Professor Ricardo Gomes, School of Design, San Francisco State University
How do we design a healthcare delivery system on an experiential level so that it is embedded into our lifestyle? Ricardo Gomes, Professor at School of Design at San Francisco State University, discusses the role of design in health care and his holistic vision of 2049 that focuses on building trust, equity and inclusion into the system.
Professor Ricardo Gomes has been a faculty member in the School of Design at San Francisco State University for over 29 years, and was chair of the department from 2002 to 2012. He coordinates the Design Center for Global Needs and the Nathan Shapira Design Archive in the School of Design. Professor Gomes is on the board of directors of the Institute for human centered design in Boston, and is a trustee of the Beta Beta chapter Epsilon Pi Tau international honor society for technology. He received his M.F.A. and M.A. at UCLA, and received a B.F.A. in Industrial Design at Massachusetts College of Art. He was a Fulbright Scholar in Nairobi, Kenya and conducted post-graduate research and product development of a container system for mobile health care delivery in East Africa from 1982 – 1987. Professor Gomes has lectured extensively, and conducted keynote speeches, presentations, symposiums, and workshops at universities throughout Africa, Asia, Europe, Latin America and the United States.
Show Notes
Professor Ricardo Gomes shares his career path into health care design, from his humble roots to being awarded a Fulbright Scholarship. [02:54]
In 2049, how do we build not only trust, but also equity into health care technology? [09:36]
We need to map a universal pathway now to achieve an equitable healthcare delivery system in 2049. [15:01]
An interdisciplinary and collaborative design approach. [16:35]
How do we design and embed health care into our culture starting at an early age? [19:03]
Community health care builds trust. [24:12]
How can we humanize artificial intelligence to benefit health care? [26:18]
What’s the one thing that could hold us back from progress if we don’t start changing it now? [28:32]
Transcript
Bisi Williams: I'm Bisi Williams, you're listening to Health2049.
Ricardo Gomes: But if we don't map the path to get to 2049, we're just not going to be teleported. We're going to have to actually move through there, means moving from now 2021, what are the inflection points? What are the stepping stones that we will need to have sure-footing to guarantee that when we arrive, we will all arrive together. There will be no first class or second class, they’ll only be world-class.
Bisi Williams: [01:47] Professor Ricardo Gomes is an award-winning educator, designer and longtime social justice advocate. He's been an instigator and practitioner of progressive inclusive design for decades. From his early days on a Fulbright Scholarship designing mobile healthcare delivery systems in Kenya, to nearly 30 years on the faculty in the school of design at San Francisco State University. He's the coordinator of the Shapiro Design Archive and the director of the university's Design Center for Global Needs, an international research and development center dedicated to promoting responsive design-thinking methods and solutions in local, regional and global issues. It is my pleasure to welcome professor Ricardo Gomes to our show.
Ricardo Gomes: [02:31] Well, thank you, Bisi Williams for inviting me to join and participate. And it's a pleasure to be here today.
Bisi Williams: [02:40] Well welcome. So I'm excited to get started, Professor Gomes, you began your career in industrial design and have taught architecture and universal design. What made you pursue this field of interest?
Ricardo Gomes: [02:54] It's interesting. I never really thought of myself as a sort of medical-oriented designer, but you've actually caused me to really reflect on my beginning in design. Mainly through the very mentors and, sort of sages or guides that I have benefited from very early on in my life. And by that being about 16 years old was my kind of beginning of the formulation of my design journey.
And actually one of the very first things I did, which literally led to my Fulbright in Kenya in dealing with mobile healthcare delivery, and I come from a very humble grassroots background and trying to impact that environment, that society where design could be a tool for development, inspired and encouraged me to try to be a change agent. Healthcare delivery was presented to me by my mentor and he had very lofty and visionary goals, but we looked at healthcare, we looked at a mobile healthcare trailer and that was my first project I designed at 16 years old and kind of carried it with me at Massachusetts College of Art in Boston.
