"weServe" - Service Through Solutions

Week 5 (5/27/2010): Royal Victorian Teaching Hospital, Banjul

2010-06-07T09:57:00.000-07:00

Royal Victorian Teaching Hospital (RVTH)

Peter from Kenya, Carlos from Cuba, and Me (From left to right)

A portable ECG next to the WeServe Drexel toolbox

Working on a DevilBiss oxygen concentrator

Peter and I working on the Siemens MRI machine

Today I leave the Gambia and head back home. I have mixed feelings about leaving because I really miss home but I've made so many good friends here. Hopefully, I will return in the future and continue my work assisting the hospitals.

Upon arriving in Banjul I checked into the Atlantic hotel because the Royal Victorian Teaching Hostpial (RVTH) didn't have any accommodations for me. At the hospital, I worked with a Kenyan named Peter and a Cuban named Carlos. They both were doing voluntary work as well to repair the nonfunctioning medical equipment. At RVTH, there is a tremendous amount of old and new equipment. It is the biggest and most advanced hospital in the Gambia, and has a tremendous amount of donors. It houses a little over 400 beds and this hospital is where all the others send the patients they can't treat. The hospital is always busy and I had a lot of work to do when I was there. Here is some of the equipment I was able to fix and diagnose.

Siemens MRI machine
3 Centrifuges
A DevilBiss oxygen concentrator
A portable ECG machine

Diagnosed:

An ultrasound: needs a new fuse
Two centrifuges need new "carbon brushes"

Week 4 (5/22/2010): Sulayman Junkung General Hospital, Bwiam

2010-06-07T09:31:00.000-07:00

Alieu studying the respiratory system.

David (the German missionary worker) and I with the quad at the Kanilai fire station.

One of the outfits worn at the Kanilai festival

The stadium where the celebrations and traditional rituals took place.

After returning to Bwiam, I continued to teach Saiko and Alieu. Mr. Badgie (Chief of the hospital) planned for my next journey to the Royal Victorian Teaching Hospital in Banjul. However, the scheduling got messed up and I will be leaving tomorrow (Sunday May 23) instead of this past Wednesday. In the meantime I was able to efficiently teach Saiko and Alieu Microsoft Office programs and I've been quizzing them daily on different biology topics. During the week I have also experienced hunting for monkey, tasting monkey, going quading at the President's town (Kanilai), seeing the traditional Kanilai festival, and dancing in part of the festival.

Week 3 (5/15/2010): Bansang Hospital, Bansang

2010-06-07T08:59:00.000-07:00

Checking the continuity of the circuit board elements in the anesthetic machine.

Disassembling an oxygen concentrator.

Suited up for a hernia surgery with one of the Cuban doctors

A repaired oxygen concentrator: we taped the humidifier together. As you can see, some of these machines can get really dirty

I’ve just finished up the week at Bansang accompanied by Saiko. It gets extremely hot here and reaches 110 degrees Fahrenheit almost everyday. It took about 8 hours to reach Bansang but I have now experienced all of Gambia’s landscape and have seen most of the villages. At Bansang I was able to visit a fire station, go into surgery with one of the Cuban doctors, see a local concert, and meet some Peace Corp. members helping out the town. The hospital at Bansang is the second biggest in Gambia and is very old. There are a lot more advanced machines but they are still old. Many machines here are foreign and do not have manuals or instruction guides. Here is some of the equipment I was able to repair though:

12 Devilbiss oxygen concentrators
2 Autoclaves
An ultrasound
A thermal ultrasound
3 centrifuges

I also diagnosed several equipment but was unable to fix due to a lack of supplies:

3 Devilbiss oxygen concentrators: All need new bottle humidifiers
Suction machine: needs new motor
Glostavent anesthetic machine: needs new circuit board element (capacitor)
Surgical Lamp: new lightbulbs

Week 2 (5/8/2010: Sulayman Junkung General Hospital, Bwiam

2010-06-07T08:51:00.000-07:00

Teaching Saiko and Alieu the newest version of Microsoft Powerpoint, Word, and Excel

Saiko and Alieu studying for a quiz on Cellular Biology that I gave them.

Saiko and I fixing the autoclaves.

I was unable to post my blog entries when I was in the Gambia (due to no solid internet connection) but here are the entries I wrote.

