Conference and Costa Rica

All of the participants of the program reunited from the different corneres of Honduras and Nicaragua in Costa Rica with the President of EWH, Cathy Peck, the new CEO, Dr. Frank Webb, and the Director or EWH, Dr. Bob Malkin. Dr. Malkin has also been my advisor for the last couple of years and will be my professor in the Fall for my Design for Developing Naitons course. The conference gave us all a chance to report on what we had accomplished, tell about what we had learned, and have a few laughs.

The different groups had very different experiences depending on where they were living and who they were working with. Mhoire and Pia worked in a very small Convent Hospital (which didn't even own a defibrillator) and worked alone for the first two weeks while Henry and Brian worked and even lived in a huge hospital in Tegucigalpa. It is estimated that together, we were able to put hundreds of thousands of dollars of medical equipment back into use!

I'm excited to take my design course in the Fall . I would like to create an unbreakable ultrasonic nebulizer. I also look forward to being able to help out translating at SHAC much more effectively with all the Spanish I've learned. And, of course, I can't wait to share the stories that didn't make it onto the blog with all of you at home.

Now I'm sitting in the airport awaiting my flight back home, so this will be my last post unless something exciting happens on the way. Thank you all for reading and leaving comments and such. Writing a blog to write kept me thinking about what I was doing, gave me a chance to reflect, and made me take pictures where I might not have otherwise. ¡Que les vaya bien!

Health Worker's Appreciation

The last week in Nicaragua was of course exciting right up to the last day. Starting off the week we got the opportunity to teach Juan (our technician) a little bit about the toxicity of mercury when the second mercury containing device came in. An original Baumanometer from the dark ages was sitting in the corner when we got there waiting to be re-filled and this week a nurse brought in a mercury based sphygmomometer for repair. The nurse was also unaware that the instrument is a health hazard as we pointed out the small beads of mercury that had escaped from the cylinder. She told us about a child currently in the ICU in critical condition who had been treated for diarrhea with a folk medicine-advised cocktail of cooking oil, milk of magnesia, and mercury bought off of the black market.

Wednesday, the ICU called maintenence about a ventilator that they thought was malfunctioning because the infant's chest was not rising with the ventilators pulses. After testing the artificial lungs' pressure and the attachment tubes, it turned out that the infants airway had become clogged with mucus so the air was not reaching his lungs. After quickly aspirating his airway, his chest rose and fell with ease. One of our biggest frustrations is that the staff doesn't have the confidence or the know-how in the use of the machines to be able to provide the best care. We hope that the few people we were able to teach will be able to help the rest of the staff in the future. Finally on Thursday, our last day, we awaited the National Health Worker's Appreciatio celebration to start at 10:30. In the morning, we were checking on another ventilator in the ICU (turned out, it just had empty O2 and air tanks and a questionable valve) when we heard a commotion from the nurses. A small mouse scurried across the threshold and behind a brick in the corner. But no worries, Juan quickly hunted it with a flat head screwdriver.

Then, at 10:30 AM, business in the hospital halted and everyone gathered in the large gymnasium space used as an outpatient consultation area. A stage with a DJ and lots of lights filled the room and music echoed out of the open doors. Lots of dancing (a provocative style from the carribean coast with lots of movement) and drinking ensued among coworkers and the party continued until after 12AM! The best i could do were the few salsa moves I had learned in Costa Rica. Imagine this happening in your work place.

8th wonder of the world?

Well, maybe not quite, but it sure is spectacular. This weekend we all hopped on a ferry (or a small wooden boat) and shuttled across a stretch of Lake Nicaragua to the island of Ometepe. Ometepe was formed by two large volcanoes: Concepción and Maderas. The larger and more active Concepción erupts approximately every 45 years... and it has been 50 since the last blast. While we were in town we even heard it groan with the pressure several times, even though we though it was thunder at the time.
Most of the hotels are bed and breakfast style and all of the people are very friendly. We even had a visitor in our bathroom (see large toad). I asked the owner if he was going to charge us extra for our 4th guest but he said no because they eat the bugs- "Que suerte! Ellos comen los bichitos." (Seriously, Mom, do not read on. Just close your browser.) Our choice of transportation around the island, for their ease of use, off roading capabilities and price, were motorcycles. One of us had experience riding the bikes and two more had experience driving a stick shift, so we drove the bikes and the others piled on back. With such little traffic on the island, the only thing to worry about were the cows!

One More Week (wait, what?..........ALREADY?!)

