Demanding Mobile Health

In 2013, MOS@N, an experimental mobile health (mHealth) network providing medical monitoring and follow-up of pregnant women, was launched in the health district of Nouna in rural Burkina Faso. MOS@N is implemented by the Centre de Recherche en Santé de Nouna (CRSN), a national health research center. It is funded by Canada’s International Development Research Centre (IDRC) and supported by the Ministry of Health. MOS@N operates in an area where maternal mortality remains a major public health challenge, and where the rates of antenatal care consultation (ANC) attendance and of assisted delivery are relatively low. It aims to pilot the use of mobile devices to improve the use of health care services by pregnant women. MOS@N sends voice medical appointment reminders and health advice to “godmothers,” community relays selected as part of the project to follow up with pregnant women in their respective villages. To do so, godmothers were provided with a mobile phone and a bicycle to facilitate their movement within the village as they travel to the local primary health care center (PHC). The cell phone has prerecorded health education messages for godmothers to play when convening maternal health awareness sessions. Equipped with phones and data connectivity, godmothers can reach remote populations to provide them with health advice and information.

MOS@N also includes an electronic health record system that runs on computers installed for that purpose at local PHCs. Since none of the local PHCs are connected to the electricity grid, they were also provided solar panels to keep the computers running. Health workers—nurses and midwives—at PHCs are in charge of entering patient data into the system, which then automatically generates the reminders sent to the godmothers’ phones. In 26 villages, served by five different PHCs, MOS@N brings together pregnant women, godmothers, rural PHCs, health workers, technicians, public health researchers, server rooms, an automatic callback system, bicycles, computers, portable solar panels, batteries, cell phones and refill cards, not to mention husbands, dirt roads, bicycle repair stations, heavy rains, and village authorities, in an experimental network.

The entrance of the CRSN

Fig. 1. The entrance of the CRSN. Photo by author.

The number of mHealth projects and systems implemented in low- and middle-income countries has doubled in the past five years. Driven by the leadership of the World Health Organization (WHO), global health organizations, researchers, and donors increasingly expect data connectivity to strengthen health systems, reduce costs for access to health care, and thus contribute to health equity. Connectivity promises to bring new bodies and populations into sight, alleviating suffering and saving lives; any obstacle to the flow of information is increasingly the cause of suffering and loss of life.

In Burkina Faso too, mHealth networks are multiplying. Most initiatives are aimed at making the national health system more data driven, with a strong emphasis on maternal and child health. In the wake of the Ebola virus epidemic in West Africa, initiatives aimed at digitizing public health surveillance and outbreak response management have also been on the rise. Organizations involved in the funding, design, and deployment of mHealth in Burkina Faso include the Centre Muraz, Terre des Hommes, WHO, Bill & Melinda Gates Foundation, UNICEF, and Grand Challenges Canada. Notable projects include the Integrated eDiagnostic Approach (IeDA), which uses mHealth devices to provide diagnostic support to health care workers and to collect data made available to public health decision makers. Another example is the integration of the WHO-sponsored Maternal Death Surveillance and Response (MDSR) into the national disease surveillance system, requiring health workers to immediately report cases of maternal death via mobile phones. The Burkina Faso Ministry of Health has been supportive of these developments, and it has recently adopted a nationwide strategy to integrate digital technologies into the national health system.

MOS@N was designed in response to a call for proposals by the IDRC to attract projects that would contribute to building evidence of the impact of digital technologies on health systems. There were three specific expectations:
 

  • Access. Information and communication technologies (ICTs) suggest the projects have the potential to make health systems more equitable through better access to health care and information. IDRC takes up a popular theme within mHealth literature: mobile devices are expected to strengthen equity by reducing disparities related to cost, distance, and inadequate health infrastructure (Mehl and Labrique 2014:184). They are expected to enable relatively transparent, seamless communication, thus facilitating the provision of health services to previously underserved populations.
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  • Operational knowledge. IDRC-supported projects should contribute in bridging the gap between research and implementation. Exemplifying the rising popularity of operational research (or operations research) in global health, projects were expected to generate evidence for decision making by studying the process of implementation itself rather than focusing only on health outcomes. IDRC’s call thus insisted that selected projects should examine how ICTs were being integrated into resource-constrained settings by paying attention to the local usage and adoption of mobile technology. Although IDRC’s call was premised on the notion that connectivity should improve access to health care, it aimed to find out what “works” and what does not in various contexts.
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  • Replicability. IDRC’s call directly responded to the lack of evidence in the literature about the scaling of mHealth initiatives into health systems. The vast majority of mHealth interventions are indeed only pilot projects, and remain so. Proposals selected by IDRC were to pay particular attention to the potential for scalability or replicability. As I suggest, MOS@N indeed raises the problem of scale: How can its implementation process be replicated so that connectivity produces similar effects in different settings?

 

Enclosures and Expenditures

MOS@N is trying to facilitate the wireless mobility of data. However, soon after it was launched, it became evident that individuals, devices, data, and information assembled in MOS@N do not move easily. Their circulation is severely hindered, if not altogether immobilized. Obstacles are many and include poor geographical access to PHCs, considering that women often live between 5 and 10 kilometers from the nearest centers; the rainy season, when roads become impassable—sandy, clayey, if not literally flooded; a livelihood depending on women working in the fields, away from home and thus from solar panel chargers, and often from cell phone signals, too; devices that were not as portable as expected, with godmothers carrying their phones in their hands, an obstacle that some have overcome by crafting neck pouches; gender dynamics, with some husbands trying to keep godmothers away from pregnant women, or pregnant women away from the PHC; broken things, including phones, solar panels, bicycles, and computers; unreliable network connectivity; unintelligible voice messages; difficulties using mobile phones and computers; health workers lacking time to enter health data into the computer, compromising its circulation; women who won’t discuss their health status with godmothers or health workers; and conflicts between health workers, godmothers, and pregnant women. A godmother summarizes some of these obstacles:

The other day, when I was accompanying a pregnant woman, we started walking but we did not reach the Bagala PHC on time so she delivered on the road. I called the nurse at the Sikoro PHC [to which the godmother would normally take women of her village, except during the rainy season] to let her know that one of my women had just delivered on the road. I then brought her to Bagala but the nurse refused to see her. She kept asking why she delivered at home. I explained that we really were on the road to come here, and that the umbilical cord was not cut yet and her clothes were soiled with blood. But she reprimanded us, so we left. I gave my phone to her husband who then called the Sikoro nurse to let her know. In the end we brought her back home to cut the umbilical cord ourselves.

The mobility of data, which MOS@N aims to facilitate, in fact still entails the mobility of devices and bodies. And it entails significant expenditure. First, there is physical labor. MOS@N generates displacement, especially for godmothers. Although they were provided with a bicycle to facilitate their travels, the role of godmothers has gradually evolved to include the accompaniment to PHCs. As the story above shows, godmothers now walk and ride along with pregnant women. They also assist health workers during deliveries. This new role was improvised in response to the technical difficulties in generating automatic voice reminders. Indeed, as a result of many of the challenges listed above, godmothers generally do not receive the automatic reminders on time, if at all, as was initially planned. Therefore, they may spend hours on the road every day depending on where they live.

Adverse Road Conditions

Fig. 2. Adverse Road Conditions. Photo by DAKISSAGA Judion.

Mobility in MOS@N also comes with material and energy expenditure. Batteries, cell phones, and portable solar panels are often recharged, disposed of, and replaced. Bicycles are repaired and replaced. Bandwidth is consumed. Project managers move across the district, not to mention donors, researchers, and other visitors traveling to Nouna. MOS@N also comes with a significant increase in workload for health workers, who have to enter patient data into the computer after each consultation, not to mention the tireless work of MOS@N’s field manager, logisticians, technicians, and supervisors. Improved access to health care and information in MOS@N has little to do with an easy circulation—of devices, godmothers, and messages—enabled by a stable, underlying network infrastructure. MOS@N foregrounds the corporeal and material demands of media mobility. Little devices apparently carry more than their own weight.

Media-Worlds

“Knowledge is like light. Weightless and intangible, it can easily travel the world, enlightening the lives of people everywhere” (World Bank 1999:1). It is with these words that a flagship World Development Report on knowledge for development began before emphasizing that millions of children die because of their parents’ lack of access to knowledge. Since the report was published almost two decades ago, mHealth devices have come to embody better than any other technology the medium promising such a life-saving access to knowledge. As such, they display a strong capacity to enchant and mobilize affect (Harvey and Knox 2012; Larkin 2013). The affective power of mHealth devices is directly related to their technical qualities, including their compact size and portability. Although the hype surrounding mHealth has lessened in recent years—a situation acknowledged by IDRC’s insistence on the need to determine what “works” and what does not—the underlying vision of mobile devices as fluid, neutral conduits for the flow of information remains largely unchallenged (Duclos, 2016).

In contrast to this understanding of media devices, ethnographic material on MOS@N points to a conception of media as messy, unpredictable, and transformational. In MOS@N, media devices not only carry symbols and meanings but actually shape connections and transform who/what is connected. This is partly due to the expenditures that come with failing data connectivity, resulting in godmothers still using their phones but now also walking with pregnant women to monitor their attendance to ANCs. Although we are left speculating about the effects of reliable automatic reminders, what is certain is that MOS@N alters individual and collective existence in Nouna in far-reaching ways.

A primary illustration of this lies in how godmothers are not merely connected to PHCs through mobile devices but in fact have come to think of themselves as the intermediaries between PHCs and their community: “We act as intermediaries between health workers and communities.” “The main effect of the project is that now villagers are not afraid of health workers anymore.” Or, in the words of a nurse speaking of godmothers:

Godmothers are extremely useful because here at the PHC, we do not know people in the community. Because they live in the villages, they have become our mouths and our ears with the population. …I’m a stranger here, but they know everyone. Who else could get them to participate in our activities? Now, all we have to do is call them [the godmothers].

In a sense, godmothers, not mobile phones, are MOS@N’s primary mediating devices. Godmothers of course are not passive conduits, and their work of mediation may have unforeseen effects. They spend considerable time with midwives and nurses, gaining practical knowledge and experience, but also experiencing conflicts and performing tasks not designed as part of MOS@N. Godmothers have assisted women delivering on their way to the PHC, stayed several nights at the PHC, cleaned up the PHC, and have mobilized local women as part of mass vaccination campaigns. Some have lent their phone to their children so that they could listen to music, sometimes never to see it back in working order. Others have forgotten to deliver messages, or delivered them late, or to the wrong person. Overall, though, godmothers and their phones have been described as a reassuring presence.

