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attitude toward payment of medical bills, there is still a great need for assistance in this area. Little is gained if a family comes to Illinois for a season of work and medical bills to be paid require all or most of the earnings. Better cooperation from local doctors and hospitals can be expected if they have more assurance that they will be paid for their services.
The great need for facilities necessary for basic hygiene make additional health education necessary since good health habits are difficult to maintain under these conditions.
The experience we have had with migrant health referrals has been most rewarding. There is, however, need for expansion in this area, especially in the area of more complete information and more time for follow up.
A total of $79,503 from the State of Illinois Children's Bureau-Fund A was paid for migrant health in the period July 1, 1966 through June 30, 1967. The withdrawl of these funds effective January 1, 1968, and the 1967 defeat in the Illinois State Legislature of a $200,000 bill for migrant health appropriations for the biennium means that additional USPHS funds will be needed until at least 1969.
An additional load is being placed on the migrant program because of unfavorable weather conditions in Texas, causing migrants to extend their stay in Illinois beyond the usual three months.
A budget showing additional needs above the present grants for the period July 1, 1968 through June 30, 1969 is attached. This is a conservative estimate of the additional needs in Illinois for the next year.
FRANKLIN D. YODER, M.D., M.P.H.,
Needs in addition to present migrant health grants, July 1, 1968, to June 30, 1969
Program director (average $100 per month).
Public health dentist services-dental van-remains in field April to October (7 months) (average_month $350).
Dental van commodities...
Gasoline, tires, etc., for van....
Printing: Spanish-English health information materials__
500 1, 000
Senator HARRISON A. WILLIAMS,
MUSCATINE MIGRANT COMMITTEE,
Chairman, Subcommittee on Migratory Labor,
DEAR SENATOR WILLIAMS: In reference to legislation S. 2688, as a grantee under the Migrant Health Act, the Muscatine Migrant Committee of Muscatine, Iowa, heartily supports Congressional efforts to expand the provisions of the Migrant Health Act and to extend it for five years or longer.
The availability of Federal funds in our area to which over 1300 migrant workers and their dependents came during 1967 has provided more adequate medical care for the migrants and has relieved the community of a residue of unpaid medical bills. The hospitalization component has been of the utmost importance in encouraging and helping to provide for hospital care before injuries and illnesses have reached acute stages. Dental funds are being used to save teeth which would otherwise be lost to decay. Through the weekly, evening family health clinic, medical needs have been brought to the physician's attention which in many cases would have been neglected as a result of the high cost of medical care.
Through the efforts of the staff provided for under the Migrant Health Act, the migrants are educated toward recognizing their health problems and toward becoming increasingly responsible for their own care.
More funds are needed, however, to extend the coverage of the existing provisions and to explore such possibilities as a federally financed group medical insurance plan for migrant agricultural workers and financial assistance to growers in the construction of adequate sanitary facilities.
We assure you that the availability of federal funds is making a significant and sometimes vital difference in the adequacy of medical care for the seasonal migrants in our area and that the extension of these funds to assist with the costs of medical care for newly settled out migrants helps to ease the trauma encountered in that process. Through your efforts, there is a chance that our country's ne glected will take their place among our country's respected.
Hon. HARRISON A. WILLIAMS,
DEAR SENATOR WILLIAMS: I would like to go on record as supporting the extension of S. 2688, which would prolong the Migrant Health Act for a five-year period.
Very truly yours,
JAMES M. MCNALLY,
KANSAS STATE DEPARTMENT OF HEALTH,
Re S. 2688, extension of Migratory Health Act.
DEAR SENATOR WILLIAMS: For the past four years, I have been privileged to serve as the medical director for the Migrant Project in Western Kansas. I am heartened that legislation has been introduced to extend the Migrant Health Act for an additional five years, as our efforts over the past years in changing cultural patterns in acceptance of medical care are only now becoming realized. The state and local health services in rural areas of Kansas are presently inadequate to meet the needs of the resident population and cannot cope with the health problems presented by migrant families,
We have been well pleased with the flexible and innovative handling of the project grants which has encouraged experimentation in the delivery of services. It also made it possible to demonstrate for a wide geographic area, a regional health service staffed by a public health team. This may point the way for reor
ganization of traditional public health services in rural areas. We have also learned the value of utilizing health aids in motivating and communicating with the migrants.
