The following article from the Columbus Dispatch describes one aspect of Enedelia’s commitment to the health of farmworkers: her support of pregnant women and their families.
THE CARING SEASON
From spring to fall, Enedelia Cisneros tends the pregnant women toiling in Ohio's farm fields. She wants to keep other migrant workers from experiencing the loss she knows too well.
Sunday, October 27, 2002
NEWS 01A
Story By Rita Price
THE COLUMBUS DISPATCH
The labor nurse leaned in close, trying to read her patient's face. Etched on it was a brave little smile, the same one the nurse first saw hours before.
Cry out, she thought. Complain. You've had nothing for the pain, and it has to be awful.
''This is what scares us,'' the nurse said, sighing. ''We'd actually prefer them to be screaming their heads off. Then we know what's happening.''
From her bedside chair, Enedelia Cisneros peeked above the pages of her Spanish-English book of baby names. She spoke quickly to the soon-to-be-mother, then translated for the worried nurse.
''You want to know if it hurts bad,'' Cisneros said. ''Well, she doesn't want to say, 'Yes.' Doesn't want to say, 'Si .' ''
What Adelina wanted, Cisneros understood, was to keep up her courage.
She and her husband had walked away from their impoverished village in Mexico with almost nothing. They crossed much of the Sonoran Desert alone. Border runners -- coyotes -- packed them into a crowded van and drove north, saddling each passenger with a $2,000 debt for the privilege.
When Cisneros found the young couple in July, toiling in steamy Ohio pickle fields, Adelina was eight months along and had yet to see a doctor.
People who endure so much know it's best not to cry too easily. Even while giving birth.
''We do the best we can to survive,'' Cisneros said. ''And you know what? We survive pretty well. Sometimes people will say: 'Oh, poor migrants. Poor, poor migrants.' I hate that. Just hate it.''
The pregnant women Cisneros plucks from farm camps and then shuttles to clinics and hospitals don't need pity; they need education and access. In her job as a Promotora -- a community-care coordinator with the Promotoras for Maternal and Child Health Project -- Cisneros fiercely advocates both.
Each growing season finds her logging thousands of miles behind the wheel of her tired car, criss-crossing Ohio farm country, regularly driving 80 miles or more over rural roads just to secure one prenatal visit.
Along the way, Cisneros leaps enormous barriers of isolation -- both cultural and economic. Her ever-growing list of clients speak little or no English, can't obtain health insurance, have no money or transportation, and count the value of hard work as their only asset.
''I think being a Promotora is a full-time job and then some,'' Cisneros said. ''Coming to the U.S. is not like it was in the '70s; it's harder. People are poorer. There's so much need.''
But the 48-year-old Cisneros cannot devote all her time to the expectant. She, too, lives a migrant life.
Before she drove Adelina to the hospital that day in August, Cisneros washed the earth from her own hands. And she thought back, as she does each time she helps coax a baby into the world, to a terrible day in 1985.
''I had a stillborn daughter,'' Cisneros said, her brown eyes brimming with tears. ''I was alone. There was no one here for me.''
So Cisneros stays with her clients no matter how many hours -- or days -- pass. Long, sleepless, worry-filled waits, repeated throughout the season, sap the strength she tries to save for the fields.
Adelina, for example, still was not ready to deliver by the time the night-shift labor nurse arrived at Henry County Hospital, a tiny, rural medical center that snuggles up to northwest Ohio's sprawling farm fields.
Just shy of her 20th birthday, Adelina was grateful to have a mother figure in the room, to feel the experienced hands of the Promotora massage her aching back. Her husband, Brigido, couldn't be there until he finished a full day in the fields, and so he had thanked Cisneros in advance the best way he knew: He asked her to name their child.
''He says I am the promotora, so it's whatever I choose,'' Cisneros said. ''It's all up to me.''
She grinned and went back to the baby-name book. It was going to be another long night.
Expecting in America
They come every year, working first in the rain and then the scorching heat, until summer finally gives way to fall.
State officials estimate that more than 14,000 migrant workers traveled to Ohio farms for temporary jobs in 2001, a figure that, although increased over recent years, many advocates still dispute as low.
