News from the Collective

The labyrinth of foil inside a glucometer strip reveals a fragile chemistry. If you peel open the plastic covering, many inner circuits contain some version of biosensor technology, electrochemical cells screen-printed with gold or other precious metals and coated in places with enzymes. The foil serves as a conductor for electrons in a drop of blood, allowing a brand-matched glucometer machine to measure the charge a sample holds.[1] Yet costly design components (including gold) are also part of the reason that glucometer strips remain too expensive for most people in the world who have diabetes.

Fig. 2. Diabetes mortality. World Health Organization 2014. Used with permission.

Today, personal blood glucose meters are widely considered best practice for optimal diabetes management. Key in calibrating safe insulin dosing, they have also become a vital part of how people with diabetes move in and out of numerical legibility: glucometers are playing a major role in the piecemeal global public health mapping[2] of a diabetes epidemic rising worldwide. Even with increasing bureaucratic recognition, the number of people with diabetes remains debated by major policy institutions. The World Health Organization, author of the concerning map above (Fig. 2), calculates some 1.5 million fatalities from diabetes each year, while the International Diabetes Federation (IDF) places its projections even higher. Trying to account for undiagnosed populations, they estimate that diabetes now kills around 5 million people worldwide annually—five times as many as the reported mortality from HIV/AIDS in 2016—and that some three-quarters of an estimated 415 million diabetics today are living in low- or middle-income countries (IDF 2015). These very different statistics help to show the murky contours of a vast epidemic that glucometers’ measures both enter and play a part in enacting (Mol and Law 2004). Yet their role in frontline diagnosis also hinges on a painful irony: glucometers’ metrics help to make visible an enormous population of people living with diabetes in contexts of poverty, many of whom cannot consistently access the same meters then vital for day-to-day care.

Fig. 3. “Cash for diabetic test strips” sign at Pennsylvania intersection (photo by author).

I first encountered these issues as an anthropologist following people’s stories about living with diabetes during a year of fieldwork in the Central American country of Belize. It initially came as a surprise to me how expensive and out of reach the basic tools of glucose home management remained for many people I spoke with in 2010. During this time, glucometer machines—some purchased at grocery stores or local clinics, others acquired from visiting care groups or sent by relatives in the United States or elsewhere abroad—were priced around $50 to $100. Some corporations even provided them for free if you bought enough test strips, which are the truly expensive component of this system. Prices are declining today, but in 2010, they went for around $50 to $70 per jar of 50 strips (which would last less than a month for someone testing twice a day, but were often stretched much further by people trying to make supplies last). They had to be constantly replenished with imported strips that require precise matching to machine model and brand (Moran-Thomas 2016). A thriving gray market (Grondahl 2012) flourishes around them even in the national contexts they are specifically designed for, a problem reflected in the image I took recently in Pennsylvania (Fig. 3). According to a CNN report, in 2012 diabetes test strips became the number one most frequently stolen item in the United States, surpassing alcohol and cigarettes (and raising disturbing questions about the systems in place when a top target of criminalized theft is entwined with health-seeking behavior).[3]

Although glucometers first seem like the closest thing there is to a “solution in a box” (Redfield 2012a) for global diabetes management, as Peter Redfield (2012b) puts the quest for such objects, their upkeep entails engaging a transnational supply line full of expensive, complex parts and hardwired assumptions. Though portable, these devices require intricate networks to maintain: codes and calibrating fluid; lancets to draw blood from fingertips (for which some people substituted pins or sewing needles); and lithium and other specialized imported batteries, for which there was no substitute. Managing these messy assemblages could become a family affair, including the coordination of foreign insurance plans and mailed parcels. Certain models became easily damaged in hot temperatures, or left people trying to recode their machine’s time stamp, which might allow recently expired strips to come back into circulation. Many said a jar that expired a day or two ago could still work just as well, but no one knew exactly where to draw the line at when a strip’s diminishing efficacy became too far expired to be worth consulting: A month? A year? Of course, drawing such lines returns to much larger unsettling questions around about glucose meters: How bad is less than ideal care—and how are people navigating its risks against the de facto dangers of no care? I wasn’t sure what the implications of expiry backdating were in practice, but observed many cases in which refusing to fiddle with a meter would have meant no way to test at all.

