We are nearing the halfway point of our internship, and have transitioned from the first round of projects onto the next. Here is a brief update on some of our main focuses this summer:
Phototherapy dosing meter. I’ve written about this technology extensively already on this blog, and am happy to share that it is now completed. The device was tested using the standard of care in the States. The preliminary testing showed a 3.7% error for our device, but the new technology costs almost $2000 less than the standard. We’ve also completed extensive documentation on the new technology, to facilitate further testing and development. We will be taking the completed device to PAM and QECH soon, to get final feedback from professional engineers and nurses on the prototype.
Suction pump attachment piece. This is the second design project we are pursuing as a team, and are currently between the brainstorming/planning phase and the prototyping phase. The idea for the project came from PAM (who fixes the broken devices from the hospital), and we look forward to involving them throughout the design process. The impetus for the creation of this new technology was the common malfunction of suction pump machines, in which the collection bottles overflow, backup into the machines, and cause permanent damage. Our device will ring an alarm when the collection bottles are ¾ full, and automatically shut the machine off when it reaches capacity. This prevents backflow into the machine, which is a cause for many dozens of suction pumps to be sent to PAM. We plan to have this prototype finished and tested within the next few weeks.
Rice and Polytechnic website. Inspired by the relationship that developed between us interns, we decided to build a website to facilitate further interaction between Rice students and Poly students (that won’t require a 35 hour travel day). The website we are building allows for students from either university to give feedback on current design projects being worked on. Additionally, general questions that may have answers sourced from the alternate country can be posted to this website. Hopefully, both student understanding and technology design will benefit from this interaction.
Orientation week. We’ve created a time table for the orientation week we are helping to plan, which will take place the first week of August for first year Poly biomedical engineering students. So far, the week is shaping up to be really fun. Currently, we are working on nailing down speakers for a few lectures, as well as creating our own content for some lectures the interns will put on. After that, we will focus on creating a week-long design project to introduce students to biomedical engineering. Planning for the orientation week will be ongoing throughout the rest of our internship.
There are a few other projects in the works—including preparation for a faculty design workshop in late July, and creating the engineering-focused activities for students at Jacaranda—which we look forward to focusing on in the coming weeks!
Voting/discussing what projects we will pursue for the remainder of our internshipBeginning stages of suction pump attachment circuitOld bottles from broken suction pump machines in PAMTesting equipment for the phototherapy dosing meter
Through the past four weeks, working nine hours a day and five days a week together, we seven Poly interns have gotten really close. In addition to the many practical benefits that this relationship has provided, it has also been the cause of a lot of laughs through discovering various cultural differences. Here are a few of the topics that we’ve found particularly entertaining:
Dancing. The Malawian interns never get tired of making fun of our (as they claim) poor dancing abilities. In our defense, dancing seems to be a far more integral part of Malawian culture than it is American culture; in public spaces, it’s rare to not hear music playing and see someone dancing a bit (Tanya wrote a good blog recently about the songs of Blantyre, if you’re interested). At first I thought the interns were just giving us a hard time about our dancing skills, but their sentiment was recently reflected by an unbiased third party. We attended a wedding this past weekend—the nephew of a professor at the Poly was getting married, and the prof kindly invited us—which was a ton of fun. There were a few hundred attendees, all of whom sat in chairs facing the stage where the bride and groom sat. For about 2.5 hours, a tradition that we have dubbed “money dancing” ensued: various groups are called out (ex: family of the groom, friends of the bride, those from the groom’s village) to rise from their chairs and move forwards to dance around the bride and groom, while tossing small bills towards the couple. Generally, the groups were each a few dozen strong, and filled with the impressive Malawian dancers. Unfortunately, Tanya, Catherine, Emily, and I were the only four Americans in attendance. So, when the MC called out for all Americans to rise and dance about the bride and groom, the four of us alone had to put forth our best efforts and embrace the money dance tradition. I thought we were doing pretty well, until we were asked (with 100% sincerity and kindness), “Are you tired? Is that why you’re not dancing well? Do you need to sit back down?” It was then we realized the interns hadn’t just been giving us a hard time—Americans have a thing or two to learn from the Malawians about dance.
Santa Claus. Prompted by some questions about American Christmas traditions that Francis had asked, I found myself attempting to explain the common story of Santa Claus. It was very difficult to find words to explain the reason for a collective, nation-wide lie that is annually passed down from parent to child. Making this even more difficult was the fact that this lie revolves around an unknown old man sneaking into homes at night through the chimney. However Christmas wasn’t voted “the weirdest” of all American holidays—that title was reserved for Halloween.
Food. New foods—both from Malawi and from America—are always exciting to try. For the American interns, we’ve grown addicted to mendazi, which are delicious, fried, dough balls. For the Malawians, a favorite has been banana bread, which Emily, Catherine, and I cooked a few weeks ago. It was very well received—though was renamed “banana cake” by them—but unfortunately has also inspired a never ending craving for the treat. Whenever we are trying to convince the interns to do a favor for us, their answer is now perpetually the same: “You know the terms.” The terms are always banana cake.
