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Cerrando Puertas de Abriendo Puertas

Our preceptor meeting to wrap up Team AP was encouraging. Sofia was pleased with the work Team AP had done and the flexibility we maintained throughout the semester. Low AP participation was not just a frustration Team AP encountered, but was also shared by the centers. The low attendance for all seasonal events, not just AP, was not projected by any of the centers and as a result they are losing funding. This is a wicked problem the centers encounter on a daily basis. Due to low attendance, funding is decreased which results in limited resources to recruit higher participation for future programs, less families are served, and less data is reported. The centers did not want us to help recruit, but we found out it was due to a misunderstanding. When we asked if we could help recruit, they thought we meant for Migrant Head Start and not just for the AP program. They are having difficulty just recruiting for the Migrant Head Start, which has not been a huge problem in the past. This helps explains why just one program in this organization (AP) did not have a high enrollment.

Throughout our practicum we saw opportunities for improvements with the East Coast Migrant Headstart/Telemon Corporation, AP classes, and migrant farmworker outreach. Our preceptor was excited to hear our suggestions. Tess, Nisel, and I are working on a more formal proposal. We found there were often disconnects in communication between the Raleigh headquarters and the individual centers. We might show up to a center and we didn’t know an event was canceled because of various reasons. Working more directly with center employees may help improve communication. However, the center directors have a lot on their plate and it is important they don’t become overwhelmed with multiple projects. Due to multiple roles, AP might not be the main focus for the employees running the lessons. Future practicum groups could have training programs where the AP teacher is taught basic skills for running an AP lesson. In addition, the government requires that certain topics be covered by the centers and it may not necessarily be information that the migrant farmworkers wish to hear. Asking the migrant farmworkers what topics they want to learn about may encourage participation and interaction. We discovered that the migrant farmworkers wanted to learn English so they could help their children with their homework. We thought about incorporating ESL into the parent meetings as a way to help them learn basic vocabulary. Sofia told us that East Coast Migrant Headstart has attempted many strategies to effectively teach English to the migrant farmworkers and none of them have worked over the years. The strategies ranged from partnership with a college to teach ESL, to giving the farmworkers tape cassettes with headphones, to listen to phrases while they worked, to individual tutoring. Sofia explained that every migrant farmworker will tell you that they want to learn English. However, when they weigh work and family responsibilities, learning English is not a top priority.

Specifically with the Abriendo Puertas classes, we suggested that the lessons revolve around a “learner center model” that incorporates a facilitated dialogue, which was a focus of the Cooking Matters Program. Having open ended questions and a variety of learning styles may encourage participation. UC Berkeley evaluated AP through a national survey that was given to participants who had completed the program. Evaluations need to be made within rural areas to gain an accurate perspective of the effectiveness of AP within migrant farmworker communities along the East Coast. An interesting observation that Team AP made was that we couldn’t assume all individuals given the survey could read or even speak Spanish. English and Spanish surveys need to be available at the centers and they need to be read with enough time for the participants to understand what the question is trying to ask. Craig and Noelle evaluated the data collected from the surveys in SPSS and found some participants had put they had completed a doctorate program along with other misrepresented findings that could be attributed to misunderstanding. Providing incentives for AP participants could be an effective strategy to increase participation.

As public health professionals, it is important to continually advocate for migrant farmworkers by developing new policies and increasing outreach partners to improve their health status. Policies that provide provisions for housing or payments for living wages could improve substandard housing conditions. Due to the low attendance of migrant farmworkers at the centers, I felt like many of our interactions with the migrant farmworkers were not as intentional as I had hoped they would be. Sofia mentioned that some centers in Florida are hosting the AP meetings by rotating around in the migrant farmworker homes. If future groups could somehow receive opportunities to meet migrant farmworkers within their own environment it may help then to gain a deeper understanding of their daily struggles. There has been increased research on the use of “natural helpers” within migrant populations. Natural helpers, also known as “promotoras” in Spanish or “lay health advisors” are individuals that others naturally turn to for advice, emotional support, or aid. Research has shown they are effective in assisting health professionals by providing the population with health education materials, referrals, and resources that may be difficult to get individuals directly. Currently the NC Farmworker Project is working on providing training to chosen “promotoras”. This could be a potential project for future practicum groups.

