On The Ground in Wimauma: Healthcare providers struggle to meet needs of indigent population

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Without fail, Sister Sara Proctor, arrives with La Esperanza mobile health clinic in the Guadalupe Mission in Wimauma every Tuesday to offer free medical care to farmworkers who would otherwise have no access to it. 

The Program Coordinator of Catholic Mobile Medical Services feels committed to helping those who would otherwise suffer or perish from easily treatable diseases and conditions. 

“The idea of bringing a mobile health clinic to the area was Bishop Robert Lynch’s,” she says. “He challenged the Catholic Medical Association to take on the task of assisting farmworkers. Focus groups were organized to explore the needs and they discovered the barriers to health care in Wimauma were time, cost and transportation.”

As a result, La Esperanza mobile health clinic was formed and has been serving the area’s indigent farmworker population for the past 16 years. It is a nonprofit that operates through Catholic Charities, with the support of Allegany Franciscan Ministries and St. Joseph’s Hospital in Tampa. La Esperanza sees 2,000 patients each year.

However, Proctor, who is also a nurse and a physician’s assistant, says the services they offer are insufficient to meet the needs in Wimauma, needs that remain unchanged for the past two decades.

According to data from the 2010 U.S. Census, almost 35 percent of the population in Wimauma ages 65 and under is uninsured. The challenge of access to medical care is tripled with the arrival of seasonal farmworkers who emigrate from the North for work following the strawberry and tomato crops in Florida.

“I’ve seen families’ savings evaporate as they try to attend to their health problems,” says the Rev. Kathy Dain, Executive Director of Beth-El Farmworker Ministry in Wimauma. “A hospital admittance, for example, could empty the savings they worked years to attain.”

Striving to meet health needs in Wimauma, Beth-El works alongside various associations and professionals such as La Esperanza mobile health clinic and Suncoast Community Health Centers. Beth-El provides preventive education to fight heart and vision problems, obesity and diabetes. It also works to educate the community on nutrition during wellness events.

La Esperanza mobile health clinic uses one small exam room to treat patients and is only able to see 10-15 patients between 5-7 p.m. on Tuesdays. Nevertheless, because the need is desperate, Proctor says the mobile health clinic often continues to see patients until 9 p.m. free of charge.
Suncoast Community Health Centers, in contrast, charges Wimauma residents on a sliding scale fee. Since 2014, the fee is determined by family income, with the lowest-income families paying the least. A consultation fee could start as low as $15, and include x-ray and lab services, according to Betsy Martinez, Clinic Administrator of Suncoast Community Health Centers in Ruskin and Wimauma. If patients do not qualify for discounted rates, they must pay the regular consultation fee of $91. 

Services at the Suncoast Community Health Center in Wimauma focus on family and pediatric care. Referrals to its medical center in Ruskin are made for patients in need of obstetrics and prenatal care, birthing prep classes, ophthalmology and behavioral health.  

From 2014 to the present, the number of patients seen daily at the Wimauma center has increased from 10 to 75-80, says Janet Alvarado, Administrative Assistant of the Suncoast Community Health Center in Wimauma.

Barriers to accessing care

To address the barrier transportation poses to most of its patients in Wimauma, Suncoast Community Health Centers offers free transportation three times a week for patients who qualify and are referred to the center six miles away in Ruskin.
“We have many patients without transportation in this area, and although we offer transportation, we have to pick up patients in Ruskin, Apollo Beach and Wimauma,” Martinez says. “By the time patients return (home) they’ve had to wait long hours (to be picked up, receive medical care after all other patients have been seen and be dropped off). Add to that, the fact that Medicaid is always swamped, it’s not easy to make it on the pick-up list ... transportation continues to be a barrier to health care access in Wimauma,” Martinez said. 

Another barrier for patients who seek medical care at Suncoast in Wimauma is its lack of a pharmacy at the center. In order to receive discounted prices for their prescriptions, patients must travel to the center in Ruskin, which includes a complete pharmacy. 

“We have patients who have come back from other pharmacies (empty-handed) because their medications cost between $60, $80, $150 or more while a month’s supply of that same medication would have cost them $4 at our pharmacy in Ruskin, depending on their income,” Alvarado says.
Esperanza Quezada, a Pediatric Certified Nurse who works at the Suncoast Community Health Center in Wimauma, says diabetes and obesity are the two most severe problems she treats at the center. For every 20 infants she sees, 19 are obese. Through her time in Wimauma, she has concluded that establishing nutrition classes should be a priority in the community.

Working alongside Beth-El to fill this need, Bridges to Health of the Hispanic Services Council in Wimauma regularly holds community nutrition classes for women.

Rosy Bailey, interim Project Director of Bridges to Health, says she’s made it her mission to provide education about healthy eating.
The next cooking class will be held at Beth-El Farmworker Ministry, 18240 US Highway 301 South in Wimauma, on Thursday, Oct. 27, from 10:30 a.m. to Noon. 

