Report on Resilience Session: Resilient Health through Networks

UPDATE: We’re doing a “take 2” of this exercise.

This time more slowly, and aiming to build a 3 page document that could help people in a country where an economic meltdown is happening (or is about to happen) to get some practical things done.

This is not for “health specialists” at all. Among other things, because, frankly, what do “health specialists” know about resilience anyway? :slight_smile:

If you want to work outside the google-doc, just use the comments.

We’re only starting. Thanks!

Resilience is the ability of a system to withstand sudden shock or prolonged pressure. (Your car breaks, so you walk or phone.)

(Another definition is “in a crisis, get what you need with what you have, now”, which would align resilience with sustainability which is somewhat similar, just not refered to “now” but to “indefinitely”.)

WHAT WE DID:

23 of us met for 2.5 hours, first together, then as 3 subteams. We used http://piratepad.net/-resilience as a common notebook but didn’t do big charts. Picture by @pdavenne (thanks!). Video from the plenary will be up soon-ish.

We brought a variety of interests in specific threats (poverty, food, water, energy, climate change, pandemics, economic meltdown) and strategies (focus on specifics, focus on technology, look at culture and knowledge, look at how coordination happens).

Given the short time available, we focused on a specific kind of shock: what to do if resources for health (money for staff and stuff) are cut to 25% for 2 years.

TOOLS WE LOOKED AT:

We looked at SCIM (Simple Critical Infrastructure Maps), an agile model for vital resilience, which looks at 18 needs of individuals, groups, organisations and states. It also looks at how those needs are provided for at levels from individual to home, town, region, country to international. Finally, it can be used as a “sense making” tool to help prioritise and “redesign around damage”.

We then looked at what’s known about human networks: people and their connections, differently shaped networks being better at resisting different attacks, and ways to “grow” the different shapes by growing connections between individual nodes. In health systems, networks are mostly “star-shaped” (both for treatment and for prevention), which have some strengths but could be complemented by fostering the emergence of “dense” neighbourhood networks.

MAIN RESULTS OF OUR EXPLORATION:

We used the above to look into three areas of health systems:

- Prevention (not becoming ill or injured). We worked on ways to make individual health resilience fashionable (rebrand it as “cool”) and contagious, and on ways human networks (peer-to-peer) could be used to help people help each other with healthy food, exercise, etc. This is also where systemic resilience (food, water, energy, governance - and also water filters, sewage, communications, etc) comes in too.

- Treatment (what to do once ill or injured or needing help with baby delivery etc). We came up with at least three kinds of networks that could be created or strengthened. Instant neighbourhoods for mutual care (check on who needs help with extra attention to the vulnerable), health-care experts for condensed practical advice (what to do with the most frequent reasons to contact health-care providers), and pharmaceutical experts for local production of as many medicines as possible (out of the 35-70 basic ones according to the World Health Organisation).

- Continuity (keeping the new activities strong after the first few months of media attention vanish). We looked into ways to prime the health system for resilience. These included training for diagnosis without much equipment, use of generic medicines, providing first aid training as part of the driving license process, teaching of good health from school, identification of simple problems to stop them from progressing into expensive ones, etc.

WHAT NEXT?

Comments! Thanks!

Human networks have a lot of potential

Very good report. I wish I could have been there. I must have been an intense session.

I must admit that I’m very impressed by the ‘pharmaceutical experts for local production’. That is brilliant.

Recently, I met a woman at a friend’s house. She explained me that she works in a pharmaceutical plant. She produces vitamins. She mixes different formulas of powder and presses them into pills with some big machinery. What I didn’t know is that there are people working on night shifts doing vitamins. You know, this blew my mind away. I had no idea that people were buying so many vitamins, to have a huge plant active 24/24 hours, 363 days a year. Instead of producing vitamins - which are not really basic medecine -, people like her would have the knowledge and skills to produce other kinds of  medecine. I don’t know… If we remove them their powder supplies, would they be able to produce medecine from scratch? From using stuff from nature?

I believe that much can be done in the Prevention area. Not becoming ill or injured can go very far and very deep.

Also, the treatment, alternative ways could be explored, that would avoid having to rely on medecine production.

Identification of problems (simple or not): what causes a recurrent problems, to stop having it repeating year after year. For instance, allergies, or respiratory illness, or skin diseases, etc. Why do some people get a certain illness year after year? What is it in their system that is weaker, and attracts the same similar physical manifestations?

