Public Health

North Carolina Farmworkers Project Practicum

[tdsmithphcu]

One of the culminating experiences I have had during this semester's group practicum was having the opportunity to spend a morning working beside migrant farmworkers in Four Oaks, NC harvesting sweet potatoes. As I look at this photo taken that morning of a pile of sweet potatoes recently dug up from the rich North Carolinian soil in which they were once snugly planted, receiving the nutrients and support they need via a vital root system to be healthy and grow...my mind wanders to a metaphor I had never considered before taking part in this public health practicum. Much like how this row of sweet potatoes is dug from the ground, roots exposed to the earthly elements, the migrant farmworkers harvesting these sweet potatoes have similar stories. Migrant farmworkers are, in a sense "dug up" from their comfortable homes and lifestyles and removed from their native countries as they come to work in a foreign nation's fields. Their roots are exposed to new environments and severed as they are plucked from the familiar root systems which support them; that root system being family members, culture, social roles, and language preferences.

For sweet potatoes, as their roots are severed when harvested, the health of that potato is halted as it no longer has a root system or the support it needs to provide nutrients necessary for further growth. For migrant farmworkers when those roots are severed, they become a vulnerable population and one that must be supported in other ways so that growth remains possible. The North Carolina Farmworker Project (NCFWP) is one organization that makes such growth a possibility. It has been a tremendous opportunity to be involved with this organization and take a small part in what it means to serve a rural community. Presenting health fairs about ways to prevent heat stroke, avoiding oral health problems, mitigating exposure to nicotine poisoning which causes green tobacco sickness and the importance of adherence to medications has been a wonderful experience. Even if the overall number of people we were able to educate was rather small, I feel that the consequences of our efforts will be large because education is empowering and facilitates ripple effects as those who gain knowledge share it with others.

The resources that a well-established organization such as the NCFWP brings to this community are vital to this population's well-being. They link resources to the farmworkers and ensure that they receive the services they desperately need. Their bilingual staff demolishes existing language barriers and contributes to cultural competency. They help mitigate transportation barriers and help farmworkers access medical attention. If the workers are unable to pick up their medications from pharmacies miles away from their camps, this organization will take their medicine to them. In addition the NCFWP distributes prescription savings cards so that financial burdens are lightened. While the efforts of the NCFWP certainly impact this group, the number of people their organization supports is over 17,000! It's difficult to serve this entire population with only 20 full time staff members and this is where community efforts combine to expand available assets and resources. One example of this extension of accessibility is the Benson Area Medical Center which stays open late on Thursday evenings specifically to see migrant farmworkers.

One large effort of the NCFWP that we assisted with this fall was helping the organization determine whether or not migrant farmworkers saw the Affordable Care Act as a benefit and determining how it was utilized if they were enrolled in a plan. As we conducted the surveys, I was surprised how many workers had not had the opportunity to use their insurance. For some this was the first year enrolling in insurance while for many others it was their second year of enrollment. Almost every single worker however, saw that having insurance provided them a benefit, even if they had not used their insurance benefits. We had the opportunity to travel to various camp sites around the area and assist with more than 30 migrant farmworker surveys. For those that had utilized their health insurance they responded positively that having insurance benefited them economically. Most of the workers felt more secure in life by having the added protection of an insurance plan so that if any illnesses or accidents did occur, they would have assistance when paying for medical bills or when refilling a prescription. This research is valuable and can hopefully contribute to future policies and advances made in this population’s behalf. This is yet another example of a resource which promotes the growth of this important minority group. I will always be grateful for the experiences this practicum has given me and how it has enhanced my public health education.

[tdsmithphcu]

Participating in ACA surveys has been a really great experience so far. Talking to some of the North Carolina Farmworkers Project staff, it sounds like somewhere around 75-100 surveys have now been completed.

[tdsmithphcu]

Had a great opportunity this morning to go and work with some migrant farmworkers in Four Oaks, NC harvesting “camote” (sweet potatoes). It was truly amazing to catch a small glimpse of the work this important population does sun up to sun down, for 8 to 9 months each year.   