Glucose meters were not designed to enter humanitarian aid economies. After all, diabetes had not historically been imagined as a worldwide issue of humanitarian concern. Decades ago in the 1970s when early blood glucometer models were first being developed in Europe, North America, and Japan, diabetes was still largely considered a “disease of affluence.” Historically portrayed as linked to excess—if anything, the opposite of malnutrition—Type 2 diabetes was frequently cast as the responsibility of misbehaving individuals rather than a societal concern or urgent public health issue. Meanwhile, people with Type 1 were often mistakenly imagined scarcely to exist outside high-income contexts.[4]

In U.S. settings today, glucometers are often used in conjunction with continuous glucose monitoring systems or even insulin pumps. But these, to my knowledge, were not available in Belize even to the wealthiest, making a working “finger prick” meter more important as a checkpoint. For those who could acquire these digital devices, they commonly indexed the generosity of relatives abroad or served as artifacts of transient philanthropic interventions, networks difficult to sustain day in and out. I saw countless machines that were unusable or broken. Time and again, I encountered malfunctioning meters with elaborate features such as Bluetooth compatibility on the shelves of homes without electricity, artifacts of vast gaps between the contexts these machines’ designers envisioned and the places they have become necessary. Stored on kitchen shelves or carried in weathered plastic bags by patients trying to repair them, people’s bodies and devices often seemed to be wearing out together.

There is a story about a critical crossroads in the history of meter development. It is an oral history that perhaps might be read as an aspirational rumor, but the story goes like this: There were two major competing companies shaping design when the first glucometer machines came out, one in England and another in Germany. A top employee of the British company has described how their engineers proposed making an open machine that would read either company’s strip, and called their German counterpart with a proposal to coordinate. According to his recollections, the German company turned down the idea and did not want their strips read by any but their own machines (Mendosa 2006).

Although meters philanthropically donated by manufacturers today provide key islands of care in select low-income pockets of the world, such programs remain highly proprietary and heavily dependent on donor control, leaving huge populations excluded. There are also important efforts under way to distribute glucose meters that reflect the hard work and care of innovative grassroots communities in Belize and beyond, but such collectives still deal with devices that are prone to systemic breakdown and remain out of financial reach for many in the world. Scholars such as David Fidler (2008) have envisioned a productive “open source anarchy” that might characterize global health governance, in which private and public institutions alike could collaboratively contribute to building health networks and catalyzing competition to drive technological innovation. But the case of brand-matched strips and proprietary glucometer parts for global diabetes care seems more iconic of what Ruha Benjamin (2015) calls “discriminatory design,” technologies with foreseeable injustices built in. (And like many forms of discrimination, taken-for granted norms and complacencies that exclude certain populations from access can produce worrisome effects without being deliberately unjust.)

Is “discriminatory design” the inverse of humanitarian design? Humanitarian impulses express conscious intent to remedy injustices, whereas a glucometer’s discriminatory effects seem to derive more from assumptions and failures of imagination. As Madeleine Akrich observes in her now-classic essay “The De-Scription of Technical Objects” (1992), it is often “only in the confrontation between the real user and the projected user [that] the importance of…the difference between the two [comes] to light,” taking ethnographic work to “follow the device as it moves into countries that are culturally or historically distant from its place of origin” (Akrich 1992:211–212). When design problems for poor patients are identified, what happens next? As Alice Street discusses in this issue, point-of-care diagnostics have become a frontier of innovation for various global health projects. Yet glucose meters stand out as a boundary case example of technological design that has not been transformed by these new norms. Glucometers also serve for much more than one-time initial diagnosis of diabetes (though they at times play a diagnostic role): people then require access day in and out for the rest of a lifetime, if they hope to monitor their blood sugar in the ways their doctors recommend. Why have affordable, portable diagnostic tests for human African trypanosomiasis been developed and manufactured, but not for blood glucose?

Some people ask whether a satisfactory low-cost version of glucose testing already exists in urine strips (freighted with their own history of technical and ethical conundrums). Some of the first known technoscientific testing for diabetes was conducted with urine and bits of sheep’s wool dipped in stannous chloride, which turned black to indicate the presence of sugar. Urine tests using paper steeped in alkaline indigo-carmine were in vogue by 1883, when Bedside Urine Testing was published in England (Clarke and Foster 2012). The messy material culture of boiling your own urine was finally replaced in the 1940s by an Ames company urine dipstick test for sugar, the Clinitest. It was based on the breakthroughs of dry-reagent chemistry (the technology behind litmus paper), and popularly marketed for home use.

Figure 4. Clinitest, 1942. Gift of Robert J. Locurto, Division of Medicine & Science, National Museum of American History, Smithsonian Institution. Used with permission.

