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DATE RECORDED: Friday, July 11
PRESENTED BY: Ed Zuroweste, MD. Chief Medical Officer, Migrant Clinicians Network

MCN’s Environmental and Occupational Health Programs

Learn more about MCN’s training and technical assistance programs to help clinicians and health centers improve the recognition and management of pesticide exposures and other environmental/occupational health conditions.

Migrant workers are often employed in some of the most dangerous jobs in the United States. Lack of training, poor safety precautions, regulatory exclusions, lack of health insurance, language barriers, piece-rate pay, undocumented worker status, and geographical and cultural isolation can put these workers at increased risk for occupationally related injuries and illnesses and chronic sequelae.  

This webinar will discuss health risks facing migrants as a result of their working conditions and highlight best practices and resources to incorporate environmental and work-related health into the primary care setting.  It will aslo showcase successful initiatives employed in Community and Migrant Health Centers.  Participants will become familiar with the importance of and feasible approaches to integrate environmental and occupational health into primary care from both a clinical and social justice perspective.

SPONSORED BY: Migrant Clinicians Network

OBJECTIVES: Participants will be able to:

1. Understand the reasons for integratin environmental and occupational health into primary care
2. Recognize the role of the clinician in work-related exposure
3. Be familiar with tools and resources to address occupational injuries and exposures in primary care

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

DATE RECORDED: June 25, 2014
PRESENTED BY: Brett Pack, DMD, Dental Director, Moses Lake Community Health Center and Maria Smith, MPA, Project Director, National Network for Oral Health Access

View Recorded Webinar  

Participant Evaluation  

Presentation Slides (PDF)

The Patient-Centered Health Home is a concept being implemented through a variety of approaches including full integration, co-location, shared financing, virtual linkages and facilitated referral and follow-up. Health Homes are an important approach for helping to ensure that health center populations have access to comprehensive health care services, including dental care. This presentation will describe how oral health can be integrated into overall primary care systems to improve health care quality and outcomes of the patients we serve, by illustrating promising practices from an example health center oral health program.

Learning Objectives:

1. Understand why medical-dental integration is a positive attribute
2. Describe examples of medical-dental integration at the clinical level
3. Receive “take home” examples of how to incorporate oral health into your health center’s Patient-Centered Health Home.

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)

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.

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.

  

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 Pesticide Comic Book Order Form.  Lo Que Bien Empieza…Bien Acaba (What Begins Well, Ends Well): Spanish comic book for women about pesticides and pregnancy Aunque cerca...sano (Close but Healthy): Spanish comic book for preventing pesticide exposure in children and families working in and living near agriculture Pregnancy, Reproductive Health and Pesticides Monograph (available in English and Spanish) Lead Guidelines for the Pregnant Migrant Woman Environmental health screening tool for the primary care setting Environmental health clinical guidelines Assessment of Maternal Occupational Pesticide Exposures during Pregnancy and Three Children with Birth Defects: North Carolina, 2004 Case Report: Three Farmworkers Who Gave Birth to Infants with Birth Defects Closely Grouped in Time and Place - Florida and North Carolina 2004-2005 MCN Family Violence Resources Addressing Domestic Violence in a Clinical Setting - Manual for Health Care providers, with Screening Tool (English) Training Manual on Family Violence (English/Spanish) “La Vida Mia”Photonovella & Training Video  (English/Spanish) MCN Streamline articles Feb 02 “Exploring a Paradox” (the Hispanic perinatal paradox) Mar/Apr 06 “Screening for Pesticide Exposure” Jul/Aug 07 “Lead screening in Pregnancy” Sept/Oct 07 “Pesticide exposure and self-reported gestational diabetes in the Agricultural Health Study” Oct/Nov 11 “Preventing Partner Violence in Refugee and Immigrant Communities” (pg 3) 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.

These files are part of the Engaging Migrant Men project.

Accompanying discussion guides were created to be used by male peers, community leaders, or outreach workers for one-on-one and small group discussions with men.

Part 1 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: March 19, 2014
PRESENTED BY:  Deliana Garcia, MA, International Research and Development, Migrant Clinicians Network

View Recorded Webinar  

 Participant Evaluation  

 Presentation Slides (PDF)

**Note: Due to technical difficulities the first 7 minutes of the presentation are not recorded. Please refer to the pdf of the slides for the content that was covered in those 7 minutes.

Over the last 30 years, considerable attention has been paid in the clinical setting to cultural competency- the ability to mitigate against the effects of the sociocultural differences between clinicians and patients and to take into account how culture affects the symptoms presented or the patients’ attitude about health care.  More recently, scholars and clinicians have encouraged those in practice or health professions training to focus not only on the behaviors and beliefs of cultural groups but more importantly to consider the structural determinants, prejudices, injustices and blind spots, the “pathologies of social systems” that affect health outcomes and the stigma experienced by patients. The session will introduce participants to the broad framework of structural competency and the five core structural competencies.

Learning Objectives:

1. Identify the structures that shape clinical interactions;
2. Discuss the means of developing an extra-clinical language of structure;
3. Rearticulate “cultural” formulations in structural terms;
4. Explain the process of observing and imagining structural interventions; and
5. Describe the concept of structural humility.

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. 

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. 

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. 

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. 

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.