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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.

 

Facilitating nutritional health through the smartphone in rural Japan

LauraHaapio-Kirk7 November 2019

Communal eating in Tosa-cho. Photo by Laura Haapio-Kirk (CC BY).

In September I received the good news that a joint application I made for the newly established Osaka-UCL Partnership Funding was successful. Along with Danny Miller on the UCL side, I teamed up with Dr Yumi Kimura from Osaka University who works on nutrition from a public health perspective in Japan, Myanmar, and the Himalayas. The project also involves Lise Sasaki, who previously studied medical anthropology at UCL. Our proposed collaborative project joins my ongoing anthropological research on smartphone usage among older adults in Japan with Dr Kimura’s public research on nutrition, to develop a mobile health intervention which is sensitive to local usage of mobile phones and attitudes towards health.

The project will take place in my rural fieldsite of Tosa-Cho, a town of roughly 4,000 inhabitants, in Kōchi Prefecture, South West Japan. This rural mountainous area is remote, with the nearest city (Kōchi City) being a 1-hour drive away. Rural towns in Japan are most in need of technological innovation to deal with the growing number of elderly people who are living often alone and in need of care. We know from our ethnographic research that mobile health applications are seldom used by older adults in this town, despite smartphone usage being fairly high. This indicates that there is great potential for digital health interventions but these have to adapt to the way local people are already using their smartphones, rather than encouraging them to download new apps.

Sharing food and conversation. Photo by Lise Sasaki (CC BY).

Over the course of our fieldwork, we have seen this trend across several field sites ranging from Brazil to Ireland: although mHealth initiatives may focus on changing behaviours through the use of native apps built specifically for improving health outcomes, we think making use of the ubiquitous platforms already in common use amongst the target populations could offer significant benefits. We plan to examine the creative ways that older adults are already using common smartphone applications for health and wellbeing, and will explore how these everyday applications could be used for purposes of a nutritional intervention, for example meal tracking using the application Line, or the facilitation of social eating in order to reduce isolation among older adults.

We will present our findings to doctors and health researchers at a symposium in 2020 organised by the UNESCO Chair in Global Health and Education, held at Osaka University by Prof Beverley Yamamoto. We also want to share our findings with the local population of Tosa-cho, so we plan to run a community workshop where we will demonstrate ways for people to use their smartphone to benefit their health and wellbeing. We are hoping that this research and accompanying policy report will reach beyond Kōchi prefecture and will be shared more broadly to advise on digital health policy across Japan. As older adults adopt the smartphone at increasing rates, the potential for mHealth to mitigate some of the health challenges that come with ageing is promising, but initiatives must adapt to already existing behaviours if they are going to have a chance to be sustained.

 

 

“Iconographies for Retirement” – By Pauline Garvey

GeorgianaMurariu31 October 2019

Author: Pauline Garvey

As part of the ASSA project, we are developing mHealth (mobile health) initiatives in order to address the needs of our populations. In our two field sites in Dublin we are engaged in developing social prescribing sites that can be accessed online, on smartphones, and as hard copies for those who are not comfortable with digital media.


Figure 1: One Dublin-based social prescribing site that we are developing.

Social prescribing is based on the recognition that a person’s health is improved by the degree she or he is embedded in social networks and cultural activities (see my blog December 2018). In many cases it involves a GP or counsellor writing a ‘prescription’ for a patient to attend a social activity that will embed a person in their community and enhance their health in mental, emotional and physical ways. In one pilot study, the Irish Health Service Executive described social prescribing as a service that:

“…helps to link you with sources of support and social activities within your community. Social Prescribing is for you if you feel that you need some support to mind your health and wellbeing, you feel isolated, stressed, anxious or depressed, you simply feel you need the service.”

This approach to health has been subject to quite a bit of media attention in Ireland this year and has been subject to several pilot studies nationally and internationally.[i] As part of this rising tide, there is now an annual international conference dedicated to social prescribing which is being developed in diverse countries from UK to the United States, Canada, the Netherlands, Singapore, and Finland.

The question for our team is firstly how can we develop a social prescribing site that enhances the lives of our research respondents? Secondly, how can an anthropological approach make a positive contribution to social prescribing more generally? Our approach is very much coloured by our methodology of anthropological ethnography and participant observation. This means that our insights emerge as the result of immersive participation in our field sites, building on the 16-month ethnographic fieldwork already completed. In developing a social prescribing website, we plan on continuing to work with our research respondents to understand how they use and engage with initiatives such as these.

The first issue emerged early when our informants expressed doubt about the iconography used to denote retirement.

Figure 2: One of the icons that our respondents objected to

For the people we work with, this icon seemed to capture an ageist expectation of what retirement should be rather than their actual experience of it. For example, one of my respondents jogged the 30 km home on the day he retired. Although this man’s level of fitness is not what I would describe as ‘average’, his perspective on remaining active is more in keeping with our respondents than the icon above (see figure 2).

