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Sharing is caring: communities of abundance in rural Japan

By Laura Haapio-Kirk, on 22 October 2018

Harvested corn. Illustration by Laura Haapio-Kirk

Last week I returned from ten days among the wonderful people of my rural fieldsite in Kochi prefecture. The vibrant green rice terraces I had been mesmerised by back in August are now the colour of gold, and in the fields small pyramids of drying rice are beginning to appear. It is harvest season and I was able to experience first hand, as people kept telling me, how Kochi is truly a land of abundance. I was given bags of chestnuts and yuzu lemons, and large Japanese pears (nashi); people here are adamant about sharing the fruits of their labour. The gifting of food binds the community and is, as one woman told me, important for creating a feeling of wealth without money: “Even if we have no money here in Kochi, we have abundance because we can grow so much delicious food and we love to share it.”

Community is sustained in this small rural town through a number of institutional initiatives, such as group activities for elderly residents, or regular workshops in the town hall, for example for new mothers. But it is also through these informal networks of reciprocal giving that community is made. The building and sustaining of community is especially important to people here because Japan’s ageing and shrinking population is felt most acutely in rural areas. It is not rare to come across abandoned schools which have been repurposed as community spaces, and indeed entire empty villages. Yet, I have also come across another quite different picture – young people and families moving into this rural town in search of a slower pace of life and self-sustainability. I have met numerous families who left behind jobs in cities both in Japan and abroad, to start new lives in a place where they feel safe; both protected by a community that looks out for each other, and as a number of people have told me, far enough away from the site of the Fukushima nuclear disaster of 2011 for the food to not be contaminated.

Akaushi – a famous breed of local cow. Illustration by Laura Haapio-Kirk.

This group of relatively recent immigrants, who have mostly arrived within the last eight years, are active on Facebook community groups where they buy and sell clothing, and post about local events. I have been told that local people are less active on Facebook, but perhaps more reliant on one-to-one messaging through Line. However, I have come across local people practicing traditional crafts who share their work on social media. For example, one woodworker in his sixties who uses Instagram to promote his products has customers as far as Tokyo. He told me “It is important for us to be active online because this is how we can reach the rest of Japan and the world, and show the beautiful things that we make here from nature.” Indeed, one of the first people to move to this community eight years ago blogged about her experience and inspired others to follow her move from urban to rural living. Blogs and social media are one way that people in rural Japan can influence a wider perception of the rural from being depopulated and dying, to re-populated and thriving. Social media also provides an opportunity for local people to build and develop their community in new ways. As my bags of fruit demonstrate, they have always had an extraordinary tradition of sharing.

Empty nesters and ‘under-occupied’ homes — by Pauline Garvey

By Laura Haapio-Kirk, on 14 October 2018

Quinn, David 17/04/15, If grandparents went on strike, we would all be sunk, The Irish Independent, available electronically as https://www.independent.ie/opinion/if-grandparents-went-on-strike-we-would-all-be-sunk-31149507.html

Amongst the proposals for the recent Irish budget 2018, government ministers looked to the grey vote and weighed up options for a grandparent grant, reported on in the media as the ‘granny grant’.  The idea was advocated by Minister for Transport, Tourism and Sport, Shane Ross, who calculated that 70,000 grandparents could be eligible for the grant, costing the state €71 million a year. The proposal was based on the widespread recognition that grandparents undertake a substantial burden in a country where childcare is exorbitantly expensive and state subsidies limited. Many young couples turn to their retired parents to look after their offspring, and these grandparents undertake their labour often in their own homes. A study from 2015 found that 60% of grandparents looked after their grandchildren once a month, while one in five looked after them more than 60 hours per month.

At the same moment as talks of the granny grant circulated however, the same minister argued in favour of introducing a ‘granny-flat grant’ in order to encourage older people to transform the upper floors of their houses and rent them to lodgers, thus contributing to the housing pool and giving elderly householders a source of income. Piloted in one house in north Dublin, the granny-flat grant is far more controversial among people I meet in the course of my fieldwork.

One woman complained that it is seemingly fine for grandparents to bear the brunt of childcare but somehow their undisputed rights to their own home is cast in doubt. As she said ‘my parents worked their whole lives and paid tax, as did I. I inherited this house and paid for its upkeep from my wages since I started working fifty years ago. But now “the boys” are talking of taking my first floor?’

