Assist on the Ground

Kosovo Follow Up

2009-11-11T14:34:00.000-08:00

By Ray Schmidt

Saturday, October 31, 2009

I left this morning for Kosovo where I will be working with the American International Health Alliance (AIHA) as part of their program to improve maternal and infant care in that country. I have two primary assignments while there: to assist in repairing some medical equipment in five hospitals around the country and to assess a potential pediatric ICU/Emergency Room at one of these hospitals. I was last in Kosovo in March 2009 where I visited these same hospitals and did a general assessment of the equipment needs. This is a follow up to that initial visit.

I will be working with Greg Johnson, who is a volunteer biomedical engineer from North Carolina. This will be his first volunteer mission and I look forward to working with him.

It’s never easy to leave home. The past few months it seems that I have been away more than I’ve been home. I’m glad this will be my last overseas trip of the year—at least that is the plan. Leaving home never gets easy. I miss my family immensely.

Sunday, November 1, 2009

My celebration was too early. I should have waited before raising my arms in triumph as I saw my first suitcase come into view. I had some initial doubts about my bags actually making it. When I checked in at San Francisco yesterday morning, the counter attendant told me that I couldn’t check my bags all the way through to the Kosovo because my airline didn’t have an agreement with Croatia Airlines, which I was flying on the last part of my journey. So I would need to pick up my bags in Amsterdam and then re-check them with Croatia Airlines. I then flew to Portland and went to the NW/Delta desk and asked them to double check on this because it didn’t seem right. Sure enough, NW/Delta does have an agreement in place with Croatia Airlines. The attendant was extremely helpful and personally went down to make sure that my bags were routed all the way through to Kosovo. Great service.

But I still should have waited to celebrate the arrival of my baggage. But when your bag is the first one on the conveyor, it’s like your team scored a touchdown and you can’t stop yourself from raising your arms in celebration. That was me as the first bag (my bag) came down the conveyor. But the celebration didn’t last long. The suitcases shimmied by one by one. Greg found both his bags (no wild celebration on his part). I waited. The baggage claim area emptied of people and suitcases. Two bags left on the conveyor—neither of them mine. The baggage conveyor screeches to halt. Greg and I are left alone with ¾ of our bags. I feel like my touchdown was just overruled by the instant replay official. No touchdown. No bag. I settle for a field goal—one bag.

But it isn’t just any bag. It’s the suitcase that has most of the medical supplies and parts that I brought for the hospitals—not the bag with my clothes and toiletry items. But as a seasoned traveler, I am not worried. I always pack a toothbrush, toothpaste, deodorant, and an extra set of clothes in my carry-on bag so I’m good for at least a day. And I’m sure that my bag will show up tomorrow…

Our taxi driver didn’t speak English but he was fluent in German and so we had a good conversation on our drive to the hotel. I learned that ex-President Clinton had just left about two hours before our arrival. He was here for the dedication of a statue made in his honor to commemorate the U.S.’s support of the Kososvars during the war with Serbia. The bronze/gold image (the driver wasn’t sure which) of the President depicts him with his left arm raised and in his right arm he is holding a binder that is engraved with the date of the first bombing run by the U.S. against Serbia. Interesting choice of dates to remember but the people of Kosovo are truly grateful for the role America played in their protection and their eventual independence as a country. According to our driver Americans are greatly loved, a sentiment that I heard many times when I first visited in Kosovo in March.

I also learned from the driver that the people of Kosovo have long memories. “We will never forget what the Serbians did to our women, our children, our elderly,” explained the driver. “In 20 years we will still remember; in 30 years we will still remember; in 40 years we will still remember. We will never forget.”

Monday, November 2, 2009

I should introduce the cast of characters for this week’s activities:

Dr. Kate Schechter – Senior Program Officer for American International Health Alliance (AIHA)
Dr. Mary Packer – Program Coordinator for AIHA program in Kosovo. Mary and her husband Alan have lived in Kosovo for eight years.
Greg Johnson – Volunteer biomedical engineer, president of Southeastern Biomedical Associates in North Carolina.
Clay Buttemere – Volunteer biomedical engineer living in neighboring Macedonia (he will join us on Wednesday).
Valentina – Our translator and primary contact for the week. She works for AIHA Kosovo.
Nazmi – Our driver for the week. He speaks excellent German and only a little English. All around good guy.

Greg, Valentina, Nazmi and I went to Prizren Regional Hospital today. We also took with us the Chief of Biomedical Engineering from the University Hospital in Pristina, the primary hospital for the country. We started in the Labor & Delivery department evaluating and repairing equipment. As we started repairing some of the fetal monitors the nurses brought in more and more pieces of broken equipment in hopes that we could somehow miraculously resuscitate them. While we were able to repair or service many pieces, most remained broken. We had brought out parts and accessories for those items that we knew needed service. All we could do for these other pieces was find out the problem and then make a list of parts to send back.

We then moved to the neonatal intensive care unit (NICU) and serviced some of the equipment in that unit. The hospital biomedical engineer worked with us and was very skilled. He knew in most cases what the problem was and what was needed to fix it. Unfortunately, he has virtually no authority to purchase parts or accessories that would make the equipment operable. There were several fetal monitors that needed a new transducer in order to function. They have not been used in almost two years because the engineer cannot get approval to purchase $200 transducers. We had brought some of these with us and so we plugged them in the units and now they have two additional fetal monitors. In the NICU they had a pulse oximeter that is used to measure oxygen in the blood, a vital piece of information for doctors and nurses. A sensor that goes on a baby’s foot is needed to measure the blood oxygen, but they didn’t have any. They had a couple of sensors that they had kept serviceable by using electrical tape to hold them together, but finally they had stopped working. The sensor costs $120, but there is no budget for these items and so the engineer cannot purchase any. So a perfectly good piece of equipment, a vital piece of equipment, sits idle for the lack of a small but required accessory.

I felt bad for the engineer. He knew the problems, he knew how to fix them, but his hands were tied. Greg and I come in with our bag of goodies and leave looking like heroes. There were several things that Greg was able to show the engineer on several pieces of equipment, but if the engineer had a service manual, he would have been able to handle the repair himself. That’s another common problem: medical equipment is donated to these hospitals but they do not come with operator or service manuals. Once the equipment breaks down, the engineer is forced to repair the equipment in the dark. [Assist International always provides manuals with any piece of medical equipment that we donate]

Still no suitcase but I went out and did a little shopping so I’m good for another day. I’m sure my bag will show up tomorrow…

Tuesday, November 3, 2009

This morning on our way out to the Peja Regional Hospital, we stopped by the airport to see if my suitcase arrived. Croatia Airlines has a website that enables you to track your missing bags. I discovered the site yesterday evening and saw that my bag was scheduled to be a flight that arrived late last night. I checked the website this morning and, though there wasn’t a confirmation of arrival, I figured it was worth a try. Thankfully, it was there.

Of course the thought arose in my mind, “If they have the technology to track a lost bag, wouldn’t it be better to employ that same technology before the bag gets lost?” I was just thinking.

Peja is a beautiful city surrounded by mountains, most of them covered with a thin layer of snow. It was raining and the clouds were low so we didn’t get the full impact of the beauty like I did the last time I was here. The hospital has some great views of the mountains and if I had to be sick in Kosovo, I would want to stay at this hospital in a room that looks out on these mountains.

Greg and I started working in the NICU. It is a well run unit with excellent staff. The unit is clean, the doctors and nurses are engaged, and the atmosphere is very positive. The equipment is suffering. Same story as yesterday’s hospital. The engineer and staff do all they can to keep the equipment functioning without spare parts and accessories. One example is they took an adult SpO2 sensor, cut it in half carefully, and then taped it around the infant’s foot so that it would work. It’s a $100 sensor. There are two very good patient monitors that wouldn’t work because the battery in each was dead. No way for the engineer to buy the batteries. His hands are tied. He has requested funding for the batteries for a couple of years now. Nothing. Two monitors are working but they only had some of the cables. I opened up the our supply case and pulled out two sets of ECG cables, two blood pressure tubing sets and four boxes of infant blood pressure cuffs. It was like Christmas.

Greg had an interesting experience with some new infusion pumps that had been recently purchased. The NICU director was ready to send them back because they kept giving the same two error codes. She wanted Greg to check them out. He watched them place the tubing, set the parameters and alarms, and then press the start button. Sure enough, after a few minutes the alarm sounded, the error message came up. The unit was obviously broken—the same with the other four units. Well, not exactly. The infusion pumps were delivered by the local distributor and he gave a quick five minute demonstration and then left the devices. Ten minutes after he left, the error codes started showing up. He never came back. Repeated calls were placed to come and service the equipment. The distributor claimed it was operator error but wouldn’t come and show how the operators were in error.

Greg watched the doctor set up one of the infusion pumps and within 30 seconds he knew the problem. It was operator error but they didn’t know that because they weren’t properly trained on how to set up the infusion pump. Greg spent 30 minutes doing an inservice with 4-5 staff (what should have been done in the first place), watched them as they set it up, gave them some pointers, and finally did a test run with all five units. No problems.

After we returned from Peja we were invited to a jazz concert featuring Nicole Henry from Miami Beach. There is a jazz festival in Pristina this week featuring nine different artists. She was very good and the pianist was excellent. It was a nice way to end the day.

