What an adventure the past few days have been! I apologize for the delay in blogging – due to non-functioning internet over the weekend and a three-day bCPAP trip throughout Malawi (stay updated for a blog about traveling in the near future!) it has proven to be quite difficult to upload this post. However, I am now back in Blantyre (home sweet home with internet sweet internet) and would like to take the opportunity to write about some of the technologies that I saw last week while working at Queens.
bCPAP
The bCPAP is probably the most written about medical device on this blog. Developed by a senior design team in 2010, it is now being produced by 3rd stone design. In Chatinkha, the Queens nursery, four bCPAPs are currently up and running, and there are more in other wards in the hospital. While BTB is currently experiencing great success with the bCPAP – it has been shown to dramatically decrease mortality rates in infants at Queens – there is still a lot of work to be done. The device is currently being rolled out to district and regional hospitals in Malawi.
bCPAP
Oxygen Concentrators
Oxygen concentrators are crucial in the hospital, especially to the bCPAP project. When an infant is in respiratory distress, he or she will not be able to take in enough air to sufficiently supply oxygen throughout their body. This results in hypoxia, which can frequently lead to death. This problem is combatted by providing infants with a continuous flow of highly oxygenated air, thereby delivering more oxygen per breath. In the United States, hospitals store and use cylinders of oxygen to provide this supplementary air; however, in developing countries, commercially available cylinders of pressurized oxygen are not readily available. Oxygen concentrators take in atmospheric air, isolate the oxygen from the air, and output it in a concentrated stream containing over 80% of oxygen. As long as the concentrator remains functioning, this allows for a continuous supply of oxygen in the wards.
Oxygen Concentrator
Flow Splitters
Flow splitters are nifty little devices used to split the flow of oxygenated air when it is delivered from an oxygen concentrator. Oxygen concentrators can produce a maximum flow output of 10L/min, but neonates frequently need no more than 2L/min of air. This means that oxygen concentrators are frequently outputting 8L/min of oxygen that is not used. Flow splitters allow the 10L/min stream of air to be split into five 2L/min streams, thereby allowing more babies to receive oxygen. Unfortunately, flow splitters are expensive. While many can be found at QECH, many of the other smaller hospitals throughout Malawi do not have any flow splitters. For this reason, a design team at Rice worked on creating an inexpensive flow splitter for use in low resource settings. Hopefully we will be able to get feedback on the flow splitter from several smaller hospitals during our CPAP travels!
Flow splitter
Bilirubin-O-Meters
Bilirubin-o-meters are few and far between on the wards. From what I have been able to see, each ward has no more than one of these devices, and they are frequently circulated and loaned throughout the hospital. Bilirubin-o-meters are used to measure the amount of unconjugated bilirubin under the skin, thereby indicating if the individual is jaundiced. The meter functions through some type of spectroscopic means, though I am not entirely sure how. It is beneficial because the results are available instantaneously, allowing a doctor to monitor daily the levels of bilirubin to see if jaundice is improving or deteriorating. While these devices are available in limited quantity at Queens, they are expensive and require specialized charging stations and batteries. Frequently the charging stations are lost, rendering the devices useless until new stations or batteries can be brought to the hospital. Additionally, from what I have seen throughout my travels this week, the meter is not available at any of the smaller hospitals throughout the country. For her senior design project, Jacinta worked on a point of care bilirubin diagnostic test – hopefully we can gain feedback on her device this trip, eventually providing low resource hospitals with a less expensive way to monitor jaundiced infants.
Bilirubin-o-meter
Phototherapy Lights
As I have mentioned in previous blogs, phototherapy is an effective way to treat neonatal jaundice. The blue light breaks up excess unconjugated bilirubin under the skin, allowing it to be excreted from the body. Several years ago, students at Rice developed inexpensive phototherapy lights, several of which are currently being used at Queens. Excitingly, several electrical engineers at POLY used the design developed by Rice, gave it several modifications, and have manufactured several of these devices at the university. Last week, Jacinta, Caleb, and I worked with Rodwell, one of the engineers behind the modified phototherapy lights, to brainstorm ideas for a mobile stand for these lights, and we hope to be able to create a prototype stand before we leave. Additionally, Rodwell plans to give the new photherapy lights to Queens. Providing Malawians with the tools build medical devices for Malawi is significant, as it shows that we are doing more than donating supplies. Rather, we are creating an infrastructure for device development that is sustainable in the long run.
Jacinta examining the inside of the new phototherapy lights
That’s all for now…
While this list of devices was certainly not exhaustive, I hope it gave you a picture of some of the basic technologies that are used in the pediatric wards. Hopefully I will be able to learn about even more medical devices in the upcoming weeks, sharing about them via this blog as I go.
As a parting note, we climbed a mountain this past weekend! Mount Sochi is one of three mountains surrounding Blantyre. We took a taxi to the base of the mountain and stopped in a nearby town to ask for directions to the top. Our presence caused quite a stir among the children in the town, and 3 kids followed us up all the way to the peak! The hike was definitely more challenging than we expected, but the view and new friends were well worth it.
Aakash and our hiking companions
Emily and the view of Blantyre