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Willa Hayes, Michigan
In orienting clinicians new to health care for farmworkers, I believe you need two approaches: a) one type of orientation for resident localities, and b) another for the "upstream" projects/ agencies who see an evolving wave of migrating farm workers with very brief stays in a given area. Having said that, some of my 27 years in this field in an "upstream" Migrant Health Center have led me to list the following recommendations when recruiting and selecting clinicians:
- Do not hesitate to appeal t the humanitarian, altruistic side of a clinician.
- Select and nurture those clinicians who are challenged and inspired by improvisation.
- Expect to have to provide times for de-briefing, especially in the turbulent, hectic and demanding milieu of a Migrant Health Center.
Relative to the priority of orientation issues, I have tried two approaches: a) a careful, thoughtful and didactic orientation with written objectives and b) brief overview followed by immersion. Guess which has consistently worked best? The "on-the-job" training or orientation really works best, especially when you can pair a new clinician with a veteran.
Teach and encourage new clinicians to establish a realistic time frame with which they have to work with clients. All of the elaborate standards of care , care plans and case-management plans will go for naught is the recipient of your caring is only in your physical, geographic locale for a week or ten days. This is hardest to convey to newly turned-out clinicians, and may require daily reviews of their work by a peer. Veteran or experienced clinicians ten to adapt better to the helter-skelter lifestyle of the farm worker. I usually scatter through my orientation sessions frequent reminders of the disparity between the agenda of the farm worker and the rather ideal and lofty agenda of the clinician/ health care center. We are to defer to the farm worker's agenda, for the most part.
Encourage clinicians to trust the old diagnostic skills of palpation, percussion, auscultation and careful listening. Exhaustive laboratory work or radiology studies are not likely to be welcomed by farm workers who seek relief of symptoms so that they may return to work. Recognize that the achievement of comprehensive care for episodic patients is not going to occur very often.
There are many things I could list, but perhaps the most important advice I have to give to new clinicians is to demonstrate respect. Be warm and interested in the whole family. If you do not speak Spanish or Creole, work with translators who understand how you work. Use translators as "pass-throughs" or vehicles to get the information out and in. Eye contact and touch are crucial. Learning to be clinically relevant as ell as competent utilizing a translator is an art, and takes time and experience to hone. Learning some phrases or some of the most frequently asked questions in the language of the farm worker should be encouraged. Event the attempt to speak the patient's language will build trust and confidence.
These harvesters of the nation's food are very bright and resourceful people who travel great distances and undergo severe deprivation in order to work. The nobility of this pursuit is getting short shrift in the press and legislative bodies today, but the sheer enormity f the service this group of oppressed people do for the rest of us need to be acknowledged and honored by the clinicians who will provide primary health care to them and theirs.