Lilibeth Andrés

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Veronica Cifuentes: Ok, so I'm here with Lilibeth Andrés. We are— is that how you pronounce your name?

Lilibeth Andrés: Yes.

VC: Ok. So we are meeting over Zoom. I'm in my dorm room. Lilibeth, I believe you are at home right now, and it is April 1st at 10:23 AM. Ok. So to begin, I wanted to ask a little bit more about your family. You mentioned that your grandparents were farm workers. Could you talk a little bit more about them?

LA: Yes. So, I remember like as a kid, I remember my mom always telling me stories about how my grandpa, he would kind of go back and forth between Texas, and California, and go back home and he would like work in the fields. And like, I remember as a kid, it didn't really click with me how much time and effort it really took for him to go back and forth between like the United States and go back home to Mexico so he could take care of his kids. I'm not really sure if he was like— if there was an H1A program then or if it was just kind of, like, just on his account. But, yeah, so my grandpa, he worked in the fields for, I wanna say about 20 years. It was mainly in California, the Texas area. Unfortunately, now that I know more about how farm workers, like, how they work, how they go back and forth— he passed away like, two years ago. So, I was never able to fully get into a conversation with him of how did he like it, what did he go through as a farm worker. But I do remember the stories of my mom just being like— yeah, it was her and her four siblings and like her grand— her dad would always make sure he would go back to the States because with farm working, that's where the money was. The fast money that they could get. I wanna say, she was saying that they would get paid cash back then and this would probably be in the maybe late seventies, eighties, I wanna say. So that was a pretty— it was a while ago. But, yeah, it was always really cool to hear all the stories. And I was still able to hear some of these stories; how you would go back and forth and he would always say how different life was when she was here than when he was always back home. But his goal was always to take care of his family and he was able to do that being a farm worker.
And my grandma, she would take care of their land back home in Mexico. So, she would make sure the crops— if it wasn't her, it was like other family helping her, but it wasn't like the farm work that she would come over here. But it was my grandma. And then kind of just to go a little bit from that, my dad, he also, he was a farm worker for probably over 20 years as well. And I'm still able to talk to him a little bit more. But the same thing, when I was a kid he would always talk about, ‘yeah, I would drive the farm workers in the school buses’ and this, this, and that. And when I was a kid, I didn't really understand also. But whenever I finally started working as a community health worker, I was like, oh my goodness. I see what my dad was talking about. But yeah, he worked in the fields for I wanna say over 20 years. He started in Florida with the oranges and then he would kind of go upstream all the way up until Michigan. So, he was always kind of back and forth. And then eventually he kind of settled in North Carolina, especially in Wilmington, very eastern North Carolina area. He worked in the tobacco fields over there for quite some time and then somehow he ended up going to Sanford, which there's a lot of tobacco fields, and that's where we currently live now. So I think, it's crazy to think how he probably could have settled anywhere among those, but he ended up in North Carolina and we're still here now. So it's really cool.

VC: That's an amazing story of your entire family. Thanks for telling me more about that. Do you know why your father chose to settle down in North Carolina?

LA: I honestly, I don't know. I've asked him before. I was like, so out of all the places that you were in Florida, you were up north in Michigan— I wanna say it's because of the climate. It's very, I wanna say you kind of get the best of both. You get the summer, you get the winter, but it's not as extreme as the summer in Florida and it's not as extreme as the winter in Michigan. So I wanna say it's because of the climate. Like it's much more— I don't know, I feel like it's not as brutal as it would be up north or very, very south. So I wanna say that's why, but I definitely will probably ask him again. So like, hey, ‘why, why did you choose North Carolina?’

VC: Got it. So what state of Mexico, where was your family from? And did your grandparents notice that a lot of the people that they were living with would go to the United States with them or was there not that much migration from that state?

LA: Yeah, so they were actually from the State of Guerrero and Estado de Mexico. Like it was there, right? So the city— so my parents, my grandparents from my mom's side and my dad, they're all from the same city or town in Mexico and that town is technically in el Estado de Mexico. But like it's right at the border. So it's Guerrero also, and it's heavily influenced by Guerrero. So my dad, he always told me he was always the only one from Guerrero, from el Estado de Mexico. And it was always the workers that he worked with, they were from San Luis Potosi, Durango, very northern states and he rarely saw anybody from Guerrero. So I always thought that was interesting and even now, whenever I work with farm workers, I rarely see anybody from Guerrero. So it's always really cool—sorry, my dog (speaker laughs because her dog interrupts her)—it's always really cool to see. You know, it's mainly the northern states, even to my dad, he's always, like, ‘I always worked with all— all the workers were always from northern states.’ I can't really speak for my grandpa, but definitely my dad, he always said that Guerrero was never really seen but northern states were.

VC: Got it, ok. Yeah, that is super interesting. I'm wondering about your— you said you were raised in North Carolina? Could you talk a little bit about the city that you're from and how you grew up?

LA: Yeah. So, whenever I was born, my dad had just gotten out of the fields, so I never saw him come home from the fields. Whenever I was like a baby, I think he had just turned into his current job, which he has been now at, for almost 25 years. He's been at that job since I was born. So I never saw him come home from like the fields. I was born in Chapel Hill, but I was raised in Sanford and I still currently live in Sanford. I've been here my whole life and I probably don't plan on leaving anytime soon. It's just, I feel like we all grew up really close knit to our family. I just got a place with my boyfriend and—

VC: Congratulations!

LA: —( )minutes away from his house and I just think family is super, super important to us. My dad and my mom, they made their lives here so it's always really nice to be close to family.

VC: Yeah, absolutely. Congratulations on that. Thanks for talking more about your upbringing. I'm wondering if you could speak about your decision to work with farm workers. Maybe how you ( ) liked that or how did you begin to notice that this was a field that you wanted to go into?

