EWH - Central America 2010

Pura Vida!

2010-08-18T11:34:00.000-06:00

Program Wrap-up Meeting

Well, we are done working at Hospital El Progreso. We managed to get a few more machines repaired our last few days, and had a nice send-off from the maintenance staff. We headed to San Pedro Sula on Friday evening to meet everyone else for dinner, and headed to the airport at 4:45 Saturday morning. Our flight got into Managua at about 9:30, and we got to the hotel at about 11. The conference started shortly after that, and it was fantastic to see all of the other students!

However, I was not terribly impressed with the conference proceedings. We were briefly introduced to the EWH board and administration, and while they seemed to be generally nice people, most student's interaction with them was very limited. A few students were interviewed by either members of the EWH board or industry sponsors, but instead of having free-flowing conversations about our experiences, exchanging thoughts on what we thought could be improved for coming years, and being able to provide meaningful feedback about the program, we were asked a series of cookie-cutter questions that were not followed up. It seemed to me as though the administration was more concerned about giving the appearance of accepting feedback instead of being really interested in what we had to say, but others may have gotten different impressions. It is really a shame, since in my discussions with the other students, I have heard dozens of simple things that might really improve the program as a whole. I am sure that we will find a forum to pass these thoughts along, whether they are welcome or not :)

The bulk of the conference was filled with student presentations, some of which were quite remarkable. In particular, the final group to present had made a really impressive video and written new lyrics to a couple of songs, which they sang with gusto. It was a terrific way to wrap things up. Things pretty much tapered off from there, with people gradually heading to the airport to fly back home.

As the program was finishing up, it kind of started to sink in that our impact at the hospital was meaningful for them on the short term, but will probably have very little long-term impact. This week, the hospital will still be without a BME technician, and the broken machines will start piling up again. I guess I had not really considered what would happen when we left, but it was a tough realization to accept. But looking back on things, I think it would be very difficult for people in our position (non-experts who don't speak the language and don't have any authority) to make a long-term impact here. If I get a chance to contact people who are going on the trip next year, I think that (and a couple of other things) is something I would make sure to pass on.

Overall, I really enjoyed my summer in the program. I learned a lot about the developing world, engineering, NPOs, and a lot about myself as well. I have a lot of terrific memories of the machines that we fixed, places that we visited, and things that we saw, but my most cherished memories will be of the people that I met. The other EWH students that I got a chance to get to know and spend time with really made the program entirely worthwhile. I will not soon forget the conversations/debates/philosophical arguments that we had, or the frequent rants about mundane frustrations, or the jokes that we shared at each others expense. It was a very unique group of individuals, and I hope that we are able to keep in touch!

But enough sappy reminiscing. This week I am back in Costa Rica, getting in my kicks before I get back to the US. Tyler is coming in to San Jose tomorrow, and we will be heading to the Caribbean coast. (I am sure we will get into a little trouble, but hopefully not too much...) I am really looking forward to traveling and hanging out this weekend, and then really looking forward to seeing the family on Sunday!

I might update again, or maybe not. Regardless, I hope you have enjoyed some of the stories and thoughts. I have certainly enjoyed providing them! Thank you also for your support, it has been very much appreciated. If you are thinking about taking a trip to Central America and have any questions, please let me know!

I look forward to seeing everyone back in the US. I hope that your summers have been going well too!

Adios,
-Eric

Almost done at Hospital El Progreso...

2010-08-11T22:51:00.003-06:00

Things at work have turned around a bit since the last post. Well, things are actually largely the same, but I think that I have changed my attitude about them somewhat. Anyways, last Tuesday was a fairly interesting day, as we started things off by 'learning' how to 'weld'. I say 'learning' because I really had no idea what the guy was saying to me or what he was trying to convey, and 'weld' because I think even an inexperienced welder would shudder at the sight of the connections we produced. Regardless, it was really cool to fire up the machine and let the sparks fly! I definitely was learning through trial and error, and had quite a bit of the latter. Within about 5 minutes of getting started, it seemed like the whole maintenance department was circled around myself and Marcello as we fumbled around with the equipment and tried not to look terrified. (For those of you who are interested, I think we were using the SMAW welding technique. All I know is we had about 70 Amps running through that thing... enough to do more than a little damage!) We finally managed to get some decent-enough 'welds' to join some lengths of chain to hooks, which we used to secure oxygen tanks to the walls.

Not sure if it is supposed to spark and smoke like that, but it was a lot of fun...

The chains, in action.

Later Tuesday, we were installing some of these chains in the surgery recovery room, and got some interesting news. It turned out that there was a partial hip replacement surgery about to start next door, and we were invited to watch! I had never seen a surgery before and knew how violent orthopedic procedures could be, but thought I would be able to handle it pretty well...

Nope.