The human networks (peer-to-peer) have a lot of potential…

Also, the global surveillance networks by citizens, have shown a lot of potential too. These should be reinforced, extended.

An overall global educational and surveillance system including all types of cataclysms. Merging all resources in a comprehensive overall effort, which could serve for different emergency and catastrophic situations.

networks

Thanks, Lyne!

I’ve recently had a chat with some pharmacists. They are watching, before others, what’s going on in the area of medication. They mention discontinuities in supply, lack of money from some people, and a certain amount of fear.

I’ve used that opportunity to mention tougher scenarios. What’s going on in Greece. What we did at lote. What we might be able to do locally. How we’re at least circling around the problems, and how there are some hints at solutions.

People don’t like looking at hard possibilities. Then they accept that you have the electric grid and you also keep candles and matches somewhere in your kitchen. I’m still trying to go deeper in the conversations around the 35 (or 70, or whatever the number is) essential medications, and how many might be manufactured distributedly, either as part of the normal way to do things, or in a crisis.

You (Lyne) and I have been flubies. That means we’ve looked at influenza pandemics for some time. Other people have looked at other specific threats (peak oil, climate change, poverty and others were mentioned), and most people have vaguely looked at many threats.

For me, it was a small revelation to have to write a short definition of resilience for this summary, one that included all threats. So resilience, as came out of our conversation, is about “sudden shock or prolongued pressure”. Timing matters a lot! This economic meltdown situation is going slower than I thought (my timing model was wrong). That’s good because there’s time to adjust. But it also has a “boiled frog” component, and a “fatigue” component.

You mention vitamins and other “non essentials”. I’m quite sure there’s lots of hidden slack in the system, at least in rich (or formerly rich) countries. People know things, and have tools. How much in the beauty industry (or in the chewing gum industry, etc) could be repurposed for pharmaceuticals? What’s the map of interdependencies between raw products (herbs or wherever it is that they get the molecules from), machinery, know-how, quality control, etc? This is the kind of things that’s best asked before a sudden crisis, or at the initial stages of a prolongued one.

Some things are not easy. Where I live, 7000 people (in 2 million) are insulin-dependent diabetics, meaning exercise, diet and oral medication is not enough. Most of them are young-ish. In a sudden, deep shock, many people are surely at risk. So a question was asked about insulin, and this is one answer we got: http://www.indiebiotech.com/?p=135 But of course we need to ask other people, and that’s where networks come in.

This too was a revelation for me. Maybe there’s need to ask several different people. Map out the problem, have the network grow out of partial contributions. A bit of a mix between the “you are here” train-network maps, and the “push here” of emergency buttons. Facilitate contributions to complex problems. (In a rush, or when people don’t feel the pressure.) Extremely intriguing, not to mention possibly quite useful!

I’m still recovering from lote. But one of this days - unless someone else beats me to it (wink, wink) - I’d like to look into the list of essential medications. Maybe there could be a way to estimate how much is needed of each one, for which ones there are already generics, etc. This is needed worldwide, given that many people live on less than 2-3 dollars a day, right?

There’s still a lot to do, and we have some questions.

list of essential medications … and stuff

Easier than I thought, and more recently updated than I thought (2011): http://www.who.int/medicines/publications/essentialmedicines/en/ = http://whqlibdoc.who.int/hq/2011/a95053_eng.pdf (adults, 45 pages, index at pages 38-41 shows it’s about 360 different products, maybe some in different presentations: oral, intravenous, etc) + http://whqlibdoc.who.int/hq/2011/a95054_eng.pdf (kids, 15 pages, index at pages 32-34 shows it’s 260 different products, same caveat).

There’s probably lots of overlap between lists (haven’t checked), so probably 400-500 different essential medications, including vaccines, some diagnostic products, oxygen, etc. The “core list” is even shorter.

These lists are also a good review of what can kill people. Of course, health is not just about staying alive, but also about being free from pain, able to function and aesthetics (where aesthetics is really social pain/function) [all this was from my first-year list of “priorities”: life, pain/function, looks] … so there’s something missing in these lists: prosthetics and other devices (for diagnosis and treatment). Browse this for a sample: http://d-rev.org/projects.html and this http://www.appropedia.org/Portal:Health_and_safety

Looks like a parallelisable problem, a bit like translations (explored at http://edgeryders.ppa.coe.int/help-fellow-edgeryder/mission_case/one-glad-be-service). With help from experts. In some kind of open wiki. The edgeryders’ way? The appropedia way? At least the wiki way: content pages, user pages, index pages (in whatever order you choose, and probably feeding on each other organically & spirally). Lots of “reader beware” notices, and zoom. Easier said than done, but some already happening, so we’ll see.