LA: Yeah. So, I went to college at UNC Greensboro and I did my degree in public health with a concentration in community health education. So I kind of always knew I was gonna work somehow within my community, but I didn't know necessarily how. Whenever I was doing my degree, I did an internship in housing and underserved communities and that really was— I loved doing it but it never— I didn't have— I didn't have that personal spark, so to say. So I, I did that for a little bit and then after I graduated, I was just, you know, looking for jobs. And funny enough, there's a clinic that whenever— I had gone to that clinic since I was a baby until I was 18 years old. I was just like, oh, I wanted to see you if they were hiring. So I was looking at their jobs and their other jobs and then I noticed that they had a farmworker outreach job posted. So I was like, ‘oh, like that would be super, super interesting’, I read the description but I was still kind of confused on what the job would be like. So, I applied and then about— it took a month with the whole process of applying, interviewing and getting the job. But then I finally got the job and I was super, super excited. I remember my first week, I absolutely fell in love with it. It was right during peak season. So, I started working. It was July or August and we were actively going to the camps every single day. And I was like, oh my goodness, like this is how my dad lives. This is what he did. This is what my grandpa did. It was all, it was a very—it was through the clinic that I went to as a child. So it was a very full circle moment. And seeing the farm workers, especially in North Carolina area, I never really put it into perspective how many farm workers there are, just in this small region of North Carolina. And yeah, so it was always super interesting and, I remember we would always be in Sanford and I'm like, what, they've been here this whole time. And the more I got to talking to them, they're like, yeah, this is my 15th year coming back here. It's just so mind blowing to know. Like, I don't know. I just feel like the community doesn't realize how many farmworkers we have and they're so important to our community. And yeah, it was just such a huge circle moment. I worked there for about a year, almost two years. Until this year, I started working with the Farmworker Health Program. And this, this was also— I, with my position, my previous position, I was super happy. I loved doing what I did and then I saw this opportunity to do the engagement coordinator position for a digital equity project. And I thought it would be— I was like, you know, I'm gonna apply and, and it's still working with farm workers. So I was like, you know, if I get it cool, and if I don't, I still love my job. So it was a very like, OK, I'm gonna apply, but I'm not too like, you know, I wouldn't be too upset if I didn't get it. And so I applied because I was like, I will still be working with farm workers. And thankfully, like I got it and I still love doing what I do. I still work with farm workers. I'm still able to see farm workers go to their camps and truly, I feel like now I'm working like at a state level. So not only can I help them, you know, going to the camp, but, I feel like there could be a really big possibility of changing policies and helping them at a state level rather than just—you know. I think the the community work is 100% necessary, it’s essential. But I feel like now, we're really digging into what can we do to not only change the lives of the current farmworkers, but change the lives of farmworkers who are yet to come? So I, I don't see myself leaving the farmworker field anytime soon. But yeah, I just really think this job— sometimes I feel like, oh, I'm helping, like someone's dad, I'm helping someone's grandpa. And so I'm always thinking I was having kind of in the back of my mind. And so I, I just never see myself leaving field.

VC: That's so amazing to hear, and it's super exciting about your work as engagement coordinator, and I definitely wanna go back and ask you some questions about that. But I'm really curious if you remember hearing your grandparents or your father talk about community health workers when they were working. Or do you think that there's now a lot more now, going into and helping farm workers, if there's a lot more, funding for them or they're just a higher volume? Do you see— were there any shifts in that when you talked to your family?

LA: Yes! Whenever I would talk to my dad about it, he was like, yeah, we didn't have none of that (speaker laughs). So I definitely think that these programs are new. So there's definitely more funding for this, which I think is amazing because imagine the impact the community health workers could have had on the farm workers back then. Because you have to think about, they didn't have any cell phones, they had to go use a pay phone. And so it's like, how much of an impact did a community health worker could've have? Like, they would have been such a great communication tool. My dad, he— I was randomly telling him about how we were doing a whole like education thing on green tobacco sickness. And I was just kind of telling him about it. I was like, oh, like, because he used to work in tobacco fields. And I was like, did you ever know anybody that got it? He was like, well, the more you tell me about it, I think I had it for a week. He was like, I couldn't eat for a whole week. I just had crackers and I would have to— I couldn't keep it down for like a whole week. And I was like, oh, my goodness, did you ever go to the doctor? And he was like, well, no, I didn't really know the area. I didn't know the language. And I was like, that is insane. I think about it now, like a community health worker is such, it's such a key tool because the farmworkers go to them if they're like, if they just have a question, if they need to go to a clinic. Like, and I think about back then, like, they didn't have cell phones, they didn't have internet, they didn't have access to Google. So it's like, how impacting would it have been to have community health workers? Now I think it's amazing that I think almost every county in North Carolina has community health workers. At least, even if they can't, like, take them to the clinic, they at least have a phone number to be like, hey, I'm feeling like this, this or that, or I need to go to, um, urgent care. Where can I go? And so I think that's great because, like, not only do they speak their language but they speak both languages so they can easily, just, like, over the phone, do a quick translation and, they're settled. So I wish there was community health workers back then. But I don't— from what I've heard from my grandparents and my parents, there was not that service.

VC: Got it. Yeah, that's interesting to hear, and yeah, absolutely, you're right that having that trusted person is so, so essential to reduce all those barriers to care. So I'm happy that that is the growing trend and that now more and more community health workers are being valued and going to out and helping these people. I'm wondering about the digital equity that you touched on? Because I attended a conference where someone from your workplace came to speak about the project and about how there was very little digital— internet infrastructure. Where even if you have a phone, it can be hard to connect and access services on it. So I'm wondering if you could talk a little bit about that project and the future directions that you see in your work.

