Tag Archives: farmworker

Falling Through the COVID19 Cracks

When COVID19 snared President Trump in early October, he promptly received a dose of Regeneron and an airlift to Walter Reed Army Hospital;  physicians dispensed a course of therapeutics – Remdesivir and the steroid dexamethasone, and  supplemental oxygen as needed. That extraordinary spell of cutting edge treatment soon put the president back on the campaign trail almost within the week.

The price tag for the president’s helicopter ride and specialized, experimental treatment cost roughly about $1 million say experts, and was free, and funded by taxpayer dollars.

“I would not be surprised if it were to exceed $1m,” said Dr Bruce Y Lee, a healthcare researcher at the City University of New York.

The five star treatment afforded to Trump, however, is beyond the reach of average Americans, even those with insurance. With private insurance to cushion the cost, an average American would have to pony up $520 a vial  or $3120 for a course of anti-viral treatment.

At the other end of the healthcare spectrum are the uninsured – people who cannot afford even a single dose of Remdesivir, let alone an entire course of treatment, said Dr. David Hayes-Bautista Director of the Center for the Study of Latino Health and Culture, UCLA Health, at an October 23 Ethnic Media Services briefing.

His study of how the coronavirus impacts populations of color found that low-paid and uninsured workers in underserved communities rarely have health insurance to pay for treatment.

Without any protection, said Bautista, COVID19 finds gaps in care in the social services umbrella and the healthcare maze that marginalized communities have to navigate, and “the coronavirus falls upon them like rain.”

For uninsured workers who forage for healthcare access or have none, treatment is simply out of the question.

Quoting a UC Davis study, Bautista explained that $3120 for farmworkers in California is the equivalent of two month’s salary. What that means for farmworkers – many of whom are at high risk of exposure to COVID19 within the industry that employs them –  paying for treatment if they get infected means having to forgo food, rent, and other necessities that two months of income covers.

Disadvantaged populations have far higher case rates and mortality rates than non-Hispanic whites, said Dr. Bautista

When the virus hit, California shut down. People ‘grabbed their laptops’ and went home to work, but essential workers could not. Doctors, nurses and healthcare workers had to make sure they had PPE and equipment to treat COVID19 patients.

Other essential workers said Bautista, included meat packers, truck drivers, shelf stockers, grocery store workers, “folks working to make sure the rest of us can eat”, and check-out clerks who were far more exposed to the virus because “about 300 people pass within an arms-length.”

Those that tend to work in these occupations are mostly people of color, explained Bautista and the industries that expose them to the pandemic offer less access to care, treatment and follow up. As a result, California has high rates of exposure and mortality. The state now has a total of 922,005 positive cases. and a total of 17,626 deaths reports the California Department of Public Health.

In California, farm workers have been especially hard hit by COVID19. During the pandemic, migrant farmworkers continue to work shoulder to shoulder in ‘cuadrillas,’ and packing houses, or ride in crowded buses, putting their lives on the line to put food on our tables.

Vulnerable farmworkers (largely Latino, almost 100% immigrant, and 60-80% undocumented), are left out of the Affordable Care Act (ACA) because of their temporary status and cannot afford private health insurance. And yet, the county gave them letters confirming their essential status to travel, so they could go to work when the pandemic broke out. Workers were urged to see a doctor if they had symptoms, but without health insurance, “how would they pay to see a doctor, asked Bautista. “Some do not even know any doctors!” Their situation was further complicated by a requirement in the first few months of the pandemic, for sick people to get a doctor’s recommendation just to get a test – one they could barely afford.

“You could wind up paying $100 to almost $2000 for one test!” said Bautista. “In a farm worker family that quickly adds up.”

Even if a vaccine becomes available, said Denise Octavia Smith, Exec Director, National Association of Community Health Workers (NACHWA), it may be refused. Among Black and indigenous communities who have endured hundreds of years of medical testing and research on enslaved populations against their will, there exists a longstanding fear of vaccines, “We won’t be used as a guinea pig for white people.’’

