July 27

Sleep last night was difficult. Around midnight, the dog, Petra, began growling and barking with unprecedented urgency, running around the patio at full speed. The amount of racket was such that I wondered if there might be another dog in the yard with whom Petra was fighting. Just then, the dog—growling, yelping, and all—slammed into the window next to my bed. This startled me into sitting up, and glancing outside I saw the little protagonist: a black rat scurrying for dear life. As the noise continued, Maritza, Milania, and La Abuelita woke up and went outside, thinking there may have been a security breach. “What happened? Did you see anything?” I was asked. “There was a rat…Petra saw it,” I said. They began laughing and said, “Crazy dog,”

In the morning I began working on the blood-pressure machine calibration, connecting the pump-bulb, manometer, 500mL container, and the machine using the four-way valve Tom had fabricated from syringes on Monday. The results were discouraging, and the true values followed by the machine’s readings (mmHg) were 0:0, 50:25, 100:88, and 200:200. If the disparity between any of these measurements is greater than 3.0 mmHg, the machine needs calibration. Unfortunately, the procedure labeled “Calibration” in the manual was actually just an accuracy test, as any adjustment to the readings can only be performed by the manufacturer. I returned the machine with a note and an explanation that the blood-pressure function could not be used and that there was nothing more we could do.  

In the office of Maria, who had ridden with us from the airport at San Pedro Sula to Olanchito, I explained the letter I had prepared for CAMO and asked if she could help me prepare it for submission by the hospital director. She checked for factuality and made a couple corrections, and then printed out a copy for me to give to the director.

After much of the morning had passed, we began to worry as to why Julien had not yet arrived and why we were unable to contact him by phone, since he had to check out of his hotel by 1pm. Although he was alive and well when we parted ways the night before, nothing is impossible here. Asking around the hospital for “another white guy”, it became clear that he had not yet arrived. When I ran into José, who had driven Tom and I from San Pedro Sula to Olanchito the first day (a long treck), he stationed a sentinel to watch for Julien at the front door and offered us a ride to the hotel. Julien happened to be leaving just as we arrived, so we brought him to the hospital in style, that is, in an ambulance.

In the back of the ambulance with Julien

Before leaving work today, we took some pictures with Jairo in front of the hospital, scarcely able to believe that a whole month has already passed. Jairo asked a random man to come help us take the photos, but he had never taken a picture before and had some difficulty doing so. Nonetheless, we have some adequate pictures of the building where we spent so much time working.

Back home, we started and finished work on our Honduras experience poster, a file that will be printed as an actual poster for us to use in our presentation to Dr. Malkin, the Board of EWH, and various donors and other persons who will be attending the conference this weekend. 

Secondary Project (July 26)

I woke up extremely early this morning, but also very hungry. When breakfast was finally ready, I was pleased to be given two tortillas filled with sausage, egg, and cheese. After breakfast, Tom and I evaluated the amount of paperwork needing to be completed for research, and decided to spend some time at the homestay working on it. After about two of hours data entry and prep for interviews, we got a call from Jairo. “Hey, how’s it going with you guys? The carpenter is here!” he said. I asked to speak with the carpenter, but just as we began talking, the phone call ended—our phone had run out of minutes.

We scrambled out of the room and took the first taxi we saw to the hospital so as to not miss the carpenter. When we met him, he had already been informed about our project to build wall-mounted patient monitor holders, so I only needed to tell him a few specifications. The price for all of this, though, was only fifteen dollars. Before he left, I asked him to talk to the people in the laboratory, who were wanting a locker to secure their personal belongings during work.

We went to the carpenter’s house to get receipts, and then back home to work on more paperwork. At an internet pit stop before returning to the hospital for interviews in the afternoon, I got a letter from Lillian to use as a template for requesting equipment donations from CAMO (Central American Medical Outreach) for our hospital, which serves nearly 100,000 people in and around Olanchito, as well as people in the rest of the provinces of Yoro, Olancho, and Limón.

We returned home to resume paperwork (bringing our laptops along around the city is not recommended) and to tell Maritza that we didn’t need dinner since Julien would be coming. “Perfect, would you like lunch instead, then?” Already sitting at the table were two set places and a large bowl of spaghetti.

At the hospital, I interviewed Jairo, the technician, as part of our research to help EWH develop a curriculum for a biomedical engineering technician training program. The questions help EWH to know how much education and training current technicians have already received, how many hospital technicians are interested in more training, and what kinds of obstacles make attending a training program difficult (e.g. distance to classes, time away from family, etc.). Until the end of the week, I’ll be doing more research like this for EWH as the organization continues to seek out an understanding of the underlying difficulties to improved healthcare and their possible solutions.

Jairo gave us a ride home, but before dropping us off, we rode in the back of his truck to pick up his wife from another part of the city. This trip was scenic and fun, and when we jumped out right by Ramon’s juice stand, we bought some more fresh juice from him. Several cars pulling out of the nearby intersection skidded their tires, after which Ramon said, “One of my glass jugs [of juice] was broken by a little rock that a tire threw. That’s why I keep a clean area in the road.” Sure enough, although dust and pebbles were all around, Ramon had swept clean an area of the road around his stand to protect against tire-thrown debris. Before we left, he gave us some traditional Honduran bread “Caballito”, and fresh green oranges. Both were excellent.

When we returned from the hospital again, I went to work on the Spanish letter, making sure that it applied to Hospital Anibal Murillo Escobar in Olanchito. Later in the evening, Roger, Maritza’s nephew, was visiting, and he helped tremendously by meticulously proofreading the letter and making changes to formalize and professionalize it.

When we finished the letter, we had dinner with Julien, our On-the-Ground-Coordinator for EWH Summer Institute activities in Honduras this year. Tomorrow, he will be visiting the hospital to speak with the director about EWH’s impact on the hospital and what future goals we should work toward.

Last Monday (July 25)

Now that we have reached our final Monday working at the hospital in Olanchito, crunch-time is pushing us to accomplish as much as possible before we leave. Our final assignments: pursuing success in our secondary project and finishing our research tasks for curriculum development.

For our secondary project, we hope to construct some wall-mounted furniture for holding patient monitors in the pediatric observation ward. Other possibilities include a locker for the laboratory and a tool board for Jairo, the hospital technician. While inquiring about where to buy wood and how we could access the necessary tools, however, we were advised to have a carpenter do the work instead. At a reasonable price this alternative may be ideal since this further supports the local economy, frees Tom and I to work on other tasks, and ensures—through the carpenter’s experience and expertise—a better final product than we could produce ourselves.

After all the repairs we have made for the small hospital, only a few pieces of equipment remain out of service, so we had little technician-related work to do today. While I roamed the hospital for our research, Tom fabricated a four-way tube connector out of syringes, which we can use to calibrate an inaccurate blood pressure machine. The device clearly needs calibration, having repeatedly measured my blood pressure to be about 96/44, and giving similar readings for Tom. Another component needed for calibration is a sturdy, 500mL container, for which Jairo gave us a piece of an old anesthesia machine. Needing exactly 500mL, we decided to measure the container’s volume the Archimedean way and put water in the bottom to leave exactly 500mL of airspace. To do this, we filled the lid with water to the point that it contributes volume to the container and then poured this water into an empty bottle. Then, we filled the container to the brim with water and used a funnel and a graduated cylinder to measure the contents. First pouring out the lid, we poured out of the main container until exactly 500mL had been poured into the graduated cylinder, meaning that this much air-volume existed in the container. The water that remained will now act as the bottom surface of a rigid container of exactly 500mL, and in case anything evaporates before we can perform the calibration procedure tomorrow, we marked the transparent container at the needed fill-point.

I received an email from Lillian at EWH today with contact information to an aide organization, and I will be using the information to request some equipment that the hospital needs. At dinner time, I was happy to be ravenously hungry, and we were served a delicious meal of rice, salad, chicken, and French fries (with ketchup), all of which was eaten and enjoyed.

