Care Paid and Unpaid: Social, Economic and Human Rights Concerns

by Dr Joan Garvanwww.maternalhealthandwellbeing.com

Attempts to achieve gender equity have reached a new high water mark and the recognition and redistribution of care, both paid and unpaid, stands at the centre of this arena. The Australian secretariat – Economic Security 4 Women – have produced landmark reports, both scoping and quantifying the value of the ‘care economy’ and, more recently, Professor Marilyn Waring addressed the topic of care and dignity in the annual Pamela Denoon Lecture Series. Here below are key points from these papers and central messages made by Waring.

Two significant Australian reports on the care economy have been produced over recent years: Scoping the Australian Care Economy A Gender Perspective (2010) and Counting on Care Work in Australia (2012). These projects are concerned with the lifelong economic well-being of women. Though they are particular to Australia and reference local government policies, programs and strategies, they draw from an international body of research and deal with common concerns.

The first report references the importance of data collection and brings attention to landmark work in the Massachusetts case study that used United States Census and Time Use data to measure both paid and unpaid care work [1]. The author Valerie Adams notes tensions between unpaid work, voluntary work and paid work. She draws attention to the ‘relational’ nature of care work, and references the concept of ‘provisioning’ for human need. The report used the notion of ‘care work’ to depict both the paid and unpaid sectors. Adams considers definitions and current issues in the Australian care economy. She surveys relevant government policy and makes numerous recommendations for further research and data collection.

Counting on Care Work in Australia (2012) further develops this arena by quantifying the value of the paid and unpaid care sectors to the Australian economy. In 2009-10 twenty per cent of all paid employment in Australia was in the care sector. Care workers receive 96 cents for every dollar earned by the average Australian worker, and female workers earn on average 84 cents in the dollar to male care workers. The report valued the unpaid care sector at $650 billion with sixty per cent of this contribution being made by women aged 25 to 64. The report furthermore outlined and quantified government investment in the care sector. The authors make recommendations for further work in light of: demographic change; inter-generational concerns; and the continuing economic and life course implications for women.

Marilyn Waring prefaced her recent lecture Care and Dignity: Major challenges to economics and human rights (transcript and video available online: http://pameladenoonlecture.net/) with the proposition that over millennia care has been the primary responsibility of women. She has changed her emphasis since the publication of Counting for Nothing: What men value and what women are worth (1988) [2] and now frames these concerns within a Human Rights perspective.

Waring raised problems for the use of ‘care’ as an analytical category, arguing that most often carers are responsible for a myriad of associated tasks that could be lost through a continuing association with unpaid work. Nevertheless, drawing from studies from British Colombia, New Zealand, Papua New Guinea and the United Kingdom, she sets out a strident case whereby the human rights of care givers are being flouted. She and others set up a questionnaire for a Commonwealth report drawing from Amartya Sen’s capability approach to human rights which references choice, rest, health, meals, work and political involvement, and found multiple breeches.

With governments around the world withdrawing from social and welfare programs these kind of arguments are critical if we aren’t going to ‘throw the baby out with the bathwater’. Care, both paid and unpaid, are clearly significant to the health and well-being of the community, but further to this gender equality will remain allusive if we don’t see transformational change. Unfortunately the issues are complex and though there is increasing reference to the work of unpaid care in terms of achieving gender equity, there is a need to bolster and popularize the debates.

References

[1] Albelda, R., Duffy, M., Folbre, N. (2009), Counting on Care Work: Human Infrastructure in Massachusetts, University of Massachusetts, MA, Massachusetts

[2] In a recent anthology, Counting on Marilyn Waring: New Advances in Feminist Economics, edited by Margunn Bjornholt and Ailsa McKay, 31 authors from nine countries outline the wide ranging impact and resonance of Professor Waring’s work as well as the current frontiers of feminist economics.

 

 

‘Who is Helping Who?’ – Co-Production and Professional Boundaries within Social Care services.