MOS@N has also had a significant impact on the organization of community life in Nouna. Cell phone ownership, accompaniment, and health education sessions have brought godmothers considerable social recognition. It has changed the way they are perceived. Neighbors, family members, and children borrow their phones. Some are called “doctors,” or are given small presents. In some cases, the role of godmother has come with emotional hardship. Their husbands sometimes frown upon their ownership of mobile phones. Resentment from fellow villagers is also common. Godmothers can, for instance, be accused of spreading rumors, or of deception. The confidential nature of pregnancy, the age of godmothers (in some cases younger than the women they follow), jealousy over the choice of the godmother (and her stipend and equipment), or health complications may all contribute in causing tension, and in one case even leading to the banishment of a godmother and her family from their village. In general, though, when speaking of MOS@N godmothers express sentiments of satisfaction, excitement, and deep pride. Being a godmother arguably comes with a new orientation to others and to the world.

The Futures of MOS@N

At the time of writing, funding had run out and MOS@N had come to an end. MOS@N was designed and deployed as a pilot project. As mentioned earlier, MOS@N had to improve access to health care and information to be considered successful. To a large extent, MOS@N has done just that. In addition to creating unexpected relationships, MOS@N has generated measurable public health outcomes showing significant improvement in antenatal attendance and assisted delivery rates in participating villages. MOS@N was also expected to generate data for global health donors/funders/policymakers, particularly about how it achieved this outcome, and how this process could be scaled. This is where success became harder to measure. How could MOS@N lead to something else? Can it be replicated and, if so, under what conditions?

As discussed earlier, the mobility of data in MOS@N came at a heavy cost, whether it was in terms of physical labor, or material and energy expenditure. MOS@N depends on a persistent and demanding care for the relations that constitute it as media-world. In a related manner, MOS@N relied on a high degree of improvisation, or what could be considered an “experimental” ethos. It is important to emphasize that researchers at the CRSN were aware that MOS@N remained largely experimental. Although this was their first mHealth project, they knew, because they had worked closely with local communities in the past decade, that the demands placed upon mHealth within these communities might differ from their own. MOS@N involved qualitative research aimed at exploring these demands, at examining the project’s effect, and at fine-tuning it along the way.

In other words, researchers at the CRSN were aware of what they did not know, which is the problem: now that they are looking for funding to scale the network, there is still much they do not know. They have gained implementation skills, but can they trust that “more of the same” will lead to future success when the “same” is in itself contingent and unpredictable? To what extent does the experimental ethos guiding MOS@N’s implementation lend itself to formalization? What if the way MOS@N succeeded does not suggest easy replicability? After all, MOS@N does deflate any expectation that mHealth networks can be extended in a parsimonious, predictable manner. CRSN researchers did pay close attention to the processes that breathe life into MOS@N and make it work, thus at least partially meeting IDRC’s expectation for operational knowledge. But rendering processes visible does not suddenly make these processes amenable to prediction. The future of MOS@N faces a conundrum critical to the deployment of little development devices in general: only out of fragile, messy connections do consistencies appear to emerge.

Acknowledgments

This paper is the result of a collaboration with the Centre de Recherche en Santé de Nouna (CRSN). I would like to thank Ali Sié, Maurice Yé, Gilles Bibeau, Hamidou Sanou, Moubassira Kagoné and Hélène Sawadogo for introducing me to the CRSN, and for their work which is critical to this research. I also thank the editors of this collection for their genuine comments.

Vincent Duclos is Assistant Professor at Drexel University, with a joint appointment in the Center for Science, Technology & Society, and the Dept. of Global Studies & Modern Languages.

References

Duclos, V. 2016. The map and the territory: An ethnographic study of the low utilisation of a global eHealth network. Journal of Information Technology 31(4):334–346.

Harvey, P., and H. Knox. 2012. The Enchantments of Infrastructure. Mobilities 7(4):521–536.

Larkin, B. 2013. The Politics and Poetics of Infrastructure. Annual Review of Anthropology 42(1):327–343.

Mehl, G., and A. Labrique. 2014. Prioritizing integrated mHealth strategies for universal health coverage. Science 345(6202):1284–1287.

World Bank. 1999. World Development Report 1998/99: Knowledge for Development. New York, NY: Oxford University Press.

Image Credit: Panel from The White Ribbon Alliance for Safe Motherhood Burkina Faso, Section Kadiogo. Click to view full image.

Iterate, Experiment, Prototype

Innovation by Design

In 2012, the United Kingdom’s Department for International Development (DFID) launched its Innovation Hub (i-Hub). It thereby followed a trend among development actors who see innovation, broadly defined as generating new ideas leading to large-scale solutions, as crucial to increase the impact of their interventions. In the words of Judith Rodin, former long-time president of the Rockefeller Foundation, “Innovation alone will not solve all of the problems facing humanity, but we certainly won’t solve many without it” (2016:6). In contrast to mainstream innovation that does not pay attention to existing inequalities and can thereby exacerbate them, academics and practitioners are increasingly using the term “inclusive innovation” to describe innovation practices that explicitly aim to improve the lives of marginalized groups. Having subsumed terms such as “pro-poor,” “below-the-radar,” “grassroots,” or “frugal innovation,” inclusive innovation refers to “the inclusion within some aspects of innovation of groups who are currently marginalized,” either through products and services developed specifically for them, their incorporation into the innovation process, or support for their own grassroots innovation efforts (Foster and Heeks 2013: 335).

This innovation turn is often joined by the embrace of humanitarian design, which is the application of design methods to development ends or—as designers would say—to change what is into what ought to be. Humanitarian design has its historical roots in longstanding alternative design traditions such as universal, ecological, or feminist design. E. F. Schumacher’s Small is Beautiful (1973) and Victor Papanek’s Design for the Real World (1984) called for the use of socially and environmentally responsible technologies and design. Papanek himself designed a 9-cent radio made of a used tin can and powered by wax or animal dung burned underneath it, which was distributed by UNESCO in India and Indonesia. The tin-can radio can be seen as an early humanitarian device and the forerunner of the hand-crank or solar-powered radios now ubiquitous in many places in the Global South. More recently, when Melinda Gates and Paul Farmer were asked what they saw as the innovation that is changing most lives in the developing world, they answered, “human-centered design,” in reference to a particular brand of humanitarian design advocated by IDEO.org (Wired 2013).

IDEO.org is the nonprofit subsidiary of IDEO, a Silicon Valley–based international design consultancy that has been one of the most successful commercial entrants into the humanitarian design space. Its DesignKit website (www.designkit.org) provides popular online courses, field guides, and case studies. Through these free resources and articles in leading magazines such as the Stanford Social Innovation Review, IDEO has played an important role in legitimizing the participation of professional designers in the development enterprise. In the latter publication, IDEO Chief Executive Officer Tim Brown and IDEO.org Executive Director Jocelyn Wyatt argue, “Time and again, [development] initiatives falter because they are not based on the client’s or customer’s needs and have never been prototyped to elicit feedback” (Brown and Wyatt 2010:31). By branding its own approach as human-centered design (HCD), IDEO.org makes explicit—and appropriates more visibly than other organizations in this space—the critical centrality of user perspectives in humanitarian design.

Part of the legitimation process of humanitarian design is redefining the development problem as a shortage of creative ideas, flawed system design, and preconceived notions of development practitioners (Schwittay 2014). In addition, advocates of humanitarian design point out that the complexity and fast-paced nature of today’s development challenges calls for innovative, creative, and integrative experts—designers in short—who are best placed to tackle the problem of persistent poverty. Part of their approach is to redefine common constraints, such as poor people’s inability to pay for necessary services, as “creative springboards” and to redefine poor people’s needs as (commercial) opportunities. This vision of development is based on a conceptualization of the poor as consumers and an individualization of infrastructural problems, both hallmarks of humanitarian goods.

Amplifying Development

In 2014, DFID’s i-Hub contracted IDEO.org to the tune of £10 million to develop and implement its flagship program, Amplify (www.amplify.org). Amplify is a crowdsourcing platform aimed at engaging nontraditional development actors such as designers and other creative entrepreneurs, diaspora communities, technologists, engineers, and the public at large. It also wants to establish stronger connections between these actors and potential users of the development solutions generated via the platform. By definition, these users are constituted as poor to fit DFID’s mandate. Reflecting the hyperbole that often surrounds the uptake of innovation and design in development, Amplify’s business plan marketed the program to DFID senior management as a “platform [that] could galvanise truly transformational and unprecedented innovation by attracting new sources of expertise” and the use of collaboration (Amplify 2013). Indeed, Jonathan Wong, former head of i-Hub, reports that thanks to Amplify, HCD is diffusing across DFID and other UK government departments (IDEO.org 2016). This is also a process of making visible the informal and unseen practices already happening at the margins of many development organizations, of mainstreaming them and showing their potential contributions to DFID’s work.

The Amplify platform has been adapted from the original OpenIDEO platform, which was built to stimulate “open innovation” and uses proprietary software and a Creative Commons license. Calling it an online platform rather than a website highlights such crowdsourcing devices as socio-technical spaces that enable diverse and dispersed groups of people to collaborate on joint projects. Amplify itself consists of eight challenges, with topics ranging from women’s safety in urban areas to improved refugee education to youth empowerment in East Africa and enhanced opportunities for people with disabilities. Each challenge goes through a four-month online process, at the end of which a handful of winners attend a design bootcamp, usually held in Nairobi or Kampala, and receive upwards of £100,000 in DFID funding and IDEO design support to implement their ideas. To date, seven challenges have been completed, which allows us to examine if and how the program’s use of open collaboration and humanitarian design have been changing DFID’s modus operandi. Our analysis is based on more than 2 years of qualitative research, encompassing in-person and Skype interviews with three DFID managers, five IDEO managers, and 15 participants, predominantly finalists of the first four challenges. We also conducted detailed numerical and discourse analysis of three challenges through online research and examined secondary materials such policy papers, a business plan, blog posts, YouTube talks, and online meet-ups.

Participants in the 2016 Amplify Bootcamp

Fig. 2. Participants in the 2016 Amplify Bootcamp in Kampala, Uganda.

Most obviously, the Amplify application process differs significantly from DFID’s traditional Requests for Proposals. The latter ask for precisely defined project descriptions and timelines, budgets, and objectives, all presented in development jargon that from the outset narrows the pool of applicants to those able to comply with these requirements. Instead, Amplify’s more flexible and open-ended process emphasizes learning and iteration. Most participants—theoretically anybody with an internet connection can set up a short profile and join the platform, although there are clearly structural constraints to participation—post preliminary ideas on the Web2.0-type website. There are a number of free-form text boxes where participants answer open-ended prompts such as, “Explain your idea,” ‘“Who benefits?” and “How is your idea unique?” In addition, dropdown menus provide more precise information about the participants themselves on, for example, years of experience in the country for which the idea is being proposed, expertise in the sector, and size of operating budgets. Although written text, which has to be in English, dominates the submissions, participants are also encouraged to embrace more visual language by posting photos and short videos. All shortlisted participants have to provide a user-experience map to chart how potential users of their idea would participate in the proposed project. Initial submission can easily be changed using a simple editing function in response to questions and comments from other participants and IDEO.org managers, which are displayed in a comment section.

