This week, Ariel and I wrapped up our data collection at Queens and did our final analysis. It is my last night here in Malawi, and it has been a bittersweet end to a wonderful summer. Going around the hospital and saying farewell to all of the random people I’ve befriended, I realized how many people I am going to miss. I am so excited to be coming home to friends and family, but sad to say goodbye to so many wonderful people that I may never see again.

I could try to paint a picture of Malawi by describing all the missing things that we take for granted in the US, but I think that would give an utterly incomplete image of this beautiful place that I have grown to love. Overall, I definitely learned a lot about all of the things Malawi doesn’t have. Some of it I learned in a classroom back at Rice, and some of it didn’t sink in until I witnessed it here, thousands of miles away.  But most importantly, I learned about some amazing things that Malawi has to offer that many places do not have, such as a friendly “Hi, how are you?” from strangers, encouragement from random passerby as I jog around Blantyre, and an abundance of fresh produce on every major street. And frankly, a lot of words just sound better with a Malawian accent (baby, for example).

There were plenty of times this summer when I was overwhelmed by the immensity of the health care problems here, and times when I was overwhelmed by the ability of people to find ways of getting past them and have the courage to go on despite them. I had to see a lot of suffering, but not a day went by when I didn’t also see so much joy. I am so thankful to have had the opportunity to be here. I’m looking forward to continuing to help with the CPAP project from the US and also excited to continue work on the CPAP sleeve with some of the feedback I received here. Zikomo to all the amazing people I had the chance to work with this summer and everyone who helped me get here! TX/CO, here I come!

                    

My last Malawian meal, nsima and pumpkin leaves                    Malawian Monday                                                       With MK and Caroline at implementation

 

 

Mural near downtown Blantyre

Satemwa Tea Plantation

                     

Chatinkha nursery                                                                      Rice’s phototherapy light stand in action                                           CPAP training

                    

How Malawians keep their fish cool on the drive home                                      Blantyre                                                   Our Cure house family

Over the holiday weekend, we enjoyed a lovely weekend back in Blantyre while most people went out of town (it was Independence Day weekend for Malawi too!). Although the familiar scent and sound of fireworks were missing from our 4th of July, we celebrated the holiday with a few other Americans and people from all over the world.

I also decided to try to cook my favorite African food, Zitumbuwa, which I have mentioned before. It was pretty easy, and although Ariel assures me they’re better than the ones at the market, I’m still racking my brains to figure out why they don’t taste the same as the Malawian-made ones!

         

We also went to Michiru Mountain for the day on Monday. Riding our bikes through the village, we were met with the familiar stares and excitement from the children at seeing white people. By the time I got home I could still hear the “AZUNGUS!” echoing in my head! A lot of them only know how to say “How are you?”, so they will just keep saying it over and over again even if you answer them. It’s strange but always makes me smile to see my acknowledgement entertain people. On the mountain, we were guided most of the way up by a park ranger who carried a huge rifle to “protect us from hyenas, leopards, and other things.” We did not see any animals other than monkeys, but we did come across a large number of poachers, including a group of about 15 children. The first time he saw a man illegally cutting down trees on the nature sanctuary, he actually fired off his rifle to scare him off before chasing him into the mountain. The poacher got away, but we soon saw a huge group kids carrying massive piles of wood on their heads. This time the rifle was not necessary, but they did have to go back down the mountain for “civic education” and got their wood confiscated. It was difficult to think of children and teenagers, gathering firewood for their families to cook with, as criminals, but the law is the same for everyone I suppose. We saw a similar issue at Mt. Mulanje, where people illegally cut down cedar trees and gather firewood. It is one of the major environmental issues I’ve seen in Malawi as well as crop burning and trash burning.

 

 

 

Cute monkey family hanging out on the road to Machiru.

 

 

Since there are not enough doctors and nurses at Queens to constantly monitor the patients, every patient has a guardian with them to look after them, and feed them. It is also customary for Malawians to visit anyone they know who are in the hospital, so there are always lots of people of the grounds of Queens waiting for visiting hours. This area is across the street from Queens where the guardians and visitors cook meals (mostly Nsima).

 

Our street market

 

 

Implementation at Kamuzu Central Hospital.