Wednesday, November 04, 2009

I was awakened this morning at 2:30 by a call from a technician in Uganda who couldn’t find the driver sent to pick up from the Entebbe airport. While I am in Kosovo this week, Jim Stunkel (a long-time Assist friend and volunteer) is working with a team of GE technicians to install equipment at Mbrara Regional Referral Hospital and Kabuyanda Hospital in Uganda as part of the GE Global Health Initiative. The engineer had my number and so when he couldn’t find the driver he called me. As I’m talking to him he sees his name on a sign—the driver is indeed there to pick up him and his colleagues.

I didn’t fall asleep again until 5:30 AM only to be awakened by the alarm at 7.

We spent our day at the University Hospital in Pristina (UCCK) repairing medical equipment as well and assessing equipment and design considerations for a pediatric emergency unit and pediatric intensive care unit (PICU). We again experienced the frustration that the hospital biomedical engineers in Kosovo have to live with each day. On malfunctioning medical equipment the engineers know what the problem is and how to repair it. They are able to troubleshoot effectively on most things and figure out exactly what is needed to get a piece of medical equipment operational again. But if a replacement part is needed to repair the equipment, forget about it. The engineer has a better chance of buying a whole new piece of equipment than buying a part to repair it. I wish I was joking.

For example, in the UCCK ObGyn NICU department there are three infant incubators that require batteries. Each incubator costs about $8,000. Batteries run about $400 each. The biomed was able to order 20 new incubators for the hospital’s NICU departments (they have two NICUs) but has not been able to order batteries for the three units sitting in the corner room. The NICU is desperate for more incubators but getting three batteries will take a miracle. The biomedical engineer must first submit a bid request to three vendors since the part costs more than 100 euros. Once he receives these three bids he then submits the request to the procurement officer of the hospital. If there is funding available the procurement officer selects one of the vendors that submitted a quote and issues a requisition for the part. The part is then purchased. It seems pretty straightforward. The breakdown occurs in the bid request process. The hospital must use approved Kosovo businesses to purchase their parts. If the local businesses do not have the parts, the hospital engineer looks for the part in Europe and finds a vendor for that part. He then goes to the local vendor and suggests where the part he needs can be found in Europe. He cannot solicit a bid from the European company himself. He must use a local Kosovo business. But many times the local business have no interest in providing the part because it isn’t worth their effort for a few dollars in profit. They make a lot more money selling new pieces of equipment to the hospital. UCCK isn’t the only hospital experiencing this. Prizren and Peja also have great difficulty getting parts.

I realize that this is only one perspective and that the procurement office and local vendors may have another viewpoint. But based on my experience in March and what I’ve heard and seen so far on this trip, when it comes to obtaining parts it’s mission impossible.

So we were able to repair a few pieces of equipment with some parts and accessories that we had brought with us, but there is so much more that needs to be done.

Later in the afternoon I looked at a potential area for a pediatric emergency unit and then did a needs assessment in the PICU. I use the word PICU lightly since it was virtually devoid of any equipment whatsoever. I admire the doctors and nurses in this unit who are trying their best but lack even fundamental intensive care equipment such as monitors or infusion pumps.

Thursday, November 5, 2009

We visited the hospital in Gjilan this morning and were able to fix several pieces of equipment and train the doctors and nurses on a infant warmer that had been sitting in a corner not being used because it lacked a sensor, which I brought with me. We ran into the same issue with supplies and parts. The biomedical engineer knew the warmer needed a sensor but he could never get approval to purchase it.

Later in the afternoon we drove to the small town of Kacanik where two donated ambulances were being stored. These ambulances were donated by Northern Ireland and are part of the AIHA program to provide transport for critical newborns from the regional hospitals to the tertiary hospital in Pristina. Currently there is no way to transport infants that require special care from the regional hospitals to UCCK where more acute care can be given to the baby. If a baby needs to go to UCCK, the regional hospitals put them in a car or ambulance without the necessary medical equipment to transport the baby. Many times the baby doesn’t survive the trip to Pristina. These ambulances will be outfitted for transporting critical care newborns from throughout Kosovo to UCCK in Pristina.

After we finished measuring and detailing what the ambulances needed, Nazmi invited us for pasteries and tea at his home in Kacanik. It was a nice experience. His wife had made some bakalav, a local pastry that tasted wonderful. We sat in their living room that was heated with a small woodstove and talked about his time in Germany, his family, and his mother’s upcoming trip to Mecca. I had forgotten that Islam is the primary religion throughout Kosovo, but it is practiced differently than in other parts of the world.

Friday, November 6, 2009

We were in Gjakova today, which sits near the Albanian border. Visiting the hospital was a frustrating experience though we were able to repair a few pieces of equipment and train them on how to use some infusion pumps that were giving them problems. It was “déjà vu all over again.” Parts. Seriously, does it have to be this tough to get parts? Aren’t the hospitals and the Ministry of Health and the Ministry of Finance ever going to figure it out? The hospital has four very good engineers that are able to troubleshoot a problem on any piece of equipment down to component level. But when the engineer requests the part, he can’t get it. He’s frustrated, the doctors and nurses are frustrated, but nothing gets done. It’s beyond their control.

Another classic example. The Labor and Delivery department have a fetal monitor that isn’t working properly. One of the connectors is faulty and it is a relatively simple repair—once you have the part. But the department doesn’t want to give the unit to the biomedical department to fix until they have a replacement unit, after all, the fetal monitor could sit in the biomedical shop for six months awaiting the part. Good news though. The hospital has a brand new fetal monitor that the L & D department can use while their current unit is being repaired. There is a problem though—there always is—the new unit does not have any recording paper and they can’t get any. When the hospital ordered the unit from the local vendor, they ordered several cases of paper with the fetal monitor. But the vendor never delivered the paper because he couldn’t obtain it. So he delivered a brand new fetal monitor without paper and has never returned. And he was paid! That’s what really gets me. So the hospital is asking if I can get them some paper, so they can use this fetal monitor in the L & D department, so their current unit can be repaired. Unbelievable.

Of course we are glad to help all the hospitals with whatever supplies and parts we can. But it won’t solve the greater problem. We can repair everything that needs repair today, but next week, next month, there will be more equipment that requires parts or accessories.

5 days in Sudan

2009-08-31T11:06:00.000-07:00

Operations Vice President, Ray Schmidt spends 5 days in Sudan scouting a medical project on Aba Island, attending the dedication for the Dereige Primary School and getting eaten my mosquitoes.

Sunday, August 23, 2009 – Khartoum, Sudan

I arrived in Khartoum last night. The original plan was for my colleague, Steve Savelich, and I to travel to Sudan together to look at a potential hospital project and to commission a school in Darfur that Assist had built with funding from a generous donor. Unfortunately, Steve did not receive his visa in time. He was red listed/black listed and it will take a couple of days to work through that. Since I received my visa, I went ahead and traveled to Sudan and hoped that Steve would be able to join me Tuesday night.

Monday, August 24, 2009 – Kosti, Sudan

It rained last night. No, it poured last night. It was a first rate storm: thunder, lightening, strong winds, and buckets of water. I didn’t expect to experience this type of a storm in Sudan. The water was pouring through the ceiling into my room and I had to put out bowls to catch the rain. As we were driving out of town today we saw large billboards that had been blown over by the wind. I spoke with a man this morning who said he had never experienced a storm like last night’s. It was a good show.

I am being hosted by Dick Brogden of Aslan Associates, which is an NGO in Sudan that has partnered with us on previous medical projects in Sudan. Dick has lived in Khartoum for the past 14 years and speaks Arabic fluently and has an amazing understanding of the culture and the people of Sudan.

This morning we drove down to the South Nile Region, which includes Aba Island, Rabak (30 km south) and Kosti, which is across the river. We are looking at a potential medical project at the Abu Island Hospital. The island is about 35 km long and 3 km wide and has about 100,000 residents. There is remarkable history to the island dating back to 1870 when the first mahdi came to the island to seek Allah. He was a religious/revolutionary figure that led a revolt against the British that ended in the defeat of General Gordon. Aba Island is considered very important and sacred in the history of Sudan.

The Aba Island Hospital is a small hospital of around 80 beds and is the only hospital on the island. We were warmly welcomed by the hospital director and some local officials. As we toured the facility, I noticed that there we very few patients. I asked the director why there were so few patients and he informed me that the hospital is actually closed for renovation. The outpatient portion of the hospital was still open and there were also a few patients that required close attention. The renovation should be completed by the end of September.

The operating rooms had just been redone with new floor tile and paint. They were in very good condition, but the equipment was old. The two operating tables dated back to the 1950’s. They do not have anesthesia machines and so patients are put to sleep using the old hand applied method. The hospital needs a lot of help and I hope that we will be able to provide assistance in some manner.

Tuesday, August 25, 2009

We went back to the hospital this morning to ask a few more questions and to meet with some additional hospital staff. Yesterday, a local politician had taken the tour of the hospital with us and every time we asked a question he would give us an exaggerated answer. So we went back to get real answers to some of our questions. It went very well and I think that we could help this hospital improve the quality of healthcare that it provides.

A professor from the medical university next door to the hospital took us on a short tour of the island. We visited the site where the mahdi had dug a hole in the ground and spent time praying and seeking Allah. There is a small mosque built over it now. People will come and take a handful of the soil from the hole, and pour it over themselves or family members, believing it has healing power.

