service

The concept of Soap Operas for Social Change, developed by Mexican television producer Miguel Sabido, deftly weaves health and other socially responsible information into “traditional” soap operas to raise consciousness without compromising the compelling everyday drama that the genre exemplifies. Although this type of soap opera (called Telenovelas in Latin America) is not in the majority, there are examples of its use throughout Latin America, Asia, and Africa.

In 1967, the Peruvian telenovela “Simplemente Maria” that chronicles twenty years in the life of a maid working through the travails of the day as a single mother preparing for a career as a fashion designer was launched. It was this show apparently that opened up the possibility of social messages intertwined with popular culture. According to Hanna Rosin whose New Yorker article, “Life Lessons” helped inform this pattern, “Peru’s working-class women identified deeply with Maria; they saw her story less as a Cinderella fantasy then as a future that was possible for them, too. Thousands of maids wrote to the station to say that they were going back to school.”

The hero or heroine of a "Sabido soap" is a “transitional” character in the drama, a "fallible character who struggles to behave decently" (Rosin, 2006). In fact, the most important aspect of the telenovela is the barrage of giros (twists of fate), trials and tribulations, that continually tests the protagonist’s perseverance. In China, the program “Bai Xing,” or “Ordinary People” in English, features Luye, an unmarried rural Chinese girl who has a baby and moves to the city. This perfectly “ordinary” story is filled with the the real-life drama that people routinely face but is rarely portrayed. In recent episodes Luye discovers that two of her acquaintances have AIDS, a subject that is generally not found on Chinese television.

The non-governmental organizations Population Communications International and Population Media Center has been involved in socially responsible soap operas for many years. The focus is on usually related to population issues although this frequently involves health, sustainable development and environmental issues as well. Both are involved in the development of television and radio shows as well as work in other media, media leadership issues, and communication strategy and theory as well. The PMC web site explains that, "The advantage of using long-running, entertainment serial dramas include their huge audience appeal and the emotional bonds that are formed between the audience members and characters, which can lead to strongly positive influences of the characters on attitudes and behaviors by audience members." Sabido has developed a methodology that was informed by the integration of several key communication theories.

Ideally the social messages in the soap operas and telenovelas are presented in the form of choices that can be consciously made – not injunctions or instructions which must be obeyed. The best of these soap operas are probably more like this although the protagonist ultimately will make a choice and that choice is likely to be the one favored by the producers of the program. For many reasons, everybody who is involved in formulating a response to a given situation would be party to the dilemma played out on the television screen and weigh all the relevant factors individually and collectively. In Nepal, for example, the mother-in-law and husband are key players in decisions involving childbirth and must therefore be part of any approach to offer new choices for life decisions. Because soap operas in developing countries are shown in prime time (rather than during the day as, for example, in the U.S.) and are, therefore, seen by people across the spectrum of the population and because a high percentage of the viewers, are illiterate or are otherwise unable to gain access to relevant information, Socially Responsible Soap Operas make ideal vehicles for the propagation of useful information on such topics as family planning, domestic violence, nutrition, home management and emergency preparedness.

Socially Responsible Soap Operas are clearly subject to challenges from many sources. In Burma, for example, the radio show “Thaby e gone Ywa” (Eugenia Tree Village) was broadcast illegally over shortwave radio because Burma’s military dictatorship declared the program illegal. In the examples discussed above the creators of the programs are aware of the dangers of using the media for propaganda. As William Ryerson, president of PMC, explains, "Unlike brainwashing, PMC’s approach is to show a range of options—to broaden rather than to narrow the perspective of the viewing audience with regard to the choices available to them. For each of the options, the programs show realistic consequences."

On the other hand, the desire to fiddle with the content of popular shows could prove irresistible to overzealous governments that were intent in spreading their messages. Put in this context the practice of inserting message into soaps seems positively Orwellian. Yet commercial message are increasingly commonplace and “product placements” in Hollywood films, television shows, and, even books, while the society at least seems unfazed. Recently in the U.S. a spot in a book for teenager girls was sold to the highest bidder, a glossy lips makeup manufacturer. Also, of course, subtle and not-so-subtle messages thoroughly permeate much of the mass media, some of which is explicitly designed (for “mass appeal,” government appeasement, or as an expression of personal ideology) while others are unconsciously added to the mix, the atmosphere of commercialization is seemingly too ubiquitous to be resisted.

