Nicandro Mandujano Acevedo

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Sophie Therber [00:00:01] Alright, my name is Sophie Therber. I'm interviewing Nicandro Mandujano Acevedo. Today is August 4th, 2021, and the time is 5:08pm. Nicandro, thank you so much for allowing me to interview.

Nicandro Mandujano Acevedo [00:00:12] Yeah, of course,

Sophie Therber [00:00:15] Just to start off, where are you from? And can you tell me a little bit about that area?

Nicandro Mandujano Acevedo [00:00:19] Yeah, that's a complicated question, I guess. So, I am originally from Mexico. But my family migrated to Asheville, North Carolina in 2003. So I guess that's where I would consider my current home. So, yeah, tucked in the mountains of western North Carolina.

Sophie Therber [00:00:40] And how old were you when you moved to Asheville?

Nicandro Mandujano Acevedo [00:00:43] Yeah, I was nine years old. So, I've spent, I guess, more than half my life now in the US.

Sophie Therber [00:00:52] And what was it like to arrive in North Carolina after being born in Mexico?

Nicandro Mandujano Acevedo [00:00:57] Yeah, it was...yeah. It was weird because I think I was at that 4th, 5th [grade], transitioning into middle school-type personality, so of course I didn't want to leave my friends. But then, when I got here, I think definitely a culture shock, because there weren't that many other Latinos in the school system that I went into at that time. It increased over time. But at the beginning there weren't that many and everyone that was there was family friends, thankfully, or like family relatives. So in that sense, it was easy to transition, but still hard to adapt to a new system.

Sophie Therber [00:01:42] And what has made you decide to stay, continue living in North Carolina since then?

Nicandro Mandujano Acevedo [00:01:47] Yeah. So I actually have not. I mean, I've stayed in North Carolina right now. I went for undergrad. I've only come back to live two years out of the five that I've been out. But what makes me go back to Asheville is probably family ties, honestly, more than anything, just because I'm interested in like migrant health and displacement. So Asheville doesn't really have that. It's not that big of a hub for that sort of work. So definitely what has brought me back is family ties.

Sophie Therber [00:02:26] So your family still lives in Asheville?

Nicandro Mandujano Acevedo [00:02:28] Yep. Yeah, everyone in my family lives there, except now me and my brother. Yeah.

Sophie Therber [00:02:36] And how did you get started working with the Farmworker Health Program?

Nicandro Mandujano Acevedo [00:02:40] Yeah. So, I got my MPH last year, so I graduated in 2020? Yeah, in 2020, yeah. And one of my friends throughout the program knew about the farmworker program and they had offered I think -- well, you'll interview Natalie tomorrow, but she forwarded me the position, for that position. And at that point I was like, "well I'm not sure if I'm going back to North Carolina," but I did some research and it seemed like it was a really interesting program. So then when I ultimately made the decision to come back to North Carolina, I checked it out and I was like, "well, let's see if they have any open positions available." And they did! So, I decided to apply. That's, like, the short version. But I guess traditionally why I'm interested is because my dad and most of his family, or brothers, siblings, were farm workers before the 2000s. Since we came, we haven't done farm working, but it was part of the farmers to use them, like the whole farmworker sector, agricultural sector, when he first came to the U.S. So that family history kind of also made me go. And then when we arrived to Asheville, we lived in a tobacco farm. So I was kind of familiar with it, even though we didn't really have as much exposure with it.

Sophie Therber [00:04:11] Where did you get your MPH, and what was it like to graduate in spring of 2020?

Nicandro Mandujano Acevedo [00:04:16] Yeah, you said, where, right?

Sophie Therber [00:04:19] Yeah.

Nicandro Mandujano Acevedo [00:04:21] I got my MPH from the Brown School in Washington, in Washington University in St. Louis, which is a school of social work. It was originally social work, but now it houses the public health program and the public policy program as well. And what it was...It was really weird, graduating in 2020, just because we were doing public health and we're in a public health crisis. But it wasn't really...an emphasis in the program that I went because what I was primarily focused on was global health epi and bio sets, so like it was kind of whipped into, like, data and analysis type of portions, but with other global settings, I don't think it had gotten so out of proportion or like it hadn't had that big of an impact yet on the classes that I was taking. So it was weird because I feel like if we had been able to still be in classes in-person, it would have facilitated the conversations about the emergency response and what it was to be in a pandemic in public health classes. But because we were remote, most of the classes just remained the focus on what they were at the beginning. And it was weird because before, if something were to happen in the global setting, we would be able to discuss, like in the hallway. But because of remote learning, we didn't really have that opportunity. So I kind of feel like I missed out on that. But regardless, it was it was a good opportunity.

