As the blue-and-white bus lumbers into the yard at 5 p.m., 15 people are waiting with sore backs, roiling stomachs and throbbing headaches.
The patients have spent a long, hard day laboring in vast fields bursting with strawberries, tomatoes, melons and green beans near Tampa, Fla. The Blue Bird school bus, a mobile clinic, arrives at the end of the workday when farm laborers can take time to seek medical attention.
Sr. Sara Proctor, DW, drives the mobile clinic. She also is a physician's assistant, manager of volunteers and keeper of medical records for hundreds of patients on the margins of American health care. Sr. Proctor and her cohorts at Catholic Charities' Mobile Medical Services have been doing this work in rural east and south Hillsborough County, Fla., near the Tampa Bay area for 13 years.
Sr. Sara Proctor, DW, manager of Mobile Medical Services in the Tampa, Fla., area, speaks with a patient in the main clinic office at San Jose Mission, a 34-acre campus that provides housing and health care for about 130 families of immigrant farm workers. Mobile Medical Services is opening another permanent clinic through its partnership with St. Joseph's Hospital in Tampa.
"There are so many who need help," said Sr. Proctor, who works for Catholic Charities in the Diocese of St. Petersburg.
One of Mobile Medical's partners is Tampa's St. Joseph's Hospital, a member of CHE Trinity Health. Arlene McGannon, vice president of mission for St. Joseph's Hospitals, said Sr. Proctor's patients "can't even be called the underserved. They are the unserved. Mobile Medical reaches out with an outstanding service that no one else is providing."
Lasting hope
In February, the partnership expanded to include Wholesome Community Ministries, an independent church that serves farm laborers in the southeast part of Hillsborough County, the nation's second-largest producer of strawberries. Sr. Proctor's bus stops there twice each month, serving walk-ups who do not pay for care received. A new clinic at Wholesome Community will be financed through a $220,000 grant from Allegany Franciscan Ministries, a foundation of the Franciscan Sisters of Allegany, N.Y., who founded St. Joseph's Hospital.
Called La Esperanza Clinic, or Hope Clinic, the service will occupy a permanent, modular building.
Mobile Medical's marquee location is the San Jose Mission, a 34-acre campus east of Tampa that provides housing, day care, education and basic health care for about 130 families of immigrant farmworkers. That effort earned CHA's Achievement Citation in 2002, and its work continues.
Mobile Medical has its main clinic there. The bus serves other locations in the county, now including La Esperanza. Through grant funding, St. Joseph's provides a nurse at San Jose Mission, and is assigning a nurse and a health care advisor to the new clinic.
Sr. Proctor and McGannon said one of their shared goals is to provide follow-up and outpatient services for farmworkers who need hospital care, thus helping to prevent avoidable readmissions. La Esperanza is near the site of St. Joseph's own expansion — the $225 million St. Joseph's Hospital-South, under construction and scheduled for completion in 2015.
"We can't just turn people back into the community without a safety net of support," McGannon said, referring to the farmworkers. "Many don't understand their discharge instructions, for example, because of language barriers. Mobile Medical helps them navigate those things so they don't end up being readmitted."
Ongoing need
Sr. Proctor said Mobile Medical does not charge for its services. "We manage on grants and donations, and that will continue," she said. Florida politicians continue to debate whether the state should expand Medicaid under the Affordable Care Act; but the outcome will not impact Mobile Medical's patients because their immigration status makes them ineligible to participate in ACA-related insurance coverage.
Sr. Proctor estimates that 80 percent of the 10,000 immigrant farm laborers in Hillsborough County are undocumented. She said Mobile Medical operates under a Florida law that provides immunity from lawsuits to volunteers who help impoverished patients, but which also prohibits the program from charging fees for services.
Mobile Medical treats about 1,500 patients annually and expects to see another 500 in the first year at La Esperanza.
Sr. Proctor said few Mobile Medical patients are older than 40, mainly because of the physical demands of farm labor. The clinics provide basic medical care — checkups, pap smears, management of diabetes and hypertension and health education. If people need more, she said, Mobile Medical arranges for them to be treated at no charge or at a discount at St. Joseph's or its affiliates in the umbrella BayCare Health System.
"If someone pulls up in a Jeep with a guy who has a broken leg, we send them straight to the emergency room," she said.
Serious cases are rare but often heartbreaking. A man came to San Jose Mission complaining of abdominal pain and loss of weight. Mobile Medical arranged for a CT scan for $300, which the family raised. The scan confirmed advanced stage cancer.
Before he died, Sr. Proctor said, "He got the best care our system can offer."
She said about half of the patients return to the clinics or the bus for follow-ups or other care. Mobile Medical encourages people with chronic conditions to check back often. But some never do, given the nature of migrant farmwork.
Call to care
Mobile Medical was created after Bishop Robert Lynch of St. Petersburg challenged the area's medical professionals during a special Mass in 1999 to serve the thousands of immigrant workers in their midst. St. Joseph's has been one of the partners from the beginning, also providing discounted lab services, equipment and furniture.
McGannon, of St. Joseph's, said the program's expansion with La Esperanza Clinic "is a great opportunity to expand a wonderful and effective partnership. I don't see the need ever changing, and this is a good way to help meet it."
As for Sr. Proctor, said McGannon, "I wish we could clone her. She is that inspirational."