Thai Curry Without the Chili

That's what Fran Baum of the People's Health Movement called talking about primary health care without talking about the global political and economic conditions that lead to poor primary health care. It's mild and bland and not the real deal. This metaphor was one of many shared during the Prince Mahidol Awards Ceremony conference we are attending in Thailand.

Now you may wonder…what does primary health care have to do with InSTEDD? Everything, it turns out. A strong primary health care system is one of the best ways to encourage and protect public health. Robert Woollard, head of the Department of Family Practice at the University of British Colombia, advocates a new relationship between public and primary health. Primary health has focused almost exclusively on the individual, and public health solely on the entire community. Instead of one or the other, he suggests we think in terms of relationships. With whom are we connected? How can we build those connections? Technology may be ahead of the human side. There are already efforts underway technologically to link electronic health records with public health reporting. According to my colleague Taha Kass-Hout, in New York City when they get word of an outbreak, they send an alert to everyone whose electronic health record indicates those symptoms.

As a final, unrelated note, Thailand is an amazing place. It has fragrant juices, from lemongrass to fresh guava and a concoction sort of like a virgin mojito. It also has the usual suspects in terms of American fast food including Pizza Hut, McDonald’s and KFC. (An aside, what are the ethics on links? I really do not want to link you to the Pizza Hut page.) But strangely enough, they’ve been so penetrated by American fast food that they even have Auntie Anne’s Pretzels. Who knew there was a market for freshly made pretzels in Thailand?

Bye for now. We go to Chang Mai tonight for the Mekong Basin Disease Surveillance meeting, and then on to Cambodia.

On to Cambodia in Search of Assets...(Not the Kind You Imagine)

We leave Monday for Thailand and Cambodia to work on our Mekong Collaboration Program.

In preparation for this trip, I dug up a methodology that served me well in the social work field: the asset mapping approach. This model is not about tracking strategic assets. It is about communities focusing on their own strength and capacity. This approach often starts with a community developing a health scorecard of positive community activities, such as kids spending time with grandparents, that can then become a focus for community energy and activism.

This methodology works great when approaching general social issues, but how well does it work in the technology realm internationally? InSTEDD was hired to work in Southeast Asia because of our technology expertise. How can we share technology in a way that is relevant and empowering to communities? The obvious model is the transfer and train model, a model which many technology organizations currently use. An asset approach would take technology sharing much further than that. In the article Closing the Digital Divide: An Asset-Based Approach to Community Building and Community Technology , Nicol Turner at Northwestern and Randal Pinkett at MIT suggest that the technology itself and how it is shared should facilitate the strengthening of assets in a community. They wrote that "while e-mail and listservs are useful and value tools, we are advocating a new class of community technology, that is specifically designed to support asset-based community development" (p. 5). Technology is used to reinforce cultural identity, broaden community communciation and improve resource exchange.

Can we find ways to track infectious disease in ways that strengthen the community identity? It's tough, because infectious disease may not be the top priority of villagers in Laos or Cambodia, many of whom do not have access to clean water or adequate food. Can we serve the broader public health needs and serve community interests as well?

Welcome to InSTEDD's Community Perspectives

Welcome to InSTEDD. I am really glad you are here and interested in our mission to enhance global disease and disaster response with technology tools. In addition to managing some of the projects, my particular focus is to ensure that diverse and grassroots voices are an important part of our work, from informing the tools we refine to the way technology is shared. My background is in international politics and social work, so I come with a geopolitical perspective and a deep appreciation for how power dynamics, culture and class can complicate working with people internationally. I really care about making a difference and would love to hear your experiences on successes you have had.

We are going to Cambodia at the end of January to continue our assessment process for our Mekong Collaboration Program. Most of my personal contacts are in Africa, so if you know of great community groups or non-governmental organizations (NGOs) in Cambodia you would recommend, please let me know.

My own approach is greatly informed by my time working in a Rwandan refugee camp after the genocide with the unaccompanied minors program. Instead of coming in with our 'outsider' answers, we looked at what the Rwandans were already doing (taking in stranger's children) and supported that effort. On the other side of Rwanda (Zaire, now Congo), international media attention on the children inspired many groups to set up orphanages which encouraged families to drop off their own children so they could get more food. There were other differences between the two regions, but the two differing approaches had profoundly different outcomes. In our camp, we had 5,000 children in foster care and 20 in a care center, and in Zaire they had 10,000 children in orphanages/care centers. After that experience, I begin any cross-cultural work or community work by seeking to understand what people are naturally doing and supporting those efforts.

What experiences have shaped your own view of working internationally?

Bye for now. I will be writing weekly so check back or email me at marcus@instedd.org.

Sincerely, Mary Jane

Just Back from India

I just returned from India, a personal trip to attend a friend's wedding that also included many opportunities to explore how InSTEDD could serve the communities here. Disaster and public health are both top priorities here. India was in the midst of a major polio vaccination push, with banners displayed around Dehli encouraging families to get their children immunized on a mass immunization day - January 6th. In the eastern region, they are responding to the the once every 48 year bamboo bloom that brings with it thousands of rats and mass exoduses.

The most interesting discovery was during a conversation with my friend, Chhaya Kunmar, who works for an NGO in the Himalayan mountain regions south of Nepal. The founders of Himalayan Action Research Centre realized the greatest way they could empower people of the rural areas was to provide information. The center of HARC's platform is to share information and provide training to these rural villagers, and information alone, without direct financial aid, has had a tremendous effect. They showed villagers how worthwhile organizing into farmer groups could be, and they also introduced these farmers to large buyers who could give them better prices. These two efforts resulted in orange farmers earning from 1 cent a kilo to 5 cents a kilo. It turns out these rural villagers simply did not have easy access to information and resources that would help them improve their lives. But what is most significant is HARC's approach. They do not arrange the buying or tell farmers what to grow; they simply introduce them to better opportunities and allow the farmers to decide.

This model is relevant to InSTEDD's efforts to use technology to gather and share information more effectively in remote regions of the world.

Technology had penetrated these hill stations (though I would call them mountains they were so enormous) but to a lesser extent than one would think of India. In the village of Naugaun in the state of Uttranchal, some farmers have cell phones, and anyone with a job outside the subsistence sector has a cell phone. There was no internet cafe in the village, and computers were definitely limited to the NGO, and were further limited by the regular power outages in the village.