@mastersthesis {miscione2006telemedicinapractices,
	title = {{\textquotedblleft}Telemedicina in Alta Amazzonia - Una Prospettiva di Sviluppo Sanitario fra Diverse Pratiche di Cura{\textquotedblright} [{\textquotedblleft}Telemedicine in the Upper Amazon {\textendash} A Case Study of Health Development between Diverse Healing Practices{\textquotedblright}]},
	year = {2006},
	month = {Feb},
	type = {phd},
	abstract = {This research is based on the case of implementation of telemedicine services within the public health care system of a North-eastern area of Peru, in the Amazon (Ch. 1). Three years before this study started, a consortium comprising of Spanish and Peruvian universities {\textendash}supported by a non-governmental organization- established radio connections for voice and data communication between the local hospital and health facilities of the area, in order to provide telemedicine services. This initiative was aimed at the improvement of the health care system organization, therefore of the local health conditions. It was not secondary the intention to define a model for ICT-based health development interventions in rural areas of Latin America (Ch. 2). My study, centered on the telemedicine system, is based on the participant observation within the consortium in Spain and Peru, both in the partner universities and in the Amazonian part of the public health care system (Ch. 3, with a special attention for reflexive issues). The focus of the research has been on the organizational relevance of the interplay between designers{\textquoteright} perspectives and expectations, on one side (Ch. 4), and local process of telemedicine system accommodation in the context of implementation, on the other. Particular attention is given to telemedicine system use, and to the mutual interrelation with local constructions of health and illness (Ch. 5). It has been found a divergence between planned and observed use of the system, the former being accountable to the context of origin of the project and to the funding agencies, the latter being indirectly affected by unexpected health-seeking behaviors of the target population ({\textquotedblleft}Telemedicine And Knowledge Between Medical And Development Discourses{\textquotedblright} CMS4). A rationalist conception of telemedicine -and of organizational changes it is expected to produce- sees local healing practices as obstacles to health development, and this hinders organizational learning ("Organizational Learning in Health Care - Situating Information Technologies in the Amazon" under review process for Social Theory \& Health). I noted how people{\textquoteright}s perception and construction of their health (also outside formal health organization and scientific definitions of health and sickness) plays an important role as social regulator, as far as they are embedded in normal patterns of action ({\textquotedblleft}Telemedicine in the Upper Amazon: Interplay with Local Health Care Practices{\textquotedblright} MISQ). This needs to be understood and considered in evaluation, design and implementation of future initiatives of ICT-based health development efforts (Ch 6 and {\textquotedblleft}Policies on Health Development and Information and Communication Technologies - A Bottom-up Perspective on Policy Making about Telemedicine Services in Cross-cultural Settings{\textquotedblright} eHDC). MAIN CONTRIBUTIONS: -	Focus on telemedicine through a micro-level lens of Neoinstitutionalism (in ethnomethodological terms), which is not well-developed in IS studies -	Critique of diffusionism and of reified conceptions of medical knowledge, which cannot be made easily available though IT solutions, mostly across diverse social settings -	Empirical granularity on practices, which highlights interplays that more traditional empirical units (actors, places, issues) may not account for -	Reflexivity awareness in ICT in development contexts TABLE OF CONTENTS Telemedicine in the Upper Amazon - A Perspective on Health Development between Different Healing Practices	1 Abstract	3 Acknowledgements	5 Introduction	13 Chapter I {\textendash} Telemedicine between Knowledge and {\textquotedblleft}Development{\textquotedblright}	17 1. Research Field	18 1.1. Telemedicine and {\textquotedblleft}Development{\textquotedblright}	19 2. Boundaries of the Empirical Field	25 3. Organizations, ICT and Knowledge	28 3.1. Telemedicine and Knowledge Transfer	32 3.2. A Boundary of the Knowledge Society	33 4. Development and Organization	35 4.1. Contemporary Trends	38 5. Research Focal Points	41 5.1. Research Questions	43 Chapter II {\textendash} Introduction to the Telemedicine in the Upper Amazon case 45 1. Red Ibero-Suramericana de Salud Project	45 2. The Amazon area where the Telemedicine System is Implemented	50 3. Health Care System in the Upper Amazon	54 3.1. Public Health Insurance	57 4. Technical Aspects of the Telemedicine System	58 5. Planned Uses of the Telemedicine System	64 Chapter III {\textendash} Methodological Aspects	67 1. Documentary Study and Participant Observation	68 2. My Perspectives on the Case	76 2.1. Self Interview	77 2.2. Access the Empirical Field and Construction of my Role	79 2.3. Telemedicine as Knowledge Instrument: Contiguity of Viewpoints	82 3. Research Trajectory	92 4. Notes about Data Analysis and Presentation	115 Chapter IV {\textendash} Interorganizational Network of the Telemedicine Project	119 1. The Evaluation Conducted by Organizers	119 2. Interorganizational Aspects	130 2.1. Documentary Analysis of Mailing Lists and Chat Sessions	130 2.2. Academic Position of the RISS Project Coordinators	134 2.3. Discursive Alignments	137 3. Final Notes	142 Chapter V {\textendash} Telemedicine and {\textquotedblleft}Development{\textquotedblright}, the Case Of the Upper Amazon	145 1. RISS {\textendash} Peru{\textquoteright}s Perspectives	148 2. Arrival to the Amazon	158 2.1. First Impressions at the Hospital	163 2.2. Following the Prevention Programme	166 3. Re-starting from the Telemedicine System	172 3.1. Knowledge Sharing	185 3.2. Conference about Malaria	188 3.3. Epidemiologic Surveillance	192 3.4. Reports Transmission and Logistical Support	195 3.5. Maintenance and Responsibilities	199 4. Aspects of the Telemedicine Context	206 4.1. Use of Medical Plants	216 4.2. {\textquotedblleft}A Physician is Someone who Studies Medicine through the University{\textquotedblright}	221 4.3. Local Healers	234 5. Trajectories through Medicines	243 Chapter VI {\textendash} Discussion	251 1. Planned and Observed Uses	251 1.1. Problematizing an Approach to Telemedicine	256 2. Multiple Accountabilities	258 3. Expectations from the System	268 Conclusions	275 List of References	279},
	author = {Miscione, G}
}
