Chapter 4: Doing Good and the Becoming of a Good Person
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1The bylanes of Janta Mazdoor Colony are narrow and winding, snaking back on each other in a pattern that’s impossible to navigate through the first few tries. The SEHER office, where I did most of my interviews, is located opposite the police station in one of these streets. Stairs painted with flowers and birds by the young children of the neighbourhood lead up to a large square room that has a large window overlooking the tin roof of another house.
2One of my first interviews was with Deepti, Meena-di’s friend and the ASHA assigned to her neighbourhood. I had met her once before in August for a preliminary interview, along with fellow ASHA, Sunita. Meena-di told me that she had been much more willing for an interview this time, and she did in fact seem much more comfortable when I met her in January. As I had already met her once before, I didn’t spend too much time on preliminary questions on the nature of her work, how long she had been an ASHA and so on. We began talking about the field visits she had been doing before she came for the interview. Deepti spoke of the people she had grown close to during her time as an ASHA: ‘There aren’t many problems with getting people to do things like vaccinations and all here. Yes, there are a few people who still have their suspicions so they won’t show their documents like the Aadhar card and all, but mostly people know me and trust me so they don’t have a problem when I come to do field visits or take their children for vaccination (sic).’
3Deepti has intermittently been an ASHA for over a decade. A few years ago, she had an injury which prevented her from working so she took a break for three years. I asked her why she rejoined the ASHA programme, and if she had considered doing another job instead. She hesitated slightly and then replied ‘My family members (her in-laws in particular) took a while to get used to me going outside and working. They didn’t like it, I don’t know if they would like it if I took another job. They are all right with me doing ASHA work because it’s from the government’s side and because it’s a good job. They see that I’m helping people and getting respect from the community, so it is good work for me. I like the work also – it is very tiring but it feels like I’m doing something good for my neighbours and friends.’
4Deepti’s statement about why she chose to continue with ASHA work was, interestingly, preceded and followed by her reflections on the problems of the job. The low level of payment, the lack of timely payment, the difficult working conditions, and the lack of material and emotional support from state authorities were all cited at different points in the interview. Yet, she maintained that being an ASHA was good work. Deepti’s sentiments were reflected in all the interviews I conducted with ASHA workers. All of them independently brought up their issues with compensation and working conditions, and felt very strongly that something should be changed about the way that the scheme is structured. Yet nearly all of the ASHAs I spoke to also brought up the inherent ‘goodness’ of ASHA work on their own.
What is Work?: Conflicting Ideologies of Work and Volunteerism
5There are two things that stand out in Deepti’s statements. The first is the idea of ‘doing good’ for the community, and the second is that being an ASHA is work in the sense that it requires mental and physical labour, time, and that it is compensated (however nominally). However, ASHAs are hardly ever referred to as workers by the state, and most policy documents and official reports from the government refer to ASHAs as ‘honorary workers’ ‘volunteers’ or ‘change makers’. The nomenclature of an ‘activist’ is further intertwined by their position as ‘woman volunteers from the community’, both terms used by the state. This section will explore how competing definitions of work and volunteerism are conflated within the paradigm of community health work. Furthermore, why is this blurred distinction maintained and how is it contested? Taking examples from the qualitative data collected, as well as anthropological and sociological literature on the same, it is necessary to unpack the complex notions of labour that are imbibed within every aspect of the ASHA scheme, and how they unfold differently for the state and for the ASHAs themselves.
6The fact that ASHAs are paid but are simultaneously referred to as volunteers creates an interesting in-between situation, allowing us to more closely examine the main difference between volunteerism and work. Is it payment? Is it the kind of work done? Or is it the larger idea for which work is done? Or more likely, are there different lines of demarcation, each a combination of all three possibilities?
