All stories below are first hand accounts from Migrant Health Program staff about helping im/migrant workers and their family members navigate health and social needs.
Unaccompanied Minor: We received a referral from Milk with Dignity about a 16 year old with dental pain. Carlos* was here on his own, working long hours and sending money home to his family. Over the previous year, we had been in touch with him sporadically but with no success. Interns reached out informing him that he was likely eligible for the Immigrant Health Insurance Plan. He originally responded but when it came to set up a time to meet, he left the messages on read with no response. He reached out in the fall of last year about dental pain but then didn’t respond to additional requests for information from the Community Health Worker. By the time we heard from Milk with Dignity, he was on his third farm in a year and he had changed his number. By a stroke of luck, I was on the phone with the dental office trying to reschedule someone else’s appointment, when they got notified of a cancellation. It was for the following day. Due to Carlos’s age and presence here without a parent, we needed to get her permission in writing and verbally for treatment to take place. Carlos sent me her number and I called her in Mexico immediately. She expressed gratitude for the support and was emotional about being so far away from her son. She gave permission for treatment and sent us a picture of his birth certificate to use in the application for health insurance. Our office administrator, usually off on Fridays, agreed to put in overtime to drive him to the appointment. They called Carlos’s mom from the clinic and she answered, once again giving permission for treatment. He got on an antibiotic and is awaiting a follow up appointment. His health insurance application was approved so he is eligible for free care.
Job Insecurity & Health: Laura* arrived in the northeast part of the state with her son over the summer. She was joining her boyfriend on a farm where he had worked for many years. Upon arrival, she shared that she was feeling increasingly unwell. A trip to the Emergency Room with the help of one of our community volunteers resulted in new diagnosis of diabetes. The CHW in the region supported her in connecting to a local provider who helped her get on the necessary medications. However, she, her boyfriend and son left the farm within weeks of their arrival in hopes of finding work for them both. Both Laura and her boyfriend were in need of establishing primary care due to both having chronic health issues that required daily medication. I met with them soon after they arrived on a farm in Chittenden County. Laura was running out of her medications so I picked them up at the local Walmart and delivered them while also taking advantage of the visit to fill out paperwork. As I was getting ready to submit the paperwork to establish care in Chittenden County, I reached out to confirm information about medications. They let me know that they had moved once again and were now in Franklin County. The reason for the last move was due to Laura feeling very sick and being unable to work. Along with a volunteer nurse, we did an outreach visit to talk about the medications, dietary and exercise recommendations to help minimize the daily glucose fluctuations that were making her feel so poorly. We supported her in starting to track her blood sugar levels and checked in periodically to make sure she was feeling all right. Despite initially not wanting to establish care in Franklin County due to the couple’s plans to look for work elsewhere, the CHW in the region helped them complete this paperwork. This was completed in a long home visit that also included completing to establishing care paperwork for Laura’s father who had just arrived (with a tooth ache and out of diabetes medications) and an insurance application for another one of Laura’s sons who had arrived with his grandfather. All five family members have now been seen by a health care provider with transportation support provided by program staff and volunteers.
Mental Health: One of my clients has been struggling with the use of alcohol. He went through a hard time with the death of his father and separation from his partner. He asked me to help him. It was very hard to help him understand that I could not personally help him to get off of the farm to take him to church. I assured him that within my role, I would do my best to support him by helping him find the resources that he wanted. He initially wanted to find a church, so I put him in contact with someone from the church in Burlington. They talked a few times, but I don’t think they were able to make it work. There are many barriers like distance, time, and transportation. I sent him information about alcoholics anonymous in Spanish but he did not read it. I then connected him with Ventanillas de Salud – a collaboration between the Mexican Consulate and a Mexican University where Mexican nationas can receive support from professionals in Mexico. He liked the first session. A week later, I spoke with him, and he reported that he had suicidal thoughts, so I followed up with Ventanillas de Salud. His therapist was able to connect with him the same day. Since then, I catch up with him every 1 to 2 weeks by phone. I can hear how his voice has changed, he sounds calmer, and he expresses gratitude for the help he has received. I remind him that he has done all the work by showing up every week for his session and working every day to feel better.
