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Coronavirus and social isolation: 16 insights from Digital Anthropology

GeorgianaMurariu20 March 2020

Source: Unsplash https://unsplash.com/photos/tDtwC11XjuU

Blog post by ASSA (Anthropology of Smartphones and Smart Ageing) team

We recently conducted nine 16 month studies on the use of smartphones by older people, which is the main source of insights here. You can read more about the project here.

This is a summary of insights from our previous research intended to be on benefit for individuals or institutions considering  digital health initiatives for older people. It is a preliminary list and we hope to deepen our contribution through subsequent blog posts.

Additional insights are also drawn from Daniel Miller’s The Comfort of People (Polity, 2017), a book about the social universe of hospice patients, which includes recommendations for how to use new media to assist isolated older people to maintain social relationships.

1) USE EXISTING APPS

Our research found that older people are often very reluctant to use a new app. When trying to assist older people in using online resources it is best, if possible, not to suggest new apps. Find a way of achieving your aims through an app they already regularly use, such as WhatsApp.

2) EMPATHY

Social isolation has been a common experience for older people, especially those who have lost a partner. Isolation is particularly common in the UK. One result of this virus is that people of all ages are now experiencing isolation. They may thereby gain greater empathy with the lived experience of older people living alone or in isolation.

3) POLYMEDIA

Our research shows that today each individual has particular preferences for how they prefer to communicate. For example, a person might be fine with the webcam, but only if you text first so that they are prepared. It is important to learn about an individual’s media preferences and then respect these.

4) FORUMS

The hospice research found that people who are struggling (in that case it was mainly cancer patients) find forums of considerable value. But they divided into two equal groups. One group only wished to exchange such intimate problems when the forum was entirely anonymous; the other was only comfortable communicating with identifiable others. We need to develop and proliferate both kinds of forums.

5) FREQUENCY, NOT CONTENT

For many older people what matters is not what is contained in communication, but its frequency. Knowing that people are interested enough to make some kind of contact is far more important than anything those people actually say.

6) THE FINE LINE BETWEEN CARE AND SURVEILLANCE

This point applies to personal relationships, where older people may appreciate being in constant contact, but care greatly about autonomy and dignity. It also applies to the macro level, as where some people regard China’s response to the virus as unacceptable authoritarianism, and others see it as an entirely justified expression of how a state cares for its citizens.

7) SMART FROM BELOW

Most policy suggestions are implemented by policy experts in a ‘top-down’ manner, thereby affecting the bulk of the population, but the widespread use of digital technologies produce a democratising of creativity and ingenuity. Anthropologists seek to learn from the creative responses of ordinary people, accumulate examples (e.g. https://covidmutualaid.org/) and use these to educate others.

ASSA will soon be publishing a 150-page manual of protocols on how to use WhatsApp for health, created by Marilia Duque, who is a researcher on our team. These are not her own ideas, but best practice examples gathered from 16 months of observing how older people in Brazil used smartphones for health purposes. We need to establish platforms where people can share what they are learning from the creative response of ordinary people.

8) CARE AT A DISTANCE

Digital technologies have made the practice of care at a distance commonplace. This occurs in different ways. For example, working with older people in China and Japan, we found they have shifted to much greater use of visual communication, such as stickers and short videos, as a way of expressing care. These people found it easier to convey affection through these means, rather than through more conservative traditions of face-to-face encounters.

9) WHATSAPP SUPPORT

Today many people form WhatsApp groups with family and friends to support isolated people or patients. This is highly effective. So we need to ensure that everyone is aware of its benefits. Marilia Duque is advocating a system of `WhatsApp Angels’ in Brazil in response to the virus. As it happens, Whatsapp has already created a ‘Coronavirus Information Hub’ which includes examples of how to use the app to stay in touch with loved ones or seek up-to-date health information on the virus. The Information Hub can be accessed here.

10) WEBCAM

In a phone call, older English people traditionally tend to say they are fine, even if they are at death’s door. There are many advantages to connecting via webcam, which allows one to see how a person is actually doing. Many might find it helpful to have their webcam switched on even when people are not actually talking, since this is more akin to co-present living together.

11) NON-TECH-SAVVY ELDERLY PEOPLE

Coronavirus is about to cause a crisis for those elderly people who may never learn to use smartphones, as access is stopped for visitors to care homes. A helpful device is the Amazon Echo Show, since it can conduct webcam conversation through simple voice commands such as ‘Echo, videocall Mary’. Set-up requires another person using an Alexa App and is quite complex but the technology does work.

12) FACEBOOK

Facebook has shifted from a young person’s platform to use more by older people and community groups. At this point, the main advice is for young people to remain on Facebook where they will be able to share more family information, jokes, and other material with those older people.

13) CONFIDENTIALITY IS LESS IMPORTANT

The hospice research mentioned above suggested that, so far from protecting people, an obsession by institutions with privacy and confidentiality has become a major source of harm. People who are ill were more concerned to ensure that relevant people were informed about their condition, rather than that strangers might also know about their condition. Privacy is important, but tight controls over data because of concerns over litigation can cause considerable harm to patients.

14) PATIENCE AND PATIENTS

Older people may want and need to learn about how to use smartphones and similar skills, but they mainly reported that young people do not help teach them. They become irritable and impatient and take the phone away to make changes. With social isolation it will become even more important to help people learn to do things for themselves.

15) KITEMARKING

Googling for health information is now a ubiquitous part of how people respond to illness or the fear of illness. Users, influenced by commercial sites or scare stories, can end up more anxious and misinformed. Kitemarking has improved with the foregrounding of more authoritative sources and is promising to do more. Google have already implemented this, prompting UK-based internet users to consult the WHO and NHS pages when the term ‘covid 19’ is entered into Google. However, Google health enquiries are still often headed by commercial and sponsored sites.

16) A GLOBAL EXPERIMENT

Right now, the world is embarking upon a vast global experiment, by default: a massive shift of education, work and sociality to online. This is an important time for digital anthropology to try to help assess any associated problems that arise from these strategies, as well as any long-term benefits.

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.