As I am writing this, I am sitting in our living room alone at 2:30 am. We will be leaving in a couple hours, but I cannot sleep. I have too many thoughts swirling through my head and too many emotions in my heart, so I decided to write them down for you.

Throughout the summer, we have been having house meetings. Whenever we find a challenge to living or working together, we sit down and talk it out. These meetings are often difficult and force me to reconsider where I come from on a variety of issues, but tonight’s was only beautiful. We thanked each other for this summer, for the lessons we have learned, and for the experiences we have shared. Tonight, I told you that I am thankful for every single day we have shared together. That is not to say that they have all been good – some days, I have been frustrated. Some days, I have been angry. Some days, I have lashed out. Still, some days, we have laughed until we cried over communication mishaps. Some days, you have taught me skills with the patience of a saint. Some days, you have given me a new perspective and helped me see things from a different direction.

We do not grow, as individuals or as a family, from the easy things. We grow from the challenges, from working to understand each other, from respecting each other, from seeing each other’s perspectives.

So, I thank you. Thank you for all of the challenges. Thank you for the frustrations. Thank you for making me a more patient, understanding person.

Thank you for accepting my mistakes. Thank you for teaching me what is important and what I should let slide. Thank you for helping me grow as a person in ways I could have never imagined.

Thank you for making it hard for me to see the computer screen as I type this because, although I have cried many times this summer, mostly from laughter or excitement, I am finally reduced to a sobbing mountain of tears at 3 in the morning because I am not ready to leave you. Each of you will forever hold a special place in my heart. You are not only my co-workers or my housemates. You are my family. We have lived together, worked together, and grown together. Like any family, we have had our ups and downs, but they have only brought us closer. I am truly thankful for every moment – the easy and the hard – and I cannot imagine this summer without you.

I am glad that I do not know the Chichewa word for goodbye, because that means I can only say “see you”: Tiunana. And of course, from the bottom of my heart, zikomo kwambiri.

 

With more love than I could possibly express,

Leah

Brighton and I are nearly ready to present our designs to nurses and physicians at Queen’s, and I am interested to see what they think! One simply has 3 LEDs for cold, normal, and hot. This is the simplest model. It would be the easiest and cheapest to build, but it also gives the least amount of information. The second model has a seven-segment display that gives the temperature readout, but does not tell the user if the temperature is too low or too high for a neonate. This is in the middle in terms of material cost, but it is the most difficult to build. However, the actual temperature display is the clearest of the three options. The third model has an LCD which displays both the temperature and the word “COLD”, “Normal”, or “HOT”, depending on the temperature of the neonate. It also has a buzzer, which beeps when the temperature is too low or too high. This design has the highest cost for parts, but it also gives the most information of the three. However, the LCD is harder to read from far away than the 7-segement display.

In addition to designs for temperature display, we will be bringing designs for ways that the temperature sensor interacts with the neonate. These designs will include a backpack (similar to the KMC monitor), a belt, a hat, a sticker, and a color-change dot (similar to the ThermoSpot* ). They are made of different materials (plastic, cloth, and paper), each of which have benefits and pitfalls. We hope that by presenting a variety of options, we will be able to gain a better understanding of what the doctors and nurses want out of a device that enters their wards.

Preparing these prototypes has been a very interesting experience. Going into it, I had never coded in Arduino, designed circuits, or soldered. In order to finish in time, Brighton and I had to divide work. Because he is studying electrical engineering, he worked on circuit design while I primarily worked on code for the 7-segment display and LCD. It started slow, but after much help from Matt, Tahir, and Google, I eventually developed codes that correctly controlled both displays. Next, Brighton and I transitioned from breadboards to protoboards, which require soldering. Brighton taught me how to solder and I successfully completed the simplest of the three boards (the LED circuit). I enjoyed working with and learning from Brighton, and I look forward to receiving feedback!

 

*An interesting letter to the editor of the Lancet written by a doctor who used the ThermoSpot in the northern region of Malawi can be found here. 

