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COE, CATI. 2019. The New American Servitude: Political Belonging among African Immigrant 

Home Care Workers, New York University Press: New York, Series: Anthropologies of American 

Medicine: Culture, Power, and Practice, 304 pp., ISBN: 9781479808830 

 

Through the lens of African immigrant home care workers and their clients, Cati Coe’s The New 

American Servitude: Political Belonging among African Immigrant Home Care Workers is an 

exposition of the contested political belongingness of African immigrants in the United States at 

the wake of heightened globalization, migration, and an aging population. These processes have 

brought the global world of immigration and immigrants to the home of the elderly in the United 

States, as well exposed immigrants to the elderly. The book in based on ethnographic research 

conducted among African immigrant home care workers on the East Coast of the United States, 

particularly in Northern New Jersey and Washington DC suburbs. On the elderly research 

population, the author indicates that, “in the Washington area, many of the patients I encountered 

were highly educated members of the upper-middle class socioeconomic status that includes 

retired academics, scientists, lawyers, and mid-to-high-level civil servants in the federal 

government” (p.16). These were clients that were able to afford home health care within the 

comforts of their own homes. They were also all white except for “one African American woman, 

a retired nurse” (p. 16). The author also categorizes them as being in the top 10%, with enough 

monetary resources from their many years of savings. While the ideal situation should mean a 

symbiotic relationship where care workers gain a sense of political belongingness and patients 

receive their perceived health care, the author argues that the situation is far from the truth and that 

most Africans in these health jobs feel a sense of less political belonginess based on their 

experiences.  

Within labor migration in the United States, the author argues that African immigrants are 

perceived as having a niche employment in the home care work facilitated by a continuous pull 



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for other African immigrants to continuously join this section of employment in the job market. 

This employment niche is projected by immigrants as the macro state treatments of political 

belongingness or lack of belongingness. The African migrants, the author posits, experience a 

challenged sense of political belongingness with some perceiving the United States as a temporary 

place to raise money but retire in Africa. For example, the author argues that the realization of the 

American dream of at least attaining a middle-class lifestyle becomes almost impossible as the 

home care profession stagnates them with no room for socioeconomic mobility, the very 

motivation for them to migrate to the US. The book elaborates on how the socioeconomic dynamic 

is augmented by social and cultural treatments in a racialized care workforce, which evoke stories 

of servitude almost equated to the past experiences of African Americans servitude. The authors 

present the book with six interludes and five chapters, giving detailed ethnographic accounts and 

literature comparisons to interrogate political belonginess on several topics. The author argues that 

“work conditions are interpreted by African care workers as indicative of the society at large” (p.4) 

and that “work is one site where political belonging is negotiated in everyday life” (p.8).  

Beginning with the Introduction, the author problematizes the idea of political belongingness and 

brings in a nuanced position where political belonginess is based on the daily experiences of the 

immigrants at the local level of the workplace and their perception and use of these experiences 

and treatments as a base to evaluate their political belongingness. The author reveals that there is 

more to the political belonging of immigrants than being hosted, offered employment and even 

citizenship. Immigrants’ experiences and treatments by agencies and patients at the workplace 

reveals their interpretations of political belongness or lack of belongingness, as a struggle that is 

continuously experienced. Ending the Introduction with an interlude on food and the centrality in 

sharing food as an equalizing socialization space brings out an example of the inequality and power 

dynamic based on whose food is more valued and shared between case workers and their clients.  

In Chapter One, “Anyone Who Is Not Africa”: The racialization of the Care Work Force, the 

author, argues how the care work profession has become a niche employment for African 

immigrant. Through networks, Africans find these employment sectors easy to access, causing 

some to have a downward mobile experience once they arrive to the US because their educational 

credentials are sometimes higher than the care work requirements. The rush and need to help 

themselves and their relatives in their home country, economically, makes health care profession 



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even handy and accessible via already established networks. However, what is more striking, 

according to the author, is the racialized job market that these African migrants care workers 

sometimes experience, including, to some extreme, the experiences of racial slurs from the clients 

themselves. This employment sector is also portrayed in this book as a dead-end for African 

migrants to be socioeconomically mobile as there are no ways to advance oneself career-wise. 

Thus, the author emphasizes that, while most migrants are supposed to be incorporated into 

political belongingness in the US via employment, it is this racialized care working space instead 

that tends to challenge their belongingness. To put more emphasis on the sometimes racial 

antagonism between African care workers and their patients, the author states that, “when Africans 

come to the United States, they encounter a racialized employment market, in which their 

Africanness, Blackness, and migrant status play major roles in how they are perceived (p.79) 

The interlude, Silences about Servants, leads to the second chapter, Stories of Servitude: Racial 

Slurs, Humiliating Insults, and the Exercise of Power. In this chapter the author state that “most of 

my African research participants in northern New Jersey and the Washington, DC, Suburbs, told 

me stories of deliberate humiliation or diminishment” (p.82). Using examples from her fieldwork 

data, the author tells the experiences of case workers racialized experiences at the workplace. They 

told her many stories of racial insults that circulate among themselves as care workers. The author 

argues that while care requires some form of intimacy such as touching and cleaning, racial 

antagonism creates distance, unequal power dynamics and inequality between the care giver and 

the clients. “The imagery of slavery and servitude is available to both patients and care workers 

for evaluating and commenting on the caregiving relationship” (p.109), the author argues. The 

author also insists that, “case workers mainly respond to these kinds of recognition with avoidance 

and escape, leaving a case without clarifying to the agency or the patients why they are doing so, 

or putting up with the case because of the need to support their families” (p.124). In the next 

interlude, Longing for a House, the author reveals how building a house in Ghana and envisioning 

an eventual return, upon retirement, is one of the ways of regaining dignity by migrants. 

