Grant Anhorn: Guatemala – Blog #2

There have been a few changes to our project since we have arrived in Guatemala: the solar heaters have been malfunctioning but it is unknown if it is a human or technical problem. For this reason, we need to begin thinking about alternative strategies for heating the water such as electric. In addition, we may need to develop educational materials to help the staff with the use of the solar heater system.

We met with Jessica, our in-country director, and Roberto, the systems engineer who is our direct supervisor. This meeting was both informative, and great opportunity to practice our Spanish!

During the meeting, our team developed a plan for the beginning stages of our project. Our first task will be meeting with the engineer and builder, Erik Gonzalez. In addition to the hospital’s hot water system, he has also designed and constructed solar heaters for a nearby nursing home and for his own house itself! Erik will be an invaluable resource for us to find out all the details about the system. Next, we want to visit the hospital in Totonicapan to get the lay of the building, meet some of our contacts, and make a preliminary appraisal of the hot water heaters.

We have developed an instrument of questions and tasks that we hope to complete during our time here in Guatemala. This has helped us itemize and prioritize our work, and we feel confident about our job for the coming week. Things are moving along quite nicely!

We had a meeting with Jess and Erik Gonzalez, the engineer that developed the system, to understand how the solar water heater system of the Totonicapan Hospital works. We saw how Erik uses the siphon and piston effect to pump the water through the collector and water deposits. After a unknown time the hot water pumps to three of the 6 showers in the maternity ward.

We are going to attempt to see how long the water takes to get hot, what temperature the water is, determine if an educational lesson needs to be given to the staff of the hospital, and ultimately find out what parts of the system needs to be updated. We will use thermometers to measure temperature of water, measured buckets to determine flow rate of that water, and the various weather measurements obtained by AccuWeather.  These will help us determine trends in the system to see whether or not we need to expand the current system or develop a new system in order to get hot water to all the showers of the hospital eventually.

We will also conduct various interviews to see if the problem is actually a user error, because Erik believes that the system works fine. In all we have quite a bit to do, so wait for updates on how our tests are going.

I have included our notes of pictures of the diagrams that Erik drew for us.

First Day at Toto- When we arrived at the hospital, we met with Gustavo, a head maintenance worker at the hospital. He brought us to the roof to see the solar water system that Erik Gonzalez built. We had our ups and downs with our first day. We found a lot of problems with the current system, but the solution to those problems seem feasible with time and money.

Problem 1: Rust. The inner and outer barrels that make up the water tower are very rusted. In one case the rust created a hole in the inner barrel. This puts that whole solar panel and water tower out of commission. This is a problem that needs to be solved as soon as possible by sealing the hole with a liquid rubber sealant or welding a new piece of metal over the hole. The problem does not stop with just sealing the one hole, because we need to clean off all the rust and develop a rust prevention technique. It will be very costly to continuously repair the barrels time and time again, so we should just use a solution to clean off the rust and galvanize the metal or paint the cans with a rust proof paint.

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Problem 2: Obtaining replacement parts/ better communication. One of the other solar panel and water tower combination is also out of commission. This time it is because the float of the water tower had broken. The main problem with this is not that the float broke, it is that the float has been broken for over 15 days. The system might not have been functioning for longer than that, because Gustavo only does one maintenance check a month on the system. Neither Jess or Erik knew before today that the float was broken. We will need to better develop a system of communication, so everyone can stay updated on the system.

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Problem 3: Head maintenance did not turn the system on. After Gustavo put the apparatus back together, we measured the temperature of the water at the same shower head every hour for three hours. To our surprise the water barely heated up, and the water that was a few degrees hotter was very limited in amount. With no steady increase, we went back to the roof to check on the system. We noticed that certain valves were not opened and others were opened that should not have been. This might have been just been Gustavo getting sidetracked, but this seems like it could be a cause that nurses say the hot water heater does not work sometimes. As soon as we fixed it, the system really heated up quickly, but things like that make the nurses and patients skeptical of the system.

Problem 4: Only 3/6 of the showers are hooked up to the solar heater system. We noticed that the PVC pipes that travel to the showers only stop at three showers. These three showers that are hooked to our system work very well according to Gustavo, but the same cannot be said for the other three. One of the showers is missing the shower head, one has a broken electric shower head, and the other has a working one. It seems like the PVC pipe can easily be elongated to give hot water to the other three showers in the maternity ward. However, we do not know if the current system has enough strength to power those remaining showers. We will do tests on the operational panel to see what amount of water the system can create.

