Santiago Garza Martinez, now 47, was a young man when he started working for Anne Amie Vineyards in Oregon’s Willamette Valley in 1999. He began as an equipment operator, and today, 21 years later, he’s the field manager, overseeing a crew of 38 vineyard workers, all but eight of whom are seasonal employees. They weed, plant vines, and pick Pinot Noir grapes for Anne Amie’s acclaimed bottles. And like many seasonal farmworkers, their access to health care is precarious at best.

“The majority of the farmworkers in my crew don’t have primary care physicians,” Garza Martinez says. Even if they did, paying for the care would be a challenge for many of them. There are 2.5 to 3 million farmworkers in the United States, and many lack access to health insurance, according to Silvia Partida, CEO of the Texas-based National Center for Farmworker Health

Since May 7, ¡Salud! has screened 400 farmworkers for Covid-19.

So when America’s first coronavirus cases were reported in January in Seattle, just four hours north of the vineyard, the need to protect the Anne Amie workers was immediately apparent. That’s where ¡Salud! came in. Founded in 1991 by two physicians who loved wine, ¡Salud! is a nonprofit health care service that runs mobile clinics in Oregon vineyards. It is supported by the state’s wine industry, which throws an annual fall gala where winemakers auction off special cases and experiences. (There’s also an online summertime auction — this year’s takes place this week July 14-16.) Last year’s two auctions brought in $1 million. Over the past 29 years, ¡Salud! has raised over $17.2 million. 

“¡Salud! is basically my crew’s primary care for wellness checks, referrals, follow-ups for any conditions they might discover in their health screenings,” says Garza Martinez. 

Over the past several months, it has also become a lifeline amid a national health crisis. Since May 7, ¡Salud! has screened 400 farmworkers for Covid-19, with roughly four percent testing positive. (Only two have been hospitalized thus far and both are recovering at home.) Leda Garside, chief nurse at ¡Salud!, estimates that roughly 70 percent of the vineyard workers she sees do not have any other healthcare.

A health care worker waits by the ¡Salud! van.

Garza Martinez himself, even though he has been on Anne Amie’s health insurance plan since 2008, has relied on ¡Salud! over the years for everything from basic physicals to vaccines. Recently, he’s availed himself of a flu vaccine, a tetanus shot and a Covid-19 nasal swab test, which he says was like having a pipe cleaner shoved up his nose until it hit the back of his tongue. “I cried!” he says, laughing at it now. (He tested negative.)

¡Salud! was excellent at educating farmworkers about Covid-19, says Garza Martinez. Not only did it send Spanish-language email and text updates from the CDC and the Oregon Health Authority on the importance of social distancing and wearing masks, it provided masks to farmworkers starting at the end of February.

In the beginning, when masks were in short supply, Garside sent out an information sheet from the CDC on how to make cloth masks. But before long, Garside’s friend, a retired nurse named Maria Michalczyk, launched the Pandemic Volunteer Mask Makers of Oregon, a group of over 500 volunteers from across the state who sewed masks for vineyard workers, donating a bunch to ¡Salud! In late April, when Governor Kate Brown received a donation of N-95 masks from China’s Fujian Province, ¡Salud! alerted field managers at all the wineries, and Garza Martinez retrieved boxes of them for his crew at Anne Amie.

“¡Salud! is really the soul of the Willamette Valley,” says Cooper Mountain Vineyard co-owner Barbara Gross, whose parents were founding members of the organization.

Leda Garside, chief nurse at ¡Salud!, estimates that roughly 70 percent of the vineyard workers she sees do not have any other healthcare.

Gross was impressed by how early ¡Salud! began testing for Covid-19 — in late March and early April, a time when many states were still struggling to implement comprehensive testing infrastructure. “I think my crew had access to testing before you, as a regular consumer, had access,” she says. “Leda and her crew proactively got out there and tested. That was 100 percent ¡Salud!”