LA: Yeah. So, I just started with this job um about two months ago now, so maybe a month and a half ago. So I'm still kind of learning the ropes about it, but my overall role with this digital equity initiative. I'm the one that I'm going out to the fields to do focus groups. I'm gonna do listening sessions, we've done listening sessions with community health workers just to kind of see where are they at with digital health access. And yeah, where are they at with digital health access? Give me one second— (speaker moves to another room, recording paused). Sorry about that. Just a little bit more on the project, essentially my role is to, you know, be with the community as the engagement coordinator. So, just this past maybe two weeks ago, we did two listening sessions with community health workers. So, just all these questions about digital health access and just kind of getting where their thoughts are at. And these farmworker listening sessions are gonna be the same thing. We wanna have their— you know, this work is being done for them. They're the people at the forefront. So what better population to get information from than the farm workers themselves. So, this whole month of April and May, we're gonna be doing focus groups and listening sessions, getting their thoughts and opinions on digital health access. And I'm super excited. I really— I think having them in the front of this project is gonna help us tremendously. We're gonna be able to know exactly what they think and exactly where their thoughts are going. This project, it's, I wanna, I can't remember the exact year, but it's a lot of years, a long year project. So I'm very excited. And hopefully, as time goes by, I'll learn a little bit more and more.

VC: That's so awesome. Yeah, exactly what you said the community engagement part is so, so important. I'm wondering, so you've already had a couple listening sessions or are you just in the planning process?

LA: Yeah. So the, the first two were like um with the community health workers. No, we did too. Those were about two weeks ago, but then the farm worker listening sessions, they actually start next week. And so right now, I'm just waiting on just the final details, addresses, and everything. All of our April is like, pretty much booked and I'm very excited about that and then we're gonna start doing more in May. And we're doing them all across North Carolina. So we know different locations, they have different barriers. So in the mountains, they may have, they're in the mountains, they may not have a good signal. Whereas like maybe eastern North Carolina, they also, like if they're really, really eastern, they may not have signal either. So we wanted to make sure to have like different listening session in different parts of North Carolina. So it'll be a lot of driving but it's gonna be so worth it. Yeah, I'm very excited to, to know that we'll have different regions because you know what if this region like they have really, they're in the mountains but they have really good signal, like what's going on there that they have really good signal that maybe down the road that they don't have. So I think having these conversations is gonna be really important to kind of see what direction the project goes into. Yeah, so it's super exciting.

VC: Yeah, that's very interesting. Yeah, thinking about how location, geography affects everything because not one experience isn't for everyone. Everyone has different things. I'm wondering what are some of the things that you've learned from the community health workers from these listening sessions?

LA: Yeah. So I can't think too much but overall, we've gotten really great feedback. The community health workers, they realize that this project is super, super, super important because, you know, even though all the farmworkers have internet, there's still problems. Even if some, say all the camps had internet, there's still so many barriers; they're in a whole other country, you know, the healthcare system is completely different. In Mexico, you can go to a pharmacy and easily find what you're looking for. But here, you know, you have to go to the doctor, get it prescribed go to the pharmacy, wait for your prescription refills. So it's like with the community health workers, we can really see that they appreciate these listening sessions also. Because they know the problems don't start— stop once you provide internet, there's still so much more to do. And I think we've gotten really, really great feedback because you know, we're, we're trying to get to those root problems and we're trying to see what are our options. We're not gonna be able to solve all the problems, but if we can at least tackle one, I think that will make the biggest difference.

VC: Yeah, that's so amazing to hear. I'm, I'm super happy that you found work that you really enjoy and that you're seeing such a difference in these people's lives. I'm wondering— you talked at the beginning of the interview about like how you're excited to work at a state level because maybe you could influence policy a little bit more. Could you talk a little bit about what is going on in that space? What is sort of the goal of people working in policy to improve farmworkers health?

LA: Yeah. So I think definitely coming from like local to state level, it's been a huge difference. I feel like at the local level, you know, we're going one one-on-one with the farm workers but there's an extent. So it's like, ok, we can help them with getting them toiletries, we can help them to, like transportation. But then it's also like sometimes, there would be these barriers and not only like within our local organization, but it's like, oh there's also restrictions at the state level and there was sometimes— we felt like our hands were tied. And now that I'm in a position where I'm at the state level, I can see all the different tiers, so to say, I can see them all working, how they're working together and what's being done to try to change certain policies. Especially with this digital equity project, what are our end goals, what if it is trying to influence a policy change? I know um there's many laws regarding farmworker, health and farm workers in general. So it's like, how did they— there's some recent laws that— I can't remember the last one I remembered— but it was like late, what about 2010? They recently added a new policy. What can we do in terms of technology with those policies? And I see my coworkers and they're— sometimes we all do completely different things and I think it's really great to see everyone working on some kind of project, some kind of document to, to help the farmworkers. So it's definitely been very, very different coming from like global to state. But I think long term it's all working for the better of the farm workers.

VC: That's amazing to hear. I see here we have 10 minutes left in the interview because I have the free version of Zoom (speaker and interviewee laugh). So I'm wondering, before we run out of time, if there's something else that you wanted to touch on, or talk a little bit more about. Everything that you said right now has been so, so interesting to me and, and super informative. It's great to hear about all the work that you guys are doing and yeah, super, super inspiring to hear. So yeah, I'm just wondering, I wanted to give it to you to maybe elaborate on something else, or if you wanted to head in a different direction within the 10 minutes that we have. It's all up to you.

LA: I really like talking about my job and all the work you're speaking on. There's not really much else I can think of right now. I don't know if you have any more questions, but from my end, I think we pretty much just touched on a good amount (laughs). So I don't know if there's any that you have for me.

VC: Yeah. I'm wondering, maybe could you talk about one experience that stood out to you in your work as a community health worker?