Sophie Therber [00:06:03] And how do you feel that having a background in public health influences your role at the North Carolina Farmworker Health Program?

Nicandro Mandujano Acevedo [00:06:10] Yeah, so it's been really interesting because part of what I really enjoyed was the planning implementation, or the process of any programing. And so I think because we came and we're -- the COVID response team came in, fairly new into the program, trying to keep that aspect to making -- of course, we're in an emergency response, right? But to make sure that what we're doing has long-term effects for sustainability, like having to integrate a little bit more of that, well, let's try to plan or see what that will look like in the future. So it's really interesting, like thinking of that training being like "no, for every successful program you need to plan." But then with the emergency response being like "you're not really able to plan." I thought trying to combine both of those mentalities was really, really interesting and challenging, I will say. And it still continues to be challenging, right? Because I think there's two changes that are happening. But I think we adjusted well for the people that joined. We were very good. We made a good team.

Sophie Therber [00:07:20] Can you tell me more about the emergency response program and what that entails?

Nicandro Mandujano Acevedo [00:07:25] Yeah. So from our side of the program, since we worked with farmworkers, it's mostly outbreak response with migrant camps, but at least that's the one that we're able to have a little bit more control over, because, of course, there's farmworkers that don't live in migrant camps. But for those that do, the outreach workers knew the guidance and what to do if there was an outbreak or a suspected case. Going through that was kind of challenging, right? Because part of the guidance says, "oh, you're not allowed to work in this settings," but the challenge is that the farm workers are here to work. So it was a little bit difficult to be like, "no, this is an emergency, so this is what should happen." And then the other thing, because the state was also developing new programming and better resources to make sure that the pandemic had as less of an effect as possible. Part of that response was also us being able to connect with other state entities and being able to bring those resources to the outreach clinics so they could provide them to the farm workers.

Sophie Therber [00:08:44] And were there any plans in place just based on what you and your organization had learned from prior disasters, or was everything just created in response to the pandemic specifically?

Nicandro Mandujano Acevedo [00:08:56] Yeah, so I got to be honest, I don't know. I don't know what that response was, because when we came in, we were like “how do we treat the pandemic?” And so our team didn't really have time to look back into what previously was done. So didn't know of what was currently being done for the response for COVID. And so we kind of went with it and adapted it. But in terms of, like previous work, I'm not, I'm not completely sure.

Sophie Therber [00:09:27] Yeah, that's totally fine. But what was it like to join the team in the midst of the pandemic? So not even being able to see how things used to be, but just kind of joining throughout that?

Nicandro Mandujano Acevedo [00:09:39] Yeah, it was honestly really challenging, hard at times, well, mostly hard at times. But I think part of the issue was because the program is small. Right. But it has to cover the whole state. And to begin with, like, all of the staff has all the rules. So they had to adapt a little bit and make sure that they were covering, now, COVID and then also covering everything else. That also is a full time job. So when we came in, we basically had to take over all of the COVID response and there was little time to be able to come together and make sure that we got back on our history. So, part of it was good because it gave us kind of freedom to be able to adapt as needed. But the challenging part was that both of us that came in into the program as a COVID response team had not been working in North Carolina or with the farmworker population. And so there were there was context that we didn't know and we weren't able to get from the team as easily as we probably would have. So there was a little bit challenging to get the context that was needed. Now, that was also a blessing in disguise, right? Because what that meant was that we could come to all agricultural partners and be like, "hey, we're the new team when you really don't know much, could you explain this to us?" And that helped us get that information and might have facilitated partnerships that we currently have at the moment.

Sophie Therber [00:11:27] Can you give me an example of something that the agricultural workers were able to contextualize for you?

