Pura Vida!

Program Wrap-up Meeting

Well, we are done working at Hospital El Progreso.  We managed to get a few more machines repaired our last few days, and had a nice send-off from the maintenance staff.  We headed to San Pedro Sula on Friday evening to meet everyone else for dinner, and headed to the airport at 4:45 Saturday morning.  Our flight got into Managua at about 9:30, and we got to the hotel at about 11.  The conference started shortly after that, and it was fantastic to see all of the other students! 

However, I was not terribly impressed with the conference proceedings.  We were briefly introduced to the EWH board and administration, and while they seemed to be generally nice people, most student's interaction with them was very limited.  A few students were interviewed by either members of the EWH board or industry sponsors, but instead of having free-flowing conversations about our experiences, exchanging thoughts on what we thought could be improved for coming years, and being able to provide meaningful feedback about the program, we were asked a series of cookie-cutter questions that were not followed up.  It seemed to me as though the administration was more concerned about giving the appearance of accepting feedback instead of being really interested in what we had to say, but others may have gotten different impressions.  It is really a shame, since in my discussions with the other students, I have heard dozens of simple things that might really improve the program as a whole.  I am sure that we will find a forum to pass these thoughts along, whether they are welcome or not :)

The bulk of the conference was filled with student presentations, some of which were quite remarkable.  In particular, the final group to present had made a really impressive video and written new lyrics to a couple of songs, which they sang with gusto.  It was a terrific way to wrap things up.  Things pretty much tapered off from there, with people gradually heading to the airport to fly back home. 

As the program was finishing up, it kind of started to sink in that our impact at the hospital was meaningful for them on the short term, but will probably have very little long-term impact.  This week, the hospital will still be without a BME technician, and the broken machines will start piling up again.  I guess I had not really considered what would happen when we left, but it was a tough realization to accept.  But looking back on things, I think it would be very difficult for people in our position (non-experts who don't speak the language and don't have any authority) to make a long-term impact here.  If I get a chance to contact people who are going on the trip next year, I think that (and a couple of other things) is something I would make sure to pass on.

Overall, I really enjoyed my summer in the program.  I learned a lot about the developing world, engineering, NPOs, and a lot about myself as well.  I have a lot of terrific memories of the machines that we fixed, places that we visited, and things that we saw, but my most cherished memories will be of the people that I met.  The other EWH students that I got a chance to get to know and spend time with really made the program entirely worthwhile.  I will not soon forget the conversations/debates/philosophical arguments that we had, or the frequent rants about mundane frustrations, or the jokes that we shared at each others expense.  It was a very unique group of individuals, and I hope that we are able to keep in touch!

But enough sappy reminiscing.  This week I am back in Costa Rica, getting in my kicks before I get back to the US.  Tyler is coming in to San Jose tomorrow, and we will be heading to the Caribbean coast.  (I am sure we will get into a little trouble, but hopefully not too much...)  I am really looking forward to traveling and hanging out this weekend, and then really looking forward to seeing the family on Sunday!

I might update again, or maybe not.  Regardless, I hope you have enjoyed some of the stories and thoughts.  I have certainly enjoyed providing them!  Thank you also for your support, it has been very much appreciated.  If you are thinking about taking a trip to Central America and have any questions, please let me know!

I look forward to seeing everyone back in the US.  I hope that your summers have been going well too!

Adios,
-Eric

Almost done at Hospital El Progreso...

Things at work have turned around a bit since the last post.  Well, things are actually largely the same, but I think that I have changed my attitude about them somewhat.  Anyways, last Tuesday was a fairly interesting day, as we started things off by 'learning' how to 'weld'.  I say 'learning' because I really had no idea what the guy was saying to me or what he was trying to convey, and 'weld' because I think even an inexperienced welder would shudder at the sight of the connections we produced.  Regardless, it was really cool to fire up the machine and let the sparks fly!  I definitely was learning through trial and error, and had quite a bit of the latter.  Within about 5 minutes of getting started, it seemed like the whole maintenance department was circled around myself and Marcello as we fumbled around with the equipment and tried not to look terrified.  (For those of you who are interested, I think we were using the SMAW welding technique.  All I know is we had about 70 Amps running through that thing... enough to do more than a little damage!)  We finally managed to get some decent-enough 'welds' to join some lengths of chain to hooks, which we used to secure oxygen tanks to the walls. 

