Mambo!

(That means “hi/how are you?”. The standard reply is “poa”, which means “cool”.)

Thanks for sticking around for the third edition of my blog! A lot has happened here in the past couple weeks, so let me fill you in!

Technical Updates

With the travel incubator, we’ve continued to do heater testing with a bunch of different setups. The main thing we’ve focused on is the physical layout of the fan, material layers, and lid. We’ve learned that airflow control is extremely important for heating, and also that even within a small volume, temperatures can vary significantly depending on whether you’re close to the top or near the middle of the incubator, because hot air rises. During our testing we managed to fry one of the heating elements we were using (Figure 1). We also did some preliminary testing on thermal insulation (Figure 2) for whether it would improve the heating efficiency of our system, and it worked to make our heating coils noticeably hotter.

Figure 1: We now know that our heating elements should not glow. This is a sign that mistakes have been made. 

Figure 2: Lining the incubator box with insulatingmaterial to trap more heat.

Beyond physical testing, we improved the software side of the incubator to read data from a heart rate/pulse oximeter sensor, along with expanding the display’s functionality to include control for both fan and heater systems. Our current thicket of wires is shown below (maybe we can consider it a form of modern art?). Luckily for us, we won’t have to look at this chaotic little disaster for much longer. I spent most of today designing a printed circuit board (PCB) to which all the necessary components can be soldered

 

 

We also had the chance for a couple hospital visits. Last week, we bajaji’d to Amana Referral Hospital to introduce and get feedback on our projects with teams of doctors. There was lots of interest in the gastroschisis bag, with one doctor asking when she’d be able to use it in a clinical setting. Right now, the project is in the patent and manufacturing stage, so it won’t be too long before the gastroschisis bag is in use!

Several doctors in the pediatric section of the hospital were interested in the travel incubator project, and they brought insights that we haven’t even considered, such as making a single incubator that can fit multiple babies inside. We have been brainstorming around this idea while we continue to pursue the single-baby model. 

The second hospital visit was today, at the Aga Khan Hospital. We met with a neonatologist named Dr. Yaser Abdallah, and he was admittedly skeptical of both the gastroschisis bag project and the travel incubator project. While there is a clear need for gastroschisis bags in Tanzania, he believes that the best way to get these bags is to import them. As for the travel incubator, he believes that the vast majority of babies should be cared for via Kangaroo Mother Care (KMC), in which the baby is held by the mother on her chest for maximal skin-to-skin contact. While it was a little difficult to hear that he didn’t think our projects would make an impact, Dr. Abdallah’s perspective is extremely valuable and we will continue to consider the points he brought up. 

As for the syringe pump, we got a hold of different syringe sizes to test with and have begun iterating different 3D printed designs to be able to adapt to these sizes. As I type this post, one of the DIT Design Studio 3D printers is spending its Friday night hard at work on a dummy device casing that we’ll be using to house our prototype iterations.

Figure 4: (left) 3D printed syringe guide above a standard 60 mL syringe  (right) syringe pump prototype: the top view shows the different protrusions that are meant to house and guide the syringes.

Next week will involve rapid prototyping of different syringe guides for the syringe pump, and fabricating and assembling the PCB for the travel incubator. We’ll also likely have another hospital visit. There’s lots to do, and somehow we’re already halfway through! Time really does fly when you’re having fun 🙂

Miscellaneous Updates

I think it’s critical to share that I spelled out RICE at a beach resort in the Kigamboni district of Dar es Salaam. Photo credit: Shreya (she was very patient, even as I wasted countless attempts flailing into illegible shapes)

Equally important is my success in an eating challenge at the Grand Restaurant in which I won a t-shirt. Photo credit: Melissa

Shreya and I watched the season champion deciding match of the Tanzanian premier league a couple days ago. What a rowdy experience!

Hopefully Shreya and Melissa can provide some better pictures of the monkeys we saw in Jozani Forest, Zanzibar this past weekend. All I have to offer is a selfie of dubious quality.

 

Me (basketball star) dunking on Prison Island tortoise (embarrassingly bad defender) in Zanzibar. Photo credit: Shreya, Hoop credit: Melissa

Melissa said that Zanzibar’s waters look like Taco Bell’s Baja Blast. She’s onto something.

