The Art of Medical Interpretation: Understanding the Migrant Farmworker Patient

Hello again from the Eastern Shore! It’s been another interesting week interpreting for Eastern Shore Rural Health (ESRH). I have interpreted for many more cases, only a few of which led to some minor confusion (I mixed up pañal and puñal, and so when I wished to translate “does your son help change his brother’s diaper?” to a mother of two small children, she heard “does your son help change his brother’s dagger?”). After seeing the shocked look on her face, I hastily sorted that one out. But really! The vast majority of my interpreting was entirely successful.

If you recall, my project centers around the question—what makes a good interpreter? I am starting to think that the most important part of being a good interpreter is being able to answer the fundamental question—who are the patients I serve? This is more challenging than one might think. I must gain knowledge about my general patient demographic so I can be better prepared for the encounter. Who are migrant farmworkers? Why are they here? What challenges do they face? But I must be equally aware that the general knowledge I gather may not be true for each person in every aspect. Where is this individual from? What is his story? What makes him unique?

In other words, generalization is a necessity, and yet nothing can be assumed. I approach each encounter knowing that my patient is a Spanish speaker. But when I open the door, step inside the room and look at my patient, I do not know if he is a migrant worker, a seasonal worker, or if he works a regular 9 to 5 office job. I don’t know if he is a U.S. resident, an undocumented individual, or a fully-fledged citizen. He could be well educated or poorly educated, trusting of western medicine or distasteful of it. I don’t know at first which country he is from, and what pushed him to leave his home and possibly even his family in the first place. In some ways, I can’t even be 100% sure that Spanish is his first language; some patients have been known to speak lesser-known dialects and merely limp along with what Spanish they know. What I can tell you are the hard facts found in the electronic medical records system—the patient’s full name, date of birth, the reason for their visit in 2 or 3 words, and perhaps their spouse’s name and some contact information.

But even these basic statistics might not represent the full truth for some patients. Many of the migrant workers are here undocumented, and most of them have obtained a second name so that they can pass under the radar to work.

Let me paint a better picture for you. Working in the fields has been consistently ranked as one of the most dangerous industries in which to work in the United States: increased health risks include harm from pesticides, skin disorders, infectious diseases, lung problems, hearing and vision disorders, and strained muscles and bones. It is no surprise, then, that American companies in agribusiness are unable to find enough workers who are willing to fill these positions in the United States.

So, companies must search elsewhere. They target the most vulnerable in our society, trying to convince people from poorer countries that there are job opportunities found within their company, sometimes showing them pictures of happy, healthy families and nice homes that turn out to be entirely fabricated. Migrant farmworkers can be men, women, or children, and many of them are separated from their families when they come here to work. They are different from seasonal workers in that they follow the crops as needed, not knowing where their next destination lies, and are often only located in one place for a few months at a time. Thus, the medical care they receive and the education of their children is entirely disjointed.

The fact of the matter is that there are many jobs that are particularly dangerous but quite necessary—logging, mining, fighting for one’s country, working in factories, being a firefighter, etc. But if you think about it, providing the fruits and vegetables that literally keep you alive each and every day just might be at the very core of what we consider a human “necessity.” It is painful, then, to reflect on civil rights activist César E. Chávez’s famous quote:

 

“It’s ironic that those who till the soil, cultivate and harvest fruits and vegetables and other foods that fill your tables with abundance have nothing left for themselves.”    César E. Chávez

 

Sadly, little has changed to help this particular group of people in the last half a century. 50 years ago, “Harvest of Shame” was the first documentary made exposing the exploitation of farmworkers. It stirred up quite a conversation, but while the past 50 years have been a great success story in terms of worker rights for every other type of worker in the United States, migrant workers have remained an exception in many regards.

