A couple weeks ago, the interns and I spent a great weekend in Liwande, where just outside of our sleeping area was this MASSIVE and very beautiful Baobab tree. In Africa, many people consider baobabs the “tree of life” given how useful their fruits, bark, and general existence is to many humans, animals, and insects alike. They are among some of the largest trees in the world and can only be found in Madagascar and a few African countries, with a few species that exist in Australia. You might even recognize baobabs as the tree from the Lion King, in which wise baboon Rafiki lives! Basically, it’s a pretty neat kind of tree.

 Baobab in the Lion King!

The first time I had ever heard about the baobab tree was when I read the Little Prince by Antoine Saint Exupéry as kid. The significance of the chapter didn’t really resonate with me until a few years later after having to reread the book. But, on a very superficial level, I can still distinctly remember staring for HOURS at the funny little baobab book illustration, thinking about how much I’d like to see such a unique, monstrous tree in real life. So, when I finally had the chance to sit at the base of one of these incredible baobab trunks, I could barely contain my happiness and excitement.

 The Baobab tree in Liwande     Baobab drawing from Le Petit Prince

Now, bear with me for a second, I promise I’m not just writing about some kind of strange fascination with a particular genus of tree! I’ve been thinking a lot about these baobabs and the Little Prince chapter lately, not because we see baobab trees and baobab products everywhere, but mostly because of what the trees represented in that one extremely short chapter. Their symbolism in the Little Prince, I think, ties nicely to my internship experience with BTB over the past few weeks.

To summarize, in the book, the little prince — who lives in a tiny, tiny little planet — views baobabs trees as these terrible, destructive forces of nature that have the potential to wreck havoc on his planet if left to grow to their full size. In order to address this possibly, and quite literally, enormous problem, the prince is very careful to uproot the little baobabs bushes the minute he recognizes them for what they are. He has a conversation with the author about how before the baobabs reach their huge size, that they naturally have to start off really small — almost invisibly– as seeds. He knows that by staying disciplined and constantly addressing this problem even before it has begun, he will be able to protect his beautiful home (and precious rose) from being overwrought by the trees’ massive roots.

You can read the entire chapter that talks about the baobabs here: http://www.angelfire.com/hi/littleprince/framechapter5.html

The baobab chapter’s “life takeaways”, to me, seem to tie into the type of work that we’ve been doing here in Malawi, mainly when it comes to the importance of 1) preventive maintenance in up keeping the hospital’s medical equipment 2) routine and consistency in enacting long term change, and 3) an underlying sense of urgency to drive even the most monotonous and seemingly insignificant tasks forward,.

Preventive Maintenance

 Whether it’s after you’ve bought you first car, or if you’re talking about about dental hygiene or healthcare or whatever, you’ve probably heard about the importance of preventive maintenance. Countless studies can demonstrate the cost benefit of preventive measures to avoid problems with your car engine or a disease like diabetes, and it comes as no surprise that if you can avoid a problem from occurring in the first place, you’re in a much better situation than if you were to have to treat the issue once it’s occurred.

So, basically, like the nearly invisible baobab seeds, preventive maintenance is something that is extremely easy to overlook, especially here in Malawi, when I can see that there are so many extremely pressing matters that need to be tended to around the hospital every single day.

Particularly when working with PAM and in the CPAP office when equipment gets brought in from not just Queens but from some of the district hospitals, it is especially frustrating to seeing broken pieces of equipment that could have easily lasted a few more years if only there had been someone to effectively maintain the device within the clinics.

Just look at the picture below where we had no choice but to replace the grey filter on the left for a new, white one, just because it had gotten so dirty that I was no longer salvageable. (Also, the picture of the filter here is not even CLOSE to how dirty it used to be! Caleb had literally scooped off physical clumps of dirt and grime that had been stuck to the outside). Essentially, a tiny, literally 30-second job of cleaning the gross particle or inlet particle filters about once or twice a month, could literally have prevented the oxygen concentrators from experiencing a significant number of the larger issues due to debris and dust collection within the sieve beds and compressor.