In fact, the very last project that I did as a student was this concept to design a mobile healthcare delivery unit. And I took that idea with me to graduate school at UCLA. I went to UCLA because, at the time, it was the only program in the country that I was aware of, that had a program in design for developing countries. And I always had an aspiration as an African-American and having roots in Kabul Verde, the Cape Verde Islands off the west coast of Sunnyville and even my Caribbean background from St. Vincent Union Island in Barbados, I always had a dream of how could I contribute or give back and how could I use design as a tool for development, and healthcare seemed to be one of the more immediate areas because I realized not only how it impacted global society, particularly when we look at developing nations or emerging economies or societies, but even in the United States, when we look at the kind of health equity or inequities or disparity, and how can we bridge that in a more effective way? How can design impact that?
So, I was fortunate to explore this project in depth at UCLA. And to be very honest, I was somewhat naive about the depth and reputation of UCLA and it wasn't until I arrived there, that I realized what a wealth of resources that I was surrounded by. And the first thing I did was realize that it's about collaboration, collective activity and, I brought with me a design vision and I tried to share that with doctors at UCLA in the School of Public Health because I knew at the time, although I had this design vision of creating a mobile healthcare delivery unit, just like I may have a design vision today to share with you about 2049, I knew I didn't know about the nuances of healthcare delivery. I know about aspects of technology and how it may be incorporated to facilitate it. But I knew I had to meet and understand healthcare delivery, particularly public healthcare.
And so I started taking courses at UCLA in public health. And I was a design major and I was the only design student in this graduate program of public health. I had these amazing professors who had all these projects all over the world that they were conducting. So the whole notion of empathy and observation was something I just knew was the proper way to approach not only design, but about how design impacts society, how it impacts other disciplines, other domains.
I remember I learned so much. I think when you come from a background that is not privileged, you don't make any assumptions. You just try to acclimate and you try to engage because I've always learned through experience more so, more than reading. I was always a very touchy, feely, experiential type person. For me, that type of engagement was tremendously insightful and I followed that kind of learning process almost what you could say was service learning from the outset. So anywhere I went, I found the need to be very humble, have that beginner's mindset be very open to change and to experiences that I was not familiar with.
Bisi Williams: [08:54] I love that notion of the beginner's mindset. What's interesting here is that beginner's mindset, and that you were already thinking in the future 30 years ago, when you were imagining, right? Mobile medical delivery trucks for the United States 30 years ago and now this is potentially a thing. And so, that's a nice segue into this experience that you have of just being around the world and being of service and using your secret power of listening and observing and then making, could you describe for us your vision for health and wellness in 2049?
Ricardo Gomes: [09:36] You know, again, as I think the last thing I said was when you don't come from a position of privilege, you don't make any assumptions. And although I recognize the vastness and greatness of technology in innovation, I realized that technology and innovation is not equitably distributed, in that, unfortunately there are many of us who have not benefited equally, or in an equitable manner from health. And so, there's a tremendous opportunity in need for health, particularly when we talk about telemedicine and even the digitization or the digital aspects, or even the artificial intelligence aspects of healthcare delivery and where it may be in 2049. The question is who is going to benefit from it?
We can look at where healthcare is today, even in and around from the pandemic, to the need for equity, and we can say, how do we build not only trust, but equity in the dissemination of it because unless all of us are able to equally benefit from that, the power and influence of healthcare technology will not be envisioned or delivered. I say that because I've been kind of noting some of where the future is in healthcare, as I mentioned, some of the things from nanomedicines to artificial intelligence, to stem cell, to even sensors and other things that may help to monitor and deliver it. The big thing behind that is who is operating it or who is managing it and how do we make sure that management and operation is diverse and inclusive so that all people are benefits or benefactors because we have a history in which healthcare delivery was not disseminated in an equitable manner. In fact, it’s not even disseminated in an equitable manner, it was actually done in a way that was very discriminatory or experimental without the consent or knowledge of others.
