Here is the video Soren and I put together for our presentation at the end of summer EWH conference!
On Saturday we ended up giving a tour in the morning to the head s of our EWH program along with some special guests. We showed them around and visited the NICU, laboratory and new surgical theatre since those were the places we fixed the most equipment. Then we had to pack up all our stuff and head to TCDC one last time for our end of summer conference. On Saturday and Sunday we listened to a guest speaker then everyone presented what they’d done over the past month in a variety of ways.
Soren and I’s presentation was quite easy since we just introduced ourselves, played our video and answered a few questions. I will be posting the video to youtube once I have decent enough internet! Overall, I am very pleased with this program and I feel like I made an impact on many patients’ lives. This trip will definitely be an inspiration for any of my plans and projects in the future!
All but 5 people left on Sunday to head back to the US. I had scheduled my flight a day later because it ended up being $200 cheaper to do so. When everyone left, I got pretty antsy to leave as well or at least wanted the long flights ahead of me to be over with already. I was quite glad though that I stayed an extra day. On Friday, Soren and I were so busy with building our light set that we didn't get to give proper goodbyes to everyone. So Sunday night I headed to my mama's for one last dinner over there. It was really nice to catch up and show the fam what I'd been doing. I texted my favorite doctor, Dr. Lee and he agreed on me coming to the hospital Monday afternoon and hanging out a little before my flight. Monday morning I was wakened by Soren knocking at my door to give a final goodbye- he, Razz and Rune (known as the three Dane's) were heading out that morning to start the great Kilimanjaro climb! Saying goodbye, I realized how much I was going to miss my partner! We worked really well together this past month and I couldn't have been luckier to be paired with him. No worries though, for I will be visiting him in Denmark eventually :D
So on Monday I decided I'd head into the hospital in the afternoon to give my final goodbyes. I, of course, checked in with my favorite baby room and was so excited when one of the nurses stopped me and said how great the lights were and how thankful she was. There, I took a look at those precious little babies one last time and headed into the storage department to say goodbye to Nuru. I gave her a card I wrote thanking her for being such a great help this past month (we really couldn't have been as successful without her) ending with the line "I'll be seeing you next year Mungu akipenda" a phrase we'd say everyday meaning "If god wishes." After printing out Soren and I's final report for all the equipment we worked on the past month, she took me into town and let me pick out a scarf along with a few cards as a thanks for all the work I did, too sweet! Then I went into the operating theater to watch a little bit of an operation with Dr. Lee- skin grafting. Finally, I got to see the ESU machine Soren had fixed (the day I was sick) in action! I didn't stay for too long, but after the procedure was finished, Dr. Lee said he thought it went well and then we headed out to a late lunch/early dinner. We went to a nice restaurant called the Blue Herring where I had a delicious chicken panini with pumpkin and coconut soup! It was great relaxing and talking about all sorts of things and I've concluded that if I can someday, I'll be visiting Korea since he goes back in 6 months :D He kindly dropped me back off at my mama's house in Makumira and it was time to get ready for my journey home. John, my host brother gave me a beautiful wooden bracelet as a goodbye gift and I gave the family the clothes I was donating so they could give them away or use them in any way they wanted. I took a taxi to the airport with my host sister and brother and then I finally had to acknowledge I was leaving!
Phototherapy lights- the bili light building begins! So I’ll be posting the video we created over these past two days once I have good internet for youtube uploading! For our end of the program conference we were assigned to do a non-traditional presentation so we chose to shoot a movie about the secondary project I mentioned earlier. We were able to find all the parts we needed in the limited time we had and it worked out great. We used all local materials which was really cool, because that’s one of the hardest parts about designing equipment for developing countries. In summary, their new set of bili lights can fit 3-4 babies underneath at one time, which was a need they had addressed in my many visits to the ward. After we finished we delivered it to the neonatal room and it fit into the cribs perfectly! The materials we used turned out to look really nice as well so we hope the hospital will continuously use it. The only worry is that the lights are used for decoration normally… and people have already asked us to get them some for their home!
