BlEsSeD iI He WhO HaS FoUnD HiS WoRk; LeT HiM AsK No OtHeR BlEsSeDnEsS

1st week (26th Sep 2005 – 30th Sep 2005)
First of all, I would like to raise my glass in a toast to all that has been accomplished on my 1st week of my industrial attachment, and to the learning yet to come. Industrial attachment has helped me to see the world in a different perspective. Without this attachment, my knowledge regarding the outside world is only limited to just theoretical application and doing experiments in our lab is definitely not sufficient. Furthermore, having such wonderful supervisors such as Mr. Sin Kok Chuen and Mr. Toh Ai Leng has been an advantage as all my doubts has been clarified regarding what I have learnt for the 1st week.
My attachment starts at 8.30am. I dislike getting up so early in the morning to go to the attachment. It is not that I dislike the attachment. I just dislike having a drag myself out of bed when it is still dark outside and when my eyes refuse to open, especially after having only a few hours sleep because of watching television till late the previous night (my fault!). If only the attachment programme would start a bit later then everything will be fine. (Fat Hope!). Then I would not have to get up so early, I would not have to wait my turn to use the bathroom and best of all I would not have ton jerk myself from my warm comfortable bed. (Everybody Now: Heavy sighs!)

Day 1: 26th September 2005
The moment I hit the crisp morning air on my way to work, my whole outlook changes. Ah, the cool air is invigorating. Life is wonderful. Hopefully work is wonderful too with all my new found friends and family and definitely the surroundings. On the 1st day of my 6 months attachment to Alexandra Hospital, I reached there at 7.50am on a Monday morning. Upon reaching the main lobby of Alexandra Hospital, I waited at the lobby till 8am because the receptionist is not there for me to ask for direction. At 8am, I asked the receptionist about the location of Biomedical Engineering Department. She told me its on the second level of the main building so I went up via a lift. When I reached level 2 of the main building, there are only clinics J & K and no Biomedical Engineering insight. I heaved a sigh. I went back down to ask the receptionist again. She was sorry for making that error, now she told me that the biomedical engineering department is located at Block 18 which is at the far end of the hospital. Block 18 is actually a bungalow cum office whereby on level 1 it is designated to the biomedical engineering department whereas on level 2, it is dedicated to the hospital planning department. It is still early. Even the door was locked. I waited and waited till 8.20am, suddenly a lady by the name of ester came along. She is actually the assistant manager and in charge of hospital planning. She leads the way so that I could meet Mr. Sin Kok Chuen in person, my supervisor.
I was then brought to the human resource by Nuraini Bte Osman, the secretary to get myself a personalize card as a form of identification as well as documents to be complicated prior to my attachment at Alexandra Hospital. After which, I was given a tour around Alexandra Hospital of the various wards, Clinics and A & E department. Later on, my supervisor, Mr. Sin gave me a short introduction on what’s the role of BME at AH is, what’s need to be done and so on. In addition, he asked me if I am familiar with the various safety standards like IEC 60001 & 60101. I was familiar with the equipment safety standards of IEC 60001 but not that familiar with IEC 60101 which is a safety standard for Laboratory equipment. After which, he even asked me if I knew of the various classes of equipment, since i knew of the various classes of equipment. He did not need to explain any further. He showed the various cupboards where the manuals are being kept, safety procedures if any emergency were to happen, and I was introduced to the senior engineer, Mr. Toh, assistant engineer, Lee Chong. Unfortunately the other assistant engineer, Faz was on leave on that day, thus don’t have the chance to meet her. Mr. Toh gave a work place which consists of a spacious table, a desktop computer and some stationary.
At around 11am, Mr. Sin introduced me to the NIBP (non-invasive blood pressure) which is also known as sphygmomanometer. I personally think that repairing a NIBP is indeed the simplest of all the equipment I repaired during my 1st week at AH. It is mainly made up of a rubber inflation bad double tube, Velcro cuff (in accordance to the size- adult or neonate), plastic manometer tube (300mm or 260mm), catch spring, mercury reservoir, inflation bulb, control bulb, rubber tubing, and washer (cotton or PVC). Adequate blood pressure is essential to maintain the blood supply and function of vital organs. Measurement of blood pressure is therefore a key part of the monitoring of patients.
What I learnt about Mr.Sin is that he likes to give me a short introduction on the equipment, how the equipment works and last of all the safety that needs to come with it. I think it is good practice for my own benefits. Two thumbs up for Mr. Sin. The most common problem of this equipment are mercury can’t be pumped up, there is some air leakage of the rubber inflation bag due to excessive used, the rubber tubing was torn, the 300mm plastic manometer tube’s markings disappeared or the inflation bulb or control spoiled. Applying my knowledge of clinical engineering, firstly I did a visual inspection if there is any thing missing, lost or need to be changed. Next I try to replace the suspected faulty components / worn-out components with good ones that are available in the store. Next, I did a checked on the equipment based on the functionally testing and safety testing.
The functionally testing refers to whether the replacement replaced was good and works well without any hitch. The safety testing refers to that there shouldn’t be any mercury leakage if it was pumped to the maximum. Personally the most crucial components are definitely the PVC and Cotton Washer because the washer helps to prevent any mercury leakage which could be harmful to human health. I did some cleaning too. Throughout this repair, I wore a rubber gloves to prevent any mercury seeping through my skin if it did happened. Thank god, it went smoothly. All in all, I did 3 sphygmomanometer.
Next, I was introduced to the ProFile powered by MEDI-MIZER which is a software to create a database for all the medical equipment for easy maintenance and access if the need be. I learned how to create a work order as well as how to close the work order. Mr. Sin added my name to the database so that I could enter in and key in any work order which I did for the 21 weeks I am there.
I ended the day at around 5.45pm since i had done everything that needed to be done.

