2008 PFIG Recipient Neel Patel

Career Administrator

Neel Patel
School of Engineering & Applied Sciences
Biomedical Engineering & Economics
2009 Graduation Year 

Internship: Duke Eng World Health Summer Institute in Nicaragua

Notes on the first week 

As I woke up from my bed to start an important journey on the June 12, I had hundreds of thoughts running in my mind; How will Central America be, will I get hot water in my house as I volunteer in hospitals, what kinds of emotional situations will I be facing, am I going to make any difference in this world as I hoped when I decided to join this program… 

While the questions kept popping in my mind, my dad drove me to the Ronald Regan International Airport . Like every concerned parent he was giving me advice about personal safety, watching my passport, eating healthy food and avoiding going out in the dark. Finally, with heavy hearts we gave our regards and I started my journey alone. The plane ride to San Jose, Costa Rica was nothing extraordinary. I reached the airport in San Jose without any custom problems (even tough I was caring radioactive medical devices and sharp objects). As I came out of the airport, a Latin American middle aged woman greeted me and led me to a crowd of people that I had never met. My other companions in the Engineering World Health program looked really enthusiastic about meeting each other as many had known each other before they came. I finally realized that the majority of the students where from Duke University and funded by the Melinda Duke Engage Funds. Once the entire group had arrived to the airport, we were taken to our host families. 

My goal to travel to Central American was to take part in a summer institute with Engineering World Health, a non-profit organization created to support the medical technology needs of developing countries. The two month program included one month of training in the city of San Jose, Costa Rica and a second month working in an assigned Hospital in Nicaragua. The training would include four hours of Spanish classes, two hours of lecture related to a medical device and two hours of lab per day. During the first month, the students were assigned to live with a host family to help assimilate in the different culture and also to help break the language barrier. 

The city of San Jose, Costa Rica is very similar to any developing country’s major cities. The streets had a lot of traffic and smoke is in the air. However, the people in this city are happy and sympathetic. Even with my limited knowledge of Spanish, I had no trouble expressing my needs or talking with them about a common interest. The first week included getting used to the host family and the food. Since I was the only vegetarian in the family, food was a small problem. However, my host mom did all she can to give me delicious food every night. 

During the first week, we were learning Spanish at a very rapid speed. I had a hard time keeping up with the professor. Also, the training sessions and labs about the medical devices were challenging. We were lectured on ECG machines, Autoclaves, Pulse-Oximeter and Nebulizer. The labs included basic training on soldering and disoldering, building transformers and power supplies. Overall, during our first week we were kept busy with homework and practicing Spanish. Similar was expected for the rest of the training month. 

Even though we had a busy week, I enjoyed my first weekend in Costa Rica very much. On Saturday, the entire group decided to go for a water rafting trip in the east of Costa Rica . The rapids in the water rafting were very advanced. I enjoyed rocking through the level 3 and 4 rapids and getting soaking wet. On Sunday, I explored the city and shopped for souvenirs and needed accessories that I forgot to bring. 

In final words, my first week in Costa Rica was spent adapting to the language and the cultural differences, learning more about the developing countries and their hospitals, and attending lectures on medical equipments and labs. Although I have lived in a developing world for 15 years (I am a native of India ), Costa Rica was different and had many different things to offer. I hope to explore the culture further, and provide any help I can give while I am in the program for two months.

Midway 

Waking early every day at 5:00 AM with sun blinding my eyes was now a routine for me as I had gotten used to the no air conditioning and open windows system in Costa Rica . However, I am still not used to taking cold water showers and eating early breakfasts with the entire host family and five of my other companions. The food has been delicious so far and I enjoy it very much. However, this will be the last meal I will eat in Costa Rica . Today is the day when I finish my training and leave for Nicaragua. 

One month in Costa Rica has been one of the best times in my life. The idea of leaving the best Central American country and going to a developing country where conditions will be much worse (that idea was drilled in our head by the professors) is scary and not comforting.

During this one month I have learned many things. The main things I have learned are how to respect other cultures and live life in less materialistic way. Other than that, I have finished 2 college semesters of Spanish in one month; have finished all my labs which lasted 3 hours every day for one month. I have learned how to diagnose and work with ventilators, oxygen concentrators, fluid pumps, electrocardiograms, blood pressure machines, pulse Oximeter, defibrillators, fetal monitors and fetal Dopplesr, infant incubators, infant warmers, phototherapy lights, respiration rate meters, electro-surgery machines, suction machines, surgical lights, anesthesia machines, bottled gases, batteries, balances, centrifuges, electrical motors, microtomes, microscopes, autoclaves, laboratory incubators, water purifiers, and finally laboratory ovens. The lessons on these devices had been very informative and the lab work was hands on repairing practice on many of these devices. 

