I am writing from El Limon near San Jose de Ocoa in the Dominican Republic, approximately 2 hours west of Santo Domingo. I am spending a couple weeks in this small community of approximately 300 families getting to know more about how they are using the technology that they´ve recently acquired. I am working with Jon Katz, the director of  the development program here. Jon is originally from the US, and has a broad enough repertoire of experiences that he has been able to ignite within the community the means to achieve electrical and ICT independence. The community, which is based on agriculture (tomatoes, eggplant, and others), is powered via hydroelectricity (which as I write is undergoing repairs, which I´m told occur about once a month, so I´m writing by generator power). Jon is also working with the community to initiate a gourmet artesania business, in which the women of the community will sell handmade edibles. This will help the community diversify its source of income.

I am living with a wonderful couple named Pietrito and Jocelyn, and I´ve spent most of my time with them, learning about how the community works. I can talk more on that later.

Besides observing and learning about the community dynamics, I am spending my days here teaching how to use computers and the Internet to publish, rather than simply consume. Katz introduced the computer center to the community in approximately 1999. While the youth (the primary, if not only, users) are handy with them at this point, they use the Internet primarily for games, music, and chatting.

I was originally depressed when I first arrived to find that people I chatted with were not interested in exploring the possibilities of the Web. I began to ask myself, why should they be interested? Most of the youth at first did not appear interested in the world beyond El Limon. However, as time has gone by and the youth talk more candidly with me, I have discovered that many youth are actively looking for ways to advance their education. One is interested in mathematics and architecture, another in poetry, another two are working on making a name for themselves in the reggaeton music industry (I am helping them record, edit, and publish videos to the Web), others in business administration, others in information technology. I am showing them what I know about how to learn via the Internet in the hopes that they find something useful and with that seed they are able to begin taking full advantage of the tool at their fingertips.

Yesterday I was working with one of the co-directors of the computer center on a Visual Basic exercise. Jose Miguel is learning how to use Visual Basic, and is undergoing a distance education curriculum where he completes a large number of assignments each week and then meets with an instructor in nearby Ocoa (10 minutes by vehicle) for review. I am not familiar with Visual Basic, but I know enough Java that together we were able to work on it. It is the first time in my travels that I have programmed – an interesting and satisfying experience. Many young people whom I am beginning to know travel to Ocoa for review of their studies, I just chatted with one going for algebra.

I am beginning to understand the importance of interactive, grassroots media. More later. In the meantime, I am observing how the community residents interact with ICTs, and learning more about their perspective on the value of ICTs. I am now surrounded by little boys of about 7 years of age playing games online with great verbal animation, so my concentration is flying out the window. Hasta luego.

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I read an article from Abraham Verghese in the Wall Street Journal this morning entitled “The Myth of Prevention.” Verghese, author of Cutting for Stone and professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University, was responding to Obama’s recent speech to the American Medical Association on health care reform. Verghese argued that the current health care system incentivizes doctors to perform often unnecessary tests on as many patients as possible in order to make more money from patients. He contrasts this to the image of the doctor in Sir Luke Fildes’s painting “The Doctor” who is dedicated to the care of the patient, staying late into the night by the patient’s side in the patient’s own home.

An interesting point that Verghese raises is the virtualization of the patient into the “iPatient.” Verghese states that:

“A computer cannot take the place of the doctor in Fildes’s painting; an electronic medical record (EMR) may or may not save money (it won’t be anywhere as much as is projected) but what it will do is ensure that we doctors, nurses, therapists, particularly in hospitals will be spending more and mroe time focused on the computer, communicating with each other, ordering and getting tests, buffing and caring for our virtual patient – the iPatient is my term for this phenomenon – while the patient in the bed wonders where everybody is. Having worked exclusively for the last seven years or so in hospitals that have electronic medical records (EMR), I have felt for some time that the patient in the bed has become an icon for the real focus of our attention, the iPatient. Yes, electronic medical records help prevent medication errors and are a blessing in so many ways, but they won’t hold the patient’s hand for you, they won’t explain to the family what is going on.”