Migrant families are rapidly changing their attitudes toward utilizing health services. The evening clinics have often run as late as midnight and served as many as 100 persons. To spend a long hard day in the field, yet still be willing to come many miles to an evening medical clinic indicates good motivation. Originally, families sought health care in the clinic for their children as a requirement for admission to licensed day care programs. Attendance at the medical clinics gradually extended to other members of the family as they realized the benefits. A major health problem which remains to be solved is child spacing and family limitation. Typical childbearing experiences are as follows: One migrant family served by the program this past summer had sixteen children. Another had six living children, two infants who died and three miscarriages. Another family; ten living children; four miscarriages, and another family with seven children all under eight years of age. These families are beginning to request help in family planning. Although Western Kansas has a rather small migrant stream-5,000 to 6,000 persons, the problems of these people run deep. Unless continued effort comes from the Federal Government, it is probable the life patterns of migration, lack of education and lack of health care will be transmitted from generation to generation. Most gratifying in the past year has been the improved inter-state communication with better follow-up of health problems at the home base. We sincerely urge extension of the Migrant Health Act. Although additional funds probably will not be requested for the Kansas project, similar projects are needed in other areas of the country.
KANSAS STATE DEPARTMENT OF HEALTH,
Senator HARRISON WILLIAMS,
Chairman, Migrant Health Subcommittee,
DEAR SIR: Kansas has been a recipient of a migrant health grant for the past four years. This grant has allowed us to provide health services for approximately 4,000 migrants who come to Kansas each spring and return to Texas in the fall. These migrant families contain many small children and infants.
The migrant population is centered in the Southwestern part of Kansas around Garden City. This is largely a rural area with almost no public health services and a minimum of physicians and dentists.
The grant has allowed us to provide family medical clinics, dental clinics, hospitalization, immunizations, tests and x-rays for the detection of tuberculosis, family planning services, vision and hearing screening for children, prenatal care for expectant mothers, public health nursing services, sanitarian and health education services, and health services to children in day care centers. None of these services would be available to the migrants if it were not for this grant.
A second grant has been utilized by the Kansas City-Wyandotte County Health Department to provide similar services for around 4,000 migrants who come to the Kansas City area each summer.
These grants total $110,000 and are adequate to provide needed health and medical services to the Kansas migrants. We urge that this program be continued by the Federal Congress and will be pleased to supply additional information as
HUGH DIERKER, M.D., M.P.H.,
THE KANSAS STATE DEPARTMENT OF HEALTH,
Hon. HARRISON WILLIAMS,
Chairman, Migrant Health Subcommittee, U.S. Senate,
DEAR SENATOR WILLIAMS: This is written in support of the pending migrant health legislation.
The Migrant Health Grant has been most helpful to us in Kansas in developing public health and medical care programs for migrants. I am sure that you are well aware of the needs of this group for both health education and health service, so I will not enumerate these. Through the public health nursing service we have been able to institute, we are seeing a change in health attitudes and practices that is most gratifying. More work and service will be necessary if attitudes are to be really changed and people are to continue to seek medical care when needed and to use child and self care practices that will insure good health.
To continue the program which we have started, we will need continuing support from the Federal Grant Funds. The localities in which the projects are located are not able to support the services at present and the state is not ready to assume this load without assistance.
Because of our referrals to other parts of the country when families or individuals need care after they leave our state, we are aware that there are areas with no services. Funds are needed for new services as well as for continuing programs such
I certainly hope that the health needs of a sizable segment of our population will be considered seriously and that funds will be appropriated to make possible new and expanded services as well as the continuation of those already existing. Sincerely,
DOROTHY WOODIN, Director, Public Health Nursing.
COMMONWEALTH OF KENTUCKY,
Hon. SENATOR HARRISON WILLIAMS,
New Senate Office Building, Washington, D.C.
DEPARTMENT OF HEALTH,
Frankfort, Ky., December 27, 1967.
DEAR SENATOR WILLIAMS: This is in reference to Senate Bill 2688, introduced to extend the Migrant Health Act for five years and also expand services to reach additional migrant farm workers.
I am definitely favorable to the enactment of Federal legislation to improve the health services under this program. Due to state resident requirements, it is impossible for each state to provide the level of health care that meets minimum standards.
Kentucky has provided personal and environmental health services to migrants working in Carlisle and Hickman Counties for the past three years, from funds made available through a Migrant Health Project Grant (MG-77). However, the needs of this group remain unchanged except for the treatment, in most cases of acute conditions provided during daily clinics. Very little alleviation of chronic conditions is possible with the limited resources currently available.
