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.