25th Anniversary East Coast Migrant Stream Forum

Guest post by Magdalena Fernandez

Last month the North Carolina Community Health Center Association (NCCHCA) was once again proud to host the annual East Coast Migrant Stream Forum.  In celebration of the Forum’s silver anniversary participants were invited to reflect on the theme, “A Rededication to Health Harvests”, as they remembered the rich history of the conference and joined together to create a strong vision for the future of migrant health.

Every year since its inception in 1988, the East Coast Migrant Stream forum has brought together a broad spectrum of migrant health professionals from outreach workers and promotoras to clinicians and administrators representing Migrant/Community Health Centers, community-based and faith-based organizations, as well as government officials from across the nation.  The conference is targeted towards participants from eastern states in order to increase communication and partnerships between organizations that serve farmworkers who migrant in the Eastern Stream.  The fellowship and camaraderie that is inspired through East Coast motivates participants to collaborate and learn from each other in order to better serve their patients. 

This year’s forum hosted 174 participants and 21 innovative workshops that covered a wide range of current issues relevant to migrant health professionals.   Popular workshops included: “Tools for Preventing HIV and STD Infection among Seasonal and Migrant Farmworkers”, “Intensive Outpatient Substance Abuse Treatment Programming in Rural North Carolina”, “Building on Common Ground: How to Strengthen Collaborations among Migrant Health Centers, Hospitals, and Public Health”,  “The H-2A Guestworker Program – An Overview for Migrant Health Care Providers”, “How to Use the Pesticides and Farmworker Health Toolkit in Your Health Center: A Train-the-Trainer Workshop”, “Clinica en el Campo: Taking Medical Care and Medical Residents to the Fields”, and “Promotoras de Salud [Lay-health workers] Promoting Early Breast Cancer Detection, Health Literacy and Care Access in Hispanic Immigrant Communities”.   

In celebration of the conference’s 25th anniversary, the opening plenary featured a panel discussion entitled, “25 years: Reflecting on our Past, Envisioning our Future”.  The panel was composed of five individuals whose dedication to farmworkers has shaped the field of migrant health.  The presenters reflected on the history of migrant health and their experiences working with migrant and seasonal farmworkers and their families.  They then each presented their vision for the future by focusing on five areas of farmworker health: clinical, administrative/programmatic, outreach/ lay health, research, and policy.  The insights of the panelists sparked a great deal of discussion among participants and helped to set a tone of both reflection and innovation for the conference.

Participants also had the opportunity to see a powerful performance of, “The Stories of Cesar Chavez”, performed and written by Los Angeles based actor, Fred Blanco.  Featured in theatrical venues throughout the US and Canada, the one man show employed both humor and drama to bring to life the California farmworker struggle of the 1960s.  From youthful zootsuiters and humble farmworkers to racist teamsters and angry radicals, the audience relived the struggle of the labor movement through a parade of captivating characters.  The bilingual show was developed by Fred Blanco from interviews with members of the Chavez family and other individuals including Dolores Huerta who fought alongside Chavez.  Participants left the show with a deepened appreciation for the great triumphs that came at the price of terrible suffering and sacrifice.

Mark your calendars for next year’s East Coast Migrant Steam Forum to be held October 17-19, location TBD.  It is always an incredible opportunity for migrant health education and networking with fellow migrant health professionals.  Scholarships and special rates are available for students and lay health workers.  For more information on the forum including the full program and educational session handouts, go to www.ncchca.org under calendar.

A Heavy Burden

By Claire Carson, Toxic Free NC/Superfund Research Center Intern 

Several weeks ago, we visited the home of a farmworker, a teenage girl who was nearly four months pregnant. It was a sweltering afternoon, and we sat around the family’s kitchen table snacking on pickled pork rind dusted with chile and lime. When asked if she was taking care of herself during pregnancy, the girl replied that yes, instead of working a full day, she’d only work half days in the fields. I can only imagine the discomfort of working in the fields while pregnant, not to mention the hazards of doing so. Being around pesticides harms anyone at any age, but pesticide exposure presents a greater danger to pregnant women, who could jeopardize their child’s health in addition to their own.

It’s pretty easy to find research connecting prenatal pesticide exposure to all kinds of awful health risks. Many recent environmental health journals include studies on the effects of pesticides on a developing brain. Common pesticides can lead to an increased risk of leukemia, brain tumors, and lymphoma.They also affect brain function, leading to slower reflexes and mental development, as well as a greater risk of Autism and ADHD. Prenatal exposure leads to more miscarriages and birth defects in our population. Since these chemicals are designed to kill living organisms, it’s no surprise that they harm developing humans as well.

