My first week or so in Malawi has been incredible. The scenery is breathtaking- full of mountains, green plants, red dirt and a sky that seems more blue than anywhere else. In contrast to Houston, the night sky is full of stars and the weather is cool and breezy. We have gone to the market for fresh fruit and we eat traditional Malawian food for lunch on weekdays at the Polytechnic. Nsima (pictured below) is an exceptionally filling traditional food made from maize flour.
A typical lunch with beans, greens, and nsima
Our first week at the Poly, we met several professors who are all very friendly and extremely willing to help. Our supervisor Matthew Petney, who runs the Polytechnic design kitchen and teaches design courses, has generously offered to teach us more LabView and Arduino, among other skills. We have also learned a lot about the culture and living in Malawi from Matthew, who has been here since last August. [Like the Malawi Polytechnic Design Studio on Facebook! (: https://www.facebook.com/PolyDesignCenter/ ]
This week, the Malawian interns who are working with us this summer arrived. There are now eight of us in total, and we are living together in the Polytechnic guest house. So far has been wonderful getting to know them, and our adventures in learning to cook have brought us together as a community (Fun fact: apparently cooking times and temperatures increase at high altitudes and we are 3000ft above sea level). They also taught us a card game similar to Uno, which was really fun. Leah, Christine and I decided to do Insanity workout videos to improve our poor hiking abilities and Kate, one of the Poly interns, is going to join us tonight after seeing that we didn’t pass out during the first workout yesterday.
I’m looking forward to work picking up, but I’m also glad that we took the time to slow down, adjust, and absorb the environment. It’s even better than I imagined.
I’m in Malawi! I have been here for a week, and we have been busy getting settled into the Poly and a house, meeting the interns from the Poly, and learning about oxygen concentrators in preparation for site visits next week. There are some differences that are taking some getting used to. For example, lunch here is 1.5 hours, while lunch at school is 30 minutes to an hour. We are having trouble filling this extra time, but we have found that drinking Cokes from glass bottles is a pleasant way to do that.
Theresa drinking Coke at lunch – they taste better here!
The interns from the Poly are all rising 5th year engineering students. Kate and Brighton and studying electrical engineering, while Vincent and Harvey are studying mechanical engineering. We are also living with them. We all moved in together on Sunday, and we are enjoying getting to know each other by cooking together, eating together, and sharing awkward moments together. I have enjoyed speaking with Harvey about differences in school systems (if they fail between 3 and 6 courses/year, they must repeat the year) and learning about how to cook rice from Kate (you toast it first!). I think that living together will not always be easy (but is it ever easy moving in with strangers?), but I think it will be a great learning experience and bring all of us closer together.
Today, we split into two preliminary teams to focus on our two main projects. One team, containing Christine, Tahir, Vincent, and Kate, is focusing on learning as much as possible on oxygen concentrator repair. This team will try to improve repair methods upon returning from site visits. I am on a team with Theresa, Harvey, and Brighton. We are working on reducing instances of hypothermia in neonates. While we are at site visits to district hospitals, we will be collecting information on care for infants with hypothermia and how they prevent hypothermia. We will then use this information to develop something, be it a system, educational campaign, or device, to reduce cases of hypothermia. Later this week, we will form pairs of people (one from each team) and learn who will be going to which hospital. Two teams will be visiting district hospitals outside Blantyre, and two will be spending the week in Lilongwe to repair oxygen concentrators and collect information.
We began research on hypothermia today, and I have already learned a significant amount about its prevalence in neonates. I did not initially realize how well it would compliment the information I already know about breastfeeding from my mechanical breast pump. I did not realize that breastfeeding helps combat hypothermia, but this makes sense. Not only is skin-to-skin contact occurring, but a warm liquid is also entering the body of the infant. This does not occur when breast milk is fed to an infant after pumping. There is little skin-to-skin contact and the milk cools between the time it leaves the breast and the time it is consumed by the infant. I also learned that hypothermia is a common side-effect of sepsis, the risk of which is reduced by breastfeeding! Everything is related! I am definitely looking forward to continuing to work on this project and make more connections.
“A different pace of life” it is common to talk about but is it good or bad? Perhaps neither, or, more accurately, both?
To raise money for the hospital, a team of people put on a Ceilidh with Scottish flags in the corner, an impressive number of kilts for any gathering in Malawi, bagpipes, and a live band accompanied by a caller instructing us on how to skip and twirl and swing around with the time of the music. It was fantastic, and the dancing had a similar feel to enthusiastic square dancing. (Picture below) But the story for this post, though seemingly insignificant in comparison to such an event, is representative of something I’ve been thinking a bit about.