Over the past week I've become more accumulated to the environment and the lifestyle of the Gambia. Chirag returned to America, but fortunately I met a German missionary worker who is 22 and speaks English well. I’ve had the pleasure to play some futbol (soccer) with the locals, watch some of their matches with other schools, have a goat wake me up at 5 am, help assist building a house, experience some local food, visit the river, see both the Islamic and Christian schools, go to church, and help plant some banana trees around the missionary. I’ve also been picking up some Mendinca language (one of the six tribal languages spoken) and it makes the locals so happy to see you attempting to learn the language.

During this week, I've completed a proposed curriculum for Alieu and Saiko to study Biology, Biochemistry, and Radiology with the textbooks the hospital contains. The Chief Executive of the hospital, Mr. Badgie, has approved the curriculum and is incorporating their learning with the nurses training. I believe this will assist them in expanding their knowledge from just being a technician. Three autoclaves came in today and one was fixed with a quick cleaning of some of the machines components. The other two both had their power chords cut off and there was no replacement. All of the machines are functional with the exception of an oxygen concentrator that needs a replacement valve.

Next week I travel inland to a town called, Bansang.

Greetings from Gambia - SJGH

2010-05-05T08:32:00.000-07:00

Andrew, Aliou, and Chirag working on oxygen concentrator.

Andrew has limited internet connection and has asked me to post for him:

Greetings from the republic of the Gambia. I met up with Chirag the other day and we traveled to the town Bwiam, where he has been working on some equipment. Most the equipment has been repaired thanks to the amazing work Chirag and the the Gambians ( Saiko Gibba and Aliou Colley) have done. The hospital has recently started up a biomedical engineering department and I'm currently working with them on developing a curriculum and help on technical work. I've been teaching them basic biology and other subjects necessary. I've also been teaching the nurses basic computer skills, including Microsoft word and excel, so they can improve on their patient database. I will however be traveling to other hospitals next week to fix some of their equipment with my teammates Aliou and Saiko. I'm trying to get as much repairing done as possible while also giving them enough experience to repair on their own and teach others. It's like the saying, " catch a man a fish and he'll be satisfied for a day, teach the man to fish and he'll never be hungry".

Status update (Post 5)

2010-04-15T08:52:00.000-07:00

Hello all!

The machines that we repaired include microscopes, centrifuges, ultrasound machines, oxygen concentrators, sterilizers, surgery lights, and a physical therapy bike. I worked very closely with two individuals (Alieu and Saikou) who are currently the hospitals electronics specialists (electricians). They are keen to become biomedical engineers or technicians, so this is a great opportunity for them. The next step will be to continue to repair any equipment that the departments may find, and mainly proceed to train and educate these two individuals about what we have done and general biomedical concepts. I have also agreed to run IT workshops with any interested staff member so that they are able to use a computer.

Fixing a faulty autoclave.

Best,
Chirag

Pictures from Week 1 (Post 4)

2010-04-09T09:21:00.000-07:00

Front Gate

Fixing oxygen concentrators.

Above are pictures of the hospital's front gate (to the right) and us fixing an oxygen concentrator. This week, we will continue our work, and attempt to fix the equipment at the hospital's lab. There, they have some faulty centrifuges and microscopes.

Work Plan (Post 3)

2010-04-08T13:34:00.001-07:00

Hello all!

The administration has paired me up with two gentlemen, Aliou and Saikou, who are currently the electricians at the hospital. Both are very interested in biomedical engineering, the main reason why they will work with me. The work plan is as follows:

1) Assess equipment at each department taking note of location, equipment type, brand name and model number (if applicable), issues, and current status.
2) Group by equipment type and attempt to repair by trouble shooting. If parts are needed, order or make parts.
3) Have staff play an integral role in the entire process.

The WeServe program strives to provide solutions through service in both short term and long term. It is most beneficial to train and teach the staff so that they are able to repair equipment in the absence of WeServe members. Also, this is a learning process for both them and for us. By working together, we can solve the issues quickly and both parties come out with something.

Please let me know of any suggestions that you may have about my work plan.

Today, we were able to fix a couple of sphygmomanometers and 1 oxygen concentrator. I will upload pictures soon! Tomorrow, repairs will continue on the remaining faulty oxygen concentrators.

Best,

Pateh Bah (My Gambian name!)

Sulayman Junkung General Hospital (Post 2)

2010-04-06T14:33:00.000-07:00

Hello!

I have arrived at the hospital yesterday evening. Today, I met with the Chief of Nursing Operations, Mr. Bia, who formally welcomed me to the hospital. After the meeting, I was giving a tour by the head of the mechanics team, Famara. The hospital is quite large, and had many patients today. I will begin assessing the equipment tomorrow, so that I can begin to determine what is wrong and try and fix it.

