Bryan Parrish

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Bryan Parrish grew up in Hillsborough, North Carolina, close to farmland. After working in both AmeriCorps and Peace Corps, he returned to his home in North Carolina to work with the Farmworker Health Program at Piedmont Health Services, where he is now the Program Coordinator. He discusses why the Farmworker Health Program is necessary, explains how the program works, and recounts some of his personal experiences with farmworkers.



Anna Silver: Okay. My name is Anna Silver, and I am here interviewing Bryan Parrish about the Farmworker Health Program. The date is March 29, and it is 12:10 PM. So, to start, could you give me kind of a little background about yourself, how you came to be working here, how you came to be interested in immigrant health?
Bryan Parrish: Sure thing. So yes, my name is Bryan Parrish. [00:00:30] I am originally from Hillsborough, North Carolina, which is about fifteen miles south of where we are right now in Prospect Hill. I grew up here around farmland, my family were farmers several generations back, work heavily in tobacco, agriculture in mainly the south, southeastern part of the state. So, growing up here I was very kind of in touch with that type of population, at least the farmworker population. And then, after my high school graduation, I went off to college at Penn State University, got an undergraduate degree in psychology, minor in religious studies. After that I worked in AmeriCorps, which is in Pembroke, or I was stationed out of Pembroke, North Carolina, worked very closely with the Lumbee Indian Tribe in kind of the Lumberton, Pembroke, Robeson County area there for a year. That was my stint, big kind of farmworker territory down there, big multicultural kind of melting pot down there as well. And then after that I decided to go off to the Peace Corps, spent two and a half years in Ecuador working with populations down there, and then came back in 2013, the fall of 2013, looking for a job around this area. I wanted to kind of stay local, but I wanted something that would also reflect on my background in kind of international work and multicultural work, especially with poverty alleviation, kind of in the social worker realm there but on an international stage. I saw a posting coming out of Prospect Hill for a Farmworker Outreach Specialist for the, this Farmworker Health Program, applied, got in, and that was right about four years ago now. And, so I spent about three years as a Farmworker Health Specialist and now this is my first year, just had my anniversary earlier in March, as the coordinator for the program. So, that’s kind of the short story of it, but, yeah, that’s pretty much what’s led me here right now. It’s kind of nice to be in an area that’s so close to home, so close to where I grew up, but then also kind of reflects some of that crossing territory, crossing boundaries experience that I’ve had in the past.
AS: That’s awesome. What were you doing in Ecuador, was that healthcare related at all?
BP: So it was Peace Corps, and the funny thing about Peace Corps is that you get trained in certain areas. While I was trained in youth development and family work there—but when you get into a community, I was the first Peace Corps volunteer in my area, it was a little tiny town of about 6,000 residents right on the coast, very impoverished, no real running water where I was, very spotty electricity, no real internet. So when you get put in there, I was originally linked in with a high school, but I had, you know, as the relationships grow, you start getting thrown into all different kinds of projects. So I did work with STD prevention, sex education, early pregnancy prevention in youth, but then I also worked very very closely with the educational system in improving curriculum, how to teach certain subjects, especially English, and then I, I got looped in and did some work in their trash deposit system, and then, also built a library. So I mean, there’s a, once you get thrown in, you learn very quickly that you’re kind of, kind of riding the waves of kind of circumstance there so there’s not much that’s preplanned [laughter] coming out of it but that’s the beauty of it.
AS: That’s pretty cool. Okay, could you kind of just explain the farmworker program to me, like how it works, how everything is coordinated?
BP: Well, how much time do you have? [laughter] I’ll say, [00:04:54] I’ll give you a brief little overview—
AS: Yeah, perfect.
