Want to help me survive while I help with crisis response? Now there’s a way! I launched my Patreon recently. I’m excited to do community response as backed by the community.
I still feel a bit strange, asking the community to support my work in this as I’m also looking for more regular work gigs. If you see any program, project, or product management positions that I might be a good fit for, please do let me know. My work portfolio website, designed by the amazing Jen Thomas, has been live for a bit. You can also contract me for facilitation gigs specific to employee retention through Vulpine Blue.
We are a group of civic developers committed to supporting Hurricane victims for relief & recovery who have helped with the software development and data analysis of Hurricane Harvey and Hurricane Irma primarily in Texas and Florida. In the wake of Hurricane Maria, we want to help Puerto Rico and the U.S. Virgin Islands in the same way. Devastation has already occurred in Puerto Rico and the USVI, and we’re here to help in the response and recovery pending from Maria.
But, we won’t jump in without your permission. These places have a long history of imperialism, and we refuse to add tech colonialism on top of that.
Here’s how we might be able to help:
Rescue
Sometimes emergency services are overloaded fielding calls and deploying assistance. Remote grassroots groups help take in additional requests through social media and apps like Zello and then help to dispatch local people who are offering to perform rescue services (like the Cajun Navy in Houston after Hurricane Harvey).
Shelter updates
As people seek shelter while communication infrastructure remains spotty, having a way to text or call to findt the nearest shelter accepting people becomes useful. We can remotely keep track of what shelters are open and accepting people by calling them and scraping websites, along with extra information such as if they accept pets and if they check identification.
Needs matching
As people settle into shelters or return to their homes, they start needing things like first aid supplies and building materials. Shelter managers or community leaders seek ways to pair those offering material support with those in need of the support. We help with the technology and data related to taking and fulfilling these requests, although we don’t fulfill the requests directly ourselves.
If you are interested in this, please let us know by emailing me (willow dot bl00 at gmail) or finding us on Twitter at @irmaresponse and @sketchcityhou.
Here are other groups lending aid already (maintained by someone else).
If you’re looking to jump in an an existing task, Humanitarian OpenStreetMap Team already has a tasker active for helping to map the area for responders and coordination.
I am working with a group of civic developers committed to supporting Hurricane victims for relief & recovery who have helped with the software development and data analysis of Hurricane Harvey and Hurricane Irma primarily in Texas and Florida. In the wake of Hurricane Maria, we want to help Puerto Rico and the U.S. Virgin Islands in the same way. Devastation has already occurred in Puerto Rico and the USVI, and we’re here to help in the response and recovery pending from Maria.
But, we won’t jump in without your permission. These places have a long history of imperialism, and we refuse to add tech colonialism on top of that.
Here’s how we might be able to help:
Rescue
Sometimes emergency services are overloaded fielding calls and deploying assistance. Remote grassroots groups help take in additional requests through social media and apps like Zello and then help to dispatch local people who are offering to perform rescue services (like the Cajun Navy in Houston after Hurricane Harvey).
Shelter updates
As people seek shelter while communication infrastructure remains spotty, having a way to text or call to findt the nearest shelter accepting people becomes useful. We can remotely keep track of what shelters are open and accepting people by calling them and scraping websites, along with extra information such as if they accept pets and if they check identification.
Needs matching
As people settle into shelters or return to their homes, they start needing things like first aid supplies and building materials. Shelter managers or community leaders seek ways to pair those offering material support with those in need of the support. We help with the technology and data related to taking and fulfilling these requests, although we don’t fulfill the requests directly ourselves.
If you are interested in this, please let us know by emailing me (bl00 at mit) or finding us on Twitter at @irmaresponse or @sketchcityhou.
Here are other groups lending aid already (maintained by someone else). If you’re looking to jump in an an existing task, Humanitarian OpenStreetMap Team already has a tasker active for helping to map the area for responders and coordination.
I’ve long been interested in the question of how formal and informal groups interact in crisis. It is my proverbial jam, as no one ever says.
Basically, it boils down to this: official agencies are resourced and have predictable structures, but are slow and lack visibility to an affected population’s needs. Emergent groups in an affected region are by definition beyond their capacity to respond and are not trained in response, yet they have acute knowledge of their neighbors’ needs and can adapt to dynamic environments. While I’m still working on the long-form expression of these ideas, an opportunity to prototype an interface came up recently through the Naval Postgraduate School, Georgia Tech Research Institute, and a place called Camp Roberts.
Camp Roberts
There’s this decommissioned Air Force base near Paso Robles called Camp Roberts, where interoperability experiments are conducted quarterly. Only the engineers/implementers are invited to attend – no C-level folk, no sales. Each year, one of those four is focused on what the military calls “Humanitarian Assistance & Disaster Response” (HA/DR). I have some deeply mixed Feelings about the military being involved in this space. I respect my friends and cohorts who refuse outright to work with them. I see the military as an inevitable force to be reckoned with, and I’d rather take them into account and understand what they’re likely to be up to. Finding this place to plug different pieces of a response together without the sales folk or directors present, to actually test and play and fail is a glorious opportunity.
