INDIGENOUS (NATIVE) LATIN

AMERICAN IMMIGRANTS: among the most vulnerable workers

Leoncio Vasquez SantosSeth M. Holmes, PhD, MD

Faculty Disclosure

We have nothing to disclose

Indigenous Population in the Americas

Mexico 15.7 millions 15%

Peru 13.8 millions 45%

Bolivia 6.0 millions 55%

Guatemala 5.8 millions 40%

United States 5.2 millions 1.7%

Ecuador 3.4 millions 25%

Chile 1.9 millions 11%

Canada 1.4 millions 4.3%

Indigenous Languages in Oaxaca

Spanish Chontal

Zapoteco Mazateco

Mixteco Chinanteco

Triqui Cuicateco

Chatino Amusgos

Serrano Huave

Mixe Techuantepecano

Netzichu Zoque

Indigenous History• The 16 ethnic communities of Oaxaca

are part of the Mesoamerican Pre-Hispanic Cultures.

• Social & Political Organization:

o City States governed by royal lineages

o Hierarchical social structureo Advance forms of art, literature,

math, cosmologyo Close relationship with natureo Practice of traditional medicine

• Indigenous People face stigma & discrimination even in Mexico.

Montealban

Indigenous Culture

• Written Language

o Mixtec Codex kept 1,000 years of history

o Only nine Codex remained

• Oral tradition is predominant in the indigenous communities

Millenary Cultural Traditions

• El Tequio

• Offering ceremonies to the rain God to ask for good harvest.

• Guelaguetza

• Fiestas Patronales

• Día de los Muertos

• Traditional Medicine

Indigenous MedicineCommon Beliefs and Practices

● Traditional Medicine Approaches:● Herbolaria: Use of

medicinal plants/herbs.● Midwives: Treatment during

pregnancy.● Hueseros: Treatment for

bone problems● Sobadores: Treatment for

muscle pain / sprains● Spiritual Guides: Spiritual

realm of supra-natural conditions

Migration to the U.S.

Mexican Migration PatternMexico: (Always)• Veracruz• Distrito Federal• Sinaloa• Baja California Norte/Sur

United States: (’80s)• California • Washington State• Oregon• Florida • New York • North Carolina

Migration to U.S.• 1960s & 1970s: First indigenous families arrived with the Bracero

Program

• 1980s: Begins Massive Migrationo Early ’80’s: Only Meno After IRCA (1986): Increased in the number of whole families

• 1990: U.S. Census registers one Mixtec family

• 1991: The California Institute for Rural Studies conducted a research and found that 50,000 indigenous migrants worked in the fields of California.

• 2008-2009: The “Indigenous Farmworker Study” estimates that number of indigenous persons working in the agriculture sector in California is 120,000 and it reaches 165,000 when children are included. (Mines et al., 2010)

Estimate: 120,000 in CA Farmworker Families + 45,000

Children

Challenges Facing Indigenous Migrants

Racial Hierarchy• Racism & Prejudice (stereotypes)

• “No seas indio!”

Class Exploitation• Worse paid jobs for newcomers

• “They like to work bent over.”

Cultural and Language Barriers• Language not dialect

• The glorious past vs. the harsh present

• The politics of cultural difference

Conditions of Indigenous Migrants in the U.S.

• They perform the most physical demanded and less rewarded jobs (farm work and construction)

o They are exposed to pesticides, long working hours, no toilets with water to wash hands and drinking water.

• They earn the minimum wage and too often below the minimum wage

• Zabin and others (1993) found that Mixtec workers were more likely to accept jobs paying less than the minimum wage and were more likely to be victims of non-payment and other law violations.

Living Conditions

Living Conditions

• It is common to find two bedroom apartments with two or three families (15 people).

• Many live in caves, around the rivers, mountains and under the orchard trees.

Living Conditions

Living and Working Conditions

Immigration, Identity and Social Networks

• Informal Village Networks

• Formalization of Social Networks.

• Institutionalization of collective practices (political, social, economic and religious).

• Emergence of a subjective collective belief of membership and belonging.

Structural Competency

“A shift in medical education … toward attention to forces that influence health outcomes at levels above individual interactions.”

–Metzl and Hansen 2014

The capacity for health professionals to recognize and respond to health and illness as the downstream effects of broad social, political, and economic structures.

Structural Competency

Develop trainees’ capacity in:

1. Recognizing the influences of structures on patient health

2. Recognizing the influences of structures on the clinical encounter

3. Responding to the influences of structures in the clinic

4. Responding to the influences of structures beyond the clinic

5. Structural humility

Social Structures

● The policies, economic systems, and other institutions (judicial system, schools, etc.) that have produced and maintain contemporary social inequities and health disparities, often along the lines of social categories such as race, class, gender, and sexuality.

Structural Violence

● “Structural violence is one way of describing social arrangements that put individuals and populations in harm’s way... The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people.”

– Farmer et al. 2006

Structural Vulnerability

● The risk that an individual experiences as a result of structural violence – including their location in multiple socioeconomic hierarchies. Structural vulnerability is not caused by, nor can it be repaired solely by, individual agency or behaviors.