Another woman commented that the logistics of building a kitchen and finding a suitable tenant seemed a daunting task. While a third pointed out that ‘no one expects a 40-year old singleton in a 3-bedroom house to downsize, so why should I?’ In media reports there is no sign that the search for ‘under-occupied’ houses includes all spacious residences in the state, but instead focuses squarely on the homes of the elderly, and occasionally those in social housing. One question that this prompts is why does the idea of under-occupied housing seem to apply only to the elderly, leading some of my research respondents to feel that their right to their own homes diminishes with every passing decade?

The Purple Month — by Alfonso Otaegui

By Alfonso Otaegui, on 10 October 2018

As a member of the Anthropology of Smartphones and Smart Ageing research project, I am doing fieldwork among migrants working in Santiago de Chile. Among the many diverse migrants who live in this city, I chose to work with Peruvian migrants. Peruvians are the largest immigrant group in Chile: they represent 25.2% of the migrant population, according to the 2017 census. Many of them have been living in this country for over fifteen or more years, and most of them live in Santiago (65.2% of migrants live in the Metropolitan Region).

During the first weeks of my fieldwork, I asked a Peruvian colleague –who was also living far away from his country– on advice about meeting his countrymen here in Chile. He advised me to approach Christian confraternities. Confraternities –in this case Peruvian– are groups of people who honor their local Catholic devotions. I started then to frequent a catholic church in the center of the city, which is famous for being welcoming and supportive of migrants. There I met Peruvians belonging to several different confraternities. Some of these confraternities honor Peruvian Marian devotions, such as the Virgin of Chapi, from the southern city of Arequipa, or the Virgin of La Puerta, from the northern city of Otuzco. Others honor Peruvian saints such as San Martin de Porres or Santa Rosa de Lima. All of them were as proud of their devotions as welcoming to my ethnography.

Among all of the confraternities, I decided to join the most diverse in terms of regional origin, including even non-Peruvians: the Hermandad del Señor de los Milagros (Confraternity of the Bearers of The Lord of Miracles). This devotion originates in Lima in the seventeenth century and, although the largest confraternity can be found in the capital city of Peru, there are local confraternities –such as the one I joined in Santiago– all over the world, from São Paulo to New York (even in Hamamatsu, Japan). “Wherever there is a Peruvian there is the Lord of Miracles”, so I’ve heard them quote of Monseñor Hidalgo, the spiritual guide of the main confraternity at the Nazarenas church in Lima.

The brothers and sisters have been very kind to me and have allowed me to join them in several activities along the year, such as regular meetings, spiritual retreats and ‘polladas’ (traditional funding events where chicken dishes are sold). The biggest event of the year is the Lord of Miracle’s procession at the end of October, called the purple month, due to the typical color that identifies this devotion as seen at a number of activities (shorter processions, masses, retreats, etc). The main procession, lasting eight hours, takes place on the last Sunday of October. As a sign of the place of Peruvians in Chile, the procession goes from the Cathedral of Santiago to the migrants’ church, gathering thousands of devotees. I was invited to join one of the groups of thirty people carrying the 1.5 tons image. ‘Carrying’ is not only a body technique one needs to master (the hands at a certain position, the steps following the music) but also an honor. Besides, ‘carrying’ is a complex concept whose meaning linked to faith and community I am just starting to grasp.

 

 

 

 

 

 

 

 

Most of the miracles I have been told about are in fact related to health: a surgery that went well, a disease that was beaten against all odds, a tumor that turned out to be benign. As far as I can understand, prayers and processions do not substitute medical procedures. I see in the chains of prayers, the dedication of a procession stages, and the participation in funding activities a sense of community, a display of collective care. What is interesting for our study in the ASSA project, is that this particular devotion is not only an expression of belonging, of tradition continued abroad, but it also opens the door to the study of the relation between faith and health.

References

Institituo Nacional de Estadísticas Chile. 2018. Síntesis resultados Censo 2017. Santiago: Instituto Nacional de Estadísticas Junio / 2018.

 

 

 

Dr. Google will see you….anytime.

By Daniel Miller, on 4 October 2018

Given that I suspect almost everyone you know at least occasionally uses google to look up health related information, at least sometimes, there is not a great deal of research on the consequences – though I have no access to google’s own research. This has therefore been a major focus of my work on digital technologies and health here in Ireland. What are the main conclusions so far?

Most noticeable is the way googling exacerbates differences in class and educational background. There is a pronounced spectrum. At one end are those, often without medical backgrounds, who would comfortably use google to track down the latest medical journals, because they are trained in research. At the other end are those who simply look at the items that come at the top of their google search, which are often scare stories, rumours or commercial sites. As one pharmacist noted `They just type it into google and probably read the first couple of articles that come up. So whatever’s most recent. They don’t differentiate NHS from random.’ This can be very frustrating to medical practitioners when it leads to their patients locating the problem in the latest online speculation, rather than starting with the practitioner’s own analysis.

