To my loyal readers (mainly my mom), I apologize for the lack of blogging lately. I am almost finished with spending two whole weeks at QECH. I have observed and learned so much these last 14 days that it has been difficult to process it into coherent thoughts to share with others. These last two weeks Sam and I have:

1. Started up a system to collect data in the pediatrics and maternity (for newborns) department for the bCPAP study.
2. “Fixed” the last working freezer for lab specimens for peds. The hinge was broken so the freezer wasn’t closed properly so we took out the hinge.
3. Found the physical assets management department (PAM) where medical devices go to be fixed. It is in a very hidden part of the hospital.
4. Attended morning handover meetings for pediatrics, internal medicine, and maternity.
5. Shadowed doctors and nurses at pediatrics high dependency unit and Chatinkha nursery.
6. Became best friends with people at medical records because that is where all of bCPAP charts go after the patients are discharged.
7. Realized QECH is a maze. It is essentially a hodge podge of buildings with a network of hallways connecting it.
8. Introduced the idea of the Sphygmo to people in maternity. Hopefully we can present it to them next week for some feedback.
9. We had a late friday night data entry party with kitties and brownies!

   

 

All in all, we have met some very inspiring people, but uncovered many problems that exist within the healthcare system. We have experienced some successes, but also witnessed some very sad deaths.

Chatinkha

It is TOO MUCH to talk about everything that I mentioned above in depth now, so for now I will talk about Chatinkha (which I found out today is the name of the ENTIRE OB/GYN ward). We have been spending a lot of time in the Chatinkha nursery because that is where some of the the bCPAP machines are. Babies who go to this nursery have been delivered at QECH and transferred directly to the nursery for various health problems. The main ones I have seen are RDS, severe prematurity, and birth asphyxia.

There are three main sections to the nursery:

• High Risk: These are where the babies are first admitted. Babies in this room would usually be in incubators in the NICU in places like the US. However, instead there are around 2 dozen TINY babies. At most, I have seen 4 babies cramped into a bed with a heater. But in general, space is pretty limited, and it gets especially crowded when the mothers all come to feed their child. This room is heated with space heaters.
• Low Risk: Babies are transferred to this room once they are more stabilized. I have seen many babies undergoing phototherapy for neonatal jaundice with Rice’s Bililights.
• KMC: After babies are healthy enough to return to their mothers, they are transferred to KMC which stands for Kangaroo Mother Care. This is quite adorable, because these tiny premature babies are wrapped to the mother, skin-to skin, in between her breasts, and are carried around like a kangaroo baby would be. This is so babies can use the warmth of the mother and also the mothers can constantly monitor the baby’s condition.

Malawi has the highest rate of prematurity anywhere in the world. Prematurity can be caused by a number of issues and here HIV, TB, malaria, malnutrion, and lack of antenatal care are all contributing factors. I have great respect for the doctors here. In the Chatinkha nursery, there are on average 52 babies admitted at a time and only 2 doctors doing ward rounds. There are a few students here there, but personnel is definitely lacking. Many of the babies that I have seen have been quite frail, so it always makes me extra happy when I see happy and healthy babies.

Personal accomplishments
1. Discovered that a loaf of fresh bread at the Walmart-type grocery store is less than $1
2. Bought fresh fruits and vegetables at the Blantyre Market!

Donated Clothes
Ever wonder where your donated clothes go?? Some of them end up being sold in the markets on the streets of Malawi! It is quite bizarre because there are just giant piles of donated clothes all around the city that are being sold. Some still even have goodwill tags on them. I’ve hear you can even find some really great buys here.

Today, as Sam and I were walking out of QECH to get lunch, we passed by what looked like a ceremony with a banner reading “International Day to End Obstetric Fistula.” Not knowing what obstetric fistula was, we kept on walking and had a very nice lunch. However, after I came home and opened CNN, an article about it was on the front page! Obstetric fistula is a hole between the rectum or bladder and the vagina that will constantly leak its contents. It is caused by prolonged childbirth which cuts off blood supply to tissues in that region and tissue death. And today I got to witness the first annual International Day to End Obstetric Fistula!

I think this article is a good glimpse into health problems that we are just simply unaware of here in the US.

http://edition.cnn.com/2013/05/23/health/end-obstetric-fistula-day/index.html?hpt=hp_c3

 

First day at Queens

Although Sam and I have been in Malawi for a week already, today was our first day at Queen Elizabeth’s Central Hospital. We started off our day by sitting in on the daily pediatric morning meetings. It was fascinating and depressing because the medical school students and doctors reported on all the deaths in the department over the weekend. When the pediatric department head was quizzing students over reasons why a 10 year old would have hypertension, I was quite happy to realize that I understood some of what they were discussing!

