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only providing health benefits to one of the populations in our country that needed it the most, but it is also assisting and maintaining the health of the resident citizens.

This is evident in Laredo, where the Migrant Health Act brought a large recalcitrant segment of the population under the influence of public health.

The migrant health program has been the single most effective long-range program ever conducted by the Laredo-Webb County Health Department, particularly in results obtained from dollars spent.

In the light of recent statements made by the Surgeon General of the United States, Dr. William J. Stewart, that health is not being made available to the people who need it, the migrant health program stands out as one program that is most assuredly doing exactly what it was intended, providing health to a people who need it. (Attachments to Mr. Gonzalez's statement follow:)

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HANDOUT No. 2. Migrant health project operations, 1963-67 1

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2. Nursing services:

(a) Home visits.

(b) Referrals from home visits to migrant immunization clinic. -
(c) Referrals to other sources of medical service or health-welfare

services__

(d) Immunizations given.......

(e) Heaf (tuberculin) tests given.

(f) Serological test for syphilis.

3. Environmental sanitation:

(a) Number of inspections...

(b) Discrepancies..

(c) Corrections___

Total

5, 689

10, 557

4, 119

21, 757

4, 742

1, 800

1, 568

2 3, 533 3617

? These include substandard homes, inadequate sewage disposal, unapproved solid waste disposal, rodent and insect nuisances, poor environmental sanitation, etc.

These include corrections or improvements obtained on above discrepancies. This figure also includes 132 pit privies eliminated.

HANDOUT NO. 3.-Number of families and States (Laredo migrants)

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HANDOUT NO. 4.—Migrant family and worker's head count survey (72.5 percent

complete), 1966-67

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Remarks: Information for 1,318 inspections mentioned is complete. Total of 503 inspections not mentioned, as these have to be reevaluated.

Senator WILLIAMS. That statement certainly is complete, and we are certainly appreciative.

You are what we describe as a public health administrator. Is that right?

Mr. Gonzalez. Yes, sir.

Senator WILLIAMS. How many people do you have working with you on this program for migrants?

Mr. GONZALEZ. Under the migrant grant, sir, we have two nurses, a sanitarian, and a health educator. We have just added an assistant to the sanitarian.

Senator WILLIAMS. Most of the people that you describe as farmworkers have a long period of residency in Laredo, maybe 4, 5, 6 months?

Mr. GONZALEZ. Usually the majority of them get to Laredo in September and October, and leave in April and May.

Senator WILLIAMS. Do you have many people coming across the border, daytime workers in agriculture?

The term we use to describe these workers that come over on a daily basis from Mexico is "commuters."

Mr. GONZALEZ. We have a large number of commuters. I would say around approximately 6,000 come to work in Laredo from across the river, the so-called green carders, but I don't know what percentage of these are in agriculture eventually.

Senator WILLIAMS. Can you reach those that are in agriculture with the migrant health program?

Mr. GONZALEZ. I would say not, Senator, because our health department sees only the residents from this side.

Senator WILLIAMS. I see. You still have not been able to break the barrier or fear that people have of getting immunization shots "up north."

Mr. GONZALEZ. No, sir. I make the statement that we have broken it. I think that in the past 4 years we have made great strides in that. Senator WILLIAMS. Would it not help, though, for those who still have not lost their anxiety about going to a doctor or a clinic to have a medical profile that they can keep with them, and that you could consult to determine past services.

Mr. GONZALEZ. They have these. We give all the heads of the families a complete record of immunizations and all services, medical and clinical services, that we give them.

We have instructed them, and they are, I think, now getting around to following the practice of keeping this record with them everywhere they go.

Senator WILLIAMS. Is that true in California, Doctor?

Dr. GIANELLI. Yes, sir. They have a family health record, and they keep pretty good track of it, too. They come back the second year, and many of them still have it. They don't lose it.

Senator WILLIAMS. That was my next question: Do they honor the record, and keep it?

Dr. GIANELLI. Better than I thought they would

Senator WILLIAMS. How about Michigan, Doctor?

Dr. LOCEY. Unfortunately, this is not true. Only around 15 or 20 percent actually have any form of records with them at all.

Senator WILLIAMS. Before we come to you, Dr. Locey, do we have questions of Mr. Gonzalez?

Mr. BLACK WELL. Mr. Gonzalez, we have heard other witnesses discuss the necessary steps to improve the environmental health part of the migrant health problem.

Improved sanitation is needed in the United States. We all are generally familiar with the still more serious environmental health problem just across the border in Mexico. We saw it in Elsa. We saw it in a few other towns during our Texas hearings, and from a layman's viewpoint, I understand that this is the context from which there is the most likelihood of an epidemic stream.

