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Structural Differential: New England Journal of Medicine Features Maine Migrant Health

Workers harvest  blueberries

[photo by Earl Dotter]

Today, the New England Journal of Medicine published “Structural Differential -- A 32-Year-Old Man with Persistent Wrist Pain,” the first in a series of case studies in social medicine that the prestigious journal is offering in the coming months. The article focuses on a mobile agricultural worker whose swollen wrist was a result of a poorly designed blueberry rake. Written by our colleagues at Maine Mobile Health, the article leads readers from the concept of a clinical differential -- wherein a clinician identifies concurrent medical issues contributing to a health problem -- to the idea of a structural differential, which “delineates the social, political, and economic factors that may be influencing a patient’s health and health care and facilitates responses to the modifiable factors.”  In the case study, the answer was not just aspirin and wrist wraps. The clinician instead formed a group with other clinicians with agricultural workers, blueberry growers, and metal workers to discuss the occupational injury and how to address it, which resulted in the development of a newly designed blueberry rake.

The clinical implications for this wide-reaching New England Journal of Medicine article are significant: clinicians can and should consider the broader social landscape to assure better clinical outcomes for a patient. The article’s case study is interesting and nuanced, and will sound familiar to many MCN supporters, as external forces like political environment, economic systems, and social inequalities bear down on a mobile agricultural worker’s health.


Maine Migrant Health Program

[photo by Earl Dotter]

Read the complete article at the New England Journal of Medicine site; this would be a great time to subscribe, to assure you get every one of the new Case Studies in Social Medicine as they are launched in this coming year. And a hearty congratulations to our colleagues at Maine Mobile Health and the editors of the Case Studies in Social Medicine. We look forward to reading more case studies as they are released.

Watch this series of videos portraying the daily lives of mobile agricultural workers with Maine Mobile Health, which are entitled “Farmworkers Feed us All,” and feature photos by Earl Dotter and audio recordings by Tennessee Watson.




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