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It's about 7 p.m. on a chilly night, and Sirene Garcia is standing outside an apartment building about an hour's drive from Rochester, N.Y.
Even though Garcia has had a cold for the past few days, she has her laptop perched on the hood of her car, trying to test out the new telehealth program. Once the program kicks off, Finger Lakes Community Health's doctors and nurse practitioners will be able to see patients at their homes through video calls.
And there are a lot of patients who could use this: The center serves some 9,000 farm workers in this region near the Canadian border.
But all of that depends tonight on whether or not Garcia, the center's special programs director, can find a decent Internet connection.
"Can you hear me OK?" Garcia says to her laptop, garbled sound spitting back at her through the speakers. She's on a video call with one of her colleagues who's based at one of FLCH's eight locations.
The Finger Lakes region, well-known for its rolling farmland and vineyards, is also home to a diverse and sizable refugee and immigrant population.
Most of the challenges that plague FLCH revolve around place, and the issue of spotty cell and Internet service is no different. The rural communities FLCH serve include Mennonites, refugees from Burma and immigrants from China, Saudi Arabia, Haiti and Mexico. Yet being in rural places means potential patients may often be isolated, low-income and not have easy access to transportation — and therefore difficult to serve.
Mary Zelazny, the health center's CEO, says they've come up with a variety of approaches to trying to crack the location puzzle, including providing transportation to patients, and providing "in-camp" services, where doctors or nurse practitioners visit patients' homes, often accompanied by translators or community outreach workers.
Including the farm workers, the organization serves about 27,000 patients overall.
And in a region so close to the border, a big fear for many of the farm workers is the heavy presence of the Border Patrol. Many fear to be out on the roads for things like going to the doctor, so the telehealth clinic offers a chance to reach them in a safe place.
"We just have more presence here of border patrol," Zelazny says. "I don't ask any patients that comes into my health centers what their immigration status is, because I don't care. My job, and my team's job, is to make sure that we give them the best healthcare they can get."
The organization's eight clinics are within 100 miles from the Canadian border. By U.S. law, Border Patrol can board — and search — any vehicle within a "reasonable distance" of the the border.
And so if the patients can't get to health care, Zelazny says, then the clinic will come to them.
One the patients being served tonight is Pablo Lopez, 42, who came to the U.S. from Oaxaca two weeks earlier on a temporary work visa. Lopez, who's been to the U.S. seven times in as many years, said that when he first came, he was worried. On TV, he'd seen reports about immigration, the police and language barriers that were alarming.
Zelazny says that, throughout the years, even her own staff — many of whom are people of color — have been stopped by agents. And for a lot of farmworkers, regardless of their citizenship status, any run-ins with law enforcement cause a lot of anxiety.
"You know, there's just this fear factor that makes everything harder," Zelazny says. "They don't know what's going to happen to them. You hear a lot of stories, and they may not be true, but some of them are."
At a training for the new pilot telehealth program earlier in the day, Terri Hannon, a nurse practitioner, says she was at a dairy farm recently, giving vaccinations. A farmer came up to her, Hannon recalls, "and he stated that his farm workers are very frightened and won't leave the farm at all — not to go to the grocery store, or Walmart or medical appointments."
Hannon's and her colleagues have heard similar things from patients they've visited.
Orlando O'Neill, one of the health center's outreach coordinators, thinks the new video program will help.
"They're afraid to come health center — even if they're sick or ill," O'Neill says. "This will be a good tool for them."
The program will eliminate the need to travel at least an hour to the health clinics, and it'll keep the patients from having to take time out of their days.
Sara Rosenbaum, a professor of health law and policy at George Washington University, points to the public health issues at stake: "Keeping your patients feeling that they can trust that using the health center services will not expose them is a huge, huge challenge."