As a result, we set about working with students from computer science in Maynooth University to create something more appropriate. As we work on developing iconography that better encapsulates the experience of our respondents, we realise that this is an ongoing iterative process that we will constantly revise as we launch our websites and work with our respondents in the years to come (see figure 1). Two alternative icons we are currently considering with respondents can be seen below.

 

Figure 3: Alternative retirement icons that we are currently considering with our research respondents.

 

References:

[i] https://www.irishtimes.com/life-and-style/health-family/what-is-social-prescribing-and-how-it-can-benefit-your-health-1.3840354

 

‘If you are old, you invented the Internet’: A tribute to a senior geek

Marilia Duque E SPereira22 October 2019

I felt insecure about accepting an offer of website hosting from Dudu Balochini, who suggested we host the two websites we had developed together on his server at no cost. I asked him: “But what if you die?”. I was referring to my access to the servers, but he thought it was about his age since he was almost twenty years older them me (I’m 42). He then challenged me: “What if you die?” And that was how we laughed together and moved on. The first site we published together answered a need from the Center of Ageing Studies located at UNIFESP Medical School. Their researchers monitor the elderly population of a neighbourhood in Sao Paulo, and their studies include investigating the impact of physical activity on ageing. One of the interventions they made was to map out opportunities within walking distance for older people to exercise. This mapping was manually adapted to the address of each patient – a herculean task. But an informal survey showed that 70% of program-assisted seniors have smartphones. I had this information in mind when I met Dudu for a coffee. “Do you think we could make these activities accessible through Google Maps based on people’s location?”, I asked him. And he just said “I already know how to do that. I need two hours”. Twenty-four hours later, he produced the site we called Get Up and Go: nearby activities for the 60+. “I used the Store Location feature in WordPress, but it took me a while because it was blocked for developers from Brazil”, he apologised as though I thought he was late.

The second site is part of my delivery for the applied side of the ASSA Project – Anthropology of Smartphones, Smart Ageing and mHealth. With an ethnographic approach, I observed how WhatsApp was used for health purposes in Sao Paulo. I mapped the best practices and organised them into a set of protocols for communication within hospitals and clinics. I also developed a second set of protocols addressing nutritionists (obesity and being underweight are both health issues among older people in Brazil). Both materials are open-access and should be available for download. That is why I needed a website to publish them. This time, Dudu didn’t develop the website for me. “You’re going to become a SeniorGeek”, he told me. SeniorGeek is an initiative for digital inclusion of seniors created by him. At presentation events addressing older people, Dudu tried to demystify technological themes like Artificial Intelligence, Blockchain and Chatbots. He believed older people should know about those things or they would be cut off from conversation with children and grandchildren and, moreover, with society. Dudu also believed he could enable seniors to become digital entrepreneurs through courses that teach how to build a website, or an e-commerce or a blog. This is how I became his student. By myself, with the autonomy he wanted all seniors to achieve, I developed and published my WhatsApp manuals at http://www.saudeeenvelhecimento.com.br. In my field site, entrepreneurship gains strength among older people as a means of reintegration into the labor market. This is a consequence of the desire of many to remain productive but it is also their way to respond to corporate ageism. Dudu himself used to say he lived in a limbo: too old for the market, but not a “legal” senior yet.

Dudu was also a public figure. He was often in the media, giving interviews about the relevance of digital inclusion for seniors. At 58, he used to say, “If you are old, you invented the Internet. The problem is that people accommodated and forgot about it”. And he has a point. We just have to remember that Bob Kahn and Vint Cerf, creators of the TCP / IP protocol that enabled the Internet, are now aged 81 and 76 years old. However, ethnography showed me that this detachment from technology was also linked to retirement, when access to technology and needs in daily life change (Selwyn, 2004). Even so, Dudu’s speeches were inspiring and older people felt more confident because of him. Dudu died one week after I left my field site. An abrupt heart attack. On the one hand, he has achieved the death my informants desire the most: a death without illness or disease. I have written before about how my informants do not fear death. On the contrary, they see death as natural and even desire it when they think of the prospect of a future lived with physical, mental or financial limitations. On the other hand, it was an early death. Dudu was gone when he began to experience the purpose of life. I say experience because, among my informants, there is a feeling that the meaning of life is not something that can be explained by past achievements or by spiritual convictions. Therefore, they abandon philosophical reflections on the subject to focus on the present: they live today with purpose, filling daily life with pleasurable activities and, if possible, positively impacting the lives of those around them. Dudu brought these two accomplishments together in an intense agenda of events and courses.

