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The Plight of the Migrant Farmworker

Portrait of Farmworker

The Plight of the Migrant Farmworker

 

The health care needs of an essential yet marginalized community require special attention that is long overdue.

As seen in Issue 4 of DAP Health magazine 

Words by Trey Burnette

Invisible Yet Indispensable: The Role of Migrant Farmworkers

Migrant field workers are one of society’s most indispensable people. They’re the frontline of not only the United States’ $162.7 billion agricultural industry but, arguably — considering their hands are the first to touch the harvested food consumed by virtually all Americans — of the nutrition and health care industries. 

The Health Crisis: Neglected Needs of a Marginalized Population

They’re also one of the most marginalized and neglected populations. A whopping 23% of farmworkers in the U.S. live in poverty. The average individual’s annual income falls between $12,500 and $14,000 ($17,500 to $19,999 for families). And neither does the National Labor Relations Act of 1935 (which permits private sector employees to organize into trade unions, engage in collective bargaining, and go on strike) nor the Fair Labor Standards Act of 1938 (which preserves the right to a minimum wage and “time-and-a-half” overtime pay for toiling more than 40 hours a week, plus prohibits the employment of minors in “oppressive child labor”) cover most workers. Beyond the low pay and lack of many workplace protections, health care is one of the most significant stressors for farmworkers. Some 25% of them depend on community health centers. 

Barriers to Wellness: Challenges Faced by Farmworkers

Of the 2.5 million farmworkers who live and work in the U.S., 500,000 to 800,000 reside in California. Their age falls between 14 and 61, and most have been working for 18 years. Some 34% of them identify as women. Another 400,000 are minors.

In 2021, the U.S. Department of Health and Human Services reported that, of the 1,015,162 agricultural workers and their family members who received health services, the most common diagnoses were being overweight/obesity (25.5%), hypertension (11.4%), diabetes (9%), anxiety disorders, including post-traumatic stress disorder (5%), other mental health issues (7%), and asthma (2.5%.) But that isn’t the full scope of the health issues facing this community, because only 56% of U. S. field workers have health insurance. In California, that number drops to 37%. No matter where they are, many never seek help.

Expanding Healthcare Access: Medi-Cal's Impact on Undocumented Residents

Israel Ochoa manages DAP Health’s Centro Medico Oasis in the agricultural town of Thermal, just southwest of Mecca. He is the son of migrant farmworkers, and most of his days are spent serving farmworkers and their families. His assessment of his clinic’s patients aligns with the national statistics. He says access to affordable, nutritious food is a leading cause of their health issues. Fieldwork is arduous manual labor; the workers are up before sunrise and have to power through an excruciating workday. They rely on inexpensive sugary beverages like Gatorade, colas, and juices to stay hydrated and maintain energy, and eat a lot of processed food that “keeps” and can be eaten throughout their long workdays.

Furthermore, their children’s diets are not immune to their parents’ work schedules. Typically, 2.5 families live in one mobile trailer, and the kids are usually left with breakfast food they can make without having to turn on a stove — cereal, Pop-Tarts, or microwavable dishes. All eligible California children can get a no-cost breakfast and lunch at school, but obtaining those meals in the summer is difficult, if not impossible, because moms and dads can’t afford, or aren’t allowed, to take time off work.

Community Outreach: Bridging Gaps in Healthcare Education

Fear of being fired is also why workers don’t take personal or medical time off. They’re generally contracted, getting paid in two ways: by the hour ($15.50, plus 40 cents per box of product harvested and packed) or just by the box (about $4.25 per). Workers should get three sick days per season, but aren’t paid if they don’t work. Most avoid reporting job injuries for similar reasons. 

There are many other barriers to prosperity for farmworkers in the U.S. The lack of legal residence status is an obstacle. Nationally, 64% of workers are estimated to be undocumented — that figure is 75% in California — and most government programs, except for emergencies and sliding-scale payments, require documentation. Fortunately, on January 1, 2024, Medi-Cal expands full-scope health care for all income-eligible residents of California, regardless of immigration status. Obtaining preventive and routine care at a clinic will help people avoid emergency room visits and more severe illnesses. 

