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.

After a lock in at the school until two in the morning, we were all packed and ready for the airport.  We finally arrived in San Marcos at four that day, with a transit in El Salvador and a four hour drive from San Pedro Sula, in between.

San Marcos has a population of about 15,000. It is located on the west of Honduras near the borders of Guatemala and El Salvador. It is beautiful. TINY but beautiful. It is surrounded by trees and mountains and has such a community feel. This can especially be seen in the people. And even more so in our host family. They are lovely! Our host dad is also the main technician of the hospital who we will work with, so hopefully we will establish a really good relationship with him this coming month. This said, San Marcos has needed some getting used to.

I shall talk you through last Monday, our first day at the hospital. We had breakfast at the early hour of 6.15 and at that point we were very optimistic. Within hours I think the day turned into one of the most bizarre/ frustrating/ clueless/ draining days of my life! Lillian is my lovely partner for the month, who will work with me in the hospital, I will get a picture up of her soon. Anyway, Lillian and I were faced with more challenges than we were expecting at once! I learnt huge amounts of Spanish in Costa Rica, but I was not expecting such a huge jump into such a pool of confusion.  I had to immensely concentrate to follow what anyone was saying, and still, I think I only caught about 50%.  Their fast pace of speech and my utter confusion even seemed to amuse them.  While being taken around the hospital, we were instantly shocked to see how limited in resources it was.  The worst news I heard that day I think was that the hospital had not had a working incubator in a whole year!!! After more confusion of what our purpose was, there was the realisation of the huge challenge we had before us, the realisation we really had a huge responsibility to fix all the broken equipment. The day of cultural barriers and general challenge of meeting new people, was over we were back home and overwhelmed beyond belief.

The week has improved exponentially by the day. I am having conversations with my host family without them having a perplexed look on their face, in fact I think we now are even making each other laugh. Lillian and I have made a home in host family’s house, as well as established mark with our belongings in the maintenance department, who have definitely warmed to us.  Our plan of attack is to inventory every department in the hospital, get to know each department and in the meantime see what is actually broken. You’ll be surprised by how much each department will claim things are fine until you literally start pointing to things. We have now visited many departments, have gained some of their trust and have a very long list of equipment that needs fixing. The best thing about the week has been when we finally fix something. We’ve had our hands on BP apparatuses, Nebulizers, Pumps and my favourite fix so far is an Infant Warmer!

Despite Lillian and I warming to this town and our family so rapidly, the challenges we are facing are big. Some of them are things you readers can help us with.  We find a machine and there is no manual for miles and no trace of it on the internet. We finally find what the problem is with the machine and its about 200 pounds to replace the part and fix. I also haven’t mentioned yet that the nearest place to buy parts is 4 hours away!  However, for me personally, the thing that is disturbing me most is that there is no working incubator.  The doctors and nurses in paediatrics don’t even seem to complain about it, just look at you with a tired look. Last Friday, there was a tiny premature baby with pneumonia, and the best they could do with it was wrap it in four or five layers of blankets.  We have definitely become Team ‘We must fix, find or build and incubator by any means’.  When you can, please look at the website Lillian has set up on behalf of both of us. We really want to do as much as we can for Hospital San Marcos.

http://sites.google.com/site/sanmarcoshospital/

Sarah.

I cannot believe we haven’t updated in 3 weeks! Time has gone so quickly!

I think my main lack of blogging was due to the many unfortunate circumstances in the second week. My debit card was stolen and my lap top broke all within several days. My was this frustrating. Though all soon became well when I cancelled my card and realised that wireless Internet is certainly not the best thing by any means about being in Costa Rica. So before I start talking about the start of my adventure in Honduras, I shall tell you all about the end of the adventure in Costa Rica.

