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Senator WILLIAMS. Do you ever get down Rio Grande way?

Dr. PEAVY. Oh, yes, sir. In fact, as you know, we just had a terrific problem in that area with all the flooding.

Senator WILLIAMS. We were down there.
Dr. Peavy. Yes, I know. I believe I met you there, Senator.

Senator Williams. We are honored with your presence here and we know that you know what it is all about.

Dr. PEAVY. Thank you.
Senator Williams. The forum is yours.

Dr. PEAVY. The first one we would like, if we may, to testify is Dr. Wilson Sowder from Florida. If this is agreeable with you, Senator Williams, I will call on Dr. Sowder.

Senator WILLIAMS. It certainly is and from coast to coast, border to border, on our travels, I have commended Florida for its enlightened approach to the problems of these very poor people.

STATEMENT OF DR. WILSON SOWDER, STATE HEALTH OFFICER

OF FLORIDA

Dr. SoWDER. We appreciate that, Senator, and I want to say for Florida that we feel that this is a very good law, a badly needed law, and it is doing a tremendous amount of good.

It in my judgment needs more money than we are presently getting. We need more money. We think the bill should not only be extended, but that more money should be put into the program. It is particularly important to Florida because out of the estimated million migrants, we get about 100,000 of them, about 10 percent.

Now, of course, we share those at certain parts of the year with other States. Some of those migrants are located and work in counties where they actually outnumber the resident population and it is a little difficult for the State to cope with the problems without Federal aid.

On the makeup of our migrants—some of these come from Georgia, the Negro and white natives, and many of them come from the South into the migrant stream-about 60 percent are Negro, about 17 percent from Dr. Peavy's State of Texas or else direct from Mexico.

They call them Texas Mexicans in Florida. Fifteen percent are Puerto Ricans and about 8 percent are what they call Anglos. They come down there in September and stay whether there is work or not until about April and then they go north into the migrant stream along up to your State of New Jersey and even farther on.

They are, in essence, the same type of people that the Congress is trying to help out in the urban areas, the poverty group.

They are a rural poverty group. They are people, however, who are doing useful work. They are essential to the agricultural economy and they are earning their way. So I think that they deserve the help that we are giving them and more.

Out of our 67 counties, 17 are in this program.
Senator WILLIAMS. Out of 67 counties?
Dr. SOWDER. Sixty-seven counties.
Senator WILLIAMS. How many are in the program?
Dr. SoWDER. Seventeen.

Senator WILLIAMS. These are the areas of high concentration of farm migrants?

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Dr. SOWDER. Yes, sir.. Senator Williams. Dade County also has agriculture. Dr. SOWDER. That is right; yes, sir. In fact, it is one of the big ones. Palm Beach County is a big one. Then we have places like Collier County where they have 19,000 migrants at the peak of the season and about that many permanent residents. We have about five other counties to which we need to extend this program.

We did ask for about $1.1 million this year in the central project which takes care of all but two counties. I'wo of our counties, Palm Beach and Dade, have separate projects. The others are lumped together.

We wanted this year about $1,100,000 to run the program properly but there was only enough money for approximately $650,000. So we endorse the program. We think it is badly needed. We think a lot of people would suffer unnecessarily if the program were cut out and I personally think it meets the requirement of a special type program in that it is geographically limited.

We have here a high-risk group with all their problems, so I am not quite so convinced as Dr. Venable that it will ever be a program that can be easily merged into, you might say, the generalized program.

This problem needs special treatment.
Senator Williams. We certainly appreciate that.
Dr. SoWDER. Thank you.

Senator Williams. You head up the State health program in Florida?

Dr. SOWDER. Yes, sir.
Senator WILLIAMS. How long have you been in this position?
Dr. Sowder. A little over 22 years.

Senator Williams. You have survived many administrations, haven't you?

Dr. SOWDER. About eight or nine. I forget how many.
Dr. KANDLE. Don't push that.
Senator WILLIAMS. You must know what you are doing.
Dr. SOWDER. Maybe they don't know what I am doing.

Senator WILLIAMS. We are happy to share your view. As I indicated earlier to Dr. Venable, in its infancy this program should grow on its own foundation and not be lumped in with a lot of other very necessary programs for better health, and you put it very forcefully.

