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Separation in the Motherhood Community

By Shelby Salazar
My field site is the maternal newborn care unit at the university of Utah hospital. This unit is
located on the second floor of the main hospital. Once you get off of the elevator you will take a right
and another right once you reach the windows. There you will
find your first set of securely locked doors with a badge reader,
for people to enter who have access, or a doorbell with a
camera, for those who don’t have access but would like to visit.
These people must have the last name of the “patient”, who is a
person in the hospital, and the access code, which is specific to
each individual patient, in order to visit that person. Once you
enter you will encounter the front desk where you will sign in
and put on a mask. The visitors are asked to wear masks to
prevent the newborns from getting sick, the staff are all required
to be up to date on their vaccinations. From there you may proceed to the room of the patient, as long
as there are no more than five visitors in the room at a single time. There are
thirty-one rooms on the unit which are laid out around three walls of the
square shaped unit. The inside of the square contains four stations where
nurses sit to chart. These are located at the four corners along the inner walls
of the unit. Each room is set up the same with a bed in the middle, a pull-out
couch near the window (which is directly across the room from the door), and
a bathroom. There is also a computer in the room for staff to chart and a closet
and TV for the use of the patient and family. Every room has at least one crib
to hold their baby; the reason they are there. All of these patients have given
birth anywhere from two hours ago to five days ago. These women come to
the hospital to give birth and all assume or hope that they will be treated with
the best care and no less than anyone else. This is the hope. Unfortunately, I have witnessed the
opposite of what the average patient might expect for their care and the care of others. This unit is a
community. A community, however simple it may seem, has been given many different definitions
throughout anthropology as different ideas come about. Robert Redfield acknowledged that there are
four key qualities all communities have: “a smallness of social scale; a homogeneity of activities and
states of mind of members; a consciousness of distinctiveness; and a self-sufficiency across a broad
range of needs and through time.” A community, unlike it was previously believed and understood, is
not only people who live in a close geological region or who are of the same family or tribe, it is more
correctly understood now as to be a group of people with similar interests or goals who work together
towards those goals. Cohen was one of the most recent anthropologists (1985) who made changes to
the way we think of communities. He said “Hence, the notion of community encapsulates both
closeness and sameness, and distance and difference; and it is here that gradations of sociality, more
and less close social associations, have their abiding effects. For members of a community are related by
their perception of commonalities (but not tied by them or
ineluctably defined by them as are kin), and equally, differentiated from other communities and their
members by these relations and the sociation they amount to.” In other words, there are similarities
between people in communities but there are also differences. A community is able to come together
because of their likenesses but they are also not bound to each other from them. This creates more of a
loyalty to the community and its members rather than a responsibility. These similarities in communities
don’t have to be the same as the similarities of other communities, in fact this difference, or border as
they call it, unites the community and gives it that closeness. Robert Redfield counsels all of us, in a very
insightful way, that we all have more to learn about communities, that it is not the tools, houses and
institutions that make a community, but rather humanity itself creates communities. The unit is a
community because they are different than any other unit in the hospital but together, they are similar.
They are all there for the same reason; for their newborn baby. This is what unites them, but what could
divide this community?