User experience map created by a Food for Education, a winner of the fourth challenge.

Fig. 3. User experience map created by a Food for Education, a winner of the fourth challenge.

This online process is structured according to the HCD process of Ideas–Feedback–Improvement, which asks that participants show how comments and other feedback are shaping the evolution of their ideas. Although this structure imposes its own logic, it is miles away from the conventional log frame (logical framework) used by many development organizations. Whereas log frames demand that information is presented in boxes, organized by technical terms such as input, outputs, and outcomes, the design process operates through freeform, flexible thinking and writing to produce more open-ended submissions. Several participants we interviewed welcomed this move toward a more realistic process for formulating and implementing development projects, which one participant described as “learning rather than proofing.” Such learning also takes place at the level of the program, as Amplify itself has been conceived as one large prototype where continuous adjustments are made from one challenge to the next.

Amplify’s aim has always been to fund small organizations that DFID, which channels most of its aid through large international nongovernmental organizations (NGOs) or consultancies, is not usually able to support. An examination of the 30 winners of the first five challenges shows that just over half are nonprofit/NGO-type organizations, eight are social enterprises, three are professionals, and another three are design groups. A group of New York University (NYU) design students won the first challenge with a project developed in collaboration with a Nepalese NGO they had met on the website; this was celebrated in a newspaper article as being exactly what Amplify was about (Leach 2015). However, an IDEO manager complained to us that the program should instead be supporting Kenyan design students and connecting them to Kenyan social enterprises. He was not so much objecting to the fact that funds went to the United States rather than target countries (most of the money was channelled via NYU to the Nepalese organization), but that the U.S. students did not know much about what is going on in Nepal. It is through such internal debates that small, community-based organizations have emerged as the “sweet spot” targeted by Amplify, showing how inclusive innovation and open collaborative practices can generate their own politics of exclusion. In the fourth challenge, a Kenya-based design group called KDI did win, with a project to work with Nairobi slum dwellers to redesign open spaces to prevent flooding.

Page from KDI’s pilot concept plan submitted to IDEO.

Fig. 4. Page from KDI’s pilot concept plan submitted to IDEO.

Small Experiments

i-Hub’s first head has described Amplify as “less like Encyclopaedia Britannica and more like Wikipedia” (Wong 2016:125). For him, development knowhow is no longer created in traditional centers of power, which instead “curate” knowledge production in multiple locations around the globe. However, the above description of what is new about the program also reveals some of its continuities with more conventional development regimes. Most important, Amplify expertise remains firmly situated in the Global North, with IDEO.org designers in New York and San Francisco, DFID managers in London, and unnamed subject experts who ultimately chose the winning ideas. This replication of authoritative development geographies can also be seen in the location of the finalists. Although all of the winners of the first five challenges are based in the Global South, 24 of 30 have a connection to the Global North, with 19 to the United States. Close to 50% of all winning projects are located in Kenya, despite the fact that 27 of DFID’s priority countries are eligible for Amplify support. The sixth challenge focused on four countries in East Africa only, narrowing down Amplify’s professed diversity to long-established sites of UK development interventions.

Amplify is also subject to a tension at the heart of the design endeavor. On the one hand, there is an insistence that everyone is a designer because design is a fundamentally creative, human activity, which awkwardly stands counter to claims by professional designers that they possess the right qualifications, skills, and methods to solve the world’s problems. Although everybody who logs onto the Amplify website has to participate in its designer-y process, it is IDEO.org employees who are the program experts. Such an appropriation of expertise resonates with condemnations of humanitarian design as “soft cultural imperialism” operating through neoliberal narratives about poverty and the use of techno-scientific market devices to solve it (Johnson 2011:463). However, one characteristic of humanitarian design is precisely the ever-closer entanglement of markets and morals (Redfield 2016). In addition, it is Silicon Valley’s techno-utopian and libertarian values that shape Amplify’s operations and thereby seep into broader international development efforts.

Accordingly, Amplify’s business plan celebrates its “start small, test, and fail early” mentality (Amplify 2013). Continuous experimentation is encouraged throughout the online process and especially among finalists. In our interviews, some participants recognized the challenges that such an experimental logic can present in the complex world of development, where vulnerable livelihoods leave little room for creative destruction. There is also a qualitative difference between the beta version of the latest geolocation app failing in tests with a consumer focus group, and the implications of discontinuing a project that was providing important community services. In one case, Amplify managers urged a finalist to introduce a new employment skills project requiring substantial upfront investment in equipment against the finalist’s own judgment that it would not be economically sustainable in the long run. Having to abandon the project after the three-month period supported by a small Amplify grant resulted in confusion and disappointment among its users. The organization’s own frustration echoes critiques that humanitarian designers, in their search for marketable innovations, sometimes do not pay enough attention to financial sustainability and organizational cultures (Mulgan 2014).

Above all, Amplify operates as a micro-social generator, incubating interventions at a micro scale. It combines the qualities of a social networking platform (like Facebook/Linkedin) with the features of an open-editable content platform working through the small contributions of numerous individuals and groups and overseen by a group of administrators (like Wikipedia). By design, it supports small organizations producing local solutions that improve the lives of individuals, their families, and their neighborhoods. On the one hand, this results from the nature of design. DFID managers recognized in our interviews that design can only tackle more technical problems, and Amplify was always aimed at particular locales rather than universal coverage. This is not to say that it does not have global ambitions, as scalability is something experts look for in winning ideas. Indeed, one finalist of the Refugee Education challenge, a Jordanian organization called We Love Reading, is aiming to build a global movement to get more children to read for pleasure. But it also remains firmly rooted in its local origins: it started in a neighborhood mosque in Amman, and works through one reading circle at a time.

Image from presentation prepared by IDEO.org for We Love Reading.

Fig. 5. Image from presentation prepared by IDEO.org for We Love Reading.

On the other hand, micro is the scale of humanitarian devices, and similar to these devices, most winning ideas on Amplify advocate for solutions standing apart from state infrastructures or authorities. Working at an individualized and individualizing level, they deploy technical minimalism in the face of immediate needs. They also often create “micro-scale market opportunities” while presenting “small…approaches to social change” (Redfield 2016:179). How has this translated into the production of humanitarian goods?

Designing Humanitarian Devices

Among the winners were certainly devices that fit the inclusive innovation remit with its focus on newness: a clean birth kit for poor Indian mothers, a biogas-powered milk chiller for Tanzanian farmers, novel storage solutions for Ethiopian market vendors, a market-matching chatbot connecting Kenyan poor farmers with buyers, and a peer-to-peer SMS-based information network to alert Jakarta inhabitants to floods. But the great majority of winning projects have been quite conventional, from employment training schemes to microfinance to community health initiatives and educational programs. This reflects Amplify managers’ self-professed scepticism towards technological silver bullets and existing expertise within DFID more broadly, which ultimately limits what can be funded. Equally important, because of the organization’s value-for-money mentality stemming from its fiscal responsibility to UK taxpayers, initial blue-sky thinking has made way to safer ideas and organizations. Has this resulted in poor—rather than pro-poor—innovations, foregoing breakthroughs for incremental change? Although Amplify’s outcomes might be familiar, the process by which they have been achieved is certainly new to DFID, many of the winners, and the platform’s observers.

And what if we regarded design as a particular, “remedial” approach to changing situations whose status quo cannot be accepted, as suggested by Bruno Latour (2008)? Then, rather than being revolutionary, humanitarian design can be seen as careful in a double sense: on the one hand it can only present limited solutions to clearly circumscribed problems, and on the other it is infused with an ethics of care that accords well with the affective dimension of contemporary humanitarianism and the popular embrace of poverty alleviation causes. It can be seen as an approach to international development whose practitioners wonder whether they are asking the right questions where others have ready-made answers, who examine the assumptions that most development interventions take for granted, and who hold in view the messiness and complexity of any project of change, ultimately recommending to proceed with caution. Likewise, for researchers of these approaches, rather than subscribing to the well-trodden critique of neoliberal market dominance, might an agnostic stance that explores their potential while acknowledging their limits be more productive?

Anke Schwittay is the Head of International Development at the University of Sussex. She is the author of New Media and International Development: Representation and Affect in Microfinance. Paul Braund is a Research Associate at the University of Sussex and works at the intersection of information systems, design and international development.

References

Amplify. 2013. Business Plan. Available at link.

Brown, Tim, and Jocelyn Wyatt. 2010. “Design Thinking for Social Innovation.” Stanford Social Innovation Review 8(1):31–35.

Foster, Christopher, and Richard Heeks.2013. “Conceptualising Inclusive Innovation: Modifying Systems of Innovation Frameworks to Understand Diffusion of New Technology to Low-income Consumers.” The European Journal of Development Research 25(3): 333-355.

IDEO.org. 2016. Impact: A Design Perspective. Available at link.

Johnson, Cedric. 2011. “The Urban Precariat, Neoliberalization, and the Soft Power of Humanitarian Design.” Journal of Developing Societies 27(3–4):445–475.

Latour, Bruno. 2008. “A Cautious Prometheus? A Few Steps Towards a Philosophy of Design (with Special Attention to Peter Sloterdijk).” In Proceedings of the 2008 Annual International Conference of Design History, pp. 2–10. Boca Raton, FL: Universal Publishers.

Leach, Anna. 2015. “Collaboration Not Competition: Could This Be the Future of Development?” The Guardian, April 14. Available at link.

Mulgan, Geoff. 2014. “Design in Public and Social Innovation: What Works and What Could Work Better.” Available at link.

Papanek, Victor. 1984. Design for the Real World: Human Ecology and Social Change. Chicago, IL: Academy Chicago Publishers.

Redfield, Peter. 2016. “Fluid Technologies: The Bush Pump, the LifeStraw® and Microworlds of Humanitarian Design.” Social Studies of Science 46(2):159–183.

Rodin, Judith. 2016. “Foreword.” In Innovation for International Development: Navigating the Paths and Pitfalls, edited by Ben Ramalingam and Kirsten Bound, pp. 6–7. London, UK: NESTA.

Schumacher, Ernest Friedrich. 1973. Small is Beautiful: A Study of Economics as if People Mattered. US: Random House.

Schwittay, Anke. 2014. “Designing Development: Humanitarian Design in the Financial Inclusion Assemblage.” PoLAR: Political and Legal Anthropology Review 37(2): 29-47.

Wired. 2013. Interview with Melissa Gates and Paul Farmer. Available at link.

Wong, Jonathan. 2016. “From Britannica to Wikipedia: How Traditional Development Players Are Catalysing Collaboration for Innovation.” In Innovation for International Development: Navigating the Paths and Pitfalls, edited by Ben Ramalingam and Kirsten Bound, pp. 120–130. London, UK: NESTA.

Featured Image: Image from IDEO.org 2016 Impact Report (IDEO.org 2016). “Design: We improve the lives of people in poor and vulnerable communities through the solutions we create.”

