July 9, 2012

This past Friday was Malawian Independence Day, so Bridget and I decided to take advantage of the long weekend and head back to the lake!  It was a wonderful weekend of warm weather, relaxing by the beach, and making friends in the local town.  I think the best way to describe the weekend is through pictures, so here’s a summary of what we did:

 

Happy 4^th of July!  To celebrate, Bridget and I cooked the most American meal we could manage while living in Malawi…chili cheese dogs, French fries, and apple crisp.  We went all out with decorations and everything!  Our British friends even pitched in to help us draw and color some American flags, and so did Simon, one of the local boys who lives at the Lodge! 🙂

 

June 30, 2012

Dr. Oden, Dr. Richards-Kortum, and Dr. Woods (all professors at Rice University) visited us at QECH this week.  Their main agenda was reviewing the CPAP study data.  However, Dr. Woods also helped us to take inventory of and repair some of the unused medical equipment on the wards.

• On Monday morning, we met with the vice principal of the Malawi Polytechnic, which is an engineering college down the road from Queens.  We discussed ways for BTB to collaborate with the Polytechnic to manufacture some of the BTB devices in Malawi!  As of now, most of the BTB devices are made in the U.S. and shipped to developing countries, so it would be a big step forward if the devices could be manufactured in-country!

• I spent all of Monday afternoon entering CPAP study data.  The study has been especially busy these past couple weeks because there have been outbreaks of bronchiolitis in paediatrics due to the colder weather (despite the sunny weather…its actually winter here!).

• Throughout the week Dr. Woods helped Bridget and I to repair some of the medical equipment on the Paediatric wards.  We have made quite a few successful equipment repairs, including a surgical light, vacuum suction machine, and another oxygen concentrator!

• I spent the second half of the week in the medical records department searching for a list of important patient files that need to be located.  It was a tedious and ultimately very frustrating process.  The medical records at Queens are stored as stacks of paper tied loosely together with strips of gauze.  In some wards, the stacks are organized my month and outcome (death or discharge).  However, in most wards the paper records are just thrown into boxes…making it nearly impossible to track them down later on.  I found about a fourth of the files I was looking for, and the technicians in the medical records office were impressed I was that successful.  I cannot express how much appreciation I now have for electronic medical records…the idea of finding a patient’s record with the click of a button is amazing.  At Queens, you’d have to look through hundreds of paper files just to have a chance at finding the one you were looking for.

• Finally, on Friday night Bridget, Jocelyn, and I had dinner with Nick Kristof and Jordan Schermerhorn, who is a Rice student and the winner of Nick Kristof’s 2012 win-a-trip contest!  We discussed the development of the bubble CPAP machine with Nick, and heard fascinating stories of his and Jordan’s travels through Lesotho and Malawi.  After dinner, we all met up with Dr. Woods for a Rice reunion in Malawi!

June 25th, 2012

After a long 3^rd week at Queens, Bridget and I opted to hang out in Blantyre for the weekend.  We’ve spent most of our weekends traveling thus far, so it was nice to explore more of what Blantyre has to offer!  Here’s a summary of the weekend:

• Friday:  Pizza and movie night!  We ordered pizza from a local pizza place (with free delivery!), and watched a movie on the Lodge’s outdoor TV.  We chose the Lion King, which seemed appropriate to watch while we were in Africa 🙂

• Saturday: Exploring in the Market!  We bargained for lots of fruits and veggies and spent the day wandering around Downtown Blantyre.

• Sunday: Pool day!  One of the local hotels has a swimming pool that you can pay to swim in, so we took advantage of the nice weather and spent the day lounging on the pool deck!

June 22^nd, 2012

Whew!  It’s been a busy week at Queens.  Here are some of the highlights:

• Demonstrating our Paediatric Technologies: We demonstrated the NeoSyP, Babalung, and IV DRIP to the Paediatrics Department on Thursday morning.  Overall, the doctors were very enthusiastic about the technologies!  They gave us some great feedback on how we can improve each design, and discussed how each device could be used on the different wards.  We will be following up with the nurses on each ward sometime next week to get their feedback as well.  Here is some specific feedback we received for each device:

• NeoSyP: The doctors could definitely see the NeoSyP being used in the neonatal ward at Queens.  They particularly liked the idea of using a metronome to power the device – but they did comment on the loud noise it made!  However, the noise won’t be as noticeable on the loud wards at Queens.  The doctors also agreed that the NeoSyP would need to have a safety function added on (to stop the administration of fluids if the device malfunctioned or if the needle came out of the patient’s vein) before it could be implemented on the wards.

