Back to the Basics in Migrant Health

Transcription

1 Back to the Basics in Migrant Developed by the National Center for Farmworker Health Inc. About the National Center for Farmworker Health (NCFH) A national non-profit organization dedicated to improve the health status of farmworker families through the provision of innovative training, technical assistance, and information services. Visit our website: 1

2 Part 1. Migrant Health Basics This section includes: The history of farmworkers Demographics of the farmworker population An overview of their living and working conditions Exposure to environmental and occupational hazards Regulations affecting farmworker health Health status and the barriers to health care services Service delivery models Part 2. Farmworker Eligibility This section will provide you with the information needed to verify whether a farmworker is eligible for health care services in health centers that receive section 330g funding in the Public Health Service Act. 2

3 Acronyms The following acronyms are used throughout this presentation: BPHC Bureau of Primary Health Care CHC Community Health Center C/MHC Community and Migrant Health Center DOL Department of Labor FW Farmworker H-2A Agricultural Guest Worker Program MHC Migrant Health Center MSFW Migrant and Seasonal Farmworker OMSP Office of Minority and Special Populations OSHA Occupational Safety and Health Administration PHS Public Health Service Act UDS Uniform Data System 330 Section of the PHS Act that authorized funding for Community Health Centers 330g Section of the PHS Act that authorized funding for Migrant Health Centers Training Objectives Participants will be able to: Gain an understanding of the migrant health movement. Understand farmworker demographics, the culture of the population and how these impact on health delivery. Understand the Migrant Health Program and service delivery challenges. Understand farmworker eligibility and determine eligibility from a set of case studies. 3

4 Part 1. Migrant Health Basics I. Historical Background II. Demographics III. Farmworker Housing IV. Occupational Conditions V. Environmental Conditions VI. Regulations VII. Farmworker Health VIII. Barriers to Access & Continuity of Health Care IX. Migrant Health Structure & Policy X. Service Delivery Models Farmworker History Bracero Movement Sign up

5 Farmworker History cont d 1850 s Immigrant workers come to the US in large scale 1917 Immigration and Nationality Act passed 73,000 Mexican workers imported s Immigration from Mexico increased during World War I 1930 s The Dust Bowl Displaced farmers & share croppers become migrants The Bracero Act Act of Congress that authorized temporary visas to Mexican workers brought into the United States as an emergency measure to meet the labor shortage of World War II 1951 Public Law 78 Re-established the Bracero Program Braceros Waiting to Enter 5

6 Registration 1942 The Process Starts 6

7 Finger Prints Physical Exams and X-Rays 7

8 Vaccination Preparing Contracts 8

9 Waiting for Work Farmworker History cont d 1952 H-2 program established Similar to Bracero Program, but required certification of labor shortage to legally import workers 1962 Migrant Health Act Authorized funds to provide health services to the FW population Creation of small # of MHC s & expansion to new sites 1964 Public Law 78 terminated Although the Bracero Program officially ended, legal importation has not stopped. It is known today as H-2A Visa Program 9

10 Farmworker History cont d 1996 Health Center Consolidation Act Public Law Consolidates migrant health funding into CHC funding Recognized aged and disabled FW s 2001 Presidential Initiative - 5 yr. expansion plan meant to expand & strengthen C/MHCs with the following objectives: Double the number of people served -- 1,200 new / satellite access points -- Serve 6 million people 2009 ARRA American Recovery and Reinvestment Act The Farmworker Population 10

11 Demographics Men Women Children Farmworker Demographics 1 Estimated population of between 3-5 million 73% foreign born Ethnic composition is roughly: 83% Hispanic 6% White 4% African American 7% Other 78% Male 7th grade education 17% indigenous Spanish-dominant language (75%) Average age 34 years old 30% earn less than $10,000/yr 75% don t have employerprovided health insurance About ½ million children work in agriculture 1. Findings from the National Agricultural Workers Survey (NAWS)