Overall, my AP practicum experience contributed to my public health education. I definitely learned the importance of being flexible and overcoming frustrations dealing with data collection of a very mobile population. I look forward to future work with migrant farmworker populations and I am optimistic about the difference future AP practicum groups can make.

Today Team AP had a successful presentation and meeting with our preceptor. Wrapping up our proposal and finishing strong. Go Team AP!

Team AP has been working on finding opportunities for improvement for Abriendo Puertas, East Coast Migrant Head Start/Telemon, and migrant farmworkers. Wicked problems often prevent progress, however Team AP is brainstorming about new systems and programs that will overcome obstacles and improve health status for migrant farmworkers.

Brainstorming up ways where we can improve the next Team AP and reach the migrant Farmworkers more effectively!

Cooking Matters at the Store with Team AP.

This week AP got to participate in Cooking Matters at a Bailey, NC grocery store with the migrant farm workers. Some of the group members were not able to attend, myself included, however we all completed the online training. Cooking Matters is a curriculum that is part of the Inter-Faith Food Shuttle (IFFS) that works with Share Our Strength, a national hunger relief organization. Cooking Matters at the store grocery tours are hands-on nutritional classes that teach low income adults about how to shop for healthy foods on a budget. Research has shown that low income families that plan and budget meals by writing grocery lists are more likely to make healthy meals than those who don’t practice these habits. The four research based objectives of Cooking Matters are to teach participants how to compare unit prices, identify whole grains, buy fruits and veggies on a budget and how to read food labels. There is no charge to attend the classes and anyone can participate that is at risk of hunger or malnutrition due to low income status. The Migrant Head Start site at Bailey encourages the parents to attend the sessions. There were five parents that showed up for the session AP attended, however the translator said it was often difficult to get the parents to come. As incentive to come to the tours each participant receives a booklet that contains information regarding nutrition and food budgeting, healthy recipes, a reusable grocery bag and a $10 gift card that is used to purchase food during the $10 Challenge. The $10 Challenge is when the participants take what they learned from the lesson, which typically lasts about 60 minutes, and purchase healthy foods. They are encouraged to pick foods based off of the USDA MyPlate. MyPlate displays the five food groups that make up a healthy diet which include fruits, vegetables, grains, protein, and dairy.

What impressed me most about the program was the “learner-centered” approach where there is active participation of both the learner and the teacher in a “facilitated dialogue”. We are creatures of habit, and change does not come easy. Recognizing that learners are “experts” of their own lives will empower the migrant farmworkers and build relationships where they are more likely to listen to the teacher. Cooking Matters also takes a “hands on” approach incorporating a variety of learning styles. Research has shown that people only retain about 20% of what they hear. Simply going around telling participants what they should and shouldn’t buy will not be effective. Cooking Matters incorporates open ended questions, charts, and a variety of topics to choose from based upon what the participants want to learn. Before a session even begins, the participants have an opportunity to share what they already know and express expectations. An example of how to use open ended questions effectively is not to simply state, “The correct way to eat is using Myplate, which has these five food groups” but rather ask, “Have you seen Myplate before?” or “How do we eat according to Myplate?” This engages participants and gives the teacher an idea of what needs to be covered throughout the session.

Throughout the session the teacher encourages participants to buy produce in season because this is when they are cheaper. Buying whole produce instead of prepackaged items are typically cheaper. For example, a head of lettuce is cheaper than the bag of lettuce and you get more for your money. The teacher also emphasizes the importance of reading labels. Some suggestions are to read how much sodium is in a can, the amount of sugar present, or if whole grains are the first ingredient. Companies can mask a product to appear whole grain when in reality it isn’t.

It is important that the teacher not give biased opinions about food choices, but give suggestions and tips for budgeting healthy foods. Everyone has different preferences, resources, and knowledge.

Cooking Matters collects data before and after with surveys to measure and evaluate the impact they are making. This impressed me because some programs fail to collect data that can be reported to the public to demonstrate the effectiveness of the program. Surveys are also an effective tool to observe if the main goals are being achieved. The main goal of Cooking Matters is to show people that eating healthy on a budget is possible.

Although eating healthy is possible, it is can be especially difficult for migrant farmworkers. Reasons for why it is hard to get the migrant farmworkers to come to the grocery store tours could be due to limited transportation and time or lack of knowledge about the program. The Food Inc documentary that many of us recently watched displayed struggles migrant farmworkers may be faced with. The Latino mother expressed how she didn’t even realize how unhealthy the dollar menu from McDonalds was until someone told her. When she did realize it there wasn’t much she could do to change the family diet because they had limited funds and limited time to cook. The father required medicine for his declining health. The family had to choose to either invest what little money they had into medicine or vegetables. They expressed their frustrations about how sodas and high sugary foods are so much cheaper than produce and healthy alternatives.

