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What is a Smartphone App — by Daniel Miller

By , on 20 February 2019

A major aim of our project is to provide new insights and approaches to the question what is a smartphone, see my own contribution to The Conversation, the key to this is understand it as a collection of apps. The academic community has been relatively slow to address the nature of apps, despite their evident importance. A recent book called Appified (Morris and Murray 2018) tackles the question head on with thirty chapters each dedicated to a different App. I want to briefly review here what I found to be the most important contribution of this volume. Most of the chapters are directed to whatever the author thinks is the most interesting or intriguing quality of the topic which the App addresses, what it tells us about gender, or fitness or music making or sociality. They depend upon your interest in that topic.

There are, however, two very fine chapters that singularly, and more especially in combination, progress our understanding of the nature of the App. The first is called Is It Tuesday? (Morris 2018). This App is an intentional joke, as the only thing it does is answer the question of whether today is Tuesday and how often it has been asked that question. As such it reveals the way we use humour and irony to address our perception of this new App culture, best summarised by the phrase ‘There is an App for that’. This perspective highlights the single function App. If, to the hammer, everything looks like a nail, to the App developer, everything looks like a problem that can be solved by an App. The chapter employs terms such as microfunctionality and solutionism.

The other excellent contribution addresses what may be regarded, in some ways, as the most successful App ever invented, the Chinese WeChat (Brunton 2018), in that WeChat does more and is more completely integrated into the lives of its users than any App used outside of China. The chapter shows why the very fact that it started out as a messenger App based around texting, in particular, is one of the reasons that it was able to develop this extraordinary form of incremental functionality that lies behind this success. On the basis of its underlying infrastructure the platform could then be turned into anything from a way to pay for goods, to the means to obtain an appointment with your doctor, and a host of other functions.

The real contribution of this volume is that includes both these chapters, which are more or less the exact opposite of it each other. Most of my theoretical writings are inspired by the philosopher Hegel, whose concept of the dialectic became the foundation for my understanding of the term modernity. A key feature is the simultaneous and connected rise of ever greater particularity and ever more encompassing universality. In the introduction to the book Digital Anthropology that I wrote with Heather Horst we argued that the digital world is a major step forward in this trajectory, since it creates a vast set of new particularities on the basis of them all being reducible to code. In a rather different manner, something that we might call ‘scalable functionality’, is evident as the link between advanced in both particularity and universality as explored through the analysis of these two Apps.

The approach of our project is very different, based on the holism of ethnography. We tend to see Apps always in the context of all the other Apps it is associated with on a smartphone, and the smartphone in the context of everything else that its user is and does. But having a better sense of issues such as scalable functionality is certainly helpful in this task.

 

Reference

Brunton, F.  (2018) ‘WeChat; Messaging Apps and New Social Currency Transaction Tools’.  pp 179-187, in Morris , J and Murray S. Eds. 2018 Appified. Ann Arbor: University of Michigan Press.

Morris. J. (2018) ‘Is it Tuesday: Novelty Apps and Digital Solutionism’. pp 91-99. in Morris , J and Murray S. Eds. 2018 Appified. Ann Arbor: University of Michigan Press.

 

 

Drawing as ethnographic method

By Laura Haapio-Kirk, on 4 February 2019

Drawings made during a group interview about the smartphone.

The anthropological method of participant observation can only go so far when trying to understand the role of an object such as the smartphone in a person’s interior emotional life. The relationship a person has with their phone is deeply connected to the relationships that person has through their phone, to others and to themselves. Yet asking people about their relationship with their phone often yields limited responses: “It’s convenient for staying in touch”, “I rely on it for everything”. People take for granted that the smartphone is a helpful tool, but they typically have not considered their relationship to it specifically, and how it affects their relationships, behaviour, and identity, therefore I needed to find a way to have deeper discussions about the smartphone if I was to understand it in terms of affect. In order to explore the topic directly I thought that engaging informants in drawing might be a way to make the subject more tangible. I asked a group of middle-aged friends to make a two-minute sketch of their relationship with their smartphone, to bring to our next lunch date.

One of the members of the group has been undergoing chemotherapy for the past six months. While I was hoping that the drawing task would elicit reflection on the affective nature of the smartphone, I did not make that an explicit part of the instructions: I only asked if they could represent their relationship with their phone in a drawing. So I was delighted when this woman produced the most striking drawing out of the group, which shows her at the centre holding her smartphone surrounded by the range of ways she is emotionally affected by the smartphone in her daily life. She explained to me:

Especially while I have been sick, the smartphone has become very important to me. It is my connection to the outside world. The days following chemotherapy my body feels drained and I cannot leave the house. During that time if I receive a Line message or sticker from my friend I feel uplifted. But I can also feel sad and disappointed if I hear from my daughter that she is having relationship problems. When I am at the hospital having chemotherapy I watch films on Netflix and they often make me feel emotional. I also sometimes read surprising news stories. My smartphone makes me feel all of these things!

During this time of illness and potential loneliness, the smartphone offers an escape from her present situation to the world beyond.

