With the dosing meter nearly completed, the seven of us have started to look forward into what projects to tackle next. There are so many opportunities for ways to spend the next seven weeks, and a lot of different interests. We have a variety of ideas for new design projects, and if we spent the next eight weeks doing them we could probably finish at least a few first generation prototypes. However, we also have some ideas more related to Poly-Rice relations or the new bioengineering program, and if we jump start some of these we may have to be a little more selective with how we spend our time.

One of the design projects we are most interested in is a thermoregulator for babies at home. Neonates tend to have trouble regulating temperature, and it is not uncommon for infants to suffer hypothermia at home, especially in the winter. We were given the idea of building a feedback system that could monitor a baby’s temperature and set off a beeper if hypothermia is reached. The device would be wrapped around the infant before going to bed, so if the mother or father is asleep when the baby gets cold the would be awoken. Because it would be intended for home use, this device would have to be very inexpensive and made largely of local materials.

Another idea we had was some sort of addition to the suction pump machine used in the nursery that would prevent some of the common breaks in the device that put it out of use. The suction pumps are used to drain excess fluid from the patent’s lungs and throat. Right now, the use of a suction pump requires constant monitoring by a nurse or clinician to turn the pump off when the waste containers fill up. If the pump is neglected, it will overflow and fluid can get into mechanical or electrical parts of the machine, clogging the system and damaging important components. The Poly interns and Sarah, Catherine and I have started talking about some sort of addition to the pump that would stop suction when the waste containers are full. We have discussed both electric and mechanical mechanisms that would provide this function, but we haven’t set any of our plans in stone yet.

One of our biggest objectives for this internship is to collaborate on design projects with the Poly students, and the consensus is definitely still in favor of pursuing at least one more design. However, as the first BTB students to pilot this kind of internship that works directly and fully with the Poly, Sarah, Catherine and I also want to find a way to give the Poly something sustainable that would enhance some facet of their engineering program. The bioengineering orientation week we are helping to plan is an example of this; we are contributing something to the bioengineering program that uses our specific skills and that could be continued after we leave. We’ve also had thoughts about creating some kind of forum for communication between Rice students and Poly students, or helping build more connections for the Poly to Queens Hospital and other members of the Blantyre community, so that their new bioengineering program has a local network to work with and build off of. All of these ideas are still in the works, and we’re trying to sort out our priorities and strongest interests.

Personally, I have two main objectives that I want to pursue in choosing our next project. Of course, one of the most important things to keep in mind is how to choose projects that are guaranteed to be sustainable. If our designs cannot be improved and tested, or if our other projects are never used by Rice or the Poly, it defeats the purpose of why we’re here. We have all talked about ways to ensure that the projects we’re picking up have some kind of lasting impact on our schools or the greater community.

The other thing that I have been thinking a lot about is how to make our project unique to our internship. A lot of the design projects we have are really interesting, but there’s no reason for other students in BTB or at the Poly shouldn’t work on them later, back at the OEDK or here but without the American student’s help. I’m sure it would help the fledgling bioengineering program here to start making connections with PAM and fortifying their relationship with Queens, but I also feel that those are goals that are already being pursued by Poly faculty with BTB’s help. Some things like a website to facilitate communication between Rice and Poly design teams, or a design project that involves a replacement part to an already existent device that breaks often would be tasks that benefit from the Rice-Poly team that we have right now. I would like to think that our team dynamic and the way we were able to work together on the dosing meter would provide a unique asset to some of our ideas in a way that will be hard to replicate until next year’s interns fly out. I know that we will be keeping these thoughts in mind as we pick our new projects, and I’m really looking forward to seeing what we decide.

Yesterday, we had the opportunity to meet with an employee at PAM, the Physical Asset Management team. The seven employees at PAM have the difficult and important job of maintaining all machines and devices at Queen Elizabeth Central Hospital, as well as multiple other hospitals in Malawi; Catherine goes into more depth about the facts of PAM in her blog if you’re interested! Joseph, the PAM employee who we met with, graciously spent two hours of his afternoon giving us a tour around PAM, answering our numerous questions, describing the specific problems each device faced, and discussing the challenges that the department deals with.

