How Should Clinicians Express Solidarity With Asylum Seekers at the US-Mexico Border?

Migrants along the US-Mexico border have been subjected to transnational violence created by international policy, militaristic intervention, and multinational organizational administration of border operations. The COVID-19 pandemic compounded migrants' vulnerabilities and provoked several logistical and ethical problems for US-based clinicians and organizations. This commentary examines how the concept of transnational solidarity facilitates analysis of clinicians' and migrants' shared historical and structural vulnerabilities. This commentary also suggests how actions implemented by one organization in Tijuana, Mexico, could be scaled more broadly for care of migrants and asylum seekers in other transnational health care settings.

Los migrantes en la frontera entre EE. UU. y México han sufrido violencia transnacional por parte de la policía internacional, la intervención militar y la administración organizativa multinacional de las operaciones fronterizas. La pandemia de la COVID-19 agravó las vulnerabilidades de los migrantes y provocó varios problemas logísticos y éticos para los médicos y las organizaciones estadounidenses. Este comentario examina de qué manera el concepto de solidaridad transnacional facilita el análisis de los médicos y las vulnerabilidades históricas y estructurales compartidas de los migrantes. También, sugiere cómo las acciones implementadas por una organización en Tijuana, México, podrían aplicarse a mayor escala para la atención de los migrantes y solicitantes de asilo en otros entornos de atención médica transnacional.

Structural vulnerability and new perspectives in social medicine on the health of immigrants: Interview with James Quesada and Seth M. Holmes. / La vulnerabilidad estructural y las nuevas perspectivas en medicina social sobre la salud de los migrantes: entrevista a James Quesada y Seth M. Holmes.

A decade ago, a number of English-speaking authors focused mainly on the analysis and intervention of processes of social determination of health of migrants developed the concept of structural vulnerability as a way to combat individualism, biologism, the invisibilization of processes of structural determination and the blaming of victims. As part of the historical contributions of social medicine, the current developments of the structural vulnerability approach have been disconnected from the discussions of the collective health movement and Latin American social medicine in general, among other reasons due to linguistic barriers associated with the scarcity of publications in Spanish. The present interview, conducted with two of the primary representatives of the structural vulnerability approach, investigates its historical origins and seeks to explore the specific contributions that are being made today, as a way to bring them closer to Spanish-speaking readers and so enable dialogue with the proposals of Latin American social medicine.

Desde hace una década, varios autores anglófonos, centrados principalmente en el análisis e intervención de los procesos de determinación social de la salud de los migrantes, forjaron el concepto de vulnerabilidad estructural, como una forma de combatir el individualismo, el biologismo, la invisibilización de los procesos de determinación estructural y la culpabilización de las víctimas. Siendo parte de las contribuciones históricas de la medicina social, los actuales desarrollos de la aproximación sobre la vulnerabilidad estructural han quedado desconectadas de las discusiones del movimiento de la salud colectiva y la medicina social latinoamericana en general, entre otras razones, por las barreras lingüísticas asociadas a la escasez de sus publicaciones en español. La presente entrevista, realizada a dos de sus principales representantes, indaga los orígenes históricos de dicha aproximación y busca explorar las contribuciones específicas que hoy está realizando, como una forma de acercarlas a los lectores de habla hispana, favoreciendo el diálogo con las propuestas de medicina social latinoamericanas.

Structural vulnerability and problem drinking among Latino migrant day laborers in the San Francisco Bay Area.

Latino migrant day laborers (LMDLs) live under challenging conditions in the San Francisco Bay Area. This study explored day laborer alcohol use guided by a structural vulnerability framework, specifically problem vs. non-problem drinking as perceived by LMDLs and how they cope with or try to avoid problem drinking given their broader environment. The study utilized ethnographic methods including in-depth semi-structured qualitative interviews with 51 LMDLs. Findings revealed the considerable challenge of avoiding problem drinking given socio-environmental factors that influence drinking: impoverished living and working conditions, prolonged separation from home and family, lack of work authorization, consequent distress and negative mood states, and peer pressure to drink. While participants shared strategies to avoid problem drinking, the success of individual-level efforts is limited given the harsh structural environmental factors that define day laborers' daily lives. Discussed are implications for prevention and intervention strategies at the individual, community, national and international levels.

Sexual health of Latino migrant day labourers under conditions of structural vulnerability.

The purpose of this paper is to explore the context of the sexual health of Latino migrant day labourers in the USA, challenges to sexual health and ways of coping, with attention to conditions of structural vulnerability permeating the lives of this unique Latino population. Given the limited information about this topic and population, ethnographic research employing in-depth semi-structured interviews with 51 labourers, recruited through purposive sampling in the San Francisco Bay Area, was utilised. The sexual health aspirations of the men are deeply embedded in the core value and practice of Latino familismo or, in this case, the central goal of securing a family headed by men as providers and present husbands/fathers. However, such goals are frequently thwarted by the poverty engendering work and prolonged separations from home that characterise predominantly undocumented day labour in the USA. Resulting goal frustration, combined with pent up sexual urges, often lead to sexual risk in spite of efforts to cope with challenges to sexual health. Unless community-, state- and national-level interventions are developed to mitigate the pronounced structural vulnerability of migrant day labourers, individual level interventions to promote sexual health, and decrease risk and distress, are likely to have diminishing returns.