Doctors within borders: meeting the health care needs of migrant farm workers in Canada

Abstract

José, a migrant farm worker from Mexico, presents with a one-month history of low back pain. Through broken English and Spanish, he tells you that he has been in Canada for three months working on an asparagus farm. For the past six weeks, he has been spending 10 hours per day, six days per week, bent over cutting asparagus spears. José's boss has his health card. Because José is only in town every Friday night to shop for groceries, he is not available when the radiology clinic and laboratory are open. Recognizing that his condition is related to his work, you wonder about filing a claim with the Workers' Compensation Board. José has difficulty understanding what this means, but clearly does not want his employer to know that he has a sore back. He simply wants pills to help ease the pain. He is unsure of whether he has insurance coverage for medications and wants the least expensive medicine. You write out instructions for an over-the-counter antiinflammatory medication and direct him to a pharmacy. This patient's unique circumstances have raised a number of unanswered questions.

Medical repatriation of migrant farm workers in Ontario: a descriptive analysis

“…[10][11][12][13] Toxic exposures, lack of occupational health regulation and enforcement, frequent use and poor maintenance of hazardous equipment, poor housing conditions, increased occupational risk taking and chronic stress have been identified in this population. [14][15][16][17][18] Our data align with existing studies of the health of migrant farm workers by showing that injuries, musculoskeletal and gastrointestinal problems account for the majority of illnesses in this population.…”

“…Migrant farm workers in Canada face multiple barriers to accessing health care including workers' reluctance to seek this assistance; lack of independent transportation; language and cultural differences; lack of knowledge about the health care system; long work hours and limited clinic hours; and repatriation following illnesses or injuries. 13 Fear of employers or not wanting to lose paid work hours, as well as inadequate knowledge about how to make a workers' compensation claim, have also been cited as common factors impeding access to care. …”

How Should Physicians Help Patients Who Are Ill Because They Work in Agriculture?

“…Additionally, clinicians should provide migrant workers with easy-to-read and understand information in their native language about how to reduce exposure through use of protective equipment, more frequent hand washing and showering, and laundering of clothes. [12][13][14] Never assume that basic measures are feasible. Instead, ask about the patient's access to (and training on) safety equipment and access to washing facilities and clean clothes.…”

“…Language barriers, situational discomfort, and below-average health literacy might add layers of difficulty. 12 Thus, it is useful for clinicians to build a network and provide referrals to physicians, pharmacies, counselors, translators, and other health care workers who also provide culturally competent care.…”

Cultivating Equitable Ground: Community-based Participatory Research To Connect Food Movements with Migrant Farmworkers

“…Initiatives to advance farmworker health and safety are strongly grounded in the priorities voiced by farmworkers, along with a wealth of evidence about farmworker health and safety inequities in Ontario and accompanying proposals for policy solutions (McLaughlin, Hennebry, Cole, & Williams, 2014;Pysklywec, McLaughlin, Tew, & Haines, 2011). Numerous collaborative farmworker health initiatives involving academics, health practitioners, and civil society groups have made headway in Ontario, such as migrant farmworker health clinics that have been granted pilot funding by provincial health authorities.…”