Gayle Thomas
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Abstract
This oral history interview was conducted by Sophie Therber with interviewee Gayle Thomas via Zoom on July 19, 2021. The main focus of this interview is Gayle’s involvement with the Farmworker Health Program and her experience helping farmworkers mitigate the COVID pandemic and extreme weather. Gayle has known from a young age that she wanted to “help poor people,” in her words, and found an opportunity to help Spanish-speaking populations in North Carolina. She shares her personal journey of getting involved in farmworker health, as well as the challenges of including farmworkers in responses to COVID and extreme weather. She emphasizes the importance of the outreach workers who bridge the gap between medical providers and members of the farmworker community. She discusses unique challenges that farmworkers in North Carolina face, such as lack of access to transportation, crowded working conditions, and agricultural exceptionalism promoting a culture of exploitation in their work.R1005_Audio.mp3
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Transcript
Sophie Therber [00:00:01] My name is Sophie Therber, and I'm interviewing Gayle Thomas, today is July 19, 2021, and it is currently 4:09 PM. Thank you so much for agreeing to be interviewed, Gayle, I've been really looking forward to this. So, thank you so much.
Gayle Thomas [00:00:17] You're welcome.
Sophie Therber [00:00:19] Just to start, where are you from and can you tell me a little bit about that area?
Gayle Thomas [00:00:25] Yeah, I was born actually in Congo, which is a country in Africa, but I didn't live there very long. I left when I was about two. My parents were working there as missionary teachers, training Congolese teachers. I grew up in California where I got all my medical training. And then I came to North Carolina right after finishing residency, primarily because my husband got a position on faculty at UNC in the School of Public Health.
Sophie Therber [00:00:59] How long have you been in North Carolina?
Gayle Thomas [00:01:02] Since 1989, so a long time.
Sophie Therber [00:01:06] What was that like to be moving around from Congo to California to North Carolina?
Gayle Thomas [00:01:11] Well, I don't remember the move from Congo because I was only two, but growing up in California was great. Moving to North Carolina was a little bit scary. There's certain, you know, I would say, prejudices about southern states in California, but I was very pleasantly surprised when I moved to Chapel Hill. It had a lot of things that I enjoyed and profited from. I really found that I love the...The seasons are more marked here in North Carolina than they are in California. And I really enjoyed that change in weather and the weather drama. Now that California is in the middle of a big drought and on fire every year, I'm grateful not to be breathing that smoke. So, I love California. I love visiting it. But North Carolina has a lot of the same features: mountains, beaches, beautiful woods. And I feel very fortunate to live in North Carolina.
Sophie Therber [00:02:28] Does your family still live in California?
Gayle Thomas [00:02:31] No. I have some cousins there still, but my parents moved to be with us in Chapel Hill. My mother-in-law moved. My brothers have moved to other states. So, no, I don't have any close family in California anymore.
Sophie Therber [00:02:50] And so you moved to North Carolina, and you were in Chapel Hill. And then what influenced your decision to start working with the Farm Workers Project and the North Carolina Department of Health and Human Services?
Gayle Thomas [00:03:02] Well, I went to medical school because I wanted to take care of poor people. And originally, I was going to be taking care of poor people in Africa. I wanted to go back to Africa, and I married the person I thought wanted to go back to Africa, too. He had worked in Congo for two years as a nutritionist prior to us really beginning our relationship. And that was one reason why we got acquainted, because we had that in common. But then following residency, we decided we needed a few years in the States and he got this job in North Carolina. We weren't planning to stay, but once we came and then we started a family and then it became clear that our family needed to be sort of rooted in one place and not being bounced around the world. So, we decided to stay in North Carolina. I was entertaining the idea of being an academic physician but decided after one year in the Department of Family Medicine that although I really loved that what I loved more was taking care of poor people. So I took a job at the...It was called OCCHS, but it's a federally qualified community health center now called Piedmont Health Services. So I took a job and both Carrboro and Prospect Hill County Health Center and I began to get Spanish-speaking patients. So, I had studied Spanish in California, realizing that I would need that in medicine in California, and I did need that in med school and residency. And then when I came to North Carolina, I thought, "well, I'm not going to speak Spanish to North Carolina in 1989." But that was just as the influx of Spanish speakers began. And I had a receptionist who is bilingual and then I was barely able to speak medical Spanish and I just kind of became this magnet for Spanish speaking patients for the region. And I realized, "wow, I don't have to leave the country to do medicine in cross-cultural medicine, which was kind of what I really wanted to do. But I really need to get better in Spanish." So my husband and I took our two little kids to Guatemala for a month of immersion, which really, really helped with my Spanish. So, I worked at the Community Health Center for 23 years and really enjoyed the opportunity to be a part of my patients lives. Many of them were very recent immigrants and not farmworkers so much. After I did that for 23 years and my kids were grown, I was like, "I need a new challenge. What about that faculty position that they offered me 23 years ago? I wonder if that's still available." So, I was so fortunate that family medicine was willing to give me a job there. And as part of that job they said we need somebody to be the medical director of the farmworker health program. And I thought, "well, that's a good way for me to continue to practice cross-cultural medicine and to use my Spanish." And I had actually interacted with farmworkers in California to a limited extent and also at the prospect. So, I'm like, "yeah, that sounds great." So, eight years ago, I left the Community Health Center and joined the faculty at UNC and then was subcontracted to the state to be the medical director for the farmworker health program. And I think that's been really, really wonderful because I not only get to continue to care for Latino patients, but I also get to bring learners with me. So, med students and residents and. I developed more of an understanding of the occupational hazards of agricultural medicine so that I can teach people about that. So, it's been a really good transition for me and I've enjoyed it very, very much.
Sophie Therber [00:07:29] That's really incredible. Wow. I'm kind of interested in what you were saying about how what you really wanted to do was just kind of take care of poor people. And your original thought might have been that you were going to do that in Africa. But then over time, I like what you said about having Red Cross culture, having cross cultural experiences right here in North Carolina. That's really interesting. So when you you said that you were not expecting to have a lot of Latino immigrants when you started in about 1989, were you witnessing, like, just changing demographics or were you just kind of surprised about how many Latino immigrants there were? What was that like?
Gayle Thomas [00:08:08] No, it was definitely changing demographics. And there were tensions in our clinic. Well, when you're working at a federally qualified community health center and you're providing care to uninsured and underinsured people, you always have more patients than you can handle. At one point, we had a waiting list of 800 patients wanting to become members at our clinic. Well, it doesn't make sense to keep infecting new patients if you can't take care of them. So, like, if it's six weeks until my next available appointment, then I'm not available. So we were trying to limit our patient panel so that we could actually provide good care. But that meant we weren't able to take everybody who wanted to be our patients. And so the people who are traditionally our patients, the low-income Black and White members of our community, appropriately, were resentful about being kind of pushed out by these new Spanish speaking patients that were coming in greater and greater numbers. So while I was really excited to provide medicine, medical care in Spanish and to improve my Spanish, I also saw with, you know, with some sadness how that pushed other people out and limited their access to care just because there isn't enough there's never enough care in our country for poor and uninsured patients. And the North Carolina legislature's decision to limit Medicaid has only made that worse.
Sophie Therber [00:09:47] So when you said earlier that you were kind of a magnet for Spanish speaking patients, do you think that that was because you were one of the only people who spoke Spanish? Or do you think that there was something else that drew the kind of connected you with that community?
Gayle Thomas [00:09:59] Well, I'd like to think that I was able to express my interest in them and my concern for them and that they appreciated that. But I think also I was the only Spanish speaking provider, and I didn't speak very good Spanish at the beginning. So, they were very patient with me. They taught me a lot. After I got to go to Guatemala for that month of immersion, I did a lot better and my Spanish just continued to improve. But really, it was my patients that taught me a lot about the language, but also about their own cultural beliefs, health care beliefs.
Sophie Therber [00:10:44] And how would you say that your job has changed since you started that kind of work, versus the way that it is today or even the way that it was in recent years before the pandemic?
Gayle Thomas [00:10:56] I'll say...Rephrase that question again, I'm not sure what you're asking.
Sophie Therber [00:10:59] I'm just wondering, I mean, over time, how has just the nature of your work I mean, you were talking about how there have been changing demographics, but what are some other ways that just what you've done with Family Medicine or with the Department of Health and Human Services, just other places? How has that changed over the past since nineteen eighty nine when you started working?