This spectrum is complex because of several contradictory factors. A surprising number of people in this town mention that there is someone with medical training, within their extended family, who may mediate their searches. There is also a well educated section who use googling as a kind of anti-medical-establishment resource seeking out alternative and complementary treatments, which they feel deal with issues and consequences that are neglected by bio-medical establishments.

At both ends of the spectrum most people see equally strong positive and negative consequences of googling. They feel more knowledgeable, and in control of their treatment, but they also see googling as a cause of considerable stress and anxiety. They note that pretty much any symptom could potentially indicate cancer or some other life threatening condition. Some therefore limit their googling. Many people are wary of informing doctors of their searches for fear they will be seen as a nuisance or a challenge to the doctor’s authority. Googling may be a factor in deciding whether to see a doctor, but it also employed subsequent to visits to the doctor in order to better understand terminology, medicines and procedures. Pharmacists may actively guide people in their googling. Those who differentiate trusted sources of information mostly choose the US Mayo clinic or the UK NHS site rather than any Irish sites, and also favour specialist sites dedicated to their particular conditions. Unlike early evidence from other fieldsites in our project, such as in our recent blog post about Cameroon, there is little use of YouTube here for health information.

To conclude, google appears to provide equal information to all, but in practice, it may extend class and educational differences and create problems of online health literacy. Well-educated people become still better informed, while poorly educated people are left even more confused and anxious. The obvious solution is kite-marking those sites backed by established professional bodies. This does nothing to prevent a preference for complementary health sources, but does ensure a more equal playing field for those who, to use a common expression here, think of online as Dr. Google.

Togetherness is Strength: “making light the heaviness on one person” – by Charlotte Hawkins

By Shireen Walton, on 1 October 2018

Author: Charlotte Hawkins

The ASSA project is concerned with older people’s experiences, particularly related to health, and the impact of mobile phones on their lives. In Godown, my fieldsite in Kampala, this translates to a focus on the ways older people mobilise support for the health of an individual across family and community networks. Throughout Uganda, savings groups are a notable model of community support for individual health, popular particularly amongst the urban poor (Nakirya and State, 2013). Typically, a group of people meet weekly to save money together, with an opportunity take small loans from the savings. The Ugandan government have recently started to encourage savings groups “as a way of pooling resources together in order to facilitate development”[1].

To better understand the nature of community support in Godown, I’ve registered as an active participant of a savings group of 15 members, predominantly older men, all from Acholiland in Northern Uganda. The group name translates to ‘Togetherness is Strength’ and was founded by a group of community elders after a child was stillborn at the local government hospital; the child’s father had struggled to fund the transportation for the burial in his home village in Northern Uganda, “he had to pool resources within the night, so he saw it was a very big challenge if we had not helped him. So that was the birth of the group”. Over 5 years, the fund has accumulated about 20 million Ugandan shillings ($5250), which means there’s now a collective resource for emergency loans. As explained by the group Treasurer, this is particularly useful in times of poor health, “in our community, the income levels are very low, so in the event of one of them falling sick, he cannot even feed himself”. They also recently bought one young man a motorcycle for business purposes, which he pays off in monthly instalments with interest, later to be shared amongst the group. Every Sunday morning, they hold a meeting in a local bar, in which savings are counted and group elders advise their younger members (see image below).

Savings group meeting in Godown. Image (CC BY) project PI Daniel Miller

Whilst ensuring monthly contributions and loan repayments are maintained can be a challenge, the group represents the possibility of security through mutual collaboration, fundamental to individual, family and community health in Godown more broadly. As explained by the Vice Chairman, it is a “means of assisting ourselves, in times of grievance or happiness. We thought we should come together to form an association and make light the heaviness on one person.” Amidst conditions of socioeconomic precarity, savings groups such as this offer a form of risk mitigation through social insurance. There meets the traditional (ritual, conviviality, group solidarity) and the economic (financial and legal obligation, commercial organization) (Ardener, 1964: 222) ideals of this community, manifesting the experience of elder-led ‘togetherness’ in Godown.

Savings group meeting in Godown. Photo (CC BY) Charlotte Hawkins

References:

  • Ardener, S., 1964. The Comparative Study of Rotating Credit Associations. J. R. Anthropol. Inst. G. B. Irel. 94, 201.
  • Nakirya, J.W., State, A.E., 2013. “Nigiina”s as Coping Mechanisms of Peri-urban Low-income Mothers in Kampala, Uganda. East. Afr. Soc. Sci. Res. Rev. 29, 31–57.

