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NCDs in the time of Covid: documenting the social drivers of our wellbeing

charlotte.hawkins.1714 August 2020

Non-communicable diseases (NCDs) such as hypertension, diabetes, strokes, cancer and depression disproportionately affect people in low-income contexts, particularly as they get older. They can be some of the most resource-intensive conditions to manage, requiring changes in working routines, regular visits for hospital care and long-term medication. Chronic, long-term illness in old age can be particularly demanding for family caregivers as they navigate hospitals and home life. Yet they are also often overlooked in terms of research, policy and funding. In Uganda, for example, it was only in 2005 that NCDs were given an explicit place in the national health strategy, and there remains limited research and resources, particularly for long-term funding to support NCD information, prevention and care[i]. The relatively recent rise of NCDs as widespread health problems in Uganda is often attributed to contemporary lifestyles, the pollution and stressors of city life and personal problems imposed by global processes[ii]. As much as biological factors, NCDs can be inextricably linked to inequities around employment, education, nutrition and housing. Wide-reaching economic factors influence both experiences of chronic illnesses and access to treatment, determining who is responsible for long-term care; often families, navigating overstretched health systems and existing obligations.

Anthropology has a lot to offer in understanding how people manage uncertainty related to long-term illness. As argued in my previous blog post, it is often through dialogue and conversation with each other, that people seek to establish control in an ambiguous world[iii]. By detailing conversations around chronic illness and care, we can gain an insight into how people also understand and manage the wider world, particularly in terms of how health inequities impact on their everyday lives. The pertinence of this anthropological project, to take pre-existing conditions, their conceptualisation and management, into account, has been highlighted by the current COVID-19 pandemic, which has shown that the epidemiological boundaries between communicable and non-communicable diseases are evidently blurred, with both determined by social networks and inequities[iv]. Intensified pressures on households, health workers and hospital administrators who have to improvise and make do have shown the need for preparedness through prior and ongoing understanding of the “complex social drivers of our wellbeing”[v]. And clearly, ways of navigating stratified access to health provisions are of primary importance not just to those obstructed, but to us all.

Pharmacy service inside a regional government hospital near the Kampala fieldsite

Notice for visiting hours and Doctor’s round at the hospital

[i]  Susan Reynolds Whyte, ‘Knowing Hypertension and Diabetes: Conditions of Treatability in Uganda’, Health & Place 39 (May 2016): 219–25, https://doi.org/10.1016/j.healthplace.2015.07.002.

[ii] David Reubi, Clare Herrick, and Tim Brown, ‘The Politics of Non-Communicable Diseases in the Global South’, Health & Place 39 (May 2016): 179–87, https://doi.org/10.1016/j.healthplace.2015.09.001.

[iii] Susan Reynolds Whyte, Questioning Misfortune: The Pragmatics of Uncertainty in Eastern Uganda, Cambridge Studies in Medical Anthropology 4 (Cambridge ; New York: Cambridge University Press, 1997).

[iv] Lenore Manderson and Ayo Wahlberg, ‘Chronic Living in a Communicable World’, Medical Anthropology 39, no. 5 (3 July 2020): 428–39, https://doi.org/10.1080/01459740.2020.1761352.

[v] Napier, D. (2020) The Culture of Health and Sickness: how Uganda leads on Covid-19. In Le Monde Diplomatique p.6-7

Managing uncertainty: livelihoods in lockdown

charlotte.hawkins.1722 May 2020

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

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

Woman carrying mangoes to sell in April 2019.

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

BIBLIOGRAPHY

  • Anguyo, I and Storer, L. (2020) ‘In times of COVID-19 Kampala has become ‘un-Ugandan’, LSE. https://blogs.lse.ac.uk/africaatlse/2020/04/09/kampala-epidemic-un-ugandan-society-in-times-covid-19/
  • Honwana, A.M., 2012. The time of youth: work, social change, and politics in Africa, 1st ed. ed. Kumarian Press Pub, Sterling, Va.
  • Whyte, 2017. Epilogue: Successful Aging and Desired Interdependence., in: Successful Aging as a Contemporary Obsession: Global Perspectives. Rutgers University Press., NEW BRUNSWICK, CAMDEN, NEWARK, NEW JERSEY; LONDON, pp. 243–248.
  • Thieme, T.A., 2018. The hustle economy: Informality, uncertainty and the geographies of getting by. Progress in Human Geography 42, 529–548. https://doi.org/10.1177/0309132517690039
  • Walter, M and Bing, J. (2020) ‘Uganda’s Economic Response to Covid-19: the case for immediate household relief’ Centre for Development Alternatives (CDA). https://cda.co.ug/2140/ugandas-economic-response-to-covid-19-the-case-for-immediate-household-relief/
  • Whyte, S.R., 1997. Questioning misfortune: the pragmatics of uncertainty in Eastern Uganda, Cambridge studies in medical anthropology. Cambridge University Press, Cambridge ; New York.

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

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