Tuesday we did our final presentations. That morning I was scared. On Monday the digital display stopped working all together (thankfully it wasn’t anything wrong with the circuitry) but the temperature wasn’t displaying. So we decided to just attach the LCD display we had just so everyone can see that the temperatures were correct. We went ahead and stuffed the components into the box. Nothing. It all stopped working. So ya Tuesday I was petrified. I was waiting at my table and I checked my phone to see where Tim and Matthews were. And I saw a video the two sent me. It was a video of Matthews turning on our device, completely encased and attached to the armband. And it was working. Monday I was prepared to showcase our semi-fictional device. It’s ok if it wasn’t perfect. But my teammates saw that I was a little disappointed and they snuck the device home with them and got it to work.

The second they walked in the door that morning I gave them the biggest hugs ever. We did it. All the work we put in this past month and we got our device to work. And we were ready to present to the others what we did. Slight roadblock the computer kept freezing during our presentation haha. But otherwise it went amazing.

I cried Wednesday. I knew I would. We came in the day after the presentations to clean up our tables and give Francis and Andrew all the research and documents we had about our device. I took my team out for lunch. Matthews bought me a cute fluffy Pom Pom keychain and Nafe got me these beautiful earrings.

After lunch I thought to myself wow I’m doing a good job of holding myself together. We were about to leave to go back to the lodge and I have yet to cry. But then Timothy did it. I sat down next to him and he looked at me and said “Akshaya you are our team leader and you have also become my sister. And like my real sister I will miss you so much. I am crying in my heart so much thinking of you leaving. But I promise our paths will cross again. And I’m so proud of you.” I started bawling my eyes out. Matthews and Timothy held me and laughed saying that we’ll see each other soon and to not cry. The interns all swarmed around me and gave me hugs. And they sent us off in our taxi. I cried the entire way home. I’m going to miss them so much. My friends I’ve made in Malawi have been so kind and so supportive and so welcoming. They have helped us so much during our time here and they have taught me so much.

I wanted to say thank you to all the people I’ve met in Malawi, especially the Poly interns. Thank you Gloria for being so open and hilarious. Every time I hear your contagious laugh, I laugh too. Alfred, I could listen to you talk forever. I love the stories you tell us. Isaac, you are so focused I hope I can be as driven as you are. Thank you Nafe for being so sweet to us. You made sure we were taken care of every day (like when you got us those beanies so we wouldn’t freeze on the mountain). Thank you Taonga for your kindness. You taught me the handshake that you and your sister do together and that was just so touching. You welcomed us with open arms and I am so grateful for you. Demobre you never failed to make me laugh. You say the funniest things, and you always had our backs. Finally, I wanted to thank my two teammates. Timothy, you are so passionate and knowledgeable about what you are doing. Whenever something wasn’t going our way, you were calm and confident in us. And you taught me a lot about coding and elec. Matthews, you were always so positive and patient. You always took the time to explain things to me, and you were always quick in coming up with solutions when we experienced roadblocks. I loved meeting these amazing people, and I hope I will be able to come back to the Warm Heart of Africa and see everyone again soon!

The second to last week in Blantyre. The last full week of our internship. This week I think is the week that it hit me. It hit me how unbelievable this experience has been for me. This week was very stressful no doubt. I think the most stressful week for me. Our device just stopped working again and again and again. Friday I was so jittery watching Matthews and Timothy try to put all of our components into the case of our device. We switched on the device. Nothing. Everything was working before and Friday it just stops. I was so stressed out my hands were shaking.

But my teammates, my supportive positive teammates looked at me and started singing Every Little Thing is Gonna Be All Right. Haha a little cheesy but what I needed in that moment. They told me don’t worry. They said we worked too hard for this to happen. Everything will be ok. Sometimes I lose sight of the big picture and get so stressed at every single step. They made me remember what this internship in Malawi was really about. It’s about all the things we’ve been learning. And it’s about the connections we’ve made. I’ve made really strong connections in Malawi that’s for sure. My teammates laughing and singing, telling me it will work out. That was one of the most memorable experiences of this internship for me. I love my teammates, I love what I’m doing, and I love that I’m learning so much. Afterward, they pulled me aside and said to take some goofy pics. I definitely became less stressed because of them.