(All of this is not without risks, of course. The simplistic idea that “nuclear bombs are just tools for space exploration with the explosive part at the wrong end of the cylinder” might apply to these products. Medications are “poisons at low doses”. Knowledge - and wisdom! - around tools is needed.)

“The ‘chemputer’ that could print out any drug”

Looks relevant: The 'chemputer' that could print out any drug | Drugs | The Guardian

<<<<Professor Lee Cronin is a likably impatient presence, a one-man catalyst. “I just want to get stuff done fast,” he says. And: “I am a control freak in rehab.” Cronin, 39, is the leader of a world-class team of 45 researchers at Glasgow University, primarily making complex molecules. But that is not the extent of his ambition. A couple of years ago, at a TED conference, he described one goal as the creation of “inorganic life”, and went on to detail his efforts to generate “evolutionary algorithms” in inert matter. He still hopes to “create life” in the next year or two.

At the same time, one branch of that thinking has itself evolved into a new project: the notion of creating downloadable chemistry, with the ultimate aim of allowing people to “print” their own pharmaceuticals at home. Cronin’s latest TED talk asked the question: “Could we make a really cool universal chemistry set? Can we ‘app’ chemistry?” “Basically,” he tells me, in his office at the university, with half a grin, “what Apple did for music, I’d like to do for the discovery and distribution of prescription drugs.”

The idea is very much at the conception stage, but as he walks me around his labs Cronin begins to outline how that “paradigm-changing” project might progress. He has been in Scotland for 10 years and in that time he has worked hard, as any chemist worth his salt should, to get the right mix of people to produce the results he wants. Cronin’s interest has always been in complex chemicals and the origins of life. “We are pretty good at making molecules. We do a lot of self-assembly at a molecular level,” he says. “We are able to make really large molecules and I was able to get a lot of money in grants and so on for doing that.” But after a while, Cronin suggests, making complex molecules for their own sake can seem a bit limiting. He wanted to find some more life-changing applications for his team’s expertise.

A couple of years ago, Cronin was invited to an architectural seminar to discuss his work on inorganic structures. He had been looking at the way crystals grew “inorganic gardens” of tube-like structures between themselves. Among the other speakers at that conference was a man explaining the possibilities of 3D printing for conventional architectural forms. Cronin wondered if you could apply this 3D principle to structures at a molecular level. “I didn’t want to print an aeroplane, or a jaw bone,” he says. “I wanted to do chemistry.”

Cronin prides himself on his lateral thinking; his gift for chemistry came fairly late – he stumbled through comprehensive school in Ipswich and initially university – before realising a vocation for molecular chemistry that has seen him make a series of prize-winning, and fund-generating, advances in the field. He often puts his faith in counterintuition. “Confusions of ideas produce discovery,” he says. “People, researchers, always come to me and say they are pretty good at thinking outside the box and I usually think ‘yes, but it is a pretty small box’.” In analysing how to apply 3D printing to chemistry, Cronin wondered in the first instance if the essentially passive idea of a highly sophisticated form of copying from a software blueprint could be made more dynamic. In his lab, they put together a rudimentary prototype of a chemical 3D printer, which could be programmed to make basic chemical reactions to produce different molecules.

He shows me the printer, a nondescript version of the £1,200 3D printer used in the Fab@Home project, which aims to bring self-fabrication to the masses. After a bit of trial and error, Cronin’s team discovered that it could use a bathroom sealant as a material to print reaction chambers of precisely specified dimensions, connected with tubes of different lengths and diameters. After the bespoke miniature lab had set hard, the printer could then inject the system reactants, or “chemical inks”, to create sequenced reactions.

The “inks” would be simple reagents, from which more complex molecules are formed. “If I was being facetious I would say that to find your inks you would go to the periodic table: carbon, hydrogen, oxygen, and so on,” Cronin says, “but obviously you can’t handle all those substances very well, so it would have to be a bit more complex than that. If you were looking to make a sugar, for example, you would start with your set of base sugars and mix them together. When we make complex molecules in the traditional way with test tubes and flasks, we start with a smaller number of simpler molecules.” As he points out, nearly all drugs are made of carbon, hydrogen and oxygen, as well as readily available agents such as vegetable oils and paraffin. “With a printer it should be possible that with a relatively small number of inks you can make any organic molecule,” he says.

