Don’t Bury Failures. Share Them

Computer science students from the U.S. and Senegal designed a mobile phone application especially for fisherwomen in Senegal and yet, the Senegalese women could not use it because of a single flawed assumption.

I promised myself I would share at least one story from the MobileTech for Social Change Barcamp I attended at Hunter College in New York City on Saturday (Feb. 21, 2008). Barcamp, for those who may not know, is an approach to organizing and running conferences that tries to capture the hidden value of most meetings—the conversations that happen between sessions in the hallways—and bring it front and center. Barcamps are also supposed to be free, or nearly so, for participants to attend.

A computer science group from the State University of New York at Stonybrook presented three applications or “apps,” that is to say mini-computer programs, that they had designed for use on no-frills mobile phones owned by women working in the informal Senegalese economy. The pilot tests for two of the apps—a dictionary and a book-keeping calculator—were deemed successes. The third app—for measuring profit and loss—was judged a failure.

Since most people—myself included—don’t like to publish their failures, I was impressed by the Stonybrook group’s willingness to do so. Indeed, they were almost as enthusiastic about the failure as the two successes. “You often learn more from failure than success,” says Jennifer Wong, one of the two Stonybrook professors who, along with two students, came to present their findings. Sure, we all say it. But who really embraces the idea? Brava!

The National Collegiate Inventors and Innovators Alliance is giving the Stonybrook group and its co-investigators at Pace University and Thies Univeristy nearly $50,000 over two years to design mobile phone apps for use in the informal Senegalese economy.

What the mobile app group did right: they built local capacity. They recruited 20 Senegalese computer science students and taught a one-week crash course in Senegal on how to write and load mobile phone applications. These students in turn interviewed the local fisherwomen in Wolof (one of Senegal’s most common local languages) to customize the profit-and-loss application for their phones.

The fisherwomen are actually fish sellers. They buy fresh fish and then dry it to sell on the market. The women often sell the dried fish at a loss, which is why a simple profit-and-loss calculator on their mobile phones might help them decide when and at what price to buy the fresh fish so they could come out ahead.

The pilot was a failure because the fish sellers found the mobile phone profit-and-loss calculator useless. The computer science group did not learn why the app was useless, however, until a second round of testing in which one of the Senegalese computer science students happened to have a grandmother who was a fish seller. After talking with the fish sellers, he discovered that all the prices for both fresh fish and dried fish are fixed. Since everyone charges the same price for fish (one for dried, the other for fresh) on any given day, there is no way for the women to wait until the price is right.

One wonders why anyone would sell dried fish at all under these conditions? There is bound to be more to this story. Please enlighten us if you can, using the comments section.

Lesson learned: you have to be very specific when seeking local expertise.

Another way of looking at it: just because something looks to you like irrational economic behavior doesn't necessarily mean that it is, or that you know why it is irrational.

To find out more about applications for mobile phones in the informal economy, contact Anita Wasilewska or Jennifer Wong at SUNY Stonybrook or Christelle Scharff at Pace University in New York City or Prof. Ibrahima Ndiaye, Director of the Economic and Social Sciences Education and Research Unit, Thiès University, Senegal. See also their wiki about mobile apps in Senegal.

To learn more about what else went on at MobileTech For Social Change (New York):

• Search for #m4change on Twitter from 2/21/09 to about 2/23/09
• Read the Morningside Post stories once they come online
• Read Patrick Meier’s summary post on iRevolution
• Check out some #m4change photos on Flickr (cool search for events after 20090201)
• Read Persephone Miel at Media Re:public on why mobiles are not the future; they are right now.

(updated on 2/24/2009 to add Christelle Scharf and Ibrahima Ndiaye and Pace and Thies Universities.)

Looking for Context in Global Health Reporting

To me, the most satisfying news stories are the ones that provide a context that continues to inform long after the news has turned old. That kind of deeper context is often what I look for in global health stories but do not usually find. Something to think about if you are hoping to improve the routine coverage of global health news.

I am thinking about this now for several reasons. Sharon Schmickle’s amazing article today in the Washington Post on the growing global threat of wheat rust—she provides plenty of context—finally got me to write these thoughts down.

When Josh Benton of the Nieman Foundation was in New York a couple weeks ago, we had a long chat about what constitutes context in news stories. (That's the kind of stuff we enjoy talking about.) He told me about Matt Johnson’s project at the University of Missouri’s Reynolds Journalism Institute.