Later in the evening, Dick and I went to the Khartoum airport to pick up my co-worker, Steve Savelich. We had Steve’s visa and had to deliver it to the passport control office prior to Steve's landing. The security had us sit down and wait for someone to walk us to the passport control office. This is a fairly new procedure and the sole purpose is raise money for some official. For this walk to the passport office it costs about $10. Previously you could just walk to the office on your own. We sat in the waiting area for 45 minutes and Steve’s plane was to land at 10:35 PM and it was 10:40. Dick asked me if we should go on our own. Sure. Why not? And so we walked confidently to the passport control office without being stopped and questioned. The plane was late and so we sat in the office. One of the officials gave us a glass of cold tea and we chatted awhile. After about 30 minutes, the original security guard who had told us to wait found us and he was angry. He marched us out of the office back to the original waiting area and he threatened to call the police and so on. I don’t understand Arabic but Dick and the guard had a nice conversation after which he finally settled down. A couple of minutes later, he let Dick walk back to the passport control office—on his own.

Wednesday, August 26, 2009 – Nyala, Darfur, Sudan

I woke up this morning to pouring rain. It was raining as hard as Sunday night. Unbelievable. I’ve been in Sudan for four days and each day it has rained, at least a little. No one was in the streets. Standing water reached at least two feet in some places.

That morning, Steve and I were scheduled to depart for Nyala, Darfur at 11 AM, but Steve first had to register his passport and get a travel permit for Darfur. Normally it takes a couple of days, but a friend of Dick’s was able to get it done in two hours. We arrived at the airport (still pouring rain) and waited for the airline to open the desks so we could begin checking in. Around 11 they opened the desks and there was rush for the desks. No lines, no aisles, just a mass of people streaming to the desks with tickets in hand trying to get the attention of the agent. There was no rhyme or reason on whose ticket was processed. The agent would look up and grab one of the tickets being waved in front of his face. Meanwhile it is still raining outside but there’s water coming through the ceiling tiles into the room.

We finally received our boarding passes and then waited to depart. The 11 AM flight finally left at 3:30 PM and we arrived in Darfur around 6 PM. Steve’s suitcase didn't arrive and since he is 6’6”, my clothes wouldn't fit him. Surprisingly, Nyala isn’t too hot. It’s actually pleasant with temperatures in the high 80’s with minimal humidity.

Thursday, August 27, 2009 – Nyala, Darfur, Sudan

It was a rough night. I spent most of the night batting mosquitoes and flies. There was no mosquito net so I just had to make the best of it. I woke up this morning and there was little blood spots on the sheet from where I had killed mosquitoes that had been banqueting on my blood. I then looked at my feet and they were covered with red spots. There were hundreds and hundreds of little red dots that went from my toes up to my shins. They kind of look like freckles or like someone had spattered red paint on my feet. A little while later the red dots started to get white circles around them. Very bizarre. I was told that they are all mosquito bites. I guess I was the main course last night for hundreds of mosquitoes.

We went out to the Dereige Community Primary School for a school dedication ceremony. This was a school that Assist built with funds from a generous donor and through a local organization called EDOOS. What an experience. As soon as we stepped out of the car the students surrounded us and started shaking our hands. I think I shook the hands of every student two or three times. Then the students started giving the thumbs up gesture. It was a lot of fun. The dedication ceremony was nice and the students, teachers, local officials and the sheiks expressed their gratitude.

The Dereige school sits on the edge of an IDP (Internally Displaced People) camp of about 30,000 people outside the town of Nyala. The three classroom buildings are for grades 1 through 4 and plans are in place to add the 5th grade next year. The parents and the community were so effusive with their thanks.

Scary Flight for Assist International Communications Vice President

2009-08-19T11:11:00.000-07:00

Steve Savelich, the Communications Vice President of Assist International expected some adventure when he joined the Assist team last Spring, but he didn't expect dramatic emergency plane landings.

Steve and his wife Jan were coming home from a successful trip to Jinja, Uganda, where they joined other Assist members and GE medical staff in installing a state of the art ICU monitoring system in the Jinja Regional Referral Hospital.

It had been a long and emotional draining week for the Savelichs. In addition to outfitting a medical clinic, they helped hand out new pairs of shoes to 2,500 orphans through AOET (donated by Soles4Souls) and distributed shoes to 400 former LRA "girl soldiers" (abducted for sex slaves) and their 150 children at an IDP camp.

"The extremes in hardship and the overwhelming need is still very fresh in my mind," said Steve. "We met with former girl soldiers and their children who were trying to put back together their lives after escaping from the LRA. These young women are just like you and me who are trying to live out their lives as caring and productive people," he said.

United Flight 949

The Savelichs, reflecting on their trip, began the long journey home to Ripon, California. In London, they boarded United flight 949 bound for Chicago. Steve was excited they were seated in the exit row, which meant a little more room for his 6'8" frame. Maybe he would even get a little sleep.

About 2 hours into the flight, people could smell something burning. It was an electrical fire and smoke began to pour out of the cockpit.

According to the first captain, the pilot's were having a hard time breathing and could not see the controls. They had to use their masks to help them guide the plane. The electrical circuits for everything on the airliner is located under the cockpit and the worry was that the fire would cut the wires that control the hydraulics.

The passengers noticed that the audio and video system went out very quickly with a 'pop'. The pilots began to check the flaps on the wings.

One man later said that no one on the flight was too worried until the PA system was left on (the pilots could not see the switch to turn it off), and they heard, “we need to get down now.”

There was an announcement from the crew that they would divert the plane to Iceland. No one was sure if this was to be a ground or a water landing.

"I didn't know if we'd make it to land or if we did that the landing gear would work," said Steve.

"I thought about Paul and his prayer on the ship and prayed in a similar vein."

Being located in the exit row, Jan and Steve were called upon to get ready for action. The steward took them through the emergency procedures again. People began to gather their passports and other valuables and put them in their pockets. Some figured it was for body identification, others were hoping to use them again to get out of Iceland.

The plane decreased in altitude and the passengers and crew could began to see Iceland in the distance. The entire plane exhaled a giant sigh of relief when the plane came to a halt on the runway. Surrounded by fire trucks and emergency vehicles, every one walked off the plane shaken but uninjured.

"I know that men far better than myself have gone down in plane crashes, but God who is merciful to the poor and pathetic had mercy on me and on all who were on the plane," laughed Steve. "It was quite an experience and of course, the upside is we've been to Iceland."

Read news story here.

Another first hand account of United flight 949 here.

Kigali, Rwanda

2009-04-16T12:35:00.000-07:00

Saturday, April 4, 2009
By Ray Schmidt

It’s good to be back in Rwanda, the country of a thousand hills. I’m here as part of our partnership with GE and the Developing Health Globally project. This is our second phase in Rwanda and it will involve donating and installing medical equipment to six hospitals throughout the country, and providing training to hospital personnel. Our first two sites were completed last year at Nyamata and Mayange.

This week I will be working with a team of GE medical technicians and application specialists at hospitals in Rwamagana, Kibungo and Nemba. But first the equipment needs to get out of customs, so I came a few of days before the rest of team to make sure the equipment gets delivered to the hospitals in time. Because of various factors, the shipping and installation timelines are very close, and we had to ask the Ministry of Health if they could accommodate us on this short notice. They assured us that they could work with our schedule and make it happen.

So, I’m sitting in the car at the cargo area of the Kigali airport waiting for Primo from MOH to arrive with the trucks. He keeps saying he will be here shortly but my driver, John, and I have been waiting for over 90 minutes. I’ve finished my paperback fiction about the search for Alexander the Great’s body and the discovery of the cure for AIDS/HIV (yes, in the same book), a TIME magazine that declares that crisis is good for America, and a Sports Illustrated that featured the NCAA Sweet Sixteen (and a good article on Gonzaga University and their coach, Mark Few, whom I played against during high school).

The excitement of humanitarian work is always preceded by the minutia of shipping documents, customs clearance, trucking, and that always involves a healthy dose of waiting. Yesterday, John, Primo and I were at the main customs office in Kigali waiting for a couple of signatures. Primo was guiding the shipping documents through the various offices while John and I stood by, waiting. John is also my translator, well sort of. He speaks English better than I speak French or Kinyarwanda (the national languages of Rwanda). I would occasionally say something just so I could justify my presence at the Customs Office and John would faithfully translate, though I can’t vouch for the accuracy of the translation since many of my simple questions would lead to lengthy discussions between the various parties and so I finally stepped out into the lobby and let Primo do his work without my interference.

We were down to a final signature needed for a customs waiver but it would take a couple of hours to get that. John drove us to a little roadside café that featured a few plastic round tables and matching plastic chairs. It was sunny outside so we took a table under an awning. Good thing. Halfway through my second Coke the skies opened up. Raindrops the size of jawbreakers bombarded our covering, which promptly starting leaking. We retreated further into the little shop but the rain didn’t relent. We waited and waited for the rain to subside at least a little, but it was not about to quit. One of the waiters pulled out a large table umbrella and walked us to our car, but we were still drenched by the time we got to the Toyota.

