What is this Instrument?

Ryan checks out the oxygen level

Before we leave for Guatemala lets first learn about the anesthesia instrument!
Dr. Stuart McGrane gave us a brief lecture about how this system works. This hands on experience gave us insight to the complexities behind the anesthesia instrument!

Zipping Down, Saddling Up and Flying Out

The team gears up for a zip line tour down a Guatemalan
mountainside at Finca Filadelfia.

[From 03-08-14] After a long week of hard work, the team was due for a fun day, and today was promising to not disappoint. On the docket we had ziplining and horse back riding at the Finca Filadelfia which translates to "Farm Philadelphia". Though some in our team were apprehensive about trusting their lives and weights to Guatemalan zip lines, many of us still took the leap (quite literally). Fortunately, and to our amazement, the zip lining was breathtaking. First we rode up a steep mountain on a precarious bus, frequently waving to the coffee workers that picked the beans from the stalks that grew on the side of the mountain. Next we suited up and let gravity be our entertainment. The view was surreal, as Antigua is located in a valley surrounded by leafy mountains set against the backdrop of a towering volcano. Needless to say, we were saturated by the beauty that nature threw at us as we slid down the tight ropes. The rest of our group, Orlando, Ally, and Chris took a more intimate ride with horses through the facility and its surroundings. Since Chris was the only experienced one, the others enjoyed the challenge of riding a horse for the first time. 

Miranda zips through the forest
canopy like a pro.

After our adrenaline hit we went to the facility’s shop where many of us depleted our personal funds on delicious coffee. Later we drove back to the hotel and checked out. 
A sting of nostalgia was in the air as we cleaned our rooms out and packed our bags into Israel’s car. Nevertheless, the melancholic mood was quickly dissipated as we were determined to invade the artisan shops. After a quick tour at Pollo campero we made our way to the shops, recalling all of our haggling schemes. A couple of hours later and many Quetzales spent the group lugged their trophies back to the hotel. 

Part of the team poses near the entrance to the Mercado de Artesanías.

Back in Guatemala City the group queued up in a small hotel to hear some of the team member’s thoughts of the trip. After a heartfelt talk with Dennis and Berta the team went straight to bed to get some rest before going to the airport at 5 am.

An awe-inspiring view of the valley from the ziplining tour at Finca Filadelfia.

We departed early Sunday morning, exhausted but grateful for such an incredible week. With so much to think and reflect on, many of the group members could do little more than sleep on it for that afternoon’s flights, and thankfully we all returned safely to Nashville. But the observations, experiences and memories from that trip were sure to give us much to consider and discuss in the days to come, as they already have in our team debrief meeting March 17 and as each team member has done through the individual journaling and final report assignments. And I’m confident that, for me, as for most of our group, we’ll continue to see for months and years to come how this trip has impacted everyone involved.

We would like to thank the following people and organizations for helping to make this trip possible:

Berta Rivas and the Shalom Foundation

Annie Element and Samy Badie of Project C.U.R.E.

Mary Dockery, our TA

John Dunbar, engineer extraordinaire

Tina Shaw -- BME

Chris Rowe, Brenda Ellis -- VUSE Engineering Communications

Michele Cedzich -- VUSE

Robin Carlson -- VUSE

Sheri Stevens -- VUSE

The Moore Pediatric Surgery Center

Hospital Infantil Juan Pablo II

Hospital Nacional Pedro de Bethancourt

Obras Sociales del Hermano Pedro, especially Odra Flores

What a week!!

At the entrance to Obras Sociales de
Hermano Pedro, where we worked Friday

[From 03-07-14] Even after such an eventful week, it’s seems crazy to say that Friday’s already here, and with it, our last day to repair medical devices in Guatemala. Sorting and loading up our tool kits for the last time, the team packed in the van to head over to the site of Obras Sociales de Hermano Pedro. We began with an eye-opening tour of the facility, which serves patients in a wide variety of specialties, emphasizing vital surgeries but also incorporating several extended care areas. A particularly heart-warming section of the tour was our visit to the pediatric nutritional recuperation center. Here, infants and young children are treated for malnourishment and given the chance to gain the strength needed to undergo procedures such as cleft palette surgeries. After a week of work often filled with frustrations and stresses, the sheer joy of the children and their delight to interact with us was a truly touching moment. After our tour, we headed to our work room to receive the devices we’d be servicing.