LA: I think the biggest one that stood out to me, it was probably late last year, maybe September, October. I was working at, as a farmer outreach. And I just remember, this was on—I remember it was so clearly because it was` a Thursday. We had our work phones and I just remember I had a farmworker— he called me. He was like, hey, I woke up this morning, I felt really weak, like I could barely walk. And I should probably go get checked out. And I was like, yeah, for sure. And it was like 7:30. I was on my way to work when he called me. So I, I went ahead and answered just because I was already on the way to work. And so I remember getting to work, I found him an appointment and I was liked ok, I think his appointment was like in the next hour. And thankfully, where he worked and where the clinic was, it was super, super close. And so I remember I went to go pick him up, took him to the clinic and he was checked in. He got into the clinic and I was just kind of waiting for him because thankfully at the clinic that I was working at all the doctors and most of the nurses, almost all of the receptionists, if not every one of them, they all spoke Spanish. So it was a very welcoming space for farmworkers. And so we never really had to worry about them, with the language barrier. So they would always kind of go in by themselves because they always felt comfortable with the doctors, which they really appreciated. I remember just waiting for them, and I was just working in the office and then I get an IM from one of the doctors and she was like, hey, like you really— like he needs to go to the hospital. And I was like, what happened? I was like, is he ok? Like do we need an ambulance? And she was like, I mean, you should be able to drive him but his diabetes, his glucose level, his A1C was super, super high. It was not coming down, they had given him insulin and it was not coming down. So they were super worried. So I ended up having to take him to the local hospital, which again, thankfully was only 20 minutes away. So we were super, super close. But there, I could really see like the difference between a community health center and a hospital. So I know hospitals, some of them are legally obligated to have translators. And so that hospital, they did have translators, but it was like a two or three hour wait for them. And I was like, ok, no, we were not doing that. I was like, I'll translate for you. You can just go ahead and go get checked you in and then we can go to the waiting room. Thankfully, all that was really fast and we ended up going in and I was with him the whole time, translating, but it was really— I was so scared for him because he was like, yeah, I couldn't barely stand up and they took his glucose level again and I can't even remember if it was glucose level. I don't know if I'm saying that correctly (laughs), but I just remember it being super, super high, they had to keep giving him insulin until it was finally coming down. And we were there like I was, it was we left the first clinic where we were at 9. And then I wanna say I stayed until about 5 PM and that's kind of whenever I had to leave. But thankfully at that same time, the translator became available and his coworkers, they all went to go visit him. So I felt bad leaving, but I also knew I had to go and he wasn't alone. So yeah, they ended up having to admit him overnight. And he was diagnosed with diabetes and he had no idea. So it was a real eye-opening experience for him. And thankfully after that, he kept going to his follow-up visit at the clinic that I worked at. And you could really see like how his perspective changed, like he was taking care of himself. And going up to his follow-up appointments. But, it always stood out to me because I feel like diabetes is such a prominent thing, not only in the farmworker population but in the Hispanic community. If you don't— I'm pretty sure everyone in the family knows at least one person in their family with diabetes and that's terrible. So that was just a real, it was a crazy experience, but I was also very thankful that I was able to be there for him. And that, you know, imagine going back to the whole conversation, imagine there wasn't any community health workers. What would he have done? And would he have had to wait um those two or three hours for translator himself. So yeah, it was an experience for sure.

VC: Well, thank you so much for sharing that. Yeah, like you said, it definitely demonstrates how important community health workers are to increase access to care. But also, once you access the care, there are so many inequities that persist within the hospital. So it was interesting that you noted the difference between safety net and ( ) a hospital. I'm glad, it sounded like he got the care that he needed and that followed up, and that he had a better quality of life resulting from all of your efforts and the work of everyone. So, yeah, thanks again, so much for sharing that story and for all the stories that you shared. I had a great time talking to you and getting to know you. And I wonder if you have any questions for me or anything else you might wanna add— I'm seeing right here, we have three minutes left, (laughter) so really cutting it close.

LA: No, I think you answered all the questions I had and hopefully I answered all the questions you had. If there's like anything else that you need from me, if you run out of time, just feel free to email me, I'm pretty flexible this week if there's anything else that you need from me. But other than that, I think I'm good.

VC: Got it. Absolutely, I'm super excited to follow the Farmworkers Health Program and see all this that stuff that you do with the Digital Equity Initiative. So super excited that you talked about that, it's amazing work that you're doing.

[00:32:38] END OF INTERVIEW (PART 1)

Transcriber: Veronica Cifuentes, 04/01/2024


START OF PART 2

Interviewee: Lilibeth Andrés
Interviewer: Veronica Cifuentes
Interview Date: 2024 April 24
Location: Zoom
Length: [01:07:27]

VC: I'm Veronica, I'm here with Lilibeth. It is April 24th, 2:06 p.m. We're meeting over Zoom and this is my second time— or this is part two of our interview. So, Lilibeth, thank you so much for joining me. I think, can we start with the question of how you build trust as a Community Health Worker? I know that your family worked in the fields. But how did you initially start building those relationships with the people that you were working with? And I'm wondering, maybe, if you encountered a lot of distrust in the medical system in general, or just misinformation, and how you worked to overcome that and help build long-standing relationships with the people that you work with?