[tdsmithphcu]

Team Farmworker’s Practicum: Phase II

Seguro médico, exenciones, multas, prima de seguro, deducibles, visitas de prevención, visitas con un especialista, visitas con un doctor primario. These are just some of the terms which Team Farmworkers will be using as we begin our second practicum initiative. The world of insurance is confusing enough for me in English, so it’s hard to imagine how foreign and complex the United States insurance policies might seem to our migrant farmworker population. In order to raise awareness among the migrant farmworkers about the importance of insurance, the North Carolina Farmworker’s Project (NCFP) made a brief telenovela as highlighted in my video post above  It depicts that accidents can occur at any time, and having insurance to facilitate treatment and medical attention are well worth it. 

With the conclusion of the first half of our practicum which consisted of grant writing and giving health fairs at the Benson Area Medical Center, our next project teams with the North Carolina Farmworkers Project and the North Carolina Farmworkers Program. This new focus will gauge how migrant farmworkers understand and utilize the Affordable Care Act (ACA). Many of the migrant workers come to the United States via an H-2A visa. The H-2A visa is a nonimmigrant visa that permits these migrant farmworkers to come to the U.S. temporarily to work in agricultural services. If migrant workers are here for more than three months they are subject to the minimum essential coverage provision or the individual mandate enforced by U.S. healthcare system. Having an H-2A visa qualifies these workers to take advantage of the Affordable Care Act and since health insurance is now a taxable penalty, enrolling in the ACA could actually save these workers some money as it would help them avoid tax penalties. The 2016 tax penalty for not having insurance is $695/adult or 2.5% of adjusted gross income, up 0.5% from last year. As the farmworkers are unfamiliar with U.S. tax laws and requirements, we hope to help solve this wicked problem by first understanding the ACA utilization/value from the workers individual perspective.

The North Carolina Farmworkers Project has developed a survey which Team Farmworkers will be involved in rolling out. We will be conducting surveys in Spanish at the various migrant farmworker campsites within the area. The main goal of these surveys is to understand the farmworkers conceptions and overall value they feel the ACA provides them. The survey includes a combination of yes/no questions as well as some open-ended questions to get a good sense of what the ACA means to the workers. As we met this last week at the North Carolina Farmworker’s Project facility, we participated in a training session to help us prepare for the upcoming survey processes. Surveys will be conducted starting next week and into November as we try to reach as many farmworkers as possible before they return briefly to Mexico. We also became more familiar with some insurance terms and practiced being able to explain them in Spanish. It was an awesome opportunity to work with a community-based program and see the thorough process of and difficulties in creating a survey to capture an unbiased and open interpretation. It was also interesting to see how technicalities of languages created strain on some of the questions and how one little word can be so different in meaning from English to Spanish. Among our training group was a representative mix of diverse backgrounds and experience. English and Spanish were both being spoken to ensure comprehension of materials and expectations.

During the training they split us up into pairs and each of us was paired with someone who spoke Spanish so that we could all have a quick preview and practice run of how the surveys will be conducted. For part of the survey we were asked to be the one asking questions and for the other part of the survey we were asked to be the ones providing answers. It was a challenging yet exciting experience and I am really looking forward to conducting these surveys during the next several weeks starting Wednesday and Thursday of this coming week. If we can help the North Carolina Farmworker’s Project get a better understanding of ACA utilization and impact on the farmworkers overall health, some great benefits could arise not only for the workers, but also for the organization as pathways for funding and new public health implementations can be discovered.  

Since workers compensation only covers injuries acquired on the job (even though many will not report an injury in fear of being fired) a personal insurance can be very important for this important minority group. Team Farmworkers will be part of the very first group at the North Carolina Farmworker’s Project organization to conduct a survey at this level. The findings from this survey will be influential in future enrollment practices and forward dissemination processes of insurance education among migrant farmworkers here in rural North Carolina.

[tdsmithphcu]

This last week we met with our preceptor and Team Farmworkers is excited to start the second phase of our practicum.

[tdsmithphcu]

After a very educational career day/professional combine event, team Farmworkers gathered briefly to discuss final steps for our grant proposal. We will be meeting with our preceptor next week to start getting ideas about the transition into our next project of holding focus groups among migrant farmworkers to determine Affordable Care Act comprehension and utilization.

