Thursday, June 12, 2014

Off to the Hospital!

Two Mondays ago we got to visit one of the hospitals in Kigali for the first time since we have been here. Abbreviated CHUK, this hospital is the largest teaching hospital in the country and one of the best facilities. Since it was only our first hospital day, our group simply toured the hospital and got to see the different wards, equipment that they use, and meet some of the staff. We were able to visit the different labs for diagnostic testing, the PICU, the biomedical engineering technology (BMET) workshop, radiology, pathology, hematology, and lots of other departments. For being in a developing country, CHUK had some great lab equipment, although there is also broken equipment everywhere with signs, just waiting to finally be repaired.

In the PICU, we were actually able to walk in the ward in small groups to look around and see the photo-therapy lights they use to treat jaundice in infants. In radiology, we saw their best CT machine in the country which is one of three total. We also got to meet an American radiologist who is working there and learned a lot about the medical system here. His wife is a pediatric trauma surgeon and wanted to do overseas medical service, so they moved with their two children to Rwanda for 1 year on a federal grant and have decided to commit to another year. Along with 138 other American nurses, physician assistants, and doctors, they are working on developing the residency program for health care professionals in Rwanda. All of Rwanda's doctors have completed their residency outside of Rwanda, so there is now an effort to develop the infrastructure to train doctors within the country. For a country of 12 million people, there are only 600 doctors which translates to 1 doctor for every 2,000 people!

This past Monday and Tuesday we got to go back to the hospitals again, this time for practical work experience. This week I went to Kanombe Military Hospital, and next Monday and Tuesday I'll be back at CHUK. Kanombe Military Hospital is also one of the best in the country, and is one of EWH's Centers of Excellence (COE) which means that it must meet certain standards. In order to even visit there, we had to go through lots of paperwork to get clearance and then more paperwork and diplomacy to be able to work on equipment there. Upon arrival, we had to pass through a military checkpoint to enter the hospital grounds. All around were people in military uniforms, whether they were working as guards, doctors, technicians, or administration.

Monday morning we worked at IPRC to take apart some equipment and learn its mechanics before heading to Kanombe in the afternoon. In the afternoon, Kostica showed us around the hospital and let us visit some wards. He works for EWH, designed the BMET workshop at Kanombe, and knows pretty much everyone at the hospital, so he was able to get us into most places, even though that sometimes meant we walked in and walked right out after the department head would tell Kostica we couldn't be in there since they were receiving an ICU patient or some other major thing.

Tuesday we went back to Kanombe and were actually able to work in the BMET workshop on some broken equipment. We worked alongside some of the BMETs there to learn the process of troubleshooting, the testing steps they go through, and how they fix the device. We started with an oxygen concentrator that just needed planned maintenance done which was fairly simple and only involved taking it apart, cleaning the filter, dusting off the motor, and checking the tubing and alarm. For that device, we got to work with a BMET who was in the military and even got a picture, so that was a cool memory! 

Some of the group then worked on repairing a broken dentistry chair and then others worked on a suction machine.  Mid-morning, the head BMET got a call that they needed some repairs in the dentistry clinic, so we packed up our tool bag and headed over. All of us in our group decided that we felt pretty official with our gloves and tool bag and being able to walk right into the clinic. When we got there, one of the dentists started explaining that the aspirator tool didn't have any suction and they also had a broken machine that wasn't shaking. Immediately I thought 'what am I doing here?' because I had never even heard of the machine before that he wanted us to fix and there was a patient right beside us getting her teeth cleaned. After a couple of questions, we learned that the device was a shaker, almost like a lab vortexer, to mix the dental cement used for cavity fillings. After taking the device apart, testing all of the wires, and dealing with several bad outlets, we decided the only problem was the dial which they had lost the knob for and had taped the case to the device which was causing the switch to constantly be turned on. With no spare dial, we couldn't completely fix the device but were able to repair the cracked case and make it so that the switch functioned again.

While in the dentistry clinic, our BMET got another call for a device in the ER. Walking right into the ER was quite the experience because there is no way in the States they would let a bunch of foreigners walk right in next to a patient being treated and just start repairing a device. One of the patient monitors wasn't turning on, so there we were 3 feet from the bedside of a patient in the ER receiving care. Luckily it was an easy fix for the patient monitor and we were only there for about 15 minutes. After testing the power cord and finding a break in the wiring, we exchanged cords and the monitor worked fine. I'm excited to be back in the hospital again next week for our last 2 days of practical training before we head out to our respective hospitals for the final 5 weeks!

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