PAM is housed in what looks like a warehouse, where broken medical devices line shelves and the floor. The machines range from suction pumps used in intensive care units, to incubators used in neonatal care wards, to surgical platforms, to CT scanners, to adult ventilators, to theatre lights—any medical device used in any of the seven hospitals PAM services is fair game to be sent to Blantyre, where these few employees must troubleshoot the malfunctioning device. This job description alone is daunting, however the technical expertise required is probably one of the lesser challenges PAM faces. Sometimes, the devices delivered to PAM cannot be fixed, but not because the employees don’t how to fix the machine—usually, they do. Instead, the obstacles standing in the way often fall into one of the following categories:

• Lack of Specific Parts. Many of the complex medical devices require very specific parts, often produced only by the original manufacturer, in order to function. When a device is broken due to a bum part—a blown electrical component, a worn out filter, a lost valve, a bent heating component—the first inclination is to replace that part with the same exact piece; this would ensure proper functionality. However, most of these components are absurdly expensive; we recently fixed a jaundice meter that wasn’t charging, and the original manufacturer was going to charge $1000 for replacement batteries, in addition to who knows how much more for troubleshooting the charging station. Due to this impracticality, alternative cheap components can sometimes be bought as replacements. While this works for some devices, for many others it will not. Sometimes, machines have control systems that disallow function if official components are not used; other times, the cheaper parts can damage the machine to a greater degree, or the cheap replacement components themselves break shortly after being implemented; in other cases, cheaper alternatives cannot be found due to the intricacy of a part. To add another layer of complexity, there is little consistency in the brand of device that various wards use. Many of the devices were either donations or not bought in bulk, so there can be multiple different brands of the same device even within QECH. In PAM, we probably saw upwards of 8 different types of oxygen concentrators. The part needed to repair this concentrator, then, also cannot be bought in bulk nor kept on hand. All of this results in many of the broken devices that arrive at PAM staying broken, as the materials are not available / the funding is not existent to make the repairs that the employees know need to happen.

• Lack of Consumables. Increased use of consumables (device components that are frequently replaced, such as needles, syringes, etc.) often decrease the likelihood of a medical device being successful in low-resource settings. There’s a significant portion of devices at PAM that are most likely in working order, but the hospital doesn’t have the funding to supply the needed consumable to make the device useful. This is often an issue with donated devices. QECH receives many donated medical machines from various sources, but if the devices aren’t given with an adequate supply of consumables, the machines can’t be used as intended.

• Lack of Testing Equipment. Crucial to the process of fixing a broken device is the ability to test the device’s functionality. This was a problem that I hadn’t really considered before, but as we walked around PAM it became apparent how big an obstacle it created. For broken ventilators, a volume meter and a flow meter are needed to ensure the fixed device is truly delivering the amount of air it claims to be supplying; for broken phototherapy lights, a meter is needed to test the light intensity; sensitive temperature monitors are needed to fix incubators. However, it’s not feasible to buy and maintain testing equipment for each medical device that also needs to be bought and maintained. Without the proper testing equipment, many machines’ problems cannot be fully understood, while some fixed machines cannot be safely returned to the wards without first being tested.

• Lack of Preventative Maintenance. Many of the medical devices require routine maintenance, from general cleaning, to replacing filters, to checking water levels and valves. Some of these practices can be completed by nurses in the wards, however this requires training. Other more complex preventative maintenance practices require a PAM engineer to visit the hospitals on an ideally quarterly basis. Since the majority of hospitals that PAM services are a long drive away, both training and in-person maintenance require fuel and lodging, which requires funding, which is already limited; in order to conduct this maintenance, funding must be allocated away from other crucial resources the hospital needs.

Touring PAM and learning about these obstacles was helpful in many ways. For one, it inspired design ideas that we will pursue in the remaining portion of our internship. We like the idea of taking an engineering based project needed by PAM and developing it with local materials, as the resulting device has a greater likelihood of being sustained over a brand new design project that we come up with on our own. We also can use PAM throughout the design process to gain feedback quickly, improving our chances of developing a successful device.

