As I started packing, I have begun to think about the things I will bring back with me from Malawi. I’m not sure I could formulate an exact list because I’m bringing back more than what is in my suitcase or my camera. This is a list of some of the things I will carry home with me:

1. Approximately 2kg of Malawian-grown coffee and 250g of black tea, as well as some dried hibiscus flowers from which you can make tea- something I have started to love doing after coming home from work.
2. Approximately 16 chitenges; 6 pairs of happy pants, 4 bags, 24 napkins, 2 shirts, and a pair of shorts, along with some fabric I haven’t modified yet.
3. Four bottles of Nali, which is Malawi’s own hot sauce made from peri-peri peppers. It’s almost too hot for me, but not for many of the Malawians I have met.
4. 500 pictures; some work-related and some for myself.
5. A recipe for nsima.
6. Some ideas for devices or technology that could serve as future design projects at Rice.  I am more able to provide new ideas now that I have seen a low-resource setting and its constraints, which are very important to keep in mind during the entire design process.
7. A small but strong Chichewa vocabulary.
8. A six-pack from all of our Insanity workouts. Actually that’s pretty far from true (although I’m sure I’m closer now than I was when I left).
9. A number of new mentors and role models. I’ve met some of the hardest working and most compassionate people I’ve ever known, and of anything I take back I hope it can be the inspiration they have given me to work hard and to always treat people as though they are family. Even though I have only had a summer with them, I would consider the people I have met here to be family to me.
10. A worldview with better peripheral. You can’t understand a place like Malawi from a textbook or Wikipedia article. It takes living in the country, meeting the people, and trying to solve problems as they stand right in front of you to know what words like “developing” or “low-resource” mean. I only had two months in Malawi, and my vision or understanding isn’t 20/20, but I see much more clearly than I ever had before. Out of everything on this list, number 10 is probably the lightest- and in some ways the heaviest- thing I carry with me home.

It’s a very bittersweet goodbye leaving Blantyre, and I will miss my new friends and new favorite places a lot. The attachment I now feel to this place only highlights the desire I have to continue working in the global health field. I am grateful for the opportunity to come to Malawi, and I hope that the work I have done here and will do during my time at Rice will be as meaningful to someone else as this trip has been to me.

I guess it can no longer come as a surprise that I have learned far more from continuing my tech surveys than I expected. In the past couple weeks I’ve spent more time talking to clinicians, which has given me different insight than I have gotten from the nurses. Generally the nurses were helpful in figuring out the logistics of using a device at Queens, while the doctors I’ve talked to have illustrated what potential exists for a device to make a difference.

I had a particularly helpful conversation with one of the visiting physicians from the UK who was working in the nurseries and children’s wards. She had a lot of good feedback for all of the devices, but the thermometers in particular. She said that apart from the simple idea of detecting a fever, the thermometers have a lot more to contribute that may be slightly more subtle. A thermometer given to a mother isn’t just a signal of a fever, but also proof to a doctor or nurse that the mother was paying attention. She could give more specifics as to the child’s symptoms, feel confident in her decision to bring the child in, and have a way to keep an eye on whether or not their condition was improving. If she didn’t know before exactly what a fever was, the responsibility of a thermometer would serve as a platform for mother’s education on health in general. In short, as the doctor put it, the thermometers had potential to be empowerment for mothers. Empowerment as such could easily be as important as any technological advancements available.

This conversation tied well into a book I’ve been reading that speaks some about medical interventions in third world countries. Intervention is not a one-step process where we can bring equipment or medication and leave. Awareness and education is key to making any help sustainable in a new environment. Follow-up and continued assistance is necessary to ensure that whatever investments in time or money were made were used to their worth. In the 2000’s when the US and other nations made a large push to deliver antiretrovirals to developing countries, they were not just healing the sick. They were stimulating economic development because fewer resources were being put towards healthcare and more people were able to participate in the economy. They were bringing education about AIDS, but also about healthcare in general, about safe sex, and even about rape (in many African countries, it was commonly believed that the cure for an STD was intercourse with a virgin). I don’t want to argue that the AIDS intervention didn’t have it’s problems and setbacks, only that each change made to global healthcare has ramifications that extend past the goal of the change.

