Thursday, June 30, 2011

Last Costa Rican Blog

After everything yesterday about not having classes if the weather were nice, most of us were somewhat disappointed in today’s schedule: Spanish class (albeit a more fun version with Latin pop music and games), a regular after-lunch lecture (on ultrasounds), and lab activities not including the pre-briefings (Julien wanted to do further updates on the documents before presenting them to us). Also, because we did not have our pre-briefings today, we have to go in tomorrow morning at 9:00am to do that.

At our host hospital, we’ll be doing research to aid in a curriculum development program for Honduran technicians through EWH. Since I had heard of an “international aid” program that already had trained some technicians, I asked Julien how EWH’s program would differ and why. “There are lots of different training programs that produce qualified technicians,” he replied. “However, they graduate in clusters and won’t always stay in the country. Also, those programs have to stop when their funding runs out after three years. Eventually, we want our program to turn our third-year students into the next teachers. We want something long-term that becomes involved with the Honduran departments of health and welfare.”

Unfortunately, erasing any traces of hope in the matter on behalf of me and Tom, Julien answered our questions about the weather in the city of Olanchito by saying that it was “ridiculously hot”. Also, “you may have a fan in your shop, if your hospital has a dedicated shop for you, and you’ll want to work just standing in front of the fan with air blowing through your shirt constantly.” Another tip is to stay out of the sun in general and drink lots of water. Although Olanchito is somewhat dry and dusty, receiving less rain than many other areas, the weather remains extremely humid there.

Tomorrow’s schedule is interesting—school at 9:00am, lunch, dinner at home at 7:00pm, the National Orchestra at 8:00pm, back to the school around 9:00pm, and then a bus from the school to the airport at 3:30am. This is in good keeping with my general flight arrangements for this trip, which include a departure from O’Hare at 3:30am (June 1st) and an arrival to O’Hare at 1:00am (August 1st). Anyway, when we reach Honduras, Tom and I will be met at the airport in Tegucigalpa and then transported to our homestay in Olanchito. Blogging will resume perhaps Saturday or Sunday, depending on when I next have internet.

El dia final de clases! (Wednesday's Blog)

Spanish class today was our last Spanish class, lecture was Ric’s last presentation to us, and lab was our last full-group lab. In contrast, our Spanish class will spend tomorrow morning visiting the National Museum (unless it is raining), and the afternoon will be a briefing session for the participants going to Honduras (me and Tom).

Our training lab discussion today centered on the forms we’ll be filling out and the information we’ll be collecting for use by EWH in future work. “We develop skills in trainees literally based right off of the information you guys provide. If we see that most of the problems are calibration, we start teaching calibration. Or, for example, if 60% of malfunctions are due to power supply problems, we provide training for that,” J.J. said to stress the importance of diligence in our work at the hospitals.

One student proposed the idea of a prize for the group that fixes the most equipment during the month spent at the hospital. Some concerns were raised, however, that such a system could cause groups to be less cautious in ensuring that repairs are completed to the best of a group’s ability before declaring a repair as ‘done’. “One reason we don’t do that is it could foster too many bad things, and we don’t want you guys to think we care about how many pieces you fix, because it’s not about that. It’s about finding the needs and meeting the needs of your hospital,” J.J. said. Each location will be different, and direct comparisons between groups wouldn’t be practical.

Much to my relief, I was granted access to one member’s travel guitar after lab, which I played in the back room for about an hour before leaving the school. I may miss a few things during the second month.

Tuesday, June 28, 2011

Sense and Sensibility

Certainly next month, many of the hospitals we work in will be limited by a shortage of human and material resources; these conditions are what warrant us to serve using our training and skill sets. However, in lab today, we were cautioned against criticisms that could have the dual effect of objectifying a humanitarian problem and ruining EWH’s precious relationships with partner hospitals. 

“We’ve gotten used to seeing the images of starving little kids with the big bellies in Africa,” J.J. said, “and begin to think of them as ‘those poor little things that need rescued’ People have views of them that aren’t humanized. That’s why, after $700 million in aid, the problems are still so bad.” EWH wishes to avoid the mistakes of other well-intentioned aid organizations, and doing so will require continued, sensible work and caution on the part of program participants, which was the reason for today’s lecture and discussion about the developing world.

“People from ‘developed’ countries typically go these places, are moved with compassion by what they see, promise all kinds of big things, and then never even come back,” he continued. “One of the reasons that EWH has been so successful as an organization is that we do come back year after year, and we don’t make those kinds of promises.” Ironically, as I was reading the Central America news from the Washington Post later this evening with J.J.’s lecture still fresh on my mind, an article cited this exact problem. Organizations in the United States and several European countries promised $1 billion in funds last year to aid the fight against drug-related violent crime, a problem which is fueled by the American demand for cocaine and that is destabilizing the region. However, only $140 million of the funds were ever delivered, a meager 14% of what was promised. “EWH has spent years making contacts and building relationships with the hospitals so that you guys are able to work in them,” J.J. added. Earning the trust of organizations that have received so little follow-through is extremely difficult, and must be maintained with great care.

As far as the work we’ll be doing, needs will vary considerably from hospital to hospital and according to the resources available, including our personal skill sets. As a general rule, there are certain things that we do not want to do, such as displacing potential local jobs by doing tasks that could be done by people integrated into the local economy. Our work needs to contribute something extra that the hospital could not have without us.

Our first task, then, is to take an inventory of the equipment in the hospital: what it is, if it works, whether it’s being used, or how it’s broken. These listings provide useful insight to EWH in order to identify sources of problems and possible resources for long-term solutions. Also, if completed, an inventory makes the hospital eligible to send in requests for replacement parts or equipment. Finally, the inventory gives us the information we need to prioritize our projects.

Besides inventory, another important task in many cases is a needs-finding interview, during which doctors or medical staff are interviewed to find out what kinds of needs the hospital has (not what equipment the hospital needs, but what kinds of needs the hospital could use equipment for). Then, solutions are developed by summer institute participants (like me!) and/or students working for EWH at Duke University.

For example, David had the excellent idea today of centrally organizing ‘quick-start’ guides, which are simple diagram-instruction sheets explaining the basics of properly using a particular machine. Although groups had previously made such sheets on an as-needed basis, David suggested cataloguing each one, so that future groups could look up a particular machine and have immediate access to its quick-start guide. Also, the hospital staff could potentially look up the guides on their own so that our time and resources could be spent elsewhere.

Another aspect of our work is the ‘secondary project’, a way of helping the hospital that is not directly related to working for EWH. In the past, for example, a group built an intercom system for their hospital. Tom and I joked about building a butterfly garden for ours, given his teeth-cleaning experience in the last butterfly garden. Of course, we’ll actually build one if we get the chance.

Monday, June 27, 2011

Tamales

Our breakfast this morning consisted of tamales, a catch-all food that is traditional for Christmas Eve. Flory explained to us, “Tamales need to be the right size. The pre-made ones are expensive and taste bad, and are too big. You eat and eat, but it just doesn’t end!” We found the description quite amusing.

Today’s cultural awareness announcement? Do not celebrate the Fourth of July in Honduras or Nicaragua—just in case we did not figure that out on our own. Personally, I'm not going to say much about being a Reagan Fellow. With only a few days remaining in Costa Rica, I am looking forward to the change in scenery, but I am apprehensive of the coming contaminated water, high mosquito density, and extreme heat/humidity.

Another treat today was a modified schedule to have a little more free time in the afternoon. Our lecture today, which was on biochemistry analyzers, was held during the lunch hour instead of later and followed by only a short lab. In fact, everyone else was done with the lab already from last week, but Tom and I needed to complete a single connection on our switching, variable-voltage power supply.

All things considered, we still finished the day extremely early, which gave me a great chance to rest and get caught up on homework.

