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This video describes a pesticides poisoning incident and how it affected a community health center.

MCN's Environmental and Occupational Health Initiative

Pesticide and other chemicals, contaminated drinking water, unsanitary and substandard living conditions and lack of hand washing facilities and toilets in the fields constitute serious health risks to hundreds of thousands of farmworkers and their families. Additionally, farmworkers suffer from thousands of agricultural related injuries each year. Farmworker children are particularly vulnerable to these hazards.

To address these occupational and environmental health issues, MCN has developed an environmental and occupational health education program for healthcare providers serving migrant and seasonal farmworkers and other mobile populations. Specifically, MCN is trying to:

1. Raise primary health care providers' index of suspicion regarding environmental and occupational causes of health problems, and
2. Provide health care providers with tools and resources to address these health problems.

In 2000, MCN conducted a needs assessment to determine specific environmental health training needs by profession and appropriate environmental health topics as well as educational and training methods to reach each professional group. According to the clinicians surveyed the three most important environmental and occupational problems facing farmworkers are:

1. exposure to pesticides,
2. water and sanitation problems and related diseases and
3. musculoskeletal or ergonomic problems.

However, the overwhelming majority (83 percent) of clinicians surveyed listed no courses/training or only one course/training pertaining to environmental or occupational health.

Integrating EOH Into Primary Care

© www.earldotter.com

MCN is working to assist frontline providers to integrate occupational and environmental health practices into primary care to strengthen the quality of care and meet the unique healthcare needs of the migrant population. MCN recognizes that migrant clinicians, like the majority of primary healthcare providers, generally do not bring an occupational and environmental health perspective to their work.  MCN focuses on feasible changes in clinical practices to improve the recognition and management of environmental and occupational exposures and injuries. This is done through partnerships with Migrant and Community Health Centers and involves on-site clinical training, the provision of resources and technical assistance and peer-to-peer networking between frontline providers and occupational and environmental medicine specialists.  Between 2006 and 2011, MCN established 10 model environmental and occupational programs in health centers and clinics across this US. These programs systematically demonstrate:

• changes in clinical systems including intake, screening, outreach and education;
• primary care providers’ willingness to acknowledge and address occupational injury and exposure which leads to improved patient care;
• new linkages between health centers and clinicians and the agricultural workplace; and
• connections between primary care providers and pesticide experts and OEM specialists.

MCN’s efforts in environmental and occupational health also involve the development and distribution of clinical and patient resources, training of clinicians and stakeholders through webinars, conferences and onsite workshops, and extensive partnerships with organizations having expertise in pesticides, occupational and environmental medicine and agricultural medicine. MCN has developed a number of patient education materials and training products for lay health educators (promotores de salud) to educate farmworkers about the risks from pesticide exposure and ways to protect themselves and their families and distributes thousands of these resources each year.

MCN’s EOH efforts are guided by an expert advisory committee and a largely supported through a cooperative agreement with the US Environmental Protection Agency as part of their National Strategies for Health Care Providers: Pesticide Initiative.  The results of MCN’s work from 2005-2010 can be seen in our final report the EPA. 

EOH Partnerships

MCN partners organizations throughout the country to strengthen our ability to offer frontline clinicians expertise in EOH.  MCN works closely with the Marshfield Clinic Research Foundation’s National Farm Medicine Center and the National Children's Center for Rural Agricultural Health and Safety. MCN partners with them to address immigrant and migrant health and safety issues in rural and agricultural settings.

Our other partners include the Association for Occupational and Environmental Clinics, American College of Occupational and Environmental Medicine, AgriSafe Network, the American Public Health Association and its Occupational Health and Safety Section and NIOSH-funded Agricultural Health and Safety Centers and the Wake Forest University Worker Health Center. 