 Dirty Filter

There is a lot of value in taking measures to avoid problems from occurring in the first place. Essentially, by taking a leaf out of the prince’s book by ensuring that we stop these baobabs brushes from growing into the massive problems that they are, we can tackle a lot of challenges even before they’ve turned into actual trees.

 Fixing the dirty oxygen concentrator

Sustainability

The baobab chapter also makes me think about many of issues with sustainability with the CPAP project, most of which Carissa and Aakash already touched on in their blogs not too long ago. Through their travel experiences, they talked about the challenges with getting CPAP to really “stick” within the hospitals that they visited. The CPAP is currently not the “go-to” therapy for preemies with respiratory problems, and there are a lot of barriers to ensuring that this new technology be accepted and smoothly incorporated into the regular hospital pediatric protocol.

Namely, I believe that the CPAP or any new technology, medicine, or protocol has to become a natural as part of a hospital’s “morning toilet” as our dear little prince would call it. It is ultimately routine, an understanding of the need for the technology, and a familiarity with the equipment that is going to drive life-saving changes around the hospital.

And through the many tech surveys that Emily and I have had the chance to do together over the past few weeks, if there’s one thing I’ve learned, it is basically that the nurses run the show at Queens! Therefore, if a technology isn’t well received by them, if the nurses aren’t trained to use it properly, or if they don’t understand the need for a particular device or protocol, the change just isn’t going to happen! Nurses are the soldiers that are in clinic day in and day out and are undoubtedly the people who will be using these new technologies once they’ve been introduced. So if the training, education, and positive “attitude” towards the technology isn’t there, the nurses will never be willing or able to develop a sense of routine and familiarity with the device, and the technology will flop.

It is the prince’s habit of checking for the baobab brushes (initiated and sustained by his knowledge of the importance of catching baobabs early and ability to use a shovel) that ensures the safety and health of his home from the baobabs, in the same way that the nurses habits at Queens have the potential to do the same.

Sense of urgency and necessity

The last “life takeaway” about the importance of a sense of urgency in driving change seems kind of like a stretch, so I thought I’d include a snippet of the chapter for you to read before I go any further.

Perhaps you will ask me, “Why are there no other drawing in this book as magnificent and impressive as this drawing of the baobabs?”

The reply is simple. I have tried. But with the others I have not been successful. When I made the drawing of the baobabs I was carried beyond myself by the inspiring force of urgent necessity.

I included the illustration of the baobabs within Le Petit Prince earlier in the post, and it is undoubtedly one of the best drawings in the entire book. Naturally, the author takes the time to mention how his best work was propelled forward through a sense of responsibility, obligation, urgency to get it out there, and I believe that those are really important things in driving sustainable change forward.

With regards to the CPAP, I think that an underlying sense of urgency and understanding of the potential for device to save the lives of premature infants has to be there for the project to be a success. I believe that this sense of importance can certainly be instilled through doing a good job with presenting the evidence and the numbers that show that “hey this technology really needed and it WORKS!”. But perhaps more importantly, I think this sense of urgency should be translated to a sense of responsibility and determination among the people putting the device to work, to help them push through the massive frustrations, roadblocks, and even heartache, that come with working in this field and setting.

In short, baobabs or global health projects, even as massive as they are in their full form, have to start small, almost invisibly, and the changes that ultimately help them die or thrive, are equally as tiny and long term.

And to wrap up this blog post, just in case you didn’t catch on how incrreeddiiibbbllleee I find these trees, I’ve added a lovely picture that Carissa took with the African sunset in the background. Unreal. 

You’re probably never going to find anyone who objects to donating much-needed medical equipment to developing world clinics. Equipment is expensive and difficult to come by in these areas to say the least. Furthermore, with some the budgets that many clinics have to operate within, there are times when some medical equipment would quite literally not be getting to these clinics if not for generous outside donations. But, after my few weeks here at PAM, it is evident that there are still some barriers to ensuring that medical equipment is donated in a way that way optimizes its benefit to the recipients. Outside aid is incredibly valuable obviously, but shipment after shipment of donated medical equipment is not necessary a sustainable way to address issues in resource management and procurement.