Today’s blood glucose machines are far more accurate than urine tests because they provide “real-time” blood glucose levels, whereas urine (by the time it’s expelled) is reflecting the body’s state several hours before. This, along with other limitations in precision, now makes blood glucose meters a basic standard of care for home testing in the United States. But out of recognition that such everyday glucometer testing remains utterly out of reach for many poor patients in huge swathes of the world, one of the IDF’s important advocacy and policy engagements was to issue a position statement on glucose testing access. It boldly supported the use of urine testing at home for diabetic people who could not afford personal blood glucose meters. The IDF’s official position statement on urine glucose testing was publically issued in 2005. The three-page document reads in part:

Before the advent of blood glucose monitoring in the 1970s, urine glucose monitoring was universally used, with many people able to maintain good control. Blood glucose monitoring has now replaced urine monitoring in resource-rich settings. However, insistence on blood glucose monitoring in economically disadvantaged settings could result in no monitoring at all…

• Urine glucose monitoring should continue to be available throughout the world.
• Education about its role and appropriate use should be part of essential education about diabetes for health care professionals and governments.
• It can be used separately to, or in conjunction with, blood glucose monitoring in particular circumstances and settings.
• It should continue to be included on the World Health Organization Essential Drugs List.
• The major promotion by industry of blood glucose monitoring should not result in the appropriate role of urine glucose monitoring being underestimated.
• As long as results are interpreted correctly, and limitations understood, it provides valuable information in persons with type 2 diabetes treated by diet or diet and tablets, in people with type 2 who use insulin, and in people with type 1 diabetes, who cannot afford blood glucose testing…
• Because it is significantly cheaper than blood glucose monitoring, it has a very important role to play in settings where blood glucose monitoring is not accessible due to cost, or where blood glucose monitoring can only be done relatively infrequently. This occurs in some situations in both developing and developed countries.
• Its use should be determined by the individual healthcare professional in conjunction with the person with diabetes, taking into account all circumstances.

International Diabetes Federation, 2005.

The IDF affirms they have not updated this statement, though it is not widely publicized. (Perhaps this relates to diplomatic negotiations with glucometer manufacturers, key players in diabetes policy arenas today.) Yet controversies about digital glucometer machines versus urine testing are also tangled up in much larger debates in global health ethics: When is outdated basic technology a stopgap measure for pragmatically addressing inequality in the meantime, and when does it risk normalizing complacency with unequal standards of care?

The glucometer’s historical emergence in high-income contexts sets the stage for certain kinds of innovation being constrained around industrial players’ concerns with retaining control of lucrative markets. Yet Akrich argues that it can be easy to believe such norms are unchangeable, which makes social history useful for opening up the contingencies of past designs and suggesting how their contours may be fiddled with ahead: “processes involved in building up the technical objects are concealed. The casual links they establish are naturalized. There was, or so it seems, never any possibility that it could have been otherwise” (Akrich 1992:222). Indeed, even market realities do not put to rest the larger questions also at play: Which inequalities trouble people into action or outrage, and which ones do not? Obviously there are unequal standards all over the place, but a few, like antiretroviral (ARV) availability to treat HIV/AIDS, became points of moral action. And like HIV/AIDS, diabetes also shares the market dilemmas of treatment for a lifelong disease that afflicts populations in both high- and low-income countries.

In the famous case of ARVs, alliances of patient advocates and national governments played major roles in using state laboratory capacities to put pressure on industrial players and make proprietary life-sustaining treatments more affordable. When it comes to diabetes hardware, a number of innovative projects (Akpan 2015) to design glucose management for people living in low-income settings are starting to get off the ground. One such effort is under way at the MIT Little Devices Lab (http://littledevices.mit.edu/), where I visited to learn more about work on “open design” by Jose Gomez-Marquez and his team. Studying the circuits of various glucose meters to figure out how they are wired, they envision an open device that could be useful for practitioners in his home country of Honduras or key collaborators in Nicaragua, for example, or a design blueprint that might be published online as a template for consideration by national laboratories in countries like Brazil that have the capacity to engineer their own quality components. The Little Devices team has also begun exploring what they call “lost technologies” of diabetes care.

Fig. 5. Jose Gomez-Marquez holding an open glucometer prototype at MIT Little Devices Lab (photo by author).

Such efforts are full of techno-ethical challenges, as Gomez-Marquez describes elsewhere (Mayo Clinic 2017). Yet they surely seem worth grappling with, given how uneven global diabetes care looks at present. In Belize at least, health workers I knew did not recommend urine dipstick tests for diabetes home care because they weren’t considered best practice. But the stark reality persisted: poorer patients often had no way at home to test their sugar at all. Once I asked in a local clinic how they dealt with this quandary, and was surprised to find out that this simple alternative glucose test—costing pennies instead of dollars, and requiring no machine—had been right there on the clinic shelves all along. It turned out that the same urine dipsticks used to check for infections measured not only leukocytes, but also a row of other indicators, including nitrates, albumin protein, bilirubin, urobillinogen, pH levels, and—most important for diabetics—glucose and ketones, present in urine only when the body is off balance. There were numerous cardboard boxes filled with urine test strip jars in storage, a visiting nurse added; it was one of the few things they kept easily in stock. She invited me to look. “Intended for use in the U.S.A.,” read the bottle’s evasive label.

