I am relieved to share that, after over 20 hours of travel, I have made it to Dar es Salaam, TZ!
Our mentor Dr. Christine Bohne invited me and the two other interns Annika and Shrutika to a wonderful meal at Woodberry Cafe. We chatted about kicking off our projects in person (finally!) and tips to fight jet lag (melatonin is a must!).
Christine is such an inspiration to me, for many reasons, but among them is that she has a clear passion for integrating change into existing systems rather than trying to introduce a new “American” system into global settings. This principle will certainly guide me in my future endeavors to address health disparities. For my project on neonatal hypothermia prevention, it means supporting the public health researchers in Tanzania that have been working on these issues for years and collaborating to aid current hospital quality improvement teams.
Working at Woodberry Cafe
After some rich discussions about working in public health, Christine treated us to a dinner of some delicious local foods, including urojo (“Zanzibar mix”) and fried cassava. She explained that the coastal location of Dar makes it easy to access amazing spices.
Fried cassavaUrojo (Tanzanian dish)
In the following days, the NEST Tanzania team invited us to attend the 11th Muhimbili University of Health and Allied Sciences (MUHAS)Scientific Conference! There, I learned all about some of the pressing health issues and some innovative solutions teams are implementing. One project that stood out to me was m-mama, an emergency transport service that connects mothers in rural areas to quality care. I thought this affordable system is profound because in order to reduce maternal mortality mothers must be able to access the support they need. I look forward to hearing about more projects like this. When NEST presented, it was reaffirming to see that the project I am part of will be useful to the teams addressing hypothermia across neonatal wards.
Beautiful trees outside MUHAS scientific conference!
It is somehow so difficult to believe that we are already into the month of July! The days fly by quickly, with much to do both at work and after. This past week, I have fully dived into interviews. I am mentored by Donat, a NEST360 and IHI team member who has spearheaded the infrastructure project thus far. Donat is an incredibly seasoned researcher who has guided me through the qualitative interview process, and I am so grateful that he has been taking the time out of his busy schedule to accompany me in the interviews. On Monday, July 3, I piloted my interview guide at one of the regional hospitals in Dar. My first set of interviews with nurses at the hospital were amazingly perceptive, and I learned so, so much in just a short period of time. My interviews focus on hospitals that have undergone neonatal unit renovations in recent years, so I honed in on learning challenges and improvements from both pre- and post- renovations. I also gained a lot of valuable feedback for my interview guide in terms of prompts and question order, that I implemented over the next few days in preparation for my second set of interviews later that week.
After my interviews, I worked on the transcription and a basic level of thematic analysis that will inform my future qualitative analysis. With more limited experience in anthropological research methods, I am leaning on Christine’s expertise and learning much from her. Apart from interviews and transcription, I have also been making headway on the data analysis portion of my project. David, a Rice360 Fellow, has made a template for floor plan information, into which I have been extracting from the Tanzania drawn plans. In the near future, I will be confirming and refining this data. I do not take photos of the hospital work, but I will include some pictures of my thematic analysis in the next post!
At the beginning of the week, on Sunday, July 2nd, we visited Haruka Maruyama, a Rice alumna who is the Tanzania country director of ICAP. Christine, who graduated from Rice actually just a year after Haruka, invited us to join their meetup on Sunday. It was great to make Owl connections halfway around the world, and learn how Rice was a decade before our time there. Haruka was also involved with Rice360 as a student in building devices, which was an amazing connection to the work that we have done in previous classes at Rice.Meeting with Haruka has reaffirmed my interests in connecting with the wider Rice alumni network, and learning about different pathways through there.
Photo: Rice meetup in Dar es Salaam!
Apart from the work that we have been doing here, we have also enjoyed some delicious food and gorgeous views. As the time flies by, I can’t help but notice what I will most definitely miss when I return to the U.S. On the top of the list is the convenience of calling a bajaji on the side of the road to easily get to my next destination. Another is definitely Slipway, with its gorgeous views of the ocean, beautiful architecture, and amazing food. A third will be the many work and study locations available, from the Ifakara Health Institute office to the plethora of cafes within walking distance.
Photo: Cafe at the Slipway, where we got some work done on Friday!
Photo: (Fake) elephant at one of my new favorite Indian restaurants.
