UNION HEALTH PLAN PROVIDES MUCH-NEEDED SAFETY NET

ILL HARVEST
UNION HEALTH PLAN PROVIDES MUCH-NEEDED SAFETY NET
The Robert F. Kennedy farmworkers plan is limited, but it is the best option for many.
By David Bacon
Capital and Main, 12/15/22
https://capitalandmain.com/union-health-plan-provides-much-needed-safety-net

 
A crew of farmworkers harvest lettuce for D'Arrigo Brothers in a Salinas field in 2018. All photos by David Bacon.


For Maria Zavala's family, there are no easy years. But last year brought the family to the edge of disaster. Zavala, a lettuce worker, is diabetic, and in addition to two other medicines she has to take regularly to control diabetes, she carries an insulin pen. Her 17-year-old son has attention deficit disorder, and she says his doctor told them his depression is one reason why his weight grew dangerously.

Then this year, her 15-year-old daughter also became seriously depressed. Zavala looked for a psychologist or therapist at the local clinic and hospital in Salinas. "There were no appointments," she says, "and especially no one available who can treat adolescents."

The Zavalas are covered by the health care plan from her union, the Robert F. Kennedy Farm Workers Medical Plan. It works fine for her everyday needs, she says. She pays $25 every time she fills a prescription, far below the over-the-counter price of the medicine her family needs. A doctor visit costs $25 for the first five visits and then goes down to $15.

 

 
Maria Zavala, a D'Arrigo Brothers lettuce cutter and beneficiary of the UFW's Robert F. Kennedy Farm Workers Medical Plan.


But the closest treatment she could find for her daughter was from the Ohana Center for Child and Adolescent Behavioral Health in Monterey, 20 miles away from their home in Salinas. Ohana is not part of the network of approved providers under the RFK plan, but she talked to the plan administrators and they agreed to provide coverage. Still, the co-pay was a hardship for the Zavalas. For the $4,000 bill, the plan paid $3,000. "A thousand dollars is still a lot for us," she explains, "but it's much better than $4,000."

The RFK plan covers about 3,000 members of the United Farm Workers - about 7,500 people, counting spouses and children. "While that's a small percentage of the state's estimated 700,000 agricultural laborers," according to plan administrator Patrick Pine, "it sets a high standard even for state policymakers and other growers." In 2015, the Affordable Care Act mandated that all employers with more than 50 full-time workers offer medical coverage.

People who work in the fields, however, are usually faced with plans that cover very little, with premiums that are often prohibitively expensive, according to Lauro Barajas, a regional director for the United Farm Workers. The RFK plan may not cover everything with no co-pays, but it gives farmworkers the kind of coverage that's familiar to union workers in urban jobs that often pay much higher wages. According to Farmworker Justice, campesino families still have annual incomes that average $25,000 to $29,999 nationally.

While the RFK plan provided the basic medical care for the Zavalas at a cost they could afford, Maria's situation became more perilous this spring. For reasons she never understood, the clinic she uses in Salinas, the Santa Lucia Medical Group, began saying the plan would not cover her diabetes medication. "I talked to Edgar [her union representative], and he talked with the plan," she says. The plan administrators were able to straighten the pharmacy out, but it took two months, and in the meantime her medicine ran out.

"The pain was bad," she remembers, "but I tried to just live with it because going to the hospital would be expensive. But then I couldn't urinate anymore, and it got so bad that one night I asked my husband to take me to the emergency room." When she got out, that was another bill. The plan paid $1,600, and she paid $700. "The reality is that we depend completely on our plan," she emphasizes. "Without it, I don't know what we'd do."

 

 
United Farm Workers Regional Director Lauro Barajas.


That is the prospect that faces them now. Zavala works for the D'Arrigo Brothers Company, one of the largest growers in the Salinas Valley. She has medical coverage because it is negotiated in the contract D'Arrigo has with the United Farm Workers. The company pays the entire premium, but in order to qualify for coverage, she has to work about 80 hours a month. She can do that from May to November, but it leaves four months in the winter when she has to pay the premium herself.

Her husband also works, but at another company with a health plan that's much more expensive and covers much less. He supervises a crew of contract workers on H-2A agricultural visas, and for months he's on the road, only coming back on weekends to see Maria and the children. Still, they are all covered by RFK. So, between his job and her savings, they have been able to make it. They even bought a modest house in Salinas, where a large print of the Last Supper hangs proudly on the wall of her spotless living room. The mortgage is $2,300.

Every year, she saves about $4,000, from a monthly wage that adds up to about $3,000. That's what she uses to keep her insurance in the winter. But she expects the plan's cost to increase in 2023. Her hospital visit and her daughter's care have already wiped out her savings, and the twice-weekly visits to Ohana will continue to cost a lot. Jobs in any farmworker town like Salinas are hard to find until work picks up again in the spring. As she listed the bills she feared she wouldn't be able to pay, she began to cry. "It's going to be very hard. I don't know what we'll do, but we have to keep our insurance. My back is to the wall," she says.
 
The Origin of the RFK Plan

The idea for a farmworker medical plan came out of the grape strike that started in Delano and Coachella in 1965. The vice principal of Garces Memorial High School in Bakersfield, LeRoy Chatfield, went to work for what became the United Farm Workers in the strike's first year, at a salary of $20 a month.

Chatfield then explained to his Catholic superiors that Cesar Chavez had put him in charge of developing a plan for farmworker cooperatives. "Our idea," he told them, "is to build a complex of cooperatives (clinic, pharmacy, credit union, garage, etc.) somewhere in the valley ... owned and controlled by farmworkers themselves." The union's first effort in health care was setting up a clinic at its Forty Acres headquarters in Delano. That was followed in subsequent years by clinics in Salinas and Coachella. "We look upon this as a prerequisite for serious grassroots organizing," he wrote.

 

 
D'Arrigo Brothers strikers at the edge of a company field call on other workers to leave work and join the strike in 1998.


Chatfield was put in charge of recruiting doctors, nurses and other health professionals to staff them. "The clinics were important because prior to them, there really wasn't a place farmworkers could go to get good medical care," recalls Arturo Rodriguez, who was UFW president from Chavez's death in 1993 until 2018, when he retired. "They'd end up in emergency rooms, and there were all kinds of horror stories. What little care they got cost an exorbitant amount of money. And because farmworkers had no access, they were susceptible to all kinds of illnesses."

The clinics were not just service providers, however. They were the means to show workers that their collective action could create change. "They demonstrated to workers and their families," Rodriguez says, "that the union was trying to deal not just with low wages and bad treatment in the fields, but with the needs of families outside of work. We were saying, this is what the union can do, providing things they never got before from employers, labor contractors or the government. It gave workers a reason to take the risks we were asking to bring in the union."

The Coachella clinic was inaugurated with a march through the valley at the beginning of union representation elections in 1976. In the 1980s, the union established one final clinic in Salinas, but the clinics had become difficult to sustain. "In the '60s and '70s, a lot of doctors and nurses wanted to volunteer and spend time in programs that required work in rural communities, serving their needs," Rodriguez explains. "That changed, and we could find fewer and fewer every year who wanted to live in places like Salinas and Coachella. Once we accepted that setting up clinics was no longer possible, we began working extremely hard on a medical plan that could provide the services workers and families needed at a low cost."

Chatfield had been charged by Chavez with setting up such a plan, and by 1975 it had begun to be included in the negotiation of union contracts. Chavez would meet with the ranch committees, which were elected to represent workers at union companies. "Last night at the Perelli-Minetti winery meeting," Chatfield wrote in a journal he kept at the time, "the workers were shell-shocked about the benefits. One of the workers said, 'A year ago, I had nothing, and now you ask me if I like these benefits? They're great!'"

Changing the union's emphasis from clinics to the RFK plan, however, also meant that instead of services available to all workers, the plan only covered those who were under union contracts - a much smaller group. For the larger workforce, the union organized political campaigns to improve conditions in general.

 

 
Forewoman Blanca and Supervisor Sergio Flores check the quality of the hearts of romaine lettuce.  Maria Zavala works in a crew harvesting this lettuce.


