Racialization, Affect, and Refuge

How do we begin to grapple with the racialization of empathy? How do we capture, both ethnographically and politically, the differential allocation of sympathy, compassion, and the kind of care that mobilizes? For some people, these disparities are exemplified by the recent mass demonstrations of the Million Women March in cities around the world, with their lack of police violence, tear gas, or even “peaceful” arrest, and the celebration of—not frustration with—protesters “shutting cities down.” Across my social circles, friendsmany queer, many people of color, many dedicated activists with worn sneakers and frayed union cardsexpressed ambivalence about the success of the march. They asked, “Where were these people when Sandra Bland died? When the police were arresting us in droves or planes were dropping drones? Where are the cops in Black Lives Matter shirts?” The silence, they say, is deafening.

The issues of why and when people march; when they feel sympathy or connection with a political movement, a person, a scene; or what gets them to open their pocket books and donate to a specific causethese are the ones that come to mind when we problematize and politicize compassion and solidarity. They might, in fact, be the questionsthe thorny questions worth asking for those of us who hope that our work will bend the arc towards justice.

Taking off from the politicization of affect, my work explores how structures of feeling govern when and for whom doctors and other health professionals feel empathy, anger, disgust, frustration with, or kindness towards their patients. Take a scene from one of my first overnight shifts in the emergency department as a medical student. My patient, complaining of intense pain, drenched in sweat, screwed her face up in impossible contortions. Her body was rigid with discomfort. At first, she wouldn’t let me touch her, but I was eventually able to perform a quick exam—an act that was uncomfortable for both of us. Concerned, I ran out to tell my supervising physician her story. Her screams echoed in my ears, and I was eager to do something for her.  He agreed that she needed relief and we set to work on treating her.

I have often found myself wondering what it means to care for racially and ethnically diverse refugees in a city like Philadelphia during a time when the Movement for Black Lives and the global refugee crisis dominate the non-Trump news.
 We had not even started when the nurse who was seeing her came out and told us that our patient was an angry, demanding woman who was clearly “drug seeking” and faking her pain. If she wasn’t lying, then she was either pregnant or suffering from some “nasty STD.” Either way, the nurse wanted her out. For the rest of the evening, every intervention we tried to make was blocked by the increasingly frustrated nurse who was convinced that if we held out long enough my patient would give up her charade and leave to get her Dilaudid elsewhere. All along, I was struck by how very different my perception of and interactions with this patient were.

I write about this interaction because misunderstandings like this one were all too common in the ED. I do not discount the challenges that emergency providers face, nor their unique experience of being constantly available to the most vulnerable populations around the clock, day in and day out. That said, it was hard not to locate at least part of that tension in differences between provider and patient. Many of the conflicts present in healthcare delivery stem from the difficulty of empathizing with those who are different from us. Racial difference, especially, underpins interactions between patients and providers, particularly in contexts where a largely white physician and nursing staff is responsible for a predominantly black population. That patients who embody certain characteristics are more likely to be labeled difficult is now widely discussed (Creary and Eisen 2013; van Ryn and Burke 2000) My patient was a young, low-income woman—and black.

In order to make sense of this and other encounters, I turn toward anthropologies of care, affect, and race. I mobilize Berg and Ramos-Zayas’ notion of racializing affect (Burge and Ramos-Zayas 2015) that allows us to think the structural and the intimate in tandem, giving us a “vocabulary to talk about intersubjectivity in a way that does not negate, but in fact necessarily evokes, a series of broader material conditions and historical trajectories of which populations of color are highly conscious.” As anthropologists, we can process our encounters in the field through the use of theoretical lenses and ethnographic approaches that help us make sense of shifting movements of sentiment, feelings we know not to be entirely random, individual, and idiosyncratic but rather shaped, at least in part, by broader structural conditions and norms.

As loci of both deep compassion and vitriolic fear for their medical care providers and the broader American population, how can we understand the figure of the refugee against the implicit foil of the “difficult,” black urban patient?
 Since my encounter in the ED, I have grown more attentive to how racialization, affect, and care come together in other spaces of care provision. For years now, I have been working with and among multidisciplinary teams of physicians, social workers, nurses, psychologists, and lawyers who engage in caring for forced migrants—refugees and asylum seekers—in Philadelphia. In doing this work, I have often found myself wondering what it means to care for racially and ethnically diverse refugees in a city like Philadelphia during a time when the Movement for Black Lives and the global refugee crisis dominate the non-Trump news. How do providers contextualize their humanitarian work with refugees, both implicitly and explicitly, against the backdrop of working in a poorly-resourced, economically unequal, and heavily non-white city?

An attention to the racialization of empathy helps us see how refugee patients, their interactions with institutions, and their trajectories are shaped by their country of origin and the place they will ultimately assume—though never entirely and without resistancein American racial hierarchies. At the same time, as loci of both deep compassion and vitriolic fear for their medical care providers and the broader American population, how can we understand the figure of the refugee against the implicit foil of the “difficult,” black urban patient? In attempting to make sense of these scenes, I wish not to imply that the American healthcare system and the providers who toil in it are all unabashedly and irredeemably racist (although they often are), or to suggest that we shouldn’t maintain empathy and compassion for those who have had to flee their homes because of unbearable violence. Rather, I underscore the usefulness of ethnographic observation in providing granularity to our understanding of how racialized subjectivities are made in social practice, often through differential understandings of who is worthy of care and positive regard, and, who is not.

Michelle Munyikwa is an MD/PhD Candidate at the University of Pennsylvania.  Her ethnographic fieldwork traces the way notions of refuge and practices of care take shape in the contexts of refugee resettlement, asylum-seeking processes, and other racialized displacements in Philadelphia.

Contributions to this column can be sent to the co-editors, Tiffany Cain (tcain@sas.upenn.edu) or Diana Burnett (dburn@sas.upenn.edu).

 

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