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University of Toronto Scarborough
Health Studies
Denis Maxwell

HLTC02 WINTER 2013 Week # 4: “Health is Hard Here” or “Health for All” – Politics of Blame, Gender and Health Care for Undocumented Nicaraguan by Kathryn Goldade Abstract  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  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 prices  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 providers  Globalization of south to south migration circuits have resulted in exclusion despite the ideology of universalism HLTC02 WINTER 2013  What limits Nicaraguan migrants from accessing medical care o Their illegal status as migrants o Socioeconomic exclusion from Costa Rican society o Gendered schemes of employment o Historically particular conceptualizations of health care in this south to south migrant circuit  Universalism seems limited to all citizens of the Costa Rica Migrant Health, Bio sociality and Medical Citizenship  40% of the world’s migrants move from one developing country to another (south to south migration)  There is more scholarly emphasis placed on ethnicity than political status in research and hence undocumented migrants slip through the cracks  Migrants have used the suffering body to gain legal rights and related citizenship entitlements o Individuals migrating illegally must parlay their bodies into legal gains o Biology is remodeled not only culture but also on structural need, biological compromises are made as a primary form of political action (hunger strikes, threatening to get HIV) o Bodily infirmity has now become a stronger case for establishing claims for equity, rights and resources (Health is a Human Right)  Poor health outcomes due to radicalized globalized political economic hierarchy  Medical Citizenship in south to south migration population o Medical citizenship refers to policies of entitlements and deservedness that deem basic rights of citizens, what human rights are recognized for illegal immigrants, and who gets excluded or sacrificed when health resources are rationed or restricted o Costa Rica’s commitment to universal health coverage is constrained by the opposite notions in globalization of denationalizing economics be renationalizing politics o Citizenship is defined as a civic duty of the individual to reduce his or her burden on society (Aihwa Ong) Local Context & Study Methods  Increased need of foreign unskilled labour in Costa Rica due to out migration by Costa Ricans, implementation of non-traditional agricultural export industries under SAPs, urbanization and gendered shifts causing greater need for people in agriculture, domestic work and construction  Used snowball and purposeful sampling methods to recruit 43 migrant women interviewing them 3 times via semi structured interview questionnaires o Longitudinal design allowed for seasonal shifts over time in employment as well as perceptions of incorporation and discrimination  Interview 12 health care providers, key informants, and focused observatio
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