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Part 5 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: June 5, 2014
PRESENTED BY: Katherine Brieger, RD and Elizabeth Magenheimer

View Recorded Webinar

Participant Evaluation  

Presentation Slides (PDF)

To receive CME* or CNE credit after viewing any of these webinars you must do the following:
  • Complete the Participant Evaluation associated with each webinar
  • Send an email with your first and last name stating which webinar you completed to contedu@migrantclinician.org

Diabetes continues to be one of the most common and challenging health condition confronting migrants and other underserved populations. It is clear that a healthy lifestyle is critical to mitigating the impact of diabetes on individuals and the population, however effective and appropriate interventions can be difficult to design. Fairhaven Community Health Center in Connecticut and Hudson River Healthcare in New York, are two health centers that have long led the way in creating culturally appropriate lifestyle programs for migrants and other underserved patients. In this session the presenters will discuss lessons learned from the development of a variety of programs for diabetics and other patients including a community garden, nutrition classes, cooking classes, weight management and strategies to encourage exercise. The session will address the clinical core measures related to nutrition and BMI and will also discuss current research test second line drug effectiveness in Type 2 DM. Available in English

Learning Objectives:

  1. Describe culturally appropriate diabetes intervention strategies
  2. Identify strategies to address clinical core competencies related to nutrition and BMI to improve quality care.
  3. Receive “take home” examples of how to incorporate effective nutrition, weight loss, exercise and other health lifestyle strategies.

 

FURTHER READING

Download the Spanish Toolkit Materials

National Diabetes Information Clearinghouse, http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram

Bright Bodies, http://brightbodies.org

Part 4 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: May 14, 2014
PRESENTED BY:  Candace Kugel, FNP, CNM and Megan Danielson, CNM

View Recorded Webinar 

 Participant Evaluation  

 Presentation Slides (PDF)

To receive CME* or CNE credit after viewing any of these webinars you must do the following:
  • Complete the Participant Evaluation associated with each webinar
  • Send an email with your first and last name stating which webinar you completed to contedu@migrantclinician.org

Migrant women face significant disparities with an additional layer of complexity and require different intervention strategies. Among them are reproductive health, pregnancy and childbirth, sexual and intimate partner violence, and cancers that disproportionately affect women, including cervical and breast cancer. Women often face environmental and occupational health exposures both in the home and in the workplace that heighten health risks. This session will provide a follow-up to the July 2013 presentation “Women’s Health at the Intersection of Poverty and Migration” that was part of our Clinician Orientation to Migration Health webinar series.  During this presentation Candace Kugel, FNP, CNM, and Meagan Danielson, CNM will discuss quality improvement and health care services for migrant women. The HRSA clinical performance measures related to women’s health will be reviewed as well as resources and best practices for improving the health of migrant women.

Learning Objectives:

  1. Describe strategies to address clinical core measures that relate to women’s health .
  2. Discuss case studies that assist participants in understanding how creative collaborations and models of care can improve health outcomes for migrant women.
  3. Participants will be able to access clinical resources for working with female migrant patients.

 

FURTHER READING

Low Birth Weight Resources

Cervical Cancer Resources

Other Resources

Download Resource

Part 6 of the 7 webinar series: Clinician Orientation to Migration Health

DATE: presented live on July 17th, 2013

PRESENTED BY: Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health and Melissa Bailey, Executive Director of North Carolina Field, Inc.

 Women's Health at the Intersection of Poverty & Migration
View Recorded WebinarParticipant EvaluationPresentation Slides

  

Additional Resources:

MCN Women's Health page

MCN Health Network

Any prenatal patient who may move out of your area before giving birth is eligible to be enrolled in the Health Network. MCN will provide care coordination throughout the course of her pregnancy, until her postpartum visit is completed, to help ensure that there are no gaps in her health care.  512-327-2017 or 800-825-8205.

 

MCN Environmental Health/Pesticides Resources
MCN Family Violence Resources
MCN Streamline articles
Other Women’s Health Resources for Migrant/Immigrant Care
  • Text4Baby:  A free service that provides health education by text to pregnant women and new mothers in English and Spanish
  • The Perinatal/HIV Hotline: The National Perinatal HIV Consultation and Referral Service (Perinatal Hotline) provides 24-hour advice from HIV experts on indications and interpretations of HIV testing in pregnancy as well as consultation on treating HIV-infected pregnant women and their infants. The Perinatal Hotline (888-448-8765) is available 24 hours, seven days per week.
  • Centering Pregnancy: A model of group prenatal care widely used in a variety of settings, including FQHCs and with immigrant populations.  Materials are available in Spanish.
  • Rural Women’s Health Project  Pregnancy fotonovelas in English and Spanish.
  • Auger Communications “Teach with Stories” Prenatal Care fotonovela series and “Pregnancy and Diabetes: Lucia’s Story”
  • Wake Forest University One-page pesticides and pregnancy handout in English and Spanish. 
  • Migrant Health Promotion Farmworker Doula Manual
  • National Women’s Health Information Center. This website and toll-free call center were created to provide free, reliable health information for women everywhere, including lots of materials in Spanish.
  • March of Dimes  An array of materials at various literacy levels and almost everything in Spanish. Pamphlets, videos, "Comenzando Bien" curriculum.
  • Centers for Disease Control The CDC's Spanish website for women's health includes handouts in Spanish that can be printed from the website
  • National Perinatal Association Published transcultural perinatal education curriculum.
  • California Diabetes and Pregnancy Program.  Catalog of patient education materials in English and Spanish for perinatal issues related to diabetes and gestational diabetes.
  • “Diabetes gestacional: Guía para la mujer embarazada”.  Spanish language guide on gestational diabetes from AHRQ.
  • Association of Farmworker Opportunity Programs: “The Fields: The Hidden Faces of Farmworker Women” Interviews and stories about the issues that matter most to farmworker women’s health and well-being
  • Human Rights Watch:  “Cultivating Fear: The Vulnerability of Immigrant Farmworkers in the US to Sexual Violence and Sexual Harassment”
  • Legal Momentum Immigrant Women Program legal rights for immigrant women
  • Trafficking information

 

 

Historically, the field of women's health consisted of issues surrounding reproduction and childbirth. However, increasingly, the health care community has come to see women as a distinct patient group that has unique health concerns over a lifetime. Migrant farmworker women experience unique risks during pregnancy and otherwise, due to the physical demands, environmental exposures and other circumstances of their lives.  The provision of healthcare services to migrant women presents distinctive challenges for both clinicians and organizations.  MCN’s Candace Kugel, CRNP, CNM, and Melissa Bailey, Executive Director of NC FIELD, Inc., both with many years of experience with this population will discuss the problems, solutions and rewards of working with migrant women, through case illustrations and review of resources.

After taking this webinar:

  • Participants will be able to identify at least 2 health risks unique to women farmworkers and the impact of those challenges on work, nutrition and health.
  • Participants will be able to describe environmental and occupational health exposures relevant to farmworker women of reproductive age.
  • Case studies will assist participants in understanding how creative collaborations and models of care can improve health outcomes for migrant women.
  • Participants will be able to access clinical resources for working with female migrant patients.

PRESENTER BIOS:

Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health, Migrant Clinicians Network

ckugel@migrantclinician.org

Candace Kugel is a Family Nurse Practitioner and Certified Nurse-Midwife with over twenty years of experience in health care for the underserved. She has worked in various clinical settings, including family planning, migrant health, community health center, and private practice. She has worked almost exclusively in rural settings.

Candace has also been active in aspects of health care other than direct patient services. She has served as a clinical instructor for nurse practitioner, nurse-midwife, nursing, and medical students, and currently has faculty appointments with the University of Cincinnati and Penn State University’s Schools of Nursing. She has worked in program development in various arenas, including co-founding a “Stork’s Store” prenatal incentive program, initiating a natural family planning education program, and teaching childbirth education classes.

Melissa Bailey, Executive Director of North Carolina Field, Inc.

 mbailey@lenoir.k12.nc.us

Melissa Bailey is a native of southern West Virginia. She has worked in North Carolina migrant education programs since 2001. In 2010 AFOP’s Children in the Fields Campaign assisted community workers with forming the nonprofit NC FIELD. This effort aimed to establish an organizational empowerment and advocacy model to build capacity in farmworker communities, particularly among child laborers in agriculture. In 2012 Melissa became the Executive Director of NC FIELD. 

She has presented to local, state, and national stakeholders; assisted media; has worked as a research assistant on farmworker studies; assisted with organizational development and the leadership training of child farmworkers, and is a successful field organizer, consultant, and project manager. Melissa holds a certificate in Nonprofit Management from Duke University, among other certifications related to the delivery of supplemental education services and data.

In her spare time Melissa enjoys reading, writing, gardening, and spending time with loved ones.

New bilingual resource available April 2014!

