On Thursday Jacinta and I started teaching a Medical Equipment Troubleshooting Workshop at the Malawi Polytechnic University. This class, modeled after an advanced Bioengineering Lab at Rice focuses strongly on hands-on skills. Thus, while we have powerpoints and quizzes to work with, the main thing we have needed to prepare is the equipment itself. We did not bring any machines from the States due to the fact that we wanted to make the course realistic: showcasing medical devices that actually need to be repaired here in Malawi. The Malawian health system has its own equipment care program called PAM (Physical Assets Management). They not only inventory all of the devices that come into the hospital system, but they are also responsible for maintenance and repairs. Thus to PAM we went in search of medical devices to use in our course.

On our tentative list included an Oxygen Concentrator, CPAP, Microscope, Refrigerator, Suction Pump, and Centrifuge. Oxygen Concentrators are ubiquitous in the Paeds wards at Queens, so we knew we would cover those. Also, last week we spent a lot of time repairing CPAPs, we felt confident to teach on that. As for the other devices, our coursework is strongly dependent on what is available.

After starting the class on Thursday, our mornings have been spent teaching class, and our afternoons have been spent at PAM working on repairing broken devices to use in our class. It has been a stretch outside of our comfort zones to be teaching a class to students staff who are our age or older. What we do have going for us is that we have taken the course, and we are teaching the course to Electrical Engineers: they have the technical electrical background which we aren’t as strong in, and they don’t have the physiology background that we can teach them. Acquiring devices that work still remains the biggest challenging going forward. Hope is with us, and a restful weekend.

(A little improvising with props: This is basically what bronchiole tubes look like right?)

Week One done! It’s hard to believe.

This past week, I spent most of my time at Queen Elizabeth Central Hospital (“Queens” or QECH). At first, it was all a maze. Whereas in the United States, hospitals are built vertically, with the wards divided by floor, Queens is almost all one level only. This makes everything a little bit more spread out, but thankfully, we are limited to the Paediatric Ward (Malawi uses the British System, more on that later). For the first couple of days, we followed Shannon through the winding corridors and I thought that I would never learn my way around. Now we all know our way around, but one of our projects is to create a map for future interns and visitors.

 

 

 

 

 

 

 

 

 

 

 

 

(Map of QECH from Google Maps. Blue area is the Pediatric Ward)

 

For the most part, while at Queens, I have been shadowing a Registrar named Dominique. His role in the morning is to round in the Nursery, evaluating the stages of illness and prescribing treatment as necessary. Though I wish I could have been more helpful and hands on, I was still able to gain insight into how care is provided. This context is crucial for a successful design project, and I hope to use what I have seen and learned to help the design process back at Rice.

(Medical Devices at use in the Queens Neonatal Ward. Flow Splitter (top, center), Infusion Pump (top left), Oxygen Concentrator (on the floor) and two of the Rice bCPAPs front and center)

 

There’s a lot that on my mind can be improved. Whether it actually should be improved or not. For example the patient charts (although I use the word “chart” in a loose sense). In the neonatal ward, each patient chart starts with a vitals and medications page, kept by the nurses, and then is followed by a few pages of doctor’s notes, written on paper of various sources. The main “problem” I see is that patient charts are held together by either strip of bandage adhesive, or tied together with a strip of gauze. From my relatively wealthy perspective, I think “let’s get them a stapeler and a supply of staples, and they will have much neater records.” However, do they really need stapelers and would that even be the best solution for the problem? In this case, the gauze is handy because it is relatively easy to untie and add aditional pages can be added. Stapelers might just become more clutter to keep track of;

in this and other ways, simpler can be better.

 

In the next couple of weeks, I will shift away from working at Queens and start working more at the Malawi Polytechnic University, but it definitely has been a valuable experience, and I will write more latter.

 

British Medical System Terminology

Paediatrics -> Pediatrics

A&E (Accident and Emergency) -> Emergency Room

Registrar -> Fellow

Consultant -> Attending Physician

 

On a final note:

Mosquitos: 1  Caleb: 6

Good Morning!

As with last morning, and probably for a few more mornings to come, my team and I have overslept.

No, it is not out of sheer laziness, although after a hectic year at Rice, getting a chance to actually get a full nights sleep is readily accepted. The main culprit is jet-lag, one of the cohort of difficulties encountered when adjusting to a new place. Thankfully it hasn’t been too bad so far, (sleeping 14 hours a couple of nights ago must have helped), but being 7 hours ahead of “normal” makes it really hard to go to sleep at night and really hard to wake up at a reasonable time.