BP: It’s kind of like what we do, kind of like the elevator pitch. So, for those not familiar with migrant farmworker, migrant labor, North Carolina is number two or number three in the number of H2A migrant farmworkers that come from Mexico into North Carolina in order to harvest labor. They’re number two or number three in the country, so we’re right behind Florida, and we switch positions with Georgia here and there. We used to be number one, so we’re all kind of in flux, number one, two, and three, sometimes that’s based off of when they take the data and the statistics of how many migrant farm laborers that we have in the state at one time. So what happens is that, every year, from about, I would say, March until October, which is kind of the big season, these farmworkers, these migrant farmworkers, under an H2A contract, which is a labor contract visa, permission to be in the country, they cross the border and come to North Carolina, stay here for about three to nine months in order to harvest our crops. So, if you go to a grocery store, a Kroger or a Food Lion or what have you, and you’re looking at oranges or you’re looking at apples or the vegetabels there, cabbage, things like that, they’re probably hand-picked by migrant labor, nine times out of ten. So, here in North Carolina, our biggest export of course is tobacco, when it comes to a cash crop. So, it is a very delicate plant, there needs to be hand-picked labor, you can’t just plow through with a tractor and harvest everything like you can corn, or some types of corn. So, these farmworkers have to come up, pretty much harvest our tobacco, they work for about three to nine months, and then they go back to Mexico. So they’re only here temporarily. Now, we service not only those H2A workers that come here, with our, with kind of social work and health services, but there’s also retired workers or farmworkers that have, they used to work heavily on the farm, picking tobacco or picking crops, and they’ve kind of aged out of the work and they might do a little bit here and there, they might drive a tractor, they might work closely with the grower doing some mechanic work or what have you, they qualify for our help. And then also seasonal families, which we call them, qualify for our help, which is a family that is immigrated from another country, it stays here permanently, or right now, it’s like their family is enrolled in school, they might move in the future, who knows, but right now they are here, working this seasonal kind of rotation of agriculture. They may work in nurseries, they may work picking tobacco, but they’re not moving back and forth to Mexico every single year under this contract. There are also workers that move without that contract, that H2A contract, inside of the United States, harvesting crops and following a migrant stream, is what we call it. So they follow maybe they’ll go up to New York and harvest apples in the fall, and then come back down to North Carolina and harvest Christmas trees in the winter, go to the East Coast, further, more into the East in order to harvest sweet potatoes, so they’re just kind of, they’re mobile, but they’re within the United States, not under that H2A visa contract. So we have all these people that we’re working with, and they’re a very disparaged population, they’re hard to locate, they’re isolated in the countryside, very rural areas, and they need some sort of connection with health services, or they need a connection with pretty much anybody at all in order to keep them from being abused and taken advantage of. We see a lot of kind of labor violations, human rights violations, just disconnect, miscommunications, lack of medical access, lack of education or knowledge on how to access the medical system in the Western world, quote unquote. So that’s why our program exists is because the economics is so important to the United States, and specifically to North Carolina, that the federal government finds it of interest to invest money to make sure that they’re taken care of physically and mentally and socially, and what have you, not just throwing them out there and saying, you know, everybody fends for themselves. They understand that this is a vulnerable population, and so they filter money in through this non-profit organization that makes sure that they’re okay. So we contract out of Piedmont Health Services, but we receive funding from the federal government that is filtered through the state department of rural health, through a program called the North Carolina Farmworker Health Program. We’re a voucher program under them, so they provide our funding, they approve our grant, and we use that money in order to finance this program, hire employees, pays our bills and finances our lives in order to go out and provide health services, social work services, interpretation, transportation, education, health evaluations, routine kind of field check-ups, provide donations, condoms, vitamins, hydration salts, what have you, to this population out in the field. And what we are really, so all that kind of stuff, I know it’s a lot, if you boil it all down, we’re really just a contact here in the United States for people who may not know what to do when they’re so isolated. We’re, a lot of times we’re their first and only contact outside of their employer. So if you’re isolated and all you have contact with is an employer that you may or may not even understand what they say most of the time, there’s a lot of room for abuse there, and so, and a lot of room for disconnect, when it comes to if they really need something, like health services or legal services. So that’s why we’re here.
[00:11:13] AS: How do you guys reach these populations? How do you know where to go, how to get into contact with them?
