Week 7: Internship Reflections

At the end of the fifth week of my internship, I reflect on my time at Boston Scientific so far. I am working in the Process Development (PD) department. This is an area that I didn’t know much about before I started, but has been a really exciting place to work. PD works with both the Research and Development department to design new products and the Manufacturing department to ensure efficiency and quality when these products are being built. It therefore requires thinking about a wide range of steps in the engineering development process. I think that being part of the bridge between design and manufacturing has given me good view of different aspects of a medical device company.

The project I have been working on has been very interesting to learn about and contribute to. I’m currently digging deeper into each of the processes that will be used in manufacturing this new device. When working with medical devices, seemingly tiny details can make a huge difference for a patient, so each process must be carefully considered. I’m looking at the desired results of each process that will come together to make the best final product.

With three weeks left of the internship, there is still a lot left to be done. My goal for this summer was to learn about and see many of the functions of a medical device company throughout the engineering development process, and Process Development has put me in a great position to do just that as I work on my project. I’m sure that these next three weeks will fly by, and I’ll be in Houston before I know it. In the meantime, I want to continue to contribute as much as I can in my internship and enjoy more of the beautiful country of Costa Rica!

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Week Seven – Live and Learn

There are good weeks. These weeks leave you feeling a sense of accomplishment and pride—a knowledge that time has passed and you’ve leapt forward into new territory, conquered fading enemies, completed missions, made new connections, even found a niche in the world around you perhaps. There are these weeks…and then there are not-these weeks.

This was a not-these week.

I’m not sure if you’ve been reading all of my blog posts, dear reader, but perhaps if you think back you’ll remember the naivety of my statement: “I think I may actually be able to finish my projects”. Yea. About that. The past few weeks have been a collection of small setbacks amounting to the current realization that I am woefully behind the schedule I created for myself.

The Gantt chart I drafted at the beginning of the summer, on the first week of my St. Jude experience, has been updated weekly. I’ve watched with growing concern as “shipping-delays” and “cancelled meet-ups” have pushed back critical deliverables until certain events this week left me completely frustrated with the state of my projects.

This is not to say I am not entirely without fault. You would have thought after two summer internships in the medical field I would have learned a few things about the design process. Namely, there is no design that will please all. You can add this or that and someone will have something they don’t like about it. Someone will think it isn’t going to work. Someone will look at your sketch or your CAD or your beautiful 3D animation—slaved upon for hours over a hot hard-drive—and find something that just isn’t up to par.

That is why prototypes exist. My critical mistake this summer was not creating rudimentary prototypes. Instead I lost time and wasted effort on creating intricate designs that simply did not please the right people in the right ways. Some of my errors I see, some of my designs I still think could well work, but now with only three weeks left of my internship, I realize my mistakes have cost me dearly.

I will not be completing one of my projects. I will do the best I can to supply something that is easy and straight forward to continue on and implement, but it will not be the product I had hoped to create.

This is disappointing and frustrating. What’s harder is, looking back, I see where I could have changed things to make the whole internship smoother.

But that’s why I’m here I suppose. Perhaps the biggest lesson to be learned is that I do now know it all. From product design to manufacture, there is room for improvement. I hope the next three weeks I can learn from the mistakes of the past handful and move as far forward as I can.

 

Jeannette Nelson

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Making the Most of the Last Few Weeks – Week 7

Erica, Jeannette, and I are just returning from our three-day beach vacation in Manuel Antonio, coming back to San Jose rested, relaxed, and ready to make the most of the last three weeks of our internships. If the next three weeks are anything like this past work week, I am going to be quite busy with a jam packed schedule. This past week at work (fifth week of the internship) was the busiest work week I’ve had yet. In addition to deliverables and work done on my main project, I have been added to another project with high urgency. This new project is quite exciting, and allows me to collaborate with engineers I haven’t yet worked with. However, because of the urgency of the issue the team is attempting to solve, there is little time to waste. After a quick debriefing on Thursday to bring me up to speed on the issue, I was off with my own set of tasks and objectives.

