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Vulnerable margins or robust mainstream? Cocooners after lockdown

paulinegarvey18 June 2020

by Pauline Garvey and Bláthnaid Butler

A Dublin City Council notice placed in public parks

After two months of lockdown, Covid-19 restrictions started to be lifted in mid-May in Ireland. Instead of having to stay at home or venture only 2 km from home, people were allowed to travel 5 km and then finally, anywhere in their own county. As in other countries, the sense of excitement was palpable and many Dubliners spoke of their sense of relief in being able to meet friends, albeit with social distancing and venture further than they had for several weeks. Sports reopened to a limited degree, particularly non-contact sports, and among them, golf clubs and tennis courts were opened.  Debate continues about whether masks should be mandatory in supermarkets and on public transport. However, the measures put in place to protect older people who were cocooning is being received as a mixed blessing.

Some over-70 years old find themselves conflicted between recognising the necessity of cocooning on the one hand, while feeling pigeonholed in the category of ‘vulnerable’ on the other. Being ‘at risk’ implies being sheltered and protected but ultimately also denied the same freedoms as other members of society. One place where this was most visible was in the opening of sports clubs, particularly tennis courts, which were ‘off limits’ to the over 70-year olds.  Aware of the bubbling controversy, chief executive of Tennis Ireland Richard Fahey commented that “We are aware that there is an issue. Over 70s feel they should be allowed to go out and play tennis. But they are not the only group that is restricted in this phase”[i]. People who see themselves as fit and agile thus find themselves excluded from their regular hobbies, not as something self-enforced but as an imposition for ‘their own good’.  And this is a particular problem for those that do not see themselves as vulnerable or who consider that the category of vulnerable is too narrowly assigned to a chronological age rather than a health condition and which does not reflect their vitality and overall general health. This issue is central to our research in ASSA and discussed in detail in our forthcoming publications[ii].

It is not surprising, then, that when it comes to food, such issues arise and are frequently fraught.  Anthropologists have long been aware that the rituals around food and producing meals is pivotal to the construction of the home and family[iii]. Mealtimes rules and routines create family roles and socialise family members. We learn about the duties of gender, care and morality through the work of provisioning and preparing food. But when is it appropriate to express reliance or autonomy? And when do practices of care transition from a help to a hindrance? One ‘cocooner’ complained that when she first emerged in the public sphere and walked around the shops, she sensed people were looking at her and that she didn’t feel welcome.  She described her sense of surprise because she felt so self-conscious that she eventually retreated home.

During the lockdown, community organisations were mobilised to shop for cocooners. In Dublin, local community groups such as church groups, scouts and sports clubs set up groups on WhatsApp to shop and drop for people who needed help. Amongst families too it was common for adult children to bring weekly provisions to their parents so that they could stay home. While adult children prefer to do the shop because ‘it’s no bother’, we have found several instances where the parents prefer to be autonomous. One couple watered down their milk rather than ask their daughter to pick them up some more. Reasons for this included a mix of emotions such as fear of being a burden, exposing her to further risk and being prepared to make ‘small sacrifices’ or ‘do without’ because they decided it was ‘non-essential’. However, as soon as it was possible to venture out and shop for themselves, cocooners have often chosen to do so, preferring some risk in order to express their autonomy. At this particular moment, when the lines between safe and unsafe, lockdown or openness are blurred, older people hover between social categories that fluctuate between the vulnerable margins or the robust mainstream. When there is a lack of clarity over what is safe or not, it is worth remembering that efforts to keep groups safe not only impinge on their physical wellbeing but may also work to pigeonhole and marginalise them in unanticipated ways. Lockdown practices are not only rationalised actions but are saturated with sentiment and often conflicted.

 

[i] Watterson, J. 11/05/20 ‘Tennis courts to remain off limits for over-70s after May 18th for health reasons’. The Irish Times, available online https://www.irishtimes.com/sport/other-sports/tennis-courts-to-remain-off-limits-for-over-70s-after-may-18th-for-health-reasons-1.4250613, accedes 11/05/20.

[ii] For example see Garvey, P and D. Miller (forthcoming) Ageing with Smartphones in Ireland: When Life Comes Craft. UCL Press.

[iii] Mintz, S. W., & Du Bois, C. M. (2002). The anthropology of food and eating. Annual review of anthropology, 31(1), 99-119

Elder care beyond the household

charlotte.hawkins.1720 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.