Problem 5: Fit of apparatus. The system seems to work while using some questionable materials. The system is a huge pain to put back together. It took three men over 20 minutes to put back one system because of the materials that were used. It has to take even longer than that if it is just Gustavo on the roof. It seems that a lot of the materials have changed shape to not quite fit together perfectly. The PVC pipes sag and look like they could snap like a twig, the wooden spacer that keeps the inner barrel in place seems to have expanded to make for a hard time to put back on, and the top lid is warped to allow water to get inside. All these things cause the system to not be as sturdy long term as they should be.

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Problem 6: Insulation. The warped lid allows a lot of water to get into the water tower. This has ruined the insulation. I really do not believe that the soggy wet insulation is keeping in the heat of the system as well as it was envisioned. This needs to be replaced to allow for more efficiency.

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Problem 7: Pictures, pictures, pictures. There should be pictures on every shower to help the patients know how to get the hot water. There should be pictures on the water tanks to show how the system works. A picture is worth a thousand words, especially if the user cannot read or speak Spanish and/ or is not trained to use the system. A picture could be a simple solution if knowledge on the system is the problem and we are unable to train everyone.

Problem 8: Stairs. The solar panels are hard to hard to reach. It is pretty dangerous to get to the system when it is a nice day. I do not think I would feel comfortable sliding down the side of the roof on a rainy day. It would be a lot easier if there was some stairs or a ladder. This is the last of our problems right now but still eventually should be addressed.

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We are glad that we have found a lot of problems now as opposed to our last week. We are excited to find out the way to best help the patients of Hospital Toto!

The system did not seem to work when we checked it in the morning and took awhile to heat up. We decided that we had to patch up the system as soon as possible to continue on with our original project. We needed the system to be working the same as Erik made it in order to see if the system is beneficial. We fixed the hole in the water deposit and the hole in the water float with Poxipol. We hope that when we check the system in the morning it is working so we can survey the staff of the hospital. We also want to make something for each of the bathrooms, so that the nurses can mark when and how long each shower is. We are planning on doing that tomorrow hopefully after the system is fulling working. Adam or I will post with the update on the system after we check the showers at different times of the day.

We begin our second week working at the hospital with good news and bad news. On the one hand, the “poxi-pol” we used on the leaks in the barrel has held nicely. We therefore have 2 of the 3 heaters up and running. However, the repairs we made to the float were not sufficient. As a result, we are exploring other options.

After doing some research around town, visiting several stores and researching options online, we decided to purchase a new float. However, the only available floats are too long to fit in the heater. We recruited Eddy, one of our maintenance worker contacts at the hospital, to shorten and add new threads to the rod of the float to make it an acceptable length. This strategy seems both the cheapest option and the one most likely to be successful. We are currently waiting on Eddy’s return with the float.

Another development in the project is our meeting with Jose, one of the University of San Carlos students who was involved in the construction of the system earlier this year. In our meeting, we described the problems we have encountered, while Jose offered more details on the system’s mechanism, modes of construction, and strategies of repair. Yesterday, Jose took the time to visit the hospital with us. Together, we further analyzed all three heaters. Through this analysis, we discovered several additional components of the heaters that may need to be replaced or changed. The first is the insulation; due to the leaks and malfunctions, the fiberglass insulation that surrounds the inner barrels got wet and partially destroyed. In our research, we found a store that sells fiberglass; however, we first want to investigate if some other insulation option exists. Second, one of the metal fasteners that locks the inner barrel in place is broken as well. Jose is currently investigating options for replacement or repair.

Overall, the various maintenance issues have been slightly frustrating. However, if we can work efficiently to make some high quality repairs we are hopeful the system will be completely operational by the end of this week. Then, we will be able to start assessing its functionality as well as interviewing nurses and hospital staff to make the system as user-friendly and effective as possible.

Friday was a day filled with ups and downs. We were really hoping to finish all the maintenance repairs but were slowed down with a few problems along the way. We were accompanied by Jess and Jose, a student at Universidad de San Carlos, to help us get all three systems up and running by today.

We had purchased all the materials that we thought we were going to need and were ready to get started by Friday. However, we had to completely take apart two of the water deposits, because they were holding water and needed to be drained. They spent the weekend drying inside, so that when we put in the insulation it would not get wet immediately.

We recruited some of our friends from the EMR team to help carry the tanks inside the attic.