Now I’ll quickly just reference to the Tuskegee experiments that went on back in the day. So when we talk about today from COVID vaccines and people who are somewhat hesitant about it, not because they don't think it will work. What is the guarantee that this is going to be administered in a way that will benefit us?
So when I look at 2049, I think there’s tremendous opportunity, particularly for communities or societies, and I'm specifically thinking and addressing low-income vulnerable communities or even other emerging, developing nations, how do we better distribute that technology? Because if we talk about cloud technology, if we talk about, other aspects of delivering it from telemedicine, where we can look at some of the advantages that we see that our society has engaged in within the last year and we can say, how can this serve a greater community?
Those who are not mobile, those who don't have access to infrastructural state-of-the-art facilities. And so, we talk about, these ways in which we can say there is great opportunity, for medicine in the future and in 2049, which is only a generation away, you know, less than 30 years. So that means people that are being born today in 2021. If they are born and bred and educated in a very inclusive way and not only inclusive way, but a very representational way that better reflects the types of communities and individuals, both race and ethnicity. We can educate, we can cultivate that learning pool that will be in the position in 2049 to deliver in a very diverse, in a very inclusive and very engaging manner.
Bisi Williams: [14:23] So I think that's fascinating. And I just want to tap on one thing, Professor Gomes, which you've done is you see a role for inclusive and universal design playing along with the GRIN technologies, right? Genome, robotics, information, and nanotech. If we design holistically this platform for all of the new wonders and tools with the lens of inclusivity and universal design, can you tell me why your vision for inclusion with the caveats that you've described, how does it make the world a better place?
Ricardo Gomes: [15:01] So at some point we have to acknowledge the inequities in our society. We have to acknowledge where we can make change and impact. If we only talk about the object or the delivery. And we don't talk about what the pathway is to reaching that. I mean, it's one thing to talk about a destination. And so in this sense, we're talking about 2049 as a destination, but if we don't map the path to get to 2049 we’re just not going to be teleported to 2049. We're going to have to actually move through there means moving from now 2021, and how do we advance that? That's why I was talking earlier about the generation aspect. That means anything you do is an investment and that we can project 2049, but we want to really talk about what are the inflection points? What are the milestones? What are the stepping stones that we will need to have sure-footing to guarantee that when we arrive at 2049, we will all arrive together and there will be no, there will be no first class or second class, they’ll only be world-class.
Bisi Williams: [16:25] I love the world-class. So what should we be doing today from your view, as a design objective, to reach the vision for 2049?
Ricardo Gomes: [16:35] Well, it goes back to what you mentioned about being holistic. It's all about being collaborative and it's all about being inclusive and it's all about being interdisciplinary. No one discipline can function on its own. And so in the case of, where the future is, it's looking at design. I'm speaking as a design educator, and I know the best way that I can educate, and disseminate the benefits and the services. And even a technology-related to design is to show how it is integrated and how there is a synthesis, to the way in which that evolves.
Design is not a service unto itself. It doesn't serve itself. Even though many designers do serve themselves. You have designers who are designing for designers and not designing for the society, for the government, for the policy, for the environment and you have to realize you really can't separate all those, because if you really embrace the holistic nature of who we are, we realize that that kind of collectiveness, that kind of life cycle loop, has to be constantly engaged.
And so when I talk about design and how we get to 2049 is to really show that in design education, we can say, that if we start investing now, we start showing where the designs come together. Where are the touch points between the two? Where does one exchange lead to the other? Where's those connections of the dots? That's what we're looking at. So I think we have to look at, where does design play a role in healthcare? Not on a superficial level, not just on a technological level, but on an experiential level and by experiential, meaning not only in delivering the services, but sustaining the livelihood. We have to think about healthcare not only when we need it, but the way in which healthcare is embedded in our lifestyle.
Bisi Williams: [18:54] Can you talk about the embedding of healthcare in a lifestyle, for example, what does it mean to design and embed?
