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The Challenge of Menopause – Daniel Miller

DanielMiller3 August 2018

Photo (CC BY) Daniel Miller

For a project concerned with health and mid-life, menopause is an obvious target. What specifically does an anthropological perspective add, first to understanding menopause and second to envisaging a positive digital intervention? One key anthropological component, which is the comparative perspective, will have to wait until the team completes its research, but from my Irish fieldsite there are many possible insights. The challenge is firstly that no two women have the same experience. Menopause can start in your 30s or 50s. It can be almost symptom-free or have dramatic effects, some of which may never end.

The anthropologist will focus on the way medical issues are inextricable from the social context. The effect can be on close relationships. As a pharmacist told me, Sometimes they come and say ‘I’m ready to kill my husband I think I’m going crazy’ very reassured when you say it could be the menopause”. Or women report that vaginal dryness makes it too painful to have sex. Women have told me that their mothers never mentioned menopause to them, or that they do or do not feel they can discuss the topic with their sister or close friends. Mostly they report that menopause is a topic that can only be broached through jokes. The impact might also be on wider relationships, such as to one’s work: “You might say to your colleague `could you just take over for a moment’ and then not explain why you would disappear, because you had a flush and you needed to remove yourself”.

Then there is the relation to wider medical authorities. Concerns about HRT or addictive sleeping pills may mean they prefer to consult complementary medicine rather than doctors. Knowledge seems to be a complete lottery, where some are well aware of the potential effects on bone density while others have never had anyone suggest this is something they might look into. Listening to women, within an ethnography, also alerts one to the considerable differences in perspective. One woman will give a feminist perspective about the need to rethink menopause as a celebration of a natural process, rather than merely a medical problem. While another, who is undergoing IVF and is desperate to have children, sees nothing to celebrate.

For us, the ASSA team, it is important that this same alertness to the social and wider context should manifest itself as the anthropological contribution towards delivering that will be of genuine benefit. One of the lessons from this research is that we need to see smartphone apps less as autonomous interventions and more as potential hubs. Different women will respond to different levels of information. There are those who are turned off by text and just want visuals, contrasted to those who want to read the medical journals. In my research so far, women have split equally between those who would prefer a discussion forum based on complete anonymity, to those who would only want to discuss these issues with people they can identity and feel some sort of relation to. In making relevant information more accessible all these factors need to be taken into account, but first and foremost comes listening to what a broad range of women say.

 

Avoiding Stress in Kampala’s “Jobless Corners” – by Charlotte Hawkins

ShireenWalton30 July 2018

Author: Charlotte Hawkins

Our health depends on how we conduct ourselves, what we eat, what we drink. …Alcohol has compromised a lot of health in Uganda today.  

(Elder in Kampala fieldsite, Godown)

A nationwide study by the World Health Organisation in 2016 found 10% of Uganda’s adult population have problems related to alcohol[1]. Excessive alcohol consumption can be a contributory factor to diseases such as cancer, mental illness and diabetes, as well as accidents, domestic violence, and other detrimental effects on family life. The drinking habits of some people in my chosen fieldsite, a low-income area in Kampala, are both a cause and consequence of socioeconomic problems in the home and beyond.

Drinking for leisure has long been ethnographically recorded as part of everyday life in Kampala (Southall and Gutkind, 1957: 22; Wallman, S and Bantebya, G 1996: 83). Today, gathering points are centred around bars serving home brews, waragi, ‘war gin’, or ajono, millet beer, and branded beers, whisky and gin. Groups of men, and a few women, sit around a large shared pot with long drinking straws. It is a chance to laugh, relax, tell stories and bond; what one community leader termed a “narrative exchange of ideas”. The home brews also offer an opportunity for women to make an income; small factories like those photographed below can be found across the country.

Women brewing waragi in Kampala fieldsite (above) and rural Northern Uganda (below)

Public drunkenness, “morning to sunset”, is the subject of censure. An elder in Godown thinks that drinking alcohol should be criminalised before 6pm, as it is in neighbouring Kenya. However, he also recognises that people resort to drinking out of frustration and boredom, with a lack of employment opportunities or “what to do”. As another pointed out, “you know if there’s no employment, people tend to start drinking, drinking without proper feeding”. The local councillor, whose job is to resolve disputes in Godown, finds that “over drinking” is the main cause of conflict, husbands beating wives who have lost patience with their spending. As the women’s leader in Godown explained, they are often left to provide for their families alone:

Their husbands drink. They don’t even help them. They just take. Now their place they call it ‘jobless corner’. Even those who are working, who work at night, they come very early in the morning to go and join them. So the little money they make from work, they spend it on drinking.

