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On lighting strikes…

Cell phone coverage in Rwanda is quite good. You can call, text or even use GPRS everywhere — even in the remote places. Unfortunately for us, Rwinkwavu is one of those places where coverage sucks. MTN (cell provider) did agree to install a cell extender to boost our coverage as a temporary solution, so they came out a few days ago to power and configure our new extender.

Getting things done in Rwanda (and I’m guessing Africa) tends to be slow and bureaucratic — everything requires explicit and multiple approvals have been given. Not necessarily a bad thing, but whether you are installing a cell tower or ordering food, expect long delays. I got a message from Giscard that the cell tower would have to tap into our UPS and MTN (provider) wanted verbal confirmation again. I was off site, so I headed towards the hospital.

When I got there, the grey skies had turned dark and swollen with rain. It was mostly sprinkles at first, but then the downpour started. By the hour mark, it was clear we were in for a long night. We couldn’t leave until we knew the cell tower was working and the MTN employees were working slowly due to the rain. We went inside the hospital to take shelter and wait.

We’d only been inside for a few minutes when we heard the crack of lighting and a loud explosion. Everything went dark. As the flashlights and cellphones came out, we saw smoke leaking from the walls. Whatever had happened in the last few seconds had destroyed the light switches in the room we were standing. The switches had exploded and the smoke was from the burning plastic. Nice.

We rushed to the power room to check things out. The UPS which was supposed to run the hospital for 3-4 hours was completely dead. Not damaged, but rather instantaneously drained. It seemed something in the power grid and shorted and sucked all the power out of the hospital. The generator had suffered a similar fate — all its electronic components were dead. Awesome.

The next stop was the server room. Everything was off (we run of the main UPS) but at luckily there was no burning smell. We were unplugging everything from the wall when we heard yelling. We stepped out of the server room into a deluge of reddish water. The hospital was being flooded. Great.

It was at this point that my flashlight was commandeered by the doctors. A patient was in surgery when the power went out, and the flashlights the staff had were not adequate. I snuck a peak into the operating room and the poor guy had some sort of mouth wound that they were sewing and it would take all night. Given the lack of power there was not much else to do. We had a quick chat, and called it a night.

The morning after was no easier. The lightning did very bad things to our equipment. The spike had come through the ethernet cabling and the power lines. We lost computers, monitors, printers, and routers. Even in the house close to the hospital strange things had happened. The satellite modem, despite being on a working UPS, blew both fuses and the motherboard was toast. I took it apart, but couldn’t figure out why it was dead.

At this point, we’ve reshuffled most of the network and things are sort of working. The EMR server survived and one of the two satellites is still running so we can still work. The UPS and generator are still down, and half the network is down because we’ve run out of routers and ethernet boosters. In a few weeks, we will be getting a shipment of gear that will get us back to full capacity. Everyone in Rwinkwavu is rebuilding after the storm. This ant path appeared the morning after…

hospital flood

Bob W said,

July 7, 2007 @ 15:47

My, my…that sounds like an adventure. It’s a good thing no one was standing by that power switch…! The city you’re in seems more technically advanced than I would have imagined. Also, there’s a sort of ironical contrast between the technology that the you and the doctors are using, and the images of the children drinking and shuttling water from the dirty water bed.

It’s curious how the doctors and patients actually interact with the technology. Is there a patient database; if there is, what type of information does it contain? i.e., Is there a detailed medical history for patients that are treated in the hospital? If the man with the injured mouth has another injury that requires medical attention, will the doctors have a medical history for him that they can use to treat the future injury? Also, like in America or Western countries, is there a expectation of privacy? i.e., HIPPA laws (Wikipedia: HIPPA). Is patient information kept confidential….There’s lots of interesting questions one could ask about your experience. Lastly, for me, is, how this technology is funded?

In any event, it does sound like an adventure. And, it will be interesting to see what type of changes you can help implement. Once again, stay safe.

Yaw said,

July 8, 2007 @ 15:24

Even between the folks from Kigali (some of whom rock Nokia phones, iPods, laptops, etc) and the folks from Rwinkwavu there is a huge difference in the technology. I think this a classic rural and urban gap and so can even see it in the states. Of course, the gap out here is quite astonishing. You can live the American lifestyle in Kigali, but in Rwinkwavu, you are clearly in the developing world.

The dirty water bed is misleading. Rwinkwavu Hospital is pretty advanced. We can do surgery and chemo in addition to HIV, malaria and TB. Everything is clean, the grounds are immaculate and at the end of the day, people get better. It’s not just the medicine, but it’s the whole model. PIH provides accompagnateurs that go every morning to patient homes and hand out medications to chronically ill. Patients who are very poor get food and adequate shelter. Importantly, no one is turned away. It’s all free — and it should be. The technology is there to ensure that we do all we can to make lives a little better (medically and otherwise).

In response to the database questions, you can look at http://openmrs.org for details. Everything that is relevant to care for the patient is stored in a database. Chronic care requires a detailed history of the patient and so we do our best to support that kind of care. I think when it comes to medical problems, everyone expects some privacy so we support that as well in the software and policies.

OpenMRS is an open source project and its funding comes (directly and indirectly) from a lot of expected places (Rwanda, Clinton Foundation, Gates Foundation, IUPUI/Regenstrief, PIH, etc). I believe the hospital (and its technology) is funded by similar sources.

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