Outcomes

Over the summer of 2009, the Mashavu team worked in Africa for a span of 3 weeks.  During these three weeks the team made significant accomplishments, with plenty of feedback to better our project for the following year.  The team spent much of the time working with students and staff of the Children and Youth Empowerment Center (CYEC). The CYEC center was created to help the street children of Kenya with schooling and developing skills.  The center has become a major player in the success of Mashavu, the head nurse, Mary, devoted much time to working with the Mashavu team to ensure improvements.

On the Ground Research about Kenyan Lifestyles

Throughout the three weeks, the Social teams spent much of their time working with the community.  They spent time learning about the different people within the community and their lifestyles. The team took CYEC teachers and students to help introduce them to the public and translate for those who didn’t understand English.

The Youth

The Social team also spent much of their time educating the youth at the CYEC about Mashavu and the importance of healthcare.  There were certain students who were chosen to work with the Mashavu team to learn the different devices and help run the clinic. At first, the boys in this group were very shy and so the team worked with educating the girls about the different devices and importance of each in English first.  Then, the girls taught the boys what they learned in Swahili.  Finally, the boys then explained what they learned to the Social team to ensure both groups understood Mashavu thoroughly.  This process only took about an hour.

After the educating process was complete, the students were given a device.  The bioengineering team worked with the different students educating them on the proper use and functioning of the computer.  The students quickly became at ease with the technology and were able to use the devices.

Clinics

Important to the Mashavu venture were the three major clinics which we held in three different locations: CYEC, Mweiga, and Endarusha.  At the clinics, we would use both commercial instruments and the engineered biomedical devices to compare values.  Each device had a netbook which was operated by a CYEC student and bioengineering student.

CYEC clinic

This was the first time Mashavu used the biomedical instruments to test the health of the public.  Many women arrived, but only two men came.  The people were not asked to pay and, therefore, it became very hectic and crowded.  The CYEC nurse, Mary, participated in the clinic and would speak to the people after they were tested by each device.  Many wanted to know if they were “normal” and also wanted free medication.  It took about 21 minutes to go through the line.

Mweiga clinic

The Mweiga clinc was the second clinic of the trip and was held in the center of a field under a shed.  Here, we had Sister Purity, a nurse at the local hospital, help advertise this event.  The clinic was completely surrounded by people from the time it opened until we ended.  Thankfully, we brought a rope to keep it sectioned off from the public and to help form a line.  At the beginning, many of the CYEC students were timid about running the devices, so there was always a bioengineering student at each device to help guide the process.  By the end of the day, though, the students took charge and didn’t need much help.  One issue that arose, though, was explaining the backgrounf health information and devices to the public.  Since many didn’t speak English this was solely the responsibility of the CYEC students. It was difficult to get them to translate exactly what we wanted to ask the patients showing that more education was needed.

Endarusha

The Endarusha clinic was our final clinic of the three week period.  Sister Purity helped us arrange this clinic in church health center.  Again, it was very popular and had a constant flow of people through it all day.  At these clinics, the CYEC students were very comfortable and ran the instruments alone.  Their understanding of the devices and healthcare increased and helped this clinic become the most successful of all three.

The Biomedical Instruments

Throughout the Spring semester at Penn State, a junior level bioengineering class developed biomedical instruments for the Mashavu project.  The instruments included: sphygmomanometer, stethoscope, thermometer, weighing scale, baby weighing scale, spirometer, and pulse rate.  Each design was constructed under a $10 cost constraint.  This was possible by using little hardware and a lot of software through the program of LabView.  Throughout the time in Kenya, we had success with some instruments but also many reiterations and improvements of the designs to make the Mashavu kiosk stronger.

