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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 – by Maya de Vries

ShireenWalton25 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.

 

The place of WhatsApp in the ecology of care – by Marilia Duque

LauraHaapio-Kirk26 August 2018

Author: Marilia Duque

Dr. Gusso uses WhatsApp Business at Amparo Health Clinic (Photo: Marilia Duque)

In 2015 a PwC research report suggested that the Brazilian m-health market would reach $ 46.6 million while a GSMA report forecasted that 45.7 million Brazilians would benefit from mobile health projects (see here). In 2017 the scenario was even more optimistic. According to Statista, Brazil was expected to become the largest m-health market in Latin America with revenues of around $ 0.7 billion. These numbers explain the impressive amount of m-Heath startups and startup Incubators I’ve seen in Sao Paulo (see Eretz.bio, for example). But they don’t explain why after 7 months of fieldwork I still couldn’t find the people who are actually using these m-health apps. Instead, I found an intensive use of WhatsApp among my informants, filling the gaps in communication and making a huge impact on the ecology of care which we address in this project.

For example, every day early in the morning, Ms. M (54) sends a good morning message through WhatsApp to four lady-friends older than her. “It is like volunteer work because I know they are lonely and that message will make them happy and socially connected”, she explained. Ms. D (66) also starts her day sending a WhatsApp message. But in her case, the message is sent to her only daughter who lives in France, as a sign that she spent the night well. She is supposed to send this message every day before 10am otherwise her daughter will call a friend to check on her. “Some people say my daughter abandoned me, but the truth is that she is closer than many of my friends’ children who just live nearby”.

That is the same in the case of Dr. J., a physician who works in Sao Paulo and uses WhatsApp to take care of his 93 year-old father. After having a stroke, his father moved to Dr. J. brother’s house located two hours away.  Dr. J. created a WhatsApp group to talk to his brother and to his father’s caregiver. He gives her all the instructions she needs, and she updates him with information such as what his father ate, how he slept, how much water he drank, how much he exercised and how he was feeling. After a few months, he could tell how improved his father was and he explained how WhatsApp helped him and his family to feel safe and engaged.

Dr. K. also uses WhatsApp to provide care at distance. He works in my field site as a generalist providing ambulatory care to old people. WhatsApp allows him to give orientation about what to do when patients don’t feel well, and he can also ask them to go to his office if necessary. In many cases, he said, he can solve problems providing only care at distance. Dr. K. believes that the simple fact that the patients know they can use WhatsApp to contact him makes them feel safe and comfortable.

WhatsApp is also helping clinics to manage people’s health. Amparo Health, for example, is a clinic that uses WhatsApp Business to connect patients to doctors. The patient pays a monthly fee to have access to low-cost exams and to specialists like ophthalmologists, gynecologists, dermatologists, nutritionists and psychologists. What is new here is that all procedures and exams are coordinated by a generalist, who is available on WhatsApp. Dr. Gusso, the head physician at Amparo Health, explains that because the clinic business model is based on membership, they have no interest in demanding unnecessary exams or appointments. Doctors are paid by the hour and not by performance and that includes time to answer WhatsApp messages during the morning and afternoon. At the end of the day, he said, they are using WhatsApp to provide care at a distance, helping people to stay healthy, to feel safe and to save money. Prevent Senior, a health insurance company, also uses WhatsApp to make patients’ lives easier. In cases where treatments require on-going medication, patients can use WhatsApp to ask for new prescriptions. They can receive their prescriptions at home or they can go to the doctor office to get them, but with no need to schedule an appointment.

WhatsApp is the primary method of communication for 96% of Brazilians with access to smartphones. And among my informants older than 60 years old, that is also the app they use the most. Now imagine what can be achieved if WhatsApp features are explored to make the communication between health insurance companies, doctors, patients, caregivers, family and friends healthier too.

Blame the phone..! UI design and elderly smartphone users.

Alfonso ManuelOtaegui12 August 2018

Photo (CC BY) J Stimp.

 

As I mentioned in my previous post, a first step in my ethnography of the experience of ageing and the use of smartphones involved volunteering at a cultural center in the working-class neighborhood where I am living in Santiago de Chile. For a couple of months, I have been a teacher’s assistant in two workshops on the usage of smartphones aimed at elderly people. In these workshops lasting for four weeks, enthusiastic grey-haired students learn the basics of smartphones settings (unblocking the phone, connecting to Wi-Fi, turning on and off the GPS, flight mode and the like), how to use the Camera app, Whatsapp and Google Maps.

In addition, for a couple of weeks, I have been giving a complementary workshop by myself, for those who have already finished the main workshop. This complementary workshop focuses on repetition and exercising: students have the opportunity to practice in more extended periods of time what they have learnt in the first workshop, and to go step-by-step over and over again. This complementary workshop has given me the opportunity to be in more frequent contact with the students, and to become more familiar with their struggles and their success in mastering this nowadays pervasive new device. Many of the difficulties I noticed have been also spotted by my colleague Marilia Pereira in her field site in Brazil.

One of the most common feelings expressed by the students at the beginning is frustration: the phone doesn’t do what the teacher has just shown, the screen goes off all of a sudden, or cryptic warnings pop up, among other things. In my short experience so far, the most common —yet invisible— difficulty lies in the touch interface. Many elderly students find it difficult to distinguish between a ‘tap’ and a ‘long press’, and they tend to do a ‘long press’ when a ‘tap’ is required. I believe it is related to the lack of self-confidence when using the smartphone: they press the button long enough to be sure they are pressing it (as with a door bell). The problem though, is that the long press is a different input and therefore produces a result other than the expected one. Another difficulty lies in hitting the exact right spot on the screen, as, again, a slight miss has a different outcome (e.g. on Android’s Whatsapp’s chats menu, hitting the contact picture will show you that picture, hitting just a little to the right will open the chat), contributing to the general feeling of frustration.

