This week has been pretty busy, so I haven’t had as much time in the wards as I have previously. I have gotten to spend time in the nurseries a couple times, which is something I particularly enjoy. I don’t think I had ever spent a lot of time around babies only days or weeks old before this job. The babies are so small. Their entire hands are no bigger than my thumb, and their rib cages are dwarfed by the width of my wrist. There is rarely a lot of crying in the nurseries, and most of the time the babies are either feeding or sleeping. Last week one of the nurses in the Paeds ward had me help to change one of the babies into a clean onesie, with the permission of the mother. I was scared to death that I would hurt her just by moving her arms or unfastening buttons. The onesie we put on her practically swallowed her whole. It’s hard to believe that any human being could ever be that small. I can now understand even better the importance of technology to help babies in their first few weeks or months of life, when they are so fragile and even the most innocent things can be dangerous.
A CPAP baby in Chatinkha
Yesterday I had the opportunity to do a little bit of traveling to collect some CPAP data from other hospitals. I saw two new hospitals; the central hospital in Zomba, which rivals QECH in it’s size and capacity, and then the small district hospital in Machinga. Machinga was a stark contrast to the other two. Zomba has about 40 patients a month in it’s nursery ward, which is a comparable number to QECH’s two nurseries combined. They have multiple CPAPS that are up and running, and a lot of nurses trained on CPAP use that know how to care for a patient using the machine. Like QECH, the hospital in Zomba gets a lot of referrals of very sick children from other hospitals, and they have more resources for special care available than most hospitals in Malawi. Machinga’s nursery ward had six patients when I visited. They had one CPAP which was not in use and they hadn’t had a patient that needed CPAP in weeks. The small size of the hospital makes it more difficult to maintain the use of the CPAP. When babies that need it come in so infrequently, the nurses don’t have a lot of opportunities to practice their CPAP skills or impart them to new staff. If they can’t practice, the CPAP can be misused and even cause harm to the baby. If a technology that acts as such a lifeline for a patient isn’t used properly, it’s no better than not having the technology at all. The CPAP team has been trying to help Machinga out with keeping up on CPAP use and training, and making sure they have the support they need.
Today Becky was telling Aakash and me about an interesting problem that came up in the Paeds nursery which reminded me of the problems that Machinga was encountering with the CPAP. The nursery just got a very large donation of thermometers, which is something they desperately needed. Unfortunately the thermometers are in Fahrenheit, instead of Centigrade. The nurses don’t know the conversion, so Becky spent most of her morning helping read temperatures and diagnose fevers. While Paeds was lucky to have Becky around to help, this issue highlights an epidemic that has infected Queens as well as a lot of other hospitals in this country.
The people who donated the thermometers had good intentions. They had the determination to get the thermometers all the way to Queens from wherever they were donated, which is a feat in itself; transportation is very expensive and difficult to oversee from afar. But after all of that hard work to get them here, the thermometers are so limited in their use to the hospital. It’s the same way with a lot of donated devices from America; Malawi uses British outlets, so anything with an American or other European plug needs a converter, which is something in short supply. You cannot find fault in the efforts from those who donate supplies, but a device that people here cannot use or don’t understand is not going to make much of a difference. From my perspective, this is the biggest obstacle right now in international efforts to contribute materials-based aid to places like Malawi. If there was a better way to communicate the needs and resources that already exist in the recipient site, than maybe the contributions of the donor site could go a little farther.
The issue with the thermometers made me think about some of the work I did at home with Project Cure. Project Cure is an organization that collects and delivers donated medical supplies to low-income clinical settings around the world- including parts of Malawi. They stress the fact that they are non-political and non-profit; the work that they do is towards the one goal of getting medical supplies to those that need them most. The delivery method that they use is a multi-step process; first, they visit the site which will be receiving the supplies to do an inventory and decide exactly the site needs. Then once they get those supplies from their warehouse they hand-deliver the supplies to the same site. That way they know that the materials they contribute are needed, can be put to use, and are getting to the right people. I don’t know a lot about how much Project Cure works with medical technology, or what the problems are that they encounter in the distribution process, but I think that the deliberation that they use in their practices has resulted in a lot of good. The thermometers and CPAP problems that I have seen here have emphasized the importance of that kind of deliberation.