Levels

Determinants

Interventions

Individual

Social norms, biological norms, cultural norms, individual beliefs

· Individual beliefs of the farmworkers pertaining to TB need to be handled in a culturally sensitive manner

· Nutritional aspects need to be taken into account

· Sincere efforts need to be undertaken to reduce the social stigma associated with TB

Interpersonal

Interactions with family, colleagues at work, nurses and other health care providers

· Family members may help the TB farmworker to adhere to the treatment regimen.

· The farm supervisor should provide facilities for better housing and nutrition so that the TB patients can recover fast

· Transportation facilities to the clinic centers need to be incorporated

Organizational

Work environment, Church and faith-based groups

· Faith based groups may provide TB treatment services to the migrant farmworkers. In El Paso, we have clinics like “Clinica Bautista” that provide free medical services to all individuals irrespective of their immigration status (Personal communication—Ms. Gabriella, Phlebotomist, City of El Paso project).

· Health camps could be organized by local clinics at the migrant farmworker sites.

Community

Community Health Services, Medical Health Services, Universities, and other Institutions of Learning

· Universities can team up with local public health departments and organize health fairs to disseminate knowledge about Latent and Active TB.

· Issues related to social stigma can be negated via telenovelas, and educational materials sensitive to the needs of the Hispanic migrant farmworkers.

Policy, Law

Government policies, immigration rules and regulations

· Federal authorities like the Department of Homeland Security, Department of Health and Human Services should sign binational agreements with Mexican and Central American sister agencies to address TB related cases in undocumented migrant farmworkers.

· Health insurance should be provided for the migrant farmworkers.

· Guest worker programs with temporary visas for migrant farmworkers should be instituted so that they can come out of the shadows.

· Organizations like PAHO should spearhead the movement of TB elimination from the US-Mexico border landscape and beyond.