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Introduction

  1. Top of page
  2. Introduction
  3. Effects of Attrition
  4. Stigmatized Spaces of Exclusion
  5. Destabilizing Family Life
  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References

As of the writing of this paper, the U.S. Senate passed a hotly debated, deeply partisan, and long overdue immigration reform bill currently stalled in the House of Representatives. Whether Congress passes it and in what form remains to be seen, but while the main sticking point is the “pathway to citizenship” for the approximately 11 million unauthorized migrants, dramatic increases in policing and militarized enforcement are certain — the bill as it currently stands includes 25–30 billion dollars for border security, 20,000 more Border Patrol agents, and an additional 700 miles of border fence. In the two decades running up to this attempt at reform, what emerged was a punitive approach to immigration enforcement that many have called a “deportation regime” (De Genova and Peutz 2010) focusing on the criminalizing of unauthorized migration using federal, state, and local resources to “govern immigration through crime” (Dowling and Inda 2013). Taking the point of view of health-care providers who work directly with migrant farmworkers, this paper assesses their perceptions of the effects of this increased “interior border policing” on the health and health-seeking behavior of their clients.

The East Coast Migrant Stream Forum is a regional conference given by the North Carolina Community Health Center Association (NCCHCA), and funded by the Health Resources and Services Administration, Bureau of Primary Health Care (BPHC), and Centers for Disease Control and Prevention, and has been held annually since 1988. Bringing together health-care providers, outreach workers, and frontline staff employed by Federally Qualified Migrant and Community Health Centers dedicated to improving health outcomes and health-care delivery to migrant and seasonal farmworkers and their families along the east coast, the forum shares information about clinical trends, models of service delivery, recent medical research, and legislative and funding initiatives. The five questions below were taken from a qualitative survey developed by the Regional Migrant Health Coordinator for the Mid-Atlantic working with a student group from the UNC-Chapel Hill School of Public Health. A follow-up to a survey given to the 2012 attendees of the forum, it was distributed to migrant health centers (MHC) along the east coast.

The answers (with the outreach worker's state abbreviation in parentheses) are firsthand observations of how anti-immigrant legislation, police enforcement, and public sentiment present increasingly difficult challenges to the delivery of health care and medical service to this special population group. In addition, several open-ended interviews were done with providers in eastern North Carolina. Key concepts from critical medical anthropology and immigration studies inform our discussion of the “environment of fear” described by survey respondents and interview informants.

Effects of Attrition

  1. Top of page
  2. Introduction
  3. Effects of Attrition
  4. Stigmatized Spaces of Exclusion
  5. Destabilizing Family Life
  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References

Question #1: Do you think that recent anti-immigration laws have affected the health-seeking behaviors of migrant workers? If so, in what ways has it affected things such as scheduling appointments, attending community health events, or visiting your clinic?

The answers below reflect how anti-immigrant public sentiment, laws, and enforcement agreements are responsible for fear and anxiety among both MHC staff and the communities they serve. A predominant concern is the risks that immigrants take when traveling to receive health care and medical treatment, and to attend community events staged by health centers. When fear of deportation causes farmworkers and their families to delay seeking care and avoid health fairs and other means of regular screenings, the result is an increase in the severity of health problems, which in turn leads to more costly emergency department visits. Farmworkers are now less likely to seek treatment for injuries and to receive important vaccines, which present risks not only to their own health but to the health of the entire community.

The current anti-immigrant sentiment, laws and immigration agreements are creating fear among both providers and community. On the one hand providers are afraid of being punished for providing care and resources to migrant workers. They are not attending free health events, following up or scheduling appointments, or seeking care for their loved ones. Both providers and community are receiving wrong messages regarding local laws and immigration agreements. (NY)

Most immigrants don't seek medical attention due to fears of giving their personal information, especially their address, where they can later be found and possibly deported. This has led to increased visits to local hospitals instead of seeking regular medical care at local health clinics. I also noted a fear of appearing at public places such as health events due to possibilities of deportation. At some of these events local police and fire departments are invited that particularly increase their fear to attend. (NC)

Such changes in behavior are the outcomes of a wider strategic policy stance against undocumented immigrants. In tandem with detention and deportation, in the last decade a “theory of attrition” emerged among restrictionists and nativists, proposing that people will “self-deport” if the “social safety net” is removed (NC Policy Watch 2007; O'Leary and Sanchez 2011; Su 2013). Proponents hold that even if it is impossible to remove every undocumented immigrant from the country, “a serious and concerted effort to effectuate enforcement would convince many to leave rather than live in constant fear of detection (Su 2013:1381).”

People are afraid to be traveling, so they prefer not to visit the centers if they don't need it. (NJ)

The inability to get a driver's license makes getting to appointments or community health events almost impossible without outside interventions. (NC)

Many workers don't want to travel or drive if they have a car from fear of being pulled over. (VA)

People are scared to drive through SC, GA and AL to reach Virginia for work. They are more reluctant to drive to medical appointments out of fear of being stopped for license checks. (VA)

As the last comment shows, such fears restrict mobility between states with varying degrees of hostility toward migrants. Alabama, Georgia, and South Carolina passed copycat versions of the controversial 2010 Arizona SB 1070 law. In the neighboring migrant stream state of North Carolina, similar legislation was introduced, an effect that the social justice organization North Carolina Council of Churches deemed “the spread of toxic immigration laws (North Carolina Council of Churches 2011).”