A Game
I’ve been working on the opportunity to build a game around a formal/informal interface for years as a way to explore how collaboration would fill gaps for these different actors. This project is called “Emergent Needs, Collaborative Assessment, & Plan Enactment,” or ENCAPE. The idea is this: both sides to that equation lack understanding of, and trust in, the other. A game could externalize some of the machinations and assumptions of each side, meaning a demystification; and creating things together often leads to trust building (that’s a reason why I’ve invested so much in makerspaces and hackathons over the years).
My informal friends were into it. So were my formal friends. But in order to know we could have any impact at all on organizational change, support had to be official from the formal sector. This took years (the formal sector is resourced but slow, yeah), but the pieces fell into place a couple months ago and the chance to build a game was born.
The People
It was of course vital that a wide range of viewpoints be represented, so the call was broad, but still to folk I knew would bring their whole Selves, be able to trust each other, and would be interested in the results of the game research. Folk from informal response, official agencies, nonprofits, and private sector were all invited. In the end, were were joined by Joe, Galit, Drew, Katie, Wafaa, John, Seamus, and Conor. Thank you all for taking time for this.
What We Did
We actually ended up meeting in San Francisco for our 3-day workshop for hilarious reasons I’ll disclose in private sometime.
On Sunday night, some of us got together to get to know each other over beverages and stories.
On Monday, we went through a Universe of Topics and visualized the workflows for our various user types. I did one for the Digital Humanitarian Network, Wafaa did one for Meedan’s translation and verification services, Katie covered a concerned citizen, etc. What were our pain points? Could we solve them for each other? We overlapped those workflows and talked about common factors across them. Different personas have access to different levels of trust, finances, and attention. They use those to build capacity, connections, and decision-making power. How could we use these common factors to build a game? How could we explore the value of collaboration between different personas?
Drew took this
On Tuesday, we reconvened and started the day off with a game: Pandemic. This got us thinking about game mechanics, emergent complexity based on simple rules, and how to streamline our game. Individuals presented on what their game might look like, if left to their own devices. We explored combining the most compelling parts of those games, and started a prototype to playtest. It ended up being a counting game. Hm. That can’t be right.
On Wednesday, we drew through what the game play might look like and troubleshot around this shared understanding. It was closer to modeling reality, but still took some counting. We drafted it out to playtest, narrated through parts which didn’t yet make sense, and took notes on where we could improve. The last bit of the day was getting a start on documentation of the game process, on the workshop process, and on starting some language to describe the game. We’ve since continued cleaning up the documentation and refining the game process. And so dear readers, I’m excited to tell you about how this game works, how you can play, and how you can (please) help improve it even more. Continue reading →
Every year, Canada’s Médecins Sans Frontières (AKA Doctors Without Borders / MSF) meets for their Annual General Assembly. I know about this because two years ago their topic was “Is MSF missing the technology boat?” to which I was invited to speak about Geeks Without Bounds and community technology projects with the talk “Technology as a Means to Equality” (video broken because of issues with GWOB YouTube account, and with my apologies). I went back this year because my organizational crush on them maintains, and because Aspiration (my employer for teh past 2 years, a technology capacity building organization for nonprofits) has been working on an ecosystem map of the digital response space. The real-world and values-driven experience of MSF provided valuable insights and data points for that map, and so I went seeking their input. I spent the first day at their Logistics Day hearing about 3D printing for manufacturing and prosthetics, telemedicine, and use of smart phones. My second day was for the Annual General Assembly again, this time as an attendee. The first half of the day focused on how to deal with the bombings of hospitals in war zones, the second half on mental health for patients and for field practitioners. I’d like to speak to you here about the first half of that day, how it overlaps with things I’ve learned here at the Center for Civic Media, things I was reminded of during bunnie and Snowden’s announcement at Forbidden Research, and things which have sadly continued to be relevant.
There are certain things that humanity has learned we find untenable from past experience. Some of these lessons are most notably codified in the Geneva Conventions, ratified by the UN and its membership. Among other things, the Geneva Conventions cover how noncombatants should not be involved in conflict, the right to bring someone to trial for war crimes, and the right to access to medical treatment. This last is of most concern of MSF, namely in that more and more hospitals in war zones are being bombed. These bombings are happening without the external accountability which the Geneva Conventions and the UN Security Council claim to uphold (then again, 4 of the 5 permanent seats on the UN Security Council are held by countries linked to these bombings, so that’s maybe a conflict of interest and integrity). So, maybe this is not a system of accountability we can necessarily depend on any longer. How can the bombings be stopped? Who can (and should) hold those doing the bombings accountable, if not the long-standing (albeit imperfect) Geneva Convertion mechanism? MSF has been maintaining a campaign for public visibility, hoping this will lead to some level of accountability via #NotATarget.
