Access to Healthcare for Migrant and Seasonal Farmworkers (MSFW) and their families in Oregon & Washington Shannon Paris Oscar Ramos HE 407 Migrant Health Instructor : Daniel Lopez-Cevallos, PhD, MPH Western Oregon University

Introduction Migrant & Seasonal Farm Workers (MSFW’s) are an indispensable aspect to the United States multi- billion agricultural industry Migrant & Seasonal Farm Workers (MSFW’s) are an indispensable aspect to the United States multi- billion agricultural industry Large part of OR & WA industries Large part of OR & WA industries

Role of Farmworkers Thousands of workers harvest the bountiful produce, assuring the country have at their table accessibility to delicious, healthy, affordable foods Thousands of workers harvest the bountiful produce, assuring the country have at their table accessibility to delicious, healthy, affordable foods

What they do … Working in the heat, cold and rain Working in the heat, cold and rain Bent over and crouched most of the time Bent over and crouched most of the time Tilling soil Tilling soil Planting seeds Planting seeds Transplanting seedlings Transplanting seedlings Removing weeds Removing weeds Applying pesticides Applying pesticides Staking and pruning plants Staking and pruning plants Harvesting crops Harvesting crops Packing crops Packing crops Preparing for the market Preparing for the market

What we owe to them It would be prudent for our society to ensure that this vulnerable, economically disadvantaged, hard- working group of people and their families, have in return, accessible health care. It would be prudent for our society to ensure that this vulnerable, economically disadvantaged, hard- working group of people and their families, have in return, accessible health care.

State of Oregon Oregon has an estimated 174,484 MSFW’s and their families (State of OR Migrant Health) Oregon has an estimated 174,484 MSFW’s and their families (State of OR Migrant Health) Largest concentration found in the NW of the state near the fertile Willamette Valley. Most do not have health coverage.

State of Washington Washington has an estimated 186,976 MSFW’s and their families (Farmworker Enumeration Study) Washington has an estimated 186,976 MSFW’s and their families (Farmworker Enumeration Study) Largest concentration are found in the middle of the state and as just like in Oregon, most do not have health coverage. Largest concentration are found in the middle of the state and as just like in Oregon, most do not have health coverage.

MSFW’s Health Problems MSFW’s experience a higher incidence of health problems due to the following factors: MSFW’s experience a higher incidence of health problems due to the following factors: Lack of health insurance (cannot get it) Lack of health insurance (cannot get it) Economic factors (low pay) Economic factors (low pay) Poor living conditions (unsafe housing) Poor living conditions (unsafe housing) Hazardous exposure on the job (agriculture is the 2nd most dangerous occupation in the U.S.) Hazardous exposure on the job (agriculture is the 2nd most dangerous occupation in the U.S.) The life expectancy of a migrant farmworker is 49 years, compared to the national average of 73 (CDC 1998) The life expectancy of a migrant farmworker is 49 years, compared to the national average of 73 (CDC 1998)

MSFW’s Major Health Problems diabetes diabetes hypertension hypertension cardiovascular disease cardiovascular disease cancer cancer tuberculosis tuberculosis anemia anemia parasitic infections parasitic infections mental health mental health substance abuse substance abuse malnutrition malnutrition dental problems dental problems musculoskeletal problems musculoskeletal problems dermititis dermititis chemical poisoning chemical poisoning

Obstacles for Health Care Access MSFW’s and their families face many obstacles in regards to Health Care Access in Oregon and Washington. MSFW’s and their families face many obstacles in regards to Health Care Access in Oregon and Washington. Obstacles are socio-economic and lack of information in nature Obstacles are socio-economic and lack of information in nature

Obstacle: Poverty and Lack of Health Insurance Two of the most important factors as MSFW’s are usually undocumented workers. Two of the most important factors as MSFW’s are usually undocumented workers. Subject to abuse by frivolous employers: Subject to abuse by frivolous employers: Pay them well below the minimum wage Pay them well below the minimum wage Do not offer them health insurance. Do not offer them health insurance.

Obstacle: Distance from health care facilities and lack of transportation Many MSFW work and live in locations where the closest health care facility is many hours away. Many MSFW work and live in locations where the closest health care facility is many hours away. This problem is compounded as many of them lack transportation and have to rely on friends and sadly on their bosses (major reason why they do not complain) to get to some help. This problem is compounded as many of them lack transportation and have to rely on friends and sadly on their bosses (major reason why they do not complain) to get to some help.

