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years

© Candace Kugel

commitment vision impact

Migrant Clinicians Network:


A force for justice in health care
for the mobile poor!
© Ed Zuroweste

There is a class of people who live on the move.


They do the jobs that, even in this economy, most will not. They go where the
work is—fields, factories, construction sites—often with their families in tow,
and take enormous risks in order to survive in the hope of a better life.
They have little access to things most of us take for granted—a permanent
home, a steady source of income, well-balanced meals and good health care.
Yet, there is a group of clinicians who are committed to serving migrants and
their families—who go toward these people with services, specialties and
dedication.
MCN’s mission is to serve these clinicians. We bring education, technical
assistance, peer support and advocacy to the field, creating a chain of connec-
tion and commitment that makes everyone stronger and more effective as we
unite for one cause: healthcare justice for the mobile poor.

Migrant Clinicians Network:


A force for justice in health care for the mobile poor!

2 Migrant Clinicians Network


Dear friends, supporters,
staff and volunteers,
It happened in the blink of an eye. In fact,
some days I am sure we are adding it up all
wrong. But the truth is right in front of us:
Migrant Clinicians Network is 25 years old.
For more than two decades we have been
relentless in our mission to direct support,
attention and services to those who serve
the mobile poor. Our journey is the story of
commitment to an ideal—“healthcare
justice for the mobile poor”—and the

years
translation of that commitment into very
real impact on very real lives.
We don’t just do good work: we do good work well. In these
pages you will experience our milestones and read some of our
case studies. You will feel the depth of the perseverance required
in order to stand shoulder to shoulder with people in dedication
to the cause of healthcare justice.
Your understanding of this dedication—and of the role MCN Table of Contents
plays in serving migrant communities—is critical to our contin-
ued success.
Economic challenges make the decisions about what organiza- MCN by the Numbers 4
tions to support more agonizing than ever. Writing a check in
support of any cause has become, for many, an activity requir- A Conversation with… David Smith and Ed Zuroweste 5
ing the Wisdom of Solomon. It would be easy to think that the
Funding Sources 7
mobile poor would, in fact, suffer least because of the economic
downturn; that having the least distance to fall economically, Milestones: 1984–2009 8
they would be least touched by the crisis. This could not be
further from the truth. Why, Then, a Network? 10
If MCN is the tether between the migrant community and main- A Change in Perspective 11
stream society, your support of MCN keeps it secured. Your sup-
port is not just meaningful…it is vital. An Award-Winning Approach 12
Our mission is more important than ever: continue to expand the MCN in Action 14
flow of knowledge, tools, teachings and tenacity to those who
need it most—those on the front lines bringing healthcare jus- Clinician in Action 15
tice to and for the mobile poor.
In Their Own Words… 16
It has been an honor to have been a part of this organization,
and I continue to be thrilled and impassioned to serve with peo- A History of Excellence 18
ple who have never lost their commitment to help the migrant
community. Together we have built something important and Office Locations 20
enduring. And together we will continue to make strides toward
healthcare justice for our most at-risk communities.
Thank you for your support,

Karen Mountain MBA, MSN, RN


Chief Executive Officer

www.migrantclinician.org 3
MCN by the Numbers
During the last 25 years, hundreds of clinicians have made a difference in the lives of untold thousands of
migrant workers and their families. In the decade spanning 1998–2008 alone, the numbers are staggering.
In that time MCN has facilitated:

45,596 Clinician technical assistance encounters


3,254 Clinicians receiving continuing education credits
11,382 Medical records transferred via Health Network
30,422 Patient contacts via Health Network
506,041 Resources distributed to clinicians

MCN is one of the only resources for the


migrant clinician. Who else do we have to
turn to? Who else is such a strong advocate
for farmworker health?
Sister Eileen Eager, FNP, Seton Center,
Princess Anne, MD
© earldotter.com

Diabetes testing at a migrant clinic.


MCN’s Health Network helps maintain continuity of care.
© earldotter.com

4 Migrant Clinicians Network


A c o n v ersati o n with …

David Smith Tell us how MCN came about.


