NORTH COUNTY TIMES

(San Diego County, California)

December 23, 2007

Mobile clinic brings the doctors, services to farmworkers

By: DARRYN BENNETT - North County Times

NORTH COUNTY - Two-year-old David Fuentes' lower lip quivered and his chubby face was flushed with tears last week as the dentist tried to coax him into opening his mouth and saying "ahhhh."

"Looks pretty good," said Dr. Sharouz Fard, a dentist with the North County Health Services Mobile Medical Clinic, as she handed the toddler a new toothbrush as a reward for finishing the exam. Fard's assistant, Jaime Castillo, reminded David's mother in Spanish to bring him back in six months.

Last week was David's second visit at the mobile clinic, a truck that travels throughout North County providing free or low-cost medical and dental services to patients at more than 30 locations each week. It primarily serves agricultural workers and lower-income families in remote areas who don't often utilize social services, such as Medi-Cal, to access health care, said Anhel Reyes, the social worker who manages the clinic, called Salud Ambulante in Spanish.

The mobile clinic is a branch of the nonprofit North County Health Services organization that has community clinics in nine locations, including Encinitas, Oceanside, San Marcos and Ramona. But many migrant workers served by the program don't use the neighborhood clinics because they don't have transportation or can't afford to miss a day of work for an appointment, said Irma Cota, president of the San Marcos-based health organization. Reyes said some of the patients are undocumented migrant workers who return to Mexico when the harvest seasons end.

"We're serving a very vulnerable population. Many of our patients are young families who need to keep it together and keep working," Cota said.

The truck, converted from a medical examination room into a dental examination room four days a week, makes stops in rural areas from Fallbrook, Bonsall and Valley Center to the Black Mountain area east of Del Mar. Mobile clinic staff see at least 200 patients weekly - or more than 7,000 a year, according to Reyes, who said that bringing services to work sites ensures that more people get the health care they need.

"We're really trying to break down the barriers to health care and education," he said.

Patients are seen on a walk-in basis or with an appointment, and during the two days a week the truck serves as a medical clinic, patients can receive a full range of services, including asthma and diabetes treatment, vaccinations, inoculations and family planning education. Physicians give referrals to patients who need mental health treatment or in-patient care that can't be accommodated in the truck, health services officials said.

Six years ago, the two-room truck replaced an older, smaller mobile clinic, and in the last year, the dental care has become the most popular service because it's available four days a week, Reyes said, making it easier for more patients to be seen.

Medical services are available twice a week, he said.

Rewarding work

Situated on a remote road dotted with horses and citrus trees, Rote Greenhouse in San Marcos is one of the mobile clinic's weekly stops. Last week in the greenhouse's dirt parking lot, Fard said she saw more than a dozen patients in the truck's well-equipped examination room.

Fard, a dentist with the mobile clinic for four years who also works in several of the organization's community clinics, said motivating patients to learn better brushing habits and get regular check-ups is a big part of her job.

"My work is very rewarding because the little things make a big difference, and what the migrant workers need sometimes is really basic," Fard said.

Fard said many of her first-time patients need extractions and root canals when she first sees them because of poor dental health, but digital x-rays, cleanings and cavity fillings are also available.

"When we see patients before they have problems we can prevent a lot of the problems that require major dental work," she said.

Meanwhile, 7-year-old Gustavo Savalsa, waiting patiently on the curb outside of the medical truck for his turn in the dental chair, said he looks forward to his regular trips to the mobile clinic.

"I like to come. She gets my teeth clean and if I open my mouth good I get a toy," or at least a new toothbrush, he said.

A changing clientele

In the last five years, the mobile and community clinics are increasingly serving what Reyes and Cota described as "middle-class workers," who they said have become largely uninsured because of lower wages and surging health care costs.

"An uninsured or underinsured middle class that we didn't use to see, we are now serving," Reyes said.

More than 72 percent of the organization's patients live below the federal poverty line, set at $20,000 a year for a family of four, and more than 75 percent of adult patients are uninsured, according to North County Health Services officials.

Reyes said providing health care to the burgeoning population of uninsured workers is critical to the health of everyone in the region.

"Farm workers handle the food we all eat," he said. "Reaching all of these people is important for our future."

Funding

According to the Web site, the entire health services agency, including the mobile clinic, works on an annual budget of between $30 million and $33 million. Cota said the funding structure for the clinics is complicated because the organization uses a network of more than 30 funding sources, including grants, private donors and state and federal monies.

Some of the funding comes from patient payments or from payments from government subsidized programs such as Medi-Cal and Medicare, Cota said. Patients without health insurance are charged discounted rates based on their income, and many patients qualify for free services, she said.

Roughly 15 percent of the organization's funds come from donors, according to Cota, who said that the organization is providing a safety net for many North County residents.

Cota said the policy of the clinic was to turn no one away because of an inability to pay or qualify for free services.