Design Research for Health: Mongolia

Mongolia election update: protest video from 1-Jul-2008

This is a view of the protest in front of the MAXH (Монгол Ардын Хувьсгалт Нам, Mongolian People's Revolutionary Party) building in Ulaanbaatar around 3pm on Tues-1-Jul-2008. This is before the violence began. I was at the adjacent Ulaanbaatar Hotel for a conference on telemedicine when I took this footage.

Mongolia election update: violent protest at МАХН

What follows is a report on potentially the most notable political protest in Mongolia since 1990. The protest that happened in the beginning of 2006 only resulted in a broken door for the MAXH building. This one has been much more destructive.

My high-speed Internet is down, so I am posting the following over dial-up. No time for editing, so forgive poor prose.

MAXH (MPRP in English) took the election yesterday. See Asian Gypsy for more.

This morning, I asked my taxi driver about it and she said it was terrible. Roughly she said, "Benzin [gasoline], we can't control the price of that. But look at the price of flour and meat. That comes from Mongolia. We can't get meat from relatives in the countryside anymore, we have to buy it. MAXH is to blame. This won't change anything."

I was on my way to attend Telemedicine 2008, a symposium sponsored by UNFPA and Lux Development at the Ulaanbaatar Hotel that started at 930am. More on the symposium another day.

During the day I heard comments from a few Mongols that they weren't happy with the results. In an election where the Democratic Party was forecast to win, and claimed they would give everyone 1 million tugrugs (US$860) to every citizen, MAXH came out and said they would give 1.5 million (US$1290). They even went so far as to print checks that would be valid if MAXH took the election. The catch was that the only people that received the checks were those who registered with MAXH in the days before the election.

Starting around 2pm, during a presentation, we heard a crowd cheering outside. Immediately we knew it must be a protest in front of the MAXH headquarters, directly adjacent to the Ulaanbaatar Hotel. A few of us went to the 6th floor restaurant, where we watched as police in riot gear (helmets, batons, and shields) blocked a large crowd waving flags from the minority parties. Notably the Democratic Party flag was not present. They had marched here from 3 directions, Songino-Hairhan on the west of town, Bayanzurh on the east of town, and one other duureg, possibly Chingeltei in the north. There were broken bottles on the front steps of the MAXH building at that time. There were a few minor skirmishes between police and civilians, but mostly there were no notable confrontations. I'm not good with estimates of large crowds, but I am guessing 1000 odd people and 200 police. At that time the chants were ... "Time to break up the MPRP!" "In 1990 we achieved democracy, now it is time to reclaim it!" "People at home watching TV, come and join us!" We went downstairs to watch and after taking a few photos decided to head back in to the seminar.

Later, just past 615pm, we came back to see what was happening as the noise had noticeably escalated. The crowd had grown and had gained control of the front steps of the MAXH building (no police were on the steps), most of the front windows had been destroyed, and people were constantly hurling rocks and bottles at the building, breaking whatever was left. Aside from some street kids, the crowd was mostly, but not wholly, young men. Women and young children were still present. The 5 MAXH flags in front of the building had been replaced by flags from the minority parties, this time including the Democratic Party. In the next 1+ hour we watched as the crowd destroyed everything they possibly could. The steel fence in front of the building was ripped from the ground. One section of it was used as a battering ram for the front door. Lamp posts, air conditioners, windows on the side of the building, nothing was left intact. We watched as one fire was set to a room on the first floor. The police, who in my honest opinion were behaving in a restrained manner, used water canons, tear gas, and what was presumed to be rubber bullets - we could only hear the sounds of the gun shots echoing off buildings, but there was a man who had served in the Indian Navy nearby and confirmed that they could not be live rounds from the sound.

Around the time that I decided to leave along with a colleague from the Health Sciences University, the UNFPA representative walked by and said they weren't allowed to leave the building. I grabbed my colleague and we told the doorman we were headed north, and we walked out as quickly as we could. As we turned back we saw a big plume of smoke rising from the MAXH building. We walked together to the Chinese Embassy before parting ways. All along the way we saw groups of people walking in the other direction, some looking curious, others looking angry. Made it back home a little while ago. I will post videos and more photos when I can. It is now 845pm, still a bit of light out, and they are showing it live on TV. The crowd has not abated. A minivan is on fire.

