Last Friday I had the wonderful opportunity to visit Mulanje Mission Hospital again. We were able to bring the filter material that we had tested and the educational poster that we created. It was great going back to the hospital and showing them what we were able to accomplish in just a couple weeks. The doctor we were in contact with was really appreciative of the materials and was encouraged by the use of local resources to make filter materials. I am so glad that we were able to give them resources that can actually be used at the hospital. We were able to send the doctor a copy of the pdf and raw files of our documents so that they can create more posters to use around the wards.

To further benefit the hospitals, Harvey and I went to Queens on Monday to give out the educational posters and filters. It was wonderful walking to three different wards and putting up the posters. I truly hope that the educational posters we created get the nurses to think more about the oxygen concentrators and the maintenance that they require. We were even able to replace one of the dirty filters on the concentrator with a filter that we had created.

 

 

I am glad that we took the time to focus on educational material and filters. While they both may not have been the most technical projects to do, they were definitely needed in the hospitals. It is sad that smaller projects sometimes get overlooked or not noticed for the benefits that they can produce. Sometimes the simplest answer is the best. Even if the filters do not get used much and the posters are not always looked at, they are still a talking point for the nurses. The head nurse in the pediatric ward at Queens now understands more the importance of filters and taking care of the machines.

 

These last few weeks have been spent doing a lot of work on oxygen concentrator filters and sieve beds. We finally got the time to focus on making educational posters to place in the hospitals near the concentrators.

One thing I have learned since being here and getting feedback on different Rice designs and oxygen concentrator tools is that education really is key. A device can be the easiest to use and most needed technology there is, but if the users do not understand why it is needed, then the device will never get used. Making sure the need is present and known is crucial to creating a valuable design that has the potential for use in any setting. I have seen this problem a lot with maintaining oxygen concentrators. A main reason we focused on making locally available filters for the outside of the concentrator is because a large number of concentrators in Malawi do not have filters on them. This is a huge problem that many people do not know about. Without the filter, the oxygen concentrators lifespan is significantly reduced due to the  dirt and other contaminates that are allowed to enter the system and cause contamination to various parts of the device. Concentrators still get used without the filter simply because people do not realize it is a problem. Thus, one of our projects here has been an educational poster to show nurses and doctors the maintenance that must be done to concentrators to keep them in working order.

Whenever any new device is being developed a huge thing that needs to be talked about is education behind the problem it is solving. Unfortunately, this does not always seem to be addressed until the end when the product is being sold. Oxygen concentrators have been used in Malawi for a long time and yet the education still is not present to show how to properly clean the device and use it only with filters.

As we have been developing the educational poster, it has been great being able to go to Queens to get feedback on the material to make sure it is clear. Harvey and Vincent went to Queens and received a lot of positive feedback! A lot of nurses did not realize what maintenance needed to occur on the device and welcomed having more information.

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

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

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

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

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

Today was definitely a learning experience! The morning was spent working on filters and figuring out protocols. It was great; I love that we are trying to do everything (even testing) with local materials. At one point we even took a mini field trip to the Poly’s game center to borrow a ping pong ball for testing airflow. However, the afternoon we ran into a couple road bumps when we started working on the sieve beds.

To give a little background, there are two sieve beds in an oxygen concentrator. They both contain zeolite (aluminum silicate) which binds nitrogen and is used to filter out the nitrogen leaving only oxygen as the output. They work using a valve system with one sieve bed binding nitrogen while the other one is purging it’s contents. The sieve beds work great until they are contaminated with water (which usually happens due to bad or missing filters). Our goal is to figure out a simple and effective way to regenerate the zeolite in the sieve beds. In other words, we want to get rid of the water when the sieve bed has been contaminated.

Before we start to even go through the design process, we decided our first goal was to understand the sieve bed. We did some research on Monday and talked to Matt and found that there is a company that regenerates zeolite by heating it up for a long period of time and then placing the zeolite back into the sieve bed before it has cooled down completely.

