HEALTH CARE

By Staff

Vol. 1, No. 4, 1979, pp. 20-21

Gayle Becker and Elaine Clark had been teaching nursing for over 16 years in an academic setting and felt the need to branch out into a different area of nursing.

"Last fall Gayle and I decided that initiating a program of health care to migrant workers in the Sand Mountain area of Alabama might not only be a service to the community, but would allow us to fulfill our needs for personal and professional development as sell as allow us a means to identify additional learning experiences for our students," said Clark.

The two of them applied for sabbatical leave for the spring and summer quarters and devoted the spring to upgrading their technical skills. They learned to speak Spanish, read hooks and magazine articles about migrant workers, and contacted appropriate individuals and agencies in DeKaIb County, which is tucked away in the northeastern corner of the state, bordered by Georgia to the east.

Alabamians have long considered the people of the region fiercely independent and as rugged as the land. It is from this land - rocks, dust and more rocks - that potato farmers gouge out their living.

The nurses held more than 40 individual conferences, placed more than 50 long distance telephone calls and wrote approximately 30 letters in preparation for the summer experience. The biggest problem - establishing a clinic - was overcome when the Rev. Milton Pope and his wife, Bela, offered to share their facility at the DeKaIb Baptist Mission in Rainsville. Migrant workers attended the mission on Friday evenings and Sunday mornings for worship services and the combined spiritual-physical setting was a harmonious pairing.

However, fact was to bear out that the bulk of their work consisted of traveling in either Becker's station wagon or Clark's compact car to the seven camps, all within a 30-mile radius of Rainsville.

"Although an estimated 4.000 migrant workers are in Alabama each year, this fact seems virtually unknown to most residents of the state," said Becker. "Needless to say, primary health care is extremely fragmented and secondary care is difficult to obtain. To compound the problems of the migrant worker, there are cultural and language difficulties that result in communication barriers with others."

The migrant workers' lack of money, lack of insurance, highly mobile state and cultural differences often result in difficulties when they attempt to enter the health care system. Migrant workers are paid for the hours they work. They do not receive pay during rainy days, poor crops, equipment breakdowns or visits to a physician.

"Federal aid is of little help," said Clark. "These people rarely spend more than six weeks in one location, and by the time paper work has been prepared, the workers have moved to a new location."

The remoteness of the camps and lack of telephone service presented additional problems to the nurses. What had been envisioned as a purely clinical setting by Becker and Clark grew almost immediately into an advocate role. Hours were spent on the telephone and in cars, driving to reach the correct person or agency dispensing needed money, information or transportation.

In accordance with physician guidelines, minor health problems such as colds, diarrhea and skin problems were treated at the clinic or at camp sites. Minor emergencies such as toothaches or more complex problems such as miscarriages and job injuries required referrals to physicians. A total of 115 individual clients were seen and 185 contacts were made with clients. The number included 44 women, 20 men, 45 children and six infants.

"The poor living conditions struck me first," said Becker. "Living facilities in one camp included converted chicken houses, an old school building and numerous shacks or abandoned houses. If the facility contained more than one small room, it usually was occupied by a number of families."

Both saw that in many instances the shelters had no sinks or window screens, and the usual furnishings consisted of a one- or two-eyed gas or electric burner, a dilapidated


Page 21

refrigerator and old bedding placed on concrete blocks or boards. One refrigerator often served a number of families.

Generally, children played in bare, dusty, wet or muddy yards. No playground equipment was available for them, forcing them to "make do" with whatever was available.

Lack of health insurance and retirement security are problems which need to be addressed, according to the nurses. "It seems difficult for the migrant worker to set security programs very high on his priority list, since he appears to view his major needs as those things which affect him from moment to moment," Clark said. "Planning for the future seems beyond his grasp."

"Health education is needed in such areas as basic hygiene, nutrition, family planning, environmental health control and preventive measures for good health," observed Becker. "Helping the individual to understand the need to prevent illness and injury in order to reduce absenteeism from work and curtail doctor bills is also a high priority need."

Almost all migrant workers receive minimum wage for hourly shed work and 15 cents per basket for potatoes gathered in the field. However, most migrant workers do not receive the full amount of pay because they are indebted to the crew leader for a certain percentage of their wages. The crew leader serves as interpreter for the nonEnglish speaking migrants, negotiator in determining wages and other essentials and an advocate in making arrangements for various jobs.

"We contacted a number of organizations and individuals throughout DeKaib County and the state in an attempt to obtain figures on the number of migrants in the area, but with no luck," said Clark. "Even the growers had no accurate records of their employees, but did give rather vague estimates, such as between 50 and 100.

"On the basis of these figures, we estimated there were about 650 migrants on Sand Mountain during the summer months with approximately 315 located in the seven camps we served," she added.

Clark and Becker now are working to convince officials at the University of Alabama School of Nursing that students might profit from a similar experience if it were to become part of the curriculum.

Other recommendations include procurement of a mobile clinic, development of day care centers for migrant children, development of a composite health record for migrants which could be carried with them from location to location, enforcement of building codes and environmental health requirements, and development of a transportation program for migrants and rural citizens who need health care in distant locations.