In our attempt to buy tickets for the Ceilidh, Elizabeth and I were directed to an office at the hospital. Hesitantly we knocked and entered. The woman looked expectantly, and, as we started asking if we were in the right place and could buy tickets from her, she interrupted. “How are you?” she asked, in the same tone a parent uses when a child forgets to say “please.” After a quick backtrack we corrected our mistake and exchanged pleasantries before proceeding to buy our tickets.
It is easy to justify skipping the “Hi, how are you” as it is likely you will only ever receive the automatic response of “good” or “fine.” However, this week has been a lesson in both consciously conforming to another culture and also realizing the importance of how a conversation is started. We start by acknowledging the other human before acknowledging the task. Perhaps in this case a slower pace of life is less efficient, but is justified by its other merits.
Elizabeth, Caroline, and I with our friends Larry and Melanie at the Scottish Dance event
Our first week was an adventure – we all have learned so much already! Each morning, we work our way through the maze that is the hospital, taking in every turn down a new corridor, every peek into a treatment space, every friendly face. Our first stop each morning is a joint information meeting with doctors, nurses and students, referred to as a doctors’ handover meeting. The doctors review all of the patients, admissions, and deaths of the previous day/night, so that the doctors stepping in for them have a background on the patients they will be serving as well as recommendations for moving forward. For example, on Wednesday, the doctors spoke of many of QECH’s 259 patients on Tuesday – a 15-year old boy who was electrocuted, a 5-year old girl suffering from HIV, two twin babies born 800 g (1.76 lbs.) each, a 14-year old boy who had both meningitis and malaria, an 8-year old girl with hypertension and seizures – the list goes on. Unfortunately, the most lives lost were newborn babies, suffering from severe prematurity, struggling to breathe. Some were treated with CPR, others with blood transfusions, some with the bCPAP. Thanks to the conscientious work of the doctors and nurses in Chatinkha (neonatal ward), many were saved and grew healthy, especially those babies with respiratory distress syndrome (RDS) who were placed on the bCPAP. RDS is primarily caused by surfactant deficiency, which is consequential to developmental insufficiency. This gives the staff and us as interns great hope and motivation to continue developing the bCPAP technology and encouraging its use.
Doctors’ handover meeting
Baby on bCPAP
On Thursday and Friday, we helped execute two bCPAP trainings with Dr. George Chagaluka for doctor interns and nurses working in Accidents and Emergencies (A+E), Paediatrics (Peds), and the Chatinkha Nursery. During this training, I was saddened to discover that a number of the babies put on bCPAP between Jan 1 and Apr 1, 2016 unfortunately did not survive. In order to turn this statistic around, George (Dr. Chagaluka) set out a call for action: to use the bCPAP effectively as a life-saving device (the key word being effectively). One problem we uncovered in analyzing the four month data is that healthcare workers are putting asphyxiated babies on bCPAP. George encouraged the healthcare workers to cease this immediately and only put patients with RDS, on bCPAP. He asked “Are we going to put babies on bCPAP? Confidently? Are we going to decrease the mortality?” The doctor interns and nurses cheered with renewed insight and motivation. Since we arrived, Kinsey, Elizabeth and I have been entering and analyzing mortality data from 5 other hospitals; we hope the results will inform bCPAP trainings for these hospitals, as well.
bCPAP training
In the meantime, I created a plan of the hospital, which you can see below. I used an aerial view from Google Maps to outline the spaces, then walked through the hospital with George as he pointed out the functions of each space. This was incredibly interesting architecturally-speaking. There are roughly defined zones of function, which divide hospital programs into the following categories: Emergency (including HIV zone); Birth; Eye and Ear, Nose and Throat (ENT); Main (including TB treatment, surgery, etc.); “Paedatrics” (slightly different spelling than in the US); Research (mostly malaria); Retail and Housing for doctors and nursing students; and additional programs, such as the PAM unit, the Transport Office and the Mortuary to name a few. Before walking around the hospital with George and creating this map, I only knew the way to our office at Moyo, but now I am familiar with the relationships between the zones spatially and the vast services offered throughout the architecture. The transparent walkways between zones are denoted in dark green. These corridors are the main circulation method in the building. The courtyards surrounding the pathways, shown by the lighter green, are gathering spaces for families who are waiting for their loved ones to heal. Sometimes families live for days in these crowded outdoor spaces (pictured below). We are hoping to perfect and publish this map this week, and implement it throughout the hospital with “You are Here” notations so that patients and visitors can navigate the complex more easily and be fully aware of the services offered.
