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Tue Dec 6 21:17:19 EST 2011

the encounter of different health care practices in rural communities of =
developing countries where telemedicine services are implemented.

Telemedicine is taking to diverse social environments different =
practices of health care and different ways of legitimation:

  a.. it segments social processes differently;=20
  b.. it affects health concepts, social balances and organization, and =
linked power relations.=20

The vantage of case-studies like these is that the point of encounter =
between practices is sharp.

I am co-operating with E.H.A.S. (Enlace Hispano-Americano de Salud), =
based in the Engineering Department of the Polytechnic of Madrid.

(htt://www.ehas.org)

E.H.A.S. offers to public agencies working in the health sector of =
developing countries, low cost and site-specific telemedicine services.

More specifically:

  a.. Internet access and voice communication even where there is no =
electricity nor phone lines;=20
  b.. Remote medical consulting;=20
  c.. Distant education for the personnel;=20
  d.. Epidemiological vigilance;=20
  e.. Support in accessing medical references.=20

Working on medicine is interesting because:

  a.. it is a knowledge which is mostly accepted does not accomplish the =
status of hard science,=20
  b.. it is immanent to practices, social action and organization.=20

To be noted the particularity of telemedicine (compared to more =
traditional health development projects) that promises to permeate rural =
zones providing a kind of synchronous and sharpened contact between =
doctors and patients, potentially anywhere and anytime. A superposition =
of social environments impossible through previous artifacts.

And telemedicine allows an interesting outlook at information systems in =
the case they reify an abstract conception of knowledge.

Theoretical resources:

- New Institutionalism:

institution as a pattern or social model of social actions and =
relationships, it does not need to correspond to an organization

- Ethnomethodology:

Ethnomethods are the basis on which actors normally behave and live in a =
world that is perceived normal. Institutions are sources of accounts to =
justify own behaviors in case of need.

These theoretical references -rather than (bounded) rationality-based =
ones, are suitable to this study because principles of "modernity" (such =
as individual, choice, rationality, science) cannot be given by grant. =
For example in rural areas of developing countries:

=A7         illness may not be conceived of individuals (healers' =
activities usually are explained by their function to restore social =
balance),=20

=A7         treatment may not be chosen and judged for expected results, =

=A7         feeling the need of health care depends on social =
constructions, too.=20

Institution and accountability are suitable concepts to observe =
different cultures encounter, because traditional, charismatic and =
legal-rational legitimations are in interplay in defining a new sense of =
normality for the actors affected by telemedicine projects.

Conclusions:

If there is not an universal legitimation (not even legal-rational),

Then different paths of innovation (in "developed" societies), and =
different paths of development (in "developing" societies), are both =
social change.=20

There is the problem of evaluation:

which values to set a standpoint to evaluate from?

Rather than a cultural relativism, I agree with the Hirschman =
perspective:

Evaluation should leave the positivistic standpoint that simply compares =
what is expected with what is measured and obtained.

The process of innovation/development passes through balances and =
unbalances that imply (organizational) learning, which would shape later =
social change.

As development is not foreseeable, what is central is activating and =
support social change when it emerges.

This leads to an idea of innovation and development not based on the =
investment model but on social learning and institution building.

