Precarious patients: health professionals' perspectives on providing care to Mexican and Jamaican migrants in Canada's Seasonal Agricultural Worker Program.

Donald Cole,Michelle Tew,Janet Mclaughlin,Jenna Hennebry

doi:10.22605/rrh5313

Abstract

The intersecting vulnerabilities of migrant agricultural workers (MAWs) impact both their health and their access to health care in rural areas, yet rural clinicians' voices are rarely documented. The purpose of this study was to explore health professionals' perspectives on health care for MAWs in sending countries and rural Ontario, Canada. Qualitative research design occurred over three distinct projects, using a multi-methodological approach including semi-structured interviews in Mexico, Jamaica and rural Ontario (n=43), and session field notes and questionnaires administered to healthcare providers (n=65) during knowledge exchange sessions in rural Ontario. A systematic analysis of these data was done to identify common themes, using NVivo software initially and then Microsoft Excel for application of a framework approach. Structural challenges posed by migrant workers' context included difficulties preventing and managing work-related conditions, employers or supervisors compromising confidentiality, and MAWs' fears of loss of employment and return to countries of origin prior to completing treatments. Structural challenges related to health services included lack of adequate translation/interpretation services and information about insurance coverage and MAWs' work and living situations; scheduling conflicts between clinic hours and MAWs' availability; and difficulties in arranging follow-up tests, treatments and examinations. Intercultural challenges included language/communication barriers; cultural barriers /perceptions; and limited professional knowledge of MAWs' migration and work contexts and MAWs' knowledge of the healthcare system. Transnational challenges arose around continuity of care, MAWs leaving Canada during/prior to receiving care, and dealing with health problems acquired in Canada. A range of responses were suggested, some in place and others requiring additional organization, testing and funding. Funding to strengthen responses to structural and intercultural challenges, including research assessing improved supports to rural health professionals serving MAWs, are needed in rural Canada and rural Mexico and Jamaica, in order to better address the structural and intersecting vulnerabilities and the care needs of this specific population.

Highlights

The intersecting vulnerabilities of migrant agricultural workers (MAWs) impact both their health and their access to health care in rural areas, yet rural clinicians’ voices are rarely documented
This research starts from the theoretical underpinnings of structural vulnerability[38], which recognizes the social determinants of health, and the social structures that create systematic barriers to equitable health care for migrant workers
They want to work – most of them – and they come in here and you know, they’re genuinely concerned about some issue and you kind of feel that you’re their only person that they can talk to, so you kind of feel you’re doing something useful ... (Ontario physician). These health professionals faced a number of challenges providing care to MAWs (Table 1, with more detail in Supplementary tables S1,S2)

Summary

Introduction

The intersecting vulnerabilities of migrant agricultural workers (MAWs) impact both their health and their access to health care in rural areas, yet rural clinicians’ voices are rarely documented. The purpose of this study was to explore health professionals’ perspectives on health care for MAWs in sending countries and rural Ontario, Canada. Methods: Qualitative research design occurred over three distinct projects, using a multi-methodological approach including semistructured interviews in Mexico, Jamaica and rural Ontario (n=43), and session field notes and questionnaires administered to healthcare providers (n=65) during knowledge exchange sessions in rural Ontario. Results: Structural challenges posed by migrant workers’ context included difficulties preventing and managing work-related conditions, employers or supervisors compromising confidentiality, and MAWs’ fears of loss of employment and return to countries of origin prior to completing treatments. Structural challenges related to health services included lack of adequate

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