The trip to PAM was also an eye-opening peek into the varied and layered challenges that hospitals in low-resource settings face; the example challenges I’ve listed in this blog only scratch the surface of what the hospital must work through. As a student who hopes to enter the medical technology field in my future, there are hundreds of lessons to be learned about appropriate design through talking to and observing the processes at PAM. Design constraints extend into the complexity and rarity of the components chosen to construct the device, and consumable supply-chain problems can completely halt the use of a machine. If a device needs to be tested, the price and availability of the testing mechanism needs to be taken into account, as does the required maintenance. This first trip to PAM showed us how frustrating it can be to work with biomedical machines in this context, but it also inspired ideas about problems we can possibly solve as well as how to better design technologies in our future.

I think it’s about time that I mention a book that really shaped my perspectives about development and innovation in Malawi coming into this internship. It’s called The Bright Continent by Dayo Olopade, and it focuses on development efforts in Africa as led by African entrepreneurs, innovators, and visionaries. Central to the book is the idea of kanju, a Yoruba word that meaning “hustle” or “make do”. Olopade uses it to refer to the “specific creativity born from African difficulty” that can be characterized by “recycling, resilience, and… irreverence”. Kanju describes everything from Nigerian email scams to a South African cervical cancer clinic running out of shipping containers. Emily (who is also obsessed with the book) and I often geek out about the concept of kanju (to the point of annoyance for all the other interns, I’m sure) and how we see it playing out in our respective experiences at the Polytechnic Institute and QECH. So I thought I would take this opportunity to talk more about the instances of kanju I’ve noticed and how useful it can be to engineering and innovation.

Kanju Skills
The first evidence of kanju I noticed came from my interactions with our Malawian interns at the Polytechnic Institute. Francis, Charles, Christina, and Andrew are all incredibly talented engineers who have both book smarts and a natural aptitude for building, improving, and redesigning technologies. The day I first met them, we were coming to them to ask for help on the circuitry of the IncuBaby device because we knew that three of them were electrical engineers. The moment they set eyes on the circuitry, they immediately jumped into action and had rewired the device into working condition within 30 minutes, something that Karen and I struggled with for weeks even though we had the help of some experienced engineers.Even when one of the main electronic parts in the device broke down, the Poly students were able to find a way to continue testing the circuit by using a simple LED as an indicator for whether the device was functioning correctly. It’s these kinds of skills that go beyond theoretical classroom knowledge. Their talent is something born of interacting with machines hands-on–putting them together and breaking them down to understand how they work. It’s also this kind of talent that can lead to out-of-the box innovations that have kanju written all over them.

Kanju in Practice

Where the Poly Interns demonstrate a more refined engineering-based form of kanju, the quick fixes and adaptations found in the wards around Queens showcase an unpolished version of kanju that is a response to scarcity and necessity. In practice, it seems that the kanju in QECH revolves around gauze. Gauze, perhaps because it is so readily available, is used for everything from holding patient records together to hanging Rice 360 bilirubin lights over a crib with the help of a wooden stick (as shown in the picture above). In the spirit of using what’s available, it’s also interesting to note how different each ward is in terms of how they organize their supplies and dispose of things like syringes and gloves. In the Paeds Nursery, empty beds don’t just take up space. Instead, they are used to store tubing and other necessary materials. Meanwhile, nonsterile trash is placed in plastic buckets (labeled “Dirty Prongs and Other Tubes”) which are easy to access and more convenient to clean.Another good example is a wheelchair that was constructed out of a white plastic chair mounted on wheels. There are countless other instances like these all around QECH. Not all of these practices are ideal, but they are all prime examples of making do with what’s available. They also give important clues about what will and won’t be useful at Queens. Designing technologies that don’t account for the scarcity of resources or don’t fit into the realities of daily practice in the wards will be a waste of time and effort.

