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Elder care beyond the household

Charlotte EHawkins20 February 2020

In the contemporary context of global population ageing, anthropological studies of elder care offer a lens onto the ways global processes are experienced and managed in everyday lives (Buch, 2015; Cole and Durham, 2007). Care itself is an increasingly international phenomenon, with, for example, carers from the Global South hired as domestic carers in the Global North (Ahlin, 2017), with migrant children enacting ‘care at a distance’ (Pols, 2012), and with increasing exposure to elder care norms from different societies. In this way, as shown in the conversation with the principal hospital administrator in the Kampala fieldsite cited here, everyday family health care practices are an observable lived experience of wide-reaching socio-political processes. Elder care, or lack thereof, in turn, reflects, reinforces, and in some instances, disrupts these processes (Buch, 2015). This is both interesting for anthropological analysis, linking the individual and historical, and for the potential of sharing this knowledge to improve the health and welfare of our research participants.

In Kampala, an understanding of elder care norms in other societies present an idealised or disparaged alternative against which existing family expectations are re-established. Nakito is the principal hospital administrator at the regional government hospital near the Kampala fieldsite, which itself was built with international funding. She feels the health system she works in needs to have “better provisions for these [older] people”. With the ‘youthful population’ in Uganda, she finds that health policy and funding often forget older people, an approach which she feels should be rectified as the older population grows. She has been particularly inspired by the approach to hospital care for older people she observed on a recent training course in Korea, where she found that there were separate specialised geriatric services in hospitals. This highlighted for her the gaps in the Ugandan health system for older people. She finds that elderly people come to the hospital with multiple conditions and have to “roam around” for all the services they’re referred to, with long queues at each department. “They’re lining up around the hospital”, she says.

Queueing at the hospital. Photo by Charlotte Hawkins (CC BY)

In line with many other researchers (e.g. Nzabona et al., 2016; Oppong, 2006; Whyte, 2017), participants, policymakers and NGO advocates, Nakito is concerned about the future of elder care in Uganda, as institutionalising older relatives like in Europe and the US is “not allowed” and instead “they would rather abandon them”. She predicts that by 2040, 50% of people may choose not to take care of their older relatives, depending on their upbringing. The “natural rule and regulation” of family obligations means that global media portrayals of alternative, independent, selfish ways of life “make you feel freer than your original cultural norms”. Younger people may be influenced to become more ‘independent-minded’, with the ‘self’ more “on the agenda”. She said it’s now more common to hear people say, “I’m actually very busy”, instead of conforming to the expectation that “you must be there for people, as a team” and “check on your people” and “be responsible for your community, and your own belonging”.

Despite these concerns, Nakito herself takes care of her mother, visiting her every weekend in her home village a 5-hour drive from Kampala. She finds that most of her friends do the same thing at least once a month. Even when she allows herself a day off, at the end of it she feels it’s a day wasted without visiting someone. These family care obligations “leave little time for self”, particularly for women (see also Wallman and Bantebya-Kyomuhendo, 1996). Nakito thinks this leads people to focus on the “smaller picture of family units, and sometimes forget society”. She attributes that to the “pressure of globalisation”, which has reduced the community bond to smaller units, based on proximity. In other words, paradoxically, personal pressures imposed by global processes are turning a once more social outlook inward to immediate families or within the household.

The “pressures of globalisation” are also evident in the health outcomes of contemporary lifestyles in the city, with cooking oil and sugar prominent in people’s diets, work over long hours an economic requirement that continues into old age, and increasingly prevalent chronic long-term non-communicable diseases. In this context, the family is crucial to supporting the health of the individual, particularly to supply the time and resources for care. This can result in older people and their relatives adapting to long-term treatment routines. As Sandra Wallman & Grace Bantebya-Kyomuhendo, anthropologists of ‘informal economies of health’ in Kampala, put it; “in economically constrained settings, health choices become health compromises which in turn, become family routines” (Wallman and Bantebya-Kyomuhendo, 1996: 151). As with the ASSA project’s health collaborations and later outputs, by ‘meticulously documenting’ observations of these routines and also the ways in which health conditions are understood, medical anthropology can promote an understanding of the impact of the political economy on marginalised low-income people (Farmer, 2004; Kleinman, 2012), and attempt to centralise human experiences in health systems.

