[More than 500,000 California farmworkers play a critical role in
providing Americans with the food that nourishes and sustains their
health. Yet, for those workers, their own health is too often in
jeopardy. ]
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IN RURAL CALIFORNIA, FARMWORKERS FEND FOR THEMSELVES FOR HEALTH CARE
 
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David Bacon
December 8, 2022
David Bacon Reality Check
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_ More than 500,000 California farmworkers play a critical role in
providing Americans with the food that nourishes and sustains their
health. Yet, for those workers, their own health is too often in
jeopardy. _

Laura Perez and Maria Reyna Torres sort sweet potatoes in a San
Joaquin Valley field in 2019, all photos by David Bacon

 

Carmen Hernandez lives in a small home on Chateau Fresno Avenue, one
of the three streets that make up Lanare, a tiny unincorporated
settlement in the San Joaquin Valley. The street's name sounds more
appropriate to an upscale housing development. In reality it is a
potholed tarmac lane leading into the countryside from the highway.

In Lanare live the descendants of its original African American
founders, excluded by racial covenants from renting or buying homes in
surrounding cities. Here they rub shoulders with their Mexican
neighbors - the farmworkers who make up the valley's agricultural
workforce.

Hernandez's house sits behind a white-painted fence of bricks and
wrought iron, and a neat lawn dotted with a few small trees. On the
other side of the road are the pistachio trees that make her home
almost uninhabitable four times each year.

Just before the nuts are harvested in September, a tractor drags a
tank with long arms down the rows, spraying a thick fog of pesticide
into the trees. Quickly the chemical travels across the dozen yards
between the orchard and Hernandez's house. During other times of the
year, the spray rig lays down weed killer, or a chemical that causes
leaves to drop from the branches after harvest. Fertilizer is another
evil-smelling chemical the neighbors have to contend with. The
families on Chateau Fresno don't let their kids play outside much
anyway, but when the spray is in the air, they make sure to keep them
inside.

One might ask, why did Hernandez build a house across the street from
such dangers? She didn't. When Self-Help Enterprises helped Lanare's
low-income families to build homes they'd never otherwise have been
able to afford, the field across the street grew cotton or wheat.
Those crops also use a lot of chemicals in California's industrial
agriculture system, but when pistachio trees were planted eight years
ago, the contamination grew by an order of magnitude.

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 _Carmen Hernandez stands at her front gate on Chateau Fresno Road,
across the street from a pistachio grove. Pesticides, fertilizer and
dust from the grove drift into her house and yard._

"Why did the state or county let them do this?" Hernandez asks. "They
don't even put up notices to warn us." She's asked the tractor driver
what the chemicals are, but he doesn't know. "He doesn't even know the
name of the owner of the orchard. He's just hired by a labor
contractor."

For farmworkers, Hernandez's predicament is familiar. PolicyLink's
2013 study "California Unincorporated: Mapping Disadvantaged
Communities in the San Joaquin Valley" found that over 300,000 people
live in small, unincorporated communities spread across rural valleys
where California's agricultural wealth is produced. For them, living
in a town like Lanare is a double threat to their health. Farm
laborers work and live in a chemical soup, a source of interrelated
health problems. And because their homes are in remote rural areas,
getting adequate health care creates additional obstacles.

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 _Near Lanare the Kings River has gone dry, its water diverted into
irrigation canals._

These unincorporated towns, however, are also often organized
communities. Grassroots groups deal with the social determinants of
health, from air pollution to water scarcity and contamination. Their
experience gave them a head start when the pandemic hit. They were
often better able to respond to the needs of farmworkers than the
government or large health care institutions.

LIVING IN THE CHEMICAL SOUP

According to the Environmental Protection Agency, the San Joaquin
Valley has some of the worst air quality in the United States. One
study in BioMed Research International found "Seasonal agricultural
workers are exposed to the worst conditions of working groups" and
called asthma "an important health problem among seasonal agricultural
workers."

Children living in this environment suffer asthma as well. In the
Imperial Valley, one of the poorest counties in California, 12,000
children have asthma, and go to the emergency room for it at twice the
rate of the other kids in the state. Residents of that valley's
unincorporated communities, like Seeley and Heber, live in the same
proximity to the fields as Carmen Hernandez does in Lanare.

The relationship between illness and chemical contamination is often
hard to pin down. Nevertheless, the connection to living in small
towns where pesticides, fertilizers and dust are in the air and water
seems obvious to many residents.

