The more time I spend in Malawi the more I feel a sense of urgency to return to the land of my birth. This sense of home I feel here reminds me of the few memories I remember of visiting my country. My time so far has taught me that the most significant impacts are made locally. It’s through locally created and designed solutions that projects and advancements become sustainable achievements. I think that’s why this program is so meaningful. Direct impact has always been a priority. Two weeks ago we spent three days traveling to the district hospitals of Southern Malawi.

The first city I visited was Mulanje, home to Malawi’s tallest mountain. The scenic drive did little to prepare us for the spectacular view of the Mt. Mulanje which was situated right behind the hospital.

Being a district hospital it was much smaller than Queen Elizabeth- the hospital near the Polytechnic University. Walking around we learned that the sole X-ray for all the southern hospitals recently broke beyond repair, that long queues are a daily phoneme, nurses are plagued by severe understaffing, and that neonatal devices break constantly. It was eyeopening to see the level of improvising that nurses and doctors needed to do. Having spoken to the nurses and learned as much as we could on their cleaning methods, we spoke with the PAM (Physical Asset Management) director as he knew more on how these medical machines function and break. At Mulanje dust is an issue for their oxygen concentrators; however, maintenance procedures are in place to help alleviate the breakdown of these machines. Their preventative measures include weekly cleaning of filters and monthly internally cleaning of dust. Furthermore we gained insight into how dust may play a role in the accelerated degradation of the cup seals and the need for locally manufactured cup seals. They welcomed the idea of locally made cup seals as this would allow them to quarterly replace worn out seals thereby prolonging the lifespan of the concentrators. I walked away from Mulanje with a sense of realistic hope, even though there existed a myriad of systematic issues locally made spare parts could make a significant dent.
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After Mulanje we drove past acres and acres of tea plantations to arrive at Thyolo District hospital. You could tell this was a recently constructed hospital. The layout of the wards, the well kept garden and sitting areas contrasted the congested and convoluted layout of Mulanje and Queens. Architecture can really make a difference! We went about the same routine; visiting the nurses first and then speaking with PAM. The oxygen concentrators were placed near the ground and right against a wall. This placement contributes to their shorten lifespan by exacerbating the effects of overheating and humidity destroying the filter mineral. In addition, nurses only externally clean the concentrators weekly.

And with no internal dust removal the accumulation of dust practically destroys the machine. Thyolo like all the hospital we visited no longer has extra compressor cup seals and sole rely on the Rice CPAP team to give them some. Therefore, they use the concentrators until the cup seals’ breaking point- the point at which they are no longer is able to maintain the necessary pressure to concentrate oxygen. PAM’s response to our questions was essentially identical to previous responses.

The following day we visited two more sites- Chiradzulu and Zomba- and received relatively the same feedback. Since Zomba hospital is a central hospital (meaning its much bigger) we decided to spend our time there exclusively with PAM.

We were greeted to a large “graveyard” of broken oxygen concentrators. Whenever a district hospital can’t fix a machine themselves they send it to a central hospital like Zomba; however, for the most part these central hospitals also lack the spare parts to actually fix these machines so they end up stacked up on shelves. Since Zomba has one of the largest PAM facilities we decided to berate them with our questions which concerned the durability, material specification of cup seals, and hospital prevention procedures. We learned that dry friction and overheating were the main causes of degradation, that spare cup seals only come in kit that includes other compressor parts making it expensive to order, and that there is a real need for locally made seals. Since many devices- autoclaves, ventilators, and air compressors- use cup seals there is a potential for a commercially viable product. Traveling has really energized and moved me in a exciting way. Day in and day out the Malawian interns and I exchanged knowledge, hopes, and experiences. In a sense we have opened each others’ worldview. We inspire each other to use this internship and what we have learned as a starting point to do so much more for the global community. And with all that I have learned here, I know that one day I will return to Eritrea and use my experiences to do my part.