Photo by Negative Space, Stocksnap.io

During my ethnographic research in Milan between 2018-2019, from interviews with patients and doctors, consulting regional, national and EU reports, and participation in hospital meetings, I learnt about the development of digital health in the city of Milan, the region of Lombardy, and across Italy. Digital or mobile health (mHealth) has been developing in and across Italy in recent years[i]. Since 2016, a few regions such as Lombardy, Emilia-Romagna, and Tuscany have been particularly active in this field, and Lombardy’s activity in digital healthcare is above the national average.[ii] Developments in this area have since been impacted by the coronavirus pandemic during 2020, in Italy, and in Lombardy in particular, which saw the highest number of cases in Italy in early 2020. Digital technologies have played a significant role during the pandemic in a number of core areas relating to health from regional and national healthcare access communication and delivery and nascent public-private partnerships, to the everyday experience of lockdown. Amid the pandemic, the country has witnessed an increase in state engagement with the digital, including a range of public-private partnerships that, for example, offer ‘digital solidarity’ packages to citizens[iii] and seek to warn against ‘fake news’ about the virus that has been shared across social media. In March 2020, the Italian Ministry of Health published a warning list of ten particularly pertinent ‘fake news’ items about the coronavirus that were circulating across the Italian social web, urging the public to be vigilant about this issue.[iv]

During my broader ethnographic research studying ageing, care, and smartphones in Milan, I found that formal and informal policies and practices exist within a nexus of an emerging digital health scene ‘from above’, and a diverse adoption of digital practices by people of different ages and backgrounds ‘from below’. Amongst research participants who were smartphone users, googling for information about health and using WhatsApp to communicate with and care for others, for example, could be popular activities not wholly distinct from broader uses of smartphones for care and communication. Concurrently, these practices could also go hand in hand with the spread of mis/disinformation[v].

As such, although Milan and Lombardy are leading sites within Italy for healthcare and digital innovation, a range of factors continue to affect the equity of healthcare access, delivery and uptake, online and offline; such as income, socio-economic factors, regional location, and language; and these factors all play a role in the differentiated experience of living and ageing with smartphones in Milan that I explored during my research in Italy, and which are core themes in my forthcoming book as part of the ASSA book series with UCL Press, Ageing with Smartphones in Urban Italy: Care and Community in Milan and Beyond (2021).

References

[i] The uptake of mHealth in Italy has been reported as steady while slower than in other European countries such as Estonia and Denmark. Kostera, Thomas. 2019. ‘Digital health – Europe is moving at different speeds’. The Digital Patient (blog), 25 April. https://blog.der-digitale-patient.de/en/digital-healtheurope/. Accessed 23 November 2020.

[ii] See Postelnicu, Leontina. 2019. ‘Q&A: How Italy is working to digitise healthcare’. Healthcare IT News, 23 October. https://www.healthcareitnews.com/news/europe/qa-how-italy-working-digitise-healthcare. Accessed 23 November 2020.

[iii] In Italy during the Covid-19 pandemic in 2020, ‘digital solidarity’ packages were offered to bridge some of the socio-economic and digital gaps highlighted and perpetuated by the virus, at a time when digital practices of care and communications had taken on heightened significance. See Agenzia per l’Italia Digitale. 2020. ‘Solidarietà Digitale al servizio di studenti e commercianti’. Solidarietà Digitale. https://solidarietadigitale.agid.gov.it/#/. Accessed 21 November 2020.

[iv] See Ministero della Salute 2020 Salute (Ministry of Health). ‘Covid-19, occhio alle bufale’. http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=4380. Accessed 23 November 2020.

[v]The distinction between misinformation and disinformation has been defined in terms of intentionality. The former describes the sharing of information regardless of intention, while the latter involves the intention to mislead, misinform and/or manipulate. See: https://www.dictionary.com/e/misinformation-vs-disinformation-get-informed-on-the-difference/ and https://en.unesco.org/fightfakenews

By Laila Abed Rabho and Maya de Vries

While doing our ethnography in Dar al Hawa for almost two years, one of the songs that kept playing in our heads was Elton John’s “Circle of life”. It is not our intention to compare the ethnographic work to a Disney animation movie. However, when talking to people in Dar al-Hawa, young and old, “the circle of life” was a main concept in people’s lives. This notion is deeply embedded in everyday life, in terms of religious practices, beliefs, culture, language and the relationship to older people in the community. But it is not only older people that this notion is important to. We came to learn that the notion, or better said, the perception of “the circle of life” in Dar al-Hawa applies, first and foremost, to the individuals in society who are considered to be more vulnerable, whether it is older people, children, or those on low-incomes. This is also based on one of five foundations of Islam, that of Zakat: giving charity to those who are in need. This practice is one of the duties every Muslim should do.

The concept of “the circle of life” starts with childhood (Al-Tufula in Arabic مرحلة الطفولة  ) and includes several periods, starting with birth and continuing through to childhood, when the person, as a child, is considered to be vulnerable and cannot help others or take care of themselves without the help of another person, especially their mother’s help. The second stage is the youth stage) Al-Shabab in Arabic مرحلة الشباب), which includes adolescence and can be extended until the age of 30, depending on whether the children leave the house or not. Usually, during these stages, the person in question is considered to be at the height of their power, and he or she does not have any major life problems, he or she is ‘accepted’ as someone who can take care of himself as well as others.

