County clinic offers oasis in food desert, model for future

July 17, 2015

Gabriel Franch-Costeles picks up a bulb of organically-grown garlic and drops it into his shopping bag. He maneuvers his walker under the shade of a farm stand awning, and selects a ripe zucchini, cucumbers, a cone-shaped caraflex cabbage and bunch of red kale.

He chooses a bag of fresh-picked Dragon Tongue beans and holds them up.

“I don’t recognize these,” he says in Spanish.

Community Health Worker Julio Maldonado and health promotion coordinator Sylvia Ness are spearheading an effort to bring more fresh food to clinic patients

Zenger Farm volunteer Fanny Rodriguez looks over and smiles. “They’re magic beans.”

Franch-Costeles laughs and puts the beans in his bag. A stalk of fennel follows.

“My wife knows this,” he says. “It’s great.”

“You can take three,’’ Rodriguez says.

“Oh great. OK,” he says.

Franch-Costeles is one of 30 participants in a pilot, supported by the Knight Cancer Institute’s Community Partnership Program, to provide locally-grown produce to Mid County Health Center clients. It’s a strategy to combat chronic illnesses among people whose access to fresh, healthy food is limited by geography or income.

Like many of the clients, he lives near the clinic.

“The doctor told me to eat more vegetables,” says Franch-Costeles, who suffered a back injury five years ago and has trouble getting around. The weekly trip to the farm stand erected each Tuesday in the Mid-County parking lot helps him control his weight, he says, patting his belly.

“Right now I’m eating more vegetables, because of this,’’ he says, pointing to the table piled with vegetables.

The partnership between Mid County and Zenger Farm began in the winter of 2014.

A group of Multnomah County Health Department employees wanted to increase clients’ access to fruits and vegetables at Mid County, a clinic that serves one of the most diverse communities in the state and doubles as the state’s refugee health clinic.

“This in an international health center, and food is a big issue,” says Community Health Worker Julio Maldonado, a member of the group. “I want the community to see our clinic as an asset, as a member of the community, where they can come to take Zumba, get veggies, see their provider or join a diabetes support group.”

Sylvia Ness, the health promotion coordinator for Multnomah County clinics, loved the idea.

“I keep hearing at a clinic level that we counsel people to eat healthy but they don’t have access to healthy food,” she says. “We advise them, but then what?”

Ness suggested they consider partnering with a farm to offer fresh produce to clients at the clinic.

Community Supported Agriculture, commonly called a CSA, refers to share of produce a resident receives when he supports an individual farm.

Often a person pays a hefty lump sum to the farm in spring, and gets anywhere from 20 to 30 weeks of produce in return. That makes the model unaffordable for many working families who can’t invest up front.

“The CSA model has tended to serve those who are better off,” says Bryan Allan, a criminal defense lawyer-turned farmer for Zenger Farm. “So we’re excited to bring it to those who would not be able to participate otherwise.”

Bryan Allan, the farmer at Zenger Farms in southeast Portland, sets up for the Tuesday Mid County CSA

Instead of having to pay a large sum up front, members of the Mid County CSA pay each week on a sliding scale, anything from $5-20. The farm also accepts public benefits such as the Supplemental Nutrition Assistance Program (SNAP) in lieu of cash.

“Everyone pays so it’s truly community-supported agriculture,” Allan says. “They’re investing in the vegetables they’re getting.”

Zenger Farm in southeast Portland operates as a nonprofit with a small all-hands-on-deck staff and a crew of volunteers. Half of all the shares it distributes each year are to recipients of SNAP.  And, in the past four years staff have trained 500 other farmers across the country  how to accept public benefits in exchange for produce.

“A huge piece of what we do is food access, specifically to East Portland; It’s a food desert and the most forgotten part of Portland,” says Laleña Dolby, the farm’s communication director-slash-everything-else. “We’re only going to be as well-nourished as those who are lacking in nourishment.”

Zenger Farm obtains state and federal grants to offset the cost of providing the pesticide-free produce for an affordable price. It’s a sound investment for government. After all, eating healthy food reduces a host of costly health problems such as diabetes and heart disease.

When Zenger teamed up with Mid County Health Center, the nonprofit sought funding from the Oregon Department of Agriculture. Mid County sought help from the Knight Cancer Institute.

Katie Hennis, program director of the Knight Cancer Institute’s Community Partnership Program, says they supported the pilot with a $25,000 grant because fruits and veggies are key to cancer prevention; and because the Mid County program could serve as a model.

“This project is a great example of one that could evolve and grow and help other counties across Oregon and nationally, so the impact goes beyond Mid County,” she says.

The pilot also provides CSA members access to cooking classes through the Oregon Food Bank. And after the season, Portland State University’s Institute for Sustainable Solutions with evaluate how well the pilot met ita goals.

Julio Maldonado worked a physician in Honduras before moving (for love) to Oregon, where he earned a Master’s degree in Public Health. But he shrugs off whatever prestige comes with degrees.

As a community health worker at Mid County, he routinely stops in the clinic's community garden and loads a basket with whatever may be growing.

Then he wanders the clinic halls and waiting rooms, giving away the harvest. Last year he handed out more than 150 pounds of veggies.

At first people were hesitant, he says, whether they thought they would have to pay, or they thought Maldonado was weird.

“Now I just open the door and my basket is empty in less than 3 minutes,” he says. “People from all over they say ‘hey, bring me some mint for my tea,’ or ‘I want onions. “Or maybe I’Il have cherry tomatoes and sweet peas. They start eating them right away. I see people go into their appointment munching from their plastic bags.”

The Zenger Farms CSA sets up in the Mid County parking lot, next to the clinic's own community garden

Maldonado used these exchanges to sell clients on the CSA. He enlisted the help of Mid County Dental staffer Sulma Flores.

“I started talking to our dental patients and they were really surprised there was such a program,” Flores says. “We have a lot of immigrant clients, people are working and just trying to figure out how to get by. It feels like a luxury to talk about nutrition and wellness.”

In her free time, Flores coaches a girls’ running group in the neighborhood, and the need is striking.

“Breakfast can be Cheetos,” she says. “They come to practice tired and hungry. I ask what they ate, and they say ‘nothing,’ or ‘pizza’ or something.”

Flores didn’t just pitch the CSA to clients. She joined too, along with four other staff.

“I love kale and spinach, but I would never buy lettuce,” she says. “But I have loved the lettuce in all our CSA bags. It’s so fresh and crisp.”

On a recent Tuesday afternoon Rosa Hernandez pulled into the parking lot.

She’s been a Mid County patient for 14 years. Last time she visited the dentist, Flores mentioned the CSA.

“Right now we’re eating a lot more vegetables,” she says, squinting in the bright low 5 p.m. sun. “I make salad with the lettuce. I use the zucchini in soup. The cabbage I use in posole.”

Shortly after Hernandez leaves, Mid County client and CSA shareholder Jan Keller stops by. She chats with farm and clinic staff she now seems to consider friends.

“As a poor person, I can’t afford to buy vegetables at the stores and try new vegetables,” she says. “It was my first time eating fava beans and I’m in love. Now, I’m growing the fava beans in my yard.”