Must Reads: Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States

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Anita Chary

Anita Chary

Anita Chary, MD PhD, is an anthropologist and resident physician at the Harvard Affiliated Emergency Medicine Residency. She is Research Director of the non-governmental organization Maya Health Alliance | Wuqu' Kawoq, which provides health care and development services in rural indigenous communities of Guatemala.
Fresh Fruit, Broken Bodies

Fresh Fruit, Broken Bodies by Seth Holmes

 

The Global Health Hub recently began a new series called “must reads,” which includes books, academic articles, and items from the popular press.  The “must read” featured in this post is the book Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States by Seth Holmes, a physician and a professor of medical anthropology at the University of California Berkeley.  Holmes’s compelling ethnography concerns the health of indigenous Triqui farmworkers who migrate from Oaxaca, Mexico to California and Washington.

 

Triqui people face economic insecurity and political repression in Mexico, which drives them to leave Oaxaca to find work in the US.  Holmes crossed the US-Mexico border desert with a group of undocumented Triqui migrants and worked side-by-side with them on a berry farm in Washington and in vineyards of California. Fresh Fruit, Broken Bodies documents Triqui experiences of relentless physical labor and decrepit living conditions on the farm; the ways that race-, class-, and citizenship-based inequalities, both on and off the farm, manifest as their illnesses and suffering; and the struggles that migrants encounter when trying to obtain healthcare for work-related injuries.

 

Below is part of a conversation that I had with Holmes about some of the findings detailed in his book, as well as his reflections about migrant health, social inequalities, and economic policy.

 

 

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Undocumented Latin American migrants to the US are exposed to many hostile environments, when they are crossing the desert, living in sub-standard conditions, or engaging in constant physical labor.  What were the commonest health problems that came up among Triqui migrants you worked with?

 

The most common problems are things like back pain, knee pain, hip pain, and other musculoskeletal problems. Most people who work bent over, picking strawberries or doing other kinds of field labor and farm work, expect that after a certain number of years, they will have those kinds of musculoskeletal problems.  It’s almost something that people are resigned to.  The other things I saw that were relatively common were related to different degrees of pesticide exposure.  Some of the women had premature births or low birth weight babies. Things like that could have related to the strenuousness of the work, pesticide exposure, or both.

 

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What problems were the most salient to the farmworkers themselves?

 

In the book, I profile a few different farmworkers and their specific illness experiences.  One of them, Abelino, has a relatively typical knee problem: knee pain that develops from picking.  I describe how he experiences that, how his doctors and nurses respond to him, and what they understand to be going on.  I also write about someone with chronic stomach pain, and someone with chronic headaches that end up leading him to drink a lot of alcohol—the only treatment he could find that would work. I try to focus a fair amount on what the farmworkers’ experiences are and what the health professionals’ perspectives are, so that the reader gets a sense of both sides of the story.

 

How often do Triqui workers try to access the formal health care system?  And where do they typically turn for health care?

 

At this stage, they’re usually going to federally-qualified health centers, which include some health centers that are specifically oriented towards migrant health and may be called migrant health centers.  These usually have sliding-scale co-pays.  Most of the farm workers pay the lowest co-pay, because they make less than the minimum salary cut-off per year. But the farmworkers don’t go to access health care unless they need to, because even with the lower co-pay, it still feels like a fair amount of money to them, given that today, farmworkers in Washington state make an average annual salary somewhere around $8000.  And when I was doing my field research for this book, it was closer to $5000 to $7000. Even a co-pay of $30, or $20, is still a lot of money in that context. As well, most of the clinics are open during the day when the farmworkers are working, and they don’t want to give up a day’s work in order to go to the clinic.  Not to mention, it might actually be difficult for them to get permission to leave work to go to the clinic.

 

If workers end up getting permission to go to the clinic, and being able to pay the co-pay, what are the types of problems they run into within the clinical service?

