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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. Respectfully submitted.
DIVISION OF MATERNAL AND Child HEALTH,
KANSAS STATE DEPARTMENT OF HEALTH,
Topeka, Kans., December 26, 1967.
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 approximatels 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. Yone 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 necessary. Sincerely,
Hugh DIERKER, M.D., M.P.H.,
Director of Health.
The Kansas STATE DEPARTMENT OF HEALTH,
Topeka, Kans., January 2, 1968. Hon. Harrison WILLIAMS, Chairman, Migrant Health Subcommittee, U.S. Senate, New Senate Office Building, Washington, D.C.
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 a reas 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,
DEPARTMENT OF HEALTH,
Frankfort, Ky., December 27, 1967. Hon. SENATOR HARRISON WILLIAMS, Chairman, Migrant Health Subcommittee, New Senate Office Building, Washington, D.C.
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 marle 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. Sincerely,
RUSSELL E. TEAGUE, M.D.,
Commissioner of Health.
MIGRANT HEALTH PROJECT, 1967, STATE OF KENTUCKY, HICKMAN AND CARLISLE
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. This program was offered during the same time that the health clinic was held. Several of the children who attended the evening classes were referred to the clinic by the school program's health nurse.
After the harvest of the strawberry crop in Carlisle and Hickman Counties the migrants go on to other harvest areas. Most go to help with the vegetable, strawberry and cherry harvests in Michigan. Others go to the mid-west for the sugar beet harvest and to Illinois and Indiana for the strawberry crops. In the late fall and early winter they return to their permanent homes in the South and work harvesting the crops there.
Future predictions of the size of the harvest and, thus, the number If workers returning next year will fluctuate in accordance with the weather picture. All the growers that I interviewed, with the exception of one, who might not plant a strawberry crop next year, will be planting more strawberries next year.
ENVIRONMENTAL SERVICES Environmental conditions in the migrant camp themselves haven't improved appreciably over the past year (according to the local health officers who worked with the project). New living units, shower facilities and privies have been constructed on several farms this past year.
At a previous meeting on environmental health, both the growers and the health department agreed to accept as regulations the minimum environmental requirements from the Kentucky State Department of Health.
The regulations-minimum environmental requirements for migrant labor camps:
Water: Tank of sufficient size to allow water and proper amount of chlorine to remain in contact for 30 minutes prior to use.
Sewage disposal: Standard Kentucky pit privy for camp areas.
Specification 1: New construction-10-percent floor areas; Old construction-5-percent floor area.
Specification 2: Floor spaces per person-20 square feet.
Specification 6: Garbage-pits at least 6 by 6 by 6. Disposal-backfilled daily. None of the camps complied with the chlorination standard. All tests for contamination reported by the local sanitarian this year were negative. No improvements on the wells themselves have been made since last year. All the camps, with the exception of one, received their water from deep wells. One camp is supplied with water brought in by truck from the city water supply and is stored in a cistern. It is manually chlorinated. There is one water outlet in each camp and buckets are used extensively for transporting drinking and washing water. No plans for future chlorination have been made by any of the growers.
The privies constructed in the camps have failed to meet the minimum standards in that they are not backfilled daily. All but a few of the privies are without seats or tops and none of them are screened. In the past seats were installed in several privies; however, the migrants themselves have removed a good deal of these. The portable privies used in the fields are well maintained and are up to the public health minimum requirements.
The showers are adequate but little effort has been made to insure proper drainage. Some units' fittings are supplied by makeshift hoses and have proven more than adequate. Several new shower facilities constructed this past year have shown improvements in that they are constructed of concrete block and have the proper fittings. One grower in particular has made a remarkable effort in this particular aspect over the past year.