Expert advisory committee

• Geoffrey M. Calvert, MD, MPH, Team Leader, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
• Stephanie Chalupka, EdD, RN, PHCNS-BC, FAAOHN, Professor, Public Health Nursing and Master of Science in Nursing, Worcester State College
• Elizabeth Freeman Lambar, MPH, MSW, Program Director, North Carolina Farmworker Health Program
• Matthew C. Keifer MD, MPH,  Dean Emanuel Endowed Chair, Senior Research Scientist, National Farm Medicine Center
• Wilton Kennedy, DHSc, PA-C, MMSC, Past President of MCN, Director, Physician Assistant Program, Jefferson College of Health Sciences
• Katherine H. Kirkland, MPH, Executive Director, Association of Occupational and Environmental Clinics
• Candace Kugel, FNP, CNM, Director of Performance Improvement, MCN
• James R. Roberts, MD, MPH, Associate Professor, Medical University of South Carolina
• Daniel L. Sudakin, MD, MPH, Associate Professor, Oregon State University
• Edward Zuroweste, MD, Chief Medical Officer, Migrant Clinicians Network

Farmworker Occupational Illness and Injury

Occupational injuries and illnesses are one of the most prevalent patient care issues for clinicians working with migrant workers. Migrant patients are a unique segment of the U.S. workforce and factors such as lack of training, poor safety precautions, over representation in dangerous industries, language barriers, piece-rate pay, undocumented worker status, and geographical and cultural isolation can put these workers at increased risk for work related injuries and illnesses. Health disparities in this population are starkly demonstrated by excess mortality and injury at work. Fatal occupational injuries among farmworkers occur at five times the rate for all workers in the U.S (USDOL, 1998).

Trapé-Cardoso and colleagues described migrant workers seeking medical care at Migrant/ Community Health Centers in Connecticut. Of the 331 workers seen during medical clinic visits, 41 percent reported a work-related injury or illness. Thirty-nine percent were musculoskeletal disorders (sprains/strains, tenosynovitis, and muscle spasm), 22 percent allergies, irritation, or rhinitis, and 22 percent dermatitis (2003). The New York Center for Agricultural Medicine and Health examined over 5,000 medical charts from 12 Migrant/Community Community Health Centers and found that approximately 20 percent of visits by migrants were for obvious occupational injuries. The rate of occupational injury was as high as 50 percent for migrant men in certain clinics. Moreover, 90 percent of farmworkers with documented occupational injuries chose not to file a claim for their work-related injuries(Sorensen, 2004; NYCAMH, 1997-1999). Twenty-four percent of California agricultural workers surveyed by the NAWS reported suffering from at least one musculoskeletal injury during the previous year (Aguirre International, 2005). In a recent study in North Carolina, it was found that 45 percent of occupational heat-related deaths were in farmworkers (Mirabelli and Richardson, 2005).

Pesticides and other chemical exposures are a significant environmental hazard for farmworkers and their families. The absence of a national system for reporting pesticide poisonings makes it difficult to estimate the number of pesticide poisoning incidents in workers nationwide and estimates differ widely (Blondell, 1997; Calvert, 2004). There are a number of studies, however, that document the existence of pesticide exposures among farmworkers and their families (Arcury et. al., 2005; Arcury and Quandt, 2003; Curl, et. al., 2003, Calvert, 2004; CDC, 1997; Coronado et al., 2004).

For further resources, click here.

Las Historias de Melesio

With funding from the EPA Region III, MCN partnered with Rural Family Development of the Virginia Council of Churches to produce five radio novelas (Las Historias de Melesio) in Spanish to promote environmental health information.

1. Getting Rid of Pests /Acabando con las plagas (Inhome Pest Control)
2. Protecting Yourself from Pesticides/Protegiendose de los pesticidas
3. Be Careful with Water and Lead/Cuidado con el agua y el plomo (Water, Sanitation, Hygiene and Lead)
4. Protecting Kids from Pesticides/Protegiendo a sus niños de los pesticidas
5. Respiratory Problems/Los problemas respiratorios (Improving Indoor Air Quality)