California farmworkers avoid medical clinics over immigration fears

from Larry ValenzuelaCalMatters

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On a scorching summer day, dozens of farm workers take a break from picking banana peppers in a remote field 16 miles from Fresno and check into a pop-up medical clinic. It was a chance to take medication and get basic health checkups, like blood pressure and glucose monitoring.

For nearly a decade, UC San Francisco has sends mobile clinics like this one to rural Fresno County to help a hard-to-reach population of unauthorized immigrants who would otherwise avoid routine health care.

The program gained momentum during the COVID-19 pandemic and during the California Decade expanding health care for immigrants who are in the country without permission. But this year, doctors are starting to notice that workers aren’t showing up for care like they used to.

Doctors feel the drop in participation is related to the Trump administration aggressive immigration enforcement activity. UCSF Mobile Health Clinic Director Dr. Kenny Ban said patient visits to his rural mobile health vans began to decline at the beginning of the year when President Donald Trump took office for his second term promising to crack down on illegal immigration.

“There is a lot of mistrust. I come from the university, I wear a white coat; people are worried. We do as much as we can to tell them how we protect their data,” Ban said.

According to UCSF, visits to their mobile clinics have decreased by about 36% as law enforcement activity has increased in California. In 2024, mobile clinics will see an average of 34 patients per visit, but in the past few months the number of patients has dropped to around 22 per visit. People are also less likely to sign up Medi-Calthe government’s health insurance program for lower-income households because they are afraid to give their data to the government if they are not allowed to be in the country, Ban said.

It could get worse.

California has loosened the law that allows all citizens with eligible income, regardless of immigration status, to receive health insurance through Medi-Cal by temporarily restricting enrollment in the following year. And counties prepare for cuts to Medicaid under the budget law signed by Trump earlier this year, which they say will make it harder to sustain programs that serve diverse populations, such as one that provides health care to rural farmworkers.

“It will be more restrictive in terms of work requirements, more regular re-enrollment and stricter requirements for states to comply with federal mandates,” Maria-Elena De Trinidad Young, assistant professor of public health at UC Merced. “It’s a push. The policy is really designed to limit people from accessing Medicaid, or you know, in California, we call it Medi-Cal.”

Getting health care to remote communities

The mobile clinic Ban runs is part of a larger initiative by the Fresno Department of Public Health to reduce chronic and communicable diseases among hard-to-reach populations in the county. Most recently, it received funding through the COVID-19 Assistance Act, which Fresno County directed to the clinics run by UCSF and Saint Agnes Medical Center.

The money for COVID-19 is running out, but the program has one more year of funding.

Clinics from both organizations can be found at community events, food drives in rural communities, schools, and sometimes at farm jobs. The Saint Agnes Mobile Clinic van has two exam rooms where patients can receive care.

According to Yvonne Der Torossian, vice president of community health and wellness at Saint Agnes Medical Center, the program is designed to provide medical students with an opportunity to serve the community and create access to health care.

“We’re specifically contracted to go into rural Fresno County and serve farmworkers, partner with the employers of those farmworkers and also provide services to their families.”

Community health workers also provide health education and referrals to nearby primary care providers for individuals who cannot be treated locally.

“We do basic screenings, including primary and preventive care, for many of the families we serve. We are looking at connecting them with primary care providers,” said Der Torosiran. “We provide vaccinations, we provide glucose monitoring and we look at their hypertension and blood pressure readings. So really basic services that they would get in a primary care setting.”

There is no hospital nearby

Dr. Navdeep Lehga, a resident physician, recently started a shift at Saint Agnes Medical Van at Rojas Pierce Park in Mendota. It is a farming community just less than an hour west of Fresno. A line of people waited at the curb to pick up food from the distribution center and see her and her screening team.

As the morning progressed, Navdeep saw patient after patient in the mobile clinic’s exam room or went outside to see patients in the parking lot, checking patients’ blood pressure with an arm strap and finger-prick glucose levels.

She said most of the patients she sees are farm workers and immigrants. Much of the rural population does not have easy access to medical care – the nearest hospital is 55 miles away. Some of her patients may seek out the medical van for primary care because they don’t know where else to go.

“That’s why they come here. We give them the bottom line of what’s going on. But we’re limited in our supplies and what we can verify,” she said.

Lehga says the number of people coming to the van has slowed since immigration authorities stepped in. She has heard patients speaking to staff during the intake session talk about their fears about getting on the van and seeking health care after a summer of increased immigration raids.

“We noticed that a lot more patients were coming in before they got scared and didn’t want to because they weren’t sure who was going to show up,” Lega said. “They felt comfortable before coming here because they knew it was safe. Now I think patients are more scared to come in overall, just because they don’t know who might show up.”

Dr. Ariana Crediford, chief resident physician at Fresno St. Agnes Rural Mobile Health, said van visits are down 15 to 20 percent this year.

“We can speculate that because of the immigration issues right now, it seems to be having a big impact on farm workers and food packaging,” she said.

Crediford said she’s heard some patients mention anxiety about seeking care and what that might mean for them, but they’ve made it clear that they don’t collect immigration information and that there’s no need to talk to them about it at all.

“The idea that people have to be afraid to get health care is heartbreaking. That would really put their health conditions at risk, conditions that require weekly, sometimes monthly follow-up. We are the last line of defense that they can go to, other than the emergency room, when they come in with an actual life-threatening event. The day this population can’t calmly and safely seek care, their health will be at risk because of it,” said Crediford.

The population, which is often uninsured, suffers from high rates of hypertension, diabetes, or high blood sugar and high cholesterol, often without treatment, Ban said. Often the rural health team is the only health care provider that patients see.

With fewer patients showing up for preventive care, Ban said, people will inevitably get sicker and end up in the emergency room. This costs more money and threatens to overburden the healthcare system.

“People aren’t going away because you’ve changed policy. They still need care. What you’re doing is delaying care until the outcomes are worse, and there’s not much you can do except hospitalize the patient,” he said.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.