For our final project at the Polytechnic this summer, Sarah, Emily and I have been helping to plan an orientation week for the incoming biomedical engineering (BME) students. It’s been really exciting for multiple reasons, 1) it’s the first year the Poly is offering BME 2) it’s the first time the Poly has attempted to put on a student run, all day every day orientation for new students 3) Sarah, Emily and I have been planning all summer and the week / 42 new BME students are finally here!

This past weekend we made our final arrangements for the week, including large daily schedules we posted on the wall to keep all the students on time and informed, and a welcome message on the dry erase board.   

When Monday morning finally rolled around, we were all giddy with excitement. The first event of the week was a faculty welcome to all the new students (not just BMEs) in the outdoor amphitheater.  The energy in the group was tangible. And after spending 9 weeks on a virtually empty campus, it was shocking and awesome to see so many new students everywhere.

Then, the engineering students broke off from the rest of their class and went to receive a talk from some of the engineering faculty specifically. I’m not the world’s best estimator, but there must have been around 500 engineering students all together, which is pretty incredible considering that Francis leaned over and told me his class only had about 100! After a few minutes, we were allowed to snag just the BME students for a bit before they had to go to their next event. Sarah, Emily, Charles, Francis, Andrew, Christina, Nehuwa, Eckharie, James, Florence, (the seven Poly interns who were a HUGE help in running the orientation week and serving as mentors and friends for the new students) and I all got to introduce ourselves and the BME students likewise introduced themselves. After brief introductions, we had to release the students to do more administrative type tasks, but luckily we got more time with them later in the afternoon.

As their first day at university, we felt it was important for them to get to do something fun and low stress but that would help them meet their classmates for the next 5 years at the same time. We played a couple of different games and ice breakers, but my favorite was the Human Map of Malawi. We all went outside and the students had to arrange themselves spatially according to where they are from in Malawi and based on cardinal directions and checkpoints they determine as a group. It’s a fun exercise in group communication, team building, friend-making, and overall just a cool way to visualize what a diverse and exciting incoming class they are in.

After all the fun icebreakers, we closed out the day with two talks. One was called, “What is engineering? What is Biomedical Engineering? What does a Biomedical Engineer Do?” and the other, “Introduction to the Week.” (Our titling lacks pizzazz, but the content of the talks was great, I promise.) The “What is Engineering?…” talk gave the students a broad overview of engineering and a BME’s place in engineering while also fostering a discussion about their own perceptions of engineering and engineers coming into the Poly. In “Introduction to the Week” we gave the students a brief overview of what we’d be doing the whole week and why as a way to prepare them and excite them for the upcoming activities and lectures.

This past week, two of my professors from Rice (Dr. Saterbak and Dr. Wettergreen) came to Blantyre to teach a weeklong Engineering Design workshop for the faculty at the Polytechnic. In this workshop, they focused in on the seven step engineering design process, which includes:

1) Clarify team assignment
2) Understand problem and context
3) Define design criteria
4) Develop solution options
5) Evaluate solutions
6) Prototype solution (iterative)
7) Test solution (iterative)

In addition to this design process, they also spent time on scoping problems, low-fidelity prototyping and how to incorporate design into existing coursework. I had a lot of fun helping them out with all of the stages of the workshop, but by far my two favorite components were the low fidelity prototyping day Dr. Wettergreen led, and the scoping missions into the community.

The low fidelity prototyping session was very informative and also very fun! Dr. Wettergreen laid out all of the prototyping supplies (most of which were acquired in Blantyre and which could be as simple as a handful of toothpicks or a stack of newspapers) around the room in an inviting, slightly messy fashion to encourage the faculty to really explore all of the available materials. Interspersed on the tables were several games, activities and challenges that promoted creative thinking, hand eye coordination, rapid prototyping and kinesthetic learning. It was really fun to watch the progression of the faculty: at first they were all quite hesitant, but by the end everyone was loud, involved and making quite the mess! For Sarah, Emily and me the session was especially helpful because we plan to execute something like it for the new biomedical engineering student orientation we are helping to plan.

