IT Next to the Beneficiaries

by Jon Thompson on September 23, 2008

My friend Jeff has rescued me from my flu induced apathy by sending an excellent reality check highlighting the limits of IT in the field.  Here it is in full:

Jon writes here often about how cutting edge apps might be adapted for use by aid workers. As a tech guy myself, I love to read and dream about this kind of thing. But as a field guy, I’m unfortunately here to today to bring the dreams crashing down to reality.

The thing is, the IT life I have observed in the field, near to the beneficiaries, is not all shiny and high bandwidth. And “near the beneficiaries” is what matters. Coordination meetings with Google Earth maps projected on the wall, integrating UNOSAT imagery and placemark databases showing wells and refugee camps is the dream. But we must never forget why we are there: to work with communities to make the temporary and lasting changes necessary to let them support themselves. So that’s why the IT landscape near to the beneficiaries matters to me more than the IT context in the capital or headquarters.

Here’s a beneficiary for you: The man I’m thinking about is the data manager for a Congolese health district. He’s lucky: he lives on the eastern border of the country, close enough that the strong Ugandan economy supports his own struggling one. He’s got 30 kbit/sec Internet implemented via a serial cable plugged into a desktop mobile phone with an antenna out the window pointing across the border at Uganda. He works in a district office, so there are several computers, one of which is on his desktop, all donated by various vertical programs (the “AIDS computer”, the “Malaria computer”, etc). The WHO has supported the DR Congo strongly over the last decade, so he’s had the chance to travel 8 hours by motorcycle to the regional capital to attend classes in Microsoft Excel. He has a Yahoo email account.

During a meningitis epidemic, it’s his job to enter all the paper forms arriving by bicycle and moto from around the region into a spreadsheet setup by the WHO. It’s hard for him to get his job done… which is how I came to know him. My boss sent me over to him to try to find out why he could never give us the data we needed on time in order to make good decisions about our meningitis intervention. He explained that he can only work when the generator is on. Then he explained that sending files with Yahoo mail is slow, and doesn’t always work. Then when we looked at his computer to see why, we found evidence of several viruses making it impossible for him to open any document with “virus” in the filename. (I’d already noticed the evidence: each time our USB key came back from his office, it had a file named h.vbs on it.)

Across town in the MSF compound (a rented hotel), I was working with my own constraints. We also were dependent on the generator, since there is no electrical grid in eastern DR Congo. We had three laptops for five people, approximately the same ratio as the health office (2 desktops, 4 people putting significant time into meningitis). But because we had laptops, we could work when the generator was off. We had internet via BGAN satellite at 128 kbit/sec. It is expensive, at USD 5 per megabyte, meaning that we had a filter on our mail preventing us from receiving attachments larger than 2 megs.

The attachment limit turned out to be another problem. On the off chance that the generator, the phone, and Yahoo mail worked, and he managed to send the week’s data out to us via e-mail, we couldn’t receive it, because it was too big. We solved that problem by getting in the Landcruiser and driving across town with a USB key. Which, if you’ll recall, is how I knew that I should go over and remove his viruses.

How do we remove viruses? It’s easy, right? Update your virus scanner and scan. But an update is 12 megs, or USD 60 on satellite, and completely impossible to download on a 30 kbit/sec link from Uganda. So no update. MSF solves this problem by sending virus update CDs to the field monthly. But the viruses you catch in Africa tend to be locally written (this one was from a technical university in Nairobi). If they ever end up in the virus databases at all, they arrive late. Certainly later than my most recent update CD from Geneva. I got lucky and found instructions online for how to edit the registry and remove the virus. But I’m a programmer… who would have fixed it without me?

Keeping computers working next to the beneficiaries gets a lot harder as you pile on the constraints, doesn’t it? But it’s probably worth it, because of the benefits they can bring.

Or is it?

In Myanmar, my girlfriend worked 6 days without a computer doing mobile clinics, then came back to base on Sunday for a rest and to enter stats into the MSF spreadsheets. By necessity, she finished her stats and weekly report in an hour of work Sunday afternoon, then got on with the real business of resting up for the next week of mobile clinics. She said it was liberating to not use a computer in the field… which might be a lesson for us as well.

Here’s some tech lessons I’ve learned in the field:

  • Use POP, not webmail. Slow, unreliable, expensive connections are the enemy of web apps.
  • Don’t expect to be able to use web apps, even the ones your headquarters says you should be using.
  • Have lots of USB keys around to move documents
  • Expect viruses and struggle on regardless, there seems to be no workable answer to this. (At one Congolese internet cafe, the operator scanned USB sticks before allowing us to use them. I gave him my USB stick clean, and I got a virus back from him. Great.)
  • The simplest thing possible might work. Anything more complicated won’t.

The number one lesson: The work is worth doing, and to do it right you have to be out there, at the edge, in the mud, with the beneficiaries, in their communities. If the IT can’t keep up, leave it at home.

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