This paper examines two parallel case studies to promote remote medical consultation in Ghana. These projects, initiated independently by different researchers in different organizations, both deployed ICT solutions in the same medical community in the same year. The Ghana Consultation Network currently has over 125 users running a Web-based application over a delay-tolerant network of servers. OneTouch MedicareLine is currently providing 1700 doctors in Ghana with free mobile phone calls and text messages to other members of the medical community. We present the consequences of (1) the institutional context and identity of the investigators, as well as specific decisions made with respect to (2) partnerships formed, (3) perceptions of technological infrastructure, and (4) high-level design decisions. In concluding, we discuss lessons learned and high-level implications for future ICTD research agendas.