Day One in Roosevelt

Today was truly a Monday. It was the start of a new week, the start of a new rotation, a lot of work, pretty tiring but also incredibly indicative of what our next two weeks will look like here in Guatemala City...not to mention we survived a earthquake this morning!

We started our day at Roosevelt Hospital at 7:30AM with a site meeting with Dr. Carlos Mejia, Dr. Soto and the two chief residents, Dr. Maynor Palma and Dr. Manuel Osorio. We are literally in awe of all the work they do on a daily basis and could not thank them enough for taking time out of their days to welcome us and support us through this rotation. Our meeting was followed by brief introductions in the ICU (our main work site). We came here with the expectations and training to work on patient monitor displays, ECGs, operating lamps and defibrillators. However, upon arriving to the ICU we were told that their real priority was respiratory ventilators.

            The new ICU looks almost identical to how it was when I was working here last, over a year ago. We even found some post-it notes I had used to label and describe error codes on the ventilators from the prior year. This new ICU is still not furnished, is being used primarily for storage, and still houses all of the broken ventilators I saw last year. For me this wasn’t entirely surprising; however, it was discouraging particularly because prior to this year’s trip we did not train on any type of ventilators. 

The amount of error codes we were receiving on each vent was, excuse the pun, alarming

Ventilators exactly where I left them last summer

            But, like I’ve learned is necessary in this type of environment, you must always always be ready to adjust to every situation and have, or come up with, a plan B (or C, D, E, etc.). We spent the majority of the morning troubleshooting the ventilators. There were 5 Viasys VELA ventilators, 4 Esprit ventilators and 7 Hamilton Medical ventilators. All of these models are not supported nor were we able to find through BJC or in the Barnes systems prior to the trip. Regardless we’ve made some progress and used every troubleshooting technique we know. Now it’s time for some research.

I am legitimately scared that we will be successful in detecting exactly what is wrong with each machine but will be unable too access the proper parts to repair them. The majority of the equipment in use is extremely old and outdated and the original companies often no longer manufacture the parts necessary to complete the repair nor do modern hospitals (where the majority of the equipment is donated from) see the use in keeping these parts.

            After doing everything we could in the ICU we met up with chief residents Palma and Osorio to discuss what we need to make the trip a success. As always, communicating through different levels of the hospital will be difficult and complex; but will be essential for the most effective rotation. It is vital that we are perceived well by the rest of the faculty and staff in the hospital, it is clear that we are visiting, especially as we are a truly diverse group. The hospital operates on formalities that I have not yet mastered nor that I can always anticipate but are signs of the courteous nature of the Guatemalan people.

            We were able to walk through much of the hospital and observed much of what a typical day in the hospital is like. We arrived to the hospital a little after 7AM but it was already packed with patients. Every hallway we passed through was full with patients waiting to be seen, many of whom had traveled for hours to come to the hospital in hopes of a cure for the wide array of ailments seen daily at Roosevelt. It is incredible just how many people come to the hospital everyday and the amount of work and responsibilities the doctors, residents and nurses are given on a daily basis. Carlos, a third resident told us he has 36-hour shifts. Unlike in the US, Guatemala does not have any regulations on the number of hours or consecutive hours medical professionals are permitted to work to ensure the well being and quality of the individual.

Entering the hospital, far from the actual offices or procedure rooms

            Going forward we need to see whether we will be able to locate and then gain access to the equipment we originally came to fix. If we cannot work on these models we will continue to work on the ventilators, work with engineering students from La Universidad del Valle (UVG), assess the hospital for a power grid and hopefully work on a project I’ve been hoping to complete for some time now. I have proposed spending a day to go visit the countless makeshift warehouses and departments in the hospital and on the hospital grounds to start a database, or at least a record, of absolutely every piece of equipment owned by the hospital. I would like to at least include basic details including model numbers, the condition of the equipment, and its location. It is currently nearly impossible to locate a piece of equipment or to even estimate how many of a certain type of a model there are. It is extremely common for doctors to be in need of a certain type of equipment but not being able to find it nor even know if there is a piece that exists. This record would be a great way enhance the organization of the hospital. The one important question that remains is whether this record and system would continue to be used after we leave and whether we could convince faculty and staff to adapt the system and utilize it. The goal of the program is to support the hospital in ways that are realistic and most importantly, sustainable.

            After a long morning we are at Oakland Mall, less than an hour away from the Hospital but the most luxurious and largest mall all of us have ever seen in our lives. This mall has ever designer store imaginable, multiple stories, dog bakeries, cupcake shops and security guards all dressed in tuxedos. It is interesting to see the contrast between the rich (quite literally the 1%) and the poor in one day. Regardless, it’s a great place to get some research done for tomorrow. Wish us luck!