Working with the technicians at PAM has been both enjoyable and educational, and I feel like I’m gaining a better understanding of how QECH manages its donations. Here are some of my thoughts on a few of the current issues I’ve noticed with the medical device donation process.

 1. Lack of regulatory oversight

The World Health Organization has established a thorough set of guidelines and recommendations on donating medical equipment. The document is thorough and well organized and most definitely worth a read (Check it out here: http://www.who.int/medical_devices/publications/en/Donation_Guidelines.pdf) But unfortunately, I’m willing to risk an eyebrow that these guidelines are not strictly followed about 99% of the time, as (for the most part) there are few means of enforcing or overseeing what goes into donation shipments.

After talking to a number of different nurses, doctors, and technicians at QECH, it is clear that this lack of regulation leads to many frustrations with the equipment that come into clinic. While I was in Chatinka a few days ago, I spoke with a nurse who was so excited about the 50 new syringe pumps that had just been donated to Queens. But, once she tried to actually start using the device, she was quick to discover that it would only run on 110V. Malawi runs on 220V. So unless the donors also want to provide a few voltage converters to supplement their shipment, the syringe pumps are essentially useless. And this happens way more times than you can possibly imagine. Sadly, not only does the operating voltage not match up oftentimes, SO many devices are also donated to QECH with plugs that don’t match the outlets in the hospital. Becky (another one of the interns here) was super sweet and gave her own personal outlet adapter to the paeds clinic the other day so that they could use a vital monitor that had been donated from the states. But certainly having interns provide these adapters during their clinical rotations is probably not the best, or most sustainable, way to address this problem in the future.

Oh and just today, a bunch of thermometers came in……in Fahrenheit! Ahhh!! Becky had to go around distributing new Celsius to Fahrenheit charts she had made because none of the nurse know how to work in Fahrenheit.

PAM has had to deal with medical equipment arriving at the hospital already broken, and sometimes devices are sent that are just so outdated and run down that the clinic is better off to having received them at all. If they’re broken and can’t be fixed, they quite literally just end up taking up precious hospital space, sitting there, doing nothing.

But thankfully, I believe that Malawi (and other nations) are starting to take a stand against receiving “useless” medical equipment donations, as seen by a newspaper clipping that sits on the bulletin board outside of PAMs office.

Newspaper Clipping on PAMs bulletin board 

Some countries have even started establishing regulatory bodies to make sure that donated equipment has gone through the necessary compatibility checks and inspections. For example, Ethiopia’s Drugs Administration and Control Authority (DACA) has created some pretty comprehensive checklists for their medical device donations. I’m really interested to see how these changes and new levels of enforcement will impact clinics long term.

But for the time being, I think that another way of complementing the work that can be accomplished through these regulatory bodies would quite simply be to increase communication between donors and their recipients. I think if donors just had a better idea of what would benefit clinics the most and what specifications need to be considered when sending equipment that is manufactured and produced abroad, a lot of these types of “careless” errors could be avoided. 

 

2. No personnel or protocol in place to distribute and manage donations in country

I have spent a good amount of time at PAM for the past few weeks, and the building itself is incredibly crowded. There really isn’t even a whole lot of workspace for the technicians to work on the mountains of equipment that they are supposed to fix.

Although there are lots of medical device donations that don’t work or that aren’t compatible for the setting, there are of course those that are made up of awesome, functional equipment that could very well be put to great use within the hospital! And that’s what brings me to my second point. Hospitals need the personnel to manage these boxes, unpack them, assemble the equipment (safely), and just get them to the right departments. The picture of the boxes below has been sitting there for roughly 5 months now according to Jiwowa, and it is filled with all kinds of things that could be helping all the patients who so desperately need them.

So many dusty boxes!! And this isn’t even all of them

So point one and two ultimately kind of go hand in hand. Before equipment is even sent out, it’s important that it has gone though the proper inspections to ensure that it is appropriate and useful for the hospital in question.  Therefore, part of ensuring that these devices are used to their maximum capacity means that you also have to think through how you’re going to actually put these devices into use once they get to where they’re going! I believe that donations “regulations” should involve making sure that the clinics have the personnel and resources to actually handle receiving the donations before they are shipped, so that working equipment doesn’t end up pointlessly taking up space for months on end.

