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An Anthropological Approach to mHealth: Health & Care in the Smartphone Age

alex.clegg3 March 2022

Open access image by Mohamed Hassan

Author: Charlotte Hawkins

As part of the ASSA project, we are currently working to publish a volume called: ‘An Anthropological Approach to mHealth: Health & Care in the Smartphone Age’. This volume consolidates insights from the team’s various anthropological initiatives in mobile health or ‘m-health’ – health-related uses of the phone – in diverse settings around the world. Drawing from an ethnographic perspective, we seek to contribute an anthropological understanding of mHealth, a growing industry often otherwise dictated by top-down priorities such as bespoke app creation. Instead, building from our own ethnographic insights about older people’s everyday uses of phones, and other studies stressing the evident importance of ‘informal mHealth’ (Hampshire et al., 2021), we illustrate a ‘smart-from-below’ approach which prioritises the everyday appropriation of phones and existing communicative apps for health purposes. We analyse the failures of conventional mHealth initiatives and the emergence of our alternative perspective, and how that led to several initiatives in which team members were themselves involved.

In this book, we offer a grounded ethnographic picture of mHealth in our various research contexts, with a view to broader global trends in population ageing, health and economic crises, the Covid-19 pandemic, declining public investment, increasing phone access, and global migration. This shows the potential of prioritising the everyday appropriation of mobile technologies in line with both social change and longer-standing care norms.. This is intended topromote an anthropological approach to support the relevance and effectiveness of mHealth going forward. We have already created a free online course (available here) for those interested in the topic but hope that the book will benefit other medical anthropologists and ethnographers interested in digital health, as well as digital health practitioners interested in social research around the design, implementation and evaluation of their work.

We have organised the book into three parts, reflecting what anthropology can offer for contextualizing, analysing and informing mHealth. Part one consists of three chapters concerned with contextualizing mHealth;

  • Xinyuan Wang on mHealth practice in mainland China;
  • Shireen Walton on visual digital communications about health during covid in Italy, and
  • Laura Haapio-Kirk on social self-tracking in Japan.

This is followed by contributions analysing mHealth:

  • Daniel Miller on googling for health in Ireland, and the ways it exacerbates existing disparities;
  • Patrick Awondo on the failures of various mHealth initiatives in Yaoundé, Cameroon; and
  • Pauline Garvey outlining the uses of phones to seek information and support around the menopause in Dublin, Ireland.

The volume concludes with three chapters informing specific mHealth initiatives:

  • Alfonso Otaegui’s recommendations for scaling the ‘nurse navigator’ model in public oncological clinics in Chile;
  • Marília Duque’s protocol for meal-logging and WhatsApp communications in Brazil; and
  • Charlotte Hawkin’s and John Mark Bwanika’s work on a digital mental health programme in Uganda.

Taken together, the volume seeks to provide a grounded ethnographic discussion on the challenges and opportunities of anthropology for mHealth, and of seeking health and care in the smartphone age. We aim for publication in 2022 with UCL Press, follow ASSA on Twitter, Instagram and Facebook to keep updated.

References

Hampshire et al. (2021). Informal mhealth at scale in Africa: Opportunities and challenges. World Development, 139:105257, 1-23

A Walk for Humanity

Marilia Duque E S30 April 2021

Mike out for a walk in São Paulo

São Paulo is a city where work organises time and sociability. We are known as people who are always in a hurry and the city is a place where asking “How are you?” is usually met with people discussing what they are currently doing in their work and career. All of this has been challenged by the COVID-19 pandemic and the social distancing restrictions that were put in place to contain it, which have changed how people work and live. It doesn’t matter if these restrictions have been ineffective, a consequence of the political disputes in the country and the irresponsible actions taken by the federal government. Covid-19 was viewed as a ‘little flu’ when it first broke out[1], opportunities to buy vaccines were neglected[2] and the country now lives in a state of having to choose between saving jobs (‘the economy must come first’)[3] and saving lives, as Brazilians have not had the opportunity to benefit from a national plan that guarantees both. The result is that the number of deaths caused by COVID-19 in 2021 alone has already surpassed the total amount of deaths between March and December 2020. A special commission was created to investigate the actions taken by the executive power under the Bolsonaro leadership[4].

