Sometimes a Blender is Worth Fixing Too

Week three is finished in Roatan, and I’m feeling more and more adjusted to how to live and work here.  Jens and I have got our routine down (more or less) and figured out what we can and can’t eat, where to spend the afternoons, and how much the taxi drivers should really be charging us from place to place.  It’s not uncommon for a taxista to see two touristy-looking gringos and go for the higher price tag, but fortunately we’ve learned to haggle it down a little.  Also, one of the doctors at Global Healing was generous enough to let me borrow a camera for the remainder of the trip, so I can share a few now.

On Wednesday, we made a change of pace by spending the day at an independent, not-for-profit clinic on the island, “Clinica Esperanza,” with esperanza translating as “hope.”   The public hospital in Coxen Hole is government operated, the only one here, but there are a handful of other smaller, private clinics, some for-profit and others non-profit.  Through a contact at Coxen Hole, we arranged to spend the day with them, spending most of the day working with some sphygmomanometers and infant incubators. With these incubators, we ran into the same problem as most of those in Coxen Hole—completely functional(sometimes after a minor repair) but simply too loud.  The heating element and fan continue to work, but with age the fan motor slowly becomes louder and louder, and the low hum can do some long-term damage to the baby’s ears.  While we lubbed up the motors, it doesn’t do much for the sound issue.  At any rate, it was refreshing to have a change of location.  In traditional island style, work wrapped up for the clinic and for us around 3PM in the afternoon ;-)

During lunch on this day, we walked down the street to a little restaurant known as Tortilla Heaven, home of the “Tortizza,” a small pizza baked on a torilla shell.  For 30 lempiras ($1.62) we get a little piece of heaven—a small pizza about the size of a personal pizza from any of the major chains, but this definitely had a more home-cooked taste, and an unusually low price for the island.  However, when we ordered smoothies to go with the drinks, the blender, probably twice my age, didn’t budge.

So….after work we came back, tools in hand, and went straight to taking it apart.  It was simple to fix, a little corrosion blocking a contact, but fixing it got us not only a free smoothie but another free tortizza each.  I’ll admit it is not nearly so valuable as a piece of medical equipment, but none of the medical equipment repairs we’ve made have felt quite this rewarding ;-)

At Coxen Hole, we’ve made a few notable repairs.  So many times, the machine just needs to be taken out of the box in storage, cleaned a bit, and set back into action, but we’ve come across a few things a bit more challenging.  One was an ultrasound probe, the only one in the hospital, which required some ultra-fine soldering.  Jens and I have both done some soldering, and practiced a little more last month in Costa Rica, but I have never worked with wires so fine.  Even though it’s back to working order, the accuracy is still a little questionable.  So, I looked up the price of a new one online, and through the manufacturer this comes with a price tag of $695.00 US.  So, if we’ve saved that for them, then I’ll feel pretty good. 

Here’s a picture of us working an ESU machine, used in place of a scalpel to cauterize blood vessels during a surgery, leading to less bleeding and faster healing time for the patient.  The testing unit we’re using is one of a few EWH inventions groups have taken along for the trip.

What we have encountered more than a few times is a lack of parts.  Of course, being on an island makes shipping a much longer process, and the advice I’ve received from others on top of that is to not bother even shipping replacement medical supplies because the chances of seeing it reach the final destination are slim to none.  It is more likely to wind up on a shelf or be sold somewhere along the way.  So this is a challenge, but we may be able to purchase parts with some of the money allotted to us from EWH that doctors at Global Healing can bring with them in their luggage on subsequent trips.  I feel like I’m constantly discovering more and more devices at the hospital now that arrived here this way.

Over the weekend we took a trip with the other Honduran teams to the Mayan ruins In Copan.  I didn’t expect to make a trip so far into the mainland throughout our time here, but I’d say it was worth the haul.  Being on the touristy island, we don’t get to see much of the real Honduras.  I might be a litte jealous of the cheap prices the others get there for food, travel, and the daily expenses. The Copan Ruins were no doubt impressive.  Here’s a couple pics:

At the end of next week, we’ll head to Managua, Nicaragua, to meet up with the others for the concluding conference.  Some teams will present a traditional PowerPoint presentation and others, like us, will be presenting posters in the traditional conference style—with the final product setup for onlookers to roam around freely and ask us for the spiel.  There’s only one week left before heading home, and I think by that time I’ll be ready for it. I’ll hope this final week wraps up well.