In the next week, my interviews continue at hospitals in Dar. So far, I have been interviewing doctors and nurses who have been at their neonatal units pre- and post- renovation; I will continue this, and also interview one of the NEST360 data clerks in the upcoming days. Additionally, we will be visiting the Dar es Salaam Institute of Technology for a tour and to meet students and leaders there!
Welcome back again to my blog, and I am excited to share updates from our second week in Dar!
Bright and early on Monday morning, we visited the Ifakara Health Institute (IHI) and met various members of the NEST360 and IHI team. It was such a pleasure to meet everyone and learn about their unique contributions to healthcare in Tanzania; QI specialists, statisticians, clinicians, and qualitative method masters were all present in the office, and they detailed the amazing work that they did at NEST.
Photo: With the amazing NEST360 team!!
Photo: My meal at the IHI canteen – it was delicious, and incredibly filling!
After introductions, we discussed our respective projects and outlined our immediate next steps. On the forefront was creating an interview guide, which will direct my upcoming interviews. Additionally, I am working on the extraction of data relevant to my project as well. We also scheduled a visit at a nearby hospital, so we could learn more about the neonatal unit there.
Thus, on Tuesday, we left for Mwananyamala Regional Referral Hospital, where we met up with Dr. Robert Tillya, a clinician from IHI and NEST360 (whom we had also been introduced to the day before). One of the aspects in particular that I internally took notes on was the infrastructure and overall space layout of the hospital. As this is also one of the hospitals that I will be conducting interviews at, I wanted to gain some perspective into the spatial advantages and limits of the current layout. Our conversations with the doctor-in-charge were incredibly insightful into this matter, and others as well, including challenges like hypothermia. One challenge the doctor noted was the lack of space for mothers to stay with their babies; they had to stay one floor up, due to limited space on the neonatal ward. Afterwards, we had the chance to speak with the biomedical technician on site, and learned about some of the issues causing a build up of unusable equipment in facilities, as well as many of the improvements taking place in the facility.
The visit to the neonatal unit was very informative, and it was interesting to expand on the literature that I had read online through an in-person example. It was also a great primer to a lot of the work that we will be doing this summer, and it helped with the development of questions for my interview guide. After the visit on Tuesday, we had the next few days to work on our project. As my first interview was coming up quickly, being scheduled for the following Monday (July 3), I focused on creating the interview guide and seeking feedback from the NEST360 team, as well as data extraction.
Among all of the new learning and new connections this week, Annika, Ojas, and I have still had tons of time to explore Dar! Our residence is located just a few steps away from tons of bustling cafes and restaurants, and we have had a blast exploring all that Dar has to offer. One of my favorite activities is to spot small differences from the overall culture in the U.S. versus in Tanzania, which I believe definitely shines through in restaurant life. In Dar, everything feels much slower-paced and calm; for example, the waiters won’t bring you the bill until you explicitly ask for it, and you can spend hours upon hours just chatting at your table after you finish eating. I’m not sure yet which “system” I prefer, but it’s definitely been fun pointing out small transitions in culture that we’ve noticed during our time here!
Photo: View inside Wild Flour Cafe, a greenhouse-style place to sit and work while enjoying some delicious coffee!
Next Monday, July 3, I will start conducting interviews at Temeke, one of the regional hospitals in Dar. Our time in Dar has moved incredibly fast so far, and I have truly enjoyed it and am excited for the next several weeks that are to come!
Karibu! This one word, spoken so warmly, has followed us around our time in Dar thus far. Whenever someone enters a new location, they are promptly greeted with this word, which means “Welcome” in Swahili (it also doubles as “you’re welcome” after someone says thank you!).
Welcome back to my blog, and I am coming to you from Dar es Salaam, Tanzania! We said our goodbyes to Dr. Taylor on Tuesday afternoon, and departed for Dar es Salaam later that night. After speed-walking through our layover airport, watching approximately five-and-a-half movies in-flight, and experiencing an eventful stopover in Zanzibar, I finally made it to Dar at 1 AM on Thursday, June 22.
Photo: The beautiful view from the airplane: window seat always!
In the morning, we promptly began becoming acclimated, heading to the currency exchange and SIM card offices to get situated. We then met with Dr. Christine Bohne, the Director of Quality Improvement Systems and our in-country mentor in Tanzania. Christine warmly welcomed us with our first meal in Dar at Woodberry Cafe, a beautiful cafe that has quickly become a favorite spot to work! We spent our lunch introducing ourselves and learning more about Christine’s work with NEST360, and had some amazing discussions on global health.