 

For the scoping missions, Dr. Saterbak led a team to the orthopedic department at QECH, Dr. Wettergreen led a team to the Carlsberg brewing factory, another team went to an energy company, and I tagged along with a team that went to Lafarge cement grinding plant. From what I saw on my visit and what I heard from Dr. Saterbak, Dr. Wettergreen and some of the Poly faculty, all of the scoping locations were very receptive to a burgeoning collaboration between the Poly students in design courses and the community. They were enthusiastic about Poly students pursuing projects that could help their respective businesses and continued visits from Poly faculty/students and communication between the respective institutions. It was really cool for me to witness such excitement and positive energy at the very beginning stages of what looks to be a very long term and fruitful set of relationships for all parties concerned.

For all of our staple food needs – eggs, bread, peanut butter, coffee – we generally do our shopping at a little grocery store called Chipiku that is a quick 10 minute walk across Chipembere Highway from the Polytechnic, but when it’s time to stock up on produce, we get to make a run to the Blantyre Market. I freely admit that the bustling, loud, crowded, smelly (good and bad but mostly good smelly) and sprawling market is one of my favorite things about Blantyre.

From the street, the market doesn’t look like much, just some stalls hugging the road, but once you pass the first layer of very vocal vendors, there is a soccer field-sized parking lot full of people manning their mats mounded with produce. As soon as you enter the lot, a swarm of eager little boys will try and get you to buy their jumbas (plastic grocery bags) and people start calling you over to their stations. It is here that I can personally attest to football-sized avocados, and puts-sugar-to-shame-sweet sweet potatoes. But pro-tip: if you can make it through this section without getting too weighed down in produce, even greater treasures can be found inside.

The covered area of the produce market is a hive-like conglomeration of mixed and matched tables where the vendors tend to diversify their wares a little more. It’s here that you can find a single booth with dozens of different types of spices or an abundance of grain varieties. And if you’re savvy, you can purchase a couple of different items from one vendor to increase your bargaining power. The most exotic purchases I’ve made from here are dried hibiscus leaves for tea, passion fruit, and a fiery hot Malawian strain of chiles.

But even better than any thing you can buy at the market, I really love the – for lack of a better phrase – people watching. I love the snapshot into daily life and Malawian culture that it provides. For example, one striking aspect of market culture is how cooperative the vendors are with one another. From an outsider’s perspective, it seems like vendors do not begrudge each other in the slightest when one makes a significant sale over another. They even go out of their way to locate items for other vendors. This level of camaraderie is remarkable to me.

The sights, the smells, the sounds, and the people all make the Blantyre market a truly unforgettable experience, and one I plan to frequent as often as I can while I’m here.

I tried to take a sneaky video outside where they sell fish. The sights and sounds are captured pretty well, but the overwhelming smell of fresh fish is something I won’t need a video to remember!

Prototyping in Blantyre is a whole different ballgame from prototyping in Houston. At Rice, where we have the OEDK, every material you could need is available for you to use; at worst, it’s a simple click away from Amazon. If you need a box of certain dimensions, both the 3D printer and the laser cutter are conveniently at your disposal; to construct said box, screws, nails, washers, and bolts of every size are at the ready; dozens of various glues are in a cabinet nearby in case nails and screws aren’t working out. The abundance of materials at the ready encourages a creativity grown from the absence of limits; almost any practical thing you could want to build can be from the ground up with the resources around.

Blantyre doesn’t offer that same opportunity. Instead, it fosters a different sort of creativity, one born from the absence of materials as opposed to a limitless supply. You’re limited by what you can find in the immediately surrounding area. If you have an idea, one of the first considerations has to be practical execution; the assumption that any idea can somehow materialize (which is prevalent in the US) doesn’t exist here. Catherine wrote a blog a little bit ago about this idea, called “Little Epiphanies,” which I would recommend!

