Next week, members of the NCFH team will gather in Albuquerque, New Mexico for the 25th Annual Midwest Stream Forum. In light of recent global events, the importance of terminology in our work remains a persistent and important subject that merits intentional discussion and reflection. The content below constitutes an extended version of NCFH CEO Bobbi Ryder’s remarks in the Forum’s welcome letter.
These few days represent a unique opportunity for us to come together, share experiences, and explore new ideas in hopes of influencing the Migrant Health Movement’s progress toward increasing access to quality care for agricultural workers in the United States.
In light of our gathering and some tragic global events of late, many specific details related to our work seem more compelling to me now more than ever. For many decades the use of the word migrante by our colleagues in Mexico was thought by many to mean the same as its cognate, migrant in the English language, thus leading to confusion between immigrants, documented or undocumented, and domestic migratory agricultural workers. Because of such word associations the term migrant has come to connote a stigma and reduces the stature of this vital workforce. Recent publicity about the plight of those fleeing Syria to Europe and the U.S. caught my attention with of the interchangeable use of the terms migrant and refugee. European opposition to the arrival of these refugees evokes images of a largely unwanted and abused population with little sympathy for the terror that they seek refuge from. Calling them migrants both diminishes the reality of the political strife in Syria, adds confusion to popular understanding of the term migrant. The content of the adjoining text box has been gleaned from the abundance of common dictionary sites available on the internet, and these meanings have been selected to help sort out the appropriate use of each. Precise use of the English language is challenging when we are dealing with international affairs, but we need to get it right - at the very least we must get it right within the Migrant Health Movement. It seems that we have been groping for what to call migratory agricultural workers and their families for a long time; beginning in the Dustbowl era, when displaced sharecroppers left depleted, unproductive land in Oklahoma and Arkansas in large numbers to work in other states (Primarily California and Texas). This group was best described in popular literature by John Steinbeck’s Grapes of Wrath published in 1939, telling the true story of the Joad family. Terms used to refer to this population were derogatory in nature (Okies and Arkies) and did little to recognize the dignity of impoverished families willing to uproot themselves and cross a desolate country, desperate in search of work for sheer survival. The use of the term Bracero was introduced in 1943 with the legalization of Mexico’s contribution to the Allied War effort. The Bracero Program authorized Mexican citizens to work temporarily in the U.S, to replace the U.S farm boys who were fighting in the European War theatre. During that period more than 4.5 million Mexican citizens were legally hired to work in agriculture in the U.S. In CBS’s Harvest of Shame in 1960, Edward R Murrow respectfully uses the term migratory workers in Belle Glade, Florida at a time when the majority of workers there appear to be either of either Anglo or of African descent. The powerful impact of that CBS documentary can be found in the original Public Health Service (PHS) Act 329, that was signed into law by President JFK in 1962. You will see that the terminology used throughout the law is Migratory and Seasonal Agricultural Workers. It is in placing the name on the Act that the term migrant is used, ie the Migrant Health Act. The majority of that original terminology continues today in the PHS 330 legislation which preserves funding for migratory and seasonal agricultural workers. It has been six years since I last worked in the fields. I would migrate with my family from the Rio Valley Grande in Texas to various states across the Midwest to work in the onion and blueberry fields. One morning, while working at dawn in the onion field, I made a promise. I promised myself that I would finish college and make a difference in the lives of migrant agricultural workers that work the soil of this country and those who make it possible for Americans to have food on their table. I am proud to say that I am keeping true to my promise. I have been working at NCFH for over a year, developing health education tools that help agricultural workers better understand a health condition or how to get health care services. This October I was given the opportunity to attend, for the first time, the East Coast Migrant Stream Forum in Memphis, Tennessee. I was able to meet people who work in migrant health, from outreach workers to frontline staff working in a health center to CEO’s whose main goal is to improve the health and well-being of migratory and seasonal agricultural workers. During the three day conference, I participated in the exhibit letting everyone know about NCFH products and services. It was rewarding to see the appreciation that was given to the products and services that NCFH provides to health center staff. Furthermore, it was very rewarding to hear how these tools can really make a difference in the lives of agricultural workers. Throughout the Wall of Wonder (WOW) session, I along with almost 170 participants explored the issues of access to care for agricultural workers and strategies to increase access to care for them and