José ignored his “smoker’s cough” for months before biting the bullet, getting tested and diagnosed with active tuberculosis (TB) and HIV. He went to Allison Nist, MD, locally famous in South Florida for caring for migrant farmworkers like José, and started on meds. But when he said he had to move to Tennessee to pick tobacco—his family in Guatemala needed money—she balked. “We persuaded him to stay to finish his six months of TB treatment first,” Nist says. Then she sent him off with his records and a month’s worth of the HIV meds that had won him back his weight and energy.
Nist is clinical director of HIV, hepatitis, STD and TB Programs for the Collier County Health Department in Naples, Florida, where stories like José’s abound: “We provide housing and food so patients can complete TB therapy. Otherwise, they’d have to move on in search of work.”
Federally funded migrant clinics such as Nist’s serve only a fraction of the millions who follow seasonal farmwork from sea to shining shore. Of course, HIV makes their lives that much harder, partly because ADAP and Medicaid coverage vary by state, and farmworkers “often don’t know from one day to the next when or where they’ll be moving.” Plus, some workers from Mexico, Haiti and Central America are illegal and lack documents, so they often don’t qualify—or are too wary of officials to ask. Still, Nist says, migrant farmworkers should try these tips:
Find a clinic. The National Center for Farmworker Health (800.377.9968) or the National Migrant Education Hotline (800.451.8058) can steer workers to care near their next job.
Keep a health file. Always get copies of your records, and take them—and all meds in the original bottles—to the next clinic.
Ask Doc to make a call. The Migrant Clinicians Network (512.327.0719; www.migrantclinician.org; e-mail firstname.lastname@example.org) helps MDs figure out which programs provide which meds.