I think my soaking elicited some sympathy from Primo—kind of how a wet dog looks so pathetic that you can’t but feel sorry for it—and he suggested that I go back to the hotel and he would call me when he received the final signature. I gladly agreed. After two hours Primo called with the news that all the paperwork was done and we could pick up the equipment on Saturday.
And now it’s Saturday and I’m waiting at the airport…

Primo finally did arrive with the trucks and they were loaded and on their way to the hospitals. The Rwanda Ministry of Health and their people did a great job and now we are set to begin the installation.

Sunday, April 5, 2009

A couple of days before I left for Rwanda, our office was informed that Tuesday, April 7, was a national holiday commemorating the genocide that occurred in 1994. It was too late to reschedule the trip and so we would have to work around that. That means we had to work at one of the hospitals today. Only one GE tech is here but we actually were able to install all the equipment at Rwamagana District Hospital and Kibungo District Hospital. It was a long day but I’m glad we were able to get it done.

Monday, April 6, 2009

We worked at the Nemba District Hospital today installing what equipment we had. We were missing four packages of equipment including the monitors, ultrasound, and infant warmer. I drove back to Kigali and went directly to the airport to see if the missing items were still in the warehouse. I met the company’s agent and she was reluctant to let me go in the cargo warehouse but I informed her that the offices of the cargo company in Amsterdam were blaming Kigali for the missing pieces. It was a small warehouse and in a few minutes I determined that our items were not there. I called the company’s office in Amsterdam and they insisted that the items were not in their facility. They had gone through their warehouse three different times and could not find any of the pieces. They said they would put out a worldwide search notice for the missing pieces.

The items were trucked from our warehouse in California to Atlanta. They were put on an aircraft and off-loaded in Amsterdam. A day or two later we received notice that all 21 of our pieces were on board a plane headed to Kigali. We gave the GE team the o.k. to travel to Kigali since all of our items were in route.

Later this afternoon I received an email from the cargo agent in Amsterdam. They found our equipment—in their warehouse. They were going to try and put our items on another carrier since they only flew into Kigali once a week, on Saturdays.

Tuesday, April 7, 2009

Today was a holiday marking the anniversary of the genocide. It’s hard to fathom that in 1994 nearly a million people were slaughtered in 100 days. The previous times I have been to Rwanda I visited different genocide memorials around the country. They were packed with bones, separated into skulls, arm bones, leg bones and so on. You could see where a machete whacked through a skull or where a bullet entered and departed someone’s head. You saw the cut marks on arms where people tried to protect themselves from the machetes. It is a vivid reminder of man’s cruelty to man.

Wednesday, April 8, 2009

Yesterday is still a blur. I got up and headed out with the team for Rwamagana. A few minutes from the hotel I had my driver turn around and take me back. I went back to my room and was sick the rest of the day. Sick like a dog sick. I’ve been traveling with Assist International for nearly 12 years and have never been this sick. I guess people had tried to call me throughout the day and I think I recall the phone ringing, but at times I thought I was delirious. Not a great way to pass the day.

Thursday, April 9, 2009
Kibungo

Today we were training the hospital staff at Kibungo District Hospital on the newly installed GE medical equipment. Rose Lesobre from Paris began training on the ultrasound, then moved on to the fetal monitor, patient monitors, incubators, and the infant warmer. Rose told me later that the hospital has an infant mortality rate around 15-20%. I corrected her and said 15-20 per 1,000 births—right? No, they had told her that the mortality rate is around 15-20%. Yesterday when Rose was at Rwamagana she was told that last year the infant mortality rate was 30%, but they brought on a new doctor and the rate is now at 20%. Those are incredibly high numbers.

A big part of the training involves using actual patients. Pregnant women were scanned with the ultrasound. A mother in labor had the fetal monitor on her, monitoring the baby. The vital signs monitors were put to use on patients. As Rose was training the staff on the new incubator, a newborn was brought in and handed to her and she slipped the baby in the incubator and continued with her teaching. By being hands on with real patients, it makes the hospital less fearful of using the equipment. One area of concern is no one on the staff is familiar with fetal monitoring. They now have a fetal monitor; they know how to hook it to the patient. Now they have to be able to interpret the information generated by the fetal monitor. It’s something that will have to be addressed.

I spent some time in the hospital’s sterilization room assembling an incubator cabinet. The radio has been playing all morning and all the songs were about the genocide of 1994.

Never, never, never again,
Let us keep alive, the memory of genocide.

A man working in the sterilization room told us that these songs have been playing all week as part of the genocide memorial activities.

Friday, April 10, 2009

It’s been a good week in Rwanda but I’m also glad to be headed home. I left Kigali this morning and have a layover in Nairobi. Overall, things went well in Rwanda. The equipment we installed and training that was given will save lives. There’s no doubt. Several images stand out in my mind:

Two babies packed into a single incubator
A pregnant woman seeing her baby for the first time through the magic of ultrasound.
The Kibungo Hospital biomedical engineer excited about all the new equipment he is now responsible to maintain.

I appreciate the efforts of the GE team who put in some very long hours to make up for the day that we lost to the holiday. Mohammed, Sameed and Rose were great and I look forward to working with them again.

Ray

Kisumu, Keyna

2008-11-12T15:55:00.000-08:00

In September, we were working at the Yala Sub-District Hospital in Siaya Region, Kenya, the home to Senator, now President elect, Barak Obama's father. This area is proud of their native Grandson, as they should be.

While working there we met a young abandoned boy, also named Senata Obama (they do not pronounce the r), named by the hospital staff that care for him. He is about 2 and a half years old and sleeps in the children's ward at night and hangs out near the kitchen during the day where he is able to get food from the cooks.

While we worked, he watched us and played around the job site. Levi Culbertson, one of our volunteer workers from Los Angeles had taken a special liking to the young Senator and carried him around a lot.

We are working on getting him adopted, either to my own family or to Levi's here in the U.S., but process is extremely difficult. It looks like he will actually get adopted by Joseph and Agnes Twoli who run the Aid Orphan Education Trust, organization in Kenya. While they work with orphan children, they will actually adopt him to be there own son.

Joseph and Agnes lost a boy in child birth about 6 month ago, so they have a hole in their heart and family made just for this young boy. We at Assist International will be following up to make sure the process doesn't stall due to a lack of funds and that Senator Obama has a great future.

How can he go wrong with a name sake that has set bar so high?

Tim

China: The Ceremony

2008-05-27T11:05:00.000-07:00

May 15th

By Ray Schmidt

Ceremonies are a big part of Chinese culture. The ceremony for the CCU project proved this in spades. According to the program, the ceremony activities would begin at 8:48 AM and be completed at 10:28 AM. The number eight is very significant—I think it symbolizes success or good fortune or something.

So the ceremony began right at 8:48 AM in the large community square in the center of Taojiang. It’s difficult to describe the scene. There were banners, arches, flowers, music (including Elvis), VIPs and crowds of people. It really was a grand affair as far as ceremonies go. Everyone was very appreciative of the equipment that was donated and installed, as well as the training that was provided.

Following the ceremony in the center of town, people were transported to the hospital to view the equipment. This is always a fun part of the program. The doctors and nurses at the hospital share the details of the equipment with the VIPs, the press and all the other visitors. You can see a real sense of pride—this is their equipment and it is the finest equipment around.

For all the success of the project, the devastating earthquake is what sticks in my mind. As I’m writing this the death toll is over 25,000 and the hardest hit region is just now being reached by rescue workers. Dr. Zheng was able to get on a flight to Chengdu this evening and will soon be with her husband and parents. I don’t know how she made it through the past several days, but she did and her efforts will long be appreciated by us and the hospital staff.

China: Installation

2008-05-15T10:52:00.000-07:00

May 14th,

By Ray Schmidt

The earthquake in China has now claimed over 12,000 lives. It’s an odd feeling to be here in Taojiang, 600 miles away from the epicenter of the quake, and it’s as if nothing catastrophic has happened. The streets are crowded, the hospital is a hive of activity, and we are continuing with our installation. Qing was finally able to contact her husband in Chengdu and he is alright. None of her family or friends was hurt by the earthquake.

Today we wrapped up the installation. We converted all the monitors to the Chinese language, tested them, and connected patients to the equipment. The new ultrasound was immediately put to use on twenty patients yesterday. The installation has gone very smoothly.

A group of Rotarians from California arrived today and visited the hospital. They represent Rotary District 5170, which encompasses a large part of the Bay Area. Rotary Clubs from that district sponsored this project and we were glad to show them what their support has brought about. The Taojiang County Hospital is one of the smaller hospitals in the region and there were some questions about why this particular hospital had been selected. One reason was that the hospital had a real need. It was a neglected hospital, largely ignored by the Ministry of Health, and it needed the medical equipment we could provide. The hospital also serves a large population of poor individuals. This particular region of China is isolated from the economic boom occurring in other parts of the country. The hospital also has a strong group of doctors and nurses that would be able to utilize the medical equipment. All these factors played a role in deciding to help this particular hospital.

Armin (pictured) has made a real effort to learn as much Chinese as possible. It’s an incredibly difficult language, but he’s been working at it everyday. His attempts at the language have been a good source of humor for the locals, who burst into laughter whenever he tries a new word or phrase, but then they quickly come to his aid and encourage him.

China: Earthquake

2008-05-14T11:17:00.000-07:00

Monday, May 12th
By Ray Schmidt

I didn’t feel the earthquake, nor did Armin or Qing. Several people at the hospital felt a shaking but nothing major. Back at the hotel, Bob and Charlene Pagett, felt the earthquake in their seventh floor room and quickly went downstairs and left the building along with the rest of the hotel’s guests.