There are several examples that illustrate this. OSHA (Occupational Safety and Health Administration) requires that agricultural employers who employ or house 11 or more workers provide drinking water, hand-washing facilities, and toilets for their employees, but that leaves out a great number of farmworkers who work on smaller farms. Even for larger farms, compliance to the laws is very poor because OSHA can only afford to check a small portion of establishments. Thus, many infractions go unnoticed.

Agricultural work is incredibly intense because the timeframes for planting, thinning, and harvesting are dependent on the seasons and the weather. Lost work can mean lost crops for companies, and farmworkers must work in all types of weather conditions—from extreme heat, to rain, to the cold—to meet the demands. I have also heard from the outreach workers here that while on the job, workers are sometimes denied water or bathroom breaks in order to keep up with the sheer pace of the work. Workers have also told some clinic outreach workers that they don’t want to come in to check their particular medical condition for fear of missing work and losing their job. One recent incident that another interpreter mentioned to me was about a woman who was starting to have vision problems, but ended up not coming in because of her fear. Though some of these demands and pressures might be unreasonable and even illegal, a recent documentary on migrant farmworkers explains that companies found not complying with the laws are often just given a monetary fine, which merely amounts to a slap on the wrist in the big picture.

Some things really seem to be quite a double standard, and I have seen a few of these instances at the clinic I work at. Companies don’t seem to care that their workers are undocumented, so that passes under the table easily. However, if a pregnant woman tries to go to the clinic where she has used her real name to obtain papers showing proof of her pregnancy needed to obtain leave, the company will not accept the papers if the name does not match the one she has originally given them—her second name, used to obtain work from the company in the first place. Thus, she goes on unpaid leave or more likely loses her job. In other words, the companies turn a blind eye about being “legal” when it comes to working, but will use this to penalize a worker when it comes to basic rights that we have made “universal” in America.

I have had a chance to visit a few of the camps while I have been here, and they vary in appearance and set-up. Some appeared as groups of trailer-like dwellings, each filled several rooms, one per family, and ending with one large communal room for food preparation. A few times, I saw camps with a two-level house where 20 or more people lived in the same space. There is rarely air conditioning in the buildings, and there are no locks on the doors for privacy. Other dwellings that have been described to me but which I haven’t yet seen have mud-floors and are sometimes infested with insects or rodents. One bright side is that some of these mud-dwellings have recently been replaced with something at least a little more livable, but that isn’t true everywhere.

I have also met several of the workers in the camps, and they have always spoken to us kindly, if shyly. They have similar concerns as we do about family, the education of their children, and their health. The outreach workers try to give them a bit of information about the clinical services available and form a connection of trust incase the need for healthcare arises in the future. In the clinic, migrant workers come in most often for care of their children and for their own acute injuries. Some of the examples from the last two weeks include a man who works as a chicken catcher who injured his foot; a 19 year old with a wound from clam farming; a piece of wood that lodged itself in a woman’s finger while picking tomatoes; a woman who was infected with pubic lice; and two men with a distinct rashes on their necks from something they had been exposed to while working outdoors.

Interestingly, two of the people I work closely with now originally came from migrant farmworker families themselves—Roberto (age 22), who works as the Migrant Outreach Worker at my clinic, and Carolina (age 21), who is a Student Action for Farmworkers (SAF) intern from Idaho. Though both are deeply devoted to their families and respect farmworker culture, they are in some ways unique—Roberto was the only child in his family of eight to graduate from high school, and he even graduated from college as well. Carolina has been a hardworking student and plans to pursue a career in medicine next year. Perhaps the greatest hope that migrant workers have is in their children. But with many children having to split their time working on the farm and going to school, not to mention dealing with the stresses of changing schools frequently, the greatest challenge is making sure they don’t drop out.

So, the next time you eat a tomato, remember that there was another individual who risked a little bit of himself to give something to you. What as individuals and as a nation will we chose to give back?

Comments

  1. joannaweeks says:

    It is incredible that the state of migrant farm workers continues to slip by unnoticed by the media and those in power. So glad that you are shining more light on the subject.