Nicandro Mandujano Acevedo [00:11:34] That agriculture workers were able to contextualize, yeah. I think to me in general, it's just how farmworker clinics work and the H-2A program. Because my family history doesn't really...they didn't come through H-2A. And so learning about the process to a worker and kind of what that looks, like what it means to apply for the visa and how much they have to pay to be able to get the visa, and like the trek to North Carolina when they come to a centralized location or they have to figure it out on their own. And then when they are here, kind of what that contract entails. Right. And there's a vast difference sometimes into what that looks like. And so seeing it play out in different fields, because from what I remember, it's like, OK, like I didn't think it was this difficult or this nuanced between labor contractors and growers. So that was one thing. The other part is I really didn't know a lot about how farmworker clinics worked and what services they were able to provide. So it was nice to hear from workers and just outreach workers, kind of what they had been doing for the past 20 years, that kind of helped me realize, okay, this is what it looks like to the farm worker, but this is what it looks like in terms of programing and being able to provide those services to facilitate access to health care. Of course, there's a long way to go, but I think it's just how the agricultural sector is, unfortunately.

Sophie Therber [00:13:18] So something that you were saying earlier is that your small program was suddenly tasked with helping issues throughout the entire state. Can you tell me a little bit more about that -- what that was like to have to be in charge of such an expansive variety of problems all over North Carolina?

Nicandro Mandujano Acevedo [00:13:34] Yeah, so I will begin with...So, across the state, there's about twenty farmworker clinics. Right. But our program only funds nine. So historically, the relationship between those have always been strong. We provide technical support, really anything any type of support they need. Right. But there remain just eleven sites [that] we had really never had such a strong relationship [with] just because we weren't funding, so there's, like, a little bit less to leverage for those. So with the pandemic, because we are known as a farmworker program, and so then the state was like "Okay, so you're tasked with everything farmworker-related from our side," and what was difficult at the beginning was making sure in establishing those strong partnerships with the other clinics. So that was the challenge at the beginning. Now, I think the other part, as I said, was like knowing where our capacity went, where we could extend our capacity versus not, because we are a state program, but we kind of aren't. And that that's a little confusing to myself as well. But we definitely have leverage on our sites. But the other ones, they operate independently. And so even though we can provide guidance and protocols and do everything that is needed, ultimately, we wean ourselves off of the program to have the capacity to make sure that that is ensured. So that's when we would have to bring in DPH or the health department or any other partners that have a little bit more leverage with those clinics.

Sophie Therber [00:15:32] Wow, that sounds like a really interesting process to be not only having to adapt to new challenges, but also new farmworker clinics. Just a lot of kind of being piled on all at once. What was it like to have to create those relationships with clinics that you hadn't normally been working with?

Nicandro Mandujano Acevedo [00:15:48] Yeah, well, the good thing is for us, it was something we had to create those partnerships with our funded sites a little bit easier. Right, because we could ask our coworkers and be like, "hey, can you just facilitate our introduction to those?" But for the others, it was three of us. And so with outbreaks and everyone needed response or means, it was kind of easy, right? Because they knew all of us, thankfully, or we made sure that they somehow knew of the program. And so when there was a need be the kind of knew who we were, so we would either contact them where they would contact us directly. So for better or worse, the pandemic kind of provided the perfect opportunity to be able to, I guess, start those partnerships anew or make them stronger than before. And as I said before, like, I think because we were new, we kind of play the naive role and was like, "we really don't know!" So we kind of want to understand a little bit further that we know how to support you. So it was it was kind of easy on our side. The difficult part is...because most of these clinics are understaffed or there's like only one or two in the program, but they cover multiple counties, the difficult part was being able to have the time to fully discuss and get to know to know each other. Right. Besides just a pandemic.

Sophie Therber [00:17:20] And in addition to the partnerships with the other clinics, were there any other partnerships with other stakeholders or any other actors that your organization made because of the pandemic?

Nicandro Mandujano Acevedo [00:17:31] Yeah. So, again, I think not necessarily super new, but definitely adapted and became stronger. I think some of the stronger partners now were partners that we definitely depend on to be able to provide the response that is needed is the NC cooperative extension centers across the state or even just a centralized one; agromedicine, definitely important; and the Department of Labor, just because I'm trying to figure out housing in migrant camps, and trying to see how each of us can help. Because in fact, even though we're a farmworker program, we need to think about the whole agricultural community. I'm not sure what their relationship looked like before, and they had started to have meetings before we joined, but now I think it's like a well-oiled machine. Of course, there's new things that get thrown at us, but those are some of the few ones. CBOs [community-based organizations] that are not farmworker-specific but that we've had to come into relations to see [that] they've done previous work with the Latinx community that can include farmworkers.

