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Care through digital connectionsEnacting elder care through everyday information and communication technologies (ICTs) inIndian transnational familiesAhlin, T.

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Citation for published version (APA):Ahlin, T. (2020). Care through digital connections: Enacting elder care through everydayinformation and communication technologies (ICTs) in Indian transnational families.

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CARE THROUGH DIGITAL CONNECTIONS

Enacting Elder Care Through Everyday Information and Communication Technologies (ICTs)

in Indian Transnational Families

Tanja Ahlin

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Tanja Ahlin


Enacting Elder Care Through Everyday Information and Communication Technologies (ICTs)

in Indian Transnational Families

Tanja Ahlin

Amsterdam, The Netherlands

2019

© Tanja Ahlin. All rights reserved. Printed by: Gildeprint, The Netherlands Cover image: Tanja Ahlin, Mitja Šeško Cover design: Ilse Modder The research for this dissertation was conducted with the help of TransGlobalHealth, an Erasmus Mundus Joint Doctorate Fellowship of the European Commission, Specific Grant Agreement 2013-1479, and with the financial support from the Health, Care and the Body Program Group, Department of Anthropology, Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam.


ENACTING ELDER CARE THROUGH EVERYDAY INFORMATION AND COMMUNICATION TECHNOLOGIES (ICTs)

IN INDIAN TRANSNATIONAL FAMILIES

ACADEMISCH PROEFSCHRIFT

ter verkrijging van de graad van doctor aan de Universiteit van Amsterdam op gezag van de Rector Magnificus prof. dr. ir. K. I. J. Maex

ten overstaan van een door het College voor Promoties ingestelde commissie, in het openbaar te verdedigen in de Aula op vrijdag, 14 februari 2020, te 11.00 uur

door

TANJA AHLIN

geboren te Kranj, Slovenië.

Promotiecommissie: Promotor: prof. dr. A. J. Pols Universiteit van Amsterdam Promotor: prof. dr. S. Narotzky Universitat Autònoma de Barcelona Co-promotor: dr. K. Peeters Institute of Tropical Medicine Antwerp Co-promotor: dr. K. Sen Wolfson College (CR) University of Oxford Overige leden: prof. dr. A. Hardon Universiteit van Amsterdam prof. dr. A. Moors Universiteit van Amsterdam

prof. dr. M. van Selm Universiteit van Amsterdam prof. dr. P. Raghuram The Open University

dr. M. Domènech Argemí Universitat Autònoma de Barcelona Faculteit der Maatschappij- en Gedragswetenschappen

Dit proefschrift is tot stand gekomen in het kader van “International Doctorate in Transdisciplinary Global Health Solutions – Erasmus Mundus Joint Doctorate Trans Global Health Programme” and the Erasmus Mundus 2009-2013 Programme Guide, version 11/2013”, met als doel het behalen van een gezamenlijk doctoraat. Het proefschrift is voorbereid in de Faculteit der Maatschappij- en Gedragswetenschappen van de Universiteit van Amsterdam en in de Department of Cultural Anthropology Universitat de Barcelona. This thesis has been written within the framework of “International Doctorate in Transdisciplinary Global Health Solutions – Erasmus Mundus Joint Doctorate Trans Global Health Programme” and the Erasmus Mundus 2009-2013 Programme Guide, version 11/2013”, with the purpose of obtaining a joint doctorate degree. The thesis was prepared in the Faculty of Social and Behavioural Sciences of the University of Amsterdam and in Department of Cultural Anthropology of the University of Barcelona.

TABLE OF CONTENTS

ACKNOWLEDGEMENTS ...................................................................................................................... i

Chapter 1 INTRODUCTION .................................................................................................................. 3

The Crisis of Elder Care in Kerala ....................................................................................................... 5

A Transdisciplinary Approach to Studying Elder Care ................................................................... 11

Anthropological Inquiry in Transnational Family Life: Co-presence and Polymedia ................ 12

Enacting Care through Heterogeneous Relations ....................................................................... 13

Exploring ‘Good Care’ in Daily Life ............................................................................................. 16

Empirical Methods: Following the Families, Flying and Otherwise ............................................. 17

Thesis Overview .................................................................................................................................... 21

Chapter 2 ONLY NEAR IS DEAR? ..................................................................................................... 27

Introduction ........................................................................................................................................... 28

ICTs in Relation to Care ...................................................................................................................... 29

Methods .................................................................................................................................................. 31

Migration and Abandonment .............................................................................................................. 32

Migration as a Care Practice ................................................................................................................ 34

Transnational Care Collective: Parents, Children, ICTs, and Others ........................................... 36

Tinkering with Various Types of ICTs .......................................................................................... 37

Caring by Being the First to Call .................................................................................................... 39

Frequency of Contact and Scheduling ........................................................................................... 41

Caring for ICTs ................................................................................................................................. 43

ICTs Expanding the Care Collective ............................................................................................. 45

Conclusion .............................................................................................................................................. 47

Chapter 3 FREQUENT CALLERS ....................................................................................................... 53

Introduction ........................................................................................................................................... 54

Methods .................................................................................................................................................. 56

Enacting New Norms: Frequent Calling as “Good Care” at a Distance ..................................... 58

Mundane Matters: Keeping Track of Everydayness ........................................................................ 62

“Sharing Everydayness” on the Phone .......................................................................................... 63

Informal “Telecare” on the Phone ................................................................................................ 65

Enacting Everydayness: “Spending Time Together” on Webcam ........................................... 67

Conclusion .............................................................................................................................................. 70

Chapter 4 SHIFTING DUTIES ............................................................................................................. 75

Introduction ........................................................................................................................................... 76

Methods .................................................................................................................................................. 78

Syrian Christian Women in Kerala and within Global Care Chains .............................................. 79

Cross-border Investments: International Migration as a Duty ...................................................... 81

Returns on Investments: Remittances and Visits ............................................................................. 84

Invested Fully: ICTs Adding Value to Caring Relationships .......................................................... 88

Conclusion .............................................................................................................................................. 92

Chapter 5 DISRUPTED CONNECTIONS ........................................................................................ 97

Chapter 6 FROM FIELD SITES TO FIELD EVENTS ................................................................. 105

Introduction ......................................................................................................................................... 106

Two Ethnographic Studies, One Methodological Issue ............................................................... 109

Creating Images: Webcams Shaping Field Events ......................................................................... 110

Situating Field Events: Locally Embedded ICTs ........................................................................... 116

Temporal Engagements: The Times of the Field Event ............................................................... 120

Conclusion ............................................................................................................................................ 124

Chapter 7 CONCLUSION .................................................................................................................... 129

Enacting Care through Transnational Care Collectives ................................................................ 130

New Ways of Doing ‘Good Care’ ..................................................................................................... 133

Theoretical and Methodological Lessons for Ethnographers ...................................................... 137

Recommendations for Policy ............................................................................................................ 139

Further Research Inspirations ........................................................................................................... 141

EPILOGUE ............................................................................................................................................. 143

SUMMARY .............................................................................................................................................. 145

SAMENVATTING ................................................................................................................................ 148

REFERENCES ........................................................................................................................................ 153

LIST OF THESIS-BASED PUBLICATIONS .................................................................................. 174

LIST OF FIGURES Figure 1. An adaptation of a graphic representation of India’s aging population.

Source: Datta (2018). 7

Figure 2. Migration from India. Source: Connor (2017). 8

Figure 3. Molly’s collection of phones. Photo by the author. 38

Figure 4. The elderly in Kerala commonly used simple mobile phones. Photo by the author. 62

Figure 5. Passing the English language exam is the first step of migrating abroad.

Photo by the author. 84

Figure 6. An elderly woman in the church, waiting for a wedding of her neighbors’ son.

Photo by the author. 100

Figure 7. This is not a field site. Graphic by the author. 107

Figure 8. A snippet from a digital food diary. Photo by Fangfang Li. 114

Figure 9. Late night visit to the market with a study participant as a field event.

Photo by Fangfang Li. 122

LIST OF POEMS Poem 1, page 1: Salma. 2000. “A Deserted Place.” Translated by N. Kalyan Raman (2006). Oru Maalaiyum Innoru Maalaiyum. Nagercoil: Kalachuvadu Pathippagam. https://www.poetryinternational.org/pi/poem/8141/auto/0/0/Salma/A-DESERTED-PLACE

Poem 2, page 25: Mangalesh Dabral. 2008. “Touch.” Translated by Sudeep Sen (2008). Mujhe Dikha Ek Manushya. New Delhi: Radhakrishna Prakashan. https://www.poetryinternational.org/pi/poem/12586/auto/0/0/Mangalesh-Dabral/TOUCH Poem 3, page 51: Hemant Divate. 2005. “When I Check Email.” Translated by Sarabjeet (2011). Maharashtra Times. Mumbai: Times of India. https://www.poetryinternational.org/pi/poem/21021/auto/0/0/Hemant-Divate/WHEN-I-CHECK-EMAIL Poem 4, page 73: Mallika Sengupta. 2003. “Women.com.” Translated by Sanjukta Dasgupta (2002). Purushke Lekha Chithi. Kolkata: Ananda Publishers. https://www.poetryinternational.org/pi/poem/2926/auto/0/0/Mallika-Sengupta/WOMENCOM

Poem 5, page 95: Savithri Rajeevan. 2014. “As You Bathe Your Mother.” Translated by Dr. P. Udayakumar (2014). Ammaye Kulippikkumbol. Calicut: Mathrubhumi Books. English translation published in Malayalam Literary Survey 34 (1-4). https://www.poetryinternational.org/pi/poem/27279/auto/0/0/Savithri-Rajeevan/AS-YOU-BATHE-YOUR-MOTHER

Poem 6, page 103: Keki Daruwalla. 2002. “Map-maker 2.” The Map-maker. Delhi: Ravi Dayal Publisher. https://www.poetryinternational.org/pi/poem/2892/auto/0/0/Keki-Daruwalla/MAP-MAKER

Poem 7, page 127: Hrishikesan. 2007. “Love.” Indian Poetry. https://indianpoetry.wordpress.com/2007/07/02/“love-a-poem-by-hrishikesan/ The permission to re-produce poems 1–6 from the website poetryinternational.org has been requested from Poetry International Rotterdam in June 2019.

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ACKNOWLEDGEMENTS Since the beginning of this project in 2012, before I even landed in Amsterdam, many people have inspired and supported me, each coming my way exactly at the right moment. I’m grateful to all who have been, directly or indirectly, involved in the making of this thesis, and with that in my professional as well as personal growth.

First, there are all the people in Kerala and Oman who have opened their doors to me and welcomed me into their intimate lives, the people I write about as my ‘study participants’. I am immensely grateful to the families and individuals who shared their stories, dosha and jackfruit with me. I feel these pages barely do justice to the depths of your lived experiences and I will continue to strive towards writing them better. None of the fieldwork for this thesis would have been possible without Leyanna S. G., who introduced me to Kerala. It was pure serendipity to have met you all those years ago in Heidelberg, and I’m indebted to you and your family for your kind and caring help. This research also wouldn’t go very far without Sandeep Sir, Sajini Mathew and their jeep. Sandeep Sir, thank you for accepting me into your class, where I met many young nurses featuring in the chapters of this thesis. Sajini, thank you for joining me in this project as an interpreter, assistant, transcriber and friend. I will always treasure the memory of going to the movies with you and I’m looking forward to the sequel. Thanks also to Darsana Academy, particularly to Father Thomas, for allowing me to spend time in the English language classes where students and I learnt from each other. Also, thanks to Sebastian Irudaya Rajan for hosting me in the Centre for Development Studies (CDS) and sending me on my way with a full stack of books. Harikumar Bhaskar, not only you enthusiastically helped me with my research, but I also had the privilege to stay in your Ayurvedic clinic by the river where I could rest my mind and soul, surrounded by the beauty of Kerala – thank you! Nataša Šilec, Read Macadam, Tara Atkinson and friends in Oman, thanks for hosting me, introducing me to outdoor climbing and teaching me about the importance of playfulness.

To my supervisor, Jeannette Pols, my deepest thanks for accepting me as a student and for taking care of both me and my writing. When I first presented my planned PhD timeline to you, your immediate comment was, “You need to include some holiday!” This thesis wouldn’t have been possible, and it wouldn’t have been what it is, without your generous guidance, grounded in patience and trust. I have learnt from you more than you will ever know. I’m also profoundly grateful to my

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co-supervisor, Kasturi Sen, for the time, selfless commitment and making sure “the emotions are in.” Thank you for the most delicious meals when I visited you in Oxford, and for all the gifts for Aria, wrapped in paper with pictures of food. I’m looking forward to sharing the sweet and the sour in many years to come. Finally, thanks to Susana Narotzky and Koen Peeters for taking on the task of supervising me as a joint degree student, with all the challenges this entailed.

My PhD was generously funded through the TransGlobalHealth Joint Doctorate Scheme of the European Commission, and this funding was extended by the Health, Care and the Body Program group at the Department of Anthropology, AISSR, for both of which I’m most appreciative. Thanks to those involved in the creation and maintenance of the TGH program, especially Jacqueline Broerse, Joske Bunders and Barbara Regeer as well as Anne Belonje and Durwin Lynch at Vrije University; to Anne Buvé and Ann Verlinden at ITM Antwerp; and to Núria Casamitjana at the University of Barcelona. To my TGH mates, what a ride we’ve had! Thanks for sharing it with me and making it all the more fun, Fangfang Li, Patricia Gómez, Sofía Mira Martínez, Lily Lumagbas, Shahab, Willy Ssengooba, Mukesh Bikrem Hamal, and also Arsenii Alenichev, Ashley Witcher, Lana Meiqari, Anna Tokar, Nandini Sarkar, Ibukun Abejirinde, Ona Ilozumba, Alberto García-Basteiro and others in this boat.

At UvA, my thesis and I have benefited from the generosity of many. I’m grateful to Amade M’charek and the late Mario Rutten for reading my 8-month paper and helping me work out the next steps. Special thanks to Annelieke Driessen and Kristine Krause for establishing and chairing the Writing Care seminar. Almost every page in this thesis has been discussed at these meetings and I’m indebted to all who have attended and read my work there, especially Emily Yates-Doerr, Shahana Siddiqui, Sherria Ayuandini, Annekatrin Skeide and Christien Muusse. Thanks to Annemarie Mol, Danny de Vries, Annelies Moors, Anja Hiddinga, Sjaak van der Geest, Ria Reis, Trudie Gerrits, Marteen Bode, Shifra Kisch, Sylvia Tydey, Jarrett Zigon, Josien de Klerk, Mattijs van de Port and Bregje de Kok for talking and walking and thinking with me on various and numerous occasions. Rene Gerrets, special thanks for your support through the tough TGH times. Eileen Moyer, Robert Pool, Silke Hoppe as well as Julie Livingston and Robert Desjarlais, thank you for making the ethnographic writing workshop a reality, and a dream.

At AISSR, I’ve had the pleasure and privilege to share desks, lunches and struggles with PhDs and post-docs from whom I have learnt in countless ways. Thanks to Lex Kuipers, Megan Raschig, Sarita Jarmack, Swasti Mishra, Willemijn Krebbekx, Emil Holland, Stine Grinna, Willy Sier, Retna Hanani, Hanna Henao,

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Uroš Kovač, Mark Hann, Lisette Jong, Ryanne Bleumink, Nastasja Roels, David Bukusi, Mariana Rios Sandoval, Clément Dreano, Laura Vermeulen, Susanne van den Buuse, Aarthi Sridhar, Adrienne Strong, Ellen Algera, Hunter Keys, Victor Toom and Lianne Cremers. Special thanks to Ildikó Plájás for introducing me to visual anthropology and for working with me on the video abstract for chapter 3. Else Vogel, Anna Mann, Filippo Bertoni, Hasan Ashraf, Oliver Human, Tjitske Holtrop, Cristobal Bonelli, Justine Laurent, Rebeca Ibáñez Martín and Carolina Dominguez Guzman as well as members of the STS reading club, I’m grateful for learning with and from you all I now know about STS. Ariane d’Hoop and Wakana Kyoto, thanks for making it more of a walk in the park. Erica van der Sijpt, you are an inspiration in more ways than one. Finally, Janus Oomen, Muriël Kiesel, Cristina Garofalo and Danny van der Poel have been the most patient, resourceful and kind administrators; I truly appreciate your efforts. Hayley Murray, you bring the spark to efficiency, thanks for all your help.

Before there was a PhD position at UvA, there were Harish Naraindas, Lenore Manderson and Mark Nichter; thank you for helping me understand what it truly means to stand on the shoulders of giants. I’m also grateful to Karin Polit for raising a finger up in the air and telling me to “write that research proposal!”; to William Sax for laying the ground, and to Philip Kreager for helping me see more clearly the direction this thesis would take. Anita Hardon, thanks for being there before the beginning and all the way to the end; your presence has been instrumental to this PhD.

Beyond UvA, I’m thankful to the members of the Philosophy of Care group at AMC, especially Dick Willems, Maartje Hoogsteyns, Sonja Jerak-Zuiderent, Karen Dam Nielsen, Ben de Bock and Annemarie van Hout. Peter-Paul Verbeek and his PhD students at the University of Twente, thank you for introducing me to post-phenomenology. Nelly Oudshoorn, I’m grateful for your kind engagement with my chapter on transnational care collectives; our discussion was eye-opening. I’m also thankful to Tamar Sharon for reading the chapter on frequent calling and offering valuable suggestions on it. Casper Bruun Jensen, thanks for engaging with my questions during your visit to Amsterdam. Gili Yaron, Willemine Willems and Anna Harris, thanks for the spontaneous, spirited and inspiring chats.

This thesis has benefited from many discussions at workshops, seminars, symposiums and conferences around the world. I’m grateful to Laura Merla for inviting me to present at the UCLouvain and giving feedback on my early work; your advice is still with me, even as the thesis is finished. Special thanks to Kasturi Sen for having organized my presentations at two seminars at the University of Oxford and to those who attended, particularly Marcus Banks and Matthew

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McCartney, for their comments. Thanks to Loretta Baldassar and Nicolescu Razvan as well as to the panelists for their inspiring contributions to our Panel ‘What is the future of the field-site?’ at the ASA conference in Durham, which was a testing ground for chapter 6. Thanks to Daniel Miller and his team(s); Megha Amrita and her team; Jason Danely; Tessa Minter and Bart Barendregt; Christiane Brosius, Roberta Mandoki and Annika Mayer; Brigit Obrist van Eeuwijk, Piet Van Eeuwijk and Jana Gerold; and Urmila Goel for inviting me to panels and for thinking with me through care, aging, migration, and digital technologies. Of the participants to these events, I’m thankful especially to Michele Gamburd, David Prendergast, Monika Palmberger, Katrien Pype and Sweta Rajan-Rankin. Lenore Manderson, Mark Davis and Chip Colwell, my deepest thanks for inviting me to the Wenner-Gren workshop, a most unique event, and thanks to the workshop participants, especially Susan Erikson, Cristiana Giordano, Ravi Sundaram and Junko Kitanaka, with whom I have discussed my early findings. I’m also grateful to Peter Simonič for invitations to present and publish, to Borut Telban for sincerity and genuine passion for anthropology, and to Julija Sardelić Winikoff, Jana Šimenc, Tomi Bartole, Veronika Zavratnik and Gorazd Andrejč for inspiring discussions. Katerina Vidner Ferkov, Dan Podjed and Meta Gorup, thank you for making it clear to the world why it needs anthropologists; you are rock stars!

Of all the conferences, I have been returning to the AAA Annual Meeting most faithfully. I’m grateful for the amazing people I have had the luck to encounter there. Danya Glabau, Nayantara Appleton and Christy Spackman, thanks for your support and acknowledgement of my work; it came at a point when encouragement was much needed. Daisy Deomampo, Kristin Yarris and Cati Coe, thank you for engaging with my work and offering feedback. Lynnette Arnold, Victor Braitberg and Bianca Brijnath, thanks for being such wonderful panel co-organizers. Jay Sokolovski, Janelle Taylor, Jason Danley, Sarah Lamb and Valerie Olson, I always look forward to catching up. Amy Dao and Philip Kao, thank you for making the AAAs a meeting of friends. Bianca Brijnath and Roberta Raffaetà, your friendship has been invaluable to me ever since Montreal!

I’m indebted to scholars who have worked in Kerala and elsewhere in India. Throughout these years, I have learnt a great deal from Ester Gallo, Claudia Lang, Mark and Mimi Nichter, Marie Percot, Manja Bomhoff and Caroline Osella. Ira Raja, thank you for the most memorable dinner in Berlin. One person stands out for me in particular – Sarah Lamb, thank you for your support and encouragement through the years, I am beyond grateful to know you and I’m continuously inspired by your generosity and kindness. I’m looking forward to hiking the Himalayas with you and Ira!

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Thanks to journal editors Vincanne Adams (MAQ), Lenore Manderson (MA), Kanchana Ruwanpura (GPC), Eileen Moyer and Vinh Kim-Nguyen (MAT) as well as special issue editors Narelle Warren and Dikaios Sakellariou for your helpful comments and careful editing. Thank you, Erin Martineau and Victoria Team, for copy-editing, and Abigail Kaiser, thanks for your patience. Lucia Guaita, thanks for proofreading my writing and taking care of all those endless references.

Friends are family. Eva Vernooij, Carla Rodrigues, Carola Tize and Natashe Demos Lekker – what an academic sisterhood! I’m looking forward to our dinners in the years to come, and I truly appreciate our friendship. Special thanks to Eva and Carla for being my paranymphs throughout the cold of this winter. Beyond academia, thank you Miriam Tocino for learning with me what it means and takes to be an author, an entrepreneur, a mother and a friend, all at once. Marija Marić, thanks for listening and offering support on so many occasions. Anna Baumann and Patricia Junge, I keep cherishing our Heidelberg adventures and I’m grateful they are continuing despite the distance. Babette van der Zwaard, Marieke van Atten, Ilona, Rhiannon and others at the Klimmuur Amsterdam Centraal, thanks for being such wonderful climbing partners, and then much more. Vesna Nikolić, Chris Boothe and Jolie Ennik, thanks for keeping my body and mind sane and sound. Marko, Saša, Vida and Uroš, thanks for making Amsterdam feel like home, and Teja, Lea, Ana, Meta and Tina, thank you for making home still feel like home.

Finally, my family proper. To my mother, mati, I’m deeply thankful for your support, for instilling in me creativity as one of the greatest values, and for encouraging me to follow my own path; it is you who inspired the topic of this thesis. To Iztok, thanks for taking over some tasks that were supposed to be mine. To my parents-in-law, Mičo and Mojca, thank you for the much-needed space, time and clarity in the final stages of writing. Hvala! To my husband, Mitja, thank you for sticking with me all along this adventure, for listening and encouraging me through the tricky times; you are my rock to lean on and I’m forever grateful to have you by my side. To my daughter, Aria – I wrote most of this thesis after your birth; I was obviously flying on love fuel. Thank you for coming into my life and for simply being you. I will always pick up your call.

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Chapter 1 INTRODUCTION

Off the main road leading from Kottayam, a middle-sized town in Kerala, South India, there’s a village in which houses are comfortably spread around, with plenty of land surrounding each of them. Jackfruit, coconut, and rubber trees abound. The houses hidden below them are humble, unlike the mansions paid with “nurse money” that we, my interpreter and I, have passed on the way.1 And yet, here we find two neighboring families with children working abroad as nurses for the past few years. We first visit the family where the younger of two daughters, twenty-seven-year-old unmarried Tara, is a nurse in the Maldives.

Upon entering, I find out that the parents live by themselves. Their elder daughter has married and moved in with her husband and parents-in-law. But Tara, I am told, is “taking good care of her parents.” Not only she is the main earner in the family, sending money home regularly, but she also calls her parents on the phone every day. The father adds that he sometimes also sends Tara text messages. He would write to her, “please call URGENT.” He shows me the message history on his mobile phone and indeed, all the texts have the same content and recipient, urging Tara to call. Throughout my fieldwork, I have never come across such parental imploring, which I find surprising and touching at the same time. Tara’s father explains, laughingly, that there is “never anything urgent, really”; he simply sends these messages whenever he “just feels like talking to her.”

1 In Kerala, the expression “nurse money” is used to refer to the remittances that Keralites, working abroad as nurses, send home (see also George 2000).

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What happens with family care when aging parents and their adult children live in different countries? This is a particularly pertinent question in today’s world where migration and population aging are both increasing.2 In India and elsewhere, these trends have fueled a common discourse of abandonment, one that asserts that elderly parents are left alone and neglected by their children because of the contemporary lifestyle which increasingly necessitates migrating for work (Aboderin 2004; see also Jamuna 2003). Recently, scholars working in transnational studies and media studies have challenged this idea, contending that care is possible even without physical proximity, as family members keep in touch by using information and communication technologies, or ICTs (Baldassar et al. 2016; Madianou and Miller 2012). In this scholarship, and in this thesis, the term ‘transnational family’ refers to family members who live “separated from each other and create something that can be seen as a feeling of collective welfare and unity, i.e. ‘familyhood,’ even across national borders” (Bryceson and Vuorela 2002, 3). As the opening field note from my research in Kerala shows, phone calls and text messages featured importantly in the everyday lives of Indian transnational families of nurses. But how do landline phones, mobile phones, smartphones, and webcams, these generic devices that are readily available and accessible even to consumers from lower economic backgrounds, contribute to informal care at a distance?

In this thesis, I draw on ethnographic fieldwork in India and Oman to demonstrate how everyday ICTs not only make care at a distance possible but actively participate in ‘enacting’ such care. Following material semiotics, the science and technology studies (STS) theoretical approach which I adopt, things are ‘enacted’ within practices in which both human and non-human agents participate and thereby form relations (Mol 2002; Law 2009; Haraway 1991; Mol, Moser, and Pols 2010; Pols 2005, 2012). In the following chapters, I examine how intergenerational care is enacted by people and ICTs in specific practices, with the aim to understand in depth how technologies shape what family care at a distance comes to be.

2 Globally, the number of people over sixty years of age is 962 million, a number that is expected to double by 2050; the process of population aging is the most advanced in Europe and in Northern America where the elderly account for 35 percent and 28 percent of the population respectively (UN 2017a). As for migration trends, there were 232 million international migrants in 2013, a rise of 50 percent from 1990; the rate of migration has seen the highest increase in the global South-South and South-North directions (UN 2013).

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The research seeks to answer the following four questions:

• How do adult children living abroad, their elderly parents in India, and ICTs enact care at a distance?

• How do ICTs shape what is good care in Indian transnational families? • What are the theoretical and methodological implications of taking seriously

the participation of ICTs in practices of ethnographic research? • What are the implications of considering ICTs as actively shaping informal

care for policy makers working on aging and migration in India?

I answer these questions in the conclusion (chapter 7), based on the analysis offered in chapters 2–6. But first, in this introduction, I contextualize the research by describing the particular nexus of aging and migration in India. I then present the theoretical tools of material semiotics that I employ in my analysis, and I describe my empirical methods and study sites. Finally, I give a brief overview of the chapters.

The Crisis of Elder Care in Kerala In July 2014, The Hindu published the following news story about three elderly sisters from Kerala who “had no one to take care of them”; this came to light as a problem when the eldest among them passed away:

The plight of the sisters … is familiar to many elderly people [in Kerala]. … The two older sisters, Alli and Santha, used to teach at a government school in the city. … Alli, who was 92, passed away last week and her body lay at the house for two days before local people found out about the death and informed the police. Police admitted Santha, 82, and her younger sister Baby, who is mentally-challenged to the Ernakulam General Hospital. … The situation of the aged sisters is a reflection of the breakdown of systems to take care of the elderly in society. Increasing number[s] of people are being abandoned by their families and forced to fend for themselves in their old age, social activists observed. … “In many cases, the children are working in different places or do not have the time or money to take care of the parents,” sa[i]d Nisha Varghese, co-ordinator of the Kerala Social Security Mission’s Vayomithram project in Kochi. (Surendranath 2014)

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The story highlights two current trends in Kerala and across India: the aging of the overall population and the increasing rates of international migration.3 In 2017, India had around 125 million people above sixty years of age, or 9.4 percent of the population; this number is expected to increase to 316 million by 2050, or about 19 percent of the population (UN 2017a).4 Among all Indian states, the proportion of the elderly is the highest in Kerala at around 12 percent of the population (ISEC Bangalore et al. 2013). As mortality and fertility there have plummeted in the last few decades, Kerala is outpacing the rest of Indian states in aging by 25 years (Philip 2011; Planning Commission of the Government of India 2008).

Older people in India are facing significant challenges in terms of care, especially since in India the infrastructure catering to their needs is insufficient (Jamuna 2003, 127). As noted in an article in India Today, an Indian English-language news magazine, the country lacks economic and social policies to manage the “exponential growth” of its elderly population (Datta 2018). Despite current efforts to introduce a comprehensive social welfare system, retirement and pension benefit schemes cover just about one-quarter of Kerala’s population, with far fewer women receiving benefits: around 67 percent of men and 87 percent of women in Kerala do not receive any benefits (ISEC Bangalore et al. 2013, 10). The same holds for health insurance, as government-sponsored schemes target only selected portions of the population, such as those living below the poverty line (Zachariah, Matthew, and Irudaya Rajan 2003, 402; ISEC Bangalore et al. 2013; Ahlin, Nichter, and Pillai 2016; van Dullemen and de Bruijn 2015).

Even when services such as old-age homes are in place, people are highly wary about them and those who use their services. The practice of entering an old-age home after retirement or upon becoming too frail to live alone clashes with the kinship-based principle of reciprocity that guides intergenerational care practices in India (Lamb 2000; Cohen 1998; see also Kowalski 2016). As noted in the Manual on Old Age Homes, prepared by the Centre for Gerontological Studies in Kerala, in India “old age homes are intended mainly for the poor and indigent and those who are abandoned/deserted/neglected by their families and those who have no other

3 These are global trends and as such call for a “cross-fertilization of the conceptual frameworks of social science studies of aging and migration with a view to care” (Oxlund 2018, 72). 4 Although the World Health Organization (2012) defines “old age” to refer to people who are older than sixty, ethnographic literature shows that this notion is far from clearly delineated or uniform across the world. In India, gerontology as a medical and social practice has only developed relatively recently, because “people did not know what a senior citizen is. … At that time [before the 1980s] there was no aging in India” (Cohen 1998, 88; see also Lamb 2000, 44). In South India, for example, definitions of “old age” are importantly shaped by class (Vera-Sanso 2006).

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Figure 1. An adaptation of a graphic representation of India’s aging population. Source: Datta (2018).5

place to go” (Nayar 2016, 2). Additionally, families may be concerned about the quality of care provided in these institutions, even though neglect and abuse of the elderly may also occur at home (Selim et al. 2018; Irudaya Rajan and Arya 2018; Roy 2011). So it is little surprising that although Kerala has the highest number of old-age homes in the country, elderly people generally do not wish to stay there.6 Instead, more than 80 percent of the elderly believe that their children should take care of them, not only financially but also through co-residence (ISEC Bangalore et al. 2013, 42; see also de Jong 2011, 2014).7 The preference for co-residence of

5 The image of walking cane to represent those above sixty years of age reflects a popular ageist discourse present across India. This discourse includes the assumption that elderly people are not interested, do not need, and are not capable of using ICTs, as I learned during my fieldwork. Indeed, senior citizens and women are two groups that are most excluded from the digitalization of India (Dutta 2015). 6 In 2013, Kerala hosted fifteen government-sponsored old-age homes and 492 homes run by private agencies, nongovernmental organizations (NGOs), and individuals, catering to about 13,000 elderly (ISEC Bangalore et al. 2013, 19). There are also a few “pay-and-stay” homes, which are run by various churches and which differ from old-age homes in that their residents are wealthier and voluntarily choose to move there, in search of company and comfort provided by the closeness of their church community (Nayar 2016, 2). 7 In Kerala, 62 percent of men and 72 percent of women prefer to live with their children, particularly sons (ISEC Bangalore et al. 2013, 19). Financially, 66 percent of women and 38 percent of men are completely dependent on their children, especially sons, and about 60 percent of all elderly rely on their children for subsistence (ISEC Bangalore et al. 2013, 14).

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elder parents with their children, especially sons, is indeed common across otherwise highly diverse India, where old-age homes are generally considered as shelters for the most destitute elderly coming from what are perceived to be particularly “bad families” (Lamb 2000, 90; Lamb 2013; Vera-Sanso 2004).

In a country where aging is so closely associated with co-residence and the support of children, elder care is complicated by the large-scale migration of adult children. The scale of international migrants from India is significant. Between 1992 and 2015, as many as 15.6 million people who were born in India lived in other countries, most of them in the United Arab Emirates, Pakistan, and the United States of America (US; Connor 2017). This number increased to 17 million international migrants from India in 2017 (UN 2017b). India is the very top country in the world in terms of remittances, with migrants sending 69 billion USD to their relatives in India in 2015 (Connor 2017). Despite fluctuations, Kerala is still among the top Indian states in terms of out-migration, receiving the most (19 percent) of all household remittances in 2016–2017 (ILO 2018; RBI 2018).8 Recently, the Kerala Migration Survey indicated that approximately 2.1 million Keralites live around the world, with almost 16 percent of those being women (Irudaya Rajan and Zachariah 2019).

