DOCUMENT RESUME

ED 119 926 PC 009 069

AUTHOR Weber, David 0.TITLE Health for the Harvesters: Decade of Hope

1960-1970.California State Dept. of Health, Sacramento.Dec 7069p.

INSTITUTIONPUB DATENOTE

EDRS PRICE MF-$0.83 HC-$3.50 Plus PostageDESCRIPTORS Agribusiness; *Agricultural Laborers; *Clinics; Farm

Labor; Health Programs; History; Mexican Americans;*Migrant Health Services; *Migrant Workers; *OutreachPrograms; Program Descriptions; Seasonal Laborers

IDENTIFIERS *California

ABSTRACTIn 1970, the Farm Workers Health Service, which was

begun in 1961, included 33 decentralized medical clinics which served24,000 seasonal farm workers and their families in 17 counties duringthe peak harvest months. Seventeen clinics offered year-round generalmedical services, and in 12 counties free medical and dental care wasavailable to farm worker families under fee-for-service projectarrangements. The 26 California migrant health projects also offerednursing clinics, public health nursing, aide and environmental healthservices, maternity service clinics, and health education. Of the$1.2 million from the U.S. Public Health Service, nearly $1 milliondirectly supported medical and environmental services. The Stateprovided another $100,000 for local project activities, and thecounties subsidized about 50 percent of the services to migrantswithin their areas as a local contribution. Nearly 100,000 men,women, and dildren received medical care under the program duringits 10 years of operation. Some 132 dedicated professional andparaprofessional health workers staffed the 26 projects. This reportdiscusses the conditions which made the program ,ecessary, thefamilies who received its services, and the daily routine of thenurses, aides, sanitarians, and doctors. The 26 projects, theirsponsor, location, services and operation seasons are,listed. (NQ)

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U S DEPARTMENT OF HEALTH.EDUCATION &WELFARENATIONAL INSTITUTE OF

EDUCATION

I THIS DOCUMENT HAS BEEN REPRO-I DUCE° EXACTLY AS RECEIVED FROM

THE PERSON OR ORGANIZATION ORIGIN-ATING IT POINTS OF VIEW OR OPINIONSSTATED 00 NOT NECESSARILY REPRE-SENT OFFICIAL Nt,TiONAL INSTITUTE OFEDUCATION POSITION OR POLICY

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Decade of Hope

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A Ten-Year Report by the

Farm Wok's Health ServiceBureau of Maternal & Child Health

California State Department of

Public Health

HUMPH Resources Agency

December, 1970

t-

The 1970 harvest season has marked the tenth year in the lifeof the Farm Workers Health Service of the California State De-partment of Public Health.

Since its rudimentary beginnings in 1961, when 11 of Cali-fornia's 42 major agricultural counties shared a scant $75,000in state funds, the program has grown to include 33 decentral-ized medical clinics serving 24,000 seasonal farm workers andtheir familiessome 66,600 patient visits in 1970in 17 counties

during the peak harvest months.

Seventeen clinics offer year-round general medical services,and in 12 counties free medical and dental care is available tofarm worker families under fee-forservice project arrangementsNursing clinics, public health nursing, aide and environmentalhealth components augment most projects.

The program this year is financed by $1.2 million in federalfunds from the U.S. Public Health Servicenearly $1 million

directly supporting medical and environmental services. The state

provides another $100,000 for local project activities, and thecounties themselves subsidize about 50 percent of the services tomigrants within their areas as a local contribution.

Of course, poor health is only one of the many interwovenproblems which beset the seasonal agricultural worker and hisfamily.

When the crops ripen, growers are in desperate need ofworkers for their fields and orchards. But in most farm counties,

the peak harvest demand is followed by long months of in

activity for all but a handful of farm laborers. The moneyusually not very muchearned during the eummer dwindles.

Large families grow hungry, illnesses need attention. Rain andcold seep through thin wallsthe anxieties and depressions ofpoverty build. But there s little or no industry to provide alterna-

tive jobs.

Thus many farm workers become migrants. They follow thecrops from county to county across California, journey north toOregon and Washington, return to winter at home bases inSouthern Culifornia, Texas, Arizona and Mexico. About 160,000migrants work on California farms during the peak harvestmonths of May through October.

In some important ways, migrancy incBy definition they are on the move, hard twhen they need help, forced to accept wis immediately available, ineligible bec

quirements for the health and welfare benpoor.

In addition, most come from a differenttraditions, speak a language incomprehensiof Americans. Often they have little underconcepts as vector control, disease transguards against the spread of germs, and tPulled out of, school at an early age to hcome, their educational levels are low.

Doctors and hospitals are located infrom these workers' rural homes. An emcan be an almost insurmountable probleSpanishprovided one even has access

revvt.11

;4f

Faustina SolisFarm Workers Hoc;Social Work Consultant, 191

Director, 1968-70

7

t marked the tenth year in the lifeervice of the California State De-

'flings in 1961, when 11 of Cali-counties shared a scant $75,000s grown to include 33 decentral-,000 seasonal farm workers andtient visits in 1970in 17 counties

-round general medical services,I and dental care is available to-for-service project arrangements.nursing, aide and environmentalst projects.

anted by $1.2 million in federalealth Servicenearly $1 millionenvironmental services. The state

r local project activities, and thebout 50 percent of the services toa local contribution.

nly one of the many interwovenonal agricultural worker and his

wers are in desperate need ofchards. But in most farm counties,followed by

I of farm laborers. The moneyd during the summer dwindles.

illnesses need atiention. Rain andthe anxieties are depressions ofor no industry to provide alterna

ecome migrants. They follow thecross Corfain%)urn to winter at home bases in

izona and Mexico. About 160,000farms during the peak harvest

F.

6

In some important ways, migrancy increases their problems.

By definition they are on the move, harj to locate, hard to helpwhen they need help, forced to accept whatever shelterif anyis immediately available, ineligible because of residency re-quirements for the health and welfare benefits open to the local

poor.

In addition, ;..ost come from a different culture, share differenttraditions, speak a language incomprehensible to the vast majorityof Americans. Often they have little understanding of such subtleconcepts as vector control, disease transmission, sanitary safe-

guards against the spread of germs, and the effects of pesticides.Pulled out of school at an early age to help with the family in-come, their educational levels are low.

Doctors and hospitals are located in population centers farfrom these workers' rural homes. An emergency telephone call

can be an almost insurmountable problem if one speaks onlySpanishprovided one even has access to a telephone. Food

4

Faustina SolisFarm Workers Health Service,Social Work Consultant, 1963-68

Director, 1968-70

7

reMPIRM.1.......1.11M,IMMIR.PRIPIRWMmg.nrPI

and automobile repairs cost more for the stranger unfamiliarwith local rates. And a proud man is reluctant to seek officialassistanceespecially when that reluctance is reinforced by intri-cate snarls of red tape and a history of harassment by governmental bureaucracies.

The fiercely self-reliant migrant, who ranges far in search ofwork, is the last to queue up for welfare.

Things are not much better for the resident farm worker. Thenature of his occupation is seasonal, sowhile he may be paidrelatively well at harvest timehis entire yearly income is likelyto depend on those few months' labor. Every able-bodied familymember is pressed into service in the fields, leaving the youngestchildren, frequently, under the care of a brother or sister hardlyolder than they. How many accidents occur in these homes or inthe fields due to lack of proper child supervision can only beguessed.

While the farm worker is earning money, of course, he cannotusuully qualify for welfare or Medicaid benefits. Often, in fact,he is actually losing money by choosing to work. And the conditions under which he labors are only beginning to be broughttoward the level accepted as basic by workers in every otherAmerican industry. Drinking water, toilet and hand.washing facilities are still lacking in many fields, though enforcement of regulotions has reduced their number. But how can 80 women crew.ing five tomato harvesting machines be expected to use only twofield toilets during a single 15-minute work-break?

For years the assumption has been made that the rural poorcould improve the condition of their lives if only they would uniteinto a politically significant, cohesive group. The migrant, to besure, is disenfranchised and powerless. But is the resident farmworker any better off? These families are scattered over wideareas, bludgeoned into apathy by malnutrition, chronic sicknessand lifelong social and economic discrimination, forced to com,pete against one another for too few jobs, suspicious and resent.ful of their own neighborsnot to mention the migrant whoarrives to skim off the economic "cream."

During the decade 1957-66, Califorr :a-the nation's richestfarm state-increased its annual agricultural cash receipts from$2.8 billion to $4.1 billion. Last year, the average annual incomefor the farm worker families living in California's 23 migrant

28

housing centers was $3,019-and thethree or more children!

Even though operating at the limits othe Farm Workers Health Service projetreat only about 15 percent-15 percenof California's migrant population. A greup to 80 percent, benefit at some timeservicesfield and camp inspectionsprosanitation component. But these areplacency.

What, then, do we consider the signifiten years of operation?

First, the program has made peopleseasonal farm workers do have special

Second, even though the services areare available. For the first time, peoplginning to receive the care they require.Health Service program has proved thaare provided to the rural poor in an aaccessibility is geographical, culturalwill be utilized.

Third, in developing the program wproblems which would not otherwise benew things about the people we serve,old ways of doing things have failed..

Finally, the Farm Workers Health Serya real influence on the methods in whitbe delivered to all Americans. The progruse of auxiliary personnelthe clinic anaides drawn from the recipient populatiowill rely more and more on these invalinterpret good health practices, to transand idiom to another, and to performfunctions which detract from the full Fl

professionals.

The program has pointed up ways inices can be decentralizedbrought to tljand at the times in which they are most Igram, increasing numbers of medical stubeen and will continue to be introduced

more for the stranger unfamiliard man is reluctant to seek officialat reluctance is reinforced by intri

history of harassment by govern

rant, who ranges far in search offor welfare.

for the resident farm worker. Theasonal, sowhile he may be paid

his entire yearly income is likelys' labor. Every able-bodied familyin the fields, leaving the youngestcare of a brother or sister hardiy

ccidents occur in these homes or inper child supervision can only be

rning money, of course, he cannotMedicaid benefits. Often, in fact,choosing to work. And the condi

are only beginning to be broughtbask by Workers in every other

ater, toilet and hand washing facilifields, though enforcement of reguber. But how can 80 women crewchines be expected to use only two-minute work-break?

as been made that the rural poortheir lives if only they would unite

ohesive group. The migrant, to beowerless. But :s the resident farmfamilies are scattered over wide

y by malnutrition, chronic sicknessmic discrimination, forced to com

too few jobs, suspicious and resentnot to mention the migrant whois "cream."

6, Californiathe nation's richestal agricultural cash receipts fromt year, the average annual incomeliving in California's 23 migrant

8

housing centers was $3,019 -and the average family includedthree or more children!

Even though operating at the limits of manpower and money,the F -um Workers Health Service projects estimate that they cantreat only about 15 percent-15 percent! of the medical needsof California's migrant population. A greater percentage, perhapsup to 80 percent, benefit at some time from the environmentals3rvicesfield and camp inspectionsprovided in counties with asanitation component. But these are hardly figures for com-placency.

What, then, do we consider the significant achievements of ourten years of operation?

First, the program has made people aware that migrants andseasonal farm workers do have special needs.

Second, even though the services are meager and limited, theyare available. For the first time, peoplehuman beingsare be-ginning to receive the care they require. And the Farm WorkersHealth Service program has proved that if health care servicesare provided to the rural poor in an accessible waywhen thataccessibility is geographical, cultural and psychologicaltheywill be utilized.

Third, in developing the program we have uncovered manyproblems which would not otherwise be known. We are learningnew things about the people we serve, and discovering why theold ways of doing things have failed.

Finally, the Farm Workers Health Service program has exerteda real influence on the methods in which health care is and canbe delivered to all Americans. The program has pioneered in theuse of auxiliary personnelthe clinic and sanitation and nursingaides drawn from the recipient population. In the future, medicinewill rely more and more on these invaluable liaison workers tointerpret good health practices, to translate from one languageand idiom to another, and to perform important non-medicalfunctions which detract from the full productiveness of healthprofessionals.

The program has pointed up ways in which health care serv-ices can be decentralizedbrought to the people in the placesand at the times in which they are most needed. Under the pro-gram, increasing numbers of medical students and internes havebeen and will continue to be introduced to that forgotten patient

9

pool, the isolated rural poor.Moreover, the program has pioneered in forging a new relation-

ship between the physician and the nurse. In the future, increasingresponsibility will and must be delegated to the latter as a nurse-practitionerleaving the doctor free to devote his precious skillsto the acute illnesses and injuries of patients.

The decade 1961-70 has been a decade of progress, of achieve-ment, of renewed hope for California's seasonal farm workers.Nevertheless, much remains to be accomplished. Farm worker fami-lies continue to make do in unsafe, ramshackle dwellings, to campin automobiles and hastily improvised shelters, to suffer the state'shighest occupational disease and infant mortality rates, to live withuntreated chronic illness, malnutrition, painful dental problems,lack of hospitalization and inadequate prenatal care.

It must be remembered that ill health disables men for workthrows them onto the welfare rolls whether they wish it or not.Similarly, preventive care and early treatment of disease savesmoney. A child whose tuberculosis is properly cared for will notdevelop meningitis and become u cr:pple a rfelong word of thecounty's taxpayers.

Each year since 196, the Furm Workers Heal+ Service has

compiled an exhaustive ann,ul report W.4, data pairss+okingy

assembled by the stuffs c,f the projeos, we hare po'nted

the plight of the migrant form worker fun-ly aid d'e efforts of ourprogram.

But it is hard to convey a real feeling of who" we ore do:ng, ordwhy, and for whom .n a dense colleo:on of stoCsrcal 'Ales Theproblems recited above hove beer ft:iitd afte tea, Toblecdelineating rwmbers or cl.nec visas, hors of c",,:c sess'ons types ofconditions treated, percentages of camps .'Spei4ed Love ',een pub

bushed dutifully each fiscal y eu Do ese and po,ag,ophs

still retain any impact?

Nearly 100,000 men, women and chi!dren have received medi

cal care under the Farm Workers Health pr:sgrann durkg

its ten years of existence. Some 132 dedicated pofesslonal andparaprofessional her:th workers staff the 26 projects 'n Califorriktthe oldest and most extensive migrant Leo!On progrann ;r1 the

United States.

In this, our decade report, we WI! or, 'o focus some of those

people. Through words and pictures, we hope to convey the flesh

and blood of the migrant health programtions which have made it necessary, the fservices, the observations of those who haveit grow, the daily routine of the nurses anand doctors who offer real care and conce

The opinions and the methods reporte,representative and at the same time not rfornia projects offer a spectrum of philoshowever, are made up of peoplepeopllimits of their resources and their humanity,

We hope that reality emerges in the woofollow.

red in forging a new relation-nurse. In the future, increasingated to the latter as a nurse-to devote his precious skills

patients.

ecade of progress, of achieve-nia's seasonal farm workers.

complished. Farm worker fami-ramshackle dwellings, to campd shelters, to suffer the state'sant mortality rates, to live withion, painful dental problems,to prenatal care.

ealth disables men for workwhether they wish it or not

ly treotrnen' 1f se se s.(7...es

ort t',uOi

r

linoetPiinotcriOur

the,f

1i

s, we hope iv viirey isits

and blood of the migrant health program in Californiathe condi-tions which have made it necessary, the families who receive itsservices, the observations of those who have shaped it and watchedit grow, the daily routine of the nurses and aides and sanitariansand doctors who offer real care and concern to real people.

The opinions and the methods reported are, of course, bothrepresentative and at the same time not representative. The Cali-fornia projects offer a spectrum of philosophy and service. All,however, are made up of peoplepeople straining, within thelimits of their resources and their humanity, to help people.

