N.Y. clinic casts lifeline to isolated migrant workers

`They're poor, they don't get sick days,'health official says

April 01, 2001|By Annette Fuentes | Annette Fuentes,NEW YORK TIMES NEWS SERVICE

NEW PALTZ, N.Y. - It was 11 o'clock one night at the Hudson Valley Migrant Health Clinic and the pager affixed to Vince LaSalle's waist started beeping. LaSalle, a physician's assistant at the clinic here, had been closing up for the night.

The call was from an anxious mother whose baby's raging fever would not break. So LaSalle and an outreach worker, Kenny Gould, jumped in their cars and headed out for a house call, winding through the unlighted back roads of the apple orchard country of Ulster County.

The woman and her family were farm workers living in a trailer tucked away on a farm down an unpaved road. The baby had a 103-degree fever and an ear infection, which LaSalle treated with amoxicillin. The family had no car and no phone in their trailer - just a pay phone outdoors near the apple warehouse. "God forbid I had to call 911," LaSalle said recently of the incident. "They'd never find that place with an ambulance."

Just 70 miles from New York City, in an area known for comfortable weekend homes and the rugged beauty of the nearby Shawangunk Mountains, farm workers live a bare-bones existence, mostly hidden from view. Here, health care delivery often takes on a literal meaning for the staff of the farm workers' health clinic. They confront the usual challenges posed by serving the poor and uninsured - and then some.

Most patients wary

Most patients are undocumented immigrants and wary of institutions. Many are from Mexico or Central America, speak little English and require cultural understanding in equal doses with medical care. The migrants typically follow the harvests: to Florida in the winter and back up to the Hudson Valley for vegetable and apple crops in summer and fall, making continuity of health care a goal more than a reality.

But it is the workers' sheer physical isolation on those farms, unwired to the outside world, no buses and only the rare car for transportation, that shapes how clinic providers operate.

"The most important things to know about health care for farm workers is they're poor, they don't get sick days and they lose pay if they take a day off to come to the clinic," said James O'Barr, director of the migrant health program. "Outreach is our link to the workers. And it's a killer sometimes, driving all over the county picking people up, delivering them to the clinic."

Cultural nuances

The outreach workers must be fluent in the cultural nuances of the Mexican, Jamaican, Guatemalan, Puerto Rican and Bangladeshi workers they encounter. They must also be sensitive to the farm workers as immigrants, many in the country illegally, maintaining a low profile. While the clinic's confidentiality rules prohibit discussing particular patients' cases, and patients themselves are reluctant to talk, they appreciate the clinic.

"The clinic is very good; the people are very nice," a Mexican man whom Gould chauffeured to the clinic said in Spanish.

On a recent evening, Olga Bracero, an outreach worker, headed out in the clinic's van to begin her scheduled tasks for the night. First stop, an apple farm in Plattekill to tell a woman the good results of her mammogram and to drop off bread donated by a local bakery outlet. Inside the tidy cedar-shingled cottage, Bracero embraced the woman warmly, conveying the test results and reminding the woman that she would need a mammogram next year. Down the dirt road, Bracero stopped off at the trailer of a man with a gallbladder tumor, taking an appointment slip for a surgeon.

"Sometimes it's hard to find people because they go by nicknames," Bracero said. "I tell the crew leader, `I'm looking for Jose Perez,' and he says, `There's no one here by that name.' It turns out that everybody calls Jose `Botija' - the little fat guy."

The next stop is a boardinghouse in Modena to pick up a patient for her clinic appointment. "My knees are bothering me," the woman says in Spanish. "Maybe it is arthritis."

Before heading back, Bracero finds her way to another apple farm nearby to drop off medication for a sick child.

Some chronic ailments

Clinic staff members grapple with the chronic ailments that plague farm workers. According to 1997 data collected by the migrant health program, hypertension caused by poor diet and the workers' precarious, stressful way of life was the most common diagnosis.

Next were skin problems, like rashes and inflammations, caused by exposure to pesticides, fungi in the soil and other natural allergens. Diabetes is often diagnosed. Ear infections are also common. Muscular-skeletal problems, especially back and shoulder pain, are common among field and apple workers, who climb ladders and haul apple buckets. So are depression and anxiety, which are harder to diagnose, said Vera Wisniewski, a licensed practical nurse who works at the clinic.

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