After the first week or two our rhythm was certainly clear. Even waking up at 5 for hospital visits seemed the norm on Fridays. The 4-5 hours of Spanish in the morning no longer became a clueless stuggle but an enjoyable morning filled with laughter. Our teacher Michelle, got us to the level where we where soon sharing anecdotes and laughing in a different language which was truly something special. I will definitely miss my language classes and my teacher especially. Afternoon classes is where our technical knowledge was put to the test. The weeks were filled with successfully creating an infant warmer alarm and other days managing to achieve nothing but several mini fires. Over the weeks when we learnt how to build power supplies and took apart equipment, we became more aware of the sheer scale of problems that could go wrong with machines. Billy, our main lecturer, a very experienced engineer especially in developing world equipments, daily told us stories of all the problems he’s faced. The main things being power supply, user error (a huge problem) and just a lack of resources. Many times, these technicians can find out exactly what the problem is one if they just had the manual in their local language, or a manual to begin with and two once they do their just isn’t money. However, after a month of training it was soon time for us to pack our bags and put our language and technical skills to W

We spent many beautiful weekends in Costa Rica. It was filled with beaches, climbing volcanoes,, rafting and even a day watching the World Cup. I am already dearly missing Costa Rica. It was a wonderful month filled with wonderful people. I shall really miss my host mum, who always took care of me, my teachers who became friends and all the other wonderful students who are now in their respective towns and cities in Nicaragua and Honduras. Good luck and hopefully see some of you on the weekends.

I shall update you all on my first few days in my little town of San Marcos, Honduras tomorrow, unfortunately its only internet cafes here and I’m about to time out.

Sarah

Time in Costa Rica is going very quickly. Spanish classes are for me a strenuous fight against Italian; the two languages are so similar that I was placed in an advanced class but I cannot help mixing them up producing entertaining misunderstandings. The course is very efficient and I am progressing very quickly: I can now have normal conversations with my host family without many problems.

After Spanish classes we have technical engineering training: the classes are very well organised and Billy, a clinical engineer with 30 years of experience in the field in developing countries, is an immense source of knowledge and good advice. I really feel that, after two years of abstract theoretical knowledge, I can see where this can be applied and how useful it can be to produce a real concrete result. Every day we have a one-hour lecture over one particular piece of medical equipment and a three-hour lab where we learn practical tricks for troubleshooting machinery or building useful electrical circuits.

Last Friday we left San José at 6:20 am to visit a hospital in Turrialba, a very interesting experience because we could practice on the field on some real equipment, which helps getting an idea of what we will find in our hospitals next month.

On Saturday morning we took a bus to Monteverde: a little village in the northeast, which is famous in the whole world for the amazing scenery and its rain forest (which takes its name very seriously and makes sure that there are no more than two consecutive dry hours). On Saturday afternoon we went walking in the forest and we were all very deluded because the place was extremely touristic and the track consisted of a paved street cut in the forest that was level and large enough to make sure that even the largest American tourist could enjoy the “wild”. We later had a night tour in the forest planned but due to the bad experience in the afternoon, a large part of the group decided to skip it…bad mistake… The start was at 5pm (sunset as Costa Rica does not have daylight saving time) and we stayed in the forest until 7:30 pm. The guide was a local biologist, genuinely enthusiastic and extremely experienced. In two and a half hours we saw with our flashlights an enormous quantity of animals: two sloths, a porcupine, all sorts of insects including two stick insects mating: the female is nearly a foot long and a centimetre in diameter while the poor male is only a few centimetres long and a few millimetres thick. We then saw a tarantula, some tropical birds sleeping and loads of hummingbirds.

The day after we w0ke up early again to go zip lining in the forest. The weather was wonderful for a change and the view from the cables was fantastic, especially the ones that were connecting two different valleys and were above the tree line. The bus drive back was hot and uncomfortable but we were all so tired that we slept like bricks the whole journey.

I have to thank Jens for the pictures because i stupidly left my camera charger in London..

Lethal...and ugly..

Some private shots...

Marcello

We’ve had a week of school now and so we’ve got a good idea of what each day is like now.

My brain is being filled with so much information! It really is an intense program. My week of Spanish has consisted of being taught how to conjugate AT LEAST 100 verbs in various forms, learning how to count from cero to un milion and not forgetting how labeling my tool kit in Spanish. Alas my laptop is refusing to turn on at the moment, so you won’t get to see a picture of my toolbox in all its glory just yet, but hopefully soon!

The afternoon labs have mostly been a test of my circuit building skills. Or should I say, lack of. After two years of drawing circuits, this week I have realised it is just that little bit harder to build them.  My soldering technique is getting better, though I am still waiting for the day when someone in my lab room doesn’t suddenly exclaim in pain.

