Doctors and cultural preference

Around the same period we lost the last of Dr Arthur H McShine’s and Mrs McSchine’s children: Lyris McShine-Monsanto, Trinidad’s first female banker. We also lost the last sibling of H O B Wooding: Audrey Wooding. Both Dr A H McShine and H O B Wooding owed their profession to gaining an Island Scholarship at a time when that meant coming first in the island in the Higher School Certificate.

Dr Patrick Solomon in his autobiography catches the frenetic attempt to get a scholarship when the failure to do so was to have no other choice of a career but the lower rungs of the civil service. Neither Dr A H McShine’s parents nor the parents of H O B Wooding could have afforded the cost of University education. There was no UWI at the time. There was no American alternative: American qualifications were not accepted. Nor in general were Canadian qualifications, McGill’s was the exception. Medical studies usually meant going to the United Kingdom. This was beyond the means of most Trinis of any colour. I have written this in the light of Dr Tim Gopeesingh’s “ethnic cleansing” remarks and the debate which followed. For what was on the table together with the claim of “ethnic cleansing” was the realisation that in Trinidad and Tobago approximately 80 percent of doctors were now Indian. Indians make up approximately 41 percent of the population.

Twenty percent of doctors are usually quoted as being African. This includes small numbers of Europeans, Chinese, Syrian-Lebanese and Mixed even if Africans are by far the largest group. In other words 59 percent of the non-Indian population produce 20 percent of the nation’s doctors. The African percentage is nearer 18 percent for approximately 37 percent of the population.

The Plural Society

The ethnic, class, and increasingly gender percentages of a country’s population going into high status occupations are of concern to the authorities in a number of countries. Imbalances indicate the failure of egalitarian or integration policies. In other words the Republican principles of equality before the law and its consequence merit are not fully operative. It may be predictive of serious conflict in the future. The question of conflict is particularly important in plural societies as M G Smith who is the author of the hypothesis of plural societies has underlined. Plural societies include Cyprus, North of Ireland, Northern Nigeria, Sri Lanka, Rwanda and South Africa. In these societies the differences of culture are accompanied by the separation of social institutions often including religion. One result is the tendency for the ethnic segments to mobilise in order to capture political power. It is this tendency which renders plural societies fragile and given to conflict including armed conflict.

Where this ethnic separation includes occupational categories the chances of conflict are multiplied. We know this from the situation of our Trade Union Movement. The near-monopoly of ethnic control over medicine is not only who becomes doctors. Where 80 percent of the medical corps belongs to one group, the group will also control medical councils, unions and associations and be at least the gatekeepers for entry into the profession. It should be noted that this is happening at a time when the former ethnic-occupational categories have crumbled or are crumbling. Happily so whatever grumblings there are.

As early as 1994 Selwyn Ryan reports that his research on the civil service revealed that parity had been reached in most departments and near parity had been reached in a number of State enterprises historically controlled by Africans. In a few instances Indians had now overtaken Africans in Government departments. The striking exception was the protective services although there had been some moves to end the disparity between Africans and Indians. It is generally recognised by those sociologists or social anthropologists who have specialised in areas which include discrimination, that “choice” where it amounts to a social pattern is not by chance. This is so even if there is no legal barrier to the choice of this or that occupation.

When disparity is as striking as it is with medical doctors in Trinidad, there is severe social selection somewhere or in a number of instances, which govern the production of doctors. This would seem to be accepted by the majority of those who have attempted to explain the disparity in numbers between Indian doctors and African doctors. It is to these “explanations” to which I will now turn.

Cultural Preference

There has been the argument of “cultural preference”. According to this argument a number of ethnic groups choose their occupations because of a cultural imperative which indicates X occupation for the group rather than Y occupation. A number of the examples given have been well known to those who have specialised in what was once known as “Race Relations”. What is striking about all of these groups is not only that there is a “cultural preference” for this or that occupation, but that the groups are usually small minority groups, with an abnormally high percentage of intermarriages, usually bonded by religion and external to the main social stratification of the society. They are often “pushed” into occupations that are forbidden or not valued by the dominant society. The category is often called “trading groups” — they are so called in the UNESCO Declaration on Race and Racial Prejudice of 1967 — because of the high percentage of these groups which are concerned with commerce. Groups include certain Jewish groups particularly in Europe of the Middle Ages, Chinese particularly in South East Asia, Syrian-Lebanese particularly in West Africa, Indians and particularly Ishmaili (Aga Khan) Muslims of East Africa, Quakers in Britain.

The problem is that Trini Africans do not in any way conform to the sociological profile of these supposedly preferential cultural choice groups. Moreover one would have to explain a cultural preference for a lower status job with the chances of being more poorly paid. For that would be the result of Africans choosing to be nutritionists or allied medical fields rather than doctors and specialisations within medicine. But there is another problem, I know of no example of a group which has already been in a high status occupation deliberately of their own accord, quitting that occupational category to enter a lower status occupation.

A caste hierarchy

As important these different cultural preferences are taking place within the same profession. The picture which emerges is of occupation plus ethnicity hierarchically ranked. This hierarchy of occupations plus ethnicity is traditionally considered the essence of caste. However there is no precedent for caste emerging in the post. Enlightenment New World societies as Edmund Leach the British social anthropologist whose major work was in North India, has argued. And so far one reason: caste does indeed suppose, at least in the past, the acceptance of inferiority by lower caste groups. This acceptance is totally absent in the racially stratified societies of the Americas and the Caribbean. This alone puts into question the “Cultural Preference” argument.

Are there other reasons for the disparity? It is unlikely that a disparity as wide as this can exist without social mechanisms which ensure inequalities and for which no specific ethnic group — in this case Indians — are responsible. Chief among these are patterns of settlement, the formal and informal regulations of education and the social expectations for this group and for that group. That inequalities here in TT vastly increase after circa 1980 should surprise no one. The same process was happening in nearly every country from the USA to China and pass through Europe.