The divergent effects that these two environments have on students has been quite apparent, if you consider this group of seven inters as somewhat of a case study. The four Malawian interns are far more skilled at reconsidering materials, at seeing existing objects as potential resources to be deconstructed and used for an entirely different purpose. As I said, the lack of resources cultivates a creative ability to use alternative materials in order to continue creating. It’s a more efficient use of existing resources that fosters a mental flexibility I think is crucial to successful design. Of course, the lack of materials creates challenges and in some ways slows progress, but it also improves an ability to problem solve, think innovatively, and work within your design constraints. Here are some recent examples of making do with what’s available:

• Phototherapy dosing meter box. This was a simple fix, but still a good example of what I’m talking about. We wanted a plastic box that was handheld, long, and thin to increase accuracy and usability of our phototherapy dosing meter. Unfortunately, we only had a box that was too big and one that was too small. At Rice, we would have laser cut the perfectly sized box; here, if we had no resources, we would have built a wooden box from scratch. To save time and resources, the existing too-large plastic box was sawed down in a way that maintained all of the smooth plastic edges and screw holes, but gave us the dimensions we wanted. The super glue seam was then coated in the black dust that had fallen from the plastic during sawing, and sanded down to blend in with the adjusted box.

• Cardboard box power supply. We ran through all of the 9V batteries we brought from the US to power our Arduino during testing. There aren’t any power supplies in the room we work in, but we needed an adjustable 5V – 9V power supply in order to build and test our circuits. Andrew brought in a small power supply that he had built himself a few weeks ago, fashioned out of an old Dell cardboard box. The little device works perfectly to run tests with, is really low cost, and he didn’t even have to leave the school to build it.

• IR LEDs and receivers. Our design for the suction pump device relies on infrared light transmission and reception. While these components are available and low cost in the US, they can’t be found and bought in Blantyre. The Malawian interns, though, realized this is the same mechanism many home appliances (remotes, in particular) use to function. So, they deconstructed devices that Andrew and Christina brought from home, cut out the infrared LED and corresponding transceiver, and used these components to build our suction pump accessory device.

• Elastic material. One iteration of our suction pump accessory housing involved an elastic band. We needed elastic that wouldn’t wear much with time, but squeezed the suction bottle tightly. We found the perfect material in a discarded piece of scrap rubber used for automobiles. Again, the solution was low cost, a bit unexpected, but solved our problem perfectly.

With only three weeks left in the internship, we are officially in crunch time. Here is an update on what’s been going on, where we’re at, and what we have left to do:

• S.O.S. This is the working title of our suction pump accessory device, meaning “Stop Our Suction.” I’ve written a bit about this device before, but as a reminder it’s a project that originated from PAM (the Physical Assets Management department at Queen Elizabeth Central Hospital—they fix the broken medical equipment). Suction pumps are commonly used machines across all wards, especially in the operating theatre, and are also commonly broken devices. They are used to remove fluids (blood, mucus, etc.) from a patient; the machine applies negative pressure through a tube, which sucks up the excess fluids and deposits them into two large bottles. The problem occurs when the bottles fill up. If a nurse or doctor doesn’t notice the bottle is full and continues to use suction after this point, the fluids back-flow into the machine, often causing irreparable damage. This is a problem throughout QECH, in the district hospitals, and most likely extending outside of Malawi. We are in the process of creating an adjustable accessory device that alerts nurses when the bottle is full, and automatically shuts off the suction pump before backflow occurs. Currently, we are in the later stages of prototyping: the circuitry is finished, the housing design is completed, and initial testing is done. Still left to do is complete the physical housing, thorough testing, and documentation.

• Chitenje Warmer. We chose this project, which originated from our professors and the maternity ward at QECH, a few weeks ago. One of the biggest challenges facing newborns—especially premature babies—is hypothermia. Kangaroo care is an effective way to combat hypothermia, however there are many cases where KMC (kangaroo mother care) isn’t possible; for instance, if the mother or baby experienced complications during birth and needs to be tended to or rushed to another ward. In this case, the baby is dried and wrapped in a chitenje, then set in a cot. (Side note: chitenje’s are extremely common 2m pieces of fabric worn throughout Malawi. I’ve yet to meet a woman who isn’t wearing or carrying a chitenje. They are used as skirts, wraps, slings to hold babies with, blankets, and more. All expecting mothers bring one or two chitenjes with them for delivery, to be used for wrapping the newborn.) There was a team at Rice this past year who showed that if you warm a chitenje before wrapping a newborn—and you cycle out newly warmed chitenjes every 30 minutes—you can keep a newborn at a healthy 37C. Once their body temperature drops a few degrees lower, though, it’s very difficult to bring them back to a healthy temperature. We are building a chitenje warmer to put this idea into practice. We are currently in the testing stage, and must make adjustments to our initial design, complete very thorough testing, and produce documentation on the device.