We hope that reality emerges in the words and images which

follow.

z

.11 3

A Century in California Farm Labor

1870 California agriculture ossumes its modern pattern:lorge-scale land ownership (516 men own 9 million acres); cropspecialization (the San Joaquin Valley boosts the world's largestwheat farm, and new irrigation projects begin to give fruitorchards their increasing agricultural importance); and reliance oncheap seasonal labor, usually by non-European racial minorities(the Chinese, barred from the gold mines by a series of discrimi-natory laws and thrown out of work by completion of the trans-continental railroad, take up the dominate role in California farmlabor))

1882 Under various pressures, including that of organizedlabor, Congress passes the first Chinese Exclusion Act. Chineselaborers are prohibited from entering the United States for 10years. Re-enacted in 1892.

1888 The first Japanese workers are imported into Califor-nia's orchards and sugar beet fields. By 1909, sume 30,000 areemployed as farm laborers during harvest season?

1890 Armenians, Portuguese, (talismall tenant farmers, they specialize inchokes, and grapes respectively.3

1907 The first Hindus are importand Imperial Valleys. By 1915, there arHindus working seasonally in vegetables

1909 President Theodore Roosevelsion recommends that Congress pass leghousing, employment on an annual bapostal sovings banks to encourage thriworkers. No action.5

1913 The Alien Land Act is passfarm ownership by Orientals. Re-enacted I

1915 The U.S. Commission on Indregularization of employment, feasible 13,

I

I

A Century in California Farm Labor

chsumes its modern pattern.n own 9 million acres); cropey boasts the world's largestpojects begin to give fruitI importance); and reliance onon-European racial minoritiesmines by a series of discrimi-

by completion of the trans-incite role in California farm

s, including that of organizedinese Exclusion Act. Chinesemg the United States for 10

ers are imported into Califor-s. By 7909, some 30,000 arearvest season..?

'7'40 Armenians, Portuguese, Italians begin to arrive. As1 tenant farmers, they specialize in raisins, dairy and arti-

chokes, and grapes respectively.3

1907 The first Hindus are imported into the San Joaquinand Imperial Valleys. By 1915, there are an estimated 10,000Hindus working seasonally in vegetables and cotton.4

1909 President Theodore Roosevelt's Country Life Commis-sion recommends that Congress pass legislation to provide goodhousing, employment on an annual basis and establishment ofpostal savings banks to encourage thrift among migrant farmworkers. No action.5

1913 The Alien Land Act is passed to prevent increasingfarm ownership by Orientals. Re-enacted in 1919.

191.5 The U.S. Commission on Industrial Relations calls forregularization of employment, feasible plans for providing trans-

,.....,..

;1

portation and establishment of sanitary working men's hotels withbranch postal savings banks on behalf of migrant agriculturalworkers. No federal action.6

1917 . The Immigration Act of 1917 prohibits further entry ofHindus. Already they own or lease 45,000 acres of California rice

lands?

1918 Labor shortages, war, the Mexican revolution and newimmigration laws encourage importation of Mexican farm workers.By 1920, 50 percent of the state's migratory labor force is Mexican.8

1923 Fears of re,mctions on MexPcon ;mm;graCon causefirst importation of Filipinos to work crops Dur:ng the 1930s some

35,000 Filipinos ore employed in seasonal farm labor 9

1931 Federal Paws diasticuLly restrict 'im-n;graf;on by Mew'

cans. Thousands, including U.S. citizens, are involuntarily "repatriated" because they are on relief 16

1933 first of more thui) 350,00C M:dwest "D.,s+ Bow!" refu

geesthe Okiesbegin to arrive in California. State-run laborcamps house 15,000 unemployed men. Oversupply of workersseverely depresses wages. Hunger, disease, social unrest are

rampant."

193.5 Congress passes measure offering free one-way trans-portation for Filipinos wishing to leave U.S. Return is barred.

1938 Agriculturril Workers Health and Medical Association(AWH&MA) is established cooperatively by U.S. Farm SecurityAdministration, California Department of Public Health and Cali-fornia Medical Society. The AWH&MA provides free health andmedical care to desperately poor migrant farm workers andfamilies.

1939 John Sternbeck's controversial novel The Grapes ofWrath focuses national attention on the problems of Californiafarm workers. U.S. Farm Security Administration begins construc-

tion of 14 new migratory labor camps in state. Congressionalcommittees open investigations into California agricultural condi-tions.

1 4

1942 Bracerostemporary foreignbegin to arrive in California fields fromgency executive order designed to meet t

age of domestic farm labor.12

1944 Federal legislation restrict.AWH&MA to foreign contract workers. Eino longer have access to low-cost health

1947 Congress, pleading economAWH&MA and turns over all federally -opcto private growers associations and toBraceros receive health coverage under stsation planwhich will not apply, untilcultural workers.14

!949 National concern again turnsrhea and pneumonia claim the lives ofin the San Joaquin Valley.15

15.

working men's hotels withall of mi9roo Jg,;c..,!1,;,1

17 prohibits further entry of00 atle.. ,-1',"

exican revolution and newn of Mexican farm workers.ratnry ! I- kA P

Psntr

e,ten,to

California. State-run laborn. Oversupply of workersdisease, social unrest are

offering free one-way trans-U.S. Return is barred.

Ith and Medical Associationely by U.S. Farm Securityof Public Health and Cali-provides free health and

migrant farm workers and

ersial novel The Grapes ofthe problems of California

ministration begins construc-mps in state. Congressionalalifornia agricultural condi-

1942 Bracerostemporary foreign contract farm laborers

begin to arrive in California fields from Mexico under an emer-

gency executive order designed to meet the acute wartime short-age of domestic farm labor.72

1944 Federal legislation restricts services under the

AWH&MA to foreign contract workers. Effect. domestic migrantsno longer have access fo low-cost health or medical coverage.13

1947 Congress, pleading economic pinch, abolishes theAWH&MA and turns over all federally-operated farm labor camps

to private growers' associations and local housing authorities.Braceros receive health coverage under state workmen's compen-sation planwhich will not apply, until 1959, to domestic agri-cultural workers."

1949 National concern again turns to California when diar-rhea and pneumonia claim the lives of 28 farm workers' babiesin the San Joaquin Valley.15

55

1961. . Aroused Fresno County grower, health and communitygroups join to establish Westside medical clinics in five locationsfor farm workers and families. County infant mortality rate drops50 percent in first three years of clinic operations! 16

1960 At request of the governor, California State Depart-ment of Public Health launches investigation into "Health Condi-tions and Services for Domestic Seasonal Agricultural Workersand Their Families in California." Findings: They suffer more illhealth, use medical services less, and have higher sickness anddeath rates than any other socio-economic group. Barriers to goodhealth: hospitals and health facilities are far from their homes,services uncoordinated; residence requirements, transportation andmedicine costs and hours of service exclude them, language, cul-ture and pride often operate against preventive care and cloudunderstanding of good health practices.

.....1111111111

.....,amt.....mOyllNndsaM (i

1961 On basis of report, the govLion. State Senator Virgil O'Sullivan intrauthorizing funds for creation of a spec:partment of Public Health to promote csonal agricultural workersthe birth of tService. Fourteen agricultural counties egrams to include services for migrants.

1962 Federal Bill S-1/30 providesand coordinate a unified statewide heworkers. Public Law 87-692the Migrangrants for family clinics for domestic agri

1963 Report of tits: Governor'sHousing reveals that 80 percent of farmgrossly substandard housing, if any at

7

Lunty grower, health and communityide medical clinics in five locations'County infant mortality rate dropsf clinic operations! 16

governor, California State Depart-s investigation into "Health Condi-ic Seasonal Agricultural Workersia." Findings: They suffer more illss, and have higher sickness and

'o- economic group. Barriers to goodcilities are far from their homes,e requirements, transportation and

rvice exclude them, language, cul-against preventive care and cloudradices.

I

1961 On basis of report, the governor seeks legislative ac-tion. State Senator Virgil O'Sullivan introduces Senate Bill 282,authorizing funds for creation of a special staff in the State De-partment of Public Health to promote care and services for sea-sonal agricultural workersthe birth of the Farm Workers HealthServ;ce. Fourteen agricultural counties expand local health pro-grams to include services for migrants.

1962 Federal Bill 5 -1130 provides budget funds to developand coordinate a unified statewide health program for farmworkers. Public Law 87-692the Migrant Health Actauthorizesgrants for family clinics for domestic agricultural migrants.

1963 Report of the Governor's Advisory Commission onHousing reveals that 80 percent of farm worker families live in.grossly substandard housing, if any at allone-third with open

'44

privies, nearly one-third without bathing facilities, one-quarterlacking even a kitchen sink with running water. Median annualincome $2,207-250 percent below statewide average.

1964 Public Law 78the latest of the statutes which hadextended the "emergency" bracera program for 22 yearsis fermi.nated. At its height, the bracero program brought nearly half amillion men into the United States from Mexico each year during

the harvest season.

1965 The California Migrant Master Plan is designed under

provisions of Title 111-B of the Federal Economic Opportunity Actof 1964. First temporary seasonal "flash peak" migrant familyhousing center is erected in one week in the San Joaquin Valley.Twenty-four more centers to follow in five years. Centers provideadequate housing, child day care, edocat:on and health servicesat a cost of $1 a night per family ...hie J:9,onis we working inCalifornia but must turn away neat `y tw.ce us -y needy ;am;

lies as they can accommodate.?

1966 California Rural Lego: (.--,ded by U S

Office of Economic Opportunity Operat:ng :n 17 counties, CRIAoffers bee legal assistance to the rural poor, espec:ally farmworkers, including advice regaid:n9 schools :nbs, housing andgovernment. Nearly 26,000 (Lents served cr,ec4ly 7n 10 351 cases

handled during 1967-68.18

1968 California State Department of Education, under Pubtic Law 89 750, develops muster pun for ,ompersalory educationinterstate coordination, record transfer, teacher training andhealth services for children of migrant form torrTes Some 29,000

migrant children benefit from 38 k.oupe,c.4've p,o;ects organizedby 176 school districts in 27 counties Form Workers Health Service

provides program design, Lonsultot;on, :n fro;ning and

evaluation of health componen0

1969 The California Migrant Muster P!,1,1 s transferred from

the State Office of Economic Opportunity to the Departm of

Human Resources Development tlo«nerly Deportn-ent of Employ

menu. More than 2,600 families 13,800 people find temporaryshelter, health, sanitation, education and child care in 23 statemigrant housing centers. Another 4,337 families, however, must

be turned away 20

1970 With Farm Workers Healthgroup day-care programs for children in thousing centers are expanded on a demoninfants under the age of 2. Such pioneerfrom before dawn until after nightfall--alto work the freedom to do so, confidentwhatever age, will receive skilled care an

1971

thing facilities, one-quarternning water. Median annualatewide average.

est of the statutes which hadrogram for 22 yearsis fermi-ogram brought nearly half aom Mexico each year during

Master Plan is designed underat Economic Opportunity Ad"flash peak" migrant family

ek in the San Joaquin Valley.in five years. Centers provideedu. "1 -.

ly fW

s,

ni00:

r,,

Off

13

1970 With Farm Workers Health Service support, 0E0group day-care programs for children in three California migranthousing centers are expanded on a demonstration basis to include

infants under the age of 2. Such pioneering all-day careoftenfrom before dawn until after nightfallallows mothers who wish

to work the freedom to do so, confident that their children, ofwhatever age, will receive skilled care and supervision.

1971

Really Nice People

Gary McNamara is a tall, cheerful pre-medical graduate witha ruddily youthful face and prematurely greying hair. For the pastsix years he has been a sanitarian for the Merced County HealthDepartment. During the summer months he is responsible formigrant health sanitation in all the 700 square miles of MercedCounty lying west of the San Joaquin River.

June 10, 1970 is an unseasonably temperate day for Cali-fornia's Central Valleylow 80's, light breeze, bright sunshine.Cool weather has delayed tomato ripening locally, but now theharvest season is getting underway. Later in the summer McNa-mara will have to inspect canneries, packing sheds and the fieldsthemselves for compliance with toilet and hand-washing regula-tions of the Food Crop Growing and Harvesting Lawbut rightnow, on this day, his main concern is the 25-odd farm labor campsin his territory, into which the migrants are beginning to move.

About 10 a.m., McNamarain the company of a visitorsetsout from the county health department office in Merced to visitthe Los Banos Migrant Housing Center, 37 miles away. First, how-

ever, he calls at the county Planning Department in Merced."Has a trailer permit been issued in the name of Rodriguez?"

he inquires.The clerk checks, says no."I was afraid of that," nods McNamara. He confers with the

clerk about the procedures for obtaining a permit to install ahouse trailer. The clerk hands McNamara an instruction form andexplains that the permit cost is 10 cents per square foot of trailerspace. The instruction form, in English, looks fairly complicated.

"Does anyone here speak Spanish?"McNamara asks.

"Nah. Wish I did, though," the clerk smiles. "It sure would come

in handy sometimes.""Yeah. I can't either," McNamara agrees. He returns with his

visitor to the car."The Rodriguezes are a local family, Mexicans," he amplifies as

they drive west. "They're really nice people. Mother and fatherand eight children. This winter the family's been on welfare, butnow that the season's starting he'll go back to farm work. He'llmake less money that way than he would if they stayed on wel-fare. But these people are proud. They're not lazy. He'll migrate

later on, too. This is their home base. Rigthe county housing project at South Dos Punusual in the sense that most migrantsplace long enough to qualify for publibought a house trailer and they're planninway he tells it, he's buying 11 acres frompay it off at his convenience. I don't kno"The trailer's about 35-by-10. Ten peopplained to him he had to get a permit, buEnglishexcept for the kids. At 10 cent$35.00. I don't think they've got that kilapses into silence.

At the Los Banos Camp, McNamarathorough inspection. He exclaims at thechild day-care center. He makes a notethe outside privies need replacement, anHe recommends that springs be installeinsure that they will close. He checks themake sure weeds have been removedprevious inspection. He knocks at the dowood houses and politely asks whether e

In the second unit, a very pretty youninside. She apologizes shyly for the mess.tioned side rooms are made, the clothingscrubbed, clean eating utensils stackedcentral table in the kitchen-living room cthing is fine, but a screendoor would be nthat she is pregnant and asks if she knogrant health project maternity clinic in Sshe does and plans to attend next Tuesdwell, says she is from Holtville, near El Cfirst time she has come with her husband,thinks the camp is very nice. McNamalfriendliness and intelligence.

Observing the "5 Millas Despacio" sign'

the main gate. He comments wryly onafter heated community debate, was locroad from the county dump. He drives sev

.

Really Nice People

heerful pre-medical graduate withmaturely greying hair. For the pastrian for the Merced County Healther months he is responsible forI the 700 square miles of Mercedoaquin River.sonably temperate day for Cali-O's, light breeze, bright sunshine.ato ripening locally, but now therway. Later in the summer McNa-eries, packing sheds and the fields

toilet and hand-washing regula-ing and Harvesting Lawbut rightern is the 25-odd farm labor campsmigrants are beginning to move.in the company of a visitorsetspartment office in Merced to visitCenter, 37 miles away. First, how-

nning Department in Merced.issued in the name of Rodriguez?"

s McNamara. He confers with theor obtaining a permit to install a

McNamara an instruction form and10 cents per square foot of trailer

English, looks fairly complicated.panish?"McNamara asks.

the clerk smiles. It sure would come

amara agrees. He returns with his

I family, Mexicans," he amplifies asIly nice people. Mother and fatherr the family's been on welfare, but

hell go back to farm work. He'lln he would if they stayed on wel-

oud. They're not lazy. He'll migrate

20

later on, too. This is their home base. Right now they're living inthe county housing project at South Dos Palos, which is of courseunusual in the sense that most migrants don't stay at any oneplace long enough to qualify for public housing. But they justbought a house trailer and they're planning to move into that. Theway he tells it, he's buying 11 acres from a man who says he canpay it off at his convenience. I don't know." He shakes his head."The trailer's about 35-by-10. Ten people in two rooms. I ex-

plained to him he had to get a permit, but they hardly speak anyEnglishexcept for the kids. At 10 cents a square foot, that's

$35.00. I don't think they've got that kind of money. . . ." Helapses into silence.

