- [Presenter] "Your Fantastic Mind", brought to you in part by Sarah and Jim Kennedy.

(no audio) (thrilling music) (thrilling music continues) (thrilling music continues) (crowd cheering) (festive music) - On Friday nights in South Georgia, the whole town shows up.

Under the lights, it feels like everything is right there.

But beyond the stadium, before sunrise, there's another story, the people who plant and harvest food that feeds us and the care that comes to them.

Welcome to "Your Fantastic Mind".

I'm Jaye Watson.

First up this week, a story of survival and what it means to grow up when your brain is still at risk.

At just four years old, Elle Wilson collapsed.

What doctors first feared was a brain tumor turned out to be something rare, unpredictable, and lifelong.

Today, Elle's a teenager, learning to move forward, while science works to better understand and one day treat the condition she lives with.

(dramatic music) (horse neighing) - [Caretaker] Alrighty.

(metal clicks) Ready to walk him out?

- [Jaye] In a riding ring in Atlanta, 16-year-old Elle Wilson (caretaker faintly speaks) (mounting block thuds) - [Jaye] is doing what every teenager wants, fitting in and feeling strong.

- And then, one, two, three, up and over.

- [Jaye] For Elle, this isn't just a hobby, it's hard-won independence in a body and brain that have fought to recover.

(upbeat music) Elle was an energetic, sharp, fearless girl.

- [Mindi] She had more energy and more intellectual prowess than any kid we knew at the time.

(upbeat music) - [Jaye] In 2013, two months before her fifth birthday, Elle collapsed on a Florida beach near her family's home.

(waves crashing) - Elle just went off to the left and then collapsed.

And when she came up, we went running down to her.

When she came up, her eyes were stuck on the side of her head.

Her speech was garbled and she couldn't walk.

- [Jaye] At first, Mindy and Mike Wilson thought it was a concussion.

In the hospital, they were told something even worse.

- The first diagnosis was a glioblastoma.

The doctor came in and said, you know, that it was a glioblastoma and she was so sorry.

(object honks) - [Jaye] But then, one voice in a room filled with oncologist challenged the diagnosis and the Wilsons grabbed onto the possibility that it wasn't cancer.

- There was one doctor in the back of the room and he said, "You know, I'm not sure about this.

I'm not sure that this is a cancerous tumor."

- [Jaye] A second MRI confirmed that doctor's hunch, cerebral cavernous malformation, often called CCMs.

- "Good news is, is that your daughter's gonna live."

- Mm-hmm.

- Says, "The bad news is that she has something that she'll have to deal with for the rest of her life and it's gonna be a complication."

- We were so happy and we were celebrating brain surgery, and we had no idea what was ahead.

We really thought you could go in and fix it, and then she'd be fine.

And we also thought that any doctor could do it, any old neurosurgeon could do it.

(pensive music) - [Dr.

Barrow] Cavernous malformations are blood vessel malformations that are tangles, if you will, of abnormal blood vessels that are neither arteries nor veins.

They are fairly large channels, hence the name cavernous, like a cave.

And the blood flow through these malformations is under very low pressure and very slow flow.

(pensive music) - [Jaye] The malformations can sit quietly for years or bleed without warning.

- [Caretaker] All right, you can go ahead and walk on.

- Walk on.

- Nice job.

- [Jaye] Elle has the most severe familial form, CCM3, meaning her genes predispose her to develop multiple lesions over a lifetime.

(pensive music) Because of the rare location of Elle's malformation and the risk of it rupturing again with potentially devastating consequences, the Wilsons launched a nationwide search for a neurosurgeon with both the expertise and the courage to operate on their daughter.

(pensive music) - Research suggested there were only three or four brain surgeons in the country that would work in this part of the brain.

And there was a gentleman in Boston, a gentleman out west, and then Dan Barrow in Atlanta.

(pensive music) - They also said he had the most gifted hands in America.

They said his what you need, because it is so deep in there, a successful surgery is not a given.

- I'm now looking at the MRI that was done on Elle prior to her surgery that shows her cavernous malformation.

So, what she had would be what's called a hemorrhagic stroke.

She had a hemorrhage or bleeding into her brain.

And not just into her brain but into a critically important part of her brain called the brain stem, very specifically the pons of the brain stem.