 

• Orientation Week. This project has definitely picked up speed these past few weeks, and will continue to do so until our last week here when the orientation takes place. There are 42 incoming biomedical engineering first-years next year at the Polytechnic, and we are working on creating a week-long orientation for this class. We are especially excited because this is the first year the Polytechnic has offered a BME curriculum, so this will be the pilot orientation week. We have created a schedule for the week (5 days, 8am to 5pm daily), and are working on setting up lecturers for various presentations. We also are responsible for many of the lectures ourselves, as well as planning the design project that will be executed throughout the week.
• Website. We’re creating a site designed to facilitate communication between Polytechnic and Rice students. It has 3 main components, the first of which is a page that details various current design projects that students submit. We have built it such that other students can easily offer feedback on the design projects, enabling students at each school to learn from the expertise of the other. We also built in a question forum, for questions that commonly rise up about material availability, cost, resources, and everyday life. Finally, we have a place where new design challenges can be submitted that students (or faculty, or industry) think up but don’t have the time or resources to tackle. It will be a way to inspire design ideas, and hopefully improve the quality of all our devices. All we have left with this project are a few aesthetic alterations, and creating the first few entries as examples!
• Other. There have been a few other small projects in the works this summer. Catherine took lead and put on a Jacaranda engineering workshop; we spent some time fixing broken bCPAPs in storage over at QECH; we’ve been doing some recon for an engineering design workshop that two Rice faculty—Dr. Saterbak and Dr. Wettergreen—are hosting this week for the Polytechnic faculty. Throughout this week, we’ll be helping them some to set up and to execute this workshop. Finally, I’ve been trying to learn as much as possible about how to improve the bCPAP heating sleeve, and will be getting a sleeve made by a local tailor soon! But perhaps most importantly, it was Christina’s birthday last Friday, so we took the opportunity to add to the list of American-desserts-we’ve-made-that-the-Malawian-interns-have-never-before-tried and made some apple pie!

There are a lot of projects being executed simultaneously right now. This internship, in addition to the loads else we’ve learned, has been a big lesson in time, project, and resource management. However as I’ve said before, with 7 dedicated people working all day every day on these projects, we move fast; we have high hopes for where we’ll be in three weeks’ time.

The suction pump project I’ve mentioned in previous blogs is beginning to really pick up some steam. (Our working title for the device is the “S.O.S.” or “Stop Our Suction.”) Here’s a little about our device, our progress so far, and the next steps for our team.

Device Overview

The main components of the S.O.S. circuit are a transformer that turns the 230 volts from the wall into 9 volts, a 5 volt voltage regulator, a relay to turn off the suction pump, and of course, the IR sensors. Everything but the IR sensors are housed inside a black plastic box that includes a plug on the outside for the suction pump machine to plug into. The sensors will interface with the collection bottles by way of a velcro strap. (We’ve made the strap so that it can accommodate both the largest and smallest collection jars we’ve seen at QECH.) See the graphic below for the sequence of events after the suction pump machine is plugged into the S.O.S. and the switch is turned on:

Progress so Far / Future Steps

The circuit is pretty much complete (we are waiting on one jack that our professors from the US are bringing with them this weekend,) and the velcro strap is done as well. Now we need to build small casings to slide onto the strap that can house the sensors. The casings will need to be able to move around on the strap so that the nurse can properly align them to the jar in use. Once this is complete, we will need to do more extensive testing of the device and complete our final report.

In Other News…

…Friday was Christina’s birthday! To celebrate, Sarah, Emily and I made her an apple pie and brought it to work for everyone to share. Not to toot my own horn, but I think the pie was quite the hit!

Last Friday Tanya and I went on a second visit to Jacaranda School to teach an engineering workshop to Form 1 through Form 3 students. It was only two hours, but I think the students learned a lot and had a lot of fun in the process.

