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Since the work of public health in a local community is really directed, for the most part, to the lower socioeconomic levels of that community, then 20 percent of our total population missed really means that we were not being very successful with 40 to 50 percent of the population we were working with.

In a city with as large a population of migrants as Laredo, our very limited success with the migrant and his family was adversely affecting the overall public health picture of the community, of course. With 20 percent of the population not cooperating, or cooperating very little, it was really impossible to control communicable disease; to effectively raise the immunization levels of the children of Laredo; to carry out a complete environmental health program; and what was more important, to solve Laredo's greatest problem, the high rate of tuberculosis.

There were many reasons why we were not having much luck with the migrant and his family, the two main ones being, first, the fact that the migrant was out of the city 5 to 7 months of the year, and the second one was the lack of enough personnel to fastidiously and effectively stick with the migrant and convince them to attend our clinics and improve their health and sanitation practices.

The third reason, and in many ways the most important, was the nature of the Mexican-American migrant himself.

Some of the personnel of the health department who had tried to work with the migrant before the Migrant Health Act was passed did not believe that anything could ever convince them to follow many of our recommendations.

It was not that they ever opposed the health department openly. What little effort that was directed at the migrant, and it was never enough before 1963, was usually met with a complete lack of interest. Laredo's widely publicized environmental health demonstration program, which saw the elimination of over 5,000 privies in a period of 7 years, met its match in dealing with many of our migrants.

They refused to eliminate their pit toilets, just like they refused to immunize their children, or participate in our citywide tuberculin testing for tuberculosis. They felt that since they spent such a short time in Laredo, they did not have to obey the health code.

They would tell our nurses that they were doing all this up north, where they were working-getting their shots, getting chest X-rays, et cetera. Of course, they had no records to prove it, but there was no way of making them do it. I am sure they told the same story at the other end of the line.

The fact remained that the children were not getting immunized; the tubercle bacillus was probably being spread around the country, or maybe being brought back into Laredo. The migrant's premises were unkempt and dirty 6 or 7 months out of the year, making it difficult for the health department to make their neighbors that stayed home comply; and they were not bringing their families to receive the medical help that they needed.

As I mentioned before, the very nature of many of the migrants also played a strong part in this. The fact that the city of Laredo now, 4 years later, has a higher immunization level in preschool children, for DPT and polio, than the national average, and that the children of migrants now have the same level as the rest of the community, has been a real achievement, considering the inability a

few short years ago of many of our migrants to translate from one culture to another in medicine.

As a matter of fact, this is more surprising, since many of them still have that fatalistic viewpoint on disease-they feel that even though they are immunized against the disease, they can still catch it.

That such an about-face in the conduct of the most recalcitrant of the "hard-to-reach" in Laredo, the migrant, would ever happen would have been considered extremely unlikely a few short years ago. That it would ever happen in 3 years is unbelievable.

It happened because a small group of dedicated professional public health workers, financed by the migrant health program, centered their efforts on this 20 percent of the population.

Also, it happened because of a rather curious phenomenon which I, as a Mexican-American myself, understand perhaps better than


The Migrant Health Act, which allowed the Laredo-Webb County Health Department to hire two badly needed additional nurses, a sanitarian, and a health educator, also brought about a rather unexpected and very impressive change in the attitude of the migrant himself.

While some continued to be reluctant, large numbers of migrants started coming to the clinics that had never come before-because it was a program that Congress had passed for them. This I was told personally by several of them, they were now coming to the health department to get what was theirs.

As I said before, as Mexican-American, I can understand this. The reluctance of a great percentage of the so-called hard-to-reach in public health is due only to pride.

As I mentioned before, an environmental health demonstration program was started in Laredo in 1955, under the auspices of the National Communicable Disease Center and the Texas State Health Department.

Laredo had before this a very high infant mortality rate, particularly a very high infant mortality due to diarrhea, high morbidity rates in enteric diseases, a high morbidity rate in tuberculosis-as a matter of fact, a very high everything.

