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Anthropology of Smartphones and Smart Ageing


“I can feel the joy of the group”: a conversation with a veteran journalist on the largest march in Chile

Alfonso ManuelOtaegui18 November 2019

Massive demonstrations in Chile

Since the 18th of October, Chile has been in continuous turmoil. Protests that initially began as a response to a rise in metro fares in Santiago escalated into a national crisis, laying bare the tensions that had hitherto been contained in Chilean society. The surface calm that dominated the so-called “paradise of Latin America” was proven to be very fragile.

At the moment of writing, and since the 18th of October, there have been daily marches and demonstrations, with barricades and looting but also brutal repressions and curfews. Protester demands include pay rises for workers, education reform, changes to pensions and investment in the state health system among others. In recent weeks, these grievances have crystallised into an overriding demand: a new constitution to replace the one sanctioned by the government of dictator Augusto Pinochet in 1980.

Fig 1: Plaza Italia: the biggest march in Chile. Source: Wikipedia Commons

Fig. 2: Valeria (left), her friend holding a Chilean flag (centre), the Mapuche flag (right)

Having lived here since January 2018, and in neighbouring Argentina almost all my life, I, like many, was utterly bewildered at the scale of the outbreak. Chile isn’t a country famous for protests and mass demonstrations. During the first days of the protest, I received a WhatsApp message from Valeria, a former student in the smartphone workshops for older adults that I taught as a volunteer during my fieldwork. The message was a photo of her celebrating her 81st birthday by participating in one of the ‘largest marches in Chile’ with a friend. This was a march to Italia Square, renamed by the protesters “Dignity Square” (a change that even appeared on Google Maps for a brief amount of time). Curious about her perspective on the mobilisation of protesters and the current situation in the country, I asked her to meet. Valeria had to flee the country as soon as the coup happened in 1973 because her name was included on a list of left-leaning journalists affiliated to a political party that was in the opposition, meaning she could be searched by the police at any time. After living in the UK for 20 years, she returned to Chile in the early 1990s.

Valeria agreed to meet me and I made my way to her apartment, near the Plaza de Armas (Santiago’s main square). As I arrived to meet Valeria near her home, I noticed several stores were closed – too many for a Saturday afternoon – most of them secured with metal curtains.

“It looks like a post-war zone,” says Valeria, welcoming me in her apartment on the 13th floor. She tells me that a few weeks before, she was left without a functional lift for a whole weekend. When taking the stairs on her way out of the building she fell over, which caused her head wounds that needed stitches.

“It was a huge blow, but I did not break any bones!” –she says with relief, almost cheerful.

As she makes me tea, I observe the souvenirs adorning her living room: black and white photos of her childhood in Valdivia, photos from her years in Santiago, an old map of South America, a windmill with the Mapuche flag in a plant pot, a piece of macramé with the figure of a winged dragon (a souvenir of her exile years in Wales), and on a glass coffee table some tea boxes, porcelain cups, a half-read book and a TV remote control.

Conversing with a veteran journalist about the news

Valeria inherited this apartment from her family, and receives monthly compensation granted to former political refugees. The allowance is more or less equivalent to the lowest state pension in the country and is not enough to live on, as is the case for so many other older adults in Chile. Valeria manages to make ends meet because she does not pay rent and has a small inheritance from her parents which she manages very carefully.

Valeria brings me tea. On the table, at arm’s length, she has her smartphone. As a journalist, she is fascinated by what the device offers when it comes to information and communication. Valeria was always the one sharing videos, memes, information about free events and the occasional political opinion in the WhatsApp group chat of former students of the workshop. The members of the group chat had always had subtle differences of opinion on political issues, but in recent weeks those differences became frictions, reflecting the polarised nature of the current discourse in Chile, which is visible on all of the most popular social networks in the country. A participant decided to leave the group and the frequency of messages declined (Valeria’s in particular). Although her opinions may not be representative of the Chilean older adult population, they are shared by quite a few people.

“Fake news is the order of the day” warns the veteran journalist as she digs up news items distributed among her numerous WhatsApp groups. Valeria does not trust local TV news, preferring to receive information from trusted journalist contacts through Whatsapp, making the assumption that they wouldn’t pass on a news item without verifying the information in it first.

