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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 – 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.

 

‘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.

Mothers and Daughters in Milan & beyond

ShireenWalton22 March 2019

Milan fieldwork, May 2018

Among the themes that have emerged from my research on ageing in Milan over the last 14 months, relationships between women and their Mothers have been particularly prominent. I have been exploring the significance of physical proximity, distance, and smartphones in examining how care is enacted in these relationships, amongst women of different ages and backgrounds. The following examples illustrate some aspects of this work.

Elena (55) and her 80-year old Mother, Maria, are both from a nearby northern Italian city where Maria lives alone following the death of her husband, Elena’s Father, three years ago. Elena, who is married, without children, lives and works full-time in Milan. Maria has a range of physical mobility issues, meaning that she is largely house-bound. She refuses to accept help from care workers (known as Badanti, in Italian, who are often from other countries), for the encroachment she says she feels this would pose to her autonomy. Maria does not appear to trust Badanti and dislikes the idea of ‘strangers’ inhabiting her home space so intimately: “These carers are caring for the money after all, are they not?” She explains. “For them it’s a job. They don’t really care”. The ‘real caring’, following Maria’s definitions, is carried out by her daughter Elena, who, not having any siblings, bears full responsibility for her Mother’s care. Maria does not have a smartphone, so Elena calls the house phone up to three times a day from Milan to check in. At the weekend, Elena drives the two-hour round trip to provide weekly shopping and carry out basic household chores. The two women share in each other’s company, and Elena will often stay overnight on the Saturday. Elena herself, back in Milan, faces a range of problems of her own, including pending unemployment, and a marriage under strain.

Photo (CC BY) Shireen Walton, Milan fieldwork.

Elena’s situation is not uncommon in Italy, and elsewhere. Studies have highlighted the anxiety, depression, and emotional strain often experienced amongst children, particularly daughters, who are primary carers for elderly parents (Amirkhanyan AA, Wolf DA. 2006). These pressures characterise, for instance, what has become known as the ‘Sandwich Generation’ (Chisholm 1999; Riley and Brown 2005) of presently middle-aged women caring ‘upwards’ to parents and ‘downwards’ to younger children. From Maria and Elena’s nigh-on co-dependent relationship, one sees how what makes ageing so complex and intense a social experience is how the physical conditions of ageing bring about the modulating of roles, without altogether subverting or eradicating existing ones. ‘At a certain point” Elena explains, “you swap – daughters become Mothers and vice versa.” The relationship in reality is not as clear-cut or one-directional as Elena’s swapping over analogy implies. Instead, the layering of the Mother-daughter relationships thickens, and intensifies as the denial of change sets in. Maria appears to be very much still “the Mamma” in charge of the family home, whilst Elena effectively ‘project manages’ her Mother’s care. Never actively acknowledged between the two women is how ageing has modulated their relationship.

Where international migration is involved, daughter-Mother relationships play out in different ways. Kemala is from a small village in North-East Indonesia. She came to Italy ten years ago to study and work. She now lives in Milan with her husband and two children. Despite the distance, Kemala feels deeply connected with her childhood upbringing in Indonesia, and particularly with her Mother, who at 75 still runs the rice-packing business she had established in the village forty years ago. Despite this, Kemala has always found the intense sociality of her natal village context stifling. The youngest of eight children, she felt, from an early age, a need to leave, by pursuing education and upwards social and transnational mobility. Kemala has returned to Indonesia with her young children, but is unable able to do this often. Kemala’s wariness towards “too much” hometown sociality is reflected in her WhatsApp usage. Strikingly aware of what constitutes her “equilibrio” (equilibrium), Kemala chooses when and how she participates on family WhatsApp groups. She responds on the transnational family group (consisting of over 30 people) only on important occasions such as select birthdays, or Eid. Knowing that this group exists however, and that “everyone is there”, she confesses, provides comfort to her being physically far. She speaks with her Mother one-two times a week via WhatsApp on her sister’s phone in the village, since her Mother does not have a smartphone.

Kemala engages in care, but on a crafted, individual basis that she deems important for maintaining her sense of balance between countries and socio-cultural groups. She explains how “the distance helps. It creates a kind of a safety barrier, and behind this barrier, I quietly live my life.” Kemala’s use of smartphones recalls in part Ahlin’s (2018) notion of ‘frequent calling’ in the ethnographic context of transnational Indian families, whereby regularly keeping in touch constitutes notions of ‘good care at a distance’. The frequency of calling with Kemala, however, is modulated by her notion of self-care. For Kemala, (self-)care is constituted through distance, or rather the smartphone’s socio-technological capacity for facilitating ‘distant-closeness’ (Van House 2007). Meanwhile, the pervasive guilt that Kemala feels about honouring her individual commitment to social distance, and in being physically away from her village and ageing relatives, shows up in her everyday life in Milan. Over the months of participating in community activities together, I notice how she breaks into tears at what appear to be the slightest things that link her to Indonesia, to her village culture, but especially to her Mother.

