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Nurse navigators and WhatsApp: an example of smartness from below

AlfonsoOtaegui8 December 2018

Photo by Alfonso Otaegui

Within the scope of the project Anthropology of Smartphones and Smart Ageing (ASSA), we are committed to work collaboratively with a local mHealth initiative, or any initiative that will improve the access to healthcare or the wellbeing of the populations among whom we are carrying our fieldwork.

At the beginning, before even starting my fieldwork, I envisioned this initiative as the creation and implementation of a bespoke mHealth app, which would respond to a necessity observed in the field. This approach implied spotting a gap in the site –a need not yet addressed but noticed by the ethnographer– and creating an app which would fill that gap. It was certainly a top-down implementation approach: I would give the users something they needed but were not aware they needed.

After a couple of months, I realized it would be wiser to simply describe an app people already used in a creative way, and bring this local idea to another place, where this idea could be helpful. This approach, which could be described as ‘bottom-up’, implies acknowledging the creativity of local populations in the adoption of communication technologies, what Pype (2017) names ‘smartness from below’. With the same aim of bringing good ideas from one place to another, we have also started in our team to build up a list of ‘best practices’ in healthcare throughout all of our field sites.

With this aim in mind, I will spend the last six months of my fieldwork in Santiago doing ethnography at an oncological center in a public hospital. This particular hospital is the only public one in Santiago having implemented a ‘nurse navigator’ model of healthcare (Devine 2017).

The navigator nurses work as mediators between oncological patients and the medical and bureaucratical system of a public hospital in a low-income area. Cancer treatments mean two complexities for the patient: the medical complexity of the treatment and the bureaucracy of the public health system. Different cancer treatments can have several effects on different systems of the body, so managing the treatment implies handling a lot of information. The treatment is based on a series of procedures (image exams, chemotherapy sessions, blood tests, etc.) which require prescriptions and appointments, and have to be carried out in a specific order, and in certain amount of time (otherwise the probabilities of success decline). Navigator nurses actually manage the treatment for the patient, as they have the expertise to deal with both kind of complexities.

According to oncologist Bruno Nervi, president of the foundation Chile sin Cancer (‘Chile without cancer’), there are around 100 oncologists in Chile, when 400 are needed (55.000 people are diagnosed with cancer every year) (‘La Fundación Chile sin cáncer (…)’ 2018). Given the high number of patients, oncologists do not have the time to explain all the details of the treatment. The nurses working at the chemotherapy room face the same problem, as they try to fit in as many patients on a day as possible. The nurse navigators then, fill in this gap by educating the patient on the details of the disease and its treatment and mediate between the patient and the complex bureaucratical system of public healthcare in Chile. They make all the appointments for exams, blood tests and the like –which requires a lot of paperwork– and stay in touch with patient in case this has any doubt or question. These dedicated nurses constitute a human factor in healthcare that no app can replace. The nurse navigators, however, do use an app that is the most commonly used messaging app amongst patients: WhatsApp. According to the navigator nurses, WhatsApp gives them the chance to use various means of communication depending on the particularities and necessities of every patient: some prefer a phone call, some other need to see the info written in a text message, other will be reassured if they see a picture of the prescription or an exam order, some need an audio message they can listen to several times in order to understand the meaning (most of the patients are low-income people with low levels of education). Besides, nurse navigators are available for the patients for any doubt or question they might have. These nurses are there for them, to answer their questions and to comfort them, as the treatment and this relation of distant care can last for years.

Daniel Miller, principal investigator of the ASSA project, recommended in his last book ‘The Comfort of People’ on hospice patients and the use of new media, that it would important to create a patient/carer charter of new media use (2017: 218). The usage of WhatsApp by these nurse navigators actually follows a protocol which developed out of their experience in the last couple of years. I will attempt to describe this protocol and app usage and build up a model. I really hope it will be possible to bring this locally developed good idea to other public hospitals in Chile.

References

Devine, A. (2017, April 3). The Nurse Navigator: A Patient’s Compass On The Healthcare Journey. Retrieved from https://nurse.org/articles/nurse-navigator-career-path-salary-job-description/

La Fundación Chile sin cáncer y su contribución para cambiar la historia del cáncer en Chile. (2018, October 15). Retrieved from https://www.uc.cl/es/la-universidad/noticias/31765-la-fundacion-chilesincancer-y-su-contribucion-para-cambiar-la-historia-del-cancer-en-chile

Miller, D. (2017). The Comfort of People. Cambridge: Polity Press.

Pype, K. (2017). Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa. In C. C. Mavhunga (Ed.), What Do Science, Technology, and Innovation Mean from Africa? (pp. 97–115). Cambridge, Massachussetts: The MIT Press.