Rosario Reyes and Wilfredo Navares lived their married lives in
Poplar, another small community in the southern San Joaquin Valley
surrounded by orchards and grape vineyards. She remembers that when
her husband's doctor told him that he had amyotrophic lateral
sclerosis, commonly known as ALS or Lou Gehrig's disease, the first
question she asked was whether he worked in the fields.

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_Rosario Reyes, widow of Wilfredo Navares, stands in front of the
Larry Itliong Resource Center in Poplar, where the couple received
food and support during his illness._

"He believed it came from the chemicals he was exposed to during his
31 years as a farmworker," Reyes says. "He worked with weed killers
like Roundup, and there wasn't much known about it then. He knew the
dangers in general, but he had to earn a living. Before he got ALS he
never really got any health care."

As his incurable disease progressed, Navares gradually lost the
ability to control the muscles responsible for walking, talking and
eating. For two years Reyes couldn't work. "I had to bathe and dress
him like a baby," she says. At the end, before Navares died, Medi-Cal
covered his medical visits. "But with or without it, he would have
died just the same."

Reyes has asthma and diabetes, and got COVID-19 last year. She's 59,
the age when people begin to think of retiring. But Reyes had to go
back to work, even though it will likely prejudice her health. "I
don't have papers," she explains. "Even though we were married, they
won't give me his Social Security."

HOW MANY, AND HOW UNEQUAL?

Farmworkers looking for environmental solutions and better health care
first confront a major problem. The state doesn't really know how many
people make their living from agricultural labor in California.

According to researcher Ed Kissam, "population estimates in the
American Community Survey that determine the allocation of federal and
state funding for more than 300 programs are very low." The ACS, he
added, is a long survey that only one-third of the households in
farmworker communities answer. While Kissam said it shows about
350,000 agricultural workers in California, Zachariah Rutledge of
Michigan State University reported an annual average of 882,000
California farmworkers between 2018 and 2021. About 550,000 are field
workers or processing and packing-shed workers, according to Kissam's
estimate. "This is the low-income, predominantly immigrant, often
undocumented Latino population facing barriers to accessing health
care," says Kissam.

Kissam points out that the rural agricultural workforce is very
diverse in terms of income and immigration status. "About 300,000 work
in the San Joaquin Valley alone," he says, "and live with another
350,000 family members. Most are long-term settled immigrants, in
low-income households that include undocumented immigrants. Their
eligibility is compromised for a broad range of social programs
because they're conditioned on immigration status. Almost a quarter of
legally authorized farmworkers interviewed in the National
Agricultural Workers Survey in California lacked health insurance and
almost two-thirds of undocumented farmworkers lacked it."

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 _Ronaldo Manaay is a disabled farmworker and welder who suffers from
advanced diabetes. He is on dialysis awaiting a liver transplant. "I'm
scared," he says. "I don't know how long I'll live."_

A study by Kissam in September 2020 showed that COVID-19 cases in 25
farmworker communities overall were about 2.5 times higher than the
state average. "Even within Fresno County, farmworker communities are
disproportionately impacted - 26.4% - about 2.5 times [above] the
county-wide rate."

Farmworker communities were particularly vulnerable to COVID-19 when
the pandemic started, at a much greater rate than people living in
urban areas. By August 2020 Tulare County's COVID-19 infection rate
(1.96% of the population infected) was much greater, per capita, than
that of large cities like San Francisco or Sacramento.

The per capita income of a county resident was $22,092 in 2020,
compared to a U.S. average of $35,384. In unincorporated towns like
Poplar and Lanare, poverty forces people to live closer together to
share rent and living costs, making social distancing difficult. "The
strategy of 'doubling up' to afford a place to live is ubiquitous in
farmworker communities throughout the San Joaquin Valley," Kissam
says. Traveling to and from the fields in crowded cars or buses also
places workers in close proximity.

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_Poplar resident Antonio Lopez has cirrhosis of the liver, sciatica
and problems with his eyes. He shows his recent hernia. "I never ate
well," he says, "but I don't smoke and don't drink." When he began to
suffer acute problems eight years ago and couldn't work, he drove to
Mexico for treatment. "Because I didn't have insurance then, here
they'd just throw my papers back at me and send me to another
hospital."_

People go to work because they can't afford not to go. A day without
pay can be difficult; a week could be ruinous. "Undocumented
farmworkers with mild cases of COVID-19 are also reluctant to
self-isolate," Kissam adds, "because they're ineligible for both
unemployment insurance and CARES Act-funded pandemic assistance. In
addition, people worry about the government using personal information
for immigrant enforcement." As a result, Dr. Alicia Riley reported
that deaths of people employed in agriculture were about 1.6 times the
average in 2020.
 