Photo (CC BY) Shireen Walton. Milan fieldwork.

As Kemala continues to crafts her life in the present, this is done at the intersection of her emotional proximity but physical distance to her kin and village, and her determination to facilitate the best life she can as a Mother herself to children born and growing up in Italy.

Elena, Kemala and their relationships with their Mothers reveal how individuals navigate their wellbeing in complex ways on– and offline via a range of practices rooted in kin relations, social-cultural contexts, and normative expectations. The smartphone, highly present for some, less so for others, facilitates a capacity for virtual presence, distant-closeness and ‘care at a distance’, while physical distance for some enables self-care in the pursuit of individual wellbeing. This is particularly significant in cases of co/dependent Mother-daughter relationships, and contexts of intense family and/or cultural sociality.

Milan fieldwork photos 2018-2019 (CC BY) Shireen Walton

Milan fieldwork photos 2018-2019 (CC BY) Shireen Walton

Milan fieldwork photos 2018-2019 (CC BY) Shireen Walton

References

Ahlin, T. (2018): Frequent Callers: “Good Care” with ICTs in Indian Transnational Families, Medical Anthropology, DOI: 10.1080/01459740.2018.1532424

Amirkhanyan AA, Wolf DA. (2006). Parent care and the stress process: Findings from panel data, The Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 61(5): 248–255.

Chisholm, J. F. (1999). The Sandwich Generation. Journal of Social Distress and the Homeless, 8(3), 177-180.

Riley, L, D and Bowen, C. (2005). ‘The Sandwich Generation: Challenges and Coping Strategies of Multigenerational Families’. The Family Journal: Counselling and Therapy for Couples and Families. Vol 13., No.2. Pp.52-58

Van House, N. A. (2007). Flickr and Public Image-Sharing: Distant Closeness and Photo Exhibition. CHI’07 extended abstracts on human factors in computing systems, New York, ACM Press.

Dependence is the new death

Marilia Duque E SPereira13 March 2019

Since the beginning of my fieldwork, I’ve been asking people about death and the meaning of life. I thought that on reaching old age, people would accept death more readily and that consciousness (or fear) of death would drive them to philosophical questions about life propose, finitude and legacy. Generally they do experience death more closely: their parents are sick or died a few years ago and so do some of their close friends. But besides their grief, death is not a big issue for them. Religion and spiritual beliefs seem to bring enough comfort and resilience to deal with the end of life and life after death. “I know I am mortal”, “Life doesn’t end here” and “It is a natural thing” are expressions they use when I ask them about death.

In The Philosophy of Ageing, Time and Finitude, Baars (1) argues that consciousness of death is not the only trigger that puts life in perspective. The author highlights that we frequently face extreme situations that make us abandon idols and ideals of what life should be. At those moments, there is just real life and a balance of the past that would give the present and future some meaning. To my informants, dependence became this trigger. Many of them see the loss of autonomy as a first death and some of them wish they could die at the exact moment when they become dependent on others.

On the one hand, they are not sure if their children will take care of them in later years. When I ask them, they answer that they don’t know or they don’t think so or they don’t expect them to. “Things are different now”, they explain. On the other hand, they don’t want to become a burden especially for their kids. Martha, for example, a 63 year-old woman who takes care of her children, had made up her mind. She already told her kids that if she had Alzheimers she would prefer to go to a clinic. “They don’t deserve this burden”, she said.

Like Martha, Linda is not afraid of death, but what comes “before death” is a different matter. She prefers to try to remain healthy as long as she can. In her 70s, she still runs marathons and takes special care of her diet and sleep. Regarding her kids, she believes this is her obligation “people who don’t take care of their health don’t deserve to stay alive”.

There are also people that just don’t want to lose the right to make decisions about their own lives. Maria for example is a very independent 67 year-old woman. She calls herself “bossy” when she talks about family decisions. “I can’t stand the idea that at a certain point in my life my children will think they can tell me what I can or can’t do”, she said.

If dependence is the new trigger for the consciousness of finitude, a good question to ask would be: what gives life a sense of purpose then? My first answer would be legacy. But what I found is that the past is not enough to fulfil life before dependence comes. As my colleague Pauline, who is conducting her fieldwork in Ireland, found out, my informants are more concerned with what they are doing today. They want to feel useful by learning new stuff, engaging with new projects, volunteering or filling their time with whatever they can. Their autonomy is their legacy and that puts life in perspective.

