Senator WILLIAMS. Thank you very much, Dr. Locey. It sounds like this migrant health program is a full-time occupation for you. Dr. LocEY. Yes; it could occupy that. Unfortunately, with the small manpower we have, I have to go across the whole gamut of public health. Senator WILLIAMS. Are you in private practice in addition to this work? Dr. LOCEY. No. As you say, it is a full-time job among the migrants, and I have all three counties. I think another thing I should point out, too, is that Allegan County, which is not shown, resides just above Van Buren, and this program has done a great deal to break down political boundaries. It is probably one of the best examples of comprehensive health planning that you can find, because Allegan County, along the shore of Lake Michigan, too, has a great number of camps, and although this is not within our jurisdiction, it is served by our project, a good program, an areawide program to try to meet the needs for that particular area. Senator WILLIAMS. You have in the appendix of your statement a lot of statistical material. I am sure it would be very helpful to us, and it will be included in the record. Mr. BLACKWELL. Yes, sir. Senator WILLIAMS. We have a lot of pictorial matter, too, which we probably can't include, and yet I will keep it in our committee files. The Migrant Hospitality Center, the Keller School, and Northrup Lodge all look like wholesome and healthy places for the various activities that are going on there. Dr. LOCEY. We, too, have a mobile clinic that we pull up next to Northrup Lodge, that you mentioned, and the Migrant Hospitality Center. We use these areas for the reception center, for registering health education, and then we use our migrant health clinic for the base itself. Senator WILLIAMS. You shuddered to think what would happen if the outbreak of diphtheria had not been controlled. Was there fear of an epidemic? Dr. LOCEY. This particular case we are reporting, it took us about 20 telephone calls. By 11 o'clock that evening, we had the entire camp of 90 people isolated. They all had nose and throat colors. They were all given their booster shot, their diphtherin, and five cases we found carrying this pathogenic strain of diphtheria were immediately hospitalized and isolated, and therefore we were able to contain this thing, and not see it spread. We couldn't have come anywhere near that. We could have rationalized afterward, "Well, this is a situation. We don't have the personnel. This is way out in the country. We don't have facilities." But it is still a job. It was the proper thing to do. Senator WILLIAMS. And you attribute the national program as the major contribution to taking care of that particular acute disease situation? Dr. LOCEY. Well, I certainly think it helps, because, as I say, we act pretty much in an independent manner, and if there are clinics in every migrant area acting in that manner, we are going to be much further ahead. But I still think, of course, there should be a greater liaison and communication between the number of migrant clinics throughout the country that exist expecially in one given migrant stream. Senator WILLIAMS. A lot of the diseases that you deal with are highly contagious; are they not? Dr. LOCEY. Well, you will find in the statistics that the major diseases we come across are respiratory diseases. From the standpoint of dangerous communicable diseases, there may not be many, but when they occur, they are important. We did have one case of poliomyelitis that was discovered in our clinic in 1966. Senator WILLIAMS. You are in agreement with all our other witnesses that addressed themselves to this appropriation, that the migrant health program should stand on its own feet, and not be put in the common pot, as you said, with the comprehensive program, because it might well get lost there? put Dr. LOCEY. Yes, sir. Senator WILLIAMS. And we had directors of the health departments of four or five States, and they, without our asking them to comment, all volunteered the same observation that you did. We did not ask you, did we? Dr. LOCEY. No. Senator WILLIAMS. So it came purely as an observation that you make from the fields where you work. Is that right? Dr. LOCEY. This is correct. Senator WILLIAMS. Well, we certainly kept you late, and, as I said the other day, while we feed the spirit and feed the mind, the time comes when we ought to be feeding the body. So at 1:22 we adjourn this hearing, and I cannot guarantee this, but we feel confident that your apprehension that this program might die on June 30 next year can be allayed, or dismissed, because on this committee I think we are in general agreement that the program must continue. We are going to have some editorial problems in completing the record, with some charts and graphs and statistics, so without objection, the staff will be authorized to edit it for publishing purposes. (The following material was subsequently received.) Re S. 2688. ARIZONA STATE DEPARTMENT OF HEALTH, Hon. HARRISON WILLIAMS, DEAR SIR: The fertile valleys of central and southwestern Arizona constitute one of the nation's largest and most important agricultural areas producing close to $300 million worth of cotton, vegetables, grains, citrus, alfalfa and other agricultural products, accounting for more than ten per cent of Arizona's economy. An estimated 40,000 domestic migrant farm workers are employed year-round throughout the agricultural areas in Arizona, following the harvest seasons from county to county within the State or inter-state from California, Texas, New Mexico to Utah, Nevada, Colorado, Oregon and Washington. The average family income of these migrants is far below the poverty level, averaging about $1200 annually from our own observations in Migrant Health Clinics. To protect the health of this high risk minority group, to provide for them at least a minimum decent and healthy environment, immunization and other preventive services, as well as medical and dental care when need arises is a public health responsibility of crucial importance for the economy of the State and needed in the humanitarian tradition of this great Nation. The task becomes further complicated by the great distance the migrant worker and his dependents must travel to available health facilities, by his low income, lack of transportation, and indeed, often by his ignorance, lack of education and understanding of even the most basic principles of health protection. Only through the efforts of comprehensive community planning involving the migrants, the farmers, community leaders, as well as voluntary and governmental health agencies can we hope to make inroads into the many and serious health problems affecting the migrant farm worker and his family. But planning alone is worthless when lack of funds stymies inception of the plan. The Migrant Health Act of 1962 brought hope to the migrants, made communities look and realize their needs, and thus not only stimulated the planning process but provided the needed funds to assist Arizona communities in carrying out their plans. Through the incentive of the Migrant Health Act, Maricopa County and later Pima, Pinal and Yuma counties initiated migrant health projects that brought preventive and curative