5. SimpleBallard

Posted on June 30, 2019April 19, 2024 by Alex Lammers

This week, my team had the chance to present at the first ever Malawi Innovation Pitch Night, and after the whole experience, I realized how little I have written about my main project in this blog. As a result, the following post is gonna be a little more technical so brace yourself for some facts and figures, but I promise every one of them is important. I’m super excited about the work we’ve been doing so far and its potential impact so please continue reading! 🙂

Around the world, premature birth is estimated to be responsible for 35% of all neonatal deaths, mostly concentrated in developing countries. In many government hospitals in Malawi, nurses lack a systematic approach to identifying prematurity in newborn babies. Instead, birthweight, an inaccurate estimate of gestational age, is primarily used. In some cases, a reliable number can be calculated from the mother’s last menstrual period (LMP), but frequently no record is kept of this information. Rather than using birthweight, and in cases where the LMP is not known, a Ballard Score assessment should be performed. The Ballard Score is a set of 12 neuromuscular and physical signs that when combined, produce an accurate estimate of gestational age. However, even in hospitals where nurses have knowledge of this assessment, it is almost never performed.

Wondering why this was, our team traveled to hospitals all over Malawi: Mulanje and Zomba District Hospitals, and this week, Kamuzu and Queen Elizabeth Central Hospitals. From talking with nurses, we identified two obstacles that make it difficult to complete the assessment for each and every newborn…

Many nurses lack the necessary knowledge to perform the assessment, especially in the case of the challenging neuromuscular procedures. Some nursing students told us the Ballard Score was only a single lesson during one day of their schooling, taught through pictures of the procedure rather than hands-on practice.
Nursing teams are often understaffed and short on time. As it stands, the Ballard Score assessment takes 15-20 minutes to both perform all 12 procedures and calculate a final score. This is too long for many hospitals where as many as 20 babies are born per day needing individual care and attention.

Looking at the factors surrounding these two separate problems, my team has developed two separate solutions…

Our first design, a training model for neuromuscular Ballard signs, aims to tackle the knowledge gap between the classroom and the assessment room. The model consists of a main baby mannequin with two attachment points for interchangeable limbs: one at the shoulder and one at the hip. Each interchangeable limb corresponds to a different neuromuscular sign, and can be adjusted to replicate the muscle behavior of a baby at different degrees of prematurity.

Once fully developed, we hope to implement our model as a teaching tool for nursing schools. Imagine a classroom filled with groups of students, each gaining hands-on experience through the use of our model with different attachments. A professor could walk around from station to station, providing advice and corrections for each of the different signs as they see the motions performed right in front of them. Ultimately, the model should provide nurses with the confidence to complete the assessment when working in a hospital setting.

Our second second design aims to reduce the time required to perform a full Ballard Score. Having not conducted years of research like Dr. Ballard, there is no way we could remove any signs from the assessment while still maintaining an accurate estimate of gestational age. Instead, we decided to cut down the amount of time it takes to record and calculate a result from the assessment while also making it quicker and easier to match observations to the score’s criteria.

In every hospital we visited, nearly every nurse carries a smartphone. After seeing this, we determined that one of the easiest ways to roll out our design to as many hospitals as possible would be through app development. Designing an app also allows for a user interface that cuts out a lot of the unnecessary information on the current assessment chart. Numbers are cut out entirely, as all calculations are performed in the background, simply producing an accurate estimate of age at the end of each assessment. Furthermore, the use of a sliding scale takes the diagrams of each sign in the current chart and consensus them into one changing image, letting nurses easily scroll until the image matches their observation of the real baby.

So many aspects of care for premature babies revolve around knowing their specific age. In addition to helping nurses save these precious lives, we believe our project has the potential to contribute to an even greater picture. Organizations such as Nest360º rely on accurate data when measuring the impact of their technologies on neonatal outcomes. With the most common estimate of gestational age being birthweight, reliable data surrounding premature births is difficult to obtain in developing countries. Furthermore, the paper records of many hospitals are either non-existent for individual births or difficult to sort through. Together, our training model and assessment app for the Ballard Score can become the start of a solution.

We fully realize that any prototypes we come up with in the next few weeks will no more than scratch the surface of this issue, but it is the potential for future work that excites me. What if the app could upload each assessment to a database? What if that database could be used to assess the impact of lifesaving technologies? What if that data revealed a need that had previously gone unidentified? By creating a solid foundation for others to build off of in the future, I feel that my team has an amazing opportunity to start something that truly matters.

– Alex

Bonus: Here’s some pictures from the rest of this week’s adventures…

So much chitenge! When a few us went to the market this Saturday for next week’s groceries, we got a little side-tracked and ended up buying an insane amount of this beautiful fabric.

On Sunday, we went back to Zomba to hike a mountain, and I fell fully clothed into a waterfall.

3. Time Flies

Posted on June 29, 2019April 19, 2024 by Shadé Flavien

Team Neostatic working on our Malawi Technology Innovation Pitch Night Presentation

Last week, we started by creating a proposal for our team projects with the intention of brainstorming and evaluating our solution in the coming days. However, when Dr. Leautaud arrived at Poly from Rice University on Thursday morning, we assumed it was to have a coaching session on our presentations for the pitch competition. Little did we know that we were auditioning for one of the team spots to compete in the pitch competition that afternoon. You could imagine our surprise to find out we needed to complete half of the engineering design process in a matter of hours. This really increased the pressure for my team and I to have solid plan and collaborate on every aspect of our design. When starting this internship, I had already anticipated our project timeline to be at an accelerated pace considering we are working full time on our projects, but with the Malawi Technology Innovation Pitch Night right around the corner, there was added pressure for each team to finalize their solution. Having already written our proposal, we had a few ideas of what our solution would look like, but in that time crunch, we brainstormed, selected a solution to pursue, created our presentation slides, and ended up giving a great presentation. Unfortunately, our group was not selected to present at the pitch competition, but from our experience, I realized the added pressure of a suddenly constricted time frame taught us that timelines are only a suggestion and there will be occasions where you have to improvise in order to accomplish a task. Despite being stressed along the way, this experience also taught me that everyone handles pressure in different ways and working with others requires you to be patient to understand their different approach (especially since I was a bundle of stress).

