Migrant Farmworker Families Health Care Needs & Access Barriers

Migrant Farmworker FamiliesMigrant Farmworker FamiliesHealth Care Needs & Access BarriersHealth Care Needs & Access Barriers

Presented by

Ann M. Avery, MSN, APRN - BC

Clinical Services Director

Northwest Michigan Health Services, Inc.

Northwest Michigan Health Services, Inc.Northwest Michigan Health Services, Inc.Clinica para los CampesinosClinica para los Campesinos

36 yr history of primary medical & dental care3,500 clients/year13,000 visits/year3 clinics 7 county service area

NMHSI Service Area

NMHSI Funding Sources

BPHC 330(g)Medicaid State grants Local grantsClient fees

Farmworkers & Michigan’s 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.

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.

How Many Farmworkers Come To Michigan

Number of Farmworkers

Estimate:

12,000 – 15,000 in NMHSI service area annually.

Farmworker Housing

Labor Camps 228 licensed camps (camps with

5 or less workers not licensed) 5,146 capacity Most in Oceana, Mason

&Leelanau Counties

Farmworker Characteristics

99.9% of Mexican decent

75% speak ONLY Spanish

6th grade education

Farmworker Characteristics

$12,000/yr income

Family unit migrates

Most workers ages 25-35

Farmworker Characteristics

Health insurance – Medicaid 21-28%

(mostly children)

(No Medicaid reciprocity in Michigan)

Farmworker Characteristics

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

Farmworker Lifestyle Farmworker Lifestyle

MobilityMobilityMobility

Evidence of Mobility

48% return after 1 year

11% return after 2 years

4% return after 3 years

Common Health Problems

ObesityDiabetesHypertensionHyperlipidemiaAsthma

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

Work Related Health Problems

Falls & back strainsMachete injuriesPesticide/chemical exposuresCarpel tunnel syndromeFungal skin & nail infectionsHeat stress & dehydration

Access Barriers

Some are cement walls

Some are orange cones

Access Barriers

Influenced by Farmworkers

Mobile lifestylePovertyLimited ed & low literacy levelsLimited English proficiency

Access Barriers

Influenced by FarmworkersLack of understanding of scope

of problemEmployment - “Here to work”Fear of deportationLocation of camps

Access Barriers

Influenced by Health Care System

Hours of operationMonolingual – (huge problem with

mental health needs)No understanding of lifestyle/cultureBilingual does not = bicultural

Access Barriers

Influenced by the health care system

Little awareness of common 3rd world health conditions

Little/no knowledge of self treatment options

Ethnocentric

Access Barriers

Other InfluencesEmployers – time spent accessing care

is time away from the job. Many crops cannot wait to be harvested.

No public transportation systemNo information re: location of health

care servicesMedicaid reimbursement rates very low

When Two Worlds Collide

Occurs when farmworkers seek health care in up-stream

communities.

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

High Blood PressureHigh Blood Pressure

Barriers to Care

Cost of care/hours of availabilityDistance to clinicThe “7 minute visit”Provider does not speak SpanishInstructions on pharmacy label in

English

High Blood Pressure

Barriers to Care:

Lack of refrigerator spaceUse of seasonings in food No symptoms = no problem

High Blood Pressure

Barriers to Care:

Educational materials = litterUnlikely to ask questionsWill be in area only 4-6

weeks

Immunizations

Health Care Need:Children & adults need to be protected

from disease (some of which are communicable)

Mich. School programs have immunization requirements

Immunizations

Barriers to Care:5/1/2005 does not always mean May 1st.Many health departments do not have

evening clinic hoursImmunization records NOT available in

national data base

Assessing HIV RiskAssessing HIV Risk

Health Care Need:

–Proper identification of risk factors

–Education re: risk reduction–Testing

Assessing for HIV Risk

Barriers to Care:

Lack of cultural sensitivity –History taking –Understanding of definition of

homosexuality–Lifestyle (absence from

spouse)

Diabetes

Health Care Needs:

Medications/blood testsContinuing careDietary restrictionsWeight loss

DiabetesDiabetes

Barriers to Care:Cost of medications/ongoing availability

of medicationsMedicaid case open in TexasUse of home remediesAvailability of meds in Mexican

pharmacies

Diabetes

Barriers to Care:Glucose monitoring machines read out

in EnglishUrine testing strips read out in EnglishUnavailable past medical history“I don’t have blurred vision anymore so I

stopped my medicine.”

Condition Requiring Immediate Attention

Health Care Need:Serious in natureInpatient care Possible surgery Specialty care

Condition Requiring Immediate Attention

Barriers to Care:

CostLack of trusting relationship

with providerNeed for family to make

decisions

Of all forms of inequality, Of all forms of inequality, injustice in health care is the injustice in health care is the

most shocking and most shocking and inhumane.inhumane.

Martin Luther King Jr.Martin Luther King Jr.