After the Arizona law was shown to violate the rights of both citizens and noncitizens alike by intruding on the normal functioning of everyday life (Sáenz et al. 2011), the Supreme Court threw out three provisions in it while keeping the dangerously nebulous “show me your papers” requirement. This allows state police to check the status of an individual stopped, detained, or arrested if there is “reasonable suspicion” that the person is in the United States illegally. Perhaps emboldened, North Carolina legislators renewed discussions of new restrictionist legislation shortly thereafter.

Over the past several years in North Carolina, the restrictionists' attrition strategy entailed stepping up raids and pressuring for increased federal, state, and local cooperation. More than in any other state, local law enforcement agencies, primarily county sheriff's departments, entered into Memorandums of Understanding with the Department of Homeland Security via the 287(g) “Delegation of Authority Program.” Through this program, they agreed to take on the added responsibility of enforcing federal immigration law in the course of their daily efforts to serve and protect their communities.

It is important to note that even in states and counties where anti-immigrant laws have not been passed, there is still much anxiety among those who reside there. This is due in part to the fact that residents regularly travel across county lines and are uncertain as to where the legislation and agreements have been put into effect. News reports and information spread by word of mouth are not always reliable, and because of the mobility that is required of migrant farmworkers there is much confusion about what laws apply at the location where they are currently working and living. Such confusion serves and enforces the theory of attrition.

We are a 287g county so people are afraid of being pulled over and for good reason. Traffic stops leading to deportation are not uncommon. And roadblocks for license-checks are also common. So people try to limit the number of appointments they go to and the distance they drive to get to them. They are more hesitant to go to specialist appointments when necessary. I think this does also affect turnout to our community events. (NC)

A number of studies critiqued the “costs and consequences” of this controversial program as neither efficient nor effective. It was a drain on local budgets, captured few violent criminals, impeded policing efforts by eroding community trust, and had insufficient oversight for preventing abuse (American Immigration Council n.d.; Nguyen and Gill 2010). A small scandal erupted when it came to light in February of 2013 that internal Immigration Customs Enforcement (ICE) e-mails from April 2012 suggested that ICE was encouraging the use of apprehension quotas to boost their deportation efforts in Georgia and the Carolinas (Rosenthal 2013). Some high-profile ICE arrests at police checkpoints continued to draw attention and opposition in the state, and in September 2012 ICE suspended the program in Alamance County after a Department of Justice Investigation showed a pattern of discriminatory policing against Latinos. Racial profiling occurred while officers were attempting to increase the number of deportations of undocumented immigrants (United States Department of Justice 2012). In response to increased scrutiny and criticism nationwide after the Arizona ruling, the Obama administration began phasing out the 287(g) agreements with the remaining ones set to expire.

Difficulties have increased at the camps, stemming from migrants' suspicions and farm owners' obstruction of health-care delivery. In interviews, it was noted that in North Carolina, growers were less willing than ever to disclose the location of their workers to medical centers and health departments.

We have found this year when entering a camp and there are mostly new migrant workers, some have run from us, others are extremely hesitant to talk with us and it took a real effort to show them that we were there for them and not from the government. There were fewer patients who came into clinic this year. (PA)

Interviewees identified wide-ranging practices and attitudes of commercial growers. Lack of transparency and inadequate regulation in this shadowed market for labor create inconsistency of access to health care and protection from risk. Along with confusion regarding immigration law and the unpredictability of enforcement actions, this adds up to a heightened sense of uncertainty that produces severe consequences for health and well-being. There is an emergent literature in anthropology that addresses such processes of prolonged insecurity as structural features of late capitalism. In 2013, a year in review article in American Anthropologist and a “virtual edition” of the Anthropology of Work Review highlighted anthropology's critical interest in the concept of “precarity” — defined by Muehlebach as “multiple forms of nightmarish dispossession and injury that our age entails” (Muehlebach 2013), embodied in the lived experience of subjects facing “increased economic uncertainty; the loss of state and corporate provisioning, threats of violence, marginalization, and injustice” under processes of globalization and policies of neoliberalism (Lyon 2013).

While unauthorized farmworkers subject to the destabilizing and unpredictable effects of the deportation regime need these providers more than ever to help them navigate the precariousness of their daily lives, gaining and maintaining trust in this environment of fear and hostility is more difficult than ever. Here, we might describe anxiety compounded by “immobility” or restricted movement in an increasingly hostile setting. As Portes points out, traditionally, for those groups with access to citizenship status “working-class migrant communities effectively disappear with the occupational and residential mobility of the second generation,” but for Latino farmworkers, racism and strong structural forces, including a militarized border that makes it too dangerous and costly to cross freely, labor is bottled up, reproduced in marginal areas, and highly vulnerable to prolonged neglect, exploitation, and mistreatment (Portes 2008:22).

The effects of the theory of attrition manifest in a number of ways that make life uncertain and dangerous for migrant workers. The health impacts of uncertainty, confusion, and the arbitrary wielding of state force — an example of Foucault's “negative biopower” or the “disallowal of life” (Foucault 2003:241) through institutional stigmatizing and moralizing discourse on and treatment of a social problem — offer an opportunity to link concepts from critical medical anthropology with biomedical understandings of the bodily experience of subjects. The study of the negative health consequences of chronic stress related to social inequity is a robust field in biocultural approaches in medicine and medical anthropology (McEwen 2002; Wiley and Allen 2013:307–338) In biomedical terms, a correlation between increased “allostatic load” — the cumulative insults on vital body systems induced by persistent physiological adaptation to stressors — and undocumented status as a result of the traumas of border-crossing and living with the fear of deportation has been demonstrated for both undocumented immigrants and the “unhealthy assimilation” of their legal counterparts (Holmes 2013:101; Kaestner et al. 2009; McEwen 1998, 2002; McGuire and Georges 2003).