For whatever reason, the surgeons had barely put scalpel to skin before I started feeling lightheaded, and after about 10 minutes (or maybe less) I had to go 'get some air'. I tried going back in a few minutes later, and only lasted a few minutes more. I took a brief walk, sat down for a while, and headed back for another try. This time, as soon as I opened the door, I saw the surgeon swinging a hammer like John Henry and pounding a large-ish metal pole into the patient's femur. I immediately turned around sat back down for the remaining 90 minutes :) I'm not sure why it happened that way, but I have redeemed myself in the past couple days. Yesterday we witnessed a laparoscopic gall bladder removal, and today we saw a neurosurgery where the surgeons excised a tumor from the parietal lobe... and I didn't have any trouble with either one. I'm guessing the orthopedic surgery was a bad choice to open my surgery-viewing account. I hope we get another chance to see more surgeries in the next couple of days, the are really remarkable on a number of levels. The part I find the most impressive is the coordination between the different members of the surgical team. They are all focused on performing their own tasks, but are aware of everything else that is going on and known what needs to be done if unexpected circumstances arise. Really impressive stuff to see, and I'm glad my stomach has thickened enough for me to do so.

Anyways, after the laparoscopic procedure, we got a chance to speak with the surgeon about some of the equipment she was using. Apparently, she had been having some trouble with some of the ESU probes that were used for that procedure, and showed us what kind of shape they were in. Some insulation had been worn off on the shafts and near the tips of a couple of the cutting/coagulation probes, and someone had tried to patch them with electrical tape (a really bad idea, since it is not very biocompatible, virtually impossible to sterilize thoroughly, and had begun to unravel and interfered with the laparoscopic access ports). We knew that heat shrink tubing would probably be the best way to repair the probes, so we have been on a two-day hunt for the appropriate tubing in both El Progreso and nearby San Pedro Sula. We eventually found something that would work this afternoon, after trying about 6 different stores over the past 2 days. We are looking forward to trying it out on Thursday!

Update: it worked!

The tip in action, inside of a patient.

This Saturday, the entire group of EWH students is heading to Managua, Nicaragua for the end-of-program wrap up meeting/conference that will last until Sunday afternoon. I am not necessartily looking forward to the proceedings, but I am very much looking forward to seeing everyone again! It will be good to catch up with the people who we haven't seen for a while, and get a chance to say our goodbyes. I cannot believe things have gone by so quickly.

I will probably update again after the conference. I will be staying in Central America for another week after that, mostly just because I can :) I am excited about getting a chance to relax and really take in the culture and sights in a more laid-back atmosphere.

Until next time!
-Eric

Illegitimi non carborundum

2010-08-02T18:06:00.003-06:00

Frustrating day at work today. Nothing got done, despite our best intentions. We have decided that our 'secondary project' will be to install chains around the freestanding oxygen tanks all around the hospital. I know, it doesnt sound like much, but these tanks can be extremely dangerous if they are bumped and fall over. Anyways, we went to the hardware store with two other maintenance workers, and what should have been a 30 minute trip turned into almost 3 hours. Just a ton of wasted time, and it was incredibly aggravating. It didn't help that I couldnt ask them what we were waiting for, or if we were heading back soon, since my Spanish isn't what it used to be. But anyways. We got back a little bit before lunch and tried to track down a drill so we could install the eyelets in the walls. We got one, which promptly died. We were told that someone was using the other one (there are only 2), but it would be free in an hour. We wound up leaving at 2:30, without ever seeing the drill, or getting our hands on any new equipment to fix. So it goes. I looked at the calendar today, and saw that we only really have 7 or 8 more days to help out at the hospital... I am hoping that we can avoid having more useless days like today.

Copan

This past weekend, we went to the Copan Ruins in western Honduras. The ruins are what remains of a massive Mayan city, which was occupied from around 620-1550 AD (maybe? I actually have no idea...). It was really incredible to see. Gotta say, I felt a little bit like Indiana Jones.

That evening, we hired a driver to take us to the hot springs a little ways outside of town. For whatever reason, instead of getting a small bus or other large vehicle, we wound up standing in the back of an old pickup truck for the 60 minute drive (on winding and hilly dirt roads, no less :) ). I have had some discussions with other EWH students about the best way to really get the feel of a country, and until Saturday we felt that there was no better way than to go on a cross-country motorcycle (or bicycle) ride. We have since revised that sentiment. Even though parts of the trip were absolutely terrifying, the ride as a whole was unbelievable. Wind in our faces, looking around at all the scenery... it truly might be one of the best parts of the trip so far.

We were very glad to get our feet back on solid ground.

As always, it was really great to see everyone, and I am looking forward to next weekend. Some of us are heading to Gracias-Lempira, and going on an overnight hike to the top of the highest mountain in Honduras... nbd.

While days like this sometimes pass slowly, the summer itself is flying by. I am looking forward to having a settled stomach, getting some restful sleep, and of course seeing friends and family when I get back in just a few weeks!!

Hasta!
-Eric

Another short update + Roatan

2010-07-30T07:17:00.001-06:00

Work

Work is still going well, and we found some things to work on this week. On Wednesday, we even had a brief training session for nurses in the maternity ward on how to use the incubators we found in the bodega. (During the last week in Costa Rica, we wrote some 'quick start' training guides for some other kinds of equipment. I never thought we would actually do that sort of thing at the hospital. But, as with most of my assumptions this trip, I was clearly incorrect. Hi ho.) It was pretty hectic, as it seemed as though something that should have taken 5 minutes took an hour. There were points where it seemed as though everyone was talking loudly at once, and nothing was really getting accomplished. I think we eventually got everything ironed out though, but we told them to give us a call if they have any trouble with either one of the machines. I guess we will see what happens.

