At the end of last month, we had to say goodbye to everyone and to Malawi as the internship had come to an end. It was hard to believe that it was over while having farewell dinner with the team on our last Saturday there.
Little time paired with a lot to do for the group projects made the last few days of the internship quite intense. After making some changes to the electronic components as well as the envisioned mechanical user interface from our compression therapy device project (see my previous posts for more info), we converted the circuitry developed on a few breadboards into two manual prototyping printed circuit boards (PCBs) and finalized it. Soldering all of this was a challenging process due to the space limitations, the narrow room for maneuvering as well as the need for debugging and redoing several things. We also designed and 3D printed a new box to house all of the electronics, and placed the PCBs as well as other separate electronic components inside it. While we did not incorporate the leg cuffs into this prototype, we did explore a couple of different manufacturing techniques with a local fabric, which if developed and proven successful, could help in our efforts to make a device that can be manufactured as locally as possible. Due to the tight timeline and new debugging challenges to overcome, we did not obtain all of the functionality that we had desired and which was already reflected in the user interface of the prototype. However, we did develop and implement all of the hardware components and had working PCBs which provided key functionalities to the device.
Overall, in building the existing open source device in Malawi, we adapted the design mostly due to limitations in the available materials as well as developments to the device which we wanted to incorporate. Of course, work still has to be done to finish as well as to optimize the device, but going through the process allowed us to explore the challenges and possibilities of making a device in Malawi and to learn from it.
This is what the prototype of the box looked like:
Box housing the electronic components. The side of the box also contained a switch and a charging inlet. In case you are wondering… the 3D printing of the box lid failed several times so we could not get a perfect version.
Lastly, the Friday before leaving, we had presentations on both our group projects as well as smaller needs-finding based personal projects. Ranken and I presented about our compression therapy device after Sanjay and Tatyana had talked about their project. Then, we all talked about our personal ones, with the topics discussed relating to maternal and neonatal health as well as prosthetics and orthotics. These research topics might become future projects for other teams, so stay tuned 🙂
Looking back, with the work done and experiences had during these two months, I have been able to develop practical engineering skills, learnt to use what is available to me and work around what is not, and gotten a better understanding of the needs and design requirements of a setting like Malawi. One does not have to go very far to find needs there and while not everything is an engineering problem, one of my biggest takeaways from this experience was seeing the direct positive impact that bioengineering can make in a setting where the resources are low but the needs are high. It is thus great to know that there are people at Rice working on developing global health technologies to help tackle medical needs in low resource settings.
I want to thank everyone who helped to make this internship possible.
This week I’ve been deconstructing my perception of productivity and work. Western cultures such as the United States have a particularly intense approach to work, relative to other countries. We emphasize productivity, efficiency, speed, and punctuality. I grew up seeing myself as a strongly Type A personality, as most Rice students are. I value structured schedules, and I feel infinitely bad when I’m late to a meeting. American culture really lends itself to Type A personalities: Everything is incredibly streamlined. When I go to Starbucks in the United States, there is a predetermined script, and this script barely deviates each time.
“Welcome to Starbucks, what can I get you?”
“I’ll have a grande iced caramel macchiato.”
“Can I get a name for that order?”
“Hannah”
“Thanks, Hannah, we’ll have that right out for you!”
It’s essentially the same exact words every time, no matter what city I’m in or who’s working the register. This makes the interaction super fast and maximizes both the amount of customers Starbucks can serve and the amount of errands I have time to run in one day.
Things are less streamlined here in Malawi. Last Sunday, we shopped for groceries at the Blantyre market for the first time. It was nothing like any grocery-shopping experience I’ve ever had before. For one thing, you need to talk to a completely different person for each item you want to buy. One woman will sell you tomatoes from her beautiful, shining tomato-piles on the sidewalk, then you’ll buy rice from the man at the nearest rice-booth, then you’ll attempt to haggle for oranges (They tend to ask for more money from foreign-looking people like us. 500 Malawian kwacha for one orange? Heck no. We’ll buy them for 100 MWK each, please and thanks). It was great, because everything was so much cheaper at the market than it was at the grocery stores we’d been using before. But, if I’m being honest, the bustle and chaos of the market was a bit much for me. I’m an introvert, and many people compounded with a lot of stimulation is difficult for me. I’m used to shopping alone. In fact, I love grocery shopping in the US. It’s relaxing to take my time perusing each isle in peace, alone with my thoughts. But “alone” is not something that exists in the shopping world of Malawi.
The Blantyre Market
From grocery shopping to scheduling important meetings, everything that the US streamlines is approached differently in Malawi. From the market to the work-place, the pace here is different, and less streamlining demands more focused human-to-human interaction. Based on everything I’ve said so far, it shouldn’t surprise readers to hear that my introverted, Type A self has been struggling with an increased demand for engagement with my surroundings and a more culturally laid-back approach to productivity. I’m used to having each day scheduled out down to the minute, from dawn until 2am. That’s just the life of an engineering student at Rice. However, I quickly learned that my approach to work is different from that of my teammates. As someone who’s been through the whole engineering design process several times before, I thought that I was supposed to be a leader of my team. I spent our whole first week pushing them to match my pace and get as much done each day as we could. Unsurprisingly, I felt some resistance. I know what it feels like to be a leader who is failing to maintain investment from their team, and that’s exactly what I felt during the first week. I was struggling to change the pace that I have been socialized for 20 years to maintain.
During last week, week two, we had a pretty atypical work schedule. On Wednesday afternoon, Dr.L, Karen, and Raj from the Rice 360 office in Houston showed up and spent the day in the design studio. All the Rice interns were so excited to see them, especially since we know that Dr. L’s time at Rice 360 is ending soon. She immediately brightened up the room with her warmth, and we were quick to embrace her in a group hug. It’s an understatement to say that we’re going to miss her so much.
Dr. L and I wearing our matching Rice quarter zips! This photo was taken shortly after all four of us Rice engineering interns attacked her with a group-hug. 🙂
Another atypical event from last week occurred on Friday afternoon, when a few dozen kids showed up in the design studio. Educators at a secondary school were collaborating with faculty at Poly to show secondary school students around the university. They came into the design studio and asked us all to talk to the kids about our work as engineers. Apparently, it was all an effort to convince many of these kids that their educations didn’t have to end after secondary school; College could be a meaningful and accessible opportunity for them. Educational outreach is very near-and-dear to my heart. It was a lot of fun to watch all the interns talk to the kids about our projects and show off various technologies in the design studio.