So, this is a structure that's about the size of my thumb through which everything your brain thinks and does passes through to get to your spinal cord and everything your body experiences goes through the brainstem to get to the cerebrum and consciousness.

(object honks) - [Jaye] The malformation that bled in Elle's brainstem was an area surgeons once considered off-limits.

- I mean, during my training, that was just forbidden territory.

Nobody even thought of or talked about operating on the brainstem.

Called a developmental venous anomaly.

- [Jaye] The Wilsons talked to Dr.

Dan Barrow who was the head of neurosurgery at Emory University.

- There were a relatively small number of us at that time that had a lot of experience with this.

- So, I said, what would you do if it were your daughter?

And he said, "That's exactly what I'm thinking about."

(machine beeps) - [Jaye] A few days later, Dr.

Barrow told the Wilsons, "Bring Elle to Atlanta."

Barrow and his team performed the surgery.

(machine beeps) - This is the postoperative MRI.

So, this is where the malformation was and you can see that it's completely gone now.

And the pressure is immediately released to- - Dr.

Barrow used pre-op MRI with image-guided navigation, registering the patient in 3D space so a tract wand can be seen moving on the MRI in real time.

That precision helped the team avoid functionally critical pathways and pinpoint the safest entry point on the brainstem where the malformation and the hemorrhage came closest to the surface so they could reach it without causing harm.

- You can see the malformation, I'm kind of gathering it up and- - [Jaye] Almost 13 years later, Dr.

Barrow shows us how he removed the malformation in Elle's brainstem.

- [Dr.

Barrow] That's part of the malformation there.

It's very important to make sure that you remove every bit of it because if any is left behind- - It's a different color.

- [Dr.

Barrow] Kinda looks like a mulberry.

That's what most surgeons liken it to.

- He was smiling like no one's business.

I mean, he came out of that OR like he had just won a marathon.

He was so happy because he felt that he had got it all without a lot of damage.

- We typically like to get an MRI every couple of years to see whether we're growing new ones, whether the ones that are there have expanded, whether there's any symptoms of bleeding.

(knuckles knocking) (door thuds) - Hi.

Hello - Hi.

- [Jaye] At Children's Healthcare of Atlanta, Neurologist Dr.

Fiza Laheji goes over Elle's latest MRI.

Elle isn't showing symptoms but one of the lesions has grown.

For now, the only option is watchful waiting, tracking the lesion by tracking how Elle is doing.

- Much like an aneurysm, think of having 10 or 12 aneurysms waiting to rupture in your brain.

Any one of them can shut the lights out.

She has 12.

- [Dr.

Laheji] And you said you are in what grade did you say?

- 11.

- 11.

- [Dr.

Laheji] And doing okay in school?

- Yes, ma'am.

- Okay.

- [Jaye] Today, Elle is a high school junior.

There have been lasting effects, physical, cognitive, social, emotional.

- I'm gonna guess this was in- - [Jaye] Elle can be brilliant in some areas and struggle deeply in others.

- [Mike] She can remember anything in the world.

She's got almost a photographic memory, but she can't do simple reasoning.

That's because of the pressure that a lot of the existing ones are putting on different parts of the brain now.

(engine humming) - [Jaye] For the Wilsons, it means a constant kind of vigilance, watching for subtle changes that could signal bleeding, while still trying to give their daughter a normal teenage life.

- You're constantly watching her.

I don't like leaving her alone for long.

We are so happy for where she is right now.

And she's not what she was and she's not going to be what she could be, but she's so much more than she ought to be.

(nails tapping) (dog panting) - [Jaye] Another massive shift for the Wilson family, they never went home to Florida.

- These electors then vote for president.

- [Jaye] They stayed in Atlanta since 2013.

- This system helps prevent problems like- - [Jaye] Close to Emory, close to Dr.

Barrow, who they say saved their daughter's life and could be called to do it again.

- With those tumors that she has that could go at any moment, they could go right now.

She could have one going right now and we could be right back where we were.

(firecrackers popping) - [Jaye] The Wilsons also founded the nonprofit, Elle's Angels Atlanta, to expedite a cure for the disease.

- What we would love as a family- - [Jaye] Money raised goes to research and advanced surgical technologies.