Hanging out with the nurses after the training session.

Some of the equipment we fixed this week: two suction pumps and a surgical lamp.

The Food

Let me first say that on the whole, the food here has been very good. I hate to sound ungrateful, though, but there have definitely been times this week where I have been less than happy that it was time to eat. It is sometimes difficult to look forward to the same kind of food over and over (particularly when it is so unhealthy). I went into the trip with the mindset that I would eat whatever was put in front of me, and I was doing great until I encountered 'chicharron'. I didn't know what it was when we got it, but I only took one bite and couldn't go any farther. (We had it at home and at the hospital, on consecutive days no less.) I checked into it later on, and I think chicharron is basically an even less healthy version of pork rinds, sometimes served in soup form. So yeah, I don't think that is going to happen.

Roatan

Last weekend we went to Roatan, the largest of the three Bay Islands off the north coast of Honduras. All of the guidebooks said that it was one of the most touristic and expensive places in Honduras, but also had some of the best beaches and snorkeling in the world. I had never been snorkeling before, so I was really looking forward to that, but just kind of figured that the beach would be like the ones we had seen in Costa Rica (kind of a 'you see one, you have seen them all' kind of thing). Apparently, though, Caribbean beaches are a different breed. We went over to the island on a ferry, and then took a water taxi over to the West Bay area. The water was a color that I had never seen before, a very clear, very deep blue. It was very warm, but in a good way, and there were virtually no waves. It really felt like I was swimming in a massive pool, along with some very brightly colored fish of course.

This picture was not taken from a website. I promise, it actually looks like this.

Seriously.

Anyways, we managed to get in 2 snorkeling trips, and that is something I need to do again. We caught a boat that took us out to a huge reef, where we were free to swim in any direction for about an hour. The reef and fish looked like something straight out of an aquarium. The reef was not very brightly colored, but was really impressive to just look at. It went as far as I could see in almost every direction, which was pretty far in that water. There was a large trench that ran down the middle, which was the favorite area for the more intrepid snorkelers. The fish were everywhere, every size, and every color. In each hour we were down there, I think we might have seen 1000 fish. It was really very cool, and fascinating to see fish in their natural environment. But the thing that really caught me off guard was the noise. Whenever I wasn't breathing in or out, I could hear the fish nibbling on the reef. It was not a loud sound, but one that was ubiquitous and definitely unexpected.

On Saturday night, we found a very nice bar that had a couple of couches lined up on the beach between the palm trees. We were able to watch the sunset over the water, had some dinner, and enjoyed the nightlife :) All in all it was a great weekend.

Gratuitous beach shots. Sorry, I just can't help myself.

Thats all I have for now. This weekend we are heading to the Copan Ruins! I will be sure to write about it, of course.

Have a good weekend!
-Eric

Week 1 in the Hospital

2010-07-27T17:03:00.000-06:00

So we just finished our first week as actual volunteers in Hospital El Progreso. As I said before, I didn't really know what to expect, but went in with some ideas about how best to get things started: meet the right people, get on their good side somehow, show them that we can be productive/helpful workers, and then just wait for the equipment to start rolling in. Turns out I had a few things to learn about that too :) The first couple of days, I tried to be patient and let things run their course. But at some point on Wednesday, we realized how quickly the month was passing us by, and we didnt really have time to lay 'groundwork' and let the work come to us, so to speak. Up to that point, we had been cleaning nebulizers and dials, and basically just putting the finishing touches on some other equipment before it was sent back to the hospital. Since then, we have been trying to work around the normal 'chain of command' in the maintenance department, and see if we can find someplace where we can make a real contribution.

On Wednesday afternoon and Thursday, we were able to speak directly with doctors and nurses, as well as the head of the maintenance department (Jorge, who had been out on holiday). The head surgeon came to us with a suction pump, which we were able to fix that afternoon and get back to her the next morning. After that, we got our hands on an IV infusion pump, and helped the nurses translate the users manual so they could avoid an alarm that they had been getting. We were sent another suction pump on Friday (which had another simple problem), and will be sending that back soon. In all, we have gotten about a dozen pieces of equipment into service, which is a lot more than I expected for the first week.

Marcello looking at an anesthesia machine (one of the things we haven't repaired... yet).

The inside of one part of the bodega. Piles of pills, disposable equipment, etc, laying on top of a perfectly functional incubator that the nurses don't know how to use. We are having a training session on Wednesday, hopefully something sticks!

