Health Care and Roots of Migration

**UPDATED 8/12/11**

Her eyes open wide as the words leave my lips: “I´m from the United States.” The woman sitting next to me on the bus in El Progreso, Honduras is middle aged, with a round face and hair tied back in a tight ponytail. She is silent for a moment, looks down at her hands, and replies softly, “You know, I´ve been thinking about going there for a while now."

We get to talking. As it turns out, this woman, Marta*, has spent the last 48 hours watching over her mother`s bedside in the public hospital. Her mother has suffered multiple strokes and has sustained some brain damage. The doctors have told Marta that with a specialty surgery and some expensive medicines, her mother could likely recuperate significantly. But these medical interventions would cost Marta thousands of dollars, which is money she doesn`t have. Work options are scarce in El Progreso and most jobs that are available are low-paying. Charity-funding options are practically nonexistent. Marta sees no option for her family other than to look for ways to earn money with a high-yield.

“If I made it to the US, I would work as a maid, in a restaurant- anything! Anything to make the money to pay for my mother`s medical care.” Marta tells me. In fact, Marta isn´t the only Honduran who is making this calculation. The Honduran health system is supposed to cover the needs of poor Hondurans but suffers from low funding and fragmentation. According to the World Health Organization, over 80% of the population is uninsured and 30% receive no health care. Specialty care and care of chronic conditions are particularly difficult to obtain through public programs. In Honduras, 62% of households don´t even have enough money to pay for basic foodstuffs and yet due to scant health coverage these same Hondurans are being asked to pay high medical costs out of their own pockets. Thus, many families that are dealing with illness begin to look to unauthorized migration as a survival strategy.

But migration itself brings its own risks to the health and well being of Central Americans. Undocumented migrants traveling through Mexico are commonly victims of assaults, robbery, kidnappings, and physical injury. An estimated 40% of Central American women who make the journey are raped. Thousands of migrants die each year while crossing the desert along the US/Mexico border. At the family level, migration implies family separation, which can lead to intrafamilial stress, mental health issues, and family disintegration. Most Central Americans are fully aware of these risks, and take their decisions to migrate in spite of them.

Marta herself admits that she´d rather not have to take the trip northward. “You know, I´m worried. I know the trip is dangerous and I´m really not sure who will take care of my mother when I´m not here…” She pauses and turns to look out the window of the bus at the fields of palm trees rushing by. I know her mind is back in the hospital room, remembering her mother’s groans of pain heard over the whir of a standing fan. I know she is holding back tears. After a moment, she turns back to me. “Yes, it’s a tough choice,” she concludes, “but what else can I do?”

*Name has been changed.