The question that I remembered during bunnie and Snowden’s announcement at Forbidden Research was: are these individual blips of horror across many different countries, or is this a new norm? bunnie and Snowden were referring to the subtle but systemic targeting and killing of journalists. MSF panelists spoke of the picking off of hospitals in conflict zones, sometimes when nothing else around them has been attacked. There are two things at play here: a technological way to do the targeting, but also the acceptance of this happening. One speaker at MSF AGA, Marine Buissonniere, spoke to both of these points by indicating that we should be able to hold both highly contextual circumstances and overall trends in mind at the same time. Perhaps the bombing of one hospital happened in a silo of decision making for one military, but the fact that it is deemed acceptable by so many at the same time indicates a deeper shift in global cultural norms. She and the other panelists also spoke to how this is an ongoing attack on civic life, that hospitals are the last refuge in times of war, and to make them unsafe is to remove the provision of basic needs to entire regions. Whether a subtle cultural shift or a concerted effort to errode transparency, accountability, and safety; both the cases of hospital bombings and targeted journalist killings come from a similar place of disregard for human life and for accountability. It is our responsibility to hold those taking these actions accountable.
It can be difficult to understand what this sort of thing means. It is difficult to build empathy, a huge component in bringing sufficient public attention on those trampling human rights to hold them accountable. The panelists acknowledged “outrage fatigue” coupled with the failure to act from enforcement agencies and courts. When our attention wanes, so too do the mechanisms of accountability. Similar to the work already done around Media Cloud and Catherine’s work on location of the news, a question emerged: would people have cared differently if these bombings were happening a part of the world other than the Middle East and North Africa? Regardless, those perpetrating these violences are benefiting from our outrage fatigue. How can we take care of ourselves and each other while balancing our areas of influence with our areas of concern? How do we choose which actions to take?
Journalism and Medicine
This is in part why I think MSF is so amazing. They act both to respond to a basic human need (access to medical care) in places often abandonded or never paid attention to begin with, and they speak truth about the circumstances in which they do so. To publicly statewhere a hospital is both puts them in immense danger and also protects them through public outcry against that danger… but only if those outcries continue to occur. To seek justice for infractions to human rights can be seen as non-neutral, which would then put MSF deeper in harm’s way.
One way to navigate this might be divvying up parts of this ecosystem. Diederik Lohman from Human Rights Watched joined the panel to speak about documentation and accountability — documentation which MSF practitioners are not trained to create, and the creation of which might jeapordize their status as neutral parties. If instead someone from Human Rights Watch were to document, could MSF better maintain their role as a humanitarian, and therefore neutral, party?
Truth is the first casualty of war
Many of the atrocities associated with #NotATarget remain unaccounted for due to politics. But some have to do with a lack of visibility of the incidents and others of the context of the incidents. MSF often doesn’t disclose the nationalities of their clinicians as a way to emphasize that all tragedy is human tragedy, rather than allowing countries to cherry-pick reporting based on what seems connected to them. But they’re also not great at indicating how many different demographics across civilians and combattants they’ve served on a given day. The impartial nature of their service delivery is invisible to both local and international crowds. What would documentation look like which helped MSF do its job, made disruptions of that work visible in a trusted way, and wouldn’t add to the reach of the surveillance state?
I came away from both of these sessions with more questions than I arrived with, but also greater trust and awareness of the others doing work in these spaces. All my best, in solidarity and hypoallergenic kittens, for all that you do.
One of the hardest lessons and ongoing challenges in digital disaster and humanitarian response is how to connect with a local population. While many digital response groups deal with this by waiting for official actors (like the affected nation’s government, or the United Nations) to activate them, this doesn’t always sit well with my political viewpoints. Some of these affected nations have governments which are not in power at the consent of the governed, and so to require their permission rankles my soul. But to jump in without request or context is also unacceptable. So what’s to be done? It’s from this perspective that I’ve been diving into how civics, disaster, and humanitarian tech overlap. And it’s from this perspective that I’ve been showing up to Bayview meetings for San Francisco city government’s Empowered Communities Program. ECP is working to create neighborhood hubs populated by members already active in their communities. Leaders in local churches, extended care facilities, schools, etc gather about once a month to share how they’ve been thinking about preparedness and to plan a tabletop exercise for their community. This tabletop exercise took place on October 20th in a local gymnasium.
The approach of ECP is generally crush-worthy and worth checking out, so I won’t dive into it too much here. In brief, it is aware of individual and organizational autonomy, of ambient participation, and of interconnectedness. It has various ways of engaging, encourages others to enroll in the program, and lightens everyone’s load in a crisis by lightening it in advance. I am truly a fan of the approach and the participants. It’s also possible to replicate in a distributed and federated way, which means digital groups like the ones I work with could support efforts in understood and strategic ways.
Here is what doesn’t necessarily show through in their website: how grounded in local needs and social justice these community members are. There is a recognition and responsibility to the vulnerable populations of the neighborhood. There is a deep awareness of what resources exist in the community, and of historical trends in removing those resources from a poor neighborhood in a time of crisis. We’ve had frank conversations about what they’ll do about debris, and how the Department of Public Works parking and storage in their neighborhood is suddenly a positive thing. About what to do with human waste, and what a great boon it will be to have the waste water plant in their neighborhood. The things that wealthier parts of the city have vetoed having near them because of noise, pollution, and ugliness (NIMBY, or “not in my back yard”) will make Bayview resilient. They’re preparing to take care of themselves, and then to take care of other neighborhoods.
