Advancing the Value of Ethnography

Reimagining Livelihoods: An Ethnographic Inquiry into Anticipation, Agency, and Reflexivity as India’s Impact Ecosystem Responds to Post-Pandemic Rebuilding

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2021 EPIC Proceedings pp 259–281, ISSN 1559-8918, https://epicpeople.org/reimagining-livelihoods-impact-ecosystem/

The COVID19 induced lockdown in India and consequent migration of workers severely affected the economy. When the migrants returned to urban areas, newer challenges surfaced around the scale and nature of jobs on offer, as well as the skills and aspirations of workers. In this paper, we follow a social impact project focused on livelihoods and post pandemic rebuilding, to explore the trails of ethnography and how its engagement along multiple networks shapes its possibilities as a research method that helps foreground emic perspectives. In doing so, we analyse agencies and social relations from the field, and their role in shaping project imaginaries. Anchored in original, long-term participatory ethnographic research, our paper thinks alongside Appadurai (2013) to surmise that anticipation is imbricated in the coming together of a grounds-up ‘ethics of possibility’ and a top-down ‘ethics of probability’. Importantly, we turn to Actor-Network Theory as a framework to understand the multiple assemblages in our research field which (continue to) challenge existing knowledge practices and open up new lines of inquiry for ascertaining emergent areas of research and innovation. Such coeval realisations of aspirations and resources are evidenced on multiple occasions as we engage with designers, skilling experts, entrepreneurs, and technologists. These range from beauticians in peri urban areas following the country’s leading Instagram influencers to keep themselves abreast of the latest trends in metropolitan cities as a way of compressing spatial and temporal barriers (Field Notes 2020), to delivery boys who found meaning in working as gig-workers even though it implied precarity, and telemedicine entrepreneurs who realized that factoring in the social (of community health workers who they worked with) in the sense of integrating biomedical responses to the pandemic was essential for the success of their technological interventions (Field Notes 2021; Burgess and Horii 2012). Thus, our paper argues that future making as at once a means and an end is ‘not just a technical or neutral space’ but a ‘cultural fact’ (Appadurai 2013).

Keywords: Livelihoods, Anticipation, Reflexivity, Ethnography, Emic, Future-making

INTRODUCTION

Debashish has no time for dreams. A store helper turns to working as an ePharmacy delivery worker. He scrolls through job sites on his phone and calls companies directly to land gigs.

Figure 1: “Even dreaming comes at a price”, said Debashish. Illustration by Vidya Gopal

On a sultry June evening, we were to speak with Debashish Biswal (name changed), a delivery worker with a well-known pharmaceutical chain which had ventured into the ePharmacy business. Dialling his number, we were worried about how the conversation would go. It had barely been three months since the countrywide COVID19 lockdown was announced, the repercussions of which continued to be acutely felt by gig workers like him.

In his mid-twenties, Kolkata-based Debashish had begun his career about three years ago in retail, at a city store. The promise of a good salary had him change track to last mile delivery, with one of India’s most successful ecommerce companies. Yet, the branch he was attached to did not do too well and when the prospect of a transfer presented itself, he joined an eGrocery company as a member of their delivery staff even though the pay was lower. And from there he had moved to ePharmacy delivery just before the lockdown.

“I have a cousin brother who is also a delivery boy. I consult and take advice from him. OLX, Quickr, and Facebook have forums which I track for job opportunities. Sometimes I call companies directly.” (Field Notes 2020)

Our conversation shifted to careers. Given the pandemic and its unpredictability on one hand, and the fact that he had already spent up to three years as a last mile delivery worker on the other, we asked if he had considered upskilling. Was there a particular training programme or course which he might be interested in?

“I have an undergraduate degree in education and teaching from the West Bengal State University. I wanted to do an MA, earn my Doctorate, and then become a teacher. I even considered a career in hotel management at one point as an alternative, but could not pursue it. My father is no more. And at home I have my mother and two younger brothers, one of whom is still studying. I have to provide (for them). Sochne mein bhi paisa lagta hai (even dreaming comes at a price).” (Field Notes 2020)

After a pause, Debashish continued.

“As part of my job now, I am required to speak with pharmacists. In the process, I get to learn about medicines. The company might not have given me any training on medicines. Yet, I learn from pharmacy store owners and store hands themselves. In fact, customers ask me about the medicines I deliver, and I have learnt to be able to address their queries myself. Medicine ka composition samajh mein aa jayega toh achha hai… customers ko bata sakte hain (of course, it would be good if I knew the composition of medicines, for I could also advise customers). With this learning, I hope to one day open my own pharmacy.” (Field Notes 2020)

Appadurai (2013, 285-300) advances that an anthropological treatment of future-making might factor in ideas of the “good life” rooted in “the search for prosperity, mobility, and voice”, which he alludes to as the “capacity to aspire”. This, he posits, is an inherently social and cultural construct which draws on “local systems of value, meaning, communication, and dissent” to configure and reconfigure future imaginaries and their negotiations in a continuous and incomplete endeavour: in short, anticipation (Appadurai 2013). Ultimately, the capacity to aspire and anticipation itself is framed within affective negotiations between a bottom-up “ethics of possibility” (effectively, the emic socialities, or agencies and social relations which permit an expansion of hope) and a top-down “ethics of probability” (essentially, those etic artefacts of risk, calculation, and technocracy which serve to define what can and what can not be). This then, is why “those who seek to design the future, or even to design for the future” must recognise that “the future is a cultural fact” (Appadurai 2013).

The first nationwide COVID19 pandemic-induced lockdown triggered an exodus of migrant workers from India’s cities over March/April 2020, and brought into sharp relief the “precarious transitions” (Roy et al. 2021) of those employed in the informal and gig economies. As markets reopened and migrant workers returned to urban areas, still newer challenges emerged around the scale (numbers) and nature (different kinds) of jobs on offer to them, their skills and availability (BW People 2020), and the systemic deepening of their social and economic vulnerabilities (Srivastava 2020). In fact, these continue to be further compounded by a recrudescent pandemic and its attendant uncertainties.