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<DIV><FONT=20
face=3DArial size=3D2>Hi all,</DIV>
<DIV>maybe you can find of some interest the =
schema of=20
the seminar I'm going to run here at the Sociology Department of the =
Binghamton=20
University.</DIV>
<DIV>any response is welcome.</DIV>
<DIV>&nbsp;</DIV>
<DIV>cheers</DIV>
<DIV>&nbsp;</DIV>
<DIV>gianluca</DIV>
<DIV>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<DIV>P.S. if anyone is around here, is =
welcome to=20
come!</DIV>
<DIV>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<DIV>&nbsp;</DIV>
<DIV> &nbsp; &nbsp; Global=20
Information Technologies and Local Health Care=20
Practices&nbsp; &nbsp;</DIV>
&nbsp;<o:p></o:p>
Gianluca=20
Miscione - dadalo at tiscali.it<o:p></o:p>
PhD=20
candidate in Information Systems and Organizations<o:p></o:p>
Sociology=20
and Social Research Department<o:p></o:p>
of the=20
University of Trento<o:p></o:p>
Italy<o:p></o:p>
&nbsp;<o:p></o:p>
Visiting=20
scholar at the Sociology Department<o:p></o:p>
of the=20
Binghamton University<o:p></o:p>
New York=20
State<o:p></o:p>
U.S.A.<o:p></o:p>
<o:p></o:p>
<o:p></o:p>
<H3 style=3D"TEXT-ALIGN: justify"><o:p></o:p></H3>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></DIV>
<o:p></o:p>
I am going to draw a trajectory that =
passes=20
through some contemporary issues to arrive to my =
research.<o:p></o:p>
<o:p></o:p>
&nbsp;In any communication can be seen two=20
aspects:<o:p></o:p>
<OL style=3D"MARGIN-TOP: 0cm" type=3D1>
 <LI class=3DMsoNormal=20
 style=3D"TEXT-ALIGN: justify; mso-list: l3 level1 lfo3; tab-stops: =
list 36.0pt"><SPAN=20
 lang=3DEN-US style=3D"mso-ansi-language: =
EN-US">informational<o:p></o:p>=20
 <LI class=3DMsoNormal=20
 style=3D"TEXT-ALIGN: justify; mso-list: l3 level1 lfo3; tab-stops: =
list 36.0pt"><SPAN=20
 lang=3DEN-US style=3D"mso-ansi-language: =
EN-US">relational<o:p></o:p>=20
</LI></OL>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: =
EN-US"><o:p></o:p></DIV>
The first one highlights the literal =
meaning of=20
a message.<o:p></o:p>
<SPAN=20
style=3D"mso-tab-count: =
1">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
Ex: I write to somebody how to cook =
spaghetti<o:p></o:p>
<o:p></o:p>
The second one pays attention to the =
broader=20
social relevance of a communication act.<o:p></o:p>
<SPAN=20
style=3D"mso-tab-count: =
1">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
Ex: I=92d like a foreigner friend reminds of me, I=92m trying to =
spread=20
Italian cooking, and so on.<o:p></o:p>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: =
EN-US"><o:p></o:p></DIV>
<o:p></o:p>
The first aspect implies a formalized =

