The usefulness of surveillance information depends on consistent reporting of suspected pesticide illnesses. In Washington state, the Department of Health (DOH) usually learns about occupational pesticide-related illness cases because the worker visits a health care provider (HCP), and the vast majority of these cases are identified through a search of claims made to the state's workers' compensation system. Therefore, unless a worker seeks out health care for symptoms that they believe to be pesticide-related, there is little chance that the case will be investigated by DOH, making it more difficult to identify products or practices responsible for causing serious illness and injury. To better understand whether and when farmworkers utilize medical care for symptoms they believe are due to pesticide exposure, we conducted a series of six focus groups with approximately 60 farmworkers in Yakima County, Washington, during the summer and fall of 2001. With few exceptions, farmworkers who participated in these focus groups had a good understanding of symptoms of pesticide-related illness and routes of pesticide exposure. Many of the participants felt that they had experienced symptoms resulting from exposure to pesticides while on the job. The symptoms most frequently mentioned were rash, dizziness, difficulty breathing, and coughing. Few respondents said they had sought medical care because of these symptoms. Nearly all agreed that they would not seek medical care in the event of mild to moderate symptoms of pesticide poisoning. The key barriers to seeking health care were economic. The participants made it clear that they desperately needed the money they earned, and could not afford the loss of wages from taking time off to seek medical care. In addition, participants placed a very high value on having and maintaining their current job; they feared that seeking medical care might put their job in jeopardy. Fewer than half of the participants were aware that they were eligible for Workers' compensation coverage. Most of those who were aware were skeptical that their costs of care would be covered, and expressed concern that their employer would be notified of any such claim. Most participants indicated that, if their employer was notified, they would be reluctant to seek payment under workers' compensation because of concerns that they might be demoted to a more tedious, lower paying position, be fired, or not be rehired the following season. Another major barrier to the use of medical care for symptoms occurring on the job was a general sense of dissatisfaction and mistrust of local health care providers, but only for cases of pesticide related illness. There appeared to be two facets to this sentiment. First, many of these participants seemed to believe that health care providers in Yakima were more sympathetic to the position and needs of the growers and would not do anything to make growers uncomfortable. Many also felt that their health care provider had not seriously considered the possibility that their symptoms were the result of pesticide exposure. The attitude of the supervisor or employer was also put forth as a reason participants would or would not seek medical care. Participants told stories of supervisors who insisted a worker go to a hospital or clinic, and other supervisors who discouraged workers from seeking health care. When asked what issues were most important to them, the participants in these focus groups identified two issues: problems with field sanitation and the availability of adequate personal protective equipment (PPE). Many of the participants in these focus groups felt that all farmworkers should be provided gloves for all farm work. Many also reported problems with having access to water in the field for washing. There was also a great deal of concern about access to and the condition of sanitation facilities in the field. These farmworkers felt that, while most of the growers followed the regulations and provided the required facilities, there were a few growers who consistently did not follow regulations. Throughout the focus groups, the participants expressed frustration that the state did not inspect these 'bad actors' and force them. to follow the regulations.
Washington State Department of Health, Office of Environmental Health Assessments, 7171 Cleanwater Lane, Building 2, P.O. Box 47846, Olympia, WA 98504-7846