Farewell my migrant healthcare worker
by Bromme Hampton Cole 柯 博 明
告 别 了 流 动 护 理 工 时 代
同 志 好! What follows below is a slightly edited transcript of an interview with a young woman named “Jiang” (alias) which occurred in Beijing, Chaoyang District at a Starbucks coffee shop on December 1, 2011. All edits are primarily due to issues of translation, my imperfect “on the run” typing effort and a very uncomfortable seat at Starbucks. Otherwise, her responses are reported below in as true a form as possible. The purpose of the interview is to shed light on the single most critical issue within the burgeoning geriatric care industry in China: namely, the absolute dearth of properly trained human resources and consequently the use of inadequately trained personnel to administer care to the elderly Chinese. A read through the interview illuminates other social concerns, and while I am sympathetic to these, my focus here is senior care.
Jiang is a young lady of 36 years who is a migrant healthcare worker in Beijing. She is perfectly average for her social cohort in nearly every respect: neither pretty nor ugly, simply dressed, with serious tooth decay and a limited world view. She is a contract employee at a state run nursing facility and has no professional education in nursing other than what she has learned over the past few years. Jiang, and many of the people with whom she works are known as “Bao Mu”, or migrant workers. Being Bao Mu carries a stigma and it is not a pleasant one; they are viewed as wholly inferior, as a lower caste, dirty and unworthy. In reality, I found in Jiang a bucolic charm and a meek honesty which set her in sharp contradiction to her current urban existence; indeed, her life in Beijing could not be more uncomfortably foreign.
As we moved through the discussion, Jiang became more relaxed and began to open up. I did not intend to enter the realm of her private life but as the interview progressed, it became obvious that her past has had profound influence on her current situation. Some of her answers are startling and painful; they paint a vivid picture of not only her job but of her life as well. Lastly, you will notice that the conversation is occasionally peppered with anecdotal comments, either before or after a question, in << >> brackets. I added these notes after a final proof read as I found a simple rote reproduction of the interview resulted in a hollowness which failed to convey the emotional environment.
Jiang arrived at Starbucks prior to the translator and me. She was sitting at a small table in the back of the room waiting patiently with her coat and gloves on, giving a guarded impression and that she considered us a potential no-show. As we approached the table she stood, smiled and said hello. After a brief introduction by the translator and some explanation, I began the interview:
***
Bromme柯博明: Hello, Jiang
Jiang: Hello Sir
Bromme柯博明: My name is 柯博明 and I have a business here in China. I help Chinese businesses build private nursing homes and senior living facilities. I have explained to you that I want to ask you a number of questions about the work you do, how you came to do it, what you think about it and generally about what you want to do in the future. Is this ok? You understand?
Jiang: Yes Sir
Bromme柯博明: Also, I am asking you these questions because I intend to publish your answers in a blog I write. You will remain anonymous, but your responses will be reproduced, after translation and small edits, in their entirety. This is ok for you?
Jiang: Yes Sir
<<Jiang nods in approval>>
Bromme柯博明: Ok, let’s get started. Where were you born and where did you grow up?
Jiang: I was born in Bishan; I grew up there too; my entire life.
<<Bishan is a rural town near Chongqing. Jiang, obedient and dutiful, asks if she can take her coat off.>>
Bromme柯博明: How old are you?
Jiang: 36
Bromme柯博明: How many years of education do you have? And what have you studied?
Jiang: I studied the basic curriculum
<<This means that Jiang spent about nine years in school>>
Bromme柯博明: Jiang, I understand that you work in a nursing home, how long have you worked there?
Jiang: About three years
Bromme柯博明: What do you like most about it?
Jiang: The money, but I do not get paid much.
Bromme柯博明: How much are you paid?
<<Jiang was not eager to discuss her salary and I think she found this a little intrusive. There was some conversation between them about my question between the time I asked it and her final response. It was awkward for her and, I sensed a little painful. But I believe she was truthful.>>
Jiang: They pay me 1,500 rmb per month. I also get a bed and some food.
<<This equates to roughly USD235 plus the food and bed.>>
Bromme柯博明: What do you like least about it?