Notes on digital detox

The discussion on digital detox has been going on for some time now, also in the Netherlands, and is doesn’t look like it’s going away soon. After talking about the shortcomings in the detox-discourse, Geert asked me to write down my thoughts on the issue. Below is the result.

The phenomenon of digital detox is annoying. Obviously, it fights only the symptoms and not what lies behind them, the causes of perpetual distraction, loss of concentration, burn-outs and so on. It’s the easy way out, but in my view it’s a way out that turns out to be a dead-end. There are a couple of reasons why.

When it comes to the physical incentives to go detoxing, going out into the woods without a phone to get relieved of stress and fatigue will not help you in the long run: it’s time off that serves only to get right back in the rat-race when the camp-out is over. It’s like the carrot in front of the donkey’s nose: something to keep you going, supposedly out of free will, while it’s actually a function of psychopolitics and self-veillance. (hier staat veel over in het essay, kan eventueel citaten erbij halen…)

So, just logging off for a couple of days won’t cut the crap. Does it mean that we should not do a detox but completely cut out the smartphone and all the invasive media from our lives? Surely, that is not what we want either. At least, I’m not willing to give up on the internet, on being connected. Apart from the negative ‘symptoms’ it also – and still – offers a lot of benefits. Pleasure, friendship, courtship, knowledge, work.

To me it’s clear that we need a new way of coping with this, one that befits the ‘post-digital’ age. One that acknowledges that this internet thing is not going away, and we don’t really want it to either. One that acknowledges that doing, knowing, enjoying and discovering many different things might actually also have a good side, even if it’s relatively superficial compared to the specialised knowledge that former (elite) generations strove for. Just like the access to so many different things and people and publishing possibilities that the internet gives, and the fact that so many more people are able to participate in debates, to make themselves heard etc. – even though it leads down some ugly alleys as well. I want a strategy that doesn’t just turn away from this or turn inwards into meditation or mindfulness, but confronts the post-digital condition, sucks it in, wallows around in it, and still thrives.

One such strategy could be to actively follow your own distraction instead of just being pursued by things distracting you. It begs the question: What in the world calls my attention? What, not in the sense that we let ourselves get distracted by whatever’s meant to distract us (although of course we must also understand the mechanisms behind that), but listening to the call that actually pleases our ear, like the call of a siren. Put stress on the ‘my’ in ‘my attention’ and not just let yourself get hooked by anything that’s fishing for any attention of anyone. Think about what attention is. Attention is contradictory: it’s what media companies seek and by seeking it, they destroy it. Attention is pulled in by them, instead of pulled out by us. What is it in the world that calls out my attention? I don’t care if it’s online or offline, the two are hardly distinguishable. I care if I care and I care about many things.

(Some of these notes are worked out more elaborately in the title essay of my (Dutch) book Swimming in the Ocean: Texts from a Post-digital World)

Glucometer Foils

The labyrinth of foil inside a glucometer strip reveals a fragile chemistry. If you peel open the plastic covering, many inner circuits contain some version of biosensor technology, electrochemical cells screen-printed with gold or other precious metals and coated in places with enzymes. The foil serves as a conductor for electrons in a drop of blood, allowing a brand-matched glucometer machine to measure the charge a sample holds.[1] Yet costly design components (including gold) are also part of the reason that glucometer strips remain too expensive for most people in the world who have diabetes.

Diabetes mortality. World Health Organization 2014

Fig. 2. Diabetes mortality. World Health Organization 2014. Used with permission.

Today, personal blood glucose meters are widely considered best practice for optimal diabetes management. Key in calibrating safe insulin dosing, they have also become a vital part of how people with diabetes move in and out of numerical legibility: glucometers are playing a major role in the piecemeal global public health mapping[2] of a diabetes epidemic rising worldwide. Even with increasing bureaucratic recognition, the number of people with diabetes remains debated by major policy institutions. The World Health Organization, author of the concerning map above (Fig. 2), calculates some 1.5 million fatalities from diabetes each year, while the International Diabetes Federation (IDF) places its projections even higher. Trying to account for undiagnosed populations, they estimate that diabetes now kills around 5 million people worldwide annually—five times as many as the reported mortality from HIV/AIDS in 2016—and that some three-quarters of an estimated 415 million diabetics today are living in low- or middle-income countries (IDF 2015). These very different statistics help to show the murky contours of a vast epidemic that glucometers’ measures both enter and play a part in enacting (Mol and Law 2004). Yet their role in frontline diagnosis also hinges on a painful irony: glucometers’ metrics help to make visible an enormous population of people living with diabetes in contexts of poverty, many of whom cannot consistently access the same meters then vital for day-to-day care.

'Cash for diabetic test strips' sign at Pennsylvania intersection

Fig. 3. “Cash for diabetic test strips” sign at Pennsylvania intersection (photo by author).

I first encountered these issues as an anthropologist following people’s stories about living with diabetes during a year of fieldwork in the Central American country of Belize. It initially came as a surprise to me how expensive and out of reach the basic tools of glucose home management remained for many people I spoke with in 2010. During this time, glucometer machines—some purchased at grocery stores or local clinics, others acquired from visiting care groups or sent by relatives in the United States or elsewhere abroad—were priced around $50 to $100. Some corporations even provided them for free if you bought enough test strips, which are the truly expensive component of this system. Prices are declining today, but in 2010, they went for around $50 to $70 per jar of 50 strips (which would last less than a month for someone testing twice a day, but were often stretched much further by people trying to make supplies last). They had to be constantly replenished with imported strips that require precise matching to machine model and brand (Moran-Thomas 2016). A thriving gray market (Grondahl 2012) flourishes around them even in the national contexts they are specifically designed for, a problem reflected in the image I took recently in Pennsylvania (Fig. 3). According to a CNN report, in 2012 diabetes test strips became the number one most frequently stolen item in the United States, surpassing alcohol and cigarettes (and raising disturbing questions about the systems in place when a top target of criminalized theft is entwined with health-seeking behavior).[3]

Although glucometers first seem like the closest thing there is to a “solution in a box” (Redfield 2012a) for global diabetes management, as Peter Redfield (2012b) puts the quest for such objects, their upkeep entails engaging a transnational supply line full of expensive, complex parts and hardwired assumptions. Though portable, these devices require intricate networks to maintain: codes and calibrating fluid; lancets to draw blood from fingertips (for which some people substituted pins or sewing needles); and lithium and other specialized imported batteries, for which there was no substitute. Managing these messy assemblages could become a family affair, including the coordination of foreign insurance plans and mailed parcels. Certain models became easily damaged in hot temperatures, or left people trying to recode their machine’s time stamp, which might allow recently expired strips to come back into circulation. Many said a jar that expired a day or two ago could still work just as well, but no one knew exactly where to draw the line at when a strip’s diminishing efficacy became too far expired to be worth consulting: A month? A year? Of course, drawing such lines returns to much larger unsettling questions around about glucose meters: How bad is less than ideal care—and how are people navigating its risks against the de facto dangers of no care? I wasn’t sure what the implications of expiry backdating were in practice, but observed many cases in which refusing to fiddle with a meter would have meant no way to test at all.

Glucose meters were not designed to enter humanitarian aid economies. After all, diabetes had not historically been imagined as a worldwide issue of humanitarian concern. Decades ago in the 1970s when early blood glucometer models were first being developed in Europe, North America, and Japan, diabetes was still largely considered a “disease of affluence.” Historically portrayed as linked to excess—if anything, the opposite of malnutrition—Type 2 diabetes was frequently cast as the responsibility of misbehaving individuals rather than a societal concern or urgent public health issue. Meanwhile, people with Type 1 were often mistakenly imagined scarcely to exist outside high-income contexts.[4]

In U.S. settings today, glucometers are often used in conjunction with continuous glucose monitoring systems or even insulin pumps. But these, to my knowledge, were not available in Belize even to the wealthiest, making a working “finger prick” meter more important as a checkpoint. For those who could acquire these digital devices, they commonly indexed the generosity of relatives abroad or served as artifacts of transient philanthropic interventions, networks difficult to sustain day in and out. I saw countless machines that were unusable or broken. Time and again, I encountered malfunctioning meters with elaborate features such as Bluetooth compatibility on the shelves of homes without electricity, artifacts of vast gaps between the contexts these machines’ designers envisioned and the places they have become necessary. Stored on kitchen shelves or carried in weathered plastic bags by patients trying to repair them, people’s bodies and devices often seemed to be wearing out together.

There is a story about a critical crossroads in the history of meter development. It is an oral history that perhaps might be read as an aspirational rumor, but the story goes like this: There were two major competing companies shaping design when the first glucometer machines came out, one in England and another in Germany. A top employee of the British company has described how their engineers proposed making an open machine that would read either company’s strip, and called their German counterpart with a proposal to coordinate. According to his recollections, the German company turned down the idea and did not want their strips read by any but their own machines (Mendosa 2006).

Although meters philanthropically donated by manufacturers today provide key islands of care in select low-income pockets of the world, such programs remain highly proprietary and heavily dependent on donor control, leaving huge populations excluded. There are also important efforts under way to distribute glucose meters that reflect the hard work and care of innovative grassroots communities in Belize and beyond, but such collectives still deal with devices that are prone to systemic breakdown and remain out of financial reach for many in the world. Scholars such as David Fidler (2008) have envisioned a productive “open source anarchy” that might characterize global health governance, in which private and public institutions alike could collaboratively contribute to building health networks and catalyzing competition to drive technological innovation. But the case of brand-matched strips and proprietary glucometer parts for global diabetes care seems more iconic of what Ruha Benjamin (2015) calls “discriminatory design,” technologies with foreseeable injustices built in. (And like many forms of discrimination, taken-for granted norms and complacencies that exclude certain populations from access can produce worrisome effects without being deliberately unjust.)

Is “discriminatory design” the inverse of humanitarian design? Humanitarian impulses express conscious intent to remedy injustices, whereas a glucometer’s discriminatory effects seem to derive more from assumptions and failures of imagination. As Madeleine Akrich observes in her now-classic essay “The De-Scription of Technical Objects” (1992), it is often “only in the confrontation between the real user and the projected user [that] the importance of…the difference between the two [comes] to light,” taking ethnographic work to “follow the device as it moves into countries that are culturally or historically distant from its place of origin” (Akrich 1992:211–212). When design problems for poor patients are identified, what happens next? As Alice Street discusses in this issue, point-of-care diagnostics have become a frontier of innovation for various global health projects. Yet glucose meters stand out as a boundary case example of technological design that has not been transformed by these new norms. Glucometers also serve for much more than one-time initial diagnosis of diabetes (though they at times play a diagnostic role): people then require access day in and out for the rest of a lifetime, if they hope to monitor their blood sugar in the ways their doctors recommend. Why have affordable, portable diagnostic tests for human African trypanosomiasis been developed and manufactured, but not for blood glucose?

