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Applying ethnography to digital health aims; challenges and opportunities – by Charlotte Hawkins

LauraHaapio-Kirk10 August 2019

Author: Charlotte Hawkins

Photo (CC BY) Charlotte Hawkins

How can a holistic ethnographic understanding of ageing experiences, particularly related to health mobile phone engagement, contribute to an mHealth initiative and improve the accessibility of health services and information through mobile phones? This applied challenge in the ASSA project has initiated partnerships with digital health practitioners in most of our fieldsites – in particular, with collaborators working within existing phone practices. This aligned with our early finding across the fieldsites, that mobile phones are commonly used for health purposes, but through communication on apps evidently most popularly used, such as calls, Facebook and WhatsApp. In Kampala, I worked with The Medical Concierge Group (TMCG), a medical call centre founded by Ugandan medics to improve the accessibility, affordability and quality of healthcare. They offer a 24-hour toll-free phone line, SMS, WhatsApp and Facebook access to a team of doctors and pharmacists and have 50,000 interactions each month. At the time of fieldwork, they were in the process of researching the development a psychiatric call line, or ‘telepsychiatry’. This early stage of service development meant that TMCG were interested in and able to accommodate holistic ethnographic insight in their considerations.

Ethnographic insights included systematic information on 50 low income research participants’ existing mobile phone and mobile health practices as relevant to accessing TMCG services. For example, access to airtime and data is intermittent, with a tendency towards regular low-cost subscriptions. This suggests that calling or using the internet could be inaccessible to users at least once a day. Furthermore, 54% of participants had made health-related calls in the last month, and 27% of their previous three remittances were for health purposes, which confirmed an existing propensity to use mobile phones to support family health – but only across their own network of friends and relatives. Interviews with 50 respondents encountered during the wider ethnography also offered TMCG feedback on mental health perceptions, experiences and help-seeking preferences. These interviews were predominantly with older people, mostly older women, who would not typically opt to engage with research on mental health, and yet who represent an advisory position within their family or community. This also included interviews with health workers, including psychiatric clinicians at the local government hospital, and private health clinicians within the fieldsite. Research showed that treatment for mental illness was perceived to be unavailable, costly, or stigmatised. Often respondents said they prefer to handle mental health problems through prayer or counselling within their community, with hospital treatment sought only once problems become severe. This suggested that optional, confidential, accessible or community-based mental health services could be useful for low-income people in Kampala, if advertised accordingly.

Initially, the wide-reaching interview responses were considered thematically, from causality to treatment seeking, and condensed into representative quotes for presentation back to the team. More recently, alongside the team, these themes have been expanded to inform a draft publication in psychiatric journals, which TMCG hope to use seek further funding. We also hope to further disseminate findings in accessible formats amongst other digital and mental health service providers in Kampala. As familiar to many applied medical anthropologists, translating interpretive, subjective and relativist ethnographic information within positivist, objective and universalist medical paradigms brings challenges, such as risking that complex human experiences and perceptions are reduced into ‘practical’ or digestible concepts (Kleinman, 1982; Scheper-Hughes, 1990). However, this assumes that the health practitioners and their discipline are not open to understanding their patient’s everyday realities, which has not been the case in this instance, perhaps reflecting a particular affinity between anthropology of digital health – appropriation of phone based health services is entirely dependent on their relevance and usefulness for their target populations.

The on-going collaborative process has also highlighted what anthropology might learn from the research and writing processes of health disciplines, for example: ensuring findings are widely disseminated and thus accessibly written; avoiding anecdotal, emotive or biased claims; and ensuring that quantitative statements, “many people said xxx”, are qualified and backed-up. The collaboration has  also confirmed that the flexibility of anthropological research and richness of qualitative insight potentially has much to offer health programmes, to ensure their contextual relevance. In ethnographic research, we have the privilege of time, which comes with in-depth insight, and familiarity with the community – time and understanding which we can offer usefully to other audiences. The data provided can perhaps confirm a hunch of a practitioner from the area but can also surprise them. When documented and publicised, the data encourages practitioners to both tailor their approach, but also allows them to share the specific requirements of their target population, encouraging others to do the same – or hopefully even to offer funding to support them.

 

REFERENCES

Scheper-Hughes, N. Three Propositions for a Critically Applied Medical Anthropology. (1990) Social Science & Medicine 30 (2): 189-97.

