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. 

   Deaths among kids working in agriculture have occurred in areas the now scrubbed rules sought to address, including kids working in grain handling operations and kids working with heavy machinery.

• 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. 

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During the month of March, MCN is taking the opportunity to share with you a series of blog posts about poisonings and poison prevention. This week marks the 50th Anniversary of National Poison Prevention Week and MCN wants to highlight a range of topics around this emerging issue.

Poisonings became the leading cause of injury death in the United States in 2008 and nearly 9 of 10 poisoning deaths are now caused by drugs, according to a December 2011 Centers for Disease Control and Prevention report.

The CDC defines a poison as any substance that is harmful to the body when ingested, inhaled, injected or absorbed through the skin. Unintentional poisonings occur when the individual exposed to the substance is not attempting to cause harm to themselves or others.

The nation's 57 Poison Control Centers fielded more than 2.4 million calls related to human poison exposuresArizona, Florida, Louisiana, New Mexico, Tennessee and Washington were among 20 states in which the poisoning death rate was significantly higher than the national average rate of 13.4 deaths per 100,000 persons, according to the report. Poisoning was the leading cause of injury death in 30 US states, 14 of which boasted a poisoning death rate above the national average.

A North Carolina Department of Health and Human Services 2010 study reports that unintentional poisonings in that state exceeded deaths from hypertension, atherosclerosis, homicide, HIV and liver disease.

Unintentional Drug Poisonings and Deaths

The rate of deaths due to unintentional drug poisonings more than doubled in a ten-year period, rising from 4 deaths per 100,000 persons in 1999 to 9.2 in 2008, according to the CDC report.

CDC data shows drug poisoning deaths have remained steady over a 10 year period from 1999 – 2008 among Hispanic populations, but rose sharply among non-Hispanic white, American Indian and Alaska Native populations. The rate of drug poisoning deaths involving opiod analgesics saw a 40 percent increase during this same period increasing from about 4,000 to 14,800, accounting for 40 percent of drug-related poisonings in 2008.

Children Are At-Risk for Poisonings

Children are not immune from dangers of unintentional poisonings and exposure. According to the Maryland Poison Center website, more than 1 million suspected poisoning exposures in children ages 6 and younger are reported to poison centers across the country annually and more than half of all poison exposures occur in children.

Children too suffer from unintentional poisonings and deaths from medications. Safe Kids USA, in its March 2012 report on medications and child safety, finds that unintentional child poisoning deaths due to medications nearly doubled between 1979 and 2006, increasing from 36 percent to 64 percent.  In Washington State, cosmetics, analgesics, household cleaning substances, foreign items (toys, miscellaneous) and topical preparations were the top five sources of poison exposures in children under six years of age.

How to report a suspected poisoning?

Call 1-800-222-1222 to contact your local Poison Control Center (services provided in 150 languages).

CLINICIANS: Suspect a pesticide exposure? Use MCN's Pesticide Reporting Map to learn how to report pesticide exposures in your state.

MCN and others have several online resources to educate people about poisoning and prevention.

• Conozca a sus medicamentos is an educational podcast conveying the importance of being aware of and sharing information about medications.
• Poco Veneno… ¿No Mata? is one of several of MCN's educational Spanish language comic books with information about preventing pesticide poisonings.
• The website KidsHealth offers tips for preventing poisonings among children.
• The EPA offers tips to help prevent pesticide poisonings in the home.

The National Poisoning Data System Top 10 Human Exposure Categories for Pharmaceuticals:

1. Benzodiazepines
2. Ibuprofen
3. Other Antihistamines Alone
4. Selective Serotonin Reuptake Inhibitors
5. Atypical Antipsychotics
6. Diaper Care and Rash Products
7. Ethanol (Beverages)
8. Systematic Antibiotic Preparations (Oral, Intravenous, Intramuscular)
9. Acetaminophen (alone, adult)
10. Diphenhydramine (alone, unknown if OTC or RX)

Each year the CDC holds a national poster contest for to help engage youth in poison prevention. You can see this year's winning poster from an 8th grader in North Carolina.

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Article from Streamline, November - December, Issue: Volume 16, Issue 6

MCN- Carolyn Davis, Family Nurse Practitioner, was awarded the Steve Shore Community Catalyst Award at the 2010 East Coast Migrant Stream Forum that took place in Charleston, SC, in October of this year. I first met Carolyn in 1997, when a group of us at MCN embarked on an epic journey in a rented RV from Austin, Texas to Ashville, North Carolina for another East Coast Migrant Stream Forum. I was five months pregnant with my first child, my husband was the volunteer driver, and along with three other women from the staff we set off for a two-week tour of health centers in seven southeastern states.