Photo: Entrance to Woodberry Cafe
I was definitely fighting off jet lag afterwards, but I tried to power through because we also went out for dinner with Christine later that night. She took us to The Slipway, a shopping and restaurant strip on the waterfront of the Indian Ocean with beautiful views and even more gorgeous food! Our first dinner meal in the country was a hearty soup called Urojo, or also known as Zanzibar Mix. Urojo was incredibly fascinating because it has roots and influences from so many cuisines, which you can taste when you dig in. From the fried bhajias, to the coconut broth base, to the spicy habanero spice served on the side, there was so much represented in just one meal.
Photo: Urojo, or Zanzibar mix!
After dinner, we headed back home to get some rest, as we had a busy day on Friday. On Friday, we had the amazing opportunity to attend a scientific conference organized by the Muhimbili University of Health and Allied Sciences. We were able to listen to NEST360 experts present their work on reducing maternal and neonatal mortality. Additionally, we were able to listen to presentations by other esteemed members of the community, including a representative from the Ministry of Health and a representative from M-Mama (an innovative app connecting emergency care services to pregnant women).
One of my favorite parts was during one of the final presentations; the speaker tied together all of the previous work presented, describing the “perinatal care continuum.” It was fascinating to not only understand the work being done, but also seeing how they all linked together across space and time. Some focused on gathering research information, while others focused on the implementation based on that information, and yet others focused on gathering feedback from the implementation. This provided me with a more thorough view of the full spread of work on maternal and neonatal mortality.
Welcome to the beginning of many musings! My name is Ojas and I am a rising junior at Rice studying cultural anthropology on the pre-med track with minors in global health technologies and biochemistry and cell biology. I know—that’s a mouthful. The point is that I am a prospective physician with a deep interest in the social elements of medicine.
Honestly, I did not come to college withany background in global health. But, I was passionate about decolonization and dedicated to cross-cultural exchange. As a child of immigrants from India, a low-income country, I am familiar with many of the structural barriers to accessing care in some resource-constrained settings. But, in humility, I still have so much to learn and am learning every day.
After discovering Rice360, I felt that I found my home. I found the place to gain unparalleled perspectives on health disparities and collaborate with scholars around the world. Continue reading “0. Introductions”→
The second week of orientation flew by just as fast as the first, and I am continuously awed by the wealth of insights that each of our group conversations bring. These past few days, I dove deeper into the history of the region and organizations that I will be working with. Prior to this research, I had never really stopped and thought about the background of a group that I was to work in, so I really appreciated this activity.
On the project forefront, I have been conducting a literature review on the impact of infrastructure on healthcare. The primary director of my work has been a toolkit co-developed by NEST360 and UNICEF. Dr. Christine Bohne, the in-country mentor for my project, pointed me towards an incredibly informative overview on infrastructure (linked here if you would like to read). I have used the abundance of resources available on the toolkit to understand my work, and I have also supplemented this knowledge through literature searches. Apart from the literature review, I have been familiarizing myself with the existing materials for this project. Overall, I hope to step into Dar next week with a more thorough background that can inform my field work here.
Finally, on the more social side, Dr. Taylor, Dr. Nejad, and all of the Rice360 interns enjoyed a very eventful team bonding activity at an escape room (we did not escape). I will definitely be missing the whole team as I prepare to go abroad with Ojas and Annika, but we’ve all promised to stay in touch and send updates (and pictures!!) throughout the summer. In my downtime, I’ve been packing and preparing for our departure next Tuesday, June 20th, which means a lot of paperwork and begging that my suitcase closes shut. I don’t have too many pictures from this week, but promise to include more in the future! Stay tuned for more parts, but next in Dar!
Over the past week, the Rice 360 interns and I have been getting ready for our respective trips. In preparation, we have been training in various topics from ethics and respect to working with communities and assessing our value-based goals. We have also been learning more about our cohort and the diverse skills and motivations each person brings to their project.
In a week, I will be heading to Tanzania with Ojas and Shrutika! The three of us are working on interdisciplinary projects. The project I am working on is an analysis of the capacity of biomedical workshops in health facilities to maintain and repair medical equipment in Malawi, Kenya, Tanzania, and Nigeria. While in Tanzania, I will have the opportunity to visit these facilities and talk to the employees in the workshops to better understand their experience and inform my analysis. In Houston, I have been reading WHO guidelines for the assessing, procuring, and decommissioning medical devices in low to middle income countries (LMICs) to gain some perspective on the challenges they face and how they are advised to address it. I have also searched through the literature to gain a sense of the situation that most LMICs face regarding broken equipment and experience using the equipment they receive. Additionally, since this my first time analyzing a large dataset, I have been looking through the methodologies of some research papers to inform my own methods in this project.
