CT Scan First, then Take Two and Call Me in the AM

I started this long post curious if the economic logic of the private, not-for-profit Dallas Presbyterian Hospital where Thomas Duncan was treated led to his demise, a point raised by Amy Goodman in Democracy Now! But the issue of the scandalous treatment obviously goes beyond that.

Reportage on Ebola in Africa has been lacking, to put it inoffensively. At its worst, what I’ve seen (admittedly not much) could have come out of a zombie show or movie and slides into racist narratives of African savagery. Ebola seems but a new twist on the wars that ravaged the region, and both are presented without history, context, nuance: No Why has been asked, let alone answered. But the reportage that I’ve caught (I’ve not studied this; capture has been incidental and cursory and entirely via the Web) has only now begun to investigate Whys that Americans can put forth.

The BBC Tuesday had a decent comparison of the MSF procedure and the so-far opaque but increasingly alarming lack of coherent protocols practiced at the Dallas hospital. And the recent accounts by unnamed nurses at the Dallas hospital describing the lazy and frankly appalling procedures only points to some other questions.

Let’s start with money. Duncan walks into Dallas’ Texas Health Presbyterian (also called Presbyterian Hospital of Dallas), a private, not-for-profit hospital whose parent system is Texas Health Resources. US News & World Report rated it highly. It’s not a cheap hospital. In Duncan’s case, according to two reports, from the Christian Post and the Dallas News, the cost of his terminal care (starting with this second trip to the emergency, where he arrived via ambulance), is likely to be around 500,000 USD (The Christian Post). That sum, the Dallas News points out, will likely never be recovered from his family and will be used to justify the hospital’s not-for-profit status; as well, it will be “‘covered by the margin on commercial insurance,’ said Scott Schoenvogel, CEO of Compass Professional Health Services in Dallas” (Dallas News). [Cost is "recovered" by Dallas hospitals via a "practice known as 'cost shifting.' Insured patients have a hidden surcharge in their bills, which winds up raising the cost of annual health insurance premiums for workers and their employers" (Dallas News).]

But who paid for the initial CT scan and the lengthy if utterly meaningless evaluation the first time around? It seems that Duncan was given a CT scan of the head, which could have been of the brain (I don’t have the data) and might have cost as much as 2,925 USD (New Choice Health)—or a lot less, 210 USD. The other costs, including the evaluation, even the acetaminophen (Tylenol brand, it seems), would have been added to the charge.

Then he was sent home, with no effort to monitor him at home, or to see if he was contagious.

Put another way, the tests that were performed seemed more to satisfy a wholly ineffectual but costly ritual than to address a known problem and one that had that day, or the day before, been broadcast to hospitals as a serious threat by the CDC.

But the Texas Health hospitals, like any hospital system in the US, it seems, was under no legal obligation to abide by the CDC guidelines. I find that incredible, in that I can’t quite believe it. But then I remind myself that the US still operates under a laissez-faire medical system that seeks to maximize patient cost at the expense of social health.

South Korea faces $1bn bill after hackers raid national ID database • The Register

South Korea faces $1bn bill after hackers raid national ID database • The Register.

This situation was predicted a long time ago by me and many others. My cry now is for wide reform. But my guess is that the situation, like the ferry disaster (itself one of many instances of government corruption and misprision), will be essentially ignored. Which points to where the power lies.

Small firms and open-source software put Spine back into NHS after IT fiasco

Small firms and open-source software put Spine back into NHS after IT fiasco.

I would love more detailed work, especially something that actually lays out the steps–and the anticipated obstacles. Otherwise, this is nice, but there’s no end of happy ideas for the future that then become sad reflections.

Linux systemd dev says open source is ‘SICK’, kernel community ‘awful’ • The Register

Linux systemd dev says open source is ‘SICK’, kernel community ‘awful’ • The Register.


Seems kind of like a belated whine. Or did anyone think that Linus had altered his colorful ways and manner? And it’s also a well-known truth that open source (and this includes some parts of Linux, too) is not a simple thing but has continents of difference in how community is envisioned and organized.

COWL: A Confinement System for the Web

COWL: A Confinement System for the Web.

