Farewell my migrant health care worker

“A smile ushers in the Spring and a tear does darken all the world”,
Master Yuan in Farewell my Concubine

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 health care 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 recently. 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. Usually, Bao Mu are ethnic minorities and they have largely been disenfranchised from the Chinese economic miracle. However, I found in Jiang bucolic charm and a meek honesty which set her in sharp contradiction to her current urban existence; indeed, to 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 sufficiently 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 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 on a website I own and eventually include them in a book. You will remain anonymous, but your responses will be reproduced, after translation and small edits, in their entirety. Do you agree?

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
<<She honestly looked much, much older…I was guessing 45.>>

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 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?
<<Glancing between the translator and me, 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 every hit you? The boss?

Jiang: No. My father used to hit me but not the nurses.
<<I choked on my breath. 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 known as the crucible of Chinese entrepreneurship.>>

Bromme 柯博明: And today, do you work unsupervised?
Jiang: Yes, most of the day.

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 else 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...it is a low job.
<<The idea of being proud of her job was a novel thought, 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: My parents are alive. 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.
<<Jiang opened up here in a way that I doubt she ever had. 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 response 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: Oh,…Jiang?

Jiang: Yes Sir?
<<Jiang pauses and turns to look at me…she smiles broadly.>>

Bromme 柯博明: Have you ever seen the Chinese movie Farewell My Concubine?

Jiang: Oh, no Sir, I don’t know what that is. Anyway movies are too expensive. Goodbye!

Bromme 柯博明: Goodbye, Jiang.
<<Jiang turned and walked towards the exit. For all the weight she carried on her small shoulders, she had a carefree bounce in her step as she slid through the glass doors and waved one last time.>>

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 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. This dynamic is one reason for the decline of traditional filial piety in China and its evolution into something more modern that will make facility living an acceptable option. 

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 imagined Jiang, an apparition with suitcase in hand, furtively leaving her job, escaping under the cover of a foggy dawn.

Full of ephemeral sympathy for Jiang, I thought to myself as I got into the cab and closed the door, “Indeed…’disappearing into nowhere’ has there ever been a more poignant, unknown destination?”