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Elder care beyond the household

By charlotte.hawkins.17, on 20 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.

 

 

 

Mobile Money & Elder Care from Kampala

By charlotte.hawkins.17, on 22 September 2019

Calling and mobile money are the most ubiquitous uses of mobile phones in the Kampala fieldsite. This connects people to their relatives across distances, allowing people to check on family or request assistance. Mobile money is often lauded as an example of adapting technology to requirements ‘from below’ (Pype, K., 2017), offering financial flexibility and connection (Kusimba et al., 2016: 266; Maurer, 2012: 589). With 33 mobile money vendors in the low-income neighbourhood where fieldwork was conducted, it is the most convenient and accessible platform for saving and transferring money.

Various people in Lusozi explained how they provide for their parents and relatives in the village without visiting them as “you can send money on the phone”. People sending money take cash to an agent, who arranges the transfer to the recipient’s phone number via their mobile.  Whilst relatives living in rural areas may be able to grow their own food, money is necessary for other amenities, transport, school fees, hospital bills, and burial costs. As one woman explained, if she wasn’t sending her parents money, they would have no other source of income; recently, her mother had a stomach ulcer, so she sent her money to go to hospital.  And from the perspective of an elder in the village in Northern Uganda, “life’s easier now with phones”, as they are able to communicate family problems with relatives in the city and mobilise necessary funds. This also exacerbates the burden of care for urban relatives. A local councillor in Lusozi explained how he bought his sister in the village a smartphone in order to make communication easier between them. But he actually finds the connectivity has made life “a bit harder” for him, as it has increased his obligation; when people have problems, they can immediately let him know and he’s expected to find money for them. Before, news of a death could take a week to reach him, by which time he may have even missed the burial and the accompanying financial obligations.

In a survey of 50 respondent’s phone use, only 3 people said they had not used mobile money in the past 6 months. Those who had used it sent and received money 3 times a month on average. We asked them about the last 3 times they had sent or received mobile money, who the person was, the amount and reason for remitting. Of 130 recorded remittances, the average amount sent was just over 200,000ugx, ranging from as little as 10,000 to 10,000,000ugx. Mostly, remittances were sent or received from siblings (28%), parents (12%), friends (11%),  and customers (10%). Sometimes people had deposited money for themselves, using their phone as their bank. The greatest proportion of remittances (28%) were for ‘help’, which could include money for upkeep, food, ‘pocket money’ or gifts. This was followed by remittances for health purposes (25%), which could include hospital bills, medicine, transport to hospital and surgery costs. 6 of these transfers were received or forwarded by the respondent in a chain of remittances, for the purposes of supporting older relatives. For example, one respondent had received 200,000ugx from her daughter, in order to help her take her mother in the village to hospital; or another who received 30,000 from their Aunt for their grandmother’s hospital bills. Perhaps the older person was unable to receive the money themselves, or perhaps other relatives weren’t trusted to pass on the money.

As economic anthropologist Bill Maurer notes, mobile services such as mobile money are appropriated within existing communicative networks (2012: 593). These instances of phone use demonstrate how mobile phones can provide a platform for intergenerational care between the city and the village. This works against a pervasive academic, public and everyday discourse about the declining social position and experience of older people in Uganda and Africa more broadly (e.g. Nzabona and Ntozi: 2017; Nankwanga et al., 2013; Van Der Geest, 2011; Oppong, 2006; van der Geest, 1997), often associated with broader contextual shifts, such as the urbanisation and technologization which have necessitated and facilitated mobile money practices. Research participants often lamented the Westernisation, increasing materialism and individualism, of the younger ‘dotcom’ generation exposed to outside influences. But in these everyday instances, ‘dotcom’ technologies are also shown to up-hold family support and obligation towards older relatives, despite greater distances between them.

References:

  • Kusimba, S., Yang, Y., Chawla, N., 2016. Hearthholds of mobile money in western Kenya: Hearthholds of mobile money in western Kenya. Econ. Anthropol. 3, 266–279. https://doi.org/10.1002/sea2.12055
  • Maurer, B., 2012. Mobile Money: Communication, Consumption and Change in the Payments Space. J. Dev. Stud. 48, 589–604. https://doi.org/10.1080/00220388.2011.621944
  • Nankwanga, A., Neema, S., Phillips, J., 2013. The Impact of HIV/AIDS on Older Persons in Uganda, in: Maharaj, P. (Ed.), Aging and Health in Africa. Springer US, Boston, MA, pp. 139–155. https://doi.org/10.1007/978-1-4419-8357-2_7
  • Nzabona, A. and Ntozi, J. (2017) Does urban residence influence loneliness of older persons? Examining socio-demographic determinants in Uganda. Unpublished
  • Oppong, C., 2006. Familial Roles and Social Transformations: Older Men and Women in Sub-Saharan Africa. Res. Aging 28, 654–668. https://doi.org/10.1177/0164027506291744
  • Pype, K. (2017) ‘Smartness from Below’, in What do Science, Tehcnology and Innovation mean from Africa? eds Clapperton Chakanetsa Mavhunga. MIT Press
  • Van der Geest, S., 1997. Between respect and reciprocity: managing old age in rural Ghana. South. Afr. J. Gerontol. 6, 20–25. https://doi.org/10.21504/sajg.v6i2.116