7Much of the sociological and anthropological literature on volunteering is based on a separation of volunteer work from paid work (Overgaard, 2019; Wilson, 2000; Taylor, 2004; Wilson and Musick, 1997a, 1997b). This is evidenced by many seminal texts on the topic, one of which is Tilly and Tilly’s (1994) article on capital work and labour markets. In this piece, the authors distinguish between four kinds of work: labour markets, informal sectors, household labour, and volunteer work. Further, they define volunteer work as ‘unpaid work provided to parties to whom the worker owes no contractual, familial, or friendship obligations’ (Tilly and Tilly, 1994, 291). Another popularly used definition was given by Wilson in 2000, who defines volunteering as ‘any activity in which time is given freely to benefit another person, group, or organisation’ (Wilson, 2000, 215).
8While these definitions need critique and analysis, they provide us with an important starting point. First, understanding volunteerism as ‘freely’ giving one’s labour, time, and energy to a larger cause immediately suffuses the term with moral and political meaning. The altruism and ‘politics of virtue’ (Brown and Prince, 2015, 29) embedded in typical understandings of volunteerism make it a powerful, if ambiguous concept. As Brown and Prince further articulate,
[T]he actual practice of volunteering is often riddled with tension. Volunteering may benefit the giver as much as the receiver. The lines between altruism and material reward, and between labor that is given freely and labor that is demanded by those in political authority, are often blurred. The relation between voluntary labor and paid work may be ambiguous, and the utility of volunteering within the labor market may be significant. (Brown and Prince, 2015, 30)
9Taking Brown and Prince as a departure point, it is important to understand volunteering as a socio-political tool, wherein the assumed altruism of a volunteer is wielded by the state for specific gains. This fact often gets lost when we examine volunteerism purely in terms of monetary payment or lack thereof, or in terms of formal or informal types of volunteerism. The distinction between volunteerism and work is often blurred when we examine ground realities. For ASHAs like Deepti and her peers, work is simultaneously seva (service) and work – it is something they do out of their own good nature, but also something that they need to be paid for. As Sushila, another ASHA I spoke to, articulated, ‘[j]ust because we continue working even though we don’t receive our payment on time, or get less than we should, doesn’t mean that they can just continue doing that to us.’
10Some feminist writings on voluntary work have been critical of the gendered nature of voluntary work. Oppenheimer (1998, 1) defined voluntary or unpaid work as ‘work carried out by people within structured organisations in the public sphere’. For her, it was productive work which has to be counted as part of labour history. This binary construction between work and volunteerism points to a need to define voluntary work, volunteers, and voluntary organisations, and to understand the voluntary principles which underpin these constructs. Oppenheimer argues that volunteers can be found in many and varied groups, and that they are generally associated with the improvement of the community and society at large. Volunteers give their own time to an organisation of their choice, without being paid for their services, and many work on an informal basis, either full-time or part-time, in an area of their own choosing. Altruism, or a feeling of social concern and responsibility for others, inspires people to do voluntary work (Oppenheimer, 1998, 3). Voluntary work is also, by definition, within the public space: work done in a so-called private space – for example within the family by women, and unpaid–is not described as voluntary (Oppenheimer, 1998; Sreerekha, 2017).
11While the moving of the unpaid, household, or domestic work into the paid, public space did not have anything to do with voluntary work, the fact remains that in general, voluntary work had a lot to do with women, children, or the poor or vulnerable sections of society. As is visible through this study, there is a narrative surrounding women workers deemed as volunteers in the public sector, and this is based on the understanding that these women have been given a chance to contribute to their community through social work.
12One of my earlier conversations with Deepti and Sushila was in fact about how they had been told to approach ASHA work during their initial training. Having fulfilled the requirements to become an ASHA, such as taking a basic exam to ensure that they had attained the minimum literacy levels needed, the newly minted ASHAs were then told the specifics of their work. The trainer of facilitators, as Sushila recalled, told them that they would be getting INR 500 per month as an honorarium for their work. ‘I remember thinking that was so little, even at that time. And then they said that what you are doing is seva, it is service – in fact you should not be getting any money for it at all. Whatever you are getting, be happy with it.’
