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Reducing Hypertension in Trinidad and Tobago

alex.clegg4 August 2022

Author: Daniel Miller

The research project Anthropology of Smartphones and Smart Ageing which is now close to completion was always intended to also develop some practical projects to improve the welfare of the populations where we carried out our research. Many of the deaths that resulted from Covid in Trinidad and Tobago came through co-morbidities with diabetes and hypertension. Anthropological research by Trinidadian anthropologist Sheba Mohammid along with Daniel Miller suggested that while people were knowledgeable about diabetes, the contribution of salt to hypertension was largely unknown. We also found that most health campaigns in the area had received very few responses even when backed up by companies and government and that over the half the population were anti Covid vaccinations. We therefore tried to create our own independent campaign based on what we had learnt from our anthropological research including understanding the reasons behind anti-vaccination. For example, trying to focus on positive and creative possibilities rather than negative messages. We called the result our Chef It Up TT campaign.

The first phase of this campaign which ended on July 31st was a competition around healthy eating. Thanks to the indefatigable Sheba Mohammid and her team this produced exactly what we were hoping for. Within two months we could see a very active Facebook site with over 800 followers who had posted over 200 healthy recipes and effectively created a community of people discussing topics such alternatives to salt.

An entry for the Chef It Up TT competition

Please do have a look at our site at https://www.facebook.com/groups/chefituptt and then by all means try out some of these recipes !

In the next phase we will follow this up with a quiz on healthy eating to reduce hypertension which we are developing as a smartphone app.

Sixty may be the New Fifty but is Twenty Six the New Old?

alex.clegg14 April 2022

Anonymous illustrator in late 19th century Germany. William Ely Hill (1887 – 1962), a British cartoonist, produced a later, well-known version.

Author: Sheba Mohammid

In Trinidad and Tobago, we may not have Ponce De Leon’s fountain of youth, but we do have a pool. It’s technically an offshore sandbar, but we’ll save that ecology lesson à la David Attenborough for another time. In local folklore, taking a dip in our Nylon pool, can take 10 years off your appearance. But then what is age appearance, or biology, when as many of our research participants say they simply “do not feel their age”.

Here as elsewhere there are many popular clichés as to how sixty is the new fifty, or thirty the new twenty. It is not so much that people think they can transcend age, but frustration with the inelasticity of these categories, a revelry in defying expectations and complicating the linearity associated with ageing as fixed numerically and cumulatively in its standardisation of set expressions.

In fact, the group that emerged in my study as most commonly defining themselves as ‘old’ was actually twenty-something year olds who would regularly complain to me about their feelings of “getting old”. They brought up the topic of ageing more than any other group. Mona sighed with disbelief and exasperation when she told me she had turned twenty-eight that year. There was a shared feeling among many twenty-something year olds that when they crossed 25 and especially as they approached thirty, they were approaching a major milestone that marked the end of their youth. Whether this past phase of their twenties was enraptured by the indifference often associated with youth was not the point so much as the sense that they were leaving something intangible behind that was gone faster than they could ever quite grasp what it was. Much of this had to do with ideas of ageing being linked to ideas of responsibility, domesticity and stability and anxieties of being able to perform these. Many people felt that they had not reached as far as they were supposed to in starting a family, securing a house or finding a foothold in a career trajectory. These feelings were buttressed by feelings of being delayed even further in their prospects by the Covid-19 pandemic.

You may have noticed the picture at the start of this blog, William Elly Hill’s rendition of Young Woman, Old Woman Ambiguous Figure first created by an unknown German cartoonist in the late 19th Century. It is an illusion where if you stare long enough you will see an old and young woman in the same picture. This was the image that came to mind, a metaphor of sorts for the disruption of thinking of ageing as linear and a questioning of the convenient packaging of dichotomies and what they exclude in their delineations.

In my research it was commonplace for both male and female participants of all ethnicities aged 26 to 29 to say “I’m getting old” not ironically but as an exclamation of ageing as unwelcome, unwanted and certainly coming too fast. This discourse is part of a complex lexicon surrounding ageing in Trinidad and Tobago. Maturity embodied in terms like “getting big” or “being a big woman” were met with positive associations but the idea of “getting old” and ageing were often sources of dread. Twenty-something year old’s expectations of ageing were defined in opposition to a general sense of physical fitness and mental freedom from responsibility that they ascribed to youth. They saw this as their experience during school days bringing nostalgia to this period. “Getting old” was reflected in having additional responsibilities and growing weaker and out of shape. By comparison they simultaneously noted that their parents, grandparents, aunts, uncles or neighbours “looked young for their age”. These tensions regarding perceptions about “getting old” problematised the term and underscored the challenges of neatly ascribing age groups as categories and ageing as linear.

How these perceptions of ageing intersect with and impact health are also complex and often problematic. Firstly, when I talked to participants about their feelings of mental wellbeing, they often expressed anxiety and distress surrounding ageing and its negotiations. Secondly, participants often equated “being old” with “being sickly”. These constructions of ageing and health are laden with further tensions and contradictions. For example, participants in their twenties often express that they are “getting old” but do not equally lay claim to feeling that they need to be aware of health with a poignant “yet” often attached to their statements. Similarly, participants upwards from their thirties, forties, fifties, sixties and beyond often do not want to think about getting their blood sugar or blood pressure tested as these associations of ageing and illness are a downer and at odds with the Trinidadian sentiment that “Yuh have to live yuh life” with a subtext of clinging to vitality of youth rather than falling prey to the perceived trappings of ageing. Getting “sugar” (diabetes) or “pressure” (hypertension) are often framed among participants as diseases linked with senescence and not something to concerned about until bothersome or threatening symptoms appear. Doctors we spoke to argued that these beliefs delay testing and preventive health care, as they are seeing rising numbers of lifestyle diseases like pre-diabetes, diabetes, cardiovascular disease and hypertension among all age brackets. They also express concern regarding indications of these rising undiagnosed, “silent” killers as people admit that they do not get tested or only attempt to adjust their lifestyle factors like diet when they have fallen seriously ill.

This is one of the reasons when Daniel Miller and I thought of an applied project, we made the decision to be inclusive about ages and target a wide range of Trinis (Trinidadians) as our research demonstrates that many of the health challenges are linked to wider socio-cultural and systemic issues that are certainly not packed up into neat demographic categories of ageing. At first there was an urge that in studying ageing, I should focus on retired individuals or at least start with those aged over forty but in researching perceptions of Trinis, it became clear that understanding ageing, mobile phones and health necessitated deeper inquiry into a wider network of demographics. On the other hand, many people we spoke to about the potential project urged us to focus only on school children for our nutrition education campaign as they felt it was too late for everyone else who had already built their habits and would not be interested in learning or sharing ideas. We also want to challenge that assumption. Instead, we plan to create enjoyable formats that move away from top-down pedagogies and embrace learning from each other at all ages.