The Struggle for Care: Weiqu (Sense of Unfairness) and Family Caregiving for Sick Older People in a Rural Hospital in Southern China

Abstract

China is currently undergoing rapid population ageing, a trend accompanied by the tremendous burden of supporting ageing health care. The challenge of supporting ageing health care is especially prominent in rural areas, where older people are deprived of proper access to medical care and social welfare resources because of a rural-urban structural divide. This is also because most rural hospitals are insufficiently staffed and resourced relative to need. In this context, families play a major role in meeting older people’s health care demands, and more so in the context of hospitalisation, with regard to managing medical expenses and assisting in physical caregiving for older inpatients. Yet China’s current socio-economic realities, rural-to-urban migration, and market-dominated health care industry have undermined rural families’ capacities and resources to assist in older people’s hospital care. This study investigates family caregiving for sick older members in the context of elderly hospitalisation, combining anthropological investigation with ethical enquiries. Using qualitative methods, comprised of ethnographic fieldwork and case study analysis, a total of 20 cases about family caregiving for older inpatients were collected during six-month’s field work in a rural primary hospital in Yangjiang, Southern China. These cases centred on how Chinese rural families, who were the primary caregivers for older patients, struggled to support the inpatient care of their hospitalised older family members while experiencing China’s ongoing social transformations. Inspired by the justice-infused feminist ethical approach, this study also conducts normative analysis towards rural families’ caring experiences. A sense of weiqu (sense of unfairness or feeling of being wronged) expressed by caregivers and their older recipients and the experiences of being forced into unequal care (in terms of the unequal division of caring labour within families and the unequal relations caregivers have with older recipients) was the primary feature of rural families’ caring experiences. Various forces and constraints that contribute to people’s experiences of unequal care are also identified from their weiqu narratives. Gender hierarchy, intersecting with other intra-familial hierarchical forces, is central to constructing unequal family care relations. The process of engaging in care is highly dynamic and conflicted, under which family members strategically negotiated care and power relations and morally reasoned their experiences of care and weiqu. The actual caregiving was practiced in a way that was physically cooperative while emotionally disconnected. Infused by a justice discourse, this study normatively criticises the problem of unequal family care that violates family members’ freedom to make care-related choices and decisions. Also found to be unjust was the family negligence towards older people’s health care demands and the prevailing ageist perspectives that underpin such negligence. Furthermore, behind rural families’ micro experiences of unequal care and weiqu, is the injustice that results from the problems of broad social inequalities across the rural-urban structural divide, creating constraints that impede family care. By also adopting a caring perspective, this study appeals to the state for the provision of more affordable and accessible healthcare services that both complement care provided by rural families and that further empowers them in their capacities to take better care of older people.