Monday, June 11, 2018

Guatemala, Day 22

Well its Day 22 and I'm almost done here. I miss my family very much and I'm counting the hours till I can go home. Today I booked my transportation back to the airport (4:30am bus, anyone?) and if everything goes according to plan, I should sleep in my own bed on Saturday night.

Our program is wrapping up. The afternoon labs are pretty much finished and now we're just focused on drilling the students on the all-important "soft skills" they'll need. For example, they need to know how to write effective instructions (including diagrams) for equipment usage, as well as detailed summaries on how equipment was repaired. We're also training them to do staff interviews (as a means of needs assessment) and equipment inventories. The equipment inventories are helpful, as they get tracked from year to year so we can see what equipment falls into disrepair at a given hospital. Engineering students often complain about having to learn soft skills, but I can guarantee that its even harder when doing so in a foreign language!

Typical Guatemalan dress (not my photo: shamelessly
stolen off some website)
The Guatemalan people are really something. There are many women around town who dress in colorful traditional clothes and carry their babies in cloth swaddles on their backs. I've been wanting to take some photos but its pretty hard to do so without looking like a jerk tourist. One nutty thing we've all observed is how unfiltered some of the locals are when they interact with us. Last week at the clinic we visited, some random woman on the street stopped in her tracks to tell our Indian American student that he was the most exotic looking young man she'd seen in forever. Que guapo!!! In my own experience, people have said some daffy stuff to me when I've told them I'm "├írabe". At one hospital, the technicians started miming machine guns and and giggling, and last week the clinic director decided I had to be filthy rich with petroleum money!  The comments aren't malicious (and I wasn't really offended) but still its nutty to see people say stuff out loud that wouldn't fly in the States.

Last Friday we visited the local health clinic in town. From what I could tell, it seemed like a place for regular checkups and somewhat-urgent care, especially for mothers and children. It was pretty small but quite packed. There was tons of equipment for us to look at - some infant scales to weigh newborn babies that needed calibrating and cleaning, some blood pressure cuffs with leaks, and a wonky handheld ultrasound device. A good chunk of the day was devoted to cleaning and de-scaling the autoclaves.

Super old school autoclave

The autoclaves at this place were super minimal - basically just industrial sized pressure cookers. Without any fancy electronics, it falls on the user to manually monitor the pressure gauges and use a stopwatch to time the whole process. One model went right on the stove to get heated, whereas the rest were electric. The electric ones have a heating coil like you would see in an electric kettle or  coffee maker. The problem with these things is that if you don't use distilled water, then over time the minerals in the water will come out of solution and stick to the heating coils, which in turn become insulated and lose their ability to heat the water. Those minerals are super hard to get off - you can't chip them or scrub the coils with anything abrasive, because you'll ruin the metal coating on the heating element.

Severe scaling means subpar heating.

The best course of action is to soak the coils in an acidic solution and hope that dissolves the minerals. In your home coffee pot, you might use vinegar and let it soak over night. In this case, we didn't have all night and we had a lot of scaling to clean up so we did what any reasonable person would do: we bought a liter of hydrochloric acid for about a dollar and got to work.

Muriatic (hydrochloric) acid
The plan was to dilute the acid down to a 4:1 ratio and let it soak for about three hours. We were about to get started when we decided maybe we should wear some protective equipment. We ran to the hardware store to get some safety glasses, but came up short looking for rubber gloves. Every hardware store we went to told us to try at the pharmacy. Every pharmacy we tried said to check at a hardware store. Even the local supermarket was a bust. Finally, after an hour of searching, we wound up at a high end supermarket and eventually found some garden variety dishwashing gloves. Finally! Time to soak the autoclaves!

Enjoying sweet victory after an epic goose chase

While they were soaking, we realized that we had a new problem: how to dispose of a the dangerous hydrochloric acid. We certainly couldn't dump it in the sewer or down the drain. After some debate and Googling, we decided to try to neutralize it with baking soda. To my surprise, the very first tienda I went to had some in stock, although I was amused to see that it was sold in pre-packaged plastic baggies that made me look like I was carrying around a few grams of blow.

Hey man, you know were I can score some baking soda?

Eventually someone found a more normal sized container of baking soda and we started mixing it into the acid. It took an entire pound of baking soda before the acid finally stopped bubbling and we were able to pour the mess down the drain with a clean conscience. The process definitely worked to some extent, although it had been so long since the autoclaves were cleaned that they definitely need another round, possibly with a less diluted acid soak.

Scrubbing autoclaves right on the sidewalk

Pretty thankless job

Acid plus baking soda equals lots of bubbles

Oops! Too much baking soda too quickly and it overflowed...

Oh, one last thing I loved about this clinic. At the entrance, there were these three ladies selling all sorts of snacks. Two of them had babies with them, which they had carried to the clinics in swaddles on their backs while they carried big cardboard boxes with the snacks. Once they arrived, they set up the snacks on a blanket on the ground and then put their babies to sleep in the now-empty cardboard boxes! Seeing "babies in boxes" was definitely a first for me, but I guess as long as the cardboard stays dry, its a pretty good bassinet in a pinch!

One last hospital visit to go this coming Friday, and then I'll be heading home the next morning. Hopefully there'll be time for one last post before I head home!

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