Darkness enveloped a Western North Carolina farm packing house in early fall as physical therapy and environmental health students and faculty met into the night with migrant farmworkers. The Western Carolina University crew had accompanied staff with the nonprofit Vecinos Farmworker Health Program to the packing house, which provided temporary accommodations for about 40 men who had spent the day bent over, pulling up strawberry plant after strawberry plant. As the first bus of workers arrived, the students and faculty, and staff of Vecinos, which means “neighbors,” formed a two-sided receiving line as if welcoming an athletic team home after a hard-fought win. They smiled, said “Hola!” and shook farmworkers’ hands as they entered a makeshift living room amid stacks of cardboard boxes and fencing materials in a warehouse-like, cinder block building. The men, although weary and hungry, grinned broadly.
“Farmworkers are a clandestine population, often invisible to the majority of our community,” said Nathan Dollar ’04, executive director of Vecinos. “At Vecinos, we strive to bring farmworkers out of the shadows and recognize the men and women who help put food on our tables as our neighbors – worthy of our care and friendship. One of my favorite parts of our job is being able to greet newly arrived migrant farmworkers with a smile and a handshake and say, ‘Welcome to North Carolina. We are going to help take care of you while you’re here.’”
To assist Vecinos with its mission in a way that provides hands-on learning and service opportunities for students, departments within WCU’s College of Health and Human Sciences have partnered with the organization. The relationship has grown so close that last spring Vecinos became the first of WCU’s external partners through an agreement connected to the university’s Millennial Initiative to move into administrative offices within WCU’s Health and Human Sciences Building. The Millennial Initiative is designed to enhance learning opportunities through cultivating public-private partnerships and regional activities that also fuel development in WNC. “WCU’s partnership with Vecinos is a great example of how we can partner as an institution with an entity in the community that provides service and care, and creates opportunities for students to get clinical experience,” said Douglas Keskula, dean of the College of Health and Human Sciences.
The physical co-location made it easier for Vecinos last spring to host a two-weekend clinic for 120 people that included medical care, dietary counseling and physical therapy services. “More than 25 WCU students and faculty volunteers worked together to make that clinic a reality, including family nurse practitioner students, a dietetics intern and several students from the Latin American Student Organization,” said Dollar. Also, the location makes it easier for Vecinos staff to present in WCU classes and talk about possible opportunities with students and faculty. What staff and volunteers for Vecinos do is locate and travel to migrant farmworker camps to provide free primary and preventative medical outreach, health education and comprehensive case management services. Outreach workers, interns, nurses and physician assistants conduct health assessments and follow-up visits in a van converted into a mobile medical unit. They assist with labwork ranging from measuring glucose levels to HIV tests and distributing needed medication as well as transportation to medical appointments when needed. They distribute items such as knee braces, glucometers, car seats and toiletries. They also distribute food, recognizing that those who pick fruits and vegetables often do not have enough for themselves.
A presentation in an environmental health class and support from Tracy Zontek, associate professor of environmental health, led Osiel Gonzalez-Alanis, a senior from Statesville, to select assisting Vecinos with health education for his 400-hour internship. Having had friends and family who worked in agriculture, he knew how difficult the lifestyle was. “This work is very desolate,” said Gonzalez-Alanis, a native of Mexico who is fluent in Spanish. “They miss their families, and it is easy to become depressed.” Through Vecinos, he discussed with farmworkers topics from preventing heat-related illness by staying hydrated and diet, to reducing exposure to pesticides through wearing proper personal protective equipment. The experience has helped confirm his interest in pursuing a master’s degree in public health and becoming a physician assistant specializing in rural health.
Nursing students and faculty also are involved with Vecinos. Cheryl Clark, an assistant professor of nursing, said Dollar presents to students in her community mental health course. About a dozen students in Clark’s clinical group spend at least one evening with the outreach team helping with flu shots, physicals and lab studies. Mary Postell, a senior from Robbinsville majoring in nursing, said the hours can be late but the experience rewarding. “What moved me the most was how grateful the individuals were that we were there to provide care for them,” said Postell. “To know you have affected someone’s life – this is what nursing is all about and what I love dearly.”
In addition, Vecinos is working with WCU’s physical therapy department. Karen Lunnen, associate professor and department head, sought out the opportunity after observing farmworkers in the fields working with tomatoes, Christmas trees and strawberries, and pondering the musculoskeletal demands of their movements. Lunnen embarked on a service-learning and research project in 2008 that was focused on assessing the needs of the farmworkers who support WNC agriculture – who they area, why they want to work in the area, how they got here, where they live, the nature of their work and other information. “I was overwhelmed with the vulnerability of this population and determined to learn more to find a way to help address their needs,” said Lunnen.
