After watching recent news images of Afghani refugees climbing razor-wired fences around a Greek port, I prepared myself for the tabloid headlines screaming ‘invasion’ that would inevitably come the next day and for the government to announce yet more measures to sure up the borders of Great Britain. It seemed impossible to imagine a time when politicians in Europe actually encouraged ‘free’ movement, and discouraged the use of passports. Writers in the 16th century extolled the virtues of travel just for the sake of ‘curiosity’, and the onus was on receiving territories to extend a sense of hospitality to the traveller.

Of course, this is an idealised description: then as today, some travellers were more welcome than others. But reading Adam McKeown’s new book, Melancholy Order: Asian Migration and the Globalisation of Borders, reminded me that our current web of migration regulations has a history, one embedded in the 19th century exclusion of Asian migrants from white settler colonies in the Pacific. His detailed research raises several paradoxes which perhaps point to why, even with the intense focus given to migration control by successive governments, we still have a situation that the International Organisation of Migration (2003) has called a ‘migration governability crisis’.

The first paradox is that contemporary border controls evolved from regulations developed by settler nations such as the United States and Australia, which were ostensibly founded on the premise of egalitarianism by pioneers of political freedoms despite the obvious racism in ‘white only’ migration policies and the decimation of indigenous populations. As a result, over time, discrimination has become acceptable at borders but not overtly within the state itself.

A boat crowded with Cuban refugees arrives in Key West, Florida, during the 1980 Mariel Boatlift
[image in the public domain, from United States Coastguard Service, sourced from Wikimedia]

Second, while neo-liberal globalisation is premised on an idea of free trade between countries, migration control is an obstacle to mobility. As a result, we have seen increasing separation between regulations relating to commerce and those relating to migration. Border control is now designed to facilitate some kinds of mobility, and migrants, and block others. Attempting to guarantee freedom, for some at least, through the imposition of regulations, transformed migration for others into an act of evasion and criminality. The meaning of ‘free’ has become ambiguous and opaque as a result.

The third paradox raised in McKeown’s research is that while migration laws coerce and exclude, interrogate, evaluate and attempt to quantify migrants, they are also considered as vehicles of justice, fairness, the ‘rule of law‘, and ‘efficiency’. They reflect normative ideals of how things should be, including the international order of states. It is impossible not to reflect on these distinctions and the right to be mobile when arriving at Heathrow Airport with an EU passport that only needs to be held up for a cursory glance by an immigration officer. To the left Africa, Asia and Eastern Europe queue up and wait. I am classified as a professional migrant, incorporated into a legal, formal administration, probably disappearing from the category of migrant altogether. In contradistinction are the ‘others’, those that work in 3D (domestic, dirty and dangerous jobs) who face resistance to their formal recognition within national labour regimes.

State institutions appear unable to resolve the inherent tensions in these paradoxes so the migrant continues to find their own way through red tape and over razor-wire. The kafka-esque world of immigration bureaucracy and rigid state regulations is met by the resilient human abilities of evasion and obfuscation in the hope of a better life.

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Melancholy Order: Asian Migration and the Globalisation of Borders
Adam McKeown, published by Colombia University Press

About the author

Melissa Butcher is a Lecturer in Human Geography at the Open University. Her research and teaching focuses on managing change in culturally diverse urban spaces.

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On Saturday 5 July the UK will celebrate the establishment of the NHS, arguably one of the greatest British achievements of the post-war years. Politicians, the media, and of course, the health services are celebrating this landmark achievement, reflecting on the history of the NHS and also looking forward to the challenges facing this very British institution.

The NHS was the brain child of Aneurin Bevan and drew upon his experience of the medical aid scheme offered in Tredegar in South Wales by the major employer in the town, the Tredegar Iron and Coal Company. Bevan became minister for healthcare and housing under Clement Attlee’s post-war government and used this opportunity to radically restructure medical care, ensuring that it was free at the point of delivery for all citizens, irrespective of their ability to pay. It has become one of the hallmarks of British identity, summoning up what the then Chancellor of the Exchequer Gordon Brown referred to on January 14, 2006 in his speech to the Fabian Society as 'one of the great British institutions – what 90 per cent of British people think portrays a positive symbol of the real Britain – founded on the core value of fairness that all should have access to health care founded on need not ability to pay.’

