Opening a Dialogue with Growers through a Growers’ Survey

Tracking Farmworkers Using ID Cards

Calming Fears and Opening Communication between Farmworkers and Law Enforcement

Increasing Access to Health Care through a Patient Benefits Department

Picking Blueberries to Raise Money for Farmworkers and Increase Cultural Competency

Influencing State-Level Policy on Behalf of Farmworkers

Bringing Community Agencies Together through an Annual Summit

Outreach Orientation and Farmworker Lifestyle Tour

Bringing Cultural Competency to the Community

Monthly Newsletter of Community Events and Resources for Farmworkers

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Opening a Dialogue with Growers through a Growers’ Survey
2007, Northwest Michigan Health Services, Inc. top

NMHSI designed and conducted a survey with over 30 growers in the tri-county service area of one of its clinic sites. The objective of the survey was to discover perceptions of farmworker health issues and barriers to care from the growers’ perspectives. In addition, growers were asked about: 1) the location of farmworker housing areas; 2) how they recruit farmworkers; 3) the percentage of farmworkers who return each year; 4) how the growers prefer to be approached and contacted by NMHSI; and, 5) whether they would be open to hosting an outreach clinic on their property, ensuring minimal workers’ time lost due to travel to and from the clinic. Most of the surveys were conducted over the phone and in person and took place during the off-peak season when the growers were not as busy. Some growers expressed their unfamiliarity with local resources and requested materials in Spanish for their workers. All interviews were followed up with a thank you letter and relevant informational materials about the organization and other community resources.

Maintaining positive relationships and open dialogue with growers supports the health and well-being of farmworkers. The survey opened a forum for discussion and exchange of information with growers. It also reinforced anecdotal evidence that the vast majority of growers in NMHSI’s service area care about the welfare of their farmworkers. As a result of this survey, NMHSI was invited to set up four outreach clinics on growers’ premises. In addition, because the survey allowed NMHSI to quantify for the first time the number of farmworkers in the area who are monolingual Spanish speakers, NMHSI has set up a language assistance program in the community for the benefit of all community-based providers who serve Spanish-speaking patients. Based on last year’s successes with this survey, NMHSI plans to repeat the project this year in the service areas of its other two clinic sites.


Tracking Farmworkers Using ID Cards
2007, St. Bernadette Catholic Church top

St. Bernadette Catholic Church partners with area non-profit organizations and congregations to meet farmworker needs. St. Bernadette’s offers a screening clinic on Sundays after mass. Farmworkers who need follow-up care are referred to the Wake County Human Services Migrant Farmworker Health Program. During outreach visits to camps, outreach workers provide farmworkers with laminated ID cards, which often serve as the only identification many farmworkers possess. One side of the card includes information for providers: the individual’s name, date of birth, and instructions for accessing the patients’ medical records. The reverse side has instructions for the farmworkers: a welcome note in Spanish that explains the use of the card and that they should call 911 in case of emergency. The ID card also includes the name of the individual’s camp and the date of issue. The cards are linked to a master log sheet referred to regularly by outreach and clinical staff.

The identification card system enables the farmworkers to have a handy telephone number that they can call for assistance, offering a degree of ownership and self-direction regarding their health care. The farmworkers no longer have to wait for an outreach worker to discuss concerns or request an appointment. The master log sheet allows St. Bernadette’s outreach team to easily locate clients for follow-up and appointments. The ID cards have reduced language barriers faced by non-Spanish speaking outreach volunteers in the past. The ID cards provide consistent birthdates and spellings of farmworkers’ names and therefore, do not require that volunteers be able to converse in Spanish with the farmworkers to solicit this information.

The cards have also improved data management by enabling the church to track the types of visits to the clinic and determine if there are clusters of diseases or injuries among or within camps. These epidemiological data have been used in community advocacy efforts and to train volunteers on what they can expect to see at screening clinics and when they do outreach. An unexpected benefit of the ID system has been the calls from growers, emergency rooms, and hospital wards on behalf of the card holders in their care seeking the church’s assistance for their farmworker employees or patients.


