Physical therapy program provides care to migrant farmers at health clinics

Students and faculty from the Doctor of Physical Therapy (DPT) Program in the College of Agriculture, Health and Natural Resources (CAHNR) have been volunteering since 2008 to help bring health care to Connecticut’s migrant and seasonal farm workers, a medically underserved population.

Photo credit: Yasmeen Alsaqri

Every year thousands of migrant agricultural laborers journey to Connecticut to work at the state’s farms, orchards, nurseries and greenhouses. These temporary farm workers help plant, grow, harvest and produce a wide range of the state’s labor-intensive agricultural commodities, including tobacco, ornamental flowers and plants, fruits and vegetables, and poultry and dairy goods, supporting the state’s $4 billion agricultural industry. Most seasonal workers arrive from Mexico, Central America, the Caribbean islands and other states with large agricultural operations, such as California, Florida and Texas. For the past twenty years, farmers in the Northeast have reported hiring more migrant employees as the ability to find local, native workers has declined. It is estimated that over 7,000 seasonal farm workers are employed in the state. They are predominately male, widely varying in age from teenagers to the elderly; some workers are in their sixties and seventies. Without this workforce, Connecticut agricultural producers face labor shortages that would put businesses at risk.

Migrant workers face a number of challenges. Most do not have health insurance or are underinsured and are largely ineligible for Medicaid or Social Security benefits for medical care even though they pay into these programs. They typically receive housing in barracks provided by farms or share small apartments with several of their co-workers. Transportation is often by carpool or buses that bring workers to and from the farm. These obstacles mean that migrant farm workers are unable to easily access or afford health care, medical assistance and medications.

To provide care to these workers, UConn and the Connecticut Area Health Education Center (AHEC) established the UConn Migrant Farm Worker Clinics (MFWC) in 1997. MFWC are a mobile service that partner with local farms to provide free health consultations and medical aid to this underserved population. The clinics are staffed entirely by student volunteers and medically licensed professionals who mostly hail from the UConn but also from a number of college programs and private practices, including members of the DPT Program.

“In physical therapy, the goal is to help clients with pain management, improve or restore function and reduce the risk for further or future injury,” says Professor Craig Denegar, head of the Department of Kinesiology and former director of the DPT program. “Our presence at the clinics aids in addressing many of the most common and frequent musculoskeletal disorders that afflict farm workers.”

Musculoskeletal disorders are injuries or discomfort caused by muscles, tendons, ligaments and nerves. Patients at the clinics often complain of joint and back pain. DPT students provide the farm workers with hands-on treatment, including stretches and exercises designed to increase functionality and prevent disability. In addition to treating orthopedic injuries, DPT students also are a part of teams addressing cardiovascular and metabolic diseases. Hypertension and diabetes is prevalent. Farm workers may suffer from respiratory conditions, allergies, and other age and work related ailments.

MFWC run from June through the middle of October. They are held three nights a week until late August. When the cold weather returns and the farm worker population declines, clinics are organized once a week. The clinics provide health care to between 200 and 400 patients a year.

MFWC are funded through a federal program administered through the Connecticut River Valley Farm Worker Health Program (CRVFHP), a project dedicated to improving the lives of farmers and their families. This year the CRVFHP was able to provide additional funding to help purchase items that will assist the DPT volunteers in educating and treating occupational injuries such as repetitive motion in joint, lower back pain, etc. Many companies, religious and civic organizations as well as individuals support the clinics with donations and discounts on medicine and supplies.

“We are so fortunate to have so many like-minded students, faculty, volunteer and donors who support this clinic,” says Shannon McClure, long time Program Coordinator for the UConn Migrant Farm Worker Clinics at CT AHEC. These hard working men and women are already away from their families and socially isolated. With this bleak and dark political climate, some of the migrant workers live in fear. It truly warms their hearts to know there are people that care. I have been astounded at the outpouring of support this year for migrant workers with legal aid and Know Your Rights’ educational outreach efforts, huge donations from corporate pharmacies, Catholic religious retreat centers and other civic groups.”

