GUTTENBERG, Iowa — Caroline Johnson is not a typical nurse practitioner. Nor are her patients typical patients.
Recently, she treated people in a small room at Guttenberg Municipal Hospital’s Family Resource Center. Rather than an examination table, she had a couch and kitchen table. She could not speak to most of her patients without a translator.
“This is something they never taught us in school,” said Johnson, clinical director for Proteus Inc., a nonprofit organization that provides mobile health care to Iowa farm workers and their dependents.
Many are migratory laborers, who only live in Iowa a few months out of the year. Others might work seasonally or year-round.
“The people that we work with are an invisible population,” said Proteus health care manager Briana Reha-Klenske.
The National Center for Farmworker Health estimates that about 1,476 farm workers with 2,684 dependents live in Clayton County. The center estimates that 183 of the workers are migrants.
In Clayton, Jones, Delaware, Jackson and Dubuque counties, center officials estimate there are more than 17,000 farm workers and dependents and more than 740 migrant workers. The center estimated in 2018 that 73% of farm workers nationwide are foreign-born, mostly from Latin America.
Proteus employees believe many locals might not even realize these people are in their communities.
Among other services, Proteus runs mobile clinics throughout Iowa to help reduce barriers to health care access for farm workers, especially the migratory and seasonal. The clinic charges $5 to $20 for an appointment and will never deny services to someone who cannot pay.
“We exist to help them overcome the problems and the barriers they live with because of their lack of status or what have you,” Reha-Klenske said.
Proteus personnel also write and fill prescriptions and provide referrals as needed.
Reha-Klenske said finding patients is challenging. She drives around eastern Iowa in winter, attempting to make connections.
“That population specifically is less apt to reach out and ask for help,” said Kari Harbaugh, coordinator at the Family Resource Center.
Many of those people access services only when help is offered or someone in their circle refers them, she and Reha-Klenske said.
Proteus holds hours in the late afternoon and evening to try to minimize missed work, but many patients do not have cars.
Most Proteus staffers are bilingual, eliminating the language barrier that patients might face at other providers. Johnson, who is not bilingual, said it can be difficult to communicate complicated medical information via translator, as well as convey urgency to a population that largely goes without care.
Proteus just this year began billing Medicare and is working on Iowa and Texas Medicaid, but many patients have no insurance, some because of “under-documentation,” Reha-Klenske said.
When Proteus needs to make a referral or send a sample to a lab, she must “get creative” to get around expensive care, though Proteus is able to pay for some appointments.
“As a health care provider, it’s sad to me that more people don’t realize we need to increase access to care,” Johnson said. “And there may be people that aren’t the most typical patients, but they deserve high-quality care.”
Common among patients are chronic ailments like diabetes and hypertension. Without continuity of care — the clinic visits each site just a few times per year, but many patients are only around in summer — many patients get off their medication and see setbacks between visits, Reha-Klenske said.
In previous jobs, Johnson could order labs and send patients to specialists without a thought. With reduced capacity to do so now, she needs those resources more than ever.
“I can’t do a pap smear in this room,” she said.
Despite complications, Proteus clinics are valuable for those who use them.
Olegario Acahua, a Mexican immigrant who works on a northeast Iowa cattle ranch, visited recently with his wife and four children. Both parents had appointments.
Acahua, speaking in Spanish, said traditional doctors’ appointments are “caras,” or expensive, and his family does not have health insurance. He said Proteus is good for immigrants like him without many resources.
“It’s just such a beautiful array of people with their own stories and their own unique struggles, but all they want to do is be healthy,” Reha-Klenske said.