1. Going home on a bike taxi at 5:30 in the evening will give you a gorgeous view of the sunset.
The main shops of Namitete are about a 15 minute bike taxi (45 minute walk) from the hospital and Zitha House (where we are living). The main road goes through fields and runs through the village and over small hills. The large pond of the Duck Inn reflects the pink and orange sunset perfectly. Definitely one of the things I’m going to miss the most.

2. Mendasi may be the cheapest snack I’ve ever had.
For 20 kwacha (equivalent to 5 cents), you can buy a ball of dough that has been lightly fried. I can usually restrain myself from buying one every time we go to market, but I can’t say the same for Joao. Kids of all ages will be carrying mounds of mendasi in buckets whether you’re in the capitol city or in Namitondo.

3. “Looking is Free”
Going to the Lilongwe craft market will always be followed up with a much needed advil. On the craft market corner next to the Game complex, dozens of sellers will bombard us once we step into the market’s fifteen foot radius. Good news though: “Looking is free”. I’m not quite sure why but they like to give us fake names. The last person I bought something from told me his name was Chicken Soup.

4. You + Camera = 20 kids fighting to get in the camera’s view
Many of the neighbor’s kids love striking poses for us. Once they see us take out our phones/camera, dozens of kids (seemingly out of nowhere) will push each other to get in the picture. Introducing them to “The Selfie” was a big hit. Poses include cartwheels, karate stances, and pushups.

5. Don’t underestimate the hospital soccer team
Last weekend, we went to see the hospital men’s football team scrimmage against the Namitete Sun Downs team. The Sun Downs are semi professional and players are paid to be on the team. We shamefully thought the game would turn out to be a blow out in favor of the Sun Downs. Although the hospital team did lose, it was only by a differential of one goal (2-1 Sun Downs). The game had a large crowd, and we recognized players on both teams. Football is a common past time for people of all ages. On our way home from the hospital in the evening, we’ve never failed to not see an ongoing pickup game.

6. Knowing a few phrases of Chichewa goes a long way.
Chichewa 101. The phrases I’ve picked up this summer are by no means an extensive list, but knowing the common greetings is a great gesture to the locals. We’ve had people stare at us in shock and then laugh hysterically after we say simple phrases like “Good morning”, “How are you”, or “Have a nice day”.

7. The best time is nsima time
Nsima time refers to the 2 hour lunch break by the hospital. However, when someone mentions nsima all I can think about is the unique staple food that everyone here eats on a daily basis. The interns joke about bringing it to the Rice servery kitchens some day…

8. Tomatoes and onions are all you need
The Namitondo produce market may not provide us with a great luxury of assortments, but we can always rely on it to have plenty of tomatoes and onions. Since we cook for ourselves every dinner and the occasional lunch (if ramen/pbj sandwhiches aren’t sufficient), we try to call out to our creative sides for new choices of dishes. One criteria though: it must contain tomatoes and onions. Joao, Jesal, and I probably consume at least 30 tomatoes and 20 onions every weak.

9. Chitenje— every Malawian woman’s favorite accessory
A chitenje is an African garment roughly 2 meters long with many versatile uses. I’ve seen it used as a head wrap, a skirt, a saddle for a child to attach to the mother’s back, part of a scale, and much more! Our friend Gift said to me, “You become part of Malawian culture once you buy a chitenje”. Needless to say, we all bought ourselves a few chitenjes.

It seems like the days couldn’t go any faster. Now that our internship is coming to a close (less than 10 days left!!) we are finalizing our projects.

A huge portion of our time is being spent on Morphine Tracker. With some minor touches being worked on at the moment, Morphine Tracker (MT) has greatly improved since the last time I talked about it. Yesterday, we went over the functionalities of it with Dr. Suave, the doctor in the palliative care clinic. He is a part of the Palliative Care Association (as mentioned in the last post) and was able to provide us a lot of feedback on what we can add to MT. Today, we ventured to Lilongwe to meet his mentor, Kathryn Hamling. Kathryn runs the pharmacy at Ndi moyo, and both Kathryn and Suave are active members of the Palliative Care Association in Malawi. Kathryn expressed great interest in MT and after going over the database with her, she inquired if we would be able to come to Ndi moyo to further train her staff to allow them to adopt it. Realizing that our time is limited and with Ndi moyo being several hours away, we scheduled our visit for the beginning of next week.

