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Migrant workers are temporary low-skilled labourers from foreign countries that come to Canada through temporary migration programs and are utilized in rural settings as agricultural workers (Preibisch & Otero, 2014). Approximately 30 000 to 40 000 workers come to Canada each year and are employed under the Seasonal Agricultural Worker Program with most positions being in the province of Ontario (Glauser, 2014; McLaughlin, Hennebry & Haines, 2014). The Seasonal Agricultural Worker Program is a federal government program authorized by Human Resources and Skills Development Canada that issues up to eight month long work permits to foreign workers for employment as farm labourers (Glauser, 2014; Preibisch & Otero, 2014). The Seasonal Agricultural Worker Program began in 1966 when Canada made an agreement with Jamaica and since then has expanded to include workers from Mexico and over ten Caribbean countries (Preibisch & Otero, 2014). In 2011, the Temporary Foreign Worker Program for lower-skilled occupations started an Agricultural Stream that has allowed migrant workers to come to Canada from Guatemala, Thailand and the Philippines (McLaughlin et al., 2014). Over ninety percent of migrant workers are men and most workers are married or have dependent children that they support back home (Narushima, McLaughlin, & Barrett-Greene, 2016).

Migrant workers with a legal work visa are entitled to health coverage in Canada and are issued health cards (Glauser, 2014). However migrant workers face poor living and working conditions, receive substandard wages and benefits, commonly develop health issues and experience barriers to accessing healthcare (Preibisch & Otero, 2014). The Workers’ Safety and Insurance Board states that migrant workers have the right to refuse unsafe work and are entitled to compensation after a workplace injury (Glauser, 2014). Few migrant workers report workplace injuries because either they fear repatriation or compensation and treatment for injuries is inadequate or inaccessible (Glauser, 2014).

Temporary Migration Worker Programs in Canada

The structures and practices that Canada has in place regarding temporary migrant worker programs (TMWP’s) rely partially on labour market flexibility (Preibisch, 2010). The concept of labour market flexibility allows agricultural industries to extert greater control over the composition of their employment force to increase profit and efficiency. Canada’s temporary migrant worker program is unique compared to those of other countries. Migrant workers are assigned to one specific employer and while theoretically they could request to transfer employers, this is difficult to do. Furthermore, visas are only granted to single individuals and have no potential for family reunification (Preibisch, 2010).

Individuals coming from foreign countries such as Mexico or Jamaica only have their emigrating country’s wages to compare to. Therefore the wages they are making in Canada are significantly more when compared to what they would be making in their home country. However, this comparison means little. The current system is designed to create a population of individuals who are willing to accept any work and living conditions they are provided and are unable to fight against them, regardless of whether they are unsafe or unfair.

The goal of temporary migrant worker programs is to prevent wages from increasing, decrease cost of production and fill shortages in relatively little time (Gross, 2014). Employers must pass a labour market test, which is designed to demonstrate that they were unable to fill the shortages of these labour positions with Canadian workers. An Labour Market Opinion is also a necessary part of the TMWP process, which essentially states whether hiring a TMW will have a positive effect on the labour market (Gross, 2014). Since 2002, there have been a number of changes to Canada's Temporary Foreign Worker program. One of these changes includes that the employers are allowed to pay high-skilled temporary migrant workers up to 15% less than average wage and low-skilled workers up to 5% less, with the condition that it remains above minimum wage(Gross, 2014). In 2013, it was discovered that many employers preferred hiring temporary migrant workers and even put in place job requirements that favoured migrant workers (i.e. required to speak Chinese). Furthermore, the TMWP in Canada is also unique because there is no cap on the number of temporary migrant workers that can enter each year. Low-skilled Canadian construction workers in Vancouver felt that they had to compete with temporary migrant workers for jobs, that their job prospects were decreased due to TMW’s and that they were “not needed” (Gross, 2014).

The federal government has been consistently neglecting the gathering of actual job vacancies in this realm for decades (Gross, 2014). Appropriate documentation of shortages and accurate information about the labour market state (whether shortages are temporary or structural) are necessary interventions in establishing the actual needs of Canada’s labour market force.

Common Health Problems

Overuse Injuries

Migrant workers often perform repetitive tasks in non-ergonomic positions and in confined spaces causing overuse injuries (Preibisch & Otero, 2014). Musculoskeletal pain and injuries are common including carpal tunnel, back, knee and shoulder pain (Basok, Hall, & Rivas, 2014; Glauser, 2014). Migrant workers will not ask for reduced hours or modified work because they fear deportation, which causes acute injuries to develop into long-term conditions (Glauser, 2014; Preibisch & Otero, 2014).