medical, nursing, nutrition and sanitation services to the migrants and their environment. In 1966, the Arizona State Department of Health started a statewide program of consultation and support to local efforts with emphasis on evaluating needs and progress, stimulating interest for health services in areas with migrant population where the need was not met, nd searching for more effective methods for the delivery of health services at the time and place where the health dollar spent would do the most good for the money. Federal funds for migrant health projects in Arizona, supplemented by an estimated equal amount of local funds or services, provided for well-child and maternity services, family health clinics, family planning and immunization clinics, nutrition services, sanitary camp inspections for all farm labor camps, medical social work services, nursing visits, health education programs, contractual laboratory and X-ray diagnostic services, medical care, dental care, drugs and partial hospitalization cost for over ten thousand migrant farm workers and their dependents. Yet, we have still a long way to go before reaching the goal of providing just the most needed services to all migrant farm workers in Arizona. In Cochise County, nursing service is the only available service for hundreds of migrant families. In Graham and Greenlee counties, nothing but very limited strict emergency services are available for an estimated seven to eight thousand migrants. Even in Maricopa, Pima, Pinal, and Yuma counties, where successful migrant health projects have been established, our best estimate indicates that only fifty per cent of the migrant population are recipients of needed services. There is need for establishing basic health services in Cochise, Greenlee and Graham counties. There is need for expansion of migrant clinics in several areas in Yuma, Maricopa, Pinal and possibly Pima counties. There is need for expansion of dental services which in most areas are not available or limited to emergencies or to children under 9 or 10 years of age. There is need for payment of full cost for hospitalization in counties which simply cannot afford to carry their part of the cost. There is need for expansion of health education efforts in all migrant areas of the State in order to effectively improve the utilization of preventive services and thereby make real inroads in the health status of the migrant farm worker and his family, enabling him to take his rightful place as a wanted, needed, healthy and gainful individual in the community, which, after all, is dependent on his work ability for its own economy. Through the extension and expansion of projects and Federal funds, as proposed in Senate Bill 2688 for a five-year period, it will be possible for this State hrough orderly and comprehensive planning to help integrate all service to the nigrants. - It is needless to say that I endorse Senate Bill 2688. For further documentation of the need for passage of Senate Bill 2688 I am nclosing a copy of Arizona's Health, Vol. 1, No. 3, November, 1966, which upplements and illustrates the points that I have made in this letter. Sincerely, 87-443-68- -9 GEORGE SPEND LOVE, M.D., M.P.H., CASA GRANDE CLINIC, Hon. HARRISON WILLIAMS, Chairman, Migrant Health Subcommittee, Casa Grande, Ariz., January 11, 1968. New Senate Office Building, Washington, D.C. DEAR SIR: At this time of pending legislation, I felt that a short line about the Migrant Health Family Services Project in Pinal County, Arizona, night not only be timely but might explain some of our positions relative to the Program. As you probably already know, Pinal County is an agricultural county in southern Arizona employing a rather incredible number of domestic migrant farm workers each year. Although the health problems of this particular group have improved considerably over the past several years, the conditions to a newcomer (such as I was in 1955) to this particular area, would make our medical problems appear quite primitive. It is only through such Migrant Health Legislation as we now have that we are able to cope with the problem to any extent. May I express my complete accord with the general feeling of the need, services, and the desirability of Migrant Health Legislation such as Senate Bill 2688. It will only be through legislation such as this that any inroad into migrant health problems may be made. Thanking you for the privilege of communicating with you, I remain, Sincerely yours, R. F. SCHOEN, M.D. SAN JOSE, CALIF., December 20, 1967. Re extension of Migratory Health Act. DEAR SENATOR WILLIAMS: In 1965 I established a family health service clinic for migrant seasonal farm workers in the South Santa Clara County area of California under the sponsorship of the County Medical Society. In 1966 and 1967 we received a Migrant Health Grant to keep the clinic in operation. The number of separate migrant individuals who come into this area during the crop season is estimated to be over 7,000 and 55% of these are youth. Ninety percent of these migrants are Mexican-Americans. There is an abundance of statistics which I could present in order to indicate the significant health services provided by our clinic and the crucial need to continue to provide health care to migrants. However, I am sure you have sufficient statistical data to prove your point for extension of the Migratory Health Act. Nor do I have the time to describe a variety of other services and activities associated with the clinic; suffice it to say that in addition to providing basic health care, we are involved in a number of social, educational welfare and recreational activities. But there is something even more significant than all those things that results from the clinic of this sort, and I should like to relate a personal experience in an attempt to explain what I mean. Shortly after we started the clinic in 1965, I had the opportunity one night to examine a 17-year old Mexican girl named Maria, who had arrived from Texas one week previously. She came to the clinic directly from a long day in the fields, with a complaint of headaches of three months' duration. Though dirty and tired, she was vivacious and attractive in her ragged jeans and workingman's shirt. She was highly intelligent and had a personality which charmed everyone it touched. Examination revealed signs of an advanced brain tumor. Through an interpreter I confidentially explained the seriousness of the problem to her father, who became extremely upset, particularly because his wife, Maria's mother, several years before had died from a brain tumor. Maria was sent to the County Hospital immediately, and I have never seen her since. The story might end here. However, several subsequent events have contributed toward making Maria a significant part of my life. I later learned that she was operated upon that same night for what proved to be a malignant tumor, and she was left with paralysis of one side of her body. Some inter-faith migrant volunteers heard about her and took it upon themselves to "adopt" her, as it were, with daily visits during the many months of difficult rehabilitation in the hospital; you can imagine how many loving relationships developed in the process. The father and the other |