Kanju Innovation

The interns this year are hoping to channel the kanju spirit in order to establish new means for innovation and education for engineers at the Polytechnic. Physical Assets Management (PAM) is a department housed at Queens that maintains the medical equipment at hospitals across Malawi. They are currently a graveyard for broken equipment that can’t be fixed for lack of appropriate parts and adequate budget. The picture to the left shows one of PAM’s many shelves of machines awaiting repair. We hope to create a collaboration between the new Biomedical Engineering program at the Polytechnic Institute and PAM so that engineering students have a chance to do hands-on engineering work with the broken machines at PAM and PAM has a chance to benefit from the innovative ideas of these students. Though the idea is still in development, we hope it can be a mutually beneficial arrangement that utilizes kanju to create a sustainable cycle of problem-finding and solution-engineering between PAM and the Poly.

 

[P.S. As a more fun example of kanju, here’s a picture of our wonderful CPAP Data Officer, Vanessa, opening a Coke bottle for me on a doorframe!]

 

At 7:30 each morning, the doctors, clinical officers, and nursing staff of St. Gabriel’s gathers in a conference room. What follows is a ritual known as the morning meeting. The hospital director does a roll call of each department (1), and the night shift representative for each ward methodically goes through the number of admissions, tuberculosis patients, deaths, totals, and any interesting patients. At one morning meeting last week, a representative from the Labor Ward reported that a child had died. A terrible hush fell over the room, and after what felt like an eternity, Dr. Mbeya halted the normal progression of the meeting. He told our somber group that in Labor Ward, above all other places in the hospital, there was no time to waste.

That’s the only time I’ve sensed such palpable tension in the morning meeting. And while it’s a jarring reminder that we’re working in a part of the world where the neonatal mortality rate sits around 25 deaths per 1000 live births (2), where 71 of those 1000 children will die before their 1^st birthday (3), I promised that this post would be on an uplifting and interesting topic. And I truly do think that the fuss caused by the loss of a neonate is an indication of St. Gabe’s terrific track record in that department. According to Dr. Mbeya, last year somewhere around 80 neonates died at St. Gabriel’s- I don’t have the official stats for you, but considering that the majority of admissions appear to be pregnancy-related, that’s pretty incredible. In light of this superior performance, to the staff of St. Gabe’s the loss of a single child remains as what it should be- a big deal.

To examine the roots of St. Gabe’s success in improving maternal and neonatal outcomes is to look at their preventative programs. Now, I’m a huge public health nerd (4), so in my eyes, these are some of the most important services that the hospital can offer. If incidence rates and theories of health behavior don’t tickle your fancy, I invite you to take another look at the numbers in the paragraph above. Even if you don’t appreciate the minutiae of public health programs, you’ve got to acknowledge their efficacy.

St. Gabe’s does a lot to ensure the health of the developing child long before delivery. The hospital’s antenatal clinic is a popular outpatient program where expectant mothers can come to monitor their pregnancy and learn more about how to ensure that their baby is born as healthy as possible. Nurses monitor weight gain, blood pressure, and general health of each mother, as often as every week if the women wish to come. Perhaps even more importantly, St. Gabe’s brings these services to even the most remote of villages. The hospital’s catchment region encompasses a significant portion of the Central Region district of Lilongwe, a large segment of which includes rural villages with limited transportation access. Even if an expectant mother can find a bike taxi or minibus to take her to the hospital, she still has to pay for it, a reality that makes weekly checkups at St. Gabe’s virtually impossible for the most impoverished families. In response to this problem, the hospital sends teams of health care workers to provide antenatal care remotely, increasing program compliance by taking away the hassle and financial barriers associated with commuting to the hospital.

 

Another service that has become overwhelmingly popular at St. Gabe’s is a shelter for expectant women. Starting in their 8^th month of pregnancy, a woman can come from anywhere and stay next door to the hospital. The shelter sits adjacent to the Guardian’s Shelter, a place for family members to prepare food and wash clothing for patients. These women have weekly visits to St. Gabe’s antenatal clinic, as well as ready access to clean water, well-ventilated kitchen facilities, and a warm bed. If they should encounter any complications with pre-term labor or preeclampsia, they can receive medical attention almost immediately. And when the time comes to deliver, they are minutes away- no long walks or difficult bike rides involved!

