The Migrant Health Service clinic in Moorhead is a modest place, located in an old school with small examining rooms. The clinic serves only migrant workers, but this clinic is different in another way. You won't see any doctors here. Patients are treated by nurses and a nurse practitioner.
The idea is to help patients bring their health problems under control, and teach them how to manage chronic health conditions on their own.
Migrant Health Services operates nine other clinics like this one, stretching from Grafton in northeast North Dakota, to Rochester in southeast Minnesota.
Most migrants in the Red River Valley are from Texas, and their jobs are seasonal. They work spring planting jobs, weeding fields in the summer, and then help with fall harvest. It's work that requires a lot of travel.
When workers get hurt or sick, they tend to ignore it because few have money to pay for care. Andrea Smith, chronic disease manager at the clinic, says that's an unhealthy combination, especially for someone with a chronic disease like diabetes.
"They're going to end up in the emergency room, and there's going to be higher bills because of that," says Smith. "I feel these are people who just won't seek care unless it's an emergency situation."
Convincing people to get help is a problem. Many migrant workers are fearful because the clinic is a federally funded program. They're afraid they'll be investigated as illegal immigrants. Language is another barrier. Kristi Jacobsen has several duties at the clinic, including translation.
"Quite a few patients don't speak any English. They might understand it, but they don't feel comfortable explaining themselves in English," says Jacobsen. "I think that's another nice thing we offer here, they can come and they speak Spanish, and they feel comfortable."
Juanos Cardos is at the clinic to check on her diabetes. She and her family came to Moorhead from Texas four years ago. Cardos' diabetes is a tough illness to manage. She has to pay close attention to her diet, and take medication. As a group, only American Indians are more likely to develop diabetes.
Juanos Cardos has a job at a local store -- she says it's because the clinic has shown her how to take care of herself. In addition to being a diabetic, she has arthritis. Speaking through a translator, Cardos explains how her health has improved.
"I needed up to eight injections every week or every 15 days in my knees," she says. "I started giving those (myself). My bones are hitting against each other, bone-on-bone because of the arthritis. Now it will almost be a year in January that I haven't had to have any more (shots)."
Once a person receives care at one of the Migrant Health Services clinics, they can get help from any of the participating providers in the system, including hospitals and clinics with doctors.
When patients move out of the Moorhead area, they are given vouchers, good for care in the region. Andrea Smith says support for the program is growing.
"We have voucher agreements with over 400 providers in North Dakota and Minnesota," says Smith. "For example, if somebody needed to see an optometrist for an eye exam, they would come here and the nurse practitioner would write them a voucher for that eye exam appointment."
Patients at the clinics pay from $8 to $20 for a voucher, depending on the care they need. These are people who don't qualify for Medicare or Medicaid.
Clinic officials like Andrea Smith say the future of the clinic lies in educating people. Fewer dollars are available to fund the program, and that will force Migrant Health Services to teach their patients the benefits of preventive medicine.