‘I take care of workers in Yakima County, a coronavirus hot spot: ‘The nearest hospital is a few miles away, but most refuse to use it’
Someone picked, packaged and sent those berries off to your local grocery store.
That someone likely works in Washington State’s Yakima County, home to a $1 billion agricultural industry and now also a hot spot for COVID-19 infections. There were more than 6,283 cases as of Monday as the deadly virus works its way out of urban cities and into rural America.
Washington state not only is the nation’s biggest supplier of apples, it also produces 90.5% of red raspberries in the U.S. Fruits make up the biggest share of the state’s roughly $3.4 billion pile of annual agriculture exports.
Coronavirus has raised fears of meat shortages, and Yakima County has become a hot spot for outbreaks among farm workers.
Places like Yakima only rarely make the nightly news. Recently, coronavirus has raised fears of meat shortages and concerns that the food supply will be disrupted, and Yakima County has become a hot spot for outbreaks among farm workers.
That’s why I’m here, three days a week, working 12-hour shifts with my small team, screening workers at a food distribution center for COVID-19. The virus is here. There are roughly 700 employees at the center. I have learned that 18 have tested positive. They work 12- to 14-hour shifts at the 24/7 operation. The center distributes only what can be found at grocery stores, everything from ice cream and cereal to dog food and toilet paper.
Employees are told to come visit our bright blue, mobile breast-cancer screening bus on their breaks, before shifts or after. The setup looks welcoming, with our “waiting room” consisting of properly distanced picnic tables and a white awning to provide a patch of shade. During better times, it might look like a setup for a celebration.
Still, our daily routine often starts out looking like a dog running through a flock of birds: they scatter and spread out when we show up.
Some workers have taken up our offer of a free medical visit. They come, often starting out by asking general questions about various conditions. Trouble sleeping, anxiety, wrist pain or rash. Once in the mobile unit, more barriers come down. More pointed questions, subtle clues or intricate requests that test my ability to rapidly absorb a large amount of information, process it and produce a response.
Our daily routine often starts out looking like a dog running through a flock of birds: they scatter and spread out when we show up.
After all, the workers are on their break. They have 10 minutes. Often times, I ask them to bring me more information and come back tomorrow or next week. When our schedules jibe, they make another appointment.
But a diagnosis and recommendation are as far as I can go. I can reach into my nursing bag of “tricks and cures,” pull out what’s there, but I cannot use my prescriptive power or order required tests. Instead, I write names of over-the counter drugs, creams, drops, devices, tests and websites on a sticky note, also known as the nurse’s prescription pad.
I have seen a lot of rashes or “atopic dermatitis.” I show them my hands. I have it too. It’s likely a reaction to lots of soap, 70-proof sanitizer, disinfectant wipes and gloves. Skin is our body’s largest organ and our first line of defense. It is hard to examine workers sometimes because they are wearing layers. Many work in the freezers. It is now 80 degrees when they come out of the warehouse.
They smile at us with their eyes. Their eyes are so beautiful and bright. I know they are smiling even though they are wearing masks.
They also are worried. Many just want to be checked out. We screen them with questions about their travel or potential exposure to anyone with COVID-19. We ask if they have any symptoms. We take their temperature. We know it doesn’t really change anything. Anyone, after all, could be asymptomatic and still be contagious.
Language may be a barrier preventing more visits, even though our medical staff consists of Spanish-speakers. Also, few want to come after a 14-hour stint. They want to go home and relax. We mostly feel ineffective and wish we could do more, to really make a difference.
Limited access to health care is the one common thread between Yakima and countless other medically under-served areas I’ve served.
I can’t say that I know much about Yakima other than the people I’ve treated in their homes, and now outside of their work.
But limited access to health care is the one common thread between Yakima and the countless other medically under-served areas I’ve served, often traveling to places where people have abundant medical needs, but little access.
In Yakima, the nearest hospital is a few miles away, but most refuse to use it, telling me that care is inadequate and that there is a lack of compassion. They prefer instead to make a 45-minute drive to a larger regional hospital. Most of the people I have treated say they either do not know if they have health insurance, or what it might cover. Many say they don’t utilize health care unless there is an emergency.
Well before COVID-19, in December 2018, I spent my 43rd birthday in a Yakima hotel, my first visit to the area. I came to see Medicare recipients in their homes to perform annual assessments. That’s when I realized my limited Spanish classes really didn’t stick. But I did pick up quite a bit of medical Spanish, after 10 days packed with eight-plus patient visits per day, and a translation service that depleted my smartphone battery following each visit.
I have heard many complaints about physical disabilities, injuries and chronic pain conditions that were the direct results of physical labor. Some had 50 years of hard physical labor under their belt.
I know who the local employers are, but the workers I met do not call their employers by their corporate names. They call their employers “vineyard,” “orchard,” “meat-packing plant,” “nuclear site,” “canning factory,” “paper mill” or “warehouse” or, simply, “the fields.”
Some workers were embarrassed about their living conditions. Most impressive was their desire to make me feel welcome.
I met 70-year-olds still working 12-hour shifts, seven days a week in the fields. I once did an assessment with a Medicare member at his home after work. He was living alone in a basement room with a cot to sleep on, a hot plate and no heat.
Some were embarrassed at times about their living conditions. Most impressive was their genuine curiosity about me and their desire to make me feel comfortable and welcome.
Yet, I am not fully trustworthy either in the eyes of Yakima. Few workers want to tell me about their families, any medical history issues or about their relatives’ health. Even less is said about where their family comes from or where they live now. I can’t blame them. They fear exposing a family member that lacks legal status, a fear that has risen along with Trump administration’s threats to crack down on undocumented immigrants, even though farms and food-distributers often are run on migrant labor.
I don’t press them on it. I always remind them that an acceptable answer is: “I don’t know.”
As cases of coronavirus increase, more families are being exposed. I recently met a young woman in the bathroom of the food-distribution facility. She was clearly upset and had been crying. She looked at me in my scrubs and asked, “How long are you guys gonna be here?” I told her most likely until the end of July. I asked if there was something she wanted to talk about. “Well, I am pregnant. And I am just crying all the time,” she said.
I noticed her belly, even under the thick bibs meant to shield her from the blasting sub-zero freezers during shifts of up to 14 hours. “I’m worried about the coronavirus. What if I get it?” she asked. I recalled my oncology experience: “Don’t give false reassurance, give facts.” I told her that a lot of women all over the world have had babies during the last four months, and that even women with active COVID-19 are giving birth to healthy babies.
Her doctor told her the same thing, she said. I reminded her everyone is scared right now, but also that she has an extra responsibility. I suggested that she come talk with us, even if she’s not sick. “We can make a plan for being as healthy as possible during all of this. It will be good for you and your baby,” I told her.
“I am going to do that. Thank you,” she told me, steeling herself before exiting and returning to the deep freeze.
I am still waiting, and hopeful that she will come back.
Brandy Wiltermuth is a nurse practitioner who specializes in metabolic health, and a co-owner of ThreeHealth, Inc. in Edmonds, Wash. For the past 28 years, Brandy has taken assignments to help medically under-served communities on a contract basis. She currently gives medical wellness checks to workers during a COVID-19 outbreak in Yakima County.