Thursday, December 18, 2008

Twitter and Global Health

I finally gave in and created a Twitter account back on November 4 so I could participate in the #votereport project. It reminded me somewhat of the way mobile phone or SMS texting has shaped elections in Africa, starting with the 2000 election in Ghana and continuing on to the more recent 2008 election in Zimbabwe. It also got me thinking about how such democracy-movement techniques could be adapted to global health. Perhaps to introduce some much-needed transparency in pharmaceutical supply chains?

Votereport was a volunteer-led project that called on U.S. voters to characterize their election experience by providing three major pieces of information: where they voted, how long they waited to vote and whether the experience was a good one or a bad one. If yours was a bad experience, then you were supposed to give a brief description why, e.g. mismatch of your name compared to driver’s license records caused an official to doubt your right to vote.

From a technical point of view, we’re talking about structured-data.

I messed up my first attempt at tweeting my own vote but fortunately someone named ZekeSaysSo showed me how to do it: “#votereport. #10019 #good #wait:40 at 6 AM. longest lines I have ever seen at this polling place at this hour.

Each specific piece of information was preceded by a # sign or hashtag, also known as a pound sign, to make the information more easily sortable by computer.

People like Adrian Holovaty have convinced a lot of us reporters that one major path to a future for journalism lies through structured data. As Holovaty defined it in 2006, structured data is “the type of information that can be sliced-and-diced, in an automated fashion, by computers.”

Holovaty’s breakthrough example in 2005: using the structured data from Chicago crime statistics mashed up with Google maps to automatically generate geographical pictures of a neighborhood’s character. You can see the latest iteration of his efforts at

The new wrinkle about Votereport, the Ghanian and Zimabwean elections is that “we the people” provided the structured data—in real time with tangible results. Mobile texting plus radio coverage stopped voting irregularities in Ghana in 2000 and prevented Robert Mugabe from being able to fudge electoral results in Zimbabwe earlier this year—although it didn’t stop him from hanging on to power.

Nothing quite so impressive in the U.S. but Votereport did help a number of individuals cast regular ballots instead of provisional ballots after minor misspellings of their name threatened their franchise rights. Because anyone who tweeted #bad and provided information as to why they couldn’t vote was automatically put into contact with an election protection lawyer. In many cases, simple misunderstandings were resolved before the voting booths closed.

See also Ethan Zuckerman’s thoughtful look at the pros and cons of twittering vs. texting elections.

Seems like you could adapt this type of technology to other uses. I’m thinking specifically about the government’s drug-supply chain in Malawi.

Many, many people I talked to complained about how they can’t get the drugs they need for hospitals and clinics from the Malawi government’s Central Medical Stores. Even the taxi drivers in Lilongwe know that a lot of the pharmaceuticals get diverted from the public sector to the private sector—despite periodic purges of the employees involved.

What if every hospital administrator, clinical officer and nurse used their mobile phone to text every encounter they had with Malawi’s CMS, giving information about the number and kind of drugs that were missing? And you compared that to the number and kind of drugs they started off with—many made available through international agreements?

How long would it take before CMS employees retaliated? Could you get enough people to participate so that no one individual would be targeted for retribution?

Just wondering. What do you think?

See also this Slideshare presentation on Twitter for Health by PF Anderson at the University of Michigan.


Maryn McKenna said...

I tweet (@marynmck, @MRSA_blog). There's an increasing number of journalists who do; here in Minneapolis Twitter proved invaluable for covering the street craziness around the Republican convention - one local soc-media expert called it the "21st-c police scanner."

And where web usage is high, Twitter is very valuable for broadcasting on-the-ground info very rapidly - for instance, the Mumbai attacks - though you have to allow for a high noise-to-signal ratio.

However, I'm not sure that Twitter at this point can replace SMS. Twitter requires Web access or a smart-fone. SMS is much more lo-fi and therefore can be used on a smaller, older, less-equipped phone, which is the sort one is more likely to find in Africa, or in SE Asia where SMS is being used very successfully for bird-flu outbreak reporting.

I don't know whether or not the sort of shaming you're proposing via Twitter could be executed by SMS. People certainly could send reports in, but for accountability, what you would need is a page where they are publicly posted (which Twitter provides and SMS does not), or some other means of one-to-many broadcast. I don't know enough about the internals of SMS to know what is possible there.

Definitely interesting ideas though.

Christine Gorman said...

Good points. As always, technology and whether or not it can work in some ideal world is different from whether or not real people will find it useful.

Unknown said...

Dear Christine Gorman,

I am a German student from Berlin and have a question concerning your article "Mapping the rats in New York City" which was published on Dec 15, 2008 in the time magazine (,8599,1866594,00.html).
In one of our class tests we dealt with your interesting article. One of the questions in this test was to tell the author's attitude towards "rat maps" and how this attiude is conveyed through language.
Most of my classmates were of the opinion that you wrote this article in an ironic way as if you would mock about such maps. However, to my mind it didn't sound ironically at all...
Due to these diverse opinions I would be interested whether you really meant to write about 'rat maps' in an ironic way. I would be very grateful if you would help us!

Sincerely yours,

Lea Mattern

Christine Gorman said...

Dear Lea,

You are right. I think the rat maps are great and have been very helpful in fighting our rat problem in NYC. I was not trying to be ironic.

Unfortunately, the city's ongoing budget problems are threatening the progress that has been made. 57 out of 84 full-time pest control aide positions (rat inspectors, etc) will lose their jobs.