Workers’ Medical Records Can Now Follow the Harvest

As his brother and friends stagger back from a 13-hour shift picking wine grapes, Juan Lopez hobbles on crutches through a temporary farm worker camp here, a steel plate securing his fractured femur.

Lopez left his home in Sliao, in the Mexican state of Guanajuato, last May -- first for the peach harvest in Modesto, then for the cherries in Washington. But the day before the Sonoma wine grape harvest began, he slipped in a hole and his leg snapped.

If the accident had felled Lopez last season, he would have moved on to his next job, picking olives near Sacramento, with no medical records in hand. There, doctors would have faced a common problem: As a mobile and marginalized work force shifts, medical histories often vanish like pollen in the wind.

Not this time. Lopez shyly shows off a laminated identification card that provides a link to his medical past.

He is enrolled in a small pilot program that will soon be expanded to 2,000 farm workers statewide and has attracted attention in places as far away as Kansas and Mexico City. Visitors Information Access, or VIA, allows Lopez to grant online access to his medical records to anyone of his choosing.

All it takes is a computer, and Lopez’s user name and password. Even his X-rays will be uploaded by Sonoma health-care workers before he moves on. With the click of a mouse, Lopez’s allergies, medications and insurance information will appear in front of his next health-care provider.

“This will help me a lot,” said Lopez, who has followed the West Coast crops between May and November for the last nine years. “They’ll be able to check me again.”

While Lopez said he rarely gets sick and then only with “a bit of the flu,” that is not the case for many fellow farm workers. The state’s more than 700,000 agricultural workers suffer disproportionately from chronic health problems, according to a recent report by the California Institute for Rural Studies. Some migrate, and their medical records almost never travel with them.

It’s a story that is replayed as reliably as the harvests. Workers are tested and treated for diabetes, high blood pressure, hypertension, back injuries and more. Then they move on and the process begins anew.

The result: unnecessary tests at taxpayers’ expense, multiple immunizations for children who move from school to school and, often, a reluctance to seek medical care at all.

“These guys will do everything in their power not to see a doctor,” said Ricardo Uribe, the VIA coordinator for the nonprofit Vineyard Worker Services, which teamed up with a small Sonoma technology firm to design and implement the program.

His case in point: As 79-year-old Pablo Carrillo waited at the Vineyard Worker Services camp last Thursday for a mobile dental van to arrive, he casually turned to Uribe: If the dentist doesn’t arrive soon, Carrillo suggested, why don’t you just pull the tooth out?

Carrillo no longer works the fields, but he travels from Mexico to live with his daughter near Sonoma and care for her children for part of each year. When the dentist arrived at the camp on this recent day, she glanced at his hand-held VIA card for information on allergies and medications before getting to work. (There is no phone line at the camp; Carrillo’s full records can be accessed from any local clinic.)

Before the ease of the Internet, programs that attempted to track migrants or their children often fizzled because of high costs and cumbersome technology. Also, confidentiality requirements make it difficult for health-care providers to share patient records. VIA clears that hurdle by granting full control to the patient.

The program is being hailed as a strikingly simple cure for a problem that vexes not only migrant farm workers, but also immigrants in other sectors who shuttle back and forth from Mexico.

In recent months, migrant health organizations in Texas, Florida, Kansas and other states have expressed interest. So has the federal Centers for Medicare and Medicaid Services, which is charged by Congress to explore the farm worker health issue.

The Mexican government has also expressed interest in participating, to ensure continuous care before and after migrants head north.

“It’s not just important for farm workers; it is important for all immigrants,” said Xochitl Castaneda, who directs the California-Mexico Health Initiative out of the University of California Office of the President. “The idea is to extend it to a larger segment of the population.”

Castaneda brokered a meeting last month between Mexican Undersecretary of Health Roberto Tapia and Cynthia Solomon, the Sonoma health consultant whose company -- Medical Management Resources -- developed the program.

The program was created two years ago. Vineyard Workers Services struggled for years to build housing for migrants, whose population swells during the harvest. Sacramento-based Rural Community Assistance Corp. agreed to help under one condition: Health care had to be included in the assistance effort.

Now, pale-green modular houses with hot showers are wheeled into two Sonoma camps for the grape crush. Mobile medical and dental vans provide care once a week. Promotores de salud -- themselves former farm workers -- counsel migrants on care. Many workers have chronic problems and a poor understanding of their treatment.

“They’ll say, ‘I take this little white pill and I think it’s for the sugar in my blood, but I’m not sure,’ ” said Kathy Ficco, executive director of community health clinics for St. Joseph’s Health Systems Sonoma County, which operates the mobile units.

Solomon had already developed an electronic records system for hydrocephalus sufferers. Her adult son is among them, and the urgent need for a solution struck Solomon when he landed in an emergency room unconscious, and health workers were unaware that he had brain shunts. She adapted the program for migrant farm workers. An initial grant allows Vineyard Worker Services to enroll 250 patients, some of which are nonmigrating farm worker families.

The Rural Community Assistance Corp. will consider a proposal this week to expand the program to 2,000 workers in Sonoma County and to upgrade the software for further expansion elsewhere in the state.

It has already proved useful. One migrant spent three tortuous days in the Arizona desert on his journey north. By the time he made it to the wine country last July and started working, his feet were swelling badly. He was suffering from kidney failure.

The worker, who now needs dialysis regularly, was running late to an appointment earlier this summer and was shuffling groggily, Uribe recounted. A sheriff’s deputy stopped him, believing he was drunk, but when the worker showed his VIA card, the officer drove him directly to dialysis.

Now, with the crush on, efforts to enroll more migrants are intensifying.

As half a dozen exhausted men sat quietly eating tortillas, pork and rice under a canvas tent last week, health promoter Jose Fernandez made his pitch. The men had worked the fields from 2 a.m. to 3 p.m. They stared wistfully at the television when Fernandez turned it off. But they listened.

“If you go to a clinic and they ask for your information, you just say, ‘No problem. It’s all on my card,’ ” said Fernandez, 59, who used one himself during a recent hospital visit for a gastrointestinal problem.

The card also ensures that patients will be treated more promptly -- since insurance information (often Emergency Medi-Cal) and family contacts are listed. Workers who sign up also get e-mail accounts -- something that already has assisted one migrant with a worker’s compensation claim.

Later, the workers followed Uribe to a nearby church for a demonstration.

“God willing, nothing will ever happen, but if it does, it seems that this facilitates a lot of things,” said Jose Acevedo, 20, who came north from Mexico with nine friends from Acambaro, in Guanajuato. “This would make things much easier.”