Wednesday, March 11, 2020

So Should We... Go Back to Guat?

We left the hotel on Sunday at, as Dr. P would say, “pre-o’dark hundred.” Drifting sleepily through Guatemala City and Chicago O’Hare airports, we made sure to hand-sanitize every five minutes and wipe down our seats with disinfectant to evade the infamous Covid-19. We snoozed our way back to Nashville without a hitch. Going our separate ways at the airport, we were thankful for our successful trip and the great group of people we got to share it with.

Arriving back on campus, everything was once again normal… until it wasn’t. Around 7 PM on our first day of classes back from the break, the Vanderbilt community received the notification that all classes were cancelled for the week and would be held online for at least the remainder of the month as a preventative measure against the spread of coronavirus. The past two days have been hectic, with students considering whether to return home and faculty working out how to teach class remotely. We wish everyone the best in this confusing time, which has left us wondering: so should we… go back to Guat?

Sunday, March 8, 2020

Día de Diversión: Adventures around Antigua

Our final visit to Cerro de la Cruz

We completed our device repair work on Friday, but the fun wasn’t over! Saturday was filled with adventure, cultural exploration, and group bonding. We started out early per usual, with some of us taking the now-habitual morning run up Cerro de la Cruz. The sunrise today was particularly stunning, with soft pinks and oranges emerging to envelop the dark volcanoes. 

Climbing higher and higher!

After breakfast, the group migrated through the city to meet a shuttle that would take us up to Finca Filadelfia, a ranch at the base of the mountains that includes a coffee plantation winding thousands of feet up the steep slopes. We were excited about our first activity: ziplining! The group packed into the open-air back of a rickety truck and began the ascent up the zigzagging bumpy dirt roads, holding onto the seats so as not to tumble into the aisles. We traversed the edges of cliffs and climbed hills so steep that we were impressed our truck held on to the road. Needless to say, the views from the drive were incredible.

Arriving at the top, we suited up in full ziplining gear and got straight to the action. Stephanie impressed us with the versatility of her tricks, including hanging upside-down like Spiderman, while Dr. Adams made us laugh with his Lotus and dad-on-a-beach-chair poses. We zipped through seven lines, the sixth of which launched us out over a valley for a prolonged and relaxing view of the landscape. At the end of the tour, several of us attempted to walk a tightrope in the kids’ course (with varying levels of success). After covering significant ground on the ziplines, it was only a short drive back down to our next stop: the coffee plantation!

The VU team all geared up!
Rhett performing the Spiderman
Antonio ready to launch backwards

Mission accomplished!
The Guatemalans know their coffee, and they were happy to share what they knew with Americans. Similarly, we loved learning about the intricate process of coffee bean cultivation and preparation. We followed our guide from the coffee plant nursery to the coffee lots where the sweet red coffee cherries are picked each individually. From the plots outside, we moved into buildings that housed the machines used to extract the husks and separate perfect beans from those with defects. Finally, we observed the drying process and were able to try a delicious cup of their fresh coffee to complete our tour.

Dr. Adams examining the coffee cherries
Learning to shell the beans in the coffee factory
Finishing the coffee tour and lunch, we seized the opportunity to peruse the local Artisan Markets before leaving Antigua for Guatemala City! The bright colors of the clothing and fabrics popped as we walked from one stall to the next. We searched for gifts and trinkets at the market, each person trying to one-up the next’s haggling skills. Wandering around the massive outdoor market, we walked from the artisan area to where vendors were selling produce, shoes, and electronics to the locals. Exhausted but content with our day of bargaining, we headed back to Casa Mia Hotel with our catch to recuperate before dinner.
For dinner, Dr. P directed us to Miso, a nearby Korean restaurant renowned for its traditional meals. While the dinner was delicious, the focus of this last dinner was on reflection and conversation over the trip. We compared our current thoughts and comfortability with medical equipment with our previous thoughts and experience to note the difference between the two. We shared stories and insights about people we did not know well before the trip and thought about the value we added in Guatemala through our service. 

Although dinner ended and we headed back to our hotel to gather our things, the conversations and stories were just getting started! Dr. Adams shared his travel stories involving shady, under-the-table deals at hotels while Noah enthusiastically told us a story about pulling a prank on his girlfriend that got him dumped. The stories continued all the way back to Guatemala City, followed us into Casa del Angel Hotel where this trip started, and sparked laughter and smiles among all of us. After hours of stories and games, we headed to bed to prepare for the flights back tomorrow.