The psychological, as well as the material, toll that “interior policing” efforts, such as workplace raids, have had on families is devastating and well documented (Capps et al. 2007; Dowling and Inda 2013:20–21). Aggressive complicity between federal and local authorities produces a widespread and intense feeling of deportability among individuals throughout the wider community. It has been shown that while there is much variation in terms of actual risk, anxieties about and memories of deportation circulate throughout households regardless of status, and are internalized by their members, thus rendering deportability a powerful presence in the daily lives of unauthorized and authorized migrants alike (Quesada 2011; Talavera et al. 2010). This final provider shows concern that increased stress over immigration enforcement is a problem in the daily lives of clients regardless of their legal status.

Even those with documentation and driver's licenses are experiencing higher levels of anxiety. The overall chilling effect is wide ranging. (VA)

Stigmatized Spaces of Exclusion

  1. Top of page
  2. Introduction
  3. Effects of Attrition
  4. Stigmatized Spaces of Exclusion
  5. Destabilizing Family Life
  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References

Question #2: Have any of your clients voiced opinions or concerns about recent anti-immigration laws? If so, can you describe some of the opinions and/or concerns that you have heard?

Soliciting providers' input on what farmworkers have told them about the current immigration climate, these questions drew similar responses as Question #1, with migrants expressing anxieties associated with traveling. While there was much press covering the labor shortages that states such as Alabama and Georgia experienced after passing the most aggressive laws, it is important to recognize the effects of these laws on the well-being of people crossing “borders within borders.” Without reform and a unified federal policy, there is a contagion of the effects of laws that place immigrants in harm's way.

A provider in SC stated that since the enactment of local 287g agreements many migrant workers are leaving the state … A community leader from Houston, Texas said that since the Alabama immigration law was approved, he sees an increased number of migrants settling in Houston to save their families from harassment and potential deportation. The families stated that while driving to TX those were the most disturbing hours praying not to be caught on the road. (NY)

Driving and fear of being pulled over or deported is widespread and children are severely impacted by the anxiety experienced by their parents and extended family. (NY)

Farmworker health issues are not simply indirect consequences of a lack of protection. They are created and intensified by the state's “selective enforcement of the border” and the corresponding regimes of neoliberal economic policies on both sides (Gibler 2012; Robinson 2012; Weaver et al. 2012). The “seemingly insatiable demand for (and supply of) immigrant labor” from Mexico and Central America benefits from “closed” border policies that “generate inequality by assigning illegal status to a segment of the global labor force” (Gomberg-Muñoz 2011:34). It is not surprising that such contradictory arrangements create such unequal risks. Migrants are uniquely positioned to experience and identify these systemic structures of inequality as racist ideology, which naturalizes the risks they face because of the shadowy societal segment to which they are relegated.

Many feel that they aren't really being pulled over for traffic violations but more or less for being Hispanic. (VA)

Most voice questions as to why the immigration laws seem to be so against the Hispanics. I heard one migrant say — “Why do they hate us so much. We work for them.” (PA)

The fusion of criminal and immigration law that promulgates a fiercely punitive position toward immigrants — which Stumpf deemed “crimmigration law” — has rendered noncitizens recognizable by race and social class in ways that exclude them from mainstream social life (Stumpf 2006) This approach emerged from the post-9/11 narrative in which protection of the homeland began to structure immigration regulation to the point that unauthorized migrants were seen as dangerous threats to national security (Chácon 2008). Militarized border enforcement of citizenship status reaches across and into the homeland as a surveillance and detention system that identifies “criminals” while increasing their utility to the Homeland Project. Such identification marks and stigmatizes.

Some don't understand why there is so much hostility towards them since all they want to do is work to support their hungry families. Some immigrant teens have expressed that they are stuck between a rock and a hard place since they were brought here as young children and the US is all they know but yet are denied access to having a driver's license, work, education and health care. It has also affected many families emotionally, I see more and more men admitting to sadness, anxiety and depression due to difficulty in trying to support their families. (NC)

These comments deserve elaboration. Under the federal Deferred Action for Childhood Arrivals program, deportation is now blocked for and “legally present” status is given to young immigrants who meet certain criteria. They are eligible in most states to obtain documentation required for obtaining a driver's license. (ICE n.d.; National Immigration Law Center 2013). In March 2013, after much opposition, North Carolina dropped a plan for a special license with a vertical design and bright pink stripe (dubbed a “scarlet letter” by immigrant advocates), which the American Civil Liberties Union of North Carolina feared would “create possible avenues for harassment, discrimination, and stigmatization” (ACLU-NC 2013). Young people across the state expressed anger and frustration with this proposed mark of racialized criminality that would stain a legal document created to address one of the impossibilities of the precarious life.

