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What we can learn from World Menopause Day, by Pauline Garvey

GeorgianaMurariu17 January 2020

To mark and celebrate World Menopause Day, the Irish Nurses and Midwives Association (INMA) in collaboration with Loretta Dignam, founder of the organisation the Menopause Hub held an evening event entitled ‘#No Taboo’. To this event Dignam invited speakers who are specialists in the area including a dietitian, a consultant nurse from the NHS (UK) and singer Mary Coughlan amongst others.

Coinciding with the event, the INMA issued a position paper to assist their members and other women in the workplace to recognise the issue, noting that:

“…there are over 300,000 women working in Ireland between the ages of 45 and 64, and around 80% of those will experience symptoms leading up to menopause.  We would like to work with employers to create positive employment policies, as we do with other health and wellbeing-related issues. Currently there is an absence of policies on this issue.” [1]

One of the objectives of the event was to remove the perceived taboos surrounding menopause and encourage members of the general public to engage with such issues. The event was fully booked, and not only did women turn up in numbers, but in some cases their partners were anxious for them to attend. One woman’s husband picked her up from work and surprised her with a ticket and spent the evening ‘wandering around town’ while waiting for her.

A couple of issues were notable about the event. Firstly, except for the son of one of the speakers, no men attended. This is remarkable considering that half the world’s population is affected by menopause and indeed as it was reported later that menopausal women are ‘the fastest growing demographic section in the world’ (Hourican 2019). What other physical or medical condition would attract an audience of exclusively one sex?

Secondly, the keynote given by Barbara Taylor, a retired gynaecologist and writer, was memorable. In the talk itself, and later followed up in national media, Taylor made the point that ‘…most of the conversations we do have, are misplaced. We spend too much time talking about HRT versus no HRT, about breast cancer risks, even debating whether or not menopause is a ‘Thing’. In fact, we should be talking about heart health, osteoporosis, and Alzheimer’s’. Taylor’s point is not that issues surrounding HRT are unimportant, but that they eclipse other equally important health concerns such as the risk of cardiovascular disease after reaching menopause and the higher occurrence of Alzheimer’s disease among women than among men.  One of the most striking and memorable results of the event therefore was the light it shone on the absences  and silences that surround menopause.

 

 

References:
Emily Hourican 11/11/19 ‘Why women know nothing about the menopause’ The Irish Independent (available online at https://www.independent.ie/life/health-wellbeing/health-features/women-know-nothing-about-menopause-then-it-hits-them-over-the-head-like-a-ton-of-bricks-38674567.html, accessed 11/11/19)
 
[1] https://inmo.ie/Home/Index/217/13535

Smartphones in “Dar Al Hawa”, al-Quds (East Jerusalem)

MayaDe Vries Kedem3 January 2020

Written by Laila Abed Rabho and Maya de Vries

Please note that the participant names used in this blog post, as well as the neighbourhood name ‘Dar al-Hawa’, have been pseudonymised for reasons of anonymity and confidentiality.

Smartphones are perhaps the most important technological devices used in the world today. In our field site of Dar al-Hawa, a neighbourhood of 10,000 people in al-Quds (East Jerusalem), smartphones are part of everyday life, including among older members of society. As part of our fieldwork, we interviewed 22 women between the ages of 42 and 75 in the area. We discovered that even though many carry mobile devices with them on a regular basis, this does not necessarily mean that they make use of the full functionality of these, including apps and other features.

All interviewees agree that having a smartphone makes communication with their family members (parents, children and grandchildren) easier, whether they are in the country or abroad. Most of them actively use WhatsApp, Facebook and Facebook Messenger to communicate, as well as to send each other prayers and quotes from the Qur’an. Some also browse the Internet and follow daily news. Overall, smartphones are seen as devices that make communication between family members much easier, especially in comparison to their older, pre-smartphone counterparts:

Eman (75), remembers a time when she had to top up her phone to make calls abroad:

“I used to have a card, and I would buy a 100 shekel card every time I topped up. When I called my brother in America or in Jordan, the conversation ended quickly – today I can call him for free. Smartphones have reduced the distance between us.”

Hala (58): “I used to use my phone to check on my daughter at university – she studied outside of Jerusalem.”

Smartphone use among older women in the Arab community is not limited to family communication and calls. Some women we interviewed use their smartphones to find recipes online:

Nisreen (56): “I love to read about cooking and find dessert recipes.”

Kholud (63): “I browse the internet to find recipes that suit my diet. I would also like to read about cooking and how to make dessert recipes.”

None of the women we interviewed use their smartphone to pay bills or do online shopping however. These findings are aligned with recent research reports on the digital divide within Israel, which have shown that there are significant differences between internet adoption and use among the Jewish population and that of the Arab population. Although internet use among the Arab community in Israel had increased to as much as 84% by 2015, there is still a large disparity in terms of the scope and nature of internet (and implicitly, smartphone) use between the two groups. While data shows that as many as 7 in 10 members of the Arab community had not shopped online or made payments on the internet in 2016, for the Jewish community, this figure was only around 30%. Among the Arab community, there are also more significant differences between different generations when it comes to browsing the internet, with over 45s being even more underrepresented and less confident that older internet users in the Jewish population.