Valeria is careful not to draw any parallels between different eras, and on more than one occasion she emphasises that she did not experience the Pinochet dictatorship (having had to leave the country as soon as it started), but the conversation alternates between old memories and the events of the past few days. She remembers a ‘guanacazo’ (a hit from the water cannon, nicknamed ‘guanaco’) she suffered almost fifty years ago –at that time the water cannon was filled with dirty water from the Mapocho river– and recalls in particular the care received from her companions, the feeling of the group being close by.

At present, Valeria also experiences the feeling of being cared for, being protected during the marches. “These boys at all times surrounded us to protect us from the [tear gas] bombs with their bottles of water, they guided us –because you are blinded by the pain– to protected areas.”

Indeed, when the police shoots tear gas into the crowds, many protesters raise their hands offering their companions bottles filled with water and baking soda, a solution that counteracts the burning sensation caused by teargas.

What astonished Valeria about this year’s protests however, is the the diversity of demands coupled with almost non-existent party identification – in the 70s, she recalls, political parties and trade unions were the ones who called the marches:

“(…) and us, university students would join them. The flags were the official ones and there was also some uniformity in the photographs. During the marches, you would hear the political slogans and shouts of the political parties. The one that was chanted by everyone was ‘the one who does not jump is a ‘momio’ and now I have heard it with the variant of ‘paco’ [derogatory for ‘police officer’]. The scarves and shirts you would see were in the official colours and patterns of the political parties, and young party members used to parade in together en masse.”

Parallels between the 1970s and now: different eras, similar feelings 

The dynamics of the current marches have taken Valeria by surprise in a positive sense – now more than ever, there is a sense of joy in among all the protesting. “These young people carry our flags with a big difference: they incorporate a wonderful playful touch. We were so serious, so formal….” Valeria explains that she had never seen choreographies or dances at a march before, and couldn’t imagine something like this occuring at previous protests. This is a development that fascinates her.

The conversation swings back into the past like a pendulum. “I saw the airplanes from here,” says Valeria, pointing to the balcony. She was living in that same apartment during the coup of 73, in which the army bombed the Palacio de la Moneda, the seat of the president. Several friends called her to warn her that she had been put on a list and should stay inside. Valeria, however, devised a simple strategy to be able to walk freely through the city, despite having been declared as being ‘on the run’. She put on one of her most most elegant dresses, her best hat, golden bracelets and earrings, and carried a designer bag. “I looked like a Christmas tree!“– she says and bursts out laughing. Funnily enough, no checkpoint asked her for any documents – such an elegant woman did not fit the visual image of a dangerous citizen. “I know my country very well…”– she says, raising one eyebrow in a sardonic tone, halfway between cynicism and resignation. Maybe the strategy would still work today.

Despite parallels between anecdotes about the 1970s protests and the current day ones, we both agree that those times and these times are very different, although I can sense that Valeria is experiencing similar feelings as she did back then. It is difficult to understand what they are. The answer would come a couple of days later.

Fig 3. Gas lacrimógeno. Campus San Joaquín. Photo by Alfonso Otaegui (CC BY).

After talking for more than four hours, we said goodbye. Days later, a demonstration broke out at the San Joaquin Campus of the Catholic University where I work. The police responded to demonstrators by  shooting rubber bullets and tear gas. I captured the moment and sent Valeria pictures of it through Whatsapp. One image in particular caught her eye – an image of a statue of Christ with his arms open, surrounded by tear gas smoke. Valeria replies:

“The defenseless, peaceful Christ wrapped in the gases is like an allegory. Powerful figure. My heart goes out to the students who are fighting for their parents and grandparents, and hold up their ideals as their only shield. Unequal physical struggle. The strength of these children lies in their solidarity and in their ideals of justice. They are rara avis (rare birds) among individualism and selfishness. In all the marches I have been, I feel the joy of the group.”

La alegría del grupo: conversación con una adulta mayor en la marcha más grande de Chile

Alfonso ManuelOtaegui18 November 2019

Desde el 18 de octubre Chile ha estado en un continuo estallido social. Todo comenzó con un reclamo de estudiantes por el aumento en las tarifas del metro, pero ello era apenas la punta del iceberg de una crisis mucho mayor. Numerosas protestas masivas en todo el país revelaron la tensión contenida, la intensa fragilidad subyacente a la aparente calma cotidiana del hasta entonces llamado “paraíso de América Latina”. Desde entonces, y hasta el momento de la redacción de este post, ha habido todos los días marchas y manifestaciones, no exentas de barricadas y saqueos –pero tampoco de brutales represiones, toques de queda incluidos. Entre los clamores de justicia social –mejorar salarios, educación, pensiones, y sistema estatal de salud, entre muchos otros– el más fuerte es el pedido de una nueva constitución, ya que la actual –aunque con varias modificaciones– es aquella sancionada durante el gobierno del dictador Augusto Pinochet en 1980.