Friday was a really awesome day in that we finally got to visit a local hospital. We looked around the hospital to get a feel for the kind of equipment they use and their health system. Costa Rica has a national health care system which rightfully seems to be something they are very proud of.  The equipment they seem to use is very similar to ours but perhaps just that little bit older.  One of the interesting things I saw was a working, relatively high tech aspirator, but because it was different to the ones doctors were used, it was not being used.

We then spent several hours in the maintenance department taking apart everything they let us have our hands on! This included BP apparatuses, diaphragm pumps and sterilizer units. It was great to put the theory from the week into practice. It was especially entertaining and educational when some of us spent half an hour trying to fix a pump, only to spend another hour trying to put it back together! We didn’t manage to fix anything but maybe this Friday we will.

The entire school decided to go to Monte Verde this weekend.  It is this beautiful mountain range with tropical forest. There were hummingbirds, butterflies, insects of many kinds and some of the group even managed to see a sloth!!  The highlight was definitely zip lining through the forest. One of the lines was so high up that you were literally above the entire forest!

Pictures soon.

Sarah

So the last 5 days of my life have definitely been like no other.

THURSDAY: After 20 hours of travelling, Marcello and I finally reached San Jose Thursday night. The jet lag was really killing us. At around midnight, our host families whisked us home; I met my roommate and hit my pillow straight away. We had an 8 am start at the school and after such a long day, I definitely needed my rest.

FRIDAY: We awoke to an awesome breakfast of pancakes, four different types of fruit and hot coffee. Our host mum is really quite a cook! I cannot wait to get to know her properly but so far my Spanish is very limited and consists mostly of gracias, si, non and muy bien. It’s certainly making conversing an interesting task. The house is great as well! We’re even lucky enough to have Wi Fi!

The day then consisted of meeting the other 25 students and having some introductory lessons. But I think the most important thing we all learned was that in Costa Rica, its rains! And I mean RAINS!! The beautiful feeling of getting drenched head to toe by pounding rain made getting home loads of fun. Especially when nearly all of us realised we had no clue where we were going. No address, no map and no phone number meant getting home literally relied on gut instinct. For all of you who know me, I think you realise how much of a joke this is. I can get lost on a good day with a map following a straight road from A to B. Amber (my roommate for the month) and I somehow managed to get off at the right bus stop. The torrential rain adventure then continued when we were met by three forks in the road. But, which way do we go? After walking up and down several times in the pouring rain our host mum eventually saw us and we safely returned into a nice, dry and warm house. Phew.

SATURDAY: Despite having to get into school at the unholy hour of 620, we all got to go white water rafting on Saturday. It was just incredible!! We covered 18 miles in about 3 hours from class 1-4 rafts. I had never been before, but got the hang of it really quickly. And even more to my surprise, I didn’t fall in!! The most amazing part was jumping out of the raft for a while and floating down the Pacuare river surrounded by the sights and sounds of one of the most beautiful forests.

SUNDAY: This was indeed the day of rest! Amber and I had a nice lie in and then ventured out with some other students around San Jose.

The last two days have been where I’ve started getting into a real routine. We have about 4-5 hours of Spanish lessons in the morning, it’s crazy how much I’ve learnt in just two days!! Then we have about 4 hours of lectures and labs in the afternoon. Yesterday we covered the main causes of a broken Blood Pressure (BP) apparatus and the simple solutions to fixing such a vital instrument. Hopefully, my lab partner and I are on the path to fixing many of those next month in Honduras! The rain was so bad today that the power went out at school, which meant lab time was cut short, so learning the ins and outs of a DMM will have to wait until tomorrow.

I’ll hopefully update you shortly will some short and sweet anecdotes and adventures!

Sarah

Finally we have left for our adventure!! Its been a crazy end of term for us and we can hardly beleive we’re already leaving. We are currently sitting in-transit in Houston, Texas and should be in Costa Rica in a couple more hours. When we get there we’ll meet our partners and our host families for the next month! Give you an update on how that goes in a few days.

Sarah & Marcello

Marcello and I found out this week that our second month placement will be Honduras!! We are extremely excited! Just a few more weeks of exams and then we will be packing for our two month adventure in Central America!