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This program was offered during the same time that the health clinic was held. Several of the children who attended the evening classes were referred to the clinic by the school program's health nurse.
After the harvest of the strawberry crop in Carlisle and Hickman Counties the migrants go on to other harvest areas. Most go to help with the vegetable, strawberry and cherry harvests in Michigan. Others go to the mid-west for the sugar beet harvest and to Illinois and Indiana for the strawberry crops. In the late fall and early winter they return to their permanent homes in the South and work harvesting the crops there.
Future predictions of the size of the harvest and, thus, the number If workers returning next year will fluctuate in accordance with the weather picture. All the growers that I interviewed, with the exception of one, who might not plant a strawberry crop next year, will be planting more strawberries next year.
Environmental conditions in the migrant camp themselves haven't improved appreciably over the past year (according to the local health officers who worked with the project). New living units, shower facilities and privies have been constructed on several farms this past year.
At a previous meeting on environmental health, both the growers and the health department agreed to accept as regulations the minimum environmental requirements from the Kentucky State Department of Health.
The regulations-minimum environmental requirements for migrant labor
Water: Tank of sufficient size to allow water and proper amount of chlorine to remain in contact for 30 minutes prior to use.
Sewage disposal: Standard Kentucky pit privy for camp areas.
Specification 1: New construction-10-percent floor areas; Old construction-5-percent floor area.
Specification 2: Floor spaces per person-20 square feet.
Specification 3: Refrigeration should be more. No recommendation.
Specification 6: Garbage pits at least 6 by 6 by 6. Disposal-backfilled
None of the camps complied with the chlorination standard. All tests for contamination reported by the local sanitarian this year were negative. No improvements on the wells themselves have been made since last year. All the camps, with the exception of one, received their water from deep wells. One camp is supplied with water brought in by truck from the city water supply and is stored in a cistern. It is manually chlorinated. There is one water outlet in each camp and buckets are used extensively for transporting drinking and washing water. No plans for future chlorination have been made by any of the growers. The privies constructed in the camps have failed to meet the minimum standards in that they are not backfilled daily. All but a few of the privies are without seats or tops and none of them are screened. In the past seats were installed in several privies; however, the migrants themselves have removed a good deal of these. The portable privies used in the fields are well maintained and are up to the public health minimum requirements.
The showers are adequate but little effort has been made to insure proper drainage. Some units' fittings are supplied by makeshift hoses and have proven more than adequate. Several new shower facilities constructed this past year have shown improvements in that they are constructed of concrete block and have the proper fittings. One grower in particular has made a remarkable effort in this particular aspect over the past year.
New living units have been constructed in the camps this year. Most of these are the movable 12' by 16' duplex-type houses. These units are covered with the standard aluminum sheet siding and are designed with dividing partitions to accommodate two families if necessary. There are some new units which have been converted from barns that have concrete floors and are so fitted that many separate units can be arranged. All the new units are sturdily built and made for versatility. More refrigerators and hot plates were purchased this year by the growers. All of the camp houses lack proper ventilation for the gas burners which, on many occasions are left burning during the early-season mornings for heating purposes. The camp houses are not screened. However, the insect problem is fortunately not critical during the harvest season.
The garbage disposal facilities are deficient in that no daily backfilling of the pits is carried out. In many cases the areas around the living units illustrate the negligence on the part of the migrants in respect to proper garbage disposal practices. Upon visiting the camps in mid-September it appeared that the growers had accomplished a cleanup in the living units and in the surrounding areas. All the units appeared clean and the surrounding areas well policed. All the garbage pits were covered properly. In most cases, the migrants' attitude is a determining factor toward the success of the environmental improvement program. Efforts made by health representatives to instruct the migrants and insure proper followup have been hampered by the growers' unwillingness to have outsiders in the camps during the harvesting season.