Calming Fears and Opening Communication between Farmworkers and Law Enforcement
2007, Ellenton Health Clinic Farmworker Health Program top

Following an outbreak of violent and deadly home invasions against Latino farmworkers in two South Georgia counties, the Ellenton Health Clinic Farmworker Health Program (“Ellenton Clinic”) served as a safe haven of understanding, awareness, and advocacy for the farmworker community. Committed to cultural responsiveness, the Clinic Director invited the local sheriff’s department, the US Department of Justice, Colquitt County Cooperative Extension Service, MALDEF (the Mexican American Legal Defense and Educational Fund), the Superintendent of Schools for Colquitt County, and the Southern Pines Migrant Education Agency to discuss concerns at two community forums and help allay the fears of the farmworker community during this difficult period.

Concerned farmworkers were able to raise the following issues: 1) their mistrust of and inability to access the banking system; 2) the lack of Spanish-speaking law enforcement officers and 911 dispatchers; 3) the lack of proper housing available to undocumented workers; and 4) the fear that if they report crimes, they themselves might get deported as a result. The clinic provided space and translation services for two of these community forums.

Because many farmworkers are unable to open bank accounts and subsequently forced to keep a lot of cash at home, they become easy targets for violence. Organizing these community meetings brought the community together during a time when fears could have grown into explosive divisiveness. The Ellenton Clinic successfully demonstrated the role that community organizations can play in facilitating dialogue among city, county, and federal officials on behalf of the farmworker community. At the community forum, the 75-person classroom overflowed with participants. Farmworkers attended these meetings because clinic outreach staff were effective in making them feel safe enough to attend.

The Ellenton Clinic continues to support the farmworker community by: 1) providing home safety education to farmworkers; 2) collaborating with the Justice Department to create an ongoing community committee to address these issues; 3) educating the farmworker community about the US banking system; and, 4) partnering with the University of Georgia Archway Partnership to advocate that the banking community offer alternative banking services to farmworkers.


Increasing Access to Health Care through a Patient Benefits Department
2007, Columbia Basin Health Association top

CBHA has established a Patient Benefits Department that assists farmworkers in determining and applying for the health care coverage and insurance options available to them. In addition to providing assistance inside of the clinic, two of the department’s seven staff routinely conduct patient benefits education outside of the health center setting. The aim of these outreach efforts is to increase the health care access of farmworkers who are not current CBHA patients who unnecessarily avoid seeking medical care out of fear of the costs involved.

Patient benefit outreach activities consist of presentations to growers, farmworkers and community stakeholders and take place at work sites, migrant day care programs, and school parent meetings. Topics include different health care financing options in Washington State such as Medicaid, Basic Health Plan (a subsidized insurance program), managed care programs, and reduced fee programs. In addition to CBHA’s local efforts, the supervisor of the Patient Benefits Department advocates on behalf of farmworkers at the state level by participating in a state advisory group for health insurance.

By proactively addressing farmworkers’ health care payment concerns at both the local and state level, CBHA strives to increase farmworkers’ access to care and cultivate a wider understanding for the challenges they face. Some of these challenges include: 1) a lack of employer-provided insurance; 2) low incomes that inhibit their ability to buy private insurance; 3) lack of understanding of available health care coverage options; and, 4) a lack of documentation making them ineligible for many public assistance programs. As a former farmworker himself, the Patient Benefits supervisor knows firsthand the financial barriers farmworkers face. He places a great emphasis on his staff being sensitive and responsive to the unique needs of CBHA’s farmworker population which involves putting forth the extra effort to take their assistance directly to the community.


Picking Blueberries to Raise Money for Farmworkers and Increase Cultural Competency
2007, Southern Jersey Family Medical Centers, Inc. top

Each year, Southern Jersey Family Medical Centers, Inc. (SJFMC) asks staff to take a few hours one morning in July to pick blueberries in order to raise money for a Farmworker Emergency Fund. SJFMC staff work with different crew leaders each year to organize the activity. Flyers are distributed around the health center asking family, friends, and other staff members to make pledges based on the amount of blueberry flats picked. Although it has been the outreach staff primarily who have volunteered their time for this event, clinical staff have also participated.

