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  1. Article: "They think we wear loincloths": Spatial stigma, coloniality, and physician migration in Puerto Rico.

    Padilla, Mark / Varas-Diaz, Nelson / Rodríguez-Madera, Sheilla / Vertovec, John / Rivera-Custodio, Joshua / Rivera-Bustelo, Kariela / Mercado-Rios, Claudia / Matiz-Reyes, Armando / Santiago-Santiago, Adrian / González-Font, Yoymar / Ramos-Pibernus, Alixida / Grove, Kevin

    Medical anthropology quarterly

    2024  

    Abstract: Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and ... ...

    Abstract Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, our study analyzes the effects of spatial stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on 50 semi-structured interviews with physicians throughout PR and the US, we identified how stigmatizing meanings are attached to PR, its people, and its biomedical system, often incorporating colonial notions of the island's presumed backwardness, lagging medical technology, and lack of cutting-edge career opportunities. We conclude that in addition to economically motivated policies, efforts to curb physician migration should also address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local responses to the crisis that are in danger of being lost to history.
    Language English
    Publishing date 2024-04-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1038242-2
    ISSN 1548-1387 ; 0745-5194
    ISSN (online) 1548-1387
    ISSN 0745-5194
    DOI 10.1111/maq.12857
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2743: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  2. Article ; Online: On leaving: Coloniality and physician migration in Puerto Rico.

    Varas-Díaz, Nelson / Rodríguez-Madera, Sheilla / Padilla, Mark / Rivera-Bustelo, Kariela / Mercado-Ríos, Claudia / Rivera-Custodio, Joshua / Matiz-Reyes, Armando / Santiago-Santiago, Adrián / González-Font, Yoymar / Vertovec, John / Ramos-Pibernus, Alíxida / Grove, Kevin

    Social science & medicine (1982)

    2023  Volume 325, Page(s) 115888

    Abstract: Puerto Rico (PR) has a growing physician migration problem. As of 2009, the medical workforce was composed of 14,500 physicians and by 2020 the number had been reduced to 9,000. If this migration pattern continues, the Island will not be able to meet the ...

    Abstract Puerto Rico (PR) has a growing physician migration problem. As of 2009, the medical workforce was composed of 14,500 physicians and by 2020 the number had been reduced to 9,000. If this migration pattern continues, the Island will not be able to meet the recommended physicians per capita ratio proposed by the World Health Organization (WHO). Existing research has focused on the personal motivations for movement to, or permanence in, a particular setting, and social variables that encourage physicians to migrate (e.g., economic conditions). Few studies have addressed the role of coloniality in fostering physician migration. In this article we examine the role of coloniality and its impact on PR's physician migration problem. The data presented in this paper stem from an NIH-funded study (1R01MD014188) that aimed to document the factors associated with physician migration from PR to the US mainland and its impact on the Island's healthcare system. The research team used qualitative interviews, surveys, and ethnographic observations. This paper focuses on the data from the qualitative interviews with 26 physicians who had migrated to the USA and ethnographic observations, which were collected and analyzed between September 2020 and December 2022. The results evidence that participants understand physician migration as a consequence of three factors: 1) the historical and multidimensional deterioration of PR, 2) the idea that the current healthcare system is rigged by politicians and insurance companies, and 3) the specific challenges faced by physicians in training on the Island. We discuss the role of coloniality in fostering these factors and how it serves as the backdrop for the problem faced by the Island.
    MeSH term(s) Humans ; Puerto Rico ; Delivery of Health Care ; Surveys and Questionnaires ; Physicians ; Health Personnel
    Language English
    Publishing date 2023-04-06
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 4766-1
    ISSN 1873-5347 ; 0037-7856 ; 0277-9536
    ISSN (online) 1873-5347
    ISSN 0037-7856 ; 0277-9536
    DOI 10.1016/j.socscimed.2023.115888
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 625: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: The impact of Hurricane Maria on Puerto Rico's health system: post-disaster perceptions and experiences of health care providers and administrators.

    Rodríguez-Madera, Sheilla L / Varas-Díaz, Nelson / Padilla, Mark / Grove, Kevin / Rivera-Bustelo, Kariela / Ramos, Jeffrey / Contreras-Ramirez, Violeta / Rivera-Rodríguez, Sergio / Vargas-Molina, Ricardo / Santini, Jose

    Global health research and policy

    2021  Volume 6, Issue 1, Page(s) 44

    Abstract: Background: After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and ... ...

    Abstract Background: After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms. This article addresses how health care professionals and administrators experienced the health care system's collapse and the strategies used by them to meet their communities' health needs.
    Methods: Data were collected between September 2018 and February 2020. Ethnographic observations in health care facilities and semi-structured qualitative interviews with representatives of the health care system were conducted. This paper focuses on data from interviews with health care providers (n = 10) and administrators (n = 10), and an ethnographic visit to a pop-up community clinic. The analysis consisted of systematic thematic coding of the interview transcripts and ethnographic field notes.
    Results: Results provide insight on how participants, who witnessed first-hand the collapse of Puerto Rico's health care system, responded to the crisis after Maria. The prolonged power outage and lack of a disaster management plan were partly responsible for the death of 3,052 individuals who experienced extended interruptions in access to medical care. Participants reported a sense of abandonment by the government and feelings of mistrust. They also described the health sector as chaotic and lacking clear guidelines on how to provide services or cope with personal crises while working under extreme conditions. In such circumstances, they developed resilient responses to meet communities' health needs (e.g., itinerant acupuncture services, re-locating physicians to local pharmacies).
    Conclusions: Participants' narratives emphasize that the management of Hurricane Maria was fraught with political and economic constraints affecting Puerto Rico. Ineffective planning and post-Maria responses of the local and federal governments were determinants of the disaster's impact. The findings contribute to a growing scientific literature indicating that Hurricane Maria revealed 'the collapse before the collapse,' alluding to the structural deficiencies that presaged the catastrophic event. In the context of governmental abandonment, the authors argue for the importance of developing alternative strategies in post-disaster health care provision among health professionals and administrators who work at the front lines of recovery.
    MeSH term(s) Ambulatory Care Facilities ; Cyclonic Storms ; Disasters ; Health Personnel ; Humans ; Perception ; Puerto Rico ; United States
    Language English
    Publishing date 2021-11-10
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ISSN 2397-0642
    ISSN (online) 2397-0642
    DOI 10.1186/s41256-021-00228-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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