The COVID-19 pandemic has exposed the widespread uncertainty of everyday lives in global capitalism. For example, uncertainties related to health and resources have been exacerbated, and it has been clearly exposed how they are both often so closely intertwined. Various ethnographies around the world have demonstrated the contextual specificities of how people pragmatically mitigate uncertainties, for example through work and cooperation. This is at once a global and a specific experience.

The expected linearity of ageing is evidently disrupted by factors in the wider world, such as pandemics, politics and the economy. Typical ‘industrialist’ categories of age assign certain everyday activities of economic production to particular life stages (Honwana, 2012: 12): education and childhood, a time of dependence; work and adulthood, a time of independence; and retirement and rest in old age, which in Uganda, is said to be ideally said to be a time of interdependence (Whyte, 2017). This feeds into the stereotype of old age as a condition of certainty, in contrast to precarity faced by youth. The majority of older research participants in Kampala are still in full-time work to provide for their families, often ‘Monday to Monday’. This challenges notions of work in the city as an activity of younger generations, and of transient uncertainty as a preoccupation of youth (Honwana, 2012; Thieme, 2018).

Woman carrying mangoes to sell in April 2019.

Many sources of income have been interrupted by social distancing regulations in Uganda. Many people rely on daily income to feed their families, so relief efforts for social protection at a household level are increasingly urgent[1],[2]. To friends in Kampala, this has emphasized the importance of social networks, and particularly neighbours, who can share whatever they have, sometimes assistance they may have received from further afield. And besides resources, the current pandemic situation has shown how people often ‘engage with the ambiguity of our surroundings’ through solidarity and dialogue with each other (Whyte, 1997). Particularly accentuated is the role of mobile phones as a tool to navigate conditions of uncertainty. We saw this across our fieldsites, in the ways people use mobile phones to overcome distances and maintain relationships and care for older people. And we’ve since all seen how important phone calls and WhatsApp have been to adapt to unprecedented times and keep us in contact. This uncertain context also supports the role of ethnographic research, which allows us to look at the patterns in dialogue, how people engage with the wider and indeterminate world, and how this responds to and shapes certain trajectories.

BIBLIOGRAPHY

• Anguyo, I and Storer, L. (2020) ‘In times of COVID-19 Kampala has become ‘un-Ugandan’, LSE. https://blogs.lse.ac.uk/africaatlse/2020/04/09/kampala-epidemic-un-ugandan-society-in-times-covid-19/
• Honwana, A.M., 2012. The time of youth: work, social change, and politics in Africa, 1st ed. ed. Kumarian Press Pub, Sterling, Va.
• 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.
• Thieme, T.A., 2018. The hustle economy: Informality, uncertainty and the geographies of getting by. Progress in Human Geography 42, 529–548. https://doi.org/10.1177/0309132517690039
• Walter, M and Bing, J. (2020) ‘Uganda’s Economic Response to Covid-19: the case for immediate household relief’ Centre for Development Alternatives (CDA). https://cda.co.ug/2140/ugandas-economic-response-to-covid-19-the-case-for-immediate-household-relief/
• Whyte, S.R., 1997. Questioning misfortune: the pragmatics of uncertainty in Eastern Uganda, Cambridge studies in medical anthropology. Cambridge University Press, Cambridge ; New York.

[1]Anguyo, I and Storer, L. (2020) ‘In times of COVID-19 Kampala has become ‘un-Ugandan’, LSE. https://blogs.lse.ac.uk/africaatlse/2020/04/09/kampala-epidemic-un-ugandan-society-in-times-covid-19/

[2] Walter, M and Bing, J. (2020) ‘Uganda’s Economic Response to Covid-19: the case for immediate household relief’ Centre for Development Alternatives (CDA). https://cda.co.ug/2140/ugandas-economic-response-to-covid-19-the-case-for-immediate-household-relief/

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.