While some interns were showing the secondary school kids the laser cutter, lighting up Arduino LED circuits, and talking about our projects, I decided to stop thinking about how stressed I was about my team’s progress and let myself goof off a little. I noticed some scrap wood near the laser cutter and thought it would make for nice pictures of Nimisha and Joel. 🙂
As fun and exciting as all these schedule deviations were, I won’t sugar-coat the fact that they were interruptions. While the fact might be that this week was full of interruptions, the truth is that these interruptions were actually a blessing in disguise. They were completely necessary for me to learn how to slow down and engage with the world around me. I had been struggling with a socialized pressure to work quickly, efficiently, and maximize productivity, and I tried to force a team of Malawian and Tanzanian interns to match my pace. By being forced to slow down, I was given the opportunity to take a breath. I was able to spend some time goofing off with my team and some of the other interns, and it made me feel so much more comfortable in the design studio. Paradoxically, these interruptions actually made my team more productive.
This picture is dedicated to Karen, who was super excited to hear that the engineering design process officially condones sticky-note usage for brainstorming sessions.
A happy team is a functional team, and after forcing myself to slow down, I could feel my team start to meet me in the middle. I tried to impose an American standard onto an international team of engineers, and I am now learning from my teammates that a western approach to work and productivity is not the only path to success. By slowing down, we are given the opportunity to truly engage with each other, our environments, our clients, and ourselves. As a biomedical engineering student with a future career in global health, learning how to slow down and engage is critical. Like I said to the Biomedical Engineering Student Society when Christina asked me to speak at their inaugural event last weekend, it takes a particular type of person to study bioengineering, as opposed to other engineering fields. Bioengineers care about people. We want to help, to serve. It’s ultimately a love for our communities that drives our studies and our successes, and in order to truly serve our communities we need to learn how to slow down and authentically engage ourselves in the people and places around us.
BONUS CONTENT:
All the engineering interns from MUST, Poly, DIT, and Rice, jumping for joy with Dr. L, who will be dearly missed. <3
My mother is an elementary school music teacher. Walking into her classroom, you can see walls plastered with posters of her students’ favorite artists right alongside portraits of Beethoven and Mozart. From hearing her talk about teaching and even being one of her students myself, I’ve come to realize a central philosophy in her classroom: the most important component of education is getting students invested. A kid isn’t often motivated to learn piano so they can play “Ode to Joy,” they instead start by hammering out the melody of their favorite pop song. By first allowing the opportunity to explore and then helping a student imagine future possibilities, a teacher has created a life-long learner.
This past week, I heard a similar message when talking to Juliana, a lecturer at the Polytechnic who helped bring in a group of secondary school students to visit the design studio. She explained that there was a common mindset among young Malawians that their education ends once they graduate secondary school. By bringing these first-years to the studio, they can begin to imagine the exciting possibilities and endless opportunities that wait for them in the field of engineering.
Earlier that day, I was talking with my teammate Rodrick about what he planned on pursuing after his graduation. In addition to launching his own company and becoming an entrepreneur, he wants to focus on youth outreach centered around engineering. When we later heard that a student group would be visiting the studio, he immediately began setting up an Arduino and coding a mini light show. The same instant the LEDs began to light up, so did the faces of those students. Looking around the room, I witnessed the design studio come to life. Each intern from the Poly had taken to their favorite machine in the room and began sharing their passion for design. Questions could constantly be heard in Chichewa, and everywhere people stood crowded around screens full of code. At the laser cutter, the students knew not to stare into the bright light that sliced through wood like butter, but nobody could help themselves from sneaking a quick glance… watching your own design be translated from computer to reality is just too exciting.
On Saturday, we were invited to the kickoff event for the Biomedical Engineering Student Society (BESS). With the Poly’s first class of biomedical engineers graduating this year, the room was full of passion and an energy unlike that of any student organization meeting I’ve been a part of at Rice. Between each item on the agenda, an MC kept this energy alive while a DJ blasted tunes. Students gave presentations on the work they had done in the design studio, and encouraged their peers to take advantage of this amazing resource. As a student said, it’s one thing to learn a concept in a classroom, but applying it to a real-world project is completely different. Not only does the experience allow you to further develop and test your understanding, but the feeling when you see all of your hard work benefit another is unparalleled.
Towards the end of the event, Christina (one of our fellow interns from Poly) asked if one of us could provide a view of the bioengineering major at Rice. Hannah, being the bravest among us, got up and shared her experience with the classroom. After touching on the details, she began to dive into the reason people become bioengineers: to help people. As the statement resonated with me, I looked around the room and saw heads nodding with murmurs of agreement. In that moment, it became clear that we all shared this common perspective and had become invested in making this world a better place to live. At some point in time for all of us, the subjects of math and science had been connected to a purpose. For me, it was a summer camp. For Rodrick, it was an introduction by a teacher. For the students that visited us on Friday, hopefully it will be their trip to the design studio that keeps them imagining what’s possible.
– Alex
Group picture after the BESS event!
My team hard at work preparing for next week’s pitch competition in Lilongwe. (from left to right: Rodrick, Racheal, Me, and Betty)
How excited we all were to see Dr. L again!
The most beautiful sunset I have seen in my life! (pic creds to Shadé)
I cannot believe another week has flown by. We have about 1 month left in Malawi and there’s still so much to do! The first few days of the week consisted of heavy research and compiling of notes. Liseth and I reviewed some of the fundamental principles for interactions with devices and created a list of key aspects to pay attention to while we observed in the wards of Queen Elizabeth Central Hospital. Along with detailing the day-to-day flow of the neonatal and maternity wards, we are paying extra close attention to the user experience while using a particular technology based on the fundamental principles we have learned. We are also taking note of the proximity of equipment and machines, routines of doctors and nurses, communications/interactions between doctors and nurses, how the ward environment shifts throughout the day, and if there are any improvised solutions utilized by doctors and nurses within the ward.