Gayle Thomas [00:11:17] Hmm. There's so many changes that it's hard to hard to say. But when I started at the Community Health Center, I think the copay for somebody who was on the sliding scale fee and went all the way down with ten dollars that copay. Now it's 25 dollars. I certainly had a greater diversity of patients in terms of Black, white, and Latino. I would say now it's almost all Latino, or [it was] when I left, although we also were getting some new immigrants like Karen refugees. So, yeah, a big influx of Karen refugees who we all tried to get kind of up to speed with. Not that we can learn the language that quickly, but understand that population and what some of their unique health beliefs and health care needs were when I changed to the faculty, my life changed dramatically from just being a doctor in a clinic for low income people to being a teacher and needing to learn to give lectures and needing to learn to supervise learners and teach residents and medical students. I had been doing some of that at the center, but doing it much more full time. And then my job at the North Carolina community and the North Carolina Farmworker Health Program is very administrative. And so there's a lot of policies and procedures and official site visits and medical continuous quality improvement things that I need to do that I didn't do at the county health center. So it's been a big learning curve the last eight years, but I've really enjoyed it.
Sophie Therber [00:13:05] I'm interested in what you were saying earlier about how North Carolina health policy, like increasing the copay and decreasing access to Medicare, really impacted the places where you were working. So I'm kind of wondering, how do you see kind of the relationship between the on-the-ground community centers like family health or other places that you worked and these more broad just state legislation? What is that relationship like when these different...these changes come from the state level down to where you are working?
Gayle Thomas [00:13:37] Well, it's actually Medicaid that they limited access to.
Sophie Therber Oh, excuse me.
Gayle Thomas [00:13:42] So when Obama enrolled, or, tried to make Medicaid more available to more people, there were certain states that decided not to take that federal funding to increase access to Medicaid. So, what's really frustrating is that I would have patients who-- they go to the marketplace to try to enroll in subsidized health care from the government. And they're told you don't make enough money to get subsidies from the federal government, which is completely not intuitive. It's like the poorer you are, the more you should get subsidized. But the way this was set up is that people at that income level were supposed to get Medicaid. Well, there is no Medicaid for them, so they just fund this huge chasm between Medicaid and federally subsidized health care. So, it is very painful. It's very painful as a doctor to tell people, yeah, there's nothing for you. You're just going to have to get what care you can at our overly populated community health center, and if you need specialty care, we will try to help you apply to UNC’s Charity Care program. So that's one of the reasons, I think, that I was able to feel good about taking care of my uninsured patients, is that when I needed somebody, a specialist for one of my patients, more often than not, I was able to get it at UNC. So as a primary care provider, I can't do everything for everybody. I can't operate on their brain tumor. I can't do their dialysis. I need my specialty colleagues. And most of the time at UNC, I was able to get them access to the care that they needed, not all with, also, a very imperfect and over-subscribed program. So, when you have patients who can't get the care they need, it's very painful as a provider to watch that.
Sophie Therber [00:15:55] And that's something I could imagine would be kind of compounded by people who might be new to the United States and not necessarily have the proper documentation for insurance or access to these federal programs. Was that something that you experienced, just kind of that whole chasm, as you were saying, being made even more complicated by that?
Gayle Thomas [00:16:15] Definitely. Definitely. We...We took care of a lot of patients who were undocumented and did not have access, would not have had access to Medicaid even if the state legislature had decided to expand access and, fortunately, UNC Charity Care did not make themselves unavailable. They kind of took the reverse. So right now, to apply for Charity Care at UNC, you can't have a legal visa. So, if you have a visa to come to the United States, as about 20,000 of our farmworkers do, they're here on an agricultural guest worker visa. They tend to come in March and April and go back in November every year. Well, if they need dialysis or if they need surgery, they do not qualify for Charity Care because their visa implies that they will be here and take care of themselves and not burden our country. So now I kind of have the reverse problem of it's better to be undocumented if you need specialty care at UNC.
Sophie Therber [00:17:30] That's really interesting that it's just these different levels with having less access to some things, given having some levels of documentation. I'd like to switch gears for a second and just ask you about, have you experienced any natural disasters when you've had any of these positions, particularly with working with farmworkers or any kind of immigrants to North Carolina?
Gayle Thomas [00:17:54] Yeah, in the eight years that I've been the medical director, we've had a number of hurricanes that have impacted farmworkers. And we had farmworkers at one point call 911 because their camp, they live in work camps in large groups, and their work camp was being flooded and 911 was preparing a white-water rescue for them. But then, the owner of the farm called 911 and said, "they're fine, you don't need to go." And the 911 operators listen to the owner instead of listening to the farmworkers who probably, because of language, weren't able to advocate for themselves as well as they would have liked. So, they start calling our Spanish-speaking outreach workers. And finally, the outreach workers were able to get someone to go rescue them. But, yeah, there's all kinds of difficulties when farmworkers, first of all, if they're out of work, even if their camp is not being flooded, that they just can't work, they don't work, they don't get paid; they don't get paid, they can't eat, they don't have their own transportation. They're reliant on their employer for transportation. They have access to some public service announcements through Spanish radio and Spanish media. But if they lose power, then their cell phones are going to die and they're not going to have access to those announcements and that very important public service information that helps us all kind of navigate when we're in the middle of a disaster.
Sophie Therber [00:19:36] Yeah, that's really heartbreaking that they weren't able to get the help that they needed. I mean, I'm glad that they were able to call your Spanish speaking hotline for that kind of thing. But that's just really heartbreaking that it happened that way. So how do you your role changed when there are these natural disasters, when you're working with people who are affected by those natural disasters? How does your role and your day-to-day work change? How is it impacted by that?
Gayle Thomas [00:20:02] Well, I mean, COVID impacted all of us in health care in huge, huge ways. I've never experienced anything like I've experienced this last year and a half with COVID; my life just got turned upside down. Our program, which previously was really just caring for about ten thousand farmworkers across the state, was tapped by the state DHHS, understandably, to step up and try to care for all the farmworkers in the state, all 100,000 of them. And without prior experience, I mean, none of us had ever been in a pandemic before. Farmworkers did not do well in this pandemic because they live in large work camps. So, when one person got COVID, they all got COVID. We had camps where 90 percent of people tested positive for COVID. Fortunately, not all of them got seriously ill, but some of them did and some of them died. They go to and from work in a school bus. And so, they're all being transported together. So, the whole idea of staying home and limiting your contact with other people is just not possible for farmworkers. So that was incredibly frustrating to try to respond to COVID when there just aren't other alternatives for living and transportation. So, masks, hand sanitizer, all that's good, but it's not adequate. And then the hardest thing was...when a group of people are exposed to COVID, the ideal thing is everybody goes into quarantine separately. But you can't do that when you've got a bunch of people living together. And so, yeah, you separate the people who are sick, who have come in from the people who aren't who are just exposed. But then the next person comes down with COVID in the exposed group, and then the next person, and then the next person. And you just keep re-exposing people. And the infection just rolls through the camp and it's so frustrating to feel so helpless in trying to respond to COVID in these situations. This year is different. We have vaccines and we are seeing smaller outbreaks. We have had a farmworker already died this year and we have several in the hospital. But it's not on the scale of last year, so we're vaccinating just as fast as we can, [00:22:48] as soon as we can, when people get here from other states or from Mexico. Some farmworkers will move to North Carolina, from Florida, where they've worked in the winter, and now they're going to work here and other...and some of them may have gotten vaccinated in Florida, others not. But then a lot of them are still coming up from Mexico on these guest worker visas. So, trying to find them and vaccinate them as soon as we can is our approach this year. So, it feels better, feels like we actually have a tool that works. But a 40-hour bus ride from Mexico, when you're sitting next to somebody who's asymptomatically or early asymptomatically infected with COVID, you're going to get it. And the vaccine we get you when you arrive is not going to be soon enough. So, we're still seeing people with COVID, but it's not spreading this fast in the camps because more people are vaccinated.
Sophie Therber [00:23:48] Yeah, I think so much has changed, I mean, just thinking back to the early days of the pandemic, so in February, March 2020 versus now when we do have access to the vaccines, how kind of if you had to identify a few of the biggest problems, I mean, there's a lot, right? You were talking about crowded transportation, not being able to isolate separately, and things like that. So how have the challenges changed from the early days of the pandemic, before we kind of had an understanding of what was going, on versus the kind of middle of things, not necessarily the middle, but later on when things were kind of getting worse, and now when we do have access to vaccines? How have the different challenges evolved in that time?
