Underserved and Unprotected

I expected that assisting Sue, a nurse practitioner serving migrant camps in rural Maryland, would be an eye-opening experience. I expected to see men and women who lived in poor conditions. I expected to see laborers with unmet medical needs. But I did not expect to get so attached to our patients. Or for one of our patients to be shot and killed before the week was through.

I met Sue in a school parking lot in one of the many small towns dotting the eastern shore of Maryland. "My car looks like something out of The Grapes of Wrath," she said as she wrestled a card table into the back of her small car. "But I think it all just fits." Laden down with medical supplies, there was just enough room left for its passengers—Sue, her translator assistant Wanda, and I. Part of the Choptank Community Health system's migrant health program, our goal was to reach as many workers as we could. Like most weeks during the summer harvest times, we would be driving from migrant camp to migrant camp to care for those sick workers who had no means of transportation.

Migrant workers are frequently cut off from any kind of community support, living isolated in remote, rural areas. Most go from harvest to harvest, always on the move, making it almost impossible for them to get any kind of regular medical care. Many are uninsured and struggle to provide for their families. They are those most marginalized in our society—poor African Americans, Native Americans, and Haitians and Latinos here on temporary work visas.

"So many of the people we see out here have the kind of long-term conditions that should be monitored, like diabetes and hypertension," Sue told me as we drove towards the work camp. "I try to get to each camp at least once a week. There are about 30 work camps in our area, 500 workers or so in all. We can't do everything we could do in a clinic, not by a long shot, but we can get a lot of basic care accomplished—assessments, consultations, medications, even blood work."

That first day, we parked the car underneath a pine tree in front of a semi-circle of small, run-down cabins. The workers were just coming in from the fields for a short lunch. Tired and hungry, they nonetheless waved and greeted us as we got out of the car and began to set up our outdoor "clinic"—a card table and three folding chairs.

"Who's first?" Sue asked and an older man came forward and sat in the chair. They chatted comfortably about the harvest, his old injuries, and his asthma while Sue took his vitals. She is well-known and familiar with her patients; this man, a farm worker my grandfather's age, spoke easily about old injuries.

Before the men went back to work, we had time to see a half-dozen patients, taking blood samples from two of them. Their vitals would be taken to the clinic to be tested for everything from anemia to HIV. Sue kept up a steady stream of narration as we packed up and drove to the next camp. "These people struggle just to make it from season to season, and the smallest things—teaching them how to control their diabetes, talking to people about how to manage their health—can make a huge difference in their quality of life. Many of them have never seen any kind of medical care at all, before this."

Lorenzo is one of the few camp owners who makes an effort to keep his workers healthy—probably because he began his life as a migrant worker at the age of seven. He's hauled watermelons, picked apples, and bent over the vines of tomato plants on endless, hot days. Now in his 40s, he has a fixed residence and works as a businessperson. But he was irrevocably shaped by the migrant life. And every summer he returns to this small patch of rural Maryland to run a migrant worker camp—a camp that was once run by his mother.

"Somebody should take care of these guys," he said. "Being a migrant is a lonely business, full of backbreaking work; many have families back home. They're good people and good workers."

The work these migrants do is almost unimaginable to me. They get up at dawn and head out into the fields to gather ripe watermelons, heaving them into the bins pulled by a large tractor. When a harvest is at its peak, they may work 15, 16, even 17 hours a day, 7 days a week, sometimes without a break. Only when things are slower do they return to the camp for their lunches.

Lorenzo goes to great measures to make his camp as home-like as a migrant camp can be, painting the buildings cheerful colors, even making watermelon slushies to bring out to the workers on very hot days. But not all of the migrant camps we visited that week were like that. One group of migrant workers didn't come in from the fields until sunset. When we arrived, a line of exhausted men quickly formed. In the fading light, a half-dozen men took off their boots to reveal blackened toes. Their work requires that they stand in water all day and, no matter what we did for them, we were hard-pressed to reverse the trench foot that results.

Another common ailment is skin irritation from the pesticides in the fields. We instructed workers to wash as thoroughly as they can before doing anything else after work. "Scrub everything, a few times, and change your clothes," Sue told one young man. His wife and child are also living in the camp for the duration of the harvest; we told him to be sure to wash and change before he hugs his young son. None wear gloves or protective gear as they work. There is a single shower for 16 workers.

Migrant workers are some of the most vulnerable people in our labor system. Those with temporary work visas are not subject to the same labor protections as U.S. citizens. Most are secluded in remote, rural areas. Because of their mobile status, many keep the money they earn in cash. Thursday night, three people broke into the migrant farm workers' quarters and robbed them all. Armed with guns, the three robbers demanded their wages. The attackers hit one of the migrant workers in the face with a handgun. In response, one of his friends defended him, arguing with the robbers, who then shot and killed the farm worker before fleeing.

Robbing individuals who are among the poorest in American society, working some of the most physically demanding jobs, is maddening. Their struggle is excessive enough without being victimized by thieves and robbers.

The family of the slain man might not know for months what happened to him—if they ever find out. For the victim's friends and workmates, recently robbed of their hard-earned paychecks and witness to this traumatic crime, the day was a sober one. But aside from the interviews they gave to the police, it was off to work as usual.

Many believe that if a farm worker is Latino, he or she must also be an "illegal." What people don't realize is that each year Maryland's farms—like farms across the United States—hire international farm workers on temporary work visas. And, most strikingly, it has remained true that no one else wants to work these jobs—not even in this economy. Even more notable than the magnitude of false conceptions about migrants is the extent to which these mobile agricultural workers are unprotected. I will never forget the words of one sheriff investigating the robbery. "I didn't even know these people were out here," he said.

Three months later, the crime has still not been solved. At this point, it is unlikely that the perpetrators will be brought to justice. One headline ran in the local papers and there was a brief flurry of concern. And then this story, like the farm workers themselves, disappeared.

Z

Margaret Adams is a weekly columnist for the Bangor Daily Newsand an avid freelancer whose writing most recently appeared in Utne Reader, Gray's Sporting Journal, Transitions Abroad Magazine, and Verge. Photos of migrant workers in the Chesapeake Bay region are by Matthew Hamilton.