Aneurin Bevan.
[image © copyright BBC]

Since the inception of the National Health Service, migrant doctors have been seen as an integral but devalued part of the health workforce. These doctors were necessary for its operation, providing a mobile army of labour in the lower rungs of a pyramidal medical hierarchy, ensuring that UK doctors at the apex did not have to compete too much for pickings from the much diminished private sector. Overseas qualified doctors were provided training in the health service in return for meeting the health service requirements of the population. They were, however, systematically disadvantaged in terms of access to jobs, career mobility, the places where they found employment and the specialties they could occupy. They have come to be called ‘sepoys’ and ‘indentured labour’ pinpointing the situations of trained migrant doctors and the organization employing them. Disproportionately represented in training posts and in non-career grade posts they have, however, been a backbone for the development of this very British institution. Thus, in 2003, only 17 per cent of South-Asian doctors were consultants compared with 42 per cent of white doctors, which provides some evidence that migrant doctors from South-Asia continued into the present century to find their careers limited by the hierarchical nature of the NHS.

But one of the specialties where they have found a home and established a niche is geriatric medicine, a specialty that too was born in 1948. Marjory Warren, often considered the “mother of geriatrics” established the first geriatric unit in the UK, where older patients were admitted, rehabilitated and sent home. This was an innovation in elderly care at that time. Before the establishment of the NHS doctors had provided free medical service to support the charity hospitals but had earned substantial incomes, on the whole, through private practice. After the establishment of the NHS and the amalgamation of most existing hospitals, including the workhouses, into the national provision, doctors’ salaries were paid for out of the national taxation system and there was some resistance to taking over the regular care of elderly frail people. Geriatrics became associated with the wider disdain given to its clientele, older people. As such it became a ‘Cinderella specialty’, a disregarded area of healthcare serving the needs of one of the least regarded groups of patients. However, the work of a few pioneers such as Marjory Warren, slowly changed the nature of healthcare for old people with the development of acute care for older people and its own subspecialisms. It began to offer a career trajectory and eventually became what it is today, the second largest specialty with just under 900 consultants in hospitals. As we enter an ageing society, this development of geriatrics within the NHS is set to continue.

Silhouette of elderly man in wheelchair.
[image © copyright BBC]

In part responding to the dire medical neglect of older people within the NHS hospital system and in part to government and management pressure to improve bed occupancy figures, geriatric medicine grew rapidly, to large extent depending on recruits from overseas for its expansion. But this 'Cinderella specialty' status also gave room for overseas trained doctors who found their own opportunities for career growth to find a home. They too became pioneers in this discipline, shaping the nature of geriatric care today. It came to be a field where South Asians could find jobs so that 22 per cent of all geriatric consultants appointed between 1964 and 2001 were non-white and had trained outside the UK, compared to 14.1 per cent of all consultants in the NHS.

These doctors felt drawn to the UK, rather than the USA, because in South Asia they were already part of a socio-cognitive community for whom markers of participation in the UK labour market were central to notions of career progression. Migration to the UK for the purpose of training, gaining membership of prestigious UK Royal Colleges (MRCP etc) has long been embedded in South Asian doctors’ professional cultures.

For many doctors, their lecturers in medical school had undergone some form of training in the UK and that upgrading and validating skills through training at one of the UK royal colleges was seen as crucial to being recognized as a good doctor. Thus, the doctors’ mobility was already embedded in a network of professional development which valued temporary movement to the UK. Moreover, at least in medicine, the power of empire continued to be forceful as medical practice and qualifications were very much influenced by regulating bodies and by professional organizations, located in the metropolis. Doctors were thus already in some ways part of a professional community where migration to the UK was seen as part of career progression.

As the country is poised to celebrate, and rightly, the establishment of one of the most remarkable institutions of twentieth century UK, it is also worth remembering and commemorating the twists of history that led to the development of geriatrics and the role of overseas qualified doctors therein.

