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. a (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 sociologi 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 happr 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. EXPLANATION OF BUDGET A. General budget The General Budget reflects a continuation and expansion of present activities. Certain changes are reflected in the salary item, to wit: 1. The addition of an Administrative Officer. This is a new position, designed to provide a staff member who will function as a program representative. The work of this person will be to augment the present staff, to provide administrative consultation to existing projects, to assist in formation of new projects (see: B. Special Projects Budget), to assist new local project personnel (both staff and volunteers) in establishing and maintaining administrative and fiscal procedures, to assist in evaluation of local projects, and to augment the liaison with other agencies and organization providing services to migrants (e.g. N.C. Council of Churches Migrant Project, 0.E.O. programs, and others). 2. Redistribution of Consultant Sanitarian time. Previously, a Sanitarian III was devoting 75% of his time to migrant activities, and other consultants, 106. With the need for increased local services, and more immediate supervision of sanitation aides (employed through the N.C. Council of Churches Migrant Project), a slightly different pattern is required. Consequently, the Sanitarian III specifically designated as consultant will spend 50% of his time in this field, and each of the District Sanitation Consultants will increase their participation in the program to 15%. This will provide for direct involvement by staff more immediately available to the scene where needed. 3. It has been found that the education and experience of the Health Education Aides varies widely. This year, we plan to create two levels for this position, with two different salaries. The Aides with less training will receive $365 month (4 positions), and those with greater training, $509 month (4 positions). This will permit the Project to be more competitive in recruiting for summer work opporiunities, and will help in attracting more competent personnel. 4. For the past three summers, a State Government Intern has worked with the State Board of Health's Migrant Project. These Interns are college students, paid by the State, who are assigned to a State Agency to gain work experience as well as insight into the operations of State Government. It is expected that still another Intern will work with our staff in the coming summer, and this contribution by the State is noted. B. Special projects budget It has been recognized that it is timely to give renewed impetus to family health service clinics to migratory agricultural workers in this state. The four existing local projects need to be augmented by others in new localities. To implement this, a special projects fund is requested. These funds will be used to establish health services in areas where they are not now available. We feel that this can best be accomplished by basing these funds in the State Board of Health, then subcontracting with communities ready to undertake this program. The budget has been prepared on the presumption of four local projects, each having a basic package of services. These would include 2 nurses (or 1 nurse and 1 Licensed Practical Nurse), one part-time clerk, clinician services, and a medical student. Additional items are indicated in the budget. Purchase of equipment is not included, since these are pilot projects; however, there is an item for rental of necessary equipment. It is envisioned that a variation in the pattern may occur. For example, one "package” might be broken up so that a smaller number of demonstration clinics, with part-time staff only, could be held in more than one community, rather than a summer-long program in one place. Also, differing staffing patterns way occur within a given project. No attempt has been made to account for the community's contribution, since that would be purely hypothetical at this point. However, as in the four existing community projects, it is expected that personnel, facilities, equipment, supplies, and the like, would be contributed. Upon the successful establishment of a demonstration family health services project in a given community, it is expected that the services will be continued. It will be determined whether continuation should be on the basis of a direct grant by the Public Health Service to the sponsoring community organization, or by a grant to the N. C. State Board of Health which will continue to subcontract. Either of these methods would be acceptable. PROPOSED BUDGET, MIGRANT HEALTH PROJECT, NORTH CAROLINA STATE BOARD OF HEALTH $61,087 7,331 68,418 100 250 1, 200 1,550 A. General budget: $24, 347 $36, 740 2, 922 4, 409 27, 269 41, 149 100 100 150 Educational... 400 800 500 1,050 4, 320 2, 160 Aide travel 0.08/mile, 1,000 miles/month, 3 months, 8 persons. 1,920 Travel and per diem, other State employees. 4,000 Orientation and travel, local project start and volunteers. 1,500 Subtotal. 4,000 9,900 4. Equipment: Projectors, etc. 250 5. Other: Printing and mailing.. 250 500 Total..... 32, 269 52,599 6 nurses, $527/month 3 months each, 100-percent time.. Subtotal. 4,320 2, 160 1, 920 4,000 1,500 13, 900 250 250 84, 868 Amount $9, 486 1, 968 1,968 6,000 4,800 24, 222 1,066 Subtotal. 25, 288 1,000 1,000 2,000 4,000 2. Supplies: Clerical and administrative $250/project, 4 projects.. Subtotal.... Staff travel 0.08/mile, 1,000 miles/month, 3 months each, 3 staff members, 4 projects.. Subtotal. 2,880 2,000 4,880 1,200 MIGRANT FAMILY HEALTH SERVICE, Hendersonville, N.C., December 21, 1967. Hon. HARRISON A. WILLIAMS, Jr., Chairman, U.S. Senate, Committee on Labor and Public Welfare, Subcommittee on Migratory Labor, Washington, D.C. DEAR SIR: We wish to add our support to legislation S. 2688 to extend the current operation of The Migrant Health Program, which you and your colleagues have introduced. |
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