This week, we have really jumped into repairing equipment very efficiently. Whereas at the beginning of the four weeks, it seemed as though we would end each day with more work to do machines than when we started, now we are pulling up projects that have been left on the back burners. We fixed the collimator on a fixed X-ray machine early in the week and I’ve gotten a good deal more practice with the arc welder (see large metal fence). The arc welder actually reminds me a great deal of the electrosurgery units in the way it works. Anyone know which came first or if one inspired the other?
We are learning and coming up with many new clever tricks also for fixing devices or finding alternatives. For example, the stethoscope below has a new diaphragm cut out of an old x-ray plaque. It is held to the bell with an elastic gasket made from medical tubing, placed in a circle, fused, and sliced along its interior edge. How cool!
Finally, I got my supplementary application for UNC on Friday (yaaaay) so I’m scribbling away on the essay and trying to figure out how I am going to submit it…

Granada, Nicaragua (not Spain)

Granada is the most popular tourist town in Nicaragua. Situated on the giant Lake Nicaragua with a great view of the island volcanoes, the little town bustles with horse drawn carriages, guided tour groups and street vendors and markets. Outside of the town borders though, we stayed at a very quiet guest house called the Dolphin. We had a very relaxing weekend and visited the Laguna del Apoyo, a very large crater lake (with much easier access!). The cat we found at an inn on the water expresses the pace of life on the countryside and our prerogative for the weekend.

Care, Culture, and Cumpleaños

Week two ended with quite a bit of excitement at Hospital Velez Paiz. We started off Friday by “upgrading” the old Bili-lights donated by previous EWH groups. The phototherapy lights (blue, right) were an EWH design project and came equipped with a batter for portability and reliability during power outages. Our hospital, though, has such an influx of children in the neonatal ward that the lights need to be passed from one child to the next immediately without time to recharge. As we brought a newer version of the light with us as a donation, we were supposed to bring the old lights back for research purposes. But, as the lights were in such high demand, we were asked to replace the batteries with a wall transformer and leave them in service.
After replacing the lights, we were kindly invited to watch an orthopedic surgery on a fractured radius. The surgery was interesting and we even spotted the orthopedic saw we fixed back in service in the OR. Unfortunately there were only enough lead vests for the anesthesiologist and the radiologist to wear so hopefully the rest of us in the room didn’t absorb too much radiation during the shots taken.

Finally, one of our friends from maintenance, Yelba, had a birthday. We had been told earlier in the week that she was having a birthday and that there would be some cake but little did we know that she was throwing quite a party! You can see she is quite content with her enormous cakes (you can see the corner of the second equally massive pastry to her left). The party was complete with over 25 guests from the hospital, salad, pork rinds, blaring music, and a huge pile of presents. Even Caleb, Juan’s son, got to attend because his daycare was closed. He likes Spiderman a lot! (ok, maybe I look like I like Spiderman more).

¿Y Éste? ¿Está Malo?

Bringing the second week of working at Hospital Velez Paiz to a close, Kathleen and I have put quite a few techniques under our belts and have fixed a number of machines in high demand by the hospital. Ranging from dismantling an orthopedic surgeon’s sagittal saw to climbing on the roof to repair the hospital administration’s phone lines, we’ve seen and done quite a bit. Check out the deserted second floor of the hospital. Juanpe has 4 years of technical experience and has largely learned by teaching himself or picking up bits of information from professionals that travel through the hospital. He has worked at the hospital for 10 years and is very knowledgeable about how the place works, as he gets to see every part of it daily. He also knows all of the doctors and administrative staff very well so he is an incredible asset to us while we’re getting our feet wet. He usually works with a partner, Roger, who is out on medical leave with a broken hand (defended himself against two would-be muggers) so he is happy to have our help.

By far the most common items brought into maintenance are the nebulizers. Some of them are even broken! About half of the time though, the only fix needed is a quick two or three minute crash course for the staff on the item’s use and care. Other times, the fixes require us to manufacture tools or new mechanical parts such as corner supports for the sides of an infant warmer (arc welder) or replacement valves for a manometer. The vast majority of broken equipment comes from misuse. So much that Juan says there is a saying in Nicaragua that “La gente es un estómago; porque convierten todo en…” (The people here are a stomach; they turn everything into…). Although there is a lot of misuse of equipment such as extremely oxidized leads on things that should be kept dry, things that aren’t kept clean, and things that don’t receive the maintenance they require, I think Juan’s saying is a bit harsh. The hospital’s equipment is nearly entirely comprised of donated equipment from several different countries, with instructions in several different languages (when they are included). It’s no wonder such a simple thing as a plugging in an adapter to charge a battery is a cause for confusion.

It's an incredible feeling when we bring an infant warmer back to the neonatal ward and they immediately put a child in, or hearing how our phototherapy lights work much more effectively than the others they have. "Vengan mañana y vean como sale el amarillo" (Come in tomorrow and see how the yellowness fades) they tell us excitedly after we hang the bilirubin lights.

San Juan Del Sur

Our first adventure in Nicaragua was to San Juan del Sur, a beach near the southern border of Nicaragua on the Pacific Coast. I think the majority of us wanted to catch some rays so that we might even look like we’ve been in the tropics when we come home in August rather than looking like we’ve been in workshops up to our elbows in transistors and solder. The beach is only about 80 miles away from Managua but our average transit time was about 4 hours each way.
San Juan del Sur is a small port town with a hundred small fishing boats anchored in the harbor and just as many independent hotels, bed and breakfasts, and hostels along the mountainous cove to accommodate the tourism and surfing industry. The beach is equipped with very muddy brown sand and knee-high waves (also laden with mud). But, just about 12 kilometers north, Playa Majagual boasts a light sands, prominent rock formations, fifteen foot waves, and deserted beaches.

When we first got to the beach, we went to check out the rocky point of the island. We skirted around the edge of a cliff and crossed a shallow area of water where the point breaks away from the main land. “Wouldn’t it be funny if the tide came in while we are out there?” I asked more astutely than I knew. Neel reassured us that “The tide is usually high in the morning.” Right. Let’s go. Anyways, we trekked around the point and climbed on the rock formations there. I also learned the how to raise waves with sweeping arm motions (inspired by Mickey Mouse in Fantasia). Jordan didn’t master the trick though, and found himself fighting his way back across to the mainland after the tide did indeed cut us off.

Hospital Infantil Fernando Velez Paiz

The Hospital Velez Paiz is the oldest hospital in Managua as it was the only one to stay standing after the earthquake of 1972. The second floor of the old section of the hospital is no longer in use but the majority of the hospital still bustles with activity. The hospital is primarily for children but also houses a maternity ward, a general emergency room, a burn unit, four operating rooms, and an ICU. This time of year (“winter”), there is a greatly increased need for the hospital. For example, the GI clinic typically has capacity to admit 30-40 children but currently has nearly 200 occupants. I did not feel comfortable taking a picture for you all to see but imagine two mothers with their children per crib and chairs spilling into the hallway to accommodate the rest.

At the hospital, my partner Kathleen and I work with a crazy technician who goes by Jonny but all of his friends call him “Pelon (Baldy)”. Fortunately, he has a great sense of humor. We are blessed with an air conditioned workshop and Jonny is incredibly helpful and knowledgeable. Today we fixed the pump motor and drive shaft on a nebulizer and then calibrated a sphygmomanometer and fixed the intake valve (it worked, and I showed off my 110 /85 mmHg). There is no shortage of work though; we were introduced to heaps and heaps of broken machinery. Lack of spare parts is clearly the biggest problem we’ve run into so far. The operating room theatre lights have less than half of the bulbs working and less than 1 in five are the correct wattage and intensity. One of the operating rooms only has a dome reflector light that uses a single ~25 watt energy saver bulb similar to the one lighting my room at my home stay. Let me know if anyone has access to some of these (of course I could find out makes/models)!

Managua, Nicaragua

I made it to Managua, Nicaragua bright and early Saturday morning just in time to... do nothing for the rest of the day. The pace of life is much slower here for some. For others, like Octavio my host brother, life demands near 12 hours of work per week day, a day of English and Technical training on Saturdays and work meetings on Sundays. I don´t envy him.

Our house is located in a small neighborhood called Linda Vista Norte right behind a somewhat famous bakery, La Reposteria Norma (yes, that was my address). My roomate Kathleen and I share the house with Octavio (26 years old) and his mother. The two of them seem to really enjoy having us around as they kindly gave us a tour of Managua and took us to a nice lunch at a typical Nicaraguan restaurant.

We have two dogs at hour house: old docile Canela (cinnamon) and the excitable Laisha (after actress Laisha Wilkins Pérez). While I´ll miss having children in the house, working at the children´s hospital should make up for it. An introduction to the hospital and more pictures to come...

El Terremoto

Costa Rica was just starting to feel like home and its already time to say good bye. The past four weeks have been a blur but I think i picked up a great deal of experience with the language, practical knowledge for the engineering, and had a ton of fun. After school we often played some pickup soccer or basketball in between rain storms. We often played against local guys on this court right in the middle of our residential area. They seemed particularly excited to exercise their repertoire of vulgarities in English and amiably referred to me as "Strong Man."