Gayle Thomas [00:24:34] I think the earliest challenge was, of course, knowledge we didn't know. Could you get this from surfaces? How close did you have to be to somebody to get it for how long? You know, who was going to get really sick and who is going to be asymptomatically infected? And how many people were asymptomatically infected? You mean, we just didn't know that. And so that made it a whole lot scarier. And the lack of PPE…My program relies heavily on outreach workers. As a physician, I am not as important as the outreach workers. So the outreach workers are people who often are bilingual, bicultural, come from the community and are the bridge between the patient and me, the medical provider. If I just sit in my clinic, I'll never see farmworkers because they can't get to me without an outreach worker. So, our outreach workers are our unsung heroes who go out to the camps to get to know the workers who earn their trust and provide them in non-COVID times with transportation, financial assistance, food assistance and go rescue them when they get stuck in a flooded work camp and 911 won't come. So, they are like, amazing. But at the beginning we didn't have PPE for them. You know, the PPE was, appropriately, going first to the people who are working in the COVID hot zones: the people in the ICUs, people in the ERS who were exposed to known COVID patients. And so, our outreach workers were stuck at home trying to take care of farmworkers over the phone and obviously not feeling comfortable transporting them. And so that was really, really hard this year. Now that outreach workers have the opportunity to be vaccinated, there's plenty of masks to go around, we have a better understanding that surfaces are not as important in transmitting the infection. Now, the outreach workers can actually go out to the camps and see the guys and bring them food. And last year, all they could do basically were porch drops, which they did. But now they can actually interact with the guys. And when everybody's masked, they can put them in a vehicle and take them to appointments and things like that. So, I think the stress now is, first of all, everybody's tired, we're all exhausted. Everybody has been working at, I don't know, one hundred and fifty percent capacity for the last year and a half. And we've been vaccinating as fast as we can. And there's still guys that want vaccines that haven't had access to them. So, I think that stress now, it's just that everybody's tired. And farmworkers, one of the reasons there are marginalized population is they don't get paid time off from work. So, if you want to take care of farmworkers, you have to do it after work hours. Well, they work from sunup to sundown, so that means you're working late at night. So our outreach workers will often go out to the camps starting around seven, 8:00 in the evening. They're there till 10:00, 11:00 when the farmworkers have to go to bed because they have to get up again at four thirty five in the morning. And as a provider, that's when they take me out is late in the evenings. And one other time that farmworkers are available for vaccinations are maybe Saturday afternoon, evening and Sundays. So that's the stress now is how do you find vaccine providers who are willing to go late evenings and weekends? That's not when medical providers tend to want to work. We want our weekends off, too, but that's the only time farmworkers are available, so getting the vaccine to them at times when they're available is the challenge right now. I think the other challenge that we've been having all along is getting testing to them became very clear early on that a test that takes eight days to come back, that means nothing when you're living with 50 guys. I mean, after eight days, everybody is already infected. Now, we have tests that turn around a little bit faster. So, PCR tests that can turn around in 24 to 48 hours, that's better. It's still not good enough. And now we have rapid antigen tests that can come back in 15 minutes. But they're not 100% sensitive or 100% specific, meaning that you can have false positives and false negatives. So, getting testing out to people in rural areas, in labor camps at the end of gravel roads is hard. One of the things that we're trying to do right now is to buy these at-home test kits and to give them to the farmworkers so that they can test if and when they feel like they need it, because their access to testing is so, so poor. And given that we are seeing some breakthrough infections, people who are fully vaccinated that are getting infected, I don't think testing is over. We need vaccines, but we also need testing. That's one of our challenges right now, is getting these at home test kits to farmworkers so they can test if they get symptoms.
Sophie Therber [00:30:13] And can you walk me through...How are you distributing those at home test kits to the farmers? I mean, you were saying it's difficult -- rural North Carolina gravel roads -- but for you or the outreach workers or whoever is doing that, how does that work? How do you end up being able to do that?
Gayle Thomas [00:30:30] Well, it's the outreach workers. So, you know, my program has gotten some funds from the federal government for testing and COVID response. And so we're using those funds to buy these at home test kits and we're giving them to the outreach workers. And we're saying, here, take this with you. When you go to the camp to visit the workers, talk to them about how important it is. Obviously, we have lots of masks, too, now. So, we send out masks and hand sanitizers and, now, these test kits. And let me help you get your vaccine, but even after you get your vaccine, let me help you with this test kit if you want it. So, the outreach workers are taking them. We also are encountering workers in Wal-Mart parking lots. For the last, I guess, four or five months, we've been going to the Wal-Mart parking lot at Rocky Mount and having a health fair there where farmworkers go on Sundays to buy their groceries. We're trying to put ourselves where they are. And also we've gone to some Mexican tiendas or little shops where they tend to go on the weekends as well and handing out those test kits and that PPE and health information and stuff like that there.
Sophie Therber [00:31:46] It's so interesting because there's so much nuance in the way that the COVID response has gone. I mean, especially just because of this time frame of just not really knowing what was going on, and then being overwhelmed, and now having different challenges with distribution of vaccines and testing, like you were saying. And I'm wondering, how does the way that you and your coworkers responded to the -- ah, excuse me -- are continuing to respond to the COVID pandemic, compare to ways that you've responded to extreme weather or flooding or other natural disaster events in the past?
Gayle Thomas [00:32:21] I think that because this has gone on for so long and it's been so universal, it's not just those five counties that are flooded over there, it's all of North Carolina, it's all of the United States, it's all of the world. One thing that's happened, fortunately, this time is that we have been able to make alliances and collaborations with people that we didn't before. And those have been really, really important. So we've been able to collaborate with more of our colleagues within DHHS. We've been able to collaborate with colleagues in the agricultural extension program, in Department of Commerce, in Migrant Head Start and migrant education. So some of these programs that we always knew about each other. Right. But we didn't know each other individually and we didn't try to work together. That has made a huge difference. So, for example, early in the pandemic, we wanted to send masks to farmworkers and we were able to do that with state purchase masks and we were able to deliver thousands of them to the ag extension workers. So every one of the hundred counties in North Carolina have ag extension workers who are focused mostly, mainly on the growers, not on the farmworkers. And so, they have been kind of in a parallel universe to us. And all of a sudden we were able to ask them to help deliver these masks to the farms, which [00:34:08] was huge, was huge. We just don't have as many outreach workers as we need. We don't have outreach workers in all counties, but we did have ag extension agents in all counties. And then in terms of trying to organize the vaccine distribution, we're able to use the AG extension agents again and form some committees of the outreach workers, the ag extension agent and then the vaccine providers. So, the clinics, the health departments, people who are providing the vaccine and trying to help them work together in a collaborative way to meet the needs in their county, because they're the ones that know where the groups of farmworkers are. And then the ag extension agent is able to call the grower because they know the grower and then they're able to help that grower link to a vaccine provider. So that been different and that's been really, really rewarding and very successful.
Sophie Therber [00:35:06] So, do a lot of these partnerships kind of happen on a county-to county-basis? You're working with people who now have more specific contacts about different counties in North Carolina?
Gayle Thomas [00:35:24] Well, they didn't know each other until we introduced them. OK, so this was a sort of a strategy that the team that I work with came up with. Specifically, the state epidemiologist that was assigned to work with us, came up with this idea of forming these local committees. And so, we got these name and numbers and email addresses and we called these people and got them together and held meetings still are holding meetings to try to help them collaborate. So, these were partnerships that were conceived of on the state level and are being enacted on the local county level.
Sophie Therber [00:36:08] Okay, so what is the relationship between the state level planning and the county level plan planning for these kinds of partnerships?
Gayle Thomas [00:36:17] Well, the state level planning came up with the idea of forming these local vaccine teams by county and then pulled the teams together. And now the teams are taking it themselves and many of them are meeting weekly or every other week to talk about, okay, this grower is getting these workers this week who can provide vaccines. Have you called them? Have you talked to them? Has the outreach worker been out there to talk to the workers to make sure their questions have been answered? Has the ag extension agent called the grower to make sure they understand what's going on? So that's kind of how it works.
Sophie Therber [00:37:00] There are a lot of just a lot of different levels of things to consider, because there are so many issues that have come about because of the pandemic and so many specific steps to solve those issues. Like you were saying, like people cold calling people and talking about just what needs to be done. So, can you tell me a little bit more about how you how can you prioritize when there are so many different what needs to be things that need to be done because of the pandemic? How do you decide what to reach out to other people about?
Gayle Thomas [00:37:31] That's a hard call. I mean. You know, it's very overwhelming and there were certainly many times in the past year and a half when my colleagues and I because I'm not alone, I work with a wonderful team of colleagues in Raleigh in the North Carolina Farmworker Health Program. And when we would just feel overwhelmed and I would just have we just have to say, let's just do the next thing. Let's just do the next right thing. We can't do everything, but we're just going to do the next right thing. So, I mean, we tried to prioritize based on what we knew about the disease and what would be most effective and also what we hear from our outreach workers. So, unlike some state organizations, that might be a little detached from what's going on in the ground. We met with our outreach workers every week during the worst part of the pandemic to hear from them. What's going on in your site? What do you need? What you hear? What are the farmworkers saying to you? So, I think listening to the people that we were trying to serve also is very, very important in terms of how you prioritize what you're going to do next.