Fig 1: Plaza Italia. La marcha más grande de Chile (Wikipedia Commons)


Fig. 2: Valeria (izq.), su amiga con la bandera de Chile (centro), bandera Mapuche (derecha).

Habiendo vivido aquí desde enero de 2018 –y en un país limítrofe casi toda mi vida–, experimenté, como muchos, un gran desconcierto ante tal estallido. Chile no era habitualmente conocido como un país de frecuentes o grandes manifestaciones. En esos primeros días de desconcierto recibí entonces un mensaje de WhatsApp de Valeria, una exalumna de los cursos de smartphone para adultos mayores que yo había impartido como voluntario durante un año. El mensaje era una foto en la que esta alumna entusiasta celebraba su cumpleaños número 81 participando con una amiga en una de las ‘marchas más grandes de Chile’. Así se han dado en llamar a las multitudinarias marchas a Plaza Italia –rebautizada por los manifestantes “Plaza de la Dignidad” (cambio que llegó inclusive fugazmente a Google Maps).  Le pedí entonces que nos encontráramos, ya que quería conocer su perspectiva sobre las movilizaciones y la situación actual del país. Yo recordaba bien la historia de Valeria: apenas tuvo lugar el golpe de estado en 1973, debió huir del país porque figuraba en una lista, ya que era periodista y estaba afiliada a un partido de izquierda. Luego de vivir veinte años en Gran Bretaña, pudo regresar a Chile a comienzos de los 90s. Acordamos encontrarnos unos días después en su departamento, cerca de la Plaza de Armas.

Llegando a la zona céntrica y comercial donde Valeria vive, se ven negocios cerrados, muchos para ser un sábado a la tarde, la mayoría de ellos con cortinas de metal. “Parece una zona de post guerra” dice Valeria, mientras me recibe en su departamento en el piso 13. Me cuenta que unas semanas antes había estado sin servicio de ascensor durante un fin de semana. Como necesitaba salir, intentó bajar por las escaleras y cayó por ellas. “Me di un porrazo bárbaro, ¡pero no me quebré!” –dice con alivio, casi alegre– aunque sí debieron suturarle algunas heridas en la cabeza y realizarle varias curaciones.

Mientras Valeria prepara el té, recorro con la mirada la sala de estar: algunas fotos en blanco y negro de su niñez en Valdivia, otras de sus años en Santiago, un mapa antiguo de Sudamérica, en una maceta un molino de viento con la Wenufoye –la bandera mapuche–, sobre la pared una pieza de macramé con la figura de un dragón alado –recuerdo de sus años de exilio en Gales–, sobre la mesa ratona de vidrio unas cajas de té junto a unas piezas de porcelana, un libro empezado y un control remoto de TV.

Valeria heredó este departamento de su familia. Ella cobra mensualmente un resarcimiento económico otorgado a ex–refugiados políticos. Ese resarcimiento es casi equivalente a una jubilación mínima, como la que cobran muchos adultos mayores en Chile. Tal como a esos muchos adultos mayores, con eso no le alcanza para vivir. Valeria logra llegar a fin de mes gracias a que no debe pagar arriendo y a algún dinero heredado de sus padres que administra cautelosamente.

Llega el té. Sobre la mesa, al alcance de la mano, Valeria tiene su smartphone. En tanto que periodista, está fascinada por las posibilidades de circulación de información que brinda este aparato. En el grupo de WhatsApp de los exalumnos del curso de smartphones Valeria es –o bien, era– de las más activas en reenviar videos, memes, información sobre eventos gratuitos para adultos mayores, y también opiniones políticas. Siempre había habido roces sutiles por cuestiones políticas en dicho grupo. En las últimas semanas los roces se tornaron fricciones, reflejando la polarización acerca de los hechos, que se puede percibir en otras redes sociales como Twitter. Algún integrante dejó el grupo de WhatsApp, la frecuencia de mensajes decayó, los de Valeria en particular. No se podría decir que Valeria es representativa en sus opiniones de la población chilena adulta mayor, pero tampoco se puede decir que nadie comparte sus ideas.

