Lee la versión en español aquí . Lilian Melgar Martínez started her day at 5 a.m.
to harvest tobacco and sweet potatoes in the fields of Duplin County in North Carolina. As temperatures sweltered and the work days stretched into night, sometimes she would faint. The demanding schedule was gradually taking a toll on her health as the relentless pressure from supervisors only intensified.
Tu guía esencial para Trabajadores Agrícolas en Carolina del Norte Tu guía esencial sobre Política e Inmigración en Carolina del Norte “They would say, ‘Hurry up, we need to finish,’” she recalled. “They said that the work had to be done, or else they would fire you.” Melgar Martínez has lived in the state for about 20 years, most of which has been as an agricultural worker.
Along with her husband and their children, the family has worked in the fields for years. Despite their critical role in an agriculture industry that generates over $70 billion annually in North Carolina , they have faced persistent barriers to essential healthcare services, including annual exams, vaccinations, and screenings for chronic conditions. Recibe gratis las noticias más importantes y de utilidad de Carolina del Norte directo en tu celular.
Haz preguntas y comentarios, y charla con nuestros periodistas. Visits to medical facilities were rare and often prompted only by urgent health crises, such as the fainting spells Melgar Martínez experienced. “In the clinics they would ask for so many things.
I didn’t go for that reason,” Melgar Martínez said. “It scared me.” Melgar Martínez isn’t alone in her struggle to navigate a healthcare system that doesn’t feel welcoming and in some cases could lead to an arrest.
She’s among the state’s approximately 150,000 farmworkers and their dependents each season, many of whom are Spanish-speaking and undocumented. More than half of all crop workers nationally speak Spanish as their primary language and lack documentation, according to the latest National Agricultural Workers Survey by the U.S.
Department of Labor for 2021-2022. “I think at the very foundation of this, the US healthcare system is really challenging to navigate,” said Rebecca Young, director of Programs at Farmworker Justice. “If you're not familiar with the system, that already sets a roadblock in place for you.
” Theoretically, farmworkers should have access to healthcare regardless of their immigration status. However, many face a fragmented healthcare access at safety net organizations such as Federally Qualified Health Centers (FQHCs), and its look-alikes that operate outside of hours convenient for farmworkers. They also face language barriers and the centers’ documentation requirements sometimes pose a fear– deportation.
After years of not accessing routine healthcare, Melgar Martinez was diagnosed with a brain blood clot this summer. Her diagnosis came about only because an employee from “Sembrando Salud,” an initiative by NC FIELD, a grassroot non-profit, noticed during a home visit that she appeared unwell. Recognizing the seriousness of her condition, the employee drove Melgar Martínez to the emergency room, a crucial intervention that potentially saved her life.
But it took years. Immigrant rights advocates say North Carolina makes it harder for undocumented workers to access health care services. The challenges are exacerbated by recent legislative threats such as HB 10, which would require local sheriffs to cooperate with the U.
S. Immigration and Customs Enforcement (ICE). As a result, many farmworkers don’t seek care, and often suffer from chronic conditions that often go undiagnosed until it's too late.
Free and charitable clinics, North Carolina Farmworkers Health Clinics and Migrant Health Centers are striving to bridge these gaps with less regulatory requirements and more flexibility in service provision. Yet, they struggle with provider availability and funding. From policy to practice: Navigating healthcare options Unlike states such as Oregon, California, and Washington — where undocumented farmworkers are entitled to healthcare and overtime — North Carolina does not provide these benefits.
As a result, many farmworkers lack health insurance and must provide documentation at FQHCs to access sliding scale services. “We do have an obligation to try to collect that fee within reason,” said Brendan Riley, the vice president of Government Relations and External Affairs at the North Carolina Community Health Center Association (NCCHCA). “But as I mentioned, these are mission-based organizations.
They usually try to go above and beyond to reduce barriers to access, rather than erect them.” NCCHCA provides training, advocacy, and technical assistance to the 43 FQHCs in the state. These centers offer primary care in underserved areas and receive funding to provide services regardless of patients' ability to pay.