Saturday morning I wanted to get some money out from the ATM because Matthews and Timothy wanted to help us buy gifts at the Blantyre marker for our friends back home. I put in all my information, my card came out of the machine like normal, and I tried to take it out. It was difficult because I just painted my nails and it was raining. I guess I took too long because the machine ATE MY CARD and didn’t give me my money. I was shocked. So I had to run into the bank and ask one of the tellers to get my card back. We were going to be late meeting Timothy and Matthews so we ran all the way back to the lodge.

Despite that, I had such a great time going to the market with my teammates. They helped us a lot, showing us the best places to get gifts. We also got to go eat at KFC. The ice cream and fries are AMAZING.

Sunday my friend Daisy (who came to the secondary schools last week with us) invited Sajel and me to her house for lunch near Limbe! When we got out of our cab we heard really fun music playing loudly nearby. Apparently there was a wedding happening, and weddings are a huge deal. We walked over to Daisy’s place where we were greeted by her siblings Teresa and seven year old Horrace. Horrace was especially thrilled to see us. They showed us their family’s chicken farm, and Sajel and I got to hold a chicken.

As you can see, I was TERRIFIED. It was great just talking to Daisy and playing with Horrace. I was really sad because I wish we spent more time with Daisy. But Daisy who is wise beyond her years told us that some friendships don’t need a lot of time to become so strong.

Day 34

So funny thing. We took out our device, measured ambient temperature, and it was all good. It seemed like correct temperature readings (it’s 19 degrees in Blantyre, and that was what our device was measuring). But then Timothy wanted to see if our device would go off when someone had a fever. Of course, no one around us had a fever (I don’t think…I hope not anyways). So Matthews brought over our soldering iron and held it next to our thermistor. And the temperature DROPPED to 9 degrees Celsius. Ya…I don’t think our soldering iron is that cold considering how many times I’ve burnt myself with it. Apparently, something in our code was making our device read a drop in temperature when there was actually a rise in temperature. Our device reads the correct voltage changes when we tested with the multimeter, but we had a bug in our code that was converting the voltage values to the wrong temperature readings. I’m glad there was some trend in the error because if our device was just outputting the wrong temperature readings, I don’t know how we were going to fix that (and I definitely did NOT want to solder all over again).

Timothy and I did some research and found a revised code and equation we could use. After uploading this code, our device was reading the correct temperature and was reading an increase in temperature when the ambient temperature was also increasing. Yayyyy!

Day 35

I had lunch today with a girl I met at the presentations a while ago. Her name is Yvonne and she’s from Zomba (an hour or so away from Blantyre). She’s a third year studying civil engineering, and the crazy thing is she’s only 18 YEARS OLD. She started school really REALLY early which is crazy! We were talking about a lot of things like the school system in Malawi, jobs, day-to-day life and I’m always so amazed by how different life is here compared to the US.

Day 36

My awesome team fixing our somewhat working project.

Day 37

Gloria who is wonderful invited the interns to her house off campus for dinner. We rode the minibus after work (my first time, it was so cool) to her neighborhood five or so minutes away from the Poly. We got to her house and we met her roommate, some of her housemates, and her other friends. I got to see how nsima is made, and I got to talk to some other students who got to the Poly. It was really awesome to see how the students live their day to day lives. And Gloria made really great food for all of us.

Day 38

Women In STEM, a global organization promoting girls to pursue STEM, invited me and Sajel to visit some secondary schools in Thyolo and talk to the girls about our experiences in STEM. The Thyolo Secondary School was so pretty and I got to each lunch with some of the girls there! They told me about their favorite music and what they do in school, and they taught me a few more phrases in Chichewa. After lunch, myself, Sajel, a few girls from the Poly, Faith (who led our trip to Thyolo), and Dr. Teresa (the former dean of engineering of the Poly) spoke to the girls and we had such an awesome time! The girls were tasked with building a tower with uncooked spaghetti and balancing a marshmallow on top. And I have to say they are very talented. I had to do that challenge last semester and our tower collapsed.

Day 39

We left early this morning to go hiking Mt. Mulanje. And I was TERRIFIED. Why were we hiking so much in two days our legs are going to be LITERAL JELLY. We were supposed to hike all the way up to Sapitwa (the peak of the mountain), but we changed our plans and chose to hike up the second tallest peak, Chambe, instead. We stayed at a cabin a few hours away from the peak and it was super cool (literally, I was freezing despite the bajillion layers I was wearing). We saw the stars really well (for a few minutes before the clouds came in), and we had a fire place so we ate a really good dinner.

