B4 - Crisis Response for Covid-19 Outbreak in Migrant Worker Congregate Settings

4. Public health and primary care

  • Date: Thursday, October 8, 2020
  • Concurrent Session B
  • Time: 1:45 pm - 2:30 pm
  • Style: Live Panel Discussion
  • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
  • Target Audience: Leadership, Clinical providers, Administrative staff
    , Representatives of stakeholder/partner organizations

Learning Objectives

"There were many benefits of incorporating early intervention through the use of a Primary Care Mobile team. Accurate, timely communication in conjunction with patient education (understanding) and non-judgmental collaboration with all stakeholders was the key to success for this Model of Care.    

Throughout the Outbreak, 4 natural phases were identified by Primary care. These phases are shared below in the hopes that other Primary Care Teams can benefit from the lessons learned and experience of the Scotlynn Outbreak in Norfolk County. Primary care, through ongoing support from the community partners we were able to support the convalescent of the farm workers, though to optimal health or refer into the established SAW program, for ongoing monitoring. A sustainable model may require a mix of staff from primary care settings to help alleviate the burden one organization.    

In this presentation you will learn:

  • The response team and what members it should be composed of at minimum (NP, translator etc.) and any additional staffing which may include a combination of (physician, administration, EMS).
  • Who will Coordinate the services? In Haldimand Norfolk Public Health was the lead agency that coordinated and directed the outbreak response.
  • Identification of the management leads for each active organization is required. This helps to manage communication across the team, scheduling, supervision and all documentation.
  • The 4 phases and what each phase entails - Stage one is the Acute stage of outbreak (**most labour intensive), phase two is wellness checks daily, phase three is wellness checks weekly and phase four is primary care follow-up or a transition to a Seasonal Agricultural Worker Clinics.
  • Pre-Activation preparation, before activating the mobile team you must make sure the team is prepared and safe. Some examples are; FIT test, identifying education or training necessary etc.
  • All Equipment necessary for a mobile team to successfully manage as a mobile team. We relied on our ""Go Bags"" (thermometer, oximeter, stethoscope, clipboards etc.)
  •  PPE all the appropriate protection to keep the team confident and safe. A budget and just how much you will need.
  • Documentation - learn what forms, directives, schedules, communication plans and strategies that we used over the course of the outbreak    

Lastly, we will review future considerations that have been identified by the Mobile Health Team such as teasing out the complexities of Covid-19 symptoms from underlying, sometimes untreated, comorbidities of chronic disease management, challenges with obtaining both subjective and objective, up-to-date, accurate health information and language barriers to name a few.    

Hopefully leaving time for questions from the audience that we could answer to the best of our knowledge.


Migrant workers constitute a large portion of the workforce in rural Haldimand, Norfolk and Brant Counties. In HN there are 204 farms that hire and house over 3,300 Seasonal Agricultural Workers (SAW). Farm owners are charged with ensuring all workers were isolated on arrival for the 14-day period prior to initiation onto the farm setting. Living conditions are set up in congregate settings, mostly in the form of bunkhouses.    

In situations where there is communicable disease outbreak within the migrant farmer population, an interdisciplinary Primary Care Response Team (PCRT) has been set up, based on the June 2020 Covid-19 experiences of the Delhi FHT, Public Health, EMS, Norfolk General Hospital (NGH) and farm owners. This response involves physical screening, testing, assessment and treatment of workers when an outbreak had been declared by Public Health. Additionally, identification, treatment and follow up of comorbidities or non-pandemic illness will be treated or referred as appropriate by the PCRT.    

Being involved in the migrant worker outbreak at a local farm was an experience unlike any we have ever had in any our professional careers.  What started as a professional and moral obligation to attend to the needs of our community and its members, became a lesson in culture, quality care in an unpredictable environment, organization in the face of chaos, and collaboration between our community members. As a team we work, learn, celebrate and grieve together.  

The purpose of our involvement was to provide high level care, medical assessments, triage, and treatment to the workers in need. The hope was to provide early intervention and reduce hospital admissions.  

However, the lesser known, but equally important components, such as the compassion, advocacy, respect, and the relationships built between the care providers and the workers is the purpose of this letter.  

The human and emotional component of healthcare should not go unrecognized.  It is our hope to highlight some of our team’s personal and emotional experiences here.  


  • Robin Mackie, Executive Director, Delhi Family Health Team
  • Roxanne Pierssens-SIlva, Clinical Services Manager/RPN, Delhi Family Health Team
  • Rebecca Spencer-Knight, Nurse Practitioner, Delhi Family Health Team
  • Sarah Titmius, Program Manager, Haldimand Norfolk Health Unit
  • Shanker Nesathurai, Medical Officer of Health, Haldimand Norfolk Health Unit


  • Robin Mackie, Executive Director    
  • Roxanne Pierssens-Silva, RPN Delhi Family Health Team    
  • Barb Klassen, Execuative Director    
  • Rebecca Spencer Knight, NP Delhi Family Health Team