Sophie Therber [00:38:47] And do you think that in the future, after I mean, the hope is that the pandemic will eventually subside, and we can kind of be moving back to what we used to consider normal and everything. Do you think that any of the practices that you've adopted now because of the pandemic you and your coworkers have adopted now, do you think you'll keep any of those or do you think that that's just kind of a shorter term solution to just a specific issue with the pandemic?
Gayle Thomas [00:39:14] No, we really would like to see these local teams maybe coalesce into regional teams and to continue to bridge this gap between the grower and the farmworker by using these regional teams to do disaster preparedness. So we recognize that these teams have formed in response to the disaster, but we would like to see them continue and be earthquake preparedness teams so that when the next --or, hurricane more likely, preparedness teams -- I'm sorry, back to California where we had earthquakes all the time. Here, we don't have them very often! But, you know, so when the next big hurricane happens and then is expected and flooding is expected, then these teams will already know each other and be able to work more effectively together to get farmworkers to safety, to get farmworkers the food and water they need when they can't drink the water or they don't have electricity or they don't have works, they don't have food, all those kinds of things.
Sophie Therber [00:40:26] So I think it's really interesting.... the importance of collaboration and I mean, you were saying that that's something that you just kind of started because of the pandemic. There was a need to coordinate responses. And that need is definitely going to continue because of the future disasters that will be faced. So can you tell me anything else about how your day-to-day or things that you're doing have changed because of the presence of these other actors, these people who are collaborating? Like, for instance, are you finding yourself kind of taking on more work to coordinate between people? Or do you feel like you've noticed new issues because the new things might be coming to your attention because there are new actors in your job now? What do you think?
Gayle Thomas [00:41:12] Oh, I definitely think there's more work. Yeah, there's always more work. I am not doing all the work myself. Obviously I have this wonderful team that I work with and our collaborators. But, yeah, it takes time to to bring these teams together and to keep them going and to check in with them and to make sure that things aren't just sort of petering out because this was all added stuff. This is all stuff on top of what people are already doing. Right. And they're exhausted and tired, too. And then our vaccinators, you know, they're running around the middle of the night vaccinating people in fields. You know, that gets tiring, too, because then they have to back in their clinic the next day seeing patients and doing their normal stuff. So, this is all on top of what people are already doing. So, it's always more work, I think. You know, I spend my life on Zoom a lot of times right now because we're doing all these local team meetings on Zoom, my wonderful teammates in Raleigh. We're not working in the Office of Rural Health together anymore. We're all meeting on Zoom. So, "Zoom fatigue," or "Teams fatigue" since we have to use Teams, is very real and we're all very, very tired. But the other thing that's opened up is how, how much you can do [dog barks] in a telemedicine call -- Hold on, let me get my dog.
Sophie Therber No worries.
[Brief pause as Gayle lets out her dog]
Gayle Thomas [00:42:55] We developed, for the first time, telemedicine; so, we had we have mobile clinics that we take out to the labor camps and we do primary care. And early in the pandemic, we suspended those because of the lack of PPE and stuff. But now we're back doing those. But we are continuing to do telemedicine. A lot of our workers do have smart phones. They often don't have the Internet. That's one thing we've been trying to get them in the pandemic is to get more Internet to the labor camp. And then then we can talk on the phone and and we can refill their blood pressure medicine and refill their diabetes medicine and do a certain amount of health care on the phone, which is really, really useful for people who are in rural areas. So I hope that's another thing that we're able to continue once the pandemic is over, because I think that's meeting a need that is going to continue.
Sophie Therber [00:44:01] What support do you think that would be most helpful for you to be addressing farmworker health throughout the pandemic and with natural disasters? I know in an ideal world we wouldn't even have those in the first place. But just ideally, if if there were more resources available to you and your coworkers and the farmworker health program, what supports would be helpful?
Gayle Thomas [00:44:24] I think the most important thing we need is more outreach workers. So, as I said before, not every county in every county in North Carolina has farmworkers. Some have many more than some have many less. But not every county has outreach workers. And as I said before, you know, a health care provider like myself without an average worker, we're just not going to be effective in terms of reaching farmworkers. So, I right now, most outreach workers are paid for by federal funds that come through a person. And so that's on a federal level. So I think expanding the number of outreach workers would be the most important thing.
Sophie Therber [00:45:10] And what with expanding our outreach workers, are those....How do you recruit outreach workers or people? Do they come from the state or are they just people who live locally? I mean, where do these people come from?
Gayle Thomas [00:45:24] That's a really good question. No, they come locally. That's their connection to the community. That gives them their super magic powers, because people they look like them. They talk like them. They maybe already are known by them. And so they have entrance into a community where I, a white lady with the Spanish that's spoken with an American accent, I might not. So... But if I go with them to a community, then all of a sudden I have credibility that I wouldn't have had otherwise because the outreach worker has done that. [00:46:08]So they come -- North Carolina is part of their response to the pandemic as a whole, really stood up a big community health care community health worker program, which and that's basically outreach workers for people other than farm. So, in my program, we call them outreach workers. These are people who are not they're not licensed as a nurse or a doctor, but they have this knowledge of the community, and they are this bridge of care. North Carolina started up a big community health worker program to reach other marginalized communities besides farmworkers. And a lot of them did the contact tracing and testing that we saw earlier in the pandemic. That has become less important now because more people are vaccinated, but as cases take back up, might become more important again. And so, we have been finding those community health workers that are bilingual, English, Spanish, and trying to sort of enfold them and recruit them to the farmworker health program. So, yeah, we find them in the community.
Sophie Therber [00:47:30] Throughout, the numbers of these outreach workers, how did that change during the pandemic? I mean, I know that we heard so much just about shortages of health care workers and things like that. Do you feel that you had kind of a sustainable amount of outreach workers, or do you feel like there was room for improvement there?
Gayle Thomas [00:47:51] Well, we've never had enough, so that didn't change. But I was really pleased that we were able to support our outreach workers and keep them in their position. It's a burnout position. They are on the front lines there. They are talking to people who don't have enough food, who don't have access to health care, who are working in dangerous occupations, who are dying of COVID. It's a burnout position. And so, they need a lot of support, both technical support, medical support, but also emotional support. And I feel like we were able to hire a COVID response team and that team was able to then, as I said before, meet weekly with outreach workers just to kind of keep a finger on the pulse of what's going on the ground, how are things changing, but also how are you doing and what can we do to help and support you? So we were able to maintain our workforce and in and increase it with some of the federal emergency funds that we got. We were able to hire some more outreach workers. So never enough. Never enough, but increased that net staff some.
Sophie Therber [00:49:14] Great. Well, thank you so much. I'd just like to add, is there anything else you would like to add or anything else that you'd like just to talk about before I stop the recording?
Gayle Thomas [00:49:23] Well, I just would love people to know that farmworkers are currently exempt from many workplace protections that most of the rest of us have. And that was written into law back in the 1920s when a lot of workplace reforms were made and it was written into law that they were exempt from overtime pay, that they were exempt from disability and lots of different things, because at that time the southern states did not want those workplace rights to be extended to their sharecroppers who were formerly enslaved African-Americans. And so they made sure that those things were exempted. So, it's called agricultural exceptionalism. And it basically sets up a very oppressive and dangerous workplace for farmworkers. And most of us have no idea that that's going on. No idea that child labor is fine on the farm. You can't work at McDonald's, but you can go work in a very dangerous place on the farm and die of heat exhaustion or heat stroke. And that workplace exceptionalism has to stop that. That exploitation has to stop.
Sophie Therber [00:50:49] Wow, did you say the 1920s? Yeah, wow, that's amazing. I mean, that's just that's been around for so long and I mean, wow, I didn't realize that it had been not updated in that much time. That's really...I'm really...thank you so much for sharing that because that's definitely important to know about and that's something that...wow.
Gayle Thomas [00:51:10] And that's one of the reasons they're so vulnerable to COVID, is that they don't have any of these protections that the rest of us take for granted. And I was going to say we're able to get away with it right now because our workforce is primarily undocumented or documented immigrants and they don't feel most of them, they don't feel empowered to speak up and protest.
Sophie Therber [00:51:40] And when you are working with your addressing COVID or you're addressing other disasters in these workplaces that are just, like you said, very dangerous and based off of exploitation, what kind of challenges do you run into that are kind of unique to that kind of workplace and that kind of situation?
Gayle Thomas [00:51:59] Well, for one, we get chased off by growers where they're providing free health care to their workers late at night and they object and they feel like they should be able to control access to their workers and that only people that they allow to come see their workers should be able to come see their workers. So that's one thing that we experience. We experience growers who are like, "no, I don't I don't want my workers to be vaccinated. I don't believe that the vaccine is needed. They're fine." Or, "I don't think my workers need to be rescued from floodwaters." So we just the...And not all growers are like that. Some are very, very concerned about their workers. But the ones that are like that, it's very discouraging. And they often, because of the way the laws are written, they are able to get away with that.
