Western ageing and care systems have been important topics in gerontology for many years. There is, however, considerable growing research into different cultures, and this book, focusing on sub-Saharan African care systems and ageing, is a thoughtful and insightful contribution, adding to or supporting our discussions on Western care-giving. The text explores four interrelating spaces: the first presents an exploration of contemporary care relationships within and across generations; the second focuses on tensions in the actual care management of older people among individuals, families, societies and the state; third, the rural–urban nexus is explored in relation to care for older people; and fourth, care is envisaged as a negotiated commodity. The editors emphasise that wider issues identified here are those of policy matters and ‘programmatic interventions’ and the need for further research.
Chapter 1 on ageing in Ghana by Sjaak van der Geest discusses the idea of retirement homes for older people. van der Geest's discussion of the term ‘care’ focuses on emotional and technical/practical. The results, which he draws from his data, describe feelings of loneliness, social isolation (despite company) and the notion of reciprocity (parents receive care from children in their turn – where this is possible). If there has been insufficient ‘investment’ in a marriage, then the wife may not choose to care for her husband. As van der Geest says, welfare of older people is not a priority for Ghanaian politicians and policy makers, who have the notion that Ghana families look after their ageing members. This ‘wishful thinking’ exemplifies the lack of understanding of the economic social reality, with research being overlooked (p. 32) by policy makers. In the meantime, people seek their own solutions – money sent to parents to buy care, with possibly more distant relatives or even non-kin being employed to provide care in the home. Organisations such as churches and non-governmental organisations create day-care centres and a support centre; HelpAge Ghana closed down due to an overwhelming demand for its services. Support is needed for these organisations.
Caring for people ‘without’ value in Kinshasa in the Democratic Republic of Congo is the subject of Chapter 2 by Katrien Pype. Kinshasa, a city of more than 89 million, has retirement home accommodation for only 210 people. Pype's chapter therefore ‘aims to bring the retirement home into the conversation about care services in African societies’ (p. 45). Pype writes ‘that Kinshasa's homes de vieillards are spaces of social exclusion, mostly housing elderly people without familial support, where exogenous practices of care are enacted’ (p. 64). Residents are excluded (willingly or not) from their families and have thus lost their identities in the primary space of identity attribution. However, Pype challenges the ‘no value’ concept, saying that these indigents (the name for inhabitants of these homes) have acquired surprising meanings and a different kind of value. She emphasises that this is probably one of the most fundamental aspects of caring, showing that people's lives matter and have meaning for others. By being recognised and addressed as people who can pray for others or receive gifts, older people are ascribed good intentions, and, more importantly, an essential role in society.
In Tanzania in Chapter 3, ‘Older People Providing Care for Older People’, Peter van Eeuwijk uses the concept of ‘carescapes’ based on Arjun Appudurai's (Reference Appudurai2005) model. He tabulates his subjects (p. 83) in a variety of care situations, where wives care for husbands, a lesser number of husbands caring for wives, and other situations where children care for mother, older brother/sister, father, and siblings for each other. His case studies are interesting. Bibi Hadija takes her husband to the toilet, bathes him and buys his medicine, as well as undertaking all the household work, including marketing and fetching water – meaning she expends a huge amount of energy on daily living (p. 77).
The author discusses several (in)formal institutions, chaired and managed by older people, which focus on providing care and support for the elderly. For example, there are clubs, such as an ‘older male club’ which meets regularly to sell dried tobacco at the town market. Mutual support is there, and socialising and conversation. Associations, often instituted by church or government departments or even better-off older individuals, undertake income-generating activities (e.g. chicken breeding) and leisure-time activities, religious services and home visits for socialising. Self-help groups founded by older activists, such as older widows and widowers often caring for orphaned grandchildren, meet and create income-generating activities such as small handicrafts and regular meetings for socialising and exchange. Non-governmental organisations arrange sponsors from abroad donating to older frail clients at home, and provide formal care institutions, such as nursing homes.