12 Kentucky Horticulture Kentucky ranks 1st in the production of nonalfalfa hay Crops: tobacco barley hay grain sorghum corn soybeans apples tomatoes What Else? Kentucky Livestock Livestock and livestock products account for about half of Kentucky s farm income. Kentucky ranks 1st in both the thoroughbred horse breeding industry and in the value of sales at $1 billion. Other livestock products are broilers, milk, eggs and hogs. 12

13 Number of MSFWs by State 0-5,000 5,001-10,000 Migrant & Seasonal Farmworkers by State 10,001-20,000 20,001-30,000 30,001-50,000 50, , , , , , , ,000 Developed by NCFH 1,300,000 Alice Larson Enumeration Studies 1993, 2000, 2003 Classification of Farmworkers Migratory Agricultural Farmworker 42% of the farmworker population are migratory workers (who established temporary abode for purposes of agricultural work) Types of migratory worker: National (26%) International (35%) Seasonal Agricultural Farmworker 55% of the farmworker population are seasonal workers ( they work in a seasonal basis and don t need to establish a temporary abode for purposes of employment More workers establishing themselves in rural communities as seasonal workers 1. Findings from the National Agricultural Workers Survey (NAWS) Demographic and Employment Profile of United States Farm Workers. U.S. Department of Labor, Office of the Assistant Secretary for Policy, Office of Programmatic Policy, Research Report No. 9. March

14 Where Do They Migrate? Traditional Restricted Point-to-Point Nomadic Migration Largest home base states are CA, TX, WA, FL Largest up stream states are NC, MI, CO, IN Fewer families traveling together and more males traveling alone 14

15 Where do they Live? Farm workers live: In housing supplied by employers By the field in self made shelters In camps In cars Farmworker Housing cont d Less housing is available on or near farms (greater dispersion of population) Number of FW s in need of housing exceeds the number of available housing units Some of the barriers to renting include requirement of deposits, qualifying credit checks, or long term rental commitments Lack of cooking facilities & running water Inadequate washing facilities (laundry and showers) 15

16 Employment Availability of work is dependent on season, weather, and market demands Working Weeks Farm work (34.5) Non-farm work (5) Employed by 79% Growers/Packing Firms 21% Labor Contractors Employment 79% are paid by the hour, while others are paid by piece rate or a combination of both average hourly rate is between $7.25 $12.00hr The majority do not receive benefits, including: Sick leave Retirement Unemployment insurance (39%) Worker s compensation (varies by state) Health Insurance (8%) Vacation pay Overtime pay 22% report using Need Based Services Findings from the National Agricultural Workers Survey (NAWS) Demographic and Employment Profile of United States Farm Workers. U.S. Department of Labor, Office of the Assistant Secretary for Policy, Office of Programmatic Policy, Research Report No. 9. March

17 About Agriculture Agriculture is consistently ranked as one of the three most dangerous occupations in the nation 1 In 2006, 33/100,000 farmworkers died of work related injuries vs. 4/100,000 in the general population 2 1. U.S. General Accounting Office Hired Farmworkers Health and Well-Being at Risk: Report to Congressional Requesters. Washington, DC: U.S. General Accounting Office 2. Bureau of Labor Statistics Census of Fatal Occupational Injuries Summary Occupational Health Risks 17

18 Risks Related to Repetitive Motions and Heavy Lifting Carrying Stooping Lifting Reaching Risks Related to Organization of Work Low piece rate wages High physical exertion Fast pace of work Long hours, no breaks 18

19 Broken/crushed bones from tractors and machines Lacerations from sharp equipment and hand tools Falls from ladders Suffocation from silo accidents Risks Related to Farm Machinery/Tools Injuries from Vehicle Accidents Unsafe transport of work crews Frequent migration No seat belts Poorly maintained vehicles 19

20 Environmental Risks Chemicals/ Pesticides Weather Plants Animals Sanitation/ Hygiene Environmental Risks Weather, Plants, and Animals Extreme heat and cold Rain, snow, and humidity Lightning Sun exposure Poisonous animals Dust, pollen, bugs 20