At the Los Banos Camp, McNamara conducts a quick butthorough inspection. He exclaims at the spotless kitchen in thechild day-care center. He makes a note that worn toilet seats inthe outside privies need replacement, and detects several leaks.He recommends that springs be installed on the toilet doors toinsure that they will close. He checks the camp sewage pond tomake sure weeds have been removeda problem noted in the

previous inspection. He knocks at the doors of two occupied ply-wood houses and politely asks whether everything seems all right.

In the second unit, a very pretty young girl invites McNamarainside. She apologizes shyly for the mess. The beds in both parti-tioned side rooms are made, the clothing hung, the cement floorscrubbed, clean eating utensils stacked neatly by the sink, thecentral table in the kitchen-living room cleared. She says every-thing is fine, but a screendoor would be nice. McNamara observes

that she is pregnant and asks if she knows about the weekly mi-grant health project maternity clinic in South Dos Palos. She says

she does and plans to attend next Tuesday. She speaks English

well, says she is from Holtville, near El Centro, and that this is thefirst time she has come with her husband to Merced County. Shethinks the camp is very nice. McNamara is impressed by herfriendliness and intelligence.

Observing the "5 Mil las DespaL a" sign, he wheels out throughthe main gate. He comments wryly on the fact that the camp,after heated community debate, was located directly across the

road from the county dump. He drives several miles east and pulls

219

over beside a weed grown cluster of stucco buildingsa formerbracero camp. The buildings are deserted. "Gee, it doesn't looklike they're going to open at all this year," he exclaims in surprise."If they are, they've sure got an awful lot of work to do."

The next stop on his itinerary is the county office in Los Banos,where he usually spends a half-day each week. But first he detoursinto the local county housing project. Pretty pastel houses sit ontrim lawns. He walks into the manager's office.

"You know the Rodriguezes?" he asks after some friendlybanter. "They've bought a trailer and they're going to be movingout of the South Dos Palos project."

"That's what they told me," the manager nods. She is a gre-garious white-haired woman. "I'm going to hate to lose them.They're among our best tenants."

"I don't see how they're going to manage, with all those chil-dren in only two rooms. I don't think they can afford the permitfee, either. Could they stay on in the project?"

"Sure, I wish they would.""So do I," McNamara mutters. "I'm going to go out there and

talk to them this afternoon."McNamara and his visitor eat lunch. Afterwards they drive

south, paralleling irrigation canals which wind along the base ofparched brown mountains. A few miles outside Los Banos theyturn off the highway and thread a dirt trackan orchard of ripen;ng apricots on one side, an open field of sprouting cotton on theother. At the end of the drive is a labor contractor's campcapacity 125 single men. The camp has only been open for threedays, and there are just 26 men staying there now. McNamaratakes a cursory look at the cookhouse kitchen, assures that foodis procured from sources under inspection, tells the woman incharge to keep the lid on a galvanized garbage pail filled withflour. He says he'll come back later, when the camp is full. Beforeleaving he glances in at the dormitory. A few young men loungeimpassively on musty mattresses.

"Our big problem in this county is that most of the camps weredesigned for bracerossingle men," he says. "There just isn't verymuch housing for migrant families. The camps aren't suitable. Andthe housing situation this year is really serious."

As if to illustrate, he pulls over at a compound of abandonedwooden buildings. "Hm. Doesn't look like this one's going to openeither," he muses. The buildings, constructed in dormitory style,

10

22

have makeshift doors clumsily cut into thpartition these off for families," he expltoo well. The partitions only went eighthear everybody else in the whole placesnoring and crying..."

,He bounces over the rutted drivewayverdant field, a low rambling house is"That house was designed by Frank Llohis visitor.

The highway to South Dos Palos winds tHere and there a stately heron perches oMcNamara recalls that most of this ricefrom its Japanese-American owner duriacquired cheaply by his non-Japanese gr

The unincorporated community of Scuta post office, a couple of stores and aframe houses. It is inhabited primarilyin the 30's to work the cotton, but cmechanized operation.

"The people here are poor as church-ments, "but they're real community-mindedcommunity organization the residents hayfirst potable water system, are conductinto keep school children busy during thetiated several self-help housing projects.four incredibly dilapidated wooden shack

"Those are owned by one of our top c"I almost lost my job when I condemnedpeople back in. They're occupied now." 11

The South Dos Palos project resembleMcNamara approaches the detached unit itlive, he begins to fret. "I hope the oldestspeaks English. The mother can't understinto the driveway. "I hope Mrs. Rodrigue

At the door he is met by the 12-year-olis cradling a toddler with a bottle. Fivelsisters peer at the strangers curiously. Let'sfrom the television set ("You just passed ugleefully taunts a contestant). Mrs. Rodriglsaysshe is working in the fields withMcNamara makes a brief attempt to exl

1

1

1

1

I' of stucco buildingsa formereserted. "Gee, it doesn't lookyear," he exclaims in surprise.ul lot of work to do "

the county office in Los Banos,each week. But first he detoursct. Pretty pastel houses sit onger's office.he asks after some friendlynd they're going to be moving'I

manager nods She is a gregoing to hate to lose them.

o manage, with all those chilnk they can afford the permithe project?"

I'm going to go out there and

lunch. Afterwards they drivewhich wind along the bdie ofmiles outside Los Banos they

dirt trackan orchard of ripeneld of sprouting cotton on the

a labor contractor's camphas only been open for three

taying there now. McNamarause kitchen, assures that foodspection, tells the woman innized garbage pail filled with, when the camp is full. Beforery. A few young men lounge

is that most of the camps werehe says. "There ;ust isn't very

The camps aren't suitable. Andally serious."at a compound of abandonedk like this one's going to openonstructed in dormitory style,

have makeshift doors clumsily cut into their sides. "They tried topartition these off for families," he explains, "but it didn't worktoo well. The partitions only went eight feet up, so you couldhear everybody else in the whole place talking and eating andsnoring and crying..."

He bounces over the rutted driveway to the road. Across averdant field, a low rambling house is set in a clump of trees."That house was designed by Frank Lloyd Wright," he informshis visitor.

The highway to South Dos Palos winds through green rice fields.Here and there a stately heron perches on one leg in the water.McNamara recalls that most of this rice acreage was confiscatedfrom its Japanese-American owner during World War II, andacquired cheaply by his non-Japanese grower-neighbors.

The unincorporated community of South Dos Palos consists ofa post office, a couple of stores and a collection of crumblingframe houses. It is inhabited primarily by blacks. They camein the ,30's to work the cotton, but cotton-picking is now amechanized operation.

"The people here are poor as church-mice," McNamara com-ments, "but they're real community-minded." He notes that throughcommunity organization the residents have recently acquired theirfirst potable water system, are conducting a clean-up campaignto keep school children busy during the summer, and have ini-tiated several self-help housing projects. He drives slowly pastfour incredibly dilapidated wooden shacks.

"Those are owned by one of our top county officials," he says."I almost lost my job when I condemned them. But he's movedF.,.-..ple back in. They're occupied now." He shakes his head.

The South Dos Palos project resembles that in Los Banos. AsMcNamara approaches the detached unit in which the Rodriguezeslive, he begins to fret. "I hope the oldest daughter is home. Shespeaks English. The mother can't understand a word." He turnsinto the driveway. "I hope Mrs. Rodriguez doesn't cry!"

At the door he is met by the 12-year-old daughter, Elena, whois cradling a toddler with a bottle. Five younger brothers andsisters peer at the strangers curiously. Let's Make a Deal is blaringfrom the television set ("You just passed up $400!" the announcergleefully taunts a contestant). Mrs. Rodriguez is not home, Elenasr.ysshe is working in the fields with her husband today.A.cNamara makes a brief attempt to explain the need for and

2 3

cost of a trailer permit to Elena. She nods and seems to understand, but McNamara is doubtful as he leaves.

"I'm just going to have to come back out here on Tuesday night

when the clinic's in session," he mourns. "They're never going tofigure all this out." He turns on the ignition. "I'll tell you one lawI'd like to pass. They shouldn't let anyone come ;nto this country

to work without knowing English. At least some rudimentary, ele-mentary English."

He heads down the road a mile and turns off into a muddyclearing. Used lumber is piled about, and rusty tin cans havebeen collected into heaps. At the rear of the lot a long whitehouse trailer sits on concrete blocks A plowed field stretches away

behind the trailer.This is it, he says. He begins to prowl around "They hauled

it up from Fresno over the weekend_" He finds a deep holecovered by a tarpaulin. "They've got their cesspool in, I see Made

out of wood. He shakes his head and chuckles sadly "Illegal as

hell: He paces about. "You tell me," he suddenly challenges his

visitor, should I approve that cesspool or should I condemn itand make them put in a septic tank?"

How much would it cost for a cheap septic tank')"Three hundred dollars. Minimum They're just re,e, going to

get their hands on that kind of money!"He walks around in silence for a few moments, then begins to

mumble. See? All they want is a little independence You saw

now nice that housing project was. But they don't I:14e taking wel

fare. They want to be on their own He squirts across the field

r don t know, can they make a living on 11 acres') Rodriguezsays the guy who owns the land going to let him pay it offwhenever he s got a little casFrto spare But I kr,ow that guy andhe lust isn t that goodhearted He's mok:rg sc,e nsoney there

somewhere. I haven't figured it out yet"McNamara climbs back into his car and drives to Dos Palos

He points out the single local industry, a textile mill which produces auto floor mats. h employs 75 people A few self helphouses are going up on back streets once again opposite the

garbage dump. You see what a great ;ob government does in

picking sites!" he grimaces.Outside town he stops at a white frame farm house. Beside it

sags a row of unpainted cabins, ancient, which are rented to farmworkers. He finds the young woman who owns the place out back

24 25

She nod., ,

s he leavesback out here on Tuesday nightourns. "They're never going to

e igmhon. !!! '&± icy cne Pswanyone come into this country

At least some rudimentary, ele

ile and turns off into a muddybout, and rusty nn cans havee rear of the lot a long white

A H

to vir,eket,tot

ow;me,ey,p

'

chtun

on(

8

n ti-

11.

hite frame farm house. Beside itancient, which are rented to farman who owns the place out back

425 11

. ,`0.

gardening. He introduces himself and explains that a water sampletaken the previous week showed contamination. A complaint aboutthe water had been relayed from the county welfare department.

"We all use the same well," the woman shrugs. "Nobody aroundhere has been sick. None of my family's been sick."

McNamara examines the welI.pump. "What I'll do," he says,"is take another sample. But if that proves bad you'll have tochlorinate." He explains the simple procedure.

12

26

Later, in the car, he adds: "These arplaces. We're constantly getting comp)people. I tell them what they should do,these cabins for welfare client!, to live in.retit c fiei..k.s But they say no people haveftey want."

He stows his water sample in the backwhy everyboJ/ here isn't doubled up. I

ac- rate.. I' was throwing cultures all"e heads buck toward Merced. "The

out of place's, they II lust have towhen make housing Inspections we

I condition 1,, wt,c,tl-er they can live withe wiring, the plumbing, the structure,

.0,, landlord to fix things upt F von if w. take court action, i

!h,nqs cue broughtc-)ricierilne(; and he people ha

,,. pr Pit/ aroupi)SS"Ve 1.1JVS Irj`Pfl get 15 peoplebedroom hovse like a phone call we got

At parks in front oft4,)! ,cie it hasn't b

t t.10,)0 i finish:Imps to be a

0'144 L 01 ottoui 500 awhen I'm not in different offices.

He walks inside to his desk, where thespent writing reports, answering telephonlow-up work. He settles into his swivel chai

"You certainly spent an awful lot of timthe visitor comments.

"Yeah, well, the Rodriguezes are speciesometimes you just get involved with peasuch nice people. They're really trying to

He becomes thoughtful for a moment. TNleans back and kicks his feet up on the dia low, conspiratorial voice to his visitor.he cups his hand behind his head. "I'mcesspool!"

"

ins that a water sampletion. A complaint aboutty welfare department.hrugs. "Nobody arounden sick."

`What I'll do," he says,es bad you'll have to

ure.

Later, in the car, he adds: "These are really pretty crummyplaces. We're constantly getting complaints from the welfarepeople. I tell them what they should do, then, is stop approvingthese cabins for welfare clients to live in. Refuse to give them therent checks. But they say no, people have a right to live wherethey want."

He stows his water sample in the back -gat. "I can't figure outwhy everybody here isn't doubled up. If that last sample wasaccurate... . It was throwing cultures all over the test - tube!"

He heads back toward Merced. "The trouble is, if we movepeople out of places, they'll just have to go to worse conditions.So when we make housing 'Inspections we have to decide how bada condition is, whether they can Rye with it or not. We look atthe wiring, the plumbing, the structure, everything. Of course,when we tell the landlord to fix things up, we can't really makehim do it. Ever. if we take court action, it all winds up with thesame result. Either things are brought to standard or else thehousing is condemned and the people have to find a new placeto live. Which can be pretty difficult around here. Practically im-possible. That's when you get 15 people living together in a one-bedroom house -- like a phone call we got this morning."

At 3 p.m., McNamara parks in front of the county health de-partment. "Well, I can't say it hasn't been a typical day," hedeclares. "We get busier, though. I finished early today becauseI expected those other two camps to be open. We covered about110 miles. I usually put on about 500 a weekin the four dayswhen I'm not in different offices."

He walks inside to his desk, where the remaining hours will bespent writing reports, answering telephone calls and doing fol-low-up work. He settles into his swivel chair.

"You certainly spent an awful lot of time on that one family,"the visitor comments.

"Yeah, well, the Rodriguezes are special, I guess. I don't know,sometimes you just get involved with people's problems. They'resuch nice people. They're really trying to better themselves."

He becomes thoughtful for a moment. Then suddenly he grins,leans back and kicks his feet up on the desk. "Heck," he says ina low, conspiratorial voice to his visitor. His smile broadens andhe cups his hand behind his head. "I'm going to approve thatcesspool!"

2'r

Stanislaus County, California, June 26, 1970. Early morningspatters of rain, high overcast, Midwest humidity in air. Full-leavedtrees line San Joaquin River and sloughs.

9:30 a.m. Arrive West ley Farm Labor Center to meet Mrs.Irene Griffin, calui_ nurse for Stanislaus Migrant Health Care Pro-

gram. "Office of Health" sign hangs over door of wood framebuilding with peeling paint formerly a garage Inside ;s large

room with blue-painted cement floor, long leather couch andthree chairs, scale, curtained examination alcove with sink andmedicine cabinets, two large wooden desks at far end Yellowwalls are hung with health posters in Spanish and English "El

autobus den!...; estura en el campo e' dia 22 de Junlo," reads

largest poster, which shows Greyhound Ls Mrs Grifftn is bandag

mg cut forehead of small, sobbing boy She is pleasant faced

woman with swept-back brown hair, earrings, p"ok blouse, blockand-white checked skirt and sandals. She projects air of goodhumored competence. Greetings exchanged.

9.40 Mrs. Griffin telephones nearest physician one of four inPatterson, six miles down rood to make imrnecrate appointmentfor little boy to have sutures and tetanus shot She ascertains,

using broken Spanish, that mother has transportation and knowswhere to go.

9:50 Sorry to keep you waiting," she says to visitor. "Some

times it gets a little hectic around here. Let's go down to thedental bus."