Having grown up in China, and having traveled a decent amount, I know a little bit about adjusting to a new place, and this is helpful.

Most of the literature on Cultural Adjustment talks about roughly four stages:

1. The Honeymoon Stage
2. Culture Shock/Hostile Stage
3. Gradual Integration
4. Feeling at home

So far, I think our team is in stage 1.5. Our reception here has been wonderful: Shannon, one of the Program Associates here in Blantyre, has been very gracious in showing us around, helping us get food, and being a friendly face. However, we have yet to have our feet grounded and that drains a fair amount of emotional energy. I know it will take time, and since we have good pillars of support here, I know it will end well, but for now, we are subsisting on PB&J for the most part. Although this transition takes energy and is difficult at times, I know it will be worth it.

There is a flowering tree outside of our guest house whose yellow flowers only bloom at the very tips of its branches. If I were the bulk of the tree branch, I would be kind of bummed that I didn’t get to have any flowers. Without the branch, however, the flowers would not be possible. In the same way, this transition period, although not glamorous, is preparing us to be settled in to something beautiful.

For example, I am looking forward to this coming week. Monday morning, we will go in to Queen Elizabeth Central Hospital (QECH) to go to the morning meeting and start shadowing doctors. Hopefully having a job to do will help us make the transition from a confused Stage 2, to a more settled Stage 3.

 

But for today, we are enjoying the moment

Some material on Cultural Adjustment borrowed from http://www.cgu.edu/pages/945.asp

 

Wheww…After a long couple of weeks preparing, we are almost ready to set sail. I don’t know if it will sink in until we are on the plane, but the closer we get to leaving, the more excited I am. Tomorrow I will be traveling with Carissa and Jacinta, and in a week, we will be joined by Aakash and Emily. Blantyre, Malawi doesn’t know what’s going to hit it.

(Duffle Bags packed with supplies)

 

But, you are about to find out.

 

Bioengineering Classes at the Polytechnic University

During our time in Malawi, one of my main projects will be a collaboration with professors at the Polytechnic University in Blantyre to develop two Bioengineering (BIOE) lab courses. Apparently, they have a fairly strong Electrical Engineering department, but are just starting out with a BIOE track and our goal is to bring some supplies and expertise. To be honest, when I first heard that we would be teaching classes, I was a little overwhelmed. In the past few weeks, however, my confidence has grown as we have worked with Dr. Ramos in the Rice Bioengineering department to develop our curriculum. Today, as we were packing the necessary supplies, I felt much more prepared. There will definitely be opportunities for me to be a student, but hopefully I have been equipped with enough information to become a teacher.

(Jacinta and I working on a Suction Pump for the Biomedical Instrument Repair Lab)

 

bCPAP Clinical Study

Another big project (that we know about so far) is travelling to local clinics and helping administer the clinical study for the bCPAP (bubble Continuous Positive Airway Pressure). In brief this device uses pumps to inflate the lungs of infants with respiratory distress, helping them to breathe when they are having trouble on their own. Along with bringing duffle bags full of needed supplies, our job is to train health care workers to use the bCPAP and run the study. One of the goals of this study is to produce data that will encourage public health officials to invest in the bCPAP as a tool for their countries. This initiative interests me greatly because not only is it such a great opportunity to fight neonatal mortality, but it is a great way to participate first hand in a clinical study. For pictures and more information on the Rice bCPAP, click here.

 

Technology Surveys

This past semester I had the chance to take GLHT 360: Appropriate Design for Global Health. Out of this class came several devices that were designed specifically for the developing world and we hope to showcase them in the hospitals and clinics we visit in Malawi to get feedback on how they can be improved. My team’s device, shown below, is called PhotoDose, and measures the intensity of blue light. Blue light phototherapy is used on infants with jaundice and is a simple method that breaks down the bilirubin in the infant’s blood. However, if infants receive too great a dose, they will be sunburned, while too low of a dose will be ineffective. Our PhotoDose will enhance patient care by telling the attending nurse of physician what dose the infant is getting. While still in its early stages, the valuable feedback we gain will lead to further advancements, getting it one step closer to implementation.

 

 

 

 

 

 

 

 

 

 

 

 

 

(PhotoDose)

Wish us a safe flight!