[1] https://www.newvision.co.ug/new_vision/news/1485733/museveni-tours-kampala-wakiso, accessed 15.09.18

The challenges of staying active – by Maya de Vries

By Shireen Walton, on 25 September 2018

Author: Maya de Vries

10 years ago, in a Russian store at the city center of Jerusalem, I bought an A3 size poster from the communist time, with a drawing of an old lady who looks like a farmer, holding a book. The short text beside her image read: If you stop reading books, you might forget the language.

Recently in my field site of Dar al Hawa I found myself remembering this poster when visiting the elderly club, a central place in my field site, as I observed a variety of practices that aim to keep them sharp and vital.

One of the most challenging problems in the elderly club is to find suitable activities for the members. They need to be activities that both men and women can do; not too physical, because many are suffering from pains in their legs and can’t walk a lot, some have hearing problems, or cannot breath well. Hence, many of the activities are ‘just’ talks – it is easier for them to sit and listen. However, there can still be difficulties in establishing the time and place with lecturers as sometimes they call in the morning of the lecture to cancel. When a lecturer stands them up like this or if there is no other organized activity in the club, their alternative is an independent Quran lesson, which is quite different from the religion lesson that they have every few weeks with the local Iman. They take out larger volumes of the Quran and start reading aloud, each one in his/her turn. Hala, a member in the club who is volunteering in the Israeli welfare department and coordinates some of the club’s activities, leads the reading session and corrects them as they read. It is not easy to read correctly from the Quran,  as ech part has its own chants. The exercise is productive not just of the sense of community but also isa practice which helps stimulate memory (Collier, 2017).

The books were donated by one of the club’s members, and are large in order to make reading easier. From the perspective of our projects work on smartphones, in a site where religion plays a core role in daily life, the small screen of the smartphone poses a problem – even if they are able to change the size of the font. However, people here do find relevant uses for the technology. For example, most of them have downloaded an app that reminds them when to pray during the day.

Quran reading lessons seem to be physically passive, since they take place while sitting. However, praying in Islam is quite a physical experience, as the person praying needs to first take off his/her shoes, following this he/she may enter the mosque and begin praying. Praying also involves all kinds of physical positions such as sitting, leaning to the ground, standing up, turning the head to the side – these movements are frequently repeated. The entire group went inside the mosque to pray, some sat on the floor as is custom, while others who physically cannot get down to the floor took plastic chairs. For almost an hour, they all prayed, regardless of any physical limitations, and in a way, were challenging their bodies through the prayer. It is easy to forget that prayer is far more than just words. It is an immersion of the person physically and mentally within their religious practice, and for older people, it remains the structure to much of their life. So when thinking about the impact of the smartphone on people’s lives, one has to be continually aware of how much, and how, this is mediated by religion.

References:

https://www.medicalnewstoday.com/articles/320377.php 

The dilemma of life-saving medicines in China – by Xinyuan Wang

By Xin Yuan Wang, on 20 September 2018

Author: Xinyuan Wang

Last summer, a film about illness and medicine achieved phenomenal success among Chinese audiences. Some friends of mine who had watched the film suggested that I take some tissues or even towels along to the cinema, assuming, , half-jokingly, that many would cry during the film. But they were quite right, in the cinema there were people sitting all around me wiping tears during the film, and talking highly of it with tears in their eyes after the cinema was over.

The film, Dying to Survive,  tells the tale of a health supplements peddler Yong who smuggles illegal medicine from India to sell to leukaemia patients in China at more affordable prices. Why are Chinese people all so touched by a film about an illegal medicine smuggler?

In the film, even though the protagonist Yong initially goes into the trade by chance and was purely motivated by making money – “I don’t want to become a saver, I just want to make money” as he claimed, Yong started to become more altruistic as he gradually realizes how many lives he could save by the cheaper medicine. The film was inspired by a real-life incident in China: in 2015, a man called Lu Yong was charged for importing and selling a cheaper, knockoff version of Gleevec, a leukaemia medication. Lu himself suffered from leukaemia and began purchasing Gleevec tablets produced by an Indian pharmaceutical company for other patients who couldn’t afford the “real” drug. The indictment was later quashed after the patients that had benefited from Lu’s actions petitioned the court to lessen the sentence and release him. In recent years, the Chinese government had realized this problem and had make some effort to reduce the price of ‘life-saving’ medicines. So, the film is also in line with the state policy.