David: Gail, Willa and I met at the1984 National Farm-
Ed Zuroweste worker Health Conference which was largely comprised of
the executive directors of migrant-related service organiza-
tions focusing on policy and budgets. The three of us were
David Smith was a physician at Brownsville (TX) sitting outside a meeting room talking about how those of
Community Health Center in 1984 when he joined us working with migrants really needed an organization
forces with two leading advocates in migrant health, that was more directly relevant to our role. Our experience
Willa Hayes, a registered nurse from Northwest was that migrant families were essentially voiceless and the
Michigan Health Services, Inc., and Gail Stevens, a clinicians who worked with them were not much better
registered nurse from Delmarva Rural Ministries, to off. We saw migrants as “America’s Third World” and the
form MCN. Since then David has served as Commis- clinicians needed resources, technology and an advocate in
sioner of the Texas Department of Health, President order to serve them well. We penned a mission statement
of the Texas Tech University Health Sciences Center, pretty much right there.
and then Chancellor of the Texas Tech University Sys-
tem. Today he is President of SUNY Upstate Medical Was it challenging to convince people that migrant health
University. care was a relevant cause?
Ed Zuroweste is a family physician who cared for David: Our clinicians had very compelling stories. I remem-
migrant workers in Pennsylvania for more than 20 ber The Washington Post ran an editorial on the plight of
years. He has been involved with MCN since 1985, the migrants and the people trying to help them. Maybe
first as a board member, then as staff. He is currently we were naïve, but we were so focused on our goal of
MCN’s Chief Medical Officer, an Assistant Professor establishing a clinician network that it did not occur to us
of Medicine at Johns Hopkins School of Medicine and we would not achieve it.
a national leader in tuberculosis care advocacy for
migrants. Ed: When I went to my first national meeting the most
amazing thing happened. I’d been working with migrants
Here, David and Ed reminisce about the reasons for for five years and had felt isolated; I entered that room and
establishing MCN and why those reasons remain rel- felt as if I’d come home. At the first meeting we did not
evant today. even have a real place on the conference agenda. And we
could see that we had to push for a voice for clinicians on
A nurse practitioner cares for a the National Migrant Health Advisory board—and beyond.
migrant woman.
David: That was about the time we received a grant from
the Office of Migrant Health. Sonia M. Leon Reig was a
very big advocate for us with the Feds (through this office)
and she helped us get funds to create a clin­icians’ track at
the Farmworker Health Conference.

MCN became a stand-alone group in the early ’90s. How


did that happen?
Ed: We went from being “children” to rebellious adoles-
cents! We just reached a point where we had to stand on
our own two feet. It took about six years to accomplish.
David: It was the old “candle in the wind” story— except
we stood alight in full force gales. The ‘80s were an awak-
ening driven by an incredible group of people who felt
their mission seven days a week. In fact, many drove water
and medical supplies into the fields on their own time on
summer weekends to help migrants. By the ‘90s it was clear
we needed our independence.

www.migrantclinician.org 5
Ed: In MCN’s early years the area of migrant health was
a revolving door; people worked a while and then went
on to other things. We had to show how people from all
areas of medicine could have careers in this segment.
Former Acting U.S. Surgeon General Rear Admiral Steven
K. Galson, MD, MPH and six of his predecessors opened the How did you draw people’s attention to the challenges
National Summit for Healthcare Justice in October 2008. facing migrants?
Pictured from left to right are Drs. Audrey Forbes Manley Ed: We struggled tremendously with anti-immigration
(Former Acting Surgeon General), Kenneth P. Moritsugu (Former sentiments (and still do). Trying to get funding was at
Acting Surgeon General), David Satcher (16th Surgeon General), times difficult because we were asking for support in an
Steven K. Galson, Richard H. Carmona (17th Surgeon General), area that worries lots of people. But we stayed focused
C. Everett Koop (13th Surgeon General), Antonia Novello (14th on the issue of basic human rights—no one should be
Surgeon General). treated like indentured servants.
David: We worked hard to show how migrants
are vital to our nation’s economic stability.
Migrants are the conduit for so many products
we use daily—especially food. People think
of them as “pickers,” but they work in many
industries. And we always surprise people
when we point out that a good number of them
are “legal.”

How did you decide what services to offer?


Ed: We made, and continue to make, decisions
based on our initial reasons for forming: to
provide a home for clinicians; to provide advo-
cacy; to create products that help clinicians
provide continuity of care. These are at the
core of our best practices, lessons, technologi-
© Alan Pogue cal support and more.

Twenty-five years later, has the game changed?


This fall when we co-sponsored the Summit Ed: What has changed most is the population we serve.
of Clinicians for Healthcare Justice, I was so Migrants are no longer just farmworkers. They are a
community of “mobile poor” who work not only in agri-
proud of MCN. It just shows that if you dream culture but in construction, landscaping, agribusiness
large and advocate, people will listen and (poultry, meat packing, dairy) and a host of other indus-
tries.
respond.
David: And migrants are as diverse as this country—all
—Ed Zuroweste races, ethnicities and nationalities. The complexity of the
issue is not always fully appreciated—all the languages,
customs and diversity clinicians need to deal with. We
need more external champions in government and busi-
ness in order to make this more visible to the world at
large.
Ed: Another challenge is in getting people to see that
migrants are not a threat to their own jobs. They take
jobs we can’t get mainstream Americans—even in this
economy—to take.