Our first observational day was spent in the Nursery High Dependency Unit (HDU), where 0 to 6-month-old babies who require less intensive treatment are looked after. We spent the morning shift in this ward, attempting to document all of the activities in as much detail as possible. The ward itself was not very large in size and held about 16 beds all in close proximity to one another. Mothers either sat on low stools next to their baby or on the floor nearby. While we were observing, Pumani bCPAP machines (a Rice 360 technology) and oxygen concentrators were in use, so we got a better understanding of how these devices work to help babies breathe. The ward also had 1 multi-parameter patient monitoring machine that was rotated around in order to check pulse and oxygen saturation of the babies 4 times a day. The most informative information from the day did not come from observations, but from talking to the main clinician for the ward. She told us how efficiently they work even with the limited amount of resources available. It was amazing to hear some of the short-term solutions the ward had utilized in order to get the job done. From using duct tape to seal off the exits of leaky oxygen concentrators to creating a makeshift oxygen splitter from a surgical glove, hearing about the creative equipment improvisations was definitely the most surprising part of the day. The main clinician mentioned how they can really make the most out of every resource here in order to save many lives. In her words, “We do not have much, but we really make do with what we have.”
Our second observational day was spent in the Nursery Intensive Care Unit (NICU) which mostly consisted of patients who were born premature. We observed even more Pumani bCPAP machines in use and even had the opportunity to ask a CPAP nurse some questions about the device. The most glaring observation from this day was how the beds inside radiant warmers were holding 2 babies in 1 bed. At first, Liseth and I thought it was due to the lack of functional oxygen concentrator machines that babies had to be positioned close together. But after speaking to one of the doctors, we learned that the issue is really a shortage of available beds. The clinician described how at times, they must fit up to 4 babies side-by-side together into one radiant warmer, which must pose a serious risk for infections. I plan to investigate into this issue further and determine why incubators (which were available, but not in use) were not being used as an option to place babies.
An inside view of the neonatal intensive care unit at Queen Elizabeth Hospital. Incubators are off to the side and rarely get used except for transportation of babies
Although we worked hard, this week also had very fun moments as well. Dr. Leautaud, Karen, and Raj came from Rice 360 in Houston to visit us in Blantyre! We had a great time sharing meals together and discussing interesting highlights of the internship so far. On Sunday, our group ventured out to the Majete Wildlife Reserve in Chikwawa. We took safari rides through the park and got to see elephants, impalas, warthogs, baboons, crocodiles, and hippos in their natural habitat. It was a wonderful opportunity to get so close to animals that I would usually only get to see inside of a zoo. Our tour guide on the trip was very adventurous and funny. He managed to get a herd of elephants to chase after our safari car! One of my favorite moments from the weekend however was stopping on the side of the road on the way back to admire the breathtaking view of mountains bathing in the sunset. We took many pictures together and were amazed by the beauty of the landscape.
This week our group will be travelling to Lilongwe for an engineering design competition. We will be there from Wednesday until Friday, so I’ll post more updates about the event in the next blog. Thanks for reading and I’ll see you next week!
We got up close and personal with many elephants this day! It was amazing!Us on the safari car at Majete National Park!
As I am writing this blog post, it is June 23rd a.k.a International Women in Engineering Day!!!! To honor this day and simultaneously reflect on the week that just passed, I want to talk about women. Women in engineering. Women in education. Women in Malawi. Women in the United States. Women who have mentored, encouraged, and inspired me as I pursue a degree with not nearly enough female representation.
On the surface, most of our week revolved around brainstorming new ideas for our main projects (my team’s project is a continuous maternal temperature monitor, which we are now planning to update to be a temperature + pulse rate monitor) and finalizing our solution to begin prototyping in the coming weeks. However, after some reflection, I also noticed that many of last week’s events had an underlying running theme: women’s empowerment.
It first started when Dr. Veronica Leautaud (our Rice 360 mom, who we lovingly refer to as Dr. L), the Rice 360 Director of Education, flew in from Rice and came to visit us at the Poly design studio on Wednesday. Dr. L is one of those people that immediately embraces everyone with open arms, and makes you believe you can achieve anything you set your mind to. She has a powerful presence. At the poly, each team got to pitch our final solutions to her in a short 3-minute presentation and hear her thoughts. She was able to give each team real, constructive feedback while remaining unwavering in her support for our ideas, no matter how far-fetched they might have been. She reminded me that being a woman in engineering means more than just demonstrating technical expertise; it means lifting people up through love and positivity.
All the interns with Dr. L when she visited the Poly!
Later that day, I got to watch as Karen Turney, the Rice 360 Director of Development, filled the design studio with a sense of excitement and curiosity. Karen is energetic and encouraging, but most importantly she has a seemingly insatiable curiosity and is an expert at getting anyone to open up about their passions and life goals. I couldn’t help but watch in wonder as she made her way across the room, talking to every single intern in the studio, asking them questions about everything: from family life to hobbies to long-term goals. She makes everyone feel important, like we all have our very own unique story to share with the world. And although she is not an engineer, she reminded me that being a woman in engineering means being unafraid to ask the “silly” questions and taking the time to learn from and grow with your peers.
On Friday, Mrs. Juliana Nyasulu Masi, a lecturer at the Poly, brought in around 20 bright-eyed 1st year students (1st year = 9th grade in the US) to the design studio. While the students walked around excitedly watching interns use 3-D printers, laser cutters, and Arduino circuits, I got the chance to talk to Juliana about her experience being a female lecturer at the Poly. I only spoke to her for a few minutes, but it was enough time to see just how passionate she was, not only about her subject (she teaches C++ at the Poly), but also about inspiring and recruiting the next generation of engineers. I didn’t get the chance to ask for exact numbers, but I’m almost certain she was one of very few women graduating with her degree, and one of even fewer women lecturing a programming course at the Poly. She reminded me that being a woman in engineering means paving the way, not just for yourself, but for all young girls who dream of being an engineer when they grow up.
1st year students visiting the design studio (everyone was so excited to watch the laser cutter do it’s magic!!)
