Progress report for EDS23-056
Project Information
NC AgrAbility assists farmers or farmworkers struggling mentally or physically to remain in, or Veterans entering into, production agriculture in all 100 North Carolina counties and on tribal lands. NC AgrAbility networks and coordinates assisted services, educates farmers and farmworkers on how to prevent secondary injury and how to be safe while in production, and works with partners to recommend equipment and modifications. NC AgrAbility also assists with aging in place planning for farmers and farmworkers so they can adjust their activities to meet capacities and remain working and independent. NC AgrAbility recognized decreased quality of life of farmworkers due to a risk of musculoskeletal disorders. Currently no ergonomics training addresses the musculoskeletal disorders of farmworkers.
There is currently a labor shortage of farmworkers in the United States (Gutierrez-Li, 2021). North Carolina is among the top five states requesting H-2A workers (Gutierrez-Li, 2021). Farmworkers complete many strenuous manual tasks on the farm. Often, these are repetitive with heavy lifting, potentially causing musculoskeletal disorders (Fathallah, 2010). Farmworkers assume incorrect postures with farm tasks because they have not been taught correct ergonomics (Narushima & Sanchez , 2014). One part of this project includes helping farmworkers prevent musculoskeletal disorders through ergonomic training and assistive technology (Son & Park, 2017).
Since the identification of the need for this AT and training, input from additional stakeholders such as community health workers and medical facilities that serve farmworkers have shifted the immediate concern from posture to repetitive stress injury mitigation and prevention and stabilization of joints for both better control and pain management. Also, while a lending library of ergonomic tools is in process to be co-located with producers, community health workers and medical providers insisted that farmworkers have pain and joint mitigation devices, and, other job hazard protection such as sunglasses, that the farmworkers themselves could keep, and, use at their own discretion and also with discretion. They stressed that farmworkers would not want their employers to know of any pain they were experiencing, and, thus, we have also begun a process of potential collaboration for farmworkers to be approached and treated off site at third party facilities.
Additionally, the concept of the training has been simplified to focus only on two - three ergonomic techniques to be promoted across farmworker-engaged agencies and facilities.
References
Fathallah, F. A. (2010). Musculoskeletal disorders in labor-intensive agriculture. Applied Ergonomics, 41, 738-743.
Gutierrez-Li, A. (2021). The H-2A Visa Program: Addressing Farm Labor Scaricity in North Carolina. NC State Economist, 1-7.
Narushima, M., & Sanchez , A. L. (2014). Employes' paradoxical views about temporary foreign migrant workers' health: a qualitative study in rural farms in Southern Ontario. International Journal for Equity in Health, 13(65), 1-12.
Son, B.-C., & Park, S.-Y. (2017). The effects of a Farm Work Safety Project. Research Journal of Pharmacy and Technology, 10(7), 2308-2312.
Goal: Partner with service providers and producers for assistive technology for farmworkers to 1) prevent further repetive stress and musculoskeletal injury 2) pilot assitive technology (AT) with farmworkers 3) receive feedback from farmworkers regarding the AT and/or repetitive stress injury or other injury prevention mitigation devices
- Participants will understand the risks associated with repetitive stress and musculoskeletal issues in farm labor.
- Participants will understand two - three top ergonomic tips to prevent or mitigate repetitive stress and/or musculoskeletal damage risk.
- Participants will understand assistive technology to prevent or mitigate repetitive stress and/or musculoskeletal damage risk for farmworkers.
Cooperators
- - Technical Advisor
Education
One of the lessons learned was that stakeholder feedback at the grasstops level must be included in project design of interventions with farmworkers. Although the participating post-doc (who conceived of the need for the assistive technology proposed in the orignal submission of this grant) conducted field observations of farmworkers and noted the issues that would contribute to musculoskeletal injury, follow-up discussions and interviews with stakeholders that work closely with farmworkers as community educators and medical professionals have indicated concerns with the original proposed model for this grant.
- Community health workers at the Farmworker Institute 2023 in Raleigh, NC noted that they doubted that farmworkers would willingly use any new technology of any sort during harvest, even if it kept them from injury or pain, as they would most likely not use anything that might slow down their capacity to harvest. They noted that obvious (AT that could be seen also by employers and not used discretely) assistive technology focused on planting may have a higher chance of being adopted by farmworkers as the pressure for speed is not as great.
- Directors and project managers of major grants to conduct farmworker health and safety training, for example, at NC State, are already so consumed with their grant mandated education, especially with pesticide safety, that they have little bandwidth to include or conduct additional trainings. Both they and medical professionals that serve farmworkers recommended that a one-sheet or something short and simple that could be distributed broadly among farmworker educators would be more effective and reach more people rather than attempting to load one more train the trainer into already burdened schedules.
- Creating a lending library and educating on the use of the AT tools is still in the works, but rather than locate this with a nonprofit or medical facility, the grantee (NC AgrAbility) is in process of confirming producers for locating at least two lending libraries. Both community health workers and medical professionals that work with farmworkers said that locating the lending libraries with producers would be more effective for use and management than working through a third party.
- Community health workers were adamant that farmworkers also have access to AT or other medical interventions that they themselves could take with them and had control over, and, were not reliant upon a producer for access to. They indicated that farmworkers would not want to use AT that producers could see or potentially infer that the farmworkers was experiencing pain or discomfort that would limit job performance.
- All grasstops stakeholders wanted something simple they could distribute for ergonomic mitigation or repetitive stress syndrome mitigation, and suggested the magnet/s focus on this, as they could be put up in farmworker housing and reach sucessive groups of farmworkers with the messages.