Large, conventional-looking bus is parked beside camp laundro

mat shed. Children sit gaily, well-behaved, on long bench alongoutside wall of shed. Inside bus, youthful dentists in sandals andsportswear, and pretty young hygienist in Bermuda shorts. exchange banter. Drills whine. Man ai.ghts from bus in short sleevedshirt, slacks and tennis shoes. He is Dr. Merle E Morris, professorof pediatric dentistry at University of California Medical Center,San Francisco. UC, with Migrant Education funding, sponsors two$80,000 mobile dental clinic buses which travel through SanJoaquin and Salinas Valleys ir summer offering free preventiveand restorative care for children living in farm labor camps Bus

is staffed by six graduate dentists, three junior students, one li

tensed hygienist and one senior student hygienist Laundry shed

al

une 26, 1970. Early morningest humidity in air. Full-leavedughs.

Labor Center to meet Mrs.laus Migrant Health Care Pro-gs over door of wood framerly a garage. Inside is largeoor, long leather couch andination alcove with sink anden desks at far end. Yellows in Spanish and English. "El

el dia 22 de Junio," readsnd bus. Mrs. Griffin is bandag-g boy. She is pleasant faced, earrings, pink blouse, black-

ials. She projects air of good-xchanged.barest physicianone of four inp make immediate appointmentI tetanus shot. She ascertains,

has transportation and knows

ng," she says to visitor. "Some-d here. Let's go down to the

is parked beside camp laundro-behaved, on long bench alongouthful dentists in sandals andgienist in Bermuda shorts, ex-lights from bus in short-sleevedDr. Merle E. Morris, professorof California Medical Center,

ducation funding, sponsors twouses which travel through Sanummer offering free preventiveliving in farm labor camps. Bust, three junior students, one li-student hygienist. laundry shed

, i i

e

houses two portable dental chairs for exams, bus has four chairsand full equipment for extractions and fillings. One dentist andhygienist have gone ahead to Patterson campnext stop for busto conduct preliminary screening exams and take X-rays.

"We're going to stay an extra day," Dr. Morris tells Mrs. Griffin."Gee, things are looking a lot better here this year than last,though. You know little Miguel, the boy in the wheelchair? Heonly had three cavities. Last year his teeth were terrible!"

Dental exams often reveal other health problems and bus staffalways turns over duplicate records to camp nurses. Mrs. 34:ffinnotes that county medical society has picked up bill for expensive.root-canal job referred from mobile clinic.

"We refer everything we find," Dr. Morris says. "We have todo follow-up, or else we're missing the boot in our program. It'ssurprising how much a little thing like this, fixing up children'steeth, can make in their whole future lives. It can change theway they perform in school, how they're accepted by their class-mates and society ... not to mention making them healthier andmaking them feel better."

"Did Virginia help you out?" Mrs. Griffin asks about 16-year-oldgirl who served as volunteer interpreter and errand-girl for clinic.

"She sure did," Dr. Morris beams. "These volunteers are whatreally makes or breaks our program."

"She says it was so interesting she wishes she could go withyou to the other camps. Her mother said it would be all right.",

"Well, that would be great!" Dr. Morris exclaims. "We coulduse herI'll work on it!"

10.10 On way back to office, Mrs. Griffin stops at nearbytrailer to arrange dental evaluation appointment for child. Door-step conversation is halting but productive. "I often get a goodfeeling and real rapport out of these one-to-one talks," she comments, "even if I'm speaking English and they're speaking Spanish.We work together to understand each other."

10:15 Strolling through camp, Mrs. Griffin explains local migrant health project, which relies on nurses and aides for pre-

ventive medical screening and routine treatments."When the family arrives, we offer the father and mother a

TB sk;n test, a Wassermann, hemoglobin, urinalysis, take the bloodpressures and ask a lot of questions on family health history. Thatmay be the last time we'll see Pop. We screen the children closely,working with the school nurses. Once a month there's a well-baby

14

clinic, with immunization and physical exWe've been trained to do Pap smears rouevening clinics, and if we suspect any ofthem to a physician. During the year weclasses and show health films from timenot so good I take it outside and show thhouse. That gets a good response. And ogood health practices as I go along."

10:25 Visit camp day-care center. Msome, clean-cut young child psychology grObserve story hour. Story told in Spanishas circle of 3-year-olds respond boisterousto 100 children between ages of 2 and 5 withree Neighborhood Youth Corps workersfrom community. Children often arrive attime cots until breakfast and classes start,return from field., at 4 p.m. Thomas showgarbage piled in front of center and boar

"The garbage company refuses to makea week," he complains. "It's in court now.won't give us the windows and screens wThat's dangerous, kids and jagged glass."outside drinking fountain in playground.won't come out and fix it. They say therwould only get broken again. They wouldexceptions out here if they needed the woyear."

11:15 Mrs. Griffin drives to Patterson twho saw .doctor for pre-natal check-ups.she says, " a lot of times until 6 or 7 p.m.aon clinic nights. I stay to meet the peoplemg the day. We tried keeping office houThe idea is to be around when the peoppassengers. The doctors here are beautifa nice job. One is always on call. Thereterson, but I've only been able to get twyears, so I usually refer people to Modesto]she asks about a prescription. "I took a cotbut I've picked up most of what little I klpeople, so it's not always grammatically coof two local pharmacies to have prescriptic]

31

tams, bus has four chairsfillings. One dentist andcampnext stop for bus

Is and take X-rays.. Morris tells Mrs. Griffin.here this year than last,qf in the wheelchair? Heth were terrible!"h problems and bus staffcamp nurses. Mrs. Griffinked up bill for expensivehic.Morris says. "We have toboat in our program. It'sthis, fixing up children'slives. It can change theaccepted by their class-

aking them healthier and

fin asks about 16-year-oldand errand-girl for clinic.

these volunteers are what

dishes she could go withtid it would be all right."orris exclaims. "We could

s. Griffin stops at nearbypointment for child. Door-pive. "I often get a goodIne-to-one talks," she corn-0 they're speaking Spanish.other.". Griffin explains local mi-nurses and aides for pre-eatments.the father and mother a

, urinalysis, take the bloodfamily health history. Thatscreen the children closely,month there's a well-baby

clinic, with immunization and physical exams by a pediatrician.We've been trained to do Pap s.nears routinely on the women atevening clinics, and if we suspect any other problems we referthem to a physician. During the year we give medical self-helpclasses and show health films from time to time. if the turnout'snot so good I take it outside and show the film on the side of ahouse. That gets a good response. And of course I try to teachgood health practices as I go along."

10:25 Visit camp day-care center. Meet Len Thomas, hand-

some, clean-cut young child psychology graduate who is director.Observe story hour. Story told in Spanish and English alternately,

as circle of 3-year-olds respond boisterously. Center cares for up

to 100 children between ages of 2 and 5 with staff of five teachers,three Neighborhood Youth Corps workers and 11 aides recruitedfrom community. Children often arrive at 5 a.m., sleep on nap-time cots until breakfast and classes start, go home when parents

return from fields at 4 p.m. Thomas shows visitor around, notinggarbage piled in front of center and boarded windows.

"The garbage company refuses to make more than one pickup

a week," he complains. "It's in court now. The housing authority

won't give us the windows and screens we're supposed to have.That's dangerous, kids and jagged glass." He points to the singleoutside drinking fountain in playground. "It's broken, and theywon't come out and fix it. They say there's no point because it

would only get broken again. They wouldn't be so quick to makeexceptions out here if they needed the workers in the harvest this

year."11:15 Mrs. Griffin drives to Patterson to pick up three women

who saw doctor for pre-natal check-ups. "I work sliding hours,"she says, "a lot of times until 6 or 7 p.m.and even later, of course,

on clinic nights. I stay to meet the people who can't come in dur-

ing the day. We tried keeping office hours, but it doesn't work.The idea is to be around when the people are." She meets her

passengers. "The doctors here are beautiful," she says. "They do

a nice job. One is always on call. There are two dentists in Pat-

terson, but I've only been able to get two appointments in three

years, so I usually refer people to Modesto or Turlock." In Spanish

she asks about a prescription. "I took a course in medical Spanish,but I've picked up most of what little I know from talking withpeople, so it's not always grammatically correct." She stops at one

of two local pharmacies to have prescription filled.

31

12:25 Lunch at day-care center. Menu: enchiladas, Spanish

rice, green salad, orange drink, strawberry parfait. Mrs. Griffin,watching her diet, eats sparingly. On impact of migrant health

program, she declares: "We see less diarrhea among babies now.

A few less head lice. Certainly less impetigo. Anemia's way down.

The doctors say they see fewer serious health problems all around."

Interstate cooperation is still poor, though. "Last year I received

only one family planning referral from Texas and one report of a

Class II Pap smear from Southern California. I wrote several letters

to public health departments in Texas, but Iat all. It'd be nice to hear what happens toif anything does. That's why we're so b

save up all their health problems for us."

1:10 Mrs. Griffin returns to office. Besome 30 camp residents will call on her finclude bandaging children's scrapes, asrequire immediate attention from physiciand dental appointments, making hous

mother and child to doctor's office in P.

will observe vary from minor insect biteswollen leg in icewater), to respiratory illvulsions (she makes quick house call todrug prescription for refill), to occupatiof lower back pain in men, reported by tsprain described by victim's wife thus: "BiShe will also advise a woman confused bof county Crippled Childrens Services, awoman who apologizes, "Escribo muy ma

2:20 Enroute to Patterson: "Do farmnesses than other people?" she muses.selves they do. After all, they work hard,don't rest, they neglect themselvesbetathey have to do it!

"Most of them, once they learn and cthing is done in a certain way, they'll fisn't easy to sell them, though. In manyreceptive than the women. You know, tpublic health that if you teach a man youbut if you teach a woman you're educatithat's not always true with the Mexican cwho makes the decisions. He's the oneget medicine. You've got to get throu

trouble."We have to be careful, though, to

can do themselvesand with things thel

homes.. If you put on a bandage you dto have a sterile four-by-four! You say aldo as well. They have enough pressure cldori't have to put more on.

ter. Menu: enchiladas, Spanishstrawberry parfait. Mrs. Griffin,. On impact of migrant health

less diarrhea among babies now.s impetigo. Anemia's way down.ious health problems all around."

r, though. "Last year I receivedI from Texas and one report of aCalifornia. I wrote several letters

32

to public health departments in Texas, but I didn't get any response

at all. It'd be nice to hear what happens to these things, you knowif anything does. That's why we're so busy in California. Theysave up all their health problems for us."

1:10 Mrs. Griffin returns to office. Between now and 5 p.m.,

some 30 camp residents will call on her for aid. Her activities will

include bandaging children's scrapes, assessing conditions which

require immediate attention from physician, arranying medicaland dental appointments, making house visits, and driving amother and child to doctor's office in Patterson. Conditions she

will observe vary from minor insect bites (she soaks little girl's

swollen leg in icewater), to respiratory illnesses, to epileptic con-vulsions (she makes quick house call to pick up anti-convulsantdrug prescription for refill), to occupational illnesses (two cases

of lower back pain in men, reported by their wives, and a serioussprain described by victim's wife thus: "Big Jesse has a fat foot.")She will also advise a woman confused by document requirements

of county Crippled Childrens Services, and fill out forms for awoman who apologizes, "Escribo muy mal."

2:20 Enroute to Patterson: "Do farm workers have more ill-

nesses than other people?" she muses. "Well, they tell me them-

selves they do. After all, they work hard, they get poor food, they

don't rest, they neglect themselvesbecause when the work's in,

they have to do it!

"Most of them, once they learn and can be sold on why some-

thing is done in a certain way, they'll follow through with it. It

isn't easy to sell them, though. In many ways the men are morereceptive than the women. You know, there's an old saying inpublic health that if you teach a man you're educating one person,

but if you teach a woman you're educating a whole family. Well,that's not always true with the Mexican culture. There it's the man

who makes the decisions. He's the one who'll send his wife in toget medicine. You've got -to get through to Dad or you're in

trouble."We have to be careful, though, to demonstrate things they

can do themselvesand with things they can use in their ownhomes. If you put on a bandage you don't say, Well, you have

to have a sterile four-by-four! You say a clean piece of cloth will

do as well. They have enough pressure on them already that you

don't have to put more on.

3315

"They're really hard-working people.three in the morning to make tortillas forday. The man gets up at five to go to wcome in they'll be in the field 12 hours aof the lazy Mexican with the sombrero puis really a misconception!"

3:30 Mrs. Irma Perez, clink aide, reModesto, 16 miles away. She is strikinglywith large dark eyes, delicate features, blabun and tied with flowing white scarf. Shter and husband who works for crop-dustiShe has lived in camp 14 years. As aidespends most of each day driving peopletranslates for and shepherds them throug

"I enjoy it a lot," she says. "I like to s

and help them. They all know me arounafternoon I make calls here to remindments and be sure they have a way to gechildren who're staying home sick are twatch the office, but if they don't see thepeople won't come in. But when they haveto my house and ask me questions or askhospital. That makes me feel real good, v4,

3:50 Sheriff's wife, who is coordinatprograms at local school, and who is helpievening to raise money for camp hospivisit. Fund, established through such socialbake sales, provides pool of money froborrow when they need hospitalization bwife tells Mrs. Perez to be sure to bring he

4:05 Len Thomas stops in to report thaand Aurora seem to function better atseparated. Girls are hyperactive, hostiledefinitely need some kind of professionalMrs. Griffin agrees, notes that she has alrewith pediatrician. Later, she says, she willpare mother for questions she will be asketoo, Thomas adds. Parents merely ignoregiven up as "crazy."

4:75 Mrs. Griffin delivers prescriptionway back she encounters Virginia Romo.

34

"They're really hard-working people. The woman'll get up aithree in the morning to make tortillas for the whole family for theday. The man gets up at five to go to work. When the tomatoescome in they'll be in the field 12 hours a day. The old stereotypeof the lazy Mexican with the sombrero pulled down over his faceis really a misconception!"

3:30 Mrs. Irma Perez, clinic aide, returns from daily trip toModesto, 16 miles away. She is strikingly attractive young matronwith large dark eyes, delicate features, black hair pulled back intobun and tied with flowing white scarf. She has 3-year-old daugh-ter and husband who works for crop-dusting service in Patterson.She has lived in camp 14 years. As aide for past two years, shespends most of each day driving people to Modesto, where shetranslates for and shepherd. them through various agencies.

"I enjoy it a lot," she says. "I like to share people's problemsand help them. They all know me around the hospital. In theafternoon I make calls here to remind people of their appoint-ments and be sure they have a way to get there. And I see if thechildren who're staying home sick are taking their medicine. I

watch the office, but if they don't see the nurse's car out in front,people won't come in. But when they have emergencies they cometo my house and ask me questions or ask me to drive them to thehospital. That makes me feel real good, when people ask for me."

3:50 Sheriff's wife, who is coordinator of federally-fundedprograms at local school, and who is helping organize dance nextevening to raise money for camp hospital fund, pays friendlyvisit. Fund, established through such social affairs as dances andbake sales, provides pool of money from which residents mayborrow when they need hospitalization but cannot pay. Sheriff'swife tells Mrs. Perez to be sure to bring her husband to dance.

4:05 Len Thomas stops in to report that 5-year-old twins Doraand Aurora seem to function better at day-care center whenseparated. Girls are hyperactive, hostile and disruptive. "Theydefinitely need some kind of professional evaluation," he says.Mrs. Griffin agrees, notes that she has already made appointmentswith pediatrician. Later, she says, she will make home-call to pre-pare mother for questions she will be asked. Home life seems badtoo, Thomas adds. Parents merely ignore twins, whom they havegiven up as "crazy."

4:15 Mrs. Griffin delivers prescription to nearby house. Onway back she encounters Virginia Romo.

35

"Well, it's all set," Mrs..Griffin exclaims. When bus goes to Pat-terson camp, Virginia can commute each day from home. Butwhen it moves to Empire camp, she will be housed in local collegedormitory with other girls staffing UC project. Same arrangementswill apply when bus goes further south, to Merced. Dr. Morris willassume expenses.

Virginia's eyes sparkle with excitement, but she smiles shyly.4:25 Two womenone elderly, one young, haggard and very

pregnantmeet Mrs. Griffin outside office door. Elderly woman'sson, 15, received blow on head in fight day before. Mrs. Griffinmakes appointment with doctor for early next morning.