“During treatment my smartphone connects me to the outside world”

It was striking that half of the drawings were based on a design of the individual at the centre, with feelings or behaviours or information radiating out. When we discussed this as a group, the majority of women said that they feel that the smartphone is the centre of their life (chuushin), some had even written the word on their drawings. They agreed that it is an object that is not only physically close to them but emotionally central too since it connects them with many of the important people and things in their lives. For many of the middle-aged people in my research, beyond this friendship group, shifting from garakei to smartphones meant an increase in dependency on the device for daily activities, from communicating with friends, to arranging nurse visits for their elderly parents, to booking shifts at work, to online banking. One woman told me:

I switched from my old garakei to my smartphone last year when my husband died and I needed to start being more independent. It has completely changed my life – I do everything with it. I recently went to Tokyo to visit my daughter and I would not have been able to do the trip without my smartphone and the maps app.

This increasing dependency on the smartphone was treated with ambivalence by some members of the friendship group in this case study. One woman explained that the smartphone is the centre of her life but she wishes that it was not, because it then becomes a kind of burden.

This idea of the smartphone as a burden was repeated when discussing another similarity between two of the drawings: both depicting the user sitting while looking at their smartphone. For these two women, rather than reply to messages in the middle of doing other activities such as while on the train or walking, they almost always wait to reply to messages when they have enough time to sit and focus only on the smartphone. They explained that they are not capable of multitasking, yet the burden of knowing that there are messages waiting to be replied to gives them the sense that the smartphone is taking too central a position in their lives. They often will not open messages unless they have the time to sit and reply, because they do not want the sender to see that they have read their message and subsequently feel ignored if they do not reply immediately. While the smartphone can increase a sense of burden for some relationships, for others it can ease the burden of care:

My father has a smartphone and he sends me messages all the time, so many of them! Because it is so easy to send messages he tells me what he is eating and what he is doing. Giving him a smartphone is a way that I can care for him when I am not physically there. Although I feel he sends too many messages, it is easy to reply to him with a sticker to show that I care. So while there is more frequent contact, it is less troublesome contact than a phone call which would be disruptive.”

This statement reveals the affective capacity of the smartphone to enable a new kind of care from a distance, which is perhaps even warmer than if it were face-to-face due to its less burdensome nature.

This visual methodological experiment provided a basis for a three-hour discussion of the smartphone. I plan to repeat this experiment with other informants as I think that the activity worked well for focusing a discussion. The participants were all interested to see how their drawings differed from everyone else’s, and they were far more interested in the topic of the smartphone than on previous occasions since they had already spent some time contemplating it beforehand. After the session a number of the women messaged me to say that they had come away from the experience with a deeper understanding and appreciation of the role of the smartphone in their lives. The active nature of drawing enabled people to discuss their affective experiences in a deeper way, and connected people to their feelings about the smartphone more successfully than discussion alone.

Thoughts inspired by exhibitions in Shanghai

By , on 1 February 2019

As one of China’s major cultural centers, Shanghai boasts a wealth of cultural events. Many locals, especially the younger generation, often go to theatres, galleries and museums. During my stay in Shanghai, beside curating the exhibition for my research participants, I also go to exhibitions on a regular basis in order to keep pace with the ever-changing cultural landscape of the metropolis. Different exhibitions attract different groups of people in Shanghai, therefore going to exhibitions also allows me to observe my fellow exhibition goers in an organic way. Every single exhibition which I went to was very interesting as I could always enjoy watching people even if the exhibition per se may by any chance fail me.

For example, the 2018 Shanghai book fair attracted a quite wide range of audience. Through the lens of my research concern upon the use of smartphones, it was also curious to see that in the sea of books some were quite happy to sit on the steps checking their smartphones and a grandfather using two smartphones to take photos of his grandchildren.

2018 Shanghai book fair

Checking smartphones in the sea of books

Taking photos with two smartphones

On the West bund art expo, I met probably the most international dwellers in shanghai who also attribute to the unique temperament of Shanghai.

West bund art Expo

Whilst an amateur painting exhibition at a community library attracted many retired people from the neighborhood. I happen to spot a lady in her 60s showing the exhibition via the WeChat video call to her family with the help of her friend.

Recently, to my surprise, I happened to walk into a pop-up exhibition about the social changes in the past 40 years (1978-2018) of ‘Chinese economic reform and opening up’ (gai ke kai fang) in the middle of an underground station. With a variety of daily life materials as well as typical scenarios of social interactions, this exhibition vividly represents what has happened in ordinary people’s daily lives and what people are longing for. (Check the short video of this exhibition)

A pop-up exhibition about the social changes in China in the past 40 years

A pop-up exhibition in the middle of an underground station in Shanghai tells you about the social changes in the past 40 years of ‘Chinese economic reform and opening up’, where the techonology plays a significant role. Filmed by researcher Xinyuan Wang

Posted by Anthropology of Smartphones and Smart Ageing on Friday, 1 February 2019

In the first section, an old-school bike represents the most advanced household transportation in the first decade of the reform era. Two semi-transparent figures, being father and son, imply a scenery associated with the old bike – the father is giving a lesson of how to ride a bike, the boy is wobbling about on the bike, asking: “Daddy, can you buy me a bike once I can ride it? Oh no please don’t let me go, I will lose the balance anytime!”