Proving that this procedure works is the best place for us to start! Thus, today we decided to try to take apart a sieve bed. This seemed like an easy test, but I have started to learn that things are not always what they seem. Opening the sieve bed involves pushing down a spring and trying to pry open the top. This is done in the machine shop using a press to apply the proper pressure needed. Since there is a spring, potentially hazardous material inside, and we were using a large press: safety definitely came first! We were wearing masks and glasses during the entire process:

It is better to be over safe than sorry. Our first mistake was not applying pressure evenly. This caused the fitting on top of the sieve bed to become slanted and wedged into the cylinder of the sieve bed. Our second mistake was trying to fix the first mistake. We ended up applying too much pressure in a concentrated area which resulted in a broken fitting. The funny thing with the broken piece is that we still could not open the sieve bed and get to the zeolite. As a result, we had to admit our failures and go to Matt for more help. We eventually got the zeolite out! The entire process taught me a lot:

– Things are sometimes easier said than done
– Sometimes you need to experience failure to grow in the end and come out with more knowledge
– Sieve beds are definitely not meant to be opened up in a hospital setting
– Even after breaking something it can be difficult to open
– Just because something has a spring does not mean it will jump out at you  after a fitting is broken
– You get a lot of weird looks when you walk around the poly in a bunch of safety gear

So even though we were not successful at our first attempt to open the sieve bed, I know we will have much better luck next time and we learned way more then we ever would have if we succeeded the first time.

It’s the 4th week! We finally have design projects settled. I am on a team with Theresa, Vincent, and Harvey. We spent the last week trying to figure out project proposals for oxygen concentrators. In the end, we have decided to devote the rest of our summer to filters, sieve beds, and an educational campaign.

Filters are a big focus. In the hospitals, we found that a lot of concentrators would have the first filter missing or it would be replaced with a random piece of foam. Preventative maintenance is key for keeping a concentrator in working condition, so when there is no filter or an ineffective one, the concentrator will fill with dirt and create problems with other parts of the device. Thus, we want to create a low cost filter made out of local material that can be used when a filter is missing. We really think this is a great need. At Mulanje, one of the doctors I talked to really stressed the need for local filters. Also, when random pieces of foam are used as filters, they have not been tested and no one actually knows how good they are. As a result, we will be doing a lot of testing to ensure we find a filter that is close to the current one.

In order to start the brainstorming process we spent all of Monday doing a lot of research on what the current filter is made of. We then made a shopping list of brainstormed materials that could work and decided to go shopping on Tuesday.

Tuesday was very successful! Harvey and Vincent really took the lead with figuring out where to go shopping. They decided to go to Limbe town because there are a ton of hardware stores within walking distance of each other and it’s super close to Blantyre. Once we arrived in Limbe, we started to just walk into a bunch of different hardware stores.

I was hesitant at first and really did not expect to find all the materials we were looking for. I was definitely wrong! We found a lot of foam, sponges, car filters, and various other material we thought could potential work as a new filter. The entire experience was amazing! I loved being able to just walk into stores and find the material that we wanted. This is not the first time that we have wondered around town looking for something specific and ended up finding it. Malawi just seems to be the perfect place for wandering minds.

I cannot wait to test all the material we collected! We spent all of Wednesday morning really going through the design process figuring out design criteria and protocols for testing. It was nice learning how Harvey and Vincent go through the design process and sharing what Theresa and I know about it.

Malawi never ceases to amaze me. I feel as though everywhere I turn I continue to see the intersection of what I have learned in class and what actually occurs.  This week everyone has returned home after the site visits. I am sad that we are no longer going to hospitals, but I am happy everyone is together again. We are all back to working in the design lab at the Polytechnic and have been focused on compiling all the notes we took from the different hospitals we visited. It is really interesting to share experiences with my fellow interns and see how the hospitals differ. Theresa and Kate were at Zomba District Hospital while Tahir, Harvey, Leah, and Vincent were at Kamuzu Central Hospital in Lilongwe. Both hospitals differed greatly from Malamulo and Mulanje (the two mission hospitals Brighton and I visited). The biggest difference was the absence of technicians at both Mulanje and Malamulo. For Zomba and Kamuzu, the Physical Assets Management (PAM) team is present to repair medical devices that break.

