‘Already it was hard. Now, it’s become impossible’: Pandemic highlights barriers to healthcare for migrant workers

For most Canadians, migrant agricultural workers have been an invisible population. Called “permanently temporary,” these essential but marginalized workers have been quietly harvesting Canada’s fruits and vegetables for more than 50 years without garnering much attention from the rest of us.

That is, until the COVID-19 pandemic shone a light on the injustices they face. Contributing to the easy spread of the virus among workers were significant social issues, including precarious employment and migration status; isolation; structural racism; language and literacy barriers; poverty; over-crowded housing; and, importantly, limited access to healthcare. The result was outbreaks, illness, and sadly, the deaths of three migrant workers.  

These issues may have been surprising to many Canadians reading the news but they are not new.

“They precede COVID and they will outlive COVID,” says Janet McLaughlin, a researcher and co-founder of the Migrant Worker Health Project and Migrant Worker Health Expert Working Group.

“There are a lot of barriers that migrant workers experience accessing healthcare in any given year and COVID-19 has just amplified and complicated them,” says McLaughlin, who has been researching and advocating for this population for more than 15 years.

Indeed, some healthcare services that were previously available were hard to access during the pandemic, because many workers were prohibited from leaving farms. “In that case, there was literally no way for them to access healthcare independently,” says McLaughlin. “Already it was hard, and now, it’s become impossible.”

COVID-19 has added a layer to already complex issues. Crowded indoor workplaces (in the case of greenhouses), poorly ventilated housing with limited sanitation and handwashing stations, jobs that preclude physical distancing and a lack of personal protective equipment are cited as some of the reasons why the virus spread rapidly on some farms. This, in addition to the structural disparities facing this vulnerable and racialized population, puts migrant workers at a higher risk of both exposure and infection. By some tallies, COVID-19 positivity was an estimated 10 times higher among migrant farmworkers compared to the general population.

There is also real concern about the mental health of workers, who already experience significant psychological stress owing to their precarious status, racism and prolonged separation from family.

“The general risk of COVID, combined with the isolation they have experienced on farms, combined with the fact that COVID has exacerbated many of the issues they face in accessing healthcare and living a full and dignified life – all of these factors culminate in a disastrous mental health effect for workers,” says Stephanie Mayell, a researcher at the University of Toronto who has been studying the mental health and well-being of this population well before COVID-19 pushed them into the spotlight. “This year, they came here willing to put themselves at risk on the frontlines to feed Canadians and to feed their families back home.”

Migrant Agriculture Workers (MAWs) have been coming to Canada since the late 1960s under the Seasonal Agricultural Worker Program (SAWP). Along with the newer Lower Wage Occupations and Agricultural streams, these programs bring upwards of 50,000 workers to Canada each year. Workers come mainly from Mexico, Caribbean and Central American countries, and Thailand. They work essential agricultural jobs that are not filled by Canadian residents but are required to maintain the food supply. These programs fall under the Temporary Foreign Worker (TFW) stream; while time in Canada is limited to eight months a year in the SAWP, workers often participate in the program year after year (some coming for more than 20 sequential seasons) if invited back by their employer. Participation does not offer any pathway to permanent residency and is tied to one employer (referred to as “closed work permits”); workers in these programs are not allowed into Canada without a job offer in hand. The workers earn minimum wage and pay taxes on their earnings.

Even without a pandemic, workers are at high risk of occupational hazards, injuries and illness, working on average 10 hours per day with less than one day off per week. They commonly experience MSK pain and injury and ocular and dermatological problems related to occupational exposures. They may also have chronic illness, mental health, reproductive and sexual health needs. And with almost every social determinant of health threatening to undermine their health and wellbeing, there is a real need for primary care.

Workers qualify for provincial health insurance and are entitled to workers’ compensation insurance in the case of a work-related injury. Even so, “people fail to understand the complexities of how hard it is for them to access healthcare,” says McLaughlin.

“I often hear, ‘they could just go to a walk-in-clinic, what’s stopping them?’ and I say, ‘Well, how much time do you have?’” says Michelle Tew, an occupational health nurse at the Occupational Health Clinics for Ontario Workers (OHCOW). OHCOW is a program funded by the Ministry of Labour Training and Skills Development (MOLTSD) that has provided mobile occupational health clinics and safety services to migrant workers since 2006.

One of the biggest barriers is that workers often access care through their employer. Employers are required, by contract, to not only facilitate the paperwork for OHIP cards but also to ensure workers receive adequate medical attention as needed. This includes arranging or physically bringing workers to care facilities, thus making the employers gatekeepers of healthcare for their employees.

“Workers find it alarming that their employers are their first point of contact for any health concerns that they may have,” says Mayell. “Given their status issues and their general vulnerability to deportation, there is a lot to unpack about what it means to put an employer in the forefront of their access to healthcare. It’s a huge barrier that has been made exponentially worse through COVID.”

