Mashavu

‘Twas 5:45am and all through Ivory Hotel,
not a sound could be heard, not even a bell.

‘Til Aaron came round with a loud shout,
and woke us all up, so we could go out.

“Today is the safari!” we all thought with glee,
and even a power outage couldn’t stop our wilderness fantasy.

As we filed in drowsily for a quick bite to eat,
eggs, toast and sausage got us up on our feet.

Our two large buses sat outside waiting,
If we were using Wishvast, we would give them a great rating.

If we were using Mashavu, it might be a bit more trouble,
for 19.5 people per bus may create a health rubble.

At 7am we were off on our way!
Even a 5 shilling bathroom break didn’t dampen our day.

But one crucial thing we all faced with regret:
Marshmallows are one thing to never forget!

Our journey continued to a souvenir shop,
where some purchases were quite a pop.

1:30pm and we finally arrived at our destination,
where paying $15 per student created some frustration.

In reality, we were just tired and hungry.
Even the view of Mount Kenya couldn’t keep us from grumbling.

Thanks to our talented chefs, we soon received a filling lunch.
Ham “sandwishes” with cheese, tomato and onion gave our hunger a punch.
(No ketchup or mustard, but to expect that on a safari would be quite the hunch!)

At 3:15pm, we entered Meru Park and began to look for animals.
Luckily, we avoided all their dangerous claws.

Zebras, antelopes and elephants all were seen,
upon entering the rhino sanctuary, we watched rhinos and giraffes preen.

It was getting dark, and we wanted to be safe,
so we left for our campsite before it was too late.

At 6:30pm we arrived at our camp,
we set up our tents with no help from any lamps.

Flashlights and headlamps were all that we used,
along with some staff from CYEC that accrued.

Supposedly 3 people were arranged per tent,
but later in the evening that rule would be bent. 

At 7:30pm our dinner was ready!
Everything so far was good and steady.

We had delicious veggie soup and an African dish pronounced “Peel-ow”,
Although there was no meat, nobody was down.

The rice and veggies kept us full and happy,
even though later on we sang karaoke around the campfire that might have been sappy.

After an hour, we settled down for some entertainment.
Dr. Butler brought a travel guitar and gave it 100%.

Bello, Colin, Alice L, Min and Mike S also played a few tunes,
While everyone else sang and then laid down to watch the stars and the moon.

It was a full moon and we weren’t superstitious,
but a few people saw eyes that may have been vicious.

They thought it was hyenas that might have been nearing,
but it turned out that there were only harmless deer in the clearing.
(but this was only discovered as the morning was nearing!)

There was no electricity and only the moon shone,
The campfire burned bright and gave us feeling that was comfortable and well known.

The bathrooms contained toilets and showers,
but since it was dark we just peed by the trees and flowers.

At 2am we exhausted ourselves and (almost) all fell asleep,
dreaming about the new adventures tomorrow would reap.

Authored by: Alice Cheng

Jambo! Today was our second clinic day and it was very busy to say the
least. It was technically our earliest start as the entire Mashavu
team left Hotel Ivory by 6:45AM. Things didn’t go exactly as according
to plans, but we ended up gathering everyone together and leaving
Ivory by 7:00AM to arrive at CYEC by 7:30AM. We spent the first hour
setting up for the clinic: we decided to setup 2 fully functioning
kiosks, have a kiosk response station, interview and focus groups, and
a doctor clinic. This mashavu clinic was different from the first one
in several ways. First, the patients that came were all university
students from a local college in Nyeri. All of the students were over
18 years of age and spoke fluent English so we did not have to worry
about having translators available at any of the stations. Besides the
demographics, the operations of the clinic was also different: instead
of having pre-mashavu interviews, we received verbal consent from the
patients and then had them come into the clinic to get their vitals
first. After receiving their vitals from the first station, they could
go to the second station where a second kiosk operator could obtain
their contact, social, and medical history. Interviews and focus groups were held afterwards to get a sense of what the students thought about Mashavu in their community. Most importantly, though,
we found the link!

Each person was assigned a specific role for the clinic. Brianna and
Bello were in charge of welcoming the patients and getting
consent/recruitment at the start of Mashavu. Julie and Steve were in
charge of kiosk 1 and Rene assisted them with acquiring the medical
history after the patients received their vitals. Similarly, Rachel
and Pat were in charge of kiosk 2 and they were assisted by Tara S.
After going through the actual clinic, most patients would go to the
interviews section which was led by Carey and Alice C. Some patients,
however, were selected to attend the focus groups which were run by
Brianna and Alice. After going to interviews and focus groups, the
patients would then go the kiosk response station which was led by
Tom. Finally, Ross and Carol were on hand if any of the patients
required additional attention.

Here is a breakdown of a typical Mashavu encounter that a patient
would have experienced today. We transported all of the patients from
the university to CYEC through a couple matatus. When the patient
arrived, Brianna and Bello greeted them and acquired informed consent.
Our education team consisting of Shengian, Alice L, and anyone else who
had some free time. Once the kiosk operators were ready, Samir and/or
Tara Y would escort the patient from the line to the clinic. Upon
entering the clinic, the patient would be greeted by our CYEC helpers.
They would first take the patient to the vitals station where the
patient first got his or her height measured. The patients would then
come back to the vitals station where the following off the shelf
devices were used: weighing scale, blood pressure cuff, thermometer,
and a shared pulse oximeter. Additionally, the two kiosks had the
Bio-E’s blood pressure cuff and pulse oximeter. The weighing scale and
the stethoscope were not operational in time for the clinic. One of the Bio-E
thermometers also ended up failing in the morning so it was removed
from the list of devices.

Once the patients received all of their vitals, they would receive a
slip of paper with their vitals and then would go to the second part
of the kiosk where their medical and social history was entered. The
slip of paper was vital because it had the biomedical device
measurements that the second kiosk operator would use to enter into
the Mashavu program. Afterward, the patients would provide their
contact information to the operator, get their picture taken, and
finally go through the social and medical history. Once all this
information was captured, the data was saved locally on the kiosk
computer and then sent over the internet to the doctors (first part of
the link complete!).

After leaving the kiosk, the patient went to a post-Mashavu interview
with either Alice Cheng or Carey. In place of a post-Mashavu
interview, groups of students were invited to participate in a focus
group with Brianna and Alice Lee to give feedback on the Mashavu
experience. During these interview and focus groups, we provided the
students with some biscuits and juice! While the patient was in the
interview or focus group, the doctors were reviewing the medical
information that was electronically sent to them. The doctors logged
into the Mashavu website and selected their respective kiosk. From
there, they could see new patients that were going through the Mashavu
clinic and could select specific patient files. All of the medical and
vital information that was collected at the kiosk was available for
them to review remotely. Once reviewing that information, they could
comment on the case on the website and that information was directly
transferred to the kiosk response station electronically (second part
of the link complete!) When patients finished the interview or focus
group, they would go to the kiosk response station where Tom would
tell the patients that comments given by the doctors. Tom received the
responses of the doctors via email directly on the Mashavu program.
Most patients that we saw today were healthy, but there were a select
few who the doctors requested to see for a more thorough checkup.

Over the course of the day, 35 people were Mashavued. The clinic
officially opened at 9:00AM but the students from the university
actually arrived at the CYEC at about 10:30 (that’s Kenyan time for
you!). We finished seeing all the patients by about 1:30PM and were
back to the Ivory by 3:00PM. The student-made biomedical devices worked well. One of the thermometers had a broken circuit, but was quickly fixed later in the evening by replacing it with a different circuit. Although the adult scale was not used, the blood pressure device, pulse oximeter and even spirometer were all used. Because all three of the commercial mercury thermometers were broken the previous day, patients had to use oral thermometers under their arm in place of the mercury thermometers. For the next clinic on Saturday, we will be sure to have enough mercury thermometers, even factoring in breakages!

After returning to Ivory Hotel, the students lounged around. Some did laundry, while others grabbed a bite to eat at the restaurant (along with Tuskers, the local beer). A local woman selling tongas, traditional African clothing, came by. Students ordered flip flops, custom tailored dresses and shirts and large scarves with bold patterns.

At 8:00 PM, we had another meeting to recap the day, sans our fearless leader, “Dr. Khanjan” (in the words of Bello). However, Dr. Butler proved valiant in leading the Mashavu team throughout the past 24+ hours while Khanjan, Jeff K and Roma were in Nairobi. They will be returning late this evening.

Tomorrow we go on SAFARI!!!

Today’s lovely post written by Samir Patel (mostly) and Alice Cheng!

Steve, Rachel, Samir, and Gill giving each other backrubs after a stressful day.

     Everyone woke up this morning early and it was raining outside.  The decision was made to stay at the Ivory Resort rather than walk to CYEC.  We started out with a small brief meeting where we talked about what we will be doing for the rest of stay in Kenya and who is in charge of upcoming events. Alice L, Gill, and Tom worked on getting logistics ready for the clinic at the CYEC on Wednesday. The people who will be running through the clinic on that day will be students from the Kenya Methodist University.  All of these students will be very fluent in English.

     Carey, Alice C, and Brianna will be in charge of arranging the logistics for the clinic on Saturday where more university students will be “Mashavu’ed”. After some initial talking with Andrew, we found that 30 to 100 people will be coming to the clinic on Wednesday.  Ideally we would like at least 50 people. We will leave at 6:45 AM on Wedsnesday and the clinic will start at 8:00 AM.  Before the clinic starts the CYEC students and the kiosk operators will be taught how to use the additional instruments that will be added to the kiosk and we will set up chairs, tables, and power cords for all of our computers.

     The biggest difference between Wednesday’s clinic and last Saturday’s clinic is that we will give the patients a full Mashavu experience by including a response kiosk. This kiosk will show the patients the doctor’s response. The patient will first give consent in line to go through the Mashavu system. Patients will then one at a time enter a room and go to one of two kiosks with two computers at each. The first computer at each kiosk will utilize the biomedical devices to measure patient’s vitals. There must be a separate computer in the room that will connect to the commercial pulse oximeter and the reason behind this is that it uses a different program and we only have one of the instruments. The commercial devices will also be used to take actual measurements and these numbers will be written down on a piece of paper.

     Next they will move to the other end of the kiosk where their social and medical history will be recorded. Their vitals will also be recorded in LabView and all this information is sent to the doctors from this computer. At this point the patient will move to one of two places: an interview or a focus group. The interview is ten minutes long and ask ten questions about their experience at the kiosk. The focus group asks middle age women about social issues in Kenya. When the pateints are done with their interview or focus group, they will go to another kiosk where they will be shown the response from the doctor via an internet connection. If they doctor responds that they need to see a doctor, then they will go to a clinic at CYEC where they will be seen by Carol or Ross. If the doctor responds that they are completely healthy, then they will have completed the Mashavu experience.  If a line forms at any point during the day, the students will be shown educational materials. Since they are highly educated, we’ll ask them how to improve upon the materials.

