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André Picard

It's apple-picking time so, the next time you savour the crunchy goodness of an apple or the sweet delight of mom's apple pie, spare a thought for those who harvest our fruits and vegetables, many of them migrant farm workers from Latin America and the Caribbean.

There are about 40,000 migrant farm workers employed across the country each year under the seasonal agricultural workers program. (They are just a fraction of the 340,000 who come to Canada under the temporary foreign worker program, which has drawn a lot of fire recently.)

The farm workers do back-breaking work far from the public eye, with many risks and with few legal protections. They can be employed up to eight months a year and many come back, year after year, doing work Canadians won't, often work in ethnic enclaves – meaning groups of Jamaicans harvest tobacco, Peruvians do poultry slaughter, Mexicans pick apples, and so on.

A new research paper, published in the Canadian Medical Association Open Access Journal, provides a rare glimpse into some of the health challenges these workers face.

The study, led by Dr. Donald Cole, a global health professor at the Dalla Lana School of Public Health of the University of Toronto, looks specifically at the issue of medical repatriation – the workers who are sent back home for medical or surgical reasons.

Newcomers to Canada – and, oddly enough, Canadians who move between provinces and territories – usually have to wait three months before they are eligible for medicare (publicly-funded health insurance.)

Migrant farm workers, however, get the coverage immediately. They are also housed and fed, though often in rudimentary conditions.

What is unclear, however, is how much these workers benefit from Canada's health system, other than the occasional visit to the local emergency department to get stitched up.

Before entering Canada, they undergo screening and anyone unhealthy is rejected. Once in Canada, generally what happens is, if someone suffers a serious injury or illness, they are fired and sent back to their home countries – repatriated, to use the bureaucratic term.

Dr. Cole and his team found that, between 2001 and 2011, there were 787 repatriations among the 170,315 migrant workers employed in Ontario.

Forty-one per cent were sent home, for medical or surgical reasons, meaning they had problems ranging from hernias to heart disease, 25 per cent for external injuries like broken bones and poisoning (from pesticides and tobacco), and 3 per cent because of psychiatric illnesses. A small number of women were sent home because they were pregnant (note that roughly 95 per cent of migrant workers are men), and only 2 per cent asked to be sent home for care.

The sick and injured workers were mostly repatriated to Mexico and Jamaica, which is not surprising given that is where the largest number of workers originate.

The authors make the point that illness and injury is likely heavily under-reported among migrant workers. That's because they work in highly unusual circumstances, where, if they come forward, they risk immediately being fired and deported.

While the data are not overly surprising, it is worth noting that this information is usually inaccessible because it is collected by Foreign Agricultural Resource Management Services (FARMS), a not-for-profit company that manages contracts for migrant farm workers in Ontario. Being a private company, they are not subject to Access to Information laws that apply to government. However, the data were filed as part of legal proceedings, so researchers were able to access it.

Ned Livingston Peart, a Jamaican farm worker, died back in August 2002 when he was crushed by a large bin while working on a tobacco farm in Brantford, Ont. Workplace deaths must be investigated by a coroner, but migrant workers are excluded. The group Justice for Migrant Workers argues that this is discriminatory and, after years of lobbying, convinced the Ontario Human Rights Tribunal to hear Mr. Peart's case.

The difficult work conditions of migrant workers also received rare scrutiny when 10 migrant farm workers (nine of them from Peru) were killed in a horrific crash near the hamlet of Hampstead in 2012.

In that case, a coroner's inquest was also ruled out when the preliminary investigation said that driver error was to blame for the crash.

Canadians donated generously to help the families of the crash victims and the three survivors because, as the law stands, their health coverage ends as soon as they stop working.

That policy was actually upheld by the courts earlier this year. Two Jamaican farm workers, Denville Clarke and Kenroy Williams, were injured in another 2012 crash as they were being transported to work.

They were entitled to workers' compensation benefits but cut off after a few months, despite lingering injuries. (Other workers hurt in the crash returned home, but the pair stayed to fight for compensation.) In April, the Ontario Division court ruled that, for temporary workers, benefits should expire when their work contract ends, and they should not expect help "in perpetuity."

It is an example of how we are all-too-keen to have temporary foreign workers do our dirty work but reluctant to share the benefits of life in Canada, such as medicare.

Canadians benefit greatly from the fruits of the labour of migrant farm workers, but theirs is sometimes a bitter harvest.

André Picard is The Globe's public health columnist.

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