nization. "What to do" "How to do it" and "Why to do it" were focal points in teaching families. “Taking time to care” is considered essential.

3. Environmental Sanitation-Plans include addition of an inspector next year.

4. Employed twelve staff nurses, eight nurses aides, three inspectors. Anticipate same number of nurses and aides and four inspectors.

5. Number of school children screened: Dental 806; vision 904; hearing 887. Referrals were sent to home base for: Dental, 170 need immediate care; 364 need care within 6 months. Vision, 100 (61 need retest). Hearing, 106 (91 need retest). 6. 1316

community contacts were made with 675 different individuals. 7. 4058 Personal Health Cards were issued in 1967.

8. Three clinics operated for 20 sessions serving 259 patients; 59% females, 41% males; 38 referrals were processed for prescriptions, chest X-rays, dental care, laboratory, etc.

B. Summary of requested amount and use of Federal migrant health grant for project year May 1, 1968, to April 30, 1969: 1. Personnel: Staff includes coordinator, 112 clerks, 13 nurses, 9 health aides, 4 sanitation inspectors..

$56, 095 2. Supplies... 3. Travel-statewide tiansportation, meals, maintenance for 27 staff members.

16, 867 4. Equipment

510 5. Family health clinics—7 clinics are proposed.

2, 900 6. X-ray services...

600 7. Laboratory services -

1, 000 8. Emergency medical services.

1,000 9. Dental services..

3, 850 10. Inpatient care: Hospital services..

25, 160 Physicians services...

17, 290 11. Other--includes postage, telephone, etc.

2, 050 Total..--

128, 837 C. If the above budget request is filled, unmet needs of migrant families can be taken care of in a reasonably realistic manner.

1, 515

Missouri AssociaTED MIGRANT OPPORTUNITY SERVICES, INC.,

Jefferson City Mo., December 28, 1967 Senator HARRISON A. WILLIAMS, Jr., Chairman, Committee on Labor and Public Welfare, Subcommittee on Migratory

Labor, Senate Office Building, Washington, D.C. DEAR SENATOR Williams: I am pleased to accept your invitation to submit a written statement in support of Senate bill 2688, which you introduced in the Senate on November 21, 1967. You will find my statement enclosed, and I hope that it will be of some small help to you in securing favorable action on your bill.

I am also enclosing a copy of “The First Year of MAMOS”, a booklet we have prepared describing the goals and activities of our program, which is funded under Title III-B of the Economic Opportunity Act. Inside the front cover of this booklet, you will find a brochure which graphically illustrates the needs that we have discovered among migrant workers for health and medical services. This “HELP” appeal was sent to churches and interested individuals throughout Missouri, and more than $900 has been donated to date. The proceeds of our Family Health Services Fund are used to provide emergency medical and health services for members of migrant and seasonal farm families. Needless to say, with this small fund we cannot begin to meet the needs that exist, but it has helped to make life easier for nearly 30 migrant and seasonal farm families.

The imperative of providing health services for migrants was underscored in dramatic fashion last month, when tubercular skin tests were administered to 77 individuals enrolled in our program of adult basic education and preemployment training. Out of the 77 tests administered 34 individuals—nearly one-half of those tested-developed positive reactions!

For those of us who work with MAMOS in attempting to provide migrants with “a way out”, the need for health services is not something we affirm merely from humanitarian instinct. It is a definite, visible, concrete need with which we work each day. It may be easy to ignore statistics on migrant health, but it is impossible to ignore the man in your classroom who cannot learn because he is too sick to learn * * * it is impossible to ignore the man who has worked and studied to obtain a permanent job, only to learn that he cannot qualify for the job because of health reasons.

Migrants are not typically weaker folk. Their health problems are caused in large measure by the long hours and harsh conditions of their work, and by the fact that health and medical services are generally inaccessible to them.

You can be certain that I wish you and the senators sponsoring your bill every success. America has ignored the migrant farm worker long enough! Most sincerely,

MICHAEL D. GARRETT, State Director. .