     Tom, Alice L, Alice C, Carey, Shengnan, and Gill went to CYEC around noon to confirm this information about the clinics on Wednesday and Saturday. They also ate lunch there and walked back in the afternoon, where everyone else had a laundry party (there’s a whole lot of clotheslines and cleaned clothes around the Ivory Resort right now!) and relaxed after all the stress from the past few days.  All the surveys were typed up and saved to computers today – healthcare surveys had 50 people and fun surveys have 50 people.  Systemic Assessment outline the paper on the assessment methodology today as well.

     Alice C improved upon the appearance of her under the arm thermometer by inserting the thermistor into a pen casing. Bello worked on the spirometer to make sure that contamination of the device doesn’t occur. He decided to use a cardboard mouthpiece and a one way valve to fix this problem. The spirometer programming will be worked on tonight to get it prepared to work tomorrow. There are no commercial thermometers to compare the bioe thermometer to, but it will still be used tomorrow. Improvement were not made upon the weighing scale so that will not be used tomorrow. The stethoscopes are also not ready to be used tomorrow either, so they will not be used.

     Jeff and Samir are going to Nairobi this evening in preparation for next week’s clinic. Julie, Steve, Colin, Dr. Butler, Brianna, Ross Reife, and Carol Reife went to go run a demo of the Mashavu system at a hospital. Julie, Steve, Colin, and Roma worked in the morning to get the devices ready for the demo. The pulse function of the pulse oximeter and the temperature intruments were working previously, but they found out this morning that they were not working properly. The blood pressure cuff was the only instrument that worked for the demo.

     The demo started at Providential General Hospital and met with the doctors and nurses there.  There was a question and answer session about the feasibility of the Mashavu system, and then the demonstration was performed.  Overall they thought it was a good idea but they wanted to see the full Mashavu system.  Their biggest concern is that the novelty of the system will wear off after time.   They then showed the Mashavu demo at the second location, Outspan hospital and then a focus group with the doctors and nurses there was conducted as well.  The second hospital thought the system might work will in the triage section of a hospital, and also stated they wanted to see the entire system.  Overall the Mashavu system showed promising interest from the hospitals.

Blog 5/23

Interviews

health care 38,
fun 21

We headed back to CYEC today to work on the bio devices, kiosk operation, and to conduct
interviews. The boys headed down to the soccer field first thing in the morning to try out
the baseball bat they made with the kids. The group that was conducting community surveys had to postpone
their trip until after lunch because the CYEC and the students
that were donating their translation skills were occupied by a visiting film crew. The morning
flew by and we were all happy to have lunch at CYEC again after waiting two hours for dinner
last night at Ivory. After lunch some of ventured back down to the soccer field to teach
the kids baseball, although they had never played, some of them were hitting the ball better
than us. Meanwhile, Brianna, Tara Y, Rene, Gill, and Shengnan finally headed out to conduct their surveys.
The afternoon was quite successful and the youth they travelled with to help translate did
a great job connecting with the community. In all, 38 health care surveys and 21 surveys on
what Kenyans do for fun were recorded. A quick debrief at the end of the night revealed Mashavu
would be conducting two demos in Nyeri tomorrow afternoon. On a side note, some of the girls finally decided
to do some laundry and after hanging everything out to dry they received an additional rinse
cycle as the rain finally came pouring down for the first time this trip.

Carey and Roma had the opprotunity to spend the day with Khanjan and here is the account of their day:
We got a late start to the day because our taxi driver showed up at 9:30am instead of 8:15am as scheduled. Khanjan, Mary of the CYEC, and two members of the Mashavu core team had scheduled a number of meetings for the day, the first of which was with the Medical Superintendent of the Public General Hospital in Nyeri, Dr. Ngugi.
Although we arrived for the meeting an hour late, we still beat Dr. Ngugi to his office as he was running even later than we were. We first explained the Mashavu system and then discussed scheduling a focus group at the hospital with local doctors, nurses, and community health workers to demonstrate the system and discuss potential areas of improvement. Dr. Ngugi was very enthusiastic about the project and about the potential of telemedicine in general. Although the community health workers will be more difficult to track down, the focus group was set for 2:30pm tomorrow. We also asked Dr. Ngugi to recommend potential clinic sites and we will hear his advice in that area tomorrow.
Following that meeting and the arrangement of a new taxi driver to replace the tardy one, we drove to the Ministry of Public Health and Sanitation to meet with Dr. George Ngatiri, Provincial Director of Public Health and Sanitation, and Dr. Gichuyia Nthuraku M’Riara, Provincial Medical Director. Patrick, Deputy Director of the CYEC, and the two doctors who have been assisting the Mashavu project, Ross and Carol, joined us as well. After gathering chairs from an adjoining room in order to accommodate everyone, we introduced ourselves and discussed both Mashavu and Ross and Carol’s medical database project. Both doctors were extraordinarily supportive and expressed interest in attending either the demo at Public General Hospital or the clinic at Mary Immaculate in Mweiga next Monday. The doctors brought up the current trend in Kenyan public health away from communicable diseases towards more non-communicable diseases such as hypertension and diabetes and potential Mashavu applications in those areas. This was interesting as Dr. Ngugi had also brought up problems treating the increasing numbers of diabetics and hypertensive patients.
We switched drivers again following this meeting as our previous driver (the second of the day) had not yet returned to pick us up when we left. From there we continued to Mweiga to meet with Sister Veronica of Mary Immaculate. We were initially received by Sister Mary and we shared coffee while we waited for Sister Veronica. The coffee was cold which we all thought was great since it was very warm out but Sister Mary was mortified because apparently in Kenya it is an insult to serve a guest a cold drink. Once we had convinced Sister Mary that we were enjoying the cold coffee, Sister Veronica arrived and we began discussing logistics for the Mashavu clinic to be held at Mary Immaculate on Monday. After ironing out the details, we toured the facilities and outlined the organization of the coming clinic.
Once a tentative plan was in place, we said our thanks and goodbyes and continued on to Kimathi University to meet with the Dean of Students there. Prior to our meeting, Khanjan and members of the CYEC staff had discussed with the Dean the possibility of having some of the students there out to the CYEC this Saturday to provide feedback on the Mashavu project. The Dean was very supportive and logistics were put in place to be confirmed later on via email.
From the University, we returned to the CYEC to rejoin the rest of the team, zigzagging back and forth across the road the whole way to avoid the maze of potholes. All in all, the day was very successful. We put plans in place for a number of clinics and focus groups and were enthusiastically received by everyone.