6 Migrant Clinicians Network


Is it hard to recruit clinicians?
Ed: Each year I take Johns Hopkins medical students into
the field to work with the poor. When I started I could only
get a few to go. Now I take 10–15 students a year. Students
crave the relevance this job provides. Today people go to
medical school for reasons other than money.
Funding Sources
During the last decade MCN has grown from a handful
They know they will be in debt for a long time; that they of dedicated people to a staff of more than 35, serving
are not going to make a lot of money immediately or maybe 5,000 clinicians in the U.S. and around the globe. Today
ever. So they are looking for ways to apply their skills by we have a $1.7 million annual budget with funding from
which they can make both a living and a real difference. federal and state agencies, foundation grants, private
contracts and personal contributions.
David: This is a very dynamic career. One of the best things
about MCN is that professionals can work one-on-one with
patients and reach beyond to effect changes on a commu-
nity level, which is so important in the long run. It’s very 3.6%—Foundation grants
encouraging. 4.3%—Contracts and
8.7%—State funding private donations
What does MCN mean to you?
David: It is one of the most rewarding things I have been a
part of. We have grown so many leaders who have made an
impact at MCN and then gone on to achieve many wonder-
ful things at many levels of government, health care, aca-
demia, business. We have built bridges out into the world
in this way and it binds us. We really need to celebrate that
outcome.
83.4%—Federal funding*
Ed: MCN gave me a home. These people know what I am
looking for in medicine. I can go off and do other things,
but I do so for the purpose of coming back to MCN. It
grounds me. I can’t get arrogant—migrants are bright, hard
workers with tremendous integrity and they remind me to
stay humble.
There were times in the late ‘80s and early ‘90s when we * Federal funding comes from the Health Resources and Services
Administration, Centers for Disease Control and Prevention,
worried we would not make payroll or when funding
Environmental Protection Agency and Department of Immigration
looked bleak—but we have endured. This fall when we co- Health Services.
sponsored the Summit of Clinicians for Healthcare Justice, I
was so proud of MCN. It just shows that if you dream large
and advocate, people will listen and respond. n

Ed Zuroweste and Former Surgeon General David Satcher at the


National Summit for Healthcare Justice, October, 2008.

One of the best things about MCN is that


professionals can work one-on-one with
patients and reach beyond to effect changes
on a community level, which is as, or even
more important in the long run.
—David Smith

© Candace Kugel www.migrantclinician.org 7


Milestones

1984 Migrant Clinicians Network established

1985 David Smith selected to serve on the National Advisory Committee for Migrant Health

1985 MCN receives $5,000 “seed money” from Health Resources and Services Administration

1985 Karen Mountain signs on as Executive Director

1987 Launched the Cultural, Linguistic, Environment, Education and Follow-up (CLEF) series to help
clinicians provide appropriate care to migrants

1989 Deana James, MD of Florida receives MCN’s first Unsung Hero Award

1990 MCN becomes an independent organization

1993 MCN establishes a presence on the U.S./Mexico border

1994 First issue of Streamline published

1994 MCN initiates landmark research that documents domestic violence among farmworkers

1995 MCN launches international bridge case management program to track TB treatment for mobile patients

1996 National Clinical Leadership Conference hosted by MCN and Clinical Directors Network

1997 MCN and American Academy of Pediatrics publish Guidelines for the Care of Farmworker’s Children

1998 MCN Institutional Review Board established

1999 Environmental/Occupational Health Initiative launched

2000 Environmental Protection Agency taps MCN to serve on the Federal Advisory Committee on Pesticides

8 Migrant Clinicians Network


2000 MCN partners in first national effort to end health disparities

2001 Project Hope funds MCN to create first bi-national clinical management guidelines for patients with TB

2003 MCN mission expanded to include a full range of the mobile underserved

2003 Centers for Disease Control (CDC) selects MCN to design immunization and hepatitis prevention
programs

2003 Paso del Norte Health Foundation funds MCN for community-based pesticide education projects

2003 MCN leads a national practicum which ultimately places 102 new providers at 56 health centers

2004 Ed Zuroweste named Chair of the National Coalition for the Elimination of TB

2005 CDC publishes MCN paper on hepatitis screening, immunization and testing for mobile populations

2005 Lance Armstrong Foundation funds MCN to specifically address cancer in migrant patients

2006 MCN’s website receives its first national honors

2006 MCN receives funding from the Denver Foundation

2007 MCN serves its 95,850th meal to malnourished TB patients

2008 5,000th patient served by Health Network’s international bridge case management program

2008 MCN named EPA Children’s Environmental Health Regional Champion

2008 National Summit for Healthcare Justice hosted by MCN and partners

2009 Six offices, 35 employees, 114 issues of Streamline, 5,000 constituents, $1.7 million annual budget—and
so much more to come!

www.migrantclinician.org 9
Why, then, a network?