American TV. The Malawian interns often reference various American TV shows and ask, “is it really like that?” One show that provided some significant cause for distress was the Bachelorette.
Of course, the similarities and differences in our backgrounds—as well as what we are learning from one another—run deeper and are more significant than what I’ve listed above. But these are a few of the little things that make us laugh, allowing us to grow closer and learn more than we would be able to otherwise.
Our mendazi supplier; the dough balls are visible in the front right bucket with a green lidChristina using the bCPAP doll to show us how to carry a baby Malawian styleLaughter ensuing as Catherine showed Francis up at an arm wrestling matchCharles sharing some Malawian dance music with EmilyA shot from the wedding; the group you see at the front is currently doing the money dance as those sitting down look on
All seven of us interns in Blantyre had the good fortune of visiting Jacaranda this past Thursday. Jacaranda is a primary and secondary school, attended by around 400 students; their school is doing incredible things, and I encourage you to read more on their website (linked below). Here are a few of the roles we took on during our trip to Jacaranda.
Visitors. When we first arrived on the grounds, we were treated to a tour of the campus by two sweet, young teenagers. Everywhere we went, we were welcomed with wide smiles and a synchronized greeting call (a tradition at the school); we even enjoyed a short concert by the two acapella groups on campus.
ClassroomsOur two tour guides standing in the computer lab, in front of the libraryStudent-kept gardensExtremely talented female acapella group
Audience members. We first watched a presentation by some Jacaranda students on what engineering projects they had been working on. One team of students had taken used water bottles and reconstructed them into sturdy and versatile furniture pieces; some of the water bottle furniture had even been decorated at the school in the arts program. Another project was the creation of solar powered lanterns. They were very cheap devices, fashioned from clear food containers, a few solar panels, and various reflective materials. What had initially begun as a small project with only a few prototypes expanded, so that every student at the school had created their own lamp to use to walk home, study, and read at night. These simple technologies made a huge difference for the children, and we were all impressed by them; the students were rightly very proud of their lanterns.
Showing off his water bottle furniture
Presenters. For our presentation, we talked to the primary and secondary school students about what tertiary school is like, what engineering is, what technologies we were working on, and how the devices help those in the hospital. I have to take a moment to brag on Christina and Francis, two of the Poly interns from Malawi, who had inspiring and beautiful advice for the students during our presentation. Christina connected with the students—especially the young girls in the audience—so genuinely, encouraging them to keep up with their studies and stay focused on what is important while being aware of what is not. The rate of girls who pursue higher education isn’t high in Malawi, and the number who pursue science and engineering is even fewer; it was nice to have so many female engineering interns up on stage for the presentation, and to see Christina become a role model for many of the students in the audience. Francis began his speech by reminding everyone that, “everything in science started out as something small.” He spoke to the importance of pursuing ideas that have the potential to improve problems, even if the ideas seem impossible. His advice to continue creating, despite limited resources and the nagging feeling that your efforts will not result in huge change, I think hit home with a lot of people in the auditorium.
Audience; both primary and secondary school students attended
Before we left for the day, we hung around to talk to some of the students. One boy in particular came up to me to ask for some electrical engineering advice. Despite having no electrical training, he had deconstructed some of the extra lanterns and mounted the solar cells on top of his roof. From there, he wired the panels through the ceiling and along the walls of his room, powering light bulbs and brightening his nights; his natural ability to innovate and understand technology was impressive. Many of the students had question after question about how the medical devices we brought with us worked, and what materials were required to construct them. A large number of girls conglomerated, asking about what us female interns did in tertiary school. When they heard Karen was pre-med, they were very excited—they too want to be doctors. So many of the students were curious about the prospect of engineering, and wanted ideas for projects to pursue. The interns all decided to come back to Jacaranda on Friday afternoons for the remainder of our time here, to hold engineering workshops and information sessions. I’m excited to go back—the students were so kind, curious, and eager. Hopefully this will be an experience that starts small, but as Francis indicated, grows into something much more important.
Christina surrounded by a cohort of eager young girlsCharles giving advice to secondary students
Acquiring cell phones here was extraordinarily easy. We popped into a store located a ten minute walk from the Poly, and quickly obtained phones, chargers, and minutes all for 5,500MKW, or $12.22. Though we chose to buy the simplest phones, only capable of calling and texting (used for communication between the interns), there were also smart phones readily available for purchase. Users of all cell phones buy minutes and bandwidth on the street, from vendors who set up at small tables on almost every corner in downtown Blantyre. The entire process is run by immediate consumer need—users buy only the minutes they want, when they want them—which makes it adaptable. There are no formal bonds committing cell phone users to one supplier, and there are no wasted minutes nor wasted bites. Within Blantyre, access to the internet—and access to its world of information—through common cell phones is pretty widespread.
Internet access and cell phone usage across Africa has shot up in the past decade. Though both of these systems are still centered largely in the urban cities, they are beginning to penetrate further into rural areas. Like all expanding infrastructure, extending the digital network will take time, resources, and restructuring. However the speed that our technical abilities have grown to me indicates a promising near future in which the internet can be accessed at least by some in most areas of the world.