I have chosen to study the unspoken of “caste system” that exist in many places in society but
especially where I see it the most, at the hospital on the postpartum, or after-birth, unit. The “caste
system”, or “caste”, is an ancient practice in India of separating different groups of people based on
certain social differences. This started as a religious practice and, depending on who you ask, still is. A
person’s caste is assigned at birth; therefore, you cannot change or “get out” of your caste. Even though
this is traditionally seen in India, and is now illegal there, you will still see similar effects even in places
like the United States of America and in many religions. The caste system in India separates people into
five main groups called: Brahman, Kshatriya, Vaishya, Shudra and Dalit. The Brahman are the top of the
system and are the priests who are studying the scriptures and praying most of the day, they have the
most freedom and the best occupations in the sense that they are not doing the “dirty work”. Each level
down from the Brahman gets more and more unpleasant. The lowest group, which is not even
mentioned in most daily conversation, is the Dalit, or the untouchables, who have the jobs like picking
up dead bodies and cleaning the streets. For the people in India, you live within your caste level,
especially if you are Dalit. Most people marry within their caste and raise their children in that same
way. The lower people on the caste system definitely are discriminated upon by access to resources. For
example, the Dalit children sit in the back of the class, if they are even lucky enough to go to school.
“This ranking has been characteristically expressed in the ritual idiom of pollution and purity” meaning
that you are literally polluted and dirty the lower you rank, while those who are above you are purer.
This creates a more tangible and visible separation of the castes. You might ask how this would connect
to mom’s who have just given birth, so let me explain. Most patients are doing their own thing, in their
own space and assume that all of the other patients are similar to them. That is until they walk the halls
with their baby and see a mom, dressed just like her, pushing her baby in her crib, just like her, except
this other mom has handcuffs around her ankles and two cops walking with her. The reaction is almost
instantaneous to take a double take and move as far to the other side of the hall as possible. This is just
one example of how people are treated as less than others; you might even say they are untouchable. I
will explain more of these examples later. Then on the other hand, there are patients who are important
sports players, family members of the CEO, or chief executive officer, of the hospital, and even the staff
who work there who have just delivered their baby, who will get handpicked nurses and aides to take
care of them. The nurse is the person who will be give medicine and give most of the care to the patient
and the aide will assist the nurse and does her “dirty work”. They will be notified at the beginning of
their work day of any room that is assigned to one of these people, and their calls should be answered
immediately, even if they are not in your care. There are patients who are seen as more “important”
than other patients and in turn are treated better. Even still, this is not the top of the caste system here.
There are aides/CNA’s who in all reality are probably close enough to be placed in the same category as
the “VIP” or “important” patients, then nurses are above them, then charge nurses, then management
of the unit and finally, hospital management. The workers are technically more “superior” (based on
certification) than the patient, yet they’re taught that the patient is always right, or that the patient will
always come first. I observed how the workers interact with and toward one another and to the
patients. I noticed that the management seem to be happy and at peace with everyone and everybody
respects them and does as they ask. Then it started to go down from there. Doctors still report to
management but give orders to nurses, who report to doctors and give orders to aides, who report to
nurses and give instruction to the patients. Notice the aides do not give “orders” anymore as this would
put the patient below the aide. The aide is taught to keep the patient at the same level, if not higher,
than them. I wanted to ask the patients their view on how they feel they are seen by the workers and
how they view other patients, as well as the workers point of view on how they see each other and the
patient, to be able to more clearly classify this caste system and its levels.

I wanted to start at the top so I asked the manager, or head of the unit, “where do you see
yourself in comparison to the people who work on your unit?” To which she responded, “I am middle
management. I manage, or direct, 170 people but am guided by what my director tells me to do.” I next
asked, “How do you see others you work with? Would you place yourself above them or below them?
Why?” She said, “We are all on a team and have to all work together to meet our goals. I happen to be
the leader of one group that is tied to the end product, patient care. In my other group, I receive
instruction on how to implement this care to our patients with guidelines or rules and standards. No one
is better than the other, we all just work together to meet these standards.” I went down the line, the
doctor said, “I don’t have time to answer these questions” as he sat in the doctors’ room watching a
sports game. Next down the line is the nurse who was asked the same questions. She replied, “Nurses
are the eyes and the ears of patient centered care. Obviously, the doctors are super important and keep
us going with directions, but we also could not work to our fullest capacity without the housekeepers
(those who take out the trash and clean the rooms) and the people who work at Starbucks to make us
coffee so we can work for 13 hours a day. It’s hard though because as nurses we are the ones in
patients’ rooms, along with the aides, so we have that awareness of the patient’s condition which we
pass along to the doctors. Naturally there are less doctors than nurses so of course they are higher than
us in a sense because they have gone through more schooling.” And finally, an aide said, “I feel like I am
pretty equal to most of those I work with. I might not be a nurse but I have worked here long enough
that I know almost as much as them, I just don’t have their education in a classroom. Some people we
work with may not work as hard as I do but no matter how hard we work; we will always be seen as the
bottom to others even though we see ourselves as equals. I feel a lot of people we work with can be lazy
and unorganized. For this reason, I cannot say if I am above or below somebody; we just have different
ways of working.”