Roatan III (July 24)

Remaining in a state of sickness from the bad food I must have eaten yesterday, I tossed and turned throughout the night, moving to the other’s bed to have my own for the rest of the morning after they left for the early ferry. I could only continually tell myself, “This is not a relapse—just an unrelated sickness that will soon pass.”

Feeling quite not hungry, I spent the time between our checkout and our taxi to the ferry in the hotel lobby. When I asked the man working the front desk where the internet café was, he set up a computer for me in the lobby to use instead, and then used the opportunity to advance the business of his new hotel. He did such a good job of this in our conversation that I don’t hesitate to promote the hotel for anyone planning a trip to Roatan. Inexpensive, air-conditioned, free purified water, fifty feet from the Caribbean Sea, and excellent service.

To save money on our taxi ride five of us shared a small taxi. As the biggest person, I was lucky enough to have the front seat and the best leg circulation when we reached the docks.

The two-hour ferry from Roatan to Ceiba costs about $25. Surprisingly, however, the company, despite having a monopoly on the traffic, does not profit because the boat guzzles too much gas and ticket prices cannot successfully be raised any higher. One possible solution I considered is subsidies from the Island of Roatan for the passenger ferry company. This would lower the ticket price, encouraging more travelers to visit Roatan more frequently, which would further boost Roatan’s economy. Furthermore, increased revenue would allow the ferry company to invest in a more efficient boat.

As the ferry was full and we weren’t the first ones to get on it, all the seats were taken. To compensate, however, the staff opened a small side door leading to the stern shortly after we embarked. Standing by the captain’s box in the strong breeze and wearing my shades, I could only think about the song “I’m on a Boat” by Lonely Island. One of the most interesting aspects of the ferry ride, however, were countless schools of flying fish, always surfacing as the boat passed and cruising above the water for tens of meters before diving back in. The water was quite calm, and a very deep blue color.

From La Ceiba to Olanchito, we were lucky to have a comfortable, mostly empty bus, and I was beginning to feel hungry again. Going out to eat in Olanchito after we returned, we were surprised to see the restaurant filled with a group of Americans. We found that they were here on a mission trip from Louisiana, but could not help but be annoyed by the fact that they had just arrived in the country. “Do you like beans?” they repeatedly asked with excitement. “We used to,” we replied.

Roatan II (July 23)

On Saturday morning, I returned to the coral reef to snorkel and spent nearly the entire day inspecting the enormous variety of colorful marine life. This time I swam at a different reef, but eventually had to return to shore when my goggles began leaking more than I could tolerate.

For lunch, some of us went to a random restaurant that was reasonably priced. While waiting for our food, however, a man was doing carpentry work with a hammer, sawhorse, and power saw, which was very loud, filling the air with sawdust. I stuffed my ears with napkin to protect them from the extreme noise, and simultaneously lost all confidence in the quality of the food that we would be served. I ordered fish tacos, but was entirely disappointed by them. Later, I suspected them to be the cause of the food poisoning that struck me over the night.

After lunch, Ariel and I went out to the reef I had seen the day before, and we spent about as much time talking as swimming around the reef. Later, I learned that there were many sharks in the water while we were swimming. According to one of the diving guides, “Yeah, right now we have about eight hammerheads here,” he said. “Don’t worry; they’re friendly.”

By dinner time I was feeling quite sick, but ate anyway in hopes that things might improve. Something that did not help was the restaurant’s entertainment choices, however, as they played a Lady Gaga DVD at overdriven volume through our entire dinner. From being sick, again, I had to leave dinner early.

Roatan (July 22)

Waking up early to catch the bus to La Ceiba, Maritza asked if we wanted breakfast. “We can’t; there’s no time,” we told her. “I know,” she responded, “I made you breakfast to go.” Once we had boarded the bus and opened our food, we were surprised to have been given cold hamburgers (for breakfast). They were, however, quite tasty.

From the bus station in La Ceiba, we ran to the grocery store to get enough money for the ferry to the Caribbean island of Roatan, which costs $20. Looking then for a taxi to the dock, we actually—by coincidence—had the same driver as the one Tom had gotten the previous weekend when he went to the Bay Islands. Having tipped the driver and given him a granola cookie, Tom said, “It’s the same guy I had here last week. I gave him a cookie that time, too.”

While in line for the ferry, a group of tourists visiting the island began talking about where they were from. One girl said, “I’m from Illinois—Peoria, actually.” She is touring Latin America right now without knowing any Spanish, but speaks fluent Chinese and has been living in China for the past several years as an English teacher.

On the ferry, we came across Anjuli and Mindy, an EWH team working in the hospital at Trujillo. A few minutes into the ride, unfortunately, Mindy became quite seasick and remained so until we reached the shores of Roatan two hours later. Although we took the morning ferry, the afternoon ferry is apparently significantly worse, as every ticket is sold with a free dosage of Dramamine. We have been told, however, that the return trip will be much smoother.

At the dock in Roatan, we were assaulted by Taxi drivers asking where we wanted to go and how many people we had. Although we tried to negotiate a price, we could not get one lower than $20. “This is an island, and gas is expensive—more than $6 per gallon,” the driver said. When we arrived at the hostel where Leah and Ariel, an EWH team working at the hospital on the island, were staying, the taxi driver recommended another hotel closer to the beach (the girls’ hostel was a twenty minute walk from the water). At the Dolphin Executive Hotel, just across the street from the beach, we got rooms with air-conditioning and free drinking water for just $15 per person.

Our next step was to search for rental snorkels to swim in the ocean. In the first shop we passed, the price was just $5 for 24 hours of use for goggles, a snorkel, and flippers. I soon found that goggles do not work well with a mustache, so I had to press them against my face while swimming to slow the rate of leakage. Flippers, as always, work wonderfully.

Swimming over and around the coral reef near the shore, I was astounded by the variety of fish, seeing fish from every color of the rainbow as well as florescent fish and semi-transparent fish. Also amongst the corals were many kinds of crabs, urchins, sea anemones, and a swordfish. When a storm began brewing in the distance, the others left the water, but I stayed for a couple more hours of swimming (the storm missed the island by many miles). During this time, I met another snorkeler named Jimmy, who is originally from the Eastern province of La Moskitia. Even today, this region is only sparsely populated by groups of people with native, African, or European descent who wish to live a difficult frontiersman-like life in some of the world’s most dense tropical jungle. At this time, Jimmy is with his family on vacation from San Antonio, Texas, and enjoys the water since his first job was as a scuba instructor for eight years.

Around this time as I continued to survey the dense and diverse area of marine life, I began to wonder, “Where are the predators? Why haven’t I seen any?” At that moment and not far in front of me, I saw a creature my own size—a stingray. Immediately I thought of Steve Irwin as the creature passed without incident nearby to my left and went out to sea.

As the dusk advanced, the water became too dark for me to continue seeing anything underwater, so I left the beach for the day. Back at the hotel, however, the mirror revealed several places on my back that I had missed while applying sunscreen!

Lost in Time (July 21)

Whatever memories or experiences should have been formed this day, they have been forever lost pending subconscious recall through hypnosis or guided inquiry. We go now from Wednesday to Friday.

Balancing the Books (July 20)

We first tried to fix the pesky scale by using a variable-voltage power supply we bought from the supermarket yesterday. Needing 9 Volts and 500 milliamps of power, the device we had purchased provided the 500 milliamps at 0, 3.5, 6, 9, or 12 Volts. However, the adaptor heads for the various voltages had ambiguous + and – labels, located to the sides and not specifying which way was correct. Sliding the switch to the 9V setting and guessing the polarity, we plugged in the scale with no results. “I hope we didn’t just fry everything,” Tom said. Disconnecting the adapter from the scale, we measured the voltage of the 9V plug—a staggering 16V from a device rated 0-12V! When we moved the selector switch to the ‘off’ position, the voltage only dropped to 10V—still above the 9V we needed!

Opening up the scale once again, we smelled something like burning metal and plastic. Examining the circuitry, we found that several electrical components had exploded or melted, permanently rendering the scale useless—as the Chinese-built power supply we had purchased (“The Egg”, as the product was called) was. All was not lost, however, for when the bodega (equipment closet) was opened, we found a suitable replacement part for a broken sphygmomanometer, which we were then able to repair, test, and return to the pediatric ward for service.

Our next task was to resume work on the patient monitors (pulse-oximeter, blood-pressure machine, and ECG all-in-one), each of which costs about $2,000. One of the units would not hold power, while the other gave errors for air leaks in the blood pressure tubing, though the tubes did not have any leaks. Opening up the machine which would not hold power, Tom removed a small watch-battery which gave the chip power for keeping time and holding memory. Now having reset the on-board computer, he reinserted the battery, and then absolutely nothing more was wrong with the unit. For the other unit not functioning correctly, we found a setting in “neonatal” mode, though the machine was trying to take adult blood pressures. When we switched this parameter to adult, the errors disappeared and this machine also functioned normally.

In conclusion, although we fried a $50 scale ‘por siempre’, we netted the hospital $3,950 dollars by returning the patient monitors to service. Chah-ching.

Tuesday (July 19)

While walking to work this morning, I was struck by the sight of a young girl, six to eight years of age and in tattered clothing, diligently rummaging through the public garbage bins in search of aluminum cans, which she put into a small plastic bag. A short distance later, I saw her slightly older sister doing the same. Thinking back to when I was that age and what my life was like was an awful feeling in light of their situation. In contrast, however, the adult beggars around here are exceedingly annoying. They have credentials which certify their status as helpless beggars, and when they target us as Americans, they sometimes physically shove or prod us with their laminated beggar’s licenses while demanding money (no ‘please’ or ‘thank-you,’ just an expectation). This, of course, makes us very averse to thought of giving them anything, although, in some twisted sense, they are actually working for it.

At the hospital, a broken scale provided arduous work, functioning only with the power supply we had built and not with a 9V battery as it was supposed to. As a solution, we prepared to adapt the device to be plugged in and planned to buy the needed power supply in the town. As Tom and I left the hospital in the morning in search of a 9V AC/DC adaptor, a large truck full of heavily armed soldiers dressed in camouflage drove in through the gate. “Maybe it’s a good thing that we’re leaving right now,” Tom said. Meanwhile, I worried about why the soldiers may have come. Was this some kind of governmental power-play? After all, there had been a protest at our hospital on our first day of work.

Picking up two power-supply candidates from street vendors selling cell-phone chargers (we had plenty of options), we returned to the hospital to find that the soldiers had gone. I felt rather embarrassed after I asked why the military had come in the first place. “One of the soldiers was sick,” I was told.

The power supplies didn’t work, so we’ll have to try another approach with the broken scale tomorrow. Meanwhile, a couple of nebulizers from the pediatric ward had a problem, tending to overheat and melt the connective tubing. We dismantled them, cleaned and oiled the motors, put them back together, and then tested them by letting them run for 25 minutes. For now, they are functioning well, but if problems resurge, we may have to have the motors professionally cleaned and serviced in the town.

After work, we went to the supermarket where Felix works to find a power supply with the exact specifications we needed. At the front of the store, the armed security man, who also kept customers’ bags and purses in lockers, began shouting forcefully at someone, chasing him outside and threatening further action. Every legitimate business has an armed guard, and the illegitimate businesses probably have more.

Monday (July 18)

In the morning, we scrubbed in to inspect the maternity ward and the surgery area, both of which were very interesting. Also, the staff gave us useful information about conditions in the hospital they hoped to see improved if more resources become available. Each person, working a different job, has different views of what the hospital’s priorities should be, but certainly most of them support our work in looking for long term means of improvement.

At work today, I spent considerable time over lunch trying to explain in Spanish the meaning of “It doesn’t count if you don’t get caught,” to a vender. The best I was able to do was, “Something bad that you do doesn’t mean anything if people don’t know you did it.” No matter, though. All anyone actually wanted to know was whether the shirt had some vulgar or self-demeaning phrase that a Spanish-speaking person might unwittingly wear. “Oh, it’s fine,” I said.

The gravity of what we do was reinforced today by a death in the emergency room. Whatever the cause was, there is no doubt that medical equipment is vital in the diagnosis and treatment of medical problems of any level of severity. I heard that another group this summer was able to put a defibrillator ($20,000) back into service for their hospital after the device quit working due to the battery’s failure to charge. Without a doubt, this group’s success is a lifesaver for many people whom that group will never meet.

In the big picture, though, there won’t be volunteer workers with specialized training in salvaging batteries at every hospital whose defibrillator breaks down. This is why our work focuses not only on discrete fixes and staff training, but on research for developing a curriculum for a technical training program involving Honduran students and eventually Honduran teachers.

Lazy Sunday (July 17)

Around lunchtime, Roger and I went to the central park for a once-annual cultural festival with representatives from and representations of all the different regions of Honduras. In something like a Miss Honduras pageant, each girl was selected to represent her region in the festival. Arrayed throughout the park were regional microclimates, complete with the characteristic flora, fauna, music, dance, and foods of each locale. One interesting food I sampled consisted of bread pudding made from bread soaked in honey and juice instead of milk. It was very strong.

Roger

After the festival, Roger and I went to play pool, and I consistently beat him playing Honduran pool, while he beat me in American pool. From the short walk to the park and back, Roger was sunburned, though I was not. This could be a good thing, or maybe I just don’t feel it anymore. During our walk back, however, I learned of an interesting perspective, being told that protestant churches in Honduras, as opposed to the Catholic ones, were just businesses that pastors started to make money.

While some of the women in the house were talking before the late lunch, “Glinda” and I got into an interesting conversation about the state of affairs in Honduras. Though possibly slightly on the edge, our discussion remained within bounds as far as keeping myself entirely distanced from any affinity to one of Honduras’s vying political factions is concerned. Glinda, at any rate, has an interesting ethnic background. Her father is (was?) British, his family having been from India, though he himself is from Kenya.

When San Pedro Sula came up in Glinda’s conversation, I mentioned that I didn’t like the city much, and that comment started us in an interesting conversation.

Glinda: Why not?

Me: It’s so dirty, and too many gangsters.

Glinda: Well that depends on where you are in the city. San Pedro Sula has lots of factories and jobs and is much more developed than Tegucigalpa. Have you been there?

Me: I’ll be going to Tegucigalpa in two weeks to fly out; I heard it’s one of the most dangerous airports in the world as far as crashes are concerned. 

Glinda: It is. And it’s a stupid place for a capital. We also have a stupid history for why it’s the capital. The president of Honduras about 100 years ago was married but having an affair with another woman. When he divorced his wife to marry the other woman, he moved the capital.

Me: Washington, D.C. isn’t a great place for a capital, either. It was a swampland in the middle of nowhere when it was constructed. And now, it has one of the highest murder rates in the United States.

Glinda: Interesting. I heard something about a city in the United States that was really concerned because they had 80 murders in two years. In Olanchito, we just had 90 murders in six months.

Me: 90 in six months? Here?! In Olanchito?

Glinda: Yes.

Me: Why?

Glinda: All the corruption. In Honduras, there are 16 rich families that control everything and own all the land in the valleys outside the cities. In this area, there are three families in control, and they kill the poor people. It’s unfair. There was a law years ago to bring about land reform, but the families stalled it by killing people, and then it never happened.

Me: I read about that.

Glinda: We have no choices or opportunities here. That’s why if I quit my job I’m leaving this place. It’s a beautiful country, but I can’t stand all the corruption.

Me: Where would you go?

Glinda: I’d like to go to Africa. I used to live there, in Uganda. It’s less developed, but things are more equal there.

After lunch I went into isolation to write a song, for me always an arduous, trial-and-error process, but usually worthwhile at the end.

When Tom finally returned, alive and tired, he had some interesting stories to tell of his weekend adventures.

