Migrant Farmworker Families Health Care Needs & Access Barriers
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Transcript of Migrant Farmworker Families Health Care Needs & Access Barriers
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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.
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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
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NMHSI Service Area
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NMHSI Funding Sources
BPHC 330(g)Medicaid State grants Local grantsClient fees
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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.
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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 Farmworker Lifestyle
MobilityMobilityMobility
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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
ObesityDiabetesHypertensionHyperlipidemiaAsthma
Dental problems Anxiety/depression H. pylori infection TB/LTBI Lead poisoning Parasitic infestation
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Work Related Health Problems
Falls & back strainsMachete injuriesPesticide/chemical exposuresCarpel tunnel syndromeFungal skin & nail infectionsHeat 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 lifestylePovertyLimited ed & low literacy levelsLimited English proficiency
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Access Barriers
Influenced by FarmworkersLack of understanding of scope
of problemEmployment - “Here to work”Fear of deportationLocation of camps
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Access Barriers
Influenced by Health Care System
Hours of operationMonolingual – (huge problem with
mental health needs)No understanding of lifestyle/cultureBilingual 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 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
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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 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
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High Blood Pressure
Barriers to Care:
Lack of refrigerator spaceUse of seasonings in food No symptoms = no problem
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High Blood Pressure
Barriers to Care:
Educational materials = litterUnlikely to ask questionsWill 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 hoursImmunization records NOT available in
national data base
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Assessing HIV RiskAssessing 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 testsContinuing careDietary restrictionsWeight loss
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DiabetesDiabetes
Barriers to Care:Cost of medications/ongoing availability
of medicationsMedicaid case open in TexasUse of home remediesAvailability of meds in Mexican
pharmacies
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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.”
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Condition Requiring Immediate Attention
Health Care Need:Serious in natureInpatient care Possible surgery Specialty care
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Condition Requiring Immediate Attention
Barriers to Care:
CostLack of trusting relationship
with providerNeed for family to make
decisions
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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.