Technology???

Technology???
…….after spending five years in rural Nepal ( three years as a resident and two years as a GP), it is difficult for me to decide whether I love or hate the technologies. In all these five years I have seen people being fixed purely by human efforts. Clinical judgment was the best available technology we had in those areas. After coming back to Kathmandu and in the course of my surgical training, it came as a frightening knowledge for me to see how people depended heavily on technologies. Clinical knowhow is placed at the backseat and major decisions are made solely depending on technologies like lab reports or CT Scans or sometime on Histopathology reports. All the hotshot doctors are seen boasting about the piece of surgical gazettes they possess or they had witnessed during their foreign tours. Three chip laparoscopic cameras, Harmonic scalpels and single hole laparoscopic instruments are marketed in the lavish auditorium of five star hotels followed by equally lavish cocktail dinners as if they are here to create a permanent solution to all the health problems of this country. Laser surgeries are advertised and congratulated in the papers in such a way that it looks like they have achieved the Millenium Development Goals. This is the unfortunate picture of all developing countries where solutions for the problems of the poor dying population of the country are searched in the comfort of the capital city amidst the so-called ‘cocktail dinners’.

One of my Australian friend in one of such program declared ‘this cannot be considered a developing country!’ He had just seen an elite jet-set local businessman rushing towards his health club and talking about holidays in one of the resorts in Pattaya over his cell phone in the hotel lobby. This Australian friend of mine, who worked as a doctor, in a rural Nepal for five years, when met some of the Nepalese doctors in a conference, was dead surprised to know how these urban doctors were divorced from the harsh reality of their surroundings and its health conditions. He had a good laugh when same people delivered lectures on making primary health care accessible to the rural population of Nepal. That is the sad picture of Nepal. How our policymakers are supposed to realize the agony of the people scrounging for food and clothing, lacking basics like safe drinking water or sanitation, for whom primary health care is an unknown luxury.

When we talk about transplants and bypass surgeries, I think about the woman who lost her life because there were noone to attend her obstructed labour. This discrepancy in health care is inevitable when we cannot prioritize our needs. On one hand, we know that our crying health needs are drinking water, sanitation, public health and preventive medicine and our prime problems are rampant malnutrition, malaria, tuberculosis and infections. On the other hand, there is so much enormous pressure from the healthcare industry of the developed countries to sell their products in the name of ‘development’, it is almost impossible to resist this temptation. Laparoscopic surgery and recently Laser surgeries are the end products of such pressures. Dr Udwadia, who introduced laparoscopic surgery in India, stated in one of his book that sadly but inevitably the true picture of the developing world is a varied tapestry of all these perceptions with every gradation of inequality and deprivation in between. In contrast, Dr PK Sen who pioneered cardiac surgery in India lambasted those regressive minds and said ‘there are sanctimonious do-gooders who never accomplish anything, who will fight any form of medical progress as an expression of sympathy for the poor.’ He added ‘if we were to wait till everyone had water and sanitation, it is very possible we will have neither drinking water nor surgical progress’. What he said in 1957 is worth thinking over today. What we need at this hour of transition is to strike a balance between technology and basic need of a typical developing country.

That is the reason why, at this stage I am not sure whether I should welcome technology or denounce it. These technologies should not make poor more poorer in the name of advancement. Laparoscopic surgery is of course ‘the’ example of technology with the potential ‘usefulness’ for the whole country, as far as, patient convenience is concerned and already there are few laparoscopic centres in rural Nepal. But single hole laparoscopy or natural orifice laparoscopy, for me, is total absurd. Following the principle of ‘Cutting edge advances should be made available to all people at all places’, we should look for technologies that might serve the rural population too. Telemedicine, CDMA phones, ropeways are few examples that might bring change to new Nepal. Mahabir pun type of information technology, Grameen Bank – a Bangladeshi bank of microfinance that won Nobel Prize to its founder, our own –aafno gaon aafai banaun type of campaign, government subsidy for the small hydropower projects are already few examples that had worked wonder to the rural development. Internet connection backed by solar power, DS Manandhar incubator – a Nepal made incubator to keep newborns, alternative power solutions like Gober (cow-dung) gases, ‘sudhariyako chulho – gasless stoves and maternal waiting homes –place where pregnant women are kept to avoid complications are all examples of our-soil-friendly technologies. There are other uncountable examples where technology has crossed lines with rural development. These technologies rarely catch our attention in such ‘cocktail dinners’. Rural friendly technologies, no matter whether they are locally made or imported, should be declared ‘creams’ and all other ‘craps’.