Despite a stressful work week, that weekend, Christina (one of the interns from Poly) invited us to attend the very first Biomedical Engineering Student Society (BESS) meeting. As we approached the room, immediately, we noticed uplifting music and large gathering of people present. What I thought would be a simple ceremony to mark a celebratory first appeared to be party. When we entered the room full of students, all eyes were on us (we may have been a tad late). After filing into the first available seats, the MC for the event announces that each of us will be coming up and introducing ourselves. This came as a surprise considering we had just come to attend the event and support a friend. After each one of us went up and stated the basic name, college, year, and major, the ceremony proceeded with a quiz competition between a handful of biomedical engineers in two teams. This turned out to be no ordinary quiz with both detailed technical and biological questions leaving me stumped majority of the time, but this proved no challenge for the Poly students who fired off answers like it was second nature. Overall, I thought this was a unique way to engage all the students and showcase the brilliant and resourceful students biomedical engineers are. Once the ceremony was over and we went to take pictures to commemorate the event, I saw the sheer number of students that took the time on a Saturday during one of the busiest times of the semester to show their dedication and passion for biomedical engineering. To be honest it was inspiring, especially the amount of time and effort the officers put in to organizing the event considering their schedules as interns, full-time students, or both.

As I recollect on the events that took place during the BESS meeting, I think about my position as the recently appointed treasurer of Society of Women Engineers (SWE). With another year approaching I hope to exude the same excitement and excellence for female engineers of every discipline as the students and officers of BESS have (maybe even steal the quiz competition idea because it was so much fun).

That’s all for now!

– S

Week 3: Healthcare Disparities Here, There, and Everywhere

Posted on June 29, 2019April 19, 2024 by Sally Yan

Part 1: Healthcare Disparities Here, There, and Everywhere

I’ve spent most of last week analyzing monitoring data for the PUMANI bubble CPAP in hospitals throughout Malawi. I was tasked to use the data to create graphs looking at the impact of power outages, time of death, temperature, and weight on mortality rates of CPAP. In addition, I was told to make separate graphs for this data for the hospitals in the Ministry of Health (MOH) system and the Christian Health Association of Malawi (CHAM system) since they are given separate reports. (MOH hospitals are public, government run hospitals that offer all services free of charge, serving 63% of the population while CHAM hospitals are private not for profit hospitals that serve 37% of the population.)

While this technically wasn’t something I was analyzing, what surprised me most was that the overall mortality of CPAP patients in CHAM hospitals was consistently lower at 20-30% than that of patients in MOH hospitals at 40-50% over the last two years. In addition, the mortality rates were consistently decreasing, and the number of patients put on CPAP was consistently increasing across quarters in the CHAM system while this fluctuated a lot for MOH hospitals. (This part may, however, be partly attributed to the fact that CPAP was introduced quite recently in CHAM hospitals and longer ago in MOH hospitals.) This suggests that private hospitals in Malawi provide better quality healthcare than public hospitals. (Granted, this is a relatively limited set of data covering only CPAP patients and looking only at the past 2 years). While technically CHAM hospitals only charge “nominal” user fees to cover the cost of operations, when explaining the healthcare system to me last week, Rodrick (the Poly intern who used to be a data clerk at a rural health center) seemed to imply that the fees were still exorbitant for most people, which I also read online. This public-private divide in healthcare reminded me of that in the United States.

Graph of overall neonatal mortality for CPAP patients in CHAM system

Graph of overall neonatal mortality for CPAP patients in MOH hospitals

Ben Taub Hospital in the Texas Medical Center

While the most apparent or, at least, the most discussed issue on the political stage regarding healthcare in the U.S. is the lack of affordability, another important factor that should garner more attention is the quality of the publicly subsidized healthcare that exists. For example, the quality of healthcare available at Ben Taub Hospital—a hospital that is part of the Harris County Health System and offers local and state level programs to help subsidize the costs of services for low income patients—is, to some extent, different from other hospitals in the Texas Medical Center. For instance, I remember our mentor for the Ballard Score training model project last semester—a neonatologist at the Texas Children’s Hospital—telling use that while the Ballard Score never needs to be used at TCH due to the abundance of prenatal care (including early ultrasounds that allow gestational age to be tracked) that expectant mothers receive there, it was actually, to her knowledge, used occasionally at Ben Taub since patients there have less access to prenatal care. Additionally, I remember one of my friends who volunteers there said that patients could occasionally be in the waiting room for twenty something hours before being able to see a doctor due to relatively low doctor to patient ratio. (This congestion is also a problem that occurs in Malawi by the way—the courtyards at QECH are filled up with families waiting for long periods before they receive treatment.) (Also, this is not to say Ben Taub is not an outstanding hospital by any means. When I was reading about the hospital online, I found out it was one of only three level 1 trauma centers in the TMC and had earned numerous awards.)

Anyways, this led me to think about other disparities in healthcare that Malawi and the U.S. have in common: namely, the difference in care available in rural and urban areas. In Malawi, the healthcare system has multiple tiers providing different intensities of care. At the top are the five central hospitals located in major cities (QECH being one of them) that serve as tertiary center with many specialties available including functional operating theaters. Under that are the district hospitals for the 27 districts, which serve as secondary centers. Because the healthcare system is structured such that the available (and relatively limited) resources (both equipment and human resources) first fulfill the needs of central hospitals before the other tiers, there are substantially less resources in district hospitals. As one nurse put it when we visited the Mulanje District Hospital, they only treat the conditions that they are able to treat there—an understandable statement considering they have no incubators, one radiant warmer that was not working during the visit, and even an occasional scarcity of thermometers. The trickle down model of resource distribution even more so affects rural health centers that have very, very few resources. As Rodrick said and I later read online, these have only a few nurses—sometimes even just one as Rodrick stated—and often no clinicians. While the CHAM hospitals aim to fill this gap of healthcare availability in rural areas, as previously stated, the costs are often prohibitive.