New living units have been constructed in the camps this year. Most of these are the movable 12' by 16' duplex-type houses. These units are covered with the standard aluminum sheet siding and are designed with dividing partitions to accommodate two families if necessary. There are some new units which have been converted from barns that have concrete floors and are so fitted that many separate units can be arranged. All the new units are sturdily built and made for versatility. More refrigerators and hot plates were purchased this year by the growers. All of the camp houses lack proper ventilation for the gas burners which, on many occasions are left burning during the early-season mornings for heating purposes. The camp houses are not screened. However, the insect problem is fortunately not critical during the harvest season.
The garbage disposal facilities are deficient in that no daily back filling of the pits is carried out. In many cases the areas around the living units illustrate the negligence on the part of the migrants in respect to proper garbage disposal practices. Upon visiting the camps in mid-September it appeared that the growers had accomplished a cleanup in the living units and in the surrounding areas. All the units appeared clean and the surrounding areas well policed. All the garbage pits were covered properly. In most cases, the migrants' attitude is a determining factor toward the success of the environmental improvement program. Efforts made by health representatives to instruct the migrants and insure proper followup have been hampered by the growers' unwillingness to have outsiders in the camps during the harvesting season.
Most growers feel that they have fulfilled their obligations in providing proper living facilities to the migrants. They feel that much of the routine sanitary practices should be left to the migrants to accomplish. A good many migrants appeared satisfied with their housing except that a few have complained of the lack of privacy in the units themselves.
MEDICAL AND NURSING SERVICES
1. To provide prenatal and postnatal care to migrant women.
2. To provide health supervision and pediatric care to all children in the me grant camps.
3. To improve the health of migrant workers through provision of primary and secondary preventive medical care.
The health clinic was held five days a week alternately at the Hickman and Carlisle County Health Departments. On Monday, Tuesday and Wednesday it was held in Hickman County and on Thursday and Friday in Carlisle Counts for a total of twenty days. The clinic hours were from 5 to 8 p.m. each evening, thus enabling migrant visitation during the after-work hours of the day. This year's clinic started one hour earlier than last year's for it was believed an earlier closing time would allow the workers more time to return to their camps and thus get enough rest for an early morning start the next day. It was hoped that this would serve to improve the relationship between the health project and the growers.
One hundred and five medical cases and sixty-four dental cases were treated at both clinics. Seventy-five medical and thirty-seven dental cases were treated at the Hickman County Clinic. Thirty medical and twenty-seven dental cases were treated at the Carlisle County Clinic. Seventy-three migrants were treated by the physicians in their private clinics for a total of eighty-seven medical problems. The dentist also saw seven migrants in his private office and performed twentyfour dental procedures on them.
Three physicians, one dentist, one dental assistant, one nutritionist, two aidadministrators (both former "gray ladies”), one clerk stenographer, and one project coordinator (Administrative Assistant of Hickman and Carlisle County Health Departments) staffed the migrant project this year. Two of the physicians, the dentist, the dental assistant, the nurse, the nutritionist and the project coordinator had experience with previous projects, thus negating much orientstion training. The clerk stenographer, Mrs. Joyce Mills, underwent a three-day indoctrination program in keeping project records at the Kentucky State Department of Health and she considered this quite beneficial in the project work. The practice of rehiring experienced personnel is quite applicable in this case:
This year's clinic was conducted on simple patient-treatment basis, no screening was attempted this year as was done last year. Patients entered the clinic, were registered and interviewed by the aids and then referred to a physician or dentist. No medical histories were initiated and no examinations were given unless directed to by a physician. Transportation to the clinics was at the migrants' expense, a different policy from initial years. The first project year, transportation costs were paid by the project, i.e., the migrant crew leaders and the migrants themselves (who had their own transportation) were reimbursed for their travel to and from the clinic. More people attended the clinic the first year as a result of this added incentive, thus programs such as the examination and screening program, the health and dental hygiene program were enhanced. All the patients attending the clinic each night were seen and treated by both dentist and physician.
A new program established this year was the inpatient and outpatient treatment offered certified migrants in the Hickman-Clinton County Hospital. Arrange ments were made with the hospital for receiving migrants referred there by project physicians and for emergency care. Seven migrants received hospital care during the project period and one migrant remained in the hospital for a week after