In some families, alcohol is bought at the expense of children’s education, further perpetuating the inaccessibility of employment. Laura Haapio-Kirk’s recent ASSA blog post examined the paradoxical relationship between overworking, stress and health in Japan. In Uganda, it is the absence of formal work opportunities which perpetuates a cycle damaging to personal, familial and communal health.

References

  • Southall, A and Gutkind, P (1957) Townsmen in the Making: Kampala and its suburbs, East African Studies. East African Institute of Social Research, Kampala, Uganda.
  • 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.

[1] http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_3.pdf,

Work, stress, and health in Japan

LauraHaapio-Kirk4 July 2018

Photo (CC BY) Laura Haapio-Kirk

“Because of my job it is not easy to feel Im living a healthy life. If you have a stressful life or stressful job it is a cause of ill-health. Work gives you stress but you need work to be healthy.”

This quote is from Tomoko san, a teacher who is near the age of retirement but is not considering retiring any time soon. She works six days per week and lives alone, her adult daughter living in another city. We met in the botanical garden and, after feeding turtles, we chatted overlooking a small lake and ate rice crackers that she had brought. We talked about health and in particular its relationship to stress which has surfaced as the most commonly cited source of ill-health in my conversations with people so far. She works hard and acknowledges that work stress, particularly social stress from colleagues and parents of students, causes ill-health. But at the same time she recognises that routine and purposeful work keeps her healthy. Her quote above is interesting because it captures this idea of work as both the main cause and prevention of ill-health, expressed in different ways by all of my informants. The routine and stimulation provided by work, especially of interacting with younger colleagues, has been cited as a way that people feel like they might retain their youth and stay healthy.

Diminished mental health, widely recognised by my informants under the umbrella term “stress”, does not appear to be as much of a priority to address as bodily health and fitness. Work and social relations are simply accepted as stressful because of a deference to hierarchical structures within social life. Colleagues often may not leave work until after their boss and then, if they are required to go drinking together, they also cannot leave the bar until their boss wants to. If a boss is insensitive to the exhaustion of their colleagues, this is known as power hara or power harassment. This kind of intense pressure from social bonds is often accepted as a source of stress and ill-health which people can do little about. As one informant told me with a sense of resignation “we (Japanese) have a lot of stress in daily life”. Unsurprisingly the mindfulness trend seen in Europe is also popular in Japan. However one of my informants said that mindfulness is just trendy and that people don’t really practice such activities in their daily lives. Japanese cultural activities such as tea ceremony and flower arranging (ikebana) are also supposed to be a form of paying attention and mindfulness, but as someone told me “ordinary people want to learn (such things) because its cool. For us, the mind is not so important, lifestyle is much more important. Mental health is not visible, whereas your body is, so people easily forget to take care of their mental health. How we look is very important.” One woman in her 40s confirmed these sentiments when she told me that the invisibility of mental health means that people often ignore warning signs and then reach burn-out stage. This is what happened to her while working as a designer, a job which often required 14-hour days. She subsequently quit the profession entirely and is now working as an administrator for a medium-sized company, where she feels less pressure to work excessively and therefore her health has returned.

Another person I have been getting to know is Hiroshi san, a 66-year-old nurse who also works 6 days per week. He tried retirement for 3 months but found that he wasn’t writing the novel he had planned to write, and instead felt anxious that others were doing more than him and being more productive, so he returned to work. For him, his peers are rivals who he feels in direct competition with, and retirement means dropping out of the race. Other people have told me that they don’t want to retire because it’s not healthy, they will just end up watching tv all day long, which they feel will shorten their lives. Work and “ikigai”, or purpose in life, are so bound up with health in Japan, yet in every conversation I’ve had people cite work as their main cause of stress and stress as their main cause of ill-health. This is a paradox I wish to further explore in the coming months.

Author: Laura Haapio-Kirk

Note: all names used are pseudonyms.

The fruits of ‘olugambo’ – by Charlotte Hawkins

ShireenWalton28 May 2018

Author: Charlotte Hawkins

In many ways, mobile phones have allowed people in Africa to overcome the limits of state bureaucracy (de Bruijn and van Dijk, 2012: 12). To further credit the versatile potential of mobile communication, and the need for it, these limits have recently started closing in on mobile phone use in Uganda with two particularly contentious issues. Firstly, an embargo has been issued on SIM card registration to ensure the validity of existing data following a spate of unresolved kidnappings[1]. Secondly, President Museveni has proposed a tax on social media use in order to address the deficit. WhatsApp, Facebook, Skype, Twitter and Viber are all targets for the proposed daily fee of 100ush for all simcards using such “over the top” platforms[2]. According to the President, social media is used only for ‘olugambo’ or ‘gossip’.  He has exempted internet use for educational purposes, as “[i]t is like going to the library using the encyclopedia or referring to the dictionary. These must remain free”[3].