Smith, who is tracking the disproportionate impact of Covid19 on under-resourced health systems, suggests supporting more community health workers familiar with barriers to care and wellbeing that marginalized populations experience, as trusted messengers to build bridges within these communities. This way, people who believe in efficacy of vaccine can get it when it becomes available

That moment could come sooner that they think. In a move that could transform life in COVID19  times for marginalized communities, the CDC is considering recommendations by ACIP (Advisory Committee on Immunization Practices ) to “remove unjust and barriers to good health and well-being” in some racial/ethnic minority groups that bear the disproportionate burden of the COVID19 disease.

The recommendations ask the CDC to “commit to fair stewardship in the distribution of a scarce resource.” Under review are outreach strategies that will  overcome barriers to access, and reduce health disparities in each phase of vaccine distribution.

The interventions must ensure that all affected groups, populations, and communities are treated fairly and have equal opportunity to access the vaccine and treatment, not just the privileged few.

The coronavirus doesn’t discriminate. Even the President got infected. What’s different is he had access to treatment well beyond the reach of essential workers who work to put food on our table. They are the ones “we forgot about,” said Bautista, and who will fall between the cracks of our healthcare jigsaw puzzle without a safety net.

Meera Kymal is a contributing editor at India Currents

Image: WorldBank, migrant worker in strawberry farm

Journey from Coerced Sterilization to Misinformation

The dialogue around health and healthcare systems has increased at similar rates to that of the pandemic. Fingers are pointed at the lack of ventilators, hospital beds, and testing kits. 

While it is easy to pick at the chipped paint, the flawed structural foundation becomes glaringly obvious when there is less paint to chip. Much like the horror one might feel seeing a panel of their home infested with termites, America’s structural integrity is threatened by its hegemonic narrative – its own version of termites. Exploration of government policies, in the past and present, is a necessary context for the receptiveness of diverse communities to information from government sources. 

A History of Racialized Care Breeds Distrust

Racism was not a singular one-dimensional vector but a pandemic, afflicting…communities at every level, regardless of what rung they occupied.- Ta-Nehisi Coates

History of racialized care has had an adverse effect on communities of color. Racialized care takes into account your race and subsequently, the healthcare you receive. African American, Latinx, Native American, and AAPI populations are disproportionately subjected to worse healthcare due to income, language barriers, lack of research, and implicit bias from healthcare professionals.

But above all, healthcare in the US is informed and shaped by an oppressive history. Disenfranchised communities have been given reason to be wary of a healthcare system that has been used as a conduit for injustice.

Virginia Hedrick, Executive Director of the California Consortium for Urban Indian Health and panelist at Ethnic Media Services April 17th briefing on the impact of Coronavirus on diverse communities, noted the distrust of the healthcare system by Native Americans and their unwillingness to believe in the protocols of the pandemic. And why wouldn’t they be skeptical, considering the “sterilization of Native [American] women existed up until 40 years ago”, Hedrick added.

So what were marginalized populations encountering up until 40 years ago? And perhaps even as recently as 10 years ago?

In the 1960s, President Lyndon B Johnson led the Great Society Project in an effort to eliminate poverty by increasing access to welfare and social services. The backlash came from physicians, white men, who took it upon themselves to lower the rates of people on welfare. No short of a God complex, they believed that by sterilizing women of color, they were helping society – limiting birth rates in low-income, minority families. 

Between the 1960s and 1970s, 25% of Native American Women were sterilized by the Indian Health Service; various government programs formed the Indian Health Service. IHS had found that the average Native American woman had 3.79 children to the white woman’s 1.79 children; within 10 years that number declined to 1.99 for the Native American woman. This was attributed to education and higher income but unwanted sterilization was erased from the historical narrative. In actuality, the decrease in births had to do with the use of coerced sterilization as a procedure to help a medical ailment even if it was unrelated or nonconsensual.

A map from a 1929 Swedish royal commission report.

Latin and African women were targeted starting in 1909 when states started adopting eugenics programs. 32 states rallied together to advance eugenics during which 60,000 people were sterilized. In the documentary, “No Mas Bebes”, a Mexican American woman speaks to the trauma of being sterilized while giving birth to her children. This story isn’t dissimilar to the story of sisters, Minnie Relf and Mary Alice, two mentally disabled African American women, whose mother tried to get them birth control shots and, unbeknownst to her, they were surgically sterilized. Relf vs. Weinberger, a landmark case, revealed that 150,000 poor women were coerced into sterilization under the threat of their welfare being taken away from them. 