As at once anthropologists as well as inhabitants of spaces which we shared with the socially and economically affected, we turned to leveraging the disciplinary canon and putting research to use in collaboration with impact sector specialists. Our collective starting point was to study and design jobs which returning migrant workers as well as informal sector and gig economy workers could perform in the scenarios being defined by and through the pandemic and lockdowns, as well as the skills needed to do those jobs well. The job was thus our construction of how the “good life” (Appadurai 2013) might be imagined by those we were studying. And the intent of our collaborative endeavour was for the associated data assemblages of jobs and skills to be hosted on a technology platform which might be used by workers and their potential employers alike to realise them. In this manner, our response fell squarely within the realm of the digital solutionism which emerged as a response to the pandemic and the attendant crisis over the summer of 2020, where administrators, employers, skilling organizations and impact entrepreneurs alike turned to ontological imaginations resident at the intersection of data, platforms, and technologies, to enable speedy and at-scale matching of job demands and availability/skills of labour supply.

Debashish is thinking beyond his current job. ePharmacy delivery worker at a pharmacy, while talking to the pharmacist over the counter is dreaming of learning about medicines and opening his own pharmacy.

Figure 2: Debashish was not seeking to be a better delivery worker, but wanting to learn about medicines so as to open his own pharmacy. Illustration by Vidya Gopal

As Debashish’s example shows, our starting efforts were anchored in a top-down view manifestly as a skill development platform predicated on the job. Yet notwithstanding the limitations of capital (not having pursued teaching or hotel management because of financial constraints), this was sought to be negotiated by him through imaginaries of the “good life” (Appadurai 2013) as lying beyond the job, in the sense of the far broader notion of the livelihood (not seeking to be a better delivery worker, but wanting to learn about medicines so as to open his own pharmacy). Any intervention by us, whether sanctioned by or through technology, needed to therefore be situated in both the lived everyday as well as the incomplete localities of those whom we sought to study. And as we show in this paper, ethnographic understandings rooted in reflexive considerations (what is our research really about?, who is it helping?) allowed our project and its charter to evolve in tune with their “capacity to aspire”, as our gaze shifted from jobs to livelihoods, and from skill development to an enablement exercise. In the process, our paper serves to demonstrate how ethnography and its vocabulary can help frame the design of approaches which albeit rooted in the digital do not privilege technology alone, but instead render visible and draw upon evolving understandings and appreciations of the socialities of those we design for.

Field, Methods, And Research Questions

Our project is a continuing endeavour, as we cover different sectors such as telemedicine, delivery and logistics, home utilities, as well as beauty and health. To the extent that we (have) sought to trace how livelihoods are being reimagined in each sector, yet as part of a broader post- and in- pandemic rebuilding imaginary, our research field (has) changed from one sector to the other.

Taking our work in the telemedicine sector as an example, we note how our inquiries of the community health worker as a livelihood led us to trace teleconsultation as an activity (between the doctor and the patient), a process (including elements such as scheduling, using the mobile or laptop based app, or following up with a second consultation or even a second opinion), and an object (as defined by the app, or the wellness centres in rural or semi urban settings with their audio-visual equipment to facilitate teleconsultations for patients). While on one hand, we sought to understand the agencies of the network of stakeholders both human and non-human (as we explain later in this paper in reference to Latour’s Actor-Network Theory), we also considered various sites of participation and observation within the telemedicine sector. In other words, our research field was multi-sited, where our approach was to “follow the object”, as for example where teleconsultation was the object and its circulation is what we chose to follow (Marcus 1995). At the same time, each of the sites were bounded geographically (the city of Bangalore as one site, a peri-urban neighbourhood of Mumbai as the second site), in recognition of the fact that each presented an “incomplete window onto complexity” (Candea 2007).

In telemedicine as in the case of each of our sector-specific research fields, the pandemic’s realities pushed us to adopt and adapt various remote ethnographic methods such as ethnographic interviewing, day-in-the-life studies using photo elicitation over WhatsApp, public culture analyses (Appadurai and Breckenridge 1988), and embodiment or first-person perspectives. Yet it behooves us to clarify that this paper is in fact, a Frazerian reflection on our research across different sectors. It is imbricated in at once our positionality as researchers of those affected by crisis, the phenomenological materialization of being affected by crisis ourselves, as well as a reflexivity born of being “an-other” (Sarukkai 1997), in the sense of being members of a broader Bangalore-based team of designers, skilling experts, entrepreneurs, and technologists which sought to resolve the crisis. And so, even as our paper is moored in autoethnographic reflections on the continuing, long-term participatory ethnographic research which we have been involved in at a site of production (Hall 1999) (in the form of a technology-enabled attempt at addressing the crisis of 2020), it oscillates in its reading of subject and object (is it the informal sector worker, the designer, or the researcher?) and equally between analysis (why and how has it come to be? have our methods and notions of the “good life” (Appadurai 2013) elided the agency of our informants?) and synthesis (what can be done?). And thus, the questions we have sought to root this paper in, are as under:

  1. How is technology/digital constituted by and constitutive of the imaginaries of new roles and associated skills for migrant or informal sector workers?
  2. Who are the knowledge-actors guiding the realization of these imaginaries? Which aspects are made visible by their inherent knowledge practices? What elements are rendered invisible in the design ideologies?
  3. How does the reproduction of social relations, the agencies of the field, and negotiations in the everyday influence the project of future-making as an emergent “cultural fact” (Appadurai 2013)?
  4. And how does this in turn, shift the epistemology of future-making among the many stakeholders, including the researchers themselves?