The biggest predictor of obesity is income level. The obesity epidemic is not something that can simply be solved on an individual level. This is a systems problem, not an individual problem. The fact that buying a hamburger is much cheaper than buying fresh produce reflects power structures where powerful lobbies are connected. Cooking Matters is an effective program that attempts to change behaviors and educate individuals about food and how to budget appropriately. However, the organization is facing wicked problems that run much deeper than the faces attending the sessions.

This week Team AP is working on organizing the data we collected from the AP surveys and making a proposal for how we can better serve the migrant population. We knew it would be challenging from the start to assess the effectiveness of the AP program on a population that is constantly on the move. However, we didn't anticipate just how flexible we were going to have to be. We are learning valuable lessons about the migrant farmworkers, the nature of public health, and about the wicked problems throughout our society.

Get to know your local farmworker! The AP team did some research about migrant farmworkers to advocate for them during Food Day, which was October 24th. We made a poster that displayed their demographics, economic contribution, working and housing conditions, health status, and the current legislation in place (or lack of it). The term “migrant farmworker” does not symbolize a specific ethnicity, citizenship, or immigration status. In fact, the East Coast migratory stream is the most ethnically diverse with individuals that are Hispanic, Haitian, Jamaican, and many others. Migrant farmworkers commonly face substandard housing conditions. Many live in crowed, unsanitary conditions that lack basic utilities and are far from health clinics, grocery stores, or public transportation. These crowded living conditions can increase risk to spread diseases and pesticide exposure. A Wayne County Farmworker from NC stated, “It’s just ridiculous that we, the ones that are feeding the whole world, are the ones that live in such poor conditions.” Policies and legislation that improve working conditions and give them fair wages need to be put in place. Fight for the rights of your local farmworker!

Go Team ARTS for a successful walk to school day!

camellosenlacomunidad

This Sunday team AP heads to the St. Martin site between Dunn and Newton Grove, NC to teach a 20 minute ESL lesson to the parents at the center. Even though it’s a short amount of time, we will focus on key phrases and vocab to hopefully build confidence and inspire further English learning! I’ve...

#Go Camels!! 28-27 Homecoming Game #Go Camels! 28-27 Homecoming game

Pink Ribbon Breakfast with my beautiful mom and breast cancer survivors, celebrating their fight. Early detection saves lives, so know your bodies!!

"To,too,two"

Yesterday AP group met to discuss effective ways to teach English to the migrant farm workers at the centers. English is a tricky language. Many have expressed interest in learning vocabulary that will help them better understand their children's homework. We have limited time with them, so we wanted to give them resources that they could refer to in the future. There are so many good online resources, but you can't assume that they have access to the internet. Group AP also traveled to Angier yesterday, but unfortunately the Abriendo Puertas meeting was canceled. We are overcoming our challenges and trying to find ways to effectively reach this population who is constantly on the move.

· "We depend on misfortune to build up our force of migratory workers and when the supply is low because there is not enough misfortune at home, we rely on misfortune abroad to replenish the supply," President Harry S. Truman, 1951.

Team AP on another track...

Last night Abriendo Puertas went to Angier and presented tips on ways to eat healthy on a budget and we also did an ESL mini-lesson. Prior to coming to the center we asked what the parents were interested in learning. The center explained that the parents often get frustrated with not knowing how to help their children with homework and they were interested in learning helpful phrases/vocabulary in English. Of course, there is only so much you can teach within a 10-20 minute time frame. It would be ideal for these migrant farmworkers to enroll in a weekly English class. However, this may not be realistic due to financial and time constraints. Tess did an awesome job teaching important vocabulary/phrases with her basically fluent Spanish. Tess went over basic greetings, directions, supermarket, school, and family vocabulary, which was printed on a sheet for them to carry home. Noelle had warned me about the difficulty of speaking Spanish in front of a crowd, so I had my script in hand to go over how to eat healthy on a budget. Although I probably butchered some of the pronunciations and grammar, the crowd didn’t seem to mind. I think one thing that people often get hung up on when trying to practice Spanish is the fear that they will say something wrong or conjugate a verb improperly. However, when you submit to being vulnerable and face your fears, this is when you start to learn the language. The migrant farmworkers most likely didn’t care if we said something wrong or pronounced it improperly. In fact, showing our vulnerability may have encouraged them to face the fear of practicing their English. By not using an interpreter, I felt they were more receptive and responsive to what we were trying to teach them.