By Nick Andrews

I have been working in education and social care for thirty years, and have seen various new initiatives and buzz words come and go, whilst the fundamental principles of humanity remain the same. ‘Co-production’ in its truest senses is grounded in these principles. However, as with the concepts of ‘personalisation’ and ‘reablement’, there is a real danger that the term  ‘co-production’ is misused for hegemonic purposes to cover up what is essentially a cost cutting exercise. Under this scenario, individuals and their communities are expected to take on more responsibility for their own well-being whilst the machine of impersonal and ‘professionalised’ public services carries on as it always has done, albeit it with a few less staff employed. In my opinion, this would be a travesty and missed opportunity to restore warm humanity as the driving force for public services, not compliance with increasingly centralised and de-personalised processes and systems.

One of my favourite quotes by the theologian Martin Buber is ‘all real living is meeting’. Please note that Buber’s understanding of the term ‘meeting’ is much richer than the idea of putting a group of people together in a room or placing nurses and social workers in the same office, which is commonly assumed to result in integrated practice. I am sure many people will share my experience of being in meetings where no one actually met, where each person had their own agenda and the purpose of the meeting was to get this across – to win the argument.  For Buber, ‘meeting’ is about genuinely connecting with other people and being changed in some way by the process. In order to explain this process, he talks about two ways of relating to people and the world, which he calls ‘I-It’ and ‘I-Thou’.

In ‘I-it’ relationships, the person is detached and unaffected. In ‘I-Thou’ relationships, the person is attached and vulnerable. Tom Kitwood, in his seminal book ‘Dementia Reconsidered – The Person Comes First’ talks about his experience of seeing how people living with dementia were dehumanised through receiving emotionally detached task based care:

‘A man or woman could be given the most accurate diagnosis, subjected to the most thorough assessment, provided with a highly detailed care plan and given a place in the most pleasant of surroundings – without any meeting of the I-Thou kind ever having taken place’ (Kitwood, 1997)

By contrast, I believe that genuine co-production facilitates and nurtures the development of ‘I-Thou’ relationships between all parties, which in so doing begins to challenge the prevailing understanding of professionalism and professional boundaries.  In relation to this, I am currently co-ordinating a NISCHR and Joseph Rowntree Foundation (JRF) funded project in Wales, which is focused on the use of evidence from their ‘A Better Life – for older people with high support needs’ programme, along with other forms of evidence in social care service and workforce development.

The ‘A Better Life’ programme has identified that relationships are key and ‘Often it is the simple things that bring the most pleasure (and the lack of them can bring a sense of sadness and loss) and services do not always seem to be very good at delivering ‘the ordinary’’. (Blood, 2013 p13)

The research challenges also call for a different way of working, which is often alien to the world of emotionally detached and compliance focussed task based care, which is summed up nicely in the following quote by Edgar Cahn:

‘The world of helping others in need is now built around one-way transactions…. and with the best of intentions, one-way transactions often send two messages unintentionally. They say: “We have something you need – but you have nothing we need or want or value.”’  (Cahn, 2004).

In a series of recent focus groups and learning events involving older people, carers and frontline staff, I have been struck by how many people feel that current regulation and guidance is risk averse restrictive and at worst destructive of human relationships. For example, workforce regulation states ‘the inappropriate use of touch is not permissible’, rather than ‘the appropriate use of touch is fabulous and to be encouraged’. This is a particular issue for people living with dementia, who often have to express themselves and connect with others through feelings and emotions. Frontline staff talk have talked about feeling guilty when they do little kind things that are not written in the Care Plan or receiving small gifts of appreciation, older people have been ‘told off’ (in the name of health and safety) for pouring tea for others in day services, and carers have been made to feel that they no longer have a role when the person they love goes into a care home.

At the heart of co-production, is an understanding that everyone has something to contribute and that exchanging these contributions is enriching for everyone concerned.  I am reminded of the work of Jean Vanier, who established the L’Arche Communities in learning disability services. Vanier did not see his role as caring for people with learning difficulties, but rather sharing his life with them and being open to receive and learn from them as much as to offer them support.

