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Senator WILLIAMS. Because not only do they have the floor of the minimum wage. They have the piece rate?

Mr. WHITE. We do not work piece rates, but we remember that if the dollar is the minimum, it is only your lower or less producing worker that is going to make a dollar. If a man is worth more than a dollar, definitely you are going to pay him more than a dollar. This is true in any industry, I think.

Senator WILLIAMS. This is December. Are you harvesting anything right now?

Mr. WHITE. Yes; we are harvesting in fact quite a lot of tomatoes right now. We are harvesting about 10,000 or 12,000 20-pound cartons of tomatoes today at the present time, which is a little more than we usually do in the first of December.

February, March, and April are our heavy months.

Senator WILLIAMS. I am advised that you and Dr. Brumback are good friends and closely associated.

Mr. WHITE. Yes, sir.

Senator Williams. And you worked this appearance here in Washington before this committee out together; is that right? Mr. WHITE. That is correct. Senator WILLIAMS. Well, we are grateful, indeed, to both of you. Do you farm in two counties? Mr. WHITE. We farm in two counties.

Senator WILLIAMS. We know that Palm Beach County has a good working

health program. How about the other county? Mr. WHITE. The other county that I farm in is Martin County, which is on the north boundary of Palm Beach County, but the laborers that we have in that particular county do not receive the services or are not available to them as they are in Palm Beach County. I am not sure what the extent of the program is in Martin County, but we are located in a rural area that does not have access to the clinics in this particular county.

Senator WILLIAMS. Wouldn't it be in the interest of growers in your position to stimulate Martin County to start these health programs?

Mr. WHITE. It would be of interest to us. However, you probably know that most farmers are so busy tending to their own business that the majority of them do not give labor the attention that it needs.

I have been labor-minded since I have been in this business, I suppose that is why I am here today. I think, if they were approached, and maybe it should be my responsibility to try to help with this, that it would be in the best interests of all of us to try to promote this program, to get it to those workers that are not receiving it now.

Senator WILLIAMS. Are you a member of any farm association?

Mr. WHITE. Yes; I am a member of the farm bureau, and other local associations.

Senator WILLIAMS. You are a member of the farm bureau?
Mr. WHITE. Yes, sir.

Senator WILLIAMS. I don't know if they have taken an official position on the extension of the Migrant Health Act. Have they?

Mr. BLACKWELL. They have no position. Mr. White, you are speaking as a grower, as an individual, and not for the farm bureau?

Mr. White. I am speaking strictly as an individual grower right



Senator WILLIAMS. Well, you certainly have a most enlightened labor policy. That is obvious from what we know and what you said here today. Sometimes we wish we could get a positive position from the farm bureau organization. We haven't been successful to date, have we Mr. Blackwell?

Mr. BLACKWELL. No, sir.

Senator WILLIAMS. They did support the housing bill for migrant workers. Mr. White, see if you can't get the farm bureau to think your way on health matters.

Mr. WHITE. All right; I will try.
Senator Williams. Anything else, Mr. Blackwell?

Senator WILLIAMS. At this point I will insert in the record the prepared statement of Leonard E. White. We are grateful, indeed.

Mr. WHITE. Thank you.


Co-op, INC., DELRAY BEACH, FLA. The Migrant Health Act needs to be extended if we are to make any progress for the underprivileged migrant agricultural worker who usually does not meet residence requirements where he lives. The transient nature of his occupation usually leaves him unknown and often unaccepted in society.

Because the migrant usually lives in a rural area in a labor camp, or housing furnished by the farmer, he often does not have access to local programs designed to meet the needs of local residents.

His education is usually neglected and he does not realize what medical attention he requires. The community which he lives is not often aware of his existence or needs until an epidemio or disaster of some kind brings attention to the general public.

Hospitals and county governments do not provide for migrant care in their budgets. The local community does not usually feel that the migrant is their problem because of non-residence and therefore excludes him from local assistance.

Most clinics and doctors are located in cities or highly populated areas and in surroundings foreign to the migrant laborer. Further, because of his work schedule, loss of time and pay, he does not seek medical aid when it is needed. To provide the minimum of care for these people we should make clinics available in large labor camps, or other rural areas where the migrant can be taught what he needs to know about his own personal health as well as having medical assistance available possibly after work hours or at least accessible to him.