Timely Access to Care: A farmworker I had worked with previously reached out because her husband was having eye issues. He is uninsured and without his own transportation. I got him into the local free clinic the next week. The provider did not see any sign of infection so suggested he see an ophthalmologist. I called several, but most were booking months out. I finally found a private provider who would fit him in that week due to the symptoms he was having. During that visit, which I interpreted because the office did not have language access services set up, the ophthalmologist said she did not know what was causing the symptoms and that she would refer him to a retinal specialist at UVM Medical Center – over 90 minutes away from his home. The office called me the next day wanting him to instead come in for a visual field test. Based on the results and suspecting pressure on the optic nerve, the doctor referred him to the local hospital for an MRI, wanting it done within two days. This was on a Friday, so it had to be done over the weekend. I brought him for an MRI on Saturday and interpreted. On Monday morning, I received a call to bring him in to the ophthalmologist for the results. The imaging showed a brain tumor sitting on his optic nerve. It would continue to grow, and he would soon go blind without surgery to remove it. She referred him to a neurosurgeon at UVM Medical Center. I then brought him to Burlington to meet with the surgeon and discuss the endoscopic endonasal surgical removal of the brain tumor. He had several pre-op visits and tests to complete, which all had to be on different days the week leading up to the surgery, so we got him and his wife a place to stay for the week and organized transportation for the visits that required them. He had a successful surgery. All of this took place within 17 days. I transported him and interpreted for him at seven appointments during this time before getting him up there for the surgery week, at which point UVM Medical provided the interpretation and he was able to walk from the housing to many of his appointments. We are still supporting him with post-op visits and with financial assistance applications and follow-up. I shudder to think how this could have ended for this twenty-five-year-old with so much life ahead of him without the support of Bridges to Health. It has truly been a success story.
Health Access and Insurance: I was returning from outreach one evening when I got a call from a 22 year old from South America who had a bad leg infection. He had hit his leg on metal table at work in a place where he had previously had surgery. You could see a piece of metal sticking out. I brought him to the free clinic where a doctor told him that he needed to go to the emergency department right away because it was likely infected and he could lose his leg. Despite this and the fact that it hurt, he did not want to go to the hospital for many reasons. He was worried about missing work and about the cost of care, fearful of his bosses reaction and because it was almost time to go home he thought that he could just wait until he got home. He didn’t even tell his family what was happening because the day he was admitted to the hospital was his mom’s birthday. I was able to convince him to prioritize his health and go to the Emergency Department by offering to drive him there and help with the initial interpretation. I also helped him contact his insurance company. Unfortunately, his insurance coverage through his visa is limited and due to the issue being a preexisting condition, he was denied for coverage. I then assisted him in applying for financial assistance from the hospital.
Health Access: My first month on the job I visited a Jamaican man several times who had arrived to Vermont in September to work at an orchard. On his first day of employment, the employer noticed him walking with a limp and upon a visual inspection of a foot ulcer, brought him immediately to the hospital. He needed emergency treatment for a diabetes related bone infection that threatened the loss of his foot. He was then moved to the rehab center for over 6 weeks of IV antibiotics and monitoring. My colleagues had already started working with him before I started the job, accessing insurance and assisting with premiums. He had no money due to having just arrived when admitted to the hospital and no family here with him. We brought him a phone so he could communicate with family in Jamaica through WhatsApp. He did not like the type of food accessible to him, particularly with the hospital guidelines for a diabetes management diet. On a few occasions, we, along with a local nurse who took interest in his case, brought him food from a local Jamaican restaurant (in consult with hospital), as well as some warmer clothes as the season changed. When he was stable enough to return home, we realized there was a gap of more than 24 hours between being discharged from the hospital and his flight back to Jamaica. The orchard owner, citing liability concerns, would not let him return to the farm. I communicated with a social worker at the rehab center and then with the doctor who decided to prescribe him one more day of IV antibiotics so that he could safely be discharged to the airport and fly home where he will need ongoing treatment. We also ensured that he had an appointment set up back home for follow-up care. Although this client speaks English, he has a heavy accent. In the course of his time in Vermont at the hospital, he had many needs that were unmet until we persisted with our advocacy on his behalf.