I am reminded of one of my earliest experience of working in social care services. It was 1984 and I had started my first job as a residential support worker in a children’s home. I thought I was the ‘sorted one’ who was employed to help others. I worked hard to form good working relationships with staff and children in the home, but one boy, who had experienced a lot of hurt in his life, kept his emotional distance. As anyone who knows me well can tell you, I am not gifted in DIY or anything that involves fixing something mechanical. One day, I was trying to repair my bicycle (I did not drive at the time) and was getting nowhere fast. The boy walked past me and said ‘I’ve got a book about repairing bikes, do you want to borrow it?’. I am pleased to say that I took up his offer and our friendship took off from that day. He is now a happily married 43 years old who lives on the other side of the country, but we still keep in contact via Facebook and phone and offer each other support and encouragement whenever we can.

Jean Vanier once said, ‘I am struck by how sharing our weakness and difficulties is more nourishing to others than sharing our qualities and successes’. This is an important message for social care practitioners and agencies. We need to open our ears, our eyes and our hearts to the people we work with, which might involve sharing our vulnerabilities and concerns and allowing ourselves to be changed by genuinely ‘meeting’ with them in truly co-productive relationships.

 

References

Blood, I. A Better Life – Valuing Our Later Years, York, Joseph Rowntree Foundation, available at: http://www.jrf.org.uk/publications/better-life-valuing-our-later-years

Cahn, E. (2004), No more throw away people – the co-production imperative, Washington, Essential Books

Why dignity can’t be ‘delivered’.

By Liz Lloyd

For many years, dignity in care has been a core policy aim as well as the focus of commissions and working parties. In 2012 the UK’s Commission on Dignity in Care for Older People pointed out the breadth and depth of cultural change that would be required to secure dignified care for older people and argued that deep-seated age discrimination and stereotyping of older people were major barriers. The Commission took the view that to shift stereotypical views of old age it is necessary to show that not all older people are frail and dependent and, moreover, that older people evidently make a positive contribution to society through unpaid work and community activities. These are important points but do not add up to an adequate basis for shifting attitudes towards those who are frail and dependent. True, a cross-section of people aged over 70 will show varying levels of health and capacity for self-care but it is also true that everybody aged over 70 will at some point need care. Indeed, the same applies to all age groups although the need for care is increasingly postponed until old age. Thus, we need a different way of conceptualising dignity so that we do not always associate it with self-reliance but acknowledge its relevance in the context of dependency on others, because dependency is part of what it is to be human.

Dignity is a personal concept, involving individual identity and self-respect. The potential for a loss of personal dignity increases with age, as health declines and people live with and eventually die with or from a range of conditions. Falls, continence problems and loss of mobility, for example, affect individual self-respect in profound ways. But dignity is also a social concept, involving social and cultural practices, institutional systems and interpersonal behaviour. Personal and social meanings of dignity are strongly entwined. Importantly, in both personal and social meanings, dignity is relevant to those who provide care as well as those who receive it. The dignity of the care worker is enhanced when their job is done well and diminished when it is not, such as when a worker has insufficient time to attend to anything other than the older person’s basic functional needs. The economic and political contexts that prioritise constraints on public spending make it harder to overcome barriers to dignity in care for both the care worker and the older person.

To overcome the loss of dignity associated with declining health, older people typically make strenuous efforts to avoid becoming a burden on others.  But, at the same time, they need to adjust to their changing circumstances and learn to accept help. Striking the right balance between these twin obligations is a complex and deeply personal matter. People’s perceptions of how they wish to be supported are influenced by family ties, social and cultural background, migration experience and individual life histories. What might appear insignificant to a care provider might be deeply significant to the older person.

We should not underestimate the importance to personal dignity of the style of communication between front-line staff and older people. However, the complex issues faced by older people when health declines requires those in health and care services not simply to check their actions against a list of standards but to engage with the complexities of individual people’s lives. Understanding the impact of loss and change and helping people make the difficult decisions that follow can be an important basis for care that maintains dignity. Above all, this needs to be done not because we should behave well towards them but because frailty and dependency are part of us all.