The most surprising thing about Stone Town, Zanzibar, was the copious amounts of stray cats. They were everywhere, even in the lobby of our hostel!

Thanks to everyone who made it this far! Either your attention span is commendable, my writing is extremely engaging, or you’re being forced to read this against your will.

In any case, I’ll post again in two weeks, so be ready!

Until then,

Andy

 

June.10.2023

Hello! My name is Shrutika, and I am a rising junior at Rice University from Jones. I am pursuing a B.S. in Biosciences and minors in Global Health Technologies and Medical Humanities. Along with Ojas and Annika, I will be traveling to Dar es Salaam, Tanzania this summer as part of the Rice360 internship.

This past week has been a whirlwind of insightful lectures, fun activities, and team-bonding exercises. I have enjoyed learning more about the importance of communication and ethical engagement, among various other topics as well. Without doubt, one of my favorite sessions so far has been the PhotoVoice presentation, an activity that has emphasized the wealth of stories that can be captured by single photographs. As we each presented five photos, common threads emerged: from travel-lovers to nature addicts to sports enthusiasts to engineers, we all had some connection to each other. As I prepare to travel abroad next week, I hope to continue forming these links. As an admittedly poor photographer, I probably won’t be taking too many new pictures; nonetheless, I hope that I can continue to add new stories and relationships to my own arsenal, and I am excited about the prospect of connecting with others and learning about their lived experiences.

The three of us will be working with and learning from the NEST360 team this summer. My project will take a mixed-methods approach to evaluating neonatal unit infrastructure in health facilities in Tanzania. I will be conducting a combination of quantitative analysis, such as analyzing floor plans, and qualitative work, including interviewing healthcare workers. Through this research, I aim to understand and inform on the impact of hospital infrastructure on the quality of care delivered.

This summer, I am looking forward to working with a diverse team of individuals from all across the world. I aspire to keep a beginner’s mindset in my journey, and I hope to gain a deeper context to factors that can affect healthcare. We will be departing for Dar es Salaam in a week, and I am both nervous and excited about what the next 7 weeks have in store for me!

Shrutika

This week, we finished up the electronics teaching modules and then found a new project to work on! Dr. Moshi, one of the professors in the electrical engineering department, asked us to help review the proposed revisions for the new biomedical curriculum to be implemented in the fall.

This past year, I was one of 7 students on the Rice BIOE department’s Advisory Board. We surveyed fellow students, researched other schools’ programs, and wrote reports making recommendations for changes to our curriculum. Getting the chance to help improve DIT’s BME curriculum was super exciting, especially since our fellow interns have been telling us about its many weaknesses since day 1.

We spent a few days collecting feedback on the proposed curriculum from current and former students. Overall, they were pleased with most of the changes: reducing unnecessary modules from 12 per semester to 9, combining courses that didn’t have enough material to be stand-alone modules, and adding more practical content.

We then spent a day working with Dr. Moshi to better understand the content of the proposed curriculum and go over the comments and feedback we received from the DIT interns. The new curriculum should provide a better and more-well rounded education for future DIT students. However, many more changes will be necessary before it can be effectively implemented.

Many of the problems with the current curriculum seem to lie with lack of practical skills and fundamental knowledge. We anonymously surveyed more than 15 students and found some concerning results. Students overwhelmingly complained that the large number of modules “kept them busy” with unnecessary information rather than allowing them to focus on important core modules. They also told us that lecturers of biomedical courses often did not show up, and for some classes have only attended 1 or 2 lectures the entire semesters. This forces students to basically guess at what would be covered by midterms and final exams. Even when they did show up, there was no syllabus or course plan for the class, so lecture content was determined by the depth of the instructor’s knowledge rather than importance of each topic. They want more support, both in terms of money and instructor guidance, during their final year design project. And finally, students emphasized a need for practical experience in their coursework, from learning basic electronics skills to actually seeing and being able to take apart the equipment they are learning how to maintain and troubleshoot.

The new curriculum seems to alleviate some of these problems. The overall number of modules has been reduced, and hours have seemingly been set aside for practicals. We’ve also pointed out modules where the Rice troubleshooting course can be implemented and provided example circuits and teaching materials for learning practical electronics. However, instructors must be held responsible for attending lectures and actually communicating the knowledge that they’re hired to teach.

