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

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.

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.

VIETNAM GLOBAL HEALTH – GROUNDING OUR WORK IN FEASIBILITY

The 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 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. Olin's design curriculum unintentionally emphasizes gauging product/service desirability as the most glamorous aspect of these trips -- the criticality to product/service adoption, the rigorous interviews (and the resulting evocative photos!), the pivot-inducing insights. And considering Olin is an engineering college, we must actively check our impulses to create features for technology's sake.

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.

Because our visit to the district hospital Moc Chau fell through due to security concerns, we've spent two days, not just one, at MTTS. The cancellation was disappointing, but 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: (a) brought our MTTS liaisons up to speed with our spring semester progress, and (b) solicited advice on design-for-manufacture and product point-of-view. These sessions will be key to situating next semester's engineering and design 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 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.

-----

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. <I need a stronger conclusion here, indicating how all of our insights have allowed us to move forward. Especially since we are good at the horizontal, but not the verticals of T-shaped expertise.>

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.

Author: Maire Keene

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 :) 

Food Processing - Welcome to the shop!

Day 1

Today is our first day working at ITTU! After a good breakfast of whole wheat toast, egg pancakes with scallion, tea and Milo chocolate energy drink, we met our program manager here in Ghana, a female engineer who studied agriculture engineering at KNUST. She hugged each of us and welcomed us with her stunning smile. It took us about 30 mins to drive from our hotel to ITTU (short for Intermediate Technology Transfer Unit), located in the Suame Magazine area, where metal workers and car mechanics are concentrated in a village. ITTU is a KNUST machine shop that produces and assembles our machines. On arriving, we met all of our partners who help us fabricate the machines there. Their open friendliness and happiness to see us made all of us smile. It felt like they have already known us because we work on the same project, even though most of us have never met before, and we started meaningful conversations right away.

The entrance to ITTU in Suame Magazine

Then, we started work by making a list of technical and business tasks as well as planning a community visit.

Then, after lunch we assigned tasks to each of us and started on some of them. The business team discussed updating pricing of the machines and the customer relationship management system. The technical team started unpacking all of the tools we brought from the US, as well as press fitting some bearing adapters into bearings using the local press, and asking a senior ITTU fabricator to broach more inserts.The plan for tomorrow is to build a reference machine for a new grater design. With all of the new fixtures, we can speed up this process substantially.

            The fixtures, parts and tools we brought to Ghana with us all unpacked

Day 2

Today we made lots of progress on both the business and tech side. The business students discussed a plan to incorporate in Ghana and a potential funding partnership to support the machine owners. They also finished updating the Customer Relationship Management (CRM). The tech team trained the fabricators at ITTU to use the templates and newly designed features. They also debugged the broaching method for bearing adapters and tried a new method. We also explored the basement space downstairs that we want to move into. 

In the afternoon, we were distracted from work by a variety of local food, brought by women who carried them on their heads. First we had mangos grown at our shop manager’s house and ball fruit (fried dough in the shape of a ball), then we drank juice from an entire green coconut and also ate the fruity inside. One of our partner fabricator also offered us his daily snack, a local specialty: tiger nuts that taste like coconut but looks like peanuts.

One of our partner fabricators, holding a bag of sweet peanuts that he offered to us to try

Food Processing -- Mah Krow from Ghana!

Day 12:

Today started early at the SMS Guest House. We packed up all of the tools and parts we will be bringing back to Boston, along with some old machines for archiving, and started the 3 hour van ride back to Accra. We stopped along the way to visit and check in with two customers.

Drying grated cassava with an older QueenTech press

Getting ready to toast some gari

In the evening we met up with an importation agent that had been recommended to us by a friend of the venture. We had a productive conversation, and we are very optimistic that he will be able to help us resolve problems we have been facing with getting our grater motors from China to Ghana. Since this is a supply chain issue that could seriously impact our production schedule it is a huge relief to have made forward progress, especially as our time in Ghana winds down.

We have two more days in Accra before we leave for Boston on Sunday, which we will be spending finishing up trip documentation, identifying and prioritizing tasks for next semester, and getting to see some of the city.

Thank you for joining us on this exciting journey and continuing to support the ADE program. See you in May!