Palestinian girl scouts performing at the seniors’ club at Dar al-Hawa. Photo by Maya de Vries.

The third stage is the stage of adulthood, which extends from the age of 30 to about 40,  sometimes 50, and is also considered to be the period of the middle age (in Arabic Kahel كهل), when men and women are starting to feel, to some extent, that they are becoming older. We spoke with several women aged 40 and over and they were pleased to be living in this period, especially because most of them did not suffer from any serious medical conditions. However, an issue they raised in the interviews was that of stress – some of them said that they are suffering from mental stress in their lives.

The fourth stage is the elderly stage, seniority. This is defined by the word Sheikhuha (in Arabic شيخوخة), meaning an old man or an elderly person who is either physically or mentally/cognitively vulnerable or not necessarily physically or mentally vulnerable, but is aged above 60. The word Sheikh has a positive meaning in Arabic and refers to someone who has extensive knowledge, as defined by Muslim scholar Ibn Taymiyyah. So older people are acknowledged as wise individuals that the community should listen to, simply because they have lived longer than us and have more life experience.

The last period, after Sheikhuha , is that of Ardel al-Omar (أرذل العمر), which refers to a period that signals the beginning of dementia, when a person does not know who he or she is anymore. It can be said that the ageing process is divided into two parts: the first is the ageing of the body, which is the beginning of frailty and various diseases, when the person becomes unable to carry out his or her duties and take care of themselves. However, not every person who reaches this stage is unable to take care of themselves, and there are older people who do not need anyone’s help and are able to take care of themselves and are still residing in their homes. They usually live near their family, near to at least one of their children, which means that family care is available, at different levels, according to the older person’s needs as well as the family’s capabilities.

Old woman and a young woman in an activity at the seniors’ club in Dar al-Hawa. Photo by Maya de Vries.

Geographical closeness, the actual living in the same physical space as the family usually has a positive connotation and is an integral part of the notion of “the circle of life” in Dar al-Hawa. A person is born in a specific location, which becomes his or her home. They then raise their family there, grow old there, and eventually die there. ‘The home’ is not just four walls of concrete but also means the land, the territory the home was built upon. Hence, the holding of the home equals to the holding of the land, the family’s territory. In many ways, being an owner of land provides stability, especially when the owner becomes older and cannot work anymore. This stability is extremely important to one’s tranquillity and serenity, which are highly important when getting old. In Islam, as in other cultures, mental health and the ‘health’ of the soul are part of older’s people condition – it is important to have a healthy mind to have a healthy body. When the ‘soul’ starts to lose its connection to the body, meaning memory gets lost, a different stage begins.

When talking with older people in Dar al-Hawa, it felt that there is an acceptance of the notion of “the circle of life” as part of people’s faith and religion. Below, 77-year-old Yasmin’s quote reflects this kind of acceptance of ageing and death quite well – an acceptance we found was widely present among most of the women we spoke with:

“We’ll see what happens next year, maybe I’ll die. Am I thinking about death? I am a believer; I believe in God… Whatever comes will come. This is our religion. The way we look at life in Dar al-Hawa is almost always done through the religious prism, God is the one who determines and determines our destiny, He sees and knows everything. Moreover, the default setting of medical care in Israel, including care for the elderly, is to save and extend lives rather than maintaining the quality of life. This thesis is based on a religious belief in the sanctity of life, on the idea of ​​the circle of life – the emphasis is on the stages, on how each stage is necessary, and probably has a purpose, even if you do not see it at that moment, God knows what, and Man, in the end of things, will know what it is.”

The religious-cultural perception, and to a large extent, the moral perception in Islam, according to the popular interpretation in Dar al-Hawa, is that (older adults are among the most vulnerable in human society and should be taken care of within the community out of respect. This is a moral duty, a religious duty. When thinking about the concept of the circle of life as a framework that shapes daily life and routine in Dar al-Hawa, it is important to understand that it is embedded within the religious practices that shape how a young person should behave with older people and the reasons for behaving in this way. The young person should respect older people, speak to them with dignity, and take care of them as much as he or she can. When he or she reaches this stage (that of being older and eventually elderly), another young person will do the same for them. This is the basic understanding of the circle of life.

Social activity at the community centre, for young and old alike. Photo by Maya de Vries.

With this framework in mind, we return to one of the central topics of the ASSA project: that of smartphone use. Smartphones are carried by most older people in Dar al-Hawa. When contemplating their role in the “circle of life”, we did not see them as violating or breaking the cycle, at least not for the current older generation we were in contact with. On the contrary, we found that smartphones were making the meaning of the circle of life stronger, at least in the sense of helping maintain relationships with the family and community. Things might have been different if older people in Dar al-Hawa were strongly embracing digital culture (e.g. using apps other than WhatsApp and Facebook, paying for services and goods online, paying with their smartphone and so forth). This is one of the topics we will be tackling in our upcoming monograph, ‘Ageing with Smartphones in Al-Quds’, which is due next year.