Not sure if it is supposed to spark and smoke like that, but it was a lot of fun...

The chains, in action.

Later Tuesday, we were installing some of these chains in the surgery recovery room, and got some interesting news.  It turned out that there was a partial hip replacement surgery about to start next door, and we were invited to watch!  I had never seen a surgery before and knew how violent orthopedic procedures could be, but thought I would be able to handle it pretty well...

Nope.

For whatever reason, the surgeons had barely put scalpel to skin before I started feeling lightheaded, and after about 10 minutes (or maybe less) I had to go 'get some air'.  I tried going back in a few minutes later, and only lasted a few minutes more.  I took a brief walk, sat down for a while, and headed back for another try.  This time, as soon as I opened the door, I saw the surgeon swinging a hammer like John Henry and pounding a large-ish metal pole into the patient's femur.  I immediately turned around sat back down for the remaining 90 minutes :)  I'm not sure why it happened that way, but I have redeemed myself in the past couple days.  Yesterday we witnessed a laparoscopic gall bladder removal, and today we saw a neurosurgery where the surgeons excised a tumor from the parietal lobe... and I didn't have any trouble with either one.  I'm guessing the orthopedic surgery was a bad choice to open my surgery-viewing account.  I hope we get another chance to see more surgeries in the next couple of days, the are really remarkable on a number of levels.  The part I find the most impressive is the coordination between the different members of the surgical team.  They are all focused on performing their own tasks, but are aware of everything else that is going on and known what needs to be done if unexpected circumstances arise.  Really impressive stuff to see, and I'm glad my stomach has thickened enough for me to do so.

Anyways, after the laparoscopic procedure, we got a chance to speak with the surgeon about some of the equipment she was using.  Apparently, she had been having some trouble with some of the ESU probes that were used for that procedure, and showed us what kind of shape they were in.  Some insulation had been worn off on the shafts and near the tips of a couple of the cutting/coagulation probes, and someone had tried to patch them with electrical tape (a really bad idea, since it is not very biocompatible, virtually impossible to sterilize thoroughly, and had begun to unravel and interfered with the laparoscopic access ports).  We knew that heat shrink tubing would probably be the best way to repair the probes, so we have been on a two-day hunt for the appropriate tubing in both El Progreso and nearby San Pedro Sula.  We eventually found something that would work this afternoon, after trying about 6 different stores over the past 2 days.  We are looking forward to trying it out on Thursday!

Update: it worked!

The tip in action, inside of a patient.

This Saturday, the entire group of EWH students is heading to Managua, Nicaragua for the end-of-program wrap up meeting/conference that will last until Sunday afternoon.  I am not necessartily looking forward to the proceedings, but I am very much looking forward to seeing everyone again!  It will be good to catch up with the people who we haven't seen for a while, and get a chance to say our goodbyes.  I cannot believe things have gone by so quickly.

I will probably update again after the conference.  I will be staying in Central America for another week after that, mostly just because I can :)  I am excited about getting a chance to relax and really take in the culture and sights in a more laid-back atmosphere.

Until next time!
-Eric

Illegitimi non carborundum

Frustrating day at work today.  Nothing got done, despite our best intentions.  We have decided that our 'secondary project' will be to install chains around the freestanding oxygen tanks all around the hospital.  I know, it doesnt sound like much, but these tanks can be extremely dangerous if they are bumped and fall over.  Anyways, we went to the hardware store with two other maintenance workers, and what should have been a 30 minute trip turned into almost 3 hours.  Just a ton of wasted time, and it was incredibly aggravating.  It didn't help that I couldnt ask them what we were waiting for, or if we were heading back soon, since my Spanish isn't what it used to be.  But anyways.  We got back a little bit before lunch and tried to track down a drill so we could install the eyelets in the walls.  We got one, which promptly died.  We were told that someone was using the other one (there are only 2), but it would be free in an hour.  We wound up leaving at 2:30, without ever seeing the drill, or getting our hands on any new equipment to fix.  So it goes.  I looked at the calendar today, and saw that we only really have 7 or 8 more days to help out at the hospital... I am hoping that we can avoid having more useless days like today. 