This goat posting sanctioned by Ben Linder

India - Child Education - Learning Through Experiencing

Our first observation of the Brightbox was in a class conducted at Agastya. Students from a nearby school came to campus for an hour long lesson on light using Brightbox. A group of about thirty 14 year old girls with matching braids walked into the physics teaching lab at Agastya. We waited in anticipation at the back of the classroom while their teacher divided them into groups and demonstrated the Brightbox. As each exercise was handed out students worked intently. The students were so focused on finishing the exercise that they rarely spent time just exploring or playing with the Brightbox. Now we have observed three class sessions and noticed this as a fairly common thread. We were expecting much more discovery time and play with the Brightbox to help spark the children’s curiosity beyond the initial lesson.

However, we found a different experience when visiting a night school program called Operation Vacenta. The goal of Operation Vacenta is to provide village children a place to learn, do homework, and explore new subjects while their parents work in the evenings. While the Agastya classes took place on the clean, fresh campus, the night schools were typically one room or open-air classrooms in the hearts of local villages. The smells of food, nature, and other things were all around us, and the students were very different than those we met in class. These students ranged in age from four to sixteen, and did not have the educational experience of some of the students on campus. On our first visit to night school, students demonstrated the different activities they do there, performing songs, dances, and dramas. Of course, we had to reciprocate the act, and performed several of our own numbers, such as “itsy bitsy spider” and “head, shoulders, knees and toes.” We learned that the environment at night school was not as structured, especially because there were young adult volunteers rather than formal teachers. The leader of the local night schools, Madame Jayama, invited us to bring Brightbox to night schools the next day.          

We started our lesson off by giving each group of students time to explore and play with the different lenses, prisms, and mirrors included in the Brightbox optics kit. Each group was given flexibility to take as much time as they wanted. This was very important in allowing each group to understand some of the principles of the lenses. By giving each group a mentor who could answer questions and encourage exploration, children were able to understand and explore more than in a strongly structured routine. After some time, each group started and finished a new exercise we developed. They seemed to have a lot of fun doing it including lots of giggles and creating their own puzzles. We thought it was really great that the teams did not seem to get bored, but instead kept playing once the lesson was done. We considered the night a success, as the curriculum we had worked, and left the kids interested and excited.

When we realized that we would be conducting our next lesson at the night school with the same group of students, we struggled to create new curriculum in the hours before. None of our demos were working and we went to the night school with a list of short exercises rather than a coherent lesson plan. We were prepared for the lesson to be chaotic, however halfway through the lesson we realized that our lack of preparation was the most serendipitous mistake we could have made. 

Because we divided the groups by age, some of the groups worked at very different paces. The group of eighth graders had long since finished the first exercise by the time the youngest students successfully finished. After the oldest students solved the puzzle they began exploring other ways to play with the Brightbox, coming up with activities that were much more interesting and creative than what we could have thought of in a classroom at Olin. For example, the students working with Nick focused the elephant image to a point so that it could be passed through a slit, then diverged the point to project the elephant onto a sheet of paper. I guess they figured out how to pass a giraffe through a needle’s eye! Students at the other night school noticed that they could project the light onto the ceiling and soon created their own activities making the elephant images dance and compete with each other. Meanwhile, the younger students had the time and intrinsic motivation to continue working on the first exercise until they were fully satisfied with a solution. This is the kind of grit that the latest pedagogical theory has only just started to recognize the importance of.

While a lack of structured instruction allowed the students to become immersed in the experience, one night school volunteer made us realize the importance of some lecture. He walked over to a group of students who had just solved a difficult puzzle. Although they were giddy with their victory, the real transformational moment happened when their teacher explained why their solution worked using optics concepts. When he pulled in examples like movie projectors and rearview mirrors, the room was filled with “ohhh!”s The Brightbox set the stage for insights, but the teacher led them to the “aha” moment.

Having the opportunity to observe some of Agastya’s many use cases for Brightbox gave us insight into what kinds of environments do and do not suit Brightbox. We realized that the lack of structure in the night school allows for the kind of exploration that makes Brightbox fun. Based on what we learned, we plan to adjust the curriculum of the Brightbox to build in exploration time and an explanation at the end of the lesson even in the more traditional class setting.