The manufacturing issue my team is challenged with solving has no simple solution. The engineers on the team have been working towards a solution since May with only minimal progress. My addition to the team adds a new perspective and viewpoint to a problem that has stumped the engineers for far too long. Rather than focus on what has already been investigated by the team, the engineers encouraged me to start from square one, giving me he freedom to propose an investigation of any part or process in the manufacturing line. Because of my lack of experience with the problem, the hope is that I may come across something new that has been overlooked by the team. Given the time I have left at work, it’s uncertain if I will have sufficient time to complete this new project with the engineers, however I do think I will be able to contribute useful results from the investigations I conduct over the next few weeks.

With the internship quickly coming to an end, I have begun reflecting on my summer experience thus far. This summer has been challenging for a number of reasons, but has presented a multitude of learning experiences both at work and in other settings. I have traveled abroad quite a bit in my life, but working in a foreign country provides completely different experiences and perspectives than I had anticipated. I will leave Costa Rica with a better understanding of how a US based multinational medtech company operates in a foreign country, as well as an understanding of the importance, benefits, and difficulties of the global medical device industry. As someone who aims to work abroad in the medtech industry, gaining this perspective early on in my career is an incredible opportunity.

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Short Course v2.0

This week we took part in the second edition of the Medical Innovation Short Course right here in Costa Rica. In my case, this is where I found out about the GMI program last year so it was a slightly different experience for me in terms of my expectations.

Compared to last year’s course, we only had one week instead of two and it was all taught at the UCR main campus – except for the final presentation at CINDE. Also, I took the course as an undergraduate student last year and it seems somewhat unbelievable that so much as changed, considering I have gathered so much experience in my family’s company, in the course I teach and also in the past few weeks with the GMI program and the internship. I definitely felt my role changed within the group I had to work with since I could contribute more from personal experience and as a medtech engineer.

Overall, the topics given to us did not change too much; in my opinion, only the timeframe changed which made it pretty fast paced. It was a welcome refreshment course for me and I did enjoy working with a new team of Costa Rican college students. Last year I initially struggled with team interaction but this time I believe the few months of teaching experience I have acquired helped me guide my own team without assuming an instructor role – it was more of subtle suggestions whenever the team seemed to get stuck with a single idea. I do not mean to say that I had all the correct answers, but I did feel comfortable enough with the topics being discussed to give a solid opinion in most of our group discussions.

Of all the activities we did, the prototyping workshop was, by far, everyone’s favorite. I got to do almost every activity but I especially enjoyed sculpting parts and creatures as concept generation through sculpting. My octopus king had heavy competition from Dr. Richardson’s blue pig. It was also nice to refresh my knowledge on decision matrices. I try to implement a very basic overview of the design process in the course I teach, but I am no match for Dr. Wettergreen’s lectures – he’s at another level. I can only hope to teach at a similar level someday; it’s a real pity that he does not teach any master’s course at Rice at the moment.

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Low fidelity prototype for our hybrid medical incinerator. -By Team MedChem

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Concept sculpting – Octopus King (Own Work)

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Heavy competition from Dr. Richardson.

I must should also comment on Dr. Richardson’s lectures: he always mentions that the regulatory process is not something a lot of people are too fond of but I hope he soon realizes how much interest I have in it. I enjoyed that part of the course quite a lot and I am very much looking forward to discuss that topic in our GMI curriculum. One of the things I am more curious about is how harmonized different regulatory bodies could become since medtech development is shifting towards countries other than the US.

Regarding the specific project I worked on at the course with my team (which we named MedChem), the problem assigned to us had to do with the Pathology Lab at the Liberia Hospital, the same one we visited on our Week 1 Needsfinding tour in Guanacaste. I found our idea to be somewhat challenging as it is not as well set into a clinical setting more than an auxiliary part of the clinical workflow. This did not stop us from coming up with a great idea through the design process. We focused on reducing the environmental impact of medical incinerators for in-situ treatment of generated pathological waste. We named our solution “Flare”, a hybrid medical incinerator which takes advantage of solar energy to reduce fuel consumption. Everyone got to play a key role in mounting a brilliant presentation. Other than only focusing on the many design engineering skills we have been taught throughout both courses, I also tried to deliver a visually stunning presentation since I have worked in my graphic design skills in the past few months. I was very satisfied with my work and the team’s work. I really loved working with my team: Alejandro, Alexis, Cassandra and Glenda. I hope I run into them in the future just to catch up on what they are up to.

