Jewell and patient on desktop

Dr. Emily Jewell, who volunteers with the Community Connections Free Clinic in Dodgeville, Wisconsin, examines the abdomen of Orvilio Lopez, a worker at Cottonwood Dairy near Wiota, about 50 miles southwest of Madison, Wisconsin. The free clinic started bringing staff and supplies on a bus this past fall to farms to provide care for workers without insurance.

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WIOTA, Wis. – A farm worker examined by Dr. Emily Jewell had persistent back pain after he was kicked by a cow. Another had an ear infection and a rash.

A man complained of tenderness in his abdomen, prompting Jewell to clear a desktop in the Cottonwood Dairy office to ask him to lie down. It was her makeshift exam room for the day. As she felt his sore area she didn’t detect anything suspicious. But a test later found blood in his urine.

“This is concerning,” she said. “We’re going to have to check it out further.”

She was seeing patients as part of the Community Connections Free Clinic based in Dodgeville, Wisconsin. Jewell finished her family-medicine residency at the University of Wisconsin-Madison two years ago after graduating from an osteopathic medical school in Florida. She grew up on a hog farm between Dodgeville and Mineral Point, Wisconsin.

Her regular job is at the SSM Health clinic in Dodgeville. She has treated patients without insurance since 2006, but now Community Connections Free Clinic is bringing its services to southwestern Wisconsin farms.

The clinic is using an old Head Start bus that has been repainted and repurposed as a “free clinic on wheels” – with the apt acronym FCOW. Clinic staff and volunteers visit farms about once a month to offer basic checkups and treatments. Most of the workers they visit are Hispanic – Spanish-speaking and uninsured.

Jewell taking supplies from bus

Jewell unloads medical supplies from an old Head Start bus now used a "free clinic on wheels."

“We’re trying to make sure people are taking care of themselves,” said Rebecca Steffes, nurse manager at Community Connections. “Our goal is to do screening exams like what we would do in the clinic, to find chronic diseases.”

They check for diseases such as high blood pressure and diabetes, said Jewell, the main doctor involved.

“If we treat them, maybe 20 years from now they won’t be having heart failure or losing toes,” she said.

Jewell with Cristina

Dairy worker Cristina Castillo talks to Dr. Emily Jewell about an ear infection and a rash on her back. 

Wisconsin has about 24,000 farm workers. More than half of those who work full-time are Hispanic, according to the University of Wisconsin-Center for Dairy Profitability. It’s not clear how many are immigrants, uninsured or undocumented. Nationwide more than half of farm workers are immigrants, according to Texas A&M University. About 24 percent are unauthorized, according to the Pew Research Center.

Some migrant workers qualify for Medicaid. On farms in Wisconsin 29 percent of farm owners say they offer insurance to workers, according to the dairy center. But many workers don’t qualify. Plus coverage can be costly and farm schedules can create difficulties for travel to clinics, Steffes and Jewell said.

Farm outreach necessary

Community Connections is the only one of Wisconsin’s 100 or so free or charitable clinics known to be doing outreach to farms, said Connor Dopler, manager of the Wisconsin Association of Free and Charitable Clinics. Wisconsin clinics in Boscobel, Richland Center and Sauk Prairie treat immigrant farm workers on-site but don’t do outreach to farms, clinic leaders said.

UW-Eau Claire nursing students visit dairy farms to deliver health screenings and immunizations as well as health and safety education to farm workers. Many of the workers are from Mexico or Central America, said Lisa Schiller, an associate professor of nursing. The Rural Health Initiative, a nonprofit in Shawano, Wisconsin, offers health screenings and health coaching at farms in Outagamie, Shawano and Waupaca counties. A quarter of the patients there are Hispanic, said Rhonda Strebel, executive director.

The Multicultural Outreach Program in Dodgeville offers English classes and other services to immigrants. Staff there helped the free-clinic staff connect with area farms interested in providing health services on-site. The multicultural program is part of the Southwest Wisconsin Community Action Program, which donated the bus used to carry providers and medical supplies to the farms.

“We try to create a welcoming community (for immigrants, who are) very necessary to the farming industry – and the dairy industry in particular,” said Shirley Barnes, chair of the multicultural program. “They have other needs, among them a need for access to affordable health care.”

Community Connections has made six visits to four farms. Staff have seen about 40 patients, all of them native Spanish speakers, Steffes said. About three-quarters are men.

Steffes and Paniagua

Rebecca Steffes, nurse manager at Community Connections Free Clinic in Dodgeville, tells Roberto Paniagua, a worker at Cottonwood Dairy, that he should go to the county health department for immunizations.

Many have high blood pressure or diabetes, Jewell said, or a family history of those conditions. Others have acid reflux or chronic pain.

“I wish we had access to physical therapy,” she said.

At a visit this past month to Cottonwood Dairy, clinic staff cared for eight patients. Tirso Salazar, 26, who was kicked by a cow while it was giving birth, said he had back pain despite taking an anti-inflammatory medication and a muscle relaxant. Jewell, who speaks Spanish, discussed with him the proper way to lift as well as encouraged him to rest for a few days if possible.

Jewell on the bus

Jewell says she wants to provide health care at farms, where many workers are uninsured immigrants, because she grew up on a hog farm near Dodgeville and married a man from Honduras. "It pulled on my heartstrings," she said.

Jewell gave antibiotics and fungal cream to Cristina Castillo, 31, for ear and fungal infections. She also suggested over-the-counter remedies for Castillo’s allergies.

For Orvilio Lopez, 34, who was worried about his abdominal pain, Jewell ordered urine and blood tests. She arranged to see him again when the bus returns to the farm. After learning he smoked, she encouraged him to quit; she talked about nicotine gum and patches.

Roberto Paniagua, 33, asked about taking melatonin to sleep. He also asked where to obtain immunizations against flu and tetanus. Steffes, who also speaks Spanish, told him to visit the county health department for vaccinations.

Paniagua thanked the free-clinic team for their help.

“It’s necessary,” he said.

Health-care help needed

At an earlier visit to another farm, a patient was suspected of having active tuberculous. That’s a significant public-health concern because it’s extremely contagious. He was hospitalized and treated for tuberculous, though he was later found to have had a different infection. Farm workers who require ongoing treatment are asked to come to the regular free clinic in downtown Dodgeville, which is open Tuesday and Thursday evenings.

Jewell with patient with back to camera

Jewell examines Tirso Salazar, a worker at Cottonwood Dairy, who said he had pain after being kicked by a cow while assisting in the birth of a calf.

Jim Winn is co-owner of Cottonwood, which has 1,800 cows and 31 workers. He said the farm offers high-deductible insurance to employees. But when he posted a registration sheet for the free clinic’s visit he realized how valuable the service is.

“The slots filled up immediately,” he said.

Jim Winn

Jim Winn is the co-owner of Cottonwood Dairy near Wiota, Wisconsin.

Jewell is married to a man from Honduras who was undocumented while living in the United States for many years.

“I was well-acquainted with the plight of these folks trying to get health care,” she said. “This is a way to go out and take care of the people we know aren’t coming in.”

Visit ccfcwi.org for more information.

This article originally ran on agupdate.com.

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