Reading the short story Story of Your Life by Ted Chiang (the basis for the movie Arrival) I became preoccupied with the notion of time and how culture morphs the elusive concept. In the short story we learn- through the perspective of a linguistics professor-of humanity trying to communicate with extraterrestrial visitors who understand time very differently. The more she learns their language the more she begins to experience time as they do. From an scientific background time’s arrow is the result of entropy (caveat: after reading Story of Your Life this may just be an anthropocentric conclusion). Time’s one-directionality is a notion that I can safely assume ALL humans experience and understand. If not please contact me, I’d love to talk! This lead me to question whether culture impacts humanity’s understanding of time.

My time in Malawi has really showed me how culture truly warps time. Forewarning, I’m not saying that culture influences “scientific time” but instead that our perception and anthropomorphism of time. For example, in the States we have a saying that time is money and money is time. This causes us to be more sparing with our free time. Our culture on one hand stresses timeliness and scheduling which makes for an efficient workforce on the other hand workaholic-ism is also stressed.

Busyness is worn as a badge of honor, pervading every nook and cranny of American culture. From hospitals to college campuses, an inordinate workload has become our national pastime. Our cultural perception of time as limited and commercially valuable causes us to value this workload hysteria even with its exhaustive consequences. Using time to its fullest extent and more is a sign of maturity, success, righteousness, and modernity.

Here in Malawi time marches at a slower pace. There doesn’t seem to be a culture obsession with time. This is evident in what is playfully known as Malawian time. Wether it’s waiting to be served at a restaurant to scheduling meetings, time is negotiable. As a visitor I was at first taken aback by the long waits at restaurants, the tardiness, and the disregard for set meeting times. However, after taking a step back and realizing that I was projecting a Western understanding I was able to see the beauty in the slower pace and learned how to implement in my life.

Our cultural understanding of time is unnecessarily stressful and even though some of us may believe we work better in this stressful environment our mental health and health records show otherwise. In Malawi a lassie-fair approach does indeed make the work day and people more enjoyable (earning them the title Warm heart of Africa). I believe that both Malawian and Americans could learn so much from this difference. We know that valuing time does indeed create a more efficient society but at the same time commodifying time harms said society.

The more time I spend in Malawi the more I learn to value time with all of its paradoxes and abstractions. Time isn’t money, time is something much more special and profound. So let’s not waste it on our cultural obsession with success. Instead let’s learn to use it efficiently and meaningfully. Also who doesn’t love longer lunch breaks!

The engineering design process teaches all of us the method we must follow in order to guarantee flushed out designs and viable products. It’s first step is stressed as the most important: brainstorming. Solid, effective, and meaningful brainstorming is essential as it expedites the design process by eliminating the need to completely start over. However, an important step to the process is recognizing when one can move on.

My teammate and I learned this important notion during the brainstorming week. We only spent two days brainstorming while everyone else spent a whole week in the process. During our brainstorming session we came up with different methods of manufacturing cup seals from PTFE sheets. PTFE otherwise known as Teflon is commonly used as the non-stick coating on pans. However, in compressors its self- lubricating properties allow it to be used as a cup seal.

We understood that we must create a method for manufacturing these seals in an easily understandable, sustainable, low-cost, and precise manner. Thus we brainstormed the following methods: a puncher machine, a crank powered “cookie-cutter”, scoring machine, a hand held “cookie-cutter”, CNC machine, and laser cutting.

After scoring the ideas in a Pew scoring matrix we concluded that the most practical ideas would be the puncher machining, laser cutting, and CNC machining because of their ability to be precise, semi- autonomous, and sustainable.

After having a talk with Matt we reevaluated our original purpose and decided that immediate testing was the key component of our project. So during the second day of brainstorming we started making prototypes of the cup seals using the laser cutter and began testing the very next day. We perviously learned that vibration, dry friction (from dust), and extensive use were the main causes for cup seal degradation. And that replacement of worn out cup seals is not a procedure carried out by hospitals in Malawi. These worn out cup seals aren’t able to form a proper seal thereby air leaks (the compressor’s output decrease) which decreases the pressure and air concentration. So we deduced that we should measure the pressure output and oxygen concentration of a O2 machine with our cup seals to track their performance.

