(@Jornal do Sudoeste: http://www.jornaldosudoeste.com.br/noticia.php?codigo=105255)

In Portuguese, the term “gambiarra” is used to describe someone fraudulently tapping into the electricity supply. In everyday life, the word also refers to an improvised solution that was achieved with limited resources. In that sense, “gambiarra” is an exercise of creativity. I have previously talked about my experience teaching old adults in a WhatsApp course aimed at the third age in Sao Paulo, where I conducted my fieldwork. In this post, I will address how I taught them to do a “gambiarra” on WhatsApp. My goal was to turn WhatsApp into a diary that could help them in their daily tasks, from shopping to managing their intake of medication. This idea came from my observation that students usually bring pen and paper in order to take notes and systematise what they learned. Their notes were basically step-by-step lists that conveyed the information they received that day in the more linear way of thinking they were more familiar with. Moreover, writing things down was also a strategy they used in order to remember what they learned.  During the course, I noticed that they used this strategy not only for the WhatsApp classes but also to help them to remember what they have to do, where they have to go and how to get there.

I could have taught them to use an app designed for that purpose, such as Note or even Calendar. However, among these students and among my research participants in general, WhatsApp is the app they feel most comfortable with, as this is where their conversations with family and friends take place. Therefore, the choice to build a diary on WhatsApp would avoid any constraint related to the adoption of a new app. In other words, the diary on WhatsApp would be ready-to-use, as my students were already basic Whatsapp users. Whatsapp doesn’t have a diary functionality, so we then started our “gambiarra”. The idea was that each student would add their own contact on WhatsApp, so they could start a conversation with themselves (which would be enhanced by features like audio messages and photos). There are two ways to do this and no guarantee as to whether which of them will work, as it depends on the device students have. The first way to do this is to add yourself as a contact by saving your own phone number under ‘Contacts’ and then search for the name you have given to this contact and to start a conversation with yourself. When this option fails, you can ask someone to share your contact with you on a conversation or on a group on WhatsApp you have access to. You will then have the option to click on “message” and you will be able to start a conversation with yourself.

Option 1 (left) and Option 2 (right): starting a conversation ‘with yourself’.

I also gave students a bonus. After the “gambiarra” was done, I taught them to “pin” this chat on the top of the WhatsApp conversations list, so they could easily access their diaries.

The diaries on WhatsApp could help them in multiple ways. They could create their shopping list directly on the app. They could do so by typing the items, they could use the audio to record them and they could also take a picture of the list they had on paper.

Examples of a shopping list on WhatsApp Diary: text message, audio message or picture

Taking pictures is a powerful resource for registering, organising and accessing information they come across during their daily routines. Like any of us, older people may also use the WhatsApp camera to record a particular street name they want to remember for later reference, the bus they intend to take or the useful phone number they might want to use later to have pizza or even medication delivered.

WhatsApp Diary used to remember a street name or a location.

WhatsApp Diary used to register information about public transport.

WhatsApp Diary used to take note of a useful telephone number.

Keeping diaries on WhatsApp can also be used for self-care. Older people can type or use voice messages to register a particular symptom or event they want to report to their doctors, like a day when they felt dizzy, for example. WhatsApp can help them make a note of these events, plus the app automatically registers the date and time when the event was reported.

This functionality can also help older people manage their medicine intake. My mother’s case is one example of how this works. She is in her late sixties and has to take a pill to manage a chronic condition every day, as soon as she wakes up. This allows her to then start her day. The problem was that sometimes, she was not sure whether she had already taken the pill or not. Together, we decided to do a “gambiarra” on her WhatsApp, so she could have her own diary to manage her pills. Since then, as soon as she takes her pill, she sends a message to herself. The message (“okay”) is registered there on her WhatsApp diary together with information about the time and date, which she can access anytime she is not sure whether she has taken her pills that day.

In that sense, the use of WhatsApp for health purposes can itself be seen as a “gambiarra”. WhatsApp was not designed for health purposes, but its functionalities can be used to deliver and improve care. This requires improvisation and creativity, but also a pinch of empathy. Especially among older people, exploring the apps they are already comfortable with can save them time and effort in adopting new technology.

WhatsApp can actually be a time-saving and low-cost tool whatever the target audience and objective is. That is why the use of WhatsApp for health can become more than a “gambiarra”, that is spontaneously adopted due to a constraint on resources. Indeed, as I observed in the Brazilian health landscape, there is a shift in Whatsapp use from informality to formality, as it is also used by doctors, clinics, hospitals and health insurance plans as their institutional channel to communicate with patients. You can read more about these examples in my book “Learning with Whatsapp: Best Practices for Health”, where I describe different uses of WhatsApp for Health based on what I observed during my ethnography in São Paulo. You can find out more about the book here, and download it free here.

An example of a desire path, a consequence of erosion due to people walking on it rather than taking the pre-designed path. Photo licensed under the Creative Commons Attribution 2.0 Generic license

A few weeks ago, I was invited to mentor a startup. They used the term mentorship, but it was more like an informal talk. They are developing an app to help relatives coordinate the care of their elderly parents. Their motivation for this is genuine. The founders are three siblings who had a hard time when they found themselves having to take care of their mother, who had dementia, for several years. They believe they have learned a lot from their experience and they could help other families by combining all the resources they needed as caregivers into a single app. They did a great job. The app is a combination of a calendar for medication and doctor’s appointments, a chat feature the family can use to talk, a channel for checking health information, another channel that can be used to connect with doctors and caregivers and a function that provides reliable, trustworthy information and medical guidance. They also invited one of the most respected researchers on health and ageing to support them with the development of this tool. So, why do I think this app might fail?