That included union campaigns in support of a suit by California Rural Legal Assistance to ban the short-handled hoe, which the state Supreme Court upheld in 1975. The use of the hoe contributed to spinal damage among workers who had to bend over when thinning vegetables and other crops over a period of years. Later, when cancer clusters were discovered in McFarland and other small towns in the southern San Joaquin Valley, the union launched a campaign against pesticide use on table grapes. And in 2005, after four workers collapsed and died in the summer's extreme heat, the union successfully lobbied for an administrative rule establishing the right to shade and additional breaks in temperatures over 95 degrees, among other protections.

Until 2015, the D'Arrigo Brothers Company, one of the Salinas Valley's oldest vegetable growers and Maria Zavala's employer, had a very contentious relationship with the United Farm Workers. The nascent United Farm Workers Organizing Committee signed a contract with D'Arrigo Brothers during the great Salinas lettuce strike of 1970. It lasted only two years and the company refused to renew it. Workers voted for the union in 1976, but were unable to get an agreement.

Nevertheless, a core of union supporters worked for D'Arrigo Brothers through those decades. In 1998, another strike ended only when one of the company's owners suddenly died. Finally, in 2015 D'Arrigo Brothers Company and the union signed a contract, which is still in effect.  During negotiations in 2014, the D'Arrigo Brothers Company agreed to pay for the RFK plan, and the union signed a contract, which has been renewed. Under that contract, D'Arrigo has agreed to pay the entire premium for the RFK insurance plan, about $700 per employee per month this year. It includes vision and dental coverage and covers all immediate family members. 

 

 
D'Arrigo Brothers workers demonstrate at the company offices in 1994, asking the company to sign a contract with the RFK medical plan.


The plan is administered under the Taft-Hartley Act, with a board of three employer representatives and three union representatives. According to Patrick Pine, RFK plan administrator, "The challenge we face is that we cover workers in an industry with low pay, who live in markets like Salinas where the hospital and health care costs are some of the highest."

Some California agricultural employers who have no UFW contract buy medical insurance through the Western Growers Assurance Trust or the United Agricultural Benefit Trust. For coverage similar to that of the RFK plan, however, Pine says growers pay premiums about 25% higher. According to Barajas, they usually pass most of it on to their employees by having them pay a large part for medical insurance with high co-pays and limited coverage.

Pine says the RFK plan keeps administrative costs below those of its competitors and doesn't advertise or pay commissions to insurance brokers. Those savings result in lower premiums. "Our overhead is a lot less," he says. "I get a much lower salary and work in [the UFW headquarters in] La Paz, where the cost of living is a lot less than in Los Angeles." Rodriguez, one of the trustees, says the goal has always been "to maintain the lowest cost possible for employers and workers for a medical plan with the basic services workers use, including maternity, doctor visits and certain surgeries."

 

 
Josefina Puga cuts head lettuce in a D'Arrigo Brothers field.


To keep hospital costs low, John D'Arrigo, president of D'Arrigo Brothers, has contributed to Salinas' Natividad Hospital, which launched the D'Arrigo Family Specialty Services clinic. Natividad has hired trilingual interpreters in Spanish, English and the indigenous languages spoken by many valley farmworkers, including Mixtec and Triqui. D'Arrigo promotes the Agricultural Leadership Council, which has 160 members and donated $4.1 million to buy equipment for the hospital.
 

Supporting Long-Term Employment

A big part of D'Arrigo's motivation is maintaining a stable workforce. "It's hard to find workers today," he said in an interview. "We have a shrinking, aging workforce. We have to take care of who we have and make our jobs attractive to the people who live here. We need a long-term workforce, and we want direct hires - people who work directly for the company." At peak harvest season, D'Arrigo directly employs about 1,000 workers, and as a result the RFK plan covers about 2,500 people, including their families.

Maria Zavala may be a high-level user of plan benefits, but she is also a skilled worker, and the plan has kept her in the company's workforce. For five years, she's labored in the "corazones" crew, which cuts the lettuce for the company's leading Andy Boy brand of packaged hearts of romaine. Her crew is mostly women, doing a job that 30 years ago was limited to men. Now just one or two men load the boxes onto trucks, and women do all the other work. Still, even with the union contract and health plan, D'Arrigo finds it hard to fill all the open seats on her crew's lettuce machine.

One answer for the company has been to use labor contractors, who charge the company a price for harvesting a field, and then employ the workers.  Last year, workers with one contractor who brings crews from the Arizona/Sonora border petitioned to join the UFW so they could get covered by the RFK plan. "We worked with people in San Luis Rio Colorado to help put up a new hospital and meet the needs of the workers there also," says Rodriguez, the plan trustee. More than 200 of those workers are now included under RFK. About 250 working for D'Arrigo with another contractor, however, are not. In addition, the company has increased its use of H-2A contract workers, recruited in Mexico on temporary visas. Those workers also are not included in the RFK plan.

 

 
Former UFW President Arturo Rodriguez and UFW co-founder Dolores Huerta march with workers in Salinas during the 1998 strike against D'Arrigo Brothers.


"To me," Zavala says, "RFK has functioned well. It would be great if it paid for everything, but compared to others, it's much better." When she had problems with getting her diabetes medication, she was able to use the union's representative to complain and solve problems. Every year, D'Arrigo's employee relations director, Marla Henry, visits each crew with Mercedes Martinez, the RFK plan's assistant administrator. "If anyone expresses a concern, we get their name and contact information and investigate it," Henry says. According to Rodriguez, "Workers have access to the plan's administrators and do call the office to understand why they had to pay what they paid."

"It's not perfect," Barajas concludes, "but RFK is a model for farmworkers. D'Arrigo and Monterey Mushrooms [large companies with UFW contracts], by offering the plan, are forcing their competitors to have better medical plans in order to attract workers. Every time we go into contract negotiations, those other employers are watching. They know that what we get is what they'll have to pay, too."



ILL HARVEST
California Farmworkers and the Struggle for Health Care

 
Guillermina Diaz, a Mixtec immigrant from Oaxaca, picks strawberries.  She and her sister Eliadora support three other family members, all of whom sleep and live in a single room in a house in Oxnard.


More than 500,000 California farmworkers play a critical role in providing Americans with the food that nourishes and sustains their health. Yet, for those workers, their own health is too often in jeopardy.
 
The hazards present in farmwork - from exposure to the elements and harmful chemicals to the physical demands of picking and cutting crops - are aggravated by shortfalls in health coverage, delivery and workplace safety systems. As a result, farmworkers often go without the care they need, enduring injury and illness that might otherwise be prevented.
 
California's agricultural industry has always depended on immigrant labor, whether those migrants were from other U.S. states, Asia or Mexico. Ninety percent of California's farmworkers are immigrants, and more than half are undocumented. Many California farmworkers are indigenous laborers from Mexico for whom Spanish is not their primary language. For these workers, linguistic and cultural differences add another challenge to receiving adequate health care.
 
Journalists David Bacon and Pilar Marrero traveled to the communities where California farmworkers work and live to document the health care conditions they face. From their reporting, we provide a from-the-fields perspective through six stories:
 
In rural California, farmworkers fend for themselves to access health care
Why being a farmworker is a health risk
California's historic Medi-Cal expansion will miss many farmworkers
Treating indigenous farmworkers on their terms
Farmworkers' working and living conditions take a mental health toll
A union health plan provides a much-needed safety net

ILL HARVEST: TREATING FARMWORKERS ON THEIR TERMS

 ILL HARVEST
TREATING FARMWORKERS ON THEIR TERMS
For California's indigenous farmworker population, healthcare that respects their traditions is vital.
By David Bacon
Capital and Main,12/12/22
https://capitalandmain.com/treating-farmworkers-on-their-terms

 
Andres Ramirez plants root stock of strawberry plants.  All photos by David Bacon

Gloria Merino came to the Salinas Valley from the Mixteca region of Oaxaca, where she'd learned how to help women deliver babies. "My cousin was a curandero [a practitioner of traditional medicine] and he taught me how to heal," Merino recalls. "The Virgin, God and San Marcos all told me that I would heal people and make a living that way, so I learned to help deliver babies."

In Greenfield, in the Salinas Valley, she became a partera, or midwife, to women who wanted to deliver at home, using methods their communities had depended on for generations. She had to start growing her own herbs, since she couldn't find them in stores. "Triquis [the Oaxacan indigenous group to which she belongs] began to seek my help in healing or for trouble in their marriage," she recalls.