Day 2: 27th September 2005
From the life of a normal teenagers, to a weary freaky. I am now donning with shirts, black pants and black shoes. Life as a working adult is tough but I suppose perseverance is everything here. In spite of having obstacles along the way, i work for my goals and know that it can be achieved if i reach for my dreams with ability, determination and belief.
I arrived at 8.10am. i met Faz for the first time. We had a good chat. For today, Mr. Sin showed us Donway Traction splinting system. It is used in the A & E department for patients with leg injuries such as fractures, torn ligaments and stuffs. It is actually easy equipment to work with. The Donway Traction Splinting system does belong to the BME thus there isn’t any need to key it in to our database. We only need to do some preventive maintenance and order a few missing parts. After Mr. Sin explained to us (Faz, Lee Chong & Me) about what it is used for and how does the mechanism works. I was given a task to do the preventive maintenance for 4 of this orthopedics equipment under the watchful eyes of lee Chong, the assistant engineer.
Firstly, I did a routine maintenance programme as suggested by Mr. Sin which consists of visual inspection, Lubrication of pneumatic seals, Relief valve test and standard pressure test for each of the equipment. I found out that only 2 out of th2 4 tractions splinting system works. The other 2 fails due to some problem of the meter. Since we don’t have any spare parts for this equipment, Lee Chong suggested that we leave it aside while waiting for the spare parts to come which come from Australia Biomedical Corporation Limited.
Since there are only 2 Traction splinting system that works, I did maintenance and repair procedures such as re-lubrication of pneumatic seals, replacement of pneumatic seals, re-assemble of side arm to mainframe and replacement of traction gauge mounting adaptor.
Next, I opened up a work order for the equipment (NIBP) that I did yesterday. I key in the various steps such as Diagnosed, replaced, checked and cleaning. The time spent for each of the steps is noted too. For the replacement procedures, I need to key in the parts used for the replacement so that the inventory will know how many parts are left and when to do order new parts if the parts are depleted. After all that, I needed to close the work order which certified that the job has been completed and that the complaints have solved.
In the afternoon, new equipment came to BME for a breakdown service. It is the alternate mattress pump or in lay man term it is called as an anti-sores mattress pump and the mattress. It used to relieve sores on patients who are immobile and can’t move much, thus this pump and mattress eases their sore pains. Mr. Sin showed me how does it works and the complication that comes with it. He even drew a flow chart so that I could have a better view on how it works. He told me that the pump works with 230V, thus if I wanted to open the casing up. Preferably, switch off the power supply first of all.
After that introduction, the time shown is 5.30pm, thus he told me to continue it tomorrow. I ended the busy day at around 5.50pm.

