Senator Williams. That statement certainly is complete, and we are certainly appreciative.

You are what we describe as a public health administrator. Is that right? Mr. Gonzalez. Yes, sir.

Senator Williams. How many people do you have working with you on this program for migrants?

Mr. GONZALEZ. Under the migrant grant, sir, we have two nurses, a sanitarian, and a health educator. We have just added an assistant to the sanitarian.

Senator Williams. Most of the people that you describe as farmworkers have a long period of residency in Laredo, maybe 4, 5, 6 months?

Mr. GONZALEZ. Usually the majority of them get to Laredo in September and October, and leave in April and May.

Senator WILLIAMS. Do you have many people coming across the border, daytime workers in agriculture?

The term we use to describe these workers that come over on a daily basis from Mexico is "commuters."

Mr. GONZALEZ. We have a large number of commuters. I would say around approximately 6,000 come to work in Laredo from across the river, the so-called green carders, but I don't know what percentage of these are in agriculture eventually.

Senator WILLIAMS. Can you reach those that are in agriculture with the migrant health program?

Mr. GONZALEZ. I would say not, Senator, because our health department sees only the residents from this side.

Senator WILLIAMS. I see. You still have not been able to break the barrier or fear that people have of getting immunization shots "up north."

Mr. GONZALEZ. No, sir. I make the statement that we have broken it. I think that in the past 4 years we have made great strides in that.

Senator WILLIAMS. Would it not help, though, for those who still have not lost their anxiety about going to a doctor or a clinic to have a medical profile that they can keep with them, and that you could consult to determine past services.

Mr. GONZALEZ. They have these. We give all the heads of the families a complete record of immunizations and all services, medical and clinical services, that we give them.

We have instructed them, and they are, I think, now getting around to following the practice of keeping this record with them everywhere they go.

Senator WILLIAMS. Is that true in California, Doctor?

Dr. GIANELLI. Yes, sir. They have a family health record, and they keep pretty good track of it, too. They come back the second year, and many of them still have it. They don't lose it.

Senator WILLIAMS. That was my next question: Do they honor the record, and keep it?

Dr. GIANELLI. Better than I thought they would
Senator WILLIAMS. How about Michigan, Doctor?

Dr. Locey. Unfortunately, this is not true. Only around 15 or 20 percent actually have any form of records with them at all.

Senator Williams. Before we come to you, Dr. Locey, do we have questions of Mr. Gonzalez?

Mr. BLACKWELL. Mr. Gonzalez, we have beard other witnesses discuss the necessary steps to improve the environmental health part of the migrant health problem.

Improved sanitation is needed in the United States. We all are generally familiar with the still more serious environmental health problem just across the border in Mexico. We saw it in Elsa. We saw it in a few other towns during our Texas hearings, and from a layman's viewpoint, I understand that this is the context from which there is the most likelihood of an epidemic stream.

Do you regard this as something to worry about, with the commuters coming across in such large numbers?

You said that there are 6,000 commuters in your area, and this is just one crossing point in Texas. At many points on the Texas border there are large numbers of workers coming across for a daily work tour, and then returning to Mexico, and I think we know the kinds of conditions to which they are returning.

Mr. GONZALEZ. Mr. Blackwell, we in Laredo I think are fortunate in enjoying a very close association with our Mexican counterpart, the health department in Nuevo Laredo.

We have, however, in the past four and a half years, been doing a very strong effort to immunize all our children from TB, polio, measles, and smallpox, with I believe also very good results.

In June of 1966, Nuevo Laredo had a polio epidemic. They had 27 cases.

Mr. BLACKWELL. Was that in Laredo?

Mr. GONZALEZ. On the Mexican side, 27 cases of polio, whereas we had one case of polio, so I think that even though we cannot speak so well on the major problem of TB, we are holding our line in most things, and Nuevo Laredo, I think, has also a very effective health department now.

Mr. BLACKWELL. What year was the polio epidemic?
Mr. GONZALEZ. In 1966.

Mr. BlackWELL. That is the point. You had a polio epidemic across the border in 1966, and in this case it was a disease for which

you

fortunately, in your area, already had an extensive immunization program.