Liz Lloyd

10th March 2014

 

 

‘How can care be spiritual?’ by Dr Janice Clarke, Institute of Health and Society, University of Worcester.

It’s been noted that Revaluing Care bloggers haven’t had a lot to say about spiritual care  September 21, 2013 by Sue Westwood  so I thought I’d better step up to the plate. Nursing has tapped into the notion of spirituality because of the drive to be holistic; if nurses are supposed to look after the whole person, how could we overlook this essential bit.  Spirituality and spiritual care has been absorbed into the matrix of needs, problems and assessment which is how much of nursing is described.  Spiritual care is most often seen as the way to fill a perceived need in patients which is preventing them from achieving spiritual wellbeing and the ways most encouraged are by talking, or through putting in place something else, which could be anything from pain relief to a chaplain.

But if you ask most nurses what they think spiritual care is you’ll get some replies that don’t have anything to do with problem solving.  McSherry and Jamieson (2011) did this  and found that over 80% of more than 4000 nurses thought that they could provide spiritual care by showing concern, kindness and cheerfulness (this came second only to referral to a chaplain) but only 5.3% felt always able to meet their patients spiritual needs. So  why do they spend so much time not being cheerful, concerned and kind?  Of course the mismatch is because  although nurses interpret spiritual care as being about how they behave with patients, and how they ‘care’, they are taught, that spiritual care is about spiritual assessment and talking about spirituality and they don’t feel able and confident to engage do either (McSherry and Jamieson 2011). Similarly patients are more likely to say that they think spiritual care is about how a nurse is with them rather than how ably she is to ‘plan’ their spiritual care (Taylor and Mamier 2005).

This is where spiritual care and ‘care’ for me, converge.  Interestingly the literature about ‘care’ and the literature about ‘spiritual care’ don’t actually intersect which is another phenomenon to do with spiritual care which baffled me when I started on this trail. This was the area I set out to research for my doctorate and it grew into a whole book about how to do actual day to day ordinary care in a spiritual way (Clarke 2013). ‘Spiritual’ in this sense is about relating with compassion. The way spirituality is described in relation to health, is in terms of spiritual wellbeing which is about wholeness, fulfilment, identity, meaning, confirmation and feeling valued and loved. It seems to me that nurses can behave in a way that helps patients to feel this kind of spiritual wellbeing in all the ordinary things they do – or they can do the opposite.

This is why I’ve focused on how   professionals relate to patients and especially in how they provide physical personal care such as in bathing, moving and eating (Clarke 2013, see below).  If nurses can’t express spiritual care in how they relate in every ordinary encounter and task, how can we claim that spirituality is really at the heart of nursing?

Practicing spiritual care at mealtimes – from Spiritual Care in Everyday Nursing Practice: A New Approach (Clarke 2013, p.185)

Action  

  • Prior to the mealtime patients should be invited to choose the food they will eat.
  • Familiarise yourself with the assessments of the patients in your care
  • Invite people who might need assistance   to work out a plan for the help they need so that everyone knows what will happen when the food arrives.
  • There should be choices available which are compatible with the patients’ personal, cultural and religious needs.

Spiritual rationale

  • Empowers the patient and shows respect  for their personhood.
  • Shows competence and professionalism which expresses care and valuing of patients.
  • Empowering and shows you value their contribution.
  • Relieves the anxiety in patients of worrying if food will be okay and whether they will be able to eat it. So that patients can feel more relaxed and focus their energy on getting well.
  • Shows you are sensitive to their individuality and religious and cultural preferences, so recognising patients as full members of the community.

