Speech #920083644

Mr. Speaker. I want to call to the attention of our colleagues another program which is supposed to benefit migrant farmworkers. but which has failed to achieve its objectives. The Migrant Health Act of 1961 has been in operation for nearly 10 years. yet migrant farm workers and their families still do not enjoy adequate medical services and they suffer the consequences in terms of poor health and physical deterioration. The statistics are truly shocking: Migrant life expectancy is 25 years less than the national average. Infant and maternal mortality is 125 percent higher than the average. The death rate from influenza and pneumonia is 200 percent higher. The death rate from TB is 250 percent higher. The accident rate is 300 percent higher. Hospital care for acute illness and accident victims is often unavailable to migrants. The New York Times recently reported that in August 1970 two men having compound fractures with bones protruding and three men suffering from pneumonia with very high fevers were denied access to six hospitals even for outpatient treatment. As of fiscal 1971. 36 States and Puerto Rico had funded projects under the Migrant Health Act. These projects supposedly provided general medical care. immunization. prenatal care. nursing services. dental services. sanitation services. health education. and evening health service clinics in some migrant camps. Most of these projects have been entrusted to State and local health departments which are neither inclined. equipped. nor technically capable of delivering comprehensive medical care to migrant farmworkers. A 1970 amendment requires migrant participation in planning and implementing projects. but little has been done to put this into operation. Why has this program failed in its goal of insuring that "migrant workers and their children . . . share the health protection and services generally available to other U.S. citizens?" In the first place. far too little money has been invested in the program. The Department of Health. Education. and Welfare has spent an average of $15 per migrant per year compared to the national average of $300 per person per year on medical expenses. Second. the very limited funds that are available are spread too thinly by supporting too many individual county projects. The result is that many migrants receive inferior medical services rather than a few receiving comprehensive health services. Ironically. even given the propensity to fund several small projects instead of a few large ones. the migrant health program reaches on a temporary basis only about onethird of the total migrant population. Thirdly. the local health departments or allied agencies that run these projects are not very eager or lack the necessary resourcesin terms of facilities. personnel. and fundsto serve migrants who reside in the area only a short time each year and who have a different cultural and ethnic background from the areas residents. Finally. the failure of the program also results from the absence of program standards and evaluation mechanisms. Without objective standards by which to Judge individual programs. it becomes virtually impossible to defend or terminate any project. This has been the pattern since the outset of the program. A more detailed example. presented in testimony last year before the Senate Migrant Labor Subcommittee by Migrant Legal Action. Inc.. may illustrate some of the problems with this program. Another instance where local opposition has prevented a substantial Improvement in migrant health care programs is that of Hidalgo County. Texas (a county in the lower Rio Grande Valley with an estimated migrant population of 40.000). For the past five years. the local health department of Hidalgo County has operated a migrant health project that even It admits is totally inadequate. Not only is the program underfunded. but the health department lacks the technical capability to deliver good quality health care. It has neither sufficient manpower nor equipment. and has no direct ties to the migrant population. Dr. Ramiro Casso. a doctor In general practice in McAllen. Texas. described the public health activities in Hidalgo County as follows: "At present. these activities are limited to tuberculosis detection. followup on contagious diseases. and immunization of children. The inadequacy of our immunization program was pointed out during the past two months when in Hidalgo and Cameron Counties. we (uncovered) suspected (cases of) poliomyelitis." (In carrying out an evacuation of the adequacy of the Migrant Health Program in Hidalgo County) doctors found that: "These people are hungry for care. They are dying for want of it." Yet the Dallas regional office of HEW has been content to let the migrant health program in Hidalgo County continue to operate at its present level. A few facts about health conditions in the Valley should suffice to illustrate the total inadequacy of the present migrant health program. Hidalgo County has more cases of tuberculosis than any other county in the country. It also presently has a polio epidemic. in which 3 children have died. and at least 11 more are suspected of having contracted the disease. Dr. John Copenhaver. Director of the migrant health projects for Hidalgo and Cameron Counties. criticized the (evaluation teams) reports as inaccurate because of their shock over uncovering a case of leprosy. The local newspapers have reported Dr. Copenhaver as asking "Whats wrong with one case of leprosy? I know there are at least a hundred in the Valley." Although Valleywide inoculation efforts have been undertaken by the public health authorities in an effort to halt the spread of polio. outreach efforts are proving ineffective in reaching the persons who most need the vaccine. many of whom live in outlying areas and neither own radios nor read the newspaper. This past year. there was an opportunity to dramatically increase migrant health servIces to this area. Major efforts were initiated by the Washington office. It sought to develop ties with a local community organization (Colonias del Valle). to bring together community and provider groups. and to provide them with sufficient money to operate a comprehensive health care center.