PAM, Maternity, and More Data

This week we are finally getting settled at Queens and can now successfully (for the most part) navigate the maze of hallways and trails. Here’s a summary of what we’ve been up to lately:

Fixed a freezer for the laboratory (mostly). It closes now at least!
Ordered batteries to put in the thermometers for the neonatal center (they currently do not have any functioning thermometers)
Continued data collection in the different areas of the pediatric ward for CPAP data
Located the Physical Assets Management –PAM (the engineering department)
Met the head of department for Maternity and shadowed around the maternity ward to investigate the possible use for the Sphygmo device

PAM

We have certainly learned a lot in the last few days about some of the problems the staff are constantly facing. I’ve heard before that PAM tends to be more like a technology graveyard than an engineering department where equipment is repaired. When we arrived, the employees were very welcoming and were happy to show us around. I realized quickly that it was not for lack of trying that the equipment never makes it back to the hospital. Here are some of the key issues that I noticed :

Instead of giving PAM a budget to order parts to fix the medical devices, this task is in the hands of a higher up hospital administrator. This means that the parts usually never get ordered (presumably because the money is not available).
All of the different types of equipment have different brands and often require a company specific part to fix it.
A lot of donated equipment arrives at Queens unable to be used (partially or completely broken, in a foreign language, uses the wrong voltage and without a transformer, etc. )
Warranties on the equipment run out by the time the company gets around to fixing a device.
Hospital conditions shorten the life of the technologies. For example, one staff member thought that oxygen concentrators give out especially quickly at Queens because the mop water on the floors gets sucked up into the air compressors and contaminates the sieve bed- a very expensive part to replace).
A lot of parts are expensive to begin with and can only be ordered from the US.

It was frustrating to see so much equipment just useless and piling up there with a perfectly competent staff that can easily identify the problems. Especially the rows upon rows of oxygen concentrators, which the hospital is short on and is used in conjunction with the bCPAP. However I am looking forward to hopefully helping out at PAM and learning more about their work.

Maternity

This morning we went to the morning handover meeting for Maternity so that we can eventually present the Sphygmo device to their department and learn more about the appropriateness/need for the Sphygmo and other possibly projects. The Sphygmo is a continuous blood pressure monitoring device that automatically measures blood pressure at set intervals and has a light indicator for when the blood pressure is too high or low. The very first presentation we heard by a medical student at the meeting essentially highlighted the need for frequent blood pressure measurements in the post-natal ward and all the wards in Maternity in general . A woman had died after having what was considered a normal birth because her blood pressure was not monitored after the delivery, and her condition escalated quickly in the post-natal ward. It was good motivation to pursue feedback for the Sphygmo! Here are some things that I learned or was surprised by throughout the wards:

The sheer volume of patients and the number of deliveries every day. In fact there are so many deliveries that the nurses actually deliver the babies on their own, while the doctors handle only C-Sections and special cases.
The number of women that needed to be treated following an attempted abortion at home (abortions are illegal in Malawi).
The absence of fathers and family members in all of the maternity departments.
The high number of pre-term babies due to a wide range of medical conditions (malnutrition, malaria, TB, etc.)
The delivery ward was eerily quiet despite constant deliveries.
Sonograms are only performed for very special cases when there are medical complications.

Overall, the doctors and other medical staff seemed to like the idea of the Sphygmo and thought it could be very helpful. They also gave us some good feedback about some issues with it that occurred to them. For example, the Sphygmo has only a visual alarm, not an audible alarm, and many women do not have guardians or caretakers with them to notify a nurse that their blood pressure is dangerously low or high. Many staff members commented that people have enough trouble operating a regular blood pressure device. It would need to be very simple and straightforward to operate or else it would likely not get used.

Well I don’t want to be a Negative Nancy, since there was also lots of great work happening this week, including our improved cooking skills here at the house! This week really flew by and it feels like the whole summer is going to be over before I know it. Hopefully soon we will be in a good position to present the technologies we brought over, including the bCPAP sleeve, the phototherapy light stand, and the Sphygmo. In the meantime, we are constantly brainstorming possible technology projects to take back to Rice. We also got some good ideas today from medical students about new technologies that would be helpful. The success of the bCPAP and the Bililights are fairly well known here and give us a lot of credibility with the people we meet! I believe we are referred to as the “CPAP girls”.

This weekend we will relieve our busy work lives with a lovely hike up Mt. Mulanje, the largest mountain in Malawi. I am sure it will be different from hiking 14ers in the Rockies, but I have no doubt it will be equally awesome!!