Although many of the people who are likely to get involved in this pattern are policy-makers or media producers, other people can help promote this idea by entering into a dialogue with people who are better positioned to make changes. Although strong challenges exist, this pattern has rich potential as a tool for positive social change.

"The right of free assembly is the most natural privilege of man." Alexis de Tocqueville (1963)

This pattern makes the case that probably shouldn't even need to be made; that people need the physical presence of others and that virtual spaces however important and vibrant they can be, have not made physical meeting places obsolete.

Although situations are different in different locations, the fact remains that communities need what sociologist Ray Oldenburg calls a "great good place" or "third" place which is a physical location, more-or-less public place, where people can "hang out" and talk about whatever they need to talk about. Unfortunately these locations are threatened in many places. Many factors can contribute to the decline in great good places. Some neighborhoods may be dangerour or have a mistrusting atmosphere. Some may be too economically disadvantaged to be able to afford a safe place with a roof overhead. Moreover in the era of television and the car, the art of spending time around people that might be strangers may be dying. Other locations may have such high rents that it becomes necessary to cycle customers quickly to increase the "efficiency" of the cafe.

Oldenburg discusses many instances of the role of the "great good place" in history. These include German beer gardens in the US in the early 1990s, Viennese coffee shopts, French cafe society and the like. It also discusses the fascinating role of taverns etc. in the development of the journalism, the media, business practices, and social change — including the American revolution against the British. Oldenburg quotes Sam Warner (1968) who states that the informal tavern groups "provided the underlying fabric of the town, and when the Revolution began made it possible to gather militia companies quickly, to form effective committees of correspondence and of inspection, and to organize and to manage mass town meetings."

Bradie Derrenger makes the important point that the "great good place" might not always be a traditional coffee or donut shop. From the seat that he takes every day while waiting for the ferry that takes him to work he can engage with people he sees every day and with those who may be crossing Puget Sound for the first time. And if and when other people started congregating there it might just happen that others would also do so.

Interestingly it may be the case that communities with more "third places" are more politically and economically active. Whether this is always the case, a "third place" often contributes to a community's "social capital" which, as Robert Putnam has shown generally provides a wide range of benefits, including economic.

In order to overcome the limitations listed above, the idea that public facilities might be established within communities is now fairly commonplace around the world (Menou 2003). Modern public access points to ICT are often referred to as "telecenters" even though their origins, ownership, purposes and modes of operation are so diverse that the development of a typology of public access points might be justifed, so that the commonalities and differences might be understood (Menou & Stoll 2003b).

Telecentres first emerged in Scandinavia and the UK during the 1980s and early 1990 and were known as telecottages, telehus, teleservice centers and electronic village Halls (Day, 1996 a&b) while the first "Community Computer Center" in the US was established in 1981 in the basement of a housing project in Harlem (New York City) (Schuler, 1996). Intended to provide public access to computing technology, these initiatives were either run as community development projects, commercial ventures or a bit of both (Day, 2001; Day & Harris, 1997). In the so-called "developing countries" one might distinguish 3 main avenues that the development of telecenters took. Most publicized is "pilot projects" initiated by international development agencies such as UNESCO, World Bank, IDRC, USAID, etc., which resulted in the implantation of isolated facilities with limited involvment of the communities at the beginning, e.g. Timbuctu in Mali, Kothmale in Sri Lanka. Another line is government programs pretending to overcome the "digital divide" by the implantation of a large number of telecenters in "undepriviledged" communities (e.g. @Argentina) with the same drawbacks of a top down approach, no networking plus bureaucratic constraints. A third line combines individual initiatives by grass root NGOs in particular locales and a franchising model developed by the Red Cientifica Peruana in Peru, known as "Cabinas Publicas Internet" which entertained ambiguities between community service and small business development.

Today the variety of public ICT access points (or PIAPs) and the nature of their roles is more wide-ranging and can be distinguished according to:

- their origin, ranging from ad hoc initiative of an individual to national and international programs;
- their purpose, ranging from profit of business owners - e.g. cyber or internet cafés - to free support to community development endeavors - e.g. true community telecenters;
- their ownership, ranging from individual small entrepreneurs to community groups, local and central government entities;
- the community participation in their governance, ranging from nil to full control;
- the mix of ICT available, ranging from only one, e.g. public phone booths, to all (e.g. phone, fax, internet, radio, web TV, etc.);
- the variety of services offered ranging from independant use of ICT to a wide mix of economic, social, educational and cultural activities;
- whether they stand alone or are part of a more or less extensive network

True community telecenters are part of the efforts undertaken by community members to build community and improve community conditions; they utilise ICT as a means, among others, that facilitate the attainment of these objectives (Menou & Stoll, 2003a). The centers are designed and managed with full participation of the community (Roessner 2005). Non- community telecenters are only concerned with providing access to ICT at an affordable cost to people who are deprived from it, whether temporarily or permanently. For the remainder of this pattern we focus exclusively on community telecenters.