Today we finally got to figure out what was wrong with the autoclave hooked up to three phase wiring. With Amon, the electrician that stops every once in a while at the hospital, we brought our mulitmeter into the sterilization room to figure out what was happening with the wires. The wiring was all tangled but luckily it was easy to find where it was wired wrong. They had hooked L1 into the first phase then L2 and L3 were both in the second phase. So all we had to do was put one of the wires into the third phase and test the autoclave out. After the error code sounded for about 10 minutes saying there had been a power cut and after recognizing the normal power supply, started right back up again! That was a great fix because there is a great need for sterilization, there aren’t very many autoclaves in the hospital and the new surgical ward does most of the sterilization for all of the wards. When that was all settled and tested, there was a surgical lamp that kept falling down so all that was needed was a tightening of the screws. Then it was back to the suction pump for the very last time. Testing it out for over an hour, we came to the conclusion the axel was misaligned either to begin with or being shipped over to Tanzania. One side refused to create a vacuum so instead of both sides creating suction, only one would. This created too little suction for much of anything to go through. We delivered it saying what was wrong and the head doctor said he’d be calling the company to see if there was anything to be done further. Right before we left, some nurses called my name in the storage room saying they needed some wheelchairs put together immediately so we took about 15 minutes tightening screws and assembling the premade chairs.
Arm Surgery! Today we made sure to arrive at the hospital just before nine to head in to watch a surgery done by our favorite doctor! He is an orthopedic surgeon from Korea and literally raised the funds to build the new surgical theatre he now works in (including the equipment!!!). The patient was a young man who had fractured his radius over three months ago and had never been able to get it set properly. This caused the bone to grow back wrong with a lot of pain. In a nut shell, the doctor sliced open his arm and re-broke and chiseled down the bone for a perfect fit. After confirming the puzzle piece like fit, he screwed in a metal plate to ensure proper growth. It was interesting to see the procedure and how the team handled limited sterility. Soren and I even got to help out a little by adjusting the surgical light and pouring some cleaning fluid! After we’d seen enough we went out to work on the suction machine again. Again, we spent the whole afternoon fidgeting with the motor to see if there was any chance we could get it up and running. One of our coordinators came to visit and help us out and then headed to have a delicious late lunch with all of my housemates. Soren and I then headed to TCDC to drop off our hiking clothes to be washed since they got so dirty on the climb! But then… both of us fell asleep on the dala dala and ended up missing our stop so by the time we got back, the laundry place had closed! It’s times like these we can tell we’re really exhausted. After that, I headed back to the hospital before dark. I wanted to hang out with my favorite nurse on her night duty in the preemie room. Aubs decided to join so it was nice to have someone to walk with. When we got there the power was out AND the hospital wasn't running the generator. Since the heaters weren't running all the babies were wrapped up tight in their kongas, looking snug and warm. Luckily, the power turned on after about 20 minutes. It was nice to sit and chat and really see what it's like to be a nurse there. I can't imagine regularly being in charge of 29 babies (I counted) all by myself!
Monday, Soren and I decided to put all of our effort into opening and fixing the suction machine. Our best guess as to why the motor wasn’t starting was the starter cap so we went on a hunt to buy one. After getting back with it and testing it out- nothing changed : SHOOT! It took about 2 hours to even get into the middle to see what was going on because the casing was so ridiculous. After fidgeting around for quite some time, we realized that oil had yet to be placed anywhere inside the machine, including the reservoirs for it. Luckily, we still had some oil left over from the operating table we fixed so we put oil everywhere to see if it’d make a difference. Without reassembling every part back together, we tested the motor with the newly added oil and it was up and running. After testing it for a while we then attempted to get it all back together- another big problem. For being a new machine, the seals were made of out oily newspaper and we noticed that the axle of the motor wasn’t aligned with the suction chambers. After spending the entire day on the machine we at least got a good news call that the led blue lights we had ordered arrived and we could pick them up before 4. We headed over there and were so excited to get them and see. The owner had them specially delivered from one of his workers in Dar, which was really nice. We tested them that night and we were amazed on how bright they were! I can't wait to finish up on the machines we've been working on and concentrate on our secondary project.
Saturday was the start of a great and terrifying adventure: climbing the “Mountain of God”, Ol Doinyo Lengai- the only active volcano in Tanzania. It is safe to say I can classify that it was a “once in a lifetime” experience, not only for the amazing view and challenging hike, but also because I really would never do it again! From the start, I really wanted to plan a trip to go because my friend told me it was one of the coolest things she had ever seen. So the hunt for a Safari company began but everyone was saying a price out of my budget. In Moshi, two weekends before, Aubrey and I came across a hole in the wall company that found us looking on the streets. He gave us a deal for 9 people for one car, two guides, a campsite and 3 tents where we provided our own food. So setting out, with 5 of my housemates and 3 other EWH members, we started our adventure.
