Last week

August 20, 2009 at 4:45 pm Leave a comment

Ok I am not writing from my huge apartment back at Duke, but I realized that I never finished up my blog from the summer.  Sorry to leave you hanging for so long.  I will just give you a quick overview of my activities last week and a half before we left to go to a 24 hours conference in Washington DC with all the students in the EWH program- Nicaragua, Honduras, and Tanzania.  Then I came back to Duke to start with freshmen orientation!  Crazy!

So Monday, we walked into the hospital and found Veronica at the desk.  She asked if we wanted to watch a surgery, so we said sure of course!  We ended up watching 2 gall bladder removal surgeries as both women at gall bladder stones.  It was crazy because the doctor removes the entire gall bladder, which is a dark maroon color, and then the helper girl cut it up to remove the stones for testing.  Inside, there are these marble-sized yellow balls.  No wonder they hurt!  The first surgery went smoothly. Then in the second one, right after the surgery slices open the women, the power goes out!  No joke!  Everything turns off (except for the monitor that we brought because it has back-up battery so we could see her stats).  But everything else went off- lights, ESU knife, anesthesia.  But no one panicked.  They just stood there and waited probably about 5 minutes for the back-up power generators kicked in.  The hospital has 2 back-up power generators run on diesel that provided for the entire hospital- one for the OR, the other for the ER.  The thing is though that someone has to go start the generators when the power goes out, so it takes a while.  Good thing that there really aren’t any machines that need immediate power like breathing machines besides the anesthesia in the OR and the anesthesiologist is there.  Then the finished up the surgery as if nothing happened!  Absurd!  They did cancel the rest of the day.   After that we wandered around the hospital checking things out and went to go talk to Harold for a while because he was back from vacation.  He was very patient with my Spanish and understand me when I spoke incorrectly (which was the entire time).  Then we couldn’t do a whole lot with equipment as there was no electricity, so we actually finished making our posters.   In the afternoon, we went to the store and bought anti-hongo paint for the neonatal ward.  That night, I was sitting out in the dining room attempting to write some things, and Maria Feliz and Julissa came out to talk.  I just was really impressed by both of them- their perspectives on life and the good sense they have.  Maria wants to wait until she has graduated and worked before getting married despite the norm there.  Julissa was telling me how her mother raised her by herself, so they are really close now.  Her mother is her “everything, her life” she said.  Wow!  What a great role model for her to have!  It was fun sitting around the table talking to Julissa about where in the world she wants to visit.  I felt like we both have the world at our fingertips and its amazing!  Tuesday, we worked on the neonatal wall!  We scraped off the mold and painted the first layer of white anti-hongo paint.  I can’t believe the mold.  So gross! In the afternoon, Veronica the receptionist took us out for ice cream at Eskimo.  She is so adorable and sweet!  She bought both Rita and I a banana sundae each (which was heavenly but so rich that we could barely finish) while we got just a single scoop of the month on a cone.  I can’t believe how nice it was!  I was truly touched.  Wednesday, we painted the second layer of anti-hongo paint in the morning and then went to the paint store to buy the sea green paint that we needed to repaint the wall to make it look like the rest of the hospital.  In the afternoon, we painted the first layer of green overtop and it looked really good but smelled really bad. We also put up or good health posters around the emergency department!  That night, we also caught the Doctora in the kitchen and had a really great conversation about healthcare.  I have been trying to figure out why there are no patients in the hospital and no funding/equipment.  She explained to us that although all the services are free at the hospital, the medicine is not.  So many of the patients that need medicine to treat their illness wouldn’t go because they can’t afford the medicine.  Also she said that many people don’t have time to be sick because they need to work in order to earn money for food to survive.  I asked about her pharmacy and private clinic, and she said that those have had very few patients lately especially because of the economic crisis (which I guess is affecting everyone even the people in Nicaragua!)  She also said that Jinotepe, while the city is smaller than Diriamba, is the capital of the province, so it has more amenities than Diriamba, such as a larger hospital. When we took a tour the last week, Rita and I were amazed!  They had literally 7 incubators in neonatal, and 10 in the maternity.  We have one right now!  I couldn’t believe the discrepancies in equipment from Jinotepe and Diriamba!  Doctora explained that the government funds the hospitals based on their size, which makes sense but creates a bad cycle for the smaller ones.  They can’t get more money to buy more equipment or treat more patients, so then they can’t ever get bigger and can’t get more money.  She also mentioned that there is a problem between the government and the religiousity/ congregation of nuns that runs the hospital.  The government got mad, and forced Luxembourg, who has helped the hospital a ton through a 5-year cooperation (donating equipment, setting up computers and internet in the office, making maps and fire escape routes) to quit helping.  The feud might also explain why they don’t have a lot of funding and then why they don’t have a lot of doctors or doctors in the afternoon as they can’t pay them enough to keep them around.  I never asked why the doctors work there in the first place then if most work at a private place in the afternoon.  My guess is that they have to work part time in public medical care, but I don’t know that for sure.  All interesting huh!  So patients will come to get care if it is something that is must be done in the hospital like having a baby, or it is fast and can be fixed without a long time in the hospital or expensive medication- such as diarrhea, fever, pneumonia.  Also I saw mostly women and children in the hospital, probably because men didn’t want to take the time off to be sick and parents just ignored their own sickness yet were more willing to take care of their children’s health. The rest of the no-patient mystery is just day by day fluctuations, as Monday the next week there were 5 C-sections so it just depends.

