A. General budget EXPLANATION of 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, O.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, 10%. 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 opportunities, 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 4 medical students, $400/month, 3 months, 100-percent time... Subtotal $9,486 1,968 1,968 Clinicians' fees $20/hour, 21⁄2 hours/night, 3 nights/week, 10 weeks, 10 weeks, for 4 projects. 6,000 4,800 24, 222 Staff travel 0.08/mile, 1,000 miles/month, 3 months each, 3 staff members, 4 projects..... 2,880 2,000 MIGRANT FAMILY HEALTH SERVICE, 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. 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, Hon. HARRISON A. WILLIAMS, JR., 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 2688. 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 clinics 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 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, Senator HARRISON A. WILLIAMS. Columbus, Ohio. DEAR SIR: I have been in contact with the office of William O. 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, Senator HARRISON WILLIAMS, STATE OF OKLAHOMA, Oklahoma City, Okla., December 20, 1967. Chairman, Migrant Health Subcommittee, 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 community. |