Tag Archive for: Disaster/Humanitarian Relief

MSF doctor kneels next to young girl with cast on her leg

Photo: MSF

By Médecins Sans Frontières

As a project manager for MSF (Médecins Sans Frontières/Doctors Without Borders), a medical emergency humanitarian agency, I attended this year’s South by Southwest (SXSW) festival in Austin, Texas, in the company of a friend and collaborator from Google who is involved in crisis mapping. We gave a presentation on some mapping work we had done together, and inevitably we discussed the differences and similarities in our geek (high-technology) and primitive fieldworker (humanitarian) cultures.

The two cultures are, on the face of it, rather distinct.

Geeks live in highly connected environments, usually urban, surrounded by technological infrastructure straight from the most outrageous science fiction of decades past. They inhabit an intellectual world of abstractions: math, code, logic, creativity, and business; while their physical existence is supported by a seamless layer of luxury and connectivity. The food, and the coffee, is good.

Humanitarian fieldworkers live a variety of environments from luxury hotels or palatial mansions to mud huts or tents, with variable connectivity, but almost always with constraints. Even in the most modern of African or South Asian capitals the technological infrastructure is often wobbly; there may be high-speed internet but it usually features random periods of downtime. In the mud hut scenario, internet and telephone use generally involves a satellite rig, great expense, and substantial cursing at the fiddly configurations and on-again-off-again unreliability. Our lives are never far abstracted from the constant effort required to enable working conditions, and the intensely pragmatic work of solving immediate problems. That patient is in danger of dying NOW, that refugee camp needs clean water NOW, and if we don’t get the car fixed in the next few hours we’ll be spending the night by the riverbank eating dry emergency ration biscuits. Most of us have at one time or another shared a single broken-down laptop with several people, a leaky thatched roof over a mud floor, and a plate of sandy, oily rice that is as good as we’re going to get for dinner.

Despite these disparate viewpoints (abstraction vs. immediate physical pragmatism) and differing ecological niches (urban café vs. mud hut) there is an unexpected similarity; primitive fieldworkers and geeks share a culture of problem-solving. Nothing makes a geek happier than a tough problem that gets all the neurons firing, and nothing makes a fieldworker happier than a serious emergency that gets the adrenaline flowing (if that sounds callous, in our defence it’s not the suffering that we enjoy, but the chance to make a real difference with our work).

At SXSW we had the chance to share that cultural crossover with a broad audience of geeks, fieldworkers, and an assortment of others, all of whom shared an interest in the intersection of humanitarian work and technology.

My main take-home message was: we are not alone.

We humanitarians tend to take pride in our ability to deal with problems by stretching our ingenuity and using only what is available in the field. My friend from Google was astounded at what we do with spreadsheets, saying “I didn’t think that this could be done without software coding capacity”. We use spreadsheets as databases, stock management systems, maps, payroll systems, and sketchpads. This is, perhaps a strength but I am beginning to realize that we take it too far. There is an enormous community out there in the world, with increasingly robust electronic links to even the most remote field locations, who can help us. Open source code can be written to address problems that we would normally tackle with tortuous repurposing of spreadsheets; there are incredibly talented programmers delighted to donate their efforts, especially to interesting problems. Informal slums can be mapped by volunteers, either people who once lived in the country or even by people who have never been there simply hand-tracing satellite imagery. The astounding success of the Ushahidi project (follow the link to read about an open-source crisis mapping project that started in Kenya to assist people during electoral violence and has since been used around the world, including Washington DC, to map emergencies) shows the power of crowdsourcing or distributed voluntarism to assist people in crisis.

Humanitarians need tools and information, particularly during crises. The tech world is bursting with possibilities to provide just that, often free of charge and with an astonishing level of professionalism. I hope that this meeting of cultures continues to deepen and that the early promise of these innovations translates to real benefit to the populations in crisis that we serve.

Ivan Gayton

Ivan Gayton is a project manager with Médecins Sans Frontières, currently working in Nigeria. During the Haiti cholera outbreak in 2010, he worked together with a team from Google to develop tools to map the outbreak using freely available software (Google Earth). He and Google’s Pablo Mayrgundter continue to work on an open-source epidemiological mapping tool in their scant spare time. Other than an interest in seeing further cultural cross-pollination between humanitarians and techies, Ivan has no conflict of interest, and no financial interests whatsoever in the matter.