Much progress has been made since our local mobile clinics have been operating in rural areas. Many cases that could cause epidemics or serious health hazards are discovered sooner than they would if neglected, saving much time and grief to the migrant as well as losses to the farmer, the local hospitals, etc.

The total amount of migrant labor used in South Florida has not decreased in the past 10 years. The size and scope of the problems still remains before us. It is too much to tax a local community to pay the bills that they might not have any control over. The problem is interstate and national in scope.

There has been and still is a lot of talk of mechanization taking over the agricultural industry, which would replace the migrant. With mechanization advancing in the past ten years, it still has not relieved the need or visibly reduced the number of migrant laborers needed to harvest our crops. Our population is growing requiring more food. In the next four or five years it does not appear that varieties of vegetables will be developed fast enough to lend themselves to mechanical harvesting as fast as some would think. Some particular crops such as beans can be harvested mechanically for fresh market, others for processing may be harvested mechanically and this is being done. In Florida where the nation's large supply of fresh vegetables, for winter consumption is grown, a different problem exists. Most vegetables for fresh market must be harvested by hand until such time as the machinery and varieties are developed to change over. This takes several years at a minimum and very likely later than the extension of the Migrant Health Act would last. Any decrease in migrant labor needs is yet to be seen, and it does not appear to be as soon as most would like to think.

Senator WILLIAMS. The witness list indicates that the next three witnesses have much in common, all coming from the health care area and farmwork. Possibly we ought to create a little panel of Mr. Jose Gonzales, Dr. Virgil Gianelli, and Dr. Robert Locey.

Why don't you one by one identify yourselves and the position from which you speak. STATEMENTS OF JOSE L. GONZALES, DIRECTOR, LAREDO-WEBB

Dr. Locey. Dr. Robert P. Locey, from the southwestern corner
of Michigan.

Dr. GIANELLI. I am Dr. Virgil Gianelli.
Senator WILLIAMS. That is St. Joseph, Mich.?
Dr. LOCEY. That is St. Joseph.

Dr. GIANELLI. And I am from California. I am a physician in private practice, also project director for our local project, and presidentelect of my society.

Mr. GONZALES. I am Jose Gonzales, acting administrator of the Laredo-Webb County Health Department, and project director of the Laredo migrant program.

Senator Williams. You share that activity in common, do you not? You are all project directors in this field?

Dr. GIANELLI. Right.
Whom do you wish to have first, Mr. Chairman?
Senator WILLIAMS. Why don't you start, Dr. Gianelli?
Dr. GIANELLI. Thank you.

This morning I wish to outline for you experimental programs undertaken by the San Joaquin Medical Society as they relate to medical care of migrant agricultural workers.

For the sake of orientation, the society comprises four counties in central California, of which San Joaquin is ranked as the fourth richest agriculturally in the Nation with a 1966 farm income of $252,862,843. During 1965, farm employment ranged from 11,750 in the winter to 24,475 in the fall at the peak of the tomato harvest. The volume of farm workers depends heavily on migrants who come to San Joaquin County during the major harvest activity. As near as we can determine, the migrant population is between 12,000 and 14,000 with the major influx of out-of-State workers from Texas, Oklahoma, Arkansas, and New Mexico entering California at the South and following the crops northward through Oregon and Washington,

In 1954, the San Joaquin Medical Society, in an attempt to bring the benefits of modern medical care to all people, established the foundation for medical care, which embraced the principles of prepayment, fee schedule, claims review and quality control. It was then that our agricultural committee began meeting with representatives of organized agriculture in an attempt to meet the bealth needs of the worker. This activity continued for 6 years without bearing fruit.

With a feeling of frustration, we engaged in a radically different approach in 1960 when members of the society voluntarily staffed a clinic for migrant agricultural workers in proximity to a soup line and used clothing depot. Three years later it was apparent that we were reaching too few people by waiting for those who were forced to us through hunger or nakedness.

At this time, we inaugurated the policy of going to the people in the fields and their camps on the riverbanks, using the trunk compartment of automobiles as dispensaries.

To the question “Why don't you go to the county hospital?”, the answer was, “We don't belong there. They don't like us, but we know that you like us because you have come to us when you did not have to do so." To the confession, "We are bringing you very poor medical care," the answer was, "We know that, but at least someone is at last trying to do something."

