Mashavu

Saturday, June 7th

Today we all awoke between 9 and 10, ate breakfast and got ready for the day. We had a demo planned at CYEC with visitors from the Ministry of Health, as well as Canadian student who was working on HIV/AIDS research in Nairobi. We walked over to the CYEC around 10:30, and as James described in an earlier blog it is a refreshing and vivid walk every time you take it. Each time we traverse to the CYEC we notice something new, whether it be a bushel of brightly colored flowers weaving around a barbed wire fence, or the crazy juxtaposition of a cow chewing grass outside a small wooden house that has a satellite dish. There are also many interesting people you encounter along the way -An older woman carrying wood back to her home, school children chanting “how are you, how are you” as you pass by, the old man watching his grazing animals who rambles in Kikuyu to which you politely smile and nod. Every situation provides laughter, if you can look up long enough not to stumble on the protruding rocks that make the walk part obstacle part entertainment. Anyway, once we got to the CYEC the kiosk and BioE teams got the demo set up in the clinic. The rest of us took the opportunity to play with the kids. I cannot say enough about the children at the CYEC from the small 3 year olds to the older vocational students, every one of them has the ability to brighten your day which is why most of us seize every spare moment to be around them. After some rousing games of tiga, tiga, samba, sharks and minnows, and freeze tag we returned to find out the ministry of health still had not arrived (not so shocking once you have become accustomed to the African pace of time). With that we all broke for lunch, some of us headed back to ivory to do some documentation work while others stayed at CYEC to wait for the ministry of health.

By 4 all hopes of the ministry of health showing up had faded and we packed up the kiosk for the day. One of the most comical events of the day occurred when Khanjan ordered spaghetti for dinner at the hotel. After incorrectly making his dish twice, Khanjan escorted the chef into the kitchen where he provided him with a cooking lesson. Many of us scattered to the window of the kitchen where we were able to witness this hilarious altercation. The third dinner was a winner much to the happiness of the chef, who probably had his share of visitors in the kitchen. After dinner we had a free evening to enjoy however we wished, hotel Ivory was packed with guests that had attended a conference for the day so the hotel was bustling with activity. Most headed up to the bar area and enjoyed Tuskers and music. Everyone has really appreciated the down time we’ve had recently. After some pretty intensive work days it has been worthwhile to sit back and absorb the Kenyan community we have spent so much time in. With our time winding down here, we all have been making a point to soak up every bit of time Kenya we can!

-Julia

As Thursday night began to conclude, Mashavuers either got some early shut-eye, played jolly-rancher poker, or danced the night away in the suite. Of note headlamps placed on the blinking setting make pretty sweet strobe lights. Everyone was able to sleep in as the day kicked off with a debriefing session at 10 am. We discussed the previous day’s events at Endarasha and laid out plans for the weekend. Everyone was excited to learn that we were going to spend the day in town running some errands, eating lunch, and perusing the local market. At around noon we moseyed out the top of our street and “hailed” a matatu to take into town. After squeezing fifteen of us in to the delightfully decorated van, we were off for town. Ten minutes later we arrived at the Mashavu wallet refueling station also known as the ATM.

We all then ate lunch at Nyama (meat) Choma Village. They had roof seating from which we could eat and observe the bustling streets of Nyeri below. While taking in the sights of street vendors, store fronts, and honking cars we realized we were one member short. James B. has fallen asleep after the meeting and subsequently missed leaving with the rest of us. Not to worry, our CYEC driver Kabu quickly came to the rescue and scooped up James and had him in town in no time. From lunch we went to the supermarket, internet café, and the local market. The local Nyeri market consists of winding wooden stalls connected by red dirt paths. From flip-flops (aka slippers) to frying pans to fruit the market has a taste of it all. While some snagged traditional African blankets and scarves, others bargained for woven baskets. Perhaps the most amusing purchase of the day was by Mike P., Mike F., and James B., who custom ordered hats. These aren’t just any hats, they are the uber-popular winter hats adorned by nearly every 4 year old in Nyeri. These hats are more of a combination between snow hat and hood, so they can’t fall off. Much to the surprise of the women vendor who told the boys “but you will look childish”, the orders were placed at a very thrifty 70 Ksh (a little less than a dollar). After returning from town everyone enjoyed a little down time before we headed to the Mashavu hot-spot Banana Leaf. Banana Leaf- part restaurant, bar, and dance club- had an Indian buffet dinner, and I think everyone was up for a change of pace when it came to our food. After arriving around 7 we had a chance to chat with Eco-Village and many people from the CYEC who joined us. Unfortunately, Therese, an eco-village team member was greeted with a surprise from one of the birds nesting in the roof of the tent. To her credit she handled it and the many laughs that ensued very well. Food was served around 8, and the massive buffet seemed to delight most pallets (even though the lighting made it difficult to see exactly what we were eating). After dinner some people headed to our home sweet home at ivory, while others stayed at banana leaf and kicked back late into the night. All in all everyone enjoyed having a day to explore more of the local community!

