Now that I have been home for a week, I’m not sure how to feel. Everything is familiar yet different at the same time. I somehow managed to go from living with 10 other people to 11 considering I had extended family in town. However, it was quite easy to keep busy with unpacking and spending time with friends and family. Every once in a while when things slowed down, the little things would remind me of my time in Malawi and the people that became another family. Like making tea and piling on the bus to head to the Poly design studio in the morning or joking around while cooking dinner. It feels like only yesterday we were at the studio working on our prototypes.
On our last day in Malawi, saying goodbye was the hardest part. In the midst to completing our presentations and celebrating our hard work, we realized that it was time to say goodbye to everything we had known for the past few months, goodbye to the Poly design studio, goodbye to market in central Blantyre, and goodbye to our friends. Without them, I don’t think I would have enjoyed my time in Malawi. Sometime in the distant future when I will look back on this time, it won’t be the little things I remember, but the friends we made and relationships we built.
Overall, this experience has been one that I will cherish forever. It taught me so much about engineering, people, new cultures, and healthcare in different countries. I hope the knowledge I have gained does not end here and I can continue similar work in the future. I am proud of my teammates and our engineering accomplishments and I wish them all the best in their future endeavors. I know they are going to do great things and impact people’s lives for the better.
I also want to say a special thank you to donors who supported Rice 360 and made this internship possible without your help I would not have another place to call home.
A few weeks ago, I wrote about how hard it was to believe that we were halfway through this internship. Now, looking out the window of one of my four flights back home, I can say it is even more difficult to accept that our time in Malawi has come to an end.
This morning felt just like any other morning: I woke up, showered, and watched the sunrise while drinking my morning tea. Soon after we finished dragging our luggage up the stairs, Mr. Richard appeared with the bus to drive us back to the Lilongwe airport. While loading the suitcases, we joked about how it was just like the day we first arrived in Malawi, only now he would put the bus in reverse.
It was then time to say goodbye to Kabula: the kitchen where we cooked all of our meals together, the terrace where we soaked ourselves doing laundry, the place we all began to call home as time went on. Soon after that, it was time to say goodbye to Blantyre, then our friends from Tanzania, and finally Malawi.
One Week Later:
The past week has been full of quality time with friends and family. Due to the time difference between Michigan and Malawi, it was difficult to keep everyone fully updated throughout the course of the internship. As a result, I often share my stories starting from day one, using my journal entries and photos as guides to what I was seeing, thinking, and feeling. In day-to-day conversation, I’ve noticed myself begin to repeat a phrase: “When I was in Malawi…” I’ve said it while driving down the road and cooking dinner, comparing my experiences here to my time abroad. I’ve even said it while going under for oral surgery, sharing that we had gathered feedback in Malawi on a locking mechanism for the IV that was feeding into my arm.
In my downtime, I’ve also been working on finishing a book I started reading at the beginning of the internship. “Don’t Let’s Go to the Dogs Tonight” is a collection of personal narratives from the African childhood of Alexandra Fuller, some of which take place in Malawi. Reading through them at a time when I am also reflecting on the past few weeks has given me a lot to think about, and one quote, in particular, has stuck with me…
When describing an English guest to their house in Zambia, Fuller writes about how people like this man never last long, and then they return to their homes and say “when I was in Africa” for the rest of their lives. Coming across this similar phrase, I couldn’t help but compare myself to the foreign man. We too had spent a short period of time in another country, seen both its beauty and its challenges, and then returned to the United States to share our experiences.
Thinking through this comparison, I began to once again flip through pictures of our work, and eventually the differences became clear. I saw our very first hospital visits, our ideas at every stage of the design process, and the final prototypes that came out of it all. Continuing to flip through my camera roll, I soon came across our speeches at the internship’s closing dinner. As I played the videos, I heard Nana talk on living with people of diverse cultures, personalities, and mentalities. Hannah highlighted the similarities between each of our lives, despite living on opposite sides of the world. Foster recounted an interview question that we all received: “Are you able to associate with people of different backgrounds?” Tebogo then gave the answer, saying that the studio would not feel the same once we all returned home.
Finally, I began to play the speech of Dr. Ng’Anjo, one of the professors who welcomed us to the design studio when we first arrived at the Polytechnic. To the room of interns from three different countries, he said, “Keep the course. Whatever you have learned, don’t just say: Oh, it was an experience. We were in Malawi … Blantyre … a lot of dust.” The room laughed. Smiling at his own joke, he continued: “Amidst the dust, amidst the noise, amidst all that you have experienced… say this is the knowledge that we got, and I’m going to run with this knowledge.”
Listening to these words once more, I am reminded that while our time in Malawi has come to an end, the experience is not confined to a single summer. The names of my fellow interns do not simply stay on the pages of my journal, they light up the screen of my phone. Despite the distance, ideas continue to flow. I receive updates from my teammates as they gather feedback from district hospitals on our training model and application. As progress is made on the MUST Design Studio, suggestions are shared from what is done at the OEDK and the Poly.
When I was in Malawi, I found something that I want to continue to be a part of for years to come. As Dr. Ng’Anjo put it: “by working on these types of projects, you serve life itself.” I chose bioengineering because it lies at the intersection of technology and people. I wrote this statement when I applied to Rice. Last year, I used it as motivation whenever I was struggling with a problem set in a physics or math class. This summer, I had my first opportunity to understand what this statement truly meant.
– Alex
Team SimpleBallard after final presentations.
I would also like to thank all of the donors and supporters of this internship program for making this possible. Without you, our newfound community of engineers from Malawi, Tanzania, and the US would not exist.