Action

  • Make patients comfortable and ready for eating. Give the chance to wash hands and face ready for eating.
  • Give the option of sitting away from their bed and with other people if possible.
  • Tidy the area around each patient removing urine bottles and wiping surfaces. Shows sensitivity to and respect for patient’s feelings.
  • Shows competence and attention to detail and so inspires trust
  • Shows how you value the eating experience.
  • Check the food is   appropriate, attractive, the right temperature and prepared so that each person can manage it.
  • Ensure it is what the patients ordered. Expresses care for the patient and shows that they are valuable enough for you to care if they are not enjoying the food.
  • Give help to each person individually without interruption.
  • Ensure the patient is not disturbed while they eat. Monitor what food is eaten and how patients  are managing where appropriate.

Spiritual Rationale

  • Expresses care for  patients’ needs and concern for their recovery.
  • Be prepared to be an advocate for patients to make complaints and make changes  if the food is unacceptable or the amount of help available  is not enough.

Action

  • Be imaginative and creative in finding better ways to manage mealtimes.

Spiritual rationale

  • Shows the patient that they matter and are valued.

References
Clarke, J. (2006) A discussion paper about ‘meaning’ in the nursing literature on spirituality: An interpretation of meaning as ‘ultimate concern’ using the work of Paul Tillich. International Journal of Nursing Studies, 43, 915-921.
Clarke, J. (2013) Spiritual Care in Everyday Nursing Practice: A New Approach. Basingstoke, Palgrave
McSherry, W., Jamieson, S. (2011) An online survey of nurses’ perceptions of spirituality and spiritual care. Journal of Clinical Nursing, 20(11/12), 1757-1767.
Taylor, E.J, Mamier, I. (2005) ‘Spiritual care nursing: what cancer patients and family caregivers want’, Journal of Advanced Nursing, 49(3), 260–267.
Swinton, J., Pattison, S. (2010) Moving beyond clarity: towards a thin, vague, and useful understanding of spiritualty in nursing care. Nursing Philosophy, 11, 226-237.

 

 

 

 

 

 

ReValuing Care in 2013

A wordle of the ReValuing Care Blog 2013

ReValuing Care in 2013

As we approach the end of 2013, the time is ripe for a brief look back over the activities of the ReValuing Care research network in the last 12 months, and a peek forwards into ReValuing Care activities for 2014.

I’ll begin with a heart-felt “thank you”. To all of you – who have written for the blog, read contributions to this blog, shared those contributions on twitter, facebook and other social media. Since the launch of our regular blog series in June of this year, there have been nearly 50 blog contributions from members of the network. The website visitor numbers have increased from just 120 in January, to over 2,000 unique visitors in November. The ‘wordle’ image on this page provides an overview of the topics that have been covered. Of course, we’ve been talking about ‘care’; but we’ve also seen posts on topics as diverse as dementia, gender identity, soup kitchens, parenting, childlessness, sexuality and ageing (to name but a few). Care has been explored in its personal, practical, and conceptual senses. Blog contributors have explored the challenges and possibilities of care, and the multifaceted ways that research into and about care can lead to the (re)valuing of all forms of care. The international nature of our network has been demonstrated by the diverse locations of care research that have been shared: we’ve had contributions from the UK, the Republic of Ireland, India, Kenya, the US, Italy, and Australia. Creating a network is a very difficult thing to do. It takes time, energy, thought. It takes care. We all have to care about the potential and possibilities that arise from being in touch with others who care about care.

The way this blog has developed over the last six months, demonstrates the vitality and diversity of research about care. The challenge we face for the future is how to keep our conversations going; how to make the most of the network that we have created. Our AHRC grant, which funds the current phase of the ReValuing Care research network ends in the next few months. It would be all too easy for our network to spit, and fade and fizzle out when the money runs out. For the network to continue to develop, and for the conversations to continue beyond that time, we need to think creatively about how to take things forward. I have some ideas, and I’m sure you all do too.

To keep this network going, to build on the work that we’ve done, we need to nurture it, feed it and let it grow. We need to take care of it.

