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Dennis Penzell, Florida
A professional career in migrant health entails some of the most challenging patients as well as medical and social complexities which can be found in contemporary medicine.
A new provider is first challenged by a culture with beliefs and practices foreign to their own and frequently contradictory to the dogma of our professional education. A clear understanding of how these beliefs interplay with a diagnostic and treatment regimen is essential to establishing and maintaining wellness and the successful treatment of the patient. Sensitivity, respect and acknowledgment of those beliefs is essential in establishing trust and rapport.
The new provider is challenged, secondly, by the living and social situations or our migrant patients. These are quite different from those situations of patients cared for during professional school and postgraduate training. The lack of adequate housing, appropriate sanitary conditions, refrigeration, heat and air conditioning play an integral part in the complexities of caring for our patients.
The third unique aspect of medicine which a new clinician will confront is the exposure of our patients to chemicals, pesticides and other toxic materials in the environment. Probably the most dramatic, emotional, and challenging experience I have faced during my career with migrant and seasonal farmworkers occurred during the treatment and follow up of 84 migrant workers following the largest pesticide accident to occur in Florida and possibly the country. This incident dramatized many of the issues and problems seem by clinicians in migrant health, including lack of education on health issues (protective clothing, food washing, reentering sprayed fields too soon). The deficiencies in our legal system regarding the protection of farmworkers was exemplified by the shortage of investigators and the lack of enforcement of existing laws regarding worker safety and health.
These deficiencies were, however, balanced by the faith, trust, respect and confidence the farmworkers placed in myself and our staff. This was a most gratifying experience. Several elderly patients were specially accommodated with regard to scheduling, etc. due to multiple health problems. I explained that I was here for them, that they were my patients, and were important to me. They then began to cry. I guess no one had ever taken an interest in their lives, their health, and their well-being. Had anyone ever related to them as human beings?
By far the greatest rewards of this profession are the gratitude, the appreciation, and the thanks we receive from our migrant patients. In no other professional experience have I felt the affection, respect and warmth that I feel with these clients.
Finally, working in migrant health medicine allows me the opportunity to teach medical students and residents about farmworkers, to open their eyes not only to the medical and social necessities, but to nurture the compassion and sensitivity necessary to work with farmworkers. This will carry over to their work with other ethnic groups, minorities, and people of different cultures.
I explain to all students and residents that the lessons learned in working with migrant farmworkers are lessons of more than just complex medical care. They are lessons of tolerance and of dignity. In short, they are lessons of integrity, lessons of justice, and lessons of life.