Figure 2. Migration from India. Source: Connor (2017).

8 On the importance of remittances from Kerala migrant workers in the Gulf countries, see Zachariah and Irudaya Rajan (2012). Upadhya and Rutten (2012) and Osella and Osella (2000) describe the meaning and use of remittances in the Indian context, and particularly in relation to Kerala, as a means of increasing social status in the home community.

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Among labor migrants from Kerala, nurses, especially women with Syrian Christian background, are particularly well represented (George 2005; Nair 2012; Percot 2006, 2016; Percot and Irudaya Rajan 2007). The trend of international nurse migration started in the late 1960s when work opportunities appeared in the US; these were followed by large-scale recruitment by Middle Eastern countries in the mid-1990s (George 2005, 50–51). Precise numbers of Indian nurses abroad are not available, but according to estimations 40,000 to 60,000 nurses from Kerala work in the Gulf countries (Percot 2006, 43).9 Most recently, Keralite nurses have been migrating primarily to English-speaking countries such as Australia, New Zealand, and the United Kingdom (UK; Percot 2016).

The nurses’ motivation to migrate as well as their choice of destination countries have been stimulated by the international socioeconomic inequalities that fuel global care chains (Hochschild 2000; Yeates 2009; Eckenwiler 2009a, 2009b; Johnson, Green, and Maben 2014; Percot 2016; Prescott and Nichter 2014; Timmons, Evans, and Nair 2016).10 India, particularly its state of Kerala, has been trying to follow the Philippine model of “nurse production for export” by establishing agencies for market regulation and labor recruitment (Yeates 2009, 179–180; see also Kodoth and Jacob 2013).11 This endeavor has been supported by the Indian corporate health care training system, including hospitals, which promotes nurse migration as a “trillion dollar business opportunity” (Yeates 2009, 180; Walton-Roberts 2015; Khadria 2007). The prospects of migrating, earning significantly better salaries abroad, and sending remittances home have made

9 Estimates suggest that from 20 to over 50 percent of Indian nursing graduates intend to seek overseas opportunities (Thomas 2006; Walton-Roberts 2010; Zachariah and Irudaya Rajan 2015). In one study, 81 percent of nurses aged twenty to twenty-nine and 42 percent of nurses in higher age groups intended to migrate; furthermore, 73 percent of Christian nurses and 48 percent of Hindu nurses planned to migrate abroad (Thomas 2006). 10 “Global care chains” refers to a “series of personal links between people across the globe based on the paid or unpaid work of caring” (Hochschild 2000, 131). While it is beyond the scope of this thesis to address this topic in depth, it is important to acknowledge that neoliberal policies take advantage of and simultaneously perpetuate global economic inequalities and related gendered, racialized, and colonial hierarchies in (health) care (Das Gupta 2009; Prescott and Nichter 2014; Nair and Healey 2006; George 2015; see also Moors 2013). Yet it is possible to observe some changes; for example, Moors and colleagues (2009) describe the increasing public presence of female migrant domestic care workers in Middle Eastern countries. 11 The Philippines is a famous example of a state that produces nurses as a human capital for export (Yeates 2009). As such, this country has been extensively described ethnographically and theorized within the literature on global care chains (see for example Parreñas 2001, 2008; Choy 2003; McKay 2016; Amrith 2017).

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nursing a desirable profession especially among lower and middle-class families, across genders and religions (Zachariah and Irudaya Rajan 2012; Johnson 2018).12

The phenomenon of migrating Kerala nurses is an excellent case study to explore care at a distance. Their migration patterns have given rise to what is called the “zero generation,” or the first generation of parents who remain in their home country while their children migrate abroad (King et al. 2014). The migration of adult children may lead the elderly to experience “de facto childlessness,” as they remain without their children’s immediate presence and support in their old age (Kreager and Schröder-Butterfill 2004). In Kerala, local socioeconomic circumstances have created a perennial dilemma for adult children: Keralites of all classes, castes, and religions are compelled to migrate internationally due to the lack of appropriate employment opportunities and salaries that are too low to support themselves and their own families, let alone their parents (Chua 2014).

But once these adults migrate, they are subject to criticism for leaving behind their aging parents (Lamb 2009, 85; 2013). In line with the discourse of elder abandonment that I encountered in Kerala, these adult children who provide their parents with remittances could be described as “semi-absent,” a term offered by Azra Hromadzić (2018, 165) to refer to children who are “materially present … and physically far away and unable to deliver love and care at close proximity, or physically nearby but materially unable to support their elderly family members.” Like the elderly in Bosnia described by Hromadzić (2018), aging people in Kerala have found themselves caught in the cracks of the “breakdown of [care] systems” (Surendranath 2014), in which the state infrastructure is insufficient to accommodate their needs and their adult children are too far away to be able to help.

The idea underlying the “crisis of care” (Hromadzić 2018), which depicts the elderly as neglected by their families as well as by the state, is that all care necessarily requires physical proximity. However, research in transnational migration and media studies shows that family ties and some sorts of support do persist in transnational settings (see for example Baldassar and Merla 2014; Ducu, Nedelcu, and Telegdi-Csetri 2018; Yeoh and Ramdas 2014; Madianou and Miller 2012; Francisco-Menchavez 2018). As Roger Goodman and Sarah Harper (2008, 4) point out, “family structures and the widespread provision of public forms of

12 In Kerala, the monthly salary for nurses was about 10,000 Rs (150 USD) at the time of fieldwork in 2014-2015 as reported by my study participants. In April 2018, after years of protests, the Kerala government raised the minimum monthly wage for nurses to 20,000 Rs, or about 290 USD; this ruling has yet to be implemented (TNM Staff 2018; Express News Service 2018).

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care may be changing, but there is little evidence from studies across the world that kin do not continue to ensure that their family members are cared for and supported.” So, in today’s globalized world, care systems are not necessarily falling apart, but are adapting to new socioeconomic circumstances. Such making of the family at a distance includes the migrants’ sending remittances (Hoang and Yeoh 2015; Baldassar 2008; Lutz 2002; Parreñas 2008; Van der Geest, Mul, and Vermeulen 2004; Mazzucato 2008; Singh, Cabraal, and Robertson 2010). Regular yearly visits, too, have been described as essential for maintaining trusting relations (Baldassar and Merla 2014, 37; Urry 2003). As Loretta Baldassar and Laura Merla (2014) maintain, rather than emphasizing how migration inevitably damages family relations, it would be more constructive to explore how family members work to sustain their families in a transnational context. This is what I aim to do in my thesis, with paying special attention to how transnational family relationships and care are transformed by ICTs.

A Transdisciplinary Approach to Studying Elder Care Transdisciplinary research is oriented towards solving complex societal problems that are difficult to address within one disciplinary approach (Bunders et al. 2010; Bunders and Regeer 2009; Pohl and Hadorn 2008; Schuitmaker 2012). Transdisciplinary studies strive towards practical application of academic research, such as with respect to public health challenges (for example, Madni 2010). This thesis is transdisciplinary as it offers policy-relevant insights into the issue of elder care in times of intense migration by combining the anthropology of aging, family, migration, and communication with the material semiotic analytical approach, particularly as it has been developed in STS care studies (Mol 2002; Mol, Moser, and Pols 2010; see also Haraway 1991; Law 2009). In this way, I expand STS care studies into a South Asian context and simultaneously further the anthropological inquiry of aging in India that has hitherto focused on elder care within this country (Cohen 1998; Lamb 2000, 2009; Brijnath 2014; Bomhoff 2011; but see Brijnath 2009). By doing so, I aim to produce a thesis that acts as a “generative interface” between anthropology and STS (de la Cadena et al. 2015). Such interfaces are sites where practices, topics, and analytical tools of various disciplines come into conversation; they are generative in that they provide opportunities for establishing new, open-ended connections between different empirical and theoretical methodologies (de la Cadena et al. 2015, 437). Bringing together the research techniques of anthropology and STS care studies is a form of “bridgework,” the

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intellectual work that scholars do to create possibilities for generative interfaces (Rodríguez-Muñiz 2016). Through bridgework, this thesis generates novel understandings of what family care becomes when it is practiced in a transnational context with the help of ICTs. Anthropological Inquiry in Transnational Family Life: Co-presence and Polymedia To start with, I build on earlier anthropological studies of migration, media, and communication that have explored ICTs in transnational family care. In an effort to challenge the ideal of proximity in care, which rests on the assumption that geographic distance prohibits caregiving, Loretta Baldassar and her colleagues argue that ICTs make care possible across geographic distances (for example, Baldassar 2016; Baldassar et al. 2016). Inspired by new materialism, particularly by Jane Bennett’s (2004) idea of ‘vibrant matter,’ which acknowledges the agency of materiality, this body of research has described how ICTs enable transnational family members to generate “co-presence,” or the feeling of being together, at a distance (Baldassar 2016; Baldassar et al. 2016; Peile 2016; Madianou 2016; see also Miller and Sinanan 2014). The proliferation of ICTs and what they can afford has led these authors to identify more than one type of co-presence (Baldassar 2008). “Keeping in touch” and “staying in contact” via ICTs have been described as “virtual co-presence” (Baldassar 2008), “virtual connectedness” (Wilding 2006), “ambient co-presence” (Madianou 2016), and “ordinary co-presence” (Nedelcu and Wyss 2016), each of which emphasizes a slightly different aspect of co-presence that people can strive to achieve with ICTs.

For example, with the notion of “ordinary co-presence,” Mihaela Nedelcu and Malika Wyss (2016) present ritual as a part of everyday life. As one particular type of ordinary co-presence, they propose “ritual co-presence” to refer to the brief, regular, ICT-based contact between transnational family members in which the content is not significant, but “the fact of communicating is significant per se and has a crucial emotional and relational importance” (Nedelcu and Wyss 2016, 209). Another kind of ordinary co-presence outlined by Nedelcu and Wyss (2016) is “omnipresent co-presence,” or the sense of being together that is enabled through online ICTs that combine oral and visual forms of communication and that may be turned on continuously. Because of the possibility to also see another person, this kind of co-presence is the closest to face-to-face interaction, “creating

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a feeling of continuously being and doing things together” (Nedelcu and Wyss 2016, 211).

Co-presence has been made possible, and variously shaped, by “conditions of polymedia” (Baldassar 2016, 147; see also Madianou and Miller 2012). The theory of polymedia was developed by Mirca Madianou and Daniel Miller (2012) who explored ICT-mediated childcare provided by Filipina nurses living in the UK. The notion of polymedia refers to combined uses of various kinds of ICTs through which families support communication as well as manage emotions. In Madianou and Miller’s (2012) study, people constantly switched among different media that catered to different emotional registers: written messages and emails helped avoid confrontation while frequent phone conversations were experienced by children as disturbing their daily life and representing a form of surveillance (Madianou and Miller 2012, 132–135). Additionally, Madianou and Miller (2012) developed a theory of mediation, whereby ICTs highlight the tensions in family relationships that had existed prior to migration, or help to maintain an ‘ideal distance’ between parents and children that makes their relationship better across geographic distance than in face-to-face interaction.

The outlined literature shows that within the context of transnational family life, ICTs have become key to caring at a distance. Building on this scholarly work, I explore in further depth the specificities of how ICTs participate in care at a distance by employing the material semiotic analytical tools of STS care studies. According to this approach, described further in the following section, 1) care is something that humans and non-humans enact through the relations they form with each other, within practices aimed at improving a certain situation or keeping it stable; and 2) what is considered ‘good care’ is a matter of practical accomplishments and tinkering, rather than external ideals that people follow.

Enacting Care through Heterogeneous Relations

In STS care studies, care is analyzed as something that is enacted within practices (Mol, Moser, and Pols 2010; Mol 2002; Pols 2005). As Annemarie Mol maintains in The Body Multiple (2002), the identity of objects that medicine is concerned with is multiple, as what these objects are or come to be—their ontology—is contingent on particular practices through which they are enacted.13 For example, a disease 13 In STS, the notion of “worlding practices” (Blaser and de la Cadena 2018), which describes how things are enacted through practices, challenges a particular understanding of reality whereby objects have an essential identity that people may observe from different perspectives. Such ‘perspectivism’ underpins the divide between nature and culture, reflected in the division of

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like atherosclerosis, which Mol (2002) takes as a case study, becomes something else when it is enacted in the outpatient clinic, the laboratory, the pathology department, and other sites. In the consulting room, it is enacted primarily through the conversation in which the patient complains of “pain when walking” and answers the doctor’s questions about it. In the laboratory, atherosclerosis is not so much about talking, but about taking measurements. The technician uses various measuring tools and together they enact the disease either as a “fall in blood pressure” or an “increase in blood velocity.” At the pathology department, atherosclerosis becomes yet something else; with the help of a microscope, it is enacted as “thickened blood vessel walls.” In this way, an object is enacted differently in different sites, by different actors who form relations with each other within different practices.14 Furthermore, the identities of the actors involved in enacting something are also “not a given, but an outcome of their relations” (Pols 2014, 176; see also Pols 2013; Mol 2013; Law and Mol 2008; Woolgar and Lezaun 2013; Haraway 1991). Thus, actors and the things they enact through their relations are all mutual, mutable, and fluid.15

Approaching care as being enacted within practices allows me to investigate how calling on the phone and webcam as well as sending money to parents and even migrating abroad are practices of intergenerational care in Indian transnational families. Employing ‘enacting’ as an analytical tool makes it possible to examine in-depth the specificities of care practices in a transnational context. For example, what precisely do people do with ICTs in order to achieve particular kinds of co-presence, and how exactly do ICTs shape this co-presence? In other words, I can analyze how people and ICTs engage in mutual relations within specific practices through which they enact a certain kind of ‘co-presence.’

Importantly, the relations through which something is enacted are heterogeneous, as they are established between humans, objects, machines, and animals, as well as organizations, ideas, and geographical arrangements (Law 2009; Callon and Law 1997). In STS care studies, this view of relations as heterogeneous

sciences into natural and social, and further in the division of labor between medical doctors, studying disease, and medical anthropologists and sociologists, studying illness (Mol 1999; Latour 2005; Pols 2005; Law and Lien 2018; Viveiros de Castro 2004; cf. Kleinman 1988). 14 Another example is Ingunn Moser’s (2008) study of how Alzheimer’s disease is enacted differently in a medical textbook, general practice, parliament, conference on dementia, and other sites, each with its specific actors engaging in specific practices. 15 The denunciation of objects as stable is a key difference between material semiotics and new materialism, which considers the active role of non-human actors, but does not consider their identity as flexible and shaped by relations with other elements (Mol 2013; Abrahamsson, Bertoni, and Mol 2015; Hoogsteyns 2008).

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was brought together with the ethics of care to analyze care practices in terms “radical relationality,” whereby “things, activities and words are added to the study of relations between people” (Pols 2014, 176; see also Pols 2012). Radical relationality implies that technologies, too, are involved in the making of identities within care practices. For example, in their study of telecare in Spain, Daniel López and Miguel Domènech (2009) show how an alarm pendant, which elderly people living alone can wear and touch to call for help in emergency, enacts the users’ bodies in different ways. Wearing the alarm device constantly enacts the user as having a ‘body-at-risk,’ as it makes the user aware that their body might fail them at any moment. By contrast, when the user wears the pendant only occasionally, the body is enacted as ‘vigorous’ since the user still considers it to be capable of everyday activities.16

The understanding of care relations as heterogeneous creates an opportunity to ‘decenter’ people as the only agents in enacting care. For example, in her research on disability in France, Myriam Winance (2010) argues that care is achieved through a “care collective” that involves the carer, the person with disability who is cared for, and the wheelchair. As a member of this care collective, the wheelchair needs to be adjusted to fit not only the disabled person but also the carer who spends much time pushing the wheelchair around. By modifying the relationships of dependency between them, care becomes dispersed among all the members of the collective. In the process, the carer and the cared for are enacted as persons who are differently attached or detached, dependent on and independent from each other and the technological device.17

Scholars of India have described family relations as key to shaping the identity of family members (Ahlin 2018a; Brijnath 2014; Gregory 2011; Sax 2009; Mines 1994), but in the Indian transnational families that I study, these relations are also mediated through ICTs. Approaching care relations as heterogeneous is therefore crucial to this thesis in order to analyze how care at a distance is enacted by people as well as by ICTs and also other non-human actors, such as money. Since the notion of the care collective pays attention to the dynamics among heterogeneous actors involved in care practices, I build on this concept extensively and develop it further to fit the context of transnational families and ICTs.

16 Perhaps as a consequence of coming into contact with STS (Miller 2005; Callon 2005), the acknowledgement that technologies and people shape each other is also noticeable in the recent development of material culture studies (for example Miller et al. 2016). 17 There are many other examples in STS care studies that explore the identity-shaping relations between people and technology, including Pols and Moser (2009); M’charek (2010); Mort, Roberts, and Callén (2013); Pols and Willems (2011).

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Exploring ‘Good Care’ in Daily Life

How to study the ways that ICTs shape what is ‘good care’ in Indian transnational families? This question can be answered through empirical ethics, a methodological approach from STS care studies that explores how people strive to achieve ‘the good’ in everyday care practices (Pols 2013, 2014; Willems and Pols 2010). To establish what works well in care and what does not, empirical ethicists compare and contrast various practices to “consider and weigh what is the best way of living, or the least bad, for whom, and why” (Pols 2013, 23). What is ‘good,’ then, is not a matter of judging how well a particular practice aligns with a particular norm. Indeed, STS scholar Miriam Winance (2007) challenges Erving Goffman’s (1968) conceptualization of norms as external, pre-existing rules to which people should adjust their behavior. Rather, Winance (2007, 631) adopts Harold Garfinkel’s (1984) ethnomethodological approach to understanding norms, suggesting that people “constantly develop and produce, within the situation, the rules for their action.” What is ‘normal,’ then, is not a matter of following fixed norms, but something that is situated in and shaped by particular social and material interactions.

Empirical ethics, then, explore how people achieve some form of ‘the good’ in care through daily ‘tinkering’ with material things such as technologies (Mol 2006, 2008; Mol, Moser, and Pols 2010; Pols 2012; Winance 2010). In cases of chronic illness, for example, ‘good care’ is not about finding a cure, as that is an impossible goal. Instead, ‘good care’ becomes about tinkering and making small adjustments to achieve a ‘good enough’ life in the context of the chronic illness (Pols 2013; Mol 2008). Similarly, for Winance (2010, 111), to tinker in care collectives is to “meticulously explore, ‘quibble’, test, touch, adapt, adjust, pay attention to details and change them, until a suitable arrangement (material, emotional, relational) has been reached.” What is ‘good,’ then, is continuously and locally enacted through heterogeneous relations, with ‘local’ referring to the specific situations in which practices occur rather than to geographic regions (Yates-Doerr 2017; see also Raghuram 2012, 150). Moreover, empirical ethics are concerned with the social rather than the individual level (Pols 2013). According to Jeannette Pols (2013, 22), the ethics of the social include other people and things such as technologies that are involved in care and that work together to achieve good care, and sometimes also fail at it.

In line with empirical ethics, I explore ‘good care’ not in terms of norms but in terms of everyday “practical accomplishments” (Winance 2007, 631) through which people find the best possible ways of “doing family” at a distance (Morgan

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2011).18 In transnational families, attempts to ‘do family’ across geographic distance are mediated through ICTs, which are thereby essential to shaping ‘good care’ at a distance. With its emphasis on social as well as material relations, empirical ethics make it possible to investigate daily calling in Indian transnational families; comparing this practice across different ICT devices helps to understand what kind of activity this is and under what conditions family members see it as ‘good care.’ Furthermore, when combined with anthropological insights about the Indian colonial past, the patriarchal Syrian Christian kinship system, and the migration patterns of nurses from Kerala, an empirical ethics approach allows me to bring to light how everyday ‘good care’ in transnational families is shaped also by particular histories, tied to certain geographic locations. While attempting to avoid “geographic exceptionalism” (Raghuram 2012, 150), whereby care is understood as different in different places because it is shaped through different ‘cultures’ or moral values, I show how everyday care practices are situated within specific “geohistories” that shape the “structural conditions of caring” (Raghuram 2016, 512). Thus, I explore how in transnational families of nurses from Kerala, children, and particularly daughters, are shaped as ‘good children’ through certain intergenerational care practices that are new, yet influenced by the geohistory of Kerala.

Empirical Methods: Following the Families, Flying and Otherwise I conducted ethnographic fieldwork in India, as the country of migrants’ origin, and in Oman, as one of the many destination countries for Indian migrants.19 Oman has historically been linked especially to the South Indian state of Kerala through trade and, from the latter half of the twentieth century, through labor migration. Thus, Oman is a longtime migration destination for Keralites (Irudaya Rajan and Percot 2011; Zachariah and Irudaya Rajan 2012).20 Using the method of ‘following the people’ (Marcus 1995), I visited each of these two countries twice, spending five months in India and three in Oman in total. In both countries, I

18 In line with the STS emphasis on practice, “doing family” explores family life as “a set of activities,” which moves away from seeing ‘family’ as something static or in terms of positions and statuses (Morgan 2011, 6). As Morgan (2011, 6) notes, family members are not only people defined as mothers, fathers, and so on, but also people seen as ‘doing’ mothering or fathering. 19 I obtained the ethical approval for this study from the University of Amsterdam in November 2013. 20 For ethnographic studies of the Indian diaspora, see for example Rutten and Patel (2003) for the UK, Lamb (2009) and Das (2012) for the US, and Vora (2013) for the United Arab Emirates.

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conducted fieldwork in urban, semi-urban, and rural sites, ranging from Oman’s capital city of Muscat to the middle-sized town of Kottayam in Kerala, and to smaller villages in both countries.

To understand the phenomenon of migrating nurses, Kerala is the most interesting state in India, since the majority of nurses originate from there (Nair 2012). Within India, Kerala is renowned for educating large numbers of nurses.21 Importantly, Kerala hosts a considerable Christian community that, in contrast to Hindus, sees nursing as a noble profession and encourages women to follow it (Simon 2009; Walton-Roberts 2010).22 Additionally, Kerala has the highest rates of literacy and is at the forefront of all Indian states in terms of ICT use and initiatives (see for example Joju and Manoj 2019). Kerala has the highest mobile phone penetration (about 90 percent) and internet penetration, with 20 percent of households being connected through broadband and another 15 percent of the population being connected through mobile phones (Mathews 2018). The increased presence of ICTs, such as smartphones and social media, is changing the way people organize and act collectively in Kerala. For example, I found that nurses in Kerala were taking great advantage of Facebook to share information about the ever-changing migration regulations, employment opportunities, and work conditions around the world. In 2011, the nurses even used Facebook to organize into what later became the United Nurse Association (Biju 2013). Such engagement with ICTs makes Kerala a most interesting place for studying the impact of ICTs on how people relate to each other.

Besides focusing on those Kerala nurses who migrated to Oman, this study also included nurses who had migrated to other countries, but whom I did not follow physically to their migration countries. I interviewed nurses working in the United Arab Emirates, Saudi Arabia, the US, the UK, Australia, New Zealand, and Guyana when they returned to visit their families in Kerala during their yearly leave from work. Additionally, some families in Kerala invited me to interact via ICTs with their members abroad. In this way, I found myself conducting participant observation and interviews on the webcam and phone with nurses living in the US, UK, Canada, the Maldives, and Australia. Including ICTs in the practice of fieldwork was a particular methodological challenge in itself. I realized that ICTs

21 In 2011, more than 27,000 nurses were registered in Kerala, and as many as 80 percent of nurses in cities like Delhi came from Kerala (Kodoth and Jacob 2013). Precise numbers of graduating nurses in India are difficult to establish due to the questionable reliability of data about the education of health care workers (Walton-Roberts et al. 2017, 18). 22 Although only about 3 percent of the Indian population are Christian, as many as 30 percent of Indian nurses have this religious background (Simon 2009).

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influence not only care and family relations but also the practice of fieldwork, a discovery which I address in depth in chapter 6.

I met most of the nurses in a popular English language school in Kottayam where they were preparing for the International English Language Testing System (IELTS), a required exam to migrate to English-speaking countries, and where I volunteered as a teacher. With these nurses, I carried out group and individual interviews, and some of them invited me to their homes to meet their parents. Additionally, I was introduced to several families by an Ayurvedic doctor based in the town of Thiruvalla. My main recruitment criterion was that the family had one or more children working abroad as a nurse, regardless of where the children lived and for how long. Besides carrying out interviews and participant observation among members of twenty-nine such families, I also stayed for some time with four of those families, spending two days with one family in India and between two and fourteen days with three families in Oman. Throughout my fieldwork in India, I lived with a family that had no children abroad, which enabled me to observe and learn about conventional elder care practices. In all of the families in my study, every family member used some kind of ICT, from landline phones or simple mobile phones, to smartphones, laptops, tablets, and personal computers. They had various levels of knowledge, skills, and abilities regarding ICTs and used these devices accordingly.

English and Malayalam are the official languages of Kerala, and I carried out most of the interviews and discussions in English. However, the very elderly people mostly spoke only Malayalam and to interview them I relied on a translator. My inability to converse in Malayalam is one limitation of this study, as I was not able to follow the conversations between the children abroad and their parents during their interaction via ICTs. Instead, I depended on the children’s impromptu translations. It is therefore possible that some nuances in personal relations have eluded me. On the other hand, not being able to focus on the words that the family members exchanged among themselves helped me direct my attention to the materialities of these events and to what people did rather than said.

The transnational families involved in this study are specific in two ways. First, since the nurses are professional carers, the kinds of care they practice at a distance in relation to their family members may be different from the Indian transnational families in which the migrating children have other professions (cf. Lamb 2009). As professional carers, nurses may be particularly well equipped to articulate their caring practices, which makes them especially valuable to a researcher seeking to learn about care. Moreover, among the parents, whose age ranged from about fifty to eighty, chronic illnesses such as diabetes and

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hypertension were common, yet not severe. They managed their daily health by themselves, although accidents like falls and food poisonings did occur. In only two families did one of the parents require hands-on care: in one, a widowed mother suffered from dementia, and in the other, the father suffered from Parkinson’s disease. The wife provided most of the hands-on care for the latter, but in both families one of the daughters living nearby helped with physical and practical care. In other families, the parents did not require constant physical care but only an occasional doctor’s appointment.

Finally, an assumption underlying this thesis is that care is enacted in all families, in one way or another. However, I do not mean to imply that relationships among family members in my study were always good. Family relations were a sensitive topic especially when relationships were poor or conflicted. One mother, for example, was in an “old-age shelter”, as the locals called the institution she was in, while her daughter worked as a nurse in one of the Gulf countries. This mother had left her husband and daughter due to marital disputes and had no contact with her daughter at all, a story that she recounted through tears. In another family, five children were in dire conflict with each other, as they disagreed about the best way to take care of their aging mother. One of them, a nurse living in the US, told me that their disputes were related to the neglect they had experienced as children. While she described these conflicts and her feelings in detail, she explicitly asked me not to audio record the most disturbing parts of her account. Finally, some family members did not openly discuss their family relations, but their actions were revealing. For example, one male nurse preparing to migrate expressed much love for his parents and had great plans for taking care of them from abroad. However, when I asked to meet his parents, he introduced me, without any warning or explanation, to a couple that he referred to as his “almost parents.” Several key participants in my study, with whom I shared this experience, suggested that this man’s relationship with his parents must have been deeply troubled, or they were from a very poor background, and that he was likely trying to conceal both of these things from me in order to preserve an image of coming from a ‘good family.’ Whatever his reasons, he obviously preferred not to reveal his family situation and therefore I decided not to investigate further. Excepting these three families, family relations seemed reasonably good and this was reflected in people’s willingness to discuss their caring practices at a distance.

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Thesis Overview When I first arrived in Kerala, several people I met told me it would be impossible to carry out my research, as the elderly people I was seeking to interview would not want to talk to me. According to these first interlocutors, elderly parents would be too ashamed of their migrating children having ‘abandoned’ them. In chapter 2, published in Medical Anthropology Quarterly, I critically examine this discourse of elder abandonment and explore how migration can be understood as a care practice rather than an act of abandonment. I introduce the notion of ‘transnational care collective’ to show how care is practiced in transnational families, for example through phone and webcam calling. I describe in detail how the dynamic is established differently in each transnational care collective.

One important aspect of the transnational care collective is the frequency of calling. In Oman, one person told that me he called his mother as many as fifteen or twenty times a day! Why would adult children who live abroad call their elderly parents so frequently? In chapter 3, published in Medical Anthropology, I show that when family members are scattered around the world, frequent calling becomes a way to enact ‘good care’ at a distance. I investigate how daily calling shapes family members’ conversations and interactions. Comparing two types of technologies—phones and webcams—I explore how their different affordances support ‘spending time together’ at a distance in distinct ways. I describe how the different kinds of ‘co-presence’ achieved through frequent calling support reciprocity in care.

Caring at a distance also enacts gender in specific ways. As a care practice, migration is enveloped in intergenerational ambivalence; the parents experience a conflict between the common disapproval of receiving financial support from daughters and the dire need to accept such support. Chapter 4, a scholarly article that I co-authored with Kasturi Sen and which has been accepted for publication after additional minor revisions and editing in Gender, Place and Culture, explores how norms of filial care are reshaped in this transnational context, and how money and ICTs participate in this transformation. We show how daughters increase their bargaining power with their in-laws which enables them to become primary carers for their own parents. We discuss how this transformation of what is considered good care further influences the position of men as husbands and sons-in-law. By studying how gender is enacted through elder care practices, this chapter adds nuance to scholarly discussions of the influence of migration on patriarchal hierarchies.

Chapter 5 is an editor-reviewed blog post that was published as part of the series Thinking with Dementia on the online academic platform Somatosphere. As such,

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it is shorter and more narrative in form. This chapter relates a story that complements previous findings about transnational care collectives. Specifically, it illustrates what may happen when an elderly parent becomes afflicted with dementia, as speaking on the phone becomes increasingly difficult and as greater attention is required in terms of hands-on care. This story did not become a part of any of the earlier chapters, because I initially, and prematurely, concluded that the formation of transnational care collectives with the help of ICTs is not possible in the case of late-stage dementia. The inclusion of this story in the thesis, however, indicates that an alternative explanation is possible.

In my fieldwork, ICTs influenced not only the family relationships that I was studying; these technologies also impacted the practice of fieldwork itself. Chapter 6, accepted for publication in Medicine, Anthropology, Theory, is a reflection on ethnographic methods in a world where ICTs have become essentially intertwined in the lives of ethnographers and study participants. My co-author Fangfang Li and I draw on our individual research projects which had common points in that we both worked with migrants and included ICTs in the practice of fieldwork. We introduce the notion of ‘field events’ as an alternative to ‘field sites’ to explore how ICTs co-create the field together with ethnographers and study participants. If it is possible to conduct interviews and participant observation via ICTs with study participants who are scattered across numerous geographic locations, does it still make sense to visit those locations in person?

Finally, in chapter 7, I draw together the theoretical insights from the previous chapters to answer the questions outlined in this introduction. In this introduction, I have presented material semiotics and the emphasis of this approach on the relations between human and non-human agents as an entry point to studying care at a distance. The concluding pages reflect on how people and ICTs relate to each other within transnational care collectives. What are the necessary conditions for family relations to be sustained across geographical distance, and how are various non-human actors involved in enacting care in transnational families of nurses from Kerala? What makes for ‘good care’ and ‘good children,’ specifically ‘good daughters’? And what theoretical and empirical insights does this thesis bring for ethnographers? In particular, I maintain that analyzing ICTs as active participants in relations offers new understandings of not only the notion of ‘care’ but also ‘gender,’ ‘kinship,’ and even the ‘field’. Finally, I consider what lessons this thesis offers for policy makers in the fields of migration, aging, and care, both in India and elsewhere, and I offer a few questions that might inspire future research.

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Chapter 2 ONLY NEAR IS DEAR? Doing Elderly Care with Everyday ICTs in Indian Transnational Families In Kerala, South India, young people, especially women, are encouraged to become nurses in order to migrate abroad for work and thereby improve the financial status of their family. Meanwhile, many of their parents remain in India by themselves. This is occurring in the context of a strong popular discourse of elder abandonment, related to the local norms of intergenerational co-habitation. Based on fieldwork in Kerala and one of the nurses’ destination countries, Oman, I present evidence that complicates this discourse by showing how 1) migration is a form of elder care practice in itself, and 2) care for the elderly continues across countries and continents with the help of information and communication technologies (ICTs). Using the theoretical approaches of science and technology studies (STS), I analyze ICTs as key members of care collectives and argue that ICTs have a significant role in re-shaping care relations at a distance. Keywords: Care, ageing, ICTs, migration, Indian transnational families This chapter has been published as: Ahlin, Tanja. 2018. “Only near is dear? Doing elderly care with everyday ICTs in Indian transnational families.” Medical Anthropology Quarterly 32(1): 85-102. doi: 10.1111/maq.12404. For this thesis, the text has been changed for style (font size and style, paragraph alignment) and minor editing, including changing the subtitle “The Care Collective” into “Transnational Care Collective.” I also added one photo (Figure 3).