Manuel Antonio National Park

After taking the bus to downtown San Pedro at 5:00AM, we decided as a group of sixteen to walk a few blocks to the bus station that we needed for our journey to Manuel Antonio, a national park on the Pacific coast. Despite the size of our group and the early hour, however, Tim, who was walking just behind me in our essentially single-file line, was the victim of a theft. A man began walking rather close to his side, bumped him, stole his aluminum water-bottle, and then ran away. Tim was immediately rather unhappy about the situation.

Unfortunately, the day as a whole did not turn out any better for me. Shortly after we left the rest stop toward the second half of our trip, a sudden, stabbing pain rose up in my left shoulder and the left side of my chest. Dislocated or misaligned joints? A reaction to an infection (I was very sick the night before)? Pleurisy? Heart problem? Because of high blood pressure and previous symptoms I have had, I could not just ignore the pain as I hoped for it to subside. However, the pain did not lessen when reached our destination, and seemed to be growing worse. At that point, breathing was difficult because each breath substantially added to the pain in my shoulder and chest. Eventually, I told James, one of our leaders who happened to come with us, that I needed to have the problem looked at.

We took a bus to the nearby town (Quepos), and then a taxi to the hospital, which was a substantial distance from the town. When I arrived, I could not help but be reminded of the hospitals we had already toured in Costa Rica. Strangely, James and I could not help noticing that none of the clocks in the hospital worked, and one of the clocks didn’t even have hands! Eventually, I was called back and had to explain everything to the nurse in Spanish.  I was then taken to another room where my pulse, blood-oxygen saturation, and blood-pressure were taken, and although I was very tired and almost sleepy, my blood pressure was disappointingly high (140/80). However, this test and an ECG that followed revealed no heart or circulatory problems, and the cause of the pain was narrowed down to inflammation of one of my ribs.

Although I have no idea why one of my ribs would be swollen, knowing that this was the cause was very relieving, and helped to explain why breathing was so painful. Next thing I knew, I was in a room for billing, where the bill was prepared using an adding machine and a typewriter in an air-conditioned room. I was then able to pay the bill using a credit card and was told to have my insurance company reimburse it. That will be fun.

My next stop was the in-hospital pharmacy, where I waited until my shots could be prepared. Finally, after one in the afternoon, I was called back for an anti-inflammatory shot and a pain-killer shot. When the whole fiasco was over, James and I went out to eat and then went back to Manuel Antonio. By this time, I would only have a couple of hours of daylight at the beach.

When I finally arrived at the beach, I was stricken by the beautiful water, islands, mist, and trees in the background; this was my first time to the Pacific. A large sign at the entrance of the beach warned of rip currents, and the lifeguards were like sharks as they ran frantically back and forth whistling for people to come closer to shore each time they saw a rip current in formation. Additionally, an armada of boats waited out at sea to scoop up anyone who got sucked away. Alternatively, these same boats provided parasailing rides. Last weekend, some EWH students went to the beach and got pulled out by a rip current, luckily being able to stand up well enough to reach shore, carrying a little girl with them who couldn’t do the same. Last year, an EWH student was swept significantly further offshore by a rip current, which carried him off for two hours before he was rescued by the Coast Guard.


After our time at the beach, we went for dinner at a reputably cheap sports-bar, which was, in fact, no less expensive than anywhere else was. Our motivation for going to that specific restaurant, however, was to watch the USA versus Mexico soccer game. Apparently, everyone else there had the same intentions, because the entire place was filled with Americans. When the “Star Spangled Banner” played after the Mexican national anthem, we all sung along, and we all also reacted with one accord to the events of the game, which were in the end unfortunate.

Back at the hotel room, I had a great deal of difficulty sleeping because of the pain in my chest, which grew worse when I lied down. However, when I rolled from my back onto my right side to put my weight on the ribs opposite the swollen one(s), the pain subsided and then went away so that I was able to sleep without a problem.

I woke up quite early and relatively refreshed the next morning and went out to the beach at 7:00 to take pictures and collect seashells. For the most part, I was the only one on the beach at this time, which was quite peaceful. Later, people were parasailing.





When I arrived at the most crowded portion of the park and forest, I was surprised to see there the highest concentration of monkeys. The first one I saw was up in a palm tree with a crowd of people gathered around to take pictures. Meanwhile, a man was shouting at the monkey, “Yeah. I’ve got you; I’ve got your [phone] number!” as he occasionally startled the monkey by hitting the tree trunk with a large plank. At the time, I thought, “how cruel, and what a dumb thing to say... especially to a monkey.” Looking back, I have a pretty good idea of why the man was so irritated.

The white-faced monkeys, as they are called, were all around on this beach, and are considered one of the smartest species in the New World. They also spend more time moving along the ground than most species do, I overheard a guide saying. While I was surveying the troop and looking for photo opportunities, I saw one grab someone’s juice bottle and go running away. As the victims of the theft chased the monkey, it ran faster until eventually reaching a tree that it considered safe. After climbing to a sufficient height, the monkey promptly grabbed the juice-straw and tossed it aside as if performing a familiar task before lifting the carton to its mouth and drinking the contents. Meanwhile, everyone who had seen what the monkey did was surprised at its intelligence and audacity and laughed accordingly. When the juice became inaccessible through the straw-hole, the monkey even ripped open a new hole to fully drain the carton.

Later, one of the tourists wanted to give the monkeys a banana. No sooner had she unpealed it than three monkeys came, each one hanging down by its tail from the branches as it grabbed a chunk of banana. Immediately, monkeys came from the surrounding trees to try to take some of what the others had, causing a general ruckus. Other monkey highlights included seeing the creatures groom each other, attempt to sleep in familial clusters, and one carrying a baby monkey on its back. On more than one occasion, a monkey running or jumping from one tree to another came very close to me, allowing for great pictures.


Also at the park, in nearby pools of water detached from the beach, were “Jesus Lizards”, which I had previously seen on TV running over water. Indeed, the lizards frequently went from place to place by scurrying over the surface of the water on their hind legs, but the creatures moved too quickly for me to be able to fully appreciate their method of locomotion with the naked eye.

In addition to these animals, iguanas were relatively commonplace throughout the park, some being rather large. While taking a trail on our way out of the park, Brandon and I stopped first to investigate the largest anthill I have ever seen, and second to watch a sloth do nothing. Also, though I did not get to see them, some other members of my group saw caimans, a type of crocodilian.



When we arrived back in San Pedro, Gavin, the one who has bad luck with traffic and was almost run over by a train, was almost run over by a bus. This time, however, it wasn’t his fault, and he actually prevented anything from happening to himself. What happened was that as we readied to exit the parked bus through the back door at the bus station, another arriving bus came to pull in between our bus and another parked bus. The result was that right as Gavin was about to step out, a bus whizzed by a few inches in front of him and only about two inches from broadsiding our bus as a whole. The driver quickly slammed on the breaks, as the arriving bus simply wouldn’t be able to fit into the space. 

Friday, June 24, 2011

Children's Hospital of Costa Rica

Our hospital visit was local today, so we were able to sleep in until 9:00. Of the three hospitals we have visited, the children’s hospital, which we visited today, was by far the best equipped. Martin, the hospital’s lead engineer and our guide, spoke only in Spanish, but I understood the vast majority of what he said. The children’s hospital was built in the 1950s, having been designed by architects in Washington, D.C. Martin then showed us a CT scan, x-ray machine, and a specialized head/face x-ray, all of them designed for use with child patients. When we didn’t ask him enough questions about the hospital and the machines, he began asking us questions. Specifically, he demanded that we tell him the things we learned since coming to Costa Rica that were uniquely Costa Rican. I answered, “Pura Vida!”  Our final stop was in the technicians’ shop, where Martin showed us an assortment of specialized diagnostic tools, often costing thousands of dollars, for use in testing electrical or pressurized-gas systems.

After the hospital visit, most of us elected to rest for the remainder of the day, which was great until I became ill, as I am now. I’m hoping to be better by five in the morning tomorrow, because I would like to go to the beautiful beach on the Pacific side for the weekend.

