the lottery of birth

From getrichslowly:

As I’ve mentioned already, at times I felt guilty too. It’s hard not to feel guilty when you’re staying at a hotel where the average room runs $618 a night — and meanwhile, half a mile from this posh palace, men and women are scratching to make ends meet.

On the road outside of Dharavi, Asia's largest slum.

Four miles from Dharavi, is the Intercontinental Grand Mumbai.

What is my moral obligation to these people? Do I have one? Should I feel guilty for spending money on tourism? Or, as our guides suggested, should I be comforted by the fact that I’m participating in a transfer of wealth from the rich to the poor? What productive ways can I help aside from just throwing money at the problem?

I don’t have answers to these questions.

Ultimately, however, I’ve realized that guilt is not productive. Guilt doesn’t accomplish anything. I can’t change who I am or the circumstances I’ve been born into. I’ve made the most of what I have: I’ve been lucky, and I’ve worked hard to build upon that luck. I can’t change this, and I can’t regret it.

Instead, I feel like it’s my responsibility to do something with this hand that I’ve been dealt. Do what? I don’t know — and I’m not sure I need to know right now. As I travel, I’m becoming more aware of the world around me, and I feel like maybe there’s something I can contribute to make it a better place. I’m not sure what that something is, but I’m willing to be patient until I discover it.

I could have been born to any family, anywhere in the world, under any set of circumstances. I could have been any Indian girl - one of 600 million others.

But I wasn't. I was born to incredibly intelligent and educated parents. Who had families that supported them and career choices that made them successful, in today's terms. Who left the country of their past in hope of a country that could change their futures.

A man sleeping on a makeshift cot placed on a pile of trash near Loni Road in Delhi.

The Bah'ai Lotus Temple is one of the biggest tourist attractions in Delhi.

In Warren Buffett's words, I (like most of you) have won the lottery of birth. It's an incredibly humbling thought. As he describes it, if just before your birth you were put in front of a barrel containing 6.8 billion balls, and you pick one ball - one ball that would determine your gender, your birthplace, your parents - that determined the circumstances of your life. If you had that chance, would you put your ball back in hopes of something better?

I know I wouldn't. That's the hand that I've been dealt. All I can do now is give something back for it.

how information moves to create empowerment

Late last year I met with some folks in Boston who are working on some neat emerging technologies for diagnostics in the developing world. Since then, we've all been trying to brainstorm ways to engage others who are interested in this topic into the conversation. Recently, Aaron posed a really interesting series of questions to me in thinking about the world after their diagnostic technology becomes widespread:

(photo courtesy of... )

"How does the data move; what is done with the data when it gets there? How does it influence caregivers, governments, funding sources, etc? Can we predict what we might learn?"

I have an endless curiosity for questions like these (as Thomas Friedman calls it, this is my "inner fire truck"). Although my design skills are still in their infancy, and I hopefully have a long road in global health and technology ahead of me, these are the best kinds of questions to ask to move further down that path. Essentially, development is about empowerment, and empowerment comes from information. When you design for the developing world, and with the developing world, the primary concern is access to information. What information do these people need to make appropriate decisions (and how does that differ from the information that we provide for traditional devices in domestic hospital settings)? How can we deliver that information in a usable and readily accessible format? What will happen to that information once we obtain it? What other things can we couple it with to make the most of it?

Of course, you have to optimize your physical design for the environment that it will be used in, but these are questions of design intent, and they're far more interesting than questions of form or function.

how bollywood is teaching india to read

Love this thought of the day from the New York Times (tip: Will - thanks!):

Think of the old follow-the-bouncing-ball singalongs, with a serious purpose. In The Boston Globe, Riddhi Shah writes that “same-language subtitling” of music videos in India improves literacy, once people become curious about the text at the bottom of the screen:

Indians and musical device for learning to read.

 According to Hema Jadvani, a researcher who has been studying the effects of the subtitles on Khodi [in western India], newspaper reading in the village has gone up by more than 50 percent in the last decade. Her research also shows that the village’s women, who can now read bus schedules themselves, are more mobile, and more children are opting to stay in school.

India’s public karaoke-for-literacy experiment is the only one of its kind in the world. Technically known as same-language subtitling, or SLS, it manages to reach 200 million viewers across 10 states every week. In the last nine years, functional literacy in areas with SLS access has more than doubled. And the subtitles have acted as a catalyst to quadruple the rate at which completely illiterate adults become proficient readers.

The article adds that “this is big news” for fighting poverty, since literacy “is linked not only to economic growth, but to better health, greater gender equality, and a more transparent political process.”

It's originally an article in the Boston Globe. The development community has understood for a long time that literacy is a key step in building an economic future. The problem is that the conventional method of teaching people to read is labor-intensive and time-intensive, and requires access to ancillary reading material. But with the advent of television, even in the rural areas of India, and the popularity of its Bollywood film industry, a whole new vector to transmit information is being put to use.

I've talked at length about design for the developing world and of course, India holds a special place in my heart. This is a great example of a keen understanding of a target population and some very thoughtful and deliberate (yet unobtrusive) design to create access to literacy. 

she would give her life to preserve that kind of trust

(Dr. Muhammad Yunus and myself, bright and early this morning... please do not reproduce without permission)

I dragged myself out of bed at 6 am to attend a small lecture and meet-&-greet with Muhammad Yunus this morning. My academic background is in both biomedical engineering and development economics, and Dr. Yunus is a huge force in poverty eradication. The Grameen Bank is wildly successful, and incredibly simple. He spoke for a little more than an hour, off the cuff, and had some really great stories to tell. One of the most vivid, though, was about Grameen’s vision of having 50% of its borrowers be female.