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Introduction In January 2014, I traveled to the South Indian state of Kerala to carry out fieldwork among families who had children working abroad as nurses. I was interested in how these migrants to the Middle East and elsewhere took care of their parents who remained in India, and to explore the role of information and communication technologies (ICTs) in this process. Once there, I was told that the situation for the elderly was pitiable because so many youngsters migrate, leaving their aging parents behind. Educated high and middle-class people talked about old parents living alone in tragic terms: being put into old age shelters and hospitals, or having live-in maids or visiting nurses take care of them. “This is what is happening today,” one interlocutor lamented, reminiscing about the old times when at least one of the children, preferably the youngest son and his wife, would stay in their parents’ house. When I expressed the wish to meet some of these elderly people living alone, he retorted, “Impossible, they will never speak to you,” insinuating that parents would not want to disclose their profound grief of missing their children.

Nevertheless, I easily arranged an interview with Alice, an elderly lady who was living alone after her husband’s death a few years earlier.23 To my surprise, Alice was visibly cheerful when I met her, a state that she attributed to the practical benefits of having children abroad. She said, “Because my children are abroad, I am living happily here. If they lived here and had no jobs or earned a very poor salary, would we all be happy? No!” Alice’s daughter, a nurse, lived with her family in Australia, while Alice’s son and his family lived in Dubai. Both children provided for Alice financially, they visited her every year, and they phoned her daily. The obvious benefits of the situation were, for Alice, a worthwhile trade-off for not having her children geographically near.

Thus I stumbled into the complex territory of diaspora and its management in relation to care for the elderly in India. Popular claims of abandonment were met with lived experiences that suggested a more complicated picture. Although migration entailed leaving one’s parents in a country with little formal infrastructure catering to the elderly, and although the ideal of parental co-habitation persisted, many young adults left anyway. How was this trade-off managed? In what follows, I illustrate how

23 All personal names are pseudonyms.

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information and communication technologies, or ICTs, emerged as crucial in supporting the parents in India and their children abroad in daily care practices. I argue that elders were not abandoned by out-migrating children, but that migration led to a particular understanding, and practice, of care by way of communication technologies. No doubt, parents felt lonely and missed their emigrated children. Nor does reliance on ICTs represent a substitute for embodied face-to-face care that can be optimal for caring, especially when hands-on care is required. Still, ICTs enable a reformulation of care that mitigates abandonment. As others have shown for refugees (Robertson, Wilding, and Gifford 2016) and economic migrants such as nurses from the Philippines (Madianou and Miller 2012), families rely on ICTs to remain connected as the only alternative to being together physically.

In this article, I explore how elder care is re-shaped through ICTs in the context of migration. I approach care as a relational practice between people and technologies (Pols 2012). I discuss the discourse of abandonment in relation to the ideal of physical proximity as a pre-requisite for family care. I then describe how Christian nurses from Kerala see migration itself as a care practice rather than abandonment. Finally, I explore how care continues to be practiced in Keralite transnational families (Bryceson and Vuorela 2002) through care collectives that include human and non-human entities (Winance 2010).24 ICTs in Relation to Care Information and communication technologies (ICTs) have been hailed as technologies of social change at all levels, from transforming intimate relationships (Wright and Webb 2011; Gershon 2010) to spurring revolutions (Bonilla and Rosa 2015; Brym et al. 2014; Postill 2014). Scholars have argued that in Anglo-American families, ICTs impair the quality of relations (Turkle 2012) and increase the pressure of balancing work and family (Wajcman 2015). In contrast, others have shown that different types of ICTs can enhance social relations. For example, in Jamaica (Horst and Miller 2006), Trinidad (Miller 2011) and Israel (Brown 2016), cell phones 24 Transnational families are “families that live some or most of the time separated from each other, yet hold together and create something that can be seen as a feeling of collective welfare and unity, namely ‘familyhood,’ even across national borders” (Bryceson and Vuorela 2002, 3).

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and the Internet are used to create extensive social networks that may be mobilized in crises. Showing how webcams helped to maintain personal relationships in Trinidad, Daniel Miller and Jolynna Sinanan (2014, 6) concluded that technologies do not make human relations any less ‘real’ or ‘natural,’ but they do co-create them.

In this article, I pick up where these insights leave off in exploring how technologies, beyond being inert communication tools, are actively involved in shaping caring relations through interaction with their users (Oudshoorn and Pinch 2003). I broaden the anthropological insights about elder care in India (Cohen 1998; Lamb 2000, 2009; Brijnath 2014) by using the material semiotic approach of analysis (Law 2009; Pols 2012). Material semiotics examine the complex interactions between technology and people by describing “the enactment of materially and discursively heterogeneous relations that produce and reshuffle all kinds of actors including objects, subjects, human beings, machines, animals, “nature,” ideas, organizations, inequalities, scale and sizes, and geographical arrangements” (Law 2009, 141). Thus, the identity of people and material objects such as ICTs is enacted through their mutual relations, which are situated in particular practices (Pols 2012, 17; Mol 2002). Identities are then fluid, multiple and temporary, as they transform whenever practices and relations through which they are enacted change.

With material semiotics as a starting point of analysis, I investigate what happens when ‘care’ is understood as an enactment of relations between humans and technologies. As I will show, in the case of Keralite transnational families relations are enacted as shared work, dispersed in a collective of family members, non-kin and ICTs. The work of care then involves “a transformation of what these entities are, of their materiality and their sensations, of what they do and, above all, of the way in which they are linked to one another” (Winance 2010, 111). I will demonstrate how a particular transnational “care collective” arises from such work.

According to Myriam Winance (2010), the notion of care collective reconsiders the relationship between care receivers and care givers as one of dependency, with technology mediating and thereby modulating this relationship. The care collective members balance their positions through “empirical tinkering” (Winance 2010, 95), namely through adjustment of details (for example, the attributes of the technology used) until they reach a material, emotional and relational arrangement that suits them best. The object of care is then not an individual, but all members involved, including

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non-human ones. This will be important for understanding how ICTs contribute to complicating the discourse of abandonment by shaping care in the context of transnational families. Methods I gathered ethnographic data during eight months of multi-sited fieldwork in Kerala and Oman in 2014 and 2015. Oman is one site among many that represent popular destinations for Keralite migrants (Zachariah and Irudaya Rajan 2012). While Indian diaspora elsewhere has been anthropologically explored (Vertovec 2000; Lamb 2009; Vora 2013), little is known about the Indian community in Oman. Since 1970, low-paid, unskilled men, especially Muslim, started leaving Kerala for temporary work in the Gulf (Osella and Osella 2000; Gulati 1983; see also Saxena 1977). In contrast, I focused on skilled international migrants, particularly nurses who are mostly female Syrian Christians. In Kerala, nursing became a profession of choice for aspiring international migrants, as this has proven an efficient strategy to increase economic status (Percot 2016; Nair 2012; George 2005).25 For this reason, even some men and Hindus have recently entered this profession. Without making claims about other groups from India, my study thus offers insights that are specific to nursing and its historical developments in terms of class, gender and religion.

I supplemented the stories I collected in Oman with interviews with Keralite nurses that lived in other locations, for example in the USA, UK and Australia. I conducted these interviews in person with those nurses who were in India visiting their family, and sometimes remotely by phone and webcam calls. Altogether, I carried out participant observation among twenty-nine families of children who had emigrated. Most of these were of various Christian denominations, although four were Hindu. In most families (22), the nurses were female. I talked with and/or observed either the parents (5) or the children (11) or both (13). Most parents were between around 50 and 70 years old and had only minor health issues or chronic ailments like diabetes and hypertension.

25 This phenomenon has been examined in terms of ‘global care chains,’ a notion emphasizing the global socioeconomic inequalities that push (non-)professional carers into working abroad (Walton-Roberts 2012).

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I observed family members communicate via ICTs and I was often invited to join in, sometimes using English and other times Malayalam with the help of an interpreter. As family relations were a delicate topic, and discussion of tensions was not always directly discussed, I used the technique of triangulation (Stake 1995), comparing the information obtained through interviews with the comments of my perceptive interpreters and my own observations. Migration and Abandonment In February 2014, well into my fieldwork in Kerala, I was told by an Ayurvedic doctor about the predicament of elderly Indians who had been abandoned. From my field notes:

The doctor tells me of an eighty-year-old male patient, a widower, whose kids are abroad. He lives alone and has a lot of health problems. The doctor suggested to him to find a paying guest who could help in case of emergency. But the man replied that his son returns home every year for one month and he is saving the empty room for him. “Because he wants his son to live with him for one month per year,” the doctor says, “this man suffers for 11 other months.”

The doctor mentions another widower living with his married son and family. His problem is loneliness, too, the doctor suggests, because the son and wife both work and the grandchildren are in school. The son only asks him if he ate, he replies “Yes,” and that’s it. So he goes to the bus stop by the road and he sits there, watching people. In the evening, he returns home. He knows that his time will come soon and he is just waiting for it to pass.

The two men, the doctor concludes, have the same problem – one living alone and the other living with his son, but still lonely, because everybody is at work or school. The doctor says many elderly come to see him only to chat. That’s why he takes time to talk to them.

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The doctor’s account suggests that for the elderly in India, loneliness may be folded into sentiments of abandonment even when they live together with their children. The notion of abandonment assumes some kind of dependency on others to have one’s physical, emotional or other needs met. Both men in the doctor’s story were abandoned, but the nature of their abandonment differed in the kind of needs that were unmet: the man living alone had no support with practical matters while for the man living with his married son had his emotional needs unfulfilled. This shows that even though in India intergenerational co-residence is considered ideal, an elderly person living this ideal in practice may still feel lonely (see also Lamb 2009). Thus, physical proximity of close relatives is important for the elderly, but it is not sufficient.

When I discussed elderly care with people in Kerala, they used the English term “abandoned” to mean something like “left behind,” often the same way it is used in academic and policy discourses on transnational families in which the elderly are presented as ‘dependent’ on the migrating adults (Sørensen and Vammen 2014; Escriva and Skinner 2008; UN 1999). A good deal of this literature argues that intergenerational support in many places may decline because of lack of resources and motivation on the part of children, but also because of geographical distance between family members. This situation, in which the elderly are forced to organize their life as if they were childless, has been described as “de facto childlessness” (Kreager and Schröder-Butterfill 2004). Such insights suggest that geographic distance between family members automatically translates into the impossibility of all kinds of caregiving (Baldassar and Merla 2014, 12). Indeed, in the South Indian state of Tamil Nadu, the “PICA (parents in India, children abroad) syndrome” has been described as “a horrific emerging reality in urban India” (Krishnamoorthy 2015). The elderly ‘afflicted’ with this syndrome are left to live alone, and even children’s visits cannot provide any comfort – a very gloomy picture in which international migration is presented as a serious, detrimental phenomenon.

It is thus widely assumed that out-migration of children is a major cause of abandonment among elderly Indians, leading to loneliness as well as lack of sufficient practical and other care. Narratives of abandonment are particularly prevalent among the Hindus who link old age with the practice of seva, or service, which younger family members are expected to provide to the elderly (Cohen 1998; Lamb 2000). It then comes as little surprise that

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the initial founders of old age homes were Christian organizations which put less emphasis on seva and saw providing a place to live for the poor and the elderly as a service to them and thereby to God (Lamb 2009, 57). How does this impact on families of migrating nurses from Kerala, which mainly come from Christian background (George 2005; Nair 2012)? Let us look at how migration, rather than resulting in a decline of care, may become re-interpreted as a new kind of care practice. Migration as a Care Practice Anthropologists have argued that kin relationships in India are particularly strong because they are created through embodied activities such as daily eating and living together; these practices are described as co-constitutive of personhood among Hindus (Lamb 1997; Mines 1994; Raval and Kral 2004). In East-Central India, physical touch in close family relations has been deemed so important that these ties are termed ‘skinship’ (Gregory 2011). How, then, do families of nurses from Kerala manage not to disintegrate when they become extended across large geographic distances?

First, many emigrated children returned home for visits regularly, thereby manifestly countering the notion of abandonment. The nurses usually benefited from one yearly leave from work, which they used to return to India. The importance of these visits, which sometimes served to provide hands-on care and generally reinforced emotional relationships between family members, cannot be underestimated (see also Baldassar 2007; Baldassar, Baldock, and Wilding 2007; Baldassar and Merla 2014). One might say these visits built on the embodied closeness (or skinship) that the nurses experienced during their upbringing. In only two out of 29 families, the migrating children were not in contact with their parents or parents-in-law, which they attributed to having severely damaged family relations before migration. But all others used their leaves for returns home, suggesting that pre-existing family closeness configured the migration experience in ways that favoured at least one kind of ongoing care. Migration was in this sense infused with efforts and persistent care, despite the distances of geography.

Second, the families saw migration as a form of care in itself. This is for example evident from the way in which parents recognized the benefits of international migration. Rather than feeling helplessly abandoned, they

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were generally heavily invested in migration plans. International migration was “a family project” (George 2005, 43; Nair 2012; Percot 2014), planned for years and starting with steering children towards the nursing profession. In one family, all three daughters became nurses due to their mother’s encouragement; two of them had already established their families in the UK while the youngest one, Molly, was studying English with the same goal. Molly’s mother even tried to influence her choice of destination country. During one of my visits, she started asking me how much nurses earn in my country. She then mentioned Switzerland, saying she heard the wages for nurses were high there, so that might be a good country for Molly to migrate to. For parents, international migration represented a strategy to secure their own material and physical wellbeing in old age by relying on their children’s remittances. This was particularly important for aging parents as, despite recent efforts to introduce health insurance, India has no universal system to cover health expenses and pension for a large majority of elderly people (Ahlin, Nichter, and Pillai 2016). This sentiment of migration as a valuable part of elder care was echoed in those of emigrated children. Nurses saw migration as a way of ‘repaying the suffering’ their parents had endured to raise and educate them.26 Education represented a significant financial burden, as many families acquired loans for this purpose and became subject to interest payments. Molly, for example, said her parents “suffered a lot” by working hard, saving and obtaining loans to provide their daughters with nursing education. The three daughters therefore felt deeply indebted to them. As many other nurses I met, Molly saw it as her and her sister’s responsibility to finish their studies, succeed in migrating, and provide for their parents financially even after marriage (see also George 2005, 43).

Given great practical and emotional involvement of both parents and their children in reaching their common goal of international migration, the notion of abandonment appears inaccurate to describe what the nurses were doing in relation to their parents when they moved abroad for work. The parents were actively involved in migration by agreeing on it, but also planning and providing for it through financing their children’s education

26 This is similar to the idea of the ‘moral debt’ that children incur through the food their parents provide for them when little. This obliges the children to participate in long-term, or deferred, reciprocity whereby they are expected to provide nourishment for their parents in old age (Lamb 2000, 45–46).

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and the migration procedure. The children thus did not withdraw protection, support or help from their parents, as the term ‘to abandon’ suggests. Instead, through migration and by sending remittances, they became active carers for their parents and they provided other kinds of care, too. As I will show, an important part of this involved using ICTs.

The historical conditions that created nursing as a pathway to remittance income leads to insights about the Christian communities that were established in Kerala and that encouraged nursing, against Hindu ideologies which considered this profession polluting (George 2005, 41). For Christians, good elder care also became related to remittances (Zachariah and Irudaya Rajan 2012; Osella and Osella 2000). As Sheba Mariam George (2005, 187) noted, a “parish was able to collect money from immigrants to build a home for the elderly, which ultimately became useful for the immigrants whose parents needed such assistance.” Financial ‘giving back’ by international migrants thus became supported by the larger Christian community and gained priority over intergenerational co-residence. Thus, the postcolonial formation in which families were torn apart by international labor migration and yet held together by remittances was, and is, in Kerala aided by the Christian church. Since these remittances are partially used for elder care, whether through institutions such as the church or through supporting elder family members directly, migration in this context can be considered a form of care. Transnational Care Collective: Parents, Children, ICTs, and Others Given the framing of migration itself as a form of care, how do ICTs further contribute to shaping care relations in Indian transnational families? Globally, the increased availability of ICT devices has resulted in significant decrease of prices for telecommunication services, better infrastructures and policies aimed at improving ICT access (Kilkey and Merla 2014). Cheap phone calls have been described as “a kind of social glue connecting small-scale social formations across the globe” (Vertovec 2004, 220). But what precisely is this ‘glue’ and how does it work?

In delving into this issue, the material semiotic approach is particularly useful, since it considers technologies as active co-creators of relations with and between humans. Following the proposition that in a care collective, the object of care is not one single person but the collective itself

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(Winance 2010, 102), I suggest that the object of care in Indian transnational families is not ‘the parents,’ but ‘ICT-connected families.’ This formulation highlights that not only parents, but also children and even ICTs are involved in care relations as both care givers and care receivers. In what remains, I will explore how such ‘technological relationality’ was accomplished as a co-creation between technologies and humans in the caregiving of elderly by migrating Keralite children.

Tinkering with Various Types of ICTs

While preparing to migrate, Molly lived with her parents in Kerala, but her two married sisters were already working as nurses in the UK. The first time I visited Molly’s home, she proudly showed me her collection of four devices, two of which were simple mobile phones while the newer two were smartphones. These devices were bought by Molly’s sisters as gifts. When I asked Molly why she kept them she replied, “To show them to my nephews one day, so they will know how well my sisters took care of us!” Molly and her parents also had a laptop with a USB webcam. In their household, Molly knew best how to use this technology and establish connection on Skype. Expecting Molly to migrate soon, her mother was learning how to use Skype, but was not yet very confident in her own skills. Molly’s parents each had their own basic mobile phone. Additionally, their house was equipped with a landline phone and wireless Internet for which the family paid about 300 Rs (around 4.5 USD) monthly for unlimited use. All devices and telecommunication subscriptions were provided and paid for by the sisters living abroad. Such presence of ICTs was quite typical of the families I encountered.

Text based communication on mobile phones, for example short text messages or notes via social media, was rare between the elders and their children, and only one nurse told me that she emailed her parents once to send some legal documents (cf. Baldassar 2007). The main mode of communication was calling, as it was free or inexpensive and also the most practical for the parents. Anthony, who worked as a nurse in the UK and then Australia, described how and why he relied on cheap phone calls to call his parents:

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Figure 3. Molly’s collection of phones. Photo by the author.

It’s not that expensive to call home (to India) from Australia … (It) costs two cents (0.02 USD) per minute and the connection rate is about 29 cents (0.22 USD) per call. In the UK there was no connection charge, it was only 1 pence (0.01 USD) per minute. … I don’t use the Internet to call my parents. Sometimes I use it to call my brother and friends … who use similar apps, but my parents don’t normally use them. I don’t mind spending 2 cents per minute to speak to my parents.

Anthony additionally mentioned free online calling through “Voice over Internet Protocol” (VoIP), but pre-paid mobile phone calls were so inexpensive that he did not even consider using the VoIP. Anthony preferred to pay these small amounts to adapt to his parents’ ICT use habits.27 If he asked them to switch to any VoIP, the parents would need to acquire smartphones and skills to use them.

For nurses, the availability of ICTs depended on the country they lived in. In contrast to Western countries, several Gulf countries have banned VoIP services to protect the revenues of the national telecom operators (Aziz 2012). In Oman, Viber and Skype were prohibited, but

27 This is indicative of the economic situation of the migrant nurses and their families, which improved following migration (Percot 2014).

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these rules changed so often and unexpectedly that it was difficult to be sure which platforms were allowed at a certain moment. Most nurses who relied on VoIP to call to parents’ landline or mobile phone numbers used several of the permitted VoIP services interchangeably. For example, I observed one male nurse, Benny, use a number of apps, including MoSIP (to call his mother daily because the sound was clearer than with other apps), Facebook Messenger (“also for calling”), Talkray (“often busy”) and Viber (“currently banned”). Benny also told me that he did not use video calling with his mother as “the sound was not clear”.

Exploring the use of various ICTs reveals how care was enacted in several ways. One form of care for the collective was financial, with the children buying ICT devices and paying for all related telecommunication services. More than gifts, these ICT offerings were essential to creating the technological infrastructure that supported the transnational care collective. Moreover, people empirically tinkered with various ICT devices and software communication programs until they discovered which suited them best. In material semiotics, ‘tinkering’ is the normative and creative “process of caring by adapting to changing situations” (Pols 2012, 166; see also Winance 2010). In a polymedia environment, where a number of media coexist and are evaluated in relation to each other (Madianou and Miller 2012), flexibility and pragmatism in terms of convenience rather than cost were key for the Indian transnational families. The chosen preferences depended on parents’ skills and comfort with using particular technologies as well as on ICT availability in the children’s destination country. Through tinkering between technologies and people the families then discovered the optimal way of enacting care within their particular transnational care collectives.

Caring by Being the First to Call

Sonia and Ajay had a son, John, who worked as a nurse in Guyana, and a daughter Jasmin who studied nursing in another Indian state. When Sonia was asked about communicating with them, she replied:

We have a landline phone. So we just have to attend to it when they call us here. We don’t know how to handle the mobile phone. … Our children call us on this mobile … When we get a

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call on the mobile, I can identify the number before I take the call. The children showed me how to take and cancel a call. That is all that I know.

In this family, the children called their parents rather than the other way around, and this was common among other families I encountered. According to my informants, the children were more skilled in calling, especially when the call involved VoIP and thereby the use of devices and software programs other than a simple mobile phone. Sonia did not feel very comfortable in making calls with her mobile and was not even sure which number she should call to reach John. Some parents also mentioned that the “duty”, or work obligations, of their children were a priority, and they did not want to disturb them. By calling first, the children automatically assumed the costs, which was yet another way for them to financially support to the care collective.

The cases where the parents initiated communication were exceptional and related to specific circumstances with a sense of urgency. Aman’s parents, for example, were very anxious about their son when he first travelled to the UK. They were desperate when he failed to report himself by phone after reaching London. Instead of spending their time worrying, they decided to do something about it. Aman’s mother:

When Aman first left for the UK, it took about two weeks for him to call us. He had never stayed away from us. He was in a place he had no idea about. There was a family we knew who also had some family members in the UK. We called them and they contacted one of their relatives (in the UK) and later Aman called us. We were really destroyed. Aman also didn’t know how we felt. It was like he had left us for good …

Besides being concerned for Aman’s wellbeing, his parents alluded to feeling abandoned due to lack of contact on the part of their son. But instead of being helpless they demonstrated resourcefulness and agency by employing ICTs to locate Aman. ICTs were instrumental in assuring the parents that Aman had not abandoned them, but was only momentarily unable to

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contact them due to practical circumstances. As he told me, the effort that his parents put in connecting with him also indicated to Aman how important it was for them that he kept in touch, and he subsequently made sure to call them regularly.

What do these examples say about initiating interaction via ICTs in relation to care? Let us consider them in comparison with care provided when family members are not separated by geographic distance. Among other aspects of care, intergenerational co-residency makes it possible for children to provide their elderly parents with food. In India, preparing and sharing food with one’s parents has been described as “perhaps the most fundamental of all filial obligations” (Lamb 2000, 50), a gesture expressing reciprocity for the nurturing received in childhood. My observations of families in Kerala confirmed that eating together, even while watching television in silence, was considered essential to elderly care.28 In transnational families, intergenerational reciprocity was partially enacted through remittances, but additional attention was required from the children to dispel parents’ feelings of abandonment. In the face of the impossibility to physically prepare and share food with their parents, the children could offer their attention most effectively by calling on the phone. Thus, ICTs shaped care at a distance by making verbal communication central to it, starting with the children’s new responsibility to initiate phone calls.

Frequency of Contact and Scheduling

The children called their parents from several times a week to several times a day, while they contacted their in-laws less frequently but nevertheless regularly. The frequency and regularity of contact varied between families and between siblings, and depended on what people aimed to achieve. For example, Angela, a nurse in her 50s working in Oman, always first asked her mother about her current state of health and inquired if she needed any medicines. Then they talked about domestic animals, the neighbors’ children, other people living nearby and the church. Using ICTs to share details of everyday life was an attempt to transform geographical distance into intimacy, that feeling of closeness arising from knowing the small details of another person’s life. Put differently, as a mother of another nurse

28 See also my earlier field note on the Ayurvedic doctor’s account in which food is mentioned explicitly as a gesture of elder care.

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revealed to me, “I talk to my daughter every day on either phone or Skype, and I never feel she is far away from me.”29

The children generally planned their calls according to their own work obligations. Additionally, they took into account their family members’ personal habits. From my field notes:

Priya (middle-aged nurse in Oman) finishes her morning duty at 3pm, comes home, eats and sleeps for an hour. She starts work at 6.45am, so her family should let her rest in the afternoon … Priya’s mother watches TV from 6–8pm (Indian time), around 8–9pm her parents pray, then watch another TV serial from 9–10pm. Priya calls them after prayer, at about 8.30pm their time (there’s one and a half–hour time zone difference). Priya’s husband watches TV with his mother, then they cook and finish dinner at about 11pm (9.30pm in Oman). That’s when Priya usually speaks to him.

Instead of calling spontaneously, the nurses and their families tinkered with time to eventually develop a system of who calls whom and when. Breaking these implicit rules indicated that some kind of a problem or emergency had occurred. If Priya knew she would be unable to call on time, for example because of a change in her work schedule, she informed her parents in advance. This gave her calls a certain structure, transforming everyday interaction into a routine. Through a period of tinkering, ICT-mediated relations thus became regularized and systematized to accommodate schedules of all involved.

But spontaneous contact outside schedules also occurred, generally in the context of crisis. Jancy, a nurse living in the USA, called home every day after her night shift which was convenient given the time zone difference. Once, however, she had a sudden urge to call home in the middle of the night and she discovered her mother-in-law was not doing well:

29 Feelings of ‘being together with others’ via ICTs have been described elsewhere as “co-presence” (Baldassar et al. 2016).

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When we called (the mother-in-law’s house) we found out that she was sick … I told (our relatives) to take her to the hospital … I think she must have had a ruptured abdominal (aorta) … We were talking to (the relatives in the car), giving them instructions (and) asking ‘how is she’, but we knew she was gone by the time they reached the hospital.

This story highlights how, during times of illness and accidents, practical care was delegated to siblings or other relatives living nearby, and to institutions such as hospitals. But how did increased frequency of calling in such situations translate into care? The phone enabled Jancy to be constantly in touch with her relatives in the car, with only short pauses between calls. In this way, she was ‘travelling’ together with them without being physically in the car. Being constantly updated about what was happening, Jancy was also able to activate her professional knowledge to establish the diagnosis and, from a distance, guide her relatives in providing hands-on emergency care. Jancy was not able to save her mother-in-law’s life by phone, but given the seriousness of the old lady’s condition, it is likely that she would not have been able to help much more even if she was in Kerala. But frequent calling helped Jancy to create a feeling of her presence in Kerala even while she was physically far away, and enabled her to provide care in the form of emotional support and professional advice.

Caring for ICTs

One of the compelling insights about the care collective is that the object of care becomes dispersed among all involved, humans and technologies alike. The ICTs not only enabled family members to provide care to each other, but they also demanded care in their own right. To begin with, the families mostly used pre-paid phones which had to be regularly recharged with credit. This could be done easily at any small shop where the shopkeeper had the appropriate license. Such shops were common and usually within a short stroll from almost any house, also in rural areas. Many elderly people mentioned that they recharged their mobile phones by themselves, although women often asked their husbands to do it for them. I observed this gender difference in town shops, where typical customers recharging mobile phones were men. The process was quick and uncomplicated: the shop-

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keeper noted the phone number to be recharged in a notebook, along with the requested amount (usually for about 50–60 Rs, or less than 1 USD). The customers then received a text message confirming that recharging was successful.

What happened if ICTs were not properly taken care of? Sonia and Ajay, parents of two nurses living away from home, told me about the trouble they experienced if they neglected their mobile phone:

Ajay: We can’t call on the mobile when the balance is over. But the landline doesn’t stop working in the middle of the conversation. Sonia: With the landline, even if we fail to pay the bill on time, we can call. … (With the mobile), if there is no balance, no matter how much we try to call we can’t. Interpreter: How do you check the balance in the mobile? Ajay: That I know! The phone seller taught me. (…) Sonia: I surely get angry (if the connection breaks). Just as we are about to know about each other’s well-being, the balance in the mobile is over and the connection cut abruptly. Wouldn’t anyone get angry? (The interpreter later notes that this problem could also refer to an empty phone battery.)

Sonia and Ajay thus preferred to use the landline, which they also found better due to the clearer sound it produced. But this device, too, had its demands. As Sonia explained, “The landline phone was out of order for two or three months, because the line was broken during heavy rains, and it took a long time to repair.” The couple had to contact their telecommunication company and demand repairs several times before the issue was solved.

The care for ICTs was primarily about paying attention to their operational needs: the mobile phone must be charged with energy, the landline must have all its lines in order, and in both cases the telecommunication services have to be paid. These duties were shared between the children and the parents, with children financing the devices and related services and the parents taking care of the local practical concerns. But what motivated all of them to provide this care to ICTs? The use of and care for technologies may be motivated by various affective

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values, like forming friendly relations through and even with technologies (Pols and Moser 2009). Sonia’s comment on becoming angry if devices stopped functioning indicates that her motivation to take care of ICTs was fueled by values of strong kin relations and intergenerational, reciprocal care. Thus, through caring for technologies the parents and their children attended to the relationship between them, which was based on kin affection as well as obligations of reciprocity.

ICTs Expanding the Care Collective

The ICTs facilitated caring relations outside of the children-parent dyad, as I already mentioned when discussing situations in which parents initiated contact or required emergency care. In everyday care, ICTs that involved images, either photographs or video calls via webcams, were particularly good at expanding the care collective. To start with, the elderly, especially women, used photos and webcams to interact with their grandchildren living abroad. For this purpose, some grandmothers attended computer classes so that they could become skilful ICT users. Images were especially important for grandparents when their grandchildren were not yet speaking. One grandmother, Anna, eagerly showed me the photos of her grandson living in Canada, posted by her daughter on Facebook. Anna particularly enjoyed playing with her grandson via Facebook Messenger video chat. On one occasion, I was surprised by how deeply she became immersed in the interaction with her grandson via webcam, to the point of not noticing the humdrum of having visitors nor of the failing technology:

Anna is most interested in her grandson, not her daughter and son-in-law. She is so involved with his image on the webcam that she doesn’t even notice that Thomas (her son) assembled speakers until he takes the phone from her hand and tells her to speak without it. But the speakers don’t work well, so they return to phone for sound. I watch Anna stare intensely at the video on Facebook Messenger, holding the phone to her ear and making funny noises at her one and a half-year-old grandson. The boy doesn’t speak yet, but seems well familiar with such webcam meetings.

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Moreover, this ethnographic note points to the instrumental role of children still living with parents in tackling the operational aspects of ICTs. When the youngest children in the family were also not around anymore, helping to set up image based ICTs strengthened non-kin relations that would otherwise remain weaker. Specifically, the relation deepened between parents living alone and their “son’s good friend” who usually lived nearby. Following the sons’ departure, these friends became quite involved with the life of the parents, to the point of becoming “family friends.” This became evident also in that they stayed present during my visit:

I’m welcomed by several people: the parents, their visiting daughter, and another man, Anand. The parents describe him as a “very good friend” of their son who lives in Abu Dhabi … Anand sometimes helps them by calling their son on Skype via his smartphone. For that purpose, the father walks to Anand’s shop nearby where the Internet connection is better, but the mother can’t do that because of her injured knee.

In another family, the mother told me, “Our son who recently moved to Australia has given us the numbers of his friends who are very helpful. He told us to call them in time of need.” Thus, the sons used ICTs to care for their parents in at least three ways. First, they called home daily. Second, they provided their parents with phone numbers of their friends to deliver hands-on care if needed. Third, they arranged visual communication through their friends’ smartphones. ICTs were crucial in these practices to maintain a link between parents and their sons. Additionally, ICTs intensified the relationship between parents and non-kin by making them interact frequently and by actively involving sons’ friends in the parents-son relationship.

Image based ICTs are thus at the intersection of more relations than those between elderly parents and their migrating children. They promote social relations outside this dyad, whether virtually (as with grandchildren) or face-to-face (as with sons’ friends). As they facilitate these additional relations, they simultaneously strengthen those between parents and children and thereby make them feel connected across geographic distances.

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In this way, ICTs can mitigate feelings of abandonment and loneliness in the face of the physical absence of children from their home. Conclusion In India, intergenerational co-residence remains an optimal way to provide good elder care (Lamb 2009). My aim in this article was not to compare ICT-based and face-to-face care to evaluate which is better, nor to claim that ICTs diminish the importance of physical proximity for caring relations. Indeed, strong family relations, built throughout the years of co-residence during the children’s upbringing, form an essential foundation for care to continue, albeit re-shaped, across vast distances. But what ICTs do is to bridge geographic gaps and make people feel as if they were in the same room, racing down the same roads to the hospital, jointly taking care of technologies, and so on, even while physically apart. Thus, just as it is not possible to claim that ICTs entirely replace face-to-face care, it would also be inaccurate to state that ICT-based care practices do not mitigate feelings of abandonment among parents of emigrated children.