Merino was careful not to attempt dangerous deliveries. "If a woman has a fetus in a breech position or she feels bad during pregnancy," she says, "I rub almond oil on the mother's stomach and give her herbs, but I don't deliver breech babies myself. I just turn them around if they're in that position." For difficult births, she says, women go to the local Clínica de Salud del Valle de Salinas.

Although Merino saw midwifery as a calling, it was not easy to earn enough money from what indigenous immigrant women could pay her, so she also collected cans for recycling. But her biggest problem was that she had to practice in fear. "I heard that if you deliver at home, they can incarcerate the mother and father because it's illegal," she says.

 

 
Gloria Merino, a Triqui woman, practices as a partera, or midwife, in her community.  She holds a bundle of the different herbs she uses in making remedies for various illnesses or problems.


Until 2014, California law made it illegal for midwives to work without the supervision of a doctor, and few, if any, doctors were willing to provide it. Today, changes in the law require that midwives be licensed and limit the types of deliveries they can perform.

The Las Islas Clinic Connects With the Mixtecos
    
Indigenous Mexican migrants like Merino now make up a large part of the farm labor force in California. In 2010, the Indigenous Farmworker Study estimated that, including children, about 165,000 people had come from towns in southern Mexico to work in the state's fields.

They have their own system of health care and traditional medical practices, and once they're in the U.S., that system comes up against the existing U.S. health care system. How the relationship between the two develops requires respect for their practices, as well as ensuring that indigenous families get the health care they need, regardless of the system.

These indigenous immigrants speak languages that were thousands of years old when the European colonization started. In California's agricultural counties the two most common languages are Mixtec and Triqui, but people speak over a dozen others. There's no more recent count, but the number of indigenous farmworkers has undoubtedly grown.

In agricultural regions like Oxnard and Greenfield, most Triquis and Mixtecos get their health care in community clinics when they choose to access western, or nontraditional, medicine. It's often there that the divide between two cultures of health care becomes apparent.

Sarait Martinez, executive director of the Centro Binacional para el Desarrollo Indígena Oaxaqueño, says traditional practices, especially for giving birth, are a fundamental part of the rural indigenous culture of Mixteco and Triqui immigrants. "I don't think traditional practices should be left behind," she urges. "They're part of who we are as an indigenous community, and it's our responsibility to support the people who value them. Why can't they be combined with our current medical system here in California?"

 

 
The Diaz family, Mixtec immigrants from Oaxaca, sleep and live in a single room in a house in Oxnard, where other migrant families also live.  The Diaz family are strawberry workers.  From the left, Guiillermina Ortiz Diaz, Graciela, Eliadora, their mother Bernardina Diaz Martinez, and little sister Ana Lilia.


The question highlights the importance of the relationship between indigenous communities and health care institutions, especially community clinics. That relationship  - and the ability of clinics to gain the confidence of migrants - plays a key role in determining what care is available to these farmworkers from southern Mexico.

According to researcher Ed Kissam, "Many clinics like Clínica de Las Islas [the Las Islas Family Medical Group] in Oxnard were first organized by groups of progressive doctors, nurses and health care activists, who saw a community need and acted in the absence of support by the established health care system, in the era that followed the civil rights movement."
    
Although indigenous migrants from Oaxaca began coming to work in California during the Bracero Program that ended in 1964, it was only in the 1980s that flows of indigenous migrants began to increase rapidly. So, in their early years, few of the clinics knew much about indigenous migrants. At Las Islas that began to change 23 years ago, when Sandy Young, a family nurse practitioner, realized that most of her farmworker patients were speaking Mixteco.

 

 
At the Las Islas Clinic in Oxnard Family Nurse Practitioner Sandy Young examines her patient, Anita Arce, with the help of Nicolasa Revolledo, a Mixtec interpreter.


"The clinic started in the early '80s, and it wasn't until 1998 when the Mixteco community made its presence known," she remembers. "I realized we couldn't think that all we needed to do was hand people pieces of paper. I was the critic who said, 'What was done yesterday can't just be what we do today.'"

In the first step Young convinced clinic director Miguel Cervantes to hire Mixtec interpreters from the community, so that clinic staff could communicate with monolingual patients. But the clinic needed more than translation. Often women would come in with a paper bag full of papers they'd received in the mail or on previous visits. "Since they didn't read English, and sometimes couldn't read at all, everything went into that paper bag," Young recalls. "So we needed case managers who could handle that, and do it in the language people understood. We had to get used to everyone coming into the exam room, kids and all, since no one had childcare."

To help Mixtecos get used to the clinic, Young organized classes for 20 people in a conference room. "We explained how to prepare for a visit to the clinic, to create confidence so they'd come. On Saturday night the clinic became a community center, a safe and accepting place.

 

 
At the Las Islas Clinic Mixtec mom Rosalia Solana comforts her baby Joel Galvez.

 
Eventually the classes grew and she moved the meetings to the cafeteria, and then to a school. As Young realized that other needs in the community had to be addressed, she helped Mixteco activists establish a nonprofit organization, the Mixteco/Indígena Community Organizing Project (MICOP). "The community just called her Doctor Sandy, and went to her when they needed medicine, or a woman needed an appointment for a prenatal exam," says Arcenio López, MICOP's executive director.

The Clínica and ICE

"Mexico and Oxnard have very similar circumstances, in terms of access to health care," López explains. "Our indigenous community comes from the rural areas of Oaxaca, Puebla and the south, where people have lived as farmers for generations. Formal health care is a privilege for elites, so they depend on traditional medicine. Prenatal care doesn't really exist, and a pregnant woman has her baby at home. It's the health care system of the colonizer.

"People come to the U.S. and work for years and still can't access health care. But at least there's some possibility of it here. What determines whether they can get it are the priorities of the family. The first priority is to pay the rent, then to buy food and clothes. Health is not a priority because their economy doesn't permit it."

The Mixteco migration from Oaxaca to California began in the mid-1980s, so most Mixtecos were not eligible for the immigration amnesty of 1986, which had an eligibility cutoff date of January 1, 1982. Many, therefore, are undocumented. This also created special problems at the clinic.

"When the rumor mill warned that ICE [Immigration and Customs Enforcement agents] had roadblocks in Oxnard," Young remembers, "no patients would show up. The fear is so huge. We tried to keep people's immigration status out of patient records, and when we had the community meetings here I'd stand at the door, ready to defend people. Actually, I think one of the beauties of community clinics is that we're kind of untouchable."

 

 
At the office of the Mixteco Indigenous Community Organizing Project in Oxnard pregnant women and mothers with children, from Oaxaca and Guerrero, attend a Bebe Sano, or Healthy Baby class.


MICOP's López says that while clinics have to create safe spaces, understanding the importance of immigration status has to be deeper. "That fear becomes part of you - fear of big institutions and the government," he explains. "It's what happens when you cross the border, and you begin to think, 'We're breaking the law.' You take the risk because your need is so great, but you try to keep quiet and not cause trouble. That fear has a big impact. You become so anxious, and your children pick up on it."

For over a decade the clinic tried to get people to come despite that fear. "But all our work was thrown into the trash when Trump came out with his public charge rule," López says bitterly. "People heard that if they used any public services they'd never have a chance to get legal."

Migration creates another challenge for providing consistent medical care. Most Mixteco farmworkers in Oxnard work as strawberry pickers during part of the year, and have to migrate north to find more work. Staff at the Las Islas Family Medical Group tried to develop a relationship with the Clínica Salud de la Gente in Watsonville - where pregnant women could go with a copy of their medical records - so they could keep track of any problems.

The Pandemic Hits

When the pandemic hit, the relationships between the Las Islas Family Medical Group and the Mixteco community proved their value. "In the first year of the pandemic," Young says, "people were so frightened that they were unwilling to come to medical appointments. So we did what we could by phone, often while people were working in the fields, with an interpreter. Most farmworkers don't have laptops or internet access. After talking with moms about children or pregnancy, we'd talk about what to do and what not to do, the symptoms and how to get tested. We'd schedule times for vaccinations so that no one had to wait in the waiting room."

 

 
Juan Carlos Diaz talks with a farmworker outside the Panaderia Susy early in the morning before work.


CBDIO's relationships with community clinics were sometimes not as positive. "In Monterey County we had a hard time with the Clínica de Salud del Valle," Sarait Martinez recalls. "When the pandemic hit, growers would take busloads of people in, including H-2A workers, and they'd get service right away. But when we'd ask about community people not getting service, they'd never get back to us. It was hard to get appointments for testing and you had to register online. Our staff did thousands of registrations in little towns, signing people up in places that were closest to them." The clinic did not reply to an email asking for comment.

