Masculinity and undocumented labor migration: injured latino day laborers in San Francisco

Abstract

Drawing on data collected through clinical practice and ethnographic fieldwork, this study examines the experience of injury, illness and disability among undocumented Latino day laborers in San Francisco. We demonstrate how constructions of masculine identity organize the experience of embodied social suffering among workers who are rendered vulnerable by the structural conditions of undocumented immigrant status. Theoretical concepts from critical medical anthropology and gender studies extend the scholarly analysis of structural violence beyond the primarily economic to uncover how it is embodied at the intimate level as a gendered experience of personal and familial crisis, involving love, respect, betrayal and patriarchal failure. A clinical ethnographic focus on socially structured patriarchal suffering elucidates the causal relationship between macro-forces and individual action with a fuller appreciation of the impact of culture and everyday lived experience.

Introduction

Fieldnotes

Estefan, a young Mayan Mexican farmer crossed the US border without papers in 1999 to support his wife and two children as a day laborer in San Francisco. While working for an uninsured roofing contractor he overturned a bucket of hot tar, scalding his face and upper body. Several weeks later, still recuperating in a homeless shelter and disfigured by scars from burns to 60% of his face, he reflects on his responsibility to provide for his family:

I am sad but I give thanks to God. Because blind—then we are not complete. I would not be fit to serve my family. Left with one hand, I would not be fit for anything. With one foot I would not be fit before God. Better that I go all at once; that I am not here sufferingy…I would kill myself. I really think that I would.

Early each morning, throughout the 1990s and 2000s, the sidewalks along the central boulevard leading to the freeway in San Francisco’s predominantly Latino immigrant neighborhood known as the Mission District filled with Latino men seeking employment from passing motorists. As untrained temporary day laborers in many of the United States’ most hazardous industries, these undocumented day laborers are at disproportionately high risk for work injury (Walter, Bourgois, Loinaz, & Schillinger, 2002). The clinical and statistical literature identifies immigrant Latino workers as having almost double the occupational injury rate of the US labor force (12.2/100 versus 7.1/100) (del Pinal, 1996; Pransky et al., 2002). In many European countries immigrants suffer more than twice the rate of injury of native-born workers (Bollini & Siem, 1995, Table 4). There have been repeated calls for health care providers to address the special cultural needs of immigrant workers and their families. Public health needs to address the inequalities that expose immigrants and ethnic minorities in industrialized countries to dangerous working conditions and impede their access to services and legal protection (Bollini & Siem, 1995; Felton, 2000; Siem, 1997).

Drawing on participant observation fieldwork and community-based clinical care among injured day laborers in San Francisco, we examine the cultural experience of occupational injury through the lens of gender. Specifically, we argue that cultural constructions of patriarchal masculinity among undocumented Latino day laborers organize their sense of self-worth and define their experience of poverty and social marginalization. This dynamic emerges especially clearly when immigrant workers become disabled and are unable to fulfill their masculine obligations of maintaining their families economically in their home communities.

Putting gender and family relations at the center of the experience of work injury clarifies the linkages between structural forces and intimate suffering at the level of the individual. On a theoretical and methodological level, we take up the call of the clinically based anthropologist Paul Farmer to develop an ethnography of socially structured inequality—what he calls “structural violence”—from a medical anthropology perspective by focusing on the embodiment of macro-forces that result in distinct patterns of social suffering (Farmer, 2004). A close examination of how this process is gendered reveals how culture shapes not only the experience of illness and injury but structural forces themselves. It highlights the causal linkages between macro-dynamics and individual action with full attention to the nuances of culture and lived experience.

Clinically based ethnographies can provide privileged access to data on social suffering and reveal how structural forces relate in an embodied manner to individual action because the clinic is a site where people reveal the most intimate dimensions of their physical and emotional distress. The gendered experience of the international migrant labor system is rarely assessed in policy-making; nor is it systematically addressed in medical therapeutics, whether it be in occupational health, primary care clinics, or county hospital emergency rooms and psychiatric wards. By broadening the scope of analysis to the family and to definitions of gendered worth, we can show how the injury of an undocumented worker in the United States has material and emotional ramifications that ripple outwards to affect families and communities in distant settings. The physical and/or psychological ailments being treated clinically are often only the tip of an iceberg that is shaped by specific cultural patterns rooted in globally structured political economic power relations that are usually experienced intimately as a moral existential crisis.

