Free clinic on wheels _ FCOW _ visits Wisconsin farms

David Wahlberg
Wisconsin State Journal
Dr. Emily Jewell, who volunteers with the Community Connections Free Clinic in Dodgeville, Wis., examines the abdomen of Orvilio Lopez, a worker at Cottonwood Dairy near Wiota, Wis. on Sept. 23, 2019. The free clinic started bringing staff and supplies on a bus to farms last fall to provide care for workers without insurance.

WIOTA, Wis. (AP) - One of the farm workers examined by Dr. Emily Jewell had persistent back pain after he was kicked by a cow.

Another had an ear infection and a rash. A man complained of tenderness in his abdomen, prompting Jewell to clear the desktop in the dairy farm's office — her makeshift exam room for the day — and ask him to lie down.

As she felt his sore area, she didn't detect anything suspicious. But a test later found blood in his urine.

"This is concerning," she said. "We're going to have to check it out further."

Community Connections Free Clinic in Dodgeville, which has treated patients without insurance since 2006, has started bringing its services to southwestern Wisconsin farms, the Wisconsin State Journal reported.

Dr. Emily Jewell, a volunteer with the Community Connections Free Clinic in Dodgeville, Wis., unloads medical supplies for health assessments of workers at Cottonwood Dairy in Wiota, Wis. on Sept. 23, 2019. The free clinic started bringing staff and supplies on a bus to farms last fall to provide care for workers without insurance.

Using an old Head Start bus that has been repainted and repurposed as a "free clinic on wheels" — with the apt acronym FCOW — clinic staff and volunteers visit farms roughly once a month and offer basic check-ups and treatments.

Most of the workers who sign up are Hispanic, Spanish-speaking and uninsured.

"We're trying to make sure people are taking care of themselves," said Rebecca Steffes, nurse manager at Community Connections.

"Our goal is to do screening exams, like what we would do in the clinic, to find chronic diseases" such as high blood pressure and diabetes, said Jewell, the main doctor involved.

"If we treat them, maybe 20 years from now they won't be having heart failure or losing toes," she said.

Wisconsin has about 24,000 farm workers, and more than half of those who work full-time are Hispanic, according to UW-Madison's Center for Dairy Profitability. It's not clear how many are immigrants, uninsured or undocumented. Nationwide, more than half of farm workers are immigrants, according to Texas A&M University, and about 24 percent are unauthorized, the Pew Research Center said.

Some migrant workers qualify for Medicaid, and 29 percent of farms in Wisconsin say they offer insurance to workers, according to the dairy center.

But many workers don't qualify, coverage can be costly and farm schedules can make it difficult to travel to a clinic, Steffes and Jewell said.

Cristina Castillo, a worker at Cottonwood Dairy in Wiota, Wis., right, converses with Dr. Emily Jewell, a volunteer with Community Connections Free Clinic in Dodgeville, Wis. during a health assessment at the farm on Sept. 23, 2019. The free clinic started bringing staff and supplies on a bus to farms last fall to provide care for workers without insurance.

Farm outreach

Community Connections is the only one of Wisconsin's 100 or so free or charitable clinics known to be doing outreach on farms, said Connor Dopler, manager of the Wisconsin Association of Free and Charitable Clinics.

The Benevolent Specialists Project Free Clinic in Middleton, the only free clinic in Wisconsin that offers only specialty medical care, is adding a bilingual health coach program this fall, said Christopher Mullen, an AmeriCorps VISTA worker at the clinic. Nearly three-quarters of the clinic's patients are Hispanic, he said.

Free clinics in Boscobel, Richland Center and Sauk Prairie treat immigrant farm workers on site but don't do outreach to farms, clinic leaders said.

At UW-Eau Claire, nursing students visit dairy farms and deliver health screenings, immunizations and health and safety education to farm workers, many of them from Mexico or Central America, said Lisa Schiller, an associate professor of nursing.

The Rural Health Initiative, a nonprofit in Shawano sponsored in part by ThedaCare, offers health screenings and health coaching at farms in Outagamie, Shawano and Waupaca counties. A quarter of the patients are Hispanic, said Rhonda Strebel, executive director.

In Dodgeville, the Multicultural Outreach Program, which offers English classes and other services to immigrants, helped the free clinic connect with area farms interested in providing health services on site.

Southwest Wisconsin Community Action Program, which includes the multicultural program, donated the bus used to carry providers and medical supplies to the farms.

Dr. Emily Jewell, center, a volunteer with Community Connections Free Clinic in Dodgeville, Wis., rides a bus with her mother, Marcia Jewell, a volunteer nurse with the clinic, left, and Rebecca Steffes, the clinic's nurse manager, during a trip to Cottonwood Dairy in Wiota, Wis. on Sept. 23, 2019. The free clinic started bringing staff and supplies on a bus to farms last fall to provide care for workers without insurance.

"We try to create a welcoming community" for immigrants, who are "very necessary to the farming industry and the dairy industry in particular," said Shirley Barnes, chair of the multicultural program.

"They have other needs, among them a need for access to affordable health care," she said.

Cottonwood Dairy

Starting last fall and picking up again this spring, Community Connections has made six visits to four farms and seen about 40 patients, all of them native Spanish speakers, Steffes said.

About three-quarters are men, and Jewell said many have high blood pressure or diabetes, or a family history of those conditions. Others have acid reflux or chronic pain. "I wish we had access to physical therapy," she said.

At a visit last month to Cottonwood Dairy near Wiota, an unincorporated community in Lafayette County, Jewell, Steffes and Marcia Jewell — Emily Jewell's mother, who is a nurse — cared for eight patients.

Tirso Salazar, 26, who was kicked by a cow while it was giving birth, said he had back pain despite taking an anti-inflammatory medication and a muscle relaxant.

Dr. Jewell, who speaks Spanish, discussed the proper way to lift — using the legs, not the back — and encouraged him to rest for a few consecutive days if possible.

Jewell gave antiobiotics and fungal cream to Cristina Castillo, 31, for ear and fungal infections, and suggested over-the-counter remedies for Castillo's allergies.

For Orvilio Lopez, 34, who was worried about his abdominal pain, Jewell ordered urine and blood tests and arranged to see him again when the bus returns to the farm. After learning he smoked, she encouraged him to quit and talked about nicotine gum and patches.

Roberto Paniagua, 33, asked about taking melatonin to sleep and where to get immunizations against flu and tetanus. Steffes, who also speaks Spanish, told him to visit the county health department for vaccinations.

Paniagua thanked the free clinic team for their help. "It's necessary," he said.

High demand

At an earlier visit to another farm, a patient was suspected of having active tuberculous, which is a significant public health concern because it is highly contagious. He was hospitalized and treated for TB but later found to have had a different infection.

Farm workers who require ongoing treatment are asked to come to the regular free clinic in downtown Dodgeville, which is open Tuesday and Thursday evenings.

Jim Winn, co-owner of Cottonwood, which has 1,800 cows and 31 workers, said the farm offers high-deductible insurance to employees. But when he posted a sign-up sheet for the free clinic's visit, he realized how valuable the service was.

"The slots filled up immediately," Winn said.

Jewell finished her family medicine residency at UW-Madison two years ago after graduating from an osteopathic medical school in Florida. Her regular job is at the SSM Health clinic in Dodgeville.

She grew up on a hog farm between Dodgeville and Mineral Point, and is married to a man from Honduras who was undocumented while living in the U.S. for many years.

"I was well acquainted with the plight of these folks trying to get health care," she said. "This is a way to go out and take care of the people we know aren't coming in."