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! After sleeping in after a long night of dancing, a group of us headed out to get some ice cream and visit the Arusha Cultural Heritage Center. It was a gorgeous day to walk around so it was perfect to head over there. The center itself is shaped like a huge drum and shield with tons and tons of artwork and sculptures inside. It was fascinating to see all the different paintings, beadwork and photography they had to offer. After that, we headed back fitting 6 people in a taxi- which led to me sitting on a lap of course. I then packed up quick and headed to my host family’s house once again with plans to make a wonderful spaghetti dinner for my mama. Turns out she didn’t get my text about me making dinner so food was already ready when I got there! We talked over dinner about all sorts of things. It is always good catching up with my ol’ roomie Ash-girl to see how everything is going at her hospital in Machame as well. Sunday morning I had a wonderful pancake breakfast and headed to Cradle of Love for the third time to play with my favorite toddlers! They were ready and waiting to be played with so that was fun and then left after feeding them delicious ugali, beans, and mchicha. It was the coolest thing on Friday, I had been awing over a set of orphan twins whose mother had died giving birth and it turns out that after a couple days of care at Mt. Meru, they are actually going to Cradle of Love (picture of them below)! That was kind of neat to see that Cradle of Love was contacted right away, and they take such good care of orphans right when they are born. Then, since Aubrey’s host mama works as a cook at the center we took classes at last month, so we got to eat lunch for free- a meal they usually charge $14! YUM! Then, we headed to a festival called Nane Nane, which stands for the date 8/8. Although it is actually Monday, they have the festival all weekend. I had no idea what to expect and it ended up being very similar to a county fair with a lot of agricultural products. It was really neat to see! Also, I lived on the wild side this weekend and took my first piki piki ride (motorcycle). Instead of being packed into a tin can with 25 people, the alternate is to ride a motorcycle with no helmet! It was a lot of fun and I actually felt quite safe after telling the driver to go pole pole. And since it is a national holiday, none of us went into our hospitals on Monday so I stayed at my mama’s Sunday night again and finally cooked her a dinner. Monday was spent relaxing and getting some groceries for the next couple of days. Today was not too shabby- In the morning we headed to the dentist office to continue to work on a piece of equipment other EWH students had started on last month. The machine itself looked in decent condition but one of the main tools- a water/air sprayer had not been spraying and air was leaking out of the handle. After some epoxying and figuring out the water trigger, we were able to get it mostly running. There is a loose rubber ring in the handle making the water unpredictable. First thing on Monday, we will be coming up with an alternate seal. Also, I checked back in with the lab and they found the other piece of equipment that isn’t working/programmed properly so I’m hoping just by googling it I can find the general manual since they don’t have one. Soren and I packed up around 4 p.m. since that’s when the storage department workers head out. Instead of leaving, I decided I’d go and check in the newborn room if they were using any of the equipment we had fixed. Turns out, they were! The oxygen concentrator we fixed the first week was on and running with the preemie I had seen all week, baby James (his picture was in one of my last blogs). It was great to see them using it, but it was not so great to see the little guy having such a hard time breathing. The nurse on duty was really nice and let me walk around and watch her do her work. It is amazing how much responsibility is placed in one person’s hands at the hospital. She had the evening shift from 2:00-6:00 and was the ONLY person on duty, can you imagine trying to take care of over 20 newborns, some who are in respiratory distress!? Little James, about a half hour after I was there, stopped breathing so the nurse had to direct all of her attention towards him trying to get color back in his pale blue skin. I couldn’t believe how “easy” or natural it was for her to do so. Once he was breathing again, she continued her work with the other babies administering shots and asked me to keep an eye on him. While she was feeding a baby, she asked me to repeat what she had been doing with him by basically squeezing his chest baby CPR style since he stopped moving. That was a pretty crazy experience seeing him start to breathe again. The nurse would also flick his little feet to get him to react which seemed to help a lot. At the end of her shift she had to sit down and do paper work in the little office next to the room so she appreciated that I’d watch to make sure he kept breathing and in the mean time, I asked if it was alright to hold some of the babies that were crying. Nothing like holding a little life in your arms and having her fall asleep within minutes of feeling warm and safe! I ended