Female health workers: invisible, underpaid and stigmatised
POLITICS OF PRECARITY BY PANCHALI RAY IS AN ETHNOGRAPHIC STUDY THAT INVESTIGATES HOW HIERARCHIES IN THE NURSING SECTOR INTERSECT WITH SOCIAL IDENTITIES TO PRODUCE A DIFFERENTIATED WORKFORCE. THE BOOK’S RELEVANCE IN TIMES OF COVID-19—WHERE THESE INVISIBLE HEALTH WARRIORS ARE PERFORMING YEOMAN’S SERVICE—CANNOT BE MISSED. IN THESE EXCERPTS, THE AUTHOR EXPLORES THE QUESTION OF NURSING ETHICS
THE URGENCY to label nursing labour as “care labour” could arise from nursing ethics, which has a history of accommodating care ethics in its methodology. Nursing overlaps strongly with domestic work. The distinctions between affective labour that calls for “taking care”, “responding to needs” of the recipient of care, and menial/manual labour oriented towards cleaning rather than caring, is at best fuzzy.
The domestic worker, nurse, or governess fulfils a role that is crucial in reproducing life in its most crude and biological form. What exactly comes under nursing care, and under what other domestic services? The difficulty in disentangling nursing from other kinds of domestic labour often leads to a conflation between the two, thus extending the stigma associated with the former to the latter. In fact, the struggles of the nursing profession have been to disassociate itself from domestic work and establish itself as skilled, trained labour, often leading to compartmentalization. While nursing within the domestic sphere overlaps with other kinds of reproductive labour, it is assumed that the professionalization of nursing would have countered such trends.
Nursing labour is essential for
THE CLASSIFICATION OF NURSING POSES A PROBLEM GIVEN THE MULTIPLE TASKS, WHICH RANGE FROM UNSKILLED DOMESTIC WORK TO HIGHLY SPECIALIZED MEDICAL TASKS
reproduction of life: cleaning the sick body, tending to bed sores, feeding, aiding in daily ablution, fanning and sponging, uttering soothing words to calm patients enough to administer medicine or keeping the environment clean, making the bed, disinfecting and sterilizing instruments, watching over patients for symptoms that help in diagnosis—a range of activities that include menial, manual, and affective labour which requires varied skills. For example, changing soiled sheets without making the sick person get up from bed requires not just skill, but also strength and dexterity. It goes without saying that diagnosis and administering medicine is one component of healing; regular care, cleaning, and vigilance over the sick body and the environment forms the backbone of the healing process. Not just reproduction of life, nursing—like domestic work in middle-class households—is also status-producing work; it is bound with reproduction of lifestyles. Nurses have the responsibility of ensuring that both the sick person and his/her environment are not dirty, infected, and contaminating. They are the keepers of the boundaries between sickness and health, ill-being and well-being, contamination and purity.
Thus a nurse is not just responsible for ensuring that there are no open festering wounds, infected equipment, dirty and soiled bandages/clothes, but also for maintaining a clean, sanitized, and cheerful sick room essential for reproducing social order. The classification of nursing labour thus poses a problem given the multiple tasks that fall under its ambit, which range from purportedly unskilled domestic work to highly specialized medical tasks.
The increasing commodification of women’s reproductive labour raises newer questions on ethics. The tension between acknowledging the relational and the emotional component of feminine affective labour and the difficulty in measuring and adapting it to market values informs most of the debates on paid care work. The demand for valorizing reproductive labour as skilled work so as to be able to ascribe a market value to emotional/affective labour is in direct tension with understanding “care” as a distinct feminine quality that escapes masculine market transactions. It would be fruitful to look at the intersection of feminist debates on care ethics with newer concerns of renaming paid reproductive labour as care work, particularly in the context of nursing.
Carol Gilligan’s
(1982) sparked the debate on care ethics, where she argued that feminine morality and conception of the self as relational, interdependent, and located in a complex web of social relations gave rise to an “ethics of care” as against the masculine “ethics of morality”. This context-bound character of care ethics informed much of later theorization on work ethics, particularly for health service providers; nursing ethics, for instance, is far more hospitable to care ethics than others. Feminists have critiqued the traditional
Western health care system that presumes that doctors are the sole repositories of specialized knowledge, and patients are constructed as passive recipients and beneficiaries. The questioning of such traditional views of knowledge has highlighted the role of patients and other health care providers as equal participants in knowledge production.
This challenge to traditional ways of knowing has opened up debates on nursing ethics that perceive nurses as equal participants in the healing process, but distinguishes them from that of a physician. Nursing ethics highlights the “caring” role of nurses as relational and contextspecific interventions that stress on affective bonds as against medical approaches. However, traditional nursing ethics are hardly feminist; deploying genderoppressive norms and stereotypes, it promotes nursing as secondary to other forms of medical interventions.
The association of women’s work with care implied that historically doctors distanced themselves from such roles, carving out a professional function that had no linkages with affective/emotional labour. In later periods, when nursing education was modified to incorporate scientific and medical components, it occasioned debates regarding the suitable role of a nurse. This sexual division of labour within health care services reflects wider hierarchical binaries of objective/subjective, reason/ emotion, masculine/feminine whereby male doctors practiced medicine and female nurses healed through affective labour, both inhabiting normative gender roles.