Part 1: Independence and Interdependence

“Thirty-five years of independence, but are we really independent?” This question rang out at the Kwa Haraba Art Gallery and Café last Wednesday, the week of Malawi’s independence day, as the first poet of the night finished his poem. The answer was not spoken but was palpable in the night air. As the evening went on, more poets performed, many of them also contemplating the fragile state of Malawi’s independence. (The only guy who claimed otherwise was a Caucasian man who sang a song whose only lyric was “One Malawi, One People”…).

Considering what we’ve seen in Malawi, it’s easy to understand why they might feel that way. Driving through the city of Blantyre, you can see UNICEF, UKAID, and the names of various religious institutions plastered on signs outside buildings. The shiniest, tallest office building around the Polytechnic/QECH belongs to a Chinese company, and stickers with Chinese characters are plastered on the windows and doors of trucks. A good portion of the businesses are staffed by Malawians but owned by South Asians. And many of the doctors who work in the QECH pediatrics department are from other (mostly European countries). (In fact, approximately 60% of Malawi’s healthcare expenditure comes from foreign donations.)

This thought lingered with me when we visited a tea plantation right outside of Blantyre on Saturday. When we got to the entrance of the tea estate, I was surprised to find that the manager of the estate was a Caucasian woman with a crisp British accent and later learn that the estate was founded by and has continued to be owned by a Scottish family for three generations. In the video we watched before tea tasting, the tea estate was billed as a sustainable business and community with a portion of the plantation left for the natural forest, a self-sufficient bluegum tree logging and replanting operation, two clinics for the workers, and a primary school for the workers’ children. Later online investigation showed that this was the only Fairtrade certified tea plantation in the country and numerous other projects had been undertaken under the Fairtrade agenda (investment into the nearby Thyolo District Hospital, subsidized solar panels for workers, construction of roads, etc.).

Nonetheless, it’s hard to forget that the tea plantation was founded during and built off a legacy of neo-imperialism that lined the pockets of western nations and exploited the workers. And it could hardly be claimed that the plantation is an utopia now—only half the workers’ children are able to finish primary school, and food insecurity is an issue during the dry season. This exemplifies the issue that the poets at Kwa Haraba lamented and that I noticed while here: it is difficult and almost impossible to differentiate between the lingering effects of colonialism that put Malawi in this position and the efforts of foreign aid that attempt to improve the situation.

As a result, some people, especially many young Americans, would argue that it is better to avoid foreign intervention (and, to some extent, foreign aid) all together, at least at the national level. Although I truly do not have enough information to make judgments about the tea plantation or any of the other instances of foreign investment I described (clearly they’re not all equal), despite, or perhaps due to what I’ve seen here, I strongly believe past mistakes do not excuse in current inaction. While the ultimate goal is a Malawi that is truly independent from foreign influence, in the meantime, we, as an interdependent global community, have a responsibility to help Malawi and other countries like Malawi get to that point.

Part 2: Scales of Change

I fully admit that the last part of my blog was a statement of lofty thoughts and aspirations that I personally can do very little about. However, the importance of differentiating between ultimate goals and current realities has also been impressed upon me on a smaller, more personal scale recently.

As I was walking through the hospital grounds to lunch from the Rice 360 CPAP office one day last week, a man stopped me and telling me that his brother was being discharged and that he needed 2000 kwacha to pay for the minibus trip from QECH to their home in a village. I didn’t know what to do. The other interns and I had encountered people asking us for money before, and we had discussed it extensively. We talked about how giving people on the street money ultimately perpetuates an unsustainable system since it incentivizes them to keep coming back to the random people on the street instead of seeking more long-term aid from nonprofit organizations or government agencies and, consequently, prevents the social issues from garnering the attention they need. For the most part, I believed this, but, in that moment, I realized the flaws in this perspective.

I knew that transportation was a major barrier to access to healthcare services, even in the United States. For instance, during my Alternative Spring Break on maternal mortality in Texas, I learned that a major reason that pregnant women missed prenatal appointments (putting them at increased risk for maternal mortality) was that they could not bring their other children to these appointments using Medicaid covered transportation. (Though this has changed during the last state legislative session.) How could I blame that man for his country not having adequate public transportation to health facilities when this was so recently still a problem in Texas, which has exponentially more resources than Malawi?

