Sister Patrice and a mother holding her child on CPAP

At the end of last week I started talking with mothers and nurses about their opinions of a thermometer that was designed in GLHT 360 last semester. The thermometer project has been thrilling for me because it has provided me an opportunity to interact with mothers and babies, and to get to know some of the nurses more personally.

The thermometers are very simple; they contain sheets of liquid crystal that change color when heated to certain temperatures. The thermometers are designed to have a red region and a white region, each of which contains liquid crystal sheets. If the color change occurs in the white region of the thermometer, the user is healthy, and if the color changes in the red region, the user has a fever.

The goal for this device is to eventually be able to send it home with mothers so that they are better equipped to tell when their children have a fever. The fact that the thermometers give a reading based on a color change instead of a specific temperature reading leaves the thermometers more accessible to mothers with less education. My aim in conducting the surveys was to get the opinion of mothers and nurses on whether it would be easy to use the thermometer, and whether it would be helpful to have them. So far there have been some significant trends in my responses, enough so that I was able to draw the following general conclusions:

1. Mothers care strongly about the wellbeing of their children.
1. This leads to mothers paying fairly close attention to the health of their child, so that they can notice subtle changes in body temperature even with palpation, and they will err on the side of caution when they think their child might be sick
2. It also means that something like this thermometer would be highly valued, and mothers would take good care of the device. Even though the thermometer is small, they would be cautious about losing  it because it relates to the health of their children.
2. Mothers come from a variety of educational levels.
1. This means that some mothers are better prepared than others to understand the significance of having a fever, and the use of a thermometer to prevent one. Less education could possibly correlate to something that looks like negligence because mothers don’t know how useful the thermometer could be.
2. Despite variances in education, it would be absolutely necessary for mothers to be well educated about the use of the thermometer and why it is helpful to them. For mothers that don’t know what a fever is, more information would be necessary to catch them up.
3. The primary question lies in whether the thermometer would help mothers be more careful about bringing their children into the hospital.
1. The thermometer would serve to erase doubt on the part of the mothers; it would act as an alarm that they could take seriously instead of wavering when unsure about palpation.
2. If mothers are already cautious and seem to already be able to know when their children have a fever, the device would not make a large difference in the practices of the mothers when they think their children are sick.
3. The general consensus has been that palpation works sometimes, and that a device such as this thermometer would be welcome. However, at this point it cannot be inferred whether the thermometers would be a significant enough intervention to provide a substantial change in the standard of care practiced by mothers and in clinics for children with a fever.

Of course, these conclusions are very general and only highlight trends in the responses I got; they don’t completely encompass all of the feedback I received. I intend on continuing to survey nurses and mothers in regards to this thermometer and the other one that has been brought to Malawi, whose purpose is the same. Everyone in the hospital that I have introduced to the thermometer seems to be highly enthusiastic about the prospect of having access to such a tool, which to me shows promise that with further testing and development this kind of thermometer would be a viable intervention in places like Malawi.

This is already a fairly long post, but as a favor to my mother I wanted to add a sort of glossary for my blog to make it easier to follow. I realize that some of my acronyms or language may not be entirely intuitive for those that aren’t from Rice or Blantyre. Here are some of the terms that I hope will help clarify what I’m talking about in my posts:

QECH or Queens: Queen Elizabeth Central Hospital, one of the large district hospitals in Malawi. This is where I’ve spent most of my time thus far.

Poly: The Polytechnic University of Malawi, where some of the other interns have been teaching classes and helping develop a bioengineering program.

PAM: Physical Assets Management, the engineering department at Queen’s where broken medical devices are sent to be fixed. The other interns have also been spending significant time there helping to repair equipment.

CPAP or bCPAP: The device that was designed a number of years ago at Rice to help neonatal babies breathe. There is a lot of information on the CPAP on the BTB website.

BTB: Beyond Traditional Borders, the institute from Rice University that sent me to Malawi. This is another one where much more extensive information is available on the BTB website.

Paeds: The pediatric ward at Queen’s. Most often when I refer to Paeds I’m talking about the Paeds nursery, which has an average of about 20 neonatal and infant patients.

Chatinka: The nursery at Queen’s attached to the maternity ward which houses about 40 neonatal babies on average, most of whom are suffering from respiratory problems and sepsis associated with prematurity. This and the Paeds nursery are where CPAPs are used at Queen’s.

GLHT 360: A global health technology class offered at Rice where many of the technology we have brought to Blantyre were designed and developed. I took this class last semester.

Palpation: A method of detecting fever by feeling the forehead, cheeks, chest, and neck for excess heat.

Kwacha: The Malawian currency; 1 US dollar is equal to about 400 Kwacha.

Thandie and myself in the BTB office

The more time I spend in Chatinkha and the Paeds ward, the more I am aware of the profound impact that the CPAP project has had on the nurseries, and the extent to which the project has grown since it was a design project at Rice a number of years ago. In Chatinkha, the arrival of the CPAPs led to the arrival of a lot of other necessary technology. As the CPAP study could not be performed without functioning pulse oximeters and respiratory rate clickers, now not only the babies on CPAP but also all of the other patients in the ward benefit fromthe availability of the new technology. Devices such as pulse oximeters can make vast improvements in the quality of care that is administered in a ward, especially in one where the patients are so vulnerable that if treatment is not closely monitored it could end up hurting the patient more than helping. Also, since fewer resources are going towards finding a means of affording a CPAP, those resources can now help to fund other necessary equipment or pharmaceuticals that would otherwise be too costly. This effect should not be undervalued in a setting like QECH, where every Kwacha goes towards the lives of the patients. It is common knowledge for those familiar with CPAP that the device saves lives; it may be uncommon knowledge the number of ways in which it does so.