It is not certain that the same success has been experienced all along the U.S. side of the Texas border with our own citizenship. Of course, we have no immunization program for some other diseases.

Mr. GONZALEZ. I think we have made a strong effort to give the information to the new Commission on Border Work on the MexicanUnited States border of what our programs are, including TB.

We have not really solved the problem that can be on the border, and for this we are going to need a united effort, even more than what wy are now conducting.

In all fairness, I would like to say that during the polio epidemic in Nuevo Laredo-I believe it can happen to any city that was not as immunized as it perhaps should have been--they immunized in a period of 48 hours 9,000 children. They brought nurses from everywhere and they just

went from door to door to immunize kids. Mr. BLACKWELL. This was in Laredo? Mr. GONZALEZ. This was on the Mexican side.

Mr. BLACKWELL. When an epidemic occurs, do you have a massive effort to deal with it?

Mr. GONZALEZ. Yes. If it weren't for that, there probably would have been more. They did conduct a rather effective program at that time.

Mr. BLACKWELL. This really is not a sound way of dealing with epidemics, though, trying to stop them after they have already broken out, and currently there are no procedures for having knowledge of the health status of these individuals at border crossings.

There is no required health certificate, unless for example they are working in a cafeteria on this side.

Mr. GONZALEZ. Yes; everybody that handles food does need a good kind of certificate, but I believe that most people that are working on this side have to have their X-ray at the U.S. Quarantine-Public Health Service Quarantine Station at the bridge.

Mr. BLACKWELL. That is when they are first certified?
Mr. GONZALEZ. Yes.
Mr. BLACKWELL. Then all of the many years afterward-
Mr. GONZALEZ. They don't have it.

Mr. BLACKWELL (continuing). Anything can happen, and there is no procedure for knowing about diseases following initial certification?

Mr. GONZALEZ. This is right.

Mr. BLACKWELL. TB, for example, could develop after the admittance procedure?

Mr. GONZALEZ. Yes.

They could ostensibly pick it up on this side, and we do have a rather effective system of followup in conjunction with their health department.

Whenever one of the residents of Nueva Laredo gets sick of TB, they pick him up right away, and they report him to the Mexican side, but this is the biggest problem that we have.

Mr. BLACKWELL. It is cheaper by far to have identification and prevention procedures, though, than dealing with an advanced case of TB, or having to program immunization for 12,000 people; isn't that right? Mr. GONZALEZ. Yes, sir. Mr. BLACKWELL. Is that correct? Mr. GONZALEZ. That is correct.

Mr. BLACKWELL. Are you able to supply now, or perhaps subsequently, an estimate on the cost of providing adequate medical care to the migrants, the migrant population in your county? Do you have a per capita figure on your project?

Mr. GONZALEZ. Not really, Mr. Blackwell. Actually, about 18 months ago, our health educator estimated that the migrant was getting $18 per head of our public health prevention.

Mr. BLACKWELL. Is that all migrants, or the ones you are reaching?

Mr. GONZALEZ. These are the ones we are reaching, and this I do not believe is correct.

We never publicized the figure, because, since we have an integrated program, where the migrants come to clinics not financed by the migrant program, and since we have other people that have come to clinics that are financed, this has been difficult to ascertain.

When you have a population of 20 percent migrants all over the city, actually in a way the best program is just a shotgun program. We have been able to be more successful that way, because in the one section of Laredo, which is the northeast section, migrants and their

families do very well, and you can now see very beautiful little homes that they have. They painted them up, spruced them up.

They take care of them during the time they are gone. Their yards are clean, and a very large percentage of these migrants are certainly not a blight on the community now.

Mr. BLACKWELL. What proportion of that migrant population do you think you are reaching? Twenty percent? Thirty percent?

Mr. GONZALEZ. We feel that it is between 30 and 40 percent that are coming to the clinics, that are following our clinical recommendations.

Most migrants have been approached by our health educator, sanitarian, and his assistant. Almost all have been seen and visited. They are participating in the services that we have for them.

We think that 40 percent would be a good figure to say that are taking advantage of what we have now.

I could be wrong in this, but many, many of them now don't even go to our clinics. They will go see their own private physician.

