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“在地”理性：生命历程视域下医院女性护工的健康实践
Localisation of rationality: Life course perspective on the health practices of hospital female care workers
女性农民工是中国社会的边缘群体，她们不仅面临健康困境，且鲜有研究关注，但同属这一群体的医院护工又是其中最靠近健康资源的职业。研究在文化中心路径指引下，运用深度访谈和参与式观察的方法，关注女性护工生命历程中的健康实践。研究发现，在家庭私域、异乡漂泊以及照护工作阶段，宏观的经济政策、医疗保障制度和微观的家庭责任、工作环境等影响了其健康体验；而农村女性有着在地化的理性应对方式，直到她们成为护工后才形成传统乡土经验与现代医疗经验并置的健康理性。女性护工的健康实践是基于时空变化，由“家庭本位”传统驱动的发展理性，只有理解这种理性才能真正帮助她们从“他者化”的健康传播桎梏中解脱出来。
Female migrant workers are a marginalized group in Chinese society, who face health challenges with little research attention. Some of them work as hospital care workers, which are close to health resources. Guided by culture-centered approach, the study uses in-depth interviews and participant observation to focus on the health practices of female care workers in their life course. The study found that factors such as economic policies, health care systems, family responsibilities and work environment influence their health experiences in the private sphere of the family, in their wandering away from home and in their care work phase. Rural women have localized rational measures, but it was not until they became care workers that they developed health rationalities that juxtaposed traditional vernacular experiences with modern medical experiences. The health practices of female care workers are based on a rationality based on spatiotemporal conditions coupled with driven by “family first” tradition. By unfolding this rationality of rural female care workers, researchers can truly help them to free themselves from the shackles of ‘othering’ health communication.
Female migrant workers / culture-centered approach / healthy narratives / family first
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Based upon the culture-centered approach that foregrounds the relevance of interrogating the taken-for-granted assumptions that circulate in the dominant models of health communication on family planning, this article argues that traditional approaches to reproductive health campaigns are concerned with safe motherhood (e.g., fertility, birth spacing, hospital delivery) rather than with the processes through which women construct, negotiate, and maintain meanings of motherhood and health within their cultural contexts. In doing so, this traditional framework leaves out the broader sociocultural, political, and economic contexts of social structures that constrain and enable the possibilities for health in the realm of motherhood. The culture-centered approach notes the erasure of these voices of women from dominant epistemic structures, and seeks to interrupt knowledge production by co-constructing meanings of reproductive health through dialogues with women at the margins. Therefore, in-depth interviews were conducted to centralize experiences of the cultural participants, allowing alternative health meanings to emerge within their local contexts. In particular, highlighting narratives of young Nepalese women living under poverty, we are able to understand how women actively (re)construct meanings of motherhood within their localized cultural spaces.
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Against the backdrop of contesting the mainstream biomedical models of health communication, the culture-centered approach suggests dialogic research methodologies to coconstruct meanings of health through direct engagement with cultural communities. In this project, we engaged in in-depth interviews and informal conversations with elderly Druze women and their caregiver daughters to develop an understanding of the intersections of religion and health meanings in the context of aging women in this Lebanese community. Attending to the cultural constructions of health, particularly in religious contexts, opens up the discursive spaces of health communication to alternative cosmologies of health, illness, healing, and curing. Four themes emerged as a result of our grounded theory analysis: health as faith; mistrust, privacy, and modern medicine; polymorphic health experiences; and health as structure. These themes serve as the backdrop for playing out the competing tensions between the local and the global in the realm of interpretations of health meanings.
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1. 2018年，四川省实现基本医保市级统筹。意味着从理论上讲，现行的城乡居民基本医疗保险可以实现省内异地结算，但要面临复杂的线上申报和线下的流程和手续。同时，不同层级的医院报销比例也不同。一旦遇到重大疾病，对护工群体而言难以支撑所在医院的医疗费用，返乡治病将成为大多数护工的唯一选择。
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