Still in Tanzania, Brigitte Obrist, in Chapter 4 ‘Place Matters’, discusses the home as the physical structures which her respondents bought or built. Self-made shelters, with outdoor washrooms and squat latrines, crowded and poorly serviced houses, or spacious cement buildings well equipped with facilities. Her stress on the toilet and bathing facilities arises from the importance placed on them by her participants. Commonly discussed topics were ease of access to latrines, difficulties using them and their value in care-giving. From the practical she moves to the social and describes another important space in many homes – the verandah. Sitting there watching people pass by offered the potential for a chat and reduction in loneliness. Within these lived spaces of care, of course, is the body, and Obrist observes that the body not only defines the space of care, it also defines temporality. Obrist refers to the activities of everyday living and the feelings expressed by people suffering. Parkinson's, for example, is described as ‘shaking … speaking is also difficult … it is getting me down’ (p. 99). The awareness of the lived body comes through clearly in the quotations, such as this on chronic diarrhoea: ‘your movements are only on the bed … you try but it is just pain everywhere’ (p. 100).
In Chapter 5, we are in Malawi, with Emily Freeman who highlights the significance of identity in her sensitive research. Her participants, in demonstrating this pattern of discursiveness, revealed more about what the giving and receiving of ‘care’ said about them, rather than discussing availability of care. It clearly brings out how ageing and care are ‘actually experienced’, as Freeman says (p. 133). The ideal of African family care is not present here, rather it seems that her participants presented expectations of care for them in ageing, which depended on reciprocity and self-sufficiency. Freeman observes that ‘the political assumption’ of older people expecting and wanting care from their families ‘doesn't accord with the more nuanced experiences of the older men and women in this study. She says that a wish for family care to be available was modified by a desire not to need it.
Then we come to Chapter 6, Josien de Kleerk's ‘Neglect in Northwest Tanzania’. Here, different mechanisms to care emerged, when family care is diminished. There was a growth in mutual groups such as burial associations, religious groups and women's groups. This growth happened before 2000 when many people were dying from HIV/AIDS, and neighbourly support, such as providing food and water for funeral guests, fetching firewood and digging graves was rapidly decreasing. Part of group membership was to contribute a defined contribution when a close relative of a group member died. The tasks could therefore be done by others. De Kleerk quotes Kleinman (Reference Kleinman2006) when he describes care-giving as taking place in a local moral world, one which is constantly reinvented with stories and observations about care. Much of the reinvention comes from generational references and observations on contemporary care. De Kleerk describes the new normal social reality of grandparent–grandchildren households, leading to grandmothers hoping for care from young adult grandchildren. He describes possibilities for changing care-giving practices in this constantly reinvented world. Among foreseeable changes are that the life-stage and maturity of these grandchildren might mean that practices of care-giving might change: intimate care might be outsourced to non-kin and new definitions of ‘kin’ might emerge as same-generation health support groups of older people increasingly become a resource for older people needing care.
Chapter 7, the final substantive ethnographic chapter, by Jaco Hoffman focuses on South Africa. Hoffman describes the capacity of family networks to care for both older as well as younger dependants as being severely limited by socio-economic factors and the impact of pandemics such as HIV/AIDs. Old-age homes have been introduced in South Africa, but study participants cannot conceive their lives without the younger generation, and choose or expect a particular person to care for them. Hoffman describes two competing processes in future care. The first is where older people would prefer to be accommodated in institutional care, albeit reluctantly; but the younger generation object to this because of the ‘performed discourse’ of older people being cared for by their family. This discourse, however, hides a common fear of losing the regular old-age pension income. The second process is a scenario where younger generations explore the idea of formal care for older people, and if employed the younger people would prefer that the elderly spent their days either at a service centre or be admitted to an old-age home.
The last chapter, by Andries Baart, on discourses of care summarises these ‘discursive formations’ as: conventional habits, personal engagement, formal opportunity, trained solidarity, market mechanism and improvisational efforts to save oneself. Baart then proceeds to analyse these in terms of discourse analysis, with questions about language and power.
This is an invaluable book on Africa's older population, a thought-provoking discussion on the practices of care – familial, informal and formal – in Africa and an interesting discussion on the spaces of care. A notable limitation is information on transnational and virtual spaces, given the deep penetration of mobile phone technology in sub-Saharan African.
