This document discusses the implications of pesticide exposure for migrant and community health centers. It notes that most medical professionals have not received education on pesticides during their training. It identifies populations at high risk for pesticide exposure and outlines six essential skills for healthcare providers in managing pesticide exposure cases, such as taking environmental histories and providing prevention education. Key barriers to care for migrant farmworkers are also discussed, such as fear of job loss and language/cultural barriers.

1. Pesticide Exposure Implications for Migrant and Community Health Centers Judith Fitzgerald, B.S.N., R.N. Special Programs Manager InterCare Community Health Network May 20, 2009

2. Significance for Health Centers Most Migrant and Community Health Center staff did not receive any pesticide-related instruction during medical or nursing education. Many have had little or no continuing education on this topic. Few have experienced identifying pesticide induced conditions and making appropriate reports and/or referrals.

3. National Strategies for Health Care Providers: Pesticides Initiative The National Environmental Education & Training Foundation (NEETF) U.S. Environmental Protection Agency (EPA) U. S. Department of Labor (DOL) U.S. Department of Agriculture (USDA) U.S. Department of Health and Human Services (DHHS)

4. Why should CHC staff be especially alert to pesticide exposure? Hundreds of millions of pounds of pesticides are used in the U.S. annually (most are herbicides applied to agricultural crops). Many other applications are made in homes, lawns, businesses, schools, on pets, and on human skin Opportunities for over-exposure abound in our environment Effects of pesticide poisoning are often misdiagnosed, yet can be devastating

5. Occupational and Environmental Risk for Pesticide Exposure Ranch and farm workers Gardeners Groundskeepers Florists Structural pest control workers Hunting and fishing guides Health care workers who deal with decontamination People employed in pesticide production, mixing and application Family members of those at occupational risk Treated foods and plants Ground- +/- well-water contamination Breast milk Placental transfer

6. 6 Essential Practice Skills Taking an Environmental History Awareness of Community and Individual Pesticide Risk Factors Knowledge of Key Health Principles Clinical Management of Pesticide Exposure Reporting Pesticide Exposure and Supporting Surveillance Efforts Providing Prevention Guidance and Education to Patients

7. Environmental History: Agricultural Workers and Their Families Is their spraying going on while you are in the field? Do you feel sick while in the fields? Were the fields wet while you were picking? (Dry fields can be sources of residues also) Does anyone else have the same sickness as you? Were Restricted Entry Interval (Danger/Peligro) signs with dates posted in the fields? How close do you live to the fields? Do your children play or work in the fields? Do you have lunch in the fields?(Do you eat what you pick?)

8. Barriers to successful medical interventions with MSFWs Fear of job loss if any incident is reported Lack of awareness of the dangers of pesticides Lack of knowledge about the specific pesticides being used Substandard housing conditions; lack of hot water and indoor plumbing Shared, antiquated or no in-camp laundry facilities Poverty; few clothes, lack of laundromat money; poor diet Language barriers Culturally learned explanations for health problems

9. Barriers to successful medical interventions with MSFWs Symptoms resemble other medical conditions Environmental history not taken Explanatory model approach not explored Poor integration of clinic and outreach operations Failure to follow through with a report http://www.oem.msu.edu/Resources/MIOSHA-MTSD-51ODreporting.pdf

10. Eliciting MSFW Patients’ Explanatory Models What is the name of your problem? What caused it? Why did it start when it did? What will this problem do to your body? How has this illness affected your life? What worries you most about this problem? What are your expectations? What kind of treatment do you think you need? Are there other things you want (support, reassurance, or explanations)? Guidelines for the Care of Migrant Farmworkers’ Children , AAP, MCN, p. 21 http://www.dshs.state.tx.us/THSteps/cultural/model.shtm