On Saturday, my amazing teammate Christina invited all the interns to a Biomedical Engineering Student Society (BESS) event that she helped organize. Christina, a Biomedical Engineering student at the Poly, is the Diploma Representative of BESS. The event was a great success: it had project presentations from current Biomedical Engineering students, a fun and interactive engineering-themed quiz competition, and an awards ceremony for the best performing students – all tied together by a talented DJ who periodically mixed music to keep the room entertained. As I looked around, I quickly noticed that I could count the number of women in the room on my two hands. Still, it was so humbling to be surrounded by so much talent (including the first ever graduating class of Biomedical Engineers at the Poly!!). Christina, the only woman on the BESS board of representatives, managed the event with so much grace and confidence. She reminded me that being a woman in engineering means being unapologetically confident in yourself and not shying away from the spotlight.
My teammate Christina speaking at the BESS event she helped organize
Finally, I want to thank my fellow interns, the people who I have already learned so much from and who continue to inspire me every single day. Of the 7 Rice interns, 6 of us are girls. We are still learning what it means to be women in engineering and other healthcare-related industries, and how we can speak up to support other women trying to enter similar fields. They remind me that being a woman in engineering means learning through trial & error and taking your time to find your place and your voice.
As a woman in engineering, I’ve always been aware of how lucky I am to be surrounded by powerful, intelligent women who inspire me to follow my dreams. I’ve also always been aware of the odds against me. The odds against all the women around me. If there’s one thing that this week reminded me, it’s this: I’m here, in Malawi, working on meaningful and impactful engineering projects, and I’m going to defy the odds.
***completely unrelated bonus content***
Continuing our tradition of eating icecream at Mikos for lunch every Friday. Special shoutout to Alex (he may not be a woman in engineering, but we love him regardless!!) All the Rice + DIT interns after our safari this weekend at the Majete Wildlife Reserve
Going into our first week of work, I felt excited and a little nervous for what was to come. I wasn’t sure how the technologies we brought over from Rice would be received or what to expect from the hospital visits. I wasn’t sure I would like the food (I’m usually a pretty picky eater) or if I would click with the Malawi interns in the same way that I have with the Tanzania interns. So many questions but not much time to worry about them…
June 10th, Monday – Anything is possible!
Our first day at the Poly began with a warm welcome from the Polytechnic’s Dean of Engineering and a few presentations on the engineering design process and human-centered design. We also had mini brainstorming session: we had to write down as many uses we could think of for bricks. After a minute of frantically scribbling down uses, we shared our ideas with everyone. Some of my favorites were “a giant game of Jenga” and “a SUPER effective paperweight”. This small activity reminded me why I love engineering so much. No idea is a bad idea. Anything is possible!! I’m going to try my best to carry this mindset with me as we start brainstorming for our main projects.
Later in the day we each presented the technologies that we brought from Rice to the rest of the interns and administration at the Poly and it was so nice to hear everyone’s thoughts and feedback on our projects. We ended the day with a design challenge where each team had 2 hours to create a contraption that would allow a ping pong ball to fall to the floor from a height of 1m in no more than and no less than 30 seconds. My team tried to make a kind of maze that the ball could fall through for 30 seconds before hitting the ground. Ultimately our ball fell in 5 seconds, but I think we deserve an A for effort. It was really good to get our ~creative juices~ flowing and get to know some of the other interns.
All the Rice + DIT + Poly + MUST interns ready to start work!
June 11th, Tuesday – Learning
Tuesday was dedicated to refreshing our knowledge on essential engineering design skills like Arduino, SolidWorks, 3-D printing, and laser cutting. Since I was already familiar with the basics of Arduino and laser cutting, I spent most of my time learning how to CAD on SolidWorks from Hillary (our internship coordinator at Poly). Our mini-project was to design and assemble a functional syringe. I’m so excited to see how all these new skills will translate into prototyping when we start work on our main projects.
The outer and inner parts of the syringe I designed on SolidWorks
Later that day, Hillary sent us our team and project assignments so we could begin preparing for hospital visits. I’ll be working on a continuous maternal temperature monitoring device with Joel (DIT), Boniface (MUST), and Christina (Poly).
June 12th, Wednesday & June 13th, Thursday – Hospital Visits
Wednesday and Thursday were probably the most eye-opening days of this week, and the inspiration for this blog’s title – Looking Closer. We went to Mulanje District Hospital and Zomba Central Hospital where we visited the nursery, high-risk ward, kangaroo ward, labor ward, and Physical Assets Management. The nurses we talked to were so experienced and knowledgeable, and their dedication is so admirable. It was amazing to see the things they achieve with the limited resources they have. Getting to actually walk in to the different wards, I started to look closer at all the ways nurses “improvise” when they don’t have something you might easily find in a high-resource hospital. One sight that stuck out to me in particular was a make-shift wheelchair made using a common plastic chair and some wheels tied on with rope. The high-risk ward was a small, hot room (the whole room is kept at a high temperature for the premature, hypothermic babies since there are no incubators in use) with radiant warmers lined up against one wall. Each warmer (meant for 1 baby) fit 2-3 babies and had a single patient monitoring system with a temperature probe, which meant all 3 babies could not be monitored at once. Still, the nurses did everything they could to make sure all the babies got the attention they needed. Through all my observations, it was clear that there is no lack of creativity, dedication, or intelligence in these hospitals, simply a lack of resources.
Broken Multi-Parameter Patient Monitor, my team hopes to create an affordable, wearable version of this device.
Listed below are some of my main takeaways from both visits:
Lack of nurses – Often times, the neonatal ward has around 20-30 babies but only 3-4 nurses. The labor wards get approximately 20 deliveries per day, but only 2-3 nurses to look after the mothers. Because of this, nurses are usually more preoccupied caring for the large number of high-risk premature babies being born and mothers may end up going unmonitored for certain periods of time.
Thermometers are limited and break often – The labor wards usually have only a couple of thermometers to monitor all the mothers’ temperatures regularly. In Zomba, the labor ward had NO thermometers. This left nurses relying on using their hands to check whether a mother has a fever. There is definitely a need for continuous monitors to help nurses quickly monitor all patients.
