Handshake

Thank you, Arkadeep Kumar, for your story!

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Kamarhati, West Bengal
December 2015

I was going to visit one of the schools in peri-urban Kolkata, about one hour by train, in Kamarhati. The NGO which runs the after-school tuition center for students in the slums had an enthusiastic staff member who wanted to accompany me to the center. He suggested taking the train instead of the bus. And thus, here I was, almost at the end of the day, trying to locate this stranger from a sea of people in a busy railway station. It was almost evening, and I saw the majority of people being commuters, leaving work and starting for their homes, a little far from the main city.

One chance reading of a news article about Dr. Neha Kumar had made me write to her on the email listed in the article. Unlike other times, when I email people and never get a reply, I got a prompt reply this time, and an invitation to attend her class. After a few more classes, unusual turns of events, and after-class ramblings, I decided to take a dive into the ICTD space. I found that a friend had started thinking about online education in low-resource contexts and decided that, for a start, I would get some “in-the-field” experience, visiting schools and after-school locations for underprivileged children. And here I was, on my way to such a field visit.

After making several calls to his mobile number, raising my hand multiple times to unsuspecting strangers, I located the person who would take me to the after-school center I was to visit. We waited for a bit on the station before getting on the train, where he spoke about how the students were now doing better in school, with the after-school coaching they were getting from the NGO. I nodded along, one part of me skeptical if he was highlighting the successes to paint a rosy picture, while the other part of me trusting that indeed there was real impact being made.

I was traveling to a location where I could speak my native language and interact with the children and teachers in conversation. I did have some questions in mind. They were fairly simple, yet there was a strange sort of nervousness creeping in. We alighted from the train a few stations later, and took an auto-rickshaw to reach the site, after which, I was told, we could only walk. I was guided through a dense area with slums on either side of the dirt path. When we reached, the students seemed to have been waiting for me along with their teachers. After the introductions, I went about asking the students which classes they were studying in, what was their favorite subject, etc., to break the ice. Since it was almost time for the new year, the children had created cards, all hand-made, with their newly learned art and craft skills. I came to learn that most students were studying in class 4 or 5 to class 8. Very few continued education after that, with only two students in class 10. This was apparently unusual, because most students were pressurized by their parents to earn money doing various jobs. The nearby factories and jute mills seemed to be the likeliest employers.

One of the tenth graders was introduced to me by the NGO coordinator, who explained how this student, Noor, had been fighting against odds to continue studying. The student came up, smiled, held out his hand, and said, “How are you, Dada?” I put my hand out for the handshake and immediately realized how his hand had hardened, with rough skin. I was taken aback a little, and heard the NGO coordinator speaking that the boy’s parents were forcing him to work, and he had been trying to convince them to let the boy finish class 10 at least. I nodded, with the boy still smiling, while I imagined how he might be working at the factory and balancing his studies. The boy asked me again, “How are you?” and I managed a meek “Okay”. He beamed and let go of my hand. I asked him about his exam preparations. He took out a book of model questions from his bag. He then asked me about what I did, what I studied, and if I had such model exam papers? I shared a little of what I was studying in college, explaining about solar cells, which he exclaimed that he had seen in pictures. I went on to ask him about his family and his life. Even as I moved on to other students and teachers, I wondered if at all my visit, and work, would make a difference to this boy and his rough hands.

Before long, I found myself talking with some other students, this time in a group. I asked if they had used mobile phones, especially smartphones. They talked about Temple Run and car racing, and how they got to play on their parents’ phones only if they did well in class or on their homework. I asked if they had seen tablets, and one student claimed his sister had a tablet as big as a television. I looked at the watch and found that it was time to go. As I prepared to leave, Noor came running to me, and asked cheerfully, “Dada [elder brother], handshake?” This time I smiled more, inspired by his indomitable spirit, before wishing him well for his studies. I went on to the group of students to take pictures, bidding them goodbye. I left with mixed feelings.

Arkadeep is a Ph.D. student at Georgia Tech, doing research in Mechanical Engineering and now also in ICTD. 

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Breaking Silence

Thank you, Nova Ahmed, for your story!

Apu (sister), will you write my story on your computer?

It was the girl who works at my mother’s house. She was harassed in her village, left school and got married, which did not work out and finally, started to work in the city. She was eager to share her stories, she believed that the story would somehow help another girl who may not have to leave her school. She actually broke her silence.

