Again, I write to you surrounded by huge piles of clothes and miscellaneous supplies that, this time, are being unpacked from my overly stuffed suitcases. After the exhaustingly long series of flights, I’m finally back home with my family in DC. I had meant to post this right before we left Namitete, but the slow internet lost to my sleep deprivation. It was bit bittersweet leaving Namitete—I’m excited to be home and see my friends and family, but on the other hand, I’m going to miss Malawi and all the friends that we made here so much, and I don’t know if I’ll ever be back.

I’ll miss Katharina—our German doctor friend who lived with us at the Zitha house; her constant friendly presence turned our little threesome into a foursome. I’ll miss Aaron—the owner of Namitete’s bakery, who gave us our first tour of the village and has been our good friend ever since. I’ll miss Suave and Alex—the two people in charge of the Palliative care ward, who served not only as amazingly helpful mentors, but also as dear friends. I’ll miss Annie—a community health worker who lived at the Zitha house; she taught us how to cook nsima and always felt more like family than anything else. I’ll miss Barbara and John Gray—the couple who owns the Duck Inn and welcomed us into their home and lives with open hearts. I’ll miss so many others that I’ve had to privilege to get to know during our time in Malawi; it was such unbelievable experience!

But enough with the gooey sentimentality; I don’t want to get even more emotional right after leaving. So lets talk about something a bit more light-hearted: all of the semi-embarassing incidents that I stumbled myself into while in Malawi. Most of you that know me have probably realized by now that I’m not the most put-together person. Or the most coordinated. Or the most organized. So its not too much of a surprise that there have been many ‘flops’ during my time here. So with that in mind, I put together a list of my top ‘flops’ during our time in Malawi:

1) Flooding the Zitha House. The water goes off in the Zitha house about once a day, usually (unfortunately) right around lunch. On one particularly desperate day, I really needed to wash my hands but the water was out. So I tried all the faucets in the house, including my shower. Apparently I didn’t close the shower tap all the way, because I later learned that if you do that, the house becomes partially flooded under a couple inches of water. So a couple others and I spent about an hour wiping up the mess of my creation. My room was the most flooded, so I also spent to rest of the day washing clothes (they were all on the floor).

2) Buying mystery fruit. On one particularly busy market day in Namitete, we were wandering around, and I saw (what I thought was) a nice large pile of limes. Thinking that we might need some in the near future, I bought some for the very good price of 20 kwacha each (about 5 cents). Fast forward a couple of days, and we were craving guacamole. We cut everything that we needed to: the avocados, tomatoes, onions and peppers. And then I cut open the limes I bought, and it turns out they were actually something more like oranges! I didn’t feel so bad about this flop though, because when we sent Jesal out to get more limes, he came back with the same lime-orange things. But even though they weren’t what we expected, at least they were really tasty!

Looks like a perfectly good lime right? Nope! Its an orange.

3) Wearing black pants. The dirt in Namitete is kind of this really fine, reddish-brown dust that seems to find its way into everything. Usually I wear khaki pants, so the dust blends in really well. However, one day I had the not-so-smart idea to wear black pants. Let’s just say that my pants weren’t so black at the end of the day (I also got a few laughs from the neighborhood kids). Take note interns of the future!

4) Calling two different taxi drivers. As I’d mentioned before, during our second weekend here, we went up to Lake Malawi and met up with the Blantyre interns. Long story short, I was apparently really bad at telling the difference between Malawian cell phone numbers, and I (with the help of Jesal) accidentally arranged for two different drivers to take us to the lake. So when we were heading to Namitete (on the bike taxis) to get picked up by one of the drivers, I was really confused when I had another person call me and say that they were at the Zitha house. When we met up with him in Namitete, we tried to insist that we already had a driver. But we soon found out that we had half-negotiated with him and half-negotiated with the other driver; which explained a lot in retrospect, especially since every time he called back, he seemed to change price! Even though it was a bit frustrating, we all had a good laugh about it at the end.

5) Leaving laundry out for two weeks/ leaving out laptops and wallets. I don’t think this is particularly bad, but Jesal and Truce have constantly chastised me for it. I have a tendency to leave my things out where they probably shouldn’t be, like forgetting that I left my clothes in the laundry room for two weeks (I was beginning to wonder why I had so few clothes left). Also, I had a habit of leaving my laptop and wallet in the living room all night, next to an open window. In a bigger city like Houston, it would’ve been snatched up the first night, but thankfully, the rural areas of the country are known to have considerably less crime.