Qing was particularly worried since her family lives in Chengdu, which is about 60 miles from the epicenter of the earthquake. She tried for hours to reach her parents and her husband. At dinner she was able to reach her mom and then her father who are both safe, but I haven’t heard if she’s been able to reach her husband.

The earthquake is about 600+ miles northwest of Taojiang.

Taojiang, China

2008-05-14T11:03:00.000-07:00

Sunday, May 11th
By Ray Schmidt

I arrived last night in Taojiang, China along with the rest of the AI team. Taojiang is a city of 830,000 residents located in the Hunan Province. This morning we began working at the Taojiang County Hospital. We are installing a 6-bed patient monitoring system with central station in the hospital’s Cardiac Care Unit (CCU), a 6-bed step down monitoring system, and an ultrasound.

The first action item for the day was meeting with the China Customs officials to go over the donated equipment. The customs officials agreed to not inspect the contents of the shipment until we arrived to unpack the items. We’ve had problems in the past where our shipments our inspected at the airport and we lose one or two pieces somewhere between the airport and the hospital. Not only did the customs officials agree to do their inspection at the hospital with the medical team present, they agreed to do it on a Sunday. This was very kind of them and enabled us to begin work right away.

The lead engineer on the project is Armin Sohrabil from Union City, California. He is a field service engineer for GE Healthcare and this is his second trip with Assist International. Armin is a great worker who adapts well to whatever situation we encounter at the hospital. He also relates well with the local hospital personnel and the rest of the team.

Our trainer is Dr. Qing Zhang (pictured above, left), a cardiologist from Hong Kong. In 1999 Assist International installed a patient monitoring system at her hospital in Chengdu, China. She learned the equipment quickly and by the end of the week she was training others in the hospital. Several years later we asked her to be our lead trainer for a project in Ili Kazak in western China. Naturally, we thought of her again for this project.

The project is being sponsored by the Santa Cruz Rotary Club, Rotary District 5170 and Rotary International.

The installation phase went very quickly since we had six workers from the hospital helping to mount the monitor brackets and string cable. There was also very little activity in the hospital because it was Sunday and we were able to work very quickly. By the end of the afternoon we had finished all the cabling and mounting the monitors.

Chile: One Last Item

2008-03-18T15:32:00.000-07:00

We returned to the Dr. Lautaro Navarro hospital (pictured) late Saturday night after two days of relaxing in the mountains of Patagonia. The power supply for the central station came in and so we went down to install it and get the second central station up and running. It took only a few minutes to install the power supply and another few minutes to configure the central station. This now gave the hospital two central stations that would enable them to expand in the future.

And so ends another medical project. This was a great project. The hospital was wonderful. Our hosts, the Punta Arenas Rotary Club, treated us so well. The doctors and nurses were exceptional. There is no doubt in my mind that this equipment will serve the hospital well for many years. Not so much because of the equipment, but because the hospital personnel are truly outstanding and will be able to fully utilize these monitors for many years to come.

I have to add one more note on this project to Chile. Our bus driver, Sergio, was terrific. He would pick us up at any time during the day or night and deliver us to wherever we needed to go. Even last night when we called him to pick us up from the bus station (we were returning from our trip to the mountains), and take part of the group to the hotel and then some of us to the hospital. So at 9:30 PM he met us, and his daughter, Joseline, was with him. We met her several times before, but yesterday was a special day for her. It was her 13th birthday and when we found out we sang 'Happy Birthday' and that made her laugh. I can’t fault her for that—it was pretty bad.

So this morning, Sergio and Joseline met us at the hotel for our drive to the airport. Sergio shook each of our hands and seemed very emotional. After we got on the bus he presented the team with a gift—a large wood carved penguin. It is the first time that I have ever received a gift from our driver. It was quite humbling.

Chile: Show and Tell

2008-03-18T15:30:00.000-07:00

When we first walked into the unit on Saturday, I was a little surprised to see the condition of the unit. The walls were dirty, the paint was peeling and the floors were a mess. But today when we walked into the CCU it had undergone a transformation. The hospital workers had been up most of the night painting the walls, bringing in beds and putting new sheets and pillows on them. It was beautiful.

We spent a few more hours training and then helped get the CCU ready for the opening ceremonies. At 3 PM the CCU was opened and it seemed that most people were pleased with the results. In particular, Dr. Berr, a Professor of Cardiology at the University of Chile Teaching Hospital in Santiago, who began the heart program in Punta Arenas, was impressed with the equipment that had been donated and installed. He began a cardiac program at Punta Arenas 15 years ago when everyone told him that it was impossible. Against all odds, he recently performed the first open heart surgery in Punta Arenas. I had the opportunity to speak with him at length and he kept saying that we don’t realize what kind of impact this CCU will have on the whole region. Rob Busby, our lead engineer, showed him all the features of the monitors and the central station. He was especially excited about the telemetry monitoring system, which he did not know was being installed. His comments made the whole team feel great about what we had done.

After a few newspaper and television interviews, we were done—well, almost. We still had one midnight dinner to get through, which turned out to be a wonderful time.

Chile: Wrapping Up

2008-03-12T16:07:00.000-07:00

We wrapped up the installation by noon today. Everything is running great and the director of the Cardiac Care Unit (CCU), the hospital director and everyone else involved are thrilled with the results. The nurses from the adjoining ICU are asking if they can have some of the monitors placed in their unit. They have four different monitors in the ICU and none of them are connected to a central station. They really like the capabilities that the monitors and central station offers. Training continued for the nurses and several doctors. We also began training the biomedical engineers.

Tonight was a large dinner given by the Punta Arenas Rotary Club. It was a formal affair in an old 19th century home that had belonged to a large sheep rancher who had over a million sheep at one point. It was a very ornate building and seemed out of place in Punta Arenas. We arrived at 9 PM but dinner wasn’t served until 10:30 and we didn’t get back to the hotel until after 1 AM. These late dinners are brutal but the team is handling the late nights well enough, although we could use more than 5 or 6 hours of sleep.

Chile: Training

2008-03-12T14:48:00.000-07:00

Ray Schmidt

The installation in Punta Arenas, Chile slowed down a bit today since the hospital administration had to make some decisions about the location of the telemetry system. The original plan was to have it on the first floor but when they fully understood the capabilities of the telemetry system, they opted to place it elsewhere.

Like any hospital, the decision had to work its way through the channels before the final location was determined. This process took most of the morning, but after lunch we were installing the telemetry antennae.

Pam began training the nurses and doctors today with Teresa interpreting. I always enjoy this part of the project because it always brings about an air of excitement. The hospital staff begins to realize that this equipment belongs to them. It’s interesting to watch some of the nurses that really get into the training and then begin to show the other nurses how to operate the monitors.

One of my standards for success on each project is to find 2 or 3 nurses that really excelled at the training. If I have that, I know that a “train the trainer” type program will continue at the hospital.

The level of experience and knowledge displayed by the nurses was very high. They were asking about some of the sophisticated features on the monitors—features we normally don’t cover in our training. But they were very knowledgeable and eager to learn every aspect of the monitors and central stations.

The central station issue still hasn’t been resolved. We blew the power supply the other day and though we were able to find one in town, it did not quite work properly. So I had one sent out today from California and it should arrive on Friday. We were able to put all the monitors and the telemetry system on a single central station, so the second one will be used as a backup.

______________________________________________________

March, 1

It’s not the end of the world . . .

We made it to Punta Arenas! We arrived at 9 AM, checked into our hotel, had breakfast and made it to the hospital by 11 AM where we were greeted by the hospital staff. We had thought about grabbing a quick nap before going to the hospital, but there were a number of hospital personnel waiting to greet us. So, after sleeping only a few hours on the plane trip, we headed right to the hospital.

The Dr. Lautaro Navarro Avaria Hospital in Puntas Arenas is the primary public hospital for the region. Puntas Arenas is isolated from the capital, Santiago, with no roads and ice packs that make it impossible to get to the capital without traveling through Argentina by car, or flying out of the region by plane, or boarding a ship. If a person needs critical and immediate medical care, it costs $40,000 to get him from PA to Santiago by an emergency plane. It is the southernmost city in the world. It’s not the end of the world, but you can almost see it from here—Antarctica is only a few hours away by plane.

Heart disease is very prevalent in this region because of the poor diet, sedentary lifestyle, and other factors and the hospital is in need of medical equipment for a Cardiac Care Unit (CCU). That’s where we come in. By partnering with the Rotary Clubs in Los Gatos and Puntas Arenas, Assist International is able to provide 19 patient monitors, a central station, a telemetry monitoring system, two ventilators, one cardiac ultrasound and 12 pallets of miscellaneous medical supplies.

So today we began the installation and made excellent progress. We had lots of help from the hospital personnel and we were able to unpack everything and get almost everything assembled. My son, Christian, did a great job as well. I figured he would be so tired that he wouldn’t be much help, but I was wrong. He worked relentlessly assembling roll stands and pitching in wherever he could until we were done for the day.

But our day didn’t end there. We returned to the hotel, slept a couple of hours and then headed to a dinner hosted by the Puntas Arenas Rotary Club. They eat very late here. We arrived for dinner around 10 PM and didn’t finish until after midnight.