Weather Exposure

Migrant workers are exposed to unfamiliar vegetation, soil, dusts, insects, animals and extreme weather while working on Canadian farms (McLaughlin et al., 2014; Preibisch & Otero, 2014). Sun damage and heat stroke are major concerns in the summer months when farm labourers work the greatest amount of hours (Preibisch & Otero, 2014). Skin and eye problems are most prominent among migrant workers regularly exposed to UV radiation from the sun and pesticides (Salami et al., 2016).

Pesticide Exposure

Workers are exposed to carcinogenic chemicals and are often not provided proper personal protective equipmentincluding gloves, clothing and respirators (Glauser, 2014; Preibisch & Otero, 2014;). Additionally confined and poorly ventilated work environments are common and increase the risk of chemical exposure (Preibisch & Otero, 2014). Workers have reported acute symptoms including nausea, vomiting and fainting, but also suffer from chronic disease from prolonged exposure including kidney failure and cancer (Glauser, 2014).

Mental Health Issues

Mental health issues are prevalent among migrant workers because they are away from friends and family, lack a support system and work long hours with no alone time (Glauser, 2014). Migrant workers often endure strenuous physical work ten to twelve hours a day seven days a week with pressure from employers to work at a fast pace (Glauser, 2014 ; Preibisch & Otero, 2014). Migrant workers experience fatigue and mental stress and as the level of stress increases so does the risk of injury (McLaughlin et al., 2014).

Sexual Health Issues

Migrant workers have high rates of HIV, AIDS, sexually transmitted infections and other sexual health issues (Narushimaet al., 2016). Condom use among migrant workers in Canada was found to be low due to cultural beliefs (Narushima et al., 2016). Migrant workers engage in sexual encounters with other migrant workers or Canadian citizens to cope with separation from friends and family, fulfill a need for intimacy, to relieve boredom and to earn money or other material items (Narushima et al., 2016). Female migrant workers have also reported higher rates of breast cancer and reproductive health problems such as spontaneous abortion after working as farm labourers (McLaughlin et al., 2014; Salami et al., 2016).

Unsafe Living Conditions

Migrant workers in Canada are required to live on their employer’s property, which often results in overcrowded living conditions leading to the spread of infectious disease (Glauser, 2014 ; Preibisch & Otero, 2014). Many workers have reported not having access to clean drinking water, or facilities to maintain their hygiene including toilets, places to bath or wash their hands and no washing machines to clean their heavily soiled clothes (Preibisch & Otero, 2014). Housing often lacks adequate cooking and refrigeration facilities, which poses a further health risk because many workers only have access to a grocery store once a week (Preibisch & Otero, 2014).

Road and Equipment Accidents

Motor vehicle collisions resulting in serious injury or death are common among migrant workers (Glauser, 2014). Employers provide transportation for their workers and often vehicles do not have enough seatbelts for the number of passengers (Glauser, 2014). When fatal collisions are investigated employers have been found to be using unsafe multi-passenger vans or buses with faulty parts and unlicensed drivers (Preibisch & Otero, 2014). Accidents mostly occur when transporting workers between work locations using tractors with wagons or trailers that are not road safe (Preibisch & Otero, 2014).

Farming has been ranked one of the most dangerous occupations in Ontario due to the high rate of work related injuries and fatalities (McLaughlin et al., 2014). Migrant workers often report unsafe work environments and equipment causing falls from a height resulting in traumatic brain injuries and harm including: burns, lacerations, bruises, crush injuries and amputations (Basok et al., 2014; Preibisch & Otero, 2014). Employers often fail to provide cell phones or transportation so that in the event of a workplace injury help does not arrive in a timely manner (Preibisch & Otero, 2014).

Systemic Vulnerabilities

Repatriation

Migrant workers hired under the Seasonal Agricultural Workers Program (SAWP) are vulnerable to medicalrepatriation (Orkin, Lay, McLaughlin, Schwandt & Cole, 2014). To repatriate by definition, is to send a person back to their home or original country (Dictionary.com, 2016). If injuries are reported and work is temporarily delayed, workers can be sent home before their contract has come to completion (Orkin et al., 2014). Statistics from the Foreign Agricultural Resources Management Services (F.A.R.M.S.) show that 1198 migrant workers were sent home from Ontario for medical reasons between the years 1996 and 2011(Glauser, 2014). Even though F.A.R.M.S. is federally funded to assist with the SAWP program, it is a private organization, which makes the statistics inaccessible (Glauser, 2014). Under the Ontario Coroner’s Act, the death of an agricultural sector worker is not automatically investigated and an inquiry about a migrant worker’s death has never been made in Canada (Glauser, 2014). Recent concern for migrant health and public complaints however, forced the statistics to the surface by the Human Rights Tribunal (Glauser, 2014).