Day 3: 28th September 2005
For today, I tried to repair the alternating mattress pump. After the visual inspection and functional check of the circuit and the rubber tubes inside, I found out there isn’t any problem with it. However, since I am not too sure whether the internal circuitry is correct, I tried to find the manual for this. Unfortunately, the manual was no where to be found.
I consulted the senior engineer regarding this. He told me to try to check the internal tubing if there is any torn parts or disconnection inside. Once again, I found out nothing. It is in perfect conditions. I took it upon myself to check for any holes in the mattress. As suggested by Mr. Sin, I should used soapy water on the mattress, if there are any bubbles then the leakage is there. Thinking that it will be very difficult to do the procedure all by myself and seeing the lack of spaces to do this steps. I decided to think outside the box. I used a one connecter pump instead of two, I pump up into one of the hole and let it pumps for just one alternate side of the mattress. I checked meticulously for any holes. After a few minutes of checking, I found out that there are 2 holes. I did a small patch up using the same material from the store room.
After doing so, I connect the pumps to the mattress and it works fantastically. I even tried to lie on it to see how it feels like. I keyed in the components and what I did to rectify the problem. Next, I closed the work order. Paste a sticker on it; write the Work Order Number and the ward no. that it needs to be sent to. Then it’s all done. (Good Job!)
After lunch time, Mr. Sin passed me a few documents pertaining to the theoretical parts of a Pulse Oximetry. After reading, I found out that a range of 96% to 100% of Oxygen is generally considered normal. Anything below 90% could be life-threatening. Pulse Oximeter works on the principle of the red and infrared light absorption character and deoxygenated hemoglobin. Oxygenated hemoglobin absorbs more infrared light and passes through. Deoxygenated (or reduced) hemoglobin absorbs more red light and allow passing through. Red light is in the 600-750 nm wavelength light band. Infrared light is in the wavelength light band.
The inaccuracy of measurement of the pulse Oximetry could be result of motion artifact, ambient light, dried blood, nail polish, intravenous dyes, abnormal hemoglobins, carbon dioxide and hypercarnia.
I did ask Mr. Sin for any Pulse Oximetry around in the BME Centre, so that I could have a hands-on on the equipment instead of theoretical applications. Maybe I could even try it on myself. Unfortunately, there isn’t any around. He said rest assured that he will show me if any of pulse Oximetry are being brought to the BME Centre for breakdown service or Preventive Maintenance (PM).
I finished my day at around 5.50pm.