Kleinman A. The teaching of clinically applied medical anthropology on a psychiatric consultation-laison service. In Clinically Applied Anthropo1ogy: Anthropologists in Health Science Settings (Edited by Crisman N. and Maretzki T.) Reidel. Dordrecht, 1982.

 

New and Old Friends — by Charlotte Hawkins

XinyuanWang9 June 2019

Many people in the Kampala field site who use Facebook like to use it to search, add and chat with new friends. They sometimes attribute it to ‘friendliness’, enjoying making contact with new people and chatting to them. A few also see it as an opportunity to network and learn from others.

Nakito is 48 and owns a salon with her son. They also share a smartphone as they don’t have money to buy their own, with each taking ownership on alternate weeks; they even change the password so the other can’t access it without their permission on their week. She uses Facebook to look up friends, add them and send messages. Mostly they are other women who live in Uganda. She would never meet with them but just chats to pass the time.

Nakito with her grandson, her son working in the background

Opoka is 48 years old and has had a smartphone for 5 years. He uses Facebook to talk to old friends and look for new ones. “When a new face appears we’re eager to talk to them”.  He especially likes finding international people, learning from them, sending photos and sometimes exchanging phone numbers.

Amigo also accepts or sends requests on Facebook, “creating friends worldwide…you see their photos, you like some and want to make friends…maybe they can take you to a higher level.” Like Nakito, he wouldn’t meet them in person, and generally loses contact eventually, “like one in Spain, we used to chat a lot, but my phone got stolen so we lost contact”.

Frank is only 33 and also sometimes likes to find new friends on Facebook by sending requests or receiving them. They are ‘outside Uganda and all over the world’. He said, “I like chatting to new people and meeting friends. I like people and being friends”.

Namubiru is a 45 year old market vendor. She has old friends she connects to on Facebook, but also is sometimes looking for new friends. Her kids even look for new friends for her. Usually they are ‘from here’, women or families. She’s never seen them in person, it’s ‘just to make friends’, like families sometimes can’t come ‘live’ in person so they connect on the phone. Her kids can call them and they chat, just asking them how they are; they always want to find out how her elderly mother is.

‘Checking on people’ is probably the most common use of mobile phones more generally. In a survey on phone use conducted with 50 respondents last year, we asked people who their previous 3 phone calls were with, the purpose and duration; 34 of 150 (23%) phone calls were for the purpose of ‘checking on friends and relatives’, or them ‘checking on me’; “they wanted to know how I am”, “he wanted to know how home is”. They were generally brief phone calls, less than 2 minutes. Exchanging greetings through the phone acknowledges connections and reiterates the importance of such relational ‘presence’, even if at a distance.

The impact of physical work in old age — by Charlotte Hawkins

XinyuanWang16 April 2019

In Uganda, 70% of the workforce is employed in the ‘informal sector’ [UBOS, 2014], mostly self-employed in unregistered business. This is reflected in Godown, the Kampala fieldsite, where the majority of interviewees run their own small business, such as hawking fruits, market vending, driving bodas (motorbike taxis) and brewing waragi. Many of these jobs require physical labour.

The deterioration of physical health, accelerated by physically demanding work, can mean that old age presents a significant challenge to people who rely on their bodies for their income. This is the case for Achola’s husband, who throughout our recent interview, was busy bending to serve food to frequent lunchtime customers. It turned out he had chronic back pain. A visit to the hospital the day before had confirmed that ‘his spine is splitting’, a slipped disk. He’s not responded to other treatments and can’t afford a brace, so they’ve recommended surgery, but he’s nervous to weaken himself; he needs to work for his wife and grandchildren, and elderly relatives in the village. He was even planning to take the 10 hour bus to visit them the following day, ‘I have to go and farm, it’s the month’.

65 year old Palma also has back problems after 30 years of ‘moving with bananas’, carrying a basket to sell in town. She has to continue working to support her 3 orphaned grandchildren. ‘It was her parents to take care of them and her’, but now she has to do it alone. She struggles to pay their school fees, and in return, they cook, wash and clean for her. Sometimes she falls sick, and the family must rely on her neighbours to bring them food. Whilst she feels that her work has kept her active and healthy, she’s now tired, so hopes she can get a market stall so she can sit in one place.