13The next chapter will explore in further detail how such narratives are articulated by policy makers and the state, through official documents, in order to mobilise the labour of women for service.
14The case of community health work across the globe is one such area where the lines between work, volunteerism, and care frequently overlap and therefore are poorly defined. I argue that community health workers, who are referred to as volunteers, are in a unique position wherein their labour patterns and structures follow that of paid work, but the moral and ideological framework of this is structured as that of volunteers. In this way, they are doubly disadvantaged by a system that uses the morality of volunteerism to justify the poor treatment of workers. The Alma-Ata Declaration of 1978 was a key turning point in the framing of public health and primary health care systems of which community health programmes were a primary focal point (Maes, 2015; Lehman and Sanders, 2007; Abbatt, 2005). Initial phases of community health programmes in many countries emerged in the wake of this declaration, and a crucial point to note regarding Alma-Ata was its emphasis on ‘full and maximum participation’ of the community, connecting the idea of local participation to the pursuit of social justice (Maes, 2015; Muller, 1983). The morality of social justice and equity was therefore embedded into the notion of participatory health systems.
15The social justice approach emphasised by Alma-Ata was the ‘driving force’ behind how community health workers (CHWs) were trained: they were seen as change makers, as educators for the community. Lately however, many authors have argued that CHWs are being increasingly perceived as ‘apolitical health technicians’ who transmit information from one source to the other, as ‘human resources to be incentivized, supervised, and retained in ways that maximise cost-effectiveness and returns on investments’ (Maes, 2015, ,8)
16While the intentions of these scholars are to point out the unfair manner in which such programmes are structured, this passive framing of the situation unfortunately also serves to further reduce the agency of the CHWs (Kironde and Klaasen, 2002). Furthermore, this transition to CHWs as apolitical health technicians is not universal nor even widespread, as is demonstrated by accounts such as Svea Closser’s ethnographic work with the Lady Health Workers (LHWs) in Pakistan (2015), Glenton et al.’s work on perceptions of volunteerism in Nepal (2010), and Maes et al.’s documentation of CHWs in rural Ethiopia (2015). The ASHAs too, are firmly in control of their narratives and are strong actors in shaping the community health discourses of their area.
17Closser (2015), for example, examines the worker-volunteer question in a certain way through her extensive ethnographic research about Pakistan’s Lady Health Workers, who are government-deployed CHWs in the country. The dominant narrative surrounding the LHWs are that they are heroes, dedicating their time and service to the health of their community. Paradoxically however, LHWs have been the target of militant attacks since 2012, caused by national political instability and fear of fake vaccination campaigns. Their precarious position is caused by their affiliation with the government, for the attackers see them as carrying out government sponsored programmes with a high political profile. However, the government in Pakistan has done little to alleviate their distress, instead, strengthening the narrative of their heroism and bravery. The LHWs themselves do not describe themselves as heroes, Closser points out, instead seeking better wages and working hours, often through formal labour movements. Closser argues that the narratives of heroism circulated at high levels of governance are ways of overshadowing and misrepresenting the actual morals and values of CHWs.
18Closser’s account of the narratives of heroism in Pakistan closely mirrors the situation in India. Issues of caste-based discrimination, gender discrimination, and sexual harassment have unfortunately been a part of many ASHAs’ lives since the conception of the programme. Harassment and mistrust further increased during the COVID-19 pandemic, even as their responsibilities and working hours were greater. Despite being responsible for door-to-door testing, distribution of medicines, survey-taking etc., ASHAs were never given protective equipment, increased health benefits, or even better rates of payment. Many ASHAs reported that in fact, their pay was further delayed, with responsible authorities citing the delays caused by the pandemic as the reason for this. At the same time, multiple news reports were published describing the ASHAs as hard working, selfless women who put themselves in harm’s way in order to protect their community.
