The “Corona Warriors”? Community health workers in the governance of India's COVID-19 response

India's nearly 1-million strong band of quasi-volunteer accredited social health activists (ASHAs) have been key actors in government efforts to control COVID-19. Utilizing a nationalist rhetoric of war, ASHAs were swiftly mobilized by the government in March 2020 as ‘COVID warriors’ engaged in tracking illness, disseminating information, and caring for quarantined individuals. The speed at which ASHAs were mobilized into mentally and physically grueling labor was all the more stunning given these minimally paid community health workers have long been seen to have low morale given their precarious, informalized work arrangements. Building on work examining the spatialities of global health governance alongside literature on geographic contingency, this paper explores the ways that nationalist COVID-19 war rhetoric promulgated from Delhi worked as a technology of health governance to propel ASHAs into certain forms of action, yet also opened up spaces of potentiality for them to reimagine their relationship to both the state and the communities they serve. In particular, in our analysis of in-depth telephone interviews with ASHA workers in the state of Himachal Pradesh, we find that their hailing as COVID warriors inspired patriotic calls to duty and legitimized their (long over-looked) roles as critical governance actors, yet also was subject to resistance and reworking due to a combination of institutional histories, local politics, as well as happenstantial everyday encounters of ASHA work. The precarious employment of ASHAs – in terms of basic remuneration as well as the great on-the-job risks that they have faced – underscores both the fragile nature of India's health governance system as well as possible political movements for its renewal. We conclude by calling for geographers to give greater attention to community health care workers as a key window into understanding the uneven ways in which health systems are made manifest on the ground, and their ability to respond to citizens' healthcare needs – both in the COVID-19 pandemic and beyond.     

HEALTH CONCERNS OF ‘INVISIBLE’1 CROSS-BORDER DOMESTIC MAIDS IN THAILAND

With the rising number of sex venues along the Thai–Burmese border and the perceived links between migration and the HIV epidemic, the Thai authorities and NGOs have begun concerning themselves with health problems of immigrant workers and seeking effective social welfare programmes for them. However, this paper argues that formal service programmes targeting specific groups may not be enough and notes a need to call attention to officially invisible migrants, particularly domestic maids from Burma who are more vulnerable precisely because they are ‘invisible’. The ‘maid trade’ from Burma to Thailand is statistically invisible firstly because domestic work is not recognized as a formal occupation either by the employers or the employees and therefore, they fail to be registered in census data. Burmese female domestic workers in Thailand are normally recruited through informal channels facilitated by regional trans-national networks that also engage in human smuggling. Domestic workers remain invisible in Thailand also because most of them are live-in and tend to work for one family for lengthy periods of time. They are normally out of reach of labour unions, religious organizations, non-governmental organizations and public health services. The fear of being caught as ‘illegal workers’ by the authorities further hinders their contact with the public. This paper also attributes the migrants’ invisibility to the tradition of ‘domestic servitude’ in Thai society. Using three detailed case studies, the paper demonstrates how the invisibility has contributed to the health vulnerability of these women in their daily lives.     

Cross-border childcare strategies of Burmese migrant workers in Thailand

In discussing the challenges of cross-border childcare faced by migrant workers, most research focuses on ‘distance mothering’, assuming that children remain in the place of origin. In contrast, this article focuses on childcare at the place of destination in the context of migrant Burmese factory workers in Thailand. Since many of these workers are ‘undocumented’, they have few rights in their place of destination. This is especially problematic in the areas of reproductive health and childcare rights. Despite such obstacles, Burmese migrant workers strive to manage their childcare responsibilities by mobilizing whatever resources are available, as well as seeking to maximize the possibilities of citizenship and education rights for their children. According to our research, the specific strategies deployed vary according to the particular location in Thailand in which migrants are working. This study analyzes three locations in Thailand – one in the central Thailand, and the other two at the borderlands between Burma and Thailand. Through a feminist analysis of the ‘care diamond’, the study demonstrates how Burmese women migrant workers utilize the different migrant labor governance systems and porous international border as resources and opportunities to develop complex and changing strategies to juggle their childcare arrangements.     