Although the U.S. does not have a centrally mandated healthcare system that purposefully imposes this type of disparity and admittedly has a lot more resources overall, this disparity between healthcare in rural and urban areas still exists. I honestly was not aware of this (and I suspect a good portion of the general public also isn’t) until Dr. Sonia Parra’s lecture on LUCIA—a training modeled designed by Rice 360 to improve cervical cancer screening and treatment—in the Introduction to Global Health course. It surprised me so much to learn that, like many lower resource countries, the Rio Grande Valley—located in the same state as the world’s biggest medical center—has a high incidence of cervical cancer due to the lack of availability of screenings for HPV. To further emphasize this rural-urban divide in healthcare, statistically speaking, the doctor to population ratio is almost 2.5 times higher in urban areas (at 31.2 physicians per 100,000) compared to rural areas in the U.S. (at 13.1 physicians per 100,000). The commonality in the health disparities between Malawi—with a government run healthcare system—and the U.S.—with an almost entirely privately controlled healthcare system—show that the question we should be asking about healthcare policy is not merely how do we make healthcare affordable and available for all in the U.S. but how do we make high quality healthcare affordable and available truly for all on a global scale.

Sources:

http://www.aho.afro.who.int/profiles_information/index.php/Malawi:Service_delivery_-_The_Health_System

http://www.health.gov.mw/index.php/2016-01-06-19-58-23/national-aids

https://www.malawiproject.org/zzz/hospitals-healthcare/

https://www.harrishealth.org/locations-hh/Pages/ben-taub.aspx

https://www.ruralhealthweb.org/about-nrha/about-rural-health-care

Part 2: Fun Pictures from this Week

I realize this was more of an op-ed than a blog, so here’s some fun pictures (and captions) highlighting last week’s adventures.

Up-close snapshot of elephant from safari at Majete wildlife reserve (pc: Alex Lammers)

Sunset yoga pose during stop on road back from Majete wildlife reserve

Group photo in front of beautiful sunset landscape on road back from Majete wildlife reserve

Week 3. Getting to Work, an Alternative Approach

Posted on June 24, 2019June 24, 2019 by Hannah Andersen

This week I’ve been deconstructing my perception of productivity and work. Western cultures such as the United States have a particularly intense approach to work, relative to other countries. We emphasize productivity, efficiency, speed, and punctuality. I grew up seeing myself as a strongly Type A personality, as most Rice students are. I value structured schedules, and I feel infinitely bad when I’m late to a meeting. American culture really lends itself to Type A personalities: Everything is incredibly streamlined. When I go to Starbucks in the United States, there is a predetermined script, and this script barely deviates each time.
“Welcome to Starbucks, what can I get you?”
“I’ll have a grande iced caramel macchiato.”
“Can I get a name for that order?”
“Hannah”
“Thanks, Hannah, we’ll have that right out for you!”
It’s essentially the same exact words every time, no matter what city I’m in or who’s working the register. This makes the interaction super fast and maximizes both the amount of customers Starbucks can serve and the amount of errands I have time to run in one day.
Things are less streamlined here in Malawi. Last Sunday, we shopped for groceries at the Blantyre market for the first time. It was nothing like any grocery-shopping experience I’ve ever had before. For one thing, you need to talk to a completely different person for each item you want to buy. One woman will sell you tomatoes from her beautiful, shining tomato-piles on the sidewalk, then you’ll buy rice from the man at the nearest rice-booth, then you’ll attempt to haggle for oranges (They tend to ask for more money from foreign-looking people like us. 500 Malawian kwacha for one orange? Heck no. We’ll buy them for 100 MWK each, please and thanks). It was great, because everything was so much cheaper at the market than it was at the grocery stores we’d been using before. But, if I’m being honest, the bustle and chaos of the market was a bit much for me. I’m an introvert, and many people compounded with a lot of stimulation is difficult for me. I’m used to shopping alone. In fact, I love grocery shopping in the US. It’s relaxing to take my time perusing each isle in peace, alone with my thoughts. But “alone” is not something that exists in the shopping world of Malawi.

From grocery shopping to scheduling important meetings, everything that the US streamlines is approached differently in Malawi. From the market to the work-place, the pace here is different, and less streamlining demands more focused human-to-human interaction. Based on everything I’ve said so far, it shouldn’t surprise readers to hear that my introverted, Type A self has been struggling with an increased demand for engagement with my surroundings and a more culturally laid-back approach to productivity. I’m used to having each day scheduled out down to the minute, from dawn until 2am. That’s just the life of an engineering student at Rice. However, I quickly learned that my approach to work is different from that of my teammates. As someone who’s been through the whole engineering design process several times before, I thought that I was supposed to be a leader of my team. I spent our whole first week pushing them to match my pace and get as much done each day as we could. Unsurprisingly, I felt some resistance. I know what it feels like to be a leader who is failing to maintain investment from their team, and that’s exactly what I felt during the first week. I was struggling to change the pace that I have been socialized for 20 years to maintain.
During last week, week two, we had a pretty atypical work schedule. On Wednesday afternoon, Dr.L, Karen, and Raj from the Rice 360 office in Houston showed up and spent the day in the design studio. All the Rice interns were so excited to see them, especially since we know that Dr. L’s time at Rice 360 is ending soon. She immediately brightened up the room with her warmth, and we were quick to embrace her in a group hug. It’s an understatement to say that we’re going to miss her so much.