Las fake news están a la orden del día” advierte la veterana periodista mientras hurga algunas noticias entre sus numerosos grupos de WhatsApp. Descree en particular de la TV, a la que considera ya una fuente inaceptable para obtener información fidedigna. Prefiere la información que recibe por WhatsApp de parte de contactos en los que confía, y de los que asume chequean la información antes de enviarla, ya que varios son miembros del círculo de periodistas.

Aunque Valeria es cuidadosa en no establecer paralelismos entre distintas épocas y en más de una ocasión resalta que ella no vivió la dictadura –porque se tuvo que ir del país ni bien comenzó– la charla va como un péndulo entre viejas memorias y eventos de los últimos días. Recuerda algún ‘guanacazo’ (golpe de agua) que sufrió hace casi cincuenta años –en aquellos tiempos el camión hidrante se surtía con agua sucia del Mapocho– y rememora en particular el cuidado de los compañeros en esos momentos, el sentir la cercanía del grupo. También en estas marchas de ahora se siente cuidada, protegida. “Estos chicos distintos en cada momento nos rodeaban para protegernos de las bombas [lacrimógenas] con sus botellas con agua, nos guiaban –porque quedas ciega por el dolor– hacia espacios protegidos.”

En efecto, cuando en las marchas llega el gas lacrimógeno de los carabineros, se pueden ver muchos manifestantes ofrecer con el brazo en alto sus botellas con agua y bicarbonato de sodio, preparación que al rociarse en los ojos alivia el ardor.

De las marchas de hoy le sorprende la diversidad de reclamos junto con la casi nula identificación partidaria. En los 70s, según recuerda, los partidos políticos y las agrupaciones gremiales convocaban las marchas “(…) y los estudiantes universitarios nos sumábamos a ellas. Las banderas eran las oficiales y también había cierta uniformidad en las fotografías. Durante las marchas se oían las consignas políticas y gritos de los partidos. Uno que era coreado por todos era ‘el que no salta es momio’ y que ahora lo he escuchado con la variante de ‘paco’ [carabinero]. Tanto pañuelos como camisetas eran oficiales: color y leyenda. Tendían las juventudes de los partidos a desfilar en bloque.

La dinámica de las marchas actuales le ha impresionado agradablemente, sobre todo por la alegría que nota en ellas. “Estos jóvenes llevan nuestras banderas con una gran diferencia: incorporan un maravilloso toque lúdico. Nosotros éramos tan graves, serios…”. Me quedo pensando en el ‘llevan nuestras banderas’ que amalgama pasado y presente, mientras Valeria me sigue contando que nunca había visto coreografías o danzas en una marcha, que eso le fascinó, y que a ellos nunca se les hubiera ocurrido.

El péndulo de la conversación vuelve al pasado. “Vi los aviones desde acá” dice Valeria, señalando al balcón. En ese mismo departamento vivió el golpe del 73, en el que el ejército bombardeó el Palacio de la Moneda. Varios amigos la llamaron por teléfono: ella estaba en una lista, debía tener cuidado, debía quedarse adentro. Valeria, sin embargo, urdió una simple estrategia para poder caminar libremente por la ciudad, a pesar de estar declarada “en fuga permanente”. Se vistió con uno de sus más elegantes vestidos, con su mejor sombrero, se puso pulseras y aros de oro, y al hombro una cartera de marca. “¡Parecía un árbol de navidad!” dice entre carcajadas. Absolutamente ningún puesto de control le pidió documentos: una mujer tan elegante no encajaba visualmente en el perfil de lo considerado peligroso. “Yo conozco bien a mi país…”, dice enarcando las cejas con un tono socarrón, a mitad de camino entre el cinismo y la resignación. Me pregunto si quizás la estrategia aún hoy funcionaría.

Valeria insiste, a pesar de los vaivenes y las anécdotas emparentadas, que los tiempos son muy distintos, precaución epistemológica con la cual no es difícil estar de acuerdo. Sin embargo, se percibe en sus palabras que algo que siente ahora lo sintió en aquel entonces, pero es difícil entender qué es. La respuesta llegaría unos días después.

Fig 3. Gas lacrimógeno. Campus San Joaquín. Foto de Alfonso Otaegui (CC BY).