Community telecenters typically get started via two main avenues:

1) They are the brain child of interested individuals or grass root community groups who champion their development and implementation through various community strategies and actions; or
2) They form part of a top down (usually government or international agency) program purporting to bridge the "digital divide".

Telecenters face a variety of problems and challenges that can be categorized as either social, political, economic, or technical.

In the social realm the key issues are:

- the relevance of the telecenter and ICT use as a means to support the various development efforts undertaken by the community
- the appropriateness of its role, the social interaction it permits and the information it makes available, especially with regard to cultural and gender biases
- the availability of people with required skills to operate and manage the telecenter and provide training and support to the users
- the level of information and computer literacy in the community and the availability of intermediaries to offset their deficiency
- the availability and accessibility of local information.

In the political realm, key issues are:

- the degree of ownership that the community might have from the inception, or progressively reach;
- the level and continuity of community involvement in the management of the telecenter
- the support of, or conversely conflict with, local and national authorities and pressure groups
- the relationship with national programs in the area of universalization of telecommunications services and digital inclusion, and the ability of the telecenters to preserve their identity and autonomy though participating as appropriate in such programs;
- the attitude of telecommunication companies vis a vis competition, universalization and digital inclusion efforts.

In the economic realm, key issues are:

- funding for initial investments
- securing regular income streams that can can support the operation of the telecenter
- securing resources for the maintenance and renewal of the equipment
- offering employment conditions that are attractive enough for retaining the permanent staff

In the technological realm, key issues are:

- reliability and cost of power supply
- reliability and cost of telecommunications
- reliability and cost of access to the international internet backbones
- ability to implement a distributed network
- capability of operating FOSS applications
- capability of deploying media integration, in particular radio

In many countries central governments have funding programs to encourage the development of "telecenters". Significant financial backing from international organizations is also commonplace and support is also often available from local governements.

Telecenter associations have been set up and are seeking to establish their influence at the local level as well as forming broader groups at regional and international levels. These structures are powerful instruments for sharing knowledge and experiences, helping each other and consolidating the movement Menou, Delgadillo Poepsel & Stoll 2004). Such grass root organizations should not be confused with a number of top down portals and support schemes that pretend to represent telecenters and disseminate second hand knowledge for sake of specific political and commercial interests

Mirroring events from the 1980s & 90s when computers were parachuted into communities as part of top down development programmes, the current crop of telecentres face similar challenges of social, financial and technological sustainability. At that time telecottages and electronic village halls (EVHs) were very much flavor of the month among government and funding agencies (Day, 2001; Day & Harris, 1997). However, they were viewed as short-term project that were expected to achieve sustainability with no support or training. Some transformed themselves into small commercial ventures but most closed eventually leaving behind them a great deal of frustration and dissillusionment in the community.

Very few lessons from that period appear to have be learnt. In the UK, the UK Online Centre programme, some 10 years or so after the initial telecottages and EVHs closed, many of the UK Online centres have closed or are closing after massive amounts of public funds had been pumped into them. Across the globe, the present tranche of telecenters seem to be following a very similar pattern of contradictory trends. On the one hand they are recognized by governments and international agencies as key instruments for achieving digital inclusion. Thus a proliferation of funding programs to support their establishment has been witnessed in recent years. On the other hand the support currently being displayed has no long-term policy substance behind it and may not resist the medium term hazards of development endeavors. The pressure toward securing financial sustainability in the short-term - usually 3 to 4 years - may indeed push many telecenters to close or attempt to reinvent themselves as business enterprises wherever this is feasible despite the fact that by definition they serve a population which does not have a level of income sufficient for paying for non essential goods and services. Similar attempts in the UK and Scandinavia have historically proved fruitless and we hold out little hope for the future of most telecenters without significant changes being made to policy and funding strategies.