19Closser argues that the morality of heroism in the case of CHWs in Pakistan has been used to sideline the actual demands of the workers in a covert way, and I argue that the same can be said of the case of ASHAs in India. By positioning these women as heroes and life savers, the narratives effectively imply that such selfless people would not want to be paid for their efforts, which are based purely on their ‘inherent goodness’ and ‘selfless work’ for the community. The next few sections will explore how ASHAs negotiate and position themselves in unique ways in order to gain some form of material and emotional respect that has been denied to them by virtue of their semi-employment.
The Goddess of All Hope and the Beast of all Burdens: the ASHA as a Good Person
20While I was interviewing Deepti, another ASHA came by for an interview. Pooja-di is one of the oldest ASHAs in the area, having started her work as soon as the scheme was launched in Delhi. Older than Deepti, arrayed in a brightly coloured shawl and salwar kameez, she had also just come from her field visits. Meena-di had told her that I would be in the area for the next couple of months and would like to speak to her if possible, and Pooja-di had arrived as soon as she could. As someone with decades of experience in not just the ASHA scheme, but in many government social welfare and social upliftment programmes, she came as well-prepared for the interview as I was. It was towards the middle of the interview however, that she veered a little off script in response to some of my questions.
21Pooja-di clearly felt very strongly about the idea of ASHAs as fundamentally good people. Once Deepti left the office, she immediately asked Meena-di if Deepti had been allocated more houses than before, which she had. The contempt in Pooja’s voice was clear as she gave her opinion on this matter. ‘It’s not as though she doesn’t have enough houses, but there are other women who need the extra money more than her, no? Look at Chanda. Her husband doesn’t work, she needs the money. She’s a good person, a hard worker, she’s a good member of the community – you (addressed to Meena-di) have seen all that she’s done. But because Deepti has more experience as an ASHA, she will get allotted more houses. How is that fair? She left her job didn’t she? Where is the fairness in that? Why should she have left the job at all? It shows she isn’t as invested in caring for this community.’
22Community health work, as illustrated by the previous section, is a particular kind of articulation of volunteerism and care work. Both of these forms of labour are intrinsically connected to the idea of doing good. Pooja-di also used the words ‘achcha’ (meaning good in Hindi) often, when she was speaking of an ASHA whom she felt deserved to get more work than another. The good nature of this ASHA was further contrasted by the ‘lack of commitment’ of the other ASHA, who had left her job for health reasons but was nonetheless seen by Pooja-di as being someone who didn’t ‘care’ enough for the community. So what does it mean to do good work? And who is the ‘good person’ who engages in such work? Finally, how do such conceptions of goodness inform the ways in which ASHAs navigate and negotiate their positions of precarious labour?
23The idea of ‘good’ and ‘doing good work’ has primarily been studied in the fields of anthropology by development anthropologists. Focusing on discourses of global development and humanitarianism, scholars such as William Fisher (1997) have examined how notions of being good and doing good are articulated in top-down developmental processes. In ‘Doing Good: The Politics and Anti-Politics of NGO Practices’, Fischer explores how NGOs are intricately linked to the idea of being good because of their disassociation with governments. The idea of doing good is also intimately linked to an understanding of change, which as Fischer points out, is change that is based on Western-centric societies. However, Fischer’s seminal work does not explore how these notions of doing good can be reflected in the motivations and ideologies of the people involved in these developmental practices. Liisa Mallki, whose book ‘The Need to Help’ explores the motivations of Finnish Red Cross volunteers, also points out that there is an intrinsic desire to link this idea of doing good to the self. Malkki is one of the scholars of development anthropology whose focus in this book at least, is on the people involved in the development process such as aid workers and volunteers. She engages in what she calls a ‘fundamental question of studying humanitarian intervention: how do these people (i.e. humanitarian workers) think about themselves? What kinds of relations of self to self did they form? How did the self, engaged in work that is often described as “selfless” undergo transformations—in contexts of humanitarian aid and emergency relief in war and violence, and death and grieving? Is there such a thing as selflessness? What does that mean? When is the self undone?’ (Malkki, 2015, 3).