Zulema Uscanga, 24, Hispanic Services Council Program Manager for Promotoras, helps coordinate all health classes in Wimauma, covering a range of topics from diabetes to nutrition and cooking. She also supervises all seven health promoters -- including one based in Plant City. The promoters are responsible for distributing information to families regarding disease prevention, pharmaceuticals, how to measure their blood glucose levels, and more. 

Alvarado is grateful for the prevention services because she observes that diabetes is a prevalent problem in the community. According to Alvarado, half of all Suncoast patients in Wimauma struggle with diabetes.

Dental care does more than prevent cavities

Dental health is another challenge facing the community. Suncoast offers preventive dental care through a mobile clinic once a month, and has noted the number of children with cavities has risen.

“Seeing a child without a single cavity is rare,” Quezada says. “We’ve made a lot of progress, but a dental clinic with complete services -- from preventative care, routine cleaning and education for parents about the importance of their children’s dental health -- is needed in Wimauma,” she adds. The Suncoast dental mobile bus will be providing service in Wimauma on Nov. 5th, Dec. 10th and Jan. 1st.

Mark Haggett, Principal of RCMA Academy in Wimauma, says he appreciates the dental services rendered through Suncoast Community Health Center’s mobile dental clinic.

Suncoast started working with the charter school six years ago as a pilot program meant to meet the schoolchildren’s dental needs free of charge. The pilot program includes follow-up visits. The program is ongoing and the mobile dental clinic makes about 12 trips to the school each year.

“Suncoast comes to the school, prepares a room with all the equipment and sees patients,” Haggett says, adding he hopes the program will never cease because it is a big help for the kids and their parents.
Martinez says Suncoast has plans to expand in Wimauma and she hopes the expansion will help to resolve some of the barriers needy patients in town are facing.

“We are currently in talks to buy this building, we hope it will happen soon. But if we don’t come to an agreement with the owner, we will search for land to build elsewhere,” Martinez says.
The expansion plans include the possibility of opening a pharmacy in Wimauma that would offer discounted medications for qualifying patients, Alvarado adds.

Proctor, with La Esperanza mobile health clinic, is also looking for additional ways to help bridge the gaps in access to healthcare for farmworkers in Wimauma. Passionate about what she considers her mission, Proctor says a stationary clinic is what’s needed in Wimauma, one in which La Esperanza would be able to expand its services, such as dental health for adults — a service not currently available in the mobile facility and not easily accessible to farmworkers.
“I would like to find an immobile and permanent facility for the clinic,” she says. “Right now we are in a borrowed space, and are therefore limited in what we are able to offer. We need a permanent clinic in the heart of Wimauma,” Proctor adds.

Her sights are set on the old firefighter station #22 located on 1120 7th St. She believes that would be a good location from which to continue operating La Esperanza clinic and would allow for the expansion of services that can’t be offered in the mobile health clinic because of space restrictions and a lack of resources.
“I’ve started the process,” Proctor says. “I will be contacting commissioners from Hillsborough County to lay out this need. If we are able to obtain the firefighter station, the clinic would be able to expand its charitable services. We already have volunteer professionals lined up to help, but who haven’t been able to do so because we lack the proper facilities,” she adds.

Community need continues to exceed growing services
For now, La Esperanza provides free services at the Catholic Guadalupe Mission in Wimauma and in the Catholic San Jose Mission in Dover.

Though the services they provide free of charge in the community seem insufficient, they have developed and increased throughout the years. 

At the beginning, La Esperanza functioned as a walk-in-clinic. It didn’t take appointments and saw patients on a first-come-first-serve basis. Now, appointments are needed. As the years have gone by, services such as routine exams, including a pap smear for women, have been added. 

Once every three months, a dermatologist sees patients with skin conditions, an ophthalmologist sees patients affected by diabetes and hypertension who are in need of eyecare, and a gynecologist sees women. In addition, once a month, a doctor comes to do ultrasounds.
“All these services continue to be free,” Proctor says. “We’re still working to meet the needs identified 16 years ago, but there’s more we can do.”

If La Esperanza is successful in attaining the old firefighter station, Proctor says a dental office for adults would be added. 

“Dentists require a chair, a drill and other technical equipment that a medical clinic doesn’t usually have,’’ Proctor says. “I have many dentists willing to generously donate their time and talent to the community in Wimauma. All we need are the facilities.”

Proctor also hopes to see more experts whom she calls “patient/health navigators" help the people in Wimauma to navigate the medical system. Some of them may qualify for a medical insurance plan under the national Affordable Care Act (Obamacare), for example, but they have no idea how to even begin to inquire about it.

“A patient navigator is someone from the community who understands the system, has a basic understanding of health care, and walks the patient through each phase of the system ensuring to take them from point A to point B,” Proctor explains. “They make sure the patient goes to all their medical appointments and to their follow-ups.”

This is a full-time job and service that is not covered by medical insurers. Instead, patient navigators, in general, are currently employed by health institutions. 

“I’ve worked with health navigators and I’ve seen that this concept really works,” Proctor says.