Our last couple of days in Malawi were a whirlwind and I honestly can’t believe that it is over. Of course, we had a lot to do and not enough time, but part of the experience is making do with the time and resources available. On Monday, we were finally able to set up the first ever design studio at the Malawi University of Science and Technology (MUST). For majority of the summer, the design studio has been under construction, but we finally had the opportunity to view the space and at least begin the process of organizing and assembling the equipment. Due to time restraints, we only had the Rice and MUST students set up the new studio while everyone else continued to work on their projects. Our focus for the day was to get as much of the 3D printers built as possible, create an organized inventory check out system, label everything, and make sure all the laptops brought had the proper software. Unfortunately, we couldn’t finish everything we set out to accomplish given that we only had a day, but we made a good start and left and extensive list of tasks to improve the studio in the future. One day I hope I get the chance to see it in use knowing it will encourage students to learn through hands on experience.
Tuesday, the final workday before presentations, was a long day to say the least. The only way to we were going to accomplish everything remaining in the project was to make design decisions together and then divide and conquer. Once deciding on the best way to approach completing the last portion of the project, Maureen and I worked on the final presentation, while Cholo and Tebogo started assembling the acrylic pieces. As we were making the presentation, we had to anticipate that our audience did not have prior knowledge of our project or the need we were trying to solve, yet technical engineering experience
Late night at the studio
as they were mainly professors. With that in mind, our main priority was to demonstrate the need to prevent hypothermia specifically during transportation between the wards, how it significantly impacts a neonate’s health, and how the device functions. After a tedious amount of time, we were able to include the information we wanted and now it was just a matter of making it presentable and easy to understand. By this point, majority of the students had left the studio and the rest of us came to terms that it was going to be a late night, so it was all hands on deck. After putting the last touches on the presentation, I began working on the device with the rest of the team. The device was almost done for the most part, we only had a few brackets to put secure the device which seemed simple enough, but took time working with acrylic and the size of our device. We did one last check to make sure everything was working properly (thankfully it did!) and we Eventually we are able to finish the device and it is a huge relief. Now all that remained was our big final presentation the next day.
Final presentations!
On Wednesday morning, we were all a bundle of nerves for our presentation. For me personally, this was only my second formal engineering presentation, so I was especially nervous to say the least. As the time came near, we each practiced our presentation multiple times to ourselves and each other and made sure everything transitioned smoothly. Luckily our group was going third, so we had the opportunity to observe a few presentations before presenting. Before the first group presented, all the professors and Rice 360 engineers in the audience introduced themselves which only intimidated me more. The first two groups did an amazing job clearly describing the need for their device as well as how it works and handled questions from the audience with ease. Finally, it was our turn and there was no going back. During the presentation, everything went off without a hitch. We remembered to say all the additional information however the questions were more of a challenge. A few of the professors already had experience working with devices in the same field as ours and were more technical with our questions, but having only developed a first iteration, it gave us a lot to consider for future improvements. At the time it felt like we were under a lot of pressure, but we received nothing but positive. Of course, there were questions about why we chose to design something a particular way or if we had considered doing something differently, but that is how progress is made. Obviously, these professors had way more experience and their criticisms could only improve our design and in the end help people. Walking away from that project, we had a long list of future improvements to make and design aspects to reconsider, but it could only get better from there. That last day in Malawi could not have ended better, with everyone together celebrating our accomplishment and looking to the future with hope.
It’s been four days since I returned home to Prosper, Texas, USA. People keep asking me if it feels weird to be home. I think people expect me to say something along the lines of “Yes, of course! Everything is so different! What a strange feeling!” And it’s true that lots of things are different. I’m readjusting to driving on the right side of the road. My family and I stopped at Buc-ees on the way from the Houston airport to my hometown near Dallas on the day I got back to the states. For those non-Texans who are unfamiliar with Buc-ees, it’s basically this massive gas station general store. It has every gas station snack you could ever imagine, times ten. I was sleep deprived from over 45 hours of travelling at that point, and I almost had a meltdown when my sister walked my half-asleep self into the Buc-ees. It was something to behold. I had forgotten how absolutely massive stores in the US are. The sheer number of options was unsettling. Another area where the differences particularly struck me was this morning when I went to the GP for my yearly doctor’s check-up. After spending weeks growing used to the state of hospitals in Malawi, the cleanliness and abundance of technology and resources in my GP’s office really struck a chord. As the nurse took my blood pressure, I stared at the mobile BP machine and all I could see in my mind’s eye were the dozens of mobile patient monitors sitting broken in PAM facilities that I visited over the last two months. She took my temperature and all I could think about was the lack of temperature monitors in the labor wards at the hospitals we visited and how nurses often resort to using the back of their hand to guess if a patient has a fever. There are so many differences, and it’s important to recognize them and talk about them.
It is important to talk about the differences between our two countries. It is true that I will move forward being eternally more grateful for all that I have in this amazing country I was lucky enough to be beorn in. I will never again use random and obscure electrical components from the OEDK without thinking about how the Poly Design Studio didn’t have access to a pulse sensor for Nimisha’s team to complete part of their prototype. I will never walk into a hospital or doctor’s office without remembering the babies wrapped in chitenge in the neonatal ward of Queens Hospital. But what I think is a more important thing to say after this experience is not so much how different Malawi and the US are, but actually how we are both the same. While some differences are critical to speak about and deserve attention, most differences are illusions. During our last week, we had a really fancy dinner with our boss, all the interns, a handful of professors at Poly, and people who work in the design studio. Our boss asked one intern from each of the four universities to speak to the whole group on behalf of our cohorts: What had our experience been like? What did we expect coming in to the internship, and what did we take away at the end? It ended up being an emotionally charged moment. All four people who spoke talked about how in the beginning they were afraid that it would be difficult to relate to people from other countries, but how working with and becoming friends with all the interns was actually so easy. Everyone spoke of learning from each other and growing close to people they feared they’d never relate to. I am so, so sad to leave these friends behind. In Tebogo’s speech, he looked right at the US interns and told us “The studio is going to feel empty without you.” I almost cried.