The real beauty of Cronin’s prototype system, however, is that it allows the printer not only to control the sequences and exact calibration of inks, but also to shape, from a tested blueprint, the environment in which those reactions take place. The scale and architecture of the miniature printed “lab” could be pre-programmed into software and downloaded for use with a standard set of inks. In this way, not only the combinations of reactants but also the ratios and speed at which they combine could be ingrained into the system, simply by changing the size of reaction chambers and their relation with one another; Cronin calls this “reactionware” or, because it depends on a conceptualised sequence of flow and reorientation in a 3D space, “Rubik’s Cube chemistry”.

“What we are trying to do is to combine the notion of a reaction with a reactor,” he says. “Conventionally the reactor is just the passive space or the environment in which a reaction takes place. It could be something as simple as a test tube. The printer allows it to be a far more active context.”

So far Cronin’s lab has been creating quite straightforward reaction chambers, and simple three-step sequences of reactions to “print” inorganic molecules. The next stage, also successfully demonstrated, and where things start to get interesting, is the ability to “print” catalysts into the walls of the reactionware. Much further down the line – Cronin has a gift for extrapolation – he envisages far more complex reactor environments, which would enable chemistry to be done “in the presence of a liver cell that has cancer, or a newly identified superbug”, with all the implications that might have for drug research.

In the shorter term, his team is looking at ways in which relatively simple drugs – ibuprofen is the example they are using – might be successfully produced in their 3D printer or portable “chemputer”. If that principle can be established, then the possibilities suddenly seem endless. “Imagine your printer like a refrigerator that is full of all the ingredients you might require to make any dish in Jamie Oliver’s new book,” Cronin says. “Jamie has made all those recipes in his own kitchen and validated them. If you apply that idea to making drugs, you have all your ingredients and you follow a recipe that a drug company gives you. They will have validated that recipe in their lab. And when you have downloaded it and enabled the printer to read the software it will work. The value is in the recipe, not in the manufacture. It is an app, essentially.”

What would this mean? Well for a start it would potentially democratise complex chemistry, and allow drugs not only to be distributed anywhere in the world but created at the point of need. It could reverse the trend, Cronin suggests, for ineffective counterfeit drugs (often anti-malarials or anti-retrovirals) that have flooded some markets in the developing world, by offering a cheap medicine-making platform that could validate a drug made according to the pharmaceutical company’s “software”. Crucially, it would potentially enable a greater range of drugs to be produced. “There are loads of drugs out there that aren’t available,” Cronin says, “because the population that needs them is not big enough, or not rich enough. This model changes that economy of scale; it could makes any drug cost effective.”

Not surprisingly Cronin is excited by these prospects, though he continually adds the caveat that they are still essentially at the “science fiction” stage of this process. Aside from the “personal chemputer” aspect of the idea, he is perhaps most enthused about the way the reactionware model could transform the process of drug discovery and testing. “Over time it may redefine how we make molecules,” he believes. “In particular we can think about doing complex reactions in the presence of complex chemical baggage like a cell, and at a fraction of the current cost.” Printed reactionware could vastly speed up the discovery of new proteins and even antibiotics. In contrast to existing technologies the chemical “search engine” could be combined with biological structures such as blood vessels, or pathogens, offering a way to quickly screen the effects of new molecular combinations.

After publishing some of this thinking and research in recent papers, Cronin has of course been talking to various interested parties – from pharmaceutical companies intrigued by its implications for their business models, to Nato generals responding to the idea of the ultimate portable medicine cabinet on the battlefield.

He hopes that large-scale humanitarian organisations – the Bill and Melinda Gates Foundation and the rest – might take a hard look at the public health and cost benefits of introducing such a possibly revolutionary technology to the developing world. As a scientist, Cronin tends to play down the potential legal and practical obstacles that will no doubt challenge the idea – “I don’t imagine gangsters printing their own drugs, no” he says to one question – and sees only benefits.

“As yet,” he says, “we don’t even know what the device would look like.” But he believes that now the idea is established “there is no reason at all – beyond a certain level of funding – why it all couldn’t happen very soon.” Cronin is impatient to get on with it as quickly as possible. “As well as transforming the industry and making money,” he says, “we could be saving lives. Why wait?”>>>>

Plan B should include strategies to remove the fear about panic

You said you are still ‘recovering’ from lote. I’m ‘recovering’ from The Lancet’s model of estimated global mortality associated with the 2009 pandemic influenza A H1N1 virus. The 31 scientists who signed this paper demonstrated that the number of deaths was 15 times higher than what was announced in official press releases of governments.