Copan

This past weekend, we went to the Copan Ruins in western Honduras.  The ruins are what remains of a massive Mayan city, which was occupied from around 620-1550 AD (maybe?  I actually have no idea...).  It was really incredible to see.  Gotta say, I felt a little bit like Indiana Jones.

That evening, we hired a driver to take us to the hot springs a little ways outside of town.  For whatever reason, instead of getting a small bus or other large vehicle, we wound up standing in the back of an old pickup truck for the 60 minute drive (on winding and hilly dirt roads, no less :) ).  I have had some discussions with other EWH students about the best way to really get the feel of a country, and until Saturday we felt that there was no better way than to go on a cross-country motorcycle (or bicycle) ride.  We have since revised that sentiment.  Even though parts of the trip were absolutely terrifying, the ride as a whole was unbelievable.  Wind in our faces, looking around at all the scenery... it truly might be one of the best parts of the trip so far.

We were very glad to get our feet back on solid ground.

 
As always, it was really great to see everyone, and I am looking forward to next weekend.  Some of us are heading to Gracias-Lempira, and going on an overnight hike to the top of the highest mountain in Honduras... nbd.

While days like this sometimes pass slowly, the summer itself is flying by.  I am looking forward to having a settled stomach, getting some restful sleep, and of course seeing friends and family when I get back in just a few weeks!!

Hasta!
-Eric

Another short update + Roatan

Work

Work is still going well, and we found some things to work on this week.  On Wednesday, we even had a brief training session for nurses in the maternity ward on how to use the incubators we found in the bodega.  (During the last week in Costa Rica, we wrote some 'quick start' training guides for some other kinds of equipment.  I never thought we would actually do that sort of thing at the hospital.  But, as with most of my assumptions this trip, I was clearly incorrect.  Hi ho.)  It was pretty hectic, as it seemed as though something that should have taken 5 minutes took an hour.  There were points where it seemed as though everyone was talking loudly at once, and nothing was really getting accomplished.  I think we eventually got everything ironed out though, but we told them to give us a call if they have any trouble with either one of the machines.  I guess we will see what happens.

Hanging out with the nurses after the training session.

Some of the equipment we fixed this week: two suction pumps and a surgical lamp.

The Food

Let me first say that on the whole, the food here has been very good.  I hate to sound ungrateful, though, but there have definitely been times this week where I have been less than happy that it was time to eat.  It is sometimes difficult to look forward to the same kind of food over and over (particularly when it is so unhealthy).  I went into the trip with the mindset that I would eat whatever was put in front of me, and I was doing great until I encountered 'chicharron'.  I didn't know what it was when we got it, but I only took one bite and couldn't go any farther.  (We had it at home and at the hospital, on consecutive days no less.)  I checked into it later on, and I think chicharron is basically an even less healthy version of pork rinds, sometimes served in soup form.  So yeah, I don't think that is going to happen.


Roatan

Last weekend we went to Roatan, the largest of the three Bay Islands off the north coast of Honduras.  All of the guidebooks said that it was one of the most touristic and expensive places in Honduras, but also had some of the best beaches and snorkeling in the world.  I had never been snorkeling before, so I was really looking forward to that, but just kind of figured that the beach would be like the ones we had seen in Costa Rica (kind of a 'you see one, you have seen them all' kind of thing).  Apparently, though, Caribbean beaches are a different breed.  We went over to the island on a ferry, and then took a water taxi over to the West Bay area.  The water was a color that I had never seen before, a very clear, very deep blue.  It was very warm, but in a good way, and there were virtually no waves.  It really felt like I was swimming in a massive pool, along with some very brightly colored fish of course. 

This picture was not taken from a website.  I promise, it actually looks like this.

Seriously. 

 

Anyways, we managed to get in 2 snorkeling trips, and that is something I need to do again.  We caught a boat that took us out to a huge reef, where we were free to swim in any direction for about an hour.  The reef and fish looked like something straight out of an aquarium.  The reef was not very brightly colored, but was really impressive to just look at.  It went as far as I could see in almost every direction, which was pretty far in that water.  There was a large trench that ran down the middle, which was the favorite area for the more intrepid snorkelers.  The fish were everywhere, every size, and every color.  In each hour we were down there, I think we might have seen 1000 fish.  It was really very cool, and fascinating to see fish in their natural environment.  But the thing that really caught me off guard was the noise.  Whenever I wasn't breathing in or out, I could hear the fish nibbling on the reef.  It was not a loud sound, but one that was ubiquitous and definitely unexpected.