It took some months, in both Ventura and Monterey counties, but broad community-based networks were eventually created to fight the COVID-19 pandemic. In both counties, the networks relied on promotoras (community health workers) to fill crucial roles in fighting the pandemic - helping families get tested for COVID, distributing masks, explaining how to best avoid infection, organizing vaccination events. In Monterey County, CBDIO played a key role in the community coalition, reaching indigenous families and farmworkers, for example, going to the fields to distribute masks and water and talk with workers about safety. In Ventura County, MICOP promotoras trained by Sandy Young play a similar role, while MICOP's popular community radio station Radio Indigena and its on-air host, Jesús Noyola, and others promoted vaccination.

"The state and counties partnered with us because we could speak indigenous languages and we had roots in our communities," says Martinez. "Indigenous migrants are very diverse, but generally invisible within the larger Mexican immigrant population. We had 27 people speaking 15 Mexican indigenous languages. We don't call them promotoras, because they don't promote things. We call them community workers because that's what they do."

Ed Kissam emphasizes that relying heavily on promotoras began long before the pandemic, however. "Rural health clinics have relied on community health workers' cultural capital and communication skills to provide counseling on diabetes, prenatal health, dental care and mental health. But often community health workers wonder how their roles can be expanded to do more than provide prepackaged health information or routine follow-up. What opportunities exist for promotoras to build greater skills? Can they provide unique insights on the social determinants of health in a local community or become more effective advocates?" he asks.

 

 
Celestino Najera plants root stock of strawberry plants.


"As the COVID-19 pandemic continues, farmworker health will require adapting the national 'Test to Treat' model to assure easy access to testing as a basis for rapidly prescribing antivirals or monoclonal antibodies," Kissam adds. "Orienting families to routine use of home testing to identify those at high risk for serious COVID illness could mean faster service and greater efficiency. These needs argue for expanding the roles of community health workers in farmworker clinics."

Overcoming the Divide

Kissam believes that rural community clinics can play a broader role addressing socioeconomic and environmental factors in California farmworker and immigrant communities. The initial efforts, he says, to create a distinctive rural health system, responsive to community input and relying on local community workers, came as a result of the War on Poverty in the late '60s. In its earliest years, the White House Office of Economic Opportunity tried to integrate housing, employment, health, education and child development services into broad-based efforts to improve all aspects of community life.

"When the federal Rural Health Clinic Services Act passed in 1977, however, the definition of rural was so limited that it treated many farmworkers in California as urban rather than rural residents and affected funding," Kissam says. "A still more serious problem today is coordinating bureaucratically defined funding into a coherent and flexible system responsive to diverse communities."

Equally important, however, is the relationship between those clinics and the communities they serve. Within these communities are the traditional practitioners, like Gloria Merino. The lack of a role for them in the current medical system highlights the gulf that sometimes separates indigenous communities from community clinics. Fear of the criminalization of these practices makes this gulf wider.

Arcenio López describes a case in which a mother gave manzanilla tea to a sick child, and a nurse reported the family to child services. "It just takes one case for that fear to make people stop using traditional practices. The irony is that it's now becoming a luxury for white people to have midwives and babies at home. A recent training for midwives didn't even include parteras."

 

 
Judy and her infant son Ian, purchasing remedies at the Botanica Juquila.


MICOP would like to see more recognition of the value of traditional medicine. "Clínica de las Islas and other community clinics should understand that we have two worlds here," says López. "They could create more confidence in parteras by hiring them to help pregnant women, and train them in western practices. But if we don't have a formal relationship with the clinics, we can't achieve this or decide how we'll work together."

López says MICOP doesn't currently have such a relationship with the Las Islas clinic, now operated by Ventura County, or the other local network of Clínicas del Camino Real. "Our relationship is based on the interpreters, who are key people," he explains, "but a more formal relationship would involve continuous training for their staff about Mixteco culture and history, ways to overcome barriers to services, and mentoring community people. We need more than a meeting where they tell us about the clinic's programs."

In the wake of the pandemic, neighboring Santa Barbara County began reaching out to MICOP, asking for dialogue about what farmworker communities themselves think they need. "Santa Barbara's [now former] Health Department Director Van Do-Reynoso talked directly with our community about the ways structural racism prevents access to health care. We proposed changes inside the structure of the system," López says. "MICOP suggested creating health policy associates and health navigators, who would work on data collection, help people learn of services in their various languages and organize mobile clinic events, especially for new migrants."

"Health can be impacted from the prevention aspect," Do-Reynoso told the Santa Barbara Independent, "through changing policies, the environment, and systems to achieve a healthy community. And I'm proud of partnerships we formed; we linked arms with health care providers and community-based organizations and community leaders."

 

 
Eduardo Retano plants root stock of strawberry plants.


CBDIO, however, has had more problems overcoming the divide between clinics and indigenous communities. "Clinics should be culturally and linguistically accessible," says CBDIO's Sarait Martinez. "Our people often don't know how to read and write. They feel discriminated against when they're told they have to fill out a form, and when they have trouble, someone says, 'I can't help you.' They struggle to have access because they live far away, and often come only when their pain is unbearable. We have a base in farmworker communities and people trust us, so the state needs to support and pay attention to us. We were expected to respond to the emergency, because we knew that if we didn't, our community would suffer, but in the past we never got much."    

Sandy Young retired two years ago, and in the end felt frustrated by the slow pace of change. "For me it was never just about treating individual patients. It's about changing how our society is organized. So it is frustrating to realize that my ability to impact that is limited. That's why we have to build organizations and treat root causes, the social determinants of health. It's not enough to treat people when they're sick."


ILL HARVEST
California Farmworkers and the Struggle for Health Care

 
Guillermina Diaz, a Mixtec immigrant from Oaxaca, picks strawberries.  She and her sister Eliadora support three other family members, all of whom sleep and live in a single room in a house in Oxnard.


More than 500,000 California farmworkers play a critical role in providing Americans with the food that nourishes and sustains their health. Yet, for those workers, their own health is too often in jeopardy.
 
The hazards present in farmwork - from exposure to the elements and harmful chemicals to the physical demands of picking and cutting crops - are aggravated by shortfalls in health coverage, delivery and workplace safety systems. As a result, farmworkers often go without the care they need, enduring injury and illness that might otherwise be prevented.
 
California's agricultural industry has always depended on immigrant labor, whether those migrants were from other U.S. states, Asia or Mexico. Ninety percent of California's farmworkers are immigrants, and more than half are undocumented. Many California farmworkers are indigenous laborers from Mexico for whom Spanish is not their primary language. For these workers, linguistic and cultural differences add another challenge to receiving adequate health care.
 
Journalists David Bacon and Pilar Marrero traveled to the communities where California farmworkers work and live to document the health care conditions they face. From their reporting, we provide a from-the-fields perspective through six stories:
 
In rural California, farmworkers fend for themselves to access health care
Why being a farmworker is a health risk
California's historic Medi-Cal expansion will miss many farmworkers
Treating indigenous farmworkers on their terms
The mental health toll of farmwork is heavy while access to therapy is scant
A union health plan provides a much-needed safety net

WHY BEING A FARMWORKER IS A HEALTH RISK

ILL HARVEST
WHY BEING A FARMWORKER IS A HEALTH RISK
Both the nature of the work and flaws in the support system cause injuries and illness.
By David Bacon
Capital and Main, 12/9/22
https://capitalandmain.com/why-being-a-farmworker-is-a-health-risk

A sign in the dirt of a cabbage field warns of the dangers of the pesticides used on the crops. All photos by David Bacon


In the summer of 2008 Andres Cruz got a call from a crew of Triqui workers picking peas near Greenfield, a farmworker town in California's Salinas Valley. They told him they were on strike, and because he's a leader in their community, they asked him for help. Twenty-five pickers had been fired, they said.

"They told me the labor contractor fired them because they were working on a piece rate and weren't picking fast enough," recalls Cruz, who himself works as a broccoli cutter. Pickers have to use their thumbnails to cut the pod from the vine. "Their nails were tearing off because of this. They tried to wrap up their hands and keep working, but they couldn't work as fast, and the foreman wouldn't listen to them."

Triquis are Indigenous people from small villages in the hills of Oaxaca, Mexico, speaking a language that predates European colonization by centuries. Thousands have migrated to the U.S. in search of work, and they have a prominent presence in Greenfield. Almost all work in the fields, and their families in Mexico depend for survival on remittances sent back from their wages.

Cruz and organizers for the United Farm Workers met with the Triqui pickers. They explained they had the right to complain to the California Division of Occupational Safety and Health, the state agency responsible for enforcing laws pertaining to workplace safety, and could get treatment and workers compensation pay. Cruz said the landowner called the sheriff, however, who confronted the workers and organizers at the field.

"When the contractor saw the union was there," Cruz says, "he agreed to let the fired people go back to work. I told them they could get time off so their hands could heal, but they said they couldn't afford to lose a day of work. So they went back."

 

 
Andres Cruz with his wife Catalina and their son.


Their work stoppage was powerful enough to win reinstatement for those terminated. But the pressure of families in Mexico who need remittances, and the low wages paid for farm work, was a potent combination. Even when the pickers learned about their legal rights to medical treatment and some degree of compensation, the need to keep working overrode their ability to exercise those rights.

Multiple studies document the high rate of illness and injury for field laborers. According to Farmworker Justice, a Washington advocacy group, "Agricultural injuries and illnesses take many forms from falls, cuts, and lifting injuries to chemical exposures, vehicle and machinery accidents, and even chronic pain associated with repetitive movement. ... These conditions disproportionately affect migrant and seasonal farmworkers ... ."

The U.S. Department of Labor says that in 2020 589 farmworkers died at work. Official sources have historically undercounted workplace illness and injuries, however. The Bureau of Labor Statistics estimated that there were 32,100 illnesses and injuries among U.S. farmworkers in 2011. But it left out workers employed by labor contractors (in California 55% of the farmworker workforce) and didn't account for nonreported cases. When health economists at the University of California, Davis reexamined the data, "the estimated number of job-related injuries and illnesses experienced by agricultural workers ... rises to 143,436," their study concluded.

Surveys of farmworker health are rare. According to a 1998 California farm survey of occupational injuries and hazards in Monterey and Fresno counties, "29% of the workers reported occupational injuries associated with farm work, farm equipment or transportation. Among the injured workers, 20% reported multiple incidents, [and] 27% missed at least one day of work ... ." Less than half got any medical care.

Farmworkers in California have important legal protections for their safety and health at work, won through decades of advocacy. The state has a workers compensation system that should guarantee treatment and some replacement wages for those who do get sick or injured on the job. But according to Garrett Brown, who spent 18 years as a field inspector for Cal/OSHA, and two as the special assistant to the agency's director, "the power imbalance between workers and employers in agriculture is much greater than almost any other industry. That determines what happens to farmworkers in real life."

Cruz's wife, Catalina, had difficulty using the workers comp system when she was hit by a ladder on a machine that packs broccoli in the field. Although the pain was enough to make her cry, she didn't tell the foreman right away and kept working. "I was afraid to lose pay, or that I might get fired," she recalls. Finally, when the pain was too much, she went to the emergency room at the local hospital, which sent her to a community clinic. "The doctor told me I could go back to work the next day. And when I asked about workers compensation, the foreman said they weren't responsible because I'd waited two days to tell them."

 

 
Eliadora Diaz, a Mixtec immigrant from Oaxaca, picks strawberries with her sister Guillermina.


Juvenal Solano, senior community organizer for the Mixteco Indigena Community Organizing Project, says that Catalina Cruz's experience is common because companies pay less for workers compensation insurance if workers don't make claims. "They tell workers that if they notify the company a day or two after an injury they'll be disciplined," he explains. "But when you're working your body is warmer and in that moment you don't always feel as much pain. Then, if you feel it later and complain, the foreman says he'll give you a warning because you didn't report it right away. So the worker keeps on working."

Getting released from work is particularly difficult for pregnant women. "Indigenous women often lose their babies in the first two or three months," Solano charges. "In the strawberries women have to work bent over double all day, and lift heavy boxes every few minutes. That can cause injuries even without being pregnant, but once women are 3 or 4 months along, it's dangerous. If they ask for disability benefits so they can stop working, a doctor who thinks working in the field is like working in an office often tells them that pregnancy isn't a disability. Some women, when they're denied benefits, decide to stop working anyway. But most can't survive economically if they don't work."

Among strawberry pickers, back pain and injury is endemic, but going to the doctor usually means taking off work and making an advance appointment. "If the pain is intense they can't wait, so they go to a solvador [a traditional massage therapist] recommended by someone in the community," he explains. "Those who know their rights might make a report and open a case, but most don't. They take pills and keep working."

Lauro Barajas, regional director in Salinas for the United Farm Workers, emphasizes that "in the strawberries people have to work bent double, year after year. After 15 or 20 years it's clear that the resulting injuries are from work. But when workers complain they're sent to the company's doctor who often sends them back to work right away. The doctors are almost worse than the foremen. And if a worker makes a claim for workers compensation, the company has lawyers, a human resource department, supervisors and doctors. How can one farmworker overcome all of that?"

Anne Katten, legislative advocate for the California Rural Legal Assistance Foundation and director of its pesticide and worker safety project, agrees. "The workers comp system is very bureaucratic and daunting. For anyone with a problem like a back or shoulder injury, it's hard to get diagnosis and treatment. But farm work is seasonal, and those known to have an injury are less likely to be hired for the next season. Most will work with back pain or respiratory problems because they only have a few weeks of work to begin with."

Pesticide exposure is an acute problem for field laborers, who can experience effects ranging from nausea, vomiting and headaches to fainting, seizures and even death. Some pesticides are known causes of cancer, neurological disorders and birth defects, especially from chronic exposure over years of work. Yet despite EPA estimates that 3,000 workers every year suffer from pesticide poisoning, there is no national tracking system for cases.

 

 
A strawberry worker picks in a field in Oxnard.


"In Santa Maria I got a call that a boy from Oaxaca was sick," Barajas recalls. "He had just come from work, and I found him lying on the floor in convulsions. That morning he'd started working in a field where pesticides were applied the day before. He began to vomit and couldn't keep working. With no way to leave, he stayed in a car at the edge of the field until work ended that afternoon. I called an ambulance. The company then told the hospital they weren't responsible and the worker would have to pay for his treatment. That happens a lot in pesticide injuries."

For a contested claim like this, a worker can appeal a denial of the workers compensation benefits that should pay for medical expenses and a percentage of lost wages. "You're supposed to be able to get an attorney," Katten says. "But most don't want to take challenging cases where a settlement is uncertain, especially pesticide illnesses. There should be a simpler way for people to get care. The system is very broken."

While the cause of illness in acute poisoning cases can be obvious, it's harder for workers to get recognition for more chronic problems. "I've seen pesticide illness reports," Brown says, "where doctors say workers are just responding to smells or are having psychological reactions. Often there's no thorough analysis of what caused the exposure. In community clinics, where farmworkers are most likely to go for treatment, few staff are able to identify pesticide illnesses. We really need people trained in occupational medicine, and to keep medical histories of what people are exposed to."

That long-term perspective is critical in tracking the impact of pesticide exposure on whole communities. A 2010 UC Davis survey found "an elevated prevalence of indicators of chronic disease, but lack of health care access."

In Oxnard, Solano says the Mixteco community has seen an increase in cancer and birth defects. "When people come to the U.S. their kids born here have autism, and people die of cancer," he explains. "Our home towns in Oaxaca don't have these problems. We don't have studies but we suspect that it's because of the chemicals. Yet people here have to work, and the workers comp system doesn't provide health care access for this."

 

 
A crew of Mexican farmworkers plants the rootstock of strawberry plants during the winter in Lompoc.


The pandemic added another layer of hazard for farmworkers. In rural counties the raging virus produced infection rates more than twice those of urban counties. According to a report by the California Institute for Rural Studies, between March and June of 2020 agricultural workers in Monterey County contracted COVID-19 at three times the rate of workers in other industries.

Farmworkers were particularly impacted by the coronavirus, he says, in part because of a breakdown in Cal/OSHA's system of enforcement. According to Garrett Brown, "In the first year there were 9,000 complaints, but for most of 2020 there were very few onsite inspections. There weren't enough inspectors, and many were unwilling or unable to go into the fields. Instead, they sent letters to employers asking them to report any incidents by mail. Farmworkers, however, continued to go to work, and this left them at risk."

