Sorry it took me so long to upload a blog! It turns out that the internet company here has a limit to how many gigabytes you can use. I didn’t realize this and burned through mine in 2 days. Needless to say we purchased unlimited internet when we went to Lilongwe this weekend. So be prepared for very frequent pre-prepared blog posts for the next couple of days!
I can’t believe that Renata and I (and all the other interns) are finally here in Malawi!!! It’s been a crazy first week here. After two solid days of international flights, we landed in Kamuzu International Airport, were we were graciously greeted by one of the hospital workers who drove us 45 minutes from the international airport to the village of Namitando, where St. Gabriels Hospital is.
We are currently staying at the Zitha house which is fully stock
ed with a complete kitchen, en suite bathrooms, and a television for watching Nigerian soap operas, which are my favorite.
Me at the Zitha House. Not gonna lie, I get mistaken for a Malawian pretty often. Also my pants are purple like an eggplant.
I’ve absolutely fallen in love with the village. From the friendly smiles in the hospital, to the casual Chichewa lessons with our housemates, and the friendly people in the market, the villagers here really embody the idea of Malawi being the “warm heart of Africa”.
What’s that you say? You didn’t know Malawi had a nickname? You didn’t know anything about Malawi?
*A Brief History of Malawi*
Malawi, formerly known as Nyasaland, is a landlocked country surronded by Zambia, Tanzania, and Mozambique. Its one of the smallest countries in Africa and is about 1/3 water. Initally settled in by migrating Bantu groups in the 10th century, the country was colonized by Great Britian in 1891. After going through several phases of government changes, Malawi became and independent country on July 6, 1964. Malawi is largely rural; agriculture makes up a substantial part of the economy. In addition, Malawi has a low life expectancy, high infant mortality rates, and high maternal deaths rates. (Side note: this is one of the reasons why what St. Gabe’s is doing in the community is so important). The currency is the Malawian Kwacha (1 USD= 440.00 MK) and the official language is English, but Chichewa is most widely spoken. This is especially true in Namiete, where many villagers speak absolutely no English. There is a pretty substantial tourism business for people looking to backpack, safari, climb mountains, or visit the amazing inland beaches. So come visit me!
*End History Lesson*
By far, what is sure to be the most meanigful part of our stay here is the time we spend in the hospital. Dr. Myeba, Alex, and Suave are such good mentors that I know that we will get a lot accomplished. This is going to be a great summer!!!
Renata: Well, we’ve just finished off our Friday work, meaning that Nkechi and I have spent exactly a week working at St. Gabriel’s.
You: Well golly gee, a week sure is a long time.
(this role may also be played by your 1950s children’s show counterpart in the unlikely event that you do not regularly use the phrase “golly gee”)
You: Surely you’re well on your way to saving St. Gabe’s, Namitando, Malawi, and all of Africa.
Renata: …
Okay, so I might have exaggerated your parts in this script just a little. At least I hope you know I’m hyperbolizing, because that would be the overstatement of the CENTURY! It’s just that, exaggerations aside, we’re taking dialogue from the wrong part of the script. What’s happening now is more like Act 1 of my work.
Don’t get me wrong; I’m very proud of the steps that we’ve taken towards achieving our objectives this week. Just this afternoon, I experienced the tremendous joy of fixing one of the functions in Morphine Tracker, a database that allows the hospital’s palliative and home-based care program to have an up-to-date record of how many patients are on this Schedule II controlled substance (1) (2) (check out interns Joao (3) and Jesal (4) ‘s blogs from last summer, which do a great job of explaining the importance of morphine records for palliative care in sub-Saharan Africa). My fix was a minor one, but to anyone who knows how truly awful I am at coding, it was just shy of a miracle. (This is the point where the BTB staff is probably cringing at the realization of my technological incompetence)
I made this happen! The graphs now update to provide quick information on morphine usage during a specified timeframe (monthly, quarterly, annually, or for a custom period)
I’m also really happy with how our tech surveys have gone so far. Earlier this week, we brought a respiratory rate timer and binary thermometer to the paediatric ward, where they were put the under intense scrutiny of the nursing staff and the patients’ mothers.
The respiratory rate timer is an electronic device that assists clinicians in diagnosing pneumonia, a major cause of morbidity and mortality among children under 5. Once diagnosed, the young patients can be continually monitored, receive antibiotics to treat the infection in the lungs, and can receive supplemental oxygen from one of St. Gabriel’s many O2 concentrators (more on this to come). What’s handy is that there’s a reliable predictor of pneumonia. If a child exhibits tachypnea (abnormally rapid breathing)(5), it indicates pneumonia with 50-85% sensitivity and 70-90% specificity (6). In other words, those are pretty good odds that the child is indeed sick with pneumonia.
