Each May, a group of Duke EWH students travel to Xela, Guatemala to repair medical equipment in the regional hospital. They work closely with Joe Leier, an in-country biomedical engineer, and the local hospital maintenance team. They stay in home stays with local families, study spanish at Celas Maya Spanish school, and immerse themselves in the local culture. Since the first trip in 2013, Duke EWH has formed a lasting relationship with Celas Maya, the regional hospital, and the Guatemalan engineers and maintenance team. The EWH students share their engineering knowledge and skills with the in-country technicians while gaining valuable knowledge and experience in return. The students learn about various medical equipment and gain first-hand experience while providing much needed repairs and solutions for broken or missing technology.
We were guided and taught by Joe Leier (left), a biomedical engineer living in Guatemala who is a long-time supporter of EWH. Members attending the Guatemala trip included (left to right) Ashley Myers (sophomore), Veronica Brtek (senior), Chris Zhou (senior), Bill Tian (senior), Andrew Wilcox (senior), and Don Gex (senior). During our week in Quetzaltenango (Xela) working at the Hospital Regional de Occidente and exploring the town, we learned much about Guatemalan culture and fixed many pieces of medical equipment including:
- Cautery machine
- Suction device
- Blender for the kitchen
- Autoclave bag sealer
- OR overhead light
After work at the hospital and on the weekends, we were able to explore more of Xela and Guatemala by staying in homestays, eating local cuisine, touring and taste testing at a chocolate factory, interacting with the local Spanish school–Celas Mayas–walking around the city and visiting local outdoor markets, hiking the Volcan de Chicabal, and visiting a hot springs.
Joe Leier (far left) was our onsite leader at the hospital once again. The students on the 2017 trip were (from left to right): Josh France (sophomore), Michael Casio (sophomore), Claire Fu (sophomore), Anna Cunningham (sophomore), Sarah Gregorich (sophomore), and Caroline Kittle (P ’17). We had a slow start getting authorization to work in the hospital, but we still managed to repair a good amount of equipment. In the five days we worked in the hospital, we fixed the following:
- Cauterizing machines (3)
- An operating room light
- Anesthesia machines (2)
- An OBGYN chair
We also took a tour of the hospital and picked up a cooking pan from pathology, which we were unable to repair. Outside of the hospital, we climbed a volcano, toured a chocolate factory, and met up with some other Duke students who were also spending time in Quetzaltenango.
The students on this trip were (from left to right) Taylor Konrath (senior), Caroline Kittle (senior), Rachel Glenn (senior, trip leader), Anica Nangia (junior), Noa Saint-Marc (sophomore), and Michael Shen (senior). Joe Leier was again our on-site leader at the hospital. Unfortunately though, this year we were not joined by the maintenance director since he broke his ankle the first day of our trip. However, we strengthened our working relationships with the rest of the maintenance team and met many new people as well.
Like last year, this year we received a list of equipment in need of repairs, and several of the devices on that list were in disrepair last year as well. We repaired the devices on this list that we had parts for but some of last year’s devices could not be repaired with only our supplies and without major investment in parts like oxygen sensors. The team also surveyed the hospital for other broken equipment, repairing colonoscopes, fetal monitors, and other in-room equipment. Despite a few setbacks, we were able to work with the local maintenance staff and technicians to repair many devices, including:
- Foot pedal for cautery pen – removed oxidation, resoldered wires, preventative care to prevent future rust
- Baby warmer for newborns – replaced hardware
- Patient monitor – replaced microcontroller
- Fetal monitors (3) – cleaned extensively, combined working components from three printers to create two working devices
- Cast cutter (4) – replace variable speed control, faulty contacs
- Cavitron (2) – identified leaks, cleaned tubing, restored water flow
- Birthing table – repaired broken wires and replaced hardware
- Tourniquet – replaced emergency battery, designed external battery casing
In addition to these device repairs, Joe and the team adapted an old military oxygen concentrator into the existing oxygen delivery system. The device should provide cheaper oxygen for use throughout the hospital.
Below is a journal entry recorded by one of the participants, summarizing a typical work day.
Today we went to the pediatric unit and spoke to the director there about fixing a baby incubator. However, all were in use so we may not be able to make repairs until Thursday or Friday when they become available.
Then we went to the laboratory area to ask about their broken oven, but the head of the department said they had no broken oven. However, there is a fridge they keep samples in that is not staying cold enough either. We opened up the bottom of the fridge and the condenser was very dirty, which can make airflow and subsequent cooling difficult. Monthly cleaning should happen on the fridge, but that clearly isn’t happening because it is difficult to create a maintenance schedule. We removed the dust from the condenser.
They showed us to another fridge they didn’t think was getting cold enough. Joe checked the back, but there weren’t condenser coils like the other fridge nor was it particularly dirty. He thinks a possible issue may be things blocking the airflow in the freezer itself, or ice build-up on the fridge blocking air flow. We will return in a couple hours to check the fridge because Joe put it on the heating position to melt the ice. We will see if that worked later.
More pictures here: https://drive.google.com/file/d/0B7jEVdklJb2MRk1teXVHV1VMenM/view?usp=sharing
The students on the 2015 trip were (left to right) Ashwin Prakash (junior), Kate Gelman (junior), Scott Lee (sophomore), Rachel Glenn (junior), and Adarsh Ettyreddy (sophomore). The regional hospital in Xela, Guatemala went under new management this year, and the new director was insistent that that hospital was not to be seen as a charity case. It was through lots of communication and previously established relationships with the maintenance and medical staff that we were able to return for the third annual trip.
The staff with whom we had worked previously provided us with a list of equipment that needed to be repaired. We were able to fix a good deal of it, including two autoclaves, a cautery machine, a tourniquet machine, and four patient monitors. We also went to various departments to inquire what needed to be repaired, as we knew from previous years that most departments do not report their broken equipment since it does not get generally get fixed. We repaired some of their equipment including a dental chair and a pathology examination table. We also obtained contacts from the other departments so that in future years, we can contact them before arriving. One of our major projects for the pathology department embodied the EWH ideal of using readily available materials to create an easily replicable solution. We created a system for the microtome by making adaptors that we cut from the legs of an old hospital bed that we found in the hospital junk pile.
It was on this trip that we developed the idea for the LED surgical light design project. One of the surgery nurses alerted our attention to an operating room lamp that was missing a part due to an unsuccessful bulb change. There were no other lights like it in the hospital, and we could not determine a solution. Through brainstorming with the in-country technician and surgical staff, we came up with the beginning of a plan to create a kit to convert all of the surgery lamps to use LEDs instead of incandescent light bulbs. The kit will ideally be uniformly adaptable to all of the types of lamps in the hospital. LEDs use less energy and last longer than incandescent bulbs, so they will save the hospital a great deal of money and maintenance work. They generate less heat in order to keep the operating rooms cooler. Ideally, the LEDs will have a battery back up in case of a power outage, giving them another advantage.