We have been working on harassment in Dhaka, Bangladesh- we worked with urban girls where harassment – especially street harassment, cyber harassment, and harassment in many other forms are present. The major problem we faced was silence – it was so profound that at one point we thought that the problem is not so severe in the city. But once the silence was broken through intimate communication sessions, there was a flood of stories. Many of them did not fall into the target group – many of them did not listen to the rules of the interview methods – many of them asked for suggestions – and it was evident that everyone tried to help, support each other directly or indirectly.

We have a long way to go in terms of dealing with a social problem. Our initial effort has been greatly appreciated and we look forward to open the doors so that the silence is broken, awareness is generated. The girl who shared her story voluntarily at the beginning often sits down by me and asks what we are doing, when we will go to her village, and I know – we will do it. If not today, tomorrow.

Nova is currently an Assistant Professor at North South University in Bangladesh, where she returned after completing her doctorate at Georgia Tech, in order to serve her country.

Unexpected Events

Thank you, Susan Dray, for sharing your story!

Doing research in another country is always interesting and challenging. Doing research in shanty towns, slums, informal settlements or townships (as they are called in South Africa) adds another dimension of both interest and challenge.

We did a study in Khayelitsha, the largest Black (Xhosa) township in Cape Town, and in Mitchells Plain, the Coloured township that adjoins it. To learn about how people use technology, we did a series of interviews, contextual inquiries, naturalistic observations and participant observations aimed at giving us the richest possible experience of life there. Because it is common for younger people to move to the city in order to support their family back in rural areas, we also flew to the Eastern Cape to visit 3 families of people we had visited in Khayelitsha to understand these relationships and to understand if technology enabled or could enable closer ties.

While we were in “the bush” (rural Eastern Cape), riots against “foreigners” from other African countries (e.g., Zimbabwe, etc.) broke out in Johannesburg. They quickly spread to Cape Town and by the time we returned, they had swept the townships. The US Consulate advised me to stay out of the townships until further notice. That night, when we went to dinner with our “fixer”, we drove past a small settlement that was filled with rioters. It was a distinctly uncomfortable feeling, even though the protests were against other Africans who were perceived as taking jobs away from township resident, not against us.

By the time we were scheduled to do the visits in Mitchell’s Plain, the rioting had subsided according to the Consulate, and we were given the “all clear” to return to our research. We discovered that the rioting was not completely over, however, when our rental car was side-swiped and we needed to go to the Police station to report it. As we approached, we saw a huge crowd of angry people with anti-foreigner signs. Obviously, we weren’t going to try to cross their path!

But the real mob experience came on the very last day. My client had flown back to the States and it was just my Afrikaans-speaking translator/driver/facilitator and me doing the final visits. All went well and at the end, he invited me to come to his home for a beer. I am always very happy for such invitations from locals when I am doing field research, so I eagerly agreed.

We started up the hill to go to his house. Suddenly, he pushed me to the floor of his car and threw a large unfolded map over me. “Don’t move and don’t make any noise!” he whispered nervously. My heart leapt into my throat and I broke out in a cold sweat as I hunkered down under the dashboard, pulling the map down around me and making myself as inconspicuous and as silent as I could. I was afraid they could hear my breathing, so I held my breath.

The car slowed down and with it, time became molasses. He rolled down his window and spoke to someone in Afrikaans. I couldn’t understand what he was saying, but it sounded like a hearty greeting. There was a roaring underneath the conversation. There were shouts from the crowd and more words with the driver, and then, again slowly, the car started to pull away from the intersection, up the hill. The roaring subsided and then, as he gunned it, the car hurtled over the top of the hill.

It had been at most 60 seconds at the absolute most. But to me and to my driver, it had been an eternity.

Once we had crested the hill, he peeled back the map and, ashen, smiled at me. “Phew! That was close!” he said, and I nodded, still confused. “What was close? What happened?” I asked.

He told me that there had been 2 large crowds of men converging on the intersection halfway up the hill – one from the left side, and one from the right. They were brandishing something – sticks or (as it turned out) rifles, and were shouting and denouncing foreigners in Afrikaans. I asked, “But why did you need to hide me?”

“Because,” he answered, “Had they seen you in my car, they would have killed us both.”

We were both quite rattled by the experience to say the least. Although that beer at his house would have been a nice way to unwind, ultimately, he was worried that we might have a similar encounter en route to or from his house so we turned onto the freeway and returned to the center city for our debriefing. Slowly, our racing hearts quieted and the adrenaline in our veins dissipated. Slowly, life became normal again.

Never before or since have I been faced with physical harm of this proportion while doing research for clients. And he said that, although he lives in a nearby township, he had never felt so threatened either.

