Monkey engineering

Today was a bit of a different day here, a day where I had to get my hands “dirty” and try out some true field engineering.

One of the projects I helped with in the past was an intravenous fluid pump delivery system for pediatric patients. Often, hospitals will only receive large, adult-sized (1000 mL) IV bags. The problem is that many, many patients who require IVs are children. When children become dehydrated, which is especially common because of diarrheal disease, they often need to be treated with IV fluids. However, there is a precise formula that must be followed, because overhydration (administering too much fluid) is just as dangerous as dehydration. In the US and other developed countries, we have complex cut-off mechanisms using electronics that ensure that pediatric patients don’t receive too much fluid. The cut-off allows the doctor to administer only 200 mL of a 1000 mL bag, for instance, to a baby. However, in some places around the world, these electronics are not available. In such places, the only way to ensure that a patient doesn’t receive too much fluid is to carefully monitor the IV bag and manually cut off the flow. 

So back to the story- after our work in Malawi last year, Dr. Muelenaer has been using this a great teaching project for an incredible group of high school students from Roanoke County. He challenged them to develop a mechanical solution for cutting off fluid flow of IV bags. This year, they worked to create version III of the device, and they had a great time doing it. They took ownership and really made it their own. So my job today was to assemble the device for them, take some pictures, and see how it worked (and if it still worked after the pieces were thrown around a plane for 17 hours). 

So today, I got to get out my tools and give this a go. It’s nice to work with my hands and have time to think. But the best part of working on this today was being outside all day! As you can see from the picture, the flora is just beautiful. All day, the birds tweeted sweetly and kept me company. Also, Dr. Penny was pediatrician of the year and jumped elbows deep into the engineering project. I was so impressed. We were two women on a mission.

As the afternoon went on, I kept hearing this loud noises in the trees around me- it sounded like maybe the branches were going to fall. Finally, the noises got so loud that I stood up, put down the tools, and thought to myself “those have got to be some big birds in that tree!”. I walked out of the patio area where I was working to get a closer look, and to my surprise, there was a family of monkeys! Between 12-15, I would say. I was just elated. I ran back to grab Dr. Penny (and also my camera!) and snapped some awesome pictures of these little guys. They were hungry and looking for food!

And this is where the story gets really entertaining. Dr. Penny had run in to get a banana to feed them while I snapped pictures. She came outside, threw the banana- and then we had a riot. Actually, it was a bit terrifying, even though they are much smaller than us and amazing adorable. Instinctively Dr. Penny grabbed my arm and ran towards the door- “I think we’d better get inside NOW”, she said. So we ran inside and shut the door as fast as we could. 

Then, the monkeys became very interested in the IV pump. They circled around in for a good ten minutes, eyeing it as if to say, “what is this strange creature?” This picture cracks me up because it is the epitome of field engineering- interrupted by a band of monkeys!

The rest of testing the high school team’s IV device design will have to wait until another day, because the monkeys hung around the device until dark. I have to say, I’m not too disappointed- these memories (and pictures!) will make me laugh for a lifetime!

Happy Birthday Sissy!

Happy Birthday to my Aunt Sissy!

Last night, I taped a piece of paper (with bright pink duck tape- so fun!) to my mirror so that I wouldn't forget to wish Sissy a happy birthday first thing this morning. When I saw my friend Gift this morning, I told her it was one of my family member's birthday back home. She said that if Sissy was here, she would make her favorite food because that is the Malawian way. I told her that we do the same thing back home! It's comforting to know that everywhere, family is family. On birthdays, we celebrate family for the unique and special people they are! So today, I celebrate Sissy, who is hilarious, vibrant, generous, kind, and honest. Thank you for all that you do, Sissy! I love you!

Marching and the Universal Language

In Malawi, everyone is incredibly friendly. I’m not exaggerating. This country- nick-named by the world as the “warm heart of Africa” must be the friendliest place on earth. I do believe just being in this vibrant place could thaw even the coldest of hearts.

A picture from our vehicle window. Breathtaking beauty.

Chichewa is the local language here. It is a lovely, joyful language, but boy do we make ourselves look silly trying to speak it. Still, we try, and through the enduring patience of our sweet Chichewa-speaking friends, we are getting better. We keep trying, put aside our pride and passionately vowing to build genuine relationships with our friends in Malawi. Many times, these relationships may begin with Chichewa.

And so, we practice. In the streets, we wave and strike up conversations. Confession: I always try to talk to the kids, who I know will tolerate my imperfect Chichewa (and get such a kick out of it! I love their giggles!).

“Muli bwanji?”

“Tidi bwino, kainu?”