On a lighter note, this morning before the hospital visit I emailed the dean of the School of Computing and Engineering at the University of Missouri in Kansas City in order to ask him about the feasibility of starting a 3-2 engineering program with Eureka. He emailed back in only an hour saying that it sounded like a great idea and that such an agreement could be made quickly if both schools pursue it.

Thursday, June 23, 2011

The tunnel at the end of the light

I have noticed that on my walk of about three blocks between my bus stop and the academy in San Pedro, the birds squawking overhead every day are green parrots—lots of them. I figure they’re relatively entertained by the bustling city below.

Our lecture was about electrical safety on the scale of the hospital as a whole. We need to make sure that a dedicated ground exists, created by pouring concrete, wrapping the concrete in copper wire, encapsulating the device with more concrete, and then burying the entire thing at the depth of the water table or deeper. “Ground is ground,” Ric says. Then, we must ensure that all of the power outlets in the hospital are correctly wired to this ground, a time-consuming but important task which has hopefully been accomplished by previous groups of EWH technicians.

Gladys began testing our Spanish skills today by roaming about the lab and probing everyone as if she were a worker at a hospital in Honduras or Nicaragua needing to know what was going on or what to do. The pressure of speaking Spanish to the “Jefe de Jefes”, as some have decided to call her, caused me to mess-up all kinds of simple phrases which I knew quite well, kind of. In just a week, I’ll be in Honduras with far fewer English speakers! This is, of course, when I'll gain the most valuable learning experiences, and though as we come to the final days of training, Costa Rica is easy to live in, I must relish the challenge of facing the unknown that lies ahead.

Wednesday, June 22, 2011

An Ordinary Sort of Day

Good news! Since the Children’s Hospital of Costa Rica that we are visiting this Friday won’t be ready for us in the morning, we can sleep in and arrive at the school around noon. Also, Dr. Malkin gave an interesting TEDx talk titled Donations Hurt, in which he discusses how he came to co-found Engineering World Health as well as the rationale behind the way the organization operates.

As Tom and I walked into the cellphone store after school to buy a charger for use in tomorrow’s lab, the guard inside, wearing a uniform with a black bulletproof vest, was servicing and loading a sleek silver shotgun. His presence made us feel quite adequately protected, but also somewhat nervous as we tried to not look suspicious. Luckily for Tom and me, we were even more pressured by the fact that no one in the store knew any English at all, except for the word “cash” as we prepared to buy (credit card was also an option). Nonetheless, we managed to get by with what we knew, and left with a $6 charger which we will convert into a variable-voltage switching power supply tomorrow.

The same one who was almost run-over by a train the other day (Gavin) had more bad luck with transportation this afternoon. While he was riding the bus during rush-hour traffic, his bus driver decided to veer into the oncoming traffic of the four-lane Trans-American highway in order to pass all the cars held up by the traffic. The oncoming cars responded by moving out of the way and not having head-on collisions. When I was in the same bus before with the same bus driver, he held down the (loud) bus-horn for nearly a full minute, which obviously had no effect on the jammed cars other than to annoy everyone.

Tuesday, June 21, 2011

Picture Imperfecto

Gladys gave an announcement this morning about the culture shock, fatigue, and depression being experienced by many students at this point in the program. From her observation and those of J.J. and James, we are in “the depths” of culture shock, during which a variety of physical and psychological symptoms can greatly reduce alertness, productivity, motivation, good posture, etc.  I am certainly not feeling this way, though, and I’ve been looking forward to this week, this weekend, next week, next weekend, etc. I suspect that several past experiences have helped me to adjust quickly to the Costa Rican environment. Academically, the Spanish and technical courses and activities are intensive but less demanding overall of my available time than was my class and activities schedule during my senior year of high school and every academic term since. Psychologically, there is less heat, fewer bugs, more amenities, and less personal responsibility here than what I experienced while caring for a group of campers 24 hours a day as a camp counselor for eight weeks in 2009. I also have the distinct advantage of having been to Costa Rica before, which may lessen the shock of cultural and societal differences. Of course, Honduras may yet be thoroughly shocking.

Monday, June 20, 2011

Becoming a Statistic

Every morning when our group gets off the bus from the Trans-American Highway, we have to cross four lanes of rush-hour Costa Rica traffic with the added adventure of an active railroad track separating the opposing lanes. When traffic opens and there is no train, we dash across the first two lanes and stand on the tracks until we get the opportunity to dash across the remaining two lanes. Every time we successfully cross the road, I jokingly quantify our success with a fabricated statistic, e.g. “Alright! We’re 12-for-12 crossing the road, guys!”

This morning when we arrived at our stop, the traffic was heavy and the train was approaching. As I sullied around waiting for a chance to cross the road, I perceived that the train was sounding its horn more than usual. When we were finally able to cross, I was shocked to see Gavin, one of our group, waiting for us on the other side. Before I could make any sense of the situation, he relayed to us the details of his unfortunate incident. After getting off the bus, he crossed the first two lanes of the highway during a brief opening in the traffic, stopping on the tracks. By this time, of course, the train was just about right there and was honking at him vigorously. Perhaps with less regard for the traffic than for the train, he moved out of the way and crossed the remaining two lanes of the highway. Gavin almost became a statistic!

Later we learned from Gladys that one of her employees had had a similar experience. Being tired and not fully cognizant (as was the case with Gavin), the woman failed to notice the train at all but happened to have just finished crossing the tracks as the train passed. I venture to say that this train passed the woman absolutely as closely as possible, because it ripped off parts of her clothing.

In lab today, each group built an infant incubator temperature monitor which sounds an alarm and causes an LED to flash if the temperature rises above a given value. We soldered the components (a thermistor, microcomputer, piezoelectric speaker, LED, battery pack, and resistors) into a circuit board and then took the device to J.J. to have the operating program loaded onto the microcomputer.

During lab, one of our lab instructors, James, a mechanical engineer, showed us some videos illustrating the uses of microcomputers at his own workplace. His team developed specialized gloves with accelerometers in each finger for the manipulation of robotic arms and computer controls. Part of the glove project is a DOD contract intended to develop a bomb-diffusing robot that can be operated by an expert wearing a blast suit, including gloves. Current bomb diffusing robots require the operator to manipulate the remote control with his or her bare hands, which is dangerous in a blast area.

After classes today I stayed at the academy to work on homework until this week’s Latin dance lessons began. Although I felt much better about the footwork and movements this time, I certainly have a long way to go.

On another note, at this point, having only twelve more days in Costa Rica, I’m beginning to realize how much I’m going to miss this place when I leave. I’ll miss the guys I’m currently living with; Flory and her 3, 5, and 6 year-old grandsons; Flory’s Costa Rican cooking; the friendly shop owner a block from the school who provides us with the cheapest, quickest lunch (after asking how we’re doing); Ric’s expertise and training help; etc. But all things must happen in their time, and I need to remain focused on the fact that Costa Rica is only the training month (no pun intended), while the primary purpose of this program lies in what may be accomplished during the second month in Honduras.

Sunday, June 19, 2011

Sweet to the ears and sour to the mind

I awoke this morning feeling quite rested at 8:30, early enough for the Orquesta Sinfonica Nacional in the Centro Nacional de la Música. Since I was going alone, Flory urged me as I walked out the door to be cautious in the downtown area. “You don’t have any more money than you need, right? And you are not taking your passport?” she warned in Spanish.

My ticket for a balcony seat with an excellent view of the stage and the performers was only 3.000 colones ($6). Many families had come to the symphony to celebrate Father’s Day, which is the same day in Costa Rica and the United States, though Mother’s Day is different. The guest conductor was Irwin Hoffman, a Julliard graduate who conducted for Chicago and Florida and is now the conductor for Bogatá, Columbia (this in addition to guest conducting throughout the world). Surprisingly, he conducted without using any sheet music for the entire program, which consisted of a Berlioz overture, a Hindemith symphony, and a Tchaikovsky symphony. His memory for the details of all the pieces, such as the cues, dynamic levels, and tempo changes, was impressive, as was the performance of the orchestra in general.

