- Email: [email protected]
Migrant Seasonal Farm Worker Women
Joc;A\ C L I N I C A L
I S S U E S
Mlgrant and Seasonal Farm Worker Women Mary I. Lambert, RN,MN, CS
Migrant and seasonal farm worker women are part of a population whose health care needs are underserved. This article provides some definition of this population and reviews some of the health needs specific to them. The significant need for outreach to and assessment of this population is addressed. The significance of the nurse’s role is addressed. The need for health care services being delivered in a culturally sensitive manner is discussed. Resources to assist health care providers in providing more effective interventions and referrals for care of migrant and seasonal farm worker women are identified.
igrant and seasonal farm workers are considered to b e one of the most underprivileged groups in this country. This population is mobile, multicultural, difficult to reach, and has significant health needs. The size of the migrant farm worker population in the United States has been estimated to b e between 2.7 a n d 5 million people. The ethnic groups represented in this population include blacks, whites, Hispanics, and Haitians. The migrant farm worker population tends to have more young people and fewer older people. A migrant farm worker is an individual whose principal employment is in agriculture o n a seasonal basis and w h o establishes a temporary residence for such employment. A seasonal farm worker is an individual whose principal employment is in agriculture o n a seasonal basis but w h o remains in t h e area throughout the year. Seasonal farm workers often exist o n low wages from irregular employment, with access to only poor housing a n d often inadequate health care. According to Slesinger a n d Pfeffer (1992), t h e r e a r e t h r e e primary streams of migrant farm workers in t h e United States. T h e s e streams a r e t h e Western, C e n tral, a n d Eastern. Western Stream migrants travel north from northern Mexico, s o u t h e r n Texas, a n d s o u t h e r n California u p t h e West Coast. Central Stream migrants travel north from n o r t h e r n Mexico into t h e Midwest. T h e s e two streams a r e primarily m a d e u p of
Murcb/AprillYYS
people of Mexican heritage. T h e Eastern Stream migrants most o f t e n travel north from Florida, working in Georgia, t h e Carolinas, a n d o t h e r states o n t h e Northeast coast. T h e Eastern stream is ethnically varied, with African-Americans from rural Florida, Haitians, Puerto Ricans, a n d s o m e individuals of Mexican heritage from Texas. Migrant farm workers generally work a n d travel in g r o u p s o f individuals or groups of families. S o m e individuals f o u n d in t h e migrant farm worker population d o not travel in a g r o u p but roam t h e country in s e a r c h of farm work. T h e condition of t h e s e f r e e - w h e e l e r s may be even m o r e underprivil e g e d than o t h e r migrant farm workers w h o travel in g r o u p s . This is because they d o not have labor c o n tracts, may a c c e p t wages that a r e b e l o w t h e minimum w a g e , a n d may live in housing that is not inspected or b e h o m e l e s s , living in cars, a b a n d o n e d farm buildings, o r o u t s i d e . . O u t r e a c h to a n d assessment of t h e n e e d s of individuals in t h e population a r e difficult a n d of critical importance. Farm workers, migrant a n d seasonal, g e n erally a r e f o u n d to have many health care needs. T h e s e individuals a r e subject to m o r e accidents, d e n tal disease, mental health p r o b l e m s , substance abuse p r o b l e m s , malnutrition, higher rates of diabetes, hyp e r t e n s i o n , tuberculosis, anemia, a n d parasitic infections. I n addition, infant mortality is reported to be higher in t h e s e g r o u p s than in t h e general population, according to t h e National Migrant Resource Program, Inc. (1993).
Women’sHealtb Care Issues in Migrant Fawn WorkerPopulations Significant challenges present when providing services to w o m e n in migrant a n d seasonal farm worker popula-
Outreach to and assessment of the needs of individuals in the farm worker population are difficult and of critical importance.