…I realized that, like the farmworkers we strive


to serve, many of us on the front lines of migrant An outreach worker takes time to explain the importance
health are isolated. We face many of the same of taking the medication as prescribed.
challenges and frustrations but have no one with
whom to share experiences or to call on for help.
Why, then, a network? Because a network is a
professional home where we can share ideas, sto-
ries and gather our strength together. Because a
network can take those new ideas and develop
models of care that can make our efforts more
effective. And, because a network can gather our
individual voices and send a powerful message to
decision-makers about the health needs of farm-
workers and their families.
I love my work. Even though I wish I wasn’t so
tired and it wasn’t so late, I like coming home feel-

© earldotter.com
ing I did something truly worthwhile that day.
I cherish the opportunities I’ve had to meet and
work with other remarkable people who feel as
I do. Through our network, I am not alone. My
reach can go beyond my grasp, and my voice does
not have to be lost in the wind.

Steve Crane, MD, Former MCN Board Chair Health educators learn how to integrate
information about pesticide safety into their
prenatal education program.
© Candace Kugel

10 Migrant Clinicians Network


The U.S. and Mexico share a 2,000 mile border.
Walls and fences along the border push migrants
to cross in remote and dangerous places.

I remember my first MCN meeting in a small room


among a dozen or so people in 1986. Everyone
was very inspiring to me…most had been meeting

© Karl Hoffman
together occasionally for two or three years already.
It was wonderful to feel that I was a “migrant clini-
cian,” meaning that my career choice signified, not
just to myself but to others, in a peer group, that
I had a special dedication to serving farmworkers.
Moreover, there was that distinct Public Health/
Community Health orientation—an attention to
upstream determinants of health, community-based
initiatives and strategies, and a savvy-ness about
A Change in Perspective
epidemiology, demographics, and forecasting—that
had been largely missing for me in other circles. In 1997 Dr. Barb Lee helped organize the Childhood Agricul-
In all the years since, including times I was a more ture Safety Network (CASN), a group dedicated to connecting
active member (on the Board for a while), I’ve con- the major organizations charged with tracking similar issues
tinued to be impressed and inspired. MCN has cre- so they could share information. In the beginning the focus
ated partnerships that are broad and deep, across was on getting organized, gathering resources and outreach. A
political and geographic borders, across disciplines decade later, the group was ready for something even more: a
and professions, across funding and research enti- “real world” experience on the U.S./Mexico border.
ties, and much more. I can’t say enough about MCN. Enter MCN, which created a customized training session in El
Tina Castañares, MD, La Clínica del Cariño Family Paso for CASN members. The program allowed participants to
Health Care Center, Hood River, OR visit U.S. migrant farmworker communities and bring medical
aid to those in need. They experienced crossing the border to
better understand what drove migrants to risk everything to
cross into the U.S. in search of work.
“MCN offered us the most eye-opening experience we had to
that point,” said Lee. “The program had a tremendous ripple
effect, not only on those directly involved but on their home
organizations.”
Because of the training, seven national organizations began or
increased their inclusion of migrant issues in their strategies
and priorities. CASN became a federally-designated center for
childhood agricultural safety and now receives federal fund-
ing for research and intervention to help migrant children
who live and work on farms.
That led to MCN’s participation in a national initiative to
establish formal research priorities—the National Occupational
Research Agenda (NORA). MCN helped to raise awareness on
integrating non-English speaking workers into this effort,
including them in interventions and outreach.
Added Lee, “From training to advocacy to resources, MCN
is always out there; we can always depend on them for help,
which makes them an amazingly valuable resource.” n