Implementation and training has gone very smoothly this week. We delivered 8 CPAPs in one day yesterday! We have also been joined this week by our new co-worker, Caroline, who is awesome and a huge help already! However, I can’t help but feel a bit sad to meet such awesome people with such little time left here in Malawi. Ariel and I are already reminiscing, and we still have a week and a half left…

 

Happy 4th of July everyone! Yesterday we took the CPAP gear out to Machinga. We tested out the pulse oximeter on a few babies that had just been born and got everything set up in the nursery. The Machinga trainees were really happy to see the CPAP actually on their ward. Then on the way back to Blantyre, we stopped by Zomba to check up on things and see how everything was going with the new CPAP cart. When we arrived there was a little girl with bronchiolitus in very poor condition and getting worse. Her oxygen saturations were at about 50% even when she was on oxygen therapy (below 90% is not good). They had been waiting on a doctor to get a recommendation, but since we had brought two of our CPAP nurses along with us, Sister Patridge and Glyssie, they decided we should definitely put the baby on CPAP. So our Machinga trainee Roseby went ahead and helped put Machinga’s very first pediatric CPAP patient on the machine. The bCPAP can make such a dramatic difference when small children are in respiratory distress, and yesterday it was really amazing to be able to see the results of so many’s people’s hard work. It’s easy to get caught up in data analysis and mountains of medical charts, but this was one of those days when I feel so blessed to be able to help with this project. It’s crazy to think that Pumani bCPAPs will soon be all over Malawi!

 

 

Training Update

Second week of training has gone swimmingly. Now we have a detailed agenda and have even been running more on schedule than usual! It is really impressive how quickly the trainees pick up the skills. Today we were even able to go down to the wards and have the trainees observe the CPAP in action as the nurses put new babies on the machine. This was really helpful since the trainees all practice on baby dolls. I’d also like to share a couple of great quotations from training. It helps if you read them with a Malawian accent…

Florence (Queens CPAP nurse): Make sure there is space between the septum and the nasal prongs. They will sue us and the baby will need plastic surgery.

Alfred (our Malawi Ministry of Health helper): First you save lives, and then you can have your…Fanta.

 

Weekend

On Saturday we went to a Malawian play about witchcraft. I was expecting it to be super creepy, but it turned out to be a comedy! As far as I could tell, they were basically poking fun at witchcraft and making it seem ridiculous. The cast was made up of only four people who were incredible actors. One of them was also the writer and director and is a very famous actor in Malawi. It started off really funny, but soon the subject matter made me, as well as most other Azungus (white people), uncomfortable. Basically this boy had come to the best witch doctor in order to get something that would allow him to rape girls and get away with it. However, he broke the terms of the original agreement and had to return to the witch doctor for help. The solution required him to rape his mother and kill his father. The second act opened with a big sign over the newly converted witch doctor’s place which read in Chichewa, ” We have stopped practicing witchcraft. We are born again.” There was a couple of dramatic plot twists, but it involved a lot of rape and didn’t seem to have a happy ending. What was surprising to me was really the audience’s reaction to the play. Most of the audience were male Malawians, and pretty much everyone except the Azungus thought it was hilarious. Seeing people laugh and joke about things like rape and HIV was a bit of culture shock to me. But the more I thought about it, it really isn’t all that different from the inappropriate humor found in American media. It’s just that different topics are more relevant in different cultures, and these particular topics were rather uncomfortable for me. Maybe Malawians would find American humor quite offensive. Regardless, it was a good experience, and like I said, the cast was really talented.

On Sunday we attended a picnic for the music program of a private primary school. It was a lovely day and the children’s performances were highly entertaining. Tiny musicians are adorable in any culture! I also got to stock up on African cakes, my latest food obsession. It’s basically just little circles of banana and corn maize mashed into a dough and then fried.

 

Picnic with the housemates

The Season of Leaving

It’s about that time of year when a lot of volunteers are heading back home soon. It’s made me think about how difficult it is, on a person and professional level, to be in a place where people are constantly coming and going. For Malawians I imagine it’s really difficult to have so many volunteer doctors come for a few months to a year, and then have new co-workers all the time. And since the volunteers can come and leave as they please without any set schedule, they often end up with periods of lots of doctors on the wards, and periods where they are seriously understaffed. It also makes it difficult to make lasting relationships with people. A few of our friends here are here for about a year, and I can’t imagine having so many “short-timers” like myself coming through all the time. Answering the same questions to clueless newbies and saying goodbye to so many people throughout their time here. However the ex-pat community here is so small that everyone knows everyone, and you start to feel really popular when you run into people you’ve met. In fact, Ariel and I have not travelled anywhere without seeing people from Queens!

