Reaching Out

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 individuals.

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 next year.”

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 location.”

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 working together.”