This is also relevant to the feedback I’ve received from the tech surveys about the importance of the nurses’ and clinicians’ attitudes for a new device to be successful. A device like the Chemoseal or Biliquant may have a lot of potential and Queens may have the resources to implement it but if the nurses aren’t in favor of using it in the nurseries or oncology wards it’s no use. The way we present each device is very sensitive; in my surveys I always try to emphasize that the goal of my program is to make the job of the healthcare provider easier by giving them the tools they need. When a device is misunderstood, it won’t be put to use. If it is presented as a lot of work to use or difficult to comprehend, it is less likely that the nurses and doctors will feel positive towards it.

I’m only here for a matter of days more; the people that work in the hospital year round are the ones to whom the responsibility of implementing a technology falls. Without the support of the healthcare workers, a device is next to useless in a setting so far from where it was developed. Sustainability of any intervention is in the hands of the people who will be there when the intervenors have disappeared.

I haven’t really talked about this before, but I think it is appropriate to mention some of the things that make this internship sometimes very difficult for me. I am working in one of the poorest countries in the world with one of the highest infant mortality rates. I can’t spend two months in and out of hospital nurseries without learning what those statistics really mean.

Last Friday I was in the nursery for less than two hours total the entire day, but I was still present for the passing of two babies. Both were very sick and had little chances of survival. It isn’t uncommon to become acquainted with a child or their mother one day only to see a new baby in their place the next. While doing some data entry in the past week we’ve spent a lot of time looking at clinicians’ notes. The notes will chronicle the story of the patient’s entrance, their improvement or worsening condition, and often afterwards their death. At every death, the nurse or clinician taking notes will write “so sorry” underneath the notes of their passing.

It’s very hard to play witness to some of the hard facts of the hospital. A lot of times I feel helpless because there is nothing I can do that could give these children better chances than what the nurses and clinicians are already doing. I feel guilty that if the babies grew up where I did, they would have access to so much more that could help. I have to constantly remind myself that what I am doing here is, in it’s small way, contributing.

The difficult sights I have seen illustrate the importance of the work that groups like BTB are doing. Statistics are far more compelling when you’re standing in the middle of them, but they’re as important in Houston as they are in the nursery. I’m so grateful to everyone that has contributed to this program or a similar one, because work like that Rice has been doing is absolutely necessary. As I have now actually observed, interventions like the CPAP have often drawn the line between life and death.

I realized looking back at my previous posts that I had promised a description of Blantyre which I haven’t given yet. The start of this week has been occupied mostly with more technology surveys which I have already discussed quite a bit, so I figured now was an appropriate time to write this post.

Blantyre has a population of 650,000, which is roughly the size of Denver, Colorado. It is surrounded on almost all sides by mountains, including Mt. Magete which is the third tallest mountain in Africa. As one of the largest cities in Malawi, Blantyre is unique from a lot of the rest of the country in that it has a lot of poverty but also a lot of significant wealth. There are large banks and car dealers that look entirely American, with big glass windows and gated parking lots. We have also glimpsed sides of the city itself that seems to house some very nice office buildings and commercial areas. At the same time, we have seen some of the less affluent parts of the city that act as a reminder that Malawi is not the US. We see children leading blind grandmothers around the markets asking for change, and people walking through town without shoes on their feet. Malawi has a per capita GDP of $900 (the US’s is $52,800), and it is considered one of the poorest and most densely populated countries in the world. This fact may be less apparent in the parts of Blantyre we spend most of our time, but it is nonetheless true in the city.

One of the most colorful and interesting parts of the city is the Blantyre market. The market is very large, and it offers not only produce but also street food, fabric, electronics, clothes and shoes. As a visitor, I have learned that it is important to hold your ground when bargaining or you could easily be subjected to prices much higher than what they tend to charge locals. Employing the little chichewa I know always helps. The produce market sells almost anything you could think of; fresh vegetables, fruits such as bananas, oranges, and apples, passionfruit, pumpkins, eggs, garlic and ginger, coconut, papaya, avocado, and even live chickens. We have also bought popcorn kernels and dried hibiscus flowers which you soak in boiling water to make tea. We tried what is called a “national cucumber” which looked like a small cucumber that had long spikes protruding from all sides of the fruit. Even though we didn’t know what to expect, we were somewhat disappointed in the national cucumber- it tasted like an unfortunate combination of a lime, a cucumber, and an onion. In the breads and dry goods section, they sell something called an “Obama roll” which is a large, puffy bread roll. Thandie from the office told me that the bread was so named because it is a beautiful roll, and the people in Malawi consider President Obama to be beautiful too.

