This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.
The Michigan Department of Health and Human Services encourages migrant workers to call 833-SI-AYUDA to ask questions on COVID-related and other health topics, or to get referrals and information about other farm worker services in Michigan.
Born in the Mexican border town of Nuevo Laredo, Dilayla Martinez came to Michigan after graduating high school to be a migrant farm worker at Riveridge Cider Company
in Grant. Most of the time at work, she weighed apples as they were prepared to be processed into cider. For Martinez, the job served as a stepping stone to a college education. With guidance from Grand Rapids-based Migrant Legal Aid
, she enrolled at Grand Rapids Community College
in May with hopes of transferring to Grand Valley State University
and completing a degree in accounting.
"After that, I want to get a job in the future and then do my own business to help people that speak Spanish to do their taxes," Martinez says.
Unfortunately, Martinez’s story is not typical. While fair farms that maintain good working and housing conditions do exist, many of Michigan’s migrant farm workers contend with long hours, exposure to agricultural chemicals, dangerous heavy machinery, crowded housing, extreme heat, dehydration, and lack of access to healthy food — resulting in injuries, illness, and chronic disease. Fear of being fired and subsequent deportation prevents many migrant workers from seeking medical treatment. State and nonprofit programs are available to help migrant workers in these situations, but many workers don't know that assistance exists.
"They face a variety of health disparities in Michigan specifically, but also across the United States," says Molly Spaak, an attorney with Migrant Legal Aid. "Many migrants lack stable health insurance. And options are communicated to them in a language that, in most cases, they don't really understand. Moreover, they face higher prejudices from the medical profession, which in turn can result in lower-quality care."
Spaak shares that these health disparities shorten migrant workers’ lives by an average of 26 years
as compared to the average person in the US.
"A lot of those disparities can be related to unsafe working conditions, isolation, language barriers, and confusion with poor literacy rates," Spaak says. "Because a lot of times their health issues are related to their job, it puts them in a position where they have to choose whether they want to support their families and keep earning money, or take care of their own health and well-being. The whole thing can be really dehumanizing and cause a lot of mental health and mental stress issues that totally factor into [poor health]."
Deliver or be deported
Spaak shares the story of a middle-aged man who had spent much of his life as a migrant farm worker. Over those years, working long hours in high heat with limited bathroom breaks and insufficient water destroyed his kidneys until he collapsed one day in the fields. Although he was transported to the emergency room, his employer opted to deport him to his remote Mexican village rather than let him recover here in the hospital, where he was on dialysis. He died soon after his return home, as dialysis was not available there.
"This situation is common," Spaak says. "Usually when growers or crew leaders see that a worker has been injured or sick, instead of offering them care here in the United States, which they're entitled to under their H-2A visa, they just send them back to their home country and let them deal with it there."
When migrant workers do go to a doctor or emergency room, medical staff often rely on the employer’s crew leader to translate for them. Even if the crew leader has the ability to translate what the worker is saying, they often minimize symptoms to reduce the employer’s liability.
"Migrant workers really need to be treated as if they are victims of abuse, where their abusers are with them," Spaak says. "They need to speak alone to health care professionals and be able to speak for themselves."
Education and income also come into play.
"If they do not know how to read or write, it's very difficult for them to sign up for health insurance even if they are eligible for it. It's difficult for them to fill out papers when they go to the doctor," Spaak says. "And if there are fees associated with going to the doctor, how are they going to be able to pay those?"
While they may be surrounded by fresh produce on the job, many migrant workers subsist on nutrient-poor packaged foods with a long shelf life. Barracks housing dozens of H-2A workers typically have one refrigerator in a small kitchen. The workers tend to store their food in their bunks. Also, trips to the grocery store may be limited to once a month, so foods purchased have to last a long time without refrigeration. Rates of Type II diabetes are high among migrant farm worker families
"I was walking through a migrant camp inside one of the housing units. I was looking around their kitchen and all I saw was packages of ramen, packaged cupcakes, packages of every processed food you could possibly imagine," Spaak says. "I asked the guy who was talking to me in his kitchen, ‘Wow, what's with all the ramen? This looks like a frat house.’ He said, ‘Well, yeah, we wake up at four in the morning to go to work. Ramen noodles are a very easy and quick and sort of filling way to get breakfast.’"
