ADDISON COUNTY — Faced with mounting administrative demands on its small staff, the Open Door Clinic (ODC) in Middlebury on July 31 stopped coordinating rides for migrant workers to get to their medical appointments.
It’s a move that some fear might limit health care access for a population that currently labors in the shadows.
Not wanting to leave the county’s estimated 500 migrant workers completely in the lurch, the clinic has provided lists of volunteer drivers to farmers, laborers, Spanish-English interpreters and others who remain committed to getting transportation to what is a vulnerable population. And clinic officials — in concert with Addison County Transit Resources (ACTR) — have also applied for a $150,000 grant through the JM Kaplan Fund to eventually re-establish a coordinated ride program. That grant money would be used in part to pay for a part-time bilingual dispatcher and subsidize medical rides for migrant workers, according to ODC Executive Director Heidi Sulis.
“We would all like to step up our efforts to reach more patients,” Sulis said.
It was around eight years ago that the ODC, the Office of Migrant Health at the University of Vermont, and Bi-State Primary Care won a federal grant to help migrant farm workers gain greater access to services. State officials estimate there are more than 500 people, primarily from Mexico and Central America, who have crossed the U.S. border and made their way into Addison County, Vt., to take farm jobs that have drawn little or no interest from local workers.
Those workers have not strayed far from the farms on which they work, due to limited immigration paperwork, the language barrier and/or a lack of transportation. Knowing that these workers needed basic medical services, the ODC initially began offering health care screenings at some local farms. The organization eventually began organizing rides, thanks to volunteer drivers and interpreters, for migrant workers to get to appointments at the ODC at Porter Medical Center, and to specialists in Addison, Chittenden and Rutland counties.
“Once people started coming to the clinic, we started arranging rides,” Sulis said.
In 2009, the ODC coordinated 31 health care-related rides for migrant workers in Addison County.
Last year, the clinic organized 667 rides, a dramatic increase that comes in spite of Vermont’s adoption of a new law in 2013 that allows undocumented workers to obtain driver’s licenses.
“The number (of rides) has grown and really started to explode during the last couple of years,” Sulis said.
Officials at ODC at first were able to keep pace with the demand for rides. A big reason for this was the creation of a grassroots organization called “Amistad,” which is the Spanish word for “friendship.” Amistad volunteers, through the Addison County Farm Workers’ Coalition, helped make sure clients got to their medical appointments.
Amistad and the ODC lined up more than two dozen regular volunteers to shuttle the workers to appointments. The organizations made sure that an interpreter was available to make sure the driver and rider were on the same page.
Christiane Kokubo, an administrative assistant with ODC, has been a lead coordinator of the volunteer rides. She has even served as a driver herself when no one else was available. Volunteer drivers expect no compensation, though the ODC has occasionally been able to give them a gas card for some fuel reimbursement.
“The number of volunteer drivers has not increased a lot in the last year,” Kokubo said. “The number of (medical) appointments has increased faster than the number of drivers.”
The effort took another hit recently when Amistad’s lead volunteer had to step away. Suddenly, Kokubo found herself spending around 25 hours of her average work week coordinating medical rides for migrant workers. And it’s no walk in the park; Kokubo has had to consult maps; network with drivers, riders and farm workers; line up interpreters; and sometimes round up multiple drivers for a single round-trip.
“We were putting a lot of resources into this service,” Kokubo said. “We started questioning if we should still be doing this.”
Sulis agreed that it was too much for the little organization.
“This was becoming too huge for us to coordinate as a free clinic,” she said.
The ODC experimented for two months paying its own driver to shuttle patients. But one driver could not cover the entire county and the many farms in Orwell, Shoreham, Addison, Bridport, Cornwall, Middlebury, Bristol, Ferrisburgh and other communities. So the ODC made the painful decision to stop coordinating rides on July 31.
Kokubo and Sulis have compiled a list of drivers that are still prepared to drive while ODC and other local nonprofits look for a more permanent fix to the transportation problem for migrant workers. That list has been furnished to the various stakeholders in hopes that they will independently organize rides while the clinic and ACTR seek the $150,000 from the JM Kaplan Fund. Patients have also been told that they can default to ACTR, which, in addition to its buses, operates a dial-a-ride serve. That service matches volunteer drivers with individuals needing transportation.
But ACTR Executive Director Jim Moulton and Sulis acknowledged that dial-a-ride might not be ideal for some migrant workers. There is no assurance that these drivers know Spanish. And ACTR assesses a $13.20 administrative fee for each round-trip ride, in addition to a rate of 57 cents per mile. That could translate into a $40 to $50 charge for a patient seeking to a medical round trip from Orwell to Middlebury, Sulis noted.
Moulton noted the charge reflects, among other things, the cost of various insurances and background checks for drivers to ensure adequate coverage for any potential accidents or other liability issues. Riders covered by Medicaid or other federal programs do not pay full freight for these trips, Moulton noted, but migrant workers generally do not qualify for such coverage.
Volunteer drivers through the clinic have not enjoyed the same insurance coverage as those driving for ACTR, Moulton said. An individual’s private policy is generally not extensive enough to cover all the potential liability involved in an accident while carrying a patient, according to Moulton.
“From my perspective, there are some pretty significant risks,” Moulton said. “ACTR has those kinds of insurance policies.”
Moulton stressed that ACTR is hoping to work with the Open Door Clinic to provide rides to migrant patients in a more affordable manner. Like Sulis and Kokubo, Moulton is crossing his fingers for the $150,000 grant.
DRIVERS’ PERSPECTIVES
Meanwhile, some of the ODC’s volunteer drivers are anxiously waiting to see how the transportation issue is resolved.
It was around two years ago that Spofford “Cap” Woodruff of Middlebury began driving patients for the ODC. A retiree, Woodruff was looking for ways to help.
“I wanted to do something good for the community,” he said. “I realized that the farms needed the workers, and the workers needed the jobs.”
While he speaks no Spanish, Woodruff said the chauffeuring has been very satisfying. He has made roughly one trip per week, traveling as far away as the UVM Medical Center. He has at times waited in the middle of a herd of cows for a person to get ready for an appointment, but things have generally gone smoothly. He drives only during the day and expects no remuneration for his efforts.
“Every once in a while I will get a gas card, but that’s not high on my list of priorities,” Woodruff said.
Jill Vickers of Bridport also began providing medical rides around two years ago. She heard some good things about the program from another driver and got some more information through the media.
“I said ‘This is something I need to do,’” she recalled. “I don’t mind driving and I live near a lot of the farms.”
Vickers worked with the clinic to pick up clients within around 20 minutes of her home.
“The drawback for me is that I don’t speak any Spanish,” she lamented. “We (driver and passenger) didn’t really get to know each other.”
But Vickers felt she was providing a good service and she praised the program for being very well coordinated by Kokubo. She received phone reminders and access to an interpreter, when needed.
“I got so much out of it,” Vickers said, “and received so much appreciation from the workers.”
Reporter John Flowers is at [email protected].