As I understand it, Matt’s key insight came when he read decades worth of stories about commercial development in and around Columbia, Missouri. He realized he didn’t feel any better informed about the major factors, developers and politicians involved after reading one or 100 stories. Each story had to be taken on its own—separate from the others. The long-term context did not emerge from reading all those stories. It was all information overload with no meaning.

Johnson’s project is to see if there is a way to make that context more explicit, so that each news item about development either contributes to the context or benefits from it. What Matt Johnson says about the search for more context in the news makes a lot of sense to me.

In January, Jeb Sharp of PRI’s The World launched a new history podcast called “How We Got Here.” It looks at the history that continues to shape current events. Her inaugural piece was about Iran—because of all the talk about the incoming Obama Administration’s possible diplomatic outreach to that country.

But Sharp’s reporting on the three weeks in 1953 in which CIA agent Kermit Roosevelt nearly single-handedly engineered a coup in Iran provided some of the missing context that I was looking for in an entirely different story. Namely, it helped me understand a little better why the Iranian government recently tried and convicted a pair of Iranian AIDS doctors for conspiring to foment a “velvet revolution” by attending international medical conferences.

Earlier this month, Ethan Zuckerman, co-founder of Global Voices, wrote a very good piece that provides the missing context around the recent unrest in Madagascar. I have actually been following this in the news—in the New York Times and on the web. But nothing explained WHY this was happening NOW in the way that Ethan’s blog post did.

It makes me think of David Pogue’s Missing Manuals enterprise. You know, computer software doesn’t ship with printed instructional material any more. You have to either go online or screen through an electronic manual. But a lot of us still find a book a useful way to organize information—to get the broader view. So when software companies stopped supplying physical manuals, Pogue stepped into the gap with his Missing Manual series.

Supplying the missing context turned out to be a good business model for Pogue. Makes me wonder if that case is transferable to reporting about global health?

What's New in Health and Human Rights?

I am giving one of two keynote speeches at the 2009 GlobeMed Global Health Summit in Chicago April 2-4. The theme for the gathering is "From Idea to Implementation: Securing Health as a Human Right," so I chose as the working title for my talk "Health and Human Rights: A Journalist's Perspective."

Kind of as a lark, I threw that phrase "Health and Human Rights: A Journalist's Perspective" into a Google search and much to my surprise got an exact hit. Television producer Rory O'Conner chose that as the title for a blog post that has some vintage video of the late Jonathan Mann talking about health and human rights.

So I changed my working title to "Health and Human Rights: One Journalist's Perspective," which isn't much of a distinction I admit. I also watched the interviews with Mann and others. They have held up quite well--even after ten years.

And they remind me how much AIDS, like the Holocaust before it, has taught us about human rights.

Update on the Global Health Blogging Experiment

Thank you to all who participated in our little "global health blogging experiment." Nine posts on "prevention vs. treatment" were published--out of an expected 12. Respectable numbers for an all-volunteer effort.

I do not have much time to write today, alas, but wanted to leave you with at least one thought. I was particularly intrigued that Liz Borkowski pointed us to a larger story--the gradual abandonment of anti-tobacco/anti-smoking programs in the U.S. That's the kind of piece--big and slow-moving--that can be very hard to get a grip on in the traditional media. And precisely the sort of thing that can thrive on the web.

An example comes to mind from well outside the global health sphere--how the folks at Talking Points Memo aggregated their own reporting with that of disparate professional journalists to tell the story of the number of US attorneys who had been fired under the Bush Administration for not toeing the line politically. (The TPM, incidentally, also won a George Polk Award for Journalism for its work.)

Anyway, I hope folks look at the other entries and post their own responses/analyses/constructive critiques. So, without further ado, here are the other global health posts on "prevention vs. treatment."

Healthtwine: Prevention vs. Treatment
On why "we tend to value current health more than future health."

Superbug: Prevention v. treatment (1st Global Health Blog Carnival!)
On the need for a vaccine against methicillin resistant staph aureus.

Perspectives: Prevention vs. Treatment
On why prevention vs. treatment is the wrong way to think about drug resistance to malaria.

Karen Grepin's Blog: Prevention vs. Treament in HIV: Have we given prevention a chance to shine?
Proving prevention works is a lot harder than you might think. Maybe that is another reason why there are so few studies on the effectiveness of prevention.

