Sangaramoorthy, Thurka, and Emilia M. Guevara. “Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access.” Journal of Immigrant and Minority Health (2016): 1-8.
Immigration to rural areas in new receiving communities like Maryland’s Eastern Shore is growing. Despite a rapid rise in immigration and diminishing health system resources, little attention has been focused on barriers to health care access in this region for immigrants. Participants perceived limited health care resources, lack of health insurance coverage, high health expenditures, language barriers, and non-citizenship status as barriers to immigrants’ access of health care. Immigrants living and working on the rural Eastern Shore face serious barriers to health care access.
Guevara, Emilia. The Dilemma with Cultural Competence. Anthropology News 56. 3 (2014).
The reductionist approach known as cultural competence is analyzed by medical anthropologists with a critical eye, not only because it simplifies the understanding of “culture” and stereotypes groups of people, but because providers may withhold health information by assuming patients are unable to fully understand medical instructions or procedures. Cultural competency also obscures the significance of economic factors and the limited agency of the patient. Ultimately, the critique of cultural competence is essential because this conversation may assist in reducing health disparities by moving towards responsive, appropriate, and effective care.
Sheffield E., Guevara E., and Sangaramoorthy, T. An Evaluation of Barriers to Health Care Access for Haitian Immigrants in Rural Maryland. Poster Presented at: BSOS Summer Research Initiative; 2016 July 22; College Park, MD.
A lack of health insurance coverage and the general high cost of health expenses create affordability barriers for Haitian immigrants, particularly those who do not speak English and are working in low-skilled employment. Language barriers complicate access because of inabilities to communicate with health providers or read prescription instructions. Poor treatment by health providers discourages Haitian immigrants from seeking health care when it is needed. Poor treatment in low-skilled labor occupations often forces immigrant workers to choose between seeking health treatment and attending work to avoid termination. Barriers to education services exacerbate existing language barriers and add another component of financial stress for Haitian immigrants.
Guevara, E., Sangaramoorthy, T. The Place that Time Forgot: Gender, Labor, and Immigration on Maryland’s Eastern Shore. In M. Carney (Chair), Ethnographies of Migrant Mental Health in the United States. Presented at the 2016 Society for Applied Anthropology Annual Meeting, Vancouver, British Columbia, Canada.
The delivery of health care and specialty care for migrant populations remains a challenge in these rural communities because of insufficient financial resources to increase health facilities and the supply of physicians to staff the clinics. Little to no mental health care access is offered and only during severe crises (either through police or emergency rooms/hospitals). Immigrants conceptualized mental health or emotional or psychosocial well-being by being free of pain, mental anguish, and maltreatment. They employ strategies of self-care and facilitate interactions between themselves and the local community which have a positive effect on stress and reduce symptoms of depression and anxiety.
Guevara, E. Migrant Workers. In Sarah Janesko (Chair) Snapshots from the Field: Five Minute Photo Presentations. Paper presented at the 7th Annual AnthroPlus Student Conference, University of Maryland, College Park.
In the past, migration was often considered permanent, a way for a person or family group to establish a new life in a different country or region. However, migration patterns are constantly changing and involve “greater temporality and spatial configurations.” As migrants move after being somewhere for a temporary basis, they often find their lives becoming inextricably linked to the receiving place whether or not their status is or is not permanent.
Guevara, E., Sangaramoorthy, T. “Bastardized” Forms of Care: Negotiating an Underground Economy of Health Care on Maryland’s Eastern Shore. In S. Raskin, J. Mulligan (Chairs), Defamiliarizing ‘Choice’ in Health Care. Paper presented at the 2015 American Anthropological Association Annual Meeting, Denver, Colorado.
The struggle Maryland’s Eastern Shore faces in responding to drastic population shifts given its relative geographic isolation and often limited resources is an example of an underground economy of care that is increasingly present in rural and underserved areas. We argue that providers and immigrants produce and maintain an underground economy of (health and other kinds of supportive) care in the face of economic constraints, tenuous immigration policy environments, and frail healthcare systems. They are also interpersonal, relational, and reciprocal in nature, in contrast to the impersonal and self-interest logic of formal health care access.
Guevara, E., Sangaramoorthy, T. Health-Related Deservingness and ‘Illegality’ on Maryland’s Eastern Shore. In S. Horton, W. Alexander, (Chairs), Reconsidering Migrant Health: Anthropologists in Conversation with Public Health Paradigms. Presented at the 2015 Society for Applied Anthropology Annual Meeting, Pittsburgh, Pennsylvania.
Providers working in migrant health or immigrant social services believe that immigrants are entitled to legal rights and legalization is the only way to ensure the right to health (along with other kinds of rights like labor and social services). Because of limited resources and funding, providers indicated there was a constant day-to-day decision making aspect to their work. The data suggests that providers weighted each individual situation based on available resources and potential for positive outcomes. Haitians on the Eastern Shore were keenly aware that groups were in competition for resources and were being excluded from care. They noted that the idea of “migrant” was exclusively seen as Latino and the Haitian population was perpetually excluded from this positioning.
Reconsidering Migrant Health: Anthropologists in Conversation with Public Health Paradigms
Presented at the 2015 Society for Applied Anthropology Annual Meeting, Pittsburgh, Pennsylvania.
Ethnographies of Migrant Mental Health in the United States.
Presented at the 2016 Society for Applied Anthropology Annual Meeting, Vancouver, British Columbia, Canada.