The political economy of undocumented labor migration in California

In the early 2000s San Francisco’s day laborers are part of California’s estimated 2.3 million undocumented immigrants (Passel, 2002) who are essential to the economies of California as well as those of Mexico and Central America. A contradictory dualism underlies the laws and populist nationalist sentiments that structure the conditions for undocumented workers. Public policy waxed and waned throughout the 20th century between repression and tolerance, usually in response to economic cycles and political exigencies. On the one hand, nationalist and often racist hostility towards immigrants identifies the undocumented as unwanted parasites draining social services and stealing jobs from the native born. On the other hand, business and political leaders are keenly aware of the economic imperative of maintaining a flow of low-wage, undocumented laborers to lower production and service costs.

In the 1970s the sociologist Michael Burawoy (1976) compared the dynamic of undocumented Mexican migration to California to the migrant labor market system of South Africa mandated formally by apartheid. By separating migrant workers from their families, the receiving economy displaces the burden of reproducing its labor force. The cost of creating and supporting a family, including the education and healthcare of children, spouses and elders is shouldered by the home community that sends the migrants. In the case of California, child rearing, education, pediatric health, as well as retirement and disability care are charged in pesos—not dollars—and accrued to Mexico—not the United States. Unhealthy, disabled, problematic, and superannuated workers can be legally deported. The externalization of those reproduction and labor discipline costs onto a cheaper, non-industrialized country results in lower wages for migrant laborers and has represented a boon to the US economy.

As Burawoy notes, the separation between worker and family in both South Africa and the United States must be actively maintained through “structures of coercion” (Burawoy, 1976). In California at the turn of the 21st century, for example, the Border Patrol of the Immigration and Naturalization Services (INS) made some 1.5 million arrests per year (Heyman, 2000). Each year, several hundred would-be immigrants die attempting to cross the border illegally in often remote settings, from drowning, exposure, suffocation, traffic accidents and criminal violence (Hastings, 2000). This ensured that only the physically and emotionally strongest young migrants succeeded in crossing the border to join the US labor force. Children, the elderly, the disabled and the fearful are discouraged from even attempting to enter the country.

A contradictory policy combines aggressive enforcement of border control with partial tolerance for the presence of undocumented migrants in the workplace coupled with limits on their legal civil rights. Employer sanctions are confined to warnings or relatively small fines and are inconsistently enforced. As a result, a large, continuously replenished supply of highly motivated inexpensive and healthy laborers with minimal social entitlements is available for employment in low wage industries, most of which have high rates of occupational injuries such as agriculture, meatpacking, and the construction trades.¹

Participant-observation methods

Cultural anthropology’s methods of participant-observation in a natural setting over the long-term are an effective way to study socially marginal population groups which avoid institutional contact out of fear of legal or cultural sanction. While training as a medical student, the first author (Walter) immersed himself as deeply as possible for eight months into the everyday lives of undocumented laborers. He interacted with hundreds of day laborers in the course of fieldwork but focused intensively on four distinct social networks of immigrants totaling approximately 40 individuals. With their informed consent, he kept detailed fieldnotes documenting their everyday life and interactions including subtle expressions of emotion displayed through demeanor and body language. Most interviews were conducted as free-flowing conversations in the course of routine daily activities in order to diminish distortions to statements addressing intimate taboo subjects that impact masculine self-esteem. He also treated undocumented day laborers as a resident in internal medicine at the County Hospital where he also took fieldnotes.

The primary author’s ethnographic data was further contextualized by drawing on fieldnotes and transcribed tape recordings prepared by the second author (Bourgois), based on his 12-year relationship to a network of Salvadoran rural immigrants who have sought work on these same street corners. He accompanied them as they sought employment on the boulevard and also repeatedly visited their families in their home communities in rural El Salvador (Bourgois, 2001). Two undocumented Salvadorans lived in Bourgois’ San Francisco home for a total of a year and a half. Finally, further comparison and contextualization was obtained through the clinical experience of the third author (Loinaz), an internal medicine physician who has worked for over 15 years with San Francisco’s undocumented day laborers in homeless shelters, at a street-based labor exchange program and in primary care clinics. She is herself an immigrant from Latin America.