Sophie Therber [00:53:00] That's really interesting and upsetting that the growers have so much kind of control over the well-being of the people that are working there, and that's I mean, really unfortunate that that's an issue that you are running into and your work and other people who are doing similar work. All right, well, thank you so much for your time. I just, I would like to ask again if there's anything you'd like to add.
Gayle Thomas [00:53:23] No, no, that's okay.
Sophie Therber [00:53:26] Thank you. I'm going to go ahead and stop the recording but thank you so much.
End of interview. [00:53:32]
Gayle Thomas [00:00:17] You're welcome.
Sophie Therber [00:00:19] Just to start, where are you from and can you tell me a little bit about that area?
Gayle Thomas [00:00:25] Yeah, I was born actually in Congo, which is a country in Africa, but I didn't live there very long. I left when I was about two. My parents were working there as missionary teachers, training Congolese teachers. I grew up in California where I got all my medical training. And then I came to North Carolina right after finishing residency, primarily because my husband got a position on faculty at UNC in the School of Public Health.
Sophie Therber [00:00:59] How long have you been in North Carolina?
Gayle Thomas [00:01:02] Since 1989, so a long time.
Sophie Therber [00:01:06] What was that like to be moving around from Congo to California to North Carolina?
Gayle Thomas [00:01:11] Well, I don't remember the move from Congo because I was only two, but growing up in California was great. Moving to North Carolina was a little bit scary. There's certain, you know, I would say, prejudices about southern states in California, but I was very pleasantly surprised when I moved to Chapel Hill. It had a lot of things that I enjoyed and profited from. I really found that I love the...The seasons are more marked here in North Carolina than they are in California. And I really enjoyed that change in weather and the weather drama. Now that California is in the middle of a big drought and on fire every year, I'm grateful not to be breathing that smoke. So, I love California. I love visiting it. But North Carolina has a lot of the same features: mountains, beaches, beautiful woods. And I feel very fortunate to live in North Carolina.
Sophie Therber [00:02:28] Does your family still live in California?
Gayle Thomas [00:02:31] No. I have some cousins there still, but my parents moved to be with us in Chapel Hill. My mother-in-law moved. My brothers have moved to other states. So, no, I don't have any close family in California anymore.
Sophie Therber [00:02:50] And so you moved to North Carolina, and you were in Chapel Hill. And then what influenced your decision to start working with the Farm Workers Project and the North Carolina Department of Health and Human Services?
Gayle Thomas [00:03:02] Well, I went to medical school because I wanted to take care of poor people. And originally, I was going to be taking care of poor people in Africa. I wanted to go back to Africa, and I married the person I thought wanted to go back to Africa, too. He had worked in Congo for two years as a nutritionist prior to us really beginning our relationship. And that was one reason why we got acquainted, because we had that in common. But then following residency, we decided we needed a few years in the States and he got this job in North Carolina. We weren't planning to stay, but once we came and then we started a family and then it became clear that our family needed to be sort of rooted in one place and not being bounced around the world. So, we decided to stay in North Carolina. I was entertaining the idea of being an academic physician but decided after one year in the Department of Family Medicine that although I really loved that what I loved more was taking care of poor people. So I took a job at the...It was called OCCHS, but it's a federally qualified community health center now called Piedmont Health Services. So I took a job and both Carrboro and Prospect Hill County Health Center and I began to get Spanish-speaking patients. So, I had studied Spanish in California, realizing that I would need that in medicine in California, and I did need that in med school and residency. And then when I came to North Carolina, I thought, "well, I'm not going to speak Spanish to North Carolina in 1989." But that was just as the influx of Spanish speakers began. And I had a receptionist who is bilingual and then I was barely able to speak medical Spanish and I just kind of became this magnet for Spanish speaking patients for the region. And I realized, "wow, I don't have to leave the country to do medicine in cross-cultural medicine, which was kind of what I really wanted to do. But I really need to get better in Spanish." So my husband and I took our two little kids to Guatemala for a month of immersion, which really, really helped with my Spanish. So, I worked at the Community Health Center for 23 years and really enjoyed the opportunity to be a part of my patients lives. Many of them were very recent immigrants and not farmworkers so much. After I did that for 23 years and my kids were grown, I was like, "I need a new challenge. What about that faculty position that they offered me 23 years ago? I wonder if that's still available." So, I was so fortunate that family medicine was willing to give me a job there. And as part of that job they said we need somebody to be the medical director of the farmworker health program. And I thought, "well, that's a good way for me to continue to practice cross-cultural medicine and to use my Spanish." And I had actually interacted with farmworkers in California to a limited extent and also at the prospect. So, I'm like, "yeah, that sounds great." So, eight years ago, I left the Community Health Center and joined the faculty at UNC and then was subcontracted to the state to be the medical director for the farmworker health program. And I think that's been really, really wonderful because I not only get to continue to care for Latino patients, but I also get to bring learners with me. So, med students and residents and. I developed more of an understanding of the occupational hazards of agricultural medicine so that I can teach people about that. So, it's been a really good transition for me and I've enjoyed it very, very much.
Sophie Therber [00:07:29] That's really incredible. Wow. I'm kind of interested in what you were saying about how what you really wanted to do was just kind of take care of poor people. And your original thought might have been that you were going to do that in Africa. But then over time, I like what you said about having Red Cross culture, having cross cultural experiences right here in North Carolina. That's really interesting. So when you you said that you were not expecting to have a lot of Latino immigrants when you started in about 1989, were you witnessing, like, just changing demographics or were you just kind of surprised about how many Latino immigrants there were? What was that like?
Gayle Thomas [00:08:08] No, it was definitely changing demographics. And there were tensions in our clinic. Well, when you're working at a federally qualified community health center and you're providing care to uninsured and underinsured people, you always have more patients than you can handle. At one point, we had a waiting list of 800 patients wanting to become members at our clinic. Well, it doesn't make sense to keep infecting new patients if you can't take care of them. So, like, if it's six weeks until my next available appointment, then I'm not available. So we were trying to limit our patient panel so that we could actually provide good care. But that meant we weren't able to take everybody who wanted to be our patients. And so the people who are traditionally our patients, the low-income Black and White members of our community, appropriately, were resentful about being kind of pushed out by these new Spanish speaking patients that were coming in greater and greater numbers. So while I was really excited to provide medicine, medical care in Spanish and to improve my Spanish, I also saw with, you know, with some sadness how that pushed other people out and limited their access to care just because there isn't enough there's never enough care in our country for poor and uninsured patients. And the North Carolina legislature's decision to limit Medicaid has only made that worse.
Sophie Therber [00:09:47] So when you said earlier that you were kind of a magnet for Spanish speaking patients, do you think that that was because you were one of the only people who spoke Spanish? Or do you think that there was something else that drew the kind of connected you with that community?
Gayle Thomas [00:09:59] Well, I'd like to think that I was able to express my interest in them and my concern for them and that they appreciated that. But I think also I was the only Spanish speaking provider, and I didn't speak very good Spanish at the beginning. So, they were very patient with me. They taught me a lot. After I got to go to Guatemala for that month of immersion, I did a lot better and my Spanish just continued to improve. But really, it was my patients that taught me a lot about the language, but also about their own cultural beliefs, health care beliefs.
Sophie Therber [00:10:44] And how would you say that your job has changed since you started that kind of work, versus the way that it is today or even the way that it was in recent years before the pandemic?
Gayle Thomas [00:10:56] I'll say...Rephrase that question again, I'm not sure what you're asking.
Sophie Therber [00:10:59] I'm just wondering, I mean, over time, how has just the nature of your work I mean, you were talking about how there have been changing demographics, but what are some other ways that just what you've done with Family Medicine or with the Department of Health and Human Services, just other places? How has that changed over the past since nineteen eighty nine when you started working?
Gayle Thomas [00:11:17] Hmm. There's so many changes that it's hard to hard to say. But when I started at the Community Health Center, I think the copay for somebody who was on the sliding scale fee and went all the way down with ten dollars that copay. Now it's 25 dollars. I certainly had a greater diversity of patients in terms of Black, white, and Latino. I would say now it's almost all Latino, or [it was] when I left, although we also were getting some new immigrants like Karen refugees. So, yeah, a big influx of Karen refugees who we all tried to get kind of up to speed with. Not that we can learn the language that quickly, but understand that population and what some of their unique health beliefs and health care needs were when I changed to the faculty, my life changed dramatically from just being a doctor in a clinic for low income people to being a teacher and needing to learn to give lectures and needing to learn to supervise learners and teach residents and medical students. I had been doing some of that at the center, but doing it much more full time. And then my job at the North Carolina community and the North Carolina Farmworker Health Program is very administrative. And so there's a lot of policies and procedures and official site visits and medical continuous quality improvement things that I need to do that I didn't do at the county health center. So it's been a big learning curve the last eight years, but I've really enjoyed it.