Now, she and John Carzoli, assistant professor of physical therapy, coordinate with students a full-scale research and service project. They structured the study to identify common injuries that might be related to repetitive movements, such as back injuries that could be linked to lifting large boxes of produce, or wrist and hand injuries that might be related to work in the fields. “We hope to better understand how activities related to agricultural work affect musculoskeletal health so that we can provide the farmworkers with more focused preventive education and more effective direct intervention when issues arise,” said Carzoli.
They also have collaborated with Agri-Medicine, a national agency focused on injury prevention among agricultural workers, and are in early discussion with engineering faculty about the possibility of students designing equipment that would have better ergonomic features to prevent repetitive strain. They have shared preliminary findings at the 2013 North Carolina Farmworker Institute Summit and the North Carolina Physical Therapy Association fall conference.
Meanwhile, students say their hands-on experience with the farmworkers is memorable and moving. This fall, against the smell of frying cauliflower and the sounds of crickets chirping, two-person teams of physical therapy students asked the farmworkers in Spanish to let them know where they felt pain as they guided them through an assessment that included extending arms overhead and to the side, bending their knees while reaching forward, rotating at the waist and other movements. “I just wish we had some way to do even small interventions,” said Joey Marion, who is pursuing a doctorate in physical therapy. “I wish we could do more.”
Nathan Dollar ’04 traced his connection to Vecinos to his experience as a sociology student at WCU. “Sociology teaches us how to think and showed me a new way of looking at the world that was very empowering,” said Dollar. He pursued a minor in Spanish and, after spending a semester studying in Bolivia, decided to double major in sociology and Spanish. Writing a term paper about the plight of undocumented immigrants in the United States, he began to understand the difficult conditions and hardships immigrants experience who come seeking the American dream. Then, to complete an assignment for a community development class taught by Anthony Hickey, professor of sociology, Dollar connected with Vecinos and went on an outreach trip to serve farmworkers. The week before he graduated from WCU, the organization offered him a job.
“The mission of Vecinos is really to create community, said Dollar. “We consider farmworkers our neighbors deserving of friendship, protection and in the case of Vecinos, medical care. That mission really spoke to me.” He worked at Vecinos for a year before serving in the Peace Corps in El Salvador. Then, while pursuing his master’s degree in Colorado, he was invited to come back to Cullowhee and become executive director of Vecinos. “It was an amazing homecoming for me,” said Dollar.
The work is not easy. During peak seasons, there can be days Dollar leaves home at 7 a.m. and returns at midnight. In the off-season, he and his staff focus on applying for the grants and fundraising efforts that sustain the organization. The agency’s core funding comes from a grant through the N.C. Farmworker Health Program within the Office of Rural Health and Community Care, but the organization also depends on private donations and other local support. Also during the off-season, Dollar continues to assist seasonal workers, such as Alba Poxtan, a native of Mexico and mother of three who lives in Tuckaseegee. Poxtan works during Christmas tree season making holiday wreaths for a local grower. Through an interpreter, she said she trusts Dollar and that without Vecinos her family might not have health care and cannot afford to go to the hospital. She calls Vecinos when she needs medical care and help in other areas, such as when she had difficulty enrolling her oldest daughter in school. “We don’t have another place to go,” said Poxtan.
The Vecinos team also includes WCU alums Amy Schmidt ’06, lead outreach worker, and James Holbrook MA ’06 BSN ’11, outreach nurse. Schmidt said she met Dollar in Spanish classes at WCU and inquired about the possibility of working with the organization when she returned from teaching English as a second language in Vietnam.
“There is a community within our community that is overlooked at best and more often discriminated against,” said Schmidt. “The people who pick the food we eat are often among those without enough food, with poor living conditions and little access to basic resources. Along with providing health care to farmworkers, I hope that Vecinos can raise awareness about the human cost of food and the lives and hands that bring food to our tables. The more connections we can make and the more student involvement we can have, the more awareness we can raise.”
Holbrook said he came to Vecinos to work as an outreach nurse after earning two degrees at WCU. After completing his master’s in English, he went back to study nursing when he found himself talking more about multiple drug resistant tuberculosis than sentence fragments. He also was troubled by what some of his students were writing about immigrants. He now works with Vecinos in addition to working at the emergency department at Mission Hospital while pursuing his doctorate of nursing practice at East Tennessee State University.
“I was drawn to nursing because of my interest in social justice,” said Holbrook. “I hope that I do more than simply alleviate suffering. I hope that I am part of the systemic change that prevents the suffering from happening.”