Facing a medical professional shortage that threatened to close down the tiny Ashland Health Clinic, the facility’s CEO developed an innovative pitch: Medical candidates who joined the clinic could take eight weeks off each year to do missionary work overseas.
This quote, from CEO Benjamin Anderson, explains why a mission-focused provider would be attracted to working in a rural region of the country:
“When you recruit a mission-focused provider, they want to see the ghettos,” he says. “They want to know that there’s no Spanish-speaking provider in more than a one-hour drive. They want to see houses that are falling down, widows that are uncared for. They want to know that there’s need and that by them coming there, they would fill a disparity that would otherwise not be filled. So we reversed it.”
So, would this work arrangement work in the Valley? The region has fewer primary-care physicians and specialists than are recommended by nationally recognized benchmarks, according to the California Health Care Foundation. Of Valley physicians, just 6 percent are Latino.
It could certainly help fill positions at individual clinics in the region. But I suspect that pipeline programs like the high school Doctors Academy, medical school programs – like the new UC Merced San Joaquín Valley Program in Medical Education - that train doctors to address the region’s unique medical needs, and the proposed medical school at UC Merced, will more effectively fill the critical doctor and specialist shortage in the region, over the long term.
Above, Agustín Morales, a student in the UC Merced San Joaquín Valley PRIME program, rallies in support of health care. Below, Selma High School student Karen Vásquez shadows nurses. By Héctor Navejas and Daniel Cásarez.
On the second day of his two-day tour through the San Joaquín Valley, EPA regional administrator Jared Blumenfeld visited the east Tulare County communities of East Orosi and Seville.
Standing in the driveway of an East Orosi home, Blumenfeld listened to the personal stories of community residents like Berta Díaz, in pink, who has fought for more than a decade for clean drinking water.
“I have fought with mis compañeros for eleven years, and we have not seen any change in this very contaminated water,” Díaz said.
“We are not complaining, we’re simply telling you our reality,” said Jesus Quevedo, pictured at right, as he described the health struggles of family and friends who have been sickened by the poor water.
“I’ve been having to growing up not being able to drink my tap water, which I think is something that’s not really right,” said Jessica Mendoza, 16, pictured above, at left. “All I’m asking for is just a change, because it is not just for my generation, but generations that are yet to come.”
From there, Blumenfeld traveled to Stone Corral Elementary School, where he addressed residents, including Rebecca Quintana, pictured below.
“I really wanted him to visually see what really exists,” Quintana said after the short community forum. “There is a difference between hearing and seeing. I actually wanted him to see with his own eyes what communities and their infrastructure look like.”
Hearing about residents’ personal struggles to access clean drinking water, and seeing their determination to bring potable water to their communities, seemed to leave an impact on Blumenfeld, pictured below.
“You can read statistics,” he said. “But when you meet someone with a name and a face and a child and a house – it is definitely why we all do this job. Our job is to protect human health and the environment.”
“Anyone can read about the problem… but it is one thing to read it, and it is another thing to be able to come to the actual communities that are impacted by the issue and hear directly from residents,” she said. “That makes a huge difference.”
U.S. Environmental Protection Agency Regional Administrator Jared Blumenfeld (pictured above) is expected to make some major announcements regarding health and the environment tomorrow morning in Stockton.
The announcements will kick off a two-day tour through the San Joaquín Valley that will take him from Stockton, to UC Merced, and eventually to Seville, where he will speak with Tulare County residents who can’t drink their water.
The way I see it, it’s good news anytime a public official with clout comes to the Valley and speaks with residents about air and water quality, protection of public health, and environmental justice.
These visits give residents a voice, when they often feel their concerns are ignored. And for public officials, these visits can help put a human face on the Valley’s very serious health and environmental justice concerns.
“I feel calmer,” Magdalena Romero, whose daughter was born with birth defects and died, said after meeting with Blumenfeld in her home. “I feel like a weight within me has been lifted. I feel relieved, because we are going to have answers soon.”
And that was the case when Catarina de Albuquerque, the U.N. Special Rapporteur on the Human Right to Safe Drinking Water and Sanitation, visited Seville in 2011.
“The power that I have is to draw attention to issues, and to point my finger at problems that I see in the countries that I visit,” said de Albuquerque, pictured below.
I will be tweeting updates from the road over the next two days, and posting photos on the Harvesting Health Facebook page. Follow these updates, or check out next week’s edition of Vida en el Valle.
More from Harvesting Health on environmental justice:
The New York Times and Los Angeles Times both ran stories this week about the apparent stalling of the country’s obesity rate.
Here’s an excerpt from the New York Times’ Well blog:
After two decades of steady increases, obesity rates in adults and children in the United States have remained largely unchanged during the past 12 years, a finding that suggests national efforts at promoting healthful eating and exercise are having little effect on the overweight.
While it is good news that the ranks of the obese in America are not growing, the data also point to the intractable nature of weight gain and signal that the country will be dealing with the health consequences of obesity for years to come.
But, the stories caution, there are still disparities in obesity rates. Here’s an excerpt from the Los Angeles Times story:
But though obesity rates may be flattening overall, increases and disparities can still be found in specific racial and ethnic groups.
Rates have risen to 58.5% among non-Hispanic black women and to nearly 45% among Mexican American women since 2004, for example. And among children and teens, about 21% of Hispanics and 24% of blacks are obese compared with 14% of non-Hispanic whites.
It is encouraging to hear that the overall obesity rate has not continued to skyrocket. But from recent interviews with school nurses throughout the San Joaquín Valley, I’ve heard that obesity and diabetes remain huge health issues among students.
“We are seeing a lot more overweight kids,” said Sandy Dutch, a school nurse with the Tulare County Office of Education. “Kids are concerned about being overweight.”
Being overweight or obese is not only a health problem – it can take a toll on students’ education, said Aurora Licudine, chairperson of school nurses for Modesto City Schools.
“Students who are overweight have more absences, and students who are overweight are not as academically successful,” she said.
“Our goal is to make them independent, and have them make these lifeystle changes, and that takes time.”
If the state legislature approves cuts to CalWORKS proposed in Gov. Jerry Brown’s 2012-13 budget, low-income families could lose the child care they depend on. That could cause parents to quit their jobs to stay home with their kids, and sink back into poverty.
And it could cause Sharon Esquivel – who has transformed her southeast Fresno home into a colorful day care, complete with a cozy classroom (pictured below,) a small library, and a backyard garden (pictured above) – to be out of a job.
Under the governor’s proposal, “the folks who really need help, and the folks who are struggling to get out of poverty, are left behind,” said Mike Herald, legislative advocate for the Western Center on Law and Poverty. “It’s a much higher mountain to climb out of poverty under this proposal than current law.”
The proposed cuts are a personal blow to Esquivel, who grew up in Fresno as one of 14 kids born to a poor, single mom. She goes above and beyond to provide children in her day care with educational opportunities, entertainment, and food, even though she is paid just $29 per child, per day.
“When I see these little children with their beat-up little shoes and their moms bringing them in with their little second-hand sweaters and their second-hand shorts, I recognize it, I know it,” she said. “It is deep for me to do all these things for them because I didn’t have it, and I wanted it.”
As Esquivel waits for the state legislature to determine which CalWORKS cuts will go through, her only option is to keep doing what she has excelled at for 21 years: Caring for children.
“We’re just grinning and bearing it,” she said of the proposed cuts.
More from Harvesting Health on the 2012-13 budget:
Si eres como muchos estadounidenses, aun no entiendes todos los cambios y beneficios de la ley de la reforma de salud.
Pero es muy, muy importante que la comunidad latina comprenda todo lo que ofrece esta ley, la cual entra en vigor en el 2014. Aunque casi el 16 por ciento de la población del país es latina, los latinos representan el 31 por ciento de la gente no anciana que está sin seguro médico.
“Esta traducción es un ejemplo de nuestra obligación en educar miles de latinos y personas de bajos ingresos sobre cómo va a cambiar nuestro sistema de cuidado de salud, y cómo pueden aprovechar de las provisiones de la nueva ley,” dijo el Dr. Robert Ross, presidente y CEO de The Endowment.
Si quieres aprender más, The Greenlining Institute ofrecerá una reunión sobre la ley el 18 de enero, de las 6 p.m. a las 8 p.m., en el Chicano Youth Center, 1515 Divisadero Street.
Nicholás Chávez, 16, of Tipton, suffered from heat illness this summer after he worked the night shift in the pepper fields, when the temperature was still in the triple digits, according to Vida en el Valle.
Armando Ramírez, 16, of Arvin, died this summer after he was overcome by fumes inside an 8-foot-deep drainage tunnel at Community Recycling and Resource Co. in Lamont, according to the Bakersfield Californian.
María Isabel Vásquez Jiménez, a pregnant 17-year-old, died of heat stroke in 2008 after collapsing in a Farmington vineyard, according to Vida.
For the first time in 40 years, the Department of Labor has proposed updates to the country’s child labor regulations. Tougher regulations, advocates say, could have protected the health of these San Joaquín Valley youth, and the health of other children who work in the agriculture, which is consistently ranked as one of the most dangerous industries in the country.
