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Going up or getting out? Professional insecurity and austerity in the South African health sector

Published online by Cambridge University Press:  21 May 2020

Elizabeth Hull
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Abstract

As a precondition of belonging, professionalism is often a taken-for-granted feature of being middle-class. Yet ethnographic attention to experiences of work reveals that professional identity can be fragile. Drawing on ethnographic research among nurses in KwaZulu-Natal, this article traces the feelings of precarity about work and the ambivalence that pervades ideas of professionalism. This ambiguity arises partly out of a peculiarly South African story in which histories of professionalism are entwined with the repressive apartheid project of separate development. Many of the professionals working as teachers, nurses, lawyers and administrators today were trained in the former ‘homelands’. Practices of professionalism are entangled with those of clientelism inherited from this earlier period of homeland politics. These local histories combine with wider processes of neoliberalism, as conditions of austerity produce structural shifts towards casualization. The article traces these dynamics in the stories of two nurses and considers what may be at stake politically as middle-class trajectories are threatened. Moving away from a view of the middle classes as either democratic or anti-democratic, feelings of ambivalence about work make questions of political allegiance an ambiguous and fraught matter.

Résumé

Résumé

En tant que précondition d'appartenance, le professionnalisme est souvent une caractéristique considérée comme allant de soi pour décrire ce qu'est être de classe moyenne. Pourtant, l'attention ethnographique aux expériences de travail révèle que l'identité professionnelle peut être fragile. S'appuyant sur des études ethnographiques menées auprès d'infirmières au KwaZulu-Natal, cet article décrit les sentiments de précarité concernant le travail et l'ambivalence qui imprègne les idées de professionnalisme. Cette ambiguïté résulte en partie d'une histoire spécifiquement sud-africaine dans laquelle les histoires de professionnalisme sont intimement liées au projet de développement séparé du régime d'apartheid répressif. Parmi les professionnels qui travaillent aujourd'hui comme enseignants, infirmiers, juristes et administrateurs, beaucoup ont été formés dans les anciens « homelands » (foyers nationaux). Les pratiques du professionnalisme sont indissociables de celles du clientélisme hérité de cette période de politique des homelands. Ces histoires locales s'associent à des processus de néolibéralisme plus larges, des conditions d'austérité produisant des changements structurels vers la précarisation. L'article décrit ces dynamiques dans les histoires de deux infirmières et examine les enjeux politiques possibles à l'heure où les trajectoires des classes moyennes sont menacées. Loin d'une vision des classes moyennes qui serait démocratique ou anti-démocratique, les sentiments d'ambivalence autour du travail font des questions d'allégeance politique un sujet ambigu et délicat.

Type
The lived experiences of the African middle classes
Information
Africa , Volume 90 , Issue 3 , May 2020 , pp. 548 - 567
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Copyright
Copyright © International African Institute 2020

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