Both stories here emphasise the reliance on family support in old age and the burden this places on individuals, especially when it breaks down. The head of physiotherapy at the local government hospital is all too familiar with such stories. He feels that informal workers contribute significantly to the Ugandan economy but are neglected by public services. He hopes for further investment in prevention and promotion to alleviate the impact of physical work on people’s bodies over time, seeking health protection for informal workers and advising them on how they can better protect themselves.

As part of the ASSA project, we plan to make a short film on the impact of physical work on older people’s health in Godown, that he can use to support further research, advocacy and community sensitisation to this end.

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

LauraHaapio-Kirk24 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.

 

Keeping up appearances: the importance of ageing smartly – by Charlotte Hawkins

XinyuanWang24 November 2018

Author: Charlotte Hawkins

Gloria works for KCCA (Kampala City Council Authority) cleaning the roads, starting every morning at 6am. This often means she arrives late at the bi-weekly meeting of a support group for women in Godown where we first met. She hopes to set up her own business, investing in a machine for grinding g-nuts and sesame, but it would cost 2 million Ush ($535), capital she doesn’t yet have. Meanwhile, she said she makes ends meet by “joining hands together” with her sons, all in their 20s. She earns 180,000 Ush ($50) each month, putting 80,000 Ush ($22) on food and 20,000 Ush ($5.50) on beauty products, including make-up and hair oil. “Even without money I have to be smart. I don’t need to be shabby”. The rest goes on rent and her sons ‘top up’. I asked what they do when there’s a health emergency to pay for, and she said, “we rarely fall sick” thanks to her prayers: “when you light a candle for Mother Mary you cannot fall sick”.

Gloria’s hair and make-up collection. Photo by Charlotte Hawkins

Gloria’s candles for prayer. Photo by Charlotte Hawkins

Almost 10% of her monthly salary is invested in being ‘smart’, a word often used here to compliment the visible effort someone has put into their appearance, “you’re smart today!”. Gloria is not alone in stressing the importance of ‘keeping up appearances’, despite financial constraint; as one older man explained, dressing well and looking good are “a way of gaining public trust”. Or as at the weekly parties for a women’s savings group in Godown, the ways the beneficiary and her two ‘honourable members’ dress up is an important part of the celebratory proceedings. They often design and tailor their matching outfits, taking photos of each other and themselves on smartphones. Even the bar will be ‘dressed’ according to the beneficiaries’ preference, with different colour fabrics and lights draped on the ceiling and walls.

Women dancing and looking smart at a weekly party for their savings group. Photo by Charlotte Hawkins

Taking photos of a beneficiary, dressed up for her party. Photo by Charlotte Hawkins

It seems that another way to look smart, especially for older women, is to look young. According to my research assistant, who grew up in the area, many of our female interviewees lie when we ask their age, wanting to seem younger than they really are. Whilst being called ‘Jajja’ (grandmother) signifies respect, so do remarks on a deceptively youthful appearance. Ageing gains admiration, but particularly if you’re smart.

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

ShireenWalton1 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

Avoiding Stress in Kampala’s “Jobless Corners” – by Charlotte Hawkins

ShireenWalton30 July 2018

Author: Charlotte Hawkins

Our health depends on how we conduct ourselves, what we eat, what we drink. …Alcohol has compromised a lot of health in Uganda today.  

(Elder in Kampala fieldsite, Godown)

A nationwide study by the World Health Organisation in 2016 found 10% of Uganda’s adult population have problems related to alcohol[1]. Excessive alcohol consumption can be a contributory factor to diseases such as cancer, mental illness and diabetes, as well as accidents, domestic violence, and other detrimental effects on family life. The drinking habits of some people in my chosen fieldsite, a low-income area in Kampala, are both a cause and consequence of socioeconomic problems in the home and beyond.

Drinking for leisure has long been ethnographically recorded as part of everyday life in Kampala (Southall and Gutkind, 1957: 22; Wallman, S and Bantebya, G 1996: 83). Today, gathering points are centred around bars serving home brews, waragi, ‘war gin’, or ajono, millet beer, and branded beers, whisky and gin. Groups of men, and a few women, sit around a large shared pot with long drinking straws. It is a chance to laugh, relax, tell stories and bond; what one community leader termed a “narrative exchange of ideas”. The home brews also offer an opportunity for women to make an income; small factories like those photographed below can be found across the country.

