Professional Documents
Culture Documents
© Candace Kugel
years
translation of that commitment into very
real impact on very real lives.
We don’t just do good work: we do good work well. In these
pages you will experience our milestones and read some of our
case studies. You will feel the depth of the perseverance required
in order to stand shoulder to shoulder with people in dedication
to the cause of healthcare justice.
Your understanding of this dedication—and of the role MCN Table of Contents
plays in serving migrant communities—is critical to our contin-
ued success.
Economic challenges make the decisions about what organiza- MCN by the Numbers 4
tions to support more agonizing than ever. Writing a check in
support of any cause has become, for many, an activity requir- A Conversation with… David Smith and Ed Zuroweste 5
ing the Wisdom of Solomon. It would be easy to think that the
Funding Sources 7
mobile poor would, in fact, suffer least because of the economic
downturn; that having the least distance to fall economically, Milestones: 1984–2009 8
they would be least touched by the crisis. This could not be
further from the truth. Why, Then, a Network? 10
If MCN is the tether between the migrant community and main- A Change in Perspective 11
stream society, your support of MCN keeps it secured. Your sup-
port is not just meaningful…it is vital. An Award-Winning Approach 12
Our mission is more important than ever: continue to expand the MCN in Action 14
flow of knowledge, tools, teachings and tenacity to those who
need it most—those on the front lines bringing healthcare jus- Clinician in Action 15
tice to and for the mobile poor.
In Their Own Words… 16
It has been an honor to have been a part of this organization,
and I continue to be thrilled and impassioned to serve with peo- A History of Excellence 18
ple who have never lost their commitment to help the migrant
community. Together we have built something important and Office Locations 20
enduring. And together we will continue to make strides toward
healthcare justice for our most at-risk communities.
Thank you for your support,
www.migrantclinician.org 3
MCN by the Numbers
During the last 25 years, hundreds of clinicians have made a difference in the lives of untold thousands of
migrant workers and their families. In the decade spanning 1998–2008 alone, the numbers are staggering.
In that time MCN has facilitated:
www.migrantclinician.org 5
Ed: In MCN’s early years the area of migrant health was
a revolving door; people worked a while and then went
on to other things. We had to show how people from all
areas of medicine could have careers in this segment.
Former Acting U.S. Surgeon General Rear Admiral Steven
K. Galson, MD, MPH and six of his predecessors opened the How did you draw people’s attention to the challenges
National Summit for Healthcare Justice in October 2008. facing migrants?
Pictured from left to right are Drs. Audrey Forbes Manley Ed: We struggled tremendously with anti-immigration
(Former Acting Surgeon General), Kenneth P. Moritsugu (Former sentiments (and still do). Trying to get funding was at
Acting Surgeon General), David Satcher (16th Surgeon General), times difficult because we were asking for support in an
Steven K. Galson, Richard H. Carmona (17th Surgeon General), area that worries lots of people. But we stayed focused
C. Everett Koop (13th Surgeon General), Antonia Novello (14th on the issue of basic human rights—no one should be
Surgeon General). treated like indentured servants.
David: We worked hard to show how migrants
are vital to our nation’s economic stability.
Migrants are the conduit for so many products
we use daily—especially food. People think
of them as “pickers,” but they work in many
industries. And we always surprise people
when we point out that a good number of them
are “legal.”
1985 David Smith selected to serve on the National Advisory Committee for Migrant Health
1985 MCN receives $5,000 “seed money” from Health Resources and Services Administration
1987 Launched the Cultural, Linguistic, Environment, Education and Follow-up (CLEF) series to help
clinicians provide appropriate care to migrants
1989 Deana James, MD of Florida receives MCN’s first Unsung Hero Award
1994 MCN initiates landmark research that documents domestic violence among farmworkers
1995 MCN launches international bridge case management program to track TB treatment for mobile patients
1996 National Clinical Leadership Conference hosted by MCN and Clinical Directors Network
1997 MCN and American Academy of Pediatrics publish Guidelines for the Care of Farmworker’s Children
2000 Environmental Protection Agency taps MCN to serve on the Federal Advisory Committee on Pesticides
2001 Project Hope funds MCN to create first bi-national clinical management guidelines for patients with TB
2003 MCN mission expanded to include a full range of the mobile underserved
2003 Centers for Disease Control (CDC) selects MCN to design immunization and hepatitis prevention
programs
2003 Paso del Norte Health Foundation funds MCN for community-based pesticide education projects
2003 MCN leads a national practicum which ultimately places 102 new providers at 56 health centers
2004 Ed Zuroweste named Chair of the National Coalition for the Elimination of TB
2005 CDC publishes MCN paper on hepatitis screening, immunization and testing for mobile populations
2005 Lance Armstrong Foundation funds MCN to specifically address cancer in migrant patients
2008 5,000th patient served by Health Network’s international bridge case management program
2008 National Summit for Healthcare Justice hosted by MCN and partners
2009 Six offices, 35 employees, 114 issues of Streamline, 5,000 constituents, $1.7 million annual budget—and
so much more to come!
