Blogphilosophy: learning is a way out of life's options given at birth

Life is a long strand of actions, choices, forced decisions, or results that can be causes themselves and causes leading to results... my learning path cannot be called normal nor without its challenges, nevertheless, I made it. Meaning: I got out of a precarious place, I left chaos behind me. I now have a job, a house, a partner that loves and loved me even when the chips were down. I survived and all of a sudden I realized when looking what happens in the world today ... life was easy.

If you have ever been poor, or challenged, or have fallen victim to one of the many temptations that lead to a life of misery and complexity, you know why at a certain point you pull yourself together and start learning. For if you had to fight for a long period of time, simply to keep on living, there is only one way out. Granted, a way out that has many faces, but the same at its core: learning.

We learn to get out of the mess we are in, or - less dramatic and urgent - to improve our lives. In the first case, we cannot but learn the hard way.

Yesterday I got word that one of the children from the day care center my son is at, will be banned. Her parents no longer have the money. They are in debt. Having been poor, I picked up certain familiar traits indicating financial challenges creeping up on them. Nothing big, the last thing any of us want is that poverty becomes apparent at first glance, but nevertheless those of us who have been there, see it.
That little girl of not even two years of age will now stay at home. Her family situation is tough and with no quick fixes.As soon as finances become a heavy burden, family life gets harder. Everything becomes a discussion. Tensions arise. Everything becomes a priority, and sadly every choice deletes another priority. So here she is, that little girl, amidst dire straights, no longer at a nanny for 7 hours a week. She was at ease at the nanny. There she got organic fresh food, a good and safe shelter, and positive stimulation's. During every day at the nursery that little girl would learn from her peers, have no or less worries for a big part of her waking day. Now, she will be out. And once a child is out of daycare in my region, it is almost impossible to get back in. Because she will now be home, the chances of her parents being able to earn extra money diminish as well... she risks being caught in a downward spiral simply because of her position since birth.

In the same week I heard that the 21 year old Somalian athlete Samya Yusuf Omar, who carried the Olympic flag for her country during the Beijing games perished. Dead because she was on a path to improve her living conditions, her chances. She wanted to compete during the London Olympics and had the potential, but ... on her way to find a coach (she did not get funds in her own country), she died during a shipwreck, while escaping her living conditions in an attempt to increase her chances, attain her full potential. Living conditions she tackled were undoubtedly plenty: sports, endurance, perseverance, creating chances ... unfortunately her birth chances put her in a difficult starting position and because of that, at a certain point she embarked on a fatal trip in a raggedy ship, heading North to Fort Europe.  

The thing is, learning is not simply getting a degree, having some paper indicating you went through hours of books, assignments... For the most of us learning is the only way out of personal challenges, and its a hard road without guarantees. And what is worse, hardly any of us get to learn what it takes to learn. Learning takes a lot of unwritten skills. That is why learning in any form is so dear to my heart. I need to believe that when we all pitch in, we can make a change. Create more chances... not to become the president or prime minister of any country, but to attain peace of mind, or peace all together.

In the meantime my son has two mothers watching over him, both of them now working in education. We know the benefits of education and of the simple act of learning. We know how the system works, what the pitfalls are and why simply learning to learn will improve his chances for a healthy, happy life. For us, he does not need to become anything else but a happy human being, able to find his way. Not sure if it will work, but ... at least there are increased chances. Would not it be lovely to create these chances for all of us?

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Does #mobile learning really make a difference in this world?

Years ago I met Devaji Patil in Bangalore, India and … I related to his spirit and wisdom. Devaji is a philosopher at heart and a medical doctor by profession. In his new job he wants to set up mobile health projects, but at the same time he wants to make sure they will be durable and basically… make sense to the people it is designed to help. So he challenged me with some tough questions comprising ethics, meaningfulness, gender challenges and effectiveness of learning with mobiles. I could get some thoughts in, but I feel many more people are needed to answer his questions in full, so feel free to add ideas or send Devaji additional answers.

1. how are we sure that mobile learning is really empowering

For ages people, both philosophers and lay-people, have been discussing the empowerment of learning or education in general. Looking at the Millennium goals, I can see that most of us still believe in it, but even the most basic primary education is not reached yet. I think this is due to lack of durable, educational vision. Any learning, including mLearning will only be empowering if it is made accessible to all, inspiring, comprehensible, participative as well as collaborative, with guidance for those learners that feel the need to have a guide-on-the-side and most of all durable within a flexible learning environment. Looking at teachers that are real corner stones of education, they know how to appeal to their learners, lift their spirits, inspire them to reach their full potential. That type of teacher is creative, knows how to reach his/her learners and find the strength within the learner. This being said, I feel that every learning is based on inspirational, creative people with vision and trust in the future of their learners. As such I am sure Devaji that if you set up mLearning courses, they will be empowering.  

2. how to actually negotiate the barrier of technology to an 'illiterate' health worker?

The best way to negotiate the barrier is by using what they use, or trying to reimagine new technology with how they use old or known technology. It is not necessary to read if you have a phone, in that case speech can be enough to exchange knowledge/information. So basic cell-phones can be used as help-lines, where patients phone in, and health workers phone back.

If the spoken feedback of the health care workers are than added to a data-base after ‘speech to text’ software, this database can be used for future cases. At the same time radio transmissions offer a great, non-reading, durable way of getting knowledge (continued medical education) distributed to large crowds in a less expensive way, and radio is a mobile device. A case study using radio for this reason (in Philippines for rural farmer women) is linked here (http://www.tistr.or.th/RAP/publication/1999/1999_08_rome.pdf). What strikes me is that funding is much more difficult to get for this type of proven, mobile learning than small scale smartphone projects (but that is another discussion).