6) Sitting in the dark for 20 minutes. The lights in Namitete go out every couple days, and on one of those nights, I was just sitting in my room with my just laptop and my headlamp (they look really dorky, they’re so unbelievably helpful!). At one point, I heard some clamoring outside my door, but I didn’t think much of it. About twenty minutes later, I noticed a small sliver of light peeking through my door. Apparently I had been sitting completely in the dark, when the lights were already back on, for about 20 minutes. This wouldn’t actually have made the list if it was isolated incident, but then if I said that this was the only time that this happened, I’d be lying pretty badly.

Those were just a couple of the many little incidents, trip-ups and flops that happened in Malawi. But even though there will always be things that make an experience less-than-perfect, we can always learn from them and have a good laugh about it afterwards! I’ll come back and post one last time next week after having time to reflect on this whole experience, and when I’m (hopefully) no longer completely confused on which time zone I’m in.

A very Namitete bike-taxi sunset

In case you couldn’t tell from all of our last couple blogs, we’ve spent a lot of time in St. Gabe’s Palliative Care ward. More specifically, we’ve been working a lot on palliative care data collection, centering around two pieces of software: DataPall and Morphine Tracker (MT). While we have been making some changes to DataPall over the summer, lately we’ve been focusing on putting the final touches on the software of our own design, Morphine Tracker.

But why is the (morphine) gone?

It all started when the Palliative Care Clinician here, Dr. Suave, approached us with a problem—Morphine is a highly regulated, much needed drug for patients receiving end-of-life care, so hospitals and clinics are required to closely monitor its usage and report that data to the Ministry of Health (MOH) and other funding organizations. However, Dr. Suave and his mentor, Kathryn, recently performed a study attempting to quantify morphine usage in Malawi (which is in the process of being written up!), but they found that the vast majority of palliative care centers are (illegally) not reporting sufficient/correct data on morphine usage. Even hospitals (like St. Gabe’s), who are very rigorous about reporting their morphine usage will still sometimes make mistakes when adding up figures like total amount of morphine used, total patients on morphine, etc.

Home Screen of Morphine Tracker

As Malawi buys the morphine supply for the entire country, this poor data has apparently helped to lead to significant country-wide morphine shortages (some lasting as long as five months). The end result is that patients who desperately need morphine are unable to receive any.

“Have you ever seen a cancer patient cry [because we can’t give them morphine]? It’s very, very sad” -Dr. Suave

Trying to keep track of morphine

This is where Morphine Tracker comes in: we created the database to allow hospitals and clinics to easily track their morphine usage, and automatically create reports that already conform to the Malawian legal standard. Suave seemed very optimistic about how the software could change the way morphine is tracked in Malawi, so earlier this week, he introduced us to his mentor, Kathryn. After briefly showing her the software, she was similarly optimistic about Morphine Tracker (MT), and invited us to do a pilot implementation at the clinic she works at, Ndi Moyo Pallitive Care Center (www.ndimoyo.org/) in Salima. We plan to visit Salima this Wednesday, and we’re super excited about being able to see another site where palliative care has a very active presence.

Entrance to PACAM

We were also able to meet with the Palliative Care Association of Malawi (PACAM) to talk about Morphine Tracker. After giving a short demonstration of the software, the director of PACAM also expressed his support for the software, indicating that it had potential to greatly improve the manner in which morphine is tracked in Malawi. The overflowing optimism from our meeting with PACAM obviously did not help our patience in rolling out the software: we would’ve released it to the whole country, right then and there, if someone let us.

Urgency vs Rigor

However, when working in technology development for low-resource settings, there’s always this double-bind between urgency and rigor. Morphine Tracker is a good example of this. There is an obvious and urgent need to track morphine better in this country, and MT seems like it could be a usable solution to the problem: it automatically keeps track of the hospital pharmacy’s morphine stocks, can generate reports on morphine usage for donors and MOH, and encourages accountability of where the morphine is going.

These features seem to have made it very attractive to all the people that we have talked to, and all have been encouraging us to look into wider-scale, even country-wide, implementation. While we obviously love MT and would be thrilled if it could be implemented across Malawi, there are bugs that can be found in the software, and potential usability problems could still be discovered. The last thing that we want is to let hospitals all over the country use the software, only to later find some horrible bug that throws off the report’s accuracy.