During our next few weeks, Caleb, Carissa, and I plan on filling in that “personnel/resource” gap and will sort through and distribute some donations within the large boxes at PAM. But, we will also be trying to work with the hospital to try to figure out a new process/protocol that will continue and sustain this kind of work after we’re gone.

 

3. Lack of local capacity to fix equipment

While governments, international NGOs, and non-profits usually handle the actual donations on a large scale — an emerging problem is the lack of local capacity and resources to handle the maintenance and repair of devices as they break.

At Queens, the technicians are all incredibly well trained and obviously know what they are doing. But, many of the districts hospitals in Malawi lack the personnel to be able to troubleshoot/fix the broken equipment at their clinics, and will therefore just send this equipment to QECH to be fixed. So, the broken equipment build up is just horrendous and the ratio of personnel to broken equipment is so ridiculous that it’s really difficult for the repairs to happen within a reasonable time frame.

Malawi is taking steps to provide individuals with the proper tools (both literally and figuratively) to handle more equipment repairs by partnering with Japan’s International Cooperation Agency (JICA). With JICA’s technical support, they aim to train and develop PAM technicians all across Malawi. It’s great to see these kinds of changes taking place, especially after having spent the last week and a half teaching one of these types of workshops at the Poly! It’s been said so many times before that sometimes it almost sounds a little bit cliché, but seriously investing in human capacity is the way to go! The Poly is developing a new BME program and teaching its students valuable troubleshooting and medical device repair skills, and the Malawi Ministry of Health is setting up workshops to train more people already on the ground. Lots of exciting things are underway to address many of the issues related to maintaining the medical equipment in country, and I couldn’t be more excited to playing a little part within this much larger goal.

 Another small paper clip about Malawi’s Ministry of Health’s JICA/PAM partnership

4. Need for spare parts and repair manuals

The technicians at PAM are really good at identifying what is wrong with a piece of equipment very shortly after it is brought into the warehouse. However, 9 times out of 10, PAM just doesn’t have the budget or resources to get the spare parts that are in need of replacement to bring the technology back to life.

The picture below is of roughly 68 oxygen concentrators all in need of various spare parts to get working again. It is both really frustrating and sad.

Instead of having new equipment always being donated, I think that perhaps donations should start shifting towards providing technicians with the spare parts needed to fix the equipment that’s already in country. Getting devices back up and running would clear up a lot of space and also let technicians put their incredible repair skills to use!

Finally, when equipment is donated, the service manuals are usually 1) not included in the mix or 2) get lost along the way. When it comes to more complex pieces of equipment, a manual makes a world of difference, and could make or break a technician’s ability to figure out what’s wrong with a particular device. And then fix it!

All in all, my main take away is that it is not enough for donors to just be thinking about how medical device shipments have the potential to help a hospital in the short term. They should evaluate all aspects of sustaining the service that this equipment provides long term. From the consumables, to spare parts, maintenance, and repairs, etc. a LOT more is needed to sustain these devices once they are in country, and these things should all be considered and addressed well before the equipment ever reaches the hospitals they are trying to help.

I am motivated to learn more about the ins and outs of the donation process at QECH and in Malawi in general, and hopefully can find some creative ways to make a positive difference in this area. I think we have a few good ideas for now, and I will keep you guys updated on what we accomplish in the next few weeks!

After seeing the types of newspaper articles, training programs and classes that are popping up around Malawi, and hearing some of the discussions about these issues around Queens, I am hopeful that changes to the medical device donation landscape are pangono, pangono (little by little) underway.

Tionana zangas!

Time seriously just seems to fly out here in Blantyre! I am having the best time living at the CURE house and working on our various projects with all the Rice interns, and we have made a great group of new friends from the UK and Australia, who make the downtime/adventure time all the more exciting.

