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Protecting Vulnerable Workers: Profile of Matt Keifer, MD, MPH

Matt Keifer MD, MPH
Doctors -- in the US and around the world -- have very few tools at their disposal to actually make a diagnosis of a pesticide overexposure when it occurs.
Protecting Vulnerable Workers: Profile of Matt Keifer, MD, MPH

Matt Keifer, MD, MPH, has challenged himself with a number of roles in his diverse career -- university professor, researcher, clinician, scientific advisor, editor-in-chief. But all of his roles have centered around one goal: protecting vulnerable workers from occupational injuries and pesticide exposure. Board certified in internal medicine and occupational medicine, Dr. Keifer is internationally renowned for his vast expertise in the clinical care of patients exposed to pesticides, for his research on pesticide health effects, and for his advocacy work on behalf of worker health and safety. 

EARLY YEARS

He began his medical training in the Dominican Republic, where he studied for two years, finishing his final year at the University of Illinois and graduating as valedictorian of his class. After his residency at the University of Washington, he began working with Dr. Linda Rosenstock, a renowned occupational and environmental medicine specialist, on a project studying the neurobehavioral effects of pesticides.  This project led to two years in Nicaragua, where he conducted studies on pesticide underreporting in Central America and neurological effects of pesticide among US and Nicaraguan farmworkers. Seeing firsthand the severity of the injuries caused by pesticide poisonings and worker injustices was pivotal in motivating Dr. Keifer to devote many of his efforts to advocacy.

He began his medical training in the Dominican Republic, where he studied for two years, finishing his final year at the University of Illinois and graduating as valedictorian of his class. After his residency at the University of Washington, he began working with Dr. Linda Rosenstock, a renowned occupational and environmental medicine specialist, on a project studying the neurobehavioral effects of pesticides. This project led to two years in Nicaragua, where he conducted studies on pesticide underreporting in Central America and neurological effects of pesticide among US and Nicaraguan farmworkers. Seeing firsthand the severity of the injuries caused by pesticide poisonings and worker injustices was pivotal in motivating Dr. Keifer to devote many of his efforts to advocacy.

MCN KeiferIn 1992, Dr. Keifer became a full-time faculty member at the University of Washington in both the School of Public Health and Community Medicine and the School of Medicine. Shortly thereafter, he started an occupational clinic at the Yakima Valley Farmworkers Clinic, in the heart of Washington’s labor-intensive agricultural region, which he facilitated once a month for 14 years. His occupational clinic was one of the first in the country directly located in a Migrant and Community Health Center. 

About ten years ago, Dr. Keifer recalls, a patient came into the clinic, who had been diagnosed with asthma, but Dr. Keifer was unconvinced. “She was hyperventilating in response to certain stimula… particularly fire sirens and police sirens,” Dr. Keifer noted. Over the course of a few appointments, Dr. Keifer and the patient discovered the root cause of her problem: work-related trauma. The patient recounted an episode of carbon monoxide poisoning, in which a cherry packing facility where she had worked had taped up vents and windows, to prevent insect infestation in a shipment to Japan. Dr. Keifer was told that, at the time, Japan would reject shipments if even one insect was discovered, and consequently, packing facilities took extra measures to assure bugs stayed out. But those measures also assured that carbon monoxide from forklifts’ engines stayed in. Shortly after noon, Dr. Keifer said, “all the workers emptied out. They were passing out in the parking lot, passing out in the workplace, and falling over and throwing up. There were ambulances arriving. It was just total chaos, as she described it.” His final diagnosis was post-traumatic stress disorder and anxiety associated with stimuli that reminded her of the event.

Dr. Keifer would like to see this model continue throughout the country: “Migrant Health Centers should have regular and in-house access to occupational medicine,” he advised.

TO THE MIDWEST

In 2010, after over 25 years at the University of Washington, Dr. Keifer was offered an endowed chair at the National Farm Medicine Center in Wisconsin. After two years, he was asked to be the director. “We work quite closely with the farmers here on projects, working off their suggestions, developing projects to help them making their farms safer,” he explained. The center is “not a university, but it behaves as a university in terms of the research it does,” he said. It also raises money from donors to sponsor service activities to improve worker safety on farms. One example is the center’s rollover protection installation program, in which the center pays for 70 percent of an installation of rollover protection on farm tractors, for any farmer who applies. “Rollovers on tractors are the leading cause of death on farms in the United States. The rollover protection, when used with a seatbelt, is about 99 percent effective in preventing serious injury or death,” Dr. Keifer said. “This is a product of research.”

MCN KeiferSHARING HIS EXPERTISE

His firsthand knowledge of farmworker injury and exposure, his extensive understanding of the agricultural workplace, and his research background have allowed Dr. Keifer to strongly advocate for better pesticide regulation to protect farmworkers. He has served, and continues to serve, on a number of advisory committees regarding pesticide safety. His efforts in Washington State, including serving as principal scientist on a scientific advisory committee and providing testimony before the state supreme court, helped foster important worker protections to monitor pesticide applicators' levels of Cholinesterase, an enzyme that acts as a marker of exposure to certain pesticides like organophosphates and N-carbamates.  

He also serves on a federal advisory committee to the Environmental Protection Agency’s Office of Pesticide Programs, on the Methyl Bromide Subcommittee for the National Academy of Science. “It’s pretty inevitable that human beings are going to have some exposure to these chemicals,” even when exposures, like pesticide drift, are unintended. “And we know from the epidemiology that people actually get sick from them, not infrequently,” he added. “Doctors -- in the US and around the world -- have very few tools at their disposal to actually make a diagnosis of a pesticide overexposure when it occurs.” The pesticide manufacturer, however, has researched the chemical extensively by the time it is ready to go to market. 

Dr. Keifer’s work on the committee has centered on the idea that a pesticide company, when it registers a chemical with the EPA, could be obliged to provide a biomarker, “so physicians can make a diagnosis of overexposure, if one happens,” Dr. Keifer said. Amy Liebman, MCN’s Director of Environmental and Occupational Health, has also worked on this committee in the past, and MCN works closely with Dr. Keifer to advocate for biomarkers to improve clinical diagnosis. Representatives of the pesticide industry, however, have stalled the process.

Dr. Keifer recently completed work as a member of the National Academy of Science’s National Toxicology Program Committee, which reviewed California’s pesticide registration process. The final report has been submitted to the state. 

He is also developing a biomonitoring program as part of the President’s Malaria Initiative, an effort on behalf of President Obama through the United States Agency for International Development (USAID). The biomonitoring program will monitor pesticide levels in the blood of the workers applying pesticides to help control mosquitoes, in 21 countries around the world. 

Dr. Keifer feels the most pressing issue for the farmworker population is economic and social vulnerability, the “disequilibrium between the power they have socially and the power of the institution where the work,” he described.  

Dr. Keifer’s impressively lengthy list of accomplishments keeps getting longer. Still, he has found hope and inspiration from the simple interactions with the workers that he is working so tirelessly to protect. “I am inspired when I can work with a worker and we share the common goal of getting the worker back to work. There is harmony,” he explained. “The worker wants to get back to work, I want the worker back to work, and the employer wants the worker back to work.”

30 CLINICIANS MAKING A DIFFERENCE is a project celebrating Migrant Clinicians Network's 30th anniversary through the life stories of 30 clinicians making a difference in migrant health. Learn more about Migrant Clinicians Network.

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