Ok we did A LOT so imma split up my blogs for this week 😀

Day 6

I tried to dress semi-nicely today because we presented our devices to the Dean of Engineering at Rice, the Rice 360 staff, students and teachers from the Polytechnic school, and people working for the US Aid. Agh I was very nervous but it was actually a lot of fun! Our devices as well as some devices made by students at Poly were set out on the tables in the Design Studio, and it was so cool getting to see everyone’s designs. And it was so lively there were so many people running around and asking questions I loved it. We met Sanga, who is incredible. He taught himself electronic design from books and videos, and with that knowledge, he made a low-cost portable monitor that tracks and records ECG, temperature, and heart rate data! And he’s planning to work with some telecommunication students so that the data in the device can be sent to a phone app. He explained to us that with this device, smaller hospitals that are farther away from the city will be able to gather key information and send the data to cardiologists and other specialists at larger hospitals. It’s unbelievable he is so passionate about his device and he won an engineering design competition with his entry!

We met another team that designed and 3D printed a drone that can be controlled from a phone app! They flew it for us (it was difficult since we were inside and it hit the wall a couple of times) but it was amazing! I was also really happy because I got some great feedback on the continuous maternal temperature monitor my team and I were working on (this device essentially reads temperature continuously for mother’s in labor and warns nurses using LEDs if the mother is experiencing intrapartum fever). I have ideas now on how to make it smaller, more comfortable, and more efficient thanks to the Poly students:

1. Use the IC directly from the arduino nano rather than the entire component to make the device much smaller
2. Use a flexible plastic case rather than a brittle 3D printed case so the device can fit more naturally on the mother’s arm
3. Use larger LED lights so nurses can better see if the mother is experiencing intrapartum fever

I cannot wait to meet the Poly students we will be working with next week because these guys are so ambitious and driven. They are so passionate about the things they do and I cannot wait to start designing with these guys.

Side note I got a LOT of recommendations for places to get ice cream in Malawi 😮

1. KFC – according to Francis, KFC not only serves fried chicken but really great ice cream (I wish they had that back home)
2. Mikos – Erica (a member of Rice 360) told me that this dessert bar serves amazing ice cream in soft, warm waffles (this is going to be a problem for me considering how DANGEROUSLY close this is to Poly)
3. Victoria Gardens – also really close to the Poly uh oh
4. Gelato Carnival – a carnival of Gelato I guess?
5. Shoprite – I forgot the name of the actual ice cream place, but Shoprite is filled with different food places so I am bound to venture here too

Mental preparation pales in the face of actual experience, a lesson that I have become very familiar with in my first week in Malawi. It’s a beautiful mountainous country and the people here are some of the friendliest people I have ever met. There have already been challenges from getting settled in but I, along with the other interns, are already adjusting to the tempo of the country. We couldn’t have done it ourselves, of course. Enock and Francisco, doctors at Queen Elizabeth, have done so much to help us settle in and get around the city. I’m forever thankful for the kindness and selfless nature of the people here.

During the first few days, we toured our bases of operation: the Queen Elizabeth Hospital and the Polytechnic Institute. At the hospital we met the Rice 360 Malawi staff and headed off to the neonatal ward. Most of the babies in the ward suffer from some sort of condition, usually being premature. Prince, a nurse working at the QE and our knowledgeable guide, gave us incredible insight into the technologies and systems of the hospital. The nursery’s system has been improving and seems to be effective, reducing the number of infant and mother deaths to less than three in that past six months. There is equipment in place that works well within their system of operations: hot cots to keep the infants warm and heaters to keep the room at ambient temperatures. But Prince also mentioned several areas that could benefit from improvement. Complicated technology (like incubators) that are given to the hospital have a hard time replacing the simplistic design of devices like hot cots (wooden boxes with switches to control the heat) because it seems too time intensive to learn the technology and incorporate it into their operations. Temperature control in the ward is difficult when there is no way of keeping the temperature constant. Staff is spread thin, taking care of over 60 babies and their mothers. I think we need to develop a deeper understanding of the hospital administration and how they truly operate. It’s only then that the ideas and prototypes we develop can become useful for the nurses and doctors.

