FORT LUPTON, Colo. -- Colorado's community health centers have had to shift gears during the coronavirus pandemic to ensure migrant workers, who harvest the food for dinner tables across the nation, have access to health care.

In addition to increased on-site checkups and distributing Personal Protective Equipment, Deborah Salazar, migrant health director with Salud Family Health Centers, said telehealth services have been critical for workers out in the fields from sunrise to sunset on the state's eastern plains.

"And so for them to actually have to take off time to go somewhere to wait for the doctor, to get into the visit, and then go back somewhere - and especially if transportation is an issue - this is perfect for them," Salazar said.

Many migrant workers were slow to seek care, even when they had COVID-related symptoms, because they couldn't afford not to work. When workers became eligible for paid sick leave after the state issued a guidance that would compensate employers with tax credits, health center staff played a big role helping employers implement the policy.

Dante Gonzales, director of program operations at Valley-Wide Health Systems, said relationships built over the years with community leaders trusted by workers in the San Luis Valley was key for connecting workers with care during the health crisis. He said from March through August, health center staff were able to bump up their outreach efforts by nearly 50% over the same time period in the previous year.

"While people were running away, locking themselves up, this team has just stepped up, went out there, partnered with the community, and made sure that we were doing our best to still give access and touch base with all these individuals that need to be assessed," Gonzales said.

Salazar said the integrated health care model pioneered by Federally Qualified Health Centers, which puts medical, mental and dental care under the same roof, continues to put providers in a good position to meet shifting needs.

"Access to behavioral health right now is as important as the medical side of things, because people are scared," Salazar said. "Having access to that behavioral health piece, for the general population as well as the agricultural workers, is really important."

Additional information and guidance from the state for agricultural workers navigating the pandemic is available at COVID19.colorado.gov.


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They may sit empty right now, but high school athletic fields and gyms will soon be active with practices for fall sports ramping up. Health advocacy groups in Minnesota hope more schools are being proactive in preparing for a cardiac emergency.

Each year, according to the American Heart Association, about 23,000 children 18 and younger experience cardiac arrest outside of a hospital. Many states are adopting laws requiring schools to have response plans in place, either for sporting events or in the classroom - but Minnesota isn't among them.

Dale Wakasugi, owner of My AED and CRP Solutions and a volunteer for the American Heart Association of Minnesota, is a former Minnesota high school referee who experienced cardiac arrest during a game several years ago.

"Several people came to my rescue, including a 16-year-old high school student who had just learned CPR," he said. "Her and several bystanders came out and did two rounds of CPR - no response. They put an AED on me, one shock, and brought me back."

Wakasugi, who is now a certified CPR trainer and sells life-saving devices, said he hopes his story inspires school districts to train staff and have the right equipment onsite until Minnesota requires such planning. Supporters of a bill tried to get it passed last session, but there was some pushback over certain language. Backers hope to get the differences sorted out next year.

Minnesota law does require CPR training for students, and Wakasugi said that, as a whole, the state is among the leaders for survival rates. Still, he said, it's important to keep raising awareness, especially among younger people.

"That's why there are several foundations out there now trying to encourage screening for high school students," he said.

Health experts have said sudden cardiac arrest among young people is rare. But Wakasugi and other advocates say detecting issues ahead of time can prevent a tragedy on the court, in the field or in the classroom. Officials say the preparation that could be required can be standalone guidelines, or merged with a school's existing emergency response plan.

Nurses with an expired union contract in Oregon are holding an informational picket on Friday. Negotiations on a contract with Samaritan Pacific Communities Hospital in Newport started in April, but the two sides have yet to reach a deal. The nurses are represented by the Oregon Nurses Association. Their contract expired on June 30th.

Brook Clark, a registered nurse at the hospital and member of the union, wants Samaritan to bring its pay up equal to other Samaritan hospitals. Clark also noted that about a quarter of staff are traveling nurses.

"That cost is really going to eat into our budget as an organization and that cost is going to eventually trickle down to our patients and our community," she said.

Traveling nurses are paid more than local nurses. The Oregon Nurses Association notes Samaritan Pacific Communities Hospital is one of the most profitable hospitals in the state. A bargaining session takes place on Friday. The nurses have also an informational picket planned for Friday. Samaritan Pacific Communities Hospital CEO Lesley Ogden says the talks are on the right path and he hopes they'll agree to a package "that is competitive in our market and will help Samaritan retain and attract the best nurses to care for our patients and the communities we serve."

Clark says housing, child care and other living costs are higher in Newport, and added that the hospital has struggled to stay fully staffed at times.

"Even with the travelers, we still have very regular holes in our staffing that are due to the fact that we can't recruit and retain nurses out here on the coast," she explained.

Clark added the nurses at her hospital do the same work as other nurses in the Samaritan system and their wages should reflect that.

"It really comes down to just the principle of things. It comes down to treating our nurses equally, fairly, and treating us with respect," she said.

Nurses at Samaritan Albany General Hospital reached a deal with their managers on a new contract earlier this week.

Research shows many people in low-income California communities are having a hard time filling their prescriptions because pharmacies in their area are struggling and even closing.

One in four communities in Los Angeles County, for example, is now considered a "pharmacy desert."

Dima Qato, associate professor of pharmaceutical sciences at the University of Southern California, and her team have developed a mapping tool that reveals the extent of the problem, which she said hits communities of color hardest in both urban and rural areas.

"I think that it's getting worse," Qato observed. "In the next several years, a lot of chains have announced plans to close many of their stores. At the same time, one and three independents are at risk for closing."

Qato would like to see Congress reform the practices of pharmacy benefit managers, who decide where a patient can go to fill their medications, how much a pharmacy will be paid and which pharmacies are considered "in network" for health insurance. The bipartisan Pharmacy Benefits Manager Accountability Act, currently in Congress, would increase oversight of the industry.

Qato argued stronger policies could keep more independent pharmacies from going out of business, which could also improve health equity.

"It's due to the role of pharmacy benefit managers and low reimbursement rates, and the growth of pharmacy networks, which restrict where patients can and cannot go," Qato outlined. "Sometimes, patients have to bypass the nearest pharmacy to go to another pharmacy that's within their network."

University of Southern California researchers have called for policies encouraging pharmacies to locate in pharmacy deserts, including increases to Medicaid and Medicare reimbursement rates for those most at risk for closure.


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