Examples
Asodigua, Guatemala: http://www.asodigua.org
SAMPA.org, Brazil: http://www.sampa.org
Container Project, Jamaica: http://www.container-project.net

In 1991, two program directors at the Seattle Worker Center conceived of a small project that had an unpredictably potent impact. Called Community Voice Mail (CVM), the idea responded practically to a specific problem: How can a homeless person find work or housing, receive medical or social services, or navigate daily life without a reliable and direct point of contact? Furthermore, how can the job developer, the doctor, the advocate, in short, the social services system charged with the mission to respond to the needs of the poor and homeless, do so efficiently and effectively if they must devote hours to tracking down the individuals they serve?

Community Voice Mail responds to this need by acting like a home answering machine for thousands of people across a community. The CVM service is a shared resource operated by the CVM national office and a local community-based organization that takes on the role of host. This host builds a network of participating agencies to maximize the distribution of the resource cost-effectively. People in crisis and transition may enroll in CVM through any number of social, human, or health services agencies in the community. By providing multiple points of access, the service allows practical and flexible eligibility criteria while maintaining basic measurement standards.

As of 2008, the program operates in forty-one U.S. cities and in Melbourne, Australia, connecting more than 461,000 people annually. The CVM national office provides guidance on how to start a CVM service and supports the resulting federation of peer sites. Cisco Systems is the majority funder of the nonprofit program and donated equipment and software for a centralized network that uses Voice Over Internet Protocol (VoIP) to manage accounts for tens of thousands of users. The network’s advanced capabilities include a broadcast messaging feature that is used to distribute information about job openings, training opportunities, community resources, and emergency weather warnings to the voicemail subscribers.

Connecting individuals via communication services integrates people into existing communication networks but, also, helps establish new networks. These networks could help support the community of people who use the system by allowing the users and the managers of the system to share relevant information and mobilize users in relation to specific issues and events.

Universal voice mail presents a meaningful pattern and objective that can assist communities by encouraging the integration of all people into the community. At the same time the employment of this pattern will necessarily take a wide variety of forms depending on many factors. These forms will be determined by the people who will use the services, organizations in the community that are providing the services, and the general nature and climate of social services in the community. Other things, including the technological infrastructure, social capital, and the ability to raise funds in the community, perhaps through an innovative commercial sector are relevant as well. The dedication of the organizers is also key, as is their ability to collaborate and incrementally improve the level of support over time. Since technological systems are still changing rapidly (although they are unevenly distributed, with the more technically sophisticated systems concentrated in economically privileged regions) the nature of the service needs — and the technological support that is needed to support the service — will undoubtedly change as well.

Stepping away from the interventionist model of development, self-designed or autonomous development emphasizes at its core development designed and implemented by the people it is intended to affect. While on one hand this pattern presents an orientation towards the practice and approach of development at one level, at another it is meant to be translated into the direct actions of peoples pursuing the right to define the trajectories of their lives, the lives of their families and their overall communities. It tries to avoid the assumption that all peoples want to be developed, rather it does assume that peoples wish to enjoy a certain type of life defined on their own terms and the hope is that they have the opportunity to realize that desire in their life-time.

The words self-designed or autonomous are meant to address the fundamental notions of power, who has it, who uses, and how it’s used and to what end. As a pattern that values autonomy, but also a notion of development towards greater well-being traditional as well as modern knowledge must be acknowledged, understanding that they do not always have to be perpetually competing forces, but when approached carefully they can be utilized to promote viable path towards community transformation that honors the social, cultural and political realities a community exists within. Thus, the overall basis of the self-designed development places both the responsibility and power of change into the hands of those who have been historically disempowered through the processes of traditional ‘developmentalism’.

At the level of orientating this process, its necessary to re-frame development and stress a redefinition of the roles between peoples in communities seeking transformation and the various outside agents who are working for authentic social and economic change. Here we would emphasize facilitation over the management and design on the part of the part of the so-called professional, and community independence and autonomy over dependence.

Take for example, the Participatory Rural Appraisal (PRA) (See: Action Research) so often thought of as the mainstay of the development practitioner seeking to design projects, becomes instead an awareness tool for community members themselves to guide their own decision making process on what steps are to be taken to better their livelihoods, and offer clear paths to achieving that. In fact this tool can be used by a community without the need for complex levels of understanding into social research and can be used in a relatively low-tech way within a variety of settings. Therefore, the role of the outside agent can be to act as observer and identify ways in which they can help a community realize their mutually defined goals.

At the level of implementation the pattern can guide specific actions to be taken up by communities to include any number of projects defined by a community. For example, projects can be anything from a system of check dams used to provide electricity to power a rural village; another project could be the construction of a primary school or health center for women. They can include the creation of farming cooperatives to ensure the community not only achieves the ability to provide sustenance, but can then also generate income by selling their products outside their geographical community.