We also went to the design studio inside the Polytechnic Institute. It truly feels like an OEDK transported to Malawi. We got to meet Francis and Andrew, the two who keep the design studio running, and took a look at our devices to make sure they survived the transport here. Thankfully our models made it through the plane ride in tact and ready to go. On Monday we will be presenting our projects to Dean DesRoches, the Rice University Dean of Engineering.

Thankfully we’ve also done fun activities and seen some of the sights in Malawi. We visited Satemwa Tea and Coffee Estate to taste different types of teas. We’ve also found amazing food for a very affordable price ($2 for lunch!) and tried nsima, a staple dish here in Malawi made from maize flour.

The trip from Bethlehem, PA to Blantyre, Malawi took 5 flights and a total of three days. I went from Bethlehem>Chicago>Houston>Frankfurt>Johannessburg>Blantyre. We arrived in the evening on June 6, 2018. So far I love Malawi! Everyone is so nice and I can DEFINITELY see why its nicknamed the warm heart of Africa.

Day 1
Thursday June 7, 2018
Settling In (Thank You Enock)

Goals Accomplished:

1) Met our bosses
2) Visited Our Workplaces
3) Located Restaurants and Grocery stores
4) Exchanged Money
5) Bought Food, and Phones

The morning after arriving, we began visiting the sites where we would be working. First, we went out to the Rice 360 office to meet Dr. Leautaud and let her know we had settled in. Enock, one of the doctors who picked us up from the airport, was able to give us a ride there. The office was really nice and we met some of the Rice 360 staff there including Vanessa, Sara, Ava, and others (not sure if I’m spelling their names right). This is where we will be meeting for team debriefs/ meetings with Rice 360 staff.

We then briefly visited the Neonatal Intensive Care Unit (NICU) at Queens where we will be visiting to do needs finding (looking at areas that need help). Prince, one of the registered nurses at the Queens NICU, was able to give us a rundown of the different areas of the (small) NICU and some of the obstacles they are encountering. Queens is the LARGEST NICU in Malawi and it had about 20 beds for babies (about the size of a large living room). We were all taking many notes on our phones/ notebooks already. Some of the major things we noted included:
1) Low Staff: Prince is the only one who knows how to use the centrifuge to test the blood bilirubin levels (indicator of jaundice) in babies. (He was supposed to be on vacation but he was still at Queens because of the babies)
2) Medical Device Grave Yard: Many medical devices are donated without instructions or repair manuals so they are thrown away
3) Dangerous Equipment: They use make shift incubators called hot-cots that are easy to use but they often overheat babies (no temperature sensors) or break.
I have a ton of other observation. Too many to list them all here.

After the 30 minutes at Queens, we walked back to the Rice 360 office and Dr. Leautaud gave us a rundown of the week’s events including a dinner with Dean Reggie, (Rice Dean of the School of Engineering), project presentations, and visits to the local hospitals. She also gave us suggested places to buy cell phones buy groceries, and buy lunch.

Next we all walked from the office to the Design Studio/MOEDK (Malawi Oshman Engineering Design Kitchen) at the Poly. We met Francis who will be working with us during our time at the design studio. He gave us the keys to the studio since the whole Rice 360 team had a retreat planned the next day (Friday) and we needed the space to work on our prototypes before the presentations on Monday.

The rest of the day was spent settling in. Enock was a great help to us since he helped us figure out our phone situations and helped us exchange money. We are definitely adjusting to living in Malawi.

Day 2
Friday June 8, 2018
Make NO Assumptions

Today we made many assumptions that kind of threw off our schedule! It is very dangerous to make plans that are based on assumptions! From now on, we will make sure that our facts are straight before we proceed with anything else.

