Migrant Farmworker Families Health Care Needs

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Migrant Farmworker FamiliesHealth Care Needs
Access Barriers

• Presented by
• Ann M. Avery, MSN, APRN - BC
• Clinical Services Director
• Northwest Michigan Health Services, Inc.

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Northwest Michigan Health Services, Inc.Clinica
para los Campesinos

• 36 yr history of primary medical dental care
• 3,500 clients/year
• 13,000 visits/year
• 3 clinics
• 7 county service area

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NMHSI Service Area
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NMHSI Funding Sources

• BPHC 330(g)
• Medicaid
• State grants
• Local grants
• Client fees

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Farmworkers Michigans Economy

• Agriculture is the 2nd largest industry in
  Michigan. Migrant farmworkers are vital to the
  survival of this industry.
• Farmworkers are not in Michigan to bleed the
  social service system dry.

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Migration Patterns

• Eastern Stream from Florida to Georgia, the
  Carolinas
• Western Stream from Mexico thru California to
  Oregon
• Midwest Stream from Mexico, Texas Florida to
  Mich, Wisc, Indiana, Ill, Minn.

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How Many Farmworkers Come To Michigan
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Number of Farmworkers

• Estimate
• 12,000 15,000 in
• NMHSI service area annually.

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Farmworker Housing

• Labor Camps
• 228 licensed camps (camps with 5 or less workers
  not licensed)
• 5,146 capacity
• Most in Oceana, Mason Leelanau Counties

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Farmworker Characteristics

• 99.9 of Mexican decent
• 75 speak ONLY Spanish
• 6th grade education

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Farmworker Characteristics

• 12,000/yr income
• Family unit migrates
• Most workers ages 25-35

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Farmworker Characteristics

• Health insurance Medicaid 21-28
• (mostly children)
• (No Medicaid reciprocity in Michigan)

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Farmworker Characteristics

• Familia (family)
• Respeto (respect)
• Personalismo (personal)
• Confianza (trust)

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Farmworker Lifestyle

• Mobility
• Mobility
• Mobility

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Evidence of Mobility

• 48 return after 1 year
• 11 return after 2 years
• 4 return after 3 years

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Common Health Problems

• Obesity
• Diabetes
• Hypertension
• Hyperlipidemia
• Asthma

• Dental problems
• Anxiety/depression
• H. pylori infection
• TB/LTBI
• Lead poisoning
• Parasitic infestation

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Work Related Health Problems

• Falls back strains
• Machete injuries
• Pesticide/chemical exposures
• Carpel tunnel syndrome
• Fungal skin nail infections
• Heat stress dehydration

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Access Barriers

• Some are cement walls
• Some are orange cones

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Access Barriers

• Influenced by Farmworkers
• Mobile lifestyle
• Poverty
• Limited ed low literacy levels
• Limited English proficiency

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Access Barriers

• Influenced by Farmworkers
• Lack of understanding of scope of problem
• Employment - Here to work
• Fear of deportation
• Location of camps

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Access Barriers

• Influenced by Health Care System
• Hours of operation
• Monolingual (huge problem with mental
  health needs)
• No understanding of lifestyle/culture
• Bilingual does not bicultural

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Access Barriers

• Influenced by the health care system
• Little awareness of common 3rd world health
  conditions
• Little/no knowledge of self treatment options
• Ethnocentric

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Access Barriers

• Other Influences
• Employers time spent accessing care is time
  away from the job. Many crops cannot wait to be
  harvested.
• No public transportation system
• No information re location of health care
  services
• Medicaid reimbursement rates very low

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When Two Worlds Collide

• Occurs when farmworkers seek health care in
  up-stream communities.

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High Blood Pressure

• Health Care Needs
• Medication
• Blood tests
• Understanding that this is an ongoing condition
  that causes kidney heart problems
• Salt intake should be limited

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High Blood Pressure

• Barriers to Care
• Cost of care/hours of availability
• Distance to clinic
• The 7 minute visit
• Provider does not speak Spanish
• Instructions on pharmacy label in English

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High Blood Pressure

• Barriers to Care
• Lack of refrigerator space
• Use of seasonings in food
• No symptoms no problem

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High Blood Pressure

• Barriers to Care
• Educational materials litter
• Unlikely to ask questions
• Will be in area only 4-6 weeks

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Immunizations

• Health Care Need
• Children adults need to be protected from
  disease (some of which are communicable)
• Mich. School programs have immunization
  requirements

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Immunizations

• Barriers to Care
• 5/1/2005 does not always mean May 1st.
• Many health departments do not have evening
  clinic hours
• Immunization records NOT available in national
  data base

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Assessing HIV Risk

• Health Care Need
• Proper identification of risk factors
• Education re risk reduction
• Testing

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Assessing for HIV Risk

• Barriers to Care
• Lack of cultural sensitivity
• History taking
• Understanding of definition of homosexuality
• Lifestyle (absence from spouse)

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Diabetes

• Health Care Needs
• Medications/blood tests
• Continuing care
• Dietary restrictions
• Weight loss

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Diabetes

• Barriers to Care
• Cost of medications/ongoing availability of
  medications
• Medicaid case open in Texas
• Use of home remedies
• Availability of meds in Mexican pharmacies

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Diabetes

• Barriers to Care
• Glucose monitoring machines read out in English
• Urine testing strips read out in English
• Unavailable past medical history
• I dont have blurred vision anymore so I stopped
  my medicine.

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Condition Requiring Immediate Attention

• Health Care Need
• Serious in nature
• Inpatient care
• Possible surgery
• Specialty care

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Condition Requiring Immediate Attention

• Barriers to Care
• Cost
• Lack of trusting relationship with provider
• Need for family to make decisions

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Of all forms of inequality, injustice in health
care is the most shocking and inhumane.Martin
Luther King Jr.