STATEMENT RELATING TO LEGISLATION S. 2688 One of the most glaring needs exhibited by the rural poor is the need for health services of all kinds. The President's National Advisory Commission on Rural Poverty recently reported a startlingly high incidence of disease and premature death among the rural poor. Infant mortality, for example, is far higher among the rural poor than among the least privileged group in ubran areas. Rural residents, regardless of income, are more likely to have disabling chronic health conditions than their urban counterparts. Řural people have a higher rate of injuries than urban residents and rural farm residents have the highest rate of injuries canse by work-related accidents. Despite these factors, medical care and health services are conspicuously absent from rural America.

The lack of health services in rural America is most keenly felt by the Nation's one million migratory farm workers. Typically, these migratory farm laborers work under harsh and unhealthy conditions. They are exposed to heat, cold, wind, dust, chemicals and mechanical hazards. Their crowded living quarters frequently lack sanitary toilet facilities and water that is safe and accessible for drinking and washing. In 1964, the migrants' mortality from tuberculosis and other infectious diseases was 242 times the national rate, and their mortality from influenza and pneumonia was more than twice the national rate. The accident mortality rate for migrants in 1964 was nearly three times the national rate.

These statistics present more than interesting information about a faceless mass of humanity. These statistics reflect the deplorable condition of one million men, women and children who travel annually to work the harvests in more than 700 United States counties. This condition is aggravated by the migrant's inability to help himself. (1) Characteristically, the migrant is a member of an economic or social minority group. Chiefly, he belongs to Negro, Spanish-speaking, Indian and low income “Anglo” minorities. (2) The migrant is poor. In 1965, his annual income from all sources averaged $1,400. (3) The migrant lacks upward job mobility. The average migrant adult has only a fifth grade education, and many function at a far lower educational level. While the migrant necessarily acquires a degree of agricultural skill, he has little experience or skill in other work. (4) The migrant is usually ineligible for public assistance. Because his work requires extensive travel, the migrant is a non-resident in most of the areas where he does his seasonal work and cannot qualify for medical or health assistance from local public hospitals or welfare departments.

The plight of America's migrants is not going to improve automatically. Over the future of the migrant farmworker there hangs the threatening cloud of increasing automation and technology. From 1950 to 1965, new machines and methodology increased U.S. farm output by 45 percent-and reduced farm employment by 45 percent. During the next 15 years, the need for farm labor will decline by another 45 percent. In 1951, only 1 percent of Missouri's cotton was picked by machine. Today, 95 percent of this cotton is machine-picked. A single two-row mechanical picker replaces 70 workers in the harvesting of cotton. Something affirmative must be done to aid the migrant.

The adoption of Senate Bill 2688, which would extend and expand the Migrant Health Act, will not meet all the needs exhibited by America's migratory farmworkers. However, the adoption of this legislation is an imperative first step in meeting these needs.

Minimal health services should be readily available to all Americans, regardless of race, income, place of residence or type of occupation. Because the Migrant Health Act has begun to make these services available for the first time to migrant farmworkers, and because the legislation introduced by Senator Harrison A Williams, Jr. would expand and extend this essential program, I would urge that the Migrant Health Act be renewed in 1968 as proposed in Senate Pill 2688.

MICHAEL D. GARRETT, State, Director, Missouri Associated Migrant Opportunity Services, Inc.

(MAMOS).

COUNTY OF CUMBERLAND, DEPARTMENT OF HEALTH,

Bridgeton, N.J., January 4, 1968. Hon. HARRISON A. WILLIAMS, Jr., Chairman, Subcommittee on Migratory Labor, U.S. Senate, Washington, D.C.

DEAR SENATOR WILLIAMS: My letter is to urge you to do everything in your power to extend the Migrant Health Act for five years and to include as many more farm workers as possible. The agriculture workers whether migrant or local comprise a large percentage of the impoverished people of our county. Poor health can be the cause of the improverishment as well as lack of education and skill.

Seasonal transient workers coming to our area to supply labor to one of our major industries, agriculture, call for additional services to supplement the local year around health services. The latter are not adequate as yet to meet the preventive and diagnostic medical needs of the local population.