Brighton and I have decided the methods of information display we want to bring to Queen’s: LEDs (blue for hypothermia, green for normal temperature, and red for hyperthermia), an LCD that displays temperature and the words “HOT”, “Normal”, or “COLD”, and a three-digit 7-segment display. The LED display had already been built, because we were considering using it with the KMC Monitoring system. However, we had to build circuits and write code for both the LCD and 7-segment displays.

Brighton is studying electrical engineering, so he focused on the circuits while I sat down to learn how to code literally anything for Arduino. With the help of Tahir, Matt, and Google, I eventually figured out some basic functions. Controlling a 7-segment display takes quite a bit of information, since you need to tell which LEDs to be on when. Controlling 3, the number we need to display temperature, is more difficult. At the Poly, we only have individual 7-segment displays, so in order to use them we must wire together segments and control segments and digits using a tool called a shift register. This is quite complicated, and using a 4-digit 7-segment display would be much simpler.

For this reason, Brighton and I went to Limbe (the part of town that has many shops for electronic components, cloth, tools, and pretty much everything) in search of a 4-digit 7-segment display. We went to 6 shops that morning. At the first 4, they said they did not have them. At the 5^th, they initially asked if it was something you attached to a cellphone. When we explained what it was, they told us that they did not have it. The owner of the 6^th shop was the first to know what it was. Unfortunately, however, he did not have the display either. He said that he used to carry them, but no one ever asked for them, so he never restocked when he ran out. He then added that the same had happened for breadboards.

This surprised and saddened me. The 4-digit 7-segment display is not a very complicated component, and the idea that it was not available anywhere in the city shocked me. How can people create new technology if the instruments for doing so are not available? I was struck by how lucky we are at Rice: if we need a component, we go down to the Electronics lab or ask a professor and they probably have it. On the off chance that it is not available, we order it on Amazon and get it in 3 days, free shipping. Here, if a component is not available, you need to figure out a work-around.

In the end, Brighton and I found a relatively simple way to multiplex 3 7-segment displays to generate the display we needed. However, it was still much more complicated than it would have been had we had the desired component. Because we needed to use significantly more wires, loose connections were a bigger problem and it was generally less elegant than it could have been.

After spending a two weeks researching current methods for monitoring temperature in neonates and beginning the design process for an improved temperature monitoring system, we had a bit of a change in direction. Initially, we wanted to start from scratch, designing a new method that is inexpensive and accurate. However, we soon learned that even at Rice alone, quite a bit of work is already being put into solving this problem. (At least we found a good need!)

Next, we decided to focus on modifying the Kangaroo Mother Care Monitoring device to be used for temperature sensing in neonates who are not receiving KMC. We thought this was a good plan, since we would be building off existing technology, but modifying it according to what the client wants. We expected to do many visits to Queen’s in order to adapt the KMC device to its new purpose.

This did not work out either. At this point, we were asked to focus solely on the Chitenje Warmer. This is a device that interns began to implement last year, but was not currently being used. To be honest, we were not completely enthusiastic about this and did not think that there would be enough for 4 people to do full-time. For this reason, Tahir, Kate, Brighton and I decided to split into two groups. Tahir and Kate would focus on the Chitenje Warmer, validating data obtained by previous students and educating staff on how to use it. Brighton and I would continue work on temperature monitoring. However, instead of working on any device in particular, we would focus on user-interaction, building a few different prototypes that display information in different ways. We will then bring these to Queen’s. Our hope is to get a good idea of what type of user-interface is favorable to clinicians and nurses. We will then pass along our findings to future teams, both at the Poly and at Rice, so they know the best way to display information for their designs.

Although this is not the type of work I initially expected to be doing while here, I think the information we gather could be very helpful to many teams in the future. I am nervous, because I have very little experience with circuit design and exactly zero experience with Arduino, but I am excited to learn!

