Last year, advocates for migrant farmworkers successfully pushed for a new law that requires doctors to report pesticide-related illness to the N.C. Department of Health and Human Services. The thought was that stronger surveillance would lead to better enforcement from regulators at the N.C. Department of Agriculture's Pesticides Division.
But almost a year after the change went into effect, not a single doctor in the state has used the new program to report farmworker sickness. It appears that the migrant workers are more reluctant to come forward than they were previously, advocates say. So rather than helping victims—and stopping violators—the new program may be driving the problem deeper underground.
"There are a number of reasons that farmworkers tend to be reluctant to report," says Dr. Deborah Norton, medical director of the state's Office of Rural Health and Community Care. "One is that the current law does not protect them from retaliation. There is no confidentiality to the report. If anyone asks who reported this exposure, the Department of Agriculture considers it public record."
The NCDA investigated 12 cases last year, and four in 2004 and 2005, according to Patrick Jones, deputy director of pesticide programs. His teams haven't investigated a case this year.
"Workers don't want to report anything because they don't want their boss to get in trouble," says Fawn Pattison, executive director of the Pesticide Education Project, which lobbied for the rule change. "They don't know the difference between one government agency and the next. And the lines are being blurred."
The new rules took effect on Jan. 1. The program requires physicians to report pesticide-related illness or injury within 48 hours of diagnosis or immediately after a death. Doctors must also pass along personal information about the exposure victim, including his or her name, address, telephone number, date of birth, race, gender and occupation. That information is then forwarded to the NCDA, which can further investigate any wrongful exposure.
Sheila Higgins, an epidemiologist with the Division of Public Health in the Department of Health and Human Services who wrote the new rules, says she has seen 300 or 400 cases since the rules were implemented. Most involved homeowners and children in accidents—not the populations Higgins and advocates hoped to monitor and protect.
"The majority of our reports are coming from Carolina Poison Control, but I think that's a misrepresentation of what's really out there," Higgins says. The new rule also requires the state poison control center to report its pesticide exposure calls. "I'm thinking that there are probably more work-related incidents."
The Carolinas Poison Center reported to the Department of Health and Human Services 135 calls from medical staff, and 52 of those calls were occupation-related, says Dr. Marsha Ford of the center. They were not necessarily farmworker cases.
In the past few years, there have been a significant number of pesticide-related illness cases among migrants, and this year's sudden dip has caused concern and speculation among farmworker advocates and outreach workers.
Last year, the Office of Rural Health and Community Care analyzed client health assessments from its 13 farmworker health clinics; those clinics see 300 to 500 farmworkers per year.Medical Director Dr. Deborah Norton reviewed 10 health assessments from each clinic, and found that nearly 40 percent of the clinics had at least one pesticide exposure (which is not necessarily an illness). The clinics reported five confirmed cases of illness to the NCDA for investigation, Norton says.
Her office did not conduct the analysis this year, but at the request of the Independent, Norton surveyed a few clinics with traditionally high numbers of pesticide exposure cases. She says a worker at one site reported that growers used more farming equipment this year rather than manual labor, and were more carefully applying pesticides. Norton says two other sites had several possible cases but the farmworkers wouldn't give their names.
"I think it's going to take so much more effort to collect good data and I think it's going to take a lot of trust building with the worker community," says Pattison from the Pesticide Education Project.
Pattison says next year she'll push for funding for the program, so outreach workers and translators can work more closely with the migrants.
Higgins, the epidemiologist analyzing the results, hopes to gather the data and publish the program results by the end of January.
"I'm optimistic," she says. "I think it's a baby step toward a continued effort in getting folks to report and study the issues so we can identify how often [exposure] happens and use that data to recommend prevention methods."