Until mid-November, for my fellowship placement through Student Action with Farmworkers, I am currently working as a health outreach worker with the North Carolina Farmworkers’ Project in Benson, North Carolina. Since most people have no idea what I mean by this job title, I figured I should take some time to explain.
What is it that I do most days as a health outreach worker? My main responsibility is to work as part of a team that devotes itself to connecting migrant farmworkers with health services in the Benson area. In my office, our team consists of five outreach workers including myself. Generally, we do “outreach” twice a week, heading to farmworker camps in our three-county service-area around 6 or 7pm when the workers arrive home from the fields. To give you an idea of how many farmworkers there are in Johnston, Sampson, and Harnett counties, we can visit one or two camps an evening all growing season, from early spring to early November, and still not reach all the farmworkers in our area. This season, our team will talk one-on-one with over 900 farmworkers through our health assessments and health education.
The main goal of an outreach visit is to complete a basic health assessment (weight, height, blood pressure, medical history, etc.) with each worker at each camp and to let them know about our clinic and the health services available to them through our office. We use the health assessment to screen for any acute problems that might require immediate medical attention, and we also use their answers as a starting point for basic health education on topics such as smoking, alcoholism, pesticide exposure, and healthy diet. Time permitting, we might give a few more in depth health education talks to the group on topics such as pesticide exposure, heat stress, and sexually transmitted diseases (this last one is my specialty!). At each camp, we leave our phone numbers and information about our clinic as well as handouts on health topics, condoms, and other donated toiletry items we might have available.
In addition to outreach, my co-workers and I at the NC Farmworkers’ Project coordinate two clinics each week: a mobile clinic night in farmworker camps and a more traditional clinic night at the Benson Area Medical Center. We also have a variety of case management duties beyond outreach and clinics including coordinating referrals to specialist doctors, providing transportation to clinic nights and other appointments, arranging for or acting as interpreters at appointments, and dropping off and delivering prescriptions. We also keep track of all our health encounters with farmworkers through detailed paperwork that we then enter into a statewide computer system for migrant health organizations.
While the basic substance of my job is medical in nature, the skills required to be successful as an outreach worker are much more varied. Day to day, my duties are about as far from the work of a nurse at a hospital as Benson, North Carolina is different from Oaxaca City, Mexico. A successful outreach worker with the migrant farmworker community truly practices an art form – one that requires refining a host of organizational, social, and cultural skills in order to maximize the number of positive health outcomes in the farmworker community. It is a job that can be learned with practice, but truly performing it well is more of an innate matter. The best health outreach workers are more like activist artists fueled by passion, instinct, and creativity than simply lay health educators.
For one, the Farmworkers’ Project and many similar organizations like it across the country are non-profit safety-net organizations. We are not only charged with providing for the health of one of the most marginalized groups in our society – migrant, Spanish-speaking, often undocumented farmworkers – but we must do it by cobbling together resources from the margins of the mainstream healthcare system. In many ways, we do not work within the system to provide healthcare for farmworkers – we create such a system. While my office does receive a small, steady flow of funding from the NC Farmworker Health Program in Raleigh (a branch of the state Department of Health and Human Services), we are still always searching for donations, networking with allied organizations, and trying to make community connections in Johnston County.
Working where I do has provided me with valuable insight into the important work of safety-net organizations. For many farmworkers, migrant clinics, charity programs, religious health fairs, and non-profit ventures truly are the only route they will or can take to see a doctor when they get sick, much less when they want routine preventative care. (See this recent article more of a discussion of migrant health issues). I have also become acutely aware that giant gaps still exist in this net despite the hard work and ingenuity of health outreach workers across the country. My co-workers and I do not have the luxury of being complacent in our jobs; for every camp we do not get around to visiting (and it would never be possible for us to visit or even find all of them), a whole group of workers will likely not get the care that they desperately need. And despite all of the positive changes that may take place if the Affordable Care Act gets implemented, the outlook for migrant farmworker health is still not likely to change anytime soon (for discussion of the ACA and farmworkers see here, here, and here.)
My job also demands a large amount of social prowess from its practitioners. Surprisingly (at least to me when I started), the amount of health benefit that farmworkers receive from our outreach attempts is often directly proportional to how outgoing and socially-savvy we are in our interactions at the camps! Before we can ever hope to have the chance to talk with a group of workers about a health education topic or give them information about the clinic, we first have to get them to leave their rooms and come join us. But we must accomplish this while knowing that we are guests in their homes during their few precious evening hours of rest. Our attitudes, therefore, must portray energetic self-confidence in order to command their attention and earn their trust, but always tempered by at least equal amounts of deference and respect for their wishes. Once we have initially commanded their attention, then actually convincing them to attend a clinic appointment requires reaching another level of trust beyond that, especially for those who are undocumented.
In fact, so much of our work rests on just making friends and earning the workers’ trust, that my supervisor sat me down the first week on the job and gave me a lecture on the importance of my working on being outgoing, striking up conversations, and always trying to put the workers at ease. Given that my personality does not tend this way naturally, I am lucky to work with a team of experienced and outgoing outreach workers who can take the lead much of the time. But I have certainly had to push myself in a good way. And as I see it, what better time to force myself to practice my small-talk skills, when, for once, small talk actually has big payoffs!?
Finally, given that the majority of migrant farmworkers in the United States are Latin Americans (and at my job, all of my co-workers, too), a large portion of my responsibilities involve translating and interpreting. I do spend a lot of time interpreting between the doctors and farmworkers at our clinics and at specialist appointments. But my “interpreting” extends even farther; I often feel as if I am the farmworkers’ guide or entry-point into myriad aspects of the mainstream culture and workings of life in the U.S. I have taken workers to specialist appointments and helped them navigate the confusing bureaucracy of a big hospital. I have helped an injured worker fill out a Workers’ Compensation form – not just telling him the words in Spanish but trying to cut through the jargon to get to the bottom line for his health and wallet. And I have been thrown into the middle of negotiations between workers and their English-speaking employer – knowing that due to the power differential between the two parties, my choice of phrase, tone, and approach were just as important as conveying the cut-and-dry gist of the message.
Really, on a daily basis, I do this “cultural” interpretation just as much as changing words from one language to another. From finding Spanish-language health education material that is also culturally- and education-level appropriate, to knowing that, out of respect, I should always try to accept food or drinks that the farmworkers offer me, my usual thoughts about soda or unhealthy foods aside. What is more, I am just as often seeking help from my co-workers and the farmworkers in order to better understand and navigate Latino culture. In fact, in many ways, I often feel like the “foreigner” in the room, even though I have not left my own home state!
As I said before, outreach truly is an art form. It is a job with a long learning curve, and I am still barely climbing the ropes although I have but one month left in my fellowship. While much of me wishes that I could have the chance to keep refining my skills as a health outreach worker beyond mid-November, I know that I will be leaving the Farmworkers’ Project in very capable hands. As they did a few weeks ago, my co-workers can turn a simple mobile clinic night at a camp into a fiesta filled with smiles and laughter. They may not have advanced degrees in nursing or social work, but they have deep wells of compassion and energy. Their hearts are in their work – their art. Given the demands of the job, in my opinion, that is the only prerequisite that matters.
See the video here: