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Migrant Health Service clinic meets regional need

Lori Boike, site supervisor of the Migrant Health Service Inc. clinic in Willmar, runs a lab test for a client. The clinic targets migrant, seasonal and year-round farmworkers who are uninsured and might otherwise have no access to health care. (Tribune photo by Anne Polta)1 / 4
Terry Stetzel, a family nurse practitioner, is one of six clinicians who staff the Migrant Health Service clinic in Willmar. The site, which opened last year, averages 50 to 60 patient encounters a week, both in the clinic and on the phone. (Tribune photo by Anne Polta)2 / 4
The Migrant Health Service clinic in Willmar is housed in a former storefront just off Willmar Avenue Southeast. (Tribune photo by Ron Adams)3 / 4
Office staff members work at their desks in the front reception area of the Migrant Health Service clinic. The clinic is cramped, and everyone on the staff does everything, from charting to answering the phone to taking out the garbage. (Tribune photo by Ron Adams)4 / 4

WILLMAR -- Terry Stetzel is on the phone with a patient's chart in front of her, and she's worried.

She needs a Migrant Health Service voucher so that the patient can fill two prescriptions -- but one of the medications costs $9 a pill and the $100 voucher won't stretch far.

"It can be frustrating," sighed Stetzel, a family nurse practitioner with the Migrant Health Service Inc. clinic in Willmar.

Nonetheless, the clinic helps meet a critical regional need for migrant and agricultural workers who would otherwise fall through the health care cracks.

"There is a big gap. That's what we're trying to fill," said site supervisor Lori Boike.

The Migrant Health Service clinic in Willmar, housed in a former storefront just off Willmar Avenue Southeast, only opened in June 2009 but already its volume exceeds projections. In just one year, the staff has doubled from three to six, Boike said. "That's progress."

On a recent autumn morning, the waiting area is full. Boike has been in her office since 7 a.m., arriving early so that she could draw a blood sample for a client who needed to be at work by 8.

It's one of two days a week that Stetzel is in the clinic, and she has 14 appointments on her schedule.

Migrant Health Service has been a key provider of health services to qualifying farm workers in Minnesota and North Dakota since the early 1970s. The nonprofit organization, whose headquarters are in Moorhead, is funded by public and private grants.

Data from the National Agricultural Workers Survey put the number of seasonal and migrant farm workers in the United States at 3 million. This population is one of the most economically disadvantaged in the U.S. Nearly three-fourths of farm workers earn less than $10,000 a year and more than 90 percent are uninsured. Because of their mobility and, in many cases, lack of citizenship papers, they rarely qualify for any kind of assistance.

If it weren't for Migrant Health Service clinics, there would be "no other option," Boike said. She has seen patients with diabetes that's undiagnosed or poorly controlled. Sometimes they have blood sugar numbers that are "off our charts," she said.

One of the clinic's goals is to help manage common chronic diseases such as high blood pressure, high cholesterol and diabetes. The clinic offers screenings, health education and children's physicals.

Often the staff serves as social workers, connecting clients with resources such as parenting classes or domestic violence programs. In an emergency, they will do basic triage such as stitching up a wound or dealing with a broken collarbone.

It's a far cry from Boike's previous life as a school nurse.

She joined Migrant Health Service two years ago, working first at a seasonal clinic in Olivia and then as an outreach nurse, traveling with a mobile unit bringing basic health services to rural sites across the region.

Boike said it was eye-opening. When the opportunity arose this year to become site supervisor at the new year-round clinic in Willmar, she took it.

"There was nothing about this kind of nursing in the books I learned about when I was going to school," she said. "When you wake up in the morning, you never know what your day brings. You help people with so many different things."

Funding is tight and the clinic is cramped. Boike shares her office with laboratory space. There's no radiology equipment; patients who need an X-ray or CT scan must be sent elsewhere. Everyone on the staff does everything, from charting to answering the phone to taking out the garbage.

"We're usually at least half an hour late with appointments. We try to cram so much into the time slot," Stetzel said. "We have to spend more time because of the interpreter. We have to say everything twice."

Although vouchers and income-based fees help cover some of the cost, Boike and Stetzel are acutely aware that most of their clients have little money. They recounted a recent workshop on diabetes care, during which one of the speakers extolled the benefits of a new insulin pump. The cost -- $10,000, far beyond the reach of most farm workers.

Stetzel used to work as an emergency room nurse at Willmar's Rice Memorial Hospital.

"I saw a lot of uninsured people," she said. "Stuff is not available to these people because they have no insurance. Here, I feel like I'm keeping them out of the ER."

Partnerships are critical for leveraging resources. For instance, Migrant Health Service participates in SAGE, the federally funded program for providing breast and cervical cancer screening to low-income women.

Even something as simple as low-cost or free insulin syringes can help, Boike said.

Her biggest challenge, she said, is spreading the word that there's a Migrant Health Service clinic in Willmar. "I want people to know we're here," she said.

Her dream is to some day have more space and to be able to offer more services.

"I want a full-fledged clinic, a community center," she said. "We want a bigger place. We want to expand and take care of clients that other clinics don't take. ... We want to be here for the people who need us. It is a rewarding job. I love it when I go into the store and they remember you. They come over and they shake your hand. That makes your day."

Anne Polta

Anne Polta covers health care, business/economic development and general assignment. Her HealthBeat blog can be found at Follow her on Twitter at @AnnePolta.

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