Update - photos from today:

1) 2) 3)

4) 5)

1) 330pm, still relative calm, view from 6th floor of Ulaanbaatar Hotel.

2) 331pm, many video cameras, digital cameras, camera phones used to capture today's events, view from 6th floor of Ulaanbaatar Hotel.

3) 351pm, view from ground level in front of MAXH building.

4) 354pm, view from ground level in front of MAXH building.

5) 702pm, protesters in control of the area in front of MAXH building, as seen from 6th floor of Ulaanbaatar Hotel.

Updates:

1125pm: See Mongolia - Election 2008 updates:Violence and Riots from Asian Gypsy, including links to international coverage. Top floor of MAXH building is reportedly on fire.

1205am: A front loader (Mongolian: екскаватор) which saw earlier use in the protest was just shown on television being driven onto the front steps of the MAXH building. Lighting is not good, but that's what it looked like. The protest has spread into Suhbaatar Square and they have attacked the Cultural Palace which is now fire. The rioters have set up barricades in the streets.

1215am: Special law in effect. Everyone needs to carry identification with them at all times or they are subject to arrest. Fire on the steps in front of the Chinggis statue in Suhbaatar. Ban on sale of alcohol.

105am: 10pm-8am curfew in effect for the next four days inside of Baga Toiruu. Eagle TV reports on their blog that they can no longer report on the riots based on an order from President Enkhbayar. Only State Television for next four days.

130am: MNB and Eagle TV each said they had reporters beaten and equipment damaged.

135am: Central Cultural Palace on fire. 90% sure on the following. Children's Library burned. Modern Art Gallery looted and on fire. Some sections possibly saved. Trying to prevent the fire from spreading to the theater.

245am: An unconfirmed report that the opera building was on fire. MNB stops news coverage at 242am.

3am: Reports on the state of emergency from AFP and BBC News. Been at least 30 minutes since we've heard any shots (police flare guns). Going to bed for a few hours now.

1040am: This morning's television coverage was of PM Bayar through the night.  Meeting with the Chiefs of Police and Ontsgoi Baidliin Alba (government agency responsible for emergency situations).  Touring damaged areas including the MAXH building and the Central Cultural Palace. Visiting the Trauma Hospital (Gemtel), shaking hands with doctors and injured rioters.  Four deaths so far, one by shooting, one in a fire, and two in a beating.  Outside, on the north edge of town anyway, people are going about their daily business.  I've canceled my morning meetings at the Ministry of Health.

1155am: Armored cars and police vehicles have cordoned off some streets in central Ulaanbaatar.

Mongolia election update: morning after media roundup

From the English language media this morning:

"The two major parties in the race, the Mongolian People's Revolutionary Party (MPRP) and the Democratic Party, have both pledged to share more of the country's natural wealth with the public. However, they disagree over whether the government or private sector should hold a majority stake of the country's mineral deposits. Both parties have attempted to win votes by promising cash handouts. A poll showed the ruling MPRP with a slight lead over its rival, but if neither win a majority in the 76-seat parliament and are left to form a coalition, the smaller parties on the ballot could be the real power-brokers." Al Jazeera

"The last election four years ago resulted in a hung parliament, leaving the parties to scramble to form a government to rule the landlocked country of less than 3 million, whose empire under Genghis Khan once extended west as far as Hungary. In the event of another deadlock in the 76-seat parliament, or Great Hural, the smaller parties on the ballot could be the real power-brokers. 'Our party's position is very constructive. We raise our voices if there is bad and we support what is good,' said Sanjaasurengin Oyun, of the Civil Will Party." Reuters

"Despite strong midday thunderstorms that caused flooding in parts of the capital, voter turnout across the country was 74 percent. Gobi Altai province saw 83 percent turnout. Vote counting began soon after the polls closed at 10:00 pm (1400 GMT), but results are not expected until Monday morning at the earliest. A new voting process is widely expected to cause delays in counting." AFP

"[A] new multi-mandate system of voting means that ballot counting will take longer than usual, because each ballot will have up to three circled names. Although results have previously been known by the morning after an election, officials warn that this one might take several days to sort out." BBC News

"New electoral rules that change the previous, first-past-the-post system mean there could be confusion at the ballot box and several days before an official result. 'The system of calculation is very complicated,' said Luvsandendev Sumati, director of the Sant Maral Foundation, a non-governmental organisation that carries out polling and surveys. 'I'm afraid that if they calculate the ballots ten times they will get ten different results,' he said." Scotsman

Mongolian parliamentary election today!