Even at Rice, there is currently research focused on, classes offered about, and programs aimed towards creating clever ways to expand internet access into low-resource areas. Discovering methods to reduce necessary additional physical infrastructure in order to drive down the price of internet while maintaining quality is an area of research where I see electrical engineering overlapping with the potential to improve global health.
Of course, in some instances, there is no feasible digital substitute for an in-person, trained doctor. In the ideal future, there may be an adequate number of capable health care workers to work on-site with patients; as it stands, however, the ratio of doctor to patient in much of Africa is far less than this ideal:
As a result, for every one physician in Zimbabwe there are 6,300 patients, and in Cambia, 9,300. In Ethiopia it’s 45,400 patients per physician, and in Liberia, it’s 71,400 to one. There are only 120 doctors and 100 nurses for the 11.3 million residents of South Sudan. (1)
Stable internet and a framework through which district hospitals and smaller health-care centers can interact with larger hospitals may provide a trusted channel for rural healthcare workers to communicate questions to and glean advice from specialized doctors in the city centers. While not ideal, such interactions may improve education and health care practices in the interim. There is also opportunity for increased efficiency. Trainings and updates that can be communicated over the web prevent excess time and resources from being spent. A quote from Wired magazine conceptualizes this potential:
Wires warp cyberspace in the same way wormholes warp physical space: the two points at opposite ends of a wire are, for informational purposes, the same point, even if they are on opposite sides of the planet. The cyberspace-warping power of wires, therefore, changes the geometry of the world of commerce and politics and ideas that we live in. (1)
Once this network is made accessible, interacting with it is quick and easy—just like our experience buying cell phones here. Supplying the internet is the hard part of this equation, but once present people of vastly varying ages and education levels will be capable of benefitting from it. The project of expanding Wi-Fi is incredibly complex, and is something that long-term (after much more schooling) I may look into pursuing. For the time being, though, we as interns can at least begin thinking about the various ways in which we can take advantage of this expanding network.
New devices for digital healthcare. For internet-enabled-healthcare to be feasible, current health technologies and practices have to be reimagined. For pictures and videos to transmit information from a patient to a physically distant doctor, we must find alternative ways to communicate accurate information about attributes such as size and color of objects that, in person, are taken at face value. This is a problem that a recent Rice global health team tackled. In Barretos, a cancer hospital has nurses take photos of patient skin lesions across southern Brazil, then send these photos in to the central hospital. A doctor then evaluates these photos to determine if the patient should make the trip to the hospital for further evaluation. The device is a physical attachment to cell phones which improves color and size interpretation, as well as photo clarity. Two Rice BTB interns are in Barretos this summer, rolling out the new technology—if you are curious and want to learn more, check out Pablo or Megh’s blog!
Development of communication channels. I wrote a post about the importance of collaboration before, and access to Wi-Fi facilitates the development of these relationships. Looking forward in this internship, one of the projects we hope to pursue is creating a system to connect Polytechnic students with Rice students; this connection has the potential to benefit both academic growth as well as device success. Almost any two institutions involved in my global health experience so far could benefit from increased communication, resulting in rising rates of both efficiency and efficacy.
Preventative maintenance. During our tour of PAM last week, we noticed many of the devices suffered a malfunction caused by user error. Considering the array of machines that fills hospital wards, it isn’t surprising that small user mistakes are frequent. Even more frequent is forgotten technology maintenance: some devices require a new filter every 2 months, while other devices require lubrication every week, still others require water to be kept at a steady level throughout use, and others require constant monitoring for overflow. The intricacies of every device can get overwhelming even for maintenance engineers, and far more so for busy nurses who have patients to attend to. Sometimes, simple check-ins with the trained employees at PAM could prevent major device breakdown. However, as I’ve mentioned before, PAM does not have the funding to visit various district hospitals for preventative maintenance needs. There are many possibilities that can be explored to decrease device misuse/overuse by establishing a live connection between engineers and the smaller healthcare centers. For example, technology-specific overview videos could be created to remind nurses of common user interface problems and required maintenance needs; training updates for new practices could be conducted over the web, or forums created for common questions. All of these channels would need to be streamlined and organized, however they again provide the potential for increased efficiency and efficacy.
Of course, the expansion of internet has far greater implications than just healthcare, and the adoption of these new, Wi-Fi enabled technologies may meet some huge barriers. Users would need to adapt to a new method of communicating and working, as computer technology brings in its own learning curve that could slow progress. However, since internet usage rates are already on the rise, a new market full of largely untapped possibilities is coming regardless; it only makes sense to begin reconsidering past solutions to present problems.
Taking photos of the finished dosing meter to send to friends over textWorking on blogs, which are one example of how the internet is helping us to form cross-continent global health connectionsTypical day at work, surrounded by desktops, laptops, and cell phones used to GoogleOne of the many AirTel stands in Blantyre, where minutes are easily bought.
(1) Olopade, Dayo. The Bright Continent: Breaking Rules and Making Change in Modern Africa. N.p.: First Mariner, 2015. Print.
