The past couple days have again been consumed mostly with data collection, but they have nonetheless been very interesting. There is a particular issue in the collection of CPAP data which makes it very important for the team to be very organized and meticulous in its’ collection. The target patient base for the CPAP is neonates and infants whose trouble in respiration is fatally dangerous. The sickest babies need the help of the CPAP the most. Therefore, the ratio of mortalities on the CPAP to the total number of patients put on the device is much higher than any other respiratory therapy such as oxygen. At a glance, this seems to reflect that the CPAP is not as successful as other interventions in saving lives. That is a misguided conclusion because the babies who receive the CPAP treatment would have very slim chances of survival without the treatment. Therefore, by contrasting the babies on CPAP to those equally sick who are not on CPAP, we can start to get a better idea of the efficacy of the device.

But opening the door for that kind of comparison raises many more strong ethical issues. When treatment is available, it is highly unethical to abstain from treating so as to have a control group with which to compare. The intention of the CPAP project is to provide treatment to the neonates that need it most, not just to some of them so that the device’s abilities can be proven. It would be against the entire goal of the study to try to do a test that would jeopardize the health of an infant. Therefore, the method assumed for the CPAP study is to observe the use of CPAP machines and their affect on mortality in the wards over time. With this approach, the data collected by the CPAP project must be carefully interpreted and it’s significance completely understood for us to comprehend the information we are seeking.

Along with the CPAP data collection, I have had the opportunity this week of introducing myself to more of the technical side of the internship. Caleb and Jacinta showed me PAM and let me observe as they tried to diagnose a broken suction pump. I performed a minor repair of a CPAP today with the help of some repair instruction documents. Jacinta invited me to shadow one of the days that she and Caleb are teaching classes at the Poly, which would be a good opportunity for me to become more familiar with some of the medical technology around QECH. They also said they would help me become more familiar with some of the basic repairs they have seen for CPAPs and oxygen concentrators, which would be useful for me to know when a broken device is brought to the office and none of the other interns are around.

 Becky, Caleb and Jacinta in the office.

Along with busy days in the office, the other interns and myself had a fairly busy weekend. We made an overnight trip north to Liwonde, where we did a boat trip and a game drive to see some wildlife. We saw a lot of hippos, elephants, water buffalo, impala and warthogs, along with a lot of very beautiful vibrantly colored birds. It was good for all of us to see a new part of the country and have a reminder that we are staying in a place that is different from home in more ways than one. I was also reminded that even a country as small as Malawi contains a myriad of different cultures. It is insufficient to try to draw a picture of one experience in Blantyre, or Malawi, or Africa, because there is no way to capture the poverty as well as the wealth, the urban and the rural, or the traditional and the western. I am not visiting the Africa that my family, my friends, the internet, or my own imagination had fabricated for me. Our trip to Liwonde just highlighted another piece of the puzzle of this continent which made me more aware of the magnitude of the puzzle itself.

 A Liwonde sunset

 Caleb, Aakash, Jacinta and Carissa on the Safari boat in Liwonde