knowledge, which -by the way- maybe my grandmother could not have, =
although she=20
cooked very well.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">The second one tends to imply tacit =
knowledge=20
and mutual understanding. Usually it is not explicit, it needs to be =
explicated=20
when something goes wrong (ethnomethodology).<o:p></o:p></SPAN></P>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">Even if cooking is not a science =
(although in=20
Italy is being opened the =93University of Taste=94) usually formalized =
knowledge is=20
backed (legitimated, Weber) by Reason, nowadays, mainly=20
Science.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">On the other hand, the relational =
aspect of any=20
communication mainly depends on the (social) context in relation with =
which it=20
is meaningful.<o:p></o:p></SPAN></P>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">So there is a dualism between =
universality and=20
situatedness:<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<TABLE=20
style=3D"BORDER-RIGHT: medium none; BORDER-TOP: medium none; =
BORDER-LEFT: medium none; WIDTH: 100%; BORDER-BOTTOM: medium none; =
BORDER-COLLAPSE: collapse; mso-padding-alt: 0cm 3.5pt 0cm 3.5pt; =
mso-border-alt: solid windowtext .5pt"=20
cellSpacing=3D0 cellPadding=3D0 width=3D"100%" border=3D1>
  <TBODY>
  <TR>
    <TD=20
    style=3D"BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 3.5pt; =
BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 3.5pt; PADDING-BOTTOM: =
0cm; BORDER-LEFT: windowtext 0.5pt solid; WIDTH: 50%; PADDING-TOP: 0cm; =
BORDER-BOTTOM: windowtext 0.5pt solid"=20
    vAlign=3Dtop width=3D"50%">
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US">Informational aspects of =
communication=20
      <o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US">Formalized=20
knowledge<o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US">Science<o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: =
EN-US">Universality<o:p></o:p></SPAN></P></TD>
    <TD=20
    style=3D"BORDER-RIGHT: windowtext 0.5pt solid; PADDING-RIGHT: 3.5pt; =
BORDER-TOP: windowtext 0.5pt solid; PADDING-LEFT: 3.5pt; PADDING-BOTTOM: =
0cm; BORDER-LEFT: medium none; WIDTH: 50%; PADDING-TOP: 0cm; =
BORDER-BOTTOM: windowtext 0.5pt solid; mso-border-left-alt: solid =
windowtext .5pt"=20
    vAlign=3Dtop width=3D"50%">
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US">Relational aspects of=20
      communication<o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US">Tacit =
knowledge<o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US">Uses, =
practices<o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
      <P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN =
lang=3DEN-US=20
      style=3D"mso-ansi-language: =
EN-US">Situatedness<o:p></o:p></SPAN></P></TD></TR></TBODY></TABLE>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: EN-US">&nbsp;</SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">&nbsp;</SPAN><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">Usually information technologies, =
when=20
purposely implemented, are (implicitly?) seen as consistent with the =
left=20
column. Any piece of knowledge formalized and legitimized by science (or =
by a=20
science-looking reasoning) can be transmitted everywhere, and it is =
supposed to=20
be effective everywhere.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">&nbsp;</SPAN><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">But scientific truth is a source of =
truth only=20
where science has already arrived.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">&nbsp;</SPAN><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">So it could be interesting to focus =
on=20
relations among IT and practices instead of =
Knowledge.<o:p></o:p></SPAN></P>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: EN-US"></SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">&nbsp;</SPAN><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">What are =
practices?<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">Practice it is a buzz word to =
describe social=20
relationships, it does not have a definite meaning; it is among action =
and=20
habit, tacit and social, formalized and informal. <o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">&nbsp;</SPAN><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">Practice is a skilled performance =
situated in a=20
social context. It has material and symbolic =
elements.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"MARGIN-LEFT: 35.25pt; TEXT-ALIGN: =
justify"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: EN-US">Ex: the daily work of =
air traffic=20
controllers is made up of practices, rather that procedures. Indeed a =
light kind=20
of strike is following all procedures strictly, it always has the effect =
to=20
delay all flights.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">&nbsp;</SPAN><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">Practice is here a central concept =
because it=20
is in the practices that knowledge is embodied.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">Practices are resource and boundary =
of=20
organized actions.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">&nbsp;</SPAN><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">The concept of practice offers an =
useful=20
perspective on how knowledge and power are embodied in social=20
action.<o:p></o:p></SPAN></P>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: EN-US"></SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">Different social practices are very =
evident in=20
the encounter of different cultures and through an information=20
network.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">From this standpoint, the following =
empirical=20
example is interesting: the encounter of different health care practices =
in=20
rural communities of developing countries where telemedicine services =
are=20
implemented.<o:p></o:p></SPAN></P>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P></DIV>
<P class=3DMsoNormal><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Telemedicine=20
is taking to diverse social environments different practices of health =
care and=20
different ways of legitimation:<o:p></o:p></SPAN></P>
<UL style=3D"MARGIN-TOP: 0cm" type=3Dsquare>