But there’s a catch.
Making the diagnosis requires careful scrutiny and an accurate calculation of their breathing rate, which is much harder than walking and chewing gum at the same time (7). Think more along the lines of paying careful attention to minute risings and fallings of an infant’s rib cage, doing mental math, and keeping an eye on the clock.
That’s where the respiratory rate timer comes in, keeping track of breaths and making rate calculations for the heath care workers. Seeing the timer develop over this past semester in GLHT 360 (shout out to Nkechi’s team) was pretty cool, but seeing the nurses lay hands on it was something else entirely! Their competence, their enthusiasm, and their honesty were an overwhelming combination (in the best of ways). Similarly, getting to talk to mothers who would potentially use BTB’s binary thermometers really put the device in perspective.
It’s definitely a small start, but I’m glad to be fully entrenched in Act 1. Because at the moment, perhaps even more important than my official tasks are the relationships I’m forming- the incredible people I’m meeting, the scene that’s set before me in the form of St. Gabe’s. I think of it as the exposition, the fleshing out of these characters. We’re starting to get glimpses of the motives and relationships that are really going to advance our plotline. This is the time when I start to understand how the hospital works, and with any luck, how BTB can partner to improve quality of life for patients at St. Gabe’s. This is still just the beginning, and I invite you to grab some popcorn (8) and watch to see how the rest unfolds.
Tionana! (see you later!
Meal times are a chance to meet a wide cast of characters. The hospital cafeteria introduced us to Nsima, a Malawian staple, and the cafeteria staff has introduced us to Malawian hospitality (and some Chichewa words!)
P.S. As you may be wondering, I intended to post this on Friday, but had to wait until we got Internet from Lilongwe to post. That being said, I’m looking forward to staying up to date with the Blackhawk’s likely Stanley Cup victory tomorrow (GO HAWKS!!!), and you should be on the lookout for another blog post on what I see as a really fun topic in the next few days.
(2). Only tangentially related, but given the technology focus of this internship, II had to share an interesting development for pharmacological tech: http://www.bbc.com/news/health-32780624
Queen Elizabeth Central Hospital challenges every notion of a traditional hospital. Its mudbrick buildings and outdoor hallways create a haphazard facade that hides the bustle of doctors and nurses caring for their patients. Most striking is the crowd of people sitting, standing, cooking, cleaning, and eating on every grassy surface outside the hospital. A deconstructed waiting room, the wide, open courtyards at Queens are filled with families who are waiting to feed, clothe, and comfort their sick loved ones. Given the limited resources they’re working with, QECH can’t afford to provide nutritious and filling food to all of its patients, which is why families wait outside with ample supplies. These people come from all across Malawi, traveling days to get their sick relatives the best possible care at the premier government hospital in the country. Which is why they can’t afford to commute every day. Instead, they set up camp and lay out on a lawn of colorful chitenges (all-purpose cloth wraps) that sport designs as strange as eggplant-purple pineapples and political propaganda in favor of one-term ex-president Joyce Banda.
Sheets, chitenges, and aprons hung out to dry near the Maternity Ward
This community of waiting women (women still being the primary caregivers for sick family members) is a great captive audience for people who want to educate and spread news. Often, preachers come to sing songs and lift spirits in the crowd. Karen and I discussed an interesting twist on this idea: NGOs, nonprofits, and even doctors or nurses could use this opportunity to talk to women about health and sanitation practices or even teach them marketable skills.
Preachers and public health aside, the families there are waiting for a reason. The hospital has very strict times when families can visit: an hour and a half during breakfast, lunch, and dinner. At mealtimes, there’s always a long line of men and women waiting outside the entrances to the wards being told to wait just a little longer by a worn down security guard. In a lot of ways it seems unfair and wrong to make these families wait in line to provide their relatives with care and attention. The strict mealtime visiting hours definitely do not fall in line with a patient-driven approach to providing healthcare, but in a hospital with as limited space as Queens there’s no other practical way to deal with the crowds. Already, skinny walkways and cramped spaces make it a struggle to move freely in the hospital. Crowd control is a necessity. And so families settle for a system of patient waiting and limited contact.