Chapter Three, Making and Breaking Practical Kinship: Affectionate Names, Occasions, and the 

End of Life, introduces a new lens in the relationships between the case workers and patients. The 

author argues that despite the sense of political belongingness challenges and connotations of 

political exclusion, a case worker sometimes also “creates opportunities to produce intimate bonds 



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that form a basis for partial political inclusion” (p.130). The author also states that “it is not 

surprising that care could generate the feelings of intimacy and closeness that people name as 

kinship” (p.131). Patients and care workers are referred to as using fictive kinship terms such 

brother, sister mother and father. Patients allow care workers into intimate family gatherings and 

occasions and gifting by patients to care worker can happen. The author demonstrates this form 

kin relationship with the interlude Playing Tennis. However, she is quick to distinguish between 

two forms of kin relationships i.e., Practical kin and official kin. The author argues that African 

care workers forge practical kin relations that are brief and unpredictable and that “terminates upon 

the patients’ death” (p.134). compared to their counterparts who are the official kin. Thus, 

practical kinning does not, according to the author, lead to political belonging.  

  

Chapter Four, Reciprocity: Who Deserves What, and on What Grounds? The author argues that 

“the mutuality integral to belonging requires ongoing reciprocal exchanges that support feelings 

of interdependence and interest in the other’s well-being” (p.175). However, the author is quick to 

mention that the chapter is on care-taker’s perspective on these forms of reciprocity and what they 

feel they deserve in this connection. According to the author, care workers evaluate these reciprocal 

relationships or lack of them as the macro-views of the American challenges to achieve their 

immigration goals. Care workers expect appreciation and gifts which they sometimes receive but 

not always or to the magnitude they expect to receive. For example, the author explains that care 

workers sometimes feel humiliated and develop a sense of exclusion but must continue to work 

because of their financial vulnerability. The section on care workers perspectives on reciprocities 

delves into acknowledgement and appreciation, money as spirit, gifts, divine reciprocity, and 

negative reciprocity: theft. These sections concentrate on the intricate reciprocal exchange 

relationship between care workers and patients and are more visible at the patients end of life as 

author argues with an in-depth illustration with the interlude, Intangible Gifts, and the End of Life. 

This chapter illustrates that “African care workers evaluate political belonging through the lens of 

reciprocity” (p.203).  

 

The last chapter, A Lack of Reciprocity: Wages, Benefits, and Contingent Employment, argues that 

there is a lack of reciprocity when it comes to wages and benefits deriving from their work. This 

is considered a challenge to political belongingness because the author indicates that “the wages 



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and benefits of work are signs of recognition” (p.203). The author continues to illustrate that state 

benefits such as pension are one of the indicators of belonging by their capacity to signal 

citizenship. Most also struggle with lack of insurance, time off work, job insecurity, poor credit 

and, to the extreme, some end up losing their houses that they purchased in the US as illustrated 

in the foreclosure interlude. The chapter explains how after working for many years as care 

workers, some felt that they had not realized their American dream and did not see themselves 

retiring in the United Stated or being able to afford to do so. Some saw a better alternative in 

building a home back in their country where they would eventually retire and afford a comfortable 

life economically. Though they talked about their concerns, concentrating on work and most were 

not able to organize themselves in labor union to air their grievances as the author states “however, 

such disgruntlement did not lead them to political engagement or labor activism, in part because 

they spent so many hours working. Instead by directing their energies towards returning to their 

home countries, they rendered their complaints politically invisible” (p.205) 

 

The book concludes with the topic, Recognition and belonging through care that summarizes the 

main argument in the book within the context of the nation state and the global world and the lived-

in daily experiences of African immigrant care workers. Since elder care is projected to be on the 

increase within the United States and the need for care worker will continue to increase, the author 

in end suggests to “reconfiguring our politics from an emphasis on individual autonomy and self-

reliance to an acknowledgment of human vulnerability and interdependence.” (p. 252). This 

research is very timely given heightened the global circulation of individuals and the search for 

greener pastures, economic stability, political identities and belonging.  

 

Serah Shani is an associate professor in the School of Social and Behavioral Studies at Mercy 

University in New York. Dr. Shani is author of two books, African Immigrant Families in the 

United States: Transnational Lives and Schooling and Indigenous Elites in Africa: The Case of 

Kenya’s Maasai. Dr. Shani is currently working on her third book project, based on an ongoing 

research project funded by a grant from the John Templeton Foundation. 

 

 

© 2024 Serah Shani 