www.migrantclinician.org 9
Why, then, a network?
© earldotter.com
ing I did something truly worthwhile that day.
I cherish the opportunities I’ve had to meet and
work with other remarkable people who feel as
I do. Through our network, I am not alone. My
reach can go beyond my grasp, and my voice does
not have to be lost in the wind.
Steve Crane, MD, Former MCN Board Chair Health educators learn how to integrate
information about pesticide safety into their
prenatal education program.
© Candace Kugel
© Karl Hoffman
together occasionally for two or three years already.
It was wonderful to feel that I was a “migrant clini-
cian,” meaning that my career choice signified, not
just to myself but to others, in a peer group, that
I had a special dedication to serving farmworkers.
Moreover, there was that distinct Public Health/
Community Health orientation—an attention to
upstream determinants of health, community-based
initiatives and strategies, and a savvy-ness about
A Change in Perspective
epidemiology, demographics, and forecasting—that
had been largely missing for me in other circles. In 1997 Dr. Barb Lee helped organize the Childhood Agricul-
In all the years since, including times I was a more ture Safety Network (CASN), a group dedicated to connecting
active member (on the Board for a while), I’ve con- the major organizations charged with tracking similar issues
tinued to be impressed and inspired. MCN has cre- so they could share information. In the beginning the focus
ated partnerships that are broad and deep, across was on getting organized, gathering resources and outreach. A
political and geographic borders, across disciplines decade later, the group was ready for something even more: a
and professions, across funding and research enti- “real world” experience on the U.S./Mexico border.
ties, and much more. I can’t say enough about MCN. Enter MCN, which created a customized training session in El
Tina Castañares, MD, La Clínica del Cariño Family Paso for CASN members. The program allowed participants to
Health Care Center, Hood River, OR visit U.S. migrant farmworker communities and bring medical
aid to those in need. They experienced crossing the border to
better understand what drove migrants to risk everything to
cross into the U.S. in search of work.
“MCN offered us the most eye-opening experience we had to
that point,” said Lee. “The program had a tremendous ripple
effect, not only on those directly involved but on their home
organizations.”
Because of the training, seven national organizations began or
increased their inclusion of migrant issues in their strategies
and priorities. CASN became a federally-designated center for
childhood agricultural safety and now receives federal fund-
ing for research and intervention to help migrant children
who live and work on farms.
That led to MCN’s participation in a national initiative to
establish formal research priorities—the National Occupational
Research Agenda (NORA). MCN helped to raise awareness on
integrating non-English speaking workers into this effort,
including them in interventions and outreach.
Added Lee, “From training to advocacy to resources, MCN
is always out there; we can always depend on them for help,
which makes them an amazingly valuable resource.” n
www.migrantclinician.org 11
An Award-Winning
Approach
Children of migrant workers face environmental risks
that most of us can’t comprehend. From pesticides in and
around their homes to unsafe drinking water, from lead
to indoor air triggers of asthma, risks are around every
corner.
In 2006, Amy Liebman, MCN’s Director of Environmen-
tal and Occupational Health, spearheaded a program
to reach these issues at their source: in the homes of
migrant workers. Partnering with the Virginia Eastern
Shore’s Migrant Head Start program, MCN sought to
bring healthcare justice to the front lines, reaching out
to clinicians and the migrants they serve to create safer
home environments for migrant children.