I ended up giving him the money. (I’m aware that he may not have been truthful, but I choose to believe otherwise.) In the end, 2000 kwacha was not a lot of money to me, and while I may not have contributed to improving rural healthcare access or the public transportation system, the money allowed that man and his brother to return home after receiving the healthcare they needed.

This realization about the difference between long-term sustainable change and short-term measures led me to decide to pursue a side project I had been thinking about. Seeing the Ballard Score poster, which was really a sheet of letter sized paper with the diagrams in black and white, in the NICU at QECH made me want to make a larger, laminated, and colored poster to at least match the other poster in the ward. However, I kept going back and forth about whether I should do this initially. A larger poster really doesn’t change the fact that the Ballard Score to difficult to use and that nurses don’t like performing it. Nonetheless, in my last blog, I talked about how, even in the best case scenario, a Ballard Score training program and assessment app would take years to implement. In the absence of a better training system or a better method of gestational age determination, at least a better poster would make it easier for nurses and doctors in the cases where the Ballard Score is used.

After corresponding with Prince (the nurse at QECH who works with Rice 360) and getting approval from the ward in charge to post the poster, I ultimately made four copies of 11 x 17 inch poster with a colored coded version of the Ballard Score diagram to hang in the NICU, the low risk area, and the Kangaroo Mother Care ward. While this poster clearly doesn’t make any meaningful, large scale change, I’m happy to have helped the nurses of one ward in one hospital in a small way. This week has been a valuable lesson in distinguishing between overarching aspirations and immediate measures and understanding the importance of contributing to both.

Sources:

https://mwnation.com/health-budget-at-donors-mercy/

https://www.fairtrade.org.uk/Farmers-and-Workers/Tea/Satemwa-Tea-Estates-LTD

https://doctorsforchange.org/dfc-2019-policy-priorities/

Hello everyone!

It has been such a whirlwind of a week (2 weeks?) since I wrote my last blog entry. I have many new updates to share so I’m just going to dive right in.

This past week and a half, Liseth and I have been busy continuing our usability observation project. We wrapped up our note taking from Queen Elizabeth Hospital with a visit to the pediatric oncology ward, pediatric special care ward, and an overnight stay in the neonatal intensive care unit (NICU). From speaking with nurses in oncology, we learned that the lack of syringe infusion pumps meant that nurses had to calculate the average amount of fluids and chemotherapy drugs administered per hour. They discussed with us the challenges of manually regulating these dosages for every chemotherapy patient.

While spending the morning in the special care ward, we observed that the bulk of the medical equipment and technologies (oxygen concentrations, bCPAP machines, patient monitors) were concentrated to the high dependency unit (HDU) for special care patients requiring respiratory support. At first, we were surprised to see that all of the patients were in the HDU and the main bay area beds were completely empty. But around 9am, floods of kids and families entered the ward from outside and filled up almost every bed in the main bay area. In the special care ward, patients and their families must gather their belongings and leave their beds to wait outside twice a day while the ward gets cleaned in the morning and afternoon. We learned that many of these main bay patients were typically kids suffering from anemia, malaria, HIV, and tuberculosis. These serious conditions would generally warrant the use medical equipment and monitoring devices, however the limited resources available simply must be used towards the HDU patients.

Our overnight stay in the NICU at Queen Elizabeth was my first experience spending the night in a hospital setting. I did not really know what to expect, as my hospital expertise stems from episodes of Grey’s Anatomy. At Queens, we noticed that the night shift was when many of the babies get put on and taken off of different medical devices. We saw the setup of oxygen concentrator machines, the preparation for phototherapy treatment, and the administration of various drugs. The night provided excellent insight into how nurses and doctors interact with the technologies and Liseth and I got pages of informational notes from our time here.

Our next overnight visits provided additional insight into the night routine and ward procedures for Zomba Central Hospital and Mulanje District Hospital. The Zomba Central Hospital nursery was quite large; it had 4 separate rooms for high risk patients, low risk patients, patients who were brought in from home, and for kangaroo mother care. 1 continuous monitor was available for all patients to check vital signs so again, Liseth and I watched as a lack of resources continued to influence healthcare and outcomes. Seeing the nurses face difficulties to keep neonates alive was extremely difficult and probably the hardest part of my internship experience so far. Our overnight visit at Mulanje shared many similarities. Here, human resources were scarce as 1 nurse was on the night shift for the entire NICU. No continuous monitor was available for the ward, so vital signs and recording were limited to temperature checks using 1 thermometer for all the neonates.