The whole day was not a complete disaster. We got the deposit with the broken float operational. We decided to use two 3″ pieces of insulation to completely surrounded the inner tank of the system instead of the one 3″ piece that was previously used. We found that the inner tank was losing a lot of necessary heat during the cold nights of Toto, so insulation was packed in to really keep in the heat. We checked on the system today, and that water was almost boiling. We are very optimistic with the new and improved system.

Today we started off by painting the inside of the tanks with anti-rust paint. We then put all the tanks back together slowly but surely by connecting the tubes back together with new Teflon tape. We cut and put in all new installation just like the tank we assembled on Friday. Also Adam flattened out the previously unusable inner-tank top with shear wrist and forearm strength. We are now done with all the repairs! We wanted to make sure that the system was put back better than we found it! Onward to our next half of the project! Sad to say our job as maintenance workers is over…

Part 2-

We have been taking measurements of the water temperatures at different times (we haven’t told the nurses it is fixed in order to get more consistent data), with different weather statistics (temp., cloud coverage, UV radiation), and different flow rates. We are trying to find the relationship between all these factors and the temperature of the water. We have been getting some really convincing data that is showing us how great the system is working. It is showing correlations between the outside temp, UV radiation, and time in the day. The temperature and radiation usually rise with the time of the day until the afternoon. This is going to help us find the recommended time for showers to start. We have also been measuring after waiting different amounts. This helps us create a plan for the nurses, so they know how to better serve their patients.

We are going to conduct interviews with the nurses all next week along with taking meausrements at new times. We have figured out the best time for morning showers but need afternoon or night showers schedules. Dr. Scarlett has created a schedule for us, so we can create soft data as well. We will need to make friends with the nurses, because they are going to be the people that need to execute our plan.

We had a meeting with nurses today. They were very busy but did not seem to mind us talking to them and asking a few general questions. We might even think a few of them les gusta Adam or he might have asked for their numbers… not quite sure. We started by introducing ourselves and thanking them for their time. We then told them our findings so they can most effectively use the system. We explained that the water will be hottest between 11 and 4, but is still tolerable a couple hours before and after that time frame. We also told them that they could use the electric showers that they have installed in the other showers if the patients absolutely need to shower during undesired times. They did not seem to understand how to use the various knobs and valves in the shower, so we showed them the differences, and how to mix water sources if the water is too hot or cold.

They seemed to be happy to use the system to help the tight budget of the hospital. We told them that we would be outside the nurses table to have individual interviews with them whenever they have free time. We still want to know if the system merits additional funding and project time. I guess we will find out tomorrow and Thursday through our interviews if patients and nurses are satisfied with the solar system.

Overall, this was an important step in our project. We have now fixed the system, and explained our findings to the staff. The last piece of our project will be to find out about the general perceptions and ideas for the future through individual interviews.

Well, our time at the hospital in Toto has come to a close. These past 4 weeks have flown by! The project was different than we expected, but I would definitely consider it a success.

The second half of this last week was spent planning and installing different materials in the maternity ward bathrooms. We designed illustrations instructing which shower handles deliver hot versus cold water. We wrote out a list of showering instructions for the nurses to consider when helping patients– guidelines like waiting for 15-30 minutes between showers to allow the heating system to function optimally. And, we developed a data collection sheet where nurses can enter details about each shower, such as duration, heat, and other comments. We included words in both Spanish and K’iche, which is the language predominantly spoken by many patients in Toto.

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All of these materials need to be waterproof, so we learned how to laminate by hand with the help of Miriam at the UVA-GI office. This turned out to be rather challenging, but over the course of laminating 20-25 sheets, I think we became relative experts. Finally, on Thursday we put up all of our materials on the bathroom walls. We spoke with the nurses to remind them a final time of our ideas. They seemed very receptive to our project, and we have tried to be as minimally disruptive as possible.

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As a farewell to our time in the hospital, we had a final meeting with some members of the hospital administration, including the main director of the entire hospital, the directora of the Ob/Gyn department, and the head of maintenance. We reviewed with them our entire project, and showed them the system on the roof as well as the signs in the shower.

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The director of the hospital then took us out to a famous hot chocolate cafe in downtown Toto. This was a great way to wrap up our time here.

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We’re very hopeful for the continued success of the solar heater system. Not only have we repaired the system, we have taken prevention measures to ensure the same problems don’t recur. Moreover, we have established a stronger relationship between the maternity ward, maintenance unit, and UVA-GI, such that if any problems do arise, there is a system of communication in place to resolve it as quickly as possible.

We are now looking forward to next week, with more Spanish classes and the final wrap up of the project. Until next time!

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