"When are you going to see the doctor?" she asks pregnantwoman.

Woman is noncommittal, avoids Mrs. Griffin's efforts to setfirm date for visit to county hospital maternity clinic. Later Mrs.Griffin explains, "Last year her two children got infectious hepa-titis and were treated at the county hospital. They sent her a billfor $784. It's on a deferred payment basis, and I've told her notto worry, that they can pay a little bit whenever they canifthey can. But she doesn't like to have that hanging over herhead, which is understandable. Now she's reluctant to go to theclinic. She's RH-negative, and she's going to abort, no doubt. Shelost a baby last year when she was working in the tomato fields.Harvester shook it right out of her. She was told not to get preg-nant again, but when she went home to Texas some quack in-formed her an IUD would cause cancer. So she didn't take anyprecautions at all. Now she's in her fifth month and she shoulddefinitely get an evaluation and have the arrangements madefor the hospital, but she uses the excuse that she can't get any.,one, to watch her children at seven in the morning when she hasto leave...."

4:35 During lull Mrs. Griffin checks over day's log, whichserves as basis for project statistics.

"It goes against the grain for a nurse to diagnose, you know"she comments, "but I have to sometimes, to make sure what'sbeing reported is as accurate as possible. Otherwise there's nota true picture of what the conditions are."

She makes entries in family history folders which she keeps onhealth of every camp resident.

5:10 Mrs. Griffin rests on couch, momentarily without callers.Evening has turned sunny and hot. "I'll probably get busy again

36

soon," she says. "From now until aroundin who've been working. You'll noticehere today. Except two women did comefor their husbands. But that's why I try tothe first day they're here." She draws dethe state's getting its money's-worth in thi

5:20 Visitor bids goodbye. As screephone rings. On sidewalk outside, sun -brain battered stroller is approaching "Office

37

s. When bus goes to Pat-ach day from home. Butbe housed in local collegeoject. Same arrangementsto Merced. Dr. Morris will

t, but she smiles shyly.young, haggard and veryce door. Elderly woman'st day before. Mrs. Griffinly next morning.

tor?" she asks pregnant

s. Griffin's efforts to setaternity clinic. Later Mrs.Idren got infectious hepa-pital. They sent her a bill:is, and I've told her notit whenever they canif

e that hanging over here's reluctant to go to theg to abort, no doubt. Sheking in the tomato fields.was told not to get preg-to Texas some quack in-. So she didn't take anyh month and she shouldthe arrangements made

e that she can't get any-he morning when she has

s over day's log, which

to diagnose, you know"es, to make sure what'sle. Otherwise there's not

Iders which she keeps on

mentarily without callers.probably get busy again

soon," she says. "From now wail around seven the people comein who've been working. Vt.,..111 notice I didn't see many menhere today. Except rwo wornen d.d come in to make appointmentsfor their husbar.js. But that's why I try to screen the men carefullythe first day they're here." She draws deep breath. "Well, I thinkthe state's getting its money's-worth in this program."

5:20 Visitor bids goodbye. As screen-door slams shut, tele-phone rings. On sidewalk outside, sun-browned woman with babyin battered stroller is approaching "Office of Health."

3717

Honor and Honesty

/S.. . Alienated f, am the larger community around

them, the migrant poor have had to come to terms withthe violence of poverty. And harassed too often bypolice, welfare workers, indifferent bureaucrats, pred-atory employers and entrepreneurs, and sometimeseven by those who come to help, the migrant poorhave also come to recognize the subtle violence ofluxurious ranch-type farm homes set against the back-ground of tents and packing boxes . . .

"When the poor discover that even hard work pro-vides no escape from the institution of poverty, theymay react with physical violence which even if itoffers no solution, at least permits the dignity of ac-tion. For many of the poor, all that we have leftthem is hope through violence, and we must ask our-selves whether we have the moral right to removefrom people their last remaining hope...."

Dr. Virgil Gianelli is a bluff, peppery 59-year-old Stocktoninternist who for the past four years has served as chairman ofthe Migrant Health Committee of the San Joaquin Medical Society.The Society sponsors one of California's most ambitious and mostsuccessful migrant health projectsand when Dr. Gianelli wrotethose words in the introduction to last year's annual project re-port, some people in the county were upset.

"Well, I think I survived that one," he grins from behind hishalf-rim glasses. Dr. Gianelli has curly grey hair and a face thatsits quite comfortably with his Italian ancestry. "My introductiondisturbed some individuals. They said I was 'advocating violence!'Hell, I was doing no such thing. I was just trying to point outthat the violence in our society is of two kindsand that a manwho starves to death is just as much a victim of violence, andjust as dead, as a man who is shot!"

Dr. Gianelli is lunching this noon in Stockton with one of theproject's clinic physiciansa ,handsome, dapper general prac-titioner of Filipino descent, Dr. Nicanor Bernardinoand with avisitor.

18 38

How, the visitor asks, did Dr. Gianellispecial problems of farm workers?

"Well, back in 1955," he replies, "Oldin Stockton started a soup kitchen for indsoon it became clear that they neededthe men who were obviously ill. They askseveral physicians in town responded.clinic at the church for an hour each afteday through Friday. There wasn't too mucteers to staff the clinic, but they neededon the job of making sure there was physi

"Then one day in 1964 our County Pubcame up to me and said they were havinat Linden, and somebody ought to lookcherry orchard area. They hire a lot of pthese people would begin to arrive in latthere'd be a two-week wait for the seasogood wages, so the migrants came up eara contract. If they missed the cherry seasmajor portion of their annual income.

"So, anyway, I drove out to see whatfound just awful conditions. Rain was holthe families were camped on the riverbaliving in tents, and cars and cardboardbecause they were waiting for the growwere living behind a levee, cut off from thdrive by without even knowing they exist

"We set up a clinic in the firehouse atsix-week harvest season we'd hold night swas our satellite clinicand then the moautomobile. I'd load up the trunk and thesupplies, and then my office nurse andcamps and the fields, looking for sick pego to the county General Hospital exceThey were completely alienated. But ourall the difference. Even though it was louhell, it was lousy.

39

Honor and Honesty

rger community aroundhad to come to terms with

harassed too often byerent bureaucrats, pred-reneurs, and sometimeshelp, the migrant poor

e the subtle violence ofmes set against the back-boxes. . .

hat even hard work pro-stitution of poverty, theyolence which even if itermits the dignify of ac-, all that we have lefte, and we must ask our-moral right to remove

'fling hope.. .."

peppery 59-year-old Stocktonrs has served as chairman of

e San Joaquin Medical Society.rnia's most ambitious and mostand when Dr. Gianelli wrotelast year's annual project re-

re upset.ne," he grins from behind hisurly grey hair and a face thatIlan ancestry. "My introduction

id I was 'advocating violence!'I was just trying to point outof two kindsand that a manuch a victim of violence, andI"n in Stockton with one of the

dsome, dapper general prac-canor Bernardinoand with a

38

How, the visitor asks, did Dr. Gianelli become interested in thespecial problems of farm workers?

"Well, back in 1955," he replies, "Old St. Mary's Church herein Stockton started a soup kitchen for indigent single men. Prettysoon it became clear that they needed some medical help forthe men who were obviously ill. They asked around for help, andseveral physicians in town responded. We set up a year-roundclinic at the church for an hour each afternoon after lunch, Mon-day through Friday. There wasn't too much trouble finding volun-teers. to staff the clinic, but they needed an organizer. So I to:Aon the job of making sure there was physician coverage.

"Then one day in 1964 our County Public Housing Coordinatorcame up to me and said they were having a lot of problems outat Linden, and somebody ought to look into it. Linden's a bigcherry orchard area. They hire a lot of pickers in early May, butthese people would begin to arrive in late April, and then oftenthere'd be a two-week wait for the season to begin. Cherries paygood wages, so the migrants came up early to be sure they'd geta contract. If they missed the cherry season, they'd miss out on amajor portion of their annual income.

"So, anyway, I drove out to see what the situation was, and Ifound just awful conditions. Rain was holding up the cherries, sothe families were camped on the riverbank along the Calaveras,living in tents, and cars and cardboard boxes, without any foodbecause they were waiting for the growers to start hiring. Theywere.living behind a levee, cut off from the road, so people woulddrive by without even knowing they existed.

"We set up a clinic in the firehouse at Linden, and during thesix-week harvest season we'd hold night sessions. So that, you see,was our satellite clinicand then the mobile clinic: that was myautomobile. I'd load up the trunk and the back seat with medicalsupplies, and then my office nurse and I would take out forcamps and the fields, looking for sick people. See, they wouldn'tgo to the county General Hospital except in a dire emergency.They were completely alienated. But our going out to them madeall the difference. Even though it was lousy medicine... what thehell, it was lousy.

39

"Well, for six years we tried to find some support to really getthe project established on a sound basis. But nobody was inter-ested. I talked with the farmers around here until I was bluein the face. I've never heard a group that moans more. God, theymoan! I can remember in the old days, my father owned agrocery store, and the farmers would come in for supplies. Thefarmer used to have a paternal relationship with his employee.Even the farmers would go to the county hospital, and the workerswould live with them and eat at their tables. But mechanizationand agribusiness are putting the squeeze on. So now it's kick thedog and try to wring a little more out of the worker. . . ."

"Last week," Dr. Bernardino interjects, "a Filipino man cameinto the clinic. He told me he'd been working for the same grower

for 27 years. He'd sprained his ankle carrying a sack of rice. I

fixed him up, but I was a little surprised that he'd had to cometo the clinic. Then a little while later the farmer called, sort ofsheepish, and said to make it a workman's compensation case."

40

Dr. Gianelli nods. He resumes his hisdecided to do was to go to the 0E0 Chere in the county. I went in a suit and egot heckled. I don't think they heard anine months for the, proposal to get rejexactly the words they used: The sodaproviders of health care and the recipieplementation of your project.' Well, I

aren't going to do the providing, I don't"So the next thing I did was fly to

congressman, and then I went over to thto the man in charge of health programs.ing room from 10 in the morning till 5secretary, said he wouldn't be able to seand there didn't seem to be any side dwhere. So I just said I was going to waithe came out. So he saw me. But youtactful guy in the world sometimes, and I

"Anyway, finally we got the state toWorkers Health Service supporting usmobile clinics. Last year the county Boarto kick in $15,000. And just recently wethe Regional Medical Programs to set ufor migrants and poor people in the cou

How, the visitor asks, is the project go'

"Well, in the areas where the seasonagregated in fixed locationsthe flash-peaforthwe catch just about everybody. Evway. But we are still missing a lot of peon the fringes of Stockton living in suWhat we have to have is some kind of o

"We have a very good relationshipdepartment. Their nurse and a bilingualin the Lii.den area, say, and the nursecan do, but if she sees something serious!the list to see the clinic doctor that veilduty at the clinic, so she makes suresaves physician time, and screens out th

aspirin. Then the nurse and the aide wnext day to make certain the person I

41

d some support to really get)asis. But nobody was inter-ound here until I was bluethat moans more. God, theydays, my father owned a

come in for supplies. Thetionship with his employee.ty hospital, and the workers

it tables. But mechanizationeze on. So now it's kick theit of the worker. . . ."ects, "a Filipino man cameorking for the same grower

carrying a sack of rice. I

ised that he'd had to comethe farmer called, sort of

man's compensation case."

Dr. Gianelli nods. He resumes his history. "The next thing I

decided to do was to go to the OEO Community Action Councilhere in the county. I went in a suit and explained the project andgot heckled. I don't think they heard a word I said. But I waitednine months for the proposal to get rejected. I can quote youexactly the words they used: 'The social distance between theproviders of health care and the recipients is too great for im-plementation of your project.' Well, I mean hell, if physiciansaren't going to do the providing, I diTh't.know who is!

"So the next thing I did was fly to Washington. I visited mycongressman, and then I went over to the OEO and tried to talkto the man in charge of health programs. I sat in that guy's wait-ing room from 10 in the morning till 5 that night! Finally thesecretary said he wouldn't be able to see me. I scouted around,and there didn't seem to be any side doors or escape exits any-where. So I just said I was going to wait right where I was untilhe came out. So he saw me. But you know, I'm not the mosttactful guy in the world sometimes, and I think I aggravated him.

"4nyway, finally we got the state to help, and with the FarmWorkers Health Service supporting us we got $60,000 for ourmobile clinics. Last year the county Bourd of Supervisors agreedto kick in $15,000. And just recently we received a grant fromthe Regional Medical Programs to set up multiphasic screeningfor migrants and poor people in the county."

How, the visitor asks, is the project going?"Well, in the areas where the seasonal farm workers are con-

gregated in fixed locationsthe flash-peak housing centers and soforthwe catch just about everybody. Everybody who's sick any-way. But we are still missing a lot of people. Especially the oneson the fringes of Stockton living in substandard housing units.What we have to have is some kind of outreach or city program.

"We have a very good relationship with the county healthdepartment. Their nurse and a bilingual aide will be working outin the Linden area, say, and the nurse will pick up on what shecan do, but if she sees something serious she'll put the person onthe list to see the clinic doctor that very night. Then she's onduty at the clinic, so she makes sure the person comes. Thatsaves physician time, and screens out the people who only needaspirin. Then the nurse and the aide will be back in the areanext day to make certain the person is following the doctor's

4119

prescription and taking his advice. We have pretty good fol-low-up.

"We're ..tieing people earlier than ever before. Bronchitis is

being caught before it's seen at the County Hospital as pneu-monia. We've cut out a lot of catastrophic illness. They seldom doradical surgery for cancer of the uterus at the County Hospitalany more, and we feel that's a result of our routine Pap smearsat the family planning clinics.

"And because we have a pediatrician at the clinic one nightand a surgeon, say, the next, there's referral from one physicianto the otheras well as to the doctors in town when special prob-lems come up."

"The people I see," Dr. Bernardino comments, "feel they have totake advantage of this opportunity, because the best care avail-able to them in the whole country, they say, is in California."

"I think in the future everyboly is going to have prepaid healthcare of some kind," Dr. Gianelli observes. "People won't take theold style of county hospital medicine any more. I've had to changethe way I practice out of my own office, too. For years I spentevenings catching up on the calls that piled up during the day.Now I use my nurses much more. And I've told one, 'Your jobis to keep the people out of my hair so I don't have to sit hereall night making damn stupid phone calls.' At first I lost a lot ofpatients because of that... about half of whom came back whenthey got the same treatment from other doctors! Middle-classpeople have been spoiled. Ninety percent of the house calls I

used to make were totally unnecessary. What I'd like to see is a24-hour clinic in town that's open to anyone who is sick.

"The Migrant Health Project here in San Joaquin County wasstarted because some of us felt there was a moral obligation totake care of sick people. Years ago, someone told me this projectwould die because we wouldn't be able to find doctors who'dbe willing to serve. But we have a waiting list right now of physi-cians who want to help out. So I think it's been pretty well ac-cepted that there are doctors willing to treat sick people, nomatter who they are.

"Now, of course, it's not 100 percent, but you won't find 100percent in any group. And I think part of it is that some peopleare afraid of change. They grew up in a system that was profit-able to them. A lot of it is insecurity. Maybe I'm just too damnsecure ... but a man with an education as a physician has

20 42

nothing to be insecure about, I don't thiheard of any physicians starving anywhe

"One thing we'd like to do here is getinvolved. We've had a hell of a time fispeak for other migrants. What's needworkers' union. I don't see why theydoctors have a pretty good union, dogrowers do too. You have to have equalsthe bargaining table. Otherwise they wo

As Dr. Gianelli wrote in his report:

"The poor are often consideredus not forget that they exist for eas for themselves, and as suchcommunity. The poor have numbelearning something about the useing if they cannot use it more rsocial order which landed men ocannot free all of its members fromhumanization of poverty.

