WiRED Turns Its Focus to Medical and Health Education
after Work in Kosovo
BY WIRED DIRECTOR GARY SELNOW, PH.D.
Beginnings in Kosovo
In 1999, not long after the end of NATO’s aerial bombing of Serbia, the U.S. State Department asked me to join a team that the Department had assembled to build a network of seven Internet Access Centers (IAC) across Kosovo. The State Department had been tracking WiRED’s Internet programs elsewhere in the Balkans, and it recognized that WiRED International knew the region, knew the technology involved and knew what training programs were necessary to prepare administrators to manage local centers.
My first trip to Kosovo was in the summer of 1999, and the chaos that defined the place was evident almost immediately. Actually, the Wild West show started even before I ever got to Kosovo, because getting there was a two-step process. The airport in Pristina, the capital, was closed, so I flew to Skopje, Macedonia, then found my way up to Pristina, 54 miles away on the worst road in all of Europe. The trip took three hours when traffic was light; a full day when traffic was normal. It was the only road in, so everyone drove on it. It had two narrow lanes riddled with pot holes and broken pavement that kept traffic to a crawl. Toppled vehicles on the side of the road reminded impatient drivers that the pavement was precarious, and that passing on the shoulder wasn’t a good idea.
Describing the road to Pristina is getting ahead of the story. I arrived in Skopje on a delayed flight from Zagreb, Croatia. By the time I got there, my planned ground transportation driver was long gone. Of course, there was no bus service or scheduled transportation. Here, if you wanted to get anywhere, you needed to know someone with wheels or you walked.
People pushed their way out of the small concrete terminal that, because of the extra Kosovo traffic, served way more passengers than it was designed to handle. Crowds dragged their heavy luggage into the pick-up area where rusted Tito-era Yugos loaded passengers. Taped-up suitcases and overstuffed plastic bags, tied precariously with thin plastic ropes, were stacked like wobbly wedding cakes on the roofs of the tiny cars. I watched a car slowly approach the exit, and saw a man’s whiskered face pressed flat against the window as other passengers squeezed tightly against him. The Yugo, straining under its burden, blew thick black exhaust and gurgled out of the pickup area.
Now I had to find a ride. I walked up to several people, all of them smoking cigarettes (everyone smokes in the Balkans) and asked if they were heading to Pristina. I asked in English, which made me entirely invisible to them. I asked a few other groups and got the same result. It would be dark soon, and I didn’t know whether they closed the airport at night. I sat on my duffle bag and thought about next steps. There weren’t a lot of options, but just as despair began to set in, a shiny new van pulled up, and several men with backpacks walked out of the terminal and approached the vehicle. I ran over and asked if they were going to Pristina.
Can I ride with you?
I need to get there.
To do some work on the Internet.
There is no Internet.
I know; that’s why I’m going there — to help put it in.
Who are you with?
We’re working with the U.S. State Department on an Internet project.
I threw my backpack and duffle into the van, and, as the sun was beginning to set, the van moved into the bumper-to-bumper traffic for the 54-mile, five-hour trip, through passport checks, past the toppled-over vehicles and on up to Pristina. Several passengers, who had been to Kosovo before, told me what to expect, what to avoid and, of course, told me about good places to eat, where to buy groceries and where to get cold beer. Two or three of the passengers worked for non-profits, and the others were contractors with companies hired to repair damaged utility systems. They were Americans, Italians and Germans, and one was a Turkish man, living in the Netherlands. The Kosovo recovery effort had brought in a wonderful mulligan stew of workers.
We got to Pristina near midnight, and I needed to figure out where I’d spend the night. Lodging had been arranged by the people who were planning to give me a ride from the Skopje airport, but it was late, and they had left. No one had cell phones in those days to help align schedules that had gotten out of whack. First things first. Several of us from the van went to eat dinner in a dingy restaurant that served good kebabs and cold Peja beer. We ordered the meal; then the power went out. The power always goes out. The restaurant fired up a generator, and I could hear generators all over Pristina firing up, so emergency lights came on, and the city hummed from the generators and took on the muted glow of neon lights. Someone at our table took pity on me and said he thought I could probably crash on the sofa in the apartment he was renting with a group of people. That’s how the first night in Pristina went.
The next morning, after lots of thick Balkans’ coffee, I set out on a long walk through the city to find the International Organization for Migration (IOM) office. IOM led the IAC project, and their job was to pull together the people and resources needed to get the planned computer facilities up and running quickly. IOM employees are members of a group that exists to respond in emergencies, like this post-conflict mission, but also in earthquakes and epidemics. I couldn’t have known it then, but WiRED would be working with IOM again in Iraq and later in Africa. Over the years, as our health education mission evolved, WiRED, too, would become part of that group.
