North Carolinas Farmworkers North Carolina Farmworker Health Program

North Carolina’s Farmworkers North Carolina Farmworker Health Program Office of Rural Health and Community Care NC Department of Health and Human Services www. ncfhp. org

Overview l l l Farmworkers in North Carolina The North Carolina Farmworker Health Program Internship and Service Learning Opportunities www. ncfhp. org

Farmworkers in North Carolina l Demographics l Environmental and occupational health risks and other health concerns l Access to care issues www. ncfhp. org

Agriculture l North Carolina’s agriculture ranks among the state’s most vital industries, contributing over $59 billion annually and representing 22% of North Carolina’s income. l At the heart of this industry are migrant and seasonal farmworkers whose hand labor is relied upon to plant, tend, and harvest tobacco, sweet potatoes, cucumbers, apples, bell pepper, Christmas trees, and a variety of other crops. l Each farmworker’s labor contributes annually over $12, 000 in profits to North Carolina’s agricultural industry. l North Carolina ranks 6 th in the nation for having the largest number of farmworkers (CA, TX, WA, FL, OR) www. ncfhp. org

North Carolina’s Farmworkers There approximately 92, 603 farmworkers working in the state – 63, 956 Migrant; 7, 671 are H 2 A – 28, 647 Seasonal Employment Security Commission Estimate, 2006 www. ncfhp. org

Some are… Migrant Farmworkers l 62. 5% have home base in Florida, Georgia or Mexico l 90% of Latin-American descent l Mostly young, unaccompanied, poor Mexican-born men l Spanish-speaking, with little or no English l Less than 9 years of formal education, average 6 th grade l Earn less than $11, 000 per year www. ncfhp. org

Migrant H 2 A Workers l H 2 A is a guest worker visa l Contracted by farmer to enter country as farm laborers, either directly or through North Carolina’s Grower Association l Do not come with their family l Usually do not know where they will be working until they arrive l May stay for 6 - 9 months www. ncfhp. org

Some are… Seasonal Farmworkers l 37. 5% permanently reside in the state and work in agriculture for part of the year l Made up of African-Americans, some settled migrant workers of Mexican-American descent, and a few American Indians l Mostly low-income, poor population www. ncfhp. org

Challenges Farmworkers Face l Geographic constraints (rural) and social isolation l Subject to extreme weather conditions and occupational hazards such as pesticides l Poor working & living conditions l Limited or no transportation l Limited or no access to phones l Work long hours, with little or no breaks l Subject to and dependant on farmer and/or crew leader www. ncfhp. org

Challenges Farmworkers Face l l l Language and cultural barriers Unfamiliarity with US systems Lack of information about resources No health insurance or worker’s comp Limited or no daycare services Limited access to healthcare services www. ncfhp. org

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Occupational Health Issues l Pesticide exposure l Green Tobacco Sickness l Heat illness l Musculoskeletal strains and fractures l Dermatitis l Eye – Pterygium, trauma l Insect/Animal Bites www. ncfhp. org

Other Health Concerns l Sexually Transmitted Diseases, particularly high risk for HIV/AIDS l Tuberculosis Hypertension Diabetes Oral Health Depression l Motor vehicle accidents l l www. ncfhp. org

TOP CONCERN: Pesticide Exposure Estimate 10, 000 -20, 000 cases/yr Exposure: Chronic, Acute www. ncfhp. org

How Does it Happen? Accidental contact with spray (51%) Residue on plants or produce (25%) In soil or irrigation water On pesticide equipment In pesticide storage and handling areas On work clothes and boots In the home www. ncfhp. org

Health Effects Where? Systemic poisoning: (inside the body) 43% Skin injury: 31% Eye irritation: 23% Nose, throat irritation When? Acute – right away Chronic- later www. ncfhp. org

Acute Systemic Poisoning Nausea, vomiting Dizziness Blurred vision Increased salivation or drooling Muscle cramps or twitches Difficulty breathing Unconsciousness Pinpoint pupils www. ncfhp. org

Chronic Effects of Pesticides Allergic reactions Effects on pregnant women, such as birth defects Effects on reproductive system… infertility, miscarriage Neurological problems. . . Anxiety, Parkinson’s disease, developmental delay, neuropathy Increase in tumors. . . leukemia, lymphoma, myeloma, sarcoma, & in brain, testicle, stomach www. ncfhp. org

There are children in the fields! www. ncfhp. org

Access to Care Concerns l Significant barriers to health care – – – – – Language Transportation Geographical isolation Cost (lack of insurance) Knowledge of services Hours of operation of clinic services Fear Lack of phone Immigration status www. ncfhp. org

Who is providing services? NCFHP contract sites Migrant and Community Health Centers Rural Health Centers Health departments Hospitals Free clinics www. ncfhp. org

Reaching NC Farmworkers l l l l l NC Farmworker Health Program Community Health Centers Migrant Head Start Programs Migrant Education Programs Student Action with Farmworkers North Carolina Grower’s Association Farm Labor Organizing Committee- NCO and other farmworker advocacy groups or health services providers www. ncfhp. org

NCFHP Sites & FW Density www. ncfhp. org

North Carolina Farmworker Health Program’s Mission …to improve the health of migrant and seasonal farmworkers and their families in the state. . . working with and through a statewide network of service providers www. ncfhp. org

We achieve our mission by… l Funding health centers and reimbursing private providers to provide health care and dental services to farmworkers l Building organizational and workforce capacity through training and technical assistance l Disseminating information about the needs and contributions of farmworkers in NC l Building relationships and collaborations to connect and leverage resources in the community. l Advocating for access to quality healthcare and a better healthcare system. www. ncfhp. org

NCFHP Enabling Services Model The program utilizes an enabling services “outreach” model to link farmworkers with services. An outreach team works to… – Identify farmworkers – Share clinic information – Conduct health assessments – Provide health education – Provide case management – Link farmworker families with medical, dental, specialty and/or and social need services www. ncfhp. org

Eliminating Barriers to Care NCFHP funded sites… l l l Hire a Farmworker Health Coordinator and outreach staff that represent the racial and ethnic background of the farmworker population in your service area Establish policies that outline culturally and linguistically appropriate service delivery focused to meet the needs of farmworker families Determine method for communication between multiple sites and Farmworker Health Coordinator www. ncfhp. org

Incorporating Outreach Staff l l l Orient agency staff (including providers) about farmworker health needs and the role of the outreach worker Train front desk staff and eligibility officers to determine farmworker status Document farmworker status of agency patients and services provided Work with outreach team to communicate follow-up of high need patients (patient case management) Assure participation of coordinator and/or outreach team at agency staff meetings. www. ncfhp. org

Visit the Fields with your Outreach Team! www. ncfhp. org

North Carolina Farmworker Health Program Office of Rural Health and Community Care, NC DHHS 2009 Mail Service Center Raleigh, NC 27609 (919) 733 -2040 www. ncfhp. org