Hasta luego!

Roatan

One of the ironies of travel blogging is that when we have the most to write about, we generally have the least time to write about it.  It has been an adventure adjusting to Roatan, to say the least!

The first day Jens and I arrived at the hospital, the main hallway (which doubles as the waiting room) was packed from wall to wall—men and women, mothers with sick children, and so on.  Someone else later described walking through here as reminiscent of running the gauntlet.  We had been picked up at the ferry dock the day before by a member of the hospital staff, so it seemed like they had made arrangements for us and would be expecting us the next day.  However, once we arrived and started asking around for who we should talk to and how to get started, nobody seemed to know who we were or why we were there.  A staff member in the main office was explaining that we should leave and return the next day once they could speak with the director.  Fortunately, one of the doctors suddenly made the connection between us and the participants from last year.  He was able to explain who we were, and the pieces started coming together from there.

The hospital is almost easy to miss as you pass by.  While it has over 40 beds and occupies a good amount of space, the yellow concrete easily integrates with the surrounding housing, tiendas, and other structures of Coxen Hole.  Most of the floors, doorways, and halls are discolored and tattered from years of wear and tear.  Many areas of the hospital are without AC, and the departments and rooms that have it use wall units.  The hospital has departments for pediatrics, OBGYN, emergency care, psychology counseling, an OR, along with others I’m bound to overlook.  There is not, however, any intensive care area in the hospital.  Patients pay a symbolic fee that varies but is generally less than $1 US.

Despite the rough start, the experience here has gotten much better.  In these first two weeks, we’ve tinkered with some nebulizers, incubators, and pulse oximeters, and managed to get their only ultrasound machine back into usable condition.  We expected to encounter some biomedical technicians at the hospital, but in essence the two of us became the biomed repair team upon arriving—running off what little training we’ve had. The hospital has a maintenance technician, more for general repairs throughout the hospital (fixing the leak, replacing the lights, etc.) and another who comes sporadically doing similar work, but no staff member dedicates a significant amount of time to repairing or working with medical equipment.  A small room behind pediatrics has become our workshop, more or less.  Every day it feels as though we are becoming more acquainted with how to be effective in the environment and the staff more comfortable of working with us.

We have been fortunate enough to make the connection with a non-profit group at the hospital, Global Healing.  Based out the US, the organization hosts a clinic at the hospital that has been an invaluable resource in getting started at the hospital.  It’s a small clinic, with only 3 staff members.  Two are doctors doing a residency along with a third intern.  They have given us tips on how to be effective in the hospital, introduced us among the various departments, and shared their wireless internet (the only one available in the hospital).

And, of course, Roatan . . . .  which is gorgeous and everything it was cracked up to be.  The beaches and clear waters have an almost bizarre comparison with the developing nature of much of the island. The island is around 30 miles long and never more than 2 miles wide.  The oceanfront is within walking distance of any spot you can stand on throughout the island and the water is as clear as any I’ve seen.  Standing in water up to your neck, you can still look down and see your feet on the sand below.  The two nicest beaches open to the general public are in West End and West Bay.  Our hotel is just outside West End, within walking distance really.  The hotel owner was nice enough to drive us around the first day and stop by the beach during the rounds, so we got a glimpse on day one.  Most of the internet cafes are along the shops at West End, overlooking the beach.  Making Skype calls on a laptop with the oceanfront just a few meters away is definitely new on me.

As for the living quarters, we are not with a homestay this time around but a hotel instead.  Our room consists mainly of two beds and a TV stand.  I was a bit spoiled from the previous month in Costa Rica, when our homestay mother cooked our breakfast and dinner, the outside temperature never left the comfortable range, and our dirty laundry would mysteriously vanish on occasion, only to appear a day or two later folded and clean on the shelf; it wasn’t so different from home, really.  So, of course, Jens and I had to make the adjustment.  It turns out we are very lucky in comparison to our comrades.  While the water is not drinkable on the island, we are fortunate to simply have running water, flushing toilets, laundry facilities in the surrounding area, and less heat than much of mainland Honduras.  Getting updates from the others during a visit last weekend made me realize we are as lucky for the basic accommodations as for the scenery.  Some are doing laundry by hand and only getting running water to shower, while using the shower water to fill buckets for flushing the toilets later.