After the concert, I happened to come across J.J., our on-the-ground coordinator, and his wife, Gina. Since cameras, being frequently targeted by thieves as the mark of a tourist, are not recommended in the downtown area, J.J. and Gina had built their own from duct tape, a roll of film, a winding mechanism, and an aperture for film exposures, which could be opened and closed by sliding a piece of paper. Besides the fact that building a camera may have been a fun project, I do not consider their level of precaution to be overkill considering that their backpack was stolen from inside the school during classes on Friday.

I passed by many beggars while looking for a restaurant in which to eat lunch, and some of them were starving. Although one can safely assume in most cases here that their condition has come about through addiction to cocaine, I nevertheless could not finish my meal with the knowledge that they were suffering nearby. In fact, while I was eating, a ghastly, unkempt woman came suddenly into the restaurant and stacked together four Styrofoam plates with half-eaten meals that had been left behind by a family celebrating Father’s Day. A waitress promptly came up behind the famished woman, put her hands on the woman’s shoulders, and pushed her to the door before shoving her out.

Saturday, June 18, 2011

Free Day

Sleeping in until nine in the morning was fantastic. After a quick breakfast, Andrew, Cliff, Gavin, and I took a bus downtown to meet some of the EWH girls in the plaza for a Bible study. However, we barely opened our Bibles and instead primarily shared about the blessings and challenges of being part of this program. Just as we were finishing at noon, the rain which had been coming our way from the mountains arrived. Unfortunately, I had left my rain jacket at the homestay, so I had to share an umbrella as we searched for a restaurant in the pouring rain (which has continued with varying intensity for about eleven hours now). At lunch, we mainly discussed how disappointed we’ll be when we return to the States and then have to pay more money for food that is less fresh, less healthy, and less delicious than the food in Costa Rica!

After lunch, we splintered up to explore the city in groups (our last chance to do so since we’re going to the beach next weekend and leaving the country the weekend after that!).Thinking that the Gold Museum was closed, my group went to a bookstore. While in the bookstore, however, we actually found a book with the Gold Museum’s hours, and the museum was open. When we reached the museum in the pouring rain, though, we found that construction work kept most of the exhibits closed to the public for the next two months.  Despite the limited access, we entered and saw some gold figurines and artifacts, as well as many works of a contemporary Costa Rican artist.

From the Gold Museum we went to the Metropolitan Cathedral, which had some elegant architecture. Outside of the cathedral was a music festival (a stage covered with a tent as well as tented areas for people to stand out of the rain), and we arrived to one of the tents just in time for the last song. At the National Theater about one block away, we realized that the Costa Rican symphony orchestra is playing tomorrow at 10:30am (admission $5 and up). I may go if I’m awake in time, while the rest of the group is getting up at 6:15 tomorrow morning for a trip to a volcano which I saw last spring when I was in Costa Rica. Finally, we went to a nearby supermarket, where I bought a cheap block of ‘fresh cheese’. Unfortunately, since the cheese had not aged for very long, the flavor was very weak and the texture was quite similar to tofu.

When we arrived back to the homestay, no one was home even by the time that we would normally have dinner. But just when we had given up and decided to go out and buy something, Flory (our host mother) arrived and announced she had lost track of time at her nephew’s wedding. We were fine with going out anyway, but she told us that she had already made supper and needed only to heat it up.

Strangely, no one at our house had any blatant side-effects from the chloroquine, such as nightmares or bizarre dreams. However, we noticed ourselves being extraordinarily goofy after dinner while playing the card-game form of monopoly, and we joked that if chloroquine was to blame for the new dynamic, our host family must be used to every EWH group being normal for the first half of the month, and then half-crazed for the two weeks prior to leaving for Nicaragua and Honduras—in fact, our hosts seemed to be completely unsurprised by our behavior. 

Friday, June 17, 2011

Alajuela

Around 9:00am, we arrived at the hospital in San Ramon, Alajuela.  In contrast with my group’s hospital visit last week, the hospital in San Ramon was well managed, highly competent, and well prepared for us. The staff quickly led us to a conference room, where the senior engineer and several technicians gave a presentation about the hospital in San Ramon and Costa Rican healthcare in general. The senior engineer presented in Spanish, but prepared the presentation notes (powerpoint) in English for our convenience. He was proud that Costa Rica (population 4.5 million) was able to economically support public healthcare and a medical infrastructure, and told us that Costa Rica served as a healthcare model for other nations. More preeminently, I wish that his hospital would serve as a model for other hospitals in Costa Rica, such as the one we visited last week.

Until lunch, we worked with Ric to diagnose problems with an electrical surgery unit, an infant incubator, and an anesthesia machine, all of which had just arrived from other hospitals. Since this hospital’s techs didn’t need any help fixing stuff, they saved some equipment which was sent to them from elsewhere for us to look at. During this time my partner, Tom, and I talked to Ric and learned more about his background. He has worked as a medical technician for over 30 years, having received his undergraduate degree in aeronautical engineering. Using his expertise, he quickly found the problems with each machine and told us and the hospital technicians how to fix them. Of course, we had to test the electrical surgery unit, so we used it to slice through a raw potato in lieu of flesh.

About five of us from the EWH group were joined for lunch by the hospital technicians. I ended up talking mostly with Marcelo, who spoke to me primarily in English while I spoke to him mostly in Spanish. He has a latin band for which he plays bass and sings on weekends, and we enjoyed talking about different instruments. We also talked about the differences between the weather and food in Costa Rica compared with that of the United States, as well as the similarities between Costa Rica and the United States concerning government corruption (jailed Illinoisan governors and Costa Rican presidents).

After lunch we were given a hospital tour, and I was especially excited by a “butterfly garden” in which nearly 30 species of Costa Rican butterflies fluttered therapeutically around us. Just as we were getting ready to leave, a large butterfly landed on Tom’s face. Despite his uncomfortable groans and facial contortions, the butterfly remained on him and began to climb down the bridge of his nose. Reaching the tip, the investigative creature put a couple of its feet into his nostrils (butterflies taste with their feet). Apparently unsatisfied with the taste of Tom’s nose, the butterfly crawled further down, uncurled its proboscis, and proceeded to feed from the surface of his teeth. Meanwhile, as Tom continued to openly display his discomfort, we laughed while taking pictures and videos of the incident. I only wish that it had instead happened to me.


After the butterfly garden, we went to the x-ray area to learn about various kinds of x-ray machines and their uses (the basic funness-factor of our journey today was paramount to a grade school fieldtrip). We saw standard, fluoroscopic, and mammography machines before returning to the shop to learn more from Ric before leaving.

Immediately following our most delicious supper at the homestay (and the food seems especially good now that my stomach has been feeling better) most of us began our anti-malarial course of chloroquine. Taken once weekly as a small pill, this drug prevents malaria from metabolizing hemoglobin, thereby effectively starving the blood-borne parasites. Initially classified as too toxic for human use when discovered in 1935, chloroquine has expected side-effects that include itchiness, headaches, nightmares, and blurred vision—a fair trade for preventing malaria.

Getting robbed is an adventure that I have yet to experience

During lunch today (Thursday), we discovered that J.J.’s backpack, containing cash, personal items, and keys to the school, had been stolen from inside the school that morning during classes. The academy is a small, house-sized building with four classrooms full of people and a room for general lecture, and the only doorway to enter or exit is within the fortified garage. Also, this door has a grated metal cover which can be opened only with a key or by someone pressing a button from the inside. Incredibly, despite 30 people in classes, the thieves entered the garage, picked the lock of the door, came inside the house, and took J.J.’s backpack! The classroom closest to the door heard the opening and closing of the door, but assumed that the sound was simply from someone coming or going legitimately. Tomorrow, all the locks are being changed. For tonight, however, we had to remove everything of value in case the thieves should realize what the keys are for.