Mental institutions and prisons became breeding grounds for such programs and even a law was passed allowing anyone committed to state institutions to be sterilized. Until as recently as 2010, there were cases of inhumane treatment in California prisons and it is reported that 150 Latina inmates had been inflicted with forced infertility. 

Eugenics was just the start of questionable activity by the US government. It progressed beyond sterilization when marginalized populations became lab rats for large-scale experiments. There are 40 documented studies done on incarcerated peoples and we have yet to know the number of undocumented studies; most studies hurt the recipients and yielded no results.

The US Public Health Service worked on a study with Tuskegee University to observe the natural history of untreated Syphilis for 6 months. The Tuskegee Syphilis Experiment ran from 1932 to 1972, lasting 40 years during which the patients were purposefully misinformed, misdiagnosed, untreated, and eventually, forgotten. 600 impoverished African American men, 399 with Syphilis and 201 without, joined with the promise of free healthcare; healthcare which was inaccessible to the black diaspora due to their race. Without informed consent, those with Syphilis were not told of their condition. Instead, they were led to believe they were being treated for “bad blood”. To make a bad situation worse, the free treatment the patients were receiving was no treatment at all. By 1947, penicillin was discovered as a cure but was not given to these patients for another 25 years. Not a single one of the patients consented to the experiment and many died without ever knowing their actual cause of death or that their death was preventable.

Racialized disparities in health factors in the omission of and lack of care given to minorities. Asian Americans were less likely to be asked about their lifestyle, mental health, and doctors did not understand their background and values. The same study, additionally mentioned that Asian Americans felt their doctors did not listen, spend as much time, or involve them in decisions about their care. Significantly, not much is documented about Asian American health until the 2000s. 

Lack of Access Presently

Genoveva Islas, Founder of Cultiva La Salud and panelist for EMS, is confronting the plight faced by the farmworkers in Fresno. Fresno has 1% of the farmland, provides 25% of the food we’re eating in California, yet the farmworkers don’t have personal protective equipment, health insurance, savings, or retirement funds. A majority of these farmworkers are left out of the CARES Act and their housing and food security are in question. “We need a just and fair immigration system”, Islas advocates, putting the spotlight not on the lack of healthcare, but on our immigration policies that leave immigrants and undocumented people at a disadvantage. She wants to ensure that the pandemic is not a time when those who are already being exploited are driven to the fringes of society without access to basic human rights. 

Distrust is the Seedling and Misinformation is the Byproduct

COVID19 has brought with it an onslaught of news, statistics, and warnings, both fake and real. Minority groups are struggling with effectively parsing and using this information given their inconsistent histories with the US government and healthcare systems. 

Virginia Hedrick reminds us that in Native American populations, the myth is that the Coronavirus “was here in December and that now, there is herd immunity.” Many within Native communities believe that homeopathic remedies have the ability to heal and protect someone from COVID19. 

Another reporter at the EMS video briefing expressed that African American populations are taking social distancing and Coronavirus information lightly. 

One only has to look as far as their WhatsApp groups to find confusing and misleading information and anti-Asian propaganda.

A doctor on the frontline at the University of California, San Francisco, and EMS panelist, Dr. Tung Nguyen, acts a buffer to inaccurate information:

People within your network may be struggling, sifting through information and misinformation (real and fake news) about COVID19. The onus is on our communities to understand that American history is rife with instances of disinformation and misinformation. Discerning what information is relevant requires collective work.

And right now, more than ever, action must be taken against an infodemic that is percolating through the pandemic. 

Srishti Prabha is the current Assistant Editor at India Currents and has worked in low-income/affordable housing as an advocate for children, women, and people of color. She is passionate about diversifying spaces, preserving culture, and removing barriers to equity.

Featured image is a poster for a 1971 rally against forced sterilization in San Francisco, CA designed by Rachael Romero. (Library of Congress)