For details of a project exploring the experiences of South Asian geriatricians, visit Overeseas-trained doctors and the development of geriatric medicine.

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About the author

Parvati Raghuram is Lecturer in Geography at the Open University. Her research interests focus on the ways in which the mobility, of individuals, goods and of ideas is reshaping the world.

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How much is each one of us worth? And where do we find this answer? Some of us will look at our life insurance policies and quote the figure that our family might get if we were to die. Others may have a critical illness policy that places this value through what the family would get if we were unable to work anymore, say due to illness. And still others may think of the Valentine’s day flowers they received just a week ago and decide that they are priceless – at least to someone! And I am sure there are some who have never felt they needed to ask themselves that question, or indeed have anyone ask it of them – they know their value and so do others.

Certain individuals always seem to raise more questions about worthiness than others – migrants being an obvious category as evidenced by all the discussion on how migrants can prove they are worthy of citizenship in the UK.

‘Housewives’ are another. This week a poll of 4,000 housewives for an online networking website alljoinon.com ‘suggested that the average mum worked for nearly nine hours a day every day. The website said a housewife would earn almost £30,000 a year if she was employed to do all the same errands.’ This is significantly higher than the UK’s average annual wage of £23,700.

[Photograph taken by Geekgirly. Used under Creative Commons license.]

There is a lot going on in this snippet – for one, ‘housewives’ is not a category we hear much about any more so it had me intrigued as to why we don’t really hear much about this ‘category’ anymore. Have they fallen off all policy agendas and media interest? Or are they now called something else? In this snippet it is also assumed that all housewives are mums – has the model of the working woman become so ubiquitous that the only ‘housewives’ in the country are mums? What of women, who do not have children, are they not housewives too? And then the article calls what a housewife does ‘errands’ – cleaning the toilet never feels like an errand to me!

But what really riveted me in reading this piece was the fact that yet again we see a desire to calculate the value of housework. Back in 1972 Chase Manhattan Bank estimated the value of housework undertaken per household in the US at $257 per week. In 1978 Canadian housework was valued at 40% of GNP. By 1984 in Germany the value of "house and family work" was estimated at three times total government expenditure. Clearly, these attempts at calculation have been going on for some time now.

Social scientists too are in on the act. In the 1970s most of the analysis of housework revolved around the sexual division of housework and its economic value in a capitalist society. Feminists argued that women who did most of the housework without pay within their own households contributed to the economy by subsidizing the family wage and by ensuring the growth of the next generation of workers at a rate far cheaper than that which could be purchased in the market. And some feminists argued for the need to place a value on housework so that those who did housework would be adequately and appropriately remunerated. As Selma James, one of the founder members of the Wages for Housework Campaign said many years ago "Work that is not valued is not happening and therefore cannot be refused".

However, for other feminists there was something about the love and affection that went into ironing children’s clothes and in cooking their food which was never easily calculable. They argued that the psychological and the ideological aspects of housework were omitted in economic calculations of ‘worth’. As Diane Elson, an economist, argued in 1991, household work cannot be assessed solely in terms of its economic utility as it has an intrinsic value and not merely an instrumental value. The emotional elements of housework contribute as much to society even though there may be no way of counting exactly what these contributions are worth. And then there may be other elements of housework that never come into calculations. They plainly do not qualify for calculation – indeed, they may even resist any attempts to put a value on them. And if we were to be humble we could even say that we simply do not know what they are worth.

So today when we weigh up yet again how much housewives are worth, it might be useful to remind ourselves of how worth is counted up and the qualities that never come to be calculated when we take stock of our own and others’ worth to society. Perhaps, it is that incalculable quality that the Valentine’s card evokes. And one day we may even be able to extend that incalculable worthiness to the strangers around us – to recognise the limits of simply numerically evaluating the ‘worth of migrants’ to the UK.

About the author

Parvati Raghuram is Lecturer in Geography at the Open University. Her research interests focus on the ways in which the mobility, of individuals, goods and of ideas is reshaping the world.

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