Digital access and consequently, digital equality, tend to vary based on the socio-political background of a specific group or individual. In addition, the lack of motivation to use the internet can also occur due to a fear of technology, especially among minorities or more marginalised groups such as older people. Such groups are more likely to suffer from a lack of basic digital skills and knowledge and have limited exposure to the internet. As we have learnt from our informants, joining the digital world and learning how to navigate it are not self-evident processes, and can both take a long time. Even when adults learn how to use the phone and have practised using it multiple times, they may forget how to use it with time, some even forgetting the right way to properly use a touchscreen, for example. Such difficulties can have the effect of severely limiting the way these members of the population will use their phone, limiting their use to voice calls and WhatsApp.

Mayar (46) was very explicit about this: “I am afraid that a time will come when everything will be online. I do not know how to pay in this way. Sometimes when I am in a car park, I am asked to pay for the space online. I am also afraid that a day will come that I cannot find a machine [where I can still pay manually]. That’s why I wish to find a class to teach me how to use the smartphone. Girls in their twenties may know how to pay via the internet, but us women over 45 need education in this field.”

We also asked informants whether they use their smartphone to contact their doctor. Interviewees were keen to stress that they would never use their smartphone to communicate with their doctors in a direct way. There was one exception, Hamda (75), who said:

“Of course, I use it to communicate with my doctor. Today I want to call my doctor because I want to cancel an appointment I have. I want to tell him that I am not coming.”

It is interesting to note however that Hamda uses her smartphone to place a direct call to her doctor as opposed to using the clinic’s app or messaging him via WhatsApp. However, she is quite unique in this matter. Another research participant, Jumana (75) says: “As for communicating with doctors, I do not use it [smartphone]. I go to see the doctor face to face. If I had the clinic’s doctor’s number, I would contact them, but I don’t know how to use WhatsApp.”

The women we spoke to also highlighted the importance of phones among elderly people who were childless, or those whose children were far away and unable to provide them with immediate assistance.

Haya (62) says: “The phone is very good, I like having it with me in the knowledge that I can use it to communicate with my children at any given time. It is better than the house phone. It is very good to be able to use the camera no matter where you are. I sometimes also use YouTube.”

Rana (43) says: “Having a mobile phone is very important for the elderly who live alone today. There is even a service that allows older users to call the police or an ambulance at the touch of a button.”

The evidence from our interviews shows a widespread perception that phones have numerous advantages, assuming of course that informants know how to use their functions and features. The widespread use of smartphones also presents downsides – a fact that appeared as a more subtle implication in our  discussions with informants – something that is related to the specific cultural context of our field site.

For example, Haya (62) talks about the smartphone and the ridiculous things that can happen as a result of using the phone incorrectly:

If you know how to use it {the smartphone}, it is true that there is a lot of good in it. This phone is a blessing from God, but most people do not know how to use it in a good way, so they use it to do bad stuff. This is why some people prefer the old ‘stupid’ phone.”

The community in Dar al Hawa is considered a conservative one. It is not unheard of for some members of this community to use smartphones for abusive purposes that include discrediting or shaming other people.

While smartphones can make life easier, they can also complicate it, carrying the potential to influence the life of individuals (particularly women) and their families in a negative way.

Bearing all this in mind, it was particularly interesting to see in the WhatsApp group of the Elderly Club in “Dar Al Hawa” the following image praising the “stupid” old phone and its lack of capabilities:

It lived with dignity
It died with dignity
Never took a photo of a girl
And did not record any embarrassing situations (scandals)
And it did not carry music

 

الهاتف الذكي في حي دار الهوى، القدس

ليلى عبد ربه ومايا دة-فريس

 

تعتبر الهواتف الذكية من اهم الأجهزة التكنولوجية المستخدمة بكثرة لدى أغلب فئات المجتمع. خلال اللقاءات مع النساء الفلسطينيات في حي “دار الهوى[1] – القدس حول الهاتف الذكي واستخدامه، قالت أغلب النساء ان الهاتف الذكي سهل عليهن التواصل مع الأهل والأبناء سواء كانوا داخل البلد او خارجها.

حتى الآن تم اللقاء مع 22 امرأة بالفئة العمرية ما بين 42 و75 عاماً، جميعهن أكدن على استخدام الهاتف الذكي كوسيلة للاتصال والتواصل. أغلبهن يستعملن تطبيق الواتس اب والفيسبوك والمسنجر كوسائل للتواصل ولإرسال الادعية الدينية، كما يتصفح بعضهن الانترنت لمتابعة الأخبار. أكدت جميع النساء على سهولة استخدام الهاتف الذكي (على عكس الهاتف القديم) للتواصل مع افراد عائلاتهن خارج البلاد و داخلها:

إيمان (75) قالت: “كنت استخدم الكرت (كل مرة اشتري كرت بمئة شيكل) عندما اتصل بأخي في امريكا او في الاردن فينتهي بسرعة, اليوم انا باتصّل ببلاش. هو يقرب البعيد”.

هالة (58) قالت: كنت استخدمه للاطمئنان على بنتي في الجامعة“.

قسم من النساء يستخدمنه لتصفح ما يتعلق بالطبخ والحلويات. نسرين (56) قالت: أنا أحب ان أقرا عن الطبخ وأن استخرج وصفات للحلويات. خلود (63) قالت اتصفح النت لاستخراج وصفات للرجيم وأيضا أحب أن أقرأ عن الطبخ وكيفية عمل بعض الحلويات.

لم تقم أي من النساء اللواتي تم اللقاء معهن بدفع فواتير الهاتف او الكهرباء أو اي فواتير أخرى عن طريق الهاتف الذكي.

