New book 'Fresh Fruit, Broken Bodies' looks at the sorry state of migrant farmworker health care -- and its larger implications in the global economy
Today, a lot of workers are not mestizo Mexican, but of indigenous Mixtec descent, from increasingly violent mountain villages of Oaxaca in southern Mexico like San Miguel and San Pedro. Bloody land disputes, ethnic tension, the collapse of the local agriculture market that was exacerbated by the North American Free Trade Agreement in the 1990s and continued through the recent global recession, and the rowdy and malevolent presence of US-funded anti-drug military forces (strange since no major drug cartels operate there) have isolated this area, forcing its men, women, and children to look for work in America.
Triqui, not Spanish, is their native language — just one of the major hurdles when it comes to delivering healthcare to this population. Another hurdle comes with the specific cultural record of Triqui and general Mexican healthcare. Many Triqui workers rely on native healers, even in American farmworker camps, whose methods of consulting cards and drawing evil spirits from bodies using oils surely provide some psychosomatic respite. But reliance on native healers — out of a combination of tradition, availability, and fear of discovery or of health institutions in general — often prevents workers with deeper problems from receiving a wider range of appropriate treatments. Self-medication through alcohol is common (Holmes observed no drug use), and in one case a man named Bernardo took to the habit mashing his abdomen with soda bottles to ease a chronic stomache ache.
The migratory nature of these workers — and their shifting relationship to the law — all but insures disruptions in preventative and prescriptive care, lack of access to medications, frustratingly spotty medical records, and the inability to form a valuable personal bond with a trusted physician. But the major hurdle is that the system put in place by the government to serve migrant populations hasn't been revisited since 1962, when a wave of media concern spotlighted the plight of migrant workers — most of whom, at that time, were white Oakies descended from the great Dustbowl diaspora of the '30s and '40s. The system has been only slightly adapted and enlarged since then, with dozens of clinics and organizations competing for limited grants, and nonprofits charging as little as they can (often still a steep fee on a farmworkers' wage).
The picture Holmes paints of the clinics he visits and the doctors, nurses, and caseworkers he encounters is a mostly warm one — most health workers are hard-working and well-intentioned, stymied by cultural and linguistic differences, lack of funds and proper medical records, and racist attitudes from the surrounding communities. Some are prone to misinterpretation, and there are a couple outbursts of frustration that borders on stereotyping.
Still, most migrant worker health care providers are dedicated to their patients' welfare. As one doctor, a mountaineer who serves the Tanaka Brothers Farm workers, put it: "It's a very difficult problem. We have a bad situation where citizens cannot really afford health care. And the migrant workers, I truly believe they should have at least the same access as the others. I mean, this work that they are doing is something that nobody else is willing to do. That's the truth. That's probably the only reason why we are able to go to the supermarket and buy fruit for a fair price. So this is a group of people that really deserves our attention."
That group will most likely be left out of the Affordable Care Act's initial implementation, with possible implications for other, growing fields of migrant work, like software coding or childcare. Holmes' book will hopefully inspire other investigations into this critical area of the nation's health care gap — and concerted action to bridge it.
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