These California workers struggled to get health care before COVID. Pandemic made it worse
This story is part of the Central Valley News Collaborative — a bilingual, community journalism project funded by the Central Valley Community Foundation and with technology and training support from Microsoft Corp. The collaboration includes The Fresno Bee, Valley Public Radio, Vida en el Valle, Radio Bilingüe and the Institute for Media & Public Trust at Fresno State.
Indigenous farmworkers’ deep distrust of the healthcare system made it even more difficult for them to access vital medical services during the coronavirus pandemic, exacerbating long-standing health disparities, according to a new study of more than 300 agricultural workers in California.
The report, conducted by the Davis-based California Institute for Rural Studies and various grassroots organizations, finds 54% of the participants said costs, lack of insurance and lack of protections like sick leave posed significant barriers that prevented them from accessing healthcare. Another 13% said their fear of government agencies prevented them from seeking care, according to the study.
When the farmworkers who were surveyed did go to a clinic, many said they felt their medical care was “rushed” and that doctors made racial assumptions about them and their health needs. Their hardships were intensified due to language barriers that impeded their ability to receive information in their native Indigenous languages.
“Our expertise and skills in agricultural food production is rooted in our ancestral knowledge and sustainable agricultural practices that have carried on for generations that supports that multi-billion dollar industry in California,” Dr. Sarait Martinez, executive director of the Fresno-based Centro Binacional para el Desarrollo Indígena Oaxaqueño, said during an online briefing Monday. “Indigenous communities in California are further marginalized by the existing exploitative industrial agriculture system, and the federal, state and local governments’ chronic neglect.”
The workers surveyed and interviewed for the study were contacted as part of a collaborative research project, known as the COVID-19 Farmworker Study, facilitated by the California Institute for Rural Studies.
The second phase of the 18 month-long study consisted of phone-based surveys and in-depth interviews with California farmworkers who struggled to access the healthcare system during the pandemic. The project, which includes community based organizations, advocacy groups and nonprofits, first launched in March 2020. Apart from California, the complete study also surveys workers from Oregon and Washington.
Indigenous farmworkers surveyed in the study said their needs were largely ignored by healthcare institutions, even before COVID-19 hit. These workers regularly lack access to information in their own language, health insurance or other means to seek adequate medical attention, the study found. In addition, fears over their immigration status also created barriers to seeking medical care.
These experiences contributed to a widespread “lack of faith and confidence in medical doctors” that was only made worse during the pandemic, according to the study.
“I am afraid and anxious about catching coronavirus and for my family because I no longer have trust in doctors,” said one 51-year-old farmworker from the San Joaquin Valley identified in the report as Martina.
Lack of interpretation, translation creates barriers
Of the 800,000 estimated farmworkers in the state, at least a quarter of those identify as Indigenous, said Dvera Saxton, a researcher with the California Institute for Rural Studies.
Many speak Indigenous languages like Mixtec, Zapotec and Triqui, and speak Spanish as a second language. Without access to a translator or interpreter, Indigenous farmworkers are often left to rely on their children or their limited understanding of English or Spanish to receive critical information about their health, said Deysi Merino-González, a health advocate with the San Diego-based Farmworker CARE coalition.
To prevent children from being tasked with the emotional burden of communicating dense information to their parents, Merino-González said it is important that interpretation services for Indigenous people are offered at doctor’s offices, hospitals, community health clinics and other medical settings.
“Language is crucial,” Merino-González said. “We have heard really terrible stories about kids interpreting for their parents, and not just for COVID but any other illnesses when we know kids are not prepared for it mentally.”
Amid the pandemic, the researchers found that many Indigenous farmworkers did not know about assistance programs like emergency Medi-Cal or about testing sites and vaccination clinics because relevant information was not available in their native languages. Often, terms like “quarantine” or “contact tracing” could not easily be translated, according to the study.
Bilingual community workers helped provide interpretation and translation services, but demand was high at the beginning of the pandemic and the researchers found that they did not have sufficient staff or resources to scale up their outreach efforts. Phone-based interpretation services, they added, were “no substitute” for on-site interpreters, “who not only translate but relate to Indigenous patients.”
Incorporating these services in medical settings would create a “safer, welcoming environment for patients,” Merino-González added, which could help build trust and repair the relationship between health providers and the Indigenous community.
Researchers call for creation of agricultural worker agency
The participants in the project were also asked about other struggles they endured that affected their working conditions, job security, child care, mental health and finances, among other quality of life issues.
In response to the findings, the researchers called on local and state leaders to create a new state “agricultural-worker specific” agency dedicated to the enforcement of workplace health, safety and hygiene regulations. In addition, they’re hoping to create a network of county-led committees made up of farmworkers and grassroots organizations to hold the new state agency accountable.
The researchers also advocated for policy changes that include guaranteed access to a government-funded safety-net, unemployment, emergency and disaster assistance programs that are “culturally inclusive and do not have burdensome eligibility requirements,” “liveable” salaries as well as immigration reform.
“By bringing these stories to light, we want to uplift critical information on farmworkers’ abilities to protect themselves and their families,” said Saxton, the California Institute of Rural Studies researcher. “The time for policy to address disparities for Indigenous farmworkers is now.”
This story was originally published October 21, 2021 at 5:00 AM with the headline "These California workers struggled to get health care before COVID. Pandemic made it worse."