Last week, Mikaela (my partner for the breast pump) and I realized that it has been one complete year since we began the project. We started with a foot-powered pump that was extremely difficult to operate, and we worked on this for 7 months. In February, we essentially started from scratch to reach our current rocking chair-based model. In the past year, we have come a very long way, and I am excited to see where the project goes. With this in mind, it is fitting that I went to Queen’s yesterday to receive feedback on our design. This was a great opportunity to learn where Mikaela and I can improve our design. I presented it to the morning handover meeting for Pediatrics and received some very useful responses.

Many of the doctors wanted to see more tests done before being comfortable implementing the design, and some of these tests were for things I had not thought would be a problem. First, they want to see information regarding the maximum weight limit of the pump, since a considerable amount of force is being placed on the canister on the corners. Although it has supported 200-250 lbs in the past, these have only been for small amounts of time We need to have the breast pump support this amount of weight, or greater, for the time of a full expression while rocking is occurring, then examine it for any damage.

Another test that they were interested in regards which portions of the device become contaminated by breast milk, leading to concern about the spread of bacteria and HIV. Initially, I had not considered droplets traveling up the tubing, but quickly realized that this was a possibility. If the tubing becomes contaminated, so could the syringes, making our “multi-user pump” a “single-user pump”. To combat this, Mikaela and I need to find a way to prevent the spread of bacteria and viruses into the tubing. We know that this is possible, as breast pump company Ameda has a method of doing this described in the video linked here.

Beyond these concerns, most of the doctors who looked at the breast pump enjoyed it! They think that a rocking chair-based breast pump is a clever idea and they think it could be helpful for mothers in the pediatrics nursery as well as in Chantinkha, as many mothers there have trouble expressing. Many doctors sat in the breast pump and operated it, feeling the suction on the hand or arm. They were surprised by the amount of suction it could generate and enjoyed the rocking motion.

I am excited by the feedback we received in this meeting. The feedback was not all good – many doctors made comments about portions of the design that I had not considered problematic or brought up concerns that I had not thought of, but that is a good thing! Mikeala and I now have a better idea of where we need to focus our work in order to produce the best design possible. I cannot wait to return to the OEDK in August and continue working, iterating, and improving.

I’m in Malawi! I have been here for a week, and we have been busy getting settled into the Poly and a house, meeting the interns from the Poly, and learning about oxygen concentrators in preparation for site visits next week. There are some differences that are taking some getting used to. For example, lunch here is 1.5 hours, while lunch at school is 30 minutes to an hour. We are having trouble filling this extra time, but we have found that drinking Cokes from glass bottles is a pleasant way to do that.

The interns from the Poly are all rising 5^th year engineering students. Kate and Brighton and studying electrical engineering, while Vincent and Harvey are studying mechanical engineering. We are also living with them. We all moved in together on Sunday, and we are enjoying getting to know each other by cooking together, eating together, and sharing awkward moments together. I have enjoyed speaking with Harvey about differences in school systems (if they fail between 3 and 6 courses/year, they must repeat the year) and learning about how to cook rice from Kate (you toast it first!). I think that living together will not always be easy (but is it ever easy moving in with strangers?), but I think it will be a great learning experience and bring all of us closer together.

Today, we split into two preliminary teams to focus on our two main projects. One team, containing Christine, Tahir, Vincent, and Kate, is focusing on learning as much as possible on oxygen concentrator repair. This team will try to improve repair methods upon returning from site visits. I am on a team with Theresa, Harvey, and Brighton. We are working on reducing instances of hypothermia in neonates. While we are at site visits to district hospitals, we will be collecting information on care for infants with hypothermia and how they prevent hypothermia. We will then use this information to develop something, be it a system, educational campaign, or device, to reduce cases of hypothermia. Later this week, we will form pairs of people (one from each team) and learn who will be going to which hospital. Two teams will be visiting district hospitals outside Blantyre, and two will be spending the week in Lilongwe to repair oxygen concentrators and collect information.