Approximately 8-12 staff participate in this effort every year picking between 20-30 flats of blueberries. Last year, the effort added $400 to the Farmworker Emergency Fund, the proceeds of which are used to fill a gap when assistance is not available. There are many organizations that help with food, clothing, and medicines for farmworkers, but many times, for one reason or another, some farmworkers do not qualify for these programs. There are also instances of farmworkers in abusive or dangerous situations who need emergency monies for transportation or temporary housing. In addition to raising money, this event helps SJFMC staff increase their cultural competency by gaining a better understanding about the nature of farm work and building rapport with farmworkers by working side-by-side with them in the fields.


Influencing State-Level Policy on Behalf of Farmworkers
2007, North Carolina Farmworker Health Program top

NCFHP participates in several state-level task forces in order to influence policy and be a voice for farmworker issues. Because farmworkers are not always included on certain policy and programmatic agendas, NCFHP strives to ensure that policymakers are aware of their presence in the state and their unique needs. In 2006, NCFHP made significant contributions to the North Carolina Office of Minority Health and Health Disparities’ (OMHHD) Hispanic Health Task Force and the North Carolina Emergency Management Human Services and North Carolina Department of Health and Human Services Disaster Coordinator's committees.

Through involvement on the Hispanic Health Task Force, NCFHP staff were able to inform the development of a Community Health Workers curriculum used for a Lay Health Advisor Program. Originally, the curriculum only addressed issues affecting Latinos in the state as a whole, overlooking farmworker-specific demographic data and cultural information. NCFHP staff highlighted the unique vulnerabilities of this population and shared information on popular education techniques that are effective with farmworkers. As a secondary and unexpected result of this effort, the OMHHD now collects and disseminates farmworker demographic data and health information on their Latino Fact Sheets.

As a result of increased advocacy and education with the two emergency management and disaster committees, consideration for the state’s farmworker population has been incorporated into emergency response plans. Before NCFHP’s participation on these committees, disaster response agencies were relatively uninformed or unaware about farmworkers and their unique lifestyles and living conditions that impact these organizations’ abilities to respond effectively. NCFHP recently trained state disaster coordinators on issues such as the barriers farmworkers face in accessing emergency shelters, the challenge of communicating with non-Spanish speaking emergency responders and how to provide financial reimbursements to farmworkers during the recovery period when they have already left the area. Though these efforts are relatively new, it is anticipated that the critical discussions started by NCFHP will ensure that North Carolina farmworkers are no longer overlooked when emergencies occur.


Bringing Community Agencies Together through an Annual Summit
2007, North Carolina Farmworker Health Program top

In 2005, North Carolina Farmworker Health Program (NCFHP) held the first Farmworker Summit and Networking Event to bring farmworker-serving advocacy agencies together. This has become an annual program coordinated in collaboration with other members of the North Carolina Farmworker Institute, an interagency project of the Farmworker Ministry Committee and funded through participant registration fees ($15 per person) and local sponsorships. In 2006, about 100 people representing approximately 35 organizations attended the day-long event. Session topics included the following: legal rights of farmworkers, trends in H2A recruitment, participatory educational techniques, college access for undocumented students, and ways for religious congregations to support farmworkers during the harvest season. During the closing plenary, there was a dinner and multi-media presentation titled, Nuestras Historias/Nuestros Sueños: Our History/Our Dreams – Educational Aspirations of Immigrant Farmworkers and their Families.