While out among the people, we observed the activity of the local public health nurses and sanitarians. It was a normal evolutionary development that wben we wrote a program seeking to bring comprehensive medical care to these people that it should be a joint effort of the San Joaqun Medical Society and the San Joaquin local health district. We submitted a budget of $315,000 this year and received grants from the following sources:

1. Initial grant from California State Department of Public Health, $76,322.

2. U.S. Public Health Service, $60,901.

3. California State Department of Public Health, another grant of $25,000. There are two migrant housing facilities in the county: one situated in the northeast portion adjacent to the county dump, Harney Lane Camp, containing 100 units. The other is in the south-central portion adjacent to the county hospital, Matthews Road Camp, with 144 units. Two fixed clinics were operated at the camps Monday through Friday from 7 p.m. until all patients were seen.

The Harney Lane Clinic operated for 6-months; The Matthews Road Clinic, with 44 occupied units for 6 months, and with 144 occupied units for 4 months.

Obviously, the great majority of the migrant workers are living elsewhere and it was for this reason that we became interested in the mobile clinic concept.

A mobile clinic traveled 5 nights a week to outlying areas with particularly high farmworker populations, for a period of 4 months. We missed the cherry harvest, with a peak employment of 9,300. Our statistics cover a period to November 1, 1967. These variable intervals were necessitated by delays in construction and lack of funds.

Senator WILLIAMS. What does that mean exactly, Dr. Gianelli, when you say that you missed the cherry harvest?

Dr.RGIANELLI. The cherry harvest occurs in May: The people come into the area about March and April. They come in early. If I may digress, if

you have the time, the people that are going to pick cherries come into the area much earlier than the harvest season. I asked one woman why she was so far in advance of the harvest season and she said, "My husband and I cannot afford to miss the picking of cherries because it represents a large part or the largest part of our annual income.

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I said, "Where are you from?” She said she was from the Bakersfield area. I said, "Why didn't you step into the farm employment office and find out when the cherries were ripening in San Joaquin County?” The reply was the only information they had available is for their own immediate use.

She said, “It is necessary for us to come up here ahead of time because there is such a competition that we have to line up the grower well in advance or somebody else will get the job.”

1 said, “Economically, what does this mean to you?” She said, "Well, in the Bakersfield area my husband and I, working full days at the best, the best day we had, was $9 earnings for both of us, whereas in cherries the two of us working together can earn $50 a day.” So this year we were not funded early enough to man our clinics during cherry season; 2,693 patients were served with 7,129 visits in 379 sessions; 201 patients were referred to the offices of specialists in private practice, 93 to dentists, and 239 to private clinical laboratory and X-ray departments. There were 98 women given prenatal care and 183 took advantage of family planning and other gynecological services such as Papinicolau smears. They were served by Boardcertified or Board-eligible gynecologists.

Children not only were treated for acute illnesses but also were seen for counseling, well-baby checkups, immunizations, and tuberculin skin testing.

While on the subject of tuberculosis, it should be noted that skin testing was a routine for adults also and those who reacted positively had chest X-rays. We found only one case of active tuberculosis. One adult whose skin test converted is receiving treatment. Seven children who had positive skin tests are undergoing treatment. We think this demonstrates that tuberculosis among migrant agricultural families is not the problem that it has been among the single migrant workers.

Four children were seen suffering from malnutrition, and 15 children and six adults with anemia.

Since our request for private hospitalization was disallowed because of lack of funds, patients were hospitalized at the county hospital. There were 36 such, of which 12 were maternity and five were newborn. There were 31 additional patients whom referring physicians felt should be hospitalized but who were not accepted by the county hospital because of the lack of continuity of care; that is, physicians in training overruled the judgment of senior physicians who had been following the patients, and the other reason is the elective procedures, as now there is a residence requirement in the county for what is termed or thought to be an elective procedure, and this elective procedure is a bugaboo in California at the moment, and I am sorry that Senator Murphy is not here with you this morning.

If I can make myself clear on that, for example, a gynecologist might see a woman and decide that she has an ovarian tumor. To this man with experience this could very well represent a cancer. To him this is an emergency procedure. But a house officer at the county hospital can examine the woman and decide that she has a benign cyst which can be taken out in some other county and so the woman is turned away, so that we feel that hospitalization is a very important part of our program because without it it is difficult to keep the morale of the physicians participating at the proper level.

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