Precarity, Assemblages, and Indonesian Elder Care

ABSTRACT

The provision (or failure) of care reflects and produces vulnerability in old age. Reliable and appropriate care widely affects the imagination of “good care” of older Indonesians in North Sulawesi. Yet, their striving for better life goes with the growing chronification of conditions and processes with unpredictable endings. Three factors shape such uncertainty in elder care in North Sulawesi: (1) unsustainable, fragile care arrangements; (2) progressive-degenerative non-communicable diseases and aging impairments; and (3) structural insecurity in elder care and health-care institutions. Older persons mitigate the degree of chronifying care uncertainty by expanding social spaces, but often in normatively less accepted ways.

KEYWORDS:

• Indonesia
• care assemblages
• chronic diseases
• chronification
• elder care
• uncertainty

Acknowledgments

The author wishes to thank the editors of this Special Issue, the three anonymous reviewers and Medical Anthropology’s editors for their substantial comments and suggestions. I would like to give thanks to my Indonesian collaborators at “Sam Ratulangi” University (Manado, North Sulawesi) for their full commitment, and to the older Indonesians for their warmth and hospitality.

Notes

1. My understanding of “chronicity” encompasses the dimension of point in time, duration and temporal origin as well as the dynamics of particular events, procedures, and courses from a time perspective.

2. The lower age limit of 60 years in this study corresponds to the official Indonesian age definition for older people or lansia (an acronym for [orang] lanjut usia: [person of] advanced age) (Department of Social Affairs 2003). This purely numerical bar to inclusion was applied for methodological reasons.

3. This normative concept of “triangle of uncertainty” is constituted of a social uncertainty (“filial piety and kinship obligations no longer assured”), an economic uncertainty (“customary material and financial support systems no longer reliable”) and a health uncertainty (“increasing vulnerability to chronic non-communicable diseases and degenerative disorders through increased life expectancy, changing life styles and socio-economic conditions”) (van Eeuwijk 2006:63).

4. Adat refers to the unwritten, mostly uncodified rules of conduct and thus serves as customary practice in Indonesian society. I refer in this article to the Minahasa and Sangihe adat, which represent two ethnicities in North Sulawesi.

5. I found only older sisters as same-sex intragenerational elder care arrangement in this study.

Additional information

Funding

This work was supported by research grants from the Swiss National Science Foundation (SNSF) in Bern (Switzerland).

Notes on contributors

Peter van Eeuwijk

Peter van Eeuwijk is senior lecturer and researcher in Social Anthropology at the Institute of Social Anthropology of the University of Basel, the Swiss Tropical and Public Health Institute, Basel, Switzerland, and the Department of Social Anthropology and Cultural Studies of the University of Zurich, Switzerland. Since 2000 he has specialized in the study of aging, health and care in Indonesia and Tanzania.