In fact, the organophosphate class of pesticides was designed to kill more than just the insects that eat our food; they were developed during World War II to be used as nerve agents (http://www.epa.gov/opp00001/about/types.htm). Chlorpyrifos, one of the most well known organophosphates, appears in numerous studies to determine how it affects the human nervous system. Last year, the New York Times drew attention to a UC-Berkeley study showing that higher exposure to Chlorpyrifos lowered a child’s IQ (http://well.blogs.nytimes.com/2011/04/21/pesticide-exposure-in-womb-affects-i-q/). Closer to home, Duke’s Dr. Ted Slotkin researches the effects of pesticides on brain development (http://sites.nicholas.duke.edu/superfund/?page_id=122), and has shown that prenatal Chlorpyrifos exposure leads to newborns with abnormally-shaped brains. After being banned from residential use, Chlorpyrifos remains in use in the fields, although use has declined over the past decade. 

Even if she does not work in the fields, a pregnant farm worker can still run the risk of pesticide exposure. Standing in the backyard of that same home near Wilson, the pregnant girl’s mother swept her hand across their backyard of commercial sweet potato fields. A few years ago, when the fields were planted with tobacco, planes would spray pesticides that the wind carried through their house (Even though the EPA’s Worker Protection Standard (http://www.epa.gov/pesticides/health/worker.htm) specifically prohibits pesticide handlers from spraying pesticides in a way that causes direct human exposure). Had this girl been pregnant while the fields behind her house were planted with tobacco, her exposure would have been many times worse.

For most American mothers, shielding their kids from pesticides is a personal lifestyle choice. Expectant mothers can choose not to use insecticides and herbicides in their homes and gardens to limit prenatal exposure. Later, they can send their children to daycares and schools committed to using Integrated Pest Management (http://www.toxicfreenc.org/informed/factsheets/whatisIPM.html) instead of traditional insecticides. Most American mothers cannot 100% ensure their kids stay away from pesticides, but they do have a certain level of control over their kid’s exposure. Farmworker mothers don’t have any of this control– these women and their children breathe, eat, and live in pesticides every hour of every day. It’s incredibly unfair that farmworker women must risk the health of their future children in order in earn the money they need to live. Farmworkers already carry the burden of harvesting America’s food– why should they carry the burden of a higher risk of chronic illness as well?

The Affordable Care Act's Prognosis for Farmworkers

Cross-posted with the North Carolina Council of Churches

Every day, about 243 agricultural workers suffer injuries that cost them work time; about five percent of these injuries result in permanent impairment. Agriculture consistently ranks among the three most hazardous industries in the United States. In 2008, the National Safety Council ranked it as the most dangerous industry, and the U.S. Department of Labor reports that children performing farm work are four times more likely to be killed than those employed in all other industries combined.

Nationally, migrant health clinics serve only about 13% of the intended population, according to the Center for Disease Control and Prevention. Of the more than 150,000 farmworkers in North Carolina, less than 20% receive health care. At the same time, the fatality rate for farmworkers statewide is higher than the national average, and nearly 10 times higher than the average state fatality rate for all other occupations.

It is appalling that many of those who harvest our food and contribute to our well-being often work at such personal risk without basic health care. One step in the right direction was the recent announcement of $128.6 million in awards through the Affordable Care Act (ACA) which will add about 5,640 doctor, nurse, dental provider and support staff jobs nationally to clinics serving farmworkers and others. The money will go to 219 health centers nationwide, increasing access to more than one million additional patients.

The Supreme Court ruling that upheld the mandate contained within the ACA helped to ensure the continuation of these programs that allocate money to public health care centers. While this decision will benefit many, including some farmworkers, many more will be left behind. According to a detailed analysis by Farmworker Justice, undocumented farmworkers, who make up a majority of the U.S. farmworker population, will only marginally benefit from health reform and will continue to encounter enormous barriers to health care.

Eighty-five percent of farmworkers in the U.S. have no health insurance, and 9 out of 10 children in farmworker families are uninsured. The majority of these workers do not qualify for social services because of their immigration status, even though many live significantly below the federal poverty line.

Because  farmworkers are often impoverished, uninsured, live in isolated areas and move frequently to follow work, many face financial and logistical barriers to receiving health care, says the Texas-based National Center for Farmworker Health. In addition, few health delivery sites have adequate Spanish language resources, including those in North Carolina, where 94% of farmworkers are Spanish-speaking.

Meanwhile, unresolved health problems can limit farmworkers’ ability to maintain productive employment, further perpetuating their position in a vicious cycle. Farmworkers are not protected by sick leave and risk losing their jobs if they miss work. Industry exemptions from rules that protect workers in other sectors and poor enforcement of existing rules leave farmworkers vulnerable and without legal recourse.

Harsh working and living conditions put farmworkers at a high risk for injuries and illness, including work-related lung diseases, noise-induced hearing loss, skin diseases, chemical-related illnesses (such as neurological disorders, miscarriages and birth defects), and certain cancers associated with chemical use and prolonged sun exposure.