Dr. L and I wearing our matching Rice quarter zips! This photo was taken shortly after all four of us Rice engineering interns attacked her with a group-hug. 🙂

Another atypical event from last week occurred on Friday afternoon, when a few dozen kids showed up in the design studio. Educators at a secondary school were collaborating with faculty at Poly to show secondary school students around the university. They came into the design studio and asked us all to talk to the kids about our work as engineers. Apparently, it was all an effort to convince many of these kids that their educations didn’t have to end after secondary school; College could be a meaningful and accessible opportunity for them. Educational outreach is very near-and-dear to my heart. It was a lot of fun to watch all the interns talk to the kids about our projects and show off various technologies in the design studio.

While some interns were showing the secondary school kids the laser cutter, lighting up Arduino LED circuits, and talking about our projects, I decided to stop thinking about how stressed I was about my team’s progress and let myself goof off a little. I noticed some scrap wood near the laser cutter and thought it would make for nice pictures of Nimisha and Joel. 🙂

As fun and exciting as all these schedule deviations were, I won’t sugar-coat the fact that they were interruptions. While the fact might be that this week was full of interruptions, the truth is that these interruptions were actually a blessing in disguise. They were completely necessary for me to learn how to slow down and engage with the world around me. I had been struggling with a socialized pressure to work quickly, efficiently, and maximize productivity, and I tried to force a team of Malawian and Tanzanian interns to match my pace. By being forced to slow down, I was given the opportunity to take a breath. I was able to spend some time goofing off with my team and some of the other interns, and it made me feel so much more comfortable in the design studio. Paradoxically, these interruptions actually made my team more productive.

This picture is dedicated to Karen, who was super excited to hear that the engineering design process officially condones sticky-note usage for brainstorming sessions.

A happy team is a functional team, and after forcing myself to slow down, I could feel my team start to meet me in the middle. I tried to impose an American standard onto an international team of engineers, and I am now learning from my teammates that a western approach to work and productivity is not the only path to success. By slowing down, we are given the opportunity to truly engage with each other, our environments, our clients, and ourselves. As a biomedical engineering student with a future career in global health, learning how to slow down and engage is critical. Like I said to the Biomedical Engineering Student Society when Christina asked me to speak at their inaugural event last weekend, it takes a particular type of person to study bioengineering, as opposed to other engineering fields. Bioengineers care about people. We want to help, to serve. It’s ultimately a love for our communities that drives our studies and our successes, and in order to truly serve our communities we need to learn how to slow down and authentically engage ourselves in the people and places around us.

BONUS CONTENT:

All the engineering interns from MUST, Poly, DIT, and Rice, jumping for joy with Dr. L, who will be dearly missed. <3

4. Getting Invested

Posted on June 24, 2019 by Alex Lammers

My mother is an elementary school music teacher. Walking into her classroom, you can see walls plastered with posters of her students’ favorite artists right alongside portraits of Beethoven and Mozart. From hearing her talk about teaching and even being one of her students myself, I’ve come to realize a central philosophy in her classroom: the most important component of education is getting students invested. A kid isn’t often motivated to learn piano so they can play “Ode to Joy,” they instead start by hammering out the melody of their favorite pop song. By first allowing the opportunity to explore and then helping a student imagine future possibilities, a teacher has created a life-long learner.

This past week, I heard a similar message when talking to Juliana, a lecturer at the Polytechnic who helped bring in a group of secondary school students to visit the design studio. She explained that there was a common mindset among young Malawians that their education ends once they graduate secondary school. By bringing these first-years to the studio, they can begin to imagine the exciting possibilities and endless opportunities that wait for them in the field of engineering.

Earlier that day, I was talking with my teammate Rodrick about what he planned on pursuing after his graduation. In addition to launching his own company and becoming an entrepreneur, he wants to focus on youth outreach centered around engineering. When we later heard that a student group would be visiting the studio, he immediately began setting up an Arduino and coding a mini light show. The same instant the LEDs began to light up, so did the faces of those students. Looking around the room, I witnessed the design studio come to life. Each intern from the Poly had taken to their favorite machine in the room and began sharing their passion for design. Questions could constantly be heard in Chichewa, and everywhere people stood crowded around screens full of code. At the laser cutter, the students knew not to stare into the bright light that sliced through wood like butter, but nobody could help themselves from sneaking a quick glance… watching your own design be translated from computer to reality is just too exciting.

On Saturday, we were invited to the kickoff event for the Biomedical Engineering Student Society (BESS). With the Poly’s first class of biomedical engineers graduating this year, the room was full of passion and an energy unlike that of any student organization meeting I’ve been a part of at Rice. Between each item on the agenda, an MC kept this energy alive while a DJ blasted tunes. Students gave presentations on the work they had done in the design studio, and encouraged their peers to take advantage of this amazing resource. As a student said, it’s one thing to learn a concept in a classroom, but applying it to a real-world project is completely different. Not only does the experience allow you to further develop and test your understanding, but the feeling when you see all of your hard work benefit another is unparalleled.

Towards the end of the event, Christina (one of our fellow interns from Poly) asked if one of us could provide a view of the bioengineering major at Rice. Hannah, being the bravest among us, got up and shared her experience with the classroom. After touching on the details, she began to dive into the reason people become bioengineers: to help people. As the statement resonated with me, I looked around the room and saw heads nodding with murmurs of agreement. In that moment, it became clear that we all shared this common perspective and had become invested in making this world a better place to live. At some point in time for all of us, the subjects of math and science had been connected to a purpose. For me, it was a summer camp. For Rodrick, it was an introduction by a teacher. For the students that visited us on Friday, hopefully it will be their trip to the design studio that keeps them imagining what’s possible.

– Alex

My team hard at work preparing for next week’s pitch competition in Lilongwe. (from left to right: Rodrick, Racheal, Me, and Betty)

How excited we all were to see Dr. L again!