And it was precisely the technology Dudu was so enthusiastic about that mediated his farewell. The news of his death spread via WhatsApp and was shared from group to group, giving rise to dozens of messages. Information about his funeral was also shared throughout the night, as well as information about the seventh day mass. For this last meeting, friends used WhatsApp again to prepare a last tribute. They have the idea to reproduce the “uniform” worn by Dudu, a black T-shirt, with the SeniorGeek logo. And during the days leading up to the mass, they spoke about how this production was made feasible all through their smartphones, as Dudu would like. The mobilisation was properly registered. And the pictures dominated social media again, now accompanied by the text “We are all senior geeks”. Dudu’s original WhatsApp group for his SeniorGeek initiatives was deactivated. A new one named “Senior Geek Connected” was created instead. It’s still a place where older people can find information about technology and new learning opportunities, keeping Dudu’s original idea alive. For him, above all, SeniorGeek was a manifesto against the invisibility of older people, something he believed only technology could solve.

 

 

 

 

Selwyn, N. (2004). The information aged: A qualitative study of older adults’ use of information and communications technology, Journal of Aging Studies, 18, 369–384

 

Digital Social Participation: Cases from Milan

ShireenWalton9 September 2019

Photo (CY BY) Shireen Walton

Social participation is among the most significant factors linked to health and wellbeing later in life. As a variety of studies have shown, loneliness (both social and emotional [i]) is one of the most pressing issues of ageing. Individuals, of all ages and backgrounds seek roles, a sense of belonging and purpose, but these needs becomes particularly pertinent following retirement, in ‘empty nest’ contexts of family members having moved away, or in conditions of limited physical mobility

One question we have been exploring in the ASSA project is what might be the significance of digital social participation, or rather, social participation that is facilitated by smartphones and digital practices. My ethnographic research in one inner-city neighbourhood in Milan reveals how smartphone practices play a significant role in facilitating social participation amongst a range of individuals and groups, helping to combat issues associated with loneliness and physical/social isolation, via on– and offline practices.

To illustrate with a couple of examples.

Ugo, 75 is a retired engineer lives with his wife, Anna, 70, a retired schoolteacher, on the 5thfloor of an apartment building where they have lived for the last 30 years. Due to a severe spinal condition that affected the use of his legs, Ugo hardly ever leaves the house. A combination of technologies, the Internet, historical fiction books, and daily interactions with his wife make up his social world where he spends the days in a wheelchair at home. From the moment he wakes up in the morning until he goes to bed, Ugo is connected to the Internet via the house WiFi. Ugo uses his smartphone primarily for communication with the wider social world – he wears his smartphone round his neck in a well-worn, knitted phone case that Anna had knitted for him a few Christmasses ago. Through WhatsApp, Ugo enjoys receiving photographs from family and friends. At one point, Ugo was added to a WhatsApp group of the apartment building that was set up by one of his neighbours, a Peruvian woman called Angela, as a communication porthole for residents of the building. Before long the group transformed ‘from below’ into a forum of sharing, posting, commenting, celebrating, via emojis, memes, screenshots, even poems. While Ugo is not active overly himself on the group, the messages he receives on his phone, in addition to wider notifications such as the news, bring him a certain pleasure throughout the day, making him feel connected to a certain buzz of being-in-the-world where his physical conditions had otherwise gradually removed him from.

Ugo also uses WhatsApp to communicate with his (family) doctor.  In one instance, Ugo had a rash that had developed on one of his legs. The first thing he thought of to do was to take a photograph of it on his smartphone and send the image to his doctor on WhatsApp. This led to a kind of informal digital consultation between the two. “We are close”, Ugo explained. “He (the doctor)is like a son or nephew to me. With WhatsApp we are like family – I know he is never far away if I need anything, which comforts me. From time to time he will ask if he can pop round to see me on his way home.”

In a different example, Rosalba, 69, originally from the region of Abruzzo in central Italy is a retired secondary school teacher. She lives with her husband (75), a retired electrician, and their dog. Rosalba found the adjustment to full-time retirement a difficult transition, and missed the sociality of her professional role and buzz of school life. She soon sank into daily routines within the home; household chores, shopping, cooking for her and her husband, a few outings. But without real purpose, Rosalba found herself drifting through the days and weeks. Before long, her home space became a kind of benign ‘prison’, and she found herself feeling suffocated by emotional isolation and loneliness. One of Rosalba’s former colleagues from her school who she sees regularly at the supermarket recommended that she should come along to a women’s choir that meets once a week in the neighbourhood. Rosalba found aspects of the choir refreshing and stimulating; the multi-cultural and cross-generational aspect resembled what she had experienced at work at the school. The choir’s WhatsApp group, in particular, was extremely active. The women share photos, videos, song lyrics, emojis full of hearts, flowers, shooting stars, laughs, cries, thumbs up and down, amid a broad repertoire of digital-visual expressions of emotion. After a year, Rosalba found that she had discovered a new lease of life through the choir and its associated fora of sociality, including the WhatsApp group. The stream of messages that flows between the women and the immersive, ‘affective community’ it forms, comforts Rosalba in her day-to-day life, and she became to feel less alone throughout the days. Retirement now feels like something Rosalba can participate in and even shape, as she begins to carve out spaces for herself and her need for collectivity. She has developed her singing voice in expressing powerful and politically and emotionally-loaded lyrics of defiance, human solidarity, sisterhood, in a range of languages and dialects, and this empowerment appears to have seeped into other aspects of her life, including how she participates more actively in her social relationships, and in trying out new hobbies such as walking groups. Ageing and retiring with smartphones has been a gradual but creative and rejuvenating experience for Rosalba, and digital communications have facilitated and boosted her social participation.

