As I mentioned in my last post, new technologies are being introduced primarily by the mobile service providers.  And for as much as I’m developing bits and pieces of software, my research is to introduce these technologies to the healthcare service providers (HSPs), to educate them on their use, and to study how they are assimilated.

Brief aside: For you students out there, what makes this a vaguely experimental context is that I’ve manipulated the context by forcing the introduction of computers, Internet, and Internet-enabled mobile phones, so I can ask very specific questions.  It’s only vaguely experimental because there’s all sorts of exogenous variables that I can’t control and, well I only have 8 subjects that are ultimately wildly different from one another.   All the statistical data I presented in my last post was from a survey of 59 health facilities, so that’s slightly different… but also to be discussed.

Okay, now this is long overdue, since MTN changed their GPRS settings at least 6 months ago.  But this week and next I’m setting up my 8 facilities with mobile Internet, so yesterday I went to Warid, MTN, Orange, and Zain and purchased Internet plans from each of them.  (UTL has CDMA and DSL broadband services, so they don’t offer GPRS services by monthly subscription, although they do have 3G equipment installed on their masts in Mbarara. We don’t know what their deal is.) Here’s a run down of all the prices:

The prices listed are in Uganda Shillings (conversion varies from day to day, I think it is actually about 1950 UGX to USD, but I generally use 2000 as my conversion rate for this blog, for round numbers, and so I don’t have to get out a calculator.)  For Orange and MTN, they offer discounted rates if you subscribe for multiple months. You can view Orange’s price list and coverage area online, and MTN’s price list as well.  Warid calls their plan Smartlink.  A primary thing to note is that not only is Orange half the price of the others, but Orange has 3G coverage in many of the major towns throughout Uganda, including Mbarara.  Practically speaking, this means I can watch live streaming video on the BBC News website using my Orange modem, and use skype again. Yikes.  My one modem is faster than the entire Mbarara University VSAT connection.  At the same time… I took the modem to Kaberebere yesterday, about half an hour away to a health facility, where only EDGE coverage was available, and I was only getting 4Kbps instead of 100Kbps, and when I took it to Kanoni, it didn’t work at all, so it really depends on where you are.

I spent yesterday morning purchasing mostly just the SIM cards from each of the providers – which I get away with because I’ve previously purchased modems from them and they all know me.  Usually you’ll have to argue with them if you try to purchase a monthly subscription without a modem, and prove that you have a phone that’s capable of handling it.  They just don’t want to deal with third party modems.  Don’t tell them that you have one if you do.

For each one, if you know what you are doing the APN is listed above, and the username and password is blank. IP address and DNS settings are automatic, and there are no proxy settings.

With Warid, there’s a trick – there’s a current promotion, in which for all the airtime you load, you get bonus airtime, which can be used for calling, but not for things like Pakalast or Internet.  So I loaded my personal phone with the airtime for the Internet and then transferred the airtime to the Internet SIM.

You don’t have to go to a Warid office to activate Internet on your Warid line.  Just send an SMS with the words data 85 to 158. Warid will deduct 85,000 from your account, and you will get 30 days of Internet.  Make sure you have 85,000 UGX already loaded on your phone.   By my experience I usually just go to the customer care office because no one but them actually sells that much Warid airtime… You can also send the words data 5 to 158, and you will get one day of Internet instead for 5,000 UGX.  I was told also that you can check your SIM card: if you have a 32k SIM card rather than a 64k SIM card, you may have some difficulties with Internet, and you should get your card replaced.  I have, however, never had a problem with using a 32k SIM card on a pay-per-kb basis.

For MTN, if you already have a line, and you don’t have Internet, you can call customer care on 123 and tell them you want Internet to be enabled on your phone.  If you already have 90,000UGX on your phone, then you can ask them to deduct that from your balance and then they can subscribe you.  Or you can just enable Internet and start using it at the pay-per-kb rate.