Day 40

We woke up early and set off to Chambe Peak. It took a few hours and honestly the SCARIEST thing I’ve ever done. We had to scramble up a really steep slope and if I looked down, I definitely would have fallen off. It was horrifying. But we made it to the top and it was so breath taking. I honestly didn’t realize how high up we were it was crazy. Kristoffer and Franklin wanted to go higher so those two set off to scale another treacherous part of the mountain while Sajel and I watched from a distance, eating our cookies and chips. We hiked back down (which was way easier than going up haha), said goodbye to our guide Davys and his team, climbed into our cab, and passed out from exhaustion. Would I do that again? Probably not. But I don’t regret it. It was a wild experience that’s for sure.

Day 27

We continued working on our project today. Since everything was all good on the breadboard, we decided to go ahead and start soldering all the components together on a PCB board so that we could start testing the accuracy of the thermistor on the skin. On the board we could only detect ambient temperature. I think I burned myself ten times with the soldering iron but it was all done. We will see how it works tomorrow. Oh we also ate at the school cafeteria today instead of our usual spot and there were no utensils so we had to eat with our hands. But it was REALLY good food.

PS Karen doesn’t really know how to eat with her hands so Kristoffer made her a makeshift spoon out of the container.

Day 28

We went to Mikos (again) and got some really REALLY good ice cream (I got a flavor that tasted very much like McDonalds soft serve). This was after I got really frustrated because the soldering was so bad that our thermistor was reading really wrong temperature readings. We spent all day trying to fix it, but in the end we just took everything apart and agreed to re-solder everything the next day. I took my frustration out when we went rock climbing that night. There is a boldering wall in a field behind a high school (kind of random) and it was so fun.

Day 29

We soldered our device once again and are hoping to see if this time, we get accurate readings (it took ALL DAY). I was really exhausted after burning my hand four times and wanted to just sleep, but we stopped at a café near our lodge. There was a poetry reading there, and it was actually really great. I’m not a huge poetry fan, but everyone that was reading a poem was from Malawi and talking about Malawi. It was really moving hearing what they had to say about their country and lives. I liked it a lot and we are definitely going again.

Day 30

Today was the last day before the three day weekend. We finally got some right numbers on our thermistor (yay thank you Matthews for helping me do a MUCH better soldering job this time). What a satisfying way to end the week and start a three day break. Hopefully next week we can start testing our device to see if it measures accurate body temperature (fingers crossed).

Day 31

We woke up early this morning and it was cold and rainy. But I was really excited because we were going to Lake Malawi! It was a five hour drive (I never get car sick but the road was so rocky at the end I almost threw up). We got to Cape McClear and passed by a bunch of SUPER PACKED lodges. I was a little worried that we would be staying at a super crowded part of the lake. But when we got to our lodge I was so happy. There was literally NO ONE there. It was quiet and empty and so pretty. And it was warm! That night was probably my favorite experience in Malawi. The five of us went to the beach right in front of our dorms and we laid down on the sand and looked at the stars for such a long time. It was so quiet and we could see parts of the Milky Way! I’ve never seen so many stars in my entire life it was amazing. It got kinda cold but we all huddled close to one another and just stargazed. It was the best.

Day 32

We got on a boat today that took us to an island off the coast. Apparently it’s a really great place to go snorkeling! I was really scared I’ve only been “snorkeling” in our pool, and the water was really choppy. ingested a lot of lake water. And I almost got hit by a boat while I was underwater. But it ended up being super awesome! We also fed eagles, and two eagles ran into each other mid air while diving for some fish it was wild.

Day 20
Since we got our projects assigned to us, we visited our first hospital today to ask specific questions about our project. We started out by going to Zomba (which apparently is nicknamed Texas according to the Malawian interns? I’m still not sure why…). We visited the maternity and labor ward at Zomba Central Hospital, and met up with Daniel (the nurse I met a couple of weeks ago when we visited different hospitals). I got to ask him a lot of questions regarding the maternal temperature monitor. Ideally during labor, temperature should be monitored at least every one hour. However, because there are 25 mothers and only 1-2 nurses on duty at a time, temperature is actually monitored every 4 hours. And the main reason the ward runs out of digital thermometers is because of the batteries. They have a really short lifespan, and it may take a while for the pharmacy in the hospital to order more thermometers. The last time I visited the hospital, I noticed a TON of posters all over the walls with information for the nurses. There were posters about how to measure dilations, infection prevention protocols, what to do immediately after the baby is born, and other helpful tips for the nurses. I asked today if the nurses had a book with all this information that they could refer to quickly rather than searching the walls for the information. Daniel told us that a handful of books with this information were distributed around the hospital a while ago. There aren’t enough books for everyone, but the few nurses who got to keep these books will refer to them often. I’m hoping that we could try to get the necessary information on the posters and maybe compile it all into pamphlets for the nurses in maternity to have on hand.