My favorite repair happened on Friday. The surgeon came to us with a large electrosurgery unit, which they were using for laparoscopic surgery. If you are not familiar with these things, they output a huge amount of wattage, and basically act as a scalpel that cuts using electrical current. (In other words, they can be kind of dangerous if someone screws up the repair.) Anyways, the surgeon came to us saying that the unit was only working when it was set to extremely high wattage, and was not functioning at all at lower settings. We initally told the her that we did not have any experience with the inner workings of these kinds of machines and that they were very dangerous. We took a look at it anyways, and tried to use the machine on a piece of liver that we got from the hospital kitchen (they were cooking it for lunch that day - que rico :) ). We were able to reproduce the fault, and took a closer look at the cables and dispersive electrode. Long story short, we were able to identify a broken connection, and fixed it with a new clip and a bit of solder. Even though it was an incredibly simple fix, it kind of felt like we had achieved something... and I didn't think that would happen the first week (if at all).

All of our 'fixes' have been really easy and basic changes, so I am thinking that we are getting our hands on the low hanging fruit and our output might start slowing down soon. But regardless, it feels really good to give equipment back to the clinicians, and see how our work helps them to do their jobs and help more people.

Anyways, thats all I have that is work-related. Next post will have some pictures from our weekend at the most amazing beach I have ever seen...

Adios!
-Eric

At Hospital El Progreso

2010-07-21T19:08:00.000-06:00

We started working at the host hospital on Monday. It is a very small hospital: two floors, maybe 50-60 beds, and only 3 main wards (Emergency, Matrnity, and Neonatal). On the first day, we got there at around 7:30 with our host Marvin. We were introduced to the head BME technician Juan Carlos, some more of the maintenance staff, and a few of the administrators. Juan Carlos really helped us get our bearings, and took us on a brief tour of the hospital. I had thought that my Spanish was at a level where I could understand at least a good portion of what people were saying, but I quickly realized how wrong I was about that. When people speak with us, I can generally pick up the topic of the conversation, but often have no idea about what is being said. I also don't think I have said more than a few dozen words over the past 3 days. Luckily, Marcello is quite good at the language, and is doing nearly all of the talking and conversing. I am kind of hoping that changes eventually, but I guess we will see.

The hospital is generally in good shape: it seems as though there are a lot of people who come through each day, see doctors, get treatment, and leave better off than when they got there. The BME equipment maintenance and inventory, though, seem to leave something to be desired. The maintenance staff focuses on the building and upkeep, and doesnt appear to spend a lot of time or energy on the machines. On Monday, we had 6 nebulizers on the floor of our workroom, which had been brought there by the nursing/clinical staff for repair. We were able to 'repair' all of them by early afternoon simply by cleaning them inside and out, and loosening up the rotor of the electric motor. We also found some infant incubators in the bodega/'inventory', which were much nicer and newer than the ones that were in operation. We expected to find some sort of major malfunction, but were very surprised to see that they worked. Perfectly. We are still trying to figure out why they were in the bodega, but are guessing they were not being used because the nurses were not used to the alarms and settings. If this is the case, we will be having a short training session at some point in the next couple of days. We have also opened up an anesthesia machine, and have identified a couple of major issues that we are going to look into. I am hoping that we can get some of the tubing that it needs, and we will see if we can get it up and running.

The home stay is still very nice, and the food is as good as ever (even better than CR!). The only hassle in addition to the oppressive temperature is the very random and very inconvenient inconsistent water supply. On 2 of the 5 days we have been here, there has been a significant interruption of the water line to the house. This is made even more unfortunate by the fact that the best way to cool off is to take a cold shower. Since we can't cool off, we sweat even more and get even more filthy, and even more in need of a shower. It is truly a vicious cycle :) Luckily the water usually comes back after 4-6 hours, so there haven't been any hygiene crises yet.

There isn't much of a nightlife in EP to speak of, so most of our afternoons and all of our evenings have been spent at the host house. I am looking forward to getting out this weekend and seeing some of the other EWH-ers on the north coast :)

Anyways, thats all I have for now. Hope things are going well back home!

Hasta,
-Eric

Honduras

2010-07-17T19:27:00.002-06:00

I just got into Honduras earlier today and have been getting everything unpacked/situated/etc. It is really hot here compared to CR!

Friday our Spanish class went on a field trip to the National Museum in San Jose. It was fun to take the class on the road :) . We saw some exhibits on the indigenous people of Central America, the Spanish colonization, etc. I think the Spanish classes were my favorite part of most weekdays (apart from the dinnertime conversations with the other EWH students living in our homestay). It was very cool to learn about the language and the culture, and I enjoyed spending time with everyone in the class.

Class photo outside the museum: Michelle (the teacher), Sarah, Manu, Amanda, me, Salman, and Denachi.

This morning we got to the airport at 2:30am for our 6:15am flight. We spent the previous evening having dinner with our host family, saying our goodbyes, and hanging out at the school. I cannot believe that a month has gone by already! By far the best part so far has been meeting and spending time with all of the other people in the program. For the second month we are all paired up with one other person and the pairs are spread throughout Honduras and Nicaragua... it will be different not seeing them all everyday.

Flory y yo, durante el ultimo noche en la casa de familia anfitria.

The Chinchillas, with our host mom Flory.

Gladys, the jefa of the language school.

