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, HON. HARRISON WILLIAMS, Chairman, Migrant Health Subcommittee, A. B. COLYAR, M.D., STATE OF OREGON, OREGON BOARD OF HEALTH, Portland, Oreg., December 22, 1967. 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., 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 Health 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 seasonal farm workers 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. (d) Physicians outpatient service. rate (b) Hospitalization at the present rate of 54 percent of posted medicare $35,000 (e) Physicians inhospital care. 23,000 23,000 (e) Emergent dental care. 17,550 2,500 3,000 12,000 3,000 119, 050 (f) Pharmaceuticals.... (g) Special laboratory and X-rays. (h) Transportation_ Total..... 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. Hon. HARRISON A. WILLIAMS, Jr., COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF HEALTH, 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 required 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. Dental care, curative and prophylactic, is provided through contract with the Pennsylvania Dental Services Corporation. Migrant camps are inspected by health department sanitarians throughout the season. Approval is a prerequisite for licensing by a sister department. Where feasible transportation by bus to care facilities is provided and drugs are made available through local pharmacies. If the Migrant Health Act is extended and additional needed funds are appropriated the greatest remaining health needs of migrants in Pennsylvania can finally be met. This is the need for the payment for hospitalization and to underwrite the cost of surgical and obstetrical care. Failure to provide adequate prenatal and obstetrical care contributes to the high morbidity rates among pregnant migrant females. Inability to pay for needed surgery for hernia operations, to correct poorly united fractures, to repair injuries resulting from accidents-has denied migrants a badly needed health service. Hopefully, this lack can be corrected during the coming migrant season. The migratory worker is a stranger in an unfriendly land. He is not a native. He is poor. He is tolerated by many only because he is needed to harvest the bountiful crops that are grown each year in the Commonwealth. To provide adequate health services to migrants can be justified as meeting a well-documented human need. For those whose minds are profit oriented keeping migrant workers healthy and productive is a sound investment in the national economy. The 1967-68 budget of $196,005 allotted to Pennsylvania insured migrants medical, dental, and nursing care; improved their living and working conditions; and gave all who participated in the program a sense of pride in haying provided an invaluable service not only to the voiceless migrants but to the people of the Commonwealth as well. A modest increase in the 1968-69 appropriation, to $247,783, will permit the Commonwealth to provide badly needed hospitalization, and surgical and obstetrical services to seriously ill or disabled workers and their dependents. It is earnestly hoped that Congress in its wisdom will decide to extend this Act for a five year period and increase the appropriation to permit us in the States to give migrants the health services upon which their good health depends. Sincerely, THOMAS W. GEORGES, Jr., M.D., Secretary of Health. STATE OF UTAH, DEPARTMENT OF HEALTH AND WELFARE, Hon. HARRISON WILLIAMS, Chairman, Migrant Health Subcommittee, New Senate Office Building, Washington, D.C. DEAR SENATOR WILLIAMS: Enclosed please find the data and arguments to support the continuation and expansion of the migrant health program. It is hoped that this will be of value in extending this important legislation. During the past three years, the program in Utah has met a very real need. Considerable progress has been made but much remains to be done. Sincerely yours, G. D. CARLYLE THOMPSON, M.D., MIGRANT HEALTH NEEDS WITHIN UTAH Continuation of the present level of funding permits only a minimum program. During the previous three years of project operation, community personnel and private industry have been mobilized toward the solution of the health problems of migrants. Previous planning, organization, and expenditures would be wasted in the event that this program was curtailed or reduced. Additional services are needed if the health needs of the agricultural migrant laborer and his family are to be met while in migrant status. While outpatient care is less expensive per patient, there is great need for providing hospitalization. It is generally recognized that many conditions cannot be properly managed even by the best of medical office management. Among these conditions are the more severe ones such as the critically ill and childbirth. It is assumed that childbirth should occur in a hospital. For practical purposes this is always the case with migrant mothers in Utah. Migrants first arrive in Utah about April 1 and remain until November 1. There were approximately 5,695 migrant farm workers in Utah during the 1967 season, an increase from the 3,211 of last year. The medical program provides payment for medical care in physicians' offices. Preventive services include chest x-rays, tuberculin testing, serological tests, venereal disease control activities, health education activities, and environmental health consultation to migrants and migrant camp operators. Services are provided at the convenience of the migrant. Clinics are held frequently at night. Health education films were shown at the clinics and public health personnel were available to discuss health problems with the migrants and their families. To coordinate activities and bring together agencies and individuals involved in the migrant program, a statewide seminar was held in Logan, Utah, on May 3, 1967. A total of 115 persons attended this seminar. During 1967, public health nursing services visits numbered 784 and there were 682 visits to physicians' offices. Public health nurses made periodic visits to the migrants living in camps and to individual housing areas. During these visits the following