After sitting down with Suave during lunch, he told us about his history in palliative care. Being such an active member for PACM (Palliative Care Association for Malawi), he has traveled to other countries in southern Africa and seen many examples of palliative care systems, including their record keeping. His interest in MT is very strong, but he ensured us that although many others may have the same interest does not mean they have the desire or will to accept it right away. Kathryn exasperated how morphine dispensing needs to be legally, regularly, and accurately monitored– the very opposite of what is happening now. Some hospitals, like St. Gabriel’s and Ndi moyo, take their morphine tracking very seriously. Although done manually, it is kept up to date, even with the painstaking amount of time needed to produce records and count amounts manually monthly, quarterly, and yearly. Not every hospital has the manpower to do so. The greatest hurdle to battle: implementation. St. Gabriel’s and Ndi moyo are ready to implement MT and will do so in the next week. However, they already had the personnel and will to track morphine. But what about the other hospitals that may need an electronic database even more? Suave has told us PCAM has been looking into the problem of morphine usage reports for quite some time, but nothing has been done as a solution. Many problems can come up: lack of computers, lack of personnel knowing how to use the computers, lack of time to input the data recorded from that day or week, and much more. In the next ten days, implementing MT at St. Gabriel’s and Ndi Moyo can provide us with substantial feedback on tackling these problems, because if we can’t put a strong foot hold in these two, how will we be able to do so in other hospitals?

Future plans (for the next 10 days), purchase supplies for the stirrups, create a presentation for the hospital staff about our work during the internship, producing an updated DataPall manual as well as a MT manual, update DataPall reports, finish LCTemp testing, and last but not least, enjoy our final days in Namitete!

Next blog post: Namitete and Lilongwe

I apologize for the lack of posting these past few days, the past week has been pretty hectic. As mentioned before, our internship requires us to partake in 4 projects:
1. Gather feedback regarding the technologies from Rice design teams
2. Look for other problems to become potential design projects
3. Finish any projects the hospital may give us
4. Create our own project

In the past couple of posts I have talked about projects 1 and 2. I promise to write more about these in future posts! These past two weeks have been busy with the last two projects.

Hospital given project: DataPall Renovations

As a reminder, DataPall is a palliative care record keeping database using patients’ diagnoses, symptoms, and prescribed medications to produce reports. Designed by Rice interns two years ago, it has been successful in its long term goal: to be sustainable. It is still up to date with its data entries and has eliminated wasted hours in manual calculations. The palliative care doctors has asked us to eliminate the possibilities of duplicate records, create more readable and useful reports, as well as some other small enhancements to the database. Microsoft Access has been a challenge, but after a lot of research and looking up helpful websites (as well as reading Microsoft Access for Dummies and another Microsoft Access Help Book), I’ve definitely improved my knowledge of the database. To eliminate the duplicate records, Joao has created a searching algorithm that will produce matches once the database recognizes similar parameters between the name, age, and village. We will be adding graphs to the reports as well as organizing the charts to eliminate any confusion when reading them.

Our own project:
After spending a lot of time in the palliative care data records room, one of the doctors approached us with a problem. He is part of the Palliative Care Association in Malawi that meets once a month. Although St. Gabriel’s has DataPall, with one of its features being morphine usage record keeping, most hospitals do not have any electronic record keeping and must resort to the manual system. In their June meeting, it was clear that morphine record keeping needed to be addressed. Morphine usage records are necessary when the country imports morphine for the district hospitals to ensure that hospitals do not receive too little or too much morphine shipments. Most hospitals do this by hand and it can be very cumbersome and inaccurate due to human error as well as having duplicative patients. The doctor asked us to create a database that is similar to DataPall but much simpler and will only measure morphine usage and record morphine shipment records.

To make the morphine database more user friendly, on the home page I added a section where the database would keep updating the amount of morphine stocked up. It updates whenever a patient appointment is added with an output of morphine or when a new shipment gives an input of morphine. Next to do on my list is to add warning messages. Once the morphine stocks come under a certain limit, a warning message will come up to remind the user. Reports on how many patients are currently on morphine, what kind of morphine is being used the most (tablet or liquid, 5 mg vs 10 mg, etc), and other facts need to be readily retrieved. Many updates are coming and we have agreed to start a pilot study at the St. Gabriel’s pharmacy and see the outcome of it.