As shown in the film, an old lady said: “one bottle of genuine medicine cost me 40,000 CNY (around 4,500 pound), I have been sick for 3 years, and I have been eating these pills for 3 years. In order to buy this medicine, my family had to sell the house, my family has been totally dragged down. Which family does not have a patient? Can you guarantee that you will not get sick for a lifetime? I don’t want to die, I want to live.”

A 45-year-old woman whose mum died two years ago because of cancer, told me: “I just can’t stop crying, when the old lady in the film said ‘Can you guarantee that you will not get sick for a lifetime? I don’t want to die, I want to live’,” she adds, “everybody who has experienced a major illness themselves, or of their family member or good friends can feel for the film. You would never imagine the desperate feelings about losing somebody you love dearly just because you can’t afford the saving-life medicine.”  Indeed, even though there is life-saving medicine, there is no life-saving money. In the film, the only sincere line a deceitful drug dealer uttered was “there is one illness in the world which you can never cure – poverty.”

Satirical films such as this unveil and spotlight the social concern that no Chinese would not bear to ignore – that for normal people, a major disease can potentially tear a family down both mentally and financially. Dying to survive has sparked and leveraged tremendous discussion over many topics nationwide, which is unprecedentedly in China’s film history. Without a doubt, the film has touched a few sour points of Chinese medical care from the high price of imported medicine to major illness insurance policy (da bing yi bao). Each aspect requires thorough investigation in order to understand the situation.  If you are interested in the film, here is the trailer with English subtitles. https://www.youtube.com/watch?v=on82VId28l4

The Internet of Health in Yaoundé – by Patrick Awondo

By Shireen Walton, on 12 September 2018

Author: Patrick Awondo

Over the last decade, Internet penetration rate in Cameroon has more than doubled, from around 10% in 2007 to 21-30% in 2017 (these figures leave aside small and medium-sized cities, and do not take into account connection-sharing practices that are part of people’s daily habits). The internet boom, made possible by the democratization of smartphones (which 80% of the population now have) has impacted significantly upon behavioural habits and the ways in which individuals and groups live at different stages of their lives. Among the areas chiefly affected by such changes, health is attracting attention in the digital landscape because it is the subject of unprecedented publicity, and is considered to offer many affordances to people.

In Yaoundé as in other African capitals, health remains a significant problem, but also, is undergoing  ongoing processes of change, and permanent questioning. In the smartphone age, health is an area of intense social activity. Three types of issues in the online health context deserve attention for the importance of the activities they generate:

  1. The variety of access to online health resources
  2. The diversity of information and forms of access offered by the Internet
  3. Challenges related to the density of supply, and what our colleague, Daniel Miller, perceives as inequality in interpretation, and the ability to appreciate in a fair and balanced way, the different “resources” of health online.

The variety of access to health resources

Generally speaking, people in Yaoundé use the Internet in contexts of/for health either to publicize health resources, that is to say, to present information that aims to simultaneously improve access to health through good practices. Or, to find the right information about very specific health problems. The latter is undertaken through a range of sites and links dedicated to specific health issues. Specific health issues can include pandemics such as malaria, tuberculosis or HIV / AIDS, which are priority public health problems usually treated by public health actors. However, people also turn to the Internet to search for diseases that have no visible presence in public health discourses, and which generally lack in public awareness – such as Typhoid fever, as well as certain female health issues such as ovarian cysts, dermatological problems, and infertility. These issues are addressed in forums, and blogs, but more and more, via dedicated Whatsapp groups that are often created by individuals with such concerns. There are also many health bloggers from Cameroon and the Cameroonian diasporas. Some are not always of Cameroonian descent or nationality, but blog membership appears most strong when individuals are Cameroonians or presented as originating from the country.

Overall, there are different ways of accessing the  internet of health in Yaoundé. Informants could be classified into 3 categories:

  1. those who watch YouTube for health
  2. those who Google-search health problems
  3. those who follow specialized health blogs

Health-searching practices on YouTube

Amongst my young informants, (19-31 years), the practice of searching for information on YouTube seems to be fairly common. Informants describe a typical double scenario, whereby they have a health concern, for various reasons that may be related to a lack of economic means, or the inability to join a health service. In this case, they will introduce on YouTube the name of one or more symptoms, which they hope a video will help inform them about. A 31-year-old security officer at a mobile phone operator explained how she regularly used YouTube on her smartphone to get video responses mainly about intimate grooming techniques, and a set of problems related to gynaecology. Interested in plant medicine, she regularly follows a “youtubeuse” specialized in herbal care for women. Many under-educated people like this female informant with limited income, but also among people with higher levels of education follow the youtubeurs of Cameroon almost daily. Other informants in the same social category stress that seeing a specialised doctor can be difficult in Yaoundé because of the high rates that these specialists practice. About 10,000 XAF consultation is already 10% of the salary of a security guard as our informant.