LA: Yeah. So, I feel like I could say so much about this question. Whenever I first started with as a Community Health Worker, I remember being like, I wonder how they're gonna trust me? They've never met me before. But what we really heavily relied on is— the program I was with, they had already been going to the camps for about four or five years at that point. So it's relatively new, but they've had these past relationships. So, they knew who the clinic was, even though they maybe did not know who the Community Health Worker was. They're like, oh, ‘ustedes vienen con la clinica.’ So, they were kind of like, ‘oh, ok. I trust that clinic. So I trust you.’ And the coworkers I was working with, they've been to those camps for 2-3 years at that point. So, as soon as they saw their face, they're like, ‘oh, I know you.’ They had that trust. And it really helped me connect with the farm workers because they trusted the clinic, they trusted my coworkers. Me going in as a new person, they're like, ‘ok, you're with them’ and that trust kind of built on over time. And then it also ended up happening to me where the farm workers would leave for the season, I would come back to their camps the next year and I'm like, oh hey, how are you? And so they— I had that trust ongoing from when I would take them to their appointments and I would drop off medications. And so that was a really big thing. I already had someone's trust prior and I just kind of built on that. And also, whenever there was some camps that none— nobody had visited before, so they were completely new. And I think one of the biggest things is, we always remembered, you know, we're going into their space and this is where they— yes, they're just here for work. But this is also where they're living, they're sleeping, they have dinner. And so we have to be super, super respectful. And that was one of the biggest things. It's like, we always introduce ourselves, in a very quick 2-3 minute thing, especially if they had never met us before. And we were like, ‘we are here to do outreach with you guys, give you a little bit of health education and here's more information on the clinic that we work. If you need any services, here's the services.’ And we always made it to where it's like if you don't want us here, we all— you don't have to participate. This is completely up to them. We never wanted them to feel like they were forced to be part of a program or forced to do a health assessment. None of that. And I think that really helped with the overall— they felt comfortable with us, they felt trusting with us. And I think whenever we have those soft introductions, you know, we're like, ‘hey, you know, even if you don't want to see today, here's our phone numbers. If you need anything, you can still call us.’ And that really, really— you could see how they, maybe a month or two down the line, they’ll be like, ‘oh, you know, I'm interested in getting a physical, you came here.’ And whenever they saw us actually pull through— say, for example, they called me two months later, like, ‘hey, you came to my camp a month ago, I'm really interested.’ If I went, got them to their appointments and they saw— they got their appointment, they got their medication. That really helped build that relationship one-on-one with the farm worker as well as, you know, everyone else in that camp who— they may have not you know, called us directly. But they're like, ‘oh, he went to the clinic and he got taken care of.’ And so that kind of gave us credibility, and it just really helped overall. There's just so many different components to that, but the biggest thing is just remembering we're in their space and we have to respect their privacy, their wants and their needs because we're here for them more than anything.

VC: Thank you for sharing that. I'm wondering if, in your experience, you encountered farmworkers who were a little bit hesitant to seek medical services. Maybe because they were misinformed about their eligibility for it, or they thought if they reported some sort of health problem in their camp that they wouldn't be able to work there anymore. I’m wondering if you saw any of that, and if you did, how you helped support and advocate for these people?

LA: Yeah. And unfortunately, it was a really big thing that we saw. We would go do health education and we would do case management. So, we were always able to at least take their blood pressures and we were always doing that one-on-one, and there they were able to talk to us. And I think, especially whenever the COVID vaccine was rolling out, that's when you really saw a lot of distrust in the medical system. They would have— they would come from Mexico, and they'd be like, ‘oh no, well, in Mexico they told us that you went to the doctor, they would give you a shot and they would kill you.’ And so it was a bunch of, you know, a whole bunch of misinformation where it would be the most randomest things that you would— you were like, what, who told you that? And they're like, ‘oh yeah, the people back home, they would tell us that. So, we're not going to go to the clinic because we don't want to die.’ So, the way that we really approached it—we didn't want to be disrespectful. We didn't want to be like, that's not true at all. We were like, we hear you but, here's this information. If you want the vaccine, or whatever service, you know, call us, we can give you more information. You can talk to a doctor, a receptionist at the clinic and if you have more questions— and we always respected that. You know, even though we wanted them to go to the clinic, if they did not want to, we always respected their decision because, you know, they have full autonomy over their appointments and all of their wants and needs. But yeah, and so not only with the COVID vaccine but sometimes we would do health education on, for example, diabetes, which was a really, really huge one. A lot of the farm workers—. Diabetes and hypertension, especially hypertension. A lot of the farm workers, they always had like that thought where, you know, ‘I'm fine right now. So there's nothing wrong with me.’ And so we always— we were super, super hard on health education because hypertension is the silent killer. And we really, really emphasized that to the farm workers. But still, we were— we got those comments like, you know, ‘I feel fine. I don't have fever, I don't have a cough. I'm not sick, I'm ok.’ And so that's where our health education— we really, really were like, here's this flyer, here's this, here's this video, just make sure you have that in mind. And we didn't necessarily push, like, ‘go get this test and go get this done.’ We were always like, ‘you know, it doesn't hurt to get a physical once a year. And even if you don't get it with us when you go home, maybe just go get a quick physical.’ And it was something where we didn't want to push it on to them and make them feel uncomfortable, but we really wanted it to be the message from our health education to be pushed and at least go get your physical, or even if it's not here when you go back home, get a physical, get your labs done just to make sure that you're ok. Kind of reemphasizing that, ‘Yes, you’re ok. So let's just get the numbers, the results to reinforce that you're ok. And they're like, ‘oh, ok. Yeah.’ And you could kind of see some of them and be like, ‘oh, well, you know, physical when I’m hurt. And ok, whenever I'm off one day I'll call you and it just went like that.

VC: Yeah, that preventative care is so important. Yeah, definitely, addressing the health concerns before they become a bigger problem is a really important thing to do. I know we talked in our previous conversation about how it can be difficult for them to take a day off from work to go to the clinic because that means the loss of income. So catching all of these like chronic diseases before they begin, it's—.

LA: Yeah. It was one of the biggest— I guess just kind of a side note, the biggest days that they would call us would be when it was thunder storming, when it was raining. Because, you know, nine times out of ten they didn't work unless they were in a nursery or something with the roof. But if they were out on the fields and it was raining, that's when we would get the most phone calls because they wanted to take a— like it raining. So, we're not working. So, if they wanted an appointment, that's when a lot of them would take advantage of it. So we always, every time we saw the weather and it was thunderstorms or heavy rainfall we’re like oh, it's gonna be a busy day today. And we were always right, we always got those phone calls, whether it was medical or dental. You could see them— you could see the need from those calls, that they wanted to go but they didn't want to miss work. So, they would take advantage of when they weren't working.

VC: Wow. Yeah, that's so interesting. I didn't know that. Yeah, that makes a lot of sense. In that same line, I'm wondering what your experience was with workplace hazards and the working and living conditions. And if they— I mean, if you noticed that the farm workers were are really having a lot of health problems because of the way— the conditions that they were working in, and if that you were met with some resistance with the employers. Maybe they didn't provide enough protection for the workers. Yeah, I'm just wondering if you could speak to that or if you've heard of other community health workers seeing things in different camps and what your approach is with that to help the farmworkers that maintain the relationship with the growers because they're their employers.

