Health across borders: Mixtec transnational communities and health care systems (Mexico)

For the last 40 years the Mixteca region of Southern Mexico has experienced an intense out-migration that is transforming the landscape and economy as well as communal and familial relationships of its indigenous communities. The central thesis of this dissertation is that the relationship of Mixtec transnational communities with clinical health care systems is a result of structural violence, a socioeconomic arrangement impacting the health and well being of Mixtec communities. The dissertation explores the intricacies of this arrangement through analysis of the marginal position of Ixpantepec Nieves in Mexico, the construction of migrants and of indigenous peoples as irrational social actors, the biomedical health care systems serving Mixtecs in Ixpantepec Nieves and California, and the biomedical conceptualization of "cultural barriers" to clinical health care as primary to the perceived ineffective utilization of clinical health care systems by Mixtecs. These factors disadvantageously position Mixtec transnational communities in the accessing and utilization of health care systems. The systems, themselves overwhelmed with their charge, thus interact with Mixtec transnational communities in a paternalistic fashion instead of in a collaborative one. Thus, clinics participate, along with other forces and institutions, in structural violence that ultimately harms the health of Mixtec transnational communities. Mixtec transnational communities react to a range of institutional and structural borders and barriers through a process operationalized in the dissertation as "hallarse," which is defined as how a migrant "finds themselves" or becomes comfortable on a daily level within their own community and throughout the migration process. The dissertation examines this tension by examining the ways in which the transnational community reacts to the various borders and barriers impacting their daily lives in the process of migration. The dissertation finds that community ties, obligations, and ethnic identity allow the community to "find themselves" and carve out a distinctive space within the transnational space where they create alternative strategies and react to the structures of violence that work to marginalize them.