For Zain, once you first connect to the access point, you will need to activate a plan before using the Internet.  If you go to the store, then they will do this for you.  Now, first, I will mention that yesterday and today, Zain has been very very flaky – the coverage has been okay (totally down in Ruharo) but the AP has been down more often than up.   However, once you are able to connect you need to use a web browser to connect to http://www.zain.com.  You will then be redirected to a page that will invite you to choose between three Zain plans, Zain Access, Zain 1GB and Zain True Unlimited.  Zain Access is the pay-per-kb plan, Zain 1GB is the monthly plan for 90,000UGX per month, and True Unlimited is another monthly plan with no bandwidth cap, at a price I don’t remember.  Click on the link corresponding to the plan you want and it will display the name of the plan, its validity, and the price.  Then click on the subscribe link.  From there it should take you back to the Zain page and you should be ready to go and use any mobile web application on your phone.  Note – if you select Zain Access, you won’t be able to switch to Zain 1GB for at least one month on that same SIM card without a LOT of hassle, so make sure you know which plan you want to be on.  Or just get two SIM cards.

Orange offers 1GB, 3GB, and 10GB plans, both with and without their modems.  If you choose not to purchase their modem (150,000 UGX) then you have to subscribe for a minimum of 3 months. I tried to purchase one instance of this plan yesterday and was told that they were sold out of modem-less Internet SIMs and would have to return the following week, so clearly modem sales are a priority.  And iPhone sales. At 3G speeds, 1GB gets used up really really quickly.  3GB is probably reasonable 10GB is pretty expensive…

If you are using your mobile phone, most networks will try to configure your phone over the air (OTA).  I haven’t had a lot of success with the OTA configurations on my Nokia, and none with the Palm phones. But whatever.

If you purchase a modem from one of these providers, you’ll find that the modems from MTN, Warid, and probably Zain (they have a new modem now that I haven’t tried) all include OSX-compatable software.  I don’t use it.  The Orange modem doesn’t come with software, but is made by the same manufacturer, a Taiwanese company called Huawei.  Basically, I go into my Network Preferences, select the “HUAWEI Mobile” device, and add a new configuration.  From there I click the “Advanced” Button, and the Modem window displays.  For Vendor, select “Generic”, for Model, select “GPRS (GSM/3G)”, and enter the APN as above.  All other settings under advanced can be left as default.  If you have any proxy settings, you might want to uncheck them.  Click Ok to save your advanced settings, and then enter *99# as the telephone number. Click Apply.  Then Click Connect.

On a Mac you can also share your Internet connection with other WiFi-enabled people in the room.  Once you are connected, click “Show All”, then double-click on “Sharing”.  If you click on the words “Internet Sharing” you will see options for “Share your connection from:” and “To computers using.” Select the appropriate options (i.e.  Huawei Mobile and AirPort respectively) and click on the checkbox next to Internet sharing.  If you are successful it should  1) turn on your airport if it is not already on 2) ask you to start Internet sharing  3) turn your little wifi icon into an up arrow.

Of course, now having one of each network (except UTL) and being able to test them side by side in multiple locations I’m learning their differences.  I’ve extolled Warid and Zain before as having better performance, probably because their network isn’t glutted by lots and lots of users.  However – now the situation is different.  Warid has a lot more users, and it seems that I can barely get the modem to connect.  Zain is just having technical difficulties right now – I’m not sure if that is temporal or endemic.  After my previous post, I discovered that both Warid and Zain are much better in Kampala.  But from my perspective – it doesn’t matter – it’s much more important to ICTD to know how all of these networks are performing in the villages and towns outside of Kampala, for rural health centers where our potential users are, where the so-called bottom billion are receiving health care (or not receiving health care, as the case may be).

I’ve been putting up coverage maps for the past year, claiming that wherever there is mobile coverage there is GPRS coverage.  This is only partially true.  I just went to Kanoni on Monday and found that I couldn’t get any of my phones to connect to the Internet successfully – there was extremely weak phone signal, and no GPRS coverage.  I even got the Orange software to connect.  To no avail. (it connected on windows, but not on OSX, or on my phones) We suspect, it might work on Zain, but I didn’t happen to have a Zain card on me… and I’m worried, given the quality of the Zain network here right now.

So there’s theory and reality.  Orange makes a claim “All areas covered by the Orange network have EDGE available with speeds of up to 236kbps.” And yet in Kanoni we had 2-3 bars of reception, with no Internet at all.  I travelled to Ibanda with the doctor finally, and we uploaded his attachment at a whopping 1-2kbps.  Yes, we were connected using EDGE, but it was a slow and painful (dare I say dull?) EDGE.

