[Collateral effect of transnational migration: the transformation of medical habitus]

OBJECTIVE

To analyze health practice transformations in health providers in Mexico.

MATERIALS AND METHODS

. We used qualitative data to explore transnational health practices of men with migration experience to the US, healthcare professionals in Mexico from eight rural communities, and Mexican providers in US. Data used came from a study that explored transnational health practices in the context of migration.

RESULTS

Healthcare professionals provided care to migrants through remote consultations or via a family member, and in-person during migrants' visits or by health-care professionals relocating to migrants' destination com-munities in the US. The remote consultations mainly caused three changes in the field of medical practice: providing care without a patient review or clinical examination, long-distance prescription of medications, and provision of care mediated by a family member.

CONCLUSIONS

Changes in their medical practice shifted roles of healthcare professionals and of migrants as patients, transforming the hegemonic biomedical model in Mexico.

Transnationalism and health: A systematic literature review on the use of transnationalism in the study of the health practices and behaviors of migrants

Transnationalism explores social, economic and political processes that occur beyond national borders and has been widely used in migration studies. We conducted a systematic review to explore if and how transnationalism has been used to study migrants' health and what a transnational perspective contributes to understanding health practices and behaviors of transnational migrants. We identified 26 empirical studies published in peer-reviewed journals that included a transnational perspective to study migrants' health practices and behaviors. The studies describe the ways in which migrants travel back and forth between countries of destination to countries of origin to receive health care, for reasons related to cost, language, and perceptions of service quality. In addition, the use of services in countries of origin is related to processes of social class transformation and reclaiming of social rights. For those migrants who cannot travel, active participation in transnational networks is a crucial way to remotely access services through phone or email, and to acquire medical supplies and other health-related goods (traditional medicine, home remedies). We conclude with recommendations for future research in this area.

[Social support and living conditions in poor elderly people in urban Mexico]

The aim of this paper was to analyze social support and living conditions among poor elderly people in Mexican cities. A qualitative study with eight focus groups was carried out in Guadalajara, Cuernavaca, Chilpancingo, and Culiacan, Mexico, in 2005. Forty men and 63 women participated in the study. The main support for the elderly in daily living came from their immediate family and in some cases from neighbors. Social support was basically material and economic, in addition to providing company and transportation for medical appointments. Daily emotional support, companionship, and social inclusion were minimal or absent. The study identified a significant lack of support from government and religious or civil society organizations. The family is still the main source of support for the elderly. Increased government collaboration is dramatically needed to combat the misconception that the needs of the elderly are the individual family's responsibility rather than a collaborative effort by society.

[Health services in the Mixteca: use and conditions of affiliation in US-migrant and non-migrant households]

OBJECTIVE

To describe the socioeconomic and demographic characteristics of households in the Mixteca Baja and analyze differences in affiliation with health care programs and utilization, among members of households with migrants (HogMig) and without migrants (HogNoMig) to the United States.

MATERIAL AND METHODS

A cross-sectional, descriptive survey was used with heads of households in a representative sample from the Mixteca Baja of 702 homes with and without migrants to the US.

RESULTS

Members of HogMig had more personal and economic resources than those of HogNoMig; they also regularly received remittances. The majority of members of both HogMig and HogNoMig did not receive benefits from the Oportunidades program or health coverage through Seguro Popular, IMSS or ISSSTE. In general, while they used the local health clinic, they often preferred to pay for private practitioners. A small proportion of those covered by IMSS or ISSSTE reported very low utilization of the health services offered by those institutions.

[A model for integrating mental health care resources in the rural population of Mexico]

OBJECTIVE

The purpose of this project was to identify behaviors of health service utilization to solve mental health-related problems among rural inhabitants of Mexico. A model of pathways to mental health services was built. Based on this model, an integration-intervention model is proposed to help improve access to mental health services and their quality.

MATERIAL AND METHODS

In 1997, in-depth interviews were conducted among 21 adults (9 men and 12 women) and seven healthcare providers, in a rural community in Jalisco, Mexico. Women's age ranged from 23 to 44 years; ten were married and two single. Men were between 30 and 74 years old; eight were married and one was a widower. Healthcare providers in the same community were: a priest, a general physician, a pharmacy clerk, two nurses, and two traditional healers.

RESULTS

The pathways models suggest that the first attempt a person does to solve a symptom is self-care. When such strategies are not sufficient to relief the symptom, the person turns to the members of his/her social network for help, who in addition to providing information about remedies, offer their emotional and instrumental support. If after consulting the social network, the symptom is not relieved, the individual seeks help from other external resources, such as the members of the ethnomedical local system. Inhabitants of rural communities tend to seek help from physicians, only when the symptom persists and the suffering associated with it seems to be out of the individual's control, or if members of the social network or the ethno-medical local system refer the patient to the physician. Seeking help from a specialist in mental health (psychiatrist or psychologist) is quite improbable among the rural inhabitants of Mexico, mostly due to difficulties in accessing these services, such as geographical location, distance, transportation, cost, and cultural distance between the health providers and the patient.

CONCLUSIONS

In order to conduct successful intervention programs that are culturally sensitive for rural inhabitants, it is necessary first, to have detailed information derived from research and second, the active participation of all human and institutional resources, from professionals and truly multi-disciplinary researchers, to educators, social, religious, political leaders, and members of the communities and local institutions. The proposed model of integration of personal and community resources for healthcare requires establishing programs that sensitize, inform, and train community members, as well as members the ethno-medical system and the formal heath system.