Sophie Therber [00:18:53] And is there anything that your organization started to do because of the pandemic that you can see carrying over, even after the pandemic has subsided?

Nicandro Mandujano Acevedo [00:19:03] Yeah, something definitely that has started because of the pandemic has been communication newsletters that were specifically first for just COVID and to our partners. And now that that has expanded to is like anyone that is interested in farmworkers, can they participate? So I think that's something that started because of the pandemic, and we're thinking of making it go farther, right? Because there's health departments that never knew about farmworkers or like other partners that we are working with that didn't really know. And so we're kind of thinking into how that can be transformed into us being able to rely on the farmworker training, the one about farmworker health, and that takes a little bit of the pressure off the clinics and they're able to focus to do more outreach and then we're able to educate the general public or just anyone interested in the farmworker community.

Sophie Therber [00:20:05] I'm kind of struck by just how many different layers of difficulties or challenges or have affected the farmworker community throughout the pandemic. If you had to just choose what, choose one or two, what do you think are the most important challenges that are being faced?

Nicandro Mandujano Acevedo [00:20:23] I think that those answers would have changed depending on the time period. Right at the moment, what I think is probably the most challenging if the new COVID variant, especially with the current movement, because now what we're seeing a lot is farmworkers arriving from Mexico, workers moving from east to west within the state, or workers moving from Florida and Georgia to this state, and with the new variant and with a mixture of vaccination versus unvaccination, that has increased the propensity to have outbreaks. So I think that's one of the major challenges. But probably why I see it this way is because I'm trying to help with that response. Now, in general, I would say that part of the big issues are like transportation purposes, whether that means to be able to go to get health care or just really any sort of transportation issues with that. And then education. Because as the state, we're not able to provide for them or develop some of the specific materials. And the state in general has limitations in the types of communication that are released. So to meet those, those would be challenges. But of course, again, those are probably because I'm in the deep on that, if you asked other people from my team, they would probably have different answers. But to me, those are probably the key ones at the moment.

Sophie Therber [00:22:10] I want to clarify something that you said. Did you say that right now there are workers moving from eastern North Carolina to western North Carolina or just east to west throughout the whole country?

Nicandro Mandujano Acevedo [00:22:20] Sorry. Yeah, within North Carolina.

Sophie Therber [00:22:22] Oh, okay.

Nicandro Mandujano Acevedo [00:22:22] Of course, I'm assuming that there's probably going to be some movement between the states, but not to say that there won't be movement within like eastern North Carolina to eastern North Carolina, but because of how the systems work, the crops that are at the moment being harvested or [were] when the farm workers first came, they were in eastern North Carolina. But because now we're moving into fall/winter, the crops that need to be harvested or planted are in the westernmost counties. So that's why that movement is happening.

Sophie Therber [00:23:00] Okay, thank you for clarifying that. That makes sense. And that's kind of something that seems so clear, that with the seasons changing, there are different patterns of movement, but kind of overlooked at the same time. I mean, I personally had not thought of that. So that's interesting to think about.

Nicandro Mandujano Acevedo [00:23:14] Same. Yeah, something new that we also didn't know. Right, until we kept seeing like outbreaks happening. And we were like, "wait, why is this happening if they had been here before?"

Sophie Therber [00:23:26] And how would you say that the challenges to the farm workers have evolved throughout the course of the pandemic? I mean, from when you started earlier in 2020 versus now when the vaccines are available, but the Delta variant is also occurring.

