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Posted by Ruma Rajbhandari

The team investigates the problem.

When Dhan Bahadur, our X-ray Technician, called us over and told us that our X-ray machine was broken, I was shocked.  This was the WHIS-RAD, the extremely durable and safe machine promoted by the World Health Organization, for being perfect for resource-poor settings.  It was supposed to last for many years, not break down after merely 15 months of operation.

However, here we were, Gregory (our Country Director), Bharat Rawal (our Maintenance Assistant), Deepak Bista (our Database Manager), and Dhan Bahadur staring at the machine, wondering why none of the lights that signified that the battery was charging were lighting up.  The machine would start up but when we tried to shoot a film, it would automatically shut down and a light would flicker—“Error 11”.

“You know, the last time the x-ray broke, we opened up the machine and found a wire that had been eaten by a mouse,” offered Dhan Bahadur.

Deepak Bahadur Bista, Database Manager, goes in for a closer look.

So, we proceeded to unscrew the large metal case of the machine and take a peek inside.  The first things that caught my attention were tiny, black mouse droppings, littering the inside of the machine.  My heart sank—a $30,000 machine potentially ruined by these nasty, tiny creatures!  Although the whole machine was encased in a metal cover, there was a small hole in the back for wires that the mice could get in through.  Dhan Bahadur, to his credit, had duct-taped the hole after the last mouse incident, but it was still possible for a persistent mouse with good teeth to get through.  We combed through every part of the machine but found no wires that had been chewed through this time around.

Dr. Ruma Rajbhandari, Volunteer Physician, reports voltage readings to Sergio in Spain.

The WHIS-RAD is produced by a Spanish company called Sedecal.  We emailed their customer support department with our problem and received an immediate response.  However, the response was quite technical, requiring us to measure voltages across various internal parts of the machine.  I think that they must have assumed the hospital would have some sort of a Maintennance or Engineering Department that would be involved with fixing the machine.  Little did they know that our X-ray technician and Maintennance Assistant simply had a 10th grade education.  We wrote back to Sedecal explaining the situation and asked them to come on Skype and lead us step by step through the process of figuring out what was wrong with the machine.  Sergio Rios, the Support Engineer for Sedecal, promptly downloaded Skype (or Skypeeeee as he likes to call it) at 3:30p.m. Achham time, or 10:30a.m. Madrid time.

For the next eight grueling hours, a Spanish engineer in Madrid (Sergio Rios) and three Achhami staff at Bayalpata Hospital were linked together via a laptop computer and an amazing video chat program, transfixed by a single goal—how to fix the x-ray machine so that we wouldn’t have to turn away any more patients who had walked for hours (some over 2 days) to obtain an x-ray.

Dhan Bahadur Bogati, X-Ray Aide; Deepak Bahadur Bista, Database Manager; and Bharat Rawal, Maintenance Assistant (left to right) think through new angles to the problem.

Despite their limited formal education, our Achhami staff came together as a team and each brought with them a skill without which the x-ray could not have been fixed.  Dhan Bahadur, having been the x-ray technician since the very beginning, knew all the nuances of the machine—when certain sounds would emanate from the machine and which lights should light up at what time.  Bharat was our hospital’s “Mr. Fix It.”  He was particularly good with electrical repairs and owned a small handheld voltmeter, without which we could never have figured out what was wrong with the machine.  Deepak, with his Bachelor’s in Computer Science, had put together the circuit boards of computers and was instrumental in replacing the defective line monitor board, the ultimate culprit behind the broken machine.  Voltage fluctuations are very common in Achham where triple-phase electricity still does not exist.  According to our Spanish support engineer, despite the use of a voltage stabilizer, erratic voltages had damaged the line monitor board.

Sergio Rios, Support Engineer from Sedecal, leads the charge from Spain.

At 11:30p.m. Achham time (6:30p.m. Madrid time), we all broke out into huge smiles and yelps of joy as we saw all the battery lights on, the machine lighting up, and Dhan Bahadur finally able to shoot an x-ray!  We cannot thank Sergio and the Customer Support Department at Sedecal enough for their dedication in leading us step-by-step through the process and essentially giving us a whole day of their time.  When our internet connection was too weak for video, Sergio would even take pictures of various parts of his prototype machine and send them to us over email.

Finally, an enormous thank you to Skype for being not only amazing (what other program can claim credit for bringing people in the unlikeliest corners of the world together to fix a machine?) but also free!

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Ruma Rajbhandari is a physician at Boston’s Brigham and Women’s Hospital.  She volunteers with the Nick Simons Institute and Nyaya Health.

One Response to “Bayalpata Hospital’s X-ray Repairs: A Story of Mouse Droppings, Sedecal, and Skype”

  1. Mark Arnoldy says:

    Also note that Sedecal has shipped replacement parts to our Boston office from Spain to carry over to Nepal. They are a truly extraordinary company, and we owe them a great deal of thanks!

    Mark

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