Photo (CC BY) Laura Haapio-Kirk

Someone recently told me about how he encourages his 86-year-old mother, whom he lives with, to use her home blood pressure monitor every day and record her readings in a notebook. He said that doctors had prescribed her medication to lower her blood pressure, which she did not like to take. His solution was to turn to traditional Japanese medicine which he explained is tailored to the individual’s body, rather than western medicine which relies on a universal concept of the body. He was able to track the success of this approach through the home monitoring kit, and now her blood pressure is back to normal. This story reveals how infrastructures of care are made up of various integrated systems – that blockages in the form of non-adherence may reveal alternative routes by which people navigate care and self-care.

I am part of a reading group at Osaka University hosted by Gergely Mohacsi and Atsuro Morita. A few weeks ago we discussed Morita’s recent co-edited volume called ‘Infrastructure and Social Complexity’ (Harvey, Bruun, Morita 2017). He explained that a recent focus on infrastructure in social sciences, indeed an ‘infrastrucutural turn’ in anthropology, is a result of infrastructures becoming increasingly precarious and therefore more visible. Ageing infrastructures are becoming more and more tangible as we bump up against cracks in roads and other markers of decay. Infrastructures are systems that should enable things to flow, whether that’s water, electricity, goods, or people. But what happens when people are disconnected from infrastructures, or for whatever reason the flow is blocked?

Photo (CC BY) Laura Haapio-Kirk

I began to think about how smartphones are integral to navigating many of the infrastructures that enmesh us, for example through maps that visually place you within an infrastructure of roads, or health apps that extend the infrastructure of a national health service towards more individualised care. However, as digital technology becomes more integral to health services will people with limited access (through lack of digital literacy, or affordability for example) face increased marginalisation from infrastructures of care? And how are health professionals to identify blockages in the flow of care before it’s too late for individual patients? In such cases where care is not received, it is not only the infrastructure which is revealed to be vulnerable, but individuals themselves.

A couple of days after the seminar I happened to read a newly published article titled ‘Thinking with care infrastructures: people, devices and the home in home blood pressure monitoring’ (Weiner and Will 2018) in which the authors use the concept of care infrastructure to look at the variety of people, things and spaces involved in self-monitoring using a blood pressure device. Their work reveals self-monitoring as a socio-material arrangement that expresses care for self and for others, as opposed to focusing only on the individual and the device: “Specifically, our analysis has drawn attention to the range of local actors and work involved in the practice of self-monitoring, even in the case of consumer technologies. Through this attention to work, monitoring may also come to be seen as involving not just data, but also care amongst kin, family and colleagues.” My intention for my research was always to look at smartphones as situated within wider practices and things including other technologies and people, but thinking specifically in terms of infrastructure expands my scope and gives rise to questions about how multi-layered flows are connected (or not), ranging from state level, to family based care.

References

Harvey, P., Jensen, C. B., Morita, A. (2017). Infrastructure and Social Complexity. Routledge

Weiner, K. and Will, C (2018) ‘Thinking with care infrastructures: people, devices and the home in home blood pressure monitoring’ in Sociology of Health and Illness 40: 270–282. doi:10.1111/1467-9566.12590.

(CC By) Laura Haapio-Kirk

Yesterday I met a woman who told me about her grandmother who lived until the age of 99 years and 11 months. She told me how she lived alone in the countryside yet was busy every day up until the end of her life. In her later years she took it upon herself to care for the mountain behind her house, focusing especially on ridding it of weeds. Her granddaughter claimed this daily (and apparently endless) work was one of the main reasons why she maintained her health up until the end. Such stories have been told repeatedly to me in the three weeks since arriving in Japan. Stories of elderly people maintaining their health by cultivating vegetables, teaching traditional arts, or indeed weeding mountains, abound.

(CC By) Laura Haapio-Kirk

From the conversations I have had, there appears to be a social expectation for an individual to maintain an active life for as long as possible and to continue to contribute to society in old age. This can also involve minimising the appearance of frailty and dependence. Another woman told me of how her grandmother, who also lives alone, makes use of a local health facility which picks her up in a minibus twice a week. However, she does not let the minibus collect her from outside her house, preferring to walk around the block so that her dependence on institutional support will not be visible to the neighbours. For this elderly woman, the fact that she lives alone and not with her family gives rise to sense of shame. She continually puts pressure on her children and grandchildren, asking when they will move closer to take care of her.

What is fascinating to me is the tension between an individual’s responsibility for self-care and the social motivations for maintaining one’s health. As Japan undergoes a shift towards a more individualised society (Allison, 2013), consequences such as loneliness and isolation are felt particularly by the elderly, especially if they are used to living in traditional multigenerational households (known as ie). However, my project focuses on the middle-aged who are caught in the middle of these tensions. They both desire the privacy and independence of living apart from parents, while wanting to fulfil their sense of filial piety. The couple with whom I am staying are both in their 60s and close to retirement. Their house is attached to that of the husband’s parents who are in their 90s and mostly independent. The elderly parents shop and cook for themselves and I have witnessed only rare interaction between the two households. The main mode of communication is an interphone system which buzzes sometimes in the evening, for example when the grandmother wants to share gifts of food she has received from the temple, or simply to let her son know that she is going to bed. While the elderly parents do not own a telephone, the interphone allows them to maintain a separation while facilitating daily communication. As monitoring and smart home technology becomes more commonplace, it will be interesting to see if this technology accelerates the trend towards an individualised society by facilitating care at a distance.

References

Allison, A. (2013) Precarious Japan. Duke University Press