______________________________________________________

February 28th,

Leaving on a Jet Plane…eventually

Today a medical team from Assist International departed for Puntas Arenas, Chile, but not without a few glitches.

The medical team included Pam Finger, a registered nurse from the Palo Alto Medical Foundation, Teresa Reyna, Director, Program and Operations, Guest Services, from Stanford Hospitals, Rob Busby and Duane Kellogg, medical engineers from Philips Medical Systems, my 12-year-old son, Christian, and me. Rob and Duane flew out separately and were to meet us in Miami. The rest of us flew out of San Francisco, but our flight was delayed. The flight was first delayed for 15 minutes and then 30 minutes. Then a tire had to be repaired and that delayed the flight another hour. At 2:00 PM they boarded us on the plane (90 minutes late). At 2:45 we were told that we could exit the plane if we’d like because the tire repair still had not been completed. Finally, at 4:10 PM we departed and there was no way we would make our Miami to Santiago, Chile flight.

We arrived in Miami only to find out that the crew for the Miami to Santiago flight never showed up and so they delayed the flight until the next morning at 10:30 AM. That meant that Rob and Duane were also stranded in Miami. We made it our hotel around 2 AM and then returned to the airport around 9 AM for our flight to Santiago. We arrived in Santiago, Chile, around 10 PM and by the time we finished getting our visas, arranging flights for Punta Arenas, and driving to our hotel it was almost 2 AM.

The airline (which will go unmentioned) paid for us to stay in a 5-star hotel in downtown Santiago. We wanted to take advantage of this but, in what can only be called a cruel irony, we were able to stay in this plush, luxurious 5-star hotel for a mere two hours. We checked in at 2 AM, napped, showered and then left at 4 AM so that we could catch our 5:30 AM flight.

I must hand it to the team though. They were upbeat, positive and anxious to get to Puntas Arenas, in spite of all the hassles that we endured thus far. Nothing like traveling with a good team.

It's Good To Be Home

2008-03-06T10:32:00.000-08:00

Tim Reynolds

I just got back from Honduras on Saturday night. It was like a time warp, the same group of kids were sitting on my couch watching movies as were on my couch watching movies when I left one week before. (And they weren't my kids, that would be normal).

Monday we went to Yosemite and snowshoed around the valley floor. It's good to be home. We're blessed to be in America.

Actually Honduras was nice, hilly, and the weather was perfect. It was nice to be Central America, actually it was nice to be anywhere other than Africa for a change since I have been going to Africa on a regular basis for the last four years.

One interesting thing about Central America was that they speak better English in Africa than they do in Central America. I kind of enjoyed it actually as I have always had a warm spot in my heart for Spanish speaking people. I enjoy speaking the language and have fancied myself a Spanish Speaker for many years now. Based on the smiles I get when speaking Spanish, everyone else seems to enjoy it also.

I remember my Honeymoon in Mexico. Trying to impress my new bride, I ordered a pizza with extra bones (You know, Queso vs. Hueso). Hey, what's a letter or two among friends? I'm sure worse mistakes have been made (Some of them by me). Like the time I kissed the Minister of Health in Afghanistan on national T.V. and started a national scandal. You should have seen them confiscating T.V. cameras. I found out that following the lead of others is a good way to adapt to new cultures, unless the "others" happen to be women and your a man. Such is the life of a humanitarian.

On a more serious note, it is a privilege to be involved in helping others. In Honduras we poured two concrete pads that will receive water treatments plants for hospitals in La Esperanza and Gracias Limpira. Both are nice communities that just need a little help. The water treatment plants will ensure safe drinking water for all the in patients at the hospital. Imagine going to the hospital for a simple treatment and getting sick from the water. Not a good thing. Like I said, it is a simple pleasure to be helping others.

Like the old biblical adage says, It is better to give than to receive.

Until later,
Tim

Chile: Power Supplies, Penguins and...Pink Flamingos?

2008-03-06T09:51:00.001-08:00

Ray Schmidt

We slept in until 8 AM today, but I could easily have gone another couple of hours. But there was work to be done. Our goal was to get the CCU monitors connected to the central station and then take part of the afternoon off to go see some penguins. We got all the monitors installed, all the wiring done and connected the monitors to the central station. In the picture (above), you see Teresa Reyna, the Program Director for International Guests Service, Michael Picchetti, one of the Logistics Coordinators for the project and my son Christian helping with the installation. We tested the first central station and everything was fine. We then hooked up the second central station and plugged it in.

Pop!

We all knew right away what happened. We blew the power supply on the PC. We failed to switch the unit to 220 volts. It was a simple mistake and all of us knew better. We had switched everything else to 220 volts, but we missed this one. However, the hospital engineer is confident that he can find a replacement power supply tomorrow. We’ll see.

Our day at the hospital ended on this sour note and none of us felt too good. We headed to a penguin reserve that was a little over an hour away. I always pictured penguins surrounded by snow and ice, but these penguins lived in lush green conditions near the ocean. The penguins live in burrows that they dig into the tundra. On our way out of the park, we spotted some birds standing in a lake several hundred yards away. It was hard to determine what they were but they sure looked like pink flamingos, but that didn't make sense—penguins and pink flamingos sharing the same habitat. However, we did get confirmation that the birds were indeed pink flamingos and they do migrate here. I would never have guessed it.

The team is heading out to dinner in a few minutes. The hospital is hosting a dinner for us and they agreed to make it an early dinner—9 PM.

2008-03-06T09:46:00.000-08:00

Penguins in Chile

Honduras: Road Trip

2008-03-03T10:04:00.000-08:00

Ray Schmidt

I kept putting off this trip to La Esperanza and Gracias, the site of our two previous projects in Honduras. I needed to visit each hospital to make sure the additional equipment we had ordered had arrived, been installed and was functioning well for the hospital. In addition, I needed to check in to make sure the previous GE equipment that we had installed was working well for the hospitals. I was leaving for home tomorrow so the job had to be done today. I left at 6 AM this morning.

My fellow travelers included Freddy (the Driver), Oscar (the translator/guard) and Yolanda, an official from the Ministry of Health that had to inventory the newly received items. The first leg from Tegucigalpa to La Esperanza was a pleasant 3-hour drive made more pleasant by the fact that I slept almost the entire way. We arrived at 9 AM, visited with Dr. Amador, the director of the hospital, and then made our way around the hospital looking at all the equipment. Everyone is still very grateful for the equipment. I visited the laboratory first and they were thrilled with the new lab equipment—microscope, gas analyzer, centrifuge and a few other pieces. The chemistry analyzer will be delivered and installed next week.

Our departure was delayed by an hour but we left at 11:30 for Gracias—a 2-1/2 hour drive over some seriously rough road. Fred felt he had to drive especially fast to make up for lost time. After bouncing, jolting and shaking for two hours, we made it to Gracias and were met by Dr. Gavarette, the hospital’s director. We did a quick walk through and made sure all was functioning well. This hospital was also very grateful for the donations that had been made.

“We have been able to help three times as many people now with the new ultrasound given by GE,” said Dr. Gavarette. “Everyone is watching us now. People from far away are coming to this hospital because they have heard of the changes at this hospital and how we have new equipment.”

While in Gracias, the local TV crew came out to interview me. Since my Spanish consists of eleven words, I said that we would need to use Oscar as the translator. The reporter asks us a question and Oscar takes the microphone, but instead of translating the question, he talks for about two minutes answering the question himself. The reporter asks another question and Oscar does the same thing. By this time, Dr. Gaverette is poking Oscar in the side and pointing to me. I’m laughing off-camera because Oscar was really getting into it. He is a very passionate guy and he just kept talking. I still don’t know what he said but he sure enjoyed being on TV.

As we drove back to Tegus, we watched the lunar eclipse. It was quite a spectacular sight. About two hours from Tegus, Oscar found a radio station that played American hits from the 70’s and 80’s. All four of us were in the early 40’s and so these were songs that we grew up with. I was surprised how many songs they knew—well, they at least knew the tunes and some of the words. On every song they would ask me what some of the words were because they hadn’t figured them out. It was a great time singing these songs and trying to remember the artists who performed them. It really is a small world.

Honduras: Installation Begins

2008-02-28T12:56:00.000-08:00

Monday, February 18th
Ray Schmidt

The 7-member GE team arrived yesterday and this morning we headed to the hospital to begin the installation. Over 100 pieces of medical equipment had been taken to the 5th floor where the neonatal unit is located. The unit was so packed with equipment it was difficult to move around for a while until we unpacked the equipment and cleared out all the packing debris.

We actually have a 9-member team if you count Oscar, our driver, guard and translator. Oscar is very eager to help wherever and however he can. He not only drives me around or translates, but at the hospital today he worked until he was exhausted. He unpacked crates, cleaned up all the packing materials, ran errands, and anything else he could find to do.

He kept saying, “You help my people and I want to help too.”

Honduras: Medical Equipment Carcasses

2008-02-28T12:44:00.000-08:00

Sunday, February 17

Ray Schmidt

I was down in the basement of the Escuela Hospital (pictured) when I came across a hallway filled with broken medical equipment. The halls were lined with infant warmers, incubators, anesthesia machines and other medical equipment. I know some of the equipment had just reached the end of its life and was being used for spare parts. But some of the equipment had been donated by well-intented organizations and individuals without being checked out before shipment.