And yet it is the best we have.  The best I’ve seen Warid connect with out here is GPRS. MTN connects in general using EDGE, but always more slowly than Orange, unless we’re out of an Orange coverage area (e.g. in Ruharo). MTN’s fallback in rural areas is GPRS, Orange’s fallback in rural areas is EDGE.  Much of Isingiro, a district bordering Tanzania, the location of the Uganda UNDP Millenium Village Project, has very little Orange/Warid/MTN coverage, and is only accessible by Zain. In those locations, Zain is the only recourse – and 3G is available (or so it is rumored).

In my office, Orange is faster (and cheaper) than our VSAT connection, and doesn’t go out when there are power cuts.   We used it to download all of the Windows updates for the six deployed laptops in my research study, with little effect on the connection performance. Useful. And I can skype again, not that I have the time these days… =)

I am deploying these modems according to which network works the best for the various providers in their facilities.  Each of them will get a subscription for one month, after which they are free to continue subscribing on their own, or to return the modem to me.  After the second month, they will have to arrange to purchase the modem from me or from the appropriate mobile phone company.  They also are equipped with Internet enabled mobile phones, and are keeping logs of their usage and spending.  Hopefully by the end of two months they can make an informed decision as to whether they would prefer to use Internet on their phones (cheaper but limited) on subscribe to Internet on laptops (expensive but more flexible).

I know it is a little weird to be working in development but to still be telling people in Africa to spend money. But I’m also perfectly fine with any decision, whether they choose to forego the phones and laptops altogether, or to spend lots and lots of money for everything.  I just want to learn their preferences, and why they make these choices, and how what they learn changes their choices and how they communicate.

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Now, there’s clearly a difference between the startups of Silicon Valley that get venture capital and make millions, and the small business owners that run grocery stores or laundromats, and street hawkers that sell chewing gum from baskets on top of their heads. Profit margins are one.  But everyone has to start somewhere, and not everyone has the same connections; certainly environment and geography plays a large role in the probable capacity of an individual to aspire.

So what does it take to start a formal business in Uganda? To be a small business owner?  I’ve been encouraging some of my students along these lines, and thinking about the “Coded In Country” concept.  One thing that plays a large role in the ability to build local capacity is the country’s business environment; how hard is it to start and run a company in Uganda?

After a bit of word-of-mouth consulting, and talking to some small business owners here, I turned to google, and found the Doing Business Project, which provides indicators on 10 topics in 183 economies.  While the data itself is also very useful, from a very practical standpoint the fact that they’ve documented all of the (18) steps for starting a business in Uganda, and put them on the web is totally amazing to me.  This is not formal e-governance, since the government isn’t the one putting this information on the web, and in theory, the gov’t could change the policy, making this document out of date. However, this does make things easier for people… as long as they have Internet access and pick the right search terms (e.g. “starting a company in Uganda“).

Now, what does this information mean for my students?  Mostly it means that they need to hire a lawyer to incorporate as a partnership.  We’ve consulted with a friend of a friend of theirs, and it will cost about 365,000 UGX (180 USD) in licensing and lawyer’s fees to go through the entire process. Their hope is to start a company that uses information technology to support healthcare in Uganda, through the development of software and the support of IT systems. They are helping me by providing ongoing computer and mobile phone maintenance to the healthcare providers I’m working with, even after I go back to the States, and working on supporting the software we’re developing.

Now they just have to come up with a name for the company…

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Dembbe Clinic WECARE Solar and Netbook Deployment

Kathe Medical Care Netbook Deployment

Barefoot Power PowaPak and Palm Treo Deployment

Here’s how my research works: There’s a lot of complicated stuff about claims and claim processing. However, what I actually do is a lot of qualitative research on how people do their work, perceive information technology, and manage information. Then I introduce new technologies, and then ask them what they think of them, and see what they do with them. Sometimes I’ve done weird things with these technologies (like umm.. written them or installed specific software), and I definitely have a specific approach – I interfere with my subjects a lot in terms of computer training, and in the case of my partnering agency, being an IT consultant in this office for 15 months.

My baseline studies and are showing that my target user base 1) has a high interest in using information technology for patient information management but 2) very little training (for the most part). So if I were to introduce a new system, let’s say a laptop/netbook, 1) they would be very interested in learning how to use it, even paying for it but 2) they would have little to no background knowledge on where to start.

