The human need of the migrant laborers that harvest our crops is so extensive that unless you worked in this program, you would not believe that these persons were American citizens. Their plight is pitiful! A day to day existence-no workno eat.

We who work directly with the migrants have respect for their efforts in trying to care for themselves by following the season for employment. Health Services, Education and Sanitation is a need so the migrants and seasonal farm workers can continue to try to maintain their own family welfare. In the field of health, both restorative and preventive medical and dental care is a crying need. Sex education, family planning and up-grading the education of the children in the migrant stream is a challenge to all workers employed in the program.

Federal grant assistance is imperative as rural communities cannot carry the financial burden of the influx of the seasonal worker who are necessary to the economy of the areas in which they labor. Very truly yours,

CLAIRE H. BURSON, P.H.N., Project Director.

STATE OF Ohio, DEPARTMENT OF HEALTH,

Columbus, Ohio, December 22, 1967. Hon. HARRISON A. WILLIAMS, Jr., Chairman, Committee on Labor and Public Welfare, Subcommittee on Migratory

Labor, U.S. Senate, Washington, D.C. MY DEAR SENATOR WILLIAMS: The Migrant Health Act has provided better care for many migratory farm workers and their families during their stay in Ohio.

The Stark County project was the first one approved in the nation following the passage of the Act in 1962.

There are now eight funded projects in Ohio and one, Wood County, has been approved but not funded due to insufficient appropriated funds.

The total amount of monies approved for the eight projects for the fiscal year 1968 was $295,436. Requests for the fiscal year 1969 have been prepared and total $463,658.

Project personnel were advised to limit their requests to bare essentials since the total funds available would be insufficient to meet the demand.

The $168,222 increase was considered minimum. The Sandusky County project anticipated a ten percent increase in service this migrant season and experienced a 100 percent increase.

The enclosed report summarizes some of the needs for Senate Bill 2658.

We sincerely support the continuation of this program and the very modest appropriation requested. Sincerely,

E. W. ARNOLD, M.D., Director.

Ohio's MIGRANT HEALTH PROJECTS GAIN MOMENTUM

To emphasize the growth in migrant health services it is necessary only to compare the years 1966 and 1967.

In 1967, there was a 78% increase in the number of migrants identified in six of the counties in Ohio which have local migrant health projects which provide comprehensive health services to migrants. In 1966, there were an estimated 12,307 migrants in the six counties. In 1967, there were 21,907. Some of the increase identified in 1967 may be due to better methods of taking a census of the migrant population. However, project personnel in every conty reported that they had more migrants than in previous years. Several factors accounted for the employment of more migrants. More acres were planted in tomatoes and pickles. A number of areas started employing migrants to detassel corn.

In the same six counties there was approximately a 56% increase in the number of patients given service in the medical clinics. In 1966, 2,929 individual patients were registered at the medical clinics for service. In 1967, there were 4,582. The 56% increase in the number of individual patients registered at the ciinics was accompanied by approximately a 47% increase in the total number of clinic visits. In 1966, 5,484 clinic visits were made and in 1967 there were 8,140 visits.

To provide service to the increased number of migrants seeking care at the clinics, thirty additional clinic sessions were conducted. This increased the number of clinic sessions from 146 in 1966 to 176 in 1967. A clinic in one county averaged 69 patients per session. On two evenings, the clinic staff which included two physi

cians, four nurses, two health aides, clerical personnel and volunteers, worked hard from 6:00 p.m. until midnight to see all the patients. On one of these evenings 110 patients were registered. At the other one there were 134 patients. In two of the counties that have the largest medical clinics, some patients start coming as early as two hours before the clinics are scheduled to open. They wait patiently for their turn to see the doctor.

It is apparent that where organized medical and related health services are available specifically for migrants, the migrants will avail themselves of the services. The evening hours, simplicity of clinic facilities, interested professional and volunteer staffs, and Spanish-speaking interpreters have contributed to the migrants participation in health services.

