nicaequipo2010's posterous

Defibrillator at Ocotal

Mon, 29 Mar 2010 10:54:00 -0700

We visited a hospital in Ocotal and this is one of their defunct defibrillators.

As you can see, Michael bravely volunteered to run the risk of electric shock for the sake of D-lab, but nothing really happened except we got some incorrect EKG readings.

ciao ciao
grace

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Outside the Sabana Grande Clinic

Sat, 27 Mar 2010 11:56:00 -0700

We happened to be outside the clinic when this ambulance drove up so we pounced on the driver and a nurse and interrogated them a little bit.

i think you can add annotations/translations by clicking on the video, which takes you to the actual youtube page and near the top of the page next to Edit Video, there's a tab that says "annotations."

ciao ciao! grace

- Note: the annotations don't work for some reason when you follow the link to youtube. However, they are enabled when you follow the link from an email. I'll send everyone a link to each video so that you can add anotations. See everyone on Sunday!

Michael

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Planning while en route to the Central Hospital in Esteli

Wed, 24 Mar 2010 09:36:50 -0700

Caroline, Vicki, Krithika and the rest of the DLab Health team brainstorming in the back of the CARE truck about what questions to ask the nurses, doctors and lab technicians at the central hospital in Esteli.

where do you get your technology?
What are the main differences between the hospital and the health center?
What post-treatment services are offered?
What are the most common problems you see?
If you could redesign your equipment what features would you add?
What causes the technology to break?

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Hola! (Addition to post 3/23)

Wed, 24 Mar 2010 08:35:40 -0700

We started off early at the Children’s Hospital in Managua- the only Hospital in Nicaragua that solely specializes in pediatrics. The Hospital served children less than fifteen years of age in all specialties. We were impressed by the director’s introduction and willingness to help us. After lots of general questions, we proceeded to split into three groups (lead by our Spanish speakers) and visited areas of the hospitals that would allow us to explore their technologies.

Group I

- Major Lab and Autoclave Storage/Shop

o Very high-tech new equipment but that was hindered by the old and failing technology that supported it. One of the autoclaves had exploded due to pressure failure and no one had fixed it for over two years. Want to explore possibilities to maintain equipment in a hot environment.

Group II

- Oncology Lab, Intensive Care Unit III (Grave cases, mostly pneumonia in newborns and young children), and Neo-Natal Unit

o Many of the oncology lab machines were not atomized thus coagulation, counting cells, me stasis, etc took considerably longer and had to been performed in series. We want to explore how to speed up the manual process and ways to minimize human error (example, in manual coagulation, test tube is held up to the light and “eyeballed”, rather than using laser in automatic machine); multi-patient testing techniques.

o In intensive care unit, major problems with the filter for ventilator. Filters were disposable and when the hospital would run out, they had to wait for up to a month for money to collect so they could go buy a packet of 100-200. Meanwhile, the machines were used without and would daily need to be replaced by an entirely new machine while it was cleaned for use. Want to explore ways for low-cost permanent filter that could be used for back up.

Group III

- All Intensive Care Units, Nephrourology Department, and Neo-Natal Unit

o ICU’s: monitors always had problems with their pulseoximeters. Machines were around 8 years old and the sensors and/or computer would fail. There are no local parts, so when something breaks it is difficult to fix. They keep adding machines to support the process so 3 machines end up doing the same work as one.

o Nephrourology: For dialysis, the filters for blood were really expensive, around $5,000 for 10 patients. Want to explore vital signs monitoring made from locally available parts.

Jose finally joined us, battered from three days of traveling from Japan! After lunch and repacking, we set off to Esteli, and spent the night bonding all in the same dorm room! Almost like summer camp, but in Nicaragua. We are now spending the first hour of the day sipping on fresh juice concoctions (most interesting is probably the mint, watermelon, lemon and cucumber juice!) Until next time!!

Best,

Caroline

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Los aventureros!

Wed, 24 Mar 2010 00:50:00 -0700

Hola! So I can't quite figure out how to attach videos yet because all of mine are too large, but we've got some good ones. Anyway, today at La Mascota Children's Hospital, Kristin, Divya, and I visited the Nephrology department where we got a look at their dialysis machines, the three ICUs, and another NICU.