There’s a plan in NYC now to knock on every. single. resident’s door in the next crisis. It’s an approach other cities might also consider. But it’s one which is nearly impossible to implement. Who is doing the knocking? What are they doing with the information they gain? ECP’s approach is to apply their own oxygen masks first, and then to check on their neighbors, to know what the local Hub can take care of and what is needed for external support. When/If a city employee comes knocking on their door, they can then speed up the process of getting aid to where it’s needed (“I’m ok, but Shelly up the street has our 7 disabled neighbors there and they need a wheelchair, medication, and no-sodium food.”)
The end of the tabletop exercise had Daniel Homsey, the gent who heads up this program, talking about how we didn’t devise plans while together, but we did learn how to suddenly have to work at another role with people we’d barely or never met before. And I, as a digital responder, listened to what the community’s needs were, how they organized themselves, and considered the smallest interventions which could be maximally applied.
We have been working on a map of the digital response ecosystem here at Aspiration. While we still have a ways to go, I wanted to pause to reflect on why we are working on it and some things I have learned along the way. If you’re so inclined, the closing section includes a request for feedback and a way to be in touch.
The current state of affairs
Disaster and humanitarian response happen in a chaotic and low-information environment. Even if historical context, accurate maps, and up-to-date data existed before a shock, an extreme event will have disrupted that baseline in dramatic ways. Response organizations deploy into these environments seeking what we call “situational awareness,” sometimes wondering about who to ask about the location of vulnerable persons, other times wanting to know which roads are still navigable. In order to know more about their physical and logistical environment, many response organizations and community groups are beginning to make use of digital tools. There are also digital tools which allow us to do truly new things in addition to information gaining and sharing. Digital tools might be in the form of crowd-sourced maps about needs and outages made from Twitter updates with hashtags, or images composited from a drone for an overview of an affected region for locating the most damaged areas, or heavy statistical modeling based on datasets from multiple sources for more precise resource distribution. The introduction of these new people, processes, and tools for digital response can increase the chaos of response or alleviate it.
Official and specialized actors such as United Nations Office of Coordinated Humanitarian Affairs (UNOCHA) and the International Federation of Red Cross and Red Crescent Societies (IFRC) stand to benefit from the new skills of digital tools and the processes they enable when they are able to fold these new tools into their existing structures. When they are able to do this, we all benefit from their increased capacity. Frontline populations in affected regions continue to use digital tools like Signal and Facebook to organize themselves and coordinate response. Community groups such as churches and schools are using their existing digital community infrastructure to organize larger local relief efforts. Digital responders help to clean, structure, and utilize the massive amounts of information generated in times of crisis so those in the midst of the chaos can have more visibility to the requests, offers, and other factors in play around them.
Is there any signal in this noise?
What does this flurry of activity look like, and how can it be improved? How can we someday make crisis response boring? What are the patterns in who does what, when, and how do they coordinate with each other? While some official organizations have name-brand recognition, there is little understanding of local, emerging, and digital sectors. Their contributions and challenges are often rolled up into the official response organizations’ documentation, if it is documented at all. The flows of information, communication, and other aspects of coordination are poorly understood, even by those within the ecosystem, and especially in regards to the smaller and newer groups. Is it feasible to have a roster of all local groups with capacity related to response? Who would build it and keep it up to date? Would we trust the data it contained? It is this complexity which is partly to blame for official response organizations not being able to have situational awareness and to relatedly struggle to meet local needs. So when an extreme event happens, groups spin up locally and remotely because of pressing need and the invisibility or inadequacy of pre-existing response groups. Those new groups persist, morph, merge, or dissolve through response and recovery phases of the disaster cycle. It used to be standard for several hundred response groups (pre-existing or otherwise) to respond to a crisis. Four thousand responded to the Haitian earthquake. The desire to involve technology in this mix has increased the number of factors to consider by adding in tools, active remote and local people, and even new abilities. Most people also point at the 2010 earthquake in Haiti as the first instance of digital tools making a discernible impact in crisis response. While this is a moment of potentially increased chaos in a space sorely needing alignment and sharing, it is also a moment of potential. What if we bring our ideals of openness and co-equality to the table? What if we trust the network (frontline community members, official responders, volunteers, remote assistance, etc.) to understand and sort itself out, adapting to challenges as they emerge?
Making the invisible visible
With acknowledgement that the digital response ecosystem is a living and changing thing, a map of it could provide a shared view of current actors, the tools they use, the data generated and used by those tools, and the resources we build from and contribute back to. Our hope is that this shared view might help us to provide better ground for refining information flow, to discover possibilities for collaboration, and to devise shared infrastructure. We could thus begin to think more holistically about response, get insights into how to make response infrastructure and mechanisms more sustainable and scalable, and be able to easily share an overview to newcomers or other interested parties. It is with these hopes that we started asking for help in building a map of the digital response ecosystem. Through calls with allies and structured activities at Humanitarian Technology Festival, HumTech, the Doctors Without Borders Logistics Day, and at the June 2016 Digital Responders’ Meetup, the map is slowly beginning to take shape. Here are some things we have learned along the way.
