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!

Sophie
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.

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!

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.

Leah: CHOCOLATE

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!

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!

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.”

"C'mon Vamanos, Everybody Let's Go..."

Everyone put on your backpack. We're going on an adventure. 

Today we spent the day exploring the sites (and food) of Guatemala city. After getting a late start to the day, we set off on our first food experience. To say it was amazing would be an understatement. From crepes to nutella frappucinos, Saul was definitely a restaurant for the books. 

Enjoying a meal at Saul! It's always good day for crepes.

After our first real meal in Guatemala, we took advantage of the gorgeous weather and scenery to walk off the delicious treats. We found ourselves in the midst of a religious parade which included a float with a large Jesus and a band. We wandered over to the central Plaza Mayor, home of the Metropolitan Cathedral and the National Palace. There were also multiple food and clothing stands. The central plaza truly emulated the amazing beauty of the Guatemalan people and their culture. 

The Guatemala team in front of the Metropolitan Cathedral.

We returned to our hotel for a couple hours. Some of us enjoyed a relaxing book while other chose to embark on the conquest of Catan (the most wonderful board game... I'm biased). We finished out the night with our first taste of real Guatemalan food. Needless to say, we definitely made the dishwasher's job easier. 

Niki's delicious Guatemalan meal. Does this even need a caption?

We are all "Dora'd" out and ready to begin the real work tomorrow fixing our first medical devices. Don't forget to come back tomorrow for more updates!!

Bienvenidos a Guatemala!

Hola! After a day of planes, trains, and automobiles we have all landed safe and sound in Guatemala City. Our day began outside of Towers East with everyone arriving exactly on schedule, to the delight of Dr. P. Unfortunately, Dr. Nick Adams is feeling under the weather and was not able to accompany us on today's journey, but should be joining us later this weekend! After a quick attendance count off, Ari, our official "people wrangler", directed us to our shuttle. We arrived early enough at BNA for everyone to grab a quick brunch, then the group was whisked away to Dallas. We enjoyed this airport for all of 40 minutes before boarding our next plane. Niki has proven to be our dedicated social butterfly, striking up a quick friendship with fellow passenger and Guatemalan native Cindy. A mere 3 hours later, Niki was forced to bid farewell to her new pal as we breezed through customs and boarded our shuttle to Casa del Angel. We were greeted by the wonderful proprietor Janet and Vanderbilt alum Ben Kessler who, to our overwhelming delight, surprised us with a pizza feast! Ben is serving as our in-country consultant, having moved to Guatemala City shortly after graduating last May. Tomorrow he has promised us a day full of exploration in and around Guatemala City's Plaza de la Constitución! Spirits are high, but the busy day of travel has left most of us ready for a good night's rest; we leave you tonight with some terrific trip snapshots provided by photographers Sophie and Niki. Buenas noches!