This has deep implications for user interface design. For many people, they choose a “kiosk” approach, making computers that have only one application (also known as the “appliance”). However, this has implications on sustainability. For private health facility owners who need additional skills, or for programs that cannot be expected to finance the equipment externally – paying for purpose-built machinery when the computers are capable of general purpose applications is impractical.

In this case – Claim Mobile is probably not a sufficiently valuable application to motivate purchase of laptops or phones. However – the phones, bundled with a camera, medical calculators, bible readers, internet browsing capabilities, etc, and the netbooks, with Microsoft Office, and Hesperian ebooks, and other medical resources, Barack Obama’s speeches, and the ability to access the Internet are of great value to the health facilities, and to the program management of the Uganda OBA project, even without the claims processing component.  However – we hope to find out in this study how this value will actually play out against real purchasing decisions: laptops vs phones, Internet subscriptions vs pay per kb Internet use.  In addition, we will observe over time how the health facilities and the Uganda OBA project will make use of their ownership of these devices, and how the new uses play into relationships, communications, and the management of the OBA program in general.

Some caveats about the deployments so far.  Out of the first three deployments, two facilities did not have power.  In one location, we donated a solar suitcase to Dembbe Clinic through WE CARE, an organization I’m involved with that seeks to provide improved electricity and communications for maternal health care.  The two 20W panels provide sufficient power to charge the netbook, phone and lights for the facility.

In the second location, we are experimenting with the Barefoot Power Powapak, which provides solar led lighting sufficient for rooms (not quite surgery), and a cigarette adapter to charge phones. However I went back on Monday to check on the solar deployment, and discovered that the battery was completely discharged – probably because the solar panel was failing to charge the battery.  I’ll introduce some solar logs to have them track usage more closely in January. The phone is being charged every few days from the clinician’s other place of work, which has access to electricity.

• Daily WE CARE Solar Logsheet
• Daily Usage Log

The third location, Kathe Medical Care, has very reliable access to electricity, because they are on the power line connecting to Rwanda. However, what interests me about this particular clinic is their innovative uses of ICTs prior to the study.

Kathe Medical Care analyzes output indicators by local sub-districts

During my baseline surveys, I was introduced to Kathe Medical Care’s many colorful computer generated graphs and charts, all produced from the government-mandated monthly summary data.

There were charts showing trends of increasing numbers of antenatal visits over the past year, since the beginning of the OBA program, charts, comparing non-OBA deliveries to OBA deliveries, and charts showing from which  sub-counties patients were coming.

I learned that the clinician did all of these from an Internet cafe, taking his monthly reports to Mbarara each month, entering them into Excel, to produce the charts.

Based on these charts, I assessed this clinic, and had high hopes that I would be able to learn from him how other clinics could use their data to benefit from computers.

I also assumed that he had a usb flash drive.

But to my surprise – one of his statements upon entrance into this study was that he had been giving people these charts for a while and hoped that at some point  someone would think to give him a flash drive. You see it turned out that each time he produced one of these charts, he was entering in another year’s worth of data, all over again – he had nothing on which to save the Excel spreadsheet that he was using to create this chart. I think none of us ever imagined he could achieve so much without a flash drive in the first place!

This sort of begs a question: clearly he has enough income to purchase a flash drive, if he’s willing to purchase a netbook, and even a printer… What stopped him? (This is another blog entry entirely, maybe a paper or two).  There’s a lot to be said at this moment about 1) trust in electronics purchased in Uganda and 2) the perturbation that I am as a ethnographic researcher in this environment.  But I won’t say it now.

In the meantime… given what he was doing without a flash drive, and with the nearest Internet cafe an hour away at $1.50/hour,  let’s just imagine what he’ll do with his own netbook and Internet access.  Or perhaps not imagine… we can wait and see.

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On PRI’s The World

Solar medical system
http://www.pri.org/business/social-entrepreneurs/solar-energy-clinics1583.html

A self-contained, solar-powered system for operating rooms ensure clinics in the developing world aren’t impaired by blackouts.

