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The year 2020 has changed so much about the way we live our lives. With this change has come a variety of new policies in place that public health professionals have researched to protect the public from the novel COVID-19 virus. During this roll-out of public health prevention policies, some fragile populations have been left behind in the enforcement of these guidelines. Currently, those guidelines pertain to things like wearing mask, keeping six feet distance, checking your temperature upon entering your place of employment or just general appointments along with implementation of important COVID-19 screening questionnaire.

Rural populations are already vulnerable to this virus due to the wicked problems that connect anteceded facts. Because they are rural, they do not have the same access to testing facilities, grocery deliveries, telehealth doctors appointments, short drives to the hospital or increased hospital capabilities that this virus has deemed as necessary or at least protective measures. When you evaluate the combination of rurality and employment as a farmworker, this population is extremely vulnerable due to their lack of protections from the state government. Currently, legislation mandated by the department of labor in NC dictates that “growers” or farm owners, are not required to enforce lifesaving public health guidelines like wearing a mask, checking temperatures daily, COVID-19 screening questions, and social distancing while working. This is essentially an invitation for the virus to infiltrate the agricultural community in North Carolina.

I argue that these essential workers deserve the same considerations as the general public and other places of employment simply because they are humans and a part of our community. However, as that is apparently not enough to change policies enforced by the department of labor, I will make the case that if these essential employees become infected, North Carolina will feel the effects from it economically in a myriad of ways. First being that these essential workers will not be healthy enough to do the agricultural work set out for them. This would lead to the issues of food security we experienced early on in this pandemic. Without the workers to harvest the produce, how will our state have access to nutritious food that boosts our immune systems, which is even more important as we enter flu season during a pandemic. Additionally, as agriculture is a leading industry of North Carolina, our state will suffer economically and may never be able to regain the agricultural lead it has due to lack of both farmers and growers who will certainly become infected and could possibly die due to the lack of enforced protections. However, these arguments should not need to be made- we should value migrant farm workers just as we value any other worker in our society. By neglecting to enforce these protection mandates, we are sending a message to farmworkers about the value we place on their lives.

When working with nonprofit agencies who need to utilize their finances efficiently, how do you ensure that efforts are being documented and goals are being worked towards? Data cannot be analyzed if there is no starting point of measurement. As a part of our practicum experience working with the NC Farmworkers Project, we have been designing a few data analysis projects. The first of which pertains to blood pressure education for the farmworker population. As previously posted about, one of the biggest health disparities affecting this population is hypertension. There are many upstream effects that could be discussed in addressing why this is, however, the goal of this portion of the project is to find ways to ameliorate the issue.

           Early on in our time with NCFWP, we were informed that the organization wanted to work on orchestrating a video in Spanish focused on blood pressure monitoring to encourage the workers to monitor more often and advocate for their own health. This is especially important this year as COVID-19 has prevented a significant amount of outreach and appointments that the NCFWP would usually provide. In a normal year, the rurality of these camps creates issues of access and availability that the NCFWP has worked hard to overcome. These workers spend daylight in the fields and most do not have transportation. Even when transportation is available, the camps are located on desolate country roads often long distances from traditional health care and health education. Not to mention, the issues presented in receiving quality health care as a migrant worker in rural North Carolina. However, one of the things this organization does best is overcome barriers of access to provide farm workers with the basic rights of health care and education on maintaining that health. Even before COVID-19, NCFWP was utilizing telehealth to overcome accessibility issues which has ultimately prepared them to adapt to this new world. For the purposes of blood pressure monitoring, the organization had already distributed many blood pressure monitoring machines to camps.

           Our portion of this effort would be to film, edit, and publish this video on social media platforms like Youtube that workers were already comfortable with accessing. To analyze the impact of this video with the farmworkers, we developed a set of questions that could be presented both before and after a sample of workers viewed the video. The raw data from these answers to the survey pre-video viewing was to be analyzed and compared to the answers post-video. Unfortunately, in the week we were set to survey our sample, a few of the outreach workers had to quarantine and could no longer assist us in translation and distribution of the video and surveys. While this is an ultimate disappointment for our group, the NCFWP now has our questions and the video to serve as the basis of quantitative data analysis when they are able and healthy.