Jiang: I do not like taking care of old people; I am a young person. The old people yell at me and sometimes try and hit me when I have to touch them.
Bromme柯博明: Do you get hit a lot? Why do you have to touch them? What do you mean?
Jiang: Sometimes I get hit but often they miss me because they are slow. The nurses tell me I have to clean them when they shit in the bed. Or sometimes I have to help them go to the bathroom by inserting my finger into their anus. Also, sometimes the families blame us when the old people die.
<<Jiang tried to release this bit of information as if she were sorting laundry, but she could not contain the anguish; it was embarrassing for her.>>
Bromme柯博明: Does anyone else hit you? Have the nurses ever hit you? The boss?
Jiang: No. My father used to hit me but not the nurses.
<<Obviously, this was unexpected and the result of a miscue in translation. It made both the translator and me a little uncomfortable, and I decided to ignore it for the time being. After a breath, I continued.>>
Bromme柯博明: How did you find your job here at the nursing home?
Jiang: My friends told me.
Bromme柯博明: How did they find this job?
Jiang: I don’t know
Bromme柯博明: What did you do before you worked at the nursing home?
Jiang: I was a food worker. I prepared food in a factory.
<<Her answers here were robotic and truly conveyed that she was disconnected to her job; it was merely a means to an end.>>
Bromme柯博明: Jiang, when you left the factory (Where was the factory?) and came here to Beijing to work at the nursing home, what training did they give you?
Jiang: I worked in Wenzhou. When I was contracted, the nurses told me what to do and after a few weeks I was able to do most of the work alone.
<<Wenzhou is located on the coast of China, not far south of Shanghai. Wenzhou is the crucible of Chinese entrepreneurship.>>
Bromme柯博明: Other than clean the patients, what else are your duties?
Jiang: I feed them, give them medicine, help wash them, help them exercise if they want.
Bromme柯博明: Jiang, how long do you think you will work at the nursing home? Do you have other plans? What would you like to do with your life after the nursing home?
<<This question was either puzzling to Jiang or the translation was off. It took a few iterations to get it on target>>
Jiang: I have to work here because I need the money. Someday I might find another job but I don’t know. I would like not to work here, but I don’t know where to go. I would like to have a shop and sell things.
Bromme柯博明: What type of things would you like to sell?
Jiang: All sorts of things, cute little knickknacks, dolls, sweets!
<<Jiang turned into a little girl describing this. She was almost excited and literally disappeared into another world for a moment.>>
Bromme柯博明: So, Jiang, if I understand you correctly, you work at the nursing home for no other reason than you need the money? Right? You essentially hate the job, nothing about it interests you. In fact, caring for the old people disgusts you…they even hit you sometimes, right?
Jiang: Yes Sir
Bromme柯博明: Do you think you are good at your job? Are you proud to be a health care worker?
Jiang: Today I know my job and I do it, but I do not like it. I am not proud of being a health care worker.
<<The idea of being proud of her job was novel, but once she understood the question, she responded with little hesitation>>
Bromme柯博明: Do you think being a health care worker is an important job?
Jiang: It is not an important job, if it were I would be paid more money.
<<Jiang’s logic was unassailable and her honesty was simple. I was beginning to sense that this idea of mine, that is to interview a migrant health care worker, needed something more. So I decided on a different track>>
Bromme柯博明: I want to ask you some questions not related to your job at the nursing home, ok?
Jiang: Yes
Bromme柯博明: Did you have a happy childhood and are your parents still alive?
<<I felt this was a reasonable subject to explore given her prior admission about her father.>>
Jiang: We are a very poor family. And when I was little my parents had to split up and work in different cities. I had to go and live with my relatives for a long time. One day my father came to get me and take me home. But he would beat me all day and tell me to call my mother and beg her to come home. I had a very bad relationship with my father. My parents are still alive.
<<Jiang opened up here in a way that I doubt she has in quite some time. She was almost eager to say these things. Her answer above is an abridged version of her entire response.>>
Bromme柯博明: If you could buy anything what would it be?
Jiang: A nice house for my mother and a shop for me!
