E-health for the world’s rural poor

The British microprocessor design giant ARM has tweeted 15 predictions for 2015. Some of them are incomprehensible geekspeak: “Benchmark data will shift end-user choice to purpose-optimized servers versus monolithic approaches”. But not this:

Mobile operators will deploy smartphone services as de facto healthcare for rural areas.

iphone_healthHow should they know? ARM just makes and licenses processor designs. Licensees incorporate them in complex chips (SOCs); the licensees’ customers incorporate the SOCs in gadgets; the gadgets are sold to final customers. It’s a long chain. But ARM’s business model requires it to keep abreast of these final markets, so it can steer its design programme. That’s why ARM puts a lot of effort into designs for the booming automotive market, and very little into the stagnant one for desktop PCs. The chances are they know what they are talking about.

Sure enough, Google quickly finds an example in Kenya:

“Safaricom has employed a wide-network infrastructure across and there is therefore opportunity for us to layer on services that make a difference to the Mwananchi,” Safaricom’s Enterprise Business General Manager, Sylvia Mulinge said in a recent statement. (Mwananchi is the Kiswahili word for “Common man” or “Citizen.”) “We have set up 800 digital villages and target to push the number to 5,000,” she said.

The company has partnered with Cisco to roll out e-health services across Kenya so as to enable patients in rural areas consult with doctors in urban areas. Through its e-health services, small clinics will be stationed in digital villages, where patients can consult doctors via video conferencing facilities.

In case you are worried that this is just feelgood PR, the telcos are into e-health for the money, like Adam Smith’s butchers and bakers. Health ministries even in Africa have budgets, and a major delivery problem; if e-health is value for money, they will pay for it. 800 digital clinics is not greenwashing. 5,000 will be major change.

If this works in Kenya, it will be rapidly replicated. The mobile phone revolution in Africa has wirelessed the continent – with >700m subscriptions, probably 80% of Africans have access to a least a basic mobile phone. Smartphones and 3G networks are following (another ARM prediction is 64-bit smartphones for under $70). Current Internet penetration is 26% for Africa as a whole, with 51m Facebook accounts. The operators are parts of big multinational groups: Safaricom is 40% owned, and operationally controlled, by Vodafone. The company launched the mobile phone payment system M-Pesa in Kenya in 2007, and has now spread it to 10 countries, including India. P-Pesa has rivals, like this one sponsored by India’s Airtel operator.

The mobile operators have found themselves in the unlikely position of being the first universal utility to reach half of the world’s population. They have already become de facto banks. If e-health takes off, they will become healthcare providers too.

Safaricom’s digital clinics don’t quite match ARM’s prediction. The clinics will presumably piggyback on the high-quality microwave links the operators have set up to their cellphone towers, and there’s no mention of smartphones. But mobile telcos are run by IT types, with no preconceptions about the proper way to deliver health care, and a keen understanding of their own technology. Why not set up a Kenyan WebMD, in Swahili, Luo, Masai, and Kikuyu? A smartphone is a very capable multimedia communications device: it has a microphone you can link to a stethoscope; a camera you can link to visual probes; and wifi you can connect to a cheaply pre-equipped blood pressure or blood sugar monitor. That’s a lot of diagnostic kit already.

This sort of health care was pioneered years ago in the days of radio, in the sparsely populated Australian Outback and more recently in the Canadian North. These are tiny niches in terms of the population covered. Telemedecine in the developing world is about to change the lives of billions of Mwananchi.

Mr Smith goes to Katoro

Mark rightly gives points to Gordon Brown for providing arguments for Scotland to stay in the Union (as it in the end chose to do) based on principle and sentiment, not merely interest. Contrast the absence of Tony Blair, junketing with Davos Man (or worse) and Menton Girl  somewhere sunnier than Scotland. Brown’s argument was based on shared battlefields and domestic glories like the NHS rather than Hume and Hutton. But it was fair of Mark to say that it reflected the cosmopolitan, outward-looking values of the Scottish Enlightenment. Its leading lights, apart from Burns, were SFIK all Unionists and anti-Jacobites. The mathematician Colin McLaurin actually supervised, though unsuccessfully, the defence of Edinburgh against the Jacobite army rampaging its way south. The Scots’ combination of physical courage, industry, and respect for learning have made the world their oyster.

So here’s a small salute to the whole gang, represented by Adam Smith, Professor of Moral Philosophy at Glasgow University. (Scotland had four universities by 1600 to England’s two). His best known sentence must be this, from Book I, Chapter 2 of The Wealth of Nations:

It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.

(The website is libertarian. They might try reading a bit more of him; he isn’t Rand at all.)

Perfectly illustrating the point, here’s very nice and cheering photograph of Mr. Edward Buta’s flourishing solar shop in Katoro, Tanzania (pop. 11,925). (H/t Tim McDonnell at Mother Jones.)

Continue Reading…

Remembering Black Nationalist Marcus Garvey

VO-1541-p29-Marcus-GarveyHappy Juneteenth! The joy of Emancipation quickly yielded to grief after the Compromise of 1877 triggered a new round of repression of Black Americans. Since that time, Black Americans have debated and employed a range of strategies to fight racial oppression. One of those is nationalism, so this seems an appropriate day for me to update an extended review (originally published in an academic newsletter) of four books on one well-known exponent of that view: Marcus Garvey.

Books discussed in this essay:

Cronon, E. David (1955/1969). Black Moses: The story of Marcus Garvey and the Universal Negro Improvement Association. Madison, WI: University of Wisconsin.

Fax, Elton C. (1972). Garvey: The story of a pioneer Black nationalist. New York: Dodd, Mead & Company.