Employers can act as translators and may even speak for workers during medical appointments. This arrangement forces disclosure of personal health information and introduces a potential conflict of interest for work-related injuries/exposures. It also makes it impossible for workers to maintain the privacy to which they are entitled.

“Even if employers have great intentions, we all deserve confidential access to healthcare,” McLaughlin tells me.  “With an employer as mediator, you’re adding in all these layers of power imbalance. There is concern for the worker of upholding an image of a healthy worker. They don’t often want to admit their health concerns in front of their employers. They may fear judgement or fear they may not be invited back if they reveal an illness.”

That fear is not unfounded. Workers have been repatriated for becoming ill or injured. It is understandable, then, that workers would avoid anything that could result in punitive action against them or jeopardize their employment and immigration status.

Even those who don’t have language barriers may depend on a mediator during appointments: “English-speaking Caribbean workers may require assistance in systems navigation, health literacy or experience cultural safety issues in the clinic,” states Mayell. “Oftentimes, things get lost in a health encounter. They may not be understood, or understand next steps, or know what to ask. They may not understand what they are entitled to. But who assists the worker should really be up to the worker.”

Shelley Gilbert is a social worker and advocate at Legal Assistance Windsor and has spent the past six years helping migrant workers experiencing exploitation or labour trafficking. Many come to her looking for information and assistance and she has noted the difficulties they have navigating the healthcare system independently.

“They don’t know what their rights are or in some circumstances, they may be prevented from accessing their rights – even having their OHIP card, for instance,” she tells me. “Even just explaining the healthcare system helps people feel better. This information should be provided in the workplace, in the community, and in the appropriate languages.”

Yet, a recent survey found that only 22 per cent of workers had ever been given such information. And while the majority of workers surveyed said they had troubling health symptoms, less than a quarter of them reported having ever seen a doctor.

“This year was hard. People didn’t know that they could get tested or treated if they didn’t have an OHIP card,” Gilbert says. “There was a lot of communicating about your rights: if you feel sick, how to isolate, how to get tested, how to get treatment. That kind of information was crucial to get out.”

In communities where migrant workers are concentrated, many community health clinics and family health teams have stepped up, rapidly setting up virtual and mobile clinics to reach workers on farms. “There have been really good attempts from primary care providers to be able to service migrant farm workers this year. They really ramped things up in a number of geographic areas. It has been quite impressive,” says Tew.

Eduardo Huesca, who works alongside Tew at OHCOW, where he is the Migrant Farmworker Program Coordinator, says the past year presented new challenges. “Early in the pandemic, we tried to figure out what the key issues were for migrant farm workers that we would need to consider to support their safety as they arrived and continued to work. Within that was mental health – we recognized that the initial quarantine period and the isolation that would follow would have folks stressed.”

The unprecedented situation has inspired some creative solutions, including recruiting Mexican psychotherapists to offer virtual therapy and mental health support for Mexican workers in Canada. The goal was to provide culturally safe, accessible talk therapy over the phone, to address stress and reduce isolation. “For the people who contacted us, it was really good. We were able to provide a service they needed,” says Cynthia Mora, who has worked with OHCOW as a translator. She has a background in psychology and collaborated with Huesca on the project.

The past year also inspired a flurry of advocacy work.

Academics, realizing the gravity of the situation, were quick to release letters, recommendations to government, and policy papers to demand worker protection and improve their conditions. They call for moving away from closed work permits to improve workers’ autonomy and allow them to refuse unsafe working conditions.

A group of physicians led by Shail Rawal organized a petition to oppose controversial provincial policies regarding COVID-positive migrant workers. Advocacy groups such as Justicia 4 Migrant Workers and Migrant Workers Alliance for Change continue to work tirelessly to demand permanent residency for workers and protest unfair policies. Migrant workers themselves have bravely spoken out against injustices despite punitive consequences.

The federal government, in response to these efforts and to the outbreaks, has begun to critically look at housing standards for migrant workers. This fall, they launched consultations seeking feedback to assess and improve living conditions for migrant workers – a small step in the right direction.

“The attention that migrant farm workers have received this year has put them in the spotlight.” says Tew. “And now, they are being recognized as skilled essential workers. Although it continues to be difficult for workers to have a voice due to fears mentioned, people in decision-making positions are starting to listen.”

After the long, arduous season that was 2020, some workers are still in Canada due to delays and travel restrictions preventing them from returning home as scheduled. Others are already preparing for their return for the 2021 season (which officially started Jan. 1). This is amidst new and ongoing COVID-19 outbreaks in the agricultural sector. (At the time of writing, there were 11 outbreaks in agricultural workplaces in Windsor-Essex county alone).

Among those working on behalf of this vulnerable population, some are looking to this season with trepidation while others have guarded optimism, hoping that there will be more government protections and contractual changes to benefit workers.

For a population that has been invisible for more than 50 years, now would be the perfect time.