21 Environmental Risks Pesticides Agri-chemical spills Chemical leaching into groundwater Chemical run-off into surface water Contaminated clothing Pesticide drift carried by wind Recycling of pesticide containers for home use Environmental Risks Sanitation Unavailability of safe drinking water Lack of nearby toilets Lack of nearby hand washing facilities 21

22 Regulations At times, agricultural risks are compounded by the lack of safety regulations or inconsistent enforcement of regulations that deal with agriculture. Regulations 1 Migrant and Seasonal Agricultural Worker Protection Act This Law is Enforced by the DOL Wage and Hour Division and requires: Employers to disclose terms of employment at the time of recruitment Employers who use farm labor contractors to confirm registration with the DOL. Farmworker housing to meet local and federal housing standards The use of safe and insured vehicles to transport farmworkers Exceptions: Doesn t apply to smaller employers 1. Oxfam America Like Machines in the Fields: Workers Without Rights in American Agriculture 22

23 Regulations 1 cont d OSHA Field Sanitation Standard Employer must provide Cool drinking water One toilet and hand washing facility per 20 employees Safety fittings on some machinery 1. Oxfam America Like Machines in the Fields: Workers Without Rights in American Agriculture Regulations 1 cont d EPA Worker Protection Standard Pesticide safety training Notification of pesticide applications Use of personal protective equipment Restricted entry intervals following pesticide application Decontamination supplies; and Emergency medical assistance EPA s enforcement and inspection powers are limited Worker s Compensation Only 13 states provide the same coverage to farmworkers as is required for workers in other occupations. In all other states, coverage of farmworkers is voluntary or special provisions exclude farmworkers. 1. Oxfam America Like Machines in the Fields: Workers Without Rights in American Agriculture 23

24 Child Labor Laws & Agriculture Children can : work as young as age 12 work unlimited hours outside of school engage in hazardous labor beginning at age 16 Minimum wage provisions in the FLSA do not cover many MSFW children No guaranteed minimum wage Not entitled to overtime pay Children: cannot work before age 14 ages can only work 3 hours on a school day, no more than 40 hours/wk when school is out of session and not before 7am Performing hazardous labor is prohibited until age 18 Minimum wage for most jobs Regulations 1 Despite these laws to protect farmworkers: There is inadequate enforcement by federal agencies Penalties for violations are minimal Employer compliance with the regulations is generally low 1. Oxfam America Like Machines in the Fields: Workers Without Rights in American Agriculture 24

25 Farmworker Health Farmworker Health Occupational, environmental, economic, and other factors strongly influence the health status of FWs. FWs are at a high risk of hypertension, allergies, arthritis, dermatitis, tuberculosis, diabetes, and dental problems. (1) Only one in four FWs has access to the health services provided by C/MHCs. (2) 1. Suffering in Silence: A Report on the Health of California's Agricultural Workers, Don Villarejo et al, California Institute for Rural Studies & The California Endowment, November U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care. Health Centers: America s Primary Care Safety Net, Reflections on Success, Rockville, MD. June

26 Farmworker Health Farmworkers are more likely to suffer from health conditions that can be attributed to the occupational and environmental risks associated with agriculture work: Dehydration Heat Stroke Insect Bites Malnutrition Pesticide Poisoning Musculoskeletal Injuries from Repetitive Motion and Heavy Lifting Back Pain Carpal Tunnel Syndrome Lumbar Disc Disease Spinal Stenosis Ulnar Nerve Compression Arthritis 26

27 Infectious Diseases Conjunctivitis Gastro-intestinal Infections Intestinal Parasites Urinary Tract Infections HIV/AIDS Tuberculosis Associated with lack of sanitation facilities, housing and living conditions Chronic Conditions Allergies Asthma Cardiovascular Disease Chronic Renal Failure Chronic Obstructive Pulmonary Disease (COPD) Degenerative Joint Disease (DJD) Diabetes Hypertension Thyroid Disease 27