Beside the parent-child interaction, there were household items including an old sewing machine, a radio, a fridge and a TV set. The caption of this section read “My understanding of happiness started from the moment of our whole family watching TV together”. For long, the TV set has had great significance in Chinese households and the place where the TV set is located is where the family spends quality time together.

As shown in the neighboring showcase, more technology entered into people’s daily life, among them the landline telephone was the most important one. To have a household landline installed was regarded as a great honor in the late 1980s as only the public institutes had such privilege before. The caption of this section reads “For years the landline telephone had been my pride, and since then I always used the landline number as my password for my bank cards.”

Many of my research participants share the similar memories displayed at the exhibition that one has to queue at public telephone booths or visit friends who were privileged to have household landlines to make a phone call. In front of the showcase, a little boy asked his grandpa what is the landline telephone, the grandpa answered, “it is called landline telephone (zuo ji), kind of mobile phone before you were born!” Here the future is used to define the past.

Little Boy: what’s that? Grandfather: It is called landline, kind of mobile phone before you were born

The next highlighted landmark of daily technology is OICQ in 1990s along with PC. OICQ soon changed its name to QQ, and even nowadays QQ is still one of the most widely used social media platforms in China. The conversation between a school boy and a girl in the showcase is – boy: “I have got 50 friends on OICQ, and one of them even come from HuHeHaoTe (a city in northern China” Girl:” Please help me to register a QQ account!”

For years, QQ has occupied the PC screen of millions of Chinese people. The use of QQ also gradually spread from Chinese cities to rural China. Six years ago, when I conducted my PhD field work in a small factory town in southeast China, QQ was still the most widely used social media among rural migrant workers.

In terms of the digital device, as one of my research participants put it “In the past decade, the screen has become smaller, while the function has become stronger”. After a series of mobile phone ‘evolutions’, by the beginning the fourth decade of the reform era, China has entered the age of the smartphone. With proliferation of the use of smartphones, more and more older people in China have adopted a new way of interpersonal communication with their family members.

As shown in the last section of the exhibition, in a well-equipped modern kitchen, a young person is cooking while having a video call with his parents, saying: “Mum, look, I can take care of myself. Those are what I just got from the food market. Daddy has high blood pressure, don’t let him drink too much! ” His mum said: “What worry us most is that you don’t eat properly when you live outside alone, having take-away for every meal.”

A passer-by in his 30s commented: “it is so true, my mum would nag so at least ten times a day!” and his friend remarked: “in my case, it’s my mum who will hold her smartphone while she was cooking, showing me all the nice food at home via video call.”

From the old-school bike to landline telephone, from the offline family time in front of the TV set to the online family time facilitated by the digital technology, a small pop-up exhibition captures those subtle but significant material and moments of the daily lives of ordinary Chinese in the past forty years.

On top of it, located in the middle of one of the busiest underground junctions in Shanghai, this exhibition manages to reach the widest audience as possible – I have never seen so many older people and young kids in other exhibitions. Furthermore, I was most impressed by the way this exhibition gets all kinds of people involved, and such willingness and skill to disseminate knowledge is also something our project can learn from.

Female mutual support in Kyoto and Kampala — by Charlotte Hawkins & Laura Haapio-Kirk

By Laura Haapio-Kirk, on 24 January 2019

Two of the ASSA fieldsites, Uganda representing the youngest population in the world, and Japan the oldest, have a surprising amount in common when it comes to the experiences of ageing, especially regarding the importance of female mutual support in mid-life and beyond. In this blog post we present how peer-support manifests in both fieldsites and look at how friendship is mediated both face-to-face and via the phone.

In the Uganda fieldsite, researcher Charlotte Hawkins attends the weekly meetings for an NGO for single mothers, many of whom are HIV positive. Here, they receive practical support for school fees, medicines, primary education and exercise training, but many also profess to attend due to the mutual support and belonging offered by the group.  This is an excerpt from an interview with the group Director and the Nurse:

Director: They feel they’re sisters

Nurse: Being together

M: Unity is good

Director: You have it, get friends, go back free

M: You can’t just finish your problems yourself

Director: Talking about problems, you learn that mine is the same…You can be happy when you’re sick, even when you know you’re going to die

These gatherings are always loud with laughter, music and dancing, showing how such sisterhood and ‘unity’ brings these women happiness, despite any problems they may face.

Maggie, a 67 year old Go-down resident, also feels happy when she discusses her problems with her friend Alice on the phone:

So when I’m tired of sleep, I wake up and pray Lord I call her, because it is 95%, I call her, I say eh Alice how are you… I told myself thank you God it’s great to hear from you, how are you? I become so happy, I say now I’m now sick, and Alice says Maggie, if you are to die who am I to talk to, we are only 2? [laughing]

The need to share problems in order to overcome them was also recognised by a woman in the rural Northern Ugandan field-site, who claimed to be over 100 years old. She said that stress comes from thinking too much about what you lack or have lost, which “can kill you, not only make you go mad”. The way she counters her own stress is by avoiding isolation. If she passes her life-long friends’ home (see photograph below) and she finds her door closed, she will always knock and find out why she’s indoors. She advises her to not be isolated, “don’t stay alone in the house”, and they share their problems.