Most growers feel that they have fulfilled their obligations in providing proper living facilities to the migrants. They feel that much of the routine sanitary practices should be left to the migrants to accomplish. A good many migrants appeared satisfied with their housing except that a few have complained of the lack of privacy in the units themselves.
MEDICAL AND NURSING SERVICES
1. To provide prenatal and postnatal care to migrant women.
2. To provide health supervision and pediatric care to all children in the m grant camps.
3. To improve the health of migrant workers through provision of primary and secondary preventive medical care.
The health clinic was held five days a week alternately at the Hickman and Carlisle County Health Departments. On Monday, Tuesday and Wednesday it was held in Hickman County and on Thursday and Friday in Carlisle County for a total of twenty days. The clinic hours were from 5 to 8 p.m. each evening, thus enabling migrant visitation during the after-work hours of the day. This year's clinic started one hour earlier than last year's for it was believed an earlier closing time would allow the workers more time to return to their camps and thus get enough rest for an early morning start the next day. It was hoped that this would serve to improve the relationship between the health project and the growers.
One hundred and five medical cases and sixty-four dental cases were treated at both clinics. Seventy-five medical and thirty-seven dental cases were treated at the Hickman County Clinic. Thirty medical and twenty-seven dental cases were treated at the Carlisle County Clinic. Seventy-three migrants were treated by the physicians in their private clinics for a total of eighty-seven medical problems. The dentist also saw seven migrants in his private office and performed twentyfour dental procedures on them.
Three physicians, one dentist, one dental assistant, one nutritionist, two aidadministrators (both former "gray ladies"), one clerk stenographer, and one project coordinator (Administrative Assistant of Hickman and Carlisle County Health Departments) staffed the migrant project this year. Two of the physicians, the dentist, the dental assistant, the nurse, the nutritionist and the project coordinator had experience with previous projects, thus negating much orientation training. The clerk stenographer, Mrs. Joyce Mills, underwent a three-day indoctrination program in keeping project records at the Kentucky State Department of Health and she considered this quite beneficial in the project work. The practice of rehiring experienced personnel is quite applicable in this case. This year's clinic was conducted on simple patient-treatment basis, no screening was attempted this year as was done last year. Patients entered the clinic, were registered and interviewed by the aids and then referred to a physician or dentist. No medical histories were initiated and no examinations were given unless directed to by a physician. Transportation to the clinics was at the migrants' expense, a different policy from initial years. The first project year, transportation costs were paid by the project, i.e., the migrant crew leaders and the migrants themselves (who had their own transportation) were reimbursed for their travel to and from the clinic. More people attended the clinic the first year as a result of this added incentive, thus programs such as the examination and screening program, the health and dental hygiene program were enhanced. All the patients attending the clinic each night were seen and treated by both dentist and physician.
A new program established this year was the inpatient and outpatient treatment offered certified migrants in the Hickman-Clinton County Hospital. Arrangements were made with the hospital for receiving migrants referred there by project physicians and for emergency care. Seven migrants received hospital care during the project period and one migrant remained in the hospital for a week after
project termination. The arrangements proved quite adequate in accomplishing their objectives. Administrative control was maintained by the project.
One migrant, who was reported to be acting strangely by his fellow workers, and having a record of psychiatric treatment, was examined and diagnosed as suffering from "Schizophrenic Reaction, Paranoid Type, Chronic" and was admitted to the Western Kentucky State Hospital in Hopkinsville, Kentucky on June 15. He responded to treatment, and was thus released six weeks later to return to his group.
The farm labor representative who accompanied the migrants to the HickmanClinton County area was quite helpful in overcoming the language barrier, a major problem between the project workers, growers, and the migrant laborers. The medical community, a good deal of which was involved in this year's work, was very cooperative. When there was a shortage of medical and dental supplies (also a major problem this year), the local clinics and hospitals were called upon to lend out the necessary provisions.
