“They think we wear loincloths”: Spatial stigma, coloniality, and physician migration in Puerto Rico


Puerto Rico (PR) is facing an unprecedented healthcare crisis due to accelerating migration of physicians to the mainland United States (US), leaving residents with diminishing healthcare and excessively long provider wait times. While scholars and journalists have identified economic factors driving physician migration, our study analyzes the effects of spatial stigma within the broader context of coloniality as unexamined dimensions of physician loss. Drawing on 50 semi-structured interviews with physicians throughout PR and the US, we identified how stigmatizing meanings are attached to PR, its people, and its biomedical system, often incorporating colonial notions of the island’s presumed backwardness, lagging medical technology, and lack of cutting-edge career opportunities. We conclude that in addition to economically motivated policies, efforts to curb physician migration should also address globally circulating ideas about PR, acknowledge their roots in coloniality, and valorize local responses to the crisis that are in danger of being lost to history.

A damaged hallway looked through a window
A public hospital hallway shows severe damage two years after Hurricane María, demonstrating the ongoing abandonment of biomedical infrastructure under coloniality in Puerto Rico.” Photo by Mark Padilla.
A mural of a woman crouching down in front of trees and water
A women-centered mutual aid initiative in the island of Vieques features a mural that protests biomedical abandonment, demanding ‘A hospital for Vieques NOW!’” Photo by Mark Padilla.