Medicine: Oases for Health

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Whether or not they have read The Grapes of Wrath, most U. S. citizens today have heard of the hordes of migrant farmers who left their worn-out farms to harvest oranges, lettuce and peas up & down California. Because many of them came from Oklahoma, they are called "Okies." Some of them camp in packing-box jungles and drink ditchwater; others are lucky enough to lodge in new government camps with modern plumbing and electric washing machines.

No matter where the 250,000 nomads wander, 100 nurses and doctors of the California State Board of Health pursue them in shiny station wagons, inoculate them against typhoid and smallpox, take X-ray pictures of their lungs, give them Wassermann tests and treatment for syphilis. In 1939, reported State Health Director Walter Murray Dickie last fortnight, there were no first-class epidemics among the "Okies," although there were 696 cases of smallpox, 280 of malaria. Strangely enough the incidence of venereal disease among the migrants is lower than among native Californians, and they have relatively little tuberculosis. Greatest plague: dietary diseases (scurvy and pellagra), resulting from lack of fresh meat and vegetables.

Function of the State Health Service is to prevent epidemics, not to treat sore throats, broken ankles, pellagra or appendicitis. Until 1938, penniless migrants were left to doctor such maladies themselves. But after the fierce winter floods, the Farm Security Administration offered to finance a system of community medical care which would give the migrants free doctoring, medicines and hospital care, pay local physicians reasonable amounts for their services. Joining with representatives of the California Medical Association, and Dr. Dickie, FSA formed the Agricultural Workers Health and Medical Association, only Government-supported "panel system" in the U. S.

Last week, in the Journal of the American Medical Association, Dr. Rosco Genung Leland, director of the Association's Bureau of Medical Economics, reported on the activities of this unique health plan.

Its operation, he wrote, is simple: Public health workers refer sick and needy cases to local offices of the Health and Medical Association. After they join (and agree to foot, in the hazy future, the doctor's bills paid for them), the migrants are shipped to nearby physicians, or clinics, if any. Any registered physician may join the Association's panel. His fees are fixed according to schedules determined by the Association's board: a group of seven doctors and social workers from FSA, the California State Board of Health, the State Medical Association. Dentists, druggists and hospitals may also join the panel, if they agree to charge fixed prices. Every month, they all send in a list of their cases and their bills to the Association. Payments are far from meagre: For an appendectomy, FSA, through the Association, pays $50; for an obstetrical case $20; for setting a broken limb, $13. A day in a hospital ward runs to $3.75. Total cost to FSA since May 1938: $1,000,000.

There are now 750 doctors serving 38,000 migrant members through ten health oases, "extending south to the Imperial Valley and north as far as Willows, Marysville, and Santa Rosa." When the migrant population shifts to greener fields, the Association's local offices follow them.