interest (e.g., pesticide intoxication and heat stress in agricultural field workers). Few
primary care providers ask patients the questions that would be likely to alert them
to the possibility of pesticide-related illnesses. Although it is important for primary
care providers to take environmental histories, a full environmental history can some-
times take up an entire patient visit. However, getting primary care providers to ask
just a few simple questions, such as ‘‘Where do you work?’’ and ‘‘Do you think your
problems are related to something that happened at work?’’ could go a long way to-
ward answering pesticide-related health concerns about low-dose chronic effects as
well as acute high-dose poisonings and effects on children.^28 Therefore, it is essential
to obtain an adequate history of any environmental or occupational exposure which
could cause disease or exacerbate an existing medical condition.
In many instances, rural health care providers possess neither the knowledge nor
the training to record a proper medical history of a person’s work exposure or the
incident that led to the injury or illness. Furthermore, migrant clinicians either do
not have access to prevalence data for specific kinds of injuries and illnesses or are
unaware that such data exists. In other cases, either time constraints or an employer’s
unwillingness to cooperate prevent a physician from learning more about the origin
of an individual’s particular health problem. As a result, the migrant health clinic usu-
ally sees the hired farmworker on only the occasion of illness or exposure, and the cli-
nician loses any opportunity to examine the long-term effects of a given injury or
illness.^29
Cultural origin is another obstacle blocking successful intervention by clinics and
rural health facilities. Primarily due to language and cultural differences, farmworkers
and clinicians may have trouble communicating with each other. Differences in ter-
minology can affect a clinician’s ability to take an accurate health history from a
farmworker. In addition, many hired farmworkers hold biases against Western medi-
cine, and as a result do not readily accept the advice of health care providers.^30
Data Limitations
As is the case with the reporting of occupational injuries and fatalities in non-
farming activities, there are serious data-gathering deficiencies in the reporting of
pesticide-related illnesses and deaths. In the absence of comprehensive national
information, the EPA uses four databases to provide some indication of the extent of
acute pesticide incidents and illnesses. These databases are: 1) the American Associa-
tion of Poison Control Centers’ Toxic Exposure Surveillance System, 2) the data
reported to the EPA under FIFRA, 3) the National Pesticide Telecommunications
Network, a cooperative effort between the EPA and Oregon State University, and 4)
the California Pesticide Illness Surveillance Program. However, each of these data-
bases has its limitations:
¥The American Association of Poison Control Centers maintains information on
poison exposures. However, its database does not isolate pesticide exposures thatPesticides in Agriculture | 39