- I know- - Hello.

- [Jaye] Elle's care now is a long game, monitoring the lesions that remain and seeing how Elle is doing.

- I think she's done remarkably well.

I mean, first and foremost, she has not had a recurrent hemorrhage.

So, the malformation I removed, I believe, has been removed completely.

Her follow-up imaging studies show an abnormal vein that is oftentimes associated with cavernous malformations.

And in fact, we have to go to great effort to avoid injuring that vein because injury to that results in a devastating stroke.

'Cause even though it's an abnormal and funny-looking vein, it serves as a normal vein for the part of the brain within which it resides.

So, that's all that is remaining there.

And the other malformation she has have not bled or caused any trouble.

I think the important thing to understand is that- - [Jaye] Dr.

Barrow encourages Elle to keep having a full and active life.

- Ongoing activities are not going to increase the risk of a cavernous malformation bleeding.

There isn't any activity we know of that does that.

- [Jaye] Being a teenager is always hard.

- She said to me just last week how she knows that she has to work harder than everybody else.

That just getting to and from class, changing classes, watching her feet, everywhere she goes.

She said to me, she said, "The kids can run."

She said, "I can't run.

I'll fall."

(machine beeping) - [Jaye] For now, surgery is still the main option when a lesion bleeds in a dangerous place, but researchers are working towards something bigger, medical treatments that could stabilize or prevent these malformations, especially for genetic forms like CCM3.

- I think that in the foreseeable future, we will have medical treatments and maybe other non-surgical treatments for cavernous malformations.

Already, there are various drugs that have been developed for other reasons, that have been repurposed and have been used in clinical trials, some of which have shown some early promise.

- Yay!

- Yay!

- [Jaye] Until then, Elle keeps doing what she's always done, showing up, working harder than everyone else just to move through the world.

- You know, she's in there, who she was, her spirit, her humor, she's in there.

- [Caretaker] All right, Elle, let's do it.

- Walk on.

(caretaker faintly speaks) - [Jaye] She's finding her way in a rhythm all her own.

(group chattering) - And now, we go to South Georgia, where the work is relentless and for many, access to care is anything but guaranteed.

But three times a year, a team from Emory brings medicine directly to the fields, meeting workers where they are.

(dramatic music) - [Host] Ladies and gentlemen, at this time- - [Jaye] On fall Friday nights in South Georgia, (classical music) the center of the community is easy to find.

(festive music) Beneath the stadium lights, families gather for high school football.

(festive music) The band plays.

(crowd cheering) (energetic music) Players break through banners.

Seniors are honored.

- [Announcer] Thomas Williams with mother, Mary Williams.

- [Jaye] In towns like Bainbridge, these traditions are part of the rhythm of small town life.

(whistle blows) (crowd chattering) - [Jaye] But beyond the lights, there's another part of the story that's harder to see.

(bird squawks) At sunrise, South Georgia looks different.

This is one of the most productive farming regions in the southeast.

(engine humming) (pensive music) More than two and a half million acres of farmland stretches across the region.

Peanuts, cotton, corn, blueberries, tomatoes, and vegetables that end up on tables across America.

(rooster crows) (pensive music) Agriculture brings $91 billion a year to Georgia's economy and supports hundreds of thousands of jobs.

Thousands of people spend long days planting, picking, and harvesting food that feeds the country.

(pensive music) - [Jodie] This is a community that in particular, very, very rarely is seen.

(bag thuds) (plastic crinkles) - We're gonna go take care of some people.

(car door thuds) - [Jaye] And three times a year, a caravan of medical volunteers makes the drive from Atlanta to meet them where they are.

(volunteer cheers) (upbeat music) For nearly three decades, students and faculty from Emory University have traveled here as part of the Emory Farm Worker Project.

- And we're gonna start a caravan off to our clinic site.

- [Jaye] Jodie Guest, Professor and Senior Vice Chair of Epidemiology at Rollins School of Public Health is the director of the project.

- As Emory Farm Worker Project is a project where we provide healthcare to migrant and local farm workers who pick our fruits and vegetables here in Georgia.

(traffic droning) - [Jaye] In South Georgia, the workday often begins before sunrise and ends long after the heat of the day.