اثبتت الدراسات التي تمت حول الهاتف الذكي في إسرائيل الفرق بين المجتمع اليهودي والمجتمع العربي في استخدام الهاتف الذكي والانترنت. حيث وصلت نسبة مستخدمي الانترنت في المجتمع العربي حوالي 60% في عام 2011، مقارنة ب 77% لدى السكان اليهود. أما في عام 2015 فقد ارتفعت هذه النسبة في المجتمع العربي الى 84% (لجنة الاحصاءات المركزية في إسرائيل)، ولكن لا يزال هنالك تفاوت كبير في نطاق وطبيعة الاستخدام بين الشعبين.

اتضح أن أكثر من 70% من مستخدمي الشبكة من المجتمع العربي لا يتسوقون أو يجرون الدفعات بشكل يومي مقارنة مع 30% من المجتمع اليهودي. ظهر أيضاً تفاوت كبير بنسب التصفح بين الاجيال (فوق أو تحت عمر 45) بالمجتمع العربي ولكنهم يستخدمون الشبكات الاجتماعية.[2]

تتنوع التفسيرات بموضوع المساواة الرقمية حسب الخلفية الاثنية بموضوع التكنولوجيا وتبنيها:

أولا، قلة الأجور لذوي الياقات الزرقاء بسبب عدم المساواة الاقتصادية/الاجتماعية/الثقافية/التعليمية والتي من خلالها سيكون الانكشاف للعالم التكنولوجي متدني.

ثانيا، عدم وجود الدافع لاستخدام التكنولوجيا بسبب الخوف من التكنولوجيا من قبل الأقليات، نتيجة لعدم معرفة استخدام المهارات الحاسوبية والانكشاف المقتصر لشبكة الإنترنت.

مع ذلك، وكما يظهر من المقابلات فان الانضمام للعالم التكنولوجي وتعلمه ليس بديهي ويستغرق وقتا طويلا. حتى عندما يتعلم الكبار كيفية استخدام الهاتف عدة مرات، فانه قد ينسى كيفية استخدامه، أو يكون استخدامه محدود جدا (للمكالمات والواتس اب فقط).[3]

رغم هذه الدراسات إلا أن بحثنا يظهر استخدام النساء المسنات للهاتف الذكي في القدس بوضعها السياسي المركب. كما ويؤكد البحث على عدم استخدام النساء للإنترنت بشكل واسع في الهاتف الذكي، بالمقارنة مع استخدامهن للواتساب والفيسبوك.

هالة (58) قالت: “زوجي وابنائي يدفعون الفواتير

ميار (46) ابدت تخوف من هذا الامر: أنا خائفة ان يأتي وقت يصبح فيه كل شيء عن طريق النت وأنا لا أعرف كيف يتم الدفع بهذه الطريقة، احيانا يطلبون مني في موقف السيارات الدفع عن طريق النت. خائفة ايضا ان يأتي يوم لا أجد مصف فيه الدفع عن طريق ماكنة عشان هيك يا ريت حد يقوم بتعليمنا كيف يتم الدفع عن طريق النت. الفتيات في سن العشرين يعرفن كيف يدفعن عن طريق النت لكن نحن النساء فوق الخامسة والاربعين نحتاج لتوعية في هذا المجال.”

إضافة الى ذلك أكدت النساء أيضا على عدم استخدام الهاتف الذكي للتواصل مع الطبيب بشكل مباشر، سوى واحدة، حمدة (75) قالت: طبعا باستخدمه في التواصل مع طبيبي انا اليوم بدي اتصل في طبيبي لأني بدي الغي موعد بكرة بدي اقول له انا مش جاي بكرة.

لم تستخدم أي من النساء الهاتف الذكي للتواصل مع الخدمات الطبية ‘الديجيتال’. جمانة (75) قالت: “أما بالنسبة للتواصل مع الاطباء لا أستخدمه [الهاتف الذكي] فأنا اذهب لرؤية الطبيب وجها لوجه. بالنسبة للتواصل مع الطبيب قالت إذا كان رقم العيادة معي ورقم الدكتور باتواصل معهم بس انا لسا بتعلم على الواتس آب.

زاهرة (74) اذا بدي اشي من الطبيب بقول لنعمة بنتي بتتصلي اذا بدي اشي من المكتب بتصل عليهم كمان ما باستعمل الواتس آب.

كما أكدت اغلب النساء على اهمية الهاتف الذكي ومساعدته للمسنين خاصة المسن الذي ليس لديه أبناء او أن أبناءه بعيدين عنه ويعيش في البيت لوحده.

هيا (62) قالت: استخدم الواتس وباتفرج على الفيس ومرات أتصل على اختي من المسنجر. البيلفون منيح كثير بتطلعي مشوار بكون بلفونك معك بتتواصلي مع اولادك هو احسن من تلفون الدار كثير منيح بتكوني في اي محل وبتفتحي الكاميرا وأحياناً أستخدم اليوتيوب.

رانا (43) قالت: مهم جدا للمسنين الذين يعيشون وحدهم اليوم يوجد خدمة يستطيع المسن ان يضغط على الزر فتأتي الاسعاف او الشرطة.

أظهرت المقابلات أن الهاتف الذكي يتمتع بمزايا كبيرة، على افتراض أنهم يعرفون كيفية استخدام تقنياته. في الوقت ذاته، للهاتف الذكي ايضا يوجد جانب سلبي، والذي لم يظهر بشكل ضمني إلا في المقابلات مع النساء ويعتمد على السياق الثقافي لمجال دراستنا.

