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Maine Migrant Worker Mobile Clinic Eyed as Rural Model
08/13/2013   Reported By: Jennifer Mitchell

Hundreds of workers from Mexico and Haiti make the long journey to Eastern Maine each year to get the blueberry harvest in. Without these workers, berry companies say their businesses would fail. But these men and women can face challenging conditions, from camping out in tents - in all weather - to the injuries and strains common in farm labor. To help ease the burden, there's the Maine Migrant Health program with its mobile clinic. As Jennifer Mitchell reports, some say the clinic is a model of how health care could work for rural states like Maine.

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Maine Migrant Worker Mobile Clinic Eyed as Rural M Listen

Migrant van 3

It's one of the first sunny days in a while, and when the sun shines, the workers rake. That means the clinic (above) probably won't be that busy today.

"Folks start rolling in - they kind of pop in throughout the course of the day," says coordinator Liz Charles. Charles is getting the unit ready to receive the first walk-in patients, while Dr. Matt Libby fiddles with the Migrant van 1lights. "Since there's only one person waiting right now, I'm just going to see if I can get the generator on," Libby says.

There are only a few people in the parking lot, checking out the facilities. Currently parked at the Rakers' Center in Columbia, the axis of Maine's wild blueberry harvest, the unit looks like a big RV. But instead of shag carpets and mini fixtures, the inside looks spare and efficient.

"So our mobile unit here has two different exam rooms," Charles (right) says, "and then a central room, which is used for consults by our behavioral health specialist. So we have medications stocked in each of our rooms, and basic exam equipment, so we're able to provide services on site."

Jennifer Mitchell: "As a practitioner, what is it like to work in a mobile unit like this?"

Dr. Matt Libby: "It's kind of nice, actually. Everything you need is all in one place. And you kind of know in the medicine cabinets there are medicines, blood pressure cuffs are there. It's also convenient to be able to go right to where the migrant workers live and take the mobile unit there, which you can't do anywhere else."

Because the workers are in the field during the day, the clinic has adapted itself to fit their hours, traveling from site to site, and holding walk-in hours in the evening as well. The nurses and doctors who staff the mobile unit never know exactly what kinds of cases are going to walk through their doors.

Beth Russet, a nurse practitioner who has specialized in farm worker care for more than 20 years, says access to a basic check-up can mean the difference between life and death. Just a week prior, one worker came in with some troubling symptoms.

"He was moving with the migrant stream, and so he had stress, which leads to GI problems," Russet says, "and also he was treating himself with ibuprofen for muscle aches and muscle pains," which, she says, can mask other symptoms and exacerbate stomach problems, and lead to serious intestinal bleeding.

"And so he arrives here with the symptoms of a GI bleed and is in the hopsital for 10 days," she says. "And he's a 40-year-old, relatively healthy, hard-working person who has this accute life-threatening issue, because he's had no access to health care and because he's had the stress, and the physical stress, of doing this labor."

It's a tale that resonates with other farm workers around the state.

"You know, you get stepped on, you get kicked, you crush your finger putting on an implement - or taking off something, you hurt your back. All of these things happen to a majority of farmers on a fairly regular basis," says John Jemison, with the University of Maine Cooperative Extension.

As an industry, John Jemison says, farm labor can be hard on the health, and its workers are notoriously underinsured and underserved. As part of a Cooperative Extension project two years ago, Jemison traveled around to farms all across Maine, and learned that one of the biggest issues facing farm workers everywhere is a lack of access to affordable care, and that lack of care is keeping some from getting into agriculture, he says.

For an industry that can't easily accommodate the 9 to 5 office hours of most clinics, and where injuries are more likely, Jemison says the mobile clinic idea is intriguing. "I can't think of anything about that model that wouldn't make sense. I guess the question is, is how would it be paid for?"

Expanding mobile care to Maine's general farm populace would take some serious planning, he says, but the idea is an exciting one. The migrant worker health program is mostly funded through federal grants, and no one is denied treatment if they can't pay.

But many patients do choose to pay something. They don't want charity, says nurse practitioner Beth Russet, they want to be well in a system where the health care is some of the most expensive in the world. In that regard, she says, they're in good company all across America.

Photos:  Nick Woodward


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