“Ah, tidi bwino, zikomo.”

“Zikomo kwambiri.”

“Duandani?”

“Ine dine Bridgette.”

“Hi, Bridgette! Ine dine Ashley.”

In the hospitals, we are lucky that the doctors and nurses all speak English. Still, we offer a simply greeting in Chichewa to try to show that we aren’t arrogant people who only want to do things our way. We want to understand, to work together. We want to speak the same language both metaphorically and literally. It is inadequate to simply and clumsily stumble through a few phrases of the local language. But it is something. Chichewa is something, so we try.

As we walk through the hospital with the brilliant nurses and physicians, it feels strange and impolite not to speak to the patients at the hospital, we I awkwardly mutter “how are you?”

“Muli bwanji?”

“Muli bwanji?”

“Muli bwanji?”

This feels slightly strange, too- to ask only at surface level how a patient is doing. But it does seem better than coldly ignoring everyone. So again and again, Lauren, Dr. Penny, and I enthusiastically offer “muli bwanji?” as we walk through the corridors. A toddler runs through the hallway, burning energy I presume. “Muli bwanji?” I say to him, but he just throws his head back in laughter and runs even faster.

“Muli bwanji?” I start to say as I turn the corridor of the hospital, but immediately I regret my enthusiastic tone. Marching down the corridor towards me is a procession of people, dressed in white, and their faces are hauntingly somber. As they get closer, my brain frantically reels as I realize they are carrying a child on a stretcher, covered by a white sheet. They are slowing marching towards the mortuary.

Our kind host whispers somberly, “let’s step back”. We had been frozen in our tracks in disbelief. He bows his head and we do the same. I closed my eyes, partly to lift up a prayer, and partly, I am ashamed to say, because I couldn’t bear to look into the eyes of this child’s mother. But I didn’t need to have my eyes open to see her pain. I keenly felt the grief, the sorrow as she passed us by, wailing from the depths of her soul. “My baby, my baby”.

There are no words to offer- in English or Chichewa- so we all stay silent. Our leader, Dr. Penny, stops for a moment, tears streaming down her face. And I am angry at myself, because I am too filled with sorrow to even cry. No tears will fall. Instead, we keep marching on to our task in the hospital. And everything in me just wants to stop, to pause, to grieve with this precious momma whose child has just entered heaven’s gates.

There’s an amazing thing about communication between human beings: sometimes words aren’t needed. Sometimes words are even futile, like in this moment. I had focused so much the language of Chichewa- reciting things over and over in my head- in a desperate attempt to communicate. But now, the only part of me that can communicate is my heart. Heart to heart with this momma, with her family. And as the procession moves slowly in front of us, I close my eyes and muster every part of my energy on prayer. Prayer of the heart. I lift her up, this momma, knowing that God knows the cry of my heart without language, without words, and more importantly, He knit together her heart and hears her cry. All of us, I think, cry out to heaven not in Chichewa or English, but in a universal language that surpasses all understanding. I am quieted by this.

The funeral procession continues to march, and so we do the same. We march- toward hope, towards faith, towards a tomorrow that may be better than today.

The Market and the Bible

Yesterday was our first Sunday in the country, and it was a perfect day from start to finish. We started the day with what we thought would be a mundane breakfast of eggs, bananas, and toast- but boy were we in for a surprise when a family of monkeys (nearly 20!) arrived at our lodge in the morning. Quickly we realized they were our friends and not enemies, but the innocent façade quickly faded as they began to steal our bananas right from under our noses on our plates. I nearly had a heart attack when I felt a little hand on my leg and looked down to see a furry face swipe my banana- I still can’t believe this is real life! The lodge staff wasn’t nearly as endeared by our monkey friends as we were, so eventually they shooed them away. The monkeys got their bananas though, so I think they still accomplished their main mission! (Pictures to come soon- they are NOT camera shy ;)

After breakfast, we walked into town to go to church. No sooner after stepping around the corner and hearing the singing, I felt a warm flood wash over me and I was overcome with gratitude to be back in this place. I fought the tears as I entered the church, afraid that we (as visitors) might get called to the front. But this time, we slid in the back row to worship with our friends.

And worship we did. While we didn’t know all of the songs, some of the songs were old mountain hymns from back home in Virginia! We sang “Bringing in the Sheaves” which reminded me of my momma, and as we exited the church, we sang “this little light of mine”. There is nothing more powerful and humbling than singing hymns with brothers and sisters from around the world. I am always moved to tears just thinking about it because I just imagine that’s what heaven must be like.

