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In the Field with the South Georgia Farmworker Health Project

At first, the field is quiet. Patches of trampled grass and a few faded tire tracks are the only hints that something is about to happen.

Fifteen minutes later, the field is completely transformed into an open-air, rural health clinic. Brightly colored tents and striped umbrellas shelter makeshift screening rooms from the rising sun. Students and supplies spill from large, white vans, ready to serve the farmworkers who have gathered to visit the clinic.

For many, the morning shift is short. Once the sun is high enough in the sky to dry the dew, the farmworkers head off to begin picking bushel after bushel of crops from the surrounding fields. When they return home at sunset, it all begins again.

For the last 18 years, the South Georgia Farmworker Health Project, a collaborative service-learning endeavor of the Emory School of Medicine Physician Assistant (PA) Program, has been providing healthcare to migrant farmworkers and their families free of cost. Students from across the School of Medicine, including the MD and Physical Therapy (PT) programs, also participate. For two weeks each June, student and faculty volunteers set up outdoor clinics in Valdosta and Bainbridge, Georgia, providing one of the few opportunities these men, women, and children have to receive safe, quality healthcare.

The demand for healthcare is high.

This year alone, the Farmworker Health Project saw 1,383 adults and nearly 230 children. When they arrive at the clinic, the farmworkers are matched with a translator and a PA student who take a thorough medical history and perform a physical exam. Depending on availability, an MD or PT student may also be a part of this initial consultation. Each patient receives a hygiene kit with items such as a toothbrush, toothpaste, washcloths, fungal foot powder, and whatever else the volunteers can collect throughout the year.

The setting is rustic, but the quality of care is high. The limited nature of the pop-up clinic forces the students to “really use their eyes and ears,” said Karen Newell PA-C, MMSc 89A 06A, Instructor and Academic Coordinator of the PA Program. Instead of ordering complicated blood work or an expensive test such as an MRI, the students focus on the fundamentals of history taking and a thorough physical exam. It teaches them they “don’t have to have all that ‘stuff’ to make a difference in people’s lives,” said Newell.

The Farmworker Health Project “is a large reason why many students come to the [Emory PA] program,” remarked Alex Cornwall, a third year PA student and student co-representative of the project. This year, a 45-year-old farmworker had his blood pressure taken and his heart listened to for the first time in his life. “Every now and then you need to have an experience like this. It really grounds you and reminds you why you’re doing it,” said Cornwall.

Many of the workers suffer from ailments caused by prolonged exposure to the elements and musculoskeletal problems brought on by the repetitive nature of their work. Michael Rothschild, a fourth year medical student, said that a quarter of the workers he screened had pterygium, a benign callus on the eye that is often seen in people who spend a lot of time outside. It is completely preventable with protective eyewear. But many of the farmworkers can’t wear sunglasses because it distorts their perception of color, which is how they determine if certain crops are ripe. To work around this, the Farmworker Health Project donated 1,000 pairs of clear, UV-blocking glasses to help prevent pterygium. This way they can still “pick a blueberry at just the right shade of blue,” said Rothschild.

The clinics are staffed primarily by the students and faculty of the PA Program, but there is growing support from other divisions, schools, and the local communities. MD and PT candidates from Emory, as well as PA students from Mercer University and Marriage and Family Therapy students from Valdosta State University, were on hand this June to offer their services. Many of the workers hail from Spanish-speaking countries such as Mexico and Guatemala, so volunteer translators are recruited from Atlanta and the surrounding communities.

For many students, this is the most immersive example of Interprofessional Education—or IPE—they will receive during their training. “Healthcare is delivered by a team of people,” said Douglas Ander, MD, Assistant Dean of Medical Education. “Everyone needs to understand each other’s roles and how it all fits together.”

This team-based approach is highly effective. For example, a pairing of a PA and PT student was assigned to examine a farmworker who presented with chest pain on his right side. After a comprehensive physical exam and history, the PA student ruled out any cardiac problems, but wasn’t able to determine the cause of the pain. The PT student took a very different approach to interviewing the patient and discovered that the farmworker spent his days picking grapes—using only his right arm. The students were then able to quickly diagnose the pain as a simple pectoral strain. Unfortunately, the standard treatment of rest wasn’t an option. However, they were able to recommend that he switch arms throughout the day to reduce the repetitive stress he was putting on his right side. It was a “really great ‘a-ha’ moment for me as a professor,” said Sara Pullen, DPT, MPH, a professor in the PT Program. “It’s the direction that healthcare is and should be going.”

The participating students agree. “[It] really has changed the way I feel like I can interact with other healthcare providers,” said Rebecca Russ, a fourth year MD/PhD student. Russ worked in both the Valdosta and Bainbridge clinics this year and screened 180 children for eye problems. With the help of Lions Lighthouse, 27 children received free prescription glasses.

In addition to honing their clinical skills, the students get a first-hand look into the challenges facing people of lower socioeconomic status in our society. Although they spend their days picking fruits and vegetables, the farmworkers subsist mainly on a diet of tortillas and beans. They rarely have the chance to eat the more healthful crops they pick with their own hands. Since they are paid at such a low rate—often based on how many pieces they pick each day—grocery stores are able to offer produce at a “fair” price.

Alisha Smith, who coordinates the project, is reminded of its importance every time she shops for groceries. “When I look around the market, I go in with a different perspective now. Do people realize every piece of produce was touched by a farmworker? It didn’t just fall into the grocery store. It’s not mechanized. It’s brought to you by folks just trying to make ends meet.”

The Farmworker Health Project is planning a follow-up trip this fall and is already preparing for next summer’s clinics. If you are interested in volunteering as a clinician or translator, or if you would like to donate supplies for hygiene kits, please contact Alisha Smith at 404.727.6182 or asmit30@emory.edu.

Teen Corps of South Georgia Farmworker Health Project

With the help of an interpreter, David Bruce 13A (middle)  demonstrates his interview technique for a Teen Corps of South Georgia Farmworker Health Project mentee. Photo by Craig Krupansky 13A

Rose Musille

Mercer University PA graduate Rose Musille and Emory Healthcare PA-C Christiane French providing on-the-spot treatment. Photo by Randy Bundschu 73OX, 78A