BP: Sure, a lot of—the H2A contracts are public information. So you can go on North Carolina Department of Labor, you can look at the agriculture safety section, look at the migrant housing map, so you just follow these little tabs, and you can filter it by county, and by year, and you will see every single grower or farmer that has requested H2A workers for that year and how many they requested because the department of labor has to keep information on whether the housing that these people are put in when they come here is up to standard, and up to code. So, that’s one of our jobs too, is to kind of go into that house and say, you know, has things changed since the time the Department of Labor went in and looked at it. And if it has, we can go to the Department of Labor and say, hey there’s some kind of disparities here, this isn’t really up to code, there’s too many people in this house, so we can be a little bit of an extension of everybody if we feel like something is incorrect. But, yeah, it’s public information, the growers public information, so we go by that a lot of times. There’s a lot of word of mouth, where farmworkers are, especially when it comes to the non-H2A workers. If we go to a farm with H2A workers and we see an American retired worker driving a tractor or a seasonal worker at a—well a lot of times we just call nurseries and ask if we can go in and talk to their workers and provide some healthcare. If they’re not providing health insurance, that may be a good way for the employer to say hey, we’re still kind of connecting people with health services, and so, it’s probably a good, it’s kind of a good PR move for them. So, there’s a plethora of different ways, but, it’s, a lot of it is public information, a lot of it is word of mouth, and then we just kind of take that information and go in the field, and see what we can find.
AS: How many different places do you go to, and how big of an area do you cover?
[00:13:22] BP: We cover thirteen counties in the center corridor of North Carolina, called tobacco road, right, it’s pretty much the space between Winston Salem and Durham, and it goes from Person County, Caswell County, Rockingham County that are bordering Virginia, all the way down to Moore, Lee, Harnett, which is not quite the border of South Carolina but it’s very close, it’s like one or two counties, in the middle there, or, or in between. Thirteen counties and we did the write up, it looks like about five hundred camps we’re looking at or five hundred—we call them camps, but they could be somebody’s home, they could be a camp, per say, but they could just be a trailer, in a field, you know with four guys. We call them camps. So about five hundred, our high water mark that we’ve reached was about sixteen hundred and thirty, but we, we range anywhere from about thirteen hundred to sixteen hundred depending on the season, and a lot of things change, you know, politically, for example, or in the amount of those contracts given out, those visas, our ability to access them, what have you, our ability to fluctuate, but we’re in between about thirteen hundred and sixteen hundred usually that we see per year.
AS: Wow. So then when you guys actually go to the farm, are you providing healthcare services there, providing screenings there, are you doing more health education there, and trying to get them to come into the clinic, how does that work?
[00:14:59] BP: Right, so we are considered an enabling service, and there are different types of farmworker health programs. Some are medical services and some—or medical capacity programs—others are enabling capacity. We are an enabling capacity and the reason for that is, or the difference is, is that an enabling capacity will go out, do a health assessment, which is basic questions. There are about twenty of them, there’s a good amount of questions that we’re asking the farmworker, it takes maybe about fifteen minutes. We check their BMIs, their blood pressures, look at their medications, see if they have any chronic illnesses or history of illness, and what we want to do with that, that fifteen/twenty minute interview for example, with the basic vitals check, is just to see how are you doing? Are you doing alright? Do you need to see somebody? Like do you have a rash all over your body that you, that you know has been bothering you for three weeks, but you don’t know who to contact, do you have a blood pressure that’s two hundred and twenty over one hundred and thirty, you know, what is going on? Do you feel alright? And we just want to—you know, how are your teeth, dental? How, there’s a lot of other things we ask about, you know, mental health wise, dental health wise, do you have enough food, how are people treating you, things like that, and we just, we take that information, and then we can come back here to the clinic and boil it all down and then we start, pretty much going to work and connecting those dots and saying okay this person needs mental health services, they need dental services, and we schedule those appointments, we provide the transportation, the interpretation, so we just bring those together, we’re kind of like that, the spider web, in that sense. Now in a medical capacity would be taking a mobile unit van out, or taking a provider out and saying okay we’re at a camp of twenty guys, who needs to see a doctor, line up, you know, and we’re gonna provide vaccines in the field, we’re gonna provide HIV, you know, screening in the field, we’ll provide pretty much everything that you would get here at a clinic, but mobile-ly. Now we haven’t done that so to speak because Piedmont has several different, I mean we have about ten different clinics right, so we can transport them to those clinics pretty close by. Some people don’t have access to those types of services, to a community health center that really makes space for people to come in without health insurance and be seen and getting medications without paying, you know, an arm and a leg for that. Because we work out of a community health center, all that stuff is in house, we can—we have our pharmacy here, we have our lab here, we have WIC services, we have our dental here, so, it makes a lot more sense just to have them here because once we have them in the clinic, they can get all those things. It’s not like okay, we’re bringing one provider out, which works great for programs that are maybe more in rural areas, that have way bigger camps, and don’t have community health centers close by, that can provide low-cost services. So that’s pretty much what we do. We provide the assessment, and then we provide education, and then we come back here to the clinic and boil all that down and then we start connecting the dots.