J O C N N
265
CL
IN I C A
L I S S L‘E S
tions. Many of these women are of childbearing age, so issues of contraception, pregnancy, and childbirth are major concerns. In addition to sexually transmitted diseases, other gynecologic infections or complaints are of major concern. Research and the literature indicate that migrant farm worker women are more likely to enter prenatal care after the first trimester of pregnancy and usually receive less prenatal attention than is recommended (Watkins, Larson, Harlan, C(r Young, 1990). This population may have a lower or less consistent use of contraceptives. In addition, because of their economic status and other lifestyle factors, migrant farm worker women and their families are likely t o have daily dietary intakes that are below the recommended dietary allowances for many nutrients. Inflammatory diseases of the cervix, vagina, and vulva often are diagnosed in this population. In addition, according to a report by the National Commission to Prevent Infant Mortality (1993), the number and rates of human immunodeficiency virus infection for farm worker women are growing more rapidly with each passing year. The Commission also reports that migrant and seasonal farm workers are contracting human immmunodeficiency virus (HIV) in significant numbers. Farm workers are disproportionally subject to conditions that facilitate HIV transmission (sexually transmitted diseases a n d alcohol and other drug use) and often lack access to prevention, treatment, and educational services that can slow the spread of HIV. Migrant farm worker women, even those w h o are pregnant or breastfeeding, sometimes work in t h e fields to supplement family income. Agricultural occupational hazards can adversely affect the reproductive and breastfeeding systems of a pregnant farm worker and t h e health of unborn children. Because of the strenuous nature of the work and the shift in a woman’s center of gravity during pregnancy, the pregnant migrant farm worker is at greater risk for falls and musculoskeletal injury. Voiding as often as necessary during pregnancy may be problematic when working in t h e field. Another agricultural occupational risk to the pregnant farm worker and the child s h e carries is the chemical compounds used in pesticides. Domestic violence is of particular concern with this population. Case findings and self-reporting sometimes are made difficult because of factors such as mobility, economic sratus, and uncertain immigration status in s o m e of the migrant farm worker population. These circumstances make assessment and intervention challenging. Another important health n e e d of migrant farm worker women is family planning. The high proportion of high-risk and undesired pregnancies is indicative of this health need. The mobile and unsettled lifestyle of individuals in the population may compromise the consistent use of a particular family planning method.
The nurse’s role in providing health services for migrant farm worker women is an important o n e . This role in pro-
viding migrant health services is most effective through multidisciplinary team efforts. Because many farm worker women present to health care centers for health supervision visits for their infants and children, the value of these opportunities to assess and address the health needs of the woman and of her family should not be overlooked. In providing for family planning needs, creative interventions may bring the most beneficial outcomes for this population. Interventions such as group education at migrant camps, use of trained lay health workers, and clinic hours that accommodate late work days of migrant farm worker women a r e found t o b e effective. Nursing outreach is important in seeking those in need of family planning education and services. Because farm worker w o m e n often lack transportation resources, nursing outreach in the form of visits to homes o r camps in which farm workers live is useful. T h e usefulness of these n u s ing outreach visits is that they provide an opportunity to assess needs, provide patient education, and introduce these women a n d their families to services a n d resources available in the area. T h e goals of this nursing outreach should be to assist migrant farm worker women to have only as many children as they want and t o assist in assuring that the pregnancies and children that these individuals have are healthy. Nursing assessment of the family planning status and needs o r interests is necessary for all migrant farm worker women of childbearing age (Migrant Clinicians Network, 1989). The role of males in the population in family planning should not b e overlooked or viewed as always negative or resistant to family planning. The nonreproductive health needs of migrant farm worker women also should b e assessed. This includes assessment of health needs of the women w h o are n o longer of childbearing age, although the numbers of such women are not large. Health education is an important component of the health care needs Qf migrant farm workers. The women in this population play an important role