THE PANDEMIC COMES TO LANARE

In Lanare, the pandemic arrived after years of a crisis affecting the
community's water. The water under Lanare contains arsenic, which
occurs naturally in the San Joaquin Valley's arid, alkaline soil. When
residents dug wells, Sam White remembers, county authorities minimized
the danger. "We'd complain and they'd tell us to boil the water. They
say arsenic cuts your life span by two years," he says. Indeed,
arsenic exposures can cause rashes and even in small doses have been
linked to Alzheimer's. "My mother had all that."

Connie and Charlie Hammond live in a small house next to the highway.
"My mom had a lot of illnesses that I think were connected to arsenic.
We'd have to take her to Fresno [28 miles away], although at the end
she went to a clinic in Riverdale [4 miles away] before she died."

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 _Connie and Charlie Hammond live on Mt. Whitney Highway in Lanare.
Their well has gone dry, and they now depend on their children to
bring them water._

Eventually a water treatment plant was built to remove the arsenic,
but it only ran for a few months before the local water company went
broke. Nearly 40% of Lanare's residents live below the poverty line
and could not pay the bills. They organized Community United in Lanare
and finally got the state to step in and dig new wells. After a year,
the water was declared free of arsenic, but it smells and leaves a
residue on sinks and toilets. Residents say no one will drink it.

Meanwhile the water table keeps dropping. The Hammonds, who moved
across the highway a few years ago, had their well go dry. "Our
neighbor ran out first, and we helped them. Then ours ran out a month
ago," Connie Hammond says. "Having water would certainly make our
health better. We're fortunate to have kids who bring us water, but
not having it causes a lot of stress, especially for seniors like us."

While fighting for water, Lanare faced the onset of the pandemic and
hunger among residents isolated in their homes. Community United in
Lanare was already distributing food several times a month when the
lockdown began. "We were handing out food to 150 families," Lanare
food bank volunteer Isabel Solorio recalls, "and the number doubled
and kept growing. The stores were empty. In Raisin City and Laton
[other unincorporated communities], they were afraid and stopped their
distributions. We didn't."

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 _Connie Hammond receives groceries at a food distribution event held
at the Lanare Community Center._

Due to a shortage in protective equipment, Solorio and other women
sewed their own masks. "A hundred people got the virus here and three
died," she says. Community United in Lanare asked the Leadership
Counsel for Justice and Accountability in Fresno for help because the
county was unable to provide adequate testing or vaccinations, says
Solorio. They used their relationships with health authorities and
elected officials, she adds, to get the state to set up a mobile
testing and vaccination station.

"We asked for priority - farmworkers first," she recalls. "Four or
five hundred came the first day. You could tell by their boots they
were coming from the fields. We were the first people to give
vaccinations, before the local clinics, and we were distributing food
at the same time. Since then we must have tested and vaccinated
thousands of people."

POPLAR'S ORGANIZING PROJECT

In the summer Poplar is the center of the valley's oppressive heat,
where the temperature soars to over 110 degrees. Almost none of its
homes have air conditioning, and swamp coolers, used to chill off,
also produce mold. The resulting respiratory problems are complicated
by the almond harvest. "There's dust over everything and in everyone's
lungs," says Arturo Rodriguez, co-director of the Larry Itliong
Resource Center. "It's hard just to breathe."

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 _A poultry farm on the outskirts of Lanare. Dust from the poultry
sheds blows into the town._

Rodriguez and co-director Mari Perez-Ruiz opened the center on June
15, 2020, and by June 19 they started food distributions. When they
had problems getting food from the local food bank, they convinced a
county supervisor to give them two pallets of groceries every week
from the food he had available.

When the pandemic started, several residents died. "Often three
generations live in small houses or trailers where there's no space to
quarantine," Rodriguez says. "Our harvest season used to last nine
months, and now, with growers bringing in more H-2A workers, people
living here get only four months of work. Local farmworkers feared not
having enough work to feed their families, so they went to work even
when they were sick. Often several family members work in the same
crew, and they were afraid to report anything to the boss, because
then everyone in the family would have to stay home."

The center got some computers donated and built booths where people
could go online to get telehealth advice. "When the pandemic began,
the service providers closed. We stayed open," Perez-Ruiz says. "We
were one of the first to provide free testing. We coordinated with
Tulare County to do free events, and gave out PPE [personal protective
equipment] and clothing with food. We had to push, so we were a little
loud. But our first event had 600 families."

