It was a typical April overcast morning in Moss Landing when Erika Romero, MD, asked the packing crew's foreman for a megaphone.
In Spanish, the second-year resident in the Natividad Family Medicine Residency program discussed the coronavirus pandemic with a small agricultural worker cohort. The residency program, affiliated with UCSF, is the only one on the Central Coast.
Holding the megaphone up close to her mouth, Dr. Romero talked about how you can prevent getting sick, know if you're sick, and what to do if you become ill. A hand shot up.
“¿Y los niños? ¿Se enferman (Do children get sick)?” he asked.
“Hasta ahora, pensamos que no se enferman con tan severedad (From what we know so far, they do not get very sick),” Dr. Romero responded.
A look of relief came over the man.
Later that month, Anne Irvine, MD, also a resident in the Natividad Family Medicine Residency program, presented COVID-19 education to a crew of H2A visa holders in a hotel's parking lot on the outskirts of Salinas.
When the coronavirus pandemic hit, Dr. Irvine knew that agricultural workers would be the most impacted and worked to mitigate the virus's spread by teaching about social distancing rules, effective hand sanitation and how to wear face coverings properly.
At the time, the third-year Natividad Family Medicine Resident was in the process of securing a donation of 40,000 reusable fabric masks from Hedley & Bennett, an apron manufacturer in Southern California. When the deal was complete, she distributed them free to Central Coast farmworkers. There are an estimated 55,000 agricultural workers in Monterey County alone and 90,000 in the tri-county area.
"The heart of the Salinas Valley is the farmworker community," said Dr. Irvine. "As a family medicine physician in Salinas, I've come to know them also as my patients, my teachers, and growers/harvesters of the food that feeds my family. When COVID-19 began to affect us all, I saw their need for PPE (personal protective equipment) as essential workers, and the lack of resources available.
California Academy of Family Physicians (CAFP) resident members Dr. Romero and Dr. Irvine are among the many Natividad residents and nurses who have taken part in a unique outreach program for essential agricultural workers in partnership with the Grower-Shipper Association. All four hospitals in Monterey County have signed up to bring doctors, RNs and LVNs into fields, warehouses and packing facilities to meet farmworkers where they are. Through the trade association's program, growers and labor contractors request site visits at no cost, despite membership status.
These workshops, or "charlas," are held in Spanish and English. Natividad Foundation provides interpreters to help with this vital community education service. The talks involve the work leader, or "mayordomos," and field workers and build trust. Natividad staff serves as both a mediator and a medical expert. Presenters work to understand the unique challenges each organization, individual, and family faces. They help them produce solutions to mitigate potential problems. Solutions have included cohorting workgroups, wearing PPE when unable to stay six feet away from others, and social distancing during lunch breaks and carpooling. Presenters also tell stories about patients to help farmworkers understand the severity of the disease, which changes beliefs and alleviates fears about going to the doctor or emergency department.
Sally Tirado, residency program faculty and co-director of community medicine at Natividad, has attended several charlas. Tirado was instrumental in kicking off the outreach program and training the participating medical staff.
Natividad's earlier community outreach experience has enabled its doctors and RNs to gain trust immediately, and those involved have understood the goal of protecting them. Health care providers also supply a wide range of resource information — from food security to mental health to domestic violence to family doctor referrals — and help individuals strategize and create plans to keep their families safe. To date, more than 5,000 farmworkers have been reached through the program, said Grower-Shipper Association Vice President Abby Taylor-Silva.
During the COVID-19 health crisis, Natividad has focused its resources on providing education and outreach to help prevent the disease's spread in its community. Disadvantaged communities and communities of color are disproportionately affected by the disease with higher infection rates, hospitalizations, and death.
"It is rewarding to do this," Dr. Romero said. "This is what I imagined family doctors would do. We want to be advocates for our patients."
Many CAFP residents are doing great things during this extraordinary time. We are proud of their community service and outreach. We encourage all of our members to get involved. If you or your FMRP are doing something you would like to share with our members, please let us know by sending an email to CAFP.