Jens (far right) teaches everyone a traditional Danish drinking song.

The new host family is very nice. So far, I have met the father, the 2 kids (a ~15 y.o. son and a 10 y.o. daughter), and the grandmother, who is a really excellent cook. The house is really really nice too. We have a kind of guest house that is separated from the rest of the house, and it is perfect. I am looking forward to the next month!

Work starts on Monday, and I think our hours will be 7am-3pm. I am excited about getting our hands dirty, and hopefully bringing something helpful to the table. I will post about that when I get a chance.

Have a good weekend, and I will fill in more later!
-Eric

Keeping busy...

2010-07-14T18:18:00.002-06:00

Hola again! I am still in CR, but only through this week. On Saturday, everyone will be heading to their host hospitals in either Honduras or Nicaragua. I will be in El Progreso, Honduras, which is a medium size (~110,000 ppl) agricultural town in the northern province of Yoro. None of the guidebooks I have read have had many nice things to say about it, but that might just mean that there won't be many tourists (which is always a plus :) ). I think it will be an interesting experience, and can't wait to get started.

Anyways, the past 2 weeks have been very busy as we have been having class every day and have done some traveling on the weekends. We still have Spanish classes in the morning, and an engineering lecture/lab in the afternoon. We have also gone on 2 more hospital visits, and met with the technical staff at each. Two weekends ago, the whole group went to Manual Antonio National Park, and this past weekend a few of us took on a different kind of adventure.

Spanish Classes

The Spanish classes are still pretty intense, but I think we are finally starting to get the hang of them. We still have about an hour of hw each night, but it doesn't seem to be as stressful as it was a couple of weeks ago. Last week, we had to write a presentation on a specific piece of hospital equipment and present it to the class. (I was assigned the sphygmomanometer.) It took a while, but it was really cool to be able to write 2 (semi-coherent) pages in a different language! It was probably written at a pre-preschool level, but oh well. It was fun to see how far we have come in just a couple weeks of classes, and I think it might be an indication the teachers know what they are doing (sorry, Salman).

My favorite result from the Spanish classes occurred last Friday, when we went on a tour of the San Jose Children's Hospital. The tour leader was Martin Valverde, the head engineer for the hospital. As with most of the other hospital trips, Martin didn't speak any English. As we were going through the different wards and departments, there were short stretches where I think I was able to understand everything he was saying. I didn't really expect it, but it was really kind of a rush to realize that I could understand another language! There were definitely times where I felt like I was tuning a radio... every now and then I could pick up what they were saying, and some other times where it may as well have been static. All in all, it was a pretty good day.

Engineering Classes

Engineering classes and lectures have been going well. We have covered a few more topics, including anesthesia machines, EKGs, pulse oximeters, incubators, and some other common machines. In lab, we have been building some simple circuits: a small LED flashlight, a variable power supply, and a temperature sensor. I don't know how handy they will be in the coming weeks, but it has certainly improved our soldering skills if nothing else. We have also gotten our hands on some actual hospital equipment, both on the hospital visits and recently in lab. About a 2 weeks ago we toured the

hospital in San Ramon, and visited the different wards and the maintenance area. The hopsital was similar to the one we visited earlier in Turrialba. It was very well maintained, had a very good engineering staff and highly functional equipment, but again had very little patient privacy. I am not sure what to expect in Honduras, but if the hospital is anything like the ones we have seen in Costa Rica, then we might not have a lot of work to do.

We did get a chance to open up a suction pump (again), but this was a simpler repair. We were able to fix the control knob, change some valves inside the pump, and clean the diaphragm. We were able to increase the suction from 300mmHg to about 500mmHg, but I don't know if that was high enough to be returned to service. It felt pretty good to get our hands dirty again, and I am looking forward to do it again soon.

Manuel Antonio

On Saturday the 3rd, the whole group headed to Manuel Antonio National Park, in southern Costa Rica. It is one of the most popular places for tourists in the country, so I wasn't particularly thrilled when we first made the plans. It turns out that it is popular for good reason. We first saw the beach from the bus when we were still about an hour outside of the park, and I was blown away. It was the kind of thing you see on postcards! Fields of plam trees leading up to the beach, mountains in the background... very impressive stuff. Our hotel was directly across from the beach, so we checked in as soon as we got there and headed out to the ocean. The beach was beautiful: cliffs on either side covered with thick rainforest, white sand, lined with palm trees.

The waves were perfect for body surfing - if you didn't mind getting roughed up a bit. I have tried body surfing a couple of different places in Florida, but nothing compared to this. There were some waves that really turned me upside down. I think they are called 'lavanderias', which means 'washing machine', and the comparison is a good one. That evening everyone went out, and we had the best sangria I have ever had the pleasure of drinking, with a bunch of tropical fruit, bananas, and other good stuff.