Day 4: 29th September 2005
That morning, Faz showed me how to diagnosed, replaced and calibrate the flowmeter. Before I did the actual stuffs, I tried to scout around in one of cupboards for the manual for the flowmeter for easy understanding and greater appreciation for flowmeter. I tried to mingle around with the flowmeter and if I did not understand any parts of the manual, all I need is to ask Faz for help. The flowmeters are from IDS Medical Systems.
I found out that the flowmeters are in bad conditions. The marking on it are gone and the bolt and nuts are not that tighten anymore due to the lost of threads. I suggested to Faz to change the flowmeter. She said yes so I did change all the flowmeter to brand new ones. Once again, the routine of closing the work order and updating what components I used for replacement are stated clearly. Then I Paste a sticker on it; write the Work Order Number and the ward no. that it needs to be sent to. Then it’s all done.
Before Lunch time, all the BME department staffs are needed to attend to a safety and terrorism prevention talk conducted by Queenstown Police Post to educate us on what to do if there is any emergency happening within Alexandra Hospital compound. Luckily it was a short and sweet presentation. After that, I went for lunch.
At around 1.05pm, Lee Chong introduced me to the Terumo infusion pump, Model STC_503. He told me repairing infusion pump is the most routine job in the BME Centre and can be quite tedious due to steps taken. Since the month of October is just around the corner, Preventive Maintenance (PM) for infusion pump is on top of their list. There are lots of infusion pumps in the wards, SICU, MICU and lots more (can’t remember where).
Before he introduces me the infusion pump on how to go about doing the Preventive Maintenance (PM), I always make it a habit to find the manual first and take a look at it before having to do the hands-on so that I could understands what he is talking about. First of all, visual inspections are taken to look for any missing parts, loosen bolt, nuts or even screws. Next, we check if all the LED lights up, the buzzer functions accordingly and does the mechanisms work wonderfully?
Subsequently, he showed me how to run the infusion pump using the infusion analyzer IDA-4 which looks like a machine that hooks with a dripper. We started of with the volume tester. We changed the specification in accordance to manual which is at the rate of 300ml/hr and a limit of 100 for 20 minutes. After that, the volume should be around 98-102ml. if it does not meet the specification, then we need to adjust the “S1” in accordance to the discrepancy amount. Next, the check of Occlusion, the range should be around 10-17.1 psi. After that, we need to test for electrical leakage using the electrical safety analyzer. Charged it up.
I ended the day at around 5.40pm

Day 5: 30th September 2005
I continued doing the Preventive Maintenance for Terumo Infusion pump. From what I have learned yesterday for the Infusion Pump, I applied the knowledge to the other 2 remaining infusion pumps. I did the visual inspection, Volume testing, Occlusion Testing, Electrical Testing and charged it up.
From the manual, it states that the most common problem with infusion is flow rate not accurate; pump could not charged up, Occlusion is not adjusted to the ideal value between 10-17.1 psi and Air-in-Line. After doing the Preventive Maintenance, I charged up all 3 infusion pumps for 10 hours to see if it works after the charging. (I will check it again on Monday).
Lee Chong, Faz and Me went to the various wards, Clinics and other departments to return to medical equipment after their breakdown service or Preventive Maintenance for last week of September. Using a palm Top as a medium, Signature are needed as a mean of justification that the equipment have been returned to their owners. After all the equipment had returned to their rightful owner, back at the BME Centre, Faz taught me how to transfer the signatures to a file so that it could trace back if any departments called saying that we have not returned their equipment.
From 12-1pm, I went for lunch. Then I went to the Hang Jebat Mosque which is located not far from Alexandra Hospital. Before I went to the Mosque, I did ask the senior Engineer first because my Supervisor cum Boss of the BME Centre was on leave on that day.
Upon Returning at around 1.45pm, I received a few more faulty Alternating Mattress Pump that need to be repaired. So I attended to it as soon as possible. Approximately around 2.15pm, Mr. Toh asked me to return the power cord to the A&E department and get back the optomoscope power cord. A optomoscope is a device whereby it is used to look into the ears. So I went alone. Upon reaching the A&E department, I returned the power cord and get back the optomoscope power cord. However, one of the staff nurse asked me whether I had returned the correct physiologic monitor earlier. So I checked, indeed it is the correct ones. Since the preventive Maintenance sticker have been changed, thus the serial number has been changed as well, thus create the confusion. I assure the nurse that the physiologic monitor is correct.
When I returned to the BME Centre, I continued to repair the Alternating Mattress pump. I did change the base of the alternating mattress pump because of some breakage found. I changed all the screws too because they are all rusty and their threads almost disappear.
At around 5.30pm, a stethoscope arrived for a service. However, I shall continue repairing the stethoscope on Monday since it is late. Everyone seems to have return home because usually Friday we are entitled to return 30 minutes earlier.
I left the building at around 5.40pm.

In Conclusion for Week 1
Regardless all of the above, it’s the spark of wanting to learn and ultimate inspiration of meeting deadline that get me through the week. Blessed is he who has found his work; let him ask no other blessedness.