Saturday, June 10, 2017

Ghana Food Processing - Cape Coast, Slave Castle and Accra

After six days of hard work at ITTU, we packed up into an AC tro-tro for a long ride to visit the slave castles at Cape Coast and Elmina. We first stopped at Elmina to look at the bay and harbor. 
Elmina Castle

 Fishing bay at Elmina
 At this big fishing bay there are Ghanaian frying little fishes right from the sea, buckets of crabs for sell and many other seafood.
Fishing harbor at Elmina
 Then we headed to Cape Coast castle for a tour. We first toured the museum for 20 mins to learn about the history of the triangle slave trade and Ghanaian Culture. Then, our local tour guide led us into the underground dungeon where thousands of male slaves were kept for months in the space of a 3 bed room apartment. The only light that comes to the basement space is through two tiny windows high up. Food was thrown in from the window, and sick slaves were left to die lying on top of each other. Many were kept for up to 6 months before going through the tunnel to the gate of no return, onto ships for America.

Entrance to underground slave dungeon

The English church right on top of the male slave dungeon
 Unbelievably, many English people go to a church right on top of the slave dungeon every Sunday. The governor's spacious house is also located on top, his single person taking up more space than a thousands slaves. Besides, he had the privilege to pick any female slave for the night.
View from the governor's home on top of the slave dungeon/ Harbor where the slaves were shipped from
This was a heart breaking and unforgettable experience. The cruelty against humanity reminds and nudges us to be compassionate and kind human beings.

After the visit, we rode to Accra to have dinner at a Cote d'ivoire restaurant with some friends. For the night we stayed at Ben's friend house. The next day we went to the cultural arts market and bought some beautiful African paintings, bags, hats and earrings. Then, we packed up and headed to the airport. We also bought lots of Ghanian chocolate both at a grocery stand and at the airport (pro-tip: at the airport they have a Ghanian store that sells many flavors of Golden Tree Chocolate (entirely Ghanian). So don't spend all the money at Duty Free). Ghanian chocolate tastes very original and delicious!

We have learnt a lot in Ghana and everyone of us is thankful for the experience. We are moved by Ghanaian's open and friendly nature and made lots of good friends that we will stay in touch with at ITTU. There had been some hard times that required us to be flexible, But that also contributed to giving us more perspective for the future.

Jun 3rd, 2017

Friday, June 2, 2017

VIETNAM GLOBAL HEALTH: VISITING YEN MINH HOSPITAL

Today and yesterday we made the 9 hour trip to visit Yen Minh, a referral hospital nestled in the mountains of northern vietnam that is much more similar in terms of treatment capabilities and resources to the district hospitals we have had in mind while designing Otter than previous user visits the Global Health ADE team has been able to conduct. This entailed plenty of gorgeous scenery and valiant battles with car sickness on the twisty switchback roads, but we managed to make it in one piece!

Caption: Gorgeous scenery nearing sunset while driving amongst the mountains of northern Vietnam.

Upon arrival, we were able to meet the Director of the hospital and offer our thanks, before touring the NICU and the Labor and Delivery wards with the Director of the NICU (Thi Minh Nguyen) and several other doctors from those wards. We saw some great examples of how the equipment they had was being used, such as positioning aides, the temperature probes on the incubators being plugged in but not attached to the babies, and a repeat of Firefly having a hospital gown draped over it because it was directly below the AC unit.

Caption: A patient at Yen Minh hospital napping in the incubator, with temperature probe plugged in… and coiled up to the side. Broken, perhaps?

Unbeknownst to us, our interview was to be with what seemed like the entire department of the neonatal ward! While a little intimidating at first, this meant we got some really valuable feedback from a whole group of folks and captured a number of useful back and forth conversations between the doctors-- thanks to our amazing and persevering translator Hoa Dang Thanh and MTTS liaison, Engineering Fellow Chloe Nguyen.

Caption: 11 people giving us great feedback on the interface of Otter… simultaneously.