The line of families waiting to come in during dinnertime
The dilemma of patient preferences versus practicality manifests itself in a lot of situations around QECH. This week, Karen and I got an inside look at the Maternity Ward and the Delivery Suite under the guidance of Dr. Edward Kommwa. We were there to do some research on current practices for delivering Magnesium Sulfate (MgSO4) to pre-eclamptic patients in order to prevent seizures. The procedure is fairly simple and there are two ways to do it. In the infusion method, the patient gets a 4g loading dose over 5-10 minutes and then receives 1g of MgSO4 per hour for up to 36 hours after delivery. The intramuscular (IM) method requires a 14g loading dose with 4g delivered as IV and 5g delivered via injection to each buttock. Subsequently, the patient has 5g maintenance doses injected intramuscularly every 4 hours for up to 36 hours. The latter method is extremely painful for the patient and has to be delivered with local anaesthetics. According to Edward, Queens is transitioning towards the more patient-friendly infusion method. But here’s where we run into the problem of practicality. When we watched nurses perform the MgSO4 procedures, they all used the more painful IM method. Why? Because it wasn’t feasible for these busy nurses to continuously monitor an IV drip and make sure thepatient was getting exactly 1g of MgSO4 per hour. Normally, this job can be automated by an infusion pump–a device that slowly pushes out the right dosage of a medicine into an IV line–however at Queens only the High Dependency Unit (HDU) has working infusion pumps and even the nurses in that ward rarely, if ever, use it for MgSO4 delivery.
Naomi, an HDU nurse we talked to, cited lack of adequate equipment (for example 60mL syringes) and lack of knowledge about the infusion pumps as the two main reasons why they’re never used. The first problem–lack of equipment–is something Rice 360 is trying to address with AutoSyp, a low-cost infusion pump that will hopefully allow nurses to deliver MgSO4 using the more patient-friendly approach. In order for AutoSyp to be successful, though, there has to be an educational effort to give nurses the knowledge and skills they need to successfully operate the infusion pumps in a practical and efficient way.
Karen asking Naomi about infusion pumps in the HDU
At first glance it’s easy to criticize QECH for disregarding patient preferences. After all, quality of life is an important consideration for those who are hospitalized for long periods of time. But when you look beyond the surface, the very practices that seem unfair are those that were born out of a need to run an efficient and effective hospital that can adequately address the needs of its countless patrons.
While last week was spent laying a lot of general groundwork for the internship, this week has focused in on beginning our first design project: a phototherapy dosing meter.
Background. The particular phototherapy devices we are targeting treat neonatal jaundice, a condition that effects up to 60% of premature babies. Neonatal jaundice is caused by a buildup of bilirubin (a protein) in the bloodstream, and is often harmless. In more extreme cases, however, the bilirubin levels will become dangerous and can lead to long-term neurological damage. Queen’s (the hospital down the street from the Poly) uses blue phototherapy lights, designed and built largely from the efforts of both Rice and the Poly, to treat these more dangerous cases of hyperbilirubinaemia. The device is a sort of plate of blue LED lights, all of which output the same wavelength of blue light. The LEDs are placed a short distance above the baby’s body so the light passes through the skin, breaks down bilirubin, and allows the baby to process the protein and prevent buildup.
View of the blue phototherapy LEDs.
The problem. It is very difficult for a doctor or a nurse to discern how much light the baby is receiving; the intensity of light received by the baby changes significantly with distance from baby to light, and different amounts of light are needed to treat varying intensities of the disorder. The current phototherapy lights have a knob to adjust the light irradiance, however this knob ranges only from the designated “min” to “max,” not numerical measures of irradiance. We’re setting out to design a device that can measure the irradiance (which is essentially a measure of how much light the baby is receiving) of the bililights quickly, accurately, and cheaply.
Light intensity meter on the phototherapy lights.
Past solutions. This problem isn’t a new one; the particular bililights found at Queens have been around for a few years, and a method to measure the exact dosage of light has been needed for longer. However, the commercial dosing meters available in the US cost thousands of US dollars, making them too expensive to be practical at Queen’s. The current dosing meter used in Queen’s only costs around $40, but is an analog meter. This means the meter suffers from calibration drift: when the mechanical components that control the meter start to wear, the device begins to become inaccurate. Additionally, the analog meter can become inaccurate if it is dropped, bumped, overused, or slightly tilted such that the meter pin falls one way or another due to gravity, disturbing the irradiance measurement. Teams at both the Poly and Rice have developed alternative solutions, however most still use analog meters—which suffer from drift, bulkiness, and inaccuracy—while their digital counterparts haven’t been properly calibrated.
Our solution. We wanted to use ideas from previous teams who have tackled this challenge, but combine various aspects of these past designs to optimize a device that can hopefully finally meet all of the design criteria needed for a dosing meter. We decided to make a digital device, which will be more accurate in both short and long term as compared to the analog device. The circuit has been mostly redesigned in order to fit the components that we have and to optimize sensitivity. Additionally, the housing has been modified to make the device portable and easy to use, while maintaining accuracy by keeping the meter perpendicular to the light source.
