Africa Aid had an interesting service running in Ghana and Liberia. They offered free cell phone calls for all doctors in these countries. I was a bit confused as to why a non-profit would do this, until they explained the context. In a lot of West African countries, doctors are hundreds of miles away from each other. In this country, if a doctor encounters a problem, she can just walk down the hall and ask a co-worker to take a look at the patient. In Ghana, this isn’t the case. Quite often a doctor is just a General Practitioner and he can’t easily ask for a second opinion. So what does he do? He picks up his cell phone and makes a call. This behavior creates a bit of a tension between economic forces and medical service. The truth of the matter is that phone calls are expensive and a lot of times doctors have limited paychecks and don’t want to spend all the money they do make… doing their job.

So that was the problem, and Africa Aid helped eleviate it through free “Doctor to Doctor” phone calls. They brought my company in because they wanted to know what a next logical addition to this service should be. They knew that doctors weren’t giving up their feature phones for iPhones anytime soon, but they also knew that with a bit of extra tech, Africa Aid could offer a lot more functionality. The board of Africa Aid had plenty of ideas. They thought a web interface would be nice, expanding to nurses and other medical technicians would be good too, but they didn’t really know how to make this decision, so they wanted to bring my company in to figure out what’s going on with doctors in West Africa now, and what would be a good way to improve their lives and work in the future.

Working Remotely

At this point, we realized this project was going to be a little different. The first oddity, was that Africa Aid was a completely remotely run company. It was founded by a few college students, and after they graduated and moved on to bigger and better places, they kept ownership and management of the company and worked solely through a series of set weekly meetings. I don’t even remember if we did the contract revision dance or not, but I do remember we couldn’t meet face to face with the whole C suite in front of a whiteboard so we needed some other way to make sure that we were on the same page. Some poeple think that a document can hold a consensus of ideas and opinions, but it’s nothing compared to a face to face living conversation where the body language and intonation of people’s voices add texture to their words. Usually we run an alignment meeting, but this time we had to get a little creative. In the end, we asked everyone to make a visual map of what they thought this project was about. We gave some examples, but the outcomes were telling that each Africa Aid staffer thought something a little different about the project. Some thought that it was about creating new technology, server side, that could add function to phones. Some thought that the project was about bringing organizations like the phone company and the medical association together to offer more services through the current infrastructure, basically asking for more free stuff for doctors. During a video conference, we had everyone talk about their map of the project, and at the end, we pointed a camera at a white board and drew up, together, what we thought this project was about. The final map wasn’t important, but the conversation that lead to that map, the discussions around “that box that represents nurses” and the connection between doctors in Ghana and the org here in the states, were invaluable.

The Known Unknowns

After our video chat, we drafted up a contract to work the project. We knew the organizations involved: Ghana Medical Association kept an up-to-date list of all the doctors in the nation and handed out SIM cards, those SIM cards were provided by Verizon and those folks kept track of all the calls made between doctors. We decided to have a “breadth and depth” strategy to research in Ghana. We were going to shadow a few doctors for full days, multiple days a week, and fill in the breadth through 30 minute interviews with an additional 10-15 doctors, nurses, and med techs.

At this point, things were getting exciting. I had never done any research in Africa, and we seemed to have a good handle on things. Flights were booked, and we headed out.

The Unknown Unknowns

I had a contact in Ghana, from Africa Aid, who was scheduling doctors so that by the time I touched down in Ghana for my two week trip, my schedule would be stacked. I touched down and after 5 minutes of conversation, realized that there were no doctors lined up for me to interview. I needed to make good use of my time in Ghana, so I decided to talk to people at the Ghana Medical Association. Once I stepped into the GMA office, I saw the secretary’s screen was using an app called Ghana SMS.

” What do you use that for?”, “Oh, I use it to text all the doctors in the network.”, “Does it cost anything?”, “We pay a monthly rate to be able to send out a certain number of mass texts a month.” The GMA was paying someone to send texts out to the doctors when that was a free service offered by Verizon. I walked to a back office to talk to someone higher up in the food chain, only to find out that the GMA is a union that supports doctors, and they probably only have contact with 80 percent of all the doctors in the nation. After that, there was one surprise after another. I spoke with doctors who explained that Verizon SIMs could only call other Verizon SIMs so if a doctor used another SIM for personal use, they would have to switch SIMs to call a doctor. I learned that it was the Ghana Council of Health who accredited each practicing doctor in the country and they were the ones who kept tabs on all doctors.

A Living Book

After surprises from one organization after another, we finally lined up a few doctors to interview, and we had that flash of light instant where we knew how to make the most impact overall. This is really why designers do research in the first place–they are looking for an instant where their intuition gets a spark and they know the direction they should be taking. In this case, we knew Doctors had free calls, great, but doctors didn’t have other doctors’ phone numbers. WTF amirite? Each doctor had an address book that was filled with a few med school friends. When they needed help, they’d call a friend from med school who might have another doctor friend, and they’d call that number and get refered to another doctor. The saddest part of this project was during an interview where the doctor explained a situation where she spent an afternoon trying to find a specialist and because of this wasted afternoon, a child died.

So we needed to make a Doctor Directory. But we also needed to figure out how to manufacture the directory, and keep it fresh. From here on out was a lot of logistics and ground work. You’d think making a little book with a bunch of names is easy, but there was much more to it. Our first voluntary constraint was to piggyback on the GMA’s quarterly magazine. The GMA offered us a 6 page spread, so we need to fit all the doctors into 6 pages sorted once by name and again by specialty. So there was a week of finding typefaces specifically for fine print and cramming as much data as we could on each page. We also needed to identify a design firm in Ghana who could produce the pages once we were out of the picture, and a system so that the GMA could create changes to the document without destroying the layout.