Shannon Paris Oscar Ramos HE 407 Migrant Health

1. 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

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

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

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

5. 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. What we owe to them

6. State of Oregon • 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.

7. State of Washington • 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.

8. MSFW’s Health Problems • MSFW’s experience a higher incidence of health problems due to the following factors: • Lack of health insurance (cannot get it) • Economic factors (low pay) • Poor living conditions (unsafe housing) • 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)

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

10. Obstacles for Health Care Access • 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

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

12. 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. • 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.

13. 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. • Many times is a language issue but at times it is also an educational issue as many MSFW’s cannot read.

14. 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. • Many do not understand the dangers of pesticides, or the needs of vaccinations.

15. 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. • 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.

16. 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. • 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.

17. 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.

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

19. La Clínica Del Cariño - Services • 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 • care for acute and chronic medical problems in adults, children and senior citizens • pregnancy care (including deliveries) and family planning services • care for children from birth through age 18 • walk-in visits and urgent care • immunizations • minor surgery (mole removal, suturing, vasectomy, circumcision) • casting and splinting for bones and joints

20. La Clínica Health CareMedford, OR

21. What would Steinbeck say??