A Difficult Harvest: Translation and Interpretation
Services for Farmworker Healthcare in the U.S.
Thomas Allison
There are millions of migrant and seasonal farmworkers planting, cultivating, harvesting, packing, and preparing crops for market or storage in the U.S. The nature of this work—grueling shifts, prolonged heat and pesticide exposure, and hours spent in bodily stress positions—creates a great health risk for farmworkers; agricultural occupations consistently rank among the most dangerous in the U.S. Although the men, women, and children who work as migrant and seasonal farmworkers are essential to the economy, they represent one of the most medically underserved populations in the country. The numerous barriers to healthcare that farmworkers face are exacerbated by the fact that most workers are foreign-born from Latin American countries and are not proficient in English. Translation and interpretation services are essential to providing adequate, culturally appropriate healthcare to this population, yet the demand for such services is not always met. It is not financially feasible for the organizations that deliver free or affordable healthcare to farmworkers to staff translators and interpreters; therefore, these responsibilities are often delegated internally to bilingual staff members or left unmet.
Of the estimated 2-3 million migrant and seasonal farmworkers in the U.S., the majority are foreign-born from Mexico and Central America. According to the most recent National Agricultural Workers Survey (NAWS) findings from 2001-2002, 78% of the hired crop labor force was born outside the U.S.—75% from Mexico, 2% from Central American countries, and 1% elsewhere (Carroll 3). Migrant workers, which the survey defines as “persons who travel at least 75 miles during a 12-month period to obtain a farm job,” comprised 42% of the farmworker population (Carroll 7). The farmworkers who do not follow the harvest, referred to as seasonal workers, live in one community year-round and work in agriculture during local harvest seasons. The NAWS indicates that the farmworkers were mostly male and relatively young in age; 79% of the farmworkers interviewed were male and over half were under the age of 31, with 6% being younger than 18 years of age. 58 % of the farmworkers interviewed were parents, with an average of 2 children (Carroll 7-12). Of all the farmworkers interviewed, the average level of formal education completed was 7th grade (Carroll 18).
The reality of the situation is that the U.S. agricultural industry employs a population of largely foreign-born workers, most of whom are young men and parents, for one of the most hazardous occupations in the country. According to the North Carolina Farmworker Institute’s “United States Farmworker Factsheet,” farmworkers experience “higher incidences than other wage-earners of heat stress, dermatitis, urinary tract infections, parasitic infections, and tuberculosis, as well as significant rates of eye injuries.” Additionally, it states, “farmworkers suffer from the highest rate of toxic chemical injuries and skin disorders of any workers in the country.” Pesticide exposure is a major risk for farmworkers, as pesticide use is one of the most common and most hazardous aspects of the job. While anyone on a farm can come into contact with chemicals and pesticides, the level of exposure for farmworkers must be considered separately; As Arcury, Quandt, and Russell point out, the extensive hand labor that most farmworkers perform and the limited power they have to influence workplace safety results in higher levels of exposure (233). This threat is heightened even further by the often questionable appropriateness, both culturally and educationally, of the safety materials and information accessible to farmworkers (Arcury, Quandt, and Russell 233). Amy Schmidt, Executive Director of Vecinos Farmworker Health Program in western North Carolina (a state with the 6th largest population of farmworkers in the country), reiterated the seriousness of the problem in a recent personal interview (NC Farmworker Inst.). She stated, “Most of the farmworkers we work with don’t even know the names of the chemicals and pesticides, although they should. If they have a problem with one and they have to go to the doctor they should know what chemicals they’re working with. They are often not told, nor do they often ask.”
The barriers that separate farmworkers from adequate healthcare are numerous. A certain degree of difficulty is to be expected for a population that makes $11,000 per year on average and is 53% undocumented, but the obstacles to healthcare extend beyond wealth and legal status. They include language/cultural discrepancy; lack of resources, information, and available services; frequent relocation; limited non work-related transportation; and no option of sick leave (NC Farmworker Inst.). Language is certainly one of the largest isolating factors for farmworkers. The NAWS reveals the pervasiveness of this issue: When asked “How well do you speak English?” 44% of farmworkers responded that they could not speak English “at all,” 26 % said that they spoke “a little,” and 6% said “some.” The question of “How well do you read English?” yielded similar results: 53% could not read English “at all,” 20% could read “a little,” and 6% could read “some” (Carroll 21).