In lab today we learned how calculate the time, wattage, and voltage needed to correctly charge a given secondary cell (rechargeable battery), since charging certain common kinds of batteries too quickly or for too long causes a hazardous accumulation of hydrogen and oxygen gas. Using one equation and a parameter under our control to find a second parameter’s value to be used alongside a third parameter in a second equation in order to maximize a fourth parameter was quite difficult, and our results were by no means exact. Although there may be some simplification, the problem intuitively seemed like a multivariable calculus maximization problem that would be difficult to solve. Tom and I settled on charging our battery over several hours at 18 volts, though an exact solution could have reduced the time slightly while changing the needed voltage.

After school was the party at Gladys’s house, since she had invited us early in our training for being a well-behaved group. Since her house is some distance from central San Pedro where the academy is, she arranged for a bus to pick us up. The cost of a Mercedes Benz charter bus from 4:00-11:00pm? About one-hundred dollars for the entire group. Gladys’s house seemed quite nice (and was in a beautiful location overlooking the city), and I speculate that the house was designed for hosting parties, since the bathroom was located directly next to the front door. After an incredibly delicious course of corn chips with a homemade dip of refried beans, fresh guacamole, sour cream, and cheese, we had hotdogs on tortillas, cheeseburgers, and cups of mixed fresh fruits.

Arriving back home around 11:45 that evening, we went quickly to bed in anticipation of catching the bus at 6:15 the next morning. Pura vida!

Wednesday, June 15, 2011

When it rains, it pours

Today was characteristically Wednesday-ish. I stayed awake much later last night than expected, partly from feeling sick, so when I got out of bed four hours later, I was quite tired for the rest of the day and still sickly.

After the first two hours of Spanish class, I had to give a presentation on the respirator (respirador), discussing the purpose of the machine, how it works, what could go wrong with it, and how to fix it. Luckily, Ric, our technical instructor from the Philippines, had skipped out on the second half of class to prepare his own foreign language lecture (in English), so I didn’t have to answer his questions about the respirator.
After lunch, Ric gave a hodgepodge lecture about fluid pumps, blood pressure measuring devices, and infant incubators. For the first time (in this program), I had a lot of trouble paying attention and staying awake. Fortunately, I had already read those sections which he was lecturing on.

Our lab today was a group activity during which J.J. (the on-the-ground-coordinator) followed directions from us as we tried to repair machines that he had sabotaged. The first machine was an electrical surgery unit that would not turn on. Immediately, someone suggested checking the fuse.   Opening the fuse box, J.J. remarked, “Huh—it’s empty.” He then drew a fuse out of his shirt pocket and put it into place. Plugging the machine back in and turning it on, we were able to begin slicing a bar of soap with the bovie pen; a strange result considering that J.J. had also sabotaged the bovie pen’s source of electrical power. I speculate that the electricity found another way to the ground, but in any case, the device should not have been working. Our second project was to help J.J. use a sphygmomanometer after he suddenly became unable to use it or to speak/understand English. Our third machine was a centrifuge that would not turn, and I found the problem (a small fail-safe that prevents the centrifuge from spinning if the lid is not down). Again, he pulled the missing part out of his shirt pocket. The EWH participant from Denmark observed, “it can’t be fixed yet; there’s still a lot left in his pocket!” However, the machine then worked.

After classes, we had several hours of down time before our special guest speaker for the evening came at 6:30pm (as a manufacturing engineer in Costa Rica, he could not arrive any earlier). Since I needed some money to help pay for the party at Gladys’s house tomorrow, I attempted to use the ATM about a block away from the school. The machine did everything except process the transaction and deliver money—going only to a blank screen. I was then relegated to another machine several blocks away. Near the ATM, I was relieved to see a guard with a gun and bulletproof vest ready to thwart any would-be-robbers. Then I thought, “Strange. Having a full-time guard kind of defeats the purpose of having an automated teller machine.” Before leaving the booth, I spread the 10,000 colones bills (approximately $20 each) among several pockets and locations, as I was instructed to do as a precaution against high-loss muggings. (So far, no one in our group has been mugged).

For about two hours, Tomas, our special guest who studied mechanical engineering at the University of Costa Rica, described his experiences in school and as an engineer and also answered our questions about working in the developing world. He used quite a lot of humor in references to engineers being different than “other people”, including the pre-med folks (which include his girlfriend). Someone asked which classes had done the most to prepare him to be an engineer. “Well,” he said, “all of them. And none of them.” By virtue of how tired I am today and how I’m feeling right now in general, I can’t remember all of the witty things he said. However, I think that they are somewhere deep within for me to hopefully be able to use when I face the kinds of situations he was talking about.

Of course, when we started back to our homestays, it was pouring down rain.

Tuesday, June 14, 2011

Always Follow Directions

Ric’s lecture this afternoon was all about anesthesia machines and what can go wrong with them. For some reason, anesthesia machines collect the combination of oxygen, carbon dioxide, and anesthetic agent exhaled by the patient and attempt to scrub and sequester the harmful components of the gas before releasing them into the room for everyone else to breathe. On more than one occasion, Ric has witnessed surgeons and nurses becoming dangerously tired because scavenger gas filtration was “full” and “spilling over” so to speak. Also, there is no way to know when the scrubbers become saturated other than to notice the anesthetizing effects on people other than the patient. For these reasons combined with common sense, Ric recommends sending the exhaled gas outside where no one will be harmed. He then cautioned, “Don’t return a machine as being fixed that might still be broken, or it may bring you to jail as the biomed.” Luckily (kind of), he followed that up by saying, “Well, nevermind. It’s fine. The anesthesiologist should know if the machine is working; he’ll go to jail. Just don’t ever sign anything to certify that a machine is repaired and you won’t be too mixed up in it.”

Our lab project today was “dry”, that is, involving no building or troubleshooting work. Instead, we focused on creating quick-start guides for teaching anyone a new task. Quick-start guides are similar to what we find in the instructions of most products, teaching us as clearly as possible but with the minimum number of words how to use a product properly. My group of four chose to create a guide for tying a bow-line knot, meaning that the pictures were somewhat difficult to draw. Luckily, since I was obsessed as a young child with depicting the spatial relations of snakes wrapped around tree trunks, I was able to draw the rope positions relatively quickly. We then gave our quick-start guide to a volunteer whom we were not allowed to communicate with, and he successfully tied the knot! One group made a guide for a cootie-catcher and asked who in the room had never made one before—I was the only one. After I struggled through that, the day was done (We had also earlier discussed at length the conditions we’re likely to face in a developing world hospital).

Back at the homestay, I took a more relaxed evening, since I worked extra on homework last night. Tomorrow, I have to give a presentation in Spanish class about the purpose of the ventilator, how it works, what could go wrong with it, and how to fix it. Although the presentation, followed by a question-and-answer session, must be entirely in Spanish, I’m more concerned with the fact that Ric, the biomedical technology specialist, is in my Spanish class!!

Monday, June 13, 2011

Mondays Are Mondays Everywhere and Are Usually Not Fun

Our lab project was to troubleshoot our variable-voltage power supply. The situation was that if our power supply was not working, we had to get it to work, but if our power supply was working already, we would have to trade with another group, sabotage each other's power supplies, and then give them back to each other to try to fix. Luckily, we had screwed up our power supply already and didn’t need another group to short or open-circuit a connection, add extra parts, or douse the components with water for us. Luckily, we found our (extremely minor) mistake relatively quickly, and then our power supply worked well without melting or blowing up anything (as occurred with some other groups).

Our next task was to create instructions for using the power supply in Spanish and English. I was surprised by the need for the subjunctive form when saying, “adjust the knob until the voltage is (subjunctive) correct.”

Besides that, today’s only distinguishing features were some digestive issues (which hopefully will quite literally pass) and a tiny lizard on the wall during dinner, which I caught and then took outside. Even so, come, Friday, come!