One method we suggested was to have instructors create course syllabi and schedules for the semester. This would also help students understand how much each subtopic is emphasized and provides a study guide. Finally, a syllabus would hopefully ensure that scheduled practicals actually occur as planned. We sent Dr. Moshi a few examples of Rice course syllabi, which we hope will provide a good starting point. Dr. Moshi seems excited about the new curriculum’s potential, but acknowledges that it’ll be a lot of work. He predicts that his fellow instructors will be resistant to creating the documents, so the responsibility to create and reinforce the syllabi may fall on him.

Dr. Moshi seems to be somewhat of a visionary in terms of trying to change DIT’s education system. He’s in charge of curriculum for 8 degree programs and recently attended a conference on active learning in Malawi headed by Drs. Matthew Wettergreen (current Rice engineering lecturer) and Ann Saterbak (former Rice professor and basically the creator of Rice BIOE). He came back from the conference with lots of ideas for improving the BME curriculum by implementing more practical project-based learning. Though he seems so stressed out already, I hope that he will be able to fulfill his dream of creating a more effective curriculum.

This past week was Week 5 out of 7. While we waited for a response from Muhimbili, we worked on the two projects we developed during Dr. Leautaud’s visit. For the electronics modules, we taught the DIT interns how each component worked, then how to use a breadboard, and finally how to assemble the circuit on a through-hole board. We also created some guidance documents on using a DMM, breadboarding, and soldering. As for the centrifuge safety switch, we successfully modified the two centrifuges we had available so that the motor only runs when the lid is closed. All we needed for each circuit was a small push button, epoxy, and some wire- a really simple but effective solution that will help protect future device users.

Watching the interns put these two projects together made me feel really proud! We were able to teach them some new skills and provide some more practical experience. The feedback for the electronics modules was especially positive; it seems that they would be an effective teaching tool if incorporated into their coursework or offered by the new design workshop.

While we didn’t receive a response from Muhimbili last week, we did get permission to visit Aga Khan. Our intern group was able to see more of the new facilities and talk to a nurse in the maternity ward. Aga Khan definitely has more resources than Muhimbili does, including newer facilities and equipment and a lower baby:nurse ratio. The two technologies that we’re especially interested in, phototherapy for neonatal jaundice and syringe pumps, are used frequently there, but the nurses rarely have problems with the devices. I’m glad that we were able to visit Aga Khan, whose maternity and neonatal care practices seem to be working well. If we get a chance to talk to a nurse or doctor at Muhimbili, I wonder what differences we’ll see. I also wonder how the DIT interns will view those differences, in terms of a potential workplace.

Though at times things have moved more slowly than I would have liked, I’m also surprised that the end of our internship is so near! There’s so much that we would still like to do here: get faculty feedback on the proposed OEDK space, help with curriculum revision, and visit Muhimbili again. But we’ve accomplished a lot too, from piloting the troubleshooting course to teaching the interns how to solder. Most importantly, we’ve developed strong relationships with the DIT interns and our supervisors. On Saturday, after our visit to Aga Khan, we had all the interns and Madam Kianja come over to our apartment for a lunch featuring Italian, Chinese, and American dishes. We had a great time and I hope that we can spend more time together outside of work before the end of the internship!

This week we finally got a chance to go to Muhimbili. We spent 3 days there working with the technicians and helping troubleshoot equipment. There are a lot of broken devices here! Much of it sits in the BME department’s main workshop, waiting for spare parts from dealers or other cannibalized equipment. If broken parts can’t be obtained or the device can’t be fixed, then it is “condemned”: stored in the courtyard for an annual public auction. Additionally, Muhimbili seems to depend on inconsistent government funding and donations from NGOs to obtain new equipment, unlike Aga Khan which replaces its equipment after 5 years. Thus, the hospital has many brands of the same type of equipment, but parts in those devices are not analogous with each other, resulting in even more machines collecting dust in the workshop. I wonder how this lack of functioning equipment affects Muhimbili’s patients, doctors, and nurses, and if there are any technologies that Rice and DIT students could develop to help.