Mr. Ashley Beckham, the Regional Public Health Service Representative, visited the clinic on one occasion and encouraged efforts towards collecting medical case histories, and some were consequently taken. Initiating and maintaining medical and immunization records is quite necessary in dealing with the migrants, More efforts in this sense, however, should be made in the permanent home areas of the migrants.
Six migrant women received prenatal care and one woman postnatal care. One delivery was made during the project period.
This year, due to the number attending the migrant school children program, fewer children accompanied their parents into the clinic. Six children received immunizations, three of these were for Smallpox, one for Diptheria, one for Pertussis and one for Tetanus. Two were given the Sabin II vaccine, Free access to the farms during the clinic hours would have insured a wide range immunization program.
Pediatric care consisted mainly of treatment for impetigo, worms, and upper respiratory complications. Approximately twenty-one percent (twenty-three children) of the patients treated at the clinics were children from ages one through fifteen. One child was hospitalized for a period of seven days.
Seven migrants received inpatient care at the Hickman-Carlisle County Hospital. The average length of stay for hospitalization was, 5.71 days per patient, Eighteen migrants received out-patient (emergency) care,
1. To improve dental care in an attempt to relieve pain and infection, and improve the home care of the mouth of the migrant workers in Kentucky
Dental services were offered on a similar basis as the medical services. Doctor Robert Jackson, an experienced project worker, treated a total of sixty four patients of which forty-nine needed services. Of these forty-nine, forty five were partially completed and five not started. Of the total one hundred eleven services provided, seventy-five were simple extractions, thirty-one were corrections and five were preventive.
A dental clinic was inhibited due to the initial absence of dental supplies, which had been ordered beforehand, but did not arrive during the project period. (This was a result of a delay in fund allocations and purchasing systems.) Consequently, the first two weeks of the dentists' work consisted entirely of simple extinctions and routine examinations. Only after borrowing from his own cline was he able to provide corrective services. Prior planning and coordination are necessary in order that the correct supplies be delivered in time,
Thirty-three toothbrushes were distributed and the children were urged to use soda and salt if no toothpaste was available. The hygienist and nutritionist both demonstrated proper dental care techniques, emphasizing proper home cure for all who were able to attend the clinic. Again the lack of directive communication between the project and the migrants in the camps mullifies any possibility of effective dental education.
1. To assist the growers and community in understanding the need to make available foods that are in keeping with the workers and their families' cultural eating habits.
2. Assist people in food planning, purchasing, and preparation as needed
3. Work as a member of the health team to provide nutrition services for prenatals, postpartums, infants, and children.
4. Assist workers and families and other members of the health team with any nutritional problems such as modified diets, feeding, or eating problems.
5. Work with other members of the health team in planning, preparing and implementing the phases of all health services to be rendered to the migratory worker and his family.
Sales to migrant groups in previous years have given the local grocers sufficient knowledge concerning the food requirements and habits of the workers. Some spices and ground corn were not stocked, yet substitutes were available. A certain antiseptic is in great demand yet the grocers have tried but failed to locate a wholesale source.
Most of the local grocers stated that the migrants' eating habits, especially the Texans, were above average. The Texans bought great quantities of food, picking choice cuts of meat and the most nutritious foods. The Negroes were average buyers, selecting less nutritious foods than the Texans.
Prior planning and pre-ordering on the part of the area nutritionist and the project nutritionist insured the ready supply of illustrative materials for the clinic. Charts in Spanish, obtained from the Texas Extension Service, were posted in the clinic and handouts were available for all visitors.
The project nutritionist utilized the patients' (or dependents') waiting room time for holding informal nutritional instruction. Basic food-group charts were presented and explained by the nutritionist. Home safety charts were posted. Instant breakfasts (it was found the migrants frequently missed breakfast), were prepared and samples were handed out. Tang, encouraged as a nutritious unrefrigerated drink, was served each night. Dehydrated milk was prepared beforehand and cooled and then served to the migrants. Cost charts comparing these latter items with those they substitute were posted. Peanut butter cookies were given to the children. Vitamins (Paladac and ADC), and Similac were distributed upon prescription by doctors.
