AEL 667 Group project: Immigration and Healthcare

Team members: Melissa Cates, Natalie Hart, Lois Konzelman, Linda Patterson, and

Melissa Carruth

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SHOULD HEALTHCARE BE DENIED or PROVIDED FOR THE NON-CITIZEN RESIDENTS OF THE U.S.?

Should Healthcare and Nursing Care….The Critical Debate

PRO Our national identity of generosity to

those less fortunate; human kindness , national philosophy “Give me your tired, your poor”

Prevention of public health issues and costs of disease from lack of immunizations and safe, healthy housing for thousands of residents who are not eligible in some states

Retail tax income from healthy, motivated employees

Increased healthy labor pool as essential for some businesses to thrive

To deny healthcare to immigrants displays racism and classism

Structural Violence through bringing immigrants in to work the fields and work in nursing, but denying help to others

CON The reality of radical inequality of

healthcare costs and access for U.S. citizens---basic healthcare is not even a right of citizenship

The recent economic crisis has strained taxpayers who are contributing the most to support healthcare costs through high taxes and health insurance premiums

Lack of income tax and business taxes to support health services directly for illegal residents

Flood the country with immigrants needing healthcare

The national debt and obligation to protect those already here

A breech in national security

Objectives:

•To lear

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•To better understand how social, political and structural systems affect healthcare systems

•To learn how to engage in both sides of a debate and discover evidence for your own nursing practice

•To address your own thoughts and feelings about racism, classism, structural violence, nationalism and silence and how these pertain to your role as a nurse

•To develop a true sense of holistic care

What Do YOU Think?

5 Critical Concepts:

Classism

Structural Violence

Racism

Silence

Nationalism

Take out a sheet of paper. Write which side of the debate at this point you would support.Which of these 5 critical concepts contribute to your decision?

Immigration Categories

Legal Immigration: Lawful Permanent Resident (LPR)

Immediate Relatives Family-Based Employment-Based Refugees Student Visa

Illegal Immigration: An individual who is

not a U.S. citizen or U.S. national and resides in the U. S. without legal status

As defined by Government Regulation: Illegal Aliens

ILLEGAL IMMIGRATION POPULATION

Estimated at ~ 11 MillionAbout 27 % increase in past decadeOf all unauthorized immigrants

living in the U. S. in 2010 39 % entered in 2000 or later, and 62 %

were from Mexico.

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Immigrant Lawful Permanent Resident

~ 12 Million with immediate family members also eligibleThe process toward citizenship is variable and may be lengthy and expensive.work legally, have a “green card” and if well-employed may hold work-related health insurance benefits. Regardless of employment they are eligible for public health and educational services.Annual Quotas include 226,000 family-based, 140,000 employment-based, 90,000 refugee, and 10,000 special status for a total expected lawful immigration of ~1 million per year

CLASSISM, SOCIAL JUSTICE AND NATIONALISM

Labor migration is a significant phenomenon throughout the world, from the most vulnerable illegals through the most educated STEM professionals (Farmer, 2005; http://www.nam.org/Issues/Employment-and-Labor/Workforce.aspx, 2011)

Mexico’s minimum wage is a little over $4.00 per day. (Minimumwage.com/international)

CLASSISM, SOCIAL JUSTICE AND NATIONALISM

Employment issues… Agribusiness and manufacturing have long

used immigrant labor to reduce costs and increase cooperation of employees when U.S. workers were not willing to tolerate minimum wage for hard labor without health insurance or other benefits.

U. S. businesses have legally relocated a portion of these jobs in other countries through NAFTA (Farmer, 2005, Loewen, 2007 ).

Some jobs have been taken to the other countries through NAFTA (http://www.nam.org/Issues/Employment-and-Labor/Workforce.aspx ).

The belief that races have distinctive cultural characteristics determined by hereditary factors and that this endows some races with an intrinsic superiority over others.

Racism. (n.d.). Collins English Dictionary - Complete &

Unabridged 10th Edition. Retrieved November 29, 2011, from : http://dictionary.reference.com/browse/racism

 

RACISM

Racism Types

Barbee (1993), described three types of racism, based upon theworks of Jones, (1972).