Yesterday, we had the opportunity to meet with an employee at PAM, the Physical Asset Management team. The seven employees at PAM have the difficult and important job of maintaining all machines and devices at Queen Elizabeth Central Hospital, as well as multiple other hospitals in Malawi; Catherine goes into more depth about the facts of PAM in her blog if you’re interested! Joseph, the PAM employee who we met with, graciously spent two hours of his afternoon giving us a tour around PAM, answering our numerous questions, describing the specific problems each device faced, and discussing the challenges that the department deals with.
PAM is housed in what looks like a warehouse, where broken medical devices line shelves and the floor. The machines range from suction pumps used in intensive care units, to incubators used in neonatal care wards, to surgical platforms, to CT scanners, to adult ventilators, to theatre lights—any medical device used in any of the seven hospitals PAM services is fair game to be sent to Blantyre, where these few employees must troubleshoot the malfunctioning device. This job description alone is daunting, however the technical expertise required is probably one of the lesser challenges PAM faces. Sometimes, the devices delivered to PAM cannot be fixed, but not because the employees don’t how to fix the machine—usually, they do. Instead, the obstacles standing in the way often fall into one of the following categories:
Joseph standing next to tables that were without proper adaptors.
Lack of Specific Parts. Many of the complex medical devices require very specific parts, often produced only by the original manufacturer, in order to function. When a device is broken due to a bum part—a blown electrical component, a worn out filter, a lost valve, a bent heating component—the first inclination is to replace that part with the same exact piece; this would ensure proper functionality. However, most of these components are absurdly expensive; we recently fixed a jaundice meter that wasn’t charging, and the original manufacturer was going to charge $1000 for replacement batteries, in addition to who knows how much more for troubleshooting the charging station. Due to this impracticality, alternative cheap components can sometimes be bought as replacements. While this works for some devices, for many others it will not. Sometimes, machines have control systems that disallow function if official components are not used; other times, the cheaper parts can damage the machine to a greater degree, or the cheap replacement components themselves break shortly after being implemented; in other cases, cheaper alternatives cannot be found due to the intricacy of a part. To add another layer of complexity, there is little consistency in the brand of device that various wards use. Many of the devices were either donations or not bought in bulk, so there can be multiple different brands of the same device even within QECH. In PAM, we probably saw upwards of 8 different types of oxygen concentrators. The part needed to repair this concentrator, then, also cannot be bought in bulk nor kept on hand. All of this results in many of the broken devices that arrive at PAM staying broken, as the materials are not available / the funding is not existent to make the repairs that the employees know need to happen.
All broken oxygen concentrators–you can see multiple brands in this picture alone. Most of these devices have the same broken component or missing filter, but there are no materials with which to replace these parts.
Lack of Consumables. Increased use of consumables (device components that are frequently replaced, such as needles, syringes, etc.) often decrease the likelihood of a medical device being successful in low-resource settings. There’s a significant portion of devices at PAM that are most likely in working order, but the hospital doesn’t have the funding to supply the needed consumable to make the device useful. This is often an issue with donated devices. QECH receives many donated medical machines from various sources, but if the devices aren’t given with an adequate supply of consumables, the machines can’t be used as intended.
In the pile of discarded equipment, you can see dozens of similar looking white/green devices–these were a batch a donated syringe pumps. They would have made a great impact (all the same brand, needed devices, user manuals included) but no syringes (a consumable) were included. Unfortunately, this makes the devices unusable, as there is no money to buy the particular syringes needed.
Lack of Testing Equipment. Crucial to the process of fixing a broken device is the ability to test the device’s functionality. This was a problem that I hadn’t really considered before, but as we walked around PAM it became apparent how big an obstacle it created. For broken ventilators, a volume meter and a flow meter are needed to ensure the fixed device is truly delivering the amount of air it claims to be supplying; for broken phototherapy lights, a meter is needed to test the light intensity; sensitive temperature monitors are needed to fix incubators. However, it’s not feasible to buy and maintain testing equipment for each medical device that also needs to be bought and maintained. Without the proper testing equipment, many machines’ problems cannot be fully understood, while some fixed machines cannot be safely returned to the wards without first being tested.
Inside the warehouse, learning about suction pumps.
Lack of Preventative Maintenance. Many of the medical devices require routine maintenance, from general cleaning, to replacing filters, to checking water levels and valves. Some of these practices can be completed by nurses in the wards, however this requires training. Other more complex preventative maintenance practices require a PAM engineer to visit the hospitals on an ideally quarterly basis. Since the majority of hospitals that PAM services are a long drive away, both training and in-person maintenance require fuel and lodging, which requires funding, which is already limited; in order to conduct this maintenance, funding must be allocated away from other crucial resources the hospital needs.
Dysfunctional equipment; hopefully, some of these machines can go to the Poly to use as learning tools.
