Migrants Strain South’s Safety Net : Farm Workers: Harvest time brings costly problem to communities trying to meet health needs of immigrant labor crews.

For Martha Rich, Edgefield County’s assistant administrator, autumn brings a bitter harvest.

It is budget time now, and she and other officials in this western South Carolina county of about 18,000 people must find ways to pay the increasingly expensive cost of providing medical and other services for migrant farm workers who pass through here during the spring and summer months.

The migrants “cost Edgefield quite a bit of money--about $10,000 if you count the law-enforcement costs and everything,” Rich said, thumbing through documents in her office. AIDS presents serious problems, she said, including fear among health workers. And Rich added that “we have more TB than I expected.”

The clash between strained local resources and a burgeoning need focuses attention on the policy--begun under former President Ronald Reagan and continued under President Bush--of shifting the financial responsibility for social programs to states. The situation is complicated by the special problems of assisting migrant workers, including unhealthy environments, frequent movement, language problems and resentment of the workers by native-born residents.

Additionally, in the South there are special problems, such as the absence of large populations of immigrants in towns and farm communities, reluctance of doctors to practice in areas with migrants and the inability of workers to organize unions or powerful lobbies.

Michael Hancock, executive director of the Farmworker Justice Fund, calls the workers “woefully underserved,” adding that in the South the problem is especially bad. Union-won benefits for migrants, including paid health care, have helped migrants in Florida and California, he said, declaring: “In the Old Confederacy, unionization has been difficult at best.”

Given the current situation, costs likely will continue to rise for Edgefield and other communities that lie in the migrant stream in deep Southern states and along the south Atlantic coast. The number of migrant workers seeking services grows annually, and a new study by Georgia Southern University shows that migrant workers are surprisingly uneducated about diseases and how to prevent them.

Only half of the migrants surveyed know what causes the deadly Acquired Immune Deficiency Syndrome. “We found a worst-case scenario in terms of what they know about AIDS and the way it is transmitted,” said David Foulk, chairman of the department of health sciences at the university.

The study of 400 migrant workers along the East Coast, expected to be released later this year, also found that “people are sharing (injection) needles, but not for drugs,” Foulk said, noting that needle-sharing puts people at risk of contracting AIDS. “They’re using injectable drugs like penicillin and vitamins. They have a history of self-injection” in Mexico and other countries that provide many of the estimated 3 million migrant workers who follow U.S. crops each year.

Between 800,000 and 1 million migrants are estimated to work in the Eastern Stream, which runs from Florida to Delaware. They pick tomatoes, cucumbers, peaches, tobacco, bell peppers, squash and other crops. Some work in poultry factories. For the most part, their employers are small operators who cannot afford to pay for workers’ medical care.

Thus, the migrants, many of whom resist taking off from work with an illness or injury until they absolutely must do so, rely on free care at clinics, or pay token sums that do not nearly cover costs.

Elinor Ezzell, administrator of Goshen Medical Center in Faison, N.C., said the increasing influx has put the center in “a tremendous strain.” In 1984, she said, the clinic treated 314 migrants. By last year, the number had ballooned to 2,287.

In Duplin County, N.C., Patricia Blanchard, nursing supervisor of a prenatal clinic, said the clinic sees “a good number of migrants” and that “no one pays. The county and state absorb the costs,” which run as high as $10,000 a year. Blanchard said the clinic received $3,000 from the state but had to use the money to hire a Spanish-language interpreter. “We were between a rock and a hard place trying to talk to” Mexican migrants, she said.

Dr. Melinda Roe, assistant public health officer for Alabama, portrayed the federal policy of shifting financial responsibility onto states as a two-sided mirror, providing more local control but also requiring “that community . . . to come up with more funds.”

Many advocates for migrant workers urge the federal government to do more. Hancock of the Farmworker Justice Fund said federal programs for migrant health are “woefully underfunded.” He described the programs as “plain vanilla, bare bones health services” that “at best serve 20% of migrants who need them.”

But in Washington, at the U.S. Public Health Service’s Office of Migrant Health, Director Sonia Leon Reig defended the Bush Administration policy of “not having the federal government meet the whole problem but be a partner in solving the problem.”

Reig said her office’s $45.6 million budget funds 122 migrant health centers nationwide and acknowledged that only 15% of migrants are served by the centers. However, she said federal funds should not be increased until migrants are better educated on health matters, including AIDS.

Indeed, in the absence of increased federal help, many small communities are exploring a variety of alternatives, including pressing farmers to buy health insurance for workers.

Rich, the Edgefield County official, said the county commission tried to pass such a law here a few years back. “That ordinance failed,” she said, “because of so much objection” from farmers, who argued that they cannot afford to foot migrants’ medical bills.

It is not surprising that such laws are difficult to pass. In many quarters around here, as in other towns around the South, migrant workers inspire neither sympathy nor compassion.

Here in downtown Edgefield, population 2,713, several men sat outside Mims Corner Store, across the square from the county courthouse, and talked with a visitor about the migrant workers who each year pick peaches and live in nearby work camps.

Robert Williams, a plumber, said many of the workers cut and shoot each other and “go ‘round butt naked. They act like a bunch of monkeys. They like to (almost) shut the hospital down, they owed so much money.”

Despite such feelings, migrant workers do frequently interact with local residents, say experts. Therefore, said Foulk of Georgia Southern University, health problems of migrant workers “make an impact on the health of the general public. From a practical as well as humanistic standpoint, migrant and seasonal farm workers’ health must become more of a public health concern.”