You indicated that we have been short in our numbers on dollar amounts for this program. Would you mind if I recall your testimony to Senator Holland and Senator Smathers? Dr. Sowder. I would be very happy for you to; yes,

sir. Senator WILLIAMS. Thank you, Doctor.

STATEMENT OF DR. JAMES PEAVY, PRESIDENT-ELECT, ASSOCIA

TION OF STATE AND TERRITORIAL OFFICERS, TEXAS Dr. PEAVY. Senator Williams, let me again express to you our very deep appreciation for the opportunity of appearing before this committee.

In Texas, as you know, we have something over half of all the migrants in the country home-based in our State. This was a terrific problem with us prior to the enactment of the bill in 1962. I do want

I can.

all of the committee to know that we are grateful for the bill itself and for giving us the opportunity to provide some of the badly needed health care services in the State of Texas.

We had terrific public health problems prior to 1962. Health care was almost nonexistent for this type of person and this bill has been of tremendous help to us. At the present time we have 27 projects, one of which is statewide, and the remaining 26 are local projects in areas where the migrants are concentrated.

We do have a great need to extend the type of program that we have. We feel quite sure that if we had double the present amount of funds, we could use them in a very effective manner. The big problem that we have, of course, is health care.

Tuberculosis is a problem. We also have prenatal problems, in fact the whole gamut, and this bill allows us to provide health care. In about half of these 26 projects we do have a provision for hospitalization of the migrant worker himself.

I think everyone in our State from all the reports I get is tremendously grateful for the opportunity of providing health care to the migrants and we have nothing but good reports every week throughout our State where we have projects.

We are certainly grateful to you and we hope you will see fit and find the means of at least doubling the program and we feel that the whole Nation will benefit by this extension of the migrant health bill.

Again, we appreciate the opportunity very much for being here, Senator Williams. I will be glad to try to answer any questions that

Senator WILLIAMS. Bringing health care to people who are on the road, who travel, and who have no permanent residence, presents a great problem to you men, doesn't it?

Dr. PEAVY. Yes, sir; it does.

Senator Williams. It is obviously a greater problem than serving people who are settled in a community. You almost have to find the people that you want to immunize or test for tuberculosis or whatever it is. It is a hard job.

Dr. PEAVY. Yes, sir; it certainly is. We have had some outbreaks. We had an outbreak prior to the enactment of this program in 1962. We had a big outbreak of diphtheria because the susceptible population were not immunized against diphtheria.

They migrated to the plains area and we had an outbreak as a result of that. Now with the financial means to give the necessary immunizations early, we think it goes a long way not only to help the migrant himself, but to help the entire population.

Senator WillIAMS. But again you couldn't expect them to come to the community clinic. You almost have to go where they are.

Dr. Peavy. Yes, sir; and it takes a health education program along with it, as you know. It's not just making the services available, you have to convince them that this is a necessary procedure.

Senator Williams. You have the cure for tuberculosis; do you not? Dr. PEAVY. Yes, sir; we certainly do.

Senator WILLIAMS. I can remember as a kid delivering milk to my uncle up in the Adirondacks to Trudeau Sanitarium, and the treatment for tuberculosis then wasn't really treatment. Well, it was Trudeau's pioneering effort. It was a fresh air treatment.

Dr. PEAVY. Yes, sir.

Senator WILLIAMS. You know what Trudeau Sanitarium is today? Dr. Peavy. Yes, sir; I believe so.

Senator WILLIAMS. The headquarters for the American Vianagement Association.

Dr. PEAVY. Yes, sir.

Senator WillIAMS. Although doctors have found the answer to tuberculosis, the incidence of tuberculosis among migrants is very much higher than the general population.

Dr. PEAVY. That is right.
Senator WILLIAMS. You have to find them and treat them?
Dr. Peavy. Yes, sir.

It is still a problem, of course, in our State because of the problems we have. In the particular area that is home base for the migrants we have sort of unusual problems and we still have not conquered tuberculosis, but I think we are making progress.