Nicandro Mandujano Acevedo [00:23:40] Yeah. So, at the beginning, one of the major concerns was the testing. And being able to provide testing to the workers because that was the primary prevention measure that we had. Not to say that social distancing and, like, the three Ws weren't consistent, but it's just harder if you live in a migrant camp to be able to do that. So, like, testing was one of the priorities for us throughout the first, I guess, last year until December. Now, with the vaccine at the beginning, it was, like, how do farmworkers get the vaccine? And so the challenge that was like, okay, first meeting to educate the farm workers and be like, so this is the vaccine and this is how we went about trying to get ahead of hesitancy and of what threw a wrench into that was, I think, the whole policy would change, like more side effects would change, breakthrough cases, things like that. But I guess between January to March, that was like our concern, like how do we prepare the farm workers for when the vaccine, they're eligible for the vaccine, how to do it. And then after that, it was like, okay, now that they're eligible for the vaccine, how can we ensure that they have access to the vaccine? And so that's when the whole local team initiative kind of came into play [and] that DPH was developed with our directors. And so then it was like, OK, once we have that, how do we as a program ensure that the team has the support they need to be able to either bring the vaccines to the camps or be able to transport the workers to get the vaccine? And that kind of what we're seeing is that there is still hesitancy, right? But with arriving workers it's like, how do you...not convince, but educate and want to make the decision to get vaccinated and how and where can they do it? Because what we're seeing is now health departments or clinics have decreased their funding or don't have the funding no longer available to have enough manpower. So like, their manpower has decreased to be able to do what was [...] at the beginning when the vaccine was made available to go to camps, to host events later at night when the farm workers are out. So we're seeing more of those challenges now. So, yeah, I don't know if that that's a clear answer, or if it just complicates things.

Sophie Therber [00:26:27] No, that's definitely a clear answer. It sounds like there's been a lot of just change in the priorities. I mean, when this was first going on, the need for testing, especially for farm workers, who can't social distance or stay isolated for a long time, is really important. And now the vaccine being available is a really great thing. But it does present a lot of other difficulties in just preparing the farm workers, as you were saying, and just making sure that it's accessible to them.

Nicandro Mandujano Acevedo [00:26:52] Yeah. Housing isolation for the farm workers have has been challenging. Both of the growers are able to provide isolation in housing, right? But I think in general, every population in this, across the US has struggled with being able to have safe quarantine and isolation housing, especially with communities that typically live with more than just nuclear family, right? Yeah.

Sophie Therber [00:27:27] So aside from the changing challenges and changing priorities for meeting the needs of the farmworker communities, how has your role specifically evolved since you arrived at the farmworker health program in earlier 2020?

Nicandro Mandujano Acevedo [00:27:42] Yeah. So how it started, I was tasked mostly with communications. And at that moment it was only COVID, and it still is only COVID. But the program didn't have a communication specialist. So when I first started I was kind of tasked with everything that communication tools like developing new things, like finding things that we could use and/or newsletters, things like that. Simultaneously to when that was happening, we, I guess, I started kind of keeping track or helping our data specialists keep track of outbreak, not know what the response would entail, but definitely doing that, I guess kind of what contact tracing would have been to make sure that we had the details of outbreaks. And then one of my team members would coordinate the response and be like, "okay, this is the guidance, it's what you need to do." And then we got a communications specialist. And now I work more closely with her. And she's able to support most of the efforts. And now I've kind of digressed a little bit from communications, and she and she has been able to take the lead now with outbreak. Unfortunately, my team member was no longer with us. And so instead of just being in contact, sharing the information, I needed to coordinate outbreak response with that. And that was last year. At the beginning of this year, it was like trying to figure out the whole vaccination strategy and where I would fit in. And so with that, now, everyone from our team is kind of like the support for the next number of local county teams that focus on farmworker vaccination. And so now that's like part of my primary focus. And what that means, being able to get...records requests so that we know where farmworkers are going each month.

Sophie Therber [00:29:57] And how did those record requests work? Who has those records that you're getting them from?

Nicandro Mandujano Acevedo [00:30:03] Yeah, so we get them from the Department of Commerce. I forget the full title, but there's a special division that works on processing H-2A visas, which are all agricultural, and then there's some H-2B visas that are part of the agricultural community.

Sophie Therber [00:30:25] Can you just briefly explain what the H-2A and H-2B visas are?