Ni Poa,

Julia Wittig

…do as the Endarashans do.

Wednesday was a very busy day for the Mashavu team. As a follow-up to a previously scheduled meeting, Katie Briggs, Renee Stepler, Sarah Fucci, and James Bock of the education team met with the former Chief Nursing Council of Kenya, Mrs. Margret Ngure. During this meeting the team was surprised to learn that there are currently a large amount of unemployed nurses in Kenya and many of these nurses are having a difficult time finding employment. This piece of information brought up an interesting discovery, many of these nurses who are qualified and willing to work could serve as Mashavu kiosk operators. After previously meeting with many nurses and doctors who would be assessing the case from the website we have found that the kiosk operators must be qualified and certified nurses, Mashavu could serve as an effective solution that addresses the problem of unemployed nurses in Kenya.

Further discussions with Margret revealed that Mashavu has potential to be used as a public health tool in a number of ways. Currently, the Kenyan government administers free vaccines in hospitals. Margret suggested that a Mashavu station could be used to administer these vaccines because qualified nurses would be working at them. This would save the patient time and money if they do not live near a hospital. Margret stressed the importance of preventative health and if Mashavu were to evolve into a working system a long-term plan must be developed with an emphasis on preventing disease and illness. One suggestion was to host awareness for a specific ailment (e.g. HIV/AIDS) every month to get the community engaged and educated on important health topics.

The portion of the Bio Engineering team that did not attend the visit to the Outspan Hospital worked on formulating new questions to be asked at their respective device stations. These new questions were based off of the past experiences at Mweiga and at CYEC. The questions were rehearsed and discussed later that night for use at the clinic in Endarasha the following day.

Meanwhile, a team consisting of Anthony Zmoda, Khanjan Mehta, our driver Kabu and Sister Purity embarked on a trip to scout out the site for our second Mashavu community testing center in Endarasha. The goal of the trip was to introduce ourselves to the staff members at the clinic where Mashavu was to be held, and explain to them what resources would be required for us to set up. We also needed to go over specific details about what Mashavu offered the community. Luckily, the site was a complete 180 from what we found in Mweiga last Wednesday. It was a site that was both indoors and outdoors, and sufficiently covered if it was to rain. There was adequate seating for a proper queue, even if the number of patrons we encountered exceeded our capacity. We would able to put bioe devices in separate rooms, which would aid the flow of patients quickly and effectively. We were told that it wasn’t going to be a market day when we were to be setting up, so we knew that the crowd would be easy to be controlled. The team left the site feeling confident with the facility.

Lastly, the Web Development team, along with parts of the Bio Engineering and Education teams, was busy this Wednesday traveling to the local private hospital, Outspan. The reason for this trip was to understand and ascertain relevant information regarding healthcare in Kenya, through the local doctor’s eyes. We were able to gather a plethora of information regarding the kiosk system, the doctor interface system (iPath – telemedicine interface), and the pulse rate device. Some relevant data that we collected were: necessary vital statistics needed to diagnose a patient, relationship between the caregiver and the doctor, pertinent steps to gain permission for testing the Mashavu system while avoiding confrontation from the government, and qualifications for the caregivers who are utilizing the kiosk.

We talked to a lot of important people in the Hospital including: Dr. Stephen Ojive – Consolata Misson Hospital (Nyeri), Jack Kihumba – Hospital Administrator, Alex Kuria – IT Director, a doctor, and many others. Some other important information that the doctor suggested was for us to use a top-down approach when implementing our Mashavu system. He suggested that we pick a provincial or ministry establishment, and then provide then with the necessary education to make our system sustainable. They were very excited about our system and said they would use the Mashavu system themselves once implemented. The staff at Outspan was also very amazed by the capabilities of the devices that we are using and the software that’s integrated with our system.