The language barrier is widened by the increasing demand for translation and interpretation services, which is growing faster than outreach organizations and healthcare providers can manage. In a report outlining barriers to healthcare for migrant farmworkers, Schmalzried and Fallon describe the problematic series of steps that migrant workers must often take in order to receive care:
Respondents rated not having an interpreter as a main barrier to receiving medical care [. . .] Most community/migrant health centers have offices for health providers and usually have bilingual staff. However, when such facilities are not located near places of employment (the nearest community/migrant health center in the study area was more than 80 km [50 miles] away), MAWs [migrant agricultural workers] are likely to seek healthcare services elsewhere, such as from a local health department, a non-profit agency or a private healthcare provider. These organizations are not likely to have bilingual staff. While some of these organizations may have access to interpreters, it is cost prohibitive to have them available on a continuous basis (7).
While the isolation of farmworkers caused by the language barrier is clear, there is another aspect that is often overlooked: the difficulties that non Spanish-speaking educators, state agency staff, outreach workers, and healthcare providers experience when working with Spanish-speaking farmworkers. LePrevost, Blanchard, and Cope indicate that these individuals reported, through interview responses, that minimal proficiency in Spanish, lack of comfort with speaking the language, and/or the need for an interpreter “limited the ability to facilitate discussion among and with farmworkers” (602). In her interview, Schmidt stressed the importance of these interactions, drawing from personal experience: “I’ve seen failed communication, and patients often can suffer from that. If the provider or doctor doesn’t understand what is going on with the patient or the patient doesn’t understand, for example, where to pick up the medication or what the medication is for, they’re likely not going to take what was prescribed to them [. . .] It can be as valuable as life and death.”
The organizations and agencies that strive to provide affordable healthcare for farmworkers are typically government-funded and, as a result, are perpetually underfunded to meet the enormous demand for their services. The necessity for more translators and interpreters in this setting is obvious, yet the establishments that should be employing them must direct their limited resources at more immediate needs. In response to this predicament, employers in the field are beginning to require bilingualism of staff and associated workers. Schmalzried and Fallon claim, “The value of utilizing outreach workers to convey medical care information to MAWs cannot be underestimated,” advising organizations to “employ bilingual staff whenever possible” (8). These organizations and agencies are utilizing individuals with broad skillsets who can fill a number of positions in addition to that of translator or interpreter. Schmidt, whose largely state-funded, non-profit organization does not have the “capacity” to hire outside translators and interpreters, seeks well-rounded employees to fill her “Outreach Worker” positions. These staff members handle case management, translation, interpretation, event planning and coordination, medical education, and patient transportation.
The agricultural industry in the U.S. depends on an abundance of cheap labor. While this tactic keeps costs low and the price of crops relatively affordable, it leaves an entire population of disadvantaged farmworkers in its wake. These conditions create a network of challenges and barriers to basic human rights, perhaps the most important of which is adequate healthcare. As long as this situation continues, there will be an overwhelming need for translators and interpreters to help facilitate healthcare for farmworkers, but the men and women who undertake this task should be prepared to get their hands dirty.
Works Cited
Arcury, Thomas A., Sara A. Quandt, and Gregory B. Russell. “Pesticide Safety among Farmworkers: Perceived Risk and Perceived Control as Factors Reflecting Environmental Justice.” Environmental Health Perspectives 110.2 (2002): 233-39. Academic Search Premier. Web. 5 Mar. 2015.
Carroll, Daniel, et al. “Findings from the National Agricultural Workers Survey (NAWS) 2001-2002: Research Report No. 9.” doleta.gov. United States Dept. of Labor: Education and Training Administration, March 2005: 1-66. Web. 5 Mar. 2015.
LePrevost, Catherine E., Margaret R. Blanchard, and W. Gregory Cope. “Beliefs of Science Educators Who Teach Pesticide Risk to Farmworkers.” International Journal of Environmental Science and Education 8 (2013): 587-609. Academic Search Premier. Web. 5 Mar. 2015.
Luque, John S., and Heidi Castañeda. “Delivery of Mobile Clinic Services to Migrant and Seasonal Farmworkers: A Review of Practice Models for Community-Academic Partnerships.” Journal of Community Health 38 (2013): 397-407. Academic Search Premier. Web. 5 Mar. 2015.
North Carolina Farmworker Institute. “U.S. Farmworker Factsheet.” ncfarmworkers.org. Farmworker Ministry Committee of the North Carolina Council of Churches, 2012. Web. 5 Mar. 2015.
Schmalzried, H.D., and L.F. Fallon Jr. “Reducing Barriers Associated with Delivering Heath Care Services to Migratory Agricultural Workers.” Rural and Remotes Health 12.2088 (2012): 1-10. Academic Search Premier. Web. 20 Mar. 2015.
Schmidt, Amy. Personal interview. 14 Mar. 2015.
