Healthcare, intimacy, and gratitude: Haitian immigrants in the U.S. health system

Healthcare institutions are intimate sites where bodily vulnerability, care, and state power intersect. Yet scholarship on immigrant healthcare has primarily focused on structural barriers and the negative emotional consequences of exclusion, paying less attention to the role of positive affect in how immigrants experience and navigate unequal systems of care. Drawing on fifteen months of ethnographic observations in clinical settings and fifteen semi-structured interviews with Haitian immigrants in upstate New York, and using affective citizenship as the analytical framework, I examine gratitude in this article. I argue that gratitude operates as an affective practice through which Haitian immigrants navigate conditional forms of inclusion within U.S. healthcare institutions. First, I show that gratitude is the dominant affect shaping Haitian immigrants' healthcare encounters by examining how it emerges through transnational comparisons with healthcare in Haiti and remains salient in how immigrants interpret negative healthcare experiences and potentially discriminatory treatment. Second, I show how gratitude as an affective practice shapes immigrants’ negotiations of recognition and conditional belonging within healthcare institutions. By centering gratitude, this article expands immigrant healthcare scholarship beyond its predominant focus on structural exclusion and negative affect and draws attention to the affective dimensions of racialized deservingness within everyday healthcare encounters.