Although Kerala is hailed as the most progressive Indian state, socioeconomic circumstances, including lack of employment opportunities, often compel people into international migration; among young adults who have failed to migrate or to establish their life abroad suicide is rampant (Chua 2014). It is therefore little surprise that despite being aware of the negative implications of migration for co-residence, the families in my study accepted it as an unfortunate fact of life. Under these conditions, they re-interpreted migration as a care practice through which children ‘repaid the suffering’ that their parents endured to educate them as nurses. Additionally, ICTs helped shape these care practices so they made parents feel that rather than being abandoned, they were cared for better than had their children stayed at home.

But what does such ICT-mediated care look like? The material semiotic approach helps to answer this question, as it focuses on how technologies and humans can form relations with each other and jointly enact care through tinkering. In Indian transnational families of nurses, care was enacted through care collectives that were co-constituted by relations between elderly parents in Kerala, their emigrated children, other people, including grand-children and non-kin, and also ICTs. In care collectives,

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ICTs were contributing agents, shaping the kinds of caring transactions that extended across large geographic distances. While in most of the literature ICTs tend to be seen as ‘tools of communication’, the practices described here were not only about communication, just as remittances are not only about ‘sending money.’ ICTs turned communication into a concrete set of care practices, much like remittances were about sending money to effect material improvements in quality of life. To the extent that ICT use in Indian transnational families highlights how human and non-human entities may work in relation to each other and thereby enact care at a distance, we might think of these care collectives as forms of ‘technological relationality.’

The involvement of parents in the migration process additionally indicates that they were not helpless and straightforwardly abandoned by their children. This also became clear in that within the care collective, parents were care-receivers, but also care-givers to their children, grandchildren and their ICTs. The case of Indian transnational families and their ICTs thus importantly challenges our understanding of, and possibly use of the notion of, abandonment as well as leads to new questions. Perhaps we might ask how ICTs will in the future influence the discourse of abandonment itself: the norm of co-residence might become replaced by the norm of frequent calling. Perhaps that is already happening. As one of the nurses said, whenever she failed to call her parents as expected, her father would scold her, saying, “So, are you becoming like your brothers now, only calling once in a while?”

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Chapter 3 FREQUENT CALLERS “Good Care” with ICTs in Indian Transnational Families In the context of transnational family life, everyday information and communication technologies (ICTs) are key members of transnational care collectives. Through the approach of material semiotics to care as a relational practice between people and non-human entities, I explore frequent calling as one aspect of these collectives. I analyze the practice of frequent calling on phone and webcam between elderly parents living in Kerala, South India, and their adult children who work abroad as nurses. When family members are scattered around the world, frequent calling becomes a way to enact “good care” at a distance. Keywords: India, care, everydayness, frequent calling, ICTs, transnationalism This chapter has been published as: Ahlin, Tanja. 2018. “Frequent callers: ‘Good care’ with ICTs in Indian transnational families.” Medical Anthropology (online first). https://doi.org/10.1080/01459740.2018.1532424. The publication includes an abstract in Malayalam and a video abstract, accessible at https://vimeo.com/304097146. For this thesis, the text has been changed for style (font size and style, paragraph alignment) and minor editing, and I have added one photo (Figure 4).

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Introduction It was evening in a desert town in Oman, end of October 2014. I had just had my hands painted with mehendi, a brown paste of the henna plant which is used in India to draw magnificent, temporary tattoos for festivities such as marriage, or sometimes just for fun. The Indian nurse I was staying with had invited several of her co-workers over for a visit. Among them was Benny, an Indian who worked in the local hospital laboratory. He started recounting his experience of using the mobile phone to keep in touch with his mother who lived alone in the southern Indian state of Kerala. Unable to write notes, as the paint was still drying on my fingers, I struggled to memorize his account. But his story stuck with me easily, as it was quite surprising. Benny told me that when he first moved to Oman in 2007, he called his mother fifteen to twenty times a day, sometimes more than that. At that time, he was posted in an isolated small village. Later, when he relocated to Muscat and was joined by his wife, a nurse, he reduced the number of calls, but he still talked to his mother four or five times daily.

During my fieldwork, I commonly heard and observed migrating adult children in many other Indian “transnational families” (Bryceson and Vuorela 2002, 3; Lam, Yeoh, and Law 2002; Yeoh and Huang 2017) who would call their parents living in India at least once a day. Talking on the phone to their parents daily clearly “mattered” (Miller 1998) to them, but how? Ethnographers have previously described how family members from other countries, separated by geographic distance, kept in touch via information and communication technologies (ICTs) (for example Valentine 2006; Wilding 2006; Baldassar et al. 2016; Costa 2016). For example, Filipina nurses based in the United Kingdom (UK) and their children in the Philippines typically used a wide range of technologies, like text messaging, email and social media, to communicate with each other on a daily basis. This finding lead Mirca Madianou and Daniel Miller (2012) to propose the term “polymedia” to refer to the proliferating media that people used with varying effects on family relationships. In Italian transnational families, email has been described as a popular type of communication between elderly parents in Italy and their adult children in Australia (Baldassar 2008). By contrast, in the Indian transnational families that I encountered, none of the adult children used email. Rather, they used text-based forms of communication such as Smart Message Service (SMS) or the Internet-based messenger service Whatsapp with their siblings and younger extended family members (see also Baldassar 2008, 254), made daily phone calls and, in some families, webcam calls. This led me to

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wonder why my informants would call their parents so frequently and how this practice influenced their relations.

As I illustrate in this article, it became clear through my fieldwork that frequent, usually daily, phone calls and webcam was related to intergenerational care. In India, good elder care is associated with family members living together, with elderly parents ideally sharing their residence with a son and his family (Irudaya Rajan and Kumar 2003). Besides making it possible to provide hands-on care, living together is crucial among Hindus because of seva. This notion describes a complex institution of obligations that children have towards their elders, such as preparing and sharing food with their parents as a gesture of reciprocity for the nurturing they received in childhood (Lamb 2000, 50; Brijnath 2014). In transnational contexts, where family members are separated by vast geographic distances, practices demanding physical proximity are not possible. However, physical separation does not preclude all kinds of intergenerational care (for example Wilding and Baldassar 2018). As I have shown elsewhere, ICTs allow for the creation of “transnational care collectives” (Ahlin 2018b). Within transnational care collectives, ICTs provide the technological infrastructure to support caring relations among family members across distance, while at the same time they demand care for themselves. The transnational care collective has a particular dynamic in terms of the types of ICTs it included, how frequently people use ICTs to interact with each other, who contacts whom, and how ICTs help to expand the collective to other people beyond the parents-children dyad.

The notion of “transnational care collective” builds on the concept of “care collective,” which describes how people and things, such as medical technologies, may “tinker” together with the aim of enacting care (Winance 2010; Mol, Moser, and Pols 2010). This approach to care is based in science and technology studies (STS), specifically material semiotics. Material semiotics consider how people and objects mutually shape each other through their relationships which are situated in practices (Pols 2012, 17; Mol 2002, 4–6; see also Haraway 1991; Law 2009). Just as words get their specific meaning when they are put in relation to other words and the context in which they appear, so material objects such ICTs get their meaning in the specific practices in which they participate, in relation to other participating objects and people (Pols 2016, 2). The material semiotic approach allows me to explore how ICTs feature in transnational care relations as active participants rather than passive tools. Thus, instead of asking how people use ICTs, I ask how people and ICTs work together to enact care and how they are mutually shaped in the process. Further, rather than pre-conceiving care as “a thing” that can be given or received, I employ material semiotics to discover what care is by examining how

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it is “done” through particular practices. Such an approach facilitates to expose the “conflicting roles and the multivalent positions that provide local meaning” to care (Smith-Morris 2018, 5).

In this article, I explore frequent calling in detail as one aspect of transnational care collectives of migrating nurses, their parents in India and ICTs. In what follows, I first describe how frequent calling via the phone and webcam, at least once a day, is a practice of enacting “good care” in Indian transnational families. I then explore how frequent calling is associated with certain content exchanged in phone calls and webcam interactions. Scholars in migration and media studies have argued that the gesture of calling frequently may be more important for the maintenance of personal relations than the actual content of those interactions (for example Licoppe 2004; Licoppe and Smoreda 2005; Wilding 2006; Nedelcu and Wyss 2016). While my analysis, too, indicates that the gesture of calling was significant, I show that the frequency of these calls was also needed to achieve particular content. This did not focus on “sharing information” but “sharing everydayness” as a way to be present, across geographic distance, in other people’s lives as they unfolded. Methods This article is based on ethnographic data gathered among families of nurses from Kerala as one example of transnational families. In Kerala, nursing has historically been a popular profession for women, in association with religious context: most nurses come from Christian communities which recognize nursing as a virtuous service to those in need (George 2005; Nair 2012).30 Nursing has also developed into a favored migration strategy, starting some 50 years ago with the US and countries of the Middle East, followed by the UK, Ireland, Australia, and New Zealand and now worldwide (George 2005; Nair and Percot 2007; Percot 2006; Percot 2016). This trend reflects the global political economy of care work, theorized in the literature on global care chains (Walton-Roberts 2012; Hochschild 2000; Yeates 2012; Amrith 2017; Choy 2003; Parreñas 2005; Smith-Morris 2018). Among the push factors for nurses from Kerala have been very low salaries in India, especially in the private health care sector (Walton-Roberts et al. 2017). For example, a nurse may earn between 2500 and 10,000 Rs (about 36–150 USD) per month in India, while in a Gulf country such as Saudi Arabia her salary would

30 In Kerala, about 18% of the population are Christians, compared to 2.3% in India (Government of India 2011).

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be around 80,000 Rs (about 1200 USD; see also Percot 2016). Nurses are encouraged to migrate internationally as their family members and others in Kerala rely substantially on their remittances, so much so that the state is claimed to have “remittance economy” (Samuel 2011; Zachariah and Irudaya Rajan 2012). The money that the nurses send home is important to their families as one form of care that they can provide at a distance (Ahlin 2018b; see also Hoang and Yeoh 2015). Nurses generally come from lower middle-class families of small-scale farmers, shopkeepers and clerks (Johnson, Green, and Maben 2014, 12; Percot 2016), and sending remittances is appreciated as a care practice to such a degree that this may even be more important than returning to Kerala to provide hands-on care in times of health crisis (but see Ahlin 2018b, 90). This contrasts with other Indian transnational families, in which the workers abroad are professionals other than nurses, among which physical care delivered by family members in India has greater value than the money sent from abroad (Singh, Robertson, and Cabraal 2012).

While nursing used to be an exclusively female profession, the prospects of migrating as a nurse have become so alluring that even men and non-Christians have started entering nursing schools (Johnson 2018). These circumstances have given rise to transnational families, in which family members are spread across large geographic distances and maintain their relations through easily accessible and available ICTs. Transnational families of Keralite nurses provide a rich case to study the way ICTs change everyday family relations. It is, however, important to bear in mind that the nurses are both informal carers for their families and professional carers simultaneously. This limits the possibility to generalize the findings to transnational families where children abroad have other professions.

For the purposes of this study, I conducted long-term fieldwork in 2014 and 2015. I made two trips of five months in total to the South Indian state of Kerala, and two trips of three months in total to Oman, one of the countries to which nurses from Kerala migrate for work (Irudaya Rajan and Percot 2011). I carried out interviews and participant observation among 29 families, including with elderly parents in India (five families) or adult children living abroad (11 families), and in 13 other families, with both the parents and their children. In several families, I stayed at their homes from two days to two weeks. I observed family members communicating with each other via ICTs and was often asked to participate in this. I conducted interviews on phone and webcam with adult children living in the United States of America (US), the United Kingdom (UK), the Maldives, Canada and Australia. Most families belonged to various Christian denominations (25), most of them being Syrian Orthodox Christians, while four

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families were Hindus. Most nurses were women (22); in seven families they were men.

In my analysis of frequent calling, I focus on two everyday ICT devices, the (mobile) phone and the webcam, which were used most commonly among my interlocutors. However, there were differences in how people used these two technologies. Due to lack of experience with ICTs more complex than mobile phones, fewer families used a webcam, and only three of the 29 families interacted over webcam daily or several times a week. A comparison of different devices is a fruitful way to investigate the practices related to them. As Jeannette Pols (2016) argues, there is no such thing as universal “technology;” instead, there are many different technologies, each with their own characteristics. Paying attention to how particular devices are used in particular practices, and drawing on the contrasts between them, makes it possible to see what these technologies help to enact, what types of relations emerge between various human and non-human participants in these practices, who could benefit from this and what goals people work towards by using certain technologies. In other words, what is the “good” that people want to achieve by using particular technologies to communicate with each other daily? Enacting New Norms: Frequent Calling as “Good Care” at a Distance When I visited Indian elderly parents in their homes or chatted with their children about how they kept in touch with each other, the same response came up again and again: they told me that they were in touch with each other via ICTs daily. The adult children called home at least once but sometimes several times every day. For instance, Anthony, a young single nurse who had been working in the UK for three years when we first met, explained: “I speak to my parents every day on the phone. I ring them and we talk for ten to fifteen minutes or even more than that.” Anthony related this frequent practice to “care”:

I think (care) is the understanding, it’s trust, it’s not touching … it’s not giving money. It’s the understanding and the actual care, it’s a feeling that you have. It’s the trust. And love. But there are different ways to express it. Some people never express it. Some people are over-expressive even without having that much care in their mind … Well, I call my parents every time, but I don’t tell them, ‘Mommy I love you, Daddy I love you’, but I call (his emphasis) them every day. That’s a

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gesture. That’s … how I show my love. I call them every day, I speak to them, I’m well informed and they discuss everything with me, I discuss everything with them. And that’s how it is.

For Anthony, care was about mutual “trust” and “understanding” expressed through the gesture of calling rather than through words or physical contact. I have shown elsewhere how remittances were important in re-interpreting international migration of nurses from Kerala as a care practice in itself (Ahlin 2018b). But Anthony pointed out that that “money,” for him, was not the most important practice of caring for his parents. Rather, he specifically emphasized the act of frequent phone calling as a key gesture of showing his affection towards his parents and a way for him to care for them. Thus, brief, regular calls were not only significant to express basic solidarity between transnational family members (Nedelcu and Wyss 2016), but they were a practice of care and an expression of “love” and “trust” that could not be expressed verbally. Rather than expressing their feelings, the children communicated them non-verbally through the very act of calling.

The practice of calling as a form of care at a distance also became evident when it was not delivered, as parents perceived lack of calls from their children as a non-verbal expression of abandonment. In two families, the relations were so poor pre-migration that family members had no contact over ICTs after their adult children migrated abroad. In other families, where the relations were strong before migration, failure to call on the part of the children alarmed their parents and made them anxious, triggering worry about the wellbeing of their children and about how the physical distance would impact their relationship. In India, where co-residence is deemed significant to good elderly care, international migration may even connote abandonment (Lamb 2000, 2009; Krishnamoorthy 2015). To appease their worries, the parents would go to great lengths to reach the child abroad, as Aman’s mother told me:

When Aman left for the UK (for the very first time), it took about two weeks for him to call us. He had never stayed away from us. He was in a place he had no idea about. In between, there was a family whom we knew and who also had some family members in the UK. We called them and they contacted one of their relatives (in the UK) and later

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Aman called us. We were really destroyed. Aman also didn’t know how we felt. It was like he has left us for good.31

Aman’s parents felt as if he had left them for good, indicating that a lack of any interaction invoked in them feelings of abandonment. Without phone contact, they felt as if their relationship had abruptly broken. Apart from that, absence of any phone calls could mean that something unfortunate happened to their son. After Aman’s parents had invested much effort into tracking Aman down, he realized it was important to call home as this “mattered” (Miller 1998) to his parents greatly. He was not used to doing that while living in India, but after having migrated, calling became necessary as a way to communicate to his parents that he was doing well and, additionally, that he still cared about and for them. Thus, care was not expressed verbally, but was the message implicit in the act of calling itself.

Frequency of calling was entwined with regularity. Rather than calling on the spur of the moment, the children and their parents “tinkered” with calling times to accommodate for different time zones, work schedules and pastime activities. In material semiotics, “tinkering” is the normative and creative “process of caring by adapting to changing situations” (Pols 2012, 166). “Tinkering” is about attentive experimenting, trying out and making adjustments in care relations to find out which practices, situations and settings are the most suitable for all those involved in a care collective (Mol, Moser, and Pols 2010, 13; Winance 2010). Through such tinkering with ICTs, family members established when would be best to call and they began to adhere to those particular times of the day. Eventually, calling regularly became a routine which, if broken, signaled potential problems. For example, one mother admitted she was not able to sleep if any of her three daughters, all nurses working in different continents, failed to call every evening. Sitting in her living room, she pointed to the clock above the TV set and said that she waited for each of her daughters to call at a particular hour which correlated well with the time zones and work schedules of her daughters’ various locations. In another family, Celia, a middle-aged nurse living in Oman by herself, told me:

If I don’t call for two or three days, even if it is because of my work schedule, then my father would say, ‘Ha, are you also becoming like your brothers? Have you changed your mind, you are only calling us

31 The quote is a slight adaptation of a quote which also appears in chapter 2 (Ahlin 2018b).

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weekly now?’ (laughs) He will ask like that, and then I will know he is feeling … sad that I’m not calling. That’s why (he’s jokingly complaining).

Throughout the years of her working in Oman, and through daily tinkering, Celia and her family in India had established a schedule according to each other’s timetables, habits and different time zones. Celia made sure to always inform her parents in advance about the changes in her work schedule that would affect her calling time: “If I’m busy at work, I can’t call, so they know (that I’m on duty). I tell them in advance.” When parents were not informed about such changes in the routine, this raised alarm as they thought of the only other possible explanation, an emergency situation. In case neither of these two options were true, they might start fearing that the children were withdrawing their care. Lack of calls could indicate that the caring relation was endangered, as Celia’s father’s statement, camouflaged in jest, demonstrates.

Besides finding the most appropriate time to call, nurses also had to tinker with choosing the most appropriate type of ICT, especially when they used Internet-based calling services. This was tied to the geo-political localities that dictated which ICTs were allowed at a given moment. In the Gulf, several countries have banned Internet-based calling services to protect the revenues of the national telecom operators (Aziz 2012). In Oman, Viber and Skype were banned at the time of my fieldwork. Nevertheless, nurses were able to switch between a number of Internet-based platforms. For example, Benny switched constantly between a number of available apps, including Rounds, Imo, MoSIP, Facebook Messanger, Talkray and MyPeople. Some of these allowed for video calls, but he did not use that option because it affected the quality of the call. When I started noting down the app names, Benny suddenly became nervous. He worried that any of these apps might have become illegal and he was afraid that talking to me about his app use would cause him trouble. This encounter shed light onto the unpredictability of telecommunication regulations in the country and on the related feelings of uneasiness and anxiety for ICT users. Yet, stringent ICT restrictions did not completely obstruct communication, not even video calls; rather, they made the nurses tinker with the legally sanctioned ICTs to find which media suited them best.

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Figure 4. The elderly in Kerala commonly used simple mobile phones. Photo by author.

Through daily tinkering with various calling applications and working around time zones and work schedules, people and ICTs worked collectively to enact care at a distance. In this way, ICT devices helped to shape what good care was. Frequent calling was thus more than soothing parents’ worries as it became a new norm of intergenerational care. To represent “good care” it was not sufficient to call home sometimes – this had to be done frequently. On the other hand, lack of contact was associated with abandonment. One mother who had no contact with her daughter, a nurse in Bahrain, was living in a shelter for elderly people and was deeply saddened by her daughter not being in touch with her. In India, letting one’s parents live in a shelter is considered neglectful (Lamb 2000; 2009), but for this woman, the abandonment was exacerbated by the lack of phone calls from her daughter. Not calling frequently came to be interpreted as a non-verbal expression of poor care and even a new way of “doing” neglect and abandonment. Mundane Matters: Keeping Track of Everydayness My informants told me that their phone interactions would last from several seconds to about an hour, and I was also able to observe that the more frequent their calls, the shorter they were. Migration and media scholars have argued that in transnational families, the gesture of calling is key for family relations and it was

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even more important than the content of the daily conversations which revolve around “insignificant” details of everyday life (Licoppe 2004; Wilding 2006; Licoppe and Smoreda 2005). For example, Raelene Wilding (2006, 132) found the content of such exchanges “meaningless” and “prosaic,” and suggested that “more significant than what is said in these exchanges is the moment of exchange itself.” But why would people talk about “trivial” things every day, sometimes for hours?

In what follows, I describe what the Indian families in my study discussed when they were conversing on the phone or webcam daily, and show how this is crucial to understanding these practices as care practices. Among my informants, frequent calling was about sharing two kinds of content. I first investigate how family members participated in each other’s life via ICTs by sharing details of everyday activities. I then explore how children, through frequent calling and sharing of everyday matters, kept an eye on their parents’ health.

“Sharing Everydayness” on the Phone

In the families that I encountered, the content of daily phone conversations revolved around mundane details of day-to-day life. Angela, a middle-aged nurse working in Oman, told me that whenever she called her mother, she first asked her how she was and if she needed anything, specifically any medicine for her hypertension. She then inquired about the animals her mother had – the goat, one dog and two cats – and then about the neighbors’ children, other people living nearby and the church, so she was “well informed” about what was happening with her mother and her home community. Beyond monitoring health, the goal of Angela’s frequent phone calls was not to inquire about something specific, or exchange information on something particular, but to participate in her mother’s life through inquiring about the mundane details.

Such frequent calls were not always easy. Detailed phone accounts of the everyday life could also become a source of tension, leading to situations that were uncomfortable for the conversation partners. Mathew, a young nurse working in Australia, increased the number of calls home significantly after migrating abroad. When he lived in another Indian state during his nursing studies, he “only called his parents when he had to ask them for money,” as one of Mathew’s friends half-jokingly said. Because of the intensification of contact post-migration, Mathew and his mother encountered problems regarding what to discuss. As Mathew’s mother said:

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We are sad (about Mathew being in Australia). But since he calls us every day, we don’t miss him that much. He informs us of everything. He keeps telling us, “Say something, say … What news is there?” What is there to talk so much every day? We say the same thing again and again. (We usually talk) between 15 and 20 minutes. What is there to talk every day? Because he calls every day. So he asks about the plants, the domestic animals, neighbors and so on.

Mathew’s mother looked weary when she recounted her experience of these frequent calls, as she spoke of struggling with frequent phone interaction when she exhausted the repertoire of news she deemed important to share. Nevertheless, she did not cut the conversation short, but resorted to talking about domestic animals and plants. This was not the kind of topic she would normally address with her son, yet she did not end the call. Instead, she filled the time with mundane, even “trivial” small talk. In this way, both Mathew and his mother adjusted to the new context in which their relation was taking place, across two continents connected by ICTs. For Mathew’s mother, this was also a way to take care of Mathew and reduce his homesickness, enabling him to remain a part of the domestic realm even while he was physically far away. This brings to light how care within the transnational care collective was not unidirectional, but dispersed among all members.

While the content of these interactions may seem inconsequential at first glance, the daily exchange of details on the phone was a way for transnational family members to create and maintain a kind of “shared everydayness” at a distance. This demanded much work, such as tinkering to find the most appropriate time and type of ICT, maintaining regularity of calling and finding ways to keep the conversation going. Yet, none among my informants complained, even indirectly, about calling their parents daily as representing any sort of financial, practical or emotional burden. They had accepted frequent calling as their new “duty” (Bomhoff 2011, 131–132). The labor involved in this practice shows that “everydayness” did not happen by itself, but that people had to work together with technologies to actively construct it.

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Informal “Telecare” on the Phone32

As Anthony explained, daily calling provided an opportunity for him to be “well informed” and to “discuss everything” with his parents. This included health issues. According to my informants, health was one of the first topics they discussed. An example comes from Lucy and her parents. Lucy was a nurse, living in the US with her family for the past eight years. She called her parents on the phone every day before and after coming from her night shift. Lucy was particularly attuned to her parents’ health, as her father was suffering from Parkinson’s disease. When Lucy’s mother had suffered a heart attack a couple of years earlier, Lucy made an exceptional trip to Kerala for five weeks to provide her with hands-on care, including physiotherapy. Otherwise, Lucy provided care to her parents at a distance:

I call them every morning and every night. Every day, first I call my mom, and before I go for work (in the evening) I call them, because the twelve-hour difference is perfect for my call. … I ask them “Morning, how is dad, where is he sitting?” So I know if he is sitting, where he is sitting and what he is saying, I know his mood … I will ask my mom, like, is there any sign of skin infection (on her father’s leg), like any temperature? Is he ok moving the lower leg? How is the temperature? What is the color? I always ask my mom all this stuff. Then I ask mom about the site of the wound. How often is it getting worse? Then I have a picture, oh, that is that. Ok. It’s that same chronic condition. … Today also my mom was saying my dad has some skin problem on his lower legs and I told her, “Give him some massage so he will have more circulation to that part. That’s all, don’t take him to any hospital, they will put him there and he will get lots of antibiotics and I don’t want him to go for that.” I always direct them to do this, do that. … I always ask (my parents) to do this (kind of) blood test, (then ask) what is the report, and I direct them. I don’t want them to go for aggressive medical management, they are in their 80s or 70s, that doesn’t make any sense to me. I just want them to be comfortable.

32 “Telecare” refers to “the technical devices and professional practices applied in “care at a distance”, care that supports chronically ill people living at home” (Pols 2012, 11).

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I know my father very well … I know each word that is going to come out of his mouth, when it means something. And I know what is going on between them (original emphasis). That’s the way this is working out here, otherwise it (would) not.

Lucy’s mother took care of her father practically, while Lucy was continuously involved in this process through her daily calls. Through daily updates about the smallest detail about her father’s state, gained explicitly through her mother’s descriptions or implicitly through nuances of his voice and words, Lucy continuously monitored his chronic illness (for the way family members “read” voice on the phone, see also Baldassar 2008, 254). She used her professional knowledge as well as the intimate familiarity she had with her parents. In this way, she was able to “set a diagnosis” at a distance. Lucy thus used her multi-layered knowledge of her parents’ situation, including about their health histories, personalities and the relation between them, to “direct” them in treatment.

Why was it important for Lucy to call home so frequently? As she explained, this was a way for her to be “always there for them,” “to find out what is the problem with them” and then to “call others around them” in case her parents needed any kind of help. Through daily calls, Lucy signaled to her parents that her caring “attitude” continued despite geographic distance. In this way, Lucy maintained her parents’ trust, which she deemed most important in ensuring that they follow the health-related advice she provided on the phone: “It is main thing, first thing is they must trust you to do what you are telling them to do.” She contrasted her situation with that of her younger sister, a nurse working in a Gulf county. Lucy’s parents told me that they talked to their other nurse daughter only once a week, and Lucy had an impression they did not take her sister’s health advice as seriously as they took hers.

Lucy’s example serves to illustrate how, in the practice of frequent calling, care may be simultaneously enacted as a gesture and through the content that is shared during these calls. Daily calls thus influenced care on several levels: by calling frequently, Lucy not only re-assured her parents that she had not abandoned them, but she also practiced pragmatic care at a distance. This included close monitoring of their health and well-being, and fostering the trust needed for the parents to follow her advice on treatment. The care for Lucy’s father’s chronic ailment was thus shaped within the care

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collective through frequent calls. Care took place not only in their local geographic world, but extended into a transnational space.

Enacting Everydayness: “Spending Time Together” on Webcam

“Being together” face-to-face involves not only speaking, but sometimes also being silent. However, silence as a type of non-verbal communication may be problematic on the phone which was designed specifically for verbal communication. As Ann Goelitz (2003) found in her study of telephone support for family caregivers, silence on the phone can be “hard” because it is impossible to see what the other person is doing. It is difficult to interpret: something might be wrong with the technological connection, or with the relation between the conversation partners. To overcome this issue, Mathew and his mother turned their conversation into detailed descriptions of daily life, a strategy used not only to share “what news is there” but also to fill silence and to “be together” at a distance. If silence as an ingredient of “being together” is problematic on the phone because people cannot see each other, what happens when image is added to sound, as it is the case with the webcam? I explore this question in the examples that follow. To start with, frequent calls on the webcam helped some families to alleviate homesickness and loneliness of the adult children working abroad. This mattered especially to those nurses who worked in harsh conditions. For example, Joy was a young, unmarried nurse who was spending her second year working in Saudi Arabia. She kept in touch with her mother daily, using the landline phone, mobile phone and Skype interchangeably. Joy favored Skype. She explained that her mother sometimes made a dish and showed it to her on the webcam. Talking on Skype, she added, had a “good impact on (her) wellbeing” when she was missing her home and had a hard time being so far away. I asked her if she felt sad not to be able to share the meal with her family, to touch, taste and smell it. But Joy replied, “No, it makes me feel soooo happy! Just to see, it’s enough!” Frequent calling thus had another purpose than elder care – the adult children abroad used this practice as a form of self-care.

Although the children did the actual calling, receiving their calls was an opportunity for the parents to practice care for their children. For instance, Joy’s mother explained that frequently seeing her daughter on Skype was a way for her to continuously monitor Joy’s health and wellbeing. Through the webcam, she closely inspected her physical appearance: “Does she look thin? Does she look pale? Is she eating enough? Is she smiling enough? Or is her face sad and worried?” Tracing changes in her daughter’s mood and appearance through their

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frequent webcam interactions was important as it allowed her to notice any trouble quickly and immediately offer emotional support and encouragement. For Joy’s mother, this mattered especially because she was well aware of the poor living conditions that unmarried Christian women like Joy experienced in a largely Muslim Saudi Arabia. Due to religious tensions, Indian nurses have described this country as a “jail” (Percot 2006, 23), which made Saudi Arabia the very last on nurses’ destination country “wish list”. But the webcam enabled Joy’s mother to mitigate Joy’s feelings of loneliness and homesickness by “spending time together” at their home in Kerala, for example while preparing dinner.

The effect of the image was also transformed through frequency in a paradoxical way. The materiality of the webcam “afforded” (Fisher 2004; Costa 2018) its users a different way to relate to each other than the phone. With daily use of the webcam, the significance of image as something that is meaningful because it is visible faded away as the family members concentrated on “being together” without words and even without looking at each other. For example, Mary was a nurse in her early 20s, living with her parents in Kerala and preparing for migration while her two elder sisters lived with their own families in London where they worked as nurses. When visiting Mary’s home, I noted the following experience of webcam interaction. It took place just after Mary’s middle sister, Susan, who was nine months pregnant, finished her checkup in the hospital and was driving home with her husband and their toddler son:

Susan calls home to Kerala through Skype on her mobile phone. At first she’s pointing the phone to her face, so that we’re looking at her directly, but the picture is very blurry and she doesn’t seem to be very interested in our picture. She’s not very talkative, she’s looking tired or maybe concerned. … She is holding the phone on her left-hand side, below, as if having it on her left knee. She’s not looking at the picture at all, we see her face from below as she’s looking on the road. She says all was well in the hospital. … Then there is some silence. I find the following several moments quite magical – it’s as if we are all sitting in the same car, looking out the same grey sky somewhere (where?) above London. The conversation is not taking place all the time, there are silences, just as if we were all in the same car. There’s no real focus, nothing much to do, we’re just all taking the drive back home.

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While Susan and her family were sitting in their car, on the other end of the webcam Mary and I sat in the chairs at the table while the parents sat on the bed. After exchanging the most important piece of information – Susan’s checkup, all of us were quiet for most of the time, staring at the laptop in front of us. This interaction, full of interruptions and silences, was nevertheless about ten minutes long. During this time, no specific information was exchanged, we were all just “travelling together” for a while. In contrast to the phone, silence was not problematic as it did not signal a break in communication; at any moment, everyone could see what was happening on the other side of the webcam. But this example also shows that the webcam did more than enabled being silent together. While the webcam made seeing other people possible, it was not necessary anymore to be looking at them continuously. In this way, the webcam enabled “spending time together” that was different from an interaction focused around a conversation, as was the case with the phone.

The way transnational families were “spending time together” on the webcam differed from a Skype interaction set up as a meeting with the goal to talk about a specific topic. For example, Jeannette Pols (2012, 102) described the use of webcam in health care where nurses, in that context acting as professional carers, used the webcam to monitor patients with chronic lung disease at their homes. In that case, the conversation partners sat in front of their computers and gazed at the screens, careful not to move out of the camera frame. Using the webcam in this way created a meeting-like experience, with the specific purpose of sharing health information. By contrast, Mary’s family members called each other on the webcam every day and did not follow any sort of formality characteristic of Skype meetings in which the date, time and topic were predetermined. However, frequency was not the only factor in fostering “spending time together” on webcam; familiarity was important, too, as the relationship between parents and children are underpinned by personal affect and attachment differently than personal relationships. Finally, in Indian transnational families, care was not a unilineal process, but an intersubjective one: beyond children providing health care to their elderly parents, the latter were also concerned with the wellbeing of their children abroad. “Spending time together” on the webcam allowed the parents to alleviate their children’s feelings of loneliness and homesickness in harsh foreign environments.