Monday on the BioE front was filled with running tests and tinkering with our devices in an attempt
to produce some compelling results. The blood pressure cuff, our pride and joy, works like a charm and
produces accurate results consistently. The thermometer also seems to be adequate, despite Alice C. somehow
managing to shatter three commercial mercury thermometers in a day and a half, leaving us without known values for
comparison. We’ll let it slide this time because she is one of the few with a quazi-working device and they aren’t
too expensive to replace. The pulse oximeter team spent most of the day rewriting their labview program to be more
simplistic and mesh better with the other devices. The rest of the day was spent trouble shooting this new program
and continuing to decipher the problem behind the erratic oxygen saturation readings. Apparently Jeff, Pat, and
myself have around 219% oxygen in our blood? I think that’s more than Batman. But I digress. The pulse oximeter does
yield accurate heart rate readings and pulse waveforms. The spirometer is still struggling but we’ll get back to you
all about that,hopefully with some good news. Dr.Butler finally arrived yesterday after a cancelled flight due to
volcano ash, lots of waiting and layovers, and lost baggage. He did, however, bring with him a soldering iron and
peak flow meter, two extremely crucial instruments in our tinkering efforts. The peak flow meter allowed us to
digitally detect a patient’s force expiratory volume and peak flow rate and to calibrate our spirometer calibrator. Sorry
for the redundancy; we’re still quite confused ourselves. Jeff and myself stayed up late last night with the help of
Khanjan, Chanakya, and our newly aquired soldering iron to finish making the new circuit board that we will use for the
adult weighing scale. Upon completing, we handed it over to the electrical engineers for a more comprehensive analysis
and troubleshoot. Lastly is the stethescope, which had a pretty good day at CYEC. Dr. Butler worked for hours with
Tom on filtering the sound received from the device. Their solution was to encorporate a second microphone which
detects only background noise and use that to remove the noise from the actual, desired signal. All in all, it was a
successful day at the CYEC. Each day I see progress on the devices as new ideas are formed and minor breakthroughs
are made. About half of the devices work completely and accurately, and the rest are extremely close to completion.
We have one more day to finish them up and I have all confidence in my BioE team. Tune in later to see what tomorrow
will bring.

Like the other six days, this Sunday morning too is a beautiful one with the busy snow white clouds moving eastwards adapting more of a grayish color. The leaves scented breeze is a little cold with slight warmth, so today might be the first day we are experiencing rain in Kenya. This didn’t discourage the happy energetic birds, because they are carelessly singing and chirping here and there. It is around 8:45am but the private and commercial vehicles look like they have been circulating around the city of Nyeri with the red rich loamy soil embedded into their tires all night.

Waiters of Ivory resort Hotel are already in the conference room that is been used for breakfast and meetings with flasks of tea, ceramic cups and coffee beverages waiting for the Humanitarian Engineering group to stop by for breakfast. They have been there since 7:00am without knowing that everyone is allowed to sleep to 9:00am. With a smile on the elderly waiters face who was wearing a slightly worn out blue suit, he asked me to stop by for a grub, and politely told me that no one stopped by for food. I replied to him with a relatively wide smile on my face and walked out to the front yard of the hotel to get my daily share of nature’s gift; the delicious natural smelling air, green leaves and flowers, the slight warmth of the air.

After 10 minutes of appreciating having the chance to be here, I happily walked back to the conference room to get breakfast, where I met about five of my colleagues biting and chewing their sausage, bread, fried eggs and salad, and sipping their steamy hot tea and coffee. Without wasting anytime, the lean waitress with thick curly black hair, white shirt and black slacks horridly walked to my table and poured me a cup of steamy hot water. She reminded me that I don’t want milk in my tea, and sausage on my meal. I gently said yes, impressed. Her name is maybe Grace or Naomi, I couldn’t remember unfortunately, but amongst 37 of us, the 5ft kind waitress with thick black lips remembers exactly what I like to order for breakfast.

Despite the fact that I was very tired the night before, I feel good this morning watching my colleagues walk into the conference room for morning food. The smell of fresh oranges, water melon, fried eggs and coffee is mixed in the room air while I chewed on my last piece of soft organic wheat bread.