The Pump Handle: For Whom Prevention Pays
On one of the bigger, overlooked stories of public health in the U.S.--the faltering anti-tobacco struggle, another victim of the economic crisis.

HIV Information for Myanmar: Two Quotes from Bogyoke
A few words on the greater good from the late Bogyoke (General) Aung San, who led the fight for Burmese independence after World War II.

Health Reform Watch: Health Care, "Common Sense" and a Global Health Blogging Experiment
A bit off-topic and somewhat rambling (the French revolution?), but a look at whether concerns over health reform in the U.S. will crowd out discussion of global health.

Global Health at Change.org: Prevention vs. Treatment--an Eternal Debate?
On why good decisions in public health "are about balance, and looking for long-term systemic solutions instead of the quick fix."

And from a public relations perspective:

Ruder Finn's DotOrg (U.K.): The Lazarus Effect
Lucy asks "Are there are any differences between ’selling-in’ stories that have a prevention angle over those that emphasise treatment."

Prevention vs. Treatment: A False Choice

The long-running debate over the relative importance of prevention or treatment is the theme that at least a dozen global health bloggers are exploring today. In many ways, the debate represents a false choice; a well-functioning health system requires both prevention and treatment. But how do you strike the right balance? Is the measuring stick simply the one provided by economics? Or do equity and fairness also play a role?

“An ounce of prevention is worth a pound of cure,” or so the old saying goes. But we don’t always practice what our folk wisdom preaches.

The U.S. medical system, as currently set up, rewards cardiac surgeons at a much greater rate than it does programs for avoiding weight gain or controlling high blood pressure.

About 5% or less of the U.S. budget on health care is spent on prevention, according to Don Wright of the U.S. Department of Health and Human Services. Most of the rest is spent on treatment—and, I would venture to guess, paper work.

And yet, you can bet that if I ever experience a gripping pain in my chest or back, accompanied by nausea and perhaps an overwhelming sense of anxiety—classic signs of a heart attack in women—I am going to get myself to an emergency room right away to get treated and be mighty thankful if the specialists at the cardiac catheterization lab can open up any blocked arteries.

The year I spent at Harvard taught me a lot about how academics argue the prevention vs. treatment debate. Indeed, just a few years ago there was that rare thing in public health—a big public debate between some folks at the Gates Foundation on one side and some at Harvard on the other about whether prevention or treatment was the better—read more “cost-effective”—approach to tackling HIV/AIDS in sub-Saharan Africa. Eventually the Harvard side won the argument—especially once the cost of anti-retroviral therapy dropped dramatically. What made the difference was the fairness issue: How could you withhold treatment when so many were dying?

A few months in rural Malawi gave me a whole other perspective. There I learned that tremendous strides have been made in decreasing maternal death rates at the Embangweni Mission Hospital through a variety of efforts—not least of which was an emphasis on both prevention and treatment.

It did not happen by accident and it did not happen overnight. When the effort began, several years ago, there was only a single sink in the labor and delivery room. So improving the physical plant was a priority in terms of providing better treatment. Embangweni Hospital also worked really hard to get the right people in the ward—namely more nurses and clinical officers—and keep up their training. Alas, hard experience also taught them they had to make the ward off-limits to many of the grandmothers or “gogos,” who would slip their daughters and daughters-in-law a powerful herbal concoction to induce labor but that also increased the risk of potentially fatal uterine rupture.

On the prevention side, community health nurses have been working throughout the South Mzimbe region for the past ten years to provide prenatal care to pregnant women. To give just one example, the community health workers I met, like Joyce Ngoma and Tamala Chirwa, work hard to identify women who may have trouble delivering—because they are carrying twins or the fetus is not positioned properly. The nurses advise those women to go to the hospital early so that they can be watched more closely and scheduled for a caesarean operation, if need be.

Each side—prevention and treatment—benefits from the other. With fewer pregnant women showing up at the hospital in crisis, the clinical officers and nurses there are able to save more mothers' lives. The nurses in the field can see that their efforts have saved lives and are encouraged to do more prevention work.

Today's posts on Prevention vs. Treatment from other global health blogs (as I learn of them):

Healthtwine: Prevention vs. Treatment
On why "we tend to value current health more than future health."

Superbug: Prevention v. treatment (1st Global Health Blog Carnival!)
On the need for a vaccine against methicillin resistant staph aureus.