I twisted off the plastic lid and examined its contents, but they yielded no easy answers either—just little strips of rainbow colored patches, paper bands expiring in a jar.

Fig. 6. A jar of urine test strips that include glucose and ketone indicators (photo by author).

References

Akpan, Nsikan. 2015. “Weavers Turn Silk into Diabetes Test Strips.” NPR, January 8. Available at link.

Akrich, Madeline. 1992. “The De-Scription of Technical Objects.” In Shaping Technology/Building Society: Studies in Sociotechnical Change, edited by W. L. Bijker, pp. 205–224. Cambridge, MA: MIT Press.

Benjamin, Ruha. 2015. “From Park Bench to Lab Bench: What Kind of Future Are We Designing?” [Video]. Available at link.

Clarke, S. F., and J. R. Foster. 2012. “A History of Blood Glucose Meters and Their Role in Self-Monitoring of Diabetes Mellitus.” British Journal of Biomedical Science 69(2):83–93.

Fidler, David. 2008. “A Theory of Open-Source Anarchy.” Indiana Journal of Global Legal Studies 15(1). Available at link.

Grondahl, Paul. 2012. “Growing Diabetic Population Fuels a Black Market.” Albany Times Union, January 30. Available at link.

International Diabetes Federation (IDF). 2015. “IDF Diabetes Atlas, 7^th Edition.” Available at link.

———. 2005. “The Role of Urine Glucose Monitoring in Diabetes: A Valuable Technology in Appropriate Settings.” IDF Position Statement. Brussels, Belgium.

Mayo Clinic. 2017. “Jose Gomez-Marquez.” Transform Conference 2017. Available at link.

Mendosa, David. 2000. “Meter Memories.” Diabetes Wellness Letter, pp. 1–6.

Mol, Annemarie and John Law. 2004. “Embodied Action, Enacted Bodies: The Example of Hypoglycaemia.” Body & Society 10(2-3): 43-62.

Moran-Thomas, Amy. 2016. “Breakthroughs for Whom? Global Diabetes Care and Equitable Design.” New England Journal of Medicine 375: 2317-2319. Available at link.

Redfield, Peter. 2012a. “The Unbearable Lightness of Expats: Double Binds of Humanitarian Mobility.” Cultural Anthropology 27(2):358–382. Available at link.

———. 2012b. “Bioexpectations: Life Technologies as Humanitarian Goods.” Public Culture 24(166):157–184.

Yoo, E.-H., and S.-Y. Lee. 2010. “Glucose Biosensors: An Overview of Use in Clinical Practice.” Sensors (Basel) 10(5):4558–4576.

Notes

[1] This is a gloss of one biosensor technique, described in lay terms to the best of my understanding, but various meters use many different variations of this technology that involve much further nuance. For detailed technical specifics of glucose biosensor technology, see “Glucose Biosensors” (Yoo and Lee 2010).

[2] Mapping the “global burden” of diabetes is very unevenly underway, as these statistics begin to suggest. Laboratory tests (such as fasting blood glucose or A1Cs) are more accurate to determine if someone has diabetes, since they provide a picture of glucose beyond the particular moment of testing. But these are much more logistically difficult than glucometer checks to realize outside clinics. Institutions currently rely on a patchwork of differently collected and missing data to estimate their diabetes projections, projects that raise their own conundrums (see IDF 2015).

[3] HLN News Now, CNN International Television; 7 June 2012.

[4] Though trimmed for space here, elsewhere this project unfolds in close dialogue with many other ethnographic and historical projects that also consider about how diabetic conditions are socially framed and materially enacted across distinct global contexts.

Featured Image: Foil inside an opened glucometer strip (photo by author).

The mobile phone revolution in Papua New Guinea (PNG) began in July 2007 when Irish billionaire Denis O’Brien’s company Digicel, in response to the government’s liberalization of the tele-communications sector, began rolling out its wireless network. Digicel was warmly welcomed by a country whose citizens felt neglected—if not downright mistreated—by the erstwhile state-owned monopoly Telikom due to the prohibitively expensive and geographically limited wireless services of its subsidiary Bemobile. Digicel did not disavow nationalism, to which Telikom reactively appealed, and also apparently cared about PNG, sponsoring sports teams and cultural festivals.