Of course, I was hoping to share some pictures of the hospital and Roatan, and I have some great ones on my camera.  However, where this camera is, I have no idea.  It might be close to my wallet, personal cell phone, and the EWH cell phone that were also stolen from my backpack.  Yup..... it really happened.

This happened over the past weekend, while our group was out for the night.  All of the other Honduras participants were ready to see what the Roatan hype was all about, and everyone made the weekend visit to the island.  We were out at a bar in West End, which happened to have a pool as well.  While we were all in the pool and swimming, I had left my bag at the edge, containing more than I really needed to get by for the night.  Someone snatched it up, took it behind the building to dig out the valuables and leave the bag and umbrella (They weren’t as interested in that). 

I lost all my debit and credit cards, camera, and two cell phones, but the timing was really a blessing. It happened while others were here, and they helped me make a few phone calls to get things sorted out.  It happened that the following day, one of the trip coordinators made his visit to the hospital.  He was able to purchase a new cell phone and cover some other meals already on the agenda.  My family also managed to get the cards canceled from the US and wire some cash to Honduras from home.  It looks like I will be running off straight cash for the remainder of the trip.

Also, we’ve heard enough warnings about the water and food in Nicaragua and Honduras that the trip would be lacking something if we didn’t get the slightest bit sick.  And I’ve recently gone through my first bout of stomach and digestion upsets.  I’ve had some indigestion and stomach pains for about 4 or 5 days now, topped off with a little diarrhea.  Fortunately, EWH has provided every team with a first aid kit.  I couldn’t help but laugh a little the first time I saw it, not with the standard Neosporin, gauze, alcohol pads, or different-sized band-aids, but instead Immodium, Pepto Bismol, Tums tablets, Rolaids, and Ibuprofen.  I am now, however, very glad to have them!  Jens also went through a bout of the same, although his was shorter-lived.  Let’s hope we have both finished the last of it for the trip.

Thank you for reading, and hopefully I'll get some pictures up next time.

Marching Orders

Vamos a Roatan! Earlier this week every team received a debriefing on our hospitals and travel itineraries, and today I’m leaving for Roatan.  The majority of our group, all of the Nicaragua-bound participants and some heading to Honduras, left in the wee hours of the morning today, around 2AM, but six of us who will be working in the La Ceiba area are heading out early this afternoon.  Roatan is just off the La Ceiba coast if you check out the map in my first blog post.  Last night we took a final snapshot of our household with our host mother, below.  She’s been very good to us throughout.

My hospital partner for the coming weeks is Jens(Yens), another BME student from Aalborg University in Denmark.  He and I seem to have the lengthiest travel itinerary.  We’ll leave with the others early this afternoon to fly over Nicaragua and into El Salvador.  We have a shorter than short layover of about 20 minutes there before flying into La Ceiba, where we’ll stay in a hotel overnight and then hop on a ferry to make the cross to Roatan on Sunday morning. 

I still have a lot of unanswered questions about Honduras--the food, what the living area will be like, what a given workday will be like, etc., but we should learn a lot in the coming days.  Also, I received a few statistics comparing the US and Honduras, and thought I would share them here:

3 Weeks Down

Hola!

This has been a great but awesomely busy week.  Yesterday morning we made our third hospital visit, this time to the main children’s hospital of San José. This was easily the nicest of the three we’ve visited thus far in Costa Rica.  The visit was mainly a tour without the hands-on repair work of the first two visits, which they didn’t seem to have much need for anyway.  Almost all the equipment we saw was nearly new and in excellent condition.

Our second hospital visit was last Friday to a hospital in the city of Turrialba.  Like our trip to San Ramon, we took a tour of their facilities and spent some time with some broken equipment.  I spent the majority of the afternoon with an old mercury sphygmomanometer, in which the mercury in the column seemed to jump up and down during every reading.  We found a couple leaks in the device, the second of which was a crack we noticed a little too late to do much with.