Perspectives: Prevention vs. Treatment
On why prevention vs. treatment is the wrong way to think about drug resistance to malaria.

Karen Grepin's Blog: Prevention vs. Treament in HIV: Have we given prevention a chance to shine?
Proving prevention works is a lot harder than you might think. Maybe that is another reason why there are so few studies on the effectiveness of prevention.

The Pump Handle: For Whom Prevention Pays
On one of the bigger, overlooked stories of public health in the U.S.--the faltering anti-tobacco struggle, another victim of the economic crisis.

HIV Information for Myanmar: Two Quotes from Bogyoke
A few words on the greater good from the late Bogyoke (General) Aung San, who led the fight for Burmese independence after World War II.

Health Reform Watch: Health Care, "Common Sense" and a Global Health Blogging Experiment
A bit off-topic and somewhat rambling (the French revolution?), but a look at whether concerns over health reform in the U.S. will crowd out discussion of global health.

Global Health at Change.org: Prevention vs. Treatment--an Eternal Debate?
On why good decisions in public health "are about balance, and looking for long-term systemic solutions instead of the quick fix."

And from a public relations perspective:

Ruder Finn's DotOrg (U.K.): The Lazarus Effect
Lucy asks "Are there are any differences between ’selling-in’ stories that have a prevention angle over those that emphasise treatment."

Community Organizing Meets Global Health Blogging

Towards building a social network around global health news.

At least a dozen global health bloggers have publicly said they will be posting on the broad theme of "prevention vs. treatment" this Thursday, January 29, 2009. (Feel free to join in!) This is part of an experiment that grew out of a Twitter conversation to see if we can coordinate posts in a kind of "global health blog carnival" to increase awareness of global health issues. I'll be posting about my experience in Malawi and reflecting on whether the prevention vs. treatment debate is really a false choice.

But there are some larger questions here that I would like to explore: Is a social network around global health news starting to emerge organically on the web? What can we do to nurture it? Do economic realities dictate that this will have to be a volunteer led endeavor, at least for a while?

Or, another way of putting that last question: Is news about global health subject to the same market failures that afflict products for global health (e.g. free-market forces alone will not lead to new tuberculosis medications and other drugs that affect mostly the poorest people in the world)?

Some preliminary thoughts on the first question: Is a social network around global health news starting to emerge organically on the web?

Although blogging has been around for a while, we haven't really had the critical mass of bloggers interested in global health issues until recently.

International news coverage has suffered terribly in the retrenchment affecting the journalism industry. There are efforts to do something about that. The Gates Foundation is funding more coverage of global health issues at National Public Radio, Public Radio International and on television's The NewsHour with Jim Lehrer. The new kid on the block is Global Post, which I am happy to say, has a global health correspondent in South Africa. And let's not forget Global Voices Online, whose international health reporting is growing.

The British newspaper The Guardian is partnering with AMREF, an NGO dedicated to medical relief in Africa, to report development news from the Ugandan village of Katine. (See Laura Oliver's post on a UK journalism blog for news on the project's growing pains. Larry Hollon also has thoughts at Perspectives.)

I suspect we have only scratched the surface. In my view, a true social network for global health news would go far beyond encouraging comments, cross-linking, blog carnivals and re-tweeting. But those are the first steps.

Note to self and others: the news innovation barcamp for entrepreneurial journalists at the University of Missouri last week may give us some ideas for how to share ideas, organize efforts. They have created an online site for collaboration among groups of like-minded people (journalists and non-journalists) who want to explore new ideas for news coverage but have low or no budgets for experimentation.

Links: Journalism, Development, Antibiotic Resistance

Two important news items that should be getting more attention. The first is on a "midnight rule" change from the former Bush Administration that is just coming to light. The other is on a unique partnership between a journalistic outfit and a global development organization.

Well, this is bad news
Maryn McKenna tells us "the FDA has quietly reversed a decision it took last summer, and will allow cephalosporins, a human medicine, to be used without restriction in food animals." McKenna takes the time to put the news in context and add some of her own reporting--good journalistic habits. About that headline . . .

Media and Development
Excellent post from Larry Hollon at Perspectives about an "agreement between the African Medical and Research Foundation (AMREF) and the Guardian, the London-based daily newspaper, to document a development program in Katine, Uganda." I was most struck by Larry's concise summary of the high expectations and journalistic conflicts that accompany such projects.