www.migrantclinician.org 11
An Award-Winning
Approach
Children of migrant workers face environmental risks
that most of us can’t comprehend. From pesticides in and
around their homes to unsafe drinking water, from lead
to indoor air triggers of asthma, risks are around every
corner.
In 2006, Amy Liebman, MCN’s Director of Environmen-
tal and Occupational Health, spearheaded a program
to reach these issues at their source: in the homes of
migrant workers. Partnering with the Virginia Eastern
Shore’s Migrant Head Start program, MCN sought to
bring healthcare justice to the front lines, reaching out
to clinicians and the migrants they serve to create safer
home environments for migrant children.
MCN hired and trained a team of graduate students and
promotores de salud (lay health workers) on ways to limit
these risks in the home. Over two summers these team
members worked door-to-door in migrant communities
to evaluate the behavior and practices of migrant work-
ers. Then the promotores taught migrant families how
simple steps could limit their children’s exposure, such
as showering and changing their clothes before hugging
© Kate Bero

their kids and taking off their shoes before entering the
home so as not to track pesticides. Long term follow-
up in these communities continues to help improve the
health of children.
The initial program reached 800 farmworkers and is now
a pilot model for programs around the U.S. Its primary
strength comes from the promotores who train other
members of the community who then go on to train even
more people. The promotores use culturally-appropriate
resources like comic books to illustrate steps parents and
children can take to stay safe from these risks.
In 2008 the program was awarded a Children’s
Environmental Health Champion Award by
the U.S. Environmental Protection Agency for
minimizing these hazards to migrant workers
and their children, increasing the knowledge of
migrant workers and their families of environ-
mental hazards, and teaching other professionals
about how to further these ideals. n
© earldotter.com

12 Migrant Clinicians Network


MCN Makes the Call

A few years ago we provided an HIV test to one


of our fruit pickers which unfortunately came
back positive. The worker was devastated and
insisted he was going to leave immediately for
Florida to stay with his cousin.
We called MCN to get the name of a clinic in the
city where he was going. Within an hour we had
a clinic address and phone number and the name
of a staff member who was expecting our worker.
Incredibly, the clinic was located a block from the
cousin’s home.
Our worker did go to the clinic and received such
a warm welcome, he decided to remain in Florida
and receive treatment. We hear from him periodi-
cally and he remains hopeful for his future. By
going the extra step MCN saved this man’s life.
Selina Zygmunt, Regional Manager, PA Farmworker
Program, Keystone Health Center, Reading, PA

© earldotter.com
Clinicians treat patients when and where possible—
in storefront clinics, on mobile units, and in the field.

MCN’s award-winning website provides


resources for clinicians around the globe.
© earldotter.com

www.migrantclinician.org 13
MCN in Action
The mobile poor barely hang on to the bottom rung International Impact
of the American economic ladder. They are often In 1984 our resources were focused “locally” on the U.S. What
newly-arrived immigrants with few connections, or we’ve learned these last 25 years is that in a global environment,
individuals with limited opportunities or skills, rely- everything is local—including health care. Today we manage
ing on farm and other manual labor for survival. In patients in more than 30 countries including Mexico, Guatemala,
addition to low pay and impermanent homes, these Chile, Peru, China, Korea, Pakistan, Nepal, Uzbekistan and more.
jobs are high risk: agriculture, mining and construc- How is this possible? When a migrant is deported or repatriated,
tion comprise the top three industries for occupation- or has simply returned home to his or her family, medical chal-
related injuries and deaths. Even in their homes, lenges can follow. Whether a patient is pregnant, has TB, cancer
migrants may face environmental exposures such as or another long-term medical challenge, MCN bridges the gap to
pesticides and unsafe drinking water. find continuity of medical care in the patient’s home country.
It is no surprise then that migrant workers still suffer
mortality and morbidity rates greater than the vast Family Violence Prevention
majority of the American population, due in part to MCN is a recognized leader in the field of family violence preven-
poverty, limited access to health care and hazardous tion. One of the more innovative programs developed through
working conditions. MCN is a peer-to-peer initiative that trains a handful of families
in a community to teach others about preventing family vio-
The clinicians who serve this population are an
lence. Taught in places migrants frequent, such as flea markets
extremely dedicated group. Our mission is to give
and work camps, this program has been very effective at chang-
them the tools and information they need to do their
ing attitudes about communication and the balance of power in
jobs. These stories celebrate our successes, illustrat-
relationships.
ing how we reach the clinicians and the people they
valiantly serve.
Immunization Centers of Excellence
n MCN has worked with six organizations to establish Immuniza-
tion Centers of Excellence, health centers that focus on providing
a full schedule of immunizations to migrant children (and adults)
who have not been vaccinated. Using MCN tools, these organiza-
I’ve always enjoyed the energy MCN brings tions work to assure that immunization schedules are established
to any issue. MCN has a way to bring people and completed, explaining to workers and their families the need
to the table who might not get there otherwise. to have their vaccinations, especially as it relates to enrolling chil-
A prime example is TB Net with the Immigra- dren in public schools.
tion and Naturalization Service. MCN was able
to get access to border detainees to help ensure
Health Center Support
continuity of care for those testing positive for
TB. While the impact of this program may never MCN understands the challenges facing a migrant clinic start-up.
be fully realized, the impact to improving global For example, in 2008 we began working with a newly-funded
health and decreasing the spread of TB cannot center to provide onsite assistance in the development and imple-
be underestimated. Who would think that you mentation of clinical policies and programs and the hiring of
could bring together the federal government, a medical director. Our consultative role included developing
law enforcement and global public health to pre- Health Care Plan objectives, assistance with development of a
vent the spread of TB? That is the energy that recruitment and retention plan for providers, and new provider
MCN can bring to improving the lives of mobile orientation to migrant health. We provide trainings on occupa-
populations around the world. tional health, adolescent and adult immunizations, cultural com-
petency, immigration issues, continuity of care while migrating,
Wilton Kennedy, DHSc, PA-C, Former MCN identifying migrant and homeless patients in the health center,
Board Chair, Jefferson College of Health Sciences, and access to care, infectious diseases, and emergency prepared-
Roanoke, VA ness for special populations. n

