Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, July 12, 1993 TAG: 9307120014
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: KERRY DOUGHERTY LANDMARK NEWS SERVICE
DATELINE: NASSAWADOX LENGTH: Long
Fernando, a 20-year-old Mexican migrant worker, is sitting stiffly on the edge of the examining table. Dr. Richard Andrews is peering into his ear with a lighted otoscope and asking the man with the infected ear a series of questions in Spanish.
Suddenly Fernando laughs. Then Andrews laughs. The doctor explains that the words for Q-Tip and condom sound similar.
"I just asked him if he's been putting condoms in his ears," Andrews says.
Stumbling in Spanish is a rarity for this 37-year-old doctor, who lived in Spain - his parents were American civil servants - until he was 17.
In fact, it was Andrews' fluency in Spanish that brought him to the spartan clinic for migrant farm workers on the Eastern Shore.
When Andrews was finishing his residency in family medicine at Georgetown University in Washington three years ago, he decided to practice what he calls "Third World medicine." Andrews toyed with the idea of working on an Indian reservation or in an inner-city clinic.
"I knew I wanted to work with indigent people," he says simply.
Patients don't come much more indigent than this.
Of the almost 4,200 people Andrews treated last year in the federally funded Delmarva Rural Ministries health clinic, most were Mexican and Guatemalan farm workers. All were impoverished.
Northampton County is the second-poorest county in Virginia, according to the 1990 census. But it would leap into first place if migrant workers were counted.
Andrews estimates the migrant population of Virginia's Eastern Shore swells to between 6,000 to 7,000 each summer. The workers are hired in Florida by crew leaders who bring them to Virginia to cut asparagus, tomatoes and cucumbers and to harvest potatoes. About 40 percent to 60 percent are illegal immigrants, making them easy prey for unscrupulous growers and crew leaders.
"Migrant workers have nothing," Andrews says. "There's no worker's comp for them, no sick pay, no health insurance. . . . They are completely impoverished."
The doctor came to Nassawadox three years ago. He bought a house near the water, got involved in community groups and says he plans to stay.
"I'm a come-here," he says, laughing at the Eastern Shore term for new arrivals. "But I find the people pretty accepting of outsiders."
Andrew's permanence is a bonus for the clinic, where his predecessors had been almost as temporary as migrants.
"Most of our other doctors came to us through National Health Corps. They were trying to repay their student loans," said Sister Claire Heroux, an administrator at the clinic. "Richard is the first to come with the idea of staying."
The 20-year-old clinic, which houses Andrews and his medical staff - plus social workers, outreach workers, a translator and an ever-changing assortment of medical and nursing students - is almost directly across the street from the Northampton-Accomack Memorial Hospital.
From the moment the clinic doors open at 8 a.m. until they close - sometimes after midnight - the neat lobby is full of migrant workers, each holding a number and waiting to be seen by a boyish doctor with green eyes and freckles, a young doctor who would rather care for them than work in the prosperous suburbs.
"I'm not altruistic or anything," Andrews insists. "This would be altruism if I didn't like what I'm doing. But this is exactly where I want to be. I'm doing what I want to do."
Andrews is more than just a doctor. Dressed in jeans and a T-shirt, his feet clad in running shoes, he dashes from patient to patient treating maladies and counseling on everything from domestic violence to tooth care.
Domestic violence is prevalent in the migrant community, Andrews says. He has come up with his own technique to try to prevent it. First, he offers to take the woman and children to a shelter. If she wants to stay with her abusive husband, Andrews asks the couple to come in for a meeting.
Andrews has both sign a contract, in Spanish. In his, the husband admits he has beaten his wife and acknowledges the behavior is not normal and is against the law. He promises to stop. The woman signs a similar statement promising to seek help and leave her husband if it happens again.
Andrews does not suffer delusions that this will end domestic violence, but he hopes it helps.
"I have a low threshold for domestic violence," Andrews says. sitting in his office and examining a sample contract. "These people rarely sign anything, so I've designed this in hopes they will take signing a contract, giving their word, seriously.
"Of course, it's not enforceable."
It's easier to counsel migrants on health care issues.
A black woman, her face grotesquely swollen, is suffering from an abscessed gum. She explains she had a tooth extracted from the offending spot. A piece broke off and the dentist asked her to come back to have it removed. She didn't, and now a massive infection has set in.
Andrews prescribes antibiotics and a mild painkiller. But the sight of the suffering woman ignites a gentle diatribe about dental care among migrants.
"They wind up getting teeth yanked rather than filled," he says as he scribbles the prescriptions.
Turning to the patient, he says sternly: "From now on when you have a bad tooth ask the dentist to fill it, not pull it. Do you know that by getting your teeth pulled you'll get old faster? . . . Your face actually shrinks when you don't have teeth, so even though you're a young woman you'll look much older than you are."
The woman looks stricken and probes her mouth with her index finger.
"How many am I missing?" she asks. "One, two, three and this makes four."
"That's all right," he reassures. "You have plenty of teeth left, just don't let them pull any more. OK?"
"I won't," she says, carefully folding her prescriptions. "Thank you, thank you."
As the morning ticks away, Andrews dashes from examining room to examining room, grabbing files outside the door, then greeting each patient with a cheerful "Hola."
By noon the lobby is nearly full, every examining room occupied. Andrews sneaks a peek at the crowd and begins moving faster.
A family of Mexican migrant workers is squeezed into the pediatric examining room. There is a man with a sore knee and a facial cyst in the gynecological room. There is a man who has just tested positive for tuberculosis in the treatment room. Down the hall, in the adult exam room, a victim of domestic violence is waiting. Next door, a man suffering from sciatica waits.
In the lobby is a worker with a badly swollen elbow, a woman holding her 5-month-old baby boy, who has a kidney infection, a man with a nasty case of athlete's foot - "nine out of 10 migrants have athlete's foot, not a concern to yuppies, but a really bad disease in the camps," Andrews mutters later while probing the man's inflamed toes - a woman about to find out she's 14 weeks pregnant and too far along for an abortion she wanted, a girl who needs a tetanus shot, a man suffering from AIDS.
Andrews enters the examination room where the Mexican family waits. There is the father, mother and their two little boys, ages 3 years old and 20 months. Although they arrived in a Virginia migrant camp just two days earlier from Florida, the parents have already tried to enroll their sons in Head Start. All they need is a health certificate from the clinic.
Each member of the family gets a PPD shot - to test for tuberculosis.
Both parents work in the fields. As proof, the dark-haired woman turns over her small hands, revealing rows of thick, scaly calluses.
"I cut tomatoes," she says simply in Spanish, and continues: "Si no trabajo no puedo comer." ("If I don't work, I can't eat.")
"That's what you hear every day," Andrews says with a shrug. "There is no worker's comp for disability for migrants. When they don't work, they don't get paid.
"It's hard to make them respect an injury, to take time off."
During a break, Andrews ruminates about life on the Eastern Shore.
"I like it here," says Andrews, a bachelor. "If I had kids, I'd like to raise them here.
He acknowledges that social life is somewhat limited in a town that is little more than an intersection on U.S. 13.
"Well, there's a new pool table in one of the bars," he says, grinning. "That's lots of fun . . . and we've been doing work on the new library. That'll be a hub of activity eventually.
"Working with migrants is very gratifying. No one is more in need than they are."
by CNB