This Wednesday I had a chance to visit everyone at the Polytechnic and watch their presentations. It was a wonderful opportunity to see how far everyone has come since the projects were proposed last month. Everyone has worked with their partners to find solutions and bring those to life. Although I’m sure the other interns have elaborated on the details of their designs, I’ve listed out the basics of each group (for those at home who might be a little lost).

One element that I’ve realized is integral in the Rice 360 model of designing solutions is the smooth continuation from group to group. Due to the nature of undergraduate coursework and summer internships, each project is usually worked on by numerous groups of students. One semester it’s a group of students in the global health design course, the following semester it could be an individual’s personal study, and the next summer it could go to Malawi with a team of interns! While this sounds like it might get confusing, I actually think there are lots of benefits to this process. Instead of being limited to one group of students, each project gets multiple sets of eyes and brains working and reworking how it could best benefit the intended users. For example, Millie and Kelvin’s work on the PneumaShoe has taken this two year project and completely changed some integral components. If the original group of students in Houston said, “we’re done!” and then we gave their device to a hospital in Malawi- it would not had nearly the impact it could have now that Millie and Kelvin are redesigning it.

As a lot of these solutions and devices are created for very niche settings, it’s very important to get feedback on them before trying to implement. As I’m sure you’ve read in other blogs- medical equipment graveyards are a real problem because there is no continuity between donated machines. However, not only are there these problems when the devices break, there is also the issue of devices that are working but unused. For example, one of the days that I was shadowing Prince, a study nurse in Chatinka, he pointed out a few very fancy looking incubators. He didn’t know whether or not they were still working but assumed that at least one was entirely functional. However, these incubators are only used as transportation trolleys. Why weren’t they being used to warm babies? These incubators were designed for high resource settings where the nurses have time to check on the babies through specially designed holes in the device and only one baby is on the cot at a time. In Queens it’s just not practical or possible for the nurses there. They need easy access to the baby so they can check on them quickly. If the bays are full or they want to keep a close watch on several babies, then those infants are sharing mattresses. It’s simply doesn’t make sense to try and integrate these fancy incubators into the system they have. This proves how important it is to gather as much feedback on the device as possible before trying to give it to a hospital. The solutions we are creating should be useful to those you are trying to help. I’m glad to see that process in motion with all of the engineers working at Polytechnic this summer.

Here’s a quick list of the projects!

• Serena and Chikondi have designed a final prototype stand for the bililight, a phototherapy device used to treat neonatal jaundice.
• Millie and Kelvin have adjusted the PneumaShoe (now called MwaziFlow (mwazi means blood in Chichewa)) to be a pneumatic compression device for bedridden patients. The cuff now goes around the calf, thigh, or arm instead of the foot.
• Vin and Mpha have designed the graphical user interface (GUI) for a Nurse Alert system so that patients can call the attention of a nurse from their bedside.
• Erik and Alinaya have redesigned the external filter for the oxygen concentrators to prevent the damage caused by dust.
• Naod and Webster were able to find a process to manufacture cup seals for the oxygen concentrators locally so that replacement parts are not so expensive.
• TK and Bernadette fixed several oxygen concentrators and wrote a novice training manual to teach how to fix broken equipment.

Reporting live from the office, it’s me, your favorite non-engineer in this internship! (by default as the only one) Unlike everyone at the design studio, I have no exciting photos of the device I’m working on. Instead I thought it was more realistic to have a picture of some of the data I’m working with. As exciting as over 200,000 data points sounds, it can be a slight pain to manage! Here’s a spreadsheet of some of the ambient temperature data collected from the nurseries at different hospitals.

Essentially, each time our CPAP team visits a district hospital to check on equipment and ensure proper maintenance on CPAP devices, they gather temperature information from sensors that run 24/7. Unfortunately, they usually end up putting these txt files into a dropbox folder and then don’t get a chance to organize them. Now that our CPAP office has a handy dandy intern (oh hi, that’s me) we now get a little more analysis and insight into how hospitals are managing their temperatures! I took aaalllllll of that information and condensed and compiled and sorted and added until we could look at all these numbers and actually understand what was going on. As a result we can now compare night vs. day temperatures, Northern vs. Central vs. Southern hospitals, summer and winter temperatures, District vs. Central hospitals, etc. The graph below managed to provide a very interesting insight on this last comparison.