Maggie Robbins was an occupational and environmental health specialist for Worksafe, a nonprofit worker advocacy group, during that period. She helped negotiate a new standard for keeping workers safe. As in Washington state (see Capital and Main, "Are Washington's Farmworkers COVID-19 Guinea Pigs") a conflict quickly developed between growers and unions over transportation and housing regulations.

"The basic consideration for all migrant workers was to keep safe distances between people in the motels and labor camps, and on buses taking workers to and from the fields," she explains. "Labor contractors, transport companies and growers all said regulations weren't necessary because compliance would cost them money. But in November the board adopted a standard requiring a six-foot separation. That was a good step, and beyond what other states were requiring. The problem, as always, was the lack of enforcement."

At Primex Farms, a pistachio grower in Wasco in the San Joaquin Valley, 150 workers had tested positive for the virus by July of 2020. When many stopped showing up for work, the company said they were on vacation. By the time it admitted that workers were getting sick, many had brought the virus home to their families. In July Primex employee Maria Hortencia Lopez died and another worker was taken off life support. Yet knowing the risk, some laborers went to work anyway because the company wouldn't pay for time off to quarantine.

The UFW helped Primex workers organize a strike to force the company to comply with the federal law mandating paid leave for COVID victims. Ultimately, Primex agreed to follow the law and to rehire contract workers it had terminated when they protested the lack of COVID protections. But the company then laid off 60 workers while hiring replacements. Primex told the Grist website that it "worked hard to protect and support employees through the crisis."

 

 
Andres Ramirez works in a crew of Mexican farmworkers planting the rootstock of strawberry plants during the winter.


Cal/OSHA fined Primex $27,500 following publicity from the strike and demonstrations, including a $5,000 penalty for not reporting two cases. Its labor contractors were also fined.Advocates say such enforcement is ineffective because for large companies such penalties are a small cost of doing business.

"Cal/OSHA had around two hundred inspectors for 9,000 complaints," Brown charges. "The failure of enforcement, not just for COVID but for other work-related problems, meant that more workers got sick and needed greater access to health care. Since farmworkers historically have access problems, their health conditions deteriorated."

During 2020 the Legislature passed bills to meet the crisis, including measures for bilingual campaigns to educate workers, coronavirus sick leave and workers compensation benefits, and improved access to medical care through telehealth services. But the enforcement crisis grew worse. The 84 unfilled positions at Cal/OSHA before the pandemic became 130 by mid-2020. Brown says the number of unfilled field inspector positions is now 60, and will grow by an additional 24 in January.

 

A crop duster sprays pesticides on a field next to the U.S./Mexico border in the Imperial Valley. 

According to a UCLA study, at the beginning of the pandemic 79% of California's undocumented workers were employed in industries deemed "essential," including agriculture. The Migration Policy Institute estimates that 156,000 undocumented people worked in the state's agriculture industry in 2019.

"Immigration reform would therefore make workers healthier as well," Brown says. "In my experience doing field worksite inspections, undocumented workers avoided anything that might result in them getting reported to immigration authorities and being deported. That includes reporting illnesses and injuries, and getting treatment for them."

 

 
A worker mixes pesticides, which will be sprayed on a field farmed by La Brucherie Produce, south of Seeley an unincorporated community in the Imperial Valley.  Pesticide drift is one component of poor air quality in the valley.


Making complaints and getting care is easier and safer for farmworkers in a union workplace, including the undocumented. "If a worker has a problem," Barajas says, "he or she calls us. We go to the company, ask for a report, and send the person to a doctor. The company doesn't hide the problem, and we educate people so they know their rights. If someone has a lot of pain and still needs to work, we ask the company to give them a less demanding job."

Worksafe's Robbins calls this the union effect. In bargaining a union contract, workers can advocate changes to make work safer and healthier and improve their health care access. "Legislated standards give them credibility," she says, "but changes in a workplace happen when workers have a way to get their employers to implement them. You need organized workers for this."

Given the low wages in agriculture, however, health and safety changes and health care access are not always worker priorities. Solano describes work stoppages organized by Santa Maria strawberry pickers at the beginning of the 2022 season. Most were in their 20s and 30s, he says. "Their main demand was raising the wages, along with cleaner bathrooms and better drinking water. Because they're young they weren't thinking much about the impact of the next 15 or 20 years of work."

To lessen the stress on workers' bodies, Barajas says, the union included in its strawberry growers contract an agreement to give workers the option of resting every hour and a half - more frequently than legally required. "But there's such economic pressure from rent and food bills, plus sending money home, that most workers just worked through the break," he says.

The attitude of strawberry pickers is like that of the Triqui workers losing their thumbnails - earning enough money to survive is the overriding necessity. "We need to build their awareness that they won't always be young," Solano says. "They need to think about working with dignity, work that won't put their bodies in danger."

 

 
A tractor sprays pesticides on a field of green onions farmed by La Brucherie Produce, south of Seeley in the Imperial Valley.


In the early 1960s, that logic impelled California Rural Legal Assistance and the nascent farmworkers union to push the state to ban the "cortito" - the short-handled hoe. The long-term use of this tool, which forced workers to bend over double to thin lettuce and other row crops, led to widespread spinal injuries. California became the first state to prohibit its use. Farmworkers' need for better access to health care continued, while the cortito's elimination improved their health and made that need more manageable.

Changing the work in strawberry fields might have the same impact, since laborers have to bend over much as they did using the short-handled hoe. Getting rid of the cortito was relatively easy and cheap, however, since it just required substituting a long handle for a short one. "Changing the way strawberries are picked would be much harder," Barajas says. "Some growers now are beginning to change the structure of the rows, making the beds higher and covering them with rubber. But that's very expensive, and smaller growers can't do it."

In strawberry picking, like many jobs in agriculture, workers get paid for the amount they pick. "This system is the key to why people kill themselves," Barajas says, "but workers don't want an hourly wage because the minimum is so low. A much higher hourly wage would ease that pressure. But if the companies would just raise the price they pay per box from $2 or $2.10 to $2.30 or $2.40 people would be able to rest more. We need to look for ways workers can make enough so they don't have to mistreat their own bodies, and their access to health care doesn't have to be such a crisis."

 

 
Garrett Brown, a former inspector for CalOSHA, interviews a worker about her workplace health and safety complaint.



ILL HARVEST
California Farmworkers and the Struggle for Health Care

 
Guillermina Diaz, a Mixtec immigrant from Oaxaca, picks strawberries.  She and her sister Eliadora support three other family members, all of whom sleep and live in a single room in a house in Oxnard.



More than 500,000 California farmworkers play a critical role in providing Americans with the food that nourishes and sustains their health. Yet, for those workers, their own health is too often in jeopardy.
 
The hazards present in farmwork - from exposure to the elements and harmful chemicals to the physical demands of picking and cutting crops - are aggravated by shortfalls in health coverage, delivery and workplace safety systems. As a result, farmworkers often go without the care they need, enduring injury and illness that might otherwise be prevented.
 
California's agricultural industry has always depended on immigrant labor, whether those migrants were from other U.S. states, Asia or Mexico. Ninety percent of California's farmworkers are immigrants, and more than half are undocumented. Many California farmworkers are indigenous laborers from Mexico for whom Spanish is not their primary language. For these workers, linguistic and cultural differences add another challenge to receiving adequate health care.
 
Journalists David Bacon and Pilar Marrero traveled to the communities where California farmworkers work and live to document the health care conditions they face. From their reporting, we provide a from-the-fields perspective through six stories:
 
In rural California, farmworkers fend for themselves to access health care
Why being a farmworker is a health risk
California's historic Medi-Cal expansion will miss many farmworkers
Treating indigenous farmworkers on their terms
The mental health toll of farmwork is heavy while access to therapy is scant
A union health plan fills gaps, but for only a few

IN RURAL CALIFORNIA, FARMWORKERS FEND FOR THEMSELVES FOR HEALTH CARE

ILL HARVEST
IN RURAL CALIFORNIA, FARMWORKERS FEND FOR THEMSELVES FOR HEALTH CARE
Where government and health care institutions are absent, some communities turn to grassroots action.
By David Bacon
Capital and Main, 12/8/22
https://capitalandmain.com/in-rural-california-farmworkers-fend-for-themselves-for-health-care

Laura Perez and Maria Reyna Torres sort sweet potatoes in a San Joaquin Valley field in 2019. All photos by David Bacon.


