After a few days back home, I already miss my Malawian friends. This experience has been incredible and I have learned so much about technologies, people, and myself. On the technologies side, we came back with amazing feedback for both the CHW backpacks and the pregnancy backpack. Both these technologies have promising futures in Malawi and I cannot wait to see them scale up nationwide in the next year. The community health workers and outreach nurses have done amazing work and I hope that the backpacks will empower more community health and outreach workers around Malawi. They are my inspiration to work hours upon hours on a piece of technology and ensure that they can effectively help patients.

I’m so grateful for this experience and look forward to coming back soon. Every moment was an adventure and I have met some of the most extraordinary people. My favorite parts of the experience include traveling to the distant communities and working in the pediatric ward. It is amazing to see how one backpack can start in a design lab at Rice and then travel to the patients in rural Malawi. The pediatric ward also made me smile everyday. In a place that was sometimes clouded by sickness, it was refreshing to hear the kids laugh and smile.

Over my past six weeks, I have met some of the most happy and good people. They are the true spirit of Malawi and have taught me that there is hope even during the darkest of times. When the news only seems to broadcast war and destruction, there are good things and good people in the world who fight for what is right. So for now, it is not good-bye Malawi but tionana (see you later)!

Every morning around 8:30am, you can find me in the pediatric ward. I take the kids’ morning temperature while the nurses prepare for the day. Visiting the pediatric ward can sometimes be chaotic. There are crying babies and sick kids, but in a strange way, I love stopping by every day to take temperatures. I have the chance to get to know the kids and their moms in the ward. Sometimes, I only see a kid in the morning, but majority stay anywhere from two days to two weeks. It’s great to see a patient grow stronger and healthier over time. The two-year-olds are scared of me, because I’m a stranger (or “azungu”) with a pointy object (the thermometer). My technique of placing the thermometer under the squirming kid’s armpit has improved over the last five weeks. My favorite patients are the older kids, because they know that I’m here to help, not hurt. I can also carry a small conversation with them in Chichewa, and seeing them smile makes me jump for joy.

In the afternoon, I revisit the pediatric ward to hand out stickers. This has also helped me get to know more of the patients. Some of the kids are so perplexed by the stickers, especially when it sticks to their hand. The moms love it as well. One of the girls in the ward has been creating a fashion statement by putting small heart stickers on her ears like earrings. This has become a growing trend among moms and the older girls in the pediatric ward (I wear a pair around as well). Although the kids are sick, I enjoy bringing some kind of happiness to their day. It’s not a huge toy or surprise, just company and a cool sticker. It reminds me how the small things in life actually count and that a smile or a hug can bring more happiness than anything else in the world.

This week Z and I headed to Mulanji, located in the Southern region of Malawi. Mulanji, like the rest of Malawi, is beautiful. At the center, Mount Mulanji reaches past the clouds and Sapetwa Peak stands tall at 10,000 feet above sea level. Vibrant green tea fields can be seen for miles and stretch far beyond the horizon.

Our first stop was the Mulanji Mission College of Nursing where we met Idah and Annie. Idah was one of the nursing instructors and Annie was a community nurse at the local district hospital. Annie goes out to one of the 230 hard-to-reach areas everyday on a motorbike and will be part of the pilot project for the pregnancy backpack. The backpack contains all the basic tools and medications for antenatal and post natal care and an emergency delivery kit. Currently, the backpack is being used as a teaching tool in the college’s practical room. We received excellent feedback on the materials needed for the backpack and found a copy of the Ministry of Health’s midwifery guidelines. Idah continued to give us the full tour of the school and adjacent hospital. The hospital was complete with a pediatric, female, male, and labor ward and had a VCT clinic. Most of the nurses were either graduates or students at the college. The hospital reminded me of the Mulanji version of St. Gabriel’s. Idah also gave us a tour of the district hospital about mile down the road. This was one of the biggest hospitals I’ve been to in Malawi. Along with the normal wards, the hospital also had rooms for antenatal clinics and workshops. They worked closely with the HSAs for community outreach as well.

On Tuesday, we traveled back up north to visit St. Joseph’s College of Nursing. We met with Rose, the principle of the college, and talked to her about the pregnancy backpack. This nursing school actually has a community outreach component and they have been trying to bridge the gap between community outreach and the midwives. Rose told us the pregnancy backpack would be the perfect tool and introduced us to Zeli, head of the school’s midwifery department, and Maggie, head of St. Joseph’s community outreach department. We interviewed Maggie and Zeli and, again, received incredible feedback on the backpack. They finalized the list of what materials would and would not be needed, and we received their guidelines for community outreach as well. With the guidelines for both midwifery and community outreach, we could create a manual for the backpack that would match the midwife training and have the appropriate tools. Although the community midwife program was new, they were excited to have the backpacks. We would be sending twenty five backpacks to St. Josephs, and hopefully, continue with a nationwide scale up for all midwives. It has been incredible to see the pregnancy backpack go from a first generation prototype to a future nationwide tool.

