Hello friends!!! In approximately  18 hours I will be on [several] planes to Lilongwe, Malawi, followed by a 1 hour car ride to the rural village of Namitondo to work in Saint Gabriel’s hospital. There is no doubt that this will be a life-changing experience and I’m truly a mixture of emotions.

First and foremost, I am excited. I am so incredibly thankful to Rice for giving me this opportunity to learn about new people, places, and opportunities for technology advancement. I am so ready to test our technologies and find chances for improvement.

I am busy. Renata (my internship partner) and all the other BTB interns and I have spent the last two to three weeks in the OEDK preparing our technologies. We will be bringing four major technologies: the CPAP heating system, the thermometers made by a GLHT 360 team last year, an updated flow splitter, and the Respiratory Rate Timer that my team and I made this semester (pictured below).

I am nervous and curious.  I am going to a place where I don’t know the language, culture, the food, or the people. I’m uncertain of how daily life will go, but I’m eager to learn.

I am sad to leave. This is the longest and farthest I will be a way from my loving caring family. I know that I am giving my mom and dad major heart palpitations.  I will miss my brother Obi coming back from his first year of medical school. I will miss my sister Ngozi getting ready for Emory University. And I will miss my youngest sister Nneka turning sixteen and rushing to get her driver’s license. I will miss all the little details.

I am ready. See you in Malawi!

Greetings from Chicago! Right now it’s a rainy 45 degrees Fahrenheit- who would guess that this time next week, I’ll be finishing off my first week in Malawi?

I’m celebrated my little brother’s graduation this weekend (shout out to Gregor, the kindest and smartest kid I know); I know it’s cheesy, but I’m getting a bit nostalgic and thinking back on the hopes I had in high school for what my future would hold. The BTB internship program was one of the key factors that drove me to consider Rice, and having the opportunity to participate in this experience is completely surreal! I was hoping to use this post to say a little bit about my motives for participating in this program, but I think that a combination of binge-watching the Walking Dead and a deep-dish pizza coma are making it difficult to be articulate. Do you know what I am still good at?

Making lists.

The past month or so has been chock full of lists: parts lists for our medical devices, Chichewa words I need to cram in my brain, packing lists. So it seemed only natural to add one more list: the things that most excite and concern me going into this experience. I assure you, my posts will get shorter and more picture-heavy once I’m on the ground in Namitete. But for now, without further ado:

The good stuff (abridged for your benefit, otherwise this would be a novella)

1. Flexibility: St. Gabriel’s Hospital has given us some idea that we may be working on Morphine Tracker (more on that later), and BTB has given us an amazing assortment of student-designed technologies to present to clinicians at the hospital. But in general, the internship will largely be what we make of it. And I love that! I’m thrilled at the range of opportunities I have to make a contribution in a way that both meets the community’s needs and utilizes my skills.
2. Distinctiveness: I’m sure I’ll be able to speak in tomes to this once I get there, but the impression I get is that there is a HUGE contrast between St. Gabriel’s and Queen Elizabeth Central Hospital (where several of the other BTB interns are working). Located in a major city, Queens is Malawi’s premiere teaching hospital (1). In contrast, St. Gabe’s is a small, privately run hospital in a rural area. It will be fascinating to compare the two: Which medical problems are most pressing? What personnel structures exist at each hospital? What is the role of various technologies? What are the predominant cultural influences on treatment and physician-patient relationships? Stay tuned and take a look at the Blantyre interns’ blogs to learn more.

3. Perspective: I firmly believe that the greatest resource we will explore during this internship is the wisdom the people we meet along the way. Getting feedback on BTB’s student designs is one of the aspects of the program I’m most excited for; my GLHT 360 design project, the bCPAP heater will be getting some attention, which is an immense privilege. Malawian clinicians’ input will be an invaluable contribution to making these devices viable solutions for low-resource settings! I’m also looking forward to developing relationships with people in the village, as well as my awesome fellow intern Nkechi (check out her blog as well).

The stuff that’s keeping me awake at night (for now)

1. Flexibility: The same element that gives this experience so much potential could easily blow up in our faces. I know that coming in with fewer concrete plans means that it will be up to me to reach out, ask questions, and speak up. I hope I’m ready for the challenge.
2. Programming: This is oddly specific, but one of our tasks is to take a look at Morphine Tracker, a student-created database that records morphine use in St. Gabe’s palliative care unit. It’s a cool project with incredible potential, but my lack of coding background has me a bit wary. Like everything else in this process, however, I am ready and eager to learn!
3. Assumptions: One of my greatest strengths coming into the process is that I have 4 summers-worth of experience in Haiti. It is a place that holds a large portion of my heart, but it’s also a connection that makes me wary of my perspective on Malawi. I don’t want to assume that Malawi and Haiti somehow get lumped together in this giant nebulous label of ‘the developing world’ (2), (3); although I am privileged to have the opportunity to draw comparisons between the two, I hope to take more away from this internship than a giant Venn diagram of Haiti and Malawi. *Disclaimer: I’m still not ruling out the possibility that I’ll post a chart at some point.

