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Nurse navigators and WhatsApp: an example of ‘smart from below’

By Alfonso Otaegui, on 8 December 2018

Photo by Alfonso Otaegui

Within the scope of the project Anthropology of Smartphones and Smart Ageing (ASSA), we are committed to work collaboratively with a local mHealth initiative, or any initiative that will improve the access to healthcare or the wellbeing of the populations among whom we are carrying our fieldwork.

At the beginning, before even starting my fieldwork, I envisioned this initiative as the creation and implementation of a bespoke mHealth app, which would respond to a necessity observed in the field. This approach implied spotting a gap in the site –a need not yet addressed but noticed by the ethnographer– and creating an app which would fill that gap. It was certainly a top-down implementation approach: I would give the users something they needed but were not aware they needed.

After a couple of months, I realized it would be wiser to simply describe an app people already used in a creative way, and bring this local idea to another place, where this idea could be helpful. This approach, which could be described as ‘bottom-up’, implies acknowledging the creativity of local populations in the adoption of communication technologies, what Pype (2017) names ‘smartness from below’. With the same aim of bringing good ideas from one place to another, we have also started in our team to build up a list of ‘best practices’ in healthcare throughout all of our field sites.

With this aim in mind, I will spend the last six months of my fieldwork in Santiago doing ethnography at an oncological center in a public hospital. This particular hospital is the only public one in Santiago having implemented a ‘nurse navigator’ model of healthcare (Devine 2017).

The navigator nurses work as mediators between oncological patients and the medical and bureaucratical system of a public hospital in a low-income area. Cancer treatments mean two complexities for the patient: the medical complexity of the treatment and the bureaucracy of the public health system. Different cancer treatments can have several effects on different systems of the body, so managing the treatment implies handling a lot of information. The treatment is based on a series of procedures (image exams, chemotherapy sessions, blood tests, etc.) which require prescriptions and appointments, and have to be carried out in a specific order, and in certain amount of time (otherwise the probabilities of success decline). Navigator nurses actually manage the treatment for the patient, as they have the expertise to deal with both kind of complexities.

According to oncologist Bruno Nervi, president of the foundation Chile sin Cancer (‘Chile without cancer’), there are around 100 oncologists in Chile, when 400 are needed (55.000 people are diagnosed with cancer every year) (‘La Fundación Chile sin cáncer (…)’ 2018). Given the high number of patients, oncologists do not have the time to explain all the details of the treatment. The nurses working at the chemotherapy room face the same problem, as they try to fit in as many patients on a day as possible. The nurse navigators then, fill in this gap by educating the patient on the details of the disease and its treatment and mediate between the patient and the complex bureaucratical system of public healthcare in Chile. They make all the appointments for exams, blood tests and the like –which requires a lot of paperwork– and stay in touch with patient in case this has any doubt or question. These dedicated nurses constitute a human factor in healthcare that no app can replace. The nurse navigators, however, do use an app that is the most commonly used messaging app amongst patients: WhatsApp. According to the navigator nurses, WhatsApp gives them the chance to use various means of communication depending on the particularities and necessities of every patient: some prefer a phone call, some other need to see the info written in a text message, other will be reassured if they see a picture of the prescription or an exam order, some need an audio message they can listen to several times in order to understand the meaning (most of the patients are low-income people with low levels of education). Besides, nurse navigators are available for the patients for any doubt or question they might have. These nurses are there for them, to answer their questions and to comfort them, as the treatment and this relation of distant care can last for years.

Daniel Miller, principal investigator of the ASSA project, recommended in his last book ‘The Comfort of People’ on hospice patients and the use of new media, that it would important to create a patient/carer charter of new media use (2017: 218). The usage of WhatsApp by these nurse navigators actually follows a protocol which developed out of their experience in the last couple of years. I will attempt to describe this protocol and app usage and build up a model. I really hope it will be possible to bring this locally developed good idea to other public hospitals in Chile.

References

Devine, A. (2017, April 3). The Nurse Navigator: A Patient’s Compass On The Healthcare Journey. Retrieved from https://nurse.org/articles/nurse-navigator-career-path-salary-job-description/
La Fundación Chile sin cáncer y su contribución para cambiar la historia del cáncer en Chile. (2018, October 15). Retrieved from https://www.uc.cl/es/la-universidad/noticias/31765-la-fundacion-chilesincancer-y-su-contribucion-para-cambiar-la-historia-del-cancer-en-chile
Miller, D. (2017). The Comfort of People. Cambridge: Polity Press.
Pype, K. (2017). Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa. In C. C. Mavhunga (Ed.), What Do Science, Technology, and Innovation Mean from Africa? (pp. 97–115). Cambridge, Massachussetts: The MIT Press.

Second Life

By Daniel Miller, on 11 July 2017

We had intended to only start blogging in October when our project actually starts. But the inclusion of a special section in this week’s The Economist (8/7/2017) on the `young old’ is too great a temptation to resist. There are three main components to our forthcoming project. The ethnography of the smartphone and the development of mHealth are two foci. But our foundation is in re-thinking the experience of age for those who can no longer be designated at either young or elderly, i.e. those between the ages of 45 and 70. For me, an interest in how older populations appropriate technology had grown partly from previous projects. When Facebook started to become ubiquitous I was arguing that in the long-term I could see this as more of an older person’s than a younger person’s innovation. My logic was that this was in essence a platform for social communication, and in most societies studied by anthropologists the traditional ‘burden’ of active social communication had been that of older women rather than younger men, especially when it came to keeping up with what is happening in families. Our Why We Post project has shown how in many regions of the world, this kind of intra-family communication is the core to Facebook usage. When I first suggested this alignment, people thought I was insane since Facebook was assumed to exist only for teenagers. But in The Economist the same point is now being taken seriously.

The Economist is mainly concerned with the economic implications of longevity, but for our project there is a real intellectual challenge in researching how living longer than previous generations changes peoples’ understanding of themselves, but also ultimately of the meaning and purpose of their lives. We want to get involved in the practical implications, as in the rise of mHealth, but first we want to compare the experience and meaning of ageing for this demographic across our 12 fieldsites.

The Economist also has a leader asking for a new category or label for this age group. Their own proposal of ‘pre-tired’ is fun, but is probably not intended to ‘stick,’ to the degree that a category such as ‘teenagers’ has. In a preliminary discussion with the team I had proposed the term ‘Second Life’. I know this was the name of a popular computer game but that seems to have faded somewhat and I think it is possible to re-use the term. The reason for this choice is that it seems clear that many people in their fifties and sixties actually want to stay in work, but not necessarily in the work they have done so far. Many would like to return to education, but to study something different. Those who were working when they were parents and were therefore unable to spend as much time with their children as they had wanted to are more likely to want to be active grandparents. Whereas perhaps those who were full-time parents are less likely to be as involved in grand-parenting. In other words, people realise in their fifties that they may have done thirty years of work, but then may have another thirty active years to do something else. So the idea of Second Life, suggests that people now have the opportunity to, as it were, start again, based on the experience and the mistakes of life so far.