Apple a day: Health care providers struggle to treat migrant workers

Hundreds of migrants—the majority of them Latinos here legally on work visas—work in Central Virginia’s orchards each fall. This year, a lack of funds meant their best option for low-cost medical care wasn’t available. Photo: Jack Looney Hundreds of migrants—the majority of them Latinos here legally on work visas—work in Central Virginia’s orchards each fall. This year, a lack of funds meant their best option for low-cost medical care wasn’t available. Photo: Jack Looney

The several hundred migrant workers who flood Albemarle and surrounding counties every apple season have come and gone. But the community of nonprofit health care providers that supports them each season is already thinking about next year.

The Blue Ridge Medical Center (BRMC), which provides medical care to more than 10,000 patients each year in some of the most rural and impoverished areas surrounding Charlottesville, has been using its mobile clinic since 1999 to serve many who would otherwise go untreated, including migrant farm workers. Strapped for cash due to a lack of donations, the nonprofit wasn’t able to send its mobile health clinic into the orchards in Albemarle and Nelson counties to serve permanent and migrant orchard workers during the picking season, leaving an unknown number of people in a dangerous line of work underserved.

There are seven major migrant camps and extension camps in Albemarle County, ranging in size from about a dozen workers to about 60, with a couple of hundred more workers in the Nelson area orchards for the season, which ended last week. According to police, health care workers, immigrant rights advocates, and the workers themselves, the vast majority of the migrants travel legally from Mexico to Virginia on H2A agricultural visas requested on an individual basis by orchard owners. But upon arriving in the state, they are met with a series of obstacles. Most of the workers are unable to buy or rent a car while they are in the country because of financial constraints, so they are dependent exclusively on the orchard owners for transportation: to get groceries, go to the post office, and get health care treatment.

“Transportation is limited for guest workers who come from outside of the country,” said Christianne Queiroz, program director for the Virginia Farm Workers. “They usually have to depend on their employer, but that’s limited to one time a week for a trip to the grocery store. Farm work is one of the most dangerous professions in the country and people are really in need of medical care, whether it’s preventative or something more serious.”

Many of the orchard workers don’t speak English well, which makes communicating and interacting in the surrounding communities difficult. As a result, migrant workers often feel isolated and unable to seek out services like medical care.

And they need it. Exposure to pesticides is constant among farm workers and the harmful effects that can arise as a result often go overlooked outside of the farms and orchards themselves. Health care advocates say part of the problem is ignorance of the chemical and pesticide world within the medical field.

“One of the things I’d really like to see are doctors specializing in detecting pesticides so people could be treated and could develop claims for pesticide poisoning,” said Queiroz, at a recent Hispanic Services Summit held at the BRMC’s facility on Route 29 where legal experts, health care providers, and representatives from a local church and orchard met to discuss how the Latino and migrant farm working populations can be better served.

“We’ve had people with rashes,” said Queiroz. “And doctors are not generally trained to address that specific cause, so they feel a little reluctant to affirm that something is caused by pesticides when it can be caused by so many other things.”

Several farm workers interviewed for this story said they either personally experienced a rash from working closely with pesticides or knew of coworkers who had, but none of them would go on the record for fear of losing their jobs next year. Others in the health care community have been told by orchard owners that they are not allowed to visit their private farms during certain periods.

In an effort to break through cultural, linguistic, and geographical barriers to ensure the farm workers get the health care services they need, the Blue Ridge Medical Center has been carting around its mobile unit, which resembles a giant moving truck housing a sleek exam room and medical supplies.

But this year, according to center Executive Director Peggy Whitehead, BRMC couldn’t afford to hire the nurse practitioner who typically accompanies the mobile clinic. With only 18 percent of its budget coming from federal funds, the medical center has relied on grants and donations from area residents and farms. But they didn’t come through in the numbers necessary this year.

“Everything we do on the outreach level is funded through grants and donations,” said Whitehead. “And that’s getting a bit more difficult to come up with. We do a really good job of getting services to people now, but in the future I see more and more difficulty finding the funding to make that happen.”

The Lovingston-based center has tried to keep up with the area’s needs. But with limited funds, it had to prioritize its services to orchards closest to its home base. As a result, hundreds of local farm workers likely never saw a visit from a health care provider this fall.

One orchard worker, who has lived in the area for years and did not want to be named, said she heard the center was short staffed and wasn’t accepting new patients. Luckily, she said, the orchard reached out to the center directly, which ultimately sent a health care worker to the camp. But other area camps had received similar word about the center’s financial state and likely did not inquire further, the worker said.

The center charges the poorest of its clients—which include most migrant workers—about $30 per visit, which covers lab and diagnostic work as well. Some in the Latino community have suggested that the orchard owners themselves pony up money for the medical center as a makeshift health insurance plan for their employees. But Whitehead and the center’s head of its rural health outreach program, Vanessa Hale, stressed that these are not huge corporate farms. They are mom-and-pop operations with relatively low bottom lines.

“These growers, while they’re big for Nelson and Albemarle County, they’re still small family farms,” said Hale. “I’m not saying they couldn’t pay more for the service they receive. However, it’s not like it’s some huge multinational corporation grinding down on these workers. It’s more complicated than that.”

To bolster their ranks, Hale oversees eight health promoters at the Blue Ridge Medical Center who volunteered more than 350 hours this year to visit with migrant and permanent farm workers at the various camps, determining their needs while giving them information about various health care issues like diabetes, high blood pressure, and obesity risks.

Henry Chiles, who owns the Chiles family orchards, said he and his managers try to make sure all of their workers get the health care access they need, providing them with transportation if need be.

“As far as I know, everyone’s been taken care of and is in good shape,” said Chiles.

And there’s hope that the underfunded BRMC program will be back on wheels next year. Whitehead said the group has hired a part-time bilingual nurse practitioner, and that the provider shortage shouldn’t exist next year

“By the time we get to the season again next year, we should be in great shape,” she said. “It shouldn’t be so difficult.”