Posted by Gregory Karelas
Before beginning our conversation, Deelip Saund showed me a brief video clip of one of many interviews that he had collected from his patients at Bayalpata Hospital. Many of them had never had an x-ray before. He said that their conditions and experience taught him more about his work. Yet he candidly admitted that they taught him about life.
Although medicine has taken giant steps into resource-limited regions the world over, its necessary supportive services seem to have been largely forgotten. Primary care, surgical and obstetrical services rely on diagnostic imaging for quality delivery, but have been too often forced to proceed without it in poor rural areas. Unfortunately, little data exist to offer significant statistics regarding the extent of this neglect. But it can be intuited from stories like ours. Some surveys report that almost 70% of x-ray machines in some developing country settings do not work. In far Western Nepal, Bayalpata Hospital offers the third of three x-ray machines to a population of over one million people.
Deelip Saund was among the first to greet me in Achham. He had come to Bayalpata Hospital as a visiting radiographer. His command of English was impressive, which I erroneously assumed resulted from his professional connections in Europe, and his smile had the kind of excitement that stood out in a crowd. Beyond what I could see in front of me, I only knew that Deelip Saund was somehow affiliated with Borgny Ween, a Norwegian radiographer and PhD student, and long-time friend of Nyaya’s. During our interview later that week, I asked him what he had learned from his time at Bayalpata and if he had captured that in his interview documentary. His answer was indirect but relevant, as he began to speak about dedication to people through service.
In rural resource-limited areas, X-Ray and ultrasound are ideal diagnostic tools because they can meet over 90% of the imaging needs of the primary and emergency care of those settings. Conversely, their absence increases the risk of misdiagnoses, treatment delays and negative health outcomes for patients that have traveled long ways at substantial cost to receive life-saving care. In response, the rapid and standardized introduction of x-ray and ultrasound machines deserves global attention with consideration for the following criteria: a) reliable functionality in harsh environments, b) operational ability with unstable electricity, c) minimal emission of dangerous radiation, d) ability to be operated by non-specialists, e) high quality imaging capabilities. Unfortunately, demand for these machines has been insufficient to warrant their production.
Deelip Saund’s patient interviews consisted of one simple question: “How do you feel when you receive an X-Ray?” As a native New Yorker with the privilege of having never even considered this question, I looked at him quizzically. He smiled. Since most of his patients had never had an x-ray before, their responses to his question were important. As a small team of us had learned only a week before, the scarcity of x-rays in Achham had led to myths of its powers as a cure-all technique and highly sought magical treatment throughout the region. Many of Deelip Saund’s patients answered that the x-ray made them feel amazing. Some reported fear. Some simply said “cold”. Deelip Saund laughed at this last response; perhaps in realization of its veiled wisdom, or perhaps because it was just funny. Regardless, he cherished them—his patients and their responses—and said he hoped to return to Achham and Bayalpata Hospital as soon as possible.
There is hope for diagnostic imaging for the rural poor. The mobilization of governmental and non-governmental actors, academic institutions, the private sector and the resources of each, can drive the production of affordable imaging mechanisms that meet the criteria for optimal functionality in resource-limited settings. Such collective leveraging can surpass the demand threshold for their production and prompt the development of programs for their safe and easy operation. In fact, it must, for there seems to be little incentive for these needed tools beyond it.
We, at Nyaya Health, hope that Deelip Saund’s visit was the first of many—for him and myriad others–to herald learning through service to the people of Achham. The only detail lacking from Deelip Saund’s interview was how much he taught Bayalpata Hospital. His expertise and magnanimous disposition were as instructive as they were appreciated. We thank you, Deelip Saund, for what you taught us, and hope that Achham brings you back for further instruction soon.