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Nurse navigators and WhatsApp: an example of smartness from below

AlfonsoOtaegui8 December 2018

Photo by Alfonso Otaegui

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

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

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

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

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

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

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

References

Devine, A. (2017, April 3). The Nurse Navigator: A Patient’s Compass On The Healthcare Journey. Retrieved from https://nurse.org/articles/nurse-navigator-career-path-salary-job-description/

La Fundación Chile sin cáncer y su contribución para cambiar la historia del cáncer en Chile. (2018, October 15). Retrieved from https://www.uc.cl/es/la-universidad/noticias/31765-la-fundacion-chilesincancer-y-su-contribucion-para-cambiar-la-historia-del-cancer-en-chile

Miller, D. (2017). The Comfort of People. Cambridge: Polity Press.

Pype, K. (2017). Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa. In C. C. Mavhunga (Ed.), What Do Science, Technology, and Innovation Mean from Africa? (pp. 97–115). Cambridge, Massachussetts: The MIT Press.

Living alone vs. loneliness: Notes from a Milanese neighbourhood

ShireenWalton1 September 2018

Photo (CC BY) Shireen Walton

One of the key features of living in Milan are the characteristic apartment buildings (pictured below). Built in the early 20th century, these buildings, known as ‘palazzo’ (palazzi pl.), have housed generations of families, groups and individuals over the decades; Italian and non-Italian, working and middle-class.

Typical apartment buildings in the Milan fieldsite. Photo (CC BY) Shireen Walton

Photo (CC BY) Shireen Walton.

Living here, in an inner-city, multi-ethnic neighbourhood in Milan, I am struck by how many people I have come to know who live by themselves. My findings reflect official figures on single-person households, which are increasing exponentially within Europe [1] (a majority being in northern European countries), as well as globally, as witnessed in countries such as Japan, China, and Brazil [2]. In 2016 in the EU, single-person households accounted for almost one third (32.5 %) of private households, with a higher proportion of women (18.4 %) living alone than men (14.1 %) [3]. In Italy, the national average for people living alone is 31%, while in Milan, 52% of households consist of one person [4]. Among a number of explanations for people living alone through choice and/or circumstance are; a number of socio-economic changes over the last 60 years, shifts in work and lifestyle patterns, higher separation and divorce rates, evolving gender roles, and a potent legacy of 1970s Italian Feminism in challenging normative expectations of nuclear family models.

In light of this increasing trend, ethnography can help question some common assumptions about people who live alone – namely, that such people are alone in their lives. In her monograph (2015) on the subject of Italian women above the age of 45 living alone in Milan, Sociologist Graziella Civenti, based on a sociological study of 250 women, found that through a variety of collective ties, practices, and networks, such women establish intricate care and exchange networks that carry out many of the social and economic functions traditionally carried out within and by the nuclear family structure. In so doing, they are able to establish a functional sharing economy that is mutually sustaining and nurturing based on the premise of solidarity, mutual assistance, and attending to common problems [5].

Civenti’s findings resonate with my own unfolding research here in Milan, on ageing and smartphones amongst Italians and migrants, where among my informants who live alone, there is a similarly strong emphasis on the role of networks, of various kinds, on- and offline, in offering care, comfort, and physical/virtual participation in various contexts. To take two brief examples to illustrate:

Claudia (Italian) is 54. She originally moved to Milan from a nearby northern Italian town to study, work and to ‘escape her family and close-knit life’. Claudia lives alone in a palazzo building in a central part of the neighbourhood. She is separated from her husband, and has no children. She works full time at an administrate job in the city. Her Mother (late 70s), who she duly visits every weekend, lives in another northern Italian city. Claudia’s next-door neighbour is a female widow, Clara (84) whose two children live in other cities across Italy, and who she sees infrequently due to their busy lives. What once started out as a co-sharing of responsibility of watering each other’s pot plants on the balcony of the floor in which they live, eventually blossomed into a friendship over the 15 years the women have lived side-by-side. Claudia describes Clara as her ‘go to person’ for many things:

“If one day I was to have a fall, or pass out on the floor, it would be Clara who would notice first. She would notice my absence; my leaving for work in the morning, my coming home at night… family/friends wouldn’t notice for days, even weeks. Clara would go around to check on me. I’ve given here a key of course. I also have hers.”

The relationship between the two women now constitutes a kind Mother-daughter one; one that has been gradually crafted through a mix of neighbourly goodwill, as well as a cross-generational female bond nurtured through mutual care giving and receiving.

