Although Tara, Teresa, and I have been huddled in front of computer screens and patient records for the past eternity, we still try to remain active throughout the hospital. We don’t get to see patients as often as we’d like to, but we make up for that by hearing about all sorts of crazy happenings during morning report, when the nurses report on the notable events of the previous night, and the doctors discuss bizarre cases. And so we learned of the case of the woman who delivered a rock:

A woman came in to the hospital, saying she was pregnant. She was walking with her back arched and her stomach/abdomen sticking out, as if she were pregnant.  So she goes into the labor ward to give birth, and manages to convince the clinical officer to ensures that all women who enter are about to give birth that she is indeed pregnant. She climbs onto an examination table, undergoes “contractions,” and delivers a rock. To make a strange case even more outlandish, the clinical officer noted that her cervix was sealed shut: she was nowhere near pregnant. She had come to the hospital twice before over the past six months, and both times, she was told that she was not pregnant. However, here in rural Malawi, traditional magicians (healers) are sometimes esteemed more than physicians, especially because doctors don’t always tell you want you want to hear.

Apparently, a magician in her village had convinced her she was pregnant by placing a stone inside her, and telling her that its magic would allow her to deliver… All she had to do was pay him a few kwacha and go to the hospital to have a baby. Of course, she was not pregnant, and the whole affair only served to deprive the patient of her money and health. Traditional medicine is widespread throughout Malawi, and its implications on health can be felt by everyone involved in the healthcare process. Patients might believe that a disease is a result of witchcraft, or that modern medicines will harm them. Sometimes patients forego medical treatments because a magician convinces them that cancer or HIV can be cured by a concoction of herbs. Even though it is difficult to convince patients of the advantages of modern medicine, sometimes the results speak for themselves. HIV-positive children given anti-retrovirals (ARVs) live until their teens, outliving those who didn’t receive treatment by years. Vaccines render once-fatal diseases harmless: We have managed to eradicate smallpox, which killed millions until its reign of terror was brought to an end in 1977. The future of medical advances looks bright: we just have to solve our problems one at a time.

During the past three or so weeks, we have been working on a project with the palliative ward here at St. Gabriel’s. Currently, the hospital has a variety of paper records to keep track of their inpatient, outpatient, and home-based visits. Unfortunately, digging through tomes of registers and notebooks is anything but simple, and Alex, Suave, and Comfort spend countless hours compiling data at the end of every month. Their time could be much better spent with patients, as Suave does with outpatients on Tuesdays, or Alex at villagers’ homes every Monday and Friday.

A database of some sort was definitely in the works: something that’s simple, straightforward, and most importantly, secure. Over the past decade, NGOs and governments have poured millions of dollars into robust, open-source, web-based systems that mimic those used in the West. But using them is a dream in the warm heart of Africa, where internet consists of a skimpy, sporadic wireless 2G network. Rolling brownouts mean that any computer-based system can crumble in a few seconds. St. Gabriel’s needs a system that ties in with its paper records and compiles patient data with an intuitive, local interface. And so we developed a database in Microsoft Access.

Of course, we soon realized that a proprietary solution isn’t really a solution. An open source alternative would free St. Gabriel’s from the whims of software availability. After already developing the entire system over the past three weeks, we realize that our database, our “solution,” is anything but: it significantly restrains the hospital and is simply unreasonable. We could provide the hospital with a version using Microsoft Access to solve their short-term needs, but in the long run, we’re only perpetuating a harsh cycle of proprietary lockdown. Since we have practical open-source alternatives like LibreOffice or Apache OpenOffice, it makes sense for us to port the database to a more reasonable and sustainable end, to design an actual solution to the hospital’s needs. It seems like we now have yet another way to keep ourselves busy over the next few weeks…

It’s a slow Sunday at St. Gabriel’s: The roosters are crowing, the goats are bleating, and the staff are milling about. The hospital’s director, Dr. Kiromera, stopped by our new home, the Zitha House, to say hello and to talk about some the goings-on at the hospital. I was glad to report on progress on our own projects at the hospital, since the past two weeks have been especially productive as we’ve settled in and become acclimated to St. Gabriel’s.

To offer some perspective, Teresa Yeh first reported on the technologies we’ve brought with us to help make the work of the staff here more comfortable. These include:

• Bililights: Blue LEDs that treat infants with jaundice by causing bilirubin to break down
• Dremofuge: Low-cost centrifuge based on a dremel for urine and stool analysis
• IV DRIP: Low-cost, automatic, and mechanical IV regulator that limits the volume dispensed
• Length Board: Portable, light-weight device to measure the height of infants
• Morphine Dosing Clips and Invertabottle: Add-ons to a liquid morphine container to allow patients to accurately receive the target volume
• SAPHE Pad: Disposable pads to estimate the volume of blood lost during delivery

Over the next few weeks, Tara Slough, Teresa, and I will further look into implementing these technologies. Our adventures throughout the hospital have revealed that St. Gabriel’s already has state-of-the-art centrifuges, rendering another device unnecessary. They also have a set of older phototherapy lights. However, they seem to especially need a morphine measuring device in the palliative center, along with an IV drip monitor in the pediatric ward. We also had an opportunity to talk to a physician from Ndi Moyo Hospital in Salima, Dr. Mindiera, who was interested in  these technologies and wanted to learn more about them. I’m looking forward to going to Salima next Tuesday with Tara and Teresa to demonstrate what we’ve brought with us. It should be a great opportunity to see what other hospitals in Malawi are like, and I’m super excited to visit!