This post is not about the macroeconomic or political perspective of this crisis. It is about the micro-perspective of everyday life during the pandemic in a middle-class neighborhood in São Paulo where I live. It is also written from the privileged perspective of someone who can afford to work from home. It is about my observations of how people’s behaviour has changed when it comes to time and openness in my local area. Between May to July 2020, the number of divorces in Brazil increased by 54%[5]. I am among those counted in this percentage. Living alone with my 17-year-old son, far from our relatives and isolated from our friends, we decided we should have a dog. And so Mike came into our lives. My son says that Mike is his ‘antidepressant’. What I found out is that he is not alone.

I take Mike for a walk twice a day and I try to combine these walks with quick stops in the local supermarket when I have to buy food or any other supplies. Similarly to me, walking the dog has become an opportunity for many of my neighbours to meet and talk to other people face to face. In the past, when two dogs inevitably stopped to smell each other, their owners were more likely to pull their leash and move on. This has changed. With the excuse that the dogs are ‘getting to know’ each other, owners now allow themselves to stop and talk.

That was how I got to know a young couple who moved to São Paulo one month before the pandemic started. He told me about his challenges as a teacher who had to learn how to teach online overnight. He also told me about how his wife ended up working in a hospital, even though she is trained as a dentist. Another older woman told me the history of her dog, a pet that originally belonged to her daughter, and how she had to take over the dog when her daughter got married. She is now thankful that she has her dog for company. Another man I spoke to found out that I was named after a small city in Brazil that is close to the city he was born in. Since then, every time we meet, even though his dog doesn’t like mine that much, he tells me about the particularities of his city and how he ended up in São Paulo.

These conversations are not restricted to dog owners. Each dog can become an opportunity for someone to stop and talk while petting the dog. Sometimes, they just really want to talk, like the woman I met who took her smartphone out to show me her daughter’s dog and talk about her family. At the time, I thought about warning her that it was not safe to take her smartphone out on the street and show it to someone she had never seen before, but I couldn’t ruin her happiness with security issues. So, I let her talk and show me some pictures and videos.

However, sometimes, people really just want to pet the dog, they want to give and to receive some affection. My son is responsible for taking Mike for a walk early in the morning before he starts his online classes at school. He has had to start waking up 10 minutes earlier so he could allow for people who want to stop and show their affection for Mike on his way. One woman explained this phenomenon to me: ‘It is dog therapy’, she said. She then explained in detail the hygiene-related habits she has adopted since her mother, who has an underlying condition, moved to her house at the beginning of the pandemic. Her dog is also great company for her mother, so she does everything she can to minimise the risks of COVID-19 transmission.

We both agreed that people are feeling lonely and the dogs provide time to pause and reflect, reminding us that among everything else, there is love and humanity. The conversation also reminded me of a young man I had met the day before. While he was on his knees petting Mike, he told me he was alone and that he was considering getting a dog. He was interested to know whether a dog like Mike could live well in a very small flat.

Like in the US[6] or Australia[7], the desire for some company has resulted in a wave of pet adoptions at the beginning of the pandemic in Brazil. One year after the ‘pandemic puppies’, as the phenomenon was known worldwide, a report conducted by dog-sitter provider Rover.com among Americans[8] showed that those who had welcomed a ‘pandemic pet’ did it for emotional support and happiness (41%) or because they needed something positive in their life (39%). 93% said it improved their mental and or physical wellbeing. The report also showed that 54% of owners adjusted their budgets or reduced expenses in order to keep their pets and 90% are still completely happy with the decision they made almost a year ago[9].