Nicandro Mandujano Acevedo [00:30:30] Yeah. So H-2A visas are specific to agriculture. So anyone that comes through an H-2A to a visa, it has to be an agricultural worker. Right. And I don't know the full history of when those started, but that's what H-2A is now. With H-2B, I'm a little bit less familiar because the only ones that kind of are covered under, like, farmworker clinics are those that come into nurseries ore live in migrant camps, which are typically those in seafood processing. But H-2B visas are also temporary visas, just like H-2A. But most of them are in any service or critical infrastructure sectors. So a large number of H-2B recipients come for landscaping or construction or hotel-type work. And so there's not that many that come through through the H-2B side that are, or would be, considered farm workers, which is also a weird definition that I'm not completely sure [of].

Sophie Therber [00:31:46] OK, that makes sense. Thank you for explaining those. I want to go back to what you were saying about how you part of your job was contract the contact tracing for the farm workers. What was the process like of contact tracing for farm workers who don't, as you were saying, live just in traditional nuclear families? How did that work?

Nicandro Mandujano Acevedo [00:32:07] Yeah, so most of what that contact tracing was and is, is if they go through the main H-2A contractor of the state. Because we know that everyone that comes through them has to go, come together each week or whatever. And so one with contact tracing was getting the details of when did the worker arrive? How many people live in the camp that would have become exposed? Date of symptom onset? And things like that, like the regular data gathering. And then once that information was given to the health department or the DPH, we would see if the symptoms onset and the date of arrival kind of coincided. And if so, we would ask for a list of workers that arrived or had contact with them during their trek to their grower or camp. And from there, we would share that information. I mean, there were instances that were needed-- most of them have been before my time. So for me, while I was here, it was mostly like the data gathering side of contact tracing.

Sophie Therber [00:33:32] I want to switch gears and just ask about in general, so you've lived in Asheville for a large portion of your life, and have there been any other -- have you had any other experience with any kind of disaster, whether it's a natural disaster or any other kind of disaster in Asheville before the pandemic?

[Internet connection problems]

Nicandro Mandujano Acevedo [00:34:01] Hi, Sophie.

Sophie Therber [00:34:02] Hey!

Nicandro Mandujano Acevedo [00:34:02] I don't know if it's my connection or yours. I couldn't hear.

Sophie Therber [00:34:07] Yeah, sorry about that. I'm not sure if it would be helpful. We can turn off our videos in case. Otherwise we can try again. Either way is fine.

Nicandro Mandujano Acevedo [00:34:16] I'll turn off my camera then.

Sophie Therber [00:34:19] Okay, I can turn mine off, too, just in case it helps. My question was, just since you've lived in Asheville for a large portion of your life, have you witnessed any other disaster, whether it's a natural disaster or any other kind of disaster that has affected you or your community there before the pandemic?

Nicandro Mandujano Acevedo [00:34:38] Oh, yeah. Well, what I remember most would be like hurricanes, right? And I think that's common throughout, like most of North Carolina. I don't think Asheville has been hit with a lot of hurricanes or bad hurricanes as recently as the eastern part of the state. But what I remember would be like the hurricanes. And one, for us being school age, not being able to go to school, but like for my parents and others, it's like being [un]able to go to work because of road blocks or flooding, things like that, or like some of -- most of -- my family works on the fields, whether that's like construction or like yard work or are still farm workers. That would affect their income. Our family or my parents were mostly affected by like transportation issues and roadblocks to because of hurricane season.

Sophie Therber [00:35:44] And it sounds like the challenges of the hurricane season, especially since you were in Asheville instead of an eastern North Carolina, have been pretty different from the challenges of the pandemic. But are there any ways that they that you've experienced any similarities between those?

Nicandro Mandujano Acevedo [00:36:00] Yeah, to be honest, is probably communications. Right. And part of it is because I think most counties don't really have a strong, like Spanish language communication or like emergency communication system. And so part of it has been that like even with it now and before, now we're struggling and relying on CBOs [community-based organizations] or other partners to be able to provide like Spanish, or any language, really, support communications in terms of like this is what you need to do, this is what you need to know. That has improved a little, but with hurricanes, it was also the same. Knowing, well, it's supposed to be hit here or there like these are the resources that you have in case you experience XYZ. So I think that's a challenge that was before. And it's still happening with this pandemic.

Sophie Therber [00:37:06] And how, how do you feel that the farmworker health program, I mean, of course, a big part of that program is having resources available in Spanish, but how specifically do you feel like they've addressed that issue of the communication?