The most beautiful sunset I have seen in my life! (pic creds to Shadé)

4. “We Make Do With What We Have”

Posted on June 24, 2019July 1, 2019 by Kyla Barnwell

Hello everyone!

I cannot believe another week has flown by. We have about 1 month left in Malawi and there’s still so much to do! The first few days of the week consisted of heavy research and compiling of notes. Liseth and I reviewed some of the fundamental principles for interactions with devices and created a list of key aspects to pay attention to while we observed in the wards of Queen Elizabeth Central Hospital. Along with detailing the day-to-day flow of the neonatal and maternity wards, we are paying extra close attention to the user experience while using a particular technology based on the fundamental principles we have learned. We are also taking note of the proximity of equipment and machines, routines of doctors and nurses, communications/interactions between doctors and nurses, how the ward environment shifts throughout the day, and if there are any improvised solutions utilized by doctors and nurses within the ward.

Our first observational day was spent in the Nursery High Dependency Unit (HDU), where 0 to 6-month-old babies who require less intensive treatment are looked after. We spent the morning shift in this ward, attempting to document all of the activities in as much detail as possible. The ward itself was not very large in size and held about 16 beds all in close proximity to one another. Mothers either sat on low stools next to their baby or on the floor nearby. While we were observing, Pumani bCPAP machines (a Rice 360 technology) and oxygen concentrators were in use, so we got a better understanding of how these devices work to help babies breathe. The ward also had 1 multi-parameter patient monitoring machine that was rotated around in order to check pulse and oxygen saturation of the babies 4 times a day. The most informative information from the day did not come from observations, but from talking to the main clinician for the ward. She told us how efficiently they work even with the limited amount of resources available. It was amazing to hear some of the short-term solutions the ward had utilized in order to get the job done. From using duct tape to seal off the exits of leaky oxygen concentrators to creating a makeshift oxygen splitter from a surgical glove, hearing about the creative equipment improvisations was definitely the most surprising part of the day. The main clinician mentioned how they can really make the most out of every resource here in order to save many lives. In her words, “We do not have much, but we really make do with what we have.”

Our second observational day was spent in the Nursery Intensive Care Unit (NICU) which mostly consisted of patients who were born premature. We observed even more Pumani bCPAP machines in use and even had the opportunity to ask a CPAP nurse some questions about the device. The most glaring observation from this day was how the beds inside radiant warmers were holding 2 babies in 1 bed. At first, Liseth and I thought it was due to the lack of functional oxygen concentrator machines that babies had to be positioned close together. But after speaking to one of the doctors, we learned that the issue is really a shortage of available beds. The clinician described how at times, they must fit up to 4 babies side-by-side together into one radiant warmer, which must pose a serious risk for infections. I plan to investigate into this issue further and determine why incubators (which were available, but not in use) were not being used as an option to place babies.

An inside view of the neonatal intensive care unit at Queen Elizabeth Hospital. Incubators are off to the side and rarely get used except for transportation of babies

Although we worked hard, this week also had very fun moments as well. Dr. Leautaud, Karen, and Raj came from Rice 360 in Houston to visit us in Blantyre! We had a great time sharing meals together and discussing interesting highlights of the internship so far. On Sunday, our group ventured out to the Majete Wildlife Reserve in Chikwawa. We took safari rides through the park and got to see elephants, impalas, warthogs, baboons, crocodiles, and hippos in their natural habitat. It was a wonderful opportunity to get so close to animals that I would usually only get to see inside of a zoo. Our tour guide on the trip was very adventurous and funny. He managed to get a herd of elephants to chase after our safari car! One of my favorite moments from the weekend however was stopping on the side of the road on the way back to admire the breathtaking view of mountains bathing in the sunset. We took many pictures together and were amazed by the beauty of the landscape.
This week our group will be travelling to Lilongwe for an engineering design competition. We will be there from Wednesday until Friday, so I’ll post more updates about the event in the next blog. Thanks for reading and I’ll see you next week!

We got up close and personal with many elephants this day! It was amazing!

Us on the safari car at Majete National Park!

3. The Future is Female

Posted on June 24, 2019July 30, 2019 by Nimisha Krishnaswamy

As I am writing this blog post, it is June 23^rd a.k.a International Women in Engineering Day!!!! To honor this day and simultaneously reflect on the week that just passed, I want to talk about women. Women in engineering. Women in education. Women in Malawi. Women in the United States. Women who have mentored, encouraged, and inspired me as I pursue a degree with not nearly enough female representation.

On the surface, most of our week revolved around brainstorming new ideas for our main projects (my team’s project is a continuous maternal temperature monitor, which we are now planning to update to be a temperature + pulse rate monitor) and finalizing our solution to begin prototyping in the coming weeks. However, after some reflection, I also noticed that many of last week’s events had an underlying running theme: women’s empowerment.

It first started when Dr. Veronica Leautaud (our Rice 360 mom, who we lovingly refer to as Dr. L), the Rice 360 Director of Education, flew in from Rice and came to visit us at the Poly design studio on Wednesday. Dr. L is one of those people that immediately embraces everyone with open arms, and makes you believe you can achieve anything you set your mind to. She has a powerful presence. At the poly, each team got to pitch our final solutions to her in a short 3-minute presentation and hear her thoughts. She was able to give each team real, constructive feedback while remaining unwavering in her support for our ideas, no matter how far-fetched they might have been. She reminded me that being a woman in engineering means more than just demonstrating technical expertise; it means lifting people up through love and positivity.

*All the interns with Dr. L when she visited the Poly!*

Later that day, I got to watch as Karen Turney, the Rice 360 Director of Development, filled the design studio with a sense of excitement and curiosity. Karen is energetic and encouraging, but most importantly she has a seemingly insatiable curiosity and is an expert at getting anyone to open up about their passions and life goals. I couldn’t help but watch in wonder as she made her way across the room, talking to every single intern in the studio, asking them questions about everything: from family life to hobbies to long-term goals. She makes everyone feel important, like we all have our very own unique story to share with the world. And although she is not an engineer, she reminded me that being a woman in engineering means being unafraid to ask the “silly” questions and taking the time to learn from and grow with your peers.