Luego de algo más de cuatro horas de conversación, a las que este breve recuento no hace justicia, nos despedimos. Días después, en ocasión de una manifestación en el Campus San Joaquín de la Universidad Católica, donde trabajo, carabineros reprime con balas de goma y gas lacrimógeno. Tomo entonces algunas fotos que luego le hago llegar por WhatsApp. Una imagen en particular le gusta, aquella en la que se ve la estatua de un Cristo con los brazos abiertos entre el humo del gas lacrimógeno. Valeria  responde:

El Cristo indefenso, pacifico envuelto en los gases es como una alegoría. Figura potente. Mi corazón está con los estudiantes que luchan por sus padres, abuelos, ¿y cuyo escudo es qué? Sus ideales. Lucha física desigual; la fuerza de estos chicos está en la solidaridad y en sus ideales de justicia. Son rara avis entre tanto individualismo, egoísmo. En todas las marchas que he ido siento la alegría del grupo.


Enfermeras de enlace y WhatsApp: un ejemplo de ‘inteligencia desde abajo’

Alfonso ManuelOtaegui11 December 2018

Foto de Alfonso Otaegui

Dentro del marco el proyecto Antropología de los Smartphones y del Envejecimiento Inteligente (ASSA), nos hemos comprometido a trabajar colaborativamente con una iniciativa local de salud móvil, o cualquier iniciativa que mejore el acceso a los servicios de salud y el bienestar de las poblaciones con las que hacemos trabajo de campo.

Al principio, aún antes de comenzar mi trabajo de campo, yo imaginaba que esta iniciativa consistiría en la creación e implementación de una aplicación específica de salud móvil, la que respondería a una necesidad observada en el campo. Este abordaje implicaba detectar un vacío en el campo –una necesidad aún no abordada pero advertida por el etnógrafo– y crear una aplicación que llenaría ese vacío. Era en verdad una idea de implementación desde arriba hacia abajo: sería yo quien le daría a la gente algo que necesitaba, pero cuya necesidad ellos mismos desconocían.

Luego de un par de meses, advertí que sería más sensato simplemente describir una aplicación ya en uso –y usada creativamente por la población– y llevar ese uso particular, esa idea local, a otro lugar donde tal idea pudiera ser útil. Este abordaje, que podría definirse como ‘desde abajo hacia arriba’, implica –al contrario del abordaje anterior–  el reconocimiento de la creatividad de las poblaciones locales en la adopción de tecnologías de comunicación, lo que Pype (2017) llama ‘inteligencia desde abajo’. Con el mismo objetivo de llevar buenas ideas de un lugar a otro, también hemos comenzado en el equipo a armar una lista de ‘buenas prácticas’ en atención médica a lo largo y ancho de todos nuestros sitios de campo.

Con este objetivo en mente, pasaré los últimos seis meses de mi trabajo de campo en Santiago llevando adelante una etnografía en un centro oncológico en un hospital público. Este hospital en particular es el único hospital público en Santiago que ha implementado el modelo de cuidado de ‘enfermeras de enlace’ o ‘nurse navigator’ (Devine 2017).

Las enfermeras de enlace trabajan como mediadoras entre los pacientes oncológicos y el sistema médico y burocrático de un hospital público en una zona de bajos recursos. Los tratamientos oncológicos implican dos complejidades para el paciente: la complejidad médica del tratamiento en sí, y la burocracia del sistema de salud pública. Los diversos tratamientos oncológicos pueden tener variados efectos sobre distintos sistemas del cuerpo, por lo que seguir el tratamiento implica manejar mucha información. La gestión del tratamiento implica una serie de procedimientos (diagnósticos de imagen, sesiones de quimioterapia, exámenes de sangre, etc.) que requieren recetas y turnos, que tienen que llevarse a cabo en un orden específico, y dentro de cierto tiempo (si no, las probabilidades de mejora decaen). Las enfermeras de enlace gestionan el tratamiento para el paciente, ya que tienen conocimientos para enfrentar ambos tipos de complejidades.