Goals Accomplished
1) Figure out the Shuttle
2) Finish Up Project Prototypes at the Poly
3) Pick up other necessities

Assumptions Made
1) The shuttle outside my room was the Kabula Lodge shuttle
2) The Poly Has Wifi
3) The bread at SPAR was jelly filled
4) The Kabula shuttle was picking us up at 4:30

The lodge we are staying at has a daily shuttle to and from Queens. We were told that the shuttle left at 7:30 AM and returned at 4:30 PM. Because of Assumption 1, we got on the wrong shuttle and missed the actual shuttle. We ended up arriving at the Poly around 9:30 AM instead of 8 AM. Then we began getting familiar with the design studio and all of the tools available. It is very similar to the OEDK at Rice, just a bit colder and smaller. There was also no wifi (Assumption 2) which made it slightly difficult to communicate and to retrieve some information that we hadn’t downloaded.

Sajel and I unpacked the Cervical Cancer Training Kits and thankfully they made it to Malawi unharmed! We had nothing to really fix so I helped out Franklin with the bilispec. I helped him solder some connections using a soldering iron, solder, wire, a battery, crimp pins, heat shrink, and a connector. We finished our prototypes by noon and headed to lunch at a place across the street called SPAR. There was a really good bread that looked like a jelly filled donut (Assumption 3). I ordered it. There was no jelly but still good.

After lunch we prepared our presentations and cleaned up our mess. At around 4 PM, we walked back to Queens to be picked up by the lodge shuttle (Assumption 4). The shuttle never came (I think it was his day off) and we called Enock to give us a ride home.

Day 3-4
Saturday and Sunday June 9-10,2018
It’s The Weekend!

Friday night we made last minute reservations to visit a tea plantation for a tea tasting. It was a very nice trip. The plantation had a ton of different teas and we learned that all teas come from the same leaves, but are processed differently to achieve different flavors. Tea is also a hardy and bitter crop, therefore it doesn’t need much protection from bugs unlike coffee (coffee beans are sweet). Lastly we learned not to gift Malawians any tea unless it is accompanied by twice its weight in sugar!

We also went out for a traditional Malawian meal with Edson, a Rice 360 favorite driver. I had Nsima (kind of like mashed potatoes but made of maize/corn) and the local fish. It was very good. All of the food we have had so far has been so fresh and so amazing! I love it.

Today, Sunday June 10, 2018, marks the end of my first week in Malawi. We worked out in the morning, then we did laundry (hand wash). We will be having dinner with Dean Reggie later today! Afterwards we will practice our presentations for tomorrow morning! I am excited to get the ball rolling with our technologies afterwards!

Day 1:

Hi! We are finally in Malawi! We arrived at the Malawi airport Wednesday evening where we met Francisco, who gave us all big hugs as if we’ve met before. It was actually such a touching scene. Francisco is a general surgeon at Queen Elizabeth Hospital who is currently doing research on rotavirus in the city. He and Enock, another doctor at Queens, drove us thirty minutes to Kabula Lodge. The drive was amazing. There were people walking up and down the roads, bustling markets, and kids running back home after school. Everything is so lively and colorful here. By the time we got to our new home, it was pitch black (since it’s winter, it gets dark at 5:30 so it feels like the day goes by so quickly). The view of the mountains from our place is really breathtaking. I don’t think I will ever get over it. Every time I see the view, I’m always amazed 

Day 2:

The next morning, we visited the Rice 360 office and were greeted by the Malawian staff working there. We walked over to Queens next door and met Prince, a licensed nurse who also works for Rice 360. Prince gave us a tour of the neonatal ward and the stark differences between their hospital and what we are familiar with is unbelievable.

The ward can house about 60 infants, divided into high-risk, medium-risk, and low-risk. These babies were premature and had so many different complications as a result. There are only 6 or so nurses in the ward during the day, making it very difficult to monitor all the infants. At night, there are even fewer nurses on duty (2 or 3). And during this time, many babies die because of the lack of constant monitoring.

We saw some wooden boxes side by side down the middle of the ward, which were called hot cots. These cots consist of a bulb and some basic electrical components which, when turned on, quickly heats the boxes and acts as make-shift incubators for the infants. The babies were so helpless, nestled in the hot cots with the warm glow of the light over them. Prince told us that these boxes were dangerous because the bulbs often overheat and shatter. The boxes themselves were also extremely unstable. I thought some of theme were going to break when touched. However, these boxes are still used by the staff because they are simple, can be easily fixed when broken, and can be made quickly in large quantities, making them the preferred choice to despite the perfectly functioning incubator that was collecting dust in the corner of the ward. None of the nurses knew how to use this incubator and preferred the unsafe hot cots instead. This really showed me how important it is that the medical devices given to the hospitals are simple to use and simple to troubleshoot, otherwise the staff will continue to use a more basic and less effective alternative.