LA: So thankfully in the area that I worked in, which was very central North Carolina, all of the growers, all the farmers, they were always super understanding when it came to appointments. Every now and then you would see— it wouldn't necessarily be that the grower wasn't allowing them. It was the farmworker themselves, that they did not wanna disrupt their workplace. Because a lot of the places like tobacco farms, they have an assembly line type of thing. So, even though everyone's working together in the same farm, everyone has their job every day. So, the farmer themselves didn't want to disrupt the line because they're like, ‘oh, if I'm not there who's gonna take my spot.’ And then it would cause a whole— they would always feel bad about leaving work for their coworkers and for themselves missing their work. So, it wasn't always necessarily— in our area, it wasn't always— The grower was always super understanding. A lot of the times we would even tell the grower if we were not able to do transportation because we were with another farmworker. A lot of the growers would be like, ‘oh, it's ok, I'll take him’, and it was always just something like that. It was always really nice to see the growers looking out for their farm workers. But, on the other hand, you would see where the farmworkers didn't want to come because they didn't want to miss their work. Unfortunately though, I have in other parts of North Carolina, I'm sure if you, you may or may not have heard of it. There's a really big case that's in Nash County where a farm worker— he was denied proper water and shade and he ended up passing away. And he was super, super young. He was in his thirties. And he had just gotten here from Mexico. He hadn't even been a month or two and it was a really, really big farm. I want to say it was over 100 workers, maybe more. But, a lot of the farm workers ended up speaking up that they did not have the adequate shade. They didn't have the adequate amount of breaks, no water. And so, he was— they still to this day have not released the cause of his death. But all the farm workers that worked with him, they were like, ‘it's heat exhaustion, it was super hot. We didn't have enough breaks, we didn't have enough water and he ended up collapsing.’ And it was just a really big deal. And so, it really sucks that it's happening and, you know, that was a really fatal case, but I'm sure it's still happening around, not even just North Carolina, but around the United States where farm workers are, you know, in the really tough heats. And I'm imagining Florida, I cannot imagine the heat down there, the humidity. Here in North Carolina, it's humid and hot. But I'm sure, if you go down south even more— I just couldn't imagine it. But yeah, so I think I answered your question.

VC: Yeah that— thank you for mentioning that case. Because it is interesting to see what the current open legislation is, surrounding farmworker health and abuses from the workforce. But, I'm glad that you said that in your area, at least, the growers seem to be concerned about their employees’ health. But also, I think maybe it's also in their favor to have a workforce that—.

LA: Exactly! And sometimes we as a Community Health Workers, we'd be like— we would think, we would talk about these topics when we would go to conferences and stuff. It's like, why wouldn't the grower want their workers to be healthy? You know, if you don't have healthy workers, you don't have good productivity, you know? So it would just make sense for them to keep them happy and healthy and they work even better.

VC: I'm also curious about the laws surrounding worker compensation. Because I know in North Carolina— I'm not sure like the size of the, the farm that you work with, but I know if they employ less than 10 H2A workers they’re not required to provide compensation. I'm wondering if you conduct outreach to those kinds of camps and what is— how is your approach different as a Community Health Worker knowing that they're missing that sort of protection.

LA: Well, all the camps that we really went to, they either had their personal health insurance, which is really, really great for them. The farm workers from that have H2A visas. They all qualify for ACA. And in our clinic, if you signed up, a lot of them were not even— they didn't even have to pay anything. They just had to sign up and they had really, really good insurance through there. So thankfully, a lot of the farm workers, if they didn't have workers comp, they had ACA insurance. So, they always kind of knew they had a backup. But what's also super interesting about workers comp is I've had instances where I would take a farm worker to an urgent care and even the receptionist would be like, ‘are you not gonna do workers comp on that?’ I remember this time— it's a guy. He picked up a box of tobacco and they're super, super heavy and he mishandled it and he ended up dropping it on his feet and he was— it was super, super bad. His nail came off and we— he didn't let me know until the next day because he was like, ‘oh I thought it was gonna get better but it's still bleeding.’ And I was like, oh my goodness, it's bad. So, I took him to the urgent care and since this obviously happened at work, all of the doctors were like, ‘oh you're gonna use worker's comp, it happened at work.’ He was like, ‘what's worker's comp?’ And I, and I explained to him a little bit, you know, when you have an injury at work, you can— your employer is entitled or— what's the word? He's required to pay for your medical visit. And he was like, ‘what?’ He's like, ‘are you sure?’ And then I remember going to the front and the receptionist is like, ‘oh, are you gonna call your employer?’ And he was like, ‘why would I call my employer?’ And she was like, ‘well, this happened at work and you were here, he’s paying for workers comp before, like call him, he'll pay for it.’ And like the worker was like, ‘no, no, no. I don't want to bother him. What if he doesn't request me to come back for work next temporary?’ And I was like, are you sure? I was like, we can call him, you can just ask him. And he was just like, ‘no, don't call him, I'll pay for it.’ And so ok, farm workers have workers comp but are they gonna use it? I don't know how, maybe there needs to be a system where it’s enforced onto the farmworkers. Or, emphasize that, you know, if you get hurt at work, use your workers comp. But yeah, that happened, and I was— it really, it just really sucked. Thankfully, they ended up giving him somewhat of a discount because he paid all cash, and it was a 30% discount. So, it was a pretty good discount, I think. And he was like, ‘I'm happy to pay today,’ blah, blah, blah. And it was just a whole other, I guess issue, that there is with workers comp and farm workers and growers.

VC: That— yes, that's super interesting. What is— why didn't he want to use it? Was he afraid maybe it would change his relationship with the grower and wouldn't be back the next year?

