by Mark Heffington, M.D. (as presented to the IPHU Course in Atlanta)
The typical migrant farmworker in western North Carolina is a Mexican male between the ages of 14 and 31, although there are many nuclear families and women as well. (Children as young as 10 can be seen picking tomatoes in the fields at times, and babies are often carried into the fields by their working mothers). Because of neoliberal policies of the U.S. and Mexican governments, he and his family are impoverished, and can no longer make a living farming locally. He must leave home to try to earn enough money to feed his family. He is recruited in his home town by a labor contractor or “coyote†who promises a good job with good pay in the U.S. In return for a fee of two or three thousand dollars, the coyote will arrange for transportation, or accompaniment on foot, illegally across the border and to the work site. The worker, not having the money for such a fee, becomes immediately indebted to the coyote. If the worker is fortunate enough to make the border crossing without being captured or killed, or dying from the perils of the crossing, he eventually arrives on a farm, sometimes a thousand miles from his home. He remains in the custody of the coyote until his debt is paid off by the garnishment of his wages, or until his debt is sold to another contractor or to a farm owner. At any rate, he remains bound to work for the owner of his debt, with no recourse in the event of ill-treatment or abuse. He is told that he can trust no one other than his bosses, and that communication with others will result in his deportation or worse. He is made to understand that if he complains about his treatment, his working conditions, his living conditions, or his pay, that he will lose his job and be sent back to Mexico. He also understands that those who hold his debt know where his family is.
He is “paid†from 4 to 10 dollars an hour to work up to 10 hours a day, 6 days a week. He does not get overtime pay. He may not even be paid for all the hours he works. From this is deducted money for transportation to and from the fields, and for groceries brought to where he lives by the contractor or the owner. Often, money is withheld for “taxes and social security,†whether that money actually ever makes it to the government coffers. (If it does by chance go to the government, he will never be able to claim social security benefits). Rent may also be deducted from his pay. His living conditions are crowded and unsanitary, and the rent is high. He sends all of the money that he can back to his family in Mexico, paying Western Union unfair fees for the privilege. He often lives on the farm owner’s land, and is totally dependent on his employer for transportation, food, lodging, and information.
If he is fortunate enough to be recruited in Mexico by a contractor with access to the “legal†guest worker program, known as the “H2A†program, he may have to pay a smaller fee to get to his job. When he arrives in North Carolina, he is taken to a large metal warehouse where he is given warnings not to speak with anyone from the state Legal Services agency, shown a short film about the need to wash hands and clothes after pesticide exposure, and then transported to a farm that has been selected for him. He has no choice in employers, and he understands that if he does not make his employer happy, or if he causes any “trouble,†he can be sent back to Mexico and be “black-listed†for further employment. Under the laws governing this system, he is supposed be provided clean and safe living conditions, safe and sanitary working conditions, and guaranteed wages. The state Department of Labor is supposed to enforce these laws. In practice, however, his working and living conditions will be the same as those of his undocumented co-workers.
In either of these cases, he joins the three million or so migrant and seasonal farmworkers in the United States, becoming one of the most marginalized members of our society. They contribute much to the well-being and economy of our country, and in return are treated with little or no respect for their human dignity or rights.
Farm work is one of the most dangerous occupations in our country. Migrant farmworkers are exposed to extremes of heat and cold, often performing arduous physical labor for 10 hours a day, six days a week, or more. They work in painful positions, often bend over for hours at a time, performing repetitive tasks, under pressure to work ever faster and harder. They sometimes work around heavy machinery. They are also exposed directly and indirectly to pesticides, whose long-term effects are largely unknown. They are generally transported to and from the fields, and between fields, in farm vehicles with no seat belts. Often, they are not provided with toilet facilities or facilities for handwashing in the fields. They may or may not have the time or the opportunity to drink adequate water during the work day. In addition to the dangers in the field, most migrant and seasonal farmworkers live in “third world†housing conditions, with overcrowding, lack of privacy, and poor sanitation. We have visited homes where multiple families or up to 12 men live in a single-wide trailer, with electricity supplied by an extension cord run from a neighboring trailer, and toilets that do not work properly. Mattresses in any condition are considered luxury items in many cases. Insects and rodents are frequent cohabitants of the workers. A large percentage of farmworker families live adjacent to farm fields and thereby receive incidental exposure to pesticides. Their poverty (the median annual income of a U.S. migrant farmworker is $7,500, and 60% live below the poverty level, and an average of about 25% of their pay is sent home to Mexico) limits their ability to correct these factors as well as adversely affecting nutritional choices.