 

One problem is related to language.  A lot of the farmworkers that I worked with speak indigenous languages, Triqui or Mixtec, and speak Spanish as their second language.  And most of the clinics and hospitals don’t have translators for Triqui or Mixtec.  The patient has to be speaking in their second language to someone who is interpreting from that language into English for a provider.  So they’re already a couple steps removed and there are possibilities for misunderstanding.  Some clinics and hospitals don’t have enough translation services in Spanish, so oftentimes, the clinic visit or the patient interview in the hospital happens without an appropriate Spanish translator.  It happens either with a relative of the patient, or the physician or nurse doing their best in Spanish, even if they don’t speak it very well.  So the language problems are difficult.  In addition, part of what I focus on in the book are some of the ways that in which science, as it is understood in the world today, especially in the West, and medical training, lead health care providers—even the best healthcare providers with the best intentions—to blame their patients for their sicknesses, in a subtle way, because providers tend to be trained primarily to consider biological causes of illness and behavioral causes of illness. And there’s a sense in which both the biology of the patient’s body and the behaviors of the patient are understood to be coming from the patient.  So the reason for the sickness is coming from the patient instead of being understood to be coming from the economy, society, social inequalities, or social hierarchies, etc.

 

In your book, you describe that some farmworkers have access to workers’ compensation for work-related injuries.  Could you tell me about how that system works?

 

Many states don’t allow farmworkers, especially migrant farmworkers, access to workers’ compensation, partially because they’re moving from state to state and partially because many of them are undocumented. In Washington state, one of the people whom I profiled in the book did have workers’ compensation for a time, which covered his medical care expenses, but in the end, his workers’ compensation was terminated because he migrated out of state.

 

From your descriptions in the book, many of the Triqui’s injuries result from occupational hazards, but obviously, they can’t stop working if they want to keep earning wages.  As health care providers, we tend to feel a bit powerless about those sorts of situations.  What would be your advice to health care providers trying to work with these populations and trying to address their work-related injuries?

 

Part of my advice is that we should update our medical training system so that all physicians and nurses get more education in analyzing social issues, social inequalities, and how social determinants of health are affecting their patients.  So that when they are seeing their patients, they’re not only thinking, as I said before, of biological or behavioral issues that might be understood to be coming from the patient—in other words blaming the patient for their illness.  Another thing that some social scientists have written about is the way in which healthcare providers have a certain kind of moral authority to speak out on social and political issues in society from the health perspective, and how those issues affect people’s health. I would encourage healthcare providers not only to interact with their patients in a way that acknowledges these social issues and social inequalities, but also keeps in mind ways in which they as healthcare professionals can have a say in social change, societal change, and political change that affects the health of their patients.

 

You describe that Triqui migrants often return to Oaxaca when they are too sick to continue working.  What does life look like for older return migrants?

 

A lot of them are living back in their ancestral lands with extended family, and a lot of them are being taken care of by extended family who are there.  In my experience, a lot of elderly people will help take the goats or the oxen to pasture each day, but won’t work as much in the direct farming, in terms of planting and harvesting corn in Oaxaca.

 

In the conclusion of the book, you advocate for broader political changes that need to occur to guarantee better health for vulnerable populations like Triqui migrants.  Where do you think a good starting point for advocacy would be?

 

First, I am convinced we need to support fair and truly comprehensive immigration reform.  Another important place to consider getting involved is transnational and international economic policy—for example, the North American Free Trade Agreement [NAFTA], but also the Central American Free Trade Agreement and other such international economic policies.  NAFTA, which was signed into being in 1994, outlawed the possibility for the signatory countries to tax goods from the other signatory countries.  But it did not disallow subsidies, such that the relatively wealthy country, the United States, was able to increase corn subsidies by over 300% since NAFTA was signed, whereas Mexico, the relatively poorer country, was not able to increase any subsidies during that time.  Mexico was not able to enact tariffs to protect itself. Part of the reason that Triqui people are migrating to the United States is because they can no longer survive by selling the corn, beans, and greens that they grow on their family farms in Oaxaca, because corn from the United States is underselling them in their nearby towns.  So if there were a way for NAFTA and other economic policies to be renegotiated in such a way as to avoid forcing a large population off of their own farms in order to cross dangerous desert and then to work as wage laborers on other farms, that would be very important.

 

There are currently no provisions for immigrants in the Affordable Care Act.  How do you think this will affect migrant health and the health system across the country?

 

That’s a great question. A lot of us are waiting to find out what will happen for immigrants, especially undocumented immigrants and farmworkers, with the Affordable Care Act.  There are many things about the Affordable Care Act that are very important and helpful, in terms of broadening health care access and health care coverage for larger populations in the United States, but it’s still unclear at this point how the Affordable Care Act will affect undocumented immigrants and migrant farmworkers.

 

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