children in the meantime had to move on to Salinas for work and survival. One night at the clinic, about two weeks after I had seen Maria, I discovered her father sitting among other patients waiting to see me. I was informed that he had made a special trip to personally thank me. He merely grasped my hand, and with tears in his eyes said: "Maria lives. . . gracias!" and then he quickly turned and left. The next contact occurred six months later when I found an unexplained package of Salinas celery on the front porch of my home. Then I heard nothing until six months ago, when just by chance I heard a progress report on Maria from a local inter-faith migrant volunteer who had kept in close touch with the family from the very beginning. Maria had finally left the hospital and rejoined her family in Salinas and had managed to complete her high school studies in time for June graduation despite a severe handicap of one-sided weakness and speech difficulties. But the volunteer who gave me the report was much more excited about something else. She had just learned that Maria had accepted her invitation to spend the summer as her guest in San Jose! How many lives in how many ways have been favourably effected by this one little migrant clinic . . . we'll never know completely. But we do know in part! There are many, many Marias migrating throughout our country, and I sincerely hope we can consider them as much with compassion as with computers. I urge that Senate Bill #2688 be passed. Respectfully yours, STANLEY A. SKILLICORN, M.D. COLORADO DEPARTMENT OF PUBLIC HEALTH, Hon. HARRISON A. WILLIAMS, Chairman, Migrant Health Subcommittee, New Senate Office Building, Washington, D.C. DEAR SIR: In reply to your invitation to submit a written statement in connection with the extension of the Migrant Health Act. We hope the following comments will be of assistance in assuring the passage of this much needed legislation. Each year, approximately 20,000 migrant workers and their family dependents are engaged in the production of Colorado field crops. The classic problems of their mobility, poverty, and cultural isolation are compounded by the nature of crop production in our state. Due to the decentralization of farm housing, and the subsequent dispersion of the migrant population, delivery of health services is a difficult task. 1. A serious void exists in meeting the in-patient hospital care needs of migrants in Colorado. Hospital care is an essential, but missing, link in the chain of comprehensive health care, which is being forged under the auspices of the State Migrant Plan for Public Health Services. 2. Medical and dental service are both areas in which expansion is needed in order to meet the total need of the target population. Public health in irsing must be made available to more migrants in order that medical and dental services may become available to all who need them. 3. Due to lack of sufficient Environmental Health staff, problems have been attacked on an area-by-area basis, rather than as a whole. Many areas in the state have not yet been subjected to intense scrutiny as to environmental conditions. Often, as project emphasis is shifted to a new area of the state, housing conditions in the area just left begin to deteriorate again. 4. Each year the efforts of the dental hygienist, employed by the project, yield more cases of need than available funds can provide for. We are certain that even her intensive efforts have not uncovered all of the migrants' dental health needs. 5. The current amount of our grant, MG 09 is $157,581.00. This is the amount authorized for the calendar year, which will end December 31, 1967. In order to meet some of the needs referenced above, a continuation request was submitted for the period January 1, 1968 through December 31, 1968 in the amount of $262,048.00. 6. This level of funding would have provided for the employment of a fulltime public health nursing supervisor and consultant, whose duties would be to involve greater numbers of county level public health nurses in migrant health matters. Some progress was made during the current calendar year in the direetion and it was found that the gield in direct services to migrante far exceeded expectations. 7. It was planned to employ an additional dental hygienist for six months to assist the full-time hygienist in screening and referral work during the migrant season. 8. Also included, was provision for a very modest in-patient hospital care program. It was estimated that an absolute minimum of 365 patients would require care at an average of 3%1⁄2 days per patient and at an average cost per patient of $215.00, with an estimated total cost of $78,475.00. In that Public Health Service (Migrant Health Branch) guidelines would have restricted us to only 53% of this, a total amount of $41,592.00 was applied for. Provision was also made for commercial transportation of patients to hospital facilities. 