Musculoskeletal injuries, respiratory infections, skin diseases (especially dermatitis related to exposure to chemicals and plants), eye injuries and complaints (especially irritation from sun, chemicals, and dust), and heat-related illness are some of the more common conditions suffered by migrant farmworkers. Migrant farmworker children are more likely than others to be behind on routine vaccinations for childhood infectious diseases. Compared with other children living in the US, they have a higher rate of asthma, untreated respiratory and ear infections, significantly higher rates of dental disease, and malnutrition. Parasitic diseases are more prevalent (20-80%) in migrant farmworkers. This population has an increased incidence of tuberculosis. Depression and anxiety are frequently encountered, and alcohol is often used as a means of “escape,†resulting in an increased risk of domestic violence. Complications of chronic diseases, as well as more advanced stages of acute diseases, are seen as a result of delays in seeking medical attention for the reasons mentioned below. Prenatal care is often delayed or deferred completely by migrant farmworker women.
Obstacles to health care access for migrant farmworkers include:
The North Carolina Farmworker Health Program (NCFHP) began in 1993 with the support of federal funds from the Bureau of Primary Health Care. The program is located within the Office of Rural Health and Community Care (ORHCC) within the North Carolina Department of Health and Human Services. It provides voucher funding to Community Health Care Centers, Migrant Health Centers, and individual providers to improve access to health care by migrant and seasonal farmworkers throughout the state. Unfortunately, it is estimated that only 20% of eligible farmworkers and their families are served by this program.
Vecinos Farmworker Health Program, in Jackson County, N.C., is a mobile program funded by this program as well as by donations from individuals, churches, and organizations in the area. It consists of a registered nurse, a health educator/outreach worker, and a physician. Each of these individuals speaks Spanish and has had cultural competency training. Services are provided in a passenger-size van at the farms, trailers, and “camps†in which farmworkers live. In addition to receiving basic medical services via our mobile unit, referrals to other services, such as health departments, dental clinics, and specialists are arranged as possible. In addition, education regarding health issues, disaster and emergency preparedness, workers’ rights and other legal rights is provided. Because of the nature of farm work, these services are provided mostly at night and on Sundays. Transportation to sites of other services is also provided. The nurse and the outreach worker are also actively involved in enrolling children of workers (and child workers) into the school system (only about 30% of migrant farmworker children graduate from high school).
This program serves patients in five counties of western North Carolina, but reaches an unknown (but undoubtedly small) percentage of the eligible population. We see first hand the living conditions, working conditions, and the ill-treatment by employers, the community, and government agencies (including those who are supposed to protect the workers and enforce labor and safety laws) that are the daily reality for this “vulnerable population.†We have faced resistance from the community, from the farm owners, and from local government because of our advocacy and education activities. Our aim is to provide for the health and medical needs of the migrant farmworkers in our area, respecting their dignity and their rights as humans. But we are unable to significantly affect the underlying determinants of health. The work is frustrating but rewarding. It is our hope that one day the obstacles mentioned above will be removed by a transformation of the health care system, and that “Farmworker Health†will be the same as “People’s Health,†as advocated by the People’s Health Movement.
For more information about Migrant Farmworkers in the U.S., see “Close to Slavery†published by Southern Poverty Law Center.
There is further general information on farmworker health at http://www.ncfh.org/. However, here and at other sites, there are a lot of statistics from the National Agricultural Worker Survey, which I believe have critical flaws. Their survey techniques completely eliminate farms whose owners do not allow their workers to be interviewed, and includes only individual workers who are selected by their bosses (who know that they are breaking laws by hiring undocumented workers), and who are paid $20 for their interviews. Further, workers’ answers to questions such as “are you a legal resident of the U.S.?†and “how much are you paid?†are accepted as true without proof, despite the fact that the workers have good reasons to misrepresent the truth.
More information about North Carolina Farmworker Health Program
I will be glad to answer any questions that I can, or to research questions that I cannot answer. Mark