First off, the car was definitely a 7 person car. Of course, we are so used to being crammed into vehicles that it wasn’t even a hindrance. We packed our bags on top and climbed in. Second, the windows didn’t have handles, not a problem again, we had some wrenches. We set out to Shoprite to get some snacks and pay our final amount to the tour guide. Then, we officially began our journey to Ol Doinyo. It was about two hours of smooth pavement and then we stopped for a quick lunch. Then we learned another fun fact about our car: the back doors didn’t shut all the way and the vents in the back had no filter/casing from the outside. Dust got EVERYWHERE once we hit rough dirt road onward! Over time, the entire car became a puff of dust on the inside, coating each and every one of us in unbelievable amounts (see pictures below). Even though it was hard to breath, it was so funny that nobody could even be in a bad mood about it! As we got nearer to Ol Doinyo, we saw some zebra, giraffes, ostriches, and wildebeests which were pretty darn cool to see in the middle of nowhere. The initial sighting of the volcano was a little cloudy and gray so we didn’t get a good look until we got much closer. We eventually got to the campsite around 6 p.m., so it was quite the long drive. Arriving was hilarious as we piled out of our car looking like we’d been in the desert for a month without showering. There were Italian wazungus everywhere looking nice and clean so we certainly set that off balance upon arrival. Then it was time to make some food (aka peanut butter and banana sandwiches) for the climb and eat whatever we packed for dinner. It started raining a bit so we were glad to have three tents to hide and rest in. At 11 p.m. we were ready to go with our guides and headed to the volcano for a midnight climb!
The first two hours of our journey involved regular old climbing on steep ground. After that, things got interesting! The angle got so steep that we were literally climbing on all fours off and on the rest of the time. Luckily, we picked the perfect weekend to go- a full moon filled the sky with light as we headed up so we didn’t even need flashlights. Also, it was good that it was dark or I think I would have been much more scared at being able to fully realize how dangerous some of the areas were to climb! There were countless times where we’d grab onto a rock for leverage to only find it dissolved right in our hands. Around 5 a.m. I could finally see I was close to the top, and I could also see that it was the steepest yet.
By 6 our entire group reached a flatter area right before the top to rest and wait for the sun to rise- it was soooo cold! Once the sun rose, it was such a beautiful view. Even though the thought of having to climb down alive was quite terrifying, it was worth the effort! Unfortunately our guide poked the ground with his stick towards the highest peak and it was hollow, so we couldn’t climb to the very top without a good chance of falling through. Abdullah decided to defy the odds and go for it so he was the only one who officially made it to the highest point. After hanging out at the top for a while and enjoying the view we headed back down in two separate groups so that if anyone loosened any rocks they had less chance of hitting somebody else. The way back down was surprisingly better than expected because I could actually see where I was climbing! I decided for the first 2 hours down to use the sliding on your butt technique so I wouldn’t keep slipping in the thick ash. After that, somehow our legs kicked in to be able to jog/run the rest of the slope once the ash wasn’t so thick! My legs were shaking like crazy and I knew I’d be feeling sore for many days to come. We all learned quickly that usually the climb is done with more hiking gear-like ropes or at least a walking stick which we had neither! The climb itself lasted from 12:00 a.m. until 12:00 p.m. where I'd only been able to sleep for one hour that night- I was pretty impressed all of us made it up and down with no complications!
The drive back was another adventure as well. Fifteen minutes into the ride back, the exhaust pipe fell off. Once we got going again, as you can imagine, the car got pretty loud. A few hours later almost off the dirt road we hit a cow crossing the road and kept driving! This of course is the time that I always think “Only in Tanzania.” Then the guide and driver made us stop at a town to get the exhaust pipe welded back on which took forever so we finally arrived back in Arusha at 10:00 p.m.- quite the long weekend adventure. Again, I wouldn’t trade it for the world, but I wouldn’t do it again!!!
Friday was certainly a good day! Taking half of the day to shop for some parts, it turned out to be a huge success. Finally, after hanging out in the preemie room for so long, I decided that for our secondary project we should try to make a new set of bililights for them! For those of you who don’t know, bili is short for bilirubin, the natural product in the breakdown of heme. It is very common in the first days of a newborns life to have much higher levels of bilirubin because their body is not developed fully to break it down to its proper level- causing the yellow tint on a baby’s skin. This being said, in premature babies and those with a low birth weight, it is even more common to have higher levels which is why in this department, the lights are vital. I had e-mailed our trainer, Larry, as well as a Rice University student who I had read an article about to see if we could get any tips about how to go about building one of our own. After getting great responses from both (thanks!), Soren and I decided that it was in fact something we could try and do.