Nate works his magic
on a set of surgical drills

The victorious team of Dr. Walker, Casey and Anna celebrate their successful
troubleshooting and repair of a cast-cutting saw on Friday afternoon

Before we could work on these machines the entire group had to suit up in some stylish scrubs. Even though we each had to wear similar attire each one of us donned them with our own unique style. As if that didn’t make the situation feel serious, we were literally working right next to the OR. We knew that the machines we would be working on would be directly used to perform delicate procedures on patients. Pretty soon the room was full of monitors, surgical lights, drills, and saws. Jake and Orlando worked on a surgical light to assess its functionality. Miranda, Mary

One of the monks from Hermano Pedro
thanks Chris for his work in the hospital

Kate, and Daniel found a defective pulse oximeter cable and found a replacement part to be ordered. Michael was our anchor as he was our detective, researching for parts, manuals, and product websites. Casey and Anna performed surgery on an electric cast cutter, taking it apart and making it all better. At lunch the hospital provided us with a delicious meal.

In the afternoon, the team resumed their efforts. Miranda and Mary Kate found the source of a defective automatic tourniquet. Daniel continued work on an anesthesia unit in an OR room, providing the surgery unit with new electrocardiogram cables and recommendations on parts for their ventilation unit. Nate focused on surgical drills and saws the entire day and managed to fix some and recommend correct usage for others.

At the end of the day, each member of the team was presented with a 'diploma' of appreciation for our work at Hermano Pedro. We then took a bittersweet photo with our interpreters and the hospital workers, and after many hugs and private tears shed (Orlando) the team headed back to the hotel.

The team celebrates our day of repairing devices for Obras Sociales de Hermano Pedro and a great finish to our week

After some rest the team enjoyed a candle lit dinner at a Guatemalan Italian restaurant. (I feel like that’s gotta be breaking UN laws or something). Regardless it was a good end for our last working day.

Tomorrow will be our rest and fun day as we will head out to Filadelfia park where some of our team members will zip line and Orlando will horseback ride.

Some interesting facts about our time at 'Hermano Pedro'

• The hospital performs over 4000 surgeries in one year!
• Exchanging facebook friend requests with our interpreters led to some interesting explanations for some of our profile pictures.
• Orlando: "shots fired."

Bring it on (and get it working, reading, monitoring, heating, lighting, ...)

Following a challenging first day at Hospital Nacional Pedro de Bethancourt, the team headed back bright and early Thursday morning to continue our efforts. After arriving at the hospital and dividing into groups, Anna, Daniel and Sara grouped up to investigate the functionality of several patient monitors. The team also tested and repaired an infant monitor, and worked with the hospital staff to teach them in detail how to operate the monitor. Michael, Chris, Mary Kate and Casey tested the ECG, blood pressure and SpO2 measurement functions of four other patient monitors. In this project, they also repaired several beat up SpO2 modules. The quartet, with the assistance of Dr. P, also tested three ventilators and identified malfunction in their oxygen-level sensors. Chris also repaired a cervix cauterizing implement. Miranda, Nate and Dr. Walker took the title of electronics sleuths of the day for their work on an infant warmer and incubator.