Empowering Through Education: Overcoming Educational Hurdles

Veronica Garcia is a care coordinator specialist regional coordinator and certified enrollment counselor at DAP Health. Alongside five siblings, she was raised in Coachella by her single farmworker mother, who also toiled at a citrus-packing plant. She does frontline community work and says her employer has an excellent outreach program. With the expanded Medi-Cal program, more people will be counseled and given health care. Outreach is critical because health workers can personally converse with farmworkers and clarify program misunderstandings. Many people think government programs, like Medi-Cal or the Medically Indigent Services Program, are debt services, so people hesitate to utilize them. 

Addressing Essential Needs: Affordable Housing and Nutrition Education

In addition to program education, Dr. Frank Figueroa — a councilmember for the city of Coachella who serves on DAP Health’s board of directors, as he did on Borrego Health’s board of trustees — says other fears about using programs can be laid to rest. He, whose grandparents and parents were farmworkers, states there’s the belief that those applying for permanent residence, work visas, or citizenship will be “flagged,” only to face negative consequences like losing rights they currently have, or could gain in the future. Undocumented workers are scared of deportation if they seek help. Applying DAP Health’s educational outreach to explain legal rights, enrollment, and using health care benefits will spur great progress in the health of this population. 

Education is also a challenge toward that progress. It’s estimated that 78% of farmworkers lack a high school diploma, with ninth grade being the average level of education. Just over 1% of these employees have a college degree, so there is a need to improve technology literacy.

Riverside County Supervisor Manny Perez, a son of migrant farmworkers, says that one of the many things that make DAP Health a superior federally qualified health center (FQHC) is its ability to provide affordable housing, a significant need for farmworkers as rents increase. He also strongly advocates for community clinics because they can address specific community needs like nutrition education through ancillary services. 

While Perez believes community health centers like Centro Medico Oasis are expertly poised to provide care for the rural poor, Ochoa insists finding health care providers to serve in remote locations such as Thermal is a challenge. All true. But it’s a challenge DAP Health is determined to meet as it endeavors to bring better wellness to this vital yet often-forgotten populace.

DAP Health Makes Bid to Protect Health C …

DAP Health Makes Bid to Protect Health Care Access for 120,000 People

In line with its mission — and in tandem with longtime community allies Innercare and Neighborhood Healthcare — the Palm Springs nonprofit leads a life-saving alliance to acquire Borrego Health. 

 

PALM SPRINGS, February 5, 2023 – Palm Springs-based Federally Qualified Health Center (FQHC) DAP Health made a bid to acquire Borrego Health, which on September 12, 2022, filed for bankruptcy and solicited potential acquisitors to assimilate its clinics and assets. The proposed investment would be based on total enterprise value, assuming a debt-free, cash-free transaction.    

At its height, Borrego Health served 275,000 patients annually across its various sites throughout San Diego and Riverside counties. Today, the system continues to cater to an estimated 120,000 individuals a year. Through their shared commitment to care for all members of their communities, DAP Health, Innercare, and Neighborhood Healthcare formed an alliance and are joining forces to continue operating Borrego Health — with DAP Health acting as the acquirer in order to protect patient access to integrated outpatient services.   

“Our approach ensures patients who currently rely on Borrego Health for high-quality, culturally competent care would not experience an interruption in their service,” says DAP Health CEO David Brinkman. “With distinct service lines and expertise, all three alliance members are uniquely positioned to care for Borrego Health’s patients. Building upon longstanding relationships, and through strong leadership collaboration, our alliance has the experience, operational expertise, depth of management, and strategic foresight to be successful in this endeavor.”    

The winning bidder will be notified this week. In hopes that the Borrego Health board of directors selects its bid proposal, the alliance has developed a comprehensive three-year operational plan that would allow for stabilization, optimization, and ultimately, growth of the current Borrego Health system.    

The initial steps would focus on the stabilization of the clinics, with a substantial investment of managerial time and material investment in the system. Employees at DAP Health, Innercare, and Neighborhood Healthcare would not see a change in their employment terms, benefits, or compensation resulting from this process. Rather, the alliance intends to make significant investments to retain the current staff of Borrego Health and to reinforce Borrego Health teams by addressing staffing shortages while bringing the current system up to a higher standard of staffing ratios and workflows.   

“Speaking for the remaining few founders and myself, it’s very rewarding to observe how this current outreach resonates with the agency’s nearly 40-year heritage,” says inaugural Desert AIDS Project Executive Director George Sonsel. “Through the decades, DAP Health has consistently demonstrated its perpetual readiness to share its expertise and professional guidance in support of the community’s needs.”   

