Tracking Immobilities: Explorations of In-Access to Healthcare Resources Among South African Labor Migrants

Labor migrants have long been blamed as vectors of infection. As a clinician-ethnographer studying mobile populations living with HIV/TB, I see my informants not as vectors but rather as one mobile component amidst a broken system in which many components do not move. Through ethnography, I reframe the fundamental question about health and migration to ask: Given that the majority of Xhosa-speaking South Africans are on the move between the Eastern and Western Cape provinces as they seek livelihoods in an era of tremendous unemployment and economic uncertainty, what is effectively circulating with them, and what is failing to move? Even as remittances, family members, commodities, and infections travel with these migrants, the immobility of medical records, clinical protocols, and public health resources (material and personnel) interfere with migrants' access to healthcare, including but not limited to HIV/TB treatment. The mobility and immobility of various elements along these migrants’ route is poorly understood. To work toward more continuous access to care and treatment for mobile South African populations searching for work or other forms of livelihood, we must consider how policy and planning decisions are restricting certain flows and thereby leaving sick migrants to move between vastly disparate medical landscapes.