AS: Okay, great. [00:18:30] What specific health problems do these workers face, you know, as a result of their working conditions, what have you guys encountered?
BP: Biggest thing, number one cause of death in Mexico—do you know what it is?
AS: No.
BP: Diabetes.
AS: That’s what I was gonna guess but I didn’t want to be wrong [laughter].
BP: Yeah, there you go. I will say diabetes is big, we’re just screening for that, we’re educating on that, it’s probably the biggest thing, it’s like the prevention part of that one because that’s such a killer. I mean in the United States it’s huge as well, but, it’s such a killer, and it’s so deeply rooted into that, into the Latin American community that we really want to target that. Also, high blood pressure of course, yeah hypertension is gonna be a big one. And these are things, you know, heart disease and diabetes, these are things that affect the United States as well, that’s nothing too specific to farmworkers, when it comes to the labor that they’re in, so when you talk about that side of it, too. So we do hypertension, diabetes is big, but then we also want to focus on pesticide exposure, and we want to focus on heat illness. We want to focus on injuries that happen in the field, so—and worker’s comp situations, somebody, somebody could step in a row of tobacco that is soft from maybe some, some rain, and tear an ACL, I mean we see stuff like that, and then how do you follow up. So, the most common for us I would say—one has gotta be diabetes, hypertension, heat illness, and then I would say green tobacco illness has gotta be there too because of the tobacco that we work with. So that’s very occupationally specific, and what that is is, when you’re working with tobacco, and you’re in the rows and you’re touching all this tobacco and harvesting the leaves, if it’s wet at all, if there’s dew on it, or if it’s been raining, the nicotine will actually protrude through the leaf into the water and the water will get on the skin, absorb through the clothes, and then you get an acute nicotine overdose there. So, a lot of symptoms, you know, vomiting, headaches, dehydration, even some hallucinations, it can cause a very debilitating condition where the person, they feel like they’re about to die. And you come in, you know, they hook them up to an IV, give them fluids, flush it out, rest for a couple days and they’re okay, but, yeah that’s a big one too.
AS: That’s interesting, I’ve never heard of that. You mentioned worker’s comp. [00:21:25] What does happen if they get an injury on the job?
BP: It all depends on the grower, of course. I mean, you have some people that are good as gold, they will hook them up to all of those resources that they need, and we just come in and check up and say is everything going alright, you know, here’s our name and number, I know you have an injury here, you’re out, your leg is kind of elevated, and you’re not working, but are you getting paid the, you know, about 70% of what you need to get paid for one, do you have a lawyer that you’re in contact with, is the, are all your medical bills being paid for, you know, XYZ. So we ask those kinds of questions. Then you have some people that, you know, it can go on the other side, it can get a little bit more nefarious in the fact that somebody gets injured on the job and they’re all of a suddent they’re trying to get kicked out or moved out of their housing or saying this worker’s not fulfilling their role or duty, send them back to the contractor and give me another worker. You know, so there’s a whole, there’s a whole range across the board. Some growers are completely awesome, some of them we have to follow up with in the sense of, we have contacts with several different organizations across the, North Carolina that can give us advice on worker’s comp or kind of point us in the right direction. And it could be through a, just an independent, you know, legal entity that speaks Spanish, knows of immigration rights, things like that, or it can be through some, you know, something like legal aid, which can provide some low-cost legal advice and legal help there, so yeah, there’s several different avenues there. We just really, our job is to just make sure that those things are going correctly and then connect them to different areas if they are not going correctly.