For the past week and a half, Caleb and I have had wonderfully packed days, splitting our time between teaching a class at the Poly and working with PAM at Queens. Being in front of the classroom, trying to keep the class energy up, prepping for the following day’s lessons plans, etc. makes teaching absolutely, but wonderfully, exhausting! The oldest students that I have ever taught before in a classroom setting have been at the high school level, but at the Poly we have 4^th year electrical engineering students and three faculty members to top it off. I get extremely nervous before going up for our mini “’lectures” that we start each class off with, and we do our best to make these parts seem more like a conversation/discussion than us lecturing at the class. Even though I’ve taken the troubleshooting class before and Caleb and I put a lot of prep time into learning the materials and organizing our class materials before coming out here, I still feel like I should be the one learning from the students and teachers in Malawi and not vice versa! But, in the end, the teaching and learning has undoubtedly turned into this wonderful two-way street that has led to friendship along the way.

                

Students fixing a suction pump!                             Our class and their workshop certificates

For the past two weeks, we have spent our afternoons at PAM working with Nelli, Timothy, Wiseman, and Jiwowa, fixing the broken medical equipment that have been brought over from Queens and sometimes other hospitals as well. I learn so much about the difficulties with fixing their broken equipment each time I go, and will write a bit more about some of my thoughts on medical device donations in my next blog. We have fixed a suction machine, a few oxygen concentrators, and one of the big hospital autoclaves so far. This week, we will be spending some more time with PAM, which I am very excited about! PAM has been very generous with letting us take some of their medical equipment to the Poly with us in the mornings when we would teach. For the first few days, Caleb and I attempted to draggggg the equipment to and from Queens, but quickly found that it was really quite difficult to keep this up! Thankfully, Dr. Gamula and Jiwowa were super generous is helping us transport some of the heavier equipment in their cars, which definitely saved us a lot of time and muscle soreness!

            

Caleb and O2 concentrators in JiWowas car                           Caleb and JiWowa working at PAM

Work has been so jam packed (Caleb and I usually leave the house by 7: 30 ish and get back around 5 pm). Sometimes I get home after having spent almost 7 hours on my feet, just wanted to sit down with a nice cup of tea and relax. BUTTTTT thankfully we’ve got some serious (positive!!) peer pressure going on within our family that forces me to do an Insanity workout at the end of every day! My new friend Gaby is a physio student and triathlete at the University of Nottingham in England, and she and I have even taken to waking up early in the morning to run and workout at the track just 5 minutes down the road from our house. I guess after all the mendazi and samooooosas that I eat here, I’m quite lucky to have been placed with some ridiculously fit housemates.

I love my job, my friends, and every little thing about Malawi, and am so grateful every day for the wonderful life and home I’ve found here.

Rice’s CPAP study is really incredible, all the way from the technology’s elegant and simple design to the people on the ground working and using the device every day. From ensuring that the device is used properly, that the data is recorded consistently, and that (long term) the technology can be effectively maintained and repaired, so many little pieces need to come together to facilitate the CPAPs ultimate roll out and adoption in the region.  And when you think about it, it’s really quite a beautiful but extremely daunting thing!

So, I’m super lucky and thankful to be working alongside so many different people here in Malawi, learning about just how much it takes to make this project run and succeed. I mean, just looking at what the BTB interns have been up to specifically, has really highlighted for me the importance of a whole “team” working together to successfully carry out any kind of global health project!

Carissa and Aakash have been travelling with the Shannon and Caroline this week to work on CPAP data collection and have really gained a better understanding of the challenges and limitations to adopting the CPAP device in the district hospitals. Emily has been at Queens being involved in developing educational materials for mothers, nurses, etc. and lots of data analysis, and she and I even had a meeting today with a physician to get a better understanding of the equipment supply chain at Queens.

Caleb and I are a little more removed from the CPAP project as we are primarily working with the Poly and PAM. But, with the biomed repair workshop we’ll be teaching starting tomorrow (ahhh!!), our repair manuals, and the potential for a new partnership between PAM and the Poly, hopefully we can come up with some creative ways can help the local capacity address all the local medical equipment repair and maintenance needs (including CPAP!).