In accordance with government policy, migrant workers on temporary work visas are eligible for publicly funded health care, but they must wait three months in order activate their health cards (Preibisch & Hennebry, 2011). Furthermore, compensation from provincial health insurance is lost once a migrant health worker is sent home (Hennebry and Williams, 2015). Therefore, challenges to health care access present themselves to migrant workers throughout their entire experience. This instills fear in employees to seek medical treatment, or report an injury to employer (Hennebry & Williams, 2015).Migrant workers are allocated to a particular employer, which creates additional fear to challenge the system (Preibisch & Hennebry, 2011). Interviews from migrant workers and community members state that the vulnerability stems from systemic flaws and minimal access to repatriation statistics (Hannebry & Williams, 2015).

Current Solutions

Migrant farm workers are particularly vulnerable and socially disadvantaged. Since they do not have the same full rights that Canadian citizens do, migrant workers are unable to access health and social resources. To address the issues faced by this vulnerable, yet virtually invisible population, projects and solutions have been brought forth to help migrants working on farms. One example the New Canadian Centre in Peterborough has a program to help migrant workers on farms in Northumberland County. The program is called the “Migrant Farm Workers Project”.

Migrant workers, especially those working in agriculture have low rates of accessing health and safety training (McLaughlin, 2009). To correct this finding, the Seasonal Agriculture Worker Program (SAWP) has informed workers on their agreement form that “workers handling chemicals and/or pesticides have been provided with protective clothing at no cost to the worker, received appropriate formal or informal training and supervision, where required by law” (Government of Canada, 2016). However despite this declaration, health and safety training is still inconsistent among migrant farmworkers, particularly in Ontario. Therefore, more needs to done in this area to ensure the safety of migrant workers. For example, Migrant farm worker program provided by the Occupational Health Clinics for Ontario Workers (OHCOW) offers health clinics for migrant farm workers, Occupational Health and Safety Workshops

To ameliorate the difficulties that migrant workers face obtaining healthcare can be addressed by developing health resources to meet the unique needs of migrant workers. The OHCOW with the support of Niagara Region Public Health also provides health clinics for migrant workers in the Niagara region, many of whom are farm workers in rural areas. The clinics employ an occupational doctor, a nurse, a hygienist and volunteer interpreters. The clinics are also in accessible areas and are open at times that the migrant workers have off from work, generally Friday nights. The health care providers are trained to be able to identify health issues that migrant workers face, in particular workplace injuries.

The majority of Canadians may be uninformed about migrant workers and the social and legal issues they face. To raise awareness of the importance of migrant workers in Ontario’s agricultural sector and the inequities they experience, Sustain Ontario organized a Farm Worker Awareness Week.

Rural Nurses and Seeking Medical Attention

There are certain health aspects that are more prevalent to migrant patients that would require registered rural nurses to focus on these aspects in order to provide the proper care. With migrant workers traveling from Mexico, various Caribbean countries, Guatemala, Thailand and the Philippines to rural communities in Canada for employment, nurses must be aware of cultural differences (Preibisch & Otero, 2014; McLaughlin et al., 2014). It is crucial that nurses gain an understanding of the different behaviors, values, perspectives and traditions that come with caring for patients of different cultures in order to avoid “over generalizing and stereotyping”  (Douglas et al., 2014). Nurses must also be self aware, meaning they must know their own personal values and beliefs in order to ensure the care they are providing is not compromised or altered by their own beliefs and values (Douglas et al., 2014).

Some poor health outcomes that migrant workers face are poverty, hazardous temporary work, stress and language barriers (Edmunds, Berman, Basok, Ford-Gilboe, & Forchuk, 2011). Migrant workers often have language barriers because they speak a different language in their home country. Language barriers can create miscommunication, especially with more complex topics, needs or desires (Viveros-Guzman & Gertler, 2015). Their English may not be sufficient enough to understand medical terms and therefore impede on the care being given by nurses and other HCP’s. This language barrier causes a potential for putting the patient at risk because patients may lack information given by HCP’s that is crucial to proper self care in order to avoid further or reoccurring injuries. Nurses usually overcome language barriers through the assistance of the patient’ family members or interpreters (Van Rosse, Bruijne, Suurmond, Essink-Bot, & Wagner, 2016). Another barrier rural nurses are challenged with because of the language barrier is that migrant workers are not traveling with family and interpreters may be hard to find depending on the size and location of the rural community. Encouraging nurses to speak slowly and clearly with images and gestures can be helpful, as well as using other migrant workers with better English or a community member that speaks the language. If available, the use of technology for animations or voice translation systems can also be helpful to overcome these barriers and provide proper care (Van Rosse et al., 2016).

