Day 10: Enhancing neonatal care

We had another successful day at Roosevelt. Upon arriving to our work area in the old ICU we turned on the incubator we repaired yesterday and tested its ability to both heat up, stay and change temperatures. It was successful on all accounts!

It successfully heated up to the desired 37 degrees Celcius

We then continued working on two patient monitors from the infant neonatal critical care unit. We were soon ready to return to the unit and test the monitors. This critical care unit seems to be one of the busiest places in the hospital, partially because it is a relatively small unit, and because there always seem to be a dozen doctors running around and mothers anxiously awaiting news. A resident assisted us in testing the monitors on a patient, an adorable baby named Daniel, who was almost ready to go home. The monitors proved to detect his heart rate, SPO2 levels and print ECG patterns correctly. We gave the unit 2 more usable monitors!

One of the monitors was almost 30 years old.

The two monitors we fixed, on a cart ready to use!

Checking the readings of the monitor.

After returning the repaired monitors we returned the repaired incubator as well. Returning equipment after fixing it is extremely rewarding. Our help is appreciated immensely and there is no doubt that the equipment we were asked to fix (and was completely out of use) will help Roosevelt provide to care to the countless number of patients seeking care daily. We spent the rest the day at Roosevelt working on some ECGs we were just given- unfortunately they are missing essential parts and are hard to troubleshoot, but we are doing our best.
Before we left we had to say goodbye to the fabulous Jose who has been our point person throughout the trip, he has been an integral part of making us feel welcome here and helping us whenever any problems arise. We also met with Dr. Mejia about the potential of UVG entering the hospital to work us. Last summer we had meetings between the deans of UVG, Directors of Roosevelt, myself and the mechatronics students interested in working at Roosevelt. By the end of our trip they had been granted full access to the hospital. Since the change of security at Roosevelt they have been unable to reenter the hospital. Dr. Mejia confirmed that, due to the tough political times in Guatemala, granting the students access to help in Roosevelt will be difficult and will have to be postponed for at least a couple of months. Politically, Guatemala is in a state of flux, as I have mentioned in previous posts. In fact, tomorrow, we have been told not to go to Roosevelt at all.

The notice about the protests.

There will be mass protests all along the routes to the hospital, in the capital and at the hospital (a public institution that suffered due to government corruption). The number of warnings we received tonight about the protests and the fact that everyone insisted we stay at the hotel tomorrow has been sobering. We are disappointed we will be unable to return to Roosevelt tomorrow, we are close to repairing an ECG, but understand that we must put safety first. We will keep everyone updated tomorrow. To read more about what is currently going on in Guatemala: Read this.

Day 6: Moving Right Along

It is crazy to think that it’s already Friday and our first week at Roosevelt has come and gone. We spent the morning in Gastro working on the remaining broken equipment there. It’s amazing that in only 3-4 days we have made a significant impact on their equipment. Today we fixed another monitor, tested outlets, worked on a blood pressure monitor that is more than 50 years old and potentially repaired the last broken monitor they have, we will find out on Monday if it’s functioning after it’s new batteries recharge. 

Before we fixed the monitor Imani's heart beat was a little spastic...

Working in gastro has been extremely rewarding for a number of reasons: we have successfully fixed 2 endoscopy towers, 2 monitors (potentially 3), we work along side a wonderful staff of nurses who have always been welcoming and informative while working along side us, we have been told countless times, particularly after a repair, that we are a “blessing” and that we are saving the hospital and patients thousands of dollars and directly impacting the state of the unit. We have promised them filters for their respirators, a new bp cuff and pump and a pulse oximeter we have brought with us. 

The WUGI team with the wonderful gastro nurses.

They definitely have a great sense of humor that's made gastro (of all things) fun.

We spent the second part of our day touring the infant ICU that actually has large plastic crates full of broken equipment. The infant ICU and maternity wards are extremely crowded—there is hardly room to stand. It is clear that any help we can provide them will be appreciated.

Outside the entrance of the maternity ward.

Inside the infant ICU.

They decorated for mother's day in the marternity ward.