Carmen Hernandez lives in a small home on Chateau Fresno Avenue, one of the three streets that make up Lanare, a tiny unincorporated settlement in the San Joaquin Valley. The street's name sounds more appropriate to an upscale housing development. In reality it is a potholed tarmac lane leading into the countryside from the highway.

In Lanare live the descendants of its original African American founders, excluded by racial covenants from renting or buying homes in surrounding cities. Here they rub shoulders with their Mexican neighbors - the farmworkers who make up the valley's agricultural workforce.

Hernandez's house sits behind a white-painted fence of bricks and wrought iron, and a neat lawn dotted with a few small trees. On the other side of the road are the pistachio trees that make her home almost uninhabitable four times each year.

Just before the nuts are harvested in September, a tractor drags a tank with long arms down the rows, spraying a thick fog of pesticide into the trees. Quickly the chemical travels across the dozen yards between the orchard and Hernandez's house. During other times of the year, the spray rig lays down weed killer, or a chemical that causes leaves to drop from the branches after harvest. Fertilizer is another evil-smelling chemical the neighbors have to contend with. The families on Chateau Fresno don't let their kids play outside much anyway, but when the spray is in the air, they make sure to keep them inside.

One might ask, why did Hernandez build a house across the street from such dangers? She didn't. When Self-Help Enterprises helped Lanare's low-income families to build homes they'd never otherwise have been able to afford, the field across the street grew cotton or wheat. Those crops also use a lot of chemicals in California's industrial agriculture system, but when pistachio trees were planted eight years ago, the contamination grew by an order of magnitude.

 

 
Carmen Hernandez stands at her front gate on Chateau Fresno Road, across the street from a pistachio grove. Pesticides, fertilizer and dust from the grove drift into her house and yard.


"Why did the state or county let them do this?" Hernandez asks. "They don't even put up notices to warn us." She's asked the tractor driver what the chemicals are, but he doesn't know. "He doesn't even know the name of the owner of the orchard. He's just hired by a labor contractor."

For farmworkers, Hernandez's predicament is familiar. PolicyLink's 2013 study "California Unincorporated: Mapping Disadvantaged Communities in the San Joaquin Valley" found that over 300,000 people live in small, unincorporated communities spread across rural valleys where California's agricultural wealth is produced. For them, living in a town like Lanare is a double threat to their health. Farm laborers work and live in a chemical soup, a source of interrelated health problems. And because their homes are in remote rural areas, getting adequate health care creates additional obstacles.

 

 
Near Lanare the Kings River has gone dry, its water diverted into irrigation canals.


These unincorporated towns, however, are also often organized communities. Grassroots groups deal with the social determinants of health, from air pollution to water scarcity and contamination. Their experience gave them a head start when the pandemic hit. They were often better able to respond to the needs of farmworkers than the government or large health care institutions.

Living in the Chemical Soup

According to the Environmental Protection Agency, the San Joaquin Valley has some of the worst air quality in the United States. One study in BioMed Research International found "Seasonal agricultural workers are exposed to the worst conditions of working groups" and called asthma "an important health problem among seasonal agricultural workers."

Children living in this environment suffer asthma as well. In the Imperial Valley, one of the poorest counties in California, 12,000 children have asthma, and go to the emergency room for it at twice the rate of the other kids in the state. Residents of that valley's unincorporated communities, like Seeley and Heber, live in the same proximity to the fields as Carmen Hernandez does in Lanare.

The relationship between illness and chemical contamination is often hard to pin down. Nevertheless, the connection to living in small towns where pesticides, fertilizers and dust are in the air and water seems obvious to many residents.

Rosario Reyes and Wilfredo Navares lived their married lives in Poplar, another small community in the southern San Joaquin Valley surrounded by orchards and grape vineyards. She remembers that when her husband's doctor told him that he had amyotrophic lateral sclerosis, commonly known as ALS or Lou Gehrig's disease, the first question she asked was whether he worked in the fields.

 

 
Rosario Reyes, widow of Wilfredo Navares, stands in front of the Larry Itliong Resource Center in Poplar, where the couple received food and support during his illness.


"He believed it came from the chemicals he was exposed to during his 31 years as a farmworker," Reyes says. "He worked with weed killers like Roundup, and there wasn't much known about it then. He knew the dangers in general, but he had to earn a living. Before he got ALS he never really got any health care."

As his incurable disease progressed, Navares gradually lost the ability to control the muscles responsible for walking, talking and eating. For two years Reyes couldn't work. "I had to bathe and dress him like a baby," she says. At the end, before Navares died, Medi-Cal covered his medical visits. "But with or without it, he would have died just the same."

Reyes has asthma and diabetes, and got COVID-19 last year. She's 59, the age when people begin to think of retiring. But Reyes had to go back to work, even though it will likely prejudice her health. "I don't have papers," she explains. "Even though we were married, they won't give me his Social Security."

How Many, and How Unequal?

Farmworkers looking for environmental solutions and better health care first confront a major problem. The state doesn't really know how many people make their living from agricultural labor in California.

According to researcher Ed Kissam, "population estimates in the American Community Survey that determine the allocation of federal and state funding for more than 300 programs are very low." The ACS, he added, is a long survey that only one-third of the households in farmworker communities answer. While Kissam said it shows about 350,000 agricultural workers in California, Zachariah Rutledge of Michigan State University reported an annual average of 882,000 California farmworkers between 2018 and 2021. About 550,000 are field workers or processing and packing-shed workers, according to Kissam's estimate. "This is the low-income, predominantly immigrant, often undocumented Latino population facing barriers to accessing health care," says Kissam.

Kissam points out that the rural agricultural workforce is very diverse in terms of income and immigration status. "About 300,000 work in the San Joaquin Valley alone," he says, "and live with another 350,000 family members. Most are long-term settled immigrants, in low-income households that include undocumented immigrants. Their eligibility is compromised for a broad range of social programs because they're conditioned on immigration status. Almost a quarter of legally authorized farmworkers interviewed in the National Agricultural Workers Survey in California lacked health insurance and almost two-thirds of undocumented farmworkers lacked it."

 

 
Ronaldo Manaay is a disabled farmworker and welder who suffers from advanced diabetes. He is on dialysis awaiting a liver transplant. "I'm scared," he says. "I don't know how long I'll live."


A study by Kissam in September 2020 showed that COVID-19 cases in 25 farmworker communities overall were about 2.5 times higher than the state average. "Even within Fresno County, farmworker communities are disproportionately impacted - 26.4% - about 2.5 times [above] the county-wide rate."

Farmworker communities were particularly vulnerable to COVID-19 when the pandemic started, at a much greater rate than people living in urban areas. By August 2020 Tulare County's COVID-19 infection rate (1.96% of the population infected) was much greater, per capita, than that of large cities like San Francisco or Sacramento.

The per capita income of a county resident was $22,092 in 2020, compared to a U.S. average of $35,384. In unincorporated towns like Poplar and Lanare, poverty forces people to live closer together to share rent and living costs, making social distancing difficult. "The strategy of 'doubling up' to afford a place to live is ubiquitous in farmworker communities throughout the San Joaquin Valley," Kissam says. Traveling to and from the fields in crowded cars or buses also places workers in close proximity.

 

 
Poplar resident Antonio Lopez has cirrhosis of the liver, sciatica and problems with his eyes. He shows his recent hernia. "I never ate well," he says, "but I don't smoke and don't drink." When he began to suffer acute problems eight years ago and couldn't work, he drove to Mexico for treatment. "Because I didn't have insurance then, here they'd just throw my papers back at me and send me to another hospital."


People go to work because they can't afford not to go. A day without pay can be difficult; a week could be ruinous. "Undocumented farmworkers with mild cases of COVID-19 are also reluctant to self-isolate," Kissam adds, "because they're ineligible for both unemployment insurance and CARES Act-funded pandemic assistance. In addition, people worry about the government using personal information for immigrant enforcement." As a result, Dr. Alicia Riley reported that deaths of people employed in agriculture were about 1.6 times the average in 2020.
 
