As she does every Thursday in the summer, Elizabeth Jacinto steps off the bus into the afternoon sun and walks down Division Street to a farm stand set up in the shade of Oregon Health and Science University’s Richmond clinic. There she picks through turnips, fennel, green-tipped garlic and radish greens.
“Lovely to see you,” OHSU intern Jennifer Tsai says when she sees Jacinto. “How did it go last week? Did you eat it all?”
“Yes,” Jacinto says with a grin.
“Even the turnips?” Tsai asks.
Jacinto nods and smiles, then turns to greet Carla Remeschatis, a community health worker at Multnomah County’s Southeast Health Center, where Jacinto receives her primary care. As they talk, Remeschitis slips a fistful of bok choy leaves into Jacinto’s already-bursting bag. “I know your kids like these,” Remeschitis says.
Her kids like all of it, actually. Last week Jacinto grilled kale quesadillas and prepared posole with chopped radish and pureed spinach. “My daughters loved it,” she says. “They didn’t even know it was spinach. It was so good.” This week she’ll learn to prepare fennel. She’s never cooked the root vegetable before, but she says she’s not concerned. “There’s a recipe here,” she waves the farmstand newsletter, which Remeschatis had slipped into her bag.
Other patients come by.
Yirbebu Addbie points with excitement to all the vegetables she didn’t have in her native Ethiopia. “I never used this in my country,” she says, pointing to a bushel of turnips. “This one I never used,” she says and shakes a kohlrabi leaf. “Or this, or this,” she says as she moves down the table. “I don’t even know their names.”
Tonya “Queenie” Bradshaw comes with her 12-year-old sheltie Poppie. “It’s a fabulous program,” she says after focusing lengthy hellos and hugs on county staff. She stays long after filling her bag, just to recap the week.
Across town, clients at the North Portland Health Center, Mid County Health Center and La Clinica de Buena Salud also pick up weekly deliveries of vegetables, each patient paying $22 a month for the organic produce grown at area farms. The community supported agriculture — or CSA — Partnerships for Health program is subsidized with support from Zenger Farm, Providence Health & Services, Kaiser Permanente and its Healthy Eating Active Living program, the Oregon Health & Science University Knight Cancer Institute, Portland State University, Bob’s Red Mill, Wholesome Wave, Village Gardens, Portland Fruit Tree Project, and Active Children Portland. Now in its third year, the county-farm partnership serves more than 100 households at four county clinics. And it plans to expand the program.
“This is about health equity,” says Katy Pranian, a program coordinator for the county’s Integrated Clinical Services. “A lot of our patients live in areas where they can’t access fresh vegetables, let alone organic produce.”
That’s the thing that really gets Raeyven Thomas, a patient at the Southeast Health Center dental clinic and a participant in the CSA.
She recently stopped by a chain grocery store in an East Portland neighborhood to buy some grapes. “They didn’t have grapes. But there were bins and bins of potatoes,” she says. “Not even the little potatoes, but the Idaho potatoes. The worst kind.”
Her husband chimed in with a shake of his head, “Starches. Starches. Starches.”
So they drove to another store of the same chain in a wealthy neighborhood and found grapes and cherries, “Everything,” she says. “It makes you feel like you don’t matter. That you’re limited to eating unhealthy food.”
Compared to wealthier neighborhoods, low-income neighborhoods and communities of color have more convenience stores and fast-food restaurants, and fewer grocery stores with a smaller selection of produce, research has found. And for parents on a tight budget, the cost of introducing their children to new vegetables — foods they might reject eight to 15 times before their taste buds adjust — is prohibitive.
But why are health insurers and primary care clinics stepping in?
“What we’re recognizing is that much chronic disease is related to upstream issues, otherwise known as social determinants of health,” says Dr. Peter Mahr, a family physician at Multnomah County’s Southeast Health Center. “More and more, people are recognizing that the social environment, transportation, housing, and income inequality have much more impact on people’s health than what we do day-to-day at a primary care clinic.”
Low-income neighborhoods experience higher rates of obesity and chronic disease such as diabetes. But Mahr says programs such as the county CSA have a tangible impact for families who participate.
“There’s a health impact, the nutritional impact of that. That’s immense. It’s very low cost and they have very high quality food,” he says. “What we’ve also found is that there’s an impact on people's mental health. They feel more empowered, less depressed. And that has to do with social engagement.”
Nowhere is the social connection more evident than at Mid County Health Center, where the county launched its pilot CSA three years ago with 25 patients and support from the OHSU Knight Cancer Institute’s Community Partnership Program.
In the shade of a garden maintained by clinic staff, patient Mary Casey sat on a recent Tuesday with a full bag of vegetables and her emotional support cat, Cooper. She chatted with other patients who came by for their farm shares. Nearby, Fanny Rodriguez, a community health worker and site coordinator for the clinic’s CSA, fielded phone calls from patients scheduled to pick up their shares and coordinated alternative drop-offs for those who couldn’t make it.
She’s constantly interrupted, much to her delight, by patients who want to chat, hug or offer congratulations on her recent marriage. Sandra and Gerald Howe recently brought her a hand-made chrome and beaded wind chime as a wedding gift. Edith Arriaga-Flores brought her a card that read “Love is forever, day after beautiful day.”
“Sometimes you get so caught up in the daily caseload,” she says. “Then you get something like this and you realize they care.”
Patients at Multnomah County’s clinics say they have seen significant changes in their physical health too, after joining the CSA. In fact, one mother credited the organic whole foods with saving her son’s life.
Tiffany, who asked that her last name not be used, takes her kids to a primary care doctor at Mid County Health Center.
Tiffany was one of the first to sign up three years ago; her son Stryker was 5 years old at the time. He had already undergone brain and back surgeries to treat Ehlers-Danlos syndrome, a genetic disorder that kept his fragile skeleton from growing strong and caused debilitating pain. He was pushed in a wheelchair and fed through a tube.
The steady diet of commercial formulas, supplements and vitamins didn’t help him put on weight, and Tiffany had had enough. She wanted to try feeding him real food. The CSA — offering low-cost organic fresh vegetables — came at a perfect time, she says.
“It was the turning point,” she says. Within six months Stryker transitioned off his feeding tube. He began to devour smoothies blended with berries, watermelon, spinach and kale. Then he began to chew his food. Today he has his favorites: potatoes (with butter), pickling cucumbers, bok choy, and the black beans that Bob’s Red Mill donates to the program. “They make you fart,” he says with a grin.
After years of being underweight, Stryker has put on 14 pounds. He’s lanky now, with two big front teeth and a floppy mop of hair dyed neon orange. This is the first summer he’s been able to come with Tiffany to Mid County to pick up their farm share.
On a recent visit he grabs a cucumber from the share basket and chomps away while his mother fills her bag.
“Before we were chasing this problem, spending so much time in the medical community,” Tiffany says. “Now we’re living.”
Find Out More
Are you a patient at a Multnomah County clinic and interested in signing up for next year’s CSA program? Contact Katy Pranian at 503-988-9895 or email email@example.com
Zenger Farm accepts SNAP benefits and offers other low-cost CSA options. To find out more, check out their site or contact Lauren Lubowicki, CSA Partnerships for Health Program Manager, at firstname.lastname@example.org or call 503-282-4245 x102.