Some people ask whether a satisfactory low-cost version of glucose testing already exists in urine strips (freighted with their own history of technical and ethical conundrums). Some of the first known technoscientific testing for diabetes was conducted with urine and bits of sheep’s wool dipped in stannous chloride, which turned black to indicate the presence of sugar. Urine tests using paper steeped in alkaline indigo-carmine were in vogue by 1883, when Bedside Urine Testing was published in England (Clarke and Foster 2012). The messy material culture of boiling your own urine was finally replaced in the 1940s by an Ames company urine dipstick test for sugar, the Clinitest. It was based on the breakthroughs of dry-reagent chemistry (the technology behind litmus paper), and popularly marketed for home use.

Clintest

Figure 4. Clinitest, 1942. Gift of Robert J. Locurto, Division of Medicine & Science, National Museum of American History, Smithsonian Institution. Used with permission.

Today’s blood glucose machines are far more accurate than urine tests because they provide “real-time” blood glucose levels, whereas urine (by the time it’s expelled) is reflecting the body’s state several hours before. This, along with other limitations in precision, now makes blood glucose meters a basic standard of care for home testing in the United States. But out of recognition that such everyday glucometer testing remains utterly out of reach for many poor patients in huge swathes of the world, one of the IDF’s important advocacy and policy engagements was to issue a position statement on glucose testing access. It boldly supported the use of urine testing at home for diabetic people who could not afford personal blood glucose meters. The IDF’s official position statement on urine glucose testing was publically issued in 2005. The three-page document reads in part:

Before the advent of blood glucose monitoring in the 1970s, urine glucose monitoring was universally used, with many people able to maintain good control. Blood glucose monitoring has now replaced urine monitoring in resource-rich settings. However, insistence on blood glucose monitoring in economically disadvantaged settings could result in no monitoring at all…

  • Urine glucose monitoring should continue to be available throughout the world.
  • Education about its role and appropriate use should be part of essential education about diabetes for health care professionals and governments.
  • It can be used separately to, or in conjunction with, blood glucose monitoring in particular circumstances and settings.
  • It should continue to be included on the World Health Organization Essential Drugs List.
  • The major promotion by industry of blood glucose monitoring should not result in the appropriate role of urine glucose monitoring being underestimated.
  • As long as results are interpreted correctly, and limitations understood, it provides valuable information in persons with type 2 diabetes treated by diet or diet and tablets, in people with type 2 who use insulin, and in people with type 1 diabetes, who cannot afford blood glucose testing…
  • Because it is significantly cheaper than blood glucose monitoring, it has a very important role to play in settings where blood glucose monitoring is not accessible due to cost, or where blood glucose monitoring can only be done relatively infrequently. This occurs in some situations in both developing and developed countries.
  • Its use should be determined by the individual healthcare professional in conjunction with the person with diabetes, taking into account all circumstances.

International Diabetes Federation, 2005.

The IDF affirms they have not updated this statement, though it is not widely publicized. (Perhaps this relates to diplomatic negotiations with glucometer manufacturers, key players in diabetes policy arenas today.) Yet controversies about digital glucometer machines versus urine testing are also tangled up in much larger debates in global health ethics: When is outdated basic technology a stopgap measure for pragmatically addressing inequality in the meantime, and when does it risk normalizing complacency with unequal standards of care?

The glucometer’s historical emergence in high-income contexts sets the stage for certain kinds of innovation being constrained around industrial players’ concerns with retaining control of lucrative markets. Yet Akrich argues that it can be easy to believe such norms are unchangeable, which makes social history useful for opening up the contingencies of past designs and suggesting how their contours may be fiddled with ahead: “processes involved in building up the technical objects are concealed. The casual links they establish are naturalized. There was, or so it seems, never any possibility that it could have been otherwise” (Akrich 1992:222). Indeed, even market realities do not put to rest the larger questions also at play: Which inequalities trouble people into action or outrage, and which ones do not? Obviously there are unequal standards all over the place, but a few, like antiretroviral (ARV) availability to treat HIV/AIDS, became points of moral action. And like HIV/AIDS, diabetes also shares the market dilemmas of treatment for a lifelong disease that afflicts populations in both high- and low-income countries.

In the famous case of ARVs, alliances of patient advocates and national governments played major roles in using state laboratory capacities to put pressure on industrial players and make proprietary life-sustaining treatments more affordable. When it comes to diabetes hardware, a number of innovative projects (Akpan 2015) to design glucose management for people living in low-income settings are starting to get off the ground. One such effort is under way at the MIT Little Devices Lab (http://littledevices.mit.edu/), where I visited to learn more about work on “open design” by Jose Gomez-Marquez and his team. Studying the circuits of various glucose meters to figure out how they are wired, they envision an open device that could be useful for practitioners in his home country of Honduras or key collaborators in Nicaragua, for example, or a design blueprint that might be published online as a template for consideration by national laboratories in countries like Brazil that have the capacity to engineer their own quality components. The Little Devices team has also begun exploring what they call “lost technologies” of diabetes care.

Jose Gomez-Marquez holding an open glucometer prototype at MIT Little Devices Lab.

Fig. 5. Jose Gomez-Marquez holding an open glucometer prototype at MIT Little Devices Lab (photo by author).

Such efforts are full of techno-ethical challenges, as Gomez-Marquez describes elsewhere (Mayo Clinic 2017). Yet they surely seem worth grappling with, given how uneven global diabetes care looks at present. In Belize at least, health workers I knew did not recommend urine dipstick tests for diabetes home care because they weren’t considered best practice. But the stark reality persisted: poorer patients often had no way at home to test their sugar at all. Once I asked in a local clinic how they dealt with this quandary, and was surprised to find out that this simple alternative glucose test—costing pennies instead of dollars, and requiring no machine—had been right there on the clinic shelves all along. It turned out that the same urine dipsticks used to check for infections measured not only leukocytes, but also a row of other indicators, including nitrates, albumin protein, bilirubin, urobillinogen, pH levels, and—most important for diabetics—glucose and ketones, present in urine only when the body is off balance. There were numerous cardboard boxes filled with urine test strip jars in storage, a visiting nurse added; it was one of the few things they kept easily in stock. She invited me to look. “Intended for use in the U.S.A.,” read the bottle’s evasive label.

I twisted off the plastic lid and examined its contents, but they yielded no easy answers either—just little strips of rainbow colored patches, paper bands expiring in a jar.

A jar of urine test strips that include glucose and ketone indicators

Fig. 6. A jar of urine test strips that include glucose and ketone indicators (photo by author).

Amy Moran-Thomas is an Assistant Professor of Anthropology at MIT, interested in questions of environmental change and ethnographic approaches to science, technology, and medicine.

References

Akpan, Nsikan. 2015. “Weavers Turn Silk into Diabetes Test Strips.” NPR, January 8. Available at link.

Akrich, Madeline. 1992. “The De-Scription of Technical Objects.” In Shaping Technology/Building Society: Studies in Sociotechnical Change, edited by W. L. Bijker, pp. 205–224. Cambridge, MA: MIT Press.

Benjamin, Ruha. 2015. “From Park Bench to Lab Bench: What Kind of Future Are We Designing?” [Video]. Available at link.

Clarke, S. F., and J. R. Foster. 2012. “A History of Blood Glucose Meters and Their Role in Self-Monitoring of Diabetes Mellitus.” British Journal of Biomedical Science 69(2):83–93.

Fidler, David. 2008. “A Theory of Open-Source Anarchy.” Indiana Journal of Global Legal Studies 15(1). Available at link.

Grondahl, Paul. 2012. “Growing Diabetic Population Fuels a Black Market.” Albany Times Union, January 30. Available at link.

International Diabetes Federation (IDF). 2015. “IDF Diabetes Atlas, 7th Edition.” Available at link.

———. 2005. “The Role of Urine Glucose Monitoring in Diabetes: A Valuable Technology in Appropriate Settings.” IDF Position Statement. Brussels, Belgium.

Mayo Clinic. 2017. “Jose Gomez-Marquez.” Transform Conference 2017. Available at link.

Mendosa, David. 2000. “Meter Memories.” Diabetes Wellness Letter, pp. 1–6.

Mol, Annemarie and John Law. 2004. “Embodied Action, Enacted Bodies: The Example of Hypoglycaemia.” Body & Society 10(2-3): 43-62.

Moran-Thomas, Amy. 2016. “Breakthroughs for Whom? Global Diabetes Care and Equitable Design.” New England Journal of Medicine 375: 2317-2319. Available at link.

Redfield, Peter. 2012a. “The Unbearable Lightness of Expats: Double Binds of Humanitarian Mobility.” Cultural Anthropology 27(2):358–382. Available at link.

———. 2012b. “Bioexpectations: Life Technologies as Humanitarian Goods.” Public Culture 24(166):157–184.

Yoo, E.-H., and S.-Y. Lee. 2010. “Glucose Biosensors: An Overview of Use in Clinical Practice.” Sensors (Basel) 10(5):4558–4576.


Notes

[1] This is a gloss of one biosensor technique, described in lay terms to the best of my understanding, but various meters use many different variations of this technology that involve much further nuance. For detailed technical specifics of glucose biosensor technology, see “Glucose Biosensors” (Yoo and Lee 2010).

[2] Mapping the “global burden” of diabetes is very unevenly underway, as these statistics begin to suggest. Laboratory tests (such as fasting blood glucose or A1Cs) are more accurate to determine if someone has diabetes, since they provide a picture of glucose beyond the particular moment of testing. But these are much more logistically difficult than glucometer checks to realize outside clinics. Institutions currently rely on a patchwork of differently collected and missing data to estimate their diabetes projections, projects that raise their own conundrums (see IDF 2015).

[3] HLN News Now, CNN International Television; 7 June 2012.

[4] Though trimmed for space here, elsewhere this project unfolds in close dialogue with many other ethnographic and historical projects that also consider about how diabetic conditions are socially framed and materially enacted across distinct global contexts.

Featured Image: Foil inside an opened glucometer strip (photo by author).

Customer Care

The mobile phone revolution in Papua New Guinea (PNG) began in July 2007 when Irish billionaire Denis O’Brien’s company Digicel, in response to the government’s liberalization of the tele-communications sector, began rolling out its wireless network. Digicel was warmly welcomed by a country whose citizens felt neglected—if not downright mistreated—by the erstwhile state-owned monopoly Telikom due to the prohibitively expensive and geographically limited wireless services of its subsidiary Bemobile. Digicel did not disavow nationalism, to which Telikom reactively appealed, and also apparently cared about PNG, sponsoring sports teams and cultural festivals.

Digicel billboard in Goroka, Eastern Highlands Province, Papua New Guinea, 2015.

Digicel billboard in Goroka, Eastern Highlands Province, Papua New Guinea, 2015. Photo by D. Doiki

Most important, Digicel delivered wireless service to areas where it was never before available (Fig. 1), thus making good on its promise to bring the nation together (Fig. 2).

