Borderland and Binational Health and Health Care, by Dr. Jill Fleuriet
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This document discusses various topics related to health and citizenship including definitions of personhood and citizenship, discourses around motherhood and gender, birthweight, American views of the US-Mexico border, resilience among local communities, and access to healthcare for Mexican immigrants and low-income Mexicans suffering from end-stage renal disease. It also lists locations and organizations in Mexico involved with cross-cultural medicine and global health research, including universities, hospitals, and research centers in Guadalajara and Monterrey.
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Borderland and Binational Health and Health Care, by Dr. Jill Fleuriet
- 4. Who is a person? Who is a citizen? How do these definitions impact health?
- 5. Mexican and American Discourses of Motherhood and Gender * Social Status and Stress during Pregnancy * Birthweight
- 6. What are American discourses about the southTexas border? * What are local discourses? Resilience, expertise, innovation Binational potential for transformation
- 8. Cross-Cultural Medicine UTSA Study Abroad in Guadalajara, 2016 * ITESM, IMSS, CIESAS
- 9. Cross-Cultural Medicine UTSA Study Abroad in Guadalajara, 2016
- 10. Global Health and the Environment UTSA Study Abroad in Guadalajara, 2017 * UDG, Universidad Cuauhtémoc, Centro Para la Conservación e Investigación de laVida Silvestre
- 11. Access to Dialysis in the U.S. for Mexican Immigrants with End-Stage Renal Disease * health, immigration, citizenship
- 12. Access to Dialysis for Low-Income Mexicans with End-Stage Renal Disease * CIESAS Unidad Noreste, Monterrey, NL, Mexico
Editor's Notes
- First, I would like to express my appreciation for the hospitality of the Institute for Texan Cultures this evening. It is an honor and a pleasure to spend the evening with CIESAS faculty and UTSA administrators, faculty and students. In fact, our intellectual and cultural exchange tonight reminds me of the eleventh Binational Policy Forum on Migration and Global Health in 2011 that was the beginning of the book we discuss tonight. I would like to briefly present how our book contribution developed, highlighting the opportunities and experiences that emerged from our chapter. I speak on behalf of myself, and then I will also present on behalf of my co-author, Milena Melo.
- During the Binational Policy Forum on Migration and Global Health, I presented on my work on birth outcomes among immigrant women from Mexico living in South Texas. I am a medical and cultural anthropologist. My research focuses on the ways in which health and health care inequalities are produced by political economic and social processes and the experiences of those who suffer those inequalities and those who fight against them. For my Forum talk, I spoke about the special case of prenatal care for undocumented immigrant women and the birth weight of their infants.
- My work necessarily engages research from scholars on both sides of the border. When Dr. Harriett Romo asked me to contribute to a book that involved both Mexican and American scholars of social sciences, I was honored. It was a chance for me to delve more deeply into how and why migration processes impacted women’s understanding and experience of pregnancy and prenatal care and how and why migration processes may influence birth outcomes of these women. I also grew up on the US-Mexico border in the Rio Grande Valley of Texas. It is a transnational area, rich with histories of exchanges between Mexico and the United States. Dr. Romo’s book was a logical extension of my personal and professional commitments to binational dialogue, particularly during the tense political times in the United States. That same Fall, a new doctoral student entered our Anthropology program at UTSA. Her name was Milena Melo. Milena is also from the Rio Grande Valley of South Texas, and she was born in Mexico. She arrived at UTSA with a commitment to studying inequalities in access to health care by low-income undocumented immigrants from Mexico. She herself is from this community. When Dr. Harriett Romo met Milena and learned about her research involving immigrants, she asked me if we would write a chapter together for the book.
- Milena’s work and my work fit together so seamlessly that, honestly, I was a little concerned about how easily the chapter came together! It was as if the chapter was meant to be. Milena and I wrote about the ways in which constructions of personhood and citizenship directly influence immigrant health and health-care eligibility. We used contrasting case studies: mine of prenatal care for undocumented immigrant women and hers of dialysis for undocumented Mexican immigrants with advanced diabetes and hypertension in communities in South Texas. In the case of prenatal care in Texas, undocumented immigrant women have access to preferred medical care, which is correlated with improved birth and child and adult health. In the case of undocumented immigrants with advanced diabetes, hypertension, and related conditions in Texas, care is irregular and fragmented at best, which increases morbidity and mortality. Both case studies are complicated by state definitions of deservingness-of-care criteria for publicly funded health care. State criteria for who receives health care, in turn, are shaped by understandings of what constitutes a person and a citizen. For analysis, we drew from our respective ethnographic work in Hidalgo and Cameron Counties of the lower Rio Grande Valley of Texas. We illustrated how access to health care at the beginnings and endings of life fundamentally shape the well-being of immigrant communities. We concluded with a brief discussion as to how differential access to health care can shape immigrant experiences of incorporation, using Portes and Böröcz’s (1989) typology of modes of incorporation, and how these analyses could inform policy.