Hill, Robert A., & Bair, Barbara (Eds.). (1987). Marcus Garvey: Life and lessons: A centennial companion to the Marcus Garvey and Universal Negro Improvement Association Papers. Berkeley, CA: University of California Press.

Martin, Tony. (1983). Marcus Garvey, hero. Dover, Mass: The Majority Press.

On March 23, 1916, a flamboyant and eloquent activist named Marcus Garvey arrived in Harlem with plans to bring African-Americans a program of economic and spiritual renewal, autonomy, and self-reliance that he had developed in his native Jamaica. His original hope of securing the support of Booker T. Washington was dashed when The Sage of Tuskegee died just prior to Garvey’s journey. As Garvey explains in his essay “Aims and Objects of the United Negro Improvement Association (UNIA)” (Reprinted in Hill and Bair’s collection of Garvey’s papers), he decided that even without Washington’s assistance, he could personally inspire and lead a worldwide movement that would create a sense of unity and racial pride among all people of African descent, promote mutual help among Blacks, oppose European colonialism in Africa, and develop a self-supporting network of Black-controlled businesses and educational institutions. In the words of Elton Fax, these goals clearly did not “suffer from the encumbrances of modesty” (p.58)”, but Garvey’s indefatigable spirit and organizational ability enabled him to come impressively far towards meeting them before internal and external enemies brought the man and his movement to a crashing halt by the close of the 1920s.

Of the four books discussed here, E. David Cronon’s Black Moses is the most comprehensive and best documented, and thus serves as the best introduction to Garvey’s life and works. Through painstaking research, Cronon tracked down Garvey’s surviving family and friends and unearthed valuable published and unpublished sources. Cronon begins his story in St. Ann’s Bay, Jamaica, where Garvey was born in 1887 and named after his father Marcus Garvey Sr.. Although the Garvey family was initially financially stable, they suffered a steady decline in their fortunes as Marcus Garvey Sr. became increasingly prone to paranoia, irrational outbursts, and disastrous business decisions (problems with which Marcus Jr. himself would later struggle). A particularly sad index of the family’s difficulties is that of the 11 Garvey children, only Marcus Jr. and his sister Indiana lived to maturity. Marcus was a bright and inquisitive child, but received little formal education because his family’s economic situation required him to work. Garvey’s shame about his lack of education never abated, and later fueled his envy and vituperation of his Harvard-educated arch-rival, Dr. W.E.B. DuBois of the National Association for the Advancement of Colored People (NAACP).

As a young man, Garvey supported himself and his family by working as a printer. He was highly skilled at his trade and became a master printer and foreman at The P.A. Benjamin Company by the age of 20. In 1907, unionized workers at the company went on strike for higher wages, and elected Garvey to be their leader. Unfortunately, the strike was broken when the union treasurer embezzled the strike fund and the company imported linotype machines and scabs to replace the striking workers. Although the strikers were re-hired, Garvey was blacklisted by the printing industry in Jamaica for his role as organizer. This bitter experience made Garvey permanently skeptical of the value of labor unions, and lead him to look for alternative means to improve the lot of Blacks. Continue Reading…

Can President Obama Save Uganda’s Oppressed Gays and Lesbians?

Chatham House has an illuminating and disturbing report on the domestic and regional politics of Uganda’s anti-LGBT oppression. Bottom line: pressure from the West to stop the nation’s brutal anti-homosexuality bill — which mandates a life sentence for gays and lesbians – might only foster bigoted actions in the short run.  Equality for LGBT people is regarded by many Uganda elites as “colonialist decadence.” Now, that’s decadence I can believe in!

But what to do? At this point, the administration’s best option is to order the US Embassy in Kampala to start processing LGBT Ugandans for humanitarian parole. According to United States Citizenship and Immigration Services, humanitarian parole can ”bring someone who is otherwise inadmissible into the United States for a temporary period of time due to a compelling emergency.” USCIS may grant parole temporarily “to anyone applying for admission into the United States based on urgent humanitarian reasons or if there is a significant public benefit for a period of time that corresponds with the length of the emergency or humanitarian situation.” Humanitarian parole does not bring with it immigration status, although it is very rare for parolees to return their country of origin.

Of course, there is one obvious threshold question: how would the Embassy determine whether someone is actually threatened?  The best first approximation would be to consult with NGOs inside Uganda who serve the population.  (Full disclosure and kvell: I’m proud to be working with the American Jewish World Service, which has close ties with many NGOs in Uganda that do this work, and which has developed a major campaign around LGBT and women’s rights.).

This would obviously be an imperfect way of identifying people at risk of incarceration, but in many ways, this is a feature, not a bug.  Two decades ago, Larry Lessig wrote an important article on “The Regulation of Social Meaning.” The law, Lessig, can at times change not only what is prohibited or allowed, but the meaning of actions. For example, before anti-discrimination laws, lunch counters that wanted business from African-Americans would be pressured into segregating from the local Conservative Citizens Council.  But after the Civil Rights Act, the owner of the lunch counter — who did not need to be a saint, but rather just someone out for a buck — could respond to such pressure by saying, “Oh yeah? And are you going to pay my legal bills when I’m sued?” The meaning of an integrated lunch counter changed after the passage of the Civil Rights Act.

Back to Uganda.  It would be salutary to see thousands of Ugandans claiming to be LGBT if they thought it would get them into the United States.  The very ambiguity of who is LGBT and who is not could do some work in reducing anti-LGBT sentiment in the country.  We might call it a Spartacus moment:

And oh yes — allowing humanitarian parole in these circumstances could save hundreds, perhaps thousands of lives.  Note to the President: No Congressional authorization necessary.