2010 PFIG Recipient Kevin Klembczyk

Career Administrator

Kevin Klembczyk
School of Engineering and Applied Science and College of Arts & Sciences
Biomedical Engineering and Economics Major
2012 Graduation Year

Internship: Engineering World Health

Notes on the first week

For the next two months I will be participating in the Engineering World Health Summer Institute in Tanzania. Today I depart from John F. Kennedy Airport in New York City. I connect through Amsterdam and will arrive at Kilimanjaro International Airport tomorrow night at 8:25pm, where I will meet program coordinators. There are about 25 students participating in the program. About half are from Duke, and the rest are from distinct universities in the US and Europe. I haven’t met any of my fellow EWHers, but I’m really looking forward to spending the next two months with 25 people who share my interests and motivations.

During the month of June, I will live and work near the town of Usa River, which is a suburb of the larger city Arusha, I believe. I will live with a local Tanzanian family. I don’t know much about my living situation beyond that. I expect to be fully immersed in the traditional culture and customs. Daily tasks that I usually take for granted in the US (eating, sleeping, showering, conversing) may be more adventurous and uncertain. However, from what I’ve heard from past participants, the conditions in the family stays seem to be fairly stable and adequate. I believe this specific experience will be very effective in aiding my adaptation to life in Tanzania.

For this first month, I will be taking classes at a local training and development center: MS-TCDC (don’t remember exactly what this means). Each morning will be filled with Swahili language classes, and in the afternoon I will be taking a lecture and lab class regarding the operation, maintenance, and repair of medical equipment in the developing world. For the past few weeks, I’ve been tentatively exploring some Swahili resources, in an attempt to better prepare for the intense classes. To be honest, the language is overwhelming at this point. It uses essentially the same alphabet as we do, but there are many distinct sounds and letter combinations which are rarely if ever encountered in English (e.g., dh in Swahili = th in English, but denotes a slightly different sound than th in Swahili). I spent about two hours looking over and practicing these sounds in the airport today. I’ve also learned maybe about 15 of the most common Swahili terms (but probably mastered only 2 or 3). Language and communication will certainly be a struggle at first, though English is gaining popularity in Tanzania.

The medical equipment aspect of training during the first month at MS-TCDC serves as preparation for the second month of the program, when I will relocate with just one other student and work in a hospital. My partner is Peter Park from Duke, but I haven’t met or talked to him yet. We will be living and working at Nkoranga hospital, which is west of Usa River. Our goal is to apply the techniques and knowledge we attain in our training to equipment in the hospital. The hospitals that we will be working in are targeted by EWH because they have a severe lack of personnel equipped to maintain and repair essential equipment. I am really hoping that Peter and I will be able to significantly improve the operating conditions and quality of care at the hospital.

When I traveled to Argentina on a volunteer trip in January, I learned a few things about adapting to a working environment in a foreign country that I believe will also apply here. Specifically, my fellow volunteers and I were often frustrated with the slow pace and seemingly relaxed attitude at the worksite in Argentina. However, in attempting to resist adapting to this cultural style, I believe we stepped a bit outside of our boundaries and may have offended some of the locals. Instead of appreciating our productivity, they resented our lack of regard for their customs, which is completely understandable. I will be better prepared for differing values on this trip.

Finally, Tanzania offers some incredible "touristy" opportunities, like safaris, beaches and towns on Zanzibar, and tribal culture. We should be able to take some great weekend trips and experience this side of the country as well.

Midway

I have been absolutely blown away by my first two weeks in Tanzania. Most of my expectations have been shattered. For example, I expected a somewhat arid, hot climate, but it rains just about every night here, and it is 75 and beautiful every day. I expected food to be a struggle - specifically getting enough of it - but I am honestly eating better here than I usually do at home. I expected my homestay situation to be a bit awkward due to the language barrier, but the mutual excitement of experiencing something completely new and foreign on both sides has overcome that.

My typical day begins with my roommate and me struggling to roll out of bed at about 6:45. I live with a fine Scottish lad named Alisdair. We get along really well, and I’m grateful I was put with him, since I think I’ll learn a lot more than I would if I lived with an American student. Breakfast is usually two hard-boiled eggs, toast with plum jam, and fruit. To get to school, we rely on dalla dallas, which are rugged vans that are stuffed full of people, animals, and really anything else that needs to get transported. The other day I found myself literally clinging to the outside of one, with only one foot on the outside step. It’s exhilarating.

School starts with about three and a half hours of jam-it-down-your-throat Swahili lessons. It’s hard to keep up, but I’m definitely learning a ton. It’s a pretty simple language in the structural sense, but there is a ton of random vocabulary to memorize. After lunch, we have an hour of lecture from Dr. Larry, a rugged and experienced international engineer, followed by a three hour lab. We’ve been learning and practicing techniques to assess and repair broken medical equipment. The class is incredibly well-organized, and I can tell that it is based on many years of field experience in developing hospitals. We get out of school around 5:30, and free time is spent going to town, relaxing, exercising, etc.

