This paper utilizes eighteen months of ethnographic and interview research undertaken in 2003 and 2004 as well as follow-up fieldwork from 2005 to 2007 to explore the sociocultural factors affecting the interactions and barriers between U.S. biomedical professionals and their unauthorized Mexican migrant patients. The participants include unauthorized indigenous Triqui migrants along a transnational circuit from the mountains of Oaxaca, Mexico, to central California, to northwest Washington State and the physicians and nurses staffing the clinics serving Triqui people in these locations. The data show that social and economic structures in health care and subtle cultural factors in biomedicine keep medical professionals from seeing the social determinants of suffering of their unauthorized migrant patients. These barriers lead clinicians inadvertently to blame their patients - specifically their biology or behavior - for their suffering. This paper challenges the focus of mainstream cultural competency training by showing that it is not the culture of the patient, but rather the structure and culture of biomedicine that form the primary barriers to effective multicultural health care. © 2011 Elsevier Ltd.

Physician-patient relationship US-Mexico migration culture Farm workers barriers to health care Unauthorized immigration Biomedicine Indigenous Mexican migrants Clinical gaze

Vulnerable Populations Health Personnel doctor patient relation ethnographic research multiculturalism cultural tradition poverty Health Status Disparities agricultural worker follow up human immigration health belief medically underserved Agriculture communication skill participant observation Cultural Competency funding Mexico Indians, Central American cultural competence indigenous population interview United States foreign worker Attitude of Health Personnel Oaxaca Humans California male female medical record cultural factor Article work schedule health care health care access international migration Mexico [North America] Sociology, Medical Transients and Migrants Washington [United States] illegal immigrant Health Services Accessibility