Según el oncólogo Bruno Nervi, presidente de la fundación Chile sin Cáncer, hay cerca de 100 oncólogos en Chile, cuando se necesitan 400 (55.000 personas son diagnosticadas con cáncer cada año) (‘La Fundación Chile sin cáncer (…)’ 2018). Dado el gran número de pacientes, los oncólogos no tienen el tiempo de explicar todos los detalles del tratamiento. Las enfermeras que trabajan en la sala de quimioterapia enfrentan el mismo problema, ya que tratan de atender tantos pacientes como sea posible. Las enfermeras de enlace, entonces, llenan este vacío al educar a los pacientes sobre los detalles de la enfermedad y su tratamiento y al mediar ente los pacientes y el complejo sistema burocrático de la salud pública de Chile. Ellas hacen todas las citas para exámenes, análisis de sangre y demás –lo que requiere mucho papeleo– y se mantienen en contacto con el paciente en caso de que éste tenga alguna duda o inquietud. Estas enfermeras dedicadas constituyen un factor humano en los servicios de salud que ninguna aplicación puede reemplazar. Las enfermeras de enlace, sin embargo, sí usan una aplicación, la aplicación de mensajería más usada por los pacientes: WhatsApp. Según las enfermeras de enlace, WhatsApp les da la capacidad de usar los varios modos de comunicación según las particularidades y necesidades de cada paciente: algunos prefieren una llamada por teléfono, otros se sienten tranquilos al ver una foto de la receta o turno de examen, algunos necesitan un mensaje de audio que puedan escuchar varias veces hasta entender (muchos pacientes son de bajos recursos con escaso nivel educativo). Además, las enfermeras de enlace están disponibles para los pacientes por cualquier duda o pregunta que puedan tener. Estas enfermeras están ahí para ellos, para responder sus inquietudes y confortarlos, ya que el tratamiento y esta relación de cuidado a distancia puede llegar a durar años.

Daniel Miller, investigador coordinador del proyecto ASSA, escribió en su último libro ‘The Comfort of People’ sobre el uso de nuevos medios de comunicación con pacientes terminales con cuidados paliativos. En ese libro Miller recomienda crear un protocolo de uso de nuevos medios entre paciente y personal de salud (2017: 218). El uso de WhatsApp por parte de las enfermeras de enlace de hecho sigue un protocolo que se fue desarrollando en los últimos años a partir de la experiencia. Yo intentaré describir este protocolo y este uso de WhatsApp y construir un modelo que pueda ser replicado. Realmente tengo la esperanza de poder llevar esta buena idea que se desarrolló localmente a otros hospitales públicos de Chile.



Devine, A. (2017, 3 de abril). The Nurse Navigator: A Patient’s Compass On The Healthcare Journey. Extraído de 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, 15 de octubre). Extraído de 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. En C. C. Mavhunga (Ed.), What Do Science, Technology, and Innovation Mean from Africa? (pp. 97–115). Cambridge, Massachussetts: The MIT Press.

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

Alfonso ManuelOtaegui8 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.


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.

Experiences of ageing: as diverse as the experiences of using a smartphone

Alfonso ManuelOtaegui11 June 2018

Photo (CC BY) Garry Knight

Conducting an urban ethnography in Santiago, Chile,  has so far involved looking for opportunities in which to meet people who would agree to share their experiences on ageing and on the role of the smartphone in their everyday lives. As the coordinator of this project, Daniel Miller, once said, ‘Actually, as is often the case in ethnography, the best approach is through volunteering […], which has the clear upside that you are also contributing something’.

I started, then, to volunteer as a teacher assistant at a cultural center for the elderly, helping out in two workshops on the usage of smartphones. This experience has been as rewarding as it is interesting. In four weekly meetings the students are taught the basics of smartphone usage: general settings (connecting to Wi-Fi networks, setting screen brightness, etc.), using the camera, WhatsApp and Google Maps. These very enthusiastic and engaged students do not represent the whole spectrum of relationships that the elderly have with the digital world.

In a recent study in the UK by the Centre for Aging Better and the Good Things Foundation on the usage of internet by people aged between 55 and 93, the researchers aimed at including three key groups: resistant non-users (people who do not use the internet and do not intend to do so), lapsed users (former users of the internet who had stopped going online) and current users (experienced users and also beginners). If we used the same categories in my field site, we could say that the students of the workshop would be in the third group.

Even though I am working with a limited sample of people and am in the early stages of fieldwork, it is remarkable how ethnography has already allowed me to perceive the complexity of the practices surrounding the smartphone and to question several taken for granted assumptions on the life experiences of the elderly.