On Saturday night, we found a very nice bar that had a couple of couches lined up on the beach between the palm trees.  We were able to watch the sunset over the water, had some dinner, and enjoyed the nightlife :)  All in all it was a great weekend.

 

Gratuitous beach shots.  Sorry, I just can't help myself.

Thats all I have for now.  This weekend we are heading to the Copan Ruins!  I will be sure to write about it, of course. 

Have a good weekend!
-Eric

Week 1 in the Hospital

So we just finished our first week as actual volunteers in Hospital El Progreso.  As I said before, I didn't really know what to expect, but went in with some ideas about how best to get things started: meet the right people, get on their good side somehow, show them that we can be productive/helpful workers, and then just wait for the equipment to start rolling in.  Turns out I had a few things to learn about that too :)  The first couple of days, I tried to be patient and let things run their course.  But at some point on Wednesday, we realized how quickly the month was passing us by, and we didnt really have time to lay 'groundwork' and let the work come to us, so to speak.  Up to that point, we had been cleaning nebulizers and dials, and basically just putting the finishing touches on some other equipment before it was sent back to the hospital.  Since then, we have been trying to work around the normal 'chain of command' in the maintenance department, and see if we can find someplace where we can make a real contribution.

On Wednesday afternoon and Thursday, we were able to speak directly with doctors and nurses, as well as the head of the maintenance department (Jorge, who had been out on holiday).  The head surgeon came to us with a suction pump, which we were able to fix that afternoon and get back to her the next morning.  After that, we got our hands on an IV infusion pump, and helped the nurses translate the users manual so they could avoid an alarm that they had been getting.  We were sent another suction pump on Friday (which had another simple problem), and will be sending that back soon.  In all, we have gotten about a dozen pieces of equipment into service, which is a lot more than I expected for the first week. 

 

Marcello looking at an anesthesia machine (one of the things we haven't repaired... yet).

The inside of one part of the bodega.  Piles of pills, disposable equipment, etc, laying on top of a perfectly functional incubator that the nurses don't know how to use.  We are having a training session on Wednesday, hopefully something sticks!

My favorite repair happened on Friday.  The surgeon came to us with a large electrosurgery unit, which they were using for laparoscopic surgery.  If you are not familiar with these things, they output a huge amount of wattage, and basically act as a scalpel that cuts using electrical current.  (In other words, they can be kind of dangerous if someone screws up the repair.)  Anyways, the surgeon came to us saying that the unit was only working when it was set to extremely high wattage, and was not functioning at all at lower settings.  We initally told the her that we did not have any experience with the inner workings of these kinds of machines and that they were very dangerous.  We took a look at it anyways, and tried to use the machine on a piece of liver that we got from the hospital kitchen (they were cooking it for lunch that day - que rico :) ).  We were able to reproduce the fault, and took a closer look at the cables and dispersive electrode.  Long story short, we were able to identify a broken connection, and fixed it with a new clip and a bit of solder.  Even though it was an incredibly simple fix, it kind of felt like we had achieved something... and I didn't think that would happen the first week (if at all).

All of our 'fixes' have been really easy and basic changes, so I am thinking that we are getting our hands on the low hanging fruit and our output might start slowing down soon.  But regardless, it feels really good to give equipment back to the clinicians, and see how our work helps them to do their jobs and help more people.

Anyways, thats all I have that is work-related.  Next post will have some pictures from our weekend at the most amazing beach I have ever seen...