24Malkki explores the conceptions of the self through notions of both self-escape and self-transformation that are constructed through engaging with humanitarian work. However, rather than falling into the pitfall of associating humanitarianism with selflessness and self-sacrifice, Malkki instead points out that this sort of selflessness, as a martyred form of giving, in fact had no place in the professional discourses of the Red Cross. ‘I was often told that an aid worker bent on self-sacrifice was not only foolish and inexperienced but also a possible danger to herself and others on her team in the field.’ (Malkki, 2015, 10)
25The kind of self and personhood that emerged from Malkki’s exploration of the field, however, was less of a sacrifice of the self and more of a configuration of the self to the work that they were doing, a form of self-escape, rather.
If such self-escape could be thought of as a kind of selflessness, it was of a decidedly non-sacrificial kind. It was not as saints but as experienced professionals that they sought their line of escape. For many, such selflessness became most powerfully articulated as a desire to lose themselves in the intensity of sustained demanding work. (Malkki, 2015, 12)
26This conception of the good person as seen by the ASHAs however is not only about selflessness but also resilience and strength and powerful acts of everyday care. Similar to how the Finnish aid workers of Malkki’s ethnography did not see what they were doing as some form of martyred self-sacrifice, ASHAs also do not conceive their seva in the manner of a selfless, pious act. Being a good person is a way for ASHAs to see themselves as more than just employees of the state, as people entrusted with the care of their communities. Goodness is mobilised by them and for them, rather than by the state and for the state.
27The ASHAs are individuals squarely placed within the society and community they are helping - they are not external individuals who undertake NGO work or volunteerism as a way of helping the distant ‘other’. The dialectic relationship between the self and the other is what forges the ‘dividual’ identity. Dividuality, according to Marilyn Strathern, is the idea that people are frequently constructed as the plural and composite site of the relationships that produce them, ‘continually forms and returns in the complex play of bodily, linguistic, political, and psychological dimensions of human experience, within and against new infrastructures, value systems, and transforming afflictions and injustices of today’ (Biehl and Locke, 2010, 323). Thus, the subjectivity of the individual engaging with this state of continuous change, of flux and unpredictability, is one of openness, of becoming. (Hamilton and Placas, 2011).
28Dividuality radically departs from the idea that personhood is constituted through kinship and descent, but posits the idea that becoming a person, and individual, is an intimately social process which takes place through the multitude of social relations within which the self is able to relate to the other – whether the other is another individual or a group of individuals. For ASHAs, such as the women I spoke to in Seelampur, their personhood is deeply tied to their role as ASHAs and simultaneously their roles and relationships within the community as neighbours, mothers, wives, and friends.
Seva to Oneself: What Do We Get from Giving?
29In any sort of work or employment, there are non-monetary benefits that accrue alongside a salaried payment. The ASHAs acknowledge this in different ways. However, it is important to note that these other benefits do not necessarily outweigh the payment aspect – the ASHAs are very clear that this is, first and foremost, work that they get paid for, or rather, are supposed to get paid for. Each ASHA brought up the significance of earning money, even though it might not be very much, in different ways. However, when we spoke of what they like about being an ASHA, many of them brought up factors such as respect, freedom, and mobility from the house as well. It is important to note at this juncture, that these are some of the reasons cited by the government as well during their conceptualisation of the ASHA programme and other such community health schemes – that apart from bringing in monetary benefits, such forms of work are also empowering to women in other ways (GoI, 2005). These conceptions of women’s work as simultaneously empowering them while devaluing their labour are subtle yet dominant discourses that fundamentally shape conceptions of the public and private spheres and allow the state to exploit women’s labour while advancing the narrative that they are ‘helping’ them. The ASHAs however, see the two as going hand in hand.