           The impacts of COVID-19 have trickled down to every facet of how the NCFWP conducts work. Although, it has not stopped them from conducting quality outreach to this population. It is because of this impact that we set out to analyze the COVID-19 response from the organization. While strict quantitative analysis could have been preformed on the epidemiological aspect of the response, we thought it would be more beneficial to collect qualitative data that would increase our understanding, avoid marginalization, connect to their purpose and the hurdles they have overcome. While we did collect some hard numbers on how many tests they were able to administer and how many farm workers became infected, we were more focused on how the work these outreach workers do was changed. This can certainly be useful for the project moving forward in addressing areas of success and opportunities of improvement from the first-hand experiences.

Our student group prepared six questions pertaining to the COVID-19 response of the project and found three willing participants to interview: the leader of the project’s COVID-19 outreach response, a worker on the same task force, and the NCFWP director. We scheduled interviews over zoom with each of them, recorded the video and transcribed the audio for analysis. After data was collected, we got the whole team together to begin the process of analyzing qualitative interviews. Thankfully, our participants were happy to share their stories with us and did not require much probing or convincing to open-up about this experience. After we conducted the process of trawling, assigning labels and selecting codes we found a few underlying themes each level of the COVID-19 response team experienced. While a full analysis will be a portion of our final project and discussed thoroughly, we are still finalizing the results of the interview analysis. So far, we know that four underlying themes emerged: the significance of teamwork, the shared burden of financial strain and need for support, adaptation as a necessity for outreach, and overall success of their interventions.

Have you ever avoided going to the doctor because you were afraid of the cost? Did you do that while you were covered by health insurance? Now imagine, you are working in crop fields all day, pulling sweet potatoes and tobacco under the hot sun for 10 every day. There’s no water break, there’s no bathroom break, just you and your crew in the field for hours on end with no relief. The normal days worry is of heat exhaustion, or dehydration, but suddenly, your skin starts to burn. All over your arms and your torso- where you’ve been holding crops against your skin. It burns but you can’t stop working, or even tell anyone for fear you will lose your job. Your family relies on your below minimum federal wages to make ends meet at home. So you just ignore it, you finish out your day in agony, and show your crew when you get back to the camp hours later. It’s obvious something is wrong, the skin has wilted and is still searing, but if you tell the farmer, your boss, you wont be able to work, and you may not be invited back to work next year.              The North Carolina Farm Worker Project (NCFWP) provides free health care to farmworkers, no matter what kind of status they hold in this country. Whether it be H2A, DACA recipient, permanent resident or undocumented immigrant. They care about our farmworkers, and they advocate for their rights. Every Monday of the season, the NCFWP partners with Campbell University School of Medicine (CUSOM) and comes to alternating camps to provide health care to whoever needs it. The above situation while extreme, is not uncommon. However, the mobile clinic doesn’t require you to be in a state of emergency to get care. Do you need your blood pressure checked? A refill on your medication? Just a general physical because you can’t remember the last one you had?  NCFWP has you covered, and they are only a phone call away to make an appointment. Additionally, if the clinic is not at YOUR camp this week, transport can be arranged for you to be brought there and returned home. Aside from that, if you need labs done, if you are prescribed antibiotics for that wicked ingrown toe nail you called about, they will get them for you and they will deliver them to you the next day.

             In modern America, it’s difficult with a normal 9-5 job to get to a doctor’s appointment without missing work. Often, we face struggles of appointments a month out from when we called. Consider the cost of this appointment if you live in rural North Carolina, over an hour from a primary care physician, with no insurance, and little if any English proficiency to explain your situation and advocate for yourself. What is the true cost of this doctor’s appointment? If you have to miss work, find transportation hours away ( you don’t own a car in this country), risk your days wages, potentially your family’s livelihood, and your opportunity to be employed the following year for fear of deportation, all to possibly to not even be able to afford the cost of the treatment or medication you require to continue working if you overcome all those other barriers.

             Every Monday, members of our team have been out at the mobile clinic helping NCFWP and CUSOM check patients in, get vitals, provide health education, and genuinely show that there are people here who care about the work these people are doing. Recently, our health education has been in the form of COVID-19 education games, and blood pressure monitoring videos and questions. Every Tuesday, we go to outreach and assist in transporting medication that was prescribed the day before, we help our beloved outreach worker ferry people to and from the Campbell University clinic to get whatever they might not have been able to receive the day before; an ear exam, blood work. Before the night is done, the outreach worker figures out what camp the clinic will be hosted at the following week, and we go there and make appointments, register people, and find out what needs aren’t being met.

