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Just there to help

Rural Health and Safety Clinic faces many challenges
Roger Stutsman (left) and Kelley Donham are the co-executive directors of the Rural Health and Safety Clinic of Greater Johnson County. Their goal is to help farmers improve the safety of their operations and promote wellness for farm families and employees. The trailer was purchased to serve as a mobile one-stop-shop for health services and safety equipment sales, but is also available for use in emergencies. (photo by Chris Umscheid)

By Chris Umscheid
North Liberty Leader

HILLS— President Ronald Reagan is quoted as saying, “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.’”
For four years, Roger Stutsman and Kelley Donham have been trying to convince farmers they are not from the government, and they truly are there to help.
Stutsman and Donham founded the Rural Health and Safety Clinic (RHSC) of Greater Johnson County in 2011 as a collaborative effort involving farm safety advocates and Iowa’s Center for Agricultural Safety and Health (I-CASH). The goal was simple and noble: to help farmers improve the safety of their operations and to improve the health of farmers, their families and employees.
The RHSC was billed as a “one-stop-shop” for an array of preventative health and safety services, including health screenings, safety inspections, providing safety equipment and personal protective equipment (PPE) through a safety store, certification as a “Safe Farm,” and farm safety and agricultural rescue training.
However, it’s not been an easy row to hoe for Stutsman and Donham. They ran into several obstacles while trying to establish the clinic, some financial and others cultural.
To understand the RHSC’s situation today, one must look back a few decades. In 1984-1985, Donham was on sabbatical in Sweden. He’d been involved in agricultural health and safety for over a decade and realized the message just wasn’t getting out.
“You can tell people what’s ‘safe’ and what’s not, but that doesn’t necessarily mean it’s going to actually happen out on the farm,” he said.
He cited a lack of people in the rural areas who can provide occupational health and safety risk assessments. While in Sweden, he discovered the government had established 40 clinics throughout the country providing the same array of occupational health services as would be found in a large corporation, including on-site risk assessments. Donham wondered why such clinics didn’t exist back home.
Back on American soil, he and others talked with state legislators and, in 1987, pilot grants were disbursed for establishing clinics in Spencer, Mason City and Waterloo to offer the same general services. In 1990, the Iowa Center for Agricultural Safety and Health (I-CASH) was legislatively mandated, bringing together Iowa State University, the University of Iowa, the Iowa Department of Public Health and the Iowa Department of Agriculture in a collaborative effort that created 27 clinics throughout Iowa. A large grant from the National Institute for Occupational Safety and Health (NIOSH) initiated a “Certified Safe Farm” program, whereby participants could ask for a safety assessment and, upon voluntarily making upgrades and improvements, would earn certification; a point of pride, as well as peace of mind. Donham called the clinics and NIOSH grant a formulated way to attack health and safety problems on the farm, noting the model was very similar to the Swedish program.
But none of the clinics were remotely close to Johnson County, and only five of them are still in operation today. Donham gave two reasons: funding for the Certified Safe Farm program was discontinued; and the nature of rural hospitals and administrators most of the clinics were affiliated with.
“Everything that happens in a rural hospital is dependent first on what brings money in, and then on the hospital administrator (and their priorities),” he said.
Some administrators saw the benefits, from good public relations to patient care, he explained. But rural hospital administrators tend not to stay in one place very long, and their replacements often focus more on revenue generation.
“Losing that support, that’s the main reason why most of the clinics have closed,” he added.
As a former member of the Johnson County Board of Health, Donham tried for years to promote rural health issues in a county he described as, “kind-of Iowa City-centric, even though we still have 1,000 farms in the county.” Eventually, Donham and Stutsman were able to garner support from the Board of Health. The two men share the heavy burden of having lost family members in farming accidents, and they were able to turn tragedy into awareness and attract the board’s attention, Donham said.
A proposal to the Johnson County Board of Supervisors in 2010 led to $17,000 for the startup of the RHSC, initially called the Johnson County Agricultural and Rural Health Service and Training Center. It was to be housed in the Johnson County Extension Office at the Fairgrounds. At the same time, I-CASH was able to commit three years of funding.
“We put together enough funds to hire an executive director, Donham said, but the director has since left the position. “Now it’s mainly the (volunteer) board members, Roger and myself to put this thing together, keep the wheels on it and build it back up to where our expectations were.”
The RHSC also had a few part-time employees and interns.
“We were going along pretty good,” Stutsman said, noting they had secured a $90,000 grant from Iowa State Extension through the College of Design in Ames, in addition to other grants from the U of I, including grant money for an All-Terrain Vehicle (ATV) safety program through the Children’s Hospital.
“We really had an awfully nice ride,” Stutsman said, “but in this business, you totally live off of grants. And as they start to dry up, things get tough.” Reapplying for various grants meant matching funds must also be brought to the table. With no steady income stream, finding matching dollars became a problem.
While Donham and Stutsman were looking for money to fund their operation, Donham said, farmers were looking for ways to increase their bottom line. Donham saw it as an opportunity to offer financial incentives for safety.
“One of the things we’ve realized is that one of the biggest motivators for any farmer to do anything on their farm is a little like those hospital administrators; ‘Show me the dollars. How is this going to help make me money?’ Because, at the end of the day, the bottom line is, ‘we have to make money to keep this operation afloat.’”
Donham said as part of rebuilding the RHSC, they’ve contacted insurance companies in an effort to convince them of the value of preventative measures. “If we can decrease the injuries and illnesses out there, and the claims, then that’s going to save the insurance companies money. And in turn, the insurance companies ought to give a break back to the farmers to install and institute these programs. You’ve got one hand washing the other.”
