Enacting Life: Dialysis among Undocumented Mexican Immigrants in the U.S.-Mexico Borderlands

Federal policy classifies undocumented immigrants in the United States as ineligible for the majority of publicly funded healthcare services by virtue of their "illegal" status. As a result, those with chronic, debilitating illnesses struggle to find adequate treatment for severe conditions. In this dissertation, I examine the treatment experiences of undocumented Mexican immigrants who suffer from end-stage renal disease (ESRD) in South Texas. Utilizing over two years of fieldwork including participant observation, semi-structured interviews, and case studies with 42 healthcare professionals and 100 Mexican-born dialysis patients (50 undocumented and 50 documented), I employ dialysis as an extreme case study demonstrating the detrimental and fatal consequences that occur when access to care is restricted or denied based on citizenship and legal immigration status.

I trace how undocumented immigrants with ESRD navigate the U.S. healthcare system which seeks to elude them in all but immediate, life-threatening emergencies, leaving them with only one viable option: to become a patient at risk of dying in order to maintain life. I document the ripple effects of exclusion experienced by family members and the healthcare professionals who serve these patients as they must negotiate their role and commitment to their employers, hospital regulations, and the Hippocratic Oath. In dialogue with anthropological work on Foucauldian biopolitics and Agamben's "bare life," with a particular focus on agency, this dissertation contributes theoretically to cultural and medical anthropology by analyzing how categories of exclusion in policy affect immigrant subjects in ways that produce or prolong social and/or physical suffering.