Nate troubleshoots circuitry inside an infant warmer with our translator, Josh

First, they identified that it was missing fuses and fuse caps, which they were able to replace with the help of our local translator Josh. Then, after hearing from the hospital maintenance staff that the warmer burned through these fuses especially quickly and that a burning smell resulted when the device was powered on, they searched through all the boards and found a resistor with significant burn marks. The team replaced it, eliminating the burning smell and restoring usability to the infant warmer ("Elementary, my dear engineer"). Nate also got a firsthand look at the user environment of a device designed and donated in 2012 by Vandy alumna Becca Hudson.  In the neonatal unit, Nate tested the bilirubin light and got some firsthand experience of the busy facility where several newborn babies were transported to and from. Ally, Orlando and Jake were able to apply the lighting repair skills honed yesterday at the X-Ray viewing light box to the repair of an infant warmer and its associated light fixture. Amidst the busy, crowded environment nestled between actively used delivery rooms and newborn care areas, the team repaired their assigned devices as they jumped back and forth between hallways and break rooms in order to minimize their interference with the maternity ward’s activities. Each of the three team members applied some clutch electronics diagnostic and repair skills as they reinstalled a heating element to the infant warmer, troubleshot the light for a burnt out bulb and replaced it, restoring the entire module to use and demonstrating it to the maternity ward staff.

Jake, Ally and Orlando install a heating element into an infant warmer for the maternity ward

At the entrance to our tasty Thursday
night dining location

"Los tres cebollines" (Daniel, Michael and Jake)
se disfrutan Los Cebollines

After a busy day at Pedro de Bethancourt, the team retreated to the hotel to clean up and walk over to dinner at Los Cebollines on a rainy night in Antigua. The team had the pleasure of being accompanied by Clara, a personal friend of Dr. P and native Antigua resident. Enjoying a wide variety of platos de pesca, frijoles, cedra, pollo y más (fish, bean, pork and chicken dishes and more), our group was treated to yet another memorable dinner. Among other great conversation was a group discussion of yesterday’s discussion question: What is your opinion on the ethics, advantages and problems of the product life cycle seen in the medical device industry? As with virtually all the week’s reflection questions, the team had an enhanced view of the subject as it drew on a multitude of experiences we've had here in some of Guatemala’s various healthcare facilities. 

The team enjoys a customarily awesome and stimulating dinner discussion after a long day of work;
pictured is a rare photo of a seldomly witnessed occurrence: Chris talking to people

Pedro and Pablo

A breathtaking panorama of the mountains surrounding Antigua as seen from our hotel's rooftop

After a refreshing night the team woke up to a delicious breakfast from the hotel. The weather could not have been any better. Even as we drove through the bumpy roads of Antigua to the Hospital Nacional de Pedro Bethancourt, the leafy mountains provided a breathtaking backdrop to any line of sight. The picturesque scene was quickly cut off as we arrived into the large hospital. Pedro Betincourt is a national hospital that cares for any sort of person in any condition. It was a bit overwhelming starting out as there were several machines to fix that we had not previously known about and the team had

Anna and Daniel test
oxygen supply flow.

Daniel, Dr. Walker and Chris get together
before going into Hospital Nacional
Pedro de Bethancourt Friday morning

to split up in various wings of the building. It is quite an understatement to say that Dr. P did an astonishing job facilitating work for every separate group, running tools back and forth, talking with the hospital management, and help in fixing machines at the same time. It is with pride that I can say that the team also did an incredible job in staying flexible and adapting to the hectic environment. Sara, Daniel, and Anna spent their time verifying the function of all of the oxygen flow meters in the pediatric emergency unit, successfully fixing one. They also worked on a baby heater, replacing some broken fuses, and fixing some archaic blood pressure readers in the pregnant woman emergency ward. Dr. Walker, Nate, and Miranda worked on some incubators, replacing fuses and checking for a possible short. Michael, Casey, and Mary Kate donated a manual and pulse oximeter for a patient monitor that was thought to be giving errant measurements. However, after long testing and installing of the pulse oximeter the three were able to bring the monitor into full working power w
ith accurate measurements. The rest of the team worked hard on a hallway X-ray viewing box that was brought to normal functionality.

Miranda, Ally and Chris enjoying lunch together at Pollo Campero

Orlando, Daniel and Jake having some laughs before lunch,
proving that Orlando does indeed have teeth

After a long morning at the hospital the group drove to Pollo Campero for lunch. Though the restaurant was pretty westernized, the food was delicious. The team then took a stroll around Antigua, taking various pictures and doing sorority poses. After some loitering, which essentially meant trying to recharge from the morning in a local coffee shop.