• Babalung: The Babalung also received very positive feedback – Queens currently has no method for detecting apnea in premature infants, so many babies who suffer from apnea attacks are not detected until it is too late.  The main concern with implementing the Babalung is its power source.  Right now it relies on rechargeable batteries, but the rechargeable batteries currently used at Queens tend to wear down quickly or go missing altogether.  We’ll be collaborating with the doctors and nurses over the next few weeks to determine the ideal source of power for the Babalung.

• IV DRIP: The doctors loved the idea of using a mousetrap to kink IV tubing and stop fluid flow!  The Paediatric Department at Queens treats many children who are severely dehydrated, and the IV DRIP device would allow patients to receive a large volume of fluid at the beginning of their treatment, without the risk of overhydration.  The doctors we spoke with emphasized how it is very important to keep the IV bag as high above the patient as possible while fluid is being delivered (so that the fluid can travel “downhill” with gravity).

• Demonstrating the SAPHE Pad: Bridget and I presented the SAPHE Pad to the Obs and Gynae Department this past Wednesday.  The doctors liked the idea of being able to easily measure post partum hemorrhaging, and seemed interested in trying the pad out on a patient at QECH.  We plan to follow up with the Head of Department next week to see if this will be possible.  We also surveyed some of the doctors on the readability of the SAPHE Pad user manual, and received some helpful feedback about important details that could be added to the manual to make it easier to understand.  (For example: the current manual does not specify how long a health worker should wait for blood to be absorbed before counting the amount of blood-soaked squares on the pad)

• CPAP Repair Session: Bridget, Jocelyn, and I met with the Physical Assets Management Department (which is responsible for managing and repairing the medical equipment at QECH) to demonstrate how to repair the pumps used in the bubble CPAP machine.  The repair session went well!  The pumps used in the CPAP device are actually the same pumps used in fish tank aquariums – and they’re fairly simple to repair.  Although none of the CPAP pumps have broken so far, the repair session is one of the many steps we’re taking to help ensure the sustainability of the Rice bubble CPAP devices even after the CPAP study is completed.

• Exploring PAM:  After our CPAP pump repair session, Bridget and I had time to explore the Physical Assets Management (PAM) building.  The PAM building was overflowing with piles of broken equipment.  It was evident that the PAM department has nowhere near enough engineers on staff to manage all of the equipment at Queens.  There is a LOT of medical equipment at Queens, and when broken equipment is sent to PAM it is typically stored on shelves for months before being attended to.  In most cases, the “broken” equipment simply needs a missing part replaced…but unfortunately there are rarely spare parts available.  As a result, the PAM Department mostly serves as a graveyard for unusable equipment.

• A few thoughts on donated equipment: Based on my experiences at PAM and on the Paediatric wards, I’ve begun to realize that although many organizations donate medical equipment to QECH with good intentions, not much thought is put into the sustainability of their donations.  Most of the donated equipment lasts for 2-3 years, breaks, and then ends up sitting in a storage closet indefinitely.  In order to truly make a lasting impact, it is important that donated medical equipment is easy-to-use, easily repaired, and that any spare parts can be bought in-country.  But most western equipment doesn’t meet this criteria…in the U.S. it seems as if medical equipment is becoming more complicated every day.  It’s a tough dilemma – under-resourced hospitals desperately need new technologies, but technologies designed for western hospitals are rarely much of an improvement.  The bubble CPAP machine is a great example of an appropriate technology, but as the nurses at Queens all say: “we need more CPAPs!”

June 18, 2012

We spent the weekend at a safari camp at Liwonde National Park!  We camped in “luxury” tents, made s’mores, saw lots of wild animals, and enjoyed the outdoors!  Some of the highlights included:

• Showing our British friends how to cook s’mores

• Watching baboons walk through our campsite

• Being ambushed by thousands of mating flies

• Watching the sunset from our Safari boat

• Seeing elephants and crocodiles right next to our boat!

• A hippo coming up for air and crashing into the bottom of our boat

• Impala, impala, and more impala

• Walking next to a warthog!