their families. Participants were able to learn about the AG 2020 campaign , an effort to encourage health centers to take credit for all migratory and seasonal agricultural workers they serve, and how important this is in order to preserve the Migrant Health Program. Keynote speaker and U.S. Poet Laureate, Juan Felipe Herrera, reminded everyone that we all have a voice that is helping agricultural workers. He motivated us to continue doing the work that we do because it is much needed, but furthermore to keep our voice alive. He talked to us about his project La Casa de Colores, and expressed how this is a house for all voices and encouraged everyone to be part of it. I found this experience rewarding in many ways. It provided me with the opportunity to meet and learn from others that have been in the migrant health movement. It reminded me that the work that I do day to day is much appreciated and needed. This experience also reminded me about my promise and motivated me to continue helping our migrant agricultural workers. By: Joanna Arevalo Photos:
Left -Wall of Wonder (W0W) Session at the East Coast Migrant Stream Forum 2015 Right- U.S. Poet Laureate, Juan Felipe Herrera, Keynote Speaker at East Coast Migrant Stream Forum 2015 Photo Credits: Joanna Arevalo It is Health Literacy Month.
It’s alarming to think that only 12% of American adults are considered health literate, according to the National Assessment of Adult Illiteracy. In other words, nine out of ten Americans lack the basic knowledge to manage their health and prevent disease. This holds true for the vulnerable populations of our country, including migratory and seasonal agricultural workers. These populations face barriers to a basic understanding of their health and to receiving appropriate health education. Health Literacy – put simply – is one’s ability to understand and obtain health information. That is the simple definition. A much more complex definition resides in the specific factors and barriers contributing to a population’s lack of health literacy, which can correlate (not exclusively) to a person’s language, culture, location, and socioeconomic environment. Migratory and seasonal agricultural workers face unique obstacles to managing their own health care, including access to transportation to services, language barriers, and (in some cases) not being treated well due to undocumented status. When blockades exist to access to health, one’s access to health education will also be barricaded. Migrant and Community Health Centers strive for the elimination of health illiteracy among all their patients by providing preventive treatment and low literacy education materials for patients to learn more about a specific diagnosis or their risk factor(s). The patient is not solely responsible for his or her healthcare and health education. Health center staff are being trained to become culturally competent in their respective positions. Cultural competency – according to Health.gov – “is the ability of health organizations and practitioners to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of diverse populations, and to apply that knowledge to produce a positive health outcome. Competency includes communicating in a manner that is linguistically and culturally appropriate.” NCFH prides itself on our ability to orient and train staff to implement cultural competency curriculums in the migrant and community health centers we serve. Participants of NCFH cultural competency courses learn to understand the meaning of diversity and its relationship and impact on communication and human relations. Along with that they increase awareness of their personal attitudes, beliefs and behaviors related to cultural diversity; and enhance skills for improved cross-cultural communication. NCFH also offers low literacy and English/Spanish translation services in order to continue improving a patient’s health literacy. Improving a health center staff’s cultural competence and patients' overall health literacy, allows for more involvement with, and awareness of, the diverse populations that health centers serve, and ultimately contributes toward eliminating one of the many barriers a patient faces related to health literacy. By: Mindy Morgan Behavioral and mental illness disorders remain part of a large conversation among the American public, and recent events make the need for depression and other mental health disorder screenings a must for health centers that serve the vulnerable communities in our country. Community Health Centers (CHCs) realize the very real concern of behavioral health issues among these populations. Nearly 70% of CHCs are screening for depression and other related mental health disorders around the nation, while 40% provide substance abuse counseling and treatment. According to the National Association of Community Health Centers (NACHC), “Persons living with mental illness have a higher mortality rate and often die prematurely due to preventable diseases such as: diabetes, cardiovascular disease, respiratory diseases, and infectious diseases.” The good news? There has been a dramatic growth in assessing the quality measures of behavioral health within the last decade. Although there is a growth in assessment, there is still work to be done. U.S. migrant and agricultural workers suffer with a higher susceptibility to the risks of behavioral health and its diagnosis. Migrant agricultural workers who are separated from their families may be more susceptible to mental health disorders, such as depression, alcoholism, and substance abuse. Nervios is a “culturally defined definition of stress.” A study conducted by National Agricultural Worker Survey (NAWS) reported that 20% of male agricultural workers experienced some form of Nervios and those who were separated from their families had reported a higher rate at 28%. When behavioral and mental health goes untreated, the results can be devastating on a personal and communal level. Many untreated disorders result in patient suicides, incarceration, homelessness and severe episodes of violence. To find a Community Health Center offering depression screening please visit: http://findahealthcenter.hrsa.gov/ By Mindy Morgan