It is also always exciting to explore the other parts of the market as well. We have found a lot stands with a lot of beautiful chitenge fabrics, and I think after our six or so weeks in Blantyre we have made a pretty significant contribution to the income of some of those merchants. The chitenge is a 2×1 meter piece of cotton fabric which serves indiscriminate uses in Malawi. Women tie them around their waists and wear them as skirts, and sometimes wrap them around their heads in a turban-like manner. Sometimes they will tie the chitenges around their backs with  young children inside of them, so that the infants rest on their mother’s backs and the moms can have both hands free. Around the hospital chitenges are laid out like picnic blankets as families wait for their loved ones inside. On cold days people wrap up in them to stay warm, and in the church service we attended they were even included in some of the hymns as props. All around the city men sit outside on the streets with sewing machines, and you can bring your fabric to them to make you a dress or a pair of pants.

Unfortunately the other interns and myself haven’t had that many opportunities to explore much past the market except for some of the stores and tailors, and the wood market. Blantyre is a pretty large city to cover by foot, and where we are staying is about a forty minute walk to the start of downtown. I hope that my description of the market and the basic information about Blantyre helps to draw a clearer picture of the city, although as a visitor and not much of an inhabitant myself I guess I am not completely qualified to try to draw a complete one. Here are some pictures I have of the area that may help further the image:

 

These are the 5 ways my internship has been like a Pumani CPAP machine:

1. It’s fairly simple: I didn’t bring a lot of technological knowledge or engineering education with me to Malawi. A lot of the work that has proven most helpful to the BTB team or to Queens has been very simple, such as designing a poster or typing up nursery register data. It isn’t revolutionary and it doesn’t take a genius to get the job done, but it is far more important for me to address the needs here than to try to suit this internship to my own personal growth. The brilliance of the Pumani machine is that it is very simple; it didn’t require a lot of complicated machinery or electronics that would make it too expensive for a place like Malawi. The CPAP meets a need, and that has always been my goal in this experience.
2. It has sometimes taken adjustments: In the BTB office there are many CPAP machines that have been brought in from the wards to be inspected and fixed. The problems they contain are varied; sometimes straightforward but other times slightly more subtle. There were many things I was unprepared for at my arrival to Blantyre, and there have been many other changes I have had to make in my perceptions or my work. I have modified projects based on their usefulness in the office or the wards, and as time has gone on my interactions with those around me have changed- even just the simple expansion of my chichewa vocabulary has made a large difference. The breaks in the CPAP machines are not reflective of an inability to deliver, and neither are the faults I find in my own actions. Changing a pump in a CPAP or changing a question in one of my tech surveys has sometimes been all it took to return everything to a fully functioning state.
3. It’s multifaceted: In my conversations with some of the CPAP nurses in the wards, I learned that often the nurseries will have more babies that need CPAP than they have machines available; they have to make a decision based on the chances of each child’s survival as to who gets hooked up. I have talked in previous posts about how without proper education and reminders, the CPAP can actually prove dangerous to life instead of protecting it. It’s easy to glance at the CPAP project and see a simple program with a straightforward goal. The purpose of the program is the same as that of my internship; to develop and deliver a life-saving device. The application of such a large and noble goal is inevitably more complicated than it’s definition. In my work, I have seen good ideas or promising technology that haven’t turned out as expected. Very few things are as uncomplicated as I initially think or plan for. It has been essential for me to remember in reference to my work’s multifaceted nature that regardless of any complications, the goal of the work and the integrity of that goal are unchanging.
4. It bears witness to a lot of hard work and perseverance: There are a lot of strong, intelligent, and diligent people working at Queens’ hospital. My interactions with the rest of the CPAP team, the nurses in the wards, and doctors and clinicians has been inspiring because of the dedication so many people have demonstrated to their work. While it has on occasion been hard for me to digest the conditions that are present even in Blantyre, the people I have met that care so strongly about what they do have made it easier to swallow. I know as well that the people behind the CPAP project are equally dedicated and motivated; it is evident in the way the program is run that it was built on giant’s shoulders. The people around me have been great inspiration and motivation to try to act with the same levels of care and diligence that they do.
5. It has pressure: This one may be kind of a reach, but it’s still true. The CPAP machine delivers positive pressure into a neonate’s lungs so that they are able to inflate them and get oxygen. My experience here has also delivered to me a similar positive pressure. You cannot just be a witness to such need and such hard work to fill that need. It would be a disservice to everyone that has sent me here to come home and let the things I have learned from this summer collect dust. Spending this time in Malawi has illuminated medical and technical opportunities that my next three years at Rice will give me the chance to fill. Now that I have seen the resources that exist and are still necessary to Queens, I am better prepared to try and contribute. This internship has been a privilege, but it comes with a responsibility to make a sustainable difference while I’m here, and make sustainable contributions to BTB and the CPAP program even after my departure.

