Doing Good: Racial Tensions and Workplace Inequalities at a Community Clinic in El Nuevo South

1. Introduction: Meaningful Work and Moral Identity

1 1 Introduction Meaningful Work and Moral Identity In the following analysis of the construction and maintenance of “moral identity” (Kleinman 1996) by health-care providers at a community clinic in North Carolina (pseudonymously referred to as “Care Inc.”), I explore the ways that workers’ race, class, gender, and nationality shape their fashioning of a superior self-image. I examine how workers, like Eva above, construct a moral identity in the context of reconfigured race relations resulting from rapid Latina/o immigration to North Carolina, a new destination for these people. The mobilization of Mexican immigrants and other Latinas/os in sizable numbers to North Carolina altered the white–African American racial proportion of the state, transformed the ethnic makeup of social classes (in particular the working class of North Carolina), changed local politics, and affected both public and private institutional dynamics as organizations incorporated newcomers (Zúñiga and Hernández-León 2005). The arrival of Mexicans and other Latinas/os also transformed what Zúñiga and Hernández-León call “the symbolic definition of receiving localities,” as Catholicism, Spanish language, Latina/o music, and Latina/o cuisine became part of public spaces (i.e., shopping centers, street corners, and commercial storefronts) and of the region’s socioeconomic landscape. The presence of these newcomers created interethnic and linguistic tensions—as residents and public officials discussed the pros and doing good 2 cons of bilingual education—as well as economic tensions and new economic dynamics, through the rise of immigrant entrepreneurship (187–274). Throughout this book I address the question: How do workers maintain a sense of value about their work while long-standing race relations are reconfigured in the context of hyper-immigration? I highlight the dynamic nature of racialized relations, as well as the gender-based, class-based, and citizenship-based systems of oppression that shape the construction and maintenance of the health-care providers’ moral identity. For the health-care providers at Care Inc., the worth of Care Inc.—and their worth as health-care workers— depended on whether they believed they were “doing something good,” a phrase I heard repeatedly throughout my research. But there were different definitions for “doing good” and different moral foundations underlying those definitions, depending on the workers ’ gender, class, race/ethnicity, and citizenship status. Most importantly , these health-care providers failed to see how, in constructing and maintaining their own positive moral identity, they were led to treat each other and their patients unequally, and thus to contradict their ideals of doing good. Furthermore, the staffers denied that the ways they acted had hurtful consequences or reinforced race, class, and gender inequality. As Kleinman (1996, 11) writes, “We become so invested in our belief in ourselves as . . . ‘good people’ that we cannot see the reactionary or hurtful consequences of our behaviors.” Meaningful work can aid in safeguarding a positive moral identity. Analyzing how workers maintain a sense of value about their work, despite difficult working conditions, falls in the tradition of Everett C. Hughes (1958, 1971) and the Chicago School of Sociology. For example, Joffe (1978) found that abortion counselors at Urban Clinic, a private nonprofit family planning agency, wanted their clients to perceive and acknowledge abortion as morally problematic, something that clients were less and less willing to do. The clients’ behavior was important to counselors because they felt ambivalent about abortion: they were pro-choice, but their involvement in the abortion process became troubling to them. Joffe found that clients’ attitudes, in large part, determined whether counselors experienced their work as “heroic” or “suspect.” Counselors were more likely to see their work as suspect when counseling cynical or detached Introduction 3 women, hostile clients, and women who acted bored when discussing future contraceptive plans. In her later work, Joffe (1986) analyzed how birth control and abortion counselors at a women’s health clinic responded to difficult working conditions. The administrators of the clinic saw counseling as time-consuming and expensive, and as a potential Pandora’s box, because the clinic would have to provide for all clients’ needs. Counselors used coping strategies to deal with their highly intense and low-paying jobs, including being pro-natalist. To avoid presenting an anti-natalist image, abortion-clinic employees gave pregnant staffers special attention. Others document how difficult it is for abortion providers to feel good about their work. Simonds (1996) found that workers had difficulty assisting in second...