In A Border Region Where Immigrants Are Wary, A Health Center Travels To Its Patients

Apr 6, 2018
Originally published on April 26, 2018 9:40 am

Our Take A Number series is exploring problems around the world through the lens of a single number.

It's about 7 p.m. on a chilly night, and Sirene Garcia is standing outside an apartment building about an hour's drive from Rochester, N.Y.

Even though Garcia has had a cold for the past few days, she has her laptop perched on the hood of her car, trying to test out the new telehealth program. Once the program kicks off, Finger Lakes Community Health's doctors and nurse practitioners will be able to see patients at their homes through video calls.

And there are a lot of patients who could use this: The center serves some 9,000 farm workers in this region near the Canadian border.

But all of that depends tonight on whether or not Garcia, the center's special programs director, can find a decent Internet connection.

"Can you hear me OK?" Garcia says to her laptop, garbled sound spitting back at her through the speakers. She's on a video call with one of her colleagues who's based at one of FLCH's eight locations.

The Finger Lakes region, well-known for its rolling farmland and vineyards, is also home to a diverse and sizable refugee and immigrant population.

Most of the challenges that plague FLCH revolve around place, and the issue of spotty cell and Internet service is no different. The rural communities FLCH serve include Mennonites, refugees from Burma and immigrants from China, Saudi Arabia, Haiti and Mexico. Yet being in rural places means potential patients may often be isolated, low-income and not have easy access to transportation — and therefore difficult to serve.

Mary Zelazny, the health center's CEO, says they've come up with a variety of approaches to trying to crack the location puzzle, including providing transportation to patients, and providing "in-camp" services, where doctors or nurse practitioners visit patients' homes, often accompanied by translators or community outreach workers.

Including the farm workers, the organization serves about 27,000 patients overall.

And in a region so close to the border, a big fear for many of the farm workers is the heavy presence of the Border Patrol. Many fear being out on the roads for things like going to the doctor, so the telehealth clinic offers a chance to reach them in a safe place.

"We just have more presence here of border patrol," Zelazny says. "I don't ask any patients that come into my health centers what their immigration status is, because I don't care. My job, and my team's job, is to make sure that we give them the best healthcare they can get."

The organization's eight clinics are within 100 miles from the Canadian border. By U.S. law, Border Patrol can board — and search — any vehicle within a "reasonable distance" of the the border.

And so if the patients can't get to health care, Zelazny says, then the clinic will come to them.

One the patients being served tonight is Pablo Lopez, 42, who came to the U.S. from Oaxaca two weeks earlier on a temporary work visa. Lopez, who's been to the U.S. seven times in as many years, said that when he first came, he was worried. On TV, he'd seen reports about immigration, the police and language barriers that were alarming.

Zelazny says that, throughout the years, even her own staff — many of whom are people of color — have been stopped by agents. And for a lot of farmworkers, regardless of their citizenship status, any run-ins with law enforcement cause a lot of anxiety.

"You know, there's just this fear factor that makes everything harder," Zelazny says. "They don't know what's going to happen to them. You hear a lot of stories, and they may not be true, but some of them are."

At a training for the new pilot telehealth program earlier in the day, Terri Hannon, a nurse practitioner, says she was at a dairy farm recently, giving vaccinations. A farmer came up to her, Hannon recalls, "and he stated that his farm workers are very frightened and won't leave the farm at all — not to go to the grocery store, or Walmart or medical appointments."

Hannon's and her colleagues have heard similar things from patients they've visited.

Orlando O'Neill, one of the health center's outreach coordinators, thinks the new video program will help.

"They're afraid to come health center — even if they're sick or ill," O'Neill says. "This will be a good tool for them."

The program will eliminate the need to travel at least an hour to the health clinics, and it'll keep the patients from having to take time out of their days.

Sara Rosenbaum, a professor of health law and policy at George Washington University, points to the public health issues at stake: "Keeping your patients feeling that they can trust that using the health center services will not expose them is a huge, huge challenge."

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Our Take A Number series is looking at problems around the world and solutions through a single number. And today's number is 9,000. That's how many farm workers are getting health care thanks to a nonprofit in upstate New York. Many of these workers are immigrants living close to the Canadian border. Some don't like to drive and risk running into the Border Patrol. So if they can't get to the clinic, the clinic is coming to them. NPR's Kat Chow explains.

KAT CHOW, BYLINE: We're in a rural town in Yates County, about an hour's drive from Rochester, N.Y. It's around 7 p.m., dark out. Sirene Garcia's laptop is on the hood of her car.

SIRENE GARCIA: So the problem is that there's very poor Internet connection inside.

CHOW: Garcia is the director of special programs at Finger Lakes Community Health, a network of health centers in the region. Right now, Garcia is trying to find Internet service to test out a video call for the center's pilot telehealth program. Good Internet service means a doctor miles away can talk to a patient about his or her health concerns on video.

GARCIA: Can you see me OK?

CHOW: Inside the apartment are half a dozen or so people, most of them farm workers. They're standing around a small kitchen next to a shelf filled with cans and bags of food. Some of Garcia's colleagues have set up a makeshift doctor's clinic. They're meeting their patients for the night.


CHOW: Pablo Lopez is one of the people who lives here, and he's getting a checkup. Two weeks ago, he came here from Mexico on a temporary visa to work on a vineyard. He's come to the U.S. for this sort of work seven times over just as many years. And when he first got here, he was worried. He'd seen TV reports about immigration, the police.

PABLO LOPEZ: (Speaking Spanish).

MARY ZELAZNY: We just have more presence here of Border Patrol.

CHOW: This is Mary Zelazny. She's the CEO of Finger Lakes Community Health, which serves about 27,000 people total in the region. She championed this new in-camp video call idea. The organization's eight health clinics are within a hundred miles from the U.S.-Canada border, which means a lot of these farm workers are afraid to get on the roads. Many of them are people of color or immigrants. And regardless of their citizenship status, any run-ins with law enforcement can cause a lot of anxiety.

ZELAZNY: I don't ask any patient that comes into my health centers what their immigration status is because I don't care. My job and my team's job is to make sure that we give them the best health care that they can get.

CHOW: Earlier that day, I went to a training for the new telehealth program. So far, besides concerns about getting Internet service to actually make the video calls, it's working. Orlando O'Neill is one of the outreach coordinators, and he thinks the program will address a lot of the fear.

ORLANDO O'NEILL: They're afraid to come to a health center even if they're feeling sick or ill. This will be, you know, a good tool for them to - better health care.

CHOW: That is, if they can get decent Internet. Back at the apartment building, Sirene Garcia fiddles with her laptop and a portable Wi-Fi hotspot.

GARCIA: So it says that we have excellent service right now. So I'm going to try to walk into the house and see what happens.

CHOW: She carries her gear into the apartment, slowly watching the laptop screen.

GARCIA: When we come into the building, the call disconnects.

CHOW: The pilot program still has some things to work out before launch. Tonight, a nurse practitioner checks 42-year-old Pablo Lopez's vital signs the old-fashioned way.

UNIDENTIFIED PERSON: One-twenty-two over 84.

LOPEZ: (Speaking Spanish).

CHOW: Kat Chow, NPR News, New York. Transcript provided by NPR, Copyright NPR.