Doctoral Dissertation Research: Status and Healthcare Access in the U.S.-Mexico Borderlands

社会科学家知道，获得关键服务，包括医疗保健，不仅取决于成本和可用性，还取决于多种社会、文化和政治因素。这些因素包括寻求护理的人的地位，他们住在哪里，他们如何与医疗保健提供者互动，以及他们是否符合应得的文化观念。然而，这些因素是如何在个人的实际护理体验及其结果中相互作用和共同作用的，这一点还没有得到很好的理解。本研究项目将通过详细探索法律地位影响拉丁美洲移民在德克萨斯州南部格兰德河谷下游寻求终末期肾病（ESRD）透析治疗的多种途径来解决这一差距。这项研究将由德克萨斯大学圣安东尼奥分校的博士生Milena A. Melo在Kathryn J. Fleuriet博士的指导下进行。德克萨斯州南部的边境地区是美国贫困率和无证居民率最高的地区之一。边境日益军事化使得无证移民进入墨西哥就医几乎是不可能的。因此，这些边境地区是一个特别合适的研究地点，在其中追求外部因素对医疗保健的影响的问题。研究这些问题的特定视角是移民法和医疗保健政策对具有不同法律地位的移民的实际影响。方法将包括12个月的参与者观察、调查和对医疗保健专业人员和低收入拉丁美洲透析患者的半结构化访谈。这项研究的结果将有助于理解对权利、公民身份和健康差异的社会生产的规范性理解之间的关系。虽然以前的研究倾向于概括护理提供者和接受者，但这个项目的结构是分解这些群体，看看他们如何在系统中不同地导航，这将有助于更好的理论和更好的政策。

Social scientists know that access to critical services, including healthcare, depends not only on cost and availability but also on a multitude of social, cultural, and political factors. These factors include the status of those seeking care, where they live, how they interact with healthcare providers, and if they fit cultural notions of being deserving. However, what is not well understood is how these factors interact and come together in any individual's actual experience of care and its outcome. This research project will address this gap by exploring in detail the multiple pathways through which legal status affects the experiences of Latin American immigrants who seek dialysis treatment for end-stage renal disease (ESRD) in the lower Rio Grande Valley of south Texas. The research will be conducted by University of Texas at San Antonio doctoral student Milena A. Melo, under the supervision of Dr. Kathryn J. Fleuriet.The South Texas borderlands are characterized by some of the highest rates of both poverty and undocumented residents in the country. Increasing militarization of the border has made crossing into Mexico for healthcare a virtual impossibility for undocumented immigrants. As a result, these borderlands are a particularly appropriate research site in which to pursue questions of the effects of external factors on healthcare. The particular lens through which these issues will be studied is the lived effects of immigration law and healthcare policy implementation for immigrants with different legal statuses. Methods will consist of twelve months of participant observation, surveys, and semi-structured interviews with healthcare professionals and low-income, Latin American dialysis patients. Findings from this research will contribute to understanding the relationship between normative understandings of rights, citizenship, and the social production of health disparities. While previous research has tended to generalize both the providers and the recipients of care, this project is structured to disaggregate these groups and to see how they navigate differently within the system, which will contribute to both better theory and better policy.