Touring PAM and learning about these obstacles was helpful in many ways. For one, it inspired design ideas that we will pursue in the remaining portion of our internship. We like the idea of taking an engineering based project needed by PAM and developing it with local materials, as the resulting device has a greater likelihood of being sustained over a brand new design project that we come up with on our own. We also can use PAM throughout the design process to gain feedback quickly, improving our chances of developing a successful device.
The trip to PAM was also an eye-opening peek into the varied and layered challenges that hospitals in low-resource settings face; the example challenges I’ve listed in this blog only scratch the surface of what the hospital must work through. As a student who hopes to enter the medical technology field in my future, there are hundreds of lessons to be learned about appropriate design through talking to and observing the processes at PAM. Design constraints extend into the complexity and rarity of the components chosen to construct the device, and consumable supply-chain problems can completely halt the use of a machine. If a device needs to be tested, the price and availability of the testing mechanism needs to be taken into account, as does the required maintenance. This first trip to PAM showed us how frustrating it can be to work with biomedical machines in this context, but it also inspired ideas about problems we can possibly solve as well as how to better design technologies in our future.
One of the most fascinating parts of the internship so far has been watching our team dynamic form. As in all group projects, each of us brings a unique set of strengths to the table. However in this circumstance, the skills that each of us possesses is far more greatly varied than in any group I’ve worked in before due to our different backgrounds. The Malawian interns are rising fifth-years who have been trained exclusively at the Polytechnic, while the American interns are rising third- and second-years trained exclusively at Rice; we have four electrical engineers, two bioengineers, and one mechanical engineer; the three American interns have project-based design backgrounds through the global health technologies program and the OEDK, while the Malawian interns have far more extensive technical knowledge; four were born and raised in different parts of Malawi, two in Texas, and one in Colorado.
We are all coming from and going to different places, but have time now to delve into our shared interest of developing healthcare technologies. This gives us the unique opportunity to hear new ideas and perspectives, “piggy-back” off one another, get inspired, and continuously learn. Watching our team come together to form this special balance has I think encouraged all of us to begin appreciating the vast potential that collaboration creates, and wonder about the other mutually beneficial partnerships that are important to us and our programs—particularly between the Polytechnic, Queen Elizabeth Central Hospital, and Rice.
QECH and Rice. The relationship between Queen’s and Rice has been established for years now. Queen’s played a significant role in helping to get the bCPAP (more info about this device on Tanya’s blog, another intern in Blantyre) off the ground, and sources many ideas for design challenges posed to teams of Rice students in the global health technologies program. The bCPAP office is stationed in Queen’s, and many nurses and doctors there are close contacts for Rice faculty. Conversely, when we visited Chatinkha (the neonatal care ward) last week, I noticed many technologies filling the ward that were developed through Rice for Queen’s.From a student perspective, the relationship between QECH and my university is a huge source of inspiration. It makes the projects we spend our time on in the global health technologies program real; they aren’t just projects given to us for purely academic growth, but instead are real problems that originate from a hospital that has exhibited a need. Students learn a lot from the hospital’s perspective, and can design more successful devices due to this. Additionally, the opportunity to work with a hospital like Queen’s is an invaluable experience for students pursing work in the global health field. The hospital, on the other hand, has more contacts that solely want to hear the pressing problems the hospital faces and attempt to make headway in solving them; there’s a ready pool of eager students, helpful faculty, and astute professors focused on innovating affordable technologies that the hospital needs.
The Polytechnic and QECH. The first thing I noticed regarding the Polytechnic and Queen’s was the physical proximity of the two. Every day, Catherine, Emily, and I make the short, 10 minute walk to the Poly from the hospital, which are connected by a single road; you can even see QECH from some upper floors of the Poly. For engineers interested in medical technology design, this physical proximity is invaluable. The hospital will give students greater access to doctors, nurses, and many standard machines (or lack thereof) from which they can learn. If Queen’s is the source for new device ideas, the students at the Poly will have the opportunity to more directly involve the relevant healthcare workers at Queen’s in their design processes. Feedback and guidance is available a short walk away, which can advance technologies quickly. Additionally, there is a great probability that technologies developed for Queen’s with iterative and immediate feedback from doctors at Queen’s will prove to be more successful.The Poly will also be offering a biomedical engineering degree for the first time next year. Simply being in the wards and observing processes/practices has shown to be immensely helpful to Rice students, and I can imagine the same will be true for Poly biomedical students. Not only do you become more aware of constraints, but you can also find inspiration for new biomedical devices to help address observed needs.
Rice and the Polytechnic. The potential for growth through this relationship becomes clearer to me every day through working with the Malawian interns. As I mentioned above, we all have varying, complementary strengths. We have different backgrounds as well as access to different materials and resources, which can be combined to lead to more appropriate, optimized devices. For Rice students, it is often difficult for us to fully understand the context for which we are designing medical devices, and it can be hard to get feedback from the intended users of our devices; however for the Poly students, this barrier is almost nonexistent. On the other hand, access to standards of care and design execution can be more difficult for Poly students that Rice students. Increased communication between students at these two universities has the potential to help all of our design processes immensely.We also have observed the potential for increased efficiency by working Poly and Rice students together versus individually: the first week, when we pulled out some of Rice’s device prototypes to hear feedback, the Poly students had pretty immediate ideas to improve the devices. These suggestions would have been even more helpful at earlier stages in the design process, so that they could be incorporated and tested early on. Similarly, when the same project is worked on at both the Poly and Rice—such as the phototherapy dosing meter—both projects would probably benefit from communication between the teams.