Designing new phototherapy meter.
Progress. We first spent time sifting through the past designs to understand the design decisions they made. This helped us understand what components we wanted to keep vs. what we wanted to change. After deciding on the digital design, Mr. Vweza pointed out the need for proper calibration (turning the current created by a photodiode into a measure of irradiance) as well as a few other design modifications, so we researched solutions to improve our device from previous models. We also had a large brainstorming session on various housing options, and have finally chosen a model that suits the device’s constraints. Finally, we’ve laid out the circuit on a breadboard and begun troubleshooting this new circuit as well as adjusting the Arduino code to obtain the best results.
The next steps. We will continue to optimize the circuit tomorrow, and hopefully begin building the housing tomorrow as well. With 7 people working all day on this project, things move fast, and we hope to have an initial prototype sometime next week. Then, we must calibrate the device and test with the gold standard of care, and finally make any adjustments needed. Hopefully we will have the device up and running soon!
In other news! We’ve begun searching for our own design project, meeting with many people around the hospital to identify needs. We have a large list going now, but hopefully by the end of next week we’ll have narrowed it down and decided upon a novel design project! We also had a meeting with Mr. Mafuta about the orientation week, but that will be a work in progress throughout this summer. Finally, the five Rice interns in Blantyre hiked part of Mount Mulanje last Sunday, which was incredibly difficult and something my legs were not ready for, but also was beautiful and well worth the effort.
At a beautiful waterfall nestled into Mount Mulanje, the highest peak in central Africa!
For all the technologies that Rice 360 has built over the years, one of the most dramatic and impactful projects has been the bCPAP machine. In just one week at Queens, I’ve been able to see how important the bCPAP is for patient care in the Pediatrics Ward and the Chatinkha Nursery. Additionally, one of our main jobs last week was to enter data from the bCPAP clinical trial from hospitals in Malawian districts as far away as Mzuzu and Rumphi, a task that showcased the reach and impact this simple technology is having not only at QECH, but also across the country.
Though previous interns have written extensively about various aspects of the machine, I thought I would take this opportunity to lay out an overview of how the device was developed, how it evolved, and how it continues to spread to new areas and new patients.
What is the bCPAP?
The Bubble Continuous Positive Air Pressure machine is a device that helps neonates with respiratory distress breathe properly through the use of bubbling water. The device is an innovative redesign of an existing medical technology that costs $6000 in US hospitals. Made with aquarium pumps, a water bottle, and sheet metal casing, the bCPAP only costs $800. (1) It is astounding to see the impact this technology has had in Queen Elizabeth Central Hospital as nurses and doctors have embraced the bCPAP and are starting to use it as a new standard of care for their sickest patients.
What was the timeline?
Working in the bCPAP store roomlast week gave me the opportunity to look at the various design iterations of the machine and at the cyclical nature of the design process itself. Though it now has prettier packaging and a cooler name (Pumani means “breath” in Chichewa), the essentials of the bCPAP haven’t changed much over the years. 3rd Stone Design, with feedback from Rice 360 staff at QECH, continues to make important changes and improvements to allow for wider acceptance and use of the device. With the help of several grants, the device spread from QECH to district hospitals across Malawi and is now making the transition to Zambia, Tanzania, and South Africa.
Implementation and Acceptance
The bCPAP is now used in hospitals around the country, but it was by no means accepted immediately. The machine was designed with affordability in mind and 3rd Stone Design made sure it would be available in adequate quantities. However, there were still several barriers to adoption, as with all new healthcare interventions brought to a community. At first, some bCPAPs weren’t used because nurses felt they lacked adequate training and were not comfortable with it. However, with better training procedures, nurses are beginning to accept and use the devices. At QECH, I was introduced to Nurse Florence (Chatinkha Nursery) and Nurse Chrissie (Paediatric Ward), two CPAP nurses who are prime examples of well-trained, proactive healthcare workers. These two are the bCPAP’s most ardent supporters at Queens, regularly encouraging health workers to use bCPAPs on patients and traveling to district hospitals to provide CPAP mentorship.
Another major problem in the implementation of the device was accounting for hypothermia in neonates. Especially in the winter months, data collected from the bCPAP clinical trial showed lower survival rates since babies were hypothermic and unable to get the warmth and care they needed. This led to another innovation by a team at Rice: the CPAP heating sleeve. Designed by Sarah, Renata, and their teammates, the heating sleeve is a cloth cover for bCPAP tubing that uses resistance wires to keep air warm as it flows to the infant. We’re hoping to get useful feedback on this addition to the bCPAP system by talking to people like Nurse Florence and Nurse Chrissie, who are highly familiar with and highly invested in the CPAP project.