Masculine identity among healthy workers

Feminists and masculinity theorists have demonstrated that male identity is never static. It is a cultural product that is continually reshaped by relationships between individuals as well as by changing macro-power inequalities (Connell, 1995; Gutmann, 1996; Segal, 1990). Masculinity in patriarchal family contexts that prize the authority and respect of senior men is often thrown into crisis by labor migration under the kinds of coercive conditions prevailing in the United States and South Africa (Bourgois, 2003, Chapter 8; Ngwane, 2001). The day laborers we worked with in San Francisco’s Mission District do not share a single, monolithic male identity. They are of different ethnicities, ages, geographic, class and educational back-grounds. They all share, however, a common motivation for their migration, and they endure similar economic and cultural stresses while injured in the United States.

Almost all of the day laborers report that they came to the United States driven by economic crisis primarily to support their families left behind in Mexico or Central America. Upon arrival they usually find themselves homeless and unemployed. They spend their daylight hours waiting on corners where there are usually ten times more laborers than jobs available. The competition for employment is compounded by the insecurity and unpredictability of life on the street as an illegal immigrant. They generally avoid contact, especially at first, with public institutions including health services, fearing that they might attract the attention of law enforcement or the INS.

Standing on the corner unemployed, they worry about their evident outsider status, racialized Latino ethnicity and often disheveled appearance. Most of the men strive to make friendly eye contact, waving and smiling at cars which slow down or stop at traffic lights. They attempt to stand politely but firmly in order to project the image of having a strong, healthy body eager for hard, honest labor. This stylized posture conveying masculine strength, but contradictorily also docility, makes them susceptible to humiliation when passers-by occasionally taunt them. They frequently discuss how they might be perceived by the flow of passing drivers and they are ashamed of the fact that some people mistake them for “lazy good-for-nothings [vagos],” drunks or drug addicts.

The competition, insecurity and public embarrassment of tenuous survival on the street creates an underlying condition of chronic anxiety among unemployed migrants. Many feel that their identities both as Latinos and as men are under assault. One common response among the majority of those who are Mexican is to cultivate a hyper-male identity that outwardly embraces an image of responsible machismo in the heroic Mexican nationalist sense described by anthro-pologists of Mexico (Gutmann, 1996; Limón, 1994; Lomnitz-Adler, 1992). They consider themselves to be “men of honor,” courageous, stoic and generous for the welfare of their families and the dignity of their nation. The term of highest respect day laborers use for a compatriot is “very hard worker [muy trabajador].” The converse is the frequently invoked invective: “soft [flojo]” or “lazy, good-for-nothing [vago].” The value placed on a male, hardworking identity becomes a bulwark for maintaining self-esteem and countering the awkwardness of being obliged to offer eagerly one’s labor power on the street corner to a sometimes hostile public. Asserting themselves as tough, but hard-working Mexican men, they consequently, resist their structural vulnerability in a historically evolved low wage labor migration system that denies them citizens’ rights.

This is the case, for Mario, a 44-year-old man from Mexico City who came to the United States because he was unable to support his five children on the four to five dollars per day he earned in construction in Mexico. His incapacity as primary provider in Mexico is further impugned by the fact that his family is unable to afford their own home. They reside with Mario’s mother-in-law. He reports that work in the United States has been irregular, nevertheless he is consistently able to send $250 home every two weeks. He is especially proud of the fact that his wife no longer has to work for a wage outside the home:

Mexicans like us, a lot of the time we will say that the gringos are wimps [pinche guevones]. They don’t go out to the fields. They don’t work themselves to the bone like us.

Take a look at the growing fields—it is always only [puro] Latinos, pure Latinos. You don’t see a single Asian, a single African American, a single American-North American.

You’re always going to see only Latinos busting their asses. But in the offices, there you’re going to see pure gringos, pure gringos. But go to the fields and you’ll never see a gringo there screwing up his back [jodiendose el lomo].

Mario’s statement captures a conflicted sense of wronged male identity. In one sense, by adopting a traditional masculine identity that emphasizes physical strength, Mario resists the insults of the host society and the structural violence of a discriminatory labor market. With a nationalistic edge he angrily impugns the virility of the “pinche guevon gringo wimp,” suggesting they are not man enough to work like Mexicans. Mario’s pride in his toughness and virility, however, is double-edged. Implicit in his statement is a recognition that his value to US society is restricted to his brawn. Significantly, the word he uses for “back” is lomo, a term more commonly used for farm animals or a cut of meat than for human anatomy.

