Telemedicine and Development: Situating Information Technologies in the Amazon

Introduction

Development - a normative concept whose meaning is deeply rooted in the idea of progress - is a widely legitimated field of activity. It has become highly ramified, as there are economical, human, social, cultural, political developments, depending on which goals are emphasized. Beyond differences, the common meaning of the word implies that oriented social change is conceived as a desirable and morally legitimate improvement. In recent years, knowledge has become a key concept in rewording and reframing development projects; so knowledge is strongly oriented towards the ends. This goes on side by side with the spread of information technologies. IT is often the basis to promote development in the so-called Third World: educational, medical, market, administrative institutions have become knowledge-intensive and coherently redefined their priorities, strategic plans, organized actions, and IT implementations. Through those processes, IT affects constructions of reality, social relations, contexts and perceived senses of normality. ICT tend to reify knowledge, often reduced to transmittable information, and expected to be universal. This prevents us from understanding some aspects of the complex relations between actors, IT-artifacts, and knowledge. The aim of this paper is to show that health care systems -and telemedicine specifically- provide a relevant viewpoint in questioning a universal development approach.

I define telemedicine here as the implementation and use of IT for health care delivery purposes. Telemedicine for development is always implemented within health care systems, whose organizational routines are designed on biomedical knowledge. This means that technology is shaped for biomedical usage, and, on the other hand, that telemedicine is affected by the context and made up of intentions and expectations that inform related actions. Telemedicine relies on, implies and promotes a formalized and universal conception of medical knowledge. Assumed universal rationality, and its utilitarian application, risks to make other knowledge types invisible to development efforts, so unexpected side-effects arise and remain unexplained. This paper addresses the issue by describing the telemedicine adaptation to a particular environment, with its interplay with local knowledge forms and health practices.