Stigma, like race, is a social construction that generates specific meanings in specific places. Racism, the stigma of illness, and the stigma of the “immoral” or “illegal” activities of marginalized groups often work together as obstacles to treatment in the form of victim blaming or rationalized inattention to a public health issue (Bourgois and Schonberg 2009:16, 172, 298; Farmer 2006:xii–xiii; Holmes 2011; Horton and Barker 2009, 2010). Providers targeting special populations have to overcome the “site effects” (Bourdieu 1999:123–129), in which “environments of risk” (Nichter 2008:112) are stigmatized social spaces of exclusion. Agonizingly long-delayed reform in immigration policy casts scrutiny regardless of legal status. In response to the liminality of incomplete citizenship described to her in the “Here, Not Here” stories of her informants, Boehm coins the term “citizen alien” (as a counter to the legal category alien citizen, a citizen by virtue of birth in the United States) for those whose contributions are vital, yet whose membership is limited by obstructed access to social services and restriction of movement (Boehm 2011:136–138).

Khosravi develops the concept of the “border gaze” to describe his experiences as a stigma-bearing Iranian refugee seeking asylum in Europe and as an exile living in Sweden. Not operating through a “simple function of exclusion,” the border gaze of essentializing institutional scrutiny and suspicion does not see immigrants as individuals but “reads them” as a “type.” Placing immigrants in a liminal indeterminate space, they are given little chance to develop a sense of belonging, yet are nonetheless expected to participate in social life. In our case, indeterminacy is created by the current broken immigration system, yet workers continue to be recruited and sustained by the demands of commercial agriculture. “Included without being members,” Khosravi writes, the lives of “undesirable immigrants” are imperiled by a xenophobic gaze that “is not an innocent act of seeing but an episteme — Foucault's term for an authoritative body of knowledge — determining who/what is visible and invisible” in ways that are “forceful, formidable, and sometimes deadly.” (Khosravi 2011:75–76). The zero-sum game of a “biopolitics” that positions the health and safety of the racially unmarked privileged segment against the vulnerability of stigmatized “unworthy” outsiders takes many forms (Foucault 2003:255; Lemke 2011:42). Indiscriminate immigration enforcement tacitly supported or directly promoted by hostile societal sentiment and public policy renders the formidable and sometimes deadly consequences of inadequate medical treatment “understandable” at the least, and under the most brutal applications of the theory of attrition excusable or even warranted.

Destabilizing Family Life

  1. Top of page
  2. Introduction
  3. Effects of Attrition
  4. Stigmatized Spaces of Exclusion
  5. Destabilizing Family Life
  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References

Question #3: Have you witnessed any changes in the health conditions of the migrant families you serve since the passage of recent anti-immigration laws? If so, can you describe the changes you have seen?

There is a dangerous tendency to conflate the denial of health and safety under a radically exclusionist immigration environment with the accepted risks and vagaries of undocumented and inadequately regulated farmwork. There is also a need to avoid reducing “breakdowns in public health tied to broader political decisions about health” (Lock and Nguyen 2010:102) to the personal choices and cultural perceptions of farmworkers. Overemphasis on the “cultural competency” of providers to deliver health messages and medical attention to special target populations has been effectively critiqued by medical anthropologists who focus on structural factors of poverty and powerlessness as root causes (Bourgois and Schonberg 2009:305–306; Farmer 2001:257; Kleinman and Benson 2006; Lock and Nguyen 2010:8–9). The providers' answers show that they are cautious to avoid monolithic “cultural-barrier explanations” about delayed care, disinterest in preventative health, or inattention to illness. Such representations would reify their clients' health-seeking behavior as, in the words of Nichter, “both stagnant and somehow juxtaposed to the modern” (Nichter 2008:7).

I have noticed that more workers are saying that they are going to wait to care for their medical needs until they return to their home countries. These conditions include but are not limited to chronic conditions that need to be dealt with in the present, not in months. (NC)

Internalized stereotypes about strong bodies and propensity for hard work serve many functions. These identities (1) help migrants position themselves within the market for agricultural labor, (2) make them more vulnerable to exploitation and associated ill-health, and (3) reproduce the racist ideology behind these “naturalizing principles” that normalize risk (Duke 2011; Gomberg-Muñoz 2011:34–36; Holmes 2013:172–173). Holmes has called for the application of Metzl's “structural competency” concept (Metzl 2011) in the training of medical educators in the social analysis of “the continuum of violence located in ethnic and citizenship hierarchies and international policies that place their patients in injurious conditions in the first place” (Holmes 2013:153). The ripple effects of policies of attrition on family life, especially mixed-status households, are becoming well documented in the anthropology of immigration (Boehm 2011; O'Leary and Sanchez 2011). The respondents confirm that decreased medical attention is one such effect.

Family members have gotten deported which leaves fewer resources to care for the health of remaining family members, makes it harder to provide for the family, and has had mental health consequences. (NC)

The expulsion of family members from the country means that those left behind are at greater risk. This risk is in turn exacerbated by failures in the delivery of services due to heightened concerns over legal status. Anti-immigrant laws negatively impact the mental, physical, and social well-being of children. The increase in depression, anxiety, substance abuse, and domestic abuse that has been reported by health providers serving farmworkers severely impacts the health and development of children.

A licensed clinical social worker in North Carolina described treating three children who had been severely traumatized when their mother was detained because of her immigration status. Although these children had been born in the United States, their health and well-being were negatively impacted by the separation from their mother. Parents and children live with the constant fear of having their family torn apart, and many worried parents often will not allow children to leave the house for fear that they will be detained by immigration agents. Not allowing children to go outside and play decreases their activity levels and contributes to the growing epidemic of childhood obesity.