We were also able to see some of the hospital wards, like maternity and the surgical ICU. Unfortunately, we found that we had yet another obstacle to overcome: while we were allowed to work alongside the BME department, we had not received authorization to ask doctors and nurses questions about neonatal and maternal care. We’ve now written and submitted yet another letter that specifically requests permission to do so, and I hope that it is approved soon.

While I’m getting more accustomed to the slower pace here, peeling back these layers of red tape is incredibly frustrating. My main goal for this internship is to learn about patient care in a low-resource setting. I hope to compare the standard of care, available facilities, and patient/provider needs here with those at the hospitals and clinics I will be trained at when I begin medical school in the fall. Of course, I expect that the technologies and resources in an American hospital would far exceed those at Muhimbili or Aga Khan, but I wonder if those advancements have any trade-offs that might be revealed when talking to healthcare providers here. Furthermore, I am really interested in observing patient care that occurs in a different culture and language.

On Thursday, Grant and I attended a signing ceremony of a memorandum of understanding between Rice and DIT. We witnessed the principal of DIT sign the document and said a few words about our schools’ partnership. I’m excited to see what the internship looks like in a few years’ time! Hopefully, pushing through all of our current difficulties will pave the way for future interns here.

Finally, some bad news. We spent the weekend in Zanzibar, which was beautiful and lots of fun! But Gilden was right to be worried about my phone; it was stolen while we were there. 🙁 Sadly, my future posts will probably not have pictures. Note to future interns, especially wearers of pants for women: your pockets are not a safe place for your phone!!

As always, our week was quite eventful! Since we had finished all the troubleshooting modules, I was honestly feeling a bit frustrated going into the week. I’m the type of person who likes to plan things out and get things done, especially when responsible for a group of people, so not having any specific next steps was a bit stressful. However, Dr. Leautaud joined us at DIT from Monday through Wednesday, and helped us establish some more goals for the coming weeks. I also learned that I should be more patient, take things slower, and try not to stress about things that I can’t control. For example, we finally got a permission letter sent to go to Muhimbili, and ~yay!~ got internet working in our room.

Dr. Leautaud also brought the great news that Rice 360 has received a grant from the Lemelson Foundation, similar to the one received for Malawi (1,2), to further the Rice-DIT relationship and help establish a biomedical engineering design studio and practical workshop. Our DIT cohort was really interested to learn about the resources we have at the OEDK, and together we created a set of student and instructor surveys to help gather ideas for the new spaces.

We also came up with a few more projects to tackle: creating practical electronics modules and installable centrifuge safety switches. For these two projects, we walked the DIT students through the design process: defining design criteria, brainstorming solutions, and selecting the best one. The DIT curriculum only has 1 design project that is assigned during the final year of study, and it consists of pitching a solution to a problem, building it, and giving a functional demonstration. It seemed that they are not taught the processes of needs-finding, definition of design criteria, brainstorming, and validation of design criteria, so these exercises were a bit challenging. However, with lots of patience, we pooled together some good ideas and a shopping list for electronic components to buy in Kariakoo.

Kariakoo is a HUGE market that sells everything. Literally everything. The DIT students accompanying us on the trip took us straight to the electronic components shop, but we easily could have spent hours looking for the right place if they hadn’t guided us there. Seriously, Kariakoo was like a physical Amazon.com, without the search bar. Unfortunately, I didn’t get a photo of the streets because Gilden was paranoid I’d get my phone stolen, and kept it in his pocket for safekeeping.

On Saturday, Grant and I had a chance to visit Aga Khan, meet the head of the BME department, and tour some of their facilities! We will get a chance to take the group there in the next few weeks as well. Their current ICU is tiny, only 4 or 5 beds, but they are constructing a new building with an entire floor for the new ICU, complete with brand new equipment.

And finally, on Sunday we ended the week with a visit to Coco Beach! Though I only have Galveston Beach to compare it to, I thought it was absolutely beautiful. We even found a spot to do a little cliff diving! All in all, a very relaxing trip that provided some time for me to destress and think about what we’ve accomplished so far. “Pole-pole” (slowly, take it easy): adjusting to a slower pace of life has been different but definitely enjoyable.