Chemotherapy that has been put into effect for tuberculosis has shortened hospitalization. Casefinding methods are better and I certainly think in the near future we can reach the goal of eradicating tuberculosis.

Senator WILLIAMS. How about polio? Dr. Kandle will recall in the State of New Jersey when the Salk vaccine came out there was a doctors' boycott on the roundup of people to come in and they wouldn't administer the Salk vaccine. They wanted to do it on a business-as-usual basis.

And what was the next? The wafer?
Dr. PEAVY. Oral vaccine.
Dr. KANDLE. Sugar.

Senator WILLIAMS. Yes, the oral vaccine. When that came on it became a public responsibility to show up on Sundays, every three Sundays, to get the vaccine. That is easy in a suburban community or a city community, where you have the people concentrated. But inoculation of migrants presents a far more difficult health problem.

Dr. PEAVY. Much more so. I remember, Senator, when I was director of the communicable diseases program in the prevaccine days we had as many as 250 paralytic polio cases reported in a week through the State of Texas.

This year throughout the year, we have had a total of seven cases. I think this is dramatic and shows what can be done in public health.

Senator WILLIAMS. You are reaching them? Dr. PEAVY. Yes, sir. Senator Williams. We appreciate, Doctor, your endorsement of what we are trying to do. It means so much more because you know more about what we are trying to do because you are on the firing line administering the program.

Dr. PEAVY. Thank you, sir.
Senator WILLIAMS, Who is next? Dr. Kandle?

STATEMENT OF DR. ROSCOE KANDLE, STATE HEALTH OFFICER

OF NEW JERSEY Dr. KANDLE. Yes.

Senator WILLIAMS. Dr. Kandle, I am honored indeed that you are in charge of my own good or bad health in the State of New Jersey, and you serve with great distinction.

I do want to say, Dr. Kandle, before you make your statement, that this committee can't perform the task alone. This health program, for example, would never have been passed without the help of Senator Holland of Florida, Senator Byrd, now deceased, of Virginia, and some of the other Senators who were with us, and we passed this bill without objection.

It was a unanimous vote, and I am grateful indeed to many other Senators who were there at the beginning. We have had a unanimity here in the Senate that has made this possible.

Dr. Kandle.

Dr. Kandle. Thank you, sir. New Jersey has had Federal grant money for 5 years and in 1963, when we really got started, we were able to see 2,000 persons and they got a rather skimpy kind of care.

However, during that year, we were able to introduce this very vital factor that you have already spoken of, Senator; that is, the Outreach. Of course, having been brought up as a Calvinist, this is an easy term for me, and we were able to put the Outreach really into effect.

We really go out and see them, as you say, in the camps and in the fields as we need to, and we dealt then with the multiple and difficult problems of alcoholism, out-of-wedlock pregnancies, accidental injuries, mental retardation, or whatever.

I mean we see them all. And somehow or other, we had to begin to come to grips with their problems. We saw, for example, dysentery and hepatitis from bad sanitation. I remember particularly that we were struck by the great dental needs.

But what can you do with a little bit of money and small program to begin with? So at the first we said, well, we will only be able to help those who need, for example, the control of hemorrhage or elimination of pain, bone infection, dental infection. But even so, even with such limited and rigid criteria, we were able to look after some 200 people right at the beginning.

Now we have a reasonable range of medical services. We have the New Jersey State College of Medicine and Dentistry involved and the several departments of education and labor. We have students from the four university medical and dental schools, and best of all, we now have more than a dozen practicing dentists and physicians who are serving the migrant people just as they serve the rest of the people.

We think this was a tremendous breakthrough because now the agricultural migrants are getting the same kind of care and the same quality of care under the same kind of a system that the rest of the people get, including hospitalization and all the rest.

I don't know; I couldn't get an unduplicated count for the current year, but I know we served 10,000 people and, perhaps as importantly, we supervised 566 camps, and that is quite an undertaking.

One of the interesting things, and I think it shows that things are working well developmentally in this specialized program, and I do think it ought to be specialized, is that during the current fiscal year $40,000 worth of services were provided under medicare.

We just didn't think we were going to see that many older people. But from among the families and groups who came into our program, this many are now part of a regular medical system.

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