Each Friday, we travel to Mt. Meru Hospital in the city of Arusha to work on actual broken equipment. This past Friday was the most rewarding day of the trip to this point, as I was actually able to practice and apply the many techniques I’ve been taught. I worked with a team of four other students. Upon arriving to the hospital, we were brought directly into the main operating room (theatre). Sterilization consists of taking off one’s shoes and putting on dirty sandals - absolutely mind-blowing. A surgeon brought us to the (several hundred thousand dollar, nearly brand new) donated anesthesia machine, told us it hadn’t been working, and left us to fix it. We first worked at a faulty power supply, which took a while to repair, but we were soon able to power up the machine. After a few hours of careful disassembly and testing, we found several mechanical faults, including a grossly clogged exhalation circuit and a few broken switches. We thoroughly cleaned everything and fixed the broken parts before reassembling the machine. When the surgeon and anesthesiologist came back, they tested it and declared that it was working perfectly. Their gratefulness was heart-warming. Literally 30 minutes later, they brought the machine back into the operating theatre and used it to anesthetize a patient for surgery. I think this conveys very strongly the incredible differences between medical care here and back home.

Saturday morning, I and about half of the other participants departed to give our best shot at climbing Mt. Meru, the second highest peak in Tanzania, after Kilimanjaro. Highlights included approaching giraffes on foot (maybe 20 meters away), hiking through ancient tropical forests with more wildlife than imaginable, and summiting Little Meru (Big Meru typically takes 3-4 days). It was a rugged trip thrown together at the last minute, and I think it went exceedingly well given the circumstances (carrying all our own cold food, no sleeping bags). It will definitely be up there with the highlights of the summer when I look back. Next weekend we’re heading to Ngorongoro Crater, a natural wildlife preserve, for a two day safari. It should be a blast. I love the freedom and simplicity of living here. Time is going by much too fast.

Final Reflections

My internship ended and I departed Tanzania on August 14th. There are certain parts of being back in the US that I appreciate, but I will always remember these past two and a half months as one of the best times of my life.

For the entire month of June, I lived with a host family near the training center where I attended class each day. My host parents are two of the most compassionate and loving people I have ever met, and the other family members always kept things bright and lively. I absolutely intend on returning to visit them in the future. In general, I lived a pretty comfortable life for this month - my biggest challenges were adapting to the local culture and accomplishing menial tasks like getting to school, doing laundry, and showering. It was definitely the perfect way to be introduced to a society so different from the one I was used to.

On the first of July, I moved out of my host family's house in Makumira to my hospital in Nkoaranga, where I lived and worked for the entire month. It was a small hospital - about 80 beds and just three doctors - but it was relatively well run and maintained. Just one other student, Peter, was assigned to the hospital, and we lived together in a guest house which was about a thirty second walk from work. I'll describe our typical day. We woke up at about 7:30 (this time became progressively later and later as we began to realize the advantages of living in such proximity to work) to make it to work by 8:10 for the morning church service (the hospital is affiliated with the Lutheran church) and daily hospital report in the chapel. These two events were definitely highlights of each day. The service included lively singing and preaching in Swahili, which often left us looking lost and foolish, but our colleagues were understanding and appreciative that we came each day. The morning report comprised one or two doctors talking about the important events from the previous day and night. Any non-typical new patients were reported on and discussed, which often developed into a teaching opportunity for the head doctor, Julius. He was always enthusiastic about spreading his knowledge through to the hospital staff, which was a great learning experience for Peter and me, since we are both considering going to medical school.

After the morning gathering, we had a regular work day in the hospital. We had a small workshop where we brought malfunctioning equipment. Throughout the month we worked on about thirty pieces of equipment that were either completely out of service or functioning improperly. The hospital lacks a full-time technician, so essentially no attempt is made at repairing broken machines. If something stops working, they put it into a closet and leave it. Therefore, many of the problems we worked on were as simple as replacing a bent plug or soldering together a broken connection, but we often did encounter more complicated internal issues as well. There were a few projects we ultimately abandoned due to their complex nature, but the majority of equipment we worked on, we were able to put back into service in the hospital. Our most important fixes included a water distiller, an electrosurgery unit which was immediately put to use (as in five minutes later), an oxygen concentrator - the hospital only had three, several suction machines, and an infant warmer. After work, we bought food from the local village markets and cooked our own dinners. I played soccer almost every day with students from the secondary school next to the hospital.

Working at the hospital was definitely the most rewarding part of the internship. We worked in close collaboration with doctors and nurses to complete our projects. The learning experience was a two-way street. We were able to teach the staff how to better maintain their essential equipment, and they allowed us to stand in on several surgeries and other patient procedures. I had the opportunity to observe many things about the inner workings of medical care, which I did not expect. The thing I most appreciated about this summer was the simple and purposeful nature of daily life. Each day, whether we were working or exploring the country, I felt like I was doing something meaningful. Even when I was in class, I was learning things that I could apply immediately and directly. The focus was always on the present moment - I didn't feel pressured to meticulously plan out every step of my future. I felt a sense of absolute freedom that is often difficult to realize when I'm locked into the complexities of life in college.

My experience this summer taught me many things, both technical and non. It also motivated me to be more aware of challenges and opportunities outside of the western world. I appreciated every minute of my trip. Thank you, Parents Fund, for helping me to realize this opportunity.