Nicandro Mandujano Acevedo [00:37:19] Yeah, so most of it, most of how that has been solved is through the newsletter and us making sure that the people that interact with the farmworkers have the latest information. Right. So that's one of the ways that that has been solved. Now, part of it tied to that is now we're able -- we have a little bit more leverage in asking the state and be like, "hey, this type of communication is needed. Can you either help us develop or can you develop it and make sure that it's there now?" I think it's a little bit easier with everyone being connected to the Internet because there's a lot of groups that are trying to work in ensuring that the Latinx community or any other HMP [historically marginalized population] community has access to this information in the best way for them. And so, like for us, it's been like looking into what AMEXCAN is doing in Latin-19 in the Research Triangle or like in the Western counties, kind of what coalitions are doing. And so it's been that combination of us looking into what CBOs are doing and how we can support or tag-team with them, but also making sure that the state is aware of the challenges that we're hearing and develops things that would be appropriate.

Sophie Therber [00:38:43] And when you are -- you and your organization are -- bringing concerns like that to the state, so concerns about communication or other concerns and addressing farmworker health, do you feel that the state has been receptive to those kinds of concerns?

Nicandro Mandujano Acevedo [00:38:56] Yeah, I think for the most part, yes. Right. Or when where they can, they are. It's, I guess I don't really fully yet understand how the whole state processes work, because I'm a little bit...detached. Not detached, but I'm, I guess, on the forefront instead of in the fully administrative roles. So from what we hear, they've been really receptive to listening and trying to see what can come up or solutions that can be made. But the difficulty part is then making those solutions available or developing those solutions. But in terms of sharing and looking into the concerns, I think they've been receptive.

Sophie Therber [00:39:54] And you mentioned partnerships with coalitions such as AMEXCAN and other organizations. What do you feel that you and your organization have learned from those partnerships?

Nicandro Mandujano Acevedo [00:40:05] Yeah, so part of it and, well, I guess most of what we've learned from them, it's kind of like, I guess, the intersection between farmworker's and regular Latinx community, so mostly those seasonal families. And so that's one thing. But also part of it is like...they're letting us know, kind of, the challenges that the community in general is facing with the pandemic that kind of...not complements, but is congruent to what we're seeing from the outreach workers. So that makes it a little bit easier for us to be able to be like, "look, this challenge just not only faced by farmworkers, but the Latinx community in general or any other HMP in general." And so that makes it for us to be able to have a collided front in making sure that we can push the envelope as needed. So that, I would say, being able to get a greater picture of just not farmworkers or migrant farm workers, but seasonal families as well has been the greatest strength with those.

Sophie Therber [00:41:16] That's interesting, what you're saying about having partnerships with these organizations, just being able to shed more light on the similarities or differences between the ways that farm workers are dealing with this pandemic versus the way that other members of the Latinx community, or just migrant communities in general, are dealing with a pandemic. So that's really interesting to be able to have that kind of partnership and learn that.

Nicandro Mandujano Acevedo [00:41:38] Yeah. Yeah, it's been really good for us. Unfortunately, sometimes it feels very one sided because we're able to learn and try to make sure that that doesn't happen or mitigate any of those needs. But that may or may not happen.

Sophie Therber [00:41:57] Right. If you could -- you and your organization, if you have any supports available to you or resources, what would that look like? What supports or resources would you want to have to be able to address farmworker health?

Nicandro Mandujano Acevedo [00:42:13] Oh, God, yeah. Well, let me let me think about that.

Sophie Therber [00:42:22] Yeah, take your time.

Nicandro Mandujano Acevedo [00:42:29] I mean, I guess...Part of it is just being able to hire more people so that the outreach clinics have enough capacity to to not get burnt out, to have the support needed, to be able to do outreach to all the camps in all of their counties. So I think we're getting more funding for staffing and promoting more staffing would be greatly beneficial. Also [these] positions, the outreach clinics have a lot of turnover. Part of it is because there's really not much farther that they can go up the ladder. So it's not like it has a lot of professional development aspect to it. And then the, like...I mean, to be honest, I think it's a service, they're service provider. And unfortunately, we all know that they should be getting paid more. So would I want that? Yes! I don't know how that whole system works, but to me, it's like something that our program could in theory try to to see. Unfortunately, we don't really control how much they're paid. So that that's the other challenge.

