September 2021

A little over a century ago Bronislaw Malinowski sailed to the Trobriand Islands, an archipelago now part of Papua New Guinea, to carry out anthropological research. At the time, the kind of research he intended to conduct was novel. For it was predicated not on armchair reflection (or self-referential assumptions) but instead, observed and lived in the field, with the people it sought to study. It championed ethnography as a methodological immersion in the lives of others. The book Argonauts of the Western Pacific followed in 1922/23, laying the ground for a science which asked why people behave and organise themselves the way they do. As Malinowski writes:

“...in every act of tribal life, there is, first, the routine prescribed by custom and tradition, then there is the manner in which it is carried out, and lastly the commentary to it, contained in the natives’ mind.”

Today this quote might be considered problematic and anachronistic, and not in the least for the colonial gaze it perpetuates (who really, is the native?). Yet implicit in these lines, and as Malinowski documents throughout his seminal tome, is what most design thinking professionals would likely recognise as the contours of that enduring tool of their practise, the empathy map: asking what people say, do, think, and feel. 

Fast forwarding the narrative to a more contemporary setting, Jay Hasbrouck (the resident anthropologist and strategist with Facebook) describes how ethnographic thinking provides “an interpretive lens to see how cultural worlds are organized …[as well as]... frameworks for thinking about how they’re formed, and how they evolve and interact”. Moving through the ‘empathise’ and ‘define’ stages of design thinking, and upto the ‘generation of ideas’, insights rooted in ethnography permit the designer to analyse and ask why, before turning to the synthesis of the what. Even in the latter stages of  ‘prioritising ideas’, ‘prototyping’, and ‘testing’, the designer returns to ethnographic insights to anchor their solution (which touchpoint on the user journey might it warrant designing for?). As my colleagues and I often submit, ethnographic thinking and design thinking are thereby in fact coterminous. In its essence, anthropology is the study of lifeworlds and how and why they come to be. It studies the spaces and places we inhabit, the relations and flows which structure our societies, the cultural rubrics which define our everyday, and the lived experiences with humans and non-humans (consider technologies, apps, and objects on one hand, and policies and programs on the other) from which we derive meaning and construct our identities. And thus I argue, where ethnography is practised in engagement with anthropological theory and with the comparative perspectives it permits (how do other people use the app?), anthropology proffers itself as a veritable yardstick by which to gather how acceptable the design is to the user. Or in short, to what extent will the solution work?

As an example, I turn to an anthropological study we carried out at LagomWorks earlier this year, wherein we sought to understand teleconsultation’s limited uptake in India by doctors and patients alike, notwithstanding its promise for leapfrogging healthcare. After all, teleconsultation was not new to the country, having been introduced over a decade and half ago. The ongoing pandemic had given it a significant filip, with the entry of multiple platforms, better technologies, and improved access. It also commanded administrative attention now, with an evolving digital health policy and a supporting national skills framework. 

As I have explained earlier in this essay, anthropology concerns itself with lifeworlds, the everyday, and lived experiences. And so, through the difficult summer which the country witnessed, we studied teleconsultation ethnographically, by asking how it was practised and experienced by its multiple stakeholders. How did doctors and patients schedule appointments? Did they transpose the physical routine onto a digital architecture? How did habits such as seeking a second opinion play out? What helped build trust? Who was the app designed for? And how did the app team articulate design principles? 

Our observations built on existing anthropological scholarship on how reactions to questions of health and disease were never biomedical alone, but also inherently social. And the fact that Indians derive their identities through their family and community. Just as people would often have a friend or family member accompany them on a visit to the doctor, so it was with teleconsultation sessions, where a patient was joined by one if not several members of the household, asking questions and tabling clarifications (often to the doctor’s consternation). Yet most teleconsultation apps and platforms privilege one-to-one interactions between the patient and the doctor. Given the transmutation of the physical world into the digital, there was therefore a need for a uniquely Indian design, and not one which borrowed from evidently misplaced Western notions of individual privacy which tended to efface the role of the family or community. In short, how might we design such a contextual teleconsultation platform? What could make it acceptable to the Indian patient? And her household? What could ensure that the doctor’s time is used efficiently?

Anthropology’s inimitable strength lies in its ability to provide context. This is also how it differs from design research. While the latter centers its lines of inquiry on a design and its features/functionalities, anthropology is explorative. The question of the Indian design for a teleconsultation app/platform had us zooming out to a broader question of healthcare, and layering the original ask with ethnographic insights ranging from how people still relied on traditional systems of medicine (such as Ayurveda and Unani), to how they would insist on a physical prescription, or how ASHA and community health workers played a critical role in the processual scheme of things by filling the intrinsic need for human interaction. It is here that I table my point of departure, as I conclude my argument that the science of anthropology and its accompanying methods (and in particular, ethnography) do not merely share a symbiotic relationship with design thinking, but also serve as the episteme or vocabulary of knowledge through which the relevance of its application can be gauged.

Is it time, I ask then, for a ‘designthropologist’ to work alongside the ‘designeer’? 

This article was first published in the anniversary edition of The Weave magazine.