As the migrant health program began to develop during the 1960s and 1970s "downstream" clinics serving migrant farmworkers in homebase states of Texas California and Florida were set up for year-round operation. The National Migrant Referral Project (NMRP) was established to effect continuity of quality health care for migrant farmworkers and their dependents by facilitating the exchange of information within the network of migrant health providers. The purpose of the migrant health referral system is to enable health care providers to transfer medical information for their migrant patients as they travel throughout the nation so that treatment may continue. In 1970 NMRP initiated the use of 2 referral instruments: 1) a multi-copy family planning referral form for the patient and 2) a directory of participating family planning projects. In 1978 and 1979 NMRP staff met with a team of health administrators and practitioners to evaluate and design the referral system. The design and development of 2 new model programs were engaged: 1) a computerized linkage with health information of the Migrant Education Program and 2) a computerized migrant health management information system. Today the goal of NMRP has been expanded to include the production processing and distribution of not only referral instruments but a variety of information which seeks to promote continuity of care for the migrant population.
As the size of the agricultural enterprise grew and as new sparsely settled areas were opened for cultivation the seasonal labor need could no longer be met locally in many parts of the US. California Texas Florida and North Carolina lead at the present time in the number of seasonal farmworkers required for from 6 weeks to 6 months. The US Public Health Service Office of Migrant Health estimates the number of farmworkers and dependents to be 3.5 million. Todays farmworkers are predominantly Hispanic US citizens as well as newcomers from Mexico and from Central and South America. Many travel as single men but about 1/3 of the migrant population are women and children. Seasonal farm labor is characterized by a lack of organization and the lack of many of the legal protections other workers take for granted. In relation to health status and access to health services the seasonal farmworkers personal handicaps of minority group status cultural difference poverty and lack of education are amplified by poor living and working conditions. In the 1950s and 1960s a Fresno County California health project attracted nationwide attention as it began providing seasonal farmworkers families access to health services along the lines once followed by the Agricultural Workers Health Association. The Migrant Health Act became law in 1962 authorizing the Public Health Service to make special project grants to either public or voluntary organizations to pay part of the cost of establishing and operating family health service clinics to serve migratory farmworkers and their families. Now as in 1962 when the Migrant Health Act was 1st passed there is a need for special arrangements for health care for migrant people and other seasonal farmworkers living and working under similar conditions.
Current immigration into the US by persons from the Caribbean has reached its highest levels ever; these immigrants are distinguished not only by their legal status at entry income occupation and education but importantly by language and a diversity of cultural values. This article gives particular attention to a growing number of working class and poor immigrants who tend to anifest stronger attachments to traditional cultural beliefs and are more likely to experience disproportionate stress in adapting to the complex bureaucratic American health system. Ones nutrition and dietary habits and responses to pain are neatly bound to culture and are important information to the practitioner who is conducting a diagnostic work up on a patient. Few poor and working class immigrants have received adequate health education about the effects of their high salt fat and carbohydrate diets on the nature of the illnesses they develop. The community at large suffers when a group of people carry around health problems and are discouraged from seeking care. Future health policy should stress that additional federal health dollars be directed to those regions of the country where the greatest concentrations of Caribbean migrants have been reported. These resources could be used to provide training through seminars and workshops on critical aspects of Caribbean life and culture to a cross section of health personnel and students of various health professions and semi-professions. Overall the American view which assigns casual importance to cultural effects and supports the bootstrap theory that new groups assimilate and progess successfully through their own efforts must be challenged.