It was a grim reminder that what we do when we do research is not always without risk. Knowing that the risk is real is a first step to mitigating it, but this experience reinforced that it is *always* critical to work closely with local people to help to interpret what you find out AND to read the landscape as well. I never would have thought my life could have depended on it, but clearly, at least on this occasion, it did.

Susan Dray is President of Dray & Associates, Inc., where she provides contextual and ethnographic user research, usability evaluation, and interface design consultation for a wide range of products systems, and applications. She has received several prestigious awards for her work, including the SIGCHI Lifetime Achievement in Practice Award in 2015. 

Newborn care in Dodoma

Thank you, Neal Lesh, for your story.

One story that has stuck with me over the years (so you may have heard it from me before) is from when we tried to introduce newborn care information in Dodoma, Tanzania. Dimagi had equipped about 35 community health workers (CHWs) there with our mobile application, CommCare. The CHWs were using the app during monthly visits to the households they served, to promote various good health practices and utilization of relevant health services available in the area.

After some deliberation, we concluded that one of the most useful additions to the CommCare app we could make would be to add a new module with specific guidance for newborn care. There was a high rate of neonatal mortality in the area, as is the case for much of the region. And there are also a number of actions families could take that had been shown to reduce mortality, such as a mother holding her infant against her body for warmth, or seeking immediate care and potentially getting antibiotics if there are signs of possible infection. It’s important that these practices are done very soon after birth, and there is a lot of urgency around having a CHW visit within 24-48 hours after a home birth.

We developed a module that would guide a CHW to promote these activities, based on international standards. We then asked the CHWs to use it for every birth, and to let us know what worked and didn’t so we could improve it. The initial uptake was very slow. We further encouraged the CHWs to figure out which of their clients were pregnant and expected to deliver soon, and ask to be notified when there was a birth. But we still were seeing only a few births per week. I recall repeatedly doing calculations based on the fertility rates of the area to confirm that there really should be more births happening in the areas served by these CHWs. (I might mention at this point that I was doing all this from afar, working with colleagues based in Dodoma.)

Out of desperation to get more feedback on our newborn module, we decided to add in an incentive. After consulting with the CHWs about items the mothers might be interested in for newborn care, we decided that the CHWs would give a small gift package to mothers they visited within 24 hours of birth: soap, a blanket, a knit hat for baby, and cloth diapers. This did the trick. There was palpable excitement among our CHWs, and the number of births in the area seemed to shoot up overnight! The team continued the practice of these gifts for new mothers for as long as Dimagi helped support the program. The 35 CHWs eventually went on to run a number of enterprises in the area, including a pharmacy in an underserved area, and were excited to continue the practice even then, if they could.

This has stuck with me as an important lesson to always think about what is valued by the various users in our system. It was a bit too easy for us to decide that the information we were providing would be very motivating. From our perspective, we were providing incredibly high-value information to the community, information that could literally be life-saving. But the community may have been used to getting lots of public health messaging. On the other hand, there was clearly a lot of excitement around the CHWs providing something of tangible, concrete value to their clients—rather than just gathering data or providing advice. This connected us in a much more positive way: welcoming CHWs into the homes of new mothers celebrating this happy moment.

Dr. Neal Lesh is currently the Chief Strategy Officer at Dimagi. 

 

Karekura

And here’s a story from me – Neha Kumar.

My introduction to “this new field called ICTD” took place on a rainy Saturday evening in January 2006 at a Starbucks on Highway 84, when one Joyojeet Pal – then graduate student at Berkeley – was generous enough to meet with me, a disillusioned software design engineer at Microsoft. He gave me a quick primer and suggested some readings, including the famous Brewer et al. paper that had just been published. I was ready to make my departure from “developing technology for technology’s sake” (as I saw it) and these papers showed me the way. Chance encounters, good fortune, and hard decisions got me admission into Stanford’s Learning, Design, and Technology program one year later. I decided to quit my job early and use the summer for getting some “field experience” (and whoever knew what that meant!). This led to a clueless, impulsive, and very verbose email to Eric Brewer, who kindly connected me with Matthew Kam so I could maybe help him with his PhD project.

Matt’s MILLEE deployment was about to begin. He was working with a team of Indian undergraduates, trying to get primary school-children in Karekura – a village 15 km from Mysore – to learn English on MotoRazr mobile phones. My first order field experience entailed building a relationship with these all-male students (and I remember them fondly to this day). My second order field experience began right after, when I visited the school in Karekura for the first time.