Basically each of us operates within out own sphere of responsibilities, which when all put together contributes to the larger task at hand. And it kind of works that way at home too! When we cook dinner together every night, each of us takes care of one little slice of the work, be that cutting the vegetables, cooking the rice, setting the table, tag teaming the dishing washing at the end or whatever! I am optimistic that if we each keep working hard within our own tasks and keeping learning from one another (both at work and at home) we’re going to be able to accomplish some really neat things by the end of our time here.

I am excited and motivated to tackle the work we have ahead of us, and seriously can’t imagine a cooler group of people to be working alongside.

#strengthinnumbers

Dinnertime with the BTB family!

What an incredible first week in Blantyre it has been!!

On Tuesday, I had the chance to travel with Shannon and Caroline to Thyolo and Mulanje District Hospitals and learn a bit more about how they carry out their CPAP data collection. Thyolo was the first clinic that we visited in the morning, and never before have I seen such a beautiful hospital! The walls are a stunning shade of clay-red that stands in awesome contrast to the green, green, green of its surroundings. I didn’t feel comfortable whipping out a camera and taking pictures, so I don’t have one for you here, but you can just google some images of it online if you want to see it. Here’s a pretty good link: http://www.sydellewillowsmith.com/photography/msf-in-malawi/sws_thyolodistricthospital_msf_malawi20131010_0014.jpg/

Since it was really only my second day on the job, I spent the majority of my time observing Shannon and Caroline doing all the heavy lifting. We went through a number of the pink data collection forms that are currently being used to record the heath outcomes out neonates who are eligible to be put on CPAP. We wanted to ensure that the baseline information that was being collected at Thyolo was thorough and accurate, and we spent some time talking to a few nurses in the various wards to try to track down any missing data. Thyolo District Hospital is one of the clinics has not yet started using any of the CPAP machines, as collecting this baseline data has proven really difficult so far. The problem with trying to get all this information can’t really be attributed to just one specific thing, but rather is impacted by many little different things that build on one another. Most notably, the lack of functional oxygen concentrators in many of the wards forces patients to be transferred from department to department in search of the sole functioning device in the hospital. This jumping around from Labor and Delivery ward, to Maternity, and then Peds and then back again, is problematic due to difficulties in coordinating and communicating between the various wards of the clinic. So, tracking down these CPAP-eligible patients and properly documenting their progress from enrollment to discharge is far from perfect. Training staff to properly collect this data on the specified CPAP study forms is already difficult even just within one ward due to the enormous amount of staff rotation that occurs in Malawi.  Working between different wards multiplies this challenge ten-fold.

To start addressing the problems with data collection at this clinic, we suggested that the first step would be to get a new functional oxygen concentrator within the nursery/pediatric ward, or at least to work with PAM to bring the failing ones into service once again. Then, it would be useful to re-train any nurses or coordinators within the department to properly record the relevant neonate information. Getting all these pieces into place will obviously take some time, resources, and patience, but after seeing how much the nurses, doctors, coordinators, and everyone at the hospital care about their patients, I am hopeful. We plan on re-visiting Thyolo in about a month.

At the Mulanje clinic, I was happy to see two CPAP machines being put to use, with a functioning oxygen concentrator right next to them. While I was there, I showed the CPAP repair video to two PAM personnel and answered their questions about the CPAP machine. This week, Caleb and I plan on starting to develop a CPAP and oxygen concentrator step-by-step repair manual with all of the major/most common breaks, which can hopefully serve as another useful resource to future PAM members at the CPAP clinics.

                CPAP machines at Mulanje

As for the rest of the week, Carissa, Caleb, and I have spent a good amount of time fixing the broken CPAP machines that are sitting in the BTB office. And at the Poly, we have even been assigned a design project! Rodwell, one of our supervisors, asked us to design a stand for the phototherapy lights he has developed. The phototherapy lights are great, and Rodwell took us through his designs and everything and even let us take the lights apart to get a better look inside. An ENG 120 team last year developed some kind of stand for some phototherapy lights last year, which is actually being used at Queens currently. However, there are issues with transporting this 3-fold steel stand design from bedside to bedside. Also, since the lights Rodweel designed are about double the weight of the current ones, we came up with a new  IV-pole-esque design entirely, which we plan on prototyping in the next few weeks.

