Abstract
Relying on the experiences of migrant patients, research on migration and health in South Africa has documented a particular concern with public health care providers as indiscriminately practicing ‘medical xenophobia’. This article argues that there is more complexity, ambivalence, and a range of possible experiences of non-nationals in South Africa’s public health care system than the current extant literature on ‘medical xenophobia’ has suggested. Based upon in-depth interviews with frontline health care providers and participant observation at a public health care clinic in Musina sub-District, this article demonstrates how discretion may play a crucial role in inclusive health care delivery to migrants in a country marred by high xenophobic sentiment. It finds that in spite of several institutional and policy-related challenges, frontline health care providers in Musina provided public health care services and HIV treatment to black African migrants who are often at the receiving end of xenophobic sentiment and violence. The article concludes that citizenship, nationality or legal status alone do not appear to tell us much as ‘bureaucratic incorporation’ and ‘therapeutic citizenship’ are some of the modalities through which migrants are constantly being (re)defined by some of South Africa’s health care providers.
Highlights
The fieldwork for this article began with the expectation that the investigation focusing on health care providers would reveal their practices to be exclusionary and xenophobic
In an ambivalent system that pushes them to deny care through ‘hidden bureaucratic barriers’ (Marrow, 2012, p. 847), an action that may be inconsistent with their values, this kind of bureaucratic incorporation is characterized by instances where health care providers struggle to cope and resist, yet subscribe to an ethos of ‘what is right for the patient’ (Walter and Schillinger, 2004)
This article focuses on the interactions between frontline health care providers with three categories of migrant patients living with Human Immunodeficiency Virus (HIV) and on antiretroviral treatment (ART): undocumented migrants; migrants without referral letters (‘self referrals’); and non-native speaking migrants in Musina, South Africa
Summary
The fieldwork for this article began with the expectation that the investigation focusing on health care providers would reveal their practices to be exclusionary and xenophobic.
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