Friday, March 6, 2020

Lights Out on Equipment Repair

We woke up to refreshingly cool air with some cloud cover in hermosa Antigua. A few of us watched the sunrise while running stair repeats up the hill at Cerro de la Cruz, while others worked out on the rooftop of Casa Mia overlooking the city.

Hospital Nacional Pedro de Bethancourt
After grabbing a quick breakfast, we hopped in our beloved beige bus to make our way to our third and final workplace, Hospital Nacional Pedro de Bethancourt (PdB). Unlike the other hospitals where we worked this week, PdB is a government-funded public hospital with even more limited resources. Dim is an appropriate adjective to describe PdB - dim lighting, dim conditions, and dim hopes. Still, dedicated people serve there, working hard to provide healthcare.

If at first you don't succeed...
try, try again

After finishing inventorying and repairing over 100 pieces of equipment at Obras Sociales de Hermano Pedro on Thursday, the BME students arrived at Pedro de Bethancourt Friday morning surprised to find fewer pieces of equipment to fix here. With several examination and infant warmer lights to fix, the Vanderbilt students paired off to tackle the necessary repairs. Jorie and Michael were tasked with an examination light that would not turn on due to a faulty socket and shorted connections within the lampholder. After taking apart the socket and testing the connections within the lamp, they found that a trip to the local hardware store was necessary to find a functioning socket for the lamp. With a new socket incorporated, the lamp was ready to be tested again for functionality. While the bulb itself was able to turn on, Michael quickly found that the switch within the socket was very weak and needed further repair. A few hours and extra parts later, they were able to fully repair the socket and rewire the lamp to have a single pole switch that is more reliable and robust for the hospital setting.

Jorie, Michael, and Dr. P testing continuity in their lamp socket

Zach and Hunter melting heat shrink onto a wire

Zach and Hunter were tasked with repairing a bilirubin light, which is a bright blue light used to treat jaundice in newborn infants. This light, which was built by a previous Vanderbilt group on their trip, had several issues including frayed wires, unlit LEDs and an unreliable transformer. Zach and Hunter first resolved an unlit strip of LED lights by identifying the burnt out bulb and soldering in a wire to bypass it, returning function to the other LEDs in the strip. Next, they removed the frayed wire and soldered the two ends together, then covered it in heat shrink and electrical tape. Lastly, they added a spacer to the transformer to stop the internal parts from moving and superglued the cover on. We successfully fixed this light and all pieces of medical equipment we worked with today!

Christia testing repaired laryngoscopes
Aidan and Antonio replacing blown-out diodes for a bilirubin light
Stephanie and Cerie screwing electrical wires into their light socket
After wrapping up at Pedro de Bethancourt, the team made its way to Fonda de la Calle Real for another authentic Antiguan meal. The team celebrated two birthdays tonight -- Professor Adams (March 7th) and Stephanie (March 2nd), complete with cheesecake, party horns, and candles! The celebrations continued at night with games and conversation.

Stephanie and Dr. Adams blowing out birthday candles!

Thursday, March 5, 2020

A Full Day with Hermano Pedro

Our runners braving the cobblestone streets of Antigua
Our group of runners jumped from sidewalk to sidewalk in the predawn, spending as little time on the risky cobblestone streets as possible. Street light illuminated las calles of Antigua. Most of us were in the jogging group, a few in the walking group, and a couple had decided to stay at Casa Mia Hotel. The majority of us were headed towards the scenic hill called Cerro de la Cruz. We heaved and puffed as we climbed to the top from whence we could see all of Antigua and three volcanoes spread before us. While on the top of the hill, Volcan de Fuego gave us a performance, spouting smoke and fire from across the valley. We took in the sunrise and the incredible view before heading back towards the hotel to begin the day.

At the top of Cerro de la Cruz with Volcan de Agua in the background

Swinging on the playground at Casa Mia

Breakfast at the hotel was a chance to discuss our journal questions from the day before while enjoying a breakfast of huevos and plantains. The conversation and coffee woke us up, preparing us for the day of concentration ahead. Today, we were close enough to Obras Sociales del Hermano Pedro to grab our bags and walk our ten tool bags to the hospital. The brisk morning air, vibrantly colored buildings, and Guatemalans hurrying to begin their days filled us with energy and excitement for this incredible city and people. We arrived at Hermano Pedro, refreshed and ready to work.