Our adventures were nearly halted in Eutaw, Alabama, when we realized that the shoestring operation we’d used to rent the RV didn’t actually have insurance that covered us. But our intrepid leader, Karen Mountain, figured out some way around that hurdle from her post in Austin and we continued eastward.

Every stop along the way was unique and we were awed by the creativity and dedication we witnessed at each subsequent health center. On day six we rolled into Beaufort, South Carolina, a bit road weary and overwhelmed by all we had seen. We parked our monstrous RV in the parking lot of Beaufort Jasper Hampton Comprehensive Health Services, Inc. and were met in the waiting room by the Migrant Health Coordinator, Carolyn Davis, the most gracious and enthusiastic person we had yet encountered in a trip full of wonderful people. Carolyn took one look at us and declared us in dire need of the best local fare. We followed her out through the beautiful flat coastal lowlands to a hole-in-thewall on the dock called The Shrimp Shack. The “Shack” specializes in shrimp burgers made from the fresh catch hauled onto the dock daily. Unfortunately they will not reveal their recipe, but to this day that is one of the best meals I have ever had.

Beaufort Jasper Hampton Comprehensive Health Services, Inc. is located in the midst of the “low country” of South Carolina. This is a beautiful part of the United States; a land of spreading moss-covered oak trees, palmettos and thousands of acres of stately southern pine. The marshy coastal region is made up of many small islands, including exclusive resort islands such as Hilton Head. From her home on a nearby island, Carolyn can hear the guns from the Marine training grounds on the neighboring Parris Island.

This region is also known for its agriculture, particularly for tomatoes and watermelon in the summer with winter vegetable crops such as winter squash, collard greens and sweet potatoes. Unlike some other regions of the country, the crops in this area of South Carolina are still largely worked by migrant farmworkers, many of whom travel up from Florida, others of whom come from Mexico, Central America, or Texas. Most of the migrants in this region are Hispanic families and young single people; however there is still a contingent of Haitian workers who primarily work in the packing sheds. Once the picking season is over in the Beaufort Jasper area, many of the same farmworkers travel further north to the Delmarva Peninsula where the season begins a couple of months later.

While agricultural employment has remained stable in this region, in recent years many migrants have also found work in the booming construction industry, particularly in the upscale resorts of the barrier islands. The increase in luxury housing on the barriers islands has moved more of the agricultural production inland. As Carolyn says, the islands now “grow more condos then veggies”.

Carolyn Davis did not start her career with the intention of working with migrant farmworkers. The daughter of a career Navy man, she moved regularly as a child, graduating from high school in Guantanamo Bay, Cuba. She received an associate degree in nursing from Florida Junior College, eventually graduating from the University of South Carolina with a BA and a Masters in Nursing. At that point she went to work for the local county hospital where she was the Director of Nursing.

In the early 1980’s, for a variety of reasons, Carolyn was looking for a change. She decided to explore the world of community health and left her job with the hospital to work for Beaufort Jasper Hampton Comprehensive Health Services, Inc. At the time she was unaware that there were even migrants in the area. The only thing she knew was that during the summer months hospital emergency room staff saw a jump in the number of people coming in. It took her only eight weeks to fall in love with the work and she has worked as the director of the migrant health program since that time. In addition to being the Migrant Health Coordinator, Carolyn was also
appointed the Director of Nursing for the health center. In the mid-90’s Carolyn went back to school and received her family nurse practitioner degree from the Medical University of South Carolina.

The migrant health program at Beaufort Jasper has grown tremendously and now serves farmworkers from three counties and a large number of migrant camps. The program runs year-round, but the biggest push comes during the 6-8 weeks of harvest time when there is a large influx of migrant workers. During this time, Carolyn brings in many different professionals from the community and the clinic to provide a wide array of services to the migrant patients. Most of these services are provided during the night clinic where they have seen as many as 87 people in one night. Carolyn says that the night clinic is “controlled chaos that somehow works”. She typically has people lining up to work in the migrant program long before the season begins.

In addition to the clinic time, Carolyn runs a number of outreach efforts in the migrant camps throughout the region. Outreach in the camps includes health education, screenings and mini physicals. When doing outreach, Carolyn often serves a number of different roles including advocacy, screening and referrals for further care.

One night a health center outreach worker called Carolyn in a panic to say that some of the farmworkers had been attacked by several members of the community. Carolyn drove out to the camp to investigate the situation and determined that everyone was safe and not badly injured. While there the farmworkers gave her a dog that had been traveling with them since Florida. She named the dog Dempsi, after the camp where the farmworkers had been living. Since that time she has rescued several other dogs from the camps.