“So, on Saturday I went to Utila and rented a Kayak by myself. Pretty soon there was a storm blowing me around, and I travelled all the way to the keys. I was going to go back to Utila anyway, but even though the storm passed, the wind didn’t die down, so I couldn’t really go anywhere that night. I landed on this little deserted island and was thinking about camping out next to a tree for the night or something, when suddenly this guy named Junior in a homemade dugout canoe rigged with a motor sees me. ‘Hey, do you want a ride over to the next key?’ he said. Well, I figured it would be better to go to the next one, since there were actually people there and it would be less paddling the next day anyway.”

“I ended up staying at the guy’s house with his family, and they lived all Robinson Crusoe style. They used the roof to collect rainwater in a giant tank, and then would use pulleys to hoist it up and create water pressure for the sink, shower, and toilet. All the dirty water from the sink went over to fill the toilet, which then went to a low-maintenance septic tank. The electricity was an array of solar panels, and the family talked about their pirate heritage and fed me conch stew. The next day, they fed me breakfast and then I paddled back to the main island, but it still took all day because the wind was against me.”

Sabbath of Rest (July 16)

This morning I woke up for breakfast at the homestay, having elected to go nowhere as a strategy for rest and recovery.  I then left the house for the internet café, and ended up clandestinely following an old man for most of the distance. Hunched over and well-dressed, the short-statured man walked briskly and deliberately toward his destination not far from mine, navigating a variety of obstacles without incident. Most interestingly, since Olanchito is a small town (approximately 20,000 people with 80,000 people in the area) he was frequently met by people who knew him. The uniqueness of my perspective was to see his actions and reactions during these encounters—a window into the heart and soul of the cities inhabitants. Those who greeted him were generally younger and seemed to respect him, but he apparently saw them all so often that he found no need to spend any more than five seconds talking before moving on toward wherever he needed to go.

 I spent almost the entire day on the internet—probably just about enough time to make up for my “deprivation” Monday through Friday. Our situation is work from 8:00-3:00 at the hospital, dinner at 5:00 or 6:00, and then little opportunity to reach and use the distant internet café which closes at 8:00. No internet gaming for me (or using the bathroom or eating lunch), just social interaction, research, and moving information from place to place for various purposes (For instance, in the course of my time at the café, it became necessary for me to email the NSA).

While walking home for dinner shortly after a rainstorm, a car drove unnecessarily fast through a deep puddle of water as it passed me, completely drenching me from near the waste down. I was appalled by the lack of consideration, but just before I could project these frustrations on all Hondurans, I was assaulted by kindness from every other person I met on my way back to the house. First, a farmer with a two-foot-long machete greeted me cordially saying, “Buena” as he passed by from the opposite way. Then, an impoverished man saw me and said in English, “God bless you, too, man!”

By dinner time, I was ravenously hungry, a comforting sign of good health that makes meals, as well as life in general, more satisfying (I’m even beginning to look forward to Monday, as well as our research tasks for EWH).

Later in the night while I sat barefoot in my room showing Roger some pictures from my trips to London, Japan, Italy, and Costa Rica, a millipede swiftly scurried past on the floor. Roger immediately rose from his seat to grind the creature to smithereens after pausing briefly to ensure that his flip-flop was positioned so as to fully protect—to whatever extent a flip-flop could ever protect anything—his foot from millipede exposure. I’m used to the relatively harmless centipedes from where I live, but millipedes are poisonous.

Roger had a portable internet modem, and since he loaned it to me for the night, I was able to have even more internet on this Sabbath from travel or work.

Friday, July 15

On my way to work in the morning, I rounded a corner and was surprised to see two horses walking down the road by themselves. ¨Where might they be going?¨ I thought.

During work at the hospital, our progress was rather slow because of a number of converging problems. We still haven´t heard back from the manufacture of the pulse-oximeters we´re trying to fix, and we don´t want to do something that damages the units. Furthermore, two separate sets of scrubs are needed for us to enter the maternity and surgical wards, preventing us from going in there today. In searching for spare parts throughout Olanchito, we had difficulty finding even the most basic components that could potentially be used in adapting incompatible tubing for sphygmomanometers.

After work today, I felt relatively well and went to the internet café for a few hours of time online. On the way there, however, I heard a strange sound behind me, and turned to see a baby horse—about six feet tall—chasing me in a frantic search for its mother. Turning back, the braying creature ran down the concrete road, weaving in and out of traffic. (We had already seen the same baby horse many times, running around behind its mother). At the café, I transcribed some notes of mine into email to send to the rest of the EWH Honduras students. Having translated into Spanish a few sets of questions we’re supposed to ask hospital staff, an EWH staff member working on a technician training curriculum for Honduras had asked me to share them. After that, I was again hungry and ate dinner, and if I’m feeling well tomorrow, I’ll go to the beach in Trujillo and snorkel in the Caribbean!

Thursday, July 14

This morning, I woke up dreading breakfast and realized I still wasn’t better from my illness. Walking in for pancakes, I ate few bites before being unable to continue. “Do you have Jairo’s number?” Maritza said. “It’s not good for you to still be sick; you need to see a doctor before you do any work this morning.”

Much to my luck, Allen, a doctor who knows English very well, was working in the emergency room at the time and already knew what was wrong with me and the medications I was taking. “I can see that you’re very sick,” he said. “Your face is pale and your eyes show it as well. What we’re going to do is give you I.V. fluids for rehydration and also intravenous antibiotics—because you need them.” Apparently I was quite dehydrated despite drinking more than three liters of water and Gatorade each day, because the veins in my hands, which are normally quite prominent, could not be found. After two failed attempts on the top of my left hand, and another on the side of my wrist (ouch!), the nurse switched to my right hand and was successful in inserting the I.V. there. For the next three hours, I lied in the E.R. as two bags of saline and one bag of antibiotics slowly drained in (making my arm quite cold).

When I left around lunchtime to rest at home, my veins were once again quite prominent, and I became very hungry! Taking a taxi back from the hospital, I was surprised that the driver knew English. “I used to live Miami and Ohio—had a wife and family there. We separated,” he told me. “Hot out, isn’t it?” he added, “You’re unlucky. This valley is the hottest place in Honduras.”

In both the hospital and the homestay, everyone coming by to check on me would comment that I was sick because I lacked/needed a girlfriend. When dinnertime came, I was relieved and excited to be once again extremely hungry, and look forward to recovering soon and resuming work in the hospital!

Wednesday, July 13

Slow day today, as I´m still not feeling well after so much medicine. However, I was quite excited (and somewhat shocked) when I got home, as a guitar sat waiting for me on my bed. This best of medicines belonged to Roger, Maritza’s , nephew, who is loaning it to me until I leave. Scarcely had I begun to play it, however, when we were told to come to dinner now and eat quickly. “Did she say something about a fire or smoke?” we said to each other. “Eat fast—the house is on fire,” we joked. As we finished, smoke began to pour over the walls of the yard, and suddenly the obscure language became clear to us. Fumigators! Guitar in hand, I hopped into the truck with Maritza and went a few blocks over to her sister’s house to stay for three hours until the fumes passed.

At Maritza’s sister’s house, I met Roger, my musical benefactor, and we played a few Beatles songs. Roger shared with us about himself. “I studied mechatronics engineering, but can’t get a job doing that in Honduras right now. I work at a [gas-fired power plant], which is unfortunate because Honduras has much more dirty energy than clean right now.” “It’s the same way in the States,” I replied.

Tuesday, July 12

After a great deal of sleep, I woke up for medicine and a pancake breakfast at 7:15am, feeling better than I had in many days. Although I felt well enough to go to work, my productivity was very low because of the drag of sickness. However, one significant task we performed was to completely remove and dispose of a dental chair and all of its ridiculously heavy components, e.g. arms and booms, suction vacuums, etc. In order to move heavy equipment around the hospital, we use a retired patient cart/bed.  However, when we were moving one of the heavy parts of the chair, the cart hit a bump in the brick pavement outside and one of the swivel wheels turned sideways and then deformed its axle as a result of the cart’s continued forward motion. For the rest of the way, we had to lift on the cart in the broken place to keep the weight on the working wheels. For some reason, a camera man from a local news station was there, and he whipped out his camcorder to film our debacle. He then interviewed Esau, a man who works with replenishing and transporting oxygen tanks, although the interview likely had nothing to do with the dental chair.

