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 4: Gastro

I asked the group how to start the blog entry today. As it is currently 9:30PM and we just received the pizza we ordered at 7PM, they aren’t the most happy of campers and they asked me to make a general announcement that ordering food in Guatemala is not the way to go.

Anyways, today we spent the morning from 8-1PM at Roosevelt, in the gastroenterology unit. We entered feeling more or less prepared  after hours of research the night before and particularly after receiving advice from Margarita at BJC. We entered the unit where we were working while nurses were administering an endoscopy. The smell definitely woke us up.  The nurses brought over much of the equipment we were shown yesterday and reiterated just how important the endoscopy equipment is to the hospital. They mentioned it costs 12,000 Quetzales to receive an endoscopy at a private practice and there is a constant influx of patients in need of these services. Unfortunately the nurse present today had completely different views (which we confirmed were true) than the views we received yesterday explaining what caused them to deem the equipment unusable. Therefore a lot of the research we conducted was not as useful as we had anticipated.

Inside the Pentax Processor of the endoscope. We decided to change the bulbs and rewire the connection.

Inside a respirator, it is heating up way too quickly making it dangerous to use.

We spent the next hours working on further diagnosing and working on equipment. We left with a lot of questions because we have never been trained or worked on this equipment previously. We did successfully fix a monitor before we headed off to the mall to eat and start researching answers to the questions we accumulated during the workday.

We are excited to have a full day tomorrow at Roosevelt and will hopefully make some more headway with all of the equipment we started researching today!

Day 3: The start of our time at Roosevelt

Today was our first full day with the entire team together and our first day at Roosevelt. We arrived at the hospital at 8AM to meet with the directors and maintenance staff to discuss our visit and changes in the hospital. After many conversations and meetings (all in rapid Spanish, of course) we headed to the Gastroenterology unit. I had never been to this part of the hospital before and was excited to see that Byron, a resident we met last year, is now specializing in gastro. While we were waiting for procedures to finish we sat in the resident lounge. I immediately noticed the curtains in the room, which are embroidered with different brands of medicine used to treat various gastrointestinal illnesses such as Levolona. Early this year, in a class at WashU, I learned about FDA regulations and drug advertising laws in the US, primarily through a Vioxx case study. It was really interesting to hear that direct-to-consumer advertising takes place in Guatemala as well and that drug companies actively visit Roosevelt with gifts such as the curtains and even the table in the room we were waiting in.

 

The curtains in the gastro lounge

The Gastro unit at Roosevelt is very important, particularly due to the high rates of diabetes and kidney disease in Guatemala. Byron told us the unit sees about 20-30 people each day. There were patients lined up in the hallway waiting to be seen, many of whom did not look well, to say the least.

Seconds after the procedure ended we were invited into the room to look at the equipment. It was interesting that we did not see any sanitation procedures taking place, even though we literally saw the patient wheeled out in front of us before entering. Gastro nurses noted that of the 6 endoscopes the unit has only 2 are currently working. They pointed out many other pieces of equipment including respirators, monitors and sensors. After reviewing this equipment we headed out of Roosevelt to Oakland to start researching more about endoscopes, a piece of equipment we have no experience with whatsoever.

The three members of the traveling team who had never seen Roosevelt before will be posting later to share their reflections.

We ended the day with a traditional Guatemalan meal at La Casita Canchita full of tamales, pepían and cuchitos.

Day 2

Mark and I enjoyed exploring the city today while waiting for the rest of the group to arrive after all of the flight cancellations. After we enjoyed a great Guatemalan coffee at the hotel while researching more about the extraction of the former vice president we began our walk to Oakland Mall. I am familiar with this 20 minute walk from the gated community where we stay, along a busy high-way like street, to the enormous and extravagant Oakland Mall. After charging our phone, purchasing some minutes and gawking at the surplus of elegant shops (I’m talking every designer brand you can think of, a carousel, water bumper cars, fountains, dog pastry shops and gourmet cupcakes) we grabbed a cab to Zone 1 to explore downtown, or El Centro. Our cab driver, Luis, was extremely conversational and told us more about his views about what is currently going on in the country.  He doesn’t believe in the government at all as predicted that a lot of time will pass before a woman candidate is even considered as a viable candidate. I asked him if he thought viable candidates existed at all. He laughed at me responding, not the way our country is working now. Each one is corrupt, that’s just the way it is. Luis dropped us off, recommending that grab a Gallo to cool down.