in the entire family’s health. Health education interventions for migrant farm worker populations and assessment of and consideration for the particular needs o f this population are influenced by cultural differences, economics, and the migratory lifestyle. These relevant and realistic health interventions will b e most effective in improving the health status of migrant farm worker women and their families. Health assessment and interventions with migrant a n d seasonal farm worker populations provide a potential for multiple misunderstandings, conflicts, and possibly tensions. This will occur when t h e cultures of the provider and the patient are different, as is often the case with migrant and seasonal farm worker populations. Cultural sensitivity can be achieved by the provider when the provider seeks accurate information about a cultural group. Consultation with professionals experienced in cross-cultural issues can be an extremely beneficial guide
266 J O C N N
Volume 24. Number 3
Nursing Caref o r Women in Migrant Farm Worker Populations
Cullurul Concepts in Clitzicul Cure
in assessing patients’ needs and in developing programs to deliver health care services. If professionals with this
expertise are not available locally, educational institutions with a transcultural nursing studies specialty should prove helpful. Nursing assessments and interventions for migrant farm worker populations also should reflect environment risks, provide treatment within the patient’s capacity for adherence to treatment plan, ensure adequate follow-up and referrals, provide accessible medical records for subsequent providers, and be communicated to the patient in an understandable language. These criteria for interventions with this population were developed by the Migrant Clinicians Network in the Cultural, Linguistic, Environment/Education Follow-up Process (CLEF). Some characteristics of this population that present challenges in health care delivery, as identified by the Migrant Clinicians Network (1988), are mobility, language barriers, cultural barriers, educational barriers, incomplete health histories, poor referral service resources, low priority for health care because of the pressures of work, timing of health visits, transportation for health visits, health risks associated with living and working conditions, and health problems that providers may not recognize if they are uncommon in the surrounding population.
Guidan ce/Reso u rces fo r Health Care Providers The goal of a health care system should be to provide quality care for all clients, but with a multiethnic population this can be accomplished only if providers are culturally sensitive. This population of patients is comprised of individuals from a variety of ethnic or racial groups, who speak various languages and who often have customs that are different from those found in the areas in which they live and work. According t o Caudle (1993), treatment plans developed to meet assessed needs must be acceptable to the client, and the client’s acceptance will be influenced by her culture. Culture was viewed by Burgess and Ragland (1983) as a fundamental component of the broader concept of ethnic groups. With migrant farm worker women, culture also should be viewed within the culture of migrant farm workers. A critical component in working with a culturally diverse client population is to be careful making generalizations about a group, i.e., to become more culturally sensitive while continuing to assess the individual needs of the client. To become more culturally sensitive, the health care
T h e goal of a health care system should be to provide quality care for all clients, but with a multiethnic population that can be accomplished only if providers are culturally sensitive.
Murch/April1995
providers need to continually work on their attitudes toward individuals o f cultures different from their own. Becoming culturally competent is an ongoing process. The process begins with being aware of our behavior, and attitudes are determined by the culture of the family and community to which we were born and raised and in which we live. As described by Torres (1993), cultural competence is achieved by the provider by developing the capacity to appreciate differences and continue to assess one’s reactions to different cultures. In becoming more culturally competent, organizational policies and practices may need t o be changed to be more sensitive to cultural differences. An essential element in achieving cultural sensitivity and cultural competence is valuing diversity. Cultural competence is characterized by a respect for and an acceptance of differences among groups and continual work on achieving real cultural competence (Grossman, 1994). Cultural competence is not achieved by merely having a translator or other staff members who speak the language of a different cultural group. Bilingualism is not necessarily biculturalism.
Health care providers involved with migrant farm worker clients can benefit from using the resources of the National Migrant Resource Program and the Migrant Clinicians Network.
