Muli Bwanjee! Greetings from Blantyre, Malawi. Emily and I arrived Wednesday afternoon, where we met up with Jacinta, Carissa, and Caleb at the Beit International Cure House. I’ve finally unpacked, and so far our stay has been great. Our house is equipped well: there is a kitchen where we cook most of our food, a living room, a few bathrooms, bedrooms, and an outdoor porch. Plus, there is a great café right next door where I had lunch yesterday (and tried Nali, a super tasty but SUPER spicy Malawian hot sauce). I’m going to make sure to bring some back with me.

So far since I’ve been here, I’ve been able to walk around Blantyre a bit. Yesterday I went to the local strip mall where I bought a SIM card, exchanged money, and bought some groceries. The big grocery store nearby is called Shoprite, and they sell fresh, homemade bread everyday. I think the five of us have polished off 5 loaves since we’ve been here. Apparently there’s a huge market nearby as well where the other interns have purchased fruit, vegetables, and eggs, but I haven’t been able to visit yet. I was also able to walk by the Polytechnic of Malawi, where Jacinta, Caleb, and Carissa have been working this past week to develop their BIOE curriculum and fix some broken phototherapy lights for QECH.

However, I’ve spent a lot of my time here so far at Queen Elizabeth Central Hospital where I was able to shadow doctors (more on that later) and meet Shannon, one of the directors of the bCPAP project here in Blantyre. For the next few weeks, Shannon, Carol (another person working full time on the bCPAP project here), Carissa and I will be traveling to many different hospitals around Malawi to collect data on how the bCPAP is being used at those locations so we can see what is going well or not-so-well.

Which brings me to some thoughts on sustainability. While I was taking an engineering design this past year at Rice, where I built a prototype of a dosing meter to be used for the phototherapy lights, the emphasis was always on building new technologies and introducing them to the hospitals in Malawi. But now that I’m here and I understand the work that needs to be done, I realize that most of what I will be doing this summer is on the back end, with implementation. When Carissa and I travel around to the various hospitals in Malawi, we will be collecting a lot of data on how often the hospitals use CPAP and with what diagnosis, training nurses to use CPAP in their hospitals, and trying to understand what the most common failures with the machine are and teaching people how to fix them. This work will take up the majority of my time this summer, while introducing the new technologies will take up much less.

I think what a lot of people observing from the outside fail to realize (including me until recently) is that the hardest part of implementation comes after the introduction. It’s maintaining and ensuring the quality of the machines that takes the most work and makes the bCPAP machines sustainable, even though the work is less glamorous. I think the same can be said about the implementation of many things in different fields: we’ve seen in the Arab Spring that revolution isn’t enough to ensure democracy or that solar panels aren’t enough to ensure clean energy. This may seem fairly obvious in hindsight, but I think that because most of the attention is focused on the front end, many people end up surprised when technologies or causes with enormous potential fall through.

Zikomo (for now)!