Medical Record Hunt

Our dear friends at Medical Record are on a major hunt to find about 25 files in the vortex of the medical record storage. A doctor gave them a list of patients that needed to be tracked down so they have been diligently going through piles on piles of charts trying to find these patients. They have found several over the last week, so they are very excited about that. Whenever they find one there is lots of whooping and celebrating! Going to medical records, once a daunting task, is often the highlight of our day. They always keep us laughing and also like to teach us Chichewa.

                      

 

The Pediatric Nursery crowded with med students!

The prettiest produce stand on the street.

No Fear Aloe Vera

Well now that I’ve gotten you to read all this random stuff, I’ll now explain the blog post title. One of the nurses in Chatinkha nursery thought I was a doctor, so we spent some time talking as I tried to explain who I was. She couldn’t figure out how to same my name, so I wrote it out. She asked what my name meant, and I sadly replied that it means nothing in particular in English as far as I know. She then told me that in Chichewa, “Sa” means “without” and “mantha” means “fear”. And she interpreted my last name, Olvera, as “a medicinal plant used for many purposes”– aloe vera.  So in Chichewa my name is quite exciting. All this time I thought I was just named after my brother’s childhood stuffed animal…She also has the same name as my grandmother, so it was a good bonding experience overall.

This week we finally began training for the CPAPs! We started Monday morning at Queens with 3 trainees from 3 different hospitals. Each hospital brought two nurses and one clinical officer. We also had our four lovely CPAP nurses from Queens helping to run the training as well as a couple of Queens doctors, Alfred from the Ministry of Health, MK, Jocelyn, Ariel, and me. We started off a bit late, which we basically anticipated happening. I have learned here to not expect anything to run according to schedule. But eventually, we had 9 eager trainees before us ready to learn all about CPAP.

To start off, Alfred gave a really great motivational talk getting everyone fired up about the CPAP. He talked about how important it is to learn how to use CPAP to save the lives of neonates in Malawi as well as the importance of teaching others and continuing to collect good data so that the project can continue successfully. The training video that was put together was a really great way to introduce the technology. The Queens nurses also really enjoyed seeing themselves on camera! We also did a lot of hands on learning and practiced with baby dolls. On the second day the trainees got to go into the ward and see what CPAP is like on an actual baby. For a simple machine, there is a surprising amount of information to know about it! We taught everything from the basics of common respiratory problems, how to identify potential CPAP patients, feeding tubes and suctioning, setting up the machine, making the stockinette hats, putting the baby on the machine, monitoring, and weaning the baby off of CPAP.

The best part was definitely seeing the enthusiasm of all of the trainees. A couple of them asked to take the manual home with them on the first day so that they could study it more for the next day and one also asked about getting a copy of the training video to bring to their hospital and show others. They picked up on everything really quickly, and I think they will be able to teach more people about using CPAP in their districts. The Queens nurses were equally excited about helping out at training. They take a lot of pride in their work as the CPAP nurses and really enjoy teaching others about it.

Yesterday, we drove up bright and early to Zomba to install the equipment and bring all of the necessary supplies to the hospital. As soon as we arrived, there was a crowd of people that came out to see the new gear. They wanted to all take a photo with the new CPAP before we could even bring it into the wards. (See parking lot photo below)

               

The road to Zomba is under construction, so it was a bumpy 2 hour ride on this dirt road, but all of the equipment (and people) survived thanks to MK and German’s driving skills. It truly takes a lot of skill to avoid potholes, the many pedestrians walking in the road, big rocks, bikers, oncoming traffic, and goats.

Despite a shortage of space on the Zomba wards, we got all four CPAPS and other supplies successfully set up. Then before we knew it, a huge group of nurses had gathered around the new cart and Florence was giving an impromptu orientation on CPAP. It was so amazing to see how interested and thankful everyone was. Before we left, we even saw a big group of people already starting to make the stockinette hats for CPAP patients!

 

Now it’s back to Zomba to finish some data collection. Can’t wait to see if there are any babies on CPAP already!

 

Random Photos:

Lake Malawi!

 

The orange cloth on top of the basket is a People’s Party chitenge supporting the President of Malawi, Joyce Banda. People here in general have mixed views on Banda. She was very popular when she was first elected but has lost support since the devaluation of the Malawian Kwacha.

Early morning at Queens outside of the Peds ward. Notice the woman with the green cloth on her head–she’s carrying two babies on her back which is perfectly normal here. The women here basically lean over so their back is flat, place the baby on their tummy on their back, and then wrap the chitenge cloth around the baby and tie it in the front (and sometimes wrap an extra cloth around for warmth). I am curious to see that process with two babies though!