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At the moment, I’ve totally given up on using my 64/64 WiMax+VSAT link via Infocom (which costs $300/month) and I’m using my Warid Telecom GPRS/EDGE modem (cost $60 + $40/month), which incidentally also claims speeds up to 128kbps (16KB/s), but in reality usually sits at about 2-5 KB/s on a good day (I am getting about 1.0KB/s now).  The MTN EDGE/HSDPA service ($150 + $45 modem) is a bit of a joke and I have never seen it go above 1-2 KB/s (It’s supposed to be 384kbps, or 48KB/s).  My suspicion is that MTN, as the pre-dominant service provider in Uganda is over-subscribed, and they use older equipment here in Mbarara. Rumor has it that they get better performance in Kampala.  But it is totally beyond me why they claim 3G services and sell HSPDA modems but offer a service quality that is really completely unusable. In practice – I was able to get data services (with the same sim card) using my android g1 phone, but not with the modem they provided. Okay, I’m straying from my original topic – I’ll do another series later reviewing available mobile data services in Uganda, since that’s part of what I have to research here for Claim Mobile. (My findings are mysterious and intriguing, let me tell you… or just plain frustrating, take your pick.)

So why is a mobile phone researcher sitting here worrying about ISPs and various telecommunications providers, other than the fact that I can’t send emails and every time I manage to load my credit card website it times out and kicks me back to the log on page? Well, it’s actually part of my participant observation activities.  Yes… I get to be my NGO’s consultant on all things IT.  But it is also useful to know and understand these things – not just in theory but on the ground – what are NGOs actually facing in day-to-day experience trying to deal with ISPs, from selection of an internet service provider, to daily maintenance of an Internet connection, to their own understandings of why things are and are not working..

The technical people to whom we outsource things are in general okay.  There is a dependence on Windows products.  And I could wish that they would install proxy caches, especially since we are using VSAT services.  I like that Infocom uses WiMax.  But their connection to the Internet seems less than reliable, which is unreasonable given that they are multiplexing WiMax users. And really, when the Warid mobile internet for $40/month performs better than the $300/month Infocom link, you know that something is seriously wrong.

As I mentioned at the beginning – this isn’t an all-across Uganda problem.  I can go to my Mbarara University office, and my internet connection is fine – we use Uganda Telecom as an ISP there, and the connection is a lot faster.  Unfortunately for me, the sysadmin is a bit paranoid since he doesn’t quite know what he’s doing, and the firewall doesn’t let me POP3 my mail.

And I will also note that the story differs a lot when you change regions – East Africa Internet prices are very different from West Africa – in Ghana you can get fairly decent DSL broadband for $90/month, with out paying an arm and a leg for VSAT equipment, purely because West Africa has the SAT3 submarine fiber with a landing point in Ghana and a few other countries.

We’re waiting for that submarine fiber to Nairobi to be finished this summer?  Hopefully with a non-monopoly business plan? But even once East Africa has submarine fiber, that doesn’t solve pricing problems for the land-locked countries in central Africa.  While, there are many capital projects working on getting broadband Internet around the coast of Africa, no capital projects that I am aware of to date are investigating lowering the cost of Internet beyond the coast. More than a few invest in broadband via VSAT (e.g. o3b), but while VSAT may be expedient, it will remain expensive to maintain, and is not a new solution.

How many development projects have died after their three year term when the supporting NGO was no longer able to pay the $2000/month subscription fee for the VSAT service?  Even when coupled with on-the-ground last mile solutions like WiMax or WiFi for sharing the VSAT link amongst a number of users, we find that the per-user cost of VSAT is too high.  $2000/month here pays for maybe a 263/790kbps connection, which will support about 20-30 users.  That’s almost $100/user/month!  Let’s say we restricted applications to low-bandwidth apps and could support more users. With an optimistic 200 users, assuming no costs for maintaining a network that supports 200 users, $10/month is a lot of money to ask from a rural villager, discounting the cost of whatever device you are giving them. There’s still no real scenario in which this pricing model becomes affordable and sustainable. Shared VSAT plans are less expensive – but as I allude to in the beginning of my email – shared plans support fewer users.  This 64/64 Infocom plan is virtually non-functional at the moment.

