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project termination. The arrangements proved quite adequate in accomplishing their objectives. Administrative control was maintained by the project.
One migrant, who was reported to be acting strangely by his fellow workers, and having a record of psychiatric treatment, was examined and diagnosed as suffering from "Schizophrenic Reaction, Paranoid Type, Chronic” and was admitted to the Western Kentucky State Hospital in Hopkinsville, Kentucky on June 15. le responded to treatment, and was thus released six weeks later to return to his group.
The farm labor representative who accompanied the migrants to the HickmanClinton County area was quite helpful in overcoming the language barrier, a major problem between the project workers, growers, and the migrant laborers. The medical community, a good deal of which was involved in this year's work, was very cooperative. When there was a shortage of medical and dental supplies (also a major problem this year), the local clinics and hospitals were called upon to lend out the necessary provisions.
Mr. Ashley Beckham, the Regional Public Health Service Representative, visited the clinic on one occasion and encouraged efforts towards collecting medical case histories, and some were consequently taken. Initiating and maintaining medical and immunization records is quite necessary in dealing with the migrants. More efforts in this sense, however, should be made in the permanent home areas of the migrants.
Six migrant women received prenatal care and one woman postnatal care. One delivery was made during the project period.
This year, due to the number attending the migrant school children program, fewer children accompanied their parents into the clinic. Six children received immunizations, three of these were for Smallpox, one for Diptheria, one for Pertussis and one for Tetanus. Two were given the Sabin II vaccine. Free access to the farms during the clinic hours would have insured a wide range immunization program.
Pediatric care consisted mainly of treatment for impetigo, worms, and upper respiratory complications. Approximately twenty-one percent (twenty-three children) of the patients treated at the clinics were children from ages one through fifteen. One child was hospitalized for a period of seven days.
Seven migrants received inpatient care at the Hickman-Carlisle County Hospital. The average length of stay for hospitalization was, 5.71 days per patient. Eighteen migrants received out-patient (emergency) care.
1. To improve dental care in an attempt to relieve pain and infection, and improve the home care of the mouth of the migrant workers in Kentucky
Dental services were offered on a similar basis as the medical services. Doctor Robert Jackson, an experienced project worker, treated a total of sixty-four patients of which forty-nine needed services. Of these forty-nine, forty-five were partially completed and five not started. Of the total one hundred eleven services provided, seventy-five were simple extractions, thirty-one were corrections and five were preventive.
A dental clinic was inhibited due to the initial absence of dental supplies, which had been ordered beforehand, but did not arrive during the project period. (This was a result of a delay in fund allocations and purchasing systems.) Consequently, the first two weeks of the dentists' work consisted entirely of simple extractions and routine examinations. Only after borrowing from his own clinic was he able to provide corrective services. Prior planning and coordination are necessary in order that the correct supplies be delivered in time.
Thirty-three toothbrushes were distributed and the children were urged to use soda and salt if no toothpaste was available. The hygienist and nutritionist both demonstrated proper dental care techniques, emphasizing proper home care for all who were able to attend the clinic. Again the lack of effective communication between the project and the migrants in the camps pullifies any possibility of effective dental education.
NUTRITIONAL SERVICES Objectives
1. To assist the growers and community in understanding the need to make available foods that are in keeping with the workers and their families' cultural eating habits.
2. Assist people in food planning, purchasing, and preparation as needed.
3. Work as a member of the health team to provide nutrition services for prenatals, postpartums, infants, and children.
4. Assist workers and families and other members of the health team with any nutritional problems such as modified diets, feeding, or eating problems.
5. Work with other members of the health team in planning, preparing and implementing the phases of all health services to be rendered to the migratory worker and his family.
Sales to migrant groups in previous years have given the local grocers sufficient knowledge concerning the food requirements and habits of the workers. Some spices and ground corn were not stocked, yet substitutes were available. A certain antiseptic is in great demand yet the grocers have tried but failed to locate a wholesale source.
Most of the local grocers stated that the migrants' eating habits, especially the Texans, were above average. The Texans bought great quantities of food, picking choice cuts of meat and the most nutritious foods. The Negroes were average buyers, selecting less nutritious foods than the Texans.
Prior planning and pre-ordering on the part of the area nutritionist and the project nutritionist insured the ready supply of illustrative materials for the clinic. Charts in Spanish, obtained from the Texas Extension Service, were posted in the clinic and handouts were available for all visitors.
The project nutritionist utilized the patients' (or dependents') waiting room time for holding informal nutritional instruction. Basic food-group charts were presented and explained by the nutritionist. Home safety charts were posted. Instant breakfasts (it was found the migrants frequently missed breakfast), were prepared and samples were handed out. Tang, encouraged as a nutritious unrefrigerated drink, was served each night. Dehydrated milk was prepared beforehand and cooled and then served to the migrants. Cost charts comparing these latter items with those they substitute were posted. Peanut butter cookies were given to the children. Vitamins (Paladac and ADC), and Similac were distributed upon prescription by doctors.
