Tuesday, March 13, 2018

Behind the Scenes

This trip was made possible through the hard work, coordination, and benevolence of many people. From fielding teams and evaluating hospital needs to supplying vital support and logistics, the services provided by these individuals were invaluable to our mission. All of you have our sincerest gratitude.

Project C.U.R.E.
Karen Bice
Danielle Rand

Vanderbilt University Department of Biomedical Engineering
Prof. Mike King
Prof. Amanda Lowery 
Matty Sevilla
Amanda King
Meagan Crawford
John Dunbar
Willy Reichert 

Vanderbilt University Center for Latin American Studies
Prof. Ted Fischer
Dr. Avery Dickins de Girón

Vanderbilt University School of Engineering
Prof. Chris Rowe
Prof. Tim Holman
Brenda Ellis
Pam Coyle
Michele Cedzich

Vanderbilt University Staff
Juliana Staples -- Office of Admissions
John Fellenstein -- VU Physics Machine Shop
Bob Patchin – VU Physics Machine Shop

Dr. Shari Green -- -- VU Zerfoss Student Health Center
Penny Meek -- VU Zerfoss Student Health Center
Craig Self – VUMC Department of Histopathology
VU Athletics

Hospital Infantil Juan Pablo II
Dra. Maritza Quex
Lic. Rudy Marroquin

Dr. Eddie Gharzouzi
Dra. Sylvia Blijidenstein
Julio Valdez

Hospital Nacional Pedro de Bethancourt
Dr. Miguel Soto
Dra. Carmen Cifuentes 

Obras Sociales del Hermano Pedro
Sergio Morales
Anabela Morales
Dra. Julissa Piñeda
Bryan Valle

Guatemala Support Team
Ben Kessler - Logistics Coordinator
Andres Gonzalez -- Translator
Estuardo Mendoza -- Translator
Evi Perez -- Driver

Clara Chacon -- Antigua Community Volunteer (and Dr. P.’s awesome Spanish teacher)

Universidad del Valle de Guatemala
Prof. Luis Pedro Montenegro – for tireless leadership, coordination, and instruction
Prof. Carlos Esquit – for years of partnership in this collaboration
Profesor Miguel Zea
Prof. José Eduardo Morales
Prof. José Antonio Bagur
Prof. Pablo Oliva

Universidad del Valle de Guatemala Students
Ana Bartra 
André Rodas
Andrés Lainfiesta
Arturo García
Cecilia Marsicovetere
Christopher Chiroy Miranda
Dan Álvarez
Darwin Rivas
Delbert Custodio'
Diego Alejandro Juárez Lossi
Edwin Fernando Coronado Roche
Guillermo de León Archila
Jonathan Aguirre Orantes
José Alejandro Rivera García
José Ramón Corona Boch
José Roberto Ruano
Juan José Tzun
Julio Ronaldo Diéguez Ochoa
Luis Ralón
Luis Ruano
Marcos Benedict
María Belén Hernández
María Gabriela López Castellan
María José López Ayala
Marlon Josué Castillo Martínez
Michel Ramírez
Miguel Godoy Garín
Mynor Franco
Pedro Joaquín Castillo

Spring 2018 Service Learning in Guatemala Team
Prof. Cynthia Paschal
Prof. Nick Adams
Nicole Budgell
Leah Fassinger
Candace Grisham
Austin Hardcastle
Seiver Jorgensen
Chad Keller
Sheng-Yau Lim
Ariana Nicol
Tori Qualls
Nicholas Wigginton
Anna Word

Sophie Xie

Monday, March 12, 2018

Leaving Paradise

Our last day of the trip cannot be described with words. Some of us started the day with a walk back up to the cross overlooking Antigua and a morning coffee near the central square. After a quick breakfast, we took off for our first adventure at Finca Filadelphia.

During our tour of the coffee plantation, we were able to see the complete process of coffee from the plants to the roast. At the end, we tried fresh coffee right from the plantation. This provided the perfect boost of energy for the next excursion... zip lining. If you are a fan of flying over the trees while simultaneously feeling like you may fall hundreds of feet, zip lining is for you! We were able to take in the amazing view of the volcanoes and Antigua from above the trees (after you got over the fear aspect).

We wrapped up our time at Finca Filadelphia with lunch (including coffee cake) and gift shopping for authentic Guatemalan coffee. We returned to the city of Antigua and meandered through the Artisan market for souvenirs. After our last exploration through Antigua, we settled in for our last dinner in Guatemala at Las Palmas. Immediately after dinner, we returned to Guatemala city for 6 short hours before heading to the airport.