The health inequalities were extremely evident as my mind couldn’t help but draw comparisons to the equipment availability in the United States. After looking more into a holistic economic picture of the country, I learned that Malawi suffers from a climate vulnerability that has widespread influence upon agriculture, energy, forestry, water, gender issues, and human health. In 2015 and 2016, Malawi suffered from a pattern of floods and droughts that impacted over 5 million Malawians with food insecurity. Any extreme floods and droughts of a growing season can be detrimental to the climate-sensitive agriculture sector which contributes to up to 40% of the gross domestic product, employs 85% of the workforce, and supplies 70% of raw materials for manufacturing. With an under-financed health sector, 60% of the country’s total health expenditure needs to be obtained from external sources such as donations.  Reports suggest that in order to break out of a cycle of systematic poverty and dependency, Malawi needs to target the rural poor who depend on mainly agriculture alone for subsistence. Expanding the access and quality of health services available these rural communities in Malawi would help address some of the social, economic, and environmental determinants of health as a means of reducing overall health inequities. (Based on WHO Country Cooperation Strategy: Malawi https://apps.who.int/iris/bitstream/handle/10665/136059/ccs_mwi.pdf;jsessionid=55B8169FD0E2EFBE8B253B154BF5AF96?sequence=3).

When examining global health, I feel that it is incredibly crucial to consider all influences and factors that contribute to current health situations. Policy reforms targeting healthcare delivery and accessibility systems, human and monetary resource allocation, and overall health development are so vital to helping alleviate morality and disease burdens for a country. Although it can be an uphill battle, tackling global health with a comprehensive economic and policy approach lays the groundwork for sustainable widespread change.

 

 

Thanks for reading! I’ll check in again soon for my last week in Malawi! See you next week!

Thinking about how fast these first few weeks have flown by, it’s really hard to accept that we are halfway through this internship. Recently, I have been taking more and more pictures of regular day-to-day tasks, not wanting to forget the small things: the sunrise, the walk from Queen Elizabeth to the Polytechnic, and our home-cooked family dinners at Kabula Lodge. The following blog will take you through one day of our lives here in Malawi. I’ll walk you through decisions my team makes while prototyping, things I notice on the streets of Blantyre, and my thoughts from when I untuck my mosquito net in the morning until I tuck it back in at night. Hopefully this blog gives you a sense of what it is like to be an intern in this amazing program. 

– July 5th, 2019 –

7:26 AM

It’s become kind of a tradition that every morning as we are eating breakfast, I will set down my tea and declare the time to be 7:26. The bus from Kabula leaves every morning at 7:30, and through trial and error, we’ve discovered that in order for every intern to take their seat on time, this is when we all must begin to scarf down our remaining tea and toast. 

This morning the normal bus was out of service. Instead, we rode to work in a smaller replacement bus with fewer seats and unfortunately, less leg room. Once at Queen’s we began our usual walk along the busy streets of Blantyre: through the small market outside of the hospital, under the bright blue walking bridge, and between two tall palm trees marking the side entrance to the gated Polytechnic campus. From there, we usually have around 30 minutes until work starts, so we spend our time either reading or journaling in the sunny seating of an outdoor amphitheater.

8:30 AM

Wongani, a technician at the design studio, waves to us from the covered red walkway on his way to unlock the doors to the studio. Inside, light pours in through the 360º windows onto the clean and shiny tables, signaling a fresh start to a new day. While we wait for the rest of our project teams to arrive, Shadé and I make progress on the Clean Machine prototype. 

9:00 AM 

My Ballard Score team sits down and begins a brainstorming session for one of the training model’s attachments. For 10 minute intervals, we sit in silence, each writing down whatever comes to mind in our journals. At the end of the time, we each have several pages filled with a mix of potential solutions and mechanical components. Each one of these ideas is then shared with the group, free of any immediate criticism. As someone reveals a drawing, others build off of it, presenting their own related thoughts and combining concepts. 