References

  1. Ahlin, T., 2017. Only Near Is Dear? Doing Elderly Care with Everyday ICTs in Indian Transnational Families: Elderly Care with ICTs in Indian Families. Medical Anthropology Quarterly. https://doi.org/10.1111/maq.12404
  2. Buch, E.D., 2015. Anthropology of Aging and Care. Annual Review of Anthropology 44, 277–293. https://doi.org/10.1146/annurev-anthro-102214-014254
  3. Cole, J., Durham, D.L., 2007. Generations and globalization youth, age, and family in the new world economy.
  4. Farmer, P., 2004. An Anthropology of Structural Violence. Current Anthropology 45, 305–325. https://doi.org/10.1086/382250
  5. Kleinman, A., 2012. Medical Anthropology and Mental Health: Five Questions for the Next Fifty Years.
  6. Nzabona, A., Ntozi, J., Rutaremwa, G., 2016. Loneliness among older persons in Uganda: examining social, economic and demographic risk factors. Ageing and Society 36, 860–888. https://doi.org/10.1017/S0144686X15000112
  7. Oppong, C., 2006. Familial Roles and Social Transformations: Older Men and Women in Sub-Saharan Africa. Research on Aging 28, 654–668. https://doi.org/10.1177/0164027506291744
  8. Pols, J., 2012. Care at a distance: on the closeness of technology, Care & Welfare. Amsterdam University Press, Amsterdam.
  9. Susan Whyte, 2017. Epilogue: Successful Aging and Desired Interdependence., in: Successful Aging as a Contemporary Obsession: Global Perspectives. Rutgers University Press., NEW BRUNSWICK, CAMDEN, NEWARK, NEW JERSEY; LONDON, pp. 243–248.
  10. 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.

 

 

 

Imagining Our Digital Futures: The View From Japan

LauraHaapio-Kirk14 February 2020

Japan has gained a global reputation as being the sort of place where one can ‘imagine our digital future’ – from stories of men marrying their virtual girlfriends, to techno-cemeteries replacing tombstones with LED Buddhas, an imagination of ‘techno Japan’ has developed which can be quite removed from the everyday experiences of people living there. Japan has been slow in many ways to adopt new technologies despite an international perception of being at the forefront of technological innovation. This imagined futuristic Japan is perhaps a result of the prominence of robots and advanced technologies in Japanese popular culture, or because of the impression made on travellers by iconic bullet trains and singing washlet toilets. Day-to-day life in Japan is actually remarkably low-tech; the economy is still largely cash-based despite government attempts to encourage card and mobile payments, much bureaucratic work is still paper-based rather than computerized, and old technologies such as fax machines are still popular. Indeed the name of new Reiwa era (Japan’s new imperial era following the end of Emperor Akihito’s 30-year reign) was announced internationally in April 2019 via a fax sent to Japanese embassies worldwide.

On 26th of February I will present my work at a symposium in Sheffield called ‘Imagining Our Digital Futures: The View From Japan’. The event is organised by Sheffield University’s School of East Asian Studies, bringing together scholarship on technical innovations of Japanese art and design with discussions about the use of digital technology to understand Japan. The organisers envision Japan-focused digital research as a productive model for emerging and developing studies of digital cultures around the world. “Imagining our digital futures” requires us to look at our digital present, which in Japan is more commonly about the smartphone rather than robots. And the age-group who are especially keen to imagine a digital future is the middle-aged to elderly, who are finding digital means for challenging previous models of ageing. While Japanese youth have historically been seen to drive innovation in digital communication practices, older people are now starting to embrace the smartphone and are developing their own digital cultures.

My talk will present findings from long-term ethnographic fieldwork I conducted among older people in Kyoto and Kōchi Prefecture, examining ageing, health, and everyday usage of the smartphone. Given the economic and social challenges posed by Japan’s ageing population, the government has turned towards technological solutions, such as assistive robotic devices, to cope with a decreasing health and care workforce. Yet it is in everyday smartphone practices such as messaging, Googling, and using social media that older people are re-imagining care, finding new forms of independence, and crafting new experiences of ageing when compared with previous generations.

With many nations around the world exhibiting ageing populations, there is international focus on how super-ageing Japan is dealing with this demographic shift. By studying the digital practices of middle-aged to elderly Japanese people, this research demonstrates that the smartphone is increasingly central to their lives, and will be key to developing technological innovations for dealing with the challenges associated with ageing.

If you’re near Sheffield do come along, and also check out the Japan Now North festival in the week preceding the symposium with a range of film screenings and discussions on Japanese art, literature, and film. The festival includes a screening of the film ‘I Go Gaga My Dear’ by veteran Japanese documentary filmmaker Naoko Nobutomo. After the screening I will be chairing a Q&A with Nobutomo, discussing her film within the wider context of the Japanese ageing society.