These three institutions each have a particular set of strengths that, like the interns, differs from the other’s capabilities. The relationships that develop open long hallways with a lot of new doors, and the more that I observe the team dynamic between us interns, the more attracted I get to the potential built into the relationships between QECH, Rice, and the Polytechnic. Moving forward, I think all of the interns are interested in utilizing our unique circumstance, in this unique team, to help in some way continue to forge the unique relationships that have so much potential to offer.
A roadside view of the Polytechnic.Troubleshooting a jaundice meter, which was in use at QECH until it began malfunctioning. The hospital gave the meter to the interns to troubleshoot, and we got it back up and running today!
While last week was spent laying a lot of general groundwork for the internship, this week has focused in on beginning our first design project: a phototherapy dosing meter.
Background. The particular phototherapy devices we are targeting treat neonatal jaundice, a condition that effects up to 60% of premature babies. Neonatal jaundice is caused by a buildup of bilirubin (a protein) in the bloodstream, and is often harmless. In more extreme cases, however, the bilirubin levels will become dangerous and can lead to long-term neurological damage. Queen’s (the hospital down the street from the Poly) uses blue phototherapy lights, designed and built largely from the efforts of both Rice and the Poly, to treat these more dangerous cases of hyperbilirubinaemia. The device is a sort of plate of blue LED lights, all of which output the same wavelength of blue light. The LEDs are placed a short distance above the baby’s body so the light passes through the skin, breaks down bilirubin, and allows the baby to process the protein and prevent buildup.
View of the blue phototherapy LEDs.
The problem. It is very difficult for a doctor or a nurse to discern how much light the baby is receiving; the intensity of light received by the baby changes significantly with distance from baby to light, and different amounts of light are needed to treat varying intensities of the disorder. The current phototherapy lights have a knob to adjust the light irradiance, however this knob ranges only from the designated “min” to “max,” not numerical measures of irradiance. We’re setting out to design a device that can measure the irradiance (which is essentially a measure of how much light the baby is receiving) of the bililights quickly, accurately, and cheaply.
Light intensity meter on the phototherapy lights.
Past solutions. This problem isn’t a new one; the particular bililights found at Queens have been around for a few years, and a method to measure the exact dosage of light has been needed for longer. However, the commercial dosing meters available in the US cost thousands of US dollars, making them too expensive to be practical at Queen’s. The current dosing meter used in Queen’s only costs around $40, but is an analog meter. This means the meter suffers from calibration drift: when the mechanical components that control the meter start to wear, the device begins to become inaccurate. Additionally, the analog meter can become inaccurate if it is dropped, bumped, overused, or slightly tilted such that the meter pin falls one way or another due to gravity, disturbing the irradiance measurement. Teams at both the Poly and Rice have developed alternative solutions, however most still use analog meters—which suffer from drift, bulkiness, and inaccuracy—while their digital counterparts haven’t been properly calibrated.
Our solution. We wanted to use ideas from previous teams who have tackled this challenge, but combine various aspects of these past designs to optimize a device that can hopefully finally meet all of the design criteria needed for a dosing meter. We decided to make a digital device, which will be more accurate in both short and long term as compared to the analog device. The circuit has been mostly redesigned in order to fit the components that we have and to optimize sensitivity. Additionally, the housing has been modified to make the device portable and easy to use, while maintaining accuracy by keeping the meter perpendicular to the light source.
Designing new phototherapy meter.
Progress. We first spent time sifting through the past designs to understand the design decisions they made. This helped us understand what components we wanted to keep vs. what we wanted to change. After deciding on the digital design, Mr. Vweza pointed out the need for proper calibration (turning the current created by a photodiode into a measure of irradiance) as well as a few other design modifications, so we researched solutions to improve our device from previous models. We also had a large brainstorming session on various housing options, and have finally chosen a model that suits the device’s constraints. Finally, we’ve laid out the circuit on a breadboard and begun troubleshooting this new circuit as well as adjusting the Arduino code to obtain the best results.
The next steps. We will continue to optimize the circuit tomorrow, and hopefully begin building the housing tomorrow as well. With 7 people working all day on this project, things move fast, and we hope to have an initial prototype sometime next week. Then, we must calibrate the device and test with the gold standard of care, and finally make any adjustments needed. Hopefully we will have the device up and running soon!
In other news! We’ve begun searching for our own design project, meeting with many people around the hospital to identify needs. We have a large list going now, but hopefully by the end of next week we’ll have narrowed it down and decided upon a novel design project! We also had a meeting with Mr. Mafuta about the orientation week, but that will be a work in progress throughout this summer. Finally, the five Rice interns in Blantyre hiked part of Mount Mulanje last Sunday, which was incredibly difficult and something my legs were not ready for, but also was beautiful and well worth the effort.