See the full gallery on Posterous

The three dialysis machines in Neph cost $4300 per machine per month to run. A large part of the cost are these one-time use "triacetate hollow fiber dialyzers," which are very, very expensive (left silver bag in picture 1, we've got better video of it). The kids who need these come in 2 or 3 times a week (schedule, picture 2)! When I asked one of the kids, "Le duele?" he nodded his head and he looked SO SAD.

In the ICUs, the most prevalent devices included ventilators, pulse oximeters, EKGs, incubators, and nebulizers.

Here is an ambubag that the nurses had tied a glove to; Agustin (the technician who was giving us the tour) seemed a little embarrassed but I think he said it was for sterility (picture 3).

This (picture 4) is a Braun compact perfusor donated to them, which doesn't give the right amount of medicine because the syringes provided by the Minsa (Minesterio de Salud) aren't exactly the right size. They are still okay because although the diameter is a little bigger, the syringes still fit into the clip. This could be a cool lab though, maybe to make a perfusor with an Arduino? It seemed like the clip can accommodate slightly different sizes, but probably nobody has time to calculate different pushing speeds for different diameters. It would be better if the device made calculations internally and had a more intuitive interface, like the nurse could enter an amount of time and amount of medicine and the machine could figure it out. Probably not a big enough problem to spend more than a week on.

The rest of the equipo (picture 5...I don't know who the lady with the baby is??) visited other places in La Mascota, and then Jose arrived! We spent much of the day traveling, and now everyone else is asleep in our hostel in Esteli.

Ciao ciao!

Grace (the ave-averse one)

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Day 2!!

Tue, 23 Mar 2010 15:01:47 -0700

Day 2!!

Packed day. Woke up EARLY to delicious breakfast, then went to the Univerisdad Nacionale Ingenieria to talk to the team building solar-powered autoclaves.
Then, went to CIAS, a public health teaching center, where we visited the D-Lab outpost there. Also talked to a doctors about their frustrations with kiddie nebulizers and arsneic poisoning problems, got some really useful information.
Visit to hospítal was delayed so instead we CLIMBED A VOLCANO. It was great. Much billowing sulphur.
Gatecrashed a small health clinic (in Monimuo), much to the suprise of the head doctor. Got a chance to talk to him, to some other doctors and some patients.Found a lot of interesting design challenges, to do with nebulizers, diabetes, remote diagnostics, sterilization, and some others (which you will hear about later, when we have more time...). By chance came across the medical equipment delivery truck as we were leaving, got to ask them some questions and help them carry the boxes in.
Went back to hotel after a delicious meal, and spent a looooong time

Currently up late playing "contact", but will be up bright-eyed and bushy tailed for hospital visits and Jose-collection tomorrow.

- Bird-Friendly Grace

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Visiting IIH's H-Lab in Managua

Tue, 23 Mar 2010 10:51:12 -0700

The D-Lab health students felt right at home visiting the H-Lab In Managua at CIES-UNAN, the school of public health. The lab is full of prototyping materials and tools which allow medical professionals to design and develop medical devices beyond the typical constrains of their work place. Here the students are exploring the drug delivery material available-- they proceeded to bring a dinosaur inhaler (designed for children) to lunch, Whig served as a talking piece for a doctor who explained the difficulties she has administering medicine from a nebulizer to her four year old child.

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THE PINK PEOPLE!

Sun, 21 Mar 2010 21:55:12 -0700

We were trapped in the last row of the plane behind about 6 rows of people with bright pink shirts, singing "Party in the USA" like they had all popped out of High School Musical!

.... I love High School Musical.

In other news::

The woman sitting next to Mary and me was returning to Nicaragua for a family reunion after 30 years of distance! Also, she thought I was Nicaraguan. SCORE.

I received a wonderfully random high five from one of the pink people.

We were greeted by the warm humid air of the Nicaraguan night, "like a welcoming blanket" quote Kristen

Fruit here is unbelievably heavenly

Mango attacked Amrita

Anna went over the 3 levels of healthcare in Nicaragua: Hospitals, Health Centers, Community Posts

Brainstormed good questioning skillz, went over trip itinerary

ICEBREAKER: telephone pictionary aka Learning Lady Gaga.

-Krithika

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We're flying on a Sunday at noon...

Sun, 21 Mar 2010 00:14:21 -0700

Make sure you get to the airport with plenty of time to spare!

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