Mario is keenly aware of his low status on society’s bottom rung. He sees himself as enduring this position for the sake of improving his son’s life prospects back in Mexico City and he talks with pride about financing his son’s education through high school. “I’m going down; he is going up.” Nevertheless, Mario embraces the role of hard manual laborer with a sense of pride at his toughness, determination and sacrifice for his family.

Workers as providers

The pride day laborers exhibit in their work ethic is matched with a sense of themselves as successful patriarchal providers. Estefan, a 27-year-old indigenous farmer from rural Chiapas in Southern Mexico explains that he left home because low crop prices and ecological degradation made farming “almost pointless” following the North American Free Trade Agreement in 1994. His family’s diet was restricted to staples. There was no money to buy new clothes or pay for the education of his three young children. By working in San Francisco, Estefan plans to invest in land and cattle that he hopes will provide a sustainable income for his family upon his return.

Being indigenous marks Estefan as different within the day laborer community. He is darker skinned than most and prefers to speak Tzetzal, his Mayan language with other immigrants from his community rather than Spanish with the mestizo majority. Non-indigenous workers frequently comment unselfconsciously that “Indios” are “ignorant and backwards [atrasados]” and have a “low cultural level [bajo nivel cultural].”

You come with the idea of getting yourself out, lightening things for the family. There in Chiapas there is nothing. Before, the land gave a little. We planted beans and chili peppers, but now it has been five years that the land doesn’t give anything. There is a lot of plague and prices are low.

When someone gets sick there is no money. Even though you are working sometimes there is not enough to eat. Sometimes you just make enough for your lunch, but you can’t prosper and lift yourself up. That’s why you come here, with the goal of raising yourself up a bit.

Like Mario, Estefan does not want his wife to work outside the home for wages. When pressed on the subject he asserts, “The man is the only arm of the family [el hombre es el único brazo de la familia].” This patriarchal definition of the male, head-of-household as primary provider develops exaggerated importance for day laborers because of the hardships and danger they undergo in order to fulfill that masculine script. The choice to leave home and migrate North in search of employment involves risks and costs. Migrants usually incur thousands of dollars in debt and sometimes risk their lives in order to make the illegal passage. Once in the United States, success is by no means assured. In some cases, workers migrate against the wishes of their spouses or families. Finding work that enables them to send money home, consequently, becomes a vindication of the choice they made to come to the United States. It legitimates them as patriarchs and providers and offers a sense of purpose, helping them endure homelessness and/or cold rainy days without work on the street corner punctuated on occasion by public ridicule.

The centrality of the role of family provider to masculine identity is further enhanced by Mexican popular images of migration. Venturing to the United States for work is respected as a constructive, legitimate and important contribution to the household. Men and women—but especially men—who make the arduous and dangerous journey North are appreciated and admired for their sacrifices and for their courage.² In a speech, for example, the President of Mexico, Vicente Fox referred to labor migrants as “heroes” (Martin & Teitelbaum, 2001). The position of migrant workers in the collective imagination of Mexico was also captured in Western Union commercials aired on Mexican television in the early 2000s. Stirring music plays as handsome and dignified Mexican men and women in Chicago, Detroit and Houston gaze up soulfully from their position on the assembly line into the camera. A voice-over explains, “They sacrifice because of their dedication to their familiesy… Only Western Union should be entrusted to transmit the fruits of their labor home”. These images and family ideologies allow day laborers to frame their experiences as honorable masculine sacrifice and maintain a sense of dignity for their responsible patriarchal family commitment.

The worker as absent father

The day laborers’ sense of worthy male sacrifice is frequently accompanied by a contradictory anxiety over the ramifications of having “abandoned” their families—especially when they have young children. As long as they are able to work and generate income, they usually manage to maintain an uneasy tension between their success at providing for the family materially—as a good man should—versus their failure to be emotionally engaged fathers overseeing the discipline and well-being of their spouses and children. Many, like Estefan, fear that by leaving home to provide materially they may have abdicated paternal responsibilities:

It has already been a year since I left and I would like to go and see my children. When you’re not there it is not the same. Well, they have their mother, but it is not the same as a father. No!

Like if something happens to the children, if they get sick, you’re right there ready to take care of it. I’ll be the one to think where to take them. A woman just isn’t the same. A woman has responsibility, too, but the father always has more.