Betty and I spend the rest of the morning developing low-fidelity prototypes for two of the brainstormed ideas. While we bend pipe cleaners and straws to create proof-of-concept models, Rodrick and Racheal continue work on two other neuromuscular attachments: heel to ear and the popliteal angle. With a goal of finishing prototypes for both of these attachments by the end of the day, they make final adjustments to dimensions in various CAD files. 

12:07 PM

Not wanting to waste valuable time, my team hangs back a few minutes into lunch to get our 3D prints started. With stomachs growling, we all make our way across the street to Miko’s Dessert Shop. Rather than getting their extravagant ice cream waffle cones (like we do every Friday), we instead order freshly baked cinnamon rolls. Unable to resist the smell, I finish mine on the walk to get an actual lunch from LJ’s – a small red shack across from Queen’s.  

At LJ’s you get a choice of nsima or rice, a meat, and a variety of vegetables. I prefer to have nsima over rice, mainly because I think it is way more fun to eat. From what I have been taught, here’s how to best enjoy these bouncy scoops of corn flour: first roll a ball in the palm of your hand (quickly because it’s hot), use your thumb to press a hole in the center, then use the nsima as a spoon for the rest of your food. 

1:30 PM

The work ethic of the Polytechnic and MUST interns is incredible. In addition to the internship, they are still attending classes, completing homework, and working on their own side projects. I honestly have no idea how they manage to do it all. Today, Rodrick had to leave for a few hours to give a presentation. In his absence, Racheal, Betty, and I have found little ways to be productive. Racheal has begun working with the software we will be using next week to design our app. Betty continues to work on her low-fidelity prototype, and I start designing components of the training model’s arms in SolidWorks.

3:30 PM

Just as bright light pours in through the windows every morning, the warm beginnings of a sunset flood the design studio starting at around 3:30 p.m. Over the past few days, I’ve begun to notice the effect of this lighting on our productivity. This final hour truly becomes a test of our willpower to accomplish the goals we established in the morning. Today, we had hoped to finish prototypes for both of the neuromuscular attachments on the hip, but as the orange tint of the sun overtakes the fluorescent blue of the LEDs, we haven’t assembled either. 

When Rodrick returns from his presentation, I am staring with frustration at my computer screen, unable to get one dimension of an arm to change without having to start over again from scratch. Unlike the rest of us, he is somehow still full of energy. It spreads to the rest of us, and the next hour becomes a mad rush to finish at least one of the attachments.  

4:26 PM

With 4 minutes to go before the end of the day, we have completed the prototype for the heel to ear attachment. My fingertips are encrusted in a layer of solidified super glue and our table is a mess of PLA shavings, bits of elastic, and random hand tools. During the walk back to the bus, I reflect on what we were able to accomplish.

It’s difficult setting goals and then not being able to accomplishing them fully. Back at Rice, the OEDK is just a short walk away from my dorm room, allowing me to work on a project until I am satisfied, sometimes into the early hours of the morning. Here, a 15 minute bus ride separates me and the design studio. At the end of every day, we must set down our tools regardless of whether or not we have reached a natural stopping point. As frustrating as this is can sometimes be, I feel that it has helped me to become a better teammate. 

In the past, I have struggled to let others take the reins in group projects. If a calculation was being made, I wanted to double check it. If a prototyping method was modified, I wanted to be there to understand the decision. But for the first time in my life, the engineering design process has been shoved into the time constraints of a workday. With so much to do, there is no longer time for me to obsess over every detail. My group at the Polytechnic has learned to strike a balance of task-division and making sure the whole group remains on the same page.  

5:30 PM

Once back at Kabula, we all walk under the beautiful orange flowers that drape over the reception area. Having done laundry the night before, I take down my clothes from the line and begin to pack for our weekend hike of Mount Mulanje. Hannah, Liseth, and Cholo start preparing dinner in the kitchen. At the very beginning of the internship, we randomly selected four teams to trade off cooking duties. The system works well and has been a fun opportunity to learn how to make some new dishes from the Tanzania interns. For our last meal, Joel taught Kyla and I how to make nsima, or as it is called in Swahili: ugali. The process turned out to be more difficult than expected and requires a lot of arm strength (more than I have), especially when you’re cooking for 11 people.  