The health status of migrant farm workers generally is viewed as underserved through the usual state and lo-
cal governmental and private resources because of a number of factors. The establishment of migrant health clinics was authorized in 1962 with the Public Health Service Act, which was a part of a program for the poor and medically undersewed populations in rural and urban areas. Federally funded migrant health centers can be found throughout the United States where there are significant groups of migrant farm workers. Staffing usually includes physicians, nurse practitioners or physicians’assistants, nurses, and other outreach workers who provide primarily translation and transportation services. Staffing also may include social workers and health educators. Some o f these health service programs include dental care and eye care. According to United States Public Health Service officials (Commission on Security and Cooperation, 1993), there are more than 100 organizations around the country providing health care services through more than 400 clinic sites to migrant and seasonal farm workers. These programs are linked to other health and social services and hospitals existing in the area. Although these clinics exist in many areas of the country, other areas are not served by such clinics. Dever (1991) reports estimates that migrant clinics can serve
JOG”
267
CLINlCAL
I S S U E S
only 20% or less of this nation’s migrant farm workers. Thus, many migrant and seasonal farm workers seek health care from providers available in the communities in which they live and work. In addition to established migrant health programs that may be in an area, health care providers involved with migrant farm worker clients will benefit from using the resources of the National Migrant Resource Program and the Migrant Clinicians Network. Since its inception in 1975, the National Migrant Resource Program has evolved into a program that provides products and services in support of migrant health centers and others involved in providing health care services to migrant and seasonal farm workers. This organization has a resource center that is a repository for information for migrant health centers, providers and patients. The address for the program is National Migrant Resource Program, Inc., 1515 Capital of Texas Highway, South, Suite 220, Austin, TX 78746; the telephone number is (512) 328-7682. The Migrant Clinicians Network, established in 1984, is an organization o f clinical professionals who provide a wide range of health and human services to migrant and seasonal farm workers and their families. Among the many resources and services offered by this organization are clinical care guidelines and guidelines for using the CLEF process, which are specifically tailored for use with a culturally diverse migrant and seasonal farm worker population. The address f o r the network is: Migrant Clinicians Network, 1515 Capital of Texas Highway, South, Suite 112, Austin, T X 78746; the telephone number is (512) 327-2017. These resources and consultations with professionals experienced in health care delivery to patients of different cultures will result in the development of more effective programs and services for migranf and seasonal farm worker women. This population of individuals is concerned about having their health care needs met and will use and continue to seek o u t services and providers who can meet these needs.
268 J O G N N
Refermces Burgess, W., clr Ragland, E. C. (1983). Community health nursing philosophy, process, practice. Connecticut: AppletonCentury-Crofts. Caudle, P. (1993). Providing culturally sensitive health care to Hispanic clients. Nurse Practitioner, 13(12), 40-51. Commission o n Security and Cooperation. (1993). Migrant farmworkers in the United States: Briefings of the Commission on Security a n d Cooperation. US Government Printing Office. Washington, DC: Author. Dever, G. E. (1991). Migrant health status: Profile of a population with complex health problems. Austin, TX: National Resource Program, Inc. Grossman, D. (1994). Enhancing your cultural competence. AmericanJournal ofNursing, 94(7), 58-62. Migrant Clinicians Network. (1988). Clinical care guidelines: CLEF,An introduction. Austin, TX: Author. Migrant Clinicians Network. (1989). Clinical care guidelines: Family planning. Austin, T X : Author . National Commission to Prevent Infant Mortality. (1993). HIV/ AIDS: A growing crisis among migrant a n d seasonal farmworkerfamilies. Washington, DC: Author. National Migrant Resource Program, Inc. (1993). 1993 recommendations of the National Adtiisory Council on Migrant Health. Austin, TX: Author. Slesinger, D., clr Pfeffer, M. (1992). Migrant farm workers. In C. Duncan (Ed.), Ruralpotwrty in America. New York: Auburn House. Torres, S. (1991). Cultural sensitivity: A must for today’s primary care provider. Aduatrcrfor Nurse Practitioners, I , 16- 18. Watkins, E. L., Larson, L., Harlan, C., clr Young, S . (1990). A model program for providing health services for migrant farmworker mothers and children. Public Health Reports, 6,567-576.
Address for correspondence: Mary I. Lambert, RN, MN, CS, PO Box 146, Federalsburg, MD 21632. Mary I. Lambert is a commander In the Untted States Public Health Servtce and is asstgned as the Health Services Coordtnatorfor a Delmarva Rural Mtntstries, Inc. cltntc in Federalsburg,MD.
