‘Why do your people do things that just aren’t right’? Latinas/os and race relations at a community clinic in el Nuevo south

ABSTRACT

In el nuevo South, the immigration of Latinas/os complicates our understanding of relations between races. Drawing on 18 months of participant observation, I explore how the employees of a community clinic decided to regulate health-care access and how race and the perception of ‘who is entitled’ figured into their practices. My study shows how racial conflicts influence access to public resources, such as health care, and how those conflicts stem from constructions of citizenship, social membership, and belonging. This article sheds light on race relations in a new immigrant destination, explores workplace conditions that might incite racial conflict, and highlights racialised constructions of citizenship and belonging. It concludes that the resulting stressful work conditions at the clinic, lack of resources, and threat from ‘the other’ fomented racial conflict between African-Americans and Latinas.

KEYWORDS:

• El nuevo South
• racial conflict
• othering

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. Pew Research Center 2011 at http://www.pewhispanic.org/states/state/nc/ (accessed May 2016).

2. African-Americans felt economically threatened, as jobs available to them were often grueling, dangerous, and poorly paid, and many employers favored migrant (often undocumented) workers, whom they deemed more tractable (Vaca, 2004). Blacks perceived a threat more acutely when the immigrant population was growing rapidly and they were in the minority (Marrow, 2011). In contrast, whites did not feel threatened economically by Latina/o immigrants (Marrow, 2011; McDermott, 2006; McClain et al., 2011, 233) because ‘immigrants take low-skill jobs formerly held by natives and that immigrants also help push natives upward in the occupational stratification system’ (Rosenfeld and Tienda, 1999, 97–98).

3. Bureau of Primary Health Care. ‘Health Center Program, Fact Sheet 2016: Health Resources and Service Administration.’ Found at http://bphc.hrsa.gov/about/healthcenterfactsheet.pdf (last accessed May 25, 2016).

4. All names are pseudonyms.

5. Community health centers resulted from President Lyndon Johnson’s ‘War on Poverty.’ In 1965 the U.S. Office of Economic Opportunity gave grants to community groups – health departments, community organisations, hospitals, and medical schools – to set up and administer health centres in poor neighbourhoods to ‘provide high-quality health care to low-income populations lacking access to such care and, at the same time, serve as a model for the reorganisation of health-care services for the entire U.S. population’ (Sardell, 1988, 4). This radical health-services innovation was a response to the ‘discovery of poverty  …  a fear of urban unrest  …  and a broader concern for the needs of the urban poor, primarily minorities’ (Sardell, 1988, 6). In 1995, 822 health centres operated in the U.S. and served almost nine million patients (NACHC, 1996). In 2001, 845 health centres were serving almost 12 million clients in the U.S. (Rosenbaum and Shin, 2003, 3); slightly more than half of them (51%) operated in rural communities (Rosenbaum and Shin, 2003, 2). As of 2016, more than 1300 health centres operate approximately 9000 service-delivery sites that provide care to nearly 23 million patients in the U.S.

6. For an analysis on how Care Inc. regulates delivery of health care, especially to undocumented migrants see: Deeb-Sossa and Bickham-Mendez (2008).

7. For a client to be considered for a low fee, as determined by federal guidelines, the client had to provide the clinic with: (1) proof of address; (2) proof of household income; and (3) an insurance card, if she or he had it. Proof of address could be either an envelope or a copy of a bill from the telephone company, electric company, or a copy of a lease, rental agreement, and so on. To provide proof of household income, all members of a household had to supply proof of income: a wife had to document her income and that of her husband; people living together and sharing income, even if not related, had to supply proof of income for each individual. A client also presented all insurance cards, whether the insurance was private (e.g. provided by an employer) or public (Medicaid or Medicare). If clients’ household income was at or below the poverty line, they were charged scale fee ‘A’ and did not have to pay for medical care; clients whose household income level was at least twice the poverty level were charged scale fee ‘E’, and they paid 100% of the cost of the services rendered.

8. Charging clients based on their ability to pay increases accessibility (and therefore demand), yet it reduces the resources available to the clinic to meet demand, creating understaffing.

9. As Butter et al. (1985) explain, ‘Historically women physicians have had a propensity to cluster in salaried employment and in bureaucratic work settings in contrast to the highly autonomous, self-employed practice mode of their male peers’ (25).

10. Black staffers were receptionist, medical assistant, laboratory technician, WIC/Nutrition Department coordinator, and nutritionist. Most of the Latinas also held lower-status positions, working as receptionist, client-care coordinator, medical assistant, laboratory technician, WIC administrative assistant, and pharmacy assistant.

11. Although the higher-status staffers in the clinic were sought out to resolve disputes, they were relatively sheltered from the conflicts between lower-status Black and Latina staff. This was due, in part, to the high regard the lower-status staff (Black and Latina) granted them for sacrificing more lucrative jobs elsewhere and staying to help the poor. By passing up bigger salaries, the higher-status health-care practitioners earned a ‘moral’ wage that consisted of esteem and sympathy (from the staff and community) and a positive self-image. Higher-status workers in the clinic were seen by the staff (and themselves) as moderators and not participants in the clinic’s racial tension (regarded as a problem between the lower-status Black and Latinas). They were buffered both by their race and their position as higher-status workers.

12. This was understandable. For example, at Care Inc. in 2002, a recently hired medical assistant (level I) was paid $17,200 a year, and a medical assistant (level II) was paid $18,900. A licensed practical nurse was paid a little more (between $19,700 and $28,700). MCCs were paid $26,000 a year, and the registered nurse, $31,000. Medical assistants working at a private practice or firm on average earn $26,605 a year, while a licensed practical nurse is paid $33,054 year, and a registered nurse $49,987 a year.

13. The idea of a ‘moral’ wage is related to W.E.B. Du Bois’ concept of a ‘psychic wage’. He argued that, during Reconstruction, low-class whites would accept low wages from white elites in exchange for esteem and freedom from violence:

The white group of laborers, while they received a low wage, were compensated in part by a sort of public and psychological wage. They were given public deference and titles of courtesy because they were white. They were admitted freely with all classes of white people to public functions, public parks, and the best schools. ([1935] 1998, 700)