Now that we are over halfway done with the CR experience, I am starting to feel some excitement (and inevitably a little anxiety) over what is to come in fall. These remaining four weeks will go by even quicker than the first part of the internship. I hope we are assigned more tasks and learning experiences at BSC this coming week just to keep on taking in as much as we can from the industry.

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GMI Short Course – Week 6

We are now more than halfway through our time here in Costa Rica! This week, the GMI students and I took a break from our internships and participated in the Medical Technology Innovation short course taught by Rice professors, Dr. Richardson and Dr. Wettergreen. The short course was designed to teach medical technology product development, from concept generation to commercialization, and to provide experience working on an international, cross-disciplinary team. About 20 Costa Rican engineering students from different schools and disciplines were accepted to the course and worked alongside GMI students throughout the week to develop prototypes and solutions for various medical needs and challenges.

I worked on a team with four other engineers from the Instituto Tecnológico de Costa Rica (TEC), each of them studying a different engineering discipline, from Mechatronics Engineering to Industrial Engineering. Our team was tasked with developing an innovative solution for treating cardiac tamponade, a condition characterized by fluid build-up around the heart. This week was a great refresher course on the design process of medical technology. The course material was very familiar to me since much of the material was also taught in my capstone design course at Rice last year (also with Dr. Richardson).

It was extremely rewarding to see how quickly my team became interested and invested in our project, as well as to see the amount of hard work they put in despite the constrained time frame. Our hard work paid off at the end of the week, and my team took home first place in the design showcase that consisted of a 15-minute presentation about our solution, market analysis, and regulatory considerations.

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Me and my teammates with Dr. Wettergreen and Dr. Richardson after we won first place in the design showcase!

This week brought back many fond memories of working with my capstone design team at Rice last year. Though it is sometimes a challenge to work collaboratively with a team, there is no better feeling than when a team comes together to create something everyone can be proud of, knowing each member worked as hard as they could to accomplish their shared goal.

I’m excited and ready for the last four weeks of my internship at Boston Scientific, and am eager to see what challenges and successes await me and the other GMI students in the weeks to come.

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Week 6: Medical Technology Innovation

This week we took a break from our internships to participate in the Medical Technology Innovation short course taught by Dr. Richardson and Dr. Wettergreen from Rice. The class was held at Universidad de Costa Rica with students from several Costa Rican universities.

We were put into teams and spent the week learning about the process of medical device design and then applying the concepts to a design project. The first two days included doing research on our assigned project, establishing the criteria for our design, brainstorming solutions, and screening them to decide which one we would move forward with. By Wednesday we were ready to build our low fidelity prototype. This meant that the prototype would illustrate the main aspects of our design using very basic materials, so we built our device mostly of popsicle sticks, tape, straws, and paper clips. We then learned about and discussed how we could potentially move forward with our device, including strategies for manufacturing, receiving FDA approval, and applying for a patent.

Working with my team on all of this was a really exciting process. Each of the five of us has different majors within engineering, from Mechatronics Engineering to Industrial Engineering. Working in such an interdisciplinary team meant we each had different skills and ideas to contribute, and we all ended up working very well together. It was great to work with such passionate students that really want to make a difference in the field of medical technology for Costa Rica and the world. I had never gone through an engineering process so quickly before, and I was amazed by how much we accomplished in just five days. It was a great week filled with new friends and a very successful project!

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My team with our prototype

 

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Week 6: Expectations and Inspirations

We are now more than half way through our Costa Rican experience and this past week was spent in an intensive, collaborative medical product design quick course. With twenty Costa Rican engineering students from a variety of majors, representing the major universities in the San Jose region, the course covered a high-level overview of everything from market analysis to idea generation, rapid-prototyping to manufacturing cost analysis, medical regulations to patient creation.

For the most part the information presented in this lecture was not necessarily new to me. While my degree in Mechanical Engineering did not cover many of the aspects specific to Biotechnology the overall process of product design was review. The part of the class that was the most interesting, and the most education, was the project-based component. The class was divided into subgroups, each given a specific need to design a product to. My team’s need revolved around my trip to Liberia and the growing number of dialysis patients in low income communities.