Time flew like a scared bird before everyone assembled at the conference room for the daily briefing at 10:30am. All the teams (Mashavu, WishVast and Essential Design) reported to the coordinator, Khanjan Mehta about the projects, clinics and general progress. Various members of the groups and kiosk operators described their major success and milestone. As a kiosk operator, I detailed how my kiosk went, and how the CYEC students picked up the whole diagnostic process really fast. I was happy to talk about it. Mr. Khanjan then informed us that Dr Peter Butler (Bioengineering professor at Penn State who got his initial flight cancelled) had arrived in Nairobi and he will be joining us later in the evening. He then outlined the events and work for the next three days. The meeting was dismissed at 11:49am as everyone dispersed to either having launch, or getting ready for the field interviews.

At noon, the atmosphere was filled with music from shops and cars, and the noise of the vehicle mostly Mutatus boasting of Kenyan pride, cruising on the dusty and bumpy Kenyan roads. Most of my colleagues ordered chicken, chips (fries) and chipati for launch. I had some fries with some Nigerian spice I brought with me, and drank from my Highlands water bottle.  I was assigned an interview team, consisting of Alice Lee and a young man from CYEC called Duncan. Duncan is a local, so having him was a good thing because he can translate to us information that we cannot understand at the interviews. We walked into a nearby neighborhood and started interviewing people about fun and entertainment. It was a great experience because the place consists of a diverse group of people. There are single old women who only take care of their goats and depend on their siblings for income and university professors who live in nice condos. There are law enforcement officers who have so much to say about the political system in the world and Kenya, and there are a lot of students who just want to make a decent living and live their lives in Nyeri.

At 6:00pm, we called it a day and walked back to Ivory resort. We talked about how great it was to go into the community and have a feel at their worlds. Most of the group members were back and sitting in the front porch of the hotel having dinner. We ordered dinner and went into the debriefing meeting of the day at 9:00pm. The sky was clear with the moon bright white in the middle of the sky and I wondered whatever happened to the grey clouds early in the morning. It didn’t rain and the air was slightly chilled and smelt really good. Dr Butler arrived and without wasting anytime, he started working with us to get all the Bioengineering devices in perfect working condition.

As usual, Mr. Mehta coordinated the meeting this night. He started by asking the interview teams about their experiences that day, and fortunately there were a lot of funny stories out of them. We then went over the progress of the devices and called it a day. Most of the teams went into working on their devices while others went to bed to get good rest for the next eventful day.

-bello

After a long day at the clinic, we were treated to a lovely dinner at the Banana Leaf. The dinner consisted of an array of authentic Kenyan dishes from pumpkin and coconut soup to cow intestines mixed with small pieces of cow stomach lining. Many of us decided to try a little bit of everything, not knowing exactly what we were eating until Graham announced that the dish which looked similar to noodles was actually cow intestine. Overall the food was very good and unique. The restaurant played current popular American music and allowed a few of us to connect our ipods to the dj station. Everyone enjoyed the dinner experience and it was truly an excellent way to conclude the first successful Mashavu clinic.

This morning we began the day starting with a debriefing session at 10:30 am. We discussed the important points that were successful during the Mashuva clinic and what could be done better for the next clinic;we also set our plans for the rest of the day. Brianna, Gill, Rene, Shengnan, Alice and Bello were broken up into teams of two to conduct social surveys in the local area which consisted of health questions and another which asked questions about what Kenyans in the area do for fun. Brianna and Gill worked together with David, member of CYEC, and Alice and Bello worked alongside Duncan, member of CYEc, to collect data about what Kenyans do for fun. The members of the CYEC helped translate the questions to the villagers and the answers that were given. Shengnan and Rene worked with Ms. Ebdallah, member of CYEC,as their translator to ask the villagers questions about their health. All groups encountered similar issues with langauge barriers and the hestitation from the villagers to participate. Many villagers didn’t exactly understand why collecting this information was important and were expecting  something in return for their time. Another problem that arose was some of the questions that were being asked seemed to mislead the villagers. The fun survey consisted of a question that asked what would you do if you were given a 100 schillings, many of the villagers thought they would be recieving 100 schillings at the end of the survey. The groups came across many interesting people and recieved some very good data.

The rest of the Mashavu team spent the day re-evaluating how to improve their specific part and caught up on improving sections that needed to be updated. Roma and Samir re-evaluated the concept of operations. At future clinics the process will begin with collecting the patients vital signs at the first computer, then collect history and contact information at the second computer, from here the patient will continue to the post-interviews then meet with the doctors. The assessment group spent time putting the data collected from the vital signs into the computer database. Steve continued to work and improve the labview program.

    Jambo! The day started bright and early in preparation for our first clinic.  The Mashavu team left Ivory by 7:30am and made it to the CYEC around 8am.  We spent the first two hours setting up the physical clinic, creating three independent kiosks.  We also arranged 2 stations for pre-Mashavu medical information collection and 2 stations for post-Mashavu interviews.  Additionally, the doctors (Carol, Ross, and Susan) set up a room to examine the patients at the end of the Mashavu experience.  Each person on the Mashavu team played a vital role in the concept of operations of the clinic.  Julie and Brianna were in charge of welcoming and consent/recruitment at the start of Mashavu.  Rene’ and Tara Y were responsible for pre-Mashavu information collection.  Kiosk 1 was run by Alice L and Bello, Kiosk 2 by Rachel and Pat, and Kiosk 3 by Jeff and Colin.  Alice C, Carey, Tom, and Tara S performed post-Mashavu interviews and Shengnan guided the patients from the interview to the doctors.  Lastly, Steve, Gill, Roma, and Samir concentrated on troubleshooting and overall management of the clinic.
   