Well, I hope this hasn’t been too lengthy or introspective. I’m hoping to write up a summary of our student technologies in the near future, but the internet situation will be quite the adventure in the next few days, so we’ll see. For now, feel free to reach out to me with questions or comments at ryw2@rice.edu.

1. From the abstract of: http://www.medcol.mw/commhealth/mph/dissertations/Idana_Ibrahim_disseration_280906.pdf
2. https://www.globalcitizen.org/en/content/27-myths-about-the-developing-world/
3. tangentially related and remarkably interesting: http://www.cnn.com/2014/02/07/world/africa/africa-is-not-a-country-campaign/

It’s hard to believe that it’s finally here, but we’re off to Malawi! This summer, I’ll be working with Tanya at Queen Elizabeth Central Hospital in Blantyre. Our primary task is to help with data collection and verification on the Bubble Continuous Positive Airway Pressure (bCPAP) clinical trial, but we’ll also be presenting several student-designed technologies to clinicians and hospital staff to obtain feedback for future work on these projects.

Tanya and I have spent the past couple of weeks at Rice’s Oshman Engineering Design Kitchen (OEDK) preparing prototypes of these student technologies since most of the original devices will stay at the OEDK this summer for further testing and modification. It’s always impressive to see the design solutions that Rice students develop during the academic year in courses like Introduction to Engineering Design, Design for Global Health, and Senior Design for Global Health. Tanya and I are excited to be able to acquire feedback that will ultimately help inform future work on these projects.

Here’s a bit more on each of the technologies that we’ll be presenting on:

IncuBaby – A low-cost incubator for neonates

By far our most technical project, IncuBaby has given us a chance to learn several new skills including circuit building, soldering, and laser cutting, to name a few. This project was completed this year as a Senior Design project, and a group of Bioengineering students designed and built an incubator that includes real-time temperature feedback and controls and is made of easily sourced materials such as plywood and acrylic. While incubators in high-resource settings can cost upwards of $30,000, this design costs about $250, and at scale would remain between $300-$400. Most of the feedback we’ll be obtaining for the project will be size and usability related, and these informal recommendations will help shape the next steps in the incubator’s design. We’ll also be looking into ways to locally source the materials so to determine if parts of the production could occur in Malawi. Here’s a photo of the final prototype:

RespiRate – a respiratory rate timer for neonates and children

Pediatric pneumonia and other respiratory infections place a significant burden on the healthcare system in low-resource settings. One simple way of identifying early warning signs of infection include an increased breath rate that can be observed by counting the number of times a child’s stomach rises and falls in one minute. Two design teams (one freshman engineering team and one global health team) worked separately this year to create a low-cost timer device for healthcare workers to track a patient’s breath count and determine whether he or she is exhibiting warning signs of a more serious infection. Both teams’ prototypes show great potential, and we look forward to returning with informal usability feedback and suggestions for improvement on the designs. Here’s a photo of the inner components of one of the timers:

AxillaProbe – an at-home temperature probe for detection of fever in infants and children

Similar to an elevated breath rate, feverish temperatures in infants and children can be a sign of a more serious infection that requires medical attention. Currently, most parents in low-resource settings must rely on human touch to determine if their child has a fever. This method is highly subjective and also makes it more difficult for parents to track how long their child has been feverish. AxillaProbe is a low-cost thermometer designed for parents to be able to quickly and definitively tell if their child has a fever above 99.5ºF. It is a simple armpit probe that uses liquid crystals that change color to indicate either healthy or fever temperatures, and it can be cleaned and reused on multiple children for up to two years. Most of the informal feedback for AxillaProbe will be on size, usability, and availability of local resources for production as well. Here’s a photo of the device:

I’m incredibly grateful to have this opportunity to travel to Blantyre this summer and be able to see and experience the places I’ve heard so much about while completing the Global Health Technologies curriculum at Rice! I know that I’ll be challenged to think about problems in new and exciting ways, and I hope to gain more insight into how thoughtful technology design and implementation can deliver quality healthcare to all populations.