While trying to take inventory of the maternity ward, we briefly and accidentally crossed a sanitation boundary, definitely catching the attention of the staff. One of them then brought us two patient monitors that weren’t working properly, while the other, named Allen, stayed to talk to us for a while in English. “I’ve studied English a lot and graduated from a bilingual high school in my hometown, Tegucigalpa, but I never get to practice it.” The ease in speaking to him was a great relief for Tom and I, especially since the focus I needed to speak in Spanish had been noticeably lacking while I was sick. “I’ve been studying really hard for the Kaplan test (MCAT), and I’m hoping to go to medical school in the States.” He then told us more about his educational background and prospects. “I was going to go to a university in the United States, having applied and been accepted. The thing is, since I’m not a U.S. national, the price for me would be the full $60,000 per year, and I couldn’t afford it. Here, we pay around $500 per year.”

Later in the day, I made a shocking discovery which motivated me to rehydrate more vigorously: I had lost ten pounds over the weekend (Jairo has a scale in his shop). Also my blood pressure was lower than I had ever seen before, 108/70, and since my pulse was high at 90 bpm, the low blood pressure could not have been caused by my blood pressure medicine, which lowers blood pressure by lowering pulse. All told, I drank three cans of apple juice, a liter of Gatorade, and three liters of water today—good progress, but still not quite enough. At lunch, I was again feeling averse to eating at all, and Jairo tried to convince me to go to the emergency room. When I resisted, explaining to him that I had just begun another course of antibiotics, he actually grabbed me by the arm and pulled until I followed voluntarily. “Your eyes look bad right now,” he said. “Don’t worry; it’s no problem to go to the ER. Let’s go.”

By chance, Allen, who I had met earlier, was working in the ER when we went in there. “Oh, yes. I already know your sickness from our conversation earlier,” he said. I then explained once again that I had just started new drugs after finishing the old ones. “It doesn’t matter,” he said. “The thing is, when they only give you three days’ worth, the bacteria become resistant. You need five days, and you can take these with what you’re already taking.” Although we weren’t able to fix the patient monitors today, I finally seem to be getting better, and now look forward to working on them more tomorrow.

The Ruins of Copan...and my intestines (July 8-11)

I woke up at a bright-and-early 6:00am on Friday, solely due to being sick. However, at this point, I was still feeling better than I had the day before. When we arrived at the hospital for work, Tom’s bleeding elbow, which had resulted from his riding the super-tall bike, was seen by some staff who then took him to the emergency room for treatment. They cleaned and bandaged the wound, prescribed preventative antibiotics, and were amused by how Tom’s injury had occurred.

Still being sick and seeing how easily Tom had received antibiotics, I asked about seeing a doctor myself. After asking a few questions, the doctor prescribed for me an antibiotic and an anti-parasitic medication, and the prescription was filled at the hospital’s pharmacy. Asking about the price, I was told, “es gratuito,” meaning, “it’s free.” Feeling confident about the health I would have over the weekend completely changed my attitude about my coming travels, which I had dreaded while sick in spite of the exciting destination—ancient Mayan ruins. The hassle-free and comforting nature of the entire situation made me think seriously about the benefits and challenges of a public healthcare system.

While I was gone, Tom had begun working on a hand-held sonic infant heart monitor unit, which would not even turn on. A challenge we encountered in fixing it was the integrated design of the device, which dictated that the device be mostly assembled in order to draw power from the batteries. “If only we could see the other side of the chip,” Tom said. “Actually, Tom,” I said in response, “we can.” Using the AC-to-DC variable power supply we had built in lab last month, we created the needed 3.2 volts of power and were able to test the device without the battery plate being connected. The problem was found to be in the on/off switch, where a small piece of contacting metal had broken off. Soldering on new piece of metal to replace the old, the device works once again, although there is risk that the mended switch could later break in the same manner.

Having been given permission to leave work after lunch to try to reach the Copan Ruinas in time to see them over a two-day weekend, Tom and I were confused by conflicting information throughout the bus station. Luckily, some of Maritza’s staff apparently worked a second job at the bus station, and they came and helped us when they saw us trying to find the right bus. Since our bus, we were told, would leave in just a few minutes for La Ceiba, we rushed to the house to pack hastily for the weekend trip. Reaching our bus just in time, we departed for La Ceiba and arrived there just in time for the last bus of the day leaving for San Pedro Sula, a city only about three hours from the ruins. Luckily, the boleteria in La Ceiba accepted dollars for the purchase of tickets, as we had run out of lempiras. Just before leaving the bus station, I witnessed a rather unique situation: one of the heavily armed and armored police officers stood next to where our bus was parked, holding with one arm his machine gun, while with his free hand he was texting on a cell phone!

I took many pictures during the bus ride of the beautiful Honduran countryside, though I wasn’t able to capture one of the most distinguishing sights I encountered. During sunset, a space between the peaks of two mountains contained a small raincloud from the base of which a brilliant rainbow stretched to valley below. Seconds later, the beautiful sight was out of view.

San Pedro Sula, or SPS, where we would be staying the night, is a dangerous city and a hub of one of the Western Hemisphere’s most violent gangs. In fact, riding the city’s municipal busses is not recommended for tourists, since in certain neighborhoods on the bus routes, gang members enter the bus to collect tribute from each passenger for the right to pass through the territory safely. Unfortunately, our taxi driver from the bus stop to our hotel cheated us, asking first for 100 lempiras, but then saying that this was the price-per-person once we reached the hotel. Although this was, by far, the most we had ever paid for a cab anywhere in Central America, we paid thinking we had little option since the neighborhood was dangerous and the driver seemed to be acquainted with the staff of the hotel he had brought us to (although he actually wasn’t).

The hotel itself was quite ‘sketchy’, being guarded by a man with a machete in the lobby area. While certainly an indispensible tool in rural areas, machetes can rarely be justified as anything more than a weapon in the city. However, the machete-man recommended to us an excellent nearby restaurant, “El Recreo”, which we could safely walk to in the dark. At the restaurant, we were given lots of useful information by the family who owned and ran the place. An English-speaking woman named Rosie, the sister of the restaurant’s manager, was especially helpful as she was able to find even more in-depth information about the area for us, having lived in New York for the past many years. “I’m here for a month to visit family, and then I have to go back because my kids miss me” she told us. She then lamented, “but everything here is so dangerous now with all the gang activity. Years ago, it didn’t used to be this way at all. You didn’t have to watch your back everywhere you went.”

Having asked Rosie where to find replacement printer parts, we set out the next morning to search for them before taking the bus to Copan Ruinas. Unfortunately, the store we had been referred to did not have the parts we were seeking, and the stores, one after another, that we were referred to after that did not have parts either. We then took a taxi to the bus station, but, unlike what our lying taxi driver the night before had told us, our bus did not leave until 11:00am, which was going to give us very little time to enjoy the ruins.

While waiting at the bus stop, we met an American named Mike, a Duke University student coming to Honduras to do research in World Health for his masters thesis (specifically, the effects of American junk-food brands on the oral health of Hondurans). Before we had spoken much to him, though, a bizarre, English-speaking character named Sharlin approached us. “Do you know how I can get to Belize?” he asked. “I’m from Haiti, but I can’t go back there because I have a problem with the president. I have to stay here for 30 days, and then I can go to Belize where I’m told there are people who can help me get political asylum. My family is in Canada, and they will send me money.”