Empty nesters and ‘under-occupied’ homes — by Pauline Garvey

LauraHaapio-Kirk14 October 2018

Quinn, David 17/04/15, If grandparents went on strike, we would all be sunk, The Irish Independent, available electronically as https://www.independent.ie/opinion/if-grandparents-went-on-strike-we-would-all-be-sunk-31149507.html

Amongst the proposals for the recent Irish budget 2018, government ministers looked to the grey vote and weighed up options for a grandparent grant, reported on in the media as the ‘granny grant’.  The idea was advocated by Minister for Transport, Tourism and Sport, Shane Ross, who calculated that 70,000 grandparents could be eligible for the grant, costing the state €71 million a year. The proposal was based on the widespread recognition that grandparents undertake a substantial burden in a country where childcare is exorbitantly expensive and state subsidies limited. Many young couples turn to their retired parents to look after their offspring, and these grandparents undertake their labour often in their own homes. A study from 2015 found that 60% of grandparents looked after their grandchildren once a month, while one in five looked after them more than 60 hours per month.

At the same moment as talks of the granny grant circulated however, the same minister argued in favour of introducing a ‘granny-flat grant’ in order to encourage older people to transform the upper floors of their houses and rent them to lodgers, thus contributing to the housing pool and giving elderly householders a source of income. Piloted in one house in north Dublin, the granny-flat grant is far more controversial among people I meet in the course of my fieldwork.

One woman complained that it is seemingly fine for grandparents to bear the brunt of childcare but somehow their undisputed rights to their own home is cast in doubt. As she said ‘my parents worked their whole lives and paid tax, as did I. I inherited this house and paid for its upkeep from my wages since I started working fifty years ago. But now “the boys” are talking of taking my first floor?’

Another woman commented that the logistics of building a kitchen and finding a suitable tenant seemed a daunting task. While a third pointed out that ‘no one expects a 40-year old singleton in a 3-bedroom house to downsize, so why should I?’ In media reports there is no sign that the search for ‘under-occupied’ houses includes all spacious residences in the state, but instead focuses squarely on the homes of the elderly, and occasionally those in social housing. One question that this prompts is why does the idea of under-occupied housing seem to apply only to the elderly, leading some of my research respondents to feel that their right to their own homes diminishes with every passing decade?

Togetherness is Strength: “making light the heaviness on one person” – by Charlotte Hawkins

ShireenWalton1 October 2018

Author: Charlotte Hawkins

The ASSA project is concerned with older people’s experiences, particularly related to health, and the impact of mobile phones on their lives. In Godown, my fieldsite in Kampala, this translates to a focus on the ways older people mobilise support for the health of an individual across family and community networks. Throughout Uganda, savings groups are a notable model of community support for individual health, popular particularly amongst the urban poor (Nakirya and State, 2013). Typically, a group of people meet weekly to save money together, with an opportunity take small loans from the savings. The Ugandan government have recently started to encourage savings groups “as a way of pooling resources together in order to facilitate development”[1].

To better understand the nature of community support in Godown, I’ve registered as an active participant of a savings group of 15 members, predominantly older men, all from Acholiland in Northern Uganda. The group name translates to ‘Togetherness is Strength’ and was founded by a group of community elders after a child was stillborn at the local government hospital; the child’s father had struggled to fund the transportation for the burial in his home village in Northern Uganda, “he had to pool resources within the night, so he saw it was a very big challenge if we had not helped him. So that was the birth of the group”. Over 5 years, the fund has accumulated about 20 million Ugandan shillings ($5250), which means there’s now a collective resource for emergency loans. As explained by the group Treasurer, this is particularly useful in times of poor health, “in our community, the income levels are very low, so in the event of one of them falling sick, he cannot even feed himself”. They also recently bought one young man a motorcycle for business purposes, which he pays off in monthly instalments with interest, later to be shared amongst the group. Every Sunday morning, they hold a meeting in a local bar, in which savings are counted and group elders advise their younger members (see image below).

Savings group meeting in Godown. Image (CC BY) project PI Daniel Miller

Whilst ensuring monthly contributions and loan repayments are maintained can be a challenge, the group represents the possibility of security through mutual collaboration, fundamental to individual, family and community health in Godown more broadly. As explained by the Vice Chairman, it is a “means of assisting ourselves, in times of grievance or happiness. We thought we should come together to form an association and make light the heaviness on one person.” Amidst conditions of socioeconomic precarity, savings groups such as this offer a form of risk mitigation through social insurance. There meets the traditional (ritual, conviviality, group solidarity) and the economic (financial and legal obligation, commercial organization) (Ardener, 1964: 222) ideals of this community, manifesting the experience of elder-led ‘togetherness’ in Godown.

Savings group meeting in Godown. Photo (CC BY) Charlotte Hawkins

References:

  • Ardener, S., 1964. The Comparative Study of Rotating Credit Associations. J. R. Anthropol. Inst. G. B. Irel. 94, 201.
  • Nakirya, J.W., State, A.E., 2013. “Nigiina”s as Coping Mechanisms of Peri-urban Low-income Mothers in Kampala, Uganda. East. Afr. Soc. Sci. Res. Rev. 29, 31–57.

[1] https://www.newvision.co.ug/new_vision/news/1485733/museveni-tours-kampala-wakiso, accessed 15.09.18