To clean the mercury in the device, we tried a tactic from one of our classes, running the mercury over white notebook paper to catch some of the suspended debris.  Of course, mercury sphygmomanometers are nearly non-existent in the US and are being phased out worldwide because of the element’s toxicity.  We played it safe the entire time, without any personal contact.  This was my first time working with mercury, which is some strange stuff, almost otherworldly—a fluid metal that only reminds me of the terminator in Terminator II who can “flow” back to his original form after an injury.

In Spanish class this week all of us gave presentations on a piece of medical equipment completely in Spanish—Powerpoint, speech, and all.  Mine was Wednesday, and I presented on the pulse oximeter, for measuring pulse and oxygen saturation in the bloodstream.  The device uses a combination of red and infrared light to make these calculations, and explaining how one works is a challenge in plain English, all-the-more so in Spanish.  Fortunately, many of the Spanish words for medical equipment and circuitry have similar spellings.  “Oximeter,” for example, is “oxímetro,” and “infrared light” is “luz infrarroja.”

In these courses, we don’t work for any sort of letter grade or college credit, but simply to be effective next month, and the need for what we’re learning feels much more immediate and tangible than most of what I’ve studied elsewhere.  We’re starting to wrap up some of the more technical, electrically-based labs and shifting focus toward mental preparation for next month with labs on working in the developing world, training across cultural barriers, identifying the needs of the hospital, and so on.  Next week we should get more details on how we’ll be getting to our hospitals, where we’ll be staying, conditions there, etc.

I haven’t described much yet about the local cuisine here, which is distinct but also very different from the spicier Mexican foods, which I had originally suspected to be universal throughout Latin America.  Fruits are ubiquitous.  We have not yet had a meal at our homestay that has not included some sort of fruit-juice drink.  Pineapple, mango, and papaya are the more popular ones.  Papaya was new to me, which is somewhat similar to the mango in color and taste, but has a much softer texture.  

For lunch, without any vehicles, we are mostly limited to what is within walking distance of the school.  A small convenience store and restaurant known as “El Tipico,” only a block from the school, has become somewhat of the default lunch spot.  I've eaten here at least twice a week every week thus far.  For 2,000 Costa Rican colones, or about $4.00 US dollars, we get the meal in the picture below, with fried plantains, chicken or fish, a small salad, and red beans with rice. Costa Rica is very well known for its red bean and rice.  This is probably the flagship staple of the country, even more so than fruits.  Some seem to poke fun at the stereotype.

Also, last weekend we had a great trip to the Manuel Antonio National Park, which contains a national park alongside some of the prettiest beaches in the country.  I was a little surprised to find monkeys swinging in the trees next to the shoreline.  Monkeys and beaches have always held very disparate places in my mind, but by the same token, some of the Costa Ricans seem surprised we don’t have them running around the U.S.  One of them is in the picture below, along with a lizard next to one of park trails.

The waves of the beaches caught me a little by surprise.  This particular beach was on the Pacific Coast of the country, and the waves were a lot stronger than most of what I’m accustomed to in the U.S.  The rip currents are also strong enough that the coast guard heavily patrols the area in a boat just off the shore.  It's great for body surfing or surfing, but probably not the ideal family beach.

It hasn't taken long for me to accumulate more pictures than I can share in blog, so to share more I've created a Flikr page, which can be found here: http://www.flickr.com/photos/tomburkhead/.

I'm looking forward to finishing class this week and sharing more soon.  Thanks for checking in.

hasta luego!

Hospitals, Buses, and Rainforests

We are well into our routine now, and time is flying by. It’s been over a week since my last post, but I have plenty of updates and, I’m glad to say, a few pictures to share.

Last Friday we took our first trip to a hospital in Costa Rica for a small taste of what we’ll encounter next month. Of course, the hospitals and healthcare in Costa Rica, while not what you would find in Europe or the US, are much better off than what we’ll probably encounter in Honduras and Nicaragua.

In the morning, the hospital director gave a presentation to the group to share a little about the hospital and healthcare system of Costa Rica. While the slides were in English, the full speech was in Spanish, so my understanding was limited to the occasional word, phrase, or number. I was able to learn more talking to a hospital engineer, or “ingeniero médico” as they are called. Ultimately, I gathered Costa Rica relies on a system of universal healthcare, with a few private hospitals available at a greater expense. It seems more or less similar to other universal plans in which all citizens—wealthy and poor alike—pay a fixed portion of their income, around 9% in C.R., for full access to healthcare. Most citizens and employees of the hospital really seem to take pride in the Costa Rican system and its effectiveness.

