A unique nursing program at the University of Wisconsin–Eau Claire (UW-EC) pairs nursing student visits with local dairy farms to assess farm worker health and safety.
The program, now in its seventh year, has identified some critical health issues in dairy farm workers, such as diabetes and latent tuberculosis (TB) infections. In the case of TB, it represents a potential threat of infection to other workers—and if the form of TB they carry is Mycobacterium bovis, it can infect the dairy herd as well. More on that later.
The program is a partnership made up of the UW-EC nursing program, the public health departments of Buffalo and Pepin Counties, Puentes/MF Interpretation (a Spanish interpretative services group), the Chippewa Valley Free Clinic and local dairy farmers.
“We chose to participate in the program because I felt both parties benefited,” says Chris Weisenbeck, Durand, Wis., who milks 350 cows and employs four Hispanic workers. “Our employees could certainly use basic health education. The education they receive about basic health care is priceless. Getting a baseline for their cholesterol, checking for diabetes and also learning the importance of good nutrition and taking care of their bodies will help them live longer.”
The farm-visit program started in 2011 on a couple of midsized farms, and TB screening followed in 2012. The program has grown to 19 midsized dairy farms. Nursing students visit each farm twice a year and screen 65 to 100 farm employees each semester.
A team of five nursing students and two interpreters visit the farms. They are supervised by a public health nurse and Lisa Schiller, who is a licensed nurse practitioner and an associate professor with the College of Nursing and Health Sciences at UW-EC. Employees are screened for blood pressure, body mass index based on height and weight, glucose and TB. The students also give tetanus and flu vaccines.
Typically, farms involved in the program have two to 10 employees. “We’ve been able to follow some of these workers for six or seven years now,” Schiller says. Most recently, with changing dynamics on immigration policy, she has noticed more movement of employees from farm to farm as they follow higher wage incentives. They typically see 10 to 20 new employees each year.
The most common health issues are diet related. Most of the workers are young Hispanic men, living away from home for the first time, and not disciplined in healthy eating. “About a third of the workers have elevated BMIs,and we find a fair amount of high cholesterol and blood pressure,” she says. “This last year, we found two new cases of diabetes.”
John Rosenow, who milks 530 cows near Cochrane, Wis., had one of his 17 employees diagnosed with diabetes. “And one of my employees had bad eating habits, drinking way more Pepsi than he should among other things. When the nurses checked him, they almost called the ambulance,” he says.
“This woke him up to start taking care of himself,” Rosenow says. The nurses’ education program has helped him along the way and his health, while not perfect, has improved.
THREAT OF TUBERCULOSIS
Another troubling health concern is TB infections. While the incidence of TB in the U.S. is three cases in 100,000 people, it’s seven times higher in Mexico. If the form of TB is M. bovis, it can infect cattle as well. There has been one documented case of human-to-bovine infection in North Dakota, and there have been suspected cases in Wisconsin and California.
In the UW-EC program, 7% of dairy workers have been identified with latent TB. “We have no way, however, to tell whether or not a latent infection is related to M. bovis or M. tuberculosis, which is responsible for most TB infections in humans,” Schiller says. The likelihood of M. bovis being the causative agent is limited, with M. bovis representing 1.3 to 1.6% of cases in the U.S. But if M. bovis is present, it’s a “big deal” for the dairy farm because of the risk of infecting the herd, she says.
If a worker is identified with a positive TB test, he or she is referred to the public health department. Medical tests and X-rays determine if the case is latent or active, and a 12-week course of antibiotic treatment is initiated if warranted.
Both Weisenbeck and Rosenow have had employees test positive for TB. Both of Weisenbeck’s cases proved to be false positives. But two of Rosenow’s 17 employees were confirmed positive, and were placed on the extended treatment program.
For their part, nursing students conduct the health screening and also provide health education. That includes nutrition education around healthy eating, occupational safety information and advice on proper lifting techniques to avoid injury.
In turn, the nursing students receive a real-world education about agriculture. “Most of my students haven’t had the opportunity to experience agriculture,” Schiller says. “It also helps them understand working with patients from other cultures.
“What they learn here about agriculture and the risks farmers and workers face they can take with them as they take careers in clinics, emergency rooms and hospitals.”