GRAFTON, N.D.-Earlier this summer, Community Health Service Inc., which offers healthcare to agricultural and migrant workers across North Dakota and Minnesota, opened a new clinic in Grafton.

Previously, Community Health operated its site from the second floor of a state development building. "Not a lot of visibility," site supervisor and registered nurse Tylah Wildey recalled. "Now you can see us right from the highway, and I think it's just more inviting."

The organization's executive director, Kristin Halvarson, works in the organization's earliest building, in Moorhead. "Grafton was one of our first locations, I believe," Halvarson said, where she noted there traditionally has been a large migrant population.

Besides a change in location, Halvarson and Wildey noted they've had a change in the types of patients they receive and the care they provide.

This year, Halvarson said the Grafton clinic is on pace to care for about 750 patients.

"Agriculture has changed," Halvarson noted, specifically relating to types of agriculture and migration patterns. With more technology in the beet industry, for example, fields require less workers pulling crop on hands and knees.

"Over the last 10 years or so, I think we've seen a change in our patients and what they do for work," she said.

While most migrant workers Community Health receives are still Hispanic, Halvarson said, Wildey noted the Grafton site is seeing more patients originally from Ukraine and South Africa. Many migrant workers also are working jobs outside the agriculture sector-Halvarson said she has seen more patients from construction, service industries and the Oil Patch in recent history.

Caring for migrant workers

Most often, when migrant workers come to work for a season in places such as Grafton, Halvarson said healthcare is a secondary thought. Normally, her clinics will see influxes in patients on rainy days and rare windows when the fields aren't open for work.

"And that's kind of the unique thing about us," Halvarson said. "It's, 'How do you adapt to that need to be flexible, to work around your patients' hours?' "

Staff caring for migrant workers also need to pay attention to the short timespan patients are in Grafton, and where the patients are going to live for the rest of the year.

"They're here for, let's say four months," Wildey said. "And then they go and leave.

"So, it's also, 'How can we connect them with someone?' "

There's no easy solution to that question; instead, Wildey said she and other clinic staff work with patients one on one to connect them with resources available in the place they're going next. "And when it comes to low income, there's a challenge there," Wildey said.

The three most common health problems Halvarson has noted among migrant workers visiting Community Health are diabetes, high blood pressure and cholesterol issues. "Almost 20 percent of the patients have diabetes and hypertension," she said.

Connecting patients with diabetes to a resource outside North Dakota is difficult, just as treating diabetes while patients are nearby is. "When it comes to diabetes, there's so many components to it," Wildey said. For example, many patients need to refrigerate their insulin shots. How or where does someone refrigerate insulin while working outside in a field?

Educating patients and working with them on personalized solutions is key, Wildey said.


When staff aren't treating existing problems, Halvarson said the clinic hosts prevention programs to keep diabetes and cholesterol problems from becoming a health issue in the first place.

Last summer, Wildey recalled an evening diabetic class with the Grafton clinic's physician assistant.

"The class was during evening hours because that's when patients could come," Wildey said.

The clinic has also hosted classes on eating healthy, reading labels and exercise.

Community Health's new clinic sports its own education room, where patients can watch educational videos and go through reading materials on prevention and health care. "Just to get out of the sterilized environment and into a little more homier feel," Wildey said.

On other occasions, Wildey recalled "cluster clinics," where different community providers, including an eye doctor, a pharmacist and a hygienist, come in to check on patients.

Various patients

Not all Community Health patients are Hispanic migrant workers working in a beet field. Some can be in North Dakota from another state, and some can even work in different fields of agriculture, including beekeeping and nurseries.

"There's a whole big federal definition of what agriculture is, and I just think people don't realize they qualify," Halvarson said.

Patients going to the Grafton clinic aren't exclusively from Grafton-Halvarson noted historically all four clinic serve a 60-mile radius. Wildey noted many patients come from communities such as Thief River Falls and Willmar in Minnesota and Carrington and Hillsboro in North Dakota.

"We do cover patients from quite an area," Halvarson said; between all four clinics, patients have visited from 67 different counties.

"Our goal is to keep all our patients healthy," Wildey said, "so they can keep on working and make a living."