Post Written By: James Mesta, Anthony Zmoda, Jonathan Sauer

Today we traveled to Endarasha to test the full Mashavu system for one last time during our time in Kenya. Upon arriving in the chilly atmosphere of the Endarasha Health Clinic, the BioE team set up the temperature, blood pressure, pulse rate, height and weight, spirometer, and stethoscope stations in two of the rooms. James and Katie of the Education team were responsible for educating the patients on the background of the devices before they used them. For each of the stations, students from the CYEC helped to both translate Swahili and operate some of the medical devices. It was brought to the attention of the BioE team that questions asked during the testing in Mweiga and at the CYEC were leading questions and compromised statistical analysis of data gathered. With the help of the Education team, the BioE team eliminated most of the questions previously asked and replaced them by asking how the patients felt about the experience after each device. However, the reworded questions hindered the acquisition of useful feedback about the user experience due to difficulty in translating the exact words we wanted and focusing the user on the exact questions we wanted. Patients typically responded with “good” or “happy to be tested,” which did not necessarily provide any more insight than what we had encountered previously. Michael ended stethoscope testing early because no new user experience data was being collected, and sufficient sound files from the stethoscope had been obtained to determine flaws in the design and programming. At the beginning of the day, sixty cards were handed out to people interested in using the clinic so that we could conclude the testing at a reasonable time. Throughout the day our plan changed significantly as Sister Purity recruited additional volunteers to be tested in our the clinic. After about three quarters of the card recipients had been run through the clinic, Mike’s pulse rate and Brittany’s temperature sensor were shut down in order to save time and allow all the patients to receive height, weight, and blood pressure. Mary, the CYEC nurse, once again proved to be very important in satisfying the patients’ expectations of being able to talk to a true medical professional. She was able to talk to many of the patients at the end of their testing to provide a quick analysis of what each of their numbers meant for their overall health and well-being.

A full Mashavu kiosk was assembled by Aaron and Sara in another room, which included the thermometer and pulse rate monitor devices created by the BioE teams. Random participants were picked from the queue outside to bypass the BioE devices and head straight to the kiosk room. Mary was on hand to help to focus the background questions toward those which would be asked in a face-to-face interview. Data from the kiosk was sent over the Internet to the Web Development team, seated in another room, to test the communication of the telemedicine system. This was the first full case sent as an attachment over the iPath system of Mashavu that had a nurse on both ends of the data transfer.

During the testing, the rest of the Education team worked on crowd control and helped to organize “a proper queue” by giving numbered cards to each patient. They also helped in educating the patients about Mashavu before entering the rooms with the BioE devices and the kiosk.

After completing testing on all the patients waiting outside the clinic, we departed from Endarasha around 3:45pm and left for Hotel Ivory. There was an amazing view of Mt. Kenya on the way back, and we followed it up with a relaxing/fun evening.

Michael Fickes and Mike Perone
BioE Team

Tuesday, June 2

Earlier in the week, the Mashavu and the Wishvast team scheduled meetings in the Nairobi area with two key organizations; Jamii Bora, and Acumen Fund.

Jamii Bora Trust is a charitable trust reaching out to people within the more impoverished areas of Kenya, ranging from slum communities to street dwelling families. The purpose of the organization is to give individuals the means to rise out of poverty through micro business loans. These loans are offered to individuals who have saved money with Jamii Bora for a minimum of six weeks. Jamii Bora matches whatever the individual has in their savings account for their first loan. A successful borrower can then work his or her way up to larger loans for education and housing depending on the number of successful repayments. Jamii Bora also has several other departments regarding affordable housing as well as their own business academy that teaches their students: business studies, home economics, management, leadership as well as literacy, and basic computer skills.

Acumen Fund is a non-profit venture capital fund whose main goal is to solve the issues of global poverty. In trying to provide health, water, housing and energy to those who need it, Acumen Fund seeks to provide sustainable solutions through patient capital. By investing in entrepreneurial ventures, both loans and equity yield economic and social return. All the money gained is re-invested into new projects.

We left early Tuesday morning at 6 to make our meeting with Jamii Bora in Nairobi later that morning. We arrived with no delays to the Jamii Bora branch, where we were gathered into the conference room to go over the concepts of Mashavu and Wishvast. We first received introductions on the ideas behind the Jami Bora Trust, as well as their current and future goals. After getting caught up on the concepts behind Jamii Bora, we were told a wonderful inspirational story behind one of Jamii Bora’s own social workers, Benta, who was one of the original 50 street beggars who began saving towards her future, heping to create the Jamii Bora that we know and see today. After the introductions and stories, we received important feedback regarding both the Mashavu and Wishvast projects. We found out for Mashavu that there was a great need for kiosks to be placed in centralized locations of various communities to cut down on the costs of visiting a doctor. An example was given by one of the staff members whose baby had grown sick in the night. He had to rush to the nearest hospital which was over 4 km away, forced to take 3 different buses to reach the hospital which is not only time consuming and dangerous by night, but expensive. The idea that this hassle of traveling on 3 taxis could be cut out, and the fever potentially prevented through regular checkups at a local Mashavu kiosk was of great value to our validation for Mashavu. We also confirmed the notion of women as being the primary caregivers for the Mashavu system. An interesting part of Jamii Bora’s history is that in the beginning, the business dealt with only women regarding micro business loans. They wanted to do business with women, through the notion that the women would repay their loans and were worth the investment. This seemed provided insight culturally to the gender roles within our social context. There were also large discussions on the ideas of Wishvast and how you can gain, and define trust in others, especially outside of an individual’s social network. We learned that there is a great market for this system regarding smaller businesses such as shop owners and farmers who rely on their own social networks to operate.

