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Building Bridges, Reaching Beyond Walls: Increasing Access to Health Care

Monday, December 17, 2018   (0 Comments)
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Building Bridges, Reaching Beyond Walls: Increasing Access to Health Care for Migrant and Seasonal Agricultural Workers (MSAW)

 

Colleen Pacheco, MIM, MPH

Special Populations Program Manager for Skagit & Whatcom Counties, MSFW Promotores & Homeless Healthcare Programs Sea Mar Community Health Centers



As one of the nation’s 166 Migrant Health Centers, Sea Mar Community Health Centers provides comprehensive primary and preventive health care to Migrant and Seasonal Agricultural Workers (MSAW) and their families. Expanding access to care and improving health equity for Migrant and Seasonal Agricultural Workers (MSAW) requires a multi-faceted approach to overcome significant barriers and health disparities worsened by laws, which push them further into the shadows and discourage them from seeking services and resources. By tailoring localized programs and interventions and addressing administrative processes and training agency-wide, the Sea Mar Community Health Centers MSAW Promotores Program increased the number of MSAW we served by 96% in four years. For its efforts, Sea Mar won the 2018 Increasing Access to Care Promising Practice Award from the National Center for Farmworkers Health. 

 


MSAW experience more barriers to care, and greater health inequities, than year-round agricultural workers. Agriculture is one of the most dangerous industries and MSAW face significant occupational and environmental hazards, such as pesticide exposure, muscoskeletal injuries, skin disorders, and respiratory problems. They work long hours at a fast pace, performing physically hard work in all kinds of weather, jeopardizing their health and making them prone to missing medical appointments and encounter difficulties managing chronic health conditions. In order to survive, they tend to ignore personal discomfort and usually have no time, or knowledge, of preventive health practices.  Frequent mobility, low literacy, limited language abilities, transportation options, lack of knowledge regarding services, as well as differing cultural beliefs and health practices, create significant hurdles to accessing resources and care.  Over 54,000 MSAW and family members reside either year round or temporarily in the nine counties in Western Washington where Sea Mar offers clinical operations. 

 

 



Agency-wide processes and systems were initiated, including training to help staff better identify and capture a client’s special agricultural status. In Skagit and Whatcom Counties, where two-thirds of the MSAW and families reside, efforts were focused on increased community engagement, building relationships with both growers and the agricultural workforce, and initiating innovative outreach service delivery models to overcome structural barriers to care such as lack of childcare, transportation and long work hours.

 


In these two counties, the MSAW Promotores Program has been operating since 2010, facilitating access to services and improving quality of service delivery. Community Health Workers, or “Promotores,” are the core of this program and are recruited from the local agricultural community to serve on the front lines of public health, effectively forming a bridge between the agricultural community and health services. They are especially effective at this role as they possess deep knowledge of social networks and special health needs and are trusted by the community. Promotores have strengthened existing relationships with growers and agricultural communities and helped create new access points, allowing us to reach deeper into these increasingly hidden agricultural communities. During the high harvest season of berries over the summer months, Promotores visit farms, migrant camps, housing sites and common gathering places with mobile medical and dental clinics. During the non-peak season, they lead health workshops and presentations for farmworkers who reside in the area year-round or who remain in the camps over winter. Although innovative and special initiatives are undertaken routinely, our multi-faceted approach focuses on:

  1. Relationship building to establish trust with highly ethnically diverse communities and address social determinants of health
  2. Expanding service delivery to outreach sites
  3. Increasing health literacy and preventive health knowledge
  4. Fostering relations with new farms to expand reach and gain access to difficult-to-reach communities  

 


Key to building connections and relationships with MSAW was the initiation of the MSAW Mapping Project. We knew the agricultural workforce had transitioned from primarily Spanish speaking Latinos but were unsure of the extent of the transition. Through this ongoing project, we discovered a highly ethnically diverse workforce with unique linguistic and cultural barriers. We identified more than 16 Mexican and Guatemalan indigenous linguistic communities, with high monolingualism and varying degrees of literacy and Spanish speaking ability across age, gender and community. We began forging connections with these communities as well as a large Punjabi community in Whatcom, with similar English language limitations.  The Mapping Project provided significant insight into the diversity, linguistic complexities, cultural barriers, health care beliefs and practices, such as lack of understanding of health processes and preventive health practices.   The findings justified the hiring of staff who speak these indigenous languages and the increased community engagement resulted in leaders reaching out for services and assistance.  The findings provide ongoing insights on health messaging and on clinical tools to enhance patient-provider communication. As these isolated and shy communities felt more welcome and understood, they began reaching out asking for assistance or workshops and information.  

 


To address lack of transportation, childcare, and time, clinical services were expanded beyond the clinic walls through mobile medical and dental clinics at farms, migrant camps and other gathering sites.  Over the last four years, more than 2,100 MSAW have received medical, dental and health screen services through 96 mobile clinics facilitated during the summer months.  Many of these patients are newly diagnosed or with chronic conditions such as diabetes or hypertension who do not regularly visit clinics. The remainder have usually never seen a medical doctor for a wellness check-up (especially males). All were able to get relevant health information and follow-up care often not available due to lack of time, money or a tendency to ignore pain or illness until it becomes acute.  In 2017, we began holding mobile flu clinic events for seasonal workers during the shoulder season and year round TB screening workshops due to the high prevalence of tuberculosis within the agricultural community.  In addition to workers obtaining needed vaccines or information, we take advantage of these access events to compel them to visit the clinics for additional follow-up appointments, for annual exams and preventive screens. Most of them do end up asking for follow-up appointments. 

 

 


Increasing health literacy and preventive health knowledge through outreach clinics and specific health topic workshops helped expand the culturally appropriate health promotional workshops and events, which the program has always done through door to door canvassing, workshops at gathering sites, and public service announcements.  However, five years ago, farms began creating space for the mobile clinics. Each year, more farms open their facilities during the paid work day so their workers can attend our workshops. Additional projects in the community and clinics are focused on improving patient experience and health outcomes, including an Indigenous Prenatal Research Grant to research barriers to care and to create effective health messaging for early prenatal care. 

 

 

 

As communities recede deeper into the shadows, opening new access points for farmworkers is an unending initiative. Building better connections with the ethnically diverse agricultural workforce communities and their employers has been critical in our success in expanding access for MSAW. Over four years, we’ve partnered with eight new farms, 16 in total, annually expanding grower collaborations and strengthening existing farm collaborations.  These relationships have allowed us to work with farm management to help workers with urgent or chronic conditions schedule clinic appointments by coordinating approval to leave work and find transport to the clinic. Every team member (from manager to promotores) are involved in cultivating these relations, which can take years, and may require leveraging connections we have through existing farms or community partners. 

 

This multi-dimensional approach, supplemented by ongoing research and periodic trainings and audits has allowed the program to build deeper connections and trust with agricultural workers and employers while finding new ways to improve access and patient health.

 

For more information, please contact Colleen Pacheco at colleenpacheco@seamarchc.org or Marcela Suarez at marcelasuarez@seamarchc.org

 

 

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