• Sphygmomanometer
  • Two teams worked on two different designs for this device.  One team used an old bicycle tire as the cuff while the other team used a more traditional looking cuff.  Both teams used a pressure sensor to detect the measurements. At the end of the spring semester, neither device was functioning properly.
  • Work was done to the LabView code the first week in Africa, but due to the three week time constraint it was decided to just use a commercial cuff at the clinic.
• Stethoscope
  • The stethoscope worked very well at the end of the spring semester and was sent to Kenya with confidence.
  • Issues arose with this device when it was not functioning properly on the small netbooks used at the kiosk.  Also, for this device to work properly, it needs to be in a quiet area, which can be hard to find in Africa.
  • The device was only used at the CYEC clinic and at the Endarusha clinic were a quiet room could be used.
• Thermometer
  • This device worked great both in Penn State and in Kenya.
  • Small issues arose with cleaning this device, since it is put under the arm for measurements.  It got dirty very quickly.  Also, since it had to go under the arm, privacy became an issue with women who had to lift their shirts slightly to position it properly.
• Weighing Scale
  • At the end of the semester, the scale was not functioning properly, a commercial scale was used during the clinics.
• Baby weighing scale
  • This device functioned in both Penn State and Africa.
  • While we were in Afrcia, we purchased a basket to connect to the scale for the baby.  This allowed for mothers to gain trust in this device since the basket was locally made and, therefore, reliable.
• Spirometer
  • The spirometer’s code needed to be fixed when we arrived in Kenya.  After a few days of working with it, the spirometer worked and was ready for the first and second clinics.
  • One major issue arose in the third clinic of Endarusha.  A woman had TB and used the device.  There was a concern with not sterilizing the device properly so its use was discontinued..
• Pulse rate
  • This device worked properly as soon as we got to Kenya.
  • The pulse rate, though, could not be used for children since it was too large.  Also, it was difficult to find the correct spot to attach the sensor to the wrist.

Technical Aspects

Two major components of the Mashavu system were the Web team and Kiosk team.  Within the first few days in Kenya, these teams became very busy due to the unexpected computer issues.  There were hints of malware and viruses from the USB causing them to have to clean the computers and reinstall multiple programs, a very tedious job.  After this was done,  ipath was used with the Safaricom modem allowing for a successful interaction between kiosk and ipath at the first clinic at the CYEC. All information was formatted properly and could be successfully sent to a doctor.

The Web and Kiosk team also focused on educating different nurses to use the Mashavu system.  This was very successful since the nurses understood how to use the computer and devices quickly.  This process, though, needs to be more organized to make it easier for the nurses or potential kiosk operators to follow.

The work conducted both at The Pennsylvania State University and on the ground in Kenya yielded many fruitful results that served as the grounds for the team’s redesign of bio devices. However, it was the trends that they discovered while in Kenya that helped the team restructure their approach to the type of research conducted, the determination of services to provide and most important the team’s goals for the following year. A few of the Mashavu team’s findings are listed below.

Interesting facts  discovered:

• Many people of the community had fatalistic attitudes; therefore, nothing could better their lives.
• Many of the community members had a disease referred to as Jiggers.   Jiggers are fleas that dig into your skin, lay eggs and cause a lot of pain.  One woman the team was introduced to couldn’t even walk.  If Jiggers is detected early enough, it can be removed and treated.
• One family had no food but had a cell phone.
• Primary school is free but secondary schooling is not.  Many children stop going to school after the primary level.
• There is a local quarry which employs many men of the community.  Some children even work at the quarry instead of going to school.  An issue which arises with this job is the safety.  This type of work is already dangerous, but there are no precautionary measures to make this safe including such things as support beams.  There is only one entrance into the quarry which is prone to collapsing. If an emergency was ever to occur, it would be hard to get help to the people in need.  Many of the men also spend their money at the local brew instead of taking it home to their families.
• In this community 60% were poor.
• People were not interested in healthcare but became interested in Mashavu once it was explained.
• The majority of people who have seen the doctor have seen a western doctor.
• There is a surplus of trained nurses who are currently unemployed due to the government.  These nurses would be perfect operators to the kiosk.