Food Access: I am working with an undocumented mother with a young child who is a US Citizen. After completing the online application for benefits for the child, I called Economic Services Division (EDS) last week. I was on hold with them and the mother for 1.5 hours before getting to speak with someone. Once connected, I explained that I had a Spanish speaker on the phone and asked them to get an interpreter. I was put on hold again. We waited another 30 minutes on hold with no additional information provided. We ultimately hung up because the client (mom) was no longer available to stay on the call. We called again this week. We were on hold for 1 hour before speaking with someone. Once connected, I explained that I had a Spanish speaker on the line and said ideally we wanted interpretation. I asked if this would mean us getting put on hold for another extended period of time. We were told maybe yes, depending on whether a Spanish language interpreter was available. I asked if I could interpret the call, and we proceeded with me interpreting. The person we spoke to from ESD was confused about the scenario of applying for benefits only for the documented child in the household. She asked questions such as “I see “mom” and “dad” say their citizenship status is “other.” What does that mean? How did they get here? Do they have a visa?” Person was on verge of ending the call saying that if the parents didn’t have legal status they couldn’t get benefits. I advocated and explained we were aware that the parents were not eligible and that they were only applying for benefits for their daughter. The ESD person at one point asked the mom “How long have you been here (meaning in the U.S)?,” which is not one of the application questions. Now mom has received a letter in the mail asking for documentation of income for the Dad (which they can provide). AND verification of both parent’s entry dates to the US.
Child Immunizations: On one of a handful of farm-based vaccine clinics in collaboration with the St. Albans district office, I was able to facilitate a visit with the Immunization Nurse to provide four vaccines to a child who had recently arrived from Mexico. He did not have health insurance to cover the cost of a visit to the pediatrician for the vaccines. Providing these vaccines in a timely manner allowed the family to comply with school regulations. I was then able to assist him in being established with a pediatrician and an Immigrant Health Insurance Plan application has been submitted.
Health Literacy & Health Access: A client in my region called Bridges to Health one weekend with extreme groin pain. In consultation with a volunteer provider, the recommendation was to go to the emergency department in case it was a life-threatening strangulated hernia. Without transportation or knowing anyone close by who could drive him 30 minutes to the closest ED, we were able to find a local family willing to take him to the hospital. She interpreted via a WhatsApp video call to get him checked in. It was determined he had an inguinal hernia that was urgent but not in need of emergency surgery. He was scheduled for a follow-up visit with general surgery two days later. The client recently arrived in Vermont and is alone with no family and no car, lives with co-workers who have their own challenges, and is barely getting by, working for his rent, trying to send money back to Mexico to support a young child and wife while paying off debts from his journey here. He works six 12-hour days a week doing very heavy lifting. With no other transportation options, I brought him to the appointment, interpreted for him with the receptionist and filled out paperwork. This led to my discovery that he is illiterate. I began interpreting in the appointment, but the nurse came in with the iPad and said that they needed to use their own interpreter, despite the client’s wishes and despite my being a trained interpreter. The doctor recommended surgery the following week. I checked in with him throughout the week and he was in excruciating pain barely managing with the pain meds he had been prescribed. We reported for the surgery, and I interpreted throughout the entire process. I filled out financial assistance application forms while he was in surgery and communicated with the financial counselor from the hospital. He gave me his phone so that I could answer any calls from his mother in Mexico. I messaged her and let her know that the surgery was successful. She was so grateful that I was there to support her son, which was impactful for me as I have a teenage son and can only imagine what it must have been like for her, let alone him. Once he was discharged, we returned to his town, went to the pharmacy where I went in to get his prescription pain relievers, and then I helped him into his apartment and up to his room. I heated up a burrito for him and came up with strategies for him to remember when to take each med, since he does not read at all in Spanish, let alone English but he can read numbers. We communicated a lot over the phone that following week as he had questions about his meds or was concerned about his pain levels. He has been healing well and we will go together to the follow-up appointment tomorrow. I do not know what he would have done without Bridges to Health. All that is offered by the hospital is video interpretation. There are no in-person staff to support a client that is unable to read much less one whose only language is only Spanish. There is also no support outside of Bridges to Health to ensure a client in his situation has assistance navigating the myriad barriers he faces.
Timely Access to Care: In an effort to utilize the established health care system, I helped the worker get established with a PCP at a Community Health Center by filling out about 18 pages of paperwork. Initially, they wouldn’t let him schedule an appointment because he didn’t have any records from Jamaica. Then, it took 3 months to get an appointment (and he is only in the US for 7 months). He had an expensive cost for his medication. Due to internal mistake – the clinic sent the prescription to a local pharmacy instead of the community health pharmacy where they give a discount. In addition the doctor’s bill from the clinic did not include a discount based on his five dependents in Jamaica that he had listed on the sliding fee application. Though I was able to resolve the issue of cost eventually, due to the significant barriers of cost and time, I took another approach with the other workers with the same health condition. I was able to utilize our pool of volunteer providers who went to the farm and met the workers where they are. They were able to see a provider at a time that did not require them to miss out on work. The provider prescribed them medications and I was able to help them use GoodRX for a discount and thus they only had to pay a very small fee.
