Saturday, May 23, 2015

Nicaragua - Day 6

The autoclave in the
 Granada hospital. Note
the two pieces of wood
holding up the autoclave door!
Well, my first work week has come to an end. On Wednesday, I did a lecture about batteries and power supplies, which was pretty straightforward. We also did a lab where students got to make some basic circuit measurements including on a transformer. The students always get a kick out of watching someone stick the multimeter probes directly into the wall outlet to verify whether we are getting the correct line voltage. This is especially relevant since some of the outlets in our class don't seem to work quite right, which means that the transformers won't work right either!

But I digress. By far the most fun we had was hospital visits on Thursday and Friday. On Thursday, we took half the class to the local Granada public hospital, which is the same hospital he worked at last year. The technicians and engineers were super excited to see me again, and it was a happy reunion. They gave us a tour of the hospital, and also gave us some equipment to take apart, clean, and in some cases repair. We took apart and repaired a handful of nebulizers that weren't working for a variety of reasons.
A nebulizer under repair. The
two-sided pressure chamber is
opened up (bottom right).
One of them seem to have just been clogged with some debris. Another one had a frayed wire that needed replacing. These experiences are helpful, because the students gain confidence opening and troubleshooting the various pieces of equipment while having someone around to supervise. We also got to take a look at the hospital's autoclave, which is an enormous piece of equipment that can sterilize maybe cubic yards worth of supplies at once. Although the control electronics and mechanics look complicated, method of operation is fairly simple. Water is boiled into steam and forced into the chamber at pressure. The temperature and pressure do the job. We also took a look at some electrosurgery devices, and even did a fair amount of menial work such as cleaning ceiling fans! All of it is good experience, especially the social aspects wherein our students learn how to interact with staff, how to work at their pace, and how to work at their direction. 
A team effort!
At some point after lunch, I got roped into helping the technicians carry an enormous water reservoir bucket up a long ladder to place on a scaffolding. This is fairly commonly used as a water backup tank around here. How five of us got that tank up the ladder is anyone's guess, but nobody fell off and I felt pretty good about it afterwards!

Yesterday, Friday, we took the other half of the class to a hospital in Nandaime which is a village about 35 minutes outside of Granada. The hospital was very small, and although the staff seemed fairly knowledgeable, they were certainly resource deficient.
They had no engineering staff of their own, which meant there was a lot of equipment sitting around that needed repairing. They happily handed us a couple of autoclaves, an ECG machine, an infant incubator, and some common scales. We did the best we could and had a good deal of fun in the process. The infant incubator was fairly easy to repair. In fact I'm not even really sure what we did to fix it! We took it apart, cleaned a few ports, put it back together, and the alarm that had been going off magically stopped! The students cleaned and polished it until it looks like new, and we gave it back to the doctor, who was extremely happy. Apparently it was their only one in the hospital, and they hadn't been able to use it for a couple of years.

Sizing up the incubator.
The ECG machine had some sort of quirky electronics problem which we were unable to diagnose or repair. That was a little unfortunate, but to be expected given our relatively meager tools. The students who tackled the scales had a real adventure! They managed to get a decent number of the scales built up and functioning moderately well, but calibrating them was a complete headache. The scales were not very precise, and our efforts to calibrate against our own (known) body weights didn't get us very far. Well, better than nothing I suppose. We learned that once the springs in scales are shot, they're pretty much shot for good.
Calibrating the scales was a real challenge!
The autoclaves turned out to be a real challenge. I spent a lot of time studying the piping and electrical lines in an attempt to sort out how the devices work. Unlike the system in Granada, these were smaller benchtop models. Water from a tank gets pumped into the main chamber where heating elements turn it to steam at high pressure. Once the instruments are sterilized, the steam is released, passed through a condenser, and returned as water to the tank. One of the devices also had a vacuum pump which somehow accelerated drying and/or cooling  in the main chamber. The high pressure piping is a bit intimidating to mess with, and clogs with water scaling are apparently common. Judging from the condition of the autoclaves, both of them need a thorough scrubbing, especially with wire brushes inside the pipes, since there were mineral deposits everywhere. Unfortunately, we didn't have the right tools (and we ran out of time) so we'll have to try again next week when we go back.
The insides of an autoclave. The water tank (grey, left) pipes water into the tank (silver, right). The tubing is all high pressure, meaning we'd better put it back together properly, or else!
The people at the hospital were very good sports and seemed content to have us take apart their equipment and make a mess of the spare room they set us up in. The hospital director was very involved and wanted to know which equipment was fixed and what couldn't be salvaged. A few doctors poked their heads in too to watch the progress and ask questions. We're very fortunate to have our coordinator Inka who speaks very good Spanish, as well as a student who is a native speaker. So language wasn't a huge barrier. One gentleman from the lab hunted me down, telling me he had an electrical problem with his two microscopes. Turns out they just needed light bulbs, which of course we didn't have. I'm going to try to hunt them down in Granada this week and hopefully get him going next Friday. It was an interesting example of the problems EWH tries to solve. The microscopes were beautiful high quality ones, donated from abroad. But once their bulbs burned out, they were basically useless to this guy. Anyways, the hospital director had the lunch ladies treat us to a big meal of chicken and rice which was delicious and filling. I'm looking forwards to being back next week!
A well-earned lunch!

Well it's the weekend now, which means exploring around Granada, and maybe going zip lining tomorrow. Tomorrow is also a very big religious holiday here, the feast day of Mary Help of Christians. There have been a lot of parades and loud music, and fireworks that don't make any light but make these very loud explosion popping sounds. It's kind of nice, except that the firework explosions go on literally through the night.

I'm looking forward to next week's work schedule. We start talking more about specific pieces of hospital equipment, and the labs get more interesting too. I think considering the success we had in the hospital this week, students will be pretty engaged with the lectures as they start to see the physical principles underlying the various pieces of equipment that they saw at the hospitals.

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