Prior to receiving project funds to provide health services for the migrant worker, unpaid bills for hospital and other medical services had to be absorbed into the charges for services to the regular users of the services. These conditions added another stigma to the migrant's acceptance in the community.

The agricultural worker has benefited greatly from Federal funds supporting the health services in our County. It would be most tragic if planned programs for extended health services would have to be curtailed because of lack of these funds. Respectfully yours,

William P. DOHERTY, V.M.D. Director, Migrant Health Project, Cumberland County.

SEWELL, N.J., December 29, 1967. Re bill S. 2688 Hon. HARRISON A. WILLIAMS, Jr., Committee on Labor and Public Welfare, Subcommittee on Migratory Labor, U.S. Senate, Washington, D.C.

DEAR SENATOR WILLIAMS: The need to provide and increase Vigrant Health Service is readily recognizable. In the 1967 Vigrant season in Salem County, migrant farm workers were provided with over 1500 migrant health service visits. All needing services were not reached as desired, due to budget limitation.

The current concept of health, “The state of mental, physical and social well being and not merely the absences of disease” should be applicable to the migrant population as in other groups. The statistical records of health services to the migrants indicate that the need is there.

To provide this group with the health services to obtain "the best quality health”, there is a need to continue, as well as, to increase the financial assistance for the Migrant Health Services. Respectfully yours,

CLAIRE V. LINKA, R.V., VI.S., Director for New Jersey State Department of Health Services for Salem

County-Migrant Season, 1967.

FAMILY COUNSELING SERVICE IN MIDDLESEX COUNTY,

Highland Park, N.J., December 29, 1967. Re S. 2688. Senator HARRISON A. WILLIAMS, Jr., Chairman, Subcommittee on Migratory Labor, U.S. Senate, Washington, D.C.

DEAR SENATOR WILLIAMS: The Family Counseling Service in Middlesex County is well informed about the conditions of Migrants in New Jersey, having for the past three years participated in a Migrant Health Program in Middlesex and Mercer Counties in cooperation with other private agencies and with the New Jersey State Department of Health. Assuming availability of funds, The Family Counseling Service, in cooperation with the other agencies, will continue the program in 1968 and thereafter.

For the Board of Directors of Family Counseling Service, I am writing to express appreciation to you for having introduced $.-2688 and given it strong support. All of us associated with the Family Counseling Service believe that the living and health conditions of the Migrants represent a blot on this country's record that must be eliminated.

Thank you for your concern for these periodic residents of New Jersey who at all times are citizens of the United States. Sincerely yours,

WALTER R. SHERMAN, ACSW, Executive Secretary.

Monmouth County ORGANIZATION FOR SOCIAL SERVICE,

Red Bank, N.J., December 28, 1967. Senator HARRISON A. WILLIAMS, Jr., Committee on Labor and Public Welfare, Chairman, Subcommittee on Migratory Labor, U.S. Senate Building, Washington, D.C.

GENTLEMEN: We view with great interest Senate Bill 2688, which would extend the Migrant Health Act for five years. As a voluntary agency which has conducted an active health program for migratory workers and as a recipient of funds under the existing migrant health program, we know at first hand how much these federal funds can do to improve the lives of these citizens,

The enclosed clipping points up the accomplishments which we have observed over the past seven years: the growing awareness of family health needs and the use of community services by the migrant population.

When the MCOSS started a mobile clinic in a trailer in 1961, there was evident apathy among the migrant workers. Poor health was tolerated and few preventive services were used to protect the health of the workers and their families.

In seven years we have played a part in changing the attitudes of the migrants, The federal funds which assisted us in conducting the migrant health programs aided immeasurably and made possible many services which we might not have been able to perform without this financial assistance. We are very hopeful that S. 2688 will make further progress possible. Sincerely,

Winona E. DARRAH, Executive Director. (From the Daily Register, Red Bank, N.J., Nov. 15, 1967)

MIGRANTS ARE SERVED BY MCOSS RED BANK.—The use of the Monmouth County Organization for Social Service health services by migrant farm workers during the past summer and early fall was described as “astounding in a report issued yesterday by Miss Winona E. Darrah, executive director, and Mrs. Dorothy Garvin, supervisor, Freehold Health Center.