For other women in the neighbourhood, such as those living alone away from their home country, the issue takes on different dimensions.

Zaina (35) is from Tanzania. She lives alone with her two-year old daughter in a small apartment obtained through the help of social services. Zaina left her country two years ago in the hope of what she envisaged to be better economic opportunities in Europe. Her husband (also Tanzanian) is currently working in another African country. She is in contact with him, and her Mother back home, via WhatsApp. As an outsider to many of the social and ethnic groups here in Milan (most of the Tanzanian people she knows in Italy are in Naples – she is connected with them via a WhatsApp group), Zaina explained how she can feels lonely sometimes. With a young daughter that she has been told is too young to attend some of the local nurseries, searching for a job proves challenging. However, due to various on– and offline practices, Zaina described how she is ‘never really alone’. Her smartphone, providing she has credit on it, keeps her company. It connects her to family back in Tanzania, and to siblings living in other European countries. From time-to-time, Zaina attends community events at the public school in the park near to her apartment, where she can be around other Mothers, celebrate festivals such as Eid, and connect with the wider community, including attending Italian language classes. Unlike Claudia, for Zaina, it is not the apartment building space that provides the community feeling she finds so comforting, but the exact opposite – it is through her reaching out beyond the confinement of the apartment – to wider spaces in the community, and online to social media – that she feels she and her daughter are present and to varying degrees, cared for, both in Milan and back home in Tanzania.

Photo (CC BY) Shireen Walton

There therefore seems to be a complex sociological relationship between living alone and loneliness that I am exploring through my ethnography. I am beginning to see how in various spaces (social, geographical and digital) of/for care, people who live by themselves co-construct wellbeing through everyday acts, through which they craft themselves into social worlds, on- and offline – from the next-door-neighbour chats, to family/culture-linked WhatsApp groups, and beyond. At a time in history when an increasing number of people are living alone, (digital) anthropological findings that emphasise everyday lives lived can help unpack societal prejudices and assumptions, such as the hyper-individualism of such people, or that living alone infers a person’s loneliness and/or alterity in society. Challenging these ideas may prove difficult in the societies themselves, but nuancing the issue further by taking into account a range of individual lives and practices, can have a number of implications for social policymakers, particularly when it comes to ageing populations such as Italy, with 28% of the population over 60, and 31% living da sola/o.

References:

[1] Eurostat, 2017: https://ec.europa.eu/eurostat/web/products-eurostat-news/-/DDN-20180706-1?inheritRedirect=true

[2] Civenti, G. (2015). Una Casa Tutta Per Sé. Indagine Sulle Donne Che Vivono Da Sole. FrancoAngeli, Edizioni.

[3] Eurostat, 2016 report: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=People_in_the_EU_-_statistics_on_household_and_family_structures#Single-person_households

[4] Civenti, G. (2015). (Ibid.)

[5] Civenti, G. (2015). (Ibid).

[6] United Nations 2015 World Population Ageing Report

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.

AlfonsoOtaegui12 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.

Double feature – by Maya de Vries

ShireenWalton19 July 2018

Author: Maya de Vries

My field site last month was a bit sleepy as it was Ramadan. This holiday continues over a whole month during which Muslims fast throughout the day, break the fast after sunset, and continue eating throughout the night. In Jerusalem, during these days, school and work places usually finish early and people who fast prefer to stay home, especially when Ramadan takes place in the summer and the heat forces people to stay indoors. During Ramadan, the elderly club at Dar al Hawa was closed and there were no activities at all. However, its WhatsApp group, “The group of the elderly club members,” was open 24/7.

As mentioned in my previous blog post, as part of my ethnography, I conduct a participatory observation at the elderly club at Dar al-Hawa Community Center. Recently, they agreed to add me to their WhatsApp group, which was established in October 2015. The admin of the group is also the coordinator of the elderly club. Besides the admin, there are 30 members in the WhatsApp group, although 50 members participate in the weekly meetings and activities at Dar al Hawa. That means that people do not receive information through the WhatsApp group. Instead, the coordinator phones them about the regular activities of the club, such as sport lessons, field trips, and so on. However, some information they miss since they are not part of the WhatsApp group; that is the informal messages, which are usually composed of images of flowers combined with a “good morning” or “good evening” blessing or other quotes from the Qur’an calling to pray to the Prophet Muhammad.

They also do not receive the various videos containing information about bad foods, such as snacks, that cause cancer, a disease that bothers everyone at the club.

