A toast to the health of Oregon wine workers

B.S. Nursing Science '83 Hometown: Cañas, Guanacaste, Costa Rica Fun Fact: Worked at UAA's sports complex while in school, opening the building every single morning for early bird athletes.

¡Salud!

For anyone who's traveled in South and Central America, the word conjures images of colonial watering holes and Latin hospitality. The Spanish word salud indicates a toast-akin to the familiar English phrase cheers-and literally means "health." ¡Salud! therefore, is the only name that fits for Leda Garside's organization- a mobile clinic marrying healthcare and wine production with a Spanish-speaking focus. It's a rare triple play on words and an equally unique public health program, focused on migrant workers and fully funded by the vineyard owners themselves.

In a world of rising costs and expanding paperwork, the American health care system can be daunting for even native English speakers. Imagine the confusion facing a Spanish-speaking migrant worker with low funds and no insurance. Faced with a fleet of obstacles, many migrant workers understandably skip the headache of health care completely and only seek treatment when preventable conditions reach a tipping point. This is where Leda and the team at ¡Salud! step in, rolling through the region's valleys and vineyards in a mobile clinic armed with options, access and support for the migrant community.

From the tropics to the tundra

Leda grew up in the small town of Cañas in northern Costa Rica. Her family worked in health care in the area, which shaped her career interests from an early age. She distinctly remembers the first public health nurse she ever met-an American Peace Corps volunteer stationed in the region. "She started talking about nursing and all the things the career could offer," Leda said. "The information she provided was very helpful when I moved to the U.S."

Leda started her life in the States with a move to Seattle, then headed farther north when her husband got a job with a marine transportation company in Alaska.

Although she had her sights set on nursing school, her first classes in Alaska were spent mastering English. "It was a challenge," she said. "I had a very good education in my native country and it really served me well ... it's one thing when you can speak and read and all of that, but its another thing when you have to write papers."

Once she felt confident in English, she switched to nursing classes at UAA. "I'm still very grateful that I received that opportunity. I think at one point I was the only Latina in the whole school back then," she said. "I had a wonderful group of friends that supported me through the whole process."

Her first job after UAA was across the street at Providence Hospital, where she had completed her senior rotations. She continued nursing in hospitals for the next 10 years as her husband's job took the couple across the West. Finally settling in Oregon, Leda was tapped to join ¡Salud! and she made the switch to public health, meeting the needs of a completely new population. It was an adjustment, she admits. "I didn't know much of community health, public health and definitely migrant health," she said, "[but] I'm glad I took that leap and it's been an amazing ride."

Public health meets pinot noir

¡Salud!, most recognizably, is a mobile clinic visiting vineyards across the wine-producing Willamette Valley of western Oregon. Based out of Hillsboro-a western Portland suburb-a two-hour drive is not uncommon for the ¡Salud! team. Wherever seasonal workers are plucking, trimming, clearing, pruning and planting vines, ¡Salud! will be there.

On an average day, Leda and her team will see 40 to 60 workers and their families, providing everything from dental and vision exams to vaccinations and x-rays. They also provide CPR and First Aid classes, prenatal care, housing assistance, childcare recommendations and food pantry directions. For a community without ready transportation, ¡Salud! is a lifeline reaching over 4,000 people each year.

The Willamette Valley, with its Mediterranean climate and fertile valley, is an ideal setting for growing grapes. Leda's nursing career is inextricably tied to the wine industry, and she readily sings the region's praises. "Oregon is becoming very competitive," she said. "There are amazing winemakers and an excellent growing area very similar to the most prestigious areas in France. It's the soil, the climate, everything makes it into a very unique wine-producing region."

The region's reputation attracts a steady stream of migrant workers, especially during harvest season from late May through September. Most workers and families disperse after the summer season, though, often landing their next gigs at the Christmas tree farms of America. "It's just a moving target," Leda admitted.

With such a large population, Leda and her team have a short time to deliver the most care in each location. Her native Spanish has helped her immensely, but her passion, awareness and professional training are far more valuable. "Just knowing the language is not enough," she said.

"The reality is a lot of migrant agricultural workers are undocumented. Many are here by themselves. Not being with families creates stress, not knowing if you're going to have a job tomorrow, knowing there are people left behind that are counting on you for their survival, that's stressful ... and that stress brings other health issues."

¡Salud! seeks to relieve that stress and prevent medical emergencies through free screenings, vaccinations and outreach. They currently see roughly 40 percent of the vineyards and workers in the growing wine region.

An amazing aspect of ¡Salud! is the complete financial support from the vineyards. The program developed in 1991 as a unique partnership between vineyard owners and the Tuality Healthcare Foundation, an independent non-profit hospital in Hillsboro. "It's one of the very few hospitals in the States that's an independent community-oriented hospital," Leda explained. "It's small, but it has a very strong sense of community."

That sense of community is clearly evidenced through ¡Salud! "The wine industry provides 100 percent of the funds. It's really an industry-driven program," she said. "They've taken ownership of their migrant workers and their health care needs. It's the only program nationwide that is entirely financed by the industry." The organization's main fund-raising event-an annual auction celebrating the pinot noirs of the region-has raised over $9 million over the years, funding over 7,400 free medical and dental encounters annually.

She calls the program "very unique, very Oregonian," citing the operation's personal touch and family focus. "People care for each other; they see a need and they see these workers as key to their success and they're taking ownership of that."

Leda has taken ownership of the program as well, referring to the organization as "kind of my child." Her dedication earned her a Distinguished Nurse of the Year award from the March of Dimes in 2012.

"It's been an amazing nursing career," she said. "I have received some awards that are very dear and close to my heart."

Migrant health care has its challenges-nursing skills, clinical skills and diagnostic skills are all used interchangeably-and UAA prepared her well. "You're really using every piece of education you received to really work with this population that has an incredible number of health needs," Leda said.

"I feel very proud of this program and that I used my education. I have to say I received an excellent education at UAA, no question whatsoever. I had amazing professors and they taught me well.

"It's been a great program," she said reflecting on her recent career. "I'm very proud of this, and my nursing education has served me well.

Visit the ¡Salud! website to learn more about the organization.

Written by J. Besl, UAA Office of University Advancement