 

On a related note, the Malawian government is making sincere efforts to reduce maternal mortality rates (5). In order to do so, the government has promised to pay for deliveries, making births in a hospital financially viable for women who previously might have faced unsafe delivery in their villages. (6)

What’s really unique is that St. Gabe’s commitment to infant health doesn’t stop with delivery. Their programs for malnourished children under 5 are especially comprehensive, with inpatient services, distribution of nutritionally enhanced peanut butter and meal (7), frequent measurements, and parental education. One day, as Nkechi and I were walking back from the Guardian’s Shelter, we saw a large fenced-in garden on the hospital periphery. Curious, we asked about it, and found out that the hospital actually uses the garden to show families that nutritionally sound food choices can fit into their lifestyle! The plot was modest enough, but filled with different fruits and vegetables that can be grown locally with minimal effort. The message came across loud and clear: a family can get adequate nutrition for their children, even if they are of modest means or live in a rural area!

 

There are plenty of other public health initiatives that I’ve caught wind of in the past week, and I could write for days on all of them! But you’re in luck, because I decided a) to spare you the comprehensive catalog of my nerdvana and b) hopefully make a point about a thread that is carefully woven through the heart of one of the hospital’s biggest sectors. My experiences over these past few weeks have taught me that St. Gabriel’s has made a serious commitment to continually improving treatment for both mothers and their children. Based on the programs I’ve described and the people who stand behind them, I am convinced that clinicians here not only engage in these practices, but believe in them, continuing to set the  standard of care higher and higher.

(1).  Paediatrics, Surgical, Male, Female, Private, Palliative Care, Labor, and Maternity. I’m probably forgetting a few..

(2). From the WHO ‘s 2012 Neonatal and Child Health Profile of Malawi

(3). That ranks Malawi at 174 out of 187 countries based on the UN’s Human Development Index.

From: http://hdr.undp.org/en/content/under-five-mortality-rate-1000-live-births

(4). One of the few, the proud, no doubt.

(5). THIS ARTICLE IS INCREDIBLE IF YOU LOOK AT NOTHING ELSE FROM THIS POST READ THIS!!! http://www.un.org/africarenewal/magazine/january-2010/save-lives-mothers-infants

(6). http://www.bbc.com/news/health-29228448

(7). This would be an example of the kind of nutritional supplementation used: http://www.huffingtonpost.com/meimei-fox/the-life-out-loud-a-peanu_b_3526957.html

One of the really neat things about this internship actually comes from Sarah, Emily, and Catherine’s internship at the Polytechnic University of Malawi(affectionately known as the Poly), which is right next door to the hospital. The Poly is starting a biomedical engineering program in the fall, and Sarah, Emily, and Catherine are collaborating with current faculty and students there this summer to work on ideas for design project ideas and prototyping frameworks for the new curriculum. (Check out their blogs linked above if you’re interested in more of their day-to-day work!)

It’s been great working in Queens and getting to know the staff members, nurses, and clinicians here, but the collaboration with the Poly gives all five of us from Rice a unique chance to better understand and experience Malawi from the perspective of college-aged students living in Blantyre. Christina, Andrew, Charles, and Francis are all rising fifth-year engineering students in mechanical and electrical engineering. This opportunity for cultural exchange has been so helpful for learning more about Malawian life on several levels.

Last week, we had them all over to our house to do an American-Malawian exchange meal, and the menu was quite extensive! On the Malawian side, it included nsima, the staple starch here; a mixed vegetable dish of fresh tomatoes and rape greens; green beans cooked with carrots and tomatoes; and of course, Nali, a Malawian hot sauce also known as “Africa’s hottest peri-peri sauce”. On the American side, it included peanut-butter (and/or Nutella) banana pancakes with baked apples and cinnamon. We might have been a bit ambitious on the amount of dishes, but between the nine of us, there wasn’t much left at the end of the night!