Digicel billboard in Goroka, Eastern Highlands Province, Papua New Guinea, 2015. Photo by D. Doiki

Most important, Digicel delivered wireless service to areas where it was never before available (Fig. 1), thus making good on its promise to bring the nation together (Fig. 2).

Individual customer benefits mattered too. Digicel quickly put basic handsets such as the Nokia 1020 within affordable reach of tens of thousands of people, many living in remote rural areas. By virtue of small, prepaid purchases of airtime, villagers could for the first time experience long-distance communication, especially with kin living and working in urban centers. And when a customer had no credit on her phone, she could use the free “call me” short-message service (SMS) to request that a loved one get in touch (Fig. 3). Digicel clearly understood the value of mobile phones as affective technologies, objects that “mediate the expression, display, experience and communication of feelings and emotions” (Lasen 2004:1).

Fig. 1. (left) Digicel newspaper ad, September 2007. Photo by R. Foster
Fig. 2. (right) Digicel ad, circa 2011.

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In the beginning, people did not have many numbers to call or much credit with which to call. So they called Customer Care. Dial 123. 24/7. Free. They still call. But now there is a charge for calling during off-peak hours. The charge is meant to discourage prank calls, especially late at night.

Fig. 3. Digicel ad for “call me” sms service,
circa 2007.

People also called numbers randomly in search of phone friends who might become romantically involved and eventually meet face to face. Persistent calls from unknown numbers became a common topic of public conversation and a compelling justification for legislating mandatory registration of subscriber identity modules (SIM cards), which finally happened in 2016.

Mobile phones entrained new possibilities not only for sustaining long-distance kin relations but also for experimenting with self-development. The capacity to engage in novel forms of intimacy with strangers and in private forms of communications with intimates was welcomed by some, decried by others, and regarded with ambivalence by most people. New ways to express care and concern—such as sending and receiving credit requests for airtime—were offered by a company that promoted itself as a caregiver to its customers and to the nation as a whole.

At the same time, mobile phones, understood as social and material assemblages that include more than the discrete handset, were taken up in ways that exposed the premises of a robust moral economy: what companies, consumers and state agents owed to each other posed a perpetually open question. The capacity of the PNG state to regulate Digicel, which owns and controls the network it built, is weak; the business challenge faced by Digicel to overcome the absence of a reliable electric power grid and the chronic insecurity of corporate assets such as cell towers, which are regularly vandalized, is enormous; and the ability of consumers to use the network in the face of limited financial means and increasing demand for smartphones and data is always under threat.

In short, the moral economy of customer care in PNG is precarious for everyone. Here I offer five brief ethnographic examples.

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Karen acquired her first mobile phone when she came to university in the capital city of Port Moresby in 2011. She already had friends who owned mobile phones despite an official ban on the devices at her high school. But at university, every student seemed to have not just a phone, but a smartphone that enabled use of the internet for their studies. Having a phone appeared to be a standard expectation, and students who did not have them felt an acute sense of being left out. Karen’s uncle gave her an old Samsung model that he brought from Australia, which she used until the inconvenience of not having a matching charger for the phone compelled her to buy a new entry-level Alcatel smartphone for 149 kina (approximately US$50; Fig. 4).

Fig. 4. Entry-level smartphone on display
at Digicel retail outlet, 2014.
Photo by R. Foster.

For Karen, the phone was helpful in overcoming her nervousness about approaching her lecturers and tutors in person. She would instead call them and pay attention to how they conversed and asked her questions: “How may I help you?” Karen learned and repeated her lecturer’s conversational strategies in her face-to-face interactions with others, developing a sense of confidence and clarity in her public speaking. “I learned how to approach people…. I felt like my life changed.”

The phone allowed Karen to overcome her timidity (and she has witnessed similar transformations in other female university students). For example, Karen now has no hesitation about calling Digicel’s Customer Care when she has questions about the accuracy with which her prepaid balance of airtime is being managed. Dial 123, send: “How may I help you?” Digicel will find the right person to attend to her concern. The next time Karen makes a call, she will be charged at a lower rate. She is not sure how it works exactly. But they respond. “They respond…because I am their customer.” As a customer, Karen received the sort of recognition that many Papua New Guineans seek in vain from a state that has failed since independence in 1975 to bring development to its citizens in the form of tangible goods and services.

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Not all Digicel customers agree with Karen. The evidence is found on the Facebook page of the Digicel Complaints Group, a public forum for more than 43,000 mobile phone users. Group members who purchase airtime from Digicel, the dominant mobile network operator, use the forum to register dissatisfaction with the company’s services. They express particular concern about the conversion of prepaid airtime into data and the dubious ways in which Digicel adds and subtracts data from an individual’s balance. Complaints often concern the failure of credits to appear on a person’s phone after a purchase has been made or the disappearance of data from a person’s balance even when the phone is not in use.