Before working on this project, I had not considered that equipment maintenance could serve such a vital role in the hospital. As someone who is interested in the medical field, my conceptions around patient care have focused on the practice of medicine and the inclusion of social determinants of health into that criteria as a means to treat health. At a more fundamental level, the availability of resources and the built environment can become a barrier just as strong as any other. I hope that through my projects and those of my peers, I will gain a better understanding of the complex factors that contribute to patient care, remain humble in my own experiences of care, and be open to the experiences and knowledge of the people in Tanzania I have come to learn with.
I clearly remember my interviews for the Rice 360 Summer Internship. My first interview was with Dr. Leautaud, who told me more about the Tanzania internship. “Tanzania presents a unique challenge. It is a very new site, and all there is at DIT is an empty room with a few tables. Do you think you would be up for this challenge?”.
At that time, sitting in Dr. L’s 9th-floor office in the BRC, the answer seemed almost obvious to me. This internship excited me, aligned with my goals, and I was raring to go. “Of course! I understand why that can be very challenging, but the process has to begin somewhere! I would be excited to face that challenge and make the most of my opportunities to pave the way for the future of the internship!”
I often thought of this exchange while in Dar es Salaam, and it never failed to remind me of the big picture and provide perspective. It has now been two weeks since I have returned. I have gotten over jetlag, had multiple intense catch-up sessions with my parents, and have had a long time to reflect about my time in Dar es Salaam. As Dr. L predicted, this was a uniquely challenging internship. Here are my learnings from my time in Tanzania.
An image that I will never forget is the Muhimbili Hospital Equipment Graveyard. Near the biomedical technicians’ workshop were piles and piles of decrepit hospital equipment. Hospital beds, oxygen concentrators, suction pumps, all of brand names seen commonly in the US, lay in a mountain of metal and plastic. They were here because they simply didn’t work anymore. The hospitals had to make do with few working machines and were stretched for resources. Our interviews informed us of the crucial need for technology innovation made exclusively for the context. It seemed that technology manufactured for developed countries could not stand up to the stresses of a low resource hospital. Any new technology introduced has to consider the training of its users, the frequency and conditions of use, and maintenance routines to be effective in this hospital environment. This was summed up beautifully by Dr. Shah, a newly trained doctor who we interviewed, who used a quintessentially Indian reference to explain this to us- “You can’t drive a Ferrari on a road meant for a Maruti”. I will bring back to Rice a deeper understanding of the design criteria that would make technology suitable and sustainable for a low resource setting.
The Muhimbili Hospital Equipment Graveyard
On our first visit to Amana Hospital, Dr. Mafele asked us to prove ourselves. I immediately began to worry. Our group of six engineers had little experience with repairing medical equipment. We had limited knowledge about the context at Amana Hospital. Would we be able to convince Dr. Mafele that we were worth our salt? A month later, after having fixed multiple items of hospital equipment, developed recommendations and presented project prototypes, Dr. Mafele said: “Yes, you have proven yourself”. Apart from being incredibly proud of our team, my belief in our abilities as engineers was affirmed. We combined our different skills and experiences with our common passion and knack for problem-solving to give our best to help Amana Hospital. I remember standing in the neonatal ward, looking at the tiny babies, with the cries of infants punctuating our conversation with the nurse. She wanted the oxygen concentrator we repaired to be calibrated as soon as possible so she could use it on the babies. It struck me that a simple soldered connection to repair the concentrator could save the lives of these children. I bring back to Rice an appreciation for the need to establish trust and credibility and an unshakable belief in the capacity of engineers to touch lives.