The delicious Choco Museo of Antigua

The latter part of the day was filled with going to a chocolate museum and a delicious dinner. The chocolate museum was an instant hit with the team. Pablo (or was it Pedro), was our charismatic guide that taught us everything we would want to know about chocolate. From the intricate history of chocolate to how to literally make the same chocolate drink that the Mayans and Aztecs drank we were saturated with Pablo’s knowledge. I would greatly encourage anyone to go there. Seriously, buy a ticket to Antigua and go to the chocolate museum.

The team and Pablo celebrating the joys of chocolate.
To note: Dr. P and Dr. Walker clearly proud of their chocolate creations

Memorables:

•  The happy meal was invented in Antigua, Guatemala.
• Sara is a chocolate mashing guru.
• Orlando continues to say “shots fired”, creating animosity between him and anyone within ear shot. 
• Props to Michael, Chris, Anna, and Dr. P worked in what looked like Old World Catacomb.
• Chris got into a serious altercation and lost to the watery deluge.

Chiles y Días Rellenos (Stuffed Peppers and Days)

Ally tests an old ultrasound unit, showing that Daniel indeed has a heart

Following a fantastic morning with our international undergraduate engineering peers at Universidad del Valle, the team headed back to El Hospital Infantil Juan Pablo II to finalize our repairs and assessments of the clinical equipment inventory. The team’s productivity on Monday left us with only a few device reports to finalize. However, we were determined to make the most of our last hours at the hospital and deliver the best information and resources possible for the clinicians and patients there. In addition to all the progress we blogged about yesterday, several patient monitors were restored to function, including one that had previously been deemed worthless. We also cleaned up two infant incubators and verified their function.

The entire group huddles with the JP2 administrators to deliver
our final equipment report summaries

Sara brought them a new ultrasound monitor and verified that it worked with the old ultrasound unit. Utilizing a bit of improvisation, the team was able to substitute some hand sanitizer for ultrasound gel and take a look at Casey’s renal artery and Daniel's heart (yes he has one)! Orlando was able to troubleshoot the tricky power supply needs of a pair of pulse oximeters and order a new AC/AC transformer to replace a faulty one and restore the device to clinical usability. Mary Kate determined that an old ECG unit was unusable, allowing the hospital to eliminate clutter in its equipment inventory. During our testing of the ventilators, Michael and Jake determined the output volumes were insufficient, but were unable to fully assess their functionality and had to recommend that the hospitals solicit further investigation of the devices by certified technicians. They were, however, able to verify the correct functionality of the associated humidifier. The team also verified the functionality of an
audio testing unit and supplied the clinic with a backup photic stimulator bulb, among other projects.

After the team’s final summary report to a few of the hospital staff members, Lorena Sóto, one of the hospital directors, was brought to tears as she expressed her gratitude to the visiting students and faculty members.

“Queremos que ustedes sepan que Guatemala siempre sera una pequeña parte del mundo donde simpre estarán bienvenidos,” she told us (translated: “We want you to know that Guatemala will always be a small part of the world where you are always welcome”).

The entire group gathers as we close out our time with our friends at El Hospital Infantil Juan Pablo II

Incredibly gratified and humbled, we said our goodbyes at JP2 and packed our bags for Antigua. Decompressing from a whirlwind afternoon doesn’t come easy in a van packed with luggage and short-tempered college students. But nonetheless, about an hour later (seemed like 15 hours, I’ll have to take Israel’s word on it though) we arrived in the beautiful, ‘ancient’ city of Antigua, Guatemala. Pulling up to the Casa Mía hotel, we dispersed briefly to our quarters and soon rejoined on the rooftop to enjoy a breathtaking view of the valley. Chris continued his weeklong swing dancing saga during a little rooftop routine with Mary Kate (dipping her head scarily close to the roof’s edge multiple times… but don’t tell her that!). After taking in some astonishing vistas of the misty mountain tops, we took to the streets and hoofed it

