Health Literacy & Latino Migrant Dairy Farmworkers in Vermont

While eating your breakfast this morning – maybe pouring milk into your cereal or coffee – did you stop to think about how it got to your table? Did you know that there is a hidden community of 1,500-3,000 Latino migrant farmworkers within Vermont working 50-80 hours a week, contributing more than 50 percent of the dairy production to support the state’s economy? The majority of these workers are in their late 20’s, male, and from Mexico, but it is not uncommon to find women,  Guatemalans, and Hondurans working among them. Working year-long with schedules that range from fours-hour on/fours-hour off to 12-hours on/12-hours off, weekend is not a familiar concept to these individuals. Given the rural environment they live in, the sparse Spanish-speaking providers available, and their limited understanding of the U.S. healthcare system, these farmworkers face many structural, cultural, and linguistic barriers when accessing health services in Vermont. I was reminded of some of the challenges my family and I faced when we first immigrated to the United States, and was compelled to help address the medical needs of such a vital subpopulation in Vermont.

To help empower the Latino migrant dairy farmworkers to make more well-informed healthcare decisions, my classmate at the UVM College of Medicine, Alejandro Velez, and I proposed to implement a system to disseminate health information and orient the workers to the U.S. healthcare system through farm visits and health conversation. An Albert Schweitzer Fellowship, which funds a year-long service project to address the needs of an underserved population, and our partnership with Bridges to Health, UVM Extension’s health access program for the farmworkers in seven northern Vermont counties, made the project – titled “Healthy Fields: Cultivating a sustainable system to empower Latino farmworkers to make informed health care decisions” – possible. We spent this past summer meeting farmworkers in Lamoille and Franklin County who have experiences with the U.S. healthcare system to develop literacy health materials. Support from Champlain Valley AHEC allowed me to work with Jack Fitch, a nurse practitioner student, to create lesson plans that introduce our country’s healthcare system, financial assistance programs, and medical bills to the farmworkers. The additional support I received from the Arnold Gold P. Foundation allowed me to reach out to the farmworkers in the Northeastern Kingdom (Caledonia, Essex, and Orleans County), and create even more lesson plans explaining the concept of consent and confidentiality, interpretation services, and the difference between over-the-counter and prescription medication.

I feel very privileged to have had the opportunity to work with the farmworkers and to be welcomed into the homes and lives of this private, fearful, and isolated population. I have gained a deeper understanding of the challenges faced by these farmworkers in accessing healthcare. For example, many of them were not aware of their rights as patients to have access to interpretation services, to give consent for medical treatments, and to have their medical information protected. Other farmworkers do not have a good understanding of the medication they have been prescribed and do not feel empowered to ask the doctors for clarification. The inability to read the English labels on the bottles further discourages many of the farmworkers from following their doctor’s recommendations, and may contribute to the pervasive culture of self-medication. I saw how their proximity to the Canadian border affects both their visibility in the community and how they are received among the locals; there is a stark contrast between the lives of the farmworkers in Franklin county as compared to those in Addison County. It was frustrating to see how these individuals are isolated and marginalized from the rest of Vermont, yet, they have given so much to this state (including tax)!

Alejandro and I have begun farm outreach visits to distribute health access and preventative health information to farmworkers with no prior healthcare experiences. We are excited and fortunate to have been joined by several compassionate and enthusiastic first-year medical students, many of whom are interested in extending our project. While my fellowship year will be coming to an end in March, it will not be the end of my efforts to address the health disparities of these farmworkers as well as other groups confronted with similar issues.

A new documentary called Hide screened at the UVM College of Medicine November 21. The film takes viewers inside the daily lives of several migrant dairy workers from Latin America who sustain Vermont’s iconic dairy farms and working landscapes. An informational session on the Albert Schweitzer Fellowship was held December 8.