Hello, Mr. Obasanje? The Doctor Will Text You Now

The Bush Telegraph is a phrase that describes how people quickly pass information to others in a particular region, typically in an African "bush" setting. It conjures up exotic locales in faraway places where mosquito nets are commonplace and transportation is not. And where making a simple local call can turn into an all day event.

I learned about the bush telegraph during my time in Africa as a Peace Corps Volunteer. Imagine my surprise when I received a letter from a fellow volunteer posted several days journey from me, congratulating me on my new hut. I hadn't written to him yet so how had he heard about this so quickly? It seems the bush telegraph got to him within a week's time, with word passing and repeating from person to person - from my village to every road stop between my southern village and his remote desert village in the north. And while I was in awe of the power of the bush telegraph - I'd thought it was a myth - today, it has been replaced with the new and improved bush telegraph system, the cell phone, or "mobiles" as they're commonly referred to in Africa and Asia.

The first time I really remember the power of the cell phone in a developing country setting was in Vietnam in 1999. I was walking home with some colleagues, from a lovely dinner in Hanoi late one warm summer evening. It was about midnight and the only other people on the streets were the street sweepers who clean the streets and gutters of Vietnam all night long. I noticed one of them take out a cell phone and I thought, "Wow, cells are everywhere now, even the street sweepers have them."

Suddenly, a drunken motorbike driver came careening down the street, hitting one of the street sweepers and running her over, then speeding off into the night. I stared across the street, trying to decide how to help, but before I could do anything, or remember enough basic Vietnamese to say anything, the other street sweeper had flagged down another moto driver, and they were on their cell phones, calling the hospital to see what they should do. The woman was put on the back of the moto, and quickly driven off to hospital while her friend called her family on the cell phone, telling them what happened and what hospital she was being taken to.

It all happened so quickly, and yet, without cell phones, what would have happened? There would have been no call to the hospital to ask for help, no calls to the family. Nothing. It was then that I started hating cell phones a little less. You see, coming from the US, I was getting so tired of people pulling out their phones all the time and yapping loudly, forcing me to listen to their inane telephone conversations during a movie, dinner, wherever. I was a bonafide cell phone hater. This was the first time I'd seen a cell phone used for a non-frivolous purpose and it hit me how much more seriously the Vietnamese took their cell phones. Sure they called around to friends and family to gossip. But they carried phones back in the late 1990's because there weren't - and still aren't - public phones or reliable communication for general use.

Fast forward to now. People in Asia and Africa are leading the way in how they access and use their cellular communication. I remember several years ago being on a long assignment in Hanoi, and being amazed at the level of cell phone access, far easier than here in the United States. I wanted to buy a local phone number for my three-month stay so I sought out the hippest looking dude in my office and said, "Hey Tung, where can I buy a sim card and some cell phone time?" He called me over to his desk and pulled up the internet site for one of national cell phone companies and asked me to "pick a number". I had no idea what he was talking about and he had to explain to me how to get a sim card. He could not believe I didn't know how to do this and he was even more floored when I told him we didn't have such services in the US. I felt like a child being taught something that everyone else knows how to do.

It seems in Vietnam, for years now you've been able to log onto the internet, choose which cell company you want, select the phone number of your choice from lists of available numbers, and then have your new sim card and phone minutes card delivered to your place of choice via a xe om (a guy on a motorbike) - to your home, your office, the local café you're hanging out in that day. Wherever. It's amazing, so convenient and easy, and the best part is that there's no delivery fee. Interestingly, you do pay a higher price for the sim card depending on which phone number you select. If you let them choose for you it's the cheapest price. If you choose the number it's a bit more. And if you choose a phone number that is particularly easy to remember (repeating numbers like 448- 4484) or if the number is considered an "auspicious" number by local Asian standards, then you pay the highest price. This ease and convenience surrounding cell phones in Asia has always made me wonder why we are so far behind Asians in terms of managing our cell phones and how we use them.