IOM provided administrative and staff support and brought in an American technology company for the engineering which was required to install the Internet equipment. That involved setting up a large satellite dish in Pristina and relay facilities to get a signal from the dish to the seven centers scattered throughout Kosovo. Finally, the technicians would network the computers within each IAC. WiRED’s role was to teach the administrators and their assistants how to run the computer facilities and how to teach basic computer skills to people who had never before seen a computer.
Most of the people WiRED trained were teachers, but only a few had had computer experience, so we started with the basics: “This is the ‘on’ button, this is a mouse.” Several hours later, we moved to Internet searches. The purpose of the entire project was to allow people to search for relatives and friends, and for that, they needed to know how to run a search. The search tools available in 1999 were primitive by today’s standards. The remarkable and easy Google search engine wasn’t in the field yet, so we taught the trainers how to search using Yahoo and Netscape. Search engines back then operated with Boolean Logic (don’t ask), so there was more involved than just typing a word or phrase into the search bar as we do today. Training lasted a week, and when the classes were over, the administrators and trainers went back to their hometowns and opened the doors to their Internet Access Centers, where people lined up every morning to use the new, cost-free Internet facilities, which had been donated by the American government.
I had several opportunities throughout that year to visit the IACs in Kosovo. The center in Mitrovica, 25 miles northwest of Pristina, faced the greatest challenges. A few blocks away stood a footbridge that served as an infamous symbol of the harsh ethnic division that marked this tinderbox of a town. Violence in Mitrovica, much of it occurring around the bridge, set in motion ripples that would for years stir the bitter emotions of people on both sides of the conflict, on both sides of the bridge and throughout all of Kosovo. Serbians stood a restless watch on the north side; Kosovar Albanians kept nervous guard on the south side. Even with the dark clouds that hung over Mitrovica, the IAC kept its doors open and its computers available for families to reach out to lost relatives. Under difficult but less tense conditions, each of the other six centers provided an electronic link between people who stayed and people who left, and families that split apart, then lost touch.
Background on Kosovo
Kosovo had been plagued for generations by tensions between the Serbian and Albanian populations. Ethnic conflicts rose to the surface after the death of Yugoslavia’s President, Josip Tito in 1980, and grew through the next two decades, spiking in 1996 with growing aggression from Serbia and with the emergence of the ethnic-Albanian Kosovo Liberation Army (KLA). Intense international diplomacy failed to curb the aggression, which was often staged by state-sponsored thugs. In fall 1998, more than 250,000 people were displaced, with many escaping to Albania, and more than 30,000 driven into the woods without food or shelter, when winter was fast approaching.
In January 1999, in retaliation for a KLA attack on four Serbian officers, Serbian security forces killed 45 Kosovar Albanians, which set off a firestorm and made a peaceful resolution almost impossible. In late March, with Serbia’s growing hostility, and with peace talks dead, NATO initiated aerial bombing raids in Serbia. PBS Frontline reported that three months and more than 38,000 combat missions later, the bombing ended, when Serbia agreed to accept terms of a peace deal calling for a complete end to hostilities in Kosovo.
The Internet Access Centers were part of a larger effort by the State Department to restore stability to Kosovo by helping the people rebuild their dismantled social systems. The IACs provided Internet portals that allowed people who remained in Kosovo to reconnect with family and friends who fled the fighting. This opened a critical channel. Kosovo’s communication systems were broken as a result of years of conflict. The telephone network was damaged, mobile phone systems were not functional, mail service was shut down, and the Internet had not yet been introduced. It was difficult to reach people within Kosovo or to get word from the outside. The State Department wisely saw that Internet communications, which were expanding rapidly in the United States and in Western Europe, could provide an essential tool at this stage of Kosovo’s recovery.
The Internet offered a virtual bridge for people separated by war. The people who remained in Kosovo could communicate with family and friends who had left the province, and people outside could reach back to the homeland to find out who lived and who died, to discover whether their homes were still standing and to confirm whether it was safe to return. This may have been the first use of the Internet for such a large-scale humanitarian outreach program.
The computer facility in Pristina, located in “The National and University Library of Kosovo,” took on a special meaning for WiRED because it played a significant part in our organizational evolution. We installed computers in the spacious central hall that allowed small groups to gather around each of the 12 or so available computers. The place was always packed, and a full house was about as gratifying as anyone could hope for.
I spent a lot of time in the library center and noticed something unexpected. Physicians, way out of proportion to their numbers in the population, sat hunched over several of the computers, downloading files to CDs. A few regulars arrived at the opening bell of each day and stayed until their clinics opened a few hours later. I wondered whether doctors’ families were more likely than others to flee Kosovo during the hostilities. Did they have more searching to do for lost friends than anyone else?
I talked with many of those physicians, and most told me they were doing medical research. They were astonished by the easy access to current medical information . . . in the middle of Pristina. How could such resources be so easily available, and for free? Today we take for granted how easy it is to get our hands on almost any information we wish; two decades ago people were just realizing the power of this new medium, and for the doctors, it was a quick and valuable immersion into the cyber world.