One of the first things to notice here is the lack of homogeneity in the expectations of usage of smartphone: one lady wants to take HDR pictures to post later on Instagram, a man wants an app to scan QR codes he comes across in flyers, others want to use an app to measure glucose levels. In the same vein, the difficulties they encounter are also diverse: some might find it difficult to understand the difference between (paid) mobile data and (free) WiFi, or to understand the notion of ‘the cloud’, some others might have trouble with the touch interface. This diversity in the usage of the smartphone echoes the general diversity in the experience of ageing.

As a psychologist specialised in pyschogerontology, Daniel Thumala, points out: ‘no hay una vejez, hay ‘vejeces’’ (2017). The contrast between the singular and the plural applied to ‘vejez’ (‘old age’) could be translated as ‘there is not one [standard] experience of ageing, there are [several] experiences of ageing”. Several factors play a role in every particular experience of ageing: family (as child and as parent), education, work, eating habits, exercise, toxic habits, etc. (Villalobos 2017). This is also true of the diversity of factors that play a role in the adoption and usage of smartphones by the elderly, which can be shaped by the following:

  • the usage of previous technologies (e.g. familiarity with a keyboard, or with playback icons),
  • family support (e.g. tech assistance provided by grandchildren),
  • education,
  • fine motor skills and general expectations on the usage of the device (e.g. to gain independence, to stay in contact with family, to track bodily functions, etc.).

It will be interesting to go beyond the context of the workshop and to learn how the smartphone is integrated in the diverse experiences of everyday life of these engaged students. Media reports on the smartphone usually focus on the capacities it might bring to the user. If we take that perspective for a moment, even though it is by no means the only possible one, we could ask ourselves to what extent, if at all, the smartphone might be helpful for the elderly to gain higher autonomy. According to Thumala (2017) –and this goes against ageist preconceptions on the dependency of elderly people–, 76% of elderly people in Chile are autonomous. It would be interesting to see if the smartphone plays any role at all in this autonomy.


Miller, Daniel (@DannyAnth). “Actually, as is often the case in ethnography, the best approach is through volunteering (I am pretty good at making tea), which has the clear upside that you are also contributing something.” 19 April 2018, 12:18 a.m. Tweet.
Richardson, James. 2018. I Am Connected: new approaches to supporting people in later life online. Centre for Ageing Better and the Good Things Foundation. [free download at https://www.goodthingsfoundation.org/research-publications/i-am-connected-new-approaches-supporting-people-later-life-online]
Thumala, Daniela. 2017. Imágenes sociales del envejecimiento. Material del curso “Cómo envejecemos: una mirada transdisciplinaria”, impartido en UAbierta, Universidad de Chile
Villalobos C., Alicia. 2017. Conceptos básicos acerca del autocuidado. Material del curso “Cómo envejecemos: una mirada transdisciplinaria”, impartido en UAbierta, Universidad de Chile.

“Heal our wounds” Does religious devotion increase with ageing?

Alfonso ManuelOtaegui9 April 2018

Photo by Alfonso Otaegui (CC BY)

The huge cupola of the Our Lady of Lourdes Basilica is hard to miss while walking through the peaceful neighborhood of Quinta Normal in the western area of Santiago de Chile. Just in front of the temple lays a street market of a particular kind. Street markets are common in Santiago. Some of them are permanent, while some others come up during specific days for a couple of hours and then vanish. Vendors set up tables and plastic roofs and sell the most varied merchandise: fruits, shoes, books, vegetables, bags, fish, used electric devices, clothes and plastic containers. Vendors cry out their offers and some of them even sing. The merchants in front of the temple, however, sell a quite distinctive paraphernalia, more in tune with the ambiance of the place. Yellow candles, brown crucifixes, grey statues of saints, blue bottles for holy water in the shape of the Virgin Mary, red bracelets and pink quartz stones lay next to each other in colorful contrast. Their colors are as varied as their purposes: specific saints (or stones) heal specific ailments or protect against specific evils. The diversity of this pantheon does not distract from what is beyond the market: the impressive open-air temple of the Lourdes Grotto.

This open-air temple, built in the late XIX century, hosts a reconstruction of the Lourdes Grotto, the cave in France where, according to Catholic tradition, the Virgin Mary made a series of apparitions to the 14-year old shepherd Bernadette in 1858. A series of minor displays to the left and to the right of the major shrine tell the story of Bernadette and her many encounters with the Lady. At the center, in the main shrine, a statue of Bernadette can be seen to the left. If you follow her gaze upward, you will find a statue of the Virgin Mary next to the words “Mother of Christ, heal our wounds and increase our faith”. For a couple of hours the shrine is open and people are invited to go in and touch the rock. While a lady at a pulpit reads the story of the apparitions and prays to Mary, people come to the front, piously caress the feet of Bernadette, touch the cave wall behind the altar and then reach a holy water font, where they wet their fingers and make the sign of the cross on their foreheads.