Donateddevices aren’t always useful – most of the devices we saw (incubators, oxygen concentrators, suction machines, etc.) were either broken or not being used. Donations come from many different manufacturers, often without manuals, and nurses don’t have the time to learn to use these new devices from scratch. Instead, nurses become comfortable relying on their experience and intuition and their clever “improvisations”.
Hospitals are focusing on educational material – In both hospitals, the hallways were decorated with colorful signs and depictions to educate people about things like the importance of STI testing and breastfeeding. I found this to be an interesting contrast to the clinical white walls in most American hospitals.
Broken oxygen concentrators, suction machines, radiant warmers, patient monitors, and ultrasound machines in Physical Assets Management a.k.a the “equipment graveyard”
As a bonus, on the way out of Mulanje District Hospital, we got to see Mount Mulanje and it was so tall that the peak hid from our view behind clouds. Shadé, Alex, Liseth and I are determined to climb it – hopefully we can convince the others to come with us!
June 14th, Friday – Common Ground
On Friday we worked with our teams to compile all our findings from the hospital visits and give a short presentation to the rest of the interns and staff about what we learned. This was the first time I got to work with my whole team, and we had so much fun getting to know each other while also being productive! We ended up talking about the similarities between South African weddings and Indian weddings and it reminded me that although we all come from different places, there is so much we have in common.
June 15th, Saturday & June 16th, Sunday – Good Food and Good Company
This weekend we visited a local market to put our bargaining skills to the test (we weren’t very successful…), cooked some good meals, and spent quality time watching the latest episodes of Black Mirror together.
Trying Nsima (staple food in Malawi) at Pamudzi, an authentic Malawian restaurant. Everything tasted so good!
Ending the week, all my initial worries have vanished. Our technologies from Rice were received well, the hospital visits were educational and inspiring, and I love the food here. I’m already starting to get to know my team and we are beginning to form a good team dynamic to start working on our project. Get ready for some serious brainstorming sessions next week!!
Hello everyone! Although its only been 1 week, I have a ton of new experiences to share. In the Rice 360° office at Queen Elizabeth, Liseth and I have begun compiling the introduction and methods section for our reports concerning the use environment of the maternity and neonatal wards. We are currently awaiting permission to have full-time observational access, but we have been able to tour both wards and ask some questions about the day-to-day flow of the areas. While touring, we paid special attention the use of oxygen concentrator machines and incubators. We gained a much deeper understanding of how both of these technologies functioned specifically within the wards. The neonatal ward had many incubators, but they were off to the side and not in use. Through chatting with a nurse, we discovered that these incubators mainly serve for transportation of the babies to and from different wards, as some of the display interfaces of the incubator machines are very complex. As for the oxygen concentrators, we learned that it was difficult to determine whether or not a machine was outputting the correct oxygen levels for a patient. There were a number of oxygen concentrators around where the functionality of the machine was unknown.
The incubators at Queen Elizabeth Hospital. One of my goals while here is to assess the usability of the Rice 360 Incubaby prototype-a new low-cost neonatal incubator.
Incubators seemed to not be in use at Mulanje District Hospital and Zomba Central Hospital as well. In the middle of the week, we took visits to these hospitals within Malawi to tour the neonatal and maternity wards and ask more questions about operations. We learned that Mulanje District Hospital had no incubators at all and instead relied on skin-to-skin contact via Kangaroo Mother Care or radiant warmers to warm up cold neonates. At Zomba Central, radiant warmers were also the preferred heating technology. Speaking to nurses at these hospitals about some of the challenges they faced while on the job was extremely revealing. Many helpful insights came about by asking the nurses what they had to improvise around the ward due to lack of resources. It was incredibly eye-opening to see the unique ways in which the nurses work with what they have in order to care for their patients. The most substantial observation that stuck with me this week was how continuous monitoring systems were rare or nonexistent in these hospitals. This is something that I have never thought about before, as when I envision a hospital, I automatically picture a patient hooked up to machines that are constantly recording and measuring patient vitals. The only ward that had a multi-parameter patient monitor was at Zomba Central. They have 1 machine for the neonatal ward, a ward that can have up to 40 newborns at one time. When it comes to assessing measures such as blood pressure, pulse, heart rate, and temperature, consistent monitoring can make a drastic difference in health outcomes.
Our visit to Mulanje District Hospital-unfortunately Liseth and I missed the group picture 🙁Mulanje District Hospital is right beside Mount Mulanje-the tallest mountain in Malawi with a height of 3000 meters!
Liseth and I are continuing our work with documenting the use environment of Queen Elizabeth this week and we are preparing to conduct our structured interviews with nurses about the Rice 360° Incubaby prototype. Incubaby is a double-walled incubator for neonates that automatically regulates to maintain a baby’s temperature. The prototypes will be arriving at Queen Elizabeth next week and we will be conducting interviews about the device with nurses to assess the usability of the device and identify areas of improvement. We also look forward to joining the other interns stationed at Malawi Polytechnic as they tour Queen Elizabeth hospital this week. This will give us more chances to learn in-depth information about the technologies implemented in the maternity and neonatal wards. Overall, it has been very cool to think about how machines and equipment actually work within their clinical setting from a Human Factors’ perspective. We really hope the information we are gathering will help Rice 360° develop systems that are appropriate and optimized for use in these hospitals so they can make a real difference in patient care. Thanks for reading and I’ll check in again soon!
Me, having a traditional Malawian meal of chicken, mustard greens, and nsima.On Sunday, we visited one of Blantyre’s open air markets. There were so many colorful fruits and vegetables. When we asked where to buy chicken, we were led right to a coop with very much alive chickens! Can’t get any fresher than that!
June 10th (Monday): The Bumpy Road to Implementation
This was my first day working in the Rice 360 CPAP Office! The Appropriate Design for Global Health (GLHT 360) course drilled in my head that the engineering design process is long and arduous, especially the implementation phase and even more so in the field of global health. However, I don’t think I truly conceptualized exactly how long and arduous this process is until today when reading previous monitoring reports for the implementation of the PUMANI bCPAP device, considered one of the most established Rice 360 technologies.
