A Visit in the Promised Land – mHealth in context

Last week I took a break from fieldwork in southern Cape Town and Khayelitsha to go to two high profile academic events about mobile health technology in the Global South. In development policy and public discourse mHealth (the use of mobile technology for health) is at times seen as the Promised Land. Something that potentially can cut at least 25% off health expenditure and improve health systems and the delivery of services to citizens. So what does the Promised Land look like from the point of view of those bringing it about?

Clinicians, epidemiologists, engineers, medical practitioners, politicians, civil servants, representatives of NGOs and funding bodies were gathered at the Stellenbosch Institute for Advanced Studies. The emphasis of the center is to allow for the crosspollination of ideas between researchers and between researchers and the societies they work in. The idea of crosspollination as an approach to interdisciplinary work inspired the format of “roundtables” in which the participants are introduced to new research but also charged with working in groups, around the table, to develop ideas or solutions for pressing problems based on the presentations. The table I sat at had people working in the public health sector in Africa, doctors, communication experts from the private sector, and me, the lone anthropologist. In the discussion around the table we moved far and wide, from health informatics in Malawi to the use of everyday media genres in the ear-nose-throat-doctor’s office in the “ear selfie”. At the end of the meeting, a list of priorities and a roadmap regarding the development of mobile technologies for health care was decided upon. It is difficult to get, say, a lab technician from Zimbabwe, the leader of a think tank, a junior researcher in health engineering, and a representative of a major research funding body to talk together in ways that bring their specialized expertise and experiences into play. But somehow the crosspollination happened quite effortlessly and gently by placing people with very different backgrounds and positions around a table and giving them the task of solving very complex problems.

The second event was a workshop focused on the use of mobile phone technologies for maternal, infant and child health in low resource settings. The anthropologist was mind-blown by the presentations of the ongoing development of devices and apps that can help front-line health workers with diagnosis and care. A mobile phone based microscope that allows  diagnosis of infectious diseases at the level of village clinics. A phoneoximeter, in the form of an app and clip-on for smart phones, used during anesthesia, and as a diagnostic tool. There were lots of acronyms and descriptions of processes what were entirely lost on me. But what was easy to understand is that there is a rich field of research on the possible uses of mobile phones to improve health outcomes for mothers and their children.  Devices, apps and programs aiming at health systems, hospitals, community health workers, and individual mothers and families. Though political development discourses may appear to be utopian about the promise of technology to deliver health services in low resource settings at almost no cost, and the “quick-fix”-pace at which this can happen, the researchers developing the technology tell a different story. It takes time, man-power, money, political good will, persistence, and patience to develop new solutions, and even then, they might not really work as intended.

My presentation at the workshop sought to scramble the conventional ways of thinking mHealth, with vantage point in the everyday use of mobile phones among young women in Cape Town. Instead of asking how can mobile phones improve health outcomes in maternal, infant and child health, I asked: what is health, if seen though the mobile phone of a mother?

The product of anthropological research is usually intangible, why it may at times may seem a bit bleak compared to the invention of something like a mobile microscope. The objective of the MediAfrica project is for instance to develop new ways of thinking about the relationship between new media and social change in Africa. What difference does such "thinking" really make? Alongside the research of clinicians, engineers, epidemiologists, and medical practitioners, the value of the anthropological approach to health and phones was quite clear: to know the social context and media ecology that mHealth programs and inventions engage with is crucial for them to be meaningful and effective to their users.

mHealth may be the Promised Land, but the Promised Land is situated within other landscapes.