What’s the impact?
The main criteria for success in the bCPAP trial are the survival rates and the cost-effectiveness of the device. In its initial pilot trial at Queens, the bCPAP showed stunning results. Infants put on CPAP had a 71% survival rate as compared to a 44% survival rate for infants given the standard-of-care oxygen treatment. Specifically, the bCPAP was good for treating Respiratory Distress Syndrome (RDS) and Sepsis. (2) In a follow-up cost-effectiveness study on the same data, the bCPAP was found to have an incremental cost-effectiveness ratio of $4.20 per life year saved, making it an extremely effective investment in neonatal care. (3)
Numbers aside, a more visible indicator of success is the integration of the bCPAP into the clinical practices of nurses and doctors at Queens. A quick walk through Chatinkha Nursery brings you in contact with numerous infants breathing steadily with the help of Pumani bCPAPs under the watchful eye of a trained CPAP nurse. Additionally, Karen and I often go to the morning handover meetings in the Paeds Ward where doctors debrief on the status of their patients during the previous night. The most striking moment for me was when an attending physician interrupted a debrief on an infant with RDS to ask, “Why wasn’t this baby put on CPAP sooner?” The fact that this technology is now such a crucial part of clinical decisions at QECH is both telling and encouraging. Hospitals like Queens need access to low-cost technologies like the CPAP, but more importantly, the technologies have to be accepted on all levels–by healthcare workers, doctors, and families–in order to make a meaningful difference.
It’s been a busy first week getting settled in Blantyre and at Queens, and things are already off to a great start! Tanya and I have spent the first few days getting to know our way around the hospital wards, meeting clinicians and nurses, and working at the bCPAP Office.
When it was first introduced at Queens in 2012, initial results showed that the bCPAP improved survival rates of neonates in respiratory distress to almost the same degree that the introduction of CPAP in the US did in the 1970s. The device, designed by a group of Rice bioengineering students in 2010, offers a low-cost alternative to CPAPs commercially available in the US, and the technology is currently being rolled out to all district hospitals in Malawi as well as into Tanzania, Zambia, and South Africa.
A large part of the technology implementation involves ongoing data collection and monitoring of all of the patients who are treated using bCPAP. This data includes important details such as primary diagnoses, duration of treatment, outcomes, and most recently, admission temperatures. Each of these factors plays a role in understanding not only how the technology is performing, but also whether or not it is being used appropriately and if additional treatment considerations could help improve outcomes.
For example, outcomes of bCPAP treated patients compared to outcomes of O2 treated patients may show us how the device is performing at a baseline level, but looking at primary diagnoses of patients helps us to understand how clinicians and nurses are selecting patients for bCPAP treatment and whether or not these are the patients that would benefit most from the treatment. Sometimes, patients with birth asphyxia are treated with CPAP, but complications associated with this condition would not be improved by CPAP assistance, so a poor outcome for these patients would not necessarily mean that the bCPAP is performing inadequately. Similarly, after monitoring patient outcomes across several seasons, data showed that during winter months, survival rates of bCPAP patients decreased. This observation led to the current project of collecting admission temperature data for all patients in order to analyze how variations in core body temperature affect treatment outcomes, and that’s one of the projects that Tanya and I will be helping with throughout the summer. Collecting this type of data can help determine what kinds of additional treatment considerations, such as maintaining stable core body temperatures, can further improve outcomes for bCPAP patients.
Within just the first few days of interacting with the CPAP study, I’ve gained a much greater appreciation for the amount of attention and scope of analysis required of clinical trials on medical devices. Contextualizing a device’s performance becomes critical in finding tangible ways to continually improve both implementation and design, and these improvements are essential for a device to remain relevant and effective.
Sarah, Catherine and I came to Malawi with a lot of different medical device prototypes and ideas. Some of them were products of global health and senior design classes that need feedback for further modifications. A lot of space in our suitcases was occupied by parts of theoretical designs that we anticipated prototyping with our Poly friends during our internship. We also carried a significant amount of general prototyping materials, so that if we discovered any particular opportunities for completely new designs, we would have what we needed to build our ideas.