I remember a conversation with Matthew over dinner at the City Mall Food Court approximately halfway through our internship. While our peers in Brazil and Malawi already had projects, we had yet to go on our first hospital visit. Julia was untiringly following hospital leads, visiting with letter after letter, and the bureaucracy and paperwork that came with a new hospital relationship was simply taking time. We were restless and were venting our frustrations to each other. I was relieved that we were on the same page, and I realized that I simply had to be patient, trust the process, and wait. This proved to be particularly difficult in the unfamiliar environment – work is often my crutch to cling on to a sense of familiarity and normalcy. Instead, we poured our time into the design studio, working on team building, writing shopping lists of tools for the studio and making multiple trips into Kariakoo to buy these tools. When we eventually had our projects, we worked like a well-oiled machine and had a fully stocked design studio with materials for our projects. I bring back to Rice an appreciation for going at the pace that the situation demands and satisfaction for having contributed to the set-up of the DIT Design Studio.
We began our days at the Design Studio with Pictionary. Julia thought it would help us with our non-verbal communication, so every morning, we would arrive at the studio to be divided into two teams and engage in a fiercely competitive game. It always struck me how effective this was in bringing us closer and improving our communication. We left every game having learned something new about each other. Over meals in the DIT canteen and trips to Kariakoo, we shared our varied experiences and found common ground. The world seemed so small – the things that bound us seemed to be universal. The Tanzanian interns were well versed in the Bollywood classics, Julia’s ‘hype music’ playlist transcended language boundaries and never failed to put us all in a good mood, and I enjoyed finding words that meant the same in both Hindi and Swahili. I bring back to Rice an appreciation for how similar we truly are and six new friends.
Our team of six + Julia after our final presentation to the DIT Faculty
Three years ago, I watched a video about Dr. Richards-Kortum and Dr. Oden’s work in Malawi and it inspired me to apply to Rice. After having spent two months in Tanzania, I have immense appreciation for the vision of Rice 360. I feel like I have come full circle. I return to Rice a changed person- inspired and grateful for this opportunity. I was so honored to have been given this opportunity, and I have been incredibly lucky to have had the experiences and met the people that I did. DIT and Dar es Salaam welcomed us with open arms and excellent weather. I am proud of the work and progress we made this summer, and the united front with which Matthew and I faced every challenge. I am sure the DIT Design Studio and our relationship with Amana and Muhimbili Hospitals will continue to grow, and I am so excited for the future of this internship. My time in Tanzania stretched my abilities. I return to Rice motivated and ready to learn and grow.
I would like to thank the donors for their support to the internship and to Rice 360. None of this would have been possible without them.
Our time in Tanzania was nearing its end. By now, we had done an adequate amount of hospital visits and had identified problem areas that we could innovate within. It was time for us to do our final internship capstone project! Julia narrowed the projects down to two: a mechanism to prevent the backflow of fluid in suction pumps, and a modification to the Clean Machine to serve Amana Hospital’s needs. As Joel, Sadick and I had already worked on repairing and troubleshooting the suction pump from Amana, and we were assigned to the suction pump project.
After our experience repairing the suction pump, we had multiple ideas to address this problem. These ideas were varied- they ranged from a training and troubleshooting app to a completely revamped design of the pump. Our assigned project statement helped us narrow down these ideas and focus on the problem at hand. We knew that we had to focus on a mechanism to prevent, delay or limit the damage caused to the aspirators by fluid backflow. We narrowed down our ideas to those that explicitly addressed the problem.
During our visits to Amana and Muhimbili Hospitals, we had a chance to focus our observations and interviews on the suction pump problem. In addition to interviewing nurses and surgeons about the common problems faced with the suction pump, we got an opportunity to see broken suction pumps in the Muhimbili Hospital Graveyard, as well as speak to technicians who had to repair these suction pumps. From this, we learned about the problem with the current solution. The built-in valve mechanism was often removed by the users. The bacterial single-use hydrophobic filters were not always effective, expensive and had to be replaced often. Our solution had to serve the purpose of the valve as well as ensure that it was not removed by the users.
Although we had just about eight days till the end of the internship, our team decided to go through the entire engineering design process, doing focused research, forming design criteria and making screening and scoring matrices. Our design criteria focused on what we thought was the most important to Amana Hospital- requiring minimal clinician input, effectiveness, accuracy, durability, and low cost. After screening and scoring our ideas, we decided to prototype our top two ideas, to be able to further decide what was best suited to Amana Hospital’s needs. Our top two ideas were a multiple canister system- adding more canisters to the suction pump to delay the backflow of fluid, and a sensor system that would detect when the valve shut off the suction and alert the user that the canister needed to be emptied.