<<Jiang smiled broadly. She missed her mother enormously>>
Bromme柯博明: Jiang, I have only a few more questions. When your mother is old and frail will you take care of her? Or would you consider a nursing home for her?
Jiang: Yes, I will care for her.
<<Jiang oozed empathy>>
Bromme柯博明: But you will have to work, right? How will you take care of her and work at the same time?
Jiang: I don’t know.
<<And again, Jiang’s honesty was never more apparent than in this answer. She paused for a while before answering, looked down at the floor hopelessly and responded without looking up. I think that this may have been the first time she ever considered the difficult situation of either caring for the mother she loves more than anything or supporting herself. I don’t want to read too much into her answer but I suspect that she began to rethink her plight at this moment. Her answer in a way almost made me feel guilty about presenting her with this dilemma>>
Bromme柯博明: Jiang, do you have any questions for me?
Jiang: Sir, why do you want to work in nursing homes?
<<Clever girl, I thought>>
Bromme柯博明: I don’t really work in them. I help people build them and operate them.
<<Jiang waited for the translation. It didn’t appear that my response really answered her question.>>
Bromme柯博明: Thank you, Jiang. I have enjoyed speaking with you.
Jiang: Yes Sir, Did I do a good job?
Bromme柯博明: Yes, Jiang. You did a great job.
<<Jiang rose from the table and put her jacket back on. She thanked the translator, smiled and began to walk out, when I asked her one last question>>
Bromme柯博明: Jiang, have you ever seen the Chinese movie Farewell my concubine?
Jiang: Oh, no Sir, movies are too expensive. Goodbye
Bromme柯博明: Goodbye, Jiang.
***
In my two hours with her, I found Jiang to be much like Chen Dieyi in the film Farewell my concubine. Not on a superficial level, but in terms of how tortured she must be; caught in the middle of a miserable triangle with the angles of her life defined by a father who beat her as a child, the necessity of holding down a job she despises and a mother to whom she is fully devoted and loves dearly but cannot live with for financial reasons. Making this mosaic more complex, Jiang now knows that she, like millions of other poor and middle income Chinese, face a dreadful dilemma of ultimately having to care for their parents and lose a job or keep the job and turn their parents over to a nursing home.
Update: Last week I found myself in the vicinity of the nursing home where Jiang works. I stopped by to say hello and thank her again for her time. The manager of the facility seemed frustrated when I inquired about her; he told me she had quit her job three days ago and did not know where she went.
She just left he explained, raising his hands in exasperation, “Like all the Bao Mu, appear from nowhere and disappear into nowhere”.
I turned and walked out of the nursing home, leaving behind the caustic tang of bleach and sour reek of dirty clothes. The cold air bit into my nose and cleared my lungs as I stepped outside. I walked down the street and thought about what the manager said regarding Bao Mu disappearing into nowhere. As I hailed a cab, I looked back at the nursing home and pictured Jiang, an apparition with suitcase in hand, furtively leaving her job and escaping under the cover of a foggy dawn into a thoroughly uncertain future.
Full of ephemeral sympathy for Jiang, I thought to myself as I got into the cab, “Indeed, has there ever been a more poignant, unknown destination?”
为 人 民 服 务!
China Senior Living is pleased to announce its sister blog
India Senior Living!
The first blog should be posted in early 2012!!
Find it on www.indiaseniorliving.com
Dear Bromme,
Even though the story of Jiang is saddening in a way….I hope she realised that this job was not fulfulling and she either went back to her mother that she misses so much or she went out to venture new paths where her heart lies. The situation is recognisable from other stories I heard but even closer to home: the supply/demand of health care made it possible to enter the profession without the what I call “Florence Nightingale” factor. As this factor is getting more blurred we can find more and more workers in health care who do not have an intrinsic motivation or the right qualities to do the job. Cheap….but eventually ineffecient and not quality driven may be my conclusion.
In January we’ll be preparing operations in Jakarta, Indonesia: I hope to meet more enthousiastic and driven health care workers there.
Thanks again for your insight and I hope we’ll have a opportunity to work together someday.