‘Traditional Birth Attendants’ and Reproductive Expertise in Postcolonial Mali

Over the twentieth century, Malian families turned to older women reproductive specialists like excisers (who initiated young women into adulthood), nuptial counsellors (who educated women for sex within marriage) and popular midwives. Their work reflected an expansive understanding of health and fertility. In the 1970s, Mali's government sought to incorporate ‘traditional medicine’ into the health system. State health workers trained popular midwives as ‘Traditional Birth Attendants’ (TBA). The same health workers defined nuptial counselling and excision as un-therapeutic and outdated cultural practices. Comparing these responses reveals the role of gender and social status in the making of an African health system.     

Interaction during mental health floating support home visits: managing host–guest and professional–client identities in home-spaces

Mental health work has been transformed by ‘shifting geographies of care’ from institutions to care in communities, in particular by the emergence of support located within home-spaces. This article studies a floating support service targeted at people with mental health problems and contributes to research on post-institution and home care geographies. The data contain 17 audio-recorded home visits conducted by professional care workers. An ethnomethodological analysis informed by geographies of care in home-spaces shows how the home as a material space has consequences for conversations and the relations between the service users and workers. The parties orient to two relational and shifting identity pairs in their ‘home-space talk’: a host–guest pair (social call talk) and a professional–client pair (targeted intervention talk). Professional–client pair dominates, and in this sense floating support produces institutionalization of home-spaces. However, social call talk that enables service users to act as hosts governing their home-spaces has important functions. Orientations to hosts and guests create symmetry and trust among the parties that encourages recovery promoting interaction. The article also demonstrates the applicability of the methods developed in the geographies of mental health and home in the ethnomethodological interaction analysis, and the other way round.     

HEALTH OF HOME-BASED SEX WORKERS AND THEIR CHILDREN IN RURAL ANDHRA PRADESH,INDIA

This study uses secondary data from 2006 to assess the physical and mental health of rural, home-based sex workers and their young children in rural Andhra Pradesh state of India. The analyses of survey and clinical data show a high level of morbidity amongst sex worker women and their children. Women show high levels of nutritional deficiencies, anaemia, weight loss and hospitalisation. Women's mental health is particularly serious, with 92 per cent being depressed and 57 per cent having attempted suicide. The majority have experienced domestic and work-related violence, including rape. Clinical assessments of sex workers’ children show that most have received vaccinations, but almost half have parasites, dental problems and nutritional deficiencies. Both the physical and mental health of sex worker mothers are associated with the health of their children. Therefore, health interventions focusing on sex worker mothers have the potential to improve the health of their children.     

The complexity of aspiration: the role of hope and habitus in shaping working-class young people’s aspirations to higher education

In this paper, I explore how working-class young people in Leicester hope and plan for their futures as they consider the possibility of attending university. I respond to Pimlott-Wilson’s [2011. “The Role of Familial Habitus in Shaping Children’s Views of Their Future Employment.” Children’s Geographies 9 (1): 111–118] call for further research to investigate how individual dispositions and habitus affect how young people hope and aspire towards the future. I do this in three ways. First, I empirically test Webb’s [2007. “Modes of Hoping.” History of the Human Sciences 20 (3): 65–83] hope theory to understand how aspirations are formed on an individual and societal level. In doing so, I critically question what is understood by the term ‘aspiration’. This allows me to question what it means for young people to ‘raise aspirations’ towards university. Second, I explore how a spatial analysis can contribute towards an understanding of how habitus, hope and aspirations interlock to shape young people’s futures. Third, I argue that hope can be regarded as a form of capital which in turn influences habitus.     

Rural–Urban Migration and Gender Disparities in Child Healthcare in China and India

This article assesses the impact of rural–urban migration on gender disparities in children's access to healthcare in China and India. Much research has shown widespread discrimination against girl children in both countries, including in health investments, contributing to the well‐known problem of Asia's ‘missing’ women. Much less clear is the impact of the massive rural–urban migration now occurring in China and India on discrimination against daughters. Migration is usually thought to have a positive effect on child health, because of improved access to healthcare facilities, but this is not necessarily equally beneficial for both sons and daughters. Based on fourteen months of fieldwork with rural migrant families in Shenzhen (China) and Mumbai (India), this article argues that where migration improves access to healthcare, it may increase rather than decrease the gender gap in treatment of child illness in the short term, as resources are concentrated on the treatment of sons. Furthermore, it is not the case that rural–urban migration necessarily leads to better access to healthcare even for sons: some forms of migration may actually have an overall negative effect on child health outcomes. For these two reasons, development strategies focusing on large‐scale rural–urban migration should not be seen as a short‐term solution to problems of gender inequity in child health.     