Gambia Trip Preperations (Post 1)

2010-03-31T16:33:00.000-07:00

Hello all!

My name is Chirag Patel, a junior here at Drexel. I will soon be embarking on a journey to a hospital in Bwiam, Gambia called the Sulayaman Junkung General Hospital (SJGH), along with Andrew (who will be joining me in a few weeks). SJGH is a 200 bed health facility serving a population of approximately 100,000 people. It is located in a village called Bwiam, about 3 hours outside of Banjul. Some of the challenges that the hospital is currently facing include: shortage of doctors and trained staff, shortage of electricity, limited access to educational resources and technical information, lack of biomedical equipment and more importantly, the absence of a qualified biomedical engineer. Due to the inability of the minimally-trained maintenance team to handle imported medical equipment, there is a genuine need for a biomedical (clinical) engineer capable of facilitating the installation, restoration, and maintenance of the equipment, as well as promoting sustainability through training workshops. We will be serving as the hospital's clinical engineering for a period of two months. Our responsibilities include:

· Conduct a thorough assessment of the hospital’s medical equipment inventory

· Supervise and train staff on medical equipment

· Facilitate installation, restoration, and maintenance of equipment

· Create user and service manuals for staff to reference

· Develop a protocol for broken equipment management

· Develop standard operating procedures (SOP) for equipment

· Assist local health professionals with community health initiatives such as workshops on hygiene, disease transmission, etc.

We both have been training with faculty and staff in the Biomed department so that we are able to complete our objectives to the best of our ability. We have been trained in basic electronics, ultrasound, EEG, sphygmomanometers, and other medical equipment (including autoclaves, centrifuges, oxygen concentrators, incubators, etc.). In addition, we shadowed several biomedical engineers at Lankenau hospital, who have also been on similar trips. The engineers at the hospital have given us a general overview of the equipment we may encounter there. Throughout the training, we learned how to efficiently and effectively trouble shoot so that we can identify and resolve issues with the equipment there. The training will prove to be invaluable to our trip, and we are very thankful to everyone who has put time aside for us. I, personally, am very excited for this trip, and will write more once I arrive in Africa!

some sights from our trip

2010-01-05T13:28:00.000-08:00

Our Work In Mozambique

2009-12-29T13:07:00.001-08:00

The following is a list of the work completed by us at the Chicuque Rural Hospital in Mozambique. The trip was a success and the hospital director looks forward to receiving more "WeServe" students in 2010.

Ø Completed an inspection of medical equipment in all departments of the hospital

Ø Created a list of equipment that required restoration, service or maintenance (or any combination thereof)

Ø Diagnosed defects in equipment through inspection, testing and research

Ø Restored equipment to functional state (listed below)

Ø Located and translated manuals (to Portuguese) for future reference of users and maintenance department

Ø Created and posted instructions for:
1) the correct handling of equipment, including blood analyzers, autoclaves, centrifuges, and incubators
2) the correct protocol for procedures related to microscopy, pipetting, sterilization, and centrifugation

Equipment restored:

§ 1 surgical endoscope (Surgery)
§ 1 centrifuge (Laboratory)
§ 1 X-ray ID card scanner (Radiology)
§ 1 ophthalmic microscope (Opthalmology)
§ 1 incubator (Maternity)
§ 1 EKG machine (Medical Ward)
§ 2 ophthalmic machine (Opthalmology)

Equipment requiring replacement parts:

§ 1 incubator (Maternity): requires a new transformer
§ 1 scale (Laboratory): requires a new memory chip
§ 1 autoclave (Surgical): requires a silicone gasket
§ 1 autoclave (Surgical): requires a new heating element

2009-12-28T07:51:00.000-08:00

Our final day at Chicuque Rural Hospital

2009-12-28T07:49:00.000-08:00

With Dr. Jeremias Franca, Chief Administrator

2009-12-18T08:44:00.000-08:00

Alexa posting reference material for the

maintenance of laboratory microscopes

2009-12-18T08:43:00.000-08:00

Restored incubator in use

2009-12-18T08:16:00.000-08:00

Restored ophthalmic microscope

Work at the Hospital (Post 9)

2009-12-17T11:55:00.000-08:00

We have been working at the hospital for over a week now, and only a few more days remain before we fly back to the U.S. Progress has been good, and together with the maintenance team, we have managed to restore over half a dozen pieces of equipment. We still have a lot of work to do and hopefully, a few more machines will be functionalized before we leave. We are meeting with the Administrative Director of the hospital tomorrow to discuss future plans. He is very excited about hosting more “WeServe” students next year