How? We could hold another ReValuing Care workshop (does anyone want to host?). We could reach out more to sectors beyond academia through other types of events (do you have ideas?). We could consolidate our academic contributions so far through an edited collection. We could apply for further funding to take forward additional questions and ideas. We could encourage our colleagues and contacts to get involved (from PhD students to professors, policy makers to activists, it doesn’t matter who you are, so long as you are interested in care). Perhaps the easiest thing of all to do is to keep up this blog. When we see a news story about care that makes us feel (in many ways it doesn’t matter which emotion sparks us off: angry, confused, impressed, concerned, happy…) we should write about it.  There are so many things we can do. I hope that we do at least some of them.

I’ll end with the caring equivalent of a call to arms (maybe a call to alms?): 2013 has seen the ReValuing Care research network develop into a community of scholars from across the globe. I very much hope that 2014 has even more in store for us. For this to happen, we need you to join in. I hope you will.

Revaluing Care Workshop 2: September 2013, University of Adelaide, Australia.

At the beginning of September 2013 our Revaluing Care network had its second workshop, following an earlier workshop at Keele University, UK, in September 2012. This second meeting over two days at the University of Adelaide, in South Australia was marked by its attention to analytical concerns that had been raised in the 2012 session. It was also marked by much convivial discussion over food and wine at the end of each day.

We met in a room with views of the city all around us and, fortunately, the sun shone almost all of the time. What I recall most clearly was the very high standard of the papers, the sense of an extraordinary level of conversation within a group which has now forged a strong identity. The degree of confluence of ideas, of substantive and strongly supportive debate was striking. It is rare to attend such an event and feel constantly engaged by an extremely stimulating exchange of views. The event was both inclusive and demanding in the very best sense.

The workshop looked at a wide variety of existing services around care and their impacts on social interconnection (such as services around HIV/AIDs, young people and dementia care), as well as a range of existing legal and policy frameworks. This international orientation informed extensive discussion around new ways of conceiving care (for instance, in relation to social activism, migration and cross-national mobilities). However, it also enabled us to consider where the term care begins to fall away, or seems insufficiently recognised or activated. Consequently there was a significant interchange over the two days concerning the analytical and practical boundaries of care (for example, in relation to sexualities, diverse families, the notion of the human, marginalised services and public institutions seemingly distant from care including parliaments and courts).

These deliberations led to a range of theoretical and terminological discussions around the continuing usefulness of the notion of care, around what it covers and its limits.

The success of the workshop was not only evident in the strengthening of the network as an active, participatory and supportive research community, but also obvious in the final discussions around building research teams, projects and publications across the world and across disciplinary constraints. We aim as a result to produce articles, books of collected works, and grant applications. Many of these aims are now in process. The group was also firmly of the view that further workshops would be very worthwhile and assist in the development of these aims. So, watch this space.

In sum, I can only say that I, for one, gained immensely from the workshop and now have an even stronger sense of the considerable research capabilities of the group. This is a group with much to gain from our continuing association! It is one of the few research clusters that I have been involved in which shows ongoing promise of generating important intellectual exchanges and innovative new work .

Professor Chris Beasley

Discipline of Politics & International Studies (POLIS)
School of Politics and History
 
Co-Director, The Fay Gale Centre for Research on Gender

WeAreOne by Ambreena Manji

Who Cares?

And behind me I hear the footfalls of countless generations and ancestors. And around me the living community of my people, whose woes are my woes; whose moments of joy are mine.

Kofi Awoonor, Ghanaian poet murdered at Westgate, Nairobi on 21st September 2013

On 19th September 2013, at the Annual Lecture of the British Institute in Eastern Africa in Nairobi, Dr Ann Stewart delivered a lecture entitled ‘Caring about care: Recognising and regulating body work in a global market’. Based on her recently published book, Ann gave a compelling and wide ranging talk about forms of care and asked the question ‘who do we care about and how’? The discussions that followed the lecture were vibrant and engaged, the sorts of critical conversations about labour and about gender that I had hoped would come about in my time at the Institute.