For others in the neighbourhood, digital social participation can be an important way of participating in community life for other reasons. Angela (45) is from Lima, Peru. She lives with her husband and their 12-year old son in the same apartment block as Ugo mentioned above, working as a part-time teaching assistant in one of the local public schools. Angela describes her life with her family as ‘quiet and closed’. She is not particularly sociable or confident in public settings, and some of this she attributes to a difficult background and upbringing in the low-income neighbourhood her family lived in in Lima. She is particularly concerned about street crime and violence and the safety of her son growing up in Milan. Although she is reasonably active during the day between her job, the food shopping, and taking care of the family at home, Angela avoids going out at night. Through digital forms of engagement however, Angela has enhanced her social participation in the community in a manner she feels comfortable with – from the comfort and safety of her home. She participates enthusiastically on the apartment block WhatsApp group she set-up for neighbours in the building – sharing friendly messages and greetings on festive days – and is a member of various groups tied to her son’s school such as parents’ groups on WhatsApp and Facebook, which keeps her both informed and feeling involved. When one of her Peruvian friends recommended a weekly women’s sewing group, Angela joined and became an active participant on the WhatsApp group. The social worlds contained within Angela’s smartphone constitute some of the main sources of Angela’s present social life. Her social participation is both offline and online, but is most frequently played out via the smartphone.

Engaging socially in digital forms can be important in a variety of contexts and at any age. Although the politics and practices of inclusion/exclusion via digital practices are far from simple matters, requiring delicate critical and contextual attention, my research in Milan highlights how smartphone-facilitated sociality can modulate experiences of loneliness, isolation and/or social exclusion amongst a range of people, including older adults and migrants in the city, forming an overall central part of how socialities are crafted in this context.

References:

[i]  De Jong Gierveld, J. & Van Tilburg, T. (2006). A 6-item scale for overall, emotional and social loneliness: Confirmatory tests on survey data. Research on Aging, Vol. 28 (5): 582-598.

 

Applying ethnography to digital health aims; challenges and opportunities – by Charlotte Hawkins

LauraHaapio-Kirk10 August 2019

Author: Charlotte Hawkins

Photo (CC BY) Charlotte Hawkins

How can a holistic ethnographic understanding of ageing experiences, particularly related to health mobile phone engagement, contribute to an mHealth initiative and improve the accessibility of health services and information through mobile phones? This applied challenge in the ASSA project has initiated partnerships with digital health practitioners in most of our fieldsites – in particular, with collaborators working within existing phone practices. This aligned with our early finding across the fieldsites, that mobile phones are commonly used for health purposes, but through communication on apps evidently most popularly used, such as calls, Facebook and WhatsApp. In Kampala, I worked with The Medical Concierge Group (TMCG), a medical call centre founded by Ugandan medics to improve the accessibility, affordability and quality of healthcare. They offer a 24-hour toll-free phone line, SMS, WhatsApp and Facebook access to a team of doctors and pharmacists and have 50,000 interactions each month. At the time of fieldwork, they were in the process of researching the development a psychiatric call line, or ‘telepsychiatry’. This early stage of service development meant that TMCG were interested in and able to accommodate holistic ethnographic insight in their considerations.

Ethnographic insights included systematic information on 50 low income research participants’ existing mobile phone and mobile health practices as relevant to accessing TMCG services. For example, access to airtime and data is intermittent, with a tendency towards regular low-cost subscriptions. This suggests that calling or using the internet could be inaccessible to users at least once a day. Furthermore, 54% of participants had made health-related calls in the last month, and 27% of their previous three remittances were for health purposes, which confirmed an existing propensity to use mobile phones to support family health – but only across their own network of friends and relatives. Interviews with 50 respondents encountered during the wider ethnography also offered TMCG feedback on mental health perceptions, experiences and help-seeking preferences. These interviews were predominantly with older people, mostly older women, who would not typically opt to engage with research on mental health, and yet who represent an advisory position within their family or community. This also included interviews with health workers, including psychiatric clinicians at the local government hospital, and private health clinicians within the fieldsite. Research showed that treatment for mental illness was perceived to be unavailable, costly, or stigmatised. Often respondents said they prefer to handle mental health problems through prayer or counselling within their community, with hospital treatment sought only once problems become severe. This suggested that optional, confidential, accessible or community-based mental health services could be useful for low-income people in Kampala, if advertised accordingly.