Reading This Paper

In the first chapter, we describe the collective project/endeavour we were part of and which came to be known first as Reimagined Livelihoods (wherefrom this paper draws inspiration for its title) and subsequently as Upjeevika (Upjeevika 2021) (translating from Hindi to occupation or livelihood). We trace its evolution, and highlight how ethnography helped foreground an emic perspective.

Our second chapter has us delve deeper into how agencies and social relations from the field influenced project imaginaries and design ideologies. And in our third and final chapter, we examine the turns and resets in epistemological perspectives and ontological realizations, as the project evolved. Taken together, we note how such negotiations and shape-shifting respectively, aided the coeval realizations of aspirations and resources.

As we conclude, we return to our principal argument that adopting an emic perspective permits anticipation to be understood as an engagement with an emerging field, and to be framed as a “cultural fact” (Appadurai 2013). For the future is not only always up for change but is also continually being challenged through reconfiguration and reterritorialization. And ethnographic readings can help identify such moves and trends.

CHAPTER 1: THE IMAGINARIES OF REBUILDING

The reimagined livelihoods endeavour owes its origins to a series of “thought starters” as posts on social media which were initiated by two impact sector professionals in the early months of the pandemic in India (Vasudevan and Kaushal 2020a). With their individual focus on communications and skill training, they sought to use the updates (titled “Reimagining Livelihoods to DeCoronize India”) to investigate and articulate the shifts in migrant worker jobs which could “enable aspirations of India’s informal workers in a post COVID-19 world” (Vasudevan and Kaushal 2020a). The distress engendered by the pandemic-induced lockdown, such as reverse migration, is well documented (Patel 2020) with visuals both disturbing and sobering. In particular, the informal sector was the most affected, with 71% of the demographic (or 91 million people) having lost their jobs by April 2020 (Vyas 2020).

While an exercise in future making, the initiative concomitantly sought to invoke an archetype of the past, in the form of Mahatma Gandhi’s economic philosophy of the “self-sufficient village” which emphasizes the need for meaningful employment in the rural economy, by creating infrastructure in the form of ‘village and cottage industries’ (Datta 2021). The updates variously realised and represented livelihoods as distinctly bounded jobs, different for rural and urban India (we will shortly return to this in greater detail). The envisaged shifts in job roles purported to lay the ground for reskilling and relearning, so as to “equip individuals in these job roles to be better prepared” (Vasudevan and Kaushal 2020a). The initiative invited “colleagues in the states, corporates, civil society organizations and urban communities” to support this tangible transition, and to “deCoronize” (Vasudevan and Kaushal 2020a).

Each of the posts as indicated in Figure 1 (Vasudevan and Kaushal 2020b) was job or role specific, carried infographics on industry and consumer trends that validated the market demand for that job, and outlined the persona or profile of a role holder in the form of demographic and socio-economic data (such as age, education, and salary). Finally, each post proposed what the job could look like in a pandemic reality, and the skills that might be needed to “future proof” (Vasudevan and Kaushal 2020b) them as livelihoods. Buoyed by the popular support it gathered, the initiators of the posts added that it was time to stop talking about job losses [in the present] and to start thinking about how jobs/work could be created for the most affected [in the future] (Field Notes 2020).

A social media post on the persona of an auto service technician, carrying infographics on the persona or profile of a role holder in the form of demographic and socio-economic data (such as age, education, and salary). A social media post on the role of an auto service technician, with infographics that clarify skills needed in line with how the role could be reimagined. A social media post on the evolving nature of the auto serary. There are infographics on industry and consumer trends that validate the market demand for that job.vice technician role, along a rural and urban bin

Figure 3 (Vasudevan and Kaushal 2020b): The thought starter posts of the reimagined livelihoods initiative, in the early days of the pandemic

Ethnography As A Way In

As consumers of social media content, our interest was piqued by how the persona of a role holder had been laid out, drawing on demographic and socio-economic data as facts. Reaching out to the authors of the posts, we tabled the need for understanding existing knowledge practices amongst the role holders before designing communications to support the initiative, as a methodological way in for the inclusion of emic, bottom-up views in the narratives. In the process, we sought to endorse the inclusion of the voices of the role holders, their lived realities, and their aspirations in the articulation of the persona. Our subsequent involvement in the project towards June 2020 thus marked the second phase of the initiative, with a weaving in of ethnography as a praxis.

Over the next few weeks, we started reaching out to migrant workers who had returned from cities, as well as informal workers in the cities who were delivering groceries and medicines as essential services during the lockdown. In light of the restrictions that the pandemic presented as also the distress across the country, we were conscious and mindful of the situation which these individuals and their families found themselves in. This had a bearing on our research methodology as well, and we sought to adopt channels that our interlocutors were familiar with, such as phone calls, WhatsApp chats in the vernacular, and mobile photography (serving as a record keeper of the everyday). Furthermore, these methods yielded oral, written, and visual artefacts as “cultural texts” (Geertz 1973) or meanings. These meanings informed our subsequent lines of inquiry, but more importantly, started challenging our own understanding of the context.

As a starting point, our own understandings had been shaped by studying the Reimagining Livelihoods project’s narratives and communication materials, interviews with the two impact sector professionals who had initiated it, as well as an analysis of the demographic and socio-economic data that had been foregrounded in the existing personas of the role holders. Our conversations with our research participants prompted a return to this material, where adopting an interpretive approach (in a Geertzian manner of sensemaking (Tholen 2018)) rendered visible the assumptions which the initiative had incorporated as a given on one hand, and brought into view its invisible negotiations on the other, in the manner which only a bottom-up emic gaze could unearth. As an example, the project had conceptualized the urban and the rural as having distinct permutations of how jobs/work could be created (Vasudevan and Kaushal 2020a). Furthermore, the reverse migration was envisioned as a finality, with a belief that “those who have moved back to their roots, may decide to stay there, either due to social pressures from their families or due to the inability of the urban ecosystem to absorb them back” (Vasudevan and Kaushal 2020a). And finally, the role holder was now divorced from the socialities of their workplaces which were once possible in a pre-pandemic era, and instead conceived as a “solopreneur”, as for example in the case of the auto service technician, whose job role was envisaged as shifting from service centre delivery to doorstep delivery (Vasudevan and Kaushal 2020b).

Back And Forth To Move Ahead

Our research organically led us down the path of a hermeneutic spiral (Tholen 2018), with each conversation challenging our notions and shaping our participant interactions. This new understanding helped shape how livelihoods came to be represented in the articulation of subsequent job roles. At the very least, as one of the two impact professionals pointed out, the voices “from the ground” (Field Notes 2020) were being included as aspirations and challenges of the individual role holders. Soon enough however, we realized that the meanings that individuals drew from their work often went beyond their jobs or livelihoods, and were a commentary on the larger socio-cultural realities that shaped their possibilities. These possibilities were not of livelihood alone, but of the social relations which governed them. They were indeed the possibilities of life itself. Furthermore, we noted that neither the urban, nor the rural was a terminal point or a final destination. This was corroborated by the fact that the migrants largely returned to the cities they had fled from, after the lockdown restrictions were lifted (Kumar 2020). Where most approaches to studying migration have adopted a structuralist approach, we advance that the issue of migration is one that involves moving lives. In short, migration covers a variety of life aspects, on account of the movement from one socio-cultural ecosystem to another. Thus, our ethnographic inquiries questioned the binary assumption of rural and urban livelihoods in the project thus far, and whether they could even be considered as being distinct.

Our conversations with electricians based in peri-urban areas of a city in central India, revealed that the aspirations of an urban livelihood were rooted in not the individual’s, but the family’s aspirations (such as quality education for the children), that supported the social goal of family mobility. Even within cities, migrants relied on existing (rural) kinship networks which had served to facilitate joint livelihoods, and were translated into their lived realities on how an individual found work, gained skills, and got support when in need. In this sense, livelihood was not an individual construct but rather, a social one.

And on a similar note, our conversations also made clear that the connections which the electricians had with their villages were inextricably linked to ownership of land and assets in the rural areas, without which, they were unwilling to move back for good. These insights led to fresh contexts, and a shift in the narratives that Reimagining Livelihoods subsequently adopted. In the articulation of emergent job roles for electricians, the distinction between urban and rural was called out as indicative (and therefore having a contingent meaning) and it was acknowledged that the roles should be viewed as a whole, as a reflection of the possibilities that were offered by the urban and rural ecosystems jointly (Figure 4) (Vasudevan and Kaushal 2020c). The contingent meaning has started to blur the boundaries of the binary.

Social media post describing the persona of an electrician in terms of aspirations and constraints in addition to demographics. Social media post describing the reimaginations of the role of an electrician beyond the job role, and in terms of the livelihood. Social media post describing the reimaginations of the role of an electrician differently for rural and urban areas, while recognising the social and cultural differences.

Figure 4 (Vasudevan and Kaushal 2020c): The thought starter posts of the reimagined livelihoods initiative, as ethnography was introduced

The Scale Of Imagination, And The Imagination Of Scale

These newer understandings in turn opened additional lines of inquiry. Considerations on how livelihoods might be made “future proof” (Vasudevan and Kaushal 2020b) led to a focus on skills and skilling. Not only were the existing skills being examined for continued relevance, but new skills such as hygiene and sanitization skills started entering the frames. The gaze had shifted from tracing individual skill progression, to skills that guaranteed reliance and sustainable livelihoods, as well as livelihoods rooted in the socio-cultural realities. Would for example, community or network-based skilling be more effective for electricians? How could training be imparted for skills and tasks which were tactile? A digital platform began to be visualised, as a repository of jobs/skills which could be accessed by workers, employers, and other members of the ecosystem to enable the livelihoods in question.

The reception of the social media updates inspired the imagination of a bigger scale of impact. The thought starters had yielded areas of opportunity for rebuilding, and with an influx of funds, a technology led narrative started to materialize. The pandemic had established the certainty of an uncertain future, with the livelihood and hunger crisis progressively intensifying as infection or caseload waves waxed and waned (Paliath 2021). This uncertainty brought technological solutionism in its wake, with the scale and speed of pandemic rebuilding being construed as necessary for impact. As we have noted elsewhere, in our study of the discourses and negotiations within the startup ecosystem in Bangalore over 2019, “scale begets scale”, where “with each subsequent stage of scaling-up, the necessary evidence was acquired as at once a qualification and an exercise in preparing for the forthcoming stage” (Saksena and Mohanty 2020). We can draw comparisons with how the imaginaries of rebuilding (as envisioned through and by the Reimagining Livelihoods project) transformed with scale. Funding was secured towards the end of 2020 and with it, the scale of imagination was amplified. A narrative of technology-led leapfrogging took centrestage. The intent of the initiative did not stop at merely galvanizing support, but turned towards seeding a social impact incubator which proffered “an ecosystem that can provide promising social enterprises with the skills, technology, community support, and market linkages they need to scale their impact” (Upjeevika 2021). The Reimagining Livelihoods project was rechristened as UpJeevika – Reimagining Livelihoods at Scale, and sought to leverage analytically grounded, anthropological interrogations of how livelihoods in specific sectors (such as telemedicine, delivery and logistics, and energy) were being “imagined, represented, negotiated, and experienced in the everyday”, to define mandates for innovation challenges that could source ideas and social enterprises for incubation (Upjeevika 2021).