During fieldwork in the Ugandan context of intrinsic kinship (Whyte & Whyte, 2004: 77) and “scattered families”, I have observed many instances in which social media is used for more than ‘olugambo’, which itself is more than fruitless. As Tanja Ahlin notes in her study of migrant families’ care of elders through ICTs, phone practices are “not only about communication, just as remittances are not only about sending money” (2017). This frames an overarching question for my on-going research in Uganda; what are “over the top” platforms used for other than gossip? Many people have shown me how WhatsApp groups are used to circulate information –

I’m told that even the news of this proposed taxation reached 15,000 people in 10 minutes; “if anything seems to be relevant and effecting the lives of people directly, the messages tend to go very fast”.

WhatsApp groups also appear to be commonly used to share information about health. As one interviewee told me, he is part of a group with friends who are Doctors and teachers, “any information one of them gets, I get it here”. Or another, who recently found out the nutritional content of beetroot and bananas through his WhatsApp group and has started eating more of them. Or the hospital staff, who have a forum on WhatsApp for sharing information about patients and medical supplies, supporting health workers to do their jobs efficiently. As one message about the benefits of lemon peel circulated on WhatsApp recently stated, “thank goodness for Social Media…Pls forward to lots of friends”.

Photo (CC BY) Charlotte Hawkins. Tthis solar panel is used solely to charge the household’s phones, suggesting that access to communication is a priority.

[1] https://www.independent.co.ug/mtn-stops-sale-of-new-sim-cards/, accessed 03.04.18

[2] http://nilepost.co.ug/2018/03/31/tax-facebook-whatsapp-users-museveni-to-minister-of-finance/, accessed 03.04.18

[3] Ibid.

References

  • Ahlin, T., 2017. Only Near Is Dear? Doing Elderly Care with Everyday ICTs in Indian Transnational Families: Elderly Care with ICTs in Indian Families. Med. Anthropol. Q. https://doi.org/10.1111/maq.12404
  • de Bruijn, M., van Dijk, R., 2012. Introduction, in: de Bruijn, M., van Dijk, R. (Eds.), The Social Life of Connectivity in Africa. Palgrave Macmillan, New York.
  • Whyte, S.R., Whyte, M.A., 2004. Children’s Children: Time and Relatedness in Eastern Uganda. Afr. J. Int. Afr. Inst. 74, 76–94. https://doi.org/10.2307/3556745

Infrastructures of Care

LauraHaapio-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.

Thinking beyond health apps – by Pauline Garvey

LauraHaapio-Kirk13 April 2018

Author: Pauline Garvey

Breast Cancer Survivor App developed by Professor M. Kell, Mater Hospital, Dublin, Ireland.

I recently came across an app for survivors of breast cancer. It allows its users to calculate their body-mass index, access nutritional advice, read recipes, set exercise goals and make donations towards cancer research. The app provides a fairly comprehensive guide to health management, but I wonder if it could offer more. Increasingly, the promise of health comes in a surprising variety of packages, and these often exceed a solitary pursuit of nutrition and exercise advice.

The Irish Longitudinal Study on Ageing (TILDA) led by Trinity College Dublin examines the social, economic, and health circumstances of over 8,000 people aged 50 years and older, resident in Ireland. Researchers have found that instead of later years being a time of decline and dependency, older adults make a valuable contribution to society, with many active in the lives of their families and in their communities. The TILDA report suggests, for example, that volunteering is life enhancing as is regular social participation in sports and social clubs. Overall, it finds 60% of adults aged 54 years and over take part in active and social leisure activities at least once per week while 47% participated in at least one of these organised groups at least once per week.

In my fieldwork site, there are groups that meet weekly to knit and chat while sharing coffee and cake. Other groups swim in the sea, go to church, go for bracing walks or gather to engage in litter picks. Many research participants talk of these activities as both building community and enhancing health, activities that are usually moderated through smartphone apps. Some activities that do not seem, on first glance, to be related to health come to be framed as such. For example, one participant in a craft group shared a post called ‘The Health Benefits of Knitting’ (Brody 2016) which argued that the repetitive work of knitting reduces the stress hormone cortisol. Are people joining these groups for purposes of health or fun or ‘community-building’ or for other reasons altogether? Are these distinctions blurred or even relevant for participants? Similarly, WhatsApp is integral to the moderation of these groups, not only in how groups are made but in the types of sociality that they engender, such as in the frequency of online interactions. Continuous online conversations that research participants have on WhatsApp can be experienced as a delight or disappointment, but either way have been described to me as new. These are some of the issues that I’m pursuing in my on-going research.