Day 21
The next day, we went to Thyolo district hospital (which was also VERY busy). We went to the postnatal ward, where mothers and healthy babies are sent to be monitored immediately after birth. Most of our focus has been on mothers going into labor, but we found that mothers after birth should be checked up on as well. The nurse told us that temperature can vary after birth, especially for mothers who were given C-sections. They have to follow a strict protocol for temperature measuring: measure every 15 minutes the first hour after birth, every 30 minutes the second hour, and hourly afterwards. However, because there are so few nurses and only a couple of digital thermometers on hand, this is not followed all the time. We also received some really great suggestions from the nurse. An LCD display would be much easier to read rather than a four digit blocky display. Our device should also have memory of the patient’s information if the nurses need to check past temperature data. The nurse also said that it may be difficult to see all the patients from the nurse’s station, so having a buzzer and light that goes off at the station when a mother’s monitor reads fever would be helpful. I really liked the last idea, and hopefully my team can come up with a way to create that.

We stopped by the market in Thyolo to get some avocados (the avocados here are AMAZING and we go through A LOT). The interns also bought us some sugar cane for the drive back to Blantyre and I guess Karen and I don’t have strong teeth like them because they finished their canes in like 5 minutes! The Poly students were making fun of us the entire time we struggled through our canes.

Day 22
After visiting two hospitals with our team, we had to present our findings to the rest of the interns as well as a few lecturers from Poly. It was interesting to see what kind of findings the others discovered while on their trip, and I’m excited to see how everyone is going to approach their respective problems. We only have three weeks to work on our solutions, so we have a ton of work ahead!

Day 23
I was pretty satisfied with today. We made it official that the IR sensor is dead and cannot be salvaged. However, we decided to go ahead and use a thermistor instead. We updated our code and changed the circuitry of our device to include the thermistor, and everything seems to be working! We just have to see if the device is reading the correct temperature values so cross our fingers that it is.

Day 24
Yeah so our thermistor isn’t reading the correct values. We tried changing the resistances of our circuitry and after getting some readings like -75 degrees Celsius and 137 degrees Celsius, we finally got an accurate reading. Yay! Now we have to see if the device will accurately read body temperatures.

Day 25
We prepped all day for a BBQ with our interns! They came over later in the afternoon and we cooked with them and got to see them outside of the Poly which was a lot of fun!

Day 13

We finally met the interns from Poly today! There are 8 of them, all finishing their fifth and final year here. It was really exciting to get to see who we would be working with for the next month. We did a bunch of introductory/get to know you stuff (like a scavenger hunt, which we placed dead last because we don’t know what a jigsaw looks like haha). But I’m really excited to start working on our projects with them!

Day 14

Francis and Andrew brought some broken syringe pumps and oxygen concentrators from Queens and we got to see how they worked. It was really cool because I had no idea how these devices were used. They opened them up for us and we got to look around and really get an understanding of how these devices may break down. A lot of the potential projects are based around syringe pumps (like a making a device that will stop the machine if the syringe pump starts to overflow with fluid) and oxygen concentrators (like an improved filter that will prevent dust from entering the machine).

We got our projects assigned today and I will be continuing to work on my temperature monitor along with Timothy and Matthews! We are all very excited to start improving the device, so I can’t wait to see the improvements in the next four weeks.

Day 15

We had a microcontrollers crash course today and I had a lot of fun! We learned a lot about how an Arduino works and we wrote some basic codes to turn on LED lights, display things, and read temperature with a thermistor. I really liked how hands-on everything is. I’m learning a lot thanks to Francis and Andrew for letting us play around with different things in the studio. And I think with a better understanding of the Arduino, I will be able to improve my code and my the temperature sensor more sensitive for my device.

Day 16

So the Poly students all have HUGE final projects that they have to present Saturday so they were all scrambling in the design studio to make them perfect. We didn’t want to get in their ways so we practiced using Autodesk Inventor, which is the program the design studio uses to create files that can be sent to the 3D printer. I am VERY bad at drawing, so I was happy to get a lot of practice. I made an elephant which I was very proud of. Maybe I’ll print it.

