Health center doubles reach to ag workers

MOUNT VERNON, Wash. — In the past four years, a Sea Mar Community Health Centers program that provides health care services to farmworkers has nearly doubled its reach, said Colleen Pacheco, who has run the program since 2011.

The Migrant and Seasonal Agricultural Worker Program, primarily based out of Sea Mar’s clinics in Skagit and Whatcom counties, has seen a 96 percent increase in access to care, Pacheco said.

Earlier this month, Sea Mar won the 2018 Increase Access to Care Promising Practice Award for the program. The award, presented by the National Center for Farmworker Health, recognizes creative and successful strategies to increase access to care for farmworkers and their families.

Pacheco attributes the program’s growth to two main practices: knowing their clients and getting out into the community.

“For a while, migrant health centers weren’t aware of the changing demographics of their agricultural clients,” Pacheco said.

Through an initiative called the “farmworker mapping project,” Pacheco said she and her team identified many indigenous groups within the larger farmworker community.

Pacheco and her team increased outreach into the agricultural community, started documenting where their clients are from and implemented staff training.

“If we want to provide access to health services, we need to know about our clients and understand what they need to better understand their barriers,” she said.

They identified at least seven Aztec linguistic communities, seven Mayan linguistic communities and a large Hindi Punjabi community working in agriculture in Skagit and Whatcom counties.

“By just continually being out there we realized our clientele are more diverse than we even thought,” Pacheco said. “Even within our indigenous community.”

The majority of the almost 30,000 farmworkers in Skagit and Whatcom counties are from Mexico, according to Sea Mar. Between 60 and 80 percent are from indigenous communities in southern Mexico and Guatemala.

In Skagit County, the majority of indigenous peoples speak Mixtec and Triqui.

Each of these communities has unique linguistic and cultural barriers to accessing health services, Pacheco said.

Some indigenous people don’t understand English or Spanish, she said, so they may be unaware of the services Sea Mar provides or won’t visit for fear they won’t be able to communicate with staff. Many communities’ health perspectives are rooted in ancient traditions, Pacheco said, creating a hesitancy to seek outside services.

Sea Mar received funding in 2009 to create the Promotores Program, an initiative to recruit volunteers from local agricultural communities to act as liaisons.

The promotores help Sea Mar clinics breach linguistic and cultural barriers, spread awareness of the services available and provide health education in indigenous languages.

The promotores are the front line of the Migrant and Seasonal Agricultural Worker Program, said Promotores Coordinator Marcela Suarez.

“They are the bridge between our services and the community they belong to,” Suarez said. “Without them, the purpose of the program is not possible. They know the barriers and needs of the community we serve.”

Most promotores are from indigenous communities in Mexico or Guatemala, she said.

“They suffer the same barriers,” Suarez said. “So it’s easy for them to approach the community.”

The program has six promotores, with two of them serving in Skagit County. Suarez said volunteering as a promotora is often a stepping stone from agricultural work to working in a clinic, in a school district or as an interpreter.

While Suarez said she’s elated to see promotores furthering their careers, the high turnover and a limited budget make the promotores program difficult to maintain.

Suarez is the only full-time staff member for the promotores program.

Estela, a Mixteca promotora from Oaxaca, Mexico, who didn’t want her last name used, said she’s helped build her community’s trust in Sea Mar services.

“The promotores help with trust building,” Estela said through an interpreter. “Because many people don’t go to doctors in their homeland. They lack trust in the system because of where they come from.”

Estela speaks Spanish and three dialects of Mixtec.

In her four years volunteering as a promotora, she said she’s seen farmworkers gain confidence in Sea Mar services.

“They have a relationship with the clinic and with staff now,” she said.

Another component to the success of the farmworkers program has been outreach directly to farms, Pacheco said.

The program coordinates with farmers to send mobile medical and dental clinics directly to farmworkers, navigating around long work hours, and the lack of transportation and child care.

Of the 3,452 farmworkers served in Skagit and Whatcom counties by Sea Mar in 2017, about 300 of them have received medical and dental services through mobile clinics at farms and camps, and another 300 received health screenings, Pacheco said in an email. In Skagit County, 113 received medical services and 80 received dental care.

The promotores act as interpreters at these events and make presentations in indigenous languages.

“This group has just done a stellar job,” said Bobbi Ryder, CEO of the National Center for Farmworker Health. “Under Colleen’s leadership, they have grown in cultural sensitivity to ask the right questions, grown outreach, refined policies and practices. There’s a very strong commitment internally at the corporation starting at the board of directors level.”

The Promising Practices Award was given to the entire Sea Mar network, Ryder said, but the Skagit and Whatcom clinics have shown the most growth for the Migrant and Seasonal Agricultural Worker Program.

“They’re serving twice as many workers as they were four years ago,” Ryder said. “It’s possible. If this organization can double farmworker outreach, then any other could do the same.”

Ryder said it’s in the best interest for rural communities to make sure farmworkers have access to health services.

“If the workforce is healthy and able to work — that generates resources in local economies,” she said. “If you’re a consumer, an employer or a grower it’s important.”

Moving forward, Pacheco said she and her team will continue to explore the rapidly changing demographics of the farmworker community.

“This is global health on a local scale,” Pacheco said. “It’s going to be an ongoing process to identify indigenous communities and new challenges, but I feel we are making headway.”