It’s important to note that doctors came to the center to research the latest medical information because they had been deprived of resources for years; medical journals and papers still were not available in Kosovo, so medical professionals were unable to obtain useful research documents or updates on diagnostic and treatment procedures. The conflict had blocked medical journals from arriving in Kosovo, had prevented outside experts from visiting, and had made it difficult for physicians to leave Kosovo to attend conferences and lectures, where they could catch up on new developments.
In addition to accessing Web material with their Hotmail and Yahoo accounts, the physicians could exchange emails with colleagues on the outside, who offered advice and who attached scientific papers. Communications worked in the other direction as well, allowing physicians in Kosovo to share with colleagues on the outside the useful techniques they had discovered in their clinics and operating rooms to treat conditions caused by or made worse by the hostilities.
The doctors were impressed with the variety of medical information they found online, although the amount of information available at that time doesn’t hold a candle to the vast resources obtainable today. Now most journals offer online editions, while only a few journals were published online back then. The World Health Organization’s brilliant HINARI program wasn’t available then, but today it provides doctors in low-resource countries access to hundreds of topline medical journals for free or with minimal charges. Even though HINARI is almost free in developing countries, it is still unavailable to most doctors because they must be associated with a hospital or university in order to use it.
Seeing how the Internet could deliver medical information to the Kosovar physicians offered me a clear and compelling lesson. I realized that this new technology — the Internet and computers — could be incredibly effective in delivering information and education programs to people in remote places.
Physician in Kosovo working on medical research
at the IAC in Prishtina.
The Kosovo experience was an eye-opener for us at WiRED. After additional research and discussion, WiRED shifted its organizational mission away from a general application of communication technology toward a reconstruction of our programs to include a wide range of services to deliver medical and health information and education to underserved areas.
Hundreds of thousands of doctors and nurses, community health workers and others in the health field suffer isolation similar to that which we saw in Kosovo. We took up the challenge to develop and deliver medical and community health information to the most difficult places — places where communities have been marginalized by geography, poverty, technology limitations and political abuses. Over the years, that revised mission has guided our small volunteer-driven organization in its service to millions of people in some of the most challenging environments on earth.
Why Is Medical Education Needed?
While there is a wealth of medical information available online today, it’s still beyond the reach of hundreds of thousands of medical professionals. Why? For many it’s geographic. They practice medicine in remote regions where there are few libraries or other resources. For even more, it’s economic. They just can’t afford journal subscriptions, online fees or computer and Internet hardware. For others it’s technological. Populations in many underserved countries have little Internet access and few computers. In some places where WiRED works, fully 80 percent of medical professionals have no Internet access or have only occasional access. Finally, there is political obstruction. In these cases, political leaders may seek to control the flow of information, even scientific information, to community leaders, including doctors. Such was the case with Saddam Hussein in Iraq. Political instability that led to the conflict in Kosovo and to the war in Syria and elsewhere in the Middle East would fall into this category. Of course, these reasons for isolation are not mutually exclusive. Economically challenged regions, for instance, are also likely to have limited Internet connectivity and no computer hardware.
Medical communities in low-resource locations have limited access to reliable scientific information and to updates about the latest diagnostic and treatment procedures. This is a real problem in places already marginalized and disadvantaged. But why is it a problem? Medical and scientific advances would stop in their tracks without the ability of professionals to share information and research. Free and open communication in these professions has a multiplier effect, with one study leading to another, and one discovery inspiring another. Science without collaboration comes to a standstill.
The practice of medicine without collaboration becomes less effective because without collaboration, doctors can’t benefit from techniques developed by researchers and other practicing physicians. Think about where isolated medical teams would have been in West Africa when the Ebola virus struck if they hadn’t been connected to outside researchers. Think about isolated doctors treating a polio outbreak in Syria several years ago, who knew little about the illness until WiRED and others rushed in with appropriate medical information. Collaboration and communication serve medical communities in these crisis environments, but they also provide guidance for the practice of routine medicine. It’s a rare profession in which a person can perform as well alone as he or she can when collaborating with others in the field, and this is especially true in medicine.
This is the second story in a series about WiRED International. How it evolved; how it went from providing computers and Internet connections for towns and villages in underserved regions to focusing on medical and health education using computer technology. How it expanded its work throughout the Balkans to Africa, Central and South America to the Middle East and Eurasia. How WiRED’s training programs, carried by the Internet, have now become global resources, used by hospitals and clinics, schools, other non-governmental organizations and universities.
An element of WiRED’s operation that repeats in every story is that all of WiRED’s programs are run mainly by volunteers, who have made it possible for WiRED to provide medical and health training programs cost-free to everyone. WiRED’s administration is volunteer, we have a volunteer board, and our writers and editors are volunteers. A small paid staff builds and shepherds the training modules through the production process, but even their work is augmented by that of volunteers. I’m proud of the people in the United States and abroad who donate their time and lend their talents to this organization’s efforts to provide people in low resource regions with some of the finest public-access, health training material available anywhere.