Individual customer benefits mattered too. Digicel quickly put basic handsets such as the Nokia 1020 within affordable reach of tens of thousands of people, many living in remote rural areas. By virtue of small, prepaid purchases of airtime, villagers could for the first time experience long-distance communication, especially with kin living and working in urban centers. And when a customer had no credit on her phone, she could use the free “call me” short-message service (SMS) to request that a loved one get in touch (Fig. 3). Digicel clearly understood the value of mobile phones as affective technologies, objects that “mediate the expression, display, experience and communication of feelings and emotions” (Lasen 2004:1).

Fig. 1. (left) Digicel newspaper ad, September 2007. Photo by R. Foster
Fig. 2. (right) Digicel ad, circa 2011.

In the beginning, people did not have many numbers to call or much credit with which to call. So they called Customer Care. Dial 123. 24/7. Free. They still call. But now there is a charge for calling during off-peak hours. The charge is meant to discourage prank calls, especially late at night.

Digicel ad for “call me” sms service, circa 2007.

Fig. 3. Digicel ad for “call me” sms service,
circa 2007.

People also called numbers randomly in search of phone friends who might become romantically involved and eventually meet face to face. Persistent calls from unknown numbers became a common topic of public conversation and a compelling justification for legislating mandatory registration of subscriber identity modules (SIM cards), which finally happened in 2016.

Mobile phones entrained new possibilities not only for sustaining long-distance kin relations but also for experimenting with self-development. The capacity to engage in novel forms of intimacy with strangers and in private forms of communications with intimates was welcomed by some, decried by others, and regarded with ambivalence by most people. New ways to express care and concern—such as sending and receiving credit requests for airtime—were offered by a company that promoted itself as a caregiver to its customers and to the nation as a whole.

Since its launch in 2007, Digicel has achieved market share of about 95% in PNG. The company claims that its “bigger and better network” of more than 1,100 cell towers now covers almost 90% of the population. The so-called penetration rate of mobile phone subscriptions is 49%, representing some 4 million subscriptions (compared with 1.6% in 2006, which is also the current penetration rate of fixed-line telephony). A Digicel official reported in 2016 that approximately 800,000 of these subscriptions are for smartphones. These smartphones are the primary means for most people to access the internet, hence the remarkable growth in the last several years in the number of internet users in PNG from less than 2% in 2010 to more than 11% in 2016.

At the same time, mobile phones, understood as social and material assemblages that include more than the discrete handset, were taken up in ways that exposed the premises of a robust moral economy: what companies, consumers and state agents owed to each other posed a perpetually open question. The capacity of the PNG state to regulate Digicel, which owns and controls the network it built, is weak; the business challenge faced by Digicel to overcome the absence of a reliable electric power grid and the chronic insecurity of corporate assets such as cell towers, which are regularly vandalized, is enormous; and the ability of consumers to use the network in the face of limited financial means and increasing demand for smartphones and data is always under threat.

In short, the moral economy of customer care in PNG is precarious for everyone. Here I offer five brief ethnographic examples.

Karen acquired her first mobile phone when she came to university in the capital city of Port Moresby in 2011. She already had friends who owned mobile phones despite an official ban on the devices at her high school. But at university, every student seemed to have not just a phone, but a smartphone that enabled use of the internet for their studies. Having a phone appeared to be a standard expectation, and students who did not have them felt an acute sense of being left out. Karen’s uncle gave her an old Samsung model that he brought from Australia, which she used until the inconvenience of not having a matching charger for the phone compelled her to buy a new entry-level Alcatel smartphone for 149 kina (approximately US$50; Fig. 4).

Fig. 4. Entry-level smartphone on display
at Digicel retail outlet, 2014.
Photo by R. Foster.

For Karen, the phone was helpful in overcoming her nervousness about approaching her lecturers and tutors in person. She would instead call them and pay attention to how they conversed and asked her questions: “How may I help you?” Karen learned and repeated her lecturer’s conversational strategies in her face-to-face interactions with others, developing a sense of confidence and clarity in her public speaking. “I learned how to approach people…. I felt like my life changed.”

The phone allowed Karen to overcome her timidity (and she has witnessed similar transformations in other female university students). For example, Karen now has no hesitation about calling Digicel’s Customer Care when she has questions about the accuracy with which her prepaid balance of airtime is being managed. Dial 123, send: “How may I help you?” Digicel will find the right person to attend to her concern. The next time Karen makes a call, she will be charged at a lower rate. She is not sure how it works exactly. But they respond. “They respond…because I am their customer.” As a customer, Karen received the sort of recognition that many Papua New Guineans seek in vain from a state that has failed since independence in 1975 to bring development to its citizens in the form of tangible goods and services.

Not all Digicel customers agree with Karen. The evidence is found on the Facebook page of the Digicel Complaints Group, a public forum for more than 43,000 mobile phone users. Group members who purchase airtime from Digicel, the dominant mobile network operator, use the forum to register dissatisfaction with the company’s services. They express particular concern about the conversion of prepaid airtime into data and the dubious ways in which Digicel adds and subtracts data from an individual’s balance. Complaints often concern the failure of credits to appear on a person’s phone after a purchase has been made or the disappearance of data from a person’s balance even when the phone is not in use.

My friend Cletus’s complaint to the group is fairly typical:

At exactly 11am today, I entered two K5 flex numbers: 01 7249 490 5910 & 16 2662 659 3637. At exactly 11:14am, Digicel sent me two messages: 1. Advised that I have used up my data and 2. Asked whether I need airtime of K13 advance. I immediately checked my balance only to see K5.03. I texted Digicel and 5 minutes [later] I was reimbursed K3 and not the whole K4.77. What a daylight robbery!

People sometimes post screenshots of the balances on their phones as evidence of stolen data. Accusations of robbery and theft, of being “ripped” (off), are commonplace. Such complaints recall historian E. P. Thompson’s (1971) well-known account of the protests that erupted as a moral economy of food provision gave way to practices and principles associated with “free trade” in 18th-century England. These protests, which often led to direct action, invoked notions of fair and transparent dealing in the face of concerns that the poor suffered at the hands of those with “command of a prime necessity of life”  (Thompson 1971:93). Much like the folks about whom Thompson wrote, Digicel Complaints Group members express intense feelings over “weights and measures” and beseech the authorities to regulate business transactions. In other words, offended consumers look for help from the same neglectful state that let them down before Digicel arrived.

The capacity of poor people to own and operate a phone in the developing world hinges on technologies of prepay, which allow users to pay as they go by buying small amounts of airtime when necessary or when funds become irregularly available. Managing one’s airtime requires tempering the practice of self-discipline with responsiveness to the obligations of caring for others.

Winnie is a heavy user who can spend up to 100 kina (US$33) a week in airtime credits. She is a young single woman living far from home and regards frequent communication with her family and friends as nothing less than essential. Winnie has a steady income and is generous when her kin send credit requests for airtime, which she can transfer directly to their phones for a small fee. She says that she is capable of spending all her savings on airtime, and she has on occasion come close to doing so by “topping up” her phone through a mobile banking account, a relatively new service that effectively enables users to purchase airtime anytime, anywhere. (A fair comparison is with gambling machines that provide access to a player’s bank account without requiring the player to leave his or her seat in front of the machine.) To discipline herself—and she used the English word discipline—Winnie has opened an account with another bank into which she makes weekly deposits. This bank, Winnie explained, does not offer the mobile top-up service. She has thus safeguarded her money from herself (see Foster, in press).

Winnie is explicit about the calculations that she makes in managing her mobile phone. She says that she does not feel able to start the day unless she is equipped to communicate. So, in the morning she will top up her phone for 5 kina (US$1.66). This top-up gives her 100 free promotional minutes for use between 11pm that night and 7am the following morning. She then purchases a one-day data pass: 60 MB for 3 kina. This data is enough to allow her to go online and communicate with friends and family via the applications WhatsApp and Viber. Winnie discovered that she could send voice messages over the internet for much less money than making voice calls. Finally, Winnie purchases a discounted bundle of 60 text messages for 1.20 kina. She will use most if not all of these text messages before they expire at midnight. That leaves 80 toea as a balance in case Winnie needs to make a quick phone call during the day (100 toea = 1 kina). (On-net calls from one Digicel phone to another are billed at 79 toea per minute, with per-second billing, during the peak hours of 7am to 9pm.) Once she has made these preparations, Winnie feels ready to go out into the world and meet the demands of the day.

Winnie’s daily routine might understandably lead one to conclude that a peculiar kind of calculative rationality has been baked into the phone itself, such that Lucy’s habit of giving gifts to her relatives is subsumed within the sort of measuring and monitoring associated with markets and commodity exchange. This same tension between alternative logics of gift and commodity shapes the larger social and material assemblage of which the phone itself is part. It is a tension that threatens the future of customer care.

Phone repair vendor’s table, Goroka, 2015

Fig 5. Phone repair vendor’s table, Goroka, 2015. Photo by W. Magea

Matthew, a single man in his early thirties, repairs mobile phones and sells airtime at a street stand in the highlands town of Goroka (Fig. 5). He occupies a particular spot on a particular corner with other vendors who sell cigarettes, betel nuts, hard-boiled eggs, soft drinks, and the scratch (or “flex”) cards that people buy to top up their mobile phone airtime balances (Fig. 6). Matthew was one of the first to teach himself how to repair phones; he and his friend and workmate Gabriel were also among the first to start selling airtime in 2009 as Digicel expanded its network of cell towers across the country.

Street vendor selling scratch or “flex” cards, Goroka, 2015

Fig. 6. Street vendor selling scratch or “flex” cards, Goroka, 2015. Photo by W. Magea

Matthew regards his work as a service to the community; indeed, to the nation. His business yields to the demands of a moral economy that Thompson would easily recognize. Villagers who come to town with no money can offer their homegrown bananas or sweet potatoes in exchange for repair services. Town workers, however, will be sized up and charged according to Matthew’s estimate of their ability to pay. The vendors, moreover, care for each other: they all offer their goods at the same price and eschew overt competition. One vendor’s business crashed when he overspent his revenue and was unable to purchase a new supply of scratch cards. A fellow vendor hired him until he was able, a year later, to save enough money to re-establish his own business.

Matthew insists that he and his fellow vendors are part of Digicel: without them the network would not work. His recognition of people as infrastructure is entirely plausible; Digicel still relies on vendors in places like Goroka to distribute airtime credit into the hinterlands where people prefer to buy scratch cards in town for use (or resale) later in the village. In cities like Port Moresby, however, the advent of smartphones has enabled more and more people to top up directly online, buying airtime like Winnie through linked banking accounts. Moreover, new forms of “self-care”—quite different from the kind of care that Matthew affords his customer—are being promoted. In January 2017, Digicel launched the My Digicel App for smartphone users, promising customers an efficient tool for “managing their Digicel life” (The National 2017). Several months later, the company introduced a menu that would allow customers, including users of basic handsets, to assist themselves with queries relating to data and top up, among other things. Dial *123#. 24/7. Free. A list of frequently asked questions appears on the phone’s screen.