Not only are the cellular services far ahead of us in most developing countries, but my Asian colleagues have been using texting - or SMS as they refer to it in Asia and Africa - for many years now, far longer than has been popular here in the US. In America, we're still in the texting "diaper" phase when you compare us to a country like Vietnam. Working in the HIV/AIDS sector, it is now commonplace for me to encourage and recommend using SMS as a means to get messages and information out to, and engage with youth populations. And SMS has been incorporated into several public health HIV/AIDS communication projects, where information and contests have been made exciting and accessible to anyone with a cell phone, allowing for both targeted and general population participation in HIV/AIDS programs on a scale that is far greater than relying solely on newspapers or more traditional mass media channels such as radio or television. I mean, if you're young, hip and living in Vietnam then you live with an extended family. If there's a show about HIV/AIDS on radio or TV and you want to phone in with a question, or participate in a contest, you can't really do that discreetly when you're surrounded by your family, granny, aunties and uncles, right? But by cell phone, you can easily receive information and participate back via SMS without causing your family to wonder why you want to know about such things. It's a brilliant communication channel for young people in particular, though it's useful for any population, really.

Even the little tchotchkes that you can put on your phone now - the colorful skins and dangling doohickies (cellularbilia, it's a new word, I made it up) - those have all been around Asia and Africa for at least a decade by now even though they're relatively new to the US markets. You've been able to buy Hello Kitty cell phone dangling doohickies in Japan and Asia for longer than I care to remember, even though they've only been here a few years. Every time I'm on assignment in Asia or Africa I always look for the latest use, gadget, etc. related to cellular communication because it's always something that hasn't reached us here yet, or it's not quite caught on with the American masses.

I got to thinking about why developing countries surpass the US in terms of how they use their cell phones, and I suppose the most obvious reason is simply that people who never could afford, or have access to land line phones, can easily purchase a cheap cell phone. Street sweepers, busboys, the local market fishmonger, just about everyone has a cell phone these days. In countries where having electricity is still not a given, having cellular communication is. It's an amazing dichotomy to see someone living in a mud hut, with oil lamps for lighting, but there's a cell phone on the table. They might charge the phone up at work or in a public place that has electricity by day, then bring it home to use in their non-electric home by night. And since the cell phone industry in Asia and Africa is "pay as you go", you aren't locked into a contracts you can't afford. You simply buy the increment of time you can afford, you get a little card with a scratch off number and code, you punch the code and number into your phone and instantly, your phone is topped up with new minutes and ready to go. And because top up cards can be found in more places than Starbucks, you can always have your phone topped up, anywhere, anytime. If you're short on cash that day/week/month, no worries, just let your phone sit idle. Your phone number will remain yours, unused, for six months or more depending on the local carrier's policy.

But what I find really fascinating are the cutting edge, appropriate technology uses that people are looking to cell phones for now. I recently spoke to a colleague in a big DC-based public health organization, and learned that they're embarking on a huge telecommunication project in Nigeria.

I was trying to put "public health" and "telecommunications technology" together in my head but it wasn't clicking until my colleague explained that they were trying to identify new ways of utilizing hand held cellular devices to link remote health posts to the larger district health clinics and tertiary hospitals. They're creating protocol on how to send urgent patient files and information to the larger medical service centers, where specialists will be able to quickly review a remote-dwelling patient's test results, look at a photo of a symptom, etc., and be able to let the rural health post staff know how to treat that patient, or if they should be referred to the district or national level service centers for treatment and care. Finally, a use for cell phones that I can get into!

This makes so much sense that I can't believe we're not doing this here. Are we? I don't think we are. We have so many FCC and HIPAA rules and regs that I don't think we could do this here. But think about it, how we could accelerate the health care services of remote-dwelling Americans in places like Appalachia, if we were adopting such cutting edge use for our most prevalent and pervasive technology? I will be looking to Nigeria to see how this all pans out. And I will continue to recommend cellular communication channels like SMS for public health related communication during my overseas assignments. I just wonder when we'll start using our beloved cell phones here for things other than gossiping about what's happening on The Hills, or where that new hot handbag is on sale. If Americans used their phones half as wisely as folks do in developing countries, I might not hate cell phones so much anymore.

If you're interested in learning more about what's going on with cellular technology, particularly surrounding innovative usage of SMS functions, check out http://mobileactive.org/.