    The Mashavu experience for the patient was the following.  When the patient arrived, Julie or Brianna greeted them and acquired informed consent.  Each patient was given a copy of the Mashavu consent form before moving on to the next step in the experience.  The patient went to one of the two pre-Mashavu stations with either Rene’ or Tara where the patient gave contact information, case information (health complaints), and medical history.  Tara and Rene’ recorded all information onto paper for the patient to take with them to the kiosk.  The patient then entered the kiosk room and were directed to one of the three kiosks.  Kiosks 1 and 2 were for adult patients and Kiosk 3 was for children.  Kiosks 1 and 2 had the following off the shelf devices: weighing scale, blood pressure cuff, thermometer, and a shared pulse oximeter.  Additionally, the two kiosks had the Bio-E’s blood pressure cuff, thermometer, and pulse oximeter.  Kiosk 1 also contained a webcam used to take a picture of the patient for their account.  When the patient arrived at the kiosk, they got their height taken, followed by measurements from all of the devices.  At least one of the CYEC students was helping to operate each kiosk; they took measurements using the devices and also aided in communication between the Mashavu team and the patients.  The numbers collected from the devices were recorded and copied onto a slip for the patient to take with them.  While the measurements were being taken, the hand written pre-Mashavu information was typed into the computer into the patient’s file.  After leaving the kiosk, the patient went to a post-Mashavu interview with either Alice Cheng and Carey or Tom and Tara S. In place of a post-Mashavu interview, six women were invited to participate in a focus group with Brianna and Gill to give feedback on the Mashavu experience.  Following the interview or focus group, the patient was directed by Shengnan to the doctors.  One of the doctors performed an examination of the patient to conclude the Mashavu experience.  The doctors noted that Nurse Mary was critical in aiding them in the examinations, offering insight into what was the best treatment available.  Besides operating the kiosks, the CYEC students were very helpful in the overall running of the clinic.  This was particularly tru`e for increasing communication between the Mashavu team and the patients; the students were able to clarify what we were saying in English using Swahili words.  The clinic was officially open from 10am to 3pm but the final patients finished up with the doctors around 4pm.  Approximately 40 adults and 10 CYEC students (over the age of 18) went through the clinic during the 5 hours.
   

    During the course of the day, 52 patients were Mashavued. Many of the patients had serious health issues and were at the CYEC to take advantage of the free clinic offered by the doctors. High blood pressure was very often observed and it is important to incourage awareness about this problem because there are no noticable symptoms. The Mashavu clinic can take vital measurements, blood pressure, height, weight, temperature, heart rate, % oxygen saturation, spirometery and health history questions, so people can catch their health problems before they become serious. One of the goals of Mashavu is to increase awareness about health care, particlarily about preventative care, and yesterday at the clinic we accomplished this.
   

    Both off the shelf and BioE devices were used for comparison purposes.  The BioE weighing scales immediately saturated so they weren’t used during the clinic.  The BioE team is currently rebuilding the circuit to get it working for our next clinic.  Because the off the shelf scale (in pounds) was used, the patients were confused at the numbers they were seeing for their weight.  The BioE blood pressure cuff gave consistenly similar readings to the automated off the shelf blood pressure device.  Off the shelf thermometers weren’t used orally due to cleanliness so instead temperature was measured either in the crease of the elbow or in the armpit, sometimes over clothing.  Both the off the shelf and BioE thermometer were giving low readings but this was most likely due to incorrect placement.  From now on, we will be using new mercury off the shelf thermometers and placement in the armpit.  The off the shelf pulse oximeter isn’t giving accurate measurements so calibration of the BioE pulse oximeter isn’t currently possible.  The BioE version is giving accurate pulse rate but needs work on the oxygen saturation measurement.  The spirometer and stethoscope were not used at this clinic but are continually being worked on; there are some mathetmatical and filtering issues to be solved.  Our current plan for the weighing scale, blood pressure cuff, and thermometer is to compare values from the off the shelf device to the BioE device for calibration purposes.  We also plan to work on getting the internet working so that the information can be sent over Gmail to the doctors.  Lastly, today will be used for surveys in the community and completing work for the 2 upcoming clinics.

Thanks for reading!

