OCTOBER 1, 2009 ISSUE
Caring for the Underrepresented
Local Farmworker Health Program Assists Migrant and Seasonal Workers
Dr. Bill Herring tends to a farmworker at the free Wednesday night clinic in Linville. Photo submitted
Hundreds of farmworkers come to the area from Mexico each year from March to November to work on Christmas tree farms, and the local Farmworker Health Program strives to offer them a critical service they would otherwise have little or no access to: basic healthcare.
“Farm work is still considered the second most dangerous job in the U.S. after mining,” said Allison Lipscomb, program director, who holds a master’s degree in public health.
The work is considered dangerous, she explained, because it often involves pesticide exposure, frequent injuries and the environmental exposure that results from working outside. Oftentimes, farmworkers also have language and cultural barriers and the added disadvantage of living in crowded housing conditions.
Additionally, farmworkers are not familiar with the healthcare system and earn, on average, $7,000 a year, Lipscomb said.
The Boone office of the North Carolina Farmworker Health Program (NCFHP), located at 215 Doctors Drive, opened in 2005 and operates an outreach program that helps farmworkers in Avery, Caldwell and Watauga counties. The farmworkers do not have to be from Mexico; the program was created for all farmworkers, Lipscomb said.
“The Farmworker Health Program plays a critical role in addressing health disparities in the High Country,” said Bryan Belcher, manager of Healthy Carolinians. “The program addresses the needs of a population that has unique health risks, and the workers and the community mutually benefit. Improving the health outcomes of this population enhances their quality of life, provides healthier and more productive employees for local industry and saves tax dollars by potentially preventing the use of the local hospital emergency room for primary care.”
In Caldwell County, farmworkers tend ornamental trees, which are raised to go into landscaping, Lipscomb said. “In Avery and Watauga counties, it’s nearly all Christmas trees, with some nursery [ornamental] trees mixed in,” she said.
Chelly Richards, outreach worker, and Rebecca Crain, 2008 student intern, provide pesticide education to a farmworker camp. Photo by Katie Langley
“We go out into the community,” Lipscomb said. “Our job is to link farmworkers in this area with existing health services in this area. Very few [of them] can get Medicaid or be covered by Worker’s Compensation.”
Lipscomb and Chelly Richards, who holds a master’s degree in agronomy and has been employed as an outreach worker with the program since January 2008, are the only two paid staff members. They are often assisted by an intern provided either by the Durham-based nonprofit SAF (Student Action with Farmworkers) or through ASU’s ACT (Appalachian & the Community Together) office.
The program serves more than 400 farmworkers each year in its three-county area, Lipscomb said.
If farmworkers are here with a legal work visa, their boss is required to provide them with housing, Lipscomb said.
The bosses must also provide directions to and addresses of this housing to the N.C. Department of Labor, which inspects all registered housing units once a year, she said.
“Undocumented workers rent their own housing or sometimes are provided with housing through growers,” she added.
Since the establishment of the program in the area, Lipscomb has sought out and built relationships with both the Christmas tree growers and the farmworkers.
“The relationship with workers is the most important thing to us, to build up trust,” Lipscomb said. “Culturally, our clients are more likely to trust a person than an agency.”
She and Richards create a relationship with the farmworkers to let them know they can go to the doctor, and they build relationships with the providers to accept the form of payment available, Lipscomb said, adding that the N.C. Migrant Fee-for-Service Funds pays for some appointments for some workers.
One way in which the Farmworker Health Program links farmworkers with services available locally is by informing them of a free medical clinic in Linville. Lipscomb and Richards do intake and interpretation at the clinic’s front desk on Wednesdays, where any uninsured person can receive care from 5:00 to 8:00 p.m. in the Grandfather Specialty Clinic at the Sloop Medical Plaza.
Rosa Benfield, FNP, started the free clinic about six to seven years ago and Dr. Bill Herring is the medical director now, Lipscomb said, adding that four doctors volunteer their time to see patients each week at these hours.
To receive care at this clinic, patients pay a $10 fee, which covers sample medicines and testing supplies, she said.
If farmworkers need specialty care, dental care or eye care, the Farmworker Health Program helps them find a place in which they can receive care and sometimes provides transportation to appointments.
“It’s really hard for those without insurance in the High Country to see a dentist,” Lipscomb said. “Many [of the farmworkers] have never seen a dentist before.”
Usually the farmworkers who go to the dentist through the program are in severe pain and in need of an extraction, she added.
“In Mexico, [dental care is] not such a priority,” she said, adding that children can die from an untreated tooth infection making its way to the brain.
For this reason, the program’s education component of dental hygiene is very important to the clients’ wellbeing.