At a beautiful waterfall nestled into Mount Mulanje, the highest peak in central Africa!
We have just finished our first week at the Polytechnic! Everything thus far has been incredible, though the best part has been meeting and getting to know the Malawian interns from the Polytechnic. As I mentioned before, the Polytechnic is where we will be working this summer; I’ve since found out it is the only engineering school in all of Malawi. Four students from the Poly were selected for the internship—Charles, Christina, Francis, and Andrew—and together with Catherine, Emily, and I, we compose the 7 person internship team working at the Polytechnic. Christina, Francis, and Andrew are all rising 5th year electrical engineers (engineering degrees at the Poly require 5 years), and Charles is a rising 5th year mechanical engineer. They are some of the most brilliant people I’ve ever met, and even in this short time I have learned a ton from them. Here are a few of those things:
How to make improve devices.
Feedback. We took out a few devices the Rice interns brought with us from Houston—a rolling frame used for physical therapy, flow splitter, respiratory rate timer, bCPAP heater—and we all brainstormed ideas for potential improvements that could be made. The Malawian interns immediately had dozens of new ideas for how to make these devices better. They suggested making the rolling frame more adjustable, to be appropriate for various ages of children; for the flow splitter, there were many ideas about how to substitute alternative designs in order to bypass the need for a check valve (which is hard to find and expensive); ideas were thrown around for how to automate a respiratory rate timer, incorporating it into a different existing BTB device that already measures neonatal breaths. For the bCPAP heater, which is the project I am most familiar with, Andrew had a great idea to incorporate an internal transformer and current limiting circuit within the control system box, which both makes it cheaper and uses less parts bought from the US. It was impressive to watch him draw up an entire circuit schematic without any outside resources in a matter of about ten minutes.
Troubleshooting. Many of the Rice technologies that we brought had electrical circuits that were built by students with more of a medical background and less of an electrical background, plus the technologies had to survive three airplane flights over 35 hours. Somewhat expectedly, many of the technologies no longer were in perfect working order by the time they were unpacked at the Poly. The Malawian interns took lead in troubleshooting these devices, which was both an impressive and wild ride to be involved in: they worked very quickly, almost immediately identifying problems and rectifying them; when one part broke and no replacement was found, it was taken out and replaced with a completely different though equally functional component; when a power strip stopped working, they quickly took it apart, located a blown fuse, and replaced it. In less than two hours, all of our technologies were working, some even improved from initial design.
Where to shop. We had many materials we needed to locate for a workshop happening this summer, as well as for rebuilding existing Rice technologies from local material. Charles, Francis, Andrew, and Christina helped us come up with about 12 stores around Blantyre we needed to go to, and we managed to get all of our shopping done in one day. Not only were we able to see more of the city and meet more people, but it was also an eye-opening experience in searching for parts to build our medical devices with. We went to five or six stores searching for simple, plastic y-splitters, which are really easy to find in the States and we had assumed would be no problem here, but couldn’t locate any. Charles called other mechanical engineers and we even asked our supervisor, Dr. Vueza, but no one had ever used or seen this part. The same story applies to our search for check valves. We went to hardware stores, plumbing stores, and medical supply stores, but we could only find a few new medical devices, not parts to build or fix those devices. The experience helped me to realize how important it is to build devices that can be created or maintained with local materials, otherwise they have much less of a chance to be built at the Poly or sustained in Malawi.
Where to eat. The four Malawian interns came with us to the market and to Chipiku, a grocery store across from the Poly, to point out good food and good prices—they also took us to the cafeteria on campus, and restaurants Crazy Foods and Kips for lunches this week; the food so far has been great! They came over to our house Friday night, where Christina took charge in home making a huge meal of nsima, fish, and various veggies, while the US interns made a dessert of banana pancakes and cinnamon apples.
How to speak. Every day, the Malawian interns help us with our Chichewa. We always carry small notebooks on us to jot down words and phrases, but it’s hard to keep up! So far we have some greetings, some goodbyes, and some common phrases (“no problem,” “it’s all good,” “thank you”) down, but one of our most commonly used phrases is, “ndikuphunzira Chichewa,” which means, “I am learning Chichewa.” This is what we use when we don’t understand anything (which unfortunately happens a lot.) When we speak Chichewa, most often we get a kind, hearty laugh in response—most likely due to our very slow speech and American accents—but occasionally we also get high fives for our efforts!
On top of everything that the Malawian interns have taught us, they are also some of the most kind, helpful, generous, and funny people I have ever met; the faculty at the Poly, as well as the other Malawians we’ve met where we are staying, in the shops, and in the market, have made us feel at home. I am very lucky for the chance to get to work with this team, and I can’t wait to see what projects we complete!