From 1955 to 1962, great strides in public health were made in Laredo, but then we became aware that we were not having much luck with a very large percentage of our population, composed of migrants and their families, who spent a great deal of time out of the city.

While I did not have time to break up the statistics between 1954 and 1962 as compared to now, I have here a handout which I prepared for a talk I gave in Houston last September.

This, gentlemen, is the first handout at the end of my talk in the report that I hope you have.

I can assure you gentlemen that the difference between 1954 and 1962, which is the last year we had without the migrant health grant, was not as marked as you see between 1954 and 1965.

The Laredo migrant health program added two things to our health department within a period of 2 years which gave an unbelievably sharp rise to all our progress charts, of which only a few are represented by this handout.

Those two things that were added were the family health service clinic for migrants, and the migrant environmental health program.

Thanks to this grant, this large pocket of resistance, which we had to contend with before, is now gone.

As you can see, this principal way of showing the public health of a community, infant mortality rate, has been cut in half. Our infant mortality rate now is actually slightly under the national average. Senator WILLIAMS. Do you have with you your budget figures showing the division of money to various parts of the program? Mr. GONZALEZ. No, sir; I do not.

Our migrant grant this year is approximately $60,000. This does not include hospital, which we are getting next year, hopefully.

However, we have for the most part now an integrated program. For instance, to the $60,000 we could well add at least one-third of the $20,000 that we have for our dental health clinic for children. Onethird of the children that receive that clinical help are migrants. This is from other than migrant funds.

Senator WILLIAMS. Do you get any State money?

Mr. GONZALEZ. Yes, sir.

Senator WILLIAMS. What is the proportion of State and Federal funding?

Mr. GONZALEZ. Well, the State health department gives our local health department approximately $78,000, and this is really difficult to break down, Senator, but when we figure that in our clinics, our general medical clinic, in particular, one-third of the people we see are migrants.

Then we can say that one-third of that could very well go to the migrants.

Senator WILLIAMS. Are there many programs similar to yours elsewhere in Texas?

Mr. GONZALEZ. Yes, sir. There is a big one in Hidalgo County, which is the biggest county, as far as migrants are concerned. Out of the approximately 105,000 migrants from south Texas that leave each year, 25,000 come from Hidalgo County alone. They have an excellent program.

Senator WILLIAMS. That is also on the border?

Mr. GONZALEZ. Yes, sir.

Senator WILLIAMS. Hidalgo?

Mr. GONZALEZ. Yes, sir.

Senator WILLIAMS. As is Laredo?

Mr. GONZALEZ. Right; yes, sir.

Senator WILLIAMS. What is the town across from Laredo? Reynosa? Mr. GONZALEZ. That is across from Hidalgo County, yes, Reynosa. Nuevo Laredo is across from Laredo.

Of course, I can only speak for Laredo, and there are differences. between the places where our migrants go to work to and the home base area.

But our end of the line is also very important. In many ways, the most important. If the Laredo migrant calls any place his home, it is Laredo, where he goes to spend the winter months and Christmas.

We firmly believe that the close association that our migrant health staff has had with them has given a little bit more meaning to the word "home." Everyone wants to be accepted somewhere, by somebody. You do not have to be cultured and educated to want to be-wanted.

The identification of this program as a migrant health program has done that for them. They have opened up, as they had never done before.

The primary goal of public health is to influence and motivate man's behavior. Before anyone can be motivated in doing what you want him to do, that person has to be influenced by the public health worker attempting it. And in this I believe our staff has been immensely successful. The migrants consider them their friends. They consider our clinic, their own clinic, to which they look forward to coming back the following winter.

This change that we are now seeing in many of our migrants has taken time, and it has not come easily. It has taken a continuous and persistent effort by our staff patiently working with the same families every year, after they get back home, and the migrant is responding.

He has not only found out that there is a health program that takes care of him and his family, but he knows that wherever he goes, this health department will insure that there is a proper followup for conditions requiring repeated medical attention.

One of the most encouraging things of all is that the migrant is now beginning to take responsibility for learning and applying better homemaking an personal health practices.