Growing up in South Florida, Emergency Preparedness for things like hurricanes was taught as early as primary school. So much so that hurricane warnings just became another symbol of summer in the south. However, of all my years on the coast, in a Hispanic community, and with an undergraduate major of public health, I never thought about the populations that were most at risk during these times. Working with the North Carolina Farm Worker’s Project has opened my eyes to the heightened risks that Spanish speaking farm worker communities are subjected to during natural disasters. As part of this practicum experience, our team has been evaluating the resources these communities have in times of emergency in seven counties (Johnston, Harnett, Wake, Sampson, Duplin, Cumberland, Wayne). This year, we have the added complication of COVID-19 and avoidance of congregate living facilities that a hurricane shelter would represent.

Each member of our team has been responsible for researching what resources farmworkers have according to their county’s Emergency Preparedness plans as well as a list of important contacts. I have been accumulating this data and organizing it into an easy to read and reference table for stakeholders to access. So far, this research has been disheartening. Most of the counties seem to have a lack of regard for their Spanish speaking and farmworker communities. However, I do not believe this has been done in malice. I genuinely believe there is a lack of knowledge about the constituents of the community. That is where our practicum group comes in. After gathering this data, gaps in the emergency preparedness of counties will be identified and a plan to include them as a strategic partner in the future will be formed.

Questions to be answered in our research include whether there are the same guides offered on the county webpages in Spanish as they are in English.  Does the county’s webpage even have the ability to be translated so that the guides can be found by this population? It is vital to know what counties are doing to prepare shelters during the pandemic for people who need to evacuate. At these shelters, will there be staff that speak multiple languages to help these families navigate through a stressful time of searching for resources and locating their loved ones? How does the county emergency management disperse such vital information to the entire community, and does that communication include an option for non-English speakers?

To assist in answering these questions and developing a strategic partnership, I attended a workshop hosted by the North Carolina Farm Worker Health Program. Members from various organizations such as Manos Unidas were in attendance to share their struggles and successes. One of the services our team and many others are realizing is lacking in most counties is the notification system. These notification systems are created to disperse important information to many people at once. However, many do not have directions for sign up in the Spanish language. Even those that do not do not actually send alerts out in that language. Without this notification system, in times of emergency outreach workers have to individually contact each farm worker throughout the county to notify them. This takes away from the efforts that can be used to safely evacuate workers and prepare them for the disaster. To add complications to the problem, as rurality often does, many of these workers live in isolated communities on farms with poor cell phone service. How do we inform them of the health risks associated with hurricane damage? How do we get involved with Emergency Management at a county level to be included in the conversation?

Building a strategic partnership is a cycle. The first step is determining barriers, such as lack of Spanish language guides, lack of Spanish emergency notification systems, and lack of information on evacuation shelters. Second, is identifying a partner. For this topic, the best partner is Emergency Preparedness and the County Health Department. Third is to align shared values. Many county entities have the mission of serving the community. Aligning these values can include informing the partner of how much of their community is made up of these Spanish speaking farm workers whose well-being is disregarded in these plans. Acclaim should be given for the tireless work the county already does to protect many people, but ultimately the long-term goal of inclusivity and increased access should be discussed.  Once a partnership is formed, it is important to define roles and set boundaries. For example, using the already established notification system of a county with the help of the NCFWP to translate services to disperse the messages to the Spanish speaking community members.  Finally, maintaining communication is key in achieving goals. This can be completed by planning a regular time and method of communication. Then, once those goals are complete, we start back at square one: Are there any additional barriers?  

NC Worker Week of action is focusing on food workers this week! Currently, legislature dictates that employers in NC can chose whether to follow CDC guidelines or not. This is absolutely absurd and favors large corporations while leaving front line workers at risk. This puts these workers and families in danger, and therefore everyone in danger. We are working to change this by petitioning our local government. If you’re willing to join us, you can here:

https://p2a.co/n1jhRLx