Archive for August, 2010

Department: Recien Nacido

Mission: To fix at least ONE of the incubators in the hospital

We were defeated by two incubators do to circuit problems that alas seemed to complicated for us to solve. Then, suddenly, a ray of hope shone an old transport incubator and our spirits were lifted. The story of how we got this incubator to recovery however, is not a simple one.

ATTEMPT #1: The maintenance department most likely had given up on this machine as it looked at least 20 years old. We soon worked out, with the help of Billy, the coordinator in Honduras who had visited us that day, that the incubator had a broken ‘Jones’ plug. A Jones plug allows for the machine to draw power from both a AC power supply and DC battery supply. However, since the hospital had no working incubator whatsoever we thought the sacrifice of not being able to us it on a DC source we were willing to make. We changed the power cord, gave the machine a good clean, replaced the broken doors and hey presto the machine actually turned on!! In excitement we gave the machine to Recien Nacido straight away and told them they finally had a working incubator. We returned the next day to find out that the though the machine turned on and was heating, none of the hot air was circulating. Back to the drawing board. Sigh.

ATTEMPT #2: Something Lillian and I have learnt from this experience is that sometimes thinking simple can dramatically solve your problem. The idea of simply wiring a small fan into the compartment seemed to be perfect, so that’s what we did. We decided it was best not be too hasty about giving the incubator back this time as we didn’t want to create more false hope. We allowed the machine to heat for an hour and yes, the hot air had circulated!! A red light even turned on when the temperature was getting to high! This old incubator was proving to be quite a gem. We gave it back to the department telling them the problem was now fixed and that it was heating and for them to use it. We returned after a weekend and it was sitting outside the ward having not been used at all. When asked what the problem was, they said it was not heating. How is that possible?!

ATTEMPT #3: Unfortunately we could not test whether it was not heating that day because their was a power outage to add the our frustrations. We came back the next to find that the switch had been selected on the DC voltage option and the fan had magically been turned the wrong way. This meant that the hot air was being blown out of the incubator rather than in. At this point we realised that user error would definitely be an issue with this machine. We then labeled everything we possibly could on the machine, telling the user what they are allowed to change, what they should not touch and other general instructions. In Spanish, of course. No more problems then?

ATTEMPT #4: A few days later we returned again to find the machine still not being used!! This was when we realised that if you fix something and teach people how to use it, the most important person to inform really is the head of department because otherwise the message will just not be passed! We then talked to the head of the department explained everything to her. She seems eager to finally use it, and when a baby needs it, I think it will be used. FINALLY SUCCESS!

Us, Dilcia, the head of department and the incubator!

DAY ONE

The second week starts on a Tuesday as we took the Monday off for our weekend travel to Roatan.
Back to work we finally, after a week of being ready, give back the nebulisers that we had fixed on the first day..We have to insist and Melvin finally brings us to all the departments (very slowly). As soon as we give them back we are given new ones with the same problems and we fix those in the afternoon. While fixing them we encounter another Electrosurgery unit abandoned and we ask why. Apparently the footswitch is missing and the scalpels they have have a different connection to that one.

We notice that the footswitch jack is similar to a normal headphones jack so we write that down on our little notebook.

DAY TWO

I bring in the headphones i was given at the airport and we start a little experiment: we wire the connection for the scalpel with alligator clips and we connect the two terminals of the headphones plug to a hand switch that we take from a flash light..the result is shown in the picture…

We run to a guitar shop and we buy an electric guitar footswitch and some banana plug jacks to make an adapter..the surgeon will be happy to now have two working electrosurgical units for laparoscopy.

We are back ready to go to the maternity nurses to have our little lecture. They are very amused by me and Eric. They like to shout at each other but they learn fast, in twenty minutes we are done and the oncubators are ready to be used for newborns. We win some home made tortillas and new friends..

On top of that we are given two more pumps that, after a bit of troubleshooting, are found in need of new switches. We go to the bodega and we get two broken oxigen concentrators from which we get the switches. we now need the drill to finish the job but Melvin feels lazy: he answers yes and disappears.

DAY THREE

Boring day, still no drill from Melvin and the only thing we get to fix is a sphigmomanometre with a little leak, we replace the valve and it’s done.

DAY FOUR

We finally get the drill and we can finish the two switches for the vacuum pumps and we notice that the majority of what needed to be fixed is done.
We see Jorge so we ask him about an Idea we have been having for a while: we noticed that all O2 tanks are unbound, El progreso is a sysmic area and we imagined how terrible it would be to have all the tanks falling at the same time, breaking the pressure regulators or, even worse, shooting like missiles around the hospital. We asked him if we could buy chains and locks to secure all the tens of tanks that are around the hospital. He seemed really positive and he said we would talk about it the following week.

SECOND WEEKEND

This time we went to Copan in the west of the country.

Saturday was horse riding, Mayan ruins, crazy drive in 18 on a pick up truck and hot springs, it could not be better.

Hello,

I have to apologise, the lack of posting is due only to my lazyness…

In this post I will describe our progress in the Hospital of…El Progreso..
Eric and I arrived here two weeks ago from Costa Rica, we were welcomed by Melvin, a gynaecologist who works in the hospital here, teaches at the faculty of medicine in San Pedro Sula and is currently doing a Ph.D. in Economics..not bad. He leaves in a fairly modern house 5 minutes away from the hospital in a compound protected by walls and barb wire. Honduras is not a safe place and we were told in the first day to take care and not to walk on the streets at night.

DAY ONE:

The first day at the hospital we met Juan Carlos, a very intelligent and outgoing man, trained as a technician that was working in the maintenance department. he showed us around the hospital. The structure appears quite old and extremely busy. the machinery is often very old and often in bad condition. We asked if there was a ‘bodega’, a warehouse of broken equipment and the answer was promptly no.. We were given some nebulisers to look at and by just unclogging the motor from dust and fixing some simple connection issues we were able to  have them working…to send them back to operation…that is another story.

Juan Carlos never showed up again and we later found out that, very sadly, he earns more money by being a driver than a technician so he left his job at the hospital. We are therefore left working alone in the maintenance department, supervised by Melvin, a technician that supposedly works in general maintenance (air conditioning etc.)   but  we believe he just doesn’t work.. He, as many others here, has the tendency of replying what you want to hear and then forget immediately what you have asked him. We are also a bit confused by another presence, Devis, a very skinny guy nicknamed ‘El Flaco’ that seems standing outside our door and having no other job than, whenever we leave, closing it and disappear..

DAY TWO

Left in this condition we are, on the second day a bit depressed, no machines to fix and noone taking us seriously. Luckily there was Billy, who came to visit our Hospital and , seen the situation, he started running around the Hospital with impunity asking for the sub-director that was called from the ER to talk to us, Billy introduces ourselves and we are taken to the Bodega that actually exists where the situation we found was quite disconcerting

What stroke us were two brand new incubators lying under boxes of expired medicines and pieces of broken furniture…

We took them to our little workshop and started testing them…surprise…they are perfect…we are astonished so we start asking around..nobody knows. Whit a little more research we find out that they have been lying there for five years. Some nurse did not know how to programme them and had decided that they were broken; result is: in maternity the incubators are 50 years old, in the warehouse the incubators are brand new.

DAY TREE

Billy left and on Wednesday we had our darkest day: Melvin is angry at us because we stepped on his feet, he does not want to give the incubators back because it’s too much work, the nurses do not know how to use them, they will break the sensors again etc.. Result: the incubators go back to the Bodega. We are left with our sadness and a few other nebulisers to fix…

DAY FOUR

Things suddenly get better: we are called to maternity to fix a infusion pump, while there the doctor asks us about what we are doing and while we are talking i hear her complaining to the nurse that they do not have enough incubators…as I mention the ones we have seen and tested the day before she is excited and wants to see them..now we have the autorisation and we get them out of the bodega again and show her how they work. She tells us that the following Wednesday there is the reunion of the maternity personnel and we have to prepare a talk and train the nurses in using the modern incubators. Now it’s Melvin that is sad..and we are happy..

We start realising, by wondering around the hospital, that our expectations were totally different: I was picturing empty shelves and people doing everything they could to use the little resources. The problem is the opposite: they have a lot of donated equipment and spare parts, all lost in an indescribable confusion and people needing to take care of them being extremely slow and lazy, with some exceptions obviously. The doctors on the other end do everything they can and we started noticing that, once they realise that we are willing to work and help, they start bypassing the normal process and giving equipment directly to us.
On that day we were given a suction pump from a surgeon and a pulse oximetre from the maternity nurses. The pump was an electric problem and we manage to bypass the broken connection while the pulse oximetre was displaying a strange error that we had to look up the internet. It was enough to press two buttons together to reprogram the unit and in 10 seconds a 1000$ machine was back to work. We later found two others with the same problem lying for two years in the bodega and again with twenty seconds we saved 2000$ to the hospital.

DAY FIVE

This was the most productive day: we met Jorge, our real boss, that came even if he is on holiday. He is vey intelligent and very experienced: when he is around people start working a little more and he appreciates our job.

in the morning a surgeon came, almost in tears, because her only electrosurgery unit for laparoscopy was not working properly and she had patients to operate with urgency. Eric and I were extremely sceptic seen the complexity of the machine but we sat with jorge and tried to test it (by cutting and burning a piece of liver).

After an hour of trying to figure out the problem we  saw that one of the connection in the dispersive electrode was loose: a bit of solder and the machine is as new…the surgeon is the happiest person i have seen in a while and we have won her trust..from there on things are in descent.

After work we leave to Roatan in the bay islands for the weekend..Jorge gives us the permission of taking Monday off because the travel is very long.

FIST WEEKEND

Roatan is one of the best tropical pradise i have ever seen (even on TV), i am extremely jealous oj Jens and Tom that are located here with their hospital.
all the 16 EWH students in Honduras met there and we had an incredible weekend of beach, snorkelling more beach more relaxing.