“It's really hard work”

Farmworkers regularly do back-breaking labor, often in harsh weather conditions. They’re out in the fields every day, picking berries, kale, asparagus and citrus — or pruning, thinning, training vines and weeding. When the Covid-19 crisis hit in mid-March, it disproportionately impacted Latinos, who comprise 72 percent of farmworkers in the U.S.

“It’s really hard work,” says Garside. “You’re exposed to the elements: cold, wind, rain — you name it.” Luckily, because most Willamette Valley vineyards farm organically or biodynamically, pesticide exposure is not a big factor. But laboring in the fields for years on end can cause health issues that accumulate over time. “And we do have workers who are in their seventies and eighties!” Garside says. A network of 174 federally funded community health centers across the country serves farmworkers, but these clinics only reach one million farmworkers and their family members, says Partida, from the National Center for Farmworker Health, leaving a big gap.

¡Salud! aims to fill that gap — at least in Oregon’s vineyards — providing healthcare to vineyard workers year-round. Spring through fall is the organization’s busiest season.

Before the pandemic, many medical procedures were conducted in the ¡Salud! van. Now, more often, they happen in the field.

“This time of year, we’re out in the vineyards every week, three to four times a week,” Garside says.

Garside, who has been working for ¡Salud! for 23 years, is its beating heart. Raptor Ridge Winery proprietor Annie Shull fondly calls her “the good witch of the Valley.” 

Garside and her team of bilingual nurses roll into vineyards in a retrofitted Sprinter Van that contains a reception area and a full examination room. Before the pandemic, they would see a patient in the van, where they’d do blood pressure checks, basic bloodwork, vision exams and vaccinations. But now, due to strict Covid protocols, the nurses set up outdoor service stations separated by dividers to maintain privacy. (They can still do basic tests and health education in the vineyard, but for other medical tests, they’re steering farmworkers to their clinic at OHSU Hillsboro Medical Center.) 

In 2019, over 900 farmworkers received wellness exams via ¡Salud! and over 500 received flu shots. Some 68 workers received free vision exams via a partnership with Oregon Health Sciences University’s Casey Eye Institute and Pacific School of Optometry. And 114 received dental services through ¡Salud!’s partnership with local dental hygiene science programs, Medical Teams International and community health centers. Until recently, most of this dental work was done in the ¡Salud! van, but that’s also on hold during the pandemic. 

Several farmworkers have tested positive for diabetes or pre-diabetes and with diet and lifestyle changes recommended by ¡Salud! nurses, have been able to manage and even reverse the condition.

Since diabetes is so prevalent in the migrant seasonal farmworker community, a blood sugar test is always done as part of routine bloodwork. Results are immediate, which allows ¡Salud! nurses to give advice on how to make diet and lifestyle changes, even if the patient is just pre-diabetic. If blood sugar levels are very high, they make an immediate referral to a primary care doctor. Garza Martinez says several of his crew have tested positive for diabetes or pre-diabetes and with diet and lifestyle changes recommended by ¡Salud! nurses, have been able to manage and even reverse the condition.

The day I spoke to Garside, she had seen 25 farmworkers on the picturesque grounds of Stoller Family Estate in Dayton. She made a dental referral for a worker whose bridge work, done in his native Guatemala a decade ago, had broken. “So he is walking around with these little stubs from four teeth and it’s super uncomfortable,” Garside says. 

“There’s a lot of conscientiousness about the land and how to maintain it and treat it well. It’s the same philosophy with health care.”

She called a local community health clinic that could squeeze him in the following day. (¡Salud! provides a dental grant if the patient cannot afford even the lower price that the health clinic charges.) Another patient had extremely high blood pressure and Garside was able to connect with his primary care doctor, who ordered a prescription he could pick up the next day. 

“We are a safety net service,” Garside says. She is grateful to the Oregon winemaking community for coming up with the idea of delivering these vital healthcare services 29 years ago. “There’s a lot of conscientiousness about the land and how to maintain it and treat it well. It’s the same philosophy with health care,” she says. “We are very fortunate that the industry has proven itself — how to take care of the land and do something for the seasonal agricultural workers.”