- From this collaboration, Milena and I both began to think more strategically about how to incorporate binational perspectives into our research and teaching. Participation in the conference also strengthened my commitment to interdisciplinary collaboration. For my research, writing our book chapter reinforced the cultural diversity of immigrants coming from Mexico and the need for interdisciplinary investigation into the relationship between mental health, immigration, and health outcomes. I recently completed a fruitful collaboration with Dr. Thankam Sunil, a demographer and sociologist at UTSA to extend my work in the Rio Grande Valley. We conducted a five year investigation into understanding why low-income Mexican immigrant women had healthier infants that Mexican American and non-Hispanic white women – and why Mexican immigrant women started having less healthy babies the longer they lived in the United States. Since 2011, we have surveyed 630 Mexican immigrant and Mexican American women for psychosocial health, subjective social status, and reproductive histories; we surveyed another 558 women about psychosocial health, pregnancy intendedness, and contraception use. Finally, we conducted in-depth, ethnographic interviews with 83 women for their experiences and narratives about their social status during pregnancy and prenatal care practices. The majority of immigrant women were from cities in Central and Northern Mexico. These immigrant women from central and Northern Mexico had quite similar prenatal care practices as U.S. born women. But, they did have different understandings of the social status of pregnant women, and they experienced significantly less perceived stress when pregnant, as compared to U.S.-born women. Thus, in our most recent article we document how meanings of pregnancy and motherhood increasingly integrate notions of stress the longer immigrant Mexican women live in the United States. Stress has consistently been linked to low birth weight. We argue that understandings of pregnancy and motherhood among Mexican immigrant women living in the United States change; pregnancy becomes a more stressful time. The increased stress may affect the increase in low birth weight infants born to those women. We have published our work in four journals and presented on our work at twice as many conferences.
- My new project is also on the US-Mexico border, and it involves a different way of imagining binationalism. At its most fundamental, my new project is about the stories we tell about places and peoples and how these stories shapes efforts to promote community health and wellbeing. The places and people of my project are the US side of US-Mexico border, specifically the Rio Grande Valley. A colleague and I systematically analyzed local, state and national stories about this region. We found that the most common stories were about border corruption, poverty, health and health care inequalities, and educational inequalities. Rarely were the stories positive. Next, I have so far conducted over 75 interviews with elected and appointed leaders in the Valley in the areas of politics, business and development, health and health care, and education. I have recorded their stories about the Valley and documented their initiatives to promote health and wellbeing in the border communities. The resilience, expertise, and innovation of these leaders are at odds with the dominant news stories in the US about the border. Ultimately, my book will offer an alternative story about the Texas border region that is grounded in the actual lives and stories of the people who live there and who work hard to help their communities. One of the most prevalent themes I hear from border leaders are the productive, rich, and potentially transformative relationships between the United States and Mexico. I think it’s time that story is heard. Here is a brief example. The picture on this slide is from a Texas Tribune panel that was held this summer in McAllen, a large city in the Valley. The panel was called “Life on the Border: Rhetoric or Reality?”. It was hosted by The Texas Tribune, a highly respected, bipartisan, statewide news outlet. The Trib, as it’s colloquially known, recently began a yearlong investigative series.
- Entitled “Bordering on Insecurity,” the series considers the ways in which the Texas-Mexico border is “secure,” especially with respect to the movement of people and crime. The picture on the series’ homepage is of a still river, shrunken with dry patches and surrounded by a brown desert landscape. On the far right hand side of the picture are two white and green border patrol trucks, waiting. Below the picture are the headlines: “Cracks in the Wall: When Border Watchdogs Turn Criminal,” “Love and Money Join Agent, Drug Smuggler,” and “How Investigators Linked a Headless Body to a Border Patrol Agent” (August 10, 2016). In smaller font, the sidebar Investigative Highlights reads: “We’ve also explained why the border region is safer than much of the rest of the state and brought you the voices of immigrants longing to cross the Rio Grande.” When The Texas Tribune defines the U.S.-Mexico borderlands as insecure, corrupt, and broken, defined by immigration alone, a narrow vision of the borderlands is reinscribed and perpetuated, especially during an intense election year demarcated by discourses on immigration and national security. The McAllen panel was in response to loud and public criticism from editors of the McAllen and El Paso newspapers. Old friends with both editors, the editor of The Trib said that yes, it was true the series perpetuated border stereotypes, but he was keeping it. He did ultimately add that sidebar about how safe Valley cities were – and he held the panel in McAllen. But that’s it.