In my ten years with Assist International I have seen many such hallways of equipment carcasses. Sometimes the equipment does not work in the first place; sometimes none of the accessories needed to use the equipment were provided; sometimes manuals were not provided and no one knew how to use the equipment. There are many reasons but the result is the same: disappointed hospitals that thought they would be getting equipment that would really help their patients but now just have a hallway filled with useless pieces of metal and plastic.

Assist International will only donate new or fully refurbished medical equipment and then we install it and warranty it for a full year—though we usually continue support long after that period. One of the great things about partnering with GE on medical projects is that the equipment that is donated is new. The equipment is then installed by GE technicians and training is provided by expert GE clinicians. Finally, all that equipment is guaranteed so if the hospital has any problems with it, we will fix it.

Honduras: Close Call

2008-02-28T12:38:00.000-08:00

By Ray Schmidt

The next morning (Feb. 16th), I arrived again at the customs office at 8:30 with our clearing agent. We were clearing the most critical piece of electrical equipment that day. There were two electrical panels that were air freighted from the U.S. on Tuesday and arrived on Thursday, Feb. 14. Most of the clearing process was completed yesterday. All we needed was a signature on a document, pay a handling charge, and then pick up the items. We were first in line and the customs officer said that he would sign our document as soon as it was found. The office filed it yesterday but this morning no one could find it. Ninety minutes later it was found. Now we just needed the officer to sign it, but no one could find him.

A little later we found him but he was in the middle of something and would sign our document as soon as he was done. “Give me ten minutes” is something we heard a dozen times today. It’s getting closer to noon—that’s when the customs office closes for the day. We can see this officer through the window and he is working diligently on some other paperwork. Every time he stands up, a dozen clearing agents jump to the window shaking the papers they need signed. Each time he sits down and starts on another set of documents.

11:45AM: Agents become very restless and begin yelling.

11:50AM: Half of the agents still in line give up and leave.

11:55 AM: The officer stands up and comes to the window. We push through the others and stick our piece of paper in front of him to sign. He glances at it and signs. We run to the payment counter, pay the small handling charge, and then sprint to the loading dock. Noon, straight up. We’re good now. Fifteen minutes later our stuff is loaded on a small truck and we are headed to the hospital where the electricians can install the panels today and tomorrow, and we’ll be ready to go on Monday.

It was a close call.

Honduran Customs

2008-02-27T10:00:00.000-08:00

February 15

Ray Schmidt

The medical team will start the installation of equipment on Monday, Feb. 18. But before we can begin, all the equipment has to get to the hospital. The most important is the final electrical items that need to be installed over the weekend so that the medical team will have power on Monday. And that means that I get to experience Honduran Customs up close, such as import/export, duties and Customs Office.

Today I spent all day at the Customs office (pictured) in Tegucigalpa with the clearing agent from the Ministry of Health (MOH). One of the agreements with the MOH is that all the donated items will be exempted from customs charges. That means the MOH has to get clearance from the Ministry of Finance, and then the Customs office signs off on it and then we can get the equipment delivered to the hospitals. While most of the equipment had gone through this process there were a few late arriving pieces that still needed go through this. I went along to encourage our clearing agent and to pay any handling charges, minor fees, and truck rental. This would save us the hassle of having to go back to the MOH to cover these expenses and speed up the process.

We arrived at 8:30 AM and left at 5 PM. We were able to get three of the remaining six shipments cleared and delivered. This is the second time that I’ve gone through this process in Honduras, and I still haven’t quite got it figured out. There are at least six different stations you have to go to. Sometimes you just need a signature, or have to pay a small fee, or fill out some paperwork. It all has to be done sequentially. And if one of the officials from whom you need a signature decides to take an early lunch, you’re stuck. Now picture about 100 other clearing agents trying to go through this same process. It can get very frenzied.

But we managed to get six UPS batteries, each the size of a freezer and weighing 2,500 lbs., delivered to the Escuela Hospital so that the electricians could install them.

Hondurus: Landing in Teacup

2008-02-26T10:01:00.000-08:00

By Ray Schmidt

I’m excited to go back to Honduras—even though it is Valentine’s Day. We are partnering with GE on another project that will have a great impact in that country. We are donating and installing medical equipment for a 65-bed neonatal care unit. This includes a 10-bed neonatal intensive care unit (NICU), a 25-bed intermediate care unit, and a 30-bed neonatal ward. In addition, the electrical system for the entire unit was upgraded and we added a power supply (UPS) system that cannot be interupted. The UPS will keep the power surges, brown outs and black outs from damaging the equipment.

The Escuela Hospital had over 15,000 births last year. The average stay after a mother gives birth is 8 hours. The hospital just doesn’t have the room to keep mothers and their babies any longer than that unless there are complications.

I arrived this afternoon in Tegucigalpa (Tegus for short) and the landing was quite exciting. Approaching the airport requires a lot of turns and adjustments by the pilot and then a quick drop and landing followed by a slamming on the brakes. It was quite intense. One of the passengers commented that it’s like “landing in a teacup.” I went to Youtube and watched several clips of airplanes landing at the Tegus airport. I now see why the landing was so exciting.

Pecs, Hungary: Installing the Equipment

2007-11-06T15:58:00.000-08:00

By Ray Schmidt

Dr. Adamovich is an extremely grateful man. Today he shook my hand and thanked me in his broken English on four different occasions. He thanked the other team members as well. As the director of the neonatal ICU he can't believe all the equipment that was donated for his unit. He was particularly overwhelmed when he saw the new incubator. During the incubator training class for the nurses he couldn't help but jump in and press the buttons and explain all the features of the machine. It was nice to sit back and watch this man, who has dedicated so much time and effort into helping infants, receive a Christmas-like gift. Even though it is for the hospital and all the infants that will benefit from it, the incubator is also a blessing for him.

At one point during the incubator training given by Dr. David Kasting, he pointed out a feature that he called the "baby Susan" because it was like a "lazy Susan" that you see in kitchen cabinets. It allows nurses to rotate the baby inside the incubator so they can access the baby more easily. The ten or so nurses let out an audible, "Ahhhhh," followed by a few small claps.

Later he demonstrated how the incubator can be lowered or raised depending on the size of the nurse. There was this nurse who was just a little over four feet tall that was so delighted with this feature. She could now reach the baby without having to reach above her head.

As we were leaving after a day of training and installation, Dr. Adomovich came into our work room and asked if he could take the baby bassinets. The new bassinets were donated by GE and they are beautiful. We had finished assembling them but hadn't cleaned them yet. He didn't want to wait until tomorrow, so he rolled them out of the room. When I left they were being cleaned and readied for infants. I am anxious to see what they look like in the infant rooms.

I always like these days when the equipment is set up and the training is going on and there is excitement on the faces of the nurses and doctors. Tomorrow, when patients are hooked up to the monitors or placed in the warmers, it will be even better.

I should note here that yesterday we located a very good ice cream parlor in Pecs. I'm sure our bus driver thinks we're a bit odd when after dinner we asked him to drive us downtown to the ice cream place. The temperature was just above freezing, it was kind of late, but the ice cream beckoned and we followed. I think we won him over when we invited him to join us. Good ice cream is always a great way to end a day.

God Bless,

Ray

Pecs, Hungary

2007-11-05T14:25:00.000-08:00

Ray Schmidt - November 4th,

Pecs (Hungary) is a beautiful city. The team and I arrived yesterday after a three hour bus ride from the Budapest airport. The city dates back 2,000 years and the wall that surrounded the old city is still intact in many areas. A cathedral with four large towers dominates the town center and when lit up at night has an other-worldly glow to it.

Our host for this project is the Pecs Rotary Club and they have treated us well. They took us on a tour this morning of the city including a recently opened UNESCO World Heritage site. The city is built upon layer after layer of ruins dating back millennia and we were able to look at some of the old elaborate tombs. The Rotary club president and his English-speaking daughter then hosted us for dinner and we had a very enjoyable 4-hour meal. No such thing as quick bite to eat, but it was a great time.

November 5th,

We began setting up the medical equipment for the Pediatric Hospital of Pecs at 7:30 AM. Yesterday afternoon we toured the hospital to get an idea of what to expect for today. I was impressed with the hospital. It is operated very well and the doctors and nurses are knowledgeable and experienced. One of the hospital's larger problems is that they are understaffed in the neonatal intensive Care unit (NICU). In the USA there is typically a 3:1 ratio of nurse to infants, but if the infant is in very critical condition than the ratio is 2:1 or even 1:1.

Not here.

The ratio at the hospital is 6:1 in the NICU and there are some very severely ill infants. The nurses are constantly going back and forth between babies trying to keep up. The hospital also has a real need for additional medical equipment. Although they have some patient monitors, infant warmers and incubators, it's not nearly enough to handle all the infants in their care. Dr. Adamovich, who is in charge of the NICU, is anxious to get the equipment and installed so he can begin using it on patients. We expect to have patients on the monitors and in the incubators and warmers by tomorrow afternoon.

