Power of Rural | Migrant Medicine

Families that fuel North Carolina’s $78 billion agriculture industry are being cared for through mobile efforts; new and future clinics

Farm workers have the eighth-most dangerous job in America; behind loggers, pilots, roofers and truckers, to name a few.

And of the 150,000 farm workers in North Carolina, a whopping 80 percent do not receive health care. Eighty percent also lack transportation to get to and from hospitals or health clinics. And 94 percent are Spanish speaking, with too few health delivery services offering adequate Spanish-speaking resources. Documented or undocumented, insured or uninsured — the men, women and (yes) children whose work fuels the state’s $78 billion agriculture industry deserve proper health care.

Economists or elected officials may argue this point with statistics of missed work days having a large negative impact on North Carolina’s bottom line. But for Dr. Charlotte Paolini, chair and associate professor of family medicine at Campbell’s Jerry M. Wallace School of Osteopathic Medicine, providing care to these families — many of them migrant workers — is all about following the example of Jesus Christ by providing unbiased healing to the underserved.

“It’s not any of my business if the person I’m treating is here legally or illegally,” she says. “I’m here to provide care and support, whether that’s medical or spiritual.”

Campbell’s medical school is part of the North Carolina Farmworker Health Program, whose function is to improve the health of migrant and seasonal workers and their families through funding, training and other assistance to a network of outreach and health care providers.

Farm workers face several occupational risks, from operating heavy equipment to extreme conditions in unshaded fields. They are more prone to toxic chemical injuries and skin disorders (often caused by pesticides) and are at an increased risk of heart disease and diabetes. Their households are more likely to be food insecure, and more than half of the children in migrant farm families have an unmet medical need. It gets worse for tobacco workers — they are highly susceptible to nicotine poisoning through the skin (in one day, a worker can absorb the amount of nicotine found in 36 cigarettes). 

Paolini says the mobile units are far from “fully equipped battleships” that can meet the workers’ every need. But those who do require follow ups or additional care are referred to Campbell’s free student-run clinic, which operates on campus on Tuesday nights.

“People get to be seen by students who care about them,” she says. “They’re put into our system, they’re monitored and they’re treated, free of charge.”

Campbell’s Community and Global Medicine program oversees its migrant worker clinics in rural towns like Newton Grove and Goldsboro and the health screenings the school hosts at the annual Episcopal Farmworkers Festival and Southeastern Health’s “Compassion for U.” The program also takes students on yearly short-term medical mission trips to Ecuador, Guatemala, Honduras, Haiti and Jamaica.

Run by Dr. Joseph Cacioppo and Dr. Doug Short, the Community and Global Medicine program has already helped thousands of men and women, but equally important has been the training and practical skills students have received and learned by taking part in these trips.

“One of my biggest pet peeves is the notion that doctors are cold and sterile … that it’s almost a painful event to go see your doctor,” says Short. “That’s why we want to impart on our students that you can be a doctor or you can be a physician. It’s your choice. There’s a bond that occurs between a physician and a patient. It’s a relationship, and it’s the most important thing. Working out in the community or out in the world gets students outside of their bubble. They see that these people aren’t just a number.”

Adds Paolini: “Our students are eager to go out and provide this care, and in doing so, it increases their perspective in terms of taking care of the poor and underserved. It gives them experience in learning how to provide care in ‘hard places.’”

The importance placed on mission work and community care is what attracted Paolini to Campbell from all the way up in Maine in 2012, a year before the school launched.

“I started doing mission work back in 1995, and back then, I did it on my own time, usually through faith-based groups,” she says. “When I met [founding med school Dean Dr.] John Kauffman, it was wonderful to learn how mission-minded he was and how he wanted to make mission work part of the curriculum. I told him, ‘I’m there.’”

Paolini was also key in Campbell’s decision to open its first off-campus medical clinic in Dunn in 2017. Her role has shifted from family medicine to geriatrics, and when she’s not teaching on campus, Paolini is training students at a nursing home in Lillington or at the clinic in Dunn, the city she now calls home. She says the clinic — which offers services in geriatric medicine, osteopathic manipulative medicine, sports medicine and spine and back treatment — has been “huge” for Campbell’s neighbor to the east.

“Campbell is being very true to its mission,” she says. “We know from statistics that 62 percent of residents end up practicing medicine within 20 miles of their residency program. We are educating students who will go on to live in the communities they are currently serving. Many of our students are staying in North Carolina, and many are training in family medicine. They’re fully committed to what we’re trying to do here.”


Billy Liggett Author
Lissa Gotwals Photographer

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