Throughout the week we worked to develop a design given the specific customer needs of the Liberia and Guanacaste communities. Five strangers, very different in their age, experience, background and technical knowledge came together to complete a demanding project. I could not be prouder of the team and people I was put with for this project. Their passion and exuberance, desire to learn even though a class in English was well beyond many comfort zones, and team attitude was inspiring to me.

I am not sure what I expected with the class. Coming from a large school it was not uncommon in my undergraduate to get students who were lackluster in both effort and attitude—preferring to skate by with low effort, mediocre performances. Those on my team showed no such demeanor, going above and beyond what was required by spending time outside of the class to do additional research, practice, and complete assignments.

I can only hope that I work with teams of similar individuals in actual jobs in my career.

Jeannette Nelson

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Week 5: Spanish Challenges

One of the greatest challenges during the past few weeks has been the language barrier. I took Spanish classes for four years in school, but had no other experiences with the language until coming to Costa Rica. Now, having to communicate in Spanish, not only for casual conversations, but also for work-related conversations, has been very challenging.

All of the engineers at Boston Scientific are required to have a certain English proficiency level. However, most conversations in the office take place in Spanish. On Monday of this week, I took part in a training course about the statistical methods used to validate manufacturing processes. Although the written information was in English, the instructor spoke in Spanish. The material I learned in the course will be very useful for the testing I will be doing in the next few weeks, but understanding the language the course was taught in would have made it that much more valuable. In addition, most of the employees who work on the manufacturing lines know little to no English. This makes it more difficult when I need information about the equipment or processes used in manufacturing. All of this has added an extra layer to the learning curve of my first internship at a medical device company.

Through these difficulties however, my understanding of Spanish is certainly improving. As I speak and hear it spoken more, I can usually understand enough to get the main ideas of what is being said. Everyone at Boston Scientific has been very understanding and accommodating as I try my best to learn. We’re now at the halfway mark of our time in Costa Rica, and I am happy with what I have accomplished so far and looking forward to improving my Spanish more in the weeks to come.

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Halfway Through the Internship!

This week was very intense compared to the rest as we got to do a little bit of everything in a relatively short amount of time.

On Monday we attended a Sampling Plan & Validation training which really helped understand the way processes are guaranteed to do what they are supposed to within manufacturing lines. We got a glimpse of how Minitab is used to calculate many different aspects that determine different aspects of validation plans. This was all very new to me but I believe I got the hang of it so far (we were even tested on it!). Training sessions are a lot more concrete than simply reading documents which tell you about it so I am thankful for this learning opportunity. Since this training was done in the Coyol site, we got to see the contrast in size and complexity compared to the Heredia site.

The rest of the work week at BSC consisted in more of my process characterization project but we also had to tend to a pressing request from our peers. We had to help them meet a deadline regarding some technology assessments; I was very glad to help as it is something I was familiar with from my training as an electromedical engineer. Even if the main purpose of the internship is to learn as much as we can, sometimes it is refreshing to help with things you already  feel more comfortable with. For that assignment I had to consult dozens of documents in the database, do some research and, best of all, I got to run through all -and I mean *all*- the production lines in a single afternoon just looking at equipment and their respective processes. I am glad we managed to help the other engineers within such a short notice. Sometime in all that working frenzy, I accidentally dropped my keys in a meeting room but I was impressed how easily I  got them back from the security department!

One other thing we did this week was visit the Viña Christian Community Center at Bajo de los Anonos, Escazu where we met up with Giancarlo and George from the CWB Foundation. We picked up Carolina, a GP who donates part of her time to help children without access to much healthcare, on our way to Anonos. I enjoyed working all morning to help mostly single mothers and their children; even if I don’t have proper medical training, I helped organize the time table, record-keeping and basic pharmaceutical inventory. I figured that before determining what was needed, we had to organize what was already available. I also had Jean Carlos drive me to my family’s office to get a few face-masks mostly due to my personal concerns that the patients might catch something by just being in the waiting room, especially with the ongoing respiratory virus alert emitted by the National Children’s Hospital.

We were toured around the neighborhood (with due precautionary measures) which always serves as a reminder on how much need for social intervention these places have. This one in particular is of a lot of interest to me since my grandmother helped this same neighborhood a few years back, and the fact that it is so close to where I used to work and where I live makes it even more accessible for any future help I can provide.