After the meeting with Jamii Bora, we took a lunch break in a shopping mall outside of the Acumen Fund office. Everyone rushed out of the buses into the shopping complex eager to see all of our eating options. Many of us chose to take a break from the traditional Kenyan foods to eat and a restaurant that served yummy greasy bacon cheeseburgers and fries, along with sandwiches and an assortment of milkshakes. Sitting at the table I could see the anxious shifting of my group members as they waited for food, excited to eat food that we all know so well back home. Upstairs, the rest of the group enjoyed some great Indian food at a local restaurant. Running on a tight schedule, some people rushed to the Acumen meeting, while others waited back to pay for the food. Arriving at Acumen Fund, we met with Wendy who was a portfolio manager for Acumen Fund. She discussed the criterias that they specifically look for in potential investments. The main things that they look for in a company are scalability, social impact, and scalability. Above all however, the most important thing for Acumen Fund is social impact. The four areas that Acumen Fund will invest in are water, health, energy and agriculture. She mentioned that one of the important things that she wants to see from any of the companies that Acumen Fund invests in is how well they know their customer. Do they have a customer profile? Have they thought of all the reasons of why their customers are their customers and what all the reasons why someone might not be their customer? These are important aspects looked for in potential investments. The idea of trust was spoken of extensively here, regarding how business is done here in Kenya. Wendy stressed that Kenyans do business heavily based upon trust. This is a custom that is embedded within the culture; however the ideas of trust are slowly diminishing as western influences change how companies do business. The newer generations are finding that it takes more than just trust; it takes credit scores and more to do business. These ideas of trust proved very valuable to Wishvast and the concepts of trust and social networking.

After our last meeting we went drove to some gift shops within the downtown area to buy souvenirs and gifts for friends and family. By now, everyone had a general idea of the value of a Kenyan shilling, and this was a perfect opportunity to practice our bargaining skills. There was extra motivation for getting a good deal, as the person who got the best deal would be awarded a free Tusker. After collecting our gifts we headed for dinner at the restaurant Carnivore. As we pulled into the driveway for the restaurant, beautiful signs, elaborate lighting and intricate designs caught our eyes. We were welcomed by a man in traditional attire, and brought to our table to eat. The menus were set, with soup, salad, and a wonderful main course of assorted meats, including more exotic meats such as alligator and ostrich meatballs. The waiters would come around the table with giant chunks of meat on a sword where they would cut small portions off onto your plate upon request. Everyone had a great time, the food and drinks were wonderful. With our bellies stuffed to their limits, we got back on the bus and headed back to Nyeri after an exciting and eventful day.

Written By: Katie Briggs

Today the Mashavu team was pulled in many different directions. The day officially started off at 09:30 with individual team meetings to discuss the plan of action for the week, specifically focusing on getting ready for our Endarasha Clinic on Thursday. The BIOE team also began to discuss plans for a peer reviewed journal paper honing in on how this trip has affected students’ views on designing for the developing world as well as reflecting and commenting on the structure of said design classes.

After these meetings a group of us were going to go into Nyeri to see the Outspan Hospital Health Clinic which was providing free medical consultations and antibiotics as well as food and clothing for street families in Nyeri. We were ready to go by 10:45, but Andrew had to make a “quick” trip into Nyeri to pick up supplies for the CYEC and the Eco Village teams. While we waited for him to return, some people decided to catch a few rays of the African sun, and actually got slightly burned, some discussed future journal publications and some worked on writing journal bound papers. At 12:00 Andrew still had not returned to take us to the clinic so Khanjan decided that we should just get all of our things together for the day and walk over to CYEC for lunch.

