Indigenous Population in the Americas Mexico 15.7 millions 15% - - PDF document

INDIGENOUS (NATIVE) LATIN AMERICAN IMMIGRANTS:

among the most vulnerable workers

Leoncio Vasquez Santos Seth 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:
• City States governed by royal

lineages

• Hierarchical social structure
• Advance forms of art, literature,

math, cosmology

• Close relationship with nature
• Practice of traditional medicine
• Indigenous People face stigma &

discrimination even in Mexico.

Montealban

Indigenous Culture

• Written Language
• Mixtec Codex kept

1,000 years of history

• 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 Medicine Common 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 Pattern

Mexico: (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 Migration
• Early ’80’s: Only Men
• 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)

• 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

• rchard 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

• Before SC Training: genetics, behavior,

culture

• 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.”

Be g ins Drinking Mo re He a vily Ca n’ t Pa y Re nt, Mo ve s to Stre e t I njury, Ca n’ t Wo rk Be g ins Wo rking a s Da y L a b o re r Mo ve s to Sa n F ra nc isc o I nflux o f Che a p US Co rn; Ca n’ t Ma ke a L iving 4th Ge ne ra tio n Co rn F a rme r in Oa xa c a I n E me rg e nc y De pa rtme nt Afte r F

• und o n the Stre e t

Ge ts Assa ulte d Standar d Me dic al History & De fault Provide r Inte rpre tation

Nor th Ame r ic an F r e e T rade Agre e me nt (NAF T A) Punitive US immigration Polic y/ Disc rimination City polic ie s c ontributing to high re nts & displac e me nt No He alth Insuranc e (e xc lude d fr

• m ACA)

Be g ins Drinking Mo re He a vily Ca n’ t Pa y Re nt, Mo ve s to Stre e t I njury, Ca n’ t Wo rk Be g ins Wo rking a s Da y L a b o re r Mo ve s to Sa n F ra nc isc o I nflux o f Che a p US Co rn; Ca n’ t Ma ke a L iving 4th Ge ne ra tio n Co rn F a rme r in Oa xa c a I n E me rg e nc y De pa rtme nt Afte r F

• und o n the Stre e t

Ge ts Assa ulte d Syste matic marginalization of and viole nc e against indige nous c ommunitie s in

• S. Me xic o

Rac ialize d low-wage labor marke ts Be g ins Drinking Mo re He a vily Ca n’ t Pa y Re nt, Mo ve s to Stre e t I njury, Ca n’ t Wo rk Be g ins Wo rking a s Da y L a b o re r Mo ve s to Sa n F ra nc isc o I nflux o f Che a p US Co rn; Ca n’ t Ma ke a L iving 4th Ge ne ra tio n Co rn F a rme r in Oa xa c a I n E me rg e nc y De pa rtme nt Afte r F

• und o n the Stre e t

Ge ts Assa ulte d Standar d Me dic al History & De fault Provide r Inte rpre tation

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

Nor th Ame r ic an F r e e T rade Agre e me nt (NAF T A) US immigr ation Polic y/ Disc rimination City polic ie s c ontributing to high re nts & displac e me nt No He alth Insuranc e Be g ins Drinking Mo re He a vily Ca n’ t Pa y Re nt, Mo ve s to Stre e t I njury, Ca n’ t Wo rk Be g ins Wo rking a s Da y L a b o re r Mo ve s to Sa n F ra nc isc o I nflux o f Che a p US Co rn; Ca n’ t Ma ke a L iving 4th Ge ne ra tio n Co rn F a rme r in Oa xa c a I n E me rg e nc y De pa rtme nt Afte r F

• und o n the Stre e t

Ge ts Assa ulte d

Possibilities for Change

• Ho w c a n we inte rve ne o n the struc ture s

a ffe c ting he a lth a nd he a lth c a re ?

• 1. Intrapersonal
• 2. Interpersonal
• 3. Clinic
• 4. Community
• 5. Research
• 6. 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

• r 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 status
• B. Racism
• C. Preferred language is assumed to be Spanish
• D. 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
• ther 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.