The future of the prepaid scratch card is dubious, and the economic niche of street vendors is shrinking. There is a policy argument to be made that preservation of the scratch card vendors’ livelihood would support the so-called informal economy on which so many Papua New Guineans depend. For Matthew, however, it is an ethical as well as economic question: Does Digicel really care about him and his fellow vendors, who were present at the beginning when the company was first establishing itself in the country? His concerns echo those of the Digicel Complaints Group, and pose the unsettling question of whether Digicel still cares for the people of PNG 10 years after the company brought them a revolution in communications.

Digicel of course expresses care and concern in ways that are familiar to corporate observers, if not immediately relevant to Matthew. The company has set up a branch of the Digicel Foundation in PNG as a way of giving back to the community by funding health and education projects—providing bits of infrastructure that the state has not—like a reliable nationwide telecommunications system. The company has even addressed one of the main problems for individuals in operating a mobile phone, namely keeping the battery charged. Outside of urban centers, which experience frequent power outages, access to electricity is severely restricted. Digicel has responded by marketing small solar panels for 95 kina (US$31; Fig. 7).

Fig. 7. Digicel ad for solar panel
at Jackson’s Airport, Port Moresby, 2016.
Photo by R. Foster

The Digicel Foundation attracts the standard critiques of corporate social responsibility: it’s window dressing and public relations and so on. Whether the Digicel Foundation is successful in promoting goodwill and positive sentiments among the people of PNG is unclear. The uptake of mobile phones in the country, however, continually surprises with respect to the capacity of these devices as affective technologies. My final ethnographic example underscores the high stakes involved in the emergence of a desirable new form of affective technology over which one’s control is exceedingly tenuous.

Lucy is in her early fifties, a rural woman with little education who, after being diagnosed as HIV positive, was struggling to live on her own after her older brother had refused to take her in.[1] A previous husband offered Lucy some money and a used mobile phone. Desperate, hungry, and contemplating suicide, Lucy began calling the contacts saved in the phone until one woman, instead of yelling and hanging up, agreed to speak with her. This woman, Angela, responded with compassion and began sending Lucy small gifts of food, money, and secondhand clothes. Lucy and Angela never met, but continued to talk by phone, thereby restoring Lucy’s feelings of hope and alleviating the anxieties that Lucy thought would reduce the effectiveness of her anti-retroviral medications. A friend found by chance on a random call enabled Lucy’s old mobile phone to function therapeutically as an affective technology, a medium for giving and receiving care.

Lucy’s story, like Matthew’s, exposes not only the possibilities but also the vulnerabilities inherent in the shifting moral economy of mobile phones. But Lucy’s story does not end well. Her phone, the source of Lucy’s emotional sustenance, was eventually stolen: “All those phone friends, in Port Moresby, Mt. Hagen, and other places, they would send me credit, and we talked all the time, every night, and now I don’t have a phone, and I’ve lost all those numbers. It’s terrible. I can’t stop crying about it. I had the same phone for four years, and had so many numbers, so many friends. And now it’s all gone.”

Robert J. Foster is Professor of Anthropology and Visual and Cultural Studies, and Richard L. Turner Professor of Humanities at the University of Rochester.

Acknowledgments

In this essay I draw on research supported by the Australian Research Council through a grant (DP140103773) awarded to Professor Heather Horst (University of Sydney/RMIT University) and the author. Wendy Bai Magea offered helpful research assistance.

References

Foster, Robert J. In press. “Top-Up: The Moral Economy of Prepaid Mobile Phone Subscriptions.” In The Moral Economy of Mobile Phones: Pacific Islands Perspectives, edited by R. Foster and H. Horst. Canberra, Australia: ANU Press.

Lasen, Amparo. 2004. “Affective Technologies—Emotions and Mobile Phones.” Vodafone Receiver Magazine 11. Available at link.

The National. 2017. “Digicel PNG Launches My Digicel Application.” The National, January 20. Available at link.

Thompson, E. P. 1971. “The Moral Economy of the English Crowd in the Eighteenth Century.” Past and Present 50:71–136.

Wardlow, Holly. In press. “HIV, Phone Friends, and Affective Technology in Papua New Guinea.” In The Moral Economy of Mobile Phones: Pacific Islands Perspectives, edited by R. Foster and H. Horst. Canberra, Australia: ANU Press.


[1] Lucy’s story is told more fully in Wardlow (in press).

Featured Photo: Digicel Flex Cards. Photo by M. Boie.

Précis: Little Development Devices / Humanitarian Goods

“Little Development Devices/Humanitarian Goods” seeks to explore objects or instruments designed to care about and improve the welfare of infrastructurally marginal populations (i.e. those lacking connection to “networked” forms of modern provisioning—such as water, sewerage, communication, electricity—or to services such as health care and finance). As our title suggests, we perceive two trajectories into this phenomenon.

The first derives from the legacy of the large, capital intensive and spatially fixed infrastructural projects of post-World War II development — such as dams, power plants, and road networks — which embody a substantive vision of societal transformation as laid out and organized by technocratic experts and government officials who act in the name, and for the benefit, of a whole nation. In contrast, the devices we highlight arose against the backdrop of sustained and polymorphous critiques of this older paradigm of development. They combine elements of earlier attempts to define more “appropriate” technology with new techniques for monitoring, calculation and testing. In reacting to perceptions of past failure, their normative rationality is oriented to immediate, measurable and testable outcomes.

The second trajectory stems from the parallel emergence of humanitarianism as a mode and set of techniques for crisis response, including the establishment of intergovernmental agencies and nongovernmental organizations devoted to the care of distant others, as well as the standardization of associated mobile technologies like refugee camps. The devices we examine here respond to perceived incapacities, failures and perverse outcomes of this very aid regime, even while seeking to further its general goals of alleviating pressing needs and saving lives. Many rely on market logic and present themselves as commodities more than gifts, ostensibly enrolling profit motives into the service of a greater good.

In this issue of Limn we seek to ask: What are we to make of the proliferation of such small devices? What do they tell us about the state of “development” and “humanitarianism” as projects? And what do we make of the convergence of humanitarian and developmental projects around them? What forms of life, and what kinds of subjects, do they work on and constitute? What relationships do they establish between expertise, government, and the purported beneficiaries of these devices? What politics do they make possible – or preclude? Do some appear analogous to hacks, exploiting the vulnerability of existing infrastructures for other ends? And what might a critical social science have to say about them?

Little: These devices are little in a number of senses. First, they are light, inexpensive, scalable, and portable; they may be deployed experimentally and flexibly, for small units of population. Second, they are little in the sense that they operate at the level of the “micro” in economics – their target is not the “national economy” or macroeconomic aggregations but individual preferences, aspirations, and calculations. Third, they are “minimal”; they are, for better or worse, deployed with relatively limited assumptions about the form of life into which they are to be inserted. None of this is to say that they need remain small scale. Some have, indeed, been deployed by national governments and have large aspirations (e.g. affecting national poverty or mortality rates).

Development: Although these devices may not define development in terms of national populations, they do aspire to social transformation, to improvement of conditions of existence and the quality of lives – even to saving the planet! They thus require and entail the assembly of new kinds of expertise, new visions of a better future (whether for individuals, communities, or nations), new articulations of populations and new instruments.

Devices: Here is where the assembly—as technical or techno-political work—takes place. Because they are deployed with “minimal” assumptions about context, a very great deal is packed into these devices themselves, and it has to be unpacked. Many are technologically-laden, depending on everything from GPS to mobile phones to solar panels. But they are not merely machines in the conventional sense of that word, drawing on forms of accounting, and various kinds of expertise in modeling and forecasting. They also embody norms, models of how people make decisions, assumptions about what people want, what might translate across scales, and what constitutes a good life.

Humanitarian: These are things that are designed to do good, intervening in worlds where large-scale infrastructures, like those for the delivery of health and energy, do not reach or have collapsed. They reflect an explicit desire to alleviate suffering and save lives. They focus on moments of present crisis and a future in which states may no longer have the capacity to build, manage or sustain universal infrastructures in territorial grids. As they move through contexts of design and use, and through spaces of poverty and humanitarian emergency, they remind us of just how difficult it has become to imagine ways of expressing care and concern without fostering markets.

Goods:
These are things that also seek to do well (financially) while doing good. Humanitarian goods that are premised on conditions of state fragility often hold out the promise that they can transform that fragility in productive or profitable ways. Things like solar lanterns or nutritionally fortified foods, for example, are also built to generate economic value for a diverse array of investors, via sales to institutional consumers like humanitarian or aid organizations as well as directly to the poor. Thus, they present themselves as caring commodities rather than disinterested gifts.

“Happy Homes Have Gramophones” –Gender, Technology, and the Sonic Restaging of Community Before and After the Partition of Bengal

co-edited by Praseeda Gopinath and Monika Mehta

Our listening practices are discursively constructed. In the sonic landscape of India, in particular, the way in which we listen and what we hear are often normative, produced within hegemonic discourses of gender, class, caste, region, and sexuality. . . This forum, Gendered Soundscapes of India, offers snapshots of sound at sites of trans/national production, marketing, filmic and musical texts. Complementing these posts, the accompanying photographs offer glimpses of gendered community formation, homosociality, the pervasiveness of sound technology in India, and the discordant stratified soundscapes of the city. This series opens up for us the question of other contexts in India where sound, gender, and technology might intersect, but, more broadly, it demands that we consider how sound exists differently in Pakistan, Sri Lanka, the Maldives, Bangladesh, Bhutan, Nepal, and Afghanistan. How might we imagine a sonic framework and South Asia from these locations? —Guest Editors Praseeda Gopinath and Monika Mehta

For the full introduction to the forum, click here.

To read all of the posts in the forum, click here.

“She compelled respect at once by refusing on any account to be phonographed: perhaps she thought, amongst other things, that if she committed her soul to a broken piece of wax it might get broken…my subsequent experiences showed that it was only too likely,” wrote the British musicologist A.H. Fox-Strangways in 1910 about Indian female singer Chandra Prabha, while remarking on the harsh reactions to the gramophone in India (90).  Such deep-rooted discomfort with the gramophone speaks to the cognitive, perceptual and experiential challenges faced by a listener/performer when a new auditory technology substitutes familiar terrains of musical production.

In this post, I revisit the decades prior to and following the 1947 Partition of Bengal, a phase singularly volatile not only in India’s political but also its musical and technological histories.  I examine how the introduction of European harmony/polyphony in the aural imaginary of Bengal negotiates ideologies espoused by the nationalists in the (re)constitution of gendered space post-Partition by transforming relations of consumption. The production of gendered domesticity was vitally related to rigid conceptions of physical space and its allocation in colonial Bengal which, further, influenced music reception in ways worth probing.