"And so any report on services Sol

presented, and must be read, in therty's indictment of our existing strlarge and dismal record, we will recesses and small increments of progis to be honest, it must recognizewhich it is framedthe dishonesty ogovernment, of our social and econcontinues to allow us to do too liftthe most ingenuous will find sufficithought that too little too late is beThe times demand a great deal many concept of honor and honesty.

43

. We have pretty good fol-

an ever before. Bronchitis is

e County Hospital as pneu-rophic illness. They seldom doterus at the County Hospital

ult of our routine Pap smears

rician at the clinic one night's referral from one physicianrs in town when special prob-

comments, "feel they have tobecause the best care avail-they say, is in California."going to have prepaid healtherves. "People won't take theany more. I've had to changeoffice, too. For years I spenthat piled up during the day.And I've told one, 'Your jobit so I don't have to sit here

calls.!.At first I lost a lot ofIf of whom came back when

other doctors! Middle-classpercent of the house calls I

ary. What I'd like to see is aanyone who is sick.in San Joaquin County was

re was a moral obligation tosomeone told me this projectable to find doctors who'd

aiting list right now of physi-hink it's been pretty well ac-ing to treat sick people, no

rcent, but you won't find 100part of it is that some people

in a system that was profit-ity. Maybe I'm just too damnucation as a physician has

2

nothing to be insecure about, I don't think! Do you? Have youheard of any physicians starving anywhere?

"One thing we'd liks to do here is get more of the communityinvolved. We've had a hell of a time finding migrants who canspeak for other migrants. What's needed, I think, is a farmworkers' union. I don't see why they shouldn't have onewedoctors have a pretty good union, don't you think? And thegrowers do too. You have to have equals talking to equals aroundthe bargaining table. Otherwise they won't get anything."

As Dr. Gianelli wrote in his report:

"The poor are often considered powerless, but letus not forget that they exist for each other as wellas for themselves, and as such develop a truecommunity. The poor have numbers, and they arelearning something about the use of power: wonder-ing if they cannot use it more rationally than thesocial order which landed men on the moon, butcannot free all of its members from the grinding de-humanization of poverty.

"And so any report on services to the poor must bepresented, and must be read, in the context of pov-erty's indictment of our existing structures. Out of alarge and dismal record, we will report on small suc-cesses and small increments of progress. If the reportis to be honest, it must recognize the dishonesty inwhich it is framedthe dishonesty of medical care, ofgovernment, of our social and economic orderwhichcontinues to allow us to do too little too late. Onlythe most ingenuous will find sufficient comfort in thethought that too little too late is better than nothing.The times demand a great deal more, and so doesany concept of honor and honesty...."

43

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FactsWhat Is Meant by Agribusiness?

O California led the nation in farm production and profitsfor the 22nd consecutive year in 1969.21

0 Average California farm size in 1968 was 617 acres, withthe average farm valued at $325,000-370 percent higher thanthe national average.22

O State agricultural trends: fewer farms, especially smallfarms (17,000 lost between 1964 and 1968), but siable amount

4 4

of acreage under cultivation (37.2 millioncreasing emphasis on "migrant crops" (fracres in fruits, nuts, vegetables and mel1968).23

Mechanization is displacing seas33,000 jobs were reported lost betweenmajor California crops employing season

ti"4-.410`Ple:04,

:444:141Allion-L_ $

V,LINar.

..r 7

Facts

production and profits

968 was 617 acres, with70 percent higher than

farms, especially small1968), but stable amount

of acreage under cultivation (37.2 million acres in 1968) and in-creasing emphasis on "migrant crops" (from 1.95 to 2.13 millionacres in fruits, nuts, vegetables and melons between 1964 and1968).23

Mechanization is displacing seasonal labor. More than33,000 jobs were reported lost between 1964 and 1968 in 11

major California crops employing seasonal workers.24

4'5 21

Who Work the Farms?

Some 742,300 people had farm income in 1965, of whomonly 486,700 earned more than $100.25

. Average monthly farm employment in California in 1969was 292,300 people. During the peak harvest week, however,108,700 women and youths were in the fields-28 percent of thefarm work force.26

Workers of Mexican origin constitute 46 percent of thetotal California farm labor pool. Negroes, Orientals, Indians andother non-Anglos make up 10 percent.27

About one-third of all farm laborers available for full-timework nevertheless spend more than half the year unemployed.28

Over 200,000 agricultural migrant workers and their foe-lies were on the mcr,e in 43 California counties during 1969.

Who Are the Migrants?

About 84 percent of California migrants are of Mexicanorigin, 13 percent Anglo, 1.7 percent Negro, and 1 percentAmerican Indians, Orientals and others.

Where Do They Migrate From?

tit About 34 percent are California residerits, 35 percent fromTexas, 17 percent from Mexico, 7 percent from Arizona, thebalance from other states.

What Do Farm Workers Earn?

Median annual income for California farm workers in 1965,including non-farm earnings, was $1,388.29

Annual income for migrant families living in state migranthousing centers in 1969 was $3,019compared with a nation-wide migrant income average of $891130

Average hourly wage for California farm workers in 1969was $1.78compared to $1.33 for all U.S. farm workers, thelowest paid force in American industry 31

22 46

Under historic contracts signed byunionized California grape workers, hou$1.80, increasing to $1.90 next year. Etional 12 cents hourly for health and we

'

4.;

byhou.Ewe

farm income in 1965, of whom$100.25

ployment in California in 1969peak harvest week, however,

in the fields-28 percent of the

Under historic contracts signed by growers this year withunionized California grape workers, hourly base pay is $1.75-$1.80, increasing to $1.90 next year. Employers pay an addi,tional 12 cents hourly for health and welfare benefits.32

in constitute 46 percent of theNegroes, Orientals, Indians andrcent."

laborers available for full-timean half the year unemployed.28

migrant workers and their fami-fornia counties during 1969.

'comics migrants are of Mexicanpercent Negro, and 1 percentothers.

fornia residents, 35 percent from, 7 percent from Arizona, the

California farm workers in 1965,$1,388.29

t families living in state migrant,019 compared with a nation-$8911 4

California farm workers in 1969for ail U.S. farm workers, the

dustry.31

What About Nontinion Benefits?

Farm workers are specifically excluded from the unemploy-ment insurance program.

Claim rate for farm workers in the California DisabilityInsurance Program in 1965 was 45 per 1,000 insured workersless than half the claim rate for the general population 33

Since 1959, all hired workers in agriculture have beencovered by the Workmen's Compensation Lawbut many do notknow it or, because of migrancy and scattered services, cannottake advantage of the law's benefits.

48

What Are the Working Conditions?

Farm labor varies from grueling stoto fruit-picking among trees whose scratcwith pesticides. Temperatures in grapedegrees Fahrenheit. High organic contentpeat dirt severely irritates skin. SixteenCounty orange groves were poisoned inphosphate pesticides.34

Agricultural workers suffer the highrate in California-71.9 per 1,000 workerate for all industries combined.35

The accidental death rate for farmhigher than for the U.S. population as a

A Salinas Valley packing corporfederal court in June, 1970, with fraudberry pickers from Texas with prodiises ofthose actually offered when the workers

What Are the Living Conditions?

4,337 families were turned away fo23 state migrant farm labor housing cen20,000 people.37

In the 11 counties with migrant hcomponents, the local state housing cenpercent of all family-type housing availthan 68 percent of the 2,042 camps insingle men only.

One-third of California's deteriorhousing is concentrated in rural areas 38

6 Compared to the state's general pditions are Ave times worse for migrant fc

What Are Their Educational Levels?

46 percent of farm workers didgrade, and 70 percent of those who dschool are of Mexican origin.39

49

1

iy excluded from the unemploy-

rs in the California Disability5 per 1,000 insured workerse general population.33

kers in agriculture have beennsation Lawbut many do notand scattered services, cannot

its.

8

What Are the Working Conditions?

Farm labor varies from grueling stoop labor in broiling sunto fruit-picking among trees whose scratchy leaves are, powderywith pesticides. Temperatures in grape arbors often reach 130degrees Fahrenheit. High organic content of San Joaquin Valleypeat dirt severely irritates skin. Sixteen farm workers in TulareCounty orange groves were poisoned in June, 1970, by organicphosphate pesticides.34

Agricultural workers suffer the highest occupational diseaserate in California-11.9 per 1,000 workersmore than twice therate for all industries combined.35

The accidental death rate for farm workers is three timeshigher than for the U.S. population as 'a whole.

A Salinas Valley packing corporation was charged in

federal court in June, 1970, with fraudulently recruiting straw-berry pickers from Texas with promises of wages far in excess ofthose actually offered when the workers arrived.36

What Are the Living Conditions?

4,337 families were turned away for lack of vacancies from23 state migrant farm labor housing centers in 1969 more than20,000 people.37

In the 11 counties with migrant health project sanitationcomponents, the local state housing centers comprise a full 15percent of all family-type housing available to migrants. Morethan 68 percent of the 2,042 camps in these counties are forsingle men only.

One-third of California's deteriorated and substandardhousing is concentrated in rural areas.38

Compared to the state's general population, housing con-ditions are Ave times worse for migrant farm workers.

What'Are Their Educational Levels?

46 percent of farm workers did not complete the eighthgrade, and 70 percent of those who did not complete gradeschool are of Mexican origin.39

,** 4923

More than 87 percent of those over 18 living at state mi-grant housing centers in 1969 had not completed high school.°

What Are Their Health Problems?

The postneonotal deoth rate per 1,000 live births in theSan Joaquin Valley in 1965 was 9.1 for farm workers, comporedto 5.8 for all occupational groups in California.

48 percent of farm workers cloiming hospitalizotion bene-fits under the stote disobility insurance program required treat-ment for more than one week, as compared to 38 percent forthe general population.4

Major health conditions commonly seen of project clinicsinclude gross dentol problems, molnutrition and upper respirotoryillnesses. Injuries, skin oilments and chronic diseoses predominateamong adult males, though injuries are seldom treated at clinicsand men, in general, do not utilize project services. Mothers andchildren constituted over 80 percent of those receiving services inmedical care facilities in 1968.

The mean hemoglobin levelthe measure of anemiaat onemigrant clinic was 9.6 for women and 13.0 for men, compored to12.6 and 14.2 respectively for the general population treated ata metropoliton hospital in Oakland, California.

31 percent of the wives of farm workers who deliveredlive bobies in California in 1965 hod five or more children, ascompared to 14 percent for wives in other occupational cate-gories.

What Is the California Farm Workers Health Service?

Administratively, the Farm Workers Health Service is a unit ofthe Bureau of Maternal and Child Health under the PreventiveMedical Program of the California State Department of PublicHealth.

The staff includes consultonts in public heolth nursing, healtheducation, environmental health, social work and statisticalanalysis, as well as the project director and an administrativeassistant.

The purpose of the Farm Workers Health Service is to promote,initiate and provide consultative, stotisticol mid directive servicesto the local migrant health projects.

24

*Au

;410o4:4-4'

ta1E946:1

51

se over 18 living at state mi-not completed high school.4

per 1,000 'live births in the.1 for farm workers, comparedin California.

claiming hospitalization bene-ance program required treat-compared to 38 percent for

manly seen at project clinicsutrition and upper respiratorychronic diseases predominateare seldom treated at clinicsproject services. Mothers and

t of those receiving services in

he measure of anemiaat onend 13.0 for men, compared togeneral population treated at, California.

farm workers who deliveredad five or more children, as

s in other occupational cate-

Ith Service?

rs Health Service is a unit ofHealth under the PreventiveState Department of Public

public health nursing, healthsocial work and statistical

irector and an administrative

Health Service is to promote,atistical and directive services

51

What Kinds of Health Services Does the Program Offer?

The 26 California migrant health projects offer one or moreof the following services:

Fee-For-Service Medical CareA system whereby patients arereferred by project nurses to local private physicians who haveagreed to accept migrants for diagnosis and treatment. Paymentis made from project funds, subject to local and Farm WorkersHealth Service review.

General Medical ClinicsEvening clinics, either mobile or sta-tionary, serving all age groups and located in areas where mi-grant farm workers concentrate. Physicians provide care, whilenurses assume most coordinating, counseling and follow-up re-sponsibilities. Nearly all clinics provide English' interpreting serv-ices. Medicroion may be dispensed at the clinic, or patients re-ferred to local pharmacies. X-ray and laboratory services arecontracted to local facilities.

Maternity Service ClinicsSeparate clinics held periodicallyusually weekly or bimonthlyat which prenatal, postnatal andfamily planning services are offered under the supervision ofpediatrician and/or obstetrician-gynecologist. Registered nursesand bilingual community health aides usually offer 'group healtheducation in addition.

Dental Care ServicesRestorative and preventive dental careunder a fee-for-service referral system. Funds for such servicesremain limited, though utilization and need are rapidly increasing.

Public Health Nursing ServicesHome or school visits for thepurposes of casefinding, referrals, teaching, counseling, coordi-nation of services among social agencies and insuring continuityof care. In addition to overall preventive health care responsi-

bilities within her assigned territory, the nurse may provide individual services through well-baby, immunization, crippled children,tuberculosis and other specialty clinics. Registered nurses andlicensed vocational nurses also serve in clinic positions. Nursingaides assist in clinics and in field visits under professional super-

vision.

Environmental Health ServicesSurveillance by sanitarians offarm labor camps, other farm worker-occupied housing, fields andfarms .where food crops are grown and harvested to assure that

52

legal and proper public health standSpanish-speaking environmental health aiassist in inspections and in education efforecently been focussed on emerging ocsafety problemse,oecially in connectionsurance of safe sewage and water systcamps.

Health EducationActivities, either onthrough group sessions, designed to educfamilies to a better understanding of theconditions and problems, the types of seand the ways in which to care for themmake appropriate use of the services. Becprojects employ health educators, most tethe-job by doctors, public health nurses,munity aides. Some projects have develoin Spanish for use on local media, and thService has designed and published a schores which explain, in simple Spanish,health, rabies vaccination for pets, familynutrition, environmental health and dentalprogress on pamphlets covering family p)home accidents and work safety. A Spanhealth personnel has been developed and

Aide ServicesUse of highly motivatesonnel drawn from the recipient communitysuch tasks as field visits, clinic services, adagency relations, health education with gclients and interpreting. Increasing emphthe employment of well-trained and qualiin California projects in order to achievetion of health manpower.

How Effective Is the California Migrant Health 11

In 1963, when the first federallywere established under the program, soo410,000 clinic visits. In 1969, about 25,clinic visits. Nearly 43,000 diseases were

53

ore legal and proper public health standards are maintained.Spanish-speaking environmental health aides may be utilized toassist in inspections and in education efforts. Special attention hasrecently been focussed on emerging occupational health andsafety problemsespecially in connection with pesticidesand as-surance of safe sewage and water systems in all farm laborcamps.

Health EducationActivities, either on a one-to-one basis orthrough group sessions, designed to educate migrants and theirfamilies to a better understanding of the nature of their healthconditions and problems, the types of services available to them,and the ways in which to care for themselves properly and tomake appropriate use of the services. Because only a few of theprojects employ health educators, most teaching is conducted on-the-job by doctors, public health nurses, sanitarians and com-munity aides. Some projects have developed spot announcementsin Spanish for use on local media, and the Farm Workers HealthService has designed and published a series of illustrated bro-chures which explain, in simple Spanish, subjects such as childhealth, rabies vaccination for pets, family relations, immunization,Nutrition, environmental health and dental health. Work is also inprogress on pamphlets covering family planning, pre-natal care,home accidents and work safety. A Spanish-English Glossary forhealth personnel has been developed and received wide usage.

