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By student from Miami, Rachel Becker
A paucity of literature provides an in-depth exploration of the mental and physical health of migrant workers. Researchers and clinicians have a variety of unanswered questions that could help them better serve this community, ranging from methods of health promotion to help-seeking behaviors to resiliency factors. High quality research will not only provide them with a better understanding of this population, but also assist them in tailoring their efforts and interventions.
Given the historical trauma, marginalization, and disenfranchisement of migrant workers, research frameworks must empower communities to have a strong voice in the focus, process, and dissemination of research. Without this type of paradigm, the best-intentioned research projects can maintain the status quo, silencing and pathologizing the community. Furthermore, without extensive community input the results of research might not have strong validity and applicability. In this article, we outline community-based participatory research (CBPR) methodology that privileges the needs and input of the community throughout the entire research process. We, undergraduate and graduate students at the University of Miami, are currently working with the Everglades Community Association (ECA; a migrant worker camp) and EnFamilia (a community organization that provides a wide range of services to ECA) to examine aspects of educational attainment and mental health. We will use our experiences in our current work to illustrate the core elements of CBPR and to provide other practitioners with ideas on how to incorporate these principles into their clinical work and research.
Before initiating research, we focused on building relationships with different community partners. By focusing on building alliances and identifying key stakeholders, CBPR ensures that researchers stay grounded in the community instead of locked away in ivory towers. The second step formalizes this process and provides a foundation of community input that will shape and guide the research throughout the project. During this stage, we formed a community advisory board (CAB). For us, this group included the heads of EnFamilia, who are not only service providers, but are also on the board for ECA. The CAB is a core guiding force that helps to ensure that the community’s needs, not those of outside groups (e.g., a university) or those only perceived by service providers, are the focus of research. Additionally, the CAB co-creates the focus of the research, data collection methods, analysis, and how the data will be reported and used within the community. In a fully developed article, we will outline each of these steps in more detail and illustrate each phase with lessons learned from our own experiences.
MCN Honors Workers on International Workers' Memorial Day, Children in Agriculture Have Unequal Protections
On the heels of International Worker Memorial Day, the day slated to honor the ultimate sacrifice of workers and families throughout the world, the Obama administration released a statement saying it will no longer pursue protections for children working in agriculture. MCN is deeply saddened that children working in agriculture still lack equal protections under the law as compared to children working in all other industries.
The Department of Labor’s (DOL)Wage and Hour Division (WHD) on Thursday announced it is withdrawing proposed revisions to child labor regulations in the Fair Labor Standards Act that would have provided additional protections to children hired for work in agriculture.
Protecting Working Children in Agriculture
Amy K. Liebman, director of MCN’s environmental and occupational health initiatives told Bloomberg's Occupational Safety and Health Reporter that the (Obama) administration still must address why children hired to work on farms do not have the same safety protection of youth in other jobs.
"This is a real disservice to the migrant child," Liebman told BNA April 27. "For any child who is employed (in agriculture), they are basically being neglected by this process."
The Fair Labor Standards Act sets age 12 as the legal limit for farm work with exemptions available for children as young as age 10 or 11, according to the National Center for Farmworker Health. The organization estimates that up to 300,000 children under age 18 perform dangerous and strenuous work on US farms, annually.
"We have a subpopulation of very young workers (in agriculture)," said Celeste Monforton, Assistant Research Professor in the Department of Environmental and Occupational Health at The George Washington University School of Public Health. "Public health science showed these youth workers were at risk and preventative measures could protect these workers," she said.
Migrant children and the children of migrant and seasonal farmworkers - who are often hired for work in agriculture - are particulary vulnerable to harsh working conditions and will continue to face unequal protections given DOL's announcement. Poverty, migration patterns, weak labor protections and disparate or a dearth of formal education leave migrant children and families few options.
In April, the National Children's Center for Rural and Agricultural Health and Safety published the 2012 National Blueprint for Protecting Children in Agriculture. MCN's Liebman was an author on the report, which outlines goals and strategies for reducing injuries and deaths among children on farms.
Proposed Child Labor Rules Changes
The proposed rules amended exisitng Hazardous Orders governing child labor in both agricultural and non-agricultural sectors and included provisions prohibiting children under 16 years of age hired for farm work from operating heavy machinery and performing certain high-hazard tasks.