Before we began our presentation, two mental health consultants presented on their role within the center and gave parenting advice. The mental health consultants explained that their presence within the center is not to hunt for children with disabilities or mental health disorders, but rather to provide timely and effective identification of mental health issues so that the teachers and students can have the best experience in the classroom. They want to make sure the pre-school aged children are prepared for Kindergarten emotionally and mentally, with a clear understanding of how to effectively cope and manage emotions, such as anger or sadness. For parenting advice they explained the importance of establishing rules, even for children who are under the age of five. Some parents have the mindset that children under the age of five don’t understand much, so there is no need to have rules. However, this can be problematic when they enter school. They also discussed the importance of expressing emotions. Many parents hide emotions from their children, but when children don’t understand what “sad” or “angry” looks like, they may improperly manage their emotions by biting, punching, throwing temper tantrums, etc. Another tip they gave to the parents was to always have a beginning and end to every problem. An example that was given was spilled milk. First step is to identify the problem (spilled milk), then calmly fix the problem, and then move on. Children are observing parents to learn how to respond to problems. Even though Abriendo Puertas has yet to see an actually AP lesson in action, the points the mental health consultants covered seem to coincide with those they would learn within an actual AP lesson.

I was impressed that Telamon/Migrant Head Start is bringing attention to mental health issues. Although the mental health consultants were specifically addressing atypical behavior or development in children, there is also a need for mental health services for adults. There has not been a lot of research to understand the factors that influence mental health within the migrant farmworker population. One research study I found looked at specific stressors within the immigrant lifestyle that could contribute to poor mental health. They found that social isolation and hard working conditions were the top two indicators that contributed to anxiety and depression. I can imagine leaving your family behind and moving to a country where you don’t speak the language can lead to anxiety. This stress could be lessened if the community formed a network to help during this difficult transition. The network could include faith groups or athletic teams that could positively influence stress levels. To address the working conditions, farmers could provide drinking water or improve field sanitation. These are only a couple of suggestions that could help reduce stress levels, but the main issues are the lack of facilities within rural areas to meet mental health needs and the stigmatism that often comes with them. There is also the issue that even if the migrant farmworker wanted to seek help they may not have the financial resources, the transportation, or the knowledge of where to go. Mental health issues need to be addressed among this population and more research needs to be conducted to understand what contributes to poor mental health.

Research referenced was from Journal of Rural Health. “Migrant Farmworker stress:mental health implications”. Hiott AE, Grzywacz JG, Davis SW, Quandt SA, Acury TA.

nprglobalhealth

No, Seriously, How Contagious Is Ebola?

Holy moly! There’s a case of Ebola in the U.S.!

That first reaction was understandable. There’s no question the disease is scary. The World Health Organization now estimates that the virus has killed about 70 percent of people infected in West Africa.

The Ebola case in Dallas is the first one diagnosed outside Africa, the Centers for Disease Control and Prevention said Tuesday. And the health care system in Texas didn’t quarantine the man right away. He was sick with Ebola — and contagious — for four days before he was admitted to the hospital.

But when you look at health officials responding to the case in Dallas, they seem cool as cucumbers, despite the initial misstep.

"I have no doubt that we will control this importation, or case, of Ebola so that it does not spread widely in this country," said the director of the CDC, Dr. Tom Frieden.

Why is Frieden so sure this virus won’t spread beyond a handful of cases?

It boils down to something called “R0.”

The reproduction number, or “R nought,” is a mathematical term that tells you how contagious an infectious disease is. Specifically, it’s the number of people who catch the disease from one sick person, on average, in an outbreak.*

Take, for example, measles. The virus is one of the most contagious diseases known to man. It’s R0 sits around 18. That means each person with the measles spreads it to 18 people, on average, when nobody is vaccinated. (When everyone is vaccinated, the R0 drops to essentially zero for measles).

Image by Adam Cole/NPR

In honor of Breast Cancer Month and in honor of my mom, a 3 year breast cancer survivor, don't forget to do your monthly breast exams ladies!

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