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

5. “Neediest of the Needy”: How Midlevel-Status Workers View Their Work as “Moral”

84 5 “Neediest of the Needy” How Midlevel-Status Workers View Their Work as “Moral”* The maternity care coordinators provided family planning and contraceptive counseling for all women who came to Care Inc. for a free pregnancy test. They saw all new prenatal clients before their first visit with a clinician. In this one-hour visit, the maternity care coordinators provided clients with information about Care Inc.’s services, the WIC nutrition program, and North Carolina’s Baby Love program . They also took applications for Pregnant Women’s Medicaid program and Infants’ and Children’s Medicaid program. Medicaid is an assistance program that provides medical and health-related services for low-income families, a jointly funded cooperative venture that began in 1965 between the federal and state governments to assist states in providing medical care to eligible needy persons (see: http://cms.hhs.gov/medicaid/mover.asp). In this first visit, and in subsequent prenatal visits, the maternity care coordinators evaluated the women’s pregnancy-related needs and recommended services or plans to meet those needs. The maternity care coordinators were also trained to intervene in cases where they suspected a woman was being abused by her partner or when a child was being mistreated or abused. *A condensed version of this analysis was published in 2007: “Helping the ‘Neediest of the Needy’: An Intersectional Analysis of Moral-Identity Construction at a Community Health Clinic,” Gender & Society 21(5):749–772. “Neediest of the Needy” 85 The maternity care coordinators taught a six-week birthing class for Latinas in their second or third trimester of pregnancy. This program was implemented in 1988 when Care Inc. became one of the 206 federally funded community centers to which the US Congress gave money “to implement services to improve pregnancy outcomes and reduce infant death rates” (History and introduction to [Care Inc.] perinatal program). When the clinic first opened in 1970, 80 percent of the clients were African American. By 2002, 57 percent of the clients were Latinas and Latinos, 17 percent were white, and 16 percent were African American. Only a year later the proportion of Latina and Latino clients had increased by 10 percent. Since 1990, some Southern states, including North Carolina, have become common destinations for Latina/o immigrants. According to the US Census Bureau, North Carolina’s Latina/o population has grown 394 percent since 1990, and Latinas/os account for 4.7 percent of the state’s population. The rapid growth of the state’s Latina/o population outpaced the nationwide rate of almost 60 percent since 1990 (US Census Bureau 2010). The maternity care coordinators also dealt with difficult working conditions. They were poorly paid, overworked, and interacted with clients experiencing physical and economic hardships. Despite these challenges, they constructed a positive self-image, a moral identity (Kleinman 1996) that helped them persevere under difficult circumstances . These maternity care coordinators, two of them white and two of them Latina, saw themselves not only as good people, but also as health practitioners responsible for helping the “neediest of the needy” (as one maternity care coordinator put it). The maternity care coordinators’ moral identity relied upon characterizing the Latinas as the “moral” clients, while demonizing the attitude of African American Care Inc. staffers. The maternity care coordinators identified Latinas as those who needed them the most, and they became allies for these Latinas. In doing so, they lumped the other clients—African American and white women—into the category they called “American.” The term “American” became a synonym for privilege, at least relative to Latinas. The white and Latina maternity care coordinators felt they needed to protect and save Latina clients from the discrimination they experienced in wider society and, as the maternity care doing good 86 coordinators’ saw it, from the African American staff of Care Inc. as well. It is not surprising for US citizens to refer to themselves as “Americans .” In the broadest use, the term includes any US citizen, regardless of her or his ethnicity, race, sex, class, or sexual orientation. So how did it come to be used differently by the maternity care coordinators ? They used the term descriptively, but also at times in a way that was synonymous with privilege. For example, Melanie, a white maternity care coordinator, used it in an interview to describe her family: “My dad is American. My dad is as white as you can be—born...