They nurture the sick, frail and disabled, tending not just to their physicals needs but, frequently, to their hearts. It is service work so singularly close that many who do it say they can’t help but develop deep connections with the people under their care.
In Sonoma County, caregiving is a profession that has been embraced by a tight-knit community of Fijian immigrants, who bring to the role values based on tradition, respect for elders and a Christian belief in caring for the vulnerable.
The face of a caregiver may be the last someone sees, their touch the last they feel, before taking a final breath. As intimate eyewitnesses, they have developed a unique perspective on what it means to live fully and die with grace.
Brad Dreyer’s day begins in Glen Ellen at 8:30 each morning with the arrival of Bentley Wan.
For the rest of the day, the patient man with an easy grin will be Dreyer’s eyes, ears, legs, arms, voice and mind, a surrogate for everything Brad can no longer do for himself. Wan is his nurse, physical therapist, driver, valet and best friend.
Dreyer, 26, has limited use and control of his hands and legs after suffering a traumatic brain injury five years ago when he was struck by a hit-and-run motorcyclist while riding his skateboard. It will take Wan nearly three hours to ready Dreyer for a chiropractic appointment in the early afternoon.
Wan is careful to skip no step in this meticulous and unhurried process. He will prepare the morning’s nourishment and medications, exact recipes and proportions he will deliver through a feeding tube. He will discreetly dispose of the waste from the previous night.
Wan, 47, is one of hundreds of Fijians who live in Sonoma County and are in-home caregivers to people most in need, from the severely disabled to those in hospice care and nearing death. While some come to the job after realizing how hard it is to get work in the United States, there are values in their Fijian culture that make them particularly suited to caring for others.
Wan gently massages Dreyer’s facial muscles with the hope that eventually this well-loved child from a close-knit family, a lively and helpful kid who played drums and soccer and was a pirate in his high school production of “The Pirates of Penzance,” will smile again.
“OK, buddy. Start smiling, man,” Wan cajoles. “I could give you a million reasons to smile even though you’re in this situation.”
Wan will do anything it might take to provoke those muscles to express happiness — dancing, making a funny face, telling jokes. The smile hasn’t happened yet. “I end up laughing at myself,” he conceded. But even after two and a half years of caring for Dreyer with the same tender care he would his own son, Wan keeps the faith.
“Get your tongue to work, that way you start eating and talking. Push up Brad, push up,” Wan says as he brushes Dreyer’s teeth, gums and tongue. There is no noticeable response, but Wan keeps coaching him as he gently goes over every part of Dreyer’s body with a soapy washcloth, paying attention to every piece of a man’s grooming ritual, including deodorant and a finishing pat of Old Spice.
There is no moment in this ritual that Wan has performed several hundred times that appears perfunctory.
An uplifting drumbeat of Christian motivational affirmations about healing and wellness pours out of a laptop Wan has set up on a shelf in Dreyer’s room. There’s a Batman poster on the ceiling, a Sonoma Valley High School class of 2006 photo and other reminders of an old life that Brad’s mother, Mary Kate Dreyer, still hopes he might, through intensive therapy from professionals and committed caregivers like Wan, reclaim in at least some small measure.
“I want to see you talk on my watch, before I leave this place,” Wan declares sternly, looking into the still-handsome face of Dreyer, whose eyes, behind glasses, don’t appear to be focused.
By definition, Wan is a caregiver. But he is more like a close uncle, best friend and extension of Dreyer himself, intuiting his needs, desires and discomforts since he can’t speak for himself. By Wan’s estimate, Dreyer may understand only 10 words.
Still, Wan reads to him, anything from sports stories in the newspaper to books he knows his sons of similar age would like. He takes Dreyer for wheelchair walks in the neighborhood park, plays his favorite old TV shows such as “The Simpsons” and “Family Guy,” and helps with home physical therapy.
“I talk to him as I would talk to my son. I get mad at him. I’m joyful with him. I make silly jokes. I just want to believe he’s enjoying it,” Wan says.
He maintains with understatement that “the only qualification you need for this job is compassion.” Mary Kate Dreyer does not agree.