A 3 AM wake up call has never felt so refreshing.... just kidding. Most of us slept on the first flight from Guatemala to Dallas. Luckily, customs in Dallas was very peaceful and allowed for a smooth transition to our connecting flight. We picked up our first American meal in a week. Ironically, some of us chose a hispanic restaurant. Our last flight to Nashville flew by (pun is absolutely intended). We are now peacefully in our dorms unwinding and preparing for this upcoming week.

We want to express our sincerest gratitude for being able to go on this service trip and impact not only the hospitals but also the students and faculty we worked with from UVG.  We hope they can continue their awesome work until we return next time. Thanks for following us through our journey!

Saturday, March 10, 2018

Closing Time.... One last call for Medical Equipment

Hola amigos! Today was our last day working in the hospitals in Guatemala. We returned to OSHP  and continued to inventory, test, repair, and organize the medical equipment. Halfway through the day we took a short break for lunch and were presently surprised with gifts from the leadership of OSHP. It included the photograph we took on the first day along with a letter expressing their appreciation and a calendar. It was an incredible experience to hear about the larger impact we would have on their patients and increasing their ability to serve those in need.

After lunch, we continued our work and made final presentations. We inventoried over 250 medical devices!!! It was a wonderful ending to our work week. We also enjoyed a joint dinner with the students and faculty of UVG with whom we worked with during the week. Professor Luis Pedro Montenegro gave the Vandy Crew  "Guatemalan goody bags" filled with wonderful mementos. In our penultimate post, we leave you with a couple reflections of our Antigua endeavors.

Dr. Paschal
This has been an amazing week in which we tested and fixed more equipment than any group I've ever brought to Guatemala.  This is due in large part to two factors -- the deep engagement of Prof. Luis Pedro and so many of his del Valle students and some serious organization on our part.   I am really proud of Anna and Seiver who did a fabulous job designing and implementing a system for us to use to inventory, collect notes on, and tag well over 250 pieces of medical equipment at OSHP.  Working with the del Valle crew brought in such strong electronics perspective to complement our biomedical perspectives.   The synergy was both productive and instructive.  Our BME's have knowledge and confidence now that they will carry forward in their careers.  To top off a wonderful week, I used Linus Lee's Pass the Pigs style to roll an incredible double leaning jowler!

It has been an incredible week in Guatemala and the past couple of days spent at OSHP have been both exciting and rewarding. When we first arrived at OSHP, I was overwhelmed by theCecilia and I worked on  I have learned so much from her and the other the del Valle students this past week, and hopefully we will still be in contact even after the trip.

Friday, March 9, 2018

Quality AND Quantity

What better way to start the day than 5:30 AM cardio? You may come up with some good answers to this, but nothing can beat the view of a sunrise over THREE volcanoes. This was an amazing start to our second full day in Antigua. The sunrise perfectly illuminated the city as well as the green backdrop of three volcanoes.

After our short hike, we returned to the hotel to get ready for Obras Sociales del Hermano Pedro (OSHP). OSHP was nothing short of a dream for biomedical engineers. We entered a room filled with hundreds of medical devices needing our attention. Seiver and Anna explained their wonderful inventory process, and we got to work. By the end of day one of two, we had completely inventoried 172 devices! We have some short highlights from Anna and Seiver detailing their excitement about today's successes.

Anna and Seiver: Masters of Inventory
Today was the first day of the OSHP inventory project.  We would rate it as a success. We were able to accomplish much more than we originally anticipated because of the hard work of our fellow Vanderbilt and del Valle students as well as our wonderful translators Andres and Estuardo. The colored labels proved effective in easily identifying the state of the devices as we expected. We were exited to be able to easily update the excel sheet and print labels for the devices as we worked. We hope that OSHP will be able to continue using our organization system after we have left and that the del Valle students that we worked with will be able to return and continue their excellent work. We are looking forward to finishing the inventory tomorrow on our last day working in Guatemala.

We ended our day with a pleasant meal at a local Guatemalan restaurant recommended by Dr. P's longtime friend and Spanish teacher Clara. During the meal we were treated to a traditional Antiguan dance performance which integrated colorful masks and clothes, and maracas; they even recruited Anna and Tori to join in the production! Tomorrow is our final day of work and our last day with the del Valle students. It is not possible to put in words what an incredible experience this partnership has been. These dedicated and talented engineers have taught us so much and have been such an amazing asset to the program, we are truly honored to have worked alongside them. We'll stop their today before all of us get too teary-eyed, and also because we've been up for nearly 20 hours. Hasta mañana!