For several years, there was not a coordinated effort in North Carolina to bring together farmworker advocates from various disciplines, including health, education, legal rights, advocacy, and regulatory agencies. Individuals from these organizations expressed various needs, including:1) the need to collaborate more and make the most of limited resources; 2) the importance of agencies targeting farmworkers to be informed about what other organizations are doing; and, 3) the need for farmworker groups to be informed about national issues that affect the well-being of farmworkers in the state. The Farmworker Summit and Networking Event successfully responded to these requests bringing together a large interdisciplinary group of individuals from across the state. Overall, the response has been very positive and participants have encouraged the continuation of this event.


Outreach Orientation and Farmworker Lifestyle Tour
2006, Blue Ridge Community Health Services, Inc. top

Blue Ridge Community Health Services, Inc. (BRCHS) provides all new employees with an outreach orientation in addition to providing cultural competency trainings annually to all staff. The outreach orientation is a cornerstone of the overall orientation to BRCHS, given the center’s founding as a migrant health center. The outreach orientation session, led by the Outreach Coordinator, gives a comprehensive overview of the outreach department, farmworker-specific lifestyle issues and the history of the health center. Participants learn how BRCHS defines and conducts outreach, the difference between migrant and seasonal farmworkers and the impact of farmworkers on the local economy. Employees also tour the agricultural areas surrounding the clinic in the clinic van visiting grower-provided farmworker housing as well as community-based housing.

The outreach orientation is an effective way to create awareness and a better understanding of the lifestyle of farmworkers in the area. Some staff members have never interacted with farmworkers or been exposed to the substandard conditions in which many farmworkers live. It has also been important to introduce staff to the roots of the organization as a migrant community health center in order to emphasize BRCHS’ long-standing commitment to farmworkers. The annual all-staff cultural sensitivity trainings and the new hire outreach orientation together illustrate how well the outreach department is integrated into the overall health delivery system at BRCHS.


Bringing Cultural Competency to the Community
2005, Greene County Health Care, Inc. top

The outreach department at Greene County Health Care, Inc. provides free trainings on cultural competency and traditional Mexican medicine and curanderos to community and migrant health centers, hospitals, medical centers, and universities throughout North Carolina. The trainings are advertised through referrals, primary care associations, and migrant stream forums. An average of twenty trainings are provided each year.
Greene County Health Care, Inc. is not only doing outreach with farmworkers, but conducting outreach in the larger community to increase awareness of farmworkers and farmworker issues, and to ensure more culturally competent care across North Carolina. By conducting free trainings for other health care providers, Greene County Health Care, Inc. engages other organizations in sharing their mission to provide appropriate and adequate care to farmworkers, and increases the potential network of culturally competent health care services accessible to farmworkers in North Carolina.


Monthly Newsletter of Community Events and Resources for Farmworkers
2005, Southeast Missouri Health Network: Farmworker/ Community Health & Resources top

Southeast Missouri Health Network’s (SEMO) Farmworker/Community Health & Resources program distributes a monthly newsletter, Cosechando la Noticia, to farmworkers across their five county service area. The newsletter highlights community events, educational and training opportunities, and programs and resources available to farmworkers through private and government agencies. Highlights also include information on programs available across SEMO’s six clinic sites and through their outreach program. Newsletter submissions are collected each month from SEMO’s Farmworker Advisory Council, made up of area farmworker serving agencies, state and local government agencies, universities, area hospitals, and churches. The newsletter is distributed to farmworkers at all SEMO clinic sites, as well as through SEMO outreach workers and promotoras, SEMO’s food distribution program, outreach and case management home visits, and through other SEMO sponsored events such as tai chi classes, legal aid, and fair housing and renters’ seminars.

Through the creation of Cosechando la Noticia, Southeast Missouri Health Network has effectively utilized resources in their organization and community to reach a large number of farmworkers with a needed service. Cosechando la Noticia is the only Spanish-language publication in the surrounding five county area, and SEMO has led local efforts to gather submissions and distribute the newsletter at a variety of locations. The result of their effort has been increased knowledge in the farmworker community of area services, programs, and community activities, increased knowledge of SEMO among farmworkers and other agencies, and increased networking between the six SEMO sites and the SEMO Farmworker Advisory Council member organizations.