A Mobile Clinic Delivers Critical Care for Texas Shrimpers

He carefully rolls the cuff of his jeans to his knee and raises his foot so she can see it more clearly. Through a medical student translating her English to Vietnamese, Díaz asks about the cluster of yellow and pinkish-red sores and his history of diabetes as she wipes his foot with gauze and a cleansing solution.

The shrimper is one of a handful of men who’ve come out for UTHealth Houston School of Public Health’s Docside Clinic, monthly pop-up events where local commercial shrimp fishermen—many of them Vietnamese immigrants—can get primary medical care, food, clothing, and social and legal services at no charge. The clinics connect shrimpers to care they would not be able to otherwise access, given many are uninsured, unhoused, and have limited English proficiency and varying immigration statuses.

“It felt like it was a population that was quite literally invisible,” said Shannon Guillot-Wright, an associate professor in the department of environmental and occupational health sciences at the school. She launched the clinics in 2021 with a one-off event to research how to reduce “slips, trips and falls,” but after the shrimpers revealed deeper health disparities, the clinics turned into a monthly commitment.

“When we went out there, everyone basically was like, ‘You’ve got the wrong story,’” Guillot-Wright said. “Many of them would talk about, ‘I haven’t had access to a physician in 10 years. I don’t have access to food; I don’t have access to housing.’” Guillot-Wright changed her approach from specifically focusing on traumatic injuries to seeing them as part of a much bigger picture, one that centered on the fishermen’s basic needs.

Now, patrons gather for a few hours each month under a pop-up canopy to seek care—for everything from work-related injuries to chronic conditions like diabetes and hypertension—from a nurse, two community health workers, a volunteer lawyer, a handful of medical and MPH students, and researcher Guillot-Wright.

Traumatic work-related injuries make commercial fishing one of the most dangerous occupations in the U.S., with a fatality rate over 40 times the national average, according to the National Institute for Occupational Safety and Health (NIOSH). Out in the open water, fishermen labor for long hours in all kinds of weather as they handle heavy equipment and pull in catches on wet surfaces, which can lead to falls overboard, slips, and severe injuries from machinery. On the docks, fishermen can fall or be struck by fishing gear at boatyards.

Shrimping has proven to be particularly dangerous. Compared with other commercial fishing fleets in the Gulf of Mexico, the shrimping fleet experienced the highest number of fatalities—about half the region’s total—from 2010 to 2014, according to a NIOSH report.

Despite this, the Trump administration has been working to deregulate commercial fishing and cut safety funding and resources for fishermen, creating an even more dangerous work environment—and making the work of the clinic even more vital. Additionally, healthcare costs are skyrocketing; Affordable Care Act (ACA) marketplace premiums are expected to more than double on average this year after Congress failed to extend the ACA’s enhanced premium tax credit.

Amidst this increased instability and need, the Docside Clinic is trying to fill the gap for fishermen who often risk their lives to put food on tables across the U.S. The clinic continues to care for its patrons while also figuring out how to ensure its long-term financial stability and expand the model to fishing communities elsewhere in the country.

Vietnamese fishermen arrived in Texas following the Vietnam War, in the 1970s and 80s, when many people fled Vietnam as refugees. They settled in Galveston and the Texas Gulf Coast, where they could use their fishing skills in a coastal environment similar to that of their home country. Many came with their families, establishing close-knit communities of Vietnamese immigrants here.

They faced intense discrimination from white fishermen, however. In 1981, after the Ku Klux Klan intimidated and harassed them by holding rallies, burning a boat, and hanging an effigy of a Vietnamese fisherman, the Vietnamese Fishermen’s Association successfully filed a lawsuit against the hate group that stopped their intimidation and dismantled their paramilitary militia.

Today, many of the shrimpers are Vietnamese men in their 60s accustomed to the grueling labor of shrimping. They are used to being at sea for four to six weeks at a time, trawling the water with thick green shrimping nets and hauling in 75-pound loads of shrimp—and only sporadically returning to shore.

Before the shrimpers had access to the clinic, many avoided seeking medical care. Guillot-Wright said her research revealed most deckhands reported that they hadn’t seen a primary healthcare provider for years—even decades—due to many barriers, such as the length of time they spent at sea, their tendency to lose important documents in the water or from boat accidents, and financial and language barriers.

A shrimper drags his nets down the dock, flanked by shrimp boats. (Photo credit: Joseph Bui)

To cope with aches and pains, fishermen are also especially prone to self-medicating with alcohol, cigarettes, and substances. Across the fishing industry, substance abuse—including a surge in opioid addiction—is a widely known issue that is intertwined with the high rate of fatal injuries.

One shrimper, who has been in the industry for 40 years, has become accustomed to hearing about and experiencing accidents. He describes his work with a dismissive wave: “No, no—it’s easy.” Yet the broken pinky finger of his leathery, tanned left hand juts out at a  90-degree angle from an accident years ago. While he initially went to the hospital, he missed followup appointments, so his finger didn’t heal properly. He also recalls slipping on the deck and hurting his ribcage, which he didn’t seek medical care for.

Still, he’s used to hearing about far worse. Offhandedly, he mentions a fatal accident that once happened on a nearby boat, when a cable came loose and hit a fisherman. “Somebody there, he [died] in the boat,” he said, pointing into the distance.

That’s why the Docside Clinic is so vital: It makes it easier for fishermen to address injuries and health issues they would otherwise be prone to brush off. “This is definitely a good opportunity to make sure that we’re trying to meet people where they are,” said Díaz, who’s worked at the clinics for over four years.

Kait Guild is the assistant director of Harvard Medical School’s Mobile Health Map, a network of mobile health clinics focused on health equity. She said the flexibility of mobile health can help rebuild trust with people the traditional healthcare system hasn’t been able to reach. “It’s providing care in accessible spaces, places where underserved and marginalized community members and patients of all backgrounds feel safe,” she said.

Though the dock is an unconventional spot for a health clinic, it’s where the fishermen feel most at home. Their presence permeates the space, from a note written in Vietnamese taped to a door window to a white marble Buddhist statue looking out on the water.

Given the long history of discrimination they have experienced, many of Galveston’s Vietnamese fishermen are wary of strangers, including reporters, and building trust can be complicated.

CucHuyen “Cecile” Roberts and her sister Cuc Hoa Trieu, who migrated from Vietnam to the U.S. in 1986, have worked for more than 20 years as community health workers and translators in Houston, which has the third-largest Vietnamese population in the U.S. The sisters have been pivotal in building trust with the shrimpers since the clinics launched over four years ago.

Their shared heritage with the shrimpers helps them understand the cultural stigma other health workers might miss, like the fishermen’s difficulty asking for help. “That’s culture because it’s embarrassing, it’s shameful, to say you need something. Like, ‘Oh you can’t take care of yourself,’ ” Roberts explains.