Malawi driving problems…

With CPAP training beginning next week, things have been picking up here. It was also the first week I actually believed it was winter here.  We had a couple of very rainy, cold, and muddy days, but I think it was a false alarm because the sun is already back out today! I really hope it lasts. With no heating or a/c system (and lots of open windows), it is always the same temperature in the hospital as it is outside, except in the nurseries where they have radiant heaters to help keep the babies warm. The rain also makes it a lot harder to hand wash and hang dry your clothes! I can only imagine what it’s like during the rainy season.

Yesterday Ariel and I spent some time doing the regular data collection and entry as well as helping to make some stockinette hats for the CPAP patients over at Chatinka. They are surprisingly simple to make! We officially put the new Pumani bCPAPs out on the wards and distributed the new supplies which was super exciting. The med students are also done with their schooling, so I am interested to see how things are different with all of them gone. There are so many of them and so few doctors that they seem to do a lot of the day to day monitoring of all of the patients.

Our presentation of technologies went very well this morning. A couple of people told us afterwards that it was good. We were hoping that we could get a lot of different opinions by presenting each of our technologies in a group setting at the Pediatric department morning handover meeting. We unfortunately did not get as much feedback as I would have like, but we will continue meeting with doctors and nurses individually to try and get more suggestions and advice. On the bright side, they hardly had any criticisms for us. I had braced myself for the worse and was prepared for lots of tough questions. One interesting point that was raised was the issue of people stealing power cords and batteries. They really liked the idea of the ASAP monitor made by the Spygmo team this year, especially the fact that it runs off of rechargeable solar batteries. However, we learned that people often steal the power cords and batteries to various machines (the copper wires are valuable even if the cord itself is not). They suggested putting the batteries inside the device and making it so that a clinician has to use a specific key to open the device and remove the batteries. Another issue that came up while talking about the manual breast pumps was the fact that there is little screening done for Hepatitis B, so that would need to be addressed in order for babies to receive donated breast milk or for mothers to share the breast pumps. Some ideas for new technologies included a peak flow meter for asthma patients and a more durable blood pressure bladder. Pelham also introduced the new Pumani bCPAP and overall, I’d say it was a very successful presentation.

Other than that, we are just preparing for CPAP training to begin by reviewing the training materials. The training video is not quite done yet, but already looks really great! I think the Queens nurses will really get a kick out of seeing themselves on camera. Whenever we take pictures here, and then show people the image they are always extremely amused and usually laugh at it. Tomorrow will be an eventful day as Ariel and I will get to see an orthopedic surgery over at Cure Hospital tomorrow! I have no idea what I am in for, but I’m sure it will be really interesting. I’m hoping it’s not a total hip replacement. We will also be off to Lilongwe tomorrow with Jocelyn.

 

                

Pelham fixing a CPAP                                                 Why Ariel and I want to create a map of Queens                                Making stockinette hats

 

                

Tiny hats for tiny heads!                                             Favorite hangout–medical records!                                 Florence and Chrissy with the new Pumani!

Well it was quite a busy week on the road again. We are currently in the process of a data review for the bCPAP project. Training for the CPAP nurses starts soon, so there is lots to be done. This week we went to Kasungu, Mzuzu, and Mwanza for data collection. This involved a lot of tracking medical charts down, sorting through the charts, documenting information from the registers, and filling out new data forms.  Things went fairly smoothly and were particularly efficient with a team of 6 instead of 3. Last night we packed up all the medical gear going to the various hospitals in their respective suitcases which took a surprisingly short amount of time with all five interns, MK, Jocelyn, and Pelham all working together with some quality music in the background to motivate us. It was also great to see my fellow interns from St. Gabes this week. Now we get to show them what life is like in the big city this weekend!

                

                

Malawian style  “ceiling fan”

Last week Dr. Queen Dube met with me and Ariel to talk about the technologies we brought from Rice. We also brought a manual breast pump  as a donation to the hospital in order to help the process of designing an improved manual breast pump that would be suitable for a site like Queens. We are hoping to find out what qualities the mothers want in a manual breast pump to incorporate into the design criteria. While chatting with Dr. Dube, we learned about a future breast milk bank that is in the works at Queens.