PS: We went to Mikos and got some ice cream and it was REALLY GOOD.

Day 17

I decided to work on my device some more, and I was pretty upset when I found that the IR is broken. And that was the ONLY IR I had on me. My device was reading numbers like 210 degrees and I am pretty sure that’s not correct. But I think the design studio has some extra IR’s, so hopefully we can use those and readjust our code depending on the model. We were also thinking of going back to a thermistor since they are way cheaper. A thermistor has a longer warm-up time than an IR, so our team back at Rice opted for an infared sensor instead. But I am hoping to do some more tests and see if I can reduce the time to warm-up a thermistor. Oh and today was very exciting because our sixth intern, Kristoffer arrived! So we have our entire team here in Malawi!

Day 18

We drove an hour and a half to the Majete Wildlife Reserve in hopes to spot some animals! We camped over-night (it was pretty nice, except it got VERY COLD) and went on three different safaris. We saw a lot of gazelle-like animals call Nyalas and we saw a family of elephants! It was really cool how close we were to them. We took a boat down the river in the middle of the reserve and saw a bunch of hippos! It was really amazing. Oh personally, warthogs were my favorite animals that we spotted. They are part of a group of animals called the Ugly Five which is rather unfortunate. It’s ok warthogs I appreciate you.

Day 8

Sajel and I visited our third and final hospital in Zomba, which happened to be a central hospital rather than a district hospital. In fact, Zomba is the first central hospital built in Malawi. A lot of the older, more worn down parts of the hospital were built in the colonial times. Zomba was also the very first nursing school in Malawi, and Prince said he came to Zomba to train during his nursing school days.

In the nursery, we saw many of the same problems as in Thyolo and Mulanje.

1. There are 30-40 infants, but only 3-4 nurses on duty. This is common in all the hospitals we’ve visited, so it makes it so difficult to test vitals and constantly check on the babies.
2. We saw a continuous monitor in the corner of the ward that tracks temperature, oxygen levels, and pulse. However, it was broken and the spare parts were not readily available, so the nurses couldn’t use it.
3. Sajel and I saw a baby being treated with gastroscesis there. I never saw an actual case of gastroscesis until that moment and it was truly eye opening. The nurse told us that since Zomba was a central hospital, they were able to treat gastroscesis. However, they didn’t have the special plastic gastroscesis bags (just like in the previous hospitals), so they used gauze also to cover the intestines prior to surgery.

We met Daniel at maternity and he told us that the most challenging aspect is checking for contractions. Ideally, the nurses try to check for contractions every hour by feeling with their hand and checking the amount of time between each contraction using a stopwatch. However, there are sometimes only 2 nurses for over 20 patients every day, and it takes at least 10 minutes to do this measurement. Daniel was really excited to talk to us because he is a huge advocate for maternal health. Every year he hosts a walk from Blantyre to Lilongwe (which is over FOUR HOURS AWAY by CAR). The walkers will stop at various locations and host events and talks educating people on maternal health! It’s such an amazing initiative and I’m excited to have gotten his contact information so I can learn more about what him and his team do!

Visiting PAM at every hospital was equally discouraging because it was like a graveyard for donated medical equipment. There were oxygen concentrators (which are so important for babies with birth asphyxia), syringe pumps, constant monitoring systems, and so many other devices that could be used in the wards but aren’t because they are broken. These devices may last for 6 months to a year, but then break down. Since these devices are donated from all over the world, it is difficult to order parts and components. And there are a ton of models for all the devices, so it is both expensive and inefficient to order components for all these different models.

Often times, these devices are donated with no user’s manual, so nurses and staff are not properly trained on how to use the devices. Furthermore, PAM workers are unsure of how to fix these devices. It’s so frustrating seeing this because sustainability is so important when it comes to medical devices. They can’t be donated without proper training to both the nurses and PAM workers and access to parts. Otherwise these devices will be unused and gaps will still exist in hospitals like Mulanje, Thyolo, and Zomba.

Day 9

We went to Queens today for a second time, and after visiting the district hospitals, I was able to see a lot of overlaps. Although Queens is one of the primary hospitals people are referred to, there are still some gaps. For example, the nursery had about six different syringe pumps,  but none of them were being used because they were broken. And only two out of the six or so radiant heaters were working. For the most part, kangaroo care is heavily depended on (just like the other hospitals we visited).

