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While computers speed up these tools, all that is necessary is pencil and paper. We hope these tools may be useful in worlds as different as academic medical centers and pre-literate tribal societies. \textit{Literacy Bridge} a clever and effective program produces changes in maternal and child health and agriculture by supporting communication with spoken word devices.  \marginnote[][+1cm]{\emph{Literacy \marginnote[][0]{\emph{Literacy  Bridge} A description of the program that illustrates how word of mouth transmission, clever personal devices and advanced program design support community education and development can be found at \url{www.literacybridge.com}} \subsection{Complexity}  Complex systems have multiple parts. Human use the technical parts and interact with other humans, introducing communication. All this is in constant change over time. I stumbled upon this example on the internet. We could consider the magnets as non-human parts of the system, marbles as humans, and sticks and pieces of wood as designed control factors to keep the components in a safe range. We can see there are many ways things can go wrong and how hard it is to modify one part without unexpected results elsewhere. \marginnote[0]{Marbles and Magnets. Use the link to the video and click on the arrow to show the operation of a model of a complex system. If you can, use the full screen view. \url{http://www.eetimes.com/author.asp?section_id=216&doc_id=1329692}}  Note there could be a cascading series of minor defects in the system that could result in a complete breakdown. We will return to that idea. Also note that while the marbles are almost passive once they are set in motion, humans can observe and react in complex processes in which they find themselves. Richard Cook in the next section feels this is how expert participants can pick up errors in progress and intervene to change the course of events. To perform in that way they must have learned thru mistakes. That is how knowledge is acquired and generalized to new situations.\marginnote[][+2cm]{Marbles and Magnets. Use the link to the video and click on the arrow to show the operation of a model of a complex system. If you can, use the full screen view. \url{http://www.eetimes.com/author.asp?section_id=216&doc_id=1329692}}  \subsection{Investigating and Defining Complex Systems Failure} This area has been investigated extensively and from many points of view. A summary of important considerations concerning health care is found at the Cognitve Technologies Lab in a handout by Richard I. Cook: \textit{How Complex Systems Fail } accessible as full text through Research Gate. One of the problems of research in this area is the view from the top down is strongly influenced by the language and habits of the different disciplines, they are looking for a particular canary in the coal mine, one from the areas with which they are familiar and were they can develop testable hypotheses. From the ground, the bottom up, the case report, the life story, the perspective is somewhat different. We do not want to miss something just because it is new, or rare or unfamiliar to us. One of the most troubling problems in medicine is the patient who presents with something unexpected or unknown to us. They are frequently blamed for not having the right picture to fit our expectations. They are blamed for imagining something or come to feel they are hypochondriacs. One of my OB/Gyn professors drummed into our minds the "first symptom of carcinoma of the cervix is no symptoms." \marginnote[-2]{\url{https://www.researchgate.net/publication/228797158} Many additional papers are available through Research Gate where you can select those appropriate to your own interests.}  \subsection{Extending an Investigation}