Initially, the wide-reaching interview responses were considered thematically, from causality to treatment seeking, and condensed into representative quotes for presentation back to the team. More recently, alongside the team, these themes have been expanded to inform a draft publication in psychiatric journals, which TMCG hope to use seek further funding. We also hope to further disseminate findings in accessible formats amongst other digital and mental health service providers in Kampala. As familiar to many applied medical anthropologists, translating interpretive, subjective and relativist ethnographic information within positivist, objective and universalist medical paradigms brings challenges, such as risking that complex human experiences and perceptions are reduced into ‘practical’ or digestible concepts (Kleinman, 1982; Scheper-Hughes, 1990). However, this assumes that the health practitioners and their discipline are not open to understanding their patient’s everyday realities, which has not been the case in this instance, perhaps reflecting a particular affinity between anthropology of digital health – appropriation of phone based health services is entirely dependent on their relevance and usefulness for their target populations.

The on-going collaborative process has also highlighted what anthropology might learn from the research and writing processes of health disciplines, for example: ensuring findings are widely disseminated and thus accessibly written; avoiding anecdotal, emotive or biased claims; and ensuring that quantitative statements, “many people said xxx”, are qualified and backed-up. The collaboration has  also confirmed that the flexibility of anthropological research and richness of qualitative insight potentially has much to offer health programmes, to ensure their contextual relevance. In ethnographic research, we have the privilege of time, which comes with in-depth insight, and familiarity with the community – time and understanding which we can offer usefully to other audiences. The data provided can perhaps confirm a hunch of a practitioner from the area but can also surprise them. When documented and publicised, the data encourages practitioners to both tailor their approach, but also allows them to share the specific requirements of their target population, encouraging others to do the same – or hopefully even to offer funding to support them.

 

REFERENCES

Scheper-Hughes, N. Three Propositions for a Critically Applied Medical Anthropology. (1990) Social Science & Medicine 30 (2): 189-97.

Kleinman A. The teaching of clinically applied medical anthropology on a psychiatric consultation-laison service. In Clinically Applied Anthropo1ogy: Anthropologists in Health Science Settings (Edited by Crisman N. and Maretzki T.) Reidel. Dordrecht, 1982.

 

Smartphones,’addictions’ and connections in Italy

ShireenWalton14 May 2019

Photo (CC BY) Shireen Walton

Last week during one of the women’s group activities at the Multicultural Centre I have been regularly attending in Milan I was asked if I could take a photo for one of the Italian women, Maria, in her early 70s, who volunteers at the Centre three days per week. Maria had just been found on Facebook by an old school friend and wanted to instantly send her a nice photo of herself ‘here and now’ on Facebook messenger to acknowledge and build the connection. Maria spent some minutes deciding where to pose, and how to fix her appearance, to the extent that it cut short in an abrupt manner the end of the meeting. Maria’s desire to connect across time/space there and then was so strong that the barries between the smartphone’s buzzing social universes and the physical social setting of the Centre had crossed over, with mixed responses by others present.

Centro Multiculturale, Milan. Photo (CC BY) Shireen Walton

Such examples of smartphone ‘intrusions’ into a social scene are not uncommon, and go hand in hand with a range of attitudes and judgements – that are often expressed and shared, ironically in smartphone-circulated memes, cartoons and photos. During my time in Italy a range of popular mantras reflect the alleged intrusion that digital connectivity feel poses to life: ‘we are all addicted!’ ‘just look at people on the metro – all face down, scrolling away, ignoring everyone and everything around them’, ‘at a party, no-one speaks to each other anymore, it’s crazy!’ and so on..

As an anthropologist, I find the worries and anxieties that some people have about smartphones – their over-reliance, seeming addiction or just about their general usage, part of the curiosity in exploring what the smartphone is, and how people describe it in relation to their everyday practices.  Peeling back the layers of these discourses, one sees the spectrum of practices that smartphones are implicated in in individuals’ lives, from connection with family, friends and community, to tools for navigating bureaucracy, citizenship, and health. All the while, the digital infrastructures that form and shape the basis for these interactions and practices (wifi, roaming data, connection speed…) form a part of people’s contextual and sited experience with their smartphone in daily life.

The notion of the ‘switched-on-self’, the boundaries between digital and non-digital lives has been a more general theme in my research and participant observation in my fieldwork with Italians and migrant groups in Milan. The correlation between being on/off in the person’s mind/body recalls and in some sense plays into wider global social trends like the flourishing of mindfulness and yoga that are posited by many people I speak with here as opportunities for peace – ‘places’ and practices to go to and do to ourselves and our bodies to ‘switch off’ from our busy, including constantly connected, digital lives.

