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The TL;DR Version of Our Trip!

If you didn’t have the time to read through all our posts (though we highly encourage it), you can watch this short video that is a compilation of our entire trip! The video was compiled by one of the team members, Polly, and is a fun way for us to look back and remember our trip. Enjoy in HD!

 

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Inner Musings: Polly

One of the things we learned in the CBID Business Course by Professor Aronhime this summer was the phrase “Crop and Focus”. We learned that a technique to taking great photos that told a story, was to crop the frame and focus in on the subject of the picture. Similarly, this analogy was applied to understanding a problem, where you narrow down to define the scope and then focus on something worth solving. As someone who has always been interested in photography, that phrase really stuck with me.

On this trip, I constantly felt like we were flipping between looking at the bigger picture of maternal and child health and the smaller area we are targeting through earlier identification of sickness to prevent neonatal mortality. While we received a lot of positive feedback on our device, it sometimes became easy to lose sight of how large an impact we were really making on saving a neonate’s life. We learned that there were so many other delays to care, like lack of transportation, that we were sometimes left feeling that perhaps we weren’t focusing on the right problem. This even led us to float crazy ideas like a baby-transportation drone that could carry the newborn to care (we know it’s a crazy idea… for now). However, as we received more and more stakeholder feedback, we were able to validate our hypothesis that earlier identification of neonatal illness at the home would be useful and potentially life-changing. More than this, our device offers a chance to bridge the gap between health facilities, community health workers, and mothers. We also found that our device was wanted, not just by mothers and community health workers, but even at private facilities where monitoring many newborns at once with limited personnel was a huge challenge.

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For me, that was the beauty of this global health immersion: to actually be in the field interacting with the people who would really be using our solution. To others, this project may be just another project in CBID, but to our interviewees, this project could be an intervention that forever changes how newborn monitoring is carried out in their country. The trip helped me finally understand what the buzzwords “human-centered design” really meant and what it takes to engineer a solution that is really needed. I also realized how badly I want our intervention to be able to help those with the greatest need and the greatest pains. Taking the time to understand the point of view of every person we were lucky enough to interact with, has helped us shape and reshape our solution. This incredible learning experience is so unique and is definitely one of the reasons that drew me to apply for CBID.

Screen Shot 2016-08-30 at 2.28.31 PM.pngIn a more literal sense, I also had the chance to take a ton of photos during the trip. It was a bit awkward at first, because while most people we encountered were so excited to have their picture taken, but it felt strange to walk away without being able to share the photos with them. Luckily, I also brought along my Polaroid camera which can instantly print photos and save a digital copy at the same time. Being able to share the pictures helped me build a more personal connection with the health workers, mothers, and children we met.

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Above: The children holding a polaroid of themselves    Below: The polaroid image

One of the most fun things about taking photos watching the kids react to having their photos taken. In the rural field sites, most of the children have pictures taken, let alone selfies. Exposing them to the filters on Snapchat was definitely one of the most adorable and hilarious experiences, and they especially had a lot of fun using the dog filter! The joy of taking pictures (and especially selfies) is something that can topple even the toughest language barrier and requires nothing more than a smile and a lens.

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Last Days in Africa

For our last day in Jinja, we had some free time and decided to take advantage of the tourist attractions and activities .The girls left early in the morning to go white water rafting, while the boys finished up a couple of remaining interviews then went kayaking in the Nile.

White water rafting down the Nile was great! During one of the rapids, the raft tipped so much that Rachel let go of the rope, flew across the raft, and tackled Polly into the water. There were many points along the river where we were able to jump out of the raft and just float along with the current. At one point, the guide yelled at us to jump off while we were in the rapids, which was slightly terrifying. The ride back from the river to the hotel was an added bonus, as we were able to stand on the back of an open truck and we sped along the countryside. When we got back to the hotel, we asked the staff for a clean towel, which somehow turned into an hour long photoshoot with the entire hotel staff. We’re still confused as to how or why this happened, but it was a fun experience.

