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Future hospitals: 4IR and ethics of care in Africa

How will algorithms be coded into Africa’s care infrastructure? What kinds of hospital will we need and what will they look like? In this project, we initiate critical reflections on artificial intelligence (AI) as part of the Fourth Industrial Revolution (4IR) and the possible future of hospitals in Africa.

What is the social and ethical life of algorithms and AI machines? Who is coding, for whom, in the interest of what, and what are the ethical principles that underpin machine learning and the work of coders? What regulatory and policy frameworks are African countries and communities putting in place preserve life, protect human dignity, eliminate bias and safeguard sovereignty? How can the African experiential be computerised?

The fusion between the human body, new technologies and the experience of being human requires critical questions on what kinds of technologies are being humanized, what kind of human (and life) is being coded into technologies and rendered technological, how technologies are rendering or articulating the human (life) experience, what kind of life is left behind or rendered invisible/precarious, and how to render technologies more ethically liveable.

The hospital is where these abstractions come into a concrete way, illustrating the life and death consequences of these dynamics, and thus bringing science and government closer to people, society and everyday life. The hospital is taken as a location from which to think through the ethical quandaries of digital life, being and institutionalised care, as the continent understandably rushes to embrace new technologies in its project to decolonise progress and suffering.

We ask intriguing questions about entanglements of AI and persistent modes of care, being and solidarity that have come to define what it means to be human.

  • What is the ethical life of algorithms?
  • How will AI change our relationship with ethics, care and hospitals?
  • How will it affect our ideas about what it means to be well, disease-free, hospitalised and cared for?
  • How are new technologies changing the work and training of health professionals?

This programme is funded by the Carnegie Corporation of New York

Research projects

Future hospital imaginaries: AI and the ethical quandaries of care infrastructures in Africa

Divine Fuh | Director, HUMA – Institute for Humanities

How will algorithms be coded into Africa's care infrastructure? What kinds of hospitals will we need, and what will they look like? In this essay, I reflect on artificial intelligence and the possible future of hospitals in Africa. The hospital is taken as a location from which to think through the ethical quandaries of being and institutionalised care as the continent understandably rushes to embrace new technologies in its project to decolonise progress and suffering. The paper asks the intriguing question about entanglements of AI and persistent modes of care, being and solidarity that have come to define what it means to be human. How will AI change our relationship with care and hospitals? How will it affect our ideas about what it means to be well, disease-free, hospitalised and cared for?

"Will god become obsolete?" The future of African Lutheran hospitals: digital health, AI, and religious medical ethics (Madagascar/Liberia)

Dominique Somda | Junior Research Fellow

In this project, I explore the ethical debates accompanying medical AI's introduction within faith-based organisations providing healthcare services in Africa. I focus on African Lutheran Churches and their health departments; they run numerous hospitals and nursing schools across the continent. I also examine the contributions of powerful Lutheran institutions such as the Evangelical Lutheran Church in America (ELCA) and the Lutheran World Federation (LWF) as they assess the moral and theological implications of medical progress and technology uses. In addition to conventional therapies, African Lutheran churches effectively promote holistic and spiritual care. My primary field site is in Madagascar, where the Malagasy Lutheran Church (FLM) operates – concurrently with its hospitals – revival centres that cure physical and psychological ailments through exorcisms and prayers. Medical pluralism is not without its tensions, and the introduction of forms of care associated with AI could represent a new moral challenge. I am also investigating the medical and confessional work of the Lutheran Church in Liberia; this secondary field site offers the specific example of a post-conflict context – with the impact of a recent Ebola outbreak –, where a definite sense of crisis may have precipitate changes.

Southern narratives of the Future Hospital

Ralph Borland | Junior Research Fellow

This project focuses on a method for eliciting ideas about the future impact of Artificial Intelligence (AI) on healthcare from workers in hospitals in two Southern locations: South Africa and Brazil. Workshops conducted with a diverse range of hospital workers, from doctors and nurses to administrators, union representatives, orderlies, security guards and cleaners, will use creative methods including story-telling, role-playing, multimedia and narrative, to stimulate and record their ideas about the role AI is playing – and will play – in their future of work. The workshops will include communication and collaboration between the two remote groups to identify commonalities and differences between experiences in the two locations and facilitate shared learning and solidarity. The research project will use ideas and methods from work in Futures Studies, including Futures Action Research (FAR) and Ethnographic Experiential Futures (EXF), along with perspectives from "Global Narratives of AI" to explore the role of the human and the ethics of care in the 4th Industrial Revolution (4IR) in South Africa and Brazil.