It ended up being a very fruitful first visit (by either ADE or DtM!) with lots of great insights and answers for some of our persistent questions. Excitingly, the staff of Yen Minh believe Otter would enable them to extend Firefly treatment to some premature newborns and others newborns who need additional warming, and they also showed interest in Otter as a means of keeping a baby warm next to its mom.
Yen Minh is the first hospital we’ve ever visited that reported power outages, and they independently asked about getting a battery power source to help them get through a typical 2 hour outage with some active warming still available, as their only current recourse is abundant swaddling and waiting. Fortunately, it just so happens that both MTTS and DtM are both working on battery projects for situations just like this, with MTTS hoping to make theirs charge from either AC or solar after having visited hospitals in Nepal.
We also encountered for the first time a preference for the interface to be mounted along the long side of the bassinet-- possibly because their single Firefly is oriented with the long side facing the healthcare worker and not on a wheeled cart like we’ve seen in other hospitals. We definitely have some good future iteration on iconography and the form factor of the interface cut out for us-- for one thing, in this context, our ‘too cold’ snowflake was interpreted as a fan. Oops.

Caption: A patient at Yen Minh receiving treatment in Firefly, under the cover of a draped hospital gown as this Firefly is positioned right underneath the AC unit.

At the end of our visit we were thrilled to hear that they would be willing to have us out for a longer visit in the future, and with the keen feedback and discussions we had, we are looking forward to coming back with our next iteration of Otter.









Ghana Food Processing - Community visit!

After a week of work at ITTU, the team was very excited for our community visit trip this weekend.

On Saturday we packed the tro-tro to leave for Konongo at 7:30am. Konongo is a market town in the center of the village’s communities. Here we stopped at a local bakery owned by our partner’s family and picked up our partner to help us translate throughout the trip. We also got ingredients for dinner by squeezing through a small open market, as well as mattresses for the night.

tro-tro with matress packed on top at our overnight stay


Peanut butter (left) at the Konongo market. In Ghana, most foods are wrapped and sold in plastic bags.


Then we departed for the three villages Wyaso, Nyanpenase and PKK, where we looked at the women’s machines and fixed any issues in the hot sun. Children in the communities crowded around us as 'O bruni' (foreigners) is a rare sight for them.

Wyaso village, the first one we visited

At Wyaso a nut on the lead screws of the press came off so we changed 2 handles with new nuts onto the lead screws. We also collected samples

At PKK, we met with one of the most productive user of QueenTech’s machines Auntie Ak in her yard.  Her machine had several issues: it was overheating so rust and bearing rubber was oozing out of the bearings, and the weld on the foot broke so it was re-welded in an incorrect way. We decided to take away her machine with us to fix it.

One of Auntie Ak's son using a good grater to grate cassava

From left to right: QueenTech's program manager in Ghana, a friend who owns a bakery in Konongo who translate for us on the trip, Kinsford, Auntie Ak's husband who is an agricultural extension officer and Ben

Auntie Ak with two helpers tying up a bag of cassava to press

Then we headed to where we are staying overnight. The women there cooked a delicious groundnut stew with rice balls and yam chips for us, which we enjoyed in the twilight. We also had fun hanging up bed nets in creative ways. All the Oliners slept on the patio outside the main house, while the others slept in the rooms inside.

The yard we stayed at for the night


Groundnut stew with garden eggs and chicken

Bednets we hang outside on the patio

On Sunday we visited another community Adomkrum, where QueenTech has three owners Auntie H, A and R. Auntie H is our first customer. She has a great fashion taste and takes care of her machines very well. In Adomkrum the tech team fixed issues on Auntie H's machine and checked on R's machine. The business team interviewed Auntie H and R for a potential funding partnership. When asked what is her dream, Auntie H said she wanted to produce more and more gari. She mentioned that high schools now include gari as their lunch and she wants to supply for that. The more gari she produces, the more she can provide for her own children (which she has many). Queentech's program manager also had a successful conversation with A's husband about payment options, and received some money from him for grater loan repayment!


Auntie H and her husband


Regina with her grater

One of the many cute goats munching around freely in the villages. There are also many chicken (free running) and other animals, along with the children.

We have accomplished and learnt a lot on this trip, as well as met many hardworking and warm people (including the queen users). After two long days in the heat without showering, we headed back to the guest house for a cool shower and rest.




Thursday, June 1, 2017

VIETNAM GLOBAL HEALTH – GROUNDING OUR WORK IN FEASIBILITY

These next couple of days mark the era of road trips.  I am currently sitting in a seven-seater car with Hoa, Chloe, Elizabeth, and Maire -- on our way to Yen Minh Hospital, 9h north of Hanoi.  The plan is to arrive in the evening, get some rest at the local hotel, and start Friday morning with our interview.  Another 9h trip back to Hanoi, a brief weekend respite, then two hospital visits on Monday.  We will certainly need to process each interview right after they occur, so that we can adequately adapt and prepare for the next.