Links: Ebola, Toilets and Corruption, Iodized Salt

Filipino tests positive for Ebola
From Reuters in Manila: "At least one person has tested positive for the Ebola-Reston virus in the Philippines, where the disease has broken out in pigs at two farms north of the capital, the government said on Friday."

Are Working Toilets A Good Anti-Corruption Indicator?
From the BBC's Mark Doyle: Reading official reports about corruption can be so boring. Doyle's lighthearted look at whether working toilets indicate progress against corruption in Sierra Leone.

The Challenge of Iodized Salt
From Alanna Shaikh, who just moved to Uzbekistan Tajikistan: A quick look at why it is so hard to make iodized salt universally available.

Broken Links at DotGov Sites

Are broken web links at U.S. government sites going to be a feature of all future changes in Administration? I'm having trouble finding some of the links I had saved on a couple of global health issues from official U.S. government sites. Shouldn't we have some web continuity between Bush and Obama Administrations?

I can no longer get at a press release about human rights from Dec. 10, 2008 that was on the whitehouse.gov site. I get redirected to the Obama briefing room, not even a "page has been moved" message. Very Ministry of Truth.

Yesterday, Maryn McKenna found a broken link to whitehouse.gov that used to tell about the President's Malaria Initiative. No refer pages to where the pages are archived (although the Malaria Initiative itself is still available at fightingmalaria.gov).

I thought, okay, that is the White House--a very political place. But then in writing up my post about the Iranian AIDS doctors who were just sentenced to prison terms for trying to foment a velvet revolution via international HIV meetings (you can't make this stuff up, unfortunately), I realized that a link to an official statement from U.S. State department about the Alaei case was broken. The error message read "We're sorry. That page can't be found and may have been moved."

Since the statement was made by the Bush Administration, the contents had been moved to an archive site. Okay, fine, but at least give me the refer. I had to go and search by eyeball (keyword search Alaei brought up nothing) to find the archived statement.

That's when I started to worry. What about all the press releases at the Centers for Disease Control? Are all those links broken, too? Fortunately, as of Jan. 22, 2008, the CDC's RSS feed for press releases about vaccinations, mortality data, etc. is intact.

I used to think saving links to U.S. government web sites was a safe thing to do because, well, it's the government, they have to preserve those web pages--right? It is a matter of public record. And press releases are part of the public record. But what if the government webmasters preserve the pages and destroy the links? Makes keeping track of things mighty difficult.

It's a different kind of way of politicizing the record--every bit as Orwellian as deleting the word "abortion" as a search term from the Popline database last spring. Fortunately, that was fixed.

Is there a technological fix for broken links, too? Can the new Administration put up their stuff without losing the links to the old information? It is the same government of the same country, after all--just different temporary leaders.

Do you have any other examples of broken government links about global health post-Obama transition?

Iranian AIDS Docs Get 3 and 6 Years in Prison

While the rest of the world was focused on the peaceful transition of power in the U.S., Iranian AIDS doctors Kamiar and Arash Alaei learned on January 20 that they had been sentenced to three years and six years, respectively, in prison, according to Physicians for Human Rights.

The Alaei brothers' case is one of several recently in which professionals and religious minorities have been falsely accused of fomenting revolution. Lawyer and Nobel Laureate Shirin Ebadi's Human Rights Defenders Center was raided and shut down by police in December (Los Angeles Times). Her former secretary was arrested earlier this month in a roundup of six B'hai women (B'hai News).

(Update: The LA Times says Sylvia Hartounian, 33, a reproductive medicine specialist, was sentenced along with the Alaei brothers.)

Radio Free Europe has a good summary article that ties all these moves to internal Iranian politics--trying to sow fear among the Iranian electorate ahead of presidential elections in June.

The Washington Post quotes an unnamed Iranian official as saying the brothers' treatment is part of a "full-fledged intelligence war" between the U.S. and Iran. "A soft revolution has been programmed against our country and carried out in some instances, but it was suffocated in the cradle," the Iranian official was quoted as saying.

Further update (1/29/2009): For deep context, listen to Jeb Sharp's excellent podcast on Public Radio International's "The World" about the long-term damage to US-Iranian relations caused by the 1953 coup engineered by the CIA.

Related posts:
Jailed Iranian Docs
Jailed AIDS Docs Tried in Secret
Sentences Expected for Iranian AIDS Docs