Prince pointed out the heating lamps lining the walls above the infant beds. He laughed as he told us that the nurses turned on the lamps when they felt cold and turned off the lamps when they felt hot. There wasn’t a way to find the ideal temperature in the ward for the infants, and there is no way to adjust the temperature.

Prince showed us his office and we saw some vials with serum samples in a test rack and a small spectrometer in the corner. He told us that he is technically on vacation, but he is still working at the hospital because he is the only staff member who is able to test the infants for jaundice by analyzing bilirubin levels in their blood. There are so many infants that come to the hospital on a daily basis, and along with his other duties he has to test every single one of them for jaundice. It’s incredible.

We left the hospital with so much information, despite this being our very first visit. We realized that there were so many different directions we can focus our attention on:

1. We can improve the hot cots so that they are safer for the infants but still easy to use for the nurses.
2. The ambient temperature in the ward can be analyzed and a temperature monitoring and controlling system can be made so that the heating lamps are not turned on and off arbitrarily by the nurses.
3. There are only a couple of monitors for the babies that measure oxygen levels, heart rate, and temperature. These monitors are also only temporary, because they are part of an ongoing project and will be taken away in a couple of weeks. Simple monitors can be made for all the infants in the ward to make up for the lack of nurses.

These are just some of the ideas we came up with. I’m sure that we will come up with many more as we continue to speak to the nurses and hospital staff at Queens. I’m looking forward to speaking with Prince again because he is so insightful and knowledgeable. He was very straight forward about what the hospital needs, what was lacking, and what we as interns could focus on for our future projects.

Day 3:

The next day, (after a VERY long period of getting kicked off one bus because it wasn’t our ride and waiting another hour for our actual bus) we went to the Polytechnic school, which is about a ten minute walk from Queens. I was second-hand stressed because the students are currently studying for their finals (for a second, I panicked and asked myself if I have things I should be studying for too). Francis and Andrew (our Malawian mentors at Poly) gave us access to the engineering design studio so we could work on our devices that we brought from Rice.

I definitely found my home in that studio. The windows were all open so it was pretty chilly, but the workspace was awesome. They had everything we had back in our OEDK, including a laser cutter and multiple 3D printers. I could spend hours and hours just working on projects there. I love the space.

Also, across the street there are some amazing shops and places to eat. So far, our favorite place to eat is Spar and they have some AWESOME pastries.

I’m excited (and a little anxious) about presenting our devices this Monday to our Dean of Engineering, a US Aid, and faculty of Rice 360. But I am excited to be getting feedback and showcasing the models that we have tirelessly been working on. After next week, we will finally get to meet our Malawian interns and I cannot wait! I know they will have so much information and knowledge about problems being dealt with here. I’m excited to see what insight they will bring!

Day 4

We spent today exploring! We met Edson, an awesome driver (and even better photographer as we found out). He took us to try some amazing Malawian tea at Satemwa (about an hour drive away from Blantyre), and it was so good. I hate tea, but I bought so much!

He took us to a local Malawian restaurant that he always eats at and the food was so good (and so filling I ate way too much). We then went to a market and bought a few things so we can do our laundry (and adventure on it’s own, I just spent four hours getting drenched and washing my clothes).

We started preparing for Malawi in April 2018. Immediately after accepting the position, we began being bombarded with information. First, I met the other Malawi interns: Angela, Akshaya, Franklin, Sajel and Kristofer. (Angela, Franklin and I are all from Brown!). We then began working together to figure out what needed to be done in the two months before the trip. Mainly, we had to 1) Go to the doctor, 2) Make travel plans 3) Prepare the medical devices 4) PackWe started preparing for Malawi in April 2018. Immediately after accepting the position, we began being bombarded with information. First, I met the other Malawi interns: Angela, Akshaya, Franklin, Sajel and Kristofer. (Angela, Franklin and I are all from Brown!). We then began working together to figure out what needed to be done in the two months before the trip. Mainly, we had to 1) Go to the doctor, 2) Make travel plans 3) Prepare the medical devices 4) Pack

 

1) The first thing we took care of was all of our shots. Akshaya, Franklin, Akshaya and I bonded over our trip to Passport Health. We all had to get at least 2 shots (Typhoid, yellow fever) and malaria pills. I also made appointments to the dentist, the general doctor, and the optometrist.