In the beginning of the workshop, all the students wrote down their definition of engineering/what it means to be an engineer, and then as a group we went through some of their definitions and talked about the best qualities from each one. Then, we finished off with my most basic definition of an engineer, “Engineers work on teams and use math and science to build things that help people.”

From there we talked about some of the main branches of engineering – mechanical, electrical, civil, and biomedical – and the different kinds of things specialized engineers do. I think the students were really interested to see that engineering isn’t only working on cars, and that engineers of different disciplines often work together to solve problems. After that portion, Tanya and I talked about 3 qualities that make good engineers: creativity, team work and problem solving. We did some fun group activities that tied into each of the qualities, as well, and I think the group favorite was by far the Human Knot game. In Human Knot, all the participants stand in a circle and grab two other people’s hands. (They can’t be the hands of the person right beside you, and you can’t grab both hands of a single person.) The challenge is then to “untangle the knot” that was formed without letting go of anybody’s hands.It is an exercise in team work and problem solving, to be sure, and it was great fun to watch the group dynamics evolve as the game went on and the knots became tricker.

Finally, we talked with all of the students a little bit about scoping and problem identification along with design objectives and criteria. It was a bit of a crash course into the beginning stages of the engineering design process, but important nonetheless and I think the distinction between understanding problems and coming up with solutions was an especially good lesson for them to learn.

All in all, it was a fun and informative visit. The students really seemed to enjoy learning, and I know Tanya and I had a great time teaching.

At the request of our professors and several doctors at QECH, we have recently begun work on another project – a chitenje warming box for use in the Maternity ward. Common practice at QECH has mothers bring two personal chitenjes with them to the hospital to wrap their new born babies in right after delivery. Then, the mothers would ideally hold the bilayer baby bundle close to their chest to share some of their own body warmth. However, for varied reasons, sometimes this procedure is not followed completely or still does not provide enough warmth for the babies, and the problem of hypothermia persists. We hope that by building a box where chitenjes can be stored and warmed before a baby is delivered, hypothermia can be reduced with the very first hug the baby receives.

Our design is based on a modified design of a previous Rice senior design project that is currently in use at QECH – the Hot Cot. The Hot Cot is a warming box for babies that is made of wood and uses several incandescent light bulbs as a heat source. The beauty of the Hot Cot is that it can be 100% locally sourced and built, is relatively inexpensive, and poses little to no risk of overheating. Our Chitenje Warmer will operate on the same heating principles, but has a modified silhouette to maximize chitenje capacity while minimizing the risk of cross-contamination.

We are very excited for the potential of this project and hope to have a working and tested model that we can give to QECH before we head back to Texas. It’s a hefty goal, but we’ve already finished construction on the first generation prototype this week and just today we’ve received the supplies necessary to begin testing the device.

“Relief from pain and suffering is a human right.” –WHO 1990

The words above were printed out and taped onto a wall in the pediatric oncology ward at Queen Elizabeth Central Hospital.

The day I read it, we had just left a meeting attended by QECH doctors, where they had convened to discuss the preceding week’s maternal mortality cases. Each case was thoroughly explained, from when the patient was admitted, the condition of the patient throughout her stay, the birth proceedings, and the time/cause of death. Case after case, we listened as doctors explained what resources—medicines, machines, tools, blood, extra nurses, an open operating theatre—may have saved the patients’ lives.

In pediatric oncology, where the poster was, we were looking at the only electronic body scale in the pediatric oncology unit. Karen and Tanya had been asked by the nurses to come by, as the machine wasn’t charging correctly. We found the machine hooked up to the incorrect power plug—the jack and the plug were two different shapes—despite the fact that the nurses said they had been using that particular plug with the scale for a long time. The scale was many years old; most likely, the correct cord had been lost or broken months ago, and the nurses had improvised a solution in the interim. Unfortunately, their solution wasn’t going to last, and the scale was probably going to soon cease functioning.