Photo: Alan Pogue Although there has been substantial progress in cancer treatment, screening, diagnosis, and prevention over the past several decades, addressing cancer health disparities—such as higher cancer death rates, less frequent use of proven screening tests, and higher rates of advanced cancer diagnoses—in certain populations is an area in which progress has not kept pace. These disparities are frequently seen in people from low-socioeconomic groups, certain racial/ethnic populations, and those who live in geographically isolated areas. – National Cancer Institute The U.S. Latina population has lower-rates of breast cancer than non-Hispanic women. However, they have a 20% greater chance of dying than other women after receiving a positive diagnosis. Many attribute this discrepancy to the social determinants of health that influence patient survival – including a lack of access to quality education and healthcare, which is exacerbated by patients’ socioeconomic statuses. The unique seasonal and migratory lifestyles of female agricultural workers further compound and complicate these issues – as do the effects of existing misinformation regarding screenings and cultural beliefs amongst this population. The necessity of consistent appointments and follow-ups for effective care proves problematic for those on the move and those working under severe occupational time constraints. Women over the age of 50 are urged to get annual mammograms in addition to performing frequent self-examinations. However, a positive exam only constitutes an initial step in the breast cancer diagnosis process. Patients must return and provide a tissue sample before the disease is confirmed. Federally Qualified Health Centers (FQHCs) served more than 2 million women over the age of 50 and 440,000 women utilized services at Migrant Health Centers in 2014. FQHCs also performed more than 470,000 mammograms and found almost 110,000 breast abnormalities last year. The National Center for Farmworker Health recognizes the need for a special focus on breast cancer outreach to the U.S. female agricultural worker. Through its Cultivando la Salud program, NCFH offers health centers and other Hispanic-serving organizations the opportunity to receive train-the-trainer instruction intended to provide program planners with the knowledge, step-by-step process, and the tools to successfully plan and develop a comprehensive breast and cervical cancer education program for the agricultural population as well as other Hispanic communities. The training includes basic program planning information from designing the program goals and objectives to developing a budget to recruitment and training of lay health workers. The program also includes an evaluative component and specialized focus on the teaching tools lay health workers will be using in the community. At the end of the training, training participants will be provided with a complete training curriculum, a program manual to guide the implementation of the program, and the CLS teaching tools for lay health workers to use in the community. By Lindsey Bachman
Photo: Steve Debenport, iStock On Monday, the Environmental Protection Agency (EPA) announced a series of revisions to its existing pesticide regulations in hopes of providing additional protection to agricultural workers in the United States. Approximately 16% of the 2.4 million agricultural workers represented in the 2012 National Agricultural Workers Survey (NAWS) reported loading, mixing or applying pesticides in the last 12 months. That’s almost 400,000 workers. The effects of ag worker pesticide exposure reportedly generate $10-$15 million in healthcare costs each year. In the Huffington Post on Monday, Gina McCarthy, U.S. EPA Administrator, and Thomas E. Perez, U.S. Secretary of Labor, wrote: There are serious financial consequences for businesses that don't acknowledge the importance of worker safety. They not only endanger their own workers, they reduce their competitiveness and harm their bottom line. It's time to raise the bar for our agriculture workers in the United States. The article also included insight from Norma Flores, a woman from a migrant ag worker family, who now works for the East Coast Migrant Health Project. Migrant farm labor supports the approximately $28 billion fruit and vegetable industry in the United States. At NCFH, we proactively support the work of migrant health centers and the empowerment of farmworker communities in our mission to improve health status. We are determined to eliminate the barriers to health care and increase access for farmworker families to culturally appropriate quality health care. By Lindsey Bachman
Photo: iStock Fall is upon us, which undoubtedly means pumpkin everything; from pumpkin spiced lattes to jack-o-lanterns sitting on our front porches to cuddling up next to a loved one spooning pumpkin pie in our mouths – the season of pumpkin is here. But with the demand for pumpkin-everything comes the increasing demand of pumpkin picking farm labor.