A view of our excellent Tuesday evening dining location from the balcony

over to the Restaurante Fonda de la Calle Real. I must admit that the “TripAdvisor Certificate” displayed in the entryway made me slightly skeptical of RFCR as a genuine local flavor, but a fantastic menu and atmosphere forced me to quickly retract my earlier sentiments. Daniel and Michael were crushed to learn that there wouldn’t be any tamale
s served tonight, but the extravagant three-course (and sometimes four) meal that followed more than quelled their disappointment. Feasting til full on chiles rellenas, lomito de carne, papusas, plátanos and many other Guatemalan delicacies, the group enjoyed one of its most memorable meals of the week thus far, with plenty of great conversations and laughs to spare.
We let our meal settle by taking a short stroll in the brisk park near the restaurant. Antigua is truly a beautiful city. 

Ally displays one of the excellent dishes served at Restaurante
Fonda de la Calle Real

Memorables:

•  An awesome intercultural experience meeting Guatemalan students at Universidad del Valle
• [Orlando speaking to team troubleshooting an ultrasound machine] “You can put on my belly, see if there’s a baby in there.”
• Dr. P loves baby koalas.

Follow the (yellow) brick road to Antigua

Quick update: The team was dazzled by the beauty and horror of a volcano that erupted in Guatemala yesterday. Even though we found out about the eruption much later through google images and our translators, we felt as if we had really been there. 

Second update: Whenever we talk about the danger of eating salad or apples it is because of the lack of sanitation that Guatemala has for their water. Unfortunately they lack potable water and drinking it would mean spending the remainder of our trip in bed. Thus, we are advised to refrain from fruits and vegetables that would have been processed and washed with this water. We are continually replenishing our bottled water repository and the continual reminders of our health adviser, Anna, keeps us from certain misery. 

Dr. Walker, Casey, and Sara ambushed by some papparazzi (michael) before
we leave our hotel in Guatemala City

Nate capping the day off with an enviable research presentation
at Universidad del Valle

Now, today, renewed by the night’s rest and rebooted by the hardy breakfast, the team packed up and left hotel Casa de Nazarenos. The first thing on the docket was to go to Universidad del Valle. This university, located 30 minutes from the hotel, is one of the most prestigious ones in the country. After some light introductions, Casey, Orlando and Nate presented in front of some of the school’s undergraduate electrical engineering students. Even though they had rehearsed their presentations with us before, I couldn’t help but be impressed by some of the work that these Vanderbilt students do. These were accompanied by more excellent presentations, given by two students from Universidad del Valle. Learning about their work was truly stimulating and exciting, and it was encouraging knowing that these represent some of Guatemala’s finest students and the future leaders in engineering and technology of the country. 

Orlando drools over a power supply in the university lab
Not shown: A couple hours later, four team members forcefully removing Orlando from the lab.

Following these student presentations, Profesor Carlos Esquit gave us a brief introduction to the Engineering School at Universidad del Valle and held a brief Q&A for the Vanderbilt students, as did Dr. Paschal for the Del Valle students. In addition to a great tour of their very impressive facilities and a wonderful luncheon, we finished out our time with our Del Valle friends with a generous lunch provided by our hosts and some very thoughtful gifts: t-shirts from Universidad del Valle. Leaving with new knowledge, friendships and garb, we headed off for our last afternoon at La Hospital de Juan Pablo II.

Dr. P caught in action: Uniting Vanderbilt, GEO, and guatemalan hospitals.

A candid shot of two engineers in Universidad de Valle
The back story: FGH is the name of Vanderbilt's engineering building.
The back back story: Jake and Michael gave up modeling for a career in engineering

Memorables:

·        - Shout out again for our amazing presenters! Keep doing science kids!

·        - Orlando continually claiming that he was going to drop out of school to go to Universidad del Valle

·        - No one has gotten sick!