The fear and isolation experienced by many mixed-status families often present a barrier to enrolling children who are U.S. citizens in programs for which they are eligible. The 2011 Universal Data System data for North Carolina CHCs showed that 35 percent of the children they serve are uninsured (BPHC n.d.:5). The NCCHCA conducted a survey of patients, providers, and staff, and found that one of the main reasons for children remaining uninsured despite being eligible for Medicaid was because their parents were undocumented, and were either scared of enrolling their children in Medicaid or were not aware that their children are eligible. This is especially concerning due to the current efforts of outreach and enrollment for the Affordable Care Act. By 2016, 70 percent of CHC funding will be reduced in anticipation of more patients being insured (National Association of Community Health Centers n.d.) This will leave very few resources available for patients who remain uninsured, and it will be even more difficult for children of undocumented immigrant to receive the health care they need.

increased anxiety and depression, more difficulty in accessing specialty care and hospital indigent programs that now consider undocumented people ineligible for charity programs. (VA)

It has become increasingly more difficult to get patients on emergency medical assistance in the state due to their status. (PA)

Deportations and detentions reduce resources, both material and emotional, making it more likely that those left behind will have illness go untreated and experience new or increased forms of suffering. The term “pathogenic law enforcement” has recently been used by Bourgois and Schonberg to critique the way that policing activities destabilize lives and bring about negative health outcomes for those in society who have been marginalized to the point of invisibility (Bourgois and Schonberg 2009:111–113). They also identify the “iatrogenic pathology” of some institutional encounters that amount to punitive violence against those whose illness is framed by a moralizing discourse that stigmatizes the poor as criminals in a hostile political climate and an era of declining state budgets (Bourgois and Schonberg 2009:100–106). While Bourgois and Schonberg's ethnographic community is the urban homeless, workers in the migrant stream experience many of the same legalistic impossibilities, and the responses here demonstrate that these terms have analytical potential in the study of the disproportionate health risks that migrant farmworkers face.

In our case, pathogenic immigration enforcement and iatrogenic pathology are products of increased susceptibility to suffering located in the syndemics of militarized border enforcement that places roadblocks, both physical and mental, between migrants and the health providers who strive to reach them. Syndemics are mutually reinforcing sets of synergistic health, environmental, and social problems encountered by specific populations (Nichter 2008:157–158; Singer 1996; Singer and Clair 2003). In the field in which these providers operate, the interactions of factors include the availability of services, transportation problems, limited education, isolation, high transience, language barriers, and confusion, along with the specific destabilizing tactics of the attrition theory enforcement and the general fears and anxieties of apprehension, detention, and deportation.

As Jing shows in an example from China, migrating agricultural labor critical to national and regional economic development yet excluded from social services entails a “pathological confluence” of “ideologically sustained” syndemic factors that forms a reciprocal, rather than causal, relationship with illness and disease (Jing 2006:536). Cartwright recently explored the immigration system itself as a powerful pathogen in the syndemics of the ill-health of Latino agricultural workers in western United States (Cartwright 2011). In contrast to the politically neutral public health language of risk, Smith-Nonini specifically identifies the systemic risks of the dynamics of neoliberal politics, citizenship status, and corporate agriculture that shape migrant vulnerabilities (Smith-Nonini 2011). In the examples described by our providers above, deportation of income earners increases illness and anxiety, and restricted access to health care makes it more likely that such suffering will go untreated in a vicious circle that is sustained ideologically in states in which it is politically profitable to enact strict anti-immigrant laws against workers whose labor is of vital importance.

Orders of Risk and Violence

  1. Top of page
  2. Introduction
  3. Effects of Attrition
  4. Stigmatized Spaces of Exclusion
  5. Destabilizing Family Life
  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References

Question #4: Have you seen any other changes in the migrant families you serve since the passage of recent anti-immigration laws? If so, can you please describe these other changes?

These syndemics can be conceptualized as part of a structure of power shaping the life chances of migrants and their families, throwing up obstacles to health and well-being while providing the cultural resources to adapt to these serious challenges. Paul Farmer's powerful concept of “structural violence” (Farmer 2001, 2004) has proven useful in understanding the particular health risks that put migrant, homeless, and transient populations in harm's way (Bourgois and Schonberg 2009:15–17; Jing 2006:536; Salazar 2009:170–171). Quesada, Hart, and Bourgois recently coedited a double issue of Medical Anthropology on “structural vulnerability and health” of migrant workers around the world (Quesada et al. 2011). Here, susceptibility to suffering is differentiated and mediated by a complex array of social arrangements that structure risk differently for individuals in different population segments. For Farmer,

(t)he 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 … neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress (Farmer 2001:79).

The historical and economic dimensions of the farmworker stream are to be found in the articulation of the development of commercial agriculture in the United States with the creation of labor surpluses in Mexico and Central America. This flow of labor has long been a “commodity chain” of neoliberalism (Greenberg et al. 2012:14) managed by migrant networks (Kearney 1998). More and more, social and kin networks that buffer risks for migrants are disrupted by hostile legislation and enforcement that breaks up and limits the movement of families.

Many of the regulars that come up to Virginia year after year aren't traveling this far north anymore. (VA)

There may be a trend toward less movement from site to site, less movement to and from countries of origin. (VA)

In Maryland we are getting migrants that would have otherwise worked in the more southern states. (MD)

As the responsibilities of the state are rolled back under neoliberal regimes of advanced poverty and institutional neglect, families shoulder an increased “burden of care” (Biehl 2005:22; Garcia 2010:9–10). Undocumented farmworkers occupy a position of economic precariousness in which family resources are critical, yet families are socially isolated by fear and torn apart by deportation relations with the state with regard to health shift from benign neglect to overt antagonism, an intensified form of structural violence.

