a revolution at your fingertips

By Hom Lal Shrestha

Medical Transcription (MT) services is an innovative start-up and a milestone in Information Technology (IT) development in Nepal. Medical transcription service is one of the broad IT enabled services for Nepal to have enormous potential for export to the US. The main clients are hospitals and medication organizations throughout the US.

Medical Transcription is a process of accurately and swiftly transcribing medical records dictated by medical professionals. Also, computerization allows for easier access, presentation and distribution of patient records. Medical Transcriptionists listen to a voice file and type in using plain text. There are three levels of quality checks before the final text is compiled and submitted back to US hospitals over the Internet. Grading of transcriptions are done daily by the supervisors.

Doctors and medical professionals in US hospitals have to record every patient’s medical transcription. Voice is converted into digital format and the digital voice is transmitted to the servers over the Internet. The medical transcription documentation for hospital, clinics and medication centres throughout the US should be transcribed, which is received as voice file via V-SAT or servers through Internet. The key medical transcription documentations are: discharge summaries, operative reports, history and physical examinations reports, chart notes, emergency room reports and letters and other reports.

Medical Transcription service has already been well established in the US, but qualified manpower is unwilling to take up this job. Twelve hours time zone difference works to our advantage, cost and time savings is the key plus point for medical transcription services.

Nepal has a world-class telecom infrastructure in South Asia with the potential to emerge as the preferred global destination and the hub of IT and it offers cost and quality advantages. Nepal is the first and probably the only country that allows private companies to have their own V-SATs to act as gateways into the rest of the world.

According to AAMT, USA, the demand for transcription has been growing at a rate of 20%- a result of the 5% growth in outpatient visits and increased scope of transcription services to include new hospital and departments. More than 6,700 hospitals in the US scramble to meet Federal Certification requirements to convert medical records to electronic formats. Employment in US is 270,000 and availability of medical transcriptionists is falling by approximately 10% per annum.

According to MT Daily News, there are numerous medical transcription companies involved in the SAARC region. In India, there are more than 250 companies involved in medical transcription services. In Nepal, more than 100 million rupees have been invested in medical transcription services for over a year for infrastructure, and human resources development, and training.

Nepal is being placed on the Global Map of IT in this millennium. The government approved the IT Policy 2000. To disseminate and communicate on medical transcription business in Nepal, a paper entitled "Medical Transcription (MT) Revolution: A Millennium Opportunity and Challenges towards IT Development in Nepal" was presented during the IT Conference CAN Info-Tech 2001 early this year. The Conference theme was "IT Revolution: A Millennium Opportunity" and was well received among public and private sectors and international IT organizations.

The pioneer medical transcription services business companies are Himalayan Infotech and Unlimited Numedia. AAMT unanimously granted membership to Unlimited Numedia on February 2001, and Unlimited became only a pioneer member of AAMT in Nepal to expand and explore the potential markets in US as well as professional development.

The government has given high-priority for private sector participation. The policy projected export to increase up to 10 billion rupees by 2005 of IT products and services. The most important feature of this policy is to facilitate twenty-four hour software services rendered companies and declared "Essential Services" to guarantee regular production by employees working in the respective companies.
Medical transcription service has not been reflected in IT policy broadly as it is an enormously economically significant IT enabled service which has export potential. Policy reform is vital.

The joint venture between US medical transcription companies and Nepal has not been tied-up legally in terms of financial and technical commitments and assurances. As a result, the Himalayan Infotech has been closed in the preliminary phase of production due to breach of their joint venture partnership with US medical Transcription Company. The Himalayan Infotech invested over Rs.70 million to establish and operate training on medical transcription in Nepal for the last two years.

The new regulations in the future would make it mandatory for 128-bit encryption of patient records being transmitted over the Internet to uphold security. According to the AAMT, legislation has been passed in the US that requires state-of-the-art security to be in place for all transmissions of medical records, in order to do that US and Europe have already signed data protection laws.