Troubleshooting respiratory rate timerSign for a medical supply shop; most of the shop owners didn’t want us to take pictures inside their shopsChristina and Andrew teaching me how to make some Malawian dishes!Signs for shops on our search for materialsGrowing Chichewa vocab
When I fly to Blantyre, Malawi this Saturday, I will carry with me many things. Emily, Catherine and I have spent the past three weeks working to determine, prepare, and pack all that we anticipate needing for our internship this summer at the Polytechnic University of Malawi (“the Poly”). To help explain what we have been up to and what we will be doing for the next ten weeks, I have made a list of a few things we will carry with us:
Suitcases. We will each tote two very stuffed suitcases—one filled with materials for the internship, the other filled with personal items—that have been strategically packed to almost exactly 50.0lbs each (trying to avoid those overweight baggage fees). Here are a few things filling the internship suitcases:
Over a hundred electrical components. One of our goals during the internship is to develop new health technologies for use in low resource settings. We will be working on teams with Malawian students, combining each of our strengths to hopefully begin solving some of the healthcare challenges we observe around us. However, we don’t know exactly what projects we will be working on, nor what materials are available, nor what resources are needed. Emily, Catherine, and I—the Poly interns—have spent a good chunk of time creating and ordering a grand list of basic prototyping materials to help enable the innovation of new technologies over the next two months.
Funnels and bike pumps. There are a few projects already in the works at the Poly, though prototyping has been made difficult by the lack of available materials. While we had the luxury of access to abundant resources in Houston, we ordered dozens of parts that we predicted and heard were needed to further these existing Poly design projects. Some of these projects include a phototherapy dosing meter, a mechanical breast pump (this is where the funnels and bike pumps come in), and an automated blood pressure sensor.
Bouncy balls, pool noodles, and extra-long pipe cleaners. Two Rice faculty members will be traveling to Blantyre for a week during the summer to teach a design workshop to the Poly faculty. Part of our responsibility as interns will be to assist with this workshop, which includes hauling over a ton of materials beforehand. Additionally, we have a list of a few dozen materials to buy in Malawi, which we look forward to using as a means to explore the city!
New technologies. For me, one of the most inspiring experiences thus far in my entire education has been the opportunity to help create relevant and needed healthcare technologies. There is great potential for these technologies to really have a positive impact, however a barrier to their long-term success is technology adoption; if a doctor or a nurse doesn’t like the device, there is a high probability it won’t be used, no matter how well it works. An important step in the development of new technologies is initial feedback, which is where the interns come in. All of the interns have spent time the past three weeks prototyping around nine new technologies, most of which have been developed this past year by students in the global health program. I’m particularly excited to hear feedback on the bCPAP heating sleeve, which is the product of my team’s labor from this past semester in Global Health Technologies 360: Appropriate Design for Global Health. All of the interns learn how to describe and answer questions about each new tech so that we can present these developing devices to healthcare workers in Malawi and get their feedback about what they do—and don’t—like. It’s one of the ways that we, working as students in Houston, have a chance to develop technologies that are needed and liked by healthcare workers in Malawi.
Laptops. The fourth, unofficial member of our internship team is Google Drive. In addition to gathering physical materials before departing, we’ve been having meetings with Rice faculty to gather information to help with one of our biggest tasks this internship: designing and implementing an engineering orientation week for incoming engineering students at the Poly. This project will be ongoing throughout the internship, culminating in our final week when we actually execute this orientation week. In order to prepare ourselves to create this event, we spent time meeting with Rice’s engineering faculty, the director of the engineering leadership program, students and faculty involved in Rice’s freshman orientation week, and professors who teach the engineering design process. We know that our conception of this orientation week will change as we spend more time in Malawi with the Poly students and faculty, however we have gathered many ideas, materials, and insights in hopes that they can be tailored to help create a novel engineering orientation week at the Poly.
Chichewa flashcards. We’ve been given an incredible learning opportunity to go to Malawi and live and work in the context for which we are designing health technologies. We will have the chance to get to know the nurses and doctors who use the technologies, the engineers who fix them when they break, the students who will design many future technologies, the professors who guide these students, and the mothers whose infants are treated with the technologies. In order to best form these relationships, we thought it would be a good idea to try and learn words and phrases in one of the major languages of Malawi, Chichewa. Even though my accent and pronunciation right now is awful, hopefully it will help to at least try!
A healthy dose of excitement (and nerves). At the beginning of anything new, I always feel a nervous, eager anticipation. I feel this especially now, as what is coming is something I regard as very important, but is also very unknown. This opportunity will afford me the chance to learn and contribute things I wouldn’t otherwise be able to. It is a chance I am humbled and grateful to have, and I hope to somehow live up to the potential it has created. We have done our best to prepare, filling up flashcards, suitcases, and Google Drive folders, but it is impossible to really know what is going to come next. My role and perceptions will shift throughout the next ten weeks, and the projects I will be working on will most likely take a shape vastly different from the one I have created so far in my head. I don’t know in what final form the funnels, the pool noodles, or the (currently) poorly-pronounced Chichewa words will be used, but I do know that a passion for the work will hold steady, if not grow stronger. Acknowledging the unknown and growing comfortable with the probability of continuous change will hopefully best enable me to progress through this internship open minded, open to recognizing present needs and meeting them as opposed to imposing any other agenda, and open to new lessons, new work, and new ideas.