2009-12-15T08:41:00.000-08:00

Zain testing an incubator in the maternity ward

2009-12-15T08:32:00.000-08:00

Zain and Miguel (head of maintenance department)

examining incubator control panels

About the Chicuque Rural Hospital (post 8)

2009-12-14T13:34:00.000-08:00

The hospital is funded in partnership by the Mozambique Ministry of Health and the United Methodist Church. It serves a population of a half million people, many of whom travel a long distance for primary care. Health care remains affordable, regardless of patient background – a fee of 5 meticais (approximately $0.18) is the flat rate for care.

We are continually impressed and inspired by the staff of Chicuque Rural Hospital. Despite limited space, resources, and training, overwhelming numbers of patients, and frequent interruptionjs in electricity and internet, doctors and nurses perform their seemingly impossible duties with enormous dedication and patience. This tolerance and composure applies to patients as well, who arrive without appointments and wait in the reception and consultation areas. Even in the maternity ward, women await their turn to deliver without complaint. Family members await loved ones by passing time on hospital grounds. The conversations and meals shared between families afford an overall sense of community and support among hospital patrons.

Patients and families awaiting consult

Mothers and children passing time

outside of the pediatric ward

The major hospital wards include: general medicine, maternity, pediatrics, and surgery (pre- and post-op care). There are additional units for radiology, dentistry, ophthalmology, emergency medicine, laboratory diagnostics, surgery (and sterilization), and tuberculosis treatment.

Hospital ward

The large undertakings of sterilization and laundering specifically demonstrate the commitment and diligence with which the hospital staff compensates for insufficiencies in the management of equipment. The sterilization unit serves the entire hospital, relying on the work of rotating surgical unit staff. The laundering of linens, bedding, and hospital gowns is performed completely by hand by staff members.

Sterilization unit

The restoration of equipment such as autoclaves and washing machines, as well as the training of operators and technicians on the proper usage and maintenance of these machines, are much needed. Replacement parts and technical assistance are both costly and often available only in Maputo. Resultant delays in the preparation of tools and materials for usage can hinder overall hospital efficiency. However, the staff rises to meet this challenge as hygiene and sanitation are of utmost importance.

Washing machines requiring technical assistance

The hospital is also the site of teaching and training. Medical residents fulfill assignments prior to further specialization. Future lab technicians undergo instruction and examination in the laboratory. We have also learned that Mozambican health care workers acquire wide-ranging proficiency in their respective fields. Surgeons, for instance, have been trained to perform all customary procedures. Irrespective of the limited resources at their disposal, this level of competency allows doctors and nurses to uphold commendable standards and comprehensiveness of health care.

Day 3, Chicuque, Mozambique (post 7)

2009-12-11T10:30:00.000-08:00

We started worked today at Chicuque Rural Hospital. We were picked up from our accommodation (in a town called Maxixe, 5 km from Chicuque) by the ambulance and taken to the hospital.

We attended a staff meeting and were introduced to all of the doctors and nurses. The medical team is comprised of doctors from Cuba, Brazil and Mozambique. Following the meeting, Mr. Franca took us to meet with the maintenance team.

We spent the day touring the hospital, from one department to the next, taking note of equipment that required attention. The equipment operators in each department briefed us on the status of malfunctioning equipment. We took notes and asked some questions, and also collected as many operation/service manuals as we could find.

The following biomedical equipment were found to be in need of restoration:

Laboratory - centrifuge, scale, blood analyzer, microscope
Surgical Unit - autoclave, anaesthesia machine
Radiology Department - X-ray generator, ID camera (to scan patient information onto X-ray)
Maternity Department - incubator (baby warmer)
Ophthalmology Department - ophthalamic microscope

The following biomedical equipment were found to be in need of servicing (basic maintenance):

Maternity Department - ultrasound machine
Laboratory - blood analyzer, facscount, microscope
Radiology Department - mobile X-ray unit
Surgery - autoclaves

The following general equipment was found to be dysfunctional (causing inconvenience to hospital staff) or in need of service:

Washing machines and dryers
Refrigerators and freezers
Air-conditioners (in the laboratory)
Water heaters

We were able to familiarize ourselves with the infrastructure and challenges related to the hospital's equipment. Tomorrow we will start tackling problems in order of urgency.