My friend Cletus’s complaint to the group is fairly typical:

At exactly 11am today, I entered two K5 flex numbers: 01 7249 490 5910 & 16 2662 659 3637. At exactly 11:14am, Digicel sent me two messages: 1. Advised that I have used up my data and 2. Asked whether I need airtime of K13 advance. I immediately checked my balance only to see K5.03. I texted Digicel and 5 minutes [later] I was reimbursed K3 and not the whole K4.77. What a daylight robbery!

People sometimes post screenshots of the balances on their phones as evidence of stolen data. Accusations of robbery and theft, of being “ripped” (off), are commonplace. Such complaints recall historian E. P. Thompson’s (1971) well-known account of the protests that erupted as a moral economy of food provision gave way to practices and principles associated with “free trade” in 18th-century England. These protests, which often led to direct action, invoked notions of fair and transparent dealing in the face of concerns that the poor suffered at the hands of those with “command of a prime necessity of life”  (Thompson 1971:93). Much like the folks about whom Thompson wrote, Digicel Complaints Group members express intense feelings over “weights and measures” and beseech the authorities to regulate business transactions. In other words, offended consumers look for help from the same neglectful state that let them down before Digicel arrived.

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The capacity of poor people to own and operate a phone in the developing world hinges on technologies of prepay, which allow users to pay as they go by buying small amounts of airtime when necessary or when funds become irregularly available. Managing one’s airtime requires tempering the practice of self-discipline with responsiveness to the obligations of caring for others.

Winnie is a heavy user who can spend up to 100 kina (US$33) a week in airtime credits. She is a young single woman living far from home and regards frequent communication with her family and friends as nothing less than essential. Winnie has a steady income and is generous when her kin send credit requests for airtime, which she can transfer directly to their phones for a small fee. She says that she is capable of spending all her savings on airtime, and she has on occasion come close to doing so by “topping up” her phone through a mobile banking account, a relatively new service that effectively enables users to purchase airtime anytime, anywhere. (A fair comparison is with gambling machines that provide access to a player’s bank account without requiring the player to leave his or her seat in front of the machine.) To discipline herself—and she used the English word discipline—Winnie has opened an account with another bank into which she makes weekly deposits. This bank, Winnie explained, does not offer the mobile top-up service. She has thus safeguarded her money from herself (see Foster, in press).

Winnie is explicit about the calculations that she makes in managing her mobile phone. She says that she does not feel able to start the day unless she is equipped to communicate. So, in the morning she will top up her phone for 5 kina (US$1.66). This top-up gives her 100 free promotional minutes for use between 11pm that night and 7am the following morning. She then purchases a one-day data pass: 60 MB for 3 kina. This data is enough to allow her to go online and communicate with friends and family via the applications WhatsApp and Viber. Winnie discovered that she could send voice messages over the internet for much less money than making voice calls. Finally, Winnie purchases a discounted bundle of 60 text messages for 1.20 kina. She will use most if not all of these text messages before they expire at midnight. That leaves 80 toea as a balance in case Winnie needs to make a quick phone call during the day (100 toea = 1 kina). (On-net calls from one Digicel phone to another are billed at 79 toea per minute, with per-second billing, during the peak hours of 7am to 9pm.) Once she has made these preparations, Winnie feels ready to go out into the world and meet the demands of the day.

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Winnie’s daily routine might understandably lead one to conclude that a peculiar kind of calculative rationality has been baked into the phone itself, such that Lucy’s habit of giving gifts to her relatives is subsumed within the sort of measuring and monitoring associated with markets and commodity exchange. This same tension between alternative logics of gift and commodity shapes the larger social and material assemblage of which the phone itself is part. It is a tension that threatens the future of customer care.

Fig 5. Phone repair vendor’s table, Goroka, 2015. Photo by W. Magea

Matthew, a single man in his early thirties, repairs mobile phones and sells airtime at a street stand in the highlands town of Goroka (Fig. 5). He occupies a particular spot on a particular corner with other vendors who sell cigarettes, betel nuts, hard-boiled eggs, soft drinks, and the scratch (or “flex”) cards that people buy to top up their mobile phone airtime balances (Fig. 6). Matthew was one of the first to teach himself how to repair phones; he and his friend and workmate Gabriel were also among the first to start selling airtime in 2009 as Digicel expanded its network of cell towers across the country.

