A critical element of American agriculture is the migrant and seasonal farmworkers (MSFWs) who pick the apples, cherries, pears and other foodstuffs that are too fragile for machine-harvesting. Hard numbers are impossible to generate, but an estimated 50 to 70 percent of Oregon's MSFWs are undocumented (illegal aliens), mostly from Mexico. Because they primarily live and work in rural agricultural areas, this poor, disadvantaged and medically indigent population can put a significant strain on rural health care systems.
Agriculture is, along with meatpacking and mining, one of the most dangerous occupations. MSFWs are paid minimum wage if they're lucky. They are either provided sub-standard housing (for which rent is deducted from their wages), left to rent an apartment in town, or camp in a car or tent. They receive no breaks, days off, overtime, health insurance or other privileges of the workaday world. They work in hot fields and are exposed to concentrated doses of fertilizers and pest-control agents. All these variables add up to a variety of health issues for MSFWs and their families.
In 1986, a group of public health practitioners decided that they wanted to treat this population specifically. With the assistance of a federal grant and a HeadStart agency, they opened the doors of La Clínica del Cariño (The Caring Clinic) in Hood River. Tina Castañares, the clinic's medical director, was there at the beginning.
"There are only six Migrant Health Center grantees in Oregon," she says. "It was hard to get the clinic started, but we rallied around the need for obstetrics — all the older docs were retiring. We knew we could make an impact."
Though still dedicated to obstetrics, the clinic's focus has diversified: its original staff of eight has grown to more than 70, including 10 family physicians, three mid-level medical providers, four dentists and a dental hygienist. More than 8,200 patients were served in 2002, in almost 31,000 total clinic visits. The majority of these patients had incomes below 200 percent of the federal poverty level, and more than a third lacked health insurance. Most of those insured are enrolled in the Oregon Health Plan (Medicaid); fewer than 20 percent had private insurance.
Perhaps the biggest challenge to MSFW health is a change in diet — farmworkers and their families quickly discover America's cheap, sugary food and drink, which can result in diabetes and severe dentistry issues. "We're lucky to provide dental care," says Castañares. "We prioritize the children, and there is currently a 2-month waiting list."
MSFWs aren't always aware of their opportunity to seek health care; or else they put it off for fear of losing their jobs or residency in this country. "Most of the care being administered is acute or emergency care," Castañares says. This means insulin for diabetes instead of diet regulation, and root canals and tooth extractions instead of fillings, compromising people's health and costing the health care system more money. "Because new people are constantly churning through the system, it's a chronic issue."
Since Spanish is a predominant language, most of La Clínica's front-line employees and providers are competent in it. In addition, La Clínica sponsors "field clinics" to The Dalles and other outlying areas during peak agricultural seasons, and partners with Northwest Medical Teams to provide mobile dental clinics. A prized program dispatches "Promotoras de Salud:" local, Spanish-speaking public health workers who bring health care knowledge and support to MSFWs where they live.
Despite the work of organizations like La Clínica, the Oregon Department of Human Services recently estimated that almost 90 percent of the state's MSFWs and their families do not receive health care. "We're proud of what we've accomplished," says Castañares, "but there's lots of room to do better." The community- and coalition-building modeled by La Clínica del Cariño may set the standard for communities across Oregon.
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Photo courtesy of La Clínica del Cariño