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