Mr. BlaCKWELL. The migrants in Laredo settled in what, generally speaking, is part of an urban area in the fringe of Laredo, or in the city? Mr. GONZALEZ. Inside the city limits; yes.

Mr. BLACKWELL. In Hidalgo they are more scattered throughout the rural areas?

Mr. GONZALEZ. Yes; it is out in the country, not so much in the city, but then Hidalgo, like I said, has an enormous number of migrants, and their families. They have approximately 25,000, just that county alone.

Mr. BLACKWELL. So it is obviously easier to reach the migrant settled inside the city limits?

Mr. GONZALEZ. Definitely.

Mr. BLACKWELL. So your 30 or 40 percent would be how much higher than in a county like Hidalgo, for example?

You could not logically expect them to have the same success in reaching them as you have in Laredo.

Mr. GONZALEZ. I believe so.

I am not too acquainted with the Hidalgo County program, but I think that they are having more success.

Mr. BLACKWELL. But your success is better than generally throughout the rural counties?

Mr. GONZALEZ. Let me say it is easier.

Senator WILLIAMS. Thank you very much, Mr. Gonzalez. Your presentation has been a big contribution to our deliberations here.

Mr. Gonzalez, do you know whether there is a health program under this act in Starr County?

Mr. GONZALEZ. I believe that that is covered by the statewide program, Senator. I do not think that they have a local program.

I know Zapata County just south of us does have a program now.

I am not sure if Starr County is included in the Hidalgo County program. It may be a multicounty program. I think it is under Dr. Copenhaver. He may be in Zapata and Starr Counties also.

If not, then it is covered under the State program.
Senate WILLIAMS. Thank you very much.

We will now hear from Dr. Robert Locey, the director, migrant health program, in three counties in Michigan.

We kept you waiting a long time, Doctor, but better late than never.

Dr. LOCEY. I hope I have enough calories to continue, here.

Senator and staff members of the Subcommittee on Migratory Labor, I am very pleased to be able to represent the southwestern corner of Michigan to you.

When I introduced myself, I did not mention the names of the towns, and I think if I mentioned the names of any of the towns in our area, I doubt if you would recognize them.

Senator WILLIAMS. Oh, we have been there.
Dr. LOCEY. Well, I am glad to hear that.
Senator WILLIAMS. That is good cherry country, too.

Dr. Locry. Yes, and you made reference to strawberries at one time.

I think with all due respect to Florida, that you really ought to come see ours sometime. Our area is one of the most diversified crop areas of the country, and the growing season opens up in May with asparagus and closes with grapes and apples in the late fall.

Our particular agricultural industry requires large numbers of seasonal farmworkers, and thus we rely heavily on migrant laborers.

The U.S. Department of Agriculture lists one of our counties, Berrien, as the Nation's third-ranking county in the utilization of migrant workers, and another of our counties, Van Buren, in the eighth ranking position.

Our peak utilization time is usually the middle of June, when some 23,400 migrants are on hand, 19,800 of which are of working age.

We generally maintain 6,000 to 10,000 seasonal workers during the 8-month harvest period, which covers some 25 different crops. To house this large influx of people, we have approximately 700 camps.

When I first became director of the associated health departments in November of 1964, I was charged to do something about "the migrant problem."

Being new to the area, I did not know what this problem was. However, I soon discovered it was a situation of grave concern, and one about which the community was quite ashamed. In fact, it may have been a very strong factor in finally organizing an approved health department in ou

In talking with doctors, dentists, hospital administrators, pastors, growers, city folk, and heads of civic and voluntary agencies, I found the community divided in itself, each willing to blame the other, and no one willing to take the leadership to solve this problem.

This was not surprising, in view of the magnitude of the situation. Because our communities are largely agricultural, the tax base was not felt to be sufficient to undertake a program that would meet the needs of these people.

Our ratio of doctor to resident population is low, and that same ratio for dentists is even lower. Paramedical manpower is at a premium.

The many small political jurisdictions acted as so many fences, each enclosing a typical rural or semirural conservative people. Yet, the fact remained that the migrant suffered during his tenure with us, and that unnecessarily high medical bills for migrant medical care were being paid by the taxpayer, due to lack of preventive care, and of early care in cases of illness.

area.