Building Health Liaisons
Between Multiple
Communities
Loretta J. Heuer, Ph.D., R.N.
Andrea Smith, BS
Mari Lou Gonzalez, DLE
Migrant Health Service, Inc.
810 4th Avenue South
Moorhead, MN
Demographics
• The U.S. Public Health Service estimates a total
of 3.5 million migrant and seasonal
farmworkers in the United States
(http://www.migrantclinician.org/migrant_info/migrant.php)
• Each year, 20,000 to 35,000 migrant
farmworkers travel to Minnesota to work in
agriculture (CURA Reporter, 2001).
• Migrant Health Service, Inc., (MHSI) Voucher
Program in Moorhead, Minnesota annually
provides health care services to 7,000
farmworkers.
Demographics
Migrant Farmworkers
• 50% Hispanic; 35% African-Americans; and
15% Asian, White, or “other” (Bureau of Primary Health Care
Program, 2001).
• Median education level for the head of the
household was six years (National Center for Farmworker Health,
2005).
• Annual wages of less than $6,250 (National Agricultural
Workers Survey, 2000).
• Some workers live apart from their families,
others travel with their families (National Centers for
Farmworker Health, 2005).
Migrant Health Service, Inc.
Background
• A non-profit agency that provides health care
and education to migrant and seasonal farm
workers and their families.
• MHSI has six seasonal and three year-round
nurse-managed health centers located in rural
Minnesota and North Dakota.
• MHSI employs four mid-levels, 28 nurses, 50
Bilingual Health Outreach Workers, and nine
office managers.
• Over 450 community providers work with
MHSI.
Migrant Health Services, Inc.
Nine migrant nurse-managed health
clinics in Minnesota and North Dakota.
Migrant Health Service, Inc.
(MHSI) Diabetes Program
Background
• In 1998, MHSI piloted a diabetes program in six
rural, summer-only, nurse-managed health
centers.
• In 1999, the Diabetes Program was revised and
expanded to encompass eight nurse-managed
health centers and two year-around sites.
• In 2000, Diabetes Lay Educator (DLE) were
incorporated into the MHSI Diabetes Program.
The Diabetes Lay Educators
2003 - 2005
Grafton, ND - Laredo, TX
Bathgate, ND - Crystal City, TX
Minto, ND - La Joya, TX
Moorhead, MN - Roma, Rio Grande,
La Grualla, TX
Hiring Diabetes Lay Educators
• Diabetes Program staff recruited natural leaders
from the migrant population to learn concepts of
health education and to conduct support group
meetings for migrant farm workers in Minnesota,
North Dakota, and Texas.
• Advertised for the positions throughout MHSI.
• Word of mouth traveled fast and soon there were
six individuals ready to take on the position of
being a DLE.
• DLEs work on a contractual basis. Contract is
renewed yearly.
DLE Job Description
• Schedule educational/support group meetings for
diabetic clients while in Minnesota, North Dakota
and Texas.
• Act as a liaison between clients and health
providers to ensure quality services.
• In the community, take clients’ blood pressures,
blood sugar, and monitor the management of their
diabetes.
• Complete reports and necessary documentation at
regular intervals.
• Perform duties essential to this position and the
Diabetes Program.
DLE Training
• Initial training session was 2 days with the Altru
Diabetes Center staff.
• Additional training sessions are held 2-3 times
each summer.
• Continual education thru bi-weekly conference
calls during the off season.
• Topics of Training:
• Etiology of diabetes, self-management of diabetes,
complications of diabetes, medications, how to conduct
support group meetings, and other topics as requested
by the DLEs.
DLE Support Group Meetings
• At the Support Group Meetings:
• An area health care providers speak on a topic
related to diabetes
• Clients blood pressure and blood sugar is
taken.
• Test strips given as needed for attendance at
meeting.
• Door prizes are given to motivate and educate
the clients.
• Clients are asked to fill out evaluations at the
end of the meeting.
DLE Experience
• Background
• Personal History
• Wapato, Washington
• Grew-up as a migrant
• Family worked in the apple, plums, peaches, and pears
harvests
• Graduated from high school.in Washington
• Currently as a Diabetes Lay Educator
• Texas - Roma, Rio Grande Valley
• Minnesota – Moorhead, Hillsboro
DLE Experience
• Client Story
• Minnesota
• 52 year-old, male farmworker with diabetes and
depression.
• Death of a son, strain on family relationship
• Emotional Support – Needs attention and
someone to listen to him.
• Show appreciation and recognition as a person
• Social Support - Makes an effort to attend MHSI
activities such as the Diabetes Cluster Clinic.
• Appreciative of services provided by MHSI staff
and DLE.
DLE Experience
• Client Story
• Texas/Minnesota
• 51 year-old female nonworking due to her obesity
and diabetes.
• Difficult for her to walk because of her obesity.
• Gastric bypass
• Emotional Support – Needs attention and
someone to listen to her.
• Social Support - Makes an effort to attend MHSI
activities such as the Support group meetings and
Diabetes Cluster Clinics.
• Always treats MHSI staff and DLE with respect.
• Appreciative of services provided by MHSI staff
and DLE.
DLE Experience
• Working as a DLE, I am able to:
• Learn about diabetes, cardiovascular, and obesity
• Educate clients in the support group meetings and home
visits.
• Feel like I am helping the clients.
• Gain client trust and support resulting in feeling of comrade
• Feel like I am part of a group with the other DLEs (e.g.
respect and trust).
• Teach MHSI staff and providers about the Mexican
American culture and health care.
• In conclusion, a lot of respect and caring is
demonstrated from the clients, MHSI staff, and
providers because the DLEs are known as
educators in the community.
Program Challenges
• Continuing education or updating of current diabetes
information for the DLEs.
• Supervision needs to be conducted from a distance while
the DLEs are in Texas.
• MHSI staff visit the DLEs in Texas to:
• Meet with them and address they issues they are
encountering
• Attend support group meetings
• Conduct home visits with clients
• Meet with health care professionals
• Communication with the DLEs from a distance.
• Conference calls
• Continuing availability of funding for the program.
Conclusions
• Establishing relationships in Minnesota, North
Dakota, and Texas is essential.
• Agencies at the community, state, and national levels.
• Political officials at the local, state, and national levels.
• DLEs:
• They have become advocates for their clients.
• They have taken on more responsibilities; they help
clients with outreach in communities.
• Migrant Clients:
• They are able to have more continuity in their care.
• They have formed relationships with the lay educator
that covers their area.
Conclusions
• Chronic Disease Registry:
• Information gathered from the DLEs is entered in the
Chronic Disease Registry.
• National Rural Health Association (NRHA) Award
for Outstanding Rural Health Program.
• In 2003, the NHRA recognized the program as an
innovative community-based program that meets the
health care needs of the rural Hispanic farm worker
population in Minnesota, North Dakota, and Texas.
• National Association for Rural Health selected our
program to be recognized in a book.
Questions?