Kathmandu: Week 4
Making aid sustainable
When I returned to Bir Hospital and dropped by the reading rooms, it was business as usual. Residents were hanging films and discussing the findings with the attendings. I was curious why no one was using PACS. One of the residents explained that the PACS had stopped working three days before.
I ran over to the resident classroom, where the main PACS server was, and saw that it was turned off. When I asked what had happened, one of the residents said that the computer had simply turned off. When I turned the computer back on, it stayed on for a few minutes and then turned off again. It turned out that the power strip was faulty. I went out and bought a new power strip at the local market for only about $4. After that, the computer stayed on without any problem.
A secondary problem was that the computer was now receiving DR radiographs and CTs but the MRIs were still not coming across. I went to check the MRI scanner. The network cable was cut. Apparently the cable had been damaged during some construction work on the room. The hospital IT was able to reconnect the cable. The PACS was working again!
I realized at that point that the department had to have a better understanding of how the system worked in order to be able to maintain it. I spent the last week educating the residents, techs, and faculty on how the system worked and stressed that they must take ownership of the PACS and try to troubleshoot when the PACS goes down.
My time in Nepal was characterized by both triumph and set back. By the end of my stay, my initial frustration with the misdealings, inefficiencies, and disorganization had faded. Perhaps with a western mindset and philosophy, one might expect to be able to come into a hospital — as a stranger, many years junior to the people who are hosting you — and change how a department runs because the ideas you bring are considered more efficient. I believe that with this attitude one is likely to be disappointed. Service, I think, in eastern philosophy is looked at much more for its intrinsic value. As the Indian spiritual master Sathya Sai Baba said, “Love seeks no reward: love is its own reward. Transform love into service.” Once I understood this, I then realized how successful my trip had really been.
By Wojciech J. Kapalczynski, MD, University of Texas Health Science Center at San Antonio