Caroline and I were on the road visiting the northern district hospitals for a little over a week. We visited 12 hospitals all over Malawi, and saw so many incredible/heartbreaking/thought-provoking things. I decided to share a small taste of our trip through my favorite signs, whether from the hospitals or on the road.

 

Salima District Hospital (as well as many others) claimed to be “The Baby Friendly Hospital” right smack dab over the front of the entrance. The other panel opposite the painting of the mom and baby was 10 reasons why breast-feeding is beneficial. Just right in the parking lot.

 

Seen at Machinga District Hospital promoting Kangaroo Mother Care.

 

 

Seen at Mua Mission Hospital outside the labor ward.

 

 

Seen inside the Kangaroo Mother Care ward at Mua Mission Hospital. Goals to combat neonatal mortality. You go, Mua Mission.

 

 

Seen at Ntcheu District Hospital. Not sure the correlation, but without context, it’s pretty funny.

 

 

Seen right next to the visa desk at the Zambian border passport office.

 

 

Seen at the edge of a bridge over looking a gorgeous river in Rumphi. Food for thought.

 

 

Seen in Salima. Not at all true, but I love the Ice Cream Den’s confidence.

One of my individual projects is a qualitative analysis of the CPAP mentorship program at district hospitals. Basically, very well-trained CPAP nurses from Queen’s go to struggling district hospitals to mentor nurses and staff on CPAP. From this visit, the mentor’s write a report on each mentee’s performance and improvement, as well as a general report about the neonatal ward in the hospital. So what I do is, go through all these reports and code various trends that I find pervasive across the hospitals to help to give more information on the condition of the nurseries, adherence to CPAP procedures, and if the mentorship program is effective, which informs the CPAP team about how to improve the mentorship program. I draw information from these reports, as well as personal interviews with the mentors here at Queen’s.

Okay, all the technical stuff is out of the way.

Let’s talk about how all this data collection and analyzing gave me goosebumps. Surprising, no?

Yesterday, I interviewed a veteran CPAP nurse from Queen’s named Chrissie. I told her about my project, and we worked out that 2pm is the best time to conduct the interview. Being in Malawi, things often seem to run on their own clock, so I knew 2pm could mean anywhere between 2pm to… well, anytime this week. Chrissie comes into the office at 1:50pm with a stack of reports from all her mentorships compiled and ready to go. One can say I was caught a little off-guard. So, I ask my questions, she gives me thoughtful, insightful answers. I can tell when she talks about her work that she is completely committed and believes in what she is doing. I see this commonly among nurses here, but still every time I come across it, I’m inspired by their dedication. As the interview was coming to a close, we were getting up and putting our things together to go our separate ways. I asked her what she had going on the rest of the day, and she told me she was on her way to teach a CPAP refresher for the nurses in the pediatric nursery and she was so excited. I asked her, “You really love CPAP, don’t you?” to which she responded with, “CPAP is why I do what I do.” From there she told me all about what CPAP means to her and this hospital.

Chrissie told me that she goes into work each day and mothers waiting in the hallways recognize her as the CPAP nurse. “Mothers come up to me and say [cradling her arms as if she was holding a baby] ‘Do you remember me? You are the nurse that saved my son’s life.’ ‘You’re that CPAP nurse! Look at my girl, she’s healthy and alive! Thank you, sister!'”

Then she told me about a time that MBC, the major news broadcasting company in Malawi, was interviewing patients at Queen’s. One of the interviews was with a mother that had recently given birth to a preterm baby that had to be put on CPAP. “In the news cast, this lady said, ‘My son is alive and breathing because of the endless care of the amazing nurse, Chrissie Mbendera.’ My name! On the news!”

After I was fully in awe of everything about Chrissie, she told me a story about when she was shopping for potatoes at the market. She told me that it was some random weekend, and she was buying potatoes from a vendor at the market. “I told the woman, ‘I would like one bunch of those over there.’ Then, I felt a person come up behind me and put my hand on my shoulder. This person said, ‘No, she wants two bunches and I am buying them for her. This woman saved my baby boy’s life.'”

Was I wrong about the goosebumps?

The new Chatinkha nursery in QECH.

http://www.rice360.rice.edu/#!day-one-project/udbk5

While abroad, it is really easy to get wrapped in your own bubble of experience. I have noticed this about myself this summer and have been actively fighting this instinct. I know that I am constantly trying to push my boundaries while being here–whether it be jumping into an icy waterfall, trying to eat food with only my hands and nsima (blob of maize flour and water), or convincing myself to enter wards knowing I’ll see patients in a lot of pain.