Outdoor yoga in the park in the Milan fieldsite; moments for digital detoxing. Photo (CC BY) Shireen Walton

Throughout my research I have noticed how the issues of technology addiction and connection have been defined along age lines. At AUSER, a nation-wide NGO association for active ageing in Italy with a headquarters in my fieldsite, and Milan-based organisation Grey Panthers that is concerned with ageing and technology, what I have deduced is that while facilitating digital connectedness is a core policy concern aimed at older people (senior/anziani) [1], while policies and initiatives being designed to tackle digital addiction have been identified an issue prominent amongst the young (giovani) [2]. The ASSA project’s interest in middle-age has helped nuance these discourses about young and older populations by looking at how people live their lives with smartphones – including between ‘old’ and ‘young’ categories of age.

To take some examples. Alberto is 60, by policy standards he is neither old nor young. He still works full-time as a history school teacher at the local public school, and is an active volunteer in local community events. Reflecting upon his relationship with his smartphone Alberto describes how he does not consider himself particularly technologically savvy, nor up-to-date with regards to apps. However, from the moment he wakes up (first his alarm, followed by checking WhatsApp, Facebook and then email notifications from bed) he is attaccato (‘attached’) to his phone. He says he is mindful of his pupils’ usage, particularly in the classroom, but confesses to regularly checking his phone during school hours himself. He is in touch with his daughter in her 20s who is searching for work, as well as with the left-wing community organisations he co-runs with friends, monitoring Facebook pages dedicated to spreading awareness of local history and resistance to Fascism, particularly in light of the current policies of the present Interior Minister Matteo Salvini’s far-right anti-migrant stance. Alberto’s smartphone is a reflection of his social universe, and this visibly engagements and investments with this smartphone.

Photo (CC BY Shireen Walton)

Meanwhile Davide, 64, is retired, on a state pension. He volunteers running one of the community allotments in the neighbourhood several days a week. Davide uses his smartphone regularly. It is central to the way he runs the allotments, communicates with the community, and maintains his social life as a single, retired, socially-active man in his mid-60s. Davide also does not consider himself a tech-savvy person. Speaking about apps and app usage he, like many other people I find, explains: “I don’t have any apps really… I rarely use any…” We then discover together, by observation with the phone, that he does have a number of apps, and in fact uses a number of these frequently – many of the social media apps, an app for his gym, an app for the weather, apps that identify what certain plants are… He is not ‘addicted’, but he is reliant, reasonably heavily, on his phone.

Milan neighbourhood community allotment. Photo (CC BY) Shireen Walton

Smartphone practices for some like Alberto and Davide are involved in reflecting and shaping individual lives, social identities and wider offline practices. However, digital infrastructure and connecting to the Internet also plays a significant part in explaining smartphone reliance, and people’s conceptualisation of their phone. In some cases, loss of Internet connection (due to low reception or running out of credit) can be annoying, humiliating, and harmful.

Adla from Tanzana is in her mid 30s, and has a 1-year old daughter. She has been in Milan for a year and a half. Her daughter was born in the city, but has been told by authorities that her daughter is not yet old enough to attend nursery. Adla explains how she does not feel entitled to take part in certain social / support groups since her daughter is too young to go to school and she is uncomfortable attending the mothers groups in here area that are a big source of community life here but which are dominated by Arabic-speaking Egyptian women, which makes Adla feel like the ‘wrong kind of foreigner’ with the ‘wrong kind of languages’, being Tanzanian, speaking Swahili and some English, but limited Italian. Adla relies on her smartphone to navigate the geography of the city, including finding relevant administrative offices, using Google Translate to communicate in basic Italian, and maintain connection with her family – her sister in Sweden, her husband is working in another country in Africa, and the rest of her family are back in Tanzania. Adla does not have Wi-Fi in the one-bedroom apartment where she lives, so uses data roaming through her basic monthly social services allowance to access her familiar social universe. This connection to her smartphone as a physical thing holds intense meaning for her and her ability to navigate her way through each day. Even when the data has run out and it is not connected it is of comfort to Adla in the absence of physical, familiar, offline social life. Unlike Alberto or Davide, whose smartphones reflect their wider activity and presence in the neighbourhood, Adla’s smartphone life takes on heightened significance where her offline life is marred by insecurity and limited physical participation.

In a final example, an Egyptian family in the neighbourhood have been applying for a visa to visit their immediate family in the US who they have not seen for several years. The couple, in their mid-40s, work full-time in Milan as a baker and cleaner respectively, and their teenage children attend local public schools. Every year they apply for entry to the US via a lengthy application system. The family do not have WiFi at home and have limited data roaming on their phones. Upon receiving a letter in the post saying that they need to check the status of their visa application on the US state department website within a specific time period, the couple try to do this in the hours when they are not working, and due to their long working hours that leaves little time to stay for long periods of time in Internet cafes. The site keeps crashing and needs refreshing, and entering the application details in English, a language neither of them speak, is time-consuming. They repeat the process over and over again on their basic smartphones, at times in public free WiFi zones in the city, or at home with their limited data, to no avail. Upon learning about their experience with this process I become involved – the couple ask me to assist with internet access and English translation. Eventually, we discover that their application has been refused, to the couple’s stoic acceptance. It is but a small anecdote in this family’s larger experience of social stress, living on the margins of society in Milan as a close-knit ‘stranieri’ (foreign) family making do in their current set-up, where smartphones, Internet connections, are all part and parcel of broader lived realities; practices, experiences and desires.