[tdsmithphcu]

Writing grants is way better when you have friends and Starbucks to help you get it done. This week team Farmworkers finalized our application for our Walmart community grant which if approved will help us buy incentive materials for our focus group participants.

[tdsmithphcu]

You know that feeling you get when it feels like everyone in a large crowd is looking right at you…the feeling that everyone is silently judging you as you walk on uncomfortably…the feeling that you are the only person that is different than everyone else? I can vividly remember the first time I stepped on a bus in Mexico and I was the only gringo on board. At that time I was still learning the Spanish language and could barely understand every third or fourth word spoken.  I remember the looks, the silent conversations, the overwhelming feeling of being alone in an unfamiliar place. I think every person at least once in their lives should have this experience as it can serve as  a great way to put yourself in somebody else’s shoes and have a better understanding of what it feels like to be the minority.

My practicum group, team Farmworkers and I had a similar experience this past weekend as we attended the 26th Annual Farmworkers Festival. As my team and I walked around in our Campbell University Public Health t-shirts we could feel the awkward stares and the silent thoughts of “what are these Americanos doing at our festival”.  Even though the mostly Hispanic crowd may not have really been thinking those thoughts, this scenario made me think about how these farmworkers must feel almost all the time they are here working in the United States. Many of the farmworkers speak very little or no English, the American culture is very different from their own, and they are constantly underappreciated and overworked. The goal of our practicum is to find ways to mitigate these inequalities, misunderstandings, and barriers that migrant farmworkers face. Having the opportunity to catch a glimpse of what this minority experiences, even at the minimal level helps me see the importance of why I chose to attend Campbell University’s Master of Public Health program.

We had a neat experience to present the poster our team made on the subject of heat stroke. As a group of workers gathered around our table, differences melted away. Once again my team and I were the minority but when we were engaged with the farmworkers none of that mattered. We were providing vital education to the farmworkers and they were appreciative and polite as they listened to our presentation. Heat stroke is among one of the most common illnesses these workers suffer. When asked if they or somebody they knew had ever experienced symptoms of heat stroke, almost all of them nodded their heads in the affirmative. Some of the preventions we encouraged the farmworkers to utilize were to drink water at least every 15 minutes, take breaks in the shade, to be aware of their co-workers and to be trained in recognizing the risks and symptoms of heat stroke. That day at the fair we educated a large group of workers and now they can take what they learned to their different work sites which in turn could have great benefits for their camps.

Earlier on in the week, on Thursday evening 9/15/2016 we gave another health fair presentation at the Benson Area Medical Center. This clinic stays open Thursday evenings specifically for these migrant farmworkers to receive care. We presented our poster on Heat Stroke and another presentation about oral health. We had several activities that the farmworkers could participate in after we had presented the information. One of the activities we did was playing a version of hot potato while playing Spanish music. The workers enjoyed the game and it was fun for them to be involved. For the heat stroke activity we had a number of questions which we asked to evaluate understanding. All the questions we asked had good responses so it was very rewarding to observe that the information we had presented was understood.

For the oral health presentation we had another activity where we had written questions on different pages of paper and crumbled the papers into a ball that could be passed around. As the paper ball was passed, the person who ended up with it had to unravel the paper and answer the question.  During this activity we were able to observe something which was very humbling. As the workers unraveled the papers we offered that they could read the question or that we could read it. All of the workers handed us the paper to read, perhaps because they couldn’t or perhaps because they were too embarrassed to read it themselves.  I don’t think I realized until that moment the extent of the disparities and difficulties these farmworkers face. Providing education and being a resource for this population is one of the greatest life experiences I have had and I feel extremely privileged to be a part of this practicum.  

[tdsmithphcu]

Team Farmworkers ready to present at the Benson Area Medical Clinic.

[tdsmithphcu]

Brainstormed today with this great crew and our awesome preceptor to make final plans and preparations for the health fair we will be participating in next Thursday @ the Benson Area Medical Center.