In 1967, there was a 53% increase in the number of expectant mothers given medical service through the projects in the six counties. In 1966, there were 200 expectant mothers admitted to the clinics for health services. In 1967, this number had grown to 306. It is known that in 1966, 80 maternity patients delivered while in Ohio in the six counties and in 1967, 101 delivered. Between visits made to migrants in the camps by nurses and by health aides, it is believed that there would be a negligible number of expectant mothers who are not located and receive care during pregnancies. All deliveries taking place in Ohio occur in hospitals. One of the county projects had 68 expectant mothers registered at the medical clinic. Laboratory examinations of blood samples of these women showed 66% to have anemia.

One chronic disease which came in focus this year was diabetes. Sixty-two migrants were given medical service in clinics for this disease in 1967. Many of these were diagnosed for the first time. The concentrated efforts necessary to instruct diabetic patients in modifying diets, in personal hygiene, and in taking medications regularly for the control of the disease sorely taxed the resources of existing project staffs.

Migrant project funds are used in this state to support nursing services in nine counties. In 1967, nurses employed in these counties made approximately 5,000 visits to camps to work with the migrants. During these visits health problems were detected and arrangements made for care. Nursing care and instructions were given in caring for existing health problems. The importance of nursing services for migrants in the home cannot be overemphasized. There are many many illustrations of how a nurse who happened to be in a camp found persons acutely ill. In some instances the migrant does not seem to recognize the seriousness of the situation. One example is a visit a nurse made one evening to see a woman who was a known diabetic and who had a tooth extracted earlier in the day. The nurse found the woman in diabetic coma. An emergency admission to the hospital was arranged by the nurse. The woman recovered and had no further trouble during her stay in the state. In no county in Ohio where migrants are employed does any existing health agency have local funds sufficient to employ nursing staffs to provide the depth and concentrated service the migrants and his family need.

One of the outstanding features of health services to the migrant is the comprehensive scope of services he is now getting. He can now get services necessary for diagnosis and treatment of medical problems. Furthermore, the staff of physicians and nurses see to it that the migrants follow through with recommendations for additional care. If a patient is referred to a specialist, the nurse sees that he gets there and that recommendations are followed. Arrangements for hospitalization for patients can now be made without delay since funds for this were made available this year. As of November 1, 1967, 230 migrants were known to have been hospitalized in counties with projects for a total of 1,043 hospital days. Reason for hospitalization ran the gamut of medical problems including one patient who had heart surgery. At the time this report is being prepared another patient is hospitalized in a large medical center awaiting heart surgery. It can be said that the migrant in these six counties is no longer falling into the cracks of community health services.

Another interesting feature of health services for migrants is the system of interstate referrals of migrants who need continuing health care. As the migrants leave Ohio, a report of health problems of specific migrants who need more care is sent on to the next state to which the migrant is going. This system has been in operation now since 1964. The percentage of replies that come back from health departments in other states has increased each year. An increasing percentage of the replies indicate migrants referred are located and receive care. This percentage has risen from 57% in 1964 to 72% in 1966, the latest year for which

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information is available. This means the migrant is getting continuing care as he travels about the country because of the existence of similar projects in other states.

An interesting case illustrating how the referral system works is that of a young woman who had had a radical breast amputation because of cancer in another state. A referral was received from that state with recommendations for deep X-ray therapy treatment. Arrangements were made with the local hospital for the treatments and women from a local church organization provided transportation for the many visits to the hospital for the treatments. This woman could speak no English and the volunteers spoke no Spanish. Somehow the volunteers communicated their understanding and friendship. The woman came to the state depressed because of her diagnosis and surgery. She left a well and happy woman. She received care and had found people in a strange area who were interested in her.

It has taken some areas in the state a number of years to become interested in providing health services to migrants. At this point there are at least two county health departments in Ohio who wish to plan programs for migrants and make application for grants. Additional counties undoubtedly can be motivated now to plan programs and make application grants if there is assurance that funds would be available to finance the programs.

THE GOVERNOR'S COMMITTEE ON MIGRANT LABOR,

Columbus, Ohio. Senator HARRISON A. WILLIAMS.