I have many colleagues who are working on digital or telehealth care (e.g. Hyoumanity, Amita Telemedicine, and TIER projects). While digital technology allows patients more control over their health care and increases patient access to medical care, it indeed can be seen as a mechanization of personal care. In some regions (e.g. rural) where medical care is limited or unavailable, digital technology can serve as a bridge between providers and patients, allowing a patient in rural India to receive eye treatment that would otherwise be impossible. However, in regions where medical care has been available and provided by a dedicated personal physician, a computer can be seen as imposing a layer of foreign complexity between the doctor and the patient.

Designers of digital technology for health care must consider the relationship between the patient and the doctor and how the technology will impact that relationship. Health care in its truest form is a most intimate human experience. Digital technology cannot at this time replace that experience. Designers of digital tech for health care must design technology that promotes patient-provider interaction, rather than replace it.

Bill Buxton (www.billbuxton.com) of Microsoft Research – a pioneer in interface design – visited my User Interface Design & Development class this Tuesday. Bill spent most of the hour and a half discussing the role of design in Apple’s success. He identified 3 key areas that a designer must analyze when considering a company like Apple: marketing, design, and business creativity. For design success, a company must cater to each of these areas. To make this post easier to digest, I’ll outline his lecture with key phrases that made an impact on me.

- It doesn’t matter if you have a great design team, if you don’t have the business structure to enable you to do what you do.

- To be a designer, you’ve got to be a collector. Get a good notebook and start collecting.

- You’ve got to prepare for success as well as failure, high as well as low demand (e.g. Nintendo Wii).

- Feed high end to set aspirations, then let it trickle down (e.g. Apple iPod).

- Creativity is understanding how to learn from others, and making it your own.

- Stories are the most important form of viral marketing.

- If it’s free, it’s got to be perfect. Easy come, easy go.

- Surround yourself with a community of people who continually piss you off because of their insight, and try to piss them off likewise.

- If you want to make change, you have to have access to the power hub of the organization.

- Design is choice.

- Design is multiples. Don’t offer less than 5 equally valid options whenever you are critically analyzing a design. This promotes true criticism as well as creativity. Constant criticism is important for good design. “Design is like Swiss cheese – you’ve got to leave enough holes for the imagination.”

- The biggest problem is not the design of one product, but how the products work together.

My goal over the next year and a half is to design an interactive agricultural knowledge database (including agricultural sciences, market information, and resource coordination) accessible on any mobile platform (including widely available mobile phones like the Nokia 1110). I plan to work with a variety of people and organizations, including Tapan Parikh, Jenna Burrell, Question Box, Kurtis Heimerl, Neil Patel, and Ken Banks of Kiwanja.net. These people are approaching agricultural knowledge exchange from diverse angles, including voice messaging, radio, telephone trees, live operators, and text messaging.

My next step would be to analyze these various approaches and identify which is the most scalable model. To do this, I would need to further explore the limitations farmers face in exchanging knowledge across distances. After identifying the approach that best responds to these limitations, I would like to work with the project lead to design a growth plan or respond to the project’s key challenges or next steps.

Sonesh Surana, a student from UC Berkeley’s CS department, presented his work with the Aravind Eye Hospital in Designing Rural Computing Applications this week. I unfortunately missed this presentation. I instead attended a presentation on innovative mobile design by Lars Erik Holmquist from the Mobile Life Center in Sweden.

Neil Patel, a CS PhD student at Stanford, visited my Designing Rural Computing Applications course on Tuesday. Neil is studying ICT in agriculture in rural Gujarat, India. He presented two projects he’s been working on: Avaaj Otalo and Jatan Certification System. Neil explained that most international certification systems are designed with a global standard in mind. The problem is that local farming practices are diverse – organic doesn’t mean the same thing in all countries. Additionally, certification systems often leave out smallholder farmers, as they often require the infrastructure provided by cooperatives and other organized farmer associations.