Ricardo Gomes: [19:03] Well, this is where the equity comes into place. Most people, particularly those who die younger or more vulnerable to dying younger or not being able to benefit from longevity, they don't have the proper health care.
Why don't they have the proper health care? Because health care is not being monitored. Or they feel like the monitoring of the health care is a cost factor they can't afford. So if we are able to look at wearables or other types of timely monitoring of services, whether it happens in your elementary school, so that you have elementary services. Think of elementary schools, think of the children who are not able to have breakfast and lunch, which is really when you build nutrition and energy and ability to think in a clairvoyant manner, likewise health care so if they're able to get good healthcare monitoring, you know, on a school level that also transcends to their parents. Because the parents are their caregivers.
So you got to look at again, this kind of holistic, these connections, you can't separate one from the other. And again, when we look at where there are disparities is because the parents can't afford to be good caregivers because maybe they're working constantly outside of the home. Or as a result of that, aren't able to really properly take care of themselves. And so if their life is shorter than that means the livelihood of their children will not be fully fulfilled and in terms of what they do.
You have to really look at those connections and say, aha, there is a connection between the monitoring of one's health. How do we use health technology to not only monitor and again, that monitoring could easily be done through mechanisms like from video screening and health that will not be such an exclusive feature, but something that can be more inclusive. Now, whether it happens in the home or whether it happens in a community center or some type of health spot.
I can remember growing up young that I never got a chance to really go to the hospital, but there were always community centers that provided some level of health monitoring or supervision or guidance. And so wherever, health care can be distributed, whether it happens within the home or there's a more communal structure, whether that's in a house of worship or whether that's in school or whether that's in some kind of community center or maybe even where they buy food, just dealing with food and nutrition. And that maybe helps also limit food deserts or food scarcity. So you can say, well, how can we connect all of them?
I had a notion that you talk about healthcare workers. You talk about midwives. These things are in our cultural background. In Kenya, when I lived there, they have the doctor, they call mgunga. Mgunga is kind of the, some people that don't know will call it a witch doctor. But mgunga is basically a community doctor, someone who monitors the health of the community. And if we can, again, integrate these people, things that are recognized and not only just in terms of cultural kinds of nuances, but ways in which we can better integrate what one does.
We can think about how people talk about, for example, mental health in 2049. Mental health is probably one of the more critical things that we tend to not monitor well in vulnerable communities, to even consider anything about mental health was considered to be frivolous. But other people who receive it often will talk about going to their shrink or something as a common, as they talked about going to the dentist, but because of cultural taboos or because of the fact that kind of healthcare is exclusive, we can't afford to think of it.
Bisi Williams: [23:27] You know what, you've just touched on a number of things, Professor Gomes, that I find absolutely fascinating when you talk about this design journey starting from birth, middle school, et cetera, and one is people talk a lot about the medical industrial complex and really how we've designed it around the hospital. And what I hear in your discussion is notion of communities. So we've really taken it away from the final destination and put the monitoring of care, kind of redistribute, if you will, the access and power in a way that meets people where they are. And that builds trust. That builds a place where we can grow.
Ricardo Gomes: [24:12] Yeah. that's the big word. Right. And also, when you think about community, and again, I want to go back to the community because community builds trust. As you talked about that complex, it seems very remote and insensitive and you think, how can we build more trust? How can we build more empathy in the way in which we deliver?
And I think it is quite possible because I know, unfortunately I've had, too often, too many experiences in healthcare, in which, body parts that have to be secured or whatever. But I notice every time I go into healthcare, and I'm fortunate to have very good healthcare services and coverage, that there's more empathy. People ask you questions. They want to know how you doing, are you okay? And it's not so much administered in a matter of fact manner. It's more about people are conscientious, not only about the technology and its delivery, but the experience. And that experience means, and this will touch on another area of where a lot of healthcare was going and we wanted to know how do we humanize it, or how do we sensitize it?