On this graph the warm colored lines demonstrate Central hospitals (yellow line is daytime, orange line is nighttime) and the blue colored lines show District hospitals (lighter line is day, darker line is night). What we can see is that the larger, better funded Central hospitals manage to keep relatively consistent temperatures throughout the year, only dipping slightly during the colder month. However, the District hospitals show a huge drop in ambient temperature in the nurseries.

You might be wondering – why do we care about the air temperature anyways? Newborn infants, especially those who are premature, often struggle to maintain body temperature. Hypothermia kills lots of neonates each year because when so much energy is spent trying to maintain temperature, their bodies have a harder time fighting infection, breathing, or absorbing nutrients. One discovery when analyzing CPAP data was that below a certain threshold temperature, it doesn’t matter if the infant is put on CPAP or not, they usually don’t make it. This knowledge energized efforts to keep neonates warm through all means possible. While kangaroo mother care (where the baby is wrapped tightly to the mother with skin to skin contact and radiant warmers/ hot cots are very useful tools, often they are not enough by themselves. All hospitals are strongly encouraged to use any available space heaters and warming lamps to keep the entire nursery at a higher temperature. This way babies are better supported  while being fed, moved, or adjusted. As a result of organizing this ambient temperature data we now have more insight when looking at mortality rates month by month. It might be able to help explain differences between Central and District hospitals throughout the year. It’s great to see that the Rice 360 program and our CPAP team here in Malawi are not just focused on one device. Instead they are dedicated to determining each element of essential neonatal care so that the support and technology we provide is comprehensive and focused holistically on the health outcomes of the babies.

 

While during the week we all work very hard to achieve our goals and make strides on our projects, the weekends are a great time for relaxing. This weekend in particular was very special! Some of you back home might be thinking “Independence Day” is July 4th, but here in Malawi we celebrate on July 6th! It just so happens that Malawi gained independence from England 2 days and 188 years after the US. In America there were fireworks to blast the fact we’ve been our own country for 241 years. Meanwhile, here in Malawi there is a huge gathering in the stadium with a speech from the President, this year to recognize 53 years of being independent! Although the rest of the country took Thursday off of work, we decided as a group to do our holiday in a slightly unconventional way. We convinced our mentors to allow us to switch Thursday and Friday. Therefore we came to work on Thursday and managed to get a long weekend! This allowed us to seize the opportunity to visit Lake Malawi.

We drove up to Cape Maclear on Friday morning and spent Friday and Saturday nights in Malambe camp. While there was some controversy over the accommodations when we arrived, in the end I think everyone was happy to be right on the beach even if the straw huts were basic in the way of luxury. We managed to catch both of the beautiful sunsets right from our little stretch of beach. Saturday was our adventurous day where we had the opportunity to take a boat out to Thumbi Island and go snorkeling! Everyone had a chance to at least stick their googles in the water and see all of the amazing fish swarming around the bits of bread our guide threw in. Erik and I got a bit of swimming in and swam from our rocky snorkeling outcrop to a little beach further on the island (the boat took everyone there only minutes later). Naod and I tried to help Webster and Vin perfect their swimming technique (looks like my years of swimming was good for something). We had a great time laying on the beach, swimming, doing some acro yoga, saying hello to our Irish friends who are also staying at Kabula, and talking with another American about his time in the Peace Corp (he was concluding 2 years in Mozambique with a vacation with family). Then we headed back towards our cozy beach home, stopping on the way to feed Eagles! It was incredible to watch them dive out of the sky to come swoop up the fish our guides threw to them.

In the evenings we had a braai (equivalent to a BBQ) where Webster AKA our “Braai Master” did a great job of cooking lots of chicken and beef. After eating, we talked to some of the local kids who were constantly playing on the beach, running into our pictures, taking selfies, playing soccer (football) with us, dancing, wrestling, or head standing around us and asked if we could borrow their canoes. However, these were not your typical plastic bodied boats with two seats. These canoes were entirely made out of wood and did not have enough space carved out to sit down. Instead you were supposed to put your legs into the crevice and sit on the outside of the body of the canoe. There was only a few kids who could speak English, so Kelvin and Webster just talked to them in Chichewa. After a bit of chaos and confusion (from my point of view) I got into the front of one of these boats (without a paddle because there were not enough) and my captain (who couldn’t have been much older than 12) paddled me out towards the sunset. The photo below is one that Serena captured from our beach of the sun going down behind Thumbi island and me and my new friend in our traditional Malawian canoe.

