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 9: Busy, busy, busy

There is so much to write about today, I hardly know where to start.  We only spent 4 hours at the hospital today but in those four hours we: met with el Jefe control de Propiedad, had a meeting with Dr. Mejia, recorded all equipment in the ICU, critical care observation rooms, and hemodialysis room, arranged to have Huy follow a respiratory therapist for a couple hours, and got to look at more equipment that we received today from the ER.

            El Jefe Control de Propiedad, Carlos Pineda, is the man in charge of the current organizational equipment system. On every piece of equipment we’ve looked at it’s been clear that a numbering system exists but it’s been extremely difficult to understand how these numbers are selected or whether they belong to a larger system. All we really knew was that we wanted to get started on creating an organizational database of all equipment and parts in the hospital. Sr. Pineda explained that every floor has one binder with all equipment, the number his department assigns to each machine, and it’s general condition. He was enthusiastic about us working to add to his system and, with his information and blessing we made arrangements to start taking inventory of the hospital.

            This database could be helpful to us in a wide variety of ways. It would be helpful to all medical professionals in the hospital to locate equipment and parts, for maintenance staff, for the future ordering of equipment, and to ensure that our work is sustainable. The idea is to have staff update the database with details about the condition of each piece of equipment, what problems they are having with it and where they move it after labeling it as broken and useless. If this database is created and updated regularly we will be able to ensure we are training on the correct equipment and staying up to date on the state of equipment, which is particularly important at Roosevelt where things are malfunctioning and breaking daily.

            Shortly after our meeting with Sr. Pineda ended, Kelsey and I went to talk to Dr. Mejia about our progress, plans for the week and our hopes for our connection with UVG and how he would like to proceed to secure the relationship. We would really like to set things in motion while in Guatemala and, after the meeting I became confident we could make the connection between UVG and Roosevelt a reality. Mejia also acknowledged some of the difficulties we’ve been having with equipment repair. He believes some of the equipment that is hospital owned is being sabotaged. We have seen a lot of equipment that has parts missing that then prevents us from repairing the machine entirely. He believes it may be possible for people to be harming this equipment intentionally in order to financially benefit companies that rent equipment to the hospital. This was something we had not even considered, but definitely gave us something to think about.

            While we were standing in Dr. Mejia’s office a doctor from the ER stopped by with two broken ECG’s. He accompanied us down to our workspace telling us that there are 3 other ECG’s in the ER out of commission that he’d like us to look at later this week. We only have 3 days left and there is still equipment coming in from all parts of the hospital, it is clear our work is far from over and the hospital could use all the help it can get.

            Speaking of extra volunteers, as we were recording information for the equipment database, a women dressed in green scrubs approached us. She told us she had seen Kelsey and I in the hemodialysis room and bluntly asked, “So, are you gonna help?”. This woman was the first volunteer I have ever seen in Roosevelt and was clearly passionate about the hospital. She spoke impeccable English and clearly communicated to us exactly what she thought the hospital needed. She, herself, had fundraising goals to paint the walls and refurnish the floors. It was great to see someone who was so passionate about helping the hospital who was not working there.  I would love to see other community members get involved, or at least visit Roosevelt- we’ve agreed that it’s hard to come to Roosevelt without feeling a need to get involved.

Taking inventory

We had lunch with the UVG Mechatronics association after our busy morning at the hospital. Lunch was great. After emailing for the past couple of months it was great to finally meet up, get to know each other and talk about the future of the relationships between the two universities and Roosevelt. Two students and a professor, Sr. Savaria, are coming to Roosevelt Thursday morning to meet with Dr. Mejia to formally get introduced to the hospital to start this program. This is all I could have ever dreamed of and am so excited to see things getting accomplished. UVG’s involvement at Roosevelt will be absolutely invaluable and key to ensuring our work is sustainable.   

WUGI and the UVG mechatronics assocation

      

The meeting with the UVG students left us all ready to get some research done before meeting  up with two professional engineers that I had met last summer. Hector Bonilla and Mario Valdeavellano both reached out to me once seeing I had returned to Guatemala. I am so grateful for their thoughtfulness and generosity and we ended the day on a high note after spending a couple hours catching up with them.