Imagine…You are a Walgreens pharmacist and have about thirty people ready to have their prescription filled. However, you don’t know where any of the medications are to fill that prescription. This was similar to my experience working the pharmacy last week. Sister Blendina, the head pharmacist, was gone for most of the week, which left the nurses to fill in for her. She runs the pharmacy with such grace, and filling prescriptions is second nature for her. I was a complete novice and struggled to find the pre-marked medication bags. Normally, I would help Sister fill the bags or count out pills for prescriptions. Now, I stepped up to the plate and helped the nurses in the pharmacy scavenger hunt. It was a bit stressful in the beginning, but overtime, I acclimated to my surroundings and could find my way around the cabinets.
On Saturday, Sister came back and asked me to help her with filling prescriptions. She taught me “amodzi mawa masana madzulo” or “take one in the morning, afternoon, and evening”. It was a tongue twister at first, and I mistakenly said mwana (child) instead of mawa. Regardless of my lack of Chichewa, the patients were happy to see that I was trying pon gono pon gono (little by little).

Last Thursday, I had the opportunity to visit some of the volunteer community workers with Alex, St. Gabriel’s chief Home Based Care nurse. We brought the Community Health Worker (CHW) backpack and handwashing system for the patient visits. Our first stop was in the Chileka village where I met Lucy and Claudina. These two amazing women lived in the area and had been community volunteers for almost five years. They also had CHW backpack of their own to treat patients in the community. We treated two patients in this village using materials from the CHW backpack and then used the Handwashing system to clean up. I was extremely excited to see how well it would work in the field. The volunteers and Alex both liked the system and said it would be useful for future outreach trips. They said the design was easy to set up, and the only thing they needed was a bar of soap. Just from my short visit, I could see the tremendous impact the backpacks have had on communities and volunteers. As Alex said, “The CHW packs give the volunteers a role and identity in the community”. These backpacks empower the community and let community members contribute to the health of the village. The volunteers dutifully keep the backpacks stocked and report to Alex if any materials are missing or needed. So far, there are twelve backpacks in Malawi and almost 140 volunteers using them.

This Sunday was the Feast Day of Corpus Christi, or the Celebration of the Eucharist. Over the past three weeks, Danielle and I have attended Mass at the local church. Normally, it would start around 8:30am, but today was a special feast day. When we arrived, no one was in the church, and we followed a group of people to a nearby school. The courtyard was completely transformed and had decorations for the celebration. Mass started around 10:00am instead and the entire courtyard was filled with about 300 people. Everyone in the community was joyfully singing the gathering song, and the students from the school were dancing and led the procession to the altar. My favorite part was the presentation of the gifts, because everyone in the community was represented. The children, dancing, lead the way up to the altar followed by the mothers with the Eucharist and gifts, and then the fathers of the community with money collection. I have difficulty painting the entire picture of the singing, dancing, and joy, but can only describe it as true beauty.

The priest at my church would always say, “Singing (in a strong, clear voice) is like praying twice.” I can understand this more after attending masses in Malawi. Here the Mass is full of life and spirit, because everyone sings and dances. It is a true celebration of the Eucharist!

Today, I went on an early morning run through the nearby village. The community was awake and doing their normal Sunday morning chores. Two kids in the community joined me on my run (without shoes), and I had to try to keep up with them for most of the time. I practiced my Chichewa, but I only knew enough to ask them how they were doing. We ended up singing the Rocky Balboa theme song every time we ran up a hill and then would do a victory dance when we made it to the top. On my way back home, I had about ten more kids join me and we were all doing a victory dance at the end.
I have been on several runs this past week, and everyone I pass always says hello and “Muli Bwanjie?” (or in English, “How are you doing?”). When my mom and I run at home, we have a rule of saying good morning or good afternoon to each runner we pass. Most runners are too concentrated on their pace or have their iPod on too loud to return the greeting, but there are a few runners who will wave back. In Malawi, everyone takes their time to greet each person, and most of the time I slow down to say “Ndini bwino, kaya inu?” (I’m good! How are you?). I love it, because it builds a stronger sense of community. Everyone is looking out for each other whether they are at St. Gabriel’s or walking in the village. It also reminds me to slow down and enjoy the company.
So, muli bwanji?