On Sunday, we went into the National Park bright and early, and I was not disappointed. There are two separate beaches, separated by a thin strip of land no more than 30-40m across, and we had both pretty much to ourselves. The waves were even better (and rougher) than the day before, and there were some massive swells. At times, it was challenge to even enter/exit the water because of the waves. We found a trail at one end of the beach, and decided to take it. The trail went around the peninsula, and had some incredible views. We also saw a (small) monkey in the trees just off of the trail and some fairly large lizards running through the forest. When we got back to the beach, we encountered even more monkeys, traveling in a group of 12 along the beach. I hadn't seen wild monkeys before, so I was glad to check them off of my 'To See' list :)

All in all, it was probably the nicest/most beautiful beach I have been to, and might have been the second or third best beach trip I have been on.

Bungee Jumping

This past weekend, a couple of us decided that we should jump off of a bridge, so we did. I cannot believe I haven't done that before! I was a bit nervous leading up to it, and every time we talked about it I got a little bit nauseaus, so I didn't know how it would go. Anyways, we got there at about 8 in the morning, and pretty much pulled up to the bridge and immediately started putting on the harnesses. We didn't get any sort of preparation or instruction, but the process is really quite straightforward. It turned out to be more of a bungee fall, but it was a huge rush! I will definitely be doing that again, and encourage everyone I know to do the same!

The bridge was structurally sound, but jumping off seemed sensible at the time.

Everyone watches closely as Salman is strapped in... he was the first to go.

Right before the moment of truth.

Yes, I was nervous.

...but it was definitely worth it!

I will try to post again when we get to Honduras. Hasta Luego!

Life in CR

2010-07-01T00:35:00.000-06:00

Hola again! Things have been extremely busy here. I didnt intend to go so long without posting, and I hope to post more often for the rest of the trip. Anyways, Spanish classes and engineering labs started last Monday, we went on a hospital visit on Friday, traveled to Monte Verde over the weekend, and have been experiencing life in Centroamerica. I will try to update on all areas, one at a time...
Spanish Classes
... are muy dificil. We have Spanish class every Monday-Thursday from 8:15-noon, and by the end of every class I am completely mentally drained. The classes are taught in an 'immersion' style, and the instructors speak very little to no English. I have found that I can grasp the vocabulary pretty quickly, but have been having a very tough time with sentence structure, verb tenses, and all of the other fun stuff. (I don't know what 'subjunctive tense' means in English, which makes it even more difficult to learn in Spanish.) But overall the classes are going well. The teacher is patient, which is a must. The group is divided into 5 different classes, so there are only 6 other people in my class and the teacher can really tell who is understanding things and who isn't. We have homework each night, which usually takes me about 1-2 hours. The cool thing is is that We can now have (low-level) conversations with our host family. That was actually a pretty huge hurdle, and it seems like they have opened up just a bit since we have shown even the slightest amount of improvement. I am hoping that by the end of these 4 weeks, I will actually be able to a moderately sophisticated conversation with our host family.

Engineering Labs

Every Monday-Thursday afternoon, we have a short engineering lecture and a hands-on lab from 1~5. So far, the lecture topics have covered pumps, ventilators, anesthesia machines, blood pressure monitors, and a few other things. These mainly focus on the common problems that are encountered with these machines in the developing world, and some methods that we can use to fix them. The lectures and methods have been fairly straightforward thus far (and much of it has been a review of stuff I learned in Dr Geddes' class a few years ago). At some level, it is frustrating to hear about some of the problems that hospitals have with their equipment because it seems as though the repairs would be very straightforward if someone had the proper equipment and even minimal training. I am hoping that I get an opportunity to help out with this in El Progreso.

The engineering labs have primarily been circuits-based, which has taken some adjustment. I have not really thought much about circuits for 3 years, so I have been doing a lot of re-learning. After some early struggles with the soldering iron, things have been going fairly well. I am working with Marcello, who is the person I will be paired up with in Honduras. He is from Italy, and goes to school at Imperial College in London. He is extremely bright, and I am looking forward to working with him for the next 6 or 7 weeks.

A recurring theme in the lectures (and something we do not have a formal lab on) is the lack of a cheap and reliable way to test the oxygen concentration of an air sample. This is something that is very important when using ventilators or respirators, especially when they are used in conjunction with an oxygen concentrator. A few of us have been doing some brainstorming on a potential method to test for O2 concentration, and have started some experiments in our 'free time'. I think I need some new hobbies :)

Hospital Visit

On Friday, half of our group traveled to the hospital in Turrialba, which is about 2 hours outside of San Jose. I didn't really know what I expected, but I do know that it was an eye-opening experience. We first took a quick look at the machine shop, and saw some technicians doing random repairs. we looked at some old equipment, specifically an autoclave, BP monitor, and a couple of pumps. After a cursory glance at the equipment and talking with some of the maintenance staff, we took a tour of the hospital. The first thing I noticed was the near total lack of privacy. As we walked through the various wards, the beds were lined up against the walls and were filled with patients. There were no dividing walls, curtains, or any sort of separation between any of the beds or patients. I have never seen anything like it in the US. On top of that, the air was stuffy and warm, and only the neonatal ward had AC. Perhaps a lot of it has to do with cultural norms, but I think I would struggle to be comfortable if I was a patient in those conditions.

