Another challenge with gathering data, said Carol Sipan, a public health lecturer at the University of California, Merced, is the fact that, “many [farmworkers] would go back to Mexico if they got really sick.” In Mexico, she added, valley fever is not a reportable disease.
Farmworkers in the crosshairs
Like many farmworkers who contract the illness, Gutierrez found the cost of the antifungal medication needed to treat valley fever astounding. At the height of the illness it cost $1,200 for two months of pills because he had to take two to three times as many as one would if they were treating a typical candida infection.
He didn’t have insurance at the time and said his family often had to choose between food and his medication. He still isn’t able to work regularly and his family mainly survives on the money his wife, Maria, makes in the fields.
“It has changed my life a lot,” Gutierrez said. “When I used to work, I would always have money in the house — to eat, to buy my children clothes, for everything. But right now, I have debts.”
Like 68 percent of the estimated 800,000 farmworkers in California, Gutierrez was born in Mexico. An estimated 49 percent of the state’s farmworkers lack work authorization and most live under the federal poverty line in unincorporated communities with few public services.
Meanwhile, the Central Valley’s lengthy harvest season brings long hours, extreme heat, and other challenging conditions. At home, these workers face limited access to health and education, an array of mental health challenges, and high rates of food insecurity. Valley fever only adds to these challenges.
Isabel Arrollo-Toland knows both sides of this story intimately. She is the daughter of a former farmworker and directs a small nonprofit organization, El Quinto Sol de America, which trains farmworkers and other recent immigrants in civic engagement in a handful of unincorporated communities in Tulare County, an hour south of Fresno.
Arroyo-Toland was diagnosed with valley fever in 2007 and again in 2008 when it spread to her skin in the form of painful lesions — and both times she endured months of misdiagnosis. Then, in 2012, she was told that her kidneys were failing due to the impact of both valley fever and the medication she had relied on to treat it. Since then, she’s had to undergo peritoneal dialysis in her home for 10 hours every night. She’s currently on the donor list for a kidney.
Arrollo-Toland makes it a point to advise workers to get tested for the illness at the first sign of a cold or flu. “Sometimes I’ll be talking to a farmworker and they’ll say ‘Oh, I have these symptoms …’ And my first thing is, ‘You should go get tested for valley fever.’”
She also points to the many challenges farmworkers face when it comes to staying healthy — from regular exposure to pesticides and dust clouds, to lack of fresh produce and clean water — a growing challenge for many residents of unincorporated areas.
“The valley fever fungus might actually expand its territory with climate change.”
Antje Lauer, microbial ecologist
“It’s really difficult to say you have to keep your immune system at 100 percent, because your environment doesn’t provide that for you,” Arrollo-Toland said. “Seeing the doctor for prevention is another issue because you have to go to the clinic, which is probably 30 minutes away …and always so full.”
Several studies have shown that farmworkers suffer from elevated levels of chronic stress and anxiety — more factors that have been linked to suppressed immune function.
In U.C. Davis professor McCurdy’s recent research, he found that those who reported having valley fever “lost about 20 work days of on average while they were sick.” McCurdy is currently working with other researchers on two studies involving farmworkers and valley fever, including one survey of almost 120 Latino workers at two migrant labor centers in Kern County.
Worsening conditions
The stakes are changing, in part because rainfall in the Southwest has become less common and less predictable. Very wet winters, like the one that just passed, followed by dry summers, have historically been particularly bad when it comes to the growth of cocci spores, said Antje Lauer, a microbial ecologist at California State University, Bakersfield. Lauer has received funding from NASA and the U.S. Department of Defense to study valley fever in soil.
“The valley fever fungus might actually expand its territory with climate change,” said Lauer, pointing to the fact that cocci spores were found in Washington state in 2014.
Although farmworkers and others who work outside are in an especially vulnerable position, Lauer added that it only takes one exposure to make someone sick. Dust masks can be effective at limiting some exposure, but it’s not a real solution for those who work in the fields.