Using lunchboxes, modeling clay and pipes, we began by prototyping the multiple canister system. Although the prototype worked, we agreed that it was not a permanent solution to the problem. We could add multiple canisters to prevent the backflow, but it would take up precious space in a surgical theater. It was also a temporary solution- how many canisters could we keep adding before the backflow ruined the pump?
We decided to move on to our valve-sensor mechanism. It was a combination of a 3D printed valve which served as a reusable backflow prevention mechanism, coupled with a sensor system that would alert the user when the canister filled up. We hoped that the sensor system would let the user know exactly why the pump stopped working once the canister was filled, and hence prevent the removal of the valve. To prototype this idea, we needed a functioning suction pump to test our valve and our sensor mechanism. We had returned our repaired suction pump to Amana Hospital and did not think that they had one to spare for us to prototype on. Hence, in the spirit of ‘making do’, we fashioned our own suction pump out of a leak-proof lunch box, 3-D printed parts, pipe, and a hand-pump. We estimated the dimensions of the cage that would house the valve and 3-D printed it. Now, with a makeshift suction pump ready, we decided to work on our prototype.
Our makeshift suction pump
We began by researching the shapes of existing valves. After some research and testing, we had a simple valve that fit in our cage, floated, and shut the suction off once the canister was full. Our next step was to prototype the sensor system. Here, we ran into some problems. We first attempted to use an IR sensor and emitter pair to detect the valve closing. Although this system worked in the beginning, we ran into some trouble making the system accurate. It would give us plenty of false positives and false negatives. We tried to fix this problem by using different materials and colors for the valves, as well as creating temporary ‘hoods’ to remove interferences to the system. But after multiple attempts were unsuccessful, we realized time was running out and we had to try a different system.
The valve inside the cage attached to the lid of our suction pump
Our second attempt was a magnetic sensor system. This system was a little bulkier as it required the use of an Arduino board, as well as a bigger sensor and a magnet on the valve. Although we got the electronics to work, we ran out of time and couldn’t manage to design a valve that could float while handling the weight of the magnet. With just a couple of hours left until our presentations, we decided to create a functional prototype that would communicate the idea. For our final presentations to the DIT Faculty and Dr. Mafele from Amana Hospital, we presented our valve in our in-house suction pump and presented the sensor mechanism separately with an external magnet. These were enough to demonstrate our idea, and we also explained that the entire system could be customized to any make and brand of suction pump.
The magnetic sensor apparatus without the magnet stimulusThe magnetic sensor apparatus responding to the magnetic stimulus
Our prototypes were well received by both the faculty and Dr. Mafele at Amana Hospital. Along with the positive comments, we also received multiple suggestions and additions that could make our system more effective and easier to operate. This experience reiterated to me how important it is to have constant clinician interaction and input while prototyping a device that will be used in a medical, surgical setting. Dr. Mafele and the professors at DIT brought up points that we hadn’t heard of during our interviews and that we hadn’t thought of during our brainstorm sessions.
Our project was far from a complete prototype, but we had done the work of developing the problem, homing in on a solution, eliminating options that would not work, and making the first attempt at a prototype. I felt myself get restless and frustrated when our ideas and their executions failed, and I was disappointed that we couldn’t make a complete, neat prototype. Julia, Matthew, and my team helped me put things in perspective and appreciate that working on any project is a slow, iterative process, and no amount of progress is too little progress. I’m sure that this project will continue to be worked on by engineers in DIT, and I plan to bring this project back to Rice so we can work on it here as well! In the meantime, I am happy to have learned so much more about CAD, 3D printing, Arduino, suction pumps, valves, sensors and patience in the process.
There was an anticipatory silence in the room. Dr. Mafele, Dr. Marie, and a small group of nurses and doctors sat in a small, dimly lit office with a faint smell of disinfectant. To further our relationship with Amana Hospital, we were presenting on the progress we had made since our last visit. After a week of working on instrument repairs, brainstorming project ideas and recommendations for the hospital, we were very excited to present to our audience. We had planned this presentation well- we knew who would talk about what and had prepared a deck of slides that Julia printed out and handed to all the clinicians. Julia said a few words introducing us, and then the presentations began.
I have a weird relationship with presentations. I usually get very nervous a few minutes before, but when I’m giving the presentation, I am relaxed and excited. I love explaining the thought process behind my work, justifying my decisions, and getting feedback. As I sat in the room waiting for my turn to present, I felt the familiar butterflies in my stomach. Only this time, the feeling was exacerbated by the knowledge that I would have to present solely in English to an audience that, although fluent in English, was more familiar with Swahili. I realized that while my DIT peers could easily switch to Swahili to explain something further, detect audience cues and understand concerns, discussions and questions, I could not do the same. I was nervous about my accent being understandable and being able to answer their questions satisfactorily.