However, most farmers are self-employed, thus do not have workman’s compensation insurance, which makes it tough to get much help beyond general liability, Stutsman said.
Both men pointed to a trend in more farms hiring employees rather than just a few family members working the land, which leads to the need for workman’s compensation and brings them under the jurisdiction of the Occupational Health and Safety Administration (OSHA).
“We’ll be seeing more and more of that. Agriculture is changing a lot,” Donham said.
OSHA does not regulate the traditional family farm without outside employees. Farmers by their nature tend to be private persons and embody the stereotype of American rugged individualism, Stutsman said.
“Most farmers won’t allow anybody on the farm to do an inspection. We’re all alike. We all walk by dangers everyday and think nothing of it,” he said. “But if somebody would point it out and check it off on a box (on a form), we might do something about it.”
Unfortunately, Stutsman added, “they get in their heads that we’re an enforcement agency, and we have no intention of being an enforcement agency. We’re just an education agency. And if it gets past that, we’re out of business too,” Stutsman said. “Kelley and I are both farm kids, we understand that that’s not the way you’re ever going to get through to agriculture. We just got to try to help them to understand some of the dangers.”
Currently people in New York, North Carolina, Nebraska and Pennsylvania are trying to come up with a set of standards for a national farm safety certification program that insurance companies could accept.
“It’s been a real good effort on everybody’s part. They pretty much just want to do what’s right,” said Stutsman.
Stutsman said after his son Mike was killed in a machinery accident, he thought he could go to his neighbors and conduct surveys. “They still wouldn’t do it. They still didn’t want us on the place,” he said. For example, farmers did not want to put rollover guards on their tractors. “And we didn’t say you had to. With the criteria, you’d probably still pass (Safe Farm Certification) even with one or two things that aren’t right.”
Donham said farm operators are more likely to engage in practices that benefit the farm’s bottom line. In North Carolina, some farmers are saving up to $10,000 per year on their insurance from having the Safe Farm Certification. Those kinds of financial incentives will drive changes in the agricultural safety culture, he said.
Stutsman said he believes insurance companies should be providing such discounts anyway, with or without national standards.
“If they really don’t want to pay out a lot of claims, they should be making inspections,” much like electrical inspections that occur from year to year, Stutsman said.
Some changes are easy and relatively inexpensive, such as putting a Roll Over Protection Structure (ROPS) on an older tractor, putting a cover over an open Power Take-Off shaft, or even just putting the cover back on a breaker box. In Europe, ROPS became a requirement, which cut the death rate to tractor rollovers by 98 percent. While new tractors come equipped with ROPS, many older non-equipped tractors are still in use.
“Every year, some farmer’s mowing a road ditch without a ROPS and dying,” Stutsman said. “That’s something that’s so manageable; $2,000 (to retrofit an old tractor) compared to losing the farm because Dad’s dead?”
The RHSC has offered several levels of memberships in an effort to generate revenue and provide specific services requested by individual farmers. However, to their dismay, nobody ever signed up. Currently Donham and Stutsman, along with their volunteer board and advisory members, are in a state of reorganizing and strategizing on a new operating plan.
They may be down at the moment, Donham stressed, but they are far from out.
“We’re not giving up,” said Donham. “We’re looking for opportunities and we’re going to do our best to make it work.”
Stutsman agreed.
“We’ve have absolutely the most incredible board of directors, you couldn’t ask for better,” Stutsman said. “People with the same kind of passion, and everybody’s pretty much got the same story, they’ve lost somebody (in an agriculture-related incident).”
Donham said marketing and gaining the farmers’ trust will go a long way. “When I started doing this back in 1973, the trust issue was not nearly so critical as it is now,” he said. “There were more family farms, there wasn’t this big, divisive (split) between the left and the right sides of the political spectrum. It was just easier. Trust was more forthcoming.”
It’s more of a challenge now because of the way the farming industry has evolved. The farm population has been denigrated by the general population over things like pollution concerns, Donham said, and the fact that fewer people come from a deep farming culture. “We have to separate from that. We’re not here to denigrate you at all, we’re here to keep you alive and well and doing what you’re doing.”
However, the day may come when changes are mandated, either by a government entity or the insurance providers.
Overall, the number of agricultural-related fatalities has declined over the years, but farming still remains one of the most dangerous occupations based on the number of deaths per percentage of the population involved. Statistics indicate agriculture is seven times more dangerous than any other job. “Our work is not done,” Donham added.
September 20-26 was National Farm Safety Week, and while Donham said it’s great to raise national awareness, but he wants to see action.
“Let’s see what happens to remove the hazards out there on the farm so it doesn’t get (mandated),” Donham said. “It’s a win for the farmer, it’s a win for the insurance company and it’s a win for all of the people that put resources into this business of agriculture. That’s the only way it’s going to happen.”
The RHSC is still offering subscriptions and will have a reorganization meeting in the near future.
“We’re not in limbo, we’re re-booting. We’re just two old farm boys trying to do things to overcome bad things that have happened in our lives. Roger’s lost his son, I’ve lost my great-grandfather who was killed in a farm accident, my grandfather was almost killed, I ran over my own father with a manure spreader and almost killed him…so the beat goes on,” Donham concluded. “Our goal is, because we love agriculture and we love the people who do agriculture, to make it a safe and less-hazardous place to work.”
For more information contact Roger Stutsman at 319-325-4675 or Kelley Donham at 319-530-6002. Find more information about agricultural safety at the I-CASH website at http://www.public-health.uiowa.edu/icash/.