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l1 level1 lfo8; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">it=20
  segments social processes differently;<o:p></o:p></SPAN>=20
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l1 level1 lfo8; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">it=20
  affects health concepts, social balances and organization, and linked =
power=20
  relations.</SPAN><SPAN lang=3DEN-US=20
  style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN> </LI></UL>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">The=20
vantage of case-studies like these is that the point of encounter =
between=20
practices is sharp.</SPAN><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">I am=20
co-operating with E.H.A.S. (Enlace Hispano-Americano de Salud), based in =
the=20
Engineering Department of the Polytechnic of =
Madrid.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">(htt://www.ehas.org)<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">E.H.A.S.=20
offers to public agencies working in the health sector of developing =
countries,=20
low cost and site-specific telemedicine services.<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">More=20
specifically:<o:p></o:p></SPAN></P>
<UL style=3D"MARGIN-TOP: 0cm" type=3Dsquare>
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l5 level1 lfo11; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Internet=20
  access and voice communication even where there is no electricity nor =
phone=20
  lines;<o:p></o:p></SPAN>=20
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l5 level1 lfo11; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Remote=20
  medical consulting;<o:p></o:p></SPAN>=20
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l5 level1 lfo11; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Distant=20
  education for the personnel;<o:p></o:p></SPAN>=20
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l5 level1 lfo11; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Epidemiological=20
  vigilance;<o:p></o:p></SPAN>=20
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l5 level1 lfo11; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Support=20
  in accessing medical references.<o:p></o:p></SPAN> </LI></UL>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Working=20
on medicine is interesting because:<o:p></o:p></SPAN></P>
<UL style=3D"MARGIN-TOP: 0cm" type=3Dsquare>
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l2 level1 lfo14; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">it is a=20
  knowledge which is mostly accepted does not accomplish the status of =
hard=20
  science,<o:p></o:p></SPAN>=20
  <LI class=3DMsoNormal=20
  style=3D"TEXT-ALIGN: justify; mso-list: l2 level1 lfo14; tab-stops: =
list 36.0pt"><SPAN=20
  lang=3DEN-US=20
  style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">it is=20
  immanent to practices, social action and =
organization.<o:p></o:p></SPAN>=20
</LI></UL>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoBodyText><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'">To be noted the =
particularity of=20
telemedicine (compared to more traditional health development projects) =
that=20
promises to permeate rural zones providing a kind of synchronous and =
sharpened=20
contact between doctors and patients, potentially anywhere and anytime. =
A=20
superposition of social environments impossible through previous=20
artifacts.<o:p></o:p></SPAN></P>
<P class=3DMsoBodyText><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'"><o:p></o:p></SPAN></P>
<P class=3DMsoBodyText><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'">And telemedicine allows =
an=20
interesting outlook at information systems in the case they reify an =
abstract=20
conception of knowledge.<o:p></o:p></SPAN></P>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Theoretical=20
resources:<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">- New=20
Institutionalism:<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"MARGIN-LEFT: 35.25pt; TEXT-ALIGN: =
justify"><SPAN=20
lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">institution=20
as a pattern or social model of social actions and relationships, it =
does not=20
need to correspond to an organization<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">-=20
Ethnomethodology:<o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"MARGIN-LEFT: 35.25pt; TEXT-ALIGN: =
justify"><SPAN=20
lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US">Ethnomethods=20
are the basis on which actors normally behave and live in a world that =
is=20
perceived normal. Institutions are sources of accounts to justify own =
behaviors=20
in case of need.<o:p></o:p></SPAN></P>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P></DIV>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p></SPAN></P>
<P class=3DMsoNormal style=3D"TEXT-ALIGN: justify"><SPAN lang=3DEN-US=20
style=3D"mso-ansi-language: EN-US">These theoretical references -rather =
than=20
(bounded) rationality-based ones, are suitable to this study because =
principles=20
of =93modernity=94 (such as individual, choice, rationality, science) =
cannot be=20
given by grant. For example in rural areas of developing=20
countries:<o:p></o:p></SPAN></P>
<P class=3DMsoNormal=20
style=3D"MARGIN-LEFT: 71.25pt; TEXT-INDENT: -18pt; TEXT-ALIGN: justify; =
mso-list: l4 level1 lfo16; tab-stops: list 71.25pt"><SPAN=20
lang=3DEN-US style=3D"FONT-FAMILY: Wingdings; mso-ansi-language: =
EN-US">=A7<SPAN=20
style=3D"FONT: 7pt 'Times New =
Roman'">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
</SPAN></SPAN><SPAN lang=3DEN-US style=3D"mso-ansi-language: =
EN-US">illness may not=20
be conceived of individuals (healers=92 activities usually are explained =
by their=20
function to restore social balance), <o:p></o:p></SPAN></P>
<P class=3DMsoNormal=20
style=3D"MARGIN-LEFT: 71.25pt; TEXT-INDENT: -18pt; TEXT-ALIGN: justify; =
mso-list: l4 level1 lfo16; tab-stops: list 71.25pt"><SPAN=20
lang=3DEN-US=20
style=3D"FONT-FAMILY: Wingdings; mso-fareast-font-family: 'MS Mincho'; =
mso-ansi-language: EN-US">=A7<SPAN=20
style=3D"FONT: 7pt 'Times New =
Roman'">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
</SPAN></SPAN><SPAN lang=3DEN-US style=3D"mso-ansi-language: =
EN-US">treatment may=20
not be chosen and judged for expected results, </SPAN><SPAN lang=3DEN-US =