Thursday, March 8, 2018

Ingenieros de Chocolate

Welcome back friends! Today was another eventful day filled with multiple machine successes, CHOCOLATE, and a very special birthday! We have some guest bloggers here to talk about some of their favorite moments from today.

Sheng-Yau and Sophie: Infant Warmer
We walked into Hospital Nacional Pedro today without the faintest idea of what medical devices were in store for us.  It soon became clear that there were far more devices to be examined than the four devices other members of the team had prepped for.  We quickly separated into teams and worked alongside Christopher, a del Valle student, on an infant warmer.  The infant warmer we worked on was able to turn on, but unfortunately was accompanied by a burning scent.  After taking apart the device, we were able to determine that the problem was within the circuitry and not the heating apparatus.  We found several burn marks on the circuit board and concluded that the overheating problem was due to faulty diodes and/or resistors, along with a broken off transistor.  We did not have the replacement diodes, resistors, and transistor at hand to test our theory, so instead we used parts from another nonfunctional infant warmer.  After mixing and matching parts, we turned on the switch and to our relief, did not smell anything burning.  We performed a few more tests until we were satisfied that the device was safe and functional.

Niki and Leah: Bilirubin Lamp
Today we worked on fixing a bilirubin light to treat jaundiced babies. We partnered with Del Valle student, José, who was a wonderful asset with all of his mechatronics knowledge. The device we were remedying was somewhat functional, however some of the blue LEDs never turned on and others came in and out. After taking the device apart, we were able to replace the burned out LEDs and make better connections for the others. The box the device was built into made it difficult to access the electrical components, but we were eventually able to fix it and even more challenging get it to stay together after it was fully functional. Later, Ari was able to see the adorable, premature baby who would be treated by the light.

The Day of Chocolate. This is one of my top five activities ever. We were able to see how chocolate is made from the cacao starting from the original traditions the Mayans used all the way until the modern methods that currently are used to make chocolate. Along this tour through history, we made the traditional Mayan drink, a Spanish drink, our own chocolates to take home, and chocolate tea. I think I bought more chocolate in this store today than I ever have in my life—I have one of everything to recreate this experience for my family (all while wearing a chocolate masque)!

However, not everyone is destined for a future in artisan chocolate.......

We did celebrate Dr. Adams birthday at dinner tonight. There were many dad jokes and fun conversations filling the air. It was a perfect ending to our day. We hope he had as much fun as we did celebrating his existence. We don't know where we would be without his (seemingly truthful) jokes and fun personality, but honestly, he is getting the best birthday present tomorrow by getting everyone to wake up at 5:00 AM to go on a sunrise expedition.....

Thanks to our devoted fans (shoutout to Dr. Russ and Dr. King). We'll be back tomorrow! Adios!

Tuesday, March 6, 2018

Spanish Lessons and Fixing Machines.... What more could we ask for?

Hello again! Today was day two working in Hospital Infantil de Juan Pablo. Once more, we worked with the del Valle students to wrap up our work in Guatemala City. Although not all devices could be fixed, we made terrific progress in restoring several machines and were also able to provide the hospital with a thorough digital library of medical equipment manuals to use in future maintenance (thanks Sheng-Yau!). In addition we received some personal Spanish lessons from a few of our del Valle friends, though our pronunciation leaves much to be desired. After finishing up at Juan Pablo, we immediately boarded our van and set course for the next stop on the trip! An hour of winding roads and haphazard napping later, and we found ourselves in the beautiful city of Antigua. Bordered by steep mountains, Antigua astounds us with its heavy emphasis on floral decoration, intricate architecture, and Spanish ruins. However, the true astonishment was the incredible meal we received at our first Guatemalan steakhouse.  With full stomachs and sleepy eyes we leave you with some personal highlights from today!

Tori and Chad: Infant Incubator
At Juan Pablo II, Chad and I worked with Belén and Guillermo, Universidad del Valle electronics students, to repair an infant incubator.  When we started yesterday morning, the incubator made this loud rattling noise when it was turned on.  It turned out that the impeller was leaning over and hitting another part of the machine, causing the noise.  After further dismantling the machine, we found that the rubber attachments used to stabilize the impeller’s motor had broken off causing the impeller to lean to one side and bump into the machine when spinning.  Later that day we bought a rubber tie down strap, some screws, and some nuts from a local store.  Upon our return today we fixed the rubber attachments with super glue then created additional stabilization using the strap so that the incubator will still work if those rubber pieces break again. To do so, we cut a slit in the middle of the strap, added holes in the strap for screws, drilled some holes and notches in the machine frame, and wrapped the strap around the motor, attaching the ends to the rest of the machine.  After reassembling, we tested the incubator to find that it is fully functional and should be ready for use soon!