This week has been very exciting. Jacinta and I have spent a lot of time in different wards, getting to know the nurses and gathering feedback on some of the technology we brought with us. The surveys have allowed me to see a lot more of the hospital, and investigate its most profound technological needs. Even with extensive research and good communication, there is often a gap between what we back in the states think is appropriate or useful and what is actually practical in the recipient site. After being a witness to events like that with the Fahrenheit thermometers I talked about in a previous post, I can really appreciate the importance of doing surveys early on in the design process so that the projects students at Rice work on remain true to what is needed in Malawi.

Today and yesterday we brought four new technologies to the wards besides the liquid crystal thermometers I’d been working with previously. The four include Chemoseal, which protects healthcare workers while delivering chemotherapy; Biliquant, which measures biliruben in the blood to diagnose jaundice in infants, EasyFlow, which allows multiple patients to be connected to the same oxygen concentrator; and a temperature sensor for neonates in incubators.  While a lot of enthusiasm was shown for all of our technology, not all of it was deemed completely applicable to our location. For example, Paeds nursery doesn’t have any incubators. A temperature sensor would be of penultimate importance to having an incubator itself. Also, both Paeds and Chatinkha nurseries have access to very high-quality flow splitters, which are sufficient for the needs of both nurseries and their access to working oxygen concentrators. When a nursery only has two working oxygen concentrators, it doesn’t need three oxygen flow splitters. Despite some of these realizations, the nurses we interviewed were happy to continue giving us feedback about the technology even when they didn’t think it applicable to them. I think we will return to Houston ready to give the design teams who made this equipment a lot of information on the pros and cons of their designs.

For me personally, the technology surveys have been some of my favorite projects in Queens. As someone with a strong interest in global development and healthcare, it has been a privilege for me to get to explore more of the wards and spend time talking to nurses and clinicians. Working here has taught me so much, and my technical, medical, and cultural knowledge base has grown incredibly. I have matured a lot as a person because of my experience so far, and I have a much stronger faith in my self-awareness and my awareness of the rest of the world. With any luck, the next three weeks will give me the chance to ensure that I have been giving back to the same degree as I have been receiving from this trip.

At the end of last week I started working on a poster that can help nurses and new clinicians know how to wean a baby off of CPAP. Because of the mechanics of the CPAP, it is essential for health care providers to have a complete understanding of how to wean a baby off of the machine so that they don’t end up doing harm to the patient.

The patient pool for the CPAP machine is neonates whose lungs are underdeveloped. When babies are so premature, their lungs often collapse and are unable to let the baby consume oxygen. The CPAP delivers constant air flow that provides enough pressure to inflate the lungs. With this help, the baby can inhale and exhale to get enough oxygen into their bodies until they can breathe on their own. Weaning a baby off CPAP improperly can cause even a negative pressure, making it harder for the baby to breathe on the machine than it would be in normal room air. The baby also still needs continuous monitoring, so any deteriorations in their condition will be noticed and rectified before the child is seriously harmed.  The goal of the poster I made was to be both specific and concise so that any health care professional attending the baby would be able to wean the baby properly without risk to their health.

After looking back again at the blogs of interns of previous years, I remembered how limited my knowledge of Queens and Blantyre was before coming here. I thought it might be helpful to future interns or others less familiar to have a more extensive image of the two. Queen Elizabeth Central Hospital is one of the largest hospitals in Malawi. Its two nurseries alone house upwards of 200 patients a month, which means the whole hospital sees thousands of people monthly. Because of the climate, a lot of the hallways and waiting areas are outdoors. There are a number of small grassy courtyards where families lay out blankets and wait for their loved ones that are in the wards. It is far from uncommon to see women doing their laundry in the large sinks in the courtyards while waiting.