“I could not have Brad at home without Bentley. You are a gift from heaven, Mr. Wan,” she calls to him as Bentley finally readies Dreyer for his wheelchair. A skilled carpenter, Wan even built her a fence and fixed an antique dresser.
After earning an MBA, Wan taught high school math and economics, managed a bank for 11 years and oversaw the Fijian branch of an Australian government agency serving underdeveloped South Pacific communities, similar to the Peace Corps.
This is not the job he envisioned when he came to the U.S. with his wife, Dee, in 2009 after winning a green-card lottery that allowed him to emigrate. Disenchanted with what they believed was government corruption following a series of military coups in Fiji, the couple decided to start over in the U.S., hoping to provide better opportunities for their three sons, ages 19, 21 and 24.
They joined a growing community of ex-pat Fijians in Sonoma County that Dr. Narayan Raju, the honorary consul for Fiji in San Francisco, estimates at about 600. Some within the local Fijian community believe they could number 1,000 or more, and an extraordinarily high percentage of them, by some estimates as much as 90 percent, are or have been caregivers.
Although the highest proportion of California’s more than 15,000 native Fijians live in Sacramento, many are migrating to the Petaluma and Santa Rosa areas, said Raju, because of an influx of retirees in the area who need help with day-to-day living. Eritrean, Filipino and some Latino immigrants have also taken to caregiving, but the Fijians have claimed it both as family business and a religious calling. Most have a strong Christian faith, primarily Methodist and evangelical, and call upon that as motivation to attend to others.
It is a job, nonetheless, that most have assumed by default and economic necessity. Many, in their 40s or older, arrived in the midst of the economic downturn and found doors closed to them in their professions, even those with high qualifications and documentation.
At that age, it is not realistic to go back to school and retrain. Those who are in-home caregivers are paid by the day or week, and for many, a day is 24 hours long. Their pay in reality is much less than minimum wage and if they need time off, they have to find and pay for their own relief.
Under California’s Domestic Worker Bill of Rights, which went into effect in January 2014, caregivers and others who provide in-home service work must be paid the minimum wage of $9 an hour and time-and-a-half for every hour over nine in a day, and 45 in a week.
But enforcement can be a challenge. Caregivers worry about losing their jobs, particularly the undocumented, even though they are entitled to the same rights, said Maureen Purtill, director of the Graton Day Labor Center, which seeks to advance workers’ rights and facilitate fair employment. The center is doing outreach within the Fijian community and other immigrant communities, encouraging workers to stand up for themselves and make claims to the state for back wages if employers don’t comply.
“I came here thinking it would be easy to get the type of work I was doing in Fiji,” says Licia Banuve, 57, who came with her husband, Lekima (Lex) to Santa Rosa in 2007 with a green immigration card, leaving behind a good job in the office of the High Commission for Papua New Guinea in Fiji. But neither she nor Lex, who also worked in diplomatic offices in Fiji, could find jobs in the private or public sector.
So they became caregivers, a job for which they say they are innately suited, even though the occupation barely exists in Fiji. The people of this South Pacific island have strong family ties and the cultural norm is for multiple generations to live together. Some quietly express bewilderment that there is such a high demand for their services in the U.S.
Still, they take pride in their profession and express tenderness for many of their clients, coming to embrace them as family members, particularly those with absent or neglectful families.
“Caregiving is in our blood in Fiji,” says Ili Raiyawa, who was a research librarian for an international social welfare agency before coming to the U.S. in 2000. She spends her nights caring for a 67-year-old woman who is partially paralyzed from a stroke. By day, Raiyawa helps connect fellow Fijians with clients who need caregivers, working out of an office in her garage in Santa Rosa’s Roseland area. She answers calls 24 hours a day.
“We take care of our elders,” she says of Fijian culture. “We don’t pay people to take care of them. We take turns in the family. We have only one or two old people’s homes and it’s a big thing if someone takes their elders there. We have love in the house and we can take care of them better than anybody else.”
Wan said he took care of his bedridden father for the last year of his life, doing many of the things he does for Brad Dreyer. Before that, his father lived with his sister, who also cared for their ailing mother as she was dying.