Undoubtedly the use of this pattern at this level will be context specific and must be shaped by the various needs and desires, and including the capacities and capabilities of peoples seeking to pursue this pattern of development. This recognizes that not all communities possess the same needs or desires, nor do the posses the same levels of capacity or capabilities. Therefore in one community where the level of civic capacity is high, as well as a great deal of cohesion and participation among community members, then a more autonomous approach to development is going to be more easily realized.

Yet, to a community that lack a certain level of capacity and cohesion it may be necessary for the community to seek the assistance of an outside agent to facilitate in the process. This could include consciousness raising, financial support, transfer of knowledge and so forth, but fundamentally any such assistance must be a result of the wishes of the community and brought forth based upon the terms and desires of those these plans are meant to assist.

There may however, be situations in which such a pattern may not be at all viable, or only very minimally. This is particularly true in situations of displacement, through war, famine or other outside forces that breaks a necessary level of cohesion due to fissure in the very nature of their communal ties, and thereby fragmenting the people’s capacity to coordinate and act collectively. In these situations, the pattern may still be utilized but it will be much more of a goal to be actualized by development agents who are seeking to ameliorate the problems associated with fragmented communities. The pattern thus becomes a guiding force for the interventionist, and care must be taken not to cross the boundary of creating development dependence among peoples.

In these situations it can also be potentially problematic as it can be difficult for agencies to relinquish control over development initiatives as community reconstitute themselves and gain a level of independence and cohesion that would allow for them to participate in a process of autonomous development. And since its difficult to say when the work of an NGO is done in area there remains this tendency maintain a role of interventionism long after a community has acquired the capacity to define their own goals. It therefore begins to become the kind of development the outsiders envision and not that of the community.

Thus, this pattern not only becomes an orientation to community driven development but an orientation and guide by which NGOs themselves can pursue a process to empower communities by emphasizing any number of projects designed to empower peoples to regain control over their lives in the wake of a rapidly modernizing world.

A very basic description of the Self-Help Group (SHG) has been summarized by the Rural Finance Learning Center. According to their definition: " Self-help groups are usually informal clubs or associations of people who choose to come together to find ways to improve their life situations. One of the most useful roles for a self-help group is to provide its members with opportunities to save and borrow and it can act as a conduit for formal banking services to reach their members. Such groups can provide a guarantee system for members who borrow or they may develop into small village banks in their own right. In rural areas self-help groups may be the only way for people to access financial services " (2006).

The structure of the SHG is meant to provide mutual support to the participants by assisting one another in saving money, opening up cooperative banking accounts that help women and other peoples to build credit with a lending institution. The SHG also functions to support members through maintaining consistent contact among group members to aid the individual’s savings goals, to help support the creation of these micro-enterprises. Often the SHG helps in the conception of these businesses and even the implementation of these enterprises upon receipt of the micro-loan.

The SHG also supports accountability for ensuring that the loans are paid back and the SHG can continue to include other members and support greater access to credit and capital to those within their community. SHGs also provide a space which facilitates the discussion of many issues pertaining to the community’s socio-economic, educational and health status. Thus, the formation of this group provides a forum to initiate many participatory activities (including training and awareness camps).

This process has also shown to increase confidence among participants, and help support greater levels of decision-making status in their society, particularly within South Asia. This hopefully will encourage members to participate and contribute in general social and political matters in their respective villages.

As peoples are supported in building their credit they in turn are able to apply for micro-loans geared towards a number of self-sufficiency based business ventures. Many of the business commonly financed consist of seamstress shops, beautician parlors, and in the rural areas these business can be as diverse as natural healing clinics, chicken farms and aqua-culture projects, to silk weaving or any number of handcraft based ventures.

While a great number of SHGs have been initiated by communities themselves, many of the SHGs are implemented through the help of an NGO that can provide the initial information and support to establish these groups. Such information and support often consists of training people on how to manage bank accounts to include deposits, withdrawals and balancing of the cooperative and individual accounts. Similarly informal education regarding a number of possible trades can take place in order to build up the capabilities of the participants to function as business owners.

But the SHG has some instances shown problems that must be addressed when considering their use as a pattern of community empowerment. For instance, many of these people are in absolute poverty and the little that they do save can put a family in an already precarious financial situation in a worse of place.

