"After getting to know the farmers and farm workers, what has emerged as the major medical issue for the workers is access to care," Dietrich says. "Most migrant workers were not aware that within a 15-minute drive to the farm was a community health center that would see them for free, no questions asked. "

Before medical school, Holly Schroeder traveled to Patagonia and volunteered in an emergency room in Coyhaique, Chile—where many patients traveled for hours to seek routine medical care due to a lack of doctors in the surrounding rural region.

“I remember a woman with a broken tibia who traveled two hours by horseback to reach a highway where she could hitch a ride to the hospital four hours away,” Schroeder says. “By the time we saw her in the ER, her simple fracture had become more painful and difficult to treat than it needed to be.”

But as Schroeder and Karl Dietrich both realized, very similar scenarios were unfolding much closer to home—specifically, within the rural Vermont Upper Valley’s large community of migrant farm workers.

Read on to discover how these two Schweitzer Fellows from Dartmouth Medical School (DMS) joined forces to do something about it.

Why did you decide to develop your particular project?

Schroeder: [Observing the patient described above] and many others made an indelible impression on me.  I decided to return to the U.S. and apply to medical school, so that I could bring medical care closer to patients like her wherever they may be.

In rural parts of the U.S., as in Chile, limited access to health care can cause major complications for geographically isolated patients.  For the migrant workers of the Upper Valley, their distrust of the system, lack of knowledge of available services, and language barriers puts them at the same risk as the female patient I saw in Chile, even though many of them have medical services five minutes down the road. As a physician, I am committed to working with underserved populations in rural areas. Last year, when I discovered this almost invisible population of migrant workers on the farms an hour north of Dartmouth, I knew this was a project I had to make happen. Working with farmers and farm workers, I am able to use the language skills and cultural understanding I gained living and working in Latin America. I also get the chance to spend time on the farms getting to know local farmers and the struggles they face, so I can better serve this population as a physician in the future. DMS is one of the only rural medical schools in the U.S., and we have the opportunity to learn about this patient population that most medical students don’t have access to. For me, this Schweitzer project grew out of a dual interest in migrant workers and rural medicine, and I feel lucky that I’ve been able to make a small contribution to the local community.

Dietrich: My interest in migrant populations began as a college student in Lewiston, Maine, where I had the opportunity to work with a rapidly growing Somali population in local schools and community organizations. These experiences helped me gain insight into the incredible challenges faced by migrant populations in new communities, and complemented my longstanding interest in serving others. In each case, new residents needed to learn a new system and a different way of doing practically everything, all without the cultural background to understand the way things work. My interest was expanded during times I lived abroad, as it gave me better insight into how it feels to be an outsider in a new place.

When I entered medical school, I knew I wanted to apply my growing medical skills to continue to help underserved populations and become involved in the larger community. Holly and I were able to connect over our interest in migrant populations and Latin American culture, and looked for a way to apply those interests in the Upper Valley. We realized there was a unique population of year-round migrant farmworkers on local dairy farms in Vermont and New Hampshire that is often overlooked. This is a relatively invisible population, and in most cases does not have the same access to health care as other local residents.

What do you hope will be the lasting impact of your project on the community it serves?

Dietrich: Over the past year, the shape of our project changed several times. After getting to know the farmers and farm workers, what has emerged as the major medical issue for the workers is access to care. Most migrant workers were not aware that within a 15-minute drive to the farm was a community health center that would see them for free, no questions asked. There was also a lack of comfort with the American medical system, and a reluctance to seek out health care services. Most of the migrants spend at least one month a year in Mexico, and due to lower health care costs and availability of doctors, they generally put off their medical concerns for those visits. We’re hoping that by visiting the farms regularly and holding a series of on-site yearly events that the workers can rely on, they will become more comfortable with the services in the Upper Valley.  To make this sustainable, we hope to strengthen the relationship between DMS, the Little Rivers Community Health Center, and the local farms so we can work together to provide the workers with the full spectrum of health care services available.

Schroeder: At the moment, our project is focused on providing health care to the migrant workers, but we’ve noticed that there are many farm workers from Vermont who also don’t regularly seek health care. We hope an extension of our project will be to encourage those workers to visit the doctor. A lot of our interest in this population comes from a desire to improve the quality of life for the migrant workers who are spending so much of their time working to support Vermont’s struggling dairy industry. They spend so much of their time in the United States working to send money home to their families that they are essentially putting their own lives on hold.  If in any way we can make the experience better for them while they are here, we will see our project as a success.

