Happy August!

This marks the end of our third week here, and it was pretty different than the others.  At work, we finished most of the repairs that we could accomplish, meaning that we were then left figuring out what to do.  On Monday as I wrote, we (with Harold’s help) finished working on the centrifuge, only to discover that it couldn’t be fixed.  We Cheyo gave us a nebulizer that is missing the plastic piece to connect the tubes to the hole where the air comes out.  We didn’t understand what he was talking about, so we kept asking “Que falta?” to figure out what was missing.  Then I followed him up to pediatrics where he was given the tubes and a plastic connector piece that was too big for the hole.  Then he took us into his workshop where he had another old nebulizer to show us the missing piece on that one.  So asked if we could take them both and try to switch them up.  Turns out we couldn’t, so now we had 2 broken nebulizers.  Monday we cut the “too big connector” and super-glued it over the hole of one. We then gave Sor Ligia the fixed nebulizer and infusion pump complete with instructions.  When we visited Sor Ligia on Friday to ask some questions, they were still there.  For a hospital with such little equipment, I would think that they would snatch up any machines.  Doesn’t seem to be the case, and I’m not sure why.  It seems like Sor Ligia has all the power, so if she doesn’t do anything with something, it doesn’t happen.  I don’t know why she didn’t place those somewhere though to be used.  Well, now in our room we have the equipment that we are stuck on and Rob (our medical equipment teacher in Costa Rica and absolute genius at all medical equipment) tells us to throw in “El Rio” (the river): a 40-year-old ECG machine that doesn’t show anything, 40-year-old ECG/ defibrillator that also doesn’t show anything, a centrifuge that needs a new motor, 3 fetal Doppler monitors that can’t pick up and hear a fetal heartbeat, and a nebulizer with a ridiculously loud motor.  We also have the equipment that need parts that we are waiting for: Drager baby incubator that needs a 220 V-> 110 V transformer, Olidef baby incubator that needs a new heater lamp, and Vickers baby incubator that needs a temperature sensor.  We gave all the info to Casa Sarria, a medical supply store in Managua, over a week ago, and they are supposed to give us prices, and they told us they were coming Tuesday morning.

Tuesday, with our equipment kinda at a standstill and waiting for Casa Sarria, we asked to scrub into a surgery.  Rita and I have become pretty good friends with the adorable receptionist Veronica who patiently answers our questions, introduces us to people, and asks people for favors for us such as to watch a surgery.  So we got to not only enter the double doors into the operating room, but we also got to scrub into 2 surgeries that morning:  the first a sterilization procedure where they cut the Fallopian tubes which was super fast we didn’t realize it was happening, and the second a hysterectomy where they remove the uterus.  The hysterectomy was super cool as I could figure out what everything was.  The surgeon just cuts the lady open, sticks his hands in, feels around, and then pulls out this large lighter bulb that is the uterus.  The rest of the surgery is preparing the areas around it to cut it out.  The operating room was, I thought, very nice and spotlessly clean and looked very similar to one you would find in the US.  It definitely had more equipment than anywhere else in the hospital with an anesthesia machine, ECG monitor/ defibrillator, and the bedside monitor that we brought!  It made me so happy to see it being used and as the main device for the anesthesiologist in the surgery.  It was beeping the whole time though because her blood pressure was really high.  I didn’t know if he wanted the alarms or not, but he seemed to know what he was doing.  In the room, there was 1 general surgeon, 1 helper doctor who is actually general medicine doctor, a nurse helper, a helper’s helper, and 2 anesthesiologists that traded off.  The surgery run very much as it did in the US with a sterilization zone and everything: preparation, anesthesia, procedure, stitch up and wheel out The biggest difference I noticed was that they opened less autoclaved tools (just 20 instead of the 100 in the US) and opened stiches as they went rather than opening and wasting them. Oh and the surgeon was missing about 1.5 fingers on his left hand.  Inspirational that he is still a surgeon!  I enjoyed watching the surgery but had very little interest in doing it.  I think that surgery would get very repetitive and boring after a while.  Rita and I were discussing how we can understand why many engineers become surgeons because of the clear-cutness of surgery: see a problem, fix it, and see the solution; have a particular way to do things or steps to take, there is really only one way to do things.  There are actually 2 operating rooms but really only that 1 is used because they typically only have 1 surgeon working each day with average of 4 surgeries a day.  The other room had a really old anesthesia machine, which apparently works but is really old.  That afternoon, after Casa Sarria didn’t come, we decided to do a little needs finding so we interviewed a few people.  So also met this crazy nurse in the ER who wants to learn bad words in English!