This new scale also presented an opportunity for us to reflect upon our research, and reestablish our key considerations. In the process, and in a continuing endeavour, our study of subsequent livelihoods has thus come to be marked by the following:

  1. Studying considerations of the future as “cultural facts” (Appadurai 2013). For example, the construct of resilient livelihoods was now seen as imperative, to build readiness for the next crisis (Upjeevika 2021). And with these new imaginaries entering the narratives, what implications could they have for the lived realities of those whose livelihoods were at stake?
  2. Investigating the imaginaries of technology solutionism as building and augmenting the potential of impact. For example, the potential of livelihoods within telemedicine had to be studied across the value chains that defined its technological landscape (such as teleconsultation, eHealth, ePharmacy, and last-mile-telehealth). Within these frames, which of these technologies were being considered for matching providing better healthcare (as both reach and quality) with patient data privacy? And thus, where did the opportunities of rebuilding livelihoods at scale lie.
  3. Actively exploring the turn to actionable research, that is translating meaning to reflexive inquiries or “livelihood challenges” around which potential solutions from organizations and enterprises could be invited for “building livelihoods at scale” (Upjeevika 2021), whilst keeping in mind that migrant, informal, and gig worker socialities in India are “essentially composite and digitally immature communication ecologies” (Rangaswamy and Toyama 2006).

In this chapter, we have described how the starting point or impetus for the Reimagined Livelihoods project was to identify those jobs which returning migrant workers could turn to, as an immediate response to the reverse migration problem. As we have shown, the imaginaries of post-pandemic rebuilding evolved at the confluence of an inherently technological discourse and a comparatively low-resource/analog socialities. Thus, the focus of the project shifted first to the design of a skilling technology platform for various roles, and subsequently to the enablement of livelihoods and enterprise in different sectors (through the livelihoods challenge) informed in turn by ethnographic readings of the lived everyday and incomplete localities of the pandemic. In short, adopting an emic view which incorporated the socialities of migrant, informal and gig economy workers, catalysed the evolution of the project’s gaze from jobs, to skills, and finally to livelihoods.

CHAPTER 2: ETHNOGRAPHY AS NEGOTIATING THE NARRATIVES OF FUTURE-MAKING

Had he not said as much, we would have been hard pressed to guess from the Zoom video call alone that he was still studying for his medical degree. In his final semester, Ali (name changed) was volunteering with the local municipal authorities in Bangalore to triage COVID19 patients, advise treatment for them via teleconsultation, as well as conduct vaccination camps. Evident from the manner in which he shared his views, the experience had instilled a remarkable sense of confidence.

“Telemedicine is here to stay. There were network and connectivity problems last year, yes. And we had to turn to WhatsApp. But all of that has been addressed now. The larger worry is that most of the teleconsultation apps are just too complicated. The older doctors in particular find the whole process rather cumbersome. They have to boot the system, navigate the app, schedule the consultation… I mean, ultimately it would be simpler if the doctor could just talk to a patient.” (Field Notes 2021)

It was the month of May 2021, when India was in the midst of the COVID19 pandemic’s devastating second wave, and Bangalore itself was among the two cities recording the highest infection case counts (Dutta 2021). We ask how patients have found the turn to teleconsultation.

“It saves them time and money. And protects them from unwanted infections, and more so at a time like now. Yet they do need more convincing on a video consultation, than in person. And there’s also the rest of the household… the whole family gets involved. Sometimes, they ask questions for themselves as well. Before you know it, a fifteen minutes’ consultation has turned into a half-hour session.” (Field Notes 2021)

We are interrupted by a zealous phone call, which Ali excuses himself for. While the audio is muted, the camera-feed is still live. And we can discern that the call is quite the animated one.

“I’m sorry for that. I can’t exactly switch my phone off, you know. It is mostly about prescriptions… patients have doubts about the prescriptions. They call us or text us… Our privacy… we really do not have time… everyone expects us to be hooked to our phones… They keep calling us. We really don’t have time for ourselves. And all of this is not counted… it is a whole package deal that one teleconsultation session leads to.” (Field Notes 2021)

Although the COVID19 pandemic has focused public attention on telemedicine, the concept and its coeval practices such as teleconsultation, telediagnostics, and telehealth are not new in India (EY 2020). Critical analyses of its successes and failures in fact, have pointed to a need for considering factors such as connectivity and reliability (in low resource settings), tutoring (in the sense of improving the competence of healthcare professionals), and moulding the patients/beneficiaries (by increasing their self-efficacy and ensuring social support) (Chandwani, De, and Dwivedi 2018). And sitting alongside this is the anthropological understanding that responses to health are socially determined as opposed to merely being biomedical (Burgess and Horii 2012). In other words, a consideration of the socio-cultural logics of the telemedicine interventions become imperative.

In March/April 2021, the gaze of the Reimagined Livelihoods project shifted to the telemedicine sector. The community health worker was identified with a view to understanding how the livelihood could manifestly enable interventions such as teleconsultation. Our first ethnographic port of call included doctors and patients, as at once users of teleconsultation apps and platforms on one hand, and as members of the ecosystem who community health workers engaged with to drive the adoption of teleconsultation initiatives on the other. These encounters had us calibrate our approach in varied ways. As we have explained earlier in this paper, it became evident that we needed to “follow the object” (Marcus 1995), and thus trace the entanglements of a teleconsultation app/platform or initiative. Our field thus emerged as multi-sited, to cover healthcare actors engaging with a nascent teleconsultation platform. Furthermore, and as our interaction with Ali suggested, we expanded the field to encompass both direct and indirect users such as patients’ families (as multiple members of the family tended to participate in a consultation), members of the teams which scheduled and coordinated teleconsultations (to help doctors navigate the process), and even the designers of the app/platform themselves (how were they accounting for the interactions which lay outside of the app/platform-based teleconsultation itself?) (Field Notes 2021). The preliminary ethnographic interactions also informed our research questions as we sought to understand if and how the app/platform considered the competing constraints of connectivity, tutoring, and moulding (Chandwani, De, and Dwivedi 2018) and whether it proffered an opportunity for the community health worker. And finally, our research methods adapted to the low resource settings which the app/platforms themselves were being used in, as for example by resorting to asynchronous tools such as photo elicitation over WhatsApp.