The Jatan Certification System is designed by farmers for farmers. The requirements of Jatan reflect the realities of organic agriculture in Gujarat, which is locally known as Sajiv Kheti (sustainable farming). Jatan includes farmers in the inspection process, but as appraisers rather than inspectors. These volunteers serve as mentors to farmers that are pursuing certification. Another important aspect of Jatan is that certification under this system is not binary (organic/inorganic), but rather scalar in three criteria: environmental sustainability, health, and social. Farms receive a sustainability score that recognizes farmers who are going above and beyond in their practices. Farmers believe that this will help them gain a market premium, but the concept is still too new for real metrics of the success of the program. Certificates are in the local language (different from most certification systems where the certificates are provided in a European language). I asked Neil about the cost to become certified. There is a nominal fee to join the system, somewhere in the hundreds of rupees (50 rupees = US$1), and Jatan will assist farmers who cannot afford this (this is similar to the Fair Trade certification financial requirements, where a nominal fee is required but a scholarship is available).

I was particularly interested in Neil’s second project: Avaaj Otalo. Avaaj Otalo is a project where farmers are exchanging agricultural information via mobile phones. This is very similar to a personal project I am pursuing. In Avaaj Otalo, a local radio program serves as a “development support center” for natural resource management information and communications. The information is broadcast as a radio program translated as “Network of NGOs” in English. This program is about 2 years old, and is a public state broadcast. In this system, farmers call into the program via a toll-free number (which is subsidized by the NGO) with a question or comment. The question or comment is then featured in the next broadcast of the radio program.

Avaaj Otalo is an example of a mechanism for the exchange of agricultural information. Other examples include Question Box and Kiwanja.net. I will integrate these projects in my next post, where I will also propose an ICTD project that I would like to pursue over the remainder of my graduate education (through May 2010).

Our presenters to the Designing Rural Computing Applications course this Tuesday were four UC Berkeley students: Brian DeRenzi, Roxanne Miller, Alison Bloch, and Charlene Chen.

Brian discussed automating routine tasks for community health workers. Brian worked with Neal Lesh in Africa. An interesting observation that Brian raised in his presentation was how a community health worker used the program that Brian and Neal were representing to manipulate community members to abide by the health workers’ public health guidelines. For example, she would say something similar to “they will leave with the cell phones if you don’t start washing your hands more often.”

The second presentation, by Charlene Chen, was on Charlene’s experience designing a customer relationship manager tool for an urban client in Ghana. Charlene used SugarCRM because it is a free, open source database tool. Salesforce.com is another database tool that provides 10 free licenses to nonprofits (you can petition for more free licenses through an application process). One disadvantage to Sugar compared to Salesforce.com is the level of support they provide (I believe there is none for Sugar). Charlene provided a terrific outline of her management of this project. This is particularly useful to me, as I have been working with a local nonprofit myself around the design of a CRM tool. I’m sure this will come in handy many more times in the future.

The final presentation was on Bodas for Life, a project of the UC Berkeley Blum Center. Roxanne Miller and Alison Bloch discussed this project. Bodas is an interesting case in that the group began with an initial idea which evolved into a different conclusion by the end of their field work. UC Berkeley and the Uganda Ministry of Health began the program with the plan to improve access to routine and emergency health care services in rural Uganda through the availability of safer and cheaper boda rides (bodas are motorcycle taxis). The group saw the bodas as passive participants in the program – simply ensuring that the rides were affordable and safe was thought to be enough. However, the program resulted in boda drivers becoming accountable to patients – they began showing preference to patient delivery, even being provided with emergency training. Bodas have become a reliable form of ambulatory care, when they have traditionally been viewed as a cause of many traffic injuries. The Bodas for Life program demonstrated the value of flexibility and empowerment, and is expanding successfully. Their expansion still relies on donor support. If you are interested in contributing to this program, or to find more information on Bodas for Life, visit UC Berkeley’s Blum Center.