I have noticed an increased feeling of insecurity and general isolation in the families. They often say “Oh I just come straight home from work, I don't go out anywhere else if I can avoid it.” (NC)

We are seeing an increase in unaccompanied adolescent workers and an overall shortage of labor. (NY)

Men are coming to New Jersey leaving their family in the other state afraid of immigration, so they prefer to travel alone. (NJ)

Such structural violence often precipitates violence within households. A number of studies have focused on the link between authorized status and women's vulnerability to domestic violence, as undocumented women, disconnected from traditional social ties and financially dependent on abusive partners, are often reluctant to get help (Boehm 2011; Gomberg-Muñoz and Croegaert 2012). Created in 2000, the “U Visa” program is an attempt to protect victims of crime (including domestic violence, sexual abuse, and human trafficking) by allowing them to remain in the country legally and one day apply for citizenship in exchange for assisting law enforcement with the investigation (U.S. Citizenship and Immigration Services n.d.). Capped at 10,000 per fiscal year, the good intentions of the U Visa program are subject to distortion under the current broken system, as the provider below reports:

There are a lot more families who are missing a family member due to deportation. There are a lot more cases of spouses claiming domestic violence in order to get U-visas. I am all for people denouncing violence in the home, but I have heard too many reports of claims that may be false–solely for the purpose of getting papers. (NC)

Bourdieu's concept of “symbolic violence” has been used extensively in medical anthropology to analyze the degree to which socially, economically, and politically marginalized people overemphasize and come to identify with their role in their own suffering (Bourgois and Schonberg 2009:17–18, 106–111; Holmes 2013:156–157, 193–184). When victims of domestic violence blame themselves for abuse or for putting themselves at risk, it is a manifestation of symbolic violence, a kind of psychic trauma in the wake of physical harm. When such allegations are falsified as a desperate attempt to acquire legal residence, both parties are victimized by a system that presents a traumatizing and disruptive action as a rational choice. To choose not to seek protection when it is needed or to choose to falsely accuse a partner are not choices that anyone should willingly make. They are acts of additional violence, insults to be suffered by individuals and their families.

In some ways, the extent to which false accusations leveled at family members in order to acquire U Visa status are actually happening is secondary in importance to the social suffering that makes it an option in the first place. Like refugees whose memories of violence are “made over into trauma stories (that) then become the currency … with which they enter into exchanges for physical resources and … status,” the appropriation of suffering and its reduction to a “core cultural image of victimization” entails the rewriting of social experience in terms that are useful to the system and the professionals working within it (Kleinman and Kleinman 1997:9–10). Through interference and the contradictory effects of national policies, the state intrudes into what Boehm (2011) calls the “intimate lives” of migrants. Turning inward to protect themselves (“covertness as a response to risk” [Talavera et al. 2010:167]), migrants forgo police protection, put off the treatment of illness, and experience high degrees of anxiety as a result of the rumors of immigration raids (Foxen 2007:115–116). To extend trust is to make one's self vulnerable, as the respondent states here and as other providers will elaborate in the final question.

It is impacting the levels of trust towards community based organizations and health centers. (NY)

The Interior Border Spectacle

  1. Top of page
  2. Introduction
  3. Effects of Attrition
  4. Stigmatized Spaces of Exclusion
  5. Destabilizing Family Life
  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References

Question #5: In what ways (if any) have recent anti-immigrant laws affected your staff or the way you do your job? For example, have these laws had any effect on staff morale or day-to-day operating procedures?

A number of analysts have described the process by which the theater of “the Border Spectacle” provides the staging ground in which ambivalent immigration practices (restrictionist law coupled with the tolerance of unending importation of unauthorized labor) render a racialized Mexican and Latin American migrant “illegality” visible, and produce the commonsense understanding of migration as a “loss of control” to be policed by progressively militarized means via the state or by paramilitary vigilantism (Chavez 2008; De Genova 2004; Rosaldo 1997). The resulting “Funnel Effect” in Arizona (Reineke 2013; Rubio-Goldsmith et al. 2007), the increase in migrant deaths in the desert — even when crossings as a whole were in decline — is the lethal outcome of this show of force. For Doty, the geographic space of the desert gives a “moral alibi to shun official responsibility for migrant deaths” and is a key element of “prevention through deterrence” border control policy, the logic of which not only assumes the possibility of death but would be meaningless in its absence (Doty 2011). There is a similar unmerciful logic operating in the east coast migrant stream as the shift toward interior border policing forces immobilized, unauthorized farmworkers into a “space of non-existence” — contradictory physical and social presence combined with legal absence (Coutin 2000; Horton n.d.).

One outreach team member had ICE show up at her home. This has heightened awareness for staff and increased our education efforts for patients around what to do if they are stopped. (NY)

We had one raid by ICE at one of our large camps in October. They entered the camp with weapons and bullet proof vests. They carried off fifteen men. Some were able to return but the other are being deported. This of course had a terrifying effect on the wives and children and also the growers. It made our staff, particularly myself so very angry. For me this whole thing is a “vergüenza nacional” (national disgrace). (PA)

Checkpoints and raids, as spectacles of the state, perform what Goldstein (via Foucault's concept of spectacle as “an organized ritual” that “marks and punishes” [Foucault 1977:34]) terms the “pedagogical function of spectacular violence” (Goldstein 2004:25). In coupling the security and well-being of citizens with the insecurity and vulnerability of immigrant workers, these arbitrary public expressions of state power serve to instruct and enforce by destabilizing families and diminishing the quality of lives of those carrying the burden of noncitizen criminality. Migrants learn to fear interactions with all state agents, even those whose mission is to deliver health care and not to enforce citizenship laws. In outlining the contours of the “Spectacle of the Securitarian State,” De Genova (2013) includes such “uncertainty (and) ambiguity” as “hallmarks of our political present” (De Genova 2013:213). These comments show that the effects of this intimidation are felt by providers as well as the commercial growers, who learn to avoid scrutiny and confrontation through inaction or obstinacy.

