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The indigenous Mixtec farmworkers of Oxnard, CA, face financial hardships, discrimination, and a host of other factors that threaten their health. In a pioneering partnership, a Fielding School team is working with a community-based organization to assist the population in assessing and addressing its needs.
In the city of Oxnard, one of the largest suppliers of strawberries for California, the majority of the pickers are indigenous farmworkers from one of the poorest regions in Mexico. Mixtecs representing large swaths of certain villages in Oaxaca migrate to the community 60 miles north of Los Angeles, typically drawn by the prospect of farm work and better futures for their children. Most speak only Mixteco, a language with no written form. Many are undocumented, going out of their way not to draw attention. “They interact among themselves, but little with people outside their community,” says Dr. Annette Maxwell, a Fielding School professor. “They take some of the hardest jobs and are often exploited. They have many needs, and have been mostly overlooked.”
Maxwell was part of a team of UCLA Kaiser Permanente Center for Health Equity and Center for Cancer Prevention and Control researchers who were conducting studies and training activities in Ventura County’s farmworker community when they were introduced to the Mixtecs. As they learned more about the population, Maxwell and colleagues found that many of the Mixtec women knew little about preventive services such as breast cancer screening, much less how to access them. For those who did, cultural norms dictating that no one should touch a woman’s body other than her husband posed a formidable barrier to seeking the exams.
Now the two Fielding School centers have forged a partnership with the Mixteco/Indigena Community Organizing Project (MICOP), an organization founded more than a decade ago as a means of addressing the pressing concerns of this most vulnerable of populations. Together, UCLA and MICOP have embarked on one of the first research projects in the Mixtec community to focus on breast health – and one of the largest systematic efforts to survey the needs of any indigenous community, undertaken by peers speaking the indigenous language.
Sandy Young’s first hint that a substantial Mixtec population resided in the community came more than a decade ago, when the family nurse practitioner began noticing that a growing number of her patients understood no English and little Spanish. “They were virtually unknown in Ventura County,” Young recalls. “Our health care system and school systems didn’t recognize that this population existed.
Young decided to act. First she persuaded her own clinic to employ a part-time Mixteco- and Spanish-speaking interpreter to help the staff communicate with the patients. Then, through word of mouth, she invited Mixtec residents for a meeting in the back room of her clinic to discuss basic issues – from Medicaid enrollment requirements to accessing the bus system for transportation to and from the clinic. “At the end of the meeting, everyone wanted to know when we were going to do it again,” Young says.
Based on that initial response, in 2001 Young founded MICOP – English-, Spanish-, and Mixteco-speaking people who join together to empower and help improve the health and well being of indigenous Oaxacans in Ventura County. Monthly community meetings, having evolved into a celebration of culture and language as well as an opportunity to discuss issues of importance, now regularly draw several hundred Mixtec community members.
After learning of the presence of the Mixtec population and their needs, the UCLA Kaiser Permanente Center for Health Equity and the Center for Cancer Prevention and Control decided to invest resources in the community. The researchers approached MICOP about using one of its monthly meetings to recruit women from the community interested in being trained as bilingual Spanish- and Mixteco-speaking promotoras (health promoters). Paying the women with stipends from a Cancer Prevention and Control Research Network-funded grant headed by Dr. Roshan Bastani, director of the UCLA Kaiser Permanente Center for Health Equity, the Fielding School team trained them so that they could learn more about the community’s needs. “These women felt really empowered that they could do something that would help Mixtec families,” Maxwell says.
With that as a foundation, UCLA and MICOP jointly applied for funding from the California Breast Cancer Research Program. Their pilot study, “Building Mixtec Community Capacity to Address Breast Health,” is exploring attitudes and barriers to breast cancer screening, as well as the strategies most likely to encourage utilization of services.
Nine indigenous Spanish/Mixteco bilingual promotoras were trained to carry out a needs assessment involving 1,000 households in their community. Conducting a scientifically rigorous survey for a largely non-literate, monolingual population without a written language was no easy feat. In collaboration with a Mixtec advisory committee, the research team devised a questionnaire in Spanish and had the bilingual promotoras agree on the translations and audio-record them in Mixteco; the recording was then provided to all of the promotoras to practice as a way of ensuring consistency in the face-to-face surveys.
The needs assessment revealed that among the Mixtec women 40 and older, only 32 percent had ever had a mammogram (Maxwell notes that in the general U.S. population, an estimated 80-85 percent have had one). What’s more, only 42 percent even knew what a mammogram was – the concept of preventive health is foreign to much of the community, Young says. The next steps for the study will include a series of focus groups (two among women as well as two among men, given the importance of their role in the decision) to discuss strategies for promoting breast cancer screening that would be acceptable to the Mixtec community.
Speaking in Spanish as she took time out from a recent MICOP community meeting, one Mixtec woman describes migrating from Oaxaca in the hope that her children – a 5-year-old son and the daughter she’s expecting to deliver any time now – will have a better life. Hers is not easy. She describes 12-hour days on the farm – including work on weekends – followed by precious little time with her son before he goes to bed. “Here we don’t get to enjoy our children,” she says. The seasonal nature of the work brings another kind of hardship. “When the work is over, the money is also gone and we don’t have enough [for] rent, food, clothing.”
Well aware that breast health isn’t the most pressing need for the Mixtec women, the UCLA/MICOP team decided that the needs assessment should be much broader to help point the way toward a range of health and social services that would be welcomed. The results indicate a strong desire for more knowledge about health issues. Maxwell intends for this to be the first of many projects with the Mixtec community in Ventura County: Among the stated aims of the current study is to strengthen the collaboration between MICOP and UCLA to facilitate future joint projects that will benefit the community.
As deforestation and soil erosion in Oaxaca drive entire communities north in search of work, the Mixtecs have become one of the largest indigenous groups of workers in California. Although they suffer substantial hardships, Young points to a resilience that comes from their tight-knit and highly organized community life; indeed, the reason Oxnard has such a large Mixtec population is both for its farm work and because it became a “receiving village” for entire Oaxacan communities.
“This population faces difficult conditions,” Young says, “but we should also recognize that this is a culture and a language that has survived for 1,500 years, and that there is a strong sense of community and loyalty. From a public health perspective, these are very positive characteristics that should not be overlooked.”