3. with rapidly changing technology ... what is happening to pedagogy? Does pedagogy change too ? As fast as technology ?

Good pedagogy stands apart from technology, but technology can be used to get good pedagogy out to the masses and via distance education (reaching the difficult to reach, in every sense of the word). I feel that pedagogy is very human, and as humans only change slowly, good pedagogy will also only adapt to the pace in which humans can reach their own bigger potential. However with the evolution of technology, the variety of teaching/learning that can be reached via distance education does evolve more rapidly than before: which means that more people can be reached based on the same concepts of good pedagogy (e.g. participation between rural health care workers is now possible by using simple cell-phones).

4. Are we in a position to make 'learning' a central theme of Health systems strengthening if we are then where is it being seen if not why not ?

The knowledge and application of durable and scalable mLearning is still in its early beginnings. In just a couple of years’ time mLearning starts to take off. This means that a lot of projects did not take off due to lack of knowledge about all the factors impacting a project or target population, other projects do take off but are sometimes stopped due to non-durable options… And sadly those projects not attaining what they were meant to obtain are rarely disseminated, although most of us are eager to learn from mistakes to ensure successful future endeavors.

To me learning or training should be at the center of any system, including health systems. The concept of Lifelong Learning did not come out of the blue, but came out of an awareness that constant education will be a must in a world where changes happen increasingly rapid.  

A stable, durable health system will have learning and specifically continued medical education embedded in its core, for without keeping health care workers, health managers… up to date on latest changes, the patients will not be reached with optimal health care. In relation to this, I share this National Health Service (United Kingdom) paper focusing on 29 recommendations for embedding mLearning in their health care system http://ignatiawebs.blogspot.be/2011/04/how-can-health-within-clinics-be.htmlthese recommendations do not always apply to more challenged regions, but some of them can indeed be implemented.

5 Why is human interface still important. ?

For trust, real understanding, and for reaching those that need some time to voice the problems they are facing, and to reach those that feel insecure or unable to share text.

6. How to / Why / Where/ When to place technology enhanced learning in health systems that are not just weak ... but actually in a disintegrated state?

That is something else, if a system is in a disintegrated state it needs to be rebuild from the ground up I guess. In that case technology might be used to start communicating about most urgent issues but … if a basis is unstable, you can be sure that any rapidly designed technological addition will only amount to even more disruption.

7. Is technology gender sensitive ?Technology is definitely gender sensitive. It has the old stigma (male’s are better at it), the new social-economic realities (women have less access to technology) and the gender digital divide. There are exceptions, but it is an uphill battle to get women on an equal opportunity base regarding technology or its related solutions. To that topic I refer to GSMA’s woman mobile initiative: http://www.mwomen.org   

These types of subjects will be covered and discussed during MobiMOOC in week 2 by John Traxler and week 3 by Michael Sean Gallagher, so feel free to join the discussions. Looking at the participants I am sure they will be able to add much more solutions and ideas than I can. 

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#mHealth a #diabetes #mobile project in DRCongo, Cambodia and the Philippines

Most of us want to make some kind of difference, making the world a better place. Josefien Van Olmen is one of these wonderful researchers at ITM that gets it done. A few months back she asked me to get involved in a diabetes project which would involve basic cell-phones. We all got our heads together (doctors, social scientists and technologists) and set up a really cool and easy to build and implement diabetes project. For those interested a quick overview of how it was set up:

Josefien drew up the medical side of things, taken into account national differences, regional challenges, medical ethics, etcetera. She is a very intelligent expert researcher and she drives her people hard but with an incredible warmth of heart. Will not link to any medical framework here, as this is part of Josefien’s work, but feel free to contact her if you want to learn more about it: Josefien’s LinkedIn page can be found here.

Needs going into the project:

• Getting in touch with diabetes people (diabetes 1 and 2) who are living in remote areas or who have a hard time getting to their health clinics/health care workers/diabetes educators.
• Keep the diabetes project at low cost,
• Make use of the personal cell phones the diabetes patients have (cheap cell phones, mostly java enabled) to make them feel comfortable with the technology of the program.
• Make it generic so other organizations in the country (or elsewhere) would be able to reproduce it for their own purposes,
• Get people empowered to use their cell phone for practical life changing/enhancing topics.
• Make the program strong and durable by providing patient records
• Keep the program easy to use, so health care workers as well as users will be kept motivated to use it even in difficult times.
• Allow the content and communications to be written or performed in different languages (French, Khmer, …).
• Keep control of the program and the health messages.
• Easily build health messages to send around in bulk.

Solution:

• First of all working closely with the diabetes managers in the countries: they know their patients, the challenges for their specific regions. Getting a participative project going from the start.
• Finding a low cost (free and open source!) solution that works with basic cell phones, offers the option to build your own reports/forms, and allows all the communication that is happening between the patients, the health care workers and the diabetes managers to be put into long lasting and transparent patient records => one solution the Frontline SMS medic solution.
• Testing the program: the most difficult part was finding the right modem to get frontline sms to work properly (we used a Huawei gsm modem in the end, after trying quite some other types of gsm modems).
• Getting a frontlinesms expert in to fine tune to the program’s needs. Limbanazo Kapindula was/is the man of the moment. He just finished a mHealth project in Malawi (blogpost and his presentation on the project can be found here).

Some resources
If you are interested in testing out the frontlinesms medic for your own purposes, feel free to download the frontlineSMS medic program here or check out this video and start your own project yourself or with your team.



This diabetes program is now being set up right now and will be ready for roll-out in the very near future. Josefien, you sure know how to make a difference. I know how important it is to get connected to my fellow diabetics and health care workers, thank you for your great work and the opportunity to work with you!

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