WilliamsMemo41

=Williams Memo 41 Draft Overview=

The poverty felt by several billion people in developing countries is one component of a twinned problem (poverty and disease) on a downward spiral with death as the end (Willoughby 1990). Poverty affects the ability of many to eat, and to have access to potable water and illness preventive medications. Malnutrition and poor hygiene may result in an increased susceptibility to disease. People who are ill cannot work (if jobs are even available) and thus they cannot feed themselves – a full circle. A more specific example of this might be cataracts which account for almost 50% of blindness in the world (17 million people). The magnitude of this problem is stunning, and affects the sustainable development of Less Economically Developed nations where 90% of those with avoidable blindness are located (and likewise 90% of the $19 billion dollars in lost global productivity each year). The WHO Vision 2020 program, for example, has called for eliminating cataract as a cause of avoidable blindness through intraocular lens replacement surgery (IOL surgery), a relatively cheap solution with good outcomes. The Himalayan Cataract Project (HCP), under the direction of Dr. Sanduk Ruit and Dr. Geoffrey Tabin have created many innovative 'technologies' including inexpensive plastic lenses optimized to the average Nepali eye anatomy, a rugged ophthalmic laser that can be used in eye clinics in the mountains, and a new form of eye surgery that requires more skill on the part of the surgeon, and less suture material. However, the HCP is just one 'gold standard' example of medical technology transfer that follows a path of not just adoption, but also adaptation, innovation and reverse dissemination from the LED nation to industrialized countries such as the US and the UK The purpose of my dissertation is to study such 'exemplar' cases of MTT to understand what makes them successful, including the following goals: 1. understanding the political processes which shape and guide medical technology transfer 2. adding to the discourse on appropriate technology/ ‘technology choice’ with examples of medical technology innovation 3. adding to the discourse on sustainable development with examples of medical technology innovation 4. creating a more general theoretical framework for international medical technology transfer that incorporates the transfer of culture and values. The political economy of production is an important factor in world development. Possibly because of the success of micro-loan programs (similar to the idea that everyone can be an entrepreneur that Kelso posited in his Capitalist Manifesto) many organizations are looking at local entrepreneurship as a method for sustainable development. NGOs are being recognized for their role in creating international public goods (Meyer 1995). To that effect, my discussion of MTT would be incomplete without an analysis of the self-sustaining entrepreneurial NGO and its formation of collective identity (Melucci 1996), its participation in transnational activism (Tarrow 1998&2005) and integration into transnational activist networks (Keck and Skikink 1999), and its design of public and private spaces, material artifacts and large socio-technical systems (Bijker, Hughes, and Pinch, ed. 1987). In particular, in my case study paper on intraocular lens replacement surgeries in Nepal and Nigeria (Williams 2008), I was struck by how surgical costs, while important, did not appear to be the most significant barrier to uptake of cataract surgery, and how the importance of a type of barrier changed between the two countries. Discursive space needs to be created for knowledge and artifacts to be adapted to their new cultural context (De Castro 1997). This usage invokes discourse in a Foucauldian sense, which requires the active investigation of the power-knowledge structures of government, industry and involved publics, for the purpose of choosing a pathway for MTT that best suits the developing country’s interests.) Mechanisms are required specifically for dealing with the transfer of culture and values (De Castro 1997). Boundary objects (Star and Greisemer 1989) and, or, boundary organizations (Guston 1999) might prove an interesting theoretical handle. I believe that MTT can potentially revitalize development through more sustainable practices. There is a possibility that they are using less materials, providing long-term jobs and developing skill sets in the local community. New clinics also mean new infrastructure (power supply, roads) for the community. I am interested in creating a more general theoretical framework for international medical technology transfer that recognizes that it is not just transferring medical artifacts and techniques, but also involves the translation of culture and values between industrialized and developing societies. This framework would not just describe the technological content of transfer, but would also articulate the decision-making process at multiple levels of participation by multiple actors. The key to creating a more general theoretical framework of medical technology transfer may actually lie in a careful analysis of the local context in which they occur, the networks of NGOs, governing bodies and local knowledges. So this theoretical framework will be formed around multi-sited qualitative field observations of exemplar cases of medical technology transfer. This study will be based on data collected through multi-sited: This study intends to: contribute to the empirical record of "appropriate technology design" and "technology choice"; advance conceptualization of organizational theory in respect to transnational networks and complexity theory; contribute to the body of theoretical work on SCOT; create a more general theoretical framework for international medical technology transfer. Results of this study can help transnational NGOs, policy-makers, and multi-national corporations that are trying to facilitate sustainable development of less developed countries. Dissemination of this work will be through an open access dissertation publication (with a Creative Commons license), and peer-reviewed articles in journals such as: //World Development (IF 1.565)//; //Social Science & Medicine (IF 2.453); Social Studies of Science (IF 1.651); Science, Technology and Human Values (IF 1.711); the International Journal of Public Policy//; and the //Journal of Technology Transfer.//
 * Understanding The Political Processes Which Shape And Guide Medical Technology Transfer**
 * Adding To The Discourse On Appropriate Technology, And, Or, ‘Technology Choice’ With Examples Of Medical Technology Innovation**
 * Adding To The Discourse On Sustainable development With Examples Of Medical Technology Innovation**
 * Creating A More General Theoretical Framework For International Medical Technology Transfer**
 * //participant observation// as a research student in the Unite for Sight Albany NY student chapter, the Unite for Sight Global Health Conference (New Haven CT) and hospitals, clinics, and eye camps in Nepal, India, Kenya, Tanzania and the USA.
 * //ethnographic interviews// of policy-makers in government, ophthalmologists and other non-governmental medical, technical, and administrative staff (Nepal, India, Kenya, Tanzania, USA)
 * //comparative analysis of archival and policy documents// for: (1) medical technology transfer and (2) avoidable blindness diseases (e.g. bi-lateral cataracts, congenital cataracts, onchocerciasis vector and control, glaucoma, trachoma)