The auditory regimes prior to the emergence of recording/radio-broadcast typified public modes of listening based on live performances engendering affective flows and presupposed human proximity. This culture of aurality is inextricably tied to communal modes of consumption and performance, be it the high-end salon-tradition of the Bengali modern song, the hard-hitting agitprop strains of the Bengal wing of the IPTA (Indian People’s Theatre Association) or even the stylized elite classical genres. The collective nature of musical practice conjures up traditional connotations of masculine spaces, especially in the case of the elite Bengali household where the gendered ideology of spatial orientation relegated the respectable Bengali woman (bhadramahila) to the interiors of the house (antahpur/andarmahal). The delights of salon-music were to be relished by the man of the house (babu).

‘Gramophone – a home entertainer’

Thus, the communitarian character of musical practice often made it elusive to respectable women. However, the emergence and subsequent sophistication of auditory technologies ushered a radical transformation to such a dynamic by dissociating music from the human performer. Besides leading to the obvious technological alienation in the listener, the privatization of the listening experience was accompanied by a condition of a penetrating solitude and interiority, a state speaking to the voices and /sounds emanating from the phonograph. At the sociological level, the entry of recording technology redefined long-held divisions of domestic space and the gendered dynamics thereof by not only democratizing musical consumption but also forging provisional collectivities of listeners often cutting across gender, class and caste. Besides, traditional associations of musical genres with specific loci- classical music with the salon/concert space for instance- gave way to a more fluid conception of domestic space assuming multiple sonic/musical identities depending on what the gramophone played. The phonographic interface, thus, radically reconfigures listening practices and produces a different paradigm of self, sound, community, and gender.

What is at stake here is not some covert form of linear technological determinism, but a more nuanced detour around auditory-technologies, spaces of consumption, and the affordances thereof that calibrate auditory experience along new registers. What merits contemplation is how (if at all) these technological innovations in the commercial arena complement and usher formal nuances and sonic innovations in the musical works they mediate. The gramophone renders problematic the uncritical conflation of the sonic and visual registers typical of live musical performance and, in the process, sets in motion a unique dynamic of interacting with musical sound. Severed from its visual footholds in live performance, phonographic sounds often provoke the listener to imagine the singing/performing body which, in turn, informs the way the sounds are processed mentally.

Vintage Gramophone spotted in Little India, Serangoon, Singapore, Image by Flickr User Linkway88, (CC BY-NC-ND 2.0)

Indian music has traditionally been based on a single melody which, in its skeletal grammar, is an individual mode of expression, even when performed by a group. The intrinsic form of Indian and traditional East Asian music in general exhibits a non-harmonic character. The concept of musical harmony proper is considered a European import. European harmony, polyphony, and counterpoint are in their very essences a set of disparate tonal registers forging a gestalt which impresses on the mind of the listener an overarching unity. At an experiential level, the polyphonic form embodies a distinct sonic ontology and a novel dimension, as it were, and thus cannot be reduced to merely a stylistic import. It induces a new auditory condition, a new register of being-in-listening (the lecture snippet from 57:08-.1:02:07 effectively demonstrates the morphing of the basic melody of a song into its polyphonic equivalent). The new auditory condition conjoins the familiarity of the melody with the markedly different yet complementing registers of the polyphony, creating a novel sensation for the uninitiated Bengali listener.

Among the very early records to employ musical polyphony in India were two iconic musical works of the mid-20th century, one devotional in intent– Aham Rudre from Mahishasurmardini (1931) composed by the legendary music director Pankaj Mullick–and the other, a professed experiment in introducing polyphony in Bengali music, Shurer Ei Jharna (1958), by the noted composer Salil Chowdhury.

In the current context, it is important to note how the sonic dimension of musical polyphony in Aham Rudre  and Shurer Ei Jharna embodies and substitutes notions of aural communities and restages a communitarian character. Notably, the creation and circulation of these works paralleled the establishment of commercial state-radio in India (1930) and the first microgroove record in Kolkata in 1958 by the Gramophone Company.

The Gramophone Company in Calcutta marketed its records with the Bengali tagline “Shukhi Grihokon Shobhe Gramophone/Happy Homes Have Gramophones,” projecting the phonograph as the symbolic ideal of the domestic idyll and in the process confronting gendered spatial demarcations head-on by invading the auditory horizons of the secluded Bengali women. The striking presence of the gramophone in the iconic Gramophone Scene (1:35:17-1:35:28) in Satyajit Ray’s movie Ghare Baire–set in the backdrop of the 1905 Partition of Bengal–beautifully illustrates the sorority forged by the gramophone which, notably, draws even the marginalized widow Bouthan within its field of influence.

However, the gramophone superseded its commodity-character to serve not only in crass exhibitionism but also as an index of a masculine, elite consumerist culture where “serious music” and musical connoisseurship often became synonymous with the gramophone and recorded sound. A new breed of “record-collectors” came into existence, mainly belonging to the upwardly-mobile/elite classes whose passion for records was their most prominent identity-marker in the domestic realm, occasionally outweighing even their professional concerns.

But even as the radio and phonograph transcended the hitherto gendered character of musical reception by entering the women’s quarters and dissolving time-honored segregations of auditory spaces within the household, it had to contend with a deep-seated psychological discomfort in the listener, a fundamental unease with befriending technology that substituted the human. I argue that the newly insulated character of the radiophonic auditory experience was counteracted by significant efforts, conscious or otherwise, at sonically restaging and reclaiming the community lost in technological mediation.

Indian farmers gathered to listen the Farm Forum programme broadcast by All India Radio in the 1950s, Image Courtesy of Flickr User Public Resources.Org, (CC BY 2.0)

Given pet notions of musical anthropology and the chronological coincidence between the early uses of harmony and the entry and sophistication of technologically mediated music in Bengal one could, at the risk of slight oversimplification, posit that the import of the harmonic form at this significant juncture sonically compensates the auditory solitude induced by radio/phonograph by recreating a modified and idealized Platonic (Platonic here is used as an allusion to ‘music of the spheres’ to point towards how musical harmony since medieval times has been associated with ideal public) community and restaging it within the confines of the constitutive plurality of the polyphonic mode. As an aside, the initial introduction of polyphony in Shurer Ei Jharna (1958) garnered flak from a large section of the audience who cognized it as a group of amateur performers ‘singing out of key’ (Salil Chowdhury’s lecture from 30:31-31:15). Over the next few decades, however, this form was  trans-culturated and seamlessly assimilated within the sonic vocabulary of the Bengali/Indian masses, so much so that without the regular vocal/instrumental counterpoint, commercial songs nowadays are often felt to be lacking hue.

The sonic changes that I have been investigating preceded or followed the Partition of Bengal, which informed the gendered patterns of popular musical consumption. It is well-known that the exigencies of the Partition proved emancipatory for women in that they were exposed to the vagaries of the workplace, leaving the confines of their quarters. It is with an often uncritical celebratory fervor that the Partition is credited with fashioning the independent, self-reliant and educated middle-class Bengali working woman, on occasion emerging as the sole bread-earner of the family. Jasodhara Bagchi says that the “partition accelerated the earlier trends of the twentieth century of abolishing the ‘purdah that had confined the Bengali bhadramahila to her antahpur (private quarters)…The same stroke that brought this flood of uprooted marginalised women to Calcutta also opened the door to many new opportunities for Bengali middle-class Hindu women. They came out of the private domain of domesticity and child rearing to take up public duties.’”(8) Uditi Sen, however, in her revisionist reading of the celebratory impulse argues that “situational aberrations” notwithstanding, the Partition did not lead to “a transformation of social norms or any substantive change of women’s ideal role within the bounds of the family.”(16)

In the aftermath of the Second World War, which had also witnessed the entry of women into the professional/public sphere, the USA launched a propaganda war to restore women to their hearth, revivifying the “cult of the housewife,” deploying films and popular music to promote the trope of the ideal housewife. Redefining domestic spaces as woman’s space had also been in the cards for the Indian state post-Partition, which had to a large extent been governed by patterns of popular media consumption. Arguably, the coincidental emergence of musical harmony and sophistication of private auditory technologies in the years following the Partition contributed to efforts to restore women to their private quarters, by compensating the lost professional community of the self-reliant working woman with the poetic/sonic community embodied by the polyphonic form, in the process enlivening her insipid lived quarters. Popular media technologies often employ innovation in content to revivify clichéd formats; musical harmony coupled with sophisticated audio-reproduction provides a classic instance of inaugurating a new sonic dimension in popular music which provides a powerful and enthralling form of domestic leisure.

Thus, in the context of early 20th century Bengal, the gramophone was a significant import which not only reconfigured perceptual registers and musical cultures but also listening practices by entering the interiors of elite Bengali households. Besides democratizing the listening experience, which till then had largely been restricted to male constituencies, the gramophone privatized musical consumption. It was through the introduction of musical polyphony, which is intrinsically ‘public/ communal’ as regards its sonic character, that this impulse was counteracted. As mentioned earlier, these technical/musical innovations widened the scope and impact of musical performance and arguably contributed to the reconstitution of gendered domestic space post-Partition which points to subtle and complex relations among technology, (musical) genre and gender.

Featured Image: Screen Capture from by SO! Ed. Satyajit Ray’s Ghare Baire

Ronit Ghosh is a postgraduate student at the Department of Art and Technology, Aalborg University, Denmark. His research interests include aesthetic philosophy, critical sound studies and the sociology of Indian popular music. He has published articles on sound studies in the International Journal on Stereo and Immersive Media and The Rupkatha Journal and has an article forthcoming in the Journal of Sonic Studies. He is a classical violinist and an aspiring music composer.

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Issue Number Nine: Little Development Devices / Humanitarian Goods

Edited by: Stephen J. Collier, Jamie Cross, Peter Redfield and Alice Street

November 2017. This issue of Limn examines the recent profusion of micro-technologies in the worlds of humanitarianism and development, some focused on fostering forms of social improvement, others claiming to alleviate suffering, and many seeking to accomplish both. From water meters, micro-insurance and cash transfers, to solar lanterns, water filtration systems, and sanitation devices, examples proliferate across the early 21st century landscapes of international aid. Although small-scale endeavors are far from novel, today these devices are animated by different intellectual and moral energy, drawing on novel financial and organizational resources. Many blur distinctions between public and private interests, along with divisions between obligations, gifts and commodities. At the same time, they entail novel configurations of expertise, political obligation and forms of care. The articles in this issue explore these new convergences of developmental and humanitarian projects, alongside reworked relationships between experts, governments, and purported beneficiaries, focused on fostering “participation” and “partnerships” rather than nation-building.

Contributors include:

Jacqueline Best, Marc Boeckler, Brenda Chalfin and Xhulio Binjaku, Jamie Cross, Vincent Duclos, Robert Foster, Christopher Kelty, Meena Khandelwal and Kayley Lain, Austin Lord, Amy Moran Thomas,
Jonathan Morduch, Peter Redfield, David Reubi, Anke Schwittay and Paul Braund, Tom Scott Smith, Alice Street, and Tatiana Thieme