The last three weeks in Mongolia have been nothing but an onslaught of political campaigning.  Radio ads.  Television ads.  Brochures delivered to your door. (I'm donating my collection to Allison for her research.)  Vehicles driving around town blaring music and slogans.  Gers set up in the city to provide information about specific candidates.  Party affiliates parading in the streets.  And billboards, lots of billboards.  That all ends today, election day for all 76 seats in Parliament (photo of polling place, left).

This election is marked by a change in how the election is conducted.  Instead of running for a particular seat, as was the case in the past, candidates run for any one of a block of seats across a broader jurisdiction.  For example, in Bayanzurh District in Ulaanbaatar, there are 4 seats.  In the past that would result in 4 different races.  Now it's a free-for-all, with roughly 40 people running for those 4 spots.  The consensus is that the new policy favors the larger parties (Democratic Party, Mongolian People's Revolutionary Party - former Communists).  Overall there are 356 candidates running for 76 seats with 12 parties represented.  So many people are in it that even I know people who are seeking election - I count about ten folks I met last year who are in the running.  For more on the election check out these posts from Asian Gypsy (those are in chronological order by post date).

Here are some photos from this election season.  Captions follow below.

   

  

  

Top row (L-R): Flags from the Democratic Party and Civil Will Party in a ger district near Gandan.  Ganhuyag. Ganhuyag overlaid with information for voters a few days later.

Middle row (L-R): Gantumur. Ger set up for voters in the 11th microdistrict. MPRP advertisement atop the Lenin Museum.

Bottom row (L-R): View of political advertisements from Trade and Development Bank.  The wording on this truck doesn't indicate that Gantur belongs to one of the ultra-nationalist parties, but he sure looks like he does.  View of the Wrestling Palace on Friday evening - these posters were all taken down within the next 2 hours.

Web-based psychological counseling services for health professionals in Mongolia

Through the School of Public Health (SPH) at the Health Sciences University of Mongolia (HSUM), I found out about a new 1 1/2 year project examining Web-based psychological counseling services for health professionals.  This IDRC-funded project is a collaboration between the Department of Social Sciences and Humanities at SPH and the “Setgeliin Toli” Psychological Counseling Center, an NGO with close links to the National University of Mongolia.

On Tuesday, after an initial discussion with B. Ariunsanaa, Department Head from HSUM who is leading this project, I met the project team at the counseling center (see photo) for a hybrid design review / concept brainstorm session (IDEO + Rockefeller Guide, pp60-63).  (The motivation for offering free consulting services was simply that I want to see the project succeed.)  Five of the six primary team members were there, two from HSUM and three from the counseling center.

Their project has two components:

1. Assessment of stress among Mongolian health professionals, in both Ulaanbaatar and the countryside
2. Development, marketing, use, and assessment of Web-based psychological counseling for Mongolian health professionals, targeting Ulaanbaatar

Our conversation focused mostly on the second component.  They plan to develop the following Web-based services:

• online counseling (asynchronous, likely via a messaging system built-in to the website)
• psychological self-assessment tools
• online stress relief tools
• information and references  
• e-mail-based training*
• chat among users of the site ("emch nariin hoorond") 

*For the training, they are following the model of HINARI (Health InterNetwork Access to Research Initiative, WHO) Training e-mail course in which several of them are participating. 

Our discussion touched on assessment, design, usability, marketing, privacy, and technological capabilities.  For these last two topics, there was an incomplete understanding how technology could (and couldn't) be used to manage confidential information.  I tried a few ways of filling this gap.  The most successful approach in the end was to situate the discussion in examples that were known and relevant to the group: olloo.mn, hi5, and SMS banking.

Two things stood out to me as keys to this team's success in a difficult undertaking (online psychological counseling).

First, it's diversity.  Practitioners and researchers. Teachers of public health, psychology and law.  Very different internal perspectives on what is needed to make the project successful (e.g. making the services accessible to health professionals, conducting a sound assessment, advertising well, finding a good programmer).

Second, that it is targeting a group that has shown both need and demand for psychological counseling services.  They cite a UN report that found 10.5% of Mongolian health professionals have sought professional help from a psychologist because of workplace stress and another 28.6% of them had wanted to seek such professional help.