Unwilling to admit defeat, Michael and Noah picked up the defective foot pedal from yesterday to give it another shot.The wiring that allowed the cut function to work had completely come off its pin and broke apart. Consequently, Noah and Michael had to solder the wire back together and to the pin, which was buried in a narrow connector. As a result, they had to work in a space about as big as a water bottle cap. After many methods of approaching the problem of getting the wire to stick to the pin without connecting itself to the 3 other wires in the connector, all they had to show for it were burnt fingers and frustration. The sight of Michael and Noah wearing surgical light headsets and holding flashlights in their mouths to peer into the dark crevice was quite comical for the others as they failed time and time again. Finally, after 2 hours, Michael came up with quite an ingenious plan: to spiral solder wire within a heat shrink and solder the wire and pin together. Michael says he’s never felt a sense of accomplishment in his engineering career that comes close to this “jank fix.”

Cerie and Antonio with their
 formidable opponent

Cerie and Antonio took on the challenge of attempting to repair perhaps the most complicated piece of equipment they’ve worked on so far -- an advanced ultrasound system. This ultrasound unit was a formidable challenge, weighing in at around 125 kilograms. The device failed to power on when plugged in, and the two opened up the machine for breaks, blown fuses, overheated components, or literally any other malady. Unfortunately, the ultrasound unit led them down rabbit hole after rabbit hole, eventually requiring Cerie and Antonio to practically remove around 100 screws and disassemble the entire device to seek out the root of the power problem. Sadly, they had to pack up for the day and could not fix the ultrasound system. However, they had a great opportunity to learn about ultrasound systems and got a great workout in dismantling this giant and complex machine.

Stephanie and Katie's masses of modules

While Cerie and Antonio were busy working on the ultrasound, Katie and Stephanie tackled an enormous collection of anesthesia machine monitors and modules. Saying these devices were everywhere is not an exaggeration; modules were found sitting on towers, scattered about shelves, and hiding in boxes. The team started by centralizing and sorting the hospital’s collection, after which Katie and Stephanie began testing SPO2 and NIBP/ECG modules, respectively. After measuring their own pulse rates and blood pressures countless times, a grand total of 51 vital signs, pulse oximetry, and printer modules were tested, cleaned, and inventoried! Special props to Stephanie, who sacrificed her arm's blood flow to over 15 blood pressure tests. A set of working modules was then added to each of the cases corresponding to the three viable screens, creating three monitoring sets ready for use! The greatest challenge of this project was probably finding the right ancillaries: each new module required a (sometimes frustrating) hunt for the correct connector, but almost all of them were found in the end. The hospital owns a vast, largely unsorted collection of cords and cables for the monitors: perhaps a project for the next trip?

Zach fixing a drill at Obras Sociales
Dinner was incredible. We went to La Estancia where we met Dr. P’s Spanish teacher Clara and Dr. Adams led us onto the plant-covered roof of the restaurant. The Guatemalan food did not disappoint. Some groups ordered their own meals while on group pitched in all together to create a smorgasbord of meats which they passed around family-style. With room only for ice cream, most of the group headed to the central Antigua Square where they filled in all the cracks with Guatemalan ice cream. Stuffed, everyone headed through the still lively streets to the hotel for an evening of reflection and games.

Wednesday, March 4, 2020

Guat Day is it Again?

This morning the team said adiós to the avocado trees at Casa del Angel and headed out promptly to Antigua. We marvelled at the greenery and volcanoes visible out our bus windows, as well as the skill of our driver Evi as we winded upwards. Traversing the cobblestone streets, we arrived at Obras Sociales del Hermano Pedro, where we were greeted by a friendly group of administrators and doctors who introduced us to our project: a large storage room filled with equipment. We promptly got to work!

At Obras Sociales, Christia and Noah worked on testing and repairing foot pedals for use with electrosurgical units. These foot pedals are used by surgeons to switch between cut, coagulation, and bipolar settings when performing electrosurgery. This makes switching between these settings much easier for the surgeons, increasing surgical efficiency. They tested the functionality of seven different foot pedals by using a multimeter to detect the changes in resistance that occurs in the pins of the connectors when various pedals are pushed. Of the seven pedals, four were fully functional after initial testing, and the remaining three needed repairs. 

Christia and Noah working on an ESU foot pedal
One of these pedals had a connector that was fully disconnected from the wire. Noah and Christia spent the entire morning attempting to solder the wire back into the connector, but the pins in the connector were so frayed that they were unable to make a reliable connector. Concerned about the reliability of their repair, they unfortunately decided that it would be safer to dispose of the pedal. Another of the pedals needed to be taken apart to diagnose the problem. Christia and Noah discovered that the piece of metal that makes an electrical connection with the switch when the pedal is pushed was not reaching the switch. They made a quick fix by wedging an adhesive shim underneath the metal piece to raise it enough to click on the switch. The newly-repaired foot pedal is now deemed functional for use in the hospital!

