modestly decorated and she wears no jewelry, not even a wedding
ring. These visual markers of financial hardship support her mentions
throughout the interview that money problems are significant
in her life due to the fact her whole family lives off her
husband's meager disability checks. The flea markets offer a
cheaper (although largely unsupervised) way for Ana María to buy
her diabetes medications, as well as any other medicines she needs.
I frequented local flea markets in South Texas during my fieldwork,
but had never seen anything medical for sale other than old
crutches and color contact lenses. When I asked a friend, Jorge, who
was born and raised in South Texas why I never saw any prescription
drugs he said, “Well, you need to know who to ask. And
you need to ask in Spanish. Plus they might be worried you're the
FDA or something since you're white.” Jorge highlights that this
illicit prescription drug access strategy is not necessarily available
to non-Mexican Americans. Knowing who to ask, and how, is
learned through familial capital and requires linguistic and navigational
capital that is available to South Texas Mexican American
communities. Whiteness is often associated with law, immigration,
and other types of enforcement agencies.
The flea market strategy is an important illicit access avenue for
many participants, however, like cross-border strategies, it is
accompanied by risks. The majority of healthcare providers
participating in this study cautiously defend illicit access strategies
for those patients who have few alternatives but temper their
support by expressing fears over potential health complications.
Illicit means are not an ideal healthcare access strategy in the eyes
of either providers or patients and caregivers. However, given cost
barriers to alternative options, using local forms of CHC to get
prescriptions at flea markets remains an instrumental prescription
drug access strategy for Mexican Americans
.
4.4. Navigating community medicine and aid programs
For Mexican American patients seeking non-illicit access to
cheaper prescription drugs in the U.S., there are prescription aid
programs in which they may seek enrollment. Pharmaceutical
companies, community clinics, and the Texas Department of State
Health Services manage programs to make reduced cost prescription
drugs available to low-income patients. Patients and caregivers
work with healthcare professionals at community organizations,
especially community health clinics, to enroll patients into assistance
programs. But many prescription aid programs, including the
Department of State Health and pharmaceutical companysponsored
aid, require U.S. citizenship, excluding many lowincome
immigrant patients.
Stephanie Guerrero, the director of a small primary care clinic
serving uninsured patients in South Texas, describes howexcluding
immigrants from pharmaceutical assistance programs places her
clinic in a difficult position,