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Increasing Access to Primary Care for Seasonal Agricultural Workers at #AOHC2015

In a previous issue of Voices, we featured Grand River Community Health Centre’s migrant worker clinics. Grand River CHC and Quest CHC were both funded by the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) for two year pilot projects.

The Shift the Conversation conference will highlight these two case studies through a workshop presentation (description below).

Register now and learn more>>


A12 - Increasing Access to Primary Care for Seasonal Agricultural Workers: Lessons Learned from 2 CHC Case Studies

Is your CHC, CFHT or NPC interested in exploring how to provide health care to seasonal agricultural workers in your area? Learn from the successful experiences of two CHCs who have received funding from their respective LHINs to serve this population: Grand River CHC who is running part time summer clinics in Simcoe in partnership with community organizations, and Quest CHC who has been able expand the services that they had already been providing for four years, in collaboration with community partners, through their Migrant Agricultural Workers’ Program.

Presented by: Tricia Gutierrez, Primary Care Assistant, Simcoe Clinic, Grand River Community Health Centre, Stefanie Ralph, Director, Primary Care and Community Health,Grand River Community Health Centre and Coletta McGrath, Executive Director, Quest Community Health Centre

Theme: Breaking Down Barriers

Audience: Front line/program staff|Senior management|Policy makers|Program management|Board members


We will now look at how Quest Community Health Centre has used this funding to expand the clinic services they had already been providing to migrant agricultural workers (MAWs) in their region, and to increase health promotion and community capacity building initiatives relevant to this population.

Resource Development Canada data suggests that more than 2600 MAWs come to the Niagara Region annually. Many of these workers come year after year, some returning for over 30 years. Although these workers are eligible to receive Canadian health care benefits and workers’ compensation; language related barriers, lack of transportation, fear of repatriation, and long workdays act as barriers to them accessing primary health care services.  

In 2010, the Niagara Migrant Worker Interest Group (NMWIG) approached Quest CHC about this identified gap in services, highlighting the need for access to healthcare. Quest CHC started providing primary care health services to MAWs out of a local church in Virgil. These clinics have been running for the past 4 years during the working season. Running these clinics has provided Quest CHC with the knowledge and expertise with respect to understanding the ethno-cultural backgrounds of those who work in Niagara and in providing culturally sensitive and appropriate primary care services.

With the new funding from the HNHB LHIN in 2014, Quest CHC has been able to expand the Migrant Agricultural Workers’ Program (MAWP) to include:

  • Primary health care clinics through the working season (providing services to 120 individuals with 222 visits)
  • A full time Community Health Worker to focus on outreach, clinical coordination and follow up and community capacity building
  • Health promotion initiatives (13 health events serving 525 attendees)
  • Community capacity building activities / community education and awareness sessions (provided and participated in 76 events with 308 attendees)

Quest CHC works closely with various community partners including NMWIG (includes organizations such as Niagara North Legal Clinic, Occupational Health Clinics of Ontario, Positive Living Niagara, among others) McMaster University, and Brock University in providing primary healthcare and in developing health promotion initiatives centered on topics relevant to MAWs.

Quest collaborates with these community partners on events such as:

  • health fairs
  • healthy eating workshops
  • mental health initiatives
  • community dinners
  • and other social events

In 2014, Quest CHC’s clinics took place every other Sundays during the season from 3pm to 6pm (after MAW work hours) in Virgil where the Niagara-on-the-Lake Family Health Team generously allowed the use of their clinic space.  Their model involves an interdisciplinary team consisting of primary health care providers (Physician, Nurse Practitioner, Registered Nurse, Registered Practical Nurse, Registered Dietitian, Community Health Worker), community pharmacist as well as volunteer interpreters, medical and nursing students. Common health complaints seen in the MAWP include hypertension, diabetes, sleep habits, insomnia, musculoskeletal injuries, skin, eye, throat and respiratory issues, sexual health and reproductive issues, mental and emotional health, and poor nutrition.

Through the funding in 2014, a Community Health Worker was also hired to focus on community capacity building, coordination of healthcare services, outreach, community engagement, and the creation of health promotion initiatives including engaging employers in increasing access to available health services.

“Having an interdisciplinary team, congruent with the community health centre model, serving this population, ensures that Migrant Agricultural Workers receive high quality care that is both holistic and thorough. For example, if a worker comes in with uncontrolled diabetes and a wound to their foot, they are able to be assessed by a doctor or an NP, a wound care nurse to clean and dress their wound and provide health education, a dietician to go over their diet, and finally a plan collaboratively developed by the team with the client. And if they are provided with a requisition form for diagnostics or a specialist, the Community Health Worker can follow up with them and coordinate setting up an appointment, navigating the system and providing transportation. In this way, Quest’s work doesn’t stop with interdisciplinary care at the clinic, but extends to outreach and client care coordination as well,” said Coletta McGrath, the Executive Director at Quest.   

 “Due to the low literacy levels of the workers, creating culturally sensitive, literacy appropriate resources and workshops have been a priority. For example, the sexual health workshop that was delivered to the workers in collaboration with Positive Living Niagara in 2014 was designed around using a theater approach. This model of health promotion, adapted from a resource developed in the United States by Student Action with Farmworkers, delivered health education through a skit with music and dance. The healthy eating workshop was formatted in a way where we cooked with the workers while delivering health teaching. The dietician from Quest CHC provided health teaching afterwards as well. They were both very well received by the workers,” said Babitha Shanmuganandapala, Quest Community Health Worker.

Another priority of the MAWP was to foster relationships with the employers of the MAWs to help identify and address challenges experienced by employers and collaborate with them in increasing healthcare accessibility for MAWs. Quest CHC in collaboration with volunteers and community partners focused on building rapport and educating workers/employers about the availability of health care services and about the MAWP. Quest also attends various forums and conferences geared toward employers and other key agricultural organizations to learn about key issues that employers face that may indirectly impact the health of MAWs, and to promote MAWP and other services in the community.  

After just 4 years of the MAWP health services availability, Quest CHC and their community partners have seen a huge impact on the overall health and wellbeing of the MAW population at both a systems and client level. They hope to keep building on these successes and the momentum in the community.

“Quest and its community partners are passionate about working with Migrant Agricultural Workers and are always exploring ideas about how to increase access to healthcare services,” said Babitha.  “The workers are generous and always so grateful for the services we provide. Even during the off season we still get calls from Mexico and Jamaica from workers saying thank you because their wound is better, or they’ve successfully recovered from surgery, or they’re finally pain free after 7 years. And that speaks volumes. ”

Wednesday, May 6, 2015