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) Shireen Walton

In countries such as Italy, where there is an ageing population and a decline in birth rates, a crucial question is how respective generations are coping/will cope in the future with expectations for care? A key issue is the ‘sandwich generation’. This refers to middle-aged persons caught between, or ‘sandwiched’ by caring for both ageing parents and their children simultaneously.

In Europe, including Italy, academic research has highlighted the sandwich generation issue as a health concern, as well as a socio-economic one – particularly for women, whose roles as primary caregivers stem from deeply entrenched societal and familial expectations (Brenna & Novi 2015). For example, the (mental) health effects that this ‘in-between’ or bridge-like status has on women (daughter) carers (Amirkhanyan AA, Wolf DA. 2006, Coe N., Van Houtven CH., 2009), and the potential for anxiety and depression, relating to the emotional strain, lack of personal time, financial burdens and the general conflict created by carrying out multiple care roles (Barnett RC, Marshall NL, Singer JD. 1992).

Within my project, which focuses upon domestic and international migration, these issues are complicated by having to also take into account human mobility, and what happens when forms of care diversify across time and space, perhaps incurring physical remoteness, but also in some cases, new found digital intimacies?

Deidre McKay’s work (2012, 2016) is a compelling example of the complexities of care practices in transnational/migrant contexts. Within the global networks of Filipino migrant care workers studied over a number of years in the UK, McKay discovered what she terms an ‘archipelago’ (2016) of care practices taking place on– and offline. The concept helps explain how people create a sense of stability for themselves and their loved ones through practices of care exchange and co-operation within the acute circumstances of uncertainty that accompany migration.

With the communities I am working among in a ‘superdiverse’ (Vertovec 2006) neighbourhood of Milan, I am similarly exploring transnational webs of digital caregiving, particularly with respect to smartphones. I am seeing how people routinely traverse physical and digital attention, presence, and care, through social practices – from videocalling parents and grandparents in the park, to negotiating school or hospital lifts, to ordering home-delivered food. All of this is providing much food for thought as I slowly peel back the layers of the sandwich.

(CC By) Shireen Walton

References

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.

Barnett RC, Marshall NL, Singer JD. (1992). Job Experiences Over Time, Multiple Roles, and Women’s Mental Health: A Longitudinal Study, Journal of Personality and Social Psychology, 62: 634-644.

Brenna, E., and Novi, C, D. (2015). ‘Is Caring for Elderly Parents Detrimental to Women’s Mental Health? The Influence of The European North-South Gradient.’ Healthy Ageing and the Labour Market (HALM) Working Paper 1.

Coe N., Van Houtven CH., 2009. Caring for Mom and Neglecting Yourself? The Health Effects of Caring for an Elderly Parent, Health Economics 18: 991-1010

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

Rubin RM, White-Mean SI. (2009). Informal Caregiving: Dilemmas of Sandwiched Caregivers. J Fam Econ Iss 30:252–267.

McKay, D. (2012). Global Filipinos: Migrants’ Lives in the Global Village. Indiana University Press.

McKay, D. (2016). An Archipelago of Care: Filipino Migrants and Global Networks. Indiana University Press.

Vertovec, S. (2007). ‘Superdiversity and its Implications’ in Ethnic and Racial Studies, Vol. 30, Issue 6: New Directions in the Anthropology of Migration and Multiculturalism.