DEAR SIR: I have been in contact with the office of William 0. Walker and other members of The Governor's Committee on Migrant Labor and we would like to go on record of supporting the Migrant Health Act S. 2688. We feel this has been one of the best executed programs on the State and County levels. I can personally speak for Wood Co. Ohio, where I live which I feel has been well planned and administered. Accept this statement on behalf of the Governor's Committee on Migrant Labor.

ROBERT D. MARSH, Chairman.

STATE DEPARTMENT OF HEALTH,

STATE OF OKLAHOMA,

Oklahoma City, Okla., December 20, 1967. Senator HARRISON WILLIAMS, Chairman, Migrant Health Subcommittee, New Senate Office Building, Washington, D.C.

DEAR SENATOR WILLIAMS: Oklahoma has three areas that utilize migrant labor. These areas all experience the same needs for sanitation, nursing, medical and dental services.

1. Southwest Oklahoma with approximately seven counties which use both in and out-migrants in cotton and cucumber fields.

2. East Central Oklahoma comprising three counties that are major strawberry producers.

3. Central Oklahoma near Tulsa, a vegetable producing area.

The only area receiving such services at this time is in southwest Oklahoma. A migrant health project, funded from 1965 to June 30, 1968, has not only accomplished the stated objectives (furnishing and supplementing existing Public Health and medical services) but has become a focal point for all community resources available to the in-migrant as well as the out-migrant. The project serves three counties, two of which had no Public Health facilities prior to 1965. In the third county the funds are used to provide additional services through the county health departments.

The project has made it possible to provide Public Health services to approximately 8,000 migrants (Spanish-speaking) who had never known services such as immunization, pre and post natal and dental care.

The project nurses have made it possible for the migrant to be referred to resources-medical, psychological and educational-that otherwise would be beyond their reach.

The project has led to one county's voting a health levy for the operation of a county health department to insure continued health services to all people of the coinmunity.

The present Oklahoma project is funded at approximately $85,000 per year plus the appropriate local funds.

We feel that to discontinue these services at this time would create a vacuum that would allow past and present accomplishments to regress beyond repair.

To properly serve the migrant worker in Oklahoma, the migrant project should be extended to cover another ten counties. This would require at least four additional nurses, two more sanitarians and more central administrative staff. To provide minimum services to the Oklahoma migrant we need at least $50,000 additional Federal support. Sincerely yours,

A. B. COLYAR, M.D.,

Commissioner of Health.
STATE OF OREGON,
OREGON BOARD OF HEALTH,

Portland, Oreg., December 22, 1967.
Hon. HARRISON WILLIAMS,
Chairman, Migrant Health Subcommitlee,
New Senate Office Building, Washington, D.C.

MY DEAR SENATOR WILLIAMS: As State Health Officer of Oregon, I wish to present a statement concerning the migrant health needs within our state.

I feel it is important to point out the significance to Oregon of both the renewal of the Migrant Health Act and the provision of additional funds. Sincerely,

EDWARD PRESS, M.D.,

State Health Officer.

A WRITTEN STATEMENT RE EXTENSION OF MIGRATORY HEALTH ACT

Since 1963 the Oregon State Board of Health has utilized funds provided under the auspices of the Migrant Ilealth Act to develop through its local health departments a comprehensive health service to inter-and-intra-state migrant agricultural workers and their families. It is a program that includes preventive health services, medical, dental, and hospital care, and is concerned with the total health problems of this target group.

An estimated 31,000 seasonal farm workers and their families come into Oregon each year to harvest the crops. The average population in some rural communities is doubled by the workers coming into their areas. The medical resources for the local communities are limited, especially since the majority of the harvest seasons peak during the summer months when many professional people take their vacations. This limits even more the medical resources available in these rural communities. Prior to implementation of the Migrant Health Act in 1963, every local health department concerned with an appreciable agricultural migrant population lacked sufficient resources to extend needed health care to this important group.

In 1967, approximately 27,230 of these season farm work and their families worked in nine counties having migrant helath projects: the project nurses in these counties saw 17,875 individuals for health screening purposes. Of this number, 4,998 (27%) were referred for needed medical and dental care. Of those referred, 328 were diagnosed as having a communicable disease.

