MCMC volunteers and community organizations join together to bring needed
services to those who have difficulty accessing them on their own.
In an area known for high-quality healthcare, one volunteer program at
Mid-Columbia Medical Center is working to ensure typically underserved
populations have easier access to it.
Serving Oregon and its Migrants by Offering Solutions (SOMOS) is a group
of individuals at Mid-Columbia Medical Center linked with community partners
who are dedicated to serve the thousands of migrant and seasonal farm
workers in The Dalles and surrounding areas.
SOMOS is helping Mid-Columbia Outpatient Clinics (MCOC) meet one of the
requirements of the National Health Service Corps’ (NHSC) Loan Repayment
Program. MCOC operates four Mid-Columbia Medical Center clinics that are
certified by NHSC – MCMC Family Medicine, MCMC Internal Medicine,
MCMC Pediatrics and Columbia River Women’s Clinic.
These clinics benefit from the NHSC program that funds repayment of student
loans owed by providers who agree to practice at NHSC-certified clinics.
That provides great incentive for providers according to Tessa Delacruz,
administrative assistant II at MCMC Internal Medicine.
“It’s a huge recruitment tool for us because providers want
that benefit,” she says. “Practicing in smaller, rural communities
like The Dalles is more appealing when we can offer that option.”
To earn and maintain NHSC status, clinics must meet several requirements
intended to improve access to care, one of which is provide better access
to the migrant and seasonal farmer populations and their families.
To this end, MCMC’s NHSC-certified clinics established three goals,
which included increasing community outreach to these individuals, increasing
their primary care visits and increasing the number of patients who qualify
for the sliding fee scale, which reduces the medical fees of low- or no-income
Jonathan Soffer, adult nurse practitioner at MCMC Internal Medicine had
worked on a project with similar goals while attending Emory University
in Georgia. “We were talking about ways to better reach the migrant
farm worker community here in The Dalles and we threw different ideas
back and forth,” Soffer recounts. “I talked about this program
I’d done in the past in Georgia, and people felt something similar
would be a good fit here.”
The projects were relatively similar, with the main differences found in
the population served. According to Soffer, most of the migrant farm workers
in Georgia come directly from Mexico or other Central American countries,
whereas in Oregon most of the migrant farm workers come from California.
Even with a model in place, the project was still a first for MCMC. The
SOMOS committee started from the ground up. The committee began determining
how to best reach the target audience.
Many obstacles can prevent migrant and seasonal farmers from being able
to access healthcare. The change in harvest can mean moving out of the
area for months at a time.Long work hours and inconsistent work schedules
make scheduling doctors appointments almost impossible. Poor phone service
in work areas, language barriers, and low literacy levels make communication
difficult and sometimes impossible.
Denise Dietrich-Bokum, practice manager at Gorge Urology and head of the
SOMOS committee, tells the story of a seasonal farm worker who went to
the clinic to pick up a discount application for a test. He was told to
go get another financial application, and sent to a different place for
the test, then sent to another place for a different application. In the
end, the worker ended up not getting help because it was too complicated.
Long- and short-term goals set by the enthusiastic volunteers focused on
providing a discount policy and more accessible forms, setting up off-site
visits to migrant camps, holding walk-in clinics during harvest season,
promoting the project, establishing community partners and setting up
a sustainable model.
Changes were made to the financial process.The discount application was
made simpler and more available to patients and modified to include labs
and X-ray. Bilingual staff members at clinics were trained to help explain
and complete the new forms. Medi-Cal is also now accepted at clinics,
since most migrants in the area come from California.
SOMOS focused most of its volunteer efforts during the three-to-four-week
cherry harvest overlapping June and July, when approximately 5,000 migrants
would be in the area. The “moving target” nature of cherry
harvest made it a difficult, but necessary time for SOMOS to be involved.
“We had to do it then,” said Dietrich-Bokum.“If you
miss cherry harvest, you miss the entire migrant population until the
A four-week walk-in clinic was set up from June 13 to July 7 at the MCMC
Family Medicine clinic, with flexible dates to allow for changes in harvest
times. Flyers were displayed advertising the walk-in clinic and other
facilities, a special phone line was set up to provide more information
about the walk-in clinic, and bilingual staff members were available on site.
Over the course of 11 days, between 36 and 40 patients were seen during
walk-in hours, and several others came during non-walk-in days, for an
estimated total of 50 to 60 patients seen. SOMOS also partnered with Oregon
Child Development Coalition to hold three off-site events.
The first was an open enrollment clinic at St. Mary’s Academy on
June 11, followed by a clinic at Orchard View main camp on June 22, and
ending with a clinic at McClaskey’s main camp on June 29. Various
health stations were set up, including, height/weight check, vitals check,
blood glucose testing, physical therapy, provider visits, breast health,
and occupational health for information about worker’s comp.
At checkout, visitors received free hygiene kits. Interpreters were also
available at off-site events to assist in navigating around the language barrier.
In total, 142 patients were seen at the off-site events, including 66 who
were seen by providers.
From the SOMOS committee’s standpoint, the outreach efforts were
a success. “We went into this project not really knowing what to
expect, not knowing what the community perception would be,” Soffer
said. “We ended up serving about 200 patients, which was really
good, and we had as many as 70 patients come to one off-site event in
the orchard. We were really happy with how it went.”
As for the response from the migrant and seasonal farm workers, Soffer
said, “I think people were interested in the services; I think they
felt like we were bringing a good thing to the community. We plan to continue
this on an ongoing basis, and our hope is once the migrant farm workers
know that we do this, every year when they return, we’ll have more
and more of a following.”
Delacruz also participated in the off-site events and believes SOMOS made
a positive impact. “We caught a few people who really needed to
be seen. It was really nice that we were able to provide services at their
Her favorite story involved a mother from California who came in with a
premature, 5-week-old baby. In California, the mother had been getting
a certain brand of formula through WIC, but in Oregon, WIC vouchers only
qualify for a different brand of formula. For the past two or three weeks,
the baby had been very colicky and uncomfortable, and couldn’t sleep.
Volunteers contacted MCMC’s pediatric clinic, where formula is constantly
being donated, and found two cases of sample cans — enough to get
them through until they went back to California.
“She called me about three days later and told me that the baby’s
colic was gone, and it was completely happy,” Delacruz said. The
mother thought the change in formula was what made the difference, but
she wouldn’t have been able to afford it without the assistance
of the SOMOS volunteer team.
Making the events possible were several community partners, including Maria
Elena Castro from OEI, North Central Public Health, Oregon Childhood Development
Coalition, Advantage Dental, and various MCMC departments. In addition,
46 volunteers participated, most of whom volunteered at multiple events.
Soffer said one highlight of the experience so far has been seeing how
so many different organizations and people have worked well together.
“A lot of different departments, a lot of different community partners,
and MCMC came together to really quickly develop a really, nice robust
project that helped a lot of people — that’s unusual. We worked
with a lot of different groups to put together a project that worked really
well. I think that’s exciting to see that many different people