Juan was failing second grade and his teacher couldn’t get him to sit still in class. The child of migrant farmworkers, Juan was also undocumented and uninsured—and worked in the fields with his father every morning before school to help make ends meet. The school arranged for Juan to visit to the Del Norte Clinics’ mobile health clinic.

At Juan’s appointment, “we referred him to a pediatrician, (an eye doctor), and a dentist,” recalls Nurse Practitioner Suzy Yost—“all paid for by Child Health and Disability Prevention” (a state program for low-income children not eligible for Medi-Cal).

As a result, Juan had several cavities treated and got two prescriptions, one for glasses and one for medication to treat his attention deficit/hyperactivity disorder. “His school performance and behavior improved so much, the school kept thanking us,” adds Yost.

Mobile clinics are a key strategy—and a growing one—for improving access to health care in rural areas, particularly for families of migrant farmworkers.

A growing model for care

“Two decades ago, before the first mobile clinic went into operation,” says Darien de Lorenzo, executive director of the International Mobile Clinic Association, “there was little medical care for (migrant farmworkers). The standard health system does not call for going out and finding people to be treated. (But) the interest and need is growing.” The International Mobile Health Association was founded two years ago and now has over 228 members, including 52 in California.

Overcoming barriers

Mobile clinics help address barriers that keep people in rural areas from getting regular health care—and the additional obstacles faced by migrants.

Convenient locations: “Without the mobile clinic, I would have to take my two children by bus half an hour or more to Colusa,” says Cecilia Moreno of Arbuckle, CA. The Del Norte mobile clinic stops near schools and parks—each of the rural Northern California communities it serves is 15 to 30 miles from the nearest traditional clinic.

Farmworker families may have a car, but it usually goes to work with the father, up to an hour away,” says Harold Carlson, grant writer for Del Norte Clinics. “This leaves women and children only limited—or no—public transportation. Without the mobile (clinic), a lot of (health issues) would be left unattended” until families needed to go to the emergency room, he adds.

Bilingual outreach: “Most of the mobile (clinics) are sensitive (to the culture and needs of the community), because they are going out to the community, and they recognize the majority is Spanish speaking,” says De Lorenzo.

Irma Leal, a bilingual outreach worker at the Del Norte mobile clinic, provides information about the clinic’s health services and how families can sign up for health insurance—while helping residents overcome language barriers and fears about deportation. (The federal Citizenship and Immigration Services agency has stated that receiving Medi-Cal or Healthy Families for your children will not endanger your immigration status.) She also translates at the clinic when needed.

“Everyone knows me and is comfortable coming up to me to talk and ask questions,” says Leal. “(The mothers) don’t talk to just anyone. They have to build up confianza (trust), before they open up. They have lots of problems. I also work pretty closely with the schools and businesses, offering Healthy Families and Medi-Cal presentations (for families). Every week I take over a thousand bilingual fliers to the schools for children to take home to their parents. The schools really help me a lot. I also go door to door,” she adds.

Nontraditional hours: The mobile clinic runs evenings and weekends, when most traditional clinics are not open, so workers don’t lose pay when they visit.

Care for the uninsured: “We don’t turn anyone away, whether or not (they have) insurance or the ability to pay,” says Yost. Most migrants do not have health insurance for their families (see Snapshot of migrant farmworkers in the US:)—and cannot afford health-related expenses. “(Agribusiness) is not known for its generosity in finding health care for its workers,” De Lorenzo adds.

Focus on prevention and education

An average of 20 patients a day drop in at the van for screenings, vaccinations, urine and blood analyses, breast exams, and referrals to other services. Sixty to seventy percent of the clinic’s patients are women or children. The clinic also provides physicals and shots at schools.

“We do extensive education,” says Yost. “We explain what happens if you don’t take medication. We do a lot of prevention, talking to patients about diet and exercise. Our focus on prevention is uncommon, especially for our families, who are more survival oriented.”

For more information, contact:

• International Health Mobile Health Association, 415-863-2032, http://www.international
  mobilehealthassociation.org/

• Del Norte Clinics’ mobile health clinic, 530-674-4261

Starting a mobile clinic

Funding: Running a mobile health clinic isn’t cheap—De Lorenzo estimates the cost at more than $500,000 the first year (including the vehicle) and more than $250,000 each year after (mostly staffing costs). The Del Norte Clinics’ mobile health clinic was paid for by a grant from the state office for AIDS prevention— Sutter County uses it for HIV screening on the days that Del Norte Clinics doesn’t. Other costs are paid for by grants and city, county, and federal funds, as well as Medi-Cal reimbursements.

Possible funding sources include the Robert Wood Johnson Foundation, the Children’s Health Fund, Delta Dental of California, the California Endowment, and First Five.

Staffing: Mobile clinic staff often includes a program coordinator and medical director at a fixed site who do outreach, and a physician, technician, and nurse on-board the vehicle, says De Lorenzo. On the van, Del Norte Clinics has a health care provider, a driver who greets patients, and an outreach worker, who also does outreach the day before each trip—and a receptionist and manager at a fixed-site clinic.

Collaboration: “Don’t go it alone,” says De Lorenzo. “Community agencies will probably be better off partnering with a local hospital or public health department,” because of cost and licensing requirements. Other possible partners include schools, churches, corporations, and community organizations. Screening programs, child care programs, and schools are good sources of referrals, adds Carlson. “Learn from others,” advises De Lorenzo.

Plan your work: What services will you provide? What equipment will you need? Which sites will you visit? How often? In rural areas, maintenance and gas costs will be higher, says De Lorenzo. “Make sure (the vehicle) is well utilized,” says Carlson, “and the number of days fits the customers. You have to be consistent and on-time,” or risk losing community support.

Snapshot of migrant farmworkers in the US:

• 79% are immigrants from Latin America
• 52% are undocumented
• 45% have children—32% of non-resident farmworkers have 3 children or more
• 94% do not have health insurance, except for work-related injuries
• 50% of farmworker families make less than $10,000 a year.

Source: US Department of Labor, 2000