We left Roosevelt a little early to get ready for our weekend of truly being tourists. We are headed to Panajachel, a beautiful town on Lake Atitlan. More to come on our trip, breathtaking pictures guaranteed!

Day 5: Success

Today was all around a fabulous day. It was beautiful outside, we were successful in our repairs and met with our friend, Andres, for dinner. We started our day at Roosevelt, instead of heading straight to gastro to continue our work on the endoscopes, we had a meeting with Dr. Mejia, the director of Internal Medicine, and toured the women’s ward which was nicely decorated with mother’s day banners. The nurses there brought us a broken ECG and a broken SpO2 sensor. 

We discovered that the ECG was missing a number of important parts including a paper role, pin, and battery. We asked a nurse whether she could locate a paper role and the pin, but apparently the pin has been lost making the thermal printer of the ECG unusable. It was also particularly interesting to see that the battery was simply missing from the machine. A general consensus from the staff was that the battery had to have been stolen and sold on the market. However, as this model of ECG is no longer manufactured we are having a lot of trouble even locating a replacement battery. Unfortunately the ECG battery was not an unique case, the SpO2 sensor was also missing a battery. It had also clearly been opened up before and put back together ad-hoc. It led us to many questions about how this equipment has been treated and who has damaged it in the past. For now, there is unfortunately nothing we can do except look to order more parts for these machines.

What we found where we expected to find the battery of the SpO2 sensor

We then returned back to gastro, determined to make headway. We are happy to report that by the end of the day we fully repaired two endoscopes!!! It was incredibly rewarding to see just how grateful the nurses and doctors were for our help and the machines are immediately being  put to use for procedures tomorrow.  Each endoscope we repaired saved the hospital about $4,500, money they truly do not have to spend.

We fixed it! Don't worry, Mark was happier than he looks

We left the hospital with more spirit than we’ve had the entire trip. We were feeling useful, needed, appreciated and finally confident in our abilities. We spent of the day completing research until we met up with Jorge Andres Bonilla, a friend from last summer who took us all out to dinner and drinks. It was great seeing Andres again and great to hear how successful he’s been since he finished his residency at Roosevelt. After a great night of catching up we’re all tired and ready for our last work day of the week.

Thanks for a great night, Andres!

Day 3: ¡Campeones!

We are proud to announce that we have officially repaired 1 ECG and 3 respiratory ventilators!

We started our third day working in Roosevelt hospital like the days before, arriving by 8AM to set-up and immediately diving into work. Today we took on the ECG first. After running more diagnostics and tests using a manual we had found online, we were sure that the machine internally was functioning properly reassuring our assumption that there was a problem with leads and/or electrodes. Instead of testing the ECG on a patient like yesterday we sacrificed Ananya as our test patient. We completed a successful test, confirmed our results with one of our favorite residents, Carlos, and were able to speak with nurses about the future use of the ECG. We had the opportunity to review exactly what issues we encountered and how to maintain the ECG in the future especially in terms of sanitation and correct preparatory measures. We hope to assist in the transition of Roosevelt Hospital towards the usage of single usage electrodes. It is vital that our efforts are sustainable. Within minutes she took the ECG away to use for the rest of the day.

            Within a half hour of repairing the first ECG we received another. This new model was extremely different from the first. It has a completely different manufacturer with buttons and electronic readings all in English-a clear sign it had been donated to Roosevelt from another country. The electronic leads were clearly damaged and we are in search for new leads and desperate for a manual, we’ll see what we can turn up.

            Of course, that left us to continue our work on the ventilators. After a couple hours and a visit from Hector, a maintenance worker who greeted us warmly and confirmed that creating an organizational system for equipment and parts would be incredibly useful and beneficial, we were stuck. We had not anticipated working on ventilators at all and therefore weren’t entirely confident whether our repairs were sufficient to safely test the ventilator on a patient. We were still receiving an error code but all alarms had stopped. Mainor, a respiratory therapist graciously agreed to help us out and confirmed that the vent was ready to go and the error was solely found because we didn’t have a patient connected. This was the case with 2 other ventilators as well meaning a couple of things:

1            1)   we successfully repaired 3 ventilators

2            2)   There are 3 new ventilators for the hospital to use (which is vital because they are severely lacking vents and many residents are stuck hand ventilating patients all night)

3            3)   We now have more knowledge we can use to repair the other ventilators and to share with staff, to again ensure our work is sustainable.

             We left the hospital pretty content and ready to watch the world cup with the residents. They are a great group to hang out with but also to learn from. On our way there we passed the observation rooms outside of the ICU where Carlos pointed out a man who had been there for 7 years. He requires an automatic ventilator that the hospital cannot supply so sits in the same bed hooked to machinery watching soccer day after day. His quality of life has been so severely reduced as a result of a lack of resources and funding. Also as we were leaving, we noticed that every car is stopped before exiting hospital grounds to ensure that there are no residents or staff that are stealing equipment or drugs from the hospital.

        We’re all pleased and excited about our day. It is an incredible feeling to know we’ve already made an impact after three days working in Roosevelt and having success fixing equipment really serves as a motivating force to keep working, researching and getting our hands dirty everyday. Besides, Argentina is moving on to the final game, what else could we ask for?

Day 2: A little bit of everything

Today was definitely a full, albeit incredible, fun and productive day. “It really flew by”-Connie. We started our day at the hospital and made a considerable amount of headway. Upon entering the new ICU we found 3 new ventilators waiting for us. It was clear that staff had heard we were there and jumped on the chance to get at least one piece of equipment fixed out of the steadily increasing piles.

We had contacted Ron and Margarita (our amazingly supportive and responsive clinical engineers from BJC healthcare) last night about some specific error codes we came across and to ask them whether they had any insight or manuals. They responded extremely quickly with suggestions giving us a lot of insight into equipment that was foreign to us. We spent the majority of the morning troubleshooting, running diagnostic tests, finally hooking the vents to air and oxygen sources and even getting messy with the circuit boards of a specific model (go team go!). We were successful in eliminating a considerable amount of error messages, and we look forward to testing the ventilators tomorrow to achieve full functionality.

In the middle of the morning a nurse and intern stopped by the ICU with a defibrillator and ECG (electrocardiogram). It was incredibly helpful to be able to speak with the nurse about exactly what her experience was with the equipment and what errors she suspected.

ECG machines are used to detect arrhythmias in the heart, to detect ECG morphology changes, and to measure the heart rate. The flow of blood through the heart and to the rest of the body is regulated by the electrical conduction of the cardiac tissue. In underdeveloped countries these machines are mainly used to monitor patients suffering from other health concerns. As the country develops and the life expectancy increases, the ECG machines are becoming increasingly valuable to physicians in the developing world. We had learned that when an ECG is producing a “noisy” waveform the problem is usually a result of faulty electrodes of the leads. The electrodes used for the ECGs in Roosevelt are currently banned from the united states. In the US we solely use single-use electrodes. These bulbs have been used for as long as the nurse could remember and had obviously not been cleaned.

Residents later confirmed that they are hardly ever cleaned after use and are reused over and over on different patients. They also told us that ECGs are used at least 100 times a day and there is currently only one, but potentially two that are functional. We had a few ideas as to how to fix the ECG and the residents insisted in trying to test the machine, on a patient, even though we had only been looking at it for 15 minutes. This was an experience within itself.

The defibrillator was also having trouble working and in fact had stopped working in the middle of use yesterday. We’re trying to recharge it now and will have updates tomorrow! Throughout the day we had a number of residents, nurses and maintenance staff check-in on us. They were all extremely helpful and ready to support us in any way possible (they even hunted down circuits with wye tubes and connectors to the air and oxygen supplies in various parts of the hospital).

After a long day of intense work the residents invited us to watch the world cup semi-finals with them (Germany vs. Brazil if you haven’t been following fútbol). It was great to see a different side of the residents. Over the past couple days in the hospital we have observed just how hard these residents work every single day. We are so grateful we were able to get to know them on a personal level as well. It was a blast and also really interesting that a fair amount of them were Germany fans considering how close Brasil is. We shared Dr. Palma’s pain as the Brasilians were essentially demolished. Regardless, watching the world cup in a country that is truly passionate about soccer was an awesome break before we left to research for the rest of the night.

Watching the World Cup with the residents