Volume 24. Number 3
I S S U E S
Mlgrant and Seasonal Farm Worker Women Mary I. Lambert, RN,MN, CS
Migrant and seasonal farm worker women are part of a population whose health care needs are underserved. This article provides some definition of this population and reviews some of the health needs specific to them. The significant need for outreach to and assessment of this population is addressed. The significance of the nurse’s role is addressed. The need for health care services being delivered in a culturally sensitive manner is discussed. Resources to assist health care providers in providing more effective interventions and referrals for care of migrant and seasonal farm worker women are identified.
igrant and seasonal farm workers are considered to b e one of the most underprivileged groups in this country. This population is mobile, multicultural, difficult to reach, and has significant health needs. The size of the migrant farm worker population in the United States has been estimated to b e between 2.7 a n d 5 million people. The ethnic groups represented in this population include blacks, whites, Hispanics, and Haitians. The migrant farm worker population tends to have more young people and fewer older people. A migrant farm worker is an individual whose principal employment is in agriculture o n a seasonal basis and w h o establishes a temporary residence for such employment. A seasonal farm worker is an individual whose principal employment is in agriculture o n a seasonal basis but w h o remains in t h e area throughout the year. Seasonal farm workers often exist o n low wages from irregular employment, with access to only poor housing a n d often inadequate health care. According to Slesinger a n d Pfeffer (1992), t h e r e a r e t h r e e primary streams of migrant farm workers in t h e United States. T h e s e streams a r e t h e Western, C e n tral, a n d Eastern. Western Stream migrants travel north from northern Mexico, s o u t h e r n Texas, a n d s o u t h e r n California u p t h e West Coast. Central Stream migrants travel north from n o r t h e r n Mexico into t h e Midwest. T h e s e two streams a r e primarily m a d e u p of
Murcb/AprillYYS
people of Mexican heritage. T h e Eastern Stream migrants most o f t e n travel north from Florida, working in Georgia, t h e Carolinas, a n d o t h e r states o n t h e Northeast coast. T h e Eastern stream is ethnically varied, with African-Americans from rural Florida, Haitians, Puerto Ricans, a n d s o m e individuals of Mexican heritage from Texas. Migrant farm workers generally work a n d travel in g r o u p s o f individuals or groups of families. S o m e individuals f o u n d in t h e migrant farm worker population d o not travel in a g r o u p but roam t h e country in s e a r c h of farm work. T h e condition of t h e s e f r e e - w h e e l e r s may be even m o r e underprivil e g e d than o t h e r migrant farm workers w h o travel in g r o u p s . This is because they d o not have labor c o n tracts, may a c c e p t wages that a r e b e l o w t h e minimum w a g e , a n d may live in housing that is not inspected or b e h o m e l e s s , living in cars, a b a n d o n e d farm buildings, o r o u t s i d e . . O u t r e a c h to a n d assessment of t h e n e e d s of individuals in t h e population a r e difficult a n d of critical importance. Farm workers, migrant a n d seasonal, g e n erally a r e f o u n d to have many health care needs. T h e s e individuals a r e subject to m o r e accidents, d e n tal disease, mental health p r o b l e m s , substance abuse p r o b l e m s , malnutrition, higher rates of diabetes, hyp e r t e n s i o n , tuberculosis, anemia, a n d parasitic infections. I n addition, infant mortality is reported to be higher in t h e s e g r o u p s than in t h e general population, according to t h e National Migrant Resource Program, Inc. (1993).
Women’sHealtb Care Issues in Migrant Fawn WorkerPopulations Significant challenges present when providing services to w o m e n in migrant a n d seasonal farm worker popula-
Outreach to and assessment of the needs of individuals in the farm worker population are difficult and of critical importance.