8:00 PM

Eggplant parmesan is ready. People slowly begin to crawl out of bed, up the stairs to the terrace, and take their seat around the dinner table. While eating, we joke about how we’ll probably die climbing the mountain this weekend. Liseth retells stories of Cholo’s misadventures in the kitchen. We laugh, talk, and eventually move into the lounge area. Some 0f us do research for our projects. Others snuggle up in a blanket to read a book. I begin writing.

10:00 PM

I finish this blog! 🙂

________________________________________________________________________________

 

 

After three weeks of needs finding, research, and brainstorming, we’ve finally begun to delve into the prototyping phase of the engineering design process. This week, we began to CAD parts, 3D print them, and prepare for the assembly of our prototype.

I should probably take some time to explain my team’s project, since I don’t think I’ve done that yet. We are Team Suction, and we’re working on a neonatal airway deep suctioning training model. I’ll explain what that means in a moment. My teammates are:

Napendael (Nanah) Msangi from Dar Es Salam Institute of Technology in Tanzania
Foster Sentala from Malawi University of Science and Technology (MUST)
Chisomo Mbale from Malawi Polytechnic (Poly) 

Different people with different levels of technical and medical backgrounds will read this blog, so I’ll take some time to explain neonatal airway deep suctioning and the approach we’re taking to developing a training model.
Sometimes, babies are born with their lungs and airways full of amniotic fluid, and this prevents them from taking their first breath. In order to remove the fluid, nurses must use a catheter and a suctioning machine. The catheter is a long, thin tube that must be inserted into the trachea of the newborn. One end of the catheter attaches to what they call a suctioning machine, which creates negative pressure in order to suck the amniotic fluid out of the airways of the newborn, enabling them to breathe. There are a few difficulties associated with this procedure. First, it is common for nurses to overestimate the amount of tubing appropriate to insert into the infant’s airways. If the tubing is not inserted far enough, not all the fluid will be suctioned out. If the tubing is inserted too far, past the trachea and into the lungs, the baby will go into respiratory arrest. The second issue is that it’s easy to traumatize the newborn’s airways with the catheter if one isn’t gentle enough. This is particularly difficult to avoid if the newborn is premature or is moving around a lot during the procedure. Trauma to the airways can cause a variety of issues, including scar tissue build-up within the airways, which could restrict breathing. For these reasons, it is critically important that nurses are empowered with the knowledge and confidence to complete this procedure carefully and effectively. My team and I have decided to develop a mannequin-style training model in order to give nurses the opportunity to get hands-on practice of this skill during their schooling years in order to gain confidence and experience before entering day one of their jobs in hospitals.

On Monday, we were able to visit the labor ward at QECH, where the deep suctioning occurs right after babies are born. We actually entered the ward right after a suctioning procedure had taken place – we just barely missed it! When we arrived, a nurse was wrapping a newly-suctioned newborn in chitenge and connecting them to oxygen.
The most valuable part of our visit was that the head nurse in the labor ward was able to show us an existing training mannequin. It’s used to teach manual airway ventilation, which is a totally different procedure from deep suctioning, but we were inspired by the model itself. It was a blow-up doll with a shell for the face and for the torso, underneath which the tubes reside. Similarly, we decided to use a baby doll. We made a plan to cut off the face and reattach it using hinges, making it able to open and close. The tubing will reside on top of the doll’s chest and underneath its clothing.
We have begun the process of creating CAD models of the tubing and airways. Foster pioneered the CADing process, since he had the most experience with Solidworks. So far, we have CAD models of the trachea, larynx, and airways to connect to the nose and mouth. We have also begun 3D printing these files. We finally managed to procure a baby doll that would work for us (shoutout to Sally for having an extra one from the Ballard Score project).

 

On Friday, we began to dissect our baby doll. We cut off the face of the doll, and spent far too long attempting to reattach it partially using tiny hinges. Who knew that pieces so tiny could prove infinitely more difficult to work with than their normal-sized counterparts?