Stephanie and Katie testing an automatic tourniquet system
Performing electrosurgery on a banana
Grinding the cocoa beans
After a quick stop at our new hotel, we made our way to the Museum of Chocolate. We learned about the history of chocolate, working through the Maya to the Aztecs to the Spanish and tasting chocolate drinks from each culture along the way. We learned to shell and grind cocoa beans and to mix a traditional Mayan drink with chocolate powder, chili, honey, and vanilla. Finally, we made our own dark chocolate bars with diverse combinations of cocoa nibs, coffee beans, ground coffee, cinnamon, chili, and other ingredients!

Pouring the chocolate bar

We found all the colors

As the sun set behind Volcan de Agua, we took the opportunity to take photos of the beautiful, ancient architecture and ruins of Antigua. We wound our way through the cobblestone streets, awed by the history and culture around us. We briefly visited a local artisan market before heading off to dinner at La Cuantía de Los Urquizu where we enjoyed traditional Guatemalan dishes. Satisfied, we explored the streets of Antigua, especially taking time to take in the main square and the works of art around it. Exhausted from a busy day of travel, work, and exploration, we headed back to the hotel to chat and recuperate for another fulfilling day tomorrow!
The team at El Arco de Santa Catalina in the heart of Antigua 
Goofy team selfie with Volcan de Agua

Tuesday, March 3, 2020

Making Amigos all over Guatemala City

Another beautiful morning in Guatemala started with a morning run for a few of us, then breakfast in Casa de Angel Hotel with preparation and discussion for the day over pancakes!

Exhausted but happy at the top of the hill on the morning run
We wove through the busy streets of Guatemala City in our big beige bus back to Juan Pablo II where we worked for the first half of the day. We finished up the medical equipment we had left from yesterday, then presented our results to the hospital administration. We sorted through 33 pieces of equipment and were able to fix, calibrate, or test 23 devices that will now be operational for the hospital.

Stephanie presents our finished monitors
to hospital administration
Antonio picked up where he left off on Monday, trying to test and potentially repair the 7 “defective” ECG units. None of the units had leads to connect to the electrodes on a patient’s body, so Antonio, with the aid of Noah and Cerie, made makeshift electrodes using stranded wires that wound around the ECG module and were delicately embedded in gel electrodes. This initial design worked and produced a functional ECG when placed on the body; however, the group quickly developed a better prototype by winding solid core wire around solder wire to form a solenoid-like wire that could quickly slide on and off of the ECG modules. This design allowed the team, now aided by Hunter, Rhett, Michael and Stephanie, to rapidly test the functionality of the remaining ECG systems. The group assessed the different leads of the ECG units, the printing capability, and the general settings. The team was able to recommend much-needed accessories, clean and inventory the modules, and confirm that many of the previously “defective” ECG modules were functional with minimal limitations. The collaboration during this endeavor is what enabled its success and epitomized what it means to be engineers in the field--solving problems through communication and teamwork. 

After leaving Juan Pablo II, we stopped at INCAN Cancer Hospital to meet with leadership, learn about the hospital’s mission, and look at some of the devices in the labs. INCAN is the only nonprofit hospital providing cancer care in Guatemala. We were inspired by INCAN’s work to provide care to cancer patients despite limited and occasional lack of funding. We met with INCAN leadership and Dr. Carlos Esquit from Universidad del Valle, hopefully establishing connections for future collaboration between these two admirable institutions.

Rhett, Aidan, and Christia present at Universidad del Valle
Our next stop for the day was Universidad del Valle de Guatemala (UVG) where Prof. Carlos Esquit described the many great things that they do in engineering there.   Guatemala's first satellite was developed at UVG and is about to be launched this Friday. Two of Prof. Esquit's engineering teams presented their projects, one of which involved printing 3D models of hearts defined by segmented cardiac CT images and the other involved integrated circuit design.  Dr. P. described Vanderbilt and the School of Engineering, encouraging UVG students to consider VU for graduate school. Then Christia Victoriano described her research about a point-of-care low flu diagnostic tool for low resource settings, Rhett Britton presented his microfluidic device to support a cancer-organoid for testing chemotherapeutics, and Aidan Pace described his work with Engineering World Health.