Women brewing waragi in Kampala fieldsite (above) and rural Northern Uganda (below)

Public drunkenness, “morning to sunset”, is the subject of censure. An elder in Godown thinks that drinking alcohol should be criminalised before 6pm, as it is in neighbouring Kenya. However, he also recognises that people resort to drinking out of frustration and boredom, with a lack of employment opportunities or “what to do”. As another pointed out, “you know if there’s no employment, people tend to start drinking, drinking without proper feeding”. The local councillor, whose job is to resolve disputes in Godown, finds that “over drinking” is the main cause of conflict, husbands beating wives who have lost patience with their spending. As the women’s leader in Godown explained, they are often left to provide for their families alone:

Their husbands drink. They don’t even help them. They just take. Now their place they call it ‘jobless corner’. Even those who are working, who work at night, they come very early in the morning to go and join them. So the little money they make from work, they spend it on drinking.

In some families, alcohol is bought at the expense of children’s education, further perpetuating the inaccessibility of employment. Laura Haapio-Kirk’s recent ASSA blog post examined the paradoxical relationship between overworking, stress and health in Japan. In Uganda, it is the absence of formal work opportunities which perpetuates a cycle damaging to personal, familial and communal health.

References

  • Southall, A and Gutkind, P (1957) Townsmen in the Making: Kampala and its suburbs, East African Studies. East African Institute of Social Research, Kampala, Uganda.
  • Wallman, S., Bantebya-Kyomuhendo, G., 1996. Kampala women getting by: wellbeing in the time of AIDS, Eastern African studies. James Currey ; Fountain Publishers ; Ohio University Press, London : Kampala : Athens.

[1] http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_3.pdf,

The fruits of ‘olugambo’ – by Charlotte Hawkins

ShireenWalton28 May 2018

Author: Charlotte Hawkins

In many ways, mobile phones have allowed people in Africa to overcome the limits of state bureaucracy (de Bruijn and van Dijk, 2012: 12). To further credit the versatile potential of mobile communication, and the need for it, these limits have recently started closing in on mobile phone use in Uganda with two particularly contentious issues. Firstly, an embargo has been issued on SIM card registration to ensure the validity of existing data following a spate of unresolved kidnappings[1]. Secondly, President Museveni has proposed a tax on social media use in order to address the deficit. WhatsApp, Facebook, Skype, Twitter and Viber are all targets for the proposed daily fee of 100ush for all simcards using such “over the top” platforms[2]. According to the President, social media is used only for ‘olugambo’ or ‘gossip’.  He has exempted internet use for educational purposes, as “[i]t is like going to the library using the encyclopedia or referring to the dictionary. These must remain free”[3].

During fieldwork in the Ugandan context of intrinsic kinship (Whyte & Whyte, 2004: 77) and “scattered families”, I have observed many instances in which social media is used for more than ‘olugambo’, which itself is more than fruitless. As Tanja Ahlin notes in her study of migrant families’ care of elders through ICTs, phone practices are “not only about communication, just as remittances are not only about sending money” (2017). This frames an overarching question for my on-going research in Uganda; what are “over the top” platforms used for other than gossip? Many people have shown me how WhatsApp groups are used to circulate information –

I’m told that even the news of this proposed taxation reached 15,000 people in 10 minutes; “if anything seems to be relevant and effecting the lives of people directly, the messages tend to go very fast”.

WhatsApp groups also appear to be commonly used to share information about health. As one interviewee told me, he is part of a group with friends who are Doctors and teachers, “any information one of them gets, I get it here”. Or another, who recently found out the nutritional content of beetroot and bananas through his WhatsApp group and has started eating more of them. Or the hospital staff, who have a forum on WhatsApp for sharing information about patients and medical supplies, supporting health workers to do their jobs efficiently. As one message about the benefits of lemon peel circulated on WhatsApp recently stated, “thank goodness for Social Media…Pls forward to lots of friends”.

Photo (CC BY) Charlotte Hawkins. Tthis solar panel is used solely to charge the household’s phones, suggesting that access to communication is a priority.