Sophie Therber [00:13:05] I'm interested in what you were saying earlier about how North Carolina health policy, like increasing the copay and decreasing access to Medicare, really impacted the places where you were working. So I'm kind of wondering, how do you see kind of the relationship between the on-the-ground community centers like family health or other places that you worked and these more broad just state legislation? What is that relationship like when these different...these changes come from the state level down to where you are working?
Gayle Thomas [00:13:37] Well, it's actually Medicaid that they limited access to.
Sophie Therber Oh, excuse me.
Gayle Thomas [00:13:42] So when Obama enrolled, or, tried to make Medicaid more available to more people, there were certain states that decided not to take that federal funding to increase access to Medicaid. So, what's really frustrating is that I would have patients who-- they go to the marketplace to try to enroll in subsidized health care from the government. And they're told you don't make enough money to get subsidies from the federal government, which is completely not intuitive. It's like the poorer you are, the more you should get subsidized. But the way this was set up is that people at that income level were supposed to get Medicaid. Well, there is no Medicaid for them, so they just fund this huge chasm between Medicaid and federally subsidized health care. So, it is very painful. It's very painful as a doctor to tell people, yeah, there's nothing for you. You're just going to have to get what care you can at our overly populated community health center, and if you need specialty care, we will try to help you apply to UNC’s Charity Care program. So that's one of the reasons, I think, that I was able to feel good about taking care of my uninsured patients, is that when I needed somebody, a specialist for one of my patients, more often than not, I was able to get it at UNC. So as a primary care provider, I can't do everything for everybody. I can't operate on their brain tumor. I can't do their dialysis. I need my specialty colleagues. And most of the time at UNC, I was able to get them access to the care that they needed, not all with, also, a very imperfect and over-subscribed program. So, when you have patients who can't get the care they need, it's very painful as a provider to watch that.
Sophie Therber [00:15:55] And that's something I could imagine would be kind of compounded by people who might be new to the United States and not necessarily have the proper documentation for insurance or access to these federal programs. Was that something that you experienced, just kind of that whole chasm, as you were saying, being made even more complicated by that?
Gayle Thomas [00:16:15] Definitely. Definitely. We...We took care of a lot of patients who were undocumented and did not have access, would not have had access to Medicaid even if the state legislature had decided to expand access and, fortunately, UNC Charity Care did not make themselves unavailable. They kind of took the reverse. So right now, to apply for Charity Care at UNC, you can't have a legal visa. So, if you have a visa to come to the United States, as about 20,000 of our farmworkers do, they're here on an agricultural guest worker visa. They tend to come in March and April and go back in November every year. Well, if they need dialysis or if they need surgery, they do not qualify for Charity Care because their visa implies that they will be here and take care of themselves and not burden our country. So now I kind of have the reverse problem of it's better to be undocumented if you need specialty care at UNC.
Sophie Therber [00:17:30] That's really interesting that it's just these different levels with having less access to some things, given having some levels of documentation. I'd like to switch gears for a second and just ask you about, have you experienced any natural disasters when you've had any of these positions, particularly with working with farmworkers or any kind of immigrants to North Carolina?
Gayle Thomas [00:17:54] Yeah, in the eight years that I've been the medical director, we've had a number of hurricanes that have impacted farmworkers. And we had farmworkers at one point call 911 because their camp, they live in work camps in large groups, and their work camp was being flooded and 911 was preparing a white-water rescue for them. But then, the owner of the farm called 911 and said, "they're fine, you don't need to go." And the 911 operators listen to the owner instead of listening to the farmworkers who probably, because of language, weren't able to advocate for themselves as well as they would have liked. So, they start calling our Spanish-speaking outreach workers. And finally, the outreach workers were able to get someone to go rescue them. But, yeah, there's all kinds of difficulties when farmworkers, first of all, if they're out of work, even if their camp is not being flooded, that they just can't work, they don't work, they don't get paid; they don't get paid, they can't eat, they don't have their own transportation. They're reliant on their employer for transportation. They have access to some public service announcements through Spanish radio and Spanish media. But if they lose power, then their cell phones are going to die and they're not going to have access to those announcements and that very important public service information that helps us all kind of navigate when we're in the middle of a disaster.
Sophie Therber [00:19:36] Yeah, that's really heartbreaking that they weren't able to get the help that they needed. I mean, I'm glad that they were able to call your Spanish speaking hotline for that kind of thing. But that's just really heartbreaking that it happened that way. So how do you your role changed when there are these natural disasters, when you're working with people who are affected by those natural disasters? How does your role and your day-to-day work change? How is it impacted by that?
Gayle Thomas [00:20:02] Well, I mean, COVID impacted all of us in health care in huge, huge ways. I've never experienced anything like I've experienced this last year and a half with COVID; my life just got turned upside down. Our program, which previously was really just caring for about ten thousand farmworkers across the state, was tapped by the state DHHS, understandably, to step up and try to care for all the farmworkers in the state, all 100,000 of them. And without prior experience, I mean, none of us had ever been in a pandemic before. Farmworkers did not do well in this pandemic because they live in large work camps. So, when one person got COVID, they all got COVID. We had camps where 90 percent of people tested positive for COVID. Fortunately, not all of them got seriously ill, but some of them did and some of them died. They go to and from work in a school bus. And so, they're all being transported together. So, the whole idea of staying home and limiting your contact with other people is just not possible for farmworkers. So that was incredibly frustrating to try to respond to COVID when there just aren't other alternatives for living and transportation. So, masks, hand sanitizer, all that's good, but it's not adequate. And then the hardest thing was...when a group of people are exposed to COVID, the ideal thing is everybody goes into quarantine separately. But you can't do that when you've got a bunch of people living together. And so, yeah, you separate the people who are sick, who have come in from the people who aren't who are just exposed. But then the next person comes down with COVID in the exposed group, and then the next person, and then the next person. And you just keep re-exposing people. And the infection just rolls through the camp and it's so frustrating to feel so helpless in trying to respond to COVID in these situations. This year is different. We have vaccines and we are seeing smaller outbreaks. We have had a farmworker already died this year and we have several in the hospital. But it's not on the scale of last year, so we're vaccinating just as fast as we can, [00:22:48] as soon as we can, when people get here from other states or from Mexico. Some farmworkers will move to North Carolina, from Florida, where they've worked in the winter, and now they're going to work here and other...and some of them may have gotten vaccinated in Florida, others not. But then a lot of them are still coming up from Mexico on these guest worker visas. So, trying to find them and vaccinate them as soon as we can is our approach this year. So, it feels better, feels like we actually have a tool that works. But a 40-hour bus ride from Mexico, when you're sitting next to somebody who's asymptomatically or early asymptomatically infected with COVID, you're going to get it. And the vaccine we get you when you arrive is not going to be soon enough. So, we're still seeing people with COVID, but it's not spreading this fast in the camps because more people are vaccinated.
Sophie Therber [00:23:48] Yeah, I think so much has changed, I mean, just thinking back to the early days of the pandemic, so in February, March 2020 versus now when we do have access to the vaccines, how kind of if you had to identify a few of the biggest problems, I mean, there's a lot, right? You were talking about crowded transportation, not being able to isolate separately, and things like that. So how have the challenges changed from the early days of the pandemic, before we kind of had an understanding of what was going, on versus the kind of middle of things, not necessarily the middle, but later on when things were kind of getting worse, and now when we do have access to vaccines? How have the different challenges evolved in that time?
