The need for the CVFC was identified in a study focused on community health priorities and barriers to healthcare services among Latinx and Indigenous Mexican immigrant farm-working communities in the rural desert region of Inland Southern California (9). This region, home to one of the largest Purépecha–an indigenous group from the Mexican state of Michoacán–communities in the U.S., experiences high levels of poverty, substandard housing, and lack of healthcare access, with many residents being undocumented or uninsured (10). Study findings provided medical students with baseline data on clinic location, service hours, and language and healthcare needs. Medical students partnered with community health workers (CHWs)/promotoras, trusted leaders in the community, and federally qualified healthcare centers (FQHCs) to develop the model of care. The service delivery model was conceptualized as a “pop-up” clinic in a safe community space that provided primary care in the patient's native language, behavioral health screenings and referral, lung health assessments–asthma rates are exceptionally high in the region due to exposure to environmental hazard (11, 12)–and Medicaid sign-ups (13). As detailed in Table 1, the clinic's activities—ranging from mental health screenings to culturally tailored education—yielded significant outcomes, including increased engagement, accessibility, and health awareness among underserved populations. The FQHC contributed to the project by furnishing the clinic with a mobile unit, driver, medical assistant, and clinical faculty preceptor. They also assumed legal responsibility and documented patient care in their electronic medical record system.

Medical students involved in the CVFC developed key leadership skills through their involvement in the clinic's development and operations. Through their work with CHWs, FQHCs, and bilingual premedical students, they learned to build and maintain relationships and, with faculty mentorship, to access resources through grant funding. Table 1 provides an overview of the activities that fostered leadership skills, such as medical student-led training sessions and tailored educational workshops, which enhanced students’ ability to deliver patient-centered, culturally competent care. Training provided by clinical faculty equipped students with the practical skills needed to deliver care to Spanish- and Purépecha-speaking patients and to disseminate this knowledge to classmates and part-time volunteers. By bringing together this coalition of engaged stakeholders, organizing relevant trainings, and contributing to the structural development of the clinic, students gained valuable expertise and brought a new approach to an intransigent problem. As they navigated this new terrain of decision-making, resource management, and problem-solving, the students developed skills and relationships that colored their perspective on the fluid role of medicine and its practitioners within the broader social context of patient health.

The CVFC highlighted for students how structural inequities shape healthcare access and health outcomes for the patient population, illuminating the ways in which factors such as race/ethnicity, citizenship status, indigeneity, and geography can contribute to the lived experience and health of a specific group of people (10). Structural violence– an inescapable force in immigrant farming communities– often plays out in seemingly ordinary ways, such as clinic hours coinciding with business hours. Positionality within hierarchies of power, which are patterned by social categories (race/ethnicity, gender, citizenship, indigeneity, rurality) determine individual- and population-level vulnerability to structural forces (14). Latinx and indigenous Mexican agricultural workers who reside near the bottom of this hierarchy do not benefit from the protections of regulated work environments and frequently do not have the ability to request time off to attend appointments (15). The experience of interacting with ECV community leaders and members and hearing their first-hand accounts of these barriers faced by the community allowed medical students to recognize the impact of these obstacles on their patients’ ability to seek care. The indicators and outcomes in Table 1 illustrate how the clinic's activities, including health screenings and accessibility improvements, addressed these systemic barriers while providing culturally sensitive care. Through their leadership roles, students addressed these inequities by offering services at times that accommodated agricultural workers’ schedules and providing care in the patients’ primary language.

Structural pathologies, by their very nature, necessitate unconventional remedies. If the problem exists in the framework itself, then working within it may not be feasible. Traditional models of healthcare, which rely on brick-and-mortar establishments, often pose barriers for marginalized populations, such as lack of transportation, contingent employment without sick leave, and limited or no insurance coverage (16). The vision and leadership of medical students can result in innovative models of care that challenge these dominant perceptions of “quality” healthcare. The development of the CVFC is a case in point. In partnership with the patient population and FQHCs, medical students developed a model of care involving a walk-up clinic (no appointment needed) in safe and accessible community spaces, with providers who spoke the patient's native language. As shown in Table 1, the clinic's pilot initiatives demonstrated the success of flexible, community-centered care delivery, evidenced by increased attendance and engagement in underserved populations. Providers spent time with each patient, learning about their concerns, how their living and working conditions contributed to their health and well-being, and used this knowledge to tailor treatments—a reversal of the typical model, in which patients unable to adhere to dominant practices are labeled as ‘non-compliant.’