9. In order that the public health nursing program could be expanded in an orderly fashion, two critical areas were chosen to receive assistance. These were the Northeastern Colorado Health District and the Adams County area of the TriCounty Health Department of the metropolitan area. In both cases, provision was planned for the employment of a public health nurse during the migrant season in those respective areas. 10. A realistic increase in funding for dental services was requested which would have doubled the amount of patients who could have received care in 1968. 11. While no specific plans were incorporated in the application for the expansion of the Environmental Health Program, increases would have become necessary in view of the housing regulations recently promulgated by the U.S. Department of Labor. This would have required the employment of an additional sanitarian and three sanitarian aides. This, together with the other personnel increases would have required additional clerical assistance at the State level. The total amount required to fund this additional activity would be approximately $46,000.00 annually; this would be in addition to the $262,048.00 originally requested for the on-coming calendar year: a total of $308,048.00. Even this amount would not meet the need for a full-scale assault upon migrant health problems. 12. The current level of grant support, $157,581.00 to which we are to be held during 1968, does not realistically reflect migrant health needs in Colorado. It is barely sufficient to maintain program momentum. It will not enable us to make the necessary increases in program effort which are referenced above. Hospitalization, even at the minimal level planned, will remain unavailable, there can be no increase in meeting medical and dental needs, the public health nursing program will not progress at the necessary rate of speed, nor will any substantial improvement in the environmental health program be possible. Moreover, normal salary and other cost increases will make it necessary to omit or cut back some existing activities. It is our hope that necessary legislation will be enacted which will enable our project, and others, to deliver health services at a realistic level to this segment of our population. Sincerely, Palisade, Colo., December 29, 1967. Hon. HARRISON WILLIAMS, Jr., Chairman, Subcommittee on Migratory Labor, DEAR SIR: The Talbotts are probably the largest private employers of migrant labor in the state of Colorado. We have been in the fruit business here since 1942. We want to give our support to S-2688 which will continue and extend the funds for Migrant Health Services, such as we have been receiving under S-1130. As growers, we have been greatly benefited by the health services given the agricultural migrants of our county. It has helped us recruit labor; it has stabilized our labor supply as it causes many more workers to return; and it has been a great convenience to us by making night clinics available. Fewer hours of work have been lost and the general health and productivity of the workers have been higher. Your support of S-2688 will be greatly appreciated. Mrs. H. A. TALBOTT, Secretary-Treasurer, Talbott Farms, Inc. P.S.-We could send oral testimony in support of this bill by tape, if it would be helpful. MESA COUNTY MIGRANT COUNCIL, INC., Hon. HARRISON A. WILLIAMS, Jr., December 29, 1967. DEAR SIR: The Mesa County Migrant Council, composed of representatives of clubs, agencies, lodges, churches and service organizations, urge the passage of S 2688 extending and increasing the present Migrant Health Act. If the committee could see the splendid results accomplished with a modest amount of funds made available to us through the previous bill, S-1130, all doubt as to the efficacy of the program would be removed. During the six months Mesa County has large numbers of migrant agricultural workers, a Public Health nurse visits the ranches, providing health teaching and counselling, screening for diseases such as tuberculosis, and giving immunizations. Night clinics are held during the fruit season when there is a tremendous buildup in the population of fruit areas. Medical care is provided over the entire county in any physician's office, without cost to the migrant. The doctor is reimbursed at a certain proportion of the Blue Cross fee. The grower and the general population have benefited as well as the migrant. We cannot too heartily urge the continuation of this splendid program. Yours very truly, Mrs. H. A. TALBOTT, Chairman, Migrant Health Committee. SARASOTA COUNTY HEALTH DEPARTMENT, Hon. HARRISON A. WILLIAMS, Jr., Washington, D.C. DEAR SENATOR WILLIAMS: I wish to take the opportunity, so kindly afforded by your office, to comment on your Bill S-2688 to extend and expand the Migrant Health Act which will otherwise