But the exchange goes much further beyond just a meal shared here or there- the exchange of ideas and engineering expertise has been incredibly fruitful as well. For example, Tanya and I prepared the Incubaby project prior to leaving Houston, but our electronic components weren’t performing the way we wanted them to by the time we departed. However, after just one afternoon at the Poly, Christina, Andrew, Charles, Francis, and Sarah were able to make great progress with the troubleshooting. And not only did they have great technical expertise in helping us with the electronic components, but they had thoughtful feedback on how realistic the design and materials would be for use in Malawian hospitals.

Perhaps what is most exciting about the energy and enthusiasm of the Poly students is the potential for a longer-term collaboration with Queens in which students can contribute their engineering experience to hospital technology development and maintenance while gaining valuable practical experience outside of the classroom. There is a department at Queens called Physical Assets Management (PAM) that deals with repairing and maintaining all hospital equipment at Queens and at 6 surrounding district hospitals. The nine of us actually have a meeting set up with PAM later today, so we’re really looking forward to exploring the potential of a more involved PAM-Poly relationship in the near future. I’ll be sure and give an update on how the meeting goes in a later post!

This past week, we were able to spend a good amount of time getting to know our way around the maternity ward and the delivery suite at Queens, and in doing so, I gained a bit more insight into the intricacies of the Malawian healthcare system at large.

The nurse’s station in the Delivery Suite.

One of the technologies in development at Rice, AutoSyP, is preparing to start clinical trials in July. AutoSyP is an infusion pump that can deliver medications to a patient at a constant flow rate over an extended period of time. Infusion pumps not only improve accuracy and consistency of flow but also relieve overworked nurses from having to be available to administer a medication for the entire duration of the treatment.

One of the two infusion pumps currently available in the High Dependency Unit of the Delivery Suite.

In order to prepare the clinical trial protocol, it’s important to understand how nurses currently administer medications that must be delivered to the patient over a specific time period of several minutes or hours. One example of a procedure that fits this description is magnesium sulfate (MgSO4) delivery to pre-eclamptic or eclamptic expectant mothers in the maternity ward. Pre-eclampsia is a characterized by swelling, high blood pressure, and protein in the urine, leading to a high risk of seizures during labor and delivery and placing both mother and child in danger. However, MgSO4 acts to stabilize the mother, and it must be administered constantly from the time the condition is identified to 6 hours after delivery. The goal is therefore to understand how nurses currently manage MgSO4 administration and to create a protocol that integrates as easily as possible into the existing system.

Through these observations and conversations with nurses and physicians, I learned a few things about the Malawian healthcare system in the process:

The reality of a procedure is often different from the textbook description of a procedure. We had read about the two different types of MgSO4 administration techniques, one of which uses an IV drip and one of which uses intramuscular injections, but when we went in to observe the procedure, what we found was a mix of the two techniques. Limited supplies meant 60mL syringes were scarce and infusion pumps were often unavailable. Therefore, while the loading dose was administered by a nurse through an IV (this takes only 10-15 minutes of flow rate control), the maintenance dose had to be administered intramuscularly every four hours. An IV drip of the maintenance dose would have required constant flow control, and without a nurse continuously at the bedside, this control is not possible.

An example of some of the syringes available to nurses.

There are often variations in methods for a procedure across the nursing staff. It is often hard to locate the references for these textbook procedures, and it becomes even harder to locate a protocol when the reality of the treatment is a blend of multiple techniques. There was an official reference on the procedure that was located after about 10 minutes of flipping through a book in the main office of the delivery suite, but there were limited resources for nurses on the floor of the ward itself, so many times the procedure could look significantly different depending on which nurse was administering the treatment.

Policy decisions can sometimes prioritize ease of care over patient comfort. One of the main reasons nurses were using a mix of these two protocols was actually due to something far beyond their control, and one of the obstetricians explained this reason to us. In 2014, Malawi held its first tripartite elections to vote for local government, members of parliament, and the president in one single election. Peter Mutharika won the election over the incumbent Joyce Banda, and this shift in presidential administration was felt across government ministries – particularly the Ministry of Health. Specifically, political affiliations with pharmaceutical companies led to changes in the way that the government procured MgSO4: The concentrations changed from 1g MgSO4 diluted in 2mL to 2g MgSO4 in 10mL. Now, instead of receiving intramuscular injections of 10mL, patients must receive 2.5 times that, 25mL, in order to have a full maintenance dose. Imagine being injected with 25mL of fluid every four hours- that’s a large amount that causes patients extreme discomfort and soreness. However, because it’s easier for the government to procure and intramuscular injections are faster for nurses to administer, it becomes standard of care for MgSO4 administration.

