the fallacy of the empty vessel

(photo courtesy of... )

“In the Yucatan peninsula, it is the local collectivity of Mayan women who hold authoritative knowledge about birth; that is to say, the knowledge that is considered consequential for making decisions about and managing the event. Childbirth takes place either in the woman’s own house or that of her mother and technologies are familiar household objects. There are unquestionably experts involved: a midwife, with extensive experience of many births, supported by other women of the family, each of whom has her own experience on which to draw. But moment by moment knowledge of the event is produced collectively by the participants and draws centrally on the authority of knowledge of her own body granted to the woman herself. 

Into this system, designers of development programs to promoted Western biomedicine introduce new technologies developed in the context of the high technology hospital. A case in point is the sterile scissors, introduced as an alternative to the local practice of burning the umbilical stump with a candle to prevent infection. The gap between the context of its design and the local conditions of its use (in particular, an absence of stoves) led to a reinterpretation of the technology from a sterile scissors to a pair of scissors dipped briefly into a bowl of hot water. Observation by traditional birth attendants of a subsequent increase in infant tetanus resulted ultimately in their rejection of the scissors in favor of the former, clearly more effective practice of cauterization.”   - Chapter 7: Computerization and Women’s Knowledge | Suchman & Jordan, 1988

The gap between the context of its design and the local conditions of use – there isn’t a more powerful statement in the eyes of a designer. The single most important answer one can seek when developing a new technology is answering the question of use case – where will this technology be used? By whom? In what environment?

Suchman and Jordan go on to describe the “fallacy of the empty vessel – the belief by those who design new technologies that there is nothing there in advance of their arrival.” It's an interesting point - we aren't designing for an environment which has nothing. We are designing for an environment that has something different than what we have.

These two thoughts together define the crux of the difficulty of designing for the developing world – determination of the use case by people who aren’t well-versed in the context and circumstance of the users they are designing for. In other words, how do I, with my middle-class, relatively healthy, immigrant-turned-US-citizen background, translate my background in engineering into meaningful designs for people who need it most? There has been criticism among the larger NGO community of the “helicopter designer” – those who come in without understanding the use case and drop in a technology that isn’t well-received and doesn’t build trust or collaboration between the parties, and then leave. But there’s also the reality of both an inadequate critical mass of native designers and engineers coupled with Brain Drain of those who do specialize in those fields. With every failed innovation that gets transplanted from a disparate use case to one in the developing world, we lose credibility and trust in the eyes of those who we meant to help.

The world has a long way to go to address all the health challenges that we face, and we have a collective responsibility to improve the quality of life of people everywhere. In the short term, that means developing technologies that cater to the populations who need them. In the long run, we need to empower people to develop those solutions on their own. As we develop, then, it becomes crucial to do so in a way that builds trust and fosters partnership between those who design and those who use.