Individual Racism emphasizes discriminatory acts directed towards individuals because of visible biological characteristics.

Cultural Racism involves individual and institutional expression of the superiority of one’s cultural heritage over that of others.

Institutional Racism the intentional or unintentional manipulation or toleration of institutional policies that unfairly restrict the opportunities of particular groups.

RACISMMigrant Farm Workers

o ~10 million migrant farm laborers in the U.S. Extremely poor health status of migrant workers is often the result of

structural racism and anti-immigrant practices.

o Migrant worker job assignments often made based upon perceived biological/racial attributes and differences (e.g. height).

o Clinicians and migrant workers rarely question the racism practices because they are considered natural and NOT social – societal normalizing

o Only 5% of migrant farm workers have health insurance (84%, U.S. citizens with health insurance)

Holmes, S. (2006). An ethnographic study of the social context of migrant health in the united states. Plos Medicine, 3  (10), 1776-1793.

STRUCTURAL VIOLENCE

There are human, economic, medical and political stakes (Holmes, 2006)

“Structural racism and anti-immigrant practices determine the poor

working conditions, living conditions, and health of migrant

workers.

Subtle racism serves to reduce awareness of this

social context for all involved, including clinicians” (Holmes, 2006).

STRUCTURAL VIOLENCE AND RACISM

The article we read by Holmes points out the disparities between race, class and social position in provision of healthcare. Facts that stand out: • Latino children have twice the death and

hospitalization rates from pedestrian injury than do white children in the U.S.

• Latino adults have lower rates of preventive medicine screening.

• Latino immigrants face medical deportation on a daily basis by clinicians and healthcare workers who deem them as unworthy of assistance. (Holmes, 2006).

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Connections between public health policies and the development of long-lasting representations of Mexicans as disease carriers are demonstrated by the response to a 1916 typhus outbreak in Los Angeles County. 

The disease spread from person to person, spurring the creation of local policies derived from the premise that all Mexicans spread disease (Molina, 2011).

Medical deportations were not uncommon.

Formal Letter of Complaint :Dear Sir:

Due to the difficult circumstances we find ourselves in this foreign country, we look to you asking for help in this case. We are enclosing a copy of the severe law that the railroad line has imposed on us Mexicans who work on the track, which we do not see as a just thing, but only offensive and humiliating. When we crossed the border into this country, the health inspector inspected us. If the railroad line needs or wants to take such precautions it is not necessary that they treat us in this manner. For this, they would need health inspectors who assisted every individual with medical care and give us 2 rooms to live, one to sleep in and one to cook in, and also to pay a fair wage to obtain a change of clothes and a bar of soap. This wage they set is not enough for the nourishment of one person. Health comes from this and these precautions are the basis for achieving sanitation. Health we have. What we need is liberty and the opportunity to achieve it. We need a bathroom in each section of camp and that the toilets that are now next to the sleeping quarters be moved. Many times their bad smell has prevented us from even eating our simple meal. Furthermore, we can disclose many other details which compromise our good health and personal hygiene With no further ado, we remain yours, graciously and devotedly, your attentive and faithful servants. We thank you in advance for what you may be able to do for us.

Felipe Vaiz, José Martinez, Felipe Martinez, Adolfo Robles,Alejandro Gómez, Alberto Esquivel.[12]

Why are Foreign Nurses Recruited?

Inequalities in Global Market:

The nursing shortage of the 2000’s caused hospitals to recruit foreign nurses as a means to provide fill the gap in trained professional nurses

Hospitals employed companies to go to developing countries and seek out nurses to come to the US by offering them wages that sounded great but were actually much less than American born nurses were making.

Foreign nurses are recruited from poor developing countries depleting their healthcare labor force

Immigration of Trained Nurses

Low-income, English-speaking countries that engage in high levels of bilateral trade experience greater losses of nurses to the U.K. and the US.

Poor countries seeking economic growth through international trade expose themselves to the emigration of skilled labor. This tendency is currently exacerbated by nursing shortages in developed countries (Ross, Polsky & Sochalsky, 2005).