J O C N N
265
CL
IN I C A
L I S S L‘E S
tions. Many of these women are of childbearing age, so issues of contraception, pregnancy, and childbirth are major concerns. In addition to sexually transmitted diseases, other gynecologic infections or complaints are of major concern. Research and the literature indicate that migrant farm worker women are more likely to enter prenatal care after the first trimester of pregnancy and usually receive less prenatal attention than is recommended (Watkins, Larson, Harlan, C(r Young, 1990). This population may have a lower or less consistent use of contraceptives. In addition, because of their economic status and other lifestyle factors, migrant farm worker women and their families are likely t o have daily dietary intakes that are below the recommended dietary allowances for many nutrients. Inflammatory diseases of the cervix, vagina, and vulva often are diagnosed in this population. In addition, according to a report by the National Commission to Prevent Infant Mortality (1993), the number and rates of human immunodeficiency virus infection for farm worker women are growing more rapidly with each passing year. The Commission also reports that migrant and seasonal farm workers are contracting human immmunodeficiency virus (HIV) in significant numbers. Farm workers are disproportionally subject to conditions that facilitate HIV transmission (sexually transmitted diseases a n d alcohol and other drug use) and often lack access to prevention, treatment, and educational services that can slow the spread of HIV. Migrant farm worker women, even those w h o are pregnant or breastfeeding, sometimes work in t h e fields to supplement family income. Agricultural occupational hazards can adversely affect the reproductive and breastfeeding systems of a pregnant farm worker and t h e health of unborn children. Because of the strenuous nature of the work and the shift in a woman’s center of gravity during pregnancy, the pregnant migrant farm worker is at greater risk for falls and musculoskeletal injury. Voiding as often as necessary during pregnancy may be problematic when working in t h e field. Another agricultural occupational risk to the pregnant farm worker and the child s h e carries is the chemical compounds used in pesticides. Domestic violence is of particular concern with this population. Case findings and self-reporting sometimes are made difficult because of factors such as mobility, economic sratus, and uncertain immigration status in s o m e of the migrant farm worker population. These circumstances make assessment and intervention challenging. Another important health n e e d of migrant farm worker women is family planning. The high proportion of high-risk and undesired pregnancies is indicative of this health need. The mobile and unsettled lifestyle of individuals in the population may compromise the consistent use of a particular family planning method.
The nurse’s role in providing health services for migrant farm worker women is an important o n e . This role in pro-
viding migrant health services is most effective through multidisciplinary team efforts. Because many farm worker women present to health care centers for health supervision visits for their infants and children, the value of these opportunities to assess and address the health needs of the woman and of her family should not be overlooked. In providing for family planning needs, creative interventions may bring the most beneficial outcomes for this population. Interventions such as group education at migrant camps, use of trained lay health workers, and clinic hours that accommodate late work days of migrant farm worker women a r e found t o b e effective. Nursing outreach is important in seeking those in need of family planning education and services. Because farm worker w o m e n often lack transportation resources, nursing outreach in the form of visits to homes o r camps in which farm workers live is useful. T h e usefulness of these n u s ing outreach visits is that they provide an opportunity to assess needs, provide patient education, and introduce these women a n d their families to services a n d resources available in the area. T h e goals of this nursing outreach should be to assist migrant farm worker women to have only as many children as they want and t o assist in assuring that the pregnancies and children that these individuals have are healthy. Nursing assessment of the family planning status and needs o r interests is necessary for all migrant farm worker women of childbearing age (Migrant Clinicians Network, 1989). The role of males in the population in family planning should not b e overlooked or viewed as always negative or resistant to family planning. The nonreproductive health needs of migrant farm worker women also should b e assessed. This includes assessment of health needs of the women w h o are n o longer of childbearing age, although the numbers of such women are not large. Health education is an important component of the health care needs Qf migrant farm workers. The women in this population play an important role