Ethnography was thus not merely a methodology, but also an episteme which framed anticipation (what should the research focus on? how will this help? who will this help?) against the backdrop of considerations for success/failure of telemedicine, as “cultural facts” (Appadurai 2013). It anchored a questioning of the imaginaries of technological solutionism, by advancing that they were in fact social constructions with social, political, and environmental consequences, and where (thinking alongside Heidegger) we might view the design of an app/platform or intervention as the manifestation of one of manifold potentialities on offer (Heidegger 1977). The designers of the teleconsultation platform which had come to shape our field for example, alluded (in conversation with us) to how their proposition was “a teleclinic which helped translate remote diagnoses accurately for the doctor in the hospital” (Field Notes 2021), thereby privileging at once the doctor and the hospital, contra the patient. Furthermore, ethnographic readings also catalysed the realisation of actionable research, by situating “livelihood challenges” (Upjeevika 2021) in the lived realities of the teleconsultation app/platform. We note instances such as when platform glitches made patients question doctors and seek second opinions, or for example where both doctors and patients alike turned to human coordinators for a seamless consultation experience, or the fact that the consultation itself was a social affair in the sense that it mirrored the analogous practice of having a friend or family member accompany the patient for a doctor visit (Field Notes 2021), or even when patients demanded physical copies of prescriptions as a familiar and familial practice of keeping records of health history. These not only serve to shape and challenge the boundaries of the app/platform, but also reveal symbolically what technology is and is not. Equally importantly perhaps, they underline how anticipation was liable to being configured, negotiated, and reconfigured in a manner such that the potential solutions being invited from organizations and enterprises for “building livelihoods at scale” (Upjeevika 2021) and their socio-technological futures would come to occupy the “cracks and gaps” (Sundaram 2010) or the interstitialities of its constructions.

As a final point, we observe how the teleconsultation app/platform which came to structure our field furthered a rural-urban divide in terms of the meanings which its designers imagined patients and local doctors to be attaching to its use, built on assumed inadequacies of connectivity, tutoring, and moulding (Chandwani, De, and Dwivedi 2018) in rural areas alone (Field Notes 2021). In turn, this was seen as warranting a hub-and-spoke model in the design of how teleconsultation was delivered as a service, eliding the agency of users (Field Notes 2021). Here we are reminded of the Italian cultural theorist Paul Virilio and his engagement with technology and subjectivity. Rooted in the imageries of war and (resultant) automation and speed, Virilio argued that technology/speed only serves to marginalise the individual, in the form of a “subtle enslavement of the human being to ‘intelligent’ machines” (Virilio 1998). Yet, and as we have shown in this chapter, agencies and social relations from the field influenced both the field itself as well as project imaginaries. Ethnographic understandings helped counter the foregrounding of technology in design ideologies of the Reimagined Livelihoods project, by framing and reframing anticipation within the socio-cultural logics in which the technology was realised. In our next and final chapter, we interrogate these turns and resets.

CHAPTER 3: SHAPE-SHIFTING

“Using a slogan from ANT, you have ‘to follow the actors themselves’, that is try to catch up with their often wild innovations in order to learn from them what the collective existence has become in their hands, which methods they have elaborated to make it fit together, which accounts could best define the new associations that they have been forced to establish. If the sociology of the social works fine with what has been already assembled, it does not work so well to collect anew the participants in what is not—not yet—a sort of social realm” (Latour 2005)

In his seminal work, Reassembling the Social, Bruno Latour presents a compelling argument to view sociology as a sociology of associations where heterogeneous participants are actively engaged in assembling and “reassembling of the collective” (Latour 2005). He challenges the notion of the social as a “glue” or as a “homogenous thing”, and advances a consideration of the social as a “trail of associations between heterogeneous elements” that is ever laden with the possibilities of reassociation revealing new meanings, concepts, processes and organizations (Latour 2005). These associations can be further understood as novel and active connections among things are not inherently social, and in this manner, challenge the notion of social as a given or “a thing among other things” (Latour 2005). This necessitates a shift, from using “social explanation” as a shortcut, to instead determining the new associations that have taken shape, and in turn, the multiple ontologies that they reveal (Latour 2005). Latour urges us to not limit the “advance of the shape, size, heterogeneity, and combination of associations” but instead, trace the flows as they manifest themselves (Latour 2005). In this manner, Latour elucidates his interpretation of the extant Actor-Network Theory (ANT) and proffers three key considerations. Firstly, non-humans can be deemed as actors explicitly participating in these associations and thus, demonstrating active agency beyond any “symbolic or a naturalist type of causality” (Latour 2005). Secondly, no extant paradigm of a stable social is used to validate the trails and progressions, and finally, the intent remains firmly grounded in understanding the emergent concepts and associations. We infer then that any given epistemology or ontology can only be explained within a point in time suspension of the movements, before the movements from one association to the next resume again and the collective gets reassembled.

The collective agency of the assemblage. A network of different actors, the interactions of which are not linear.

Figure 5: The collective agency of the assemblage was challenging the knowledge practice. Illustration by Vidya Gopal

Thinking with ANT, we draw inspiration from Latham, McDonald and Reeves who, in their paper titled Following the Invisible Road Rules in the Field Using ANT for CTF, reference Latour to analyse the agency of a collective, that encompasses a heterogeneous network of humans, non-humans and objects, and the role of such an agency in making “farmers [in an agricultural zone in Australia] enact a precision farming technique” called controlled traffic farming (Latham, McDonald and Reeves 2019). The authors examine the farming system to trace associations among “a heterogeneous network of interactions of human and non-human actors such as knowledge, technology, money, farmland, animals, plants, and so forth” to then draw insights on what influences the success of these flows. In privileging the collective, the authors challenge the “binary and hierarchical notions of humans versus technology and human versus nature”, and adopt ANT as an approach for analysis that aims to interpret agency as being distributed among and being performed by the human and non-human actors in the collective such as “farmers, machines and other entities” (Latham, McDonald and Reeves 2019). At the same time, the authors emphasize the importance of research impartiality, by considering the different actors “in the same terms, regardless of their effect upon others” (Latham, McDonald and Reeves 2019).