To be sure, the Laredo migrant is the unpardonable frustration of many a sociologist who contends that all Mexican-Americans would rather see a "curandero," or healer, than a medical doctor, and that they all believe in witchcraft, which is a lot of nonsense.

Witchcraft does exist, but to a very small extent. The curandero bit stems from their background. Most are descendants of people who came from the rural areas of Mexico, where there were few doctors, so some had to learn what do to in emergencies and rely on folk medicine.

Many still rely on folk medicines, when they cannot afford a doctor, but this does not cure their children or themselves when they really get sick. Folk medicines are not antibiotics-and many of them have now seen the effects of antibiotics. And they are seeing now that their children do not have to die when they get sick-even from serious illness and even when they are following the crops.

Just how much they believe in antibiotics, and in coming to see a medical doctor when one is available to them, physically and economically, is shown by the number of them that have attended our clinics since the program started.

Handout No. 2 shows a 3-year period, from 1964 to November 1967. We did not add a family health clinic until the second year of our grant, so data on migrants was not kept before. They have always been seen in our health department clinic, though not in such numbers.

Since 1964, 4,921 migrant persons have attended our general medical clinic. This clinic is financed mostly by local and State funds. Only 15 percent of the cost of the clinic is financed by the migrant health grant. Yet almost 30 percent of the people seen there are migrants.

Our migrant immunization clinic, staffed by our migrant health program nurses, has had 21,771 clinical visits in this period. Our tuberculosis control program, financed by other than migrant grant funds, has taken 1,469 X-rays of migrants during this time, though

the health educator, financed by the migrant program, has played a big hand in this.

Just to cite one more figure from handout No. 2, our dental health clinic for children, which I mentioned, financed entirely from other than migrant health grant funds, has seen 810 children of migrant families in the short period-15 months-that it has been operating.

Two of the most significant figures I have cited above are the close to 5,000 migrants, or members of migrant families, that have taken advantage of our general medical clinic, an enormous increase in migrant participation from years past.

The other one is the almost unbelievable figure of almost 22,000 clinical visits in our immunization program.

These figures do not include December of this year. December is always our biggest month.

The second part of handout No. 2 also shows some of the accomplishments of the migrant environmental health program. The interest shown by the migrants in our clinical requests has been matched by their enthusiam in cleaning up their yards and premises, and in complying with environmental health regulations.

Chief among the accomplishments of our project sanitarian has been the elimination of 132 privies from homes of migrants, with accompanying sewer connections.

The 1966 Texas m'grant labor report of the Good Neighbor Commission of Texas states that there has been a big increase in the number of families migrating out of Texas in 1965 and 1966 as a result of the termination of the Bracero Act in 1964. This is resulting in a cessation of competition from alien workers.

In 1964, the last year of the Bracero Act, only some 129,000 migrated. In 1965, a total of about 167,000, including migrants and their families, migrated, followed by 162,000 in 1966, and this year has been described as one of stabilization in the use and availability of farm labor in Texas.

Out of the 162,000 that migrated in 1966, about 129,600 migrated out of the State, and about 32,500 remained entirely in Texas. This then indicates an increase, if anything, in our work with the migrant.

The one matter that I firmly believe we have not perfected is actually one of the very first points considered when the original Texas-Michigan study was made health service continuity.

This has been a difficult problem, providing this continuity of health services on an interstate basis, particularly when many of the migrants do not even know where they are going to end up after they leave Laredo.

In all fairness, I believe that progress is finally being made in this regard, thanks to the State program in Austin, which is now demanding that all referrals from other States come through them, for a centralization of this most important item.

I feel that, in summary, the Migrant Health Act has accomplished more than it ever set out to do, in identifying this program as the migrant's very own. The more than 100,000 south Texas migrants of Mexican descent needed this slmost as much as they needed the longawaited and invaluable public health benefits the migrants are now finally receiving.

In providing the funds for additional personnel to our health department to conduct this program, the Migrant Health Act is not

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