This year's clinic didn't have as many children as last year's as can be illustrated by the lower clinic attendance and the number of children attending the school program. The mothers (who normally accompanied their children to the clinics) consequently were not available for nutritional instruction. Neither the nutritionist nor the health nurse were permitted to visit the camps this year. Home demonstration programs therefore could not be utilized.
VENEREAL DISEASE SERVICES
1. To provide adequate venereal disease diagnostic and treatment facilities to migrant workers.
2. To provide all necessary information and education to these workers in order to:
(a) Alert them to the signs, symptoms, and dangers of venereal infection. (b) Make them aware of the facilities available.
There were no personnel from the Venereal Disease Control Program participating in the Migrant Health Project this year. Four cases of Gonorrhea were diagnosed and treated and the results were reported to the State Department of Health. No venereal disease screening was carried out at the clinic this year. "A comprehensive V.D. effort combined with an initial medical screening program in Texas, Louisiana, Mississippi, and Tennessee, remain the only solutions to the problem of venereal disease control. Again, a limited time period and insufficient staffing minimized the attempt at fulfilling the objectives and solving the problem of venereal disease." (From last year's report.)
HEALTH EDUCATION SERVICES
1. To work with farm owners in such a way that they are willing to provide proper environmental conditions for workers and to personally encourage workers to improve health behavior.
2. To arouse surrounding communities to the needs of migrant workers and enlist their support in providing necessary services to workers.
3. Working with all other health professionals concerned to organize educational experiences for migrant workers involving, as far as possible, migrant leaders in the planning and carrying out of educational activities. Health educators will coordinate all group educational work in the project.
4. To insure that all educational work has carry-over value for workers as they move to other areas; for owners and communities in accepting their responsibilities for migrant labor problems and in their preparations for next year's migrant group.
Efforts on the part of the local sanitatiou officer and public health administrative assistant are continually being made in an effort to encourage the growers to improve the camps. The realization of public awareness, a foundation of the migrant project, has kept the growers moving. Conditions in the camps are not above the minimum standards, yet they have not declined.
If access to the farms can be realized in future projects, classes can be given in such areas as prenatal, postnatal, and infant care. Nutrition could be demonstated more realistically, more individuals could be reached.
This year's project was supervised more by local officials, a policy which the national and state health officials believed would improve local interest and participation. A Regional Public Health Service physician did not take part in this year's project. The State Public Health Nursing services were likewise not as active. Suggestions for the use of mobile clinics and day care centers were made by the project workers who would prefer, in the future, to reach more of the migrant population.
The growers seemingly relate all the public health programs with the repeated complications in harvesting the crops. It would supposedly be more desirable to the growers if no programs were available to take the migrants off the farms thus diverting their attention from the harvesting itself.
An educational program for children of migrant workers in Carlisle County for the strawberry harvest will begin Monday afternoon at Cunningham Elementary School. Burley Mathis, principal at Arlington, has been named to direct the program.
Financed by federal funds under Title I-Migratory Program, the school will be open daily from 3:30 p.m. until 7:00 o'clock with field trips planned on Saturdays. The county school system has been given a grant totaling $16,544.07 to meet program expenses.
The federal grant will go for teacher's salaries, supplies, equipment and materials. All equipment bought for the special school for migrant's children will become the property of the county school system after the strawberry season ends and the migrants move out.
C. Joe Baker estimated that seventy children are in migrant camps now at strawberry farms owned by David Boswell and Vodra A. Hobbs. More are expected to arrive before the season ends, he said.
The first day of school will be devoted primarily to testing and seeing that the children have suitable clothing.
Transportation to and from school and one meal each day will be provided the children. Classes are planned in music, health and physical education, art and recreation. The staff will include a counselor and others to assist in the program.