It gets me out of the house and I need to get out of the house. When I wasn’t an ASHA for those three years, I was at home all the time. I like taking care of my family too, but it felt much better when I went back to ASHA work. This way I leave the house in the afternoons, I do my fieldwork, I meet my neighbours. I go to the dispensary quite often and I’m able to do the work I like.
30Deepti spoke of the freedom that comes from being an ASHA, in the sense of not being confined to the physical space of her house. While she sees both her job as an ASHA and her role in her home as a form of caring for others, there is a separation between the two. Later, however, she spoke of how her husband only allowed her to do this work because it would bring in some money, first, and second because it was a respectable ‘sarkaari’ or government job. While ASHAs are not seen as employees in the eyes of the state, they use the legitimacy provided by the affiliation to government authorities to negotiate respect for themselves within the spaces of their home, families and community.
31This respect also transcends the home and the manner in which ASHAs position themselves within the community and their neighbours. Within the hierarchy of community health workers, ASHAs such as Pooja-di, who have been involved since the inception of the scheme, note how they have garnered the respect of people ‘above’ them, such as their direct supervisors. As I was wrapping up my interview with her, I asked if she knew of any other ASHAs who would be open to talking to me. After giving me a few names, she paused and told me to also go to the double-storey dispensary nearby, and ask the ANMs and doctors if they knew of other ASHAs as well. She also told me to mention her name to them: ‘Everyone in this community knows my name. You go to the double-storey dispensary if you want to speak to the doctors or ANMs or find more ASHAs to talk to, and just tell them you know me. They’ll help you. I have a lot of respect in their eyes, I’ve been doing this for so long after all.’
32‘Sab mujhe yaahan jaante hai’ or ‘everyone here knows me’ was a common refrain, especially one I heard from older ASHAs such as Pooja-di and her contemporaries. Knowing one’s name and having a standing in the community is a way in which ASHAs are visibilised as important pillars of the neighbourhood. The status and respect they accrue through doing ‘respectable’ work is transferable beyond creating an image of themselves as hardworking women doing good for the community, but also goes on to create imaginaries of the future of their communities. Sunita, an ASHA I spoke to slightly later in my fieldwork, has two young daughters around the ages of ten and 12. When I asked her why she liked being an ASHA, she said that she saw her daughters and their friends not putting enough effort into their schoolwork. ‘I hope that they’ll see that maybe this is something they can do in the future. You need to pass school to be an ASHA. It feels like maybe I am showing them a new path (“ek nayi raah dikha rahe hai”) that if they work a little harder then this is something they can also do.
33Being an ASHA combines narratives of empowerment of the community and of the self in complex ways, with each one serving the other. The economic aspect to this role cannot be downplayed, as it is the honorarium and incentives that give legitimacy to this work, both in the eyes of the ASHAs and their families. The ways in which they help the community and help themselves are not extraordinary ruptures in the fabric of their existence, but extensions of ordinary acts of care and service that many ASHAs pointed out that they already do on a regular basis in their homes.
The Everydayness of Seva: Ordinary Ethics and Extra-ordinary Care
34Locating the ASHAs within the broader contexts of their daily lives, their engagements with multiple relationships within the larger community and the smaller family unit, and how they take on work that goes beyond prescribed health activist roles allows us to examine the ethical dimensions and nuances of their relations and the constitution of their selves. The ASHAs are also seen by the state as being more than community health workers, but the underpinning assumptions of care as a moral, relational project are not overtly valued (Kleinman, 2009). Emilija Zabiliūtė argues that community health work depends on these women’s ‘moral striving’ in everyday life (Das, 2012; Pandian and Ali, 2011; Zigon and Throop, 2014 in Zabiliūtė, 2020). Such forms of moral striving are organised by ‘ordinary ethics’, namely ethics that emerge in the realm of the everyday, in language and practice (Das, 2012; Lambek, 2010). According to Lambek, ordinary ethics are ‘grounded in agreement, rather than rule, in practice rather than knowledge or belief, and happening without calling undue attention to itself’ (Lambek, 2010, 2). Ordinary ethics highlights the ‘ethical dimension of everyday life in which we are not aspiring to escape the ordinary but rather to descend into it as a way of becoming moral subjects’ (Das, 2012, 134).