14 Migrant Clinicians Network


Clinician in Action
For 27 years Bob Witt was a private practice physician
assistant (PA), seeing patients in his office and making it
home for dinner most nights. But five years ago he joined Pro-
teus Migrant Health, dedicating his practice of medicine to
migrant workers and their families across Iowa.
“One of the biggest issues we see is that migrant workers do
not have primary care doctors,” said Witt. “They have all the
same medical challenges of those in the stable workforce, but
because they are always moving they have no one to monitor
their care.”
June to October, Witt is in the fields with physician assis-
tants, pharmacology and medical students, offering clinics
that they schedule through the farmers, seed companies and
crew leaders. Their bilingual team brings basic health care to
migrant patients.
“We use MCN’s Diabetes Track II and Prenatal Health Net-
work to help track and create a permanent record of patient
care,” said Witt. “MCN helps us manage care once the
migrant has left Iowa, connecting Proteus, the patient and a
healthcare provider in another state or country.”
Last summer Witt’s team treated a young woman in her early
20s who had cervical cancer. There was not enough time to
find a specialist in Iowa before she had to head to her next job
in Texas, so MCN stepped in and found follow-up care for the
patient in Texas.
© earldotter.com

“MCN’s reach is such that they can provide not only


resources and programs, but real human help,” said Witt.
“That patient would have had no chance without MCN’s
resources.”

© earldotter.com

www.migrantclinician.org 15
(Working) with MCN definitely made me feel closer to the
migrant workers and mobile populations we try to help…MCN
makes those who care, care more.
George Davis, MD, Callan Family Care Center, Germantown, NY

n
The MCN Institutional Review Board is a rare gift. It enables
more people in the field—organizations and clinicians not affili-
ated with a university system­—to contribute to the body of
knowledge about migration health.
Carmen Retzlaff, MPH, Community Heath Education Concepts,
In their own words… Austin, TX

n
Today not only do I bring with me the experiences learned at
MCN, but I use their resources on a regular basis. Their tool box
has been key to the development of many of our clinic’s poli-
cies, their environmental program has helped us train our staff
and educate our patients, and the MCN staff has helped us with
technical assistance. It is one thing to promote the organization
you work for, but it is another to experience first hand the use-
fulness of its resources and realize that the work you and your
colleagues have done has had the direct impact you hoped for.
Andrea Caracostis, MD, MPH, Hope Clinic, Houston, TX, and
past MCN staff member

n
I often felt isolated and up against many odds. Those feelings
changed when I went to my first national migrant health con-
ference and met Dr. Ed Zuroweste, Karen Mountain and Don
Horton, other clinicians working on similar issues. The con-
nections made during that conference and maintained over 20
years kept me working with Hispanic/Latino communities on
community-based approaches to eliminate health inequities. The
phrase “strength in numbers” comes to mind when I think of
the impact MCN has had on me.
Kim Larson, RN, PhD, MPH, East Carolina University College of
Nursing, Greenville, NC

n
MCN has provided our Federally Qualified Health Center
and Migrant Health Center with the training we need. It has
© Alan Pogue

been inspiring to meet (people who) love their work and have
devoted their careers to helping the folks whose work is too
often invisible.
Quality health care for migrants encompasses the essence of true Barbara Boehler, CNM, MSN, CommuniCare Health Centers,
primary care, going beyond basic medical care. It includes such Davis, CA
services as dental care, physical therapy, mental health care, eye
care and more. Here, a young girl has her first dental exam.