Ironically, when I was opening my mind to new things and experiences, I seemed to have closed it the goings on of the rest of the world. I was focused on Malawi, and not much could shake that. With limited internet, in this day and age, it can be very difficult to stay informed about current events. Now that I realized how wrapped up I was in time here, I have made efforts to stay informed and not use poor Wi-Fi as an excuse to be ignorant.

What changed between that time and now was Orlando. Hearing about the biggest mass shooting in history shocked me, to say the very least. I wanted to be in the US; I wanted to mourn with my country; I wanted to talk about it endlessly and try to make sense of something that had no answer. I angrily googled things and read the latest reports about the shooter and his victims, stories from the families of the affected, speculations about the shooter’s background and motivations, and reactions from our country’s leaders and presidential candidates. This tragedy, among other things, made me realize how important it is to be a well informed global citizen. It is important to learn the incredible things I’m learning here, but vital to stay connected to the world outside my environment of Blantyre.

Since the tragedy in Orlando, there has been police shootings in Dallas and Baton Rouge, attacks in Istanbul and Nice, a political uprising in Turkey, and so many more horrible events where so many have died. Just as I am writing this now, my phone buzzed with a news alert with a headline that 2 people were killed and 17 were shot outside a club in Fort Myers, Florida. Out of all of the ways these tragedies have affected the world, me becoming more cognizant of life outside my bubble is insignificant by an impressive magnitude, but it has affected how I view the world and myself more than I know or can process.

A few weeks ago, the vote concerning whether the UK will stay or leave the European Union came out. It was a very close race with about 52% of the vote in favor of leaving the EU.

The place I’m staying for these 9 weeks, Kabula Lodge, is host to many international travelers, mostly working at Queen’s–and many being from the UK. I woke up on the morning that the result was to be announced to an Associated Press alert on my phone saying that the votes were still being counted and no decision has been reached. I knew all my friends from Kabula had been on edge the past couple weeks about whether the UK with remain or leave the EU — calling home to make sure their absentee ballot was being cast, relentlessly checking the latest poll data, and just verbally processing their thoughts with those surrounding them.  I had heard about the referendum and had done some preliminary reading about how the outcome would effect the UK before coming to Malawi, but to hear opinions from the people it would actually affect was fascinating to me. Breakfast on the morning of the vote was just a flurry of questions about how they feel about the vote, how they think their country will lean, what brought about the call for the referendum, and their opinions on party leaders and their Prime Minister, David Cameron. I learned more about British politics waiting for our bus to work than I could have possibly from the news. By the time the bus came to get us, everyone’s news alert on their phone had buzzed and delivered the result: the UK had voted to leave to EU.

That entire week, while my friends were processing what leaving the EU means to themselves and their country, I took this opportunity to pump them for as much information as possible. I wanted raw emotion mixed with political perspective to really get a feel for what this referendum meant to them. I had a friend that goes to veterinary school in the UK and had just applied to a global health masters program in Holland. Now she was left wondering whether she would have to pay international fees or could still pay fees as though she was in the EU. I had a friend’s sister, who after a long and painful process of endless interviews had just gotten job at a bank in London, be laid off that next day due to Brexit.

These would be things I might hear in anecdotes in articles or interviews on the news, it was a completely unique experience to be able to hear and empathize with people we have been getting to know this summer. I would have never have gotten the chance to hear these stories or be a sounding board for British people’s thoughts on the result at home. But, I am eager to experience this in my home country come November when the US elects a new president.

faceofmalawi.com

This past week, the other interns and I got the rip bCPAPs apart, piece by piece. This may seem strange since we are supposed to be promoting the bCPAP, not dismantling it. But recently, a new version of bCPAP came in from the manufacturers, so we needed to decommission the old machines to make room for the new ones. Our colleagues just came back from visiting the district hospitals and returned with a load of old bCPAPs that had no use anymore.

Mid-Decommisson of a bCPAP

But instead of just trashing them, which would likely be the practice in the US, we decided to get as much use out of them as possible. If we took them apart, then we knew we would be able to find a use for each and every piece.