Breast feeding is encouraged all across Malawi, but can pose a major problem when babies are too small or too unhealthy to breastfeed. Mothers have to manually produce the breast milk, and then it is fed to the baby through a small tube. This is very difficult and frustrating for a lot of mothers, and some simply can’t produce the breast milk, leaving the baby unfortunately, “out of luck”. Dr. Dube said the only time baby formula is really used is for orphans. Ariel have seen the Chatinka nursery during feeding times, and it is really discouraging to see mothers, in some cases, struggling for only a few milliliters of breast milk.  However, Dr. Dube told us about this future breast milk bank which will allow the hospital to store breast milk from women who can express and provide breast milk to babies whose mothers are unable to express. It is in the early stages, but has already been approved. This is the first I’ve heard of it, but I think it will be a wonderful undertaking for both babies and mothers at Chatinka nursery. I’m also excited for the mothers to try out the manual breast pump we brought from the US, since a manual breast pump will be a necessary element of the breast milk bank project. I think it will make things a lot easier on the mothers who have already gone through so much. Hopefully we can design something at Rice that will be suitable for something like this!

The time is flying by so fast here! This week was a bit lonely since Ariel was not feeling well and stayed home to recover. Luckily I now have lots of friends and familiar faces to keep me company over at Queens now. My average day includes a chat with the nurses at the High Dependency Unit at Pediatrics, the nurses at the neonatal center in Chatinka, a brief Chichewa lesson and life chat at Medical Records, as well as (a laughed at) attempt to talk in Chichewa with the mothers at the Pediatrics nursery. I get to work on technologies and my social skills at the same time! It really is easier to get things done once you’ve established a relationship with the hospital staff, and it also makes the job more enjoyable.

Data collection was very successful this week. Even with just one person working on it, I think we have been able to reduce the amount of time it takes to get data from the 3 main areas of CPAP patients: Chatinka nursery, Peds nursery, and Peds High Dependency Unit (HDU). In fact, the nurses over at Chatinka are definitely able to do the data collection there without our help at all, but we still have to stay on top of everything going on there for when the crucial CPAP nurses are gone for the training sessions coming up in July. Many of the doctors here are volunteers, so the staff is somewhat fluid, but the permanent doctors have been very friendly and helpful.

This last week I had a successful technology meeting/presentation with Dr. Queen Dube which was encouraging. I was particularly happy that she liked our bCPAP sleeve prototype! Although the price for the one we brought (a little under  50 USD) is a little on the higher side, she thinks it would be a worthwhile investment for the hospital. The key component that increases the cost for the newest prototype we brought is the heating pad. The inside wiring from the heating pad is cut out and re-sewed into our sleeve, but we had a hard time finding a cheap heating pad that used  220V. We have students in Houston working on the sleeve this summer, so hopefully we can do a lot of testing on the designs from last semester and reduce the cost. When we were originally assigned the project, we worked under the assumption that the heating device would be necessary to prevent hypothermia in regions with colder climates (like Pakistan) where the ambient air is too cold to be delivered directly to the baby. However, Dr. Dube was confident that it would make a significant difference even here in Malawi where it is usually warm. They don’t have functioning incubators and the windows are usually open for ventilation, so the neonates are much more exposed than they would be in a developed hospital setting. And it also gets quite cold during Malawi’s winter! Even now when it is still pretty warm it is so difficult for such tiny babies to maintain a normal body temperature. On a related note, Jocelyn brought to Malawi with her the button batteries we ordered, so Chatinka nursery now has functioning thermometers!  We took all of their broken thermometers and told them we would try to fix them/put batteries in them. After a couple of days of us failing to find the proper batteries in Blantyre, they asked for them back. We were slightly worried that they were going to lose faith in us. No worries though, the batteries solved the problem, so we are in the clear.

Mt. Mulanje 

Our hike at Mt. Mulanje was absolutely incredible. Never a dull weekend in Malawi! We attempted to climb the most difficult peak at Mt. Mulanje (we were ill informed) and made it to a halfway point. I can’t wait to go back again already.

          

 

The Flames 

In other news, the Malawi Flames (the national football /soccer team) beat Namibia 1-0 in a very important World Cup qualifying match! As I was walking home from Queens the other day, I noticed a lot of people crowded around radios listening to something. Even the guy I bought produce from at the market had his radio pressed to his ear the entire time, which was very unusual. By the time I got to Cure, I realized it must be a football match and the guards at the gate filled me in on it. I also knew immediately when they won because we could hear people chanting celebrations all around the neighborhood!