Educational & Outreach Activities
Participation Summary:
The train the trainers model proposed in the original grant was assessed by community health workers, farmworker training personnel, and medical professionals potentially to add to the already overburdened load these stakeholders have with respect to mandated federal and other trainings. The recommendation was the creation of a laminated one-sheet for broad distribution coupled with the proposed magnets. These are in process of advisement with respect to design and which discrete ergonomic and repetitive injury issues to target.
We are still in process of creating materials and will begin their distribution summer 2024.
Crystal Cook Marshall and James Fry presented on the need for assistive technology for farmworkers and the need to engage grasstops and medical professional stakeholders when devising safety and health programs for farmworkers. Presented to 100 rural medical professionals as part of the NC AgrAbility presentation at the Eastern AHEC Rural Health Symposium 2024, Greenville, NC.
Crystal Cook Marshall and James Fry presented on AT for farmworkers as part of NC AgrAbility presentation "Piloting and Hacking DIY AT & Equipment," National AgrAbility Conference March 2024. The presentation featured a wider range of issues with respect to DIY and lowcost AT, and we brought up again the need for engaging grasstops and medical professional stakeholders when devising safety and health programs for farmworkers. (40 participants-ag professionals and farmers)
Rather than collect data regarding the lending library, NC AgrAbility is partnering with Vecinos, Inc to distribute AT the medical professionals there identified as the top needs of the 700+ farmworkers that they serve.
NC AgrAbility is in process with Vecinos on how the agency (Vecinos) can best receive feedback on the AT provided. Rather than the exhaustive list of ergonomic tools submitted as part of the intial budget for this grant, Vecinos and NC AgrAbility have simplified the list to the top items that farmworkers themselves can have and use. Vecinos will garner feedback from the farmworkers to whom these items will be distributed. This feedback will be anonymous and protected, but will serve as a guide as to which lower cost AT and medicial devices do the most to mitigate repetive stress injury and/or musculoskeletal damage. From this outreach and interaction, NC AgrAbility is also seeking to be of deeper service to farmworkers that may be struggling physically to remain in production, and, to provide additional education and assistance to the farmworker community about how NC AgrAbility can serve them with additonal AT or other advocacy or support.
NC AgrAbility has identified one producer to host a lending library for his peach orchard/operation. NC AgrAbility is in process with NC Extension to locate additional producers to host AT libraries specific to their crops, and, to be responsible for utilization of these devices for their employees.
Project Outcomes
Without effective and adequate farm labor, many farms could not survive. Though precision agriculture and other larger scale technical interventions and modifications offer some reprieve for resources farmers from issues of labor, smaller operations, like those that make up the majority of farms in North Carolina, will continue to rely upon human labor. Through discussions with grasstops that work with farmworkers in 2023 and 2024, NC AgrAbility has refined the focus of this particular grant to find and serve farmworkers that have settled in NC, and, who have begun to be affected by the injuries with which this project now is concerned--not only musculoskeletal injury but also injury from repetitve stress syndromes, identified by medical professionals in North Carolina as largely affecting farmworker hands, elbows, and knees.
Medical professionals working with farmworkers in North Carolina insisted that as the interventions they propose are lower cost, then, the amount of AT provided in this grant could be increased and serve more farmworkers. As the participating new partner has agreed to elicit feedback from farmworkers with respect to the aims of reducing musculoskeletal and repetitve stress injury through this lowcost AT, NC AgrAbility anticipates producing a paper with a set of recommendations for basic musculoskeletal and repetitve stress injury AT to be made available to farmworkers. These recommendations could be distributed to farmers, farmworkers, community health workers, medical professionals working with farmworkers for reducing pain and injury to farmworkers, thereby enabling them to remain employed, benefitting both the farmworkers themselves and their employers.
Just as smaller producers are concerned with issues of aging in place and continuing to farm, as they themselves often have no retirement income, farmworkers are even more vulnerable. Farmworkers in North Carolina that have chosen to settle in North Carolina face these same imperatives of working in agricultural production as long as possible, despite medical issues or physical pain. Not only must silence be broken on the need to support farmers physically and mentally to remain in production, this same imperative must be promoted for farmworkers.
Farmers and farmworkers benefit economically when both groups can mitigate injury or pain to stay in production.
Farmers, farmworkers, community health workers, and medical professionals can be more effective when they understand the benefits of lowcost AT for farmworker wellness and productivity.
Small scale agriculture remains viable with adequate sourcing of farm labor.
The medical facility that NC AgrAbility is working with has identified that as farmworkers finish tobacco harvest season in Eastern North Carolina and come to Western North Carolina to work on Christmas Tree Farms, they are coming in with Green Tobacco Sickness. Dehydration is a secondary issue, potentially leading to heat illness. There have been no studies that track the long-term effects of Green Tobacco Sickness. The standard recommended protection--wearing a rain suit--is impractical in the heat of Eastern North Carolina. Producers are not required to provide any protections against Green Tobacco Sickness.
NCA&T Agromedicine, the department which houses NC AgrAbility, has considered working on a pilot within its College of Agriculture and Environmental Sciences on a potential materials solution together with its Family and Consumer Sciences Fashion program.
NCA&T Agromedicine, the department which houses NC AgrAbility, will continue to seek partners and additional funding for piloting assistive technology solutions for farmworkers. The department will continue to work across disciplines and across the region for solutions to farmworker health issues, and anticipates convening discussions on farmworkers and AT and also materials solutions for farmworkers at the 2024 Latino Farmworker Safety and Health Symposium, August 5-6, at NC A&T in Greensboro, North Carolina--education and outreach sponsored by the Southeast Center for Agricultural Health & Injury Prevention Center at the University of Kentucky, and bringing together interested parties from across the region.