Over the next two weeks, our biggest challenge will be figuring out how to mimic the trauma that can be caused by suctioning. We want nurses to practice on the model and know when they have not been gentle enough. Therefore, we want to include some sort of membrane which ruptures when too much force is used. The membrane would then be removed and observed in order to inform nurses whether they made a mistake. We are considering different approaches to manufacturing this rupturable membrane. Hillary recommended the use of a thin plastic such as tephlon, which could be cut into small strips and secured together at the ends to create a cylinder. I am also exploring the option of molding and casting using a delicate type of silicone. Unfortunately, we don’t have the ability to special order unique types of silicone molding and casting materials, so we’ll have to improvise if we go this direction.

Overall, I’m thrilled to have finally entered the prototyping stage. As critical as I believe the first steps in the design process are, they can feel arduous. There’s a certain exhilaration that comes during prototyping. It feels powerful to be able to turn the ideas we’ve been discussing for weeks into physical realities. This must be what it feels like to be an engineer.

 

BONUS CONTENT

Going into our 4^th week of work, all 4 teams have finally begun prototyping. After 3 weeks of extensive needs-finding and research at various hospitals, we are ready to get our hands dirty. And I mean that literally. I leave the studio every day with my hands covered in a layer of solidified hot glue.

Before I get into the details about my project and the progress we made this week, I want to formally introduce my three teammates:

Joel Ngushwai: Dar es Salaam Institute of Technology

Christina Kalulu: The Malawi University – Polytechnic

Boniface Kaseka: Malawi University of Science and Technology

As I mentioned briefly in previous blogs, my team was initially tasked with developing a low-cost continuous temperature monitor for mothers during labor. The project was actually started by a team at Rice University, and now we are taking over from where they left off. The current version of the device uses a thermistor to measure temperature from the axillary artery on the upper arm. It has 3 LED’s (blue for when temperature is too low, green for when the temperature is within a safe range, and red for when the temperature is too high) and a buzzer to alert a nurse when the mother’s temperature is unsafe.

Before I delve into the details of our prototype plan, I want to talk a little about the need for continuous monitoring devices in countries like Malawi. Over eight million neonates die due to complications during pregnancy and labor per year, and 95% of these deaths take place in low resource and developing areas. Many complications that contribute to these deaths are due to changes in maternal temperature and pulse rate during labor. Intrapartum fever (≥ 38°C) and high pulse rates (≥ 100 bpm) can lead to an increased risk of complications including infections and fetal distress.

After talking to many nurses at Zomba Central Hospital, Queen Elizabeth Central Hospital, and Mulanje District Hospital, my team learned that currently, most hospitals in Malawi use non-invasive thermometers which are often lost or easily broken, and many nurses end up relying on using their hand to check whether a mother has a fever. Additionally, many wards don’t have access to pulse rate monitors, and oftentimes, nurses have to manually count the patient’s pulse rate – which means it is too time consuming to be done regularly. As a result, nurses are typically too busy or overwhelmed and don’t always end up using a partograph to record maternal vitals. In fact, a 2017 study in Malawi found that on average, 65.3% of partographs lacked temperature recordings.

These findings confirmed the need for a continuous and accurate vital signs monitoring device that can assist nurses in monitoring and recording the incidence of maternal fever and high pulse rate during labor.

With guidance from Francis Masi (who mentored the team working on this project last summer), my team has decided to make the following changes to the existing prototype:

1. Include a circuit for pulse rate detection
2. Transition from 4-Digit 7-Segment display to an I2C LCD or TFT LCD display
3. Include a bluetooth or WiFi module to allow patient information to be stored on the device (so that nurses can access past data and view trends of temperature changes)
4. Transition from a cloth armband to one that is more easily cleaned, adjustable, and comfortable
5. Include battery life indicators

My team is slowly starting to formulate our project idea into a reality. This week we began recreating and troubleshooting the device’s temperature circuit using a thermistor, a basic I2C LCD Display, and 3 LEDs as a visual alert system. We also began designing the control unit (which will ultimately be 3-D printed) on SolidWorks.

It is absolutely crazy to think that we are over halfway done with our time in Malawi. In 4 and a half short weeks, I have grown to love this country and its people. I love waking up to the beautiful sunrise over the mountains that Kabula Lodge overlooks. I love cramming over 20 excited and passionate young engineering and medical students (onto a bus meant for 14 people) every morning to Queens. I love working with my team at the Poly Design Studio, eating lunch at LJ’s (a small red shack by Queens, which we have, rather appropriately, nicknamed “red shack”). I love family dinners back at Kabula with all the Rice and DIT interns. I love everything here and I’m determined to make the most of every day we have left.