An important part of this presentation was selling ourselves. Amana Hospital had been quite skeptical of our skills and intentions to begin with, and we were extremely keen on building this relationship with them. They had explicitly asked us to ‘prove ourselves’, and this presentation was our attempt to do just that. Over the last week, we had reflected on our observations from Amana Hospital at length- going through research and brainstorming multiple times. We had well thought out recommendations, but they were not easy recommendations. I was acutely aware of the fact that while our audience were highly educated and very experienced, we were just a group of young engineering students, inexperienced and unaware about the trials of a hospital setting. How could we strongly convey our concerns and recommendations without making assumptions or overstepping the line? In addition to my general nerves, I was afraid of being inadvertently presumptuous. I paid close attention to my tone and word choice while presenting and noticed my fellow interns do so too.
Before our presentation
Luckily, the presentations went extremely well. Our audience was receptive and appreciative. I couldn’t help noticing that while our audience listened to Matthew and me with rapt attention, when the DIT interns presented, they had an unmistakable expression of pride on their faces. Once we were done presenting and receiving feedback, the conversation switched to Swahili for a bit. From what I could gauge, the doctors and nurses congratulated the interns- telling them that the work that they were doing was incredibly important. They mentioned that they needed more engineers like them, and if they continued doing this work, they would be solving huge problems and bringing about remarkable change around Tanzania. Dr. Mafele mentioned starting a business with their ideas and making a lot of money. Our audience was noticeably excited about us and our contributions.
After conducting multiple needs finding trips and interviews, one of the biggest takeaways is the need for training of technicians and health professionals, and maintenance of medical devices. Inherently linked to these is the need for sustainable, in-house innovation. A doctor told us that most biomedical technicians are trained in South Africa and most medical equipment is manufactured outside Tanzania. This leads to increased taxes and import fees, making important medical devices more expensive, and prevents accessible, regular maintenance of those devices. This makes me think that cultivating in-house capacity for both training and maintenance can have long-lasting, positive effects on the Tanzanian healthcare system.
Synthesizing ideas and observations from Amana Hospital
Multiple times after our visits to Amana I found myself questioning my purpose as an intern. All the problems we seemed to notice were deep rooted in structural things- government policy, education systems, hospital administration. As a nineteen-year-old bioengineering student studying in the U.S., I questioned my ability to enforce lasting change. I had only been in Tanzania for a few weeks. I barely understood Swahili. How could I possibly make a difference? I felt that the most that I could do was make surface recommendations, understand the problems as best as I could, and go through the design process, attempting to innovate engineering solutions. Although those engineering solutions would make small changes and make people’s lives easier, they couldn’t solve the huge, systemic problems that seemed to permeate everything. The more I thought about it, the more pessimistic I grew.
I quickly realized that I was missing a crucial piece of the puzzle. My fellow DIT interns, who were more comfortable giving our first Amana presentation, were better suited to solve the large problems. As we went through the engineering design process together, I was struck by how perceptive they were, and how easily they understood the problems and the human factors involved. While my job was to understand as much of the context as I could to inform decisions for engineering design, they inherently operated in the larger picture and could easily tell how every issue was interconnected. This came across every time we made design criteria or screened and scored ideas. Matthew and I came in with new perspectives, different ideas, experience with developing observations into problem statements and the engineering design processes. Our contribution, apart from working on a project for an identified problem, was in setting up the design studio, supporting and collaborating with the future engineers and innovators of Tanzania. In our time working at the design studio, we have been lucky to meet inspiring role models, examples of local innovators and change-makers- Paul, a DIT graduate who is the founder of STIC Labs (see Matthew’s post about STIC Labs here), Dr. Elphace, a DIT professor who studied in Russia, Finland and Thailand, and has the craziest, most inspiring stories ever, and Dr. Shah, a newly graduated doctor with a passion for biomedical engineering. My fellow Tanzanian interns continue to inspire and amaze me. My experiences here have reaffirmed my belief in the system and this internship. I now have an unfailing belief in the potential of my friends from DIT, and by extension, the future of Tanzanian healthcare.
