Day 10: What a wonderful Wednesday

We had another day full of success! We arrived at the hospital as usual in the morning and continued to work on the ventilators and other equipment. The most exciting part of the morning was fixing another ventilator, especially after we thought that the particular machine we were working on was a lost cause. This ventilator in question originally wouldn't even turn on. 

The screen wouldn't light up, no buttons functioned and the shrill alarm that always sounds whenever a broken vent is turned on didn't even sound. We started with looking at the CPU disk, a part of the circuit board. Knowing a different vent was a lost cause as a result of an internal leak we got out our tools and opened them both up. We took the circuit board from the one vent to exchange with the other and gained functionality of the buttons and alarm and, using typical troubleshooting skills we switched different screens and, after dozens of screws, loose wires, matching and reseding connectors the vent came to life. Just to make sure, we got it approved by Mainor, the respiratory therapist, who was likewise excited to see the progress we had made. There is literally nothing better than knowing you have brought what was essentially a broken and dead piece of equipment back to life. 

Mission accomplished

Feeling great after taping yet another "funciona" sign on the newly working vent, we moved on to sort through yet another pile of broken machinery. We explored the mystery that is the broken equipment room in the corner of the new ICU.  From it, we salvaged another pulse oximeter, and also managed to find the missing part that was the only reason that it was not working, so we got that machine working too.

A lot of the equipment we've found is in extremely bad shape. It's clear someone else attempted to repair it or mettled with it the past

Our guinea pig

A nurse brought us three more ECG's today as well, but we weren't quite as successful with those.  Unfortunately, two of them were missing parts from their printing mechanism. It is completely possible that the devices themselves were functioning fine, however there's no way of knowing because they don't have the capabilities to print the output information.  We used Huy as our guinea pig to test the last one, but still could not figure out what was wrong with it.  Regardless, we are optimistic about the other successes.

After our day at the hospital, Andres, one of the residents, was going to take us to Antigua Guatemala to sightsee. However, Andres is now also sick.  He looked pale and exhausted, but despite that, walked all the way to the ICU to tell us personally that he could no longer take us to Antigua but that Carlos (Dr. Morales) and Daniel (a doctor at a different hospital) could take us instead.  We are ever grateful to him  and wishing him a speedy recovery!

Antigua itself was absolutely beautiful.  It used to be the capital of Guatemala, but after a devastating earthquake, the capital was relocated to Guatemala City, where it remains currently. 

A view from the street, if you look closely you'll find a flat area on the mountain with a cross

 Now Antigua is a lovely little town, with gorgeous old churches, colorful, squat little buildings, and amazing restaurants.  It is exactly what it's name indicates; Old Guatemala.  We first stopped by a colorful market, filled with vendors with bright stands of handmade trinkets and souvenirs. We used our bargaining skills and walked away with bags of goodies. 

Mayan craft market

We then went to a traditional Guatemalan restaurant, where they served the dishes directly from large clay pots complimented by homemade tortillas, tamales and, of course, guacamole.

Some of the typical meat-based soups

 On our way back to Guatemala City, we stopped at a placed called El Mirador, situated on a small mountain overlooking the valley of Guatemala City.  The view was gorgeous! The picture certainly does not do justice to the sight of the sprawling city lights surrounded by the night sky and the bright moon.  It was a fantastic way to end an already amazing day.  

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