Perhaps I had no reason to be, but I was nervous as hell. I wasn’t sure how to be with the kids – what to do, what to say – and there were no words to exchange because we did not speak the other’s language. One might have thought these kids would be afraid or shy but really it was I who was terrified. The kids stared at me unabashedly and curiously as though I belonged to an alien species. I looked away, sticking with the team when I could, anxious to get through the day somehow. Who knew how things would change.

About an hour later, I was done twiddling my thumbs. I brought out my big DSLR and started to take photos of the team engaging with the kids. Photography has often come to my rescue this way. The kids were quickly entranced by the sight of the camera and came running towards me. The repeated sounds of “torsi aunty, torsi aunty” (“torsi” means “show” in Kannada) ring ever so clearly in my ears even today. We took photos – lots of them. They posed and posed, insisting on reviewing every shot. I obliged with a singing heart. The ice was broken.

My stay in Mysore did not last long. The partnership came to its conclusion – and we moved ten days after to Lucknow. But those ten days were unforgettable. Over the weekend, we even had a visit from Susan (Dray) whose warmth enveloped us instantly, perhaps planting the seeds for this workshop nine years later! We made a visit out to see the village one day, letting the kids guide us to the Cauvery river, their local temple, their playing field. Even bugs, as you see in Anusha’s photo below.

Anusha was one of the fifth graders. And head girl. One day, as she and I sat together in class, going over the mobile games, we digressed from the task at hand and she started going through the photos on my memory card, asking me who was who. We shared a little of our lives, our selves with each other. I explained what I could using words and gestures. She chattered on in Kannada, trying to throw in the few words of English that she had just learned. We somehow understood. And connected.

I miss those ten days in Karekura. I miss the kids. And I especially miss Anusha. I have not seen her since, but my mind goes back to thinking about her often. She will be 19 this year. Did she finish her schooling? Will she be married soon? Does she remember me? And if she does, is it as the outsider who came to do a “project” in her school for a few days, promised to come back, and never did?

This aspect of ICTD research is the hardest for me – having to make and sometimes break many, many connections with people far away, far from me and from my reality. Nine years in, I haven’t found an easy way to do it. I doubt I ever will.

I’m currently at Georgia Tech, an Assistant Professor at the Schools of International Affairs and Interactive Computing. Here are some more of my photos from Karekura. 

Aspiration

Thank you, Joyojeet Pal, for sharing your story. 

Somewhere around the end of my Ph.D. field work in the winter of 2007, I was working in rural districts surrounding Coimbatore, Tamil Nadu. I would meet children in schools to observe their use of computers. Some of these observations led to conversations with them on how they used computers, and others with the parents themselves on what they thought about computers in schools. Part of our research exercise was mapping aspiration – for this we asked children a range of questions around what they felt they wanted to be, what their favourite subjects in school were, what film stars they liked, who their friends were, and so on. We found two interesting trends. First, we found that all the children self-assessed as being “good at computers”, even if they were willing to self-assess as “not being good at studies” or “not being good at sports.” Likewise, children were keen on affiliating with others in their classes who were supposedly “good at computers” – even when this was loosely defined as being good at using a keyboard, or playing a game etc.

The unexpected affiliation however was the connection between film stardom and computers. When we asked one child why he said he wanted to be a computer engineer, his response was “Rajnikanth,” and his friend, who happened to be nearby, chimed in “coooool.”

So this set off something of a domino effect, with the boys shouting out “coooool” in a slightly goofy tone. The reference was to a laptop used by the filmstar Rajinikanth in a film from earlier that year, Sivaji, in which he plays an action-star/software engineer with a computer that talks back to him, and his password is “coooool.” The filmstar playing a computer engineer was an immediate trigger on the “what do you want to be when you grow up?” question, since what he wanted to be was Rajinikanth, and as it turned out, Rajinikanth was a software engineer.

So moving on, we started talking to parents about schooling – the nearby school had just got computers. Discussions would eventually come around to questions about aspiration. One parent, discussing the arrival of computers to his local school pointed out how good it was likely to be for his kids. He was adamant about one thing – his children would not work in the fields. He did not have any immediate means for this, but said he was very happy that the school had computers since this was in his words, the key to moving to the city for his son. It would teach him English, something the local teachers had not been able to do.

I knew that urban migration was fairly significant in that village, especially as the climate had become drier. At some point I asked him, “So the boys from this town who have moved to the cities, what do they do there?”

“Oh, they all end up as construction laborers.” He said.

There was a bit of a pause, and I had to move on with the interview as what he just said sank in for both of us.