The sense of being powerless, due to protocols impeding us to advocate for fair and humane immigration policies. (NY)

They [the laws] make finding specialty care for my patients much more difficult. (VA)

The morale is affected by the noncompliance of farm owners who are afraid of the consequences of government persecution for hiring undocumented people. (NJ)

It was reported that ICE targeting of patients has even included setting up checkpoints between agricultural fields and health centers, and establishing an intimidating presence at clinics, something that is explicitly not allowed by law. In the absence of reform and a coherent immigration policy, subjects occupying different positions in the migrant health delivery system experience and internalize the disciplinary effects of capricious punitive enforcement. Raids, detentions, and deportations are unpredictable but significant disruptions that foster precarious circumstances and apprehensive feelings. Individuals avoid medical attention in the same way that undocumented crime victims are conditioned to avoid the attention of the police. The shadow that Homeland Security casts over the daily lives of migrants, whether rumor or reality, generates an “automatic functioning” surveillance that is in the panoptic sense “everywhere and unverified” in which uncertainty, as Boehm says, is the result of “widespread efforts that often seem, oddly, disparate or even disorganized, and yet are highly orchestrated” (Boehm 2011:149).

Despite this, providers are adapting to these challenges. They are motivated by these uncertainties to educate themselves, their cohort, and their clients about immigration policies and practices through information networks. Uncertainty inspires resourcefulness that requires an expansion of the health-care mission in order to deliver attention to this special population under these extreme circumstances.

I try to inform myself about the laws, and pass the information to them, but if they have questions that I can't really answer I refer them to local organizations in my area, or we work together with this organization in events to inform the community. (NJ)

No changes. Our staff is willing and ready to serve our farmworkers at any time! We are a team and as the coordinator I keep them informed and/or clarify any issues that will come up in regards to immigration news. (SC)

Our Latino Outreach Program staff members stay abreast of the laws/political arena in order to anticipate any barriers to care that might arise as a result. (VA)

As an outreach worker I have come to have more compassion for the situation they face on a daily basis. It is not easy living in fear every day. This has allowed me to increase knowledge within the clinic employees to inform them of their daily struggles so they better understand their situation. One example is transportation difficulties, if an immigrant patient arrives to be seen we have to understand that financially it was already a burden to get there and that they possibly had no license and so took a risk to get to our office in the first place. Taking these matters into consideration allows our staff to see how we can accommodate the patients to be seen at that moment. (NC)

The heightened empathy and compassion described in the eloquent reply above is an inspired response to the dehumanizing effects of the theory of attrition. Frontline providers develop a greater appreciation for the everyday struggles that migrants face in acquiring necessities of social life that citizens take for granted. Becoming more attentive to the needs of clients living under the current regime of immigration policing is only one part of delivering effective health treatment and messages, as this other respondent from North Carolina explains:

One change is how I have to introduce our program to new families. With the increased distrust for outsiders and fear of being detained my job is more difficult. It takes longer to build trusting relationships within the migrant population. Although my focus is the health of the community, people unfamiliar with the program are wary to trust that we are not out to verify documents before we will help them. (NC)

Providers work long and hard to foster relations of trust, the key to any successful outreach. Trust is difficult to establish and maintain among a subset of the population that is transient, has high turnover, and is reticent toward figures of authority to begin with. The training of trusted and respected community members as outreach workers is a cornerstone of the “new public health” that aims to overcome social, economic, political, and cultural obstacles in reaching marginalized target groups. As intermediaries between farmworkers and local health-care facilities, community health providers (CHPs) and lay workers, or promotores, have long been shown to be successful and integral parts of migrant public health networks and specific intervention campaigns (Eng and Young 1992; Reinschmidt et al. 2006; Weaver et al. 2010). The final quote reveals that providers must now not only worry about the health risks that clients face but the elevated risks for their own workers who are crucially important to their program.

One patient was pulled over on his way to the clinic where he was to be treated for a serious thyroid condition. Our CHP program may be restricted in order to protect our volunteers from risk. (VA)

For the most part, because of the sensitive position they occupy, health center personnel must walk a fine line between advocacy and political activism. Although federally qualified health centers recognize the importance of serving all patients in a community, most are reluctant to engage in the volatile political climate surrounding immigration reform. One exception has been the California Primary Care Association (CPCA) President and CEO Carmela Castellano-Garcia, who is a vocal advocate for immigration reform. While praising President Obama for his leadership on the issue and his support for the pathway to citizenship, in a recent issues statement she expressed disappointment that

(t)he President's plan continues to uphold barriers in current law and states that “people with provisional legal status will not be eligible for welfare or other federal benefits, including subsidies or tax credits under the new health care law.” This will continue to bar those working toward citizenship access to expanded … coverage or the ability to participate in (programs). Any comprehensive immigration reform must include provisions extending health care coverage to individuals who are now unfairly denied access solely due to immigration status. (CPCA 2013)

Like many of our survey responses, Castellano-Garcia goes on to frame this call for action within the inclusive spirit of the public health mission. This serves as a counter-message to the divisive biopolitics informing the climate of fear and exclusion we have analyzed here.

