Part of the research for Database as Documentary. An investigation into databases, birth & power.
YoHa, Data Entry
YoHa have been investigating databases since 2009 when they were invited to think about art and health in collaboration with Liverpool Primary Care Trust, a division of the UK's public health service. Rather than work directly with patients YoHa chose instead to work with data analysts, public health intelligence units and abstract models of health.
They noticed that when someone models, creates and implements a database about something, it changes the relationships of those authoring the system to the original thing itself. They initially wondered if this was related to the technicality of the relational database or if it had something to do with some other interaction involving discourse, computing and/or the aggregation of records.
Two of primary questions they had were:
How do the creation and implementation of database management systems (DBMS) affect the conduct of the authors and commissioners of such systems?
How can people who are affected and represented by the abstract models of health embodied in databases critically engage with their creation?
The following notes were condensed from interviews held in the Netherlands during the summer of 2011.
Data Entry reflects on a series of interviews with midwives carried out during the summer of 2011 in Amsterdam, the Netherlands, whilst working with Annet Dekker. The statements in the video are not those of any of the actual midwives but reflect aspects of the conversation.
Text from the film Data Entry, YoHa 2011
Normally performed live with the video screening in the back.
MIDWIFE: Woman, mid-thirties.
NARRATOR: Woman or man.
NARRATOR: A database of births appears at the crossroads of medical, political and economic kinds of governance vying for the territory of a newly emerged body. This engagement is as much about medical or administrative liability as it is a land grab for new flesh.
MIDWIFE: Each form I fill in is dedicated to a single patient, and among other details, I have to enter several names: Who was present at the birth, who was responsible, and who did the stitches in the vagina. You have to put your name to it. You stitch a wound, so there is a potential for infection. I’m a bit insecure about my sewing skills. I’m always afraid that at some point there will be complaints about the healing process, and that my name will be connected to it.
NARRATOR: Doctors have the power to open you up for inspection, place a camera inside you, tinker with your organs, and pull off bits for biopsies that are inspected by other powers. The doctor derives authority from all those exams she sat and which qualify her to manifest the collective 'truth' manufactured by the medical machine.
MIDWIFE: The head is born, but the baby is stuck - we call this a shoulder dystocia. It means that the shoulder is trapped beneath the pubic bone, and you have to release the shoulder quickly so the baby’s lungs can open up. These manoeuvres can either be difficult, causing a lot of harm to the woman, or they can be light.
NARRATOR: Databases operate on us and through us. They allow new forms of power to emerge from the machine’s ability to process and push large sets of information into the gaps between knowledge and power. As databases order, compare and sort, they create new views of the information they contain. New perspectives amplify, speed up and restructure particular forms of power as they supersede others.
MIDWIFE: If you enter shoulder dystocia into the woman’s medical record, a consequence could be that the next time she gives birth it will be by caesarean section. She won’t even be allowed to start giving birth naturally but will be operated on immediately.
NARRATOR: Creating a database throws a particular light on the items it records. It breaks the process down into discrete steps of re-ordering. The database compares lists and creates new knowledge from the relations that this sorting produces. This new knowledge then acts as a kind of remote control on the elements it defined.
MIDWIFE: Of course, shoulder dystocia is a grey area: It can be very complicated, or only require a few manoeuvres for the baby to emerge quickly, but the database doesn’t discriminate. Doctors are always sensitive to their liability, and will strongly advise operating, thereby medicalising the pregnancy and possibly harming the woman even more.
NARRATOR: The power generated from large-scale information processing changes things by altering the conduct of the substances through which power flows, or on which it acts.
MIDWIFE: The time we used to spend attending to women in our care is now spent administrating them in the database.
NARRATOR: Databases require some of us to become speedy data-entry clerks, updating, maintaining and transferring information from paper-based records. White knuckles bend, flicking fingers at a consistent hum of 9,000 to 12,000 keystrokes an hour.
Often the way a power acts on or operates through us is by how we notice the changes it makes. Keystrokes are recorded and analysed, line managers count and assess average keystroke rates. If you type fast enough for long enough, it will trigger a bonus, bending the flow of power into an extra cheesecake for the family from a local supermarket - its acquisition triggering another flow in and out of our extended minds and actions.
MIDWIFE: The job of the primary care midwife is to see where the risk is, based on data gathered previously during pregnancy or pre-pregnancy. In secondary care we are ready to deal with complications, such as having to use a vacuum, or performing surgery.
NARRATOR: A database can also be thought of as an architecture that holds a list in a particular shape while we ask it questions. It maps out a collection of objects into recipes for action. Much as contemporary buildings contain the engineering of the past so a database carries with it the echoes and residues of its former selves.
The clock that enables people to be coordinated and allows us to search for what happened, and when, reappears in date-time fields. Index card systems appear as unique identifiers, allowing relationships between the information they point to. The accountant’s ledger, with its rows and columns, arranges the data across the screen. The triangulation of terrains, of old maps of empire, reappear as post codes, electoral boundaries and other geographies.
Databases are the steam engines of information, knowledge and power that are rapidly moving through us, separating us, re-shaping us, folding us up into its parts. Its relations and queries pick us up, move us around and put us back down somewhere familiar yet unknown.
Population policing, health observation, remote controlling, truth amplification, knowledge machining, disembodied memories, extended minds.
The database is ubiquitous, and is installed in our masochistic home offices where we subjugate ourselves to the discipline of its records and fields in an attempt to take on a little of its power.
Graham Harwood and Matsuko Yokokoji
(YoHa, the Japanese word for ‘aftermath’) have lived and worked together since 1994. YoHa’s graphic vision and technical tinkering have powered several celebrated collaborations including co-founding the artists group Mongrel (199602007), specialising in digital media; and established the Mediashed, a free-media lab in Southend-on-Sea (2005-2008). In 2008 they joined long-time collaborator, Richard Wright, to produce Tantalum Memorial
, which was awarded first prize at the 2009 Transmediale Festival in Germany. Tantalum Memorial
also featured at ZeroOne Biennial, USA; Manifesta07, Italy; Science Museum London, UK; University of Plymouth and TAP Southend, UK; UKS, Norway; Ars Electronica, Austria; Plug.in, Switzerland; and LABoral Centro de Arte, Spain. http://yoha.co.uk/