Tag Archives: ECG

How Our Team Helped Roosevelt Hospital Achieve a 79x Value for Money in Guatemala — and More!

As described extensively on this blog, working in a developing country hospital is not always easy.

In effect, it always results in a great sensation of success, when one suddenly finds a hidden stash of valuable – yes – cables. Exactly that happened when our group found the ECG’s cables and power supplies shown in the pictures below.

In a storage room at the emergency department of the hospital we found 7 vital signs monitors, 7 Power supplies, 2 pulse-oximeters and 3 ECG cables in woking condition. Unfortunately, all remaining cables for the seven machines were broken, an example of which (an SPO2 sensor/pulse-oximeter) is shown here.

From all the parts we had an fixed we managed partially assemble 5 working Vital Signs Monitors: Two of them were put back in to service with pulse-oximetry and ECG working, 3 of them with ECG only. Unfortunately the department didn’t have any compatible blood pressure cuffs, so we would have to buy new ones, just as we wouls need additional pulseoximeters and ECG cables.

Vital signs monitors are fairly simple pieces of medical equipment, however the cheapest completely refurbished set found on eBay that is corresponding to these machines is $3.503.

Thus having these pieces in working condition would have an extremely high value to Roosevelt Hospital. Meanwhile the cheapest prices on eBay for replacement parts, that we need to put all of these vital signs monitors back into service, are found for $24 (SPO2) + $54.50 (ECG) + $12.5 (Blood pressure cuffs).

In “How to repair shielding on ECG cables and leads”  I described how we we repaired three sets of cables. The fixes were good, but not perfect in that we did make the cables work, but the signal was still somewhat noisy, for which reason the machines couldn’t have been used in surgery and detailed diagnosetics – rather they were useful for general “simple” monitoring.

Considereing the fixed cables as being in working condition (a somewhat noisy signal is, after all, better than no signal at all), we now just needed 2 ECG cables, 5 SPO2 censors and 7 blood pressure cuffs to make all of these machines work.

The total cost of this according to the prices on eBay would be just $321, although with used parts.

Considering that a completely new refurbished set on eBay costs 3.503, the value of these equipments reach $24521 in order to buy seven of these machines.

By repairing these machines our team achieved 79x value for money (even though the fix wasn’t perfect).

Now, I thought this story would end here, when, out of the blue, I received an email from Mr. Juan Fernández at Spacelabs Healthcare in Latin America,  who wrote that they would be able to send the broken parts to us —  free of charge! We could now make all the machines work perfectly (with no noise on the line). My collegue in Guatemala, biomedical engineer and expert technician Mr. Joe Leier will receive and bring this donation to Roosevelt Hospital as soon as possible.

I want to thank the people, that have been a part of saving these machines: my collegues Ms. Rebecca Avena and Mr. Joe Leir and Mr. Juan Fernandez at Spacelabs. We at EWH and Roosevelt hospital we are extremely thankful for this donation, which now means that Roosevelt hospital has 7 fully refurbished, high quality patient monitors working in their emergency department.

How to Repair Broken Shielding on ECG Cables

The work done by engineers in a developing country includes a range of smart repairs that help hospitals save significant expenses.

Equipment cables are common examples of broken parts found in developing countries. Just a week ago I described how our group found seven vital signs monitors out of use at Roosevelt National Hospital in Guatemala. This last week, our group found the cables for the monitors, however the shielding on them was broken. The picture on the left shows the cable with broken shielding, while the picture on the right depicts the noisy — and clinically useless — ECG signal.

Buying one new ECG   cable for a patient monitor would cost $51 if purchased on eBay.  However, it is feasible to fix the ECG cables and avoid the cost of purchasing new parts.  In order to do this, we performed three simple steps:

1) Wrap foil carefully around the ECG cables.

2)  Ensure that the foil is electrically connected to the ends of the original ECG cable shielding.

3)  Wrap the foil tightly in electrical tape

The photo on the right shows the resulting ECG signal. The ‘p-q-r-s-t” sequence of a normal ECG signal can be seen on the screen.

The result is still not optimal, as there is residual noise interfering with the signal. Our group is currently investigating ways to make the shielding more effective so that the foil is optimally electrically connected along the entire length of the cables.