***bonus content***

This weekend we finally attempted the long-overdue 3-day hike up Mount Mulanje! It was so hard that many of us found ourselves joking about how we might die before we make it to the top. Here are some pictures as proof that we made it out alive!!

— Nimisha 🙂

 

Hello everyone!

Presentations are never easy. My nerves get the best of me most times and I often stress over details, frantically writing down every sentence that I need to say. Even after doing countless presentations on our cervical cancer training model project in the Global Health 360 class, I still dread talking in front of groups. It takes a lot of concentration for me to not get flustered or stumble over my words. This past weekend, I saw presentations that inspired me to try to make presenting a more natural practice. We traveled to Lilongwe last Wednesday for the Malawi Innovation Pitch Night, an engineering design competition showcasing a variety of creative engineering ideas across Malawi. The event took place at mHub, a technology and innovation space dedicated to cultivating entrepreneurship. A total of ten inventive solutions to prominent problems in Malawi were presented to a panel of judges. Although I was just helping with the competition and not presenting, hearing the presentations was a great chance to appreciate the immense talent of young Malawian engineers. From a device that would purify water with UV light to a free educational tutoring hotline in order to improve testing scores, teams pitched a variety of impressive technologies. Not only were the technologies advanced, each presenter flowed through the information with grace and ease. They were engaging, educational, and effortless. For the future, I hope I can look at presentations not with a sense of dread, but see them as an opportunity to get more comfortable with public speaking. The entire event was a nice short break from the usual hustle and bustle of hospital wards.

Liseth and I are continuing to make our way all over Queen Elizabeth. Most recently, we had observational days within the Moyo House and labor ward of the hospital. Moyo House serves as an extension of the Nutritional Rehabilitation Centre and specifically focuses on providing nutritional support to babies and children in need. Through talking with nurses, we learned that Moyo experiences similar lack of resources issues as some of the other pediatric wards of the hospital. One new problem we encountered was that 90% of the heaters within Moyo are not functional. Patients who are undernourished or malnourished are more prone to hypothermic body temperatures, so they were bundled and wrapped in many blankets in order to keep warm without functioning heaters. In the labor ward, we learned about the heavy workload of the midwives and doctors. With up to 28 patients a day needing to be monitored every hour, it is a very strenuous work environment. The midwives showed us that they must often monitor things like blood pressure and heart rate manually by counting beats per minute. I really enjoyed discussing these issues with the midwives because they were so open and receptive to our questions. They were not afraid to say what needed improvement, which was extremely helpful in gathering ideas for future engineering projects. Some midwives had their own ideas for new engineering devices that could substantially help their day-to-day work. From my observations so far, I think I need to spend more time doing some background research into hospital resource allocation for district and central hospitals in Malawi. Scarcity of resources is a common trend across all of the wards we have observed so far, and I would like to investigate further to find out more about how funds are distributed and what economic, political, or sociological factors play a role in contributing to this problem. I believe it is important to examine this from all sides, as global health problems often do not exist in a vacuum.

In other news, the Incubaby prototypes have arrived in Blantyre! (However, we recently discovered that the team is working on changing the name, so name TBD). So Liseth and I will begin our second assignment of conducting usability interviews with the device within the week. We have a set of detailed questions to ask nurses about the prototypes. The responses from nurses should really catch any areas for improvement for the team of engineers. It is our hope that this usability interview can be used for all future devices in order to address any human factors issues early in the design process. This will help ensure that all new technologies are actually appropriate for their designated clinical setting and will be implemented regularly for their intended purpose.

On Sunday, our group took a trip to Zomba for a short (but rigorous) hike around the Chawe mountain. We ventured to Ku Chawe in the Zomba Plateau and took a guided walk with beautiful scenery and cold waterfalls. I thoroughly enjoyed being surrounded by nature (we even saw baboons and monkeys swinging in the treetops!) and I was very proud that I only tripped once during the steep and rocky descent down the mountain.

Thanks for reading and I’ll check in again soon! See you next week!