Through our own eyes and voices: The experiences of those "left-behind" in rural, indigenous migrant-sending communities in western Guatemala.

Migration from Central America to the United States has become a strategy to escape economic poverty, exclusionary state policies and violence for people of Mayan descent. Under the principles Community Based Participatory Research, we explored the health concerns of Indigenous Mayans in rural migrant-sending communities of Guatemala using their own visual images and narratives through a Social Constructivist lens. Half of households in the study region have at least one member emigrated to the United States, making many "transnational families." Focus groups and photographs and narratives from 20 Photovoice participants, aged 16-65, revealed significant health challenges related to conditions of poverty. Drivers of immigration to the United States included lack of access to healthcare, lack of economic opportunity, and an inability to pay for children's education. Health implications of living in communities "left-behind" to immigration centered around changes in societal structure and values. Mental health challenges, sadness and loss were experienced by both children and adults left behind. An increase in substance use as a coping mechanism is described as increasingly common, and parental absence leaves aging grandparents raising children with less guidance and supervision. Lack of economic opportunity and parental supervision has left young adults vulnerable to the influence of cartel gangs that are well-established in this region. Findings from this study provide insight into challenges driving immigration, and the health impacts faced by rural, Indigenous communities left behind to international immigration. Results may inform research and interventions addressing disparities and strategies to cope with economic and health challenges.