This is a volatile space
Crisis response is by its very nature generally unpredictable. A rare caveat are hurricanes, as our weather science is getting better and better so we can approximate their strength and direction. But because we still do not understand what is going on with the earth’s crust and seas, earthquakes are still widely considered impossible to predict. Droughts are often just as political as they are about complex environmental factors, so anticipating them is somewhere in between. This means it is difficult to get any sense of predictability to rely upon or plan within for crisis response. Our data model needed to factor in the components which trigger a response group deploying or emerging from a frontline community. Activation could be based on geography (local, regional, national, international), based on the part of the disaster cycle, or based on an explicit request (from an international agency, national or local government, or a community group). Some groups (like Doctors Without Borders) are not activated from external cues per se, but instead based on their own mandates. And each of these groups focuses on different topics, ranging from accountability to mapping to data sharing to telecommunications infrastructure. To try to show connections and flows between these different entities which also bridge geography and time cycles can be somewhat daunting! Too much granularity and the whole thing is overwhelming, but too little and no patterns can be picked out.
Our sharing gaps are significant
Open (and responsible) data, libre source code, and collaboration are heavily advocated for in humanitarian and disaster response. We often hope to work miracles on shoestring budgets and with little awareness of what our comrades are up to. With a few shining examples such as Kathmandu Living Labs in the 2015 Nepal earthquake and Crisis Cleanup for Sandy, efforts to share our knowledge and intentions with each other are more often stymied than not. It is a common story that the country office of one international response nongovernmental organization does not know how (or even what) the office in another country is doing. This means it is even less likely their partner organizations or other groups in the same deployment know what they are up to. During a crisis, sharing and communication occur by force of function, but also in hugely inefficient ways because other priorities are at hand. UNOCHA has done a lot of work in this space, making it easy for deploying groups to upload and view data in a shared space through the Humanitarian Data Exchange and the Humanitarian Exchange Language, along with their traditional Cluster Approach. However, much of this work is targeted at established and dedicated response groups who know how to look for each other and have potential funding infrastructure which requires their collaboration. The smaller, ad hoc, and digital response groups do not have the context or infrastructure for their sharing and collaboration amongst themselves nor with larger response groups. There is still a lot of work to be done in sharing data and plans within and between organizations, across different parts of the response cycle, as well as with local community groups.
Who will (and can) show up changes
Because there are so many factors in who can deploy where, when, and why, investing the time in building relationships and channels for communication and sharing could be seen as a waste. It is even more impossible to have a plan that will be of any use in this circumstance than in nearly any other, and to rely heavily on rigid plans rather than adaptability is a recipe for disaster. But planning is still necessary if we are ever going to get better at response than we are now. Rather than rigid plans and expectations, we can instead focus more on the sorts of response groups that show up, the types of local groups which emerge, and the patterns of their interaction. Resources for these categories and personas have to be generalizable enough to be used, improved, and updated by anyone in that category or of that persona. Mapping the ecosystem is not just about having an easy-to-approach description of the space, but also about discovering the most strategic communally-held resources to create (or to find and share).
We would like to thank all the folks who have already spent so much time and energy on this concept with us. I have especially benefited from conversations with Devin Balkind, as well as referencing past collaborations he had a huge hand in, namely Aid Badges and Resilience Colab. Heather Leson has been a huge contributor and supporter. The attendees of Humanitarian Technology Festival, the hallway conversations at HumTech, the participants of the Doctors Without Borders Logistics and Clinician Day, and cohorts at the June Digital Responders’ Meetup have also added a great deal of information and structure to this data. Because we are doing this together, it can grow beyond a proprietary or bottlenecked resource into one useful for the entirety of the space.
After HumTechFest and the Humanitarian Technology Innovation Conference, I headed up to Toronto for the Doctors Without Borders (Médecins Sans Frontières / MSF) CanadaLogistics Day. This is a day where MSF showcases and explores the ways they currently (and potentially could) do logistics. This happens in tandem with the Clinical Day, where the doctors, nurses, and other clinicians of MSF share their technology and practices. I have been a big fan of MSF for years — their delivering basic human services into regions generally abandoned by anyone else shows a level of dedication and gumption I find admirable. Medical service delivery to these areas comes with challenges even beyond standard response. Public attention has often waned, leaving a gap in funding, donations, and international accountability. Stigma is often attached to those gaining access to basic human rights, as MSF provides medical care to civilians and militants from all sides of a conflict. Many of these regions are extremely remote. The doctors and nurses delivering these services are called medics, and the folk who back up the medics are logisticians, sometimes called “Logs.” Both sets work remotely for some tasks, while other tasks require them to be in the field. The set of Logs and Clinicians in the field and remote are linked together through communication and practice, often facilitated through technology.
One of the reasons I see MSF as so amazing is because everything they do puts the patients first. The rest of their logistics, technology, and even governance systems are designed outwards from that. Any new technology is assessed in a highly pragmatic way including questions like “what impact is it likely to have?”, “what is the failure mode?”, “who is already doing this?”, “is it worth the overhead of asking skilled practitioners to learn this new thing?” It was from this progression to the the Plateau of Productivity in the hype cycle that we looked at 3D printing and then did an overview of many different technologies, including contributing to our ecosystem map of the digital response space.
