WilliamsMemo14

Williams Memo 14 Emerging Narratives

The social movement on appropriate or intermediate technology in the 70's was presumed dead by Winner in the late '80s and by Willoughby in the early '90s. Willoughby defined dead as not having shifted into institutional forms. But I believe that it has shifted into institutional forms. Perhaps our definition of institutions is different (I need to check on this). I have looked at a lot of public health and sociology of medicine literature on health technology for the developing world. From my (albeit less than thorough) study it appears to have incorporated the word "appropriate" over time. I suspect that the idea of appropriate technology by itself was not enough to incite institutional change. Instead when it joined the rhetoric of global climate change, neoliberal capitalism, social entrepreneurship, and environmentalism, under the umbrella of sustainability; that is when you see this unified mythology of sustainability affecting change.

More specifically, there is (potentially) a new/newer discourse tied to neoliberalism that a healthy developing world is a healthy industrialized world, a product of the fear in industrialized nations that low stockpiles of avian flu vaccine in developing nations could cause a worldwide pandemic. Alternatively, or, concurrently, there may be an idea that a healthy developing world is an opportunity for the creation of new markets for multinational corporations based out of industrialized countries to sell their wares in. These discourses can potentially be co-opted in order to push forward government policies and non-governmental partnerships for medical technology transfer programs that are socio-culturally situated. There are many NGOS that are focused on creating appropriate technology solutions for infrastructure and health problems in the developing world. Many of these NGOs are attempting to create/transfer reasonably priced environmentally responsible goods and services that respond to social needs in the developing world. It is possible that there is some commonality between them through the unifying myth of sustainability, and, its subset social entrepreneurship.

I believe that SICS was created in the 1980's; I am not sure if it was created by an American or European surgeon, or one from a developing country. Dr. Ruit modified SICS and claimed it as his own in the early 90's (it is possible that he created it I am not sure). It reduces surgical times from 30 minutes to 5 minutes on average per patient, but requires more skill on behalf of the surgeon than the previous surgery type called ECCE. The overall surgical technology-practice that he and his colleagues developed for the eye camps in the Himalayan mountains is sanitary but not like the sterile cleanliness of hospital surgical wards. In fact, his design intent was to make the operation more viable for eye camps which means that he potentially had to find ways around the mandated sterility of surgical standard operating procedures.

So basically I believe that Dr. Ruit and his colleagues in Nepal and the United States are influential in the following medical discourses for ophthalmologists: (1)sanitary versus optimally sterile surgical conditions (2)low cost does not mean simpler tech (3) utility of MD versus certificate programs (and, or, other less expensive or time intensive educational training) to the improvement of health care in developing nations. There are other things going on with the Himalayan Cataract Project, and other preventable blindness medical technology-practice that I am unable to verbalize as an emerging narrative because I have not done enough background research yet.

I believe that the space where nurses and ophthalmic surgeons perform their work in western hospitals, and, the places they shape for their work in eye camps in the developing world to be very different. I believe that it is possible that the way they self-organize in these two workplaces will also be different. There may be a sort of recursive process occurring, where, transnational NGOs with humanitarian and entrepreneurship focus are networked through increasing use of ICTs (thus participating, albeit passively, in a technology diffusion process for ICTs) while focusing explicitly on medical technology-practice transfer (where in this instance I intend the word technology-practice to cover the spectrum of procedures, processes, techniques and artifacts, etc.).