Wednesday, we tried to clean the other nebulizer (that we nicknamed Grandpa because it is really old and squeaky) really well with WD-40.  Grandpa needed more than a bath- he needs a new rocking chair.  I tried and tried but couldn’t figure out why the motor was soo loud.  Meanwhile, Rita was working on the EWH paperwork and powerpoint for our conference.  She has some great pics!  We also waited around again for Casa Sarria to come.  Finally that afternoon the little salesmen came with a large engineer guy in order to get more information (which they were supposed to do for the last 2 weeks).  He came in and demanded all of this stuff and just acted generally disrespectfully towards us.  He made fun of us for going to the town’s celebration during lunch the week before- totally uncalled for.  I don’t know if it was because we are 2 young, white girls that he assumed we did not know anything or if that is normal.  Or it might be because engineers are so rare here, that he is used to being the looked to as the expert on all matters.  He made me really angry because he treated us as if we did not know anything and he knew everything.  Part of it was the language barrier, some I’m guessing is culture too, but it was frustrating.  When these guys got to the hospital, the engineer was asking about a centrifuge, and all of a sudden the lab technicians pulled out an old microcentrifuge with a rubber gasket that was broken.  We had never seen it before, and now the engineer and Sor Sonia were talking really fast about it.  They then take it away to fix it and claim to be bringing back on Friday with more info too.  What a mess!  We felt trapped since we had never seen it before and then the Sor asked for them to fix it and assuming that we would pay for it. 

Thursday morning, we were again waiting for prices then from Casa Sarria.  We decided to do some needs-finding to investigate possibilities for a secondary project.  Of course, we first went to Sor Ligia because she knows everything about the hospital.  We asked her a bunch of questions about the hospital and discovered that it is a public hospital that treats everyone for free.  It also receives all of its supplies and equipment via donations.  We asked about what equipment they need most, and it was basically everything.  She said that they have 4 ECG machines that do not have paper, so they cannot be used.  Can you imagine a hospital without a working ECG machine?  She also mentioned the fetal monitors that we tried to fix and apparently aren’t working any more so now they have none L  She also said that they need ventilators and nebulizers as these are the most commonly-used equipment there since respiratory problems are very common.  We asked Sor Ligia as well as a pediatrician at the hospital what were the most common health issues: for children, respiratory issues from bad stove ventilation in the houses and malnutrition/ intestinal worms; for adults, also respiratory issues, diabetes, hypertension, and gastric problems.  A lot seem to come from the diet which is typically rice, beans, tortillas, and white cheese which are all sold in bulk for cheap at the market.  Most of these problems I would think are very common among people that live in poverty.  We also asked Sor Ligia what we could do for a secondary project and translating a list of ideas for her.  She suggested that we paint the neonatal ward wall with anti-fungus paint because it is covered in mold.  She also thought that posters that taught good health would be a good idea.  We then asked Dr. Cano, the other pediatrician besides Dr. Fernandez who is the doc we live with but never see.  She seemed to like the idea as well and gave us a few suggestions: wash hands, brush teeth, clean feet, wear shoes, and drink clean water.  We then bought posters on Thursday and began drawing a making posters!  We also got a hold of Casa Sarria for prices.  They told us: $45 for the microcentrifuge that they stole from us, $120 for the baby warmer lamp, and $150 for the temp sensor for the incubator.  Uh oh!  We definitely do not have the money for all of this!  We feel very stuck since they have our centrifuge, so we have to pay for it.  They also are bringing the lamp tomorrow.  Yet I really would rather not deal with them anymore because they kinda trapped us, so I think they might be unfairly overcharging us.  We really just want to be helpful to the hospital, but we can’t just go around buying everything.  I’m realizing that this hospital needs money more than anything else! 