In the Japanese case, middle-aged women have also expressed the importance of maintaining a circle of close female friends in order to receive emotional support. Our researcher in Japan, Laura Haapio-Kirk, has found that typically all-female friendship groups are often developed in mother’s groups, work places, or hobby groups, and can continue for decades even after the original shared activity has long ceased. Participating in girl’s night (joshikai) dinners and lunches, Laura has found that such meet-ups are commonplace particularly among middle-aged women. But between meet-ups these women typically stay in touch via the messaging app Line, and for many this can be a much-valued source of support.

At one lunch-time meet-up with such a group of friends in Kyoto, Keiko, aged 62, who works at a catering company and cares for her elderly mother explained:

 It’s really hard and sad to see your own mother and father deteriorate, especially if they get dementia. It’s like a tunnel without an ending. If you speak with your family about important matters, it gets more and more serious, darker. But if I have a particularly hard day with my mother…being able to reach out to someone right at that second when you need them is the best thing about smartphones, and receiving stickers that tell me ‘it’s okay!!’ is great.

 

Line stickers with messages such as “Goodnight”

In contrast with Kampala, in central Kyoto it is typical for neighbours to know each other by sight, but not to spend any real time with each other. Women in particular have emphasised the importance of staying connected through their smartphone to a support network of friends. However, the smartphone is typically seen as a tool for keeping offline friendships going, and for organising offline meetups, rather than having friendships which are purely online: “My smartphone itself is not a cure for loneliness, it is seeing people every day that makes me feel better.” However, as one ages and mobility becomes harder, or when illness strikes, the smartphone can provide a crucial connection to the world, as Megumi (58) who had been undergoing chemotherapy for six months explained:

Especially while I have been sick, the smartphone has become very important to me. It is my connection to the outside world. The days following chemotherapy my body feels drained and I cannot leave the house. During that time if I receive a Line message or sticker from my friend I feel uplifted.

 

A drawing by Megumi: “The smartphone connects me to the outside world”.

 

Whether two women are sat in a home in Kampala, or in a Kyoto café, the stories being shared are remarkably similar: about husbands who are inept at providing emotional or financial support, or about the latest development in one’s health prognosis. In sharing their problems with their friends, these Japanese and Ugandan women are ‘up-lifted’. In both Kyoto and Kampala, the laughter, emotional expression and mutual support that comes from face-to-face meet-ups is also possible to recreate over the phone, through morning phone calls or the use of stickers on Line messages; bridging physical distances and mediating offline and online friendship.

 

The Words of “oldness” in Yaoundé — by Patrick Awondo

By , on 18 January 2019

Hat weaving, common creative by Max Pixel

In a book published in 2004 the French linguist Alain Montandon[1] brought together studies that show how old age is expressed in different languages, not only Indo-European languages, but also in other parts of the world and especially in Africa. Montandon argues that these amount to two universal traits.

Firstly, in almost all languages, there are various categories  of old age, especially a division between terms implying  physical old age as against normative categories of old age. For example, old age may be considered a “a gift of God, a spiritual achievement”. At the same time, old age is linguistically expressed in terms of declining physical abilities, such as impotence. The decline of the body may become linguistically associated with  personality disorders that contrast other images of an old person who is “happy, harmonious, full of wisdom and serenity “.

Perception of old age may reference elements of physical modification, such as the appearance of white hair. Montandon also notes the sociocultural variability of age categorizations. Almost always signs of are or relative maturity are different when applied to the poor as opposed to the rich.  Our comparative project accentuates these economic differences because of its focus upon retirement, which presupposes a formal structure of employment, that cannot be assumed for some of our fieldsites, and this shows the importance of such comarative studies. With these thoughts in mind, what do the linguistic expressions of the perception of old age tell us about  Yaoundé and Cameroon?

Expressing old age in Yaoundé

Originally inhabited by the Ewondo, Yaoundé is today home to nearly 3 million people from across Cameroon. French is the most commonly spoken official language across the country, employed by 80% of the population followed by English.[ref UNESCO]. So linguistic terms testify to a creativity that speaks to the dynamics of contemporary French aligned with borrowings from many national and local languages which remain strong alongisde the two official languages. For example, Ewondo, the Bantu langauge of Yaounde.

However, I would prefer to start with the Ewondo language, which belongs to the Bantu group.  In Ewondo the expression “Nya modo”, ‘this cultural area and modo ‘man’. ‘Nya modo’ is a name and a notion that refers to a person perceived as old, as well as a concept symbolically meaning the attributes of nobility of spirit, of wisdom. Even today, the expression ‘Nya modo’ refers to people who are seen as being middle aged, the most prestigious age group, superseding even the elderly. The term is made up of nya’ meaning ‘mother’ and modo which means man in the sense of the human species. The female equivalent of ‘nya modo’ is ‘nya minega’, which carries less status.

