Written by David Kimmey
Contributors: Carrie Noxon, Emily Bull, and Nicole Moreno
Rice360 Institute for Global Health Technologies offers post-baccalaureate fellowships for exceptional early-career engineers with an interest in medical technology for low-resource settings. During their time as Rice360 fellows, they become part of our international teams and often travel to support the development of Rice360 supported projects.
Recently, Rice360 fellow, David Kimmey, went to Malawi to work with our colleagues at Queen Elizabeth Central Hospital on clinical studies for Celsi Warmer. The following is his account of his time in Malawi.
This blog is one of four from the team members in Houston and Malawi who worked in Malawi in early summer 2022 on these studies.
Figure 1: Celsi Warmer in Queen Elizabeth Hospital
“Tell me, and I may forget; show me, and I may remember; involve me, and I will understand.”
As engineers, we are hopeless in trying to solve problems without the hands-on involvement required for understanding. While technology makes it possible to communicate across the world, Zoom calls and email tend to focus mostly on telling and showing, often lacking the key component: involvement.
Evaluating equipment in Malawi
While it can take a significant financial and temporal commitment to travel over 14,000 kilometers to be involved with our colleagues, I recently had an opportunity travel to Malawi to do so. The chance for in-person collaboration with our incredible team in Blantyre, Malawi gave me important perspectives on the technical challenges we solve together.
Together with the NEST360 team at Queen Elizabeth Central Hospital (QECH), we focused on the Celsi Warmer – a low-cost warming mattress aimed at reducing newborn hypothermia that has been undergoing clinical studies at QECH since July 2021. This clinical study represents a critical step in transitioning an early Celsi Warmer prototype to a final product. I worked with our Malawian counterparts to continue enrollment in the clinical study.
Besides the obvious quantitative data that comes out of clinical studies, the qualitative experience of seeing the Warmer in use provides beneficial feedback. Throughout the clinical study, I was able to work with Prince, a long-time NEST360 collaborator who, as a nurse and epidemiologist, has been invaluable in providing the engineering team with clinical assistance and expertise. It was an honor to also work with Rowland and Maureen, the two amazing NEST360 team members in Malawi who set up and collect data that we rely upon as engineers.
Figure 2: Rowland, David, Shababa, and Maureen
Purpose of the team’s work at Queen Elizabeth Central Hospital
The purpose of this clinical study is to validate and demonstrate Celsi Warmer’s efficacy in a clinical setting. Beyond working on this critical step, the Celsi Warmer team also used this opportunity to help gather information on the device’s user interface. A large part of making a medical device safe and effective is designing it with an intuitive user interface. During the second half of my visit, we transitioned from clinical studies to formative usability studies. The usability studies, as the name implies, seek to determine how usable the device is for the people who will work with it daily. Studying these human factors in person will help me, as an engineer, in my contributions to the Celsi Warmer team.
Figure 3: Celsi Warmer circuit
What we learn from the usability studies will help inform the device’s future design. On a personal note, this is one area I was able to have some fun in preparing. Before we went to Malawi, I updated the prototype designing to allow us to simulate different scenarios with the device. By using the scenarios to mimic different devices modes we were able gather feedback on nurses’ thoughts, actions, and reactions to these scenarios. Validating the device’s efficacy and usability was the primary goal of our visit and that puts the team one step closer to a production-ready device.
The team’s efforts have culminated in a final prototype set to be this summer (2022). The information gathered from our visit to QECH built on all the prior studies by the team and sets us up for the final prototyping phase. The data recorded also will serve as a backbone for the regulatory documentation needed to receive a CE mark. Being involved in moving this device closer to production is an opportunity I will always remember.
Figure 4: Celsi Warmer prototype
Engineering to improve newborn health
Celsi Warmer is expected to be incredibly helpful in combatting newborn hypothermia, a leading contributor to newborn death. Newborn hypothermia has been documented to have rates up to 85% in parts of sub-Saharan Africa (Onalo, 2012). With mortality increasing by 15% with each degree Celsius decrease in body temperature, newborn hypothermia remains an often preventable, yet widespread contributor to newborn death (Mccall et al., 2018; Wilson et al., 2016).
Unfortunately, warming devices currently on the market, such as incubators and radiant warmers, are often prohibitively expensive, not rugged enough for use in low- and middle-income countries, or not appropriate for long term warming (World Health Organization, 1997). The Celsi Warmer offers continuous monitoring of a newborn’s temperature and automatically adjusts of mattress temperature to optimize thermal treatment. The efforts by NEST360 to develop Celsi Warmer will provide a simple but effective way to reduce newborn mortality.
Figure 5: David, Betsy, and Josh
My schedule in Malawi was very full, yet I found there was pace to life that can seemed relaxed. The hospitality, welcoming nature, and generosity of the people I met exemplified Malawi as the “warm heart of Africa.”
To prepare for this trip, I had learned a little Chichewa, one of the languages spoken in Malawi. Upon hearing this, one of our taxi drivers generously gave me a movie dubbed in Chichewa to help me in my study. While I may have mixed up some words, such as emphatically calling a Nyala (a large striped – impala looking animal), a “nyemba” (the word for beans), on a safari, I was met with patience and generosity when trying out new words.
Perhaps one of the most memorable moments outside the project happened on a safari when we met face-to-face with a large elephant (“njovu”). Also, my love for hiking and the outdoors was met with beautiful mountains, waterfalls, and forests to explore. The vast planes contrasted with the sharp peaks and created a sense of divine inspiration in the Malawian backdrop.
Mostly, though, I felt welcomed by my colleagues. From sharing a birthday cake, to being invited to a local church, to being invited for a delicious home-cooked meal of “nsisma, nyemba, ndi masala,” becoming involved as a part of this amazing team.
Mccall, E. M., Alderdice, F., Halliday, H. L., Vohra, S., & Johnston, L. (2018). Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. In Cochrane Database of Systematic Reviews (Vol. 2018, Issue 2). John Wiley and Sons Ltd. https://doi.org/10.1002/14651858.CD004210.pub5
Onalo, R. (2012). Neonatal hypothermia in sub-Saharan Africa: A review. Nigerian Journal of Clinical Practice, 16(2). www.njcponline.com
Wilson, E., Norman, M., Wilson, E., Norman, M., Wilson, E., Maier, R. F., Misselwitz, B., Howell, E. A., Zeitlin, J., Zeitlin, J., Bonamy, A. K., Bonamy, A. K., van Reempts, P., Martens, E., Martens, G., Pryds, O., Boerch, K., Hasselager, A., Huusom, L., … Fenton, A. (2016). Admission Hypothermia in Very Preterm Infants and Neonatal Mortality and Morbidity. Journal of Pediatrics, 175, 61-67.e4. https://doi.org/10.1016/j.jpeds.2016.04.016
World Health Organization. (1997). Thermal Protection of the newborn: a practical guide. World Health Organization, No. WHO/RHT/MSM/97.2.