Clinic on wheels provides health care for Maine’s migrant workers

COLUMBIA, Maine — Meeting the medical needs of migrant farm workers is as much about education as hands-on care, says Dr. Cheryl Seymour, an Augusta family practice physician who serves as the medical director for the Maine Migrant Health Program.

“For some of the population of farm workers, we are their primary care home,” said Seymour, who will be spending most of this month overseeing clinical care services being offered to the migrants who stream into Washington County every summer to harvest the region’s thousands of acres of wild blueberries. “Many of these people never see a doctor somewhere else. So we try to educate them about managing chronic problems like hypertension, diabetes and asthma.

“I can give someone a bottle of hypertension meds, which will last for 30 days,” she said. “What’s more important is being able to teach them about managing high blood pressure by stopping smoking, eating less salt or exercising. I know that managing chronic diseases in a four-week setting is kind of crazy, but that’s what these people need.”

Seymour said her professional interaction with farm workers reminds her that health is a reflection of a 24/7/365 lifestyle, a basic realization that she says can slip away in a more pristine clinical setting.

“So much about health is not about the numbers — what your blood pressure is or the dosage of your prescription — but about how people live,” she said. “Life, social context and work impact people’s lives. It’s easy in an office setting not to focus on that. But when you see these people work, see the mechanics of how their bodies work, see the social context they live within, you cannot ignore it. It’s right in front of you.

“We are meeting their needs in a very fundamental but functional way that gives them more independence,” Seymour said Thursday between patients at a clinic on wheels parked by day at the Rakers’ Center established each harvest season on Epping Road, two miles north of the Washington County community of Columbia. “These are people who are completely neglected by society. They are also the people who harvest our food, and helping them deal with their medical needs is the least we can do.”

Seymour is quick to note that the care the Maine Migrant Health Program provides throughout the state each year to about 1,200 seasonal farm workers who harvest blueberries, apples and broccoli is not charity care. Although most costs of equipping and staffing mobile clinics is underwritten through federal funding, all patients are asked to contribute to the cost of their care, depending on their financial circumstances.

“People pay for their visit and their prescriptions as they are able, and many people do pay,” Seymour said. “They want to pay for their care. They don’t want free care.”

Between paid and volunteer staff, the medical team that Seymour oversees numbers between seven and 10, some of whom spend the monthlong harvest season in nearby rental housing. Three mobile units traverse the blueberry barrens in the evenings, when raking is done for the day. On Wednesday, the Rakers’ Center clinic saw only 12 patients during daylight hours, but that night, after setting up at the Wyman’s migrant housing complex in Deblois, the staff addressed the needs of at least 30 workers.

Most everyone on the medical staff speaks Spanish. A bigger language barrier problem faces health care workers who are treating the growing number of Haitian rakers, who speak Creole. Only one staffer speaks that language, which is a blend of French and Spanish, so phone-based interpreters are sometimes used.

This is Seymour’s eighth year of involvement with the program, the first four served as a volunteer. A native of Maryland, Seymour attended medical school in New Hampshire and now sees patients and teaches at the Maine/Dartmouth Family Medicine Residency program in Augusta, where she was once a student physician.

“This is my second job,” she says of her work with the migrant clinics. “I love doing this, getting to work with an incredible team and to interact with patients who are so appreciative. Providing care to people who otherwise have no access to care gives me a sense of mission. It’s important to me to be serving these people who are doing incredibly difficult work under incredibly difficult circumstances.”