This year's clinic didn't have as many children as last year's as can be illustrated by the lower clinic attendance and the number of children attending the school program. The mothers (who normally accompanied their children to the clinics) consequently were not available for nutritional instruction. Neither the nutritionist nor the health nurse were permitted to visit the camps this year. Home demonstration programs therefore could not be utilized.
VENEREAL DISEASE SERVICES
1. To provide adequate venereal disease diagnostic and treatment facilities to migrant workers.
2. To provide all necessary information and education to these workers in order to:
(a) Alert them to the signs, symptoms, and dangers of venereal infection.
(b) Make them aware of the facilities available. There were no personnel from the Venereal Disease Control Program participating in the Migrant Health Project this year. Four cases of Gonorrhea were diagnosed and treated and the results were reported to the State Department of Health. No venereal disease screening was carried out at the clinic this year.
“A comprehensive V.D. effort combined with an initial medical screening program in Texas, Louisiana, Mississippi, and Tennessee, remain the only solutions to the problem of venereal disease control. Again, á limited time period and insufficient staffing minimized the attempt at fulfilling the objectives and solving the problem of venereal disease.” (From last year's report.)
HEALTH EDUCATION SERVICES
1. To work with farm owners in such a way that they are willing to provide proper environmental conditions for workers and to personally encourage workers to improve health behavior.
2. To arouse surrounding communities to the needs of migrant workers and enlist their support in providing necessary services to workers.
3. Working with all other health professionals concerned to organize educational experiences for migrant workers involving, as far as possible, migrant leaders in the planning and carrying out of educational activities. Health educators will coordinate all group educational work in the project.
4. To insure that all educational work has carry-over value for workers as they move to other areas; for owners and communities in accepting their responsibilities for migrant labor problems and in their preparations for next year's migrant group.
Efforts on the part of the local sanitatiou officer and public health administrative assistant are continually being made in an effort to encourage the growers to improve the camps. The realization of public awareness, a foundation of the migrant project, has kept the growers moving. Conditions in the camps are not above the minimum standards, yet they have not declined.
If access to the farms can be realized in future projects, classes can be given in such areas as prenatal, postnatal, and infant care. Nutrition could be demonstated more realistically, more individuals could be reached.
This year's project was supervised more by local officials, a policy which the national and state health officials believed would improve local interest and participation. A Regional Public Health Service physician did not take part in this year's project. The State Public Health Nursing services were likewise not as active. Suggestions for the use of mobile clinics and day care centers were made by the project workers who would prefer, in the future, to reach more of the migrant population.
The growers seemingly relate all the public health programs with the repeated complications in harvesting the crops. It would supposedly be more desirable to the growers if no programs were available to take the migrants off the farms thus diverting their attention from the harvesting itself.
Belladonna Angina Pectorin
MIGRANT SCHOOL TO OPEN
An educational program for children of migrant workers in Carlisle County for the strawberry harvest will begin Monday afternoon at Cunningham Elementary School. Burley Mathis, principal at Arlington, has been named to direct the program:
Financed by federal funds under Title I-- Migratory Program, the school will be open daily from 3:30 p.m. until 7:00 o'clock with field trips planned on Saturdays. The county school system has been given a grant totaling $ 16,544.07 to meet program expenses.
The federal grant will go for teacher's salaries, supplies, equipment and materials. All equipment bought for the special school for migrant's children will become the property of the county school system after the strawberry season ends and the migrants move out.
C. Joe Baker estimated that seventy children are in migrant camps now at strawberry farms owned by David Boswell and Vodra A. Hobbs. More are expected to arrive before the season ends, he said.
The first day of school will be devoted primarily to testing and seeing that the children have suitable clothing.
Transportation to and from school and one meal each day will be provided the children. Classes are planned in music, health and physical education, art and recreation. The staff will include a counselor and others to assist in the program.
Louisiana STATE DEPARTMENT OF HEALTH,
New Orleans, La., December 16, 1967. Hon. HARRISON WILLIAMS, Senator, Chairman, Migrant Health Subcommittee, New Senate Office Building, Washington, D.C.
DEAR SENATOR Williams: The State of Louisiana has had a migrant health program in Tangipahoa Parish for the past several years under the existing leg. islation. We certainly want to continue rendering services to the migrant health workers and if funds were available, we could expand the services rendered.
Our present program serves approximately 3,400 population with some remaining the year round. Our current budget is approximately $20,000, and we have requested a $33,000, budget to improve our services. We strongly support the extension and expansion of this migrant health project. Yours very truly,
ANDREW HEDMEG, M.D., M.P.H.,
State Health Officer.
MARYLAND DEPARTMENT OF HEALTH,
Baltimore, Md., December 19, 1967. Hon. HARRISON A. WILLIAMS, Jr., Chairman, Subcommittee on Migratory Labor, U.S. Senate, Washington, D.C.
