{"id":63925,"date":"2024-04-11T15:38:04","date_gmt":"2024-04-11T22:38:04","guid":{"rendered":"https:\/\/lapost.us\/?p=63925"},"modified":"2024-04-11T15:38:04","modified_gmt":"2024-04-11T22:38:04","slug":"connecting-farmworkers-to-healthcare-in-californias-rural-north","status":"publish","type":"post","link":"https:\/\/lapost.us\/?p=63925","title":{"rendered":"Connecting Farmworkers to Healthcare in California\u2019s Rural North"},"content":{"rendered":"
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By<\/span>Peter Schurmann<\/a><\/div>\n<\/div>\n<\/div>\n
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Promotoras have emerged as an essential piece in California\u2019s ambitious plan to deliver healthcare to all residents regardless of immigration status.<\/p>\n<\/div>\n<\/div>\n

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Leer en espa\u00f1ol<\/a><\/em><\/p>\n

Above: As a promotora for Ampla Health, Maria Soto is at the forefront of expanding Medi-Cal access across six counties in California\u2019s rural north.<\/em>\u00a0(Credit: Peter Schurmann)<\/em><\/p>\n

HAMILTON CITY, Calif. \u2013 It\u2019s late February and the road to Hamilton City, an agricultural community about 10 miles west of Chico, is lined with blooming almond trees, their pink blossoms blanketing the fields for miles around. A single clinic stands in the center of town.<\/p>\n

Inside the clinic we meet Maria Soto, whose work as a\u00a0promotora<\/em>\u00a0is an essential piece in California\u2019s ambitious plan to deliver healthcare to all residents regardless of immigration status.<\/p>\n

\u201cI identify very much with the community,\u201d says Soto, 57. \u201cI worked in the fields, harvesting and sorting nuts here. So, I love it. It gives me a lot of satisfaction when someone says, \u2018Thank you for helping me.\u2019 This for me is invaluable.\u201d<\/p>\n

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As a promotora, Maria Soto (L) connects migrant farm working communities in California\u2019s rural north with newly available opportunities to gain healthcare through California\u2019s newly expanded Medi-Cal program. Here she speaks with Simon Vazquez, who leads a team of farm workers in Glenn County. (Credit: Manuel Ortiz)<\/em><\/figcaption><\/figure>\n<\/div>\n

Soto is one of four\u00a0promotoras<\/em>\u00a0(individuals who provide basic health education to the community) with the non-profit healthcare provider Ampla Health, which operates more than a dozen clinics across six counties \u2013 Glenn, Butte, Colusa, Sutter, Tehama and Yuba \u2013 in California\u2019s rural north.\u00a0 As a Federally Qualified Health Center, Ampla Health is tasked with expanding access to Medi-Cal (California\u2019s version of Medicaid) across the entirety of its jurisdiction.<\/p>\n

That job took on added importance as of January 1, when undocumented immigrants ages 26-49 became eligible for the program. Earlier expansions targeted both older adults and children. This latest phase makes California one of the first states in the country to offer healthcare to all eligible residents.<\/p>\n

With nearly 16 million enrolled \u2013 or one out of every three Californians \u2013 Medi-Cal is the nation\u2019s largest Medicaid provider. With the current expansion the state expects to add an additional 500,000 to 700,000 to its list, at a cost of some $2.6 billion per year. Medi-Cal\u2019s total annual operating budget tops $37 billion.<\/p>\n

Eligibility is based on income, with the upper limit for an individual set at $21,680 per year, with approximately another $7,100 for every additional member of the household. Medi-Cal covers medical, dental and vision services.<\/p>\n

The challenge now is making sure those communities who stand to benefit are informed about the opportunities available, which in California\u2019s far north is easier said than done.<\/p>\n

Accessing healthcare \u2018without fear\u2019<\/h2>\n

We\u2019re standing in an open field of almond trees, on a farm about 30 minutes outside Hamilton City. Around us a group of about a dozen farmworkers is gathered, all originally from the same community in the state of Puebla, Mexico.<\/p>\n

\u201cShe came and interrupted our work once,\u201d jokes Elfego Palestino Vidal gesturing towards Soto. \u201cI never enrolled before,\u201d he says, adding that in recent years he\u2019s seen more of his coworkers fall ill because of the increasingly extreme weather. \u201cSometimes it gets very cold, it rains a lot, then it gets very hot.\u201d Having access to Medi-Cal will \u201chelp a lot,\u201d he says.<\/p>\n

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Elfego Palestino Vidal (foreground) says he\u2019s seen more of his co-workers fall ill of late due to the extreme weather. (Credit: Manuel Ortiz)<\/em><\/figcaption><\/figure>\n<\/div>\n