The country’s child labor laws, “have not been touched in over 40 years, despite that the agricultural landscape has changed a lot – there’s a lot more chemicals, and a lot more machinery,” said Norma Flores López, director of the Association of Farmworker Opportunity Programs’ Children in the Fields campaign.
“Instead of kids doing this kind of work, let’s keep these kids from doing this type of work until they are 16. We’re asking kids to wait until doing more dangerous work.”
The proposed regulations would prevent children 16 and under from participating in the riskiest agricultural jobs – like driving tractors, herding animals into confined spaces, working on ladders, working inside a manure pit, working in the tobacco industry, and handling used pesticide containers.
The regulations would, “help keep kids from being able to do very dangerous work, while still being able to maintain the family-farming exception,” Flores López said.
“What this really boils down to is making sure that we are protecting the well-being of children,” she said. The regulations, she said, “make sure that the safety of kids are being put first.”
In a statement, the National Farmers Union – which advocates for family farmers, ranchers and rural communities – also said it supports the intent of the regulations, as long as they don’t discourage kids from learning about agriculture.
“Farming is not simply an occupation, but a lifestyle that has been passed down from generation to generation,” said NFU President Roger Johnson.
“In order to ensure the viability of our family farms for the future, it is critical that farmers are able to teach their children how to perform agricultural work safely and responsibly. The proposed regulations preserve that ability.”
The comment period for these proposed regulations ended Dec. 1. The Department is currently reviewing comments. Photos by Héctor Navejas, Vida en el Valle, and Michael McCollum, The Record.
On Tuesday, Fresno area residents gathered in downtown Fresno to protest proposed budget cuts to health and human services. (Read this Vida article to learn more about how the cuts will impact low-income communities of color.)
Here’s a look at the people who would be impacted by the cuts proposed in Gov. Jerry Brown’s 2012-2013 budget:
SHARON ESQUIVEL In-home day care provider Major concern: Proposed cuts to CalWORKS include the elimination of about 61,000 child care slots for families that have transitioned from welfare to work.
“We have a beautiful flag with a bear on it that flies over the State of California. (The children, the handicapped and the elderly) are not the fleas on the back of that bear that flies over California so beautifully. Stop making them feel that they are less than everybody else – everybody deserves a chance.”
ANA JONES Seasonal IRS employee Major concern: If the proposed cuts go through, she and other Stage 3 CalWORKS recipients would lose their child care.
“I’m a single mom of two boys, I was on welfare for about 6 years and during those six years, I was able to earn job at the IRS… Without childcare, bottom line, I will not be able to work – I will not be able to provide for my kids.”
JOHN WILKINS 31-year recipient, In-Home Supportive Services Major concern: IHSS to the elderly and disabled would be cut by $292 million as hours are cut 20 percent and eligibility would be eliminated for recipients with other family members living at home.
“Doctors didn’t expect me to live past age 30, and I give full and complete credit to this program for giving me the value and quality of life it has taken for me to live independently.”
RICHARD YANES Executive director, Fresno Metro Ministry Major concern: Breadth of cuts to health and human services
“What we’re looking for is fairness, is equitability, and a fair budget. What we have is wealth redistribution of the worst sort – we have looters in this country who are redistributing the wealth, in a way that we don’t agree with.”
This week, I reached out to friends via social media to ask a simple question: What are your community health goals and hopes for 2012?
One woman responded immediately, via Twitter: “That young people will eat healthy foods. No more daily intakes of fast food. It can kill you.”
A man responded, via Facebook: “As someone with a pre-existing condition, I want to be able to afford health insurance!”
On this blog’s Facebook page, I posted my own hopes: “Personally, I want to continue to eat local food, at home, and continue to explore our region’s beautiful outdoors. Community-wide, I hope that health becomes a right, and not a privilege.”
What are your personal and community-wide goals for health in 2012? Please share them in the comments section below!
Happy New Year and Felíz Año Nuevo!
Have we connected on Facebook and Twitter? Please ‘follow’ me or ‘like’ this blog’s page, so we can continue these discussions!
Well friends, another year of investigating community health in the San Joaquín Valley is coming to an end.
Below are my picks for the Valley’s top five community health issues/trends of 2011. What did I miss? What issues were important to you this year? And what would you like to read more about next year? Let me know in the comments section below!
1. San Joaquín Valley’s contaminated drinking water grabs international attention
In March, a United Nations independent expert visited the tiny Tulare County community of Seville, where she learned about San Joaquín Valley residents’ prolonged fight for affordable and clean drinking water.
The visit was part of a 10-day tour through the United States that included stops in communities that have limited or unequal access to safe drinking water and sanitation services.
Her report, presented to the U.N. this fall, did not mince words when describing those communities — including numerous unincorporated, majority Latino communities in Tulare County — that have been marginalized and excluded from this basic right.
“While these groups comprise a small proportion of the population, the independent expert emphasizes that they need priority attention,” she wrote. The agricultural San Joaquín Valley is “experiencing enormous challenges, particularly nitrate contamination, with regard to drinking water.”
Water advocates hoped the U.N. report would shine a bright light on the Valley’s drinking water challenges, which disproportionately impact Latinos, and help them advocate for the Human Right to Water bill package, which was making its way through Sacramento.
It all must have made an impact. In October, Governor Brown signed the Human Right to Water bill package, which is intended to ensure that communities across the state have access to clean, affordable drinking water.
2. Poverty increases
Though the great recession officially ended in June 2009, Latinos across the country continued to struggle with poverty and food insecurity in 2010, government statistics showed this fall.
Nationwide, 26.6 percent of all Latinos in the United States lived in poverty in 2010, up from 25.3 percent in 2009, according to statistics released last week by U.S. Census Bureau. The poverty rate for whites was 13 percent in 2010.
California’s overall poverty rate — at 16.3 percent in 2010, up from 15.3 percent in 2009 — was above the country’s overall rate, 15.1 percent in 2010. In Fresno County, 20.9 percent of residents lived below the poverty line, according to the 2005-09 American Community Survey, the most recent data available.
In the Valley, the increase in poverty was evident at the Fresno Rescue Mission Emergency Family Shelter, where more and more families were seeking shelter after they had lost their job or home.
It was evident outside of Catholic Charities in September, when a husband and wife – both with degrees in social work – waited in line to receive food from the Neighborhood Market food distribution. (After I blogged about this couple, the woman was offered a job at Catholic Charities.)
And it was evident in November, when possibly hundreds of people were evicted from downtown Fresno’s homeless encampments. Two of the people I interviewed had landed on the streets when the money they made working in the San Joaquín Valley fields and packinghouses no longer covered the rent.
3. School food tops the menu
As child obesity – as well as poverty and food insecurity – has increased across the state and nation, more attention has been focused on the meals students eat while at school.
Studies show that breakfast increases kids’ health and improve their academic achievement. Also, teachers report fewer behavioral problems and higher attendance rates, school nurses see fewer students complaining of stomach aches, and school districts benefit from federal meal reimbursements.
And thanks, in part, to the efforts of celebrity chef Jamie Oliver, schools began removing chocolate and strawberry milks from their school cafeterias. Los Angeles Unified School District last week became the largest school district in the nation to ban chocolate and strawberry milk from school menus, and Valley districts – including Earlimart, in Tulare Count – have also stopped offering flavored milk.
Is all this attention on school nutrition making an impact? I’d like to say ‘yes,’ but a recent Los Angeles Times story reports that L.A. Unified’s “trailblazing introduction of healthful school lunches has been a flop.”
4. Health reform provides benefits – and challenges
The Patient Protection and Affordable Care Act won’t be fully implemented until 2014, but the San Joaquín Valley is already experiencing ups and down from the law.
The Affordable Care Act designates funds to support the ongoing operations of community health clinics, create new health center sites in medically underserved areas, and expand preventative and primary health care services at health center sites, according to HealthCare.gov.
But preparing for the implementation of the Affordable Care Act has also proven challenging for Fresno County. In September, the county board of supervisors voted 3-2 to withdraw the county’s Low Income Health Program application from consideration by the State Department of Health Care Services.
With the vote, the county became the first in the state to withdraw its application for the program, which was intended to help counties prepare for the expansion of Medi-Cal that will come with the implementation of the federal health care law in 2014.
5. Residents, experts approach environmental justice seriously and scientifically
As I reported this summer, people of color have become the state’s strongest environmentalists, since they are most burdened by environmental pollution, and the resulting health problems.
So this fall, it was neat to hear about two projects that are comprehensively measuring just how badly residents are burdened by pollution.
In Arvin – a farmworker community that has been considered one of the smoggiest cities in the nation – residents have kicked off a two-year, community-led air monitoring project, or “bucket brigade.”
And UC Davis researchers just released a three-year study that analyzes every census block in the eight-county Valley, and assigns each one a numerical score for environmental hazards, based on the most recent data reported to the U.S. Environmental Protection Agency, and another score for its social vulnerability, based on recent U.S. Census data.
In the new year, both projects could be great tools for communities advocating for health and environmental justices.