Day 2, Chicuque, Mozambique (post 6)

2009-12-10T05:52:00.000-08:00

Today we reached Chicuque by bus from Maputo.

Upon our arrival at Chicuque Rural Hospital, we were received by Jeremias Franca, Chief Administrator. We began to discuss goals for the trip and the potential for further collaboration. He was welcoming and appreciative of our interest, and assisted us with accommodation and meals.

Outside of Chicuque Rural Hospital

Tomorrow we will meet the hospital staff, tour the facility, and begin to assess the inventory of biomedical equipment.

2009-12-09T17:00:00.000-08:00

In transit from Maputo to Chicuque

Day 1, Maputo Mozambique (post 5)

2009-12-09T13:32:00.000-08:00

We spent much of the day in the electro-medical maintenance shop with the maintenance team, comprised of 5 technicians (for the entire hospital).

We had a long discussion related to the workings and challenges of equipment management and were provided the following information.

The electro-medical technicians have not received any formal training, but do have some background in electronics. They rely primarily on experience and team work to solve problems.

Equipment is either purchased by the government or donated from various sources. Most of the sophisticated (expensive) machines are acquired from South Africa.

A large percentage of machines are presently malfunctioning or broken and no standard protocols for equipment restoration are in place.

The internal maintenance team repairs and services the smaller, less sophisticated machines. Larger equipment maintenance is managed through sub-contracts with manufacturing companies (often located in South Africa), and hence, access to service is inconsistent and unreliable.

The hospital cannot bear the cost of outsourced technical services and consumables are difficult to attain. Service and maintenance manuals are often missing or lost, and if present, are frequently printed in English (rather than Portuguese, the official language of Mozambique). In addition, users are not receptive to preventative maintenance protocols.

The above are some of the challenges (related to biomedical infrastructure) that the hospital faces.

The team was amenable to the idea of hosting students from Drexel to work alongside them, asserting that they would find such as arrangement to be "very advantageous".

Day 1, Maputo, Mozambique (post 4)

2009-12-07T08:19:00.000-08:00

Outside the medical equipment maintenance shop with the head technician

We met with the Chief Administrative Director of the hospital who arranged for us to visit the medical equipment maintenance shop. The maintenance team comprises of five technicians with varying backgrounds. Most of the technicians have not received formal training and rely on previous experience to repair and service equipment.

Day 1, Maputo, Mozamabique (post 3)

2009-12-07T08:07:00.000-08:00

Teaching conference conducted by UCSD resident

We attended a teaching conference with local and UCSD internal medicine residents at the hospital and learned that the major challenges faced by health care students and professionals include: lack of quality teaching, lack of computers and access to medical journals, lack of research facilities and lab delays.

Day 1, Maputo, Mozambique (post 2)

2009-12-07T08:02:00.000-08:00

Dr. Preziosi and his team of residents

Dr. Preziosi and Alexa

Dr. Preziosi is an attending physician at HCM and graduate of the University of California – San Diego (UCSD). He supervises UCSD residents completing “Global Medicine Elective Rotations” here in Maputo. Dr. Preziosi and his team of residents, through a collaborative program between HCM and UCSD, work closely with local residents, training them through daily conferences, case-study discussions and journal writing workshops.

Day 1 in Maputo, Mozambique (post 1)

2009-12-07T07:53:00.000-08:00

Me standing outside Maputo Central Hospital

Today we visited Maputo Central Hospital (HCM) with Dr. Michael Preziosi. Dr. Preziosi is an attending physician at HCM and a graduate of the University of California – San Diego (UCSD).

HCM, located in the nation’s capital, is a 1200-bed teaching hospital serving a population of over 2 million people. It is the only hospital in the nation equipped with specialty services such as major surgery, diagnostic imaging (MRI, CT), orthopaedics, oncology, ICU and laboratory.

2009-11-19T16:46:00.000-08:00

This past August I volunteered at an elementary school in La Estrella, a village in the mountains of Costa Rica, in a ongoing project to promote literacy and continuing education. I helped to establish a library and taught English to supplement the school's WorldTeach foreign language program.

"WeServe" in The Gambia

2009-10-19T01:02:00.000-07:00

I spent 6 weeks at the Sulayaman Junkung General Hospital in Bwiam, Gambia. I worked as a clinical engineer. My job responsibilities included: making an assessment of all medical equipment in the hospital, restoring and installing medical equipment and conducting training sessions for the local staff on how to handle, service and calibrate equipment.

2009-10-12T01:24:00.000-07:00

Repairing an Oxygen Concentrator