We also just found out one of the residents, Jose was diagnosed with dengue fever today. Please keep him in your thoughts!

Day 8: Diving into Week 2

We have dived into our second work week at Roosevelt ready to start checking things off a pretty hefty to-do list. A new member, Huy Lam, has also just arrived and will be joining us for the remaining part of our trip.  Huy is the president of WashU's Engineering World Health (EWH), a national organization that designs engineering solutions to global health problems that are more inexpensive and accessible. He's here with a goal to gain experience by shadowing physicians and making detailed observations to help innovate better products for hospitals such as Roosevelt. We're excited to have him here and teach him about the hospital system.

 

    Our time at the hospital today started like the others, working on the ventilators. We now have manuals for the Viasys Vela vents (Thanks Margarita!) and, halfway through the day received a manual for the Hamilton medical vents from a respiratory therapist as well. Finally having manuals is a huge relief and gave us some hope into repairing some vents we had previously largely labeled as a lost cause.  As soon as we started taking apart some vents, literally getting our hands dirty, the head nurse of the ICU, Sylvia, stopped by. Sylvia is a great resource to us. She entered the ICU with her arms full of a defibrillator nearly as large as she is and upon setting in down opened a new room stocked top to bottom of broken equipment (particularly patient monitor displays, a few pulse oximeters, computer screens, operating lamps, power cords, stools and boxes that we haven't even started looking through). She takes extra time to ensure that we understand exactly what she is saying and actually moved into the new ICU to do her paperwork today in case we had any questions for her about equipment history and usage. This kind of care and attention is indicative of the kind of treatment that the patients receive, and is part of the reason why working at Roosevelt is so rewarding and enjoyable for us. 

Some of the new, broken equipment found in the closet

            Unfortunately the issue with the defibrillator is solely one broken part.  On one hand, it is an easy fix; on the other, we don't have the part required, so there is not much we can do besides looking into ordering it.  Another thing we learned is that fixing up these machines doesn't necessarily have to be complicated.  With one of the pulse oximeters, which had spent a couple years in the room of broken equipment, it was simply a matter of securing the power cord and input cable, which had worn down and come loose over the years.  We will be noting instances like this in the trouble shooting guide we are writing for the staff, to ensure the communication of simple fixes like this for the future.

    ​We are also excited to begin the cataloging of the equipment in the ICU.  Byron, one of the 3rd year residents, told us that he can show us around tomorrow morning so that we can start making the database. In addition to that, we have a meeting planned with the UVG students to further discuss the partnership with WashU. All in all, we are happy with our progress today and very much looking forward to a busy day tomorrow. 

Days 6 and 7: Las gringas de la selva

Sorry for the delay in posts, we have spent the past couple days in Tikal, Guatemala. Tikal is part of the Petén region, the largest region in Guatemala with 35,854 sq. km. It is an extremely rural region full of indigenous tribes, history and traces of the Mayan culture. Tikal itself is known as “La Puerta Grande de Los Mayas,” the “Corazon del mundo maya,” or as “La Ciudad Perdida.” It is the final refuge for species which need large expanses of jungle to survive such as: pumas, jaguars, red macaws, white-lipped peccary, and howler monkeys. You may recognize it in several Star Wars movies as well.

Toucan spotting at sunrise!

The view from one of at least 37 temples!

            We arrived to the Flores airport at 7:30PM on Friday and were picked up by a shuttle to drive about an hour and a half up to Tikal and the national park. The drive there was an experience within itself. It seemed as if there is one main road leading into the park and through the Flores/Peten region. Along this one road there were a bunch of little shops, a few open-air churches consisting of plastic chairs, an electric keyboard, and a full congregation  (even though it was a Friday night at 8:30 PM), a bunch of animals running around and Mayan villagers sitting around in one of the multiple “stores” watching the little traffic on this main street. We got to the Tikal Inn only stopping to purchase tickets into the park and to apply extra bug spray.

Up and at 'em at 4 AM.

            Then things started getting interesting. We made our plans to go to Tikal one of our first nights here then got completely engrossed in our work at Roosevelt, we really didn’t have time to consider exactly where we were going or what we would be encountering. So when the electricity (including the wifi, lights, outlets so we couldn’t charge phones, and warm water) was shut off for the entire hotel we were definitely caught off guard especially when we were planning to wake up at 3AM the next morning for a sunrise tour.

