Integrating health and technology through engaging local cultures: The story of InfoComm

Author : Timothy De Ver Dye
Date added : 2001-04-13

Brief Project Background

The InfoComm Project began in 1999 and aims to expand the sustainable development and implementation of community health informatics applications in Costa Rica and the Dominican Republic through mutual collaboration and training. InfoComm seeks to improve the public health infrastructure of Costa Rica and the Dominican Republic through the integration of community technology assessment, distance-learning, and training in public health surveillance with an innovative Digital Town Centre Project called LINCOS (Little Intelligent Communities). The InfoComm Project arose as a joint initiative between the Center for Future Health at the University of Rochester and the Fundación Costa Rica para el Desarrollo Sostenible with funding from the Fogarty International Center of the National Institutes of Health. The InfoComm Project is rooted in a strong recognition amongst LINCOS partners that the best way to improve local public health was through the engaging local populations with technology through the deployment of anthropological field methods while respecting and valuing local culture.

The InfoComm Project aims to expand the sustainable development and implementation of community health informatics applications in Costa Rica and the Dominican Republic through mutual collaboration and training. InfoComm seeks to improve the public health infrastructure of Costa Rica and the Dominican Republic through the integration of community technology assessment, distance-learning, and training in public health surveillance with an innovative Digital Town Centre Project called LINCOS (Little Intelligent Communities). The uniqueness of this project comes from its priority placed upon improvement in technological capacity through engaging local culture. LINCOS Digital Town Centres have been placed in seven communities throughout Costa Rica and the Dominican Republic. These LINCOS Centres are portable containers which include six networked computer workstations connected to the Internet via satellite, a telemedicine unit, portable telephone capacity, and entertainment equipment. To engage communities around the use of technology to improve health (broadly defined to include agiculture, education, and economic development), a methodology called Rapid Assessment Procedures (RAP) was developed to better understand local values, existing health systems and infrastructure, and nodes for health improvement. To build the training infrastructure, three levels of educational involvement have developed to include graduate training of local physicians in community health informatics, training of local and regional health professionals in specific informatic applications, and distance-learning training of local community members in epidemiology and surveillance using locally-defined priorities. All levels of training interact with one another, for example the graduate students’ Masters projects are focused upon development of technology applications for local community health workers to use their knowledge in epidemiology and surveillance in improving public health care. Anthropologists work closely with local professionals in the LINCOS villages, living in the communities and studying community priorities and processes, to help local health workers address their own priorities using the new and sometimes intimidating technologies available to them. The goal is to create seamless knowledge exchange among different levels of professionals, among different cultures, and in different settings, without being defined by geography or someone else’s priorities.

Results

The trip to Oviedo follows a single road out of Santo Domingo going west. The land becomes increasing arid and desert, and the ride from Barahona along the Carribean is particularly stunning. There are a number of small towns along the road nestled between the mountains and the sea that seem to have some small tourist developments, but no large population and tourist centers like the north or east coasts of the Dominican Republic. At several points the road had been washed out from hurricanes. There is a wide, main road through Oviedo. The town has an expansive feel to it and seems bigger than it likely is. Upon arriving in town, one comes upon the new, colorful LINCOS “container,” which is a refurbished ISO shipping container outfitted with six computer workstations with satellite connections to the Internet. The container forms a town center: it is open and inviting, with park benches surrounding the front and sides. The generator was running when we arrived and there was some instruction going on. There are classes that run at the container for the schoolchildren every two hours throughout the day. During the two hour block set aside daily for free community use of the internet from 6-8 p.m., we visit the container with the local doctor. The doctor works constantly, providing clinical care, transporting patients in emergency, and struggling to improve community health with no resources. She knows of the container but has never used it. We talk about her concerns in the community - about the severe lack of potable water, the frequent occurrence of high blood pressures, and - something that seems particularly worrisome for her - the spread of AIDS from mother to child. She asks how this container can help her with these problems, and we go to a workstation and within minutes have Spanish-language community and professional education materials on the prevention of vertical transmission of AIDS. The doctor is visibly engrossed in what she is reading and quickly goes from link to link, and it is clear that her world just expanded. She paces excitedly around the container which has been situated in her community for several months, exclaiming “I have to spend time here! I cannot believe this! I want to move my office right here!” She enrolls in the El programa de Entrenamiento Analítico de Salud Maternal e Infantil para el año 2010 of InfoComm and instantly becomes part of a growing network of local, community workers and citizens bringing basic principals of epidemiology and surveillance to their own communities.

Lessons

Interestingly, InfoComm arose in response to (and in anticipation of) barriers confronting the use of the technologies housed within the LINCOS containers. While community needs were strong, the technologies are foreign to the communities and their uses not always clear. InfoComm developed as a way to engage community members in more closely addressing what they can do with these technologies - addressing their own health needs, priorities, and community circumstances - and helps them learn about basic public health surveillance and development through using the technologies around their issues. On the surface, technologies simply deposited in communities could be used solely for novelty and entertainment, but through systematically linking professionals across communities and with larger educational opportunities, community members can expand their limited resources considerably. InfoComm further addressed the important barrier to public health development of others’ priorities. Public health improvement programs are often generalized and deployed without regard to local situations and priorities. InfoComm engages professionals on their terms, using their problems, to introduce them to the power technology can have in helping them solve these important issues for them. Anyone deploying new technology programs to communities are obligated to respect local perspectives, priorities, and cultural behaviors. This approach is what engages people in their own education and community improvement.

Development Impacts

The InfoComm Project (and the LINCOS project in general) has been successful because of the close inter-relationship of social methods of learning about communities with reliable technological innovation. The social studies would be pointless without a venue upon which to act upon their findings. The technology would be useless if it was not integrated with local needs and priorities. Therefore, the presence of technology has directly enabled and contributed to community development by giving communities new resources to address complex social and health problems. Too often technological interventions are brought to communities where the connection with local priorities is unclear, and very often social research uncovers problems that can never be addressed. The InfoComm-LINCOS collaboration shows that sustainable development can truly occur when the social and health issues can be systematically addressed through using an existing technological infrastructure.

Project Information

Organisation : Center for Future Health, University of Rochester
URL : http://www.lincos-infocomm.net
Total budget in US$ : $150,000/year

Are there any partners involved : yes
What is partners role?: They define the content area, facilitate all aspects of activity, provide technical capacity

Contact Information

Timothy De Ver Dye
tim_dye@urmc.rochester.edu

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