Along with my work in Chatinkha and on the CPAP data collection, I have had the opportunity to start doing research on supply chains within the hospital. In a large hospital like QECH, a lot of the money to fund disposables and common pharmaceuticals comes from the Ministry of Health. The budget from the Ministry is substantial, but because of the magnitude and scope of the Hospital’s needs it can sometimes be difficult for the Ministry to be able to support medicine that is more expensive or only effective for rarer diseases. That’s where outside NGOs such as Friends of Sick Children and Care International come in. They have more power to help supply specific medication that is equally as necessary as that from the Ministry but less available. It is in this way that the hospital is able to care for the large number of malaria cases that appear every day, and also the few rare cases of cerebral palsy or leukemia that only appear every so often. This research has exposed me to how complicated it is to keep such a large institution up and running, while also providing the best care available to each patient. I am coming to realize that Queen’s is remarkable at maximizing every given resource to the fullest of its capabilities.

All that I have learned in the past week about the CPAP and Queens has also given me some valuable insight into my overall impact on the community around me during my two months. At my arrival, I was very enthusiastic about having the chance to be hands-on and watch the work I was doing correlate directly to helping someone. After volunteering in my past for a lot of different international organizations, I couldn’t wait to be the one on the ground delivering the much-needed help. Since I landed, my understanding has significantly matured. The community here is not dependent on my help. They have been sustaining themselves for longer than I’ve been alive, and they will continue to do so long after I leave. My task has never been to come in and change the environment to stimulate development, but rather to encourage the development that already progresses in any way that I can. The other interns and myself are only here for two months, and so whatever goals we set out to achieve must be able to survive long past our departure. This realization has helped me shape the way I have structured my day and the tasks I plan for myself. Now I look for projects that not only make use of my knowledge that I bring, but also the projects I know will be sustainable beyond my assistance to them.

A CPAP at work in Chatinkha Carissa and Aakash on the walk home from Queens

View of QECH to the left and Mt. Soche to the right. Photo courtesy of Carissa

Now that I have been in Malawi a full week, I have started to set up a routine for what my days at QECH look like. I have spent some time shadowing Chatinka nursery, where many of the patients are babies in their first few weeks of life, and most all of whom are very premature. Some of the patients are barely larger than the size of my hand. From Chatinka I have been collecting some data about the use of oxygen and CPAPs. In the afternoons I have been coming back to the BTB office and working on data analysis from there. I have been setting up meeting with a number of different doctors, nurses and administrators, and in the process I have become slightly more familiar with the long hallways and numerous wards of Queen Elizabeth’s. It has taken me getting lost more than once to be able to get to the BTB office from Chatinka without having to ask for directions.

This week Jacinta, Caleb and I have been working particularly hard to pick up some more Chichewa. It would be nice to become more familiar with the language both for convenience and as a courtesy, as most of the people we’ve met are very happy to hear our improvement and communication is easier when we can better understand each other. Here are some of the words that the three of us have (nearly) mastered in the past few days:

Zikomo- thank you/excuse me 

Madzuka bwanji- good morning, answered by dadzuka or dadzuka bwino

Tionana- see you later

Pepani- I’m sorry

Ndangalala- I am happy

Most of these were patiently taught to us by Tandi who works at BTB with us and Alfred who owns the Cure House where we’re staying. Some friends at Poly also gave Caleb and Jacinta a list of common Chichewa words to learn that we have been studying in hopes of soon being able to communicate with our Malawian friends in their own language. Everyone I’ve tried my new vocabulary on is appreciative of my efforts and definitely willing to help me continue to learn.

If you’ve read the other Blantyre interns’ blogs, you probably read something of our hike on Saturday up Mt. Soche. We went with some new friends who live in Blantyre; John who is a photographer working for a year at the Cure Hospital, and Alex, a Blantyre native. We were also accompanied by three boys about ten years old who lived in the village at the base of the mountain. While the five of us struggled up the mountain dehydrated, overheated, and thoroughly exhausted, our three new friends seemed never to tire. Every time I turned around they were dancing, or sword fighting with sticks, or jumping off of rocks into bushes and leaves. They brought no water or food, and climbed the entire mountain without shoes on their feet- something hugely impressive and humbling to us less hardy hikers. All of the people that I’ve met since coming here- the children especially- are exceptionally strong and unfailingly friendly. We made sure to share some of our sandwiches and water with the boys before they left.

One of my favorite moments on this trip so far was seeing the view from the peak of Soche. You could see most of Blantyre and the surrounding landscape, and from where I sat I had almost 360 degrees of view down below. When we got back that night after the hike, I spent some time outside admiring the stars, which are very clear and numerous even in the city. The landscape around Blantyre is so colorful and vivacious during the day and so serene during the night, it has given me a lot of anticipation for getting to see more in the upcoming weeks.

The last two days have been very exciting as the start of my work at QECH. Aakash and I landed on Monday afternoon, and after getting settled in at Cure House Caleb took us for a brief tour of QECH, and to meet some of the important people around the hospital.

 Clockwise from top left: an IV dosing meter, a flow splitter, a bCPAP of a previous generation, and a current bCPAP all in use at the Pediatric Ward at QECH.

 Aakash at Windsor Castle near London (we had a long layover in London).