Aspirations and Uncertainties of Medical Labor Migrants

Review by Jason Danely
October 24, 2018

Caring for Strangers: Filipino Medical Workers in Asia

by Megha Amrith
Published 2016

Nordic Institute of Asian Studies Press

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International labor migration has become an increasingly popular topic for anthropologists, striking at the deep tensions arising from a global economic landscape dependent on both the transnational flows of people and the retrenchment of national, racial and cultural politics that produce practices of exclusion and marginalization of those people. Labor migrants stand suspended at the crux of this contradiction, embodying both its precarity and its aspirational imaginations. Megha Amrith’s Caring for Strangers: Filipino Medical Workers in Asia is a welcome addition to this field, taking the reader into lives that are perpetually unsettled, twisting and turning between worlds, both reproducing and contesting borders and boundaries that seem to mark every decision and relationship. Amrith is clear from the introductory chapter that understanding Filipino medical workers means disrupting representations of migrants as cosmopolitan entrepreneurs or as victims of global capitalism. Instead, her approach delves into layer after layer of interstitial spaces, from the colonial and post-colonial histories of Singapore and the Philippines, to the policies that encourage and restrain migrant status, to the displacements and ambivalences felt within the families of migrant laborers. Most of all, it is the way she describes the interstitial nature of medical work itself, as straddling the borders between professional and unskilled, institutional and domestic, formal and intimate, that makes Amrith’s ethnography so forceful and fascinating. While many accounts of have focused on the very real struggles of precarious labor migrants, typically from an impoverished global ‘south’ to the prosperous ‘north,’ Amrith’s ethnography brings our attention to cases that are more ambiguous, where agency is not as easy to locate as ‘resistance,’ but where is it nevertheless fundamental.

The first chapters of the book lay out the theoretical, historical and political orientations on which Amrith maps the “everyday encounters, anxieties and boundaries” (6) that inscribe what she calls a “cartography of care” (49). First, she situates the book as a response to the literature on the commodification of affective gendered labor. While acknowledging the ways care work entails intimacy and vulnerability, Amrith argues that these are entwined with workers’ empowerment and recognition. That said, Amrith points out that it is also important to recognize that migration never takes place on even terrain. The histories of Singapore and the Philippines, where she conducted fieldwork, accentuate the inequalities between and within Asia, while more recent epidemiological and demographic changes create the conditions for directing the flows of medical workers in ways that follow other biosocial transitions.

The ethnography shines throughout the remainder of the book. Every encounter reveals a new twist on the experience of borders and betweeness. In the context of the Philippines, nurses are regarded as highly skilled and educated individuals with unique access to international employment in ways that offer essential support for families that remain. The potential for mobility is beautifully illustrated in ways stories circulate through social media, charting narratives of success or providing practical advice for those on the way. Amrith shows how their qualifications, and the values and imaginaries they inspire, can lead to different trajectories, choices and consequences, none of which can be easily reduced to tropes of exploitation. These choices are best understood as new migrants try to find their place in a new society. Again, Amrith’s ethnography is thorough and revealing. The difference between the ways Filipino medical workers view themselves and the ways they are viewed in Singapore are most clearly apparent in the type of work they are expected to carry out and in the ways they are treated by patients and coworkers. Against these perceptions, themselves based in colonial histories, the Filipino workers strive for recognition and respect while simultaneously finding a basis of solidarity with some of the socially marginalized Singaporean patients or with other Asian migrants.

But again, this broad description does not do justice to what Amrith really accomplishes ethnographically. Each case contains its own rich and complex interplay between labor, place, ethnicity, the body, gender, religion and language that shift and balance differently depending on the encounter and the individual. Identities are not completely fluid and random but are reconfigured through various strategies of border drawing and crossing. This is most vividly described in the ways nurses and other medical workers choose to avoid associating with other Filipino migrants employed mainly as domestic workers. This finding was surprising to Amrith herself at the beginning of fieldwork but came to illustrate what she calls the “processual character of sociality and identity” (132) as migrants cross borders only to construct new borders along lines of class, culture and citizenship. In contrast to assumptions of collective political resistance among ethnically similar migrant communities, Amrith compares the “quiet lives” of nurses with the “lively domestic workers,” each group enacting its own political and moral negotiation of the migrant experience. Although Amrith herself does not return to the evocative notion of a cartography of care, it is strongly implied in the ways these groups form social and emotional bonds, bodily rhythms, and even spiritual belonging. The notion that medical workers efforts to keep the possibility of moving on to North America or Europe open and aspireable, also closes off a border between themselves and their country of origin is unsettling. Yet neither borders nor openings are ever total, but rather expose the work that goes into their spatial and temporal making and unmaking.

Amrith bookends her ethnography by returning to the notion of home and its relationship to the Philippines. In detailed case studies, Amrith describes how the uncertainty and waiting that pervades the betweeness occupied by migrants in Singapore is suspended not only by uncertain yet futures, but also by ambivalent feelings attached to life in the Philippines. The process of migration brings about new encounters with the “home” and how to locate it in their experience. The processes that Amrith illustrates are, as she notes, not distinctly Filipino, nor are they limited to migrants or other displaced persons.  Amrith connects her work most strongly to Bourdieu’s concepts of practice, distinction, habitus, misrecognition and social capital. Amrith’s complex and dynamic case studies have potential to do more to build on these theoretical foundations and explore the implications for how class, citizenship and culture construct global capitalisms. On the other hand, while Amrith notes the important question of “being at home in the world,” this does not take her into an existentialist or phenomenological analysis in the way that other anthropologists have. Her approach is, in this way, humanistic and grounded, and in this regard, it is both immediately accessible and thought-provoking. In full disclosure, my mother is a Filipina migrant nurse who came to the United States in 1969, and Amrith’s book is the first time I found her experience represented in ethnography. I am sure that many more students, scholars and general readers alike will appreciate, as I did, the way Caring for Strangers sensitively presents both the struggles and possibilities of betweenness in migrant lives.

Jason Danely is Senior Lecturer in Anthropology of Japan at Oxford Brookes University. He is author of Aging and Loss: Mourning and Maturity in Contemporary Japan (2014).

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