DEAR SENATOR WILLIAMS: We are in full support of Senate Bill S. 2688 which will extend the Migrant Health Act and expand the program.
During the past summer, Maryland had approximately 5000 migrant workers, accompanied by over 800 children. The medical needs of these migrants have been found to be similar to the like socio-economic groups of the counties in which these migrants work. However, their lack of knowledge of available resources and the contlict of their working hours and the hours of operation of some of the medical facilities greatly complicates the problem of fulfilling their medical needs. We presently have only one Federal migrant health grant. This is in the amount of $16,369 for the current year and is limited to Worcester County, which had less than 15% of the total migrant workers last summer. In addition, we are cooperating with a Federally funded project in West Virginia, so that an additional 96 of our migrant workers are receiving the benefits of special services available through Federal funding. Project applications are being submitted from two other counties for the coming summer. If funded, these will provide services for an additional 807 of the migrant workers.
It is our feeling that continued extension and expansion of the Federal Migrant Health Act is essential to the provision of health services for migrant workers and their families in Maryland. Yours truly,
William J. PEEPLES, M.D.,
STATE OF MICHIGAN,
Lansing, Mich., December 20, 1967.
DEAR SENATOR WILLIAMS: The Michigan Department of Public Health has been concerned and involved with the extension and improvement of health services to our migratory farm workers.
As you may know, Michigan ranks third among the states in the utilization of migratory workers. We estimate that 80,000 workers are required to harvest Michigan's crops valued in 1964 to be $175,000,000. These interstate migratory workers are housed in approximately 3,000 camps in 54 counties in Michigan's lower peninsula.
Our department has taken the leadership in promoting a healthful environment, family medical cinic and hospital care programs at the state and local level, effectively utilizing the funds made possible by the Migrant Health Act of 1962, as amended in 1965.
In the event that the Migrant Health Act is terminated, Michigan will lose medical and hospital care now available to approximately 45,000 migrants or 560
of the estimated total number of our migratory workers (80,000) and sanitation services to all 80,000 migratory workers.
Over the last four years there has been an increase of health care services for 2,500 migrants at a cost of $9,000 to services for 45,000 migrants at a cost of $471,043 in 1967 (not including local contributions of $298,887). Sanitation services during this same period increased from no Federally supported program to a statewide program supported by $176,789 of Migrant Health funds.
In 12 counties, 14 clinic site locations are providing family medical services and 20 participating hospitals are providing needed hospital care. In the various programs over 80 full-time and part-time individuals are providing the services with the cooperation of 54 participating local physicians.
We are currently assisting four local health departments in the preparation of proposed medical and hospital project applications, which would make available migrant health services to an additional 15,000 migrants and dependents with a proposed budget of approximately $100,000.
It is estimated on the basis of current expenditures, that it would cost an additional $240,000 to extend this same range of health services to migrants living and working in the other 38 counties utilizing the services of migrants,
In order to continue the current program of essential health services for migrant agricultural workers and to provide for their extension to all migrants in the state, it is urged that the Migrant Health Act be continued and that additional funds be appropriated. Sincerely,
R. GERALD RICE, M.D., Acting Director.
STATE OF MINNESOTA,
DEPARTMENT OF HEALTH,
Minneapolis, December 20, 1967.
DEAR SENATOR WILLIAMS: Through the Association of State and Territorial Health Officers we have received a copy of the invitation to submit a written statemeat to your committee on migratory labor. Attached is a brief account of the Migrant Health Project, Minnesota Department of Health. The statewide program was started in 1963; May 1, 1968 to April 30, 1969 will be the fifth consecutive year of this health service. Since 1966, when Migrants, Inc., an Office of Economic Opportunity funded organization, was formed, the Minnesota Migrant Health Project has cooperated with that program.
We trust that this written statement can be included in the record to support proposed legislation to extend the Migrant Health Act and to authorize funds, We are also enclosing a copy of the project Annual Progress Report, 1967-1968. Respectfully,
ROBERT N. BARR, M.D.,
Secretary and Executive Officer.
A. There are approximately 10,000 migrant workers and dependent family members who come to Minnesota to work in sugar beet and vegetable crops each year. The crop season is from March to November. While in the state, families are housed in approximately 770 camps, most of which consist of temporary facilities.
Staff members are employed by the health project to supplement local nursing and sanitation services. These include nurses, health aides and sanitation inspectors.
The following is a brief summary of the 1967 program (as prepared for Migrants, Inc., Meeting Nov. 11, 1967):
1. Twelve nurses reached 500 families and made 2,000 nursing visits. The number of visits has never been stressed as a goal in itself. More important is the degree to which the nurses can do intensive family visiting.
2. Health Education Services through Counseling. Greatest numbers were in areas of diet or nutrition for children and adults, personal hygiene, dental, immu