Today was a very busy day for the Mashavu team since it was our last day to prepare before our first clinic, which will be held at the CYEC tomorrow.  All teams were working fervently to tie up the necessary loose ends.  Working with the students was a priority for all teams, as the students will play an integral role in the clinic.
One main goal for today was to thoroughly educate the students about Mashavu.  The first step for this included breaking up the older CYEC students into groups of 4 or 5 in order to go over the basic Mashavu information.  We reviewed an outline that specified what Mashavu is, who will go to a Mashavu kiosk, why people will go to a Mashavu kiosk, the chain of events that will happen throughout the entire Mashavu experience, what each biomedical device is and what it measures.  We broke into groups to make the students feel more comfortable, in the hopes that they would then open up and talk more.  It worked; many of the students became much more responsive.  After about 25 minutes, the groups rejoined to play a game – speed Mashavu trivia.  The first to answer the question got a point.  This game really opened up the students and made it evident that most understood the concepts we had reviewed.
The students were then taught the Hokey Pokey game, which they thought was hilarious.  Tara and Rene then acted out a short skit of the kiosk operator and patient, to walk the students through the details of asking the questions.  As Rene acted out the parts, Tara narrated where different actions, such as using the biomedical devices, would take place.
After this game, Mashavu team members reviewed all “social and family history” and “medical” questions, that will be asked to the patients to make sure they understand everything that will be asked.  These included terms like nauseous, nasal congestion, wheezing, and bruising.
The Systemic Assessment team met with Mary to go over all the interview and focus group questions.  Wording and social appropriateness needed to be confirmed for all of the medical history questions, interview questions, and focus group question.  They then integrated their assessment plan into the concept of operations so that tomorrow’s clinic will yield a large amount of data.  Rachel, Tara, and Carey met with Samir and Roma from Concept of Operations to develop a way to evaluate the success rate of the devices.  Excel sheets were made to log data after each kiosk and word documents to log interview and focus group information.
The BioE team worked on all devices.  The main problem with the stethoscope was that the background noise could not be filtered out.  Thus, the heart and lung sounds could not be heard clearly.  Because there simply wasn’t enough time to fix it today, the stethoscope will not be used in the clinic tomorrow.
The blood pressure cuff had initial errors this morning but this was quickly fixed by  tweaking the code.  Right now both blood pressure cuffs are working.  Both were tested on multiple Penn State students and then compared to values taken from off-the-shelf devices.  Fortunately, the results were both reasonable and similar.
A huge mess was discovered when the spirometer’s code was analyzed.  The old code was quickly scrapped in order to start from scratch.  Pat Hoopes is currently working on writing the new code.  Today he worked with Aaron to figure out the physics behind it, including fluid mechanics and other principles from Dr. Mannings BioE 409 class.  Because the code is still being written, the spirometer will not be used tomorrow.  It should be used for our future clinics.
The thermometer works!  It has been working since yesterday.  Alice Cheng found the calibration constants by heating a hot water bottle to various temperatures and compared these temperatures to those measured by a commercial thermometer.  The average difference was found and then used to find the calibration constant.  The instrument was adapted so that it no longer wraps around the head; instead it goes under the arm.  The values were compared to off-the-shelf devices and the percent error was very small. Although one thermometer needs a bit of tweaking before the clinic tomorrow, we will have two functional thermometers by tomorrow.
The decision was made to nix the baby weighing scale and just use the adult weighing scale.  Although both scales have the same circuit and code, for some reason (yet to be understood) the baby weighing scale is not working.  If babies do need to be weighed, the cushioned basket from the baby weighing scale will be placed on top of the adult weighing scale, which will then be tared.  However, this is not expected to be a big concern, as our expected patients are mainly adults. It was calibrated by weighing a 10 liter water jug on an off-the-shelf scale.  This read 22 pounds while the adult weighing scale weighed 21 pounds.  Although a more thorough calibration will be conducted in the future, this showed that the values are very comparable, for now.
The pulse oximeter is now working.  A few tests were conducted to compare it to an off-the-shelf device. The IR light wave has no pattern.  It is not sinusoidal and has no distinguishable pattern.  It will be used tomorrow, mainly for heart rate, but oxygen level readings will also be monitored.
The BioE team showed the older CYEC students the entire Mashavu user interface with two devices – pulse oximeter and thermometer – attached.  Every student acted as either the kiosk operator or the patient.  Students took instrument measurements from each other and within only ten minutes some students were able to use the entire LabVIEW program, acting as the kiosk worker.  One leading student then used Swahili to teach the other students how to work the program.  This generated a lot more interest for the students and helped with clarification.  It is estimated that at least 5 students can operate the kiosk smoothly, with minimal outside help.

Our CYEC champion Patrick showing another student how to use the system

The Concept of Operations team worked to iron out all kinks and plan every detail for tomorrow.  We will be arriving at the CYEC at 8 am to have the clinic set up in the main orientation room by 9am.  There will be three kiosks within the big room.  At every kiosk there will be a BioE student, CYEC student, and Mashavu core team student.  Once the contact information is filled out, the medical data will be taken by the devices.  The rest of the information, which will be taken while the patients are in line, will be entered into the computer by the BioE student while the CYEC and core team students are greeting the patients.
The thermometers and spirometers will be cleaned by using either vinegar or rubbing alcohol.  Once all the data has been gathered, the patient will be given a slip of paper with the template of the Mashavu stamp.  This design includes the elephant emblem of the Mashavu experience and spaces for all of the data.  After the patient leaves the kiosk, he or she will enter an interview or focus group for 15-20 minutes, if he or she gave consent while standing in the line.  Afterwards, they will visit the doctors (Ross and Carol Reiffe and Susan Burriss), who will have already reviewed the medical information, which was sent to them via the internet.  Although the doctors will have already made comments about the patient, based solely on the information collected by the devices, this will be the time for the doctors to compare their initial responses to those made after seeing the patients face-to-face.
Gillian went with Mike (from the EssentialDesign team) Khanjan, and two other men to the town of Nyeri in order to run errands.  Although the ride wasn’t very long, the holes in the dusty road made the ride go much more slowly.  The snow-capped top of Mount Kenya was a gorgeous sight with the cumulus clouds setting a fantastic backdrop.  When they arrived in Nyeri, Gillian spent 3600 shillings grocery shopping for all the Penn State students while the men went to the hardware store to get estimates for the materials needed for the EDSGN projects.  Gillian went with Khanjan and Andrew, from CYEC to a cyber cafe to make about 300 copies of surveys, consent forms, and other papers necessary for the near future.  One computer was missing the enter button, and had just a small metal nub to push. There was a fake 1000 KSh note stuck on the wall. The woman behind the desk explained that counterfeit bills are determined by holding them up to the light to view the watermark. Fake bills have closed eyes on the face of the watermark, while real bills have the eyes open. One can say that it was an eye-opening experience!