On another note:

This past weekend we ventured to Zambia for my very first safari! It was everything I expected it to be and more. At Marula Lodge we stayed in furnished tents right next to the Luangwa River. Across the River was the South Luangwa National Park. Elephants and hippos were able to cross the river to our side. We were able to see many hippos and elephants right in our camp!

I’ve seen a recurring theme going through my fellow BTB interns’ minds: time in Malawi has seriously flown by. I agree 100% with this.

On my first day working at St. Gabriel’s I was amazed at the organized structure and tidiness of the hospital. A thorough tour of the facilities reinforced my initial thoughts. The hospital is small, but widespread with a long hallway that has wards on both sides . Additional buildings are found and attached to the main building through covered walkways. All the hallways are open to the outside with a number of gardens in between each ward. The hospital takes great pride in its gardens as they are very well kept.

In the back of the hospital is a long building that is available to any patient and his/her family members. This building contains spaces to sleep and is free of charge. Next to this housing is another building which is full of furnaces and stoves. Here, the residents cook for themselves. The hospital staff does nothing except for supply the firewood. The residents are responsible for making sure their space is tidy. Almost all residents are pregnant woman because many of them are not from neighboring villages. In the late stages of their pregnancy, they come to stay here so that once they are ready to give birth they will not have to travel the long distance. Like Dr. Mbeya, the hospital director, said, “It’s a home away from home”.

This free housing was provided to encourage pregnant women to come to the hospital, rather than try to go into labor without any medical attention. To come to St. Gabriel’s from distant villages can be difficult and costly, and this solution keeps St. Gabriel’s labor ward busy.

However, after speaking to a few pediatric doctors, it is obvious that solutions like these are needed in other wards as well. The absence of babies in the neonatal ward is due to the difficult and costly visits to hospitals. Today, St. Gabriel’s received another incubator from the Netherlands. When a pediatric doctor brought us to see the incubator in the kangaroo care ward, I couldn’t help but notice the entirely empty beds. There was not a single child or mother in there. The two incubators, two bililights, and one phototherapy bed were unplugged and sat pushed to the wall. Mirroring my thoughts, the pediatric doctor explained to us that because of low patient health literacy, parents of premature children do not see that it is necessary to come to St. Gabe’s for treatments. St. Gabe’s hopes that in the future this problem will be lessened by their outreach clinics and patient education teachings.

On another note: This past weekend we went to visit Blantyre. We had donations and also technology supplies to bring to the other BTB interns. Blantyre was very modern and had great craft and food markets. It was a great weekend trip!

Rice University puts a lot of emphasis on hands on learning. There are design teams consisting of senior engineers, global health minors, and freshman introductory engineers. These teams are tasked with real-world problems at the beginning of the semester, and are challenged to come up with solutions. Some of these are global health challenges. Coming up with a possible solution may be given the most attention, but the forefront of determining what questions to answer also deserves as much research and thought. How do we determine what technologies are needed for low resource countries? Or even better, how do we ensure that these upcoming technologies have the potential to be implemented  successfully?

Before my internship began, the BTB program directors challenged us to look for problems for future design teams. At the time, I thought of this as a simple goal: of course a low resourced hospital in Malawi will have many problems in desperate need of Rice’s engineers. However, this is surely not the case.

In a previous blog post, I provided a brief summary of the devices that were created by students this past semester. Some of the technologies that we brought over were received with skepticism. It is clear that problems are not uniform throughout every low resource hospital.  St. Gabriel’s does not have a need for every resource or solution that we bring them. This does not mean that these innovations are not welcomed in every hospital. When touring the kangaroo care ward, the doctor lamented on the low number of neonatal patients in the room. Combined with the fact that African babies affected by jaundice are difficult to diagnose because of their darker pigments, only one patient uses the phototherapy treatment per year. Therefore, the phototherapy dosing meter will not provide the potential impact compared to Queen Elizabeth Central Hospital in Blantyre. QECH is a much larger district hospital and sees many patients undergo phototherapy.

After talking to a pediatric doctor, he inquired why one of our showcased devices, the temperature probe,  did not have a way to output the exact temperature.  The probe provides three results: hypothermia, hyperthermia (fever), and normal through three distinct light indicators. To him, simply checking the neonate’s temperature periodically would provide more data. At a busier hospital where constant attention can not be given to neonates in incubators, the three result system would allow mothers to use it as an alert indicator.

