Thursday, 17 October 2013 00:00

ETSU project could help migrant workers, rural medical clinic Featured

Written by Bryce Phillips
Many migrant workers do not see a doctor regularly, making it hard to receive proper and consistent healthcare. Many migrant workers do not see a doctor regularly, making it hard to receive proper and consistent healthcare. Bryce Phillips

The first time Santiago Funes visited a doctor in his 25 years as a migrant farm worker was after he suffered a heart attack and had to undergo open-heart surgery at the Johnson City Medical Center. Funes said he does not know what caused his heart attack, and the reason he had never visited a doctor was because he did not have transportation.

 Before his surgery, Funes did not have any kind of medical record, and the medical record he now has in East Tennessee will remain there while he travels back home to Mexico. Since Funes will not have his medical record, any doctor he sees in the future will have a hard time learning his medical history.

“For a situation like this a clinic must be responsible for identifying a patient who is a migrant or moving to different places."

                      -Ricardo Garay, Health Network manager

A non-profit organization called the Migrant Clinicians Network has a program that seeks to help migrant workers like Funes. The organization’s Health Network is an international program that stores and transfers medical records electronically.

Health Network began as an extension of a program called TBnet, which was founded in 1995 to track tuberculosis in migrant workers. Today, the goal is to make it easier to track chronic illnesses, such as diabetes, hypertension and chronic pain, so workers can have consistent health care.

In 2012 the Migration Clinicians Network reported having 1,119 patients enrolled in its Health Network. This is an 80 percent increase from its reported 620 patients in 2011.

“One of the biggest barriers to get workers registered is the communication barrier and the fact that the workers do not want to go to the clinics because they are out in the fields working.”  

                     - Kip Weaver, medical student

The manager of Health Network, Ricardo Garay, said that all patients who migrate to work are eligible. He also said that clinics do not have to meet any criteria to register patients, and that the clinics can sign patients up either by filling out the printable paperwork on the Health Network and faxing it in or by having the patient call the Health Network themselves.

According to the Migrant Clinician Network, the medical clinic must begin the registration process for the patient. Garay said this is because the Health Network must anchor the patient to the medical clinic, so the Health Network will have a starting point for obtaining the patient’s medical record.

The National Center for Farmworkers Health reports an estimated 3 to 5 million migrant and seasonal farm workers are in the United States.

“One of the biggest barriers to get workers registered is the communication barrier and the fact that the workers do not want to go to the clinics because they are out in the fields working,” said second-year medical student Kip Weaver.

Weaver and five other East Tennessee State University students are helping the Rural Medical Services in Parrottsville, Tenn., to evaluate how best to use the Health Network program.

The six students from ETSU are medical, nursing and public health students and are completing a yearlong Rural Health Research and Practice class, which is part of ETSU’s Rural Primary Care Track. The class is led by Dr. Joe Florence (pictured, right), Dr. Sharon Loury and Dr. Ken Silver.DrJoeFlorence

Florence said that the class is split into two segments, one held during the summer and one during the fall. During the 2013 summer semester the students met with members of the Parrottsville clinic and discussed the needs of the organization.

Group member Ashton Fisher said that the group chose to focus on helping migrant workers have easily accessible medical records, after meeting with Karin Hoffman, the director of the Migrant Program at the Parrottsville clinic.

“We just asked her, ‘What are some of the problems you see?’” said Fisher. “One of the things she said was a big issue was that you see the workers at the health screenings and then never have contact with them again. There really is no continuity of care with these isolated screenings.”

Fisher said that the project’s main objective is to see if it would make sense for the Rural Medical Services in Parrottsville to attempt to sign up migrant workers to Health Network during the clinic’s health screenings.  

The health screenings provide different types of medical services and are held in different places, such as  apartment buildings and farms. Many people attend the screenings and it is not clear how many of the attendees are migrant workers.

medicalnursestudentsFisher said that his group attended the 2013 screenings, and during their time there the group tried to count how many of the patients were migrant patients and would be eligible for enrollment in the Health Network program.

During the screenings the students used a questionnaire that asked if the patients migrated to work and where the patient planned on travelling to next.  The data received from the questionnaires is still being processed and analyzed.

Group member Kent Starkweather said if the data shows that many migrant workers attended the 2013 screenings then the group can inform the Parrottsville clinic that it would be a good idea to attempt registering workers with Health Network during future screenings.

Karin Hoffman said the Parrottsville clinic registered 10 people with Health Network during the 2013 harvest season. She said registration is not a difficult process, but it is time consuming. She originally wanted to sign people up during the clinic’s health screenings but due to the large amount of people who show up and the little amount of time the screenings last, she decided against it.

The 10 people who were signed up were registered during home and clinic visits.

After this semester is over the students will move on to other classes and a new group of students will come along. The new students do not have to continue the same project, but can if they choose to.

AndreAngela“Hopefully, next year, if they like this idea, then maybe they can take it a step further, and, say ok, we see now that it is feasible and that it will work. And now we can implement it or if it is not feasible, what is another way we fix the same problem?”said Fisher.

Health Network manager Ricardo Garay said if Santiago Funes would have been enrolled in the program then his current situation could have been different.

“For a situation like this, a clinic must be responsible for identifying a patient who is a migrant or moving to different places,” said Garay.  “Once a clinic does identify patient like this and the patients are enrolled with the program then we go about ensuring their continuity of care. A lot of time that could mean us scheduling an appointment for them, transferring their medical records, and setting up interpreting for the patient.”

Photos: First group photo, from left to right: Ashton Fisher, Kip Weaver and Kent Starkweather meet with other group members to discuss their project. Second group photo, from left to right: Andrea Firth, Dr. Sharon Loury and Grace McCord attend meeting to decide what needs to be done next to their project. 

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