From a student’s perspective, I was surprised to learn that there is little distinction between an engineer and a technician in the country. While in the U.S., an engineer might complete a bachelors or masters degree and a technician might learn from a technical college and work in a hospital, Costa Rica primarily has an engineering program, and these graduates are the ones repairing and maintaining equipment on a regular basis.  The distinction doesn't seem to exist, or at least not to the same extent.  The real content of the engineering programs and whether there are many industrial or academic opportunities is something I have yet to learn.

Later we divided into pairs, each pair troubleshooting a particular device. Ours was an older ultrasound machine, probably much older than me, that was functional but not producing reliable or regular sounds. We spent a little time looking at a damaged circuit board, and attempted to resolder a couple components, but unfortunately weren’t able to get it back to full working order. Some of the other groups looked at a pulse oximeter and a suction pump, with varied success.

Also, classes are moving along . . . flying really. The language barrier is continuously frustrating, as in the hospital presentation, but when I consider what we’ve learned, it is no small accomplishment for only one and a half weeks. We are also continuing with the troubleshooting labs and lectures in the afternoons, and the picture here depicts a few of us working on our labs. In this particular lab, we are building an LED flashlight from basic components. Both the Spanish and technical classes are held at the language school here in San José.

Like I touched on before, we’re traveling around town almost exclusively by bus, and deciphering the Costa Rican bus system has been an adventure in and of itself! On the day of our orientation the six of us at our homestay were taken to the bus stop by our host mother, the grandmother of the family, who also showed us which stop we needed on the route. However, when leaving the house, we didn’t take note of the exact stop where we boarded. This would seem straightforward until you realize so many of the streets look identical. Homes seem to blend together in the characteristic light blues, pinks, and greens of the architecture here, and only the main roads have true names, so there are zero street signs!

Needless to say, coming home, we got lost…..in the pouring rain. After getting off at what we thought was the right stop, we ducked into several side stores and bars to ask for help, without much luck. Fortunately, we managed to find a Costa Rican who spoke English fluently. She was able to call our host mother, who sent her son to pick us up, drenched from head to toe. We were a little embarrassed to realize we were only one block away from the original bus stop. Sometimes we have to learn the hard way, but we haven’t missed our stop since.

We’re finding ways to enjoy the afternoons too, outside the homework lessons. The city mall, although similar to any mall in the U.S., falls along our bus route, and the main part of the city is within walking distance of the school. In the picture below, a few of us are at a local tea shop, a common tradition here.

Over the past weekend, we took a trip to a rain forest near the Nicaraguan border, known as Monte Verde, or “Green Mountain.” The park is a hot spot for tourists, with hiking, zip-lining, night-tours, etc. The mountains in the picture below say it for me, but the scenery is truly gorgeous. As a link between North and South America, Costa Rica is home to some of the greatest biodiversity and mountainous regions of the Americas. Hummingbirds, stick-insects, and tarantulas, among others, are all common in the rainforests, although I didn’t see as much wildlife as I had hoped on our hike Saturday. However, Sunday we were lucky enough to do some zip-lining and see the forest from above. The steel cables used for zip-lining are suspended high in the air, strung across trees at high points throughout the forest. A roller allows you to glide down the cable from tree to tree, over a total of about 3 kilometers. This was a blast, and definitely the highlight of the trip.

First Day of Class

Today marked the first day of class, and we are jumping straight into the lessons. Spanish was first this morning, from 8:15 to 12:15. Even for the beginners’ course, the entire class is taught in Spanish. If my count is right, our instructor, Harry, spoke a grand total of 3 English words throughout the full course of the morning! Even when it would be easy to translate a simple noun, Harry stayed true to his tactics and filled the board with diagrams of birds, firefighters, and other figures to convey the definitions. Of course, most of the instruction was focused on basic conversation, verb conjugation, etc.

In the afternoon, we had a lecture and lab on electrical safety and basic precautions throughout a hospital. The lab that followed involved the construction of an extension cord from basic components. My background in electricity is limited to an Intro. to Electrical Engineering course and to what I’ve picked up in a few projects at home and elsewhere, so it’s nice to gain these skills and apply them in context.