A List of Completely Wrong Assumptions About Technology Use in Emerging Economies

Originally posted on iRevolution:

I’ve spent the past week at the iLab in Liberia and got what I came for: an updated reality check on the limitations of technology adoption in developing countries. Below are some of the assumptions that I took for granted. They’re perfectly obvious in hindsight and I’m annoyed at myself for not having realized their obviousness sooner. I’d be very interested in hearing from others about these and reading their lists. This need not be limited to one particular sector like ICT for Development (ICT4D) or Mobile Health (mHealth). Many of these assumptions have repercussions across multiple disciplines.

The following examples come from conversations with my colleague Kate Cummings who directs Ushahidi Liberia and the iLab here in Monrovia. She and her truly outstanding team—Kpetermeni Siakor, Carter Draper, Luther Jeke and Anthony Kamah—spearheaded a number of excellent training workshops over the past few days. At one point we began…

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Remote ICT4D has problems

How “Designing with the end user” undermines ICT4D best practice – Zunia.org.

The argument: Enduser designs by the well-intentioned designer based far from the actual enduser miss the mark, if that mark is or includes “local empowerment.” “The truth of the matter is that far too many ICT4D projects are still initiated from the outside.” The summary is of an article posted at Kiwanja.net.

Five Smartphones for Under $50 USD | TechChange

Five Smartphones for Under $50 USD | TechChange | The Institute for Technology and Social Change.

Android Fragmentation

Android Fragmentation – Business Insider.

There’s a reason why Peter Kelly of UX Productivity, which makes UX Write,* chose to develop the app for iOS and not toss it into Android’s chaotic sea. Another reason is that any enterprise confronted with so many different kinds of “Android” will surely feel more than a little anxious at having to ensure that the employees who bring their own devices are using the same or compatible software and have the same sort of security provisions in place. None of this costly anxiety obtains with iOS. In fact, despite the notorious–even infamous–closed nature of Apple’s OS, the platform ends up being in practice more not less open than Android–for developers, as well as users–however much it can Google its way to the Linux cradle. Having a predictable and stable environment helps all developers, regardless of their IP philosophy, and helps users in choosing what will keep its value even into the next year.


(Note: UX Write today does iOS. It’s native. But because it uses HTML-5 and JavaScript, it’s not limited to OS boundaries–nor to what we normally think of as a “productivity” app.)


Nadella’s challenge: Saving Microsoft | ZDNet

Nadella’s challenge: Saving Microsoft | ZDNet.

So, here’s how I see it coming out. Microsoft will continue to be a giant company, but it will prove unable to dominate the mobile and cloud markets the way it has the desktop market. Without that domination, Microsoft will stagnate and start to fall behind the other technology giants.”

I agree. Only I think its stagnation has been going on longer than suggested, and I’m basing my argument on the difficulty it’s seemingly had in attracting and retaining effectual talent. I don’t doubt that the company appeals to many around the world who have other choices. But are those then hired and, better yet, listened to? Do they write to their friends and express the intense excitement they feel working for a company that’s doing interesting and even adventurous work and making them feel important doing it? (Is there anything that MSFT has done recently that would catch the eye of a brilliant developer who wants to make a difference and feel good about doing it? Any new or novel technology that is not just a copy, an emulation, a Disney-fication of something a little wilder–“disruptive”– but so much more original?)

Sure, enterprises, public sector and private, will continue to buy Microsoft. And SJV-N is right about Azure and Excel, and these will continue to earn MSFT money. But no one complained or complained that Blackberry’s network was terrible or that its email system failed. They critiqued it and first consumers then, massively, enterprises, stopped buying its products because the company demonstrated an inability to be relevant, even to understand what being relevant meant. Yes, I’m echoing the student complaint of the 60s. But they were approaching education–probably not for the first time–as consumers demanding products that mattered to them.

I don’t think MSFT can do what I did with OpenOffice, if only because the brand is so deeply etched into modernity’s consciousness and its size is so vast, much larger than empires: Which was to take a dull office suite a tool for office worker oppression and turn it into a tool for all workers’ freedom.


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