One summer morning, we loaded the van with medical supplies and headed to rural Caswell County, North Carolina. It was my first-day providing primary care to migrant farmworkers as a medical student and an Albert Schweitzer fellow. When an enthusiastic community health worker asked me why I chose this project, I explained that I am an immigrant from Bangladesh who has faced many obstacles since arriving in the U.S., from questions about my identity to navigating college and medical school without money or guidance. Those challenges led to my passion for working with immigrant communities. I believed my immigrant identity would help me relate to migrant farmworkers in a unique way, and that our lived experiences would be identical. I would soon realize that I was completely wrong.
At the farm, we entered two shabby trailer-type homes tucked away behind some trees. Inside were about a dozen farmworkers eating packaged ramen. Everything in the trailer was old: the cramped bunk beds, the sofa, floor and ceiling. Dead cockroaches littered the floor and a bucket was strategically placed below a hole in the ceiling.
We gathered each worker’s health history, took their vitals and performed physical exams. We repeated this at four other farms, and by the end of the day I had my first insights into the hidden lives of migrant farmworkers in North Carolina. Agriculture contributes $103 billion annually to the N.C. economy. Our state is No. 1 in the nation in tobacco, sweet potato, poultry and egg production. Migrant farmworkers, predominantly young males from Latin American countries, are the foundation of this multi-billion-dollar industry. North Carolina employs more than 150,000 of them annually, ranking it sixth in the nation. Yet, this economic boon fails to trickle down to this vulnerable population. Farmworkers in the U.S. have an average annual income of less than $11,000, with those in the eastern U.S. earning 35% less annually than other regions. These statistics don’t capture unreported incidences of underpayment and wage theft. Recently in North Carolina, two employers were fined $139,039 for shortchanging farmworkers and seizing their visas.
Farmworkers face significant health and safety challenges exacerbated by limited regulations and government oversight. They experience high levels of musculoskeletal discomfort, significant pesticide exposure, heavy metal exposure, and extreme heat. Many farmworkers I spoke to reported dizziness and exhaustion from the heat-related dehydration and frequent headaches and nausea from the pesticides. Two were taking dangerously high doses of Tylenol and ibuprofen daily to keep working through their back pain. In September, farmworker José Alberto Gonzalez Mendoza died days after starting work at an N.C. farm due to suspected heat-related cardiac or respiratory arrest. One study showed that a third of N.C. farmworker labor camps are hidden. Another revealed 4 to 22 housing violations per camp. And, multiple studies have found cockroach and rodent infestations, contaminated water, improper fire extinguishers and leaks in the walls or roofing — echoing what I saw.
Nearly half of N.C. migrant farmworkers are thought to be food insecure. Most of the farm workers I interviewed lacked access to the very fruits and vegetables they were farming. Instead they were consuming ultra-processed foods, cheap pasta or ramen, and sugary drinks — the only options available to them that they could afford. So, the next time you are making a sweet potato pie, grilling chicken or making omelets, ask yourself: Whose hands brought it from the farm to my table? And what am I doing to protect those hands? There are many ways to help. Contact state and federal lawmakers and demand greater oversight of migrant farmworker rights and working conditions. Volunteer with or donate to any of these groups: Farmworker Legal Services of North Carolina, Farmworker Unit Legal Aid of North Carolina, North Carolina Farmworker Health Program, or Student Action with Farmworkers. The migrant farmworkers who feed us deserve to be heard and live dignified, safe and fair lives.
Rayad Shams is a med student at the UNC School of Medicine and an Albert Schweitzer Fellow.