Other issues revolve around the nature of work and the family in developing countries where the women are often the primary householder while the male is involved in work outside the house. The creation of these businesses often adds greater levels of work upon women as they are committed to the SHG and the creation of their business to support their income and yet their household duties are still expected to be met by their husbands. In these situations the pressures can be immense to juggle the business, household chores and the rearing of children.

However, in response to some of these problems many NGOs have sought to play a critical role in lessening that burden by offering school to children and thereby giving women members the ability to pursue their career goals by providing a place for their children to go while simultaneously providing education to those children that would otherwise be working at home. Despite some of the draw backs the role of the SHG is still a vital and growing component of bottom-up development, and hopefully eventuating self-designed development in the future

In response to the failures of 'top-down' approaches to development, a shift towards emphasizing participation and empowerment have begun to make their way into the mainstream of development practice. This move toward "bottom-up," "farmer-to-farmer," and "grassroots" communication has been a fundamental reorientation. Following, the 70s and 80s, years often associated with the dark ages of development a new light has come about through alternative practices that seek to employ the community’s themselves in defining their needs, mapping out there assets and coming to terms with their own liabilities.

Through a variety of participatory processes both community members and development professionals have had the opportunity to jointly design community improvement schemes that are both appropriate to the community's needs and wants, as well sustainable and empowering.

As a result of relative success, the role of the community animator has become an increasingly important component for enabling this process of cooperation and participation between the development practitioner and the community members themselves. In some ways the animator acts as both initiator and on-going advocate for his or her community's development through regular open communication with both community members and the representative staff working in the area.

In the past highly educated teams of researchers and development field workers would enter a community and employ any number of assessment tools to identify community needs. Some of which were participatory in nature (see Power Research pattern). Upon return to their offices these assessments would be used to design various projects ranging from indoor lavatories, to treadle pumps, to community telecenters. In many cases it was shown that these projects failed to support the kind of long-term growth in people’s livelihoods they were thought to bring. Rather than looking at what the community wanted or needed from their cultural and social point of reference; these professionals designed projects relative to their point of reference.

Instead of persisting with this paradigm, NGOs such as the Institute for Integrated Rural Development (IIRD) have pursued vigorous development campaigns in Bangladesh. In this example the community animator has become a central agent for helping to identifiy and express the needs and desires of a community, as well as initiating and supporting change to include, informal education, ideas for micro-enterprise, and even supporting the creation of women’s self-help groups that have enable a number of women in rural areas to gain access to credit and thus empower them to pursue economic generating activities.

Here organizations such as IIRD would send exploratory panels out to the communities, as a "get to know you" campaign. Over a period of time they would identify predominately young men and women that they would sponsor for further education. The pool of students would often serve as the primary group that would go on to perhaps become powerful community animators.

Not only were they given a valuable education they still retain those familial bonds to their community that often gives them an immediate advantage in having the lived experience of their particular area, as well the rapport of being a community member.

However, problems of jealousy and apprehension can be potentially problematic and it is important that groups and agencies that do seek to draw advocates from the field they seek to assist find ways to mitigate the potential social conflict that might arise. Unfortunately, it may not be possible to completely eliminate it. But it is perhaps a far better approach than previous alternatives

As healthcare in developed countries becomes more complex, more sophisticated and expensive systems are being put in place, with no proof that delivery of care is improving. Inasmuch as these systems succeed in reducing costs, they tend to benefit the large public and private healthcare providers who sponsor them. They constitute ever more effective electronic filing systems for information about patients, but which those patients neither see nor use.

We live in a world of choice, and if there is little access to information about patients there is plenty of other information for them. More and more, the public seeks information so as to choose among their options for treatment. At the same time, more and more is available on the Internet (e.g. www.nhsdirect.nhs.uk) for those who want high quality information about health and well-being.

Simply providing information is a job half-done. Until patients can work with their own health indices, such as blood pressure, blood sugar, cholesterol and diabetes status, for example, they will find it difficult to relate information they find on websites to their own health. Secure systems already exist for patients to add blood pressure and blood sugar data to their records (“UK Doctors”, 2003). Clinicians welcome such information when determining a patient’s treatment management plan, especially if it can be easily found in one place. Clinicians who have experienced patient-maintained personal health records in become enthusiastic about the practice (Protti, 2005).