And the PAM area was HUGE. There were rows and rows and ROWS of devices. It was bigger than any other site.

The PAM specialist told us that if the parts are available, they could fix devices in under an hour. But because parts are really hard to get, they are just holding the devices there. Some of the machines like the oxygen concentrators have been there for 2 years! We even saw an entire MRI machine 😮

Day 10

LAUNDRY DAY. Once again, I added too much laundry powder. Now, my pants are going to be crunchy like a chip.

Day 11

We drove out to Limbe today and visited the market there! It was HUGE. There were so many stalls lining the busy road, people yelling and bargaining for things. There were A LOT of shoe stores haha. I ended up buying really pretty cloth called a chitenja, and people use them for swaddles, dresses, and other things! I can’t sew but I’ll figure out something to do with it.

Day 7

We split our group up into two teams and ventured to some district hospitals today (we always move in a pack so this was the first time we separated). We planned to focus our visits on three aspects of the hospitals: the nursery, maternity ward, and PAM (physical assets maintenance area or the place where hospital staff send off broken medical equipment). Prince, Andrew, and Jeremy (a bioengineering student) first took me and Sajel to Mulanje. I thought Queens was different, but the Mulanje district hospital wasn’t like anything I’ve ever seen.

The hospital in Mulanje was about an hour and a half drive from Blantyre. We drove up a winding hill and reached the hospital, which was at the base of Mount Mulanje. The clouds were so close I thought I could touch them. The hospital was much smaller in size compared to Queens because Mulanje is a district hospital. Prince explained to us that there are three levels of medical care people can receive. People will first go to small local health centers, which are spread throughout all districts in Malawi. The health centers have midwife technicians and medical assistants, but no clinicians or doctors. If the condition is too severe, people can be referred to the next level of care at district hospitals. They are larger and have one clinician, a registered nurse at every ward, and interns. These district hospitals are better equipped at handling more serious conditions, but may not have specialists or general surgeons. As a result, people may then be referred to the final level of care at central hospitals (such as Queens). Prince told us that it is important that the earlier levels of care are improved as this will reduce the amount of time people have to spend untreated. If people have to be constantly referred, they will spend more time travelling to far off hospitals and risk making the condition more serious.

Our first stop was the nursery. We walked into a small room with cots lining the walls. The registered nurse greeted us before we asked her some questions about the infant ward. We talked A LOT, but I’ll only cover a few of the things we discussed:

1. The registered nurse told us that power outages were extremely common. Although they do have backup power via solar energy, this only lasts about an hour before running out. Babies with hypothermia who are placed under the radiant heaters are at risk and must be put in Kangaroo care (warmed by their mothers’ body heat). As a result, hypothermia is a leading cause of infant mortality at Mulanje
2. Birth asphyxia is another primary cause of infant death at Mulanje because there are no available oxygen concentrators.
3. Gastroscesis (a condition where babies are born with their intestines outside of their body because of a large opening at their stomachs) is very common. But these babies are sent to the central hospital. Plastic gastroscesis bags to hold and protect the intestines are not available, so the babies intestines are covered with gauze as the baby is transported to Queens. This is very dangerous, however, because the gauze absorbs moisture from the intestines, destroying them. Sajel showed her prototype gastroscesis bag to the nurse and she got some great feedback!

After thanking the nurse at the infant ward, we moved on to the labor ward. It was very busy when we visited, so we couldn’t spend very much time there. It was so crowded, in fact, that all the beds were taken and patients had to be treated on the floors.

1. Thermometers are not available (because they break down or are missing), so nurses have to check the temperature of mothers using their hands. Fever is extremely common because of malaria births, so lack of thermometers is a huge problem (I was also able to briefly show them my prototype and the feedback I got was extremely helpful!)
2. The nurses use the metal fetal heart beat scopes to check the status of the fetus during labor. There are only a couple and with over 30 patients being seen every 24 hrs, it can be difficult to constantly monitor the fetus. I looked behind me and noticed a box of 4 or 5 fetal monitors and I asked why they weren’t used. The registered nurse told me none of them were working and that no proper training was given when the devices were introduced at the ward. Prince told us that checking the fetus is crucial because if they notice something wrong, they can take immediate measures. But without knowing how the fetus is doing, labor may be prolonged. As a result, birth asphyxia is a common condition there.