While we were walking around el parque central and looking at the Palace and the Church it was hard to imagine the thousands of people that had gathered to protest only 2 days earlier. 

The palace today

2 Days Earlier

The plaza was quiet and, besides the news truck parked waiting for potential action, there were no apparent traces of the scandal.  Despite the quiet downtown it is clear that the scandal has sparked a movement. The hashtag #RenunciaYaFase2 has been trending and  it was interesting to look at different newspaper to obtain all  available details of the scandal. 

This graffiti was found near the palace. It reads "masacre," "Genocida", "Roxana" and "Renunciada"

Some of the newspapers found in the city today

We explored the rest of the area including the large marketplace for the next couple hours and then headed back to Oakland to use their wifi. The sharp contrast from the marketplace and Oakland was on both my and Mark’s minds while we planned for tomorrow’s day at the hospital and worked to stay updated with the rest of the team that would be arriving that evening.

The rest of our members have had a long day of traveling and, unfortunately, faced more delays. We are awaiting their arrival at 10PM this evening and are excited to start our work at Roosevelt tomorrow.

Mission 3: Day 1

The WUGI team has officially embarked on our third trip to Guatemala. This summer we have 5 WUSTL engineers traveling: Me (Carolyn Arden), Ananya Benegal (who traveled with us last summer as well), Mark McMillin, Imani Paul, and Caroline Trier. We have worked hard this year on a number of projects. We have worked to create an iPhone application that will function as a makeshift database to store information about medical equipment and supplies in the hospital, we fundraised to buy medical equipment and supplies for Roosevelt, we trained with BJC clinical engineer, Margarita Escobar-Kampwerth, to repair and troubleshoot medical equipment, and we made plans to travel to Guatemala from May 10^th-24^th to work at Roosevelt.

Todays travel to Guatemala did not exactly go as planned. The five us all planned to fly to Dallas Fort Worth and board the same plane to Guatemala. Unfortunately, due to extreme weather in Dallas, that didn’t happen. We all had to deal with delayed or cancelled flights and, as will be necessary while working in Guatemala, we were forced to be flexible, solve problems and work as team. Mark and I were the only ones who made it to Guatemala. I made my third flight of the day only after sprinting through Miami airport while hearing “Final Call for Guatemala” ringing over the loud speaker. Caroline was stuck in New Mexico and had to take a bus to Dallas and will arrive tomorrow with Ananya and Imani. Thankfully everyone has a place to stay tonight and we will all be together tomorrow evening.

Mark and I arrived to Guatemala around 7:30PM and were greeted by Jose, the chief resident of Roosevelt, and Carlos Tapia, our good friend from last summer. After dropping our bags at Uxlabil Hotel we headed to Mono Loco for dinner and a Gallo to celebrate the beginning of WUGI: Mission 3.  Much has changed since last summer, in Roosevelt and in Guatemala. The ICU we previously had worked in was fixed and is now functioning as the current ICU. It has 15 beds currently. Many of the residents we befriended from last year have also moved on to different hospitals. Carlos is in a town about 40 minutes outside the city and Maynor Palma, a name you may recognize from last year, is working in Mexico. The government of Guatemala has also recently undergone some changes. The first female vice president, Roxana Baldetti, resigned on May 9^th amid a customs corruption scandal in which officials defrauded the state of millions of dollars by taking bribes to lower customs duties. Protestors and business leaders rallied in the city for days after learning of the scandal. Today the country is without a vice president and at least 50 private citizens (including the tax chiefs) are suspects in the scandal. Read more here.

Coming to Guatemala always provides me with a wake-up call and with a new way to consider the political state of both Guatemala and the US. After a long day I am headed to bed ready to have a full day tomorrow. Happy Mothers Day everyone, to my Mom I only saw briefly before leaving this morning, and of course to my two St. Louis mothers and mentors Melanie and Basia as well!