We talked to the electrical engineering department at the Malawi Polytechnic University, who wanted the flowmeters, tube fittings, screws, switches, and some sheet metal casings from the dismantled machines for their design kitchen. We got an estimate from a scrap metal yard to take the rest of the casings, which we would put right back into funding the bCPAP project. We went to a plastic yard to see what we could get for the tubing and pumps. Sadly, there wasn’t enough plastic for them to buy, but they wanted to support the hospital in any way they could, so the manager donated “as many buckets as one could wish for” to hospital. The hospital is always in need of supplies, so this was much appreciated. We didn’t go in the plastics yards for free supplies, but what a bonus! In addition, there were a lot of parts that didn’t change between models, so everything else could be used for spare parts for the new machines. In a low-resource setting like Malawi, replacing broken parts on machines can be difficult/near impossible, so these spare parts are vital to keeping the bCPAPs up and running.

Old bCPAPs on their way to the metal yard feat. Kinsey

This whole process of taking these machines apart and repurposing each piece reminded me so much of how Native Americans would treat a buffalo. One animal for food, clothes, tools, you name it. Every part is used, not a thing wasted!

P.S. The title may or may not be a reference to a certain sequel to a Disney Channel Original Movie musical.

P.P.S. To all concerned, it’s from the fun-loving song “Fabulous” from High School Musical 2.

It’s just our first week, and my colleagues and I are lucky enough to be able to attend and help run a bCPAP training course for Malawian medical professionals at Queen’s! I have always been interested in learning more about the implementation side of medical devices in low resource settings. Being able to witness this first hand is my main motivation for being here.
The training began with a few presentations that focused on respiratory distress syndrome, its mortality rate in Malawi, how to select the proper candidate to place on bCPAP, and how to put together the device for use. I had learned all of these things in the previous work days, so I could focus less on the information and more on how these doctors and nurses are learning about the bCPAP. The presentation concerning how to put the bCPAP together itself was short and to the point, and as someone well acquainted with the device followed it easily. But I wondered how well people new to this device retained this important information. Little did I know, that’s when the real learning began. The next portion of the training course was a practical skills session where the doctors and nurses would have to practice putting together and using the machine as a team. There were two bCPAPs, three overseers, and about ten participants. So each group had about five people, a mixture of doctors and nurses, at each machine with a bCPAP nurse/doctor to help the participants learn to use this device correctly.

Group of medical interns during the practical skills session

The third overseer, a consultant for the pediatric department, went between each of the teams and gave them different scenarios concerning the baby’s breathing and its symptoms and would ask how the doctor or nurse would respond in this situation. He came back and forth between the two teams and asked things like: “What do you do if the baby’s O2 saturation isn’t increasing?” “The baby’s heart rate is still too high and the baby has been on CPAP for 24 hours. What’s the next step?” This forced the nurses and doctors to think critically about the patient while interacting with the machine. If the answer would to be to increase pressure, then the medical professional would physically go through that step with the machine to save the baby (or baby doll, in this case). Beyond that, each nurse and doctor in the group had to show that they could put the machine together properly to their group and the CPAP overseer. Watching each team member go through the same steps over and over clearly cemented the process in their heads. The first person to go in the group was usually pretty uncertain with timid suggestions by their colleagues, but by the time the 5th person went, it was practically muscle memory.
This was a truly amazing thing to see in action. I bounced back and forth between the two groups and got to see nurses and doctors who had learned from mistakes in their own turn, coach colleagues about using the bCPAP. This really convinced me that each person taking part was learning and retaining the information in this training session. Seeing everyone work together also helped me see not only how these doctors and nurses learn, but how they will teach others in their ward.

In just 2 hours, I leave for 2 months in Malawi! I’m sitting in the airport now endlessly running through my dozens of checklists and to-do lists to make sure I am ready. With all the boxes checked, I have a few breaths to think about what the summer holds.

For the next 8 weeks, I will be working in Queen Elizabeth’s Central Hospital in Blantyre, Malawi. My main focus will be on the bCPAP device: continuing clinical trials and traveling to district hospitals all over the country to decommission older models. In addition to that, I will be presenting the staff of doctors and nurses with several prototypes of medical devices developed by Rice design teams in the Global Health department. I will be recording their feedback on necessity, usability, and future improvements for each of the devices. The devices vary from a mechanical breast pump rocking chair to an educational diabetes wound care simulator. In the past month, I have been working at the Oshman Engineering Design Kitchen learning these technologies backwards and forwards. I am impressed with ingenuity of these design teams and am eager to see how the hospital will receive them.

I would like to thank my sponsors, Jim and Linda Hargrove, for this opportunity to further my passion for global health. I am beyond ecstatic to get my feet on the ground in Malawi and witness first hand the real issues facing health in low-resource settings. Bring on the 34 hours of flying, I’m ready!