Traditionally, the medical practitioner has provided a bridge between medical knowledge and the patients themselves. If a treatment plan did not perfectly match the patient’s needs, or if the patient was challenged by changes or crises, then the practitioner would take responsibility. Nowadays, there is seldom a single clinician involved in any patient’s care; no single person is in a position to mediate between the complexities of medical technology and the real-world experience of the patient. Patients themselves are willing to contribute to this role; they are clamoring for access to their full electronic health records so as to see for themselves what clinicians have written about their individual consultations, the results of tests they have undergone, letters that have come back from specialists, and what medications they have been prescribed both in the present as well as in the past.

Fulfilling the goal of active patient involvement in healthcare through access to medical records offers many opportunities and challenges. Patients could verify the accuracy of their medical records (Cross, 2005), and access their medical records wherever in the world they travel. Given proper controls for privacy and confidentiality, patients could share their information with others if they so wish. Given professional protocols between medical practices (the lack of which has led to bad outcomes for patients in the past), availability of information on patients should be protected at all points of healthcare service delivery. Some patients may find some information in their records upsetting, while equivalent information may help in the treatment of other patients or other conditions. Patients may need protection from seeing some information about themselves before a clinician has discussed it with them, and this may limit a patient's choice to access to full information. Information about a patient gleaned from a third party requires careful treatment before it is entered into the record.

The clinician’s role as mediator between medical expertise and the patient’s experience will never go away, but it will change. Some of the opportunities of patient access to medical records may save clinician time, and others may not. Some patients will thrive on the ability to combine health information on the Internet and elsewhere with information about themselves from their medical records; others will not. With the right of online access to medical records comes the responsibility to deal with the information presented on a computer screen. The informed and responsible patient, comfortable with interpretive tools for making sense of medical data, has greater trust and confidence in the medical profession. Such changes in health behavior cannot be left to the technology and the information; they may require emotional support that depends upon some degree of human intervention.

Online recording of medical information by patients is already being done (www.ihealthrecord.org; www.healthspace.nhs.uk). Online patient access to medical records is beginning (www.paers.net; Bos, Fitton & Fisher, 2006), and it presents a cutting-edge challenge for practical trust between patient and clinician, and amongst medical providers. Medical records are being put online anyway, and over time they will become increasingly interoperable; the challenge is to make record access not merely a cost reduction measure for administrators and providers, but a tool for patients and their families to participate in their own healthcare.

The projection of a three-dimensional, multimodality, co-located, synchronous deliberation experience (i.e., communicating face-to-face in a non-virtual place) onto a two-dimensional, primarily visual, distributed asynchronous interaction requires essential aspects of face-to-face deliberation to be remapped onto a screen interface. The needed mappings can be judged according to two broad goals:

• Visible relationships. Relationships between comments and the texts they reference, between different comments, and between group members and the document and discussion should be as visible as possible.
• Distinguishable boundaries. Separations between contextually related and unrelated text and comments and between individual authors of documents and comments should be as distinguishable as possible.

We first consider visible relationships. Exhibiting relationships between the components of document-centered deliberation (document, comments, and participants) implies a number of refinements of this goal. First, the document text that is the target of deliberation should be covisible (displayed simultaneously) with comments around it, and the identities of comment authors and document text, when relevant, should also be covisible with their output. Second, the referencing relationship between a comment and its target text should be visible, that is, the interface should incorporate ostensive pointing (meaning that a pointing relationship is displayed on the screen rather than being enacted through a peripheral device) and in-text placement of comments. Third, response relationships between comments should be visible through threading. And fourth, the reactions of deliberation participants should be visible through polling and decision features.

The other goal is distinguishable boundaries. Visible relationships can be inadequate, as anyone would know who has used a map with ambiguous place labelings. The interface should also mark boundaries between text that is and is not the reference target of a comment, for example, though text highlighting. Text authored by different people at different times should be distinguishable through textual boundaries. The topic of a text should be able to be viewed separately from its main body through headers. And obsolete comments (those made on a previous version) should be recognizable through pertinence markers which indicate which versions a comment pertains to, as well as those to which it does not apply, for example, because it has been addressed in the revision process.

The Deme environment for online deliberation is a tool for document-centered discussion, polling, and decision making that incorporates all of the elements derived above in a dynamically updating (no-page-reload) interface. The introductory image above shows the most recent design of the meeting area viewer in Deme. The shaded-in header of a comment in the discussion view pane on the right points to a shaded-in comment reference in the text of a document shown in the item view pane on the left. Deme provides covisibility between document and comments through an optional split-screen view. In-text comment references are transiently pointed to (the dotted-line arrow goes away as soon as the user scrolls) when clicked on, and comments are displayed in the context of hierarchical threads. Members can vote on documents under a variety of decision rules. Boundaries are provided through highlighting, text boundaries, headers, and a versioning system that remembers when comments become obsolete and marks them as such. The design takes advantage of no-page-reload web server calls to provide dynamic relationship visibility and boundary distinguishability.