A father, well, is the head of the family and because of that I thinky… because of that I want to go back. My children are still young. Right now they’re so small and tender.

One subtext in Estefan’s patriarchal concern for his children and sense of missing them and even of failing them by being absent, is the unstated fear that perhaps his position as head-of-household is not irreplaceable. What if the family does get on well without him? His position as “the only arm of the family” might be threatened.

The fathers seeking work on the street corner are often missing the most significant milestones of their children’s development: childbirth, first birthdays, first steps, first days of school, etc. Workers talk about the pain of being distant for these liminal events as well as the stress of being absent in times of family crisis. One worker’s oldest son had a seizure disorder and he was worried about being away from home should a medical emergency arise. Mario, for example, became distressed by his helplessness on learning over the telephone that his son had dropped out of high school. He expresses his sense of anxiety over having “abandoned” his family in the idiom of the Latino psychiatric condition popularly referred to as nervios.

I’m just floundering here. I don’t know if it is my nerves or because I left my family abandonedy… Well, not abandoned. Because they have everything. I give them everything that they ask for.

But I have to stay here to struggle to take us forward. Ay! We are very poor. We don’t have much money.

Mario feels guilty that in coming North to provide materially for his family he has sacrificed his responsibility to have an emotional connection and to provide guidance to his children. “Like helping my son with his homework. My [wife and children] lack the help that a family requires. Support for the kids…comes from the father.” The Latino folk diagnosis of nervios has been recognized as a culture-bound syndrome by the American Psychiatric Association (American Psychiatric Association, 1994; Lewis-Fernández, Guarnaccia, Martinez, Salman, Schmidt, & Liebowitz, 2002). It is a particularly interesting diagnosis because it reveals the popular understanding of the somatization of distress and it usually affects women, often revolving around violations of culturally scripted gender roles. It can often apply as well to men who fail to live up to masculine cultural scripts (cf. Bourgois, 2003, pp. 300–301).

Many of the men found the tension between material and emotional patriarchal responsibility to be wrenching. These conflicting material and ideological exigencies often translated into interpersonal conflict as in Estefan’s case:

It makes me sad. The children tell me [by telephone] “come home Papi, come home already.”

“I’m coming, I’m coming,” I tell them.

“No! Really come home, Papi. I love you a lot. Come and we’ll eat chicken, we’ll have posole,” they say.

“I’m going,” I tell them. But I never go.

And she [Estefan’s wife] says, “Come home now. Come see your children.”

“No,” I tell her. “I want to save a little bit more,” I tell her.

“It is more important that you are with your children” she tells me.

And that is that! Ah, it is more important to have your children than money. But when you can, you have to take advantage of the opportunity.

But the children and your parents are always the most important thing in life. Because if you go around only thinking about moneyy…

After he was injured in his roofing accident described in the opening vignette, Estefan decided that being present with his family was indeed the higher priority and he returned to Chiapas. In contrast, when Mario injured his back he did not return to Mexico, despite his anxiety over his son dropping out of high school. Instead, he became increasingly engulfed in his loneliness:

They [the family] feed you and nurture you, not like here where you only have a telephone card and you talk to them.

And sometimes if you can’t afford a card and you want to talk to them the loneliness gets to you. For us illegals…even the manliest men [los hombres mas hombre] cry because the loneliness is a bitch [la soledad es cabrona].

The no-longer-tough worker

When workers are injured, their male identity is doubly assaulted. The delicate balance between their sense of patriarchal accomplishment at generating income for the family versus their shame at “abandoning” their wife and children collapses. Injured workers suddenly fail both as providers and as engaged fathers. When their worthwhile masculine identity collapses, day laborers fall into a personal crisis that often manifests in depression and anxiety—sometimes as nervios.

The shame at being a “weak” man is intensified by the pragmatic competition for jobs in the lowest rungs of the labor market. When employers pull to the curb, prospective workers crowd around their vehicle jostling for visibility. Any suggestion of physical impairment dooms one’s chances for employment.

