Vigor + The Vine Worker

¡Salud! Services Clinical
Nurse Manager, Leda Garside, R.N., BSN, checks a patient’s blood pressure at a wellness clinic.
Each client receives a diagnostic check-up including blood pressure checks, cholesterol
screenings, and body fat and body mass index (BMI) testing.
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Story by Kerry Newberry • Photos by John Valls

Leda Garside, the petite nurse in white tennis shoes, is a contrast to the boot-clad workers bundled in fleece jackets and baseball caps at the top of S.W. Mountain Home Road, but from the banter it’s clear: They are like family.

The early September morning at the ¡Salud! clinic is cool, and the sun shines across a backdrop of vineyard rows, vibrantly green. Garside is multitasking, explaining how to register for the clinic to the new workers and greeting visitors from the Oregon Food Bank who are carting bags of donations.

In a few minutes, the bags filled with bottles of cooking oil, rice and canned goods are lined up by the registration tables, and she bounces toward the adjacent sprawling white Adventist Healthcare van to facilitate a tour of the “clinic on wheels.” The van is set up to provide workers with a complete heath screening that includes cholesterol and diabetes checks; blood pressure and BMI (body mass index); and flu and tetanus vaccinations.

The mobile outreach clinic runs from the end of May through early September and this year traveled to 202 vineyards and wineries, with 23 days of clinics — two sites per day — where Garside and her staff will have treated between 60 to 120 patients each day.

“Think about this event like an annual health fair for your workers,” she said. “It’s all about prevention and education.”

Partnering organizations are key. Pacific University sends students and staff to conduct complete dental cleanings and vision screenings and also provides physical therapy treatment. Other significant partner organizations include: Medical Teams International (also dental service providers), Virginia Garcia and Migrant Health Education.

The services offered by the clinic are crucial. The General Accounting Office (1992) reports farm work as the most dangerous occupation in the United States. And according to the National Center for Farmworker Health, 70 percent of the agricultural worker population does not have health insurance. Because of limited access to healthcare, farm workers are often seen only when their health problems are at advanced stages. ¡Salud! has transformed the scope of healthcare for vineyard workers and their families in the Northern Willamette Valley.

The staff for ¡Salud! is housed at Tuality Healthcare Foundation. “That’s where our roots are,” said Nancy Ponzi of Ponzi Vineyards and one of the founding members of ¡Salud!. Ponzi still remembers the first meeting at Tuality, almost 20 years ago, brainstorming ideas for a collaborative fundraising event with the hospital. “We wanted to do something good and useful — not to just have a party,” said Ponzi.

She credits Paul Hart, the past president/owner of Rex Hill, with the idea to have an auction to benefit the vineyard workers. The program portion of the auction evolved under the guidance of a core group of winemakers, Tuality administrators, local health departments and through a partnership with the Virginia Garcia Memorial Health Center.

The first event was held on November 7 and 8, 1992, and was attended by 244 guests who were treated to a casual tasting of specially blended ¡Salud! cuvées at Rex Hill Winery the first day and then an elegant evening at Atwater’s in downtown Portland on the second day.

The founding wineries at this first ¡Salud! event included: Adams, Adelsheim, Amity, Bethel Heights, Bridgeview, Cameron, Cooper Mountain, Domaine Drouhin Oregon, Elk Cove Vineyards, Erath (Knudsen Erath) Evesham Wood, The Eyrie Vineyards, Oak Knoll, Panther Creek, Ponzi Vineyards, Rex Hill Vineyards, Sokol Blosser and Tualatin Estate. The first-time event was a success and raised $127,831 for healthcare services.

At that point, the profits were given to Virginia Garcia and other organizations to provide the healthcare services for the workers, but many members desired a more direct connection.

“By 1997, based on feedback received from wineries and vineyards regarding our previous efforts, it became obvious that the program needed to further improve access and healthcare to the vineyard workers,” explained Maria McCandless, the foundation manager for the Tuality Healthcare Foundation.

Dr. Vince Reyes and Terry Casteel of Bethel Heights Vineyard put together a proposal that outlined a program overseen by Tuality Healthcare with direction from the ¡Salud! Services Advisory Committee. This program was focused around hiring a full-time outreach coordinator who would develop relationships with vineyard managers and workers and with agencies that could be helpful to the workers’ health care needs. Garside had already built a great reputation as Tuality’s Employee Health Nurse and was asked if she might be interested in this newly formed position. Garside accepted and has been with ¡Salud! since 1997.

Commitment to the workers almost two decades ago is one of the many reasons Ponzi and other founding members are still so dedicated and involved.

“We don’t just throw money into a pot,” Ponzi said. “Side by side, the hospital worked with us to set up this service project, which has developed into an amazing clinic.” The clinic has been extremely successful; it is now a nationally recognized model. “We get tremendous recognition from out of state for what we are accomplishing here,” Ponzi added.

As Oregon’s vineyard acreage has increased, the outreach clinic has experienced significant growth in the past decade. In 2009, 3,575 workers and family members were registered in the program, which is a 9 percent increase over 2008, and the delivery of healthcare services, including medical, prenatal, dental and vision, increased by 16 percent. Last year, just over 1,000 wellness screenings were given at the worksite, 3,492 dental procedures were performed and 1,232 medical clinic visits were documented.

In 2009, grants for healthcare services provided on behalf of ¡Salud! clients totaled $185,458; specifically, 211 grants for emergency care, hospitalization and emergency dental care were provided. Because of collaborative relationships with partnering healthcare organizations, for every dollar put in, the clinic is able to deliver $3 worth of services.

Healthcare is not limited to the outreach program. In addition to the mobile services, ¡Salud! provides year-round medical support to the workers and their families. Additional programs are offered throughout the year, such as First Aid and CPR classes. “We have the most trained workforce in the state of Oregon,” Garside said.

The success of the program is not just in the stability and growth but also in the relationships established with the vineyard workers. Like other farm worker populations, vineyard workers can be hard to connect with, often overwhelmed in a new country and distrustful of outsiders.

“Leda has been absolutely amazing in bridging that gap and building that trust,” Ponzi said. “That’s been something that took time and has been at the core of the success.”

Garside, in turn, credits the wineries for the success of ¡Salud!. “The expertise, the ideas, the energy that they provide to make it successful — they work so hard on that,” she said.

Garside also distinguishes ¡Salud! from other programs because it is industry generated. “It’s the wineries’ program; it’s their baby,” she added. “They have a vested interest in it.”

Both sentiments ring true on any day at the outreach clinic. The services are seamlessly organized, and the resources, second to none. The clinic staff is bilingual in Spanish and when they find a worker with an indigenous language, they try to find another employee or public health educator who can translate.

Migrant Education joins at every clinic and sits just outside the van providing information to the workers and families of all the services available in their community. Supporting Garside at every clinic is a salt-and-pepper-haired man from Adventist Health, Ed Hoover. He is a longtime health educator and manager of wellness services — as well as the driver of the impressive van.

Carolyn McKay, the community outreach nurse for ¡Salud!, and Miriam Vazquez, another health educator, also staff every clinic. McKay says that after returning to the same vineyards and wineries every year, the preventive care the clinic provides and the education shared really gets a chance to establish strong roots. “It’s planting seeds,” she said.

Every worker receives brochures and phone numbers with contact information for services throughout the year. The foreman at every vineyard is encouraged to share this information with all the new workers, who, in turn, are encouraged to bring their family members.

“We have a great rapport with our workers — we know who they are,” Garside said. “Plus, the families trust us and call us when they have issues — legal, marital, we get all kinds of requests.”

Overall, the vineyard worker population is very healthy, but at the same time adjusting to the American system. The lifestyle changes and different diet patterns are the most significant. “We hear this from a lot of the wives because a lot of them start gaining weight,” Garside explained. “They’re not walking the way they used to walk in their country. Or you feel isolated because you live somewhere where there are many other barriers.”

¡Salud! provides helpful information and in their own language. Workers will find someone that speaks their own language and someone who will understand them and who will be able to provide them the care that they need.

“There isn’t anything exactly like this in the country,” said Terry Casteel of Bethel Heights Winery and one of the founding ¡Salud! members. “Especially when it’s an industry supporting a benefit to their workers.”

Back at the clinic on S.W. Mountain Home Road, Vazquez is explaining test results to the workers. Animated and in rapid Spanish, she points to a table of various drinks — a can of Coke, a jug of orange juice and a bottle of Gatorade. Taped to the side of each are vials filled with sugar to illustrate how much sugar each drink contains, which leads into a discussion on blood-sugar levels.

“We don’t discourage anything,” Vazquez explained. “We encourage moderation.” Cholesterol is also explained with two poignant and plastic examples of arteries — one clogged, one clear. Workers follow along with their test results in hand that include their total cholesterol, BMI and glucose. Vazquez is quick with examples to explain why the tests and their discussions are vital. A simple toothache not treated cost one worker thousands of dollars because of a severe infection.

“They know us, they see us enough, and they trust us to help them,” Vazquez said. When she explains results she wants the workers to respond with a plan to better themselves. “I want them to take steps forward.”

Ronni Lacroute, co-owner of WillaKenzie Estate and major donor to ¡Salud!, has participated in the service sub-committee for many years. She is enormously impressed by the efficiency of the organization as well as the positive outcomes for workers who have accessed the services — from health and safety trainings and workshops, to wellness and dental clinics, to specific cases of individuals who have requested grants for care and help negotiating payment options with providers.

“Through the wellness and dental clinics, and by directing its clients to partnering healthcare providers, ¡Salud! has diverted many workers from hospital emergency rooms, resulting in a lesser burden on the emergency system as well as far lower costs,” Lacroute said.

In 2009 alone, discounts totaling $235,244 were negotiated with healthcare providers.

The services provided can be life changing — either from a treatment or by generating a spark. Garside beams when she tells a story about their dental program.

Abel Ahumada was a migrant worker who was so inspired by a dentist from Medical Teams International who was working with ¡Salud!, that he too, vowed to become a dentist.

He finished his GED, attended a community college and Portland State University, applied to dental school and was denied several times. Ahumada worked with Garside as a health educator during this time, still focused on his dreams of becoming a dentist. Eventually, Ahumada attended OHSU dental school, has been a practicing dentist for over five years now and donates time and services to ¡Salud!.

“So much of the spirit of ¡Salud! is generosity and a willingness to just go out and do it,” Casteel said. “That spirit is what keeps things moving along.”

The ¡Salud! emblem is a sunlit silhouette of a farm worker harvesting. The focus on the worker is intentional.

“We aren’t grapes, and we aren’t glasses of wine, we are the worker,” Ponzi explained. “The figure also exudes the idea that this is a person who loves working with plants and loves what they are doing, and they deserve all the respect and care that ¡Salud! is trying to provide for them.”

Any way we look at it, the farm worker population is providing a labor and a service that is important to everyone.

“When you make a salad or you open a bottle of wine — we don’t really think what took place to get these to our table, we don’t think that way,” Garside noted. “When you see what it takes to make a bottle of wine, what it takes to bring that head of lettuce to your table, it’s an amazing process. That’s what this is all about. This is to give back. To give thanks.” 

Kerry Newberry is a Pinot-sipping, vineyard-hopping wine and food writer. She resides in Portland.

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