style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p>
<SPAN=20
lang=3DEN-US=20
style=3D"FONT-FAMILY: Wingdings; mso-fareast-font-family: 'MS Mincho'; =
mso-ansi-language: EN-US">=A7<SPAN=20
style=3D"FONT: 7pt 'Times New =
Roman'">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;=20
feeling the need=20
of health care depends on social constructions, too. <o:p></o:p>
<o:p></o:p>
Institution and accountability are =
suitable=20
concepts to observe different cultures encounter, because traditional,=20
charismatic and legal-rational legitimations are in interplay in =
defining a new=20
sense of normality for the actors affected by telemedicine =
projects.<SPAN=20
lang=3DEN-US=20
style=3D"mso-fareast-font-family: 'MS Mincho'; mso-ansi-language: =
EN-US"><o:p></o:p>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: =
EN-US"><o:p></o:p></DIV>
<o:p></o:p>
Conclusions:<o:p></o:p>
<o:p></o:p>
If there is not an universal =
legitimation (not=20
even legal-rational),<o:p></o:p>
<o:p></o:p>
Then different paths of innovation =
(in=20
=93developed=94 societies), and different paths of development (in =
=93developing=94=20
societies), are both social change. <o:p></o:p>
<o:p></o:p>
There is the problem of=20
evaluation:<o:p></o:p>
<SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: EN-US">which values to set a =
standpoint to=20
evaluate from?<o:p></o:p>
<DIV=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 1pt; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: windowtext 0.75pt solid">
<P class=3DMsoNormal=20
style=3D"BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: =
medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium =
none; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; TEXT-ALIGN: justify; =
mso-border-bottom-alt: solid windowtext .75pt; mso-padding-alt: 0cm 0cm =
1.0pt 0cm"><SPAN=20
lang=3DEN-US style=3D"mso-ansi-language: =
EN-US"><o:p></o:p></DIV>
<o:p></o:p>
Rather than a cultural relativism, I =
agree with=20
the Hirschman perspective:<o:p></o:p>
<o:p></o:p>
Evaluation should leave the =
positivistic=20
standpoint that simply compares what is expected with what is measured =
and=20
obtained.<o:p></o:p>
The process of innovation/development =
passes=20
through balances and unbalances that imply (organizational) learning, =
which=20
would shape later social change.<o:p></o:p>
<o:p></o:p>
As development is not foreseeable, =
what is=20
central is activating and support social change when it=20
emerges.<o:p></o:p>
This leads to an idea of innovation =
and=20
development not based on the investment model but on social learning and =

institution building.</SPAN></P></FONT></BODY></HTML>

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