On Friday, Mrs. Juliana Nyasulu Masi, a lecturer at the Poly, brought in around 20 bright-eyed 1^st year students (1^st year = 9^th grade in the US) to the design studio. While the students walked around excitedly watching interns use 3-D printers, laser cutters, and Arduino circuits, I got the chance to talk to Juliana about her experience being a female lecturer at the Poly. I only spoke to her for a few minutes, but it was enough time to see just how passionate she was, not only about her subject (she teaches C++ at the Poly), but also about inspiring and recruiting the next generation of engineers. I didn’t get the chance to ask for exact numbers, but I’m almost certain she was one of very few women graduating with her degree, and one of even fewer women lecturing a programming course at the Poly. She reminded me that being a woman in engineering means paving the way, not just for yourself, but for all young girls who dream of being an engineer when they grow up.

*1^styear students visiting the design studio (everyone was so excited to watch the laser cutter do it’s magic!!)*

On Saturday, my amazing teammate Christina invited all the interns to a Biomedical Engineering Student Society (BESS) event that she helped organize. Christina, a Biomedical Engineering student at the Poly, is the Diploma Representative of BESS. The event was a great success: it had project presentations from current Biomedical Engineering students, a fun and interactive engineering-themed quiz competition, and an awards ceremony for the best performing students – all tied together by a talented DJ who periodically mixed music to keep the room entertained. As I looked around, I quickly noticed that I could count the number of women in the room on my two hands. Still, it was so humbling to be surrounded by so much talent (including the first ever graduating class of Biomedical Engineers at the Poly!!). Christina, the only woman on the BESS board of representatives, managed the event with so much grace and confidence. She reminded me that being a woman in engineering means being unapologetically confident in yourself and not shying away from the spotlight.

*My teammate Christina speaking at the BESS event she helped organize*

Finally, I want to thank my fellow interns, the people who I have already learned so much from and who continue to inspire me every single day. Of the 7 Rice interns, 6 of us are girls. We are still learning what it means to be women in engineering and other healthcare-related industries, and how we can speak up to support other women trying to enter similar fields. They remind me that being a woman in engineering means learning through trial & error and taking your time to find your place and your voice.

As a woman in engineering, I’ve always been aware of how lucky I am to be surrounded by powerful, intelligent women who inspire me to follow my dreams. I’ve also always been aware of the odds against me. The odds against all the women around me. If there’s one thing that this week reminded me, it’s this: I’m here, in Malawi, working on meaningful and impactful engineering projects, and I’m going to defy the odds.

***completely unrelated bonus content***

*Continuing our tradition of eating icecream at Mikos for lunch every Friday. Special shoutout to Alex (he may not be a woman in engineering, but we love him regardless!!)*

*All the Rice + DIT interns after our safari this weekend at the Majete Wildlife Reserve*

— Nimisha 🙂

2. Week of Firsts

Posted on June 18, 2019June 29, 2019 by Shadé Flavien

Somehow, a week already flew by in what felt like a matter of hours! This past Monday was officially our first day of work at the Polytechnic Design Studio. We had a warm welcoming introduction from the Dean of Engineering at Malawi Polytechnic University along with a few guest lecturers on the engineering design process with an emphasis on meeting the needs of the people. Our first assignment as interns was the “Just in Time” design challenge. Each team was a group of four student (one from each school) and the challenge was to drop a ping pong ball from one meter, and have it reach the ground in exactly 30 seconds. My teammates, Cholo, Maureen, and Chisomo, created a tube-like path to delay the ball before reaching the bottom. Unfortunately, our delicate paper, tape, and cardboard structure only took the ball 12 seconds to reach the bottom, ultimately failing the challenge, but winning with the longest time out of the other teams! I thought this was a neat way to ease into working with new people on a simple engineering project while observing the team dynamic.

On Tuesday, the we had an engineering skills crash course in Arduino and 3D Printing. In the 3D printing group, our mini project was to design and print a functional syringe. Learning the Solidworks design software seemed simple enough however, the difficult part was deciding how to configure the shapes to match those of the syringe. In the end, we were able to 3D print and assemble the entire syringe. I was proud of the way our group worked together to help one another and complete the finished product.

First hospital visit at Mulanje District Hospital

Later that day, Hillary (the Poly program coordinator) assigned us our teams and team projects before our hospital visits the next day. My team (Maureen, Cholo, and Tebogo) was assigned the neonatal hypothermia prevention in the transport between labor and neonatal wards. That evening, we each conducted background research and formed a set of questions to ask when interviewing the nurses at each hospital as well as specific areas to keep an eye out for. The next morning, we compiled all the questions before leaving feeling confident we would be able to get all the information necessary to complete the project. Over the next two days, we visited the neonatal, postnatal, and labor wards at Mulanje District Hospital and Zomba Central Hospital. Despite being welcomed into each hospital, I felt somewhat uncomfortable intruding in an intimate place where people go to seek help. None the less, we were grateful for the opportunity to observe the hospital’s daily activities as well as gain the staff’s perspective and protocol on the transport of hypothermic neonates between the labor and neonatal wards. Both visits allowed us to gain valuable insight into the realistic situation nurses experience and appeal to their specific requests and needs. From our visits, we discovered the main therapy for

hypothermia is kangaroo mother care (skin to skin contact between neonate and mother) with the occasional use of a radiant warmer if it is working. During transport the nurses currently, wrap the premature baby in dry cloth and carry it between wards. Despite the relatively short distance, the neonates still experience drastic decreases in temperature, increasing the risk of mortality. One key aspect we otherwise would have overlooked without interviewing the nurses are the premature babies born via C-section which occurs in the theater (operating room) significantly farther away from the neonatal ward than the labor ward. With this knowledge, we would need our solution to maintain the neonate’s temperature for a greater duration that anticipated.