We began research on hypothermia today, and I have already learned a significant amount about its prevalence in neonates. I did not initially realize how well it would compliment the information I already know about breastfeeding from my mechanical breast pump. I did not realize that breastfeeding helps combat hypothermia, but this makes sense. Not only is skin-to-skin contact occurring, but a warm liquid is also entering the body of the infant. This does not occur when breast milk is fed to an infant after pumping. There is little skin-to-skin contact and the milk cools between the time it leaves the breast and the time it is consumed by the infant. I also learned that hypothermia is a common side-effect of sepsis, the risk of which is reduced by breastfeeding! Everything is related! I am definitely looking forward to continuing to work on this project and make more connections.

So far. I have been traveling for 48 hours. I started by taking a train Sunday, May 29 from Poughkeepsie, NY to New York City, followed by a cab ride to a hotel. The next morning, I went to JFK to catch a plane to Johannesburg, where I am now. Tomorrow morning, I will be flying from Johannesburg to Blantyre, when I will meet up with the rest of the interns. Having this period in limbo between worlds is giving me time to reflect on the journey I have ahead. Yesterday, I was excited with a heaping side of nervous. Since speaking with people on my flights, in transit, and communicating with the other interns, who arrived Saturday, my nervousness has begun to fade away and I am purely excited for what lies ahead.

On the flight, I met a fair number of people who are planning to do some type of humanitarian work during there time in this part of the world. One thing that all of us have in common is our desire to have a hand in generating change for the better. We all want to “be the change [we] want to see in the world”. However, we are all embarking on completely different journeys. I met someone traveling to an orphanage in Malawi to do health work for a week. I met another person going to Malawi to teach preschool and minister at an orphanage for a month. I met someone traveling to a ranch in South Africa to work for two months. And then there’s me – traveling to a university to improve the sustainability of medical technology for two months. All of us hope to have an impact, but we see that impact differently. What may be a roaring success for one of the travelers may be seen as relatively inappropriate by another.

With this in mind, what does “change for the better” mean? I think that varies person to person. To some, it may be propagating that their moral and ideological outlook. To others, it may mean improving the health of individuals in a community. For another group, it could be more focused on personal change and growth. To me, “change for the better” means improving access to quality health care, which I hope to contribute to by developing technological improvements.

In my preparations for this trip, I read many articles and watched many videos about the way change is implemented and how it can be beneficial or detrimental. (Find some of my favorites here, here, and here.) I hope that, as I work with the other interns and the staffs of Malawi Polytechnic and Queen Elizabeth Central Hospital, I have a small part in improving the state of health care in Malawi and do so in a way that is sustainable, valuable, and respectful.

After the craziness of building prototypes, getting vaccinated, making lists, going to Target countless times, and packing, I am finally ready to leave for two months in Malawi! It is absolutely crazy to me that this adventure is ready to begin, but here it is! I left this morning for New York for a family event, but I won’t be heading to Malawi until Monday.

While I am in Malawi, I will be working with students at the Polytechnic on a few projects. Our main project will be repairing oxygen concentrators and developing more sustainable ways of doing so. We will also be receiving feedback on technologies designed by Rice students over the past year, scoping future projects for Rice 360, and working on small side projects that we will determine there.

As I was packing, I couldn’t help but wonder about the adventure I am about to embark on. I feel like there is a lot I don’t know. I don’t know what my day-to-day schedule will be or who the interns from the Poly are. I don’t know what our house will be like or how to say “Where’s the bathroom?” in Chichewa. But that’s what makes this exciting! I am usually the person who plans ahead. I am used to having most of my week planned out by Monday and I color code my calendar. The fact that I don’t know what’s coming is a huge part of the thrill. I will get to play it by ear and learn about Malawian culture while I work on our assigned projects.

A week from today, I will be completing my first full day in Malawi. The fact that it is so close is surreal, and it can’t get here fast enough.