On our very first day in the lab, Christina, Andrew, Francis and Charles had a ton of great feedback about the prototypes we already had built. One of the first devices we demonstrated was a heating system for the bCPAP device. The bCPAP is used for patients who are premature and have difficulty keeping their lungs open to breathe. The device uses positive pressure to deliver air to the patient’s lungs, but the air is not warm which can be a problem as patients this fragile also often have trouble with thermoregulation. The device we showed to the Poly interns was designed by Sarah and some other students at Rice this past semester. A large nylon sleeve containing resistance wires is snapped around the bCPAP tubing, and is attached at one end to a small circuit box. With the flip of a switch on the circuit box, the resistance wires in the sleeve heat up, and the air in the bCPAP tubing is also heated. By the time the air in the tubing reaches the patient, it has been warmed to body temperature. A temperature sensor at the patient end of the tubing acts as a feedback system to ensure that the device is maintaining body temperature and not overheating the patient.
Andrew explaining a modification to the bCPAP circuit
Immediately after Sarah explained to us the specifications of the heater, the Poly interns had a number of ideas for improvements. The first one was an additional safety component of the circuit, which restricted the total possible amount of voltage that the resistance wires would receive. This ensured that even during a power surge or a short in the circuit, the patient would not be exposed to extreme heat. The second was a method of adapting the wall power in Malawi to a level that the circuit would be able to handle. This would reduce the cost of the device and make it more adaptable by eliminating the need for a special power cord. Instead, any power cord with the right connection to the circuit box and a plug that fits in a Malawian outlet can be used. To be honest, a lot of the electrical engineering components of this internship so far have been a little bit out of my realm of expertise. I’m lucky that Christina, Francis, Andrew and Sarah- the electrical engineers on the team- are so willing to slow down and help to explain things to me. I have been receiving an excellent education so far in circuit design and function, which is something I’m sure will come in handy in the future.
The things I’ve learned in the past week aren’t just restricted to prototyping and circuits. I have worked on a number of different engineering teams during my time at Rice, and I have experienced exposure to a new culture before, but this trip is the first time for be to do both in tandem. Our intern team can be much more creative in our ideas for modifications to devices or future design projects because of our different backgrounds. And working together as partners with the Poly students has given me so much more insight into Malawian life and culture. Working with fellow students allows us to use shared experiences such as life in college or our passion for engineering as a platform on which we can understand one another, and with this foundation we have a much better perspective about how our personal and cultural differences define us. I have high expectations for the next two months ahead of me, and I hope that by the end of them I can bring back with me a real understanding of the lives of my new friends.
This week was a whirlwind. There has been so much new information to take in, and so I thought I’d use a blog entry to introduce some of the people we’ve met and places we’ve been during our first week in Blantyre.
New Faces
Dr. Gregory Gamula is the head Electrical Engineering professor at the Poly. He’s been pretty busy this week finishing up grading for the semester that just ended, but he still very graciously spent some time with us to introduce us to the key players involved in our internship this summer and to welcome us to the university.
Dr. Alick Vweza is a engineering lecturer at the Poly who will be working closely with us this summer on furthering our various projects.
Mr. Million Mafuta is another engineering lecturer at the Poly and he will be one of our main resources in helping plan the freshman engineering orientation week. We meet with him on Monday to discuss our plans.
The Four Poly Interns’ names are Christina, Francis, Anjrew and Charles. The first three are studying electrical engineering while Charles is studying mechanical. They are all rising fifth year students, (at the Poly, an engineering degree is five years because the first year is spent doing more general studies,) and it looks like we’ll spend most of our time this summer working with them. They are exceedingly kind and unbelievably smart. Just as soon as we would show them one of the prototypes we brought, they would generate a dozen new design changes and even possible spin-off projects!
Here are all the Poly and Rice interns in Blantyre (except Emily taking the pic.) From back left and then clockwise: Anjrew, Christina, me, Charles, Sarah, Francis, Karen, Tanya.
New Places
Kabula Lodge is the place we are staying. We live in a house down the road a little way from the main lodge. My favorite part is having our own kitchen. Already the five of us have had great fun cooking dinners, and on Friday night we even had the Poly interns over to help us learn to make some traditional Malawian cuisine.
This is the view we get to soak in over coffee and toast every morning at Kabula!
The University of Malawi Polytechnic is where my team will be working this summer. The Poly interns gave us the grand tour on Tuesday, and so far we’ve been primarily working from a computer lab in the main building.
Here is the room we’ve been working in at the Poly. Sprawled out on the front table are all of our unpacked prototypes and supplies, and slightly out of the picture is a whiteboard filled with new project ideas.
Queen Elizabeth Central Hospital (QECH) is a massive, sprawling, bustling hospital, just from the little bit of it that I’ve seen.
Shoprite/Chipiku/Superior are all grocery stores we shopped at this week. Shoprite is the biggest, but Chipiku and Superior are closer to the Poly so we’re able to run by them on our way home from work if needed.