Thousands of people spend their days planting and harvesting the fruits and vegetables that fill grocery stores across the country.

The work is physically demanding and access to healthcare can be hard to find.

But three times a year, the Emory Farm Worker Project helps change that.

(engine humming) - We did a good job getting here.

(grass rustling) All the fellows, the PAs, med students, all right here.

- [Jaye] In just a few minutes, (metal scrapes) (trolley hums) (pole clicks) an empty field - We'll set up dispensary there.

- [Jaye] becomes a pop-up clinic.

- Hi, everyone.

This is traditionally our largest clinic site.

Two of the crews are already here and several more crews will be coming after they're done working tonight.

If somebody comes in and they wanna talk about their acne, but they're also talking about chest pain, focus on the most important thing.

(rubber pump hissing) - Everyone deserves access to healthcare and everyone benefits when a community is healthy.

And so, we are here to provide that care to a community that is often overlooked and doesn't have a lot of access.

(drawer slides) (drawer thuds) - [Jaye] The clinic goes wherever the workers are, (volunteers chattering) - [Jaye] sometimes next to the fields before the day begins.

Other times, like tonight, beside the dormitories where they live.

- We'll see the buses roll in from the field.

They travel by school bus.

A lot of times, they go inside and they shower and dress up to come out to see us.

(plastic crinkles) - [Jaye] Medical care isn't the only support here.

- See that?

It's good space.

You want space.

We collect clothes 365 days a year.

The stuff that these workers want and need, and we're repurposing it and getting it to them.

Dang, man.

Awesome.

- [Jaye] Volunteer Lisa Powell collects supplies all year, then drives from her South Carolina home three times a year to meet up with the Farm Worker Project.

- Almost any runner has probably between 5 and 10 pairs of shoes in their closet that they can't use for running anymore.

And that is the number one thing that people want here is they want athletic shoes or work boots.

They know that somebody cares.

And that's the key thing, knowing that somebody cares about the work that they do.

(worker speaks in Spanish) (medical interpreter speaks in Spanish) - [Jaye] Patients begin with the triage check, blood pressure, heart rate, another basic vital.

(medical interpreter in Spanish) - [Jaye] Then, they're paired with a student clinician, physician assistant, medical nursing, and physical therapy students.

- [Volunteer 1] So, then, you can just relax your hand like this.

- [Jaye] Each visit happens face to face.

- I'm gonna take your blood pressure.

(medical interpreters speaking in Spanish) - [Jaye] With a medical interpreter sitting nearby.

- [Jodie] We train our students to work with medical interpreters and so it is a very specific style.

The student clinician sits across directly from the patient.

They are always making eye contact and speaking directly to the patient and the interpreter is sitting to the side of the patient.

- [Volunteer 2] Do you feel like your heart is ever beating really fast?

(medical interpreter speaking in Spanish) (worker speaking in Spanish) - And completely specifically saying what the student is saying to the patient and then answering back in the voice of the patient.

(insects buzzing) - [Jaye] For the workers, it's a chance not just to receive care but to be heard.

- They're sending money to their family, but they're alone and they're here to help provide for their family.

And so, they're very isolated.

Yeah, it's tough.

The work ethic is extremely intense.

These are folks that don't want a reason to not go to work.

- Are there any other medications that you take?

- [Jodie] We see a lot of musculoskeletal pain from the consistent repetition of the type of work that they do.

- Yeah, it's extremely common.

It's something that we typically will have oftentimes based on the work that they're doing, the motions that they're doing to a lot of like, picking and bending over, doing that constantly.

How about more on this side or this side?

- You're bent over, you're picking, and then you're filling up a very large 35-pound bucket.

And then, for large tomatoes, and then you're hoisting it over your shoulder into a big truck and you're doing this as often as you can in an hour.

- Any pain?

- [Jaye] The clinics also see untreated chronic illness.

- [Bryan] Feels like it's an allergy.

- We see a lot of untreated diabetes or uncontrolled diabetes, hypertension, foot fungus, pesticide exposure.

(medical interpreter speaking in Spanish) - [Jaye] With one trip a week to buy groceries, many workers rely on cheap shelf-stable food.

- We've done work over the years that show that about, a close to 67% of the patients we will see, the people in the fields picking our fresh fruits and vegetables are food insecure themselves.