Reshaping possible futures: Deportation,home and the United Kingdom

In this article I examine how foreign nationals in the United Kingdom (UK) envisage the possibility of a forced return to their countries of origin. Drawing on ethnographic data collected in London among foreign national offenders appealing their deportation at the Immigration Tribunal, I show how preparations for an eventual return were seldom made by those appealing deportation, even if the prospect of their forced removal and its implications for the family left behind was constantly on their minds. Appealing deportation can be a long process; living with the risk of being deported strongly impacts on the plans the migrants had devised and hoped for before deportation intruded into their lives. In this sense, and in the course of the deportation process, migrants have to reshape their sense of possible futures to include family separation and possible departures – deportation being only one of these. Generational differences and sustained transnational connections were influential in the reshaping of these possible futures. The data presented shows how for most research participants deportation means ‘leaving the UK’ and not ‘returning home’.     

‘It’s a very isolating world’: the journey to HIV care for women living with HIV in British Columbia,Canada

HIV health services research conventionally defines place in terms of proximity to care. However, understandings of place must also include the social spaces that women living with HIV (WLWH) occupy which shape their experience of health and access to care. Drawing on focus group data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study, we explored how 28 WLWH navigate geographic place and social space in attempting to access HIV-related healthcare within and across a range of urban to rural localities in British Columbia (BC), Canada. We describe how existing services, even if physically close, can be socially marginalizing as women confront HIV stigma, racism, and classism, which operate to exclude women from the places and spaces they must access for care. We also emphasize how women enact ‘geographies of resistance’ and succeed in carving out their own safe options for care and support. Finally, we share recommendations identified by women themselves towards developing local and community-driven ‘geographies of change’ that support the health and healing of diverse communities of WLWH. Our findings stress the urgent need to acknowledge and redress socio-spatial barriers to care and to work with WLWH to co-create a therapeutic landscape that reflects women’s diverse identities, localities, emotions, and experiences.     

Living with toxic development: Shipbreaking in the industrializing zone of Sitakunda,Bangladesh

Based on ethnographic fieldwork among local communities and shipbreaking workers, this essay focuses on the lived experiences of toxicity in the rapidly industrializing zone of Sitakunda, Bangladesh. Shipbreaking is receiving attention as a zone of toxic exposure. There is pressure for increased regulation and protection for workers. In contrast, other forms of pollution in the industrial zone of Sitakunda, such as water, air and noise pollution, are neglected or ignored. Worries about pollution and health highlight the unevenness of promises of development to come, also expressed by marginalized fishing communities structurally excluded from industrialization. My interlocutors describe unnayan (economic development) as bishakto (poisonous, toxic). I conceptualize this as ‘toxic development’ to draw attention to how ‘ordinary people’ (migrant workers, fishing and agricultural communities, shipbreaking workers and manual labourers) without capital, land or social networks of influence endure poisonous industrial activities that both create livelihoods and destroy them.     

Living the cruel futures of industrial change

Industrial change is related to and experienced by those affected by such changes through particular sets of relations with futures. However, engagements with industrial change have in large part included futures only in the role of the temporal, and often teleological, background of industrial change rather than addressing futures in their own right. Through an engagement with the closure and later reopening of a steelworks within Teesside, UK, this paper argues that attending to futures allows the complex relationships through which industrial change comes to be rendered present, related to and lived to be brought into accounts of the experience of industrial change. Through diverse modalities such as phone calls, tones of voice, news reports, rumour and soundscapes a future of works closure was rendered present by and for the steelworkers of Teesside. In addition to this, the paper also goes on to exemplify how such relationships with futures of industrial change can be theorized through the example of engaging with pension entitlements through the concept of ‘cruel optimism’ after the work of Lauren Berlant.     

