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 As we brought a newer version of the light with us as a donation, we were supposed to bring the old lights back for research purposes.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...