As I look over my notes and go through all the technology pictures from the week, I keep coming back to one device that really stuck with me. At Mulanje I saw a wheelchair that looked very different from the ones I have seen before:

The beginning of Junior year, I took a Needs Finding Class taught by Dr. Ghosn. In this class I learned a lot about how to interview patients and establish the difference between what is needed and what would not be helpful. At the beginning of the class, Dr. Ghosn had us use a wheelchair for a day to show us that there are challenges with the wheelchair we have not thought of before. Being in the wheelchair was definitely an experience; I have such a new found appreciation and respect for people that use wheelchairs. Spring semester of Junior year, I also made a CAD drawing of a wheelchair as practice in my AutoCAD class and we spent a lot of time thinking about ways to change the design. Thus, when I saw an engineered wheelchair I was immediately drawn to it.

Upon further inspection of the chair, I found it was from an organization: Free Wheelchair Mission. This organization provides free wheelchairs for developing nations. I love that they saw a need, like wheelchairs, came up with their own design, and were able to develop a platform for delivering the chairs. Knowing that an organization like this exists makes me even more motivated to continue developing filter designs for oxygen concentrators. I am so lucky to have the opportunity to come to Malawi and see what has been developed already. After all my experience with wheelchairs last year, I never knew about the wheelchair organization and would have never known how many other organizations there are trying to develop technologies for the hospital.

After completing the site visits to both Malamulo and Mulanje, I have really learned that communication is very important for building long lasting relationships. As Brighton and I walked around the hospitals observing different aspects of the wards, we found that we received the most information when we asked the nurses to talk to us or asked for access to the Operating Theater.

We specifically had a wonderful time at Mulanje with a nurse from the Operating Theater. She allowed us to go inside and asses their equipment and talked to us for at least an hour about her experience at the hospital and specific information about the equipment used. Fostering the relationships at the hospitals will help us get feedback later on about our designs and hopefully allow for more partnerships in the future with Rice and the Polytechnic.

The site visits to Malamulo and Mulanje Mission Hospitals really opened my eyes to everyday challenges that the hospitals face. For example, the Operating Theatre is relatively far away from the Nursery. This means that if a mother undergoes a C-Section and the baby needs to be transferred to the nursery, they are exposed to the outside world for at least a couple minutes before being in a warm, temperature-controlled environment again. While the little exposure does not seem like much, it could cause a lot of damage to a premature baby already suffering from hypothermia. The hospitals already have blankets and foil wrappers in place to try to keep the baby warm during transit, but I feel as though more can be done to help. This is why I love that the summer we are not only worrying about oxygen concentrators, but hypothermia as well. Without our conversation with the nurse at the Operating Theater, I probably would not have realized that transferring the baby was still a challenge that needs addressing.

The power is out again. This seems to always happen at dinner time. If there is one thing I have learned in Malawi it is to expect the unexpected and to not be afraid wen your plans change. I was hoping to come home, make banana bread, do insanity, and then cook dinner. But instead I am writing in the dark with a flashlight (interns next year bring lots of candles). I really do hope by the end of this program to be able to adapt to different circumstances. I have definitely learned to not plan things too far in advanced or get too attached to plans already made.

Sitting in this power outage, I cannot help but think about the safety measures that must go into preventing outages in hospitals. On Tuesday while Brighton and I were at Malamulo, we experienced a power outage. Typically a huge generator turns on within six seconds. Unfortunately, the generator has been malfunctioning so someone has to activate it. The power was out for about twenty minutes before the generator finally came on. That does not seem like a lot of time (especially since power outages can last anywhere from 1-4 hours) but it could be the difference between life and death for someone that is hooked up to an oxygen concentrator or if the power goes out in the middle of a birth. It’s the little things like that that make me want to do more and get me thinking about different design projects. It is one thing for me to have read about the frequent power outages here in Malawi, but it is another thing to actually experience them and see firsthand how hospitals deal with them.

Being here it is really the little things that are important. Like tonight, even with the power out we still were able to do everything (make banana bread, do insanity, cook dinner). The power did not affect us, it just pushed our schedule back a little.

It seems as though every week is the start of a whole new, exciting internship. This week we are doing site visits to various hospitals in order to collect data on oxygen concentrators and hypothermia. To do this, we split up into teams of two. I am partnered with Brighton. Our plan is to go to Malamulo Hospital for three days and then Mulanje for two.