Nick: Anesthesia Vaporizer
 My project today was repairing a malfunctioning anesthesia vaporizer. Coming into the trip, I had no idea what was actually wrong with this device. Upon arrival, the resident equipment supervisor could tell us little more than “it delivers too little anesthesia”, and an earlier visit from a licensed technician had yielded the same result. Faced no direct course, I did what an engineer does best: I completely took apart the machine. With some vital assistance from del Valle engineer Diego, we discovered that the internal mechanism limiting the normal flow was essentially a thermostat. It was truly fascinating to find such a simple and universal operating principle in use in such a high risk piece of equipment. After deliberating with several Vanderbilt and del Valle engineers, Diego and I decided that we could “fix” the device, but could not test our solution. The result is an in-depth, photo-assisted manual drafted by myself and Diego which explains how to adjust the performance of the device depending on the level of over and under dosing. For a project whose primary outlook appeared to be a wildly expensive replacement, we counted this as a great victory and awesome learning experience!

Monday, March 5, 2018

Getting the Job Done!!!

Today, was an eventful first day. We had multiple successes at both Hospital Infantil de Juan Pablo and INCAN (an adult cancer hospital). At both hospitals we were first briefed on the extent of their healthcare services and the impressively large number of patients they treat. Furthermore, we were informed that many patients pay little to no fees during their visits; these hospitals function on donated equipment, funding, and dedicated staff. Specifically at INCAN, the doctors work (almost pro bono) for the hospital. As a result, the hospital is busiest in the morning before the doctors return to their private practice. However, love of medicine and their fellow neighbors keeps them engaged in treating the less fortunate. We will be spotlighting some of the major accomplishments today later in the post, but first.... FOOD!

We had a wonderful breakfast and lunch at the hotel and hospital (respectively), but it was dinner that took the cake or should we say pad thai. Tres Elefantes was muy delicioso (excuse the Spanglish). It was a restaurant that served Thai, Indian, and Cantonese food. The main take away was the sharing of our meals in a family style manner. This allowed us to try many of the wonderful dishes and eat until we physically could not consume anymore.

Now the most important part, our projects! Today featured an enormous range of devices; we worked with del Valle students and faculty on everything thing from infusion pumps and anesthesia machines to ultrasound printers and infant warmers (or as Nick calls them, baby heaters). To our excitement, we experienced a great deal of progress on most of our devices. We leave you tonight with a highlight of those successes, commentated by those who helped achieve them.

Candace and Ari: Ultrasound Printer

Honestly, who knew headphones were so versatile? At INCAN, we were faced with a Sony Ultrasound printer problem. Unfortunately, the print button had been giving the radiologist problems. We were able to see another working ultrasound printer with an external button that plugged into the back of the printer. Ari and I brainstormed with Miguel and Alejandro to devise a new plan for an external button. Being the music fiends we were, we realized that the input jack of the external button looked vaguely similar to our headphones. On a whim, we decided to plug in my apple headphones to the back of the ultrasound printer. VOILA! We had ultrasound images. With this new information, we found an audio jack on a scavenger hunt through Novex and rewired a new button.

Seiver and Sheng-Yau: Infusion Pump
This afternoon while at INCAN we worked on a Woo Young Medical Infusion Pump which was not functioning correctly because all buttons resulted in a ‘HOLD’ signal. After going upstairs in the hospital to see a functioning unit, myself,  Sheng-Yau, Diego, and, Marlon believed that the device needed a hard reset. After taking apart the device we found that all it needed was the hard resent and then the device was returned to working form. It was very exciting because initially we were not sure that we would be able to fix the device after an initial appraisal of the internal circuitry it did not appear that we would be able to fix the device. This made it especially
exciting when a hard reset did work!!

Austin: Microtome
The best part of my day was working with Edwin, an electrical engineering student from Universidad del Valle. I was consistently grateful for the del Valle students’ technical skill and friendliness. It was great getting to make a new friend, learn about another culture, and get a tremendous amount of help on the equipment at the same time. At INCAN, me, Edwin, and Sophie installed a microtome head
that was donated from a generous medical supply company in the States. This part allowed this machine to work with the types of samples they used every day. A technician in the pathology department was able to use the new part, and, upon seeing it, the director told us, “This was
worth the whole trip.”