Essential Care for Essential Workers

One of the many farmworkers congregating near a white tent for her health care appointment is Yunuen Lira, who waits with a family member. Her work shift, weeding chili pepper and tomato fields, began at 4:30 a.m. and ended by 12:30 p.m., giving her time to slow down and clean up before her visit to the pop-up clinic at the housing center where she lives. 

“Since we’re working all day, it’s nice to have clinic services on site,” says Lira in her native Spanish. This is Lira’s sixth season migrating for seasonal agricultural work to Yolo County from her home in Guanajuato, Mexico. When here, Lira, her husband, and their two children find seasonal housing in the Madison Migrant Housing Center, just east of Esparto. Although people like Lira were deemed “essential workers” by the government during the public health emergency, farmworkers’ well-being has long been an afterthought in the U.S.

Along the perimeter of the housing center in Madison, children ride around on bikes while community health workers greet and assist their parents and grandparents. A grandmother receives help completing enrollment forms while her daughter-in-law discusses with staff how the record rains have delayed the planting season. A middle-aged man receives a bottle of water and peeks inside a cooler full of meals on offer, which have been made from scratch by volunteers at partner organization, Heart of Davis. For migrant workers with often limited or no access to traditional health care forms, these onsite services are a literal lifesaver.

“It’s very hard work, and lots of the workers are 60 to 70 years old and still doing the work,” says Lira, who, at age 28, is one of the younger workers. “With all the rain this year, the chemicals aren’t as effective at controlling pests as normal, so that means more work for us.” CommuniCare Health Centers’ Mobile Medicine team visits each of three Migrant Housing Centers monthly during the six months that the centers are open. Operated by Yolo County Housing Authority, the centers offer several hundred units of significantly subsidized housing to families who earn at least 50 percent of their total income from agricultural work. Prior to 2022, local health care organizations offered occasional screening and health education events at the centers, but provider visits were only available at clinics located 20 to 45 minutes away. When working for as long as 10 hours, it was difficult for farmworkers to get to a clinic, and insurance coverage and fees posed additional barriers to access. 

At the monthly pop-up clinic, farmworker families meet with primary care providers for a variety of concerns and can get prescriptions for pharmaceuticals as needed. A health coach offers pregnancy and sexually transmitted infection testing and counseling, a client benefits advocate helps people apply for health insurance and CalFresh food assistance benefits, and a diabetes educator provides blood sugar testing equipment and counseling. Most members of the team are native Spanish speakers, and some are members of farmworker families. 

At peak growing season, roughly 500,000 to 800,000 farmworkers reside in The Golden State. This represents nearly half of all U.S. farmworkers. About 6,000 of the workers in California are in Yolo County. The median age of California farmworkers increased by nine years to age 41 between the time of a 2021 University of California, Merced survey and similar survey conducted more than 20 years earlier. The 2021 study also found that diabetes, anxiety, and depression are more common among California farmworkers than among other Californians.

Rates of diabetes were especially concerning and ironic, considering that California’s farmworkers are growing the very fruits, nuts, and vegetables that support blood sugar management. About 22 percent of survey respondents tested positive for this chronic, diet-related condition, an amount that is double the national average and at least 5 percent higher than that of Americans with Mexican ancestry. 

“Some farms won’t let us take produce, even if it’s just going to rot in the fields,” explains Lira. “Others encourage us to glean vegetables, but we’re often so tired and ready to get home to the kids by the end of the day that we don’t want to stay any longer.” 

The COVID-19 pandemic exacted an especially brutal toll on essential workers in food and agriculture. Working remotely was not possible, many workers were not provided with personal protective equipment like masks, and a lack of paid time off led some to go to work sick, imperiling those who worked alongside them. In October 2021, sup-port from Sutter Health, Dignity Health, and Yolo County Health and Human Services Agency enabled the Mobile Medicine team to offer regular services at sites including the migrant housing centers.

“These services wouldn’t be available if CommuniCare hadn’t been open to the opportunity,” says Suzanne Portnoy, DNP, FNP, the Associate Director of CommuniCare’s Mobile Medicine team. 

Dr. Daniel Trevizo, MD, who practices family medicine, sees patients at the Dixon Migrant Housing Center. “Our training included giving back to the community, seeing patients who would otherwise not be seen,” Trevizo says. “This is our community, and we’re bringing services right to people’s homes.” 

CommuniCare’s clinics run from 4 to 8 p.m., so services are available after residents get off work. On this day, a woman meeting with the diabetes educator gets a hemoglobin A1C test to determine her average blood sugar value over the previous three months. The instant result comes back at 6.7 percent; a value of 6.5 percent or greater indicates diabetes. While the results are not what she had hoped for, the information and follow-up sup-port from the diabetes educator will help her manage the condition so that she can continue to live a healthy life. She takes a meal from the cooler on her way out of the clinic, as staff start breaking down their stations and wrap up appointments with the last few patients. Not long after the health care workers leave for the night, farmworkers will prepare to return to the fields. 

The existence and availability of the vast majority of fruits, vegetables, and dairy products in the U.S. rely on the labor of farmworkers. Thus, good health of those like Lira and others un-der the care of Dr. Trevizo and Portnoy — the people who plant, cultivate, and harvest fruits and vegetables — is essential to an ethical and sustainable food systems.