Although during the past project year Kentucky spent $7,450.00 of a total grant of $17,053.00, the unspent funds were the result of the unavailability of qualified personnel. The lack of personnel is one of the major needs for projects that are operative for short time periods.
To develop a comprehensive program to reach the total migrant population working in Kentucky, the amount of funds must more than double during the next few years. Our past programs have provided direct medical services to less than one-third of the migrant workers in the target area. Environmental improvements have also been made in the migrant camps. I have no doubts but what all these workers are in need of, at least, general medical supervision; and that a great deal more of environmental health activities could and should be developed. An organized inter-state coordination is also vital to have a truly comprehensive program, and to this fact any legislation should place a great deal of priority. I am enclosing a copy of our 1967 progress report for the Migrant Project (MG-77). I hope this report and my comments will be of assistance in improving the health status of the Migrant population.
RUSSELL E. TEAGUE, M.D.,
MIGRANT HEALTH PROJECT, 1967, State of KENTUCKY, HICKMAN AND CARLISLE COUNTY
MIGRANT HEALTH PROJECT
Through the combined efforts of the State Department of Health and Carlisle and Hickman County Health Departments a grant of federal funds was awarded to Kentucky to improve the health of migrants coming into Hickman-Carlisle communities during the strawberry harvest season, May through June, and to provide safeguards to this community. The Project was initially started during the harvest season of 1965. Services offered through the project included prenatal and postnatal care to migrant women, family health service clinics, dental services, environmental health services, nutrition and general health instruction.
This is the third report of project activities and covers the period of May through June 1967.
The period covered by this report corresponds with the beginning and ending dates of the strawberry harvest in Carlisle and Hickman Counties from 1 May to 15 June 1967. The contract agreements arrived at prior to the project, between the project director, physicians, and dentist, allowed for any possible overlapping in that it called for a period of services from 1 May to 30 June. This schedule was well chosen for it corresponded with this year's strawberry harvest.
The general objectives of this project are listed on the following page. Few changes have been made over the one-year period. In only one objective, that concerning the health status of the worker himself through the medical services made available to him, did the project achieve fairly comprehensive success. The clinic was set up and those that were able to take advantage of its services were well cared for.
Fewer migrants came to Hickman and Carlisle Counties this year than did last year. Excessive rainfall followed by long spells of heat caused a less plentiful harvest and the migrants didn't stay as long as they had the previous year. Also, competition from Mexican growers caused the frozen strawberry market to decline. Approximately 805 migrants came this year (figure from growers' estimate). Of these, approximately sixty percent of the working force were women. There were approximately 165 children below the working age living on the farms. Another 110 dependent children accompanied their parents in the fields picking strawberries.
The composition of migrant labor was relatively unchanged from last year, mainly Texans (Spanish speaking) and Negroes from Louisiana, Mississippi, Missouri, and Tennessee.
GENERAL PROJECT OBJECTIVES
A. To seek improvement of the environmental factors affecting the health of migrant workers.
B. To improve the health status of migrant workers employed in Carlisle and Hickman Counties through (a) medical and nursing, (b) dental, (c) nutritional, and (d) venereal disease services.
C. To provide health education opportunities for the migrant workers and for the growers through health education activities.
The Spanish speaking migrants from Texas are composed mostly of family groups. The Negro migrants, on the other hand, have a greater proportion of single workers.
This report covers the third year of a three-year period that the Public Health Service has been utilized for migrant welfare.
Previous employment arrangements had been made through crew leaders who travel with the migrants acting as agents, interpreters and intermediaries between the workers and the growers. In addition to the migrant laborers there were a small number of untrained Negro commuters from Cairo, Illinois; Tiptonville, Tennessee; Paducah, Kentucky; and Hickman, Kentucky, who assisted with the picking through the peak of the season. This year, however, there were fewer cases where "outhaul" laborers were used. The unwillingness of the farmers' part to hire the less experienced and less responsible "emergency labor" coupled with the smaller crop caused fewer to be brought in. This year there was little or no publicity made in the area newspapers concerning the migrant project. Two illustrations included in this report, taken from the Carlisle County News, concerned the educational program for the children this year (not a part of the health project). In this initial program seventy-three children attended school in Carlisle County and approximately the same number in Hickman County.