The health disparities that impact migrant farm workers also take a toll on their children. They are exposed to pesticides, lack access to healthy foods, and often are exposed to violence and trauma. These kids often lack access to dental care, vision care, and even routine childhood vaccinations.
"It's extremely sad," Spaak says. "Disparities show up in kids the most. Maybe a migrant child will have general checkups, but if they require a specialist or more work done, that's just absolutely not going to happen."
State programs try to improve migrants’ health
Migrant workers with long-term permanent residency (green card holders) who meet income standards can be eligible for food assistance, medical care, child care, and emergency services as well as some cash benefits. Those who are undocumented, or here under an H-2A Temporary Agricultural Worker visa
, can receive Emergency Services Only (ESO) Medicaid
"We've got over 40 staff and local offices throughout the state [that] provide outreach to migrant farm workers, primarily with migrant farm workers," says Dale Freeman, Michigan Department of Health and Human Services
(MDHHS) migrant services director. "If they've just arrived or have been here just a short time, they may not know anything about what kind of services are available to them. Our staff go out to visit them in their migrant labor housing, or wherever they might be staying, and explain what programs they might be eligible for and help them to make an application either on paper or online."
The bilingual staff work from 11 offices providing outreach to more than 40 counties where farms employing migrant labor are located. The state also coordinates statewide migrant health community groups that are composed of local health departments, local migrant health clinics, and MDHHS’ migrant staff, as well as migrant staff from Michigan's Department of Labor and Economic Opportunity, which provides employment services, and the Michigan Department of Agriculture and Rural Development, which oversees migrant labor housing for farm workers.
Freeman encourages migrant workers to call 833-SI-AYUDA (Spanish for "yes-help") to ask questions on COVID-19 and other health topics, as well as for referrals and information about other farm worker services in Michigan. He notes that Michigan’s food and agriculture industry brings in more than $100 billion
to Michigan's economy, and migrant farm workers help make this economic impact possible.
"There's a lot of work that's done early in the year to trim the trees, and then, obviously, the main harvest focus. There's also a lot of migrant and seasonal farm workers that work in food processing," Freeman says. "They contribute to the overall economy of the state, but they also contribute to the local economies where they're located."
More than legal aid
Health assistance for migrant farm workers is also available from nonprofits like Migrant Legal Aid. With funding support from the Michigan Health Endowment Fund, Migrant Legal Aid has implemented programs to reduce health disparities and ensure more safe housing for Michigan’s migrant workers in Allegan, Barry, Kalamazoo, Kent, Montcalm, Muskegon, Newaygo, Oceana, and Ottawa counties.
Dilayla Martinez and Molly Spaak.
The nonprofit brought COVID-19 vaccines to workers during the pandemic. Its outreach work has also included services like offering mobile mammogram screenings at migrant camps and helping individual workers apply for $600 one-time payments from the USDA Farm and Food Worker Relief Grant Program
Migrant Legal Aid also helps undocumented farm workers with wage theft litigation, immigration protocols when they are victims of crimes or human trafficking, language access assistance, and help when pesticide exposure occurs. Its outreach programs involve inspecting housing at migrant camps, offering legal consultations, and providing safe housing assistance.
"Just because we're a law firm, it doesn’t mean we just sue or do hardcore legal work. We are a nonprofit that encompasses a lot," Spaak says. "In general, our outreach plays into making health more equitable for migrant workers. [Staff conversations with workers] always led to more issues being uncovered and getting migrants access to whatever they need."
Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.
Photos by Autumn Johnson, Bird + Bird Studio.