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Infrastructures of Care

Laura Haapio-Kirk19 April 2018

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.

Looking to the Future

Marilia Duque E S3 March 2018

Author: Marilia Duque

By the year 2050, the Brazilian population over 60 years old is expected to grow from 24 million to 66 million[1]. Fortunately, my first impression of the District of Vila Mariana, in São Paulo city, where I have been conducting ethnography since January, is that there are already innumerable initiatives for the elderly, both public and private.

In addition to public health units, there is the AME-IDOSO for example, a centre dedicated exclusively to the care of people over 60, taking referrals from other health units in the city of São Paulo. It provides examinations, medical appointments and treatments, as well as activities such as dance classes. Just a few blocks away, you can find the Elderly Coexistence Centre (NCI), also subsidised by São Paulo City Hall. If you are 60+ and live in the Vila Mariana District you can join a large number of activities such as knitting and crocheting, fitness, circular dancing, senior dance, manual work, pilates, painting on canvas, chanting, memory games and rhythm dancing. I went there the week before the carnival. When I arrived, it was snack time. While one group were doing a dance class in the lounge integrated into a beautiful garden, another group were chatting and eating, all dressed up in traditional carnival ornaments. The worker told me that the menu takes into account the food restrictions and needs of the participants.

(CC BY) Marilia Duque

During this first month, I have already mapped five squares in the neighbourhood, all of them with gymnastics equipment, in another São Paulo City Hall initiative for people over 60 called “Longevity Playground: Happiness is Ageless”.

(CC BY) Marilia Duque

But if you keep walking you will also see many gyms offering activities for the elderly with special prices, not to mention Aqui Fitness, which has a program of physical activities developed by a geriatrician. And just a few minutes away, you can also exercise your mind and improve yourself; the Nossa Senhora da Saúde Parish offers an adult literacy course (20.4% of the population of Brazil over 60 is illiterate[2]), language classes and a Whatsapp course, especially for people over 60.

(CC BY) Marilia Duque

One of my ethnographic challenges is to investigate how the ageing population in the neighbourhood perceives these initiatives. Do they really work? Do they work for everyone? Could appearances be deceptive? This is an important point because Vila Mariana District is far from being a utopia. You can choose to see just the modern buildings that are rising everywhere among the two storey houses. But you will have some difficulty ignoring the Mario Cardin Community, a favela where more than 500 families live in precarious conditions, or the homeless people living on the streets.

(CC BY) Marilia Duque

But for the moment let us take this apparent wealth of amenities at face value. Actually, this raises a rather different question. Do Brazilian people have to get old before they experience something approaching the support and solidarity of an egalitarian state?

 

 

[1] http://www2.camara.leg.br/a-camara/estruturaadm/altosestudos/pdf/brasil-2050-os-desafios-de-uma-nacao-que-envelhece/view

[2] https://agenciadenoticias.ibge.gov.br/agencia-noticias/2013-agencia-de-noticias/releases/18992-pnad-continua-2016-51-da-populacao-com-25-anos-ou-mais-do-brasil-possuiam-apenas-o-ensino-fundamental-completo.html