The Market – we finally went to the market yesterday! It is quite the experience. It is loud and exciting and there are lots of fresh produce and friendly people. I’m learning Chichewa pang’onopang’ono, (little by little,) but already I’ve found that the more you know, the better deals you can make.
Since our departure on Tuesday, I’ve spent a day in Frankfurt brushing up on my German, a tense hour and forty minutes rushing through customs in Johannesburg, and a full day and a half at St. Gabriel’s Hospital in Namitondo, Malawi. My body is still jet lagged (seriously, our first night, I think I set a personal record for the number of hours slept straight), and my mind is spinning, but I am very happy to be here!
Our home and inspiration for the next 9 weeks.
Our first day at the hospital was Friday, and although we were a bit apprehensive about jumping into the fray, we managed to start by planting our feet firmly on the ground. In the morning, we got a hospital tour from the matron, Mrs. Mbukwa. She was SO thorough and patient with our questions (and oh, there were many questions). We then helped sort pills in the outpatient pharmacy until lunch. Afterwards, we met with Dr. Mbeya, the Hospital Director and our resident guardian angel. Dr. Mbeya seems to be quite focused on making sure that our experiences here at St. Gabe’s are ones through which we can both learn and serve. I really appreciate that, and I feel that he will make a major contribution towards our ability to make a positive impact on hospital and our role as advocates for it.
Apart from the medical, we’ve been exploring Namitando and nearby (1) Namitete, meeting TONS of friendly people whose names I have yet to attach to faces, and catching up on sleep. The great thing is that wherever I’ve found myself during this past week, I’ve had the chance to pound some key ideas into my jet-lagged brain:
It’s okay to slow down.
I learned this one in Frankfurt, when we got on the wrong train not once, but twice while sightseeing on our layover (sorry, Nkechi!). When I finally settled in one place for long enough to get a thorough reading of the map, things became a lot clearer. The moral of the story is that it’s better to be deliberate in your actions than try to fit in.
The second moral of the story is that you should thank your parents for dragging you to German school.
Slowing down for long enough to appreciate my heritage.
Just because something isn’t explicitly in your job description doesn’t mean you can’t be helpful.
After getting a lay of the land with the matron, we spend some two and a half hours organizing pills. While this was not the kind of work that we have been officially tasked with during our internship, there were definite benefits to the work we did there. It gave us time to get familiar with the people who work in one of the busiest parts of the hospital, the outpatient clinic. I also feel that I gained a great deal of insight by looking at the medicines we were packing. I became more acutely aware of the problems facing the average patient at St. Gabe’s with just a glance at the labels: quinine (2), zinc (3), brufen (4), and erythromycin (5), to name a few.
So did we provide a crucial service that only we could? Not even close. But we hopefully made things a bit easier for the hospital staff, gaining perspective and a good rapport in the process.
Ask a lot of questions.
Saturday morning, we ran by Dr. Mbeya’s office at 11:30 AM (6) with a few questions. We came in with a plan to ask a few quick things about shadowing to get ideas for new technologies and possibly presenting our technologies at the hospital’s morning meeting. We left over an hour later, having gotten not only our answers, but also a chance to watch a surgical procedure and see some potential areas for technical improvements in the ward!
In this case, our questions led us to the operating theater.
Although most of this can be attributed to Dr. Mbeya’s enthusiasm for teaching, it goes to show that asking questions is a great way to open doors. You could even expand this thesis and apply it to the village, where a simple “Muli bwanji?” (How are you?) can elicit a smile and response from a stranger. With these experiences in mind, I’ve allowed myself to be okay with having more questions than answers. The more questions I have, the better chance that I can take away something that’s meaningful for me, for BTB, and for St. Gabe’s.
And these are just some of my questions!
(1). Nearby is a relative term. It’s a 50 minute walk each way.
(2). Quinine is used for the treatment of falciparum malaria.
(4). Brufen is a particular ibuprofen preparation that’s used to treat pain and inflammation, as well as fever, especially in children.
(5). Erythromycin is used to treat a range of infections, spanning from skin infections and strep to respiratory infections and various venereal diseases.
***2, 4, and 5 utilize the British National Formulary’s BNF 59, from March 2010.
(6). The majority of the hospital staff leaves at noon on Saturdays.