Notice, the two lower castes introduced education and training. What is this and how does it
divide two sets of people? Education is something that has been studying throughout time, both
formally and informally. By this I mean that not all education must be done in a classroom with a
teacher, but that there are skills and things anthropologists have observed from some cultures that are
learned in everyday life. Both of these types of knowledge give you “power”. If you have at least one,
then you have more power than somebody who has none. If you have both, then you have more power
than those who only have one form of knowledge. Apprenticeship is one way that people receive both
types of knowledge. They go to be taught certain things and then essentially follow and learn, hands-on,
from somebody with more knowledge in that category than them. Anthropologists studying in Arab
have noticed this increase of power with an increase of knowledge. In other words, the more you know,
the better off you will be and the better your job and life will be. In turn, the higher up you would be in
the unit or better you would be treated as a patient.

I find it interesting that they all those who were interviewed say they see each other as equal
but I noticed when one person didn’t want to do something, they would pass it down to the next until it
reaches the bottom. The aides however do not get to say if they want to or don’t want to do something,
they are in all reality, the bottom and so this is how it is for them? I next asked a patient, “What type of
people do you think are in the rooms around you? Do you think of them as any different than you?” The
new mom replied, “I would imagine they are just like me: happy to have their baby but tired from all the
work it took to get here.” This is exactly how it should be seen and it sounds good in words but once I
witnessed it, I saw a different side of this mom. I saw a more judgmental person. I saw somebody who
moved away from people who were different, whether it was their race or appearance. I also saw
somebody who moved towards, and wanted to talk to and interact with, people who may be of more
influence. This introduces a second level of caste system’s: one amongst the patients. The important
people mentioned previously would be at the top, the typical English-speaking mom would be in the
middle and the prisoners (people who are in jail or prison for doing bad things), drug abusers, and non-
English speaking patients are the very bottom. Many of the other patients will treat the bottom level as
though they are the bottom by avoiding them and looking away. The workers even spend less time with
those patients and have less care towards them. This brings up two points that play a big role in this
environment: race and inequality.

Race was developed by the Western Europeans where they essentially created and categorized
everybody into five races, with subraces and mixed races. These races were ranked based of off things
such as worth, attractiveness, intelligence and other potentials. Since there was now race, there was
now racism which is “the cultural and ideological formation that shapes perception and evaluation of
self and others according to racial identity”. There were tests and studies put in place to try to prove
that this was not just an imaginary thing but rather a biological fact. They would measure head sizes of
different races to determine “the size of the brain” or the more intellectual race. Generally, this put
white people on the top and black people on the bottom, with other races anywhere below the whites.
This created the separation of “us” and “them”. This is true in all cultures, even within the same “race”.
Many anthropologists have fought to combat racism. They addressed the fact of migration of people
from one place to another, interracial marriage, and other things that disprove that there are five races
and that anyone is better or above another. However, people who are different are still treated as
lesser.

Inequality has been a topic of discussion of many studies for years. Some theorists say that
inequality is “an inherent feature of all societies”, or in other words, it is something innate that will be
there no matter what. However, others say that there were societies anciently that were based on
equality and that we can recreate those and bring them back. Anthropologists have added better
insights to the studies of inequality. They studied about people who were “primitive” and “preliterate”
(very simple, even unable to read and write). They studied these types of people because they figured
that before certain things were introduced, like the ability to read and write and money, people lived
simpler lives, putting everyone on the same level. Engels, an Anthropologist who studied “primitive
communism” believed that property was the main cause of separation into states or classes. Engels
believed that before there was personal property, they did not find the problem of inequality among the
people because if you don’t own anything and neither does your neighbor, you cannot have more or less
than them; therefore, you are equal. Nevertheless, this has now been disregarded since they have found
examples of different types of property among most, if not all primitive societies. This means that it is
safe to say that inequality, in some form or another, has always, and will always exist. People will always
find a way to put themselves higher than others. It is a natural human thing to want to be at the top.