I was impressed by the technical staff at the hospital. They seemed to be knowledgeable and very much on top of things. According to the staff, the biggest technical problem that most hospitals face in CR is the lack of funds, not a lack of training or expertise. This diverged from what we had been hearing in the lectures and courses, but it is possible that the hospitals in Honduras are in worse condition and could use more technical help.

Regardless, things really started to sink in during the hospital tour. I realized how much more training we needed to become competent at repairing equipment, how much more Spanish I needed to learn before I could converse with the hospital staff, and how even small technical problems could be magnified if I could not communicate them to the appropriate people. I think I started to see some of the challenges that I might be facing this summer, and they seem to be pretty daunting. We will see what happens.

Monte Verde

On Saturday morning at about 6:30 we caught the bus to Monte Verde, which is around 4 hours northwest of San Jose. Monte Verde is called a 'cloud forest', which as I understand it is simply a rainforest in the mountains. Anyways, the busride was beautiful. For the entire second half, we were climbing through the mountains with really impressive views to either side. On every mountainside there was thick rainforest, which is remarkable to see in person.

We got to Monte Verde at about 11. The town itself is miniscule: it is basically 2 small city blocks on the slope of a mountain. We got to our hotel, and tried to figure out what to do that afternoon. We wound up going for the 'Bridges' hike through the forest, which turned out to be a massive tourist trap (whoops). The 3km 'trail' was nearly entirely paved (and we got POURED on), so even though the scenery was pretty cool, the hike itself was a bit disappointing. But oh well.

That evening, a smaller group of us were still determined to enjoy the forest, so we went for a 'Night Hike'. Awesome idea. Our guide, Bernado, was just terrific. He was extremely enthusiastic, and was clearly enjoying himself on the trail. We saw all kinds of different things: a strangler fig, some sort of blue-eyed newt, funnel-web spiders, huge katydids and crickets, forest porcupines, possums, tarantulas, and the stars of the show: 3 sloths. I have never seen a sloth before, and those things are really, really cool. Apparently their vision and hearing are both very poor, they sleep 18 hours a day, and are altogether awesome. We were lucky enough to get a perfect view of one of them, right above the trail. Unfortunately there was some fog, and I couldn't get a good picture, but I am hoping someone can help me out.

We also saw the single largest insect I have ever encountered. Right next to the trail, there was a walking stick insect the length of my forearm. Not only that, but it was evidently in the middle of mating, and was attached to a slightly smaller stick insect. It was really incredible to see, and I don't know what else to say about it.

Huuuge insect. This thing was as long as my forearm.

The night hike was just phenomenal. We got to ate the freshest bananas we have ever seen, and tasted some sugar cane straight out of the woods. There were a couple of tour groups out that night, along with a few spotters. They all had walkie talkies, so every so often another guide would come crackling through the tour radio saying they had seen something new. Our guide would tell us to 'stay close, and watch your step!' and go off running through the forest to check out what the other guide had seen. We really felt like little kids, just playing in the woods. As Bernado said many, many times: 'So cool!'

Eating the freshest banana ever... straight from the tree!

On Sunday morning, all 26 of us went on a ziplining canopy tour. I had never been, and had an absolute blast. We were given a harness, a helmet, and thick, leather-lined gloves. Apparently, the leather lining on the palm of the glove is what you use for a brake (if you are into that sort of thing). Anyways, the first couple of ziplines were fairly short, and underneath the canopy. I was a little nervous about the first 2 or 3 lines, but after I got the hang of it, it was all good. Some of the lines went through the trees and stayed under the canopy, and others broke through the tree tops and crossed large valleys. Both types were equally enjoyable. The last line was over 1km long, and we allegedly were going over 50mph. It broke through the treeline, and we could see Lake Arenal and a massive volcano in the distance. It really almost felt like flying, and I would recommend it to anyone and everyone.

Ziplining = fun

Thats all I've got for now. I hope your summers are going well!

-Eric

PS: Thought I should include a pic of the kids from my host family, Esteban (with the glasses) y Jonathan.

In Costa Rica!

2010-06-20T17:58:00.001-06:00

Hola!

All is well here in Costa Rica! A little bit about the past couple of days:

Things went smoothly traveling on Thursday, and I met up with some of the other EWH students at the San Jose airport. We were introduced to our homestay host family, and headed straight to their casa. The home where we are staying is a very unique situation. From all early appearances, there are up to 3 families (or 3 generations of the same family) living in their own homes, which share a large common dining area. Flory, our host 'mother', is a wonderful cook and has shown tremendous patience with us thus far. There are 6 (six!) EWH students staying here (Salman (from the UK), Jens (Denmark), Tom (Louisville), Victor (Duke), Manu (Duke), and myself), and no one speaks more than a few words of Spanish, which makes even the simplest task infinitely more challenging. Our homestay is actually in San Pedro, which is the town immediately east of San Jose. We are in the barrio Vargas Araya (I think), which is about a 20+ minute bus ride to San Jose.