We hope to be able to conduct small, provisional pilot implementations of Morphine Tracker in both St. Gabriel’s Hospital and Ndi Moyo Clinic. We believe that because both institutions have very well-run, organized palliative care centers, we will be able collaborate with them to log errors, complaints and difficulties so that the software may be improved in the future. After all, like Truce mentioned, “if we can’t put a strong foot hold in these two, how will we be able to do so in other hospitals?”.

Patient in the Palliative Care Ward getting morphine

Even before we got to Malawi, I knew that we were going to be spending a decent amount of time in the Palliate Care Unit, as we were supposed to work on DataPall and introduce a new morphine dosing system (Jesal did a post on it!). Thinking that I would obviously write a blog post on Palliative Care, and that I pretty much already knew why Palliative Care was so important in Sub-Saharan Africa (SSA), I started writing up a draft back in the comfort of the States. I began the post by throwing around a couple of HIV/AIDS statistics—like how almost 11% of the Malawian population has been diagnosed with the disease [1]—and then about how the incidence of Cervical Cancer in SSA is among the highest in the world [2]. Then I would give a little background about how the expanding field of Palliative Care—the field dedicated to the relief of suffering—was primarily due to the unfortunately high burden of HIV/AIDS and cancer.

Fortunately, I got a bit distracted/ lazy and decided to just stop writing at the introduction. Because fast forward almost two months and I now have a very different view about Palliative Care, at least how it is conducted at St. Gabe’s. Like I said, when I first stepped foot into the Palliative Care Unit, I was expecting it to be almost entirely cases related to HIV/AIDS and cancer. And while there were many, many cases related to both pathologies, the unit’s patients represented a much more diverse spectrum of diseases.

Heart Failure in Africa!?

Perhaps one of the most surprising findings was the high rate of Congestive Cardiac Failure (CCF). In fact, CCF has the distinction of being the single highest diagnosis for St. Gabe’s Palliative Care Unit (at least since DataPall was implemented 2 years ago). CCF occurs when the heart is no longer strong enough to pump all the blood that is rushing into it, so blood begins to pool up behind it—fluid then begins to accumulate in the legs, abdomen and lungs (depending on what side of the heart failed). CCF is an extremely difficult disease to live with, has a tendency to worsen over time and has a high mortality rate.

I was especially surprised at the high number of cardiovascular patients in palliative care because we’re told that heart disease is a distinctively Western problem. Heart failure is one of the so-called ‘lifestyle’ diseases, caused primarily by hypertension, which coincides with the high salt, high calorie, sedentary western lifestyle.

DataPall report for Outpatient Diagnosis for the past year. CCF is the highest single diagnosis in the ward, and CVA has a surprisingly large presence as well.

However, while Malawian citizens will probably not develop hypertension at the same rate as Americans, if someone here does develop hypertension, it tends to go undiagnosed and untreated. Untreated hypertension can lead to horrible sounding things like  heart disease, stroke and organ failure (including heart failure). So a lot of the CCF patients first come in here with the characteristic symptoms such as troubled breathing and swollen legs, but when their blood pressure is taken, it often turns out to be ridiculously high (I’m talking over 200/120).

Preventable (but Hard to Treat) Disease

As far as my studies have suggested to me, it seems like the only treatments for heart failure are ventricular assist devices (LVADs/RVADs), a full heart transplant, or an artificial heart (if transplantation is not feasible). These options are not feasible for many western patients, not event to mention Malawian patients. Thus, the majority of CCF patients are referred to palliative care for symptom management.

This is a disheartening trend, as hypertension (and then heart failure) is well known to be very, very preventable with changes in lifestyle. And while I know this is anecdotal, I’ve heard from two different people (a palliative care doctor and a community health worker) that even a simple reduction of dietary sodium is usually enough to bring their blood pressure back down to manageable levels.

More Data, More Diagnostics and More Prevention

There is very little data on the prevalence of heart disease in Africa, as it tends to be both poorly diagnosed in the community and very low on the priorities of international health organizations. This is understandable, given the huge health challenges that the continent faces with HIV/AIDS, TB, malaria and many other diseases. However, even the sparse data suggests that our observations here could be generalized to much of the rest of SSA [3]. I never thought I’d say this, but I now strongly believe that it is imperative to raise awareness of hypertension and heart disease in Africa.