Best Regards,
Ies
Greetings Ies,
What happened to Jiang and what made her leave are mysteries. Ultimately, she is driven my both the need to support herself and her emotional ties to her mother; expecting her to make rational career-building decisions is not realistic. I dont mean to demean her, but knowing her as I do and knowing how she views her station in life, it seems to me that she is resigned.
I am impressed with your victory in jakarta! I will reach out to you via email and learn more.
Great to keep hearing from you here at China Senior Living! Please keep your eyes open for my new blog series: India Senior Living. I have been fascinated with the way these two vastly different cultures are approaching elder care.
Thanks again,
Bromme!
Bromme,
First I want to complement you in talking with a Bao Mu working in a nursing home. Stories of these “小人物“ have not been told enough. Looking at CNAs working in the U.S., are they that much different from Jiang? How many of the CNAs working in the nursing homes are really for the love of taking care of the elderly?!
There are, of cause, exceptions. In the SNF I am working right now, there’s a CNA who started when the facility first opened the door 43 years ago! I don’t know what her reasons, and I don’t think money explain everything.
Hello Michael,
I appreciate your response here. I have always thought that the senior care business is a unique mixture of actual “business” and emotional dedication to a cause….in its highest form. And the management of such facilities is one of the trickiest jobs (if you can call it that) around.
China has a very high sense of aesthetics and this will translate into its senior care culture in due time resulting in a “Chinese” model.
Thanks for stopping by…!!
Bromme!
Dear Bromme,
Thank you for your interesting article. Following the Chinese nursing home market since my BBA degree and working in management in a nursing home in Germany, I was surprised by some similarities to Germany
As well as in china is the workforce up till a certain amount (50 percent) untrained in a nursing home over here. Also you can notice most of the people just working for the money and not putting her hart in the job. As Ies Paalvast put in the response, what is missing is the “Florence Nightingale” factor.
Truly not such a sad story as with Jiang, most of these workers come from Eastern Europe and just need a job to support the family. Their parent’s live mostly still back home and in conversation you can hear them worrying about their parents and who looks after them. I guess in the US you have a similar situation with workers from Latin America.
I hope for myself for the sake of the residents in nursing homes, this might change one day in China, Germany and the rest of the world. Blogs like yours and dedicated professional people, that’s my opinion a definitely a help. Knowledge and research how to do things right is everywhere available, you just have to put it on the right place.
I looking forward for more interesting articles from China and as I saw now as well India.
Best regards
Torsten
Torsten,
Thank you for your comments. Yes, Florence Nightingale is the proper paradigm here…her selfless devotion to her craft at such an early time made her a maverick. The Chinese people are naturally hospitable and I have no doubt that with the proper educational resources, they too will pick up this calling and emulate the Nightingale model.
I appreciate your attention to this blog!
Bromme!
Dear Bromme
Great article, sensitive and insightful – thank you.
In Australia we have a similar experience to many of your other respondents; newly-arrived migrants – mostly women – working as poorly paid carers in aged care facilities. In many cases they are in Australia on student visas but are hoping to stay; mostly from Nepal, the Philippines, some Mainland Chinese, equatorial African nations, South Pacific Islands, Papua New Guinea, Indonesia, Vietnam, India, Pakistan, Thailand. Their motivation is therefore quite different to some of the older long-term and ‘dedicated’ workers; tension often arises because of the perceived lack of commitment and compassion of the younger cohort. Cultural differences and religious observances add to the mix, and can result in management developing a negatively skewed perception about their reliability.
I hope to meet you one day. I work for a company that designs and builds the full spectrum of seniors’ housing; I am one of three Aged Care Nurse Managers employed to ensure that whatever is designed and built is: fit-for-purpose; easy to live and work in; and will meet not only building certification requirements but also those of the aged care regulators.
I’ve organised to spend the whole of 2015 in China, in a language and cultural immersion program in a city a few hours south of Beijing, and then see if there is any value that the aged care sector in China considers I can bring to it.
Regards
Lin
Dear Lin,
Many thanks for your thoughts here! There is so much going on in China these days, especially in the geriatric industry.
Sounds like a great trip you have coming up in 2015. Please stay in touch.
The next blog comes out in a couple of weeks.
Thanks again!