Although it is not mandatory, "it is a very common practice" for FQHCs to collect documentation of address and income to offer sliding scale fees, according to Mel Goodwin-Hurley, vice president of Risk Management and General Counsel at NCCHCA. Some health centers allow patients to self-attest to having no income where income documentation is unavailable, Goodwin-Hurley explained. But since each FQHC operates as an independent nonprofit with its own board of directors, their governance structures and patient requirements can vary.
Initially, many families pay in cash and report their income, but for follow-up visits, they must provide proof, such as a letter or a pay stub, said Amy Elkins of NC FIELD. Elkins mentioned that Campbell University's Community Care Clinic, in collaboration with Sembrando Salud from NC FIELD, frequently serves patients who feel rejected by FQHCs due to these requirements. Maria, an undocumented migrant farmworker who splits her time between Florida and North Carolina, faced a similar challenge in 2015 when she sought care at Black River Clinic, a FQHC look-alike.
She was asked for paycheck stubs and proof of residency, which was particularly daunting. Maria had submitted these documents before and had ended up paying a sliding fee of $10 per visit. But to meet these requirements, she had to ask her employer for a letter certifying her earnings under the alias she uses in North Carolina.
“In the past, I used to ask my boss for this letter, but I felt embarrassed. What if they get angry and decide not to give me work because I’m bothering too much?” said Maria, who is using a pseudonym to protect her identity. Lee Ann, CEO of Black River Clinic, clarified that the clinic generally requires proof of income from permanent residents to determine eligibility for its sliding fee scale.
But this requirement is not typically enforced for migrant farmworkers. “That was basically probably somebody not understanding that she was a migrant farmworker. And she was in the Burgaw office, most of them do end up going to Atkinson,” Ann said about Maria’s situation.
“But yeah, that's not normal. I don't know, it could have been a new employee who didn't know." To better serve farmworkers, Black River Clinic operates the 'Manos Unidas' program in Atkinson.
This clinic is funded by a migrant health grant from the North Carolina Office of Rural Health. This program is primarily dedicated to migrant and seasonal patients and is one of 20 North Carolina Farmworkers Health Clinics . However, not all FQHCs and their equivalents have separate programs for farmworkers.
Maria eventually learned about the mobile clinic option through another migrant worker and was advised to reach out to the group. “I still had to drive there; another colleague took me. But they had doctors outside, under a small shelter, and a doctor saw us there,” she recounted.
While FQHCs and look-alikes have more regulatory requirements, clinics like the one Maria went to offer more flexibility in service provision. In addition to those sites currently funded by North Carolina Farmworker Health Program (NCFHP), there are 11 additional health access points in North Carolina that specialize in serving farmworkers and their families, known as Migrant Health Centers. These Farmworker Health Clinics and Migrant Health Centers aim to fill the healthcare gaps specific to agricultural workers by requiring less documentation, employing bilingual community health workers, providing mobile health units and offering extended hours to accommodate workers' schedules.
But these resources are often stretched thin, said Marianne Martinez, CEO of Vecinos, a Farmworker Health Clinic and recently state-designated rural health center with mobile clinics that serve farmworkers across nine western North Carolina counties. Martinez highlights that chronic diseases, dental issues, and vision problems are frequently unmet among farmworkers. “For anybody to wait six to eight weeks for a primary care appointment is too long.
That right there will tell you there are not enough clinics," she said. “There are significant issues with provider availability, affecting not just specialists but primary care providers as well.” The shadow of HB 10 The fear of heightened immigration enforcement adds another layer of complexity, particularly with the recent HB 10 bill.
This project would require local sheriffs to cooperate with ICE. “We want to be able to see a doctor without feeling like they're asking us too many questions, which is starting to become scary,” Maria said. Worry affects both undocumented workers and those with H-2A visas, who rely on their employers for work, transportation, food, and housing.
“Many H-2A farmworkers have very limited access to transportation. They may be taken to Walmart once a week, but that does not suffice for medical needs,” said Quirina Vallejos the Executive Director of the NC Farmworkers Project. Undocumented farmworkers, who sometimes lack a license but own a car, often play a crucial role in assisting H-2A workers.
They provide transportation to medical appointments and other essential services, said Leticia Zavala, leader of the agricultural workers' organization El Futuro Es Nuestro. “That support system is at risk if people are afraid to drive or break any laws or be stopped by the police,” Zavala said. How barriers to healthcare lead to life-threatening conditions The barriers to healthcare faced by many farmworkers contribute to chronic conditions such as diabetes and hypertension frequently going undiagnosed until it is too late.
