A class was given in the dSchool last spring. In this class small interdisciplinary teams focused on a term-long design project, taking advantage of the design process structures and methods that have been developed in the d.school. The course developed as a collaboration between Stanford, the University of Nairobi and Nokia Africa Research Center.  The focus area was finding ICT solutions to the healthcare needs of people living in Kibera slum outside Nairobi.

Under the guidance of Jussi Impiö at Nokia and the Computer Science faculty, 27 students from the University of Nairobi Computer Science department conducted need finding studies at a number of health-related sites, including clinics, hospitals, community health workers, community leaders, and government offices. They read background materials, made observations, and talked with a wide variety of stakeholders. Their reports became the basis of the Stanford teams' initial understanding of users and needs. Communication with the group in Nairobi was also maintained throughout the course, using a Facebook group to facilitate discussions, as well as several teleconference sessions.

Working in small teams, 20 Stanford students from a wide range of disciplines worked over 10 weeks to develop initial design concepts to respond to some of the needs that had been identified. Click on the title of each project to view their final presentations:

• mNote: an online archive for community health worker notes. This application empowers community health workers by preserving the flexibility and control they appreciate in their current paper notebooks, but adding digital knowledge management capabilities.
• M-MAJI ("mobile water"): an electronic information system that allows people to use their mobile phones to identify clean water sources in their community. The application seeks to decrease the time and money spent searching for water, improve water quality, and foster vendor accountability by providing a mechanism for user feedback.
• Babybank: a dedicated savings plan designed specifically for pregnant women in the slums of Nairobi. By leveraging a popular cell phone payment system, M-Pesa, the application aims to make savings easier, so that expecting mothers can afford the services that will keep themselves and their babies healthy.
• Mazanick: an application to provide support and advice to pregnant women via SMS, with the aim of helping motivate them to attend prenatal appointments.
• PillCheck (Kifaa cha Tenbe): a mobile application to help people in Kibera find information on the availability and pricing of malaria drugs quickly.
• PatientMap :a system to make the waiting process in clinics more transparent, and to increase patient trust in the medical system.

This summer, two follow up trips are planned, with Nairobi students due to spend several weeks at Stanford, while a number of students from the Stanford group will visit Nairobi to explore possibilities for developing their projects further. Building on the success and lessons learnt so far, the Designing Liberation Technologies course will be open to a new set of students next academic year. 

The extent and existence of "defensive medicine" -- excessive medical care to defend a physician against malpractice claims -- is a perennial subject of both policy and academic debate.  For example, malpractice liability and associated defensive medicine are among the most-cited reasons for escalating health-care spending in the United States.

In this colloquium, Dr. Brian Chen will present results from his research investigating the extent of defensive medicine in Taiwan. He studies the impact of a series of court rulings in Taiwan that increased physicians’ liability risks, and a subsequent amendment to the law that reversed the courts’ rulings, on physicians’ test-ordering behavior and propensity to perform Caesarean sections.  He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected, but unexpectedly reduced Caesarean sections.  (The reduction in Caesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings.) After the law was amended to negate the court decisions, physicians reversed their previous behavior by reducing laboratory tests and increasing Caesarean deliveries.

This pattern of behavior is highly suggestive of the existence of defensive medicine among physicians in Taiwan. In other words, by studying physicians' response to legal changes in Taiwan, we find that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.

MED 242: Physicians and Human Rights Winter 2010 Lecture Series
Lunch Served

Abstract
The historic focus of development has rightfully been on macroeconomics and good governance, but technology has an increasingly large role to play.  In this talk, I review several novel technologies that we have deployed in India and Africa, and discuss the challenges and opportunities of this new subfield of EECS research.  Working with the Aravind Eye Hospital, we currently supporting doctor/patient videoconferencing in 30 rural villages; more than 25,000 people have had their blindness cured due to these exams.

Dr. Brewer focuses on all aspects of Internet-based systems, including technology, strategy, and government.  As a researcher, he has led projects on scalable servers, search engines, network infrastructure, sensor networks, and security. His current focus is (high) technology for developing regions, with projects in India, Ghana, and Uganda among others, and including communications, health care, education, and e-government.

In 1996, he co-founded Inktomi Corporation with a Berkeley grad student based on their research prototype, and helped lead it onto the NASDAQ 100 before it was bought by Yahoo! in March 2003.

In 2000, he founded the Federal Search Foundation, a 501(c)(3) organization focused on improving consumer access to government information. Working with President Clinton, Dr. Brewer helped to create USA.gov, the official portal of the Federal government, which launched in September 2000.

He was recently elected to the National Academy of Engineering for leading the development of scalable servers (early cloud computing), and also received the ACM Mark Weiser award for 2009.  He received an MS and Ph.D. in EECS from the MIT, and a BS in EECS from UC Berkeley. He was named a "Global Leader for Tomorrow" by the World Economic Forum, by the Industry Standard as the "most influential person on the architecture of the Internet", by InfoWorld as one of their top ten innovators, by Technology Review as one of the top 100 most influential people for the 21st century (the "TR100"), and by Forbes as one of their 12 "e-mavericks", for which he appeared on the cover.