2) Next, we met up with Dr. Leauteud to make travel plans. We all bought tickets to Houston from home and then to Malawi so that we could travel together. We also arranged housing plans for the two weeks after finals that we would be staying at Rice to prepare the medical devices. Next we met with a previous intern, Erik Wu, to learn more about Malawi. He was able to give us great advice on the culture and the environment in Malawi. His advice really helped us to pack clothes and other supplies. Erik was nice enough to make an entire guide for us in exchange for a bottle of Malawian hot sauce!!!

3) Six medical device projects (mostly focusing on neonatal and maternal care) were chosen to travel to Malawi. Since we had to recreate many of the devices split up the medical devices among the six of us. I took charge of working on the Cervical Cancer Training Kit with Sajel since I had worked on the project and knew a lot about it. The Cervical Cancer Training Kit is a low cost, interactive, and accurate medical mannequin of a woman’s pelvis. The purpose of the device is to train medical personnel to screen for cervical cancer. The model is made of low cost materials using 3D printing, and laser cutting. We had to make 3 more prototypes and fix 3 existing prototypes in two weeks. With dedication and planning, we were able to finish just before going home. We packed the models as well as we could (using bubble wrap, tape and boxes). Hopefully they will make it to Malawi in one piece (a great durability test)!

4) I went home for two weeks. In those two weeks I spent time with my family and I began packing for Malawi. It was really difficult to pack since there was a lot of things I wanted to bring and only two suitcases. After several lists and shopping trips, I was ready to go to Malawi.

 

 

I am very excited to see what Malawi is like! I have an idea in my head of what it will be like and I’m excited to see how it compares to real life Malawi. I’m also really looking forward to working on our projects and beginning new ones after needs finding at the Queen Elizabeth Hospital. After today, I will post updates every week on Sunday.

We stepped off of the Malawian airplane onto the tarmack and I was immediately greeted by a smiling face ushering me off the plane stairs and onto the tarmack. Looking out to my right, I saw miles of grassland until the land met the mountains. Never in my life have I stepped off of a plane and seen such untouched beauty. There was something so pure about it. The airport was a simple one room building with one baggage claim, a ticketing booth, and dozens of kind faces ready to help us. And, they all love to have a good time. After watching us take pictures for ten minutes, an airport employee approached me and asked if he too could take a picture with us. At first, I thought he was being serious, and then realized he was joking and I laughed, embarrassed. Here is to embracing the touristy-ness! 

Since leaving the airport, from our drivers to my mentors at Queen Elizabeth Central Hospital (QECH) where I will be working, we are always met with encouraging words and kindness. So far, we have been able to take a tour of QECH. We were given a tour of the maternity ward and neonatal ICU where I will be spending most of my time and met some of the nurses and doctors. The nurses and staff were eager to hear from us and I am so excited to learn from them for the next seven weeks. 

We also toured the Polytechnic University in Malawi where some of my fellow interns will be working and we met multiple university students. They were smiling from ear to ear as we asked questions about their studies and they asked us about Rice. One student answered all of our questions patiently, and after a few minutes sheepishly admitted that he must get back to studying for his finals which are going on right now for the Malawian students. I can’t wait to hear more about their studies and lives as students here. 

We are slowly settling into our home at the Kabula Lodge. Our home has an incredible view of the mountains and because of the clear air we get to see a full sky of stars every night. We took our first group trip to the grocery store and it was surprisingly so interesting to browse the rows of foods and find similarities and differences between US and Malawian grocery stores. After buying food and coming home, still exhausted from traveling this past week, I made the most gourmet of dinners: a peanut butter and jelly sandwich and Parle-G biscuits. My mom would be so proud. Let’s hope that this weekend my cooking improve as we continue to explore, learn, and immerse ourselves in this incredible country. 