After we left the ward, I spent time shadowing doctors, where I noticed example after example of “making do” when resource limitations didn’t allow for ideal care. For instance, I listened as doctors discussed the problem of newborn hypothermia immediately after birth. When the mother experiences health complications and the baby cannot be rested on her chest, the baby often grows dangerously cold without the skin-to-skin contact. Limited resources prevent the use of expensive incubators or warming blankets, so the alternative solution decided upon was the use of plastic shopping bags, which would be wrapped around the child for insulation. Though not ideal, the solution was the most current funds would allow. While in pediatrics, I saw a baby who was being treated for jaundice with phototherapy. Typically, a thick headband is used to shield the baby’s eyes from the intense light. Unfortunately, none were available. Instead, an adult sized mouth and nose mask had been carefully fastened around the baby’s eyes, attempting to substitute for the more appropriate eye mask.

 

Seeing the poster, “relief from pain and suffering is a human right,” between hearing the maternal mortality cases, seeing vital machines disappear from use, and shadowing in the wards, hit me hard, as most of the problems stemmed only from the lack of available resources. Patients fill every ward in the hospital—labor, burn, oncology, special needs pediatric, neonatal—their eyes glancing up as you walk by; family members wait nearby, walking through the hallways with bundles of food for loved ones tucked under their arms or bending over buckets of soapy water outside tending to the patient’s laundry. Busy, hardworking doctors meet with patient after patient; bustling nurses bounce between filled cots; medical students cluster around every morning during rounds.

Despite all of this effort and thought, patient care continues to suffer due to lack of resources—no amount of good will, hard work, or long shifts can take the place of needed materials. Syringes run out, life-saving medicine isn’t obtainable, tools break, and diagnostic equipment is too expensive: low resource takes on a new meaning when you observe it firsthand. Despite the right all humans have to be relieved of their physical pain, such relief often requires funds to procure, and money and access is extremely limited here. This depressing and unfair fact is a reality faced by so many we interact with every day. Doctors don’t have the medicine they need to properly treat patients; the hospital can’t buy the materials nor machines it needs to improve survival rates; the repair department can’t fix machines because they can’t buy replacement parts; engineers can’t build the devices they have created in their minds because there is no money to fund their project; patients from rural areas can’t receive treatment because they can’t afford or don’t have access to transportation.

The problem is massive, overwhelming, complex, and working against it is at times discouraging. The actions needed to move forwards, to encourage growth and progress, often feel equally massive, overwhelming, and complex.

However being here, I’ve begun to notice how this beast of a problem is oftentimes not diminished by large actions on the part of powerful governments and corporations. Large-scale action exists too, of course, and often does a lot of good (while other times doing a lot bad). As an individual, though, it’s difficult to relate to the changes that huge donations, programs, or interventions effect to combat the absence of resources. Instead, by looking at the small ways that the patients’ lives are improved by the relatively small innovations of a few, I begin to see how progress can be made. Granted, progress is slow, often difficult, and is made in small steps, but it is through these small feasible actions that I see ways we can help to solve a problem that otherwise seems too huge—even impossible—to tackle.

Many of the machines and materials used in the hospital are donations. This “free” equipment comes from various governments, NGOs, corporations, non-profits, or philanthropists, and oftentimes stickers or plaques attached to the machines themselves display the name of their donor. Walking through the halls of Queen Elizabeth Central Hospital, the sheer number of expatriate doctors is also surprising—many European medical students end up on rotations in Queens for a month or two as part of their training. The visible presence of donated material extends outside of the hospital walls as well. While walking the streets of Blantyre, I’ve seen University of Michigan shirts, shirts bought from local New York bakeries, South Padre island tourist shirts, and various other American clothing items. Considering that many Malawians have never left the country—and that plane tickets, food, and lodging in the US are quite expensive—much of this clothing comes from donated sources. Even the Polytechnic itself was founded with the aid of the US government back in the ‘60s.

On one hand, it’s easy to appreciate the goodwill that fueled many of these actions. It’s also easy to appreciate the positive results that the donated equipment and aid often produces—they doubtlessly save many lives daily at Queens alone.

On the other hand, it’s also easy to see the frequent disconnect between donor and recipient—the gap between intended benefit and actual need—which often results in donation and aid producing far more negative outcomes. Outside of the hospital, mounds of unusable donated equipment sits forgotten in dimly lit corners. Hundreds, if not thousands of dollars of equipment is wasted when donations are given without replacement parts, without a plentiful stock of consumables, without user manuals, or without a need. Sometimes, lack of understanding between people, cultures, and institutions results in an incredibly sad waste of resources in a place where proper resources are direly needed. For expatriate doctors, there are ample misunderstandings and frequently an inability to transfer practices that impede proper treatment; it can be difficult to use methods learned in high-resource settings to heal patients in low resource settings effectively, in a way the patient is comfortable with, and in a way the hospital can support.