So I was surprised when I read that some hospitals were still (or as recently as 2017—the most recent report I saw) hesitant to begin using the devices after being given them and that every once in a while, for a couple of hospitals, the CPAP mortality rate increased instead of decreased between quarters or between the same quarter in multiple years. That’s not to say there haven’t been major improvements in CPAP adoption (there have—more nurses allocated to the nursery wing, more reliable backup generators, etc), and obviously I don’t have the full scope of information about CPAP implementation. Nevertheless, I was so surprised by how challenging the implementation process still is despite the long journey its already taken, and I think I finally began to grasp what it what actually take to turn any of the projects we worked on to a device that could reach its full potential for social impact.
The Rice 360 CPAP office at QECH
June 11th (Tuesday): What About the Glucometers?
At the CPAP office today, I worked on entering information from a set of forms regarding the conditions of nursery wards in various hospitals throughout the country into an excel spreadsheet. To further explain, national supervisors (selected clinicians from other parts of the country) visit other hospitals and report on various aspects of the nursery ward to help them make improvements. One of the sections in Essential Equipment and Supplies (EES), and the list of supplies included lots of things I was somewhat familiar with—phototherapy lights, CPAP machines, radiant warmers, etc—but also a device I did not expect at all: glucometers. I was puzzled—I had always associated glucometers with the monitoring and treatment of diabetes not neonatal care. So what were they doing on the list of EES? Furthermore, I remembered reading some monitoring reports listing the lack of glucometers as a primary challenge in the neonatal ward of many hospitals.
Later this evening, out of curiosity, I did a little research online on the use of glucometers in neonatal contexts and found some interesting information: Hypoglycemia (low blood sugar) is a major issue for neonates, especially for those with low birthweight (affecting 45% of neonates in the NICU according to one review). And glucometers are more adapted to use in adults with diabetes than neonates with hypoglycemia but are commonly used to make clinical decisions since other methods of glucose detection either take too long (laboratory methods) or are too invasive for infants (continuous monitoring). I think a low cost method for glucose level detection in infants could be a possible project idea to bring back to Rice 360 (though I suspect it may have already been proposed in the past) and will definitely look into it further this summer as we get more opportunities to talk to doctors and nurses here!
(Source: Woo, Hyung & Tolosa, Leah & El-Metwally, Dina & Viscardi, Rose. (2013). Glucose monitoring in neonates: Need for accurate and non-invasive methods. Archives of disease in childhood. Fetal and neonatal edition. 99. 10.1136/archdischild-2013-304682.)
June 12th (Wednesday): New Perspectives, Old Project
I went with the Polytechnic interns to do a site visit at the Zomba Central Hospital today. As I mentioned in a previous blog, one of the projects that the interns at Poly are working on this summer is the continuation and extension of the Ballard Score training model, and I unofficially became part of the team that is continuing that project! We spoke to nurses in the neonatal and maternity ward of the hospital, and we learned lots of unexpected information. It was super interesting to basically repeat the interview portion of the research process my team did at the beginning of the GLHT 360 course but from an entirely different perspective. During the semester, almost all of the information we received was from a clinician’s perspective and mostly from a clinician in a very high resource setting at that.
We found out that while we had previously had been given the impression that only clinicians were trained in the Ballard Score and, in the U.S., actual familiarity with it was generally limited to clinicians in relevant specializations (neonatology, pediatrics, etc), all of the nurses we spoke to at Zomba told us they learned about in nursing school. (Though it seems that only the nursery ward doctors actually used it—well, only parts of it due to its time intensiveness.)
Front of Zomba Central Hospital
June 13th (Thursday): More Perspectives and More Info
This was the second day of site visits (this time to Mulanje District Hospital) to ask questions about our projects, and it was every bit as informative as the first! I had a brief meeting with the new Ballard Score team, and we came up with a second set of questions based on the answers we received yesterday. One of the interesting discrepancies that came up was that while the nurses we spoke to in the neonatal ward at Zomba yesterday were familiar with the Ballard Score, the other half of the team that went to Mulanje yesterday were told by nurses that they had only vaguely heard of it.
I had originally cast it off as a matter of individual differences, but Rodrick—a member of our team who was a lot more familiar with the Malawi health system (he was previously a data clerk at a health center and has several friends in nursing school) brought it up that it might be a difference in the level of education that the nurses at the two hospitals receive. Since none of his friends, who were in diploma level programs for nursing, had never heard of the Ballard Score, he suspected that degree level nurses may be trained in it while diploma level students may not. Also, because there is only one nursing school in Malawi that offers a degree level program, he said it is very possible that all of those nurses were assigned to central hospitals such as Zomba.
When following up on this question with the nurses at Mulanje today, our suspicions were likely confirmed since the nurse we spoke to said none of the nurses there had been trained in the Ballard Score and had only heard it mentioned in passing by the clinicians. This is when I realized the importance of having individuals of different backgrounds on an engineering team and, in this case, having members who were familiar with the local context. If it weren’t for Rodrick, I don’t think we would have discovered this key fact that will no doubt influence since of our decisions.
Me with a group of interns from the Polytechnic in front of Mulanje District HospitalOne of many signs promoting breastfeeding at Mulanje District Hospital
June 14th (Friday): Back to CPAP Office!
I finally was able to meet Sara, who will be my boss at the CPAP office, today and got a better perspective of what I will be doing for the next several weeks: helping with data entry and analysis for CPAP monitoring data, reading and helping with the qualitative reports, and maybe having the opportunity to observe in the Malaria Alert Center and/or Wellcome Trust Center (I’m really passionate about infectious diseases!) if everything works out.
I spent most of the day making charts to analyze the final diagnosis of neonates put on CPAP for the last quarter and the time of death for CPAP patients. It was super cool to put a little bit of the information I learned from my Statistics for Biosciences course last semester to use on actual data (though the statistical program the CPAP office uses and the one I learned are different—definitely plan on learning a little bit of Stata.)
Overall, this week has been filled with amazing opportunities to see and apply to the lessons—practical and technical—I’ve learned to the real world. It’s one thing to learn about the importance of implementation, different perspectives, and diverse collaborations through textbooks and readings and another to see this unfold before my eyes.