The Pandemic Comes to Lanare

In Lanare, the pandemic arrived after years of a crisis affecting the community's water. The water under Lanare contains arsenic, which occurs naturally in the San Joaquin Valley's arid, alkaline soil. When residents dug wells, Sam White remembers, county authorities minimized the danger. "We'd complain and they'd tell us to boil the water. They say arsenic cuts your life span by two years," he says. Indeed, arsenic exposures can cause rashes and even in small doses have been linked to Alzheimer's. "My mother had all that."

Connie and Charlie Hammond live in a small house next to the highway. "My mom had a lot of illnesses that I think were connected to arsenic. We'd have to take her to Fresno [28 miles away], although at the end she went to a clinic in Riverdale [4 miles away] before she died."

 

 
Connie and Charlie Hammond live on Mt. Whitney Highway in Lanare. Their well has gone dry, and they now depend on their children to bring them water.


Eventually a water treatment plant was built to remove the arsenic, but it only ran for a few months before the local water company went broke. Nearly 40% of Lanare's residents live below the poverty line and could not pay the bills. They organized Community United in Lanare and finally got the state to step in and dig new wells. After a year, the water was declared free of arsenic, but it smells and leaves a residue on sinks and toilets. Residents say no one will drink it.

Meanwhile the water table keeps dropping. The Hammonds, who moved across the highway a few years ago, had their well go dry. "Our neighbor ran out first, and we helped them. Then ours ran out a month ago," Connie Hammond says. "Having water would certainly make our health better. We're fortunate to have kids who bring us water, but not having it causes a lot of stress, especially for seniors like us."

While fighting for water, Lanare faced the onset of the pandemic and hunger among residents isolated in their homes. Community United in Lanare was already distributing food several times a month when the lockdown began. "We were handing out food to 150 families," Lanare food bank volunteer Isabel Solorio recalls, "and the number doubled and kept growing. The stores were empty. In Raisin City and Laton [other unincorporated communities], they were afraid and stopped their distributions. We didn't."

 

 
Connie Hammond receives groceries at a food distribution event held at the Lanare Community Center.


Due to a shortage in protective equipment, Solorio and other women sewed their own masks. "A hundred people got the virus here and three died," she says. Community United in Lanare asked the Leadership Counsel for Justice and Accountability in Fresno for help because the county was unable to provide adequate testing or vaccinations, says Solorio. They used their relationships with health authorities and elected officials, she adds, to get the state to set up a mobile testing and vaccination station.

"We asked for priority - farmworkers first," she recalls. "Four or five hundred came the first day. You could tell by their boots they were coming from the fields. We were the first people to give vaccinations, before the local clinics, and we were distributing food at the same time. Since then we must have tested and vaccinated thousands of people."

Poplar's Organizing Project

In the summer Poplar is the center of the valley's oppressive heat, where the temperature soars to over 110 degrees. Almost none of its homes have air conditioning, and swamp coolers, used to chill off, also produce mold. The resulting respiratory problems are complicated by the almond harvest. "There's dust over everything and in everyone's lungs," says Arturo Rodriguez, co-director of the Larry Itliong Resource Center. "It's hard just to breathe."

 

 
A poultry farm on the outskirts of Lanare. Dust from the poultry sheds blows into the town.


Rodriguez and co-director Mari Perez-Ruiz opened the center on June 15, 2020, and by June 19 they started food distributions. When they had problems getting food from the local food bank, they convinced a county supervisor to give them two pallets of groceries every week from the food he had available.

When the pandemic started, several residents died. "Often three generations live in small houses or trailers where there's no space to quarantine," Rodriguez says. "Our harvest season used to last nine months, and now, with growers bringing in more H-2A workers, people living here get only four months of work. Local farmworkers feared not having enough work to feed their families, so they went to work even when they were sick. Often several family members work in the same crew, and they were afraid to report anything to the boss, because then everyone in the family would have to stay home."

The center got some computers donated and built booths where people could go online to get telehealth advice. "When the pandemic began, the service providers closed. We stayed open," Perez-Ruiz says. "We were one of the first to provide free testing. We coordinated with Tulare County to do free events, and gave out PPE [personal protective equipment] and clothing with food. We had to push, so we were a little loud. But our first event had 600 families."

 

 
Farmworkers pick oranges in a field near Poplar, in the San Joaquin Valley. Many workers wear facemasks or bandannas as a protection against spreading the coronavirus.


In January 2021 the vaccines came. The center became a site, and has vaccinated over 5,000 people in total, providing test kits and shots at the same time. "We're an organizing project, and our campaigns are led by the community," Perez-Ruiz says. "The county spent a hundred thousand dollars, and we only spent a few hundred, but we vaccinated more people."
 
Poor But Organized

Unincorporated communities may be poor, but they're often organized. Those organizations fighting for basic social services like water before the pandemic became vehicles for fighting the virus. The residents and activists involved see a lesson for improving community access to health care generally.

"In Poplar, just to make a doctor's visit to a clinic in Porterville [12 miles away] you have to give up your whole day," Rodriguez says. "That's why Picho [his uncle Wilfredo Navarez] never went. And if the husband has to use the car to get to work, [the wife] and kids can't go."

The Larry Itliong Resource Center partnered with Dr. Omar Guzman, a physician who grew up in Woodville, a nearby community, where he returned to practice after medical school. Every month he comes to the center, bringing medical students, in a mobile clinic called Street Medicine. He organizes screenings, brings in mental health professionals and visits encampments of unhoused people on the Tule River. His young colleagues even drive into Visalia, 30 miles away, to pick up baby formula. At the end of clinic day, they gather in the center to talk about the needs of rural communities.

"People I grew up with haven't seen a doctor in a very long time," Rodriguez says. "Health care in our communities isn't proactive. People don't get regular checkups - [they] just go when there's an emergency. The infrastructure of healthcare has failed them. So this is a way to change."

Ed Kissam believes that the model for health care serving small farmworker communities has to be community based. "Community centers are established, widely trusted resources for farmworker families," he explains. "County/clinic partnerships are very useful in reducing language and access barriers that keep some people, including farmworkers, from being tested and treated."

 

 
A COVID testing station organized by Community United in Lanare.


He argues for a critical assessment of the pandemic's lessons. "The system was slower in expanding to outlying farmworker communities than in setting up testing sites in urban areas," he cautions. "Structural factors and social determinants of health have been the primary factors in the virus' spread. If we look at the real-world dynamics of life in farmworker communities, and respond thoughtfully and innovatively, we can overcome many barriers."

In Lanare, Isabel Solorio would like to see mobile testing and vaccination clinics become a way to give farmworker families much broader access to care. "We need a clinic bus with all the equipment for everything from mammograms to dentists and optometrists. Our kids are ashamed to say they can't see in school because they know their parents don't have money for glasses, so everything is blurry and they fall behind. Why can't they get free ones here in Lanare and stay in school? And if people can control their asthma with a mobile clinic here, isn't that a lower cost for the government than ambulances and visits to the emergency room? So the clinic should come to the people instead of people coming to the clinic."

But service by itself is not enough, she believes. "Why was Lanare prepared when the county wasn't? When the water stopped, who came to help us? We helped ourselves by learning to organize. That showed us we can change other things too. We pay taxes, and we have a right to survive."


ILL HARVEST
California Farmworkers and the Struggle for Health Care

More than 500,000 California farmworkers play a critical role in providing Americans with the food that nourishes and sustains their health. Yet, for those workers, their own health is too often in jeopardy.
 
The hazards present in farmwork - from exposure to the elements and harmful chemicals to the physical demands of picking and cutting crops - are aggravated by shortfalls in health coverage, delivery and workplace safety systems. As a result, farmworkers often go without the care they need, enduring injury and illness that might otherwise be prevented.
 
California's agricultural industry has always depended on immigrant labor, whether those migrants were from other U.S. states, Asia or Mexico. Ninety percent of California's farmworkers are immigrants, and more than half are undocumented. Many California farmworkers are indigenous laborers from Mexico for whom Spanish is not their primary language. For these workers, linguistic and cultural differences add another challenge to receiving adequate health care.
 
Journalists David Bacon and Pilar Marrero traveled to the communities where California farmworkers work and live to document the health care conditions they face. From their reporting, we provide a from-the-fields perspective through six stories:
 
In rural California, farmworkers fend for themselves to access health care
Why being a farmworker is a health risk
California's historic Medi-Cal expansion will miss many farmworkers
Treating indigenous farmworkers on their terms
The mental health toll of farmwork is heavy while access to therapy is scant
A union health plan fills gaps, but for only a few