To make sure that we didn’t damage the machine’s sieve beds (the containers filled with the nitrogen stripper which is connected directly to the compressor output valve) we did our testing on old O2 machines with faulty sieve beds. As a result to using faulty sieve beds we only measured the pressure output hoping for a pressure output range of 15-30 psi. Our prototype performed very well.

Brainstorming is essential and its impact is definitely well-stated; however, sometimes it may play a small role in your project.

 

 

The more time I spend in Malawi the more I feel a sense of urgency to return to the land of my birth. This sense of home I feel here reminds me of the few memories I remember of visiting my country. My time so far has taught me that the most significant impacts are made locally. It’s through locally created and designed solutions that projects and advancements become sustainable achievements. I think that’s why this program is so meaningful. Direct impact has always been a priority. Two weeks ago we spent three days traveling to the district hospitals of Southern Malawi.

The first city I visited was Mulanje, home to Malawi’s tallest mountain. The scenic drive did little to prepare us for the spectacular view of the Mt. Mulanje which was situated right behind the hospital.

Being a district hospital it was much smaller than Queen Elizabeth- the hospital near the Polytechnic University. Walking around we learned that the sole X-ray for all the southern hospitals recently broke beyond repair, that long queues are a daily phoneme, nurses are plagued by severe understaffing, and that neonatal devices break constantly. It was eyeopening to see the level of improvising that nurses and doctors needed to do. Having spoken to the nurses and learned as much as we could on their cleaning methods, we spoke with the PAM (Physical Asset Management) director as he knew more on how these medical machines function and break. At Mulanje dust is an issue for their oxygen concentrators; however, maintenance procedures are in place to help alleviate the breakdown of these machines. Their preventative measures include weekly cleaning of filters and monthly internally cleaning of dust. Furthermore we gained insight into how dust may play a role in the accelerated degradation of the cup seals and the need for locally manufactured cup seals. They welcomed the idea of locally made cup seals as this would allow them to quarterly replace worn out seals thereby prolonging the lifespan of the concentrators. I walked away from Mulanje with a sense of realistic hope, even though there existed a myriad of systematic issues locally made spare parts could make a significant dent.
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After Mulanje we drove past acres and acres of tea plantations to arrive at Thyolo District hospital. You could tell this was a recently constructed hospital. The layout of the wards, the well kept garden and sitting areas contrasted the congested and convoluted layout of Mulanje and Queens. Architecture can really make a difference! We went about the same routine; visiting the nurses first and then speaking with PAM. The oxygen concentrators were placed near the ground and right against a wall. This placement contributes to their shorten lifespan by exacerbating the effects of overheating and humidity destroying the filter mineral. In addition, nurses only externally clean the concentrators weekly.

And with no internal dust removal the accumulation of dust practically destroys the machine. Thyolo like all the hospital we visited no longer has extra compressor cup seals and sole rely on the Rice CPAP team to give them some. Therefore, they use the concentrators until the cup seals’ breaking point- the point at which they are no longer is able to maintain the necessary pressure to concentrate oxygen. PAM’s response to our questions was essentially identical to previous responses.

The following day we visited two more sites- Chiradzulu and Zomba- and received relatively the same feedback. Since Zomba hospital is a central hospital (meaning its much bigger) we decided to spend our time there exclusively with PAM.

We were greeted to a large “graveyard” of broken oxygen concentrators. Whenever a district hospital can’t fix a machine themselves they send it to a central hospital like Zomba; however, for the most part these central hospitals also lack the spare parts to actually fix these machines so they end up stacked up on shelves. Since Zomba has one of the largest PAM facilities we decided to berate them with our questions which concerned the durability, material specification of cup seals, and hospital prevention procedures. We learned that dry friction and overheating were the main causes of degradation, that spare cup seals only come in kit that includes other compressor parts making it expensive to order, and that there is a real need for locally made seals. Since many devices- autoclaves, ventilators, and air compressors- use cup seals there is a potential for a commercially viable product. Traveling has really energized and moved me in a exciting way. Day in and day out the Malawian interns and I exchanged knowledge, hopes, and experiences. In a sense we have opened each others’ worldview. We inspire each other to use this internship and what we have learned as a starting point to do so much more for the global community. And with all that I have learned here, I know that one day I will return to Eritrea and use my experiences to do my part.