16 Migrant Clinicians Network


© Alan Pogue
Rarely in a career does one come in contact with an organization
of dedicated professionals with the single goal of improving the
lives, health, and well being of a group of people, such as MCN
has accomplished with the mobile poor. I congratulate everyone
at MCN, and anticipate their continued dedication to justice in
health care for the mobile poor.
Dennis H. Penzell, DO, MS, FACP, University of South Florida
Medicine/Nova Southeastern College of Osteopathic Medicine,
Tampa, FL

n
MCN has ALWAYS been there for the clinician who lives and
works in an environment that most other clinicians turn their
noses up at…but they (other clinicians) don’t understand the
greatest rewards aren’t always what the patient pays as they
exit. More important are the rewards that we see each day on
patients’ faces (smiling faces that is), as they improve their oral
health and ultimately their total health.
Horace Harris, DDS, Tri-County Community Health Council,
Newton Grove, NC

n
A true gift that MCN possesses is the ability to attract people so
very passionate about healthcare justice for all.
Frank Mazzeo, Jr., DDS, Family Health Centers of S.W. Florida, (MCN is) the glue for clinicians compelled by passion
Ft. Meyers, FL to devote their professional lives to taking care of the
n underserved.
MCN has been a wonderful resource for our students as they Alice Larson, PhD, MCN, Institutional Review Board
learn more about providing care to farmworkers in our South
Georgia Farmworker Health Project.
Tom Himelick, PA-C, MMSc, South Georgia Farmworker Health
Project, Atlanta, GA
© Alan Pogue

www.migrantclinician.org 17
A History of Excellence
For 25 years we have been honored with a tremendous amount of commitment and support from our board of directors and
advisory committees. These dedicated people have helped us to remain true to our mission and our values while helping guide
us to be the best we can be. Here, we list all of our current and former board and committee members to whom we give our
sincerest thanks.

Migrant Clinicians Network Board of Immunization Initiative Advisory


Directors, Past and Current Directors Council
Ione Adams, MD, MPH Agnes Priscaro, RN Mercedes Collado
John Aleman, MD Hugo Lopez-Gatell Ramirez, MD, MS, PhD Glenn Flores, MD, FAAP
Mir Ali, MD, FAAP Tom Reeves, PA-C Valerie L. Polletta
Marsha Alvarez, BS, RPH Luis Reyes, PA-C Deborah L. Wexler, MD
Richard Andrews, MD Andres Rodriguez, RN Shellie Withrow, RN, MSN
Colin Austin, JD, MRP Mike Rowland, MD, MPH
CAN-track Advisory Council
Angel Braña, MD George Rust, MD, MPH
Andrea Caracostis, MD, MPH
Clara Cabanis, MD, MS Gary Simpson, MD, PhD, MPH
Maridolores Donaghy
Tina Castañares, MD David R. Smith, MD
Alma Hernandez
Henry Cisneros, Jr., DDS Rosemary Sokas, MD, MOH
Zlatica Koscina
Maurice Click, Jr., MD, MPH Gail Stevens, RN
Candace Kugel, CRNP, CNM, MS
Joan L. Combellick, CNM Francis Stilp, FNP, RN
Anselma  Lopez
Silvia Corral, MD, MPH Gloria D. Torres, RN, BSN, MS
Margarita Méndez Aparicio
Eve Covas, MD Edward Zuroweste, MD
Erika Peterson
Jaime Cruz, MD
American Academy of Pediatrics Lynn Terral, RN
George Davis, MD
Liaisons to the MCN Board of Directors Edward Zuroweste, MD
Anita de la Vega, RN, FNP, CNM
Gilberto Handal, MD
Sr. Eileen Eager, FNP, RN New Provider Practicum in Migrant
Jennie McLaurin, MD, MPH
Tillman Farley, MD Health Advisory Committee Members
Larry Meuli, MD
Willa Hayes, RN (2003-06)
David Tayloe, MD, FAAP
Ed Hendrikson, PhD, PA-C Carolyn Aoyama, CNM, MPH
Don Horton, FNP, MPH National Rural Health Association Irma Cota, MPH
Anne Atkinson Hyre, CNM, MSN, MPH Liaison to the MCN Board of Directors Magda de la Torre, RDH, MPH
Marie Jose-Francois, MD, MPH Candace Kugel, CRNP, CNM, MS Katherine H. Ensign, CHA, PA-C, MS
Wilton Kennedy, DHSc, PA-C Wilton Kennedy, DHSc, PA-C
Matthew King, MD
Streamline Editorial Review Board
Gale Monahan
Mark Koday, DDS Marco Alberts, DMD Marie Napolitano, PhD, FNP
Mary Jule Kulka, RN Matthew C. Keifer, MD, MPH Michele Pray-Gibson, MHS
Virgilio Licona, MD Nikki Van Hightower, PhD Michael Samuels, DrPH
Frank Mazzeo, Jr., DDS Migrant Clinicians Network Julie Spielmann, FNP
John McFarland, DDS Institutional Review Board
Environmental and Occupational
Kristine McVea, MD, MPH Steven Crane, MD, MBA Health Advisory Committee
Silvia Micik, MD George Davis, MD Shelley Davis, JD*
Paul Monahan, MD Loretta Heuer, PhD, RN Joe Fortuna, MD
Edith Moore, DDS Alice Larson, PhD Matthew C. Keifer, MD, MPH
Marie Napolitano, RN, FNP, PhD Lawrence Li, MD, MPH Wilton Kennedy, DHSc, PA-C
Deana James Odom, MD* James O’Barr, MSW Katherine H. Kirkland, MPH
Gloria Peña, RN
Dennis H. Penzell, DO, MS, FACP
Dennis Penzell, DO, MS, FACP
Michael Rowland, MD, MPH
Venkat Prasad, MD, MBA
Daniel L. Sudakin, MD, MPH
Edward Zuroweste, MD