Sunday, June 12, 2011

Monteverde


The bus ride from San Pedro to Monteverde was crazy to say the least. Leaving our house at 5:00AM on Saturday, we reached the bus station around 6:00AM and boarded. Although we had purchased 26 seats, only 24 of us had seats and two others had to stand or sit in the aisle (for several hours). Also, many other
people had to stand for the entire ride.

The bus itself was about the size of a charter bus, which was quite nice until we got to the narrow mountain roads. By narrow, I mean not large enough to accommodate two-way traffic, though it did. By mountain, I mean frequent drops of several hundred to a thousand feet or so just off the road. By road, I mean sharply winding and steeply inclined gravel. (Did the bus start slipping backwards once? Yes). Oncoming traffic was managed on a case-by-case basis. The worst scenario was when another charter
bus-sized vehicle came from the other direction. Our bus was noticeably tilted toward falling off the mountainside as we squeezed around the corner and past the other bus.

This was tolerable for me until the people on the bus who actually lived in the area grew anxious about the situation, apparently signifying that we were closer than acceptable to rolling over. When our pass was complete, people began applauding for the driver. In any case, the terrain we saw from the bus was incredible.

At Monteverde, we went to the rain forest (sometimes called a cloudforest) to view wildlife. Andrew, Brandon, and I split off to go ahead of the rest of the group out of concern that the noise of a large group would scare away the animals. Almost right away, we saw a large, exotic-looking bird with a black body, long neck, and blue head. Later, we saw some pigeon-like birds that primarily walked on the ground, as well as a giant blue ant. Sightings from other groups included more birds, big insects, and a monkey. For all of us, the vegetation was incredibly diverse and dense (one small tree was documented to be the host of over 70 kinds of plants). We saw different plants everywhere we looked. Interestingly, some portions of our walking trail were part of the continental divide. Of course, before we left it began to rain and pour.








In Monteverde, a small, tourist town, many stray dogs live in front of the shops, some of which befriended us immediately. They followed us from place to place, waiting outside stores and restaurants for us to come back out. At the hotel late Saturday night, I was startled on the second floor by a large, beautiful white dog which had come up the stairs and lied down in front of the door of a friend's room. We spoiled it with attention, and then it chilled with me for a couple hours as I enjoyed some fresh air and quiet time out on the balcony. Apparently, stray dogs in these areas are basically everyone's pet, being fed and cared for by everyone. All of the dogs we met were well-adjusted and extremely friendly, so I'm inclined to believe that they really are well cared for.

Our zip-line tour of the rainforest canopy the next day consisted of 13 lines through the jungle and a Tarzan-style “Superman” swing. Although I did some zip-lines last time I was in Costa Rica, it was just as cool the second time, and at this location the clouds in the rainforest really brought out the epicness of the jungle.  The last, highest, and fastest zipline, which was steeply inclined for speed and funness, had to be ridden by two people at once to avoid spinning around in the harnesses. Several people in my group engineered clever ways of attaching their cameras to their helmets or other areas (with only one camera-casualty), so Andrew got a great video of our last zipline. As I jumped off the platform of the Superman Swing, I was uncomfortable with the initial slack I felt in the rope (Am I attached?), since this was the free-fall  portion. Soon, however, I became quite certain that the slack was all gone and the ropes were, in fact, holding me up as I swung over some trees and vegetation.

Our return busride (about four hours) was uneventful, though filled with incredible landscapes and scenery. I took about a 45 minute turn standing, which was actually more comfortable than sitting, though also more demanding. 

Time for another week of class!

Friday, June 10, 2011

Early bus, scenery, hospital, scenery

No class today! Instead, we split into two groups to go to hospitals in Costa Rica and learn about our coming work environment. Luckily, my partner and I were in the group with Ric, our technical instructor from the Philippines who has an enormous background in technical medical work. He knew countless details about every machine we encountered and was able to give specific, exact answers to all of our questions.

We were told beforehand that the hospitals in Costa Rica would be quite good in comparison to those we would be working at in Nicaragua and Honduras. However, the standards that I witnessed today, especially concerning sanitation, appeared to be rather low compared to the sanitation practices in the United States. Also, equipment and supplies were noticeably low or of older makes and models.

Patients are kept in large, open rooms divided by the nature of their problems (ICU, recovery, maternity, etc.). One side of the hospital was specifically for male patients, while the other side was for females, except in the emergency room. The emergency room provided care on the spot, and people were sitting around with oxygen masks on or IV drips running while waiting for more specific attention.

All Costa Ricans are obligated to pay 12% of their salaries to the public healthcare system. While emergency care is initially given without prior patient documentation, all other healthcare can only be received after the patient has presented a paper to the hospital staff which confirms that he or she has been paying the healthcare tax.

Ric taught us many specific workings and functions of the various machines we encountered, including an AED, ventilator, endoscope, portable x-ray machine, and an ECG. Although we were working in the hospital’s area for junked equipment, Ric found in his investigations that most of the machinery was in perfect working order. This waste of the equipment was extremely frustrating to him, as he lamented to us many times.

During our return trip from the hospital in Turrialba, the scenery was breathtaking and I had a clear view of the volcano. Tomorrow, I’ll be seeing even more of the countryside as our group goes to Monteverde to ride ziplines through the jungle and tour the canopy of the tropical rainforest. However, there will probably be no blog tomorrow because I am unlikely to have internet access. Adios!

Quiero mover mi bode

Before Spanish class today (I arrived early), the teacher, having graded our first homework assignment, asked me how many years I had studied Spanish and whether or not I was actually learning in her class. I take that as a good sign! Although I could benefit from moving up to the advanced-level class, I still feel that I need the review of all the grammatical rules I’ve forgotten since high school.

Lecture centered on ventilators, which can either forcefully deliver a specific volume/pressure of oxygen to patients at specific intervals or assist in the completion of a breath initiated by the patient. Although many problems can possibly arise in the machine itself, Ric reminded us that, “Nurses are the most common problem that the biomed encounters.”

Our lab task today was to modify our power supply (a rectifier) with added capacitors to smooth out the current (remove the alternating properties) and a regulator that allows voltage to be adjusted to the needed level. One of the capacitors (charge storing devices, for camera flashes, etc.) used in our circuit could hold 10,000 micro-Farads! When my partner and I finished building our circuit, our tests showed that there was a short somewhere. However, this was true for almost all the groups and apparently this had been expected to be the case, because our next lab is scheduled to be spent fixing what didn’t work today. At the end of lab, my partner accidentally discharged the capacitor with a pair of pliers. ZAP! (Accompanied by an orange flash).

After classes, Gladys took us to a Latin Dancing class, where we learned the basics of swing, merengue, and salsa for two hours! I found that thinking about the movements was very easy because of their close association with Latin percussion and rhythmic patterns I’m familiar with, but that moving in the correct way was very difficult, not to mention a workout. Next time, I’m bringing a towel!

Wednesday, June 8, 2011

Boom

After a week of government red-tape delays, our technical instructor finally arrived today (lectures were given instead by substitutes in his absence). A resident of the Philippines, Ric Fontanilla has been working for years in the developing world as a biomedical technician after receiving training in Japan. Since he frequently encounters the same challenges we will face at our host hospitals in Nicaragua and Honduras, he is an ideal instructor for our summer program. The difficulty in getting him from the Philippines to Costa Rica in time for the first week of lecture was a U.S. government policy that prohibited him from even catching a transfer flight at an international airport on U.S. soil. EWH eventually got him a flight, however, from the Philippines to Japan to Mexico.

Today’s lecture was about pulse oximeters, the familiar machines that measure heart rate and blood oxygenation with a clip-on finger probe. Since the redness of blood is directly proportional to the blood’s concentration of oxygen-saturated hemoglobin, pulse oximeters simply sense the intensity of near-red light shined through the patient’s flesh. This signal is calibrated in real time by a second light which is unaffected by changes in blood oxygen level, providing an accurate and reliable measure of the patient’s actual SpO2. “We usually repair this kind of probe because it’s very, very expensive. If you can repair three or four like this, you already save the hospital a lot of money,” Ric said.

