CoP Blog: Meet our National Partner Claire Hutkins Sedam from the Migrant Clinicians Network
Greeting CoP Members. Welcome to this month’s Communities of Practice (CoP) Blog at the National Center for Medical Education, Development and Research (NCMEDR). This month I am excited to introduce you to our CoP National Partners at the Migrant Clinicians Network. At the Center we focus on three vulnerable populations (persons experiencing homelessness, migrant workers, and persons who are LGBTQ). Our National Partners provide are part of the way we are able to meet our goals including evaluating the evidence-base for primary care interventions targeting vulnerable populations in order to transform primary care training and clinical practice. If you are interested in learning more about the NCMEDR please contact me via e-mail at Kbrown@mmc.edu We look forward to working with you.
Katherine Y. Brown, EdD, MSEd, OTR/L
Assistant Professor, Department of Family and Community Medicine
Director, National Center for Medical Education, Development and Research
Migrant and Seasonal Farmworkers: Barriers to Care
By: Claire Hutkins Sedam, Migrant Clinicians Network, www.migrantclinician.org
Migrant and seasonal farmworkers are at high risk for injury and illness due to their lifestyle and occupation, and yet they encounter numerous and overlapping barriers to accessing and maintaining the health care they need. Migrant farmworkers, those who are required to be absent from a permanent place of residence for the purpose of seeking remunerated employment in agricultural work, and seasonal workers, those who live in a permanent place of residence but engage in remunerated employment in agricultural work for only a part of the year, are vulnerable populations whose health needs are largely absent in contemporary medical education. By understanding their vulnerabilities, the structural inequities that they face, and the avenues to reduce the resulting health disparities, clinicians can assure better health outcomes for the over 1,000,000 migrant and seasonal farmworkers working in the US today.
Migration as a health risk: For many migrant farmworkers, the act of migration itself is a health risk. Migrating across borders or within borders carries with it the dangers of heat or cold stress, dehydration, and exposure to disease. They are also at higher risk of extortion, exploitation, trafficking, sexual or physical violence, and other forms of abuse while they travel.
→ Reducing the risk of migration: First and foremost, clinicians need to know that their patients recently migrated. A thorough patient medical history remains the most potent and cost-effective diagnostic tool in a clinician’s toolbox. Migrant Clinicians Network’s recent webinar discusses why taking a detailed patient history is important for migrating patients (https://www.migrantclinician.org/toolsource/resource/webinar-treating-global-health-starts-with-good-patient-history.html).
The dangers of agricultural work: Agriculture remains one of the most hazardous occupations in the US. Additionally, the limited federal regulations that protect the health of farmworkers are currently under attack. Every year, farmworkers die of preventable causes like heat-related illness, pesticide exposure, and falls. Farmworkers experience a range of occupational health injuries and illnesses including musculoskeletal strains, lacerations, falls, trauma, exposure to pesticides and other chemicals, heat and cold extremes, and exposure to sun, irritants, and allergens. Language and cultural barriers and low literacy levels may further compound the risks of agricultural work; a farmworker may use pesticides improperly if he cannot read the warning labels in his first language. Power dynamics put farmworkers further at risk. A worker without documentation or one who does not have alternative work avenues may fear raising safety complaints to an employer or supervisor. It is important to remember that some occupational injuries may lead to chronic health concerns, years later. Farmworkers also may bring some of the dangers home; for example, children can be exposed to pesticides through a parent’s clothing or by playing in a backyard that abuts a field being sprayed on a windy day.
→ Addressing the dangers: Health providers need training and resources on farmworker-specific concerns, including the recognition and management of pesticide exposure and how to report pesticide exposure. Migrant Clinicians Network’s pesticides page (https://www.migrantclinician.org/issues/occupational-health/pesticides.html) has reporting criteria and low-literacy patient materials. Patients must be properly identified — a critical step that can be easily overlooked. Use MCN’s resource “Identifying Migratory and Seasonal Agricultural Workers” (https://www.migrantclinician.org/toolsource/resource/identifying-migratory-and-seasonal-agricultural-workers-your-clinic.html).
Structural inequities create barriers to accessing care: Migrant farmworkers encounter numerous and overlapping barriers to care. Our health systems were designed for geographically stable patients, compounding the barriers that they face. Farmworkers without legal immigration status cannot access health insurance. Those that can often find health insurance prohibitively expensive. Additionally, farmworkers on the move have to re-enroll in a new health insurance system with every move across a state line, an almost impossible task to complete when moving as often as every three to five weeks for work. Language and cultural barriers, transportation limitations, rural locations, and work hours further disrupt a patient’s ability to get care.
→ Overcoming the barriers: Migrant Clinicians Network’s Health Network, a bridge case management system, identifies a health provider in the worker’s next location, transfers records, and assists with identifying local auxiliary services to assure that the patient can get the care she needs despite mobility. Health Network is for any ongoing health concern, for migrant patients moving anywhere in the world (https://www.migrantclinician.org/services/network.html.)
Migrant Clinicians Network provides extensive training, technical assistance, resource development, networking, best practices dissemination, and more through in-person trainings, webinars, its publication Streamline, and its active blog (www.migrantclinician.org/blog). MCN has worked extensively with medical education training programs to develop information, resources, and modules around strategies to care for migrant and seasonal farmworkers, for medical curricula. Visit www.migrantclinician.org to learn more, access resources, or join the conversation.
Visit the www.ncmedr.org where you can view MCN’s webinar in collaboration with the National Center for Medical Education, Development and Research, Communities of Practice, “Addressing Structural Vulnerabilities in Healthcare for Migrant and Seasonal Agricultural Workers,” featuring Director of International Projects and Emerging Issues, Deliana Garcia.