But all that has yet to occur.  Gauging product/service desirability is often, and often unintentionally, painted as the most glamorous aspect of these trips – the criticality to product/service survival, the rigorous interviews (and the resulting evocative photos), the pivot-inducing insights struck as if from lightning from above.  But, feasibility (can we realistically make this?) and viability (can we stay in-business?) are as equally important.  Working with MTTS has therefore been a boon, because the ADE Global Health team has been able to explore design-for-manufacture and business viability in the context of an already-existing infrastructure and support system.

Source: Pinterest.

Due to a turn of events – our visit to the district hospital Moc Chau fell through due provincial security concerns – we've spent two days, not just one, at MTTS.  Though the cancellation was a bummer, it bought us time we otherwise would not have had to review IEC’s alarm standard and brainstorm a control panel that more holistically integrated alarms.  And, as scheduled, we: brought our MTTS liaisons up to speed with our Spring semester progress, and solicited advice on design-for-manufacture and product point-of-view. These sessions will be key to situating next semester’s engineering work.





DESIGN FOR MANUFACTURE

Greg (CEO, MTTS), Chloe (MTTS), Maire (ADE), and myself (ADE)
hovering around Greg's laptop, trying to distinguish response from echo

Challenge:  How to cost- and time-effectively embed the heating element into the bassinet?

We called e-BI, a vacuum forming broker located in China that currently handles Firefly bassinet production, to investigate the possibility of embedding the heating element directly into the bassinet as it is being vacuum formed.  This process would – if proven technically possible – would reduce the number of intermediary post-production steps and time between raw material and finished product.

After some back and forth, the e-BI engineers promised to deliver a range of proposals to MTTS next week.  Though we did not leave with anything definitive, the phone call, conducted over Skype, laid bare the challenges around brokering international manufacturing.  The internet lag and persistent aural echo was compounded by translation challenges: we would explain the product concept in English to e-BI’s project manager, who would translate into Mandarin for her engineers.  The engineers would ask Wendy clarifying questions in Mandarin, which she would translate back to us in English.  We spent a lot of time waiting for translation and fiddling with Skype settings, but I was particularly frustrated because though I could certainly *understand* the Mandarin, I don’t speak the dialect well enough to articulate a response past casual conversational.  When we ended the call, Greg sighed, “You see, this is why we try to keep manufacturing in Hanoi.”


Steffen and Trong said that this PCB, measuring a mere ~5" x 2",
is more than capable of filling all our electronics controls needs.

Challenge: How can we push shrink PCBs to afford freedom in form-factor design?
Steffen and Trong, engineering leads at MTTS, stated that the relatively small PCB (printed circuit board) pictured above would be capable of powering all our electronics control needs, from heating element power management to button and LCD screen control. So far, we have been using Arduinos and other hobby components -- components that are bulky and, if scaled for the manufacture level, very quickly expensive.

By assuming this small PCB size, we give ourselves freedom in developing form factors for Otter's control panel because we have fewer and smaller components to house.


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These were just two of the many conversations our tiny team has held regarding product feasibility in the past 48h. We are truly fortunate to be working with MTTS,

Tuesday, May 30, 2017

VIETNAM GLOBAL HEALTH -- VISITING ST. PAUL HOSPITAL


After we visited the injection molder, we then visited St. Paul Hospital, a provincial hospital located in the heart of Hanoi.  Though we are targeting district hospitals – which are typically smaller and have fewer resources in terms of staff, funding, and capabilities – our interview with doctors from St. Paul was fruitful.  We received two validating responses to the user experience around Otter’s interface, which we have been working throughout this past semester.  (Upon asking Dr. Duong Nguyen to set the temperature to 33 degC, she pressed the buttons and then shot us a glance that said, “Is that it?”)


Elizabeth Johansen (ADE Advisor), Nurse Bach (St. Paul Hospital), and

Dr. Hanh Nguyen (St. Paul Hospital) try the Otter prototype interface.


We also began formulating a clearer picture of medical need around Otter used in conjunction with Firefly phototherapy, our primary use-case. To better uncover this information, we created a new prop nary an hour prior to the interview: the patient flipbook.  The patient flipbook allows us to quickly ask healthcare workers about which equipment they would use with a variety of patients with jaundice by highlighting four characteristics: gestational age, weight, core temperature, and jaundice severity.  There is a range per characteristic (ex: mild jaundice to severely jaundice), again – allowing us to quickly cover a broad range of patients and their hypothetical journeys.