Family Planning: I recently worked with a woman who has limited English skills and is ineligible for health insurance and was in need of a family planning appointment. The health center she would normally go to that was just 10 minutes away closed over the summer. The hospital, also 10 minutes away, has a primary care office but I have had many issues with patients not receiving financial assistance in a timely manner. So, the patient, who does not have her own transportation, had to travel 45 minutes for the next closest clinic where she can get affordable care. None of our volunteers were available to take her to the appointment so I drove her. She decided to get the Depo shot, which could be mailed to her and it seemed like the best option moving forward because of all difficulties to get her to the appointment (her work schedule, language access, and transportation). Unfortunately, the Depo shot didn’t arrive in a timely manner. Due to the language barrier and the woman’s challenging work schedule, I called to find out why it hadn’t been mailed. After three calls because the clinic told me they would call me back but didn’t and being placed on very long holds, they realized that there was a mistake in the clinic note. The note said that she had taken a year’s worth of depo shots home the day of the appointment. Luckily, I had been at the appointment and could confirm that it was a mistake. It took a fourth call to confirm that the prescription was actually mailed. What should have been a simple process took hours to coordinate and the prescription barely arrived in time for her to get the injection without increased risk of pregnancy. In the meantime, the client’s 17-year-old niece arrived to stay with them and has her own health needs that I could have begun working on sooner had access to care been easier for the client. Without having someone like me in a community support role, it is very possible that the client would have ended up with an unwanted pregnancy.
Transportation: I recently began working with an unemployed 34 year old mother of two from South America who is here on her own and has limited English skills and no personal transportation. She came to the United States looking for an opportunity that would allow her to support her two young children and extended family in her home country where she could not find work. Shortly after she arrived in VT, she started having some health issues and found out she was pregnant. I connected with her to let her know about our program and to get her established at local woman’s center in order to get pre-natal care. I also helped her apply for Emergency Medicaid and the Immigrant Health Insurance Plan. The application was mailed in the middle of August and around that time she started getting some very large bills which made her worry about not only about not being able to work due to the pregnancy and financially support her other children in her home country but also the fact that she would be going into debt. In a recent call to Vermont Health Connect, my colleague learned that they had misfiled her paperwork and we are waiting to hear about next steps. Her daughter was born last week. Despite all our efforts to reach out to community members in her area, we have not been successful in finding local volunteers to assist with transportation. Her family member’s work long hours and are often unable to assist. This week, her 1 week old infant was crying non-stop and she was sure something was really wrong. But she didn’t have any transportation so she was very stressed and anxious. I ended up driving an hour to her house in rural Vermont to bring her to the pediatrician’s office where they realized the baby had dangerous levels of bilirubin and was losing a concerning amount of weight. We then spent 7 hours in the Emergency Room until she was finally admitted to the Children’s Hospital. She is feeling less stressed knowing her baby is being cared for. However, I am worried about her mental health as I know she is physically and emotionally exhausted constantly thinking about how she is going to be able to take care of her baby and her children back home without access to additional housing, food, and transportation supports.
Chronic Health Issues: We have been working closely with a migrant worker with unmanaged diabetes to get his health stabilized again. When we first met this worker, his blood glucose readings were in the 400s and he was feeling extremely ill. There have been many intensive needs from establishing care and financial assistance at the primary care office, setting up appointments, responding to transportation needs, frequent prescription refill request, logistics of where and how to best access expensive prescriptions without health insurance and facilitated conversations with the employer to get the health support he needs at work, and more.
Work Place Injuries: I recently got connected with a worker who experienced a workplace injury in December. Ongoing health issues related to the injury resulted in an inability to work and a strong recommendation for surgery at the local hospital. The worker was under the impression that the surgery would happen soon because an interpreter had called on behalf of the hospital to confirm. However, when the I called with him to clarify some details of the appointment, they informed the worker that they cancelled the surgery because he did not have health insurance. The hospital was unwilling to reschedule the surgery until this individual applied for financial aid and had received a confirmation on aid received. I assisted the worker in applying for financial aid. However, the poor communication on the part of the hospital from the beginning about what needed to be done in order to have the appointment created a scenario in which the worker now has to wait many months to receive the surgery and is unable to work in the meantime.