Day three of National Public Health Week is entitled “Get Out Ahead!” and is dedicated to prevention as a national priority. Community and migrant health centers across the United States serve the preventative and primary health care needs of many of the farmworkers who plant, tend, and harvest the nation’s crops. Farmworkers and their families encounter numerous barriers to accessing health care such as cost, transportation, language, and lack of sick leave, to name a few. Outreach is a critical component of health care delivery to farmworker communities. I spent several years as a farmworker health outreach worker in rural North Carolina. This personal experience working in farmworker health in a small community provides insight to health problems faced by farmworkers and the barriers they regularly face when seeking health care.
Let’s first start with some quick farmworker health facts. Agricultural work is low paying, physically demanding work. The Bureau of Labor Statistics ranked agriculture as the third most dangerous job in 2012. Many farmworker families live at or below the poverty level and approximately 64% are uninsured. Cancer, heart disease, stroke, and diabetes are among the top five causes of death for Latinos in the U.S. For farmworkers, specifically, many of whom are Latino, a recent study showed an elevated prevalence of anemia and obesity and stunting in children of farmworker families. The burden of these conditions can be lessened or prevented under the regular care of a physician. Lack of insurance limits the options that farmworkers have when they seek health care and it is sometimes a barrier to receiving care at all. Many turn to community and migrant health centers to receive preventative care where they are able to pay for health care on a sliding-fee scale based on their income. Outreach workers are a valuable part of the health care team at these health centers.
As an outreach worker, the farmworkers I served worked in the Christmas tree fields nine months of the year. Many traveled from Mexico year after year to do this work, leaving behind their homes and families to live with other farmworkers in old houses, trailers, or barracks that were provided by the growers that hired them.
My work entailed visiting farmworkers in their homes in the evenings after work, collecting their personal and contact information, asking questions about their health, and screening for diabetes, high blood pressure, and HIV. They would usually be cleaning up from work and taking turns in the kitchen so many of these conversations happened while they cooked dinner and made lunch for work the next day. I let them know their options for accessing health care in their community and explained the process for making and paying for appointments. During the day, I coordinated these appointments, making calls to farmworkers, clinics, and specialists. I drove farmworkers to appointments and provided Spanish-English interpretation. I learned about their home towns. I heard border crossing stories. I knew when their kids in Mexico were getting in trouble at school. Working in this capacity allowed me to spend the time necessary to gain the trust of farmworkers within our community. I used this insight to help doctors, nurses, dentists, and clinic administrators better understand the conditions that affect farmworkers’ health and adjust treatment plans to best fit the realities they face.
The outreach workers at community and migrant health centers connect farmworkers to important preventative health care services through education, case management, and building trust within the community. The work, while challenging, is extremely fulfilling. We recognize that regardless of where you live, everyone has a right to be healthy. Our nation’s farmworkers, who harvest the fruits and vegetables essential to our health, deserve access to quality health care.