Dr. Ng’Anjo spoke towards the end, and he told us that we shouldn’t let this internship just become an experience in our past. We should keep talking to each other, and we should make sure this week is not the end of something small but the beginning of something great: careers that transcend borders and save lives with technology. He told us to keep talking to each other, because we understand each other and the unique challenges that engineering students in the global health field face. Twenty years from now, we should be reaching out to our friends in Malawi and Tanzania to work together to start startups, help each other network and get jobs, to work at as team on the next generation of medical innovation. More than that, though, I know I will hold these friends in my heart forever, a shining testament to the fact that yes, there are differences between the US and Malawi, but at the heart of things, people are all people. For the many, many people in this world who grow up in homogeneous, small communities, it can be hard to internalize the sameness of people from very different places. But, for people making careers out of global health, or heck, even people just watching the news and voting in elections these days, it is so critical to remind ourselves that the same friends and family in our own backyards who we’d all fight for are the same as people all around the earth, and it’s important to fight for them, too.
Zikomo kwambiri, Malawi, and I will see you again.
All the interns on our very very last day in the studio, after final presentations
Zikomo (Thank You), Everyone
I’d like to thank the generous donors of Rice 360 for making this internship possible. If it weren’t for you, I wouldn’t have planted a small part of my heart on the other side of the world, and I will always be grateful for that.
I’d also like to thank all the staff members and professors involved in Rice 360 and the Polytechnic for your support and guidance throughout these weeks and beyond. It is because of your investment in education that us interns are empowered to shape our lives into careers that might change the world. Thank you for believing in us.
To the Malawian interns: Racheal, Maureen, Foster, Boniface, Christina, Chisomo, Tebogo, and Rodrick: Thank you for showing me your country. Thank you for becoming my friends. I know many of you are graduating soon, and I wish you the best of luck with your future careers. I know you’ll all do great. 😊
To the Tanzanian interns: Nanah, Betty, Cholo, and Joel: Thank you for being so much fun to live with for seven weeks. It was wonderful getting to know you all and exploring the country of Malawi together. I know our many inside jokes and memories will last a lifetime. Keep in touch. <3
Finally, to my fellow Rice interns: Nimisha, Alex, Shadé, Sally, Kyla, Liseth: It was such an honor to get to know you all better than I did before. My life is much brighter now that you’re all in it. I can’t wait to keep learning alongside you. See you in two weeks!
The past two weeks can be summarized by two words: rapid prototyping. Everyday, we walk into the studio with ambitious goals of finishing multiple attachments to our model, but somewhere along the line we’ll hit an obstacle. One 3D print’s dimensions are incorrect. A ball and socket fails to replicate the range of motion of a human shoulder. Our elastic strings don’t properly simulate muscle tension. But once a prototype falls short, its life is not over. We immediately begin shaving away extra material, cutting new holes, and taping on components to test potential directions that our next iteration could take. After a new low-fidelity prototype has been created from the remains of our previous failures, the cycle begins once more. We arrive at obstacles, meet to discuss the shortcomings of a design, and a new design is born. It’s kind of like the Circle of Life (sorry but I’m listening to the soundtrack of the new Lion King movie as I write this).
Of course, the model’s thin rods of plastic don’t necessarily resemble the contours of a baby’s arm or leg. The method of adjusting muscle tension could be simplified. But despite these imperfections, our current model establishes a solid foundation for the project.
By the end of Friday, we had completed all neuromuscular attachments to our training model, and with only one week remaining, our focus shifted to developing the assessment app. In the last half hour of work before the weekend, my team grabbed a huge white sheet of paper from the back of the studio. We then began to create a flowchart, outlining the basic progression of screens within our app. Once we decided on the placement, text, and purpose for a component, I would draw it onto our plan with a vibrant red marker (I found this part super satisfying). Not only did this process help us produce complete idea of what our app would be, but every member of our team left the studio visualizing our app in the same way. In engineering design courses back at Rice, it was always stressed that a crucial step in any project is making sure all of your team is on the same page. This helps avoid any major misunderstandings later on while prototyping.
The red markings outline different screens and the ways in which users will interact with our app (buttons, sliding scales, or scrollable lists). The dashed black lines illustrate a user’s navigation through different screens.
On Saturday, we drove to the Satemwa Tea plantation, the first fair trade registered tea plantation in Malawi. We began the morning with a tasting at the factory, where we each tried a spoonfuls of 18 varieties. I never knew this, but apparently even without flavoring, the different methods of rolling tea leaves have a large impact on the taste. My favorite teas were the white hibiscus, red hibiscus, green verbena, and the green mint. We then went on a walking tour through bright green rolling hills of tea plants, some of which were close to 90 years old. In the evening, we had dinner with some previous 360 interns from Malawi who had worked in Houston last fall. It was neat to compare experiences between the two different internship locations and hear about their time at Rice.
Sunday morning, Shadé and I woke up early to put finishing touches on the Clean Machine. With the craziness of prototyping our own projects, recreating this technology was a responsibility that we had pushed to the side. Taking it home to Kabula and working on it over the weekend was a good call, but looking back, we definitely had to get a little crafty with some components. For example, we completely forgot to bring the pulley’s counterweight from the US, and not being at the Poly, there was no clear replacement or way to attach the counterweight to the belt. Still wanting to test our work, we borrowed rocks from the garden and used some clothespins…
Eventually, we found a rock that provided the perfect amount of force to lift the lid and release the inner bucket without applying too much strain on the pulley brace.
