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Special report

Sharing Wikipedia offline medical information in the Dominican Republic

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By Lane Rasberry
Offline Innovation, a 5-minute video documentary on the Columbia students' program in the Dominican Republic

Some people who wish to access Wikipedia are unable to do so because they lack Internet access. This is more common in developing countries but demand for offline mobile learning exists everywhere. There is especially high demand for access to good health information, as both doctors and patients require up-to-date information to promote the doctor–patient relationship, inform health care decisions, and act as a general reference.

In 2017 Anne Nelson (user:Anelsona) of the School of International and Public Affairs, Columbia University (SIPA) organized Wiki Loves the Dominican Republic, a pilot project to provide offline access to Wikipedia to medical students and health care providers in the Dominican Republic (DR). The result was that Anne's graduate students traveled from New York to the DR and placed a wireless access point in medical schools or clinics. That access point was the source of an offline Wi-Fi hotspot which contained an SD memory card presenting a Kiwix installation of the Medical Wikipedia app. Any user could use this offline Wi-Fi connection to browse Wikipedia or download the Wikipedia app. 30 users could connect simultaneously without slowdown. The devices cost about $100 each including the removable memory card which contained the data.

People everywhere have smartphones which can connect to Wi-Fi, download apps, and use a web browser. In this project, people who used an Android smartphone within Wi-Fi distance of the "Internet-in-a-Box" were able to connect as with any Wi-Fi connection, then immediately start reading Wikipedia. Users hardly needed instructions. Ideally devices could be deployed and used with little or no time and labor for setup and user training to grant access to Wikipedia in places where Internet is inaccessible.

This was a small experimental project with some promising results. It demonstrated the option for professionals outside the Wikipedia community to set up an offline Wikipedia access point, and a pathway for online Wikipedia editors to deliver up-to-date content offline, and for the Wikimedia community to join in coordinating any part of this.

The challenge to address

Internet data is relatively expensive and inaccessible in the Dominican Republic.

This project began with Anne perceiving that some professionals in Latin America are unable to access the information they need. Anne's previous digital media research in Central America documented an underground economy of information sharing in which people routinely subscribe to offline data delivery services and exchange media through physical storage devices. This observation brought some insights about how and why communities in this region were open to using offline media. Anne began to consider how these offline communities could access copies of Wikipedia in a useful way.

Anne convened some colleagues who collectively decided to pilot an offline Wikipedia deployment project in the DR. Reasons for choosing this country included existing team interest in the DR; the large base of Dominicans who live in New York City and who might support project planning; prior institutional relationships between schools and clinics in the DR, and both Columbia University and Icahn School of Medicine at Mount Sinai; and the expectation that professionals in the DR would participate in testing this. As a Wikipedia community member who arranges collaborations between institutions in Central America and institutions in New York City, Anne began to articulate the information demands she heard in the DR to the Wikipedia community.

The wiki community in New York City

The student deployment project originated in NYC.

Wiki NYC is a Wikimedia chapter in New York City. Wikipedians in the city piloted the Wikipedia Education Program in 2011, with Anne and her students as pilot participants. As a member of Wiki NYC, in 2016 Anne attended WikiConference North America where all sorts of Wikipedia contributors met. Anne expressed that she needed a way to deliver health information to the DR. WikiProject Medicine participants in attendance described the health information which they had available to share. The Internet-in-a-box team described that they had a physical hardware prototype which could serve Kiwix - Wikipedia Offline to anyone who wanted the content. Various wiki groups were participating in the 2016 Year of Science and had a desire both to share medical information and to support medical students.

Sometimes it takes a regional conference and confirmation from a large number of people to convince a team that an idea is worth pursuing. The synergy from the conference encouraged everyone to advance the project of loading devices with Wikipedia and distributing them in the DR, but still it took time and conversations to make all participants confident enough to invest their time and resources into doing such a complicated multi-part project. Wiki NYC presents about 100 in-person Wikipedia events a year and at many of these people began to discuss the project to share offline Wikipedia. WP:AfroCROWD, an NYC-based project to do wiki-outreach to people of African descent, already had a community of Wikipedia editors from Haiti who would discuss the project and their interest in getting better information to the clinics in the DR where Haitian Creole was a common language. Consumer Reports supported the SIPA students with wiki-training as part of a project to encourage medical schools and health science students to develop any Wikipedia information which informs health care decisions. While Consumer Reports supported the SIPA students, Wiki NYC generally provides an environment where any nonprofit expert institution which wants to discuss Wikipedia can get answers in person by hosting or joining a Wikipedia event.