Warm Wishes- 

Sajel 

Stepping onto the plane at George Bush International Airport in Houston, I took a deep breath and while I looked calm on the outside, on the inside my mind was freaking out. Up until now, the idea of going to Africa for two months was just that. An idea. Forms I signed for my program coordinators. Trips to the doctor to get my malaria pills. Late night talks with my mom about how I, someone who barely knows how to make pasta, would cook meals for a whole summer or do all of my laundry by hand. 

I know these things will all be learning experiences and help me learn and grow this summer alongside five other incredible interns. I am so humbled to have this opportunity! As part of this global health internship, there are three main parts:  

1. My main project in Malawi will be at Queen Elizabeth Central Hospital working with the Rice 360 CPAP team. These CPAP’s are being implemented in neonatal ICU’s all over Malawi to treat infants with respiratory distress syndrome and my project will be working closely with the team to find ways to analyze and improve this system to make it more successful. 
2. My fellow Rice interns and I have brought multiple different small technologies from Rice to ask for feedback on from doctors and staff here. These technologies include a cervical cancer training kit, a temperature monitor for mothers during labor, and a silastic silicon bag to treat infants with gastroschisis: a condition in which the infants intestines are born outside their body. 
3. We are also doing needs finding at the different hospitals we travel to. We will be taking notes on current challenges and gaps in treatment and care at different facilities and bring back ideas for new projects that students can pursue at Rice. 

My team started our journey on Monday, June 4th on an overnight flight from IAH to Frankfurt, Germany. I spent most of the flight trying to sleep and was unsuccessful so I instead started writing my thoughts down and most of it was my frenzied stream of consciousness. Upon reaching Frankfurt on June 5th, tired yet equally determined to step foot outside of the airport, we went out and toured the city for a day. We went on a boat tour of the city, ate the cheapest food we could find (they are right when they tell you how expensive Europe is…I had to pay 0.5 euros just use a bathroom in a store), and after a day’s worth of sightseeing made it back to the airport. The best part of my day honestly was the $8 I was able to pay the airport staff to take a hot shower at the airport. Best shower ever. It’s the little wins I tell you… 

That evening was our second overnight flight to Johannesburg, South Africa. Out of pure exhaustion, we all passed out on the plane and reached South Africa smoothly on Wednesday, June 6th. Those german airlines do know how to treat passengers well… everyone got an entire bar of chocolate as part of our breakfast! Once we got to South Africa, we had one more flight left from Johannesburg to Malawi. This two hour flight flew by and in no time it was time to finally step foot in Malawi. This long dreamed about idea just became real.  

Warm Wishes,

Sajel 

I can’t fall asleep in cars, trains, planes, or any other mode of transportation. So the thought of flying for 22 hours without the comfort of my perfectly horizontal bed is a little…daunting. But the chronic neck pain will be worth it. I’m still in shock that I will be flying out of the states to beautiful Malawi, Africa. I’ve never flown internationally by myself before, so this will be a very new experience for me. But I’m so thrilled to be doing this. Myself and 5 other interns have been preparing tirelessly the first few weeks of summer. We called the Oshmann Engineering Design Kitchen our home as we familiarized ourselves with the devices we will be bringing on our internship.

During the first part of our trip, we spent 11 hours in Frankfurt, Germany and it was such an amazing experience! It was so different from home; everyone was on biking  from one place to another, shopping with friends, sitting outside and eating, it was just so busy and I really loved it!

We took a boat ride down the Main river and seeing the city was unbelievable. The bridges we went under were so close to us, we had to duck our heads to avoid being knocked out.

It was a little bit of a struggle buying things (we did a LOT pointing and signaling) but we got some awesome food there (of course I had to get ice cream).

We are now currently sitting in the airport, waiting for our plane to Johannesburg, South Africa (another ten hour flight, another ten hours of chronic neck pain). It’s crazy to think that we will be arriving to Africa soon, I mean just yesterday I was home with my family just imagining what this trip would be like. Well, I’m excited to see what is in store for us tomorrow!