By Pauline Garvey

A St Patrick’s Day ‘like no other’ during the Coronavirus pandemic, source reuters.com (https://www.reuters.com/article/us-health-coronavirus-ireland/deserted-st-patricks-day-streets-highlight-irish-hospitality-woes-idUSKBN21431F)

On Thursday the 12th March, the Irish government announced that schools, colleges and other public buildings in the Republic of Ireland were to close in the wake of the coronavirus outbreak in the country. Outdoor meetings or activities of up to 500 people were cancelled, and indoor meetings of 100 people or more were banned. These measures were followed by the closure of pubs on the 15th March, the grounding of airlines and the closure of cafes and restaurants amid the anticipation of an extensive lockdown of all public gatherings in an effort to slow the onward spread of the disease.

In his address to the nation on the 9pm news bulletin on 17th March, Prime Minister Leo Varadkar commented that this year’s St Patrick’s Day was ‘like no other’, where parades in towns and cities were cancelled, pubs were shut and celebrations confined to people’s homes. In an effort to introduce a degree of normalcy, the national broadcaster (RTE) showed short video clips of children parading in their back gardens waving flags, while other householders put ‘Happy St Patrick’s Day’ signs in kitchen windows for passing pedestrians. Social celebrations on this national holiday moved from the public arena of towns and cities to the private sphere of homes and gardens.

These are unsettling times and not surprisingly, in a situation where social distancing is enforced, online media has become the main site where people actually communicate. Whatsapp groups among family members, friends, work colleagues, school and sports’ groups were invigorated and the announcement of government measures sparked a flood of messages between people as they shared information, asked each other if the information they had received is correct or discussed plans for the care of relatives. Jokes, memes, gifs, news articles, videos and advice from purported medical professionals was (and still is) swapped, shared and commented upon. Often the same content circulated from one WhatsApp group to another, although very little of it was new. Arguably, most of the Covid-19 content that is passed between groups is composed of jokes, uplifting images, stories and funny videos.

Anthropologists have argued that here we can see one role of the media more generally. The activities of our daily lives maintain a sense of reliability and continuity, and these activities are managed through predictable order and taken-for-granted routines. According to the media scholar Roger Silverstone for example, the integration of television news bulletins provides a level of predictable routine that informs the audience of sources of anxiety while simultaneously offering reassurance that these dangers will be successfully combated.^[1]

WhatsApp is different in several interesting ways, however. Unlike news bulletins that ‘address the nation’, WhatsApp messaging provides a feeling of direct participation.^[2] Instead of posting or announcing or informing, on WhatsApp, people are speaking directly to known others, who often respond immediately, providing a sense of an ongoing conversation. These types of exchanges allow for more intimate and individualised communication.^[3]  In Ireland, health officials have adopted this mode of direct communication to speak to people directly and the Minister for Health (Simon Harris) circulated a WhatsApp message to urge people to stay indoors and maintain social distancing on 22nd March. Also, the WhatsApp groups that sprang into activity during the lockdown often consist of jokes, thumbs-up and emojis. Indeed, very little about the interaction seems to be about acquiring news and most of it is far more about sharing the emotional burden of what is going on. The sheer number, variety and frequency of WhatsApp messages in various groups seems to suggest, then, that it is the practice of being in touch that is more important than the actual content of these messages. One 70-year-old woman told me that she forwarded short videos that were ‘rubbish’ and even mildly offensive but circulated them to her groups anyhow because her niece had sent them to her.  People laugh or forward frightening statistics regarding how many will contract the disease while also wishing others well and commenting on the exceptional circumstances we are living in. WhatsApp in other words allows a kind of affective venting that is difficult to express elsewhere.

^[1] Silverstone, Roger 1994 Television and Everyday Life New York and London: Routledge.

^[2] For a comparable argument regarding Twitter see Rosa, J. 2015 Digital protest, hashtag ethnography, and the racial politics of social media in the United States, American Ethnologist Volume 00 Number 0, pp. 4-16.

^[3] The World Health Organisation has launched a dedicated messaging service in Arabic, English, French and Spanish with WhatsApp partners to inform the public about the virus. In order to activate the app, you have to text ‘hi’ to the relevant number. See https://www.who.int/news-room/feature-stories/detail/who-health-alert-brings-covid-19-facts-to-billions-via-whatsapp, accessed 8/4/20

Author: Patrick Awondo

Over the last decade, Internet penetration rate in Cameroon has more than doubled, from around 10% in 2007 to 21-30% in 2017 (these figures leave aside small and medium-sized cities, and do not take into account connection-sharing practices that are part of people’s daily habits). The internet boom, made possible by the democratization of smartphones (which 80% of the population now have) has impacted significantly upon behavioural habits and the ways in which individuals and groups live at different stages of their lives. Among the areas chiefly affected by such changes, health is attracting attention in the digital landscape because it is the subject of unprecedented publicity, and is considered to offer many affordances to people.

In Yaoundé as in other African capitals, health remains a significant problem, but also, is undergoing  ongoing processes of change, and permanent questioning. In the smartphone age, health is an area of intense social activity. Three types of issues in the online health context deserve attention for the importance of the activities they generate:

1. The variety of access to online health resources
2. The diversity of information and forms of access offered by the Internet
3. Challenges related to the density of supply, and what our colleague, Daniel Miller, perceives as inequality in interpretation, and the ability to appreciate in a fair and balanced way, the different “resources” of health online.