Lunch was served at 13:00 and afterwards a number of Mashavu people helped the Eco Village Ag team enclose the green house frame with a special type of plastic to help crops and other plants to grow. Around 14:30 Mike Fickes, Sara Fucci, Peter Butler, Katie Workinger, Maggie Slattery, Katie Briggs, Jimmy Mesta, Mike Perone, Renee Stepler, Brittany Flaherty, Stefanie Auf Der Mauer, and Steve Gargulio loaded into a matatu and a taxi and headed off to the clinic. We were told that the clinic was being held in the Outspan Hotel, but when we arrived at this country club look alike there were no street families in sight. The manager of the hotel knew nothing about the clinic but suggested that we try the Outspan Hospital, strike 1. Once at the hospital we again did not see any street families, strike 2, but we were able to learn the actual location of the clinic from some of the hospital employees. So we all loaded back up into our respective modes of transportation and drove to Whisper’s Park where the clinic was actually being held. As soon as we walked through the large iron gates which served as a way to regulate who could get into the clinic, we were mobbed by people taking pictures, hospital employees running the clinic and children who just wanted to talk to us. We were at the clinic for about an hour and a half and during this time we were able to gain some excellent contacts at the hospital and in the community as well as lots of valuable information pertaining to how the clinic was run and what exactly the clinic was doing with regards to testing. We found out that they were taking clients’ family and medical histories to try to form medical records for them, as well as clients’ temperatures, pulse rates, blood pressure and weight. They also had two doctors on hand to diagnose any of the sick patients and free antibiotics to give out to those who needed them. Eventually some of the teenage boys who were high from huffing glue in the open at the event, worked up the nerve to come talk to us and at that point even though we were in no danger we felt uncomfortable and decided to leave. While we waited for Andrew to come to pick us up we used our time to scope out supplies around the market which could be used in future designs as well as doing a little souvenir shopping.

Meanwhile, back at CYEC, Aaron Fleishman and Julia Wittig were hard at work finishing up a paper about the validation and verification that they received for Mashavu in Tanzania during the previous summer. James Bock, Jon Sauer and Matt Prindible played in a football game with the CYEC kids while Anthony Zmoda watched because he was still slightly injured from the previous game. When the dust had settled, the score stood 1-0 with our guys being on the victorious team!

Once the soccer game was through and everyone had returned from the Outspan clinic, we had a debriefing about what we had encountered at the clinic. This meeting was cut short with the announcement of supper, and was resumed later in the evening at Ivory after the usual Daily Mashavu Meeting.

Some other things to note about the day were that on the way back from the clinic we stopped at an ATM and as we were leaving we accidently backed into a parked car. The owners were a young couple and instead of flipping out, as most people in America would have done, they smiled, talked to Andrew for a few minutes and then went on their merry way. Also, before we went to CYEC for dinner, we stopped back at Ivory to drop off some purchases. While there, they saw a curious person walking back and forth with white stuff all over his face. We were amused to find out that this “stranger” was actually Khanjan who had apparently received not one but two haircuts that afternoon. Today Khanjan also invited Robert, the manager of Ivory, to CYEC, for dinner so that he could see just how good the food and service was at CYEC because Robert had been inquiring why we did not eat at the hotel every night. We do not yet know if this act will have any effect on our service at Ivory, but we are hopeful that it will speed things up a bit. Also, today is Maharishi, Kenya’s 46th Independence Day celebration. So lots of people are celebrating everywhere and the hotel is really hopping!

Our team spent the day at the hotel to compile and document the information we have collected over the past two weeks.  We broke up into our respective groups: Kiosk & Website, Bio Engineering, and Social Issues.  We worked in these groups for approximately 4 hours and then met as a whole for about 2 hours.  Following are the main findings and summaries for each group.

                The Kiosk & Website Team (Aaron, Jon, Anthony, Jimmy) discussed the technological obstacles they encountered in their time here and how to best prepare for them for next year.   Additionally, they had met with Sister Purity and some other doctors to discuss the layouts and information within their programs.   Their major achievement in the past two weeks was successfully sending their first patient’s data from the kiosk to the website with the proper format. 

The bioengineering team (Dr. Butler, Dr. Slattery, Brittany, Mike P, Mike F, Stefanie, and Katie W) met and evaluated each instrument used in Mashavu. The designs were revised under different categories based on the information collected from the three testing sites: CYEC students, CYEC community and Mweiga. The evaluation consisted of user and operator interaction with each device, the transition from PSU to Kenya and problems the instruments had to face including hygiene issues. The document composed was very thorough in order to guide next year’s junior design class and also to help evaluate and give feedback to the social/education team and the web team.   