Then we went back to Jocelyn’s office (which is the best smelling room in the hospital because it is also where the soap is stored) and tested the new bCPAP. Good news: they are all functioning very well.

In the afternoon, we started setting up how bCPAP data collection would work in the pediatric ward. Aside from walking past different wards, this was my first actual experience being up close with patients. As we were tracking down patients with respiratory problems, I was astonished by the number of people that had to fit in one space. Every bed had at least one or two children in them. And every patient had a caretaker next to the bed, which further crowded the room. Since there are a limited number of nurses available, every patient usually has a caretaker which takes care of the basic needs of the patient. There are always caretakers in the grounds of the hospital doing laundry and cooking because most of these people travel far distances to come to QECH for treatment.

While going through the hospital and talking to various people, it really sounds like the availability of medicine and medical technologies are often the limiting factor of whether or not a patient can be treated. A doctor who is visiting QECH for the month said that people referenced the bCPAP as a technology that is really making a difference in saving lives. This was very nice to hear. Hopefully tomorrow we can get the bCPAP data collection started in the neonatal ward.

Malawi Mondays

At the end of the day, Sam and I successfully went grocery shopping on our own, and came back to CURE for Malawi Mondays. Malawi Mondays is a tradition here where ex-pats in Blantyre get together and eat Malawian food. Today our food was prepared by one of the translators at CURE and his girlfriend. The power went out, so we ended up having a very romantic candlelit dinner with 15 people. I got to meet a lot of awesome people and learned a lot about a Malawian’s perspective on their healthcare system.

A Casual Weekend Safari

This past weekend, MK, Sam, and I drove up to Liwonde National Game Park (this is not the exact name) and went on an African Safari! We stayed at this hotel and campsite hybrid with a great atmosphere called Liwonde Safari Camp. It was embedded seamlessly with the forest, and at night, all the guests enjoyed the company of each other over candlelight and music. My words do not do it justice.

I also learned this past weekend that I probably watched too many Disney movies as a child. Everytime I saw another safari animal, a Disney song would play in my head. It was mainly Pumba from Lion King singing “When I was a young wart hog….”, but I really think I should start broadening my movie repetoire.

More Random Tidbits about Malawi

• Don’t mess with Malawian women. They are very strong from cooking nsima everyday. Nsima is very thick and requires a lot of muscle strength to constantly stir it.
• Giraffes do not exist in Malawi 🙁
• Power outages are quite common, so don’t be alarmed if the room suddenly goes dark.
• Avocados here are twice the size of American ones for the price of 25 cents!
• It gets cold here. Trust me.
• Healthcare in Malawi is free for everyone, which has both pros and cons.

Hello again! Hard to believe that I’ve already spent a week here in Malawi. The majority of the population here speaks chichewa, and “muli bwanji” means how are you in chichewa. This is the only phrase that I’ve really gotten down here, but I am going to keep trying to learn more. Here is what I’ve been up to this week:

bCPAP Clinical Study

The bCPAP Clinical Study is bringing the device to all the public hospitals in the country and accessing the benefits of this device. In order to achieve this, they have divided it into three phases, with a different set of hospital in each phase. Each phase has a 6 month baseline period where they evaluate the current state of respiratory illnesses at the hospital, and then a 9 month phase where they implement the bCPAP and then access how infant survival rates improve with the device.

Currently, they are in the baseline portion of Phase 1. In Phase 1, data is being collected from 8 different hospitals: 4 central and 4 district. At each of the hospitals, nurse and staff have been trained to fill out these forms that collect data on patients that come in with respiratroy illnesses. Since these hospitals are located ALL across Malawi, MK and Jocelyn have been calling each of these hospitals to record down the data. However, every 5 weeks or so, they travel to go scan the form and make sure that data collection at the hospitals are going smoothly… and that is where Sam and I enter the picture!

Starting early Monday morning, we drove all the way to the other side of Malawi to the northern city of Mzuzu. After a week of many hours in the car enjoying the beautiful scenery such as the one below we had successfully visited Mzuzu, Rumphi, Kasungu, Bwaili, and KCH.

While visiting all these hospitals, I realized the massive amount of effort, coordination, and dedication required to make this study happen. So many people are involved! There is the Rice team, a team of doctors and nurses from QECH, people from the Ministry of Health, and the individual doctors and coordinators at each of the hospitals. This is truly a LARGE scale effort.

And yesterday, we visited the heavily secured USAID warehouse to pick up a shipment of 20 brand new Pumani bCPAP! These bCPAP will be brought to the district hospitals for the first time in June and July.