Famed for its sprawling forests, towering peaks and rugged coastline, the North State, as it\u2019s known \u2013 stretching from the Oregon border in the north to just above Sacramento farther south \u2013 is beset by some of the state\u2019s most glaring health disparities, from higher rates of poverty and premature death to substance abuse, and behavioral and mental health challenges.<\/p>\n

Much of the region is also designated as a Health Provider Shortage Area (HPSA), meaning fewer healthcare resources per capita. For marginalized communities, including many of the farmworkers interviewed for this story, that creates additional barriers to accessing care.<\/p>\n

Another farmworker, Leonardo Hernandez Mesa, a husband and father of two, describes how he put off visiting the doctor in the past when he fell ill. He points to his throat and ear as he recalls a recent bout of infections. \u201cEmergency visits are too expensive,\u201d he says, noting that his brother \u2013 also a farmworker \u2013 has Type 1 Diabetes.<\/p>\n

\u201cThis is a great opportunity to get health insurance without fear,\u201d says Hernandez, adding that it will allow people to detect health issues earlier rather than later. He says he\u2019s often heard others talk about putting off hospital visits.<\/p>\n

A\u00a0study from UC Merced<\/a>\u00a0last year found that nearly half of all farmworkers in California lacked health insurance at some point over the previous 12 months. The study also found that just 43% of farmworkers had visited a doctor\u2019s office while only 35% had been to a dentist. Other studies have found a stark disparity in access to mental health and other behavioral services for farmworkers in particular.<\/p>\n

Simon Vazquez, who has worked at the same farm in Hamilton City for over two decades and is the foreman here, hasn\u2019t seen a doctor since 2018. He peppers Soto with questions about where and how to contact her, whether he needs to renew every year (you do), and what he needs to bring for a medical or dental visit (a photo ID and Medi-Cal card).<\/p>\n

\u201cWe\u2019re here to help you with whatever questions you have. You have my information, you have my phone number,\u201d she says patiently.<\/p>\n

Reaching the \u2018hardly reached\u2019<\/h2>\n

\u201cA big part of my day is driving around looking for farmworkers,\u201d explains Soto, who came to the US as an undocumented immigrant herself in 1991 and spent time working in the almond fields surrounding Hamilton City. In 2007, she began working with Ampla Health, then known as Del Norte Clinics, after a chance meeting with the organization\u2019s\u00a0promotora<\/em>\u00a0coordinator at a local Mexican eatery.<\/p>\n

\u201cShe asked me what I knew about being a\u00a0promotora<\/em>. I told her I didn\u2019t know anything.\u201d Soto eventually applied, was given training, and has been committed to\u00a0promotora<\/em>\u00a0work ever since. \u201cI\u2019ve fallen more in love with the work as the years have passed,\u201d she says.<\/p>\n

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Soto says a big part of her day involves driving sometimes long distances looking for farmworkers. Soto is one of four promotoras employed by Ampla Health covering six counties. (Credit: Peter Schurmann)<\/em><\/figcaption><\/figure>\n

The\u00a0promotora<\/em>\u00a0model was first developed in the northern Mexican city of Ciudad Juarez in the early 1970s as a way for the city government to deliver healthcare and related information to marginalized communities. The model soon spread across Latin America, later making its way into the US.<\/p>\n

It\u2019s unclear how many\u00a0promotoras<\/em>\u00a0are currently working across California. Some, like Soto, are employed directly by healthcare providers or community organizations. Others work in more informal capacities. The advocacy group Visi\u00f3n y Compromiso, which launched the state\u2019s first network of\u00a0promotoras<\/em>\u00a0in 2001, claims some 4,000 members across 13 regions of California, almost all of them in the southern and central parts of the state where population numbers are larger and overall demand for services greater.<\/p>\n

According to data from UC Davis\u2019s Center for Reducing Health Disparities, there are an estimated 10,000 farmworkers across the six counties served by Ampla Health. If their family members are included, that number jumps to nearly 30,000 individuals. While it\u2019s unclear how many are undocumented, data shows that nearly three quarters of the more than half a million farmworkers in California lack documentation.<\/p>\n

Dr. Sergio Aguilar-Gaxiola, who heads the Center for Reducing Health Disparities, calls these communities \u201chardly reached,\u201d and says local and state agencies have to be proactive in terms of getting the word out. \u201cI\u2019m not sure if they will take advantage of this ,\u201d he said during a recent Ethnic Media Services briefing. \u201cIt depends on how you communicate.\u201d<\/p>\n

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