These high prices are not those charged in public hospitals, where a specialist costs half the price in private. Another factor determining the choice of Youtubeurs health advice is to be found in the strong competition that plant medicine imposes on modern Western medicine in Yaoundé. This appeal of alternative, natural therapies can be found amongst all social strata.

Those who “Google read” health on the Internet

During interviews and observations in one Yaoundean clinic, it appeared that searches on Google densified as a large part of the population access the Internet via the smartphone (specifically, the android phone, which is most popular here). Healthcare professionals in this capital’s leading private clinics point to the fact that a growing number of patients in consultation rooms are talking about diagnostic elements previously sought on the Internet, or afterwards in order to be able to make analogies by comparison.

The issue of individuals making their own comparisons with official health advice is intriguing. In another clinic, a 40-year-old teacher explained his reliance on seeking health information on Google through the dual need to better understand the disease from which his son had suffered from for 6 months at the time of the interview, but also, to compare the information received during diagnosis with that available on the Internet. If the case of this Father is not isolated, it reveals the complexity of different persons and needs that are engaged in via the search for health information on Google.

So while some informants point out curiosity and the primary need for knowledge of the disease or to understand the symptoms, this informant took to researching online for secondary purposes, to in some sense validate the official medical diagnosis. Another 44-year-old informant, a married, bookstore employee and Mother of two who lives in mvog-Ada, stressed the fact that the availability of the internet is a key factor in explaining its popularity and usage. Suffering from a Glaucoma, she went to an Ophthalmologist in a public hospital. The latter professional indicated that surgery was inevitable. Frightened and seeking reassurance, she turned to Google from her office to access information about her own illness. For this informant and for the first mentioned above, the search for information becomes a way to access a second opinion on the diagnosis of the doctor, especially in the case of serious diseases.

Health blogs and their followers

At the beginning of August, I was walking in the streets of Mvog-ada, the low-income neighborhood, when I was accosted by a group of people ;  two young men, a man, and a young woman, all wearing a green T-shirt on which read the name of a company that distributes herbal medicines. The group explained to me how they had created an online site with an active blog through which to communicate and sell their products. Like this distribution company, many groups have online blogs that are subscribed to by many Cameroonians. As a rule, these Blogs are put online from Cameroon and in particular the two big cities that are Yaoundé and Douala. But some of the blogs are often domiciled in Europe, particularly in France.

Such blogs cover broad health issues ranging from exclusively female problems (such as intimate care practices, ovarian problems, and so forth) to major pandemics (Malaria, Typhoid Fever, Cholera). There is also a very large number of sites dedicated to plant medicine. These plant medicine sites, still called herbalists, are very successful in the online contexts.

In sum, health on the Internet seems to play a major role in Cameroon, affecting the way people access health information on the one hand, and the way in which this – and also non-Internet accessed medical information such as doctors’ diagnoses – is evaluated. These last observations highlight two types of concerns: on the one hand, the difference between specialized and non-specialized information (also professional and non-professional); on the other hand, the issue of inequalities, linked to the ability of informants to analyze ‘good’ and ‘bad’ news offers. This brings us back to the classic issue of the reproduction of (health) inequalities related to economic context and education levels, and how these factors influence the use or non-use of information and the evaluation of their quality and/of efficacies.

 

Living alone vs. loneliness: Notes from a Milanese neighbourhood

By Shireen Walton, on 1 September 2018

Photo (CC BY) Shireen Walton

One of the key features of living in Milan are the characteristic apartment buildings (pictured below). Built in the early 20th century, these buildings, known as ‘palazzo’ (palazzi pl.), have housed generations of families, groups and individuals over the decades; Italian and non-Italian, working and middle-class.

Typical apartment buildings in the Milan fieldsite. Photo (CC BY) Shireen Walton

Photo (CC BY) Shireen Walton.

Living here, in an inner-city, multi-ethnic neighbourhood in Milan, I am struck by how many people I have come to know who live by themselves. My findings reflect official figures on single-person households, which are increasing exponentially within Europe [1] (a majority being in northern European countries), as well as globally, as witnessed in countries such as Japan, China, and Brazil [2]. In 2016 in the EU, single-person households accounted for almost one third (32.5 %) of private households, with a higher proportion of women (18.4 %) living alone than men (14.1 %) [3]. In Italy, the national average for people living alone is 31%, while in Milan, 52% of households consist of one person [4]. Among a number of explanations for people living alone through choice and/or circumstance are; a number of socio-economic changes over the last 60 years, shifts in work and lifestyle patterns, higher separation and divorce rates, evolving gender roles, and a potent legacy of 1970s Italian Feminism in challenging normative expectations of nuclear family models.