            But we survived with only 4 hours of electricity everyday and thoroughly enjoyed learning all about the Mayan culture, exploring ancient ruins, hiking through the jungle, bathing in mosquito spray, and seeing a variety of animals including spider and howler monkeys, red macaws, toucans, coatimunidis and more. Our tour guide, Enrique, who also went by Henry, not only led us through the jungle and ruins for eight hours but gave us a lot of insight into the Mayan culture and lifestyle of tribes outside of Guatemala City. We asked him particularly about medical practices in the Flores region. He told us that when anyone is sick they are sent to a garden where they grow a wide variety of medicinal herbs and plants used to treat anything from toothaches to deep wounds. During the tour, Enrique pointed out a medicinal tree whose leaves are used to numb toothaches. We were all given a leaf to chew on and it was incredible to experience the “magic” of natural medicine.  There are some patients from this region who travel all the way to Roosevelt but only when they are extremely ill, oftentimes when there is little that the doctors at Roosevelt can do.

Grand Plaza

            While there we ran into a few WashU medical students: Dan, Sangitha and Mike who have also been working in Guatemala City. It was great to spend some time with them, share stories and reconnect over our love of our university.

            We’ve returned exhausted, disgustingly dirty but so happy we got more insight into the history and culture of Guatemala and also the lives of many patients who come to Roosevelt from various villages around the country everyday. We can't wait to get back to work on Monday!

Climbing the Mayan temples

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 4: Celebrity Spotting

Today was our last day at Roosevelt Hospital this week. The past four days have truly flown by and, as Kelsey mentioned as we were leaving this afternoon, we’re going to miss the hospital until we return on Monday. 

Our day at the hospital was fairly different than the previous days. We, of course, continued working on equipment repair, today entirely focusing on ventilators.

We definitely hit some dead ends today but still managed to end the day declaring one more vent ready to use.

In the midst of our repairs, Dr. Barnoya stopped by to check-in with us. Dr. Barnoya is always extremely informative and gives us a different perspective than anyone else we’ve talked to. As part of our discussion covering our progress, future plans, and questions we discussed where exactly to donate the 5 portable finger-pulse oximeters we had purchased with the money we had raised through various WUGI fundraisers throughout the year. Dr. Barnoya told us all about a study being done in UNICAR (the cardiology center attached to Roosevelt) that would greatly benefit from pulse oximeters. This study’s goal is to improve doctors abilities to diagnose congenital heart disease in infants. 

Meeting Dr. Aldo Castañeda

He brought us directly to meet with Dr. Aldo Castañeda a world-renowned cardiac surgeon. My meeting with Dr. Castañeda was one of the highlights of last years trip and I am so glad the rest of the team got to meet him today. Castaneda is probably the celebrity I am proudest of meeting in my entire life. He has published over 400 scientific articles and 2 books and, in 1942, he successfully achieved the world’s first every heart-lung bypass surgery in a child. Now he is working at UNICAR in Guatemala City and is largely responsible what UNICAR is today. Even just walking into the doors of UNICAR it is evident it is better funded- a direct a result of Castaneda who also founded La Fundación Aldo Castaneda which has a general goal to create a sustainable system of pediatric cardiac care in Guatemala and Latin America. To learn more about his foundation visit: http://www.fundacionaldocastaneda.org/ver_noticias.php Or, if you’re interested in donating visit:

http://saveachildshearttoday.org/Friends_of_the_Aldo_Castaneda_Foundation/Home_page.html. Castaneda had never seen the type of oximeters we had brought and legitimately seemed amazed and kept repeating that absolutely every doctor should have one. We met with the director of the study and he too was excited about oximeters. We left, refreshed and rejuvenated after a pep talk by Castaneda who insisted the work we were doing was exactly what the hospital system needed and with a goal to fundraise to purchase more oximeters, for both infants and children in general.

It's incredible to know that our fundraising has paid off!

In future trips I am confident we will work with UNICAR on some of their trouble equipment such as their catheters and sterilization equipment.

We are looking forward to going and spending a day a la universidad del valle tomorrow.

"USA Chicas out"-Connie