Topics: Health Disparities, Public Health
By Phil Galewitz
KHN Staff Writer
Jun 06, 2012
This story was produced in collaboration with
SLOCOMB, Ala. — Many of the Mexican men and women picking green beans, peaches and strawberries in this lush, southeast corner of the state are fearful about seeking health care since a tough new immigration law was enacted last year.
Caseworker Rafael Carcache, who emigrated from Nicaragua, takes Josephina Sanches' blood pressure in the field. (AP Photo for USA Today and KHN/Butch Dill)
Marisela Clemente, outreach coordinator from Slocomb Family Health Center, is trying to ease those fears —one farm at a time. She joins eight workers taking a break at a shaded picnic table at 150-acre Aplin Farms. Dressed in blue scrubs, she jokes with the men and women in Spanish, asks after their health and urges them to visit the nearby migrant clinic where the staff speaks their language and no proof of citizenship is required.
"We have to go to them because they are afraid to come here to the clinic," says Clemente, describing workers' worries they will be stopped by police and asked for papers.
Such clinics, part of a 50-year-old federally funded program to treat migrant and seasonal farmworkers, have become the latest flash points in the national immigration debate. Health center officials across the country describe how local, state and national law enforcement authorities have staked out migrant clinics, detained staff members transporting patients to medical appointments and set up roadblocks near their facilities and health fairs as part of immigration crackdowns.
"We are looking at a growing climate of fear where folks really think long and hard about accessing basic services," says Milton Butterworth, who oversees outreach migrant health services for Blue Ridge Community Health Services in Hendersonville, N.C.
Even many legal workers do not seek care at the health centers because they are fearful of exposing family members who are not legal residents, says Tara Plese, a spokeswoman for the Arizona Association of Community Health Centers. "There is a big fear factor and it's a big concern from a public health perspective."
Those concerns include making sure farmworkers' children are vaccinated, stopping the spread of infectious diseases like AIDS and treating those with chronic problems such as diabetes, officials say. Many farmworkers avoid seeking care except in emergencies.
Federal Aid Opposed
Supporters of the nation's 156 migrant clinics, which are typically part of community health centers, say caring for all farmworkers helps protect them as well as the public -- and is a humane way to treat three million people toiling at the heart of the nation's food supply. About half of those are illegal immigrants, according to the latest federal survey of agricultural workers conducted in 2009.
"Migrant health centers continue to help ensure the safety of the nation's food supply by keeping those who harvest it healthy," Jim Macrae, associate administrator of the U.S. Health Resources and Services Administration said in a statement.
Lucero Sitz, an AIDS outreach worker, accompanies clinic staff on a recent visit to Aplin Farms where farmworkers were picking peaches. She talks to workers on their breaks about preventing sexually transmitted diseases, and performs HIV swab tests. (AP Photo for USA Today and KHN /Butch Dill)
But conservative groups say the federal government should not be footing the bill for those here illegally, except in emergencies. "These people have a responsibility to take care of their own health needs … and not stick American taxpayers with this obligation," says Ira Mehlman, spokesman for the Federation for American Immigration Reform, which seeks stricter immigration laws.
In 2010, the federal government spent $166 million to help care for nearly 900,000 migrant and seasonal farmworkers, – a slight dip in the number of workers after years of steady growth. Last year, it also awarded about $8.5 million to support expanded preventive and primary health care at 23 existing health centers and two new ones to treat all underserved populations, including migrants.
In addition, workers pay on a sliding scale, with an average visit in southeast Alabama costing about $30.
About half of farmworkers use health services in the United States, according to the latest U.S. Labor Department survey of agriculture workers. Most are poor, lack health insurance and don't speak English.
Health center officials in several states say they have felt the effects of increased immigration enforcement.
--A November 2011 report by the Florida Association of Community Health Centers found that crackdown fears kept workers from getting care at centers in Alabama, Florida and Georgia.
"There have been credible reports of road blocks and raids near health clinics, giving farmworkers good reason to be afraid," the report said. "Eighty-two percent of (surveyed migrant health providers) indicated that in the past year there have been incidents of farmworkers or immigrants in their area being arrested or intercepted in the process of accessing healthcare services."
--The number of farmworkers seen at Collier Health Services, based in the southwestern Florida town of Immokalee, dropped 22 percent, or nearly 5,000, last year, says Executive Vice President Steve Weinman. He says part of the reason is an increased police presence and random roadblocks.
"People are afraid to be caught outside driving around …," he says, "and that's definitely had an impact."
--A Georgia migrant center now transports only six passengers in its 15- passenger van to avoid being subject to documentation requirements on commercial carriers, according to a report by the Migrant Clinicians Network, an advocacy group.
--Karen Watt, a farm owner who sits on the board of Oak Orchard Community Health Center, a migrant health center in Brockport, N.Y., near Lake Ontario, says she's increasingly noticed border patrol vehicles. "They park right across the street from our center," discouraging farmworkers from seeking care, she says.
--In December, a caseworker for Finger Lakes Migrant & Community Health in upstate New York, was pulled over by federal border patrol agents while driving two farmworkers to a dentist. She was handcuffed, detained for several hours and accused of transporting illegal immigrants. The farmworkers were taken to a detention center. While the case worker was not arrested, CEO Mary Zelazny says the incident shook up the staff.
Daniel Hiebert, U.S. Border Patrol deputy chief patrol agent in Buffalo, says the case was a "single incident," and not part of a crackdown on providers who treat farmworkers. But he notes it is illegal to transport illegal immigrants, whether knowingly or not.
Gillian Christensen, a spokeswoman for the U.S. Immigration and Customs Enforcement, also denies that her agency targets clinics to find illegal immigrants.
Since Alabama's law took effect last September (although several provisions are blocked pending court review), the Slocomb health center has seen a change. That same month, the clinic's annual health fair at a local church drew 74 people, instead of the 300 of previous years.
"People feared immigration services would be there," says Melissa Bradford of Southeast Alabama Rural Health Associates, which runs 10 facilities including the one in Slocomb.
Caseworker Rafael Carcache walks into the fields with Lucero Sitz to talk to farmworkers. The providers keep records of health tests done in the field. Those can help when farmworkers come to the clinic in downtown Slocomb. (AP Photo for USA Today and KHN /Butch Dill)
The falling numbers trouble Dr. Justin Hovey the Slocomb clinic's only doctor. "I have a problem with any obstacles that make it more difficult for me as a physician to do my job," he says.
Clemente's outreach work is even more important these days. Often, she travels to farms with a colleague who performs an HIV swab test, and checks blood pressure and blood glucose levels —all for free. Many of the farmworkers trust her with questions about their health, their kids or almost anything else. Her visits typically bring in dozens of new patients each month seeking treatment for diabetes, high blood pressure and a host of orthopedic problems.
Clemente also teaches workers about bike safety, heat stroke, and dangers of pesticides, domestic abuse and sexually transmitted diseases.
Maria Lopez, who has worked at Aplin Farms for several years, credits the center for helping treat her back pain and arthritis. "They are very good for me," she says.
Another booster is John Aplin, whose family owns Aplin Farms. He says he welcomes clinic staff because they help keep his workers healthy.
Aplin observes that state troopers have set up roadblocks nearby. "They say they are looking for drugs, but we know who they are really looking for," he says.
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