1. Migrant and Seasonal Farmworker Health Maine Migrant Health Program Cheryl K. Seymour, MD DMS 2011

2. Introductions

3. Key Questions  What is it like to be a migrant or seasonal farmworker in the United States?  What are the barriers to health faced by farmworkers?  How is the care provided by Migrant Health Centers unique?  What is it like to care for farmworkers?

4. What is it like to be a farmworker?

5. Demographics  Estimated > 3 million  78% foreign born  79% male, 21% female  6th grade education  Spanish language (81%)  30% earn below poverty level ($7,500/yr)  92% don’t have employer- provided health insurance  About ½ million children work in agriculture National Agricultural Workers Survey (NAWS) 2001 - 2002. Demographic and Employment Profile of United States Farm Workers. Research Report No. 9. 3/ 2005.

6. Farmworkers in Maine

9. Maine Migrant Health Program Volume & Funding Demographics  1185 unique patients  Encounters  1850 medical  1015 case management  217 dental  178 mental health  Federal base grant of $645,000  18% women  5% pediatric  90% uninsured  Language access  English – 22%  Spanish – 61%  Kreyol – 16%

10. A Case in Point  Jean is a 63 yo Haitian male currently working in Maine to pick apples. His “home” is in central Florida.  He travels north in the spring with a group of about 20 people organized by a labor contractor.  He stays in any one place about 3-4 weeks until the harvest is over, then moves to the next crop location.  Transportation, food, & housing are provided by his boss at a fee. Work and pay vary daily. In most locations, wages are at a “piece rate”.  His family, including wife and children, still live in Haiti; he has not seen them for several years, but calls home on a track phone and sends money to them by wire transfer.

11. What are the barriers to health faced by farmworkers?

12. A Case in Point  Jean speaks Kreyol and understands very little English.  He attended a primary school in Haiti for three years.  Though he has lived and worked in this country for several years he is undocumented.  He did not have access to any organized medical care in his town of origin in Haiti and has also not established a PCP in his current home in Florida.  While picking apples he lives in a bunk house with fellow workers about 30 minutes from town. They have access to a group van once a week to go shopping.

13. Barriers to Health  Cultural differences  Poverty  Mobility  Fear  Social isolation  Lack of transportation  Access to healthy food  Job insecurity  Racism  Inadequate housing

14. Health Disparities  2 nd most dangerous profession  Higher burden of chronic disease  Greater risk of infectious diseases  Behavioral health  Occupational risks  Environmental hazards

15. OCCUPATONAL RISKS

16. Environmental Hazards

17. Source: BPHC 2009 How Many Farmworkers Receive Health Care?

18. How is the care provided by Migrant Health Centers unique?

19. A Case in Point  Jean and his co-workers are visited by an outreach worker from the local migrant health center a week after they arrive.  The OW puts up flyers about an upcoming mobile medical clinic that will be coming to their camp.  After three days of working, Jean seeks out the advice of a co- worker – a camp health aide – for symptoms of headache and insomnia. The CHA talks with him about stress and checks his blood pressure with an automatic cuff – 148/92.  The CHA encourages him to come to the mobile unit for care and talks with him a little bit about high blood pressure.

20. A Case in Point  The mobile clinic comes to Jean’s bunk house a few days later. Jean signs up to be seen and has a visit with a clinician and an interpreter.  His blood pressure remains elevated and a medication is prescribed and given to him that evening. Stress reduction or coping techniques are also discussed.  The outreach worker checks in with Jean by person or by phone within the next several days to reinforce the education he has received about HTN and also check in about his insomnia.  Follow up is planned when the mobile unit returns in 2 weeks.

21. Models of Care

22. What is it like to care for farmworkers?

23. What is different?  Teamwork  Multidisciplinary  True public health  Occupational health  Diversity  Seasonality  Community-based  Service  “Patient–centered”

24. What does it require?  Flexibility  Passion  Communication skills  Teamwork  Cultural sensitivity  Resourcefulness

25. Questions?

26. Resources  All photographs in this presentation borrowed from Farmworkers Feed Us All by Earl Dotter and Tennessee Watson  Migrant Clinician’s Network http://www.migrantclinician.org/