FARGO (North Dakota) FORUM

July 11, 2010

‘Clinic on wheels’ provides health care to migrant workers

By: Emily Hartley

Pelican Rapids, Minn. - Lori Schmidt isn’t sure what the room in back of the RV parked outside of St. Leonard Catholic Church here is meant for.

It’s hardly large enough to fit a queen-size bed, let alone the exam table and medical supplies that currently fill it. Add a nurse, a patient and an interpreter, and the room is downright full.

“As you can see, we’re kind of squished,” Schmidt recently said aboard the less-than-30-foot recreational vehicle.

Schmidt, a nurse practitioner, is one of four passengers who travel the region in Migrant Health Service’s North Mobile Unit. She describes it as “a clinic on wheels.”

Migrant Health, based in Moorhead, has North and South Mobile Units that cover a dozen locations in eastern North Dakota and western and southern Minnesota. They provide affordable health care for agricultural workers and their families.

Migrant Health moves along with its clients as advances in crop technology push the area’s migrant population farther away from the Red River Valley.

The cost for Migrant Health services are based on a sliding fee scale that accounts for family incomes, with the rest of the funding coming from state grants and private foundations.

Rosa Urbano and her three children recently stopped at the mobile unit when it was parked in Pelican Rapids, Minn., so she could get a complete physical and so her son’s skin condition could be checked.

“It’s more economical and easier because of the language barrier,” Urbano said with the help of interpreter Angie Ramirez, the unit’s driver tech.

The Urbanos moved to Pelican Rapids from Mexico about nine years ago; her husband works at a turkey plant outside of town. Unlike migrant workers, who come to the area from about April to November, the Urbanos live in Pelican Rapids year-round, a situation Joan Altenbernd says is becoming increasingly common.

Roundup Ready crops – which can be sprayed with the weed-killing agent Roundup and not be affected – mean less work for migrant workers in the area, said Altenbernd, executive director of Migrant Health. Because of that, the workers branch into other service areas, often becoming seasonal workers who no longer return South for the winter.

“In years past, whole families were employed by growers in the Red River valley,” Altenbernd said. “Now they have chemical-resistant seeds, so it doesn’t require people to walk the fields and pick weeds. Maybe one person from the family is hired.”

In some of these cases, employers provide health coverage for the employee, but Migrant Health and its mobile units continue to provide support for the rest of the family, including Urbano and her son.

All hands on deck

Aboard the North Mobile Unit, nurse practitioner Schmidt is joined by registered nurse Shelly Nicholls, driver tech Ramirez and 23-year-old Dennis (pronounced “Denise”) Gonzalez, who registers patients in the RV’s dining nook and shares interpreting duties with Ramirez.

This is Gonzalez’s first year with the unit and her second summer of not working in the fields with her family. The family, originally from Monterrey, Mexico, has traveled between Texas and Moorhead every year since she can remember.

Gonzalez attended Moorhead High School in spring and fall months and went to Migrant Health as a child. She said things have changed a lot since then, and only two of her family members have found work in fields this year. The rest use job services to seek other types of labor.

“We used to work for a farmer, but before we came in April, we got a letter saying there wasn’t going to be any work this year,” Gonzalez said. “Not many of my people are coming back.”

Ramirez, who has worked for Migrant Health for 14 years, noted the same trend. She began driving the North Mobile Unit nine years ago – about three years after it was started – when the Ada, Minn., branch she worked for closed due to the shifting of workers.

Around Fargo-Moorhead, she said, “the only fieldwork the migrant people have found is picking rocks.”

Ramirez grew up in a migrant family. She said many workers have turned to Wisconsin and Illinois for jobs. Still, when the unit travels outside of the valley, its services remain in demand.

Roaming the region

In a normal week, the Migrant Health crew will put on between 300 and 500 miles and see an average of 10 patients per day. More come to register so they can receive vouchers for dental work and specialty services.

And when the unit gets to places like Tappen, N.D., about halfway between Jamestown and Bismarck, its days can be busy with up to 20 clients.

Schmidt said they’ll set up anywhere they can, be it a church, a store’s parking lot or, as in Tappen, on the edge of a field in the migrant camp.

“We come pulling up, and they go walking out,” Schmidt said.

Workers there finish in the watermelon and potato fields at 7 p.m. and then come to the unit until about 9. The RV crew heads to the hotel about 10 p.m. and is back out doing lab work at 6 a.m. before workers return to the fields.

Schmidt works in student health at Minnesota State University Moorhead, and Nicholls is a full-time nurse at Innovis Health. They work with limited space and supplies to provide complete physicals and manage long-term conditions such as diabetes and hypertension. When they can’t offer a service or when they need a second opinion, they’ll give referrals to local physicians.

Sometimes people lack the most basic services, Schmidt said. A first-time trip to Morris, Minn., two weeks ago brought out a woman who was so excited about getting a physical that she returned later with her sister-in-law, who also wanted one.

“The clients are very gracious and grateful and really pleasant,” Schmidt said. “They just don’t have the money to go and have some of these services done.”

The crew is regularly offered food as a thank you for their services, including a pig roast for their next visit to Tappen.

“We have that fortunate thing that we’re always welcome anywhere we go,” Ramirez said