After working on Clean Machine and making a little progress on this blog, we began to prepare food for a cookout we were having with all of the interns. We underestimated the amount of time it would take to chop all of the veggies, cook the hot dogs, and fry all of the chips, samosas, and spring rolls. As a result, dinner was delayed a little, but boy was it worth the wait! I think all of us were surprised at our ability to create such a spread of food.
Returning to work on Monday, our team began to develop our simplified assessment app for the Ballard Score. Looking at our plan, we started with the simple stuff: creating different screens and adding in buttons. Once that was done, we had to think a little more on how we wanted to program more complicated things like our sliding scale. Being that I was the only one who had done something like this before, I initially felt as though I had to serve as a resource for the rest of my team, but this didn’t last long. I remember the moment we tested our work on a phone emulator for the first time. At that point, we had only made the buttons that switch between screens. Still, the feeling of seeing your work come to life is thrilling. Everyone soon began to practice with the program on their own time, and our team began to fly through developing the rest of the app.
Since last Thursday, we have been testing and tweaking our work. You can find our most recent version attached below. If you are viewing this blog on an android smartphone, simply download, open, and install the file to try it out!
Early Friday morning, I hopped in a taxi to Queens for a meeting with Prince, a nurse who frequently collaborates with Rice360. He was able to give plenty of useful feedback for the Clean Machine prototype and even had the time to look at our new Ballard Score training model. After talking with him, I arranged to observe in the NICU for a few hours until work started at the Poly. Heading into the ward, I was very concerned about my presence becoming an obstacle for nurses to work around. This was the last thing I wanted, so I began by sitting in the corner towards the back of the room. After a short while, Sarah, a fellow at Rice 360, tapped my shoulder and told me that something was happening on the other side of the room that I might be interested in seeing. A new baby had been admitted into the high-risk section of the ward. From a distance, I saw nurses quickly retrieving equipment from all around the room. The level to which every nurse is able to work with one another is incredible. Their communication is clear, quick, and their collaboration is efficient. Observing led me to better understand the role in which an engineer could contribute in this setting.
Prince trying out the heel to ear attachment on the new Ballard Score training model.
When the new baby was admitted, I saw Prince run to the other side of the room and grab a linen blanket. He then held the blanket up to a radiant warmer used to heat the room for at least 30 seconds. As I was reminded by Sarah, the best treatment for a cold baby is a warm blanket, warm socks, and warm hat. After the situation had calmed down, Prince came over to tell me that a useful project would be a warm storage container for linen blankets. This idea would save time in situations where every second counts. Prince’s suggestion got me thinking about ways to simplify processes, and I soon began to observe other opportunities for engineering to have an impact.
Recently, I’ve been thinking more and more about the scope of this program. As an intern, one of my primary responsibilities is needs-finding for projects at Rice. These projects are then worked on, and taken back for feedback. Looking forward into my next few years of education, I may even end up working on a need we identified through this internship. It truly is a cycle, involving every stakeholder at every stage. From nurses in hospitals across Malawi, to the students from four separate universities, to the professors and organizers that make it all possible, everyone is fully invested in a common goal. Step by step, prototype by prototype, progress is made, never losing sight of the bigger picture.
It is surreal that we only have a less than a week left in Malawi. Somehow the time has gone by and I didn’t notice it, but on the other hand we started prototyping! Our focus for the past couple of weeks (sorry it’s been a while since my last post) after the pitch competition has been on finalizing our solution design, get materials, and physically build our prototype. We started by making a few alterations to our final design transitioning from a water heat source to a light bulb heat source and deciding on the exact dimensions for each compartment. Once we had a plan in place, we transitioned towards dividing the work into three components the electronics, heating compartment, and the neonate’s compartment. For our first task, we collectively decided on how the heating system should operate:
Contain a manual on/off switch
Measure the temperature of the neonate’s heated environment
Turn the light bulbs off when the temperature exceeds the desired temperature
Turn the light bulbs on if the temperature falls below the desired temperature
Alert nurses of the temperature
With these criteria in mind, we used various electronics, such as a thermistor, relay, Arduino, LEDs, resistors, and light bulbs, we spent multiple days trying to fit them all together. Each day we were able to build the circuit using the component and then program the Arduino to control the function of that component until we had a completed circuit. Of course, there were challenges along the way with not knowing the proper way to integrate the components together or the code not working, but eventually with enough trouble shooting we were able to acquire accurate temperature readings, automatically turn on/off the light bulbs, and indicate extreme temperatures. Not only were we able to work together and accomplish this task, but we took the time to teach each other the skills and reasoning behind each component so we understood their purpose (relays are really cool by the way).
Once we completed designing the electronics portion of our design, our next goal was to complete the heating compartment which contains the light bulbs, wiring, metal sheet, and insulating material. One challenge we faced in this portion of the design was obtaining the physical materials themselves. It seemed that the best way to know where to get the proper materials was by word of mouth. Luckily the design studio already had plenty of wood available to use, however, the more specific materials were difficult to find. Working with the materials we had in the design studio, we built a simple rectangular box out of sheets of wood. On the bottom face of the box, we decided to add a plank of wood across to attach the light bulbs parallel to bottom and ensure they fit within the specified dimensions of our design. We also added a metal sheet above the incandescent light bulbs to retain heat and lined the inside of the box with aluminum to retain heat for a longer duration of time through insulation and radiation. As we continued to work, there were many decisions and adjustments that needed to be made such as adding a closed off housing area to separate the electrical components from the heat and laser cutting outlets in the box before assembling so the LEDs are visible and power switch inlet could be added. Despite planning our design for a significant amount of time, I realized that there are always going to be on the spot changes when completing a design. Because of this, my team and I had to discuss each possibility and would only move forward when we all agreed on the best option.