The health of immigrants impacts us all. They are our neighbors and members of our community. We will never have true health care reform or comprehensive immigration reform until all individuals have access to affordable health care coverage. (CPCA 2013)

Conclusion

  1. Top of page
  2. Introduction
  3. Effects of Attrition
  4. Stigmatized Spaces of Exclusion
  5. Destabilizing Family Life
  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References

In the last decade, much work on the current “deportation regime” has been inspired by De Genova's writings on migrant “deportability.” The effectiveness of the militarized border, restrictionist immigration law, and punitive enforcement has come to be understood not in terms of the numbers of deportations but in undocumented workers' expanded and prolonged susceptibility to being deported. In this way, migrant illegality is seen as more than a precarious juridical status, but in conjunction with other vulnerabilities (such as heightened risk for illness and injury) serves the practical, material outcome of rendering unauthorized migrant labor a uniquely disposable commodity (De Genova 2002, 2010; Peutz and De Genova 2010). Maira has written about this as the “neoliberal logic” of deportation in which threat of expulsion ensures a docile workforce and is necessary for disciplining labor and depressing wages (Maira 2010). (See Ong [2006:6] on the neoliberal state's reliance on this “biopolitical mode of governing” in which “spatial practices that engage market forces” serve global competitiveness and productivity). One of the primary goals of the outreach provider, then, is to convince growers that it is in their best interest to protect and provide for their workers' health and well-being. While there is much variation with regard to growers who are receptive to this message and those who are not, in lieu of a humane and realistic immigration reform that provides legitimate protections for workers, providers will continue to face serious problems in serving a population whose transience, vulnerabilities, and invisibility are structural factors of the regime of citizenship enforcement and labor exploitation.

As Dowling and Inda put it, the border is no longer a “location at the nation's edge where the regulation of movement takes place”; in the post-9/11 period, the border has been disaggregated with certain spaces of everyday life “identified as strategic sites subject to intensified policing” to the point that the border is now a “mobile technology — a portable, diffused, and decentered control apparatus interwoven throughout the nation” (Dowling and Inda 2013:145). Our respondents offer deep insight into one key border site in the policed interior, a line drawn deeply by adherence to the theory of attrition between those who have access to medical services and those who do not. Such “deterrence and incapacitation away from the border” entails law, policing, and rhetoric operating in conjunction to diffuse obstacles into quotidian spaces, restricting mobility in ways that preclude participation in the normal routines of life (Gilbert 2009), including the routines of basic health care. The strategy of deterrence in which unauthorized migrants are constructed as criminals who threaten the safety and well-being of the citizenry situates the immigrant outside the protection of the legal system as a “non-person” to whom the state owes no obligation (Inda and Dowling 2013:7; Neuman 2005:1441). This brings to mind the observation by Das that pain and suffering are “the means of legitimating the social order rather than being threats to this order” as they are “actively created and distributed by the social order itself” (Das 1996:138).

The outreach workers in the east coast migrant stream recognize the interacting factors that place their clients at risk, and they know that coordinated efforts with community partners are essential in addressing root causes. In their influential volume in Social Suffering, Kleinman et al. (1997) advocated for a clustering approach to the conceptualization and treatment of suffering in order to overcome categorizations that isolate causes into separate fields (political, legal, medical, moral), and to realize that “health is a social indicator and indeed a social process” (p. ix). This kind of theorizing can be put to use as a kind of remediation against the theory of attrition that seeks to drive away individuals by dismantling societal and cultural resources. A coherent, fair, and humane immigration policy is necessary to remove the uncertainties and anxieties in the precarious and destabilized lives of the farmworkers served by the health-care providers who responded to this survey.

Acknowledgments

  1. Top of page
  2. Introduction
  3. Effects of Attrition
  4. Stigmatized Spaces of Exclusion
  5. Destabilizing Family Life
  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References

Dr. William L. Alexander is an associate professor of cultural anthropology at the University of North Carolina Wilmington. Magdalena Fernandez, MPP, is the regional migrant health coordinator for the North Carolina Community Health Center Association (NCCHCA).

This qualitative survey was developed by the Regional Migrant Health Coordinator for the Mid-Atlantic while working a student group from the UNC-Chapel Hill School of Public Health as a follow-up to a survey given to attendees of the 2012 East Coast Migrant Stream Forum.

Parts of this paper were presented at two professional meetings: “Impacts of Immigration Law and Detention Policies on Medical Care for Farmworkers” was presented in the session “Migrant Risks, Vulnerabilities, and Coping Strategies: Perspectives from Critically Applied Medical Anthropology and Political Ecology” at the Society for Applied Anthropology (SfAA) Annual Meeting in Denver on March 21, 2013. “Reframing the Issue, Delivering the Message: Farmworker Health Outreach and Immigration Reform” was presented in the session “ ‘Sustaining Narratives’: Integrated Perspectives on Community Health, Economic Development, and Environmentalism” at the American Anthropological Association (AAA) Annual Meeting in Chicago on November 23, 2013.

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  6. Orders of Risk and Violence
  7. The Interior Border Spectacle
  8. Conclusion
  9. Acknowledgments
  10. References
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