I think we are all anticipating an intense four weeks of class. The challenge is intimidating but also inspiring. With our resources and time, it feels like the only limitation to how much I learn and prepare in the next four weeks is the amount of energy I dedicate to it.

Like I mentioned before, we had some time to enjoy ourselves over the weekend. Rafting was a blast! We went through rapids from class I to IV through scenery some of us compared to Jurassic Park. For a boat of beginners, the six of us did pretty well. Of course, the guide directs the boat and calls out when to row forwards or backwards, so doing well mostly translates to staying in the boat! At one especially rough point, we were caught off guard and more than half our crew ended up in the water. I was fortunate enough to have a grip on the rope around the boat perimeter and stay on. This is definitely worth a try during any visit to the country.

Hola from San José

It is now Friday night, and after a smooth arrival Thursday, we are settled into our homestays and getting oriented. It’s been an eventful two days, and for the first time, I am truly feeling like a foreigner! We are immersed in a culture of altogether different people, language, and lifestyles.

Almost immediately after arriving, we were introduced to our homestay families. Ours has been more than welcoming . . . . to all six of us! Most of the group was paired off, but with six guys, we are by far the largest. This has led to the nickname of the “frathouse,” although it’s far from that environment. We are living with a family spanning three generations, of which the grandmother has primarily played host to us. She also cooks breakfast and dinner for us, as part of the program tuition, so we are fortunate enough to have some genuine local cuisine. Only one member of the family speaks any English, and his is very basic. Only one of our group has any Spanish background, so we will learn through immersion, no doubt.

Granted, none of us have spent any time in Central America, and with the warnings from home to beware of what we eat and drink, especially the tap water, we spent much of our first meal at the home in contemplation of what to eat. It was a fairly basic meal, with chicken, rice, salad, and a pineapple juice drink. The family seems to host groups such as ours often, so we reasoned they would know what is safe for foreigners and gave it a shot. We have since learned the food and water throughout the main city of San Jose should be fairly safe to drink, and did not hesitate to clear our glasses and plates tonight.

Beyond immersion into the culture of Central America, I can see we will learn from other participants as well. Participants come from all over the U.S. and Europe, including Italy, England, and Denmark. Some have Asian backgrounds as well. I have already learned from them and explained American football and the basics of Greek organizations— fraternities and sororities—of American universities.

Tomorrow we plan on a rafting trip for some fun before jumping into classes. I’m looking forward to rafting for the first time and hope to share more soon.

Adios!

Counting Down, 1 Week to Departure!

Hey everyone,

After months of anticipation, I am now only 7 days away from departure to Costa Rica!

Many of you already know the basic details of my mission trip this summer, but I’ll take this opportunity to update everyone and fill in the gaps before heading out. From June 17th to August 15th, I’ll head to Central America with about 26 other engineering students from around the globe. This is through the Engineering World Health(EWH) Summer Institute, dedicated to enhancing medical technology in developing countries. We plan to spend one month in San Jose, Costa Rica, for lessons in Spanish and medical equipment troubleshooting before partnering up and traveling to selected hospitals in either Nicaragua or Honduras to repair medical devices for a second month.

In these developing nations, a surprising amount of medical equipment can’t be used because the resources for basic repairs are lacking or because medical staff simply haven’t been trained on equipment operation. We’ll bring tools and equipment to put into practice what we’ve learned in school as well as what we learn through our training in Costa Rica to tackle what we may in just a few short weeks. Some of the tasks might include performing inventory, repairing devices, writing instruction manuals, and training others.


During the second month, from mid-July to mid-August, I’ll be working at the public hospital of Roatan, located on Roatan Island, Honduras. Check out the map. Roatan is circled, one of the three main Bay Islands, or “Islas de la Bahia.” Of several hospitals, this is the single public hospital on the island and the only affordable option for many. I’m no expert on the conditions there, but will be learning much more in the coming weeks. Ironically, just west of where I’ll be is one of the most popular scuba diving and snorkeling hot spots in Central America.

As you can imagine, I’m looking forward to an awesome cultural immersion experience and to being a part of this larger effort to improve healthcare around the globe! I’ve created this blog to help stay in touch with everyone at home in the US, and will try to post here often and as internet access allows.

Please check back often, and I’ll do my best to keep it interesting!

Tom