up leaving around 6:15 to be able to walk home before dark, but was so glad I stayed a little extra :) After that, I came home to cook some dinner and just relaxed until around 11:30 where a few of us tried out another Tanzanian club- Triple A. It was super fun and filled with almost 4 hours of straight dancing. I’m pretty good at keeping up with the locals now and of course always love to dance as long as there’s good music! Wednesday was a day of slow progress, but slow progress is better than nothing! Soren headed out into town right away to find some parts we needed- a capacitor for a compressor and oil for the scale we had worked on which had too much rust everywhere to work properly. While he did that I continued to test the incubator and write out a guide for the nurses to use for setting the temperature. As simple as the machine may seem, there are actually quite a few steps and general things to know for when the alarm will go off and what will happen at different temperatures. Now one of our biggest concerns is that we’ve been getting many requests to fix personal items such as tea kettles, radios, and irons! Of course everyone assumes if we can fix big machines, we can fix the smaller, more “simple” things. It’s good to make friends through this but mainly a waste of time and energy when it can be put elsewhere. So from now on, we are just going to say we can only repair medical equipment. I am quite excited actually to be able to now problem solve on my own electronic devices at home if I ever have any :D When Soren got back from shopping, we finished calibrating the scale and returned it to the TB ward. Then we did a quick fix on a water heater (there are so many different varieties of water/food heaters here it is craziness) and went into town to get extension cord wire. Since we’ve been working outside, it has been really hard testing things since we have to find somewhere to plug it in! Luckily we found a place with a good cord and got 10 meters so we can work better Thursday: Wednesday night I ended up typing up a manual with some pictures so the incubator would be ready for instruction and use. Nuru let me know in the morning that the labor ward had requested my assistance when I could and it ended up being yet again another problem with the entire power supply of the building. Almost all of the fluorescent light bulbs are out because they blow out immediately when installed in the faulty wiring. I wish I could think of something to help but even if we bought stand up lights, they’d need to be plugged into the wall which is all wired wrong. I’m still brainstorming! After lunch we delivered the incubator and I gave one of the main nurses we’ve been working with the instructions and showed her how to use it. It’s hard to say if they will end up using it. There are SO many babies born each day that it’s almost silly just to have one incubator and all the rest laying out in beds in just as warm of an environment. We got the oxygen concentrator -turned air compressor up and running with a new starter cap. All we need to do is find some hosing and a correct fit to be able to pump up all the hospital wheelchairs! Today we finally got to return the rest of the equipment we’ve worked on the past week. Sometimes it’s hard to remember who exactly dropped anything off since there are so many different departments. This morning we met with the head doctor to discuss the major problem in the labor ward. With our multimeter, we tested most of the sockets in the labor ward and have concluded that instead of the ground wire hooked to ground with a 0 voltage reading, it’s also connected to the live wire. This makes the circuit live at ALL times. Not only is this a safety issue but the equipment can easily fail as well as the blow out the light bulbs. The head doctor was apparently aware of the problem but could do little to fix it since the company who renovated the building keeps saying they’ll come back to fix the circuit. We wish we could do it ourselves but it is just not a reasonable tasks since I know very little about wiring an entire building. Our next big project was to tackle two more pieces of equipment from the antenatal ward: an incubator and an electronic scale. The scale just needed some new batteries and a tape job so that was ready in minutes! With the incubator, we had asked what was wrong with it and the nurses replied it never worked since being delivered. After switching the male plug to one we could stick in our testing socket, it miraculously started working! I am guessing that for the most part, the staff just doesn’t know how to operate it since there are no others in the department. I spent the day cleaning it because it had basically been used as a storage unit for who knows how long. We tested the incubator out all day, figuring out when the alarm sounds and what the settings are. The biggest challenge now will be to train the staff that can use it. It may seem silly, but even the simplest of machines won’t be used unless of course the user is completely comfortable with operating it. Since this is the only incubator I think it’s really important to ensure they start using it. |
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January 2013
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