May is a month when many farmworkers throughout California spring back into action. After a winter of little to no work in the Pájaro and Salinas Valleys' strawberry industry, or the sporadic gigs some farmworkers get pruning grapevines in the San Joaquin Valley, the return to work, and the income that comes with it, is a welcome change.
It's May 2018. The blueberry crop in Fresno County, located in California's San Joaquin Valley, proved to be an especially good one. Prior years of on-going drought left many farmworkers underemployed or unemployed and without access to drinking water at home.
But in 2018, despite more rain and more crops, my farmworker compañero (friend, comrade), Constantino, did not get to join his wife, Eusebia, in the blueberry harvest. An Indigenous man from the Mexican state of Oaxaca, 34 years old at the time, Constantino spent two weeks of May in the hospital with dangerously high blood pressure, elevated and erratic blood sugar levels and failing kidneys.
He now spends his days at home, fixing things around the house and attending four-hour dialysis sessions several times a week. With the COVID-19 pandemic, folks like Constantino who have multiple high-risk conditions are encouraged to stay home as much as possible. This leaves him bored and despondent. Not even a trip to el remate (flea market) is in the cards. Eusebia and her kids must take care of those errands.
Constantino had initially been diagnosed with diabetes at the age of 21, twelve years before, at a farmworker-serving clinic in the Pacific Northwest. He and his family sometimes migrated between California and Washington to work other harvests as things went out of season in the San Joaquin Valley, their primary place of residence and work.
What triggered Constantino to initially seek health care once again in October 2017, when his health declined to the point where he could no longer muster the strength to work, was not the intense headaches, the paralyzing dizziness or the peculiar swelling he experienced all over his body. He didn't get care until he lost his vision in one eye — another complication of untreated diabetes and hypertension.
At the San Joaquin Valley clinic where he and his family sought help that fall, the doctor rushed through the visit. He barely looked at Constantino, didn't ask him many questions or order any tests. A quick inspection of Constantino's eyes with the brightly-lit ocular instrument resulted in nothing more than being prescribed a pomada: some kind of medicated cream like you would get with a pink eye diagnosis. Indeed, the whites of Constantino's eyes were red, but not from an infection.
Being overlooked, rushed through appointments, perpetually waitlisted or misdiagnosed or undiagnosed are not uncommon experiences for Indigenous immigrant farmworkers. This fuels a widespread and, I think, reasonable distrust of the healthcare system within Indigenous farmworker communities. Like many others living and working in California's key zones of agricultural production, Constantino is uninsured, undocumented and unaccustomed to our overly complex and expensive U.S. healthcare system. Our troublingly underfunded and overwhelmed social safety net systems are also not set up or sufficiently staffed to give people like Constantino the support they need. At a minimum, this would include on-site interpretation services, culturally competent care, and navigational help; including immigrants, including food and farmworkers,
The intertwining fears of being stuck with horrendous bills, being branded a public charge, being outed as undocumented, or seeking medical help in dire circumstances only to be deported upon release from critical care, or dying alone, also inhibit farmworkers from getting help before things get really bad. Again, these anxieties are not without reason given farmworkers' lived experiences of anti-immigrant policies and attitudes, even in spaces of care.
In May 2018, Constantino was rushed to a hospital 20 miles away from his home. Geography and rural health care infrastructure and worker shortages are yet additional barriers immigrant farmworkers in the San Joaquin Valley face with respect to accessing health care. He was in chronic kidney failure with dangerously high blood pressure and blood sugar. I visited him on several occasions during his fifteen-day stay, during which doctors ran extensive tests, gave Constantino lots of different medications and eventually installed a port on his upper-chest and put him on dialysis.
I visited Constantino almost every day during his two-week hospital stay, especially on the days that Eusebia, their three children ages 9-15 at the time, and other kin, couldn't make the 20-mile trip after a long day in the fields. All I could do was keep him company and bring him hard-boiled eggs, steamed vegetables, tortillas, and hot sauce at Eusebia's behest — comfort foods that were significantly less sweet than standard American hospital fare. I did my best to translate what doctors and nurses and aides were saying about often very complex and at times scary medical tests and procedures to a man whose first and primary language is Triqui, not Spanish.
