Ohio pediatrician treats a child in eastern NC after Florence.
Vijay Srinivasa, a pediatrician from Ohio, treats a child in eastern North Carolina after Hurricane Florence. Courtesy of Farm Labor Organizing Committee

By Taylor Knopf, North Carolina Health News

Hurricanes typically hit poorer, more vulnerable populations the hardest.

So a week after Florence, a medical mission team based out of Toledo, Ohio, traveled to eastern North Carolina specifically to serve migrant farmworker communities.

Hurricanes or natural disasters tend to worsen existing health care and housing issues for farmworkers, said Justin Flores, vice president of Farm Labor Organizing Committee (FLOC), a multi-state agricultural worker organization.

FLOC is also based in Toledo, Ohio, but has a strong presence in North Carolina. Flores spends his time in Charlotte and in Dudley, where the group’s North Carolina headquarters are located.

Farmworkers often dwell in housing units supplied by growers, Flores noted, and he said many depend on their employers for rides anywhere.

“Your employer has a lot of say over when and where you get health care,” he said. “So those issues already exist and a hurricane just adds to that.”

Access to care also varies county to county in North Carolina, and he said some farmworkers are able to physically get to low-cost health clinics. But after transportation difficulties, low wages also makes it difficult to pay for, and receive, care.

There are a lot of workplace injuries and illnesses, Flores noted, such as green tobacco sickness, exposure to pesticides, stress, falls and snake bites.

Major hurricanes such as Florence wipe out a lot of the crop fields, and for farmworkers, it can result in a loss of work, wages and sometimes housing. Flores said some workers will be without work for a week or two after the storm.

The 83rd mission

Richard Paat, clinical professor of medicine at the University of Toledo College of Medicine, runs the school’s global medical mission team.

When Paat heard from Toledo-based FLOC staff about the migrant farmworkers in Florence’s path, he gathered a medical mission team – the 83rd group to go out to deliver care. Some missions are scheduled annually to places such as Honduras and Guatemala, others occur in the aftermath of natural disasters such as Puerto Rico after Maria and Texas after Harvey.

Each team member pays for their own transportation, and Paat takes care of the supplies. After dozens of missions, he’s developed a standard packing list.

The goal of the medical missions team is to target marginalized populations. They bring information in Spanish and English. Many team members are bilingual.

“We all drop what we have to do, take vacation time, reschedule patients and head down,” he said.

Thirteen duffel bags, each filled with 50 pounds of medical supplies and medications Paat brought to North Carolina were purchased with donations made by the Special Commission on Relief and Education (SCORE) of the Filipino Association of Toledo.

Due to the state of emergency declaration, members of his team obtained temporary medical licenses to practice in North Carolina.

Paat and a team of 17 doctors from Toledo, Utah, Virginia, Alabama and Wisconsin landed in Raleigh on Friday, Sept. 21, a week after Hurricane Florence made landfall. Most team members were veterans of prior disaster relief missions.

New additions were three medical students from Puerto Rico who wanted to give back after experiencing Hurricane Maria. Paat said a doctor from Duke University, as well as six members of the Philippine Nursing Association of North Carolina joined the team.

FLOC took care of the group’s logistical needs, they slept on air mattresses in its office building in Dudley. Paat said about 40 migrant farmworker families had evacuated to the FLOC building in Wayne County during the storm and they cooked for the medical missions team.

Stark reality

Over the course of three days, the team saw about 300 patients. The first day they set up at the FLOC building, the second day outside La Tropicana Mexican market in Clinton, and the third they split into mini teams and visited farmworker camps.

Paat said he often sees upper respiratory infections and skin issues following a hurricane, as well as anxiety and depression. And with the migrant workers, Paat said he saw green tobacco sickness for the first time.

They informed people about the clinics through FLOC and put up flyers in local Latino businesses. All clinic visits and medications are free to patients. Paat said he tries to remove all barriers to care during these relief missions.

When visiting the migrant worker housing on the last day, Paat said he was hit by a “stark reality.”

They drove past the growers’ residences first, which Paat said are always very nice. Then they passed the stables, which he said are well-kept. Up next  are the farmworker housing units.

“Then you realize the horses have better homes than the migrant workers,” Paat said.

The migrant farmworkers also have complex mental health needs. Paat said his team encountered high rates of depression and anxiety stemming from fear of being deported, legal issues with their employers, poor living conditions, and family separation.

Others talked about the loss of crops, jobs and wages resulting from Florence.

“I heard the tobacco was mainly gone,” Paat said. “They were hoping the sweet potato crop would come in. And a lot were looking to work in the Christmas tree industry coming up.”

He said many use alcohol as a way to treat their depression.

Treating mental health issues for this population is difficult, Paat said. In some cases, his team could prescribe a three-month supply of antidepressants or anxiety medication. Permanent North Carolina residents have the option to see a local provider.

But for a number who are seasonal employees, often moving from place to place, it can be more difficult to obtain and maintain treatment.

Before and after

As for pre-storm warnings, FLOC worked to get the word out about shelters and resources through emails, text chains and Facebook posts to the 10,000 farmworkers the organization represents.

Flores said he got the sense that Spanish language messaging and advisories ahead of Hurricane Florence were better than for Matthew in 2016, which he attributes to the projected magnitude of the storm.

Employers are responsible for evacuating farmworkers if necessary. And Flores said FLOC put the word out to members to report those bosses who didn’t help with evacuation.

Overall, with the exception of maybe one or two, Flores said employers did a good job of doing what they were supposed to do.

FLOC had volunteers at the clinics to help people who wanted to apply for FEMA assistance.

But people who may qualify for assistance through a U.S. citizen child sometimes are hesitant to do so. The applications require lots of information and for migrant workers who are undocumented, it can be intimidating, he said.

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