In light of this increasing trend, ethnography can help question some common assumptions about people who live alone – namely, that such people are alone in their lives. In her monograph (2015) on the subject of Italian women above the age of 45 living alone in Milan, Sociologist Graziella Civenti, based on a sociological study of 250 women, found that through a variety of collective ties, practices, and networks, such women establish intricate care and exchange networks that carry out many of the social and economic functions traditionally carried out within and by the nuclear family structure. In so doing, they are able to establish a functional sharing economy that is mutually sustaining and nurturing based on the premise of solidarity, mutual assistance, and attending to common problems [5].

Civenti’s findings resonate with my own unfolding research here in Milan, on ageing and smartphones amongst Italians and migrants, where among my informants who live alone, there is a similarly strong emphasis on the role of networks, of various kinds, on- and offline, in offering care, comfort, and physical/virtual participation in various contexts. To take two brief examples to illustrate:

Claudia (Italian) is 54. She originally moved to Milan from a nearby northern Italian town to study, work and to ‘escape her family and close-knit life’. Claudia lives alone in a palazzo building in a central part of the neighbourhood. She is separated from her husband, and has no children. She works full time at an administrate job in the city. Her Mother (late 70s), who she duly visits every weekend, lives in another northern Italian city. Claudia’s next-door neighbour is a female widow, Clara (84) whose two children live in other cities across Italy, and who she sees infrequently due to their busy lives. What once started out as a co-sharing of responsibility of watering each other’s pot plants on the balcony of the floor in which they live, eventually blossomed into a friendship over the 15 years the women have lived side-by-side. Claudia describes Clara as her ‘go to person’ for many things:

“If one day I was to have a fall, or pass out on the floor, it would be Clara who would notice first. She would notice my absence; my leaving for work in the morning, my coming home at night… family/friends wouldn’t notice for days, even weeks. Clara would go around to check on me. I’ve given here a key of course. I also have hers.”

The relationship between the two women now constitutes a kind Mother-daughter one; one that has been gradually crafted through a mix of neighbourly goodwill, as well as a cross-generational female bond nurtured through mutual care giving and receiving.

For other women in the neighbourhood, such as those living alone away from their home country, the issue takes on different dimensions.

Zaina (35) is from Tanzania. She lives alone with her two-year old daughter in a small apartment obtained through the help of social services. Zaina left her country two years ago in the hope of what she envisaged to be better economic opportunities in Europe. Her husband (also Tanzanian) is currently working in another African country. She is in contact with him, and her Mother back home, via WhatsApp. As an outsider to many of the social and ethnic groups here in Milan (most of the Tanzanian people she knows in Italy are in Naples – she is connected with them via a WhatsApp group), Zaina explained how she can feels lonely sometimes. With a young daughter that she has been told is too young to attend some of the local nurseries, searching for a job proves challenging. However, due to various on– and offline practices, Zaina described how she is ‘never really alone’. Her smartphone, providing she has credit on it, keeps her company. It connects her to family back in Tanzania, and to siblings living in other European countries. From time-to-time, Zaina attends community events at the public school in the park near to her apartment, where she can be around other Mothers, celebrate festivals such as Eid, and connect with the wider community, including attending Italian language classes. Unlike Claudia, for Zaina, it is not the apartment building space that provides the community feeling she finds so comforting, but the exact opposite – it is through her reaching out beyond the confinement of the apartment – to wider spaces in the community, and online to social media – that she feels she and her daughter are present and to varying degrees, cared for, both in Milan and back home in Tanzania.

Photo (CC BY) Shireen Walton

There therefore seems to be a complex sociological relationship between living alone and loneliness that I am exploring through my ethnography. I am beginning to see how in various spaces (social, geographical and digital) of/for care, people who live by themselves co-construct wellbeing through everyday acts, through which they craft themselves into social worlds, on- and offline – from the next-door-neighbour chats, to family/culture-linked WhatsApp groups, and beyond. At a time in history when an increasing number of people are living alone, (digital) anthropological findings that emphasise everyday lives lived can help unpack societal prejudices and assumptions, such as the hyper-individualism of such people, or that living alone infers a person’s loneliness and/or alterity in society. Challenging these ideas may prove difficult in the societies themselves, but nuancing the issue further by taking into account a range of individual lives and practices, can have a number of implications for social policymakers, particularly when it comes to ageing populations such as Italy, with 28% of the population over 60, and 31% living da sola/o.

