(continued from previous page)

In Mongolia, Sandhu is drawing on the so-called human-centered design approach of Agogino's Berkeley lab, a bottom-up philosophy that begins the design process in communities, not in concrete rooms. "We discover their needs and then match those needs to the best solution," Agogino explained.

That field-first approach might sound like an obvious methodology, but it's not usually what happens. "There's so much bull sometimes with all that technology can do for the poor and starving in the third world," Agogino said, referring to cases in which technologists formulate solutions based on a largely theoretical approach. "But that's not always appropriate for rural environments. (Sandhu) really understands that."

That's why, when he first learned of the PDA pilot program online, Sandhu contacted everyone who might be involved or could lead him to someone who was. "Friends, colleagues, strangers would put me in touch with people here in Mongolia and I slowly got closer and closer to the people I needed to talk to," he said.

Why Mongolian mothers are dying
The same Mongolian landscape that awes Sandhu endangers its inhabitants, and the low-tech lifestyle of Mongolian herders presents thorny health challenges for pregnant women in need of frequent, specialized care. Though Mongolia's casualties remain one-tenth that of many African nations--Zimbabwe averages 1,100 maternal deaths every year per 100,000 live births versus Mongolia's yearly average of 100 deaths per 100,000 live births--they are high, given the country's relative wealth and training standards for field nurses.

For nomads, the widespread lack of electricity and running water are a challenge, and a staple diet of meat in winter and dairy in summer takes a nutritional toll. However, the vast distances to neighbors and hospitals (up to 40 miles away), eroding transportation infrastructure and limited first aid equipment all push the maternal death rate to 10 times above the U.S. ratio.

Hemorrhages that could be plugged with surgery, sutures or proper medications bleed freely due to scarce supplies. The challenge to regularly treat nomadic patients scattered over vast unpaved terrain strains the nurses' ability to keep qualifications current.

Sandhu believes the right resources can greatly reduce the death rate, but are PDAs the key? He's trying to find out, and he's not entirely sold on using handheld devices to track vulnerable patients. What's crucial to patient health, he thinks, is the field nurses' access to continued education. The more up-to-date they are, he reasons, the more effective their caregiving can be. Indeed, he's not certain the PDA project will enable the nurses' learning.

Bayanhongor and Övörhangai are two of Mongolia's 21 provinces, or aimags. Though geographically diverse, their centrality to Ulaanbaatar makes it practical for Sandhu to keep his base in the capital and conduct his fieldwork. Like in central California, he will spend several days soaking up his subjects' needs, carefully noting the work habits and needs of the 20 field nurses he'll visit.

Shadowing the nurses as they feed their horses, goats or camels, prepare food and care for patients will show Sandhu which of the nurses' common challenges may have a clear high- or low-tech solution. That only a handful will have PDAs gives Sandhu a base for comparing how the PDAs impact the nurses' quality of patient care, if at all.

"I see my work as an approach to solutions," Sandhu said. "The entire objective is not just to design the technology, but to design an entire technological intervention."

Can handhelds clear health hurdles?
"Hold the dogs!" Sandhu will holler in a customary Mongolian greeting, as he and his translator pull a car, a luxury mode of transportation, up to the white felt tent (ger) where a field nurse and her family live. Other rituals script the visitation--the polite inquiry about whether the animals are fattening nicely, the assigned seating on stools within the ger: men to the West, women to the East. They will admire each other's snuff before sipping cups of salty, bitter tea splashed with yak's milk and enjoy a celebratory taste of vodka or airag, fermented mare's milk, as early as 9 in the morning. Courtesies given, Sandhu may begin his three or four-day interview and observation.

As Sandhu explains it, PDAs could help clear several hurdles, including shaving down the time nurses spend writing case reports during scheduled visits to the county health center. Though not currently a primary function, future project iterations could include loading the PDA with educational presentations and medical reference information.

Nurses could use the presentations to persuade pregnant herdswomen with complicated cases that journeying to a provincial hospital in frigid temperatures may be less life-threatening than giving birth in an underserved clinic. PDAs could also potentially store training material for nurses to review while traveling between patients' tents.

Though the case information now being entered into field nurses' PDAs could be useful for keeping track of periodic neonatal care scheduling, the project's goals don't include training. Sandhu may also discover that other solutions are more effective, and that the PDAs are fussy, expensive replacements for notepads and pens.

Or what if they are useful, but imperfectly designed? Batteries could lose their charge in excessive heat or cold. Physical or digital corruption could wipe stored data. A complicated user interface could make cases difficult to manage.

Sandhu could also recommend changes or additions to the current program: weather-proof hardware, additional open-source software for greater storage or emergency data recovery, a more efficient battery charging and distribution routine.

Of course, the recommendation process is just as meticulous as Sandhu's methodology. After field trials, Sandhu and his supporting team of Mongolian health researchers--ideally seven dedicated analysts in all--will analyze the interviews and observations, and derive conclusions.

Faculty and students from the University of Health and Sciences in Ulaanbaatar, as well as design engineers, will chime in as well. These independent teams will then share their proposed solutions, and Sandhu will present the best ones to the PDA program's sponsors, Japan's Asian Development Bank and Mongolia's National Center for Health Development.

In the meantime, Sandhu is testing his interview protocol in the field and happily blogging about his memorable experiences as an outsider--the street stalker who only asked if Sandhu speaks Russian (he doesn't); the people who break into Indian song and dance when they confirm his heritage; the joyous festivals and towering cakes; the polluted haze of coal burned by ger dwellers on the city's edge for warmth during the minus-20-degree winter nights.

Sure, he misses home, his girlfriend, family and friends. He misses Silicon Valley's casual work atmosphere and being able to find a variety of vegetarian food. Better transportation would be nice (once Sandhu carried a jug of airag on his lap for 10 hours on a minivan "bus" while being jabbed, jostled and jerked by uneven roads). But overall, he said, "I feel as if I live comfortably, am enjoying life and am always meeting interesting folks. Maybe it's early in the year for me, but things are really great all around."