Flipbook to explore the best warming & phototherapy devices for different newborns.

Dr. Hanh Nguyen (St. Paul Hospital), Liani Lye (ADE), and Hoa Dang Thanh

(MTTS translator) use the patient flipbook at St Paul General Hospital.


Though these are two positive takeaways from our interview, we must retain team- and project-awareness as we progress through the trip.  We must remember to always validate with our target market in mind; demand at a single provincial does not equate to blanket demand at district hospitals.  And, we should continuously balance streamlining our interview process against eliminating interviewing bias and answering many project questions thoroughly.  Forward and onwards!

VIETNAM GLOBAL HEALTH - VISIT TO AN INJECTION MOLDER

We started our first day in Hanoi with a trip to a local mold maker & an injection molding contractor. The goal was to investigate their facilities and estimate the likely cost of manufacturing our plastic user interface housing for the Otter newborn warmer. The photo below shows the team attaching the white, plastic user interface to our warming bassinet.

How many engineers does it take to drill a hole? Answer: Chloe Nguyen (MTTS), Hoa Dang Thanh (MTTS), Maire Keene (ADE) and Liani Lye (ADE).
There are many options for how to make a plastic part. As the quantities increase, injection molding can become a cost-effective way to make many identical parts with complex geometries. Design that Matters’ manufacturing collaborator, MTTS, suggested a vendor nearby in Hanoi might be able to make our part for an affordable cost.

At the mold-making shop, we spoke with Lai Duc Khoa who reviewed our CAD model and the 3D-printed part we made. We learned about the importance of working with manufacturing vendors close to MTTS in Hanoi to better ensure quality and keep costs like importation fees low leading to lower part costs.

Chloe Nguyen (MTTS Engineering Fellow) translates our questions for Mr. Khoa, a potential plastic injection mold-making vendor.

Duc (MTTS) and Maire Keene (ADE) standing near the CNC machines that make injection molding tools.
The mold maker uses CNC (computer numeric control) machines to create the mold; negative impressions of the inside and outside of a plastic part. The mold for our part would likely be made from steel. This vendor would then give the mold to a subcontractor. To create a plastic part, the subcontractor would fit the mold inside a press that holds the two pieces together while hot, liquid plastic is injected into the cavity formed by the two pieces. We visited one of the sub-contractors who was using one of the molds to create a Mickey Mouse toy.


The negative and positive sides of an injection mold for a mickey mouse toy!

Extra pieces of plastic such as the gate are trimmed from the toy by hand.
It looks like these vendors could be a good option for molding our part. The price estimates are a little higher than we planned, but would only add a few dollars to the price tag of our medical device.


Many thanks to Nguyen Duc Viet, MTTS Mechanical Engineer and Chloe Nguyen, MTTS Engineering Fellow, for setting up this visit, providing insight on how to select a vendor, and for bridging the language gap.

Ghana Food Processing - Central market in Kumasi


Day 3:
Today is a national holiday, the united African holiday, so the shop at ITTU is closed. In the morning we did some documentation and drawings work, and then walked from our hotel to the Engineering Guest House at KNUST, where Ben gave a talk about ADE and IDIN founding to a group of IDIN members. 

After the talk, we headed to the Kumasi central market to buy some fabric to make some custom clothing from a trusted Ghanaian seamstress! Ghanaian women have a great sense of fashion and the majority wear custom clothing from colorful fabric. Each day on the commute from our hotel to ITTU we see a fashion show just by looking outside on the street.

The central market sold everything you can find at a big grocery store and a shopping mall, but in the open air with small "ground stands". People flowed constantly through the narrow alleys like traffic. Women holding bowls of things on their heads, and saying Ago, Ago to you if you don't move. 

Sellers selling vegetables and soap/detergent, next to each other
There were at least 4 alleys of fabric sellers, and the variety of fabric are all so colorful and beautiful to make a choice very difficult.

Fabric shop with a woven type of fabric that is expensive 

Fabric alley full of color 

We decided to buy some batik fabric, a special soft fabric that is patterned by wax and also some block printed ones. 
Tomorrow will be another full day of work at ITTU, then we are excited to visit community villages during the weekend! 

Thanks for reading :)