Pedro, a 46-year-old former small businessman from Hidalgo tries to hide his back injury on the day laboror corner in San Francisco. Raised in poverty, he had started his own furniture store and built it into a thriving business. His life collapsed, however, when his wife took their conjugal assets and disappeared with another man, leaving him with their baby daughter. Pedro gave the infant to his mother and spent six years “lost in alcohol, sleeping in the gutter.” Eventually he stopped drinking and reconciled with his mother and daughter. Over the past eight years in order to support them, he has made several short trips to the United States, working in Minneapolis, Chicago and Los Angeles. Pedro had badly injured his back in a fall from a gravel chute in a mine in Mexico eight years ago and re-injured it while shoveling gravel (coincidentally) on a construction site in San Francisco:

You’re thinking: what if the boss says to me, “Hey bring me that cement block” and you have to say, “I can’t do it.”

At the moment that you say, “I won’t do it because I can’t;” He is going to say to you, “Get outta here!” That simply… that’s what will happen. You just can’t say that you can’t.

Most of the injured workers in this study experience various degrees of moderate disability whose prognosis is often unclear and they worry about what to tell their families over the telephone. How long should they rest? When can they return to work without re-injuring themselves? Should they return home to their country or wait in the US to recover and continue working?

Communicating these fraught circumstances to the family is daunting because as the injured worker informs the family of the economic setback they face, he may have to accept a change in his patriarchal authority. Injured workers, consequently, are often reluctant to be entirely honest with their families, often minimizing the injury, and at other times not mentioning it at all. Communicating with family, for example, is particularly difficult for Pedro because the impetus for his current trip to San Francisco is to raise money for his daughter’s fifteenth party. Known as quinceañeras, 15th birthday celebrations in Mexico and throughout much of Latin America represent an adolescent girl’s official coming-of-age. The ritual party expresses the social status of a family to neighbors, friends, and acquaintances.

As a failed businessman and a recovering alcoholic, abandoned by his wife, Pedro is already on the social margins in Mexico. His daughter’s quinceañera celebration, consequently, is especially important for reasserting his family’s good name. Unable to accumulate sufficient funds to sponsor an impressive celebration, Pedro chose to make yet another trip North. Because of his work accident, Pedro is, once again, going to fail as head of the household and disappoint his daughter and mother.

He stayed in San Francisco to wait for his back to improve. He found work cleaning after sports events at a local stadium, but only two to three days a week and he could not find other light work to fill in his remaining time. Eventually he concluded that he needed to tell his daughter that he would not have the funds to pay for her birthday party.

I told her, “Daughter, I’m going to fail you.” She already knows about my accident and knows that my back is bad.

The one that doesn’t know is my mother. She has a bad heart and I can’t tell her. She will worry more and I don’t want anything to happen to her.

Difficult conversations about injury and disability are exacerbated by the inherent complexities besetting long-distance intimate relationships. Couples are separated for months or years. At best, they talk only intermittently on public telephones. Tensions, misunderstandings and arguments are almost inevitable. In his second year of separation from his wife, Mario is well versed in the nuances of carefully moderated conversation. He feels that his wife weighs every one of his words for potential disloyalty. He discusses the dangers of sounding too ebullient, which might threateningly suggest that he is enjoying himself in the United States, or too low, which might lead the family to believe that he does not enjoy talking to them:

Sometimes, I think “Now she doesn’t love me;” or “She loves me;” or “She is mad at something they did.”

That is why you have to give them some spirit. It is necessary because sometimes the energy is really low or sometimes the energy is really high so it is important to lower it to its normal state. Because it is bad to be really high and bad to be really low. So everything is even keel… nice and mellow.

Contrast between the family’s perception of life in United States and the reality faced by immigrant workers complicates communication. Returning migrants are often conspicuously laden with prestigious consumer items. They downplay the exploitative or humiliating conditions they may have endured and instead portray the United States as a comfortable place to make easy money. This perception combined with the challenges of long-distance communication foments suspicion, doubt and recrimination that is often expressed in terms of masculine, moral worth. When the second author visits families in a rural village in El Salvador whose spouses and/or eldest sons had left for the United States, he frequently encounters expressions of anxiety and embarrassment on the part of spouses and mothers when their sons or husbands fail to send back money or gifts of clothing and other consumer items. Rumors circulate about the sexual infidelities, alcoholism or substance abuse of emigrated sons/brothers/husbands. A woman with two children who has not heard from her absent husband in several years condemns him succinctly: “He doesn’t even send money back to his own mother! That’s the kind of man he is.” In contrast, men who do send remittances are deeply appreciated.

Estefan frequently talks about his wife’s rising sense of distrust during his eight months absence in the United States:

I tell my family, “Don’t think that I am spending the money here. Everything that I make, I send.”

