Shannon Dowler, MD, holds a young patient whose family gets care from Blue Ridge Community Health Services

Migrant Clinicians Network: Collaborating for better farmworker care

By Claire Hutkins Seda, Writer & Editor at Migrant Clinicians Network Agricultural workers are just one sliver of a practitioner’s patient population, but they may require a different approach in primary care.  At Blue Ridge Community Health Services, primary care practitioners incorporated simple, practical, and flexible adaptations to address the unique environmental and occupational health needs of farmworkers. The result? They’re providing better care without draining the health center’s limited financial resources. Blue Ridge’s innovative approach was a result of a yearlong collaboration with Migrant Clinicians Network (MCN) through its Workers and Health program. The program recognizes that clinicians in primary care often lack the tools they need to effectively identify, manage, and prevent environmental and occupational health injuries, illnesses, and exposures. Through this collaboration, which is funded by the U.S. Environmental Protection Agency, Blue Ridge became one of 14 Centers of Excellence in Environmental and Occupational Health in the U.S. and Puerto Rico. “In the fast pace of the clinic, it can be easy to bypass a thorough social history, when in fact that may be the key to making an accurate diagnosis and treatment plan,” says Shannon Dowler, MD, the former Chief Medical Officer at Blue Ridge. “Simple reminders incorporated in the workflow make it easier to capture this type of critical information.” Simple clinical changes led to better care Blue Ridge implemented simple clinical changes like adjusting their systems during the initial intake to better identify the patient’s occupation and including it in the clinical encounter. Dr. Dowler and her team soon discovered how knowing the occupation can impact the differential diagnosis. Being aware that their patients work in agriculture may also help clinicians better recognize symptoms and potentially prevent a work-related condition such as pesticide overexposure. Blue Ridge also began reviewing the patient’s occupation during team “huddles,” brief daily meetings of the care team to look ahead on the schedule and anticipate the needs of the patients coming to the clinic that day. These important changes to the workflow that are pursued by Centers of Excellence like Blue Ridge result in superior health care for an important underserved population. Training, peer-to-peer networking, and popular resources MCN provided Blue Ridge with on-site training and expert technical assistance, including training outreach staff and community health workers on pesticide exposure.  Additionally, MCN facilitated peer-to-peer networking between Blue Ridge and local community partners like occupational medicine specialists, to assist in educating, diagnosing, and reporting environmental and occupational health conditions for many years to come. MCN provided popular clinical resources like its low-literacy comic books and educational materials to share in the exam room with patients to guide conversations on how to prevent pesticide exposures for the patient and his or her family. Replicate Blue Ridge’s success in your clinic Federally Qualified Health Centers (FQHCs) that take advantage of this program will improve the health status of the health center’s migrant patients through quality health care services that respond to their unique needs. If your FQHC is interested in working with MCN to become a Center of Excellence, please contact MCN’s Director of Environmental and Occupational Health, Amy Liebman, MPA, MA, at or 512-579-4535. Migrant Clinicians’ Network is a nonprofit dedicated to health justice for the mobile poor, creating practical solutions at the intersection of poverty, migration, and health.

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