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.

Author: Marilia Duque, São Paulo.

Since March this year, I’ve been working as a volunteer in one of the WhatsApp courses provided by a Catholic Parish in my field site in São Paulo. Once a week, I meet around 10 students from 67 to 84 years old who are deeply committed to improving their WhatsApp knowledge and usage. Most of them report that their children don’t have the patience or the time to help them with their smartphones. They understand that their children work hard and have many other commitments in their adult lives. They don’t want to be a burden to their families. So they opt for a regular course^[1]. As one of my students Mrs. O. (71) puts it “considering all of that, do you think I would bother them?”

We started our classes as a very heterogeneous group with people who had never used WhatsApp before and people who already pay bills, buy stuff and book flights using their smartphones. After conducting interviews with some of them, I would say the group could be classified in two key categories: the ones who are afraid of  “being overcharged”, “erasing some important information” or “pushing the wrong button” and ruining the device itself and the ones who are disposed to take more risks, using trial and error as method, without any concern about spoiling the device. According to the survey Tech Adoption Climbs Among Older Adults  (Pew Research Center, 2016), lack of confidence is one of the main barriers that can “hinder some old Americans from going online and using new technologies”. One third of seniors feel little or not at all confident when using electronic devices (including smartphones) and because of that feeling three-quarters of them say they need help to set up and start using a new device.

One of my students, Mr. M. (72), said this fear of making mistakes is the key difference between old and young people. If youngsters say something wrong, they laugh at themselves, because they are allowed to make mistakes. However people are not so tolerant with older adults. Because of that, he said, many of his friends feel so embarrassed when they fail that they became too scared to even try. But what could be achieved if all this fear is gone? According to the same Pew Research Center study, once the seniors go online, they engage “at high levels with digital devices and content”. Among older adults who own a smartphone, for example, 76% uses the Internet several times a day or more.

In my WhatsApp course, as the group became more comfortable in making mistakes, I might say they learn more and faster. They now know almost everything about WhatsApp main features: how to create a group, how to share a picture, a video, a contact or a location, how to manage WhatsApp downloads to save data, how to use WhatsApp web. They also learned some tricks a regular WhatsApp user might ignore. For example, each student now has his/her own contact in his/her WhatsApp, so they can send notes (voice and text) to themselves to remind them what to report to a doctor, what to buy at the supermarket and so on. It is great but not enough. They want to go further, so now we just decided to move forward with other apps.

After all, my challenge now is to cater to so many different interests and needs related to smartphones. As my colleague, Alfonso Otaegui, who is also volunteering in smartphone courses in Chile, said in his previous post here, old people have different expectations of smartphone usage. As a teacher, this might help me make more effort to show empathy in class. As an ethnographer, this represents a great opportunity to understand how their particular needs and curiosity about pictures, books, music, travel, languages, cooking and shopping apps reflect the very particular way each of them experience age and how smartphones can help them to get what they want.

^[1] If we consider the POnline2017 Survey from Acessa SP, an initiative for digital inclusion in São Paulo that provides free access to internet and many free courses to help users to improve their digital skills, over 70% of respondents learned to use the internet by themselves or attending to courses and just 4% could count on their relatives’ help.