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 _Farmworkers pick oranges in a field near Poplar, in the San Joaquin
Valley. Many workers wear facemasks or bandannas as a protection
against spreading the coronavirus._

In January 2021 the vaccines came. The center became a site, and has
vaccinated over 5,000 people in total, providing test kits and shots
at the same time. "We're an organizing project, and our campaigns are
led by the community," Perez-Ruiz says. "The county spent a hundred
thousand dollars, and we only spent a few hundred, but we vaccinated
more people."
 
POOR BUT ORGANIZED

Unincorporated communities may be poor, but they're often organized.
Those organizations fighting for basic social services like water
before the pandemic became vehicles for fighting the virus. The
residents and activists involved see a lesson for improving community
access to health care generally.

"In Poplar, just to make a doctor's visit to a clinic in Porterville
[12 miles away] you have to give up your whole day," Rodriguez says.
"That's why Picho [his uncle Wilfredo Navarez] never went. And if the
husband has to use the car to get to work, [the wife] and kids can't
go."

The Larry Itliong Resource Center partnered with Dr. Omar Guzman, a
physician who grew up in Woodville, a nearby community, where he
returned to practice after medical school. Every month he comes to the
center, bringing medical students, in a mobile clinic called Street
Medicine. He organizes screenings, brings in mental health
professionals and visits encampments of unhoused people on the Tule
River. His young colleagues even drive into Visalia, 30 miles away, to
pick up baby formula. At the end of clinic day, they gather in the
center to talk about the needs of rural communities.

"People I grew up with haven't seen a doctor in a very long time,"
Rodriguez says. "Health care in our communities isn't proactive.
People don't get regular checkups - [they] just go when there's an
emergency. The infrastructure of healthcare has failed them. So this
is a way to change."

Ed Kissam believes that the model for health care serving small
farmworker communities has to be community based. "Community centers
are established, widely trusted resources for farmworker families," he
explains. "County/clinic partnerships are very useful in reducing
language and access barriers that keep some people, including
farmworkers, from being tested and treated."

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 _A COVID testing station organized by Community United in Lanare._

He argues for a critical assessment of the pandemic's lessons. "The
system was slower in expanding to outlying farmworker communities than
in setting up testing sites in urban areas," he cautions. "Structural
factors and social determinants of health have been the primary
factors in the virus' spread. If we look at the real-world dynamics of
life in farmworker communities, and respond thoughtfully and
innovatively, we can overcome many barriers."

In Lanare, Isabel Solorio would like to see mobile testing and
vaccination clinics become a way to give farmworker families much
broader access to care. "We need a clinic bus with all the equipment
for everything from mammograms to dentists and optometrists. Our kids
are ashamed to say they can't see in school because they know their
parents don't have money for glasses, so everything is blurry and they
fall behind. Why can't they get free ones here in Lanare and stay in
school? And if people can control their asthma with a mobile clinic
here, isn't that a lower cost for the government than ambulances and
visits to the emergency room? So the clinic should come to the people
instead of people coming to the clinic."

But service by itself is not enough, she believes. "Why was Lanare
prepared when the county wasn't? When the water stopped, who came to
help us? We helped ourselves by learning to organize. That showed us
we can change other things too. We pay taxes, and we have a right to
survive."

ILL HARVEST [[link removed]]
California Farmworkers and the Struggle for Health Care

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More than 500,000 California farmworkers play a critical role in
providing Americans with the food that nourishes and sustains their
health. Yet, for those workers, their own health is too often in
jeopardy.
 
The hazards present in farmwork - from exposure to the elements and
harmful chemicals to the physical demands of picking and cutting crops
- are aggravated by shortfalls in health coverage, delivery and
workplace safety systems. As a result, farmworkers often go without
the care they need, enduring injury and illness that might otherwise
be prevented.
 
California's agricultural industry has always depended on immigrant
labor, whether those migrants were from other U.S. states, Asia or
Mexico. Ninety percent of California's farmworkers are immigrants, and
more than half are undocumented. Many California farmworkers are
indigenous laborers from Mexico for whom Spanish is not their primary
language. For these workers, linguistic and cultural differences add
another challenge to receiving adequate health care.
 
_Journalists David Bacon
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Marrero traveled to the communities where California farmworkers work
and live to document the health care conditions they face. From their
reporting, we provide a from-the-fields perspective through six
stories:
 
In rural California, farmworkers fend for themselves to access health
care
The occupational health risks of farmwork are legion, and not well
regulated
California's historic Medi-Cal expansion will miss many farmworkers
How clinics adapt to serve indigenous farmworkers
The mental health toll of farmwork is heavy while access to therapy is
scant
A union health plan fills gaps, but for only a few_

* David Bacon
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* Photography
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* Farmworkers
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* Rural America
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* California
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