An honest look at 3D Printing
I have to admit I am hugely skeptical of the promise of 3D printing. While I lived in Seattle, there was a friendly competition between Mark Ganter at UW in what strange materials he and his students could make work through proprietary machines versus the hacked-together machines themselves produced out of Metrix Create:Space. This framed my understanding for what intellectual property battles were being fought around machines and material, how to think about material science as related to structural integrity, and what (if any) actual utility beyond prototyping 3D printing might provide. So when my host Chris Houston at MSF indicated 3D Printing was to be a topic at MSF Log Day, I balanced my desire to be skeptical with my trust that MSF is made up of realists. I was not disappointed.
Manufacturing
Let us say you are a field practitioner working at an MSF hospital in Afghanistan. If the brackets on a baby incubator break, the entire expensive and needed piece of equipment becomes a doorstop because one of the walls that would keep the baby from falling out will not stay up. To work with your Logs to get a new set of brackets possibly requires
order forms to be filled out with specifications,
for that order to fit into other work flows,
for the company to be willing and able to produce you new ones within a decent time frame and budget,
shipping those tiny pieces in with massive amounts of other goods (meaning what box it goes in matters so you can find it later),
those boxes likely getting held up at customs for an unknown amount of time, and
needing someone to figure out how to swap in the new working parts,
(often on equipment which is highly proprietary).
This can take weeks if not months (if it happens at all). All that time, there is not a safe place for babies you are delivering and care taking.
Field Ready (as represented by Eric James) is helping field practitioners both with those one-off items through 3D printing and with relying less on an international supply chain. By putting engineers and industrial designers in the field with production skills and tools, conversations open up about what can be manufactured locally — with 3D printers, desktop milling machines, laser cutters, and through pre-existing local facilities. Someday there may be no need to order 20,000 buckets from Geneva and wait for them to be made, shipped, and clear customs when there is a local bucket manufacturer. This would also keep funding and capacity local. 3D printing is shiny and new enough that it opens up these conversations about what can be made more locally and why (or why not), whether it is with a 3D printer or in a manufacturing center.
I am excited about this Field Ready because they are training up locals on the equipment, increasing technical capacity in-region. They are working to keep international aid money local, as well as strengthening those production ties to the international response scene. And they are honest about their abilities and intentions.
Prosthetics
Another use case which is worth the fickle nature of 3D printers and works within the structural integrity of the objects they produce is prosthetics. The creation of prosthetics is a time consuming and artisanal practice, requiring weeks to produce something which a child might outgrow within months. By introducing new scanning and production techniques, well-fitting prosthetics can be produced in days and at significantly less cost. This means those in need are more likely to stick around for the process, and are more likely to have better fitting pieces (which means healthier physiology) over the course of their lives.
Dan Southwick of the Faculty of Information (supervisor is Matt Ratto) provided a reality check on both of these promises by giving a very blunt overview of both the limitations on 3D printers and the contexts into which they are deployed. 3D printers are fickle, needing what is closer to a lab (controlled) environment than what a humid, buggy, and high-stress field environment might be capable of maintaining. A group he and Matt have worked with, Nia Technologies, encountered a girl wanting a second left foot as her prosthetic, as the only right foot available was not a skin tone match, and there is a cultural stigma with a missing limb in that region. While a 3D printer could have printed out a new one, knowing to bring a variety of colors for printing material is important. The culture and environment in which we work matters, and cannot be glazed over. Computer Numeric Control (often just called “CNC”) machines like 3D printers and milling machines were also created to get people out of the chain of production, as people are unpredictable. Rather than follow this pattern of pushing people out of the process, the Critical Making Lab has worked to involve them. This also maintains a long chain of knowledge and increases local capacity.
These pragmatic and committed individuals are working hard, often together, in order to ease the complications in the field by MSF practitioners.
The rest of the day
But the day was not even over yet. Brains and bellies full, we dove into the end of the day with a rapid review of other technologies MSF had been making use of for the past year, including telemedicine, mapping, mobile diagnostic tools, and an MSF app.
Telemedicine
Human beings are complex, and the things that can go wrong with our bodies are hugely diverse. When working in the field, you may be one of only a few medics for hours and hours, and the special cases which crop up can be far outside your knowledge. There are no specialists to send someone to. Store and forward is a way to benefit from specialists who are far away. Images and descriptions of cases can be sent outward for either verification (it is comforting to have someone else say “yes, that is fatal” when you would otherwise be the only person who could make that call) or diagnosis and suggested treatment for something you have never seen or read about. MSF has been using this system for a couple years now, to great success. Each response takes a few hours, so your patient is often still present for response and treatment.
Another form of telemedicine has to do with increasing capacity through ongoing communication between emerging local practice and clinicians elsewhere. More real time, this is about conversation and skill building rather than edge cases and verification. I am excited to see both models being deployed, and how it starts to cover the complicated vastness of medical service.
Mapping
Knowing where to go relies on local knowledge and maps. Some parts of the world are not even mapped! Using satellite imagery, MSF has been working with Humanitarian OpenStreetMap Team (HOT) and the Red Cross on mapping these regions which have not been mapped before in a program called Missing Maps. Digital volunteers review satellite imagery and trace objects likely to be houses or farms, which can then be reviewed in service delivery plans to make sure more people are being reached. (Side note that the map-tile categorizing tool Map Swipe which folds into Missing Maps did a user test at our digital responders’ meetup on June 16th.)