Being able to visit two hospitals allowed us to split up into pairs and cross reference our findings. Because there was a lot of information we needed to gather within a short amount of time, we realized our initial hospital visit to Mulanje District Hospital was not as successful as we had hoped. We left with our answered questions only leading to more questions. Luckily, our teammates returned to Mulanje the next day while we visited Zomba Central Hospital and obtained all the information we needed. Both hospital visits allowed us to confirm our findings and interpret the information ideate possible solutions. Although we have only completed the research stage of the engineering design process, we are eager for the possible solutions to our project.

After a full week of work and travel, the interns and I took the weekend to relax and explore some of the local areas. Unfortunately, it rained (more of a continuous mist) all day so we did not venture far out of the lodge except in search of food. However, on Sunday we went attempted to go grocery shopping at the local market in Blantyre. Every day on the way home, we drive by the market which only piqued my curiosity further considering my initial thought of a market is mainly produce. However, once we reached the market there were people selling everything imaginable at every turn. The market itself seemed endless with vendor’s stall forming makeshift hallways (kind of like a fort made of scrap materials). Despite a few odd stares, I would say the trip was a success, but I really need to learn some more Chichewa besides “muli bwanji” (how are you) and “zikomo” (thank you).

Well that’s all for now but let’s see what new adventures are bound to happen in coming week. Stay tuned!

– S

2. Looking Closer

Posted on June 17, 2019June 23, 2019 by Nimisha Krishnaswamy

Going into our first week of work, I felt excited and a little nervous for what was to come. I wasn’t sure how the technologies we brought over from Rice would be received or what to expect from the hospital visits. I wasn’t sure I would like the food (I’m usually a pretty picky eater) or if I would click with the Malawi interns in the same way that I have with the Tanzania interns. So many questions but not much time to worry about them…

June 10^th, Monday – Anything is possible!

Our first day at the Poly began with a warm welcome from the Polytechnic’s Dean of Engineering and a few presentations on the engineering design process and human-centered design. We also had mini brainstorming session: we had to write down as many uses we could think of for bricks. After a minute of frantically scribbling down uses, we shared our ideas with everyone. Some of my favorites were “a giant game of Jenga” and “a SUPER effective paperweight”. This small activity reminded me why I love engineering so much. No idea is a bad idea. Anything is possible!! I’m going to try my best to carry this mindset with me as we start brainstorming for our main projects.

Later in the day we each presented the technologies that we brought from Rice to the rest of the interns and administration at the Poly and it was so nice to hear everyone’s thoughts and feedback on our projects. We ended the day with a design challenge where each team had 2 hours to create a contraption that would allow a ping pong ball to fall to the floor from a height of 1m in no more than and no less than 30 seconds. My team tried to make a kind of maze that the ball could fall through for 30 seconds before hitting the ground. Ultimately our ball fell in 5 seconds, but I think we deserve an A for effort. It was really good to get our ~creative juices~ flowing and get to know some of the other interns.

*All the Rice + DIT + Poly + MUST interns ready to start work!*

June 11^th, Tuesday – Learning

Tuesday was dedicated to refreshing our knowledge on essential engineering design skills like Arduino, SolidWorks, 3-D printing, and laser cutting. Since I was already familiar with the basics of Arduino and laser cutting, I spent most of my time learning how to CAD on SolidWorks from Hillary (our internship coordinator at Poly). Our mini-project was to design and assemble a functional syringe. I’m so excited to see how all these new skills will translate into prototyping when we start work on our main projects.

*The outer and inner parts of the syringe I designed on SolidWorks*

Later that day, Hillary sent us our team and project assignments so we could begin preparing for hospital visits. I’ll be working on a continuous maternal temperature monitoring device with Joel (DIT), Boniface (MUST), and Christina (Poly).

June 12^th, Wednesday & June 13^th, Thursday – Hospital Visits

Wednesday and Thursday were probably the most eye-opening days of this week, and the inspiration for this blog’s title – Looking Closer. We went to Mulanje District Hospital and Zomba Central Hospital where we visited the nursery, high-risk ward, kangaroo ward, labor ward, and Physical Assets Management. The nurses we talked to were so experienced and knowledgeable, and their dedication is so admirable. It was amazing to see the things they achieve with the limited resources they have. Getting to actually walk in to the different wards, I started to look closer at all the ways nurses “improvise” when they don’t have something you might easily find in a high-resource hospital. One sight that stuck out to me in particular was a make-shift wheelchair made using a common plastic chair and some wheels tied on with rope. The high-risk ward was a small, hot room (the whole room is kept at a high temperature for the premature, hypothermic babies since there are no incubators in use) with radiant warmers lined up against one wall. Each warmer (meant for 1 baby) fit 2-3 babies and had a single patient monitoring system with a temperature probe, which meant all 3 babies could not be monitored at once. Still, the nurses did everything they could to make sure all the babies got the attention they needed. Through all my observations, it was clear that there is no lack of creativity, dedication, or intelligence in these hospitals, simply a lack of resources.