More Fun Photos from this Week:
Me with Polytechnic interns during brief stop at Chancellor’s College–the oldest and largest college of the University of Malawi system–near Zomba Central HospitalBeautiful view from brief stop at Mount Mulanje River Park after site visit at Mulanje District Hospital
Bubble waffle ice cream for lunch on Friday!
Authentic Malawi food from Pamudze–translates to “Our Village”
Every morning starts with a 15 minute bus ride from Kabula to Queen Elizabeth Central Hospital, where all 11 interns and several other doctors and students from the lodge crowd intoa van the size of the Mystery Machine (I’ve thought really hard and this is the best description I can come up with). From the hospital, we then walk along the busy streets of Blantyre to the campus of the Polytechnic…
June 10th – First Day at the Poly
After receiving a warm welcome from the Dean of Engineering, we split up into teams for a mini design challenge: make a ping pong ball take exactly 30 seconds to fall a height of one meter. The activity was surprisingly difficult, with even the most successful of teams only able to reach a fall time of 15 seconds. Overall, the activity provided a preview of what the next 6 weeks might look like – building off of each other’s creativity with a limited amount of resources, ultimately getting one step closer to a solution.
After lunch, we were given an overview of the engineering design process by Dr. Ng’anjo. I recognized his face from when he taught some lessons in my engineering design course back at Rice, and he recognized me as well! It was cool to talk to him again and be a part of his lecture. Before hand, our table was talking with him and somehow the topic of food came up. Having visited all of our countries, he made the claim that the staple of Malawian food is nsima, Tanzanians love their maize, and Americans put cheese on everything! I hadn’t really noticed this before, but it really is true… over lunch I had shared with everyone my favorite snack from back home: Cheez-Its.
We also got the chance to share the some of the work we had been doing prior to arrival in Malawi. Here, Shadé and I are presenting prototypes of the Clean Machine, IV Drip Lock, and phototherapy masks.
June 11th – Tackling Arduino and Project Assignments
The world of computer programming and electrical engineering has always been super intimidating to me. Having not taken any classes in these fields yet, this was one of my main insecurities heading into the internship. But coming out of this morning, I felt like I had the knowledge and skillsets to approach any of the design challenges we may face in the next few weeks. Andrew, a lecturer at the Poly, had lead us in a hands-on workshop where we learned the basics of manipulating an Arduino and writing C++ code. While it may sound simple, I found the process of creating a flickering lightbulb so rewarding that I now feel excited to jump into this once-intimidating field.
Later in the day, we were given our main project assignments and developed questions to ask nurses on our hospital visits. Racheal, Betty, Rodrick and I will be working on the developing a Ballard Score training model to help nurses better identify the degree of prematurity for newborn babies.
June 12th – Mulanje District Hospital
On our first hospital visit, Betty and I joined the group traveling to Mulanje District Hospital. The drive was beautiful, filled with jagged mountains and the rolling hills of tea plantations. Not until we arrived at the hospital did we realize the sheer size of Mount Mulanje. The tallest points disappeared into the clouds and its width seemed to span on and on for miles – I still want to try and climb it, but we’ll see if that ends up happening.
None of the pictures I took truly do the mountain justice… soooo huge
Once inside the hospital we visited the maternity ward, where we met a nurse who had the time to answer some of our questions. We soon learned that the nurses were trained in the Ballard Score, but do not frequently use the signs in their day to day practice. The Ballard Score is also never performed in its entirety, and the chart itself is never used to calculate a final score for prematurity. This is because the full assessment takes 15-20 minutes to complete, and with as many as 20 babies being delivered per day, the understaffed nursing team is short on time. Instead of Ballard Score, they primarily use weight for determining whether or not a newborn is premature. This can be dangerous because weight is not a reliable measure of gestational age.
Overall, this hospital visit was a little discouraging. With only one nurse and so many teams asking questions, I sensed that we weren’t getting the full picture. It would have been nice to talk to more nurses and gather more perspectives, but their time is valuable. Ultimately, it is more important that their time be spent providing such critical care to their patients.
June 13th – Zomba Central Hospital
Our visit to Zomba began with a trip to the nursery, where we met three nurses who seemed excited to see us and willing to share their experiences. In comparison to Mulanje, these nurses described routinely using many physical signs of the Ballard Score but rarely ever any neuromuscular procedures. They even showed us a paper with the full assessment chart, but similar to Mulanje, a full Ballard Score is never calculated.
One of the most interesting responses we got from the nurses came when we asked why this was. Like at Mulanje, the nurses cited time as a major constraint, but they also spoke to an instinct they had developed after years and years of working in the hospital. When asked to elaborate on what this instinct was, the nurses ended up describing several of the physical signs of the Ballard Score: skin, lanugo, and breast specifically.
June 14th – Ice Cream for Lunch
Back at the Poly, all of the project teams met up and compiled their findings. Being that Racheal and Rodrick visited the two hospitals on different days than Betty and I, each of us had unique information obtained by asking different questions and interviewing different nurses. Going over it all, we began to find a direction for the rest of our project…
Everywhere we visited, the nurses believed there was not enough time to perform a full assessment. The goal of this project should be incremental change. If we can add one more Ballard Score sign to a nurse’s skillset, their estimate of prematurity will improve in accuracy.
Nurses find the current Ballard Score chart difficult to use and too tedious to fill out, instead, relying on their experience to estimate prematurity. An essential part of this project will also be helping nurses precisely match the physical signs they already use to specific degrees of prematurity.
If you made it to the end of this long blog post, thank you so much for reading! As a bonus, here’s some pictures of the amazing food we had on the last day of a busy week…
Ice cream for lunch at Miko’s Dessert Shop – a warm and fresh waffle cone filled with creamy soft serve and apple pie toppings + Nimisha being jealousDinner at Pamudzi – I tried nsima for the first time with an assortment of leaves and beef stew… so good, even though I was laughed at for missing my face while eating with my hands 🙂
Similarly to the way this week went, I’m going to start this week’s blog by diving right into the details.
The first two days were focused on introductions and skills. We got lectures on the Engineering Design Process and Human Centered Design, and we broke into small teams to do a short, fun design challenge! This was my first time truly experiencing how clever and driven all these other interns are. They had ideas I could have never fathomed, and the whole experience was a lot of fun. On day two, we broke into groups to learn some skills we might need for prototyping. One group spent time learning about CAD and 3D printing, meanwhile I was in the group learning about Arduino and electronic prototyping. This might sound a little silly but as Andrew walked around and around our table explaining how microcontrollers work and how they fit in the context of an Arduino board, I could feel something that in that moment I could only describe as magic. I could feel everyone around me learning and growing and I could feel myself learning and growing alongside them and it was, just, magical.
This is the circuit we made to practice using an Arduino! We programmed it such that we could use a potentiometer to control the brightness of an LED.
Interns learning how to use the laser cutter!
Later that day, we got assigned our project teams! I’m on Team Suction and we’re working on a training model for nurses to practice the neonatal airway suction procedure on. My teammates are Nana from Dar Es Salaam Institute of Technology (DIT) in Tanzania, Foster from Malawi University of Science and Technology (MUST), and Chisomo from Malawi Polytechnic University (Poly). They’re all lovely and I’m excited to get to know them more during the course of this project.
This is a neonatal suctioning machine at Zomba Hospital. Basically, sometimes babies are born with their airways full of amniotic fluid, which makes them unable to take their first breath. When this happens, a nurse puts a few centimeters of a tiny suctioning tube through their nose or mouth and down into their trachea. The suctioning machine creates pressure that removes the fluid and allows the baby to breathe! Team Suction has been tasked to create a training model so nurses in school can practice this technique more before they begin working in the hospital setting.
Before this internship, I’d worked on four different design projects during my four semesters at Rice, but I’ve never had the opportunity to immerse myself as fully in a problem space as I did this week during our hospital visits. After being assigned to our teams on Tuesday, we were given the opportunity to spend Wednesday and Thursday at Mulanje District Hospital and Zomba Central Hospital. These visits really accelerated the first few steps of the Engineering Design Process, as we were able to speak to the users themselves in the environments where they would be using our technologies. In a span of 48 hours I went from never even having heard of neonatal airway suction to having heard five different nurses from three different hospital wards explain to me the procedures and common complications. It took weeks of research at Rice last semester to get this much information about OxyMon’s problem space, and we were able to accomplish this all in only two days thanks to these hospital visits.
Speaking of OxyMon, I was able to utilize these hospital visits to get some information about oxygen concentrators to bring back to my team as we continue our work next semester. After having spent months researching the ways these concentrators are used and maintained in hospital settings in Malawi and working on prototype after prototype, it was the opportunity of a lifetime to witness the problem space and user environment live and in person. I was able to take pictures of concentrators being used in neonatal wards at Mulanje and Zomba, and I finally found out what types of splitters actually get used to connect patients (something that has been a pressing mystery to my team for many weeks). The most interesting part was our visits to the hospitals’ Physical Assets Management wards, or PAM for short. This is where technicians take broken devices to be fixed and where unfixable devices go to sit in what Rice 360 likes to call equipment graveyards. Dr. Bond talked to us about equipment graveyards at the very beginning of class last semester, and I’m having a hard time believing that I went from looking at pictures of broken equipment on a projector screen in the BRC in January to actually physically being here in Malawi, being the one taking the pictures myself. I won’t go into too many more details here in this blog, even though I’d love to write a whole report on my findings from this week (Nimisha keeps making fun of me, because apparently all I talk about are oxygen concentrators. I’ll spare you the same suffering she’s undergone as my roommate, listening to me talk about oxygen concentrators every day). Stay tuned for new iterations of OxyMon next semester, better than ever thanks to my time spent in Malawi!
This is a photo I took of the “equipment graveyard” at the Physical Assets Management of Zomba Hospital. Pictured are many broken oxygen concentrators and other broken devices. We were told that most of the broken ones that had been sitting there for awhile were older and stranger models that had more difficult-to-replace parts.
An oxygen concentrator I found being used in Zomba Hospital! (tiny baby attached but not pictured)
One of the two types flow splitters I observed, used to connect multiple patients to a concentrator. This will be useful information for my team next semester as we determine how OxyMon would be connected to a concentrator.
Me looking super happy after gaining a lot of information from the man working at Physical Assets Management in the hospital
Even though we’re done visiting Mulanje and Zomba hospitals, we are extraordinarily lucky to be positioned down the street from the Queen Elizabeth Central Hospital (QECH, or Queens). Our teams have access to Queens for the next several weeks as we begin prototyping, so we’ll be able to get all the necessary feedback. Next week, we plan to write a proposal of design criteria and present to nurses at Queens on Wednesday to ensure that we begin these projects with the correct direction in mind. For Team Suction specifically, we intend to find out exactly which difficulties of the suctioning procedure to focus our training model on.
Of course, we’ve being doing fun-stuff and life-stuff on top of immersing ourselves in our first week at work! Between the 11 of us living here at Kabula, we’ve split ourselves into mini teams to rotate the responsibility of cooking for our whole group each night. It feels like we’re having a big, family dinner every night on the deck at the lodge, and it’s a blessing to be growing closer to my fellow interns each week. My mini cooking-team made tacos last week. We persevered through a fridge that accidentally froze all our vegetables and the fact that all taco shells here are imported and unreasonably expensive compared to other foods. It ended up being a pretty successful meal for 11, all things considered!
We were also able to stop by a lodge at the bottom of Mount Mulanje on our way home from Mulanje Hospital. Some of the Malawian interns told us that some people believe spirits live at the top of the mountain. Apparently there’s a particular area on the mountain that people say not to hike under any circumstances whatsoever in order to avoid being taken by the spirits – people who go there tend not to come back. On the drive back, I saw that the top of the mountain was hidden by an eerie cloak of fog, and I could totally understand how one might feel that the top of the mountain might be home to malevolent supernatural beings.
Week one was truly a headfirst dive into life in Malawi and work during this internship. From meeting our teams to hospital visits to figuring out how to cook for 11 people every night, I feel so lucky to be learning and growing alongside so many wonderful, bright, caring young people.
BONUS PICTURE of what happens when the communal fridge gets too cold and all your vegetables freeze on taco night so you have to heat them up on a half-functioning stove 🙂