In sum, the relationship between the smartphone, and what is often viewed as addiction or social rudeness – particularly amongst youth – are important themes to nuance further, along broader demographic lines. Understanding how and how much different people, of different ages and socio-cultural backgrounds, use and shape their lives around in a given context in relation to smartphones may well point to technological addiction, ill-health, and too much screen time, but it also highlights how central the phone is as a thing itself – for many, an object of attachment, including and beyond its switched on capacity for digital connection. A wide range of factors stemming from broader social contexts thus situate the smartphone holistically as an object of everyday life.

Notes and references:

[1] Auser’s mission statement is aimed at ‘promoting the active ageing of the elderly and enhancing their role in society’, which includes technological education and encouraged usage for wellbeing and for a positive impact on lifestyle. In the University of the Third Age for over 60s that Auser runs through a network of volunteers, ‘technological awareness’, as well as lectures on the dangers of data and privacy issues form a part of a broader curriculum on a wide variety of topics from horticulturalism to cooking to tourism and so on.

[2] De Pasquale, C., Sciacca, F., Hichy, Z. (2017). ‘Italian Validation of Smartphone Addiction Scale Short Version for Adolescent and Young Adults’ in Psychology 08(10): 1513-1518.

 

 

Thoughts inspired by exhibitions in Shanghai

XinyuanWang1 February 2019

As one of China’s major cultural centers, Shanghai boasts a wealth of cultural events. Many locals, especially the younger generation, often go to theatres, galleries and museums. During my stay in Shanghai, beside curating the exhibition for my research participants, I also go to exhibitions on a regular basis in order to keep pace with the ever-changing cultural landscape of the metropolis. Different exhibitions attract different groups of people in Shanghai, therefore going to exhibitions also allows me to observe my fellow exhibition goers in an organic way. Every single exhibition which I went to was very interesting as I could always enjoy watching people even if the exhibition per se may by any chance fail me.

For example, the 2018 Shanghai book fair attracted a quite wide range of audience. Through the lens of my research concern upon the use of smartphones, it was also curious to see that in the sea of books some were quite happy to sit on the steps checking their smartphones and a grandfather using two smartphones to take photos of his grandchildren.

2018 Shanghai book fair

Checking smartphones in the sea of books

Taking photos with two smartphones

On the West bund art expo, I met probably the most international dwellers in shanghai who also attribute to the unique temperament of Shanghai.

West bund art Expo

Whilst an amateur painting exhibition at a community library attracted many retired people from the neighborhood. I happen to spot a lady in her 60s showing the exhibition via the WeChat video call to her family with the help of her friend.

Recently, to my surprise, I happened to walk into a pop-up exhibition about the social changes in the past 40 years (1978-2018) of ‘Chinese economic reform and opening up’ (gai ke kai fang) in the middle of an underground station. With a variety of daily life materials as well as typical scenarios of social interactions, this exhibition vividly represents what has happened in ordinary people’s daily lives and what people are longing for. (Check the short video of this exhibition)

A pop-up exhibition about the social changes in China in the past 40 years

A pop-up exhibition in the middle of an underground station in Shanghai tells you about the social changes in the past 40 years of ‘Chinese economic reform and opening up’, where the techonology plays a significant role. Filmed by researcher Xinyuan Wang

Posted by Anthropology of Smartphones and Smart Ageing on Friday, 1 February 2019

In the first section, an old-school bike represents the most advanced household transportation in the first decade of the reform era. Two semi-transparent figures, being father and son, imply a scenery associated with the old bike – the father is giving a lesson of how to ride a bike, the boy is wobbling about on the bike, asking: “Daddy, can you buy me a bike once I can ride it? Oh no please don’t let me go, I will lose the balance anytime!”

Beside the parent-child interaction, there were household items including an old sewing machine, a radio, a fridge and a TV set. The caption of this section read “My understanding of happiness started from the moment of our whole family watching TV together”. For long, the TV set has had great significance in Chinese households and the place where the TV set is located is where the family spends quality time together.

As shown in the neighboring showcase, more technology entered into people’s daily life, among them the landline telephone was the most important one. To have a household landline installed was regarded as a great honor in the late 1980s as only the public institutes had such privilege before. The caption of this section reads “For years the landline telephone had been my pride, and since then I always used the landline number as my password for my bank cards.”

Many of my research participants share the similar memories displayed at the exhibition that one has to queue at public telephone booths or visit friends who were privileged to have household landlines to make a phone call. In front of the showcase, a little boy asked his grandpa what is the landline telephone, the grandpa answered, “it is called landline telephone (zuo ji), kind of mobile phone before you were born!” Here the future is used to define the past.