Aide ServicesUse of highly motivated non-professional per-sonnel drawn from the recipient community to assist in or performsuch tasks as field visits, clinic services, administration, communityagency relations, health education with groups, transportation forclients and interpreting. Increasing emphasis has been placed onthe employment of well-trained and qualified auxiliary personnelin California projects in order to achieve a more efficient alloca-tion of health manpower.

areaveent

kers

sta-mi-hilere-

erv-re-

are

Hyandfarsesalth

areices

ing.

therd I-uitynsi-

ndi-ren,andinger- How Effective Is the California Migrant Health Program?

In 1963, when the first federally funded medical clinicsof were established under the program, some 4,000 patients paid

and 10,000 clinic visits. In 1969, about 25,000 patients paid 66,600that clinic visits. Nearly 43,000 diseases were treated.

5325

Problem: The unrelenting patient load is a serious burden onharried doctors who, after a full day's work in their own offices,may be called upon to spend up to seven hours at night seeing70 or 80 clinic patients. In addition, the clinic facilities are oftenextremely cramped and inadequate. Funds to build satisfactoryclinic quarters are sorely needed in nearly every project.

In 1969, 47 percent of the patients seen at clinics werewomen over the age of 14, 42 percent were children under 15,and only 11 percent were men over the age of 15. The womenpaid an average of 3.8 visits each, the men and children 2.4visits each. Compare this with a 1958 California Health Surveywhich showed about seven doctor visits each year for the averagewoman, about five for the average man and child.

Problem: The clinics with the highest overall attendance werealso those with the lowest adult male attendance. It would appearthat a waiting room crowded with women, many visibly pregnant,and overflowing with children is enough to drive even a sickman away. Indeed, statistics show that men are more than twiceas likely as women or children to leave a clinic without beingexamined.

In 1969, project nurses paid nearly 27,000 home visits andreferred nearly 4,000 people for medical care. Nevertheless, theyestimated that only about 30 percent of California's migrant pop-ulation were reached by these public health nursing services.

Problem: Many more nurses are needed, yet funds to hirethem are not available.

In 1969, migrant health project sanitarians made nearly6,000 labor camp inspections, 9,000 housing inspections and6,400 field and farm inspections. During the year's peak employ-ment week, 80 percent of California's migrants are at work inthe counties with sanitation project componentsand thus, forthat week at least, benefit from environmental inspections.

Problem: The project counties contain only about 45 percentof California's farms and irrigated land. Nevertheless, about 80percent of all the environmental services to migrants in the entirestate of California are given by these 11 projects. Without thefederal funds which support such local programs, the number ofman-hours that would be devoted to migrant environmental serv-

26 54

ices can only be speculated upon. Morworkers in agricultural countiesbecausehave received even less assistance with th

Why Isn't the Migrant Health Program More

The level of funding at which the proinadequate to sustain high quality care,expansion of services all simultaneously.emphasis must be on quality of care in ebe noted That the nationwide average pemigrant health in 1967 was only $7.20.medical expenditure for the U.S. populatiwas $256.) 42

But even if money were available, therhealth manpower which is especially acuteof two project counties, for example,physicians to serve populations of 12,2problems exist among the other health pr

onaces,eing

oftendory

werer 13,omen

2.4rveyrag,.

werepearWant,

sicktwicebWng

andtheypop-

hire

earlyand

ploy-rk in, for

rcentt 80ntiret theer ofserv-

ices can only be speculated upon. Moreover, the resident farmworkers in agricultural countiesbecause of program emphasishave received even less assistance with their environmental needs.

Why Isn't the Migrant Health Program More Extensive?

The level of funding at which the program operates is simplyinadequate to sustain high quality care, excellent facilities andexpansion of services all simultaneously. In such a situation, theemphasis must be on quality of care in existing projects. (It mightbe noted that the nationwide average per capita expenditure formigrant ealth in 1967 was only $7.20. Per capita health andmedical expenditure for the U.S. population as a whole, in 1968,was $256.) 42

But even if money were available, there is a severe shortage ofhealth manpower which is especially acute in rural areas. In eachof two project counties, for example, there are 11 practicingphysicians to serve populations of 12,200 and 15,500. Similarpr II/tns exist among the other health professions.

55

In many agricultural counties, support for government-spon-sored health services to the poor has proved difficult or impossibleto muster. Even in the best projects, community involvement andcommunity organizationboth among farm workers, and amongthe affluentcontinue as critical needs.

Has the Program, Then, Had Significant Impact Over the Decade?

In August, 1960, staff members of the California State Depart-ment of Public Health conducted field interviews at several farmlabor camps in various parts of the state. At the Richland Camp,on the outskirts of Yuba City in Suffer County, they found 365familiesoften as many as six to a familyliving in one-room tinhouses without running water or inside toilet facilities. Inadequatemaintenance resulted in unsanitary communal privies and bathhouses. A third of the families had no means of refrigeratingfood. Other than once-a-month well-cgld clinics held by the localhealth department nurse, there were. no medical services at thecamp. The antiquated county hospital was two miles away, withno available public transportation to it.

Of the families interviewed, about two-thirds of the childrenunder three years of age had never been immunized againstdiphtheria, whooping cough, lockjaw or smallpox. About two-thirds of all the children under 18 had. not been immunizedagainst polio. At the time of the interview, a severe epidemic ofinfectious diarrhea was underway throughout the campaffect-ing nearly every family. If the members were able Jo work evena few hours a day, they considered themselves well. Eight infantshad been hospitalized because of the disease the previous month.In addition, the interviewers observed untreated cases of con-tagious skin infections, acute feb-rile tonsillitis, lymphadenopathy,asthma, pregnancy without any prenatal care, iron deficiencyanemia, disabling but untreated physical handicaps, chronic dis-orders such as congenital heart disease, hemophilia, arthritis anddental cariesnone of which was receiving medical follow-up.

Appalled by conditions such as theseduplicated wherever sea-sonal farm workers gatheredThe California legislature set thepace nationally by adopting, in 1961, laws specifically designedto promote health care and services for these agricultural mi-grants. Federal legislation followed in 1962.

Now let us jump ahead 10 years, to September 21, 1970. Itis a fall-like afternoon in Sutter County, and though there are no

56-

trees among the 100 new cabins at theFlash-Peak Housing Center, a steady breacross the grass from the towering elms s0E0 Child Day-Care Center. Inside, 36families are being read to in groups byaides. On a wall near the door hangs a cand times at which the children who neethem. All of these children have been exupon their arrival at the center. Across a sbuilding houses a day-school operated formothers from the neighboring County Houbuilding are the bright, compact exaperiodic public health nursing clinics. Atables cluster under the elmsbuilt on thserved as foundations for the dilapidated,visited by interviewers in 1960.

At the flash-peak center, Mrs. Cirilamunity aide for the Sutter-Yuba Healthone o_ f her frequent home visits. The womabirth to a baby boy, Antonio, two weekscome to register the infant on the familythe local health department, and to confithe next well-baby clinic at the camp.Mrs. Amaral learns that the woman's husfind only sporadic work. As a constantaround the county-1,000 miles a monthwoman referral service. She can often rehousing vacancies or a cheap, reliablecar part. But in this case, with the prunelhas no job suggestions. Instead, she fillsthe family to receive surplus food commo

The county public health nurse respo,area, Mrs. Nancy Singh, is in the campAmaral secures her signature at onceThrough Mrs. Amaral, Mrs. Singh reminibreast-feedingto drink three glasses of ,amilk is one of the commodities the family Ni

After determining that there are no othlMrs. Amaral continues her round of calls.noon, will be a visit to a trailer in a walndemonstrate how a baby's temperaturegive the new parents a thermometer an

57

pon- trees among the 100 new cabins at the four-year-old Richlandible Flash-Peak Housing Center, a steady breeze is whipping leavesand across the grass from the towering elms surrounding the nearbyong 0E0 Child Day-Care Center. Inside, 36 children from migrant

families are being read to in groups by teachers and teachingaides. On a wall near the door hangs a chart outlining the dosesand times at which the children who need medicines should getthem. All of these children have been examined and immunized

art- upon their arrival at the center. Across a short walkway, a similarfarm building houses a day-school operated for the benefit of workingmp, mothers from the neighboring County Housing Project. Inside that365 building are the bright, compact examining rooms used for

tin periodic public health nursing clinics. Across the street, picnicuafe tables cluster under the elmsbuilt on the concrete slabs whichbath served as foundations for the dilapidated, overcrowded tin cabinsfing visited by interviewers in 1960.

local At the flash-peak center, Mrs. Cirila Amaralbi-lingual com-the munity aide for the Sutter -Yuba Health Departmentis making

with one of her frequent home visits. The we 'Ian she is calling on gavebirth to a baby boy, Antonio, two weeks ago. Mrs. Amaral has

dren come to register the infant on the family record maintained byinst the local health department, and to confirm an appointment for

two- the next wz.11-13,1by clinic at the camp. During the conversation,ized Mrs. Amaral learns that the woman's husband has been able toc of find only sporadic work. As a constant chauffeur and travelered- around the county-1,000 miles a monthMrs. Amaral is a one-

even woman referral service. She can often recommend job openings,ants housing vacancies or a cheap, reliable place to find a needednth. car part. But in this case, with the prune harvest just over, shecon- has no job suggestions. Instead, she fills out an authorization forthy, the family to receive surplus food commodities.

ency The county public health nurse responsible for the Richlanddis- area, Mrs. Nancy Singh, is in the camp this afternoon too. Mrs.and Amaral secures her signature at once on the referral form.

Through Mrs. Amaral, Mrs. Singh reminds the motherwho issea- breast-feedingto drink three glasses of milk a day. Powderedthe milk is one of the commodities the family will receive.

ned After determining that there are no other immediate problems,mi- Mrs. Amaral continues her round of calls. Among them, this after-

noon, will be a visit to a trailer in a walnut grove, where she will0. It demonstrate how a baby's temperature is taken. (She will alsoe no give the new parents a thermometer and a sheaf of Spanish-

27

57

4

tow

rtt,44...1^

28

5 8

;

4

language health pamphlets.) Later she wilcall on a newly-arrived family seen recenmigrant medical clinic held five nights aCounty Hospital. Mrs. Singh wants to asdren have all been immunized. (In fact,they havebut there are other problems.cared for by aged grandparents while thyear theft conviction in a Southwesternis told of the situation, at that night's miwill begin a lengthy correspondence withthorities in the other state.)

Why this vignette? Because "impact,'cerned, is extremely hard to convey stagram makes its impact when sick peoplwill get sick), when diseases are controlalways persist), when services which hadable are provided, when the conditions oat Richlandas in many, though by noCaliforniathe array of services crystalliHealth Program has had a dramatic imsonal farm workers.

The entire concept of a statewide Mexamplethe maintenance of safe, well-eing centers for migrant workers' familiesThe development of day-care facilities wfor young children, and of special educawho are often on the move, and of thocomponents in these programsall arethe past decade. Working and living cgraded tremendously through replacemenous housing, provision of good potable wament of sanitary standards.

The activities of Mrs. Amaral in thetrate the impact aides have had in brincational, and environmental services toMany of the Spanish-language materials

5J

language health pamphlets.) Later she will also make a follow-upcall on a newly-arrived family seen recently by Mrs. Singh at themigrant medical clinic held five nights a week at the new SutterCounty Hospital. Mrs. Singh wants to ascertain whether the chil-dren have all been immunized. (In fact, Mrs. Amaral will learn,they havebut there are other problems. The children are beingcared for by aged grandparents while their mother serves a four-year theft conviction in a Southwestern prison. When Mrs. Singhis told of the situation, at that night's migrant clinic session, shewill begin a lengthy correspondence with prison and welfare au-thorities in the other state.)

Why this vignette? Because "impact," where health is con-cerned, is extremely hard to convey statistically. A health pro-gram makes its impact when sick people are cured (but otherswill get sick), when diseases are controlled (although some willalways persist), when services which had never before been avail-able are provided, when the conditions of life are improved. Andat Richlandas in many, though by no means all, parts of ruralCaliforniathe array of services crystallized around the MigrantHealth Program has had a dramatic impact on the lives of sea-sonal fa(m workers.

The entire concept of a statewide Migrant Master Plan, forexamplethe maintenance of safe, well-equipped temporary hous-ing centers for migrant workers' familiesis unique to California.The development of day-care facilities with staff trained to carefor young children, and of special education programs for pupilswho are often on the move, and of thorough health monitoringcomponents in these programsall are part of the "impact" ofthe past decade. Working and living conditions have been up-graded tremendously through replacement of poor, often danger-ous housing, provision of good potable water systems and enforce-ment of sanitary standards.

The activities of Mrs. Amaral in the Sutter-Yuba project illus-trate the impact aides have had in bringing health, social, edu-cational, and environmental services to farm worker families.Many of the Spanish-language materials Mrs. Amaral distributes

59

did not exist until developed by the Farm Workers Health Service.The institution of medical clinics at night for farm workers, and

their varietyseasonal clinics, year-round clinics, stationary andmobile clinicsas well as their expansion from acute-care-only todiagnostic-service-on-site are part of the major impact of the Mi-grant Health Program over the past 10 years. Finally, the trainingand placementand deep involvementof health professionals inrural areas on behalf of a population with unique problems hascontributed to the impact of the program. The new Sutter CountyHospital, for example, was able to offer year-round clinic servicesto migrants because four of its dedicated physiciansincludingthe medical directorheld a contest to see who could work thelongest without pay.

The difference between Richland in 1960 and Richland todaycan only be described as "impact."

But What Does the Future Hold?

In many ways, 1970 may prove a pivotal year in the historyof California farm laborand in the future of health care pro-grams for migrant agricultural workers.

In 1970, farm workers made their first significant gains towardunionization when they won recognition from California table

grape growers, and launched, a campaign to secure union con-tracts for pickers in the Salinas Valley lettuce fields. Union repre-sentation for all farm workersif it should, indeed, come aboutwould result in crucial changes in the quality of health care avail-able to them. The grape industry contracts include health bene-fits paid into a union fund ,for each worker by his employer. Al-though it is not yet certain what directions the union health plan

will take, such benefitsalong with improved wages and workingconditionsmust have important consequences in determining the

future of government programs for seasonal farm workers.in 1970, too, a bill to create a national health insurance pro-

gram for all Americans was introduced into Congress. Althoughits defeaton economic, political and philosophic groundsis

60

practically certain, the mere fact that sureceive serious legislative considerationshattering changes in the future.

But the millennium remains far off, andFederal Migrant Health Act of 1970 muststone. The program is now scheduled to etime, it is hoped, alternative avenues ofdelivery to seasonal farm workers will ha

Indeed, if nothing else, the Migrant Hemented the fact that the problems facingare symptomatic of barriers to good heeveryone in rural America. The vast distathe scarcity of doctors and dentists and numany patients on too few practitioners, th

care, the lack of broad environmental anthese affect the farmer, the resident farmthe local shopkeeper alike. The difference;

When originally designed, the nationalimited goalto alleviate the immediate,cultural migrants in America. During theof the Farn1 yorkers Health Service progmously. The incorporation of medical clinprojects has, perhaps, been the single grehealth of migrants. And yet, it has becoclinics for a segregated population do notdesign for the future.

What is needed, then, is legislation atake into account the complexity of prohealth care. Comprehensive Health PlanniMedical Programs must take a leadingthis challenge.

Because these are years of flux, theespecially difficult to predict. Increasingfederal funding support, the emphasis onernment programming, administrative reorhealth agenciesall will dictate the shapeities in coming years.