Friday morning, we finished up our first round of posters: Rita made one for washing hands and I made one for brushing teeth.  We looked up some pics and stuff of the internet.  We couldn’t decide if we should mention diet and exercise since these are part of the culture and not always change-able.  We also worked on looking up more info on parts, so we could see if there are any better options: perhaps repair rather than buy new, find cheaper prices to barter or to buy from.  We called another store, but they needed info and pics to find the part, so we will have to wait again.  We didn’t want to buy anything without making sure we were getting the best deal, and we wanted to make sure with the nuns what was most important: which is the lamp for the baby incubator.  Sor Ligia also told us on Friday that they need 4 more lamps for the OR room which are very important as well as lamps for this blood analyzer.  They have 20W bulbs when the machine needs 10W bulbs.  I am torn because I don’t want to waste the 20W bulbs but I don’t want to destroy the machine.  We told them that we have a limited budget, but yet they expect us to be able to pay for all of this stuff.  I also don’t think it is our job to decide what to buy either since they know better what is most important.  Actually luckily for us, the men from Casa Sarria came at 4pm, which meant that we were literally the only ones left in the hospital.  The nuns were gone, so we refused to buy anything without their permission.  The men then offered to wait around until a Sor returned to ask if the Sor wanted the microcentrifuge.  We were allowed to return to our house (only to worry about our predicament) and then called to come back in order to help pay.  Boy did we feel like sugar mama!  Called up to pay and then left!  But the sister offered to pay for half of it, which made me feel a lot better.  Interesting how money flows up when need be!  We said no to everything else except for the microcentrifuge since they had already fixed it.  Now we are free to make our own decisions rather than feeling pressure to buy something from someone.  I hope we can find some cheaper prices this week.  I don’t know what to do though because we as the engineers cannot just come back every year and buy all the stuff that they need- that just adds to the circle of dependence.

This weekend was also amazing of course!  We went to San Juan del Sure, which is a surfer town on the beach of the Pacific Ocean.  It was BEAUTIFUL!   The water was turquoise blue and very salty, waves great for body-surfing, and sun in the clear blue sky.  We swam for a bit with all the Duke kids, laid on the beach, and then walked out onto some rocks to the point of the bay.  We sat on this tall rock and watched the waves hit the rocks as the sun was setting- gorgeous.  Words can’t describe it.  Then as we were walking back, it started to storm: thunder, lightening, pelting rain!  Fast and strong!  We stayed at this pink hotel on the beach owned by a man from North Carolina.  He moved to San Juan 3 years ago and “has never looked back!”  We found him sleeping the next morning on a coach in the entryway with his dog.  Very chill town it is.  Sunday we looked into surfing but realized we need to plan better for that, so we just went swimming on the beach again.  We then walked/ climbed out on the rocks on the other side of the bay to this cave that we had seen from the point the previous night.  Oh my goodness!  Breathtaking!  We would climb around the rocks to this nook where the waves would crash through the rocks around a pool of water and then onto the shore at the pool, but then as they would leave, they would fall through the rocks and make an incredible sound like a rain stick.  Then some at this one point in the rocks, there was a crack so when the waves came, they would shoot up and shower the person standing there.  We eventually got to the cave, which was absolutely huge.  I just sat down and set so peaceful- secure with the cave around, listening to the waves crashing in and falling out through the rocks, looking at the turquoise blue water and the clear blue sky with yellow sun.  I can’t describe the beauty.  The whole weekend looked like it was from a motivational calendar.  We then found this cute bookstore in town to eat lunch where I had the best banana-chocolate chip muffin ever!  It was a great, chill, fun, cheap weekend! 

Now it is our last full week at work, and we want to make the best of it.  We are going to start with finding out more info about this baby warmer light, lights for the OR, and maybe about paint as well as of course making posters and talking to people!  We hope to see a C section surgery as well.  It is also my goal to determine why there are soo few patients at our hospital.  Thursday afternoon when we walked around, there were 0 babies, 0 mothers, 2 children in pediatrics, and very few adults.  Crazy!  I asked my host family daughter, and she said it was because there is a huge party in Managua for the past 2 weeks.  She said Nicaraguans like to party, so they don’t have time to be sick then. I don’t know.  I do notice how very little people work.  The hospital almost like shuts down after noon such that we seem to be the only ones working in the afternoon.  A perplexing phenomenon…