Lifeline to the Unseen

The Farm Worker Family Health Program tackles complex global health problems in Emory's backyard.

By Dana Goldman

They live in rural areas, with limited transportation, English-language skills, education, and money. They spend 12-hour days picking fruits and vegetables they cannot afford to buy in stores—even if there were stores nearby in which to buy them. They live and work with pesticide burns, chronic back pain, and serious dental problems. They are documented and undocumented migrants, mostly from Mexico. Their life expectancy is 49 years—25 years less than the average American.

Emory nursing professor Judith Wold knows all about the health problems plaguing Georgia's farm workers. For the last 20 years, she's been spearheading what's now known as the Farm Worker Family Health Program, a collaborative, multidisciplinary effort to provide health care to farm workers and their families in south Georgia.

"This is one of the most disenfranchised groups that there is in the state," she says. Through the program, Wold hopes to tackle some of the widespread global health issues that exist just a few hours south of Emory's Lillian Carter Center for Global Health and Social Responsibility, where the program is based.

The Farm Worker Family Health Program is an ambitious project that's grown in scope significantly since its start at Georgia State University in 1993, when six nursing students traveled down to south Georgia to help out. When Wold came to Emory from Georgia State in 2001, the program came with her—and continued to grow. It is now one of five options for two-week summer immersion experiences that the nursing school offers its students. (For the others, students travel to West Virginia, the Dominican Republic, the US Virgin Islands, and the Bahamas.)

And while south Georgia may not sound as glamorous as other summer immersion destinations, that fact doesn't deter many students. Each year, more than 110 students and faculty members from Emory and other Georgia colleges caravan down to the farmlands of south Georgia, bunk four to a hotel room, and spend long days providing preventative health care, conducting screenings and physicals, and making referrals to the Ellenton Rural Health Clinic, a seven-person center tasked by the state with providing care to area farm workers. Joining about 75 Emory nursing school participants are pharmacy, physical therapy, and dental hygiene students from other local colleges. All students come at their own expense, while accompanying faculty members receive funding from their universities.

Their collective effort isn't lost on Vanessa Jones, director of the Ellenton Rural Health Clinic. "We always look forward to the students coming and showing them the farm working community and what farm worker health is about," she says. "It helps our program immensely."

For students who think global health is only something that happens outside the United States, the program is a wake-up call.

"Global is everywhere," says Mary Micikas 13BSN 14MSN. Micikas enrolled in Emory's Nell Hodgson Woodruff School of Nursing because she wanted experience and skills to work in global health. This past summer, she was one of four Emory students who volunteered as medical interpreters for the farm worker program.

In the mornings, Micikas and the other students began their days with health screenings at a summer school specifically for the children of farm workers. They ended their days at local farms, providing onsite medical evaluations for farm workers who've finished picking crops for the day. In their two weeks in south Georgia each year, the students provide care to upward of a thousand patients.

One patient this past summer stands out to Ida Curtis 14BSN. "He looked like he was 90 years old," she says, though later she found out he was closer to 60. The man was short and thin, but a blood glucose test revealed that he had uncontrolled diabetes.

"That really touched me,"she says. "Here's a guy who is working, who usually has no access to care, and now his diabetes is out of control." Curtis offered him insulin, but he declined. "Even if he started, he said he had no way to continue to get insulin," she says.

The experience was eye opening for Curtis. She'd previously worked as a nursing assistant with geriatric patients and had planned to continue working with older patients after graduation. But her experience with the farm workers—and that particular patient—changed her perspective.

"Before, I would just look at the smaller picture,"she says. "But as I graduate I intend to look at the bigger picture and hopefully look at policy development, especially with rural areas and immigrants."

That's exactly the kind of change in perspective that Wold hopes to cultivate. "This program is a tremendously good way to model what we want our students to know about social responsibility, about service learning, about public health, and working in an area where you have to make do and use the resources you have," she says. Many students find the experience so meaningful they come back summer after summer, some taking on related farm worker health projects during the school year and some returning even after graduation to help.

Students and faculty say the program is unique in that it provides not just cross-cultural experiences, but also an opportunity for healthcare professionals to see one another in action. Nurses get experience working with medical interpreters like Micikas. And Micikas benefited as well. "I learned a lot about physical therapy and dental care," she says. "The interdisciplinary part of the program is incredibly important."

Jones, the health clinic director, says there's another big advantage to the program for her, her staff, and the farm workers they serve year round. "It's always helpful when you have a well-respected institution backing you, supporting the work that you do," she says. "This is a population that is often disregarded and looked down upon. And so having the support of Emory and the School of Nursing helps us within the community."

After all, says Jones, even though farm workers live on the margins, invisible to those outside the agricultural sector, they still deserve respect. And—of course—high-quality health care.

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