Focus, Partner, Achieve: Interview with Kenett Melgar, Interpreting and Outreach Lead, Blue Ridge Community Health Services
Today, Monday December 1, marks the 26th anniversary of World AIDS Day. The theme for this year is Focus, Partner, Achieve: An AIDS-free Generation.
In recognition of World AIDS Day, Farmworker Justice interviewed Blue Ridge Community Health Services (BRCHS) about the essential health care they provide for migrant and seasonal farmworkers, including HIV services.
Based in Hendersonville, North Carolina, BRCHS is recognized as one of the nation’s oldest operating migrant health centers. The center evolved from a clinic established by volunteers in 1963 which served local migrant workers. This clinic became fully incorporated in the 1980s after which the name of the center was changed to Blue Ridge Community Health Services. BRCHS currently operates five clinical sites, offers school-based health services, and provides a mobile clinic in and around Hendersonville.
Farmworker Justice had the privilege of speaking with Kenett Melgar, Interpreting and Outreach Lead for BRCHS, regarding his experience providing HIV services to the North Carolina farmworker community. Mr. Melgar joined BRCHS in the early 2000s and became the first outreach team member certified by the state to provide pre- and post-HIV Spanish counseling to farmworkers.
Blue Ridge Community Health Services provides care for approximately 2,500 farmworkers during the agricultural season. The season typically begins in early July and lasts through the end of October. Migrant farmworkers comprise the majority of the labor force; however, there is a small portion of local seasonal farmworkers as well. When BRCHS first opened the majority of farmworkers served were African American. Over the years the demographics have changed significantly, the clinic now caters primarily to Latino farmworkers.
The outreach team from BRCHS conducts regular visits to labor camps and fields to reach farmworkers. Educational trainings are offered on a variety of health topics including, but not limited to: pesticide safety, heat stroke, and HIV/AIDS. The outreach team also collaborates with local organizations to make resources available to fulfill the needs of farmworkers and their families that may otherwise go unmet due to their migrant status. This may include collecting food and clothing from the community to provide farmworkers or connecting parents with local migrant education services.
In addition to regular outreach, BRCHS organizes a free mobile clinic which operates between two and three times during the season. The mobile clinic is able to offer nearly all of the same services as those made available at the regular BRCHS clinics. Nurses and health providers work together to offer a variety of screenings such as BMI, blood pressure and HIV testing, in addition to offering private consultations. Health providers working with the mobile clinic are also able to distribute samples of medications to farmworkers on a case basis. These medication samples are provided by local pharmacies and are those used to treat the most common illnesses seen within the farmworker community.
Throughout the season, BRCHS offers regular HIV education trainings, testing and private consultation for farmworkers. Prior to offering these services, the outreach team makes a minimum of three visits to each labor camp they attend in order to establish rapport with the farmworkers. Once a relationship is built between the farmworkers and outreach workers, nurses from BRCHS join the outreach trips and conduct screenings for HIV and STIs one to two times per week. Oral and finger print rapid testing methods are utilized during mobile screenings. In the event that there is a positive result, a blood sample is immediately re-tested to verify it is not a false positive. Farmworkers may be referred on a case basis to the local clinics for further consultation, treatment and care.
The principal challenges the outreach team faces when providing HIV services to farmworkers are fear, accessibility of services, and patient follow-up.
One of the greatest challenges that must be overcome by those providing HIV testing and education is the stigma associated with HIV. Although not exclusive to the farmworker community, there is a general fear of HIV/AIDS which prevents many from getting tested or inquiring about more information. One way the outreach team has addressed this challenge is by establishing a strong relationship with local farmworkers through regular visits. BRCHS has been operating in the community for many years and this encourages farmworkers, in particular those who may return annually, to regard the outreach team as a trusted source of information. Consequently, the farmworker community is more receptive to the HIV trainings and screening offered by the outreach team.
In addition to fear, farmworkers must overcome the challenge of limited access to local clinics. The outreach team has found that the majority of farmworkers, specifically migrant workers, working in and around Hendersonville lack a stable mode of transportation. Furthermore, farmworkers work long, non-traditional hours which makes it difficult to schedule and attend clinical appointments. We recognize these challenges and has implemented a number of measures to help the farmworker community overcome barriers related to accessibility. For example, most outreach trips and mobile HIV screenings are conducted in the late afternoon and early evening to ensure that as many farmworkers are reached as possible. In addition, several clinics operate with extended hours to accommodate for the farmworker’s work schedule. The outreach team works to coordinate transportation for farmworkers who may otherwise be unable to make their appointments.
Fortunately, in the years that mobile HIV testing has been offered by BRCHS there have been few positive results. However, ensuring that patients who test positive have adequate follow-up in the clinical system remains a challenge. The BRCHS outreach workers play an essential role in the effort to improve patient retention in care and treatment. As an established trustworthy source of information, the outreach workers can help to put farmworkers who require clinical attention at ease by explaining the system and ensuring they are aware of the services available to them. Furthermore, outreach workers can collaborate with BRCHS health providers to ensure accuracy of the contact information for patients whom are migrant farmworkers.
“We don’t carry the burden ourselves, we work with the community.” Collaboration with local organizations is essential. It is important to include HIV service providers as well as non-HIV specific organizations who work regularly with farmworkers, such as Migrant Head Start. The wider the network of organizations that are working to spread educational messaging around HIV prevention and awareness, the greater the reach and impact will be within the farmworker community.
To learn more about the Blue Ridge Community Health Services please visit their website at http://www.brchs.com/.
For more information about World AIDS Day and to find out how to become involved in the universal campaign to end HIV/AIDS please visit AIDS.gov.