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Mobile Care Successes and Struggles in Pennsylvania: Profile of Mary Englerth

Mary Englerth PA
The gratitude in people’s eyes for the little bit we can do… it’s reciprocal, it really is.
Mobile Care Successes and Struggles in Pennsylvania: Profile of Mary Englerth

Mary Englerth, PA, the Pennsylvania State Director of Migrant Health Program at Keystone Health and Maryknoll Missioner, can find herself reflecting on her patients during her off-hours. “Anytime I’m in the Giant and I pick up a piece of fruit, I think, ‘Who picked this?’“ Englerth admitted. Englerth has spent much of the last 30 years working with migrant farmworkers in Pennsylvania at Keystone Health, coupled with years of health work in the highlands of Peru and Guatemala as a physician assistant and Maryknoll Sister, a Catholic religious order of women devoting their lives to service overseas.

FROM PERU TO PENNSYLVANIA

She first entered the field of migrant health after returning from Peru for several months in the mid-80s, when her mother fell ill and needed her assistance. While back in the states, she found out about services provided to migrant farmworkers by Dr. Ed Zuroweste – now MCN’s Chief Medical Officer – as part of his private practice in New York. 

“I remembered going into that office and I said, ‘I’m a bilingual PA – can you use me?’” laughed Englerth. “That’s when I really became aware of the migrant’s problems and chronic disease.”  She returned to Peru, but was brought back again for family reasons and joined Dr. Zuroweste at his new work at Keystone Health in the early 90s.  In 1995, Keystone Health received a federal grant to start a migrant health program in 15 counties of rural Pennsylvania. Englerth assisted in setting up the requirements for the migrant program, before she again returned to missionary service. She provided primary care services in Guatemala from 2003 to 2007. When she returned to the states she found that her old job was waiting for her.

“I actually stepped back into the same job as when I left and we really went full-force,” said Englerth. The program has expanded to 30 counties. “Next year we’ll hopefully be expanding into a new county so it’ll be 31,” out of a total of 67 in Pennsylvania, Englerth said.  The program is notable for its focus on outreach. “We have five sites throughout the state,” explained Englerth, noting each site covers between five and 10 counties.  Each center has a site coordinator and a group of nurses who go out to the seasonal camps for migrant farmworkers three nights a week. “They’re able to cover a good many minor things in the camp,” Englerth explained. For those who need further assistance – “which of course, there are many” – each clinic runs slightly different. At her clinic in Adams County, they have an evening clinic every Tuesday.  In more remote areas away from one of their clinics, they have Memorandums of Agreement with different hospitals, clinics, and health centers for their patients. 

CONTINUED STRUGGLES

“We provide transportation for those who do not have it,” Englerth explained, but transportation continues to be a struggle due to the large coverage area and the lack of funding to cover growing transportation costs. “Right now, we have four men that very desperately need to get to one of our internal medicine doctors over in Chambersburg, and they just don’t have a way to get over there,” offered Englerth as a common example.  The group is instead doing outreach to local churches and others who may be willing to volunteer to provide transportation to the patients. The van for the clinic in her county, she said, is only able to cover one-third of the county per clinic night, leaving two-thirds of the county for a future clinic night.  “If it’s really serious, one of the nurses will volunteer to go out and get them in, or at times I have gone too… but transportation is a big problem,” Englerth said.

COLLABORATION PLAYS A ROLE

Englerth’s greatest challenge continues to be migrant patient follow-up, which she hopes MCN’s Heath Network will help solve, as her clinics begin to register all migrant patients with ongoing health conditions in the network.  A common scenario with mobile patients of any sort is the patient’s impediments to continued care once he or she has moved on to a new location. “You get the blood pressure [and] the glucose, never under control, but at least better, and then they go back and do not follow-up, and they come back the next year and it’s worse than what it was the previous year,” Englerth explained. “That’s really the main challenge, is the follow-up.”  In addition to relying on MCN’s ability to encourage and support follow-up, Englerth hopes that further peer-to-peer connection will enable better care.  She envisions a world where “clinicians could get together to get a formulary to use the same medicines up and down the coast… a generalized formulary,” to provide continuity of care for migrant patients.

Despite the struggles, Englerth is positive about future changes. She works with second-year PA students from local universities, who join the clinical rotation for several weeks during the summer, and experience firsthand the uniqueness of migrant health. “It shows them the real disparities of health care in the US,” Englerth believes.  “The reason I do [the PA student program] – because it’s a lot of work – is because hopefully they will see and not forget… our poor in our country.”

She also enjoys the strong collaboration Keystone has with Migrant Education in Pennsylvania.  Her team joins Migrant Ed when they visit out-of-school youth in migrant farmworker camps, and does health screens, which has helped them expand into new camps and new counties. They also do outreach to new patients through Migrant Ed’s winter ESL programs.  Englerth notes that the winter collaboration has allowed Keystone to provide health screenings for migrant workers who previously had no contact with Keystone, such as women working in the local packing houses.

Despite her administrative responsibilities, Englerth still manages to get out to the camps.   She finds the personal connection rewarding.  “[To] have someone to go out into the communities, and sit, and listen compassionately to their problems,” makes a big difference, Englerth believes. “The gratitude in people’s eyes for the little bit we can do… it’s reciprocal, it really is.”

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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