We are still gathering feedback from a variety of doctors, clinical officers, and nurses, and hope to return with more useful information for future design teams tasked with the same project.

On another note: This past weekend we traveled to Cape McClear, a small beautiful part of Lake Malawi, and met with the Rice interns from Blantyre. It was an exhausting but very exciting trip. Read Carissa’s blog for a great detailed description of our trip! Even though we were only gone for a weekend, Joao, Jesal and I were very glad to come home to Namitete.

             

 

It’s only been a week since our arrival, but it feels like we’ve been here much longer. After layovers in London, Johannesburg, and Blantyre, we finally arrived in Namitete.

 Layover in London: The London Eye and Thames River

The hospital guesthouse is very nice, we all have our own rooms and bathrooms, and even a mini tv to watch the world cup on!

Here is our daily routine so far:

At 7:30 we go to morning report at the hospital, where the staff goes over the night’s admissions and special cases. Afterwards, Joao, Jesal, and I separate to shadow different doctors in their respective wards. We have already met quite a few of the hospital staff and are hoping to make more friends this way! St. Gabriel’s has many sectors, and on our first day it felt like a maze as Dr. Mbeya, the hospital director, took us around.

12:00 to 2:30 is the afternoon break. Since this is quite a bit of time, we usually are able to go into town or explore the village. Namitondo and the markets are only a five minutes away. At first, we would always try and bargain down the price about 50-100 kwacha, but then we realized that the 5 minutes of exhausting our (very limited) vocabulary of Chichewa was not worth the 25 cents.

Meat market

2:30-5 We work on the technologies that we brought by gaining feedback from the doctors who specialize in that area. I will provide another blog post explaining more on this feedback. The past few afternoons have been DataPall oriented. We are working on cleaning up the records by standardizing the treatments, diagnoses, and symptoms that are entered in with each patient. By doing so, the final reports will be concise and more accurate.

5:30 exercise as a team (yes, it’s true, I exercise)

6:30 cook, we’ve learned how to make nsima and vegetables (traditional Malawian food), but sometimes just resort to ramen and pbj sandwiches.

After dinner, I like to read or try to use the internet (however slow it may be). Sometimes we have little Chichewa lessons as well! Learning Chichewa has been a challenge. No matter how many times we practice the phrases at night, I usually seem to freeze up and forget them when talking to the locals.

It may be a little soon to say home sweet home in Namitete, but this first week has been an amazing start to this summer internship.

Note: I apologize for the lack of pictures and also delay between posts, the internet here is a lot slower than expected and requires a lot of patience.

Excited, happy, anxious, curious…. all emotions that I am experiencing at the moment. For the past month, Jesal, Joao, and I have been working in the Oshman Engineering Design Kitchen (OEDK) at Rice to complete our tasks of technologies. Being so busy, I haven’t completely comprehended how I will be leaving in less than a day. We will be journeying to Namitete, Malawi, a very small city about an hour away from the capital of Malawi. This will be my first time in Africa, and I can’t wait to experience firsthand the Malawian culture and life at St. Gabriel’s Hospital. Learning Chichewa, toughing through little to no internet access, and cooking for ourselves will be a great skills for Jesal, Joao, and I to go through together.

Here are a few of the technologies designed by Engi 120 freshman teams, capstone engineering design teams, and global health technology teams that will be brought over.

Other technologies include:

Flow-splitter- allows one oxygen tank concentrator to be used for five patients rather than one

Phototherapy dosing meter- helps measure the correct amount of light to breakdown jaundice

Morphine Dosing Caps- prevents under/over dosage of morphine with accurate and quick dispensing

Boxyclean plans- sterilization process to decrease the risk of hospital acquired contamination

 

Many people have asked me what I hope to gain from this trip. I have planned and prepared for the past few months, but I know that my upcoming experiences can only be learned from seeing and doing, rather than being taught in a classroom. For the past few years, I have volunteered in hospitals and taken 2 design courses at Rice, and I am anxious for the feedback of our designs from doctors and nurses in Malawi. I want to gain an appreciation for constructive criticism and to develop skills to adapt to them as well. Also as a pre-medical student, I am very excited to witness the health infrastructure of St. Gabriel’s.  I can’t wait to get started on this journey!