Another common experience is the feeling of being overwhelmed by the vast array of menus, gestures, and different ways to do the same things on the smartphone. Having shared many classes with these elderly students, I started to grasp the experience from their point of view. Considering the difficulties of the touch UI, the diversity of Android iterations, manufacturer’s software skins, etc., I can see how complex and overwhelming this experience might be. All the functions of the phone seem chaotic to me now: there is no clear logical hierarchy in the arrangement of apps and functions. Most of the students do not recognize the difference between the home screens and the app drawer (the majority have Android devices), especially when the wallpaper in the app drawer is the same as on the home screens (but, adding to the confusion, this does not happen with every phone). One old man did this to access the camera: instead of tapping the camera icon on the home screen, he would tap the app drawer icon, and then the camera icon inside the app drawer. Furthermore, as the teacher of the main workshop pointed out, they expect to learn the ‘one way’ to do something on the phone, while multiple ways are possible (and sometimes these are needed, when one of the ways does not work).

In these situations of frustration, they tend to blame themselves (“I don’t understand technology” or “my head is not good for this”) as they judge themselves unable of learning the intricacies of this device, which seem evident for their grandchildren (who don’t have the time nor the patience to teach them). Having experienced this frustration myself when trying to teach a simple procedure to a new student whose specific smartphone model I have never used, I wish they would allow themselves to blame the phone now and then (I certainly do). Sometimes the interface is not as intuitive as it should be, sometimes too many shortcuts stay in the way and sometimes there is no visual cue on where to tap (the flat design of previous years has made this worse). However, I must say that they blame the phone sometimes, but in the most radical way: ‘this phone does not work’ (therefore, it must be changed). This has happened when they had accidentally left the phone in flight mode or silent mode, and they were unable to either receive phone calls or hear them, respectively. It is as if they could see the problem only in themselves or in the hardware (the phone as a device), while the software (and UI design) remains a blind spot. The interface is there, yet it goes unnoticed.

All in all, this is just the beginning of a long path for these new old beginners. It will be interesting to see if, as the workshop progresses, these engaged learners build up more self-confidence and make their way through the garden of forking paths of mobile UI.

The digital divide in age-friendly Dublin

LauraHaapio-Kirk14 June 2018

Author: Pauline Garvey.

Age Action website[1]

 

Recognising that over the next 30 years the number of people in Ireland over the age of 55 will double and the number over 80 will quadruple, there are lots of initiatives dedicated to positive and active ageing in the capital city. In 2013 the Irish Department of Health published the National Positive Ageing Strategy which set out a ‘vision for an age-friendly society through the achievement of four national goals (participation, health, security and research)’[2]. Dublin City Council claims the city was the first capital in the world to adopt a city-wide approach to becoming age-friendly[3]. In order to do this the Dublin City Age Friendly Programme 2014-2019 tackles nine key areas that may negatively impact on older individuals[4]. Under a series of headings it commits to providing alternatives to sheltered housing (Home and Community); supporting older people’s engagement with social and community life in which they live (Social Economic and Political Life); helping people volunteer or work in their locality (Learn, Develop and Work); providing facilities to engage in sports and activities (Healthy and Active Living). It also aspires to make the public sphere more manageable for older people such as providing adequate seating and level footpaths (Outdoor Space and Buildings); ensuring that public transport is adequate for journeys that older people are taking and the pedestrian crossings are timed at the correct speed (Transport, Safety) and finally ensuring access to information, both online and off-line for older individuals (Information).

Over the course of my research I will look at some of these initiatives more closely, but for now I’m interested in exploring how people access information. It is here that the digital divide can be most striking: when smart and competent people find themselves grappling with digital technologies such as simple commands on smartphones and computers. For an ever-growing number of activities such as booking a flight or reserving a table at a restaurant one is required to do it online. One organisation that is working to combat digital exclusion is Age Action and I was interested to note that one route to signing up for computing courses is by filling out an online form![5]. What at first glance looks like a contradiction is in fact something quite different. The Age Action website is directed to friends and relatives because feeling excluded from digital media impacts whole families and networks of friends rather than solitary individuals. One’s place in a social network is continually reiterated through simple messaging such as checking in with kin or organising meet-ups, allowing people to demonstrate care as well as receive it. Of course the question remains, what about the people who need help getting started but have no one who will intervene of their behalf? For these, the digital divide remains an insurmountable barrier.

 

 

  1. https://www.ageaction.ie/how-we-can-help/getting-started-computer-training/sign-up
  2. http://www.dublincity.ie/agefriendlycity
  3. http://www.dublincity.ie/sites/default/files/content/HousingAndCommunity/Community/Age%20Friendly%20Charter-English%20A2.pdf
  4. http://www.dublincity.ie/sites/default/files/content/HousingAndCommunity/Community/Age%20Friendly%20Charter-English%20A2.pdf
  5. https://www.ageaction.ie/how-we-can-help/getting-started-computer-training/sign-up

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 difficulties 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 the psychologist specialized 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). In the same way, several factors play a role in the adoption and usage of smartphones by the elderly: 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 in what measure, 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.

 

References

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.