services were provided: (a) Nursing care and counseling of parents on positive health practices. (b) Referring those in need of medical care to a physician. (c) Arranging for immunization and screening clinics. (d) Showing educational films and conducting group discussions on health and sanitation. (e) Teaching medical self-help as appropriate. The value of maintaining and carrying their Personal Health Records has been emphasized to the migrants. More frequently these records are being brought into the clinics. Physicians will be further encouraged to record pertinent information on these records. Utah's migrant labor camps range in size from a single-family unit located on a small farm to 40-unit camps owned by large corporations. Over half of Utah's migratory laborers work for individual growers. Most housing is old, consisting of abandoned buildings which have been repeatedly repaired. Environmental health services consist mainly of frequent housing inspections and consultation provided by local and state sanitarians. The Migrant Health Program sanitarian made 282 inspection visits to 103 migrant camps during the 1967 season. During these inspections, 283 significant violations were found. Checklists prepared by the State Division of Health were used to define the camp violations. The greatest number of violations were in garbage disposal, water supplies, window screens, cleanliness of mattresses, and privy construction and maintenance. Many problems still remain; however, significant progress has been made. The goal for next year is to improve existing migrant programs, add other needed services, and continue working with communities promoting interest and participation in the Migrant Health Program. in Utah. The project is in its third year of operation, and this report covers the period from July 1, 1967, to June 30, 1968. The state migrant staff may at times offer direct services in areas which lack local health departments or may offer consultative services when requested by local health departments. Services offered either on a direct or consultative basis include outpatient medical care, dental care, nursing services, environmental health services, and health education. Objectives (as listed in last approved application) (a) To improve the health of the migrant agricultural worker and his dependents by providing multiple screening and preventive medical services and by the development of a program of positive health promotion. (b) To provide the migrant and his family the benefit of a communicable disease control program, primarily directed at tuberculosis and venereal disease. (c) To provide outpatient medical and dental care through private practitioners. (d) To provide consultation and health education which will provide the basis for improvement of the migrant's living environment. (e) To continue the development of outpatient medical care in physicians' offices and of hospitalization by working with component medical societies, local health departments, welfare, industry, county commissioners, and insurance companies. Significant changes in the migrant situation from the previous year The migrant population has changed very little in regard to age, sex, cultural background, origin, and residence of record. However, there were 5,695 migrants employed in Utah this year as compared to a total of 3,211 last year. Migrants have various cultural backgrounds. The majority coming to Utah are Spanish-Americans from south Texas with a smaller number of Indians coming from Arizona and New Mexico. Most of the Indians are from the Navajo Indian Reservation in the Four Corners area. In addition to the Navajos, Ute Indians from the Uinta Reservation, Kickapoo Indians from Old Mexico, and Shawnee Indians from Oklahoma have been used as seasonal laborers this year. The migrant population is composed of families ranging in age from infants to elderly persons. About 55 percent of the total migrant population is male and 45 percent is female. (See Table D under Part III-Sanitation Services) The migrants come into the state in early May to work in the beet fields and migrate from county to county according to the crop need. The majority return to Texas in the fall, but a few working in the northern counties move on to Idaho in the late fall for potato harvesting. (See Table E under Part III-Sanitation Services) This year a number of migrants have expressed a desire to remain in Utah permanently. Many of their homes were destroyed by the hurricane and flood in southern Texas. In short, they have nothing to return to. Brigham City, located in Box Elder County, will double its Spanish-American population this year from approximately 50 to 100 persons. Economic situations For three consecutive years the fruit in northern and north central Utah was severely damaged by a late spring killing frost. Apricots, sweet cherries, and peaches were partially or totally destroyed during the 1966 season. The 1967 season also had a late frost, but only the apricot crop received extensive damage. Crops requiring migrant farm labor remain the same: sugar beets, cherries, green beans, cucumbers, tomatoes, peaches, pears, apples, and potatoes. Despite technological advances to further reduce the future need for seasonal labor in Utah, good crops necessitated a marked increase in migrants this year. During 1967 all counties reported a shortage of farm laborers. The rising cost of labor is a major factor influencing the farmer to mechanize in order to reduce labor requirements. Some crops do not and are not likely to lend themselves to mechanization. These crops due to rising cost and lack of labor, will be threatened. Medical and dental services Utah's medical and dental program for migrant families provide services in the physicians' and dentists' offices at a time that is convenient to the migrant. Physicians in some counties have agreed to make appointments for migrants after hours, making it unnecessary for them to miss work during the daytime. Persons in need of specialized care, not available in the physician's office, have been referred to the existing facilities of the Utah State Division of Health. Six children 87-443-68-12 |