Data obtained for the year 1964 showed that area hospitals had a loss of some $90,000, due to uncollected bills for migrant care. The Berrien County Welfare Department reported a cost of approximately $38,000 in 1964 for outpatient visits.

Because the migrant worker waited until he was very sick before seeking help, it taxed our already hard-pressed medical manpower.

The doctors were not so distressed at the additional hours they to put in for migrant care, but were more concerned about the followup on these people. They were concerned about the migrant's ability to obtain the prescribed medications that he should have, and about the living conditions that their sick patients had to be returned to.

Dentists in our area could handle only emergency care. No thought was given to the remedial aspect for migrants.

Organization was the only answer to the problem, and organization could only be attained through use of the Migrant Health Act of 1962. Since we were dealing with an interstate problem, we felt it was a fair and just use of Federal funds.

We were more than willing to put in our 25 percent. In fact, our contribution greatly exceeded that amount.

We knew that somehow we would have to develop some kind of educational program to stimulate migrants to seek care in the early stages of illness, that we would have to urge growers to afford adequate housing and a decent environment, to have safe water supplies, proper sewage disposal facilities, and suitable provisions for personal hygiene, laundry, and recreation; that we must somehow educate the migrant into the proper use of the facilities furnished by the grower; and that we must coordinate the health activities of official and voluntary agencies that were then providing assistance to migrants.

In looking at the map of the tricounty area, you can see, too, that we would have to provide facilities in the area where the camps were most prevalent.

In this case, the camps are indicated by red dots, the medical facilities in blue, and the dental facilities in green, and you can see that these facilities are not in the area where the migrants are most prevalent, and so we then established the three facilities that you see in a triangular fashion.

After months of planning and organization, we came up with a project that would cost approximately $1.28 per migrant per biweekly period for 13 biweekly periods. This is based on a biweekly average of 8,657 migrants from April 15 through October 15.

This is a very small amount, it is true. However, we tried to keep it practical in terms of the medical manpower we had available, our ability to recruit additional personnel, and the little experience that we had.

We would have been content that first year with just holding our own, while we were working out the bugs in the system and recruiting qualified personnel. However, our medical program was busy from the very outset. The number of outpatient visits supported in total or in part by the migrant health project for 1966 was 2,469.

The doctors working in the clinics, and again I make reference to our medical societies. I feel that congratulations are in order to them.

We have a hundred doctors. About a third are specialists, which reduces the number practicing-well, not practicing, but doctors seeing private patients--to 66, and 44 of them are in these migrant clinics. But they were enthused about the quality and continuity of care given, and the followup of these cases in the field.

Administrators at the local hospitals noticed a decrease in hospitalization of migrant workers, and members of their families. Physicians having offices nearest to the growing areas and physicians on call for hospital emergency rooms said that emergency calls for migrants had lessened considerably.

Growers felt that lost time in the fields due to illness was lessened, giving them more man-hours of work, and there were indications that many of the laborers would return next year because of the respect afforded them at the clinics.

As one migrant put it, "This is the first time I felt treated like an equal human being."

Our division of environmental health licensed 634 of the estimated 700 camps. Within this number of camps, 2,108 item violations were noted, and orders were issued for their correction.

Because of the shortage of personnel, only 93 camps were visited a second time. Among these 93 camps, 224 violations were listed at the time of the initial visit. At the time of the second visit, 147 corrections had been made, for a percentage correction of 65.6 percent, which was much better than the compliance rate for the State of Michigan as a whole, which was 39.9 percent.

I believe that this in some way reflects the value of a complete project. If the grower sees that the doctors, dentists, health department, civic and voluntary agencies are pitching in in one united effort, then he is more likely to go along.

At the time of the initial camp visit for licensure inspection in 1967, the number of violations recorded dropped by 58 percent, to 1,224. By the end of the 1967 season, our records show that over $110,000 had been put into improvements and new housing by the growers.

It is very difficult to compile, analyze, and compare data regarding costs and losses for medical care on seasonal laborers, due to several factors, including the present rapid rise in cost of medical care, and differences in the definition of migrant laborers among medical facilities, in policies of welfare departments, and in the number of migrants from year to year.

However, it is possible that any lowering of outpatient and inpatient costs for migrants could be related to the availability of facilities for early diagnosis and treatment of disease, to health education, and to the improvement of housing.

From the standpoint of outpatient cost, it is worth noting that in Berrien County the average cost per outpatient visit recorded by the department of social services in 1964 was $12.78, while, in spite of rising medical costs, the cost per outpatient visit recorded by the migrant family clinics in 1966 averaged only $7.22. For referrals made by project field personnel directly to private physician offices or hospital emergency room, the cost was only $9.36.

Also worth noting is the comparative data on direct relief medical payments made by the Berrien County Welfare Department, both before and after the project started.

In June, July, and August of 1965, the cost was $6,488.34. In these same months of 1966, the cost was only $3,079.30, or a reduction of $3,409.04.

The total cost for outpatient services during these same 3 months dropped from $9,898.32 in 1965 to $9,050.60 in 1966.