Next, we stopped by the market to pick up a few necessities, like bottled water. Lauren had agreed to carry my wallet in her backpack, so I was only carrying my Bible in my hand. As we walked around the market, I kept noticing one man eye my Bible. We made eye contact, and I smiled, and he offered a genuine smile back. I could see that his face had been severely burned, perhaps when he was young, and I wondered what he may have endured. I wondered what his story was.

I walked over to the man. “Muli bwanji?”, I said, offering my best warm greeting in Chichewa. As we exchanged a bit of small talk, I noticed again that he looked longingly at my Bible.

“Duandani?”, I asked him, which means “what’s your name?”. He grinned and said “Paul!”.

I felt an unmistakable and distinct urge: give him the Bible. But instead, we exchanged some more small talk.

Again, I felt it in my heart. Give him the Bible.

For an awful fleeting second, I thought “I can’t give him this Bible. My sister gave it to me and it means so much to me.” I am so ashamed at my selfishness in that moment of thought.

And again, more strongly, I felt it, and I keenly felt the shame at my hesitation. Give him the Bible.

“Do you have a Bible?”, I asked Paul quietly. “No mam, he said, I’ve never had one.”

I reached out with the tan leather one I had in my hand. “Would you like this one?”

His eyes lit up, but then he shook his head. “No mam,” he said, “I cannot take that one, for that one is yours and you have brought it a long way.” With tears in my eyes, I told him I believed I brought it a long way for him. I told him that my sister gave it to me, and that it was very special to me, but that my sister would be so happy to know that he had it. He was so happy, and he asked me to write down my sister’s name so that he could carve something for her. He told me he would never sell it or lose it, and that when I come back to Malawi again (if I am so lucky, I thought to myself), he would show me the Bible.

Later that afternoon, I passed by the market again, and I saw Paul sitting in that same spot, reading that same Bible. And again, today, I happened to run into Paul. He told me that he had enjoyed reading in the book of John last night.

My new prayer is that I might be as hungry as Paul for truth and the Word. I will never forget that moment. And one thing is for sure- I was supposed to be exactly at that market, with Paul, at that precise moment- because my heart was forever shaped by Paul and his joy.

Medical Equipment- No More Graveyards!

One question that gets asked a lot at the breakfast table here in Malawi is “so what do you do? Why are you here?” I suppose it’s a perfectly reasonable question since no one arrives in Malawi by accident. With about 17 hours of flight time (that’s the easy part) and hours on dusty-red roads, folks that find themselves in Malawi are certain to have some sort of purpose. My team’s purpose here is to work on medical equipment in hospitals.

Traditionally, low and middle income countries have acquired medical devices through donations from charitable organizations. In 2013 when I first came to Malawi to assess medical devices for PMDI, I was shocked to see this:

Photo taken courtesy of Mr. Grycian Massa

This is what the local clinical staff call a “medical device graveyard”. I will never forget how my stomach sank the first time that I saw this. I still get sick to look at the tragedy- so many patients in so many hospitals who are waiting to be treated, so many doctors who need reliable equipment to do their jobs- but so much of the equipment ends up behind the hospital in the graveyard. Not only is this tragic for short term needs of patients and physicians, but long-term, these graveyards may pose significant risks to human health as well, if not managed properly. Many electronic components contain chemicals which can be dangerous to humans.

So, for the past few years, we’ve been trying to understand WHY this graveyards exist. What is it about this equipment that breaks? Why does the cycle of acquiring, using, and repairing medical equipment look like? And most importantly, how can we break the cycle of so much equipment ending up in medical device graveyards?

Our team has so much to learn, but we- with the gracious help of our colleagues in Malawi- are making progress. One of the biggest problems, we have learned, is the lack of spare parts to repair medical equipment. Think of medical device maintenance like maintaining your car- even if you drive the nicest, most robustly made Rolls-Royce in town, you still have to change the oil and replace the tires routinely. What happens if you can’t buy oil or tires anywhere in your country? The car eventually breaks down. The same thing happens to medical equipment in Malawi and other places- because the equipment isn’t manufactured from locally available resources, technicians aren’t able to maintain the equipment. Something as simple as a battery or rubber o-ring needing to be replaced could render a whole piece of equipment useless, if the part cannot be found locally (shipping things here is expensive!).

With this insight from our brilliant teammates in Malawi, we started to think about how to design equipment from locally available materials. Things like PVC, car springs, bike tires. Chitenjis, pumps. And most importantly, our team’s goal is to move away from the traditional model of dependency on medical device donations and move towards sustainable development, fabrication, and maintenance of devices here in Malawi.