The wards at QECH that I’ve visited are always busy and sometimes overcrowded. The nurseries in particular are always packed during visiting or feeding hours. As far as I have seen, neither nursery tends to have the problem of not enough nurses or staff. Both Paeds and Chatinkha are kept very warm to help the babies regulate their own body temperatures, as incubators are expensive and uncommon. They sometimes would feel pretty stuffy, but never very dirty or unhygienic. Queens has a very large janitorial staff that is almost constantly mopping hallways and dusting windows, which makes me feel that the hospital as a whole is very clean and as sanitary as possible.

As far as technology goes, it is hard for me to asses the extent to which the nurseries and the rest of the hospital are well- or under-equipped. The nurses I’ve met in the nurseries are always enthusiastic about the idea of any new technology, and they have told me often about how shorthanded they are with specific devices, such as oxygen concentrators and pulse oximeters. I have seen a lot of broken technology that is either too difficult to fix or the parts to fix it are too expensive, which makes for a sad waste of equipment that could be put to use. The hospital staff though is very diligent and resourceful and they are good at making use of every available device, even if it seems outdated or in less-than-pristine shape. As far as I have seen, there have been holes in the availability of certain technology, but the standard of care- especially compared to other hospitals in low-resource countries- is still very high.

Queens is a different environment than I had expected, and than future interns might anticipate. While there are a lot of striking differences between the luxury of an American hospital and what is possible here, it is also remarkable the difference between what I have seen at Queen’s and what I saw at Machinga, or what exists in other smaller hospitals. Although I have spent most of my time in the BTB office or in the nurseries so far, I hope that I will have a chance in the next four weeks to see some of the other wards too, so that I can impart more information and experiences to the interns who will be here in future years.

This post is already probably one of my longest, so I’ll save my description of Blantyre and the people I’ve met for the next one. In the meantime, here are some of my pictures of Queens:

With everyone home from traveling and MK back from the US, the office has been much busier in the past couple days than in weeks prior. I have been working on some more data entry, which is wonderful because it’s helpful for everyone here, but it also doesn’t make for a particularly interesting blog topic. The data I’m looking at is the patient registers and mortality logs for the maternity wards and nurseries of different hospitals. When enough is collected and organized, this data will be used to notice trends in mortality and if there are any patterns in diagnoses that show particularly high death rates. If pneumonia is present and fatal in every hospital but one, then it would be important to see if they have a different means of treatment or if they simply diagnose in a different way. If most neonatal deaths are attributed to sepsis but none to birth asphyxia, it would be helpful for the CPAP team to decide whether there is a problem with the data and the records of the nurses, or if something more subtle is going on. By looking at this kind of information, we can get a lot more valuable feedback on the CPAP and on what kind of difference it is making around each nursery.

Over the weekend the other interns and myself drove north to the coast of Lake Malawi. The lake was beautiful and our lodge was very nice. On Saturday we took a boat around the lake, first to a beach, then to a small island with great snorkeling, and then to some rocks that you could jump off of into the lake. Every stop we made on the boat was incredible. The snorkeling was as good as I’ve done in the ocean, and the rock jumping was exhilarating.

The group at our lodge at Lake Malawi and a lake sunset

Before we went out, we were warned about Schistosomiasis, which is a parasitic worm found along the shores of the lake that can prove fatal. We all got medication from the hospital to take six weeks and twelve weeks after having been to the lake, so that if we happen to get the parasite we can kill it before it does much harm. Even with that medication, we were all a little wary of getting in the water out of fear of the worm. We felt more justified swimming because the sink and shower water was also from the lake, so trying to avoid the water would be a little futile.

We are very fortunate that there is medication available so that we would all be able to have such a fun weekend, but of all the people that get in the lake we are a select few. People who live along the lake wash their clothes and dishes in the water. They bathe in it. The area we were in was not particularly wealthy, and when you hardly have enough money for food you won’t be shelling any out for Schistosomiasis medication. We didn’t have a lot of time to investigate, but I was very curious about how the locals deal with the parasites in the water. I don’t know if they have some sort of immunity, or they know where in the lake not to swim, or if they just get the worm and deal with it. A lot of the children I met were small for their age but had the protruding belly that is a telltale sign of malnutrition; I wondered if some of them were also suffering from Schistosomiasis and their abdomens were swollen because of the parasite.