Also Wednesday afternoon, Michelle and her mom visited which was fun.  They inspired me too, because we showed them our room full of equipment, Michelle had some ideas for some of the equipment.  Her mom, when we showed her our room, made a comment about “how our training as engineers probably did not prepare us for this,”  which motivated me to remember why we were there.  Our first goal was the equipment and the second was these other things (even if they might be more fun to me).  So we were motivated on Thursday to return to our equipment and see what we could do.   So Thursday morning, we finished up the wall with a second layer of green paint!  And then cleaned up the room that was now very green and smelly.  We then went back to our room and asked Harold about all of our machines.  We tried a transformed on one incubator, which flashed on and then off.  When we asked Harold about it, he didn’t want us to even mess with it.  He said the others were much more important and newer and better so don’t even look at fixing that one.  Ok, we took the hint.  We tried to look at the Dopplers some more, but really didn’t get much inspiration.  We then tested the incubator that they claimed to work but was missing a sensor.  It did work perfectly!  It has a sensor to measure the air temperature, just not one to measure the baby’s skin temperature, so you would have to manually take that.  But other than that the machine worked great, so I didn’t really see the problem with using it considering the severe lack of others.  In the afternoon, we walked around the hospital, interviewing people to find anymore unused or broken machines as well as to determine what the common problems were at the hospital.  We heard from the ER nurse that diarrhea, fever, pregnant women, high blood pressure, high blood sugar, and the flu were the most common problems.  We heard from the pediatric nurse that dehydration, respiratory problems like pneumonia and asthma, diabetes, and gastro-intestinal issues from bad water are the most common problems.  The most common surgeries are C-sections, hysterectomies, gall-bladders, and hernia removals.  This was fun talking to all the different people in the hospital and all the different areas.  We made friends with the head nurse in the maternity ward, who explained to us the giant book where they write down all the births in the hospital as well as how they used to use non-disposable syringes before the year 2000.  She also pointed out to us a pulse oximeter that they use for babies that didn’t work well and a suction for babies that didn’t work.  On Friday, we determined that the pulse oximeter worked for Rita but not the nurse because the nurse had nail polish on.  We also figured out that the suction worked perfectly, but the nurses did not know how to use it because you had to keep your finger over a hole to create the pressure for the suction.  We wrote instructions, taped them on, and explained them to her.  The next week, the other nurses claimed that it didn’t work, so we then explained them again to them, and the nurses seemed satisfied.  Friday morning, we spent all morning calling different supply companies in Managua, as we were determined to find some spare parts!  We needed the heater lamp for the Olidef incubator, 4 surgery room light bulbs, and 2 light bulbs for a blood analyzer.  We thought we had some leads, but none proved fruitful except for Casa Sarria who we already had trouble with.  Another store said they could order them but they would take at least 2 weeks and about $400 for the heater lamp.  Not happening!  So we went to Managua after lunch hoping that we would start there and then see if they had any advice.  We had no idea where we were going, but some how ended up finding the store.  They had everything we needed including a man that spoke English, and all the bulbs.  Unfortunately everything was too expensive to buy all together, but we gave us a bit of a discount, so we were able to buy the heater lamp, 1 operating room bulb, and 1 blood analyzer bulb with the money we were given by EWH.  Perfect!!  We were so thrilled!!!