- My participation in the Binational Policy Forum on Migration and Global Health conference also led to innovations in my teaching, specifically my participation and development of two study abroad programs in Guadalajara, Mexico. This past summer, I co-taught a cross-cultural medicine course with UTSA students. In this course, we study the complexity of American and Mexican medical systems, considering how they are similar and different – and how this can affect patient care. We partnered with Tech de Monterrey in Guadalajara and IMSS, the largest provider of health care in Mexico. We even had the chance to spend an evening with CIESAS Occidente scholars – I call the upper righthand picture my fangirl shot.
- Our UTSA Roadrunners had a wonderful time in Guadalajara! Here they are outside of Tequila.
- In the summer of 2017, my colleague, Dr Michael Muehlenbein, and I will offer a binational, comparative research project on risk perception of Zika and zoonotic diseases. We will teach our students cross-cultural research methods and ethics and combine research and service-based learning at zoos and wildlife rehabilitation and sanctuaries in San Antonio, on the US-Mexico border, and in Guadalajara, Mexico. In Guadalajara, our UTSA students will be working alongside veterinary students from Guadalajara. In essence, my research and teaching have become even more binational.
- For Milena, writing this chapter also drew her attention to the binational implications of her dissertation research on how definitions of citizenship determine who has access to dialysis care in the United States. During her dissertation research, she interviewed and followed dialysis patients who were undocumented immigrants from Mexico as well as permanent residents. She participated in health fairs and diabetes screenings. She also interviewed and followed doctors and social workers as they treated these dialysis patients. . Doctors in the Rio Grande Valley often scolded undocumented patients for not returning to Mexico where they could supposedly receive “free” dialysis and healthcare. These beliefs conflicted with the stories Milena heard throughout her dissertation from undocumented patients. Her dissertation explores how health care access policies encode ideas of citizenship that fundamentally shape the health outcomes of undocumented immigrants. I should note that all of these pictures are used with permission of her participants; they wanted their stories told.
- While the restrictions of her Deferred Action for Childhood Arrivals (DACA) status had originally limited her research to the United States, Milena was recently granted permission to temporarily travel to Mexico to begin a comparison study of access to dialysis for the poor in Mexico. Diabetes is currently the number 1 cause of death in Mexico, with kidney disease being a close second. Likewise, the Rio Grande Valley of Texas currently has the 2nd highest rate of diabetes in the US. Kidney disease, and its two leading causes, diabetes and hypertension, are of deadly concern binationally, between our two countries. With the generous support and funding from the UTSA Mexico Center-CIESAS Fellowship, she resided in Monterrey, Nuevo Leon in order to explore the options and access of those essentially “uninsured” Mexicans who fall in between the cracks of Seguro Popular and require dialysis treatment. She continued interviews and participant observation with dialysis patients.
- She also traveled to the Mexico City campus of CIESAS to participate in discussions with Mexican social scientists. The opportunity to look at the issue of dialysis care from a binational perspective would not have been possible if it were not for Milena’s involvement in this book, the UTSA Mexico Center, and CIESAS. During her time in Mexico, Milena was also able to establish meaningful connections and networks with anthropologists at CIESAS Noreste and CIESAS Distrito Federal – what it was called then, where she participated in a special session of the Seminario Permanente de Antropologia Medica on diabetes. Throughout both her time at the CIESAS offices and the Hospital Universitario at Monterrey, Milena has built key relationships that will surely lay the groundwork for a future long-term project analyzing the experiences of Mexicans on both sides of the border requiring dialysis care. Milena’s success in research and publication has led to a number of accolades and grants. She was awarded the National Science Foundation’s Doctoral Dissertation Research Improvement Grant and recently awarded the 2016 American Anthropological Association’s Minority Dissertation Fellowship. She was also selected as a Ford Foundation Fellow – in fact, she could not be here tonight because she is at her first Ford Fellows conference. To conclude, I would once again like to express my gratitude to Dr. Harriett Romo for the opportunity to contribute to the book and to express my appreciation to CIESAS, UTSA – specifically the ITC, for this lovely evening. Thank you.