- My patient, this is actually the first patient I've had, but he was telling me that in the past year, he's had a lot of worries about running out of food and there's been several times where he has run out of food.

- So, this muscle rub is for pain.

- [Jaye] Some of the most common issues aren't physical.

- [Jodie] And then, overwhelmingly, a lot of social isolation, depression, and anxiety.

(medical interpreter speaking in Spanish) - He said he is feeling depressed, he's having some hair loss, and he wanted to discuss his blood pressure.

In addition, a fourth issue, he's feeling weak.

- [Jaye] After each visit, students review the case with a supervising clinician, a preceptor, before returning to their patient with a plan.

- Diclofenac.

How often can he take it?

- His PHQ-2 was positive, so I'm having to do a PHQ-9 right now.

- That sounds good.

- Awesome.

All right.

- You wanna go see him?

- Let's go see him.

All right.

- Okay.

(medical interpreter speaking in Spanish) (worker speaking in Spanish) - [Jaye] Depression is common here.

- They're sending money to their family, but they're alone, and they're here to help provide for their family.

And so, they're very isolated.

- We're giving him ibuprofen and a multivitamin.

(pill bottles rattle) - Can I do just a hot compress and then some muscle rub.

- [Jaye] For the students, it's real world medicine.

- A lot of musculoskeletal pain with some like knee pain, some back pain, some arm pain.

A lot of the patients present with a lot of these complaints because they're working out in the field like eight to nine hours a day.

- I want you to pull.

- [Jaye] The physical strain of the work is something the students see again and again.

- It's in his like lower lumbar spine.

- He's been having some muscle aches on his right shoulder here from the specific work that he's been doing.

So, we're trying to get some stuff to help relieve that pain.

- [Volunteer 3] He mentioned to me that he sometimes has some chest pain when he's out working in the field.

- [Jaye] Some visits are routine.

- This chest pain happens a couple times a week.

- [Jaye] Others require more careful attention.

- [Volunteer 3] We're gonna get the rhythm.

- [Jaye] On this night, one patient receives an EKG after reporting chest pain while working.

- But we just wanted to make sure that there wasn't anything more serious going on, and there's not right now.

You can go ahead and sit up and put your shirt on.

- [Jaye] Even basic medications can make a difference.

- There's a lot of dust out here while they work and it can cause some allergies.

So, what I'm getting for him is loratadine, which is a pill he can take every day before he goes out to work that will kind of open him up and help with some of the swelling that's caused by allergies.

(worker speaking in Spanish) - [Jaye] For many workers, the visit is about more than medical care.

- They want someone to talk to.

- [Jaye] Jesus Bocanegra, now a minister with this community, once worked in the fields himself.

- I was getting paid $1.75 back in '93.

I did five buckets on the first day and my back, it was killing me, and I was 16.

I was full of energy, full of, you know, I was eager to make the money, but my body was like, mm-mm, this is a hard work.

So, I could, on the four, six months, I went into depression.

(pensive music) - It's an example absolutely of public health and community engagement and investing in the people who are your neighbors.

(pensive music) It's grown tremendously.

It does not look the same as it did.

It was eight students and one faculty member in a car.

(pensive music) - [Jaye] 29 years later, the Farm Worker Project now brings together students from across Emory schools, medicine, nursing, public health, and physical therapy.

(volunteer laughing) (medical interpreter speaking in Spanish) - And I think it fundamentally changes who our students are when they graduate and how they think about where their food comes from, for sure, but also how to engage and how barriers and determinants of health impact their patients.

I think that makes them see their patients as more whole humans.

(dramatic music) - [Jaye] By the end of the evening, more than a hundred workers will have been seen.

(dramatic music) The clinic packs up, the volunteers drive hours back to Atlanta.

(dramatic music) Tomorrow, the workers return to the fields.

But for a few hours here in South Georgia, care comes to them.

(dramatic music) - [Jodie] I think this is the best of what we do.

(dramatic music) (bird chirping) - And that's gonna do it for us this week.

See you next time on "Your Fantastic Mind".

(thrilling music) (thrilling music continues) - [Presenter] "Your Fantastic Mind", brought to you in part by Sarah and Jim Kennedy.

(no audio)