Algorithmic archipelago: Cape Verde's e-governance and new technologies of cash and care

Fernanda Pinto de Almeida | Postdoctoral Research Fellow

This research project examines the intersection of these axes of public care with the National Care Plan (Plano Nacional de Cuidado) alongside the government's creation of technology hubs and reinvention of Cape Verde as a "Gateway to Africa's digital transformation" (TechPark 2020). It focuses particularly on the notion of e-governance and the rise of financial technology in a country where citizens abroad arguably outnumber the number of citizens inland and the economy consequently responds to and shapes the fast mobility of goods, money and persons (Braz Dias 2012). Pushed by a renewed public interest in Artificial Intelligence in the country, an algorithmic shift in finances and governance has not only reoriented Cape Verdeans' relation to banking but, as I will argue, accelerated the pace of transactions and social relations. Hence, this project will explore the entanglement of cash and care technologies in Cape Verde, its social and affective character as much as its political shortcomings.

Experiencing AI technologies in healthcare systems in Africa and the Middle East: a comparative approach to the usage of Babylon healthcare applications in Rwanda and the UAE

Azza M. B. Ahmed | Postdoctoral Research Fellow 

There is a common discourse in media and scientific debates that Artificial Intelligence technologies will eventually lead to humanity losing its very existence by replacing human labour. However, there are counter-narratives suggesting that AI will improve the conditions for human existence, i.e., it will help to reduce the impact of climate change by providing environmentally friendly solutions, or it can improve service provision and more of the world population will have access to adequate services, such as healthcare, education, energy, etc. Through employing theoretical and methodological approaches in digital humanities and healthcare humanities, this research will compare two case studies in Eastern Africa (Rwanda) and the Middle East (UAE) on the usage of healthcare smart technologies that operate with AI, namely, telemedicine phone applications to understand how we experience the contradictory realities of these technologies and what it says about being a human in an algorithmic world. The research will answer the following questions: To what extent is artificial intelligence integrated in the healthcare systems of both regions? How is it integrated? What are the socio-economic backdrops of such technologies? Finally, what are the ethical and legal implications of AI introduction in healthcare systems in Africa compared to the Middle East?  

Digital technology, health information-seeking, medical misinformation and young people in Nigeria

Chikezie E Uzuegbunam | Postdoctoral Research Fellow 

As the impact of technology continues to spread in African countries, the Internet and social networks are heavily relied on for health information seeking and health communication. This reliance on digital technology for seamless access to health information then results in a number of issues, such as medical misinformation or health-related fake news, with public health implications. This study aims to explore the ecosystem of health communication via the Internet and social media and medical misinformation by paying attention to how young people access information about health, in addition to how they consume, create their own, make sense of, and share health-related fake news or misinformation. Only a limited number of studies exist in developing countries around the issue of fake news/disinformation in general, even when these contexts are some of the regions where fake news in general and health-related ones are rife, worrying, and growing. The focus on Nigeria is critical as it is the most populous African country and occupies a vantage position in Africa's journey into the Fourth Industrial Revolution and its impact on the important area of health.

Genomic data, coded algorithms and deteriorated Moroccan public hospitals: the (im)mobility of cancer patients' data through AI-driven diagnosis

Amina Alaoui Soulimani | Doctoral Research Fellow

In 2008, the national project of "Digital Morocco" was launched. Its aim was to digitise Morocco's private and public institutions, notably hospitals. This comes at a time when Morocco's landscape of public health services has been denounced to be in deterioration, with the Covid pandemic unveiling further inequalities in regards to access to health care, adequate sanitation, hygiene and a severe lack of equipment. This research inquires about how space and class marginality of cancer patients influence their access to cancer care treatment in oncology wards. It intends to trace the ways in which the assemblage of AI driven cancer diagnosis of newly introduced foreign biotechnological companies have an impact on patient access to cancer diagnosis and treatment while exploring the discrepancy/intersections between the introduction of AI and deteriorating health infrastructure in Morocco. By examining the impact of missing data-points in patients' medical reports within public hospitals, the research pursues a theoretical framework rooted in hauntology since algorithms are to be considered an assemblage affiliated to further human and non-human assemblages stretching across continents (Europe-Africa). Often considered as magic, applied medicine in Morocco remains subject to the configurations of Western biomedicine since technologies and algorithms imported are often not designed with the different African populations in mind. Thus, the aim of the research is to further pursue an alternative critical approach to examining the inclusion/exclusion of particular bodies in regards to cancer treatment, access and care, offering as a result a significant additive layer beyond governmentality and biopolitics for understanding the implications of the hegemony of AI in the politics of care and hospitals in Morocco.

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