The vast majority -- some 90 percent -- are of Mexican descent. About 70 percent, according to the state's migrant ombudsman report, do not have legal status in the United States.
Much harder to determine is just how many of the young women among them, women willing to risk grave danger for a chance to flee relentless poverty, arrive here pregnant.
Cisneros and the four other Promotoras who work through Rural Opportunities, a nonprofit agency dedicated to farmworker advocacy, begin each growing season in Ohio trying to identify their clients.
They pick, watch. Shop, watch. Drive, watch.
''We go into the camps, but you don't get everyone that way,'' Cisneros said. ''I watched one young woman in Wal-Mart for a long time, then I finally went up to her and asked: 'Have you had any prenatal care?' ''
Surprised and perhaps a little frightened, she shook her head.
''Your baby is coming soon,'' Cisneros said. ''I can help.''
The Promotora program -- named for the Spanish word meaning expert or advocate -- is one of 10 community-outreach efforts underwritten by the Ohio Department of Health and its Ohio Infant Mortality Reduction Initiative. Roughly $845,000 in state-administered federal funds was divided last year among the 10 projects, including eight that target urban, black communities. Another is aimed at a high-risk, multicultural neighborhood in Cleveland, and the 10th -- the one operated by Rural Opportunities -- serves Latino farmworkers.
The goal is to support innovative programs that seek to reduce Ohio's infant-mortality rate. With eight deaths for every 1,000 live births, the state exceeds both the national rate of 7.2 and the 2010 target rate of 4.5. Overall, the United States lags far behind other developed nations in making sure babies are born healthy.
''I just went to a meeting in Washington, and all they're talking about is building more clinics,'' said Dr. Mark Redding, executive director of the Community Health Access Project, one of the grantees. ''They put billions into the doctors end of it, but that still leaves a lot of the puzzle pieces missing.''
Outcomes improve dramatically, Redding said, when respected, connected people from within the at-risk communities -- people such as Cisneros -- are employed to serve as links, going where the bureaucrats do not.
Said one official who worked with the Promotoras this summer: ''I have several degrees. I cannot do what they do.''
The praise transcends the anecdotal.
In just one year, state officials say, the percentage of low birth-weight infants born to the grant agencies' clients went from nearly 16 percent in 1999 to less than 11 percent in 2000. Births before the 38th week of pregnancy dropped from 22 percent to 14 percent.
Those who would question government's role in helping provide prenatal care to the unemployed, uninsured or, in many cases, the undocumented should consider the possible alternatives, Redding said.
''We have followed the case of one premature baby, a boy who is now 9 years old,'' he said. ''His care costs have topped $10 million, and that doesn't even include all the medication.''
Sister Mary Jo Toll, who works with migrant families through Catholic Charities in northwest Ohio, believes simple human compassion is reason enough. But those who want additional justification, Toll said, should consider the instant citizenry bestowed upon a child born in the United States.
''Hello, do we really want an American born unhealthy? Of course not.''
Toll also noted the taxes paid by migrant women, ''whether they're documented or not. They pay the flat taxes, too, and work the dirtiest, toughest jobs, the jobs no one else wants. They're not here to milk the system; they're here to work.''
Cisneros knows firsthand that some take a different view. As she sat in the hospital room with Adelina, waiting for the baby, she recounted a recent visit to the Women, Infants and Children office in Fremont, where she stopped to pick up milk for a client.
The WIC worker told them to leave. Mondays and Wednesdays are for migrants. It was Thursday.
''I said: 'But she's high-risk. She needs this now, and she doesn't have transportation to come back,' '' Cisneros said. ''She didn't care. Just didn't care. I had to say to myself: 'Enedelia, walk away. Walk away before you fight.' ''
Rhythm of the harvest
Cisneros and her husband, Jesus, have four children, and she knows all of them have endured the taunts.
''When my kids went to school, they would say, 'Hey, tomato-picker, tomato-picker,' '' Cisneros said.
She had to make them respond, she decided. To do otherwise was to fail to teach her children to be proud of their work. ''Tell them if it weren't for us,'' she said, ''there wouldn't be any ketchup.''
Dr. Alvin Jackson, medical director for Community Health Services, a clinic serving migrant workers in northwest Ohio, said the people he treats have long been a vital link in the American economy.
Like Cisneros, the doctor has a natural passion and affection for those who tend the earth. His parents, too, worked the fields.
''Except we didn't call it migrant work,'' Jackson said, chuckling at the memory. ''We just said Dad followed the seasons.''
Last year, Jackson received a $100,000 award from the Robert Wood Johnson Foundation, the nation's largest private philanthropic organization dedicated to improving health care for all. He immediately began using the money to better serve the hard-working farm laborer.
''Fruits and vegetables are a $28 billion industry,'' Jackson said. ''Without the migrant workers, it fails. Think about that every time you eat that tomato, every time you eat that apple. Without them, you have no idea what you'd be paying.''
Jim Chase, a fifth-generation apple grower in Michigan, agrees.
''Some people will try to tell you migrants take away jobs. Well, there are a lot of people in western Michigan on welfare. You know how many of them have ever come here for a job? None.
''Me, I have no illusions about where I'd be without the farmworkers. I'd be out of business.''
Cisneros first started picking because she had to. Now, with U.S. citizenship, strong bilingual skills and even some college credits, she continues a migrant lifestyle almost more out of love than necessity.
''I want people to respect this work,'' she said. ''It is hard, but it is important.''
For 30 years now, Cisneros and her family have followed the rhythm of the harvest. They tend pickles and peppers in Ohio from May until September; head north to Michigan for apples in September and October; return to their home base in Harlingen, Texas, for farm work there during the winter.
''We used to do berries in Florida, too,'' Cisneros said. ''We were on the road all year. Never home.''
She earns $8 an hour for her part-time Promotora work in Ohio, $6.50 for a similar position in Texas. If she were paid for all the extra time she spends helping people, she probably could retire.
Clients she served in Ohio tracked her down last week in Michigan, begging her to help them negotiate the bewildering process surrounding a birth certificate for their baby son, a U.S. citizen.
''I wish I could drop everything and go help them,'' she said. ''But I can't. I'm not even paid to be a Promotora in Michigan, and still it doesn't stop.''
Cisneros, her father always said, seemed the natural leader among his five children, even though she was second-oldest. Born in a small village in Mexico, she began doing migrant work with her family at age 18, during the early '70s. Back then, there was no base, no modest winter home.
Life, Cisneros said, ''was just crop to crop.''
She married and lived in Mexico again briefly but soon returned to the farms with her parents, siblings and husband, who, at 54, remains a fit and ferociously fast picker.
Their babies came on the road: Jaime, now 28, was born in Texas; Yolanda, 22, in Florida; Brenda, 21, in Michigan; Jessica, who would be 17, in Ohio; and Juanita, 14, also Ohio.
It's a circuitous trail lined with tears of joy and pain. Cisneros has buried not only a child but also a father on the road.
''Just two weeks before, we'd been sitting around having one of those 'If I die' conversations. He said: 'Where I die, I die. Leave me there.' ''
The end came four years ago in Comstock Park, a western-Michigan suburb of Grand Rapids, that, each October, turns into an autumn wonderland of crisp breezes and apple-laden orchards.
It's where Cisneros and her family have always come to pick the manzanas and stretch their backs, literally, after a summer spent crouching in the dirt to fill Ohio pickle hampers.
''One's down, one's up,'' she said of the two harvests. ''That way you don't get tired of it. The apple trees, they're like therapy.''
Brigido and Adelina, who worked in the same Ohio camp as Cisneros this summer, decided weeks ago that they would follow the Promotora and her family to Michigan after the baby is born.
Cisneros also has reached a decision. Twelve hours into the vigil in Adelina's hospital room, the Promotora has seen the sun dip, watched tree- and bird-shadows dance on the drawn blinds and realized, wearily, that it might be morning by the time she meets this child.
She closed the baby-name book for good.
''Rocio,'' Cisneros said. ''Ro-see-o. It's the name we have for the wetness of the morning, that time before dawn. What do you call it in English? Mist? Dew, I think. I like it. The world has enough Marias.''