Dr. Joseph Cacioppo, the chair of the Community and Global Health program at Campbell University and a volunteer with Campbell University Community Care Clinic in partnership with Sembrando Salud by NC FIELD, has witnessed the severe consequences of these barriers firsthand. “They wait until they're deathly ill to go into the emergency department,” noted Cacioppo, who previously worked for 42 years in emergency rooms.
He observed that farmworkers frequently postpone seeking medical help until their conditions become severe due to fears of deportation or language barriers. “The doctor said that if I hadn’t gotten there or hurried to arrive, I would have had a heart attack,” Melgar Martínez recounted. Without the organization's help, she would have had no means of accessing emergency care.
In 2017, during the free and charitable clinic's initial outreach, 68 patients were diagnosed with diabetes, including four individuals with A1C levels exceeding 15—significantly higher than the normal range of below 5.6. “Three of them were lucky; there was minimal or no organ damage at the time we found them,” the doctor explained, adding the fourth has kidney failure and liver damage “because he went so many years without knowing he was diabetic.
” Of the 68 patients with diabetes, the majority were able to get their A1C levels down to below 8, which is considered good control according to the American Diabetes Association. “That means a lot, because ultimately, diabetes, if it's left uncontrolled, the death rate rises significantly. Uncontrolled diabetes can lead to heart disease, strokes, loss of limbs, and other severe complications,” he said.
The mobile clinic’s evening hours—from 5:30 PM to 10:00 PM—are essential for reaching workers who are unable to visit clinics during their regular working hours. "We provide primary care to the residents in that community, but primarily the seasonal and migrant farmworkers in that community, because they have, otherwise, they have no access to health care,” Cacioppo said. Challenges and caps in serving the state’s most vulnerable The lack of medical providers and long wait times further exacerbate the difficulty of obtaining care.
And despite receiving funding to serve vulnerable populations in North Carolina, many clinics are falling short when it comes to actually improving health outcomes of the farmworkers population. “There's a huge accountability issue, a huge one,” according to Yesenia Cuello, Executive Director of NC FIELD. “And I think that one of the challenges that we've been faced with is the fact that even though we're asking clinics to do this, and we're telling clinics how important it is for them to measure impact, the pressure is coming from us.
And it's not necessarily coming directly from the people that are funding these clinics." NC FIELD advocates for policy changes that would require clinics to demonstrate real improvements in health outcomes, rather than merely reporting patient numbers. They are pushing for more flexible documentation requirements and expanded language access—barriers that prevent many farmworkers from accessing health care.
Dr. Daniel Frame, director of Medical Ministry at Asheville Buncombe Community Christian Ministry (ABCCM), highlights the distinctive role of free and charitable clinics such as ABCCM, Vecinos and Campbell Community Care in extending healthcare services to uninsured patients in rural North Carolina, often going beyond the constraints faced by FQHCs. For example, ABCCM’s clinic, serving 34% Latino patients, accepts donated medications paid for by insurance companies and uses retired volunteer doctors without malpractice insurance.
This flexibility is what allows ABCCM to reach more uninsured individuals compared to more rigidly-structured FQHCs in the region, Dr. Frame said. “We stand in the gap between a broken healthcare system and people in need,” Dr.
Frame said. Melgar Martínez said she knows of many farmworkers who face similar difficulties accessing healthcare. They often lack care due to ignorance or fear of using available resources until help arrives at their doorstep.
But there is no comprehensive data to fully understand the extent of the problem, said Thomas Arcury, a researcher with experience in farmworker health issues. “We need to consolidate various local studies, which often use different methodologies and are not always comparable,” said the professor at Wake Forest University. “If you don’t understand the problem, you don’t know where to allocate your resources.
” After nearly suffering a heart attack, Melgar Martínez relies on NC FIELD-Sembrando Salud for transportation to her follow-up appointments. Additionally, the organization provides her with virtual consultations with psychologists. "No one had ever helped me before, only them,” said Melgar Martinez.
"If the lady hadn't come here, I wouldn't be sitting here talking with you.".