expire at the end of the current fiscal year. By way of introduction, I would like to point out that I am now a local health officer with an ongoing Migrant Health Project and also a member of the U.S.P.H.S. National Migrant Project Review Committee. I was formerly Director of the Florida State Migrant Health Project as Director of the Bureau of Maternal & Child Health, Florida State Board of Health. In these capacities, as well as in previous local health work in Florida, I have been associated with Migrant Health programs for a period of over fourteen years. During these years I have observed Local, State and Federal programs from all three levels and feel better qualified than the average public health official on this subject. The immediate reaction might be that I am a partisan representative, since I have an axe to grind as a Migrant Health Service Project Director. I do have an axe to grind, but not due to my connection with a Migrant Health Project! My axe, the one to which I have dedicated my professional career, is to assure to the best of my ability that every human being over which I have any jurisdiction receives every health service and every health protection that my staff and budget will permit. The $22,000.00 that I receive for the Migrant Health Project is a small part of our total operational budget of $500,000.00 annually. While it permits us to mount a program we could not otherwise fund, it is not enough to warrant a "personal axe letter", unless this program were important to me for other reasons! It is! I have seen migrant families living in pasteboard boxes, chicken coops, deserted automobiles and the back end of a stake-truck. I have looked into the eyes of dying infants who suffered from lack of food, clothing and similar items we consider as fundamental necessities of life. I have provided or recommended hundreds of dollars of remedial care to migrants who waited too long for $5.00 worth of care or who sought $1.00 worth of prevention and could not obtain it soon enough to forestall a serious illness. I have also seen what a community can do, with only a few dollars, when a few concerned citizens take an interest in God's children. If our National Poverty and Foreign Aid Programs could be operated with the tight-fisted realism and dedication to service that I have observed in Migrant Health Projects, they would cost much less and produce much more, I assure you. I have, incidentally, worked as a public health specialist in both Foreign Aid and O.E.O. programs and know whereof I speak! These are the reasons this program must be extended and expanded to permit wider participation, nationwide. As a member of the National Review Team I have been forced to reject basically sound projects due to the shortage of funds available to continue existing programs while attempting to add necessary new projects. Priority must go to the continuing projects, where a competent job is being done. Sometimes this must be at the expense of a new project which appears badly needed. The Migrant Health Act has made a greater, more dramatic impact on the Health of Domistic Migrants in a shorter period than any other single project with which I am acquainted. The job isn't completed yet and should funds be withdrawn prematurely, much that has been done would be abandoned through sheer lack of adequate local resources to allow contamination. I wish to commend each of you who worked for passage and extension of the previous act. It was truly a worthy a hievement! It has been said that Federally-sponsored programs never phase out, they just grow! I know this is not true because I have personally assisted in the phaseout of three federal projects in the past seven years. With continued support for our Migrant Health Project, in Sarasota County, I expect to phase it out in two to three years to make room so another needy area may participate. Our county will be ready and able to support the project by then and we fully expect it to do so within three years, maximum! However, being familiar with each of the remaining two hundred projects in the Nation, I know that many of them will need at least five year's assistance. Many needy areas have no program as yet, they will need assistance, as we have, for five or more years in the future! The question is not, "can we afford to fund them, but can we afford not to"? I submit that a Nation which can support a foreign war, good or bad-chosen or thrust upon it, cannot turn its back on the most impoverished Americans that one can imagine. You who put the people's will into action should get to know our Migrants. Have you ever really seen a migrant? Have you ever entered his hovel? Have you ever met him in the field or orchard? You cannot all see a Migrant Infant die (thank God), but you can all see a migrant family as it lives in our nation today! I commend this experience to you, you will never