Frugal Innovation for Global Surgery

Limited or inconsistent access to necessary resources creates many challenges for delivering quality medical care in low- and middle-income countries. These include funding and revenue, skilled clinical and allied health professionals, administrative expertise, reliable community infrastructure (eg water, electricity), functioning capital equipment and sufficient surgical supplies. Despite these challenges, some surgical care providers manage to provide cost effective, high quality care, offering lessons not only for other low- and middle-income countries but also for high-income countries that are working towards increasing value-based care. Examples would be how to optimise the consumption of resources, and reduce the environmental and public health burden of surgical care.

Owing to the liberal utilisation of capital equipment and single-use supplies, surgical care in high-income countries is increasingly recognised as a significant source of greenhouse gases and other environmental impacts that adversely affect human health. Regulations require many potentially reusable supplies and drugs to be discarded after single use. Supply manufacturers may label drugs or products as single-use to increase profit, reduce liability or facilitate regulatory approval. Many high-income countries struggle to increase the value of care while maximising quality and outcomes, and minimising cost and resource use.

For most high-income countries, cataract surgery is the highest volume and most expensive surgical procedure (in aggregate) in all of medicine. Studies analysing global cataract care found few differences in outcomes, such as surgical infection, despite large differences in carbon footprint and cost.2 A single cataract procedure in the UK emits an estimated 180kg CO2e (carbon dioxide equivalents) whereas the same surgery with similar outcomes in India emits only 6kg CO2e, 5% of that in the UK.

Source: Steyn, A., et al. “Frugal innovation for global surgery: leveraging lessons from low-and middle-income countries to optimise resource use and promote value-based care.” The Bulletin of the Royal College of Surgeons of England 102.5 (2020): 198-200. [open access]

The Truth Is Paywalled But The Lies Are Free

Quoted from Current Affairs:

To see just how much human potential is being squandered by having knowledge dispensed by the “free market,” let us briefly picture what “totally democratic and accessible knowledge” would look like. Let’s imagine that instead of having to use privatized research services, there was a single public search database containing every newspaper article, every magazine article, every academic journal article, every court record, every government document, every website, every piece of software, every film, song, photograph, television show, and video clip, and every book in existence.

The content of the Wayback Machine, all of the newspaper archives, Google Books, Getty Images, Project Gutenberg, Spotify, the Library of Congress, everything in WestLaw and Lexis, all of it, every piece of it accessible instantly in full, and with a search function designed to be as simple as possible and allow you to quickly narrow down what you are looking for. (e.g. “Give me: all Massachusetts newspaper articles, books published in Boston, and government documents that mention William Lloyd Garrison and were published from 1860 to 1865.”) The true universal search,  uncorrupted by paid advertising. Within a second, you could bring up an entire PDF of any book. Within two seconds, you could search the full contents of that book.

Let us imagine just how much time would be saved in this informational utopia. Do I want minute 15 of the 1962 Czechoslovak film Man in Outer Space? Four seconds from my thought until it begins. Do I want page 17 of the Daily Mirror from 1985? Even less time. Every public Defense Department document concerning Vietnam from the Eisenhower administration? Page 150 of Frank Capra’s autobiography? Page 400 of an economics textbook from 1995? All in front of me, in full, in less than the length of time it takes to type this sentence. How much faster would research be in such a situation? How much more could be accomplished if knowledge were not fragmented and in the possession of a thousand private gatekeepers?

Read more:  The Truth Is Paywalled But The Lies Are Free, Nathan J. Robinson, Current Affairs, August 2020. Via Ran Prieur.

Landlord Tech Watch

Is your building management moving online? Have new cameras been installed in your home or neighborhood? Is your landlord using new payment, notification, or screening systems? Has access to your building changed? For instance, you no longer have a standard key? If so, then you might have Landlord Tech in your building!

Landlord Tech, what the real estate industry describes as residential property technology, is leading to new forms of housing injustice. Property technology, or “proptech,” has grown dramatically since 2008, and applies to residential, commercial, and industrial buildings, effectively merging the real estate, technology, and finance industries.

By employing digital surveillance, data collection, data accumulation, artificial intelligence, dashboards, and platform real estate in tenant housing and neighborhoods, Landlord Tech increases the power of landlords while disempowering tenants and those seeking shelter.

