Imperial Medicine: An Ethnography of Immigrant Experiences after the Affordable Care Act

Abstract

My dissertation illustrates affinity between the US health care system and border control. I conducted 11 months of ethnography at Justicia y Paz (JyP), a volunteer-run NGO based in Houston, Texas that provides free food, clothing, basic medical services and temporary shelter to hundreds of undocumented immigrants from Latin America, Africa, and Asia each year. I supplement this data with hundreds of informal interviews and 36 semi-structured in-depth interviews with migrants, volunteers, and city employees affiliated with Houston's medical district. I find that immigrant health care is premised less on legality (i.e., being documented) and more on legibility (i.e. being recognizable to health care practitioners in particular ways). Drawing on Harsha Walia's theory of border imperialism, which draws insights from critical race theory, Marxist analysis, feminist studies, and poststructuralism, I argue that illegality is not simply a determinant of but also determined by health disparities. Today's health care system operates like a border where the racialized terms of illegality are regulated, (re)produced and actively contested. My research illuminates these processes through examining how health care is understood, provided, and received at the medical district, NGO, and migrant levels. In doing so, I make several theoretical contributions to the areas of medical sociology and immigration and develop practical considerations for health practitioners and NGOs with health equity aims. On a theoretical level, I illustrate convergence between the welfare and carceral state, advance theoretical debates around medicalization, and add nation to analyzes between caregiving and masculinity. On a practical level, I implicate health practitioners and equity-oriented NGOs like JyP in different forms of migrant suffering and offer considerations for becoming social justice allies.