Third Time’s the Charm

Last Friday (7/3) we made a third trip to Mt. Meru Hospital in Arusha to put into use the skills we’ve been learning in our medical instrumentation lectures and labs. If you remember from the last couple blog posts I’ve made about my times at Mt. Meru, most of my time has been spent working on an operating table powered by a hydraulic lift that wouldn’t go down. Last week, the bed was unfortunately inaccessible due to it being used even in its broken condition, so this week the first thing Conor and I did was check to see if the table was available.

Luckily for us, the operating theater the table had been moved to wasn’t being used, so this week was our chance to finally fix the table. In order to actually move it to a place we could work in, we had to enter the clean area of the hospital, which meant putting on some fashionable orange booties over our feet. The American doctors who had been doing the cleft palate surgeries showed us to where the table was located, and helped us move it back to the original room we worked in the first week.

Along the way I got to see the operating theaters along with some of the equipment we had been covering in lecture, such as the overhead lamps and the anesthesia machines. Seeing open windows inside of an OR was bizarre to see, but sterility had to be compromised to get critical ventilation into the rooms.

One of the operating rooms (with some of the working tables)

One of the operating rooms (with some of the working tables)

Another OR

Another OR

Now that we had the table available, Conor and I felt confident enough to start some of the real work to get the hydraulic jack into the bed. We started with another cleaning of the inside of the tank, which still had a ton of gunk inside. When testing the jack by pushing down the lifting rod, we heard air coming through the outlet and the rod went all the way down to the bottom, making us reasonably certain that any clogs that may have been in the mechanism had been opened.

We used a little brake fluid to clear out the mechanism

We used a little brake fluid to clear out the mechanism

Next, we had to make sure that the brake fluid we had bought at the gas station would work inside the jack – we were a little worried since the brake fluid was somewhat less viscous than the original hydraulic fluid that had poured out of the table the first time Larry and I tried to flip it over. If the fluid wasn’t thick enough, we ran the risk of it leaking out and the bed slowly falling down if any weight was put on it. We needed some kind of platform in order to perform a weight test, and the equipment graveyard we were working in had all kinds of junk to work with.

There was a ton of junk to look through in the equipment graveyards

There was a ton of junk to look through in the equipment graveyards

We ended up finding a box of screw clamps that attached nicely to the rod of the hydraulic jack, and with this we were able to balance a wooden panel and a heavy fire extinguisher on top of it to serve as a stand-in for the real table’s weight. Placing a mark on a broken IV pole and setting a timer let us measure how much and how long it took for the table to settle to see if it was going to be an issue.

Rigging up a little weight test for the hydraulic jack

Rigging up a little weight test for the hydraulic jack

Notice the little black mark on the pole we used to see if the jack fell down at all

Notice the little black mark on the pole we used to see if the jack fell down at all

During the wait, we watched another group as they fixed a broken electrosurgery unit (ESU) and test it. An electrosurgery unit is a machine that uses high voltage to cut through a patients skin just like a scalpel, with the added advantage of cauterizing any blood vessels in the area which lets the wound heal much faster. They used an orange as a stand-in for flesh (nobody wanted to volunteer their arm), and they were able to use the machine to carve the initials “EWH” into the orange for Engineering World Health, along with a lot of smoke.

Testing the ESU

Testing the ESU

After this, we went back to check on the operating table jack and we saw that it had only settled a fraction of an inch in the half hour or so we had left it. Since it was mostly air inside of the jack and the brake fluid would be much thicker, we were encouraged enough by these results to go for the final step of installing the jack back into the table.

The next challenge was locating all the various screws and bolts and getting several people to help us lift the ridiculously heavy table so we could reinstall the jack to the bottom of the table. We poured the 8 cans of brake fluid we had bought the previous week into the tank, making sure not the repeat the mess we had made the first week, and then came the moment of truth – would the table go up and down?

Pumping the table up went relatively smoothly, but when we tried to release the table to let it go back down, it didn’t move, and my stomach dropped. We had cleared any clogs inside the mechanism so there had to be another reason it wouldn’t move. Fortunately, we were saved by a couple of astute observations – Larry, our professor, had noticed that the jack had a really small “sweet spot” for letting us release it when we were testing it outside of the table, and Conor had also noticed a bolt on the foot pedal that adjusted how far down the pedal was allowed to go. Adjusting this bolt a few turns at a time let us find the sweet spot, and finally, the table came down, which was one of the most exciting moments I’ve had in Tanzania so far.

The bolt that was the key to finding the sweet spot in the table release

The bolt that was the key to finding the sweet spot in the table release

Conor and I super happy to see the bed working, with our stylish orange booties on

Conor and I super happy to see the bed working, with our stylish orange booties on

The table was working again, but we still had a couple things to do before releasing it to the floor. We put a little grease on the rolling shaft that held the table up to keep it from getting stuck and cleaned off the top of the table we had gotten pretty dirty. I also used a sewing kit to fix the fabric skirt that prevented things from falling into the mechanism – thanks mom for making me bring that even though I said I would have no use for it!

One of the doctors walked by at this point, seeing Conor and I testing the table, and backed up to do a double take. He called some of the other doctors over to see it working again, and they seemed just as excited as us. They wouldn’t have the bend completely over to do surgeries anymore, which I’m sure made their backs feel a lot better.

After fixing the bed, Conor and I saw some other groups finishing up pieces of equipment too, such as a portable heater and an automated bed lift. Finally finishing a major piece of equipment made me a lot more confident and excited for the next month in Tengeru hospital, where I will be working on equipment every day using the skills I’ve learned this month.

A portable heater another group got working

A portable heater another group got working

A patient lifter another group got working

A patient lifter another group got working

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