35Veena Das’s conceptions of ordinary ethics, drawing from Lambek’s definitions, run along the lines of thinking of the ‘everyday’. Its ordinariness makes it difficult for us to see what is before us. She argues that we need to ‘imagine the shape of the ordinary in order to find it’, whether we understand the ordinary as the domestic, as the neighbourly, or other. Images of the everyday, of ordinary human intimacy in its nuances and subtle actions, are not presented to us as a given; they are constructed by us. Das further points out that it is this construction and imagination of the everyday which then informs how we imagine threats to this ordinariness. What is catastrophic therefore, is not a ‘spectacular’ or dramatic event, but rather that which happens through small, repetitive and recurring crises that are woven into the everydayness itself.
36Das then asks
[h]ow does one work on the self to claim an ethical life within these quotidian concerns? How does one come to lose one’s world? Said differently, instead of the sovereign subject whose utterances carry force because they are authoritative (I promise, I declare), I am interested in the fragility of the subject and of the context as mutually constitutive of the work of inhabitation and what that entails for a politics of the ordinary. (2020, 7)
37Das’s work advocates for thinking of ethics as part of, or a dimension of, our everyday life rather than as distant judgements we arrive at when we position ourselves away from ordinary practices. As mentioned earlier, ethics can be construed instead as suffusing everyday life, in which ‘we are not aspiring to escape the ordinary but rather seeking to descend into it as a way of becoming moral subjects’ (2020, 11) Therefore, ethics are so much a part of everyday life within this framework of ordinaryness and the everyday that we can examine them not as distinct acts of moral judgements, or dramatic battles of good and evil, but rather as threads that are woven through ordinary existence and inform it as much as daily acts, habits, or rituals do.
38This differs in a key way from former and prominent understandings of ethical lives and ethical decision-making. Das draws on the example of Paul Ricoeur (1994), who put forward the idea that ethics are about how we can live well with or for others. On another, yet related note, Foucault also articulates that ethics involve the self’s relation to the self, or concrete practices of the self-fashioning what he calls ‘technologies of the self’. Echoes of this are visible in Malkki’s work cited earlier, in which she examines how Finnish volunteers constructed their relations of the self to the self through transformative and altruistic work. Das advocates, however, for a radical rethinking of ethics and morality by arguing that they are not ruptures in normal existence, but are grounded in, and take root from the normative and habitual practices of everyday life.
39Within this framework of ordinary ethics, care is ‘at once a practical response to specific needs and a sensitivity to the ordinary details of human life that matter’ (Das, 2020, 25). Hence, care is a concrete matter that ensures maintenance (for example as conversation and conservation) and continuity of the human world and form of life. This is nothing less than a paradigm shift in ethics, with a reorientation towards vulnerability and a shift from the ‘just’ to the ‘important’, exactly as Wittgenstein proposed shifting the meaning of importance by destroying what seemed to be important. Assessing the importance of care for human life means acknowledging the vulnerability of forms of life (Laugier, 2016, 208).
40In their daily lives, ASHAs exercise judgement, and discern ‘when to follow one’s commitments and when to depart from them, or how to evaluate competing and incommensurable commitments’ (Lambek, 2010, 28). The ASHAs’ relatedness to the communities is differentiated. While they belong to and depend on their neighbourhood as a whole, they cultivate friendships with concrete others. Critical understanding of the ethics of community among CHWs is crucial. Across the world, women are mobilised precisely because of their gendered capacities for care, embeddedness in communities and ‘thick social relations that are seen as assets that are potentially mobilizable for public health ends’ (Zabiliūtė, 2020).