MCN hired and trained a team of graduate students and
promotores de salud (lay health workers) on ways to limit
these risks in the home. Over two summers these team
members worked door-to-door in migrant communities
to evaluate the behavior and practices of migrant work-
ers. Then the promotores taught migrant families how
simple steps could limit their children’s exposure, such
as showering and changing their clothes before hugging
© Kate Bero
their kids and taking off their shoes before entering the
home so as not to track pesticides. Long term follow-
up in these communities continues to help improve the
health of children.
The initial program reached 800 farmworkers and is now
a pilot model for programs around the U.S. Its primary
strength comes from the promotores who train other
members of the community who then go on to train even
more people. The promotores use culturally-appropriate
resources like comic books to illustrate steps parents and
children can take to stay safe from these risks.
In 2008 the program was awarded a Children’s
Environmental Health Champion Award by
the U.S. Environmental Protection Agency for
minimizing these hazards to migrant workers
and their children, increasing the knowledge of
migrant workers and their families of environ-
mental hazards, and teaching other professionals
about how to further these ideals. n
© earldotter.com
© earldotter.com
Clinicians treat patients when and where possible—
in storefront clinics, on mobile units, and in the field.
www.migrantclinician.org 13
MCN in Action
The mobile poor barely hang on to the bottom rung International Impact
of the American economic ladder. They are often In 1984 our resources were focused “locally” on the U.S. What
newly-arrived immigrants with few connections, or we’ve learned these last 25 years is that in a global environment,
individuals with limited opportunities or skills, rely- everything is local—including health care. Today we manage
ing on farm and other manual labor for survival. In patients in more than 30 countries including Mexico, Guatemala,
addition to low pay and impermanent homes, these Chile, Peru, China, Korea, Pakistan, Nepal, Uzbekistan and more.
jobs are high risk: agriculture, mining and construc- How is this possible? When a migrant is deported or repatriated,
tion comprise the top three industries for occupation- or has simply returned home to his or her family, medical chal-
related injuries and deaths. Even in their homes, lenges can follow. Whether a patient is pregnant, has TB, cancer
migrants may face environmental exposures such as or another long-term medical challenge, MCN bridges the gap to
pesticides and unsafe drinking water. find continuity of medical care in the patient’s home country.
It is no surprise then that migrant workers still suffer
mortality and morbidity rates greater than the vast Family Violence Prevention
majority of the American population, due in part to MCN is a recognized leader in the field of family violence preven-
poverty, limited access to health care and hazardous tion. One of the more innovative programs developed through
working conditions. MCN is a peer-to-peer initiative that trains a handful of families
in a community to teach others about preventing family vio-
The clinicians who serve this population are an
lence. Taught in places migrants frequent, such as flea markets
extremely dedicated group. Our mission is to give
and work camps, this program has been very effective at chang-
them the tools and information they need to do their
ing attitudes about communication and the balance of power in
jobs. These stories celebrate our successes, illustrat-
relationships.
ing how we reach the clinicians and the people they
valiantly serve.
Immunization Centers of Excellence
n MCN has worked with six organizations to establish Immuniza-
tion Centers of Excellence, health centers that focus on providing
a full schedule of immunizations to migrant children (and adults)
who have not been vaccinated. Using MCN tools, these organiza-
I’ve always enjoyed the energy MCN brings tions work to assure that immunization schedules are established
to any issue. MCN has a way to bring people and completed, explaining to workers and their families the need
to the table who might not get there otherwise. to have their vaccinations, especially as it relates to enrolling chil-
A prime example is TB Net with the Immigra- dren in public schools.
tion and Naturalization Service. MCN was able
to get access to border detainees to help ensure
Health Center Support
continuity of care for those testing positive for
TB. While the impact of this program may never MCN understands the challenges facing a migrant clinic start-up.
be fully realized, the impact to improving global For example, in 2008 we began working with a newly-funded
health and decreasing the spread of TB cannot center to provide onsite assistance in the development and imple-
be underestimated. Who would think that you mentation of clinical policies and programs and the hiring of
could bring together the federal government, a medical director. Our consultative role included developing
law enforcement and global public health to pre- Health Care Plan objectives, assistance with development of a
vent the spread of TB? That is the energy that recruitment and retention plan for providers, and new provider
MCN can bring to improving the lives of mobile orientation to migrant health. We provide trainings on occupa-
populations around the world. tional health, adolescent and adult immunizations, cultural com-
petency, immigration issues, continuity of care while migrating,
Wilton Kennedy, DHSc, PA-C, Former MCN identifying migrant and homeless patients in the health center,
Board Chair, Jefferson College of Health Sciences, and access to care, infectious diseases, and emergency prepared-
Roanoke, VA ness for special populations. n
© earldotter.com
www.migrantclinician.org 15
(Working) with MCN definitely made me feel closer to the
migrant workers and mobile populations we try to help…MCN
makes those who care, care more.
