WENATCHEE (Washington) WORLD

July 7, 2008

Health care for migrants has grown

By Dan Wheat
World staff writer

WENATCHEE — It started in the orchards of Wenatchee 36 years ago — a couple of health professionals treating ailments of migrant farmworkers from Arkansas and Oklahoma out of the back of a van.

Today, Wenatchee-based Columbia Valley Community Health operates on a $18 million annual budget, has more than 250 employees and serves 16,000 people annually, in Chelan and Douglas counties.

The private, nonprofit migrant and community health clinic serves everyone but is targeted toward the low-income and migrants, says Carol McCormick, clinic outreach coordinator and registered nurse.

The clinic offers medical, dental, maternity, pharmacy, lab, X-ray, mental health and case management services. It has a walk-in clinic.

For five years, the clinic has been working at the state-owned, county-operated migrant farmworker camps at Monitor and near Pangborn Memorial Airport. Doctors and other health care workers visit the camps about 10 times through the tree fruit harvest season, giving advice and limited treatments and referring people who need more help to the clinic or to other health services.

McCormick, 54, a health-care provider for six years and former schoolteacher, says her greatest concern with the health of migrant farmworkers is their access to health care, which is impeded by two large barriers.

"One is their lack of knowledge of how to get services and whether or not they need services," she says. Frequently, they would rather suffer through an ailment because, out of necessity, work comes first, she says.

"The second barrier is a fear of racism and anxiety about finding themselves in compromising situations," she says.

Migrants have every imaginable health care issue but will work with pain to avoid confusion, racism or anything negative, she says.

"Racism can be real or mistaken from cultural differences. We tend to speak louder than the rest of the world. When a Latino hears a loud voice they usually interpret it as anger, especially when they are having difficulty understanding what is being said," says McCormick, who speaks Spanish and knows something of the culture from living in Colombia and Costa Rica.

With the help of a federal grant called Steps to a Healthier USA, the clinic has partnered with the Chelan-Douglas Health District, Wenatchee Valley Medical Center, Golds Gym, the YMCA, North Central Educational Service District, Central Washington Hospital, WSU Extension and others to focus on diabetes, asthma, nutrition, tobacco and obesity.

The grant has allowed McCormick to start a "promotores" program. Promotores are people from the target community who are not health professionals but are trained to recognize signs and symptoms of people needing medical services, McCormick says.

The program helps the clinic establish relationships with migrants, which are important because "in order for migrants to access care they need to feel they have a relationship," she says.

Lupita Espinoza is one of the clinic's five promotores, or health promoters. She visits schools, exercise classes at the Wenatchee Community Center and migrant camps, getting to know people and looking for health issues.
She said she helped a depressed woman in an exercise class get help for her depression and helped a heart attack victim and diabetic get the right medication and start an exercise program at the YMCA.

"I have a passion to help people with their health care," Espinoza said. It stems, she said, from helping her shy mother find health services and other things.
McCormick said clinic workers find a lot of migrants with heart conditions and diabetes who have run out of medications and don't know how to get more. High blood pressure is also commonly found, she said.

She said it's hard to assess the overall condition of migrant health in general because many are young and healthy and others aren't.

"But we've uncovered some pretty interesting medical cases," she said.
Once, when McCormick was doing blood pressure checks on older men, a healthy-looking, 13-year-old boy asked that his be taken.

"He had such high blood pressure that I referred him to the physician assistant, who happened to be in the camp at the time," McCormick said. "It turned out he had osteomyelitis, an infection of the bone marrow that could have had severe implications for him."