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A young female farm worker picking fruit in Washington’s Yakima Valley came to see Dr. Matthew Keifer after pesticides being sprayed in an adjacent orchard wafted onto her. She arrived with red, swollen eyes and itchy, irritated skin — classic symptoms of exposure to Paraquat, a common weedkiller that can cause kidney, heart, and liver problems.

Keifer suspected the Paraquat had made her sick, but proving those suspicions was impossible: For many pesticides, no tests exist that would show, definitively, whether or not a person been has exposed to the chemical. Had a test existed, Keifer’s patient would have been able to to file a workers compensation claim that, if successful, would have covered the costs of her medical care and given her paid time off while she recovered. Instead, she went without.

“If a person’s illness is judged to be work-related, they enter into a care system with excellent financial support and have access to referrals,” Keifer says. “If not, they’ll be stuck out there in limbo, usually without care.”