Aging: age, social status and moral discourse

In everyday French, older age is often expressed through a term analogous with the English expression ‘of a certain age’  which for people in Yaounde seems to translate as ‘as an intermediate age’, neither too old nor too young, implying people over 50 years old. The informants of Yaounde often say “he / she has an old age” while the expression “advanced age” could mean an “older person”. The top end of this category according to most informants would be around 70 years old. When a Yaoundéan feels that a person “of a certain age” says things which are deemed unworthy, he will be called “an old man like that” or an “old woman like that”, making clear the moral expectations that are associated with the process of ageing  This puts forward a moral expectation related to ‘getting old’.  In this manner we can see the linguistic variety within yaoundé that help to both forge categories for labelling the stages of ageing, but also represent these as having moral and cultural expectations against which the actual people are judged. . These games of linguistic meaning are important especially because the people who are thereby designated with both labels and normative expectations have then to confront the manner in which they have been defined.

[1] For more please see Alain Montandon (études rassemblées par), Les Mots du Vieillir, Clermont-Ferrand, Presses Universitaires Blaise Pascal, 2004.

Ageing Actively in Focus – By Shireen Walton

By Shireen Walton, on 8 January 2019

Books about ageing are currently in the spotlight. As discussed by Daniel Miller in an earlier blog post from February 2018, philosopher Kieran Setiya has looked at mid-life, from theoretical and practical perspectives. Another more recent work comes from journalist and author Carl Honoré, who in (B)older: Making the Most of our Longer Lives (2018) suggests a rethinking of ageing as a positive feature of the human experience, to be increasingly acknowledged and enjoyed more than ever before in history – a bonus not a burden.

Image (CC BY) Shireen Walton

What these books have in common is a call to shift our thinking about ageing from a negative; to consider the positive aspects of later life, and to rebrand ageing along ‘active’ lines, recalling the European Union’s emphasis on ‘active ageing’. In Italy, a country with the second (after Japan) oldest population in the world, active ageing receives much public policy and media attention. One avenue through which I came in to contact with these initiatives is through Auser, a nation-wide NGO in Italy founded in 1989. The organisation has branches all over the country, and the Lombardy region headquarters is in Milan – located in zone 2 where I am based for my research. Auser’s mission statement is ‘promoting the active ageing of the elderly and enhancing their role in society’ from  an inclsive perspective: ‘addressed primarily to the elderly, but open to relations of dialogue between generations, nationalities, different cultures.’

Auser website (English version)

Attending one of their meetings in Milan in December, I learnt about some of the main ways that ageing is being envisioned; towards skills-acquiring and sharing; a push towards enjoying life through ‘Active Welfare’, a concept the organisation defines as follows:

“Perhaps we will all have to work on building a model of “active welfare” based on financial resources adapted to social needs, built on an integrated system of subjects and public and private interventions, where through informal networks, the State, the Third Sector and individual citizens all work to build the social welfare of people, thus strengthening the concept of community and of social cohesion.”  [Auser mission statement, website]

Auser December meeting, Milan December 2018. Image (CC BY) Shireen Walton

I do not want to detract from these optimistic and significant attempts to combat ageism, but as ethnographer, I have to also investigate, specifically, what possibilities are/could be available to who – locally, regionally, nationally? From the middle-aged Italians in this fieldsite, I hear a great deal about the devastating economic situation in Italy since the 2008 economic crash, which makes the idea of retiring for many seem nigh on impossible, particularly if sufficient structures of in-family care are not in place due to transnational family lives and financial pressures. Active ageing is is also difficult to envisage amongst some of the individuals, families and groups I am working with from countries such as Egypt, Afghanistan and Peru, many of who currently imagine their futures as continuous work(ing). Noor, 45, a schoolteacher from Alexandria, explains how she “hopes my children will take care of me, as I take care of them…if we are together, Inshallah, we will all be fine.” How, I wonder, will her 15-year old daughter take care of her Mother in years to come? What might potential future Grandparenting be like for Noor, as an Egyptian single Mother living in Milan in her 60s?

Image (CC BY) Shireen Walton

Ali, Hazara (44), from west Kabul works a number of jobs, including as a night-time lorry driver. His wife and children are currently in another northern European country with his wife’s family. Ali explained the following: “Of course for the future having money is fundamental, but it is also important if you are a helpful person, and do good things for people; for your family, for your people (Hazara), and for humanity.”

Image (CC BY) Shireen Walton

Noor’s investment in Italy seems to be long-term; her ever-strengthening language proficiency, her children growing up in Italy, attending school and speaking fluent Italian, the death of her parents in recent years back in Alexandria and her own severance from the rest of the family in Egypt means that she feels she is here to stay, intent on growing old near her children. For Ali, currently working in Italy and visiting his family when he can, the geographies of his and his family’s future remains unknown.

