COVID outbreaks on farms reveal crack in system that migrant workers slip through, say health-care workers

When you take a bite out of a locally grown apple or a slice of tomato, it's a good time to consider the well-being of the person who picked it — especially during the global pandemic, say health-care professionals who provide care for farm labourers.

Another round of COVID-19 outbreaks among migrant workers on Canada's farms highlights a crack in the health-care system that leaves the people who put food on our tables especially vulnerable, said Eliseo Martell, a health promoter and educator in Brantford, Ont.

"The accessibility to the workers has decreased a lot. They are not allowed to leave their farms [because of COVID]. And so for us to reach them has been very, very challenging in these times," he told White Coat, Black Art  host Dr. Brian Goldman.

At least 10 workers tested positive at Schuyler Farms, a major grower of apples and sour cherries near Simcoe, Ont., earlier this month. Each year, it employs more than 200 migrant workers, in addition to Canadian staff. Another 40 workers were infected in nearby Elgin County at Martin Family Fruit Farms. 

During the first wave of COVID-19, outbreaks at other southwestern Ontario farms led to around 500 cases and three deaths. All told, there have been more than 1,000 cases among migrant farm workers in Ontario alone. Tight living quarters make physical distancing difficult, PPE may be in short supply, and fear of losing income may make some workers reluctant to come forward for testing.

On Monday, Ernie Hardeman, Ontario's minister of agriculture, introduced a new strategy for curbing the spread of COVID-19 among migrant farm workers, but advocacy groups say the plan falls short by leaving employee feedback out.

And as seen in other outbreaks, this tenacious virus can wreak havoc anywhere, including places where people are taking steps to prevent its spread. 

Mobile clinic set up weekly

Schuyler Farms is the first in the Simcoe region to partner with the Grand River Community Health Centre to set up weekly clinics right on the farm during the pandemic. Although the clinic predates the outbreak there, today the team is also providing care for the workers who have contracted COVID-19.

Every Wednesday around 5 p.m., Martell, and a team made up of a family doctor and administrative staff, set up a mobile clinic in an empty machine shed.

There's a waiting area with chairs spaced well apart, and a makeshift exam room with a computer, blood pressure cuff, pulse ox machine and a portable massage table for examinations.

Originally a pediatrician from El Salvador, Martell serves as health promoter and educator, fostering relationships with the men and women, many of whom are also from Central America or other Spanish-speaking countries.

Martell explains that while most seasonal farm workers have some kind of health-care coverage in Canada — usually temporary provincial health cards — long and irregular hours mean they have challenges accessing it.

"They have the right to go to a walk-in clinic or to go to a health unit, [but] when they are leaving the farm, all those places are closed," Martell told Dr. Goldman when he and producer Jeff Goodes visited the farm clinic prior to the outbreak.

Same if they need lab work. "If the schedule of the laboratory doesn't play well with their own working schedule, too bad." 

Additionally, as a CBC investigation found in June, many of the estimated 2,000 migrant farm workers in Ontario who are undocumented assume they're not eligible to be tested and treated (hospitals will treat anyone, regardless of immigration status) and fear both losing income or being deported as a result.

Treatment of workers varies considerably between farm operations.

Some describe a setup where they're paid cash by an intermediary, live at motels and have no relationship to the owners, as was the case for Rogelio Muñoz Santos, a 24-year-old from Chiapas, Mexico, who died from COVID-19 in a Windsor, Ont., hospital June 5.

For the past seven years, Grand River has designed its clinics with hours and locations that make sense for the farm workers — first in a spare room at a pharmacy in Simcoe, and later in a trailer at a nearby shopping centre's parking lot.

When COVID-19 hit, the health centre began offering appointments over the phone and online through Zoom or WhatsApp, then came up with a plan for clinics right on the farm.

But workers may not always prioritize their health — especially if it's not convenient to do so — given that the need to provide for their families is so great, said Janet Noble, director of primary care and community health for Grand River Community Health Centre, which runs the migrant worker program.

"I think that they're here to work and I think that sometimes they might think of their health as a secondary issue in their life, and they might not be willing to go and get help because … they're making money. They're working on the farm for a large number of hours…. And so bringing a clinic to a farm like this ensures that there is an option." 

Workers may have chronic health conditions

Noble describes their farm clinic as "pretty much a MASH [mobile army surgical hospital] unit." 

"We're bringing just the very basic of supplies here, so we're checking blood pressures, we're checking for infection, we could remove sutures, we could do some small stitching if there was a small wound. Maybe they have back or muscle injury, or they want to have a check up by a doctor for a variety of general health concerns."

Dr. Matt Kennedy, the physician the workers see at the farm clinic, said that while they do treat workers for acute conditions that arise on the farm, from pulled muscles to respiratory infections, the biggest surprise is the number of chronic conditions he encounters. 

"They're very healthy people and obviously incredibly active, [but] some of them still have fairly poorly controlled diabetes," said Kennedy.

"So you try and get them up to date on blood work and various other screening tests as well while they're here."  

As health promoter, Martell's job includes education around why it's important to stay on top of chronic illnesses like high blood pressure and diabetes — and more recently — dispelling misconceptions about COVID-19.

Strain on mental health, too

Martell's presence there and translating skills also help the clinic deliver the holistic type of care that public health is grounded in, said Kennedy.

On the evening White Coat, Black Art visited the clinic, one man presented with the type of broken hand known as "a boxer's fracture," said Kennedy.

It was Martell who was able to find out that the worker had "got really upset and punched a wall, and that was how he came to attention." As a result, the clinic was able to identify that mental health support is needed as well. Martell notes that in mental health surveys Grand River conducts among farm workers in its region, Schuyler farm does well.

Now that there's an active outbreak, the Haldimand-Norfolk Health Unit has tasked the farm clinic with managing COVID-19 patients' care at Schuyler, since its staff have established relationships with the workers. Clinic director Noble calls it "a privilege to serve these workers in their time of need."  

If you want to impact the life of those communities, those populations, you cannot rely only on the medical service. You also need them to feel welcome in the society.- Eliseo Martell

In El Salvador, Martell provided health care to displaced people, those living in slums and others living marginally in the countryside, and it taught him something he finds relevant to Canada's migrant workers, who are largely hidden from view.

"If you want to impact the life of those communities, those populations, you cannot rely only on the medical service. You also need them to feel welcome in the society," he said.

He said Canadians "should consider these workers, these visiting friends who are helping us to have food on our table, [and] see how can we assist that population in staying healthy and therefore working and providing more food for us, and also [so] they have the capacity to earn for their families."

Written by Brandie Weikle. Produced by Jeff Goodes.