Supplementary Material

“Putting Band‐Aids on Things That Need Stitches”: Immigration and the Landscape of Care in Rural America

By Thurka Sangaramoorthy

ABSTRACT Growing numbers of immigrants work and live in rural, geographically isolated areas throughout the United States, places without previously settled immigrant populations. Rapid immigration to such areas already struggling with poverty, weak public infrastructures, and high concentrations of uninsured residents has given way to an increasingly precarious landscape of care. The neoliberal logics of American health care and contentious debates over immigration reform shape this landscape and condition relations among providers, immigrants, and others. Through what I call “band‐aid” care and the informal transactions that characterize it, such as rationing, bartering, hoarding, willful noncompliance, and goodwill, providers and immigrants counter these logics of exclusion and inequality by participating in the dynamic improvisation of care considered illicit and often prohibited under the market‐based economic rationale of health‐care provision. Social obligations and moral legitimacy benefit otherwise marginalized providers who engage in this landscape of care, while vulnerable immigrants gain entry and access to vital resources within this landscape through sociality and interdependence, which engender opportunities (however fraught) for living. Yet providers and immigrants understand band‐aid care to be necessary, just, moral, and legitimate in response to precarity characterized by geographical isolation, economic scarcity, civic inequality, market‐based health care, and exclusionary policies. [immigration, health care, exclusion, social inequality, United States]

The following are photographs from events discussed in the article. All photographs are by Emilia Guevara, PhD candidate in the Department of Anthropology at the University of Maryland.

Maryland’s Eastern Shore is a primarily rural, politically conservative region composed of nine counties located on the Delmarva Peninsula. Approximately 8 percent of Maryland’s total population lives on the Eastern Shore. The Eastern Shore’s rapidly changing socio-demographic landscape is key to understanding the political, legal, social, and moral aspects of immigration and the landscape of care in rural America. Migration to the Eastern Shore has been driven in large part by low-skilled employment opportunities in seafood, poultry, and agriculture industries. In the past decade, the population of Latino immigrants on Maryland’s Eastern Shore has increased exponentially, 158 percent from 2000 to 2010. Other than these broad census counts, there is virtually no information on these populations. There is also a well-established but hidden population of Haitians who have long migrated from Florida for the harvest season and who increasingly travel to the Eastern Shore directly from Haiti and other parts of the Caribbean.

Maryland’s Eastern Shore landscape

A family farm on the Eastern Shore

Watermelon harvest

Immigrants provide a significant amount of agricultural and other types of low-skilled labor on the Eastern Shore and often live and work in difficult conditions and substandard housing. Migrant workers and immigrants can sometimes pay exorbitant rents for dilapidated apartments, motel rooms, trailers, mobile homes, barns, or sheds—living situations in which basic necessities like adequate sanitation, safe water, and electricity are frequently lacking. These living conditions are a constant source of stress and anxiety for many and contribute to ill health and social isolation.

Family trailers in a labor camp

Farmworker housing

Trailer home used by migrant workers

Health care is another issue that is difficult for immigrants and residents alike on the Eastern Shore. A handful of safety-net providers and health clinics provide outreach and care to migrant workers. They provide medical and dental care along with health education, basic triage, and prescription deliveries to local residents, including migrant and low-income individuals.

Mobile health clinic staff preparing a rapid strep test

Author examining the hands of an interlocutor waiting to be seen by health provider for skin irritation

This work privileges the diversity of experiences of the various immigrant communities working and living on the Eastern Shore, including men and women from Haiti and Latin America. One particular group of immigrants that are a focus of this research are temporary migrant Mexican women employed by Maryland’s internationally renowned blue crab industry.

Wearing gloves and masks provides some protection from chemical exposure related to crab processing, but not all companies provide these items free of charge. In addition, gloves prevent women from working quickly enough to make their allotted quota of twenty-four pounds per day. Common physical symptoms for which the women seek medical care include skin rashes, fungus infections, and respiratory ailments like asthma.

Blue crabs

Crabmeat processing

Women picking crabmeat


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