By Landlord Tech, we mean technical products and platforms that have facilitated the merging of the technology and real estate industries in novel ways, particularly as they impact tenant housing. Our research has led to two major categories of what we are calling Landlord Tech: surveillance and speculation, both of which are tied up in gentrification.

Read more: Landlord Tech.

Image: Erik Henningsen’s painting Eviction held by the National Gallery of Denmark, 1892.

The Development Hoax

The promise of conventional development is that by following in the footsteps of the “developed” countries of the world, the “underdeveloped” countries can become rich and comfortable too. Poverty will be eliminated, and the problems of overpopulation and environmental degradation will be solved.

This argument, reasonable as it may seem at first glance, in fact contains an inherent flaw, even deception. The fact is that the developed nations are consuming essential industrial resources in such a way and at such rate that it is impossible for underdeveloped areas of the world to follow in their footsteps. When one-third of the world’s population consumes two-thirds of the world’s resources, and then in effect turns around and tells the others to do as they do, it is little short of a hoax.

Development is all too often a euphemism for exploitation, a new colonialism. The forces of development and modernization have pulled most people away from a sure subsistence and got them to chase after an illusion, only to fall flat on their faces, materially impoverished and psychologically disoriented. A majority are turned into slum dwellers — having left the land and their local economy to end up in the shadow of an urban dream that can never be realized.

Quoted from: Ancient Futures, Helena Norberg-Hodge, 2016 (first print 1991).

The Galaksija: Socialism’s DIY Computer

The Galaksija computer was a craze in 1980s Yugoslavia, inspiring thousands of people to build versions in their own homes. The idea behind them was simple – to make technology available to everyone. Free play was implicitly encouraged: the sharing, collaboration, manipulation, and proliferation of software was built into Galaksija’s very operation.

A computing enthusiast since 1979, Zoran Modli caught wind of Galaksija after the publication of Computers in Your Home. As host and DJ of Ventilator 202—a renowned New Wave radio show on Serbia’s Radio Beograd 202—Modli was something of a minor celebrity in Yugoslavia. Because all the day’s computers, including Galaksija, ran their programs on cassette, Regasek thought Modli might broadcast programs over the airwaves as audio during his show. The idea was that listeners could tape the programs off their receivers as they were broadcast, then load them into their personal machines.

An overnight sensation, this DJing practice quickly became a staple on Modli’s show. In the ensuing months, Ventilator 202 broadcast hundreds of computer programs. During the hour, Modli would announce when the segment was approaching, signaling to his listeners that it was time for them to fetch their equipment, cue up a tape, and get ready to hit record. In the case of games, users would “download” the programs off the radio and alter them—inserting their own levels, challenges, and characters—then send them back to Modli for retransmission. In effect, this was file transfer well before the advent of the World Wide Web, a pre-internet pirating protocol.

Read more: Socialism’s DIY Computer, Michael Eby, Tribune, July 2020. Thanks to m.

Simplifier: Creating a Stable Foundation of Technology

Mathieu Maury sends us a link to a very interesting (and minimalist) website called Simplifier. From the about-page:

Why do I simplify? How did I get started? What is the goal of this website?

Before developing any other skill, I enjoyed programming. To some extent, I still do; each program is its own universe, built from scratch, and the ability to create these on a whim is fascinating. However, the more time I spent programming, the more I became aware of the fact that software depends on hardware, and hardware is constantly changing. A program is not like a book or a painting; it requires constant upkeep and adaptation to remain in existence.

Initially, this drove me to learn about hardware, so that I could develop a stable platform to build upon; but this too was futile. Components inevitably fail, and there is no guarantee that replacements will be available in the coming years or decades. Essentially, permanent work cannot be achieved on a computer, as the hardware is fundamentally out of the control of the user. No matter what world is created inside of a program, its foundation will always rest on sand.

At this point I left programming entirely, and began searching for other meaningful work to do; but the problem had followed me! No matter what skill I intended to learn, I found that its permanence had been eroded by the chaos of technology. Materials were replaced by brands, techniques replaced by accessories, and craftsmanship replaced by consumerism. Clearly, this was something that needed to be fixed. Clearly, this is what I had to do.

Fundamentally, my work here is about creating a stable foundation of technology that is reliable, understandable, and practical for an individual to build for themselves. As of writing this, I believe I have done this on a conceptual level, but I intend to continue this work to the highest level of technology that I can achieve on my own. I encourage readers to utilize anything here which they find practical for whatever purpose they see fit, and to consider adopting a mindset of simplification in projects of their own.