About the Alliance  

Founded in 1984 as Desert AIDS Project, DAP Health was the first community-based clinic dedicated to serving low-income patients with HIV/AIDS. In 2012, it was designated as an FQHC Look-Alike, in 2015 became a 330 grantee, and today serves the general community with a full complement of integrated and lifecycle-appropriate care. DAP Health’s service area boundaries are located within the Coachella Valley, a unique desert community located in Eastern Riverside County in the Inland Empire of Southern California. The Coachella Valley comprises nine major cities as well as several unincorporated areas. The valley encompasses approximately 675 square miles, and its service area includes 310 square miles. CEO since 2006: David Brinkman.   

Established in 1970, Innercare (formerly known as Clínicas de Salud del Pueblo, Inc.) is a private nonprofit FQHC operating 10 health care centers; five dental clinics; and three Women, Infant, and Children Programs in Imperial and Riverside counties. Its service area encompasses 30 rural and urban zip codes boasting a total population of over 680,000. This area includes communities along the U.S.-Mexico and Arizona borders. It also serves communities ranging in size from Niland (pop. 1,610) to Hemet (pop. 127,443). There is significant overlap in some of the areas currently served by Borrego Health, with approximately 21% of Borrego Health’s patients currently seeking secondary care at Innercare sites. CEO since 2003: Yvonne Bell.   

Founded in 1969, Neighborhood Healthcare operates 24 health centers in San Diego and Riverside counties, serving upwards of 87,000 unique patients each year, 97% of whom are at or below 200% of FPL. Some 61% identify as Hispanic and 41% are best served in a language other than English. With deep cultural understanding, Neighborhood Healthcare excels at providing health care for all stages of life, including pediatric and adult primary care, prenatal care, family planning, HIV testing, women’s health, dental services, and basic pharmacy and lab services. Due to a large and growing Middle Eastern refugee/immigrant population in East San Diego County, Neighborhood Healthcare has developed a strong culturally and linguistically responsive program to care for Arabic speakers. CEO since 2017 (but at Neighborhood Healthcare since 2002 as a physician): Dr. Rakesh Patel.   

Important Opportunities Presented by This Alliance  

  • DAP Health would be the acquirer of the Borrego Health system with Innercare and Neighborhood providing clinical, administrative and leadership services to the alliance.  Together, the managing organizations would bring deep experience with the patient population and strong relationships with key partners such as health plans, social services agencies, and elected officials.   
  • Many employees within the expanded network may wish to transfer to a site closer to their home, offering a retention incentive for current Borrego Health and partner clinic employees alike.   
  • Each organization has unique areas of expertise it brings to the alliance. This strong partnership allows for operational and clinical cooperation for the best possible outcomes for each unique site. Innercare has deep expertise in caring for migrant and farmworker populations as well as an established presence in many of the communities served by Borrego Health. Neighborhood Healthcare offers strength in primary and family health, with strong ties in the greater San Diego area. DAP Health’s outstanding care for LGBTQ+ patients, and HIV/AIDS patients, as well as its best-practice approach to culturally responsive and relevant services, rounds out this outstanding team of partners.    
  • With strong executive leadership, oversight, and compliance, all three of the partners in this proposal can lend executive support to various sites during the transition period as the system rehires and augments operations.   
  • Neighborhood Healthcare has already successfully transferred several former Borrego Health sites to its management. This direct experience would further inform and strengthen the alliance’s approach to assuming operations for the remaining Borrego Health sites.   

DAP Health’s priority in acquiring Borrego Health is to ensure that all existing sites remain open; that services are stabilized, optimized, and expanded; and that every aspect of operations is culturally and regionally appropriate to its respective communities. Given the wide footprint of the Borrego Health system, DAP Health is honored to partner with longtime ally organizations Innercare and Neighborhood Healthcare to realize the goal of providing highly effective, compliant, and culturally tailored care throughout the region.    

“For almost 40 years, DAP Health has been dedicated not only to keeping its doors open but to extending them even wider so that an ever-expanding number of community members in need can be cared for,” concludes Brinkman. “The alliance we’ve formed with Innercare and Neighborhood Healthcare — two local organizations with similarly very deep roots in the communities Borrego Health has served — ensures that nearly 120,000 patients would not see health centers they’ve grown to depend on be shuttered by an acquisitor less familiar with and committed to our neighbors in need.”   

 

Media Contact:  

Steven Henke, DAP Health Director of Brand Marketing  

Shenke@daphealth.org