Under the proposed revisions, hired children under 16 years of age would have been barred from working as pesticide handlers, operating trenchers or earthmoving equipment, fork lifts, potato and grain combines and tractors over 20 horsepower. Children would have also been excluded from work in manure pits or inside of fruit, forage or grain storage designed to retain an oxygen deficient or toxic atmosphere. The rules would have also prevented hired kids under 16 from driving a bus, truck or automobile when transporting other passengers and required tractors operated by children to be equiped with a Rollover Protection Structure.
Farms with less than 10 employees and children of farm owners or farm operators would have been exempt from the proposed rules changes. Additionally, the proposed rules afforded exemptions to youth involved in educational programs.
According to Monforton, the proposed child labor rules changes were under development for nearly 15 years were originally based on reports published by the National Institute of Occupational Safety and Health and the Institute of Medicine to bring parity between the protections afforded to children hired for work in agriculture and other industries.
Kids Still at Risk
In its statement, DOL said it will partner with industry stakeholders and organizations like 4-H "to develop an educational program to reduce accidents to young workers and promote safer agricultural working practices."
Monforton and others contend that the reason the rules were proposed is because injuries and deaths still occur even with voluntary education programs in place.
According to the National Farm Medicine Center's 2011 Childhood Agricultural Injuries Fact Sheet, agriculture has the second highest fatality rate among youth workers with 21.3 deaths per 100,000 full-time workers, compared to an average 3.6 deaths per 100,000 workers in all other industries.
- The Huffington Post published a story about the proposed rules.
- Celeste Monforton is an author at The Pump Handle blog
- Farmworker Justice published a blog post about the DOL reversal.
I was amazed today to be copied on an email about a big concern about the emergency response of the influenza team in Eastern Europe. I was copied because of the possibility that we may need to quickly mobilize a training of rural providers on the recognition and treatment of the potential severe complications of H1N1.
It is rather fascinating now how the world has become smaller and smaller and that communications are so rapid that literally on a daily basis we are getting very accurate reports of severe outbreaks in small communities all over the world.
I have also been present for some very high level discussions about how much where resources should be deployed. Like any other large organization it is astonishing to see that at WHO sometimes petty politics and personalities get in the way of rational evidence based science and humanitarian response.
I just found out that I will be presenting the results of our training efforts and the concept of the Clinicians Manual at an annual clinical meeting of the Asian component of the WHO in Manila in about 10 days and will also be doing a full day training of the manual at the IUATLD in Cancun in December. It also amazes me how in just 2 months they have managed to insert me into a very responsible role here and I see the same thing happening with my colleagues especially this incredible family physician from South Africa who has only been here since June after 23 years on the front lines in the "bush" dealing with a population with almost a 40% HIV positive rate and tons of MDR and now XDRTB.
Dr. Ed Zuroweste, MCN’s Cheif Medical Officer, has been deployed to the World Health Organization (WHO) in Geneva, Switzerland for four months to assist healthcare providers in limited resource settings.
The WHO asked Dr. Zuroweste to serve as a Special Medical Consultant to assist with revision and field testing of the WHO Clinicians Manual for the treatment of the most common diseases in adults in limited resource setting. The manual places particular emphasis on emergency treatment of complications of the H1N1 (Swine flu) influenza. The WHO team has just finished the first pilot testing of the manual in Uganda and Dr. Zuroweste will be a part of the next phase of testing in Ethiopia. He is also likely to be conducting field tests of the teaching of the manual in Asia and other parts of Africa.
The WHO specifically sought out a primary care physician with experience working in low resource communities both in the US and abroad. Dr. Zuroweste’s 20 plus years of providing migrant care, extensive background in offering technical assistance to migrant health centers and clinicians on the front lines, the impressive success of MCN’s Health Network and his work in Honduras teaching Johns Hopkins medical students in an impoverished rural sector of the country all contributed to his selection for this assignment.
We are all very excited about this opportunity and challenge and eagerly await updates from Dr. Zuroweste as he travels the world! Stay tuned for periodic updates from Dr. Zuroweste from his international assignment.