Earlier in this paper, we have stated that our research led us down the path of a hermeneutic spiral, with emergent meanings leading us down new trails of research. In each sector, such as telemedicine, delivery and logistics, home utilities, and beauty and health, the defining process or activity was analytically approached as an object whose circulation is what we decided to follow. These collectives or assemblages were inherently constituted by humans and non-human actors, and as we followed their trails, they revealed the associations of actors and their collective agencies that the static knowledge practices of rebuilding livelihoods had not kept track of. As an example, it was our conversations with beauticians in the summer of 2020 that brought us face to face with the emergent associations and the agencies they were effecting. The prevalent imaginaries of rebuilding livelihoods entailed in – person skilling programs, with the pandemic necessitating a shift to the online. But a new association, drawing from the possibilities of life, has already been formed. Our research indicated that the beauticians in peri-urban areas, while appreciative of these training programs, did not rely on them solely as a measure of keeping themselves abreast of the skills needed for their roles. They knew that the latest styles and fashion trends originated in the metropolitan cities, and “what is popular there now, will be popular here after a few months” (Field Notes 2020). It is this anticipation that framed the skills they aspired to learn, and they actively followed Instagram and YouTube channels of leading Indian beauty influencers based in Delhi and Mumbai.

“I have a guru who is a social media influencer. I follow his Instagram channel to learn latest trends, especially make-up and hair styling because they have a high earning potential…I want to learn Russian hair styling which is popular in Delhi now, and will become popular here soon in 3-4 months” (Field Notes 2020).

In other words, Instagram and YouTube channels were actively engaged as participants in the reassembling of this collective. And their agency was compelling a shift in the existing narratives and enablement of livelihoods. Skilling practices in the beauty and health sector, for example, had to recognize the effects of the agency demonstrated by heterogeneous agents such as beauticians, Instagram and YouTube, social media influencers, makeup and hair styling trends that constituted an assemblage, amongst other such active assemblages.

We draw another example from our research in the telemedicine sector, where we noted how the design of online/ digital teleconsultation platforms often privilege the doctor and/or the hospital administration, where the focus is on convenience and ease-of-use, efficiency, and/or the technology itself. This abstracts away the agency of the patient as the user and instead proposes a behavioural compliance on their behalf, in the sense of “the idea that technological development determines social change” (Bimber 1990). Yet the interaction between a doctor and their patient is “in the form of a story” (Biswas 2020), and anchored in relations and flows. A design driven by technology and economics alone is distant, and makes assumptions on what is important for the patient as the user, at once ignoring the social relations within which the platform is likely to be used. On the teleconsultation platform we analysed, a focus on the individual patient in the platform’s design was emblematized through the notion of data privacy. This in turn implies that what perhaps lay outside design considerations is the approach of the Indian patient as an assemblage in itself where the user of the platform is not the patient alone, but also their kith and kin. Most consultations involve members of the family, either putting forward questions to the doctor regarding the primary patient’s condition and treatment, or even tabling related inquiries of their own during the same session. How can telemedicine platforms then account for such a notion of participation (in direct opposition to a notion of individual privacy), is thus a question which offered itself. It is evident that the technology or platforms for telemedicine had to factor in the contexts of the various human actors and the networks of relationships and interactions among them. Similarly, an understanding of teleconsultation as an object would have been impossible without a consideration and interpretation of the agency exercised by the non-human actors in this collective or assemblage. A series of conversations with a member of the on-ground operations team supporting the platform helped illuminate these associations.

“Patients trusting us is a challenge… people are used to in-person consultations, they have to believe in the doctors who are online. Connectivity as a problem covers time slots, network issues from both sides… earlier we used a different platform, and even did WhatsApp video conference calls after taking due consent. [This TeleMedicine platform] is a lot better from the previous app, it takes 5 to 10 minutes for the doctor and patient to get connected. … We need to connect with the patient even after the process is over, so that they come back to us… this will impact patient retention. Patients can reach out for other ailments as well.” (Field Notes 2021)

“The assemblage of ‘telemedicine’ goes beyond the act of teleconsultation. On the top left, there is a Doctor being helped by his assistant to schedule a consultation on his personal computer. In the middle is a phone superimposed on a clock, demonstrating that the work is all day, at all hours. And in the bottom right a doctor has a consultation with a patient on his phone. The patient's family members are also visible on the screen.”

Figure 6: The assemblage of ‘telemedicine’ goes beyond the act of teleconsultation. Illustration by Vidya Gopal

The assemblages entailed networks among doctors, patients, family members, community health workers, operations team members, platform designers as also with platforms, networks, video conferencing, instant messaging apps, web browsers, connectivity, prescriptions, time slots, telemedicine centres amongst others. And the examination and interpretation of this collective agency was challenging the knowledge practices guiding the reimagination of livelihoods even as they were getting formed. Within the telemedicine sector, the assemblage of the community health workers and technology platforms was critical for its success, and the performative agency of the health worker remains as pertinent in establishing trust amongst patients and their families, with the emergent role extending beyond, that is before and after the act of teleconsultation is carried out on the digital platform. We concur with Latham, McDonald and Reeves in their argument that the binary of technology and human emerges as irrelevant, with the assemblage of technology and human in turn coming to determine the continued relevance and impact of the project of rebuilding livelihoods. Similarly situated is the agency of the assemblage of platform, connectivity, devices and apps, with the collective performative agency influencing a first time patient’s acceptance of teleconsultation. A failure of this assemblage is capable of adversely impacting the credibility of the doctor. In this manner, we infer that the future in the future-making cannot be conceived any longer as a stable object, but as already manifesting as a “cultural fact” (Appadurai 2013) along multiple ontologies. The project and its researchers learnt that a project of rebuilding must continually trace these associations and study their agency in the present to navigate the way forward.