Grass-roots ambassador
Of all the different worlds she moves in, the ones that belong to the policymakers most trouble Cisneros. She has met senators and social workers, congressmen and clergy, and she serves on two national boards for farm-worker advocacy.
She laments how little understanding even the sympathetic possess.
''I was at a meeting where they were talking about helping farmworkers, and some people actually said, 'Well, if they have a complaint, they can send in an e-mail.' Isn't that stupid?
''Migrant workers don't know about e-mails. I wanted to ask those people: 'Do you know about a pickle crop? Can you do that?' ''
Another time, Cisneros said with a laugh, a nutritionist visited her Michigan camp to recommend healthier, lower-fat foods to the workers. Such as asparagus. Or broccoli.
''Which costs $1.89 a bunch,'' Cisneros noted, ''and that's a lot when you have to feed a big family. We don't eat beans and tortillas because that's the only thing we like; we eat it because it's cheap.''
She also wonders why, during the rare times that she's able to help a pregnant client obtain a medical-insurance card, no system exists to transfer enrollment to the other states in which they work.
''Sometimes, I think I should be in politics myself. I got so many questions that I don't get answered.''
For all the frustration, though, her doggedness probably serves her clients well.
''Enedelia is the most amazing promotora,'' said Kim Kratz of Migrant Health Promotion in Saline, a small city in southeastern Michigan. ''Wherever she goes, she is working as a health promoter.''
Cisneros and the other Promotoras often arrange appointments with great urgency, as some 44 percent of the pregnant women served during the past two years did not begin their prenatal care until the third trimester, said Viola Gomez, the project administrator for Rural Opportunities.
Sixty percent reported a ''poor'' living environment, and 100 percent said they'd been exposed to pesticides during pregnancy.
A few come from such isolation and poverty that the Promotoras simply make up birthdates for the mothers, then pray that the grueling, hunger-wracked journey to America has not harmed the unborn.
No wonder, Gomez said, that only ''very, very special women'' are up to the Promotora task.
Yet the rewards -- particularly within a culture where family means everything, where members tend to remain more fused than scattered -- are great.
''Why are we here,'' Gomez asked, ''if not to help those who weren't born with an equal chance?''
Adelina, thanks to Cisneros, at least had a chance to give birth to a healthy child. Her first ultrasound, at more than 32 weeks, revealed that amniotic fluid had diminished, and doctors decided to induce labor.
Without Cisneros, she may not ever have made it to the hospital, and even if she had, likely would have turned to the cleaning lady -- providing the right one was on duty -- to translate potentially life-or-death decisions.
Cisneros shrugs off glory.
''You do a lot of things in life,'' she said. ''Sometimes you get rewarded; sometimes not. My own children, I still wish for more for them. I did open the doors for them to fly. But they didn't want to.''
They could do worse, of course, than travel with loving parents and a grandmother, eat and laugh together each evening, go to work knowing their own children are safe in the care of family.
Not all migrant camps are desperate places. Some are strong, tight communities, where children romp and adults converse and rich, mouth-watering smells rise from the traditional, home-cooked meals that always seem to be simmering in crowded kitchens.
Cisneros finds herself wondering whether that is the sort of future in store for Adelina's baby. Just before the birth, the young mother was near exhaustion but still composed.
Dr. Stephen Knipe, a Columbus native who long ago learned to say ''push'' and ''breathe'' in Spanish, was on his way.
Experience told Vickey Fin, a labor nurse for more than 40 years, that, unlike the hundreds of other women who've squeezed her fingers to the point of arthritis, Adelina wouldn't need much coaching.
''She's such a good little kid,'' Fin said. ''She will deliver this baby with grace.''
At 1:08 a.m. on Aug. 10, amid a chorus of excited English and Spanish, Adelina did just that. And the beaming promotora, who'd spent hours choosing a name, now seemed unable to utter anything beyond gentle, breathy coos and heartfelt terms of endearment.
She looked down at the healthy, squirming infant.
''What is she called? La nina preciosa,'' Cisneros said, repeating the phrase again and again. ''Precious baby.''
Published with permission from the Columbus Dispatch.