Sophie Therber [00:43:56] And what is your relationship? Between your position, what you're doing, and the outreach workers; do you interact with them directly?

Nicandro Mandujano Acevedo [00:44:05] Yeah, we do. Or I do. Sorry, I was speaking as "we" because, yeah, we're just a team. But yes, we interact directly with the outreach workers. Now, again, it's been mostly like through calls, or like video chats, because we, in theory, can't support on the field.

[Internet is buffering]

Sophie Therber [00:44:38] Are you there? I think you might have cut out for a second.

Nicandro Mandujano Acevedo [00:44:41] Oh, I am here.

Sophie Therber [00:44:42] Okay, cool.

Nicandro Mandujano Acevedo [00:44:42] Yeah.

Sophie Therber [00:44:44] I think that I caught most of your answer anyway.

Nicandro Mandujano Acevedo [00:44:46] Oh, okay

Sophie Therber [00:44:46] So it sounds like you do you have a direct relationship with the outreach workers, even though just because of the challenges of the pandemic, that often means phone calls and Zoom and things like that?

Nicandro Mandujano Acevedo [00:44:58] Yep.

Sophie Therber [00:44:58] So, it sounds like, from your response, that the main supports that you and your organization would want to have more of are the outreach workers. And what exactly are the outreach workers doing? So, what are their jobs with the farmworker health program?

Nicandro Mandujano Acevedo [00:45:15] Yeah, so this is this is part of the challenge that I was mentioning right before. So the the program funds, or provides funds to FQHCs [federally qualified health centers], NGOs [nongovernmental organizations], local health departments to have a farmworker unit. And so they're the ultimate -- the individual organization is ultimately the ones who decides who to hire, when to hire, things like that. So what the outreach worker does or is supposed to be doing is provide enabling services. And so, enabling services are a wide variety of services. And basically what they need to do is ensure that the farm workers can have access to health care. A lot of what that means is like interpretation, translation services, transporting to clinics, making appointments, things like that. And so what their responsibility then is, to all this, is just to communicate with us if they need any support, but also any of the data to make sure that they're providing those enabling services. So that's kind of the extent of what the outreach responsibility was for us. Or with, to us, as far as I understand.

Sophie Therber [00:46:41] And that's certainly so important to your organization. And I think that the phrasing it as "enabling services" is kind of helpful for me to conceptualize what exactly their role is with you. So, that makes sense. Well, is there anything else that you would like to add before I stop recording?

Nicandro Mandujano Acevedo [00:47:01] Ah, no. Well, it's tricky, right? I think for the most part, we've played our cards, or with the cards that we're dealt with; unfortunately, I don't think they've been enough, right? And so part of the challenge that our program is looking into is how can we strategically think of what has worked and not worked and to ensure that we have the support system now with the pandemic, but how can we make sure that this continues further outside of this emergency, that we can be adapted if there's ever another emergency or just in general? We like to make sure that we provide this level of support to workers. So no, besides that, I don't think I have much to add. The only thing, I guess, to make sure that I have voice is most of what we're doing or that we work as a team, as the COVID response team is because of the outreach workers, because they're the ones who do the work. And we're just kind of like the messenger between them and any state entity or any resources that are available.

Sophie Therber [00:48:16] And how do you see the partnerships that you've built throughout the pandemic continuing even after the pandemic has hopefully subsided?

Nicandro Mandujano Acevedo [00:48:25] Yeah, I mean, part of what we're seeing is that a lot of the new partnerships are like, "oh, we never...we were aware of the farmworker community, but we never really had the chance to interact with them the most." And so what we're seeing is that they're like, "oh, like, how can we support further, besides just COVID?" And so that, that gives me hope that we can serve better. Right. And it also has shed light into more systematic, I guess, concerns or things that need to change. And so that's been good, that other entities are also saying that and thinking about how those things can change. So no concrete answers, I guess, unfortunately. But at least in terms of thinking and rationalizing that, that's been helpful in looking at how people are positive and to how these relationships can continue across or after the epidemic.

Sophie Therber [00:49:28] Great. Well, thank you so much for your time. I'm going to go ahead and stop the recording in just a moment.

Nicandro Mandujano Acevedo [00:49:32] Okay.