[tdsmithphcu]

As you drive down HWY 421 towards Dunn, NC you will drive past the Harnett Regional Jetport. Near this recognizable landmark you will see emerald fields surrounded by trees. Just past those trees, down a gravel road lined by soy bean plants, you reach an end in the road but not an end of civilization. At the end of this road you find several trailer homes lined up, one that serves as a communal kitchen, others which humbly serve as living quarters for a crew of migrant farm workers. This same team of workers returns each year to NC to harvest the fields and earn a living for their families back home in Mexico. Although the work they do each season is back breaking and dangerous, these workers choose to harvest the crops because for them taking care of their families outweighs these risks. Some of the greatest risks these workers are exposed to include pesticide exposure which can cause terrible rashes in addition to other very severe symptoms such as sterility, heat exhaustion/heat stroke, nicotine poisoning from harvesting tobacco leaves, agricultural accidents, and malnutrition. Many of these farmworkers do not have their own means of transportation and only have access to grocery stores and other facilities once a week. On the weekends they take school buses into town to buy groceries and wash their clothes.

I feel it a great privilege to be working with my colleagues on the Team Farmworkers Practicum. We will be working collaboratively with a non-profit organization called the North Carolina Farmworker’s Project located in Benson, NC. The goal of this organization and therefore this practicum is to increase the overall health of migrant farmworkers. Some of the direct projects my team and I will be involved in this year include conducting a health fair at the Benson Area Medical Center and holding focus groups to see how well the Affordable Care Act (ACA) health insurance benefits are being utilized or understood by these farmworkers. We anticipate that due to language barriers, there may be some misunderstandings or confusion with insurance terminology and processes. Our goal of conducting said focus groups will be to observe for areas of improvement to benefit this important group. Meeting the wonderful staff at the Benson Area Medical Center was a terrific opportunity. From the front desk people, to the interpreters, everyone is so happy to help these farmworkers receive the medical attention they so desperately need. It is uncommon to hear of a clinic that will stay open after hours to serve a very deserving yet overlooked population.

One of the greatest advantages that the North Carolina Farmworker’s Project has established this year is to implement “promotores” (promotors) in each of the farmworker campsites.  These promoters will play an essential role as they provide health education to their respective groups.  Some of the topics they have presented on already are diabetes and sexually transmitted infections. We plan on working closely with these promoters of health during our health fair so they can return to their campsites and be a critical resource for their coworkers’ health. In order to show a token of our appreciation for these promotors we have visited several Campbell University and local businesses to have items donated that we can give away as incentives. Some of the incentives we acquire will also be given to workers who volunteer to participate in our focus groups.

As we visited several of the campsites last week and got to meet a crew of workers, I realized how honored I feel to be involved in such an awesome practicum. The conditions that these workers live in are humble, the risks they are exposed to are heavy, and the burdens placed upon their shoulders are almost incomprehensible.  One of the workers explained to us that of his four children, he was only able to witness one of their births since the other occasions he was here in North Carolina to work. Another man has been migrating for twenty two years and now brings his son with him. Without the work of these farmworkers, crops of North Carolina and crops around our own nation would suffer. Is it not a worthy cause to give back to these workers in any way that we can? It is my hope that by promoting public health and providing education to these workers that I might be able to show my appreciation for all that they do such that we can enjoy the fruits of their labors.

[tdsmithphcu]

Team Farmworkers went around today talking to Campbell University and local businesses to request donations for items which will be given as incentives to focus group participants and to the "promotores" (promoters) in the various campsites as a token of appreciation for their leadership and impact they make while promoting health to their coworkers.

[tdsmithphcu]

We had the opportunity to meet at the North Carolina Farmworkers Project facility to meet the awesome staff that leads an amazing organization. One of the staff members, Leonardo took us to see some of the campsites and meet some of the workers. It was an eye-opening experience!

[tdsmithphcu]

Team Farmworker listos para trabajar!

Today we met with our preceptor Anna Jensen. Her organization spans several counties in eastern North Carolina and includes around 16,000 migrant farm workers. Last year they assisted approximately 2,300 workers and their goal for this year is to increase that number to about 2,600. Some of the things we will be working on this practicum include conducting a health fair, assisting in focus groups, helping people sign up for health insurance, and possibly even some transcription work. I am very excited to be a part of this team and look forward to an exciting semester!