فعلى سبيل المثال، تتحدث السيدة هيا (62) عن الهاتف الغبي والأشياء السخيفة التي يمكن أن تحدث نتيجة لاستخدام الهاتف بشكل غير صحيح:

اذا بتعرفي تستخدميه صح بكون كثير منيح مش للهبل هذا البيلفون نعمة من الله, لكن اكثر الناس مش عارفين يستخدموه, بيستعملوه للهبل.”

يعتبر المجتمع ا في “دار الهوى” مجتمع محافظ، ولكن قد يقوم بعض افراد هذا المجتمع باستغلال الهواتف الذكية لأغراض مسيئة تشمل تشويه سمعة أشخاص اخرين. من الجدير بالذكر ان الهاتف الذكي من ناحية يجعل الحياة أسهل ومن ناحية أخرى يعقدها.

في ضوء ذلك، كان من المثير للاهتمام أن نرى في مجموعة الواتس اب التابعة لنادي المسنين في “دار الهوى” الصورة التالية والتي تشيد بالهاتف “الغبي” وافتقاره إلى القدرات:

[1] “دار الهوى” هي اسم مستعار وكذلك أسماء الذين تمت مقابلتهن.

[2] Lev-On, A., Brainin, E., Abu-Kishk, H., Zilberstein, T., Steinfeld, N., Naim, S. (2019) Narrowing the gap: Characterization of participants, short- and long-term effects of participation in LEHAVA program (To narrow the digital gap in Israeli society, in Hebrew).

[3] Gordon, C., Al Zidjaly, N., & Tovares, A. V. (2017). Mobile phones as cultural tools for identity construction among college students in Oman, Ukraine, and the US. Discourse, Context & Media, 17, 9-19.

Facilitating nutritional health through the smartphone in rural Japan

LauraHaapio-Kirk7 November 2019

Communal eating in Tosa-cho. Photo by Laura Haapio-Kirk (CC BY).

In September I received the good news that a joint application I made for the newly established Osaka-UCL Partnership Funding was successful. Along with Danny Miller on the UCL side, I teamed up with Dr Yumi Kimura from Osaka University who works on nutrition from a public health perspective in Japan, Myanmar, and the Himalayas. The project also involves Lise Sasaki, who previously studied medical anthropology at UCL. Our proposed collaborative project joins my ongoing anthropological research on smartphone usage among older adults in Japan with Dr Kimura’s public research on nutrition, to develop a mobile health intervention which is sensitive to local usage of mobile phones and attitudes towards health.

The project will take place in my rural fieldsite of Tosa-Cho, a town of roughly 4,000 inhabitants, in Kōchi Prefecture, South West Japan. This rural mountainous area is remote, with the nearest city (Kōchi City) being a 1-hour drive away. Rural towns in Japan are most in need of technological innovation to deal with the growing number of elderly people who are living often alone and in need of care. We know from our ethnographic research that mobile health applications are seldom used by older adults in this town, despite smartphone usage being fairly high. This indicates that there is great potential for digital health interventions but these have to adapt to the way local people are already using their smartphones, rather than encouraging them to download new apps.

Sharing food and conversation. Photo by Lise Sasaki (CC BY).

Over the course of our fieldwork, we have seen this trend across several field sites ranging from Brazil to Ireland: although mHealth initiatives may focus on changing behaviours through the use of native apps built specifically for improving health outcomes, we think making use of the ubiquitous platforms already in common use amongst the target populations could offer significant benefits. We plan to examine the creative ways that older adults are already using common smartphone applications for health and wellbeing, and will explore how these everyday applications could be used for purposes of a nutritional intervention, for example meal tracking using the application Line, or the facilitation of social eating in order to reduce isolation among older adults.

We will present our findings to doctors and health researchers at a symposium in 2020 organised by the UNESCO Chair in Global Health and Education, held at Osaka University by Prof Beverley Yamamoto. We also want to share our findings with the local population of Tosa-cho, so we plan to run a community workshop where we will demonstrate ways for people to use their smartphone to benefit their health and wellbeing. We are hoping that this research and accompanying policy report will reach beyond Kōchi prefecture and will be shared more broadly to advise on digital health policy across Japan. As older adults adopt the smartphone at increasing rates, the potential for mHealth to mitigate some of the health challenges that come with ageing is promising, but initiatives must adapt to already existing behaviours if they are going to have a chance to be sustained.

 

 

“Iconographies for Retirement” – By Pauline Garvey

GeorgianaMurariu31 October 2019

Author: Pauline Garvey

As part of the ASSA project, we are developing mHealth (mobile health) initiatives in order to address the needs of our populations. In our two field sites in Dublin we are engaged in developing social prescribing sites that can be accessed online, on smartphones, and as hard copies for those who are not comfortable with digital media.


Figure 1: One Dublin-based social prescribing site that we are developing.

Social prescribing is based on the recognition that a person’s health is improved by the degree she or he is embedded in social networks and cultural activities (see my blog December 2018). In many cases it involves a GP or counsellor writing a ‘prescription’ for a patient to attend a social activity that will embed a person in their community and enhance their health in mental, emotional and physical ways. In one pilot study, the Irish Health Service Executive described social prescribing as a service that:

“…helps to link you with sources of support and social activities within your community. 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.”

This approach to health has been subject to quite a bit of media attention in Ireland this year and has been subject to several pilot studies nationally and internationally.[i] As part of this rising tide, there is now an annual international conference dedicated to social prescribing which is being developed in diverse countries from UK to the United States, Canada, the Netherlands, Singapore, and Finland.

