Humanising Healthcare: Volunteered caring and the free gift in Czech hospitals

The past decade has seen a marked proliferation of volunteering programs in Czech hospitals. These have been established with the help of national and international funding and take various organisational forms. For the most part, these programs enable lay citizens to provide hospitalized patients with company and social support for a few hours per week. This article considers the ways in which hospital volunteering is promoted and understood as a free gift, in anthropological terms (Parry 1986, Laidlaw 2000). Specifically, I probe why it is possible and desirable for participants on volunteering programs to think about volunteering in this way. I argue that the social construction of volunteering as a free gift promotes a particular ideology of autonomous personhood, which, when considered alongside other political and economic developments in Czech healthcare over the past two decades, can be thought of as part of its neoliberal transformation. I use the latter term advisedly here, concurring with recent scholars who argue that the concept of neoliberalism is unhelpful when it is too general, or when it is presented as an omnipresent or omnipotent force in the world (Kingfisher and Maskovsky 2008). Instead, neoliberalism is best seen as a combination of political projects which link ideologies of personhood and moral authority to those of the market and efficiency (Clarke 2008). I aim to reveal how these projects are historically bound up with each other in the case of hospital volunteering, and how they maintain an ideological and material coherence. In pursing this aim I focus upon the ideological framing of this type of volunteering, and give less attention to the complicated and sometimes contradictory negotiations of it within daily practices and interactions. I therefore draw attention to the ideologies that frame everyday practices, whilst not denying the role of the latter in reproducing and sometimes challenging the former. The findings of this article are based on a six month ethnographic study of hospital volunteering which I conducted in 2008. I carried out fieldwork at programs based at hospitals in three urban sites in the Czech Republic: Prague, Usti-nad-Labem, and Ostrava. In each case, the recruitment, training, and supervision of volunteers was managed by paid volunteer coordinators. The Usti and Prague hospitals funded the volunteer programs, which meant that they paid for the coordinators‟ salaries and provided office space, materials and equipment for a volunteer center at the hospital. In Ostrava, volunteer programs were organized by the Czech branch of an international NGO, which charged the hospital for coordinating volunteer programs. Alongside conducting a series of detailed interviews with volunteers, coordinators, hospital staff and patients, I also observed volunteer training and supervision workshops across the sites, and collected a range of manuals and booklets produced by the volunteer centers on these topics. It is with these training workshops that I begin, since these were occasions in which prospective volunteers received orientation in how to approach volunteering and how to conduct their relationships with patients on the wards they visited.