[00:23:24] AS: What are the working conditions like for these workers?
BP: Again, varies across the, across the board, the, now the working conditions, it’s farm labor, it’s very intensive, it’s six days a week, sometimes seven days a week, from about five/six in the morning, before the sun comes up, till about, you know, it can get into nine or ten o’clock at night, and they’re just working throughout the day, and then they have an hour or two hours for lunch break, then they go right back at it. Hot—I mean of course it’s during the summer, so it’s very very hot, very humid, but they do have to cover up in a certain manner with clothes in order to prevent, you know, injuries or pesticide exposure, things like that, so they’re super hot. It’s hard work, I’ve done, it, I’ve gone out there and picked tobacco with these guys, and I’m telling you, like, unless you know what you’re doing, it’s like trying to, you know, play a game of basketball with professional basketball players, like you have to know how to dribble and shoot, or you’re just going to exhaust yourself very very quickly. And most of these guys know these techniques, they’ve been doing it for twenty, thirty years, working in these conditions, they know, kind of, how to do it themselves. They may not know some of the health risks involved, and so we’re there to educate them on that. But I would say definitely hot, humid, a lot of work, twelve hours a day, sometimes at least twelve hours a day, sometimes seven days a week, yeah. Depending on who the grower is right, there’s a lot of, a lot of differentiation, but some growers don’t provide, you know, adequate water supply, they might provide sodas, and so they’re just drinking Mountain Dews trying to hydrate, you know, and that’s just not good. They might be providing them Little Debbie cakes for snacks, you know, along with their soda, and they’re just like, yeah here you go, take this junk and then try to work through it. So, it all depends. Some growers are completely awesome, it gets too hot, they’ll give them breaks, water, Gatorade, in the field, healthy snacks, and we try to, we try to connect with the growers too to try to shift—we feel like if we can change the grower a little bit, it affects every, all of the farmworkers involved instead of, you know, changing one or two farmworkers, so we try to, we try to do a little bit of both.
AS: Gotcha. [00:26:01] Is it difficult for the farmworkers to find time to come to an appointment, if they’re working all that much?
BP: Yes, definitely. And that’s why we are—so we have our late nights on Thursdays, so the clinic stays open until eight. But, when it comes to the farmworkers season, a big move that we’ve done that started last year was create additional slots on Thursday nights for the Prospect Hill clinic and the Moncure clinic, which is mainly where all the farmworkers are centered around. So we will create additional spaces for only farmworkers to come, so we’ll have a provider elect to work an extra shift that night with an MA with them, on a night, so we have Thursday nights, so lab is already open, or is open still, and pharmacy is open, so they can get those services they otherwise would have on a normal clinic day. We just open more space for them to come in that’s in between May and September, we’ll do that. So we’ll have ten farmworker clinics this year that will be extra slots for farmworkers, only farmworkers to come in specifically. So, yes, so the short answer is yes, definitely hard to come in, we try to make it as much space as possible for them to come in. We’re trying to accommodate that.
AS: Cool. Are the farmworkers, are most of them from Mexico?
BP: Yeah, I would say 95 percent. We have some people from El Salvador, I know some people from Guatemala, we actually have some farmworkers from South Africa, down in the Moncure region, so, we do have a, you know of course there are some American workers too and we have a, a plethora of different places they’re from, but 95 percent, yeah, from Mexico.
AS: The healthcare population—or the farmworker populations, are they, pretty much all males, are there females working there to, or?