My ongoing task then is to consider how people are ageing in – and away from – their homelands, aided by smartphone connections, but in many cases lacking public voice, and/or not involved in many of the dominant culture’s organisations and groups dedicated to ageing, health, and wellbeing. I am continuing to explore about these issues in line with broader conversations about contemporary citizenship, the role of technology, the state and NGO’s, migration trajectories & biographies, and the ongoing categorisation of peoples into strategic kinds of subjects (Giordano 2014). The approach reflects my commitment to studying ageing across cultural lines here in Milan.

References

Giordano, C. (2014). Migrants in Translation: Caring and the Logics of Difference in Contemporary Italy. University of California Press.

Riámonos juntos- por Marilia Duque

By Alfonso Otaegui, on 4 January 2019

Autora: Marilia Duque

Marilia (izq) con su amiga

Ya ha pasado un año de trabajo de campo y debo confesar que estoy aquí, riéndome sola al recordar todos los buenos momentos que pasé con mis informantes. Podría haber sostenido, al principio, que la mayoría de ellos estaban luchando contra los estigmas de la edad. Por un lado, eso quería decir que estaban haciendo lo mejor posible para ocultar sus limitaciones físicas con el fin de mantener su autonomía e independencia. Por el otro lado, eso también quería decir que estaba tratando de adaptarse al modelo del ‘envejecimiento exitoso’ (‘sucessful ageing’ en inglés), una imagen de adultos mayores respetuosos que gozan de buena salud, son productivos y tienen una intensa vida social. En verdad, están siempre alerta y luchando por su espacio, y esa resistencia puede dar lugar a una especie de auto-vigilancia, con cero tolerancia para con aquellos que intenten burlarse de los adultos mayores.

Ahora bien, basta esperar a que te acepten en el grupo, que se sientan cómodos con tu presencia y te sorprenderán. ¡Se ríen de la gente mayor todo el tiempo! Reconocen sus debilidades y se ríen de ellas. Es así que estaba en un evento con gente mayor la semana pasada, en el cual una señora mayor se llevaba todas las miradas, bailando con sus muy largos cabellos, cuando otra señora también mayor –y celosa– me suspiró al oído “le va a fallar el pañal para adultos mayores”. Después de un rato, cuando sirvieron el almuerzo y se formó una larga cola de gente mayor, uno de ellos dijo riendo “¿Cuál es la fila para ancianos? ¡Tengo prioridad!”. También hacen bromas sobre cuestiones como impotencia, pérdida de la memoria, sordera, insomnio y las dificultades que tienen con la tecnología. Se refieren con humor al tiempo que pasan en los hospitales, a todo lo que tienen que pagar con su seguro de salud, a cómo los jóvenes piensan que ellos son estúpidos, y a cuán cansados en verdad se sienten después de tener que haber fingido que no eran “tan viejos”.

Este año compartimos momentos increíbles en los que ellos no eran ‘adultos mayores’. Eran simplemente seres humanos enfrentándose a algunas dificultades en la vida y envejeciendo un poco cada día, tal como yo o cualquier otra persona.

Let’s laugh together – by Marilia Duque

By , on 26 December 2018

Author: Marilia Duque

Marilia (left) with her friend

One year of fieldwork and I must say, I am here laughing alone whilst I remember all the good times I had with my informants. At first I could have argued that most of them were fighting against the stigmas of ageing. On one hand, it means that they were trying their best to hide their physical limitations in order to keep their independence and their autonomy. On the other hand, it also means they were trying to adapt to the model of successful ageing, the image of respectful old people who are healthy, productive and socially engaged. Yes, they are always alert and fighting for their space and that resistance can result in a kind of self-surveillance, with a zero-tolerance with those who try to make fun of old people.
But wait until you are accepted by the group, wait until they feel comfortable with your presence and you will be surprised. They laugh at old people all the time. They recognize their frailties and they make fun of them. I was at an event with old people last week, and an old lady was stealing the scene, dancing with her very long hair, when one jealous old woman whispered to me “her geriatric diaper will fall”. After a while, when the lunch was served and a long queue of old people had formed, one of them said laughing, “where is the senior row? I have priority”. They also make jokes of issues like impotence, lack of memory, deafness, insomnia and their difficulties with technology. They address with humour the amount of time they spend in hospitals, all they have to do to pay their health insurance, how young people think they are stupid and how they feel tired after they have to pretend they were not “that old”.
We shared incredible moments together when they were not old people anymore. They were just human beings facing some difficulties in life and getting old day after day, just like me and anyone else.

Neurochemical selves or social prescription? by Pauline Garvey

By , on 15 December 2018

Social Prescribing Brochure available at https://www.hse.ie/eng/health/hl/selfmanagement/donegal/programmes-services/social-prescribing/social-prescribing-brochure.pdf

In an academic article in the early 2000s sociologist Nikolas Rose asks ‘How did we become neurochemical selves? How did we come to think about our sadness as a condition called “depression” caused by a chemical imbalance in the brain and amenable to treatment by drugs that would “rebalance” these chemicals?’[i]. During the decade from 1990-2000 Rose charts high rates of prescribing psychiatric drugs in Europe, Japan and the United States. In Europe growth in the value of prescription drugs rose by over 125% while growth in sales of similar drugs in the United States rose by over 600%. He notes that a decline in prescriptions for hypnotics and anxiolytics was matched by a rise in prescriptions for anti-depressants of about 200% (2003: 46).