28 Mental Health Conditions Sometimes associated with high level of stress Anxiety Depression Substance Abuse Domestic Violence Lack of family support because of separation is strongly associated with mental health conditions Intact families traveling the migrant stream together may have low rates of smoking, drug use, and risky sex. Single men traveling alone in the migrant stream may have significantly higher rates 80% of respondents to the Bi-national Farmworker Health Survey reported needing relief from stress or anxiety Barriers to Health Care Services 28

29 How Many Receive Health Care? 300, , , , , , , , , , ,000 80,000 60,000 40,000 20, ,000 C/MHC Users 3.5, million MSFW Population California Washington Florida Puerto Rico North Carolina Colorado Michigan Texas Other States Source: UDS 2011 Access Barriers Farmworker-Specific Barriers Constant mobility Limited income Lack of health insurance English limitations Levels of literacy Health beliefs and practices Not knowing where to go Lack of transportation Unavailability of sick time 29

30 Access Barriers Organizational Barriers Limited bilingual staff available Phone answering services in English only Clinic schedule advertising in English only Unavailability of interpreters Patient education & prescription available only in English Overbooked appointment schedules Service provided by appointment only Long waiting time for appointments Lack of public transportation systems Barriers to Continuity of Health Care Services Continuity of care is the most challenging issue in the provision of quality of care for FWs because: FWs may seek care only when it is necessary Once treatment begins, FWs may move If FWs seek care when they arrive in the next community, they may not remember the name or dose of the medication they are taking FWs may take records with them, but often lose them Communication between MHCs and other providers is difficult Proper case management may help prevent Disruption of chronic disease management Misdiagnosis Overmedication 30

31 Health Beliefs and Practices among Hispanic Population One shoe does NOT fit ALL Hispanics are not a homogenous group Geographic variation Generation variation - acculturation Rural vs urban background Multi generational composition of household Availability of services Cultural Beliefs Influence: The etiology or cause of an illness How one communicates health problems How one presents symptoms When and to whom one goes to for care The congruency of an illness with a medical diagnosis The willingness or lack thereof to adhere to a plan of care The use of possible combinations of folk and/or western medicine The restoration of health 31

32 Why Folk Medicine? Cultural Identity & Tradition Personal beliefs, guided by social and ethnic backgrounds Folk remedies are usually passed by word of mouth. Strong ties to nationalities, backgrounds, and heritage My Grandma used to.. This is how many of today s commonly used folk remedies are passed down. For example, how many remedies can you think of for the common cold? Drink lots of fluids Eat Chicken Soup Drink Mint Tea Drink Echinacea Tea Gargle with Salt Water (for sore throats and cold symptoms) Eat lots of oranges (for the Vitamin C) Lather your chest with Vick s and bundle up (congestion) 32

33 Curanderismo Curanderismo is the art of Mexican Folk Healing, from the word curar, meaning to heal Term used to describe the entire Mexican Folk system of disease and healing. Curanderismo uses an holistic approach to healing treating body, mind, and spirit Disease and Illness Classification Classified according to causation hot or cold type natural(according to God) elements of the body supernatural(violating God s will) 33

34 Lay Healers Yerbero Sobadore Partera Senora (abuela) Espirtualista Huesero Curandero Herbalist Massage therapist, or someone who massages Midwife Lay person with the knowledge of common ailments & traditional treatments Spiritualist Bone setter Healer Common Therapeutic Practices Religious, spiritual, magical, sacramental objects Natural substances; botanical, animal, mineral Physical Therapies 34