Mobile Diagnostic Tools
Medical equipment is bulky, expensive, and often single-purpose. With more and more sensors available via open hardware, smart phones, and wearables, MSF clinicians are experimenting with the possibility of other diagnostic tools. We heard from someone who was working in a region with higher-than-normal rates of epilepsy. In a “normal” hospital, the patients would be diagnosed by wearing an EEG cap attached to a bulky and expensive piece of equipment that would analyze the brain activity. But she was now able to process the data directly on her smart phone, eliminating a single-purpose piece of equipment which is expensive, has to go through the supply and logistics chain, and is just as prone to breaking as anything else.
Guidance mobile app
MSF has a lot of guides for various parts of their practice, but these are in paper format and often are either locked in a cabinet or are over-worn from use. It is not searchable, and any given clinic may not have the whole set in the most recent version. Asking forgiveness rather than permission, a set of MSF-ers transferred this knowledge into searchable and cross-linked information in a smartphone application. It has since been expanded to include telemedicine aspects and the layout of clinics. The use analytics show where training might be lacking, or where an outbreak may be happening. They are using that data to improve their overall feedback loops.
A web of technologies
All of this technology comes together in a web of communication and practice between clinicians and logisticians, often as facilitated by technology. Commitment to the end user, interoperability, and ease of use are the core components to these various technologies easing the suffering of others, rather than weighing practitioners down even further. Aspiration is eager to see how our ecosystem map and ongoing work in the digital response space can help (or at least not get in the way of) these efforts from Doctors Without Borders.
We have been working at Aspiration on our digital humanitarian and disaster response program for a year and a half. On June 4th and 5th, we hosted our second Humanitarian Technology Festival as an interactive and participatory event for practitioners, students, designers, etc. to gather and contribute to the current state of response. Deep thanks to all the participants, especially those who took notes so others could benefit from what we learned. We played a game, took care with ourselves, and enjoyed the outdoors.
But I do not care about humanitarian or disaster response
We all have enough to worry about without adding in disaster preparedness, even if research points to it being worthwhile (PDF). It is difficult for community groups to know how to prepare for (let alone know how to support in) a crisis. The existing resources are for enterprise-level businesses, or are focused on individual response. There is not much in the way of resources for the groups that Aspiration considers itself in solidarity with. (If you have found some — please do let us know! We would love to point at those resources.)
Palante Techhas been a community group supporting their pre-existing network in crisis, however. During Superstorm Sandy, Palante kept the groups they already served up and running, when possible, as well as providing information about what neighborhoods had what functioning communication infrastructure (and why). They would like to know how to do it better in the future. The Humanitarian Technology Festival (#HumTechFest) was lucky to have Jamila from Palante in attendance, and they led a session about how to better understand and document the needs of community groups in a crisis. Our goal is to come up with a lightweight guide with some suggestions which are manageable to deploy in advance of a crisis, as well as some guidance in how to deal during and after a crisis. The session was also attended by some folk who work with New York City for small business preparedness, an international aid networking person, and a creator of games who is generally interested in response. They talked through the arc of the disaster cycle, faith-based volunteer organizations which activate in response, and the specificity required in interacting with formal organizations.
We still have a lot of questions
Could such a guide document the needs of non-response community groups in such a way to make those needs visible and easy to process in order to get available and needed aid from official response organizations? Better yet, is it possible to do so in a way which will hold those organizations accountable?
What questions would you have about how your organization could be more resilient in times of crisis?
What measures have you already taken to deal with a possible crisis?
What have you done to keep your doors, or the doors of your constituents, open during a crisis?
We are preparing for the Humanitarian Technology Festival on June 4th and 5th in Cambridge, Mass. This participatory event is for field practitioners, media makers and storytellers, technology developers, information security practitioners, members of affected populations, researchers, and everyone in between. We are hoping for a strong contingent of civic tech and civic media folk as well, for reasons we hope this post will make clear.
Humanitarian and disaster response deals with exceptional situations. But whether through historical happenstance or through poor design, response also tends to be short-sighted and deeply siloed. As crises are by definition beyond the capacity of “the norm” (existing infrastructure like governments), responders are often military or nongovernment organizations (NGOs). We deploy into places we do not fully understand the histories of, where we are not well connected with pre-existing efforts, and when we leave we often take our data and gained understanding with us. We too often make poor choices which deeply affect the future lives of a frontline community because “it is better than doing nothing.” I generally find the whole thing paternalistic and incremental when we should instead be focusing on systemic interventions to long-term issues of inequity by working with local populations to increase their capacity. A combination of coping with exceptional circumstances in a way which actively works with, depends on, and returns to pre-existing efforts is what I see in the overlap of civics and response.
