Caregiving as mobility constraint and opportunity: married daughters providing end of life care in northern Ghana

Abstract

In the global south where care services are sparse and familial care remains practically and socially important, end of life care often occurs within families. Furthermore, in health care related policy development, care is often assumed to be ensured by ‘traditional’ norms of extended family relationships. In this context, the demands of providing care may require care providers to relocate, as well as reorganize their everyday responsibilities. This article contributes to geographies of care by offering an examination of the mobility constraints experienced by married and externally-resident daughters seeking to provide end of life care to a parent in northern Ghana. Drawing on ethnographic research, I examine how particular familial relationships are embedded with socially constructed labour obligations, leading to conflicting responsibilities at a parent’s end of life. I then consider how a woman as a daughter works to overcome these constraints to provide end of life care. I conclude that understanding the mobility of care providers can contribute to avoiding potentially damaging assumptions of ‘traditional’ norms of care and is an important consideration towards understanding the geographies of care in the rural global south.

Résumé

Dans l’hémisphère sud où les services de soins sont rares et où les soins familiaux restent importants pratiquement et socialement parlant, les soins de fin de vie se passent souvent en famille. De plus, dans la politique de développement des services de santé, il est présumé que les soins sont assurés selon les normes « traditionnelles » des rapports de la famille élargie. Dans ce contexte, les exigences d’apports de soins peuvent nécessiter que les donneurs de soins déménagent et qu’ils réorganisent leurs responsabilités quotidiennes. Cet article contribue aux géographies des soins en proposant une analyse des contraintes de mobilité dont les filles mariées et vivant à l’extérieur font l’expérience dans le but d’apporter des soins à un parent en fin de vie dans le nord du Ghana. En m’appuyant sur la recherche ethnographique, j’examine comment certaines relations familiales sont inscrites dans les obligations de travail construites socialement, menant à des responsabilités conflictuelles à la fin de vie d’un parent. Je considère ensuite comment opère une femme en tant que fille pour surmonter ces contraintes pour apporter les soins de fin de vie. Je conclus que comprendre la mobilité des pourvoyeurs de soins peut contribuer à éviter des hypothèses potentiellement préjudiciables sur les normes « traditionnelles » de soins et est à considérer comme une chose importante pour comprendre les géographies des soins dans l’hémisphère sud rurale.

Resumen

En el hemisferio sur, donde los servicios de atención son escasos y el cuidado familiar se considera como algo práctica y socialmente importante, el cuidado a personas que se encuentran al final de su vida a menudo es realizado por las propias familias. Es más, en el desarrollo de la política de salud, a menudo se asume que el cuidado está asegurado por las normas ‘tradicionales’ de las relaciones familiares lejanas. En este contexto, las demandas del cuidado pueden requerir que los cuidadores se trasladen, así como también que reorganicen sus responsabilidades diarias. Este artículo contribuye a las geografías de cuidado, ofreciendo un examen de las limitaciones de movilidad experimentadas por las hijas casadas y externamente residentes que buscan proporcionar cuidados al final de la vida de un padre en el norte de Ghana. Basándose en la investigación etnográfica, este trabajo examina como relaciones familiares particulares forman parte de las obligaciones laborales construidas socialmente, lo que lleva a cargar con responsabilidades conflictivas al final de la vida de un padre. A continuación, se considera como una mujer como hija trabaja para superar estas limitaciones para proporcionar cuidados al final de la vida. La conclusión es que la comprensión de la movilidad de los cuidadores puede contribuir a evitar suposiciones potencialmente dañinas de las normas ‘tradicionales’ de la atención y es una consideración importante hacia la comprensión de las geografías de cuidado en los países del sur rural.

Keywords:

• Mobility
• care
• end of life
• intergenerational relationships
• Ghana

Mots clés:

• mobilité
• soins
• fin de vie
• relations intergénérationnelles
• Ghana

Palabras clave:

• movilidad
• cuidado
• fin de la vida
• relaciones intergeneracionales
• Ghana

Acknowledgements

I would like to thank the people of Binalobdo for welcoming me into their community and into their homes. I would also like to thank the reviewers for their helpful comments and Dick Gilbreath at the University of Kentucky for creating the map of the research area.

Notes

1. Focus group interviews were conducted by the research assistant in Likpakpaln. Audio recordings were subsequently re-recorded by the researcher with an English translation provided by the assistant. This second recording was then transcribed by the researcher (for additional details, see Hanrahan, 2015a).

2. All direct quotes reflect the in situ translation provided by the research assistant. Where direct quotes are used, interviews were recorded and transcribed by the researcher. The quotes do not reflect an exact replication of the words of the speaker, but are an attempt to interpret the meaning of their statements to the best of our abilities. Conversations that were not audio-recorded, but interpreted in situ with notes taken, are not directly quoted.

3. Pseudonyms are used for all participants represented in this work.

4. Chronological age was not known to any of these participants, and is not used as an identifying factor. Participants were identified as ‘upininkpi’ (old woman) and ‘ujaninkpi’ (old man) during the course of household surveys and focus group interviews; self-identification was confirmed in personal interviews.

5. The number of interviews conducted with a participant varied in accordance to their interest in participating in the study, their physical well-being, lifespan, and their interest in developing a relationship with the researcher.

6. Nyaa Matulbi’s experiences of her declining mental well-being included believing people in her family and community were accusing her of witchcraft. While the family was initially concerned about these reports from Nyaa Matulbi, they ultimately determined she was suffering from mental changes they attributed to old age. Connections between witchcraft and old age – particularly old women – in Africa are well documented (e.g. Nadel, 1952; Oppong, 2006; van der Geest, 2002a).

7. It is important to note here that Nyaa Matulbi's accounts of the end of life care received by others did not necessarily coincide with how that care was perceived by its recipients.