BP: Farmworker population in general, females are included. The H2A workers, if you just say the H2A migrant labor, which is the majority of the people that we see, those are men from about eighteen to fifty, I would say. Most of those are eighteen to thirty-five. We see a lot of fifty, fifty-five, sixty year olds, I think there, my oldest, the oldest worker that I’ve seen was about seventy years old and would still come, sixty-eight, seventy, still comes through an H2A visa. So, yeah, it’s across the board. Mostly men for H2A which is the majority we see, but then, there are women too, that you know work in nurseries, work in tobacco, what have you, and that’s just maybe specific to our region because I know there are some camps down in Southeastern North Carolina, more Eastern area that have H2A women come up, there’ll be a camp of like one hundred women, so that’s kind of interesting. I haven’t seen that, but I know they’re around.
AS: Have you guys experienced, kind of, any [00:29:16] cultural differences that have led to difficulties in providing healthcare?
BP: What do you mean?
AS: Maybe different views on healthcare, distrust of American medicine, anything like that?
BS: Sure, I would say the, some of the Latin population will bring up more like natural remedies for, for medicine—eating certain seeds, or herbs, or roots, and they’ll say they go to a curandero or a huesero, which is kind of, huesero is kind of like a bone specialist, like a bone setter for maybe a sprain, or a—it’s more like a chiropractor, I would say instead of like an orthopedic specialist. Some of them will say, and I’ve heard that they’re great, and awesome, they do a couple little movements, they figure out your body, do a couple of movements, and all the pain is gone. Or a curandero, which makes a certain kind of tea or brew with certain kinds of roots and herbs in it and it helps control diabetes, things like that, very naturalistic medication. So, I would say being able to discuss that with the farmworkers and saying okay, do you see a curandero, do you see a huesero, and then educating the providers here, so that they’re not prescribing a medication that will interact with the natural medication that they’re already taking for some sort of bad side effect. So we have to be attuned to that, for sure. Issues coming in, I mean, I would say, a lot of it is specific to their work, a lot of it is specific to, you know, doing this to take care of their family, the situation that they’re in has pretty much brought about the attitudes to healthcare. A lot of these guys are super open to it though, a lot of the ones that we see, and I think a lot of it has to do with our interactions personally with the farmworkers. So, you could say, well you know, culturally, they just don’t want to come in, but are you really sitting down with them and explaining these things, you know, and I feel like anybody, in any culture would want that at least. And so I feel like they’re very very attuned to it, they’re very open to it, they’re very—and they hear things about how America is the greatest country to provide healthcare, you know, it’s the greatest place to be, why not, if they’re getting health insurance, come in and see a doctor and see what that’s like. A lot of them are very curious to see that, and they come out and they’re, they, you know, have their blood drawn, or they’re getting their vaccines, and they’re very prideful of that, they take a lot of, take a lot of pride in the fact that they came and got checked out and now they’re healthy, you know. So, a lot of it is how we interact with them, it’s hard to know whether it’s something culturally or just individually that’s happening. So there’s some cultural barriers in the sense that in Mexico, they have a social security where their, their insurance is subsidized throught the state there, they pretty much have a universal healthcare system, and so they have to get used to kind of how our healthcare system works here. And of course language barriers is always gonna be a thing that’s tied to culture to, but yeah, that’s a complicated one. But, you see it different all the time, you see differences all the time. But there are certain areas of the curandero and huesero and different people that are coming from different areas of Mexico maybe that, that express that need for healthcare in different ways.
AS: That’s interesting. It sounds like you guys do a good job of addressing everything though. I’m just curious because I’ve read things about mental health specifically culturally in Latin America being something that’s just not really discussed, do you know anything about that?
BP: I would say that’s probably the new, [00:33:30] when you’re speaking of mental health specifically, that’s the new frontier almost in healthcare in general. I mean it’s been around not that long at all, you know it’s a very very new field, and so yes, I feel like that is something that comes into play with the Latin population, that they’re like okay, no soy un loco, like I don’t want to come in and see a specialist because I’m not crazy. But a lot of this, again, is how you word it. I mean if you’re telling somebody do you want to come see a psychiatrist or a psychologist, you know, even if you’re living as an American in rural, in rural North Carolina, some people might get offended by that, right? Now if you’re telling, if you say hey, how are you feeling, how are you doing, you know, have you been feeling kind of down or anything? And a lot of these guys will open right on up to you. Hey my, I had a mother, or a sister, my brother is in a, was in a car accident, I mean we have discussions that go on for thirty minutes or so about an accident that might have happened and how they feel about that and how they’re internalizing that, and is that really affecting them, and then at the end of the day we can ask, do you want to speak to somebody about that, or do you want to come in and just kind of, you know, speak to somebody else, sometimes it’s good to and not be so isolated. And they’ll agree to that, and they’ll come in and see it. Now, I will say it’s probably a cultural, there is probably some cultural pushback about, you know, not being loco or what have you. It’s hard to say that that doesn’t happen here to, so, or, in the United States. But a lot of it is how you, I think how you approach it, and knowing how that is kind of there in that culture and bringing it to them in the way that they’re used to it, so.
