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 11: Wrapping Things Up

It’s unbelievable that today was our second to last day at Roosevelt when it seemed only yesterday we were looking at the machines and meeting the residents for the first time! Time really flies by here because our days are so jammed packed and today was no exception.

Today was our last day to finish up all equipment repair, cataloging of equipment, writing manuals and translating troubleshooting guide. Needless to say we had a lot to do to wrap up our work at Roosevelt to ensure that our final day goes smoothly and we can properly communicate to staff about the outcome of our work. We started by taking one last look at the ventilators. We had unfortunately gotten to a stopping point with many of the vents. For example, there was one Vela vent whose screen and battery we had fixed. Despite these repairs the vent was still showing symptoms of internal issues that would require replacing a part. Like the majority of the equipment we see at Roosevelt, this vent was outdated and the manufacturer no longer produces the proper parts needed to repair it.

Patient bed in the ICU

Running into various roadblocks, whether that means: missing parts, having parts stolen, lacking maintenance, or lacking communication, is the everyday reality of a public hospital in Guatemala and we hope to improve that in the near future. Broken equipment accumulates every day in various parts of the hospital and it is difficult to keep up with the various types of equipment and models. However, we are excited to know that our work will continue even as we leave Guatemala with the help of La Universidad del Valle (UVG). This morning we met with Dr. Mejia, Professor Roberto Sevaria, and two students from the UVG Mechatronics association this morning to discuss with Dr. Mejia exactly what the partnership would look like and how it would benefit each of three parties. The meeting was extremely successful and it was clear everyone left with a common understanding of what the next steps are. After the meeting we were able to show our UVG guests around the ICU and also the ER to give them a better idea of exactly what and whom they’ll be working with. It was great introducing the amazing staff at Roosevelt to new engineering faces who are already ambitiously thinking of new ways to improve the hospital including creating an app to track equipment information that any nurse, volunteer or doctor could update. Every medical professional we have spoken to is extremely enthusiastic about the UVG students.

Outside the ER

After the UVG students left it was back to Oakland mall to work on manuals, final reports, thank yous, translations etc until Dr. Barnoya picked us up to go to dinner. We went to Vesuvio, the same place he took me my first night in Guatemala last year. After a couple hours of good pizza and a lot of insight from Dr. Barnoya we headed back to Uxlabil to keep working in the early morning to ensure all our reports and manuals were ready to hand over…during our last visit to Roosevelt of this first official rotation of WUGI.

Day 5: La Universidad del Valle y WUVGI

Today we changed things up and spent a day at La Universidad del Valle (UVG). This 5-year university is located in Guatemala City, has about 3,000 students, 1,800 of which are engineers. We had arranged a meeting with Director Carlos Esquit, the dean of electrical and mechanical engineering to discuss the partnership of UVG with WashU. For us, a partnership would help us ensure that our work at Roosevelt is continued and sustainable and all in all that WUGI is successful. The schools seems to be a great fit for us (we could even start calling the program WUVGI). Esquit and Roberto Saravia, a new engineering professor who had been a student at UVG himself, both agreed that the program would be beneficial to all three parties. For me, this was a huge relief.

The start of the future WUVGI team. From the left: Dir. Esquit, Carlos Esquit, the Castillo twins, Sr. Roberto Saravia, Carolyn Arden, Kelsey Lipman, Connie Gan, Ananya Benegal

UVG is extremely different from WashU engineering in that it is largely technical and more time is spent outside of the classroom working on hands-on projects than sitting in lecture learning theory and algorithms.  For example, we were lucky enough to be given the opportunity to tour the chemical engineering labs. This lab would be better described as a factory. It had machines ranging from fractional distillation columns, to machinery that manufactures biodiesel to a machine used to make Cheetos.

Their technical skills would be very valuable in Roosevelt. Everyday the group and I come to Roosevelt and by the end of the day we are sure to have at least a few new ideas for projects to enhance the hospital. Esquit suggested that a good starting place would be to create an excel file with each project we’ve come up with and the ideal number of students needed to work on it. He said he would gladly assign students to each project so progress would be made immediately. I am confident these students are more than capable of helping us fulfill our goals. They also have an incredible amount of resources on campus at their disposal including a PCB printer. This will be particularly useful because WUGI has been working on creating ECG simulators for the past couple of months. One of our main roadblocks was accessing the proper equipment and space to create the simulators, which essentially are a PCB.

We also ran into some mechatronic students who have already expressed interest in partnering with us to support Roosevelt. We are thrilled to be giving them a tour of Roosevelt this coming week to show them just how much of a difference their involvement could make.

After a successful first week at Roosevelt we are exhausted but very satisfied with our progress. We just made it to our hotel in Tikal and are excited to “get up at the crack of dawn to further our understanding of the history and culture of Guatemala”- Kelsey Lipman

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!