I do everything I can to send it all. It leaves me with very little money. They think that it is a soft life here. They think that you are having a relaxing time up here. That is why so many people from Chiapas are coming to San Francisco.

The unique history of a particular interpersonal relationship informs the concerns of both partners. Pedro is particularly vulnerable because he is a recovering alcoholic and a jilted husband. He knows that if he does not send money and also does not return home, his mother and daughter will be convinced that he is drinking once again. Several months after he re-injured his back, he was still not able to perform heavy labor and his income was only minimal. His sense that his family would doubt his sobriety was one of the key factors that finally caused him to return to Mexico when he was unable to find full-time work due to his chronically injured back.

Injured workers are particularly ill served by popular conceptions of machismo that celebrate male sexual promiscuity. When they fail to send money home it is often assumed that alcohol or adultery must be the cause. These concerns are not baseless. Some workers do patronize sex workers, have girlfriends or a second wife and new children. Reciprocally, workers in San Francisco are also concerned about the sexual activities of the wives they have left behind. As time passes and suspicion accumulates, it becomes increasingly difficult to face distant distrustful families. Speaking as an experienced migrant laborer who has made several trips to the United States in the past, Pedro explains that eventually the injured worker who is unable to send remittances home either feels that he cannot return home or is rejected by his family:

There are people who can’t handle it, that get sick or can’t work or have no money and they leave their families waiting and soon they won’t be able to go home.

What I’m saying is that if you let too much time pass, for example if I could wait out a year or more, then you know “My family is not going to want me. They are going to reject me.”

So right now, with this problem, [pointing to his injured back] I prefer to return there and say to them, “I came, mother, I didn’t accomplish anythingy…”

While none of the workers we spent time with acknowledge having abandoned their families or admit that they might no longer be welcome home should they return, they assume that most long distance immigrant marriages end permanently. They refer disparagingly to compatriots who continually claim they plan on returning “next year,” but never do. Conversely, in rural El Salvador conversations about immigration frequently revolve around stories of men in the village who went North never to be heard from again. As noted, some of the tension day laborers feel in their long distance relationships with wives, children and/or parents and siblings is at least latently present before they emigrate. The structural political economic situation that forces men to leave families and to labor thousands of miles away, however, superimposes a significant added burden of stress and anxiety upon already fraught relationships.

Antonio, a 35-year-old man from Vera Cruz, Mexico, reflects on these stresses as his marriage disintegrated over the telephone. He has worked for many years in his home state as a piano teacher and security guard but even with his wife’s income as a nurse they were barely making ends meet. His decision to come to the United States was directly prompted by his mother’s health crisis; she was diagnosed with “cysts” in the brain. The family faced a choice between surgery at the public hospital using a standard procedure, or surgery in a private hospital with more modern equipment. They chose the latter and Antonio’s mother recovered successfully, but the cost of the operation left them with a debt of $5000. Antonio came to the United States to attempt to keep the family solvent. Initially he was able to send money regularly, enabling his wife to return to school for an advanced nursing degree. Riding his bicycle to work, in downtown San Francisco, Antonio collided with a car door as it was being opened by a parked driver. The crash separated his shoulder and he was unable to work for six weeks:

I talk to her every two weeks, but it is logical that the distance causes problems, no? So now it seems like there might be a breakup because of the distance. Well, it’s logical I think that she has started to doubt, no?

You know that if you have supported her economically and then all of a sudden there is nothing, she starts to doubt: “What’s going on? Maybe there is another woman”

And that might ruin the relationship, no? It is hard for us to stay together because even though I want to bring her here it would be hard for her to enter, despite her professional degree.

Antonio considers returning to Mexico to save his marriage, but feels bound by the family debt caused by his mother’s brain surgery. He is torn by his multiple, competing patriarchal responsibilities, none of which he is able to fulfill since injuring his shoulder:

Well, if I go back I could arrange my life with my wife, no? But I’m also aware of my mother’s operation and if my father felt left without support right now he might have nerve problems or heart problems because it is a really big debt.

So it is hard to make the decision. Logic tells me that it will probably ruin the relationship with her, because of the distance and the time.

But I can’t abandon my father like this, because it was my parents that brought me into this world. And thank God that my mother is living, no?

I can’t support my wife and abandon my parents with the debt that they owe…with the interest building up.