CONCLUSION: ETHNOGRAPHY AS A WAY OUT

In this paper, we referenced a social impact project (which we have been involved in) focused on livelihoods and post pandemic rebuilding, to explore the trails of ethnography and how its engagement along multiple networks shapes its possibilities as a research method that helps foreground emic perspectives. In doing so, we analysed agencies and social relations from the field, and their role in shaping project imaginaries. We have drawn inspiration from Arjun Appadurai’s call for an anthropology of future-making that frames anticipation itself within affective negotiations between a bottom-up “ethics of possibility” (or effectively, the emic socialities which permit an expansion of hope) and a top-down “ethics of probability” (or essentially, those etic artefacts of risk, calculation, and technocracy which serve to define what can and what can not be) (Appadurai 2013). The future then, is a “cultural fact” (Appadurai 2013). Finally, we turned to Actor-Network Theory as a framework to understand the multiple assemblages in our research field which (continue to) challenge existing knowledge practices and open up new lines of inquiry for ascertaining emergent areas of research and innovation.

In May 2021, the UpJeevika – Reimagining Livelihoods at Scale project announced the livelihood challenges for the telemedicine sector, stating its intent to “arm innovators and change-makers with actionable research, invite them to ideate collaboratively, and prototype scalable solutions that impact” (Upjeevika 2021). We reproduce a few of these challenges here.

“How might Community Health Workers (CHWs), such as ASHAs, be remotely upskilled to provide post-delivery connect with patients so that they trust and return to the online/remote doctor in a telemedicine set-up?”…“Our research tells us that ‘people are used to in-person consultations’ and are wary of treatments or ‘doctors who are online’. The role of the CHW involves ‘providing education to communities and families on a range of health issues’ as well as ‘assisting families in gaining access to medical and other health services’ (ILO 2012). And even now, CHWs take the effort to ‘connect with the patient even after the process is over, so that they come back’” (Field Notes 2021).

“How might the potential and networks of CHWs be leveraged for community mobilisation to overcome the barriers of social acceptance for telemedicine?”…“From our research, we know that the CHW is a social body and not an independent, individual actor (Field Notes 2021). And that responses to health are socially determined, not merely biomedical (Burgess and Horii 2012). We recognise therefore, that a holistic response is required to help CHWs realise their role as socio-political actors of health, touching upon multiple aspects such as training, dissemination of community relevant and accessible information to build awareness, infrastructural support, the technology itself, as well as a consideration of on-ground realities anchored in how health is negotiated through and by the community”

“How might we strengthen learning and performance for CHWs in low resource settings so that their aspirations are taken into account and their capacity to work in incentive-based structures increases?”…“We know that telemedicine’s ‘logistical ease and low cost provide a platform for increased CHW training and support availability, thereby decreasing multiple program barriers, including knowledge, competency, structural, contextual, and attitudinal’ (Vaughan et al. 2020). Prior research has also demonstrated that the effectiveness of building a community of practice around telemedicine can enhance the medical practice and sustainability of telemedicine interventions (Chandwani, De, and Dwivedi 2018). As a final note, we submit (as our research also underlines) that this must be done in alignment with the ‘cultural map of aspirations’ (Appadurai 2004) which CHWs navigate as they help realise health interventions. While doing so, it is important to account for the relations in the ecosystem that influence the success of such initiatives, including supervisors, community leaders, other CHW workers as peers, family members, patients, health officials, and professional healthcare providers”

Thus, the narratives have started shifting. Yet, an acknowledgement of the negotiations of lived realities in the everyday is neither an end game, nor should it be construed as a processual victory or validation for ethnography. If the future is itself not stable, how can the research ever reach a point of culmination? In conclusion then, we proffer that ethnography lends a continual way out of the risks of status quo. There is an ever present danger of discourses not evolving with the emergent associations or getting entrenched as rigid knowledge practices. Ethnography must seek to continually examine the realities of today, and in those specificities, locate the emergent associations among heterogeneous actors that are actively engaged in the possibilities of future-making.

ABOUT THE AUTHORS

The authors are Co-founders and Co-directors of LagomWorks, where they focus on applied anthropology led ethnographic research and design strategy, working with corporate organisations, educational institutions, social enterprises, and startups in India, the Middle East, and the EU. Along with the larger team, they also carry out original anthropological research at the entanglements of society, culture, and technology, centred on the (future of) work and ways of working, data and platforms, and livelihoods and scale.

Abhishek Mohanty is pursuing his doctoral studies at SOAS University of London, researching imaginaries of technology in the context of digital health when viewed as work. His substantive professional experience draws upon an interdisciplinary training as a result of a Masters in Social Anthropology (SOAS University of London), as well as a prior MBA (Xavier Institute of Management Bhubaneswar) and BA with honours in Economics (Hindu College, University of Delhi). He has presented his research at ASA 2021, RAI Film Festival 2021, and EPIC 2020. Abhishek may be contacted on abhishek@lagomworks.com.

Gitika Saksena has extensive professional experience at the intersection of business strategy and anthropology. In an earlier role, she held the post of Vice President at Accenture Technology. She has spoken and presented her research at ASA 2021, RAI Film Festival 2021, and EPIC 2020, as well as the Response-ability Summit 2021. She has a Masters in Social Anthropology (SOAS University of London), as well as a prior MBA (Xavier Institute of Management Bhubaneswar) and a BA with honours in Economics (Lady Shriram College, University of Delhi). Gitika may be contacted on gitika@lagomworks.com.

NOTES

Acknowledgments – The authors would like to acknowledge Lipsa Bharati for her research suggestions and inputs. They also recognise the programmatic role jointly played by Indhu MS and Divisha Upadhyaya from LagomWorks.

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