After completing the heating compartments, we then started on the base of the design to make the device mobile. Because we had already assembled the heating compartment with limited available space, figuring out a way build a secure and stable attachment point between the legs of the cart to the heating compartment was a challenge. At first, we attempted to attach for legs as a base and then add the wheels however, when we test it, legs were uneven causing it to be slanted (sawing perfectly level and straight lines with a hand saw is difficult). Unfortunately, this meant we had to either redo the base with the hopes of it being level or try an alternate method of attaching the wheels. Knowing that we were still unable to cut straight, we came up with another design that relied less on how the pieces of wood were cut but still stable enough to handle any obstacles when being pushed and this time we were happy with the physical results.
Despite having completed majority of our design, there are only a couple of days left before final presentations and we still have a lot to do, but I am hopeful that we can get it done in time. As for our time outside of the design studio, we had the opportunity to have dinner with the past Malawian interns who did their internship in the United States last year. It was really nice to compare our experiences having both traveled to different countries to work on global health projects. Something I found interesting was that they actually did their internship while Rice was still in school, so they worked mainly with Rice 360 fellows rather than other undergraduate students. I personally was curious to hear some of the cultural differences they found shocking in the US. Apparently one observation they had is how people treat pets as members of their family especially dogs. I can understand their surprise considering all the dogs I have yet to see in Malawi are either guard dogs or strays. It turned out to be a very nice dinner and I wish we could have spent more time with them or even met while we were at Rice.
On another note, here are some pictures from the adventures we have had over the past couple of weeks that I hope you enjoy as much as I did.
“Thirty-five years of independence, but are we really independent?” This question rang out at the Kwa Haraba Art Gallery and Café last Wednesday, the week of Malawi’s independence day, as the first poet of the night finished his poem. The answer was not spoken but was palpable in the night air. As the evening went on, more poets performed, many of them also contemplating the fragile state of Malawi’s independence. (The only guy who claimed otherwise was a Caucasian man who sang a song whose only lyric was “One Malawi, One People”…).
Considering what we’ve seen in Malawi, it’s easy to understand why they might feel that way. Driving through the city of Blantyre, you can see UNICEF, UKAID, and the names of various religious institutions plastered on signs outside buildings. The shiniest, tallest office building around the Polytechnic/QECH belongs to a Chinese company, and stickers with Chinese characters are plastered on the windows and doors of trucks. A good portion of the businesses are staffed by Malawians but owned by South Asians. And many of the doctors who work in the QECH pediatrics department are from other (mostly European countries). (In fact, approximately 60% of Malawi’s healthcare expenditure comes from foreign donations.)
Tea leaves from the tea estate we visited on Saturday (pc: Alex Lammers)
This thought lingered with me when we visited a tea plantation right outside of Blantyre on Saturday. When we got to the entrance of the tea estate, I was surprised to find that the manager of the estate was a Caucasian woman with a crisp British accent and later learn that the estate was founded by and has continued to be owned by a Scottish family for three generations. In the video we watched before tea tasting, the tea estate was billed as a sustainable business and community with a portion of the plantation left for the natural forest, a self-sufficient bluegum tree logging and replanting operation, two clinics for the workers, and a primary school for the workers’ children. Later online investigation showed that this was the only Fairtrade certified tea plantation in the country and numerous other projects had been undertaken under the Fairtrade agenda (investment into the nearby Thyolo District Hospital, subsidized solar panels for workers, construction of roads, etc.).
Our guide who works at the tea plantation (pc: Alex Lammers)
Nonetheless, it’s hard to forget that the tea plantation was founded during and built off a legacy of neo-imperialism that lined the pockets of western nations and exploited the workers. And it could hardly be claimed that the plantation is an utopia now—only half the workers’ children are able to finish primary school, and food insecurity is an issue during the dry season. This exemplifies the issue that the poets at Kwa Haraba lamented and that I noticed while here: it is difficult and almost impossible to differentiate between the lingering effects of colonialism that put Malawi in this position and the efforts of foreign aid that attempt to improve the situation.
As a result, some people, especially many young Americans, would argue that it is better to avoid foreign intervention (and, to some extent, foreign aid) all together, at least at the national level. Although I truly do not have enough information to make judgments about the tea plantation or any of the other instances of foreign investment I described (clearly they’re not all equal), despite, or perhaps due to what I’ve seen here, I strongly believe past mistakes do not excuse in current inaction. While the ultimate goal is a Malawi that is truly independent from foreign influence, in the meantime, we, as an interdependent global community, have a responsibility to help Malawi and other countries like Malawi get to that point.
Part 2: Scales of Change
I fully admit that the last part of my blog was a statement of lofty thoughts and aspirations that I personally can do very little about. However, the importance of differentiating between ultimate goals and current realities has also been impressed upon me on a smaller, more personal scale recently.
As I was walking through the hospital grounds to lunch from the Rice 360 CPAP office one day last week, a man stopped me and telling me that his brother was being discharged and that he needed 2000 kwacha to pay for the minibus trip from QECH to their home in a village. I didn’t know what to do. The other interns and I had encountered people asking us for money before, and we had discussed it extensively. We talked about how giving people on the street money ultimately perpetuates an unsustainable system since it incentivizes them to keep coming back to the random people on the street instead of seeking more long-term aid from nonprofit organizations or government agencies and, consequently, prevents the social issues from garnering the attention they need. For the most part, I believed this, but, in that moment, I realized the flaws in this perspective.
I knew that transportation was a major barrier to access to healthcare services, even in the United States. For instance, during my Alternative Spring Break on maternal mortality in Texas, I learned that a major reason that pregnant women missed prenatal appointments (putting them at increased risk for maternal mortality) was that they could not bring their other children to these appointments using Medicaid covered transportation. (Though this has changed during the last state legislative session.) How could I blame that man for his country not having adequate public transportation to health facilities when this was so recently still a problem in Texas, which has exponentially more resources than Malawi?
I ended up giving him the money. (I’m aware that he may not have been truthful, but I choose to believe otherwise.) In the end, 2000 kwacha was not a lot of money to me, and while I may not have contributed to improving rural healthcare access or the public transportation system, the money allowed that man and his brother to return home after receiving the healthcare they needed.
The Ballard Score poster I put together hanging in the NICU!
This realization about the difference between long-term sustainable change and short-term measures led me to decide to pursue a side project I had been thinking about. Seeing the Ballard Score poster, which was really a sheet of letter sized paper with the diagrams in black and white, in the NICU at QECH made me want to make a larger, laminated, and colored poster to at least match the other poster in the ward. However, I kept going back and forth about whether I should do this initially. A larger poster really doesn’t change the fact that the Ballard Score to difficult to use and that nurses don’t like performing it. Nonetheless, in my last blog, I talked about how, even in the best case scenario, a Ballard Score training program and assessment app would take years to implement. In the absence of a better training system or a better method of gestational age determination, at least a better poster would make it easier for nurses and doctors in the cases where the Ballard Score is used.
After corresponding with Prince (the nurse at QECH who works with Rice 360) and getting approval from the ward in charge to post the poster, I ultimately made four copies of 11 x 17 inch poster with a colored coded version of the Ballard Score diagram to hang in the NICU, the low risk area, and the Kangaroo Mother Care ward. While this poster clearly doesn’t make any meaningful, large scale change, I’m happy to have helped the nurses of one ward in one hospital in a small way. This week has been a valuable lesson in distinguishing between overarching aspirations and immediate measures and understanding the importance of contributing to both.
The design studio is filled with a sense of productivity. Prototyping is in full swing, as each team is trying to get their projects done before our final presentations next week. We even had a surprise visit from Kyla and Liseth, who are working on a low-cost, reusable ostomy bag and a cervical cancer thermocoagulation model!! A picture speaks a thousand words, so here are a few that will hopefully give you a sense of what the studio has looked like these days.
Hard at work on our prototypes!
Over the last 2 weeks, each of our teams has been faced with different obstacles: my team realized that the only pulse sensor in the design studio is broken, Alex’s team has been struggling to properly simulate muscle tension with elastic, Hannah’s team had an overnight 3-D print fail (probably due to a power outage at night), and Shadé’s team struggled to acquire the materials they need for their prototype from local markets and stores. It’s been amazing to watch as each team has adapted to these challenges and, in true Malawi fashion, come up with clever ways to improvise and keep moving forward.
Here’s how my team decided to move forward: after we realized that we didn’t have a working pulse sensor in the studio, we decided to spend the time we had left wisely, and really capitalize on the resources that are readily available to us. Since engineering is an iterative process, we decided to design the circuit and write the Arduino code for the pulse rate monitor and leave space in our CAD design for a pulse sensor. We are also going to focus our time on documenting the changes we make and write out an instructions manual to set up the device. This way, the team that works on the next iteration of this device can read our instructions manual and when they have access to a working pulse sensor, they will be able to easily incorporate it into the device using our CAD files, circuit diagram, and Arduino code.
With this decision, we switched gears and started to focus on the armband for our device. In order to make sure the armband was adjustable and comfortable, our team decided to use moldable silicone rubber and designed a 3-D printed mold. Designing the mold, a seemingly straightforward task, ended up being several days of trial and error, but we finally came up with a good design – a two-piece mold that snaps together and is easily openable, with a bar in the middle to create a hole for the temperature probe and pulse sensor wires to pass through.
The final iteration of our clipping-mechanism mold to make the armband
Outside of prototyping, these past 2 weeks have shown me how quickly new communities can be built. I’ve found myself reflecting on my initial reservations about the internship – would I bond with my teammates from Malawi and Tanzania? Would we have anything in common? Would I be able to foster an environment where everyone’s ideas feel not just respected, but celebrated? Fast-forward 6 weeks and my teammates and I talk about everything together – our love for the TV show ‘Friends’, politics in Malawi and the US, how stressed we are about getting a grown-up job in the “real world”, and how much we love the samosas in the Poly cafeteria – all while listening to each other’s favorite music as we work on our project in the design studio. I never would have guessed that in just 6 short weeks, I would have made such special connections with people from all over the world. Before we started this internship, Dr. L would remind us to “expect the unexpected”. I always interpreted it as being prepared for unique challenges during the design process, but I’ve come to realize that this advice applies to building community too.
Here is a short anecdote from my journal that hopefully conveys how strong our community has become in such a short time:
Day 40:
Friday (July 12th) was my birthday and Sunday (July 14th) was Tebogo’s birthday, so this weekend we decided to host a cookout / party back at the lodge and invite all the interns. In preparation, we bought samosas, spring rolls, potatoes to make chips (french fries), hotdogs, sodas, and other snacks – it was enough food to feed an entire army. It took HOURS for us to cook it all, but it was so worth it. Joel bought a speaker from the market nearby, and we decorated the whole place with balloons. I was so excited when everyone started showing up and we had so much fun sharing stories and playing card games. It was such a perfect day and I really thought it couldn’t get any better. Boy was I wrong. Chisomo showed up with the most BEAUTIFUL cake I have ever seen (apparently he had been pestering Hannah with questions about me…like what my favorite color was, and what flavor cake I like… I had no idea any of this was happening). It really was the sweetest gesture and made this birthday one I will never forget.
As always, here are some bonus pictures from our adventures last weekend!
Group photo from our cookout!Look how pretty the cake is 😍 Thank you Chisomo!!On Sunday, we visited the Satemwa Tea Plantation. The tea here is so flavorful, and I bought so much Black tea, Earl Grey, and Green tea to bring back for my parents!
I want to spend this blog talking about community. But first, a quick prototyping update.
We spent the week going through many iterations of CAD models and 3D printed parts. We’re still not quite done refining everything, but we got all the most basic functions down. Pictures speak louder than words, especially when it comes to prototyping, so take a moment to check out the progression pictures I crafted in the designs studio below to showcase what we’ve been working towards! All that’s left is to develop the internal membrane, which will be done using silicone casting, and to make sure that the pieces connect well in order to assemble the model.
Prototyping is an iterative process!! This is a central dogma of engineering design. Here are some trachea/larynx piece iterations.
Iterations of the piece that attaches to the inside of the nose/mouth holes on the baby doll.
Now that the obligatory prototype update is done, allow me to tell some stories.
A few weeks ago, a student at Poly approached Alex and told him that he interned at Rice last year. His name was Isaac, and he and the other Malawians who interned at Rice alongside him wanted to take us out to dinner! Apparently, while they were in the US, they met a man who owns businesses in Malawi. He told them to take us out to eat at the hotel he owns. So, Alex and Isaac set a date. Fast forward several weeks and we found ourselves in a super fancy hotel, face-to-face with three strangers plus Isaac, about to eat the fanciest buffet I’ve seen here in Malawi. As I’ve mentioned in a previous blog, I am an introvert. Making conversations with strangers is a bit of a scary thing for me. Knowing that it’s my responsibility to represent Rice 360 and be a pleasant and talkative representative of my university and country, my insides were rolling with apprehension on the whole taxi ride to the hotel. The thing is that all my fears were completely unfounded, because these people turned out to be super wonderful and relatable! We had so much fun exchanging experiences; Their time in the US, ours in Malawi. They told us about how Dr. L made them try tacos, which aren’t really a thing here in Malawi, but they really liked them! She also made them try tamales, which they weren’t as fond of. They also told us that they spent their time hanging out with the old Rice 360 interns from last year, one of whom is my good friend, Franklin! (Read his blog from last year here: Hyperlink to Franklin’s Blog) I realized with a start that they were interning last fall, which was exactly the time that I met Franklin, when we were assigned to be teammates for our PBL project. It’s so crazy to me that he was hanging out with these people on the weekends almost a year ago, while we were projects teammates, and here I am now on the other side of the world, having dinner with them in their home country! Rice 360 has really pushed past borders to cultivate an international community of engineers and students. It’s amazing to be a part of. I’m so glad we met Isaac and the other interns, and I’m thankful to Rice 360 for bringing us together.
Another manifestation of this unique international community of students and engineers occurred this weekend, at Kabula Lodge, where the US and Tanzanian interns are staying. Nimisha’s birthday was Friday, and Tebogo’s was on Sunday, so we decided to have a little cookout. We bought more springrolls and samosas than anyone could ever eat, and fried enough chips (“French fries”) to feed a whole army. Seriously, I have never cut up so many potatoes in my entire life. We made hot dogs and salads and bought soda and snacks. The US and Tanzanian interns spent the whole afternoon frying everything up in preparation to host our friends, the Malawian interns. We decorated the deck of the lodge with balloons, and Joel even bought a small speaker so we could have true birthday party vibes. All last week, Chisomo pestered me with questions about Nimisha: “What type of cake does she like? What’s her favorite color?” He showed up on Sunday afternoon with the most beautiful cake (and most tasty, too), which we had for dessert. We sung happy birthday to everyone with birthdays this month: Nimisha, Tebogo, Racheal, and Foster. It was probably the most fun I’ve had in the last two months. Having everyone come together for food and music and fun conversation beats a safari any day, as far as I’m concerned. The sun set on our fun little patio birthday party, and as the last of the Malawi interns were getting ready to leave, Tebogo told us all: “Thank you for doing this guys. I love spending time with you.” That was so sweet and really resonated in my heart. I was reminded again of how special it is to be a part of this community, to work and befriend and live with engineering students from across the planet. I am thankful that these people entered my life. I’m going to miss them so much, and I will return to my normal life stronger and better, because of them.
All this talk about communities has me thinking about my communities back home – My community at Rice, my community at Lovett. I’ve grown close to so many people who seem “different” from me on the surface. My friends are from Texas, from the east coast, from California, from India and Singapore and Cuba and… you get the point. We might seem different from each other at first glance, but in reality, we are all the same. I might have grown up in Prosper, Texas, meanwhile my friends grew up all over the US and even in different countries, but we all manage to laugh and cry together about things that tie us together – Our experiences at Rice, internet memes, politics, etc. It doesn’t matter what state or country we come from, we are one community. Similarly, I’ve learned during this internship that it doesn’t matter what continent we live on. We are all students. We are a community. We all complain together about challenging classes and exams and sympathize with the panic that comes when older people ask us the forbidden question: “So, what do you plan to do after you graduate?”
I challenge each person who reads this to think about a time when you brushed someone off because they seemed too different from you, so different that you could never possibly connect to them. I encourage you all move forward in your lives looking past these differences. In our hearts, we are all the same people. We love. We cry. We laugh. We are all brothers and sisters in this great big world, and in the face of pressing global issues such as climate change, refugee crises, and worldwide wealth inequality, it is our job to treat every person on this earth as part of one big global community. We all live together on this planet. There should be no outsiders. Only unity and love.
It has been such a whirlwind of a week (2 weeks?) since I wrote my last blog entry. I have many new updates to share so I’m just going to dive right in.
This past week and a half, Liseth and I have been busy continuing our usability observation project. We wrapped up our note taking from Queen Elizabeth Hospital with a visit to the pediatric oncology ward, pediatric special care ward, and an overnight stay in the neonatal intensive care unit (NICU). From speaking with nurses in oncology, we learned that the lack of syringe infusion pumps meant that nurses had to calculate the average amount of fluids and chemotherapy drugs administered per hour. They discussed with us the challenges of manually regulating these dosages for every chemotherapy patient.
While spending the morning in the special care ward, we observed that the bulk of the medical equipment and technologies (oxygen concentrations, bCPAP machines, patient monitors) were concentrated to the high dependency unit (HDU) for special care patients requiring respiratory support. At first, we were surprised to see that all of the patients were in the HDU and the main bay area beds were completely empty. But around 9am, floods of kids and families entered the ward from outside and filled up almost every bed in the main bay area. In the special care ward, patients and their families must gather their belongings and leave their beds to wait outside twice a day while the ward gets cleaned in the morning and afternoon. We learned that many of these main bay patients were typically kids suffering from anemia, malaria, HIV, and tuberculosis. These serious conditions would generally warrant the use medical equipment and monitoring devices, however the limited resources available simply must be used towards the HDU patients.
Here is an example of an improvised solution at Queen Elizabeth. There is a shortage of asthma spacers used to ease of administering aerosolized medication from a metered-dose inhaler for children. A repurposed water bottle with the openings sealed off with duct tape have been made into a makeshift spacer. We witnessed patients using this during our visit to the special care pediatric ward.
Our overnight stay in the NICU at Queen Elizabeth was my first experience spending the night in a hospital setting. I did not really know what to expect, as my hospital expertise stems from episodes of Grey’s Anatomy. At Queens, we noticed that the night shift was when many of the babies get put on and taken off of different medical devices. We saw the setup of oxygen concentrator machines, the preparation for phototherapy treatment, and the administration of various drugs. The night provided excellent insight into how nurses and doctors interact with the technologies and Liseth and I got pages of informational notes from our time here.
Our next overnight visits provided additional insight into the night routine and ward procedures for Zomba Central Hospital and Mulanje District Hospital. The Zomba Central Hospital nursery was quite large; it had 4 separate rooms for high risk patients, low risk patients, patients who were brought in from home, and for kangaroo mother care. 1 continuous monitor was available for all patients to check vital signs so again, Liseth and I watched as a lack of resources continued to influence healthcare and outcomes. Seeing the nurses face difficulties to keep neonates alive was extremely difficult and probably the hardest part of my internship experience so far. Our overnight visit at Mulanje shared many similarities. Here, human resources were scarce as 1 nurse was on the night shift for the entire NICU. No continuous monitor was available for the ward, so vital signs and recording were limited to temperature checks using 1 thermometer for all the neonates.
Pictured is the suction apparatus at Mulanje District Hospital in the NICU. This is one example of the hospital equipment conditions-many donated technologies break easily. With this machine, there is a glove tied around one of the suction tubes to seal off leaking air.
The health inequalities were extremely evident as my mind couldn’t help but draw comparisons to the equipment availability in the United States. After looking more into a holistic economic picture of the country, I learned that Malawi suffers from a climate vulnerability that has widespread influence upon agriculture, energy, forestry, water, gender issues, and human health. In 2015 and 2016, Malawi suffered from a pattern of floods and droughts that impacted over 5 million Malawians with food insecurity. Any extreme floods and droughts of a growing season can be detrimental to the climate-sensitive agriculture sector which contributes to up to 40% of the gross domestic product, employs 85% of the workforce, and supplies 70% of raw materials for manufacturing. With an under-financed health sector, 60% of the country’s total health expenditure needs to be obtained from external sources such as donations. Reports suggest that in order to break out of a cycle of systematic poverty and dependency, Malawi needs to target the rural poor who depend on mainly agriculture alone for subsistence. Expanding the access and quality of health services available these rural communities in Malawi would help address some of the social, economic, and environmental determinants of health as a means of reducing overall health inequities. (Based on WHO Country Cooperation Strategy: Malawi https://apps.who.int/iris/bitstream/handle/10665/136059/ccs_mwi.pdf;jsessionid=55B8169FD0E2EFBE8B253B154BF5AF96?sequence=3).
When examining global health, I feel that it is incredibly crucial to consider all influences and factors that contribute to current health situations. Policy reforms targeting healthcare delivery and accessibility systems, human and monetary resource allocation, and overall health development are so vital to helping alleviate morality and disease burdens for a country. Although it can be an uphill battle, tackling global health with a comprehensive economic and policy approach lays the groundwork for sustainable widespread change.
Speaking of uphill battles, our group decided to attempt to climb the highest mountain in Malawi (Mt. Mulanje) on a 3 day adventure during the long holiday weekend! We scaled almost 10,000 ft! Although I didn’t make it all the way to the highest peak, I am proud of myself. I’ve never physically pushed myself so hard before!Our faces were full of joy after reaching the bottom of the mountain after 3 very tiring days of intense climbing.
Our group also had a “cookout” with all of the interns from the Malawi Polytechnic and Malawi University of Science and Technology. We cooked classic hotdogs, fries, and less classic samosas and spring rolls for our meal together at Kabula lodge.
Most recently, we visited Satemwa tea plantation and took a tour of the tea fields and tasted a wide variety of their teas.
Thanks for reading! I’ll check in again soon for my last week in Malawi! See you next week!