Another week has gone by and we are already halfway through the internship. We have the upcoming GMI short course which in my case I feel very excited about! I already took the same course last year (which is mostly why I applied to the program) so I get to see what changes have been made and I get to review everything from a different perspective as a Rice student. I think the only thing I am not really looking forward to is all the traffic we might encounter on the way to San Pedro and back, but if I did it for almost five years I am sure I can cope for a single week – definitely worth it!

 

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Liberia and GMI

Let me tell you a story.

 

A Costa Rican man wakes before dawn. His family, wife and five children, sleep soundly though the house—open to the outside as there is no door—is warm, the air sticky and filled with the buzz of insects. He pulls a long sleeve shirt on, patched pants and thick boots. Though the day is going to be hot he needs the protection from sun, insects, and foliage. He notices briefly that his legs are swollen and his stomach aches but he brushes it off as just another symptom of work. He leaves for the fields before the coming sun has a chance to even dimly light the horizon.

Work is hard and intensive. He has a single bottle of water to last the day, filled from an unknown source, and the sun by ten beats down relentless. By noon there are still no clouds in the sky and the temperature climbs steadily toward its peak in the mid 90’s. The man feels each degree and movements become painful—the human body not designed to withstand such physical labor in such painful conditions. But he continues. His sons are too young to begin working, the oldest only five, and his wife cannot work as the baby needs constant attention. His lone income must support them.

By the end of the eleven-hour day he is stiff, sore, and irritable. His back aches from the stress of constantly leaning over, pulling weeds and debris from the plants destined for shipment to the United States and Europe. A headache pulses at his temple from dehydration and sun exposure. When he arrives home he says a brief greeting to his family before reaching for the pain killers, cheap and over the counter. He swallows three in quick succession with the aid of a beer.

Alcohol is cheap here and it helps him relax. The weight of the stress—feeding and clothing a family on such limited income—melts away with each drink. He eventually sleeps soundly enough.

The next day is not the same. He is nauseous and can barely pull himself from bed. His limbs are thickly swollen and he is exhausted but unable to sleep due to the sharp pain in his abdomen. He takes a ride with his friend—the only one of whom who own a car in his neighborhood of patchwork houses—to the regional Hospital. The doctor comes out looking tired but unsurprised, diagnosing the man with kidney disease. He will need to begin dialysis immediately.

He can no longer work. As they begin the surgery to implant the catheter into his abdomen he wonders vaguely…how will his family eat now?

 

This has become a sadly common story for those working in the fields of Costa Rica and specifically Guanacaste. For the Liberia Regional Hospital the average age seen beginning dialysis is only 40. Within the last few weeks, two 18 year olds (having already been working for a number of years) were diagnostic with kidney disease. Most of these people have families they are supporting and have only a very limited income. Some, those immigrants from Nicaragua, without papers or government support, will not even be able to withdraw from the Costa Rican health care system.

I traveled to the Liberia Hospital this past week to see what could be done for these patients. Many do not have the means at home to perform the dialysis procedure and must make the often lengthy and costly journey to the hospital regularly. It is in this that we, both my team in GMI and Rice University as a whole, can make perhaps the most immediate and greatest difference. The design and construct of a cheap, adjustable tool for the aid in dialysis delivery can help those who cannot currently complete this task on their own.

I’d like to think this is why the Global Medical Innovation program exists. We are students but we are also engineers, designers, builders, creators, and dreamers. With the aid of Rice, and this program, we can begin to fill the gaps in the world’s healthcare system: going to the places, meeting the people, and repairing the systems that have been ignored, forgotten, or over-looked. There are so many needs in the world of medicine and medical technology, some small and some large. We students only have a year to try and meet some of these needs but even if we bridge only a small gap in a small corner then we have moved the whole world forward just a little.

This is why I’m here. This is what moves me and why I strive to grow as a medical engineer. I don’t know if I’ll ever see any difference in the world, but if I can make a difference to one struggling family then it was worth it. That’s all.

Jeannette Nelson

 

I would like to thank a few people for my experience in Liberia this past week, it truly was an inspiration trip. First to Emmanuel and Bernal for helping me experience what is truly faced by the patients. Without them I would not have understood the hardship and real needs of the community. Secondly Rice University, the GMI program, Eric Richardson, and Sheretta Edwards for coordinating and financing the extra trip. Thank you for helping me understand why I’m here.

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