61

rvice. practically certain, the mere fact that such a program can nows, and receive serious legislative consideration augurs for precedent-

and shattering changes in the future.

nly to But the millennium remains far off, and so the renewal of the

he Mi-Federal Migrant Health Act of 1970 must be considered a mile-

ainingstone. The program is now scheduled to expire in 1973, by whichtime, it is hoped, alternative avenues of funding for health care

nals in delivery to seasonal farm workers will have been developed.ms has Indeed, if nothing else, the Migrant Health Program has docu-County mented the fact that the problems facing migrant farm workerservices are symptomatic of barriers to good health confronting nearlyhiding everyone in rural America. The vast distances between hospitals,

rk the the scarcity of doctors and dentists and nurses, the pressure of toomany patients on too few practitioners, the soaring costs of health

today care, the lack of broad environmental and sanitation programsthese affect the farmer, the resident farm worker, the migrant and

the local shopkeeper alike. The difference, of course, is in degree.When originally designed, the national program had a very

limited goalto alleviate the immediate, acute ills besetting agri-history cultural migrants in America. During the past decade, the scope

re pro- of the Farm Workers Health Service program has increased enor-mously. The incorporation of medical clinks into more and more

toward projects has, perhaps, been the single greatest contribution to thetable health of migrants. And yet, it has become clear that specialized

n con clinics for a segregated population do not alone constitute a soundrepre- design for the future.

about What is needed, then, is legislation and programming whichavail- take into account the complexity of problems surrounding rural

bene- health care. Comprehensive Health Planning boards and Regionaler. Al- Medical Programs must take a leading responsibility in meetingh plan this challenge.orking Because these are years of flux, the future for farm labor is

ing the especially difficult to predict. Increasing mechanization, dwindlingfederal funding support, the emphasis on decentralization in gov-

ce pro- ernment programming, administrative reorganization of California

(though health agenciesall will dictate the shape of Migrant Health activ-

ndsis ities in coming years.

61 29

Meanwhile, the California Farm Workers Health Service mustitself continue to invent and improve. Some new emphases for thefuture may include:

Intensified efforts to teach migrants to teach other migrants,so that knowledge of sound health practices, and of how to useexisting resources, spreads into areas where the Migrant HealthProgram does not reach.

Efforts to involve the "consumers," the migrants and seasonalagricultural workers themselves, more effectively in guiding theprogram. Project staff members must learn from farm workers, bothwhat they want and what their special strengths are. It is notenough to concentrate on traditional problems alone, or on foster-ing a "professional" outlook.

Efforts to design alternative health care systems for ruralareas. One model, for example, might be a network of satelliteclinics offering comprehensive care, radiating from central facili-ties where more specialized diagnostic and treatment procedureswould be undertaken. At the latter, the distance factor must beaccounted for, either through provision of transportation or offree overnight accommodations.

Efforts to develop environmental programs which go beyondmere enforcement of sanitation laws. Rather, such programs mightinclude a mutual inventory by consumers and technicians of localenvironmental needs, followed by community training sessions anddirect sanitation aide services. These could include rodent andinsect control, disinfection and sealing of wells, minor home andplumbing repairs, cleaning and pumping of septic tanks and cess-pools. .. .

30 62

Health for the harvestersa modest goal inPerhaps, after more than a century, this dec

to fulfillment.

63,

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randlightfocalandandand Health for the harvestersa modest goal in so rich a land.ess- Perhaps, after more than a century, this decade of hope will finally lead

to fulfillment.

63

(Sponsor, location, services, season)

1. Butte County Health DepartmentGridley Farm Labor CampMedical Clinic Tuesdays 8-12,

Thursdays 4-6Public Health NursingJuneSeptember

2. Colusa County Health DepartmentColusaMedical Clink Wednesdays 8-5Public Health NursingEnvironmental SanitationMedical Fee-For-ServiceAprilOctober

3. Fresno County Health DepartmentParlier Clinic Mondays and

Wednesdays 6-10Family Planning Tuesdays 6-10Maternity Clink Thursdays 6-10Year-round

4. California State Department ofPublic Health

Glenn CountyPublic Health NursingCommunity AidesMedical Fee-For-ServiceMayOctober

5. Kern County Medical SocietyBakersfieldMedical Clinic Mondays and

Fridays 6-10Maternity Clinic Wednesdays 6-10MayAugust

5A. Wasco Labor CampMedical Clinic Tuesdays and

Thursdays 6-10MayAugust

6. Kern County Health DepartmentPublic Health NursingEnvironmental SanitationCommunity AidesYear-round

The California Projects

7

4

9

2

22

25A 2325 26

20 25B 25C12 14D

12B12A 14A 14B

14 14C

14E 15

18

19

21B 21

21A

10

7. CaliforniPublic

Lake CoPublic HCommunMedicalMay-0

8. MercedSouth DMedicalPublic HEnvironMedicalYear-rou

8A. PlanadaMedicalYear-ro

8B. LivingstoMedicalYear-ro

8B

8A

13 8

3

16

17

24

5A

5 6

11

The California Projects

7

4

9

2

22

25A 2325 26

20 25B 25C12 14D

12B12A 14A 14B14 14C

14E 15

18

19

21B 21

21A8B

8A

10

13 8

3

7. California State Department ofPublic Heb Ith

Lake CountyPublic Health NursingCommunity AidesMedical Fee-For-ServiceMayOctober

8. Merced County Health DepartmentSouth Dos Palos Night ClinicMedical Clinic Tuesdays 6-10Public Health NursingEnvironmental SanitationMedical Fee-For-ServiceYear-round

8A. Planada Night ClinicMedical Clinic Tuesdays 6-10Year-round

8B. Livingstoh Migrant ClinicMedical Clinic Thursdays 6-10Year-round

5A16 5 6

17

24

Si.

9. California State Department ofPublic Health

Modoc and Siskiyou CountiesPublic Health NursingCommunity AidesMedical Fee-For-ServiceMay-October

10. Monterey County HealthDepartment

Gonzalez Migrant ClinicMaternity Clinic Tuesdays 5:30-10Public Health NursingEnvironmental SanitationMedical Fee-For-Service at Santa

Cruz Clinic, WatsonvilleYear-round

11. Riverside County HealthDepartment

Indio Health OfficePublic Health Nursing ,

Environmental SanitationCommunity AidesMedical Fee-For-ServiceYear-round

11A. Blythe Health OfficePediatric Clinic Monthly 8-5Public Health NursingEnvironmental SanitationAide ServicesMedical Fee-For-ServiceYear-round

12. Sacramento County Medical'Society

Court landMedical Clinic Mondays 6-10Medical Fee-for-ServiceApril-December

12A. IsletonMedical Clinic Wednesdays 6-10Medical Fee-for-ServiceApril-December

12B. Walnut GroveMedical Clinic Tuesdays 6-10

r,

32

The California Projects-ContinuedMedical Fee-For-ServiceApril-December

13. San Benito County HealthDepartment

HollisterMedical Clinic Wednesdays 6-8Environmental SanitationMedical and Dental Fee-For-ServiceJune-October

14. San Joaquin County MedicalSociety

Matthews Road Camp, StocktonMedical Clinic weekdays 6:30-10Medical Fee-For-ServiceApril-October

14A. Harney Lane Camp, LodiMedical Clinic weekdays 6:30-10Medical Fee-For-ServiceApril-October

14B. Mobile Medical ClinicLinden, Mondays 7-10Year-round

14C. Mobile Medical ClinicSt. Mary's Church, StocktonThursdays 2-5June-December

14D. Mobile Medical ClinicThornton, Wednesdays 7-10Year-round

14E. Mobile Medical ClinicTracy, Tuesdays 7-10June-October

15. San Joaquin Local Health DistrictPublic Health NursingEnvironmental SanitationAide ServicesApril-October

16. San Luis Obispo Health DepartmentNipomo Night ClinicMedical Clinic Mondays 6-10Maternity Clinic Thursdays 1-5,

alternate Fridays 9-12Minor Surgery by appointment

6$

17.

Medical Fee-For-ServiceYear-round

Santa Barbara County HealthDepartment

Santa Maria Migrant ProjectPublic Health NursingCommunity AidesMedical Fee-For-ServiceYear-round

18. Santa Clara County Medical So-ciety, Santa Clara Valley MedicalCenter and Santa ClaraCounty Health Department

Wheeler Hospital, GilroyOutpatient Medical Services

weekdays 6-10Public Health NursingMedical Fee-For-ServiceYear-round

19. Santa Cruz County HealthDepartment

Watsonville Area Service CenterMedical Clinic Mondays and

Wednesdays 6-10Immunization Clinic first Tuesdays

6-10OB-GYN, Family Planning Clinic

alternate Thursdays 6-10Public Health NursingAide ServicesMedical Fee-For-ServiceYear-round

20. Solano County Health DepartmentDixon CampMedical Clinic Mondays and

Thursdays 6:30-9Public Health NursingAide ServicesMay-October

21. Stanislaus County Medical SocietyEmpire CampNursing Clinic weekdays 9-5Medical and Dental Fee-For-ServiceMay-October

21A. PN

21B. WNM

22. SYM

MM

23. SP

Er

Y

24. VE

C.

25. Scl

Y

25A.

67

M

Y

M

25B. CiMM

25C. B

M

26. YP

E

The California ProjectsContinuededical Fee-For-Servicepril-December

n Benito County Health-Departmentollisteredical Clinic Wednesdays 6-8

nvironmental Sanitationedical and Dental Fee-For-Service

;1.me- October

n Joaquin County MedicalSocietyatthews Road Camp, Stocktonedical Clinic weekdays 6:30-10edical Fee-For-Servicepril-October

arney Lane Camp, Lodiedical Clinic weekdays 6:30-10edical Fee-For-Servicepril-October

bile Medical Clinicinden, Mondays 7-10ear-round

obile Medical Clinic-t. Mary's Church, Stocktonhursdays 2-5une-December

obile Medical Clinichornton, Wednesdays 7-10ear-round

obile Medical Clinicracy, Tuesdays 7-10une-October

an Joaquin Local Health Districtublic Health Nursingnvironmental Sanitationide Servicespril-October

an Luis Obispo Health Departmentipomo Night Clinicedical Clinic Mondays 6-10aternity Clinic Thursdays 1-5,alternate Fridays 9-12inor Surgery by appointment

Medical Fee-For-ServiceYear-round

17. Santa Barbara County HealthDepartment

Santa Maria Migrant ProjectPublic Health NursingCommunity AidesMedical Fee-For-ServiceYear-ro ,nd

18. Santa Clara County Medical So-ciety, Santa Clara Valley MedicalCenter and Santa ClaraCounty Health Department

Wheeler Hospital, GilroyOutpatient Medical Services

weekdays 6-10Public Health NursingMedical FeeFor-ServiceYear-round

19. Santa Cruz County HealthDepartment

Watsonville Area Service CenterMedical Clinic Mondays and

Wednesdays 6-10Immunization Clinic first Tuesdays

6-10OBGYN, Family Planning Clinic

alternate Thursdays 6-10Public Health NursingAide ServicesMedical Fee-For-ServiceYear-round

20. Solano County Health DepartmentDixon CampMedical Clinic Mondays and

Thursdays 4:30-9Public Health NursingAide ServicesMay-October

21. Stanislaus County Medical SocietyEmpire CampNursing Clinic weekdays 9-5Medical and Dental Fee-For-ServiceMay-October

21A. Patterson CampNursing Clinic weekdays 9-5Medical and Dental Fee-For-ServiceYear-round

21B. Westley CampNursing Clinic weekdays 9-5Medical and Dental Fee-For-ServiceYear-round

22. Sutter HospitalYuba CityMedical Clinic weekdays 6-10 (ex-

cept Tuesdays and Thursdaysonly December-April)

Medical Fee-For-ServiceMay-November

23. Sutter-Yuba Health DepartmentPublic Health NursingEnvironmental SanitationCommunity AidesYear-round

24. Ventura County Health DepartmentEnvironmental SanitationCommunity AidesYear-round

25. School of Medicine, University ofCalifornia at Davis

Yolo General Hospital, WoodlandMedical and Family Planning ClinicThursday 6-10Year-round

25A. Madison CampMedical Clinic Tuesdays 7-10May-October

25B. Ciudad del Sol Camp, DavisMedical Clinic Mondays 7-10May-October

25C. BroderickMedical Clinic Wednesdays 7-10May-October

67

26. Yolo County Health DepartmentPublic Health NursihgEnvironmental SanitationYear-round

Footnotes

The source for all statistics quoted in this report is the Farm Workers Health

Service, except the following:1. Carey McWilliams, Factories In the Field (Boston: Little, Brown and Co., 1939), pp. 20, 51,

68-70.2. !bid, p. 106.3. !bid, pp. 120-2.4. !bid, p. 117.5. Louisa R. Shotwell, The Harvesters: The Story of the Migrant People (Garden City, N.Y.:

Doubleday, 1961), p. 104.6. Ibid.7. McWilliams, op. cit., p. 119.8. !bid, p. 124.9. Mid, p. 130-1.

10. Ibid. p. 129.11. !bid, p. 296.12. Henry P. Anderson, The Bracero Program in California (Berkeley. University of California

School of Public Health, 1961), p. 178.13. Ibid, p. 179.14. !bid, p. 180-1.15. Health Conditions and Services in California for Domestic Seasonal Agricultural Workers

and Their Families. Berkeley: California State Department of Public Health, 1961.16. Ibid.17. The California Migrant Master Plan, Progress Report, 1966. Sacramento, California Office

of Economic Opportunity.18. Rural California: Hope Amidst ?overly. San Francisco. California Rural Legal Assistance,

1969.19. Regional Program for Migrant Education. A Report, 1967 Sacramento California State

Department of Education.20. California Annual Farm Labor Report, 1969. Sacramento: Division of Farm Labor Services,

State of California, Department of Human Resources Development.21. California's Principal Crop and Livestock Commodities, 1969. Sacramento: State of Cali.

fornia, Department of Agriculture. May, 1970.22. California Agriculture, 1968 and 1964-California's Principal Crop and Livestock Com.

modifies. Sacramento: State of California, Department of Agriculture.23. Ibid.24. Ibid.25. The California Farm Labor Force: A Profile. Sacramento: California Legislature Committee

on Agriculture, April, 1969, p. 7.26. California Annual Farm Labor Report, 1969, ap. cit.27. .The California Farm Labor Force: A Profile, op. cit., p. 28.28. !bid, p. 37.29. /bid, p. 6.30. Annual Operational Summary,Migront Family Housing Centers. State of California. Depart

mint of Human Resources Development, February, 1970.31. California Annual Farm Labor Report, 1969, op. cit.32. San Francisco Chronicle, May 22, 1970.33. Philip Booth, Sickness Insurance and California Farm Workers, May, 1968, Vol. 31, No 5.

U.S. Department of Health, Education and Welfare.34. San Francisco Chronicle, June 6, 1970.35. Occupational Disease in California. Berkeley: Bureau of Occupational Disease and Environs

mental Epidemiology, California State Department of Public Health, 1967.36. San Francisco Chronicle, Juno 4, 1970.37. Annual Operational Summary, Migrant Family Housing Centers, op. cit.38. California Department of Housing and Community Development, November, 1968.39. The California Farm Labor Force: A Profile, op. cit., p. 31.40. Annual Operational Summary, Migrant Family Housing Centers, op. cit.

41. Booth, op. cit.42. Research and Statistics Note, June 18, 1970, No, 7. Sacral Security Administration, U.S.

Department of Health, Education and Welfare, and San Francisco Chronicle, July 20, 1970.

83155-4S0 4/72 2U .68

Text & Design: David 0. Weber

Photography: Harvey Saul Columbus

Additional Photo Credits: Inside FrontPages 4, 6 right, 21 and 22 courtesy Mi,tion, Division of Farm Labor Services, Cpartment of Human Resources DevelopmJoaquin Medical Society; Page 28-Davi13 and 30-Anonymous.

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Text & Design: David 0. Weber

Photography: Harvey Saul Columbus

Additional Photo Credits: Inside Front CoverCal Potts;Pages 4, 6 right, 21 and 22 courtesy Migrant Services Sec-tion, Division of Farm Labor Services, California State De-partment of Human Resources Development; Page 19SanJoaquin Medical Society; Page 28David McMurdo; Pages13 and 30Anonymous.

69prink, in CALIFORNIA OFPICR OF STATR PRINTING