We need to catch the attention of both NGOs and governments so that (1) better data can be collected to help us better understand the issue and (2) more cases of hypertension can be diagnosed early, and then appropriate lifestyle interventions can be implemented. We need not develop the same huge cardiovascular research network as in the west for this problem—it does not seem like the newest expensive medications or devices are needed in this case. What is needed is attractively cheap—just diagnosis with a simple stethoscope + cuff, and inexpensive lifestyle interventions like cutting out dietary salt and increasing physical activity.

But what other surprising health trends could be lying in Africa simply because of the lack of good data?

[1] www.unicef.org/infobycountry/malawi_statistics.html
[2] http://www.afro.who.int/en/clusters-a-programmes/dpc/non-communicable-diseases-managementndm/programme-components/cancer/cervical-cancer/2810-cervical-cancer.html
[3] Opie LH. Heart Disease in Africa. The Lancet 2006; 368:9534.

Quote of the Day
“Guys, I think I accidentally killed the lizard!” – Jesal (really, really distressed)

DataPall, the brainchild of the interns two years ago (link to all their blogs), is an electronic medical records systems for the Palliative Care unit here at St. Gabe’s. The previous interns here noticed that the small staff in the unit would have to spend weeks manually adding up figures to give quarterly reports to the Ministry of Health, so they designed DataPall so that reports could be generated with the push of a button.

While DataPall has been a huge help to Palliative Care— the team here now only spends a day or two on the reports—there have still been several issues preventing a large-scale rollout. One of the most significant of these issues is accidental duplication of records. As the literacy rate in Malawi is quite low, it isn’t uncommon that patients don’t know how to spell their names, so the nurses and doctors will sometimes write down alternate spellings from appointment to appointment. Additionally, sometimes patients will change last names or accidentally switch their first and last name. Therefore, if you type the misspelled name into the current DataPall search bar, no match will show up and a new patient will be created (even though the patient record already exists under a different spelling).

This accidental duplication of records has lead to the gradual artificial inflation of patients, skewing the data that the unit is supposed to be reporting. This issue became so problematic that one of the doctors once said, “DataPall is telling me that there were 20 new patients last week, but I only saw about 15 different patients!”. To overcome this problem, they oftentimes have to go back into the paper records to make sure that the reports are giving the right numbers. While staff still doesn’t have to spend weeks generating the reports, they still have to spend a couple days to fix the errors.

Using a broad set of matching criteria, we generated a set potential duplicates, of which 121 patient records (!) were actually duplicated. After merging the duplicates, we were then able to feed this data back into the computer (using a machine learning algorithm) in order to generate an algorithm that can better predict whether two records could be a duplicate, based on common misspellings, similar village, etc. We’re really happy that the duplicate searching algorithm actually works quite well (98% sensitivity and specificity), so we’re in the process of implementing it into the workflow of DataPall as well as incorporating it into our new project, Morphine Tracker (read about it on Truce’s blog!).

Sorry for the long delay in posts! My small computer has been otherwise occupied over the past couple days trying to run a couple of programs for DataPall (a topic that we’ll save for later, as I think deserves its own post).

Last week, I did something a bit uncommon for a non-premed engineer—shadowing doctors. Even though it was a tiny bit outside of my comfort zone, its been quite the experience to directly interact with patients and to see how the everyday process of diagnosis and prescription works.

Paediatric Ward

Many of the technologies that we’ve brought are geared towards neonatal and paediatric patients, including the neonatal thermometers, temperature probe, phototherapy dosing meter, and BabyMetrix (which Jesal did an awesome post about). So I was really excited about the chance to shadow the paediatrician during his rotations. It was interesting seeing how meticulous and careful the doctor was in checking up on his patients, and how he seemed to emit genuine empathy towards the patients, at a level not oftentimes seen in Western hospitals.

That being said, you still cannot compare the standard of care to that of a Western hospital. While the doctors and nurses work extremely hard to ensure that their patients have the best chances of a successful recovery, if all the ports on the oxygen concentrator are being used and a child with TB comes in, not much can be done. This dichotomy reminded me of a passage in A Heart for the Work (which I enthusiastically recommend to everyone!), where the author argues that the ‘ideal doctor’ presented to Malawian doctor was not one of supreme technical expertise sometimes at the sacrifice of empathy (which is oftentimes the case in the West). No, an ideal doctor in Malawi was one who had a heart for the work, combining technical expertise with humanity, as in grave circumstances, the patient can at least felt looked after and cared for.