When asking their club’s coordinator if she thinks it matters that some members of the group miss such information, she said it is not a big deal. I agree with her that it is not such a big problem, as long as they get the formal information and keep on coming to the club every Sunday and Thursday. However, I do think it can affect to some extent the sociability of the members who do not carry a smartphones and cannot use WhatsApp. Those images of daily greetings have a positive impact, based on my short experience in the WhatsApp group.  Just reading the blessings and seeing the joyful image attached—usually of red and pink flowers—have a positive impact, even if it is just a minor one.

Nevertheless, an image is just an image, and it is fair enough to say that looking at it will not solve major problems of elderly such as loneliness, difficulties in walking, or reaching high shelves at home.

Overcoming such problems is not easy, and one of guest lectures at the elderly club dealt exactly with such issues. The lecturer was a representative from the non-profit organization called Mini Active. This important organization run by women only has a project for elderly people in which an authorized instructor for the golden age meets with elderly people, including the elderly club in Dar al Hawa, and brings all sort of objects for keeping the home environment safe. There was complete silence during almost the entire lecture, indicating that it was an important topic. I sat quietly as well during the lecture and took photos of the various objects.

At the end of the lecture, they all approached the table where the objects were exhibited and asked the instructor many questions. There was a big fuss and noise around the table, and it seems many of them asked if they could buy some of the objects, but they were not for sale. The instructor explained where they could buy them, but not all of them heard her, meaning they missed this important information. Furthermore, it means that probably they will have to go with someone from their family because many of them do not drive or need assistance when leaving the village of Dar al Hawa. I felt an urge to do something for those who did not hear her or would not remember how things look like when they go to buy them. Therefore, I took photos of each object and sent them immediately to their WhatsApp group. While sending it, I knew that there were club members who would not receive these important photos. Furthermore, other important information was missing, such as the locations of the shops and their phone numbers. Therefore, I prepared a file with all the photos of the objects and the names and details of the nearby shops where they can buy them. I sent the file in the WhatsApp group, but more importantly I printed 30 copies and handed it personally to each one of the club’s members who were present in the last meeting.

خدمات.docx.pdf

Why is it important to blog about this? I find this experience significant to the ASSA project that aims to understand how digitation assists seniors. It is a great example of how elderly people experience life today. They are in between the fast pace of smartphones and the digitization of life, but not all the time, and certainly not all them are, as happened at the Dar al Hawa elderly club.

So, let’s imagine a scenario of a person going to buy one of the objects he was told about in the elderly club’s lecture. But, he cannot remember its name and he mistakenly forgot his phone at home so he does not have the image with him.  The information paper handed out at the meeting was left in his bag, folded inside his wallet acting as a safety net, un-digitized. Now he can quietly buy what he needs. Therefore, it seems to me that when thinking of life improvements for older people, it should always be on both tracks, with digital and non-digital features. In a way, it is like a double feature screening, of the same movie from two different copies: analog and digital.

All mistakes allowed: my experience teaching older people how to use WhatsApp – by Marilia Duque

ShireenWalton25 June 2018

Author: Marilia Duque, São Paulo.

Since March this year, I’ve been working as a volunteer in one of the WhatsApp courses provided by a Catholic Parish in my field site in São Paulo. Once a week, I meet around 10 students from 67 to 84 years old who are deeply committed to improving their WhatsApp knowledge and usage. Most of them report that their children don’t have the patience or the time to help them with their smartphones. They understand that their children work hard and have many other commitments in their adult lives. They don’t want to be a burden to their families. So they opt for a regular course[1]. As one of my students Mrs. O. (71) puts it “considering all of that, do you think I would bother them?”

We started our classes as a very heterogeneous group with people who had never used WhatsApp before and people who already pay bills, buy stuff and book flights using their smartphones. After conducting interviews with some of them, I would say the group could be classified in two key categories: the ones who are afraid of  “being overcharged”, “erasing some important information” or “pushing the wrong button” and ruining the device itself and the ones who are disposed to take more risks, using trial and error as method, without any concern about spoiling the device. According to the survey Tech Adoption Climbs Among Older Adults  (Pew Research Center, 2016), lack of confidence is one of the main barriers that can “hinder some old Americans from going online and using new technologies”. One third of seniors feel little or not at all confident when using electronic devices (including smartphones) and because of that feeling three-quarters of them say they need help to set up and start using a new device.

