Well to start off, I am already getting the sense that it will get harder to find the time to update my blog as we dive into our projects at Queens! These last couple of days have been a blur. Yesterday was what is called Malawian Monday here at Cure. We had about 15 people here and had a romantic dinner of local food by candlelight since the power was out. Luckily we had a gas can to cook with for just such an occasion, and we also learned how to make nsima, the local staple. All you have to do is mix the flour with water, boil, and stir, but Ariel and I do not have such a great track record for cooking so far! Nsima is very nutritious and also fun since you get to combine it with some sort of side to give it flavor and eat it with your hands. A childhood dream come true. On a similar note, Ariel and I made our first “successful” meal this evening. We stopped by the market on the walk home and bought ingredients for only a couple of dollars. It’s like fast food, except with fresh produce and you still have to cook the meal. Other interesting local foods we’ve tried include sugar cane (absolutely no ladylike way to eat this) and kasavo (kind of like a giant brown carrot but tastes different).
Soya, tomatoes, beans, onions.
On a more important note, we have officially begun our data collection for CPAP at Queens. After a first day of trying to get generally oriented at the hospital, today we have a good idea of how to tackle one of our main summer projects. Ariel and I are working to create a system to collect data on the effectiveness of the bCPAP at Queens as part of the bigger project of scaling up its implementation all across Malawi. Unfortunately, many of the bCPAPs are not currently in use due to four broken oxygen concentrators that are usually used in conjunction with the bCPAP. The necessary replacement parts can only be purchased in the US, so we are hoping to get those running asap. So far here are some of the main challenges we have either already faced or anticipate:
- Identifying patients who are eligible for the study based on registers-these are sometimes difficult to find, difficult to read (they’re handwritten), incomplete, or all of the above.
- Physically locating the patients who qualify in the ward (under 1 year with a respiratory condition)
- Getting the patients’ charts once they are discharged
- Language barriers
- Finding the charts if they end up in Medical Records instead of going to us
- Navigating the maze of hallways throughout the hospital
- Formatting the sticker labels
We are hoping that we will be able to work out the kinks in our system over the first couple of weeks so that it will be running seamlessly before long. Today we started off with a handful of pediatric patients and, with the help of our nurse friend, began data collection by walking the pediatric ward calling out names. We found that one of our patients had been discharged since we started her form yesterday. The nurse, Ariel, and I all turned to each other nervously, realizing that we would have to hunt down the chart in the medical records department. Unfortunately, Medical Records at Queens can be somewhat of a black hole. In fact we are not even sure exactly what happens to the records when a patient is discharged. According the nurse, Chrissy, the records go to the pharmacy and then eventually end up in Medical Records the following day. We will definitely have to investigate this process tomorrow. Sticker labels were successfully printed this evening, data collection in the neonatal center (the Chatinka) begins tomorrow, and we are already working on becoming best friends with the workers in Medical Records as well as the nursery.
We have been starting off our day with the pediatric morning meeting, where medical students and doctors convene to talk about the previous day’s discharges, admissions, and deaths. Discussing various conditions, symptoms, and causes of deaths is not necessarily the most cheerful way to begin the day, but it is definitely a good way to learn more about how the hospital operates as well as the challenges they deal with. It also makes me thankful for my bioengineering classes that gave me enough background knowledge to understand the discussions!
Although the original plan for my morning was to shadow in the pediatric ward, I ended up in the psych ward instead! Chrissy and I were transferring a pediatric patient to get evaluated, and I learned quite a bit during these hours. Psychiatric health is not something I’ve learned much about or thought much about in terms of global health. It is such a complex area of medicine even in the US and becomes even more complex in areas where resources are simply not available. The psych ward was very crowded and unlike the pediatric ward, it’s not as easy to put many patients in the same room, leaving many people waiting to be seen in the hallway. Like other departments, they were very short on doctors but had many medical students to do help do a lot of the basic tasks. Chrissy, the patient, the patient’s grandfather, the doctor, 3 Malawian medical students and I sat for 3 hours in the examination room trying to evaluate the patient. All of the information from the patient needed to be translated from Chichewa to English, clarified, retranslated, and then documented. This was a very frustrating time for me to not know Chichewa. It was particularly important to understand very carefully what the patient was saying in order to understand the patient’s condition and required treatment. For example, even the connotation of certain words and statements could affect the diagnosis of the patient as being delusional. The language barrier made this whole process of gathering medical history and completing an evaluation extremely time consuming and difficult. It’s also very challenging to treat mental patients in general, due to the lack of medications that would be commonly used in a developed country (such as antidepressants). Many of the psychiatric patients are simply treated with sedatives. Needless to say it was a good learning experience for me, although it is not a field where technologies like the bCPAP would be helpful.
Our cozy office at the hospital, also known as “The Closet”
Chichewa lesson: Inu bambo- you sir (emphatic)
