Sara Doll

I’ve always been fascinated by culture, by large groups of human beings bound together, not by national borders but by unspoken definitions of what one considers ‘normal’. I have traveled much for my years (as I write this at 25, I have just crossed the threshold of my ‘early twenties’ into the land of ‘almost 30’), traveling much as a child with my family and while an undergraduate student at the University of Pittsburgh.

Before my journey with Engineering World Health (EWH), I had fallen madly in love with the culture of water in the island continent of Australia while studying a semester in one of her most tropical cities (Brisbane) and had fully embraced the fresh mountain air and mouth-watering chocolates of the Swiss while working ½ a year in the postcard-perfect, tri-lingual capital city of Bern.

I graduated with my biomedical engineering degree in May 2004 not just with the technical skills of a professional but also with a greater understanding of the world beyond American shores. I was no stranger to pushing the limits of my own definitions of ‘normal’ or cultural acceptance, but before my summer in Central America I knew I still had much to learn.

At the end of June, I said a tearful yet hopeful goodbye to Costa Rica. Having just spent a month training in the capital city of San Jose with my fellow EWH Summer Institute students, I felt ready for the next leg of our journey. Armed with my new yet untested skills in the Spanish, instrumentation repair and Central American culture, I was eager to finally put into practice all that I had learned and EWH had attempted to prepare me for. I was eager because I knew that, as is true with most anything, lectures in a stale classroom are only a drop in the bucket of true understanding when compared to the in your face intensity of an immersed personal experience.

Sara and Tracy

I wasn’t particularly worried about my upcoming immersion in the heart of the developing world, but I wasn’t quite sure what to expect. As it turned out, it didn’t take long for me to find out. My first hour in Nicaragua, I was sharing the back seat of a beat up SUV with my new hospital partner Tracy while our new host mother drove us swiftly through the dusty and crowded streets of Managua towards our new home. It was a rather hot July afternoon, so with the windows wide open, I began to take all the novel sights, smells and sounds. Then, as is universally customary when one sees a red light, we stopped at a busy intersection in heart of the city. Having spent all of my adult life living in cities, I was familiar with the peculiarities of beggars on the streets. I have been asked for change more times and in more ways than I care to count. But what I witnessed at that intersection that day was like nothing I had ever seen. In the middle of the busy 6-lane road, two thin men stood with their palms up, begging for money from the people in the stopped cars. One lead the other by his elbow, and they both reached their hands into cracked windows (for we all had most certainly rolled our windows up to block the begging onslaught).

Their tactic was simple yet powerful - tug at the heart strings as hard as you can - for in place of one of the men’s eyes was nothing but a sunken hole and awkwardly stretched skin. Two traffic lights later, another beggar playing the same difficult game. This time the outstretched hands and pleading eyes belonged not to a man, but to a boy – maybe 15 years old – and his deformity was not in his eyes but beneath his uplifted shirt. Where his stomach should be was a hole – about an inch wide – in the middle of a sunken chest. And protruding from it was some unidentifiable, dark brown, rope looking thing about a foot long. Through my now cracked window, I found myself quickly averting my eyes -- yet also, undeniably, unable to look away.

And so, the anguished yet entrancing reality of the developing world began to wrap its tendrils around my consciousness and heart. Through Engineering World Health and in Nicaragua, my understanding of the world and her varied cultures expanded once more.

hospital needs help

In the hospital I came to know in the following weeks, a poor yet resourceful pediatric institution desperately dedicated to her country’s children, my eyes witnessed many more acute illustrations of resilience despite the most unfortunate and uncontrollable of circumstances: the pair of knowledgeable but under-funded engineering technicians we worked with (Juan Jose and Roger) who could diagnose a wide variety of electrical anomalies in the devices of their hospital but were helpless to fix half of them without access to the right parts; the vulnerable infants in the neonatal ICU watched over by a devoted medical staff yet, with only one for the entire floor, unprotected from the constant eye of a heart rate, pulse oximeter or blood pressure monitor; a warehouse overflowing with supplies and equipment, sent by donors who meant well but who, in truth, were hopelessly naïve about what a children’s hospital in the heart of poverty is truly desperate for.

babies share a crib

For every day I spent at that Nicaraguan children’s hospital, many distressing situations like these became more and more apparent. These were intelligent and motivated people with problems that, had they been encountered in the US, would have been easy to resolve. Yet Nicaragua is not the US and, as I gradually came to understand, is a place where choices are few and resources are scarce, even the most simple of setbacks can turn into the most insurmountable of struggles.

We stayed in Nicaragua for only four weeks – the shortest of all my traveling adventures. But even in that short amount of time, I knew it had changed me.

In August, I immediately returned to my life in Washington DC, where it took about two seconds for the whirlwind pace of life in the city to pick me up in its fury and turn my days into a blur of activity. There were moments when I wondered if I really had just spent the last two months of my life in the developing world. Everything just picked up exactly where I had left it. I went to work, socialized with my friends. On the surface, it was like I had never gone. Inside though, I knew I was different. My understanding of the world had expanded.

Of the many lessons I learned, two are worth repeating here. First, related to biomedical engineering, it is my belief that medical devices in this world are designed for one market and one market only – that of the affluent West. With a cultural craving for bigger and better, devices are designed to compute faster, weigh less, measure just a little more precisely, and come equipped with more gadgets, gizmos and options than anyone knows what to do with. But these priorities are the West’s and the West’s alone.

western tech doesn't work

The developing world is simply a different place. Believing, for example, that a fancy ventilator designed for the best research institute in America can be effortlessly transplanted into a poor public hospital in Managua is a tragic delusion. The conditions are different. The resources are different. Most everything is simply just different. Just as it takes a different set of skills to create a valve for the heart instead of a car, it takes a different set of skills to design a medical device for the developing world instead of the developed one.

My second Nicaraguan lesson lies as an extension of something true to almost all of my travels overseas. It is a reminder there is at least one thing you can always trust will be the same the world over: the power of kindness. A smile is a gift that can transcend any language or cultural boundary and can often be your saving grace. The reality of developing world was difficult at first to accept, but it would have been much harder had it not been for the beauty of the people I met along the way.

people matter

I was often overwhelmed with the potent kindness and compassion I felt from the people who worked at my hospital – from the men guarding the iron gates and the women serving our meager lunch, to the electrician with nothing but patience for a foreigner’s sluggish Spanish and the operating room nurse with nothing but questions about where we’d come from. Working closely with these people for four weeks, getting to know them and gaining their trust, I came to sympathize with their struggle and admire their resolve. They work hard and care deeply about their patients and families, just as much as we would, but the choices they are forced to make every day are more difficult than any of us can imagine.

the workshop

Since college, I have known that my desire and passion is to use my engineering training to help people. I am lucky to be able to do that, at least for the American public, at my current job with the FDA’s Center for Devices and Radiological Health. After my time with Engineering World Health though, I now see that the biomedical engineering profession has a responsibility beyond the hunger for the latest and greatest advances that only the most affluent of societies can afford. We also have a responsibility to provide sustainable technologies to societies who struggle to provide even the most basic of care to their people. In the end we all deserve an equal chance at survival, no matter where our mother happened to be when we were born. Now, where I used to naively avert my eyes from the unlucky circumstances of the developing world, I – because of Engineering World Health and the people of Nicaragua - undeniably will never again be able to look away.