George Davis, MD, Callan Family Care Center, Germantown, NY
n
The MCN Institutional Review Board is a rare gift. It enables
more people in the field—organizations and clinicians not affili-
ated with a university system—to contribute to the body of
knowledge about migration health.
Carmen Retzlaff, MPH, Community Heath Education Concepts,
In their own words… Austin, TX
n
Today not only do I bring with me the experiences learned at
MCN, but I use their resources on a regular basis. Their tool box
has been key to the development of many of our clinic’s poli-
cies, their environmental program has helped us train our staff
and educate our patients, and the MCN staff has helped us with
technical assistance. It is one thing to promote the organization
you work for, but it is another to experience first hand the use-
fulness of its resources and realize that the work you and your
colleagues have done has had the direct impact you hoped for.
Andrea Caracostis, MD, MPH, Hope Clinic, Houston, TX, and
past MCN staff member
n
I often felt isolated and up against many odds. Those feelings
changed when I went to my first national migrant health con-
ference and met Dr. Ed Zuroweste, Karen Mountain and Don
Horton, other clinicians working on similar issues. The con-
nections made during that conference and maintained over 20
years kept me working with Hispanic/Latino communities on
community-based approaches to eliminate health inequities. The
phrase “strength in numbers” comes to mind when I think of
the impact MCN has had on me.
Kim Larson, RN, PhD, MPH, East Carolina University College of
Nursing, Greenville, NC
n
MCN has provided our Federally Qualified Health Center
and Migrant Health Center with the training we need. It has
© Alan Pogue
been inspiring to meet (people who) love their work and have
devoted their careers to helping the folks whose work is too
often invisible.
Quality health care for migrants encompasses the essence of true Barbara Boehler, CNM, MSN, CommuniCare Health Centers,
primary care, going beyond basic medical care. It includes such Davis, CA
services as dental care, physical therapy, mental health care, eye
care and more. Here, a young girl has her first dental exam.
n
MCN has ALWAYS been there for the clinician who lives and
works in an environment that most other clinicians turn their
noses up at…but they (other clinicians) don’t understand the
greatest rewards aren’t always what the patient pays as they
exit. More important are the rewards that we see each day on
patients’ faces (smiling faces that is), as they improve their oral
health and ultimately their total health.
Horace Harris, DDS, Tri-County Community Health Council,
Newton Grove, NC
n
A true gift that MCN possesses is the ability to attract people so
very passionate about healthcare justice for all.
Frank Mazzeo, Jr., DDS, Family Health Centers of S.W. Florida, (MCN is) the glue for clinicians compelled by passion
Ft. Meyers, FL to devote their professional lives to taking care of the
n underserved.
MCN has been a wonderful resource for our students as they Alice Larson, PhD, MCN, Institutional Review Board
learn more about providing care to farmworkers in our South
Georgia Farmworker Health Project.
Tom Himelick, PA-C, MMSc, South Georgia Farmworker Health
Project, Atlanta, GA
© Alan Pogue
www.migrantclinician.org 17
A History of Excellence
For 25 years we have been honored with a tremendous amount of commitment and support from our board of directors and
advisory committees. These dedicated people have helped us to remain true to our mission and our values while helping guide
us to be the best we can be. Here, we list all of our current and former board and committee members to whom we give our
sincerest thanks.
© Alan Pogue
in 1985, our employees and associates
have contributed to the objectives of
our organization, dedicating themselves
to the cause of healthcare justice for
the mobile poor. Our thanks—and the
thanks of more than 5,000 clinician
constituents of MCN—go out to this
amazing team of people.
www.migrantclinician.org 19
Office Locations
Austin, TX (headquarters)
Chico, CA
Salisbury, MD
El Paso, TX
Ferndale, WA
State College, PA
Written by Robbie Tarpley Raffish of a.s.a.p.r. inc. Designed by Anne Harpe of Anne Harpe Design