It’s been a busy first week getting settled in Blantyre and at Queens, and things are already off to a great start! Tanya and I have spent the first few days getting to know our way around the hospital wards, meeting clinicians and nurses, and working at the bCPAP Office.

When it was first introduced at Queens in 2012, initial results showed that the bCPAP improved survival rates of neonates in respiratory distress to almost the same degree that the introduction of CPAP in the US did in the 1970s. The device, designed by a group of Rice bioengineering students in 2010, offers a low-cost alternative to CPAPs commercially available in the US, and the technology is currently being rolled out to all district hospitals in Malawi as well as into Tanzania, Zambia, and South Africa.

A large part of the technology implementation involves ongoing data collection and monitoring of all of the patients who are treated using bCPAP. This data includes important details such as primary diagnoses, duration of treatment, outcomes, and most recently, admission temperatures. Each of these factors plays a role in understanding not only how the technology is performing, but also whether or not it is being used appropriately and if additional treatment considerations could help improve outcomes.

For example, outcomes of bCPAP treated patients compared to outcomes of O₂ treated patients may show us how the device is performing at a baseline level, but looking at primary diagnoses of patients helps us to understand how clinicians and nurses are selecting patients for bCPAP treatment and whether or not these are the patients that would benefit most from the treatment. Sometimes, patients with birth asphyxia are treated with CPAP, but complications associated with this condition would not be improved by CPAP assistance, so a poor outcome for these patients would not necessarily mean that the bCPAP is performing inadequately. Similarly, after monitoring patient outcomes across several seasons, data showed that during winter months, survival rates of bCPAP patients decreased. This observation led to the current project of collecting admission temperature data for all patients in order to analyze how variations in core body temperature affect treatment outcomes, and that’s one of the projects that Tanya and I will be helping with throughout the summer. Collecting this type of data can help determine what kinds of additional treatment considerations, such as maintaining stable core body temperatures, can further improve outcomes for bCPAP patients.

Within just the first few days of interacting with the CPAP study, I’ve gained a much greater appreciation for the amount of attention and scope of analysis required of clinical trials on medical devices. Contextualizing a device’s performance becomes critical in finding tangible ways to continually improve both implementation and design, and these improvements are essential for a device to remain relevant and effective.

It’s hard to believe that it’s finally here, but we’re off to Malawi! This summer, I’ll be working with Tanya at Queen Elizabeth Central Hospital in Blantyre. Our primary task is to help with data collection and verification on the Bubble Continuous Positive Airway Pressure (bCPAP) clinical trial, but we’ll also be presenting several student-designed technologies to clinicians and hospital staff to obtain feedback for future work on these projects.

Tanya and I have spent the past couple of weeks at Rice’s Oshman Engineering Design Kitchen (OEDK) preparing prototypes of these student technologies since most of the original devices will stay at the OEDK this summer for further testing and modification. It’s always impressive to see the design solutions that Rice students develop during the academic year in courses like Introduction to Engineering Design, Design for Global Health, and Senior Design for Global Health. Tanya and I are excited to be able to acquire feedback that will ultimately help inform future work on these projects.

Here’s a bit more on each of the technologies that we’ll be presenting on:

IncuBaby – A low-cost incubator for neonates

By far our most technical project, IncuBaby has given us a chance to learn several new skills including circuit building, soldering, and laser cutting, to name a few. This project was completed this year as a Senior Design project, and a group of Bioengineering students designed and built an incubator that includes real-time temperature feedback and controls and is made of easily sourced materials such as plywood and acrylic. While incubators in high-resource settings can cost upwards of $30,000, this design costs about $250, and at scale would remain between $300-$400. Most of the feedback we’ll be obtaining for the project will be size and usability related, and these informal recommendations will help shape the next steps in the incubator’s design. We’ll also be looking into ways to locally source the materials so to determine if parts of the production could occur in Malawi. Here’s a photo of the final prototype:

RespiRate – a respiratory rate timer for neonates and children

Pediatric pneumonia and other respiratory infections place a significant burden on the healthcare system in low-resource settings. One simple way of identifying early warning signs of infection include an increased breath rate that can be observed by counting the number of times a child’s stomach rises and falls in one minute. Two design teams (one freshman engineering team and one global health team) worked separately this year to create a low-cost timer device for healthcare workers to track a patient’s breath count and determine whether he or she is exhibiting warning signs of a more serious infection. Both teams’ prototypes show great potential, and we look forward to returning with informal usability feedback and suggestions for improvement on the designs. Here’s a photo of the inner components of one of the timers:

AxillaProbe – an at-home temperature probe for detection of fever in infants and children

Similar to an elevated breath rate, feverish temperatures in infants and children can be a sign of a more serious infection that requires medical attention. Currently, most parents in low-resource settings must rely on human touch to determine if their child has a fever. This method is highly subjective and also makes it more difficult for parents to track how long their child has been feverish. AxillaProbe is a low-cost thermometer designed for parents to be able to quickly and definitively tell if their child has a fever above 99.5ºF. It is a simple armpit probe that uses liquid crystals that change color to indicate either healthy or fever temperatures, and it can be cleaned and reused on multiple children for up to two years. Most of the informal feedback for AxillaProbe will be on size, usability, and availability of local resources for production as well. Here’s a photo of the device:

I’m incredibly grateful to have this opportunity to travel to Blantyre this summer and be able to see and experience the places I’ve heard so much about while completing the Global Health Technologies curriculum at Rice! I know that I’ll be challenged to think about problems in new and exciting ways, and I hope to gain more insight into how thoughtful technology design and implementation can deliver quality healthcare to all populations.