Nursing on the South Coast
Mayela Perez, right, helps a patient while on call in Pescadero. She works on behalf of Puente. Photo courtesy Puente

There are no dentists, primary care doctors, psychologists or pediatricians in Pescadero. The nearest emergency room is at least 30 minutes away. For some who don’t have the resources or time, that could mean doctor appointments are few and far between.

Puente de la Costa Sur has been working to fill this gap by partnering with San Mateo County and health providers to provide critical services to the South Coast that residents might not get otherwise.

“This has been something that we have really always recognized as a need for as long as I can remember,” Corina Rodriguez, Puente’s health and community development director, said.

Research indicates rural communities do not have access to health care for a variety of reasons, and, in Pescadero, Puente has been breaking down those barriers to access since the closure of the area’s only clinic.

Working long hours without insurance, Rodriguez explained, are reasons why South Coast farmworkers may not be able to travel to Half Moon Bay for medical care. Low income is a factor as well.

“It is hard for them to ask for time off work to go to Half Moon Bay,” Rodriguez said. “For us, that means a 30-minute drive there and a 30-minute drive back and whatever time you’re in the clinic itself. ... That hurts someone’s income.”

The American Journal of Public Health, in an article by sociologist and demographer Jeralynn Cossman and others, found that San Mateo County has had consistently low rates of mortality from 1968 to 2015. Cossman, who chairs the department of sociology and anthropology at West Virginia University, said she couldn’t say why this is the case without more research. However, there are other measures of the health of a community, including rates of disease and obesity.

Cossman said that while local organizations in rural communities provide invaluable services to those who live there, lawmakers don’t always realize there’s a need.

“By depending on the kindness of ... voluntary associations, lawmakers don’t realize the struggle within their constituency,” Cossman said. “Do California senators realize you’re having this problem in San Mateo County? Or does it get lost?”

At a local level, San Mateo County Health Department did notice the need and created a field medicine team to provide services to uninsured farmworkers in Pescadero in 2016. U.S. Census data estimates that more than 3 percent of San Mateo County residents are uninsured. That equates to almost 28,000 people.

The recent closure of Bay City Flower meant some people on the coast lost their health insurance, and Mayela Perez, the field medicine team’s public health nurse, has started seeing former employees at the clinic as a result.

Perez works out of Puente’s offices Monday through Thursday, and two nurse practitioners come on Wednesdays as well. Coastside Clinic, located in Half Moon Bay, comes out once a week too. Rodriguez said the clinics are booked each week.

The field medicine team provides free medication for those suffering from chronic diseases, urgent care, vaccinations and other forms of care. Perez said they also try to help people get medical insurance.

“It’s really rewarding work because a lot of these people otherwise would not get any medical attention,” she said. Some people don’t seek medical treatment, Perez explained, because of cultural beliefs or a fear among undocumented residents that they would be reported.

“A large group is undocumented,” she said. “There’s a lot of fear of a lot of different things going on currently. They are hesitant to receive care. ... They’re the ones that fall through the cracks.”

Other barriers to care include language, transportation, illiteracy and intimidation some may feel entering a large clinic or hospital, Perez said. In addition to the medical care she provides, Perez spends time reaching out to farmworkers by going to their work during lunch breaks or after they’ve finished for the day.

Despite the robust health programs Puente has coordinated, Rodriguez said there are still limitations to the services Puente can provide.

Besides Ravenswood Dental Clinic for teeth cleanings and a yearly visit from a pediatrician to conduct physicals for students who want to play sports, the only options for most children are out of town. There are also gaps in access when people need specialized treatment.

“The (dental) services are very basic services,” Rodriguez said. “... For things that are more complicated than that, they are referred out. That also becomes hard because even though they're being referred out, they don't have dental insurance and end up having to pay a large fee. A lot of our participants don't follow through because it’s a really high fee.”

The health services that Puente seeks to provide aren’t limited to doctor visits. Zumba fitness courses and walk and run classes keep participants exercising. There are free counseling services for families in the area and counselors meet with middle and high school students for alcohol and drug prevention groups.

“We know we’re doing a lot of services, but we also want to evaluate internally and externally what participants might be wanting in the future,” Rodriguez said.

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