The variety of access to health resources

Generally speaking, people in Yaoundé use the Internet in contexts of/for health either to publicize health resources, that is to say, to present information that aims to simultaneously improve access to health through good practices. Or, to find the right information about very specific health problems. The latter is undertaken through a range of sites and links dedicated to specific health issues. Specific health issues can include pandemics such as malaria, tuberculosis or HIV / AIDS, which are priority public health problems usually treated by public health actors. However, people also turn to the Internet to search for diseases that have no visible presence in public health discourses, and which generally lack in public awareness – such as Typhoid fever, as well as certain female health issues such as ovarian cysts, dermatological problems, and infertility. These issues are addressed in forums, and blogs, but more and more, via dedicated Whatsapp groups that are often created by individuals with such concerns. There are also many health bloggers from Cameroon and the Cameroonian diasporas. Some are not always of Cameroonian descent or nationality, but blog membership appears most strong when individuals are Cameroonians or presented as originating from the country.

Overall, there are different ways of accessing the  internet of health in Yaoundé. Informants could be classified into 3 categories:

1. those who watch YouTube for health
2. those who Google-search health problems
3. those who follow specialized health blogs

Health-searching practices on YouTube

Amongst my young informants, (19-31 years), the practice of searching for information on YouTube seems to be fairly common. Informants describe a typical double scenario, whereby they have a health concern, for various reasons that may be related to a lack of economic means, or the inability to join a health service. In this case, they will introduce on YouTube the name of one or more symptoms, which they hope a video will help inform them about. A 31-year-old security officer at a mobile phone operator explained how she regularly used YouTube on her smartphone to get video responses mainly about intimate grooming techniques, and a set of problems related to gynaecology. Interested in plant medicine, she regularly follows a “youtubeuse” specialized in herbal care for women. Many under-educated people like this female informant with limited income, but also among people with higher levels of education follow the youtubeurs of Cameroon almost daily. Other informants in the same social category stress that seeing a specialised doctor can be difficult in Yaoundé because of the high rates that these specialists practice. About 10,000 XAF consultation is already 10% of the salary of a security guard as our informant.

These high prices are not those charged in public hospitals, where a specialist costs half the price in private. Another factor determining the choice of Youtubeurs health advice is to be found in the strong competition that plant medicine imposes on modern Western medicine in Yaoundé. This appeal of alternative, natural therapies can be found amongst all social strata.

Those who “Google read” health on the Internet

During interviews and observations in one Yaoundean clinic, it appeared that searches on Google densified as a large part of the population access the Internet via the smartphone (specifically, the android phone, which is most popular here). Healthcare professionals in this capital’s leading private clinics point to the fact that a growing number of patients in consultation rooms are talking about diagnostic elements previously sought on the Internet, or afterwards in order to be able to make analogies by comparison.

The issue of individuals making their own comparisons with official health advice is intriguing. In another clinic, a 40-year-old teacher explained his reliance on seeking health information on Google through the dual need to better understand the disease from which his son had suffered from for 6 months at the time of the interview, but also, to compare the information received during diagnosis with that available on the Internet. If the case of this Father is not isolated, it reveals the complexity of different persons and needs that are engaged in via the search for health information on Google.

So while some informants point out curiosity and the primary need for knowledge of the disease or to understand the symptoms, this informant took to researching online for secondary purposes, to in some sense validate the official medical diagnosis. Another 44-year-old informant, a married, bookstore employee and Mother of two who lives in mvog-Ada, stressed the fact that the availability of the internet is a key factor in explaining its popularity and usage. Suffering from a Glaucoma, she went to an Ophthalmologist in a public hospital. The latter professional indicated that surgery was inevitable. Frightened and seeking reassurance, she turned to Google from her office to access information about her own illness. For this informant and for the first mentioned above, the search for information becomes a way to access a second opinion on the diagnosis of the doctor, especially in the case of serious diseases.

Health blogs and their followers

At the beginning of August, I was walking in the streets of Mvog-ada, the low-income neighborhood, when I was accosted by a group of people ;  two young men, a man, and a young woman, all wearing a green T-shirt on which read the name of a company that distributes herbal medicines. The group explained to me how they had created an online site with an active blog through which to communicate and sell their products. Like this distribution company, many groups have online blogs that are subscribed to by many Cameroonians. As a rule, these Blogs are put online from Cameroon and in particular the two big cities that are Yaoundé and Douala. But some of the blogs are often domiciled in Europe, particularly in France.

Such blogs cover broad health issues ranging from exclusively female problems (such as intimate care practices, ovarian problems, and so forth) to major pandemics (Malaria, Typhoid Fever, Cholera). There is also a very large number of sites dedicated to plant medicine. These plant medicine sites, still called herbalists, are very successful in the online contexts.

In sum, health on the Internet seems to play a major role in Cameroon, affecting the way people access health information on the one hand, and the way in which this – and also non-Internet accessed medical information such as doctors’ diagnoses – is evaluated. These last observations highlight two types of concerns: on the one hand, the difference between specialized and non-specialized information (also professional and non-professional); on the other hand, the issue of inequalities, linked to the ability of informants to analyze ‘good’ and ‘bad’ news offers. This brings us back to the classic issue of the reproduction of (health) inequalities related to economic context and education levels, and how these factors influence the use or non-use of information and the evaluation of their quality and/of efficacies.