Student Action with Farmworkers (SAF) has been using theater as an educational tool with farmworkers for over twenty years. By drawing on techniques of popular theater, SAF performs culturally appropriate, lively skits and facilitates theater workshops at farm labor camps. These performances spur conversations about mental and physical health, living and working conditions, and farmworker movements for social justice.

Many of SAF’s performances have focused on health issues, and they aim for this guide to offer dynamic tools for health care providers, educators, outreach workers, and public health innovators. Practitioners can also use these techniques with other populations across the social justice spectrum. For both organizers and educators, SAF hopes that popular theater can bolster the messages and information that you so readily share and provide a dynamic approach to outreach. Resources include songs, scripts, theater games and icebreakers. Printed copies are free, but SAF accepts small contributions to cover shipping and handling ($5-10/copy).

 

Available in print and online

Contact: Laxmi Haynes , 919-660-3660

Limited data document the multiple and repeated pesticide absorption experienced by farmworkers in an agricultural season or their risk factors.

Laboratory studies and case reports of accidental exposure to large amounts of chemicals indicate that there are immediate and long‐term negative health consequences of exposure to agricultural chemicals. 

The goal of this study was to describe acute occupational pesticide-related illnesses among youths and to provide prevention recommendations. Survey data from 8 states and from poison control center data were analyzed.

Concern about the adverse public health and environmental effects of pesticide use is persistent. Recognizing the importance of surveillance for acute occupational pesticide-related illness, we report on surveillance for this condition across multiple states. Between 1998 and 1999, a total of 1,009 individuals with acute occupational pesticide-related illness were identified by states participating in the SENSOR-pesticides program. 

In response to limitations in state-based occupational disease surveillance, the California Department of Health Services developed a model for surveillance of acute, work-related pesticide illness. The objectives were to enhance case reporting and link case reports to preventive interventions. Risk factors for pesticide illness were prevalent. 

The California Pesticide Illness Surveillance Program (PISP) is a major resource for pesticide illness epidemiology. This work attempts to improve characterization of pesticide illness in California, evaluate case ascertainment of the PISP and identify PISP’s limitations and biases for studying the incidence and epidemiology of pesticide-related illness. 

Public health surveillance for acute pesticide intoxications is discussed. Explanation of the goals, components and functions of population-based surveillance is provided with reference to key informational sources.

Pesticide Action Network, United Farmworkers of America, and California Rural Legal Assistance Foundation analyzed California government data on agricultural poisonings and enforcement of worker safety standards. Nearly 500 pesticide poisonings were reported for California farmworkers every year. The actual number of pesticide-related illnesses is unknown, since many poisonings go unreported. 

Surveillance data show that pesticide-related illness is an important cause of acute morbidity among migrant farm workers in California. Exposures occur in various ways (e.g., residues, drift), suggesting that the use of pesticides creates a hazardous work environment for all farm workers  Improved education for health care providers should be a priority. Growers should be educated about alternative forms of pest control and incentives should be provided to encourage their use.

Describes the growth from 1987 through 1996 of the Occupational Pesticide Poisoning Surveillance Program at the Texas Department of Health. The program was initially based on a Sentinel Event Notification System for Occupational Risks (SENSOR) model, using sentinel providers to report cases, supplementing the passive reporting by physicians that was required by law. 

The CHAMACOS study is a longitudinal birth cohort study examining chemicals and other factors in the environment and children's health. 

In 1999-2000, CHAMACOS enrolled 601 pregnant women living in the agircultural Salinas Valley.  They are following their children through age 12 to measure their exposures to pesticides and other chemicals and to determine if this exposure impacts their growth, health, and development. 

Print, cut, and distribute this handy bookmark to providers who treat migrant and seasonal farmworker patients. The bookmark includes links and a qr code to connect you to pesticide - related clinical tools and resources. In addition, we've included some useful phone numbers in case of a pesticide emergency.

You can also use the bookmark to keep handy the Health Network phone number to be sure your patients on the move remain in care.

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Safety and Health on the Farm

Este libro cómic bilingüe a todo color trata la indemnización laboral por accidente, los derechos y responsabilidades de los trabajadores inmigrantes que trabajan en granjas lecheras. Cuenta la historia de un trabajador mexicano de una granja lechera que se lesiona en el trabajo y los pasos que él y su empleador dan para asegurarse de que reciba sus beneficios y la granja mejore su seguridad. Incluye historias aplicables en todo Estados Unidos y otras específicas de cada estado. 