This and many other MSF blogs are available at PLoS – Speaking of Medicine http://blogs.plos.org/speakingofmedicine/category/msf-2/

Last week marked two years since the devastating earthquake in Haiti that, according to the Haitian government, took the lives of 316,000 people[1], injured 300,000[2]and displaced at least one million people[3]– more than 10% of its population[4]. Any country’s infrastructure would struggle with this, but in Haiti even some of the smallest problems were exacerbated by the fact that Haiti was (and still is) the poorest country in the Western Hemisphere[5]. Many Haitians do have access to mobile phones, though, so mHealth and mobile money services have enormous potential to fill the gaps and improve their lives.

The earthquake left Haiti’s already weak health and financial systems in tatters. It destroyed 30 hospitals, 21 clinics, 11 Ministry of Health facilities, and 22 health training centers, and it damaged 30-40% of all bank branches and ATMs in the zone of impact. From the very beginning of the recovery, mobile services showed what they could do.

A great deal of mHealth activity took place to bolster the relief effort and safeguard reconstruction, including the Fletcher School /Ushahidi’s crisis mapping and proactive messages delivered via SMS to warn about cholera outbreaks through a partnership between Voila and the International Federation of the Red Cross and Red Crescent Societies, and more. In 2009, the Bill & Melinda Gates Foundation and USAID launched a prize fund to accelerate the launch of mobile money services in Haiti, enabling the population to send, receive, and store money via mobile phones.  In the time that has followed, NGOs eagerly adopted mobile money as a safe, speedy way to distribute aid and pay people in cash-for-work programs. In fact, of the 14 mobile money use programs in the world, eight are in Haiti. These programs are realizing a range of benefits – including improved speed, efficiency, and security.[6]

This early flurry of activity is now giving way to longer-term questions. With the prize mechanism nearing completion, providers of mobile money services are looking for ways to expand them in a profitable, self-sustaining way. Haiti’s health system is rebuilding, and administrators are deciding how much to bring stopgap mHealth applications into the mainstream. And the opportunity to combine mHealth and mobile money through insurance plans, voucher programs, and other innovative services is just starting to open up.

Making these processes easier and realizing the long-term benefits of mobile services will require addressing a series of barriers in the public and private sectors:

  1. Strategy to move from prize-led launch to sustainable scale.  Mobile operators and banks must now determine their strategies to reach the mass market and move beyond the prize-led launch to sustainable scale, avoiding the sub-scale trap which many deployments face globally. This will require the consortia to prioritize, penetrate, and capture profitable segments of the Haitian economy.
  2. Interoperability and integration. The central bank in Haiti did mandate interoperability between mobile money services, but there is a continued need to integrate services, bridges, and open APIs – especially if mHealth and mobile money are to work together.
  3. The policy environment.  At present, the lack of a national ID scheme and policies for data security and privacy are holding back the development of mobile services, particularly combinations of mHealth and mobile money. E-wallets have been used to register people in Haiti in place of national IDs, but the e-wallets are currently capped at US$250 by the central bank, limiting the usefulness of mobile services.
  4. The evidence base.  Greater distillation and dissemination of the experiences of providers, users, and regulators would help the sector to develop in a more directed and way, avoiding repeated mistakes and redundancies.

Both the mHealth and mobile money ecosystems are at an inflection point in Haiti, and there is reason to be optimistic. Favorable regulatory approaches have led to the emergence of a spectrum of products, including payroll and merchant payments. For the sector to preserve its momentum, providers will have to find new ways to attract consumers, and policymakers will have to keep up with providers’ and consumers’ needs.



[1]One Year After Haiti’s Quake: Cholera Babies School Without Walls, ABC News, 12 January 2011. Retrieved 7 January 2012.

[2]“Haiti raises earthquake toll to 230,000”AP. The Washington Post. 10 February 2010. Retrieved 7 January 2012.

[3]“Haiti will not die, President Rene Preval insists”. BBC News. 12 February 2010. Retrieved 7 February 2012.

[4]“Earthquake Magnifies Haiti’s Economic and Health Challenges”. Population Reference Bureau. October 2010. Retrieved 7 January 2012.

[5] “UNICEF urgently appeals for aid for Haiti following devastating earthquake”, UNICEF, 12 January 2010. Retrieved 7 January 2012.

[6]Dalberg Global Development Advisors is currently conducting analysis for the Bill & Melinda Gates Foundation on the business case for, and operational learnings from, NGOs plugging into mobile money, forthcoming later this month.

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