HLTC02H3 Chapter Notes -Tubal Ligation, Combined Oral Contraceptive Pill, Structural Adjustment

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26 Jan 2013

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Week # 4: “Health is Hard Here” or “Health for All” Politics of Blame, Gender and
Health Care for Undocumented Nicaraguan by Kathryn Goldade
Undocumented Nicaraguan migrant women are regularly denied medical service from
the state health system historically renowned for universal medical access
Medical citizenship denied to these women because of their immigrant status (or lack
of documentation) and because they do not have work in the formal sector (and
thereby covered by employer health care insurance plans)
This article uses a critically interpretive medical anthropology approach to explore
the gendered dimension, the limits of bio sociality and the broader historical process
of Costa Rican health and economic reform
Isabel at 25 diagnosed with malignant uterine cancer and had a hysterectomy and
has had difficulty obtaining post-operative care
o Only uninsured member of her family
Costa Rica has an international reputation for achieving public health gains and for
being a context of health without wealth
Costa Rica espouses that it has universal access but that is limited to those with
medical citizenship based on documentation for immigration
Undocumented Nicaraguan workers are exempted from universality of health care
unless they come in for emergency care and that is usually coupled with exorbitant
2004, anti-immigrant sentiment led to the passage of a law that banned any
uninsured person for accessing state-provided health care due to the fact the country
felt that they were taking up limited health care resources
Without residency documents or a formal work permit (which only men could get due
to the fact they worked in the formal economy) insurance could not be obtained and
anybody seeking care aside from emergencies would be treated on a fee for service
basis. The previous loophole for providing state based insurance to any poor person
had been eliminated
Costa Rica State dominates health care provision and because of this NGO/private
service providers are scarce due to the rhetoric that Costa Rica has universal health
care (universal up to a point it seems)
o 67% of the formal economy & 89% of the total CITIZEN population are
enrolled in the state insurance plan
A portion of society left without direct access to care due to the high costs involved
and it is most likely going to be the people in the informal sector
(agricultural/domestic work), women working irregular hours or seasonally and are
predominantly undocumented labor migrants from Nicaragua
Costa Rica’s commendable health gains = lead to an absence of NGO service
Globalization of south to south migration circuits have resulted in exclusion despite
the ideology of universalism
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