Joyojeet Pal is currently working as an Assistant Professor at the University of Michigan’s School of Information. He also has a treasure trove of stories to share from his field experiences in India, Rwanda, and Brazil.

HCI Abroad: Distance Changes Everything

Thank you Anjuli Dasika, Jackie Wolf, and Nick Reid for sharing your story.

Prior to arriving in India for the University of Michigan’s Global Information Engagement Program, our team – a UX designer, public health specialist, and technical developer – had spent four months building a relationship with a health technology firm in Kolkata. Our goal was to develop a mobile tool for Community Health Workers (CHWs) in West Bengal to support communication and problem-solving during medical home visits. During conversations with our Indian partners, our team’s objective was to work with the CHWs and design something that was useful, easy-to-use, and could be well-integrated into their normal workflow within community settings. To prepare for extensive fieldwork, we conducted literature searches on Indian CHWs while in Ann Arbor, to better understand the context and the workflow gaps for these health workers.

It was one thing to dream up designs in Ann Arbor using our research on CHWs as a foundation for these designs and quite another to be on the ground in India, learning about the CHWs’ context in West Bengal as we proceeded with our project.

Our project partners in Kolkata who oversaw the operations of these CHWs and strongly favored a technology implementation for healthcare delivery had tried to provide us with descriptions of the CHWs, their locations, and their roles in providing health services to low-resource communities in rural areas. Although this information gave us a starting point, we believed that our design process would benefit from some ethnographic field research where we could observe the CHWs’ work and speak to them in person. We felt that this, combined with some lightweight usability testing of our tool, would be the focal point of our time in India.

Literature versus the Real-World

In those two months, we recognized that CHWs are not all the same, in either the work they do or the challenges they face in their communities. Much of the existing literature on health workers elucidates that experience, education level, and training are “highly variable” based on the community and region of India. However, through our interviews with CHWs in West Bengal, we were able to explore that variability even further and get a richer perspective on what those differences actually meant for their workflow.

Drawing on our field findings, we took three key aspects into consideration for the CHWs’ mobile tool, calling them the “Three Literacies”:

  • Our project partners suggested that most of their CHWs understood English. However, the women frequently told our team (via a translator) that they felt most comfortable reading and speaking Bengali. One CHW specifically mentioned that she would prefer that the electronic forms (in the mobile device) were in both English and Bengali, because “all of [their] papers forms were that way.”
  • Our project partners remained torn on whether to spend money on sleek dependable Android touch screen phones or to purchase the less expensive (and less reliable) i-Ball tablets for the CHWs. As we discovered through usability tests and interviews, this decision was irrelevant, as the women were equally uncomfortable with both. Most CHWs were unaccustomed to typing on a computer, let alone using touchscreen devices. It was clear just by the way they handled the devices that the CHWs were afraid something would break, despite our reassurances. Making users comfortable enough to interact with the device, in addition to understanding the content itself, is critical in a mobile health program implementation.
  • Something our team had already gleaned from our literature review in Ann Arbor was the immense variation in CHWs’ experience levels and health knowledge. This information was reinforced in our interviews: the amount of experience CHWs had in their communities ranged from 2 months to 8 years. A number of them could recognize medical acronyms such as “ANC,” but then could not identify this word in our electronic survey when it was written as “antenatal care.” This knowledge of medical terminology also varied greatly among the CHWs we interviewed.

Understanding the Context

Throughout our field experience, the assumptions we brought into the project were challenged and refined. We learned that the significant time, resource, and staff constraints within our partner organization made arranging field visits with the CHWs difficult. However, as our team navigated these obstacles, we saw the enormous opportunity we had to fill a gap in existing research on Indian CHWs.

To better understand how to tailor a mobile tool to their realities, we focused on the individual narratives that the CHWs had about their frustrations in managing situations they were not trained to address and the physical and political obstacles that prevented them from assuring timely healthcare to patients. Beyond taking note of the small difficulties that the CHWs had in navigating through the mobile application’s workflow, we noted each screen glare issue, each question about specific words, each button press as factors that would further hinder the CHWs in working with community members.

What we needed to do, beyond relying on literature, was to apply the CHWs’ experiences and take their feedback into consideration in order to design a mobile tool that would enhance the work that they do, even given the obstacles they face in their environments. Prior to this experience the three of us were already advocates for how important embedded work is for creating useful tools, but the time we spent in West Bengal working and listening to the CHWs reinforced that there is no substitute for first-hand contextual inquiry and ethnographic research.

Anjuli, Jackie, and Nick are currently graduate students at the University of Michigan.