Florida Migrant Workers Among Hardest Hit by COVID-19

Migrant workers in Immokalee, Fla., not only endure long shifts, intense heat, and low pay—they face increased risk of COVID-19 due to systemic inequities.

Immokalee, a rural community of around 25,000 in Collier County, has emerged as a hotspot in southern Florida’s outbreak, which has worsened statewide following its reopening. Migrant workers make up the majority of Immokalee’s population and are especially at-risk for COVID-19 due to systemic inequities, ranging from occupational exposure to overcrowded living conditions.

Driven by the belief that health care is a human right, Partners In Health is collaborating with the Florida Department of Public Health in Collier County and community organizations to establish a community health worker program.

In mid-July, PIH trained Immokalee residents—the people who know their community best—to serve as health promoters, spreading vital health information and powering the fight against COVID-19.

This work comes as part of PIH’s U.S. Public Health Accompaniment Unit, a growing effort to stop COVID-19 across the United States, from Pima County Ariz., to Newark, N.J. Through this initiative, PIH offers states, counties, cities and community organizations technical expertise learned from decades of fighting infectious diseases around the world, including tuberculosis in Peru, cholera in Haiti, and Ebola in Liberia.

The initiative grew out of the Massachusetts Community Tracing Collaborative—PIH’s contact tracing effort in partnership with the State of Massachusetts and local boards of health. Beyond advisory services, the initiative also includes a Learning Collaborative, which serves as an open-source library and educational hub on everything from how to establish contact tracing to monitoring and evaluation.

Essential Workers

Immokalee’s harvest season typically runs from October through May, though some migrant workers live there year-round. Crops harvested include tomatoes, strawberries, and watermelon.

Months after the majority of migrant workers left for seasonal work in the North, the community has emerged as a hotspot for COVID-19. In early June, 611 people in the community had tested positive, according to state data. By late July, that number had surged to more than 2,000.

Migrant workers typically fill jobs for which U.S. employers often struggle to recruit Americans, such as seasonal agricultural work. “Immokalee is one of the most vulnerable and poor communities in all of Florida,” says Matt Hing, who is helping lead PIH’s work in the area. “Most of the people in this community are essential workers; if they don't work directly in the tomato picking, they work in construction, the service industry, or as landscapers for residents in Naples,” a nearby city and one of the wealthiest in the U.S.

The majority of Immokalee’s migrant workers come from Latin America—specifically Haiti, Guatemala, and Mexico. Some are guest workers on temporary visas, some are U.S. citizens and residents, while others are undocumented immigrants.

Hing previously worked with PIH in Chiapas, Mexico, where he saw firsthand the poverty and systemic injustice that prompted people to migrate to places like Immokalee, in search of work.

“There are global forces that determine who is poor, who is sick, and who is not,” he says. “So, in many ways, this is the same community we've always served.”

‘You Have To Go Door-To-Door’

In Immokalee, PIH has focused on two goals so far: help develop the county’s community health worker program and assist community groups offering social support.

"It’s not enough to just do health messaging,” says Hing. “You have to go door-to-door and have that person-to-person contact and also address the social determinants – housing conditions, labor protections, financial precarity, documentation status – that enable someone to quarantine, self-isolate, or not."

As essential workers, migrant workers face systemic inequities on and off the clock that put them at increased risk for COVID-19.

Social distancing, for example, is nearly impossible for migrant workers who live in cramped trailers and apartments, travel shoulder-to-shoulder on crowded buses to get to and from work, and work closely in the fields. And personal protective equipment is far from a guarantee. Although some agricultural employers provide handwashing stations and masks, others do not; at least one has called COVID-19 a hoax.

When a farm worker, one of their family members, or one of their roommates falls sick, workers face systemic barriers that make quarantine and isolation challenging, if not impossible. Beyond the logistical nightmare of self-isolating in a trailer shared with five people, missing work for two weeks could drain finances and force a choice between rent or food, if adequate sick pay is not provided. And many migrant workers don’t know where to go for help or what resources are available near them.

In response, PIH has partnered with the county to develop and launch a community health worker program, hiring and training 10 Immokalee residents to share basic health information and social support resources. These health promoters come from within the community and speak Spanish and Creole.

“The team's knowledge of the culture, languages, and residents of their hometown empowers the community to protect their health,” says Reggie Wilson, Healthy Communities Program Consultant with the Florida Department of Health in Collier County. “Bringing health with a personal touch to people at home makes messaging more accessible than ever.”

Insights gained from these one-on-one conversations feed back into the county’s strategy for how best to tackle the local outbreak.

“Residents have the opportunity to ask questions and share their concerns with someone they trust,” says Mark Lemke, Health Center Administrator with the Florida Department of Health in Collier County. “They appreciate someone taking the time to help them understand how they can best protect themselves and their family.”

Joashilia Jeanmarie, an Immokalee resident and student at the University of Florida, chose to become a health promoter to help her community, which, despite its cultural diversity, resilience, and resourcefulness, she says, has been hit particularly hard by COVID-19.

“Without the ability to work from home or socially distance on the job, many of our agricultural, industrial, and construction workers have become vulnerable populations for COVID-19,” says Jeanmarie. “By going out in the communities that were hit the hardest, our health promotion team strives to alleviate this issue.”

Social Support

The team not only shares health information, such as about coronavirus symptoms and testing site locations, but also resources about social support, such as rental assistance. To do so, PIH collaborates with community organizations such as Misión Peniel and the Coalition of Immokalee Workers (CIW), which have worked in Immokalee for years and helped design creative and culturally appropriate public education materials, assemble and distribute essential PPE, and build crucial public support for key public health interventions, including mass testing, in the farm worker community.

“Having PIH join us in Immokalee has been absolutely invaluable,” said Gerardo Reyes Chavez of the CIW.  “From the very start of the pandemic, we have been sounding the alarm about the crowded and substandard housing and working conditions that would serve as a superconductor for the spread of the coronavirus here in Immokalee and in similar farm worker communities throughout Florida, but it was always an uphill battle to convince state and local authorities to take action because we are not a health organization. Having PIH lend its voice, expertise, and resources to that effort definitely opened doors that were far too hard for us to open alone.”

As health promoters go door-to-door, building trust is key. Importantly, they do not ask about immigration status.

Undocumented workers are often reluctant to use COVID-19 health services due to fears of deportation. These concerns come in spite of the health department’s assurances that it is not asking about citizenship or immigration status.

Health promoters also make sure to connect people with a host of resources that do not take immigration status into account.

The harvest ended in May and many migrant workers have left for work elsewhere. But PIH remains on alert, helping migrant workers who stayed behind and preparing for a potential surge of cases in the coming months, when thousands of workers return en masse from northern states, such as Georgia, North and South Carolina, Virginia, and New Jersey – some of which are also experiencing a spike in COVID-19 cases – for the winter growing season.

For health promoters like Jeanmarie, the work has only just begun.

“I think the best part of my job so far has been listening to the experiences, concerns, and frustrations of the people I visit,” she says. “I think it’s important that these voices are heard."