There’s something on the horizon… Warid has started offering WiMax service in Kampala, for which they are charging about $150 for equipment and $100/month for “broadband” service.  In theory they will offer the same in Mbarara at the end of the month. (End of the month in Uganda usually means sometime in the next 3-6 months, as I’ve learned..)  I assume that this is similar to Infocom and MTN’s service – WiMax to VSAT, unless Warid has some sort of wireless relay going up through Kenya and Ethiopia to the Middle East that we don’t know about.

Also on the horizon is Eric Brewer’s plan to build long-distance wireless broadband (not necessarily WiFi or WiMax) links down the Rift Valley, effectively bringing broadband inland from a number of possible submarine fiber drop points to a selection of possible inland locations using existing(?) wireless towers.  Issues to surmount?  Spectrum licensing in each country, trans-boundary traffic issues, negotiating agreements between the various ISP associations in each country, pricing models, who will administer the network, etc.  Oh, and of course, setting up the network…. But TIER has experience with that…

In the meantime.  I’ll post this and be thankful that at least two of my three available Internet connectivity options are functional.

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From:  Laura Stachel

Cross-posted from wecaresolar.com
Hello friends and family,
I’ve been in Nigeria for 5 days and it’s been a whirlwind of activity and accomplishments. Please take a look at the WE CARE website: www.wecaresolar.com if you want some detailed updates. The solar project is phenomenal – the solar panels are being installed, wiring is being done, and lights will be up in the maternity ward, operating room, and labor and delivery by the end of Monday. We’ve also installed outlets to enable suctioning in the operating room, and ongoing battery charging for the walkie-talkies and LED headlamps. Nurses in ALL of the wards are using the LED headlamps, and I’m learning that they are no longer having to postpone critical nursing care due to lighting problems. So intravenous lines are being placed on time, babies are getting the antibiotics they need, and stress levels are going down. The new antenna for the walkie talkies has been installed, and the repeater will be put in place on Monday. Then I will test the system to
verify that the walkie talkies will extend for 12 miles. That means that all the hospital employees on call will be able to use them, not just the ones who live on the hospital grounds. I also met with a group of visiting American doctors and convinced them to donate surgical supplies to the labor and delivery ward.  Finally, I have been observing and working with hospital staff, who have asked me to initiate a meeting next week to review difficult cases with poor outcomes, and to promote improved standards of care. They see me as  an allie and have responded to my gentle criticisms of their care in the most productive way possible.

And for the most special surprise – I procured a solar powered blood bank refrigerator and solar panels for the laboratory today

I’m going to be visiting the ministry of health on Monday, because the hospital wants to have a celebration in honor of WE CARE on Wednesday.

I haven’t been sending out my field notes about hospital care as I have in the past. I have been witness to many sensitive things, and worry about publicizing this for the world to see. If you would like any of my notes for your personal perusal, just let me know. They are at least as detailed and moving as the ones I blogged a year ago.

Finally, some of you have asked me how to make donations.  If you have not had a chance to make a donation to the WE CARE project and would like to, the website will accommodate donations through PAYPAL for a tiny fee, or you can send a check to: WE CARE, 3009 Hillegass Ave, Berkeley, CA. 94705.

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I was sort of hoping when I looked that they were a site that donated textbooks – so that I could get some textbooks for the Object-Oriented Programming class I’m teaching at Mbarara University of Science and Technology this year. I wanted to use Head First Java (which you can get from BWB for $32), or maybe Deitel and Deitel’s Java How to Program (available in various editions from BWB) at least as a reference, but unfortunately they don’t have either in their libraries (the library actually has a lot of copies of C++ How to Program and C How to Program), and I’m sure the students can’t afford to buy the books.  Alas even if they could I didn’t even know what class I was teaching until a few weeks ago, so it’s not like the books would be shipped on time. There are a bunch of other textbooks in the library – but unfortunately there’s about 20 books for my class of 208 students to share. I’m hoping they’ll cope with the online resources (e.g. the Java Tutorial) and my lecture notes, but that puts a lot of pressure on my lecture notes and very unreliable Internet connection.  I just gave my first lecture today, which was followed by lots of frantic copying of my slides to some very highly infected usb-keys.  Thank goodness I have an apple laptop. Whew. Sigh.

Anyone want to donate an electronic copy of a decent OOP-Java textbook?

Actually, lots of people here are asking me for advice on web development and some systems administration too.  I think we’d be happy to take donations of any textbooks, electronic or otherwise.