This week we presented our technologies to the St. Gabriel’s staff and received amazing feedback. Our technologies included the Global Field Microscope, Malaria and Tuberculosis Field Staining Kit, Sally Centrifuge, bCPAP (Bubble Continuous Positive Airway Pressure) Machine, Hands-free Hand washing System, Dose Right Clips, and Pregnancy Care Backpack. Rice students have spent the last semester or year developing these technologies through the Global Health Technologies program. My group and I spent the last semester developing a field kit that contained all the materials for proper Malaria and Tuberculosis staining, and Z and Danielle spent the last year developing the Pregnancy Care Backpack for midwives traveling to rural communities.

Dr. Kiromera, St. Gabriel’s Medical Director, was impressed with all the technologies and especially excited about Global Field Microscope. This microscope is inexpensive, compact, and does not require energy except for the battery powered flashlight. Also, he was extremely excited about the Global Health Technologies Program at Rice. He said, “We must work together. There is incredible brain power and ideas from the students.” He was eager to partner with the design classes as a mentor and have the students develop new technologies for the hospital.

I’ve learned that these designs are not just the semester’s end product or grade. A design has the potential to make a huge contribution to a local hospital or community thousands of miles away. I have also learned that an A in the classroom does not always guarantee an A in the real world. Practicality and culture sensitivity play huge roles when introducing new technologies in a different country. There are thousands of ideas for new projects here and room for improvement in our current designs. I will always remember Dr. Kiromera’s wise words. He told us “I am happy that you are thinking globally and that you are here. You are our youth and our next generation. These technologies will help us work together and solve one common goal.” The feedback and encouragement from the staff has motivated me to seek more input and find ideas for future projects.

These past few days were pretty busy in the hospital. On Monday, Z was off on an outreach clinic adventure and Danielle and I visited the laboratory and labor ward for the first part of our morning. We talked to the lab technician, Lemison, and asked him several questions about Malaria staining and other diagnostic tests. According to Lemison, the lab normally performs forty to fifty Malaria diagnostic tests a day and uses Field stains for thick and thin smears. Although this is the dry season in Malawi, most of the children admitted to St. Gabriel’s are admitted for Malaria. I can only imagine this number will double or triple during the wet season. The lab also had several machines to perform blood tests, but limited resources to diagnose cancer. The hospital normally diagnoses a patient with Leukemia through a full blood count once a month. Later, we visited the blood bank, which had a Hemocue and rapid tests for HIV and syphilis. The hospital uses these devices to check for HIV, anemia, and syphilis before accepting a blood donor.

In the afternoon, Danielle and I had the opportunity to shadow Dr. Kiromera on his rounds through the male ward. The first patient we visited was an interesting case. He had various symptoms including high blood sugar, headaches, a blind, red left eye, and seizures every ten to fifteen minutes. The doctors and medical students could not find a diagnosis that explained all of his symptoms. The more frustrating part was not the complex case, but the lack of tests to run on the patient. In the US or as seen on the TV show, House, the patients go through endless tests and screenings to determine their diagnosis. In Malawi, however, the hospital can only run a limited number of tests and the doctor must decide the diagnosis from the tests results and previous medical history. For this patient, his past medical history was vague and did not hint to any direct diagnosis. Even if CT scans and MRIs are available, other factors must be considered such as costs and travel. Dr. Kiromera treated some of the symptoms in hopes of finding answer. I could not let this case rest, and thought about this patient for most of the night. After typing in the symptoms into webMD.com, I could only conclude that he might have a complex case of Type II Diabetes (but then again, I am NOT a doctor).

This week, I hope to spend more time in the lab and figure out what other tests are available at St. Gabriel’s and other hospitals in Malawi. So far, my eyes have been opened to the challenges that face the doctors at St. Gabriel’s, and I have the upmost respect for their patience and resourcefulness.

Finally, after about two days of travel, Danielle and I made it to St. Gabriel’s Hospital. Yesterday, we met the other volunteer doctors, medical students, and nurses at St. Gabriel’s and shared a wonderful home cooked meal. Today, Z gave us a tour of the hospital and introduced us to the staff. We visited the pediatric ward, women’s ward, and labor ward and helped take temperatures of all the kids in the pediatric ward. Luckily, all our technologies made it through customs. We practiced testing the Sally Centrifuge and the CPAP machine to prepare for our technology presentation on Wednesday. Later, we helped one of the sisters organize medicine in the pharmacy. Although today was a quiet day at the hospital, it was a great start to my six week journey! I am incredibly excited to get to work.