Where one ends and the other begins
Civic tech is technology which enables engagement or participation of the public for stronger development, enhancing citizen communications, improving government infrastructure, and generally improving the public good. Civic media is any form of communication that strengthens the social bonds within a community or creates a strong sense of civic engagement among its residents. Then civic media and tech are deeply linked with digital disaster and humanitarian response. All are about how people work with each other and with institutions, each is about more intentional infrastructure, and each is about having an empowered public supported by institutions and a global public. The excellent book Building Resilience gives a precise overview of the strength of social capital and community ties as the leading indicator to a region’s ability to cope with shocks and stressors, regardless of access to other resources. We anticipate the scenario we will be playing through at the event will get at these social ties as well as laying a baseline of understanding for those new to response.
From that background theory, the practice looks like responders working with already established civic infrastructure in order to bolster those networks of trust, to benefit from that knowledge, and to have a place to return created data and delivered resources into for post-response sustainability. But where do humanitarian aid/development, civic engagement, and disaster response transition into one another?
Civics and humanitarian aid
Digital humanitarian response could be seen as civics in places where there is not yet established technical, physical, or possibly even political infrastructure to bolster or route around. In this case, considering how the civic tools you are building apply to other locations is a useful theoretical framework. Perhaps more importantly — how could tools built elsewhere apply here? (Spoiler alert: Kenya and Tanzania have had mobile money for a looooong time, and we are only just starting to get it in the States — we have plenty to learn from other places.) Improving infrastructure is more and more grounded on baseline data, which can be collected for development purposes or as a means of civic engagement. When the creation of baseline data is happening for civic reasons, it indicates those social ties are being formed around local political empowerment, versus (the still worthwhile) baseline creation by intervening groups like UN OCHA for the sole purpose of response. Our goal in response is to only be around for as long as we are needed, but civics is about investing in a longer-term view.
Civics and disaster response
While humanitarian aid is (in part) about the creation or improvement of long-term infrastructure, disaster response is about existing infrastructure being disrupted, and not even in the questionable type of disruption from Silicon Valley, but in the sense of “nothing is working the way we planned because the power and internet we have come to rely on are down and I can’t find my child.” In these circumstances, building tools which allow for (or even encourage!) off-the-grid communication or storage-until-able-to-update matter. As in, tools which would also work in low connectivity areas like humanitarian deployments are often better suited for crisis response than other everyday-use tools. We will be thinking about how to perform such coordination at HumTechFest, too.
An aside here seems necessary, to point out that the chaos of response is in this disconnection from the infrastructures on which we depend. The chaos is not in the form of people. People are amazing, often even more so in a crisis. While most of the field of Disaster Sociology points this out, a shorter (and easy) read is A Paradise Built in Hell.
The square you start from matters
While we can talk all day about the technology we use in our everyday lives and in times of crisis, the purpose of that technology is to help us connect with one another, to help us have safer and happier (and I would argue more dignified and coequal) lives. Social connections bolstered by mediating technology is how communities help themselves. Take Civic Hall‘s Noel Hidalgo, and his Coworking Map during Sandy response. It is from those spaces so many of the preexisting civic tech was reapplied to the new crisis circumstance, and that people found each other in order to address their unique concerns. The strong civic ties allowed for a more robust response. The same is true of the success of Occupy Sandy, grown from the ties created during Occupy Wall Street, and for the listening centers in West Africa which became essential for information distribution during the Ebola outbreak. Caring about sharing data in advance means you can more readily ask for external help… and then hold those responding accountable because there is a baseline.
Deepening the connection
We would love to explore this overlap further, and be more intentional in things like data hand-off and collaboration between existing community-based groups like Public Labs and Open Referral and NYC Prepared, official response organizations like FEMA and local Offices of Emergency Mangement, emergent response groups like Occupy Sandy and Boulder Relief, and back to those long-term civic groups. We would love to think about how those communication patterns might look, and what resources we can create to expedite the process. We have a lot to learn from groups like Humanitarian OpenStreetMap Team and Kathmandu Living Labs. As Heather Leson said in this blog post on Civicus,
How can maps and citizen-generated data empower civil society organisations to bring about change in their local community? In some parts of the world, existing physical layer maps are inaccurate and outdated. Imagine walking around your neighbourhood – do you know the names of all the streets, or where the nearest school or hospital is? With this kind of data, people are in a better position to plan futures for their communities. OSM enables each of these data items to be downloaded freely, making it a valuable civil society resource.
Projects like Promise Tracker, Taarifa, and the Riffle provide that strong baseline data which can also be useful in times of crisis, as well as the surrounding communities of practice. How excellent would it be to have all the capacity needed to respond already in any given location?! So rad. Because then it is not a crisis. When we frame response on strong civic engagement rather than a traditional perspective of short-term interventions, we are acting in a more efficacious and coequal way. We are acting in solidarity.
Join us in building this new world
We hope you will join us to be a part of this responsible lifecycle on June 4th and 5th in Cambridge, Mass at the Humanitarian Technology Festival. If you want to carpool up from NYC, we are happy to help with gas. If you are on the West Coast, we would love to see you at the June 16th Digital Responder Meet Up in San Francisco. And if you are remote to both those places, we have an ongoing mailing list and semi-regular call-ins you can join.
You can also contract me for facilitation gigs specific to employee retention through Vulpine Blue.
We’ve since continued cleaning up the documentation and refining the game process. And so dear readers, I’m excited to tell you about how this game works, how you can play, and how you can (please) help improve it even more. 