My friend Sofina that I met at the beach

The lake was a wonderful trip but also a very informative one; and I am very glad for the opportunity both to have such a great weekend and to come to a more enlightened understanding of this country and the way it’s people live.

This week has been pretty busy, so I haven’t had as much time in the wards as I have previously. I have gotten to spend time in the nurseries a couple times, which is something I particularly enjoy. I don’t think I had ever spent a lot of time around babies only days or weeks old before this job. The babies are so small. Their entire hands are no bigger than my thumb, and their rib cages are dwarfed by the width of my wrist. There is rarely a lot of crying in the nurseries, and most of the time the babies are either feeding or sleeping. Last week one of the nurses in the Paeds ward had me help to change one of the babies into a clean onesie, with the permission of the mother. I was scared to death that I would hurt her just by moving her arms or unfastening buttons. The onesie we put on her practically swallowed her whole. It’s hard to believe that any human being could ever be that small. I can now understand even better the importance of technology to help babies in their first few weeks or months of life, when they are so fragile and even the most innocent things can be dangerous.

A CPAP baby in Chatinkha

Yesterday I had the opportunity to do a little bit of traveling to collect some CPAP data from other hospitals. I saw two new hospitals; the central hospital in Zomba, which rivals QECH in it’s size and capacity, and then the small district hospital in Machinga. Machinga was a stark contrast to the other two. Zomba has about 40 patients a month in it’s nursery ward, which is a comparable number to QECH’s two nurseries combined. They have multiple CPAPS that are up and running, and a lot of nurses trained on CPAP use that know how to care for a patient using the machine. Like QECH, the hospital in Zomba gets a lot of referrals of very sick children from other hospitals, and they have more resources for special care available than most hospitals in Malawi. Machinga’s nursery ward had six patients when I visited. They had one CPAP which was not in use and they hadn’t had a patient that needed CPAP in weeks. The small size of the hospital makes it more difficult to maintain the use of the CPAP. When babies that need it come in so infrequently, the nurses don’t have a lot of opportunities to practice their CPAP skills or impart them to new staff. If they can’t practice, the CPAP can be misused and even cause harm to the baby. If a technology that acts as such a lifeline for a patient isn’t used properly, it’s no better than not having the technology at all. The CPAP team has been trying to help Machinga out with keeping up on CPAP use and training, and making sure they have the support they need.

Today Becky was telling Aakash and me about an interesting problem that came up in the Paeds nursery which reminded me of the problems that Machinga was encountering with the CPAP. The nursery just got a very large donation of thermometers, which is something they desperately needed. Unfortunately the thermometers are in Fahrenheit, instead of Centigrade. The nurses don’t know the conversion, so Becky spent most of her morning helping read temperatures and diagnose fevers. While Paeds was lucky to have Becky around to help, this issue highlights an epidemic that has infected Queens as well as a lot of other hospitals in this country.

The people who donated the thermometers had good intentions. They had the determination to get the thermometers all the way to Queens from wherever they were donated, which is a feat in itself; transportation is very expensive and difficult to oversee from afar. But after all of that hard work to get them here, the thermometers are so limited in their use to the hospital. It’s the same way with a lot of donated devices from America; Malawi uses British outlets, so anything with an American or other European plug needs a converter, which is something in short supply. You cannot find fault in the efforts from those who donate supplies, but a device that people here cannot use or don’t understand is not going to make much of a difference. From my perspective, this is the biggest obstacle right now in international efforts to contribute materials-based aid to places like Malawi. If there was a better way to communicate the needs and resources that already exist in the recipient site, than maybe the contributions of the donor site could go a little farther.

The issue with the thermometers made me think about some of the work I did at home with Project Cure. Project Cure is an organization that collects and delivers donated medical supplies to low-income clinical settings around the world- including parts of Malawi. They stress the fact that they are non-political and non-profit; the work that they do is towards the one goal of getting medical supplies to those that need them most. The delivery method that they use is a multi-step process; first, they visit the site which will be receiving the supplies to do an inventory and decide exactly the site needs. Then once they get those supplies from their warehouse they hand-deliver the supplies to the same site. That way they know that the materials they contribute are needed, can be put to use, and are getting to the right people. I don’t know a lot about how much Project Cure works with medical technology, or what the problems are that they encounter in the distribution process, but I think that the deliberation that they use in their practices has resulted in a lot of good. The thermometers and CPAP problems that I have seen here have emphasized the importance of that kind of deliberation.