[1] https://www.independent.co.ug/mtn-stops-sale-of-new-sim-cards/, accessed 03.04.18

[2] http://nilepost.co.ug/2018/03/31/tax-facebook-whatsapp-users-museveni-to-minister-of-finance/, accessed 03.04.18

[3] Ibid.

References

  • Ahlin, T., 2017. Only Near Is Dear? Doing Elderly Care with Everyday ICTs in Indian Transnational Families: Elderly Care with ICTs in Indian Families. Med. Anthropol. Q. https://doi.org/10.1111/maq.12404
  • de Bruijn, M., van Dijk, R., 2012. Introduction, in: de Bruijn, M., van Dijk, R. (Eds.), The Social Life of Connectivity in Africa. Palgrave Macmillan, New York.
  • Whyte, S.R., Whyte, M.A., 2004. Children’s Children: Time and Relatedness in Eastern Uganda. Afr. J. Int. Afr. Inst. 74, 76–94. https://doi.org/10.2307/3556745

What Africa Can Do for Technology – by Charlotte Hawkins

ShireenWalton29 January 2018

The Economist recently published an article called ‘what technology can do for Africa’. The article covers key discussions around the potential of technological development in sub-Saharan Africa, but falls into pitfalls common to the subject. Determinism is evident in emphatic statements like: “countries are on the cusp of a tech-driven transformation that is already beginning to make people healthier, wealthier and better educated at a pace that only recently seemed unimaginable”. Mobile phones are top of the list, said to have made ‘leaps’ possible. This pervasive image of Africa ‘leapfrogging’ stages of ‘Western development’ with mobile phones in order to improve health, education, communication and business is certainly compelling. But in reality, many digital development practitioners are increasingly skeptical of this utopian ideal, said to be Western-centric (Suchman, 2002, 2011; Tunstall, 2013; Nussbaum, 2010) and to result in unsustainable ‘pilots’ (Holeman, 2017; Huang et al, 2017) which can leave new gaps in their wake.

The Economist article attempts to acknowledge this critique by countering optimism with evidence that the region’s infrastructure is increasingly “sluggish”. The below map of Africa is entitled merely ‘Ill-equipped’, and shows limited access to electricity and mobile phones across much of the continent; in Uganda, 25% and 41% respectively. Besides a few tech hubs, technological advancement and education are unfavourably contrasted with that of Silicon Valley and “the rich world”, from which “Africa risks falling even further behind”; implying a sense of failure, and of technology as a global race.

Through 16-months ethnography in Kampala, I hope to find a different middle ground with a more considered optimism towards ‘what technology can do for Africa’, or instead, ‘what Africa can do for technology’. In the article, Liberian medic Dougbeh Chris Nyan is poignantly quoted to say: “We are forced to be inventive to become masters of our destitution”. In line with Katrien Pype’s exploration of the meaning of technological inventiveness in Kinshasa, ‘smart’ solutions are built around constraints and ‘from below’ (2017). For example, mobile money, “the bank account in your pocket”, a pertinent example of technology adapted to African requirements.

How do people in Uganda appropriate mobile phones and mHealth to accommodate their preferences and needs? During my fieldwork, this question will direct an enquiry into the active role people take as users of technology. As evident in the pilots which do scale and survive, initiatives must begin and meet with sociocultural realities.

– Charlotte Hawkins

References:

  • Holeman, I. (2017) Human-Centered Design for Global Health Equity.
  • Huang, F., Blaschke, S., Lucas, H., 2017. Beyond pilotitis: taking digital health interventions to the national level in China and Uganda. Glob. Health 13.
  • Suchman, L., 2011. Anthropological Relocations and the Limits of Design. Annu. Rev. Anthropol. 40, 1–18.
  • Suchman, L.A., 2002. Practice-Based Design of Information Systems: Notes from the Hyperdeveloped World. Inf. Soc. 18, 139–144.
  • Pype, K. (2017) ‘Smartness from Below’, in What do Science, Tehcnology and Innovation mean from Africa? eds Clapperton Chakanetsa Mavhunga. MIT Press
  • Tunstall, E. ‘Decolonizing Design innovation: Design Anthropology, Critical Anthropology and Indigenous Knowledge’. In Gunn, W. Otto, T. Smith, R. (2013) Design Anthropology: Theory and Practice. Bloomsbury Publishing, London.