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Conclusion Through a material semiotic analysis of frequent calling, I have shown how care is a relational process, which includes not only people, but also non-human entities such as everyday ICTs. Together, adult children, elderly parents and ICTs formed transnational care collectives in which people adjusted, tinkered and negotiated what “good care” at a distance could be and how it should be done. My aim was to describe how intergenerational care at a distance may be practiced with ICTs, and Keralite nurse families represented an excellent example to learn from about this topic. For these families, commonly of lower economic class pre-migration, increasing their socioeconomic status through work and savings was significant. This influenced their decisions about expenditure and taking leave from work, including limiting visits to Kerala to once a year. Since family members were scattered across the world, care practices demanding physical proximity, while still considered important, became impossible to follow. In this situation, the parents and their children tinkered with ICTs to discover how these technologies could help them establish new forms of intergenerational care that could indeed be practiced across vast geographic distances. Thus, when doing “good care” in transnational care collectives, the emphasis moved from practices that required being together physically, such as sharing residence and food, to practices that included ICTs, such as frequent calling.

Expressions like “keeping in touch” and “staying in contact” (Baldassar 2008; Baldassar et al. 2016) emphasize the importance of the gesture of calling for family relationships to continue across continents. Similarly, STS scholar Judy Wajcman (2015, 149) noted that “the call or text itself may be constitutive of the relationship.” In the Indian families that I studied, daily calling meant “I call, and through this I do care.” Further, the gesture of frequent calling became a way of non-verbal communication. In this way, people expressed their feelings of love and trust, but also worries, loneliness and fear of being abandoned. Care became enacted through everyday actions such as making calls, taking calls, coordinating time zones, being silent together and talking about or showing faces, food and ferns on the webcam. People built on them to connect and maintain caring relations at a distance, while simultaneously embedded in their various physical environments.

Beyond the gesture, frequent calls were needed to convey a particular content that people exchanged through them, in which the goal was not to “share information.” Rather, ‘“sharing everydayness” on the phone and “spending time together” on the webcam were two practices which highlighted what kind of care

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people were trying to achieve through frequent ICT contact. On the phone, talking daily about mundane matters was a way to solve a specific problem: achieving the goal of “sharing everydayness” when only words, and no visual cues, can be used for communication. The notion of “sharing everydayness on the phone” thus considers phone conversations about everyday details as far from trivial (cf. Licoppe 2004; Wilding 2006); rather, talking about the weather, domestic plants, animals, neighbors, their children and the church congregations was significant precisely because these things were ordinary—people organized their lives around them. Furthermore, the intimacy that was fostered through sharing everydayness allowed for the tracking of small changes in people’s well-being and health. In this way, children, who were also nurses, combined their professional knowledge with their intimate familiarity of their parents’ quotidian life, health histories and personalities to monitor chronic illness at a distance. Conversely, parents monitored their children’s wellbeing and happiness by closely inspecting their appearance via the webcam. Actively constructing everydayness by sharing detailed accounts of the quotidian via ICTs enabled people to share a life even when sharing residence was not an option.

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Chapter 4 SHIFTING DUTIES Becoming ‘Good Daughters’ through Elder Care Practices in Transnational Families from Kerala, India This article investigates the influence of international migration on the filial norms of elder care in transnational families of Syrian Christian nurses from Kerala, South India. We suggest that exploring transnational elder care practices brings to light complex changes in gender dynamics within kin relations. Using the material semiotic approach, we analyze care in terms of everyday practices in which not just people, but also technologies are involved as active participants. We argue that as they are tied to international migration, money and information and communication technologies (ICTs) co-shape new norms of filial care by transforming the normative expectations of ‘good daughters’. This article reveals how among Keralite transnational nurse families, ‘good daughters’ may increase their bargaining power with their in-laws, specifically in relation to caring for their own parents, and how this may also influence the position of men as husbands and sons-in-law.

Keywords: gender, migration, care, remittances, ICTs, India

This chapter has been published as: Ahlin, Tanja, and Kasturi Sen. 2019. “Shifting duties: Enacting 'good daughters' through elder care practices in transnational families from Kerala, South India.” Gender, Place and Culture (online first). doi:10.1080/0966369X.2019.1681368 For this thesis, the text has been changed for text style (font size and style, paragraph alignment) and minor editing, and I added one photo (Figure 5).

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Introduction In Kerala, South India, it has historically been popular for women, especially Syrian Christian women, to become nurses in order to migrate abroad for work and thereby improve their and their families’ economic status (Nair 2012; Percot 2016). International migration may influence gender roles in the family, as female nurses become breadwinners while their husbands may struggle to find well-paid employment (George 2005; Gallo 2005; Percot 2012; Bhalla 2008). For example, Sheeba George (2005, 151) describes how in the Indian diaspora in the United States of America (US), men who married nurses were called ‘nurse-husbands’, a derogatory term indicating their economic dependence on their wives. While women’s mobility may be limited by patriarchal institutions (Porter 2011; see also Gallo 2018), feminist geographers have shown that increased possibilities for mobility may not necessarily empower women, just as immobility may not necessarily disempower them (Hanson 2010, 10; Huang and Yeoh 1996). In pursuit of a more nuanced understanding of mobility, we suggest that examining kinship beyond the husband-wife relationship, specifically by looking at elder care practices, illuminates new layers of complexity in gender dynamics and further reveals the multifaceted impact of migration on female empowerment.

By investigating elder care in transnational families of Keralite nurses we show how these nurses “straddle the multiple places of being ‘here’ and ‘there’ simultaneously, and how this informs the emancipatory and constraining nature of gendered migrant spatialities” (Yeoh and Ramdas 2014, 1198). We have found in our fieldwork that the involvement of remittances and information and communication technologies (ICTs) in care at a distance contributed to particular transnational family dynamics whereby women became primary carers for their own parents. Women focusing their care efforts on their own parents is a significant change from conventional elder care practices in India. According to those, married sons should, and often do, co-reside with their parents and provide for them financially; their wives assume hands-on care for their parents-in-law but are not obliged to care for their own parents. Although there are regional, socioeconomic, and religious differences, about 80 percent of people aged above sixty live with their married sons (Irudaya Rajan and Kumar 2003; Kadoya and Yin 2015; see also Dharmalingam 1994). Scholars have even suggested that the normative ideal of son co-residence partially explains son preference, leading to skewed sex ratios, especially in North India (Kadoya and Khan 2016, Das Gupta et al. 2003). With that in mind, we argue that international migration, as it is tied to money and ICTs, has changed what it is to be a ‘good daughter’ in Keralite Syrian

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Christian families, a transformation that can be observed through elder care practices.

Our study speaks to feminist geographers’ scholarship on localizing and contextualizing care and care relationships across space (see for example Yeoh and Ramdas 2014; Milligan and Willes 2010; Parr 2003). But while feminist geographers have explored care in terms of care giving, receiving, and circulating (Wiles 2011; de Silva 2018), we use the material semiotics approach from science and technology studies (STS). Material semiotics is the study of how human and non-human actors form relations with each other, how their identity is mutually shaped, and what they enact within specific practices (Mol 2002; Pols 2012; Law 2009). Approaching care as something that people, money, and technologies enact in practice allows us to explore ‘the good’ in filial care not in terms of judgments, but in terms of “something to do, in practice, as care goes on” (Mol, Moser, and Pols 2010, 13). Thus, we propose the term ‘good daughters’ to describe those daughters who fulfil certain filial duties that they and their family members consider to be practices of good elder care. As we will demonstrate, these duties include migrating abroad, sending remittances, and visiting and calling frequently. The material semiotic focus on practices thus also underpins our understanding of what is considered ‘good’ in terms of “practical accomplishments” rather than in terms of consistent external ideals or norms to which people try to align themselves (Winance 2007, 631). As something that people try to achieve in practice, ‘the good’ is locally situated, based on constant work, and subject to potential transformation (Winance 2007).

Material semiotics is especially relevant for our analysis because it describes relations as “materially and discursively heterogeneous” (Law 2009, 141), thus including people as well as objects. In this way, material semiotics allows us to explore the active role of money and ICTs in shaping what care is and who ‘good daughters’ are in the context of transnational families. With this approach, Tanja Ahlin (2018b) elsewhere describes how Keralite family members and ICTs work together to enact care in ‘transnational care collectives.’ By supporting the formation of these collectives, ICTs shape intergenerational care at a distance. Here, we explore in depth one aspect of transnational care collectives by investigating how care practices shape filial norms for daughters in Syrian Christian families of nurses.

We further deepen our analysis with Bina Agarwal’s (1997) theory of gender relations and bargaining power. ‘Bargaining power’ refers to the ability of people to negotiate with their family members about subsistence needs such as food and health care. A complex range of factors shapes bargaining power (Agarwal 1997,

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8–9); here, we draw particularly on the factors of the access to kinship as a support system and of social norms guiding elder care. Migration may entail important shifts in the kind and amount of resources available to men and women, which serve as a means for negotiation (Kibria 1990). We show that international migration helped women in our study improve their bargaining power, giving them a way to negotiate with their in-laws about care they provide to their own parents. Methods We base our analysis on eight months of ethnographic fieldwork in total, divided between Kerala and Oman, which Ahlin conducted in 2014 and 2015. Ahlin recruited the nurses who participated in this research through locally well-known and respected key informants, including two doctors and two teachers at an English language school in Kerala. At this school, nurses prepared for the International English Language Testing System (IELTS), an exam required to migrate to English-speaking countries. With these nurses, Ahlin carried out group and individual interviews, and some of them introduced her to their parents. Through the key informants, Ahlin also approached elderly people whose children were already working abroad. She followed some of these family relations to Oman, where she asked them to introduce her to other nurses (the ‘snowball method’).

In this way, Ahlin carried out participant observation and in-depth interviews with members of twenty-nine families in both countries. She observed them communicate with each other by phone and webcam, and the families she visited often asked her to participate in these events. She also conducted some interviews by phone and webcam with nurses living in countries other than Oman, for example in the US, United Kingdom (UK), and Australia (Ahlin and Li, forthcoming). Twenty-three of the families belonged to various factions of the Syrian Christian church, two families were Roman Catholic, and four were Hindu. In twenty-two families, the nurses were women and in seven they were men. The nurses were between twenty and fifty years old, while their parents were between fifty and eighty years old.

With the nurses, Ahlin conversed in English, while she conducted most of the interviews with their parents in Malayalam through an interpreter who also transcribed and translated the recorded conversations. This language barrier formed a certain limitation for this study, as Ahlin was not able to personally follow the conversations between family members. While it is possible that relying

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on transcripts did not allow Ahlin to capture all the nuances of the family relationships, she did validate the information about these relationships in separate interviews with children and their parents.

In what follows, we first describe the position of Syrian Christian female nurses in Kerala and within ‘global care chains’ (Hochschild 2000; Yeates 2012). We start the analytical section by describing how female nurses became ‘good daughters’ by migrating internationally. We then show how migration impacted women’s bargaining power with their in-laws, a change which they enacted within care practices for their own parents together with money and ICTs. Syrian Christian Women in Kerala and within Global Care Chains The position of Syrian Christian female nurses from Kerala is unique in several ways. Numbering about six million, Syrian Christians are a demographic minority in India, yet they have been described as privileged in terms of caste, race, and class (Thomas 2018). The first converts to Syrian Christianism were Brahmins, members of the highest caste according to Hinduism, and this historic detail still permits contemporary Syrian Christians to claim belonging to the upper caste of Indian society (Thomas 2018, 5). Moreover, despite some class variation, Syrian Christians have secured a middle-class status through their entrepreneurial skills and landownership (Thomas 2018, 6). This context has shaped the position of Syrian Christian women, who thus belong to the “dominant minority” of those with an upper-caste/middle-class background while also being marginalized as women in a patriarchal society (Thomas 2018, 6).

Syrian Christians follow patrilineal kinship, which is another specificity, as in Kerala matriliny is historically rooted (Philips 2004; Dyson and Moore 1983). Importantly, matriliny is not to be equated with matriarchy; as Robin Jeffrey (2004, 648) notes in her description of matriliny in Kerala during the twentieth century, “Though the families were based on mother’s homes and organized through the female line, the controllers and decision makers were men.” Although authorities in Kerala legally abolished the matrilineal system in the nineteenth century, a “matrilineal ethos” remains widespread (de Jong 2011, 17). This context has empowered Syrian Christian women to challenge the patriarchy in some ways; they have, for example, achieved equal legal inheritance for daughters and sons. Yet in practice, women tend to waive inheritance claims on property out of loyalty to their male relatives (Philips 2003; Bomhoff 2011: 142–144; see also Singh, Robertson, and Cabraal 2012, 483; Chacko 2003). Among Syrian Christians,

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patriarchy thus remains powerful, as families, legal institutions, and the church continue to sustain and reinforce it. Described even as “aggressive” (Jeffrey 2004, 649), the patriarchal kinship structures continue to constrain Syrian Christian women in terms of inheritance, movement, communication, and choice of occupation (Philips 2003).

Finally, Syrian Christian women of Kerala are distinguished by the fact that many become nurses (Nair 2012; Percot 2016). According to Elisabeth Simon (2009, 88), only 3 percent of the Indian population is Christian and yet 30 percent of Indian nurses have this religious background. The first generations of nursing students came from a lower-class background and aspired to use this profession to escape poverty, but they struggled with the poor reputation of nursing as constructed through local hierarchies of caste and class. In Hinduism, work related to bodies is perceived as ‘dirty’ and those who professionally handle bodies and bodily waste as ‘unclean’ (Ray and Qayum 2009). The detrimental impact of caste on the status of nursing diminished, however, through the association of this profession with Christianity. English Christian missionaries, who began recruiting women to attend nursing schools in the twentieth century, actively encouraged the perception of nursing as a service to God and thus a highly noble profession (George 2005, 41).

With time, it transpired that nursing offered excellent opportunities for international migration and as such it became a strategy to improve a family’s status in terms of class (Nair and Healey 2006). Since the 1960s, global socioeconomic forces have pulled Keralite nurses to migrate abroad for work. With the support of the Syrian Christian Church, foreign governments have recruited nurses as labor force to the US (George 2005), the Gulf countries (Percot 2006, 2014; Percot and Irudaya Rajan 2007), the countries of the European Union (Percot 2012; Gallo 2005), and elsewhere. The phenomenon of migrating Kerala nurses can be described as ‘global care chains,’ a notion referring to “a series of personal links between people across the globe based on the paid or unpaid work of caring” (Hochschild 2000, 131). This theory highlights globally structured inequalities of class, race, ethnicity, and gender that encourage the movements of (non)professional carers from economically poorer countries in the global South and East towards wealthier countries in the North and West. As an origin country, Kerala fits this model well. Internal and international migration, common among Indians of all socioeconomic and religious backgrounds (see, for example, Lamb 2009; Bomhoff 2011; Bailey, Hallard, and James 2018; Voigt-Graf 2005), may interfere with caste, class, and gender hierarchies as well as with kin relations in various ways (see, for example, Gallo 2018). In Kerala, nursing has proven to be

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such an effective strategy for moving upward socioeconomically that this profession has even started to attract men and Hindus (Walton-Roberts 2012; Johnson, Green, and Maben 2014).

The global care chains theory assumes that those who migrate leave behind family members who would otherwise rely on these migrants for care (Yeoh and Huang 2017; Parreñas 2001; but see Baldassar and Merla 2014). In Keralite families of migrating nurses, elder care practices become differently complicated by international migration. Among those in India who follow the patrilineal kinship system, such as Syrian Christians, the main duty of a ‘good daughter’ is to marry and to do so as early as possible (Percot and Irudaya Rajan 2007). After marriage, daughters start belonging to their in-laws’ family and should provide care for their parents-in-law; simultaneously, they are discharged from care obligations towards their own parents. This is reflected in the norm of parents co-residing with their sons, while it is considered inappropriate for parents to live with their daughters (Bailey, Hallad, and James 2018, 8; Bomhoff 2011, 203; Gallo 2005, 230; see also Lamb 2000). However, as we show in the continuation, how ‘good daughters’ are enacted through elder care is not static, but a process that may be reshaped through international migration; in the process of this transformation, money and ICTs play key roles. Cross-border Investments: International Migration as a Duty To understand how migrating abroad could become an integral part of being a ‘good daughter’ in Syrian Christian nurse families, it is important to recognize the involvement of parents in the migration process. In our study, parents steered their daughters towards nursing from a young age. Indeed, families saw this particular choice of profession as the first step in migration (see also Nair 2012; Percot 2016; Nair and Percot 2007). In one family, the parents encouraged all three daughters to become nurses and migrate. Their endeavor was successful: at the time of our fieldwork, the eldest two daughters had settled in the UK while the youngest one, Mary, was preparing to follow them.33 Mary’s mother was especially engaged with her daughters’ careers and migration pathways. For instance, during one visit to Mary’s home, her mother questioned Ahlin on various European countries and their need for foreign nurses. She was particularly interested in Switzerland, adding that she had heard that nurses’ wages were higher there, so she was wondering whether it might be a good destination for Mary. Thus, although nurses had their

33 All personal names are pseudonyms.

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own individual motivations to pursue nursing, such as gaining professional and personal experience (Percot 2016), international migration was a “family project” (George 2005, 43; Percot and Irudaya Rajan 2007).

Parents were heavily involved financially in the entire project of their daughters’ becoming ‘successful nurses’ who could earn well abroad (see also Gallo 2005, 229). This included financing their education, first in nursing and then in the English language. The cost of a nursing education has risen in recent years, with average tuition fees reaching 70,000 to 100,000 Indian rupees (Rs), or approximately 1500 to 2100 USD per year (Johnson, Green, and Maben 2014, 12).34 Due to high college fees, families could thoroughly deplete their savings. In such a situation, parents took loans from banks, relatives or acquaintances (Osella and Osella 2008, 156–160; Percot 2016). One family in our study borrowed money for this purpose from their wealthier neighbors; other nurses regularly mentioned that their families took education loans which came with steep interest rates. Furthermore, parents financed the migration process, which was also a costly and lengthy endeavor. To migrate into English-speaking countries, the nurses had to pass the IELTS exam. Fees for language classes and the exam meant additional costs. Finally, the expenses of obtaining visas, travelling, and perhaps engaging a migration agency would add another 100,000 to 200,000 Rs (1,400–2,800 USD) to the bill, according to our informants.

For lower-middle-class families of small-scale farmers, shopkeepers, and clerks, from which the nurses usually originated (Johnson, Green, and Maben 2014, 12), the financial burden of supporting their daughters to migrate was considerable. The nurses and their parents both described borrowing money, working hard to generate savings, engaging nurses’ siblings to help financially, and even selling property as acts of great “sacrifice” on the part of parents. The nurses in our study regularly reported that their parents “struggled” and “suffered a lot” to support their migration. “Suffering” was thus a way of ‘doing’ sociality, since it “created a strong sense of belonging to specifically those persons who were the greatest source of the suffering [and] gave children a strong sense of responsibility towards their parents” (Bomhoff 2011, 132). By contributing to parental ‘suffering,’ money played an essential part in enacting migration as a new filial obligation for daughters. The idiom of suffering emotionally tied the daughters to parental reciprocity, which also had to be fulfilled in specific ways. In this context, in order for daughters to be ‘good’ they had to find employment abroad and send

34 The conversion rates are from 2014, according to the reference (Johnson, Green, and Maben 2014). The amounts noted by our informants at the end of this paragraph are based on the 2018 conversion rates.

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remittances, as well as care for their parents emotionally and practically through daily calls.

To fulfill duty of migrating for work, daughters first sought employment in English-speaking countries where salaries were high and it was possible to obtain permanent residency. From there, the daughters would be able to regularly send remittances to their parents and secure a stable financial future for themselves and their parents. This path, however, was not always easy to follow. The IELTS exam was challenging and a ‘good daughter’ had to demonstrate her dedication to the family migration plan by attempting to pass the exam at least a few times. This process could lead to considerable mental stress due to daughters’ feelings of guilt over their inability to reciprocate to their parents and concomitant social pressure. For example, after trying to pass the IELTS exam for several years, one nurse anxiously conveyed that her neighbors and relatives were “starting to ask” why she was still living with her parents rather than moving abroad. A nurse in her situation was expected to migrate at least to a Gulf country, where residency depended on employment and nurses earned substantially more than in India. For illustration, one nurse reported earning 80,000 Rs (about 1,200 USD) monthly in Saudi Arabia, while nurses in India earned about 10,000 Rs (150 USD) at the time of our fieldwork. Such flexibility in career pathways, specifically in terms of destination countries, shows how the norm of international migration was a ‘practical accomplishment’ (Winance 2007).

Failure to migrate could result in mental and financial struggle for the whole family and could even have tragic ramifications. A notorious example was Beena Baby, a nurse who committed suicide after receiving “inhuman treatment” as an employee of a Mumbai hospital (HT Correspondent 2011). Her fate resonated with nurses across Kerala who received salaries that were too low to repay their educational loans while their employees prevented them from migrating by withholding their professional certificates (Timmons, Evans, and Nair 2016, 44). Thus, the new filial norm of international migration, reinforced through the idiom of suffering, was flexible, but only to a certain degree. This limitation was contingent on the amount of money involved in enacting migration as a daughter’s duty of elder care: the larger the burden of suffering, specifically through assuming debt, the more pressure on daughters to successfully migrate.

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Figure 5. Passing the English language exam is the first step of migrating abroad. Photo by author.

Returns on Investments: Remittances and Visits For female nurses, the filial obligation to migrate became more important than the duty to marry early. Migrant nurses generally did not marry before the age of twenty-five, three years later than the average for Christian women in Kerala and five years later than all Keralite women (Percot and Irudaya Rajan 2007, 321). This delay created “a window of opportunity,” as one of our informants said. During the years between finishing studies and marrying, daughters could earn a salary to “repay the suffering” of their parents, as several said, via remittances without potential restrictions imposed by in-laws. In this way, money helped to enact another new duty for daughters: sending remittances to their own parents.

By fulfilling this obligation, daughters helped their natal families considerably. Joy, for example, was an unmarried nurse in her early twenties who had been working in Saudi Arabia for a year. She regularly sent almost all of her monthly salary to her parents. The money she sent home sufficed to cover her parents’ and younger brother’s living expenses, as none of them worked; repay her educational loan; pay her brother’s university fees; and renovate the family’s house. Although Joy was barely on speaking terms with her father, her remittances paid for his health expenses after his stroke. Most importantly, and as was common in transnational nurse families, Joy was also saving money for her own dowry (see

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also Percot 2016, 256). Although legally prohibited in India, dowry is a persistent practice whereby the parents of the bride transfer property, money, and/or other gifts to the family of the groom (Diamond-Smith, Luke, and McGarvey 2008; Das Gupta et al. 2003).

In patrilineal Indian families, daughters have long represented an economic burden due to the practice of dowry, and parents considered spending money on their daughters, for example on their education, as “investing in another family’s daughter-in-law” (Das Gupta et al. 2003, 17). But in Keralite nurse families, this has changed, for “the ‘burden of having a daughter’ … turns out much lighter if she is able to get a nursing diploma” (Percot 2016, 256). Even more, in this context daughters with nursing degrees became an “asset” (George 2005, 42). Besides the immediate impact of improving the family’s financial situation, the money that female nurses earned abroad helped them to marry into ‘a good family,’ meaning one that is well positioned in terms of class and caste, and thereby to advance the social status of their natal family.

Nevertheless, receiving remittances from daughters was a sensitive topic to discuss with the nurses’ parents (see also Singh, Cabraal, and Robertson 2010, 252). In patrilineal Indian families, parents “incur a considerable loss of respect” (Lamb 2000, 84) if they are cared for, financially or otherwise, by their own daughters. Thus, the parents of female nurses had difficulties acknowledging publicly that they were being supported by their daughters. Those who did talk about accepting their daughters’ financial contributions justified their actions through the idioms of ‘suffering’ and ‘sacrifice.’ For instance, Mary’s father firmly declared that he did not want to financially depend on his daughters, so he continued to work as a rickshaw driver. His wife, however, emphasized that she and her husband “suffered a lot” for their daughters. She added that while they could “not demand” anything from them, it was perfectly fine to “accept whatever (their) daughters were willing to give.” As receiving money from daughters contradicted long-established patriarchal norms of filial duties, the practice of daughters’ sending remittances was fraught with “intergenerational ambivalence” (Gallo 2018). Adhering to patriarchal structures of filial reciprocity, parents could not make open demands on their daughters’ remittances or complain if they did not receive any or enough, yet they also heavily depended on their daughters’ financial support. Despite the efforts of the Indian government to increase health insurance and pension coverage beyond specific target groups, more than 70 percent of the elderly in Kerala depend on their children or other relatives for living and health expenses (Zachariah, Matthew, and Irudaya Rajan 2003, 402; Ahlin, Nichter, and Pillai 2016; van Dullemen and de Bruijn 2015). To mitigate the

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contradiction between their financial needs and the patriarchal stipulations of financial independence from daughters, the parents appealed to their daughters’ emotions through activating the idioms of ‘suffering’ and ‘sacrifice,’ and ‘accepting’ rather than ‘expecting’ financial support from them. Thus, as sending remittances to their own parents became a new duty for ‘good daughters,’ the way in which this norm was enacted did not directly confront the patrilineal system.

With marriage, the ‘window of opportunity’ for the parents to receive remittances could close, since afterwards daughters should start contributing to their in-laws only (see also Gallo 2005, 230; Bomhoff 2011, 204). Some parents hoped to reduce this risk through their choice of the groom. Joy’s mother, for example, wanted to find “a good husband” for her daughter, meaning “one that would allow Joy to keep supporting us after marriage.” In transnational nurse families, then, a ‘good husband’ accepted his wife financially supporting her own parents; this sort of tolerance part was not conventional, but it became a sought-after quality in marriage negotiations. The nurses’ in-laws expected their migrating daughters-in-law to share their income with their husbands, call their parents-in-law regularly, and stay with them when visiting Kerala. These practices were in line with the prescribed role of daughters-in-law within the patrilineal system. The money that the nurses earned increased their bargaining power with their in-laws, such that they could negotiate about caring for their own parents.

This was revealed in the accounts of married nurses in our study. For example, Sara was a middle-aged nurse, living and working alone in Oman, while her husband Alvin and their two teenage daughters lived in Kerala. Sara had been living by herself for over a decade, with the main goal to provide finances for her husband, daughters, mother-in-law, and parents in Kerala. This is how she described her obligation to reciprocate her parents’ investment in her, rather than focusing exclusively on her in-laws:

I am giving preference to my parents [rather than my in-laws]. I am always telling that to my husband, then he tells me, “But your home is here, in [his parents’] house.” Then I will say, “No, don’t think like that, because if my parents didn’t educate me, I would be nothing, I would not get any money. You didn’t do anything, you only married me, and you gave me two children. But my parents, maybe they don’t have enough money, they struggle. … Because of [my parents] I got this job. If they didn’t educate me, I would not get this chance [to migrate].

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Nothing from [your] side, no? All [support came] from my parents. Because of them I got this job. So I have to see them first.”

Despite her husband’s initial protests, Sara felt obliged to reciprocate to her parents through remittances and also visiting. She used the bargaining power she had gained by becoming the family breadwinner to convince Alvin that it was the right thing to do. Sara referred to her parents’ ‘struggling’ to justify that “all parents [own and in-law] are the same” in deserving support from their children. In this way, money helped to establish new norms of intergenerational reciprocity whereby daughters played a key role in economic and affective care for their parents. This was significantly different from the societal discourse among Syrian Christians that discouraged daughters not only from financially supporting their parents but also from living with them for any period of time (Bomhoff 2011, 205).

As daughters successfully advocated for sharing remittances and staying with their own parents, these practices also influenced their care workload. For example, Sara described the physical exhaustion of paying attention to her parents as well as her mother-in-law during her yearly visits to Kerala:

When in Kerala, I am mentally ok, but physically … not ok [smiles], because … if I stay at my parent’s house one night, I have to stay at my husband’s house [with him and my mother-in-law] the next. So, I alternate like this, traveling every day. Then I tell to my husband, “Oh my god, I want to sleep like in Oman” [laughs].

Yet it would be difficult to claim that the daughters’ elder care workload simply doubled. Rather, the care workload became distributed differently in the context of the changing constructions of masculinity, which occurred in tandem with the new ways of enacting the norms for ‘good daughters’ (see also Gallo 2006; Osella and Osella 2006; Gallo and Scrinzi 2016). Alvin, Sara’s husband, is a case in point. Alvin first joined Sara in Oman for a few years, but he could not find work aside from several poorly paid short-term engagements. Meanwhile, his mother was living alone in Kerala. So Sara “sent him to stay with her,” adding that it was better for Alvin to return to Kerala where he could also take care of Sara’s parents and their daughters. She suggested this to him because, she said, she could “make as

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much money in one month as he would have made in three to four months.” Once in Kerala, Alvin renovated his ancestral home, where he lived with his mother and which he would eventually inherit. Alvin regularly traveled by car between his mother’s and his in-laws’ houses, which were about one and a half hours apart, taking care of food supplies, house maintenance, and visits to the doctor when needed. Since Alvin had no income of his own, he was unable to take care of his mother financially, as a ‘good son’ would do. Instead, he ‘stood in’ for Sara by providing practical care to his mother as well as his parents-in-law.

The changes in Sara’s and Alvin’s elder care practices reflected their different levels of bargaining power, which were directly linked to their earning (in)abilities, which were shaped by international migration. Alvin’s example shows how international migration “opens up new space representing newly emergent assemblages of gender, power, economics and cultural ideals that may put pressure on men to perform their masculinities differently, or at least more flexibly” (Yeoh and Ramdas 2014, 1203). In Keralite nurse families, men’s duties shifted to support their wives in practical elder care while their role as financial providers decreased (see also George 2005; Gallo 2006). As elder care practices became reconfigured for daughters and their husbands, the care workload became redistributed among them in new ways. This enabled family members to continue practicing care, rather than outsourcing it to non-kin from poorer parts of India or the world, as the literature on global care chains describes (Yeates 2012). Invested Fully: ICTs Adding Value to Caring Relationships ICTs added crucially to maintaining transnational kin relations that were important for both migrant and non-migrant family members. This possibility of relationships continuing across geographic distances through ICTs complicates the assumption of family members being ‘left behind,’ a key assumption in the theory of global care chains (Ahlin 2018b; Baldassar and Merla 2014). One way that ICTs may shape ‘good care’ in transnational families is by making frequent calling a care practice in itself (Ahlin 2018c). As Anthony, a nurse living in Australia, said, “I don’t tell [my parents], ‘Mommy I love you, Daddy I love you,’ but I call them every day.” Thus, while remittances were significant in reinterpreting international migration as a care practice, for nurses like Anthony, money was not the most important practice of caring for parents. Rather, frequent calling became a key gesture of showing affection and nurturing trust between transnational family members. We found that both daughters and sons called their parents and here we

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draw on a comparison between them to illuminate how ICTs helped shape the norms of being a ‘good daughter.’

To start with, once family members established a calling schedule, the parents expected their daughters to follow it rather strictly. Families created these ‘schedules’ through daily tinkering whereby they ascertained what time of the day was best for both the parents and the adult child abroad, based on time zone differences, work schedules, and other activities such as prayer (Ahlin 2018b, 94–96). If a daughter did not inform her parents in advance that she would not be able to call at a specific time, her parents could complain. As Sara recounted: “My father, if I am not calling for two to three days [because of] work, he will say, ‘Ha, are you also becoming like your brothers? You changed your mind, you are only calling us weekly now?’ [laughs] He will ask like that, then I will know he is feeling … sad that I’m not calling.”

ICTs contributed to establishing new parental expectations, as her parents started to anticipate that Sara would call them every day, while their two sons who lived in Ireland and the US would call them weekly. We found such a calling pattern, in which the parents expected all children to call regularly but daughters more frequently than sons, in other families, too. In Sara’s case, when she failed to call daily or notify her parents in advance of changes in her work schedule that would prevent her from calling, her father would “scold” her, a reproach camouflaged in jest (see also Gallo 2015). Frequent calling served to reinforce emotional ties between the migrating children and their parents and ensure the parents did not feel neglected even while their children were physically far away (see also Ahlin 2018c).

Maintaining strong emotional ties with parents was a significant new development especially for married daughters. Just one generation earlier, it was common for in-laws to restrict their daughters-in-law from visiting their own parents, and ICTs were not yet easily available. Thus, the contact between married daughters and their parents was limited. As Sara recounted, her father allowed her mother to visit her parents only occasionally, for the day, but he did not permit her to spend the night at her natal home. Comparing her mother’s situation to her own, Sara said: “My husband is not that strict. When I take my annual leave, first I go to my house, to see my father [and mother], only then I will go [to my mother-in-law].” When abroad, Sara called her parents every day, while she inquired about her mother-in-law through her husband rather than calling her directly. Sara claimed she did so because her parents made it possible for her to become a nurse, migrate, and earn a salary; this, in turn, increased her bargaining power to negotiate with her husband not only about remittances but also about her visits, overnight

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stays, and daily calls to her parents. Compared to earlier generations of women, these were substantial changes regarding how, and how often, married daughters maintained their ties with their parents.

Further, a ‘good daughter’ would engage with her parents’ health issues through ICTs. For instance, Sara offered her parents advice on medicines by phone, using her professional knowledge and the information she found online:

If there is anything related to disease, first [my parents] will discuss it with me. … If doctors give my mother any tablets and she feels dizziness after taking it, first she will call me [not the doctor]. Then she will ask, “Need I continue [taking this medicine] or not?” And I will search on the internet … if there are any side effects. … Then I will tell her, “Don’t worry, [dizziness] can happen. Take it for one more day, [and]if still it is continuing, then stop.” She will stop. [laughs] She will not go to the hospital then. She will call me.