Do you regard this as something to worry about, with the commuters coming across in such large numbers?

You said that there are 6,000 commuters in your area, and this is just one crossing point in Texas. At many points on the Texas border there are large numbers of workers coming across for a daily work tour, and then returning to Mexico, and I think we know the kinds of conditions to which they are returning.

Mr. GONZALEZ. Mr. Blackwell, we in Laredo I think are fortunate in enjoying a very close association with our Mexican counterpart, the health department in Nuevo Laredo.

We have, however, in the past four and a half years, been doing a very strong effort to immunize all our children from TB, polio, measles, and smallpox, with I believe also very good results.

In June of 1966, Nuevo Laredo had a polio epidemic. They had 27

cases.

Mr. BLACKWELL. Was that in Laredo?

Mr. GONZALEZ. On the Mexican side, 27 cases of polio, whereas we had one case of polio, so I think that even though we cannot speak so well on the major problem of TB, we are holding our line in most things, and Nuevo Laredo, I think, has also a very effective health department now.

Mr. BLACKWELL. What year was the polio epidemic?

Mr. GONZALEZ. In 1966.

Mr. BLACKWELL. That is the point. You had a polio epidemic across the border in 1966, and in this case it was a disease for which you fortunately, in your area, already had an extensive immunization program.

It is not certain that the same success has been experienced all along the U.S. side of the Texas border with our own citizenship. Of course, we have no immunization program for some other diseases.

Mr. GONZALEZ. I think we have made a strong effort to give the information to the new Commission on Border Work on the MexicanUnited States border of what our programs are, including TB.

We have not really solved the problem that can be on the border, and for this we are going to need a united effort, even more than what we are now conducting.

In all fairness, I would like to say that during the polio epidemic in Nuevo Laredo-I believe it can happen to any city that was not as immunized as it perhaps should have been-they immunized in a period of 48 hours 9,000 children. They brought nurses from everywhere and they just went from door to door to immunize kids. Mr. BLACKWELL. This was in Laredo?

Mr. GONZALEZ. This was on the Mexican side.

Mr. BLACKWELL. When an epidemic occurs, do you have a massive effort to deal with it?

Mr. GONZALEZ. Yes. If it weren't for that, there probably would have been more. They did conduct a rather effective program at that time.

Mr. BLACKWELL. This really is not a sound way of dealing with epidemics, though, trying to stop them after they have already broken out, and currently there are no procedures for having knowledge of the health status of these individuals at border crossings.

There is no required health certificate, unless for example they are working in a cafeteria on this side.

Mr. GONZALEZ. Yes; everybody that handles food does need a good kind of certificate, but I believe that most people that are working on this side have to have their X-ray at the U.S. Quarantine-Public Health Service Quarantine Station-at the bridge.

Mr. BLACKWELL. That is when they are first certified?

Mr. GONZALEZ. Yes.

Mr. BLACKWELL. Then all of the many years afterward-
Mr. GONZALEZ. They don't have it.

Mr. BLACKWELL (continuing). Anything can happen, and there is no procedure for knowing about diseases following initial certification? Mr. GONZALEZ. This is right.

Mr. BLACKWELL. TB, for example, could develop after the admittance procedure?

Mr. GONZALEZ, Yes.

They could ostensibly pick it up on this side, and we do have a rather effective system of followup in conjunction with their health department.

Whenever one of the residents of Nueva Laredo gets sick of TB, they pick him up right away, and they report him to the Mexican side, but this is the biggest problem that we have.

Mr. BLACKWELL. It is cheaper by far to have identification and prevention procedures, though, than dealing with an advanced case of TB, or having to program immunization for 12,000 people; isn't that right?

Mr. GONZALEZ. Yes, sir.

Mr. BLACKWELL. Is that correct?

Mr. GONZALEZ. That is correct.

Mr. BLACKWELL. Are you able to supply now, or perhaps subsequently, an estimate on the cost of providing adequate medical care to the migrants, the migrant population in your county? Do you have a per capita figure on your project?

Mr. GONZALEZ. Not really, Mr. Blackwell. Actually, about 18 months ago, our health educator estimated that the migrant was getting $18 per head of our public health prevention.

Mr. BLACKWELL. Is that all migrants, or the ones you are reaching? Mr. GONZALEZ. These are the ones we are reaching, and this I do not believe is correct.

We never publicized the figure, because, since we have an integrated program, where the migrants come to clinics not financed by the migrant program, and since we have other people that have come to clinics that are financed, this has been difficult to ascertain.

When you have a population of 20 percent migrants all over the city, actually in a way the best program is just a shotgun program. We have been able to be more successful that way, because in the one section of Laredo, which is the northeast section, migrants and their

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