North Carolina

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

• Farmworkers in North Carolina
• The North Carolina Farmworker Health Program
• Internship and Service Learning Opportunities

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Farmworkers in North Carolina

• Demographics
• Environmental and occupational health risks and
  other health concerns
• Access to care issues

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Agriculture

• North Carolinas agriculture ranks among the
  states most vital industries, contributing over
  59 billion annually and representing 22 of
  North Carolinas income.
• 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.
• Each farmworkers labor contributes annually over
  12,000 in profits to North Carolinas
  agricultural industry.
• North Carolina ranks 6th in the nation for having
  the largest number of farmworkers (CA, TX, WA,
  FL, OR)

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North Carolinas Farmworkers

• There are approximately 92,603 farmworkers
  working in the state
• 63,956 Migrant 7,671 are H2A
• 28,647 Seasonal
• Employment Security Commission Estimate, 2006

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Some areMigrant Farmworkers

• 62.5 have home base in Florida, Georgia or
  Mexico
• 90 of Latin-American descent
• Mostly young, unaccompanied, poor Mexican-born
  men
• Spanish-speaking, with little or no English
• Less than 9 years of formal education, average
  6th grade
• Earn less than 11,000 per year

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Migrant H2A Workers

• H2A is a guest worker visa
• Contracted by farmer to enter country as farm
  laborers, either directly or through North
  Carolinas Grower Association
• Do not come with their family
• Usually do not know where they will be working
  until they arrive
• May stay for 6 - 9 months

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Some areSeasonal Farmworkers

• 37.5 permanently reside in the state and work in
  agriculture for part of the year
• Made up of African-Americans, some settled
  migrant workers of Mexican-American descent, and
  a few American Indians
• Mostly low-income, poorpopulation

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Challenges Farmworkers Face

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

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Challenges Farmworkers Face

• Language and cultural barriers
• Unfamiliarity with US systems
• Lack of information about resources
• No health insurance or workers comp
• Limited or no daycare services
• Limited access to healthcare services

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Occupational Health Issues

• Pesticide exposure
• Green Tobacco Sickness
• Heat illness
• Musculoskeletal strains and fractures
• Dermatitis
• Eye Pterygium, trauma
• Insect/Animal Bites

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Other Health Concerns

• Sexually Transmitted Diseases, particularly high
  risk for HIV/AIDS
• Tuberculosis
• Hypertension
• Diabetes
• Oral Health
• Depression
• Motor vehicle accidents

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TOP CONCERN Pesticide Exposure

• ? Estimate 10,000-20,000 cases/yr
• ? Exposure Chronic, Acute

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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

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Health Effects

• Where?
• Systemic poisoning (inside the body) 43
• Skin injury 31
• Eye irritation 23
• Nose, throat irritation

• When?
• Acute right away
• Chronic- later

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Acute Systemic Poisoning

• Nausea, vomiting
• Dizziness
• Blurred vision
• Increased salivation or drooling
• Muscle cramps or twitches
• Difficulty breathing
• Unconsciousness
• Pinpoint pupils

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Chronic Effects of Pesticides

• Allergic reactions
• Effects on pregnant women, such as birth defects
• Effects on reproductive system infertility,
  miscarriage
• Neurological problems.. . Anxiety, Parkinsons
  disease, developmental delay, neuropathy
• Increase in tumors... leukemia, lymphoma,
  myeloma, sarcoma, in brain, testicle, stomach

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There are children in the fields!
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Access to Care Concerns

• 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

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Who is providing services?

• NCFHP contract sites
• Migrant and Community Health Centers
• Rural Health Centers
• Health departments
• ? Hospitals
• ? Free clinics

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Reaching NC Farmworkers

• NC Farmworker Health Program
• Community Health Centers
• Migrant Health Centers
• Migrant Head Start Programs
• Migrant Education Programs
• Student Action with Farmworkers
• North Carolina Growers Association
• Farm Labor Organizing Committee- NCO
• and other farmworker advocacy groups or health
  services providers

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NCFHP Sites FW Density
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North Carolina Farmworker Health Programs 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

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We achieve our mission by

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

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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

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Eliminating Barriers to Care

• NCFHP funded sites
• 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

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Incorporating Outreach Staff

• 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.

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Visit the Fields with your Outreach Team!
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• North Carolina Farmworker Health Program
• Office of Rural Health and Community Care, NC
  DHHS
• 2009 Mail Service Center
• Raleigh, NC 27609
• [phone]
• www.ncfhp.org