Constantino's specific combination of chronic conditions — diabetes, high blood pressure, kidney disease — is not uncommon for farmworkers in the San Joaquin Valley, or indeed, the world. Even at his young age, Constantino admits that he is among the youngest patients in his newfound group of dialysis buddies, but he is certainly not alone. The deterioration of his kidneys had likely been worsening and intensifying for years prior.
The worst cases are concentrated among the poor and further concentrated among Black, Latinx, and Indigenous communities in the U.S These diseases, and the societal inequalities that exacerbate them, are preventable or manageable in the best of circumstances. In the United States, the best of circumstances means access to private health insurance and geographic proximity to health care providers that speak your language and don't discriminate against you based on race, class, gender, sexuality or immigration status, among other things. And even then, things are not always in one's favor.
Better yet, prevention measures would also include affordable and quality housing, health care for all, access to clean air, water, and healthy food, and living wage jobs with strong safety and environmental protections. These are things that farmworkers have been historically excluded from, even now that they are deemed essential workers.
Constantino endured the worst of circumstances, and he is not alone. When I first started doing research with farmworkers in 2010, I was in my late-20s at the time. I was struck by how many people just like Constantino, who I came to know and befriend, were permanently disabled — by an overwhelming combination of factors that had little to do with so-called "lifestyle choices." They experienced these life changes well before their sixtieth, fiftieth, fortieth and even thirtieth birthdays. Their health problems ranged from chronic pain resulting from herniated discs and other musculoskeletal injuries, cancers, neurological problems, auto-immune diseases, heart problems, asthma, heat illness and complications from diabetes and high blood pressure, reproductive challenges, among other things, and often more than one of these at once. On top of this, many suffered from depression and anxiety about the social and economic strain that their inability to work and contribute to their households engendered.
Many farmworkers also die before their sixtieth, fiftieth, fortieth and thirtieth birthdays. These deaths happened before COVID-19, which is only exacerbating farmworkers' longstanding suffering and vulnerabilities, and indeed, contributing to earlier-than-necessary or normal disabilities and deaths.
Twenty-eight-year-old Indigenous Oaxacan farmworker Honesto Silva Ibarra arrived to work in the blueberry fields in Washington State in 2018. He was a guest worker under contract with Sarbanand Farms. The foremen and supervisors routinely denied workers their legally mandated water, meal and bathroom breaks. Instead, they pushed them to work harder and faster in extremely hot conditions exacerbated by wildfire smoke.
Honesto collapsed in the fields and was taken to the hospital, where he died a week later.
The agricultural industry and the medical examiner in Kings County, Washington, both claim that Silva died of "natural causes," or cardiac complications from diabetes.
Mainstream health narratives and medical opinions have been quick to attribute things like diabetes and hypertension as "lifestyle diseases," which should be managed by changes in diet and exercise habits, and perhaps in some cases with help from prescription medications. This explanatory model is very convenient for agribusinesses like Sarabanand and others, who seek to deny accountability for workplace abuses and hazards and to detract attention away from how the very design of agriculture and farm labor is disastrous and deadly for farmworkers.
And still, it is one of the only ways they can support their families; working in the fields is not a choice. Most of the farmworkers I know risked their lives crossing into the U.S., not for a better life, but to have enough to eat and to try and support their families on both sides of the U.S.-Mexico border. This has become much harder as the costs of living continue to rise while wages stagnate, leaving less of farmworkers' meager earnings to share with kin back home, let alone to get by where they are now.
In addition, many like Constantino couldn't get an education because they often had to work alongside their parents from a young age or couldn't afford the long rides from the countryside to the town centers where schools are located. Added to this, trade policies dictated by U.S. corporate interests disadvantaged rural and Indigenous Mexican communities, making it impossible to make a living through farming at home. Thus, farm work jobs far from home, in Mexico's industrial agricultural corridors like Michoacán, Sinaloa, or Baja California Norte, or in the U.S. are among their only options.