One of the MgSO4 vials used in a maintenance dose. A full maintenance dose would be 2.5 of these vials.

It takes significant time and effort to shift a system towards a new method, but if implemented well, AutoSyP could not only simplify a day to day task for nurses but also lead to more customized, comfortably delivered care for mothers. Observing the system surrounding this aspect of maternity care allowed me to see how both hospital procedures on a micro-level and policy procedures on a macro-level can directly impact patient care. Providing nurses with a viable alternative that integrates into their routine would benefit both parties, so I’m excited to see how AutoSyP is received next month!

A view of the Polytechnic with Mt. Soche in the background.

This past week was very busy, as the other interns and myself have started settling in and getting to work on our projects. The project of the week that took the most of our time was the bilirubin dosing meter, which measures the amount of blue light given to a patient with jaundice. Most jaundiced patients are neonatal and tend to be in a fairly fragile state, so delivering the right amount of light is necessary to ensure the baby is being adequately treated without any risk of over-exposure. 

The prototype we are building is inspired by a few designs that have proliferated the global health domain. Students in last year’s GLHT 360 course had created a design based off of a design from Engineering World Health, which included a solar cell and an analog ammeter to give dosage information. A design by students at the Poly used an Arduino to display light intensity on an LCD screen, and measurements were taken with a photo-dependent resistor. It was our job to come up with a prototype based off of those that already existed that was cheap, accurate, and easy to use by healthcare workers.

Some of the decisions made in our new design were fairly easy; we chose an Arduino and digital display like the Poly’s prototype because of the inaccuracies of an analog reading, and we decided a solar cell because they had a wider resolution and were cheaper than alternatives. Other decisions though, like the shape of the device or how to ensure optimal placement, required more deliberation and creativity. It was these decisions through which our team dynamic and the diversity in our way of thinking shone through. I brought Catherine, Christina, Charles and Andrew to meet some of my acquaintances in Chathinka so we could get from them some feedback on how they normally deliver blue light therapy in the nursery, and whether they would prefer a single device containing sensor and display or whether it would be optimal to separate the two to have a display component attached to a sensor probe. This kind of feedback was so valuable because it directed our design decisions; although we had many ideas on what nurses and doctors may like best about different designs, we couldn’t really know the answer to any of our usability questions without asking the potential users themselves. 

Another area that offered us some creativity in this domain was deciding how to ensure the healthcare worker was positioning the device properly. The photocell is very sensitive to minute changes in angle and positioning under the blue light. It is essential for healthcare workers to be able to easily place the device under the blue light while keeping the solar cell parallel to the ground and as close to the patient as possible. 

After some brainstorming, the team decided the best way to ensure parallel angling was to include mechanical levels on the surface of the device, like those you would use to would use to hang a picture on a wall. Thinking about how to best ensure that the sensor was placed close to the patient sent us back to the drawing board for design of the device housing. Because of the addition of the mechanical levels, the idea of a probe attaching to a display was discarded. We went through a few iterations before deciding on a design that would be an elongated rectangle, with the sensor on one end and the display on the other. The length of the box allows us to keep the width fairly thin while still housing all the components, and it also gives the nurse or doctor a good view of the display while keeping the sensor close to the patient.

I really enjoyed working on the photo dosing meter with the group because it taught me so much about designing in the context of user needs, and because the creative outlets in the design process gave me insight about our team dynamic. The seven of us are very diverse, in nationality but also in engineering background and in the way we think. I thought it was very interesting to see how our differences played into the way we approached the design, and then from there to get to build our ideas and turn out an actual device that could serve a clinical purpose. I am really looking forward to the other projects we will start to now pick up.