So it is most likely that I will lose my wife. I think that if I go back it will be mostly to sign the papers. Because she isn’t a piece of furniture, right?

Beyond blaming the victim and treating isolated bodies

The combination of the assault on male identity and intense family stress can be devastating for disabled day laborers who live in shelters without a trusted emotional support network. The third author has observed the negative health consequences in 15 years of practice as a primary care doctor for this population. She has diagnosed a high incidence of depression and substance abuse connected to injury and disability. In the absence of adequate emotional support, injured day laborers are at risk for spiraling into psychiatric illness as suggested by Mario’s reference to his nervios. Some engage self-destructive behavior such as substance abuse or inter-personal violence. As the transcripts reveal, many of the men draw a direct connection to somatized distress, both for themselves and for family members at home: Hence, Antonio worries that his father’s “nerve problems or heart problems” will be exacerbated “because it is a really big debt;” and Pedro does not tell his mother he injured his back because “she has a bad heart.” In a parallel study of homeless addicts, the second author has documented that crack and heroin distributors systematically recruit unemployed, monolingual Spanish-speaking undocumented immigrants for hand-to-hand street sales operations which entail the highest risk of arrest and violence. Many also fall prey to substance abuse—especially crack (Bourgois, 1998). While working in the Emergency Department of the County Hospital, the first author witnessed the consequences for new immigrants who had found work in the drug trade: from being the brunt of violence to self-mutilation with razor blades after crack use.

This ethnographic case study of the gendered experience of occupational injury provides a view into the complex ways in which cultural and material forces are embodied in the lives of individuals who have been rendered vulnerable to specific patterns of personal distress due to their sociallocationinahistorically evolvedsystemof labor migration. The concept of structural violence is useful here because Latino—and especially Mexican and Central American—migration to the United States is driven by a combination of historically embedded market forces that make subsistence survival difficult in the sending countries and also by political coercion in the receiving country that maintains labor costs artificially low and labor discipline exceptionally high.

Nineteenth century intellectual and political critics of the social costs of the rise of modern industrial capitalism drew an analytical connection between the political economy of labor relations and violence. Frederick Engels referred to the “social murder” of the English working class and identified it as being “y as violent as if they had been stabbed or shot (Engels, 1968, p. 108).” Rudolph Virchow the founder of cellular pathology in medicine and a leading figure in what became social epidemiology documented quantitatively the health implications of socioeconomic inequality: “Medical statistics will be our standard of measurement: we will weigh life for life and see where the dead lie thicker, among the workers or among the privileged” (Virchow 1848, cited in Farmer, 1999, p. 1). The term “structural violence” as a formal social science concept, however, was not coined in academic circles until the late 1960s in Scandinavia (Galtung, 1969). It represented a social democratic alternative to Cold War definitions of human rights and called special attention to the social suffering caused by the unequal relationship between industrialized and non-industrialized nations. In the 1970s and 1980s the term was taken in a more radical, populist direction by Catholic liberation theologians not only to critique free market capitalism and colonialism, but also dictatorial governments (Consejo Episcopal Latinoamericano, 1973). The concept has been used in the field of health to address disparities and to identify socially structured patterns of distress across population groups from mental health, occupational health and domestic violence to infant mortality (Bourgois, 2001; Martín-Baró, Aron, & Corne, 1994; Scheper-Hughes, 1996). Most eloquently the physician and anthropologist, Farmer made structural violence the centerpiece of his clinically informed ethnographic focus on HIV and multi-drug resistant tuberculosis (Farmer, 2003; see also Scheper-Hughes & Bourgois, 2004).

The concept of structural violence in critical medical anthropology has often implied a linear, economic-reductionist relationship between poverty and ill-health. Furthermore, the precise causal linkages operating at the individual level and expressing themselves physically and psychically in everyday social suffering have largely remained invisible. Our ethnographic data on work injury affirms the centrality of culture in defining the experience of structural violence and it demonstrates the interaction between intimate suffering and social structure. On an applied level our expanded interpretation of how structural violence becomes embodied can contribute to a more wholistic clinical practice that does not confine itself to treating overlapping symptoms of chronic musculoskeletal pain, substance abuse, depression and anxiety which are often ill-defined. On a theoretical and political level, the concept directs attention away from popular and expert discourses that pathologize sick individuals and dismiss unworthy behavior. It also reveals the potential of clinically based ethnography to contribute to social science theory at the interface between structure and agency.