AS: Have you encountered any kind of, I know you said most of, a lot of the people you work with have the H2A visas, but some are undocumented, [00:35:33] do you encounter just fear to come into a clinic because they’re like, don’t understand?
BP: Right. Yeah, yeah. You know, I see the fear to come in when—now our program can visit people whether they’re documented or not, we don’t ask that question. But if there is a kind of pretense that they could be undocumented, you know as a seasonal worker we know they’re not on H2A visa, they could be a resident, we don’t, we don’t ask those questions, but I can see that fear happening because of the ability to come to the clinic. So, the ability to, you know, to get in the car and drive there and not knowing on the way from your house to the clinic if there’s going to be a checkpoint. So they’ll stop. So we get a whole, we had a New York Times journalist come down and just interview some people for Piedmont Health Services, Dr. Ashkin was one of them, about how fear of deportation or encountering ICE would kind of stifle somebody’s ability to come and seek healthcare. And we do kind of see that, see those things. There’s the fear of who we are, there’s people that will just reject us completely and say hey, I don’t want my blood pressure taken, I don’t want an assessment or anything like that, but that is, that’s a rare occasion. It’s definitely the exception and not the norm, most people are very nice, very welcoming, want us to come in, want to sit down and talk to us, I mean we’re the only people that they’re really seeing besides their employer, so they want the, the donation bag too and some vitamins and they want to talk to us and sometimes—I mean we’re, we kind of build relationships with them, you know, year after year, where they’re like hey, come on, hey, how you doing, they’ll call us and say, why haven’t you come visited us? You know, so, the more, the apprehension comes more from the grower than it does the farmworker, by far. The grower doesn’t want to provide time for the farmworker to come in to go to the, to have an appointment, they see the farmworker as just kind of a tool for their own economic benefit, but even when the farmworker wants to come to the clinic, the farmworker will be like no. It doesn’t happen as much vice versa, where the grower is like, yeah everybody needs to go see the clinic, and then the farmworkers are like no I’m okay. It, the general rule is, the farmworker’s gonna want to come in or express some need to come in, and we have to navigate the grower situation, so yeah.
AS: Interesting. [00:38:15] Do the farmworkers have insurance, I would imagine most of them probably don’t?
BP: Right, so they do not have insurance when they come here, but they are eligible and required to enroll in the Affordable Care Act. So they do meet the requirements for that because they’re here for more than three months out of the year. So, but they do have—
AS: The H2A visa workers are?
BP: Exactly. The H2A visa workers. So they have an exception, an enrollment period exception, where they can come in and have sixty days to enroll after their first day of arrival. So we work closely with our outreach and enrollment staff here in order to, to go out, bring farmworkers back to the clinic, enroll them in healthcare, so then they get a certain plan. And they do qualify for premium tax credits as well, so they do not have to pay, you know, an arm and a leg for that insurance, for those premiums, they get a pretty good deduction because they just don’t make as much throughout the year in order to qualify for higher premiums I guess or, or not qualify for the tax credits, so, yeah. Now the ones, the undocumented, you know, possible undocumented ones or the seasonal workers, retired workers, most of the time they do not have health insurance unless the retired worker is over the age of, you know, to receive Medicare then they’ll receive that or Medicaid, they may receive Medicaid as well. Children of farmworkers will tend to be on Medicaid, so.
AS: Let’s see. Are there big barriers to accessing healthcare that we haven’t mentioned yet?