41Following relational ethical imperatives resulted in work deviations by ASHAs from programme protocols. Yet, these were not failures of care. Where medicine, illness, and care are constituted through intimacies, relationships, and commitments (Das, 2015; Gammeltoft, 2014; Han, 2014; Pinto, 2014; Venkat, 2017), such deviations from the programme suggest that care exceeds what medicine and development prescribes.
42Pooja-di and I were discussing what were some of the rules of the ASHA programme, what are the duties they are expected to perform and so on. She mentioned that one of the more recent ‘informal’ rules that had come to the attention of the ASHA workers was that they weren’t supposed to make night calls anymore. One of the primary roles of an ASHA is to assist pregnant women in their area throughout the pregnancy – making sure they go for scheduled appointments, support their nutritional needs, take them to the emergency room if need be and generally keep an eye on the pregnancy until the time of delivery. Pooja-di explained that earlier, ASHAs would go to the hospital if the woman was in labour, having a miscarriage or anything of that sort even if it was late at night. But ‘they’ (the officials in charge of the ASHA scheme) had decided to put a stop to this because of safety concerns for the ASHAs, and had mandated that they could perform these duties only during their working hours.
43Pooja-di’s indignation at this was enormous. ‘Look at this’ she said, ‘look at how they try to cover their tracks. They won’t pay us proper wages, they won’t even send someone with us at night, they barely reimburse us for the transportation costs to the hospitals. You’ve seen the vaccination drive, you’ve seen how much work we have and you know how little we’re paid for everything we do. They won’t help us in any way that actually matters! But they’ll put rules in place that stop us from helping our own people. If I get a call from my neighbour at night that she is going into labour, do you think I’ll say sorry but I’m not working now, I’ll help you in the morning. No! I’m going with her, regardless of what time it is. I’ve done it before and I’ll keep doing it. For me this isn't a job, not when it comes to things like this. I said I’ll work in service of the community and I’ll do it.’ She paused for a second, as if to gauge my reaction. ‘They can say what they want about me, but they’ll never say I don’t keep my word. Once I’ve said that I will help my sisters (women in the community), they know that I will.
44Pooja-di’s anger at this rule was not exactly shared by all the ASHAs I spoke to – many were, for example, concerned about their safety at night and were glad not to have to work at such odd hours. However, the essence of Pooja-di’s statement, that the authorities do not understand what true care means, rang true for all the ASHAs I conversed with. Rather than seeing care and ethical obligations only in accordance with the guidelines prescribed to them, many ASHAs negotiated care as part of their ordinary lives, seeing their work as arising not only from their positions as community health workers, but also due to their social relations and the everydayness of ordinary life that they inhabit as part of their community.
45For ASHAs, moral striving and care involves doing health work, attending to its effects on neighbourly relations, and undertaking to make life liveable, with and for their community. In the context where the programme’s gains were questioned and where public health boiled down to achieving family planning targets, ASHAs incorporated the ethical project into their work. As Donegan (2011) noted, the programme’s activities did not engage, but rather ‘constructed’ community through the collaboration of diverse actors at various levels. While ASHAs’ specific caring roles are mandated by affiliation with the state, they navigate between belonging to the programme and their neighbourhood. Their gendered care work exceeded the ways the programme imagined community care and participation: it is a moral project emerging from the ordinariness of the everyday, embedded in thick relations of care and seva.
46This chapter has explored the various ways in which ASHAs themselves articulate and live within structures of work, care, and seva. Through ethnographic vignettes and excerpts from interviews, I have attempted to depict how becoming an ASHA is intrinsically linked to their own self, beyond being an act of care or service. Drawing on the conceptualisations of ordinary ethics and particularly the gendered nature of care work, this chapter has also been about how being an ASHA manifests in, and is manifested through, the contours of daily, ordinary existence.
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