Access East is a 501(c)(3) that strives to improve health access to, and coordination of, quality care in eastern North Carolina. Access East serves as an important part of the ECU Health system of care, offering support for under- and uninsured individuals and helping navigate the health care system through service lines such as Access East Care Management, HealthAssist, ACA Navigators and Health Opportunities Pilot.
Out in the field
One such facet of their service comes through the Farmworker Program, which works not only to help enroll members of the ENC H-2A (temporary visa) farmworker community in low-cost insurance, but also to direct them to available community health care options, and to provide emergency medical training like wound care or cardiopulmonary resuscitation (CPR). In just under two months, the program has reached more than 2,000 farm workers.
Juan Allen, a community coordinator and Affordable Care Act (ACA) navigator for the program, plays a key role in helping the farmworker community receive the services and care it needs. “I’ve been with Access East for seven or eight years,” Juan said. “I was born and raised in El Salvador on a farm, which is what got me interested in doing this work.” The goal of the program, he said, is to help members of the migrant farming community prevent injuries and illness. “Last year we lost four farm workers to heat stroke, and someone else passed away because no one in the field knew CPR,” he explained.
“So, we go out to the farms and do CPR training, heat exhaustion and heat stroke education, Stop the Bleed training, education about tobacco sickness and anything else they need.” Juan said there is also skin cancer education and screenings, dental cleanings, mental health support and vaccines. “During COVID, we were coordinating vaccines, so that with providers’ help, we got 80-100 people vaccinated per day.”
Juan has also trained as an instructor for the Mental Health First Aid (MHFA) trainings, which is an evidence-based, early-intervention course that, virtually or in-person, uses community-specific scenarios, activities and videos to teach people the skills they need to recognize and respond to mental health and substance use challenges. The ECU Health Foundation awarded funding to Safe Communities Coalition, a non-profit that works alongside the Eastern Carolina Injury Prevention Program (ECIPP) to prevent injuries. “Juan has reached a population (farmworkers) that we have struggled to reach, yet we knew desperately needed the education,” said Sue Anne Pilgreen, the executive director for the Safe Communities Coalition, the manager of the ECIPP and the manager of the Pediatric Asthma Program. “This past fiscal year, we have trained a total of 196 people in MFHA, and 92% felt like they could recognize someone who was suicidal after completing the class.”
“Juan is one of the hardest workers I know,” said Shantell Cheek, the director of Access East. “He has a passion to really help those who are underserved, and he is a true link between Access East, ECU Health and the Farmworker Program.” Wherever there is a need, she said, Access East and the Farmworker Program is there.
The program, which initially was established to help H-2A workers get visas and enroll in the ACA, has grown significantly. “We still do the ACA enrollment,” Cheek said. “But Juan provides care coordination, and different entities like the North Carolina Department of Health and Human Services and the North Carolina Growers Association partner with us. We now help these individuals get medications they need, assist them when they go to the hospital and are being discharged, set up with primary care providers and provide the education like CPR and skin cancer. And it’s not just the migrant workers; it’s their families too. Wherever there is a need, anywhere across the state, they call Juan.”
Partnering with the Brody School of Medicine
She emphasized that Juan tirelessly creates partnerships with regional and community organizations. Shantell also highlighted Access East’s, and Juan’s, ongoing collaboration with East Carolina University’s Brody School of Medicine. “During their first or second year of medical school, students can select a project to work on and Juan’s name often comes up when they mention an interest in the communities we serve.”
Deanna Torres, a second-year medical school student at the Brody School of Medicine, worked with Juan this past summer as a part of a project required of the school’s four Distinction tracks. Deanna opted to apply for the Service-learning track, which is what led her to Access East. The other tracks include Health System Transformation and Leadership, Medical Education and Teaching and Research.
Deanna said she has always had a passion for grassroots community service. “I’m undecided on my specialty right now, but I know I want to help underserved, minority populations.” Deanna grew up participating in a variety of community service activities, including a medical mission to Honduras and a Benedictine Volunteer Corps trip to the Rosebud Indian Reservation in Mission, South Dakota. Once she entered medical school, Deanna continued her journey in service by joining the Service-learning track. “It isn’t required to join a track,” Deanna explained. “But when I was applying to medical schools, the Service-learning track was a major factor in deciding to come here.”
Students in the Service-learning track work extensively with medically-underserved, marginalized and rural populations during their medical school career. They attend a lecture series specific to that track, but they are also required to participate in a service-learning internship during the summer after their first year of medical school. “We select an organization to partner with, and then we create a longitudinal service-learning project aligned with that organization,” Deanna said. While the internship only lasts a summer, the students’ work on their projects continues until they graduate.
Making a difference
With Juan as her mentor, Deanna said she gained an insider’s perspective on a migrant farmworker’s daily life. “I saw how migrant farmworkers are processed after entering the country. I saw how farms are laid out, and I got to see their living conditions, which aren’t always great. I’ve lived in North Carolina my whole life, and I didn’t know how many farmworkers we have in this region or what their needs were.” This exposure led Deanna to her project’s focus, which is “Increasing Mental Health Services to Hispanic Migrant Farmworkers in Pitt County.” The migrant workers, she discovered, often struggle with mental health issues, like depression. “They leave their home country and their families, work in the heat and have no car or independence, and that can be challenging. I want to advocate for the lack of awareness and communication about mental health in the Hispanic community,” Deanna said.
Juan has been instrumental in helping Deanna make the connections and partnerships necessary to work on her project. “He’s a popular man,” she laughed. “Any time I mention Access East, everyone knows him.” Deanna said she appreciated Juan being willing to mentor her, despite his busy schedule. “As a medical student, it can feel daunting to reach out because everyone is busy, but he was always available and offered me resources, took me to the farms and provided logistics. He knows all about these things.”
Dr. Jennifer Crotty, a pediatrician and an associate professor in the Department of Pediatrics at the Brody School of Medicine, as well as the director of the Service-learning distinction track, facilitates connections between students in the Service-learning track and community partners. “The track primarily focuses on local impact and grassroots efforts,” Dr. Crotty said. Of how she came to direct this specific track, she cited her background in pediatrics. “I realized that to have healthy children, we need healthy families and communities,” she said. “That’s why we want to do this advocacy work.” Access East has been a significant partner in this work. “Access East addresses the things we know need to be addressed. When students work with them, they see the time and energy and resources it takes to do medicine in these rural communities.” While she has never met Juan personally, she knows her students get a great experience when they work with him. “He always finds a place for our students, and the students always say their experience was amazing.”
This work is valuable, Deanna said, because it puts a face and name to abstract medical concepts students learn in school. “It puts a story to what you’re learning,” she said. “It shows us that a patient isn’t just one disease, but they are dimensional, and it helps us be better physicians who treat in a holistic manner. This community needs us to advocate for them.” Dr. Crotty agreed, saying that having students participate in these service learning partnerships through ECU Health make them better physicians, no matter what specialty they choose. “They take the knowledge they gained through service learning to wherever they’re going. I love that someone in their surgery residency is thinking about whether their patient has enough food at home. We graduate good doctors because our students are exposed to these types of things, and they know how to handle it.” Juan said that ultimately, this work gives migrant farmworkers a voice. “They’re only here for eight months and they don’t know their rights,” he said. “Access East is vital to reach out to farm workers so we can be a go-between them and the health system.”