Even donations as seemingly harmless as T-shirts can cause damage. Free clothing puts local tailors and textile manufacturers out of work; free shoes harms local providers of rubber and textile, and the businesses of craftsmen. Money flow decreases, local markets can be harmed, and a dependence forms. In the event of donor fatigue, recipients are often left worse off than before donors intervened.

These negative consequences have their foundation partly in a misunderstanding between people, countries, and cultures. Considering that groups born and raised in one environment are donating or providing aid to a vastly different environment, the resulting disconnect that causes so many problems isn’t all that surprising.

So, as someone who was born and raised in the US, but is currently working in Malawi and designing medical technologies for low-resource settings, I’ve thought a lot about which models of work I feel are the most sustainable, do the greatest good, and cause the least amount of unforeseen harm.

Arguably the most crucial step in sustainable work is research: the truer of an understanding we (as foreigners) can get of the context for which we are designing, the more fruitful our work will be. This research phase involves identifying needs, and defining design constraints. Without proper research and understanding, we are effectively attempting to take our model of American medical care and implant it into low-resource settings. This would waste machines, money, time, and many other resources. Instead, it’s crucial to get a firm understanding of the existing framework. This involves conversing with the doctors, nurses, and patients in Malawi to identify present needs that exist within their hospitals and have been deemed important by the actual consumer. Additionally, observing the practices and processes within low-resource hospitals and health centers helps to develop an understanding of what attributes successful technologies must possess. For example, traits such as durability and ease of use take on a much fuller meaning after spending time in the wards and seeing how technologies are handled, stored, and how much time is taken to understand them. Visiting with the engineers who fix medical machines fills out our understanding of how machines are (or are not) repaired, how consumables will (or will not) be supplied, and what materials are (or are not) available to work with. Designing medical technologies requires particularly extensive research, as the buyer (hospital), the user (doctor/nurse), the beneficiary (patient), and the repairman of each device is a different party; an understanding of each is needed to properly understand design constraints and thus design an appropriate technology.

Apart from understanding the need, the setting, and the people, the market also needs to be considered. How will the product be marketed? Who is going to buy the product? How much will they buy it for? Why will they buy it? Who will manufacture it? How will manufacturing be sustained? Is there a large enough market to support the development costs? For how long will the market exist? These questions, and dozens more, have to be taken into account. Donations will run out, and often do little to support local economic growth; on the sustainability scale, donations rank pretty low. Alternatively, a thorough understanding of the technology’s market makes the product potentially sustainable.

Once the need has been identified, the constraints defined, and the market considered—and after all are well understood—a device is ready to be built. While these devices often have their high-resource counterparts (expensive machines that address the same health problem in high resource settings) designing a new technology is more complex than just removing the bells and whistles from these more costly machines. Instead, the design process often starts over. Too much changes with the different settings, and the required attributes of the two devices are too varied to simply adapt an existing tech to a new environment; an altogether new device needs to be created.

Which brings us to the designers, the engineers. The four Malawian interns will always have a deeper understanding of this country than any of the Rice interns will ever hope to have. As a result, their potential to design appropriate technologies for Malawi is great. As Rice interns, we bring other strengths to the table, and our backgrounds provide us with a perspective that is also important to the process. However the partnership between groups shouldn’t end with the research phase of the design process. If patients, hospitals, doctors, and nurses from low-resource settings are involved in understanding the problem, so should be local engineers in solving it.

Luckily, we are involved in a program currently that addresses most of these concerns. Rice’s relationship with Queens is unique, and we consistently get valuable feedback from those in the wards. Interns are here every summer, and multiple faculty members work here year round. There are Malawians employed to help run the bCPAP trainings and the clinical trials. Additionally, the relationship with the Poly and Poly engineers is growing, providing even more opportunity for sustainable, appropriate, and constructive work.