You can ship books to me here at the Institute of Computer Science:

Institute of Computer Science c/o Melissa Ho
Mbarara University of Science and Technology (MUST),
P.O. Box 1410
Tel: +25648520394 / +25648521373
Mbarara, Uganda

If you decide to ship anything else to me, umm, like computers (!!) let me know and I can give you an address in Kampala, which might be more secure/faster. =)

p.s. For my personal use, I’m perfectly happy to just buy and download pdfs of books from O’reilly or elsewhere and read them on my Sony Reader.  It’s a little slow sometimes, but I get instant gratification (relatively, compared to the post) and remarkably readable. And I can carry them home with me. But if you send me a physical book I’ll leave them here for the library.

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Even without the new configuration, people are raving about these netbooks. They won’t let me take them back to the states, and people keep buying them off me – so I have to replace them when I get back home, using the cash people give me. More stuff to carry when I come back – it’s a wonder I always make it through customs with my 6-8 laptops..

The reaction to my laptops this time is that everyone wants to buy these off of me “when your project ends” – to which I always say that when my project ends, the laptops will still be in use because the project will continue without me – unless they are already certain of my failure (I hope not!).

The proposal for now is twofold: two of the laptops will be used as asynchronous web servers, akin to the design used in the Ghana Consultation Network, allowing the Program Management Office in Mbarara and the Management Agency Head Office in Kampala to access claims information even when their Internet connection is down – basically, since the processor will certainly be slow, it will be a caching agent. (I might try Google Gears as well and see if that works better, but this is something that I can intelligently back up and that they can own locally.) The rest of the laptops will be allocated to two of the private health clinics for use in administering their claims forms. However – a primary distinction from the mobile phone solution is that they don’t include communications technology. I will explore a couple of options – including both a sneakernet style solution of sending the forms by SD card, or the more expensive solution of attaching a falcom modem to the laptop, which essentially doubles the cost of the laptop. A few other clinics will be assigned mobile phones, and the remaining clinics will be controls – I will visit them, continue to run surveys, and observe claims administration, and monitor their transcations, but I won’t deploy services there for at least the first 9 months, although I may encourage my partners to independent conduct their own deployment (i.e. with my supervision but not done by me) towards the end of my study.

This study involves simultaneously understanding both the technical feasibility of these solutions and the financial feasibility of these solutions – it will take time to make the service providers understand the ramifications of the various solutions – and the resultant costs and benefits to them. What are the tradeoffs they will make in the end? I think different providers will choose different means in the end.. and it is entirely possible that they might choose to purchase a laptop but not use it for online claims submission, purely for its other utilities. Or because the service provider is of higher means and higher claim volume, they might choose to do online claims submission and pay the service fees because timely payment is so extremely critical for them. I’m curious to see what happens, and I can’t wait to see how it all unfolds.

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I can’t talk much on my blog about what I’ve been doing in Uganda, besides the usual elevator pitch about my research (mobile-phone and web-based claims administration for treatment of STDs in Western Uganda).  Mostly, I’ve been taking care of errands like paying my Uganda National Council of Science and Technology fees, and working with Marie Stopes to identify a new partner to help them barcode the vouchers and process claims.

In addition, I had the opportunity to attend the Makarere University Faculty of Computing EpiHandy workshop, where I was asked to talk about TIER’s research and how we might be able to collaborate with universities in Uganda.

My slides are a little photo-heavy, and Office 2008 seems to have taken out the “compress all pictures in the document” feature, so I’ve only put the pdf online:

http://melissaho.com/talks/epihandy-11-28-08.pdf (2.6MB)

Here in Sweden at m4d I’ve just given a very different presentation, talking about our long distance wireless (WiLD) deployments in Guinea Bissau and Ghana, and how the parameters for these cases differ from TIER’s deployment in India.

http://melissaho.com/papers/m4d08-mho-reassessing.pdf (workshop paper, 1.7MB)

http://melissaho.com/talks/m4d-mho-reassessing-121208.pdf (1MB)
http://melissaho.com/talks/m4d-mho-reassessing-121208.ppt (10.1MB)

I’ll eventually put these up also on some sort of index on my main web page. Eventually.