Sara’s mother trusted her daughter’s advice on the taking medicines more than the doctors she saw in person. In other families, too, daughters guided their parents’ treatment in a similar way, by inquiring about their health every day, asking if they needed any medicine, and giving advice on how to proceed with treatment.

While parents readily exchanged information about their health via ICTs with their daughters, we encountered parents who concealed health issues from their sons. For example, John only learned that his father had had an accident upon returning home after having worked in Guyana for three years. Upon arrival, he was shocked to notice the stiches in his father’s shoulder. As his mother explained, “There’s nothing he could do from so far away, so why bother him? He would only be tense. That’s why I didn’t tell him. He’s not very near to us to come running to help.” In this way, the mother was protecting her son from what she deemed was unnecessary stress. In other families, sons found ways around parents’ trying to ‘protect’ them from bad news. For example, they engaged a good friend to regularly drop by their parents’ home with a smartphone or a tablet. In this way, a webcam made it possible for sons to check on their parents by looking for visual signs of ill health (see also Ahlin 2018b, 97–98). By contrast, daughters had no need for such arrangements; none of the parents in our study ever said they did ‘not want to bother’ their daughters abroad by sharing their health-related concerns with them.

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Daily calling was more than a new duty for daughters; it was also a practice of reciprocal intergenerational care. Through frequent calling, ICTs mitigated feelings of abandonment on the side of the parents, but also feelings of loneliness and homesickness on the side of the children. This was especially the case for female nurses who lived abroad by themselves. As Sara recounted:

My brothers are calling our parents also, but not every day, it’s not possible. … Maybe the elder one will call every fifteen days; the younger one is sending text messages in between. Because all are busy with their own families. I am free, no? I have no work, because after duty you are free, you can call. … [My brothers are busy with] family, and maybe the husband is going to work, the wife has to look after children, then the wife is going to work and the husband has to look after children. So we have to understand their situation. That’s why my parents know I am always calling. … I am free here, after duty I am free, so I am calling [laughs].

In explaining the difference between herself and her male siblings in the frequency of calling their parents, Sara emphasized her availability, saying she was “free to call.” But this freedom also entailed loneliness, as in the Gulf countries nurses had few opportunities for socializing outside their workplace. Joy, for example, who worked in Saudi Arabia, called her mother daily and particularly enjoyed their weekly webcam meetings. She explained that seeing her family, house, and garden in Kerala had a “good impact on (her) well-being”; without that, she thought she would literally become sick with homesickness. On the other side of the Gulf, Joy’s mother said she regularly inspected her daughter’s face on the webcam to trace changes in her mood and health. In this way, she could notice any trouble and immediately offer emotional support and encouragement to her daughter. Such affective care from parents was particularly important for the Syrian Christian women who worked in countries where they were a religious minority, encountering not only harsh working conditions but also racial discrimination (see also Osella and Osella 2008; Percot 2006, 23).

Whether ICTs support the relationship between married daughters and their parents in non-transnational families remains to be explored. Research in North India showed that some in-laws may allow their daughters-in-law to call their own parents daily (Tenhunen 2014) while others confiscate the daughters-in-law’s mobile phones to diminish their ties with their natal families (Doron 2012). In

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transnational care collectives as they were formed in transnational families of nurses from Kerala, frequent calling as an elder care practice entailed relatively more affective labor for daughters than sons. This could be seen as additional workload for daughters, especially as they might already be strained by the demanding emotional labor involved in the practice of their profession abroad (Dyer, McDowell, and Batnitzky 2008). However, the daughters in our study never questioned or complained about the unequal distribution of emotional care, nor did they refer to it as a burden. As common in Kerala, such family duties “simply had to be done” (Bomhoff 2011, 132). Moreover, for daughters, frequent calling was not only work but also a practice of self-care, as it provided an opportunity for parents to emotionally support them, too. Through enabling the reciprocity of affective care between daughters and their parents, ICTs made elder care inseparable from intergenerational care. Conclusion Investigating elder care practices in transnational families reveals new layers of complexity about gender beyond what has previously been uncovered through studying the relationship between husbands and wives (George 2005; Gallo 2005; Percot 2012). Drawing on material semiotics (Pols 2012; Law 2009), we analyzed care in terms of practices that involve people and technologies, particularly money and ICTs, which are intrinsically linked to international migration. Approaching care as an enactment through specific practices was useful in two ways. First, it allowed us to study ‘the good’ in care not in terms of universal, general ethical principles, but as something that is enacted in concrete situations. Second, it enabled us to explore the active role of technologies in care (Mol, Moser, and Pols 2010, 12–15). Among Keralite nurse families, money and ICTs become participants in transnational care collectives, transforming the meaning of ‘good care’ (Ahlin 2018c) as well as kinship norms, specifically those of ‘good daughters’, as they were enacted through elder care.

The transformations of the daughter-parents relationship, whereby daughters became primary carers for their own parents through financial, practical, and emotional care, are significant for the patriarchal Syrian Christian families in which just a generation ago married women had to leave their natal families and focus on their ties with in-laws (Gallo 2005). As such, the new duties of ‘good daughters’ conflicted with the Syrian Christian patriarchy and made them replete with ambivalence. Rather than openly threatening the patriarchy, transnational

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family members attempted to mitigate this contradiction through the idioms of parental ‘suffering’ and ‘sacrifice’ and, especially in relation to remittances, through the discourse of ‘accepting’ rather than ‘expecting’ financial support from daughters. Moreover, the changes in bargaining power of married daughters remained limited, as the daughters continued practicing care for their parents-in-laws and thereby complied with filial duties, as they were established within the patriarchal kinship system.

Keralite Syrian Christian female nurses have been the frontrunners in opening up women’s engagement in transnational labor markets as well as transforming filial duties in elder care. Yet it remains unclear if the social and spatial organization of nursing work that encourages women’s transnational mobility could represent a serious “threat to the patriarchal order” (Massey 1994, 198). As feminist geographers have found, “while migration often results in changes to day-to-day gender practices, ‘deep-seated transformations in gender ideologies or scripts are … more resistant to change’” (Yeoh and Ramdas 2014, 1203; see also Kibria 1999, 10). How, if at all, the described transformations of filial duties could impact the status of female nurses in Kerala beyond their families is thus an issue for further exploration.

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Chapter 5 DISRUPTED CONNECTIONS On Participation in Caring for a Mother with Dementia Keywords: aging, dementia, India, family, elderly care, care at a distance, transnational care collective, information and communication technologies (ICTs), global care chains, digital technology, family, transnationalism, migration, informal care This chapter has been published as: Ahlin, Tanja. 2019. “Disrupted connections: On participation in caring for a mother with dementia.” Somatosphere. Published online April 2. http://somatosphere.net/2019/disrupted-connections-on-participation-in-caring-for-a-mother-with-dementia.html For this thesis, I have edited the text style (font size and style, paragraph alignment) and I added one picture (Figure 6).

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On a sunny, stifling afternoon, my friend, an Ayurvedic doctor, ushers me into a scantily furnished examining room of his clinic in central Kerala, South India. There, a small, stout woman sits on a chair. Her name is Mercy.1 She is wearing a salwar kameez, an outfit comprising of a long shirt, baggy pants and a scarf, rather than a sari, which would be more typical for a woman of her standing, senior and married with children. I try to dissolve the uneasiness of our impromptu meeting by smiling a lot as I go through the explanation of my research. Finally, she invites me to visit her home. She will cook dinner, she says, and I can meet her mother! I enthusiastically accept.

When I enter Mercy’s house, I immediately meet her mother. A woman in her eighties, she is afflicted with severe dementia, diabetes and heart problems. She greets me, but doesn’t seem interested in starting a conversation. So Mercy tells me her story in the kitchen, over steaming rice and vegetables frying in the pan.

Despite having five children, Mercy’s widowed mother has found herself placeless in her old age. According to the conventional practice of elderly care in India, one of her three sons should take her into his home where his wife would cook for, feed and bathe her. Yet this is impossible in Mercy’s mother’s case: one son has cut all contact with her due to inheritance conflicts, the second son lives in another part of India, while the third son has moved to Europe. Mercy’s mother does not want to relocate, having spent her whole life in Kerala. As Mercy herself is based in the US, her mother has had to move in with her other married daughter Rosa, who lives not far from the family’s ancestral home. But this arrangement is in contradiction with the common social conventions – in India, parents are not supposed to stay with their daughters – a custom that Rosa’s husband brings to the table day in, day out. Rosa, too, increasingly complains of the exhaustion of having to take care of a mother suffering from a progressive mental illness.

For Mercy and her brothers, displaced by migration, caring for their mother at a distance is next to impossible. Mercy’s brother in Europe has offered financial help, but Rosa brushed his offer aside. Our mother needs somebody to feed her, by spoon, daily, and no amount of money could do that, Rosa reportedly said.

From the US, Mercy used to call her mother regularly, but phone calls have become increasingly difficult. How to talk on the phone with someone who has dementia and may not even remember having a daughter, let alone that she lives abroad? Mercy still calls, but ends up mostly talking to Rosa about their mother’s condition. She has also currently taken their mother into her home while visiting Kerala for the winter. In this way, she is providing care not only for her mother, but also for Rosa, by offering her some respite from the caring tasks, if only for a short time.

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But keeping their mother at home, Mercy’s or Rosa’s, is not a long-term solution. It simply cannot be sustained. The two daughters haven’t the knowledge or skills, let alone the patience, to take care of somebody with dementia, Mercy asserts. As a nurse, Mercy is familiar with specialised care facilities and she approves of how elderly people are treated there.

“People are in a group and they teach them how to sit, eat, what to do … It’s good for them!” she says. “The nurses in these homes are trained properly, and they are paid for it so they should pay proper attention to these people.”

So Mercy suggested to her siblings that they move their mother into a nursing home. And their reaction?

“They would kill me”, Mercy says. “If we put our mother in a nursing home, they said, people would ask, how can this be, there are five children and no-one can take care of her?!”

It has to do with dignity, with them being ‘good children’, with their whole family being a ‘good family’. In India, old age homes are thought of as being full of the most devastated, poor people, people who come from ‘bad families’ troubled by disagreements that lead to bruised, if not broken, relationships. From our conversation, it slowly emerges that Mercy and her siblings do indeed have a troubled relationship with their mother, with bitter memories that reach far back into their childhood. It seems that placing their mother in an old age home would bring these intimate tensions to the surface and make them visible to everyone around them.

The disagreement over the nursing home remains a painful point for the siblings. Mercy is refusing Rosa’s and her brothers’ calls because she is so angry with them. She has even declined their invitations to dinner, out of fear of not being able to hide her feelings of frustration over the issue.

Despite her siblings’ protests, Mercy plans to visit a local nursing home. “But it’s not only for my mother”, she says. “I want to see it for myself, too.” Her plans for the future are uncertain. What will happen to her once her husband, many years her senior, passes away? She doesn’t want to be a burden on either of her two daughters who are creating their own lives abroad. And yet, clearing the dishes from the table, Mercy says quietly, “Maybe, hopefully, one of my daughters will take me in”.

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Figure 6. An elderly woman in the church, waiting for a wedding of her neighbors’ son. Photo by author.

When adult children are dispersed across countries and continents, what happens to their aging parents? What becomes of care in a transnational context? I tackle these questions through my fieldwork in Kerala and suggest that digital technologies such as mobile phones and webcams participate, together with children and their parents, in forming ‘transnational care collectives’. Care is then shaped by who among family and non-family members joins in the practices of care at a distance, as well as what types of technologies are involved. When people cannot care by cooking for each other, care becomes about calling each other on the phone or webcam daily.

But I found the transnational care collective in Mercy’s family to be elusive. There were cracks in their collective, created by the onset of dementia, as well as by decades of family conflict. The cracks appeared as the siblings’ inability, unwillingness or refusal to participate in the transnational care collective. What kind of collective can be formed, if at all, if some family members are unable to join it, decline to participate, or are not allowed by other relatives to do so? Mercy could not care for her mother directly, if remotely, as dementia made it impossible for them to have a conversation on the phone. Mercy’s brother was denied participation as Rosa refused the remittances that he wanted to provide in an act of care. Another brother declined to participate due to old disagreements.

Yet, as Annelieke Driessen (2018) suggests, the possibilities to participate in care are not necessarily a zero-sum game. In Mercy’s family, care was there, with all

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its imperfections and limitations. Mercy may think that the care that she and her siblings are providing is not ‘good’, but is it not care nonetheless? Fraught with tension, ambivalence and complex emotions, care was in the daily calls between Mercy and Rosa, which included discussions of their mother’s condition. Care was in Rosa’s daily negotiations with her husband about her mother living with them. Care was in the refused dinner invitations and in the phone calls not made out of frustration over different ideas of what ‘good care’ for their mother with dementia could be. Care was in visiting nursing homes, even as these visits were accompanied by Mercy’s lingering fear of her own imminent aging.

It seems, after all, that dementia does not entirely preclude people and technologies from practicing care at a distance. Rather, it shapes the participation in the transnational care collective in specific ways. The phone, instead of connecting Mercy and her mother, connects Mercy with Rosa in their joint endeavour to organise and discuss care for their mother. Dementia also shapes the relationship between Mercy and her brothers, who have responded to the situation in different ways. Dementia as a mental health illness is not as tangible as people or technologies, but it nonetheless importantly influences relations and the ways in which care may be done. As such, dementia joins the care collective as a participant of its own.

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Chapter 6

FROM FIELD SITES TO FIELD EVENTS Creating the Field with Information and Communication Technologies (ICTs)

The incorporation of various information and communication technologies (ICTs) in ethnographic methods mandates a reconsideration of the understanding and practice of fieldwork. In this paper, we explore how the ‘field site’ may be reimagined in today’s highly mobile, ICT-facilitated world. Based on our research among Indian transnational families and young migrant workers from Malaysia, we argue that the field may be conceived as a collection of ‘field events’ that are co-created by ethnographers, their study participants, and ICTs. As ICTs are increasingly intertwined with people’s lives and thereby feature importantly in ethnographic fieldwork, we encourage ethnographers to carefully consider how these devices and platforms actively shape their ethnographic data as well as their relations with study participants.

Keywords: ethnography, information and communication technologies (ICTs), field event, field site, methods

This chapter has been published as: Ahlin, Tanja, and Fangfang Li. 2019. “From Field Sites to Field Events: Creating the field with information and communication technologies (ICTs).” Medicine, Anthropology and Theory 6(2): 1-24. doi.org/10.17157/mat.6.2.655 For this thesis, the text has been modified for style (font size and style, paragraph alignment) and minor editing, and I added two photos (Figures 8 and 9).

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Introduction Late one evening in 2014, Tanja Ahlin was sitting at the kitchen table in a home in Kerala, South India, enjoying a quiet moment after dinner, when the sound of an incoming Skype call came from one of the bedrooms. As she was doing research on information and communication technologies (ICTs) in caring relations among Indian transnational families, Ahlin found the event exciting, a highlight of the day. This particular family was indeed dispersed: in the home lived the two parents and the youngest of their three daughters, Mary.35 The two elder daughters were both nurses and working in the United Kingdom (UK). When the ringing sound came from Mary’s room, indicating someone was calling on Skype, Mary brought her laptop to the dining table. Mary excitedly encouraged Ahlin to talk to her middle sister’s Susan’s husband, whom Mary referred to according to a kinship term achacha. Feeling she had little choice, Ahlin spoke to Achacha for about half an hour, among other things about his views and experiences on caring for parents and in-laws at a distance.

The conversation was a seemingly uneventful affair, similar to many other Skype chats Ahlin had had in the past with her own family members, friends, and colleagues. Yet, when the call was completed, she felt something strange had happened that called for further investigation. Ahlin had left her home country and traveled to India to spend time with her study participants, to ‘be in the field.’ But once she reached the country that was supposed to represent her field site, she found herself spending time with her study participants online as they were physically situated in yet other parts of the world. Suddenly, her ‘field site’ encompassed more than the countries she had specified in her research plan, in which she had proposed visiting India and also Oman as a major destination countries for migrating nurses. Instead, ICTs helped her reach Keralite nurses and their families who lived in numerous countries around the globe. Ahlin found herself wondering: what kind of field was this, after all, and how did ICTs shape it? In this paper, we explore what may become of the field when the ethnographer follows her study participants by traveling to some of them and by interacting with others via ICTs. To describe this type of fieldwork, the term ‘multi-sited fieldwork—in the sense of encompassing several geographic sites that could be added together by ‘being there … and there … and there’ (Hannerz 2003; Marcus 1995)—was imprecise, since the ethnographer did not visit all the locations in person. According to Marcus (1995, 102), multi-sited fieldwork encompasses 35 All personal names are pseudonyms.

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“different, complexly connected real-world sites of investigation”; these sites may be understood as geographic or as various social ‘spheres,’ for example the spheres of everyday life, legal institutions, mass media, or policy discourse. However, in ethnographic practice, especially in migration research, multi-sited fieldwork commonly involves following people across geographic sites (see, for example, Hage 2005). But as it was conceptualized over two decades ago, ‘multi-sited fieldwork’ did not account for technologies such as ICTs and how they might impact the field site. ICTs, especially the internet and social media, have been used more recently in ‘virtual’ or ‘digital’ fieldwork.

Figure 7. This is not a field site. Graphic by Ahlin.

The full lines could represent the ethnographer’s physical travel from The Netherlands to Kerala and Oman, and the dotted lines could represent her travel via ICTs to reach people in various

geographical locations around the world. But if the field is imagined as a collection of field events, where is the field in this image?

But these notions were also not the most suitable descriptions for our fieldwork, since we did not focus exclusively on studying websites and forums (Hine 2000) or virtual worlds as places where people socialize (Boellstorff 2008; Boellstorff et al. 2012; Miller et al. 2016). How, then, could our fields be best described?

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We propose answering this question with the concept of ‘field event.’ The term ‘event’ has been used in previous efforts to reconceptualize space/place. Doreen Massey (2005, 4), for example, argues that space should not be understood simply as a surface with people and places ‘on’ it, but should be imagined in terms of ‘spatio-temporal events.’ Building on Massey’s idea, Sarah Pink (2011) proposes a theory of ‘visual-place-event’ to suggest that images are better understood not as static moments of places or things, but as always being produced and consumed in movement. Since the production and consumption of images is intertwined with “the trajectories of moving perceiving bodies,” images emerge from and are simultaneously implicated in the making of place as an event (Pink 2011, 9). Furthermore, Christine Hine (2000, 50) coined the term ‘Internet event’ to describe a particular event as it unfolds in the media, which can be analyzed without the ethnographer physically traveling to any particular location. Here, we propose the notion of ‘field event’ to shift the focus from the field as something that is situated in geographic and social spaces (‘site’), whether physical or digital/virtual (Marcus 1995; Hine 2000; Pink et al. 2015), towards understanding the field as a collection of ‘events’ that are co-created within specific practices by ethnographers, their study participants, and ICTs.

Based on two research projects that we conducted individually among South Asians, namely Indian transnational families of nurses (Ahlin) and Malaysian highly mobile youth (Li), we argue that the notion of ‘field events’ may help to understand various ways in which ICTs and people collaborate in ethnographic work. We suggest this is a more fruitful approach to understanding the role of ICTs in fieldwork than approaching these devices and platforms as communication tools that facilitate contact between people without influencing it, or as tools through which traditional ethnographic methods are translated into a digital context (Krieg, Berning, and Hardon 2017, 23; for an example see Crichton and Kinash 2003). We draw on material semiotics, a theoretical approach from science and technology studies (STS), that facilitates exploration of how people and technologies become what they are through the relations they form with each other, and to investigate what these heterogeneous actors enact together and how their identity is shaped in the process (Law 2009; Haraway 1991; Mol 2002; Pols 2012).

Importantly, the material semiotics approach, including actor network theory, emphasizes the agency of material entities within relations. Thus, relations are heterogeneous in that they “produce and reshuffle all kinds of actors, including objects, subjects, human beings, machines, animals, ‘nature,’ ideas, organizations, inequalities, scales and sizes, and geographical arrangements” (Law 2009, 141).

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Thus, relations form not only between people but are also formed with and shaped by objects that are thereby ‘active and co-creating’ (Asdal, Brenna, and Moser 2007, 31; Haraway 1991; see also Akrich 1992; Latour 2005). We draw on this approach to technologies as ‘agents’ to explore how field events may be created through relations between people and ICTs that are possible to observe within specific practices.

After outlining the background of our respective projects, we examine some of the ways in which ICTs helped shape field events in our research. We start by looking at how webcams and smartphones influenced field events according to what they afforded the ethnographer to see. We continue by exploring how ICTs were embedded in their locally specific relations, including institutions of different levels, from states to companies and families. Finally, we discuss the temporal aspects of field events, particularly in terms of managing and ending fieldwork.

Two Ethnographic Studies, One Methodological Issue We build our analysis upon two separately conducted ethnographic studies with transnational migrants from Asia that share significant methodological commonalities. Ahlin gathered her ethnographic material among transnational families of nurses from the South Indian state of Kerala, where she studied how ICTs actively participate in and shape elder care in Indian transnational families (Ahlin 2018b, 2018c). Focusing on migrating professional caregivers and their family members who remain in their origin country, the project builds on and complicates the notion of ‘global care chains’ (Hochschild 2000; Yeates 2009). This notion describes economic migrants providing professional care to people abroad while their own family members who may also require care remain at home. In 2014 and 2015, Ahlin conducted research in Kerala and also in Oman, one of the important migration destinations for Keralite nurses (Irudaya Rajan and Percot 2011; Percot 2006). Additionally, she conducted interviews via phone and Skype with nurses living in Canada, Australia, the Maldives, the United Kingdom (UK), and the United States of America (US). Ahlin conducted conversations in English or, with a translator’s assistance, in Malayalam.

Li examined food and nutritional practices among young Chinese migrants from two neighboring villages in rural Malaysia. These youths traveled frequently to urban Malaysia, Singapore, and Taiwan for higher education or temporary jobs. Her longitudinal ethnographic research examined the changing trajectory of food habits among youth migrants during their frequent travels. Between 2014 and early

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2017, Li followed thirty-three young people moving between the countryside and cities, spending time with them at different stages of their journeys and at various destinations where they temporarily resettled. In addition to face-to-face interactions, Li kept in touch with her study participants via smartphone and online social media platforms. Li conducted her interviews in Mandarin Chinese or English, and in some cases in Cantonese or Bahasa Melayu, Malaysia’s national language.

The two studies are different in the research topic, migrants’ origin and destination countries, their demography and mobility, and how ICTs featured in their lives. In the case of Indian nurses and their elderly parents, the ICTs involved included mobile phones, webcams on laptops and personal computers, and tablets, while among young Chinese migrants smartphones were prominent. In Indian transnational families, the nurses had year-long or permanent employment contracts abroad and their work obligations importantly influenced their patterns of calling their parents in India (Ahlin 2018b). In contrast, the Chinese youth had no permanent employment and traveled frequently in search of work. This constant movement was reflected in their dynamic, sporadic interaction via smartphones and social media, which was much like themselves, constantly ‘on the go.’ Thus, we both conducted fieldwork with transnationally mobile people who were savvy ICT users.

Neither of us had planned to include ICTs in our research design before starting fieldwork. However, different interactions we had with our study participants led us to develop different ways of incorporating ICTs into our methods while in the field. In both studies, the particular interaction between the study participants and ICTs had to be taken into account methodologically, with the ethnographers adapting to, and adopting, the practices that involved their study participants and ICTs. For both of us this issue was important also conceptually, prompting us to think in greater depth about what we were doing when we included ICTs in our methods. Creating Images: Webcams Shaping Field Events In ICTs, images are created through a combination of a webcam, integrated into a smartphone or laptop, and a platform that supports visual communication. While Ahlin mainly interacted with her study participants via video calls through Skype, Li used a variety of social media, including Instagram, Facebook Messenger, and WeChat. The choice of a particular type of ICT depended on the personal

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preferences of our study participants, which also fluctuated as they navigated the polymedia environment with its numerous possibilities (Madianou and Miller 2012). Ahlin’s study participants were most willing to engage in meaningful, in-depth conversations with her when speaking on Skype. By contrast, Li’s study participants avoided phone or video calls. The young people in her study often had little privacy, as they usually worked and lived together with other people in small spaces. Li was hesitant to ask them to make phone or video calls when they had six or seven roommates. But textual ‘chats’ are fairly private. Thus, some study participants sent texts or direct messages to Li while at work, in cases where their workplace (such as cafes) allowed them to use their smartphones and provided wireless internet.

In our fieldwork, ICTs enabled us to follow our study participants to places that would otherwise not be accessible to us, and they did so in different ways. Originally, Ahlin did not plan on visiting the UK or any other countries except for India and Oman due to limited financial resources and time. However, the use of webcams enabled her both to observe online interactions in Indian transnational families and informally interview family members living abroad. In comparison, smartphones allowed Li to follow her study participants wherever they went, around the clock. In Li’s study, the Chinese Malaysian youth moved frequently between homes, schools, internships, temporary jobs, and careers, situated in different countries. Thanks to the relatively manageable distances between their localities, Li was able to physically follow most of her study participants for limited periods of time. But when traveling was not possible, Li applied the method of a ‘digital food diary,’ created with the help of a smartphone that affords the taking and sharing of photographs.36

Using the digital food diary, the youth recorded their daily food intakes with their smartphones and shared these photos with Li through various social media platforms. For example, Lily moved every few days between Malaysia, Singapore, and the outskirts and the center of Kuala Lumpur for her studies, part-time jobs, and family visits. Throughout Lily’s travels, Li interacted with her regularly through social media. Lily enthusiastically kept up with her digital food diary. Almost every day, she took pictures of herself searching for food, having meals, and shopping for groceries in different places at different times of the day. She shared her photos of these practices instantly with Li via WeChat, WhatsApp, or Facebook Messenger. Additionally, Lily used her phone to make short videos on Instagram that Li could also access. For instance, while waiting for a take-away meal in front 36 On photography as an anthropological method of researching mobility, see Vium (2017).

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of her condominium in Kuala Lumpur, Lily filmed how a migrant worker from Bangladesh prepared and cooked her food.

Through the photos and short videos obtained in this way, Li tracked not only Lily’s food behavior but also her geographic shifts among Malaysia, Singapore, and Kuala Lumpur as well as her daily movements among the various locations where she purchased, prepared, and consumed her food. The smartphone made it possible to capture the everyday moments related to eating, providing a rich dataset that would be otherwise impossible to obtain. Using such digital diaries, she traced Lily and other study participants continuously for more than two years. The digital food diary method is similar to ‘photovoice,’ a method in which research participants take photographs on a particular topic and then discuss them in focus groups (Wang and Burris 1997). Photovoice has been described as particularly useful in exploring people’s experiences of place (Raffaetà 2015). Similarly, the digital food diary can help us reconsider the place and practice of the field itself.

Rather than merely serving us as a means of virtual transportation to the various locations that we could not visit physically, ICTs shaped the data we gathered through them in different ways. Specifically, the type of ICTs participating in each field event influenced the kind and quality of data we were able to obtain. As STS and media scholars have shown, there is no such thing as a universal technology, but rather many different technologies with their specific characteristics and affordances (Pols 2016; Costa 2018). Digital and sensory anthropologists have discussed how ICT devices, media, and content shape embodied and sensory experience, and how this, in turn, influences the production of ethnographic knowledge (Pink et al. 2015).37 Thus, the particular ICT device that is involved in co-creating a certain field event shapes ethnographers’ and study participants’ sensory perception. It is not possible to touch, smell, and taste via ICTs, a non-affordance we considered when sharing a coconut dosa (crepe-like pancake) with our study participants in Kerala, a lamb shuwa (rice dish) in Oman, or a plate of satay (marinated meat) in Malaysia.

Furthermore, whether image- or voice-based, ICTs shape field events by exposing certain things and hiding others from the ethnographer’s view. For example, on the phone, it is only possible to talk, so people have to rely on the information gathered through sound, including words as well as the nonverbal communication cues such as silence (see Ahlin 2018c). When Ahlin had a phone interview with a nurse living in US, she recorded the conversation, but she could

37 This discussion has been further shaped by anthropologists’ questioning of the universality of human perception and sensory categories (Pink 2009, 2011; Geurts 2003; Howes 2005).

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only imagine what her interviewee might look like, what facial expressions she was making at various points of the interaction, or what the surroundings of her home were. On the phone, then, the material environment of the interviewee, from which an ethnographer may also draw relevant inferences, remained out of reach.

Visual ICTs may help ethnographers ‘see more’ than what can be seen over the phone. However, we also found that image-based ICTs also shape the ethnographer’s view in specific ways. In the case of digital food diaries, images taken with smartphones enabled the ethnographer to gain better insight into the food practices of her study participants, but at the same time these images limited what she was able to see. The images that study participants took offered glimpses into their food consumption, but did not represent everything that an ethnographer would be able to observe had she been physically next to the study participant. So a snippet from a food diary raised a number of questions: Were the items in the photograph staged specifically for the photograph? Did the pictured food indeed end up in the study participant’s belly or did any of it end up in trash bins? Was any of the food shared with others, and if so, what, how much, and with whom? Smartphone photographs alone could not provide answers to these questions, as they only conveyed snapshots without the broader context of the situations they represented, such as lunch, dinner, or a bus ride filled with snacking. Thus, whenever possible, traveling to and even traveling with study participants remains crucial as ways to “follow ethnographically the (dis)continuities between the experienced realities of face-to-face and social media movement and socialities” (Postill and Pink 2012, 124). Not only does the ethnographer gain additional information through face-to-face interactions, but the kind of data gathered may be different from that obtained through field events.

Photographs are usually considered static representations of particular moments, whereas events involve some sort of action. How, then, could digital photographs contribute to the creation of field events? As Pink (2011, 9) argues, photographs are “a complex coming together of humans and technologies in movement” or “visual events” that illuminate multiple “sensory modalities and qualities” in its both production and consumption. In digital food diaries, this coming together occurred within specific practices, such as the study participants taking photos and sharing them via social media with the ethnographer. Study participants sent their photos to the ethnographer so frequently that Li could hardly treat them as individual images. Instead, these digital photos created a

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Figure 8. A snippet from a digital food diary. Photo by Li.

The smartphone camera may enable the ethnographer to have a better insight into daily moments of her study participant when shadowing them is not possible. Yet, what kind of data

are such photos unable to capture and what can the ethnographer do about it?

stream of images through which the study participants ‘shared their lives’ on the move with the ethnographer (see also Ahlin 2018c).38

Social media afforded Li’s study participants the ability to add commentaries to photos, and the chat function permitted her to elicit additional information about the content they shared. Through the use of emojis and icons that enable users to ‘favor’ or ‘like’ comments and pictures, social media allowed Li to capture a variety of feelings, thoughts, and attitudes that her study participants expressed about their meals and social occasions featuring food. An exclusive affordance of social media, icons and emojis transpired as important ‘communicational actors’ (Bucher and Helmond 2018). Moreover, the instantaneous, unstructured, and personalized texts and images revealed the study participants’ relation to the various environments through which they moved as well as their dietary constraints during their travels. While the primary purpose of digital food diaries was to gather visual accounts of study participants’ food practices, it also stimulated them to be creative and self-reflective. Through all these affordances, smartphones and the social media platforms that operate through them helped to yield a rich set of data and allowed Li to better understand her study participants’ diet and body transformations as well as their traveling narratives. By affording the

38 For a discussion about how a series of photographs can give the viewer an “experience of movement,” see Pink (2011, 11).

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ability to take photos, film videos, share them and commenting on them via social media, smartphones co-created specific field events, which was not possible with other types of ICTs or even in-person observation.39

What is excluded from images shown via ICTs may even be fundamental to the very creation of field events. The field event that Ahlin co-created with a webcam and Achacha, described in the introduction of this paper, serves as a good example. While Ahlin was chatting on Skype with Achacha, his parents-in-law in Kerala were not interested in talking to him; the father discreetly disappeared to his room while the mother chose to wash the dishes. They both inconspicuously avoided being captured by the webcam and thereby being drawn into the conversation. Towards the end of the discussion, Achacha offered to call his wife Susan to join, too. As Susan was eight months pregnant and had looked tired during an earlier Skype event, Ahlin suggested letting her rest. In this way, the field event was created by Ahlin, Achacha, and the webcam, while other people who were present in both houses were absent from it. However, without them, this event would not even have occurred, or would be quite different. The personal relations among these people made this webcam conversation possible. In STS, the term ‘absent presence’ (Law 2002) describes that which is involved in the making of technology but which is not immediately visible. In this particular event, Susan and her parents were such ‘absent presences,’ not appearing on the webcam image and yet participating in the field co-creation. Spending time with study participants face-to-face is valuable for detecting such absent presences that might otherwise slip the ethnographer’s attention. Detecting them may help the researcher better understand what elements are required for a creation of a field event and to consider how that may even be data in itself.