A quick reminder for those trying to following along with the blogs and being confused as to who is who. The other 4 Rice interns and 8 Malawian interns are all working in pairs at the Polytechnic University on engineering design projects. I on the other hand am the only intern working in the CPAP office at Queen Elizabeth Central Hospital (QECH or QE). As an ex-engineer and current economist, I’m having a great time helping the CPAP team here analyze information from all the different hospitals where data is collected.

Ideally we could give Pumani CPAPs to a hospital and then they could incorporate training programs into their existing rotations. However, it is much more complicated due to staff switching wards every few months, nurses not being comfortable using CPAPs, and with learning how to use them being viewed as extra work. We’re really pushing to get CPAP training integrated into the curriculum at nursing school to ensure that every nurse who comes into the workforce is prepared to use the device. That would avoid the frequent training and mentorship sessions that are required to maintain a knowledgeable staff at each hospital.

I’m currently looking at a lot of data comparing on-site mentorships with exchange programs. Both of these are methods our CPAP team uses to teach nurses how to use the Pumani devices. The on-site mentorships require that we send an instructor (someone from QE who is very knowledgeable) to go to a smaller district hospital and explain to everyone working there how to use the machines. The exchange programs on the other hand have nurses from the smaller hospitals coming to QE to learn about CPAP devices here and then go home to help introduce more knowledge at their respective hospitals. There are pros and cons to each and our team is currently in the process of trying to determine if one method of training is more effective than other. On one hand, sending a mentor to a site allows more nurses to be trained, but often at smaller hospitals in the week long training window there may not be a child who needs CPAP, thus leaving the mentees without real world practice. On the other hand, the exchange program at QE almost guarantees that a baby will come in needing CPAP care, giving hands-on experience, however less nurses can come and implementation back at their home hospital might be a little more difficult. This is definitely project where it is impossible not to bite off more than you can chew. I’m lucky to be surrounded by numerous, competent, hardworking people!

I was able to go with several members of our CPAP team two weeks ago and see how our data collection/ inventory/ checking-in process works at district hospitals. I was able to assist in replacing parts of CPAP machines that were currently in use at these hospitals and spectated the interviewing process that we conduct with the Matron in the nursery ward (in-charge nurse looking over neonates). Additionally, I was even able to tag along with the Poly interns last week to help with their surveying and questions that pertain to their projects. It was nice to be able to see numerous hospitals and compare similarities and differences. As I was interested in observing CPAPs and phototherapy lights in neonatal wards I stayed with Millie and Kelvin when we split up. They are working on the “PneumaShoe” a device which aids in the circulation of blood for bed-ridden patients. They got some great feedback from nurses in the male and female wards as well as guys from the physical therapy unit. I doubt the name will stay as there are several changes on the horizon! Mostly likely it will switch from being a foot cuff to an adjustable band for calves, things, or arms. I look forward to seeing what they are able to produce. This photo shows them with the Head Nurse at Zomba Central Hospital explaining and testing the device to get feedback.

 

On the way back from Chiradzulu and Zomba, I asked Andrew if we could buy some sugar cane from someone on the side of the road. The U.S. interns were in for a surprise. It’s an incredible plant and even more incredibly difficult to eat! In order to peel away the bark and get to the inside it feels like you’re going to break your teeth. After ripping huge hunks of bark off you can gleefully bite off a mouthful of fiberous plant, chew it a bit, and then spit it out. While our Malawian collegues who have been eating sugar cane since they can remember pulled this off with ease, Naod, Millie, and I made fools of ourselves. Groaning about our teeth, only pulling small strands of bark away, and confusedly chewing the insides, we also dripped sugar water all over ourselves and ended in a disgraceful mess of bamboo material and sticky juice. We definitely bit off more than we could chew. The picture is of Webster, the pro-bark peeler and how-to teacher.