Countries that provide most nurses are highly populated poorer nations (Ross et al, 2005).

Experience of Immigrant Nurses…

Overcoming language barriers Dealing with discrimination Adopting U.S. nursing practices Adjusting to U.S. social customs Becoming accustomed to U.S. culture Reconciling work ethics. (Lin, 2009)

IMMIGRATION, HEALTH CARE, AND SILENCE

Why do immigrants fail to seek health services on a regular basis?

Social Barriers› lack of social support› limited English proficiency› immigration status› fear

Health Care Delivery Barriers› financial cost› lack of child care› lack of transportation› lack of time

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› Immigrants use the language of silence to express themselves.

› Parin Dossa (2003) tells us that silence does not rule out speech. She tells us that much can be "said" through the silent gaps between words.

› In her Migratory Tale of Social Suffering and Witnessing, Dossa shows how Zahra uses the silent language of the body (her symptoms) to tell her story.

› Witnessing makes it necessary for us to listen to the language of silence.

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Audre Lorde (1980) says that "silence and invisibility go hand in hand with powerlessness.“

Many immigrants keep silent in hopes of staying "invisible" and not stirring up any questions, especially if they are illegal.

In research about postpartum depression (PPD) in Hispanic women, it was found that most of them will not admit to or acknowledge the fact that they are experiencing any form of depression. Hispanic women feel ashamed and that depression should be kept silent. There are many women that simply won't say anything.

Many female immigrants keep silent out of fear. Fear of authority, deportation, or in many cases their husbands (depending on their culture.)

A PERSONAL STORY

DISCUSSION

Is it ethical to entice nurses from poorer countries to come to developed countries to practice nursing?

What produces the most tension in the debate of issues of immigration ?

What is the regulatory meaning and description of immigration in the U.S?

What is the historical healthcare experience of immigrants, both legal and illegal, in the U.S.?

What is the best role of the nursing profession in serving the immigrant population?

RESOLUTION: Conceptual Foundation for Professional Nursing

Nursing encompasses an art, a humanistic orientation, a feeling for the value of the individual, and an intuitive sense of ethics, and of the appropriateness of action taken. ~ Myrtle Aydelotte

We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering ~ Elisabeth Kubler-Ross

ReferencesBarbee, E. (1993). Racism, gender, class, and health. Medical Anthropology Quarterly, 7 (4), 346-362.

Callister, L.C., Beckstrand, R.L., & Corbett, C., (2011). Postpartum Depression and Help-Seeking Behaviors in Immigrant Hispanic Women. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(4), 440-449.

Dossa, P. (2003). The Body Remembers, A Migratory Tale of Social Suffering and Witnessing. International Journal of Mental Health, 32(3), 50-73.

Farmer, P. ( 2005). Pathologies of power: Health, human rights, and the new war on the poor. Berkley, CA: The University of California Press.

Holmes, S. (2006). An ethnographic study of the social context of migrant health in the United States. PLOS Medicine (3) 10. p 1776-1793.

Lin, L. (2009). A synthesis of the literature on Asian nurses' work experiences in the United States. Research & Theory for Nursing Practice, 23(3) p 230-45.

Loewen, J.( 2007). Lies my teacher told me. New York, NY: The New Press.

Lorde, A. (1980). The Transformation of Silence into Language and Action. J. Pinkvoss & S. Brawn (Eds.), The Cancer Journals (pp. 16-22). San Francisco: aunt lute books.

Molina, N. (2011). Borders, laborers, and racialized medicalization: Mexican immigration and US public health practices in the 20th century. American Journal of Public Health. 101(6).

National Manufacturer’s Association ( 2011). Retrieved from http://www.nam.org/Issues/Employment-and-Labor/Workforce.aspx

Racism. (n.d.). Collins English Dictionary - Complete & Unabridged

10th Edition. Retrieved November 29, 2011, from http://dictionary.reference.com/browse/racism

Ross, S., Polsky, D. & Sochalsky, J. (2005). Nursing shortages and international nurse migration. International Nursing Review. 52(4) 253-62