The ‘Ayah’ and the Elderly: Illness, Nursing and Intimate Labour in Kolkata’s Domestic Spaces

Abstract

Demographic transition, global population ageing and restructuring of family has inflected questions on the appropriate care arrangement and care management in later-life adulthood. These co-evolving and intersecting trends have drawn attention to the context and setting of care. South Asian cultures rooted in the principle of seva, filial piety and moral indebtedness towards the elders view intergenerational care as a duty, responsibility and expression of normative practice. With the rise in exigencies and contingences related to care in late modernity, navigating homecare practices, solicitude politics and brokering of care within it became the epicenter of this study. Efforts are made to understand the modalities through which an ayah becomes part of the ageing, and resuscitation and dying process of older people. Drawing on feminist gerontology and critical gerontology and cultural gerontological ontology, this study deploys micro-ethnography, 16 family case studies and in-depth qualitative interviewing with 30 ayahs in South 24 Parganas, North 24 Parganas and Kolkata Municipal Corporation. In response to the interconnecting trends discussed earlier, dependence on the cheap and affordable labour of paid careworkers can be witnessed in urban India. Locally known as ayahs, these are women grappling with the multiple disadvantages of lower caste-lower class and the gender penalty of low remuneration, devaluation and stigma. Unlike the professional nurses, ayahs are not trained and unlike the ASHA workers there is no effort at capacity building of the ayahs. Despite such overt shortcomings, ayahs have developed a vocabulary to typify and categorize patients according to their plight, difficulty level in dealing such patients, and the degree of dependency of the older adults in care. Through experiential knowledge they could fathom the advantages and disadvantages of working in different shifts, attending to children vs. older population, and caring for patients in different stages of illness. This clarity of the ayahs enables them to survive in carework in the absence of training and professionalization. Ayahs are aware of the stakes of intimate body care labour and have identified certain strategies to manage dirt, stigma and repugnance. These strategies are internalization and routinization of disgust, desensitization towards the gross elements of the body, and acceptance of their status-quo in a socially graded world. To negotiate the difficulties of carework, deeming the patients as parental figures and empathizing with the pangs of old-age is not only a coping mechanism but a modality of cementing solidarity. Dealing with older patients can be challenging especially those with dementia onset, highly-dependence or intransigence. Carework involves understanding the life course of the patient, and ayahs acknowledge that amelioration of intergenerational and interpersonal tensions promotes well-being. Their willingness to go beyond their immediate tasks, treat the client’s family as her own and exercising agency integrates and knits them to the client’s family. The element of proximity and close-contact in carework creates possibilities of moral ambiguities, emotional stress and facilitation of a filial tie between the caregiver and the older adult. Ayahs are the lynchpin in the homecare model and their situated knowledge of ‘culture-centric care’ needs to be harnessed for sustainable elderly care practices. This can be referred to as the ‘ayah-centred’ approach to care and this ayah habitus is important for designing policies that resonates with NPHCE (National Programme for Health Care of Elderly). The study foregrounds the solicitude politics and contested narratives of care, older peoples’ difficulty in coming to terms with their fractured self, erosion of autonomy and patienthood, emotional distress and coping of caregivers in attending to such patients, and what it means to deal with the recalcitrant aspects of body carework.