The EWH Guatemala Winter Institute 2014/15 Roosevelt Group considering the resulting signal and if it can be further improved.
The EWH Guatemala Winter Institute 2014/15 Roosevelt Group considering the resulting signal and if it can be further improved. Left: Caty Lin – George Mason University, Middle behind: Shanyce Stewart, Rochester Institute of Technology, Middle in front: Becca Avena – Marquette University and Co-op at GE Healthcare, Right: Mohammad Ali – George Mason University.

 

Guatemala: Vital Signs Monitors and Dialysis Machines

Guatemala log #2

During our first day at the hospital we’ve been working on two projects:

The Vital signs monitors. 

The emergency department of Roosevelt hospital has received seven vital signs monitors as donations. They suspect the machines should be working fine, however the cables for measuring oxygen saturation, ECG and oxygen saturation are broken. Unfortunately we cannot test these machines as the power supplies are missing.

Furthermore only managed to collect one set of cables in condition good enough for them to be reapaired and unfortunately buying new ones would cost hundreds of dollars per machine.

For now the strategy will be to get a DC power supply for the machine as quickly as possible (18 V, 2,7A) and then we will try to get just one machine up and running.

The 13-17 dialysis machines

I have seen thirteen machines with my own eyes, some say however that the hospital has 17 Dexter 1550 type dyalisis machines. We started out trouble shooting two of the machines that looked as if they were in a proper condition.

The machines are quite old old but some of them are in a surprisingly good condition. Currently the haemodialysis department is renting machines from an external company, which is expensive, so it is our hope that we can help the hospital by getting their own machines working and thereby save some expenses.

Chancy with one of the dialysis machine.
Shanyce and Mohammed with one of the dialysis machine.

Unfortunately we are currently in doubt whether or not the consumable products are necessary to use the machine are available.

For now however, we are still testing the machine!

Stay tuned for the coming updates for the continuation of these projects and the initiation on the baby-bottle project!

Projects at Roosevelt Hospital, Guatemala City

Guatemala Log #1

On the first day of the 2014/15 Guatemala Winter institute we had an introductory morning briefing to talk about program details, safety guidelines, culture shock and logistics.

Later on that day we would proceed to Roosevelt Hospital in Guatemala City, one of the the largest hospitals in Guatemala.

As we arrived, Head of the biomedical engineering department at the hospital, Hector, showed as around and introduced us to several different projects that the EWH engineering team could work on during our three weeks.

The following is a list of the projects we found on the first day at the hospital:

1) 14 Dialysis Machines: In the basement of the hospital we found about 14 dialysis machines out of order. If can put these back into service it will be vital to find and teach a technician at the hospital about the machines as they require continuous maintenance. See picture in the gallery below.

2) 7 vital signs monitors: These machines actually work perfectly (according the emergency department staff) but the cables are destroyed. We are looking into getting a hold of all the cables from the emergency department so that we can find out if we can fix them.

3) The baby bottle project: The baby bottle cleaner of the hospital is broken. 1500 babies need to be fed everyday there are 45 different recipes for the baby food depending on the state of the babies. For example prematurely born babies are prescribed more oily food. Thus the department staff must manually clean 1500 bottles a day. They don’t have any proper substitute tools and it gets really difficult to clean the baby bottles. See pictures in the gallery below.

4) Tortilla machine (kitchen): This machine is working but the tortillas are sticking to each other and one side was burned more than the other. Sometimes the tortillas are cut in half. In effect a lot of dough is wasted. See picture in the gallery below.

5) Bread oven (kitchen): Issues with the temperature regulation.

6) The outside yard with broken medical equipment: Most of the equipment has been outside in the rain and it has become rusty.  It is likely though that there are several valualble spare parts in the “junk yard”.  See pictures in the gallery below.

Additionally a pre-trip equipment assessment was made by biomedical Joe Leier who is assisting EWH 2014/15 Winter Institute. 

7) Three additional vital signs monitors.

8) Seven suction pumps.

9) Three defibrilators were found, condition onknown.

10) Five Electrocardiographs.

For now we will start working on projects 1, 2  and 4. I will follow the progress of the projects here on this site. Stay tuned!

What’s it Like to Work in a Developing Country Hospital?

It is now a little more than a week ago that I returned from and unforgettable journey to Africa. It’s been such a journey that expands horizons, gives new perspectives, creates new visions and changes beliefs and values. During my stay I worked for a month at local hospitals, an experience that was different in so many ways from what I had expected.