During the ASSA project, I conducted a 16-month ethnography with older people in Sao Paulo. At the beginning of fieldwork, I was expecting to find people using apps specifically designed for health and care. Instead, I found people using WhatsApp to create groups to coordinate the care of relatives and to get medical guidance from friends. WhatsApp is the main means of communication among Brazilians who own a smartphone, so the decision to place conversations addressing health and care onto the platform seems natural, especially among older people, as sometimes, WhatsApp is the only app they feel comfortable with. Centralising multiple tasks on WhatsApp means they don’t have to install a new app. This is relevant because, due to many older people using a second-hand device, mobile phone memory can be a problem. Moreover, the process of downloading an app is itself one of the things that they find can make them feel like they have got stuck. Even if they succeed in downloading a new app, they may face constraints related to the adoption of new technology. As one of my research participants said: “you don’t change a winning game”. They just feel like they are at home when they are using WhatsApp.

That is not the case of the three startup founders I am talking about. They are young and technology is not a barrier to them. However, most of the siblings I met who were taking care of elderly parents were middle-aged. This demands an exercise of empathy, which is not just about identifying what caregivers need. It is crucial to consider where they would like to find what they need. It is important to learn how and where (in which app) they get things done. The eureka moment should then come when developers understand how to improve and add value to the choices the users have already made. Katrien Pype called this ‘smartness from below’[1].

In my research, I work with the term “desire path”[2]. In a park, for example, the desire path is the path users create by choosing a route that is different from the one designed by planners. The desire path is the materialisation of the free will. It can be seen as a kind of disobedience, but there is something really valuable about this unpredictable preference. Observing the desire path is an opportunity to learn what users feel is more appropriate for the experience they want. In that sense, taking the desire path into account can save resources and time and might be a good short cut to succeeding in the challenge of designing an app people are actually willing to use.

Because the app they are planning to develop contains an in-built calendar, one of the questions I asked the startup’s founders was whether they would normally use a calendar other than Google. They said they wouldn’t. So why assume their users would use something different to what they are used to? It is easier to integrate the schedule that caregivers need to keep track of the care they provide (sometimes across multiple family members) into the calendar they already use in their day to day life, rather than persuading them to adopt a new one. In that case, Google Calendar is the desire path and app developers are the ones who should adapt their journey to the use of it. The same occurs with WhatsApp. Based on this experience as well as my observations during fieldwork in Sao Paulo, investigating how doctors, clinics and insurance health plans in the city were using WhatsApp for health purposes, I developed a series of protocols for clinics and hospitals showing how WhatsApp can be used to facilitate their communication with patients when it comes to patient triage, the provision of medical care and patient education. These protocols were published under the title “Learning from WhatsApp: Best Practices for Health” (you can download this for free here). In the 150 pages of the book, I haven’t invented anything. It is just simple and pure WhatsApp. My work was to learn with people and systemise the steps.

Figure 1: Example of how WhatsApp might be used to coordinate remote care. In this case, the nurse in charge of interacting with patients via Whatsapp uses the ‘star message’ function to indicate that the patient’s query is pending, so she can go back to the patient after the image is seen by the doctor. Source: ‘Learning from Whatsapp: Best Practices for Health’, by Marilia Duque.

I also published another book called “WhatsApp for Nutritionists” (the book was only published in Portuguese and it is available here). The book is a result of a project I worked on where my challenge was to rebuild the kind of food diary[3] a bespoke m-Health app provides but using only WhatsApp features. The intervention’s effectiveness was tested by having older people assisted by the UNIFESP Medical School in Sao Paulo trial the new method. Participants were invited to take a picture of everything they ate and drank every day and shared this with the nutritionist via WhatsApp. They didn’t have to learn anything new and neither did the nutritionist, as both were already WhatsApp users. This way, the medical school didn’t have to develop an additional app in order to create a reliable method for assessing dietary requirements and needs. It was a successful and cost-effective intervention.

Figure 2 and 3: Examples of how Whatsapp can be used for nutrition purposes – the user sends the nutritionist a photo of all of their meals, thus creating a visual log of their nutritional intake for the day. These are examples of how nutritionists can visualise a patient’s food diary on their mobile and on WhatsApp Web. Source: WhatsApp® Aplicado à Nutrição, by Marilia Duque.

I do think the app I was invited to talk about is far better than WhatsApp, and it should be, as it was designed specifically for health purposes by people who have experience in the problem they want to solve. My point is that there is no guarantee people will use it. That is why my advice is to observe, learn and respect the desire paths taken by potential users before developing something new. They are the choices people have already made.

[1] Pype, Katrien. “Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa.” What Do Science, Technology, and Innovation Mean from Africa?, edited by Clapperton Chakanetsa Mavhunga, The MIT Press, 2017, pp. 97–115.

[2] https://www.theguardian.com/cities/2018/oct/05/desire-paths-the-illicit-trails-that-defy-the-urban-planners

[3] RUCKENSTEIN, M. (2015). Uncovering Everyday Rhythms and Patterns: Food tracking and new forms of visibility and temporality in health care. Techno-Anthropology in Health Informatics: Methodologies for Improving Human-Technology Relations, 215, 28-40.