We drove another hour and went to the much larger, much newer Thyolo district hospital. Thyolo sees almost double the number of patients as Mulanje, but there are almost the same number of nurses still on duty. As a result, constant monitoring for the patients is quite difficult.  There is a high rate of birth asphyxias as a result of fetal distress during labor (due to the inability to continuously check the status of the fetus). Gastroscesis is also a common condition seen by the nurses, occurring about once every month.

What stood out to me most on our visit to Thyolo was something the registered nurse at the infant ward told us. She said that the members of the CPAP team for Rice 360 were their only suppliers for supplies like oral gastric tubes and suctioning tubes. If the CPAP team were to stop visiting the hospital, Thyolo would lack a sustainable supplier for these medical equipment. This was really shocking to me because without these devices, it is very difficult to provide oxygen for babies with birth asphyxia and nutrition for premature babies who lack the correct reflexes to feed.

Ok we did A LOT so imma split up my blogs for this week 😀

Day 6

I tried to dress semi-nicely today because we presented our devices to the Dean of Engineering at Rice, the Rice 360 staff, students and teachers from the Polytechnic school, and people working for the US Aid. Agh I was very nervous but it was actually a lot of fun! Our devices as well as some devices made by students at Poly were set out on the tables in the Design Studio, and it was so cool getting to see everyone’s designs. And it was so lively there were so many people running around and asking questions I loved it. We met Sanga, who is incredible. He taught himself electronic design from books and videos, and with that knowledge, he made a low-cost portable monitor that tracks and records ECG, temperature, and heart rate data! And he’s planning to work with some telecommunication students so that the data in the device can be sent to a phone app. He explained to us that with this device, smaller hospitals that are farther away from the city will be able to gather key information and send the data to cardiologists and other specialists at larger hospitals. It’s unbelievable he is so passionate about his device and he won an engineering design competition with his entry!

We met another team that designed and 3D printed a drone that can be controlled from a phone app! They flew it for us (it was difficult since we were inside and it hit the wall a couple of times) but it was amazing! I was also really happy because I got some great feedback on the continuous maternal temperature monitor my team and I were working on (this device essentially reads temperature continuously for mother’s in labor and warns nurses using LEDs if the mother is experiencing intrapartum fever). I have ideas now on how to make it smaller, more comfortable, and more efficient thanks to the Poly students:

1. Use the IC directly from the arduino nano rather than the entire component to make the device much smaller
2. Use a flexible plastic case rather than a brittle 3D printed case so the device can fit more naturally on the mother’s arm
3. Use larger LED lights so nurses can better see if the mother is experiencing intrapartum fever

I cannot wait to meet the Poly students we will be working with next week because these guys are so ambitious and driven. They are so passionate about the things they do and I cannot wait to start designing with these guys.

Side note I got a LOT of recommendations for places to get ice cream in Malawi 😮

1. KFC – according to Francis, KFC not only serves fried chicken but really great ice cream (I wish they had that back home)
2. Mikos – Erica (a member of Rice 360) told me that this dessert bar serves amazing ice cream in soft, warm waffles (this is going to be a problem for me considering how DANGEROUSLY close this is to Poly)
3. Victoria Gardens – also really close to the Poly uh oh
4. Gelato Carnival – a carnival of Gelato I guess?
5. Shoprite – I forgot the name of the actual ice cream place, but Shoprite is filled with different food places so I am bound to venture here too

Day 1:

Hi! We are finally in Malawi! We arrived at the Malawi airport Wednesday evening where we met Francisco, who gave us all big hugs as if we’ve met before. It was actually such a touching scene. Francisco is a general surgeon at Queen Elizabeth Hospital who is currently doing research on rotavirus in the city. He and Enock, another doctor at Queens, drove us thirty minutes to Kabula Lodge. The drive was amazing. There were people walking up and down the roads, bustling markets, and kids running back home after school. Everything is so lively and colorful here. By the time we got to our new home, it was pitch black (since it’s winter, it gets dark at 5:30 so it feels like the day goes by so quickly). The view of the mountains from our place is really breathtaking. I don’t think I will ever get over it. Every time I see the view, I’m always amazed 

Day 2:

The next morning, we visited the Rice 360 office and were greeted by the Malawian staff working there. We walked over to Queens next door and met Prince, a licensed nurse who also works for Rice 360. Prince gave us a tour of the neonatal ward and the stark differences between their hospital and what we are familiar with is unbelievable.