The Roots of Farmworker Health
In the 1960s, around the time when Medicaid and Headstart began, the documentary Harvest of Shame was released, and the film brought a lot of attention to a largely invisible population in this country, Lipscomb said.
Soon after its release, the government created migrant health centers and advisory councils to provide basic care for the farmworkers.
“Migrant health centers are considered a safety net program,” Lipscomb said. “It’s not ideal; we do the best we can, [but] it’s not like having your own private insurance.”
These federally funded migrant health centers operate where large concentrations of farmworkers are found, in such places as California and Florida.
The NCFHP began in 1993, operates in 14 sites around the state. Also located in the state are a handful of migrant health centers—which are different from the outreach services offered in Boone. Several migrant health centers operate in the eastern part of North Carolina, where farmworkers tend tobacco and vegetables, but the nearest one to the High Country is in Hendersonville.
“There are not enough people here to justify having a center,” Lipscomb said. “We’re dealing with a more scattered population in rural communities.”
Since the Boone office’s 2005 opening, Appalachian Regional Healthcare System has served as the host agency and provides office space for the Farmworker Health Program, Lipscomb said. “[They] give us oversight [but they] give us a lot of independence. We’re employees of the hospital, but we have a lot of training with [the] Farmworker Health [Program].”
The NCFHP hosts three intensive training sessions per year for ongoing professional education and to keep those in the field updated on current needs and issues.
Ultimately, the federal government funds the Farmworker Health Program. It allots a certain amount of money each year to the state to operate the program, and each of the program directors at the 14 sites apply annually for state grants. The state awards the annual grant to the host agency—in the case of the local site, to Appalachian Regional Healthcare System—and the host agency, in turn, distributes funds to the program.
“It’s very unlikely to not get the grants as long as a person is here to administer the program,” Lipscomb said.
The Local Program at Work
“Before there was a program here, farmworkers would forego care or end up in the emergency room,” Lipscomb said. “A big part of what we do is education.”
The education covers diabetes, hypertension, high blood pressure, HIV prevention, dental care, basic first aid—what to do if they get cut, poison ivy or insect bites—and other health issues. Checking blood pressure, blood sugars and HIV testing are also components of the outreach.
“We’re more of a public health model,” Lipscomb said. “In the current healthcare system, [our program] helps to not burden the system if we’re able to prevent some of these chronic health problems through education, and if we’re able to manage the problems, such as hypertension and diabetes. We’re not waiting until they have a stroke or heart attack [to give them a form of healthcare].”
Workers in construction, landscaping or other fields are ineligible for services provided through the program, but the Farmworker Health employees will direct them to where they can get services. As stipulated by the grant funding, this particular program is only for those who work in row crops.
“God willing, this program will continue for many years because it’s a great benefit for all of us,” said a farmworker in an anonymous feedback survey.
The Story on Farmworkers
Many farmworkers that come to the East Coast travel from Florida up to Maine and back down each year, following the growing seasons, Lipscomb said, adding that that’s not the case here.
“Usually in Boone, we see people come from Mexico [and then] go back to Mexico,” she said, adding that trees require eight or nine months of care.
In the spring, farmworkers plant trees and clean up the grounds from the year before, Lipscomb said. In late spring, they begin spraying pesticides, in the summer, they shear the trees—shaping them into the desired Christmas tree form—and in the fall, they harvest the trees.
“They have a different concept of a workweek,” she said. “If we ask, ‘How much are you working?’ [a reply of] ‘Not much’ would be a 40-hour week.”
Even working for minimum wage here translates into making 10 times what the farmworkers would make in Mexico, Lipscomb added.
“If they’re on a visa, they go home after Thanksgiving,” she said.
In mid-October and the beginning of November, workers done with tobacco or vegetables in the eastern part of state come up to Avery and Watauga counties to work during the Christmas tree harvest, she added.
“For the first year [this year], we’ve had people coming up from Florida looking for work,” Lipscomb said.
Those in the community who do not directly interact with the farmworker population often hold misconceptions about them, Lipscomb said.
“[Farmworkers] are not just a hidden community but a misunderstood community,” she said, adding that they do not come here to take advantage of the system or to become citizens, as many people think.
“They don’t really want to be here,” she said. “It’s really hard work, long hours, not great pay [and it’s] outside work. They’re earning money for their kids to go to school, for them to start a business in Mexico [or to] support their families. It’s sad to see sometimes the backlash and misunderstanding [toward them].”
Richards agreed. “They’re away from their families and communities, [so] we become case managers in a sense [and] also give them services they need,” she said.
“It’s been really eye-opening, the number of people you don’t see here,” Richards continued. “People say to me, ‘There are not many people from Mexico in Boone,’ but I work with them every day.”
For more information about the program, click to www.ncfhp.org.
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