That weekend, we decided to spend with the family at home.  Maria Feliz took us with her boyfriend and his sister to the beautiful beach just 30 minutes away!!!  Her boyfriend drove and they bought a picnic lunch and dinner for us all on the beach.  We even got to watch the most incredible sunset with orange, pink, purple, yellow… gorgeous!  The beach was so deserted- one restaurant but no other buildings.  There were boys that lived that that raced horses down the beach and surfed in the waves.  Rita even got to ride a horse for a bit.  We went swimming, but the currents were super strong so we didn’t venture far.  Sunday, Grandpa took us on his motorcycle to his farm where he grows rice, beans, and corn!  The motorcycle was a blast!  It was interesting though because he has a helper who lives on the farm with a wife and child in a one room building made of cement, with a stove that consisted of bricks with a rock on top and spilled smoke throughout the place, with a bed that was wood with a comforter on top as the mattress, and literally 2 chairs, a soccer ball, and a radio.  It was interesting to see all the different levels of living in Nicaragua from my wealthy family to this.  It was nice to stay home and get to hang out with the family too!

Monday, we were so excited to use our spare parts!  We also heard that there were 5 C-sections and we were dying to see a birth!  So we first went in to surgery, where Doctora Fernandez was too to catch the baby when it came out.   The surgery was so fast!  All of a sudden there were 2 people instead of 1, and the mountain that used to be her stomach was flat.  It was awesome!  The baby came out, blue, and kinda gross but not too bad.  Doctora grabbed him and wiped off his face, then he started to cry.  She took him than out of the room to check him out, but he was totally fine!  Turns out the mother was 20 and this was her second C-section.  Crazy!  Glad I don’t have 2 babies at age 20!  Anyway, after that we went back to our room.  We got Harold’s help to install the heater lamp on the Olidef.  Turns out we would have done it completely wrong because it is not like a normal resister that use put into a circuit.  You have to run the current both ways, so it will get stuck and then the energy will turn into heat.  We installed it, got the nurse to check it out, and she said it worked like it used to!!!  We doubled the neonatal’s incubator capacity!!! The nurses and staff were super thankful for the incubator as well as the new wall!! They immediately cleaned it and wanted to put it to use.  They discovered though that one of the sides was supposed to be moveable but wouldn’t because it was rusted in.  We tried really hard to fix it, but just couldn’t.  Bummer!  That was not important at all but just a matter of convenience.  We then installed t the blood analyzer lamp, so the lab had a working blood analyzer.   I also had a great talk with Maria Feliz about the culture of marriage and motherhood there.  She explained how things were much worse outside the city were the people did not have as much education, which is probably like it is everywhere.  I expected her answers to be a lot worse than they were, but really it wasn’t that different than the US.  I also talked to Carla, the maid who works endlessly hard.  She began working at age 9 while going to school, yet school didn’t really change her life at all which surprised me.  I thought that everyone who had an education could have a future, but not necessarily.
Tuesday and Wednesday were our last 2 days at the hospital, which we mainly spent talking to people- nurses, doctors, staff.  We asked questions about the hospital and its needs, about their lives, about working there, about living in Nicaragua.  Wednesday we ran around taking pictures with people and then passing them out.  We also made an apple pie for our family.  In the end though, we received more gifts than we were gave I think.  Martita gave us a beautiful wood carving, Grandpa gave us an elephant candle holder, Julissa gave us hand-made necklaces that she made herself, Gilda gave us each a rose, Lilliam from the gym gave us her music to copy, Maria Feliz and her boyfriend took us out for Eskimo ice cream and a drive around town.  Everyone was absolutely incredible and I am seriously going to miss them all!  Martita and the anesthesiologist have already emailed me.  I gotta figure out how to write back in Spanish!   We were really sad to leave, but so thankful for all the wonderful people that we met!!

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Happy August! People make the world go round

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