His story then became even stranger. “All the police in Haiti, they have my picture and they will shoot me on sight if I go back there because of the problem I have with the president there. They already shot me four times,” he said, lifting his pant leg and lowering his sock to show a scar from a bullet wound. He also pointed to his hip and back as the locations of other scars. “Well,” I replied, “these bus schedules and things are as new to us as they are to you, but you should be able to get the help you need from the ticket booths.” “I’m from Haiti,” he said, “I speak French, English, and Creole but not Spanish.” Thinking it unwise to become any more involved, I said, “Some of the ticket sellers speak good English and should be able to help you.” When he left, I felt sorry for not being willing to help in case anything Sharlin said could have been true, but I took comfort in knowing that becoming involved in a political situation could potentially be even worse than if he had had other, drug- or gang- related reasons for wanting to go to Belize.

After arriving in Copan Ruinas, we were met by a hotel-owner trying to lure us to his place. “Three of you?” he said in clear, easily understood Spanish, “I can give you a nice room nearby for fifteen dollars.” Surprisingly, the room was quite adequate despite the rock-bottom low price, which was split between Tom, Mike, and I. The city of Copan Ruinas, which lies less than a mile from the ruins of the Mayan city of Copan, was rather picturesque, with cobblestone streets and old-fashioned, colonial buildings.

We finally arrived at the ruins only about two hours before the end of viewing hours, but we still had time to see many of the fascinating ancient structures. Climbing around the pyramids and ball courts, we took many photos of the beautiful scenery and ruins. Also, a storm was approaching the entire time we were there, creating an eerie background of thunder and gloom while we visited. Views from the tops of the many pyramids and buildings were astounding, and complemented by several quintessential four-legged creatures and colorful macaws. After leaving the ruins when they closed, Tom and I decided to take a nature hike on a thirty minute trail which, surprisingly, led to another, smaller Mayan ball-court. When we finally got to the end of the trail, though, the park as a whole was locked and under guard by two men with machine guns, who then let us out.

Shortly after coming back to our hotel, I was struck afresh with the sickness which had begun on Thursday, and after eating at a nice local restaurant, the resurging illness took me down for the rest of the weekend and more. I spent Saturday night sick, sleepless, and dehydrated, and was in the same state all of Sunday morning when I had hoped to be visiting either the museum of the ruins or the ruins all over again. Before leaving the city at 2:00pm for the long ride back to San Pedro Sula, I bought a package of sandwich buns and reluctantly ate some bread; virtually the only food I could even dream of stomaching at the time.

At San Pedro Sula, we were unable to reach the last bus of the day for La Ceiba in time, as the tickets for it had already sold out. Luckily, an honest taxi driver, after having earnestly tried to get seats on the bus for us, offered to drive us at a good price to El Progresso, another city from which a bus would leave for La Ceiba. We reached the bus stop in El Progresso before the departure time of 8:00pm, but the bus, which was quite full, was an hour late and did not arrive until 9:00pm. While waiting in the small lobby, I took out my Bible and happened to open to Esther, which I read thinking, “Well, however sick I am, it’s not so bad compared to what these people must have experienced.” Finishing Esther, the book beginning on the next page was Job. “Oh… that’s nice,” I thought.

During the long ride from El Progresso to La Ceiba in yet another bus with too little space between rows of seats for the length of my femurs, I sat next to a young man from Utila (an English-speaking Caribbean island of Honduras) named Clinton, who had also spent almost the entire weekend traveling to Tegucigalpa and back after dropping off his girlfriend for her flight to Denmark, where she was from. Clinton had lived in the United States (legally, I believe) for many years in New Orleans (2001-2009), and he witnessed the horror of hurricane Katrina. “Everything was flooded. Everything was destroyed,” he said. “It was a year before my family could return and rebuild our house.” However, I still wasn’t feeling well enough to talk to him much.

Later Saturday night, Tom and I finally arrived at the private bus stop in La Ceiba around 11:30pm and took a taxi to a hotel near the public bus terminal. The taxi driver gave us useful information about bus times the next day, but we may have misheard some of what he said, thinking that there was a bus for Olanchito leaving at 4:05am. With very little sleep, we took a taxi at 3:30am from our hotel to the bus terminal, where we waited for over two hours (which could have been spent sleeping) until the actual bus-time at 5:45am. At this point, I was prepared to justify my body’s rebellion against my desire for good health.

Waiting at the bus station in the dead of night was a unique experience, and we were at that time especially prone to robbery. However, most of the other eight to twelve people at the bus station during that time were bus drivers preparing for a day of work. Some were sleeping out on the open benches, others in the backs of taxis or cars, while the most innovative had full-length arrangements for themselves in the cargo holds of their busses. The funniest thing was that they walked around without shirts, etc., since they were only wearing their pajamas. Each time one of them approached us, Tom and I were made initially nervous by not knowing whether the buff and tough individual would be a bus driver or an armed robber. “Good morning, where are you headed?” each would say cheerfully. “Olanchito? Well that’s not me, but your bus will arrive later.” Finally, our bus came, and we reached our home city around 8:00am.

Going to our house, we met Maritza for the first time, and she asked if I was doing better since I had called her the day before to let her know we wouldn’t make it back for supper. “Still sick,” I responded, and instead of going to work on Monday, I spent the day sleeping and trying to rehydrate. At noon I took my last dose of antibiotics, but remained sick on into the evening. I went into the house to talk to Dilsea, saying, “I don’t have any more antibiotics but I’m still sick.” She asked several questions about my condition, and then relayed the information to Maritza, who called a doctor and described my condition. Maritza then went to the pharmacy to pick up my next round of medicines the doctor prescribed. My stay-alive-in-Honduras cocktail now contains six different drugs to control or prevent the effects of Malaria, intestinal parasites, food-borne illness, and high blood pressure. “Try not to worry,” Maritza said, “These medicines work very well, and everything will be better tomorrow.”

Down with the Sickness (July 7)

Whether from getting water in my mouth during a shower, while doing laundry, or from food washed in the tap, I woke up this morning feeling rather sick. As the day wore on at work, I felt progressively worse, eventually needing to go back to the homestay to use a sanitary bathroom, drink insane amounts of water (four liters), and pop Pepto-Bismol like candy. The morning was not entirely lost, however, as when we retrieved one of the laboratory’s broken centrifuges, we found simply that the brushes in the motor were too worn down, and we were able to replace them and put the machine back into service.

During inventory of the pediatric ward, we were directed to three infusion pumps (devices that force I.V. fluids into a patient) which sounded alarms and gave error messages. We found the problem to be in the delicate sensitivity of the tube detectors, which were designed to sense whether an I.V. tube was in the correct position to be ‘milked’ by the infusion pump. Although nothing could be changed on the pump itself, we were able to find a way to satisfy the detectors. Rather than pushing the tube back as far as possible—where it should be—as the nurses had been doing, we were more successful with the pumps by first pushing the tube deeply into the groove, and then essentially flossing the tube in the crevice until it became flush with all the sensors, as indicated by an LED.

Although the operational fix we found may prove quite helpful to the nurses, they were completely unsurprised by the cause of the malfunction or the nature of its solution. “This I.V. tubing is the wrong brand for these pumps, but it’s all that is available. That’s problem number one,” she said. Unavoidable mismatches like these, comparable to the donation of a diesel truck to a place that has only regular gasoline, are one of the reasons that Dr. Malkin of EWH as well as others discourage the donation of medical equipment in favor of processes that promote growth in the production, purchase, and maintenance of these devices as part of the local economy.

Indeed, the economy of Honduras was severely set back in 1998, when Hurricane Mitch ferociously unleashed torrential rains on the nation for four days, destroying every bridge in the country, 70% of all crops, and over 50,000 cattle in addition to killing 6,000 despite full-scale evacuations. Now, all of the many bridges we have seen in the country are quite new, with the skeletons or pieces of the old bridges visible to the sides.