Carolyn says that over the course of her career some things have improved for the migrant population while others have worsened. She believes that some of the prevention messages have made a real impact, especially in decreasing rates of sexually transmitted diseases and acute pesticide poisonings. At the same time, the migrants she sees continue to suffer from a number of musculoskeletal problems, dehydration and fatigue. Additionally, she sees more and more chronic disease, mirroring what is happening throughout the rest of the country, except that the patients she treats are often sicker and harder to manage. Finding specialty care is particularly difficult and Carolyn has to employ a number of different strategies to get people into care that they need.

A positive development has been the health center’s increasing use of MCN’s Health Network to help manage and track mobile patients. Carolyn says that Health Network “is a must for all of our diabetic patients, people with tuberculosis, our prenatal patients and anyone we screen for cancer.” In the past Carolyn says that she would have put off doing a mammogram for a woman she knew would be traveling soon, but since the advent of Health Network she knows that she will be able to find the woman and get her in care if necessary. Rosa Navarro, from the North Carolina Community Health Center Association (NCCHCA) tells the following story about Carolyn.

”When for any reason, she gets discouraged, she looks for a tree. Looking at a tree reminds her of one of the many individuals she has served. In 1986 during an evening clinic, a week before a group of farmworkers were scheduled to leave South Carolina, the physician noticed that a young man was having difficulty seeing. A visual test and health history revealed that he was almost blind and had been that way since childhood. He was able to work because he learned to use his other senses and because he had help from his co-workers. She remembered securing immediate, free consultation with an ophthalmologist by working with a local church to pay for glasses. When the young man used his eyeglasses, for the first time he noted the large object outside the window and exclaimed ‘tree’! This was the first time he had actually seen one in its entirety. Because he had never seen clearly in his life, he even had difficulty walking. Carolyn held his hand as he took his first unsteady steps. The sense of accomplishment has never abandoned Carolyn, because she believes that if she can help one person to see a tree for a first time, she can certainly line up the stars again to increase access and continuity of care for other farmworkers.”

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Excerpt of this article taken from: Liebman, Amy K. and Augustave, Wilson 'Agricultural Health and Safety: Incorporating the Worker Perspective', Journal of Agromedicine, 15:3, 192 - 199

“We are proud to be farmworkers and proud to work. We are not looking for handouts. Work gives us dignity. At the same time, when policies and laws are decided, it is important that you please include us in that process. It is more dignifying that way.” - Wilson Augustave

(c)earldotter.com

In the United States there are between 1 and 2.5 million hired farmworkers,1,2 who earn their living from agriculture, one of the most hazardous occupations in this country.3 Largely from Mexico and other Central American countries, hired farmworkers make up approximately a third of the farm labor work force.1 In addition to hazards such as working with heavy machinery and arduous physical labor, farmworkers endure exposure to pesticides, risk of heat illness, and often inadequate sanitary and housing facilities. Factors such as lack of training, poor safety precautions, language barriers, piece-rate pay, undocumented worker status, and geographical and cultural isolation can put these workers at increased risk for occupationally related injuries and illnesses and abuses. Farmworkers also face obstacles in obtaining health care due to high costs, lack of insurance, geographical isolation, and language as well as cultural barriers.

Despite the inherent dangers of farm work and the unique vulnerabilities of farmworkers, US health and safety regulations and labor laws for agriculture offer less protection to farm laborers than workers in other industries. There is a long history of farmworker exceptionalism under the law. However, this was not always the case. In the 19th century, living and working conditions in agriculture were not strikingly different than in other industries. Work in many industries, including agriculture, was characterized by hazardous and often primitive working conditions, long hours, and meager wages. Child labor was common and many workers endured extreme poverty. Immigrants, willing to accept low wages and dangerous work, supplied the labor for both agriculture and other industries.4 As other industries began to see greater protection, agriculture remained unchanged.

Reforms made during the Progressive Era through the New Deal period had a dramatic impact that transformed industrial labor in the 20th century. Child labor was prohibited or severely restricted in most industries. Overtime pay requirements helped limit the number of hours worked and minimum wage laws helped lift many laborers from crushing poverty. Workers' compensation laws ensured that workers injured on the job received medical care and payment for lost income. Moreover, industrial workers were granted the right to collectively bargain and be protected from employer reprisals. As a result of these changes, the standard of living of industrial workers improved dramatically.4

Download the full article Liebman, Amy K. and Augustave, Wilson 'Agricultural Health and Safety: Incorporating the Worker Perspective', Journal of Agromedicine, 15:3, 192 - 199

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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.

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