Obstacle: Lack of Knowledge About Available Services A very sad and preventable situation occurs as MSFW's just simply do not know what kind of health care services are available to them and their families, whether they have or lack health insurance. A very sad and preventable situation occurs as MSFW's just simply do not know what kind of health care services are available to them and their families, whether they have or lack health insurance. Many times is a language issue but at times it is also an educational issue as many MSFW’s cannot read. Many times is a language issue but at times it is also an educational issue as many MSFW’s cannot read.

Obstacle: Lack of Understanding of Health Problems and Risks This is another major problem, as MSFW many times do not know that whatever ailment their body is fighting, can be deadly if not addressed. This is another major problem, as MSFW many times do not know that whatever ailment their body is fighting, can be deadly if not addressed. Many do not understand the dangers of pesticides, or the needs of vaccinations. Many do not understand the dangers of pesticides, or the needs of vaccinations.

Obstacle: Lack of Understanding of the U.S. Health Care System While some workers will have insurance or are sick enough to consider getting help, many do noy do so as they simply cannot navigate through the process of how our health care system works. While some workers will have insurance or are sick enough to consider getting help, many do noy do so as they simply cannot navigate through the process of how our health care system works. Many do not pursue care, even if it is an emergency as they do not know laws exist in this country that emergency rooms must follow to assure all emergencies are seen. Many do not pursue care, even if it is an emergency as they do not know laws exist in this country that emergency rooms must follow to assure all emergencies are seen.

Obstacle: Cultural and Linguistic Differences with Providers of Care Many MSFW’s cannot communicate effectively with their clinicians as they do not speak English, sometimes missing important aspects of their desired treatment. Many MSFW’s cannot communicate effectively with their clinicians as they do not speak English, sometimes missing important aspects of their desired treatment. Also, cultural aspects in regards to modesty, family values and expectations are sometimes taken for granted by clinicians as they seek to heal the patient. Also, cultural aspects in regards to modesty, family values and expectations are sometimes taken for granted by clinicians as they seek to heal the patient.

Obstacle: Fear or Mistrust of the Health Care Establishment or Governmental Assistance Overall, MSFW's still associate health care agencies as agencies lead by governmental agencies and are of course afraid to go to a clinic or hospital and compromise themselves with their undocumented status. Overall, MSFW's still associate health care agencies as agencies lead by governmental agencies and are of course afraid to go to a clinic or hospital and compromise themselves with their undocumented status.

La Clínica Del Cariño Family Health Care Center, Hood River, OR Nonprofit Community and Migrant Health Care Center, serving people in the Columbia River Gorge area. Nonprofit Community and Migrant Health Care Center, serving people in the Columbia River Gorge area. Health Providers and Health Promoters Health Providers and Health Promoters Discounted medical services, sliding scale Discounted medical services, sliding scale Originally created for migrants now serves 50/50 Originally created for migrants now serves 50/50 Hood River and The Dalles, 14 MD’s, 1 NP and 3 PA’s Hood River and The Dalles, 14 MD’s, 1 NP and 3 PA’s All our providers are bilingual in English and Spanish. All our providers are bilingual in English and Spanish.

La Clínica Del Cariño - Services preventive services (yearly exams for men, women and children, immunizations, screening tests like Pap smears and mammograms, flu shots) preventive services (yearly exams for men, women and children, immunizations, screening tests like Pap smears and mammograms, flu shots) health education services for pregnancy, breastfeeding, diabetes, high blood pressure, high cholesterol, and healthy weight management health education services for pregnancy, breastfeeding, diabetes, high blood pressure, high cholesterol, and healthy weight management care for acute and chronic medical problems in adults, children and senior citizens care for acute and chronic medical problems in adults, children and senior citizens pregnancy care (including deliveries) and family planning services pregnancy care (including deliveries) and family planning services care for children from birth through age 18 care for children from birth through age 18 walk-in visits and urgent care walk-in visits and urgent care immunizations immunizations minor surgery (mole removal, suturing, vasectomy, circumcision) minor surgery (mole removal, suturing, vasectomy, circumcision) casting and splinting for bones and joints casting and splinting for bones and joints

La Clínica Health Care Medford, OR

What would Steinbeck say??