Rural registered nurses must also focus on health promotion for these migrant workers. Education is a key component to proper self care for patients and rural communities themselves. Nurses can educate the rural communities on cultural sensitivity and the importance of self care for these migrant workers (Preibisch & Hennebry, 2011). Health promotion is important because it is a way to help improve the health of migrant workers who are often not able to receive publicly funded health care until after 3 months of being in Canada (Preibisch & Hennebry, 2011). If patients are able to care for themselves, they are more likely to be aware of dangers that can cause them harm and therefore avoid them. Rural nurses can focus on health promotion by ensuring employers of migrant workers are provided with pamphlets and posters that educate workers on proper self care. Nurses can ensure the information is specific to the working condition of these individuals and therefore assist those who are less likely to seek medical attention out of fear (Preibisch & Hennebry, 2011). This will also provide employers and community members with the information to help identify employees who are in need of medical attention.

References

Basok, T., Hall, A., & Rivas, E. (2014). Claiming rights to workplace safety: Latin american immigrant workers in southwestern ontario. Canadian Ethnic Studies/Etudes   Ethniques Au Canada, 46(3), 35-53. Retrieved from  http://web2.trentu.ca:2048/login?url=http://search.proquest.com/docview/1728660867?accountid=14391

Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., & ... Purnell, L. (2014). Guidelines for Implementing Culturally Competent Nursing Care. Journal Of Transcultural Nursing, 25(2), 109-121. doi:10.1177/1043659614520998

Edmunds, K., Berman, H., Basok, T., Ford-Gilboe, M., & Forchuk, C. (2011). The Health of Women Temporary Agricultural Workers in Canada: A Critical Review of the Literature. Canadian Journal Of Nursing Research, 43(4), 68-91.

Glauser, W. (2014). Migrant workers' health rights unmet. Canadian Medical Association.Journal, 186(10), E351-2. Retrieved from  http://web2.trentu.ca:2048/login?url=http://search.proquest.com/docview/1545871730?accountid=14391

Gross, D. M. (2014). Temporary foreign workers in canada: Are they really filling labour shortages?. CD Howe Institute Commentary, 407. http://dx.doi.org/10.2139/ssrn.2428817

Hennebry, J. L., & Williams, G. (2015). Making vulnerability visible: medical repatriation and Canada's migrant agricultural workers. CMAJ: Canadian Medical Association Journal, 187(6), 391-392. doi:10.1503/cmaj.141189

McLaughlin, J. (2009). Trouble in our fields: health and human rights among Mexican and Caribbean migrant farm workers in Canada (Doctoral dissertation, University of Toronto).

McLaughlin, J., Hennebry, J., & Haines, T. (2014). Paper versus practice: Occupational health and safety protections and realities for temporary foreign agricultural workers in ontario. Pistes: Perspectives Interdisciplinaires Sur Le Travail Et La Santé, 16(2), 1-17. Retrieved from  http://web2.trentu.ca:2048/login?url=http://search.proquest.com/docview/1735927515?accountid=14391

Narushima, M., McLaughlin, J., & Barrett-Greene, J. (2016). Needs, risks, and context in sexual health among temporary foreign migrant farmworkers in canada: A pilot study with mexican and caribbean workers. Journal of Immigrant and Minority Health, 18(2), 374-381. Retrieved from  http://web2.trentu.ca:2048/login?url=http://search.proquest.com/docview/1794478552?accountid=14391

Orkin, A. M., Lay, M., McLaughlin, J., Schwandt, M., & Cole, D. (2014). Medical repatriation of migrant farm workers in Ontario: a descriptive analysis. CMAJ open, 2(3),  E192-E198.

Preibisch, K. (2010). Pick‐Your‐Own Labor: Migrant workers and flexibility in canadian agriculture. International Migration Review, 44(2), 404-441. doi:10.1111/j.1747-7379.2010.00811.x

Preibisch, K., & Hennebry, J. (2011). Temporary migration, chronic effects: the health of international migrant workers in Canada. CMAJ: Canadian Medical Association Journal, 183(9), 1033-1038. doi:10.1503/cmaj.090736

Repatriation. (2016). On Dictionary.com online. Retrieved from  http://www.dictionary.com/browse/repatriation

Van Rosse, F., de Bruijne, M., Suurmond, J., Essink-Bot, M., & Wagner, C. (2016). Language barriers and patient safety risks in hospital care. A mixed methods study. International Journal of Nursing Studies, 54(Complete), 45-53. doi:10.1016/j.ijnurstu.2015.03.012

Viveros-Guzmán, A., & Gertler, M. (2015). Latino Farmworkers in Saskatchewan: Language Barriers and Health and Safety. Journal Of Agromedicine, 20(3), 341-348. doi:10.1080/1059924X.2015.1048400