• Cooking dinner over a fire

June 15, 2012

After two weeks at QECH, we have finally begun to make progress on our BTB projects!  We spent most of this week assembling the devices we brought with us, scheduling meetings, and reviewing CPAP study data.  Here is a summary of what we’ve accomplished this week:

• Bridget sized the Babalung apnea monitor on a Malawian neonate, and quickly realized that most neonates here are MUCH smaller than neonates in the U.S.  On average, most babies weigh only 1300 grams at birth (which is only 2.85 pounds!).  Needless to say, Bridget will be making a new, smaller strap to fit the babies at Queens!

• We met with the Head of the Obstetrics and Gynecology (Obs and Gynae) Department, talked to him about the SAPHE Pads, and scheduled to demonstrate the SAPHE Pads at one of their Departmental meetings next week!

• We also met with Dr. Kennedy (Head of the Paediatrics Department) to discuss the BTB technologies we have brought with us.  He was very excited about them!  We will be presenting the IV DRIP, NeoSyP, and Babalung to the entire Paediatrics Department next week!

• We took an inventory of all of the oxygen concentrators, suction machines, and bilirubin treatment lights in the Paediatrics Department.  We assigned each device an equipment number, assessed whether or not each device was working, and attempted to fix any broken equipment.  The nurses were very happy when they found out we had successfully repaired 3 of the oxygen concentrators!

 

• Bridget and I took over most of the CPAP study responsibilities.  We check on the CPAP study patients each morning and afternoon, and collect any completed files.  I am responsible for entering all of the study data, and Bridget is responsible for testing and maintaining the CPAP machines.

• We attended Journal Club on Monday and the Grand Rounds presentation on Tuesday.  In Journal Club, we discussed the issues with diagnosing UTIs (urinary tract infections) in children.  Surprisingly, it was a very interesting discussion!  The Grand Rounds presentation was about the relationship between retinopathy (damage to the retina of the eye) and cerebral malaria.  It was amazing to hear how significant a patient’s eye exam can be in diagnosing and managing cerebral malaria!

• Finally, we visited the Paediatrics A&E (Accidents and Emergencies) ward.  It was pretty crazy…lots of sick children and worried patients waiting, and lots of frantic nurses moving from patient to patient.  We visited A&E in hopes of finding IV poles (to see where the IV DRIP device could best be used).  We did find a few poles – however it seems as if most of the IV bags here are hung from hooks on the wall behind the patient, rather than from IV poles.

June 11, 2012

We spent the weekend at Cape Maclear, which is a beautiful area at the southern tip of Lake Malawi!  It was a weekend full of adventure and relaxation!  Here were some of the highlights:

• A long, bumpy drive from Blantyre to Cape Maclear
• Kayaking on the lake
• Snorkeling!
• Seeing the local town and playing American football with Malawians and the British med students J
• Bargaining for handmade souvenirs on the beach
• Eating breakfast on the beach
• A beautiful sunset over the lake

June 6, 2012

After nearly one week in Blantyre, Bridget and I are finally adjusting to our living conditions.  Kabula Lodge has been great so far – especially because there are always other guests around to socialize with.  We have met volunteers from all over the world, the majority of who are volunteering at Queens!

Power outages: The power goes out for 1 or 2 hours almost every night at the Lodge.  As a result, we can’t use the internet, cook, or take hot showers.  While this is somewhat inconvenient, we don’t mind too much because it gives us an excuse to eat out! J

Food:  Blantyre has a lot of great restaurants!  You can get just about every international cuisine here.  We’ve particularly enjoyed the Indian food!  But although it’s been nice eating out this week, we’re ready to start cooking our own meals with our own groceries!  Bridget is an amazing cook, so I’m looking forward to eating her amazing creations!!!

Exploring: We spent a couple days this week exploring the Blantyre street market.  The market is amazing…there are hundreds of stands selling groceries, clothes, and second-hand goods.  Most stands have a theme (i.e. computer goods, cell phone accessories, books, shoes, etc).  The produce stands are particularly awesome…they sell nearly every type of fresh fruit and vegetable, all for very cheap!

 

Overall, I’m really enjoying life in Blantyre.  But of course, there are some things from home I miss…like kitchen utensils, dairy milk, liquid hand soap and high speed internet!