The skeleton of an old bridge

After lunch, we climbed up onto the hospital roof with Jairo to fix a ventilation fan needing a new belt. The sun was extra hot from the roof, but the view of the city was excellent, and I spent much of the time up there imagining what a great place the roof would be for a bunch of potted plants and small trees. I was then surprised to see Jairo jump suddenly off the roof, landing on a giant, red water tank a few feet away and a couple feet down. When he motioned for us to follow, I first took a few moments to evaluate some important factors, such as the expected friction and curvature of the surface I would land on as well as some different things gravity might do to me if I didn’t land correctly and centrally on the horizontally cylindrical tank. Thus prepared, I made the leap without incident and then climbed down the rungs on the far side of the tank, though I discovered at that time that base jumping is not for me.

After work, we went to the bus station to meet Julien, the On-the-Ground-Coordinator for Honduras who had come to visit us and check up on our progress, and went to a restaurant for dinner. After discussing our experiences and challenges so far and our priority goals for the summer, we went to a local place near the central park to play pool. After a few games costing 3 lempiras per game (that is, 16 cents), a couple of guys from Olanchito, Hector and Ricardo, offered to play with us. As we learned and played the unique Honduran version of pool, Ricardo was incredibly good, scarcely missing a shot, while Hector was able to speak to us in rather good English. “Near Chicago? Yeah, I know where you’re talking about. I have family in Florida, New York, and California. But me? No. I love my country. I’m not interested in going up through Mexico,” Hector said.

Leaving the bar, we were astounded by the cyclists we saw approaching from down the street, because while the head of one was visible across the line of cars parked by the curb, the full body of another was equally visible high above the rest. “Is he riding one of those retro-London bicycles with the giant front wheel?” we thought. As he passed, we could see that he had taken the frames of two identically sized bikes and welded one on top of the other upside down, with a chain leading from the top bike to the back wheel of the bottom bike. As we cheered the clever craftsmanship, he turned around and came back to us, offering to let us try riding it. As Tom attempted to get started on the bizarre behemoth, his balance failed due to the curb before he could reach a stable speed, and he fell flat to the side down onto the concrete sidewalk. Although he appeared to hit his head (extremely hard), he had managed to block that by sacrificing his arm as a helmet, and his elbow sustained a deep gash. When my turn came, I evaluated the situation in a similar manner to that of the roof-jumping earlier, and decided to get completely up onto the bike using the column of a nearby building for support before trying to move forward. Thus successful, I rode around the area on the mutant bike, drawing stares and double-takes all the while; a quite liberating experience, I must say.

We then returned to the house to find ourselves locked out, as the door and gate were closed. Luckily, we stumbled across a buzzer which alerted Milania of our presence. When she came to let us in, she said that our late return was not a problem, but that she simply thought that we had gone to bed already and that she always locks everything once she comes home for the night.

Papa Juan (July 6)

While Tom and I were waiting this morning for Jairo to return and give us instructions, a man whom we did not know walked into our shop area. “Hola.¿Como estás?”  I said. “I’m good, how are you?” he responded. “I speak English; where are you from?” In the conversation that followed, he told us much about himself and how he had learned English.

“I moved to the United States when I was twelve—illegally. First, I lived in L.A., but they caught me and put me in a shelter. Later, when it was time for me to go to high school, they came to me and said, ‘You have to go to Michigan right now,’ so I was like, ‘alright’, and I went to high school in Detroit.”

I asked about where he’d been in Michigan, and one of the places was Mackinak Island, a unique place I visited as a child on vacation with my family. “Yeah, all bikes and horses there,” he said “it was really cool.” Then he described his high school experience.

“For the first three months of high school, I understood nothing because it was all in English. I sat through all of my classes thinking, ‘What are they doing? What are they talking about?’ My teacher in Michigan didn’t know any Spanish, but whenever she wrote something on the board, I always copied it down. By six months, I could pick up a few words here and there. At nine months, I could speak it.”

“After graduating high school, I went to Grand Rapids Community College for two years, studying computer science. Right after that, one year ago, I got deported. I’ve spent the last year looking for a job. Olanchito sucks, man; there aren’t any jobs. I’m from Ceiba but I moved here for my girl [girlfriend].

“The thing around here is, you’ve got to know somebody to get a job. I can speak good English. I know computers. It doesn’t matter. Man, they don’t do nothin’ for you unless you know somebody. And you have to know them really well. Another thing is politics. A lot of times that determines who they’ll hire. If they’re democratic and you’re not, no job. Sometimes you’ve even got to lie about it to have a chance.”

During his time in the U.S. from ages twelve to twenty, Juan wasn’t able to make the kinds of connections he needed to get a job. Shortly after this part of our conversation, however, his cell phone rang, and he answered it to complete a short conversation. Then turning to us, we had the following unexpected conversation:

Juan: That was my girl on the phone just now.

Me: Oh, how is she?

Juan: She just had a baby.

Me: Oh? So… you’re a father now?

Juan: Yeah.

Me: Uh… Boy or girl?

Juan (smiling): It’s a son.

Me: Well congratulations! What are you going to name him?

 Juan: ‘A-veel’ 

Me and Tom: What?

Juan: E. V. I. L.  Evil… I got it from the Bible.

Me and Tom:  ….??

Juan: Oh, haha—it’s not like the English word.

He then explained to us that unlike the United States where many people are in the room for birth, in Honduras, no one except the doctors and nurses are allowed in the room during labor and giving birth (in Spanish, the literal meaning of the expression for giving birth is ‘to give light to the child’).

Since he was looking for a job, we asked for Juan’s phone number, and he offered to come be a translator for us if we needed one, which could also give him a good opportunity to meet with potential employers in the hospital and impress them with his English skill. In fact, a translator could be extremely useful towards the end of the month, when Tom and I perform ‘needs finding interviews’, an important information gathering exercise during which we ask a number of doctors, nurses, and staff about what kinds of broad, general needs the hospital has. The information is then used to guide the development of new medical devices tailored specifically for use in the developing world.

While still waiting for Jairo to return from whatever he was doing, I walked less than a block from where I was, still on hospital grounds, to a small Pepsi/Tigo shop. Tigo is a company that sells SIM cards and chips for cell phones, and at any given time, one may expect to see six or seven (or more) Tigo shops in his or her immediate surroundings. Altogether, the chip I bought and however many minutes are on it cost about five dollars.

I returned to the shop to find Jairo and Tom working in despair on the troublesome printer. Having opened up the old, broken printer to use its spare part as a replacement for the bad part in the new printer, they found that the old printer had been put out of service for exactly the same reason! With this setback, the only option seems to be somehow finding replacement parts in La Ceiba to buy for both printers.

After this, Tom and I began taking inventory in the laboratory, which contains instruments like blood analyzers, centrifuges, and microscopes, among others. The staff who were running blood and tissue sample tests showed us each piece of equipment individually so that we could easily compare the machines to the inventory from 2009 and record changes and additions. Fortunately, the laboratory staff responded well to my clumsy Spanish introduction of who we were and what we hoped to accomplish in the hospital, and the staff presented many problems to us right away. We now have no doubt that there will be a great deal of work for us to do once we organize and prioritize the list of out-of-service equipment.

Strangely, I quite enjoy having free access to all the restricted areas of the hospital, especially our next inventory stop, the x-ray rooms. A worker from the x-ray department told us about a problem with one of the machines, and although fixing an x-ray machine would be a great success, I thanked her for bringing the problem to our attention and told her that we may or may not be able to address it.

When taking inventory in the laundry department, we found that the demon-machine that broke a few days before we arrived was also broken when inventory was taken in 2009. A few tests today and more guidance from the manual seems to suggest that the problem could be associated with the ‘safety inverter contactor’ which costs about thirty dollars to replace. This would be a much better situation than the possible problem with the inverter itself, which costs several hundred dollars to replace.

We were invited by some other workers at the hospital to play soccer at 3:30 in the afternoon, but we weren’t able to find the field, didn’t catch our ride when they came to pick us up, or the game didn’t happen. Instead, however, we came across a small urban lot converted into a soccer field, with several children playing barefooted, while the older ones had shoes. Tom and I, confirming that it was a field for anyone to use, walked on and motioned for the others to join us. For the next hour, the five of us kicked the ball around to each other, not needing to use any English or Spanish at all.