Fig. 6. Street vendor selling scratch or “flex” cards, Goroka, 2015. Photo by W. Magea

Matthew regards his work as a service to the community; indeed, to the nation. His business yields to the demands of a moral economy that Thompson would easily recognize. Villagers who come to town with no money can offer their homegrown bananas or sweet potatoes in exchange for repair services. Town workers, however, will be sized up and charged according to Matthew’s estimate of their ability to pay. The vendors, moreover, care for each other: they all offer their goods at the same price and eschew overt competition. One vendor’s business crashed when he overspent his revenue and was unable to purchase a new supply of scratch cards. A fellow vendor hired him until he was able, a year later, to save enough money to re-establish his own business.

Matthew insists that he and his fellow vendors are part of Digicel: without them the network would not work. His recognition of people as infrastructure is entirely plausible; Digicel still relies on vendors in places like Goroka to distribute airtime credit into the hinterlands where people prefer to buy scratch cards in town for use (or resale) later in the village. In cities like Port Moresby, however, the advent of smartphones has enabled more and more people to top up directly online, buying airtime like Winnie through linked banking accounts. Moreover, new forms of “self-care”—quite different from the kind of care that Matthew affords his customer—are being promoted. In January 2017, Digicel launched the My Digicel App for smartphone users, promising customers an efficient tool for “managing their Digicel life” (The National 2017). Several months later, the company introduced a menu that would allow customers, including users of basic handsets, to assist themselves with queries relating to data and top up, among other things. Dial *123#. 24/7. Free. A list of frequently asked questions appears on the phone’s screen.

The future of the prepaid scratch card is dubious, and the economic niche of street vendors is shrinking. There is a policy argument to be made that preservation of the scratch card vendors’ livelihood would support the so-called informal economy on which so many Papua New Guineans depend. For Matthew, however, it is an ethical as well as economic question: Does Digicel really care about him and his fellow vendors, who were present at the beginning when the company was first establishing itself in the country? His concerns echo those of the Digicel Complaints Group, and pose the unsettling question of whether Digicel still cares for the people of PNG 10 years after the company brought them a revolution in communications.

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Digicel of course expresses care and concern in ways that are familiar to corporate observers, if not immediately relevant to Matthew. The company has set up a branch of the Digicel Foundation in PNG as a way of giving back to the community by funding health and education projects—providing bits of infrastructure that the state has not—like a reliable nationwide telecommunications system. The company has even addressed one of the main problems for individuals in operating a mobile phone, namely keeping the battery charged. Outside of urban centers, which experience frequent power outages, access to electricity is severely restricted. Digicel has responded by marketing small solar panels for 95 kina (US$31; Fig. 7).

Fig. 7. Digicel ad for solar panel
at Jackson’s Airport, Port Moresby, 2016.
Photo by R. Foster

The Digicel Foundation attracts the standard critiques of corporate social responsibility: it’s window dressing and public relations and so on. Whether the Digicel Foundation is successful in promoting goodwill and positive sentiments among the people of PNG is unclear. The uptake of mobile phones in the country, however, continually surprises with respect to the capacity of these devices as affective technologies. My final ethnographic example underscores the high stakes involved in the emergence of a desirable new form of affective technology over which one’s control is exceedingly tenuous.

Lucy is in her early fifties, a rural woman with little education who, after being diagnosed as HIV positive, was struggling to live on her own after her older brother had refused to take her in.[1] A previous husband offered Lucy some money and a used mobile phone. Desperate, hungry, and contemplating suicide, Lucy began calling the contacts saved in the phone until one woman, instead of yelling and hanging up, agreed to speak with her. This woman, Angela, responded with compassion and began sending Lucy small gifts of food, money, and secondhand clothes. Lucy and Angela never met, but continued to talk by phone, thereby restoring Lucy’s feelings of hope and alleviating the anxieties that Lucy thought would reduce the effectiveness of her anti-retroviral medications. A friend found by chance on a random call enabled Lucy’s old mobile phone to function therapeutically as an affective technology, a medium for giving and receiving care.

Lucy’s story, like Matthew’s, exposes not only the possibilities but also the vulnerabilities inherent in the shifting moral economy of mobile phones. But Lucy’s story does not end well. Her phone, the source of Lucy’s emotional sustenance, was eventually stolen: “All those phone friends, in Port Moresby, Mt. Hagen, and other places, they would send me credit, and we talked all the time, every night, and now I don’t have a phone, and I’ve lost all those numbers. It’s terrible. I can’t stop crying about it. I had the same phone for four years, and had so many numbers, so many friends. And now it’s all gone.”