Friday, August 18

We got up pretty early on the first morning, and had a breakfast of French toast, pineapple, and juice. Flory then showed us the nearest bus stop, and rode with us to show us how to get to the ALE language school. When we got to the school, we met the rest of the EWH students (26 in all), and introduced ourselves. There are students from all over the US, a handful from the UK, and a couple from Denmark, and at all stages of their college educations, so it will be interesting to learn alongside them. We talked extensively about do's/don'ts, what to expect, and some other administrative stuff we needed to get out of the way.

For lunch, we headed to a convenience store down the street, and had 'pollo y gallo pinto' (chicken, rice, and beans). They also threw in a couple of fried plantains, which were really really good!

That afternoon, we discussed the circulatory system, BP monitors (manual and electronic), how they work, and common failure modes. Our instructor, Billy, is extremely experienced in medical equipment repair training, and was very thorough in discussing how malfunctioning BP monitors can be diagnosed and repaired. We got out of class and a short lab at about 4.

It should have been clear that things were going a little bit too well :)

Our trip back to the house was something of an adventure, to say the least. We were able to find the bus stop near the school, which was a small victory in itself. However, June is the start of the rainy season in Costa Rica, and we found that one out the hard way. After getting poured on for about 15 minutes at the bus stop, we got on the correct bus, and were on our way. Unfortunately, none of us were exactly sure where we were supposed to get off. One of the curious features of the San Pedro barrios is the complete lack of street names and house numbers. We proceeded to get off the bus about 3 stops too early, and tried to find our house. This turned into a Homer-esque (either the poet or the Simpson, I cannot decide) odyssey through the residential streets of San Pedro, all in a driving rain. After about 40 minutes of directionless, clueless wandering, and 2 or 3 stops to ask for help, we threw in the towel and called Flory. Somehow, it turns out that we were within 50 yards of the correct bus stop, and no more than 200 yards from the house.

Thoroughly embarassed, we eventually dried off, had a very good dinner, and were asleep by 9:30. I also learned/made up the phrase 'muchos ropas con agua'.

Saturday, August 19

Today we went for a whitewater rafting trip on the Pacuare river in eastern CR (http://www.costasolrafting.com/). When we were picked up at the school, we were introduced to our guide Diaz, who turned out to be poco loco. On the drive to the start of the rafting course, we passed some really remarkable scenery, and had breakfast in a restaurant overlooking a very impressive valley.

Breakfast: huevos, gallo pinto, pan, banana, y pina

On the river, there were 6 students in each raft, plus one guide. I was sitting up front, and had the best view of the rapids (and caught the most water). The river valley was straight out of Jurassic Park. We were surrounded by massive trees, thick rainforest, and gorgeous waterfalls for the entire 3 hours. In one section, the river narrowed significantly, and the walls on the side seemed to go straight up. The river was particulary deep, and we all jumped out of the rafts and floated for about half a mile... it was incredible. I am definitely filling up my mental camera already. Pictures to follow.

We got back to the house successfully, and had a very colorful and wide-ranging discussion with Maria, who I think is Flory's daughter. They both talk at a normal pace when they are talking to us, although they both know that we understand very little of what they are saying. We made some noticeable progress over the course of this conversation, though, and were able to pick out words here and there and start to deduce what they are trying to say. These kinds of conversations are really fun to have, but are also really mentally exhausting.

Sunday, August 20

Today we wanted to check out San Jose, since most of us plan on traveling to different parts of the country every weekend from here on out. Many of us met at the school, and walked to downtown. We had hoped to visit the Nacional Museo and Central Market, but both were closed. We ended up wandering through the streets of San Jose, and I think we managed to see most of the sights in about 5 hours. (I don't know of a lot to do in the city. Most travel guides recommend not spending much time in SJ, as there isn't a lot for visitors to do, and not a lot to see.)

I am really looking forward to starting the Spanish lessons, because it is kind of frustrating not being able to communicate with anyone, and the shop owners are usually not in the mood to wait for us to butcher their language. I think the lessons will be a massive help, along with the conversations with Flory and Maria.

Heading to Central America...

2010-06-15T09:37:00.000-06:00

Hello all!

As some of you might not know, I will be traveling to Central America this summer to participate in the EWH-Duke Summer Institute. Basically, this program gives ~25 students an opportunity to travel to developing parts of the world and volunteer at local hospitals. At the hospitals, our primary responsibilities are focused around installing and repairing equipment and training the host staff on the best ways to use and maintain that equipment.

The program is about 2 months long, and I will be flying into San Jose, Costa Rica on June 17th. For the first month of the summer, we will be attending Spanish classes and engineering/equipment training. After that, we will be paired up and head to a host hospital in a developing part of Central America (specifically, I have been assigned to the hospital in El Progreso, Honduras). We have gotten status reports from our host hospitals, which details some specific areas where they need the most help... it will be challenging, but I think it is going to be a lot of fun!

Anyways, thats about all I've got for now. I plan on updating this blog at least once a week while I am in Central America, but hope to be able to do more than that. I want to try to give you an idea about the cities that I am living in, the work that is going on, food/music/travel, and maybe a little bit about how a student might spend some free time during a summer in Latin America :)

Adios!