There’s a small county in Texas that boasts, “Pumpkin Capital, USA.” Their mission goes on to say “We produce the world’s finest Pumpkins and a lot of them.” Patrons excited for the heat of Texas to transform into a brisk cool air travel to this small county to watch – and participate – in the beloved “Punkin Days.” From pumpkin arts and crafts to pumpkin size contests, it is truly a festival of pumpkin-everything. But the satisfied customers and crowds of Floydada, TX would not being lining up for pumpkin-everything if it weren’t for the toiled and hard-working farmworker. Texas isn’t the only state that commends itself of the perfect pumpkin patch – every year an estimated 35,000-38,000 farmworkers migrate to Illinois for the ample (and very heavy) pumpkin and autumn harvest. In 2012 the USDA’s Agriculture Census reported Illinois has 16,426 acres of pumpkin patches, making it the largest acreage of farms growing pumpkins in the United States. With hundreds of pumpkins growing approximately every acre – that is a lot of land – and pumpkin – to cover. It’s easy to overlook the occupational health risks of farm workers while we’re gutting our pumpkins and carving silly faces on them, but they exist, and they’re not going away anytime soon. Illinois reported only serving 0.9% of agriculture workers in 2014 – while in 2012 3.3% of ag workers were reported as receiving healthcare services. In fact, only approximately 18% of the estimated number of agricultural workers in the U.S. are being served by health centers. In partnership with the National Association of Community Health Centers, NCFH is working to improve the amount of agriculture workers served. The AG 2020 campaign calls on every migrant health center grantee to increase by 15% each year over the next five years the number of agricultural workers served. The migrant farm worker rarely has time or a stable home to decorate with jack-o-lanterns, but their endless days working in the pumpkin fields need tribute. When reaching for a pumpkin at the store – or even reaching for an already-harvested-pumpkin in the field, think about the hands that touched the pumpkin before you and honor their efforts while we enjoy the brisk cool air of fall. Remember the contributions of this tireless population – the selflessness and devotion they have to their jobs are an essential part of our pumpkin-everything happiness this fall season. By Mindy Morgan Image Credit: Creative Commons: Public Domain Emergency situations can happen at any time and anywhere, for this reason it is important to know what to do. Continuing with our topic of First Aid at work, this issue of HealthTips allows readers to learn about what a sudden cardiac arrest is and how to provide "Hands -Only CPR" to someone in need. This issue also addresses what to do when other emergency situations occur, such as choking, diabetic shock and heat stroke. You can use this issue of Health Tips to teach agricultural workers basic first aid steps in each of these emergency situations. It is available in both English and Spanish. For previous editions, please visit our website.
Did you know that NCFH offers a limited number of complimentary or discounted training programs to Community/Migrant Health Centers? These programs feature a selected number of services with the goal of increasing knowledge, skills, and abilities of a diverse health care workforce. Seize the opportunity to experience NCFH's programs tailored for front-line staff, management, board of directors and others. We even provide some of the trainings via Webinar and video conference! Simply identify your training needs based on our available programs, and submit your application. We only have a limited number of these special offerings left, so please contact us by October 9th for more information. Apply Today! We have updated our Governance Toolkit to include new tools, webcasts and videos! Take a look at this unique resource that helps you understand why governance is an essential component of the health center program. It includes a Consumer Board Recruitment Training Toolkit, webcast and videos on board recruitment, roles and responsibilities, collaborations, and finance. This toolkit is part of our Performance Management Tool Box which includes tools on administration, human resources, needs assessment, service delivery, and emergency preparedness. Take a look at them! |
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