The demand for medical transcription services training is growing and popular among the high school (12 standard) graduates or B.A graduates. More than one thousand IT inclined young people have shown their keen interest in a career in medical transcription. Also, there are many new private investors who are ready to invest in the business.

In Nepal, there are still strong myths against it. The key myths are: (a) no manpower available, (b) poor quality, (c) incorporate training/re-training, and (d) non-investor friendly Labour Act.

The medical transcription service is also threatened by speech recognition technology and formatted electronic records. But, at present, voice recognition software has not developed yet. But, once this technology matures, transcriptionists will be able to use it to increase their personal productivity.
To establish and sustain medical transcription services between Nepal and US, the bilateral level of the memorandum of understanding between HMG/N and US Government should be placed. It is also proposed to form a task force on Medical Transcription Services Business Promotion in Nepal.
Medical transcription services, considered as twenty-four hour services and declared "essential services" has been spelled out in IT policy, but should be published in Gazette under the Essential Service Operation Act. The labour union provision should be eliminated for the IT sector entirely.
The Employment Promotion Commission must encourage the IT-led private sector and create an environment to establish training institutes in five regional development regions of Nepal on medical transcription services to reduce unemployment.

fine print

By Ajit Baral

Open the doors and windows wide open. Let the fresh winds blow everywhere: only do not be swept away by these winds.

In the sixties, Nepali art tried to wiggle out of the cocoon of hitherto tepid art. And stepped into the world of modern art. But in doing so, our artists let open all doors and windows wide open. And contrary to "…don’t be swept away by these winds" caution, our art was swept away by the modern art movements of the world. Perhaps, it is because of this that a critic of The Indian Express wrote the following regarding Nepali Exhibition in 1973 in New Delhi: "In the history of modern paintings, impressionism and expressionism are inalienably associated with the European experience of industrialization and technicised life style.

The movements, when transformed into modern idioms of visual expression and used by painters in other parts of the globe where the social history has had a different run, tend to betray a confused pattern of imagery and execution. Contemporary Nepalese paintings, now on view at the Shridarani Art Gallery, have this contradiction. Most of the abstract expressionist paintings are confused." Still we don’t fare far better. Maybe marginally better.

A group of young artists had exhibited their paintings recently. There was some similarity in the way they handled the brush and applied the colours. They used colours and contours to define forms, and used high intensity colors— a clear take from the Fauvism of the 1900s. It was commendable that these young artists adopted European techniques to express their own culture. However the analogy in thematic concerns of the artists pointed towards the lack of diversified imagination.

It is understandable that the artists are influenced by their cultural surroundings and it’s fitting that these artists expressed their culture. But there is a whole gamut of things—many issues at the societal level—not only culture— to express. And it’s where artistic imagination comes into play. The poverty of imagination and the overwhelming concern (maybe because of the poverty of imagination) just for one’s culture tend to stagnate art. This is what happened to the revivalist art of the Bengal School later because of its obsessive concern for ‘only’ Indian myth, culture in their search for Indianness in art.     And maybe it’s because of this very concern that Nepali art has failed to touch upon issues in social and political level.

The Nepali artists thus need to cultivate their sensibility and enrich their knowledge to move away form the confused "patterns of execution and imagery" and the obsessive concern for only culture. And the communication with international art at artistic level will only help the Nepali art in this regard.
Viewed from this perspective, it wouldn’t be otherwise to bestow kudos on the National Association of Fine Art for getting the Contemporary Prints Exhibition to travel to Nepal as well. This Exhibition which kick started on April 15 runs through to the end of April.