Surgery

Truce and I also had the opportunity to observe two surgeries earlier this week (at a safe distance of course)! A professor at Rice is developing a sterile processing unit for low resource settings, so we kept a close eye on the sterile workflow of surgeons and nurses throughout the procedure (e.g. how an instrument moves from the ‘sterile space’ to the operating space, how biohazards are contained, etc). I got a bit queasy when the surgeons started cutting through layers of muscle and fat, and then seeing various types of multi-colored fluids gush of the the openings; but at the very least, the experience reaffirmed that medicine wouldn’t really be for me (sorry Mom and Dad!).

As I’ve mentioned before, I feel that as an engineering student who eventually wants to work on problems relevant to global health, oftentimes it is simply not enough to come up with a good technical solution; it also needs to be able to be easily integrated into a healthcare professional’s workflow and be easy to use. Therefore, I think it is incredibly useful to be able to see how the doctors and nurses work and utilize different technologies on a daily basis.

Blantyre

We also visited Blantyre last weekend! We needed to take a huge suitcase full of Bililights, bCPAP materials, and various other technologies. It was a ton of fun exploring Blantyre and hanging out with the interns there! But, I think my favorite part was visiting the Blantyre market—we’ve gotten used to the somewhat limited selection in Namitondo/Namitete, so seeing rows of spices and all kinds of fruits and vegetables was more than enough to make my mouth water.

Quote of the Day

“It’s nsima time!” – Everybody

Moni, Muli Bwanji! These past couple of days have gone by in blur! We’ve been working on several projects since arriving, and we’ve been slowly showcasing some of the technologies that we’ve brought along with us. However, when Americans (or other Westerners) proudly bring their new, appropriate medical technologies to a developing country, there’s kind of a hidden assumption that the hospital staff will absolutely love it right away and use it all the time. We’re absolutely no exception to making that sort of assumption, as we learned when demonstrating the oxygen flow splitter last week.

A Need for Oxygen

Many pediatric patients, especially those with respiratory diseases like pneumonia, need to be put on oxygen therapy. However, oftentimes developing world hospitals only have one or two oxygen concentrators (usually giving 5 or 10 L/min) for an entire ward. But most relevant pediatric patients would only need around a maximum of 2 L/min of oxygen, so the oxygen could be split into 2 or more streams. However, current oxygen ‘flow splitters’ that are used in the states are very expensive, and most hospitals in developing regions would not be able to afford them. Therefore, there seemed to be a need to develop cheaper, efficient flow splitters for these hospitals.

Many children that develop pneumonia need to be put on oxygen [1]

The Rice Flow Splitter

A team last semester at Rice was tasked with doing just that—designing a low-cost and effective flow splitter. They came up with a nice, simple design that could split a 10 L/min oxygen concentrator into 5 different ports. Each port could either give .5, 1 or 2 L/min of oxygen to the child, which could be changed by a simple rotating disk.

 

       First Generation Flow Splitter       Flow Splitter 2.0  – several improvements were added,

                                                                        including a locking mechanism

Truce, Jesal and I talked a lot about their design—we thought that it was a good solution—it needed some work, like all of the designs—but it had the potential to turn into a comercializable and accessible product. We even agreed that the flow splitter would have been a really good project to be involved in, as it seemed like such a cool problem that could have such an impact.

Lack of an Actual Need for a Flow Splitter

Given our enthusiasm about the design, it was a bit disappointing when we were told by the St. Gabe’s pediatrician that “[he] would not use the device”. After the initial shock, he explained that the problem was actually quite simple to solve—he already had a well working system that connected the concentrator to copper tubing (which can be kept sterile) attached to cheap flow meters and humidifiers.

 The simple flow meter+ humidifier

The St. Gabe’s system prevents numerous problems that would have arisen with the Rice flow splitter, only a couple of which I will list here:

1) The copper tubing leads directly to patient’s beds, which prevents having tangles of (hard to clean) plastic tubing everywhere in the ward.

2) Each port on the system was attached to a humidifier, whereas the Rice flow splitter would have to have the humidified air coming through the input. This increases risk of cross-contamination (as all 5 ports are connected to one humidifier) and could result in yeast/molds/bacteria growing on the inside.