The social and education team (Julia, Renee, Katie B, James, Chanda, Sara) worked on compiling the information we had from different conversations with the community members.  One of our major findings was the lack of understanding of preventative healthcare.  Many people often go to the doctors only when they have major illnesses.  For Mashavu to work well in the community there would need to be education on preventative healthcare.  We also discussed following up with many contacts we had made over the past weeks in the community including former nurses, pharmacist, and current doctors.  Additionally we discussed issues the next team of Mashavu students may want to research in order to prepare themselves for their time in Africa including the definition of poor and other examples of telemedicine working.  Our documentation was very extensive and thorough to help students next year understand the social issues and the need for education. 

                After our hard work, we decided to go to Banana Leaf, a local dance club.  We had the opportunity to meet several locals and explain our purpose for our visit while experiencing Kenyan nightlife.               

                On Sunday we continued our meeting to compile the collected information.  We discussed what needed to be finished for our upcoming and final week here in Nyeri.  We feel we have made major improvements since day one, but there is still plenty of work to do for our next week. 

Thursday began the start of our safari in the Aberdare National Park. We departed from the hotel at 8:00am in two safari trucks that were converted lorries. On the trucks we had not only our teams, but also CYEC staff and Sister Purity. As we drove through the highlands we were surprised to see the different landscapes and vegetation. We traveled through a bamboo forest, grassland, and a hardwood forest.

About thirty minutes after entering the Park we were forced to cross an old wooden bridge. We prayed that our huge trucks would make it across without falling into the small stream below. As we continued up the hill we noticed a gray figure and movement in the bushes. Our safari truck stopped and turned off the engine only to discover it was a young elephant growling at our truck. The elephant came out of the bushes and trumpeted his trunk. He then darted in front of the vehicle allowing us all to get a closer look at him. After this exciting encounter, we had to cross the bridge again and start up the mountains.

On this portion of our safari we did not see many animals, but the views were well worth the drive. Our drive lasted about an hour and a half on bumpy, narrow dirt roads where we passed through the various landscapes. We were kept alert throughout the ride with the low hanging branches that attacked us through the windows. As we approached the top of the mountain, the weather drastically changed, becoming chillier than any of us expected. When we reached the top our trucks stopped to let us explore the Chania Waterfall. As we approached the fall some stood back and snapped pictures while other more adventurous group members decided to get a close up look. Dr. Butler, Aaron, Anthony, Jimmy, and Jon decided to go under the falls and in result were soaked for the rest of the drive.

On the drive back from the fall, we got out of the vehicle to stretch our legs and noticed a water buffalo standing within approximately 50 feet. We quickly grabbed our cameras while a CYEC staff member advised us to cautiously move away. Lesson learned – be careful where you get out of your vehicle when on a safari. Afterwards, we exited the Park and dropped Sister Purity in Mweiga on route to the campsite. We stopped for gas in Mweiga where we all noticed a goat on the top of the gas station’s roof.

We drove about two hours before we reached Mount Kenya Hostel, our campsite for the night. On the way the muddy wet roads caused some problems for our travels. One main obstacle we overcame was the second truck getting stuck in the mud. All the boys on each truck had to get out and push the truck out of the mud. The girls stood back and took pictures. Finally, we reached our Hostel, ate dinner and went to bed. Half of the group slept in tents while the others had the luxury of sleeping in bunk beds.

Friday:

We awoke at 6:30am to depart at 7:30. Many of us were able to watch the sunrise over Mount Kenya. Our altitude was 6000 feet at the base of the mountain, which gave us a perfect view. After breakfast we made our way to Solio Ranch, which is a privately owned wildlife reserve converted from a rhino sanctuary.

During our day we saw many animals including zebras, water buffalos, black and white rhinos, giraffes, and impalas. Our bus today had seats in the front on top of the cab, which made for an interesting and difficult ride. The bushes and trees had toothpick sized thorns, which often hung lower than the height of the truck. Therefore, the entire group was forced to duck down and away from the sides periodically throughout our game drive.

We stopped to have lunch around 1:00pm. Our lunches contained a 4-6 slice sandwich filled with cucumber and spam covered in mounds of butter. Everyone ate a banana for lunch. We hopped back on the trucks for another hour and then headed back to the hotel. After washing off the layers of dust from the safari trails, we headed to CYEC for dinner and a dance party/performance.

Four of the staff members at CYEC put on a comedic dance performance for the CYEC students and us. In the middle of the performance they pulled Julia, Katie W, Brittany, and other Eco-Village students from the audience for a dance-off. Afterwards, we danced to some American music with the kids, furthering our bonds with the CYEC students. Throughout the night we were introduced to Kansas State students who have come to work at CYEC for 10 weeks hoping to structure the education and provide more opportunities for the children.