 

Breast Cancer Survivor App developed by Professor M. Kell, Mater Hospital, Dublin, Ireland, see https://www.materfoundation.ie/news/improving-care-breast-cancer-patients-mater/

Brody, J. E 25/01/2016 ‘The Health Benefits of Knitting’, The New York Times, available online at https://well.blogs.nytimes.com/2016/01/25/the-health-benefits-of-knitting/

The Irish Longitudinal Study on Ageing (TILDA), 11/10/2017 Trinity College Dublin, available online https://tilda.tcd.ie/news-events/2017/1702-w3-key-findings/

‘Healthy Ireland’ by Pauline Garvey

LauraHaapio-Kirk16 February 2018

From the Healthy Ireland website: http://www.healthyireland.ie/

Author: Pauline Garvey

 

Just last month the Irish government launched the latest national initiative to promote health and wellbeing across the country. The Healthy Ireland campaign 2018 was launched on the 6th January and aims to encourage people to ‘get active, eat well and mind their mental wellbeing’ (www.healthyIreland.ie).  Many of the planned initiatives run through local libraries and are advertised by pictures of families cycling through wooded glades or groups of friends exercising outdoors.

On the day of the launch in Dublin’s sporting venue Croke Park, Taoiseach (Prime Minster) Leo Varadkar said:

The message of the Government’s Healthy Ireland 2018 campaign is simple; I’m encouraging everyone to get involved, by making the small changes needed to improve your health and your family’s health. That could mean including a walk in your daily routine, making healthier choice at meal times or taking a break from your phone to give your mental health a boost. These positive and sustainable changes can help us all build a healthy Ireland (MerrionStreet 06/01/18).

The webpage dedicated to HealthyIreland acknowledges that social factors such as levels of education and income, or housing and work conditions may adversely affect health, and are determined by social, environmental and economic policies beyond the direct responsibility or remit of the health sector. Therefore the campaign asserts the ‘health sector alone cannot address these problems – we must collectively change our approach.’

Excessive mobile-phone use has now been added to nutrition and exercise as a health risk. And while this is interesting, it is perhaps not surprising. Frequent associations between an unhealthy attachment or addictive behaviour and mobile-phone use have been profiled in the national media recently. For example in December 2017 new research from Deloitte, found that 90% of 18-75-year-olds in Ireland now own or have access to a smartphone – putting Ireland among the top users of smartphones in Europe. By comparison 88% of people own, or have access to a smartphone in Europe. Richard Howard, head of technology, media and telecommunications at Deloitte greeted this figure with some caution: “Mobile devices are a relatively new ‘addiction’ to our social fabric and they form an important part of our daily activities and interactions’ (Quann 2017).

There are lots of unknowns in smart-phone use, which is why we are currently investigating this topic, and why we try to understand the smartphone in actual life situations. For example while the Deloitte study found that half of Irish people thought they used their phone too much, 60% thought their partner used it too much! What does this tell us of the place of the phone in negotiating relationships? Are people neglecting their loved ones, forging new friendships or engaging with existing friends and family in novel ways?

Meanwhile the government’s response in the Healthy Ireland Campaign is clear:  “Take the stairs rather than the lift, Eat more fruit and veg, Take a 30-minute break from your phone”. And Varadkar describes his own practice of turning off the phone during meals – “it not only makes the meal more pleasant and your interaction with people more pleasant, it is actually good for your headspace.”  (O’Connor 07/01/18)

 

References:

HealthyIreland 2018, www.healthyireland.ie

MerrionStreet Irish Government News Service 06/01/18, available online at https://merrionstreet.ie/en/Issues/Taoiseach_Leo_Varadkar_launches_Healthy_Ireland_2018_campaign.html (http://www.healthyireland.ie/about/)

O’Connor, Wayne 07/01/18 ‘Healthy Ireland 2018 aims to get us all fitter and more mindful’ Irish Independent, available online at https://www.independent.ie/irish-news/health/healthy-ireland-2018-aims-to-get-us-all-fitter-and-more-mindful-36464484.html.

Quann, Jack 05/12/17 ‘Three million Irish people now own or have access to a smartphone’, available online at http://www.newstalk.com/Mobile-phone-habits-of-Irish-people-revealed