Wikipedia's medical information

Medical Wikipedia app for Android

WikiProject Medicine curates health information on Wikipedia. Some contributors to health content in Wikimedia projects have further organized into a Wikimedia community organization as Wiki Project Med. In anticipation of projects to share information offline, Wiki Project Med coordinated with Wikimedia Switzerland to develop special Kiwix - Wikipedia Offline packages of Wikipedia's medical content.

In addition to packaging Wikipedia's medical content for offline distribution, the WikiProject Medicine community has a history of advocating for universal access to general medical information of the sort that Wikipedia carries. Different people express different opinions, but a common statement which Wikipedia's medical editors make is that Wikipedia provides an excellent option for free, ad-free, neutral point of view, high quality health information for consumers and health care providers. That base of conversation makes it easier for organizations to agree to contribute health information to Wikipedia and for them to share Wikipedia's health information in education programs. Students from the Icahn School of Medicine at Mount Sinai Wikipedia club were able to have these conversations peer to peer with others in this outreach project based on their own Wikipedia editing experiences.

Software and hardware

This Internet-in-a-Box contains offline Wikimedia content and a Wi-Fi transmitter. Anyone physically near to the device may connect to it and download the offline content it contains.

The Kiwix project develops software which presents offline copies of Wikipedia. Wiki Project Med and Wikimedia Switzerland present the Medical Wikipedia app, which is an instance of Wikipedia's medical content in Kiwix. The Wikimedia Foundation provides support for Kiwix developers to make the software better. Internet-in-a-Box is a project to provide hardware, software installation, and deployment consultation for offline content sharing.

The idea for all this is that Kiwix provides an offline Wikipedia reader. English Wikipedia with full media is currently 61 gigabytes or 25 GB for a slimmed version. For just the 50,000 medical articles in English the Medical Wikipedia app is 1 GB. For the DR project, the devices were packaged with just the medical information from English Wikipedia, Spanish Wikipedia, and Haitian Creole Wikipedia. There was demand for some other regional languages as well for which Wikipedia does not currently have content. At various points in the project the hardware team considered using different devices. The selected devices were Raspberry Pis.

Device deployment in the Dominican Republic

Students at the Universidad Central del Este browse offline Wikipedia on their own phones.

Although the software and the hardware were designed to be intuitive, graduate students from Columbia's SIPA went in person to give the devices to clinical and school faculty and staff. An essential part of deployment for this round was having conversations about digital health information, the software, the hardware, and ongoing support.

The student participants in the project were all graduate school students of SIPA. They all were fluent in English and Spanish and based in New York City. All of them were studying international policy and had experience in relevant program administration. They applied for travel support from the Wikimedia Foundation but otherwise depended on the resource contributions from their school. In NYC the students consulted with medical advisors from Icahn School of Medicine and Engineering for Change, an information and communications technology organization. In the DR the students had great support from clinicians and university staff.

Typical time for device setup to getting content from Wikipedia was 5 minutes from site arrival. The process was that students entered a room chosen for research. They placed the Internet-in-a-box device on a table and turned it on. The NYC students directed the local people who had already been invited to the presentation to seek the Wikipedia offline Wi-Fi connection on their Android phones. After connecting to the offline Wi-Fi connection, the readers were on a landing page from which they could search and browse Wikipedia. These parts of the process consistently worked and constituted success for this round of the offline Wikipedia deployment experiment.

Discussion

As is typical for Wikipedia projects, there are a few hundred people involved in this one. Few individuals had much understanding of what contributions others were making to the project. There was no central management of this. In this particular instance, Anne Nelson was essential for heading the idea to share the information in the DR, but in the longer term, somehow various teams are going to share Wikipedia's content in all kinds of ways with all sorts of new audiences, sometimes offline and increasingly online. Other individuals and teams have been essential in providing medical information, software, software applications, hardware, hardware installations, academic discourse about Wikipedia as a learning aid, community conversation about Wikipedia, and many other pieces of this project. Without all the parts available, this project could not have proceeded.

Here are some open questions:

  1. How do we empower the audience of readers of offline Wikipedia to have greater control over deciding what information they need in Wikipedia and how they can acquire it?
  2. What barriers prevent anyone from adopting offline Wikipedia and how can we address them?
  3. How do we promote cultural exchange in which people who use offline Wikipedia have the opportunity to contribute information back?
  4. When nonprofit organizations have a mission to share the sort of information which Wikipedia distributes, then how can Wikipedia make itself attractive as a channel for accepting that expert content and providing feedback which demonstrates that the nonprofit organization achieved its mission by supporting Wikipedia?
  5. How can we make participation in Wikipedia more meaningful for students who do projects like this one?