The question for our team is firstly how can we develop a social prescribing site that enhances the lives of our research respondents? Secondly, how can an anthropological approach make a positive contribution to social prescribing more generally? Our approach is very much coloured by our methodology of anthropological ethnography and participant observation. This means that our insights emerge as the result of immersive participation in our field sites, building on the 16-month ethnographic fieldwork already completed. In developing a social prescribing website, we plan on continuing to work with our research respondents to understand how they use and engage with initiatives such as these.

The first issue emerged early when our informants expressed doubt about the iconography used to denote retirement.

Figure 2: One of the icons that our respondents objected to

For the people we work with, this icon seemed to capture an ageist expectation of what retirement should be rather than their actual experience of it. For example, one of my respondents jogged the 30 km home on the day he retired. Although this man’s level of fitness is not what I would describe as ‘average’, his perspective on remaining active is more in keeping with our respondents than the icon above (see figure 2).

As a result, we set about working with students from computer science in Maynooth University to create something more appropriate. As we work on developing iconography that better encapsulates the experience of our respondents, we realise that this is an ongoing iterative process that we will constantly revise as we launch our websites and work with our respondents in the years to come (see figure 1). Two alternative icons we are currently considering with respondents can be seen below.

 

Figure 3: Alternative retirement icons that we are currently considering with our research respondents.

 

References:

[i] https://www.irishtimes.com/life-and-style/health-family/what-is-social-prescribing-and-how-it-can-benefit-your-health-1.3840354

 

‘If you are old, you invented the Internet’: A tribute to a senior geek

Marilia Duque E SPereira22 October 2019

I felt insecure about accepting an offer of website hosting from Dudu Balochini, who suggested we host the two websites we had developed together on his server at no cost. I asked him: “But what if you die?”. I was referring to my access to the servers, but he thought it was about his age since he was almost twenty years older them me (I’m 42). He then challenged me: “What if you die?” And that was how we laughed together and moved on. The first site we published together answered a need from the Center of Ageing Studies located at UNIFESP Medical School. Their researchers monitor the elderly population of a neighbourhood in Sao Paulo, and their studies include investigating the impact of physical activity on ageing. One of the interventions they made was to map out opportunities within walking distance for older people to exercise. This mapping was manually adapted to the address of each patient – a herculean task. But an informal survey showed that 70% of program-assisted seniors have smartphones. I had this information in mind when I met Dudu for a coffee. “Do you think we could make these activities accessible through Google Maps based on people’s location?”, I asked him. And he just said “I already know how to do that. I need two hours”. Twenty-four hours later, he produced the site we called Get Up and Go: nearby activities for the 60+. “I used the Store Location feature in WordPress, but it took me a while because it was blocked for developers from Brazil”, he apologised as though I thought he was late.

The second site is part of my delivery for the applied side of the ASSA Project – Anthropology of Smartphones, Smart Ageing and mHealth. With an ethnographic approach, I observed how WhatsApp was used for health purposes in Sao Paulo. I mapped the best practices and organised them into a set of protocols for communication within hospitals and clinics. I also developed a second set of protocols addressing nutritionists (obesity and being underweight are both health issues among older people in Brazil). Both materials are open-access and should be available for download. That is why I needed a website to publish them. This time, Dudu didn’t develop the website for me. “You’re going to become a SeniorGeek”, he told me. SeniorGeek is an initiative for digital inclusion of seniors created by him. At presentation events addressing older people, Dudu tried to demystify technological themes like Artificial Intelligence, Blockchain and Chatbots. He believed older people should know about those things or they would be cut off from conversation with children and grandchildren and, moreover, with society. Dudu also believed he could enable seniors to become digital entrepreneurs through courses that teach how to build a website, or an e-commerce or a blog. This is how I became his student. By myself, with the autonomy he wanted all seniors to achieve, I developed and published my WhatsApp manuals at http://www.saudeeenvelhecimento.com.br. In my field site, entrepreneurship gains strength among older people as a means of reintegration into the labor market. This is a consequence of the desire of many to remain productive but it is also their way to respond to corporate ageism. Dudu himself used to say he lived in a limbo: too old for the market, but not a “legal” senior yet.

Dudu was also a public figure. He was often in the media, giving interviews about the relevance of digital inclusion for seniors. At 58, he used to say, “If you are old, you invented the Internet. The problem is that people accommodated and forgot about it”. And he has a point. We just have to remember that Bob Kahn and Vint Cerf, creators of the TCP / IP protocol that enabled the Internet, are now aged 81 and 76 years old. However, ethnography showed me that this detachment from technology was also linked to retirement, when access to technology and needs in daily life change (Selwyn, 2004). Even so, Dudu’s speeches were inspiring and older people felt more confident because of him. Dudu died one week after I left my field site. An abrupt heart attack. On the one hand, he has achieved the death my informants desire the most: a death without illness or disease. I have written before about how my informants do not fear death. On the contrary, they see death as natural and even desire it when they think of the prospect of a future lived with physical, mental or financial limitations. On the other hand, it was an early death. Dudu was gone when he began to experience the purpose of life. I say experience because, among my informants, there is a feeling that the meaning of life is not something that can be explained by past achievements or by spiritual convictions. Therefore, they abandon philosophical reflections on the subject to focus on the present: they live today with purpose, filling daily life with pleasurable activities and, if possible, positively impacting the lives of those around them. Dudu brought these two accomplishments together in an intense agenda of events and courses.

And it was precisely the technology Dudu was so enthusiastic about that mediated his farewell. The news of his death spread via WhatsApp and was shared from group to group, giving rise to dozens of messages. Information about his funeral was also shared throughout the night, as well as information about the seventh day mass. For this last meeting, friends used WhatsApp again to prepare a last tribute. They have the idea to reproduce the “uniform” worn by Dudu, a black T-shirt, with the SeniorGeek logo. And during the days leading up to the mass, they spoke about how this production was made feasible all through their smartphones, as Dudu would like. The mobilisation was properly registered. And the pictures dominated social media again, now accompanied by the text “We are all senior geeks”. Dudu’s original WhatsApp group for his SeniorGeek initiatives was deactivated. A new one named “Senior Geek Connected” was created instead. It’s still a place where older people can find information about technology and new learning opportunities, keeping Dudu’s original idea alive. For him, above all, SeniorGeek was a manifesto against the invisibility of older people, something he believed only technology could solve.

 

 

 

 

Selwyn, N. (2004). The information aged: A qualitative study of older adults’ use of information and communications technology, Journal of Aging Studies, 18, 369–384

 

50 colours of menopause – reframing the ‘age of despair’. By Maya de Vries and Laila Abe Rabho

LauraHaapio-Kirk30 September 2019

Authors: Maya de Vries and Laila Abe Rabho

Photo (CCBY) Maya de Vries. Activity at the senior’s club: colouring pine cones.

Right from the beginning of the ASSA project, one of the main topics that we discussed was menopause. Although menopause is less of a taboo, and people talk about it much more in the al-Quds field site compared with some of the other ASSA sites, it took a us a while to be able to speak with informants about this sensitive topic. We discovered that for many women speaking about the physical and mental ramifications of menopause is still not easy to do and they tend to be shy and even embarrassed by it. It was only recently, after a year spent at the field site that gathering information about menopause became easier, mainly because women felt more comfortable to open up.

Research about menopause in al-Quds is rare. However there is some research about this issue focusing on the West Bank. In the article Age of despair or age of hope? Palestinian women’s perspectives on midlife health (Hammoudeh et al., 2017), authors depict the perception of menopause among Palestinian women in the West Bank who were born between 1960-1975. They clearly say that they had no access to Palestinian women in Jerusalem due to political and security problems entering Jerusalem from the West Bank.

The term used in Arabic in medical literature and discourse to describe menopause in the West Bank and in al-Quds is the ‘age of despair’ (sin al-yaas). However, in Hommoudeh’s article this term was unpopular with the women interviewed, and they preferred not using it. Similarly, in al-Quds, women that we spoke with in Dar al-Hawa, do not like to use this term. They are familiar with it, but do not wish to use it when talking about themselves, since it is not describing them correctly. The word despair is not relevant for them and perceived as negative, whether they are married with children, widowed, married with no children, or never married. They simply do not see themselves as in despair; for them it is very strong word, that does not describe their daily life.

The women we interviewed knew that they are in their midlife, but midlife for them means much more than just menopause, which carries negative associations. Many women articulated a positive view about midlife and ageing as a natural process that is part of life. Midlife, is considered to be an age of peacefulness and wisdom in the Holy Quran. The ‘age of despair’ is not mentioned; the term to describe older people is ‘old in years’ (Kbar fi al-Snin or Sheikhoukha, referring to old people, but they tend to see their age as an advantage because of increased life experience.

While talking with the women in al-Quds we found out that they talk about menopause in private and intimate situations such as meetings with girlfriends or with other women from their family. In such occasions, they talk more about the various physical symptoms characterising this age, such as – hot flashes, tension, incontinence, lack of sleep and more, and less on the mental issues that might appear. Some said that they were sure that these symptoms will pass with no need for medical treatment. They thought menopause is natural thing, and temporary. What was interesting to hear is how they refer to the term ‘menopause’, and what are the alternatives they are using instead.

In Yasmin’s (42) interview she referred to menopause as the ‘safety age’, when there is no chance to get pregnant.

yes, I have heard about it, there is another term that is used as an alternative to menopause and it’s the safety age. I know many women relatives and friends that reached this period of their life, but they never said that they were going through it (menopause). I think that this term is wrong, because there is no age that stops women.

Abeer (58) called menopause in a different name, considering it as ‘maturity age’, while referring not just to physical consequences of menopause, which are usually negative, but also to a better self.

I have been through the menopause period, I consider it maturity age, in this period women feel that they are able to take decisions by themselves, she feels that she is strong, she lives her life the way she wants, before the menopause her life was different.

Tagreed (60) sees menopause in contrast to what it represents. For her, the role of the women as grandmother is significant:

I don’t know, maybe when women reach this period her role in life ends, on the contrary, I believe that they are wrong because in this period her role becomes even more important than before, she takes care of her grandchildren, her children get married, she takes care of everything, and all the family depends on her. They think that if her period stops, that she is no longer able to become pregnant, her role in life ends. In contrast, in this period she takes care of her grandchildren, and her children depend more on her.

Tentatively, we can say that the term ‘age of despair’, is no longer relevant, and the concept of a novel, ‘golden’ prestige age is rising now. Our guess is that there are plenty of reasons for this shift, mainly because medicine is progressing and leisure activities are more commonly pursued. We will continue exploring how the digital environment impacts on this change; this still is an enigma for us, as many of our informants are not using digital devices, or health apps heavily. Some do not even carry a smartphone.