Deepti Chittamuru spoke in Designing Rural Computing Applications on Tuesday. Deepti worked with MILLEE over the summer of 2008 implementing and evaluating MILLEE’s learning applications in India.

MILLEE is a UC Berkeley project developed by Matt Kam, a PhD graduate of the Computer Science department. MILLEE’s goal is to design mobile phone-based software and games to help children in rural India learn English.

Deepti discussed some of impacts of demographics and socioeconomics in the adoption and usage of MILLEE’s applications. Specifically, Deepti explained that gender caste roles often implied diverse behavior towards adopting the applications. For example, older girls were observed to hand over the mobile phone to an infant brother when he obviously was not mature enough to manipulate the hardware. Similarly, children from public school or who did not attend school would often experience discrimination from children who attend private school – if a testing session was held at a private school, public or non-school children would resist entering the school campus. Additionally, private school students were observed lying to public or non-school children about the requirements of the MILLEE program in order to cause the public or non-school children to fail to meet the actual requirements of the program and be expelled from the program.

Another behavioral observation that Deepti mentioned was the group dynamics around the mobile device. A child would often have less time using the device in a group setting, and the more dominant children in the group would have more time with the device. For this reason, the testers decided to let one child begin using the program, and a group would eventually, naturally form around the child. That way, the child had more time with the program, but the testers were still able to observe the group dynamics around the device and application.

In another of my courses, needs and usability assessment, another group of students analyzed the usability of the MILLEE application for English learners in the US. This was an interesting study as the students faced different challenges from those in India. Students in the US are often more experienced with mobile technology. They are comfortable using a mobile phone, and expect more from the technology. Graphic design becomes more important for these users. However, the program itself was a hit among the kids. To learn more about MILLEE’s work, visit www.cs.berkeley.edu/~mattkam/millee/.

We were graced with three presentations this Tuesday in Designing Rural Computing Applications. Three Berkeley students, from the schools of Computer Science and Public Health, presented the progress of projects with which they have been involved.

The first presentation, by Kuang Chen, was on his development, implementation and evaluation of software called CommScape and OpenII. CommScape was a database management tool for a large HIV/AIDS treatment program in Africa. OpenII was an open source information integration tool that Kuang implemented with the Nature Conservancy and the International Rescue Committee.

The second presentation, by Kurtis Heimerl, was of a tool created by Kurtis, RJ Honicky, and Eric Brewer called mPhone. mPhone is an asynchronous messaging tool that allows for delay-tolerant message transmission. This means that messages can either be sent or received immediately if a connection is available or wait in queue until a connection is available. This is especially valuable in rural locations where cellular availability is not contiguous. A related project that has now become a social venture is (a Boston-based group that provides delay-tolerant networking boxes to place on vehicles like buses or motorcycles to transmit messages for rural populations in developing regions – I can’t remember the name, if you know what I am talking about please let me know – thanks!). In contrast to related projects who focus on SMS transmission, Kurtis’ group is dedicated to voice messaging. Kurtis argues that voice messages are actually preferred by users to SMS. He states that while direct calls are more expensive than SMS, SMS causes problems with literacy levels, reliability, and effectiveness. Users prefer voice messaging so that they will pay for voice calls until they can only afford SMS. Kurtis ended his presentation by explaining that the challenge going forward is to sell the idea to providers by demonstrating that asynchronous voice messaging promotes greater hardware utilization.

The final presentation, by Heather Zornetzer, was on ICT for health in multi-institutional disease research, control and prevention in Nicaragua. Heather is working with the Sustainable Sciences Institute to study the integration of ICT in disease control in Managua. Some of the technology the center has incorporated to date include barcode and fingerprint scanning, laboratory information database management, PDA applications, and GPS and GIS applications. You can find more information on this work at www.ssilink.org.