Acknowledgments

In this essay I draw on research supported by the Australian Research Council through a grant (DP140103773) awarded to Professor Heather Horst (University of Sydney/RMIT University) and the author. Wendy Bai Magea offered helpful research assistance.

References

Foster, Robert J. In press. “Top-Up: The Moral Economy of Prepaid Mobile Phone Subscriptions.” In The Moral Economy of Mobile Phones: Pacific Islands Perspectives, edited by R. Foster and H. Horst. Canberra, Australia: ANU Press.

Lasen, Amparo. 2004. “Affective Technologies—Emotions and Mobile Phones.” Vodafone Receiver Magazine 11. Available at link.

The National. 2017. “Digicel PNG Launches My Digicel Application.” The National, January 20. Available at link.

Thompson, E. P. 1971. “The Moral Economy of the English Crowd in the Eighteenth Century.” Past and Present 50:71–136.

Wardlow, Holly. In press. “HIV, Phone Friends, and Affective Technology in Papua New Guinea.” In The Moral Economy of Mobile Phones: Pacific Islands Perspectives, edited by R. Foster and H. Horst. Canberra, Australia: ANU Press.

[1] Lucy’s story is told more fully in Wardlow (in press).

Featured Photo: Digicel Flex Cards. Photo by M. Boie.

“Little Development Devices/Humanitarian Goods” seeks to explore objects or instruments designed to care about and improve the welfare of infrastructurally marginal populations (i.e. those lacking connection to “networked” forms of modern provisioning—such as water, sewerage, communication, electricity—or to services such as health care and finance). As our title suggests, we perceive two trajectories into this phenomenon.

The first derives from the legacy of the large, capital intensive and spatially fixed infrastructural projects of post-World War II development — such as dams, power plants, and road networks — which embody a substantive vision of societal transformation as laid out and organized by technocratic experts and government officials who act in the name, and for the benefit, of a whole nation. In contrast, the devices we highlight arose against the backdrop of sustained and polymorphous critiques of this older paradigm of development. They combine elements of earlier attempts to define more “appropriate” technology with new techniques for monitoring, calculation and testing. In reacting to perceptions of past failure, their normative rationality is oriented to immediate, measurable and testable outcomes.

The second trajectory stems from the parallel emergence of humanitarianism as a mode and set of techniques for crisis response, including the establishment of intergovernmental agencies and nongovernmental organizations devoted to the care of distant others, as well as the standardization of associated mobile technologies like refugee camps. The devices we examine here respond to perceived incapacities, failures and perverse outcomes of this very aid regime, even while seeking to further its general goals of alleviating pressing needs and saving lives. Many rely on market logic and present themselves as commodities more than gifts, ostensibly enrolling profit motives into the service of a greater good.

In this issue of Limn we seek to ask: What are we to make of the proliferation of such small devices? What do they tell us about the state of “development” and “humanitarianism” as projects? And what do we make of the convergence of humanitarian and developmental projects around them? What forms of life, and what kinds of subjects, do they work on and constitute? What relationships do they establish between expertise, government, and the purported beneficiaries of these devices? What politics do they make possible – or preclude? Do some appear analogous to hacks, exploiting the vulnerability of existing infrastructures for other ends? And what might a critical social science have to say about them?

Edited by: Stephen J. Collier, Jamie Cross, Peter Redfield and Alice Street

November 2017. This issue of Limn examines the recent profusion of micro-technologies in the worlds of humanitarianism and development, some focused on fostering forms of social improvement, others claiming to alleviate suffering, and many seeking to accomplish both. From water meters, micro-insurance and cash transfers, to solar lanterns, water filtration systems, and sanitation devices, examples proliferate across the early 21st century landscapes of international aid. Although small-scale endeavors are far from novel, today these devices are animated by different intellectual and moral energy, drawing on novel financial and organizational resources. Many blur distinctions between public and private interests, along with divisions between obligations, gifts and commodities. At the same time, they entail novel configurations of expertise, political obligation and forms of care. The articles in this issue explore these new convergences of developmental and humanitarian projects, alongside reworked relationships between experts, governments, and purported beneficiaries, focused on fostering “participation” and “partnerships” rather than nation-building.

Contributors include:

Jacqueline Best, Marc Boeckler, Brenda Chalfin and Xhulio Binjaku, Jamie Cross, Vincent Duclos, Robert Foster, Christopher Kelty, Meena Khandelwal and Kayley Lain, Austin Lord, Amy Moran Thomas,
Jonathan Morduch, Peter Redfield, David Reubi, Anke Schwittay and Paul Braund, Tom Scott Smith, Alice Street, and Tatiana Thieme

It’s here: The printed version of Limn number 8 is now available for purchase → buy the print version or get the PDF