35 Herbal Remedies The Meso-American Indians had a very sophisticated system of health, disease, and treatment. They established the first medical schools in Mexico fifty years before Jamestown was settled, and used a pharmacopeia of over 5,000 well studied and efficacious Indian herbal medications that have been categorized in the Badiano Codix (1552). In that native system of medicine, a strong connection between religion and health existed Common Folk Diseases Evil Eye - OJO Cause: Ojo occurs when a person with a powerful gaze looks at someone or something without touching them. Symptoms: Sudden high fever, vomiting, headache, fainting, and sometimes convulsions. In the case of objects, the object is either lost or broken. Diagnosis: Is done by passing a raw egg over the patient s body and then cracking it. If the egg appears cooked, the patient suffers from Ojo. Prevention: Carry an Ojo de Venado (buck eye) amulet 35

36 Common Folk Diseases Evil Eye - OJO Cure a) Have the perpetrator touch the person. b) When that isn t an option, you should pass a fresh egg over the person s body, and then broken into a bowl of water and covered by a cross of palm leaves, or straw; and put under the head of the patient s bed. In the morning the egg is examined, and if it looks curdled, the patient is cured. National Center For Farmworker Health, April 9th, 2009 Common Folk Diseases Empacho Cause: Empacho occurs by eating soft food or difficult-to-digest substances. These substances supposedly stick to the stomach wall. Symptoms: Anorexia, stomach ache, vomiting, painful Diarrhea, and general abdominal fullness. Diagnosis: By a healer noting the symptoms and checking for direct abdominal tenderness. More positive diagnosis is made by rolling a chicken egg over the abdomen. If the egg appears to stick to a particular area, the patient is considered to suffer from Empacho. To cure Empacho you need to rub the patients stomach or back, and then pop the skin on the back. Sometimes teas are useful. 36

37 Common Folk Diseases Caida de Mollera (Fallen Fontanel) Cause: Mollera Caida is commonly felt to be caused by maternal neglect. It is considered to be caused mechanically by having the nipple pulled from the baby too suddenly and therefore causing a suction. Sometimes it is also attributed to a sudden jolt, bump or fall. Symptoms: Dehydration, crying, inability to achieve sufficient suction while nursing, fever, and diarrhea. Diagnosis: Noting the baby s fontanel position in association with any of the more common symptoms. Cure: Pressing upwards on the soft palate with the thumb, sucking the anterior of the fontanel, holding the baby upside down over water with or without shaking, and other possibilities include applying raw egg, oil, or warm water to the fontanel. National Center For Farmworker Health, April 9th, 2009 Common Folk Diseases Susto (or Fright) o Cause: Susto is supposed to be caused by a sudden frightening experience such as an accident, a fall, a sudden death, or supernatural experience (ghost apparitions). Susto is considered to be highly dangerous because it causes the separation of the soul from the body. Symptoms: Nervousness, anorexia, insomnia, listlessness, involuntary muscle tics, and diarrhea. Diagnosis: Noting the symptoms and then correlating them to the viewing of a frightening experience. Prevention: When away from home carry a whole nutmeg. 37

38 Common Folk Diseases Susto (or Fright) Cure: Oral remedies can include orange and chamomile teas, while the most effective (and common) treatment is the barrida. During the barrida, the patient recounts the frightening experience while lying down on the floor. The healer sweeps the body with fresh herbs while reciting Christian prayers. This returns the soul. Common Folk Diseases Mal Aire(or Bad Air) o Cause: Refers to the harmful effects of being exposed to night air that is cold and damp. Often felt to be caused by moving rapidly from a warm or hot environment into a very cold one, breathing in cold air or working up a sweat and not allowing enough time to cool down. Symptoms: In children, primary symptom is earache and in adults, muscular spasms or paralysis; other symptoms may include cold or flu like symptoms, headaches, cramps, stiff neck, nausea and vomiting, fever, dizziness Diagnosis: Noting the symptoms and then correlating them to the event. Prevention: Avoiding drastic changes between hot and cold environments. 38