Christ from the Essential Design team, after a day's field work and playing soccer with the CYEC kids

Last night, in the gentle tropical breeze and shivering palm tree shadow, we arrived in Nairobi, Kenya. The first night was peaceful and everyone got here safe and sound. This morning, we had breakfast at two local restaurants and experienced for the first time the Kenyan concept of time. What would take the Waffle Shop in State College 10 minutes took almost an hour here. After that, we went to visit the Giraffe Park and the Animal Orphanage. Many of us “made out” with the two beautiful giraffes. Don’t worry – their saliva is anti-bacteria. In the Animal Orphanage, a girl on our team experienced an epic scene – a monkey who escaped out of the cage saw her banana and robbed it! We saw many other animals that star in “Lion King”, including a sleeping lion, cheetahs, ostrich, warthogs, and leopards. We continued on our journey, and arrived in the “Ivory Resort” in Nyeri. This is where we will be staying for the next three weeks. Tonight, we had several meetings to discuss the big picture and specific plans for our time here. The busy night foreshadows our hard work and crazy schedule ahead.

A local hang-out by our hotel in Nairobi

Giraffe’s kiss

Wishvast

Jumbo from Nyeri, Kenya. We arrived in Nyeri at about 7:00PM and while waiting to get the debriefing, the team sat down and got both WishVast systems operational. Laptops are ready, cell-phones loaded! WE ARE READY TO FIRE!!!

Penn State students are hard at work on the different projects here, with a group of nearly 40 students, faculty, and staff in total.  While we will be demonstrating and operating the system within the context, the first thing is to get all cell-phone users from the Penn State teams on WishVast, so that we have a nice ready to use communication channel within the group.  We’ll be making recommendations and demonstrations to the entire group soon as to how WishVast can be used to help with coordination and logistics while here in Kenya. In the grand scheme of things, a major priority is to identify partners at the CYEC tomorrow and begin sharing our projects with the local community.

Aside from testing and implementing the projects, the teams will be taking additional steps to increase learning and development opportunities.  For instance, we will be actively documenting issues that arise around ethics and cultural sensitivities.  As we will be working closely with local children from the CYEC to market our ideas and seek help in navigating this region of Kenya, it is difficult to speculate on the specific issues that may arise.  Regardless, we have a process in place to systematically document all ethical issues and how they are resolved.

Alongside the WishVast implementation, we will also be conducting IRB approved interviews to understand the common practices within the working communities in and around Nyeri, and East Africa in general. We will be meeting with Mary, the nurse at the clinic at CYEC, who will be helping us identify specific communities and individuals.

Essential Design

For our teams in Essential Design (EDSGN), the trip has been eye opening!  Shengnan told about our adventures in the trip so far above. Besides these fun observations, we also came across more “real” observations of everyday life, even pertaining to our projects.  FOr the High Tunnel team, they saw large scale greenhouses, much like their own project; the Irrigation Drip team saw many farms and uses of the tanks in the area; the tanks were also important to the Anaerobic Digester team, since it will be a crucial material for us.  bananas. Also for our team, we saw people lugging firewood and charcoal to their homes, which are problems we are trying to address.  These observations helped to inspire me more in that we saw what we have been studying all semester.
When we got to our hotel, we immediately settled in and buckled down with group and Khanjan debriefings.  It is important for us to get a solid gameplan in order to run smoothly.  In our team meeting, we began thinking of ice breakers and activites to initiate fun relationships with the kids we are working with. Then we started to develop a way to teach the kids about the problems and how our solutions/projects will address them.  Then, we sat down with Khanjan and Andrew (our technical guru from the CYEC) and developed budgeting and financial plans.  Tomorrow should be a crazy day for Essential Design!

Mashavu

Nairobi is a big city thriving with businesses. There are many huge billboards. Surprisingly, many are in English. English is an official language of Kenya, alongside Kiswahili. Children start learning English in Primary school. This makes the communication process of Mashavu easier.

This morning, we met with Ryan Tinker, a website developer from Chicago working for the CYEC for the next three weeks. He told us that currently, there is no way for the health administrators and CYEC administrators to know what the epidemiology or health trends are in the country. All the health data is compiled in paper. He has already developed a digital data collection system similar to the medical history survey that Mashavu uses in the beginning of an encounter. His responsibility is to teach the nurses in the CYEC clinic how to use the system. With the data system, the health administrators will be able to add some solid data in their reports and make decisions such as what medicine to purchase based on the database. We saw that Mashavu could potentially be a good addition to the database, since we will be able to collect the vital health measurements. Tomorrow, Ryan will meet with Mary and CYEC kids to discuss about what are essential to include in the database. He will update us on that.
Tonight in a series of debriefings, we laid out the big picture for the next three weeks. Our three clinics will be spread out in three weeks. This Saturday, we will hold the first one in CYEC. Next Saturday, a clinic will be held in Mweiga, a small town 45 minutes away. The “Big Bang” demo will potentially happen in the UNIDO energy kiosk in Ngong. For the time between our clinics, Mashavu team will be seperated into the following teams: Focus group survey, social science survey, “fun” survey, website team, and Samir will take the lead on a study combining social entrepreneurship and life principles. The plan for tomorrow is to meet with CYEC kids and make them understand the concept and operation of Mashavu.

Blog Authors this round:

Shengnan Chen (Mashavu)

Chris LoRusso (WishVast)

Liz Bell (Essential Design)

We are gearing up for another trip to Kenya!   In the next few weeks, the Mashavu team will be returning to Nyeri, Kenya for testing, implementation, and information gathering.  Every day from May 18th to June 8th, a new post will be written by a Mashavu team member!

Check back soon as we will be preparing a few pre-travel updates.