Engineering World Health – Tanzania and Central America

In many ways, students who participate in Engineering World Health (EWH) programs are medical MacGyvers – using their engineering training and scavenging abilities to fix medical equipment in often remote locations under less-than-perfect conditions.

In the process of providing a much needed service to medical facilities in Third World settings, the students in turn gain unique insights into the problems facing millions who don’t have access to the latest in medical care and how the medical community copes with these issues.

EWH allows undergraduates to study and work in hospitals in such developing countries as Sudan, Nigeria, El Salvador, Haiti, Liberia and Sierra Leone. Last year, the EWH programs repaired more than 450 pieces of equipment, according to Robert Malkin, professor of the practice of biomedical engineering and director of the Duke-EWH Summer Institute.

This summer, EWH groups involving Duke students traveled to Tanzania and the Central American countries of Nicaragua and Honduras. Both of the trips were supported by DukeEngage.

Tanzania

For the first four weeks in Tanzania, all students attended morning classes to learn Swahili language and culture and spent afternoons learning about equipment repair in the city of Arusha. For the final four weeks, students were sent off into the countryside in groups of two or three to work in different medical facilities.

For Pratt seniors Allison Keane and Jenna Maloka, the eight weeks they spent in Tanzania served as a powerful inspiration as they look toward their final undergraduate year at Pratt. Though both worked in different types of settings, they are now working together on campus working on a project that should further help the Tanzanian hospitals.

Keane worked in a large full-service, government-run hospital with 300 beds, while Maloka spent her time in an 80-bed mountain-side clinic offering the basics of health care.

The students often found themselves improvising, trying to make do without missing parts. For example, in order to repair a suction machine, Keane’s group couldn’t find the proper part, so they used an empty peanut butter jar. They jerry-rigged the installation of bili-lights – Duke-developed technology used to keep newborns from getting jaundiced – over bassinets by suspending them from curtain rods.

They also helped repair such diverse equipment as laundry dryers to blood pressure monitors.

“We also found ourselves spending a lot of time in the maternity wards, where they had working equipment, but they didn’t know how to use them,” Maloka said. “We also helped out wherever we could, like doing inventory or working in the kitchen. We basically did anything that was needed.”

Keane’s hospital, located at the base of Mount Meru, provided a full range of services.

“We helped fix centrifuges and other equipment,” Keane explained. “They also had a new incubator for premature babies that they didn’t know how to use. We taught them how and immediately it was put into use. They were always so appreciative of what we were able to do for them.”

Both Keane, a biomedical engineering and econonics double major from Philadelphia, and Maloka, a biomedical engineering major with a certificate in neurosciences from Chicago, are building upon their Tanzania experience by working on an independent study project together under Malkin’s guidance.

“We are looking back at our experiences and trying to determine what were the most common problems the hospitals had,” Keane explained. “We’ll be focusing on electrical or mechanical issues, and develop a curriculum to train others on how to address these problems.”

To top off the first overseas trip for both, they spent an extra week in Africa climbing nearby Mt Kilimanjaro.

Central America

Much like the group that went to Tanzania, the Central American group split the first half of their trip learning Spanish in morning and receiving training about medical equipment in the afternoon. After the entire group of 29 – with 12 from Duke – completed their initial training in Costa Rica, they were split into groups and sent to either Nicaragua or Honduras.

Within the group was a pair of Pratt identical twin seniors -- Kathleen and Mhoire Murphy. The Bloomfield Hill, Mich., natives are both majoring in biomedical engineering, with Mhoire also focusing on Spanish as a minor and Kathleen on chemistry. Engineering at Duke is a family affair -- their father, George, received undergraduate (’77) and graduate (’82) engineering degrees from Pratt.

Both Murphys went to Nicaragua, though at different locations. Kathleen was stationed at a large hospital in the capitol of Managua, while Mhoire headed off to a small Catholic-run clinic in the rural town of Diriamba. For both, the hands-on nature of the experience had a profound effect on their outlook on engineering and global health.

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“We worked on a wide range of equipment with the hospital’s technician,” said Kathleen. “Since my hospital was mainly for mothers and children, we repaired incubators, x-ray equipment, centrifuges and nebulizers. One doctor had a new nebulizer, but wasn’t sure how to use it. We helped and it was put into use immediately. We were able to help out because people at the hospital were so busy that it was difficult for them to keep up with maintenance and repairs.”

Mhoire’s group also provided repair services, but they also found themselves doing a lot of training and translating of manuals and user guides.

“Our clinic didn’t have as much equipment, but when we were able to fix something, it went right into use,” Mhoire said. “The people were so grateful that we were there. On other occasions we had to be more resourceful – if we couldn’t find a part, we had to improvise. For example, we found a switch we needed at a guitar shop. I enjoyed the problem-based approach to what we did – we got to use our engineering skills, and also experience the human side of things.”

Their time in Nicaragua has had an impact on the sisters’ consideration of their future.

“This experience has really opened my eyes to the problems facing the developing world,” Mhoire said. “Because of my time there, I’m now considering doing something in health care or world health. The trip put many things into clearer perspective. It gave me a greater appreciation of not only what we have here, but what needs to done worldwide.”

Kathleen has similar sentiments.

“Now that I’m more aware of global heath issues, I want to travel when I become a doctor,” said Kathleen, who plans to apply to medical school. Even though they had very little in terms of technology or modern equipment, Kathleen was impressed by the attitude and commitment of the doctors, nurses and hospital staff.

“I spent a lot of time talking with doctors and observing surgeries,” Kathleen said. “What impressed me so much was how hard they worked without a lot of resources. They were always so upbeat and positive.”