Being an immigrant in the U.S. over the past decade, even before Trump, can also be an immensely traumatic experience. The trope of immigrants coming to the U.S. for "a better life" is fractured by the stories farmworkers shared with me — of being abused, extorted and at times raped during their crossings and at work. They live with the perpetual fear that an encounter with the police could result in them being detained, deported, and separated from their families.
Indeed, there is nothing natural about these circumstances in agricultural production and in the communities where farmworkers live that can justify what Constantino, Honesto and countless others like them endure. An oft-quoted number that farmworker life expectancy is a mere forty-nine years is admittedly dated and contested. It is really hard to estimate farmworker life expectancy because we don't have well-organized systems that track deaths within occupational groups, let alone those that employ perpetually marginalized and excluded immigrant farmworkers.
Still, it strikes me as plausible. Even if life expectancy has improved for farmworkers, their quality of life has not. There are troubling patterns in farmworkers' life stories, in which otherwise manageable diseases can turn disabling and deadly. Constantino's disability and Honesto's death are rooted in the many struggles that farmworkers routinely endure. Farm work remains one of the lowest-paid and most dangerous jobs, with the average annual farmworker salary for a family at $20-24,000 a year. 33% of farmworkers live below the poverty level, and this is likely a very conservative estimate. During times of drought and pandemic, farmworker earnings are even more reduced. The COVID-19 Farmworker Study (COFS) found that many farmworkers lost days of work during the pandemic when restaurants and schools stopped buying produce and milk, for example. Still, farmworkers were expected to risk their lives to harvest salad greens and wine grapes, for example, during the record-setting wildfire season that stretched up and down the Pacific Coast.
Some of these factors and forces that farmworkers literally embody through poor health outcomes have remained relatively constant over the last sixty years at least. The illusion that things have gotten better with the mere passage of time or a selection of progressive agricultural labor and environmental policies neglects the many-layered social disparities that farmworkers and their families endure throughout their life-courses. Narratives from "Harvest of Shame," an almost hour-long CBS news documentary special narrated by Edward Murrow sixty years ago, are strikingly similar to images and stories one might come across today if they are paying attention.
When we sink our teeth into a piece of warm apple pie, enjoy a healthy salad with all of the freshest fixings, or dig into a holiday ham or turkey, we probably don't want to think about human suffering. Reading this may be hard to stomach. Still, there is some hope. Our food, healthcare, and social and economic systems are made and managed by humans who have the ability to change and challenge the status quo. This includes how we do business, the ways we work, and how we produce food and how we treat and are for the most vulnerable members of our society. I am inspired by the work of new cohorts of medical students and residents who are tackling the institutional racism of the healthcare system from the inside out. There are countless farmworker serving organizations, such as the Center for Farmworker Families and the Centro Binacional para el Desarollo Indígena Oaxaqueño (Binational Center for Indigenous Oaxacan Development) that do their best, albeit with insufficient resources, to support and advocate for the people who grow and produce the foods we enjoy. Some savvy economists think that at the consumer level, a modest $25 increase in annual household food budgets could make a significant impact on farmworker wages and, in turn, quality of life. So, too, would a long-overdue executive order to grant undocumented immigrants, including farmworkers, amnesty and a pathway to citizenship.
At a talk Constantino and his family and I gave recently at a social justice conference in the San Joaquin Valley, an audience member asked what could be done? His answer, in short, was that everyone should have MediCal; indeed, Emergency Medi-Cal, a program that covers uninsured individuals when they have a life-threatening condition, saved Constantino's life. But, one should not have to almost die in order to live. There is increasing popular support for comprehensive and compassionate health care systems that are more inclusive of immigrants. California is considering passing SB 562, health coverage for all Californians, regardless of citizenship status.
Constantino, now 36, is permanently blind in one eye and will be on dialysis for the rest of his life. He can no longer contribute financially to his family through farm work. He is a supportive dad who tells jokes in Triqui that make his kids laugh and encourage them to do well in school so that they don't have to endure what he and their mom have. Eusebia is now the breadwinner, followed by their eldest daughter who goes to college, works in the fields in the summers and also picks up food service jobs.
Nothing about their story is inevitable. It is all preventable if we muster the political will to do so.
Top Image: Farm worker picking strawberries from low lying strawberry plants in Watsonville, California | David Gomez/Getty Images