*Broken Multi-Parameter Patient Monitor, my team hopes to create an affordable, wearable version of this device.*

Listed below are some of my main takeaways from both visits:

Lack of nurses – Often times, the neonatal ward has around 20-30 babies but only 3-4 nurses. The labor wards get approximately 20 deliveries per day, but only 2-3 nurses to look after the mothers. Because of this, nurses are usually more preoccupied caring for the large number of high-risk premature babies being born and mothers may end up going unmonitored for certain periods of time.
Thermometers are limited and break often – The labor wards usually have only a couple of thermometers to monitor all the mothers’ temperatures regularly. In Zomba, the labor ward had NO thermometers. This left nurses relying on using their hands to check whether a mother has a fever. There is definitely a need for continuous monitors to help nurses quickly monitor all patients.
Donated devices aren’t always useful – most of the devices we saw (incubators, oxygen concentrators, suction machines, etc.) were either broken or not being used. Donations come from many different manufacturers, often without manuals, and nurses don’t have the time to learn to use these new devices from scratch. Instead, nurses become comfortable relying on their experience and intuition and their clever “improvisations”.
Hospitals are focusing on educational material – In both hospitals, the hallways were decorated with colorful signs and depictions to educate people about things like the importance of STI testing and breastfeeding. I found this to be an interesting contrast to the clinical white walls in most American hospitals.

*Broken oxygen concentrators, suction machines, radiant warmers, patient monitors, and ultrasound machines in Physical Assets Management a.k.a the “equipment graveyard”*

As a bonus, on the way out of Mulanje District Hospital, we got to see Mount Mulanje and it was so tall that the peak hid from our view behind clouds. Shadé, Alex, Liseth and I are determined to climb it – hopefully we can convince the others to come with us!

June 14^th, Friday – Common Ground

On Friday we worked with our teams to compile all our findings from the hospital visits and give a short presentation to the rest of the interns and staff about what we learned. This was the first time I got to work with my whole team, and we had so much fun getting to know each other while also being productive! We ended up talking about the similarities between South African weddings and Indian weddings and it reminded me that although we all come from different places, there is so much we have in common.

June 15^th, Saturday & June 16^th, Sunday – Good Food and Good Company

This weekend we visited a local market to put our bargaining skills to the test (we weren’t very successful…), cooked some good meals, and spent quality time watching the latest episodes of Black Mirror together.

*Trying Nsima (staple food in Malawi) at Pamudzi, an authentic Malawian restaurant. Everything tasted so good!*

Ending the week, all my initial worries have vanished. Our technologies from Rice were received well, the hospital visits were educational and inspiring, and I love the food here. I’m already starting to get to know my team and we are beginning to form a good team dynamic to start working on our project. Get ready for some serious brainstorming sessions next week!!

— Nimisha 🙂

3. We’ve Hit the Ground Running

Posted on June 17, 2019June 17, 2019 by Kyla Barnwell

Hello everyone! Although its only been 1 week, I have a ton of new experiences to share. In the Rice 360° office at Queen Elizabeth, Liseth and I have begun compiling the introduction and methods section for our reports concerning the use environment of the maternity and neonatal wards. We are currently awaiting permission to have full-time observational access, but we have been able to tour both wards and ask some questions about the day-to-day flow of the areas. While touring, we paid special attention the use of oxygen concentrator machines and incubators. We gained a much deeper understanding of how both of these technologies functioned specifically within the wards. The neonatal ward had many incubators, but they were off to the side and not in use. Through chatting with a nurse, we discovered that these incubators mainly serve for transportation of the babies to and from different wards, as some of the display interfaces of the incubator machines are very complex. As for the oxygen concentrators, we learned that it was difficult to determine whether or not a machine was outputting the correct oxygen levels for a patient. There were a number of oxygen concentrators around where the functionality of the machine was unknown.

The incubators at Queen Elizabeth Hospital. One of my goals while here is to assess the usability of the Rice 360 Incubaby prototype-a new low-cost neonatal incubator.

Incubators seemed to not be in use at Mulanje District Hospital and Zomba Central Hospital as well. In the middle of the week, we took visits to these hospitals within Malawi to tour the neonatal and maternity wards and ask more questions about operations. We learned that Mulanje District Hospital had no incubators at all and instead relied on skin-to-skin contact via Kangaroo Mother Care or radiant warmers to warm up cold neonates. At Zomba Central, radiant warmers were also the preferred heating technology. Speaking to nurses at these hospitals about some of the challenges they faced while on the job was extremely revealing. Many helpful insights came about by asking the nurses what they had to improvise around the ward due to lack of resources. It was incredibly eye-opening to see the unique ways in which the nurses work with what they have in order to care for their patients. The most substantial observation that stuck with me this week was how continuous monitoring systems were rare or nonexistent in these hospitals. This is something that I have never thought about before, as when I envision a hospital, I automatically picture a patient hooked up to machines that are constantly recording and measuring patient vitals. The only ward that had a multi-parameter patient monitor was at Zomba Central. They have 1 machine for the neonatal ward, a ward that can have up to 40 newborns at one time. When it comes to assessing measures such as blood pressure, pulse, heart rate, and temperature, consistent monitoring can make a drastic difference in health outcomes.

Our visit to Mulanje District Hospital-unfortunately Liseth and I missed the group picture 🙁

Mulanje District Hospital is right beside Mount Mulanje-the tallest mountain in Malawi with a height of 3000 meters!

Liseth and I are continuing our work with documenting the use environment of Queen Elizabeth this week and we are preparing to conduct our structured interviews with nurses about the Rice 360° Incubaby prototype. Incubaby is a double-walled incubator for neonates that automatically regulates to maintain a baby’s temperature. The prototypes will be arriving at Queen Elizabeth next week and we will be conducting interviews about the device with nurses to assess the usability of the device and identify areas of improvement. We also look forward to joining the other interns stationed at Malawi Polytechnic as they tour Queen Elizabeth hospital this week. This will give us more chances to learn in-depth information about the technologies implemented in the maternity and neonatal wards. Overall, it has been very cool to think about how machines and equipment actually work within their clinical setting from a Human Factors’ perspective. We really hope the information we are gathering will help Rice 360° develop systems that are appropriate and optimized for use in these hospitals so they can make a real difference in patient care. Thanks for reading and I’ll check in again soon!

Reports from Malawi | Summer interns

Rice360 Institute for Global Health Technologies

Month: June 2019