[00:40:09] BP: I would say of course the education, the transportation, the interpretation services. I mean you call, we do kind of this round about calling of urgent cares and ask about the insurances they accept and if they have bilingual staff, and it’s really surprising just to see how many people don’t. And that’s why it’s fortunate that Piedmont, specifically Prospect Hill, we have pretty much all of our providers are bilingual, you’re going to find somebody in Piedmont Health Services that can speak bilingually to help somebody out when they come to the door, so, um, that’s very very fortunate. They do, the barriers are definitely the transportation issue, the time issue, money is also a big barrier, even if it’s a twenty five dollar, you know, copay without insurance because they’re on a sliding fee scale, sometimes it’s hard to get twenty five dollars. Fortunately we have a charity, Selvidge Fund, here that will help that out. Dental funding, we receive funding that we pay for pretty much all except for about twenty dollars per visit so they pay a twenty dollar copay they can get pretty much complete preventative dental care here, so that’s nice. Now when it comes to specialty care, that can be a huge barrier because if they do not have health insurance and they, something happens where they have a surgery or something very, you know, a lot more serious, then we have to navigate charity care situations there, if they’re even available, some of them don’t, and some people do not qualify for, you know, maybe a charity care application in you know, I don’t know, Rockingham County or, you know, Greensboro or what have you. And so we have to just kind of explore those and see if they can and work around the system, but there’s a lot of barriers, there are a lot of barriers to healthcare, and specifically for this population because—and the biggest one is lack of knowledge, lack of contact, lack of transportation, interpretation, lack of money, I mean, the list goes on, yeah. If you could imagine yourself in the shoes of one of these guys, or, or just say okay I’m gonna go to China and I’m gonna work in agricultural work, you know, and I know nothing about the country, I know nothing about the language, I’m just gonna get on a flight and go down, I’m just gonna get dumped off at a place, they’re gonna give me a piece of paper that says this is the person I’m gonna work for, they’re gonna put me in a bus, take me there, they’re gonna put me in a trailer with four different people that I have no clue who they are, and they could all speak your language and you’re all kind of in the same boat but what type of barriers to healthcare would you find. [laughter] You know, that’s pretty much where these guys are.
AS: It’s pretty crazy to think about. Do other, [00:43:04] are there other programs in the state like this?
BP: Yes. Yes, very much so. There are about ten of us under the voucher program, that is, getting funding through the department of rural health, but there are other programs as well that have, that serve migrant workers that receive funding directly from the federal government, so yeah. I can provide you with a list of those if you would like, of all those programs, yeah so.
[00:43:35] AS: Do you know if other states have similar programs?
BP: They do, I do know North Carolina is very developed though, when it comes to these programs. So, we usually get very perfectionist and we’re like this county’s not covered and that county’s not covered because that’s the way it should be, these places should be covered completely—or, I can’t believe this farmworker’s never seen a healthcare worker or health promoter, you know, the entire time they’re here. But a lot of the states are just not as developed as North Carolina is when it comes to this, so, I just spoke with Alexis Guild who works for Farmworker Justice out of Washington D.C., and she says that North Carolina is like the golden child when it comes to Affordable Care enrollment, ACA enrollment. We, the strides that we’ve made to ensure that H2A farmworkers are enrolled in medical insurance when they come here is above and beyond pretty much the rest of the country [laughter], so that’s pretty yeah, I just heard that so that’s pretty cool to hear things like that.
AS: Yeah, that’s awesome. Let’s see, I think that’s all the questions I had. Do you have any last thoughts, anything else you would like to add?
BP: No, I mean, I think I’m okay. I probably spoke way too much for you to boil it down [laughter].
AS: No, no.
BP: So yeah, I apologize if I, sometimes I go off on rants, and we get—
AS: Oh, no no no [laughter].
BP: Sometimes we can go off, like if you came out and did outreach with us, we could sit in the car and on our way to a camp and back, and I’ll chew your ear off for days so, hopefully this was—
AS: No, this was perfect, yeah, this was wonderful.
BP: Alright. [00:45:30]
5 APRIL 2018