3) The oxygen concentrator at St. Gabe’s is 5 L/min. The Rice flow splitter only works for 10 L/min concentrators (and would thus also not work with less than accurate O2 concentrators), whereas the St. Gabe’s system can adapt to any flow rate.

While the St. Gabe’s system isn’t perfect either, it is relatively low maintenance, works well enough and perhaps most importantly, the doctors and nurses like it.

Needing a Solution to a Different Problem

While there may be a need for flow splitters elsewhere in Malawi, there is certainly no need for one in St. Gabe’s. Even so, the St. Gabe’s system is probably significantly more likely to be useful to other hospitals in the country. However, the doctor did mention that one of their biggest problems is that the O2 concentrators are expensive and fragile, so that if one breaks, its difficult to find someone in the country who can fix it, and buying another would be prohibitively expensive. I’ve even heard similar problems with the O2 concentrators over at QECH from the Blantyre interns.

So what he really wanted was a cheap, durable O2 concentrator. This would be a significantly more difficult challenge, but one that could actually be very useful for hospitals around the country.

 

The O2 concentrator at St. Gabe’s

Working Together for Solutions to Actual Problems

We need to remember that the health-related problems of Malawi—and Africa—are not just one huge homogenous lump that can be fixed in a couple weeks by a few Western engineers in a comfortable office. The people here are already working extremely hard to improve healthcare, and have oftentimes come up with better working solutions to pressing issues.

Now, this doesn’t mean that we should just give up on trying to help develop appropriate technologies because our lack of understanding. Rather, it simply suggests that we listen more to doctors, nurses and community health workers on what problems they have, what they’ve tried in the past, and what they have now; as well as ramping up our efforts to collaborate with health institutions in a diverse array of low resource settings, to get a better idea of the heterogeneity of environments that exist.

Lake Malawi with Blantyre Interns!

On a fun side note, we got to spend the weekend at Lake Malawi with the Blantyre interns! We had a lot of fun going on a boat ride, seeing lots of colorful fish and ‘cliff diving’ (which was really just jumping off some rocks). It was also really cool listening to some of their experiences at QECH, as it seems to be so different than the rural setting of St. Gabe’s. I’d highly encourage everyone to check out their insightful blogs and get a better notion of the diversity of healthcare in Malawi!

The beautiful waters from our boat                      Truce and Emily jumping together                               Jesal refused to go into the water

Quote of the Day

“Pictures just don’t do this place justice” – Truce on Malawi

[1] http://www.drugs.com/health-guide/images/204871.jpg

Over the week that we’ve been in Malawi, we’ve slowly been getting to know St. Gabe’s and Namitete. The people here have all been ridiculously nice and welcoming to us, so that even though we’ve been here for such a short period of time, we’re already starting to feel like part of the St. Gabriel’s/ Namitete family!

     Entrance to St. Gabe’s                                  First time on a bike taxi!                    The goats in Namitete are like the Rice squirrels—                                                                                                                                                 they’re everywhere and know no fear

Under-5 Clinic

Last Friday, we visited the under-5 clinic at the hospital to get a sense of how the community health workers operated it, as well as showing them Jesal’s design, Babymetrix—a single device that can take the height, weight and head/arm circumference of a baby to help diagnosis malnutrition. The clinic itself brought in kids (and their mothers) from local villages who were suffering or recovering from malnutrition to check up on their development (i.e. height, weight and arm circumference measurements). This is incredibly important work especially as up to 46% of children in Malawi are stunted [1]. The community health workers who ran the clinic also gave out some nutritious food and educated the mothers on proper child nutrition.

 

      How babies are weighed                                          Learning about nutrition

All the mothers were so eager to get their picture taken, but given our lack of meaningful Chichewa vocabulary, there was a lot of gesturing followed by all of us laughing at our struggles. A lot of people have been trying to teach us Chichewa (and its been a blast!), but probably the most useful phrase so far has been ndikuphunzila Chichewa pangono (I’m learning Chichewa very slowly) just to get across the extent of our knowledge.

 

 

Lilongwe

On Saturday, we visited Lilongwe (the capital of Malawi), mostly to get desperately needed internet “dongles” as well as some groceries. After we got our dongles, we headed to a large shopping center. Once inside, it was almost as if we had been transported to an American HEB or Target—there were huge flat-screen TVs lining a wall and huge pictures of piles of delicious-looking produce with captions like fresh and value hanging below them.