My only regret for the weeks here was that I didn't get to spend enough time with my host family. Last night we took some time and had some fun with the kids. Jonathan and Esteban were very excited to show off the song and dance they learned from a clown at a birthday party while Antoni was all radiant smiles as usual. They're quite a handful- especially Jonathan (wearing the dress and women's shoes). Flory calls him el terremoto (the earthquake).

City Tour

For Spanish class today, my group hit the streets of San Jose to see how the city was put together and how historical events persist in the architecture and culture of the city. San Jose was chosen as the capital city of Costa Rica for its convenient location nestled in the central valley between the coffee plantations on the west coast and the port cities of the Caribbean shoreline. As a city of government and trade, the city was built around two centers of power on the northern slope of the central valley. The commercial and economic center was based at a railroad and customs complex while the executive power was built around another locus with the courthouse and legislative buildings. Fanning out between the two centers towards the north (uphill) the upper middle to high class houses loom over well-paved streets and thick wrought iron gates. From a given street corner you might see the foreign influence on the upper classes: a German high sloping roofed house with earthy colored trim faces a bright Spanish villa and is backed by the arched and columned frontage of an Italian domicile. As you look southward, elevation and economic status decline sharply.

Costa Rica is one of the three countries in the world with no armed forces. They have been without a standing army for fifty eight years but would proudly tell you longer. As a reminder of the violence and lack of diplomacy that comes with having an army, the last functioning barracks still proudly displays bullet holes on its turret just ten blocks from the center of the city. A section of the Berlin wall serves a similar purpose poised outside of a legislative building.



The morpho is the Costa Rican national butterfly. This one at the national museum is drying its wings having recently hatched. You can just see from the picture the inside of its wings is stunning blue mirrored display.

The 4th and Patines Musica

Three of my favorite EWHers and their host mother, Rocío, baked a double layer American flag cake for the 4th of July. Funfetti cake, vanilla icing, red fruit loops, and an unconventional but intuitive inter-layer bed of sprinkles entertained and satisfied nearly the entire program. Thanks girls!

Patines Musica is your typical Costa Rican roller skating rink. A hard-floored, tin-roofed room substantially smaller than most roller skating rinks in the states (but with twice as many people) reverberated with the sounds of N’sync, Celine Dion, and Bob Sinclair. Patines also seemed to be hosting the national convention of All-Costa Rican doubles figure roller skating- some of the talent there was incredible.

¡¡¡¡Gooooooooooooooooooolll!!!

We exacted revenge on the (improved) Costa Rican team from last Monday! With fresh legs (and a few subs) we were able to put up enough scoring power to squeek by. The final score was 13 to 12. We even had the support of the EWH cheerleading squad who creatively produced a clever rendition of the hip-hop smash hit Crank Dat Soulja Boy appropriately called Crank Dat Solder Boy. “Build that circuit yeah you know- Now just watch that current flow…”

Hospital Nacional de Niños

The National Children´s Hospital has 325 beds, six operating rooms, an emergency department, neonatal ICU and a host of other facilities. During our visit, the hospital was only at 70% of its capacity. The hospital was spotless and appeared to run extremely efficiently; the electrical technition who gave us our tour claimed that it was the best hospital of Latin America.

As the United States largely designed, funded, and organized the hospital, we were very well accepted. I got a few pictures of some of the highlights for me. For Ned and Steve, I snapped a picture of the ultrasound scanner in use. I wasn´t quite sure how to ask if the transducers were wobblers or phased-array but I think they look like wobblers, clarify? For Dr. Stouffer, a picture of the Cath Lab. Can you believe they let 17 of us into the lab to check it out?

Costa Rica’s Namesake

The latest weekend trip brought me to Manuel Antonio, a beautiful beach southwest of San Jose with a national park. After last weekend’s intense hike into the clouds, the relaxing beach scene was a welcome one. Two days of fun in the sun left us all relaxed, refreshed, and reddened. I practiced some surfing and we played some beach soccer. For old time’s sake we played some Four Square. Much to our chagrin, the apparent All-American Four Square Champion, Sean, posted himself in the King square and could not be defeated by anyone on the beach.

We didn’t even need to go to the national park to see wildlife; the hostel was teeming with exotic animals. Large iguanas kept vigil on the roofs and happily took apple chunks for tips. I made good friends with a tree frog who joined us for our evening soirée.

Engineers Can Party Too

After long days of classroom learning (see: the fascinating lecture on the finer points of ventilators and anesthesia machines), the group had a barbecue to celebrate surviving the first half of Spanish classes.

Gladys, our host and the Spanish school owner, cooked for the entire group behind her classy house and we entertained ourselves with some good conversation. Later on in the night, after some of Costa Rica’s finest Imperial, we danced to some salsa and reggaeton. Any sociable non-engineer would be proud!