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"This book is an ethnographic witness to the everyday lives and suffering of Mexican migrants. Based on 5 years of research in the field (including berry-picking and traveling with migrants back and forth from Oaxaca up the West Coast), Holmes, an anthropologist and MD in the mold of Paul Farmer and Didier Fassin, uncovers how market forces, anti-immigrant sentiment, and racism undermine health and health care. Holmes' material is visceral and powerful-for instance, he trekked with his informants illegally through the desert border into Arizona, where they were apprehended and jailed by the Border Patrol. After he was released from jail (and his companions were deported back to Mexico), Holmes interviewed Border Patrol agents, local residents, and armed vigilantes in the borderlands. He lived with Indigenous Mexican families in the mountains of Oaxaca and in farm labor camps in the United States, planted and harvested corn, picked strawberries, accompanied sick workers to clinics and hospitals, participated in healing rituals, and mourned at funerals for friends. The result is a "thick description" that conveys the full measure of struggle, suffering, and resilience of these farmworkers. Fresh Fruit, Broken Bodies weds the theoretical analysis of the anthropologist with the intimacy of the journalist to provide a compelling examination of structural and symbolic violence, medicalization, and the clinical gaze as they affect the experiences and perceptions of a vertical slice of Indigenous Mexican migrant farmworkers, farm owners, doctors, and nurses. This reflexive, embodied anthropology deepens our theoretical understanding of the ways in which socially structured suffering comes to be perceived as normal and natural in society and in health care, especially through imputations of ethnic body difference. In the vehement debates on immigration reform and health reform, this book provides the necessary stories of real people and insights into our food system and health care system for us to move forward to fair policies and solutions."--Publisher information

This article considers ethnographic field research in order to analyze the violence and exploitation inherent to our transnational agro-food system and the ways in which temporality and statistics may aid in making visible and invisible certain experiences of migrant farmworker injury as well as individual and collective actions for wellbeing. Based in long-term, in-depth ethnographic research, this article utilizes theories of temporality and events in order to highlight social and health inequalities in agricultural labor and encourage agricultural, food and health scholars to consider critically the effects of our methods. Juxtaposing the injury and health care experiences of one Mexican migrant farmworker with statistics on the health and health care of migrant and seasonal farmworkers more generally, the article confronts both the normalization of migrant farmworker injury and the taken-for-granted helpfulness of quantitative and qualitative research alike. In addition, the argument acknowledges the everyday, individual practices and collective actions migrant farmworkers engage into demand and build wellbeing for themselves, their families and beyond.

Résumé L'objectif général de cette approche ethnographique est d'explorer les effets de hiérarchisation de l'appartenance ethnique sur la division du travail dans le secteur agricole aux États-Unis et s'attache aux processus permettant à celle-ci d'être normalisée et rendue invisible, malgré les souffrances ainsi engendrées. Cette enquête commence par analyser la façon dont le travail agricole est structuré selon l'appartenance ethnique, et montre ensuite combien cette hiérarchisation est productrice de douleurs et de maladies, en particulier au sein des populations de travailleurs mexicains illégaux.

Objectives: Specific work processes and management structures that contribute to high rates of occupational illness and injury in agricultural industries are not well described in academic literature. This qualitative study of work organization in the U.S. fresh tomato industry investigates how work processes and management structures impact tomato workers' occupational health. Methods: After conducting literature review and key informant interviews, semi-structured interviews and focus groups were conducted with 36 individuals with experience working in the U.S. fresh tomato industry. Interviews and focus groups were audio-recorded, transcribed, coded, and analyzed using a modified grounded theory approach. Results: These data indicate that participants endured income insecurity and hazardous supervisory practices, including wage theft, retaliation, intimidation, and humiliation, that put them at risk of preventable illness and injury. Support from workers' organizations and health-conscious supervisory practices helped mitigate some of these occupational hazards. Conclusion: Participants' adverse work experiences may be considered sequelae of workers' lack of job control and positions of socioeconomic structural vulnerability. Other aspects of tomato work organization, including health-conscious supervisory practices and the involvement of workers' organizations, indicate that modifying work organization to better safeguard health is possible. Such modifications present compelling opportunities for employers, employees, organizations, community and government leaders, and health care professionals to help create healthier occupational environments for tomato workers.