We are starting with Malamulo and spent the day Monday at the hospital. Malamulo is a really nice district hospital. It took about two hours to drive to from the Polytechnic and the last half of the drive is on a super bumpy, but really beautiful road through tea plantations.

Monday was all about introductions! Without a good intro, we would never have the chance to really get the data we want and wander the wards as we please. We met with the head surgeon, Dr. Hayton (he is from California like me). He is super nice and was very excited to have us look around and help improve the technologies. He especially liked that we came from a local school and that Brighton has the potential to come back even after the summer! Dr. Hayton gave us a quick tour of the hospital and told us where all the oxygen concentrators were located. He also gave us a lot of information on other technologies that have not worked for them in the past and we found out that their main method of preventing hypothermia was using Kangaroo Mother Care. After our tour, we then were given the freedom to wander the halls and look at the concentrators and how hypothermia is being treated at a nice, slow pace without keeping people from their work.

A key thing that Dr. Hayton mentioned was how some people come to the hospital to do research, take their data, leave, and never come back. This is definitely not something we want to do. Our goal is to establish connections and actively try to help the hospital in the end if we are able to come up with some solutions. Of course, my first task as a student and intern is to learn as much information as I can, but if in the process I am able to help just a little to improve the oxygen concentrators or find some simple solution to help with hypothermia, then that is even better!

Working with Brighton has been great. Here is a picture of us outside of Malamulo during our lunch break:

He is helping me be more confident in my abilities. Matt mentioned before we went on our site visits that confidence is the most important tool for gaining access to the different parts of the hospital. I was super nervous when we were first trying to establish connections in the hospital, but Brighton was very good about being optimistic and motivating which is the right attitude to have when it comes to tackling our two projects. Overall, Monday was a very successful first day at the hospital! We established the connections that will now let us conduct our research for the rest of our days at Malamulo. I know we cannot fix all of the problems at these hospitals, and we definitely cannot fix anything in just three days. But hopefully the knowledge we gain from our observations this week and the time spent during the rest of the summer developing the projects will help solve just one small problem.

This last week has been so great! We finally met the Malawian interns (Kate, Vincent, Brighton, and Harvey) that we will be working with for the rest of the summer and we all moved into our lovely house so we can cook together and really get to know each other. The best part of this week, though, was finally getting to work with the oxygen concentrators and understand how they function before being sent out to evaluate them on-site next week. On Tuesday, Kate and I went to Queen Elizabeth Central Hospital (QECH) to work with Mr. Nkosi (an engineer working at QECH). He had two oxygen concentrators that needed to be fixed, but we focused on one and used the other for reference to see if the parts were the same. I loved actually working on the devices that I have been extensively reading user manuals for and trying to troubleshoot myself.

It was such a good experience to work on the concentrator with an engineer and see how the concentrators are actually repaired in Malawi. Mr. Nkosi repairs the concentrators by systematically going through the different parts and trying to detect what is going wrong based on sight and sound. For the concentrator we were working on, you could clearly tell that there was a problem based on the sound being emitted from the compressor. To fix the device, we started targeting components related directly to the compressor. One of the problems we tried to fix was replacing the compressor filter. The filter that we replaced was black and full of particulates. Even though replacing the filter did not fix the main problem, it was still important to do for preventative measures in order to make sure clean oxygen is still being produced. After replacing the filter and some other components, we still had not fixed the main problem in our first visit and came back Wednesday morning to do more work. I have learned that sometimes it is better to take a step back from what you have been working on to fully understand the problem and think of a solution.

The greatest part about working with engineers is that they never stop thinking about the problem. When Kate and I came back to QECH on Wednesday, Mr. Nkosi had already been thinking of solutions to the problem for the entire night before. We took apart the compressor and discovered that the noise was coming from the rubber fittings at the top of the diaphragm of the compressor. The picture below shows the compressor for the concentrator with the top component taken off. The red circles are the rubber fittings that caused the noise in the compressor.

It was so rewarding to finally discover the problem and come to a solution! I cannot wait to continue working on oxygen concentrators and hopefully be able to diagnose problems on my own.