References:

[1] Eurostat, 2017: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/DDN-20180706-1?inheritRedirect=true

[2] Civenti, G. (2015). Una Casa Tutta Per Sé. Indagine Sulle Donne Che Vivono Da Sole. FrancoAngeli, Edizioni.

[3] Eurostat, 2016 report: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=People_in_the_EU_-_statistics_on_household_and_family_structures#Single-person_households

[4] Civenti, G. (2015). (Ibid.)

[5] Civenti, G. (2015). (Ibid).

[6] United Nations 2015 World Population Ageing Report

The place of WhatsApp in the ecology of care – by Marilia Duque

By Laura Haapio-Kirk, on 26 August 2018

Author: Marilia Duque

Dr. Gusso uses WhatsApp Business at Amparo Health Clinic (Photo: Marilia Duque)

In 2015 a PwC research report suggested that the Brazilian m-health market would reach $ 46.6 million while a GSMA report forecasted that 45.7 million Brazilians would benefit from mobile health projects (see here). In 2017 the scenario was even more optimistic. According to Statista, Brazil was expected to become the largest m-health market in Latin America with revenues of around $ 0.7 billion. These numbers explain the impressive amount of m-Heath startups and startup Incubators I’ve seen in Sao Paulo (see Eretz.bio, for example). But they don’t explain why after 7 months of fieldwork I still couldn’t find the people who are actually using these m-health apps. Instead, I found an intensive use of WhatsApp among my informants, filling the gaps in communication and making a huge impact on the ecology of care which we address in this project.

For example, every day early in the morning, Ms. M (54) sends a good morning message through WhatsApp to four lady-friends older than her. “It is like volunteer work because I know they are lonely and that message will make them happy and socially connected”, she explained. Ms. D (66) also starts her day sending a WhatsApp message. But in her case, the message is sent to her only daughter who lives in France, as a sign that she spent the night well. She is supposed to send this message every day before 10am otherwise her daughter will call a friend to check on her. “Some people say my daughter abandoned me, but the truth is that she is closer than many of my friends’ children who just live nearby”.

That is the same in the case of Dr. J., a physician who works in Sao Paulo and uses WhatsApp to take care of his 93 year-old father. After having a stroke, his father moved to Dr. J. brother’s house located two hours away.  Dr. J. created a WhatsApp group to talk to his brother and to his father’s caregiver. He gives her all the instructions she needs, and she updates him with information such as what his father ate, how he slept, how much water he drank, how much he exercised and how he was feeling. After a few months, he could tell how improved his father was and he explained how WhatsApp helped him and his family to feel safe and engaged.

Dr. K. also uses WhatsApp to provide care at distance. He works in my field site as a generalist providing ambulatory care to old people. WhatsApp allows him to give orientation about what to do when patients don’t feel well, and he can also ask them to go to his office if necessary. In many cases, he said, he can solve problems providing only care at distance. Dr. K. believes that the simple fact that the patients know they can use WhatsApp to contact him makes them feel safe and comfortable.

WhatsApp is also helping clinics to manage people’s health. Amparo Health, for example, is a clinic that uses WhatsApp Business to connect patients to doctors. The patient pays a monthly fee to have access to low-cost exams and to specialists like ophthalmologists, gynecologists, dermatologists, nutritionists and psychologists. What is new here is that all procedures and exams are coordinated by a generalist, who is available on WhatsApp. Dr. Gusso, the head physician at Amparo Health, explains that because the clinic business model is based on membership, they have no interest in demanding unnecessary exams or appointments. Doctors are paid by the hour and not by performance and that includes time to answer WhatsApp messages during the morning and afternoon. At the end of the day, he said, they are using WhatsApp to provide care at a distance, helping people to stay healthy, to feel safe and to save money. Prevent Senior, a health insurance company, also uses WhatsApp to make patients’ lives easier. In cases where treatments require on-going medication, patients can use WhatsApp to ask for new prescriptions. They can receive their prescriptions at home or they can go to the doctor office to get them, but with no need to schedule an appointment.

WhatsApp is the primary method of communication for 96% of Brazilians with access to smartphones. And among my informants older than 60 years old, that is also the app they use the most. Now imagine what can be achieved if WhatsApp features are explored to make the communication between health insurance companies, doctors, patients, caregivers, family and friends healthier too.