It’s been our first week here and I can’t get over how great and eye opening this partnership has been. This first week has been a mini o-week of sorts. The first few days were spent bonding with the Malawian interns and learning about the Polytechnic University. I learned about the very fulling staple food, nisma. Most of the time however, was spent having crash courses on standard engineering and prototyping skills. It was these days that were really insightful for me. My experience thus far in engineering has been conceptual heavy except with Global Health Technologies 360. Its only through an informal setting that I have learned how to CAD, 3D print, and laser cut. However, this week at the Polytechnic allowed me to further my technical experience in a much more formal way. I learned how to solder efficiently and correctly, how sensors actually work and how to pair them with arduinos, and most importantly how to take my conceptual understanding of circuitry to create functional real life circuits. Every new skill I learned really changed the way I perceived engineering. Theoretical engineering no longer was the only way I thought about creating medical devices. I could now rudimentarily take a conceptual idea and create a real life device. That’s something I never learned in any of my intro STEM classes. Don’t get me wrong though, I am a firm believer in understanding theory and that’s why I really value learning how to do something with all this theory. In my opinion its the ability to shape ideas into practical innovations that makes engineering so extraordinary. So if you are considering engineering take time to change your perspective by engaging with the crossroad of theory and real life application, its well worth the arduino hassle and solder smoke.

In other news I got my project assignment on Friday! I’ll be working with the Poly intern Webster on coming up with a process to locally manufacture worn out oxygen concentrator cup seals. Cup seals create an airtight seal in the compressor that allows for maximum pressure and oxygen concentration as such they are a critical element in oxygen concentrators. However, in Malawian hospitals the intensive use of the concentrators plus the high level of dust that enters the machine causes the compressor cup seals to degraded frequently due to high friction (from the dust particles) and high temperature (from the prolonged and inefficient cooling system and high friction). Since spare parts are extremely costly to import, many oxygen concentrator end up in tech graveyards. We are hoping that by locally manufacturing this important part then we could reduce the hospital’s reliance on a constant supply of donated machines.

Tomorrow I and four other interns will touch down in the Warm Heart of Africa, otherwise known as Malawi. This will be my third trip to Eastern Africa yet this experience I believe will stand out as one of the most profound journeys I will ever take. My reasoning being that this study aboard represents the culmination of practical, ethical, and collaborative research and innovation in maternal and newborn global health.

The Rice 360 Institute is at the forefront of creating innovative ways of solving common medical issues in low-resource settings. They represent a shift in global health that utilizes the talent pool of a university to come up with low-cost innovative medical devices. Their work has had such a profound impact that they have been named one of eight finalist for the McArthur $100 million grant. However, this study aboard is much more than just going and handing over tech that I and other interns created. Its about engaging with Malawians at the Polytechnic University and The Queen Elizabeth Hospital so that I and by extension Rice 360 can learn how to develop devices that will actually be of use. A main concern with global health these days is that low-resource settings sometimes become a tech dump for Western developers because there is no collective transnational research done on the accessibility, affordability, and effectiveness of the product. Rice 360 seeks to fill that void.

Now that I have given my spiel on the practical reasons for being a part of this study aboard, I want to discuss the much more nuanced sentimental reasoning. I was born in Eritrea, a small and relatively young East African country; in fact we just celebrated 26 years of independence. This trip represents an idea and hope that my parents instilled in me: to remember and shape the land of my birth. Growing up in America I have been provided with the skills, knowledge and opportunity to one day make a meaningful impact. My work this summer will be a testament to Rice 360’s notable work in shaping the health outcomes of Malawi and one day the whole African continent.

Here us (missing Eric) making the most of our 12 hour London layover: