Week 4. Lilongwe

Posted on July 4, 2019April 19, 2024 by Hannah Andersen

We spent Wednesday, Thursday, and Friday of this week in Lilongwe. There was a pitch competition happening at this place called mHUB. Alongside the Lemelson Foundation and Rice 360, mHUB supports what they call “innovation education”. In other words, they help empower young people to execute their amazing ideas. Ten engineering design teams from different universities across Malawi made it through the audition process in order to compete in the pitch competition on Thursday night at mHUB.

mHUB had a really cool space with some awesome artwork. Naturally, Nimisha and I had to take a picture.

I was happy to see several familiar faces: Dr. Richards-Kortum, Dr. Oden, Georgia, and Raj! We missed Dr. L and Karen though. 🙁 I imagine the 360 office in Houston feels a bit empty these days, since it seems like this is the time of year that many of them travel here to Malawi.

I really enjoyed watching the ten teams present their work. They were beyond impressive. One of my favorite teams presented an app to aid deaf people in Malawi by translating speech to sign language. Another impressive prototype was presented by our friends from MUST! Before we arrived in Malawi and began this internship, they created a prototype for a manual breast-milk pump and delivery system for premature babies who have a hard time latching onto the breast after birth. These young engineers and entrepreneurs are so smart and capable, and it made me think about my own team projects back at Rice, and how our success stories are largely attributable to the endless amount of resources and support that universities in the US offer their students (especially at Rice). I feel so spoiled: In the US, university students have access to labs stocked with any materials we could ever need. At Rice specifically, we have the OEDK, which is a huge facility and features employees and lab techs that are almost always available to give teams technical support. Engineering students at universities in the US have so many resources, and I know students here do not enjoy these same benefits. Don’t get me wrong, the design studio here at Poly is wonderful. It’s enabled so many teams to bring amazing ideas to fruition. But I can’t help but hold in my mind the idea that the OEDK is larger, more equipped, more heavily staffed, and undoubtedly much more funded. I don’t know if I have what it takes to have brought OxyMon to the success it has had if I hadn’t been given everything I needed in the OEDK at Rice.

Rachel presenting the Ballard Score project on behalf of her team!

The issue of funding is not localized to the experience of student-engineers: It is the same at the hospitals we’ve visited. In Lilongwe this week, we had the chance to meet with a medical engineer who works in Physical Assets Management (PAM) at the Kamuzu Central Hospital in Lilongwe. The medical engineer we spoke to was wonderfully helpful, and I’ve made a mental note to put him in contact with Rice 360. He’d make a great project mentor. He outlined for us a list of what he sees are the primary challenges of the PAM at KCH:

Under-staffing
Procuring consumables and spare parts for broken machines
A lack of tools necessary to fix broken medical equipment
Language barriers – donated equipment often comes with manuals in foreign languages, thus they don’t know how to install or fix these machines when they break
Dust and moisture levels are big contributors to equipment breaking down

He told us that these challenges are, in his eyes, the biggest things preventing PAM at KCH from providing and maintaining all the medical equipment necessary for the hospital to function. A quick look at this list tells me that there is one issue that most of these challenges boil down to: financial constraints. Like the teams presenting at mHUB, the staff at PAM in KCH – and truly all the hospitals we’ve visited – are constrained by money from doing the most they can do. Now, I don’t want it to sound like I am pitying these people or saying that they’re somehow lesser than engineers in the US for their lack of funding. If anything, these people are more capable, more resourceful, and 110% more hardworking. They’re forced to find clever solutions to problems that engineers in the US might solve simply by buying more expensive equipment. They work harder: Nanah once told me that she was doing a project for a lab in Tanzania, and her team spent days tracking down one critical part for their circuit. In the US, we’d probably just go to Amazon, use our lab’s money to pay for the part, and receive it in the mail two days later. We are lucky and spoiled, and I am impressed every day with the amazing things that both young engineering interns and staff members in hospitals manage to do despite the constraints they face. I feel more and more grateful for the resources I have access to in the US, and I feel a sense of renewed devotion to make the most out of my time at Rice in order to truly take advantage of what Rice offers and prepare myself for a career being the best I can possibly be.

This is a photo from PAM in KCH. It’s a whole wall of broken patient monitors. Many of them have broken probes. Probes (such as temperature probes for a thermometer) are very delicate and break often. Unfortunately, they are also expensive to replace. Sometimes, replacement probes are sold for more than the cost of the actual device! Broken devices are kept around so that parts can be salvaged for less-broken devices. For example, an oxygen concentrator with broken sieve beds might be kept around so that its compressor can be salvaged when another concentrator needs a new one.

My favorite moment of the week happened the night before the competition. That day, all 19 interns from the US, Malawi, and Tanzania traveled five hours from Blantyre to Lilongwe. We stayed in a hotel together, and after dinner we all gathered in someone’s room to help Alex’s team practice their pitch. Presenting on their team’s behalf was Rachel from MUST. It was a challenging pitch, because all the information had to be presented in under four minutes! I thought it was really special to witness all us interns gathering together at 10pm on a Wednesday night to support Alex and Rachel’s team (also including Betty and Rodrick). It wasn’t work hours, we didn’t have to be there, but almost everyone was present, sitting, listening, and offering advice. We were all genuinely invested in the success of their team, despite having our town teams to worry about, and I found that very touching. As much as stereotypes characterize engineers as being anti-social, loners, or bad at communication, I’ve witnessed us being exactly the opposite. Especially in global health, us engineers are a community. Rather than competing with each other, we work together, and I’m so grateful to be working in this field with these people.

All the interns gathered in the hotel to listen to Rachel present and give her feedback

5. mHub, Moyo, Maternity, and More

Posted on July 2, 2019April 19, 2024 by Kyla Barnwell

Hello everyone!

Presentations are never easy. My nerves get the best of me most times and I often stress over details, frantically writing down every sentence that I need to say. Even after doing countless presentations on our cervical cancer training model project in the Global Health 360 class, I still dread talking in front of groups. It takes a lot of concentration for me to not get flustered or stumble over my words. This past weekend, I saw presentations that inspired me to try to make presenting a more natural practice. We traveled to Lilongwe last Wednesday for the Malawi Innovation Pitch Night, an engineering design competition showcasing a variety of creative engineering ideas across Malawi. The event took place at mHub, a technology and innovation space dedicated to cultivating entrepreneurship. A total of ten inventive solutions to prominent problems in Malawi were presented to a panel of judges. Although I was just helping with the competition and not presenting, hearing the presentations was a great chance to appreciate the immense talent of young Malawian engineers. From a device that would purify water with UV light to a free educational tutoring hotline in order to improve testing scores, teams pitched a variety of impressive technologies. Not only were the technologies advanced, each presenter flowed through the information with grace and ease. They were engaging, educational, and effortless. For the future, I hope I can look at presentations not with a sense of dread, but see them as an opportunity to get more comfortable with public speaking. The entire event was a nice short break from the usual hustle and bustle of hospital wards.

On the bus ride back from Lilongwe, we got a flat tire. On the bright side, the views by the side of the road were incredibly scenic.

Liseth and I are continuing to make our way all over Queen Elizabeth. Most recently, we had observational days within the Moyo House and labor ward of the hospital. Moyo House serves as an extension of the Nutritional Rehabilitation Centre and specifically focuses on providing nutritional support to babies and children in need. Through talking with nurses, we learned that Moyo experiences similar lack of resources issues as some of the other pediatric wards of the hospital. One new problem we encountered was that 90% of the heaters within Moyo are not functional. Patients who are undernourished or malnourished are more prone to hypothermic body temperatures, so they were bundled and wrapped in many blankets in order to keep warm without functioning heaters. In the labor ward, we learned about the heavy workload of the midwives and doctors. With up to 28 patients a day needing to be monitored every hour, it is a very strenuous work environment. The midwives showed us that they must often monitor things like blood pressure and heart rate manually by counting beats per minute. I really enjoyed discussing these issues with the midwives because they were so open and receptive to our questions. They were not afraid to say what needed improvement, which was extremely helpful in gathering ideas for future engineering projects. Some midwives had their own ideas for new engineering devices that could substantially help their day-to-day work. From my observations so far, I think I need to spend more time doing some background research into hospital resource allocation for district and central hospitals in Malawi. Scarcity of resources is a common trend across all of the wards we have observed so far, and I would like to investigate further to find out more about how funds are distributed and what economic, political, or sociological factors play a role in contributing to this problem. I believe it is important to examine this from all sides, as global health problems often do not exist in a vacuum.

An inside look of Moyo House; the ward consists of 36 beds in total with 6 beds for high dependency patients and 4 for isolation patients.

In other news, the Incubaby prototypes have arrived in Blantyre! (However, we recently discovered that the team is working on changing the name, so name TBD). So Liseth and I will begin our second assignment of conducting usability interviews with the device within the week. We have a set of detailed questions to ask nurses about the prototypes. The responses from nurses should really catch any areas for improvement for the team of engineers. It is our hope that this usability interview can be used for all future devices in order to address any human factors issues early in the design process. This will help ensure that all new technologies are actually appropriate for their designated clinical setting and will be implemented regularly for their intended purpose.

The new Incubaby prototype-we learned that the team is working on a new name so from now on I will refer to it as a warming unit.

On Sunday, our group took a trip to Zomba for a short (but rigorous) hike around the Chawe mountain. We ventured to Ku Chawe in the Zomba Plateau and took a guided walk with beautiful scenery and cold waterfalls. I thoroughly enjoyed being surrounded by nature (we even saw baboons and monkeys swinging in the treetops!) and I was very proud that I only tripped once during the steep and rocky descent down the mountain.

One of the waterfalls we visited on the hike. The water was extremely cold but very fresh and clean.

Thanks for reading and I’ll check in again soon! See you next week!

4. Learning in Lilongwe

Posted on July 1, 2019April 19, 2024 by Nimisha Krishnaswamy

This week all 19 summer interns (16 from Poly Design Studio + 3 from Queens CPAP Office) piled onto a bus and travelled 5 hours to Lilongwe, the capital city of Malawi. The streets of Lilongwe, just like Blantyre, were lined with bustling markets selling everything from fresh fruits and vegetables to colorful chitenge cloths. As soon as we arrived, we checked in to the Bridgeview Hotel and rested in preparation for a busy day…

The main purpose of our visit was to attend the Malawi Technology Innovation Pitch Competition on June 27^th, but since the competition was in the evening we were able to squeeze in a visit to Physical Assets Management (PAM) at Kamuzu Central Hospital. We were greeted by Mr. Pius Chalamanda, an incredibly dedicated medical engineer at PAM, who was nice enough to answer all our questions for 2 whole hours AND give us a walking tour of PAM so we could learn about the challenges they face with maintaining and repairing broken medical equipment. I got to ask a lot of questions about patient monitors (which was useful for both the projects I am working on – a Maternal Monitoring Device here at the Polytechnic and a Neonatal Temperature Monitor for Kangaroo Mother Care back at Rice). One of the main issues with patient monitors, I learned, is the probes – SpO2 probes, temperature probes, ECG probes. They are super fragile and break easily even when handled carefully. Up until now, I was only aware of the infamous battery problems in almost all patient monitors. I’ve been so focused on ways to make our device rechargeable, that the probes never even crossed my mind. This new information about the fragility of probes definitely provides a new angle to pay attention to as I continue working on both of my projects.

*A whole section in PAM dedicated to broken patient monitors*

Overall, I learned that the challenges faced in PAM can be summarized into 5 main categories:

Understaffing
Spare parts and consumables are difficult to procure
Lack of diagnostic tools (to test the functionality of medical equipment) and servicing tools (to fix broken medical equipment)
Language barrier (when trying to install / service donated equipment whose manuals are often in different languages)
DUST and MOISTURE significantly reduce the lifespan of nearly all medical equipment

The visit was enlightening and everyone we met at PAM was so dedicated and hardworking. Hearing them talk about all these challenges made me realize the importance of creating medical devices that are durable, sustainable, and easy to repair (paying special attention to ensure that spare parts/consumables are locally available). Although many of these challenges initially seemed difficult to tackle because of financial constraints, I left PAM with my mind full of ideas for new projects that Rice 360 could take on to help make the maintenance and repair of medical devices a much more efficient process.

Later that evening we dressed ourselves up in business casual and headed to the Pitch Competition hosted by mHub, an innovation space in Lilongwe. The competition consisted of 10 teams of student engineers in Malawi presenting exciting innovative technologies in a short 3-minute pitch. One team presented a voice-to-text application for sign language in order to bridge the communication gap between people who can and can’t hear. Another team presented a low-cost, solar-powered water filtration device that used UV light to eliminate bacteria. My personal favorite was a low-cost cold chain box to transport blood vaccines and diagnostic samples from rural areas in Malawi to central hospitals. The team that presented this device has already sent a prototype to FIND, a non-profit in Geneva specializing in diagnostic tools for low-resource settings. I’m so excited to see where they go from here!!

*Dr. Richards-Kortum giving the opening remarks at the Pitch Competition*

After the presentations, we got the chance to mingle with the student teams and it was so amazing and humbling to be among some of the most talented student engineers and in Malawi. I got to talk to donors from the Lemelson Foundation and partners of NEST 360 about both of my current projects and it was all so exciting. We also got to catch up with Dr. Richards-Kortum, Dr. Oden, Georgia, and Raj from Rice 360! 🙂

The whole night felt kind of magical. It reminded me how grateful I am to be a part of this global health community. I distinctly remember looking around the room and feeling inspired, realizing that each one of us comes from a totally unique background: there were people from the US, the UK, Tanzania, Malawi, India. We’ve all grown up with different experiences and have been exposed to different standards of health care, but one thing brought us all together: our passion for improving health outcomes across the globe, our passion for helping people across the globe. Now more than ever, I’m certain that this is what I want to do with my life.

As always, here are some bonus pictures! This weekend, we hiked Zomba Plateau (it was around 3 hours, so just a casual warm up for when we finally hike Mount Mulanje! 😉 )

*Flat tire on our drive back from Lilongwe 🙁*

*Group photo during our hike at Zomba Plateau this weekend*

*Waterfall at Zomba Plateau! It was so beautiful but the water was literally ice cold (not cold enough to stop us from trying to swim though)*

— Nimisha 🙂

5. SimpleBallard

Posted on June 30, 2019April 19, 2024 by Alex Lammers

This week, my team had the chance to present at the first ever Malawi Innovation Pitch Night, and after the whole experience, I realized how little I have written about my main project in this blog. As a result, the following post is gonna be a little more technical so brace yourself for some facts and figures, but I promise every one of them is important. I’m super excited about the work we’ve been doing so far and its potential impact so please continue reading! 🙂

Around the world, premature birth is estimated to be responsible for 35% of all neonatal deaths, mostly concentrated in developing countries. In many government hospitals in Malawi, nurses lack a systematic approach to identifying prematurity in newborn babies. Instead, birthweight, an inaccurate estimate of gestational age, is primarily used. In some cases, a reliable number can be calculated from the mother’s last menstrual period (LMP), but frequently no record is kept of this information. Rather than using birthweight, and in cases where the LMP is not known, a Ballard Score assessment should be performed. The Ballard Score is a set of 12 neuromuscular and physical signs that when combined, produce an accurate estimate of gestational age. However, even in hospitals where nurses have knowledge of this assessment, it is almost never performed.

Wondering why this was, our team traveled to hospitals all over Malawi: Mulanje and Zomba District Hospitals, and this week, Kamuzu and Queen Elizabeth Central Hospitals. From talking with nurses, we identified two obstacles that make it difficult to complete the assessment for each and every newborn…

Many nurses lack the necessary knowledge to perform the assessment, especially in the case of the challenging neuromuscular procedures. Some nursing students told us the Ballard Score was only a single lesson during one day of their schooling, taught through pictures of the procedure rather than hands-on practice.
Nursing teams are often understaffed and short on time. As it stands, the Ballard Score assessment takes 15-20 minutes to both perform all 12 procedures and calculate a final score. This is too long for many hospitals where as many as 20 babies are born per day needing individual care and attention.

Looking at the factors surrounding these two separate problems, my team has developed two separate solutions…

Our first design, a training model for neuromuscular Ballard signs, aims to tackle the knowledge gap between the classroom and the assessment room. The model consists of a main baby mannequin with two attachment points for interchangeable limbs: one at the shoulder and one at the hip. Each interchangeable limb corresponds to a different neuromuscular sign, and can be adjusted to replicate the muscle behavior of a baby at different degrees of prematurity.

Once fully developed, we hope to implement our model as a teaching tool for nursing schools. Imagine a classroom filled with groups of students, each gaining hands-on experience through the use of our model with different attachments. A professor could walk around from station to station, providing advice and corrections for each of the different signs as they see the motions performed right in front of them. Ultimately, the model should provide nurses with the confidence to complete the assessment when working in a hospital setting.

Our second second design aims to reduce the time required to perform a full Ballard Score. Having not conducted years of research like Dr. Ballard, there is no way we could remove any signs from the assessment while still maintaining an accurate estimate of gestational age. Instead, we decided to cut down the amount of time it takes to record and calculate a result from the assessment while also making it quicker and easier to match observations to the score’s criteria.

In every hospital we visited, nearly every nurse carries a smartphone. After seeing this, we determined that one of the easiest ways to roll out our design to as many hospitals as possible would be through app development. Designing an app also allows for a user interface that cuts out a lot of the unnecessary information on the current assessment chart. Numbers are cut out entirely, as all calculations are performed in the background, simply producing an accurate estimate of age at the end of each assessment. Furthermore, the use of a sliding scale takes the diagrams of each sign in the current chart and consensus them into one changing image, letting nurses easily scroll until the image matches their observation of the real baby.

So many aspects of care for premature babies revolve around knowing their specific age. In addition to helping nurses save these precious lives, we believe our project has the potential to contribute to an even greater picture. Organizations such as Nest360º rely on accurate data when measuring the impact of their technologies on neonatal outcomes. With the most common estimate of gestational age being birthweight, reliable data surrounding premature births is difficult to obtain in developing countries. Furthermore, the paper records of many hospitals are either non-existent for individual births or difficult to sort through. Together, our training model and assessment app for the Ballard Score can become the start of a solution.

We fully realize that any prototypes we come up with in the next few weeks will no more than scratch the surface of this issue, but it is the potential for future work that excites me. What if the app could upload each assessment to a database? What if that database could be used to assess the impact of lifesaving technologies? What if that data revealed a need that had previously gone unidentified? By creating a solid foundation for others to build off of in the future, I feel that my team has an amazing opportunity to start something that truly matters.

– Alex

Bonus: Here’s some pictures from the rest of this week’s adventures…

So much chitenge! When a few us went to the market this Saturday for next week’s groceries, we got a little side-tracked and ended up buying an insane amount of this beautiful fabric.

On Sunday, we went back to Zomba to hike a mountain, and I fell fully clothed into a waterfall.

3. Time Flies

Posted on June 29, 2019April 19, 2024 by Shadé Flavien

Team Neostatic working on our Malawi Technology Innovation Pitch Night Presentation

Last week, we started by creating a proposal for our team projects with the intention of brainstorming and evaluating our solution in the coming days. However, when Dr. Leautaud arrived at Poly from Rice University on Thursday morning, we assumed it was to have a coaching session on our presentations for the pitch competition. Little did we know that we were auditioning for one of the team spots to compete in the pitch competition that afternoon. You could imagine our surprise to find out we needed to complete half of the engineering design process in a matter of hours. This really increased the pressure for my team and I to have solid plan and collaborate on every aspect of our design. When starting this internship, I had already anticipated our project timeline to be at an accelerated pace considering we are working full time on our projects, but with the Malawi Technology Innovation Pitch Night right around the corner, there was added pressure for each team to finalize their solution. Having already written our proposal, we had a few ideas of what our solution would look like, but in that time crunch, we brainstormed, selected a solution to pursue, created our presentation slides, and ended up giving a great presentation. Unfortunately, our group was not selected to present at the pitch competition, but from our experience, I realized the added pressure of a suddenly constricted time frame taught us that timelines are only a suggestion and there will be occasions where you have to improvise in order to accomplish a task. Despite being stressed along the way, this experience also taught me that everyone handles pressure in different ways and working with others requires you to be patient to understand their different approach (especially since I was a bundle of stress).

Despite a stressful work week, that weekend, Christina (one of the interns from Poly) invited us to attend the very first Biomedical Engineering Student Society (BESS) meeting. As we approached the room, immediately, we noticed uplifting music and large gathering of people present. What I thought would be a simple ceremony to mark a celebratory first appeared to be party. When we entered the room full of students, all eyes were on us (we may have been a tad late). After filing into the first available seats, the MC for the event announces that each of us will be coming up and introducing ourselves. This came as a surprise considering we had just come to attend the event and support a friend. After each one of us went up and stated the basic name, college, year, and major, the ceremony proceeded with a quiz competition between a handful of biomedical engineers in two teams. This turned out to be no ordinary quiz with both detailed technical and biological questions leaving me stumped majority of the time, but this proved no challenge for the Poly students who fired off answers like it was second nature. Overall, I thought this was a unique way to engage all the students and showcase the brilliant and resourceful students biomedical engineers are. Once the ceremony was over and we went to take pictures to commemorate the event, I saw the sheer number of students that took the time on a Saturday during one of the busiest times of the semester to show their dedication and passion for biomedical engineering. To be honest it was inspiring, especially the amount of time and effort the officers put in to organizing the event considering their schedules as interns, full-time students, or both.

As I recollect on the events that took place during the BESS meeting, I think about my position as the recently appointed treasurer of Society of Women Engineers (SWE). With another year approaching I hope to exude the same excitement and excellence for female engineers of every discipline as the students and officers of BESS have (maybe even steal the quiz competition idea because it was so much fun).

That’s all for now!

– S

Week 3: Healthcare Disparities Here, There, and Everywhere

Posted on June 29, 2019April 19, 2024 by Sally Yan

Part 1: Healthcare Disparities Here, There, and Everywhere

I’ve spent most of last week analyzing monitoring data for the PUMANI bubble CPAP in hospitals throughout Malawi. I was tasked to use the data to create graphs looking at the impact of power outages, time of death, temperature, and weight on mortality rates of CPAP. In addition, I was told to make separate graphs for this data for the hospitals in the Ministry of Health (MOH) system and the Christian Health Association of Malawi (CHAM system) since they are given separate reports. (MOH hospitals are public, government run hospitals that offer all services free of charge, serving 63% of the population while CHAM hospitals are private not for profit hospitals that serve 37% of the population.)

While this technically wasn’t something I was analyzing, what surprised me most was that the overall mortality of CPAP patients in CHAM hospitals was consistently lower at 20-30% than that of patients in MOH hospitals at 40-50% over the last two years. In addition, the mortality rates were consistently decreasing, and the number of patients put on CPAP was consistently increasing across quarters in the CHAM system while this fluctuated a lot for MOH hospitals. (This part may, however, be partly attributed to the fact that CPAP was introduced quite recently in CHAM hospitals and longer ago in MOH hospitals.) This suggests that private hospitals in Malawi provide better quality healthcare than public hospitals. (Granted, this is a relatively limited set of data covering only CPAP patients and looking only at the past 2 years). While technically CHAM hospitals only charge “nominal” user fees to cover the cost of operations, when explaining the healthcare system to me last week, Rodrick (the Poly intern who used to be a data clerk at a rural health center) seemed to imply that the fees were still exorbitant for most people, which I also read online. This public-private divide in healthcare reminded me of that in the United States.

Graph of overall neonatal mortality for CPAP patients in CHAM system

Graph of overall neonatal mortality for CPAP patients in MOH hospitals

Ben Taub Hospital in the Texas Medical Center

While the most apparent or, at least, the most discussed issue on the political stage regarding healthcare in the U.S. is the lack of affordability, another important factor that should garner more attention is the quality of the publicly subsidized healthcare that exists. For example, the quality of healthcare available at Ben Taub Hospital—a hospital that is part of the Harris County Health System and offers local and state level programs to help subsidize the costs of services for low income patients—is, to some extent, different from other hospitals in the Texas Medical Center. For instance, I remember our mentor for the Ballard Score training model project last semester—a neonatologist at the Texas Children’s Hospital—telling use that while the Ballard Score never needs to be used at TCH due to the abundance of prenatal care (including early ultrasounds that allow gestational age to be tracked) that expectant mothers receive there, it was actually, to her knowledge, used occasionally at Ben Taub since patients there have less access to prenatal care. Additionally, I remember one of my friends who volunteers there said that patients could occasionally be in the waiting room for twenty something hours before being able to see a doctor due to relatively low doctor to patient ratio. (This congestion is also a problem that occurs in Malawi by the way—the courtyards at QECH are filled up with families waiting for long periods before they receive treatment.) (Also, this is not to say Ben Taub is not an outstanding hospital by any means. When I was reading about the hospital online, I found out it was one of only three level 1 trauma centers in the TMC and had earned numerous awards.)

Anyways, this led me to think about other disparities in healthcare that Malawi and the U.S. have in common: namely, the difference in care available in rural and urban areas. In Malawi, the healthcare system has multiple tiers providing different intensities of care. At the top are the five central hospitals located in major cities (QECH being one of them) that serve as tertiary center with many specialties available including functional operating theaters. Under that are the district hospitals for the 27 districts, which serve as secondary centers. Because the healthcare system is structured such that the available (and relatively limited) resources (both equipment and human resources) first fulfill the needs of central hospitals before the other tiers, there are substantially less resources in district hospitals. As one nurse put it when we visited the Mulanje District Hospital, they only treat the conditions that they are able to treat there—an understandable statement considering they have no incubators, one radiant warmer that was not working during the visit, and even an occasional scarcity of thermometers. The trickle down model of resource distribution even more so affects rural health centers that have very, very few resources. As Rodrick said and I later read online, these have only a few nurses—sometimes even just one as Rodrick stated—and often no clinicians. While the CHAM hospitals aim to fill this gap of healthcare availability in rural areas, as previously stated, the costs are often prohibitive.

Although the U.S. does not have a centrally mandated healthcare system that purposefully imposes this type of disparity and admittedly has a lot more resources overall, this disparity between healthcare in rural and urban areas still exists. I honestly was not aware of this (and I suspect a good portion of the general public also isn’t) until Dr. Sonia Parra’s lecture on LUCIA—a training modeled designed by Rice 360 to improve cervical cancer screening and treatment—in the Introduction to Global Health course. It surprised me so much to learn that, like many lower resource countries, the Rio Grande Valley—located in the same state as the world’s biggest medical center—has a high incidence of cervical cancer due to the lack of availability of screenings for HPV. To further emphasize this rural-urban divide in healthcare, statistically speaking, the doctor to population ratio is almost 2.5 times higher in urban areas (at 31.2 physicians per 100,000) compared to rural areas in the U.S. (at 13.1 physicians per 100,000). The commonality in the health disparities between Malawi—with a government run healthcare system—and the U.S.—with an almost entirely privately controlled healthcare system—show that the question we should be asking about healthcare policy is not merely how do we make healthcare affordable and available for all in the U.S. but how do we make high quality healthcare affordable and available truly for all on a global scale.

Sources:

http://www.aho.afro.who.int/profiles_information/index.php/Malawi:Service_delivery_-_The_Health_System

http://www.health.gov.mw/index.php/2016-01-06-19-58-23/national-aids

https://www.malawiproject.org/zzz/hospitals-healthcare/

https://www.harrishealth.org/locations-hh/Pages/ben-taub.aspx

https://www.ruralhealthweb.org/about-nrha/about-rural-health-care

Part 2: Fun Pictures from this Week

I realize this was more of an op-ed than a blog, so here’s some fun pictures (and captions) highlighting last week’s adventures.

Up-close snapshot of elephant from safari at Majete wildlife reserve (pc: Alex Lammers)

Sunset yoga pose during stop on road back from Majete wildlife reserve

Group photo in front of beautiful sunset landscape on road back from Majete wildlife reserve

2. Week of Firsts

Posted on June 18, 2019June 29, 2019 by Shadé Flavien

Somehow, a week already flew by in what felt like a matter of hours! This past Monday was officially our first day of work at the Polytechnic Design Studio. We had a warm welcoming introduction from the Dean of Engineering at Malawi Polytechnic University along with a few guest lecturers on the engineering design process with an emphasis on meeting the needs of the people. Our first assignment as interns was the “Just in Time” design challenge. Each team was a group of four student (one from each school) and the challenge was to drop a ping pong ball from one meter, and have it reach the ground in exactly 30 seconds. My teammates, Cholo, Maureen, and Chisomo, created a tube-like path to delay the ball before reaching the bottom. Unfortunately, our delicate paper, tape, and cardboard structure only took the ball 12 seconds to reach the bottom, ultimately failing the challenge, but winning with the longest time out of the other teams! I thought this was a neat way to ease into working with new people on a simple engineering project while observing the team dynamic.

On Tuesday, the we had an engineering skills crash course in Arduino and 3D Printing. In the 3D printing group, our mini project was to design and print a functional syringe. Learning the Solidworks design software seemed simple enough however, the difficult part was deciding how to configure the shapes to match those of the syringe. In the end, we were able to 3D print and assemble the entire syringe. I was proud of the way our group worked together to help one another and complete the finished product.

First hospital visit at Mulanje District Hospital

Later that day, Hillary (the Poly program coordinator) assigned us our teams and team projects before our hospital visits the next day. My team (Maureen, Cholo, and Tebogo) was assigned the neonatal hypothermia prevention in the transport between labor and neonatal wards. That evening, we each conducted background research and formed a set of questions to ask when interviewing the nurses at each hospital as well as specific areas to keep an eye out for. The next morning, we compiled all the questions before leaving feeling confident we would be able to get all the information necessary to complete the project. Over the next two days, we visited the neonatal, postnatal, and labor wards at Mulanje District Hospital and Zomba Central Hospital. Despite being welcomed into each hospital, I felt somewhat uncomfortable intruding in an intimate place where people go to seek help. None the less, we were grateful for the opportunity to observe the hospital’s daily activities as well as gain the staff’s perspective and protocol on the transport of hypothermic neonates between the labor and neonatal wards. Both visits allowed us to gain valuable insight into the realistic situation nurses experience and appeal to their specific requests and needs. From our visits, we discovered the main therapy for

hypothermia is kangaroo mother care (skin to skin contact between neonate and mother) with the occasional use of a radiant warmer if it is working. During transport the nurses currently, wrap the premature baby in dry cloth and carry it between wards. Despite the relatively short distance, the neonates still experience drastic decreases in temperature, increasing the risk of mortality. One key aspect we otherwise would have overlooked without interviewing the nurses are the premature babies born via C-section which occurs in the theater (operating room) significantly farther away from the neonatal ward than the labor ward. With this knowledge, we would need our solution to maintain the neonate’s temperature for a greater duration that anticipated.

Being able to visit two hospitals allowed us to split up into pairs and cross reference our findings. Because there was a lot of information we needed to gather within a short amount of time, we realized our initial hospital visit to Mulanje District Hospital was not as successful as we had hoped. We left with our answered questions only leading to more questions. Luckily, our teammates returned to Mulanje the next day while we visited Zomba Central Hospital and obtained all the information we needed. Both hospital visits allowed us to confirm our findings and interpret the information ideate possible solutions. Although we have only completed the research stage of the engineering design process, we are eager for the possible solutions to our project.

After a full week of work and travel, the interns and I took the weekend to relax and explore some of the local areas. Unfortunately, it rained (more of a continuous mist) all day so we did not venture far out of the lodge except in search of food. However, on Sunday we went attempted to go grocery shopping at the local market in Blantyre. Every day on the way home, we drive by the market which only piqued my curiosity further considering my initial thought of a market is mainly produce. However, once we reached the market there were people selling everything imaginable at every turn. The market itself seemed endless with vendor’s stall forming makeshift hallways (kind of like a fort made of scrap materials). Despite a few odd stares, I would say the trip was a success, but I really need to learn some more Chichewa besides “muli bwanji” (how are you) and “zikomo” (thank you).

Well that’s all for now but let’s see what new adventures are bound to happen in coming week. Stay tuned!

– S

1. Moni From Malawi

Posted on June 9, 2019June 29, 2019 by Shadé Flavien

After endless hours of travel, we finally made it to Malawi! It took us a total of 3 flights to 3 different continents in the span of 4 days to finally arrive in Blantyre, Malawi. Once we landed in Lilongwe after our third flight, we were greeted by the warm and friendly Mr. Richard who would be transporting us the 4 hours from Lilongwe to Blantyre, and the other 4 interns from Tanzania who would be working at the Malawi Polytechnic (Poly for short) with us. Despite being exhausted and jet-lagged, I appreciated seeing the more rural parts of the country. Along the road we would pass through the central markets of towns with people selling an assortment of produce and goods. Little did we know that the road we traveled on spanned the border between Mozambique and Malawi. It was astounding to think that all you had to do was cross the road and you were in an entirely different country.

Rice and Tanzanian interns outside the Queen Elizabeth Hospital Bubble CPAP Office.

After settling into the lodge in Blantyre, we visited Queen Elizabeth Hospital and Malawi Polytechnic University where we will be observing patient care and working on our projects. Unfortunately, we were not able to walk around much of the hospital, but in the next couple of day we will hopefully be able to see the NICU for observations and research for future projects. After, a few of the Malawian interns took us around the Poly campus which has a huge library right next to the main campus where I assume we will spend quite a bit of time doing background research for our projects. So far everyone we have met on our trip has been so friendly and helpful, especially the Rice 360 staff in Malawi and other Malawian interns. I am excited to work alongside students who are passionate and eager to begin working.

Over the weekend, we explored some of the city on foot and went to the Museum of Malawi. The museum took us through the different ages of Malawian culture and history which was neat, especially all of the artifacts. We also had our first attempt at washing clothes by hand this weekend. Although it was time consuming and I may have lost a layer of skin on my fingers, finishing was relieving and gratifying until we have to repeat it again next week.

Most mornings, we enjoyed the gorgeous view from the lodge and talked with the Joel and Cholo, two of the Tanzanian interns. Some of the stories of their home were hard to believe,especially the ones with elephants simply passing by homes and monkeys stealing cell phones. Our stories from back home were definitely less exciting than theirs. Despite the lively city nearby which always some sort of music playing that just makes you want to dance, its also nice to relax with a book and be surrounded by all the colorful trees and flowers. One characteristic I have noticed is that color seems to be a vibrant and prominent aspect in Malawi, from the nature that surrounds everything, to the painting on the buildings, and the typical attire of many natives.

Monday will begin our first official day of work at the Poly which I am a bit nervous about, but I am sure will be fun getting to know everyone. After our first week of work I am sure I will have much more to share so stay tuned for my next blog!

Tiwonana nthawi yina (see you later)

– S

0.5: #Goals

Posted on June 2, 2019June 14, 2020 by Nimisha Krishnaswamy

I’ve traveled internationally many times – I’m from India so going home and coming back to Rice always involves long flights and seemingly longer immigration lines. The thought of having to travel for 2 whole days until we land in Malawi is not too daunting. I’m more nervous about what comes after we land. After 12 years of growing up in Bangalore, India, I can confidently say I am pretty familiar with the ~organized chaos~ of a developing country. But I grew up in a big city. Twelve MILLION people big. I’m not sure how Blantyre, Malawi (population 600,000) will compare. In fact, the only thing I am sure of is that the next two months are going to be different from anything I’ve ever experienced before. Another thing I’m sure of: I will take every new experience in my stride and I am extremely excited for the adventure I am about to embark on.

I’ve spent the last 2 weeks relaxing, and exploring Austin, TX with my sister and some friends. All the downtime got me thinking about my goals for this internship and for my own personal growth.

Internship Goals

Introduce current Rice 360˚ technologies – We will be taking 8 different technologies (listed in my previous blog post) that have been worked on by student teams at Rice. I am eager to see how these devices could work in the setting they were made for. I hope that we will receive meaningful feedback and recommendations for future improvements, and that we will be able to better understand the special circumstances of low-resource hospitals that our devices need to cater to in order to be effective.
Perform Needs Finding – The opportunity to experience and observe hospitals in Malawi first-hand is extremely unique. I hope to capitalize on this opportunity, and scope out five new potential Rice 360˚ projects that future student teams can begin work on. I will be conducting interviews and observing day-to-day activities in order to gain a deeper understanding of the gaps in healthcare that we, as Rice students, can help to address.
Set up MUST Studio – An exciting, new task for the Malawi interns this year is to lead the set-up of a design kitchen at the Malawi University of Science and Technology (MUST), similar to Rice’s OEDK. We are taking 7 suitcases filled with electronics: 3D printers, circuit components, breadboards, etc. We also designed posters with safety guidelines and instructions on how to safely and respectfully use the design space.
Work on assigned on-site project – When we arrive to work at the Malawi Polytechnic (the Poly), we will be split into four teams, each with one Rice intern, one Tanzania intern, and 2 Malawi interns. We will be assigned a project to work on for the duration of our time at the Poly. We will also be participating in a pitch competition in Lilongwe, so I’m super excited to get started!
Work on personal project – While we are there, I will have the opportunity to build a project around anything that sparks my interest! While I am an engineering student and am always eager to work on hands-on electrical and mechanical projects, I would also like to learn more about current educational barriers, training issues, and policy issues that affect the standard of care in Malawi and hopefully find a cool project to adopt for my two months there (and maybe even bring back to Rice to work on during the year)!

Personal Goals

Ask questions – These 2 months will surely provide many opportunities for me to ask questions. I am eager to learn about the standard of care in Queen Elizabeth Central Hospital (QECH) and the other district hospitals. I am adopting a beginner’s mindset, and I am ready to learn from the nurses, staff, and my fellow interns from Malawi and Tanzania.
Build confidence – This summer I will be working on many different projects and I want to focus on building my own confidence in my ability to implement these projects successfully. I am confident that I will pick up new skills quickly and learn from my mentors and fellow interns. I am ready to throw myself into the unfamiliar and make the most of any challenges I face along the way.
Get creative – One of the most important (and fun) parts of engineering is brainstorming creative solutions. The hospital environment in Blantyre will be very different from what I am used to seeing in the US and India. One of the most important things I learned during my GLHT 360 class is the importance of coming up with simple solutions that are easy for nurses to understand, and easy for technicians to troubleshoot if things go wrong. It doesn’t matter how fancy a device looks – if the nurses and technicians don’t know how to use it, it probably won’t be much help. Sometimes the best solutions are right under our noses!
“Lead gently” – Dr. Leautaud used this phrase a lot during our orientation for this internship. Although I am very excited for the opportunity to help serve a community, I can only be here for 2 months. In order to create more sustainable and valuable change, I believe that it is really important to focus on empowering the members of this community to lead their own change.
Have fun! – Getting to spend 2 whole months in a completely new culture and environment is the experience of a lifetime. I am excited to immerse myself in a new culture, establish meaningful friendships with the people I meet, and make memories!