Fifty-nine of those referred were diagnosed as having tuberculosis or were provided health surveillance for suspected tuberculosis. Six required hospitalization in the Oregon State Tuberculosis Hospital. If case finding had been carried out in the total migrant population, it is estimated that an additional twenty-five cases of tuberculosis would have been found.

It is estimated that 9,355 of the individual migrants were not seen by the nurses in the nine project counties. Since 27% of those seen were referred for medical care, it seems logical to conclude that approximately 2,527 more migrants would have been referred for medical problems if they had been contacted during the health screening program..

This year, for the first time, the project had funds to pay for needed short-term hospitalization of migrant workers and their families. During the 1967 season, 153 patients were hospitalized at a cost to the project of $18,731.55. This amount represents payment on the basis of only 54% of the hospital's posted medicare rate.

Sanitarians in the program working as an integral part of the local health departments inspect farm labor camps and fields to determine if the facilities provided for workers and their families are in compliance with Oregon laws and

regulations. Through frequent inspections and followup visits, considerable upgrading of both camp and field sanitation has been achieved. More needs to be done in this area.

This program has over the past four years expanded from three to ten counties (including Yamhill County) and now covers an estimated 90% of the migrant agricultural workers in the State of Oregon. Plans are presently being developed to further expand the Oregon Migrant Health Project to reach 100% coverage of agricultural migrants needing health services.

In order to meet the health needs of all of the migrant workers and their families in Oregon at approximately the same level of service as is presently being provided, additional funds in the amounts and for the purposes itemized below will be required:

1. Migrant health projects in the remaining six counties using seasonal farm workers who do not presently have projects. These six counties have an estimated 129 camps with a capacity of 3,000 individuals.

2. Additional public health personnel to provide a ratio of one public health nurse for each 1,000 individuals.

3. Itemized purposes and amounts: (a) Personnel

$35, 000 (6) Hospitalization at the present rate of 54 percent of posted medicare rate

23, 000 (c) Physicians in hospital care.

23, 000 (d) Physicians outpatient service..

17, 550 (e) Emergent dental care.

2, 500 Pharmaceuticals

3, 000 (9) Special laboratory and X-rays.

12, 000 (h) Transportation

3, 000 Total.

119, 0.50 With the inclusion of the above stated services, the Oregon Migrant Health budget would be increased from $380,674 to $499,724.

In reporting on Oregon's funding under the Migrant Health Act, Yamhill County which has been a separate project since 1964 should be included. We are informed that a separate statement has already been submitted to Senator Williams by Dr. J. D. Ragan, Health Officer of Yamhill County. To avoid possible duplication we have not included Yamhill County in this statement.

In summary I should like to say that the renewal of the Federal Migrant Health Act is urgently needed and that an increase in funds will be required to enable Oregon to provide the minimum essential health services to migrant agricultural workers.

COMMONWEALTH OF PENNSYLVANIA,

DEPARTMENT OF HEALTH,

Harrisburg, December 20, 1967.
Hon. HARRISON A. WILLIAMS, Jr.,
U.S. Senate, Washington, D.C.

DEAR SENATOR WILLIAMS: It is a privilege to respond to your invitation to present testimony supporting an extension of the Migrant Health Act for five years and a doubling of present appropriations.

Five years ago, Pennsylvania was one of the first states to apply for a federal grant under the Migrant Health Act. These funds, in increasing amounts, have been used during the past five years to provide services and facilities to meet, at least in part, the more urgent health needs of the approximately 8,000 men, women, and children who constitute our migrant work force.

An initial screening of a sample of migratory workers and their dependents indicated that they suffered from many acute illnesses and accidents that re quired the immediate attention of physicians. A smaller number had more chronic illnesses such as heart disease, tuberculosis, and kidney disease, or needed surgery for hernias, open fractures, or obstetrical complications.

The teeth of most migrants were in poor condition. Frequently it was found that salvageable teeth had been extracted. Gums were often diseased.

Beginning in a four-county area of the State a migrant health program was developed that now provides care in 17 counties and embraces over 80 percent of the migrant population.

Family clinics are held in some counties where physicians treat illness and public health nurses provide follow-up care. In other counties migrant care is contracted for in doctor's offices.