safety net that would appear should I, or one of the other interns, get seriously ill.

The 2015 Ebola outbreak illustrates my point well. According to a New York Times article, across six West African countries it was estimated that the mortality rate of those diagnosed with Ebola was 40%. In Guinea specifically as many as 66% of those diagnosed died. However, when looking only at the foreigners who contracted Ebola, the mortality rate more than halved, dropping down to only 20%. These foreigners were stabilized and transported back to their own countries- to hospitals where patients don’t die waiting for an ICU bed, medications are consistently in stock, and the standard is to give blood transfusions when hemoglobin is below 10g/dL rather than when it gets down to 4g/dL.

Growing up in the US has given me a mosquito net where I can be in “dangerous” places but be shielded to a large degree. This safety net is no secret, in fact those of us who are lucky enough to have it are probably less aware of it than anyone. The question is what message does this send? Will there always be some sort of unspoken barrier between us knowing that when put in the same circumstances the outcomes can be so dramatically different?

This is complicated, because we can’t say no one should be med-evacuated, or that the people who are evacuated think that they are better than the people they are leaving behind. The safety net isn’t inherently “bad” but it does make a distinction, and, perhaps one could go as far as to say it implies, whether one believes it or not, that some lives are more important than others. This idea of the value of an individual life has been in the news a lot recently, and perhaps there are many overlaps with the issues we are wrestling with in our own country. I want to narrow this idea to specifically working abroad- are we both aware of and ok with the implicit messages we are sending as we live and work from underneath a mosquito net?

Blantyre is a place of many beautiful mountains just asking to be climbed. It is also home to many sick children who are dependent on the medical care provided at Queen Elizabeth Central Hospital (QECH). As mentioned in my last post, there is a considerable lack of funding, leading to shortages in personnel as well as consumables and equipment.

The natural connection? Sponsored climbs. Since arriving in Malawi, I have witnessed the heroic efforts of the Pediatric Department to raise funds for the children they already do so much to serve on a daily basis. Friends of Sick Children (FOSC)  is a charity based in the UK that provides funds for equipment and pediatric nursing salaries at QECH.

On June 25th, and again on July 9th, members of the hospital undertook two physically rigorous courses, sponsored by friends, family, and Blantyre locals. They even took out an ad in the local paper explaining what they were doing and asking for donations on behalf of the children in the wards. The climbs were epic.

First was the Three Peaks Walk. The route started in the heart of Blantyre (3,409ft), summited Mt. Michiru (4832ft), Mt. Ndirande (5288ft), and Mt. Sochi (5019ft) before completing the loop for a total of 28 miles of walking. A number of participants from the pediatric department carried baby dolls wrapped onto their backs to remind them what the walk was truly for.

Two weeks later was the 20th annual Porters Race, “Malawi’s ultimate endurance race.” This run started with a 3k climb of Mt. Mulanji, traversed the 15k of hills along the plateau, and finished with a 5k descent for a total distance of 22k (13.6miles) with the highest point 3280 ft above the starting line. Again, a number of doctors from QECH participated in this race in a continued fundraising effort.

Between these two events the Pediatric Department has raised over $9,000 to improve care in their wards, worth a massive congratulations. They are making a way to maintain high levels of care without enough government funding. The issue is that the need is so much greater.

The problem I didn’t know existed: There are unemployed doctors in Malawi. Fewer students want to go into medicine because finding a job upon graduation is uncertain. I’ve heard about the shortage of doctors in Sub-Saharan Africa and I always assumed it was because of the ever blamed “brain drain” in combination with a lack of medical school graduates- not enough medical schools and primary and secondary school programs failing to prepare students for medical school. These are significant and contributing problems- but having unemployed doctors never even crossed my mind. Countries send doctors to these places in an attempt to fill the human resources gap but what is this gap truly caused by?

The reason (from what I’ve gathered so far): The government does not have enough money to pay the doctors. In fact, many of the doctors or nurses who are employed are not always paid consistently.

The solution: Complicated. Multi-faceted. Far beyond what I can come up with.

My thoughts: Either the government needs more money to be able to set up and fund hospitals or individual citizens need to make enough money to be able to pay for treatments in a self-sustaining hospital model. Preferably both. This means decreasing corruption, increasing GDP, and empowering communities to take ownership of their own clinics. All easier said than done.

How: Carefully. Here again I have no answer, but rather a naive hope. As we work towards solutions I think it is important that the cries for reform and development are coming from the people they will affect. It is important that outside organizations and governments continue consciously taking on the role of partner, not initiator.

So this is a hope for cries, cries for reform and cries for a solution beyond the status quo.

“Come on, cry- just cry. Cry a lot,” pleaded the doctor. A minute passed and the baby still refused to give into the doctors instructions. In the other room, under a heater, nurses took over the task of drawing a cry out of the baby. One nurse rubbed the back of the baby, another fit a mask over his tiny nose and mouth- forcing his chest to inflate every time she squeezed the attached bag.

Every once in a while there would be a pause so that a third nurse could suck mucus and fluid out of the nose and mouth. Two minutes, some gasps, then nothing, three minutes, finally we heard it: a small wail. There was a look of triumph- the baby was still hanging on for the time being. Nasal prongs of oxygen were fit into his nostrils. Emboldened with this extra air, the baby started crying- a good proper cry.

I walked back into the operating theater and observed as the mother was stitched back up from the C-section, comforted by the cries that were still audible coming from next door.

Ten minutes later the command came again, this time from a new set of nurses, “Come on, cry.” The procedure was repeated with a bag and mask forcing the little chest to rise and fall. A few minutes later the cry came, small at first then stronger and more frequent, joining in chorus with the first baby. Each cry a reminder of the lives doctors and nurses are able to save.

My day in the Ob/Gyn surgical suite was fascinating. I witnessed skilled surgeons deftly perform procedures ranging from C-sections to abscess draining to postpartum hemorrhage repair. While I enjoyed being able to observe each of the procedures, the most interesting part was having the chance to talk with the interns and doctors in the brief minutes between surgeries. They validated my observations of various challenges they have to deal with in the wards and also offered additional insights into the experience of being a doctor in Malawi. (Elaboration in Part 2)

Last week, Mikaela (my partner for the breast pump) and I realized that it has been one complete year since we began the project. We started with a foot-powered pump that was extremely difficult to operate, and we worked on this for 7 months. In February, we essentially started from scratch to reach our current rocking chair-based model. In the past year, we have come a very long way, and I am excited to see where the project goes. With this in mind, it is fitting that I went to Queen’s yesterday to receive feedback on our design. This was a great opportunity to learn where Mikaela and I can improve our design. I presented it to the morning handover meeting for Pediatrics and received some very useful responses.

Many of the doctors wanted to see more tests done before being comfortable implementing the design, and some of these tests were for things I had not thought would be a problem. First, they want to see information regarding the maximum weight limit of the pump, since a considerable amount of force is being placed on the canister on the corners. Although it has supported 200-250 lbs in the past, these have only been for small amounts of time We need to have the breast pump support this amount of weight, or greater, for the time of a full expression while rocking is occurring, then examine it for any damage.

Another test that they were interested in regards which portions of the device become contaminated by breast milk, leading to concern about the spread of bacteria and HIV. Initially, I had not considered droplets traveling up the tubing, but quickly realized that this was a possibility. If the tubing becomes contaminated, so could the syringes, making our “multi-user pump” a “single-user pump”. To combat this, Mikaela and I need to find a way to prevent the spread of bacteria and viruses into the tubing. We know that this is possible, as breast pump company Ameda has a method of doing this described in the video linked here.

Beyond these concerns, most of the doctors who looked at the breast pump enjoyed it! They think that a rocking chair-based breast pump is a clever idea and they think it could be helpful for mothers in the pediatrics nursery as well as in Chantinkha, as many mothers there have trouble expressing. Many doctors sat in the breast pump and operated it, feeling the suction on the hand or arm. They were surprised by the amount of suction it could generate and enjoyed the rocking motion.

I am excited by the feedback we received in this meeting. The feedback was not all good – many doctors made comments about portions of the design that I had not considered problematic or brought up concerns that I had not thought of, but that is a good thing! Mikeala and I now have a better idea of where we need to focus our work in order to produce the best design possible. I cannot wait to return to the OEDK in August and continue working, iterating, and improving.