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.