Ric then reiterated the importance of safety testing before returning any repaired device to the floor for medical use (or before allowing an electrical outlet to be used). “NEVER neglect an electrical plug or the leakage current,” he said, “if a patient dies because of an electrical problem, you’ll be sued.” He then reassured us of the general success that we are capable of achieving, “No matter what the manufacturer, make, model, or age of a machine, the principle is only one. Remember that. If you understand what a machine does, you’ll be able to understand how it works and what might be wrong with it.” Separate from our training in troubleshooting and repairing skills, we’ll be receiving dedicated safety training to avoid allowing any unsafe device that is entrusted to us to be put into clinical use.

Gladys, the Spanish teacher and owner of the academy, had another announcement for us today during lunch. “Normally I wait for a week or two before deciding whether or not I’m going to do this—I first need to see how a group behaves. But with this group I know already in less than a week from having seen you together in classes, lectures, and breaks. You’re a very well behaved group. So, I’d like to invite you all over to my house for dinner next week.”

Today’s lab was the introduction to power supplies. Using perfboard, solder, a capacitor, and four diodes, my partner and I created a diode bridge that functions as a full-wave rectifier, converting 30 volt, 1 Watt AC power into 40 volt, 1.5 Watt DC power. If it seems impossible to you for us to obtain 1.5 Watts of power out of 1 Watt of power, as we did, continue reading my blog and I’ll provide an explanation sometime when I’m running out of more interesting things to say. For example, many other groups made a mistake in wiring their diode bridge circuit, and as a result, their capacitors blew-up when they tried to test them. My only mistake today was to accidentally bump the soldering iron towards me. It burned a small hole through my pants. 

Tuesday, June 7, 2011

Never a dull moment

School began with a special announcement for everyone going to Honduras the second month of the program (me). Last summer, a military coup ousted the populist Honduran president and put him into exile for violating the nation's constitution. Soon after that, the nation held democratic elections, and the democratically elected president conceded to allow the ousted president to return from exile without being prosecuted. Upon the ousted president's recent return, however, he began rebuilding support for himself, which is a potential source of instability in the country. We were reminded to use common sense and to not participate in or contribute in any way to any kind of political unrest, even in casual conversation with our host family. We were also reminded that the U.S. embassy and EWH's $1,000,000 evacuation insurance are ready to pull us out of the country within 24 hours of any potential danger (our itineraries are registered with the embassy). Gladys, our Spanish teacher who has been working with EWH in Central America for many years, stressed that there is very little likelihood of being personally affected by any of the political events. Last year, for instance, the students were working at their hospitals when the coup actually took place, and none of them were affected whatsoever.

After the four-hour deluge of Spanish and the medical technology lecture, our task in lab today was to build an LED flashlight. With two AAA batteries, a switch, perfboard, epoxy, solder, and an LED, my partner and I made a compact, ergonomic flashlight with 70 hours of battery life. Groups in the past have found the flashlight very useful. Tomorrow, we're building an AC to DC converter out of diodes, which can later be used (or used as a prototype) for replacing broken power units in medical machines.

 Some of the guys in the house bought a soccer ball after school, so we went out to the park (just across the street and up on a hill) to play soccer and basketball. The park is essentially a giant slab of concrete (like the banks of Lake Michigan in Chicago) with the flat part being a court and the terraced part being the stands. Suddenly, about a dozen police officers came in cars and on motorcycles, in black uniforms with glass face shields. The cops meant business, and they searched all the non-Americans in the park for cocaine (but didn't find any). The also searched throughout the park for paraphernalia.

When that ordeal was over, we played a game of soccer with a group of local guys, 6-on-6, and we held our own! (But lost). Lacking experience in intricate footwork, I played goalie and blocked everything in reach, but missed a couple goals from being out of position. Final score: 6-3. We may have a rematch sometime soon (whenever our joints recover from playing on a concrete court).

Monday, June 6, 2011

Monday, Monday

This morning I received the first of my daily four-hour dosages of intensive Spanish con mi profezora que se llama Diana. Knowing that we've all had Spanish before, we spent most of the classtime hammering the subtle differences between the verbs ser, estar, hacer, tener, and haber, all of which express different kinds of is-ing, are-ing, having, doing, and being. Despite the hunger induced by the exhausting task of trying to understand everything (the class was conducted entirely in Spanish), our teacher accidentally held us over for 20 minutes, leaving a very short time for us to get lunch. Not that I was paranoid from being late (2-minutes) back from lunch the first day, but I wasn't about to be late again. Consequently, I had a rather small but delicious lunch: a three-cheese bagel sandwich.

Following lunch, today's instrumentation lecture focused on electrosurgery units (ESUs), a technology that replaces the knife-slicing of patients with zapping them. We're talking about up to 400 Watts of super high-voltage AC current with frequencies up to 3,000,000 Hertz. When the current passes from the metal "pen" (often called a bovie pen) into the patient, it disperses through the body and is then collected, so to speak, by a large electrode on the other side. Since the current is most concentrated at the tip of the pen and the body's resistance to electricity generates heat, the bovie pen cuts through tissue by burning it, creating the smell of burning flesh. Yum. Actually, however, electrosurgery cauterizes tissue and coagulates blood as it cuts, dramatically improving the efficiency of the operation and the recovery time of the patient. A danger of electrosurgery, though, is that electric current can again become concentrated at a place in the body other than the tip of the pen where a surgeon intends to cut, such as the collecting electrode or an alternate path to ground. When this happens, the patient will suffer burning.

During lecture, I got to go up in front of the class and use a bovie pen to cut through a bar of soap (for no particular reason, I inscribed an "M" into it), but in the field, we'll be testing bovie pens by cutting through slabs of raw meat. Then, if not vegetarians, we could conscientiously enjoy the smell of the burning flesh.

Speaking of food, tonight's dinner at the homestay was incredibly good: baked/breaded fish fillets, macaroni & cheese with tuna, seasoned rice & beans, a bowl of soup, and a glass of very, very fresh pineapple juice.

Time to study!

Sunday, June 5, 2011

requiem

Today was the day of rest for me... sort of.

I slept in until 10:45am, which was quite nice, and then had a delicious cheese empanada for desayuno. I decided to remain at the homestay instead of going out for lunch, using the time to study and prepare for the coming week. Much to my surprise, I was beckoned to eat lunch with my host family at around 2:00pm, meaning that I had to awkwardly practice my Spanish with Flory (the host mother and cook of the delicious meal), her husband, their three-year-old grandson, and his mom. I managed to tell them (with corrections from them) that I had stayed home because of all the schoolwork I had. They commended my decision and were happy to give me some food, even though host families aren't expected to provide lunches.

Anthony, the three-year-old, had a small toy antelope with him at the table, with which he amused himself by pretending to kill it in various ways. Joining in on the fun, I surprised him by flipping the animal not just to the side, as he had been doing, but completely onto its back with legs in the air to signify its death. Anthony and I were quite amused.

I slaved over the new material (how to solder and desolder, splice wires, add/remove circuit board components, build power supplies, etc.) until dinner, and then slaved over it some more. I studied for about eight hours today, which will actually be below the norm starting tomorrow, when every day will be comprised of four hours of Spanish, four hours of technical training, and then whatever time is needed to do homework on our own.

Saturday, June 4, 2011

agua, agua, agua!

Water, water, water. People often say of Latin America, “just don’t drink the water.” We’ll get back to that later.

The men of my homestay woke up at 5:00 this morning in order to participate in this weekend’s mandatory team-building/fun activity: white-water rafting (in future weekends, groups of two or more will plan and take their own trips, at their own expense). When we reached the academy, J.J. (the on-the-ground-coordinator), opened the building to let our group inside. Taking a seat on a couch by some windows, I was surprised to see some garbage on the table in front of me. Our Spanish teacher, Gladys, who had locked-up the building the night before, arrived a few minutes later and soon asked me, “What’s that? Where did it come from?” pointing at the shriveled papers. “I don’t know,” I said, “It was like that when we came in.” After a short pause Gladys responded in frustration, “They’ve taken the computer.”