                           

     Rodwell’s Phototherapy Lights                                      Carissa fixing CPAPs!

On a more fun note, we have been eating lots of yummy things (including full loafs of bread at a time, and fried dough balls- which costs 40 cents and 4 cents respectively), and keeping active! Our team has decided to do “Insanity” workouts together to stay in shape, and on Saturday we climbed a mountain with two of our friends Alex and Jonathan. This summer is off to a great start and I can’t wait for all the amazing work and fun times ahead.

                   

Emily eating the fried dough balls                     Casually eating an entire loaf of bread for lunch

   

                      Insanity Workouts                                             Carissa at the top of Mt. Sochi                                    

For our first few meals in Malawi, Caleb, Carissa, and I enjoyed some very delicious PB&J sandwiches, Nutella, and Oreos. But, as of last night –after figuring out the whole money/marketplace situation a bit better— we have started to step up our culinary game. Together, we actually cooked a full-fledge meal of chicken and rice, and have big plans for ourselves for the remainder of the summer.

        

This morning, Caleb, Carissa, and I went to a small little café down the road for a delicious brunch, and even ran into Shannon, the BTB Associate here in Malawi, with a few of her housemates while we were there. We then went over to the local market place and bought a wide variety of fruits and vegetables.

We have the weekend off to hang out and prepare for our first week of work. Our CURE house is incredibly peaceful, and the weather is wonderfully cool and mosquito-free. Our housemates are from all over the world, with some taking off to go home right as we’re getting settled, and with others staying here well longer than the 9 weeks that we will be here. While Caleb and Carissa work on their medical school applications, I am having a good time going through all of my old instrumentation exams and writing up a summary the key take-aways from the class. I am not 100% sure what to expect when I start at the Poly on Monday morning, but I am excited to meet the faculty (and hopefully even some students) to start sharing our background and experiences with one another.

Today, Carrisa, Caleb, and I finally completed our 41-hour-commute to Blantyre, Malawi. Transporting the hugeeee amounts of luggage has been quite the struggle, but we’ve managed to get all 9 suitcases and 6 carry-ons to the Beit CURE International House in one piece! I couldn’t imagine a better group of people to laugh with while clumsily hauling these bags around, and I am so excited about the amazing summer that we have in front of us, together.

As Caleb and Carissa mentioned in their blogs, these past few days have been incredibly busy with packing and preparing all of our equipment and supplies for the trip. Though it has felt rather overwhelming and stressful at times, Dr. Leautaud, Dr. Ramos, and my teammates have so wonderful to work with. And now that we are all finally here in Malawi, I think we feel much more prepared than we did just a few short weeks ago. Shannon introduced us to Dr. Godfrey very briefly today when we made a pit top at PAM (Physical Assests Management) at Queens on our way to buy some SIM cards, and even from just that brief interaction, I am SO excited, honored, and thankful for the opportunity to be spend the majority of my summer working and learning from someone so knowledgeable and experienced.

As a newly graduated bioengineering student from Rice, it was really interesting to spend these past few weeks going over all the old class materials from ELEC 243, BIOE 383, 385, and 449 so that we may work and learn from professors at the Polytechnic University to develop two Bioengineering lab courses. In light of all the personal introspection that naturally occurred before my graduation this past Saturday, I’ve also had a great time looking back on all the academic material that I’ve learned during my past 4 years at Rice. So, I’m very excited to be spending the majority of my time in Malawi working with PAM at Queens and the faculty and students at Poly to figure out how we learn from one another’s programs to eventually build a stronger BME curriculum and workforce to carry out the necessary medical repair and maintenance in the area.

My teammates and are now just working in our room at CURE, learning the ins and outs of the of the CPAP troubleshooting/repair manual. We have the next few days to get used to our new home and to prepare for the incredible summer ahead!