One of my students, Mr. M. (72), said this fear of making mistakes is the key difference between old and young people. If youngsters say something wrong, they laugh at themselves, because they are allowed to make mistakes. However people are not so tolerant with older adults. Because of that, he said, many of his friends feel so embarrassed when they fail that they became too scared to even try. But what could be achieved if all this fear is gone? According to the same Pew Research Center study, once the seniors go online, they engage “at high levels with digital devices and content”. Among older adults who own a smartphone, for example, 76% uses the Internet several times a day or more.

In my WhatsApp course, as the group became more comfortable in making mistakes, I might say they learn more and faster. They now know almost everything about WhatsApp main features: how to create a group, how to share a picture, a video, a contact or a location, how to manage WhatsApp downloads to save data, how to use WhatsApp web. They also learned some tricks a regular WhatsApp user might ignore. For example, each student now has his/her own contact in his/her WhatsApp, so they can send notes (voice and text) to themselves to remind them what to report to a doctor, what to buy at the supermarket and so on. It is great but not enough. They want to go further, so now we just decided to move forward with other apps.

After all, my challenge now is to cater to so many different interests and needs related to smartphones. As my colleague, Alfonso Otaegui, who is also volunteering in smartphone courses in Chile, said in his previous post here, old people have different expectations of smartphone usage. As a teacher, this might help me make more effort to show empathy in class. As an ethnographer, this represents a great opportunity to understand how their particular needs and curiosity about pictures, books, music, travel, languages, cooking and shopping apps reflect the very particular way each of them experience age and how smartphones can help them to get what they want.

[1] If we consider the POnline2017 Survey from Acessa SP, an initiative for digital inclusion in São Paulo that provides free access to internet and many free courses to help users to improve their digital skills, over 70% of respondents learned to use the internet by themselves or attending to courses and just 4% could count on their relatives’ help.

The fruits of ‘olugambo’ – by Charlotte Hawkins

ShireenWalton28 May 2018

Author: Charlotte Hawkins

In many ways, mobile phones have allowed people in Africa to overcome the limits of state bureaucracy (de Bruijn and van Dijk, 2012: 12). To further credit the versatile potential of mobile communication, and the need for it, these limits have recently started closing in on mobile phone use in Uganda with two particularly contentious issues. Firstly, an embargo has been issued on SIM card registration to ensure the validity of existing data following a spate of unresolved kidnappings[1]. Secondly, President Museveni has proposed a tax on social media use in order to address the deficit. WhatsApp, Facebook, Skype, Twitter and Viber are all targets for the proposed daily fee of 100ush for all simcards using such “over the top” platforms[2]. According to the President, social media is used only for ‘olugambo’ or ‘gossip’.  He has exempted internet use for educational purposes, as “[i]t is like going to the library using the encyclopedia or referring to the dictionary. These must remain free”[3].

During fieldwork in the Ugandan context of intrinsic kinship (Whyte & Whyte, 2004: 77) and “scattered families”, I have observed many instances in which social media is used for more than ‘olugambo’, which itself is more than fruitless. As Tanja Ahlin notes in her study of migrant families’ care of elders through ICTs, phone practices are “not only about communication, just as remittances are not only about sending money” (2017). This frames an overarching question for my on-going research in Uganda; what are “over the top” platforms used for other than gossip? Many people have shown me how WhatsApp groups are used to circulate information –

I’m told that even the news of this proposed taxation reached 15,000 people in 10 minutes; “if anything seems to be relevant and effecting the lives of people directly, the messages tend to go very fast”.

WhatsApp groups also appear to be commonly used to share information about health. As one interviewee told me, he is part of a group with friends who are Doctors and teachers, “any information one of them gets, I get it here”. Or another, who recently found out the nutritional content of beetroot and bananas through his WhatsApp group and has started eating more of them. Or the hospital staff, who have a forum on WhatsApp for sharing information about patients and medical supplies, supporting health workers to do their jobs efficiently. As one message about the benefits of lemon peel circulated on WhatsApp recently stated, “thank goodness for Social Media…Pls forward to lots of friends”.

Photo (CC BY) Charlotte Hawkins. Tthis solar panel is used solely to charge the household’s phones, suggesting that access to communication is a priority.

[1] https://www.independent.co.ug/mtn-stops-sale-of-new-sim-cards/, accessed 03.04.18

[2] http://nilepost.co.ug/2018/03/31/tax-facebook-whatsapp-users-museveni-to-minister-of-finance/, accessed 03.04.18

[3] Ibid.

References

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