18 Migrant Clinicians Network


Dear MCN supporters and friends,
For 25 years MCN has supported migrant clinicians,
partnering with thousands of us to bring healthcare
justice to the mobile poor. The list of people who have
helped to make these efforts successful is very long
and includes literally thousands of people, from staff
Family Violence Leadership to clinicians to consultants to government supporters.
Consortium But there is someone else who is equally important—
someone without whom no success would have been
Noël Busch-Armendariz, PhD
possible: You.
Emiliano Diaz de Leon
Nikki Van Hightower, PhD This book—and our 25 years of working for health-
care justice—are truly a testament to the commitment
Family Violence Advisory Council and support you have shown to MCN. Your corporate
Susan Bauer, MA, MPH contributions, grants and personal donations these
Marie Jose Francois, MD, MPH, CHES past three decades have made MCN the force it is
today—and assures that the mission will continue well
Juanita Lopez
into the future.
Emma Torres
Selina Zygmunt It may be a cliché, but in this instance it is true: we
could not have done this without you.
Adolescent Farmworkers at Risk
Advisory Committee As a clinician, I see the return on your investment
every day that I work with migrants. Their gratitude
Katherine Carr, MD, PhD
is conveyed in every handshake, every smile, every
Matthew C. Keifer, MD, MPH hug of thanks.
Linda McCauley, PhD, RN, FAAN
Jennie McLaurin, MD, MPH Your contributions are more than the “total” line on
a spreadsheet—they change the world for the better.
Mary Miller, MN, RN
It is because of you that we can continue to work for
Michael Rowland, MD, MPH
healthcare justice for even the most at-risk members of
*deceased our society.
On behalf of migrant clinicians everywhere, please
know that what you do makes a very big difference.
Thank you. Thank you. And, thank you.
Venkat Prasad, MD, MBA
Board Chair, MCN
From the hiring of our first employee

© Alan Pogue
in 1985, our employees and associates
have contributed to the objectives of
our organization, dedicating themselves
to the cause of healthcare justice for
the mobile poor. Our thanks—and the
thanks of more than 5,000 clinician
constituents of MCN—go out to this
amazing team of people.

www.migrantclinician.org 19
Office Locations
Austin, TX (headquarters)
Chico, CA
Salisbury, MD
El Paso, TX
Ferndale, WA

State College, PA

MCN has been a very important part of the


support structure that keeps me informed
and energized as an itinerant occupational
medicine specialist who cares for migrant
workers. MCN’s commitment to advance
the welfare of migrant workers and their
families has been an ongoing inspiration to
me. The organization is efficient, effective
and tenacious. MCN works well because of
the many deeply committed and remarkably
creative people, who, despite having many
other career options wake up and on a daily
basis, choose to keep fighting for the welfare
of migrant populations. These are people of
© earldotter.com
action who pursue their work with justice
in their hearts. My life is richer, and what
little I can do for migrant workers seems
more meaningful because of knowing them.
MCN
They, and the organization they constitute,
P.O. Box 164285 have my deep and abiding respect and
Austin, TX 78716 admiration.
512-327-2017
Matthew C. Keifer, MD, MPH,
www.migrantclinician.org University of Washington, Seattle, WA

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