FJ Blog

Wednesday, 09 April 2014

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.

by Chelly Richards
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Tuesday, 08 April 2014

The theme for day 2 of 2014 National Public Health Week is disaster preparedness. In recent years, natural disasters in the U.S. have heightened awareness of both individual and community-wide strategies for best preparing for, surviving, and rebuilding after a natural disaster. We have also learned that some populations within our communities fare worse than others and that special consideration should be taken to prepare these populations and to respond to diverse needs before, during, and after a disaster.

Farmworkers and other rural immigrant communities may not receive education on disaster preparedness when it is not culturally-appropriate, written in their primary language, or distributed at venues they trust and frequent. During a disaster, farmworker homes may not be easy to physically locate, as they are sometimes hidden and isolated or “off the grid.” Emergency services may not have records indicating where farmworkers live or their residences may be inaccessible. When seeking help, farmworkers may have difficulty communicating in English with emergency responders and may not know how to access assistance.

In 2007, wildfires in San Diego County, California burned 368,316 acres and destroyed 1,751 homes. Farmworker communities were unprepared to respond to the disaster and were especially vulnerable to the effects of the fire. Safety net providers in the community were not equipped to respond to the cultural, linguistic, economic, and health needs of this displaced community. There were fears about the presence of the Border Patrol and other law enforcement agencies. Few had information about shelters and other available assistance. As a result of the fire, many farmworkers lost their work and homes and were unable to access food, water and health care.

After the wildfires, the FarmWorker CARE Coalition (FWCC), a coalition of health centers, community-based organizations, government agencies and academic institutions in San Diego County, developed an emergency preparedness plan for farmworker communities. The emergency preparedness plan relies on community leaders to educate and prepare community members in the event of a disaster. In addition, the FWCC advocates at the local, state and national level to improve access to emergency preparedness information, resources and relief for limited English proficient, hard-to-reach communities.

Farmworker communities need access to information about available resources in the event of a disaster. In preparing the community for a disaster, community-based organizations and leaders in the farmworker community should be involved to engage farmworkers in creating an emergency plan. An effective emergency plan will include culturally- and linguistically-appropriate education and resources to prepare farmworkers before a disaster; a way to most effectively contact and distribute safety messages to farmworkers and their families during an event; and also a plan for identifying and reaching families or individuals who may need help.

To support community health centers, community-based organizations, and others in farmworker communities with disaster and emergency preparedness planning, We have developed materials on available disaster-related food, housing, and income assistance which are available for download from our website. Farmworkers should not be left out of community emergency preparedness. By working together and planning ahead, everyone in our communities will be better prepared and better served during a natural disaster.
 

by Chelly Richards
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Monday, 07 April 2014

April 7th begins the 2014 National Public Health Week! Today’s theme, “Be healthy from the start,” is especially important when bringing awareness to the current state of farmworker health in this country. Today, we focus on farmworker children and access to health care.

Individuals with health insurance are more likely to seek medical care. In the U.S., a staggering number of farmworker children do not have health insurance. Data on farmworkers and their families are hard to collect because of the seasonal and migratory nature of farm work. For this reason, we focus on statistics that describe rural Latinos in the U.S.:

• 31% of rural Latino children are uninsured, compared to 15% of African-American children and 18% of non-Hispanic white children.
• Only 33% of first-generation immigrant children are continuously insured.
• Rural Latino children whose parents are immigrants are even more likely to lack health insurance, even though the majority of them qualify for enrollment in Medicaid or the Child Health Insurance program (CHIP).

Cancer, heart disease, stroke, and diabetes are among the top five causes of death for Latinos in the U.S. The burden of these conditions can be lessened or prevented under the regular care of a physician. Children with health insurance are more likely to have a regular source of health care than children without health insurance. Children who receive regular medical care may grow into adults that value preventative care.

Farmworker Justice is working to diminish the disparity in health care coverage experienced by rural Latino children in the U.S. In the coming weeks, we will be rolling out a program called Conexiones: Connecting Rural Latino Families to Medicaid and CHIP. Four community-based organizations in Florida, North Carolina, California, and Arizona will work with Farmworker Justice to train promotores de salud (lay health workers) to conduct outreach in their communities. They will educate their peers on the eligibility requirements for enrollment in Medicaid and CHIP and help to connect them to state and local resources. In two years, the promotores de salud are expected to reach over 14,000 rural Latinos with information on Medicaid and CHIP, which will increase health care coverage of children in their communities substantially.

This program utilizes the promotores de salud model because these community health workers are extremely effective in engaging in outreach in their communities, especially with hard-to-reach populations. Often sharing the same language and cultural background as those receiving their outreach efforts, they know best where to find their fellow community members and how to effectively deliver important messages about health and in this case, access to health care.
 

by Chelly Richards
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