Although the difference is not striking, it is a definite break in the trend of increasing medical care costs for the indigent.

In terms of hospitalization during these same 3 months of 1965, $45,886.94 was spent on noncategorical hospitalization, which included migrant labor medical care costs. In 1966, the first year of the project, the cost for noncategorical hospitalization was only $39,521.95, or $6,345 less.

However, if you compare the first 5 months of 1965 and 1966 for noncategorical hospitalization, 1966 shows an increase in cost over 1965 by almost $30,000. Thus, the cost for noncategorical hospitalization had actually taken a sudden change from an increasing to a decreasing trend during the time the family health clinics for migrants were operating

Such figures as the preceding ones, which are used as indexes to evaluate the progress of the migrant health program, cannot give the entire picture. Yet, they do give an indication that preventative care and early care is less costly.

Such early care is afforded the migrant through the program developed by our communities as a result of the Migrant Health Act of 1962.

The savings in terms of outpatient care and hospitalization in no way make up for the total cost of the project, but this is more than made up by a more knowledgeable migrant, a healthier migrant, and one who is more productive, and who is less of a burden on the taxpayer. The value is immeasurable in terms of the migrant's dignity.

One of the greatest fears at the beginning of the project was that migrants who had higher than average capabilities for that class of people, and who were more stable from year to year than most seasonal workers, would abandon paying for their own care, as they had done in the past.

This proved to be untrue. Private physicians have reported that through the first and second years of the project those migrants who had been previous patients and were paying for their care were continuing to come to their office, and were continuing to pay their bills.

Our report for 1967 is being compiled, but is not yet completed. However, from observation, we know that our program has improved significantly. This year we had an outbreak of diphtheria, which we were able to handle efficiently and effectively.

After the situation was cleared up, I shuddered when I reflected on what we would have done had we not had the migrant health project.

Although we have made a great deal of progress, I am sure that you realize how difficult it is to develop something of this proportion in a 2-year period of time. We had hoped to be sufficiently organized by the time our project ran out, on June 30, 1969. Even then we will need some continuing financial support.

To say, or give the impression, that our current program will be sufficient at the end of 3 years, would be misleading. We still would not have sufficient environmentalists to inspect all camps at least twice during the season. We still would not have sufficient nurses and health education aides to make the meaningful personal contacts necessary in many problem areas.

We still would have difficulty in bringing remedial dental care to just the migrant children involved, and routine screening procedures for vision, hearing, tuberculosis, and other chronic diseases would, for the most part, be imperfect.

In our experience, it would seem desirable not only to continue the Migrant Health Act, but to furnish additional matching funds to increase the small expenditure of $1.28 per migrant per biweekly period.

We have some very conservative people in our area, but as a whole they see the value of the money that has been spent, and are for raising the amount of money that will do the job properly.

In my opinion, there is still much to be done on a Federal level. At the present time, most family health clinics within any particular migrant stream operate independently of one another. Hopefully, a cohesiveness of such clinics can be brought about to produce increasing continuity of care.

The effectiveness of the entire program could also be enhanced if migrants could be evaluated, preventive measures begun, and needed consultation given before leaving their home base.

We are now faced with the threat that the Migrant Health Act will no longer exist after June 30 of 1968. As I understand it, one of the reasons for the discontinuation is to make more money available for the Comprehensive Health Planning Act.

In effect, this would mean diluting migrant health moneys over a much broader population. This may be the right and just thing to do for categories of a universal nature, such as heart, cancer, stroke, diabetes, tuberculosis, and others which are common to all localities.

However, the migrant situation is not a universal one. It is a problem experienced by relatively few localities. These localities by their nature are rural, and do not have the resources to meet the needs of the migrant worker and his family.

If you throw migrant health moneys into a general pot with these other disease categories, you are treating the migrant as a disease entity, which indeed he is not.

Although he may speak another language, or be of a minority group, he is a human being, deserving of respect. He is necessary to the economy and productivity of this Nation. Although he is an American, he is, in many instances, an unfortunate captive of his work, because of his education, background, and capabilities.

The migrant health program is just not a mechanism to provide immediate, acute treatment and improvement of living conditions. It is designed with a lasting effect in mind, to educate and to promote and maintain the health of an underprivileged group of Americans who must eventually take their place in the mainstream of American life.

This will come as their education and social acceptance improve, and as they are replaced by mechanization.

I hope you do not see our request to continue the Migrant Health Act as a selfish move, for we are interested in more than the growing of fruits and vegetables. We would like to see America grow in a manner commensurate with its very honorable preamble. Thank you.

(Attachments to Dr. Locey's statement follow :)

TABLE I.-BIWEEKLY NUMBERS OF SEASONAL AGRICULTURAL WORKERS BY LOCATION OF ORIGIN, BERRIEN,

CASS, VAN BUREN COUNTIES, 1966

SOURCE AND MOVEMENT OF SEASONAL AGRICULTURAL LABORERS According to data gathered by the State Health Department for the year 1966, the following states supplied seasonal agricultural labor to the state of Michigan in the percentages given as follows: