The Pacific Northwest Agricultural Safety and Health (PNASH) center has found that two important audiences— health care providers and farmworkers—can be hard to reach, and has built special programs to engage them.

HEALTH CARE PROVIDERS

Rural health care workers are overworked, underfinanced, and scarce. PNASH brings training to rural providers, helps them network with one another, and reaches out to promotoras (community health workers) who are sometimes overlooked by educational programs.

Past efforts have included developing an audiotaped diagnostic tool to assess farmworker mental health and training clinicians to implement the new Washington state cholinesterase rule.

More recent efforts include working with the promotora training program at the Columbia Valley Clinic to develop educational and translational materials, and responding to a farmworker death during last summer’s heat wave by sending providers the latest findings about how to lower body core temperature.

The center continues to work with clinics involved in the Washington state pesticide-monitoring program. It provides cholinesterase testing kits and trains clinicians to perform their own analysis. A clinic-based system can provide quicker results than a centralized state system, thus allowing earlier alerts to employers and workers when a pesticide exposure problem arises.

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FARMWORKERS

To better understand and meet the needs of farmworker communities, PNASH, under Dr. Matthew Keifer, developed two large community-based participatory research projects:

El Proyecto Bienestar (The Well Being Project) focuses on the occupational and environmental health issues of Hispanic agricultural workers in Yakima. Partners include the University of Washington, the Yakima Valley Farm Worker’s Clinic, Radio KDNA, and Heritage University. The goal is to study environmental and occupational risks and develop an issuesdriven action plan that meets priorities set by the community.

Idaho Partnership for Hispanic Health, newly formed in collaboration with the Idaho Mountain States Group, will address health disparities among Idaho Hispanics. PNASH is advising on community-based participatory research methods and will provide research and health care expertise to help communities address their safety and health interests.

The center is also responding to employers’ interest in identifying the root causes of workers’ pesticide exposure with two activities. In the clinic, PNASH introduced a computerbased exposure history questionnaire responsive to the workers’ language and literacy level. At the worksite, PNASH is using evaluation measures of fluorescent tracers and urine metabolites to pinpoint pesticide applicators’ sources of exposure.

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ALWAYS A HAZARDOUS FIELD

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Bernardino Ramazzini, considered the founder of occupational medicine, described the working conditions of farmers in 1713: “While they work in the fields they are exposed to inclemency of the weather; they are buffeted now by the south wind now by the north, soaked with rain and night dews, scorched by the summer sun; however robust they may be, of however hardy a stock, they cannot support such violent changes.”

Nearly three centuries later, federal and state agencies are recognizing the hazards caused by extreme heat and cold and the need for “work hardening,” or time for the body to adjust.

FOR FURTHER READING

Ramazzini, B. Diseases of Workers: De Morbis Artificum. New York Academy of Medicine, History of Medicine Series, No. 23. Hafner Publishing Co., New York, 1964.

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