I spent four years repeating like a parrot that the official data was wrong. The Lancet study also shows that “80% of the respiratory and cardiovascular deaths were in people younger than 65 years”. What anyone with a minimum of experience with influenza viruses was able to predict, but that kept governments in denial.

I totally agree with you, people don’t like to look at the hard possibility. Why is that? Because we feel insecure and threatened by such thoughts? Because we’re not very good, in general, with long term planning?

But there is more: PEOPLE DON’T LIKE TO LOOK AT REALITY when a catastrophe occurs. The real numbers get camouflaged. This happens for a number of reasons. The main reason is that governments do not want the population to PANIC. So, instead of releasing the valuable data, they repeat insipid messages aiming to reassure the public, instead of giving people the information and guidance what would help them to become resilient. The fear of governments about the fear (panic) of citizens. This fear is extremely dangerous because it causes unnecessary deaths among the population. a morbidity rate that could be avoided with resilient and well prepared communities.

I think than in whatever Plan B, the fear attitude should be highlighted. No matter how good the plan is, if there is no strategy to neutralize the fear of the (possible) panic, the success of implementing the plan might fail. Citizens, will they really panic? On what parameters is the fear of governments really based. How do citizens really behave, when an emergency situation occurs. What do citizens do? To what extent is there solidarity emerging? What is the contribution of citizens, how many new ways and ideas emerge from citizens’ end.

During the 2009 pandemic, it was declared that the deaths were caused mainly among people 65 and older. (While any Flubie knew that this would not be the case.) We should look carefully, in addition to the list of basic medicines, to which proportions of the population are at risk, by disease type, or by various other factors.

As is done for vaccine distribution, in very severe pandemic scenarios, one should also consider the possibility of priorities in the intervention and care.

As in the scenarios of a major disaster, the number of deaths should be estimated. A graduated scale, corresponding to the different degrees of disaster. Then imagine what the effects could be at each stage. With a graduated scale, it becomes possible to organize a group of people with diversified skills to participate in simulation table exercises.

I do not think it ever took place, table simulations involving pharmacists, doctors, herbalists, midwives, mystics and others.

Another interesting aspect about a Plan B is that is suddenly would give a chance to alternative medicine, complementary medicine, natural medicine, holistic medicine, etc., to receive some recognition. Complementary medecine, integrative medecine, as opposed solely to “classical” mainstream medecine. Folk knowledge, spiritual beliefs, and newly conceived aoproaches to healing, promoting self-care and self-healing, are all part of these alternative kinds of medecine. Complementary or alternative medecine often lacks or has only limited experimental and clinical study, therefore claims of their efficacy tend to lack evidence, but this does not mean that they are bad or inappropriate. A Plan B would imply to remove another fear: moving beyond the mainstream medecine’s boundaries, and consider for the first time to switch to other forms of medical treatment. There is no simulation or estimate of the percentage of success that these alternative methods could have, in absence of mainstream medication.

So yes, there are many things to do, there is much planning and preparedness to carry out, and this should ideally be done with the help of the largest possible proportion of citizens.

AN ASIDE ON FLU: numbers, fear, alternative medicines, and plans

I’ll try and keep this short and to the point. I find flu fascinating, but wouldn’t want to drown in it!

I honestly don’t think the official numbers were wrong. Here’s what I know about it:

  • Flu viruses cause a wide range of symptoms, from no-symptoms-at-all in maybe 30% of all infections, to death in maybe about 1-2 in 10000, and severe cases are counted more easily. Countries differ widely in diagnostic capabilities, which also change along time (once the pandemic was "certified" there was no point in sending many samples to the virology labs, which were overwhelmed anyway). So official numbers - at least with flu - are known to be only part of the picture.
  • Even so, starting in 2009, people in the know (including those of us who worked with our local systems to count cases and make the best possible estimates), started building a coherent picture pretty soon (October 2009?): "this flu is abundant, not as deadly as feared, but it disproportionately kills the young". New figures, if I read them correctly, have brought solidity and comparability.
  • All of this proved hard to communicate: the full picture about the present was distorted by part of the media (those who focused on the relative small number of deaths, without mentioning the very large number of mild cases), and probably by everyone's uncertainty about the future. One key lesson is numbers can't be given alone, without sharing the understanding of how those numbers are arrived at.
You mention "panic", and I agree it's not a useful term. Fear can be appropriate (if say 5% of those who fall ill die, do I send kids to school? most likely not!), and public attention is best guided to real data, real uncertainties, and open talk about sensible behaviours. Not always done, I know! I think what matters most is behaviours: slowing down the spread of the virus, helping food supplies move along, etc.

Regarding what we might call “alternative medicines”, I know different people have different views of what works and doesn’t work. Personally I prefer to stick with the scientific method as a way of inquiry, and apply it to all alternatives:

  • To start with an example from "official science", it has been suggested that some generic pharmaceuticals might be useful in the next pandemic, and some studies have been done, but apparently we can't be sure yet. If a bad pandemic were to start before those better studies are done, we'd start flying by the seat of our pants.
  • I claim no knowledge about what's been labled as "alternative medicine". Some of those alternatives will work (and then become official!), but some won't (if their effects are better attributable a) to natural variations in diseases and people, which let us believe almost anything from the same data; or b) to the very real placebo effects). As with the other options, we'll use whatever makes sense to us.
Regarding planning, the recent papers on how bird flu might become transmissible (at least in ferrets) might signal a renewed interest, but we'll see.

Back to the financial meltdown scenario?

Contributors

Good luck with the financial meltdown. I am sure you will find valuable contributors.

Iteration 2?

This looks good, Lucas, thanks! I was wondering: is there any point doing a second iteration of this? It would entail working on a shared document to build an orderly 3-pager that could be shared around.

I guess the answer to this depends on whether we think an “(Almost) instant ultralow-cost Plan B for health care in a financial meltdown” would be of any interest to anyone. Thoughts?

and beyond!

Yes. It does sound like “(Almost) instant ultralow-cost Plan B for health care in a financial meltdown” is of interest to many already - different situations if the society around you is poor or not, of course.

So. Details …

Where:

  • We have http://piratepad.net/-resilience (I was intrigued, how do you get a name instead of a random string as the name for a new pad - ah, yes, just use the url you want, ok)?

  • Or maybe it would be better to have a googledoc (how open, I don’t know - if very open, why not the piratepad)?

  • In either case, this is just a continuation of this exercise, so we write here, right? Not sure, and that’s why I ask. Whatever works!

Structure:

  • We can just unfold what we have. Focus on some branches, maybe.

  • I’d like a “reference section” for stuff people have already been doing. Examples of people joining forces to eat healthy, exercise together, etc.

  • A second round means more people can come and add to the Stone Soup.

  • I’d like (please!) some links about how networks work. Looking at old things (for me) through that new lense was quite intriguing. I’d like to think slowly about this, as new paths open up. (My metaphor for this is driving the bike very slowly: at each point of the path described by the wheel on the ground there are alternative pathways on either side. If you drive fast you miss forks that are potentially good.)

Enlisted men (and women)

Ok, I’ll tell you what. I am happy with any tools. GoogleDocs is more inclusive for less tech-literate people. PiratePads are for hardcore cypherpunks who do not want to be logged in. Wikis are in between.

The thing is, realistically I am not going to be able to do any work for at least a week. Do you think you can enlist some people in our team to get going?

As far as networks go, you could start by reading a popularization book. Linked by Barabasi (a gold-plated network mathematician) is a little too American-style popular science, but a good start if you want to start slow. If you are curious about what I am trying to do, start here and then look for “Dragon Trainer” on my blog.

participants

I took a picture of the names of those participants who wrote their names on the table at the main entrance hall. My idea was I could post that as a nice way of showing who we were. But then my phone did something strange: it deleted photos by similarity, leaving only one of each: one mountain-top from the plane, one Strasbourg street, etc. :-?

I counted 23 in the picture above.

One more report!

http://www.theproject.ws/es/ruralab/entrada/first-edgeryders-meeting from Ricard.

take 2

I don’t know if this is too open (or too closed), but we can always close it (or take it to other places) later if needed. Over to you!

https://docs.google.com/document/d/1Dx5NZe-qaM1iRGz1nOceGch-4T1NOeB4Zb8ITAd8ZPE/edit

In a nutshell:

  1. Scenario:
    1. European country, same needs as yesterday, 25% of resources for (at least) 2 years.
    2. Some people suffer more than others: more vulnerable to disease, poorer, less networked.
    3. Some countries more self-sustainable in terms of (capability for) production of vital stuff than others.
  2. Some ideas:
    1. Focus on deaths/vital (numbers and ages for “potential life-years lost”), then pain&function, aesthetics probably falls. Work in concentric circles, or go for low-hanging-fruit or serve-as-expandable-example first.
    2. Focus not just in the obvious treated diseases (medication, surgery), but also in mortality contained with infrastructure (extreme weather, clean water, food, sewage) & public health (vaccines, lifestyle).
    3. Networks of neighbours etc can fill in some gaps. Better with helpful leaflets to give essential “disease prevention & management” leaflets built by small, focused networks of both citizens and profesionals, to help create instant networks for mutual help.
    4. Networks of a variety of profesionals can look into specialised vital supplies. There’s a list of at most 500 products, some more specialised or vital than others, some possibly impossible to manufacture locally
    5. General resilience in weather, food, water & sewage. Specialised resilience in (health-related) transport, communication, patient data, health-related knowledge, etc.
  3. Next steps?
    1. Make list of specific examples, a sample of the full scenario, so we may work on specifics. Diabetes, broken bones, baby delivery, elderly & a few other examples.
    2. Look at the details of solutions, to try and make them workable.
    3. Grab more eyeballs & hands. Grow our networks.
    4. Make a list of resources (health statistics, essential products, "where there's no doctor", you name it!).
    5. What else?
So?

numbers, negotiation, provocation and movement

Arthur wrote a comment saying 75% reduction may be [my phrasing] (a) too much for most of us to wrap our heads around, and (b) maybe more than what’s needed to bring a system to its knees.

The number itself carries no direct meaning, because the situations are messy in real life. Messy along time and space and person, because at first it’s 5% here, 10% there - then it get worse but people say it’s soon going to get better - and of course some people get a worse deal than others.

If we forget the number, we can look at the “quality” of the situation: is the decrease in funding deep enough to make us change the way we do things? An individual example: Let’s say my heart is weak but not too weak, so I can walk to the food shop which is 2 km away. Maybe a 5% decrease in my heart’s strength will force me to take the bus instead of walking, or ask for someone else to do the shopping for me.

So, yes, I believe it’s a very helpful comment, Arthur!

We cannot negotiate with the reality (country, income, health, networks) we start from. That’s a given.

But in this exercise we want to think about changes, and we have the luxury of defining our own numbers.

One way to think about changes is to try and imagine that the situation is bad enough, whatever that is. This, in lateral thinking terms, is what’s called “provocation” (a conciously applied exercise in breaking our previous ways of solving problems, splitting the puzzle into individual pieces, or whatever way you like to think about it). For me, a 75% cut is a provocation. For others, it may be enough to think of a 20%, or in some systems even a 5% decrease. Whatever works for you!

Once we imagine that, we can start to think of many small changes, here and there. A zillion small changes, or maybe a few big but doable ones. This is what’s called “movement”: finding another path through the maze, either by breaking walls, or by building bridges, or by defining better goals, or whatever. You progress from the provocation, to the hint of an idea, to a concept that smells good, to an idea that might work, to something that might be tested in real life …

Some do that by finding hidden treasures (the unused power of networks was a blast for me, and some talk about “Assets Based Community Developement” etc). Others by looking at what others have done in the past (“applied history”). Or by thinking very slowly: go through the way you do things like you would drive a bike inch by inch, so that you have time to discover useful turns that you’d normally pass by in a rush. Or, again, whatever works for you. And of course you can use all of them as tools, in turns, alone or with others, just for the productive fun of it!

Others use new perception frameworks, tools to look at things in a different way. I saw that just yesterday. We were looking at the levels by which medication comes to the individual: from international to country to region (warehouse) to pharmacy to home. The present situation is one of “just in time”: globalisation kinda works for some of us, and the flow of goods is fast and uninterrupted. So, in the event of a temporary interruption, you want some “stocks” to make up for the loss in “flow”. We could then think about what level to use for stocks, etc.

In short: for old situations we make use of our memory. For new situations, we need serious & applied creativity. This exactly is what I meant by “it was fun & we’re good at it” when we presented at the “general assembly” on Friday 14th.

Numbers? Ok, shrug, let’s just use them as a tool. (Or more.)

Vital gadgets

http://practicalaction.org/blog/practicalanswers/low-cost-neo-natal-incubators/ is a good example of a “need”: keep babies warm. You

  1. look at a device in a rich country,
  2. ask what purpose does it serve,
  3. then ask what other way can you use to attain the same goal.
Needs, not systems. A system may fail, but the need remains:
  • You have the electric grid. One day, it fails, so you have no light. Being able to read and find your way in the dark is a need. So you produce the candles and matches you had stored somewhere in the kitchen. Just-in-case tech.
  • You have the electric grid. One day, it fails, so you can't desinfect your surgical knife (another need). So you boil water burning useless paper that was laying around. Just-in-case ideas. Having the designs of a list of vital devices that can be built with local resources is almost as good as having the devices themselves. Designs that can be made with resources that are local (or easy to get, like the hexayurt's panels) are rapidly scalable.
(The above can be drawn as a mini-mindmap: "system" has branches, each of them a "need". Each "need" has branches, each of them "another way". Redesign yer life!)