39 Common Folk Diseases Mal Aire(or Bad Air) o Cure: For earache, blowing warm smoke into affected ear. For other symptoms, cupping a cup is heated and deoxified with a match or candle, then placed on the affected area. This creates a vacuum in the cup which in turn causes the skin to swell and the knotted muscles loosen up. Limpias and herbal teas can also be used. Recommendations 1. Understand (and be sensitive) to the role folk medicine may play in patients one encounters. 2. Practice delivering messages of tolerance and respect. 3. During the interview, ask "What do you think caused your illness?", and "We all have favorite remedies that we use when we are sick. What have you done to treat this condition?" 4. When appropriate, and not contraindicated, incorporate some benign folk medicine remedies into one's advice to the patient to improve the compliance and trust; i.e. when encouraging liquid intake for colds and flu, considering suggesting té de manzanilla (chamomile tea) 39

40 Migrant Health Policy JFK Signs Migrant Health Act Migrant Health Authorization In 1962, Congress authorized the PHS Act, Section 329 known as the Migrant Health Act. The Migrant Health Act authorized funds to provide preventive and primary health care services to the FW population and allowed the creation of Migrant Health Clinics (MHCs). In 1996, Congress approved the Health Center Consolidation Act, which authorized the consolidation of the Migrant (329), Community (330), Homeless (340), sections of the PHS under the umbrella of 330 Programs. 40

41 Public Health Section 330 Programs Community Health Centers: 330(e) Migrant Health Centers and Voucher Programs: 330(g) Health Care for the Homeless: 330(h) Public Housing Primary Health Care Centers: 330(i) BPHC support s >1,128 health care grantees = to > 8,500 sites. 160 Migrant Health Center grantees >500 delivery sites Health center budgets range between $500,000 and $25 million. On average, BPHC provides about 28% of the health center s total budget In general, for every dollar provided by BPHC, the health center contributes three additional dollars. Required Services for 330(g) Programs: Both health centers and voucher programs must provide the services required by the Migrant Health Program. Those services include: Primary care services Preventive services Emergency services Pharmacy services Ancillary services 41

42 Ancillary Services Follow-up Outreach Screening Case management Transportation Coordination Of care Health promotion Interpretation/ Translation Program Requirements There are 19 Key Health Center Program Requirements divided into four categories: I. Need II. Services III. Management & Finance IV. Governance (*see handout) 42

43 Service Delivery Models In an effort to increase access to care for farmworkers, 330 (g) grantees provide services through a variety of traditional and non-traditional service delivery models including: Health Center Model Voucher Model Combined Model Migrant Health Service Adaptations Voucher programs Mobile units Lay health promoters (promotoras) Outreach programs Family visits Bridge case management Portable medical record and ID card/bracelet Complementary and alternative medicine Cultural-sensitivity education for providers Appropriate language and literacy levels Collaboration with other service providers such as schools and day care centers 43

44 Service Delivery Challenges MHCs must remain competitive despite the escalating costs in the health care industry Lack of insurance coverage of the population Recruitment and retention of qualified bilingual and bicultural staff Relevant training and continuing education of staff Seasonal fluctuations of demand Part 2. Farmworker Eligibility This section will provide you with the information needed to verify a farmworker s eligibility to receive health care services in health centers that receive funding under Section g of the Public Health Act. 44

45 Farmworkers in Kentucky Horticulture Livestock Combined Total Farmworkers Dependents Total Workers Dependents Total Migrant Seasonal Sub Total Children Spouse Sub Total Total Horticulture Workers Children Spouse Total Livestock 17,253 32,837 50,090 23,954 16,210 40,164 90,254 44,640 21,427 14,285 80, ,606 Number of MHCs: 1 MSFW Patients: 1,745 Objectives Describe why it is important for health centers to identify and document the farmworkers they are serving. Learn the definitions of Migrant & Seasonal Farmworkers (MSFW). Customize the intake questions that will help identify MSFWs, including elderly & disabled. Identify MSFW status from case studies. 45

46 Can You Identify the Farmworkers? Look at the following pictures and identify who you would classify as a farmworker. Can You Identify the Farmworkers? Based on the following list of last names, please identify who you would classify as a farmworker? Smith Perez Miguel Santos Jones Johnson Bastien Gutierrez Valenzuela Dominguez Zarate Robles Rodriguez Gonzales 46