The rotations in the Costa Rica ’s hospital have been really helpful and informative. The country provides central health care for free to all its citizens and has hospitals as good as those in United States . Doctors and patients did not have many complaints about the hospitals and loved working for the government. During this one month, although the training and the Spanish classes took almost the entire day, weekends were free to travel the country. In the second weekend, the entire EWH group went to Volcano Arenal, an active volcano in central Costa Rica . Although, looking at the volcano from far away for a trace of lava was not that exciting, hiking in a tropical rainforest and climbing the mountains to swim in the volcanic craters was the most dangerous but thrilling thing I have done in my entire life. The hot springs created by the volcanic heat are unforgettable. In the third weekend, a small group of us decided to explore the well known east beaches of Costa Rica bordering the Caribbean Atlantic water. Puerto Viejo and the Cauhita had the best beaches in Costa Rica . The waves were perfect for a nice surf or riding a board. Puerto Viejo beaches had black sand beaches that I have never seen. In my last week, I went to Tourtugero, which is named after the green turtles that come there to lay eggs. The town was really small and we had to go in a small boat. The river had crocodiles and was surrounded by dense rainforest. Watching turtles lay eggs was a little disgusting, but amazing. 

As I ate my last breakfast with my host family and six of my other companions, I thought about what have I done in a month. I certainly felt well trained about troubleshooting and fixing medical devices. However, I still was not sure how much of an impact I will be able to make by my volunteer service. I have also learned many things about a different culture. However, I still have had a hard time communicating in Spanish. I was comfortable and had felt like home while living in Costa Rica with all my companions. However, I had to leave all my companions and leave the country that I have fallen in love with. I am not complaining. I chose this and I am ready to use all the skills I learned in my training and try to make a difference in this world.

Final Reflections

A rooster started crowing at five in the morning. As I woke up, I felt a sudden sadness overwhelming me. Today is the last day of my internship. I have to leave Nicaragua and go back to United States . I remembered this feeling when I had to leave Costa Rica after my training month. I cleaned myself and went to take my last breakfast with entire family. 

This last month of my volunteer program internship has been really different than what I expected when I was being trained in Costa Rica. Even though developing countries such as Nicaragua do not have state of the art medical technology, the people are happy and proud to be Nicas. From my first day, my work schedule included working from 8 in the morning to 4 in the afternoon. As an engineer, I was assigned to help hospital technicians repair biomedical equipment and to train hospital staff on the recently delivered medical devices. First it sounded like routine eight hour work shifts I had done while working in the United States . However, the differences were obvious as I worked more in Nicaragua ’s local hospitals. The main difference was the inefficiency and laid back work the employees are used to in their local hospitals. Fewer than one in five of the technicians at Hospital Espana has received formal training. The mechanics had enough work to keep them busy, but they lacked many resources and there was little they could do if a machine required any part replacement.. With no existing local source of spare parts, fixing the machines was a challenge. Therefore, most of the broken machines were staked in a room and treated as junk. 

As I started working in two of their local hospitals, I first decided to take a trip to their storage room where they kept all their broken equipment. I came across many broken photo therapy lights (due to the power supply issue), endoscope machines, electrocardiograms, X-ray processors, ventilators, surgical lights and electro surgical units. I requested to know the problems of these equipments however I got no answers. 

I started with checking their power cords and see if they had any electrical problems. I also checked if they were using same Hz power line for the machines they were made of. 

Many times the problems were in the transformer or main board which was not easily fixed unless new parts were bought. I did fix an electrocardiogram which had a problem in its calibration part. I also fixed many surgical lights which required routine maintenance (that was skipped before I came to work). I also fixed computers which had many software or small hardware problems. 

Language was an immediate barrier. Manuals accompanying hospital equipment were in English; but because almost none of the hospital staff knew English, equipment was often unused and relegated to storage. In response, we created note cards, and I provided training to hospital staff. 

Stunned by hospital conditions in Nicaragua, I soon realized that my own cultural expectations hampered my objectivity. I learned that every effort to bring more diagnostic and clinical tools to a hospital there translates into better care for a greater number of people. 

I am leaving Nicaragua with many unanswered questions but with the assurance that my contribution was valuable. These experiences have left me longing for further opportunities to improve conditions of the hospitals.