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Short abstract:

This talk examines how women carve out unique ways to provide health care within stigmatized and illicit practices. Drawing on ethnographic accounts of women “hit doctors” who provide assisted injection of illicit drugs for compensation, I discuss how they develop techniques and perform care work.

Long abstract:

This talk examines alternative ideas of health and care and how women carve out unique ways to provide care within stigmatized and illicit practices. It presents the case of “hit doctors,” people who provide assisted injection of illicit drugs for compensation, to examine how people navigate the ethics of care work in a marginalized community of people who inject drugs. Assisted injection is a common and high-risk practice that can be difficult to provide without injuring recipients. Since it is illegal, some people who need assistance turn to lay practitioners, called “hit doctors” by themselves and others.

Drawing on ethnographic work from 2013 to 2021 in San Francisco, California, I show how women hit doctors construct an ethic of care in their work. In addition to developing extensive techniques and robust anatomical knowledge, many women hit doctors perform care work. They have detailed techniques for relaxing recipients, including asking them about activities or people who make them happy, listening as they recount traumas, or having recipients perform physical or breathing exercises. Many consider their practices a form of palliative care. However, their care work practices also involve taking care, for they can put them at risk of assault.

Women hit doctors’ care work practices are part of a relational ethics of care that intertwines caring for others with needing care and taking care, and centers vulnerability and interdependence. These practices illustrate how care work is constructed to fill community needs in high-risk illicit contexts where institutionalized, credentialed care is unavailable.