The reality in Brazil is quite different. In 2020, 13.4 million Brazilians were unemployed[10]. In comparison to 2019, informal work has decreased by 2.4%, while formal work in the private sector has gone down by 7.8%. Self-employment has gone down by 6.2% and the number of people who stopped looking for a job has gone up by 16.1%. The negative economic outlook and its impact on people’s household budgets is associated with a 70% increase in cases of pet abandonment during the pandemic in the country[11]. Some people had to leave their own houses to live with a relative and couldn’t take their pets with them[12]. In addition to this, there are two other factors that have contributed to pet abandonment during the pandemic in Brazil.

In the beginning, there was misinformation and misguided fears with regards to pets infecting humans[13], which were also reported in China by TIME magazine[14]. Now, as the pandemic remains out of control in Brazil, having reached 390.000 deaths[15] while I was writing this text, the many cases of pets being abandoned also reflect the sad fatality of many owners’ deaths[16]. Other than the economic crisis affecting the country, but often working in combination with it, that is the main reason that people are increasingly deciding to leave behind the pets of their relatives who passed away[17].

Just when I was just struggling to find a way to end this text on a hopeful note, I realise it is time for me to take Mike for a walk. I will enjoy every encounter he brings my way. I will keep listening to what people have to say. I will let them pet my dog for as long as they want. It’s true that, like everybody else, I don’t have the power to change the ‘macro’ reality of the situation, but I can contribute to my ‘micro’ reality. I can turn every walk into a walk for humanity.

 

Footnotes

[1] https://edition.cnn.com/2020/05/23/americas/brazil-coronavirus-hospitals-intl/index.html

[2] https://www.nytimes.com/2021/01/18/world/americas/brazil-covid-variants-vaccinations.html

[3] https://www.nature.com/articles/s41581-020-0327-0

[4] https://www.canalmeio.com.br/edicoes/2021/04/26/covid-19-matou-mais-em-4-meses-que-em-2020-inteiro/

[5] Between May and July 2020, the number of divorces in Brazil went from 4.641 to 7.213: https://epoca.globo.com/brasil/divorcios-crescem-54-no-brasil-apos-queda-abrupta-no-inicio-da-pandemia-24635513

[6] Dog adoptions and sales in US: https://www.washingtonpost.com/nation/2020/08/12/adoptions-dogs-coronavirus/

[7] https://www.theguardian.com/world/2020/aug/16/dog-gone-eescue-pet-shelters-emptied-by-surge-in-demand-during-pandemic

[8] https://people.com/pets/pet-adoption-statistic-year-into-coronavirus-pandemic/

[9] https://www.rover.com/blog/pandemic-pet-adoption-boom/?irgwc=1&utm_term=10078&utm_source=impact&utm_medium=affiliate&utm_campaign=384088798&utm_content=2JSQAdWFyxyLR970JSywsQuwUkB0a%3AQn7zsuTA0

[10] https://economia.uol.com.br/empregos-e-carreiras/noticias/redacao/2021/02/26/desemprego—pnad-continua—dezembro-2020.htm

[11] https://www1.folha.uol.com.br/cotidiano/2021/02/apos-onda-de-adocoes-abandono-de-animais-domesticos-dispara-70-na-pandemia.shtml

[12] https://www.bbc.com/portuguese/brasil-53594179

[13] https://www.bbc.com/portuguese/brasil-53594179

[14] https://time.com/5793363/china-coronavirus-covid19-abandoned-pets-wuhan/

[15] https://especiais.g1.globo.com/bemestar/coronavirus/estados-brasil-mortes-casos-media-movel/

[16] Economic constrains and owner’s death or hospitalization also reflect in pet abandonment in UK: https://www.glasgowlive.co.uk/news/glasgow-news/charity-warns-thousands-dogs-risk-18666922

[17] https://www.bbc.com/portuguese/brasil-53594179