Recently in the UK, there has been research supporting midwifery care. Due to this research, the UK has made some policy changes in regards to maternity. Midwifery care has been shown to be more safe for women with uncomplicated pregnancies and because of these new policies, the United States may follow in their footsteps.

These bilingual posters educate workers on how to work safely with machinery on the farm.  Developed by two Occupational Health Interns (OHIP) during their internship with the National Farm Medicine Center, these posters accompany the Seguridad en las Lecherías curriculum.

Este diccionario ilustrado bilingüe de MCN, "Seguridad en Palabras/ Safety in Words", muestra los peligros que hay en el lugar de trabajo y las mejores prácticas para la salud y la seguridad en la agricultura. Desarrollado con el apoyo del Programa de Subvenciones Susan Harwood de OSHA, este recurso refuerza el vocabulario en inglés de los trabajadores que hablan español lo que ayudará a prevenir lesiones en la agricultura. 

DATE RECORDED: Wednesday, June 17, 2014
PRESENTED BY: Matthew Keifer, MD, MPH, Dean Emanuel Endowed Chair/Director National Farm Medicine Center

MCN’s Environmental and Occupational Health Programs

Learn more about MCN’s training and technical assistance programs to help clinicians and health centers improve the recognition and management of pesticide exposures and other environmental/occupational health conditions.

Mistakes can be dangerous. Accurate identification of pesticides responsible for a patient's illness is important to avoid iatrogenic errors with respect to acute treatment.  Join us for an important webinar that will focus on key decision points in the diagnosis of pesticide exposures and emphasize the usefulness of the newly revised resource for clinicians - The Recognition and Management of Pesticide Poisonings, 6th ed.  Through interactive case studies, this webinar will illustrate effective recognition and treatment of patients over exposed to pesticides. 

The webinar, sponsored by Migrant Clinicians Network, the National Farm Medicine Center and AgriSafe Network features Dr. Keifer, a board certified occupational medicine specialist and internationally renowned researcher regarding pesticides and agricultural health and safety. For over 30 years, Dr. Keifer has focused his clinical practice and research largely on farmworkers. 

SPONSORED BY: AgriSafe Network, Migrant Clinicians Network, and the National Farm Medicine Center

OBJECTIVES: Participants will be able to:

1. Better recognize the signs and symptoms of pesticide overexposure
2. Identify key decision points in diagnosing pesticide exposures
3. Demonstrate an understanding of how to use The Recognition and Management of Pesticide Poisonings, 6th ed. in a clinical setting

We encourage all participants to order The Recognition and Management of Pesticide Poisonings, 6th ed. prior to attending this webinar. Order here. PDF versions are also available at http://www2.epa.gov/pesticide-worker-safety/recognition-and-management-pesticide-poisonings
If you have experienced any trouble ordering your copy please contact: kbrennan@migrantclinician.org 

Three concise and effective environmental/occupational health screening questions for the primary care provider. English and Spanish. MCN, 2014.

An EHR-friendly version of these screening questions was developed through MCN's Workers & Health Program. This can be used as a reference for integration into the health center's Electronic Health Record. 

Part 6 of the 7 webinar series: Clinician Orientation to Migration Health

DATE: presented live on July 17th, 2013

PRESENTED BY: Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health and Melissa Bailey, Executive Director of North Carolina Field, Inc.

  

Additional Resources:

MCN Women's Health page MCN Health Network:  Any prenatal patient who may move out of your area before giving birth is eligible to be enrolled in the Health Network. MCN will provide care coordination throughout the course of her pregnancy, until her postpartum visit is completed, to help ensure that there are no gaps in her health care.  512-327-2017 or 800-825-8205.   MCN Environmental Health/Pesticides Resources Pesticide Comic Book Order Form.  Lo Que Bien Empieza…Bien Acaba (What Begins Well, Ends Well): Spanish comic book for women about pesticides and pregnancy Aunque cerca...sano (Close but Healthy): Spanish comic book for preventing pesticide exposure in children and families working in and living near agriculture Pregnancy, Reproductive Health and Pesticides Monograph (available in English and Spanish) Lead Guidelines for the Pregnant Migrant Woman Environmental health screening tool for the primary care setting Environmental health clinical guidelines Assessment of Maternal Occupational Pesticide Exposures during Pregnancy and Three Children with Birth Defects: North Carolina, 2004 Case Report: Three Farmworkers Who Gave Birth to Infants with Birth Defects Closely Grouped in Time and Place - Florida and North Carolina 2004-2005 MCN Family Violence Resources Addressing Domestic Violence in a Clinical Setting - Manual for Health Care providers, with Screening Tool (English) Training Manual on Family Violence (English/Spanish) “La Vida Mia”Photonovella & Training Video  (English/Spanish) MCN Streamline articles Feb 02 “Exploring a Paradox” (the Hispanic perinatal paradox) Mar/Apr 06 “Screening for Pesticide Exposure” Jul/Aug 07 “Lead screening in Pregnancy” Sept/Oct 07 “Pesticide exposure and self-reported gestational diabetes in the Agricultural Health Study” Oct/Nov 11 “Preventing Partner Violence in Refugee and Immigrant Communities” (pg 3) Other Women’s Health Resources for Migrant/Immigrant Care Text4Baby:  A free service that provides health education by text to pregnant women and new mothers in English and Spanish The Perinatal/HIV Hotline: The National Perinatal HIV Consultation and Referral Service (Perinatal Hotline) provides 24-hour advice from HIV experts on indications and interpretations of HIV testing in pregnancy as well as consultation on treating HIV-infected pregnant women and their infants. The Perinatal Hotline (888-448-8765) is available 24 hours, seven days per week. Centering Pregnancy: A model of group prenatal care widely used in a variety of settings, including FQHCs and with immigrant populations.  Materials are available in Spanish. Rural Women’s Health Project  Pregnancy fotonovelas in English and Spanish. Auger Communications “Teach with Stories” Prenatal Care fotonovela series and “Pregnancy and Diabetes: Lucia’s Story” Wake Forest University One-page pesticides and pregnancy handout in English and Spanish.  Migrant Health Promotion Farmworker Doula Manual National Women’s Health Information Center. This website and toll-free call center were created to provide free, reliable health information for women everywhere, including lots of materials in Spanish. March of Dimes  An array of materials at various literacy levels and almost everything in Spanish. Pamphlets, videos, "Comenzando Bien" curriculum. Centers for Disease Control The CDC's Spanish website for women's health includes handouts in Spanish that can be printed from the website National Perinatal Association Published transcultural perinatal education curriculum. California Diabetes and Pregnancy Program.  Catalog of patient education materials in English and Spanish for perinatal issues related to diabetes and gestational diabetes. “Diabetes gestacional: Guía para la mujer embarazada”.  Spanish language guide on gestational diabetes from AHRQ. Association of Farmworker Opportunity Programs: “The Fields: The Hidden Faces of Farmworker Women” Interviews and stories about the issues that matter most to farmworker women’s health and well-being Human Rights Watch:  “Cultivating Fear: The Vulnerability of Immigrant Farmworkers in the US to Sexual Violence and Sexual Harassment” Legal Momentum Immigrant Women Program legal rights for immigrant women Trafficking information

Historically, the field of women's health consisted of issues surrounding reproduction and childbirth. However, increasingly, the health care community has come to see women as a distinct patient group that has unique health concerns over a lifetime. Migrant farmworker women experience unique risks during pregnancy and otherwise, due to the physical demands, environmental exposures and other circumstances of their lives.  The provision of healthcare services to migrant women presents distinctive challenges for both clinicians and organizations.  MCN’s Candace Kugel, CRNP, CNM, and Melissa Bailey, Executive Director of NC FIELD, Inc., both with many years of experience with this population will discuss the problems, solutions and rewards of working with migrant women, through case illustrations and review of resources.

After taking this webinar:

• Participants will be able to identify at least 2 health risks unique to women farmworkers and the impact of those challenges on work, nutrition and health.
• Participants will be able to describe environmental and occupational health exposures relevant to farmworker women of reproductive age.
• Case studies will assist participants in understanding how creative collaborations and models of care can improve health outcomes for migrant women.
• Participants will be able to access clinical resources for working with female migrant patients.

PRESENTER BIOS:

Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health, Migrant Clinicians Network ckugel@migrantclinician.org

Candace Kugel is a Family Nurse Practitioner and Certified Nurse-Midwife with over twenty years of experience in health care for the underserved. She has worked in various clinical settings, including family planning, migrant health, community health center, and private practice. She has worked almost exclusively in rural settings. Candace has also been active in aspects of health care other than direct patient services. She has served as a clinical instructor for nurse practitioner, nurse-midwife, nursing, and medical students, and currently has faculty appointments with the University of Cincinnati and Penn State University’s Schools of Nursing. She has worked in program development in various arenas, including co-founding a “Stork’s Store” prenatal incentive program, initiating a natural family planning education program, and teaching childbirth education classes.

Melissa Bailey, Executive Director of North Carolina Field, Inc.  mbailey@lenoir.k12.nc.us

Melissa Bailey is a native of southern West Virginia. She has worked in North Carolina migrant education programs since 2001. In 2010 AFOP’s Children in the Fields Campaign assisted community workers with forming the nonprofit NC FIELD. This effort aimed to establish an organizational empowerment and advocacy model to build capacity in farmworker communities, particularly among child laborers in agriculture. In 2012 Melissa became the Executive Director of NC FIELD.  She has presented to local, state, and national stakeholders; assisted media; has worked as a research assistant on farmworker studies; assisted with organizational development and the leadership training of child farmworkers, and is a successful field organizer, consultant, and project manager. Melissa holds a certificate in Nonprofit Management from Duke University, among other certifications related to the delivery of supplemental education services and data. In her spare time Melissa enjoys reading, writing, gardening, and spending time with loved ones.

Part 2 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: April 2, 2014
PRESENTED BY:  Hans Dethlefs, MD and Ed Zuroweste, MD

View Recorded Webinar  

 Participant Evaluation  

 Presentation Slides (PDF)

If you have any follow up questions for this webinar, feel free to contact Dr. Ed Zuroweste at kugelzur@migrantclinician.org or 512.579.4540 .

At their best, clinical core measures serve as an important window to examine the impact and quality of care being delivered at health centers. However, without an effective system in place clinical core measures can require a great deal of time and effort without yielding important quality improvement. This session will examine both short and long term strategies health centers can employ to make the best use out of the clinical core measures to improve care for patients. Drs Zuroweste and Dethlefs will examine the building blocks health centers need for an effective quality improvement system. Through a series of case studies, this session will explore the role of clinical leadership, technology and strategies for building a short and long term quality infrastructure that works.

Learning Objectives:

1. Identify common pitfalls health centers encounter related to the clinical core measures.
2. Discuss strategies for assessing a health center’s current capacity to engage in meaningful quality improvement.
3. Through case studies, evaluate different approaches to clinical quality improvement using the clinical core measures.

These files are part of the Engaging Migrant Men project.

Accompanying discussion guides were created to be used by male peers, community leaders, or outreach workers for one-on-one and small group discussions with men.

Part 1 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: March 19, 2014
PRESENTED BY:  Deliana Garcia, MA, International Research and Development, Migrant Clinicians Network

View Recorded Webinar  

 Participant Evaluation  

 Presentation Slides (PDF)

**Note: Due to technical difficulities the first 7 minutes of the presentation are not recorded. Please refer to the pdf of the slides for the content that was covered in those 7 minutes.

Over the last 30 years, considerable attention has been paid in the clinical setting to cultural competency- the ability to mitigate against the effects of the sociocultural differences between clinicians and patients and to take into account how culture affects the symptoms presented or the patients’ attitude about health care.  More recently, scholars and clinicians have encouraged those in practice or health professions training to focus not only on the behaviors and beliefs of cultural groups but more importantly to consider the structural determinants, prejudices, injustices and blind spots, the “pathologies of social systems” that affect health outcomes and the stigma experienced by patients. The session will introduce participants to the broad framework of structural competency and the five core structural competencies.

Learning Objectives:

1. Identify the structures that shape clinical interactions;
2. Discuss the means of developing an extra-clinical language of structure;
3. Rearticulate “cultural” formulations in structural terms;
4. Explain the process of observing and imagining structural interventions; and
5. Describe the concept of structural humility.

Laboratory studies and case reports of accidental exposure to large amounts of chemicals indicate that there are immediate and long‐term negative health consequences of exposure to agricultural chemicals. 

Concern about the adverse public health and environmental effects of pesticide use is persistent. Recognizing the importance of surveillance for acute occupational pesticide-related illness, we report on surveillance for this condition across multiple states. Between 1998 and 1999, a total of 1,009 individuals with acute occupational pesticide-related illness were identified by states participating in the SENSOR-pesticides program. 

The California Pesticide Illness Surveillance Program (PISP) is a major resource for pesticide illness epidemiology. This work attempts to improve characterization of pesticide illness in California, evaluate case ascertainment of the PISP and identify PISP’s limitations and biases for studying the incidence and epidemiology of pesticide-related illness. 

Pesticide Action Network, United Farmworkers of America, and California Rural Legal Assistance Foundation analyzed California government data on agricultural poisonings and enforcement of worker safety standards. Nearly 500 pesticide poisonings were reported for California farmworkers every year. The actual number of pesticide-related illnesses is unknown, since many poisonings go unreported. 

Describes the growth from 1987 through 1996 of the Occupational Pesticide Poisoning Surveillance Program at the Texas Department of Health. The program was initially based on a Sentinel Event Notification System for Occupational Risks (SENSOR) model, using sentinel providers to report cases, supplementing the passive reporting by physicians that was required by law.