What do you think is the most pressing health-related issue of our time, and how do you think it should be addressed?

Dietrich: Fixing the health insurance system and payment reform are two of the most pressing issues facing our society today. Even at this early stage in our education, we’ve seen numerous examples of patients who are struggling with both a chronic disease and finding a way to pay for the massive costs associated with it. There are certain diagnoses that guarantee a patient will exceed the lifetime cap on their insurance policy within a matter of years leaving them in a very difficult situation. Others never even consider buying health insurance because of the expense, which only places an additional burden on the system if they get sick. The current administration has made significant progress in eliminating certain exemptions and caps, but I believe we need to consider a single-payer system, both to reduce costs and to ensure everyone has equal access to care.

Schroeder: Doctors are choosing more and more to work in specialized areas in urban centers, leaving rural populations seriously underserved. Research shows that patients do better, follow doctor’s instructions more closely, and schedule more follow up appointments when doctors are people that they know from their community. In order to provide top notch care in these underserved areas, not just in large metropolitan areas, there need to be more doctors who choose to live and treat patients in rural locations and who follow a more generalized approach to patient care.  We need more primary care physicians. Barriers to first-rate health care are already insurmountable for so many people, and it is imperative that more medical students enter the profession with a goal to correct this.

What has been the most surprising element of your experience as a Schweitzer Fellow?

Schroeder: The most surprising element of our experience has been how well this project has ultimately complemented our medical school education. This project began as a chance to help an underserved population and work with the larger community, but it has become an essential element of our training. We have been able to form relationships with workers, farmers, and health care professionals outside of the medical school, and have gained a better perspective on how we each want to practice medicine. In addition, it has motivated us and served as a constant reminder of why we entered this field in the first place.

We are also surprised to learn what can be accomplished by two medical students in a relatively short period of time when supported by each other, mentors, and the Schweitzer community. Just think what will be accomplished if this effort is multiplied across a lifetime. 

Dietrich: Another surprise has been the number of iterations our project has taken. After one year, the product is different that we originally envisioned, but this flexibility allowed us to meet our original goals while doing a much better job of meeting the changing needs of the community. In getting to know the farmers and workers, we have been able to work together to establish a plan with long-term functionality, rather than one that simply met our short-term goals. Things did not always move quickly, but we realized that moving slowly and emphasizing a trusting relationship was more important to the success of this project.

What does being a Schweitzer Fellow (and, ultimately, Fellow for Life) mean to you?

Dietrich: One of the best components of the Schweitzer Fellowship was the opportunity to connect and work with other service-oriented people and students, across a range of professional backgrounds. Balancing a service project and the demands of school is a challenge, but the Schweitzer Fellowship provided a support structure of other students who were going through the same process. Each month we were able to come together as a group and share our accomplishments and discuss the challenges we had encountered, which motivated us, allowed us to learn from each other, and improved each of our experiences. We are joining a larger network of professionals committed to their communities. I look forward to connecting with Fellows for Life wherever I end up, and hope to be able to work with new students on their projects in the future and pass on the support that I have received this year.

Schroeder: I applied to be a Schweitzer Fellow because I believe medicine is a service profession. In the first two years of medical school there is little opportunity for hands on patient care, and I knew that this project would be the perfect complement to my classroom education.

Not only has the project been a daily reminder of why I chose to become a doctor, but it has become the centerpiece of my first two years in medical school.  After hours of studying in the library, spending time in direct service is a reminder of why I started this journey in the first place.  I am hoping that being a Fellow for Life means that I have become part of a community of professionals who are as passionate about using their skills for service as I am.

Dietrich and Schroeder are Schweitzer Fellows in Vermont. Click here to read more about the New Hampshire-Vermont Schweitzer Fellows Program and the Fellows like Dietrich and Schroeder it supports in creating and carrying out yearlong direct service projects. To make a gift to The Albert Schweitzer Fellowship in honor of Dietrich and Schroeder’s efforts to expand access to care and empower migrant workers, click here.

Each week, Beyond Boulders delivers a new installment of “Five Questions for a Fellow” – an interview series with Schweitzer Fellows across the country and in Gabon, Africa who are leading the movement to eliminate health disparities. For an archive of previous “Five Questions for a Fellow” interviews, click here.