Repairing sinkholes in Ulaanbaatar

Though there were finally periods of sunshine and warmth today, it still rained.  It has been raining for six straight days now.  Traffic congestion has been much worse across Ulaanbaatar this week, in large part because of the new sinkholes all across town.  For example, yesterday it took me 30 minutes to go from the Maternal and Child Health Research Center to the Ministry of Health in a taxi.  On the route we took, that's less than 5km.  These two photos from today show the holes mostly repaired.  In the first picture, the damage to the sidewalk (foreground) is still obvious.  In the second, the work crew is waiting for a break in traffic to move dirt.

 

Living in the 11th

I moved into an apartment in the 11th microdistrict within 2 1/2 days of arriving in Ulaanbaatar.  Key to the quick move were help from friends and being flexible in what I was willing to accept.  One of my requirements was that it be a 2 room (1 bedroom) since I expect to be working on team-based data analysis from home.  The other was that it be within 2-3km of the city center.  Geographically that covers about half of non-ger-district UB.

Though I moved in quickly, the deal wasn't official until 5 days later when my landlord dragged my Mongolian friend, my research assistant, and me to a notariat.  My landlord insisted that she could only make a contract with a Mongolian citizen, hence my friend's attendance.  We waited for about ten minutes, watching the notariat, a woman about my age, handling other business.  I've only interacted with 3-4 notariats, but this one seemed among the toughest.  She scolded every single person that came to her about something that they did wrong with the paperwork.  She refused to make change for payments.  And she didn't smile.

The notariat said she could make a contract between me and my landlord, but my landlord wouldn't go for it.  It was going to have to be my friend.  The notariat asked my landlord, "Where are the other two people whose names are on the title to the apartment?"  My landlord bought herself some time with an evasive answer, took my research assistant outside, and asked her to act as her daughter.  The notariat saw through this and she clearly was not pleased.  She looked up from the papers on her desk and addressed my research assistant, "What's your birth sign?" "Uher."  We got the contract.

Apartment highlights:

• On average I see one street fight every 2 days in my neighborhood.
• When I moved in, there were paths to access the building entrance from the north road (Ih Toiruu) and the east road (Erhuugiin Gudamj).  Within 2 days, they built a wall blocking off the east path.
• Our jijur quit over the weekend and our hallways are now starting to smell of rotting garbage.
• I am now responsible for the well-being of a plant.

'ella 'ella 'ella

There is a reason that you don't pack for 10 weeks in the field the morning of your flight.  So far there are two things that I've realized that I forgot at home.

The first was Dagiimaa and Shagdarsuren's Mongolian-English Medical Dictionary.  Brought two other dictionaries with me, but they don't have some of the health-related terms that come up in conversations and interviews.  Easy enough.  Picked up another copy at the Health Sciences University on Thursday for 7150 MNT (US$6.17).

On Friday, after a hot, dry week  of dust storms that swallowed up the city one microdistrict at a time, it began to rain.  It started softly, but picked up on Saturday evening, increasing in strength through the night.  The crescendo was Sunday morning.  Water began to pool in the streets.  Mud from the roof was making a mess of the apartment stairwell.  The upstairs neighbor, one down from the roof, visited to make sure that I wasn't seeing any ceiling damage from his flooded bathroom.

On Friday and Saturday I just dealt with the rain.  As I looked out my window at the soggy, sloppy day, I realized the second thing I forgot: an umbrella.

I also needed to buy printer paper Sunday, so I went to a Korean stationery store near Ih Delguur.  "Where can I buy a kurtka near here?" I asked the cashier.  She asked her co-worker, "How about Tsetseg Tuv?"  "That's too expensive!" she replied.  They sent me in search of a place I hadn't been, Mars Tuv, to the south of the Tengis movie theater.  When I found it, it was closed for Sunday.  A woman sitting in the front passenger seat of a furgon ambulance watched me from her dry enclave and seemed to be wondering why I was trying to get into Mars Tuv when it was closed.

After confirming with someone on the street that Bumbugur Tuv, another shopping center nearby, was open, I headed west.  By the time I showed up to Bumbugur, I had to squeeze the water out of my hair to keep from dripping inside the shopping center.

