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
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