Two good sites are http://www.appropedia.org where they have http://www.appropedia.org/Portal:Health_and_safety and http://d-rev.org/projects.html

These technologies and ideas make sense for the poor, the soon-to-become-poor, and the maybe-to-become.

So, again, networks of people who know the needs, people who have the tools, people who can provide the funds. And agile development. lote, anyone?

HIAB?

Is this Health In A Box?

Nope. Health is out of the box already.

Things don’t start from scratch.

A thought experiment?

What or whom would you like to connect with to move forward…

Hey Lucas,

I see you are on to something here. How could people interested from the community help with this?

thinking hard …

… about it, Nadia, and thanks for asking!

There’s this tendency to assume knowledge needed for this challenge is specialised. Some of it may be. But surely a “coalition of the willing” - that’s us - will bring whatever each of us has to the common table. Questions count!

I’m keeping a wide ear open to what people have in them, either here, through the “wall”, the google-doc, email, twitter, etc. Shyness is not a virtue. :slight_smile:

If I force myself to think about “what needs done”, I think some of it includes looking at what’s essential (a model for what’s done in the realm of health, and numbers to tell us of what matters most) and then at how to solve it in practice (how do we use the networks in practice, what are known models, what are the real-life suggestions, how do we do it on the road).

If we look at it in terms of “agile development” (you know, people developing a piece of software for a user, as fast and as well as they can) then we need … the user. What’s called “the product owner”. Someone who will speak from (some of) the poor. Someone who will keep us focused on what matters. I’d like a solar-powered drone with a camera and an automatic voice-translator to visit the place and tell us how things are in … wherever it is that things have gone bad already.

So I guess this boils down to three questions, to start with:

  1. How do interested edgeryders read what we've compiled so far? Opinions, gaps, wrongness of approaches, kicks on the compiler's behind, etc.
  2. How do we use networks in practice? What do we know about that? What almost-useable experiences do we have that could be slightly modified to be useful in the area of health?
  3. How do we contact people on the ground, the people we are serving? This is probably the hardest one, and we may start with the others, but I won't let go off it. If ER is about something, is about gaining contact with stakeholders directly if at all possible.
Thoughts?

hard & soft resilience

Ok, just came back from a twitter conversation, involving at least four, erm, edgeryders!

I won’t re-read the whole thing: many comments in a busy hour, difficult to dig up again. So what follows is my personal recap. Good ideas are theirs, mistakes are mine, etc.

  • People who live close to each other may not be a community.
  • Being a community helps with some things ("Why hasn't person A answered the phone? Should we check that (s)he's ok? Hi, doc, my neighbour looks pale and can't speak. Ok, I'll go collect your meds and do the shopping for you"), but not with others ("Hey, it's 500 of us, but none of us has insulin and 1-2 of us need it or they'll die in 3 days").
  • We need to multitask: some in the tribe focus on resources, some on care.
  • I would personally prefer resources that are abundant enough, such that less (terminal) care is needed, but that choice is not very realistic: you want both.
  • Skills are important. Multiplying them rapidly can be done for some things ("cross training"). Some skills will fall outside a small community, no matter what.
Some other ideas:
  • Know-how on how to make meds may exist in universities or even in hobbyists. Looks dangerous without quality control, but.
  • The supply chain basically goes from maker to distributor to pharmacy to home. If globalisation works, stocks can be small. Then, if globalisation doesn't work, stocks are too small. So it might be a good idea to have larger stocks for vital medications - where? Probably in pharmacies, because keeping lots of insulin at home might be a bad idea. There could be "resilient pharmacies" that keep your medication for you - paid for already, but with your name on it. Policy would need to change, or maybe not! Who can we ask?
A fifth edgeryder had mentioned two other things in an earlier conversation:
  • Supply chains are longer than it looks. Insulin comes out of the factory, but some ingredients must get into the factory, most frequently from a (large) distance.
  • There's something called the "patent cliff", which might be relevant. Apparently, "intelectual property" expires after some time, and how to make certain meds will be open to other makers.
Did I miss something? Would others add something? Thanks!