Metzl and Roberts,

“We argue that, if stigmas are not primarily produced in individual encounters but are enacted there due to structural causes, it then follows that clinical training must shift its gaze from an exclusive focus on the individual encounter to include the organization of institutions and policies, as well as of neighborhoods and cities, if clinicians are to impact stigma-related health inequalities.”

• SC is effective in shifting student perceptions of disease etiology

o Before SC Training: genetics, behavior, culture

o Post-SC Training: poverty, racism, harmful policies, unequal resources

• Trainees indicate increased empathy and solidarity with patients

Research shows:

Case One

“Mr. Martinez is a 28 year-old male found down and intoxicated, possible aspiration pneumonia. He's a frequent flyer with many similar presentations but no history of alcohol withdrawal seizures. Nothing to do. If he's agitated assess for withdrawal and start the withdrawal protocol.”

Begins Drinking More Heavily

Can’t Pay Rent, Moves to Street

Injury,Can’t Work

Begins Working as Day Laborer

Moves to San Francisco

Influx of Cheap US Corn; Can’t Make

a Living

4th Generation Corn Farmer in

Oaxaca

In Emergency Department After

Found on the StreetGets Assaulted

Standard Medical History &Default Provider Interpretation

North American Free Trade Agreement

(NAFTA)

Punitive US immigration Policy/Discrimination

City policies contributing to high rents & displacement

No Health Insurance(excluded from ACA)

Begins Drinking More Heavily

Can’t Pay Rent, Moves to Street

Injury,Can’t Work

Begins Working as Day Laborer

Moves to San Francisco

Influx of Cheap US Corn; Can’t Make a

Living

4th Generation Corn Farmer in

Oaxaca

In Emergency Department After

Found on the StreetGets Assaulted

Systematic marginalization of

and violence against indigenous

communities in S. MexicoRacialized low-wage

labor markets

Begins Drinking More Heavily

Can’t Pay Rent, Moves to Street

Injury,Can’t Work

Begins Working as Day Laborer

Moves to San Francisco

Influx of Cheap US Corn; Can’t Make a

Living

4th Generation Corn Farmer in

Oaxaca

In Emergency Department After

Found on the StreetGets Assaulted

Standard Medical History &Default Provider Interpretation

Naturalizing Inequality

• The sometimes subtle, sometimes explicit, ways in which structural violence is erased and elided by claims of cultural difference, genetic variance, behavioral shortcomings, or racial categories.

• “Noncompliant” “Lost to follow-up” “Frequent flyer”

• The “Culture of Poverty” (usually poor communities of color)

• “Risk factors” as decontextualized, objective, apolitical realities

North American Free Trade Agreement

(NAFTA)

US immigration Policy/Discrimination

City policies contributing to high rents & displacement

No Health Insurance

Begins Drinking More Heavily

Can’t Pay Rent, Moves to Street

Injury,Can’t Work

Begins Working as Day Laborer

Moves to San Francisco

Influx of Cheap US Corn; Can’t Make

a Living

4th Generation Corn Farmer in

Oaxaca

In Emergency Department After

Found on the StreetGets Assaulted

Possibilities for Change

● How can we intervene on the structures affecting health and health care?

1. Intrapersonal 2. Interpersonal3. Clinic4. Community5. Research6. Policy

Levels of Intervention

In Emergency Department After Found on Street

Begins Drinking More Heavily

Gets Assaulted

Can’t Pay Rent, Moves to Street

Injury, Can’t Work

Begins Working as Day Laborer

Moves to San Francisco

Influx of Cheap U.S. Corn

Fourth Generation Corn Farmer in Oaxaca

Educate yourself and work against implicit and explicit racism and other bias

Approach the patient without blame or judgment

Use an interpreter

Advocate for safe spaces for community members

Research the structural forces that affect the lives and health of migrants who work as day laborers, including policy and racism in your research questions and discussion

Advocate for more just housing policy

Organize against trade agreements that contribute to the exploitation of foreign labor

Intrapersonal

Interpersonal

Clinic

Community

Research

Policy

Q1: Structural competency is defined as?A. The capacity for health professionals to recognize and

respond to health and illness as the downstream effects of broad social, political and economic structures

B. The ability to interact effectively and respectfully with people of different cultures

C. Coordinated care to individuals with multiple chronic health conditions, including mental health and substance use disorders

D. The ability to navigate the institutions of health care effectively and efficiently

Q2: Compared to the general Latin American immigrant population, what are additional risk factors that indigenous Latin American Immigrants face?

A. Immigration statusB. RacismC. Preferred language is assumed to be SpanishD. This is an understudied population

Q3: What can health professionals do to better serve indigenous Latin American immigrants? A. Assume all Latin American immigrants the same

and face the same experiences, thus being prepared to respond

B. Research and seek to understand the unique circumstances that impact this population

C. Interact with them the same way you would any other patient

D. Learn Spanish

References● Mines, R., Nichols, S., & Runsten, D. (2010). California’s Indigenous

Farmworkers: Final Report of the Indigenous Farmworker Study (IFS) to the California Endowment. Retrieved at http://www.indigenousfarmworkers.org

● Metzl, J. M. (2010). The protest psychosis: How schizophrenia became a black disease. Beacon Press.

● Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126-133.

● Haldol advertisement. (1974). Archives of General Psychiatry. ● Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural

violence and clinical medicine. PLoS medicine, 3(10), e449.