facilities and their maintenance, and inspections of water supplies and toilets provided in the fields.

Health counseling of migrants by physicians, nurses, sanitarians, professional bealth educators, and subprofessional aides; public information and education to encourage community acceptance and cooperation.

Dental examinations and treatment.

Nutrition demonstrations and counseling to improve dietary practices.

Social work services to improve the outcome of referrals from family clinics or from nurses, and to help migrants meet the many problems interrelated with health.

Specialized clinics to provide immunizations, prenatal or postnatal care, and casefinding for tuberculosis, venereal disease, and vision or hearing defects.

Services of State consultants to assist county agencies and local communities in determining needs, developing project plans, and meeting problems of project operation.

Family health service clinics usually are scheduled at night, one or more times each week. Some are held in township halls, school buildings, church basements, labor camp housing units, or other improvised space.

Patients include men, women, and children. Treatment of illness or injury, immunizations and other preventive services, and simple medications are usually provided. A complicated case must generally be referred to a local physician's office or a hospital.

About half of the patients who received medical or nursing care during the first year were children under 16 and adults past 50. Among children, the conditions most often seen included

Colds, other respiratory infections, and ear infections.
Measles, whooping cough, and other communicable dis-

eases.

Impetigo and other skin conditions.

Parasitic infestations such as hookworm and round worm.
Diarrheal disease.

Other conditions-nutritional problems, accidental injuries and poisonings, head lice, ringworm, etc.

Among adults, conditions frequently reported were

Upper respiratory infections ranging from colds to pneumonia.

Tooth decay.

Muscular aches and pains, "back troubles," arthritis, etc.
Gastroenteritis, "stomach upsets," etc.

Pregnancy.

Cardiovascular conditions.

Genitourinary infections.

Other conditions-accidental injuries, venereal disease, nutritional problems, defective vision or hearing, tuberculosis,

etc.

Although grant funds cannot be used to pay for hospital care, some projects provided hospitalization with State or local financing. Many cases were emergencies. They included the following conditions:

Pregnancy and its complications.

Accidental injuries including injuries resulting from

violence.

Tuberculosis.

Pneumonia and other upper respiratory infections.

Diarrhea and dehydration.

Appendectomy.

Malnutrition.

Specialized clinics are held by some projects to provide immunizations, dental care, casefinding for tuberculosis and venereal disease, vision and hearing tests, and other special services.

Project nurses visit families to advise them on health matters, provide first aid, and encourage sick or injured persons to go to the family clinic or to a local physician. Nurses also work in the night clinics, supervise the health of migrant children in day-care centers and summer schools, and carry out numerous other activities.

Project sanitarians assist both occupants and owners of camps to improve the environment and thus reduce risks of needless disease and disability. In some cases the camp owner accompanies the sanitarian on his inspection tour. Together they identify defects and work out a plan for their correction.

The sanitarians also teach migrant families how to mend screens and make other simple repairs, and how to maintain housing units and grounds in a way that will protect their health and safety.

Simple cleanup, fixup measures help greatly to improve some camp situations.

Water supplies subject to contamination and poor methods of waste disposal are among the defects commonly found in migrant camps. Other common defects include

safety hazards.

insufficient windows and doors.

overcrowding.

lack of bathing, laundry, refrigeration, cooking, lighting, or
other equipment for family living.

location close to animal pens, refuse, dumps, or other hazards
to health and safety.

Health workers, camp owners, and migrants work together in some project areas

to improve the camp environment for family living.

Health education improved the acceptance of health services by many migrant families. The friendly advice given by physicians, nurses, and sanitarians whenever they contacted a migrant was one important form of health education. Some projects also employed health educators and aides to broaden and intensify their educational effort.

Health educators assisted other staff members in improving the effectiveness of their counseling. They also assisted in group educational sessions for migrants, prepared and tested leaflets and other educational materials, helped identify and interpret migrants' needs to health workers, and explained health workers' instructions to migrant families.

In addition, health educators often helped to gain community understanding and support of the project.

A single crop season is too short to measure the effects of health education. Nevertheless, some projects made progress. The following reports are representative:

"Through the effort of the nurse, *** the migrants assumed personal responsibility for getting to *** clinics *** and all pregnant women were seen by private physicians

"After much preparation and guidance to the migrants, the enthusiastic response to the family service clinics and the other health services seemed to indicate acceptance of their worth

"By the end of the crop season the increased interest * * * in dental care was shown by the fact that one project had more requests for service than available time would allow