On rural Monroe County roads usually reserved for tractors, pickups and Amish buggies, an out-of-place, though welcomed, vehicle ambles through the rolling hills. It pulls into gravel driveways of preselected farms, swings its doors open, and invites the laborers – typically migrant workers from Central America – to come inside if they’re suffering from any sort of physical ailment.
Last fall, physicians and residents from Gundersen Health System joined St. Clare Health Mission in providing healthcare services on location with St. Clare’s Rotary Mobile Clinic, a full-scale, full-service family medicine unit that was unveiled in August. Its purpose was to better equip the two organizations to meet the needs of La Crosse’s unsheltered population, which it’s visited on a weekly basis since 2020.
But that team discovered another need – one of those living and working in rural areas who are new to the healthcare system in the United States and face several barriers to receiving much-needed treatment. So, beginning in October, the team set out for the country two Fridays each month – which they call Fridays at the Farm – rotating stops between several farms in Gundersen’s service area that employ a predominantly migrant workforce.
Led by Sarah Brown, MD, the attending physician and program coordinator, and joined by resident physicians from Gundersen’s Family Medicine Residency Program and St. Clare executive director Jason Larsen, the team sees anywhere from four to 15 patients each visit, providing acute care services and disease management services, including things like diabetes and cholesterol level checks. They also handle the unexpected injuries that occur while working on a farm.
“Musculoskeletal injuries have been pretty common,” Dr. Brown says. “We’ve had other unique cases like rare neurologic conditions and a number of chronic conditions, too.”
She says many of the rural patients they encounter have access to care at their local hospital or clinic, but predominately on an emergency basis. The idea behind the visits is to treat a condition early on in hopes of avoiding those trips to the emergency room.
“We’re getting to know a lot of people gradually,” Dr. Brown says. “We try to keep people connected to health systems or build a bridge back to healthcare, if possible.”
But that’s not the program’s only objective. As a training tool for residents, they’re able to work in a setting that helps foster a deep understanding of the social determinants of health – those constraints in a person’s day-to-day life that limits their access to the healthcare system.
“It forces us to be creative in using our knowledge and skill set to select appropriate medications and appropriate plans of care, considering those constraints,” Dr. Brown says. “There are a lot of people in marginalized communities for whom best practices care in medicine can’t apply because they’re not able to form their life around the treatment plans we’re trying to create.”
Second-year resident Kate Edsall, MD, made her second trip to the Farm on Dec. 2. She was on a rural surgery rotation, which allowed her time to accompany Dr. Brown and the mobile medicine team on the visits. For her, rounds at the farm allow her to get to know people in the community who she wouldn’t otherwise see.
“This is our community,” Dr. Edsall says. “This is a part of our community, but when we stay in the walls of our clinic, we don’t always see all of that. We kind of have to scratch below the surface a little bit.”
She says the people she sees do an admirable job of taking care of themselves, despite the barriers to healthcare they face.
“A lot of the patients here, they’re very proactive about their care, they’re very aware of family history,” Dr. Edsall says. “Being able to bring care to people and help to break down some of those barriers is a really neat opportunity and what we should be doing if we want to have healthy communities.”
This work, Dr. Edsall says, helps remind her of why she got into medicine.
“Most of us, especially in Family Medicine, got into this because we care about healthy communities and helping everyone get good healthcare and bridge those gaps in healthcare inequities,” she says. “It helps bring you back to your purpose and fuel you throughout the rest of your difficult rotations and difficult things we’re doing throughout our training. It’s very grounding.”
As an organization, Gundersen makes caring for people and their communities a top priority, and as members of the community, farm laborers deserve that same care.
“We view healthcare as a basic human right,” Dr. Brown says. “Not only is caring for people morally the right choice, but our hope is also that caring for people with regularity can help prevent complications from diseases long term, prevent overutilization of emergency services and even reduce hospitalization rates.”
Thanks to the fundraising efforts of the Gundersen Medical Foundation, this mobile medicine work will continue through May 31, 2024. However, the need is ongoing. If you’d like to contribute to the program, go online to foundation.gundersenhealth.org/donate-now, select “other” in the dropdown menu and reference mobile medicine, or stop in the Foundation office at 201 Third St. N.
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