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Re S. 2688.

FAMILY COUNSELING SERVICE IN MIDDLESEX COUNTY,
Highland Park, N.J., December 29, 1967.

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 S.-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,

Senator HARRISON A. WILLIAMS, Jr.,
Committee on Labor and Public Welfare,
Chairman, Subcommittee on Migratory Labor,
U.S. Senate Building, Washington, D.C.

Red Bank, N.J., December 28, 1967.

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 reported. "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 xrayed 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

the agricultural farm workers in this nation if the Migrant Health Program were allowed to expire on June 30, 1968.

In New Jersey, we are expecially proud of the record of accomplishment of the staff in charge of the disbursement of funds in the conduct of the Program. Previous to the initial grant, some five years ago, there was no provision for health services for workers and their families. A few children, about 100 in number, did receive health examinations when attending summer school. Prenatal care and hospital services were practically nonexistent. There were no general clinics except through one private agency. There was no method of checking on the sources of epidemics in migrant camps, such as hepatitis, intestinal disorders and viral meningitis.

The Migrant Health program under the direction of Dr. William J. Dougherty and his staff from the Health Department has in five years reached almost the entire migrant population. This was done through clinics conducted directly by Dr. Dougherty's staff or by contract with local and county agencies. In the County where the migrants are employed for the longest period of time, a special grant has been made directly to the Cumberland County Migrant Health Services. In 1967, four county governments and eight voluntary community health and social service agencies participated directly in the program under contract. Last summer in cooperation with the N.J. College of Medicine and Dentistry, five second-year medical students were enrolled in the program. Local initiative and responsibility have begun to develop but the finances for assumption of full responsibility have not been secured; if the federal grants are not renewed, the entire program with its promising start will be abandoned.

One very constructive aspect of the New Jersey Program has been the employment of a medical case worker to assist in working out family problems which often need remedial action along with the treatment of physical ailments. In 1967, medical social workers conducted over 4,000 casework interviewers in counseling more than 500 families or individuals faced with social problems. Over 1,000 persons were provided with medical examination and 150 persons admitted to hospitals. Dental examinations were given to 563 persons at migrant clinics and for 1,070 children attending seasonal migrant summar schools.

As a result of these examinations, seven new cases of tuberculosis were discovered in 1967. In 1963 and in 1965, a general outbreak of Shigella diarrhea occurred in a migrant camp and was checked through immediate diagnosis an treatment. Other diseases, such as infectious hepatitis and viral meningitis were discovered in time to prevent general outbreaks.

As citizens of New Jersey, we value the Migrant Health Program not only for its service to our migratory farm workers, but also for the preventive work in checking the spread of epidemics which affect us all.

Sincerely yours,

SUSANNA P. ZWEMER, President.

PREPARED STATEMENT OF DAVID N. PRATT, MEDICAL SOCIAL WORKER, MIGRANT HEALTH SERVICES, CUMBERLAND COUNTY, N.J., RE EXTENSION OF MIGRATORY HEALTH ACT

The average American citizen living in the mainstream of our affluent society is scarcely aware of the almost invisible army of fellow citizens whose livelihood depends upon moving on the season. The idea that anyone in this day and age lives this way sounds like fantasy to them. The myriad of myths that surround the migrant's way of life serves to make him a separate citizen in his own land.

There is one fact, however, that cannot be disputed. The migrant has physical illness and social problems just like the rest of America. He needs attention to his problems just like any other person residing in the community that he finds himself. Sometimes obtaining that assistance can be difficult when one's occupation has caused the person to become a resident of no where.

The Migrant Health Program is unique in that it recognizes a migrant as a person with a need first without attention to age, category, residence, etc. The focus is upon restoring the individual back to good health so that he may resume his way of life better equipped to provide for himself and family. This approach is beginning to pay dividends. The migrant is finding the program meaningful to him. Confident now that he will be treated with dignity and at the time of urgent need, the migrant is beginning to seek services before his problems reach the crisis point.

A program that has produced such results in the space of a few years is an accomplishment to be proud of. I urge that the Migrant Health Act be extended. To deny its continuance is to deny American citizens the right to be a part of the very land in which they live.

[From The Courier-News, Dec. 29, 1967]

MIGRANT HEALTH CARE

U.S. Senator Harrison A. Williams Jr. of Westfield this week said that a million "excluded Americans" suffer from inadequate health care. These are migrant farm workers and their families.

Members of this group, Williams said, have an influenza and pneumonia mortality rate twice as high as the national average. The senator pointed out that migrants live and work in rural communities where there are only half the medical personnel and services found in an average community.

These findings were detailed in a report prepared by U.S. Surgeon General William H. Stewart for the Senate subcommittee on Migratory Labor, of which the N.J. Democrat is chairman. The report verifies a "health gap" among migrants previously suspected, but never before delineated.

The senator recently introduced legislation to extend and expand the migrant health program. The project is well started, Williams said, "but we have a long way to go."

It is still the exception, rather than the rule, for the migrant worker and his family to have available even the barest minimum of medical service, the senator said.

"We are operating this year," the senator explained, "with $7.2 million. We could use almost double that amount of money simply to do a more effective job in the existing projects. In addition, we have many applications for new projects which the Public Health Service has been forced to turn down because of lack of funds."