Prostitution,variegated homes,and the practice of unhomely life in China

This paper studies a group of female sex workers and their ambivalent experiences of home in Dongguan, China’s so-called sin city, before the local government technically cracked down on the city’s sex industry in 2014. It has two objectives. First, we explore these workers’ life journey: spatially from their rural hometown to Dongguan, socially from domestic migrants to sex workers, and subjectively from poor persons to extravagant spenders. Through this journey-based perspective, we show that the departure from one home opens a door to another home, but the door to the sex industry engulfs our respondents into a perpetual condition of unhomely life. Second, we analyze sex workers’ practices of (un)homely life in various spaces of working (sauna), dwelling (rented apartment), and consumption (shopping center) in Dongguan and their imagination of a new home. We argue that home is a liminal space of ambivalent experiences that revolve around dichotomous distinctions between privacy and publicity, friendship and segregation, marginalization and belonging. This paper contributes to the critical geographies of home by incorporating these ambivalent experiences of home into sex workers’ life journey of leaving and making home in the context of China.     

The Role of Provinces,States, and Territories in Shaping Federal Policy for Indigenous Peoples’ Health

ABSTRACT

Under both Canadian and United States law, the availability and quality of healthcare and health services to Indigenous peoples are primarily a federal responsibility. Nevertheless, sub-national authorities—most importantly provinces, states, and territories—play a crucial role by virtue of covering (often through federal mandate) services, and regulating health facilities and health personnel off-reserv(ation). While both federal governments have undertaken efforts to transfer, within their fiduciary obligations, their responsibilities for Indigenous peoples’ health to the management of Indigenous peoples themselves, that transfer has considered or included provincial, state, and territorial authorities and resources unevenly, and, in some cases, in tension with the objectives of respecting standards for quality and access. This article applies the methodology used by Canadian researchers of the sub-national health authority issue to the health transfer experience in the United States. The article summarizes findings that demonstrate similar deficiencies as those present in the Canadian transfer process. The article further outlines the experiences of Hawai`i and Ontario as offering models through which to address some of these deficiencies. The article finally suggests that there is a positive relationship between greater participatory models adopted by provinces, states, and territories and better health outcomes among Indigenous groups so included.     

Regulating Body Boundaries and Health during the Second World War: Nationalist Discourse,Media Representations and the Experiences of Canadian Women War Workers

This article examines the intersections of gender, wartime nationalist rhetoric and the production of ‘healthy’ and ‘unhealthy’ bodies in both the Canadian workplace and the home during the Second World War. Analysing government, industry and media discourses in relation to oral history interviews with thirty‐eight women aircraft workers, we discuss women's distinctive role in shaping the health and morale of the social body during wartime, to ensure the maintenance of family, nation and the Allied war effort. While health in wartime was defined in terms of worker productivity for both men and women, anxiety about women's expanded roles heightened the emphasis on moral respectability as a marker of the ‘healthy’ female body. This was further complicated by the wartime emphasis on women's responsibilities to boost morale as part of their role in maintaining health and productivity for both men and women. Through such examples as workplace regulations and domestic advice, we examine the increased monitoring of women's individual and collective bodies and the intensified demands on female war workers as they crossed between the public and private spheres. We use our oral histories to examine women's embodied memories of ‘healthy’ and ‘unhealthy’ bodies within a regional context and their responses to government, industry and media discourses.     

How do Migrant Workers Respond to Labour Abuses in “Local Sweatshops”?

This article aims to provide empirical evidence on understanding how migrant workers’ responses to labour exploitation in low‐wage economies are articulated. Inspired by the low levels of conflict among workers in small urban sweatshops in Italy and Argentina, we ask ourselves what contextual and subjective factors prevent workers from organising collectively. Here we argue that in order to understand the nature of their responses, it is necessary to consider not only the organisation of the labour process, but also the class divisions within migrant communities. We also bring in briefly the role of the state in (mis)regulating migrant labour exploitation. We conclude by showing that workers’ responses are highly individualised and that community leaders with economic interests in sweatshop economies may play a role in securing their continuation by channelling the workers’ responses towards the defence of the “ethnic economy”.     