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Neat! Do the devices record any information about access/usage? Statistics comparable to Wikipedia page-views data, etc., would be useful to measure performance/success of the project, but I could imagine potential privacy concerns might exist and have to be managed, too. --doncram 02:13, 6 August 2017 (UTC)[reply]

We have little data about specific content read. We do have the number of downloads of the android app.[1] And we have comments from people who have downloaded it.User:doncram Doc James (talk · contribs · email) 03:39, 6 August 2017 (UTC)[reply]
  • Thanks for this excellent summary and also for the comment. We hope to record access/usage information, but as mentioned, there are privacy and other questions to be addressed. A member of our team is conducting expanded field trials in the DR this summer and we expect to learn a great deal more from her findings. We were very fortunate to have the essential support of SIPA's masters in development practice (MDP) program, its director, Glenn Denning, and administrator Kendal Stewart, as well as Mariela Machado, who joined me to designing and overseeing the research. Same goes for the excellent student team and Dr. Sam Zidovetski from Mount Sinai Global Health.Anelsona (talk) 14:59, 12 August 2017 (UTC)[reply]
  • What an incredibly waste of time and money They could've simply sent the hardware by mail and asked a local to install them (you know, placing the device on a table, connecting a power cord and pressing the on/off button). They got a free vacation out of it. The usefulness of these devices is of course incredibly limited; it would make far more sense to provide Wikipedia in its entirety to a busy location. 64GB SD cards are cheap. (((The Quixotic Potato))) (talk) 08:25, 21 August 2017 (UTC)[reply]
    • What is super easy for one specialty (those in the tech world) is NOT super easy or intuitive for those in another specialty (physicians and other health care providers).
    • Our specific offline medical app in EN has more downloads now than the main Kiwix app. Now you might ask why did we bother to create a specific app for offline medical content in English at all? Everyone can simply download the Kiwix and than download the all of Wikipedia ZIM to make the same thing?
    • My response is simply have you heard of "One Click" by Amazon? The other answer is branding. And a third is yes 1.2 Gb is a big difference from 58 Gb. Why use a 16 Gb rather than a 64 Gb? A few dollars matters and to reduce the risk of the SD card walking away. We specifically do not want the SD card in the device to be better than what people have in their phones.
    • Also you make "connecting a power cord" sound super easy. In much of the developing world the electricity that we take for granted does not reliably exist. Also rolling out something new requires raising awareness and building relationships. Doc James (talk · contribs · email) 07:49, 23 August 2017 (UTC)[reply]
1. True, but it must be possible to find someone who lives locally who knows how to place the device on a table, connect a power cord and press the on/off button. Detailed instructions can be provided.
2. I usually (try to) avoid asking questions I know the answer to.
3. I am an Amazon user. I have some spare 64GB micro SD cards laying around the house. I use them in a wildlife monitoring system. They are incredibly cheap.
4. See 1. I don't think this is an efficient way to raise awareness and build relationships. It is going to be difficult to convert them from visitors into editors. (((The Quixotic Potato))) (talk) 15:11, 23 August 2017 (UTC)[reply]
This is about raising awareness in a countries in which we have very little awareness rather than about recruiting editors.
Results from these efforts are also going to be published in the academic press. Doc James (talk · contribs · email) 07:29, 24 August 2017 (UTC)[reply]
I criticized 2 decisions: the decision to travel there and the decision to exclude all Wikipedia articles about non-medicine related topics (which limits the usefulness of the device). I would assume locals know more about the reliability of their own energy network(s) than foreigners who visit for a couple of days. I don't think it is reasonable to claim that a potential thief will steal a 64GB SD card, but not a 16GB SD card. That is not how criminals work. A criminal would stuff something in their pocket quickly, and will inspect it in more detail when they are in a relatively safe location where no one else can see them. A thief is not going to pull a SD card from the inside of an SD card slot of a working device, look at the capacity, and make a decision (to steal or not to steal, that is the question) based on that information. You are probably unable to see the capacity of the SD card while it is inside the device, and if you are really worried about that then you can simply remove the sticker or use a sticker that says "1GB". If you want to prevent theft you may want to use one of those fake GPS stickers or hide the device in a boring and cheap looking plastic box. (((The Quixotic Potato))) (talk) 20:42, 23 August 2017 (UTC)[reply]
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