The question of why there is not more on the Djakarta Declaration on the
internet is a good question and calls for a few comments about the state
of use of the resources of the internet - here for health information and
collaborative health work.

There is a lot of press about the divide between the 'rich' and the 'poor'
in terms of the costs of access to the internet, but much less about the
divide between those who "get it" and those who "don't get it". There are
those among the poor and those working with the poor who are trying to
assure access independent of means, access as a civil and democratic right
to participate in this important (electronic) civil and political
(hopefully democratic!) space.

What is lacking at the moment is more champions within the relatively rich
institutions who have the resources to make a difference. Many of the
internet resources in health are run 'pro bono' by volunteer labour. That
is true for CLICK4HP and a number of other sites. That leaves them
vulnerable and leaves us worried about sustainability. CLICK4HP has no
budget and the volunteer labour of Alison Sterling and Liz Rykert. It is
hosted at York University because I am at York university. If I am run
over by a snow plow the list is at risk. Important institutions should not
be so dependent and vulnerable. However, they are.

The institutions with resources still seldom allocate resources to
cultivate the electronic workspace. They will buy equipment. They will
even mount a web site which is just public relations, or a good place to
visit depending on what they produce 'in house' or how convenient they are
for finding links to elsewhere (and maintaining the validity of those
links). They are slow to understand the importance of this venue as a
place for "work" - even if the "work" is only people in purposful dialobue
with people. Frequently this is dismissed as "chat" and a waste of
valuable employee time.

The irony, of course, is that I can deliver the same message as this
posting, in a 3 hour workshop for 20 people, at a cost of several hundred
dollars, and dragging middle or senior management away from their desks
for half a day. Not only is it called a success, it it chalked up as
(a) human resource training, and (b) a contribution to the Canadian GNP.
Your reading this now is either a leisure time activity or a waste of your
employer valuable resource - your time.

Different groups 'get it' or don't get it. One large corporation trains
its workers in a half-day workshop and while the worker is at the training
session a technical team upgrades their equipment and software. They
return from training to work on the new platform and in the new venue -
along with all their colleagues. One federal initiative I work with staged
training programs for funded groups in which the funded groups 'didn't get
it'. After the training session agency senior management allocated ONE
email adddress per organization. The rest of the trained personnel were
told that each site got one fax machine, one water cooler, and one email
address. Nuf said!

In the area of health the struggle is to commit resources to make this
electronic venue a sustainable part of the health workspace. In the
absence of a senior level understanding even the best of efforts fail.
A major hemispheric organization held a conference on health informatics
last fall. As an outcome of that event a listserv was proposed and
created. The list has remined dormant and for the past week we have tried
to reach it every electronic way possible, by subscription, by query, by
post to the list manager - to no reply. A major global organization is
about to mount a global discussion on health informatics. I am involved in
that. We have spent 5 months working on details that should have taken 2
or 3 email exchanges. A small but adequate amount of funding has been
allocated. The hold-up has been the health people involved. They don't
quite get it so they don't know how to respond to proposals. So they just
don't respond. The challenge is to teach health professionals how to think
about this venue and how to make it part of their workspace, and part of
the work agenda of their organizations.

I have just mounted HI4DEV (Health Informatics for Development) as a link
to a small workshop later. There is a little bit of funding but it faces
two obstacles, really opposite sides of the same coin. The first is the
constraints on my time. Doing everything is neither easy nor a good idea -
even if one is not run over by a snow plow. The second is the almost
complete absence of training about the meaning of this within the various
'feeder' college, university, graduate and professional programs preparing
people to work in these areas.

In many cases the 'clients' and non-professional stakeholders better
understand and know more about this area than do the professionals. I get
to watch the professionals defend their ignorance by resorting to the
tried and true strategy of putting down the 'knowledge' of others - while
in passing of course exhibiting a colossal lack of wisdom.

If I have learned two lessons in doing this for 17 years, one is that the
'establishments' are singularly slow to respond. This slowness is beyond
all reasonable limits and in many cases is the fault of an arrogant
ignorance on the part of key people whose organizations contain numbers of
people who get it but have their hands tied. This applies to appropriate
curriculum for colleges and universities as well. When those of us who
work in this area are called in to "discuss it", most of the time the
'discussion' is really an attack on our ideas as an effort to demonstrate
that ignoring these areas is a good strategy. Part of the time it is a
crass effort to 'cash in' with a thinly veiled 'paste-up' of old wine in
new bottles, clothed in a lot of public relations hype.

For those who believe that there is some real territory here, and some
real work to be done, keep looking for organizations who 'get it', keep
working with training people to help them 'get it', and put greater trust
in the non-professional stakeholders since many of then not only 'get it',
it looks obvious to them and they know what to do. They just need a few
resources.

Sam Lanfranco <[log in to unmask]> "Watch out for Snow Plows"

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