Six of 10 counties that serve as "home base" for migrant workers offer no personal health care to the farm workers, the Stewart report shows.

There is no doubt that there is a large field for improvement in the nation's migrant health care program. Perhaps, now that one has gotten "off the ground” it can be expanded for the benefit of those it would cover.

STEUBEN AREA POTATO GROWERS' Cooperative,
Wayland, N.Y., December 9, 1967.

SENATE SUBCOMMITTEE ON MIGRATORY LABOR,

Capitol Building,

Washington, D.C.

GENTLEMEN: For many years, not all, but most growers have been genuinely concerned for the general welfare of the seasonal farm laborer.

For many years, not all, but most growers, without fanfare, have made it possible financially for the migrant people, disinherited by society, to bear their newborn, to care for their sick.

For many years, society has expected the grower to be doctor, educator, sociologist.

We believe that the migrant and his family need more adequate medical attention.

At present we are trying our best to provide medical care by arranging appointments with local medical personnel, But, medical facilities are inadequate to handle the influx of seasonal farm laborers, and rural medical personnel are few, and hard worked by permanent area residents.

We are genuinely concerned for the health and medical care of those seasonal farm laborers working in our area.

We believe the challenge of the seasonal farm laborer cannot be met by the grower alone. We believe it will take the fields of education, medicine and sociology to deal effectively with the migrant problem. We, as concerned growers, are willing to cooperate in every way with these fields to begin a realistic appraisal and practical solution to the migrant plight.

We highly recommend the extension of the Migrant Health Act, both financially and geographically. We recommend that the Act be extended with an appropriation of 13 million dollars into the 1969 fiscal year. We have already been studying, in cooperation with the Secular Mission of Steuben County, the establishment of medical clinics in Steuben County and recommend the geographic extension of the Migrant Health Act into the Steuben area.

We want it understood that the grower cannot handle the challenge of the seasonal farm laborer alone, as many in society expect him to.

We sincerely invite the fields of education, medicine and sociology to join with us in a more realistic approach to this-one of society's most urgent problems. With genuine concern,

BERNARD M. VOTYPKA,
President, Steuben Area Potato Growers Cooperative.

NORTH CAROLINA STATE BOARD OF HEALTH,

Raleigh, N.C., December 28, 1967.

Senator HARRISON WILLIAMS,

Chairman, Migrant Health Subcommittee,
New Senate Office Building, Washington, D.C.

DEAR SENATOR WILLIAMS: We are pleased to have the opportunity to submit a brief report on the status of health programs for migratory agricultural workers in North Carolina. The number of our migrants is of the order of 5,000 workers from other states, and about 1,500 intra-state migrants. We estimate that there are about 2,500 non-working family members, giving us a total population at risk of approximately 9,000 persons. In addition, there are some 31,000 day-haul workers in the State.

To meet the health needs of this group, there are four family health service programs in the State, supported by Public Health Service grants. These four programs, which received a total of $94,535 in Federal funds, are operated by local non-profit corporations, comprised of community churches, official and voluntary agencies, growers, and others. In addition, the State Board of Health received a grant of $38,715 which provides a small staff of consultants plus a limited number of seasonal employees who are placed in the local communities. The total received from the Public Health Service for programs for migrants is $133,250 for the current year. The local projects serve an estimated 3,885 migrants with their clinical, sanitation, and educational programs. The State Project attempts to provide consultative assistance in administration, public health nursing, environmental sanitation, and health education, to all counties with a seasonal migratory population.

To provide necessary additional health services for migrants, a projected budget was drawn up and submitted to the Public Health Service. It was realized at the time that present limitations of funds made it unlikely that full implementation of this expanded program could be realized. This proposed expansion is included as an addendum. As you see, only one additional employee is requested for the State Board of Health. An additional $89,567 was requested to be subcontracted to those communities (already identified) which were felt to be ready to initiate new family health service projects, where such programs do nor now exist. We feel that this proposed new budget total of $142,166 would be a realistic figure which would help us to more nearly meet the health needs of the seasonally employed migratory agricultural workers. When added to the budgets submitted by the four existing local projects, there should be a total of approximately $240,000 for clinical, preventive, sanitation and health promotional activities. It is anticipated that, for the next fiscal year, 6,000 migrants and their families could be reached through these services, at a cost of about $40 per person.

Another element in comprehensive health care for migrants is hospitilization. Each year it has been hoped that sufficient funds would be available to aid the communities to provide adequate hospitalization, but limitation of funds have prevented the implementation of this ideal. Title XIX of P.L. 89-97 will, of course, help in this respect. Nonetheless, some funds designated for in-patient and other hospital-related care would be necessary. Hopefully, the renewal of the Migratory Health Act will make sufficient funds available so that this gap in the spectrum of services can be more adequately filled.

I hope this information will be of use to you. If additional material is required, we will be happy to try to supply it. Please be assured of our continuing interest in this program, and our hope for a continuation of the very necessary assistance which has been provided.

Sincerely,

JACOB KOOMEN, M.D., M.P.H.,
State Health Director.

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