Little Boy: what’s that? Grandfather: It is called landline, kind of mobile phone before you were born

The next highlighted landmark of daily technology is OICQ in 1990s along with PC. OICQ soon changed its name to QQ, and even nowadays QQ is still one of the most widely used social media platforms in China. The conversation between a school boy and a girl in the showcase is – boy: “I have got 50 friends on OICQ, and one of them even come from HuHeHaoTe (a city in northern China” Girl:” Please help me to register a QQ account!”

For years, QQ has occupied the PC screen of millions of Chinese people. The use of QQ also gradually spread from Chinese cities to rural China. Six years ago, when I conducted my PhD field work in a small factory town in southeast China, QQ was still the most widely used social media among rural migrant workers.

In terms of the digital device, as one of my research participants put it “In the past decade, the screen has become smaller, while the function has become stronger”. After a series of mobile phone ‘evolutions’, by the beginning the fourth decade of the reform era, China has entered the age of the smartphone. With proliferation of the use of smartphones, more and more older people in China have adopted a new way of interpersonal communication with their family members.

As shown in the last section of the exhibition, in a well-equipped modern kitchen, a young person is cooking while having a video call with his parents, saying: “Mum, look, I can take care of myself. Those are what I just got from the food market. Daddy has high blood pressure, don’t let him drink too much! ” His mum said: “What worry us most is that you don’t eat properly when you live outside alone, having take-away for every meal.”

A passer-by in his 30s commented: “it is so true, my mum would nag so at least ten times a day!” and his friend remarked: “in my case, it’s my mum who will hold her smartphone while she was cooking, showing me all the nice food at home via video call.”

From the old-school bike to landline telephone, from the offline family time in front of the TV set to the online family time facilitated by the digital technology, a small pop-up exhibition captures those subtle but significant material and moments of the daily lives of ordinary Chinese in the past forty years.

On top of it, located in the middle of one of the busiest underground junctions in Shanghai, this exhibition manages to reach the widest audience as possible – I have never seen so many older people and young kids in other exhibitions. Furthermore, I was most impressed by the way this exhibition gets all kinds of people involved, and such willingness and skill to disseminate knowledge is also something our project can learn from.

The challenges of staying active

MayaDe Vries Kedem25 September 2018

Author: Maya de Vries

10 years ago, in a Russian store at the city center of Jerusalem, I bought an A3 size poster from the communist time, with a drawing of an old lady who looks like a farmer, holding a book. The short text beside her image read: If you stop reading books, you might forget the language.

Recently in my field site of Dar al Hawa I found myself remembering this poster when visiting the elderly club, a central place in my field site, as I observed a variety of practices that aim to keep them sharp and vital.

One of the most challenging problems in the elderly club is to find suitable activities for the members. They need to be activities that both men and women can do; not too physical, because many are suffering from pains in their legs and can’t walk a lot, some have hearing problems, or cannot breath well. Hence, many of the activities are ‘just’ talks – it is easier for them to sit and listen. However, there can still be difficulties in establishing the time and place with lecturers as sometimes they call in the morning of the lecture to cancel. When a lecturer stands them up like this or if there is no other organized activity in the club, their alternative is an independent Quran lesson, which is quite different from the religion lesson that they have every few weeks with the local Iman. They take out larger volumes of the Quran and start reading aloud, each one in his/her turn. Hala, a member in the club who is volunteering in the Israeli welfare department and coordinates some of the club’s activities, leads the reading session and corrects them as they read. It is not easy to read correctly from the Quran,  as ech part has its own chants. The exercise is productive not just of the sense of community but also isa practice which helps stimulate memory (Collier, 2017).

The books were donated by one of the club’s members, and are large in order to make reading easier. From the perspective of our projects work on smartphones, in a site where religion plays a core role in daily life, the small screen of the smartphone poses a problem – even if they are able to change the size of the font. However, people here do find relevant uses for the technology. For example, most of them have downloaded an app that reminds them when to pray during the day.

Quran reading lessons seem to be physically passive, since they take place while sitting. However, praying in Islam is quite a physical experience, as the person praying needs to first take off his/her shoes, following this he/she may enter the mosque and begin praying. Praying also involves all kinds of physical positions such as sitting, leaning to the ground, standing up, turning the head to the side – these movements are frequently repeated. The entire group went inside the mosque to pray, some sat on the floor as is custom, while others who physically cannot get down to the floor took plastic chairs. For almost an hour, they all prayed, regardless of any physical limitations, and in a way, were challenging their bodies through the prayer. It is easy to forget that prayer is far more than just words. It is an immersion of the person physically and mentally within their religious practice, and for older people, it remains the structure to much of their life. So when thinking about the impact of the smartphone on people’s lives, one has to be continually aware of how much, and how, this is mediated by religion.

References:

https://www.medicalnewstoday.com/articles/320377.php 

The Internet of Health in Yaoundé – by Patrick Awondo

ShireenWalton12 September 2018

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.