1. Migrant Farmworker Families Health Care Needs & Access Barriers Presented by Ann M. Avery, MSN, APRN - BC Clinical Services Director Northwest Michigan Health Services, Inc.

2. Northwest Michigan Health Services, Inc. Clinica para los Campesinos 36 yr history of primary medical & dental care 3,500 clients/year 13,000 visits/year 3 clinics 7 county service area

3. NMHSI Service Area

4. NMHSI Funding Sources BPHC 330(g) Medicaid State grants Local grants Client fees

5. Farmworkers & Michigan’s Economy Agriculture is the 2 nd largest industry in Michigan. Migrant farmworkers are vital to the survival of this industry. Farmworkers are not in Michigan to bleed the social service system dry.

6. Migration Patterns Eastern Stream – from Florida to Georgia, the Carolinas Western Stream – from Mexico thru California to Oregon Midwest Stream – from Mexico, Texas & Florida to Mich, Wisc, Indiana, Ill, Minn.

7. How Many Farmworkers Come To Michigan

8. Number of Farmworkers Estimate: 12,000 – 15,000 in NMHSI service area annually.

9. Farmworker Housing Labor Camps  228 licensed camps (camps with 5 or less workers not licensed)  5,146 capacity  Most in Oceana, Mason &Leelanau Counties

10. Farmworker Characteristics 99.9% of Mexican decent 75% speak ONLY Spanish 6 th grade education

11. Farmworker Characteristics $12,000/yr income Family unit migrates Most workers ages 25-35

12. Farmworker Characteristics Health insurance – Medicaid 21-28% (mostly children) (No Medicaid reciprocity in Michigan)

13. Farmworker Characteristics Familia (family) Respeto (respect) Personalismo (personal) Confianza (trust)

14. Farmworker Lifestyle Mobility

15. Evidence of Mobility 48% return after 1 year 11% return after 2 years 4% return after 3 years

16. Common Health Problems Obesity Diabetes Hypertension Hyperlipidemia Asthma Dental problems Anxiety/depression H. pylori infection TB/LTBI Lead poisoning Parasitic infestation

17. Work Related Health Problems Falls & back strains Machete injuries Pesticide/chemical exposures Carpel tunnel syndrome Fungal skin & nail infections Heat stress & dehydration

18. Access Barriers Some are cement walls Some are orange cones

19. Access Barriers Influenced by Farmworkers Mobile lifestyle Poverty Limited ed & low literacy levels Limited English proficiency

20. Access Barriers Influenced by Farmworkers Lack of understanding of scope of problem Employment - “Here to work” Fear of deportation Location of camps

21. Access Barriers Influenced by Health Care System Hours of operation Monolingual – ( huge problem with mental health needs) No understanding of lifestyle/culture Bilingual does not = bicultural

22. Access Barriers Influenced by the health care system Little awareness of common 3 rd world health conditions Little/no knowledge of self treatment options Ethnocentric

23. Access Barriers Other Influences Employers – time spent accessing care is time away from the job. Many crops cannot wait to be harvested. No public transportation system No information re: location of health care services Medicaid reimbursement rates very low

24. When Two Worlds Collide Occurs when farmworkers seek health care in up-stream communities.

25. High Blood Pressure Health Care Needs: – Medication – Blood tests – Understanding that this is an ongoing condition that causes kidney & heart problems – Salt intake should be limited

26. High Blood Pressure Barriers to Care Cost of care/hours of availability Distance to clinic The “7 minute visit” Provider does not speak Spanish Instructions on pharmacy label in English

27. High Blood Pressure Barriers to Care: Lack of refrigerator space Use of seasonings in food No symptoms = no problem

28. High Blood Pressure Barriers to Care: Educational materials = litter Unlikely to ask questions Will be in area only 4-6 weeks

29. Immunizations Health Care Need: Children & adults need to be protected from disease (some of which are communicable) Mich. School programs have immunization requirements

30. Immunizations Barriers to Care: 5/1/2005 does not always mean May 1 st. Many health departments do not have evening clinic hours Immunization records NOT available in national data base

31. Assessing HIV Risk Health Care Need: – Proper identification of risk factors – Education re: risk reduction – Testing

32. Assessing for HIV Risk Barriers to Care: Lack of cultural sensitivity – History taking – Understanding of definition of homosexuality – Lifestyle (absence from spouse)

33. Diabetes Health Care Needs: Medications/blood tests Continuing care Dietary restrictions Weight loss

34. Diabetes Barriers to Care: Cost of medications/ongoing availability of medications Medicaid case open in Texas Use of home remedies Availability of meds in Mexican pharmacies

35. Diabetes Barriers to Care: Glucose monitoring machines read out in English Urine testing strips read out in English Unavailable past medical history “I don’t have blurred vision anymore so I stopped my medicine.”

36. Condition Requiring Immediate Attention Health Care Need: Serious in nature Inpatient care Possible surgery Specialty care

37. Condition Requiring Immediate Attention Barriers to Care: Cost Lack of trusting relationship with provider Need for family to make decisions

38. Of all forms of inequality, injustice in health care is the most shocking and inhumane. Martin Luther King Jr.