Though the history of print making goes back to the fourteenth century (or, even before it, and great artists like Rembrandt and Leonardo Da Vinci have used this technique), tradition of print making in India started only around the initial decades of the twentieth century. And though the printing press came to India as long back as the middle of the sixteenth century (it was brought for missionary proposes), it was Gagendranath Tagore who pioneered printmaking technique (in India) by using it as a medium of artistic expression for caricaturing. But technical difficulty, constraints in playing with myriad of colours, etc., prevented printing to be a popular medium of artistic expression. So it was not popular as a medium, as written in the brochure, till the 60s and 70s in India. This has changed now and many artists are specializing in printmaking.

The Indian prints now on show are from the collection of the Indian Council of Cultural Relations. However, their relevance is immense as printmaking is yet to develop in Nepal and only few artists—Uma Shankar, Ragini Upadhyaya, Ashmina Ranjit—are using this technique. Moreover, this has given the Nepali artists a rare opportunity to view the works of artists like M. F. Hussain, Shanti Dave, Laxman Goud, Amitav Das etc.

This exhibition is not a representative collection of Indian art, it provides a peep into the imaginative preoccupation of Indian artists. So we don’t find an obsessive concern for cultures only. But different images bespeaking the idiosyncratic temperament and virtuoso techniques of colour application. And the haunting scene of a faceless woman maybe bemoaning the death of a near one by Anupum Sud; J Jharotia’s surrealistic work of a head with a castle on it painted in yellow in its tonal variation and ochre; of village scenes drawn in aquatint by Laxman Goude; Shanti Dave’s beautiful, collage lookalike composition with embossed hieroglyphic. And that of Husain who has based his works on the Mahabharat. These paintings, though minimalist in its rendering, done in warm colors and expressive lines create instant rapport with the audience.

when words wound

By Ajay Das

Have you ever been wounded by words? There have been times when our parents or boss have scolded us for doing exactly what they told us not to do. In such cases words become weapons with the intent of inflicting as much emotional injury as possible. The things they say don’t just feel like a slap in the face; they feel like a knife twisting in the gut. Words can be weapons. They kill love just as guns and knives can mortally wound the body. The wound caused by weapons can be healed, though it may take time. But the healing power fails in most cases when someone is emotionally hurt by words.
We can see this in our own society. An alcoholic husband, having an argument with his wife calls her horrible names accuses her of every sin known to man, says cruel things about her children, her parents, her friends and condemns her for her political beliefs or ideological stance. This verbal assault leaves her emotionally injured. If you call a street child a khate, it’s offensive. The time has come to coin a respectful word for them. Lower castes are no longer inferior but they are dalits now.
Words stand for the ideas a person has, which he would express by using them. A child having taken notice of nothing in the metal he hears called gold but the bright shining yellow colour, he applies the word gold only to his own idea of that colour and nothing else, and therefore calls the same colour in a peacock’s tail gold. It depends on how one takes the words. The introverts who minutely dissect the words spoken against them, easily get hurt. But there are the who-cares type guys who are always ready to strike back with the same level of verbal assault. Some people hurt their friends, spouse, parents, children and subordinates with careless words that they speak without thinking or accidentally in a moment of anger. The people who deliberately use words as weapons should once put themselves in somebody else’s shoes, only then will they come to know where the shoe pinches.

Some people are prone to point out the unnecessary faults even in a perfect thing. They criticize just for the sake of criticism. Criticism is unjustified when one criticizes people for doing what he or she told them to do. Criticism is unremitting when it occurs over and over and goes on for an extended length of time. Criticism is unjustified when we criticize something that was in the past, for which the person has already apologized and promised not to do anymore, and hasn’t done anymore. Many of these people have a great deal of anger stored up inside that needs to be handled. Once I was angry with myself for making a stupid mistake. Meanwhile my younger brother came to my room, I just poured scorn on him for doing nothing. Later I realized it was not fair. Essentially, we need to find constructive outlets for our tensions.

There is the other side of the coin too. Words are not only the weapon but they are healers as well. The same alcoholic husband who abuses the wife in the evening, starts convincing her with flowery words and promises in the morning. She is cajoled now and has forgiven him. Words become medical pills here. Such is the magic of words.

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