47 Answer: It s not possible to verify a person s eligibility by looking at faces or names, or by stereotyping. Although most farmworkers are Hispanic, many are Jamaican, Haitian, Asian, and White. Unless you ask, you will not know. Why is it Important to Determine Eligibility? 47

48 Why do Migrant Health Centers Need to Verify Farmworker Eligibility? Increased health care access for FW s Improved use of the Uniform Data System for documentation & reimbursement Increased accountability to funding agency Provides data needed to target migrant population Justifies need to recruit and retain culturally competent staff Increases justification for program expansion In Order to Determine Eligibility, You Need to Know The definition of agriculture What types of industries and tasks in agriculture are included and excluded under HRSA rules The classifications of farmworkers 48

49 Definition of Agriculture Agriculture (also called farming or husbandry) is the cultivation of animals, plants, fungi, and other life forms for food, fiber, and other products used to sustain life. International Labour Office (1999). Safety and health in agriculture. International Labour Organization. pp. 77. ISBN Retrieved 13 September 2010 PHS Section 330 Authorizing Legislation Farming in all of its branches, including: Cultivation and tilling of the soil Production, cultivation, growing & harvesting of any commodity grown on, in or as adjunct to or part of a commodity grown in or on the land Any practice including: preparation & processing for market and delivery to storage, or market, to carriers for transportation to market (performed by a farmer or on a farm (incident to or in conjunction with any activity as described in B) 49

50 Farming in All of Its Branches Including: Cultivation and tilling of the soil Production, cultivation, growing & harvesting Any practice including Preparation & processing for market, for delivery & for storage Preparations & processing for delivery to storage or to market Preparations & processing for delivery to carriers for transportation to market Performed by a farmer Incident to or in conjunction with any activity as describe in B or Performed on a farm that is Incident to or in conjunction with any activity as described in B o o o o Production Cultivation Growing Harvesting What Agricultural Sectors Could be Included in the Migrant Health Program? 50

51 Grains and Nuts Fruits 51

52 Nurseries Other Commodities Tobacco Cotton Hops Grains Christmas Trees 52

53 Dairy Farms Animal Farms 53

54 Poultry Farms Aquaculture 54

55 Forestry Samples of Tasks and Industries that potentially could be Excluded Transportation of livestock -U.S. Industry Landscaping - Industry Landscaping Services Meat and Meat Product Merchant Wholesalers (Industry 42447) Spectator Sporting- Industry Trucking timber- Industry Specialized Freight

56 Agricultural Tasks Preparation of the soil Seeding plants, flowers, grass, trees, vegetables, fruits, and other commodities Planting, thinning, growing, irrigating of vegetables & fruits Planting, caring, pruning, fertilizing, replacing trees Detasseling, collecting, harvesting (corn and other grains) Sorting, preparing, processing Canning, preserving, packing Transporting, storing, distributing Catching, preparing, processing aquaculture products Feeding, caring, milking cows and other farm animals Classification of Farmworkers Farmworker Principal employment is in agriculture Been so employed within the last 24 mos. Seasonal Agricultural worker Not migratory Does not need to establish a temporary abode for purposes of such employment Migratory Agricultural worker Establishes a temporary abode for purposes of such employment Aged or Disabled Farmworkers Applies to individuals who were previously agricultural workers but no longer meet the requirements due to age or disability (Health Center Consolidation Act of 1996, Section 330(g) -Public Law ) 56

