Six days a week, María Hernández wakes up at 5 a.m. to get herself and her family ready for the day. “You have to be very organized,” she said by phone on a Sunday – the only day she typically doesn’t work. A mother of four, she lives in Salemburg, North Carolina, and has worked in agriculture for decades in a state that has drawn thousands of farmworkers.
The 53-year-old has diabetes, which makes her worry about working summers in tobacco fields, where temperatures can spike higher than the surrounding area.
“It might be 98 degrees, but in a tobacco field it can be over 110 degrees,” Hernández said.
Extreme temperatures can leave workers dangerously overheated and dehydrated, a problem set to get worse as the climate heats up. That’s where Elizabeth Mizelle, a nurse and professor at East Carolina University, comes in. Inspired by hydration backpacks her brothers wore while serving in the military, she’s been collaborating with farmworkers to test similar $20 backpacks in the fields. It’s likely the first experiment of its kind in the United States, and if it succeeds, it could help agricultural workers across the country stay healthy in increasingly hot weather.
A hot state with few worker protections
Average spring temperatures in North Carolina have increased by 2.5°F (1.5°C), and summer temperatures have increased by 2.3°F (1.28°C) since 1970, according to Climate Central, a nonprofit that researches climate change and its real-time impacts.
The summer of 2025 was far hotter than usual, according to the North Carolina Division of Public Health, with dire consequences for workers and other state residents. Between May and in September, 5,748 emergency room visits were recorded for heat-related illness. “This figure is considerably higher than the average of the past five summers,” the division wrote on its website.
Outdoor workers, particularly agricultural workers, are among the most vulnerable. When body temperature rises above 104°F (40°C), it triggers heat stroke, which impairs organ function and, if not properly managed, can be fatal.
Read: How to spot the symptoms of heat stroke and heat exhaustion
But North Carolina offers little protection to farm workers. Oxfam ranked the state last in the country for working conditions in 2024 due to its lax labor policies.
That leaves workers at the mercy of their employers to stay safe. There is not much they can do beyond drinking water, but storing water bottles or taking breaks to get water is not always easy.
And the pressure to keep working, no matter what, is immense. Some workers ignore symptoms of heat exhaustion or heat stroke because they risk losing their jobs if they stop working. Mizelle said she heard of a case in which a farmworker fell ill from the heat and had to return to his home country – and as a result, his employer did not rehire him the following year.
The backpack solution
Mizelle has spent the last decade studying the effects of climate change on public health and, over the past five years, examining the effects of extreme heat on health.
“Every summer I have done this research, we have broken more and more records,” she said.
She explained that the law requires employers to provide access to water. But workers often can’t easily access it because they work in large fields, sometimes far away from the water supply. During breaks, Mizelle said, workers sometimes don’t want to drink too much because it makes their stomachs uncomfortable.
In 2020, Mizelle studied the hydration levels of a group of outdoor workers. She found that about 46% of workers were dehydrated before their shift, and all of them were dehydrated by the end of it. Dehydration is dangerous because it reduces the body’s ability to cool itself by sweating and can lead to permanent organ damage and even organ failure.
Mizelle has two brothers who have served in the military, where they used hydration backpacks. That gave her the idea to study whether similar backpacks could give farmworkers easy access to water.
A commercially available hydration pack system typically consists of a protective outer backpack and an inner water bladder holding two to three liters of water, with a flexible tube and connected mouthpiece. The cheapest backpack costs about $20.
Mizelle conducted her first study with the backpacks in 2022, distributing them to 47 male workers. Results showed that most of the participants found them useful and comfortable in the fields. And 90% said the backpacks helped them stay hydrated. Preliminary data from a follow-up study in 2025 show similar results.
Although the backpacks might seem like a simple and easy solution to a serious problem, there are some drawbacks.
Lower back pain is common among U.S. farmworkers, and that could be worsened by the 4-kg (8.8 lbs) weight of a fully filled backpack.
Cost is also an issue, along with the question of who should buy the backpacks. When farmworkers’ minimum wage is $12.78 (reduced from $16.16 in late 2025), it can be difficult to motivate workers to purchase them.
What Mizelle would like to see is farmers and workers sharing the cost of the backpacks so that both parties feel invested in the solution.
Policy could also help. In California, employers are required to provide workers with training on heat-related illness, a supply of cool fresh water, rest breaks in shaded areas, and to develop and implement a heat illness prevention plan.
Mizelle would like to see state lawmakers and growers adopt the backpack to prevent heat illness in outdoor workers. If even one worker were spared from heat illness, the price of the backpack would prove its worth, she says.
Back in Salemburg, Hernández heads to the field to start work at 7 each morning. She wears a watch that counts her steps. At the end of the day, it sometimes tells her she has walked more than 19 miles as she plants tobacco, cleans lettuce, or picks blueberries, depending on the season.
She said that if she had the opportunity to use a hydration backpack, she absolutely would. But for now, she will keep tucking her plastic bottle inside her clothing and praying she doesn’t suffer a heat stroke.
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