Adios!
-Eric

At Hospital El Progreso

We started working at the host hospital on Monday.  It is a very small hospital: two floors, maybe 50-60 beds, and only 3 main wards (Emergency, Matrnity, and Neonatal).  On the first day, we got there at around 7:30 with our host Marvin.  We were introduced to the head BME technician Juan Carlos, some more of the maintenance staff, and a few of the administrators.  Juan Carlos really helped us get our bearings, and took us on a brief tour of the hospital.  I had thought that my Spanish was at a level where I could understand at least a good portion of what people were saying, but I quickly realized how wrong I was about that.  When people speak with us, I can generally pick up the topic of the conversation, but often have no idea about what is being said.  I also don't think I have said more than a few dozen words over the past 3 days.  Luckily, Marcello is quite good at the language, and is doing nearly all of the talking and conversing.  I am kind of hoping that changes eventually, but I guess we will see.

The hospital is generally in good shape: it seems as though there are a lot of people who come through each day, see doctors, get treatment, and leave better off than when they got there.  The BME equipment maintenance and inventory, though, seem to leave something to be desired.  The maintenance staff focuses on the building and upkeep, and doesnt appear to spend a lot of time or energy on the machines.  On Monday, we had 6 nebulizers on the floor of our workroom, which had been brought there by the nursing/clinical staff for repair.  We were able to 'repair' all of them by early afternoon simply by cleaning them inside and out, and loosening up the rotor of the electric motor.  We also found some infant incubators in the bodega/'inventory', which were much nicer and newer than the ones that were in operation.  We expected to find some sort of major malfunction, but were very surprised to see that they worked.  Perfectly.  We are still trying to figure out why they were in the bodega, but are guessing they were not being used because the nurses were not used to the alarms and settings.  If this is the case, we will be having a short training session at some point in the next couple of days.  We have also opened up an anesthesia machine, and have identified a couple of major issues that we are going to look into.  I am hoping that we can get some of the tubing that it needs, and we will see if we can get it up and running.

The home stay is still very nice, and the food is as good as ever (even better than CR!).  The only hassle in addition to the oppressive temperature is the very random and very inconvenient inconsistent water supply.  On 2 of the 5 days we have been here, there has been a significant interruption of the water line to the house.  This is made even more unfortunate by the fact that the best way to cool off is to take a cold shower.  Since we can't cool off, we sweat even more and get even more filthy, and even more in need of a shower.  It is truly a vicious cycle :)  Luckily the water usually comes back after 4-6 hours, so there haven't been any hygiene crises yet.

There isn't much of a nightlife in EP to speak of, so most of our afternoons and all of our evenings have been spent at the host house.  I am looking forward to getting out this weekend and seeing some of the other EWH-ers on the north coast :)

Anyways, thats all I have for now.  Hope things are going well back home!

Hasta,
-Eric

Honduras

I just got into Honduras earlier today and have been getting everything unpacked/situated/etc.  It is really hot here compared to CR!

Friday our Spanish class went on a field trip to the National Museum in San Jose.  It was fun to take the class on the road :) .  We saw some exhibits on the indigenous people of Central America, the Spanish colonization, etc.  I think the Spanish classes were my favorite part of most weekdays (apart from the dinnertime conversations with the other EWH students living in our homestay).  It was very cool to learn about the language and the culture, and I enjoyed spending time with everyone in the class.

Class photo outside the museum: Michelle (the teacher), Sarah, Manu, Amanda, me, Salman, and Denachi.

This morning we got to the airport at 2:30am for our 6:15am flight.  We spent the previous evening having dinner with our host family, saying our goodbyes, and hanging out at the school.  I cannot believe that a month has gone by already!  By far the best part so far has been meeting and spending time with all of the other people in the program.  For the second month we are all paired up with one other person and the pairs are spread throughout Honduras and Nicaragua... it will be different not seeing them all everyday.

Flory y yo, durante el ultimo noche en la casa de familia anfitria.

The Chinchillas, with our host mom Flory.

Gladys, the jefa of the language school.

Jens (far right) teaches everyone a traditional Danish drinking song.

The new host family is very nice.  So far, I have met the father, the 2 kids (a  ~15 y.o. son and a 10 y.o. daughter), and the grandmother, who is a really excellent cook.  The house is really really nice too.  We have a kind of guest house that is separated from the rest of the house, and it is perfect.  I am looking forward to the next month!


Work starts on Monday, and I think our hours will be 7am-3pm.  I am excited about getting our hands dirty, and hopefully bringing something helpful to the table.  I will post about that when I get a chance.

Have a good weekend, and I will fill in more later!
-Eric