We kept our shopping list short to tubing, a fitting for pumping up wheel chair tires, and blue led lights. We first went around looking for some tubing and the right fitting to be able to use our compressor as a tire pump. It was quite hard trying to communicate about the specifications with the tubing but we ended up getting the right size and everything. The great part is if the store doesn’t have what you need, they usually have a pretty good idea of where to get it. We searched around asking about 7 different light/electrical shops about blue led lights for our phototherapy project, we somehow got unbelievably lucky. In a light shop, finally after about 15 minutes of explaining what kind of lights we were looking for, the owner suddenly said that he actually had a new product that came in several different led colors. In the store he only had red, but was really interested in our project and wanted to show us what they looked like. Hooking the lights up to a car battery (since there was no electricity) the lights lit up a ridiculously bright red. It just so happened that he knew that in Dar Es Salaam he had them in a variety of colors, including blue! Why blue to begin with? The wavelength that blue light emits is around 450-490 nm, proven to be around the optimal level that helps to break down bilirubin. The owner, Mustafa, then said that if we ordered it today, that he could get it to us no later than Tuesday. With this as our best shot, we went for it and put a down payment of 30,000 shillings. The product is normally used for decoration and is waterproof because it’s commonly used in pools- which will help with its durability and cleanliness for the hospital. Five meters in length and 300 LED’s we figured we couldn’t go wrong! It was quite a relief to have our project set and the possibility of a great success. When we returned to the hospital we put our tubing and fitting onto the compressor and it worked like a gem, and super fast. Then we got called in yet again to the surgical theatre for two more devices to look at: a suction pump that was brand new but wouldn’t work and a drill that our favorite Korean doctor thought he’d maybe jammed after pushing into some bone to hard. We ended up staying at the hospital until 5:30 just trying to open both and agreed to continue with them on Monday.
Wednesday, we continued trying to fix the dental unit we’ve been working with off and on the past few days. The sprayer just doesn’t want to work properly! We know there’s some type of pressure build up that’s stopping the water but it’s been super frustrating seeing such poor designs in alignment. After giving up on that yet again, we moved on to another problem in the lab. We had checked out the machine last Friday and finally had time to check it out. First off, the first thing we noticed was a leak in the pressurized cleaner container so that was our first step. One of the plastic rings to create the seal broke right off so our best solution was to start with some silicon and waited until Thursday to work on it more. We were then called into the new surgical theatre again for another piece of equipment: a huge autoclave. A fundi had recently re-wired two autoclave outlets in order to set up another autoclave which ended in one being connected wrong. We were sure right away that it was the power supply because the autoclave’s alarm sounded and a light next to “heater failure” was flashing. At the end of the day we also finally got to view that the hospital does indeed have an inventory. It’s not completely accurate, but a good start!
On Thursday, we spent half of the day finishing the seal for the Wellwash machine and reading/showing one of the lab workers the online manual for it. I’d imagine it’d be pretty hard knowing what to do with a machine you never got instructions for- especially one with over 20 buttons/switches! The seal was finished off by cutting a new plastic rim out of an old hazardous waste garbage can and a lot of silicon. By the time we were done, we had it running just as it’s intended to by rinsing out trays that hold blood samples. After that, we went to the surgical ward again to try and find some more details about the power supply. After testing the three-phase box it is attached to, between two of the lines the multimeter read 0 volts instead of around 400 where it should be like the working one. We, of course, are not electricians so we have some brainstorming and research to do and need to know how to shut the power off before wiggling around the wires.
Today was pretty darn exciting! We arrived at 9:30 and within 10 minutes a staff member came over to the storage department saying the doctor in the new surgical ward needed our help with a table. Turns out the operating table that is specialized to be used with their C-arm x-ray machine was refusing to go back down. When we entered it was as high as it goes, without budging at all. After figuring out it was hydraulic and that it was the piston that wasn’t able to move, we ended up having to tip it over on its side- spilling oil ALL over the floor! That made it pretty messy from the beginning. After draining the oil, Soren and I worked on continuously pumping the foot pedal and forcing the piston to clear out the oil. Eventually it started sliding up and down easily so we set it back up on its wheels and tested it out. Then after a few adjustments with the foot pedal, we had to go buy some more oil from a nearby station. We poured the entire container of oil in and tested it out and it started working quite smoothly! As it got higher, it made noises like it didn’t have quite enough oil to reach the top so after coming back from lunch (which was delicious at Shanghai Restaurant) we bought another container and topped it off. We tested the table a few more times and it’s pumping up and down just fine. I texted the head doctor and he was so happy that he said he’ll be taking us to lunch tomorrow! By then it was almost 4:00p.m. and our department was closing so we’re planning on fixing the things we had in mind today, tomorrow!
Go to www.kupikiatanzania.com for all the details on my cookbook!!!