LA: Yeah, he didn't want it. He didn't want to bother the grower. He didn’t— he was like, ‘what if he doesn't call me back for work because he's gonna think like, oh, you know, he just wants my money,’ da, da, da, da. So, I guess he just didn't want to bother him. And he didn't wanna— I guess maybe they had a good relationship and he didn't want to injure that. Yeah. We— I remember, I explained it to him, the doctor explained it to him and the receptionist, we were all like, ‘call him, he has this ready for you.’ And I remember he ended up calling his brother that also worked at the same camp and he was like, ‘oh, they're telling me that the boss can pay for it.’ And his brother was like, ‘oh, well, it's up to you.’ And so it wasn't like his brother was like, ‘no, no, no, don't use it.’ It was completely up to him. But, yeah, looking back at it, I'm like, what else could we have done to help him even more?

VC: Yeah. Well, it sounds like you were, you did, educate him about his rights. But that is difficult. Even with all that education— health education, education about insurance, it's hard to have— if they don't want it then they don't want it. Yes, but that is, that is sad that he was so scared to damage his relationship with the grower thinking it was in jeopardy and he wouldn't be able to work again. I wonder maybe if he had heard stories of that happening to his friends or just through word of mouth. Yeah, thank you for sharing that. I'm really glad that we had this second part of the interview so I could really like go more into depth into the questions that I had and into your stories. I'm wondering if— we've talked a little bit about this but— Oh, sorry, let me change tracks. So, one of the things that I came across in my research is this really horrible thing, that farmworkers, you know, they support our entire food system and they make it possible for all of us to have the convenience to go to the supermarket and pick up a fruit. But in North Carolina, 50% of farm workers are food insecure. They can't afford to feed their family. So, I'm wondering, what role do you play that? I'm wondering if you— what sort of social services exist to help with food insecurity in the farmworker population, if at all? And why is this a problem? Are they— I'm wondering, are they offered food in the camps or do they have to purchase it themselves? Is it an issue of the distance to the nearest grocery store and just living in a food desert? I'm just interested in how that all works out and why this is even a possibility that they are food insecure while working in agriculture.

LA: I think this is also kind of a camp-by-camp type of basis. A lot of— so the camps that are in super, super rural areas, the closest thing they have to a grocery store may be 30 minutes away. So, I think that, in itself it's already super, super hard. Another thing is they typically have one day out of the week that they can go grocery shopping and sometimes this time may be limited. So, some growers, sometimes it's maybe it's a grower or maybe it's— they call them “mini jefes”. Sometimes a farmerworker kind of takes it upon themselves to be the leader and all. And this is typically— it may be the driver that takes them to the Walmart, or Food Lion, or wherever they go grocery shopping. And they do time limits and they're like, ‘ok, we're here at 10, be back on the bus on the van by 12. 11 or 12.’ And they may go get their groceries, but this is the one day out of the week where they're outside of their camp, they're not working and there may be a Walmart, but there also may be a restaurant next door. And it's like, ok, what if I wanna eat something real quick and I don't wanna cook for myself one day out of the week. And so, time limits are super huge. Their location, it may be super rural. What else? That's, I guess some of the challenges, but I guess there's also— for example, where I worked, where I used to work at, we were actually able to go—. There's a local food pantry that would give us food. When I tell you, it wasn't just a box or two. They would fill up our trunk, plus the seats, of just food. And they'd be like, ‘how many camps are you going to?’ Would you be like, oh, we're gonna go to six camps today and they would fill up our little— it was like a small SUV and it was tiny, but they would fit so much food in there and we were able to take these to their camps. It would be like the middle of the week and a lot of them would be like, ‘oh, my goodness, like you just saved us. We were on ramen noodles right now. So, it was a really, really helpful thing and I'm sure there are other organizations that help with food pantries. But then I know there's also so many that don't have that option, which really, really sucks. But, that was one way that we would help with that food insecurity thing. Because we would have camps that would be kind of in a town where they had access to a Food Lion they had at Walmart, they had a ( ), they had multiple options, but then maybe an hour away, they only had a Dollar General that's right there. And they would have to drive 45 minutes to get to the nearest town, to get to just a Piggly Wiggly. So, we saw both sides of the spectrum, but thankfully, we were always able to provide something. And since they didn't provide you a whole bunch of food for all of the camps in our area, we would always kind of like— if we did six camps this time, we would like do another six camps that time, and just keep it on a rotation schedule. So, everyone had something at least once and it was fair to everybody. But yeah, food insecurity, like you said, it's just crazy because they farmworkers are the ones that are doing this for us and they're the ones facing food insecurity. And also like another time— sorry, there's so many things— but it's also a— I think a cultural thing. You know, many of the farm workers, they come from a Mexican culture where back home, the people or the women that make the food for them— it's the women of the house, like the mom, the wife, the daughters. And so, they may come from a culture where they're not used to cooking or making food for themselves. And that's just a cultural thing. And so, they come here and they know how to do the most basic things and those most basic things may not be the healthiest. And not only is it because they may not know how to cook. But even if they do know how to cook, do they have time to make this, to cook dinner, to make a healthy dinner? Because, you go work 12 hours a day in the fields, the hot fields, it might be humid, all these conditions. The last thing you're thinking about is ‘oh, I'm gonna go home right now and make me a nice healthy balanced meal.’ Like I don't think any of them are really thinking about that. I think the thing they're thinking about is ‘let me make some eggs and tortillas and some cheese and I'm going to bed to get some rest.’ Because that's what I would do. Because working 12 hours a day for five, six days a week is such a big toll on your body, on your mental. And just thinking— the last thing you want to do is create something at the end of the day. Of a long, long day. So yeah. So many layers [laughs].

VC: Yes it's such a complicated issue. It's just crazy to me. And obviously, it's very nice that you're able to provide with the food pantries, and provide support in that way. But it seems to me like it has to be changed at the policy level because it's just—.

LA: Yeah.

VC: I wanted to ask— I asked this question in the first part of the interview— now that you're working at the state level, do you see that they're now— do you see a lot more momentum in order to create this policy change? What are you observing in your role or with the people that you work with? I'm wondering if you work with farmworker unions in any way. Since you sort of have these related goals. Yeah, I’m just wondering how that works.