When we talk about robotics, the AI experience, how do we humanize it? I mean, we could talk about if it's seamless, then we don't see it as some kind of addendum to what can be the individual service and delivery. And it's like, how do we say, well, if you go through a toll booth on a bridge, you no longer have a toll booth person to smile at you. And thank you. And you put yours in, you just have something that's automatic. It's kind of seamless and perhaps even that person, but where do we create that community? That experience, you know, sometimes that's experience could benefit from being seamless, but then sometimes that experience could benefit from being human.
Bisi Williams: [26:16] I mean do you want to be cared for by a robot?
Ricardo: Gomes [26:18] No, no, I wouldn't. I would not want to be. Particularly, can you imagine what people are going through now when their last hours or last days of experiencing COVID where they can't even see their loved ones, their father or mother or daughter, and even having someone else have to show them a FaceTime image of their departing loved one. It just seems to really make the whole transition process more agonizing.
So how do we sensitize it? How do we give a face and a smile to that? So again, when we look at AI, when we look at robotics we talk about is how do we sustain, enhance the human element? But how does 2049 or that period open up opportunities so that, and I think this great opportunity because it's just a matter of, if we look at, if we can land a Mars Rover all the way there, why can't we land. something in a country in Africa or south America or Southeast Asia? Why can't we land something there that is going to impact the health and wellbeing for generations to come?
Bisi Williams: [27:46] Professor Gomes, I think this is great. I mean, you really paint an optimistic picture of the future of health and wellness if we design it correctly through community. And I love your humanizing way that you look at the GRIN technologies, genomes, robotics, information, and nanotech, not as things to be feared, but as things to learn about, understand, and really have our moral and ethical hat on in terms of access and how we distribute these potentially remarkable goods and services.
I'd like to ask you, what should we be mindful about in 30 years as we design our future? You know, the reality is we can do anything we want. What do you think we should not do?
Ricardo Gomes: [28:32] Well, that's a good question because, I would say just bluntly, what we should not do is be looking at 2049 as if it was still 2021. Meaning that the players, those who represent, those who constitute the health community n 2049 look more like the patients.
And again, if we really talk about how we begin to bridge healthcare delivery. We want to see how can that bridge between the healthcare community and the health care recipient be balanced. In other words, I can be receiving care and feel like I'm at home. And by at home, meaning I am in a source of comfort. How do I reduce any anxiety or ambiguity in the comfort zone in which the health care system exists. And so again, I would just avoid the current disparity that exists.
In healthcare, I can easily, as a professor, talk about the academia. And so academia has the ability to shift and to ensure the representation and equity of it because when you're bringing in academia, you're not talking about discriminating or disputing ones capability because if you're nurturing them, if you're educating them, if you are investing in them, that starts at a very early age. That starts back at the elementary school I was talking about, starts back at the middle school or the period where mentorship begins to take shape and form.
We just can't look at a date, a time and not look at how we arrive on time. And so we can look at where we are today and where 2049, who are the players, who are the cast, the participants in that. And if that doesn't change, that means we don't change. And by that meaning, we still carry with us the old baggage on that journey. We don't kind of shed that old baggage or luggage that was only either holding us down or we really needed to rethink what we wear and how we wear it. So we really need to talk about that journey. And how we accommodate that journey. What is the vehicle or the mode that we take and who is on that vehicle, you know, who is going to arrive at that destination and realize why they're there.
Bisi Williams: [31:39] Professor Gomes I want to get on that train, that design train that you talk about. Where we really look at things from a human perspective, I am a hundred percent onboard for health in 2049 that's community-based and based on trust. Thank you so much for joining us today.
Ricardo Gomes: [31:59] Well, thank you for having me and providing me the opportunity
Bisi Williams: [32:03] Professor Gomes, the pleasure is all mine. And that wraps our show with professor Ricardo Gomes. Thank you for listening and if you enjoyed our show, please subscribe or share with a friend. Until next time, I’m Bisi Williams.
