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When Dr. Olga Meave moved to California’s Central Valley to do her residency at a community health center, she fell in love with the work – and the patients.
“The patients are amazing. The level of complexity of our patients is very high, so that’s always interesting for us,” she said. “The weather is awful, but I grew up in the desert.”
Originally from Hermosillo, Mexico, Dr. Meave found common ground with the community that the health center, called Clinica Sierra Vista, served. Her patients – many of them agricultural workers – spoke Spanish or indigenous Mexican languages like Mixteco or one of the Zapotec languages.
“I can explain things better for them because I know where they’re from,” she said. “I know the culture, 100%, so they feel like they can trust me, they feel like they can reach out, they can be honest, they can be very transparent, and that helps us both.”
Today, she’s the chief medical officer of Clinica Sierra Vista, which serves about 200,000 patients in the Central Valley each year – a significant percentage of them farmworkers and their families.
That’s not a coincidence. Clinica Sierra Vista began treating patients in a small agricultural community called Lamont, California, in 1971.
“The mission of the clinic was to reach a farmworker population at a time when access to care was nearly impossible for low-income or undocumented families,” Tim Calahan, Clinica Sierra Vista’s public information officer, explained in an email.
It’s grown a lot since those early days. Clinica Sierra Vista now has 35 clinics in the Central Valley, some of them in urban centers like Bakersfield. But some clinics, located in rural areas, continue to serve primarily agricultural populations.
Even before Covid-19 appeared, California’s farmworkers were a vulnerable population.
According to Dr. Meave, farmworker communities have high rates of hypertension, diabetes and obesity. Exposure to the sun means a high frequency of dermatitis.
Then there’s a predisposition toward respiratory illness.
“Farmers are at a higher risk of contracting respiratory illnesses in general,” Dr. Meave said. “In this area, we have incredible amounts of valley fever, a lot of asthma, a lot of seasonal allergies because of the quality of the air, the use of pesticides.”
Although many farmworkers are supposed to have sick pay, they’re sometimes ridiculed, denied, or even fired for asking for it, said Armando Elenes, secretary-treasurer at the California-based union United Farm Workers, or UFW.
“If they get sick, they’re used to basically putting up with it, or doing home remedies because they feel they have no other choice,” he said.
In addition, farmworkers and their families frequently have difficulty accessing the safety net, said Ana Velasquez, who helps coordinate insurance and other services at Clinica Sierra Vista. Eligibility for public insurance programs varies by age and legal status, and even Medi-Cal coverage differs from county to county, she explained.
“These are people that don’t qualify for food stamps, and sometimes they don’t have enough food to feed the family,” Velasquez said.
When it comes to addressing the health of farmworkers, “health centers are on the frontlines,” said Sylvia Partida, chief executive officer for the National Center for Farmworker Health. “They have the infrastructure in place, they have the outreach teams.”
“They have to be very innovative about how they deliver that now, because it’s not business as usual” during Covid-19.
Clinica Sierra Vista is one of those health centers. Long before Covid-19, Velasquez and her team were signing farmworkers and their families up for health insurance; helping them find services for which they were eligible, from food assistance to help paying the electric bills; and providing hot meals and health education.
The health center even brings its health services into the field – quite literally – offering diagnostic tests for some chronic diseases and other services where farmworkers actually do their work. To meet its community’s needs, Clinica Sierra Vista’s staff is bilingual in English and Spanish, and provides translators for indigenous languages as needed.
Covid-19 and its Complications
Covid-19 has added new layers of complexity. According to Elenes, a farmworker who’s afraid of missing out on much-needed income – or losing a job altogether – may be hesitant to take off work.
“They take risks, sometimes dangerous risks, because they feel like they don’t have a choice,” he said.
Laura Siordia, a farmworker and patient at Clinica Sierra Vista, agreed. “What are people who work in the fields supposed to do? They have to keep working. They have to keep risking their health in order to survive economically,” she said.
In addition, farmworkers are likely to live in close quarters with others, to commute to and from work together, and, depending on the nature of the work they’re doing, to have difficulty maintaining social distancing.
Designated as essential workers during the Covid-19 crisis, farmworkers need to be valued, Elenes said.
“Just as doctors, respiratory therapists, nurses, and all these other…professionals that are on the frontlines in our health centers, farmworkers are on the frontlines of the food supply chain. They’re really guarding our health and our safety,” he said.
Although Clinica Sierra Vista doesn’t track testing information specifically as it maintains to farmworkers and their families, the clinic has ordered more than 3,300 tests, 540 of which had come back positive as of June 8. If the patient doesn’t have insurance, they’ll test for free.
Most cases are mild, but a few – including that of Siordia, who has since recovered from her illness – have had more severe symptoms.
Direct Relief, working in partnership with the National Association of Community Health Centers, has supplied Clinica Sierra Vista with a $49,500 emergency grant during the Covid-19 pandemic. The organization also supplies the health center with vital supplies such as personal protective equipment.
“The use of PPE is crucial…especially for the farmers because they cannot keep the social distancing at all times,” Dr. Meave said. “Hand hygiene, the use of gloves when needed, and the rest of the recommendations are also great, but the mask is what is crucial.”
When it comes to farmworkers and their families, “there’s a lot of fear sometimes coming to community health centers, because we ask questions, and sometimes they feel like that information is going to be shared,” which is not the case, Dr. Meave said.
“We’re here for them, and they need to remember that: That they can trust us, that they can come or call us, especially during Covid.”
Velasquez puts it even more directly: “We honor our farmworkers,” she said.