I can’t wait for us to finally leave for Malawi. Here’s a picture of us at the airport with 11 suitcases, ready to take on a 40 hour journey!

— Nimisha 🙂

1. Introduction: Pre-departure Preparation

Posted on May 20, 2019June 21, 2019 by Liseth Perez

Hello all!

Seeing as this is my first blog post, I would like to begin with a brief introduction. I have just graduated from Rice this past weekend with a degree in Psychology and a Global Health Technologies Minor. I am looking forward to this internship in Malawi, because it will allow me to further explore my passion for Global Public Health. I plan to make the most of this opportunity and look forward to updating everyone about my experiences through here.

The internship has 4 components. The first is taking a Rice 360 technology to receive feedback on it. I am excited that I will be taking my team, Colostomates, Low-cost ostomy bag. We have been working on this project for the past 2.5 years and I have hope that it will continue to be worked on even though the majority of us have graduated. I believe our device is a simple solution to a complex problem. A colostomy bag is needed when people undergo an intestinal surgery due to Chrohn’s disease, colorectal cancer or other complications. The surgeon redirects their intestine to an opening in their abdomen, which is then referred to as a stoma. The colostomy bag then is used to collect the waste that comes out of the stoma. In high resource settings bags cost $8/bag and people change them 2-3 times a day. However, in low resource settings, people resort to using unconventional, unhygienic alternatives due to lack of accessibility to ostomy bags. Some people even forego these life-saving surgeries due to the social stigma associated with the condition.

Therefore, the feedback received this summer will be used to improve our design and be one step closer to creating a product that could be manufactured and used by people worldwide. The feedback I will be receiving will be from nurses, doctors and other health professionals and solely be qualitative and used to improve our design. I will not be asking patients nor have anyone try on the bag, since we do not have an IRB approved study. We have applied to a modification of our previous study and are in the process of eventually being allowed to test it on voluntary ostomates (people with ostomies).

The second part is working on an assigned project by the host. For Kyla (another Rice intern) and I, this is a little different because our “boss” for this project is Dr. Acemyan, the Director of Human Factors for Rice 360, who will be here in Houston during the summer. We met with her in the past two weeks to get a better understanding what usability and ergonomics entails and to discuss what the goal of our time in Malawi will be. Our task is two-fold. We will have to first document the use environment. This involves literal environment parameters, such as temperature, space, and set-up of the NICU and other hospital rooms. However it also involves, politely observing how users interact with the devices. The users range from the baby’s mothers to the device technicians. We will noting what each person uses the devices for and how they learned to use it. Through our meetings with Dr. Acemyan and our readings, we learned that what the users report and what actually occurs may be at a disconnect. In controlled settings, users may accomodate to what they believe the experimenter expects and may hold back on their answers. This is why this observation period is crucial. Next, we will ask nurses about Incubaby (another Rice360 technology that it is at a much more advanced stage) through a set of outlined survey questions, which we are currently working to finalize. This is not meant to be a formal interview but rather the questions will serve as a guideline to a conversation where the nurses will hopefully tell us what they really think about the device and which areas can be improved. This information will then be brought back to Rice to improve the device to better fit the needs. This is one of my favorite parts of the internship, because one of my career interests is human-centered design so this project combines both my passion for Global Health and this. I believe it is important to gain the nurses trust and be a silent observer for some time, before delving into asking them specific questions. This is a balance that may be tricky and with the help of my partner, Kyla we can work through together. Since our time in Malawi will be relatively short, we need to be sure we get the information we need, through a rough timeline but we also need to be aware of our own cultural competency and be sure not to rush or seems to abrasive. One of the difficulties may be communicating with Dr. Acemyan, since she will not be in-country, but we plan to communicate with her through email and will be handing her a detailed report at the end of the summer that documents our findings. These findings along with the survey questions we are developing are the beginning of protocol that Rice360 could incorporate to evaluate other technologies when they are still in the development stage, rather than waiting until the implementation stage.

The third and fourth part I will be planning and discovering as I am abroad. To begin with I will need to find 2-5 areas where a design project would be beneficial. I will write a separate report on each of my findings and will bring them back to Rice so that they can be considered as team projects in different Global Health classes. Since I will spend most of the workday in Queen Elizabeth hospital, I plan to observe and begin to build a rapport with the nurses. This will help me with both documenting the use environment as well as finding potentials for design projects. The last part of the internship involves finding and implementing my own project. I want to go in with no assumptions and get a better understanding of how the hospital functions and see how their culture specifically differs from ours before making a decision on a project. One of the things I do know, is that I want to include the nurses or other hospital staff at some capacity. I know they are very busy, but I would like it to be a collaborative effort, maybe with the other Malawi or Tanzania interns because there is value in different perspectives and I want to make sure I am not imposing my beliefs or opinions on them.

Overall, I am excited with a tinge of nervousness. I know there is going to be an adjustment period and plenty to do work wise as part of the internship, but I do also want to enjoy my time there and get to know the other Rice interns going with me as well as the people we will meet in Malawi. For now, my focus will be working with Kyla and Dr. Acemyan on the usability survey questions and packing for the trip!

-Liseth Mariana

Reports from Malawi | Summer interns

Rice360 Institute for Global Health Technologies

Malawi