LA: Yeah, I think at the state level, I remember, whenever I was like working in a Community Health Worker level, it'd be like, oh, I'm sure the state can do this, I'm sure they can do that. But now that I'm here and I can see everything that's going on, there's so many barriers, there's so many projects that we're working on and so many initiatives that are being— that are in the works. But there's barriers with funding, there's barriers with other policies, maybe at the federal level and there's just so many things that have to be done for there to even be small, small, small amounts of change. So, I wish there was just some way where, you know, it didn't have to be like this. I wish it was like— if there was enough like petitions or something. I know that's really huge right now. I just wish there was a way to where it wasn't so hard to make just small amounts of change. Like the project that we're currently working on, hopefully it's a really, really huge impact, but at the end of the day, we have so many barriers that we have to go through, so many requirements that we have to do. So, yeah, I've just— I see all the amazing projects that just my team—this small little team that I'm in— how many amazing projects that we're working on. But we get to an end point and it's like, ok, so now what, now we wait for our policy, now, we wait for more funding. And then it's like, how do we implement this statewide and is this gonna be nationwide? So, there's just so many small little barriers that we go through.

VC: Yeah. Thank you so much for sharing that— coming across the same issue where we have six minutes left, but I'm adding this on to the first interview. So, it should be ok. But, one another thing you said that was really striking to me is the fact that these farmers only get one day a week and are sort of escorted to another place and just the lack of freedom in their day-to-day lives. I'm wondering how you’ve seen this effect? Well, you said that it does affect their physical, their mental health. And then the other thing I'm thinking about is with the digital divide, the project that you're working on, how inaccessible mental health care would be to these farm workers. And if you— I mean, we can see that their freedom is limited. But have you observed that the farmers think that in how they see their relationship with their work? Or are they, you know, just happy that they have, you know, income and are able to work and the fact that maybe their lives are more limited isn't something that really is a priority or important to them.

LA: Yeah. So, like you said, a lot of the farm workers— we speak about these issues that they may encounter, but a lot of them— they're always like, well, ‘we're here to work and we're here to provide for our family. So as long as we can do that, we're happy.’ But it’s like yes, you know, you're here for work, but you shouldn't have to suffer to be here to work. You should at least have your basic needs met. Your mental health should not be suffering. So it's, it's super interesting when you, when you ask them, it's the first thing they say; ‘I'm always thankful to be here because I'm able to provide a whole life for my family back home and they're not struggling.’ It's such a sweet—it's so sweet. But on the other hand, you shouldn't have to go through all this suffering just to be able to provide basic needs for yourself and basic needs for your family. Yeah, a lot of them, it's just the, the stories they tell you. I remember this one farmworker. He was always like, ‘yeah, I was able to give my daughter her quinceañera. I was able to build a house for my family back home. But, I haven't seen them in 15 years.’ It's all— it's just, well, I think at that time, yeah, it was 15 years because he came whenever his daughter was baby. So, it was like oh my. You're doing all of this but you're not there to be with your family. So, there's just— there's a lot of stories that they tell you and then whenever you ask them about it they’re like, oh— I remember that's always such a big opener, like, oh, ‘van al mandado los domingos o los sabados.’ And they're always like, yeah, ‘we go on like on Sundays but, you know, we only have three or four hours, but that's fine with us, it's ok. And we just come back here and we're relaxing.’ And it's like, why can't they have the whole Sunday to relax? They've been working so hard all week. And I, I don't know if that's a policy thing. Maybe there's policies that's like, because they're here on a worker visa, they can't, I don't know. They can't be out and about. So that's really, I've never thought about that. Maybe it's a policy thing, that the growers can't let them out. I— that doesn't make sense to me [laughs] if it is. Yeah. They've never really expressed themselves that they feel like crunched in together, like in their camps. What's the word I was looking for? They don't feel like their freedom is limited on Sundays. But yeah, there's just so much on that too.

VC: Yeah, thank you. Thank you so much for sharing that. And thank you so much for your time and for speaking with me. I'm wondering if you wanted to talk about anything else? I can always send you another Zoom link really quickly so you can finish your thoughts, or if you wanted to expand on whatever you just said in these past 30 minutes. But yeah, overall, I just wanted to thank you again for speaking with me and for sharing your stories and for all of your work too.

LA: Yeah, yeah. No, thank you again for your patience. I know my schedule is super hard to work with. But yeah, no, that was my final thoughts. I don't know if you have any more questions for me. I still have time until about three. So, if you do have any more questions, I'm more than happy to stay for 21 minutes, but if not, that's ok too.

VC: There's— it's such a complicated system, with, you know, immigration policy and then health policy, so many different policies intersecting and it's— your work that you do is so important because there's so many different barriers to care and addressing all of them is necessary but so difficult. So, it's very inspiring to talk to you. And what you said about how now there are more health workers than before— it's a growing workforce and seeing the connection that you have with the farm workers is really great. But still, there's so many things that have to be done, and problems and injustices to be corrected. But I'm really happy that now that there is potential for maybe a better future for farm workers and for people working in agriculture in general. And yeah, thank you so much again. I hope you enjoy the rest of your day.

LA: Thank you, you do the same. And also like just to add a little bit, I know there's 50 seconds left but just like you saying, back then there was no community health workers and like now it's a growing workforce. But even now with like interviews that we're doing now, you can see it's growing and it's expanding even more and more and more. And with like the project you're working on and interviews that you're working on. So, the work that y'all are doing is also super great. We need all of this to be documented. We need it to be said out loud and not just kept in the farmworker space. It needs to be spread out everywhere. So, thank you as well for all the work that you're doing.

VC: No, yeah, absolutely. This is not, this cannot be an invisible problem. But yeah, I'm so glad I got the opportunity to talk to you and speak with you and thanks again. Have a great rest of your day.

LA: Thank you. You too. Bye bye.

[01:07:27] END OF INTERVIEW (PART 2)