Navigating the healthcare system
The concept of health navigators is gradually being implemented in Wimauma. For now, Suncoast Community Health Centers hired a social worker to assist patients with their registration enrollment forms, and with necessary follow-up with their health insurers -- from registering for Medicaid to registering for Hillsborough County health care services. 

Starting last month, Judith Hernandez began helping Suncoast patients at the Wimauma center navigate the health care system, including filling out all the necessary paperwork. 

Elsa Rodriguez, a health navigator who works for the nonprofit Bay Care, which includes St. Joseph’s Hospital and therefore also services Wimauma through La Esperanza mobile health clinic, says Bay Care currently has five navigators. 

“In 2015, we helped 35,000 people enroll in the medical system,” she says, while working at the La Esperanza mobile health clinic in Wimauma on Oct. 18.
Wholesome Community Ministries, 16110 U.S. Highway 301 South in Wimauma, is another local organization looking to bring medical services to the community. Pastor Carlos Irizarry, of Wholesome Community Ministries, says his ministry plans to open a new health center in Wimauma next spring. The new center will have specialists who treat chronic health problems, such as a cardiologist, a neurologist, and a psychiatrist. Social workers will also be available to evaluate patients.
In 2008, one year before the organization was founded, Irizarry, who is also a registered nurse and health consultant, began organizing annual health fairs in Wimauma and is now looking to focus on meeting mental health needs in the community. During his time as a practicing professional, he has observed close-up how patients who have been diagnosed with diabetes or high blood pressure refuse to take their medications as instructed or fail to eat properly in a self-destructive cycle that is the result of past trauma.
“This could be a mental health problem and we want to address it in the new clinic because when there’s recurring bad behaviors, they could be an indication of a mental imbalance,” Irizarry says, adding the clinic will include a department of behavioral health.

Irizarry said the new clinic also plans to address the need for follow-up care to ensure the gaps in the system are filled.
“Doctors usually invest about three minutes of their time to treat a patient, and that’s it,’’ Irizarry says. “There’s no follow-up with the patient. Whether or not the patient takes his medication is unknown as is whether the patient is improving.”
Irizarry hopes to break this tendency at the new health center, which will also include after school programs for youth, a soccer camp, preschool services for 25-30 kids, a kitchen with programs for growing organic vegetables, and a store with prices accessible to the community. 

Becoming more patient-centered

Irizarry says his vision for the community health center is that it will be based on building relationships with the patients and establishing goals, responsibilities and assignments to help the patient develop a plan of action that will result in improved health.
“The idea is that the medical appointment will not end after each consultation, but that follow-up will continue beyond the doctor’s office,’’ Irizarry says. Beyond writing a prescription, follow up is needed to be sure prescriptions are filled and medicine is taken. Without that follow-up, the underlying disease goes untreated.

His hope, he says, is that the new center will be patient-centered, not doctor-centered.
Many plans are in the works to bring more medical care to Wimauma’s indigent population, which is primarily made-up of farmworkers. But Quezada believes there is still a long road ahead before Wimauma will arrive at a comprehensive improvement in the health of its populace. She pointed out that a person’s health is affected by factors such as living conditions and access to recreational facilities — both of which are found wanting in Wimauma. 

“We can’t have 14 people living in a single home,” she says. “Because when one person gets a rash, then all the others in the home may get infected with the same rash. And if there are no parks, no recreational zones, that also affects health. Services go hand-in-hand with health,” she adds, stating that overcrowding of farmworkers in housing is a general problem in the community. 

Proctor agrees.

“We have a lot of work to do. It is possible. There are many samples to indicate that we can do it,” she says, using the San Jose Catholic Mission in Dover as an example. The nonprofit developed 139 housing facilities with two, three and four bedrooms with rents starting at $425 a month. Wimauma is currently in need of affordable housing for farmworkers, she says.

“If farmworkers have such low salaries, how are they going to be able to afford a $400-$600 rent per dwelling?,” Proctor asks. “Many of the families in Wimauma are on survival mode and suffer high stress, which severely impacts their health.”

To read more stories from the 83 Degrees Media On The Ground storytelling project, follow these links for English and for Spanish.

The 83 Degrees Media On The Ground storytelling project is supported by Allegany Franciscan Ministries.

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Read more articles by Imelda Dutton.

Imelda Dutton, a native of the northern Mexican state of Chihuahua, is a bilingual journalist with extensive expertise in Spanish communications. For more than two decades, she reported on Latin American issues for Mexican and American media, including El Universal de Mexico. She has also written for and edited Spanish and English publications, including Visión Latina, formerly a weekly publication of The Ledger and The New York Times, and Ágora, a bilingual quarterly military magazine published by U.S. Northern Command. For the past decade she has been a strategic communications consultant for international companies, such as Booz Allen Hamilton and Jacobs Technology; and in 2014, she founded CrossoverComm Inc., her own content development and communications agency. Dutton is currently the Tampa Bay area correspondent for El Sentinel newspaper and enjoys looking for ways to promote diversity and cultural awareness among Americans.