in the entire family’s health. Health education interventions for migrant farm worker populations and assessment of and consideration for the particular needs o f this population are influenced by cultural differences, economics, and the migratory lifestyle. These relevant and realistic health interventions will b e most effective in improving the health status of migrant farm worker women and their families. Health assessment and interventions with migrant a n d seasonal farm worker populations provide a potential for multiple misunderstandings, conflicts, and possibly tensions. This will occur when t h e cultures of the provider and the patient are different, as is often the case with migrant and seasonal farm worker populations. Cultural sensitivity can be achieved by the provider when the provider seeks accurate information about a cultural group. Consultation with professionals experienced in cross-cultural issues can be an extremely beneficial guide
266 J O C N N
Volume 24. Number 3
Nursing Caref o r Women in Migrant Farm Worker Populations
Cullurul Concepts in Clitzicul Cure
in assessing patients’ needs and in developing programs to deliver health care services. If professionals with this
expertise are not available locally, educational institutions with a transcultural nursing studies specialty should prove helpful. Nursing assessments and interventions for migrant farm worker populations also should reflect environment risks, provide treatment within the patient’s capacity for adherence to treatment plan, ensure adequate follow-up and referrals, provide accessible medical records for subsequent providers, and be communicated to the patient in an understandable language. These criteria for interventions with this population were developed by the Migrant Clinicians Network in the Cultural, Linguistic, Environment/Education Follow-up Process (CLEF). Some characteristics of this population that present challenges in health care delivery, as identified by the Migrant Clinicians Network (1988), are mobility, language barriers, cultural barriers, educational barriers, incomplete health histories, poor referral service resources, low priority for health care because of the pressures of work, timing of health visits, transportation for health visits, health risks associated with living and working conditions, and health problems that providers may not recognize if they are uncommon in the surrounding population.
Guidan ce/Reso u rces fo r Health Care Providers The goal of a health care system should be to provide quality care for all clients, but with a multiethnic population this can be accomplished only if providers are culturally sensitive. This population of patients is comprised of individuals from a variety of ethnic or racial groups, who speak various languages and who often have customs that are different from those found in the areas in which they live and work. According t o Caudle (1993), treatment plans developed to meet assessed needs must be acceptable to the client, and the client’s acceptance will be influenced by her culture. Culture was viewed by Burgess and Ragland (1983) as a fundamental component of the broader concept of ethnic groups. With migrant farm worker women, culture also should be viewed within the culture of migrant farm workers. A critical component in working with a culturally diverse client population is to be careful making generalizations about a group, i.e., to become more culturally sensitive while continuing to assess the individual needs of the client. To become more culturally sensitive, the health care
T h e goal of a health care system should be to provide quality care for all clients, but with a multiethnic population that can be accomplished only if providers are culturally sensitive.
Murch/April1995
providers need to continually work on their attitudes toward individuals o f cultures different from their own. Becoming culturally competent is an ongoing process. The process begins with being aware of our behavior, and attitudes are determined by the culture of the family and community to which we were born and raised and in which we live. As described by Torres (1993), cultural competence is achieved by the provider by developing the capacity to appreciate differences and continue to assess one’s reactions to different cultures. In becoming more culturally competent, organizational policies and practices may need t o be changed to be more sensitive to cultural differences. An essential element in achieving cultural sensitivity and cultural competence is valuing diversity. Cultural competence is characterized by a respect for and an acceptance of differences among groups and continual work on achieving real cultural competence (Grossman, 1994). Cultural competence is not achieved by merely having a translator or other staff members who speak the language of a different cultural group. Bilingualism is not necessarily biculturalism.
Health care providers involved with migrant farm worker clients can benefit from using the resources of the National Migrant Resource Program and the Migrant Clinicians Network.