Too precarious to be inclusive? Hotel maid employment in Spain

ABSTRACT

Hoteliers have steadily been able to reduce costs and increase employees’ workload as a result of mass unemployment sparked by the financial crisis, beginning in 2008, and associated legislative reforms by the Spanish government. Outsourcing has been hotels’ main instrument in this drive. Hotel chambermaids are among the groups most affected by this phenomenon. This article analyses the impacts of outsourcing on hotel maids’ working conditions, while questioning the possibilities for achieving inclusive tourism given the current outsourcing trend. It is based on 44 in-depth interviews with a range of informants, including 24 hotel maids who have experienced the process of outsourcing, in major Spanish tourism destinations. This study aims to understand the changes these workers have experienced and perceived in their working conditions. The research results highlight a marked deterioration in hotel maids’ working conditions in recent years, most notably involving (a) a reduction in their salary and the loss of professional categories, (b) work overload, (c) greater uncertainty in the duration of employment, timetables and work schedule, (d) de-professionalisation, (e) segmentation, division and an increase in competition between hotel staff, (f) the accentuation of health problems and (g) a decrease in the capacity of representation and the defence of workers’ collective interests.     

Work intensifications,injuries and legal exclusions for paid domestic workers in Montréal,Québec

There is increasing research on the intensification of work in the post-1980s time period. The focus on flexibility in management practices has resulted in more tasks being offloaded onto workers who must then adjust their time-use to accommodate the greater workload. Studies of work intensification are not new to manufacturing production and there is increasing attention to unpaid domestic labour and service sectors. One industry, however, that has been neglected by these studies is paid domestic work where employers are individuals or families. Drawing on the traditions of feminist political economy and geography, I argue that the socio-spatial specificity of paid domestic work contributes an emphasis on workplace injury and labour law exclusion to intensification of work paradigms. Based on qualitative interviews conducted in Montréal, Québec from 2013 to 2015, I show how paid domestic workers intertwine narratives about work intensification and workplace injury yet remain excluded from the Act respecting occupational health and safety and the Workers’ Compensation Act in Québec. Migrant women caregivers are disproportionately impacted by these exclusions and I show how the Filipino Women’s Organization in Québec (PINAY) is at the forefront of challenging these exclusions. In conclusion, I propose an approach that combines feminist geography and political economy to consider how time-squeezes impacting individual or household employers may be intensifying the workloads of their paid domestic workers and how labour law structurally excludes workers along the social dimensions of gender, race and citizenship.     

Parental Migration,Intergenerational Obligations and the Paradox for Left-Behind Boys in Rural China

Drawing on in-depth interviews with caregivers of left-behind children (LBC) in rural China, this article seeks to explore their understanding of migration motives and the social process of taking on care-giving roles for LBC. The authors argue that there are underlying socio-cultural explanations pertaining to economic motives for migration; such as, making contributions to social events (weddings and funerals) in village life, and fulfilling social obligations for left-behind sons’ futures. Parents migrate to save for sons’, but not daughters’, adult lives. Grandparents, particularly on the paternal side, are expected to fulfil social obligations to care for left-behind grandchildren, even without immediate financial returns. These suggest that left-behind boys, and in particular boys cared for by paternal grandparents, may be at greater risk than other LBC, as they may receive even fewer resources in the form of remittances from migrant parents in their early childhood.     

Charity and self‐help: Migrants' social networks and health care in the homeland (Respond to this article at http://www.therai.org.uk/at/debate)

This article examines the delivery of healthcare by Haalpulaar immigrants' village association in France to their rural villages in Senegal. In the context of the neo‐liberal reforms in Senegal, the Haalpulaar immigrants have been very active in funding community project in the health sector for their communities of origin left to fend for themselves by the State. Haalpulaar migrants associations like TAD (Thilogne Association Developpement) and Fuuta Santé are improving access to healthcare in the Senegal River valley through the remittances of biomedicine, medical equipment as well as the organization of annual health caravans with the participation of French health professionals and local partners.