When they first started in the 1970s, Yunus and his students went to the villages themselves. He would wait outside under a tree and his female students would go inside and talk to the village women. When the students had a question, they would come outside, discuss with Dr. Yunus, and go back inside to the women. For years, the women were so reluctant to borrow money. They heard things like, “My husband deals with the money.” and “I’ve never even held money in my hands.” and “I don’t know what a bank is.”

Imagine – how do you explain to an illiterate village woman who has never held money, what a bank is?

Furthermore, how do you explain this to a woman who, all her life, has apologized for the fact that she was born a woman? She has been called a drain on her family, she has never gone to school, and she is expected to manage a household with whatever she is given by her husband. Her life is not her own doing. This is the culture, the history, the circumstance that surrounds her life. How do you peel back the layers of fear and convince her to take a chance… on herself?

It took six years of convincing women like this for the Grameen Bank to achieve its 50/50 goal. That is, in the grand scheme of things, a very short time, but imagine giving six years of your life to walk around villages and convince women to build a better future for themselves and their families. That is no small investment. Yunus, when reflecting on the achievement, said this:

“A woman comes to the bank after days, weeks of pondering. Can she do this? What if she fails? Her family will forever hold her responsible, blame her for any mistakes. But she knows she wants a better life for her children. So she takes this sum of money - $30, $40, $45. It’s a larger sum than she’s ever seen. For some, it’s the first time she’s ever held money in the first place. That woman is reduced to tears by the amount of trust that someone has placed in her. And she would give her life to preserve that kind of trust.

Repeat that story 8 million times, and you will understand what Grameen Bank is all about."

A call to those of us who have been lucky enough to “win the lottery of birth” - It is possible to eradicate extreme poverty in our time. It is possible to improve healthcare in the developing world. It is possible to stamp out disease, to ease suffering, to empower women. All of these things are achievable. They require us, though, to take chances. To peel back layers of fear. It’s not about making money. The Grameen Bank is profitable. It is not charity. It is a business. But the goal is not to win the game of business – it’s to solve the problems in people's lives.

A woman came back into the Grameen Bank several years after she repaid her loan. She had built a successful enterprise in her village, and had managed to send all of her children to school. That particular day, Dr. Yunus was in the bank, and she came by with her now-grown daughter. This woman could have asked her daughter to stay at home and help with the business while her sons went to school, could have pulled her child out of school because she needed the help. But she didn’t. Her daughter was now a practicing doctor in a city in Bangladesh. These two women stood side by side. They looked the exact same, except the difference in age. And while he was talking to them, he couldn’t help but think – one woman, illiterate, uneducated, took a chance and made some sacrifices. The other woman became the product of those chances and sacrifices, and was now given the chance to save other peoples' lives. Her mother could have done everything that her daughter got to do, if only society had given her the same chance.

more dreams than memories

walking it out en route to the Taj Mahal (personal photo... please do not reproduce without permission)

This one’s for Ryan -

A few summers ago, I took a long vacation. For many years before that, and ever since then, I haven’t had such an opportunity. It wasn’t a trip for the faint of heart – I spent two months trekking through India and Malaysia with both parents in tow. The trip itself was remarkable, and at the time, much-needed. I was coming off of a very stressful, crazy, and unique year, and only had a few more months to go before graduation. It was my chance to relax, to rediscover pieces of India and pieces of myself, and to do some field research for my two senior thesis papers (one in biomedical engineering on design for the developing world, and one in economics on policy, poverty, and technology in post-1991 India). As such, I picked up The World Is Flat on recommendation from a professor just before I left.

It’s one thing to read a book and understand the context in which it was written. It’s another to experience firsthand, in real-time, that context, and to explore it both intellectually and emotionally. Friedman does an awful lot of writing on things that I’m familiar with – India, economics, development, Georgia Tech – but the most interesting chapter in my eyes was the last. There is a juxtaposition of two dates – 9/11, and 11/9. The former, most in my generation are familiar with as the day that the Twin Towers fell in New York. The latter, equally (or more) important, is the day the Berlin Wall came down and sparked a chain of events that led to the solidification of democracy worldwide (and the eventual opening of the Indian economy in 1991, for those that are interested in my economics research). He then takes these dates and puts them in the context of creation and consumption – of building and destroying. From Friedman:

"[…] then you and your generation must not live in fear of either the terrorists or tomorrow, of either al-Qaeda or Infosys. […] While your lives have been powerfully shaped by 9/11, the world needs you to be forever the generation of 11/9 - the generation of strategic optimists, the generation with more dreams than memories, the generation that wakes up each morning and not only imagines that things can be better but also acts on that imagination every day.”

I was only three on November 11, 1989, but I can imagine that there was a great sense of unity and pride in the world the day that wall came down in Berlin. Friedman goes on to say that what causes people to be driven to extremism and hatred is not a poverty of money, but a poverty of dignity. To see others with opportunities that you yourself have never seen, to live in a world where those opportunities aren’t fathomable, that is a poverty of dignity. The goal of development should not be to create monetary wealth, but rather to create a sense of empowerment, a sense of dignity in a population. When I design a device to be used in a low-resource environment, I’m not trying to give a clinician in Nairobi the same technology that a doctor in New York uses. I’m trying to give them the information they need to make informed choices – on their own. I'm trying to give them tools that are meaningful to them in the context that they live in. I’m trying to give them something to look forward to, to create a dream of how things can be better, not in my eyes, but in theirs.

More dreams than memories, indeed.

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.