‘Field events’ are contingent on the polymedia environment in which contemporary ethnographers are bound to find themselves, especially when conducting research in the context of migration/mobility. As the theory of polymedia acknowledges, people, specifically transnational migrants, rely on ‘a range of different media in parallel with one another’ (Madianou and Miller 2012, 103). Beyond offering a wide variety of communicative opportunities, different types of ICTs shape interaction in different ways. Our comparison of field events that were co-created with phones and webcams, using computers and smartphones, and functioning through a variety of internet platforms illuminated what these devices allow the researcher to see, what practices of data sharing they

39 5 For another example of ‘digital photo elicitation,’ see Walton (2017). For sharing photos as a participatory ethnographic practice, see Pink (2011).

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enable, and how they influence the event in terms of particular spatiotemporal circumstances (in other words, by requiring the ethnographer and the study participants to be present simultaneously and at certain places, or not). Field events, then, are shaped not only by how the ethnographers and their study participants engage with ICTs but also by how ICTs influence the kind and quality of data that may be exchanged as well as when and how this may be done.

Situating Field Events: Locally Embedded ICTs Technologies such as ICTs “never stand alone, because they must always be connected with existing infrastructures” (Jensen and Winthereik 2013, 5). Technologies, then, are embedded in their local physical as well as sociopolitical environment, including its infrastructure, which supports or limits how they work (see for example Larkin 2008). ICTs need the infrastructure of the electric grid to provide them with electric power, and they depend on the telecommunication infrastructure to establish a connection between phones, smartphones, or laptops. Like technologies, infrastructures are not universal; they differ from one location to another, and are subject to the regional forces of nature and to the local communities at various scales (Edwards 2003). By extension, field events depend on how ICTs are locally situated within these infrastructures and communities. Just as infrastructures support ICT–co-created field events, they may also disrupt or limit them, and so “the inability of technologies to perform their functions must be subject to the same critical scrutiny as their achievements” (Larkin 2008, 219). Technological breakdowns of infrastructures impact the functioning of ICTs, for example, through poor connectivity, low credit on the phone or internet pre-paid card, or interrupted electricity current due to weather events. Such breakdowns, or ‘interferences’ (Pype 2018), may occur more commonly in some countries than in others, making field events relatively easier or more difficult to create. ICTs are embedded in and dependent on local sociopolitical configurations in complex ways. In our fieldwork, field events were most significantly influenced by various national ICT legislation and workplace regulations.

In Oman, the use of Skype and some other internet-based calling services was prohibited at the time of Ahlin’s fieldwork (Aziz 2012). Thus, she could only communicate with her study participants in that country through the phone or by driving her rented car across the desert to visit them. During one of her stayovers with Indian nurses in an Omani town, Ahlin learned about the impact of local telecommunication regulations on how migrants contacted their family members in

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India via ICTs. One of her study participants, Benny, became suspicious when Ahlin started taking notes about his use of internet calling applications, worrying that he might be violating the law if any of the applications he had mentioned happened to be illegal. In Oman, telecommunication regulations could change quickly, and Ahlin’s study participants were not always even aware of which ICTs were allowed or prohibited at any given moment. However, a number of calling applications, such as Rounds, Imo, MoSIP, MyPeople, Viber, and Talkray, were still available. These options had easy-to-use platforms at no or low cost. Such a polymedia environment enabled the migrants to manage the unpredictable changes in regulations by switching among various applications regularly, depending on which ones were currently allowed. To learn about all this, it was crucial for Ahlin to visit Oman in person, as trying to create field events in such circumstances would be rather difficult if not impossible.

In Li’s fieldwork, ICTs were also regulated, but at a different scale, by the factories where her study participants worked. This regulation impacted her options for creating field events with them at certain times. Li wrote in her field notes about one such occurrence:

I’m trying to follow up with Kevin, who works as a storage assistant for a shipping company in Singapore, but the company doesn’t allow him to use his personal phone during work hours. Now it’s almost 8pm in Singapore (2pm Amsterdam time). I have been waiting for Kevin to come online since 5pm as we initially planned, but he didn’t show up. This is certainly not the first time I experienced this. While waiting and wondering what happened, I frequently check my message boxes and find no messages from him; I check the time difference between Amsterdam and Singapore a couple of times to ensure that I didn’t miscalculate our meeting time and date; I also check our last conversation a few weeks ago to confirm once again that we were scheduled to talk today. … It’s 9 pm now. Despite all my waiting, it looks like we have to postpone our talk again.

When Kevin was not reachable for several hours, Li assumed he was still at work and not allowed to use his smartphone. In any other case, they would be able to communicate and she would find out what was happening. But in this case, no amount of effort on Li’s part, and no amount or type of ICTs available, could help. Kevin appeared online again two days later and apologized for “not showing up,”

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adding that he was obligated to stay at work overnight to replace his colleague who had fallen sick. With his access to ICTs restricted, access to the field event was also denied to the ethnographer. However, these very regulations might have served Kevin in a different way. ICTs allow their users to ignore other people’s efforts to contact them, as calls and notifications can be muted or simply left unanswered. It was impossible for Li to know for sure whether Kevin indeed had to stay at work or whether he used his workplace ICT regulations as an excuse to postpone the online meeting with her.

As our fieldwork further showed, ICTs are not only contingent on their local environment but may also influence it in certain ways. In the context of families, we observed how ICTs both supported as well as subverted local kinship hierarchies within specific field events. In Kerala, despite the widespread ‘matrilineal ethos’ (de Jong 2011, 17) that has deep historical roots among certain Hindu groups, the patriarchal kinship system remains strong among Syrian Christians with whom Ahlin mostly worked (see also Jeffrey 2004; Philips 2003). In this context, men are the head of the family, having the most power, authority, and respect among family members (Osella and Osella 2006, 24). Such power relations were obvious, for example, in Tara’s family, particularly in how her father, and his mobile phone, influenced the creation of the field event. Tara was an unmarried nurse, working in the Maldives, when Ahlin visited her parents together with Binny, who interpreted the conversation between Ahlin and Tara’s parents. During their home visit, Tara’s father led the conversation, but more importantly, he was the key person in establishing a field event together with his mobile phone. As Ahlin wrote in her field notes:

We sit in the living room of Tara’s parents, chatting, when Tara’s father suddenly asks if he should call Tara on the phone. Tara is supposed to call her father at one o’clock, after her morning sleep following her night duty. He has his mobile phone ready on the table. Because Tara is not calling at the arranged time, he starts fiddling with the phone, and then I realize he’s writing her a text message. She calls back immediately after receiving it. Tara’s father talks to her excitedly about our visit, then passes his phone to Binny. Binny introduces herself, then introduces me and gives me the phone. We talk for about twenty minutes, with a break due to a broken phone connection. Afterwards, I pass the phone back to Tara’s father (who eventually) ends the call.

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As the family explained, this event was different from the usual communication between Tara and her parents. Tara reportedly typically talked to her father on the phone only briefly, while she daily spent a half to a full hour chatting with her mother. Such intensity of daily interaction indicated a strong emotional relationship and support between Tara and her mother, which was common also in other families (see also Rastogi and Wampler 1999). In the described field event, however, Tara’s mother did not even take the phone into her hands, but she stood, rather silently, by her talkative husband. As in a typical formal visit, Tara’s father as the head of the family had the most influence over the field event, controlling this particular event by influencing who was contacted, if at all; when the event would occur; and who would talk to whom at which moment. His mobile phone, by virtue of belonging to him, supported his position of power. In this particular field event, then, the dynamic of interaction was guided by the local patriarchal kinship structures, which the ICTs sustained.

However, ICTs could also have a different influence on power relations within families, and thereby on field events. Different types of ICTs require specific knowledge and skills from people. Through this, ICTs could shift the family hierarchy in terms of gender and age. For example, in Mary’s family, the person with the most influence over the field events was Mary herself, the youngest member of the family, and a woman. This is how Mary set up one of the field events with the family laptop:

Mary tries to call her sister Susan and Achacha on Skype several times. It doesn’t work, so she tries calling her oldest sister once. No reply either. Then finally Achacha picks up Mary’s call from his mobile phone. Mary has positioned the webcam so that he can see me [she made me sit in front of the computer] and her [she is sitting on the bed]. A few minutes later, Mary’s mother and father join us in the room and Mary stands up to give them place to sit on the bed. The mother sits in the center and the father next to her.

In this case, Mary’s power over the field event was based on her skillfulness with the laptop that enabled the webcam meeting. The laptop, provided by Mary’s sister, was intended for the whole family’s use, so Mary, her mother, and her father had equal access to it. However, the device required particular knowledge that only Mary possessed. In this way, the laptop gave considerable control to Mary over this

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particular field event as well as over the daily webcam interaction the family members had with Mary’s sisters abroad. ICT skills were thus more important than gender, age, and even individual ownership of the device for the creation of field events.

Field events in our fieldwork were shaped by the specific ways that ICTs were situated in their local context at various scales, at the levels of household, work, and state organizations. Within the described field events, this influence was mutual: telecommunication regulations set by companies and state laws impacted which ICTs could be used and when, while ICTs influenced their environment in terms of gender and age hierarchies within households. These shifts in control, however, were related to the creation and dynamic of particular field events; whether ICTs may stimulate significant, long-term changes in social power structures at large remains an issue to explore. The situations that we analyze here illuminate the mutual relations among ICTs, people, physical infrastructures, and sociopolitical contexts, and how they may influence each other, thereby becoming not only inter-related, but ‘intra-related’ (De la Cadena 2015, 32; Strathern 2004; see also Pols 2012, 17; Law 2009). Field events, then are contingent on the intra-relatedness of the involved heterogeneous actors and their situatedness within particular social, political, and historical contexts. Temporal Engagements: The Times of the Field Event In any sort of fieldwork, setting meetings with study participants is an intricate practice, as the ethnographer has to adapt to people’s work, family, and other obligations (see, for example, Spradley 2016, 51–52). Including ICTs in the interactions among people adds other dimensions to this challenge. One of them is managing communications across time zones. ICTs enable the formation of field events across two or more time zones, which means that the practice of scheduling may be additionally complicated due to the time differences between the locations of the ethnographer and her study participants. For instance, Ahlin encountered the following difficulties with scheduling meetings by phone with a nurse living in the US:

Jancy is a nurse working in California, US. Her parents gave me her phone number, so I call her a few days after meeting them, in the morning my time [in Kerala]. I assume that might be a good time, as

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it would be evening on her side of the world. But her husband answers and tells me she is at work. A few days later I try again and the same story repeats: Jancy’s husband answers the phone and informs me she is at work, doing her night shift. This time, however, he takes my number and says Jancy would call me back. I don’t have high hopes about that, as I realize it takes some effort to call. To my surprise, however, Jancy calls me the next evening, at about 9 pm my time. I’ve had an intense day in the field already and I need to gather myself for this additional impromptu interview. For her, the situation is no easier: she has just returned from her night shift, called her parents first, and then immediately me. I ask if she would like to schedule a particular time to talk with me, assuming that she might be too tired to have a lengthy discussion right then. But she insists she has enough energy left. Then she tells me, with a laugh that reflects both relief and satisfaction, that she has just saved someone’s life in the hospital.

Beyond ICTs unlocking the challenge of time zones, this field note illuminates several other issues related to the temporal aspects of field events. When is a good time to call on the phone for an interview? As the example with Jancy shows, ICTs make it possible to create field events at any time of the day. Li’s fieldwork confirmed this, as she received photos from her study participants day and night. ICTs thus require a great deal of flexibility in terms of time from all the people involved. Furthermore, different types of ICTs allow for different levels of synchronicity. Ahlin’s experiences in constructing field events were based on webcam or phone interviews, which means that the field events were synchronous, bringing the ethnographer and the study participant together at the same time. In Li’s case, however, the field events were co-created through smartphones and various social media platforms, which allowed for both synchronous and asynchronous field events. The asynchronous character of certain ICTs is convenient for communicating across various time zones. But asynchronous communication may also cause time lags for a variety of reasons, including technological breakdowns, workplace regulations, or personal conscientiousness, as the Li’s experience with Kevin showed. This can create uncertainty and thereby impair trust both sides of the relationship (see also Pauleen and Yoong 2001).

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Figure 9. Late night visit to the market with a study participant as a field event. Photo by Li.

Still photographs are “anything but still” (Radley et al. 2010, 37). They are produced through a complex interaction of humans and technologies in movement, and as such participate in the

co-creation of field events.

With their different affordances in terms of (a)synchronicity, ICTs also influence the dynamics of initiating contact between the ethnographer and her study participants. For example, Ahlin was at first not hopeful that Jancy would indeed return the call, as she realized that this involved a certain effort; it was the work of the fieldwork that the ethnographer should do, or so she thought. Yet Jancy carried out this work, not necessarily to please the ethnographer, but rather as a filial duty. Jancy’s parents had already informed her of Ahlin’s visit to their home and asked her to talk to Ahlin, a request that Jancy, being a ‘good daughter,’ could not refuse. So not only did ICTs enable the ethnographer to reach her study participants across the world, but they also made the ethnographer more readily available to her study participants at any time of the day. Finally, Jancy’s example shows how, despite different time zones, scheduling field events was not always necessary, as field events could be created without previous planning. Thus, Ahlin was surprised by Jancy’s call and her willingness to talk immediately, without any hesitation or negotiation about when would be the best time for a phone interview. The spur-of-the-moment character of ICT-shaped field events meant that the ethnographer had to be adaptable and responsive, ready to gather data when she had least expected it.

While ICTs posed challenges in terms of time in specific field events, their impact was even more significant in relation to the fieldwork overall. For both of

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us, the exact moment our fieldwork started was crystal clear: the date was printed on our airline boarding passes. But the involvement of ICTs made the ending of fieldwork finished much less clear-cut. Li’s study participants continued sending her their digital food diaries even after she no longer requested them, making her field feel temporally limitless. Li had to ‘cut’ (Strathern 1996) the field short and explicitly halt regular interaction with the youths by determining a point in time when she would no longer count the received photos as data. As ethnographers may never actually ‘leave’ the field (Stebbins 1991; see also Watts 2008), Li’s ‘cutting’ it did not imply her final exit. Rather, she and her participants remained in contact, although much more sporadically, after she ceased gathering their photos as data.

Similarly, Ahlin maintained online connections with her study participants after leaving Kerala and Oman. This asynchronous connectivity included remaining ‘friends’ on Facebook with her study participants, chatting occasionally through social media, and exchanging email. In this way, she continued to collect data for months and even years. However, immersion in the field via ICTs was not ‘total’ (Carsten 2012) compared to when she was physically in one of the two countries of her study, and she cannot claim to have been doing her fieldwork continuously ever since 2014. The field events that Ahlin has been creating via the internet have been short, lasting for about several minutes to half an hour, and very sporadic. Nevertheless, these connections proved to be significant. For example, they enabled Ahlin to reconnect and conduct a follow-up interview with a study participant via WhatsApp in 2018, four years after her visit to India. If the field site of Kerala was, at least temporarily, unreachable for the ethnographer, field events via ICTs with her study participant were just a couple of Facebook and WhatsApp messages away.

As Doreen Massey (2003, 75) has argued, “there is no such thing as total immersion,” as ethnographers essentially overlook certain things while in the field and thus the knowledge they produce is always particular, or, in Marilyn Strathern’s (2004) term, partial. The opposition between being totally immersed in the field for a certain period of time and being totally removed from it afterwards is then a false opposition. Field events, created with the help of ICTs, make this all the more obvious, as they may sporadically punctuate the time since the beginning of the fieldwork until the ethnographer decides to ‘cut’ it. Rather than being associated with spending a specific amount of time in a particular geographic location, ethnographic research is shaped by the quality of data gathered both through face-to-face fieldwork encounters and ICT co-created field events.

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Conclusion The notion of field event, which we propose to refer to any situation of ethnographic importance that is co-created among ethnographers, their study participants, and ICTs, theoretically conceptualizes the influence of everyday ICTs on fieldwork, and particularly on ‘the field.’ STS scholars have asserted that technologies function not as neutral, inert tools, but instead actively shape relations with and among the people who interact through them (Akrich 1993; Latour 2005; Oudshoorn and Pinch 2003; Pols 2012). ICTs are certainly not the first or only technology to influence ethnographic fieldwork. Books and articles included in literature reviews shape ethnographers’ perception of the research matter, their choice of methodology, and their analysis; similarly, the technologies they adopt—from paper and pen to digital voice recorders, photography, and film—influence data collection in different ways.40 However, ICTs complicate the “placeness of ethnography” (Haverinen 2015, 82) as well as its temporality and the quality of data collected. As such, ICTs exert a rather specific influence over the field, and this specific influence calls for a new term.

The field site in the classical sense was understood as limited in space and time, yet if we speak in terms of field events rather than sites, the focus shifts from geographic locations to the relations between people, ICTs, infrastructures, and their sociopolitical contexts. Such a focus makes it possible to see how different types of ICTs shape the ethnographic work, together with the ethnographer and her study participants. We found ICTs to play an active role, for example, in shaping what the ethnographer could see and in influencing the local social hierarchies of authority within families. ICTs’ involvement in field events also challenges the practice of leaving the field. Writing about the impact of the internet on the practice of ethnography, Anne Beaulieu (2004, 151) suggests that “‘leaving the field’ will either be reinvented … or else ethnography will develop a more ongoing character.” Our fieldwork illustrates that both of these two options apply. The notion of field events mandates a reconsideration of not only spatial but also temporal boundaries of fieldwork. Research length, which has been one of the defining features of ethnographic fieldwork, may have to be reconceptualized in terms of what is needed to collect ICT co-created field events. But relying only on such field events would be tricky: how many events would be enough to make fieldwork valid? This question might be impossible to answer. Perhaps, then, a better method would be, as it was for us, to add such events to the time spent

40 We are thankful to an anonymous reviewer who has highlighted this point.

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doing face-to-face fieldwork and use them to enhance the quality of data rather than to entirely substitute one kind of fieldwork with another.

Finally, does the prospect of ICT co-created field events mean that ethnographers can simply stay at home and carry out their fieldwork from behind their laptop, as it has been suggested for doing research of ‘internet events’ (Hine 2000, 50)? We argue the answer is “no,” as local environments shape field events via their impact on ICTs. Access, availability, and reliability of ICTs depend on infrastructures that differ from one country to another, as do the broader social, political, and historical contexts in which people and ICTs are situated. Given the importance of localities in shaping field events, it remains crucial for ethnographers to drive in the car, sit on a plane, or sail aboard a ship and carry out face-to-face fieldwork. Being physically situated in one site, or more, makes it possible to look outside the frame of the image provided by a smartphone or laptop camera, and to explore the complexities that ICTs are not able to transmit.

In a world where ICTs represent an intrinsic part of the everyday lives of study participants of various demographic backgrounds, ignoring these technologies does not seem an option anymore, yet entirely relying on ICTs may also not be the right answer for most research questions, either. The question, then, is not whether ethnographers can rely on ICTs exclusively when choosing their methods, but rather how to include them. This issue demands special attention to the practices within which particular field events are created. Specifically, it is important to consider which human and non-human actors participate in the creation of field events, how, and under what conditions, and with what consequences, both for the ethnographic data and the ethnographers’ relations with their study participants.

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Chapter 7 CONCLUSION This thesis has engaged with the issue of care at a distance, and in particular with the possibilities for care that are raised by generic, easily available, and commonly accessible information and communication technologies (ICTs), such as various types of phones and webcams. The idea of care at a distance intervenes in a common assumption that care requires physical proximity, and the related consequence that, when family members are separated by geographic distance, care between them becomes impossible (see Baldassar and Merla 2014). In India, where I conducted most of the research for this thesis, the idea of physical proximity as a prerequisite for care has fueled a popular discourse of elder abandonment in families where adult children migrate abroad for work. However, studies of transnational families have shown that maintaining family relations at a distance is possible and, furthermore, that ICTs have an important role in ‘doing’ transnational family.41 This realization prompts the question: when ICTs become key actors in mediating family relations in a transnational context, what are the consequences for what care comes to be?

I have examined how ICTs shape care at a distance among Indian transnational families by combining anthropological approaches with those from STS care studies, which draw on material semiotics to understand care as something that is enacted within specific practices involving both human and non-human actors (Mol, Moser, and Pols 2010). In this conclusion, I bring together the findings of the foregoing analytical chapters to answer the following research questions, posed in the introduction:

• How do adult children living abroad, their elderly parents in India, and ICTs enact care at a distance?

• How do ICTs shape what is good care in Indian transnational families?

41 For some examples, see Bryceson and Vuorela (2002); Baldassar (2007, 2008); Madianou and Miller (2012); Baldassar and Merla (2014); Walsh and Näre (2016); Ducu, Nedelcu, and Telegdi-Csetri (2018).

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• What are the theoretical and methodological implications of taking seriously the participation of non-human actors, specifically ICTs, in practices of ethnographic research?

• What are the implications of considering ICTs as actively shaping informal care for policy makers working on aging and migration in India?

Enacting Care through Transnational Care Collectives How do adult children who live abroad, their elderly parents in India, and ICTs enact care at a distance? In India, practices of elder care commonly require physical proximity, for example co-residing with sons and sharing food prepared by dutiful daughters-in-law (see Lamb 2000, 2009). In transnational families, however, geographic distance between family members calls for a reconfiguration of elder care practices. As a relatively recent phenomenon, elder care in the transnational context is about making a way through uncharted territory. Examining what transnational families do when they care through ICTs offers significant insights into what informal care at a distance is and how ICTs not only support it but shape it in specific ways. Most importantly, I have found that for the purposes of enacting care, family members living in different countries and ICTs form transnational care collectives. What are these collectives, how are they established, and how do people practice care within them?

Transnational care collectives are based on the heterogeneous relations between parents in Kerala, their adult children abroad, and ICTs. A number of different ICT devices may be included in these collectives, with the parents mostly relying on landline or simple mobile phones, and their children mostly using smartphones and Internet-based calling. Family members also interact through webcams, but less commonly, since most elderly parents are less familiar with these devices and especially with the Internet platforms that support them, such as Skype or Facebook Messenger. The choice of particular ICT devices further depends on the infrastructure and telecommunication regulations of the various countries where family members are situated. In Oman, where I followed some of the adult children who migrated, certain online calling applications were prohibited at the time of my fieldwork. Such restrictions on ICT access compel these migrants to continuously explore which ICT options are available for them to communicate with their parents in Kerala. Contemporary ‘polymedia environments’ (Madianou and Miller 2012) indeed offer many possibilities, yet they are embedded in local contexts that differ from one another. Within various polymedia environments,

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family members have to ‘tinker’ with ICTs (Mol 2008; see also Winance 2010; Pols 2013) to evaluate which of them are available and most suitable, at a given moment, for establishing a transnational care collective.

Because of the accessibility of ICTs even to people from lower economic classes, “cheap calls” have been described as the “social glue” for those separated by geographic distance (Vertovec 2004; but see Haenssgen 2019). The nurses from Kerala that I encountered are highly resourceful in finding free or inexpensive channels for international communication. For them, the choice of ICTs and how often they interact with their parents through them are questions of convenience rather than costs. Having sufficient financial means based on their employment abroad, the children provide the ICTs for their less well-off family members in Kerala. Indeed, purchasing ICT devices and paying for international calls are care practices in themselves. On their side, parents must keep these devices charged with electricity and ensure that telecommunication lines are operational. Failing to attend to ICTs properly creates problems; the connection is suddenly cut, calling becomes altogether impossible. As ICTs demand care themselves, care is distributed among human and non-human members of the care collective (see Winance 2010). Taking care of ICTs is about taking care of the relationships between people, a finding that highlights the significance of heterogeneous relations for enacting care at a distance.

Caring for ICTs is important because it supports another central care practice for transnational families: making calls through these devices. Through tinkering, family members established regular calling through ICTs as a new filial obligation that can be practiced at a distance. The children usually initiate these calls, not only because by doing so they assume the costs but because the very act of calling has come to represent an elder care practice. The gesture of calling indicates to the parents that despite the geographic distance between them and their children, their relationship is still close. Calling via ICTs mitigates parents’ feelings of abandonment, which is often invoked in the public discourse of international migration. Through the act of calling, the children non-verbally communicate their feelings of love and trust, but also of loneliness, isolation, and homesickness. The parents answer their children’s yearning for home by showing them homemade dishes on the webcam or describing in detail the daily happenings in the neighborhood. This is especially important for those who migrate to countries where they experience racial, religious, and gender discrimination, such as in Saudi Arabia. Thus, regular calling home is not only a practice of elder care, but also of self-care for the children who move to foreign and sometimes harsh environments.

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While ICTs are key to establishing transnational care collectives, I have further found that these collectives are also contingent on the affective relations between family members. Their relationships are founded on and shaped by the many years of co-residence before migration. When the relationship between a parent and their child is strong, ICTs help to maintain it across geographic distance. Conversely, when family relations are poor or almost non-existent pre-migration, ICTs can do little to support the enactment of care in a transnational context. The quality of people’s relationships, both prior to migration and as it changes through time, shapes the care collective in specific ways, as it influences the level of participation of the family members in the collective. Based on the different strength of their affective ties, mothers, fathers, sisters, and brothers may be involved in transnational care collectives to varying degrees. Thus, not only ICTs but affective ties, too, are the “social glue” (Vertovec 2004) that stimulates people to engage with ICTs for the purposes of forming and maintaining transnational care collectives.

There are, of course, also limits to how technologies can be helpful in family care. Phones may run out of credit, causing a sudden break in connection, or calling may become entirely impossible because of faults in telecommunication infrastructure. A webcam may afford grandparents to see their newborn grandchild, but they cannot touch him or her. Such instances may have disturbing emotional implications for transnational family members, triggering anxiety and sadness. Moreover, some kinds of care cannot be provided at a distance. What happens when a parent suddenly suffers a stroke or becomes afflicted with a serious illness such as dementia? The (sometimes sudden) need for hands-on care does not preclude transnational care collectives; instead, the collective is adapted to accommodate a parent’s requirement for hands-on care. While severe dementia impedes calls via ICTs with an afflicted parent, the children abroad may increase their ICT contact with their siblings or other relatives who live close to the parent. The dynamic in the transnational collective therefore changes in terms of the frequency of calling among specific family members. The concerned relatives discuss how to organize the practical aspects of care, like considering extending the care collective by including professional live-in carers, geriatric hospitals, and old age homes. In less dramatic cases, such as chronic illness, webcams are especially good at extending the transnational care collective beyond the parent-child dyad. For example, male nurses abroad often ask friends living in Kerala to regularly visit their parents and set up a webcam connection for them. In this way, the webcam enables the son abroad to visually monitor his parents’ health and well-being. At

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the same time, this device strengthens the relationship between the parents and their son’s friend beyond what this relationship might otherwise be.

I initially intended to focus on the role of ICTs in care at a distance, but my fieldwork has revealed that other non-human actors—money in particular—also substantially shape such care. By providing money for their children’s nursing education and migration process, parents endure much ‘suffering’ and ‘sacrifice.’ These idioms emotionally bind children to ‘repay the parents’ suffering.’ The children do so by dutifully finishing their studies, including passing—or at least attempting to do so—the English language exam that is required to migrate to English-speaking countries. Then, the nurses’ new duties become to migrate abroad and send remittances to their parents. Remittances are particularly significant for the elderly in India, where only a fraction of the population receives pensions and the majority of health care expenses are paid out-of-pocket (Ahlin, Nichter, and Pillai 2016). As a parental investment in education and a return on this investment in the form of remittances, money enacts international migration as a care practice.

In the absence of clear norms for transnational care, people need to establish what care at a distance could be. Through the everyday process of tinkering, people engage with non-human actors, particularly ICTs and money, in care practices like making calls, taking care of ICTs, involving other people beyond the parent-children dyad, and also migrating and sending remittances. While tinkering is a task that is never fully completed, it demands considerable effort especially in the first days, weeks, and months after a family member moves abroad. During that time, family members work to establish a dynamic that is tailored to their transnational care collective. Yet these collectives are also flexible in that they can be modified over time depending on the changing needs and abilities of their members. Highlighting the significance of heterogeneous relations, the notion of transnational care collectives shows how human and non-human entities work together to achieve care when living together or near each other is impossible.

New Ways of Doing ‘Good Care’

How do ICTs shape what is good care in Indian transnational families? Transnational care has not been guided by long-established norms in the same way as elder care in non-transnational context is. In transnational care collectives, calling in itself has become a practice of care; but for such care to be considered

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‘good,’ a couple of conditions have to be fulfilled. First, as I have already described, the children should call their parents rather than the other way around. In this way, the parents do not interfere with the children’s work schedule, but more importantly, calling has become a new filial duty through which the children appease their parents’ feelings or fears of abandonment. Second, to be considered ‘good care,’ calling has to be frequent. But how frequent is frequent enough?

Whether ‘frequent’ means calling once or twice a day, or once or twice a week, depends on family members and the calling schedule they institute through tinkering. Frequent calling—which often translates into daily calling—is demanding, as it requires considerable time and energy to organize and adhere to this practice. Yet these adult children do not perceive frequent calling as a burden, since as a new filial duty it is to be fulfilled without complaint (see Bomhoff 2011). Straying from what their parents come to expect in terms of calling frequency even mandates disciplining: parents scold their adult children, especially daughters, for failing to call or for not calling frequently enough.

As a new practice of ‘good care’ for the elderly, frequent calling has some specific consequences. Establishing how to manage contact through ICTs that is ‘intensified’ through daily calling is neither effortless nor without friction (see also Pols 2012, 2011; Madianou and Miller 2012). Family members have to tinker with the content of their conversations to learn how to manage this new communication pattern among them. Different types of ICTs differently shape how people communicate, and thereby relate to each other. My comparison of frequent calling through phones and webcams has revealed that the different affordances of ICTs stimulate people to aim to achieve different goals when interacting through them. An important difference between the phone and the webcam is how they accommodate silence. On the phone, silence signals a technical or a personal problem, so people try to avoid it by talking about the minute details of their everyday life. Sharing such details is far from ‘trivial’ small talk. Rather, it becomes a way of ‘sharing one’s everyday life with family members even across geographic distance. Such ‘sharing everydayness’ allows transnational family members to maintain a daily intimacy among them that would be impossible to foster by only calling at occasional important events like births, birthdays, illnesses, accidents, or deaths. By contrast, the webcam allows people to be silent together and also to do other things than talking, such as ‘driving together’ in a car or ‘cooking together’. In this way, the webcam enables people to spend time ‘together’ even while being physically situated on different continents. Thus, through frequent calling, the phone and the webcam help family members to enact

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co-presence at a distance in two distinct ways: ‘sharing everydayness’ (on the phone) and ‘spending time together’ (on the webcam).

When calling between family members is frequent, the aim of these calls is not about exchanging some particular information, as for example in professional telecare where a health care worker asks specific questions about the patient’s condition and well-being (Pols 2012). Daily calling among family, whether on the phone or webcam, supports care for health in a different way than in the context of formal telecare. On the phone, the nurses in my study monitor their parents’ health by asking about it, usually at the very beginning of their conversation. But ‘sharing everydayness’ also fosters trust and intimacy that the nurses deem crucial to the practice of informal telecare. As such, ‘sharing everydayness’ via ICTs supports the nurses in continuously tracking their parents’ condition. This helps them to make diagnoses after having received detailed verbal descriptions, for example of wounds and mental well-being, and to guide treatment by offering advice on how to proceed. The latter is particularly contingent on frequent contact via ICTs, as parents are more likely to follow the nurses’ advice if they are in touch daily than if they only speak on the phone once a week.

In informal telecare, the webcam further adds visual clues, which makes monitoring health easier in some ways. Not everything needs to be verbalized, and health care issues may be more difficult to hide on the webcam. This is why the adult children in my study are often eager to teach their parents to use the webcam. Alternatively, the children, particularly sons, extended the transnational collective by including one of their friends and their smartphone or tablet. Moreover, the webcam is used to provide health support in both directions. In families where the parents are skilled in using the webcam, or their youngest child is still residing with them and can help to establish a webcam connection, the parents take advantage of the webcam to monitor their children’s appearance and well-being. This enables them to offer emotional support as soon as they notice that their child living abroad looks ‘unhappy’ or ‘unhealthy,’ especially with daughters living abroad alone.

While in transnational families of nurses, both sons and daughters are expected to call their parents regularly, daughters do so more frequently. According to the ideals of filial obligations, as established by the patrilineal kinship system in India, ‘good daughters’ are expected to marry early, and their obligations of care towards their own parents are replaced by those towards their parents-in-law. For married daughters—nurses who migrate abroad for work—efforts to maintain close affective ties with their own parents through daily calling as well as through yearly visits thus deviate from conventional kinship norms. A woman’s

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identity as a ‘good daughter’ changes when she continues caring for her own parents even after her marriage. Furthermore, the kind of elder care that daughters provide changes, from primarily hands-on care for parents-in-law to financial and emotional support for their own parents. As professional nurses, daughters also offer support in the form of health-related advice through ICTs to both sets of parents. To alleviate their workload of elder care, the husbands of migrating nurses are encouraged to form stronger caring relations with their parents-in-law, including through providing hands-on care by taking them to doctors’ appointments and offering practical help at home. Thus, through frequent calling and other practices of elder care, gender and kinship become jointly enacted in new ways.