BackgroundWhile several articles on MD-PhD trainees in the basic sciences have been published in the past several years, very little research exists on physician-investigators in the social sciences and humanities. However, the numbers of MD-PhDs training in these fields and the number of programs offering training in these fields are increasing, particularly within the US. In addition, accountability for the public funding for MD-PhD programs requires knowledge about this growing population of trainees and their career trajectories. The aim of this paper is to describe the first cohorts of MD-PhDs in the social sciences and humanities, to characterize their training and career paths, and to better understand their experiences of training and subsequent research and practice.MethodsThis paper utilizes a multi-pronged recruitment method and novel survey instrument to examine an understudied population of MD-PhD trainees in the social sciences and humanities, many of whom completed both degrees without formal programmatic support. The survey instrument was designed to collect demographic, training and career trajectory data, as well as experiences of and perspectives on training and career. It describes their routes to professional development, characterizes obstacles to and predictors of success, and explores career trends.ResultsThe average length of time to complete both degrees was 9 years. The vast majority (90%) completed a clinical residency, almost all (98%) were engaged in research, the vast majority (88%) were employed in academic institutions, and several others (9%) held leadership positions in national and international health organizations. Very few (4%) went into private practice. The survey responses supply recommendations for supporting current trainees as well as areas for future research.ConclusionsIn general, MD-PhDs in the social sciences and humanities have careers that fit the goals of agencies providing public funding for training physician-investigators: they are involved in mutually-informative medical research, clinical practice, and teaching - working to improve our responses to the social, cultural, and political determinants of health and health care. These findings provide strong evidence for continued and improved funding and programmatic support for MD-PhD trainees in the social sciences and humanities.

AbstractThis commentary asks anthropologists to work within communities to actively address the global mental health impact of COVID‐19 and contribute to the pandemic response. Multiple social and physical losses, worsened by numerous factors, have produced syndemic traumatic stress and suffering across populations, highlighting persistent inequalities further amplified by the effects of COVID‐19. Specifically, anthropologists can work to contribute to the development of mental health programs; confront the racialization of COVID‐19 alongside marginalized communities; support real‐time policy making with community responses; and innovate transparent collaborative research methods through open science. This pandemic can serve as an opportunity to prioritize research endeavors, public service, and teaching to better align with societal needs while providing new opportunities for synergy and collaborations between anthropologists in and outside the academy. Anthropologists collaborating directly with mental health clinicians and the public can contribute to knowledge specifically through direct program development and implementation of interventions designed to improve mental well‐being. Innovating to find impactful solutions in response to the unprecedented mental health challenges exacerbated by the COVID‐19 pandemic has the potential to promote more equitable recovery around the world.

BackgroundThe influence of societal inequities on health has long been established, but such content has been incorporated unevenly into medical education and clinical training. Structural competency calls for medical education to highlight the important influence of social, political, and economic factors on health outcomes.AimThis article describes the development, implementation, and evaluation of a structural competency training for medical residents.SettingA California family medicine residency program serving a patient population predominantly (88%) with income below 200% of the federal poverty level.ParticipantsA cohort of 12 residents in the family residency program.Program descriptionThe training was designed to help residents recognize and develop skills to respond to illness and health as the downstream effects of social, political, and economic structures.Program evaluationThe training was evaluated via qualitative analysis of surveys gathered immediately post-training (response rate 100%) and a focus group 1month post-training (attended by all residents not on service).DiscussionResidents reported that the training had a positive impact on their clinical practice and relationships with patients. They also reported feeling overwhelmed by increased recognition of structural influences on patient health, and indicated a need for further training and support to address these influences.