57 Tools for Eligibility Farmworker Status Agriculture or farm work includes: preparing, irrigating or spraying the fields, nurseries, orchards; planting, picking, sorting, packing, or transporting fruits, vegetables, grains, nuts, plants, tobacco, hops, flowers, grass, alfalfa, hay, or other agricultural products; planting trees; working with Christmas trees; picking pine needles or Spanish moss; taking care of chickens, ducks, turkeys, cows, goats, sheep, fish, clams, etc. Sample Questions to Ask In the last 2 years, have you or anyone in your household, primarily worked in any type of agriculture (farm work)? Yes Seasonal Worker In the last 2 years, have you or anyone in your household, moved to another area and left away from home in order to work in any type of agriculture? (farm work) Yes Migratory Worker Have you or a member of your household ever worked in agriculture and stopped working because of a disability or age (too old to do the work)? Yes Aged or Disabled Migratory Worker 57

58 How Farmworkers Identify Themselves By the name of the crop By the place of agriculture En el fríjol" En la cebolla "En el empaque de" "En el algodón" "In the beans" In the onions" "In packing " "In the cotton" "En la labor" "En una nurseria" Con un contratista" "Con un ranchero" "In the field" "In the nursery" "With the contractor" "With the farmer" By the name of the agricultural Activity By the geographic location "Soy amarrador" "Soy Pizcandor" "Trabajo en el plástico" "En maquina pizcadora" "En el azadón" "En el desahije de" "I fasten the plants" "I am a picker" "I work laying plastic" "In harvesting machine" "I work with a hoe" "I work thinning the.. "Me voy pa Michigan" "Voy a los trabajos" "Me voy pa los trabajos" "Me voy con el troquero" "Sigo las corridas de" "Me voy pal norte" "I go to Michigan" "I follow the work " "I follow the crops" "I go with the contractor" "I follow the crop"" "I go to the north" Case Studies : Let s Put into Practice What We Have Learned Read the following 5 case studies and determine the family s eligibility status While reading the case studies, ask yourself the following questions. 1. In the last two years, did this person/family work in agriculture? 2. In the last two years, did this person/family move to other areas to work in agriculture? 3. Can this person/family be classified as a migrant or seasonal farmworker? 4. Is this person no longer working in agriculture because they are too old or they are disabled? 5. Who, in each case, qualifies as the dependent of a migrant, seasonal, disabled or retired farmworker? 6. How is this documented in your C/MHC s data base? 58

59 Case Study # 1 A family of 8 from Kentucky travels to Michigan to harvest asparagus from April June. At the end of June, the family goes to Florida to work harvesting tomatoes. In early September, the family returns home to Lexington, KY. Today, the family is at your health center because their children need their school physicals. All the children are on the State CHIP program. The father is presently working in construction in Georgetown, KY. Case Study # 2 Tony is the oldest son of the Garcia family. For the last 4 months, he has been working in the tobacco in Barren County. Tony s economic contribution supports the family. Tony s father, Mr. Garcia is very sick and unable to work and his wife is a homemaker. Their youngest son is at your health center with an ear infection. 59

60 Case Study # 3 Ms. Lopez is 55 years old. She worked for 30 years planting onions and peppers in Colorado and Indiana. Seven years ago, she was planting onions and accidentally cut her hand. She developed a terrible infection and her hand was amputated. She is disabled and unable to work. She now lives in Lexington with her mother. She covers her and her mother s living expenses, with a small pension check. Today, she is at your health center because her mother is sick. Case Study # 4 Mrs. Perez-Smith and her family have lived in Central City since She works in a local grocery market and Mr. Smith works on a dairy farm. Mr. Smith is in your health center and he needs to see his doctor because his diabetes is out of control. 60

61 Case Study # 5 Tomas was contracted to come to the U.S. in 2006 to work for an orange grower. Halfway through the growing season, a storm hit the area and wiped out the harvest. Since the grower had no more work for him, he looked for work elsewhere. Now he lives near Louisville, where he has worked in construction full time for the last two and a half years. He is in your clinic because he fell off a ladder and might have broken his arm. Answers: 1. Dependent of a migratory farmworker 2. Dependent of a seasonal farmworker 3. Dependent of Disabled farmworker 4. Seasonal farmworker 5. Not a farmworker 61

62 Contact Information Sylvia Partida, National Center for Farmworker Health 1770 FM 967 Buda, TX (512) (800)