The past two days were very eventful and enjoyable. The safari gave us a nice break from working; however, it was still a learning experience for us. For many of us it was the first encounter with African wildlife, which expanded our knowledge of ecosystems.

Today started at 8:15 with the first group Michael, Maggie, Peter, and Stephanie from BioE along with Katie W., Aaron, Anthony, and others.  The second group traveled to CYEC to pickup our 9 translators, bag lunches, and drinks.  These drinks were fruit juices from the Highland factory and extra drinks were bought that will go toward our safari at Aberdares tomorrow.  People in the first car were able to see top of Mt Kenya faintly and Aberdares was passed along the way to Mweiga.  The first team to arrive setup the Mashavu station to be run later that day.  The first group was greeted by two goats who were using the shed for shade.  Aaron and Anthony hired a truck for 300 Ksh to transport the three tables and 25 chairs for kiosk setup.  After unloading the car, the two goats disappeared but their many gifts remained behind to haunt all of Mashavu during the sunny day ahead.

The BioE members present and Aaron setup up the table layout and kiosk computers.  The power outlet was one plug hanging from a cord that stretched across the power lines traveling over the road next to the Mashavu testing from the Mweiga Mary Immaculate Hospital.  The BioE team created data cards from notecards cut in half in order to contain a patients name, height, weight, blood pressure, pulse rate, temperature.  During setup, many locals walked by the kiosk and crowded around the testing tables in order to get a good look at the computers and the devices but they greatly hindered the setup process.  Peter entertained them while Aaron tied white rope around the perimeter of the shed in order to facilitate setup and protect the devices from damage.  Because the roof of the shed was not the best, we used a green umbrella and eventually a big tarp to cover the roof to provide shade for the spirometer and stethoscope stations.  The first table setup consisted of blood pressure and temperature.  The second table contained pulse rate, adult weighing scale, baby weighing scale, and height.  The third table contained spirometer, stethoscope, and health history.  Peter collected data from the temperature sensor and used a commercial sensor to calculate the accuracy of the device.  Maggie used the commercial blood pressure cuff to provide blood pressure data to patients even though our blood pressure cuff design is not functional.  Mike ran the pulse rate monitor and used his hand to check the accuracy of the monitor.  Katie W. took height and weight measurements for patients and sent them to Stephanie who provided spirometer data.  Michael used the stethoscope to collect only heart sounds from patients because lung sounds are too difficult to obtain in the noisy kiosk testing environment.  After that patients were sent to health history and to Mary for additional medical information.

The education team facilitated the smooth running of the station.  James spent time interacting with locals present within and outside the rope setup by Aaron.  One interesting person he met was a business student at Jomo Kenyatta University and he was antagonistic at first about the kiosk explaining that giving people their numbers and leaving helps no one.  After James informed him of the project, both its educational aspect and future plans the student was less apprehensive towards the station.  Renee monitored the CYEC kids kind enough to translate for us a second day.  The majority of the CYEC kids seemed to enjoy working the devices and translating more than class work.  The use of the devices by the translators earlier greatly assisted in the translation and use of the devices.  Chonda and Katie ran focus groups with patients after they traveled through the station.  They asked a variety of questions including would they use these devices in their community, how frequently would these use them, how much would they pay, did data collection take too long, was their privacy threatened by the quantity of people at the kiosk, how did they get to the testing station, and what does it cost (transport and consultation) to see a doctor.  People were willing to pay between 50 shillings and and 500 shillings but the majority of people said they would pay 100 shillings.  People in Central Africa are better off than Western and Northern Africa so the scalability of the kiosk system maybe be limited in these areas, a point brought up by Khanjan at our night meeting.  Also after seeing the focus group, patients consulted Mary about their information collected and got general health tips as well. Chonda also discovered that operators must be endorsed by someone respected in the community(pastor, doctor/nurse, etc.).  Julia was the traffic controller of the kiosk controlling the flow of people into the kiosk.  The experience has given her the information needed to improve the line logistics.  When the kiosk was shutting down, people were no longer admitted but many individuals were insistant on entering the station.  Many made offers to Julia including inviting her to their homes for food and many tried to appeal to her sympathy by asking her to help their grandmother.

