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.

fig. 1

11 am, UK time, 13^th September, in China it’s already early evening. Mrs. Tong (59), one of my research participants in Shanghai, sent me a WeChat animated sticker of a bright full moon surrounded by three joyful bouncing bunnies, saying ‘Happy Mid-autumn day!’ (fig. 1) This is just one of hundreds of stickers, emoji, short videos, or animated albums to do with the full moon or moon cakes that circulated among friends and family members on WeChat, the dominant social media platform in China (fig. 2) on the day of Chinese mid-autumn festival.

Falling on the 15^th of the 8^th month of the Chinese lunar calendar, the mid-autumn festival, or the ‘moon festival’, happened to be 13^th September this year. Untouched by ‘western’ superstition surrounding Friday 13^th, my WeChat profile ushered in the warmest greetings and festival wishes from a wide range of WeChat contacts from China many from my Shanghai field site which I left this June.

Mid-autumn festival is said to be second important national festival next to the Chinese New Year. Traditionally, on the festival day, family members gather to offer sacrifice (e.g. moon cakes) to the moon, appreciate the bright full moon at night, eat moon cakes, and express affection and sentiment of missing toward family members and friends who live afar.

Well, ‘live afar’ probably will be redefined as Mr. Huang (75), another research participant in Shanghai, said as a goodbye wish: “Even living in the same city, friends meet on WeChat. Live near or afar, it matters much less once you are on WeChat. So see you on WeChat.” Mr. Huang is indeed right. Three months after leaving the field work, I still feel deeply involved in the loop of neighbours’ gossips or the troublesome relationship of mother and daughter-in-law. I constantly get updates about the daily quarrels between the cat living on the 15^th floor and the dog on the 20^th floor, the routine exercises and activities in the old people’s home 5,700 miles away from London, all thanks to WeChat.

Back in London, my colleague Marilia asked me whether it was difficult to leave the field site. I shook my head: it is not difficult, it is simply IMPOSSIBLE. It may very well be the same case for other anthropologists in the age of smartphone: we meet people on social media, be it WeChat, WhatsApp, Twitter, Instagram, or Facebook, so that even if there is an end to the field work, there will be no full stop to the constant connection with people from the field site online.

“How long will the full moon appear? Wine cup in hand, I ask the sky… Why then when people part, is the moon often full and bright? People have sorrow and joy; they part and meet again. The moon is bright or dim; it waxes and wanes. Nothing in history has ever been perfect.” Those melancholy words written on a mid-autumn festival 900 years ago by the great poet Su Shi, still influence nowadays Chinese people’s interpretation and aesthetic appreciation of the moon.

Every year, on this particular night, the bright full moon conjures the collective hallucination of ‘togetherness’ among Chinese people: no matter where you are, we are looking at the same moon, and we are bathing in the same moonlight together. Almost millennium ago, clever ancient Chinese have created the ‘mega-symbol’ moon to visualize and mediate the affections in long distance. Problem solved.

fig. 2

Alas, the perfect solution doesn’t work in the face of ‘time difference’ caused by really long distance in the ‘global village’. When my Chinese friends admired the full moon at night, I hadn’t even finished the first coffee during the day. However, before I saw the full moon on the sky, I had been bathing in the moonlight on WeChat during the day. One tends to think the full moon in the sky is more ‘real’ than the full moon on WeChat, but, is it? Would the moon in the sky be the same moon had it not been wrapped with the poetic imagination of ‘togetherness’ from generation to generation in China? If it is all about the shared imagination within the specific group of population, then the moon on WeChat shared among Chinese people is definitely more ‘real’ than the moon in the sky of the unlucky Friday the 13^th.

Sometimes I am wondering, had poet Su Shi lived in today’s world, on the grand mid-autumn festival, whether he would still ask the sky for the full moon, holding the wine cup high, or, would he be equally satisfied by sending the full moon on WeChat, holding the smartphone tight.