This week we are finally getting settled at Queens and can now successfully (for the most part) navigate the maze of hallways and trails. Here’s a summary of what we’ve been up to lately:

• Fixed a freezer for the laboratory (mostly). It closes now at least!
• Ordered batteries to put in the thermometers for the neonatal center (they currently do not have any functioning thermometers)
• Continued data collection in the different areas of the pediatric ward for CPAP data
• Located the Physical Assets Management –PAM (the engineering department)
• Met the head of department for Maternity and shadowed around the maternity ward to investigate the possible use for the Sphygmo device

PAM

We have certainly learned a lot in the last few days about some of the problems the staff are constantly facing. I’ve heard before that PAM tends to be more like a technology graveyard than an engineering department where equipment is repaired. When we arrived, the employees were very welcoming and were happy to show us around. I realized quickly that it was not for lack of trying that the equipment never makes it back to the hospital. Here are some of the key issues that I noticed :

• Instead of giving PAM a budget to order parts to fix the medical devices, this task is in the hands of a higher up hospital administrator. This means that the parts usually never get ordered (presumably because the money is not available).
• All of the different types of equipment have different brands and often require a company specific part to fix it.
• A lot of donated equipment arrives at Queens unable to be used (partially or completely broken, in a foreign language,  uses the wrong voltage and without a transformer, etc. )
• Warranties on the equipment run out by the time the company gets around to fixing a device.
• Hospital conditions shorten the life of the technologies. For example, one staff member thought that oxygen concentrators give out especially quickly at Queens because the mop water on the floors gets sucked up into the air compressors and contaminates the sieve bed- a very expensive part to replace).
• A lot of parts are expensive to begin with and can only be ordered from the US.

It was frustrating to see so much equipment just useless and piling up there with a perfectly competent staff that can easily identify the problems. Especially the rows upon rows of oxygen concentrators, which the hospital is short on and is used in conjunction with the bCPAP. However I am looking forward to hopefully helping out at PAM and learning more about their work.

Maternity

This morning we went to the morning handover meeting for Maternity so that we can eventually present the Sphygmo device to their department and learn more about the appropriateness/need for the Sphygmo and other possibly projects. The Sphygmo is a continuous blood pressure monitoring device that automatically measures blood pressure at set intervals and has a light indicator for when the blood pressure is too high or low.  The very first presentation we heard by a medical student at the meeting essentially highlighted the need for frequent blood pressure measurements in the post-natal ward and all the wards in Maternity in general . A woman had died after having what was considered a normal birth because her blood pressure was not monitored after the delivery, and her condition escalated quickly in the post-natal ward. It was good motivation to pursue feedback for the Sphygmo! Here are some things that I learned or was surprised by throughout the wards:

• The sheer volume of patients and the number of deliveries every day. In fact there are so many deliveries that the nurses actually deliver the babies on their own, while the doctors handle only C-Sections and special cases.
•  The number of women that needed to be treated following an attempted abortion at home (abortions are illegal in Malawi).
• The absence of fathers and family members in all of the maternity departments.
• The high number of pre-term babies due to a wide range of medical conditions (malnutrition, malaria, TB, etc.)
• The delivery ward was eerily quiet despite constant deliveries.
• Sonograms are only performed for very special cases when there are medical complications.

Overall, the doctors and other medical staff seemed to like the idea of the Sphygmo and thought it could be very helpful. They also gave us some good feedback about some issues with it that occurred to them. For example, the Sphygmo has only a visual alarm, not an audible alarm, and many women do not have guardians or caretakers with them to notify a nurse that their blood pressure is dangerously low or high. Many staff members commented that people have enough trouble operating a regular blood pressure device. It would need to be very simple and straightforward to operate or else it would likely not get used.

Well I don’t want to be a Negative Nancy, since there was also lots of great work happening this week, including our improved cooking skills here at the house! This week really flew by and it feels like the whole summer is going to be over before I know it. Hopefully soon we will be in a good position to present the technologies we brought over, including the bCPAP sleeve, the phototherapy light stand, and the Sphygmo. In the meantime, we are constantly brainstorming possible technology projects to take back to Rice. We also got some good ideas today from medical students about new technologies that would be helpful. The success of the bCPAP and the Bililights are fairly well known here and give us a lot of credibility with the people we meet! I believe we are referred to as the “CPAP girls”.

This weekend we will relieve our busy work lives with a lovely hike up Mt. Mulanje, the largest mountain in Malawi. I am sure it will be different from hiking 14ers in the Rockies, but I have no doubt it will be equally awesome!!

       

The giant Limbe market                                           All the groceries we bought at Blantyre market for a few dollars altogether

     

An example of an improvised wheelchair.                  Friday night full of data, kittens, and brownies.