The boys finished up interviews with a pediatrician and LC5 in the morning, then went down to the Nile River to partake in river activities (aka kayaking). Andrew and Mohit parked their kayak on a rock in the middle of the river, and Mohit made the mistake of letting Andrew man the kayak. The kayak ended up floating away, and they were stranded on the rock, shouting for help, as Matt just watched from the shore. A passing motorboat attempted to push their kayak back to the rock but failed, so a fisherman named Adam XXX (we’re not really sure about the XXX part either) gave Andrew and Mohit a ride to their kayak. On the short boatride to the kayak, he tried selling them flowers. Again, we’re still confused as to how or why this happened. The girls took a boda boda to the Black Lantern to meet up with the boys, where we all caught up with stories from our day and ate more banana crepes.

The next morning, we said goodbye to the staff at the hotel and left Jinja for Kampala. With Polly’s expert(?) navigation, we were able to find the airbnb home that we were renting for our stay in Kampala. The girls met up with Winnie at the African Village Craft Market, where they bought gifts for people back at home. Matt and Andrew went to a casino with the very few remaining shillings they had. Mohit, having learned that there was wifi in our rented home, decided to stay back and enjoy some time away from us.

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For dinner, we had planned to go to a restaurant called Carnivore, which is similar to a Brazilian steakhouse except with exotic meats such as crocodile, ox balls, and buffalo. We heard about Carnivore even before the trip and didn’t have time to go to the one in Kenya, so we were pretty excited to finally go in Uganda. However, miscommunication led us to a similar type of restaurant called Carnival. Although we were disappointed and convinced that the food at Carnivore was better, it was still an experience being able to try antelope, buffalo, and crocodile meat.

On Sunday, we went to Cafe Javas for lunch, where we were finally able to satisfy our craving for “American food”. As much as we enjoyed trying the local foods in Kenya and Uganda, we still missed the comfort foods of home. We met with Dr. Waiswa and updated him on all the insights we gathered during our week in Uganda. We had wanted to go to the RAN lab at Makerere University before we left for the States, but sadly schedules didn’t end up working out.

We stopped by the supermarket on the way back to the apartment to buy dinner, which ended up being old instant ramen that was on clearance because we were running low on money. The wifi in our apartment was limited to 1.5GB, so we had to ration our internet usage. It was stressful trying to count megabytes and prioritizing what was important enough to use our internet for, but it definitely made us appreciative of the unlimited internet back at home. We spent the rest of the night discussing insights from our time on the field, closing up our global trip, and planning the next few weeks when we get back to the States.

We will be flying out tomorrow to head back to Baltimore. We’re sad to leave, and we’ve definitely learned a lot during our past few weeks, but we’re also excited to head back to start translating our observations into design considerations for our device 🙂

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Our Week in Uganda

Thanks to our guide Moses – who has the uncanny ability to find stakeholders for us to interview out of thin air –  we’ve had a very busy and productive week in Uganda.

On Monday, we visited the Iganga Office and met with a group of VHTs who were supported by Makerere University. We gave a short presentation and demonstration of our system and received positive feedback from the VHTs. We then had meetings with the Residential District Commissioner of Iganga as well as a program manager from a local NGO to get feedback on different implementation and distribution strategies of interventions in Uganda. Our last visit of the day was to a private, not-for-profit Health Center level 3 (HCIII) facility, where we met with another big group of VHTs.

We came back to the hotel, where we had tilapia for dinner. The fish must not have come from Lake Victoria, though, because the fish was not as sweet as the one we had had right along in the lake in Kenya. Polly and I also tried to do laundry, which proved to be much more difficult than we expected. We ended up hand wringing soppy, not-so-clean clothes in the dark, wrapping them in towels, attempting to pummel the water out of the clothes, then laying them out to dry in the very limited free space in our rooms.

On Tuesday, we visited a public HCII facility and had a home visit with a group of moms and VHT in a nearby village. All the kids in the neighborhood came and joined the group, so there was a big group of people just watching us do the demo and interview. We went out for street food that night, where we had “Rolex” (pretty much a flat omelet in chapatti) and different meat skewers (including chicken neck and gizzards).

On Wednesday, we visited a HCIV, the Iganga District Office, and the Iganga District Hospital, where we got to see the maternity and pediatric wards. For dinner, we decided to go to the Black Lantern on the bank of the Nile River. We discovered the greatness that is chocolate banana crepes, and we made trips back to the restaurant/hotel just for those crepes.

Thursday was a busy day, as we went to seven different sites. We started by going to a private, not-for-profit hospital. The difference between private and public facilities was apparent, in both the quality of the facility as well as the number of patients (doctor to patient ratio). There were two medical students from Germany who were also observing the Ugandan healthcare system. We then went to Jinja Regional Referral Hospital, which was the highest level hospital that we saw. The pediatric ward was supported by Save the Children, and it was one of the nicest wards we saw in Africa. We then went to Bute Village to do home visits with two groups of mothers at the village. We happened to arrive when the children at a nearby school were on break, so they flocked around and stared at us (and of course, the NeoNatalie). We then went to a private, for-profit facility and the Iganga Office to meet the District Health Officer, then finished off the day at another private, for-profit facility.

The hotel we were staying at in Jinja had very limited wifi (as in no wifi), but thanks to that, we were able to discover dubbed Indian soap operas. Many of the nights we ended up gathering in the lobby to watch the next episode of “King of Hearts” along with one of the hotel staff members.

We only have another full day left in Jinja, and we will be heading back to Kampala for a couple days before we finally head back to the States.

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A (Brief) Comparison of Kenya and Uganda

After spending a few days in Uganda, we’ve noticed some differences and similarities to Kenya. Based on our brief experience and interactions, we’ve been able to observe these comparisons!

The Food
While many of the foods were similar, one of the great finds we discovered in Uganda was “The Rolex.” It is an omelette with tomatoes, onions, bell peppers, and lettuce wrapped in chapati, and is incredibly delicious. On the other hand, the experiences that we had with tilapia were far superior in Kenya, compared to Uganda. This was surprising, since both countries touch Lake Victoria, which is where the sweet tilapia comes from. In both countries, it’s easy to find mandazi (fried bread), chapati, and ugali. We were lucky enough to try street food from both countries, and so far, everyone’s stomachs and intestines have been able to manage it!

The Diversity
Where we were based in Kenya, there was not a huge diversity in ethnicity. Our group often stuck out like a sore thumb, everywhere we went. In comparison, Uganda has been much more varied in the types of people we see around. For example, as we pulled into Kampala, we noticed many signs written in Chinese and Korean. Apparently, there is a growing East Asian population in the parts of Uganda that we were in, which resulted in a lot more Asian culture. Even the supermarkets in Uganda we went to sold items that are commonly found in Asian American shops and stores, which brought a bit of nostalgia to the East Asians on the team.

The Health System
In Kenya, the volunteer health workers were called “Community Health Volunteers” but in Uganda they are called VHTs or “Volunteer Health Team”. In Kenya, the CHVs are trained and strongly linked to the government facilities, with support from partner organizations for additional training modules. However, in Uganda, the VHTs are split into three categories – those that are organized but the government, NGOs, and partners. While both sets of community health workers were originally trained by the government, we found that Kenya’s CHVs were more supported through additional trainings. Also, Kenya’s healthcare system is broken into 4 tiers, while Uganda’s is in 5 tiers. In both countries, the community health workers are the front-line care providers, and there is a large emphasis on maternal and child health outcomes.

The Sights and Sounds
In Kenya, the atmosphere is much more arid, with the most iconic sight being the Masai Mara. Uganda is much more tropical and green, and the Nile is the most iconic thing we’ve seen. In both countries, there is the unmistakable red dust that flies up when we drive along the bumpy roads. Goats and cows saunter along the road as boda bodas zip by, sometimes carrying up to 3 passengers. The heat and mosquitoes are inescapable in both countries, as are the thunderstorms that leave the city in a blackout.