Rhett and Noah conversing with Universidad del Valle students
While our three students showed Vanderbilt academics in the strongest of lights, the rest of the students had the opportunity to mingle with the Guatemalan students and leave a unique impression on the individual level. However, none mingled quite as uniquely as Rhett and Noah. The two bee-lined straight for the back of the lecture hall where “all the rowdy students must be.” They immediately made friends with a group of students despite their broken Spanish. Noah quickly proceeded to become the loudest individual in the room, and Rhett’s witty sarcasm had everyone rolling on the floor in a few short exchanges. Whether it was talking to the students about classes where neither group understood a lick of the other group's technical terms or requesting a Spanish translation of “Aidan is a hunk of a man,” the two of them had a wonderful time laughing with the local students. This exchange culminated when Rhett finished giving a presentation and Noah stood up to ask a question in front of the whole group. Noah, intending to tell Rhett what a good job he did, tried to tell him how handsome he looked up on stage. Unfortunately, a stray dog has a better grasp of the Spanish language, and he accidentally told the whole lecture hall that he himself was very handsome. This of course elicited a roar of laughter which was completely lost on him. When he sat back down, the girl next to him leaned over and asked if all Americans “had as much energy as our group.” To which he replied, “no that’s kinda just me.” He then proceeded to consume half of the free buffet.

Antonio talking with Universidad del Valle students
We ended the day with a satisfying dinner and turned in late. Tomorrow we will be on to Antigua to work with Obras Sociales del Hermano Pedro!

Anticipating the arrival of the other half of our dinner

Monday, March 2, 2020

Building Momentum at Juan Pablo II

The morning started early with reflection questions for the day posed over a bright breakfast of eggs and toast. Dr. Adams led the group in considering the purpose of the trip and what we hoped to accomplish.

Breakfast at Casa del Angel Hostal
After planting seeds for reflection, we packed up, jumped in the bus, and headed through the packed Guatemala streets towards Hospital Materno Infantil de Juan Pablo II!

When they tell you the traffic will take another hour
Hospital Materno Infantil de Juan Pablo II serves low-income mothers and children in Guatemala City. They had accumulated many pieces of malfunctioning or broken medical equipment over the past two years, so the room we carried the pieces to was packed in no time. With plenty of work on our hands, we partnered up, grabbed a device, and set to work on repairing items!  

Getting to work!
Dr. P making use of her resources

Jorie, Cerie, and Katie worked together on a set of three autoclaves, instruments that build up high temperatures and pressures to sterilize medical equipment. They got two of them up and running! The third had a few more problems… it was found in a large container soaked in water. After fixing the water drain and wiping off the significant rust that enveloped the interior, we decided it was time to plug it in and...
The autoclave team

Rhett working on a new pointer for a broken scale

Calibrating and balancing infant scales turned out to be a taller task than expected when Rhett discovered that one of the scales was missing the indicator on the large weight. Instead of letting the scale go to waste he decided to make a new one! We bent a few pieces of scrap metal into shape and then epoxied the new pointer onto the weight. After calibration, the scale worked like a charm!

Overhead view of the internal workings of the ESU
Hunter spent the entire day fighting to revive an electrosurgical unit that was determined to stay dead. The machine is commonly used to perform delicate surgical procedures, and this item in particular was a major priority to the JPII staff, and they were really hoping we could get it up and running for them while we were here! Despite knowing that it wouldn’t turn on, when we first arrived we were very hopeful that we would be able to get it working since we had trained on this exact model of electrosurgical unit. However we quickly realized that it would be trickier than we first expected. The fuses, cable and power switch were all working fine when tested using a multimeter, which indicated that the issue with the unit was somewhere inside the electronic components of the machine. After doing a deep dive into both the service manual and the circuit schematics, he narrowed down the issue to the power supply board at the back of the device, which wasn’t providing the power that the unit needed to operate. Upon this discovery, Hunter along with Rhett removed this board, replaced it with our DC power supply, and SUCCESS! The unit was able to turn on! This victory however was short-lived, as the unit’s interface still wouldn’t respond to inputs, and indicated much more complex problems associated with the logic board. After struggling with the zombie electrosurgical unit for awhile longer, Hunter and Rhett unfortunately had to declare it dead, but not before the device decided to give them some not so kind parting words for disturbing it’s rest.

Parting words from the ESU
Hungry from our first day of medical equipment repairs, we headed off to dinner where we enjoyed delicious Guatemalan cuisine before retreating to Casa de Angel Hotel for journaling and relaxing! It’s been a full day and given us a lot to consider from the equipment we tested and repaired to the Guatemalans we observed going about their day. Time for a recharge and a reboot to be on top of our game for tomorrow. Happy 21st birthday to Stephanie!!

Showing off her engineering and gymnastics skills