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For California Farmworkers, Telehealth Visits With Mexican Docs Fill a Hole

Victoria Clayton

SALINAS, Calif. — This coastal valley made well-known by the novelist John Steinbeck is typically identified affectionately as “America’s salad bowl,” although the planting and harvesting is completed largely by immigrants from Mexico.

For Taylor Farms, a serious international purveyor of packaged salads and minimize greens, that’s made it a logical place to pioneer a novel kind of well being look after its workforce, one that might have broad utility within the smartphone period: cross-border medical consultations via an app.

The firm is among the many first clients of a startup known as MiSalud, which connects Spanish-speaking Taylor Farms staff to physicians and psychological well being therapists in Mexico. Providers aren’t licensed within the U.S. and might’t prescribe medicines however as an alternative function well being coaches who can dispense recommendation and work with a U.S.-based physician if wanted.

Amy Taylor, who has led the corporate’s wellness initiative since 2014 and is the daughter-in-law of company founder Bruce Taylor, mentioned about 5,600 of Taylor Farms’ 6,400 staff who work the place MiSalud is presently accessible have signed up for the app, and a pair of,300 have used the app at the very least as soon as. The service is free for workers and as much as three members of the family.

Amy Taylor mentioned the corporate hopes the app, which is a part of a broader wellness program, will help staff keep more healthy whereas preserving well being care and different labor prices in test. She plans a full analysis as soon as this system has been in place for 2 years.

The well being of farmworkers is a serious concern for the state’s agricultural economic system. A 2022 study led by researchers from the University of California-Merced evaluated the well being of greater than 1,200 farmworkers and located that 37% of males and 47% of ladies reported having at the very least one power situation, together with frequent situations reminiscent of diabetes, hypertension, and nervousness.

Taylor mentioned her firm’s staff, starting from fieldworkers and drivers to retail packaging and workplace workers, mirror the examine’s findings. She mentioned predominant well being issues amongst employees embrace weight problems, hypertension, diabetes, and psychological well being.

“These are the people who are feeding America healthy food,” Taylor mentioned of the corporate’s staff. “They should also be healthy.”

MiSalud — or “My Health” — was the inspiration of Bismarck Lepe, a serial entrepreneur and Stanford graduate, who hails from a migrant farmworker household. Until age 6, when his household settled in Oxnard, California, they’d journey between Mexico, California, and Washington state to reap fruit. He noticed that household and buddies usually delayed well being care till they might return to Mexico as a result of the U.S. system was too troublesome to navigate, and insurance coverage protection too costly or exhausting to seek out.

“My mother still prefers to get her health care in Mexico,” Lepe mentioned. “It’s easier for her.”

Lepe and co-founders Wendy Johansson and Cindy Blanco Ochoa launched MiSalud Health in 2021 with $5 million from a enterprise capital fund backed by Melinda French Gates’ Pivotal Ventures, which focuses on social-impact investing. It has since added Samsung Next and Ulu Ventures as buyers.

MiSalud began out by providing consultations with Mexican physicians for people who downloaded the app, Johansson mentioned. But individuals eager sufficient to seek out the app, obtain it, and join this system themselves weren’t in the end those that wanted it most, and in 2023 the corporate pivoted to providing its service to firms as an worker profit. (Individuals can nonetheless use it too.)

Besides Taylor Farms, the corporate counts the California metropolis of Lynwood amongst a few dozen different shoppers, in accordance with Johansson. MiSalud touted that just about 40% of staff served by its platform say that with out the app they’d both have ignored their well being issues or waited till they might journey to Mexico to see a health care provider.

Paul Brown, a UC-Merced professor of well being economics who contributed to the college’s farmworker well being examine, warned that telehealth consultations aren’t sufficient substitutes for in-person care by a major care doctor or a specialist. However, “to the extent that these types of programs can kind of link people into more standard care, that’s good,” he added.

Brown mentioned MiSalud’s strategy could possibly be simpler if insurance policies modified to permit Mexican medical doctors to extra simply deal with sufferers within the U.S. A California program begun in 2002 permits Mexican medical doctors to journey to the Salinas Valley and different closely Latino communities and deal with sufferers, however cross-border telemedicine, even between states, stays restricted.

Even so, Taylor Farms staff say the app has been useful. Rosa “Rosita” Flores, a line supervisor with the corporate’s retail operations, mentioned she determined to offer MiSalud a attempt after co-workers raved about it.

A latest firm wellness truthful, partly sponsored by MiSalud, had alerted her to the significance of monitoring her blood sugar and blood strain ranges, so she booked an appointment on the app to debate it. “The app is very easy to use,” she mentioned in Spanish. When she needed to cancel a video chat after her daughter received sick, the well being coaches adopted up by textual content.

Proponents of cross-border drugs say the strategy helps bridge linguistic and cultural limitations in well being care. Almost half of all U.S. immigrants — about two-thirds of whom are native Spanish audio system — have limited proficiency in English, and analysis has repeatedly proven that language limitations usually discourage individuals from looking for care.

For instance, Alfredo Alvarez, a MiSalud well being coach who’s a licensed doctor in Mexico, pointed to perception in el mal de ojo, or the “evil eye” — the concept that a jealous or envious look by somebody could cause hurt, particularly to youngsters. An American physician is perhaps dismissive of the notion, however he understands.

“This isn’t uncommon here,” he mentioned of Mexico. “It’s a belief in traditional medicine.”

It’s not that Alvarez encourages his socios, or members, to cross an egg over the kid or make the kid put on a particular bracelet — conventional methods of diagnosing and treating el mal de ojo. Rather, he acknowledges their traditions and steers them to evidence-based drugs.

MiSalud’s coaches can attempt to break stereotypes as properly. For instance, Alvarez mentioned, a Mexican reverence for machismo can translate to the concept that “men don’t do doctor visits.” Meanwhile, he mentioned, girls could overlook their well being in prioritizing different members of the family’ wants.

Coaches additionally attempt to take away the stigma round looking for psychological well being therapy. “A lot of our socios have been extremely uncomfortable with or wary of mental health professionals,” mentioned Rubén Benavides Crespo, a MiSalud psychological well being coach who’s a licensed psychologist in Mexico.

The app tries to interrupt via by making it straightforward to e book counseling appointments and asking questions reminiscent of whether or not somebody has bother sleeping, slightly than invoking extra worrisome or probably stigmatizing phrases like nervousness or melancholy.

MiSalud representatives say the app noticed a 50% enhance in requests for psychological well being help following the November presidential election. A extra frequent request, nonetheless, is grief counseling, usually following the lack of a beloved one.

“Loss requires adaptation,” Benavides mentioned.

For Sam Chaidez, director of operations for a Taylor Farms location in Gonzales, MiSalud is a welcome addition for weight administration. The son of fieldworkers, Chaidez graduated from UC-Davis and returned to the Salinas Valley to work for the corporate in 2007.

In 2019, Chaidez, a brand new mother or father on the time, started to know his danger for diabetes and different well being issues due to Taylor Farms’ wellness program. Through eating regimen and train and, extra just lately, teaching by MiSalud, Chaidez has shed 150 kilos.

Chaidez encourages co-workers to stroll with him at lunch, and he credit MiSalud coaches for serving to him hold the burden off and keep wholesome. “It’s been a great help,” he mentioned.

This article was produced by KFF Health News, which publishes California Healthline, an editorially unbiased service of the California Health Care Foundation. 

KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working applications at KFF—an unbiased supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.

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