There is, however, another trend that is gathering momentum on the international stage and which couldn’t be more different than the trends that Rose documents.  Social prescription takes an altogether different approach to health and embeds it in social networks and cultural activities. It is defined by the NHS as ‘helping patients to improve their health, wellbeing and social welfare by connecting them to community services which might be run by the council or a local charity[ii]. In Ireland the Health Service Executive webpage speaks directly to the reader and defines it as a free service that ‘helps to link you with sources of support and social activities within your community. These include Physical activity, Reading groups/books for health, Self-help programmes such as the Stress Control Programme, Men’s Sheds, Community gardening, Arts and creativity’. Social Prescribing is for you if you feel that you need some support to mind your health and wellbeing, you feel isolated, stressed, anxious or depressed, you simply feel you need the service[iii]

In a comparable project called Local Asset Mapping Project (LAMP) run through St James’s Hospital in Dublin their webpage again addresses the reader directly and conjures the scenario: ‘Imagine visiting your doctor and as well as getting a prescription for a pill, you get an electronic  prescription designed especially for you, with a list of all the local businesses and services around you that might improve your health – that is the vision of LAMP’[iv]. The LAMP project points out that wellbeing is determined by ‘good health behaviours’ such as exercise, nutrition, minimal alcohol consumption and good social networks, but notes that traditional medical consultation does not address this adequately’.   As if to echo these arguments, just two weeks ago the Irish Longitudinal Study on Ageing at Trinity College Dublin (TILDA) presented their most recent findings regarding ‘Change in life circumstances’ for Ireland’s over 50s between 2009 and 2016. They found that quality of life peaks at 68, and therefore shouldn’t be thought of in a linear way (ie as a steady decline) but also that fundamental to quality of life is social connnectedness. Quality of life improves with age for the majority of their sample, but only if social engagement is strong. [v]

As an anthropologist the holistic approach to health and wellbeing makes perfect sense. My respondents do not organise their lives ‘in silos’ (see LAMP), and how one feels ripples into all aspects of life, in the same way that everyday experiences are integral to how people think about their wellbeing, happiness – and age. Some respondents occasionally talk in neurochemical terms -particularly when wondering how to get a good night’s sleep, but the majority of their time and energy is devoted to their busy lives.  One of my informants aged in her early 80s resisted joining Active Ageing groups because she did not consider herself elderly. Another woman said ‘I’m 78 but I feel 60, I feel younger, not older’. In the course of my research I have met some retired men and women who are lonely, isolated or bored but many others take to retirement with vigour and enthusiasm. What interests me is whether these activities such as knitting, writing or meeting friends for coffee are reflected upon as ‘good health behaviours’. What are the social trends that social prescription is tapping into, or indeed leading?  Meanwhile as I conduct me research the benefits of social embeddedness seem clear. As one man told me since retiring from work he has never been so busy.

[i] Rose, N. (2003) ‘Neurochemical Selves’ Society 41 (1): 46–59.

[ii] https://www.england.nhs.uk/contact-us/privacy-notice/how-we-use-your-information/public-and-partners/social-prescribing/

[iii] https://www.hse.ie/eng/health/hl/selfmanagement/donegal/programmes-services/social-prescribing/

[iv] http://www.ehealthireland.ie/Case%20Studies/Local-Asset-Mapping-Project-at-St-James-Hospital/

[v] https://tilda.tcd.ie/news-events/2018/1812-w4-key-findings/

Enfermeras de enlace y WhatsApp: un ejemplo de ‘inteligencia desde abajo’

By Alfonso Otaegui, on 11 December 2018

Foto de Alfonso Otaegui

Dentro del marco el proyecto Antropología de los Smartphones y del Envejecimiento Inteligente (ASSA), nos hemos comprometido a trabajar colaborativamente con una iniciativa local de salud móvil, o cualquier iniciativa que mejore el acceso a los servicios de salud y el bienestar de las poblaciones con las que hacemos trabajo de campo.

Al principio, aún antes de comenzar mi trabajo de campo, yo imaginaba que esta iniciativa consistiría en la creación e implementación de una aplicación específica de salud móvil, la que respondería a una necesidad observada en el campo. Este abordaje implicaba detectar un vacío en el campo –una necesidad aún no abordada pero advertida por el etnógrafo– y crear una aplicación que llenaría ese vacío. Era en verdad una idea de implementación desde arriba hacia abajo: sería yo quien le daría a la gente algo que necesitaba, pero cuya necesidad ellos mismos desconocían.

Luego de un par de meses, advertí que sería más sensato simplemente describir una aplicación ya en uso –y usada creativamente por la población– y llevar ese uso particular, esa idea local, a otro lugar donde tal idea pudiera ser útil. Este abordaje, que podría definirse como ‘desde abajo hacia arriba’, implica –al contrario del abordaje anterior–  el reconocimiento de la creatividad de las poblaciones locales en la adopción de tecnologías de comunicación, lo que Pype (2017) llama ‘inteligencia desde abajo’. Con el mismo objetivo de llevar buenas ideas de un lugar a otro, también hemos comenzado en el equipo a armar una lista de ‘buenas prácticas’ en atención médica a lo largo y ancho de todos nuestros sitios de campo.

Con este objetivo en mente, pasaré los últimos seis meses de mi trabajo de campo en Santiago llevando adelante una etnografía en un centro oncológico en un hospital público. Este hospital en particular es el único hospital público en Santiago que ha implementado el modelo de cuidado de ‘enfermeras de enlace’ o ‘nurse navigator’ (Devine 2017).

Las enfermeras de enlace trabajan como mediadoras entre los pacientes oncológicos y el sistema médico y burocrático de un hospital público en una zona de bajos recursos. Los tratamientos oncológicos implican dos complejidades para el paciente: la complejidad médica del tratamiento en sí, y la burocracia del sistema de salud pública. Los diversos tratamientos oncológicos pueden tener variados efectos sobre distintos sistemas del cuerpo, por lo que seguir el tratamiento implica manejar mucha información. La gestión del tratamiento implica una serie de procedimientos (diagnósticos de imagen, sesiones de quimioterapia, exámenes de sangre, etc.) que requieren recetas y turnos, que tienen que llevarse a cabo en un orden específico, y dentro de cierto tiempo (si no, las probabilidades de mejora decaen). Las enfermeras de enlace gestionan el tratamiento para el paciente, ya que tienen conocimientos para enfrentar ambos tipos de complejidades.

Según el oncólogo Bruno Nervi, presidente de la fundación Chile sin Cáncer, hay cerca de 100 oncólogos en Chile, cuando se necesitan 400 (55.000 personas son diagnosticadas con cáncer cada año) (‘La Fundación Chile sin cáncer (…)’ 2018). Dado el gran número de pacientes, los oncólogos no tienen el tiempo de explicar todos los detalles del tratamiento. Las enfermeras que trabajan en la sala de quimioterapia enfrentan el mismo problema, ya que tratan de atender tantos pacientes como sea posible. Las enfermeras de enlace, entonces, llenan este vacío al educar a los pacientes sobre los detalles de la enfermedad y su tratamiento y al mediar ente los pacientes y el complejo sistema burocrático de la salud pública de Chile. Ellas hacen todas las citas para exámenes, análisis de sangre y demás –lo que requiere mucho papeleo– y se mantienen en contacto con el paciente en caso de que éste tenga alguna duda o inquietud. Estas enfermeras dedicadas constituyen un factor humano en los servicios de salud que ninguna aplicación puede reemplazar. Las enfermeras de enlace, sin embargo, sí usan una aplicación, la aplicación de mensajería más usada por los pacientes: WhatsApp. Según las enfermeras de enlace, WhatsApp les da la capacidad de usar los varios modos de comunicación según las particularidades y necesidades de cada paciente: algunos prefieren una llamada por teléfono, otros se sienten tranquilos al ver una foto de la receta o turno de examen, algunos necesitan un mensaje de audio que puedan escuchar varias veces hasta entender (muchos pacientes son de bajos recursos con escaso nivel educativo). Además, las enfermeras de enlace están disponibles para los pacientes por cualquier duda o pregunta que puedan tener. Estas enfermeras están ahí para ellos, para responder sus inquietudes y confortarlos, ya que el tratamiento y esta relación de cuidado a distancia puede llegar a durar años.

Daniel Miller, investigador coordinador del proyecto ASSA, escribió en su último libro ‘The Comfort of People’ sobre el uso de nuevos medios de comunicación con pacientes terminales con cuidados paliativos. En ese libro Miller recomienda crear un protocolo de uso de nuevos medios entre paciente y personal de salud (2017: 218). El uso de WhatsApp por parte de las enfermeras de enlace de hecho sigue un protocolo que se fue desarrollando en los últimos años a partir de la experiencia. Yo intentaré describir este protocolo y este uso de WhatsApp y construir un modelo que pueda ser replicado. Realmente tengo la esperanza de poder llevar esta buena idea que se desarrolló localmente a otros hospitales públicos de Chile.

 

 Referencias

Devine, A. (2017, 3 de abril). The Nurse Navigator: A Patient’s Compass On The Healthcare Journey. Extraído de https://nurse.org/articles/nurse-navigator-career-path-salary-job-description/

La Fundación Chile sin cáncer y su contribución para cambiar la historia del cáncer en Chile. (2018, 15 de octubre). Extraído de https://www.uc.cl/es/la-universidad/noticias/31765-la-fundacion-chilesincancer-y-su-contribucion-para-cambiar-la-historia-del-cancer-en-chile

Miller, D. (2017). The Comfort of People. Cambridge: Polity Press.

Pype, K. (2017). Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa. En C. C. Mavhunga (Ed.), What Do Science, Technology, and Innovation Mean from Africa? (pp. 97–115). Cambridge, Massachussetts: The MIT Press.

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