In rural areas, nurses come to the farm

M.L. JOHNSON Associated Press Published:

SHAWANO, Wis. (AP) -- Wisconsin dairy farmer Kevin Ainsworth rushed to the emergency room in 1992, when he sliced off the tip of his finger. Other than a quick trip in 2010 when a test during a blood donation raised a false alarm about hepatitis C, that was his last visit to a doctor.

His father jokingly hassles him about needing a prostate exam now that he's past 50, but Ainsworth shrugs that off. With a $5,000 deductible on his health insurance policy and a never-ending slate of chores, he's not eager to spend time or money on medical care that isn't absolutely necessary.

Ainsworth is a typical dairy farmer, more likely than most Americans to go without health insurance or buy his own policy. For years, he has received basic care from a unique community program that sends a nurse to farms to check farmers' blood pressure, cholesterol and blood sugar levels and screen them for health risks. Farmers with signs of serious problems are referred to a doctor or clinic.

Agriculture and health care advocacy groups had hoped the new federal health care law would improve farmers' situation by allowing them to buy affordable policies that cover preventive care and have lower deductibles. No savings are to be had, say farmers who've been shopping for insurance and believe they'll end up with plans similar to their current ones.

That's why the Rural Health Initiative remains valuable.

"I would say most farmers, in general, if it's not a lost limb or something crushed, they're probably not going to go to the doctor. If you've got a virus, it's going to wear off," said Jay Vomastic, another dairy farmer who lives minutes from Ainsworth in central Wisconsin's Shawano County.

Most dairy farms in Shawano County are generations-old and small enough to be run by a family, perhaps with one or two workers. Farmers can easily spend eight hours or more on their feet, but increased mechanization has made them less active than previous generations. Add to that a diet traditionally heavy in milk, cheese and beef, which presents cholesterol and other risks.

The initiative started in 2004 after health care workers and residents realized many farmers received no medical care until they turned up in emergency rooms. The tight-knit community, where farmers are active in schools, local government and state politics, formed a focus group.

Thirty-six percent of U.S. dairy farmers and their families lacked insurance in 2011, compared to 9 percent of all farmers and about 16 percent of the general population, according to the U.S. Department of Agriculture. Dairy farmers are less likely than crop farmers to hold off-farm jobs for insurance because their animals require constant care. Eighteen percent bought their own policies in 2011.

But insurance isn't the only issue. Chores often begin at 4 a.m., making it hard to fast for a blood cholesterol test hours later at a doctor's office or clinic. Traveling to the office and long waits are time lost from work.

In the end, farm wives helped the group realize health care needed to be delivered like agricultural services.

"The vet comes to the farm. The milk man picks up delivery at the farm. The feed comes to the farm. Why should we make them change that?" said Rhonda Strebel, the nurse who launched the program and now serves as its executive director.

Vomastic went to school with the nurse who came to his farm a few days after Thanksgiving. They joked about the three holiday meals he consumed and his fondness for Sun Drop, a locally made soda that many drink instead of coffee. A blood test showed the 39-year-old's triglyceride level was higher than it should be.

"How many Sun Drops did you have yesterday?" Dawn Dingeldein asked.

"Enough," Vomastic responded. Dingeldein laughed but recommended he watch his diet, particularly sugar, alcohol and butter.

"Three things that go good together," Vomastic joked.

The local hospital system, ThedaCare, picks up about half of the $200,000 tab for Rural Health Initiative services in three counties. Community donations cover the rest. The program will expand to a fourth Wisconsin county next year.

Nationwide, preventive care programs aimed at farmers have cropped up in states such as Iowa, Nebraska and North Carolina through the nonprofit AgriSafe Network. In Johnson County, Iowa, a network clinic has a trailer that goes to events like farm bureau meetings and fairs to provide screenings and basic services, said Kelley Donham, a retired University of Iowa professor who helped found AgriSafe.

Dingeldein pulled her SUV into Ainsworth's father's driveway as Ainsworth and his brother were finishing morning chores on the 130-cow farm. She plays volleyball with Ainsworth's wife, remembers his father's service as a state assemblyman and knows his brother's wife makes the calls on their health insurance.

Dingeldein drew blood, checked the brothers' weight and body fat and collected a questionnaire that ThedaCare will analyze for signs of health problems, such as depression.

"You did much, much better this year," Dingeldein told the 53-year-old Ainsworth after looking at his cholesterol results. "Do you know what you did?"

He didn't. They brainstormed. He lost a few pounds, and the milk he drinks comes from the bottom of the farm's tank, eliminating much of the fat that floats to the top.

His 73-year-old father, John Ainsworth, said he was skeptical when the program started, but has been won over.

"I've heard a couple of stories of people who had some little things that weren't quite right and didn't know about it until she checked their blood sugar," he said, "and then they got the care they needed."

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