Volunteers arrive at the farms and set up the clinics at 6:00 p.m. to coincide with the end of the work day for laborers. The resources at farm properties vary and clinics are arranged in available facilities, including farm buildings, tents or open land. Stations are set up and organized to guide patients easily through registration, examination and dispensation of medications. Using battery-powered lanterns and flashlights, the volunteers work through the evening, often finishing after 9:00 or 10:00 p.m.

Photo credit Shannon McClure
Photo credit: Shannon McClure

DPT students join their peers from other medical programs to create teams to care for patients. The number of teams depends on the amount of volunteers and preceptors. Each group completes the patient’s medical history and a physical. They develop an integrated assessment, then treat or refer patients as needed. Faculty and other professional volunteers supervise and confirm team findings and recommendations. Teams also focus on health education, delivering guidance on nutrition, disease prevention and other wellness information. This comprehensive process of team-based patient care allows students to learn valuable interprofessional skills alongside application of their classroom learning. Other volunteers at the clinics include UConn’s Schools of Medicine, Dental Medicine and Pharmacy. There are also volunteers from Yale Medical School, the Quinnipiac Physician Assistant Program and other practices and residency programs.

“Good health care needs to be coordinated,” says Sarah Deacon, a second-year DPT student. “Physical therapists, and other care providers, need to learn and use an interprofessional approach. Collaborating with other medical specialists means delivering the most thorough and best care possible for patients.”

“We’re all working closely together, watching and listening to each other. It helps us gain additional viewpoints because we all have valuable information and perspectives that we’re bringing from our fields. Sharing that knowledge with each other prepares us as future professionals and helps us attend to our patients needs better. There are many benefits to volunteering and this interprofessional experience is just one of them,” says Deacon.

“Interprofessional education is crucial in the health sciences. These clinics allow DPT students to work directly with their colleagues, preparing for careers in medicine, dentistry, pharmacy and physician assistant practice. Students learn from each other and become more knowledgeable about different approaches and delivery of care. Volunteering at these clinics gives students the opportunity to build these skills in real time, in the act of providing care to patients. The volunteers are doing a great thing for the workers and gaining experience in patient care and building interprofessional knowledge along the way,” says Denegar.

Denegar represents CAHNR as a member of the Committee on Interprofessional Excellence in Healthcare (IPE) at UConn. The Committee’s mission is to increase and improve collaboration and communication between professionals, students and patients. Guided by UConn’s academic vision, the group outlined four areas of focus: health professions education, patient care, scholarship and research, and outreach and engagement. IPE hosts an annual Dean’s Day event that brings together UConn’s students, faculty and researchers to gain critical knowledge and skills through workshops and presentation. Dean’s Day is historically a day selected for special events or activities at schools and colleges, designated by a proclamation from the institution’s leaders.

“The Dean’s Day event brings all of the health sciences together at UConn. It’s a unique event, but it’s only one day. These farm worker clinics give students first-hand experience over the course of several months. I’m proud that DPT is a part of these clinics. We’re helping a lot of people who need care that they otherwise wouldn’t be receiving through this program,” says Denegar.

“It’s particularly satisfying for me to watch students putting their classroom learning into practice. I see those wonderful moments where the lightbulb goes off, when the classroom learning meets the real world and it clicks. That’s what it’s all about for me as a teacher.”

“Volunteering for the clinics has been inspiring. I first heard about this work as part of a public engagement class and I have only grown more passionate since becoming involved. I have been visiting classes and sharing my experiences to recruit more volunteers. It truly benefits everyone and helps bring care to people who are doing an important job that helps support all of us,” says Deacon.

Those interested in volunteering can find the 2018 application here. The 2018 application cycle opens after January 15th and is closed by April or whenever spots fill up.

By Jason M. Sheldon