”Parents retire and they just go live with their children. It’s not even an issue with us,” he explains.
It is a job with no precise description. Every situation is different, every client’s needs unique. They may be young and severely disabled, in their 90s with dementia, or hospice patients in their last months, weeks or days of life. Caregivers can find themselves overseeing patients with complex medical needs, handling medications, catheters, syringes, colostomy bags, oxygen tanks. They might manage their client’s social lives, take them on outings, run interference with family members, do the shopping and light housekeeping, sleep at their bedsides as they are dying, clean their bodies after death and lay out their burial clothes.
“You wouldn’t believe what I handle. There are no clear boundaries,” says Teri Bond, a native Fijian who turned to caregiving after she lost a job in Silicon Valley in the dot-com bust more than a decade ago. There are family dynamics, hospital dynamics, home dynamics. The caregiver, she explains, pivots in the middle of sometimes competing forces, striking what she calls “a beautiful balance” that always seeks to keep the welfare of the person she is caring for at the center of every decision.
“The Department of Labor did a survey and found caregiving to be the most depressing kind of work in the United States because you cannot afford to be unhappy or angry,” she reflects. “The patients can. You’re kind of like a sponge who soaks everything in.”
Bond, 50, lives in an apartment with a 93-year-old former UC Berkeley professor, “a brilliant man” with Alzheimer’s disease. During a quick lunchtime break, her phone rings incessantly. She also has her own placement agency and is coordinating the homecoming of a 90-year-old man with end-stage lung disease, talking with a caseworker from the rehab hospital from which he is being released to ensure that his medical, comfort and emotional needs are met. She wants him to feels like he is still “in charge of his life.”
Bond, who is almost 6 feet tall, speaks with the assured authority of a CEO over the phone. But when she talks personally about the people she cares for, she tears up.
There was the elderly woman who lived for calls from her only son. When a call didn’t come on her birthday, Bond told a white lie. She said he had called while the woman was sleeping. The truth, she said, “would have ruined her day, ruined her week.”
Bond knows how important personal ties are to the elderly and dying, things that go beyond basic caretaking. If a client is in need of company, she becomes a detective, probing for clues about old friends. She may ask where the client went to school, look up classmates and call them over for tea. She is a careful listener, picking up on their likes, finding music they will enjoy on the computer and selecting TV shows that will stimulate them. If they mention a special restaurant, she will take them there, often doing personal advance work with the staff so that when she arrives with her client, they will be greeted warmly.
Fijian caregivers think nothing of welcoming their elderly clients into their lives, just as they would if they were part of their own family. Although those who have worked for placement agencies are counseled not to get personally involved, they insist it’s an impossible expectation.
“They see you every day. They talk to you every day, and that’s what they’re longing for, to talk to their family every day. But they’re not there. You’re the one who is there,” says Raiyawa. She has cared for more than 100 people in 14 years, many at the end of life; she will lay out a comforter to be by their side so they are not alone when they die. She has cringed inside as families have squabbled over the beds of dying relatives, denying them what she believes is the peaceful passing they deserve, unhindered by old hurts.
“We know we’re not supposed to, but we’re always emotionally involved. We feel for them when they’re being mistreated or neglected. We can’t block out what we see and hear,” says Licia Banuve, who spends nights with an elderly woman with Alzheimer’s. She and her husband Lex pour out their feelings to themselves when they get home, and “pray together.”
A “good” death was the final exit of George Greeott, a rancher and woodworker from Windsor who died in 2014 at age 104, having reveled in most every day of his life. Lex spent three years with Greeott at his hilltop ranch, preparing meals for him and doing his laundry. They were close.
“One day we had our dinner,” Lex remembers. “He said, ‘I’m going to bed.’ I said OK. Then after awhile, it was very quiet. I went into his room and he looks different. He’s already gone.”
More heartbreaking is observing how money can divide and isolate families. He recalls one wealthy client in Santa Rosa who had a son and daughter who lived in Northern California. Neither visited.