Interestingly, just as the term ‘menopause’ is being reframed, the same is happening also with the term ‘old’, as many in al Quds refrain from using it as it might be considered insulting. Many times, we see the word “seniors” instead of old, switching the word out of respect. A small example of the change in discourse can be seen in the new WhatsApp group opened two weeks ago by the coordinator of the seniors’ club under the name ‘The group of the golden age club’. The previous WhatsApp group, which is now being abandoned by its members, was called ‘The group of the older people of Dar al-Hawa’. The ‘golden’ age highlights the possibilities this age, despite menopause, can offer. Is this reframing simply concealing what is really happening in this age? Or due to various changes in the modern world, is ageing is coloured in gold? So far the al-Quds’s field site tells us that ageing is changing, and if you are financially secure, yes – you can experience the ‘golden age’.

 

 

Applying ethnography to digital health aims; challenges and opportunities

Charlotte EHawkins10 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.

 

‘Ikigai’ – what is your purpose in life? By Laura Haapio-Kirk

LauraHaapio-Kirk25 July 2019

Photo (CC BY) Laura Haapio-Kirk.

I went to meet Wada san* on his land in the heart of the mountains of Tosa-cho, where he grows the plant sasaki, common in Shinto ceremonies and used to decorate altars. He keeps ducks who help him to take care of his rice by eating weeds and harmful insects, and by fertilising the rice crop. He knows the paths and trees in his forest as well as a city person would know the streets and buildings of their neighbourhood. School children often come here to learn about nature and see how we can work with it, such as by making beautiful things out of wood, or healing ourselves with plant remedies. He told us that the plants that are able to grow and thrive here in the mountains, growing up through other vegetation, have the strength to survive and therefore when you eat them you too gain some of that vitality. Along with my research assistant Lise Sasaki and two friends, we spent several hours walking and talking together about happiness and the things in life that give a sense of purpose, in Japanese termed ikigai. While this is quite an abstract term, Wada san was able to explain his ideas through vivid analogies to the landscape that surrounds him.

“What is happiness? Human being’s happiness… I’ve heard that it is health. But after that, its whether or not you find the job you want to devote your life to. I have lived through many jobs and have picked up skills throughout. Now I use those skills to do what I do, my passion. My life story, my life history is written in the mountains, and is remembered by the mountains. Working in an office, once you retire someone else will take on your job. But in this rural area the trees I have planted will grow and remain here, and the trees will be cut down and I will plant them again. It will be a cycle. Not only that cycle, but here – (shows us the rings of a cut tree) you can see how much it has grown, how much it has lived. The trees, even if they are chopped, they will live on as someone else’s house or in another form. It reincarnates as several things. Trees live once in the mountains, giving us oxygen and giving to us our life. And it lives that way. But in its second life, it is transformed into our homes, giving us comfort. We can’t see the oxygen, but it produces it – let’s say it was living in the mountains for 50 years and then it was chopped down and lived as a house for 50 years. Then it has lived for 100 years.”

Wada san explained that trees, like humans, are naturally wild, but that with the right kind of nurture they can find their way in the world. He said that when we are becoming an adult we have to choose our path in life and our role in society – trees are the same. For many people I have spoken to the idea of ikigai is linked to the satisfaction you gain by fulfilling your role in society, especially when you see your positive impact on others. Whether through making delicious bean paste sweets and sharing them with people, or in taking workshops to become a better teacher for your students, people agree that one element of ikigai is about trying your best in serving others.

Everyone has a different definition of ikigai. For some people it refers to dreams and ambitions, such as pursuing a career as an artist, for others it is about doing daily activities which align with one’s interests such as learning English, or for others it is more about the thing in life that you could not live without, such as your children. For some people it is about enjoyment of life, for others it is about the fulfilment of obligations, and some people are in between – a sense of ikigai can come in both difficult and joyous moments and it is more about an underlying feeling of immersion in life.

The English translation of “purpose in life”, it seems, is completely inadequate for understanding the broad range of meanings that ikigai can have in Japan. In England we often talk about life dreams, or working towards goals that we want to achieve. But it seems that people here think about life purpose in a more subtle way, through trying your best day-to-day and being fully present in whatever you are doing. Wada san explained that we must live in the now, rather than waiting for happiness in the future. I think this is an important lesson for us all, especially for people living hectic city lives far removed from the cycles and rhythms of nature. We can often get caught up in our to-do lists and anxieties rather than being fully aligned with our passions and the flow of life.

Human beings are always worried, human being all have anxiety. If your passion wins over, you’re okay. If anxiety takes you over, you can’t take a step. You think life and death are far apart? They’re next to each other. You can die anytime you know? It’s up to you whether you stay anxious or live to the fullest, with passion.” 

Thank you to Wada san for sharing your time, wisdom, and inspiring passion for nature with us.

 

*Wada san is a pseudonym because this man preferred to remain anonymous.

Pandora turned 70 and she just opened the box again. By Marília Duque

LauraHaapio-Kirk3 July 2019

Photo (CC BY) Marilia Duque.

Author: Marilia Duque

I am packing up to leave my field site after a 15-month ethnography with older people in Sao Paulo. One thing I learned is that a smartphone is not smart by default. Most of the time, especially for older people, a smartphone could be a stupid little thing that releases a new set of problems they now have to deal with, just like a Pandora’s box.