 

While we’ve only been here for such a short period of time, it seems that Malawi is in a period of flux—the traditional Malawian blending with the western, most noticeably in the city but also extending out into the rural areas. However, the obvious dichotomy in lifestyle between rural Namitete and the up-scale parts of Lilongwe was a bit surprising; while we had learned academically about these harsh realities, it was still emotionally jarring to actually see.

Developing countries are vary rarely uniformly poor, rather it seems that to better understand ‘development’ (a word that I really don’t like, but that’s a discussion for another time), knowledge of the inequality among the population must be included along with the absolute wealth of individuals. The juxtaposition of the multitude of malnourished kids at the clinic with the long aisles of fresh, refrigerated vegetables in Lilongwe especially seemed to reflect the vast structural inequalities of the country.

However, there does seem to be signs that the situation is improving across the country—poverty, hunger and HIV prevalence in Malawi have all been reduced significantly over the past couple years [1]—and programs like the malnutrition clinic that St. Gabes spearheads are doing a lot to continue that trend.

Be sure to check out Jesal’s blog for another great discussion on issues surrounding wealth disparities in Malawi!

Quotes of the day:

“Malawi is a poor country—we don’t have oil or coal or minerals, but that also means that the States have left us alone” – Namitete Resident

“Just in case” -Jesal (always)

[1] http://www.unicef.org/malawi/children.html

As I’m writing this, there’s still a huge pile of clothes and miscellaneous supplies that I still need to stuff into suitcases for our long flight to Malawi on Monday. Our nearly 35-hour trip will bring us from Houston through London, England and Johannesburg, South Africa to Lilongwe (the capital of Malawi), where we’ll finally drive to Namitete.

As you probably gathered from the description, Truce, Jesal and I will be traveling to rural Namitete, Malawi for 2 months to test and implement some of Rice’s devices at St. Gabriel’s Hospital, as well as identifying any possible local medical problems that we could bring back to Rice so that a team could develop a solution. I’m also really excited that we’ve been given the freedom to pursue an independent project while there, which could hopefully lay the groundwork for a sustainable solution to a local problem as well as being really fun to implement!

All three of us have been looking forward to finally heading off to Africa, so its beyond thrilling that we’ll be starting to work in the hospital so soon!

Background

Just as a bit of background, Malawi is a small, primarily rural landlocked country in southeast Africa that is often called the “Warm Heart of Africa” for its amiable and easygoing people. While a good portion of the country speaks English (as it was a former British colony), the native language of almost every Malawian is Chichewa. Fun Fact: the (as of a week ago) former president of Malawi, Joyce Banda, was named the most powerful woman in Africa, partly due to her extensive work in developing educational and women’s health resources!

 

Appropriate Technologies!

For the past couple weeks, we’ve have been busy working in the Oshman Engineering Design Kitchen (OEDK) to prepare several of Rice’s medical technologies to test and implement at St. Gabriel’s Hospital.

One of the exciting things that we’ll be doing this summer is doing a pilot implementation of morphine dosing clips and adapter caps designed by a freshman ENGI 120 group. We made 50 of clips and caps, which are designed to more easily and accurately dose morphine for patients receiving it at home. I’m a huge fan of the design, so I’m excited to see it in the field!

Jesal cracking open an adapter cap mold

All 50 adapter caps!

 

Truce and I were on a team last semester to develop a low cost, easy to use, liquid crystal thermometer for neonates, which we call LCTemp. We’ve continued to develop it, and we’re pleased to be able to bring it with us to Malawi to perform a small pilot study to evaluate its usability and accuracy. We’re also bringing another neonatal thermometer developed by a different team (the axilla probe thermometer), so we hope to be able to compare/contrast how it’s handled and used in Malawi!

Thermometer accuracy testing: the cool bubbles kept us from getting too bored (its a slow process)

Final Prototypes

 

We’re bringing several other technologies with us, including a phototherapy calibration device, portable OB-GYN stirrups, an oxygen flow splitter, a neonatal temperature sensor and plans for a sterile processing unit. I’m sure that we’ll be talking about the technologies and other projects that we’ll be pursuing in subsequent blog posts, so stay tuned!

Truce modeling the OB-GYN stirrups and curtains

Touring Memorial-Hermann’s sterile processing center