Prior to our placements at local hospitals the students of the 2014 EWH summer institute (myself included) took part in a month-long educational course on “Engineering in the Developing World” and an introductory Swahili course – a program which proved to be of considerable advantage as we were soon to develop a trusting relationship with the departments we would come to work for.
After this first month of education I was moved to my placement along with my group, which besides myself consisted of a student from Duke and one from Harvard. We were to work in two hospitals: Kilimanjaro Christianity Medical Centre (KCMC) and Mawenzi Hospital, both situated in the town of Moshi, Kilimanjaro region.
The KCMC is one of the largest and most prestigious institutions in Tanzania and has a biomedical engineering department consisting of 30 engineers and technicians. Despite good will and hard work from the department, it was obvious that we could do much in both hospitals, just as we could learn a lot from them. Our group alone repaired more than 60 pieces of equipment during our stay. Overall, this year’s EWH summer program returned 4,200 pieces of equipment amounting to 8.6 milion according to the latest figures from EWH.
If I was to draw one conclusion about medical equipment in developing countries today, I would say that it simply should not be allowed to donate without informing properly about that specific piece of equipment in the local language (or in English, at the least):
In so many places we found rooms and whole warehouses filled with piles of medical devices. To our surprise, very often these devices could be put back into service by simple mechanical repairs. We even found completely new operating theatres that could not be used because they were packed full of unused equipment. I was left behind wondering if donations do any good at all – or if they do more harm than good. During our month at the hospital we slowly started to learn the reasons why these equipments weren’t in use: How were people supposed know how to use a piece equipment, if they had no manual for it? Or how could they use a machine, if the user interface was in Dutch or in German? When a repair was to be done after all, many reported difficulties and bureaucratic systems when having to acquire replacement parts, such as a lightbulb for a microscope.
The type of problem that could arise when departments were not provided information about new technologies became clear to me one day at the KCMC, when our group was asked to repair an Infant Warmer from GE. We were told the following: The department had received a completely new machine and put it into a small room where they normally observed newborns in the early hours after a birth. But when the staff began to use it, the machine heated the room up to a temperature so high, that it was unbearable to stay in there.
The solution turned out to be immensely simple: the skin-temperature sensor had mistakenly been placed under the bedside, and had to be moved to the skin of the newborn – otherwise the device would constantly work to achieve a temperature of 35.5 degrees under the bed instead of on the baby’s skin. Thus the machine was heating on and on (and on…).
After having cleared out this first misunderstanding, we explained that the machine could not, as some thought, be used to take X-rays images, but that it merely contained a tray for a detector plate so that you weren’t forced to move the baby around unnecessarily,  and that the machine could not calculate an APGAR-score, but that it contains a stopwatch simply to help you with the task. The problem wasn’t lack of education or ability to understand how a machine works. It was simply the fact that people were not provided the necessary information. Even if some information was provided, it was not done properly: How is a nurse going to read a 500 page manual, while working in a ward full of women in labour? Seeing this and other similar cases, one of our main focuses became developing quick start guides in order to provide departments with a fast and simple way of knowing how to use a device.
Another typical issue that we encountered was how departments virtually never took advantage of vital signs monitors and ECG’s because they had run out of the necessary electrically conductive gel. There are a number of alternatives to conductive gel – in principle anything that contains electrolytes, for example aloe vera or ketchup, can be used. It should have been obvious however (as I did not first think of), that most doctors and patients do not want to use these methods, as they are uncomfortable and inconvenient. I remember explaining to a doctor how he could make his own electrically conductive gel using water, flour and salt. His response: “Is that really recommended?”. Imagine his reaction, had I recommended him to use ketchup. In addition, many Africans are proud people to whom one can and should not just offer anything (just as one would probably not do anyone at home). Therefore, developing a gel that is more likely to be used clinically, and in addition could be produced cheaply using local materials, would be an example of a simple and small, but valuable project for developing world hospitals (while you can find alternatives to conductive gels, I still haven’t seen one that actually looks like the gel that is used in clinics). Notably the KCMC already had the means to produce their own ultrasound gel (which is acoustically and not electrically conductive) so they shouldn’t be too far away from being able to produce their own conductive gel too.
This and many other projects are still to be carried out to make the daily life at a these hospitals run smoothly. Here I have given just two examples of what it can be like to work in the developing world. So many ways remain in which one can help this  parallel world of ours, in which resources are so scarce that we are constantly forced to think in new and innovative ways to provide the best possible health care for the all people.