MCN's Director of Environmental and Occupational Health, Amy K. Liebman, appeared on the radio broadcast Epicenter: West Marin Issues on KWMR 90.5 FM to talk pesticides and the Worker Protection Standard. Liebman was joined by Hector Sanchez of the Labor Council for Latin American Advancement. Host Frederick Smith discusses with Liebman and Sanchez a variety of pesticide-related issues, including protections for farmworkers and their families, farmworkers' risks of pesticide exposures, how pesticides are regulated, their health effects on farmworkers and their families, and what healthcare providers can do to mitigate, diagnose, manage, and report pesticide exposures.

During the interview Liebman referenced the Agricultural Health Study, which is available here.

A report prepared by researchers at The George Washington University School of Public Health and Health Services features a wealth of information on occupational health and safety and the migrant population, from farmworkers to fast-food chain employees to restaurant cooks and servers.

News release:
http://defendingscience.org/news/labor-day-looking-back-year-us-occupational-health-and-safety

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Dramatic, visual and culturally relevant, fotonovelas are a successful means of communicating health information. The following fotonovela materials are downloadable.

Provided by Farmworker Justice 

Dramatic, visual and culturally relevant, fotonovelas are a successful means of communicating health information. The following fotonovela materials are downloadable.

 

Provided by Farmworker Justice

Dramatic, visual and culturally relevant, fotonovelas are a successful means of communicating health information. The following fotonovela materials are downloadable. 
 

Provided by Farmworker Justice

Two high-production value, Spanish radio public service announcements(PSAs) to promote HIV testing services at local agencies. One PSA targets men and the other women. Each PSA features a blank space for you to record your organization’s contact information. Provided by Farmworker Justice

Comprehensive Spanish-language curriculum for individuals interested in training promotores de salud in HIV prevention. The curriculum is based on popular education techniques, and is culturally competent and linguistically sensitive.

 Provided by Farmworker Justice

A directory of organizations working to promote health and prevent HIV/AIDS in California, Florida, North Carolina, Oregon, and Texas.

 

Provided by Farmworker Justice

This webinar is the sixth in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, July 17, 2013
PRESENTED BY: Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health and Melissa Bailey, Executive Director of North Carolina Field, Inc.

To view the recorded version of this webinar, click here.

Download Resource

The Occupational Health and Safety Resource Center is a virtual repository of Spanish educational materials, data sources, and links to bilingual informational websites on occupational health and safety issues related to agricultural work. It also contains an ample list of national and state agencies that have produced materials in Spanish for farmworkers’ health-related problems.

MCNs own Deliana Garcia helped in being a part of the advisory committee to this resource center.

What is the objective?  To facilitate a central access point to high quality Spanish educational materials on agricultural occupational health and safety issues for people conducting work on health promotion and prevention activities and on workers’ rights and problems related to agricultural work.

Who are the target audiences? Health-outreach workers (promotores), community advocates, health providers, contractors/employers, farmworkers and their families, and others interested in the health and safety issues of agricultural workers.

What areas are included? The materials cover five key relevant areas: 1) Farmworkers’ rights; 2) Injury prevention; 3) Respiratory illnesses; 4) Heat illnesses; and 5) Pesticide exposure.

How did we do it? To develop the Virtual Resource Center, the process entailed:

  • Asset mapping of educational, informational and research materials available in Spanish related to the five mentioned areas.
  • Selection of materials using the following criteria: accurate information, culturally and linguistically adequate (including literacy level), relevant to health area, and visually acceptable quality.
  • Insertion of resources into an excel format under five different categories, including source, type of material, and description of its content.

Development of new materials: to complement the existing educational resources, we developed a “Promotores Training Manual on Occupational Health and Safety of Agricultural Workers”.  Based on an ethnographic framework, the manual presents the perspective of agricultural workers on the five mentioned areas (their stories) and provides community health workers with tools on how to conduct prevention and promotion activities. It also refers them to existing resources.  We also produced a series of Spanish and selected indigenous languages Public Service Announcements (PSAs) on these areas.

An informative blog about workers' compensation, risk management, business insurance, workplace health & safety, occupational medicine, injured workers, and related topics.

Glenn Shor, Phd, MPP, Visiting Policy Analyst at the Center for Occupational and Environmental Health at the UC Berkeley School of Public Health.

This report was funded, in part, by The California Wellness Foundation, for UCSF Community Occupational Health Project, Barbara Burgel, Nan Lashuay, and Robert Harrison, 2004 - 2006.

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