Even though there were people of varied ages, most of them were over fifty years old, not few of them over seventy years of age. They came, they sat for a while and, if the shrine was open, they would go to touch the statue and the wall. To the left of the shrine there is a spring of holy water. People queue –some standing, some on crutches, some in wheelchairs– to bless themselves or to gather the holy water in bottles, a few of which had the shape of the Virgin. The walls demarcating the area temple are covered with marble plaques, of which I counted over 2.000. Some of them as small as a packet of cigarettes, some others as big as a magazine. Some of them ask for help for a specific individual or family. Most of them thank the Virgin of Lourdes for the received favors. Some are as anonymous as to use the initial letters of names, while others have pictures of the beloved person for whom healing or care is asked. On the marble surface further requests and gratitude notes are written in pencil. The newest one was from last month. The oldest one from the first decade of the 20th century. For over a century people have come to this shrine to ask for divine help against disease or unemployment and to express gratitude later on. The high number of elderly people is remarkable. Was it always like this? Did these devoted citizens also come when they were younger? Does religious devotion increase with age? These are some of the questions related to the experience of ageing, healthcare and spirituality I want to answer in the frame of the ASSA project.

Puzzling contrasts in Santiago

Alfonso ManuelOtaegui6 February 2018


Photo 1. (CC BY) Alfonso Otaegui

I arrived in Santiago de Chile over a week ago, in order to conduct a 16-month ethnography on the experience of age, the use of smartphones and their relation to healthcare among migrants working in this city.

The very first time I walked around Santiago I was puzzled by the sudden and stark changes in its architecture and general appearance. You can be walking by a beautiful cobbled street among art nouveau three-storey houses with iron work in their wooden doors (Photo 1) and just fifty meters later you can find a whole block of damaged late 60s ugly functionalist six-storey buildings (Photo 2). It is a feature local Chileans are aware of and remark on: the absence of transitional features that might soften these abrupt changes.

Photo 2. (CC BY) Alfonso Otaegui

These stark contrasts are evident in the neighbourhood where I am conducting fieldwork. Yungay is a protected heritage zone inhabited by the Chilean upper class in the early twentieth century. Nowadays this population has migrated Eastwards and uphill leaving behind many of these beautiful old big houses, which have been occupied by multi-rental low income migrants. By contrast, other old houses, restored as lofts, provide huge continuous areas for the few. As a result, we find well maintained homes within dilapidated neighbours. While art nouveau houses are covered by colorful graffiti, as part of this architectural palimpsest of different eras and social classes (Photo 3).

Photo 3. (CC BY) Alfonso Otaegui

These contrasts make manifest a deeper material contrast: the income inequality gap. As is sadly the case in much of Latin America, Chile has a high index of income inequality (47,7 2015 World Bank estimate). According the National Institute of Statistics, the average income in Chile in 2016 was of $ 517.540 (roughly U$S 862). But only 28,6% of the working population, receive this amount or a higher salary, with just 9,7% of the working population earning over one million Chilean pesos (around U$S 1660).

Notwithstanding the high index of income inequality, Chile shows deeper internet penetration (71,7% had access to Internet in 2016) compared to the rest of Latin America (average 56,1%). The same study by IMS Mobile showed that 9 out of 10 users connect to the internet through their smartphones. As in the Why We Post project, with which a number of the ASSA team were involved, this suggests that greater equality in online access may not result in diminished inequality more generally. But the situation is likely to be quite complex and hopefully the next 16 months will provide a more nuanced picture, beyond the facades of the architecture.


IMS Mobile in Latam Study, 2nd Edition, September 2016, free access through https://www.imscorporate.com/news/Estudios-comScore/IMS-Mobile-Study-Septiembre2016.pdf

OECD (2018), Internet access (indicator). doi: 10.1787/69c2b997-en (Accessed on 04 February 2018)

The World Bank. Databank. Poverty and Equity. http://databank.worldbank.org/data/reports.aspx?source=poverty-and-equity-database