The ward can house about 60 infants, divided into high-risk, medium-risk, and low-risk. These babies were premature and had so many different complications as a result. There are only 6 or so nurses in the ward during the day, making it very difficult to monitor all the infants. At night, there are even fewer nurses on duty (2 or 3). And during this time, many babies die because of the lack of constant monitoring.

We saw some wooden boxes side by side down the middle of the ward, which were called hot cots. These cots consist of a bulb and some basic electrical components which, when turned on, quickly heats the boxes and acts as make-shift incubators for the infants. The babies were so helpless, nestled in the hot cots with the warm glow of the light over them. Prince told us that these boxes were dangerous because the bulbs often overheat and shatter. The boxes themselves were also extremely unstable. I thought some of theme were going to break when touched. However, these boxes are still used by the staff because they are simple, can be easily fixed when broken, and can be made quickly in large quantities, making them the preferred choice to despite the perfectly functioning incubator that was collecting dust in the corner of the ward. None of the nurses knew how to use this incubator and preferred the unsafe hot cots instead. This really showed me how important it is that the medical devices given to the hospitals are simple to use and simple to troubleshoot, otherwise the staff will continue to use a more basic and less effective alternative.

Prince pointed out the heating lamps lining the walls above the infant beds. He laughed as he told us that the nurses turned on the lamps when they felt cold and turned off the lamps when they felt hot. There wasn’t a way to find the ideal temperature in the ward for the infants, and there is no way to adjust the temperature.

Prince showed us his office and we saw some vials with serum samples in a test rack and a small spectrometer in the corner. He told us that he is technically on vacation, but he is still working at the hospital because he is the only staff member who is able to test the infants for jaundice by analyzing bilirubin levels in their blood. There are so many infants that come to the hospital on a daily basis, and along with his other duties he has to test every single one of them for jaundice. It’s incredible.

We left the hospital with so much information, despite this being our very first visit. We realized that there were so many different directions we can focus our attention on:

1. We can improve the hot cots so that they are safer for the infants but still easy to use for the nurses.
2. The ambient temperature in the ward can be analyzed and a temperature monitoring and controlling system can be made so that the heating lamps are not turned on and off arbitrarily by the nurses.
3. There are only a couple of monitors for the babies that measure oxygen levels, heart rate, and temperature. These monitors are also only temporary, because they are part of an ongoing project and will be taken away in a couple of weeks. Simple monitors can be made for all the infants in the ward to make up for the lack of nurses.

These are just some of the ideas we came up with. I’m sure that we will come up with many more as we continue to speak to the nurses and hospital staff at Queens. I’m looking forward to speaking with Prince again because he is so insightful and knowledgeable. He was very straight forward about what the hospital needs, what was lacking, and what we as interns could focus on for our future projects.

Day 3:

The next day, (after a VERY long period of getting kicked off one bus because it wasn’t our ride and waiting another hour for our actual bus) we went to the Polytechnic school, which is about a ten minute walk from Queens. I was second-hand stressed because the students are currently studying for their finals (for a second, I panicked and asked myself if I have things I should be studying for too). Francis and Andrew (our Malawian mentors at Poly) gave us access to the engineering design studio so we could work on our devices that we brought from Rice.

I definitely found my home in that studio. The windows were all open so it was pretty chilly, but the workspace was awesome. They had everything we had back in our OEDK, including a laser cutter and multiple 3D printers. I could spend hours and hours just working on projects there. I love the space.

Also, across the street there are some amazing shops and places to eat. So far, our favorite place to eat is Spar and they have some AWESOME pastries.

I’m excited (and a little anxious) about presenting our devices this Monday to our Dean of Engineering, a US Aid, and faculty of Rice 360. But I am excited to be getting feedback and showcasing the models that we have tirelessly been working on. After next week, we will finally get to meet our Malawian interns and I cannot wait! I know they will have so much information and knowledge about problems being dealt with here. I’m excited to see what insight they will bring!

Day 4

We spent today exploring! We met Edson, an awesome driver (and even better photographer as we found out). He took us to try some amazing Malawian tea at Satemwa (about an hour drive away from Blantyre), and it was so good. I hate tea, but I bought so much!

He took us to a local Malawian restaurant that he always eats at and the food was so good (and so filling I ate way too much). We then went to a market and bought a few things so we can do our laundry (and adventure on it’s own, I just spent four hours getting drenched and washing my clothes).