Ageing, health and care in rural Tanzania

The PhD thesis explores what “growing into old age” means for women and men in coastal Tanzania and with whom older people engage in order to ensure care. It responds to a call for more medical anthropology research on care rather than cure and contributes to a small but growing body of ethnographic literature on ageing in Africa.
My study formed part of a larger research project with a rural and urban component. I was responsible for the rural component and conducted field research from 2009 to 2011 in the Rufiji District, more precisely in Ikwe Town and Bumba village. Following the comparative qualitative design of the overall research project, I carried out four complementary and partly overlapping sub-studies, moving from a stakeholder study, to a community study, a household study and finally an age group study. By selecting these two settlements, I wanted to find out whether differences in the types and location of the villages affected the older people’s lived experience of ageing, health and care.
A first finding is that older people in both research sites share a multi-dimensional concept of aging which is rooted in a similar way of life, dominated by the physically demanding tasks of farm work. Age was commonly assessed along six social dimensions: 1) the relative position of juniority/seniority along the life course; 2) the social status; 3) the kinship position; 4) the generational position, 5) the health status; and 6) work and leisure. Of critical importance for the (self-)assessment of old age was the link between the 5th and 6th dimensions, i.e. whether one has or does not have the strength to perform gendered routine activities and responsibilities.
With regard to care, I found that older men and women in both research sites actively engage with a flexible, dynamic and often only partly visible care network. At the center of this network are socially close kin members, especially spouses, siblings, and children, whether they live nearby or at a geographical distance. Kinship and gender intersected in defining who could provide which type of care. When these relatives are not present or when they require some practical but not intimate or basic livelihood care, the older people negotiate help with neighbours, and in Ikwe Town also with friends and tenants. A notable exception is the majosti-relationship between older women in Ikwe which allowed a closeness otherwise reserved for kin.
In both villages, few older people with a serious health problem had a biomedical diagnosis, and more older people in Ikwe Town than in Bumba had contact with professional health care providers. Older people experienced the lack of adequate professional health care services in old age care not just as a practical, technical or financial problem. They questioned the new morality of commodity relations which have begun to replace social relations rooted in kinship and religion.
Most of the older persons who participated in this study faced good and bad days in terms of strength. I often became concerned when I saw them struggle but I also learnt to respect their pride and dignity. Older husbands were proud that they could still provide emotional care and company, and the wives and sisters who stayed with them did their best to provide at least some basic care. Older women who had lost their husband due to separation, divorce or death preferred to have a daughter move in with them, but they pointed out that their children also had to fulfil commitments to their own families. The dwellings and material belongings of many older people in both settlements were often modest, also by local standards. Still, they did not complain and emphasized that they were used to a harsh life since childhood.