 

Staying connected with home

In addition to all the hospital visits, Sam and I have gotten a dongle and a cell-phone. Dongles are an awesome invention that looks like a USB drive that you plug into your laptop and magically gives you internet. I don’t quite understand how it works, but I think it uses the cell phone 3G network and you buy credit (which they sell everywhere on the streets) to insert to your account. The connection isn’t always great, but I am so thankful for it. It’s actually quite silly how excited I am everytime a webpage loads! It feels like I’m addicted to internet here because it is my connection to everyone back home.

Random tidbits that I’ve learned in Malawi

• Women here have mastered the art of carrying things on their head and babies wrapped with cloth around their back.
• Don’t underestimate what Malawians can carry on a bike. I have seen a entire furniture set being trasnported on the back of a bike.
• Always walk away at markets for the best price, and never show you want it. Yesterday, we went to a market selling all sorts of African Souvenirs. The starting price they gave me was around 20 – 30 thousand kwachas. We did an experiment this morning, and our driver, a Malawian, asked for how much a painting was and his starting price was 3500 kwacha! Almost a tenth of our price!
• Girls: keep you knees covered. It’s not proper to show your knees here.
• A staple food here is nscima, a mix of maize and water. It has the consistency of dough, and you roll small chunks of it up and eat it with your hands.
• The largest bill here is 1000 kwacha, the equivalent of $2.83. Withdrawing money at the ATM feels quite intimidating because I am literally pulling out stacks of bills.
• WARNING: Tomato Sauce in Malawi = KETCHUP!!! Do not attempt to cook pasta sauce with the tomato sauce here. We tried many times, and it did not work!

 

After 3 plane rides and a 11 hour layover in London, Sam and I have finally arrived in Malawi.

Starting at the BRC in Houston

 11 Hours in London

Sam and I had an 11 hour layover  in London and took advantage of that time to see all the major sites in London. We rode the Picadilly line into the city and saw Buckingham Palace, Big Ben, the London Eye, and Platform 9 3/4 at King’s Cross! We did this all in 3 hours and I would say we were quite successful, but exhausted afterwards. Only disappointment was that I did not see Kate Middleton while I was there; however, I did buy a postcard of her. 🙂

 

Blantyre, Malawi!!!

Flying into Malawi was very interesting. The Blantyre airport is a single room, and the airport gets 1 to 2 flights a day at most. While standing in line for customs we could see people loading suitcases onto the baggage carousel. Security was definitely a lot more relaxed than the US. Since Sam and I had to shuttle 11 suitcases out to MK (one of them didn’t make it, and will hopefully make it on the next flight in), we took multiple trips and walked in and out past customs multiple times with no problem at all. Once we got out, MK was there ready to pick us up.

We are so lucky to have MK here to help us out. She drove us to Cure House (where we will be staying for our time here), and took us to the grocery store to get food and other essentials. Cure House is a house for volunteers next to the hospital CURE. Cure is a very unique orthopedic hospital where they have the largest number of surgeons anywhere in Malawi and they provide free orthopedic surgeries to children. Their slogan is “Adults pay a fee, so children can walk free.”

Work starts tomorrow at 6 am

We are not wasting any time here at all. Tomorrow morning at 6 am, we start on a 5 day trip to hospitals around Malawi that have been collecting bCPAP data.

 

Sam and I are leaving for Malawi in less than 24 hours! Some of the final preparations include getting the technologies that we are bringing ready.

Heating Sleeve

The BTB bCPAP device lacks heating and humidification, which is included in most CPAP machines that are used in developed countries. This is not an issue in Malawi since the climate is relatively temperature; however, in order for the bCPAP to be implemented to colder countries a heating device is necessary that way we aren’t blowing cold air into premature babies. Over the last semester Sam and I have developed a heating sleeve which wraps around the tubing and heats the air as the air flows from the machine towards the baby. These last two days, we have built two new ones to bring to Malawi with us!

Sphygmo

This device measures blood pressure and alerts clinicians when blood pressure is either too high or too low.

I know I said I would be in Malawi the next time I posted, but I found some great videos about the program that is sponsoring me to go on this trip and wanted to share it with everyone.  Enjoy!

Rice profs hit jackpot then give it away – Video from Houston Fox News made about Rice 360. It talks a bit about some of the technologies that students have developed, it shows footage of the technologies being used at QECH, and it interviews Dr. Maria Oden and Dr. Rebecca Richards-Kortum about their new Day One Project. More information about the Day One Project or how you can help can be found on this website: http://rice360.rice.edu/dayoneproject

Day One: bubble CPAP in Malawi – a video about the bCPAP and how it’s being used at QECH