We are experiencing a “crisis of care” in the US and in other wealthy nations throughout the world. There are several reasons for this crisis. The population of older people is increasing, and as people live longer, they have increased health needs. At the same time, the availability of family members as caregivers is declining; and the local supply of health care workers has failed to keep up with the increasing demands for care workers.

Nation states like the Philippines and India, and recruitment firms that operate across national boundaries (and others) have stepped in to fill some of these gaps by recruiting doctors, nurses and other health care workers from abroad to fill local labor needs (Rodriguez, 2010).  There has also been a significant influx of migrant care workers from these nations and from Latin American and Caribbean countries who perform paid domestic and care work once here (Hondagneu-Sotelo, 2007); (Parreñas, 2015).

Immigrants from Africa have joined this global migratory labor force as workers in nursing, home/elder care, and disability support. Many serve as “labor brokers” in the United States; that is, they channel workers from their own countries into health care work in the U.S. However, little is known about this unique group. And the function they play in hospitals, nursing homes, residential care homes, and private homes has been largely invisible.

My research focuses on West Africans who become care workers in the United States. Broadly, I investigate the terms under which they have entered the United States through legal channels and become absorbed into the United States labor market as health care workers after they migrate here. Here’s an example from my research: 

Before coming to the U.S., Marcus had been a schoolteacher in Cameroon. He arrived here with aspirations to become a teacher. Instead, he encountered discrimination and racist attitudes because of his African accent. Discouraged by this experience, Marcus followed the advice of Cameroonian friends and acquaintances and decided to get trained as a nurse. He was also inspired by fellow Cameroonians who had opened successful home health care businesses. 

For newly arrived West African professionals like Marcus who were displaced in the US labor market after migration, occupations in health care, especially in the professional sectors, seemed accessible, even if they entered at the lowest tiers to gain a foothold in the industry.

Unlike Marcus who was a working-aged professional when he migrated, younger women I interviewed were encouraged by their mothers or other female family members to train as nurses. Claudia, a young immigrant from Sierra Leone, had migrated to the United States as a young adult to pursue a bachelor’s degree in Business Administration. A year into her studies, an aunt convinced her to switch her studies to become a nurse. Like her aunt, Claudia believed she had better job prospects and more opportunities in nursing. She completed her nursing education in the early nineties, at a time when there were acute nursing shortages in the U.S., and she was quickly recruited to work in a hospital. When I interviewed her, she was working as a registered nurse in a health care provision facility owned by Sierra Leoneans. Claudia’s circumstances provide a great example of how West African “ethnic networks” provide support to newly arrived immigrants and continue to support women as their nursing – or other health-related – careers progress.

I learned that migrants already established in the United States often regale family members back home with tales of success in America, portraying America as the land where one can make it. Here’s one example:  Fatima, a Sierra Leonean woman, told me that she knew about the US labor market even before she arrived, as she had heard stories about possible paid work in nursing homes or private duty jobs in elder care. When Fatima arrived, one of her aunts found her a job in the informal ‘gray’ market for care. She worked in the home of a white family caring for their elderly parent. Fatima’s experience demonstrates the importance of West African immigrant networks in supporting and even placing newly arrived immigrants in the labor market, thus providing one solution to the “crisis of care.”

Individuals within immigrant networks not only help one another find care-related jobs; they continue to support one another as they work in the care field.  For independent care providers, immigrant networks of home care workers refer jobs to one another, share the care of an individual, and are back-up when one person is not able to work. While these networks are often the backbone in creating stable care for individuals, the poor pay and lack of health insurance, particularly in independent care jobs, must be addressed in public policy to ensure a stable workforce.