forget it! Every state represented on the subcommittee has migrants, so they won't be hard to find at home! There are also plenty in Virginia, Delaware and Maryland, no more than two hour's drive from Capitol Hill. Let the migrant help you decide how to vote on this critical Bill. I have written similarly to my friend, Congressman Paul Rogers, and to my own congressman, James Haley. They are both fighting for Migrant Health, won't you do the same? Please excuse this overlong letter. I get wound up on some subjects and, after all, you did invite my comments. Of course, you didn't ask for a book! Gentlemen, give us the tools to work with a little longer and in adequate supply. I assure you we'll get the job done! Unlike Medicare, we won't take forever either! Best wishes for a successful year in 1968. Hon. HARRISON WILLIAMS, Jr., Washington, D.C. DAVID L. CRANE, M.D., DELRAY BEACH, FLA., December 27, 1967. DEAR SIR: Regarding S. 2688. We have a family owned farm which we have operated for the past 9 years growing to our present size of 150 acres of bell peppers. We employ 30 Puerto Rican workers (4 with families) from September to April. The migrant health services in Palm Beach County have been extremely useful in promoting better health among our workers and their families. I am sure I speak for the majority of the farmers in this area when I urge most strongly the continuation and expansion of the Public Health Service Act as it affects the migrants. It should be pointed out that the past several years have seen a minor revolution in the agricultural economy. These people are being paid more money and in many cases they are assuming more permanent positions in the work force. It is to be hoped that by increased attention to the health and welfare of the children in particular that they will grow up ready and able to take their places in an economic climate radically different from that their parents faced. Very sincerely yours, TED WINSBERG. FANCEE FARMS, Sarasota, Fla., December 27, 1967. DEAR SIR: Referring to Legislation #S. 2688, which would extend the Migrant Act for five years and also expand the program to reach twice as many farm workers, as are now being served. We wish to take an affirmative position on this legislation as we are very much in favor of its being extended as specified in Bill S. 2688. Very truly yours, PAT F. FECLISE. STATE OF ILLINOIS, DEPARTMENT OF PUBLIC HEALTH, Re extension of Migratory Health Act (S. 2688). Chairman, Migrant Health Subcommittee, New Senate Office Building, Washington, D.C. DEAR SENATOR WILLIAMS: The migrant health program in Illinois is nearing the end of its third year. We have been able to meet many of the needs of the migrants who come to Illinois but many objectives and needs are unmet. Minimum health standards have not been achieved in some areas. Assistance is needed in order to bring housing conditions into compliance with the United States Department of Labor regulations. Education for migrant children is also a pressing need compounded not only by lack of funds but also by the fact that it is necessary for children to work in the fields or care for their younger siblings during the day. The above problem reveals the additional need for more day care centers. The 1968 migrant season will see the discontinuance of certain day care centers rather than the much needed expansion of this important program. Family clinics and immunization programs would be of significant value to the migrant community. Growing interest in birth control is accompanied by fear that the cost makes it prohibitive. Education in this area would dispel misconceptions. The five federal migrant health grants now approved in Illinois serving nearly 11,000 migrants are as follows: Illinois Department of Public Health, Lee-Ogle and Vermilion Counties (MG 105C)_ $25, 365 Princeville Migrant Health Services (MG 150A). 1, 683 Jones Memorial Community Center Migrant Health Clinic (MG 151A). 15, 891 10, 305 10, 280 Total-- 63, 524 The greatest proportion of these grants goes to pay administrative expenses only; hospitalization and doctor bill requests in the grant are not enough. We have assisted in paying unpaid hospital and doctor bills which could not be collected, using Children's Bureau Funds. Funds from the State of Illinois Children's Bureau-Fund A have been made available to the migrant program through December 31, 1967 for pregnant women and children under 19 years of age. A dental van has also been partially supported by these funds for those who qualify. Since these funds have been cut and are no longer available the only source of funding is through the USPHS grant. The importance of expanding the program in Illinois cannot be overemphasized. In the past three years we have been able to help only a part of the migrant population. While the migrants and their employers have displayed a responsible |