On 21st September, at lunchtime, a terrorist siege began of an upmarket shopping mall in Nairobi, Westgate, a mile or two from the Institute. Everyone reading this will have seen the terrifying images. For well-off Kenyans who have become used to hearing the occasional distant grenade explode in the east of the city, in a crowded church or bar or bus station, the events mark a sea change. Here Kenya’s wealthy elite and the international community are the target and terror is at the heart of our lives. I’ve heard it said countless times this week that, looking at photographs of the attack taken in the mall, many of us recognised shop fronts, escalators, sweet stalls, even marble tiles on which we have trodden. As elsewhere, the mall is at once a response to, and a perpetuation of, a city segregated between the wealthy and the destitute. Reborn each day, sparkling clean, its shelves restocked with international branded goods, the Nairobi mall succeeds in making invisible the messy reality of life in a third world city. It would be deeply dishonest to deny that those who clean the mall, serve its meals, guard it – in short, those who provide us with our accustomed care and comfort – go unseen, unknown, unheeded.

Yet in the past three days we have heard stories of supermarket staff, faced with terrified customers running into the shop when the grenades and gunfire began, shepherding people into store rooms, barricading them in to conceal them from the attackers, hiding them behind boxes in stock rooms. Despite our own bleak assessment of ourselves as deeply divided along ethnic lines, as a society riven by long running racial divisions, in the terrifying and traumatic siege of Westgate mall many have commented on the intersecting unities we have discovered this week. An elderly Indian lady, recently returned home from England to care for her elderly mother in Nairobi, and desperate to do something to help, went down to the perimeters of the mall to serve tea and food to the police and media who have worked without a break for days. There she met an African woman who for many years has come to the mall everyday to sell tea and food to its cleaners, waitresses, guards. For the past three days, these two women have teamed up to cook and bring food to those working outside, plastic bags on the ground, car boot full of supplies wide open and elderly mother, still needing to be cared for, in the front seat watching them work.

But the events of the past three days have also made visible that which the well-off and the comfortable work so very hard not to see. The private security guard paid the minimum wage carried our children to safety through a pool of blood; the waitress whom we never greeted in three years of coffee drinking hid us in the cafe kitchen; the cleaner whom we never knew of ushered us to safety through a back exit.

This past three days, Ann’s question at the BIEA lecture – who do we care about – has been constantly in my mind. And as we slip back into our mutual distrust and distance, perhaps we might remember to ask, who cares about (and for) us?

Ambreena Manji

http://www.biea.ac.uk/director-professor-ambreena-manji/

 

 

Caring in Kenya, by Ann Stewart

While young men and possibly young women were laying siege to a shopping mall in Nairobi, killing young and old indiscriminately despite press reports to the contrary, I was spending the day with Maasai families experiencing care at first hand.  While they were forcing their way into this space where love and care was being bought in the same way as elsewhere in the global market place, through children’s cooking parties, coffee and tea drinking and the body work of hairdressers and cosmetic sales persons, I was sitting outside a one roomed home, made with corrugated iron sheets, drinking smoky milk tea from a pot on the open fire, with 4 generations of women from one family, the eldest 100 years old, the youngest 2 years.  The great grandmother was given her food by her grand- daughter.  She was sitting on her goat skin leaning against her hut wall eating her lunch from a bowl with a spoon.  The food had been provided by her last surviving child of 12, her youngest daughter in her 60s now living with her mother, having moved from the local ‘town’, some 8 kilometres away on a deeply pitted dirt road.  The ugali and goat meat with vegetables had been made into a stew on an open fire.  She spooned out all the liquid on to the earth in front of her because she wanted it dry.  Her daughter and grand- daughter looked on while she did this, ensuring that the food did not tip out.  When we had arrived in the sort of SUV which is ubiquitous in ‘developing’ world contexts with her grand- daughter and two great grand-daughters, she had come out to greet them but immediately went back inside the hut and come out again carrying all her belongings in a cloth bundle, secured on her head and back, which was almost her size, and her long stick.  She was intent on getting back to the town to visit her grand-daughter.  She was persuaded gently to put the bundle down and to have her food and to share tea and talk.   She was not going to be able to go back with us.  She and her widowed daughter had moved here because a grandson had taken responsibility for them.  Sons are important.  They provide this economic protection although widowed women are socially powerful within families.    We debated how we would leave when the time came.  The answer was for the men in the party to drive off in the vehicle and wait further off and for the women to stay behind.  Then at a moment when we hoped she was distracted we ran towards the vehicle.  She was not fooled and proceeded to follow us with remarkable swiftness for her age.  We clambered in and left her with her daughter to return to their home.

We were there because my Kenyan research student had studied the interaction between gender and ethnicity in matters relating to land in 3 different communities in Kenya.  The grand daughter was the sister of her interpreter for the Maasai field work.  Agnes had spent time much time and many experiences with this group of women who in Maasai terms are a wealthy and influential family, owning much land.  She was paying a visit to reminisce and to catch up on events.  I was sharing this visit as her teacher.  I also had a ‘husband’ my male partner with me.  Agnes had her husband and we had two male drivers, one for the Maasai area, an influential young man who had assisted Agnes with her fieldwork in this area, and a driver whom Agnes had used generally for all her fieldwork who drove for her family.  Undertaking fieldwork in rural Kenya is not easy.  It involves many challenges which I was only now learning about as we met up with those who had been involved.  Everyone was enjoying the stories. The interpreter’s sister, who set up many of the interviews, had been 8 months pregnant at one stage.  Her mother made it clear that Agnes must be prepared to attend the birth if this should occur on one trip which involved very bumpy terrain.   On one occasion the interpreter had had to climb a tree to try to get a mobile signal to enable someone to come and tow the vehicle out of the ditch.   The Maasai driver had been able to clear the road of a large herd of goats while the Kisii driver had not.  When the great grand- mother had been interviewed she had wanted Agnes to write down her entitlement to land on a piece of paper.  She still had this piece of paper.

I am deeply uneasy about the potential voyeurism involved in this type of narrative but it was not that sort of day.  The men in the party wandered off somewhere and the women chatted to each other lined up along the hut wall for a number of hours.  They spoke Swahili and the Maasai language and English when necessary.  I was made to feel completely welcome but not special.  I shared photos from my newly bought flash smart phone of my two small grandchildren.  They were struck by their very blue eyes.

A few days before I had delivered a public lecture entitled ‘caring about care; recognising and regulating body work in a global market’ at the British Institute in Eastern Africa.  It was based upon my book Gender, Law and Justice in a Global Market (CUP 2011).  As part of the presentation I had shown some photos of the elderly in institutional settings in the UK: older women lined up against walls in wheel chairs, heads down.  I had shown pictures of migrant care workers tending to these elderly frail people.  In the discussion which followed the presentation, we had had a very interesting discussion of the tensions and dilemmas that urban middle class/professional women face in coping with paid work and caring responsibilities in urban Nairobi where use of paid assistance in the home – domestic workers, nannies, care workers generally –are the norm.  We discussed the consequences of privatising social responsibilities with no welfare state safety net  – individual women feel responsible for the lot of other women who have left children and other family members behind to undertake these roles.  The women are not paid enough to replace their care and they may be far from their own homes in the informal settlements in Nairobi.  The Kenyan state has provided some legal protections and minimum wage requirements.  But how are these to be met by individual women with no support from the state?  Women are pitted against each other.

I looked after my mother and father in our home for the last two years of their lives.  My mum was by then very frail and needed constant care.  They both died aged over 90 in our home.  I recognised the care that the women around me were giving on Saturday.  I recognised its quality.  I recognised the power relationships, the negotiations, the vulnerabilities, the love.  I saw the dignity and worth of this very elderly woman’s life – her clean clothes, her neat hair, her alertness, her sense of being part of this community, her frustration at not being able to out run us to the vehicle.

Ann Stewart

School of Law University of Warwick