“Only when he got worse did the daughter come. She has power of attorney. She controls everything. There was sort of a struggle in the family. They ended up selling the house and he is in an Alzheimer’s facility. I feel sorry for him,” Lex says softly, his eyes looking down. “I don’t think he deserved to be treated that way.”
Caregivers seem committed to bringing to their clients at the end whatever bit of happiness they can.
“It is ingrained in us that one of the highest honors you can have is to take care of those who took care of you,” says Santa Rosa caregiver Viniana Gaunavinaka.
Bond says she has many times treated her elderly clients to island-style birthday parties, dressing them in beautiful muumuus and inviting friends and other Fijians to come celebrate with guitar music and traditional food. For the 40th birthday party of one of her own close friends, many of her Fijian guests invited their elderly clients. The bash, held in a hall at the Oakmont Senior Living community, was for the attendees like a dip in the youth-restoring pool from the movie “Cocoon.”
“There was a visiting jazz band from Fiji,” Bond says. “This was all hair down and oh, my gosh, the food! All caregivers were on standby. But who cares. These guys were on cloud nine. They danced and danced and they were crazy. They were recalling their time during the war. They never wanted to stop. We had to announce the last dance over and over.”
The relationship is not a one-way street. Caregivers speak of the life lessons they learn from their clients, of their loyalty in marriage and their frugality, often born out of an early life of deprivation.
“It’s beautiful, their sense of reality, their depth of endurance and sense of responsibility,” Bond explains. “I worked for a lady who saved $25 a week with her husband and became an established multimillionaire. She didn’t have any children, but she supported her brother’s children. She taught me how to make the simplest cole slaw with a dash of sugar, vinegar, salt and pepper. It’s the best cole slaw I’ve ever had. These people have a great understanding of this country that is something that cannot be taught. I’ve had the privilege of seeing it through their eyes.”
Gaunavinaka tells of a Windsor woman, a well-known dynamo she cared for in her last days of suffering from cancer. “One of the things I learned from her is that gratefulness releases generosity,” she says. “She was always thankful for whatever we did. Little things. Big things. Even in her last stage, when she has to stop to breathe just to talk, she says thank you. Gratefulness makes you more generous of your time and resources. We live in a society that is so strong in ‘what can you do for me?’ ”
Elenoa Waqabaca remembers the date, Dec. 12, five years ago, when she met her current client. Waqabaca had been recruited by a cousin who had been taking care of the then-90-year-old woman, but was moving back to Fiji. It was a hard time. Waqabaca was dropping her own mother off at the airport for a permanent move back to Fiji, and she was dealing with profound changes in her new life. A former aide in the office of the vice president of Fiji, she had been forced to flee the country within 24 hours after a 2006 coup.
“My first night here, when I put her to bed to sleep, the first thing she said to me was, ‘Can you pray for me?’ And I did. I hadn’t prayed for three long years, but I’m the caregiver and the client is always right. I had backslid. I had all these guilty things. But she contributed to my getting back to the church.”
Waqabaca is sitting in a small yogurt shop near Montgomery Village in Santa Rosa, where she brings her client at least once a week for her favorite treat. The woman, now 95, happily digs into her berry yogurt. She has dementia and repeats questions. Waqabaca answers each time, patiently, as if it were the first time.
She lives with Waqabaca, occupying the second bedroom in her small apartment in Santa Rosa. After her son and daughter-in-law moved out of state, the decision was made for the woman to stay with her caregiver. The 49-year-old Fijian makes room for the client in her life, while making sure the woman has photo albums of her own family within reach.
“Give me a hug,” Waqabaca affectionately urges as she helps her “roommate” on with her coat. Waqabaca brings her along on errands and if she needs time away, she says she has to “buy her freedom” by paying a neighbor, an aunt or other Fijians in her close-knit community to relieve her.
Some cases are harder, the people with disabilities and illnesses. Waqabaca considers herself fortunate to have such a sweet and easygoing lady under her own roof.
“The funny thing is, and I’ll be very honest,” she says. “I don’t find this work hard. I don’t complain about it because I have a life. I don’t have to be away from my home. I just look after her and feed her.
“It seems so hard for American society to understand. But this is just like caring for one of our own.”