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Care in the Black Dirt Region: Profile of Kathy Brieger

Kathy Brieger RD, CDE, MA
I think that connecting other clinicians in the field with people who are doing right work remains a very important role.
Care in the Black Dirt Region: Profile of Kathy Brieger

Just an hour’s drive from the bustle of New York City is the Black Dirt region of the Hudson Valley, an area named after its rich, volcanic soil, and a region equally as rich in its agricultural history. For Kathy Brieger, RD, CDE, MA, the administrator of the Alamo Farmworker Community Center -- one of the many hats she wears at Hudson River HealthCare (HRH Care)  -- the region’s agricultural workers have become more than just her patients. “Working with the farmworkers in this area [has been] one of the biggest gifts in my life,” Brieger said. “[They’ve] been woven into my life, the people of this black dirt.” 

ADVENTURES IN MOBILE CARE

Brieger first learned about farmworker communities and their unique struggles, when at age 17 she became an organizer for United Farmworkers (UFW). By college, Brieger found herself drawn to nutrition studies. “It was something I wanted to spend my life in, especially in areas of public health, and [in] trying to help people who had food security [issues],” Brieger recalled. She was just starting as a dietitian at a health clinic in the region more than 30 years ago, when a pregnant farmworker with gestational diabetes was unable to make the trip to the health center where Brieger worked. “I asked my CEO at the time if it was possible to go out and visit her. Here I was, a dietitian, and I just went out and [made] a home visit, and that’s what started the whole thing.”

Within a few years, “a lot of the work was really done out of our cars,” explained Brieger. As the local health center expanded, so did services to its patients, many of whom were migrant and seasonal farmworkers. Her health center eventually became one of the 20 locations of HRH Care, which serves the ten counties of the Hudson Valley and Long Island. 

HRH Care offers extensive services beyond primary care, including mental health care, nutrition services, transportation, and benefits counseling. Brieger notes that the many resources the health center provides, like a pottery class and an art therapist, a homework help group, and hot meals in the wintertime, are often volunteer-run and paid for by donations, but always driven by the needs of the patients. “We really try to have the farmworkers tell us what they’re interested in,” Brieger noted. She is inspired by the high level of community involvement she witnesses; a recent homework help group brought out one retired principal, ten retired teachers, and two teenage boys as volunteers.

The health center continues to find ways to improve the lives of farmworkers. One recent program brought together farmers and farmworkers for a five-year training program on eye safety, sponsored by the Centers for Disease Control and Prevention (CDC) and the New York Agricultural Center for Agricultural Medicine and Health. Brieger found the program to have positive outcomes beyond work safety, as the farmers and farmworkers worked together. “The adversarial relationship," that sometimes exists between farmworkers and their employers “doesn’t get us anywhere,” she noted. She enjoyed watching the two groups “work together to make something good happen.”

CONTINUING ISSUES FOR FARMWORKERS

Despite the increase in services, Brieger recognizes the ongoing struggles for farmworkers as the region changes. “There’s a lot more mechanization” in farms, said Brieger, leading to a decline in the need for farmworkers. “People are really scrambling for other work,” she has noticed. “More people are staying. There’s not as much movement,” as farmworkers settle into other permanent jobs in her region.

Those remaining in the agricultural sector face new problems, compared to the workers of 30 years ago. Many farmers have stopped providing housing for seasonal workers. As a result, explained Brieger, “farmworkers have now had to get apartments, and share apartments, sometimes two families or three families” per apartment, and are often far from their rural jobs. Transportation to the farms is extremely challenging, she added.

Immigration reform is another hardship for farmworkers, as it “impacts everything [from] having transportation, being able to get to and from their jobs, and health services, [to] after-school activities for their kids,” Brieger said. “There is so much animosity, with this immigration issue, that people are feeling vulnerable. I think that really overshadows everything, including many aspects of their health.”

CLINICIAN CONNECTION

Brieger notes that connection to other clinicians focused on mobile patients can make a big difference. “When I first started, I really didn’t know who to talk to or where to go,” for support in migrant health, she said. She initially encountered MCN at her first East Coast Migrant Health meeting. She remembers the thrill of coming together as migrant clinicians who encountered similar issues, and she recalls thinking, “I’ve found my tribe,” she remembered with a laugh. “It was my happy day!”

“Sometimes the work we do is very challenging,” she admitted. “It’s exhausting because you try to get whatever help you can, whether it’s a winter coat, a blanket, or even food,” but working with other clinicians addressing similar issues can be inspiring, providing perspective, new ideas, and resources. “I think that challenge [of working with mobile populations] can really wear people out,” Brieger said, “but having that community support makes all the difference.” She continues to see a need for more resources to strengthen the connection between clinicians involved in mobile patient care throughout the country. “I think that connecting other clinicians in the field with people who are doing right work remains a very important role that MCN can play,” she said. “There are such unique challenges to the migrant community,” Brieger explained, saying MCN and clinicians both have a duty to “keep the migrant issues on the forefront.”

Meanwhile, Brieger will continue to push forward programs to support the local mobile population. Over the years, Brieger has found herself part of the community – attending quinceañeras, weddings, and funerals, and watching the children grow up. She finds the community “giving and kind," adding, "They embody the best characteristics of what I think we should be about in this country.” Recently, she hosted a pool party for the teenagers in the health center’s programs. “[For at least four of them, I had known their fathers or mothers as little kids. No wonder they look familiar!” Brieger exclaimed.

“It thrills me, and reminds me why I came into this line of work – because you can really make a difference in their lives, and they are so appreciative of everything you do for them,” Brieger says of her patients. “I think I get so much more out of this than they do, and it makes me happy,” she added with a laugh.

30 CLINICIANS MAKING A DIFFERENCE is a project celebrating Migrant Clinicians Network's 30th anniversary through the life stories of 30 clinicians making a difference in migrant health. Learn more about Migrant Clinicians Network.

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