By the way the m4d conference has been really good so far. I’m totally torn between all of the different tracks, and it is a great blend of technical, development, and social-speak.  Despite the initial lack of information preceding the conference, it’s been really well organized thus far, and the talks have been interesting – I’m seeing a lot of projects here that I haven’t heard of before, and meeting people that I’ve heard of but not had a chance to meet in person.  The keynotes have been excellent and insightful – Adam Denton from GSMA, Victor Bahl from Microsoft Research (on white spaces), and Richard Heeks from University of Manchester. Karlstad is a nice location, and last night’s dinner included very interesting lessons on the bios of Alfred Nobel (timely!) and Lars Magnus Ericsson by Peter Sundh and Dag Nielsen.

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I’ve been meaning to cross-post all of HEAL Africa’s updates here, but just have been swamped with travel, etc.  I suppose it’s not too late to start.  Here’s the latest update from Judy Anderson’s conversation with Joseph Ciza:

November 14, 2008. 

I just spent time with Joseph Ciza on the phone.  (He’s in Goma, I’m in Seattle).  You haven’t heard from HEAL Africa for a few days.  It doesn’t mean that things have “settled down” in Goma.  The military action continues all around, people are increasingly unsettled, and troops from Angola and Zimbabwe are reportedly in Congo.  This doesn’t bode well at all.   Joseph said he’d heard from someone that military troops were heard in the dark, so they wait to hear what will happen in the morning.

I don’t want to inundate you with email.  We are working to consolidate our databases so you won’t get four messages from us, but thank you for your patience with us!  Thank you for your support; we need it!!!

Joseph has spent the past week and a half visiting with nurses, clinics, Nehemiah Committee members, IDPs, military and militia and rebel leaders, and with humanitarian organizations assessing the needs for their own organization to begin work in Goma, North Kivu, DR Congo.

It is deeply personal work for him.  For the past many years he has been involved in providing training and equipment to rural health clinics in North Kivu.  He has been a tireless advocate and encourager; he has visited every military group that operates in North Kivu.  In the past week he has visited looted clinics, visited community leaders in hiding, in IDP camps.  They cannot go home.  The future is very uncertain, especially with foreign troops coming in from various countries.

He has picked up wounded and brought them to the hospital for treatment.  Today he was southwest of Goma, visiting the hospital at Kirotshe, and stopped at Bweremana.    He was taken to see two women, and said “They  were shot in the legs by FARDC soldiers as they were retreating from Goma toward Bukavu.  The women were in a car coming from the market; the soldiers stopped them to commandeer the car.  The women suffered severe injuries when they were shot in the legs by the soldiers.”  The women are now at HEAL Africa’s hospital.

The number of wounded related to the present crisis today at the hospital is 127.   This is in addition to the normal number of around 180 patients.  He continued,   ” 82% of the new cases are raped women.  45 women are victims of rape from Kibati refugee camp.  45 were raped in town.  There are about 30,000 extra people in Goma town right now.”  This is in addition to the IDP camp on the northern edge of town, Kibati.  And does not include the camps to the west and southwest of town…Mugunga, Bulengo and others.

I asked him how he sees the future, “The best hope I see is that we get good leadership.  I don’t see who can lead correctly.  Both leaders (Kabila and Nkunda) were in the same military movement in 96-98″ (that displaced the Mobutu regime and installed Laurent Kabila as President, father of the present elected Joseph Kabila).   “This is a very complicated, complex situation.  We are condemned to live together. The challenge is how to live in peace and be reconciled, especially with all the violence that is happening on all sides now.  That is the real work of HEAL Africa”.

When I asked him how we can support him, he mentioned: 

• Financial support for HEAL Africa.  “The people who are coming to the hospital are very vulnerable people.  They cannot pay for the care they get; we cannot refuse to treat them.”    www.healafrica.org .
• Pray for the people working in such conditions.  Pray for Joseph and the various HEAL Africa teams.
• Pray for the ONE MILLION people in North Kivu who are displaced or lost, children and parents as well as the inhabitants of Goma.  Many parents are affected.  Joseph said, “FARDC soldiers came to rob my neighbor.  They also took the daughter from the hands of the parents.  They were unable to protect their daughter…you can understand how they feel.  What if it happened to me?”

 .

Thank you for standing with our Congolese sisters and brothers.

Peace for Congo, peace to you.

Judy

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