ACCESS DENIED

Sarah S. Willen
SMU

Do unauthorized im/migrants have a right to health? To medical care? To publicly funded care? These questions – all of them vexing, provocative, and contentious – catalyze the work we do here at AccessDenied, where we aim not to provide pat answers, but to serve as a clearinghouse for fresh ideas and resources of intellectual and practical value. Sometimes, though, we wonder how much preaching we do to the choir. What about those who find it reasonable, logical, or common sensical to declare unauthorized im/migrants automatically “undeserving” or, more commonly, those who have not (yet) given the matter any serious thought – including, quite frequently, our students?

In this post, I consider these questions through two lenses: first, a rallying cry issued 20 years ago by critical medical anthropologist Merrill Singer, and second, a recent pedagogical adventure in the Green Mountains of Vermont. I’ll begin with the rallying cry.

In a pioneering 1990 article[i], Singer boldly called for a “reinvention” of medical anthropology to foreground the role of power, political economy, and inequality in shaping the practice of biomedicine, the distribution of health related resources and attention, and the patterning of health outcomes. In choosing a maxim to “guide the praxis of medical anthropology,” he contends,

we could do worse than to set as a standard that our work be dedicated to comforting the afflicted while afflicting the comfortable. (1990: 185; emphasis added)

Here we have it: critical medical anthropology in a nutshell. Do, Singer exhorts; take action in a manner that will help those in need – but also think and, as importantly, make others think. What does this twofold charge mean for those of us whose research and teaching focus on unauthorized im/migration and health?

The pedagogical adventure: Last month, I had the privilege of pitching AccessDenied’s core questions to a sharp, engaged student audience at Middlebury College’s annual Clifford Symposium[ii] in a brief presentation titled, “Do Unauthorized Immigrants have a Right to Health? Ethnographic Reflections on Contemporary ‘Deservingness’ Debates.” The presentation and student responses that followed  suggest that “afflicting the comfortable,” although tricky business, is a powerful strategy for opening eyes and broadening minds. And we need to do it more, and more creatively – especially in the present day and age, when what goes down in classrooms is but a starting point for discussions that evolve, among other places, in those magical spaces called “class blogs.” (Oh yes, and when fake news pundits try their own hand at real-live fieldwork, as Stephen Colbert did, coincidentally enough, on the day of the talk.)

Below I draw upon several recent teaching experiences, including the presentation in Vermont and, with generous permission from Svea Closser and the students in her Global Health course at Middlebury, comments from their class blog, to consider the value of “afflicting the comfortable” using a powerful tool best known for its bodacious curve and unmistakable point: the question mark.

At the Clifford Symposium, I invited students to consider a cascade of questions:[iii] Do unauthorized im/migrants have a right to health? Why are there so many unauthorized im/migrants in the United States, and other industrialized countries, in the first place? Who benefits from their presence and their labors? What makes unauthorized im/migrants sick? How might “illegality” interact with other risk factors to endanger health? Why are unauthorized im/migrants so often portrayed as unwanted, undesirable, or undeserving? Are these negative constructions fair? Are they just? Are they prudent?

One can productively spend an entire semester puzzling through these questions, I suggested, and to drive the point home, I tossed up a slide showing the poster for a course I’ve now taught twice: “Working Hands, Unwanted Bodies: The Anthropology of Transnational Migration.” Three questions (inspired in content and tone by my own teacher, Jennifer Hirsch) introduce the course: Who picked the strawberries you ate for breakfast? Who ground the meat in your hamburger? Who built the neighbors’ new house?  In each iteration of the course, the unwritten aim has been, in effect, to “afflict the comfortable” with a constellation of hard-hitting, morally vexing, personally relevant questions like these – and to refuse the temptation of easy answers.

The first time I taught the course, in Massachusetts, I’d hoped for an enrollment of 12. Thirty-five students showed up, and we had to petition for a new classroom. When students got bored with the generalized political consensus in our group, we invited a guest speaker from an anti-immigrant organization (which self-identifies innocuously as the “Center for Immigration Studies”)[iv] to play counterpoint. One student, a nationally known migrant rights activist and blogger, vigorously opposed inviting a CIS representative to campus and lobbied to cancel the event. Another student and migrant rights activist sat in the packed basement classroom during our optional evening session, heard ideas she found repugnant, and left with her “blood boiling” – her words, expressed later. The second time I taught the course, in Texas, my learning companions were 12 freshman honors students, and we found no need to look elsewhere for a diversity of views. One of the strongest course evaluations came from a student whose political commitments could hardly be more different from my own. Now my student and I are both afflicted, and neither of us is especially comfortable. We both like strawberries for breakfast.

When these questions hit the road last month and migrated up to Vermont, I was afforded a new opportunity to see the power of the question mark in action. In reviewing Middlebury students’ blog posts afterward, I could see that some of the questions I’d posed clearly itched. Others festered. And some apparently grew legs and marched out of the auditorium and into students’ conversations with friends. Among those posed by students themselves, my favorite started with “strawberries” and went local. In Addison County, Vermont, home to Middlebury College and to Cabot Creamery, to dozens of dairy farms, and to a small but growing population of migrant workers, one student asked, “who milked the cows so we could have milk in the dining hall?”

The student comments included below – excerpted brutally, I confess, from a set of longer and far richer postings – offer just a small taste of what can happen when the power of questioning is recruited in service of “afflicting the comfortable.”  As these comments reveal, some questions spawn more questions. For some, perhaps, the itch may refuse to go away. At least this is my hope.

Student Responses to the presentation, “Do Unauthorized Immigrants have a Right to Health? Ethnographic Reflections on Contemporary ‘Deservingness’ Debates”

• To me, it seems like we are playing a role in perpetuating a horrific cycle.  The question of who should have access to or be excluded from health care is a hotly debated one, especially in our country.  But we cannot pretend that we are not responsible for some of the illnesses that unauthorized immigrants are experiencing.  They are exposed to the dangerous and dirty work that we do not want to do and we exclude them from society.  We are certainly not innocent — so why, then, are we deserving?

• [I]f you have more money are you more deserving than someone who cannot afford that same level of healthcare?

• To me, realizing that unauthorized immigrants are the ones who do much of the dirty work in our society is enough for me to form a belief … yes, illegal immigrants have a right to healthcare. If we are concerned about the conditions of our fruits and vegetables, then we should be concerned about the health of the people who pick them. … Of course, though, it is not that easy. If we were to simply provide healthcare to all unauthorized immigrants, would it lead to a greater influx of unauthorized immigrants who are seeking the same benefits? Would this then collapse our own healthcare infrastructure and jeopardize the health of our citizens?

• [S]hould it be left up to the healthcare market to sort out who is “deserving” or is it more of a moral question that needs market regulation to ensure ethicality?

• I think it would have been difficult to walk out of the lecture without feeling at least a little bit empathetic for “the people who picked the strawberries that we ate at breakfast”. … [W]hether we want to believe or face it or not, illegal immigrants are making our lives better and more enjoyable on a daily basis.