We have just finished our first week at the Polytechnic! Everything thus far has been incredible, though the best part has been meeting and getting to know the Malawian interns from the Polytechnic. As I mentioned before, the Polytechnic is where we will be working this summer; I’ve since found out it is the only engineering school in all of Malawi. Four students from the Poly were selected for the internship—Charles, Christina, Francis, and Andrew—and together with Catherine, Emily, and I, we compose the 7 person internship team working at the Polytechnic. Christina, Francis, and Andrew are all rising 5th year electrical engineers (engineering degrees at the Poly require 5 years), and Charles is a rising 5th year mechanical engineer. They are some of the most brilliant people I’ve ever met, and even in this short time I have learned a ton from them. Here are a few of those things:
How to make improve devices.
Feedback. We took out a few devices the Rice interns brought with us from Houston—a rolling frame used for physical therapy, flow splitter, respiratory rate timer, bCPAP heater—and we all brainstormed ideas for potential improvements that could be made. The Malawian interns immediately had dozens of new ideas for how to make these devices better. They suggested making the rolling frame more adjustable, to be appropriate for various ages of children; for the flow splitter, there were many ideas about how to substitute alternative designs in order to bypass the need for a check valve (which is hard to find and expensive); ideas were thrown around for how to automate a respiratory rate timer, incorporating it into a different existing BTB device that already measures neonatal breaths. For the bCPAP heater, which is the project I am most familiar with, Andrew had a great idea to incorporate an internal transformer and current limiting circuit within the control system box, which both makes it cheaper and uses less parts bought from the US. It was impressive to watch him draw up an entire circuit schematic without any outside resources in a matter of about ten minutes.
Troubleshooting. Many of the Rice technologies that we brought had electrical circuits that were built by students with more of a medical background and less of an electrical background, plus the technologies had to survive three airplane flights over 35 hours. Somewhat expectedly, many of the technologies no longer were in perfect working order by the time they were unpacked at the Poly. The Malawian interns took lead in troubleshooting these devices, which was both an impressive and wild ride to be involved in: they worked very quickly, almost immediately identifying problems and rectifying them; when one part broke and no replacement was found, it was taken out and replaced with a completely different though equally functional component; when a power strip stopped working, they quickly took it apart, located a blown fuse, and replaced it. In less than two hours, all of our technologies were working, some even improved from initial design.
Where to shop. We had many materials we needed to locate for a workshop happening this summer, as well as for rebuilding existing Rice technologies from local material. Charles, Francis, Andrew, and Christina helped us come up with about 12 stores around Blantyre we needed to go to, and we managed to get all of our shopping done in one day. Not only were we able to see more of the city and meet more people, but it was also an eye-opening experience in searching for parts to build our medical devices with. We went to five or six stores searching for simple, plastic y-splitters, which are really easy to find in the States and we had assumed would be no problem here, but couldn’t locate any. Charles called other mechanical engineers and we even asked our supervisor, Dr. Vueza, but no one had ever used or seen this part. The same story applies to our search for check valves. We went to hardware stores, plumbing stores, and medical supply stores, but we could only find a few new medical devices, not parts to build or fix those devices. The experience helped me to realize how important it is to build devices that can be created or maintained with local materials, otherwise they have much less of a chance to be built at the Poly or sustained in Malawi.
Where to eat. The four Malawian interns came with us to the market and to Chipiku, a grocery store across from the Poly, to point out good food and good prices—they also took us to the cafeteria on campus, and restaurants Crazy Foods and Kips for lunches this week; the food so far has been great! They came over to our house Friday night, where Christina took charge in home making a huge meal of nsima, fish, and various veggies, while the US interns made a dessert of banana pancakes and cinnamon apples.
How to speak. Every day, the Malawian interns help us with our Chichewa. We always carry small notebooks on us to jot down words and phrases, but it’s hard to keep up! So far we have some greetings, some goodbyes, and some common phrases (“no problem,” “it’s all good,” “thank you”) down, but one of our most commonly used phrases is, “ndikuphunzira Chichewa,” which means, “I am learning Chichewa.” This is what we use when we don’t understand anything (which unfortunately happens a lot.) When we speak Chichewa, most often we get a kind, hearty laugh in response—most likely due to our very slow speech and American accents—but occasionally we also get high fives for our efforts!
On top of everything that the Malawian interns have taught us, they are also some of the most kind, helpful, generous, and funny people I have ever met; the faculty at the Poly, as well as the other Malawians we’ve met where we are staying, in the shops, and in the market, have made us feel at home. I am very lucky for the chance to get to work with this team, and I can’t wait to see what projects we complete!
Troubleshooting respiratory rate timerSign for a medical supply shop; most of the shop owners didn’t want us to take pictures inside their shopsChristina and Andrew teaching me how to make some Malawian dishes!Signs for shops on our search for materialsGrowing Chichewa vocab