 

Reference:

Baars, Jan. Philosophy of Aging, Time, and Finitude. In: Thomas R. Cole, Ruth E. Ray and Robert Kastenbaum (eds), A Guide to Humanistic Studies in Aging: What Does it Mean to Grow Old?, The Johns Hopkins University Press, Baltimore, Maryland, 2010

 

Ageing Actively in Focus

ShireenWalton8 January 2019

Books about ageing are currently in the spotlight. As discussed by Daniel Miller in an earlier blog post from February 2018, philosopher Kieran Setiya has looked at mid-life, from theoretical and practical perspectives. Another more recent work comes from journalist and author Carl Honoré, who in (B)older: Making the Most of our Longer Lives (2018) suggests a rethinking of ageing as a positive feature of the human experience, to be increasingly acknowledged and enjoyed more than ever before in history – a bonus not a burden.

Image (CC BY) Shireen Walton

What these books have in common is a call to shift our thinking about ageing from a negative; to consider the positive aspects of later life, and to rebrand ageing along ‘active’ lines, recalling the European Union’s emphasis on ‘active ageing’. In Italy, a country with the second (after Japan) oldest population in the world, active ageing receives much public policy and media attention. One avenue through which I came in to contact with these initiatives is through Auser, a nation-wide NGO in Italy founded in 1989. The organisation has branches all over the country, and the Lombardy region headquarters is in Milan – located in zone 2 where I am based for my research. Auser’s mission statement is ‘promoting the active ageing of the elderly and enhancing their role in society’ from  an inclsive perspective: ‘addressed primarily to the elderly, but open to relations of dialogue between generations, nationalities, different cultures.’

Auser website (English version)

Attending one of their meetings in Milan in December, I learnt about some of the main ways that ageing is being envisioned; towards skills-acquiring and sharing; a push towards enjoying life through ‘Active Welfare’, a concept the organisation defines as follows:

“Perhaps we will all have to work on building a model of “active welfare” based on financial resources adapted to social needs, built on an integrated system of subjects and public and private interventions, where through informal networks, the State, the Third Sector and individual citizens all work to build the social welfare of people, thus strengthening the concept of community and of social cohesion.”  [Auser mission statement, website]

Auser December meeting, Milan December 2018. Image (CC BY) Shireen Walton

I do not want to detract from these optimistic and significant attempts to combat ageism, but as ethnographer, I have to also investigate, specifically, what possibilities are/could be available to who – locally, regionally, nationally? From the middle-aged Italians in this fieldsite, I hear a great deal about the devastating economic situation in Italy since the 2008 economic crash, which makes the idea of retiring for many seem nigh on impossible, particularly if sufficient structures of in-family care are not in place due to transnational family lives and financial pressures. Active ageing is is also difficult to envisage amongst some of the individuals, families and groups I am working with from countries such as Egypt, Afghanistan and Peru, many of who currently imagine their futures as continuous work(ing). Noor, 45, a schoolteacher from Alexandria, explains how she “hopes my children will take care of me, as I take care of them…if we are together, Inshallah, we will all be fine.” How, I wonder, will her 15-year old daughter take care of her Mother in years to come? What might potential future Grandparenting be like for Noor, as an Egyptian single Mother living in Milan in her 60s?

Image (CC BY) Shireen Walton

Ali, Hazara (44), from west Kabul works a number of jobs, including as a night-time lorry driver. His wife and children are currently in another northern European country with his wife’s family. Ali explained the following: “Of course for the future having money is fundamental, but it is also important if you are a helpful person, and do good things for people; for your family, for your people (Hazara), and for humanity.”

Image (CC BY) Shireen Walton

Noor’s investment in Italy seems to be long-term; her ever-strengthening language proficiency, her children growing up in Italy, attending school and speaking fluent Italian, the death of her parents in recent years back in Alexandria and her own severance from the rest of the family in Egypt means that she feels she is here to stay, intent on growing old near her children. For Ali, currently working in Italy and visiting his family when he can, the geographies of his and his family’s future remains unknown.

My ongoing task then is to consider how people are ageing in – and away from – their homelands, aided by smartphone connections, but in many cases lacking public voice, and/or not involved in many of the dominant culture’s organisations and groups dedicated to ageing, health, and wellbeing. I am continuing to explore about these issues in line with broader conversations about contemporary citizenship, the role of technology, the state and NGO’s, migration trajectories & biographies, and the ongoing categorisation of peoples into strategic kinds of subjects (Giordano 2014). The approach reflects my commitment to studying ageing across cultural lines here in Milan.

References

Giordano, C. (2014). Migrants in Translation: Caring and the Logics of Difference in Contemporary Italy. University of California Press.