The team from Salinas Valley Memorial Hospital is doing a great job. The team is made of Sam Downing, CEO of SVMH, and his wife Paula; Brad Carrott, Director of Biomedical Engineering at SVMH; Annette Schuessler, director of ICU; Dr. David Kasting, neonatalogist, and his wife Anna, who is a nurse; Sue Marscellas, Marketing and Public Relations at SVMH; Mike Profuma, healthcare consultant, and his wife Judy. This morning we all jumped in to get the equipment ready. We had 14 patient monitors, 2 warmers, 1 incubator, 1 defibrillator, 4 bassinets, and all the accessories. The training begins tomorrow and we had to have most of the equipment set up for the first training session.

We did have a minor problem--the power cords were not right. They were European cords but they needed a right angle on the part that connected to the monitor. The hospital engineer and I jumped into his car and took off. It was like being in a rally car race. He would weave his way through backstreets and around cars. At a traffic light he would punch the accelerator hard to the floor and his little Peugot would dart down the street only to slam on the brakes at the next light. We ended up going to four stores but we finally found what we needed and then it was an all out race back to the finish line at the hospital. It was as good as any roller coaster ride.

God bless,
Ray Schmidt

Haircut, Haagen Daz and Hungary

2007-11-02T13:55:00.000-07:00

Ray Schmidt, Operations Director and Vice President

This morning before leaving for the San Francisco airport, I had my hair cut by a local barber. Later that afternoon (plus a travel day) I was eating my favorite Haagen Daz ice cream at Schiphol airport in Amsterdam--Forest Berry Cream. By evening I was sitting in my hotel room in Budapest, Hungary checking emails.

It's just amazing to me that I can wake up in Ripon, California one morning and fall asleep in Budapest, Hungary later that evening. I know, I lose a day in there because I'm flying east, but you get the idea.

I am going to have to work on my aisle seat scowl because it failed me today. I always prefer the aisle seat on a plane so I don't have to wake anybody up in order to stand up and walk a little. If I do have a window seat I always follow proper airline seat decorum. I will wait until my neighbors have to get up and then I too will get out of my seat so that I won't disturb them later. And under no circumstances would I wake a sleeping neighbor. And I would never think of excusing myself if my neighbors were eating.

But today, my row mates were either inexperienced travelers (although they were 70+) or they had not been taught proper seat etiquette. As soon as the flight left San Francisco, I fell asleep, which I understand is quite a gift. However, less than hour into the flight, I am dreaming that the Middle Seat Man, is walking over the top of me. It startled me and then I nearly knocked the man over as I sat up and realized that he actually stood up on his seat, stepped over me and put his slipper-clad feet (that's another story) on my arm rest, which is what awakened me, and then jumped to the floor. He gave me a sheepish smile and pardoned himself in German and I gave him the look I give my kids when they do something that is inappropriate--a combination scowl and look of utter disbelief.

It didn't stop there. He returns and I fall asleep and 30 minutes later, someone is tapping me on the shoulder. This time Window Seat Woman (wife of Middle Seat Man), needs to get out. I am polite and stand up to let her out. Now, this is no exaggeration, I sit back down with Middle Seat Man and two minutes later he wants out, so I stand up again. I am now in full-scowl mode, but he never sees it because he doesn't look back at me. A few minutes later I see the two of them returning and I stand up and allow them to get in, but only Window Seat Woman wants to get in. Her husband wants to walk the aisle for awhile. So I sit back down and a few minutes later Middle Seat Man taps me on the shoulder and wants back in.

I ended up standing up and allowing one or both of them to pass four more times during the flight, including once during a meal. I know they noticed my scowl on at least two of those occasions, but I think they enjoyed toying with me. I'm pretty confident that I caught a gleam passing between their eyes once. I think they were actually seasoned travelers who enjoyed playing this game with their row mates.

So I did not get my usual 6 hours of plane sleep but I did make it to Budapest. Tomorrow morning (Saturday) I'll meet a medical team from Salinas Valley Memorial Hospital at the Budapest airport and then we'll drive three hours south to Pecs, where we will be installing a patient monitoring system at Pecs Pediatric Hospital. We will also be training the hospital staff how to use and maintain the equipment.

God bless,

Ray Schmidt

The A.I. Warehouse & 'Hungry Green' Walls

2007-10-29T12:32:00.000-07:00

The last time we connected I was sitting at the Talapia Beach, "half-of-a-star" Resort in Kisumu, Kenya.

Today I'm sitting in Pappas Bar-B-Q in Houston, Texas extolling the virtues of Assist International to a group of pastors who have gathered for a ministerial conference. I'm trying to engage them in the stories and drama of good people locked in poverty, trying to meet the basic needs of their family, lacking basic health care, some even orphaned and abandoned. In short I'm trying to get them excited enough to help support Assist International and it's efforts to fulfill the command of Christ to 'Go into all the world". I'd like to get them to fund at least "a cup of cold water" in His name, through Assist International of course.

Why Assist? For one, 97% or all donations goes straight to the need for which it was given. Less than 3% percent goes to administrate the gift.

So I'm in the middle of my stories when my phone rings.... It's my wife Cheri. She's just driven by the Distribution Center we are building in California's Central Valley and she wants to know why the stucco wall panels are "Hunter Green". Hunter Green? I say, please tell me no. Early on Bob said he wanted the trim to be "Hungry Green". For those of you who are familiar with Bob's infamous "pagettism" this translates to "Hunter Green". Hunter Green is a fine color for building trim, but I fear a Hunter Green building has to be criminal. I'm not sure anyone has ever been crazy enough to paint an entire building hunter green. I once had a neighbor who painted their house trim "Crest Blue" like the tooth paste. Again, trim is one thing, but the entire 24,000 square feet? That's about 20,000 square feet of over bearing hunter green walls. Can you say, "problems with your neighbors?"

As tears came to my eyes and I fumbled for my steak knife to end it all, she let me know she was joking. Maybe if I stayed home more she'd take it easier on me. I love her!!!

Relieved I get on the phone and find that the construction of the warehouse is coming along fine. The fund raising letters have yielded dismal returns and the need remains "great", but at least the walls aren't green. Now I can't wait to get to Ripon and see for myself that the walls are "Warm White" like they're supposed to be. Then I'll kiss the ground, take my dirty lips home and kiss my wife like she deserves. I miss her.

Until later,

Tim

Kisumu, Keyna: Tilapia for Lunch

2007-10-16T15:11:00.000-07:00

The humanitarian field does have its moments of subtle reward.

I began this blog from the Tilapia Beach Resort in Kisumu, Kenya. The Tilapia Beach isn't your typical resort. You won't find it in any travel magazines and good luck finding a web site for it, that would require electricity.

I'm taking a lunch break from hospital assessments in Kisumu. I've already been to Siaya and Yala Hospitals, which support clusters of villages. These hospitals have become a part of the United Nations Millennium Development Goals for Africa, an ambitious effort to wipe out extreme poverty by 2025. Bono (of U2) is the mouth piece and renown economist Jeffery Sachs from the Earth Institute at Colombia University in New York is the architect of the plan. General Electric has signed on to fund the Hospital refurbishment and Assist International has been enlisted to provide logistics and project management.

This is where I come in. It's my job to travel for 36 hours to places barely on the map, crawl through the attics of hospitals looking at infrastructure and photograph tons of hospital equipment new and old in an effort to see how they can be helped to reach the next level of care. In a few hours I will meet my subcontractors at Nyanza Referral Hospital, known to the locals as "Russian" Hospital because they built it several decades ago.

While I wait for that meeting I have decided to ask a "Took Took" driver for a restaurant recommendation. A took took, is a three wheeled sardine can with a canvas lid, powered by a vespa motor from yesteryear, which doubles as a taxi cab for those who can't afford an actual taxi. The took took driver, who probably hasn't ever had the money to go to a restaurant, especially one frequented my "muzungu's" (White people) suggests the Tilapia Beach Resort.

Resort? Now that sounds nice.

Ten minutes ago the road ran out of black top and the hotels turned to bamboo walled, dirt floored huts sans doors. Sans every amenity actually. Each hut has a wooden sign with the words "hotel" painted on it. Still my faith holds out because hidden gems sometimes lie at the end of a hard road. At least this is what I tell myself.

The Tilapia Beach consists of nine thatch roofed cabana's on the banks of Lake Victoria, set back just far enough that a crocodile can't bum rush you from the bull rushes. My first mistake upon settling into my plastic chair was to ask for a menu. The waiter laughed and I realized this was the second sign of "I ain't from around these parts is I".

"Menu?!" He asked quizzically. Yes, I respond, so I can see what you have to eat today. Again he laughs and says follow me. Dutifully I fall in behind the waiter who takes me to an open grill piled high with, guess what? The only thing on their menu, Tilapia. (Tilapia is the common name for many species of cichlid fish, like those shown above)

It's projects like this where medical equipment, otherwise out of reach to local hospitals, is provided through Assist International that makes gruelling travel and questionable accommodations well worth it. Whether the project is funded by a major corporation in conjunction with the United Nations, or by a local church or service club like Rotary, putting the tools to save the lives of women and children who would otherwise die or be physically impaired for the rest of their lives is a great feeling.

I wish I could take all of you along some time to see exactly what it is you accomplish when you team up with Assist International to care for those who can not care for themselves. Maybe, I humbly submit, I can help take you there through the blogs, until you can free yourself up to come along.

No matter the case, thanks for your consistent support of Assist International and our medical and orphan child projects. Without you it just couldn't happen. With you and God, there are no limits.

Until next time,

Tim