Summary of the Seminar
Eric Brewer is Professor of Computer Science at the University of California Berkeley where he leads the Technology and Infrastructure for Emerging Regions (TIER) research group.

Dr. Brewer spoke about the role for technology in effective development strategies at the base of the pyramid.

The history of development to date has been characterized by large agencies funding big projects with strings attached, usually in the form of debt or demands for political allegiance. These kinds of projects are hampered by their scale and the requirement to work with corrupt governments. They typically include little role for new technology as projects move slowly and lack the expertise to facilitate this.

Outside the sphere of traditional development, technology is having a major impact on economic prosperity. The mobile phone revolution, driven by bottom up demand, provides enormous advantages to any worker operating in a large radius. A taxi driver given a mobile phone, for example, will increase his revenue by 60% on average. Other bottom-up businesses have seen major success. The Village Phone scheme, which runs as a franchise model with capital coming from microfinance, now covers the majority of Bangladeshi villages. A village phone lady will make on average two times the income she would have done from farming.

However, the mobile phone remains a largely urban phenomenon since cellular networks require a certain density of users before they can economically justify the installation of a base station. The availability of an internet connection is crucial for the viability of businesses and services in rural areas.  WiFi-based Long Distance networks (WiLDNet) are emerging as a potential low-cost alternative to traditional connectivity solutions for rural regions. Unlike mesh networks, which use omni-directional antennas to cater to short ranges, WiLD networks are comprised of point-to-point wireless links that use directional antennas with line of sight over long distances.

Eric's Berkeley research team has partnered with Aravind Eye Hospital in Theni in the southern India state of Tamil Nadu to use this technology to address the problem of blindness in the region, 70% of which is treatable. The long-distance wireless network they have installed is allowing eye specialists to interview and examine patients in five remote clinics via high-quality video conferencing. 25,000 patients have recovered sight using this system and it is set to expand to 50 centers covering 2.5 million people.

Eric's team has also worked on software that addresses local educational needs in developing regions. In poorly resourced schools, students will often be sharing a mouse and computer screen with a group of others. Metamouse gives each student their own mouse to use; when answering questions all users must agree on a location before progressing. This encourages collaboration between students and has had impressive results in boys in particular, with a 50% improvement in scoring compared to each user having their own PC.

In the four years since a State Council think tank, the Development Research Center, bluntly declared the failure of three decades of healthcare reform, China has placed a high political priority on designing, building and financing a modern, equitable health delivery system that serves every last one of its 1.3 billion people. As publisher of practice-building trade magazines for medical specialists in China and India, Jeffrey Parker has developed unique and valuable perspectives on what's wrong with China's healthcare system -- and how Indian practitioners are able to deliver results despite a per-capita GDP that is roughly half of China's. Through an unprecedented China-India training exchange, Mr. Parker has begun testing whether Indian models of self-financed grassroots medical startup practices can help doctors shake free of China’s Stalinist paralysis without having to wait for sweeping programmatic reforms that are always on the horizon, but seem never to come. What's more, would such grassroots empowerment models not create unprecedented opportunities for participation by international investors who up to now have been largely marginalized in China's healthcare development?

In this lunchtime colloquium, Mr. Parker reviews his experiences in China and India over the past six years and looks at several exciting recent developments in China. These include:

• An ambitious rural reimbursement scheme that already has begun to complete a nationwide healthcare safety net. The program is creating a vast pool of funds to finance rural medical services, but how will Beijing populate the countryside with sustainable grassroots practices?
• The first domestic healthcare IPO, by which Aier Ophthalmology raised some $50 million as one of 28 debut listings in the Shenzhen's new "ChiNext" Growth Enterprise Market. New wind in the sails of healthcare privatization?
• Licensing reforms that have begun delinking doctors' certification from their "work unit" hospitals under trials in Beijing and Yunnan, removing a vexing obstacle to hands-on surgical training of young practitioners. Will the breaking of senior doctors' "skills monopoly" create opportunities for private-sector training programs that will shake up China's Soviet-style residency programs?

Jeffrey Parker has lived in Greater China since 1990, first as a journalist and since 2003 as a publisher. His transition from chronicler of China's historic rise to active proponent of its economic development gives him a unique perspective on the opportunities still opening up in China -- and the challenges facing anyone keen to participate. With a twin B.A. in Asian Studies and Geography from U.C. Santa Barbara and Masters training in Journalism from Columbia University, Parker trimmed his sails for a China career from an early age. After early editorial jobs in New York and Washington, D.C., he was dispatched to Beijing by United Press International as senior correspondent in 1990. During the next 10 years with UPI and then Reuters, he covered a wide range of political, economic and social stories from postings in Hong Kong, Taiwan and the Peoples Republic. In his final two years at Reuters, Parker got his first taste of media development, launching local-language multimedia news and video feeds in China, Japan, Korea, India and Southeast Asia. Since 2003, Parker has built up a family of world-class doctors' magazines serving more than 50,000 specialists in China and India from the Shanghai base of ILX Media Group, where he is editorial director, chief operating officer, a corporate director and investor. Among his objectives is to help foster a badly needed transformation of medical practice across China by inspiring grassroots doctors to deliver high-quality, cost-effective services in rural and less-developed communities left behind by government health care.