On our way back to the house for dinner, we stopped by Ramón’s juice stand to try some new varieties. Just for us, he had prepared a batch of tangeringo juice (completely unrelated to tangerine), which had a citrus/gingery taste that was very refreshing. Since Ramón wasn’t there at the time to see us try it, we asked his wife to let him know we had come.

Dinner was again delicious tonight. And the dish we were served closely resembled a taco salad, except that the nacho chips were replaced with slices of fried plantains! Afterwards, we went out in search of an internet café, and ended up staying at one late enough to need to walk back in the night. Although our information said not go out at night, we had no incidents and did not even see anyone who looked at all suspicious.

After I returned home, the time had come for me to do my first round of Honduran laundering. Although I had been granted permission to use the washing machine, I took off its covering and opened it up only to find that a great quantity of bugs or something had entered and died inside (I mean, a couple kilograms or so of them). This left me no recourse but to wash manually. Although I had never before performed aerobic laundry, using a large tub of water, detergent, a rock, and a washboard, I thoroughly cleaned six pairs of underwear and socks, two shirts, and a pair of pants in a process that required about eighty minutes of character building. Socks, by the way, are the most annoying thing to wash by hand. Hopefully, part of what I washed will be dry by morning.

Our First Fix (July 5)

Since oxygenated blood is bright red and de-oxygenated blood is dark red to brown in color, a pulse oximeter uses the simple parameter of light intensity passing through tissue and blood to measure precisely the blood oxygen concentration (SpO2). The probe uses two lights, a red one that is partially absorbed by oxygenated blood, and an off-red light that is only affected by the amount of blood present, regardless of its oxygenation. Thus, the two lights calibrate each other to provide an exact measurement, and in addition to blood oxygenation, the pulse oximeter is sensitive to changes in blood volume, that is, the pulse. The probe itself is the familiar clip-on finger probe.

When we first began inspecting the pulse oximeter, the source of the problem was completely illusive. Since the most common complications with pulse oximeter units are shorts or open circuits leading to the probe, Jairo went to the adjacent bed of the E.R. where an identical pulse oximeter unit was, taking its probe to test in the machine we were trying to diagnose. However, the probe from the working machine failed to give a pulse in the faulty machine, and the probe from the faulty machine worked just fine in the working machine, ruling out the probe as the cause of the problem.

Taking the probe back to the shop, Tom and I began looking for problems with the machine itself. We had a large manual, a small user’s guide, and a maintenance guide, all of them entirely in Spanish, as was the interface on the pulse oximeter display. Because the machine was quite new and we had confirmed that the male plugs of the probes were working, my first suspicion was that this machine’s female pulse-ox probe plug had been damaged. Additionally, a message kept showing that the ECG was disconnected. However, Tom thought the problem might instead be with a display setting, and we found that the ECG message was referring not to the pulse probe, but to a separate plug-in for a set of electrodes.

While investigating with the manual and looking for a way to find the problem, we became familiar with the machine’s interface, hoping that finding a way to switch the display language from Spanish to English would help us to investigate more intuitively. However, changing the language setting required a passkey and a registration key, which we could not find. Finally, after perhaps an hour, I found a small menu with a sub-section that said, “FC de:   ECG” (Cardiac Frequency from ECG). Bingo. Scrolling to ‘ECG’, I surveyed the options and selected “FC de:  SpO2”. Immediately, the probe began displaying both my blood oxygen concentration and my pulse.

Tom's pulse is freakishly low (52, later 45)

We brought the ‘fixed’ machine back to the E.R. and reinstalled it, explaining to one of the nurses what the problem had been and how it could be fixed in the future. Although without us the pulse-ox unit almost certainly would have been eventually ‘fixed’ and returned to the hospital at a low cost rather than needing to be replaced, if we had not found the problem and resolved it, weeks or even months may have gone by during which the hospital was unable to use one of the device’s most important functions. As we had been warned, the problem in this case was simply user error. Unfortunately, the broken washing machine is definitely not a case of user error. Today, we were able to rule out a few other possible causes of problems, but much more investigation remains to be done before we can even approach a solution. In the worst case scenario, the inverter has to be replaced or the computer is out.

After lunch, we were given an additional problem: the printer of hospital’s secretary of public health would not print on one edge of the page, broken from the good area by an unsightly black streak. As we took the printer apart, Jairo powered up an air compressor, which we used to blast the components clean. Finally, we came to the source of the problem, a cylindrical plastic sheath, one side of which had been ‘eaten’ by some other part of the machine. Tomorrow, we are going to replace the sheath with one from a similar printer in the trash and then hope that we can somehow put the printer back together correctly.

José Ángel suddenly whipped out his two-foot-long machete and went outside. He returned carrying something resembling a stick in his hand. Holding one end, he had me hold the other as he sliced off a portion with his machete. After he beckoned me to eat it, I bit into a woody stalk saturated with a surprisingly sweet, fresh liquid. “It’s sugar cane,” he said. He soon went back out for more, and I followed him to watch the process.

The machete is first used as an ax to make broad cuts in the base of the cane. Then, a few lazy strokes can easily remove the leaves on the top and the buds on the side of the plant. Using the machete now as a peeler, the outside is stripped away to expose the moist, juicy, wood-like interior. Finally, in a process akin to girthing a tree, a few hatches  in a circle around the cane’s natural vertical joints allows the snack to be easily apportioned to as many recipients as one wishes.

Sugarcane at the the hospital

Before long, a storm that had been brewing in the mountains arrived, dumping hoards of rain for over forty minutes. When the downpour finally lessened, Jairo offered us a ride home in his truck. Most of the streets had by that time been partially converted into streams, usually one to three meters wide and ten to twenty centimeters depth, all of them bearing the earthy tinge of Olanchito’s redish-orange soil. The closest that Jairo could bring us to our house, since our road is under construction, just happened to be at the exact place where Ramón sells fruit juice. Since a flash-river about twenty centimeters deep had appeared between the sidewalk where Ramon’s stand was and the street, he put a large log-stool in the center of the water to facilitate crossing. “Step here, my friends,” he said. To some others crossing from the sidewalk to the street, he joked that they would have to pay a toll to cross.

Another English-speaking man was at the fruit stand today, Juan, who is Ramón’s brother. Although I was surprised by how well he could speak and understand English, I was even more surprised by what he said. “Ramón, he learned English in school. But I never had school past primary. Instead, I just always find people, ‘Hey, are you from America? Do you speak English?’ and talk to them as much as I can. I don’t know something? They tell me.” Also hanging out by Ramón’s stand was a group of bulletproof-vested cops with a handgun in the left holster and a semiautomatic rifle strapped to the right. Since we were in a crowded area, I was usually standing within a meter of them. However, I did not strike up a conversation. When we talked to Ramón about wanting to go hiking on the mountains, he invited us to do so on his mountain property. “I’m thinking about switching to farming,” he said. “I need money now. I’ve been a street vendor for many years now, but it may be time for a change.”

Coming back to the house, we found the entire front yard to be a lake about twenty centimeters deep. “The construction in the street blocks the drainage,” we were told. A large lizard walked about in the mire, eventually diving under the surface to hide. Later in the day as I sat outside to work on my blog, I was puzzled by many strange, winged insects filling the air. “Oh, ants,” I realized. “It’s colony launching day here.” Strangely, seemingly all of them landed on me, and any attempt on my part to brush/blow/flick them off instead stripped them of their wings. Currently, I wish I could tell the ants that I am not a suitable location for building a colony.

For tomorrow, I prepared a number of simple questions in Spanish to ask the hospital staff for our inventory procedure. When Milania got back from work, she was able to go over my work and revise any incorrect or awkward Spanish phrasing. Still, tomorrow, when we ask all the staff questions about their jobs and such, is going to be very awkward.