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Windsor - Persistent pain in his right shoulder pushed 47-year-old Maurice Savage out of the cinder-block dormitory he shares with other migrant farm workers and into a dusty courtyard, transformed for the hours just before nightfall into an open-air medical clinic.
Savage, one of 22 Jamaicans working at the Markowski Tobacco Farm since April, started his day's labor at 7 a.m. Tuesday, cutting and then hanging heavy bundles of broad-leaf, cigar-wrapper tobacco in drying barns until quitting time nine or so hours later.
"It doesn't hurt until I rotate it," Savage, a slender, soft-spoken man, told Dan Ahlers, a second-year medical student at the University of Connecticut, as Ahlers gently squeezed and manipulated the tender shoulder.
Savage, one of 13 of the farm's migrant workers to visit the clinic Tuesday, will return to Jamaica in a few weeks to his wife and 13-year-old son. The money he earned at the tobacco farm will be the family's main source of income for the entire year.
A required physical exam certified him as healthy before he began work this year, he said, "but anything can happen," so he's come to the clinic every time it's been open this summer, and often in the eight or nine previous seasons he's worked at the farm.
The UConn School of Medicine runs clinics at nine farms and orchards, visiting each weekly, biweekly or monthly, depending on the size of the farm. From June through August, they focus on Connecticut River Valley tobacco farms, moving to orchards in the fall. Generations Family Health Center, which operates clinics in Norwich and other eastern Connecticut towns, runs a similar grant-funded clinic for migrant workers at a farm in Lebanon.
Farm owners host the clinics, and all care and prescriptions are provided to the workers free of charge. Arrangements for specialized care also can be made.
Since Tuesday's session would be the last for the season at Markowski farm, it also would be the last time many workers would see a doctor until they return for the 2013 season.
"Some of the workers we see haven't seen a doctor since they were babies," said Devorah Donnell, a second-year medical student at UConn and the student coordinator of the migrant worker clinic program. "We see a lot of sky-high blood pressure and hypertension and sky-high blood sugar and diabetes. We've also had a patient with an open diabetic ulcer on his foot who just kept working, and another who had a tractor run over his foot."
Since starting in 1997, the clinics have widened the circle of volunteers beyond the medical school to include pharmacy students, nursing students, translators and others, including Hartford-area physicians who act as mentors for the doctors-in-training, according to Dr. Bruce Gould, associate dean for primary care at the UConn Medical School. He oversees the clinics.
"This teaches our students how to work with vulnerable populations, and it teaches lessons in cultural sensitivity and social consciousness, that it's our responsibility to care for everyone," he said.
After an initial check-up with one of the medical students, each patient sees a doctor to have the diagnosis checked and tweaked while the student listens and discusses the case. Gould said the doctors often gain as much from the experience as the students and patients.
"Maybe they're burnt out, and medicine has become just a business for them, but then they spend a night out here and they remember why they went to medical school," Gould said, as the volunteers began packing up the supplies to take to the next farm. "This is the pure essence of caring."
Wages vs. illness
At Tuesday's clinic, UConn students stationed at folding tables checked blood pressure, took blood samples to test sugar levels and asked about family medical history. Volunteer doctors gave exams inside a white tent set up near one of the barns. Unlike the offices, labs and classrooms where the volunteers work and train, this was a health care setting without walls, lights to counter the darkening skies, laptop computers, electronic diagnostic equipment or any of the typical trappings of modern medicine in the United States.
"I've been doing this since I was a high school student in Manchester, and I've learned so much," said Donnell, 25, the second-year UConn student. "These clinics are amazing."
Pharmacy students manned a portable, makeshift pharmacy, supplying Savage with ibuprofen ordered for him by Gould and filling prescriptions for other workers.
"You can take three or four of them three times a day, but always with food," Gould told Savage, advising him not to wait for the pain to start and periodically to apply the reusable cold packs given him. "If the foreman gives you a choice of jobs, pick something that avoids any activity that makes it hurt. Try to avoid lifting your arms above your head, but if you have to, get something to step up on."
Looking on were Jordan Tragash of Farmington and Rebecca Webber of Manchester, high school students volunteering at the clinic with thoughts of one day pursuing medical careers themselves.
The situation, Gould told his patient, reminded him of the old Groucho Marx joke - the one where the patient tells the doctor he gets a pain when he moves a certain way, and the doctor pronounces an instant cure: "Don't do that."
Resting the shoulder from the demands of physical labor, however, isn't a remedy Gould could offer this patient. Instead, leaning against the back of a bus parked in the courtyard, Gould demonstrated a few exercises Savage might try to ease his shoulder pain.
"It's repetitive motion trauma," Gould said. "We can predict what kinds of things people are going to come to the clinic with, based on where they are in the growing season. These workers are weighing their wages against illness and discomfort."
The farm clinics run on a budget of about $20,000 annually, receiving funding from about 30 government and private sources, including Pfizer Inc. and the Connecticut Health Foundation. Major funders are:
• The Connecticut River Valley Farm Worker Health Program, which is funded by a federal voucher program. These funds are used to train volunteers and purchase medications.
• The Connecticut Health and Educational Facilities Authority provides money for clinic supplies and to help teach English as a second language.
• The Hartford County Medical Association pays for the student coordinator fellowships.
For information about the program, visit: http://publichealth.uconn.edu/aboutus_mfwc.php