The groups most likely to be impacted negatively by the digital divide are paradoxically the groups that need access to basic service-related information the most. Quite often, members of these groups also lack the skills needed to use the Internet effectively. In addition, nonprofit organizations (NPO's) often have the information needed by these disadvantaged groups, but also paradoxically are unable to make this information available online. The needs of both groups are in conflict, and create a context in which it is extremely difficult for either group’s needs to be met. Digital Divide Impacted Groups’ Needs: * easily accessible and up-to-date information * interaction with service providers * appealing design * intuitive navigation systems * training NPO's Needs/Lacks: * personnel to put information online while still meeting clients' needs * additional time to create and maintain web pages * knowledge and skill to create effective web sites * funds to pay for server space or a webmaster One possible solution is for the NPO's to rely on a volunteer from the community to create and maintain a website. However, relying on volunteer labor for web sites is risky, due to the turnover rate and varying skill levels of volunteers. What is needed is a pool of skilled, but cost-free, assistance. One place to find this pool is on college campuses with service-learning programs. Service-learning is a pedagogical method designed to link course content with external experiences. Students learn the course-related materials through traditional learning in the classroom and through practical projects in and with the community, as well as about the reality and significance of the social issues faced by the community; while simultaneously providing a service to the community by meeting specific needs of the agencies or the populations with which they work. A service-learning class intentionally links the content of the course to a relevant NPO's goals. Students benefit from the chance to apply their skills to a real problem, and to learn about the needs of the community; while the NPO's benefit from the chance to have some of their goals and needs met, and to influence the next generation of leaders. In the long run, research has shown that students who take part in service-learning courses feel a greater sense of connection to their local communities, as well as an understanding of their interdependence with their neighbors. Connection and interdependence are building blocks of responsibility, and responsible citizens are in turn the building blocks of strong communities. The initiative for a service-learning course can come from a number of different places. Individual professors can choose to use this pedagogical method in their courses, universities may require service-learning in certain classes, or community agencies may propose projects that fit with the learning objectives of a class. Regardless of the source, effective service-learning requires collaboration between the members of the community and the academic institution: it should be done WITH the community, not ON the community. The goals and needs of the community must be combined with the goals and needs of the course. This process of collaboration is often facilitated by offices on the campus specifically designated to assist with service-learning. The service can take one of three forms. 1) Direct service: students work with the community members served by local agencies. In the case of the digital divide, students in a wide range of courses could train local community members to access and evaluate online information. This training could be done at the local library, senior centers, retirement homes, elementary schools, and any other locations with the necessary facilities (connected computers). 2) Indirect service: students work with the local community agencies to provide them with some needed assistance, which indirectly benefits their clients. In the case of the digital divide, students in web design courses can be required to create and/or update web sites for local NPO's, or run workshops training agencies representatives to maintain their own sites. 3) Community-based research: students (with faculty support) conduct research for and with a local community agency. In the case of the digital divide, people trying to change the existing systems sometimes lack the hard evidence needed to prove that a problem exists. Students in a wide range of research-methods courses could conduct survey research into the impact of the digital divide at the local level. But most importantly, the impact of a service-learning course goes beyond the immediate project: it results in changed lives. This is because a critical component of any service-learning course is reflection. Research shows that we don't really learning anything from experience (we often make the same mistakes repeatedly); we learn from thinking about our experiences. Students in service-learning courses are required to reflect on their experience in rigorous, thoughtful, and evaluated ways. This process drives the learning home, increasing the integration of knowledge they have gained in the present course with the way they live their lives in the future. For example, to create web sites, students must understand the agency, which means they must research the role that the NPO plays in the community, the populations that it serves, and the social issues that underlie its mission. This research helps students understand how critical access to the right information is for everyone, and how information is always related to power. Putting students in contact with members of the local community can also help dispel stereotypes. Students' easy access to computers often leads them to mistakenly believe that the digital divide is just a "Mercedes divide." Requiring students to work with underfunded and understaffed non-profit agencies, who are themselves working with disadvantaged groups, can open their eyes to the very real informational needs in the communities in which they live.