What strategies work best for delivering care to Calif.'s most vulnerable?

Physicians Marcia and Oscar Sablan agreed to spend three years in the small town of Firebaugh, Calif., as part of a program that paid for part of their medical school tuition. But what began as a short stint turned into more than 30 years.

The Sablans stayed in the Fresno County town of 7,000 to provide care to the underserved at a clinic they founded. They were among several speakers who shared their stories about ways to serve some of America’s most vulnerable citizens during the Center for Health Journalism's 2016 California Fellowship this week.

Speakers, who gathered at the county-run Roybal Comprehensive Health Center in Los Angeles, shared different strategies that could be used to help the underserved across the nation:

The Sablans: Providing care where people live

Firebaugh’s population is 90% Hispanic, the Sablans said, and about half of those residents are undocumented farm workers and their families. To effectively care for this population, the Sablans said they needed to understand their lives and cater to their needs in a culturally appropriate way.

For instance, Marcia Sablan said farm workers have difficult daily schedules and work only part of the year, and it can be difficult and costly for them to take time off from their jobs. So the Sablans make sure to see patients, and provide as many services as possible, on the days they make it out to the clinic.

The clinic handles everything from pregnancy to diabetes to pesticide poisonings. Oscar Sablan recalled one incident in which many local farm workers were exposed to a pesticide, and clinic staff had to enlist the help of emergency workers to wash the poison off of patients’ bodies and hydrate those who were vomiting. 

The Sablans also helped out with an obesity study in which local children received $25 debit cards with which to buy fruits and vegetables. That program spurred local stories to stock more produce.

Mario Gutierrez: Access through telehealth

Telehealth allows doctors to see patients remotely with the help of technology.

Gutierrez, executive director of the Center for Connected Health Policy, said this links doctors and other health providers with residents who may otherwise have a tough time getting the care they need because they live too far from a specialist, for example, or are too sick to travel to a doctor’s office. He said telehealth enables seniors to “age in place” at home, and allows children and teens to see mental health professionals without the stigma that sometimes surrounds going to a mental health provider in person.

Gutierrez said technology is an important way to provide access to care for rural Californians, who face a host of health challenges, including a severe opiate epidemic and a number of chronic diseases. It’s also a crucial tool in reducing rural health disparities nationally, he said.

Roybal: Good medicine through social supports

Roybal health professionals spoke of serving the vulnerable by learning their needs and not only providing appropriate medical care but also linking them with social services and other support that helps them stay healthy. Monica Hernandez, a licensed clinical social worker at Roybal, said patients face many obstacles to care, such as transportation and communication problems.

One recent patient, for example, was very tough for clinic workers to reach because he had a pre-paid cell phone that would frequently run out of minutes. The man, a Spanish-speaker, suffered from paranoid delusions and lived by himself in a $300-a-month rented room infested with rodents. It took a while for clinic workers to gain his trust so that they could help him with his medical needs and connect him to other services.

Guadalupe Carreon, a community health worker at the clinic, said the most important first step with patients like this is to get to know them and work on trust so they feel comfortable talking about their challenges. Then, she said, clinic staff need to stay in touch, checking on patients, reminding them about clinic appointments and linking them with new services when necessary.

“It’s an ongoing relationship,” she said.

Carreon said non-medical issues, such as family problems, frequently affect health and whether people seek and receive the care they need. That’s one reason it’s necessary to understand patients’ lives and environments – because, as other speakers reiterated, health is shaped not just by biology but by nearly every facet of a person’s life.