The health status of migrant farm workers generally is viewed as underserved through the usual state and lo-
cal governmental and private resources because of a number of factors. The establishment of migrant health clinics was authorized in 1962 with the Public Health Service Act, which was a part of a program for the poor and medically undersewed populations in rural and urban areas. Federally funded migrant health centers can be found throughout the United States where there are significant groups of migrant farm workers. Staffing usually includes physicians, nurse practitioners or physicians’assistants, nurses, and other outreach workers who provide primarily translation and transportation services. Staffing also may include social workers and health educators. Some o f these health service programs include dental care and eye care. According to United States Public Health Service officials (Commission on Security and Cooperation, 1993), there are more than 100 organizations around the country providing health care services through more than 400 clinic sites to migrant and seasonal farm workers. These programs are linked to other health and social services and hospitals existing in the area. Although these clinics exist in many areas of the country, other areas are not served by such clinics. Dever (1991) reports estimates that migrant clinics can serve
JOG”
267
CLINlCAL
I S S U E S
only 20% or less of this nation’s migrant farm workers. Thus, many migrant and seasonal farm workers seek health care from providers available in the communities in which they live and work. In addition to established migrant health programs that may be in an area, health care providers involved with migrant farm worker clients will benefit from using the resources of the National Migrant Resource Program and the Migrant Clinicians Network. Since its inception in 1975, the National Migrant Resource Program has evolved into a program that provides products and services in support of migrant health centers and others involved in providing health care services to migrant and seasonal farm workers. This organization has a resource center that is a repository for information for migrant health centers, providers and patients. The address for the program is National Migrant Resource Program, Inc., 1515 Capital of Texas Highway, South, Suite 220, Austin, TX 78746; the telephone number is (512) 328-7682. The Migrant Clinicians Network, established in 1984, is an organization o f clinical professionals who provide a wide range of health and human services to migrant and seasonal farm workers and their families. Among the many resources and services offered by this organization are clinical care guidelines and guidelines for using the CLEF process, which are specifically tailored for use with a culturally diverse migrant and seasonal farm worker population. The address f o r the network is: Migrant Clinicians Network, 1515 Capital of Texas Highway, South, Suite 112, Austin, T X 78746; the telephone number is (512) 327-2017. These resources and consultations with professionals experienced in health care delivery to patients of different cultures will result in the development of more effective programs and services for migranf and seasonal farm worker women. This population of individuals is concerned about having their health care needs met and will use and continue to seek o u t services and providers who can meet these needs.
268 J O G N N
Refermces Burgess, W., clr Ragland, E. C. (1983). Community health nursing philosophy, process, practice. Connecticut: AppletonCentury-Crofts. Caudle, P. (1993). Providing culturally sensitive health care to Hispanic clients. Nurse Practitioner, 13(12), 40-51. Commission o n Security and Cooperation. (1993). Migrant farmworkers in the United States: Briefings of the Commission on Security a n d Cooperation. US Government Printing Office. Washington, DC: Author. Dever, G. E. (1991). Migrant health status: Profile of a population with complex health problems. Austin, TX: National Resource Program, Inc. Grossman, D. (1994). Enhancing your cultural competence. AmericanJournal ofNursing, 94(7), 58-62. Migrant Clinicians Network. (1988). Clinical care guidelines: CLEF,An introduction. Austin, TX: Author. Migrant Clinicians Network. (1989). Clinical care guidelines: Family planning. Austin, T X : Author . National Commission to Prevent Infant Mortality. (1993). HIV/ AIDS: A growing crisis among migrant a n d seasonal farmworkerfamilies. Washington, DC: Author. National Migrant Resource Program, Inc. (1993). 1993 recommendations of the National Adtiisory Council on Migrant Health. Austin, TX: Author. Slesinger, D., clr Pfeffer, M. (1992). Migrant farm workers. In C. Duncan (Ed.), Ruralpotwrty in America. New York: Auburn House. Torres, S. (1991). Cultural sensitivity: A must for today’s primary care provider. Aduatrcrfor Nurse Practitioners, I , 16- 18. Watkins, E. L., Larson, L., Harlan, C., clr Young, S . (1990). A model program for providing health services for migrant farmworker mothers and children. Public Health Reports, 6,567-576.
Address for correspondence: Mary I. Lambert, RN, MN, CS, PO Box 146, Federalsburg, MD 21632. Mary I. Lambert is a commander In the Untted States Public Health Servtce and is asstgned as the Health Services Coordtnatorfor a Delmarva Rural Mtntstries, Inc. cltntc in Federalsburg,MD.
Volume 24. Number 3