Besides ICTs, money influences how the duties of ‘good daughters’ are shaped through elder care at a distance. In transnational families of nurses who migrate abroad for work, money transforms daughters’ filial obligations in ways that challenge the patriarchal system. To start with, in non-transnational families, parents are responsible to fund their daughters’ dowry, but in the case of migrating female nurses, ‘good daughters’ become obligated to save money for their own dowry. The parents are still charged with finding a husband for their daughter, but what they come to understand as a ‘good husband’ is also transformed through migration. Thus, a ‘good husband’ comes to mean a man who accepts that his wife will continue sending remittances to her own parents rather than sharing her income exclusively with him and his parents.

Understanding how ICTs and money are implicated in ‘good care’, and the consequences this has for how gender and kinship are enacted, has been possible through an empirical ethics analysis of care practices. According to empirical ethics, ‘the good’ in care is achieved through everyday tinkering, exploring, and making adjustments within social and material relations (Pols 2013). In transnational families of nurses from Kerala in my study, ‘good care’ is not about following the ideals set by the patriarchal kinship system, as that would make ‘good care’ at a distance an impossible goal. Rather, it is about tinkering within each transnational care collective, day by day, until family members reach a more or less implicit consensus on how care at a distance should be done to be considered ‘good’. Most importantly, the families in my study have established that ‘good care’ at a distance is about continuous remittances and frequent, preferably daily, calling.

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Theoretical and Methodological Lessons for Ethnographers

What are the theoretical and methodological implications of taking seriously the participation of ICTs in practices of ethnographic research? To start with, the analytical tools of STS care studies, particularly the notions of ‘enacting’ and ‘radical relationality’, shift the understanding of care away from seeing it as an exclusive domain of people towards something that is enacted through sociomaterial relations within practices (Pols 2013, 2014; Mol 2002). The material semiotic approach, as it has been developed within STS care studies, provides the tools and vocabulary to analyze how people form relations not only with other people, but also with technologies, and how these relations between humans and non-humans in turn shape care. Decentering people from the analysis of care generates in-depth insights into the intricacies of ICT-mediated care that also enrich anthropological inquiries into transnational family life and intergenerational care at a distance.

Moreover, analyzing ICTs as active participants in relations as these are formed within practices influences how ethnographers approach concepts other than care. In this thesis, I have shown how in Indian transnational families ‘gender’ and ‘kinship’ are enacted in tandem through elder care practices. In the families included in my study, ‘good children’ and particularly ‘good daughters’ become such by moving abroad for work, sending remittances to their parents, calling them frequently via ICTs, and visiting them regularly. Instead of analyzing how care practices are ‘gendered’ and situated within a particular kinship system, I analyze how daughters, their parents, ICTs, and money enact gender and kinship within care practices in specific ways. In my analysis, then, I do not treat gender and kinship as analytical concepts that pre-exist the analysis itself (see Harbers, Mol, and Stollmeyer 2002; Hoogsteyns 2008; Mol 2013). Instead, I explore how they, too, are mutable and shaped by non-human actors with which people enter in relations within specific practices.

Finally, I argue that taking ICTs seriously as participants in ethnographic research influences what becomes of the ‘field’ itself. In my study, the people included in the research are situated in various locations around the world, and I followed them from India to Oman. Still, my field does not include only these two countries. I obtained data through face-to-face fieldwork as well as through ‘field events’, a term I propose to refer to situations of ethnographic importance that are co-created by the ethnographer, their study participants, and ICTs. As co-creators of field events, ICTs mediate the relationship between ethnographers and their study participants and thereby shape data collection in specific ways. Ethnographers must be aware of what ICTs can offer, such as the possibility to

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reach people who are constantly on the move or scattered around the globe. But researchers also need to be attentive to how using these technologies changes the nature of the data they gather. Much like care in a transnational context, doing fieldwork through ICTs involves considerable tinkering to establish what fieldwork through ICTs actually is, how it impacts what is considered the researcher’s ‘field,’ and how it should be done to be considered ‘good’.

Through co-creating field events together with ICTs, the study participants and the ethnographer are made relatively easy to reach for each other, regardless of their physical location. By having phone and webcam conversations as well as interacting with study participants via social media, ethnographers can obtain data that would otherwise remain unavailable to them due to limited resources of time, funding, and bodily energy (see Hage 2005). Through ICTs, ethnographers can interact with their study participants also long after they have left their physical field site. However, while ICTs offer new possibilities for reaching study participants, they do so in specific ways, consequently shaping the collected data and raising new and sometimes unanswerable questions in the process. How would the photo that a study participant shared via social media be different had it been taken by the ethnographer herself? In case of phone interviews, what material environment is the study participant embedded in and how could that be ethnographically relevant? And how are ICTs influenced by the technological infrastructures and socioeconomic and political contexts in which they are embedded? While ICTs expand fieldwork in terms of time and space, they simultaneously decontextualize the circumstances of everyday life in which the study participants, as well as ethnographers, are situated. In this process, ICTs shape the kind of ethnographic data obtained, an influence that ethnographers need to take into account.

In classical ethnographic research, ‘good fieldwork’ is determined on the basis of the ethnographer trying to achieve total immersion in the field through living within a certain community and engaging with participants in their daily activities for at least a year (Carsten 2012). While the prospects of total immersion are always questionable (Massey 2003), ICT co-created field events additionally complicate the standards of ‘good fieldwork’ based on spatial and temporal boundaries. However, as fieldwork is an embodied practice (Okely 2007; Pink et al. 2015), not traveling to the study participants’ locations at all would mean that certain information, and social relations, could remain unavailable to the ethnographer. When doing research with mobile, ICT-savvy people, a combination of visiting study participants by physically traveling to them and co-creating ICT-supported field events offers itself as an attractive option. Establishing the

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standards of such ‘mixed fieldwork’ has to be a “practical accomplishment” (Winance 2007). The possibility of ICT co-created field events thus calls upon ethnographers to seriously, and collectively, reconsider what ‘good fieldwork’ through ICTs may be.

Recommendations for Policy

What are the implications of considering ICTs as actively shaping informal care for policy makers working on aging and migration in India? The notion of transnational care collectives describes one concrete manner in which family care is organized at a distance. To support and promote the enactment of informal care in transnational families, policy makers could encourage the recognition of older people as ICT users. In this thesis, I have shown that older people are able to use basic ICTs such as simple mobile phones and further, they—especially grandmothers—are highly interested in learning how to use webcams, laptops, and social media. Indeed, ICTs are essential for the elderly to help them enact transnational care collectives with their children abroad. Kerala could be at the forefront of all Indian states in recognizing the need to encourage ICT use among older people not only discursively but also with practical measures. These could include strengthening digital communities in Kerala by providing the necessary hardware, installing affordable and high quality internet in the households of the elderly people, and offering reliable and publicly driven (rather than private) training and technical support to the elderly on ICT use.

The second recommendation is that in Kerala, and perhaps in other Indian states, the popular discourse of nurse migration as an act of parental abandonment should be amended. Looking closely at family relations has revealed that, for nurses from Kerala, leaving their homeland is a practice of care. To be more precise, only by becoming high-earners abroad and sending home remittances can these adult children effectively become carers for their elderly parents. Opportunities for international labor migration have enabled female nurses to become the main financial providers for their parents. Thus, policy could strive to change the stigmatizing public discourse about families of migrating nurses, which reproaches them for ‘abandoning’ their parents. Instead, the care that these migrating children practice through transnational care collectives should become publicly recognized and acknowledged as contemporary filial duties. Towards that end, the state of Kerala could implement stringent inheritance rules, which would be especially important for migrating daughters. While it is legally possible for

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women in Kerala to claim inheritance, they often do not request it out of fear of damaging their relationships with siblings, especially brothers (Philips 2003). Policy could encourage inheritance for daughters to be implemented more consistently as a way to repay the care work they do for their parents. After all, through remittances the migrating children contribute not only to the well-being of their natal and in-law families but also to the economy of the state of Kerala. These economic contributions necessitate an official acknowledgement as part of the care work that is done transnationally.

Moreover, the Indian families analyzed in this thesis have become transnational because of the particular global socioeconomic flows that encourage the migration of nurses from India to other countries. However, these trends may fluctuate, especially in response to changing immigration policies of individual states. In the US, for example, the annual number of foreign nurses has plummeted over the last decade in response to the increasingly complicated process of obtaining employment visas and permanent residency (Trines 2018). The decreased options for migrating may compromise transnational care collectives: if nurses are not able to migrate for work, this may prevent them from becoming carers for their parents. In such a scenario, the Indian government could then support these families by improving working conditions for nurses in India, such as increasing their minimum salary. Changing the financial situation of nurses in India would involve altering the discourse of the nursing profession as a humanitarian and noble service, a view that is tied to the colonial and missionary origins of nursing in the country (Biju 2013). Rather than perceiving nurses as providing a service that is paid through charity and donation, their work should be recognized as labor that merits appropriate remuneration. Raising nurses’ wages would benefit not only the families that have already invested in their children’s nursing education but also the health care system in India, which is facing significant shortages of qualified nurses (Gill 2016; Walton-Roberts et al. 2017; Johnson 2018).42 Additionally, it would be important to estimate the possibilities and plans for the return migration of nurses currently working abroad. The nurses in my study were looking to migrate to countries where they could obtain permanent residence, which ensured they receive a pension after retirement. The Indian government could take such findings into account when designing strategies to motivate nurses to return to their homeland. Through their skills and experience

42 In 2010, there was an estimated shortage of 2.4 million nurses in India (WHO 2010). In 2017, there were only 20 nurses available for a population of 10,000 in India; this is very low compared to some high-income countries where this ratio is between 100 and 150 nurses per 10,000 people (WHO 2019).

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gained abroad, returning nurses could play a significant role in nurse education and health care reorganization in Kerala and other Indian states.

The final suggestion for policy change relates to how technology is incorporated in health care, in India and elsewhere. Worldwide, technological innovation for elder and other care is actively being promoted by policy makers.43 In India and beyond, policy makers considering the inclusion of technology in formal and informal care may gain insight from this thesis into the substantial impact of these devices regarding how care is practiced and how the meaning of ‘good care’ is constantly reshaped by technologies. Importantly, such technologies need not be highly innovative, novel, or specific to care. As I have shown in this thesis, even everyday ICTs can shape what care is, how it is to be practiced and organized, and what ‘good care’ may be. The findings of this thesis may encourage policy makers to consider how care could be reorganized and enhanced, not only through constant, health-specific high-tech innovations but also with technologies that are generic and already easily available and accessible to consumers.

Further Research Inspirations

Finding out what care through ICTs might be and how to practice such care requires managing the tensions between family members through constant tinkering. With the ceaseless development of new technologies, the tinkering continues, and so the meanings and practices of care in transnational care collectives will likely continue to change in the future. Since my fieldwork in 2014 and 2015, the types of ICTs that help to form transnational care collectives may have changed already, bringing with them new affordances that involve family members in new ways. Moreover, transnational care collectives may work differently, or perhaps even fail to work, as the first generation of parents with migrating children comes of age and the elderly’s physical condition starts to demand more or different attention than that which may be offered through ICTs. Further longitudinal ethnographic studies could thus explore how transnational care collectives are affected through time.

Another issue that remains to be researched in further depth is related to the complex consequences of transnational care collectives on the potential 43 For example, the European Commission (2018) considers aging to be one of the “major societal challenges,” sees ICTs as “key for tackling it,” and invested more than 1 billion Euros into developing research on ICTs for aging between 2008 and 2013.

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empowerment of female nurses in India. Given that female nurses in Kerala are strongly embedded in patriarchal structures, the new care practices of international migration, sending remittances, visiting yearly, and calling frequently represent significant changes in what daughters need to do to be considered ‘good daughters’. While these practices raise “intergenerational ambivalence” (Gallo 2018), especially in relation to parental acceptance of daughters’ remittances, their potential impact on the patriarchal kinship system at large remains to be explored. Furthermore, how may daughters’ relationships with their parents change if their planned and desired career paths are unexpectedly disrupted? In a context where parents consider their daughters to be an ‘asset’ (George 2005; Percot 2016), how may family relations become affected if unforeseen structural or personal conditions, such as loss of employment or illness, suddenly disable the daughters and prevent them from bringing the ‘return’ on their parents’ investments? And how could frequent calling be about other things than care, for example about parental surveillance of migrating daughters at a distance? These are some of the questions that could inspire further research.

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EPILOGUE I started my fieldwork in 2014, having had read much anthropology and a bit of STS literature. After my first couple of months in India, I was compelled to look for ways to answer the “So what?” question: Why was calling through ICTs in transnational families important to understand, and what would doing so contribute to scholarly inquiry and to society? This question emerged and re-emerged during my conversations with fellow anthropologists when I shared my fascination over how family members in my study called each other, only to have them respond: “So people pick up the phone and call each other. What is so fascinating about that?” I have found STS care studies helpful in finding the vocabulary and analytical tools to articulate a reply, as it is formulated in this thesis, for now. By virtue of deepening the anthropological analyses of transnational family care through ICTs, as well as considering the ‘location’ of ethnographic fieldwork through the material semiotic approach, this thesis is an example of a ‘generative interface’ between anthropology and STS (de la Cadena et al. 2015). Through connecting the practices, topics, and analytical tools of these two disciplines and linking my findings to policy, I have engaged in transdisciplinary ‘bridgework’ (Rodríguez-Muñiz 2016). Most importantly, I hope I have managed to bring to light how something as mundane as picking up a mobile phone to call one’s parents is actually an astonishing, complex practice of care. It is such because it matters so deeply to people who do it. Just consider, for a moment, the last time you called your mother or your father, or perhaps your children, to ask them how they were doing and how their day was. After having read this thesis, I hope you will agree with me about just how fascinating that is: that you called, that they answered.

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SUMMARY What becomes of family care when it is practiced at a distance, with the help of everyday information and communication technologies (ICTs) such as mobile phones and webcams? In this thesis, I explore how care is practiced at a distance when adult children who are professional nurses migrate abroad for work while their parents remain in India. The research for this thesis included eight months of ethnographic research in India and Oman, as well as interviews and participant observation via ICTs with people who migrated from India to countries other than Oman. In my analysis, I draw on material semiotics, an approach from science and technology studies (STS) that allows me to investigate care in terms of practices that include not only people but also technologies. This enables me to investigate care at a distance and how everyday technologies are involved in shaping such care.

After an overview of the thesis and the research process (chapter 1), I critically discuss in chapter 2 the view of migration as an act of elder abandonment and argue that in Kerala, particularly among Syrian Christians, migration is rather a practice of elder care. Becoming a nurse who will migrate abroad for work is not an individual decision, but one in which the whole family is invested. Parents encourage their children, especially daughters, to study nursing and English in order to migrate abroad, preferably to an English-speaking country or else to one of the Gulf countries. I show that due to poor employment opportunities in Kerala, adult children with a lower-class background can only become effective carers after migrating abroad, which allows them to send remittances for their parents’ living and health expenses. Money, in the form of investment in education and remittances, thus shapes care at a distance.

Moreover, family members practice care across national borders by involving landline phones, mobile phones, and webcams. With these devices, parents in India and their children abroad form what I call “transnational care collectives.” Within these collectives, care practices that demand physical proximity are replaced by the practice of calling. In each transnational care collective, people tinker with each other and ICTs to establish a distinctive dynamic that determines which family members are involved, which ICTs they use, and who calls whom, when, and how often. Just like finding out each family member’s taste in order to express care by preparing their favorite food, so it is important to learn each other’s preferences for calling.

If calling is a care practice, what is necessary for this care to be considered ‘good’? In chapter 3, I show that in the transnational care collectives I studied,

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‘good care’ is related to the frequency of calling. These families commonly talked about good care in terms of daily calling. They established the ‘right’ frequency of calling through tinkering, and their agreement reflected the quality of the relationship between the children and their parents as it was established before migration. The better the relationship, the more frequent the calling. Discovering the most suitable frequency of calling may involve some tension, as people need to manage this new pattern of communication, supported by ICTs.

Daily calling changes the aim of communication from exchanging particular information to sharing everyday life with each other at a distance. By comparing frequent calling over the phone and the webcam, I show that people practice such ‘being together’ in different ways through different devices. On the phone, people talk about mundane details of their everyday life, such as what they did that day, how the animals and the plants around their home are doing, and the news of their neighborhood and church. While silence on the phone is filled in with such details, the webcam allows for silence, enabling the people to ‘spend time together’ without necessarily talking or even looking at each other constantly. In this way, family care at a distance, both the form and the content, is shaped by ICTs.

In chapter 4, I describe how in the patriarchal Syrian Christian families in Kerala, from which the nurses commonly originate, the transnational care collective transforms what it means to be ‘a good daughter.’ According to the conventional practices of elder care in India, a daughter’s main duty towards her parents is to marry as early as possible. With marriage, a woman assumes the responsibilities of care with her parents-in-law. In the transnational care collective, however, daughters’ duties are transformed by money as well as ICTs. The nurses’ parents ‘suffer’ a lot through providing financial resources for their children’s education as nurses. The idiom of ‘suffering’ emotionally ties the children to ‘repay the suffering’ of their parents by migrating abroad, sending remittances to the parents, visiting them yearly, and calling them daily. For nurses, mostly women, these practices contradict their filial obligations, established by the patriarchal kinship system of their Syrian Christian environment. The new duties of daughters further influence the position of men, particularly as nurses’ husbands assume the practical care for their parents-in-law.

Written in the form of a blog post, chapter 5 is a story that complements earlier chapters that describe the transnational care collective. The story describes a family of five siblings, scattered around the world, and their mother who is afflicted with severe dementia. At first, I assumed that this family, and particularly a daughter who is a nurse in the United States, cannot form a collective with their mother, since dementia precludes the two of them from talking on the phone.

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However, the family nevertheless forms a collective in which the dynamic is shaped by dementia itself. The story further highlights the struggles of practicing care when family relationships are poor pre-migration and aggravated by serious illness of the parent in need of care.

Chapter 6 considers the role of ICTs in the practice of fieldwork itself. I argue that the involvement of ICTs in fieldwork, specifically in terms of conducting interviews and participant observation with study participants via the phone and webcam, changes the meaning of ‘the field site.’ To account for the particular character of fields, which are co-created not only with informants but also with ICTs, I suggest the notion of the ‘field event.’ This term emphasizes the active role of ICTs in shaping what kind of data the ethnographer may gather as well as how they may unsettle local social hierarchies of gender and age within specific field events. For example, through possessing technological skills and knowledge, a young daughter has more influence in co-creating a field event than her aged father. For their part, ICTs are embedded in their local social, political, and infrastructural environment that influences their functioning, for example through limiting their use through national and workplace regulations.

In the conclusion, chapter 7, I connect the threads of the thesis to answer the questions posed in the introduction. I reiterate that children living abroad, their parents in Kerala, and ICTs are involved in doing care at a distance through transnational care collectives, by engaging in the practices of calling, taking care of ICTs, and involving other people in the collective. Additionally, I highlight the role of money in shaping migration and sending remittances as care practices. As they reshape filial obligations in a transnational context, ICTs and money transform the norms of what is ‘good care’ and who are ‘good children,’ particularly ‘good daughters.’ The inclusion of ICTs and money in care has implications for policy making on aging and migration in India. For example, in India, policy makers could encourage the recognition of elderly people as ICT users and work against the stigmatization of migrating nurses as abandoning their elderly parents. Furthermore, taking ICTs seriously as agents has implications for ethnographic methodology. Including ICTs in the practice of fieldwork demands that ethnographers pay close attention to how ICTs shape their field, their relations with their study participants and the data they collect. In its exploration of the role of ICTs in care and fieldwork through material semiotics, this thesis is an example of an interface of anthropology and STS.

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SAMENVATTING Hoe verandert zorg binnen de familie wanneer deze op afstand wordt verleend, met behulp van alledaagse informatie- en communicatietechnologieën (ICT’s) zoals mobiele telefoons en webcams? Ik onderzoek hoe intergenerationele zorg op afstand wordt verleend, door volwassen kinderen die naar het buitenland emigreren voor werk als professionele verpleegundige terwijl hun ouders in India blijven. In dit proefschrift beantwoord ik deze vraag op basis van acht maanden etnografisch onderzoek in India en Oman, aangevuld met interviews en participerende observatie via ICT’s met mensen die naar het buitenland zijn verhuisd. In mijn analyse maak ik gebruik van ik materiële semiotiek, een benadering van wetenschaps- en technologiestudies (STS) waarmee ik de zorg kan onderzoeken als verzameling van praktijken waarbij niet alleen mensen, maar ook technologieën betrokken zijn. Dit geeft inzicht in de vraag wat zorgverlening op afstand inhoudt en hoe alledaagse technologieën deze zorg mede vormgeven.

In hoofdstuk 2 wordt de visie op arbeidsmigratie als ‘het achterlaten van de oudere’ kritisch besproken en betoog ik dat in Kerala, vooral onder Syrische christenen, migratie juist gezien kan worden als een vorm van ouderenzorg. Opgeleid worden tot verpleegkundige om naar het buitenland te migreren voor werk is geen individuele beslissing, maar een beslissing waarbij het hele gezin betrokken is. Ouders moedigen hun kinderen, met name dochters, aan om verpleegkundige te worden en Engels te studeren om naar het buitenland te verhuizen. Bij voorkeur naar een Engelstalig land of naar een van de Golfstaten. Ik laat zien dat volwassen kinderen met een lagere sociaaleconomische status door de slechte arbeidskansen in Kerala pas ‘goede zorg” kunnen verlenen na hun migratie naar het buitenland. Zij zijn na hun migratie in staat om hun ouders geld te sturen om in de kosten van levensonderhoud en gezondheidszorg te voorzien. Geld, bijvoorbeeld ouderlijke investeringen in de opleiding en overmakingen van kinderen naar hun ouders, geeft dus vorm aan zorgverlening op afstand.

Bovendien wordt zorg verleend over de landsgrenzen heen, met behulp van vaste telefoons, mobiele telefoons en webcams. De ouders in India en hun kinderen in het buitenland vormen met deze technologieën wat ik noem ‘transnationale zorgcollectieven’ (transnational care collectives). Zorgpraktijken die om fysieke nabijheid vragen, zoals het bij elkaar verblijven en samen eten, zijn hierin niet meer mogelijk. Binnen transnationale zorgcollectieven wordt bellen via ICT een nieuwe zorgpraktijk. In elk transnationaal zorgcollectief wordt gesleuteld aan (tinkering) elkaar en aan ICT’s om een passende dynamiek te vinden waarin

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familieleden het contact met elkaar kunnen aangaan. Door dit knutselen en zoeken wordt bepaald welke ICT men gebruikt, wie wie belt, wanneer en hoe vaak er wordt gebeld. Net zoals we met zorg aansluiten op de smaak van elk gezinslid bij het bereiden van hun lievelingseten, zo is het net zo belangrijk om aan te sluiten op elkaars voorkeuren bij het bellen.

Als bellen een zorgpraktijk is, wat is dan nodig om deze zorg als ‘goed’ te beschouwen? In hoofdstuk 3 laat ik zien dat in transnationale zorgcollectieven ‘goede zorg’ samenhangt met de frequentie waarmee men belt. Gezinnen in mijn studie gaven ‘dagelijks telefoneren’ vaak als voorbeeld van goede zorg. De kinderen en hun ouders stelden de ‘juiste’ frequentie van telefoneren vast door dit samen uit te proberen. De onderlinge overeenstemming met betrekking tot de belfrequentie weerspiegelde de hechtheid van de relatie tussen de ouders en kinderen zoals die was vóór de migratie: hoe hechter de band, hoe vaker men belt. Uitzoeken wat de ‘juiste’ belfrequentie is kan ook voor enige spanning zorgen, omdat men met nieuwe communicatievormen en -patronen moet leren communiceren.

Het dagelijks bellen is niet bedoeld om informatie uit te wisselen, maar biedt de familieleden de gelegenheid om, op afstand, hun dagelijks leven met elkaar te delen. Door een vergelijking te maken tussen veelvuldig bellen via de telefoon en het communiceren via de webcam laat ik zien dat mensen op verschillende manieren op verschillende apparaten ‘samen zijn.’ Aan de telefoon praat men over alledaagse details van het dagelijks leven, zoals; wat ze hebben gedaan, hoe het gaat met de dieren en de planten rondom hun huis en welke nieuwtjes er is in hun buurt en de kerk rondgaan. Terwijl aan de telefoon stiltes opgevuld worden met dergelijke details, is er via de webcam ruimte voor stilte, waardoor de mensen ‘samen tijd kunnen doorbrengen’ zonder noodzakelijkerwijs te praten of zelfs elkaar constant aan te kijken. Op deze manier wordt zorg op afstand in de familie, zowel in de vorm als de inhoud, gevormd door ICT’s.

In hoofdstuk 4 beschrijf ik hoe, in de patriarchale Syrische christelijke families in Kerala waar de verpleegkundigen oorspronkelijk vandaan komen, het transnationale zorgcollectief mede vormgeeft wat het betekent om ‘een goede dochter’ te zijn. Volgens de conventionele praktijken van ouderenzorg in India, is de belangrijkste plicht van een dochter jegens haar ouders zo snel mogelijk te trouwen. Met het huwelijk krijgt een vrouw de verantwoordelijkheid voor de zorg voor haar schoonouders. In het transnationale zorgcollectief krijgen de taken van dochters echter een nieuwe vorm, zowel door geld als door ICT’s. De ouders van de verpleegkundigen brengen veel offers wanneer zij de opleiding tot verpleegkundige voor hun kinderen financieren. Het spreken over ‘offers brengen’

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en het ‘lijden’ van de ouders kweekt een emotionele verplichting bij de kinderen om het ouderlijk lijden te compenseren door naar het buitenland te emigreren, geld naar hun ouders over te maken, hen jaarlijks te bezoeken en ze dagelijks te bellen. Deze praktijken staan op gespannen voet met de normen en verwachtingen van het patriarchale verwantschapssysteem van de Syrisch-christelijke omgeving waar de kinderen oorspronkelijk vandaan komen. De nieuwe taken en verplichtingen van dochters beïnvloeden ook de positie van mannen, in het bijzonder die van echtgenoten van verpleegsters, die de praktische zorg voor hun schoonouders op zich nemen.

Hoofdstuk 5 beschrijft, in de vorm van een blogpost, een verhaal dat als aanvulling fungeert op eerdere hoofdstukken over het transnationale zorgcollectief. Het verhaal beschrijft een gezin van vijf broers en zussen, verspreid over de wereld, en hun moeder die lijdt aan ernstige dementie. In eerste instantie ging ik ervan uit dat de kinderen in dit gezin, met name een dochter die verpleegster is in de VS, geen zorgcollectief met hun moeder kunnen vormen, omdat dementie het telefoneren bemoeilijkt. Het gezin vormt desalniettemin een collectief, waarin de dynamiek wordt medegevormd door de dementie zelf. Het verhaal laat de worsteling zien van het verlenen van zorg op afstand, wanneer familierelaties al moeilijk waren voor de migratie en nog eens verergerd worden door de ernstige ziekte van de ouder die praktische zorg behoeft.

In hoofdstuk 6 ga ik in op de rol van ICT’s bij het doen van etnografisch veldwerk. Ik laat zien dat de gebruik van ICT’s in het veldwerk, met name in het afnemen van interviews en het doen van observaties via de telefoon en de webcam, invloed heeft de praktijk van het veldwerk, waarbij met name het idee van de (geografische) afbakening ‘het veld’ als locatie (field site) zijn vanzelfsprekendheid verliest. Om rekenschap af te leggen van de verschillende velden die simultaan tot stand gebracht worden – geco-creeërd met de informanten, maar ook met de gebruikte ICT’s – stel ik voor om het begrip ‘field event’ te gebruiken. Deze term benadrukt de invloed van ICT’s bij het veldwerk, bijvoorbeeld in het mede vormgeven van wat voor soort gegevens de etnograaf kan verzamelen maar ook door de wijze waarop sociale hiërarchieën van geslacht en leeftijd kunnen worden ontwricht. Een jongere dochter kan bijvoorbeeld meer controle of invloed hebben op het veld-event dan haar ouder wordende vader, doordat zij over meer technologische vaardigheden en kennis beschikt. Tegelijkertijd zijn ICT’s ingebed in hun lokale sociale, politieke en infrastructurele context die ook hun functioneren beïnvloedt, bijvoorbeeld als hun gebruik beperkt wordt door nationale- en werkplek-reglementen.

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In het concluderende hoofdstuk 7 verbind ik de verschillende voorgaande hoofdstukken met elkaar om de vragen gesteld in de inleiding van het proefschrift te beantwoorden. Ik vat samen hoe kinderen in het buitenland, hun ouders in Kerala en ICT’s allen betrokken zijn bij het verlenen van zorg op afstand, via transnationale zorgcollectieven, door deel te nemen aan de praktijken van bellen, zorgen voor ICT en het betrekken van andere mensen in het collectief. Daarnaast belicht ik de rol van geld bij het migreren naar het buitenland en de zorgpraktijk van het overmaken van geld naar het land van herkomst. De verplichtingen van kinderen in een transnationale context krijgen en nieuwe vorm door geld en het gebruik van ICT’s, en daarmee wijzigen ook de normen van wat ‘goede zorg’ is en wat het betekent om een 'goed kind' te zijn en met name een ‘goede dochter.’ De rol van ICT’s en geld in de zorg heeft beleidsimplicaties met betrekking tot ouderen en migratie in India. Bijvoorbeeld, in India kunnen beleidsmakers de erkenning van ouderen als ICT-gebruikers aanmoedigen en stigmatisering van migrerende verpleegkundigen tegengaan. Bovendien heeft het nemen van ICT’s als agenten implicaties voor de etnografische methodologie. Het opnemen van ICT’s in de praktijk van veldwerk vereist dat etnografen veel aandacht besteden aan hoe ICT’s hun vakgebied vormen, aan hun relaties met hun studiedeelnemers en aan de gegevens die zij verzamelen. Met dit onderzoek naar de rol van ICT’s in de zorg en in veldwerk is dit proefschrift, gebruikmakend van materiële semiotiek, een voorbeeld van een ‘interface’ tussen antropologie en STS.

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LIST OF THESIS-BASED PUBLICATIONS Journal articles 2019 Ahlin, Tanja, and Kasturi Sen. “Shifting Duties: Enacting ‘Good Daughters’ Through

Elder Care Practices in Transnational Families from Kerala, South India.” Gender, Place and Culture (online first). doi:10.1080/0966369X.2019.1681368

2019 Ahlin, Tanja, and Fangfang Li. “From Field Sites to Field Events: Creating the field with

Information and Communication Technologies (ICTs).” Medicine, Anthropology and Theory 6(2): 1-24. doi.org/10.17157/mat.6.2.655

2018 Ahlin, Tanja. “Frequent Callers: ‘Good care’ with ICTs in Indian Transnational Families.” Medical Anthropology (online first). https://doi.org/10.1080/01459740.2018.1532424 Video abstract: https://vimeo.com/304097146

2018 Ahlin, Tanja. Only Near is Dear? Doing Elderly Care with Everyday ICTs in Indian Transnational Families.” Medical Anthropology Quarterly 32 (1):85-102. https://doi.org/10.1111/maq.12404

Book chapters 2018 Ahlin, Tanja. “Intergenerational Reciprocity in Indian Transnational Families.” In

Anthropological Perspectives of Solidarity and Reciprocity, edited by P. Simonič, 145-57. Ljubljana: Ljubljana University Press, Faculty of Arts.

2016 Ahlin, Tanja. “E-care in Kerala.” In The Routledge Handbook of Medical Anthropology in the

21st Century, edited by L. Manderson, A. Hardon and E. Cartwright, 171-5. Abingdon: Routledge.

Ahlin, Tanja. “Care by Means of everyday Information and Communication Technologies (ICTs) in Indian Transnational Families.” In Approaches to Ageing, edited by C. Brosius and R. Mandoki. Heidelberg: Heidelberg University Press. Forthcoming. Ahlin Tanja. “The Unseen Care Work of Nurses from Kerala.” In “Who Cares? Health Workers, Care Extraction and Struggles over Health Care Work in India”, edited by M. John and C. Wichterich. New Delhi: Zubaan. Forthcoming.

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Non-peer reviewed publications / Media 2019 Ahlin, Tanja. “How Indians Who Migrate Abroad Take Care of Their Ageing Parents.”

Madras Courier. August 23. https://madrascourier.com/opinion/how-indians-who-migrate-abroad-care-for-their-ageing-parents/

2019 Ahlin, Tanja. “Disrupted Connections: On Participation in Caring for a Mother with

Dementia.” Somatosphere. Published online April 2. http://somatosphere.net/2019/disrupted-connections-on-participation-in-caring-for-a-mother-with-dementia.html

2019 Ahlin, Tanja. “Digital Elder Care: On Mobile Phones and Webcams in Indian

Transnational Families.” Anthropology News. June 10. http://www.anthropology-news.org/index.php/2019/05/25/digital-elder-care

2016 Ahlin, Tanja. “#Aging and #technology: Whose Concerns?” AllegraLab, December 24.

http://allegralaboratory.net/ageing-and-technology-whose-concerns/ 2015 Ahlin, Tanja. “The Gift of Panties: Protecting One Woman at a Time.” The Huffington

Post, January 5, http://www.huffingtonpost.in/tanja-ahlin-/the-gift-of-panties-prote_b_6409934.html#

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