Many workers also don’t seek preventative care from physicians for fear of being reported to ICE and consequently being deported. Those who are undocumented often avoid going to locations or institutions where they are made to present identification or where a record of the visit can be documented, which prevents many individuals from seeking proper medical care. Bruce Gould, MD for the University of Connecticut’s mobile Migrant Farm Worker clinic says that sometimes during his visits to camps he finds farmworkers hiding in bushes — they are often desperate for medical care but fear they will be fired if their foreman finds out they are sick.

The American Farm Bureau estimates that without the help of undocumented workers, the agricultural sector of the economy would lose between $5 and $9 billion in flowers, fruits, and vegetables and would cause more than 20% of the production to move overseas. Agriculture is North Carolina’s leading industry, constituting 22% of the state’s income. Eighty-five percent of fruits and vegetables produced in the United States, including those in North Carolina, are harvested by hand.

The help provided by migrant farmworkers is critical for the agriculture sector of the U.S. economy. As Guillermo Noguera, Health Outreach Coordinator in Columbus County, NC said, “Farmworkers feed the world. I think if everybody knows the importance of farmworkers, they will want to keep them healthy.”

All people deserve care. Providing health care to all is not an issue concerning only the patient that is ill; rather, it encompasses a public health dimension, which involves the health of all members of the community. As Margarita, a mother and farmworker in Oxford, NC noted “It’s very important, not just for one person but for the whole community.”

Looking beyond individual health and the economics of the law, will the Supreme Court’s decision reinforce America’s commitment to civil rights and equal opportunity for all – including farmworkers? Or will it reinforce the role of health coverage as a divider between those who will prosper and those who will not?

–Daryn Lane, Student Action With Farmworkers Into The Fields Intern

Heat Can Be Brutal To Farm Workers

On the drive into work this morning, the radio announcer warned of dangerously hot temperatures across much of NC today with heat indexes as high as 110.  For those of us who have the privilege of working in air conditioned spaces, this kind of heat poses little threat.  But for those who do some of the hardest work in the state, providing food for our tables and profits for our farms, this kind of heat can be deadly.  This story from NBC-17 explains:

Long stretches of heat can be deadly to farm workers. 

Three agricultural workers in North Carolina died from heat stress in 2006. 

None have died since then, according to the North Carolina Department of Labor. The department attributes it to extensive educational efforts, said Regina Cullen, Chief of the Agricultural Safety and Health Bureau at the Department of Labor.

"We do a heck of a lot of educating. And say, ‘this is the best way.' Nobody wants to have an accident. Nobody wants to have a fatality on their farm," Cullen said.

The department doesn't track heat illnesses. But the Association of Farmworker Opportunity Programs has received reports of symptoms of heat illnesses among farm workers this summer; and of workers without enough water, shade, or breaks.

"We have seen families that are sleeping under trailers to escape heat. We have seen slurred speech and slurred vision in a lot of the youth that are out there working in the fields long days," said Emily Drakage, the North Carolina Regional Coordinator for the Association's Children in the Fields Campaign.

The Association of Farmworker Opportunity Programs is a member of FAN.

Eye on Farmworker Health: Prenatal Care Disparities

FAN talks a lot about how farmworkers' living and working conditions - conditions beyond their control - have a tremendous impact on quality of life.  Study after study shows that farmworkers are at risk.  The summer edition of Eye on Farmworker Health investigates access to prenatal care, pesticide exposure and more.  Here's a quick summary of findings on access to prenatal care:

Approximately one quarter of migrant farmworkers in the US are female, and a large percentage of these are of childbearing age. Pregnant farmworkers are at increased risk for spontaneous abortion, pre-term labor, and fetal abnormalities as a consequence of exhausting prolonged manual labor, periodic dehydration and exposure to pesticides, as well as substandard living conditions, poor health, and malnutrition. Twenty-five percent of births to migrant farmworkers result in insufficient birth weight, pre-term labor or other undesirable outcomes. Despite this increased risk, the majority of pregnant farmworkers receive inadequate prenatal care.

Poverty, lack of work authorization, geographical isolation, lack of knowledge concerning prenatal care recommendations, poor English skills, long work hours and migratory lifestyle all contribute barriers to prenatal health care access for migrant farmworkers. Over 60% of migrant farmworkers live at or below poverty level. Over 57% lack legal authorization to work in the US, making them ineligible for health benefits. Eighty-five percent of migrants working in the US have no form of health insurance. Only 5% are enrolled in Medicaid, although more than this number would be eligible. Language and literacy barriers as well as frequent migrations contribute to this under-enrollment. The result of these barriers is that 30% of pregnant farmworkers have their first prenatal visit when they have already reached the second trimester and 14% have no prenatal care until the third trimester. Less than half of pregnant farmworkers gain the recommended weight gain during pregnancy.