Mobile Health Unit Improves Access for Hispanic and Indigenous Women in Santa Maria and Guadalupe

Many Hispanic and Indigenous women from Mexico in the Santa Maria and Guadalupe areas do not have adequate access to healthcare. These individuals often live in poverty despite working as field workers or in cleaning/maintenance. Most have less than an elementary school education, and many cannot read or write. Spanish is the most prevalent language, but around 20% speak the Mixtec or Zapotec Indigenous languages. Poverty and communication barriers make accessing medical services a challenge, and because Mixtec is a less common language than Spanish, the Indigenous population faces an additional challenge: most medical materials (informational texts, intake forms, etc.) are not translated into Mixtec.

 

The Mobile Health Unit

 

The Mobile Health Unit (MHU) is a mobile health clinic that offers free medical and preventive healthcare services for these uninsured Hispanic and Indigenous women from Mexico who are living in Santa Maria and Guadalupe, CA. Funding partners include the Santa Barbara Foundation, the National Association of Free and Charitable Clinics, and donations from Dignity Health and other private donors. The clinic is made possible by a partnership between Cal Poly, the NOOR foundation, and Marian Medical Center, and serves roughly 250 new patients per year including ongoing care and follow-up visits. The NOOR foundation provides free medical care to the uninsured, and Marian Medical Center’s medical residents rotate on the MHU as part of their underserved rotation. Marian’s labs also process many of the MHU's patient biospecimens. Services the MHU offers include:

• Women’s annual health exams
• Pelvic and breast exams
• Pap smears
• Blood pressure and blood sugar testing
• Cholesterol testing
• Family planning
• Pregnancy
• Menopause
• Heart Health
• Female cancers
• Healthy lifestyle
• Mental Health
• Referrals to partners in a network of medical, social, educational, and other community providers

The MHU also participates in community events such as health fairs, providing blood pressure and other screenings and distributing educational materials.

In order to better serve the Mixtec women in Santa Maria and Guadalupe, Dr. Suzanne Phelan of Cal Poly’s Kinesiology and Public Health department applied for and recently received $30,000 in grant funding from the Santa Barbara Foundation to strengthen the MHU’s system for serving women who speak one of the Indigenous languages and who may not be able to read or write. These critical communication tools (images and audiovisual) are used by the MHU’s Mixtec interpreters and medical team to better inform women of MHU services, facilitate completion of medical intake and other assessment forms, and engage patients in evidence-based medical educational and health promotion interventions, including diabetes prevention and weight management programs. Hundreds of written materials will be transformed into a fully interactive tool with videos, images, and audio in multiple languages constructed with feedback from patients, medical providers, and interpreters.

While work on these tools is ongoing, examples include digital health history forms with questions represented in text, read aloud via audio playback, and accompanied by images that represent the content of the questions being asked. Since the populations that the MHU serve often struggle with trust of the medical community, research into what kinds of informational images instill trust and understanding among patients is also being performed in order to make these tools as successful as possible.

Cristina Macedo, Mobile Health Unit Coordinator, shared the following success story from the MHU:

”A delightful 57-year-old patient came to the MHU for a Well Woman Exam. She worked in the agriculture industry for many years, and she was uninsured. She stated she had not received a complete physical exam in several years nor a breast exam. She was concerned about a mass on one of her breasts. After our health screening and referrals, she was determined to have breast cancer and other health issues such as diabetes and depression. We advocated for her to receive the best cancer care possible at Mission Hope and provided excellent personal support to her and her family by video calling them after chemotherapy and mastectomy. She is receiving treatment and follow-ups for her diabetes, post-cancer surgery, and mental health services. She feels like without the medical screening provided by the MHU, she wouldn’t have been able to be diagnosed and treated in a timely manner, and she is grateful for our advocacy and support.”

Cal Poly's CEI office assisted Dr. Phelan through the grant process. “As the primary office on campus responsible for supporting Cal Poly faculty, staff, and students when applying for not-for-profit funding, Corporate Engagement and Innovation (CEI), within the Division of Research, Economic Development, and Graduate Education (D-REDGE) supported Dr. Phelan’s team in preparing the necessary information to support a competitive proposal," said CEI Associate Vice President Jim Dunning, "We are delighted the Santa Barbara Foundation is supporting this very important effort in the region. This work is in direct alignment with D-REDGE’s recently adopted Diversity, Equity, and Inclusion Action Plan. Specifically, Goal 4 to engage the Cal Poly community to create innovative scholarship that addresses and responds to real-world problems of justice, equity, inclusion and diversity to create a more just, equitable and inclusive campus, Central Coast and California.”

 

 

“One of the most rewarding aspects of working with our women's mobile health program is witnessing the cultural exchange between our staff and patient populations,” says Dr. Phelan. “It's wonderful to hear expressions of gratitude from patients receiving care sometimes for the first time in their lives. Our staff and students are incredible, speaking multiple languages and managing several competing tasks sometimes simultaneously during peak hours of the clinic.”

In addition to serving the patients of the MHU, Dr. Phelan’s efforts include plans to distribute these materials to other health care community partners serving these populations.

In a recent progress report, Dr. Phelan shared the story of mother and daughter refugees from Central America whom the MHU helped:

“The mother was screened and determined to have breast cancer and major depression; now, she is receiving much needed medical care and treatment for both conditions. The daughter was screened and identified to have an extensive history of sexual assault and abuse in her prior country and was experiencing symptoms of depression; she is now receiving much needed psychological services. This mother and daughter have expressed their intense gratitude for the care received on our mobile health unit and the funding from CAFCC (California Association of Free and Charitable Clinics), which has allowed us to expand our hours of operation and reach mothers and daughters in critical need of medical services.”

In addition to the previously mentioned partners, organizations that have been key to the MHU’s efforts include:

• Herencia Indigena, which provides translation services
• Mission Hope Cancer Center and Every Woman Counts programs, which provide no-cost mammograms and cancer screenings
• Lideres Campesinas – Costa Central, an alliance of undocumented farm-working women who spread the word about the MHU and work as lay community health advocates
• Corazon del Pueblo, who collaborates on community and training events that promote the MHU, and engages creative expression towards validating the art and heritage of the communities involved
• Little House by the Park, the City of Santa Maria, and the city of Guadalupe, who provide private and public parking for the MHU

 

Part of the MHU team in front of the MHU

 

Most community members discover the clinic through Facebook posts and word of mouth, and many patients report contacting the MHU after seeing the unit in their neighborhoods. Those interested in the clinic's services can call 805-858-0943 to make an appointment. Clinic staff will coordinate a time to do intake forms over the phone prior to an appointment.

Over the next 2 years, the MHU hopes to expand operations to keep up with demand. The MHU also hopes to offer a second unit, which could allow their team to serve Santa Maria and Guadalupe simultaneously. They hope to be a regional model for other practices interested in this approach and to build a workforce for the future that increases representation of marginalized groups among healthcare professionals.

Acknowledgement Statement: This project was made possible by the work of the units in the Cal Poly Division of Research, Economic Development & Graduate Education to support student research, Learn-by-Doing, the Teacher-Scholar Model, proposal submission, award negotiation, compliance review, and post-award management. See more at research.calpoly.edu.