Where did this idea come from that says anybody has to be higher or lower than somebody?
This can be explained by understanding the topics of nature and culture. Nature and culture are two
things that anthropologists and biologist are only starting to really understand and agree on as of recent.
Cultural anthropology has obviously been studying culture from the beginning. Early on, they believed
that we fell on both sides of the line between human culture and the rest of the world. We are on the
side where we resemble animals and their natural behaviors, but we are also on the other side where
we are able to speak, learn and use symbols. They suggest that human learning is cultural and learned,
hence why other animals in nature can’t do it. Culture describes human behaviors and human
variations; this is also where biology as we know it came about. Franz Boas worked hard to expand a
theory that tried to explain different people and their ways of living and even mental capacities, by their
race. The Northern Europeans were considered the “most advanced race” and every other race was
compared to them in things such as the shape of their body, moral development and mental abilities.
Boaz showed that this theory wasn’t as simple as they had made it. He stated that there was no reason
to think that other races are any less moral or intelligent than another, especially based just on their
body. He started to study different cultures individually to see what they each learned based on their
individual and regional experiences. Culture is in fact learned then and not something inherent for
everybody. Each person can have a unique cultural experience depending on where and how they
learned it. Leslie White says that “humans are ‘symbolling’ and classifying creatures” meaning that we
give importance and priority to some things over others. Levi-Strauss, who helped further clarify this
theory, believed that the fact that we as humans make a distinct difference between nature and culture,
separates us from animals. We have things in us that are natural (a woman giving birth is the example
he gives) but there are also cultural aspects to us as well, things that we have learned to do or ways that
we have learned to act. This is why it seems to me it is so culturally taught to assume and judge other
people even if they are in the exact same situation as we may be in.

This classification or grouping starts early on in life as seen here at the hospital. The babies are
given a name. This name will distinguish them from other babies and will give them belonging to their
parents. Names are something that everyone has, some are based off of gender, some off of clan and
others from lineage. No matter where the name comes from, there is individuality and meaning to that
name. Some people may choose to change their name or go by a nickname to better coincide with how
they may feel as an individual. We generally receive names at birth but can change them as we get
older. There could also be what one anthropologist describes as “the use or non-use of names” where
they are not referred to as their individual name but rather their clan name or relational name. In
fieldwork it is very important to establish naming and who is called what because “it enables one to
perceive a groups social and symbolic relationships with others in time and space.” The unspoken of
castes are an example of the non-use of names. Its not nurse A, B, and C, its just the nurses. It doesn’t
matter if nurse A is really good and nurse B is really bad, the patient will only remember one and will
mark all nurses following the impression left by the one nurse.

There are many taboos on this unit but the biggest one is why I refer to this as the “unspoken
caste system”. Taboo was introduced to the English language by Captain Cook who soon discovered it to
be things that were prohibited, either because they were sacred or defiled. He made a list of things that
were taboo. Later, chiefs of the Polynesian islands used taboo to prohibit food intake or other things
even to the point that people fought back. They connected the chief’s mana, or power, to the taboo,
thus making the taboo now mana. Freud used the term taboo to talk about sexual prohibitions. This
term is not widely used in anthropology anymore. Essentially taboo was used as a word to describe
things that just weren’t talked about, whether it was because they were too sacred or just because “you
don’t talk about those things” it didn’t matter. These are things in society, unwritten rules if you will,
that everybody stands by and kind of leaves alone and ignores. The big taboo on this unit is called
HIPPA. It’s a rule that says you cannot talk about a patient’s information to anybody who is not caring
for that patient. It is a way to keep things private. People tend to want to know things about people who
are different because people are curious, but if you cannot just ask, then what do you do? Gossip.
Gossip is never idle according to anthropological analysis. Gossip is part of daily life for every culture, a
big part at that. There are three subcategories or approaches of gossip which include: the functionalist,
the transactionalist and the symbolic interactionist. The functionalist view is that gossip happens
between two or more groups. As the one group gossips about the others, that group becomes more
bonded and united. They may even gossip about other members in the group. The transactionalist
method is more about individuals rather than groups. So, individuals who gossip have a different
interest than others and those things which they gossip about are things they are trying to move
forward to change cultural rules. The last method is a community talking about everything happening in
their social environment and then making a plan and taking action. Since everyone has their own
opinion, this is always subject to change but for the mean time they are trying to find common rules and
conventions that they all live by. There are many ways that I observed the workers and patients
gossiping whether it was amongst themselves about others outside of their group, especially those
higher up in the “caste”, or even about people who may in the same caste as them that they feel they
are above.

There is a community that exists so perfectly together that it never stops no matter who is there
and what happens because they work so well as a team. However, they are also the ones tearing
themselves apart from the inside out by judging and dividing themselves. They say they see everyone as
equal, yet they act differently. This is something that I do not see changing. As long as we keep teaching
our children to see differences, we will all focus on what puts us above others so that we never feel we
are the untouchables; even if that involves gossiping to others to form groups together against smaller
groups so they are below you and therefore feel they are polluted or dirty, simply because we make
them feel that way.