Nobody seems to buy umbrellas when it's dry out.  I suppose it would be like buying menudo before going out for the night's drinks.  Inside Bumbugur, I overheard an old man asking a woman trying on a purse where she bought her umbrella.  She said she didn't buy it at Bumbugur.  I realized then that I had been using the wrong word for what I wanted.  "Kurtka" is Russian for coat, "zontik" is Russian for umbrella.  Still ok.  You can get anything you need at Bumbugur.

I asked the lady who sold me forks and spoons where I could get a "zontik".  She directed me to a stall of women's clothes.  I asked that woman about the umbrellas.  "We had them but they're all gone." "Where else can I get them?"  "See the the G-Mobile sign?  They're selling them down there."

By the G-Mobile sign, there were 8 people packed together into a 1m wide aisle in front of a single stall trying to buy umbrellas.  Lacking the patience to properly assess the options, I asked for a couple prices, told the woman I'd take a mid-range one (6500 MNT is mid-range today), checked to make sure it worked ok, and ran out into the rain.

[Addition: Monday morning (below) is looking much better.]

Chimi chimi 2008

Still less than one week since I have been in Ulaanbaatar and just had my first conversation about chimi chimi complete with dance moves from my 45 year taxi old driver. This segued into a conversation about his parents who were state musicians. Clarinet and violin. They live in miami now.

Design for Social Impact Symposium (2-Jun-2008)

Just after the Global Health Council Conference and just before coming to Mongolia, I attended the "Design for Social Impact Symposium" in New York (photo below), a joint project of the Rockefeller Foundation and IDEO.  Thanks to Aman for pointing out that this event has been covered by Jocelyn Wyatt and Rob Katz.  The symposium was based on the work of Jocelyn and Aaron Sklar, both of IDEO, who developed ideas about how design can play a larger role in social impact.

I had planned a detailed post about this event, but I left my notebook at home in Oakland, so this is the abbreviated version.

The two key outcomes of this meeting were, in my opinion:

1. a conceptual foundation for how the design industry can participate in social impact work
2. a network of key players in this space

The attendees included design firms (IDEO, Frog, Jump), consulting firms (BCG), NGOs (WaterAid, Design that Matters, PATH, Unitus), foundations (Rockefeller, Acumen, Gates), universities (MIT, Srishti, Duke, Berkeley), and others (World Bank, Cooper-Hewitt).  [That's not a complete list of attending organizations, just the ones that came to mind.]  I must say that I was impressed, not just by the institutions, but by the individuals representing those institutions.  These were some really good people, with some really solid experience.

The meeting was based on IDEO's findings and resulted in two publications, which they have made publicly available.  But it was also about sharing experiences of the other attendees.  The one prompt that I remember most clearly, more of an ice breaker really, was about goats.  "In our experience, there's always someone in the room who has done projects with goats.  Who here has worked with goats?"  Two hands raised out of forty.

The underlying assumption of the meeting was that the design industry has a role to play in social impact, not just design as a concept or process (I agree, by the way).  Based on that assumption, the discussion was about meeting the goals of social good while still operating a business.  Several people from design firms talked about internal pressure from designers who want to do social impact work, not just projects for large, corporate clients.

I pulled a few excerpts from the IDEO + Rockefeller Guide:

What they looked at:

How can design firms make social impact work a core part of their business? How can we collaborate with organizations that are highly resource constrained?  How can we redesign our offerings to become more accessible to social sector organizations? This initiative is focused on the process around doing this work, rather than the content of the work itself.

How they did it:

The Rockefeller Foundation invited IDEO to conduct this exploration starting in February 2008. We spent the first two months interviewing people involved in social sector work. We had inspiring discussions with foundations, social entrepreneurs, NGOs, professors, writers, students, designers, and consultants. The conversations examined the role design could play in this sector, how design fi rms might work with social sector organizations, and how we could maximize our impact in this space. Observations and interviews were conducted in offices, at conferences, and on the phone, and brought the team to Bangalore, Bombay, New York, Oxford, Palo Alto, Pune, San Francisco, and Seattle.

Definition of social impact:

To designers, it is about the impact of products or services on individuals and groups of people. We look at the broader impact of all of the design work we undertake. We think about balancing the needs of the individual with the needs of the overall community. On every design project, we can consider the triple bottom line and take into account social, environmental, and economic impacts.