Starting in July, MCOSS sent three public health nurses into the migrant camps, set up weekly clinics at the Freehold Health Center and served a total of 479 men, women and children, in the sixth annual migrant program which got underway in 1961, when a mobile clinic was taken to various locations in the farm beit of Western Monmouth County.

As supervisor of the project, Mrs. Garvin noted that many migrant crew leaders, made aware of the health program of MCOSS in previous years, sought out the MCOSS for care of workers needing medical care.

"They called us because they knew they would be helped,” Mrs. Garvin te ported. “One member of the crew had broken his leg on route. He was hospitalized. A woman, diabetic, called us on her arrival to ask us to help her obtain insulin for herself and medication for her son who has inactive tuberculosis. One member of a crew was reported to us as being very ill. A nursing visit was made immediately and the man referred to the hospital, where he spent two weeks recovering from pneumonia. There was a baby with croup, a woman with a severely infected leg."

From Florida, MCOSS, received a request to provide service for a man who was found, when hospitalization was arranged, to have cancer of the larynx. An operation was performed to remove the larynx and the man has been attending the Garden State Nu Voice Club. When he returns to Florida, MCOSS will send necessary information so that his care can be continued.

PRAISES COOPERATION Mrs. Garvin praised the cooperation between various agencies of the county. She commented on interstate referrals which give a continuity to the health care provided for the families who work their way from Florida to the northeast coast harvesting farm crops.

The new concern of the migrants for their health was evidenced, Mrs. Garvin indicated, by the fact that 80 per cent of the persons sent to doctors and clinics for treatment of illness, followed through on the nurses' and clinic physician's recommendations.

The success was not as great in referrals for dental care and Mrs. Garvin expressed the belief that fear of the dentist and a lack of appreciation of the importance of dental care was responsible for the poor showing. She is recommeding that MCOSS and the State Health Department, which helps MCOSS finance the summer program, consider having dental work done at the Health Center clinic.

Under the present plan, only dental screening is provided, and persons in need of dental work are referred to a local dentist.

She also recommends that nutritional advice be given at the clinic and diabetic detection tests be introduced.

The program received cooperation from the local MCAP which helped with transportation and also assisted the nurses in establishing a rapport with patients. The opening of the Freehold office of Family and Children's Service added greatly to the joint effort of the two agencies.

Also included in the migrant program was health service for an MCAP day care center. Planned Parenthood of Monmouth County assigned a physician and a staff member to the clinics.

Before the clinics got under way MCOSS nurses visited 79 farmers to explain the program and gain permission to enter their property. The farmers, Mrs. Garvin found, were “most cooperative," and the Farm Bureau “very helpful."

In the tuberculosis testing program, 393 were given screening tests and an additional 80 known positive reactors checked. There were 132 positive reactors x, rayed at the clinic, and 24 were referred to the Geraldine L. Thompson Hospital for further evaluation. Five adults were found to have inactive and one adult active tuberculosis and two children were diagnosed as active primary TB. Medication and further follow-up were recommended for all eight.

During the four month program, there were more than 1,200 visits made to migrant camps and attendance at the clinic totaled 325.

The original MCOSS mobile clinic was instituted in 1961 because MCOSS found that while the MCOSS community health services were available to the migrants, few were making use of them.

"The migrants this year have reached out for service. In the past we have had to initiate contact with them. Our efforts, of the past six years are bringing results, Mrs. Garvin said.

CONSUMERS LEAGUE OF NEW JERSEY,

Montclair, N.J., December 29, 1967.
Hon. HARRISON A. WILLIAMS, Jr.,
Chairman, Subcommittee on Migratory Labor,
Committee on Labor and Public Welfare, U.S. Senate,
Senate Office Building, Washington, D.C.

DEAR SENATOR Williams: The Consumers League of New Jersey supports S. 2688 to extend the Migrant Health Act for five years. It would be a calamity for