Gayle Thomas [00:24:34] I think the earliest challenge was, of course, knowledge we didn't know. Could you get this from surfaces? How close did you have to be to somebody to get it for how long? You know, who was going to get really sick and who is going to be asymptomatically infected? And how many people were asymptomatically infected? You mean, we just didn't know that. And so that made it a whole lot scarier. And the lack of PPE…My program relies heavily on outreach workers. As a physician, I am not as important as the outreach workers. So the outreach workers are people who often are bilingual, bicultural, come from the community and are the bridge between the patient and me, the medical provider. If I just sit in my clinic, I'll never see farmworkers because they can't get to me without an outreach worker. So, our outreach workers are our unsung heroes who go out to the camps to get to know the workers who earn their trust and provide them in non-COVID times with transportation, financial assistance, food assistance and go rescue them when they get stuck in a flooded work camp and 911 won't come. So, they are like, amazing. But at the beginning we didn't have PPE for them. You know, the PPE was, appropriately, going first to the people who are working in the COVID hot zones: the people in the ICUs, people in the ERS who were exposed to known COVID patients. And so, our outreach workers were stuck at home trying to take care of farmworkers over the phone and obviously not feeling comfortable transporting them. And so that was really, really hard this year. Now that outreach workers have the opportunity to be vaccinated, there's plenty of masks to go around, we have a better understanding that surfaces are not as important in transmitting the infection. Now, the outreach workers can actually go out to the camps and see the guys and bring them food. And last year, all they could do basically were porch drops, which they did. But now they can actually interact with the guys. And when everybody's masked, they can put them in a vehicle and take them to appointments and things like that. So, I think the stress now is, first of all, everybody's tired, we're all exhausted. Everybody has been working at, I don't know, one hundred and fifty percent capacity for the last year and a half. And we've been vaccinating as fast as we can. And there's still guys that want vaccines that haven't had access to them. So, I think that stress now, it's just that everybody's tired. And farmworkers, one of the reasons there are marginalized population is they don't get paid time off from work. So, if you want to take care of farmworkers, you have to do it after work hours. Well, they work from sunup to sundown, so that means you're working late at night. So our outreach workers will often go out to the camps starting around seven, 8:00 in the evening. They're there till 10:00, 11:00 when the farmworkers have to go to bed because they have to get up again at four thirty five in the morning. And as a provider, that's when they take me out is late in the evenings. And one other time that farmworkers are available for vaccinations are maybe Saturday afternoon, evening and Sundays. So that's the stress now is how do you find vaccine providers who are willing to go late evenings and weekends? That's not when medical providers tend to want to work. We want our weekends off, too, but that's the only time farmworkers are available, so getting the vaccine to them at times when they're available is the challenge right now. I think the other challenge that we've been having all along is getting testing to them became very clear early on that a test that takes eight days to come back, that means nothing when you're living with 50 guys. I mean, after eight days, everybody is already infected. Now, we have tests that turn around a little bit faster. So, PCR tests that can turn around in 24 to 48 hours, that's better. It's still not good enough. And now we have rapid antigen tests that can come back in 15 minutes. But they're not 100% sensitive or 100% specific, meaning that you can have false positives and false negatives. So, getting testing out to people in rural areas, in labor camps at the end of gravel roads is hard. One of the things that we're trying to do right now is to buy these at-home test kits and to give them to the farmworkers so that they can test if and when they feel like they need it, because their access to testing is so, so poor. And given that we are seeing some breakthrough infections, people who are fully vaccinated that are getting infected, I don't think testing is over. We need vaccines, but we also need testing. That's one of our challenges right now, is getting these at home test kits to farmworkers so they can test if they get symptoms.
Sophie Therber [00:30:13] And can you walk me through...How are you distributing those at home test kits to the farmers? I mean, you were saying it's difficult -- rural North Carolina gravel roads -- but for you or the outreach workers or whoever is doing that, how does that work? How do you end up being able to do that?
Gayle Thomas [00:30:30] Well, it's the outreach workers. So, you know, my program has gotten some funds from the federal government for testing and COVID response. And so we're using those funds to buy these at home test kits and we're giving them to the outreach workers. And we're saying, here, take this with you. When you go to the camp to visit the workers, talk to them about how important it is. Obviously, we have lots of masks, too, now. So, we send out masks and hand sanitizers and, now, these test kits. And let me help you get your vaccine, but even after you get your vaccine, let me help you with this test kit if you want it. So, the outreach workers are taking them. We also are encountering workers in Wal-Mart parking lots. For the last, I guess, four or five months, we've been going to the Wal-Mart parking lot at Rocky Mount and having a health fair there where farmworkers go on Sundays to buy their groceries. We're trying to put ourselves where they are. And also we've gone to some Mexican tiendas or little shops where they tend to go on the weekends as well and handing out those test kits and that PPE and health information and stuff like that there.
Sophie Therber [00:31:46] It's so interesting because there's so much nuance in the way that the COVID response has gone. I mean, especially just because of this time frame of just not really knowing what was going on, and then being overwhelmed, and now having different challenges with distribution of vaccines and testing, like you were saying. And I'm wondering, how does the way that you and your coworkers responded to the -- ah, excuse me -- are continuing to respond to the COVID pandemic, compare to ways that you've responded to extreme weather or flooding or other natural disaster events in the past?
Gayle Thomas [00:32:21] I think that because this has gone on for so long and it's been so universal, it's not just those five counties that are flooded over there, it's all of North Carolina, it's all of the United States, it's all of the world. One thing that's happened, fortunately, this time is that we have been able to make alliances and collaborations with people that we didn't before. And those have been really, really important. So we've been able to collaborate with more of our colleagues within DHHS. We've been able to collaborate with colleagues in the agricultural extension program, in Department of Commerce, in Migrant Head Start and migrant education. So some of these programs that we always knew about each other. Right. But we didn't know each other individually and we didn't try to work together. That has made a huge difference. So, for example, early in the pandemic, we wanted to send masks to farmworkers and we were able to do that with state purchase masks and we were able to deliver thousands of them to the ag extension workers. So every one of the hundred counties in North Carolina have ag extension workers who are focused mostly, mainly on the growers, not on the farmworkers. And so, they have been kind of in a parallel universe to us. And all of a sudden we were able to ask them to help deliver these masks to the farms, which [00:34:08] was huge, was huge. We just don't have as many outreach workers as we need. We don't have outreach workers in all counties, but we did have ag extension agents in all counties. And then in terms of trying to organize the vaccine distribution, we're able to use the AG extension agents again and form some committees of the outreach workers, the ag extension agent and then the vaccine providers. So, the clinics, the health departments, people who are providing the vaccine and trying to help them work together in a collaborative way to meet the needs in their county, because they're the ones that know where the groups of farmworkers are. And then the ag extension agent is able to call the grower because they know the grower and then they're able to help that grower link to a vaccine provider. So that been different and that's been really, really rewarding and very successful.
Sophie Therber [00:35:06] So, do a lot of these partnerships kind of happen on a county-to county-basis? You're working with people who now have more specific contacts about different counties in North Carolina?
Gayle Thomas [00:35:24] Well, they didn't know each other until we introduced them. OK, so this was a sort of a strategy that the team that I work with came up with. Specifically, the state epidemiologist that was assigned to work with us, came up with this idea of forming these local committees. And so, we got these name and numbers and email addresses and we called these people and got them together and held meetings still are holding meetings to try to help them collaborate. So, these were partnerships that were conceived of on the state level and are being enacted on the local county level.
Sophie Therber [00:36:08] Okay, so what is the relationship between the state level planning and the county level plan planning for these kinds of partnerships?
Gayle Thomas [00:36:17] Well, the state level planning came up with the idea of forming these local vaccine teams by county and then pulled the teams together. And now the teams are taking it themselves and many of them are meeting weekly or every other week to talk about, okay, this grower is getting these workers this week who can provide vaccines. Have you called them? Have you talked to them? Has the outreach worker been out there to talk to the workers to make sure their questions have been answered? Has the ag extension agent called the grower to make sure they understand what's going on? So that's kind of how it works.
Sophie Therber [00:37:00] There are a lot of just a lot of different levels of things to consider, because there are so many issues that have come about because of the pandemic and so many specific steps to solve those issues. Like you were saying, like people cold calling people and talking about just what needs to be done. So, can you tell me a little bit more about how you how can you prioritize when there are so many different what needs to be things that need to be done because of the pandemic? How do you decide what to reach out to other people about?
Gayle Thomas [00:37:31] That's a hard call. I mean. You know, it's very overwhelming and there were certainly many times in the past year and a half when my colleagues and I because I'm not alone, I work with a wonderful team of colleagues in Raleigh in the North Carolina Farmworker Health Program. And when we would just feel overwhelmed and I would just have we just have to say, let's just do the next thing. Let's just do the next right thing. We can't do everything, but we're just going to do the next right thing. So, I mean, we tried to prioritize based on what we knew about the disease and what would be most effective and also what we hear from our outreach workers. So, unlike some state organizations, that might be a little detached from what's going on in the ground. We met with our outreach workers every week during the worst part of the pandemic to hear from them. What's going on in your site? What do you need? What you hear? What are the farmworkers saying to you? So, I think listening to the people that we were trying to serve also is very, very important in terms of how you prioritize what you're going to do next.
Sophie Therber [00:38:47] And do you think that in the future, after I mean, the hope is that the pandemic will eventually subside, and we can kind of be moving back to what we used to consider normal and everything. Do you think that any of the practices that you've adopted now because of the pandemic you and your coworkers have adopted now, do you think you'll keep any of those or do you think that that's just kind of a shorter term solution to just a specific issue with the pandemic?
Gayle Thomas [00:39:14] No, we really would like to see these local teams maybe coalesce into regional teams and to continue to bridge this gap between the grower and the farmworker by using these regional teams to do disaster preparedness. So we recognize that these teams have formed in response to the disaster, but we would like to see them continue and be earthquake preparedness teams so that when the next --or, hurricane more likely, preparedness teams -- I'm sorry, back to California where we had earthquakes all the time. Here, we don't have them very often! But, you know, so when the next big hurricane happens and then is expected and flooding is expected, then these teams will already know each other and be able to work more effectively together to get farmworkers to safety, to get farmworkers the food and water they need when they can't drink the water or they don't have electricity or they don't have works, they don't have food, all those kinds of things.
Sophie Therber [00:40:26] So I think it's really interesting.... the importance of collaboration and I mean, you were saying that that's something that you just kind of started because of the pandemic. There was a need to coordinate responses. And that need is definitely going to continue because of the future disasters that will be faced. So can you tell me anything else about how your day-to-day or things that you're doing have changed because of the presence of these other actors, these people who are collaborating? Like, for instance, are you finding yourself kind of taking on more work to coordinate between people? Or do you feel like you've noticed new issues because the new things might be coming to your attention because there are new actors in your job now? What do you think?
Gayle Thomas [00:41:12] Oh, I definitely think there's more work. Yeah, there's always more work. I am not doing all the work myself. Obviously I have this wonderful team that I work with and our collaborators. But, yeah, it takes time to to bring these teams together and to keep them going and to check in with them and to make sure that things aren't just sort of petering out because this was all added stuff. This is all stuff on top of what people are already doing. Right. And they're exhausted and tired, too. And then our vaccinators, you know, they're running around the middle of the night vaccinating people in fields. You know, that gets tiring, too, because then they have to back in their clinic the next day seeing patients and doing their normal stuff. So, this is all on top of what people are already doing. So, it's always more work, I think. You know, I spend my life on Zoom a lot of times right now because we're doing all these local team meetings on Zoom, my wonderful teammates in Raleigh. We're not working in the Office of Rural Health together anymore. We're all meeting on Zoom. So, "Zoom fatigue," or "Teams fatigue" since we have to use Teams, is very real and we're all very, very tired. But the other thing that's opened up is how, how much you can do [dog barks] in a telemedicine call -- Hold on, let me get my dog.
Sophie Therber No worries.
[Brief pause as Gayle lets out her dog]
Gayle Thomas [00:42:55] We developed, for the first time, telemedicine; so, we had we have mobile clinics that we take out to the labor camps and we do primary care. And early in the pandemic, we suspended those because of the lack of PPE and stuff. But now we're back doing those. But we are continuing to do telemedicine. A lot of our workers do have smart phones. They often don't have the Internet. That's one thing we've been trying to get them in the pandemic is to get more Internet to the labor camp. And then then we can talk on the phone and and we can refill their blood pressure medicine and refill their diabetes medicine and do a certain amount of health care on the phone, which is really, really useful for people who are in rural areas. So I hope that's another thing that we're able to continue once the pandemic is over, because I think that's meeting a need that is going to continue.
Sophie Therber [00:44:01] What support do you think that would be most helpful for you to be addressing farmworker health throughout the pandemic and with natural disasters? I know in an ideal world we wouldn't even have those in the first place. But just ideally, if if there were more resources available to you and your coworkers and the farmworker health program, what supports would be helpful?
Gayle Thomas [00:44:24] I think the most important thing we need is more outreach workers. So, as I said before, not every county in every county in North Carolina has farmworkers. Some have many more than some have many less. But not every county has outreach workers. And as I said before, you know, a health care provider like myself without an average worker, we're just not going to be effective in terms of reaching farmworkers. So, I right now, most outreach workers are paid for by federal funds that come through a person. And so that's on a federal level. So I think expanding the number of outreach workers would be the most important thing.
Sophie Therber [00:45:10] And what with expanding our outreach workers, are those....How do you recruit outreach workers or people? Do they come from the state or are they just people who live locally? I mean, where do these people come from?
Gayle Thomas [00:45:24] That's a really good question. No, they come locally. That's their connection to the community. That gives them their super magic powers, because people they look like them. They talk like them. They maybe already are known by them. And so they have entrance into a community where I, a white lady with the Spanish that's spoken with an American accent, I might not. So... But if I go with them to a community, then all of a sudden I have credibility that I wouldn't have had otherwise because the outreach worker has done that. [00:46:08]So they come -- North Carolina is part of their response to the pandemic as a whole, really stood up a big community health care community health worker program, which and that's basically outreach workers for people other than farm. So, in my program, we call them outreach workers. These are people who are not they're not licensed as a nurse or a doctor, but they have this knowledge of the community, and they are this bridge of care. North Carolina started up a big community health worker program to reach other marginalized communities besides farmworkers. And a lot of them did the contact tracing and testing that we saw earlier in the pandemic. That has become less important now because more people are vaccinated, but as cases take back up, might become more important again. And so, we have been finding those community health workers that are bilingual, English, Spanish, and trying to sort of enfold them and recruit them to the farmworker health program. So, yeah, we find them in the community.
Sophie Therber [00:47:30] Throughout, the numbers of these outreach workers, how did that change during the pandemic? I mean, I know that we heard so much just about shortages of health care workers and things like that. Do you feel that you had kind of a sustainable amount of outreach workers, or do you feel like there was room for improvement there?
Gayle Thomas [00:47:51] Well, we've never had enough, so that didn't change. But I was really pleased that we were able to support our outreach workers and keep them in their position. It's a burnout position. They are on the front lines there. They are talking to people who don't have enough food, who don't have access to health care, who are working in dangerous occupations, who are dying of COVID. It's a burnout position. And so, they need a lot of support, both technical support, medical support, but also emotional support. And I feel like we were able to hire a COVID response team and that team was able to then, as I said before, meet weekly with outreach workers just to kind of keep a finger on the pulse of what's going on the ground, how are things changing, but also how are you doing and what can we do to help and support you? So we were able to maintain our workforce and in and increase it with some of the federal emergency funds that we got. We were able to hire some more outreach workers. So never enough. Never enough, but increased that net staff some.
Sophie Therber [00:49:14] Great. Well, thank you so much. I'd just like to add, is there anything else you would like to add or anything else that you'd like just to talk about before I stop the recording?
Gayle Thomas [00:49:23] Well, I just would love people to know that farmworkers are currently exempt from many workplace protections that most of the rest of us have. And that was written into law back in the 1920s when a lot of workplace reforms were made and it was written into law that they were exempt from overtime pay, that they were exempt from disability and lots of different things, because at that time the southern states did not want those workplace rights to be extended to their sharecroppers who were formerly enslaved African-Americans. And so they made sure that those things were exempted. So, it's called agricultural exceptionalism. And it basically sets up a very oppressive and dangerous workplace for farmworkers. And most of us have no idea that that's going on. No idea that child labor is fine on the farm. You can't work at McDonald's, but you can go work in a very dangerous place on the farm and die of heat exhaustion or heat stroke. And that workplace exceptionalism has to stop that. That exploitation has to stop.
Sophie Therber [00:50:49] Wow, did you say the 1920s? Yeah, wow, that's amazing. I mean, that's just that's been around for so long and I mean, wow, I didn't realize that it had been not updated in that much time. That's really...I'm really...thank you so much for sharing that because that's definitely important to know about and that's something that...wow.
Gayle Thomas [00:51:10] And that's one of the reasons they're so vulnerable to COVID, is that they don't have any of these protections that the rest of us take for granted. And I was going to say we're able to get away with it right now because our workforce is primarily undocumented or documented immigrants and they don't feel most of them, they don't feel empowered to speak up and protest.
Sophie Therber [00:51:40] And when you are working with your addressing COVID or you're addressing other disasters in these workplaces that are just, like you said, very dangerous and based off of exploitation, what kind of challenges do you run into that are kind of unique to that kind of workplace and that kind of situation?
Gayle Thomas [00:51:59] Well, for one, we get chased off by growers where they're providing free health care to their workers late at night and they object and they feel like they should be able to control access to their workers and that only people that they allow to come see their workers should be able to come see their workers. So that's one thing that we experience. We experience growers who are like, "no, I don't I don't want my workers to be vaccinated. I don't believe that the vaccine is needed. They're fine." Or, "I don't think my workers need to be rescued from floodwaters." So we just the...And not all growers are like that. Some are very, very concerned about their workers. But the ones that are like that, it's very discouraging. And they often, because of the way the laws are written, they are able to get away with that.
Sophie Therber [00:53:00] That's really interesting and upsetting that the growers have so much kind of control over the well-being of the people that are working there, and that's I mean, really unfortunate that that's an issue that you are running into and your work and other people who are doing similar work. All right, well, thank you so much for your time. I just, I would like to ask again if there's anything you'd like to add.
Gayle Thomas [00:53:23] No, no, that's okay.
Sophie Therber [00:53:26] Thank you. I'm going to go ahead and stop the recording but thank you so much.
End of interview. [00:53:32]