The web team was quite productive today as well.  They met with Rebecca, the head nurse of Mary Immaculate Hospital.  After Rebecca got to see all of our devices by walking around the kiosk, the web team took Rebecca through a step by step demonstration of what would occur if Jimmy arrived at the kiosk with a stomach ache.  Starting with entering the kiosk, going through the devices and ending with the health history and feedback from a physician.  Rebecca said she would have no problem receiving the information from the kiosk in order to provide a diagnosis for a patient.  Rebecca also provided the web team with forms that patients encounter when entering the hospital.  Rebecca said nurses only take weight, temperature, blood pressure, and pulse rate which is less than our kiosk can provide. Rebecca told them that the chief complaint a patient presents is the most important information and influences the rest of the questions asked in the clinical encounter.  The web team feels that this would be better used in a second iteration of the system but for now the questions should remain the same to ensure a properly functioning system. Rebecca brought up the point that people would not want to pay extra for individual things (extra pictures, etc.) but she was informed that our kiosk will charge one flat rate for all of our services at one time.

Asante Sana,
-Michael Fickes, Bioengineeering Team

Tuesday, May 26

The equatorial sun already beat brightly upon us as we left from our hotel around 9am en route to CYEC. I say around 9am because time here is quite relative. For those who have not experienced a light walk through the Kenyan countryside, I will try to do it justice. The paved roads only last a few steps after we set foot from our hotel. The path we follow is a copper colored road which is half compacted earth, half protruding stone. At first glance, the roads appear to be dusted with cinnamon, but under closer review this is dismissed as a Candyland fantasy (the high clay content of the soil here makes the dust have a similar consistency to the aforementioned spice). As we walk, we pass banana trees, local small businesses and the occasional livestock. Our arrival at CYEC signifies the beginning of a very important day in the development of Mashavu.

Every team’s work was on display this afternoon. Today was the day that the community members the education team reached out to yesterday would get to interact with the system in preparation for our Wednesday trip to Mweiga. But before the show could begin, there was much to be done. Julia and Anthony and Jimmy from the web team headed into downtown Nyeri to get supplies for our journeys in the coming days, run errands and purchase materials for the signage we will be bringing to Mweiga. Sara and Chonda had a follow-up meeting with Margaret Ngure, the former Chief Nursing Director for Kenya. She is truly an invaluable asset to Mashavu. They were able gather an incredible amount of insight from her, for example, choosing the proper operators is vital for the sustainability of Mashavu because if the operators are not trusted and respected in the community then the people will feel the operators have an unfair advantage over them and will not use the system. In essence, the community must choose the operators.

The BioE team had a few loose ends to tie up before we were ready for the afternoon. Grounding issues were nagging the system but they were easily defeated by Katie W. The spirometer and the stethoscope made significant progress and it is now accurate enough to be used in our test. After a few hectic hours in the war room, we would be able to perform five measurements, weight, blood pressure, pulse, temperature and lung capacity as well as letting the patients listen to their heartbeat though computer speakers.

After an early lunch, we began setting up the devices and planning the flow of the line. The CYEC students that the education team has been drilling with information since we got here about Mashavu and how the devices work were getting last minute briefings. These students were instrumental in the success of today’s testing especially because of their abilities to speak the native Swahili and Kikuyu languages as well as English. The intense sunlight from the morning was replaced by a chilly overcast sky, which is difficult to believe given we are only miles from the equator. The threat of rain would be a pain to deal with the rest of the day. We had to setup the devices under a breezeway at the centre to ensure they would remain dry. The first patients walked into the open courtyard of the CYEC around 2PM. The first device to be tested was the pulse rate monitor. This is the same pulse rate monitor that once genteelly electrocuted the author of this blog (Due to a grounding issue, I believe). A line began to develop and Mashavu was in full swing. You could feel everyone’s cheeks getting chubbier.

The devices were not the only component of Mashavu on display today. Aaron put the finishing touches on the data formats for the kiosk. The first test of sending manually entered patient data to the website was success and a great step forward. The next step is to take readings directly from the medical devices and send them which I am sure will happen swiftly. The web design team had the first legit test in Labview today as well. Tomorrow will be an important day in the progress of the web design because they will be meeting with local doctors and nurses to test the usability and mold the format of the system. The kiosk and web components are what takes Mashavu beyond a set of medical devices to a telemedicine system.

At the end of the day, 40+ community members had been Mashavued. The weather probably drove a number of the patients we were expecting to have away, but this sample size was more than enough to point out where we need to be smoother tomorrow in Mweiga. All of the devices worked properly throughout the day which is a huge accomplishment for the BioE team. A few problems did arise that we will be needed to be handled carefully tomorrow. After taking a patient’s measurements, they often wanted some form of diagnosis but we are legally and ethically unable to do this. The idea of level zero pre-primary and preventive care is a new concept for many of the patients we will encounter on this trip. It is something that we as Americans overlook everyday (Example. we all have thermometers in our homes). Challenges like this are the most difficult we will face here but I am certain that we are up for that challenge.

Asante,

James Bock