Only then did we realize that one of the windows I was sitting by was not simply open, but had been removed by burglars the night before so that they could silently gain entry. After stealing the computer monitor and an empty money box, they set a piece of paper on fire and left it as a signature or threat. Luckily, Gladys has theft insurance, and nothing else was stolen. “Now you see how it goes around here,” Gladys said in reference to our orientation and safety lecture two days before.

Our rafting destination was the Rio Pacuare, about a 2.5-3 hour bus ride from San Jose. As we travelled, the rural mountain landscape strongly reminded me of where I was in Costa Rica last spring on a mission trip with Eureka College. About halfway to our destination, we stopped for a group buffet breakfast near the summit of a mountain, overlooking the surrounding countryside. We were also introduced to the commemorative shirts that our rafting guides, who had designed them, were selling. The shirts carried these mottos: “I survived the rapids”, “life’s too short”, and “paddle hard”. Because the shirts, which dried quickly and blocked the sun, were designed for rafting, some members of our group bought them ahead of time to wear.

Upon my getting out of the vehicle when we reached our destination, I was immediately ambushed by fire ants, about fifty of which swarmed my feet and lower legs. Being near their nest, I resisted the urge to stomp on their anthill and kill all of them. The fire ants were also redeemed by some nearby leaf-cutter ants, which are quite friendly and also super-cool to watch.

The Rio Pacuare at its present water level contains many level-four+ rapids. If you don’t know what is meant by a level-four rapid, look it up and be afraid! From our launch point, however, the river progressed incrementally in difficulty and danger from placid level one to fiendish level four, making it a reasonable rafting option for crazy people. So after a set of important safety instructions, we began our four-hour, 18-mile trip down the rapids. My group of six rafters contained one other male and four females, as well as Juan Carlos, a rafting guide. His commands to us included “FORWARD!”,  during which we all paddled together (our guide could only steer if we had movement relative to the surrounding current); “RIGHT BACK”, during which those of us on the right side paddled back while those on the left paddled forward; “LEFT BACK”, which was the opposite of “RIGHT BACK!”; “STOP”, meaning, “stop paddling”; and “DOWN!!!”, during which everyone ducks into the middle of the raft and holds on tightly. Two expert kayakers accompanied our fleet of rafts, one as a photographer and the other as the rescue kayak.

Our first several rapids went well, and we successfully passed through a few level-three and level-four rapids, including “The Rodeo” and “The Cemetery”.  When one group intentionally flipped their raft in some mild rapids just for fun and some members of our raft wanted to flip as well, I remarked, “No. If we flip, it needs to be legit.” About two hours into our expedition, notwithstanding all of that experience and expertise we had gained, one thing went wrong and changed everything. That is, something went wrong involving a level-four rapid and a very large rock. When our guide Juan Carlos gave the command to duck, I grabbed the side rope and brought my weight towards the center of the raft. Almost immediately, I could feel many sudden and extreme changes in the raft’s speed, direction, and orientation. I also felt walls of water crash into me from different directions at different times, along with a few bodies. Next thing I knew, I was alone in the raft, struggling to keep it from flipping over. I also had to untangle someone’s paddle from the rope and my sandal (maybe my own paddle?) so that I would not be stuck to the raft. Looking around, none of the girls or the guide was in sight. David, however, managed to keep hold of one side of the raft.

Crash Sequence






It took some time to regain orientation and understand our situation. Current passing over a large rock in the rapids creates a “hole”, or dip in the water. These holes can be quite large, and they have a strong suction current that can trap objects indefinitely. For David and I, the entire raft was stuck in the hole, being pulled back toward the rock by the suction current, and pushed away from the rock by the current flowing forward over the rock. For about one or two minutes, David and I helplessly assured one another that we were okay and would continue to be okay while trying to think of some way out of the hole. Meanwhile I desperately tried to maintain the raft’s balance. I was most worried that if the raft were fully sucked back to the rock, the water, pushing down on one side of the raft from above the rock, would flip the raft again and  throw me into the water, possibly even into the depths of the hole behind the rock. If we could get out of the hole, I could pull David in and we could ride the raft to the next calm place and then swim ashore.

victory... for now

I was caught with the paddle (now broken)


looking for a way out

David holding on as the water tries to flip us


My best guess now is that my worst fear was exactly what happened. The raft got sucked too close to the rock, and  the current flowing over the rock flipped the raft and plunged me underwater, holding me down while the suction current held me in place. As I waited for the life jacket to carry me to the surface (I had no orientation at this point) my nose filled over and over with water, which was automatically swallowed by reflex. I was unable to see or feel my position in the water, but when I finally surfaced, I knew I had done so only by the change in sound. I then gasped for air before being plunged back beneath the surface by the currents and swallowing more water. Luckily, the current had now carried me away from the suction of the hole in which I had been stuck, but I was now in danger of crashing into other rocks.

final moments

plunged beneath the surface

Our safety instruction told us to position ourselves into a feet-first back-float in this situation so that we could see where we were going, breathe reliably, and avoid hitting our heads or necks on the rocks, but this was impossible for me in the strong current with water full of boulders. Every time I tried to reposition myself, my legs hit a boulder, causing me to tumble face-first back under the surface, swallowing more and more water. I then remembered another safety instruction we had, which was to look and listen for instructions while struggling in the water. Looking around as I continued to oscillate between above and below the raging waters, several people were cheering, with the spirit of, “Go, Mark. Way to be intense.” Also burned into my memory is an image of the photographer, who, standing on a rock some distance away with the camera to his face, gave me a giant thumbs-up for providing material for some great action shots.

Soon, instructions came from the rescue kayaker (who reached me after having just helped the other five people from my raft who had been thrown out initially). “GRAB THE BLUE ROPE!” he said, referring to a rope on a raft behind me. During this time, I struggled to continue breathing. My chest was tighter than anything I had ever felt before, and I had never worked so hard just to breathe in. I felt like I was trying to breathe with a high-powered vacuum cleaner nozzle in my mouth, and I had to fight against this suction with all my strength.  Once pulled into the raft, I began coughing up water and belching. By the taste present in my mouth, it was apparent to me that I had been vomiting some in the water (perhaps to make room for swallowing more water).

No sooner was I not drowned than I was forced back to my own raft to finish the first half of our trip. I was somewhat shaky and unsteady at this time, but I noticed as others stepped into my raft from the rafts that rescued them that they were quite shaky, too. I have a strong suspicion that my dreams tonight will be centered around rafting disasters.

During our lunch stop, more details began to unravel as to what actually went wrong with my raft. My friend Andrew, who was in another raft, said that my raft and I went over him when it flipped. Apparently I managed to hang-on through the midst of a 360 degree flip that threw off everyone else. (Correction, a review of photos shows no evidence of this flip, which must have been an illusion for the passengers in Andrew's boat). When the raft tipped a second time and threw me out, David continued to hold on as the raft stood vertically in the water for a couple seconds, meaning that he hung from the top of the raft with his feet completely up out of the water. While capsizing is relatively common, the guides remarked that they had never seen THAT before. The raft then came down outside of the hole it was stuck in, so David was lucky enough to be able to leisurely hold on and tow the raft to shore.

Also during our lunch stop, which was on a sandbar near several Native American dwellings and people, I noticed some members of our group wearing the “I survived the rapids” shirt and I made a couple comments about it. Of course, the irony would be for someone to buy that shirt and wear it while rafting, but to then not survive the rapids.

Now about drinking the water in Central America: so far, I have been drinking tap water in Costa Rica without any problems, since the water here is purified like that of the United States. However, anything that could be “in the water” to make people sick in Mexico or elsewhere is almost certainly in river water, and I drank A LOT of that today. We’ll see what happens…