Nyaya Health

Posted by Duncan Maru, MD, PHD

While the recent New York Times article by Matt Richtel on “Hooked on Gadgets, and Paying a Mental Price” focusses primarily on the effects our being “wired in” on our personal and professional lives, his thesis also carries important lessons for young global health organizations like Nyaya Health. Mr. Richtel puts forth the argument that, while modern information tech gadgetry– emails, smart-phones, laptop computers– have improved our lives and our workplace efficiency, there are dangers. Namely, our brains can become wired (addicted?) to a non-ceasing flow of information with resultant impairments in mental health, efficiency, and creativity. The question for us is: how to use these technologies to foster creativity and efficiency instead of becoming enslaved by them?

My very posing of this question may seem like a cruel joke for my colleagues currently working in rural Achham (indeed, if I were myself in Achham right now I would be rolling my eyes at my own post) where 1) most gadgets seem to break down rather quickly (at last count, four of our six laptop computers had perished into a sea of that awful “MS-DOS has malfunctioned” blue tinge); 2) internet works at blazingly slow speeds that would not even impress a 1990s dial-up user; 3) electricity is an extremely unpredictable and rare commodity. The somewhat paradoxical reality is that we rely heavily on electronic communication to collaborate back-and-forth across oceans and we are share the benefits and risks of these technologies.  This puts us in a similar situation to many modern corporations, in which according to some studies employees spend up to 2 hours per day–55 employee-days per year– on email alone.

So where do the dangers lie in electronic communication?  They lie in constantly needing to be “wired in” and allowing the myth of multitasking—of constant information flows—to run our work and lives.  At Nyaya Health, many of us are volunteers, we’re doctors and interns and students and fathers and daughters. We have too little time and money for Nyaya and for all our other obligations. So we all fall into the trap of trying to do 10 things at once. The problem?  Many of us let the email inbox, which we check compulsively or which is running continuously on our screen, run our priorities rather than going through our task lists one-by-one.  Neuroscience research has borne out that our brains are actually far less efficient at learning new information when we are flipping back and forth even as we perceive that we are getting a lot of stuff done at once. One statistic is that multitasking leads to a greater fall in IQ than that seen with acute marijuana intoxication.

Still, as we discussed in other posts on transparency and accountability, on volunteers management, and on telecommunications, Nyaya, with its extended virtual network, depends upon a few core technologies– email, listserves, evernote, and wiki– to communicate amongst our members.  The key strategy we have attempted (with continued challenges) has been to get information transfers out of immediate response media (i.e., attention-flipping modalities like email, twitter, chat, texting) and into collaborative media with the capacity to have updated, real-time priorities lists like wikis (Nyaya Health happens to use Evernote and Pbwiki for this, which is another topic). We discourage the use texting and twitter, which have essentially little productive value (typing is slow on mobile devices, and they shift our attention).We try to keep email to a strategic minimum but that is quite challenging.  Quoting from our wiki page on collaboration:

• any email longer than a few paragraphs you should consider just calling, voice chatting that person (more difficult for Achham folks; contingent upon current internet situation). any email that requires formal documentation, post to the team list serve or wiki.
• for requesting tasks for other members, you should provide organized, bulleted points.
• if you do feel compelled to write at length about a topic, you should take the time to organize your thoughts on the wiki (for pages for public consumption, or for US-based team collaborations) or evernote (Achham-based clinic operations) and then send your collaborators a link to that. it is so much more efficient for your thoughts to be in an indexable, saved format than in your email.
• it is a good idea to hit “reply all” on almost all email correspondences with other team members.

The fact that our inboxes are always full and expanding is a metaphor for our lives—there are always crises, always immediate tasks that pull our attention in multiple directions.  As a young doctor, my patients and my nursing and physician colleagues all are trying to get my attention to address their own needs of the moment.  As managers at Bayalpata Hospital, there is always a water line leaking, a machine blinking in disarray, a community member dissatisfied, and a patient with greater needs than our small operation can effectively support.  At an organizational level, we have struggled to work towards a culture where we systematically go through our prioritized, chrono-lized task lists rather than being pulled in multiple directions at once.  In constantly fighting a battle with our minute-by-minute crises, we often lose touch with our more big-picture vision.  We become so obsessed addressing the endless stream of pages on our beepers or working through our ceaseless task list that we forget our most fundamental of missions: accompanying, listening, and empathizing with patients and their families as they struggle through some of the most terrifying moments of their lives.  No simple solutions here, just perhaps a reminder for all of us to occasionally take a step back, turn off our minds and our wireless devices, and meditate for a moment on the big picture.

Tags: Achham, Duncan Maru, global health delivery, information technology, multitasking, neuroscience, nonprofit management, telecommunications