The character of Pandora can be perfectly represented by a 70-year-old lady I met who just received her box in the form of a gift from her son. This pandora’s box contained many gifts: a telephone, camera, calendar and computer and they were all hidden inside a Samsung Galaxy phone. Pandora’s husband warned her: “You should never turn this on. We are not supposed to steal technology from the youngsters”. Pandora then left the smartphone inside its box for weeks until she found out she was not invited to her old school annual reunion. The explanation they gave to her? “It was all set up through our WhatsApp group, dear”. In a mix of rage, sorrow and curiosity, Pandora immediately opened her smartphone’s box and turned it on.

As in the Greek myth, our Pandora also released some plagues and devils she now has to deal with. In her case, she faced fear, low self-esteem, and anxiety. She first experienced fear of breaking the device, fear of being charged for something she was not using, and fear of erasing something important, like the pictures of her youngest grandson’s swimming competition. She then experienced a lost of self-esteem because her smartphone’s display was set to sleep after just 30 seconds of inactivity and she just didn’t have the proper time to think about what to do before the screen turned off. And when she asked her son for some help, he simply had no patience to explain to her what was happening. Instead, he took her smartphone from her hands, reset the sleep mode to 5 minutes and gave it back to her saying “it is intuitive, even children are supposed to learn how it works”.  Pandora still doesn’t use her smartphone to its full potential, but a friend from her church has downloaded WhatsApp for her. She has finally joined her old school friends’ group and also her charity group, her meditation group and her family group. Now Pandora experiences anxiety because she has to manage so many messages that just keep coming without interruption. Pandora doesn’t understand that the connection is on 24 hours a day, 7 days per week, but she can choose not to be.

Curiosity was what made Pandora open her smartphone’s box and turn it on for the first time. But it is also curiosity which is the only thing that can save her. With curiosity (and with a little help from her friends), Pandora can dig deeper into her smartphone until she finds a solution – ‘hope’. It is hope that was left remaining in Pandora’s box. She will make ten mistakes for each thing she does right. She will be annoyed because she can enlarge the font size and the display size of her smartphone, but this will disrupt her WhatsApp screen lay-out and she will feel lost again. Even so, with time, she will become more confident to try new things and make new mistakes and learn with them. In doing that, Pandora will discover that one more gift was left inside her smartphone. Pandora will finally experience the smartness of her smartphone. A smartness that is only achieved in practice, when the smartphone provides a solution for someone’s need or desire.

Fear, low self-esteem and anxiety will still exist. But Pandora won’t have time to pay much attention to them. She is now checking Google Maps for the easiest way to go to a museum with her friends. She is deciding to take an Uber so she can improve her English with Duolingo during the trip. She is experiencing that fraction of smartness that makes her think that her smartphone was actually a gift from the gods to mankind. A gift she had the curiosity to open and the courage to keep it on.

Downsizing, Rightsizing, Upsizing

DanielMiller24 June 2019

A while back, Pauline Garvey and myself decided to write a chapter for our book about downsizing. This means that we rather assumed that downsizing would be an evident phenomenon for the age group we are studying, mainly people in their sixties and seventies. Certainly, in Ireland there is pressure on older people; hints from the media and the state that moving to a smaller home would help free up large family homes for families with children and perhaps release equity for their own children who are finding it hard to buy their own homes.

I found that most of my informants resent such pressure, feeling that they have worked hard for and deserve their homes. Their children may be living abroad and when visiting, my informants want to host them in their own homes.  Anyway, there are no hotels in Cuan. These people often want to move from the older estates they currently live in, where houses are typically expensive to maintain. But the evidence, confirmed from interviews with estate agents, is that they are not downsizing. Rather they aspire to move to new build houses, but with at least three bedrooms. When visiting such houses I found that they use this opportunity to express their desire to be modern and youthful. Far from squeezing possessions accumulated over decades into small retirement flats, they give these away and embrace modern furnishings and styles for their bright new houses.

Similarly, while they may be getting rid of their many accumulated possessions in the process. They may use this realign themselves with modern sensibility, viewing these actions as evidence that they have embraced the modern ‘green’ environmentalist perspective. So both in moving home and in divesting themselves of possessions, it seems that, far from preparing for ageing, they are seeking ways to become more youthful and more attached to contemporary mores.

Other evidence suggests that there is only limited transfers of equity down the generations to enable younger people to buy their own homes.  It seems more common for them to suggest that their children’s families can come back and stay in these reasonably spacious homes, while they are saving money to purchase their own. Most commonly, these children really want to be able to buy a home within Cuan itself, and this is expensive.

Actual downsizing is important in relation to frailty at whatever age this arrives. Alongside the need for specialist aids, downstairs bedrooms and toilets and, when required, a move to specialist sheltered accommodation or a nursing home. But, consistent with our earlier findings, this is about physical need. Otherwise, it seems to matter little whether people are in their eighties or fifties, they no longer consider themselves as old people who have to shrink their worlds, rather they remain concerned to find strategies for updating their world and remaining contemporary.

I thought this was quite an original, even radical finding; but perhaps we have not gone far enough. A 2016 report by the UK’s NHBC Foundation called Moving insights from the over-55s based on a survey of 1,500 households who have moved home, suggests that nearly a third have actually upsized, that the most popular homes are four bedrooms and that 46% have put more money into their new homes, rather than released equity. Unfortunately, the survey is not broken down by age. It is not then surprising that terms such as rightsizing are coming to displace downsizing. What that report doesn’t do, which we hope our project will do, is delve into the deeper context that may explain why this is happening.