This year, our boots-on-the-ground team is working on three main projects:

1.  Temperature Monitoring of Babies

With Cardinal Mechatronics, a company based in Blacksburg, VA, Lauren Cashman (who is such an amazing human, but that’s a different post) is working on a system that can wirelessly monitor temperatures of infants and malnourished children. One of the big problems in the hospitals is that nurses will need to monitor upwards of 30 babies at a single time. During the night, babies get very cold, and it is commonplace for several babies to pass away every night. This project is looking at how to send an alert to a nurse’s cell phone to triage babies/children who are getting too cold.

This is Lauren- she is awesome and the best roommate!

2.       MTB Device

Another problem in hospitals in low and middle income countries is a shortage of human resources. This shortage is keenly felt in laboratory settings, where time spent to screen for malaria, tuberculosis, parasites, and more on a microscope can take hours of the technician’s time. Dr. Penny Muelenaer and an amazing group of engineers (including Cardinal Mechatronics) are working on a system that uses a small, affordable computer to take pictures of slides and analyze the slides for the technicians, allowing them to spend time on other pressing problems. While I’m not part of the design process for this project, I’m honored to be the engineer on the ground demo-ing the device and getting feedback for future development.

Above, Grycian Massa (medical engineer) and Lloyd Talimanji (Malawi Health Equity Network) provide insights on the development of the MTB device.

3.       Baby Pod

And last but not least, my main project this year and a project which is so close to my heart. After visiting several rural hospitals last year, I just couldn’t sleep well after learning that babies were dying every single night simply because they got too cold. These hospitals had received donations of blankets in the past, but the blankets simply didn’t last because they can’t be bought locally, and inevitably the blankets walk out of the hospital. Let’s be honest- if I was a mother (Lord willing some day I will be!), I’m take a blanket to keep my baby warm, too. There’s nothing mommas won’t do for their babies, and no force more powerful in the world than a momma bear (or momma human, as the case may be). So we wanted to develop a more sustainable solution.

Traditional incubators work wonderfully, but they don’t work so well without electricity. So we set out to design a “pod” that would provide enough insulation to keep a baby warm through the night. The catch- the pod needed to be designed completely from local resources. Shout out to the amazing team that worked on this project- Ellen, Hamdan, Jared, Michael, Nick, and Mark! Here we have- the baby pod! And boy has it been amazing to work on this project this year in Malawi- more than I could have dreamed. More to come on that soon J

So our job is to work with our partners to figure out what works about these devices- and what doesn’t (which is so humbling!). It is only day four, and already we have learned so much. I am so grateful.

With love from Malawi,

Ashley

Moni Malawi!

Moni from Malawi! My heart could not be happier to be back in this beautiful country with my kind and courageous friends. Something about Malawi welcomed me home three years ago when I first visited, and now on my fourth visit, I feel as if this place has become my second home. I don’t use that word lightly- home- for it is a powerful word. But Malawi has become a true home for my heart- a place that is comforting to me, though still unnerving at times. It is a place where I am at peace.

It is difficult to sum up in a few sentences my journey in Malawi over the past three years (I really am too long-winded!). For nearly five years, I have been working with a nonprofit called the Pediatric Medical Device Institute (PMDI), which partners closely with the mechanical engineering program at Virginia Tech. In 2013, my supervisor and dear mentor Dr. Muelenaer returned from a trip to Malawi. He sat down with me in January 2013 and said “they need an engineering intern in Malawi- would you go?” Little did he know that I had been praying for some time about how to use engineering skills for international development- and God truly answered my prayers, when I least expected it. Since then, I have seen more answered prayers than I can count, things that simply could not have happened without divine intervention. Our God is an awesome God, and His plans are so good. My faith has never been stronger, and every part of me is reminded of His goodness in Malawi. Simply the fact that I am here again is a testament to how good He is and how BIG His plans are. I am so small and insignificant, but He is so big.

I am SHOCKED to have internet access (though limited) while in Malawi this year. To be honest, I have reveled in being “unplugged” from the modern world during my past visits here. There is such clarity to be found when emails and facebook aren’t fighting for one’s attention. But this year, development and progress have brought internet to Zomba, so I thought perhaps I should embrace this unexpected technology as an opportunity to share some stories from Malawi with the people whom I love so dearly back home. It is these stories- and the people that comprise them- that sustain my soul and give me hope. It occurred to me that maybe these stories might encourage some folks back home in the same way. Those that know me best know that I am long-winded at story-telling (perhaps that is why I’ve never blogged before). So if you read these stories- bless you and your patience with my rambling! I hope the stories might lift your spirits as they do mine.

With love from Malawi,

Ashley