Regardless of the country, everywhere we went, we’ve been treated with incredible kindness and generosity. There is a level of intimacy here that seems to be lacking in America, whether it’s the hotel owner treating you like her own family and offering tea every night, or a hospital administrator inviting you into their institution with a smile and a firm handshake. Even the prevalence of visitor’s books that we sign at every office or building we go to represents a personal touch that we rarely see back in the States. With only a few more days to go, we know we will definitely miss the wonderful people we’ve had the privilege to meet, though perhaps not the spotty wifi that makes it hard to blog!

Inner Musings: Mohit

“To BME, or not to BME? That is the question.” – William Shakespeare-ish

The last few weeks have been particularly exciting. As I semi-sleep through dinner conversations, I get the opportunity to think….a lot! Unfortunately, when your compatriot decides to publish his ramblings from Shanghai (damn you Arvind!), you are left with little choice but to lend words to these thoughts. Hence, this blog entry.

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Hopkins has been a great experience thus far. Apart from unhealthy eating, shoddy apartment-keeping and constant sleep deprivation, the move from India to US has been relatively seamless; mostly because of the people around me. It’s safe to say that in my last four years of college, this is the most inspiring set of people that I have come across. 

The global health trip has a very different ring to it. My thought process as an engineer has been evolving every day. It’s hard to believe the depth of the design methodology that is being put to use for this project.  Two months ago, I could not have even defined “ethnographic research”. Actually I still can’t define it, but we are applying the underlying principles daily and this is precisely what I like about the whole CBID process. Design is no longer focused on using what we know to solve a problem, but on identifying the real problem and figuring out what needs to be known. It’s amazing to observe of how people think, how they express their needs and what motivates them. This human element of design had largely been missing from any of my endeavors before CBID.

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I chose the neonatal monitoring project largely because of the technical challenge it had to offer. At first glance, it looked like a very simple problem, a kind that inspires a few solutions the first time you hear it. The prospects of creating a low-cost solution which could have an high impact checked all the boxes for me. But as we approach implementation research, it is becoming clear how the technical part of the project was never really the central problem. It seems almost foolish that I once treated the “BME” part as the center piece of this problem.

We are continually discovering more variables that can impact our solution. As we make more progress, a new realization has begin to settle in. There is a lot more left to learn, but it is clear that we cannot possibly succeed unless we make the grassroots level connection. Our solution needs to be developed with the community, not for them. It is about reaching the right people, understanding the pains and reservations of each stakeholder and constantly redefining the problem. As much as I would have liked to work on a super high-tech “doohickey”, in Africa, I realized the power that can be encased in just 14 grams of plastic, fueled by a 3.3 V source and some good intentions.

Touchdown in Uganda

Yesterday we flew out from Kenya and landed in Kampala, Uganda. Our host Winnie from Makerere University greeted us at arrivals with an adorable JHU sign. From the airport, we dropped our bags off at the hotel and went to an Asian restaurant at the mall and had ice cream.  Winnie actually spent the last 4 years studying in China so she was well-versed in Asian cuisine and chopstick use. Her Chinese was also better than the actual Chinese people on our team.

After dinner, we rode boda boda motorcycles back to the hotel! In Uganda, they have a boda boda company called Safe Boda that provides safer rides and helmets for the passengers. It was super fun, as half the group had not ridden on motorcycles before.

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Sunsets in Uganda are something else

Today, we met Dr. Peter Waiswa from Makerere University who is a well known public health professor, health advocate, and our connection in Uganda. After our meeting, we drove to Jinja, which is the city closer to the field sites. Our Jinja hotel is run by an incredibly kind woman who gave us a better room rate and threw on laundry (which was a huge break for us because we are quickly running out of clean clothes to wear) and transportation for free. After checking in, and another meeting with one of our field hosts, Moses, we headed to a different resort that had a pool, restaurant, bar, and amazing view of the Nile River.

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Tomorrow, we start our Uganda field visits by meeting a group of Community Health Workers and introducing our device and solution!